WorldWideScience

Sample records for catastrophic health expenditure

  1. 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.

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

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    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

  3. 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

  4. 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...

  5. Catastrophic medical expenditure risk.

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    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.

  6. 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。

  7. Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty.

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    Flores, Gabriela; Krishnakumar, Jaya; O'Donnell, Owen; van Doorslaer, Eddy

    2008-12-01

    In the absence of formal health insurance, we argue that the strategies households adopt to finance health care have important implications for the measurement and interpretation of how health payments impact on consumption and poverty. Given data on source of finance, we propose to (a) approximate the relative impact of health payments on current consumption with a 'coping'-adjusted health expenditure ratio, (b) uncover poverty that is 'hidden' because total household expenditure is inflated by financial coping strategies and (c) identify poverty that is 'transient' because necessary consumption is temporarily sacrificed to pay for health care. Measures that ignore coping strategies not only overstate the risk to current consumption and exaggerate the scale of catastrophic payments but also overlook the long-run burden of health payments. Nationally representative data from India reveal that coping strategies finance as much as three-quarters of the cost of inpatient care. Payments for inpatient care exceed 10% of total household expenditure for around 30% of hospitalized households but less than 4% sacrifice more than 10% of current consumption to accommodate this spending.Ignoring health payments leads to underestimate poverty by 7-8% points among hospitalized households; 80% of this adjustment is hidden poverty due to coping.

  8. Catastrophic expenditure on medicines in Brazil

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    Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Oliveira, Maria Auxiliadora; Arrais, Paulo Sergio Dourado; Ramos, Luiz Roberto; Pizzol, Tatiane da Silva Dal; Mengue, Sotero Serrate; Farias, Mareni Rocha; Bertoldi, Andréa Dâmaso

    2016-01-01

    ABSTRACT OBJECTIVE To describe the magnitude of the expenditure on medicines in Brazil according to region, household size and composition in terms of residents in a situation of dependency. METHODS Population-based data from the national household survey were used, with probabilistic sample, applied between September 2013 and February 2014 in urban households. The expenditure on medicines was the main outcome of interest. The prevalence and confidence intervals (95%CI) of the outcomes were stratified according to socioeconomic classification and calculated according to the region, the number of residents dependent on income, the presence of children under five years and residents in a situation of dependency by age. RESULTS In about one of every 17 households (5.3%) catastrophic health expenditure was reported and, in 3.2%, the medicines were reported as one of the items responsible for this situation. The presence of three or more residents (3.6%) and resident in a situation of dependency (3.6%) were the ones that most reported expenditure on medicines. Southeast was the region with the lowest prevalence of expenditure on medicines. The prevalence of households with catastrophic health expenditure and on medicines in relation to the total of households showed a regressive tendency for economic classes. CONCLUSIONS Catastrophic health expenditure was present in 5.3%, and catastrophic expenditure on medicines in 3.2% of the households. Multi-person households, presence of residents in a situation of economic dependency and belonging to the class D or E had the highest proportion of catastrophic expenditure on medicines. Although the problem is important, permeated by aspects of iniquity, Brazilian policies seem to be protecting families from catastrophic expenditure on health and on medicine. PMID:27982383

  9. Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico.

    Science.gov (United States)

    Galárraga, Omar; Sosa-Rubí, Sandra G; Salinas-Rodríguez, Aarón; Sesma-Vázquez, Sergio

    2010-10-01

    The goal of Seguro Popular (SP) in Mexico was to improve the financial protection of the uninsured population against excessive health expenditures. This paper estimates the impact of SP on catastrophic health expenditures (CHE), as well as out-of-pocket (OOP) health expenditures, from two different sources. First, we use the SP Impact Evaluation Survey (2005-2006), and compare the instrumental variables (IV) results with the experimental benchmark. Then, we use the same IV methods with the National Health and Nutrition Survey (ENSANUT 2006). We estimate naïve models, assuming exogeneity, and contrast them with IV models that take advantage of the specific SP implementation mechanisms for identification. The IV models estimated included two-stage least squares (2SLS), bivariate probit, and two-stage residual inclusion (2SRI) models. Instrumental variables estimates resulted in comparable estimates against the "gold standard." Instrumental variables estimates indicate a reduction of 54% in catastrophic expenditures at the national level. SP beneficiaries also had lower expenditures on outpatient and medicine expenditures. The selection-corrected protective effect is found not only in the limited experimental dataset, but also at the national level.

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

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    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

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

    OpenAIRE

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

    2015-01-01

    "Introduction: Prevention with a positive approach and provision of free ART services has been advocated as one of the main strategies to diminish the new instances of HIV and betterment of the quality of life of PLHA. But in spite of those, out-of-pocket payments remain to be one of the main obstacles in the path of this approach. The present study aimed to estimate the out of pocket expenditure incurred and the various factors determining catastrophic health expenditure while receiving...

  12. Catastrophic healthcare expenditure - drivers and protection: the Portuguese case.

    Science.gov (United States)

    Kronenberg, Christoph; Barros, Pedro Pita

    2014-03-01

    The objective of this paper is to assess the extent of catastrophic healthcare expenditure, which can lead to impoverishment, even in a country with a National Health Service, such as Portugal. The level of catastrophic healthcare expenditure will be identified before the determinants of these catastrophic payments are analyzed. Afterwards, the effects of existing exemptions to copayments in health care use will be tested and the relationship between catastrophe and impoverishment will be discussed. Catastrophe is calculated from the Portuguese Household Budget Surveys of 2000 and 2005, and then analyzed using logistic regression models. The results show that catastrophe due to healthcare out-of-pocket payments are a sizeable issue in Portugal. Exemptions from out-of-pocket expenses for medical care should be created to prevent vulnerable groups from facing catastrophic healthcare spending. These vulnerable groups include children, people with disabilities and individuals suffering from chronic conditions. Disability proxies offer straightforward policy options for an exemption for the elderly with recognized disabilities. An exemption of retired people with disabilities is therefore recommended to policymakers as it targets a vulnerable group with high risk of facing catastrophic healthcare expenditure.

  13. 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.

  14. 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...

  15. 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

  16. 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.

  17. 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

  18. 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.

  19. 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."

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

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    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.

  1. Equity in Health Care Expenditure in Nigeria

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    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.

  2. Catastrophic health expenditure for poor and low-income rural residents under New Rural Co-operative Medical Scheme%新农合贫困和低收入居民灾难性卫生支出研究--基于三省份的抽样调查

    Institute of Scientific and Technical Information of China (English)

    陈李娜; 魏伟; 王静; 张亮

    2014-01-01

    Objective:To evaluate the catastrophic health expenditure for poor and lower-income rural residents and the ability of New Rural Cooperative Medical Scheme( NRCMS) to alleviate poverty. Methods:We selected Zhe-jiang, Hubei, and Chongqing provinces as sample areas and obtained 1661 questionnaires through a field survey. We calculated the out-of-pocket expenditure per year, incidence, average gap, relative gap, and concentration index of catastrophic health expenditure for participating households. Results:Both before and after compensation, incidence, average gap, and relative gap of catastrophic health payment for poverty group were the highest, followed by low-in-come group. After compensation, the concentration index decreased. This means that catastrophic health expenditure tends to be focused more on families with financial difficulties. Conclusion:To protect poor and low-income rural res-idents from catastrophic health expenditure, we should promote critical illness insurance, improve the medical assis-tance system, implement payment reform, and improve the NRCMS.%目的:分析农村居民灾难性卫生支出情况以及新农合缓解灾难性卫生支出的能力。方法:2011年分别选取浙江、湖北、重庆作为样本地区,通过现场调查获取问卷1661份,计算参合家庭的年自付医疗卫生费用、灾难性卫生支出发生率、平均差距和相对差距和集中指数。结果:补偿前后,贫困家庭的灾难性卫生支出发生率、平均差距、相对差距均最高,低收入组次之。补偿后,集中指数降低,灾难性卫生支出进一步向经济困难家庭集中。结论:通过推进农村大病医疗保险、完善医疗救助制度、实施支付方式改革和完善新农合配套措施等方式,帮助农村贫困和低收入居民抵御灾难性卫生支出。

  3. 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

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    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

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

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    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.

  5. Incentives of Health Care Expenditure

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    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

  6. [Health care expenditures and the aging population].

    Science.gov (United States)

    Felder, S

    2012-05-01

    The impact of a longer life on future health care expenditures will be quite moderate because of the high costs of dying and the compression of mortality in old age. If not age per se but proximity to death determines the bulk of expenditures, a shift in the mortality risk to higher ages will not significantly affect lifetime health care expenditures, as death occurs only once in every life. A calculation of the demographic effect on health care expenditures in Germany up until 2050 that explicitly accounts for costs in the last years of life leads to a significantly lower demographic impact on per-capita expenditures than a calculation based on crude age-specific health expenditures.

  7. 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.

  8. 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...

  9. Population, growth and health expenditure

    Directory of Open Access Journals (Sweden)

    Luis Currais

    2000-12-01

    Full Text Available A genuine understanding of the economic growth process should take into account the extent to which fertility and mortality affect the population growth rate as an endogenous variable. To this end we construct a growth model using an infinite horizon setup in which economic development and health status influence the population growth rate. Mortality depends on health expenditure, and fertility is endogenously determined. Adults within each household take into account the welfare and resources of their current and future descendants. Their decisions determine not only the evolution of the population growth rate but also the evolution of the per capita income.Este artigo analisa a mortalidade e a fertilidade como variáveis endógenas ao modelo e determinantes do crescimento da população associado ao processo de crescimento econômico. Com este propósito, é desenvolvido um modelo de horizonte infinito onde tanto o nível de desenvolvimento econômico quanto o gasto em saúde influenciam a taxa de crescimento da população. Cada família toma suas decisões tendo em conta o bem-estar social e os recursos disponíveis de seus descendentes atuais e futuros. Suas decisões determinam não só a evolução da taxa de crescimento da população, mas também a evolução da renda per capita.

  10. 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.

  11. 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.

  12. Is income relevant for health expenditure and economic growth nexus?

    Science.gov (United States)

    Halıcı-Tülüce, Nadide Sevil; Doğan, İbrahim; Dumrul, Cüneyt

    2016-03-01

    This paper examines the relationship between health expenditure and economic growth using panel data consisting low and high-income countries. Using dynamic panel data methodology, we analyze twenty five high-income and nineteen low-income economies for the periods of 1995-2012 and 1997-2009, respectively. We find reciprocal relationship between health expenditure and economic growth in the short run and one-way causality from economic growth to public health expenditure in the long-run. In high-income countries, there is a two-way causality for both private and public health expenditures in the short-run, while in the long-run there is a one-way causality between economic growth and private health expenditures. The crucial finding of this study is that private health expenditures have negative influence on economic growth while public health expenditures have both negative and statistically significant effect.

  13. 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

  14. 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.

  15. Catastrophic payments for health care in Asia

    NARCIS (Netherlands)

    E.K.A. van Doorslaer (Eddy); O.A. O'Donnell (Owen); R.P. Rannan-Eliya (Ravi); A. Somanathan (Aparnaa); S.R. Adhikari (Shiva Raj); C.C. Garg (Charu); D. Harbianto (Deni); A.N. Herrin (Alejandro); M.N. Huq (Mohammed); S. Ibragimova (Shamsia); A. Karan (Anup); T-J. Lee (Tae-Jin); G.M. Leung (Gabriel); J-F.R. Lu (Jui-fen Rachel); C.W. Ng (Ng); B.R. Pande (Badri Raj); R. Racelis (Rachel); S. Tao (Tao); K. Tin (Keith); K. Tisayaticom (Kanjana); L. Trisnantoro (Laksono); C. Vasavid (Vasavid); Y. Zhao (Yuxin)

    2007-01-01

    textabstractOut-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that ar

  16. Defense, Education and Health Expenditures in Selected Asian Countries

    OpenAIRE

    Hirnissa, M.T; Habibullah, M.S.; Baharom, A.H.

    2008-01-01

    This study explores the inter-relationship between military expenditure, education expenditure and health expenditure in eight selected Asian countries namely Malaysia, Indonesia, Singapore, Philippines, Bangladesh, Nepal, Sri Lanka and South Korea. Autoregressive Distributed Lag-Restricted Error Correction Model (ARDL-RECM) procedure was utilized in the analysis. The empirical results suggest that, except for the case of Malaysia and Sri Lanka, whereby no meaningful interrelationship was det...

  17. Examining structural breaks and growth rates in international health expenditures.

    Science.gov (United States)

    Narayan, Paresh Kumar

    2006-09-01

    Over the last decade, there has been a growing interest in examining health expenditures. In this paper, we study the behaviour of health expenditures in the G3 countries (USA, the UK, and Japan) and three European countries (the UK, Switzerland and Spain) over the period 1960-2000 from a different perspective, in that we examine: (1) whether there is a common structural break in health expenditures across the G3 and European countries; (2) whether structural breaks have slowed down health expenditure growth rates in these countries or vice versa. Our main findings are that: (1) health expenditures share a common break in both bivariate and trivariate cases, and structural breaks and break intervals suggest that either one or a combination of events (second oil price shock, the 1987 stock market crash and/or recessions) have contributed to the commonality of break in health expenditures in the G3, while the oil price shocks have been instrumental in the commonality of breaks for the European countries; (2) except for the UK, structural breaks have slowed down growth rates in health expenditures for the USA, Japan, Switzerland and Spain.

  18. The Chernobyl Catastrophe. Consequences on Human Health

    Energy Technology Data Exchange (ETDEWEB)

    Yablokov, A.; Labunska, I.; Blokov, I. (eds.)

    2006-04-15

    Twenty years after the Chernobyl disaster, the need for continued study of its far-reaching consequences remains as great as ever. Several million people (by various estimates, from 5 to 8 million) still reside in areas that will remain highly contaminated by Chernobyl's radioactive pollution for many years to come. Since the half-life of the major (though far from the only) radioactive element released, caesium-137 (137Cs), is a little over 30 years, the radiological (and hence health) consequences of this nuclear accident will continue to be experienced for centuries to come. This event had its greatest impacts on three neighbouring former Soviet republics: Ukraine, Belarus, and Russia. The impacts, however, extended far more widely. More than half of the caesium-137 emitted as a result of the explosion was carried in the atmosphere to other European countries. At least fourteen other countries in Europe (Austria, Sweden, Finland, Norway, Slovenia, Poland, Romania, Hungary, Switzerland, Czech Republic, Italy, Bulgaria, Republic of Moldova and Greece) were contaminated by radiation levels above the 1 Ci/km{sup 2} (or 37 kBq/m{sup 2}), limit used to define areas as 'contaminated'. Lower, but nonetheless substantial quantities of radioactivity linked to the Chernobyl accident were detected all over the European continent, from Scandinavia to the Mediterranean, and in Asia. Despite the documented geographical extent and seriousness of the contamination caused by the accident, the totality of impacts on ecosystems, human health, economic performance and social structures remains unknown. In all cases, however, such impacts are likely to be extensive and long lasting. Drawing together contributions from numerous research scientists and health professionals, including many from the Ukraine, Belarus and the Russian Federation, this report addresses one of these aspects, namely the nature and scope of the long-term consequences for human health. The range

  19. 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.

  20. 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.

  1. Price elasticity of expenditure across health care services.

    Science.gov (United States)

    Duarte, Fabian

    2012-12-01

    Policymakers in countries around the world are faced with rising health care costs and are debating ways to reform health care to reduce expenditures. Estimates of price elasticity of expenditure are a key component for predicting expenditures under alternative policies. Using unique individual-level data compiled from administrative records from the Chilean private health insurance market, I estimate the price elasticity of expenditures across a variety of health care services. I find elasticities that range between zero for the most acute service (appendectomy) and -2.08 for the most elective (psychologist visit). Moreover, the results show that at least one third of the elasticity is explained by the number of visits; the rest is explained by the intensity of each visit. Finally, I find that high-income individuals are five times more price sensitive than low-income individuals and that older individuals are less price-sensitive than young individuals.

  2. 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

  3. 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.

  4. Management of health care expenditure by soft computing methodology

    Science.gov (United States)

    Maksimović, Goran; Jović, Srđan; Jovanović, Radomir; Aničić, Obrad

    2017-01-01

    In this study was managed the health care expenditure by soft computing methodology. The main goal was to predict the gross domestic product (GDP) according to several factors of health care expenditure. Soft computing methodologies were applied since GDP prediction is very complex task. The performances of the proposed predictors were confirmed with the simulation results. According to the results, support vector regression (SVR) has better prediction accuracy compared to other soft computing methodologies. The soft computing methods benefit from the soft computing capabilities of global optimization in order to avoid local minimum issues.

  5. CHINA HEALTH INSURANCE%Identification of Families at Catastrophic Medical Risk

    Institute of Scientific and Technical Information of China (English)

    褚福灵

    2016-01-01

    Study on methods for the identifi cation of families at catastrophic medical risk is needed to prevent poverty caused by illness and to realize precise poverty alleviation. Catastrophic medical risk families refer to families with catastrophic medical (Health) expenditures, which are families with large amount of medical expenses or poor families caused by illness. From the dimensions of medical expenses, diseases in family members, family income, family property, physical and mental health status of family members and so on, the catastrophic medical risk families are divided into 1-4 level (from low to high). When compensating for medical cost, it should submit to high risk family to prevent poverty caused by illness.%研究灾难性医疗风险家庭的认定办法,是防范因病致贫风险和实现精准扶贫的需要。灾难性医疗风险家庭是指发生了灾难性医疗(卫生)支出的家庭,分为大额医疗费用家庭与因病致贫家庭。从“医疗费用、家庭成员患病情况、家庭收入、家庭财产、家庭成员体能与心智状况”等维度,将灾难性医疗风险家庭分为1-4个级别。1级灾难性医疗风险最低,4级灾难性医疗风险最高。在对医疗费用补偿时,应当向灾难性医疗支出风险大的家庭倾斜,以确保困难家庭及弱势群体的灾难性医疗风险得到化解,防范因病致贫现象发生。

  6. 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.

  7. 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

  8. Can eHealth Reduce Medical Expenditures of Chronic Diseases?

    Science.gov (United States)

    Tsuji, Masatsugu; Taher, Sheikh Abu; Kinai, Yusuke

    2015-01-01

    The objective of this research is to evaluate empirically the effectiveness of eHealth in Nishi-aizu Town, Fukushima Prefecture, based on a mail survey to the residents and their receipt data of National Health Insurance from November 2006 to February 2007. The residents were divided into two groups, users and non-users, and sent questionnaires to ask their characteristics or usage of the system. Their medical expenditures paid by National Health Insurance for five years from 2002 to 2006 are examined. The effects were analyzed by comparison of medical expenditures between users and non-users. The interests are focused on four chronic diseases namely heart diseases, high blood pressure, diabetes, and strokes. A regression analysis is employed to estimate the effect of eHealth to users who have these diseases and then calculate the monetary effect of eHealth on reduction of medical expenditures. The results are expected to be valid for establishment of evidence-based policy such as reimbursement from medical insurance to eHealth.

  9. THE IMPACT OF ENVIRONMENTAL DEGRADATION ON HEALTH EXPENDITURE

    Directory of Open Access Journals (Sweden)

    VALERICĂ TOPLICIANU

    2014-05-01

    Full Text Available The purpose of this paper is to highlight the link between economic growth, environmental quality and health of the population and their implications on health expenditure growth.Health is influenced by multiple factors knows as the determinants of health, whose action can not always be kept under control. One of the determinants of health is the quality of the environment, which, together with the quality of the people (genetic heritage, lifestyle, standards of living, health system characteristics, has a bearing both on health and on health expenditure.Most of the determinants of population health have a mutual connection with the degree of economic development of a country and its level of education. In this respect, the high level of the health-related human capital has a positive effect on labor productivity and economic growth rate.Economic growth induces both an increase in standards of living, with positive effects on health, and a deterioration of the environmental conditions, which triggers changes in the degree of incidence of the disease, consequently favoring an increased financial burden on the health system.

  10. Pain Catastrophizing and Its Relationship with Health Outcomes: Does Pain Intensity Matter?

    Science.gov (United States)

    García-Palacios, Azucena; Botella, Cristina; Ribera-Canudas, Maria Victoria

    2017-01-01

    Pain catastrophizing is known to contribute to physical and mental functioning, even when controlling for the effect of pain intensity. However, research has yet to explore whether the strength of the relationship between pain catastrophizing and pain-related outcomes varies across pain intensity levels (i.e., moderation). If this was the case, it would have important implications for existing models of pain and current interventions. The present investigation explored whether pain intensity moderates the relationship between pain catastrophizing and pain-related outcomes. Participants were 254 patients (62% women) with heterogeneous chronic pain. Patients completed a measure of pain intensity, pain interference, pain catastrophizing, and physical and mental health. Pain intensity moderated the relationship between pain catastrophizing and pain interference and between pain catastrophizing and physical health status. Specifically, the strength of the correlation between pain catastrophizing and these outcomes decreased considerably as pain intensity increased. In contrast, pain intensity did not moderate the relationship between pain catastrophizing and mental health. Study findings provide a new insight into the role of pain intensity (i.e., moderator) in the relationship between pain catastrophizing and various pain-related outcomes, which might help develop existent models of pain. Clinical implications are discussed in the context of personalized therapy.

  11. 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.

  12. Metacognitive beliefs moderate the relationship between catastrophic misinterpretation and health anxiety.

    Science.gov (United States)

    Bailey, Robin; Wells, Adrian

    2015-08-01

    Catastrophic misinterpretations of bodily symptoms have a central role in cognitive-behavioural models of health anxiety. However, the metacognitive (S-REF) model postulates that psychological disturbance is linked more to beliefs about thinking i.e., metacognition. Equally the relationship between catastrophic misinterpretation and health anxiety should be moderated by metacognition, in particular negative beliefs about the uncontrollability and danger of thinking (MCQNeg). Participants (N = 351) completed measures to examine the relationship between these variables. Results indicated positive relationships between metacognition, catastrophic misinterpretation, and health anxiety. Moderation analysis showed that the effect of catastrophic misinterpretations on health anxiety was explained by the proposed interaction with metacognition. Follow-up regression analysis demonstrated the interaction term explained variance in health anxiety when controlling for other variables, and was a stronger unique predictor of health anxiety than catastrophic misinterpretation. Metacognition appears to be an important factor in the relationship between catastrophic misinterpretation and health anxiety, and would have important implications for existing models and treatment.

  13. 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

  14. 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.

  15. 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

  16. 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.

  17. Health care expenditure, laboratory services and IVD market.

    Science.gov (United States)

    Veronesi, E; Mambretti, C; Gazzaniga, P

    1997-01-01

    What has been written until now should not be misinterpreted: without doubt there is wastage in the Italian health care expenditure which must be rationalized. Moreover, the public deficit-now over two million billion lira-will probably prevent any reinvestment in health care of resources liberated through the above-mentioned rationalization process. In the near future, the attention of the authorities should be focused on how to reduce public spending, which probably also includes spending on health care. The message which needed to be passed on here does not refuse to recognize the possibility of rationalizing health care expenditure in Italy nor does it reject the need for this course of action. Instead it tries to give the following warning: in the light of the above circumstances-or the fact that even now the authorities cannot admit to spending "much" in the absolute sense, especially with regard to technology, or the fundamental role of IVDs in health care processes, or the difficulties in which the companies of the sector have been placed-it is possible to state that any blind, or worse still, ill-equipped, intervention in this field would have the undoubted effect of damaging the health care sector, or even place many companies on their knees, without receiving the expected benefits on the balance sheet. Benefits in the form of efficiency and saving can only be obtained from an effective reorganisation of the health structures, in line with the reforms provided for by legislative decree n. 502/92 (and subsequent modifications)--which, due to aspects too numerous to mention, is still a dead letter--and by taking steps towards valuing the laboratory services. As already stated, to talk of inefficiency in general terms means talking of unproductive expenditure: this occurs when utilizing factors whose cost is "too high" and/or productivity is "too low". It is with this distinction in mind that intervention must come; assessing factors not individually but

  18. Effect of household and village characteristics on financial catastrophe and impoverishment due to health care spending in Western and Central Rural China: A multilevel analysis

    Directory of Open Access Journals (Sweden)

    Zhang Hong

    2011-04-01

    Full Text Available Abstract Objective The study aimed to examine the effect of household and community characteristics on financial catastrophe and impoverishment due to health payment in Western and Central Rural China. Methods A household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Independent variables included village characteristics, household income, chronic illness status, health care use and health spending. A composite contextual variable, named village deprivation, was derived from socio-economic status and availability of health care facilities in each village using factor analysis. Dependent variables were whether household health payment was more than 40% of household's capacity to pay (catastrophic health payment and whether household per capita income was put under Chinese national poverty line (1067 Yuan income per year after health spending (impoverishment. Mixed effects logistic regression was used to assess the effect of the independent variables on the two outcomes. Results Households with low per capita income, having elderly, hospitalized or chronically ill members, and whose head was unemployed were more likely to incur financial catastrophe and impoverishment due to health expenditure. Both catastrophic and impoverishing health payments increased with increased village deprivation. However, the presence of a village health clinic had no effect on the two outcomes, nor did household enrollment in the New Rural Cooperative Medical Scheme (national health insurance. Conclusions Village deprivation independently increases the risk for financial hardship due to health payment after adjusting for known household-level factors. This suggests that policy makers need to view the individual, household and village as separate units for policy targeting.

  19. 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…

  20. 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.

  1. 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.

  2. 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

  3. Health care expenditures associated with pediatric pain-related conditions in the United States.

    Science.gov (United States)

    Groenewald, Cornelius B; Wright, Davene R; Palermo, Tonya M

    2015-05-01

    The primary objective of this study was to assess the impact of pediatric pain-related conditions on health care expenditures. We analyzed data from a nationally representative sample of 6- to 17-year-old children captured in the 2007 National Health Interview Survey and 2008 Medical Expenditure Panel Survey. Health care expenditures of children with pain-related conditions were compared with those of children without pain-related conditions. Pain-related conditions were associated with incremental health care expenditures of $1339 (95% confidence interval [CI], $248-$2447) per capita. Extrapolated to the nation, pediatric pain-related conditions were associated with $11.8 billion (95% CI, $2.18-$21.5 billion) in total incremental health care expenditures. The incremental health care expenditures associated with pediatric pain-related conditions were similar to those of attention deficit and hyperactivity disorder ($9.23 billion; 95% CI, $1.89-$18.1 billion), but more than those associated with asthma ($5.35 billion; 95% CI, $0-$12.3 billion) and obesity ($0.73 billion; 95% CI, $6.28-$8.81 billion). Health care expenditures for pediatric pain-related conditions exert a considerable economic burden on society. Efforts to prevent and treat pediatric pain-related conditions are urgently needed.

  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. 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

  6. 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.

  7. Econometric issues in testing the age neutrality of health care expenditure.

    Science.gov (United States)

    Salas, C; Raftery, J P

    2001-10-01

    A recent study by Zweifel et al. (Zweifel P, Felder S, Meiers M. Ageing of the population and health care expenditure: a red herring? Health Economics 1999; 8: 485-496) suggests that age is not related to health care expenditure among the elderly once 'closeness to death' is controlled for. If correct, this finding has major policy implications, but flaws in the econometric analysis undermine its credibility. We highlight two in particular, and propose methods to deal with them.

  8. 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.

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

    Directory of Open Access Journals (Sweden)

    Nahid Hatam

    2016-03-01

    Full Text Available 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.

  10. Estimated expenditures for essential public health services--selected states, fiscal year 1995.

    Science.gov (United States)

    1997-02-21

    Essential public health services are activities that public health departments and other partners undertake to protect and ensure the health of the public. To characterize expenditures for those services and to distinguish within them expenditures for personal health-care services from community-based health services directed toward populations, the Public Health Service (PHS) and the Public Health Foundation surveyed senior health officials in eight states (Arizona, Iowa, Louisiana, New York, Oregon, Rhode Island, Texas and Washington [combined 1995 population: 57.8 million]). This report summarizes the results of that survey, which indicate that spending on community-based health services is a small proportion of spending on essential services and an even smaller proportion of total health-care expenditures.

  11. [Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico].

    Science.gov (United States)

    Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Méndez-Carniado, Oscar; Bryson-Cahn, Chloe; Barofsky, Jeremy; Maguire, Rachel; Miranda, Martha; Sesma, Sergio

    2007-01-01

    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 of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.

  12. Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico.

    Science.gov (United States)

    Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Méndez-Carniado, Oscar; Bryson-Cahn, Chloe; Barofsky, Jeremy; Maguire, Rachel; Miranda, Martha; Sesma, Sergio

    2006-11-18

    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 (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 of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.

  13. Voluntary Health Insurance expenditure in low- and middle-income countries: Exploring trends during 1995–2012 and policy implications for progress towards universal health coverage

    OpenAIRE

    Pettigrew, LM; Mathauer, I

    2016-01-01

    Background Most low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI). This paper assesses VHI expenditure trends in LMIC and explores possible explanations. This illuminates challenges deriving from changes in VHI expenditure as countries aim to progress equitably towards universal health coverage (UHC). Methods Health expenditure data was retrieved from the WHO Global Health E...

  14. 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.

  15. 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...

  16. Reply to: Econometric issues in testing the age neutrality of health care expenditure.

    Science.gov (United States)

    Zweifel, P; Felder, S; Meier, M

    2001-10-01

    Salas and Raftery allege that in our paper, (1) remaining life expectancy is an endogenous explanatory variable of health care expenditure and (2) the parameter designed to correct for sample selection bias in fact represents a hidden relationship between health care expenditure and age. We argue that claim (1) is not supported by the available empirical evidence, while claim (2) seems to derive from a too cursory reading of our paper.

  17. Effect of the California tobacco control program on personal health care expenditures.

    Directory of Open Access Journals (Sweden)

    James M Lightwood

    2008-08-01

    Full Text Available BACKGROUND: Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California's large-scale tobacco control program on aggregate personal health care expenditures in the state. METHODS AND FINDINGS: Cointegrating regressions were used to predict (1 the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2 the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started and 2004, the California program was associated with $86 billion (2004 US dollars (95% confidence interval [CI] $28 billion to $151 billion lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%-12.1% of total health care expenditures in 2004. CONCLUSIONS: A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures.

  18. Effects of catastrophic medical expenditure on rural poverty in China%灾难性医疗支出对我国农村贫困的影响研究--基于中国家庭追踪调查

    Institute of Scientific and Technical Information of China (English)

    王钦池

    2016-01-01

    农村贫困人口脱贫是全面建成小康社会艰巨的任务。本文利用2014年中国家庭追踪调查数据,通过测算灾难性医疗支出( CHE)家庭的发生率、贫困发生率、占贫困家庭的比重、CHE致贫率等多个指标,定量分析CHE对我国农村贫困的影响。基于测算结果,建议把CHE家庭作为医疗卫生部门在农村实施精准减贫的重点对象;为了实现扶贫绩效的最大化,CHE标准的设定需要综合考虑扶贫精准度和覆盖面两个因素。%Helping all rural people living below the poverty line shake off is the most difficult task to build a moderately prosperous society in all respects. Based on 2014 China Household Panel Data Survey, this paper evalu-ates the effects of catastrophic health expenditure ( CHE ) on poverty in the rural areas of China by calculating the CHE and households poverty incidences, the poor families’ proportions, and the poverty incidence due to CHE and other indicators. According to estimated results, we recommend that CHE households should be regarded as the main target population to be shaken off poverty in the rural areas by the national health department. In order to maximize the poverty reduction performance, it is necessary to take into account both the poverty alleviation accuracy and cov-erage while setting the CHE criteria.

  19. 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...

  20. Global health and climate change: moving from denial and catastrophic fatalism to positive action.

    Science.gov (United States)

    Costello, Anthony; Maslin, Mark; Montgomery, Hugh; Johnson, Anne M; Ekins, Paul

    2011-05-13

    The health effects of climate change have had relatively little attention from climate scientists and governments. Climate change will be a major threat to population health in the current century through its potential effects on communicable disease, heat stress, food and water security, extreme weather events, vulnerable shelter and population migration. This paper addresses three health-sector strategies to manage the health effects of climate change-promotion of mitigation, tackling the pathways that lead to ill-health and strengthening health systems. Mitigation of greenhouse gas (GHG) emissions is affordable, and low-carbon technologies are available now or will be in the near future. Pathways to ill-health can be managed through better information, poverty reduction, technological innovation, social and cultural change and greater coordination of national and international institutions. Strengthening health systems requires increased investment in order to provide effective public health responses to climate-induced threats to health, equitable treatment of illness, promotion of low-carbon lifestyles and renewable energy solutions within health facilities. Mitigation and adaptation strategies will produce substantial benefits for health, such as reductions in obesity and heart disease, diabetes, stress and depression, pneumonia and asthma, as well as potential cost savings within the health sector. The case for mitigating climate change by reducing GHGs is overwhelming. The need to build population resilience to the global health threat from already unavoidable climate change is real and urgent. Action must not be delayed by contrarians, nor by catastrophic fatalists who say it is all too late.

  1. Health care utilization in the elderly Mexican population: Expenditures and determinants

    Directory of Open Access Journals (Sweden)

    García-Peña Carmen

    2011-03-01

    Full Text Available Abstract Background Worldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social or because of the increase that comes with older age (individual. Objective To analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly. Methods A secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT, 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age. Results Higher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were $240.6 am dlls, whereas in households exclusively with elderly the expenditure was $308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization. Conclusions The conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age

  2. 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.

  3. Payments for health care and its effect on catastrophe and impoverishment: experience from the transition to Universal Coverage in Thailand.

    Science.gov (United States)

    Somkotra, Tewarit; Lagrada, Leizel P

    2008-12-01

    Equitable health financing was embodied in the reform strategies of Thailand's health care system when the country moved towards implementing the Universal Coverage (UC) policy in 2001. This study aimed to measure the pattern of household out-of-pocket payments for health care and to examine the financial catastrophe and impoverishment due to such payments during the transitional period (pre- and post-Universal Coverage policy implementation) in Thailand. This study used the nationally representative Socioeconomic Surveys in 2000 (pre-UC), 2002, and 2004 (post-UC), which contained data from 24747, 34758 and 34843 individual households, respectively. The proportion of out-of-pocket payments for health care as a share of household living standards among Thai households shows a decreasing pattern during the observed period. Moreover, the incidence and intensity of catastrophic payments for health care decline from the pre-UC to post-UC period. The distribution of incidence and the intensity of catastrophic payments for health care across quintiles also indicate that the lower quintile group (1st and 2nd quintiles) incurs lower catastrophic health care payments compared to the higher quintile group. The UC policy is also effective in preventing impoverishment due to out-of-pocket payments for health care since both the poverty headcount and poverty gap decline from the pre-UC to post-UC period. This study provides important evidence that the UC policy implementation is a valuable social protection and safety net strategy that contributes to the prevention of financial catastrophe and impoverishment due to out-of-pocket payments for health care. In conclusion, the UC policy in Thailand achieves one of the goals of improving the health system through equitable health care financing by reducing financial catastrophe and impoverishment due to out-of-pocket payments for health care.

  4. 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.

  5. 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.

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

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Razmi

    2012-12-01

    Full Text Available 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 relationship between government health expenditure and human development index. Also, Granger Causality Test indicates that there is no bilateral relationship between the government healthexpenditure and HDI in Iran.

  7. 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.

  8. Is Taking a Pill a Day Good for Health Expenditures? Evidence from a Cross Section Time Series Analysis of 19 OECD Countries from 1970 – 2000

    OpenAIRE

    Verbelen, Bart

    2006-01-01

    This paper differs in two ways from previous comparative health system research. First, it focuses on the impact of pharmaceutical expenditures on total health expenditures as trends in pharmaceutical expenditures have been blamed of being a major driver of national health expenditures. In addition to pharmaceutical expenditures, other variables of interest are income, public financing, public delivery, ageing and urbanization. Second, the analysis includes a thorough sensitivity analysis on ...

  9. Effects of the Affordable Care Act on Consumer Health Care Spending and Risk of Catastrophic Health Costs.

    Science.gov (United States)

    Nowak, Sarah A; Eibner, Christine; Adamson, David M; Saltzman, Evan

    2014-01-01

    This study examines the likely effects of the Affordable Care Act (ACA) on average annual consumer health care spending and the risk of catastrophic medical costs for the United States overall and in two large states that have decided not to expand their Medicaid programs (Texas and Florida). The ACA will have varied impacts on individuals' and families' spending on health care, depending on income level and on estimated 2016 insurance status without the ACA. The authors find that average out-of-pocket spending is expected to decrease for all groups considered in the analysis, although decreases in out-of-pocket spending will be largest for those who would otherwise be uninsured. People who would otherwise be uninsured who transition to the individual market under the ACA will have higher total health care spending on average after implementation of the ACA because they will now incur the cost of health insurance premiums. The authors also find that risk of catastrophic health care spending will decrease for individuals of all income levels for the insurance transitions considered; decreases will be greatest for those at the lowest income levels. Case studies found that in Texas and Florida, Medicaid expansion would substantially reduce out-of-pocket and total health care spending for those with incomes below 100 percent of the federal poverty level, compared with a scenario in which the ACA is implemented without Medicaid expansion. Expansion would reduce the risk of high medical spending for those covered under Medicaid who would remain uninsured without expansion.

  10. 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

  11. Potential population health outcomes and expenditures of HIV vaccination strategies in the United States.

    Science.gov (United States)

    Long, Elisa F; Brandeau, Margaret L; Owens, Douglas K

    2009-08-27

    Estimating the potential health benefits and expenditures of a partially effective HIV vaccine is an important consideration in the debate about whether HIV vaccine research should continue. We developed an epidemic model to estimate HIV prevalence, new infections, and the cost-effectiveness of vaccination strategies in the U.S. Vaccines with modest efficacy could prevent 300,000-700,000 HIV infections and save $30 billion in healthcare expenditures over 20 years. Targeted vaccination of high-risk individuals is economically efficient, but difficulty in reaching these groups may mitigate these benefits. Universal vaccination is cost-effective for vaccines with 50% efficacy and price similar to other infectious disease vaccines.

  12. 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.

  13. 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.

  14. 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.

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

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    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

  16. 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.

  17. 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.

  18. 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.  

  19. The Impacts of China's Urban Employee Basic Medical Insurance on Healthcare Expenditures and Health Outcomes.

    Science.gov (United States)

    Huang, Feng; Gan, Li

    2017-02-01

    At the end of 1998, China launched a government-run mandatory insurance program, the urban employee basic medical insurance (UEBMI), to replace the previous medical insurance system. Using the UEBMI reform in China as a natural experiment, this study identifies variations in patient cost sharing that were imposed by the UEBMI reform and examines their effects on the demand for healthcare services. Using data from the 1991-2006 waves of the China Health and Nutrition Survey, we find that increased cost sharing is associated with decreased outpatient medical care utilization and expenditures but not with decreased inpatient care utilization and expenditures. Patients from low-income and middle-income households or with less severe medical conditions are more sensitive to prices. We observe little impact on patient's health, as measured by self-reported health status. Copyright © 2015 John Wiley & Sons, Ltd.

  20. 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.

  1. 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.

  2. 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.

  3. To what extent does recurrent government health expenditure in Uganda reflect its policy priorities?

    Directory of Open Access Journals (Sweden)

    Nabyonga-Orem Juliet

    2010-10-01

    Full Text Available Abstract Background The National Health Policy 2000 - 2009 and Health sector strategic plans I & II emphasized that Primary Health Care (PHC would be the main strategy for national development and would be operationalized through provision of the minimum health care package. Commitment was to spend an increasing proportion of the health budget for the provision of the basic minimum package of health services which was interpreted to mean increasing spending at health centre level. This analysis was undertaken to gain a better understanding of changes in the way recurrent funding is allocated in the health sector in Uganda and to what extent it has been in line with agreed policy priorities. Methods Government recurrent wage and non-wage expenditures - based on annual releases by the Uganda Ministry of Finance, Planning and Economic Development were compiled for the period 1997/1998 to financial year 2007/2008. Additional data was obtained from a series of Ministry of Health annual health sector reports as well as other reports. Data was verified by key government officials in Ministry of Finance, Planning and Economic Development and Ministry of Health. Analysis of expenditures was done at sector level, by the different levels in the health care system and the different levels of care. Results There was a pronounced increase in the amount of funds released for recurrent expenditure over the review period fueled mainly by increases in the wage component. PHC services showed the greatest increase, increasing more than 70 times in ten years. At hospital level, expenditures remained fairly constant for the last 10 years with a slight reduction in the wage component. Conclusion The policy aspiration of increasing spending on PHC was attained but key aspects that would facilitate its realization were not addressed. At any given level of funding for the health sector, there is need to work out an optimal balance in investment in the different inputs to

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Time to death and the forecasting of macro-level health care expenditures: some further considerations.

    Science.gov (United States)

    van Baal, Pieter H; Wong, Albert

    2012-12-01

    Although the effect of time to death (TTD) on health care expenditures (HCE) has been investigated using individual level data, the most profound implications of TTD have been for the forecasting of macro-level HCE. Here we estimate the TTD model using macro-level data from the Netherlands consisting of mortality rates and age- and gender-specific per capita health expenditures for the years 1981-2007. Forecasts for the years 2008-2020 of this macro-level TTD model were compared to forecasts that excluded TTD. Results revealed that the effect of TTD on HCE in our macro model was similar to those found in micro-econometric studies. As the inclusion of TTD pushed growth rate estimates from unidentified causes upwards, however, the two models' forecasts of HCE for the 2008-2020 were similar. We argue that including TTD, if modeled correctly, does not lower forecasts of HCE.

  7. Intersystem return on investment in public mental health: Positive externality of public mental health expenditure for the jail system in the U.S.

    Science.gov (United States)

    Yoon, Jangho; Luck, Jeff

    2016-12-01

    This study examines the extent to which increased public mental health expenditures lead to a reduction in jail populations and computes the associated intersystem return on investment (ROI). We analyze unique panel data on 44 U.S. states and D.C. for years 2001-2009. To isolate the intersystem spillover effect, we exploit variations across states and over time within states in per capita public mental health expenditures and average daily jail inmates. Regression models control for a comprehensive set of determinants of jail incarcerations as well as unobserved determinants specific to state and year. Findings show a positive spillover benefit of increased public mental health spending on the jail system: a 10% increase in per capita public inpatient mental health expenditure on average leads to a 1.5% reduction in jail inmates. We also find that the positive intersystem externality of increased public inpatient mental health expenditure is greater when the level of community mental health spending is lower. Similarly, the intersystem spillover effect of community mental health expenditure is larger when inpatient mental health spending is lower. We compute that overall an extra dollar in public inpatient mental health expenditure by a state would yield an intersystem ROI of a quarter dollar for the jail system. There is significant cross-state variation in the intersystem ROI in both public inpatient and community mental health expenditures, and the ROI overall is greater for inpatient mental health spending than for community mental health spending.

  8. 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.

  9. Daily Energy Expenditure and Its Relation to Health Care Costs in Patients Undergoing Ambulatory Electrocardiographic Monitoring.

    Science.gov (United States)

    George, Jason; Abdulla, Rami Khoury; Yeow, Raymond; Aggarwal, Anshul; Boura, Judith; Wegner, James; Franklin, Barry A

    2017-02-15

    Our increasingly sedentary lifestyle is associated with a heightened risk of obesity, diabetes, heart disease, and cardiovascular mortality. Using the recently developed heart rate index formula in 843 patients (mean ± SD age 62.3 ± 15.7 years) who underwent 24-hour ambulatory electrocardiographic (ECG) monitoring, we estimated average and peak daily energy expenditure, expressed as metabolic equivalents (METs), and related these data to subsequent hospital encounters and health care costs. In this cohort, estimated daily average and peak METs were 1.7 ± 0.7 and 5.5 ± 2.1, respectively. Patients who achieved daily bouts of peak energy expenditure ≥5 METs had fewer hospital encounters (p = 0.006) and median health care costs that were nearly 50% lower (p health care costs depending on whether they achieved monitoring (p = 0.005). Interestingly, patients who achieved ≥5 METs had lower and no significant difference in their health care costs, regardless of their body mass index (p = 0.46). Patients with previous percutaneous coronary intervention who achieved ≥5 METs had lower health care costs (p = 0.044) and fewer hospital encounters (p = 0.004) than those who achieved monitoring may provide useful information regarding health care utilization in patients with and without previous percutaneous coronary intervention, irrespective of body habitus. Our findings are the first to link lower intensities of peak daily energy expenditure, estimated from ambulatory ECG monitoring, with increased health care utilization.

  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. 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.

  12. 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.

  13. 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).

  14. Evolving Health Expenditure Landscape of the BRICS Nations and Projections to 2025.

    Science.gov (United States)

    Jakovljevic, Mihajlo; Potapchik, Elena; Popovich, Larisa; Barik, Debasis; Getzen, Thomas E

    2016-09-29

    Global health spending share of low/middle income countries continues its long-term growth. BRICS nations remain to be major drivers of such change since 1990s. Governmental, private and out-of-pocket health expenditures were analyzed based on WHO sources. Medium-term projections of national health spending to 2025 were provided based on macroeconomic budgetary excess growth model. In terms of per capita spending Russia was highest in 2013. India's health expenditure did not match overall economic growth and fell to slightly less than 4% of GDP. Up to 2025 China will achieve highest excess growth rate of 2% and increase its GDP% spent on health care from 5.4% in 2012 to 6.6% in 2025. Russia's spending will remain highest among BRICS in absolute per capita terms reaching net gain from $1523 PPP in 2012 to $2214 PPP in 2025. In spite of BRICS' diversity, all countries were able to significantly increase their investments in health care. The major setback was bold rise in out-of-pocket spending. Most of BRICS' growing share of global medical spending was heavily attributable to the overachievement of People's Republic of China. Such trend is highly likely to continue beyond 2025. Copyright © 2016 John Wiley & Sons, Ltd.

  15. Health Anxiety in Preadolescence - Associated Health Problems, Healthcare Expenditure, and Continuity in Childhood

    DEFF Research Database (Denmark)

    Rask, Charlotte Ulrikka; Munkholm, Anja; Clemmensen, Lars

    2015-01-01

    assessed in 1886 Danish 11-12 year old children (48 % boys) from the Copenhagen Child Cohort using the Childhood Illness Attitude Scales (CIAS) together with information on socio-demographics and the child's somatic and mental status and healthcare expenditure. Non-parametric statistics and regression......; they showed continuity from early childhood and association with emotional disorders, unspecific somatic complaints, and increased healthcare expenditure. Further research in the clinical significance of childhood HA is required....

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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

  18. 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.

  19. Rising Health Expenditure due to Non-communicable Diseases in India: An Outlook

    Directory of Open Access Journals (Sweden)

    Debasis Barik

    2016-11-01

    Full Text Available Abstract: With ongoing demographic transition, epidemiological transition in India has been emerged as a growing concern in India. The share of non-communicable disease in total disease burden has increased from 31 per cent in 1990 to 45 per cent in 2010. This paper seeks to explore the health scenario of India in the wake of the growing pace of non-communicable diseases like diabetes, hypertension among Indian population using data from health and morbidity survey of the National Sample Survey Organisation (2004 and notifies about the resource needed to tackle this growing health risk. Given the share of private players (70 per cent in Indian health system, results indicate a higher private expenditure, mostly out-of-pocket expense, on account of non-communicable diseases. A timely look into the matter may tackle a more dreadful situation in near future.

  20. Rising Health Expenditure Due to Non-Communicable Diseases in India: An Outlook.

    Science.gov (United States)

    Barik, Debasis; Arokiasamy, Perianayagam

    2016-01-01

    With ongoing demographic transition, epidemiological transition has been emerged as a growing concern in India. The share of non-communicable disease in total disease burden has increased from 31% in 1990 to 45% in 2010. This paper seeks to explore the health scenario of India in the wake of the growing pace of non-communicable diseases such as diabetes and hypertension among Indian population using data from health and morbidity survey of the National Sample Survey Organisation (2004) and notifies about the resource needed to tackle this growing health risk. Given the share of private players (70%) in Indian health system, results indicate a higher private expenditure, mostly out-of-pocket expense, on account of non-communicable diseases. A timely look into the matter may tackle a more dreadful situation in near future.

  1. 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

  2. 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.

  3. 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.

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

    Directory of Open Access Journals (Sweden)

    Fuhmei Wang PhD

    2015-08-01

    Full Text Available 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.

  5. 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

  6. The impact of poverty, chronic illnesses, and health insurance status on out-of-pocket health care expenditures in later life.

    Science.gov (United States)

    Kim, Jinhyun; Richardson, Virginia

    2014-10-01

    This study aims to examine poverty, chronic illnesses, health insurance, and health care expenditures, within the context of a political economy of aging perspective. Subsamples of 1,773 older adults from the Medical Expenditure Panel Survey were selected for analyses. The results showed that chronic illnesses influenced out-of-pocket health care costs. Older persons with more than one health insurance spent less on out-of-pocket health care costs. The results have implications for health care social workers concerned with the growing costs of chronic illnesses, implementing integrated care, and advocating for extending public health insurance coverage especially for our most impoverished older adults.

  7. The Impact of Universal Coverage Policy on Catastrophic Health Payments in Thailand%泰国全民覆盖政策对灾难性卫生支出的影响

    Institute of Scientific and Technical Information of China (English)

    高倩; 任苒

    2013-01-01

    Before 2002, the three existing basic medical security systems of Thailand covered 30% of the population, and the surplus population participated in the universal coverage(UC)policy of medical security system which promulgated in 2002. Since the implement of UC policy, it has improved the equity of medical service application and health financing, reduced Catastrophic Health Payments and low-income groups have obtained more benefits. The incidence rate of Catastrophic Health Payments decreased and the spending burden of catastrophic health expenditure in low-income groups decreased from 6.11%(2000)to 4.65%(2002).%2002年以前,泰国3个原有的基本医疗保障制度覆盖了30%的人口,2002年颁布的全民覆盖(UC)政策覆盖了剩余人口,使泰国实现了医疗保障的全民覆盖。全民覆盖改革实施后,改善了医疗服务利用和卫生筹资的公平性,减少了灾难性卫生支出,尤其是低收入组受益较大。灾难性卫生支出的发生率有所降低,其中低收入组人群家庭灾难性卫生支出负担从2000年的6.11%降低到2002年的4.65%。

  8. 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...

  9. The 2011 proposal for Universal Health Insurance in Ireland: Potential implications for healthcare expenditure.

    Science.gov (United States)

    Connolly, Sheelah; Wren, Maev-Ann

    2016-07-01

    The Irish healthcare system has long been criticised for a number of perceived weaknesses, including access to healthcare based on ability-to-pay rather than need. Consequently, in 2011, a newly elected government committed to the development of a universal, single-tier system based on need and financed through Universal Health Insurance (UHI). This article draws on the national and international evidence to identify the potential impact of the proposed model on healthcare expenditure in Ireland. Despite a pledge that health spending under UHI would be no greater than in the current predominantly tax-funded model, the available evidence is suggestive that the proposed model involving competing insurers would increase healthcare expenditure, in part due to an increase in administrative costs and profits. As a result the proposed model of UHI appears to be no longer on the political agenda. Although the Government has been criticised for abandoning its model of UHI, it has done so based on national and international evidence about the relatively high additional costs associated with this particular model.

  10. National health expenditure projections: modest annual growth until coverage expands and economic growth accelerates.

    Science.gov (United States)

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

    2012-07-01

    For 2011-13, US health spending is projected to grow at 4.0 percent, on average--slightly above the historically low growth rate of 3.8 percent in 2009. Preliminary data suggest that growth in consumers' use of health services remained slow in 2011, and this pattern is expected to continue this year and next. In 2014, health spending growth is expected to accelerate to 7.4 percent as the major coverage expansions from the Affordable Care Act begin. For 2011 through 2021, national health spending is projected to grow at an average rate of 5.7 percent annually, which would be 0.9 percentage point faster than the expected annual increase in the gross domestic product during this period. By 2021, federal, state, and local government health care spending is projected to be nearly 50 percent of national health expenditures, up from 46 percent in 2011, with federal spending accounting for about two-thirds of the total government share. Rising government spending on health care is expected to be driven by faster growth in Medicare enrollment, expanded Medicaid coverage, and the introduction of premium and cost-sharing subsidies for health insurance exchange plans.

  11. [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.

  12. 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.

  13. 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).

  14. Impact of cardiovascular risk factors on medical expenditure: evidence from epidemiological studies analysing data on health checkups and medical insurance.

    Science.gov (United States)

    Nakamura, Koshi

    2014-01-01

    Concerns have increasingly been raised about the medical economic burden in Japan, of which approximately 20% is attributable to cardiovascular disease, including coronary heart disease and stroke. Because the management of risk factors is essential for the prevention of cardiovascular disease, it is important to understand the relationship between cardiovascular risk factors and medical expenditure in the Japanese population. However, only a few Japanese epidemiological studies analysing data on health checkups and medical insurance have provided evidence on this topic. Patients with cardiovascular risk factors, including obesity, hypertension, and diabetes, may incur medical expenditures through treatment of the risk factors themselves and through procedures for associated diseases that usually require hospitalization and sometimes result in death. Untreated risk factors may cause medical expenditure surges, mainly due to long-term hospitalization, more often than risk factors preventively treated by medication. On an individual patient level, medical expenditures increase with the number of concomitant cardiovascular risk factors. For single risk factors, personal medical expenditure may increase with the severity of that factor. However, on a population level, the medical economic burden attributable to cardiovascular risk factors results largely from a single, particularly prevalent risk factor, especially from mildly-to-moderately abnormal levels of the factor. Therefore, cardiovascular risk factors require management on the basis of both a cost-effective strategy of treating high-risk patients and a population strategy for reducing both the ill health and medical economic burdens that result from cardiovascular disease.

  15. 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.

  16. 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

  17. How to (or not to) … measure performance against the Abuja target for public health expenditure.

    Science.gov (United States)

    Witter, Sophie; Jones, Alex; Ensor, Tim

    2014-07-01

    In 2001, African heads of state committed 'to set a target of allocating at least 15% of our annual budget to the improvement of the health sector'. This target has since been used as a benchmark to hold governments accountable. However, it was never followed by a set of guidelines as to how it should be measured in practice. This article sets out some of the areas of ambiguity and argues for an interpretation which focuses on actual expenditure, rather than budgets (which are theoretical), and which captures areas of spending that are subject to government discretion. These are largely domestic sources, but include budget support, which is externally derived but subject to Ministry of Finance sectoral allocation. Theoretical and practical arguments in favour of this recommendation are recommended using a case study from Sierra Leone. It is recommended that all discretionary spending by government is included in the numerator and denominator when calculating performance against the target, including spending by all ministries on health, social health insurance payments, debt relief funds and budget support. Conversely, all forms of private payment and earmarked aid should be excluded. The authors argue that the target, while an important vehicle for tracking political commitment to the sector, should be assessed intelligently by governments, which have legitimate wider public finance objectives of maximizing overall social returns, and should be complemented by a wider range of indicators, to avoid distortions.

  18. HIV spending as a share of total health expenditure: an analysis of regional variation in a multi-country study.

    Directory of Open Access Journals (Sweden)

    Peter Amico

    Full Text Available BACKGROUND: HIV has devastated numerous countries in sub-Saharan Africa and is a dominant health force in many other parts of the world. Its undeniable importance is reflected in the establishment of Millennium Development Goal No. 6. Unprecedented amounts of funding have been committed and disbursed over the past two decades. Many have argued that this enormous influx of funding has been detrimental to building stronger health systems in recipient countries. This paper examines the funding share for HIV measured against the total funding for health. METHODOLOGY/PRINCIPAL FINDINGS: A descriptive analysis of HIV and health expenditures in 2007 from 65 countries was conducted. Comparable data from individual countries was used by applying a consistent definition for HIV expenditures and total health expenditures from NHAs to align them with National AIDS Assessment Reports. In 2007, the total public and international expenditure in LMICs for HIV was 1.6 percent of the total spending on health, while the share in SSA was 19.4 percent. HIV prevalence was six-fold higher in SSA than the next highest region and it is the only region whose share of HIV spending exceeded the burden of HIV DALYs. CONCLUSIONS/SIGNIFICANCE: The share of HIV spending across the 65 countries was quite moderate considering that the estimated share of deaths attributable to HIV stood at 3.8 percent and DALYs at 4.4 percent. Several high spending countries are using a large share of their total health spending for HIV health, but these countries are the exception rather than representative of the average SSA country. There is wide variation between regions, but the burden of disease also varies significantly. The percentage of HIV spending is a useful indicator for better understanding health care resources and their allocation patterns.

  19. 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…

  20. Awareness and Utilisation of Health Insurance Services by the Families Residing at Urban Field Practice Area of a Medical Col-lege in Bangalore

    Directory of Open Access Journals (Sweden)

    Chethana Ramegowda, Anwith H Shivalingaiah

    2015-01-01

    Conclusion: Awareness campaign should be undertaken to increase the awareness regarding gov-ernment health insurance schemes among its beneficiaries, thereby, reducing the out of pocket ex-penditures as well financial catastrophes during the illness."

  1. 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

  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.

  6. 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.

  7. 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.

  8. Impact of China's Urban Employee Basic Medical Insurance on Health Care Expenditure and Health Outcomes

    OpenAIRE

    Feng Huang; Li Gan

    2015-01-01

    At the end of 1998, China launched a government-run mandatory insurance program, the Urban Employee Basic Medical Insurance (UEBMI), to replace the previous medical insurance system. Using the UEBMI reform in China as a natural experiment, this study identify variations in patient cost sharing that were imposed by the UEBMI reform and examine their effects on the demand for health-care services. Using data from the 1991-2006 waves of the China Health and Nutrition Survey, we find that the inc...

  9. 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.)

  10. Minamata disease: catastrophic poisoning due to a failed public health response.

    Science.gov (United States)

    Tsuda, Toshihide; Yorifuji, Takashi; Takao, Soshi; Miyai, Masaya; Babazono, Akira

    2009-04-01

    We present the history of Minamata disease in a chronological order from the public health point of view. Because the appropriate public health response - to investigate and control the outbreak - as set out in the Food Sanitation Act was not conducted, no one knew how many became ill following the outbreak. Exposure could not be stopped. In our discussion, we offer two reasons as to why the Japanese public health agencies did not apply the Act: social circumstances in the 1950s and 1960s that placed emphasis on industrial development, and the Japanese medical community's lack of knowledge about the Act. The history of Minamata disease shows us the consequences when public health responses are not implemented. Minamata disease should be an invaluable lesson for future public health responses.

  11. 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.

  12. 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.

  13. 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

  14. Age-Related Variation in Health Service Use and Associated Expenditures among Children with Autism

    Science.gov (United States)

    Cidav, Zuleyha; Lawer, Lindsay; Marcus, Steven C.; Mandell, David S.

    2013-01-01

    This study examined differences by age in service use and associated expenditures during 2005 for Medicaid-enrolled children with autism spectrum disorders. Aging was associated with significantly higher use and costs for restrictive, institution-based care and lower use and costs for community-based therapeutic services. Total expenditures…

  15. Catastrophe model for the exposure to blood-borne pathogens and other accidents in health care settings.

    Science.gov (United States)

    Guastello, S J; Gershon, R R; Murphy, L R

    1999-11-01

    Catastrophe models, which describe and predict discontinuous changes in system state variables, were used to model the exposure to blood and bodily fluids and more conventional occupational accidents among 1708 health care workers. Workers at three hospitals completed a survey measuring HIV-relevant exposures (needlesticks, cuts, splashes, contact with open wounds), the accident rate for broadly-defined injuries, and several occupationally relevant themes: safety climate, shift work, depression symptoms, work pace, verbal abuse, and professional group membership. A cusp (cubic polynomial) model predicting HIV-relevant exposures specifically was more accurate (R2 = 0.56) than a comparable linear model containing the same variables (R2 = 0.07). Some of the foregoing variables predisposed workers to greater differences in HIV-relevant and general accident exposures: shiftwork, climate, depressive symptoms, and work pace. Other variables governed how close an individual was to a critical threshold where a harmful incident would take place: verbal abuse, professional group membership. Similarly, a cusp model for accident incidents predicted from HIV-relevant exposures and occupational variables was also more accurate (R2 = 0.75) than comparison models. Two variables predisposed the worker to a greater accident risk: depression symptoms and shift work. Four other variables predisposed the worker to lesser accident risk: job satisfaction, safety climate, environmental stressors, and work pace. Compliance with the universal precautions and HIV-related training were not relevant to either of the models.

  16. 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

  17. Volcanic Catastrophes

    Science.gov (United States)

    Eichelberger, J. C.

    2003-12-01

    The big news from 20th century geophysics may not be plate tectonics but rather the surprise return of catastrophism, following its apparent 19th century defeat to uniformitarianism. Divine miracles and plagues had yielded to the logic of integrating observations of everyday change over time. Yet the brilliant interpretation of the Cretaceous-Tertiary Boundary iridium anomaly introduced an empirically based catastrophism. Undoubtedly, decades of contemplating our own nuclear self-destruction played a role in this. Concepts of nuclear winter, volcanic winter, and meteor impact winter are closely allied. And once the veil of threat of all-out nuclear exchange began to lift, we could begin to imagine slower routes to destruction as "global change". As a way to end our world, fire is a good one. Three-dimensional magma chambers do not have as severe a magnitude limitation as essentially two-dimensional faults. Thus, while we have experienced earthquakes that are as big as they get, we have not experienced volcanic eruptions nearly as great as those preserved in the geologic record. The range extends to events almost three orders of magnitude greater than any eruptions of the 20th century. Such a calamity now would at the very least bring society to a temporary halt globally, and cause death and destruction on a continental scale. At maximum, there is the possibility of hindering photosynthesis and threatening life more generally. It has even been speculated that the relative genetic homogeneity of humankind derives from an evolutionary "bottleneck" from near-extinction in a volcanic cataclysm. This is somewhat more palatable to contemplate than a return to a form of Original Sin, in which we arrived at homogeneity by a sort of "ethnic cleansing". Lacking a written record of truly great eruptions, our sense of human impact must necessarily be aided by archeological and anthropological investigations. For example, there is much to be learned about the influence of

  18. 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

  19. The effect of HMOs on fee-for-service health care expenditures: evidence from Medicare revisited.

    Science.gov (United States)

    Batata, Amber

    2004-09-01

    This paper implements a new method for calculating the extent of selection in the aged Medicare HMO market. Selection is measured as the difference in average costs between new Medicare HMO enrollees and Medicare fee-for-service stayers with data from 1990 to 1994. Results suggest Medicare HMO enrollees were 1030 US dollars cheaper in their first year of enrollment. The effect is found entirely in Part A (hospital) expenditures, confirming selection is based on inpatient rather than outpatient or preventive care. These results are consistent with previous work.

  20. 政府卫生支出与卫生改革之关系——基于浙江省“十一五”时期卫生总费用的分析%The relationship between government health expenditure and health reform based on the total health expenditure analysis of Zhejiang Province in the eleventh five years

    Institute of Scientific and Technical Information of China (English)

    申屠正荣

    2012-01-01

      Government health expenditure is an important part of total health expenditure and plays an important role in promoting health reform and meeting social medical demand. The government health expenditure increased greatly in the eleventh five years. However, the recognition, policy and structure of government health expenditure delayed the progress of health reform. We proposed to implement proactive fiscal policy and strong measures.%  政府卫生支出是卫生总费用的重要组成部分,对促进医疗卫生改革和满足社会医疗需求起着重大作用。在“十一五”期间,浙江省政府卫生支出增长迅速,成绩显著,但目前还存在着认识、政策和结构等障碍,影响了浙江省医疗卫生改革进程。因此,必须采取积极的财政政策和有力的措施加以解决。

  1. 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.

  2. 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.

  3. National health expenditure projections, 2012-22: slow growth until coverage expands and economy improves.

    Science.gov (United States)

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

    2013-10-01

    Health spending growth through 2013 is expected to remain slow because of the sluggish economic recovery, continued increases in cost-sharing requirements for the privately insured, and slow growth for public programs. These factors lead to projected growth rates of near 4 percent through 2013. However, improving economic conditions, combined with the coverage expansions in the Affordable Care Act and the aging of the population, drive faster projected growth in health spending in 2014 and beyond. Expected growth for 2014 is 6.1 percent, with an average projected growth of 6.2 percent per year thereafter. Over the 2012-22 period, national health spending is projected to grow at an average annual rate of 5.8 percent. By 2022 health spending financed by federal, state, and local governments is projected to account for 49 percent of national health spending and to reach a total of $2.4 trillion.

  4. To eliminate the financing demand of catastrophic medical expenditure and its effect on poverty reduction%消除灾难性医疗支出的筹资需求及其减贫效果测算

    Institute of Scientific and Technical Information of China (English)

    王钦池

    2016-01-01

    基于国际和国内贫困标准线和不同灾难性医疗支出的界定标准,利用中国家庭追踪调查数据,测算消除CHE筹资需求及其减贫效果。结果显示,消除CHE对减贫具有显著效果,筹资需求取决于贫困标准和CHE标准的设定等因素;从筹资需求角度看,以消除贫困家庭的CHE为扶贫目标具有较强可行性。%Based on the international and domestic poverty standards line and different defined criteria of catastrophic medical expenses (CHE), this paper aimed to calculate the elimination of CHE financing demands and its poverty reduction effect using the data from Chinese family tracking survey. The results show that CHE eliminating has significant effect on poverty reduction; the financing demand depends on the standard of poverty and CHE standard setting and other factors; it has a strong feasibility to make eliminating CHE in poor families as the goal of poverty alleviation.

  5. Physical Activity, Energy Expenditure, Nutritional Habits, Quality of Sleep and Stress Levels in Shift-Working Health Care Personnel

    Science.gov (United States)

    Vogt, Lena Johanna; Gärtner, Simone; Hannich, Hans Joachim; Steveling, Antje; Lerch, Markus M.

    2017-01-01

    Background Among health care personnel working regular hours or rotating shifts can affect parameters of general health and nutrition. We have investigated physical activity, sleep quality, metabolic activity and stress levels in health care workers from both groups. Methods We prospectively recruited 46 volunteer participants from the workforce of a University Medical Department of which 23 worked in rotating shifts (all nursing) and 21 non-shift regular hours (10 nursing, 13 clerical staff). All were investigated over 7 days by multisensory accelerometer (SenseWear Bodymedia® armband) and kept a detailed food diary. Physical activity and resting energy expenditure (REE) were measured in metabolic equivalents of task (METs). Quality of sleep was assessed as Pittsburgh Sleeping Quality Index and stress load using the Trier Inventory for Chronic Stress questionnaire (TICS). Results No significant differences were found for overall physical activity, steps per minute, time of exceeding the 3 METs level or sleep quality. A significant difference for physical activity during working hours was found between shift-workers vs. non-shift-workers (ppersonnel (median = 1.5 METs SE = 0.07, p<0.05). Non-shift-working nurses had a significantly lower REE than the other groups (p<0.05). The proportion of fat in the diet was significantly higher (p<0.05) in the office worker group (median = 42% SE = 1.2) whereas shift-working nurses consumed significantly more carbohydrates (median = 46% SE = 1.4) than clerical staff (median = 41% SE = 1.7). Stress assessment by TICS confirmed a significantly higher level of social overload in the shift working group (p<0.05). Conclusion In this prospective cohort study shift-working had no influence on overall physical activity. Lower physical activity during working hours appears to be compensated for during off-hours. Differences in nutritional habits and stress load warrant larger scale trials to determine the effect on implicit health

  6. Constraining National Health Care Expenditures. Achieving Quality Care at an Affordable Cost.

    Science.gov (United States)

    1985-09-30

    performed on an outpatient basis. Such procedures include dilatation and curettage tubal ligations , tonsillectomies, and herniarepairs.147 Medicare...example, the commission concluded that a healthy Down’s syndrome child whose life is in danger from a surgically correctable condition should receive the...for post -hospital nursing home and home health care may increase. HHS has predicted that the number of persons qualifying for the Medicare skilled

  7. 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

  8. 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.

  9. 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.

  10. Total HIV/AIDS expenditures in Dehong Prefecture, Yunnan province in 2010: the first systematic evaluation of both health and non-health related HIV/AIDS expenditures in China.

    Directory of Open Access Journals (Sweden)

    Duo Shan

    Full Text Available We assessed HIV/AIDS expenditures in Dehong Prefecture, Yunnan Province, one of the highest prevalence regions in China, and describe funding sources and spending for different categories of HIV-related interventions and at-risk populations.2010 HIV/AIDS expenditures in Dehong Prefecture were evaluated based on UNAIDS' National AIDS Spending Assessment methodology.Nearly 93% of total expenditures for HIV/AIDS was contributed by public sources. Of total expenditures, 52.7% was allocated to treatment and care, 24.5% to program management and administration and 19.8% to prevention. Spending on treatment and care was primarily allocated to the treatment of opportunistic infections. Most (40.4% prevention spending was concentrated on most-at-risk populations, injection drug users (IDUs, sex workers, and men who have sex with men (MSM, with 5.5% allocated to voluntary counseling and testing. Prevention funding allocated for MSM, partners of people living with HIV and prisoners and other confined populations was low compared to the disproportionate burden of HIV/AIDS in these populations. Overall, people living with HIV accounted for 57.57% of total expenditures, while most-at-risk populations accounted for only 7.99%.Our study demonstrated the applicability of NASA for tracking and assessing HIV expenditure in the context of China, it proved to be a useful tool in understanding national HIV/AIDS response from financial aspect, and to assess the extent to which HIV expenditure matches epidemic patterns. Limited funding for primary prevention and prevention for MSM, prisoners and partners of people living with HIV, signal that resource allocation to these key areas must be strengthened. Comprehensive analyses of regional and national funding strategies are needed to inform more equitable, effective and cost-effective HIV/AIDS resource allocation.

  11. 公共支出减损巨灾影响的理论与政策研究——兼谈促进巨灾保险事业发展的财政政策%Theory and policy on reduction of catastrophic loss by public expenditure: and taking about financial policy on promoting development of catastrophic insurance cause

    Institute of Scientific and Technical Information of China (English)

    李冲; 朱军

    2011-01-01

    In recent decades, with continuous economic development and population increase, global natural disasters are frequent and serious, incidents of human-induced damage is also increasing. In this regard, the paper discusses theoretically the economic impact, and social loss of catastrophe. On this basis, the paper presents a policy on finance and tax from public finantial viewpoint to promote development of catastrophy in surance cause.%近儿十年来,随着经济的发展和人口的增加,全球自然灾害越来越频繁,也越来越严重,人为导致的突发事件造成的损害也越来越大.对此,从理论上探讨了巨灾出现的经济影响,并从实际出发分析了巨灾造成的社会损失.在此基础上,从公共财政的角度提出了减灾的财税政策,及促进巨灾保险事业发展的财税措施.

  12. Social Welfare Expenditures and Infant Mortality.

    Science.gov (United States)

    Shim, Joyce

    2015-01-01

    This study examines the effects of social welfare expenditures on infant mortality (deaths younger than age 1 per 1,000 live births) across 19 Organisation for Economic Co-operation and Development (OECD) countries from 1980 to 2010. Data are obtained from various sources including the OECD, World Health Organization, and World Bank. The findings indicate that among three social welfare expenditure measures for families, the expenditures on family cash allowances are predicted to reduce infant mortality. However, the other two measures-the expenditures on parental and maternity leave and expenditures on family services-have no significant effects on infant mortality.

  13. 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.

  14. 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...

  15. 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.

  16. Equity and accessibility in health? Out-of-pocket expenditures on health care in middle income countries: evidence from Mexico

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    Full Text Available This study analyzes the results of a cross-sectional survey which set out to determine the costs to patients of searching for and receiving health care in public and private institutions. The information analyzed was obtained from the study population of the Mexican National Health Survey. The dependent variable was the out-of-pocket users' costs and the independent variables were the insurance conditions, type of institution and income. The empirical findings suggest that there is a need for a more detailed analysis of user costs in middle income countries in general, where the health system is based on social security, public assistance and private institutions. This study shows that the out of pocket costs faced by users are inequitable and fall disproportionately upon socially and economically marginalized populations.

  17. 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

  18. 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.

  19. 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.

  20. Publicly funded medical savings accounts: expenditure and distributional impacts in Ontario, Canada.

    Science.gov (United States)

    Hurley, Jeremiah; Guindon, G Emmanuel; Rynard, Vicki; Morgan, Steve

    2008-10-01

    This paper presents the findings from simulations of the introduction of publicly funded medical savings accounts (MSAs) in the province of Ontario, Canada. The analysis exploits a unique data set linking population-based health survey information with individual-level information on all physician services and hospital services utilization over a four-year period. The analysis provides greater detail along three dimensions than have previous analyses: (1) the distributional impacts of publicly funded MSAs across individuals of differing health statuses, incomes, ages, and current expenditures; (2) the impact of differing degrees of risk adjustment for MSA contributions; and (3) the impact of MSA funding over multiple years, incorporating year-to-year variation in spending at the individual level. In addition, it analyses more plausible designs for publicly funded MSAs than the existing studies. Government uses information available from year t - 1 to allocate its budget for year t in a manner that is ex ante fiscally neutral for the public sector: the government first withholds funds equal to expected catastrophic insurance payments under the MSA plan, and then allocates only the balance to individual MSA accounts. The government captures the savings associated with reduced health-care utilization under MSAs and we examine deductibles that vary by income rather than by current health-care expenditures. The impacts on public expenditures under these designs are more modest than in the previous studies and under plausible assumptions MSAs are predicted to decrease public expenditures. MSAs, however, are also predicted to have unavoidable negative distributional consequences with respect to both public expenditures and out-of-pocket spending.

  1. 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,...

  2. 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.

  3. 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.

  4. 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。

  5. [The abdominal catastrophe].

    Science.gov (United States)

    Seiler, Christian A

    2011-08-01

    Patients with an abdominal catastrophe are in urgent need of early, interdisciplinary medical help. The treatment plan should be based on medical priorities and clear leadership. First priority should be given to achieve optimal oxygenation of blood and stabilization of circulation during all treatment-phases. The sicker the patient, the less invasive the (surgical) treatment should to be, which means "damage control only". This short article describes 7 important, pragmatic rules that will help to increase the survival of a patient with an abdominal catastrophe. Preexisting morbidity and risk factors must be included in the overall risk-evaluation for every therapeutic intervention. The challenge in patients with an abdominal catastrophe is to carefully balance the therapeutic stress and the existing resistance of the individual patient. The best way to avoid abdominal disaster, however, is its prevention.

  6. Assessing the inequality of lifetime healthcare expenditures

    NARCIS (Netherlands)

    Wong, Albert; Boshuizen, Hendriek; Polder, Johan; Ferreira, José António

    2016-01-01

    The rise in healthcare expenditures has raised doubts about the sustainability of health systems and instigated a discussion on their design. Policy making in this field requires a proper understanding of how healthcare expenditures evolve throughout an individual's lifetime, and of how they vary

  7. The Ongoing Catastrophe

    DEFF Research Database (Denmark)

    Kublitz, Anja

    2015-01-01

    were expelled from their homeland. However, according to my interlocutors, al-Nakba never stopped, but continues in the present. To understand this phenomenon, I suggest that it is conducive to think of al-Nakba as a reverse national myth, a figure of un-becoming, which is replicated in the present. I...... argue that, unlike the spectacular catastrophes in Palestine and later in Lebanon, life in the Danish camps is characterized by minor mundane catastrophes that are each so small that they barely register or elicit a moral response, but nevertheless erode the lives of my interlocutors....

  8. Pro–poor pathway towards universal health coverage: lessons from Ethiopia

    Directory of Open Access Journals (Sweden)

    Kesetebirhan Admasu

    2016-06-01

    Full Text Available Protection from care–related catastrophic expenditures through equitable access to affordable health services is the hallmark of a pro–poor health policy. Over the past two decades, the Government of Ethiopia has implemented policies with a clear intent of reducing poverty and improving the daily lives of its citizens, especially the poor. Guided by these cross cutting pro– poor government policies and spurred by the United Nations Millennium Development Goals (MDGs, the health sector has implemented multi–pronged initiatives towards ensuring every citizen an access to affordable health services without catastrophic expenditures. The health sector initiatives have been guided by evolution of the innovative health programs nationally introduced as well as the needs of the community in each village across the country. Primary focus on the poor and ownership of new health initiatives by the community have been the linchpin for investment at scale.

  9. Accounting and Analysis on Public Health Expenditures in County-Level Maternal and Child Health Care Centers%县级妇幼保健院公共卫生费用核算与分析

    Institute of Scientific and Technical Information of China (English)

    吕丽丽; 刘国祥; 黄卫东; 高熹; 刘加卓

    2013-01-01

    Objective: Through accounting and analyzing public health expenditures of county-level maternal and child health care centers(MCHCC), to provide government scientific references for making the maternal and child health policies. Methods:The functional approach of health care accounting methods is used to account the public health expenditures. Results: The connotation and scale of public health services of county-level MCHCC are defined, and the items and contents of public health services are presented; the public health expenditures of county-level MCHCC were calculated and analyzed. Conclusion:The government financial input on public health care should be clear and enough; the government should implement the compensation mechanism to eliminate the phenomenon that MCHCC “put more emphasis on medical treatment than prevention disease” .%目的:通过核算与分析县级妇幼保健院公共卫生费用,为政府制定妇幼卫生政策提供科学依据。方法:采用卫生费用核算方法中的功能法进行公共卫生费用核算。结果:界定了县级妇幼保健院公共卫生服务项目内涵和外延,并确定了其分类及内容;进行了县级妇幼保健院公共卫生费用核算及分析。结论:政府在公共卫生服务方面的拨款应该做到用途清晰且足额拨付;政府应该尽快完善补偿机制,彻底根除妇幼保健院“重治轻防”的现象。

  10. 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... increases or decreases the unadjusted trigger level described in § 403.750(d). In no case may the...

  11. 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...

  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. 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...

  14. 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...

  15. 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.

  16. [Catastrophic antiphospholipid syndrome].

    Science.gov (United States)

    Wisłowska, Małgorzata

    2015-01-01

    Catastrophic antiphospholipid syndrome is the most dangerous form of the antiphospholipid syndrome, which is characterized by rapid onset of thrombosis in small vessels of many organs and intravascular coagulation, thrombocytopenia and hemolytic anemia. The syndrome develops over a short period of time with acute multi-organ failure, including kidney, respiratory, cardiovascular, central nervous system and adrenal glands, often associated with disseminated thrombotic microangiopathy. The catastrophic antiphospholipid syndrome involves three or more systems, organs and/or tissues, the development of symptoms must occur within less than one week, it is necessary to confirm the histopathological vascular occlusion in at least one organ or tissue, and laboratory confirmation of the presence of antiphospholipid antibodies in the serum on two occasions over an interval of 12 weeks. This syndrome is characterized by a high mortality despite the use of optimal treatment. Early diagnosis and aggressive treatment of patients with catastrophic antiphospholipid syndrome is essential to save the life of these patients. In the last 10 years, the mortality in this disease decreased from 50% to 30% with simultaneous treatment with anticoagulants, corticosteroids, plasmapheresis and immunoglobulins.

  17. Financial protection in health: updates for Mexico to 2014

    Directory of Open Access Journals (Sweden)

    Felicia Marie Knaul

    2016-05-01

    Full Text Available Objetive. Document financial protection in health in Mexico up to 2014. Materials and methods. We update the measures of impoverishing and catastrophic health expenditure to 2014, to analyse shifts since the implementation of the System for Social Protection in Health and the Seguro Popular using time series data from the Household Income and Expenditure Survey. Results. Between 2004 and 2014 there has been a continued improvement in levels of financial protection. Excessive expenditure reached its lowest point: –2.0% in 2012 and 2.1% in 2014. Impoverishing expenditure dropped to 1.3% in 2004, compared to 0.5% in 2014, and catastrophic expenditures from 2.7% to 2.1%. Conclusions. The time series of data on financial protection show a clear pattern of improvement between 2000 and 2014 and level off and low levels in 2012 and 2014. Still, levels continue to be relatively high for households in the poorest quintile, in rural areas and with an elderly person.

  18. Grau de cobertura dos planos de saúde e distribuição regional do gasto público em saúde Level of private health insurance coverage and regional distribution of public health expenditure

    Directory of Open Access Journals (Sweden)

    Samuel Kilsztajn

    2001-12-01

    Full Text Available O artigo analisa o grau de cobertura dos planos de saúde segundo as classes de rendimento mensal familiar e por unidade da federação e a distribuição dos recursos da Rede-SUS e do gasto público total em saúde por usuário dos serviços públicos de saúde nas regiões Norte-Nordeste e Centro-Sul do país. São apresentados e discutidos também os indicadores do gasto público total em saúde como percentual do PIB gerado nas regiões.This paper analyses the level of private health insurance coverage by classes of income and by states in Brazil and the distribution of the total public health expenditure by public health users in the North-Northeast and Central-South regions of the country. The paper also presents and discusses the total public health expenditure as a percentage of regional GDP.

  19. “金砖五国”医疗资源与卫生费用比较分析%A Comparative Analysis of the BRICs Health Resources and Health Expenditure

    Institute of Scientific and Technical Information of China (English)

    邓峰; 吕菊红; 高建民; 安海燕

    2014-01-01

    目的:比较分析金砖国家医疗资源与卫生费用相关情况,以期对我国目前正在深化的医改工作提供有益借鉴。方法:通过数据分析、查阅文献等方法进行。结果:我国医疗资源在“金砖五国”中处于中等水平,但人均医院床位数相对偏高;卫生总费用、卫生总费用和人均卫生费用增速均位列五国之首;卫生总费用占GDP比重偏低,且增速较慢;政府卫生总支出占卫生总费用比重提高较快。结论:中国应在加大卫生投入基础上,调整医疗资源结构,转变卫生服务模式,预防优先,医防合作,健全人才培养、服务补偿以及绩效考评等机制,重视体制创新,重视科技支撑,努力打造中国医改升级版,为实现全面小康和中国梦提供坚实保障。%Objective: A comparative analysis was conducted on the BRICS medical resources associated with health costs, to provide useful references to the currently deepening reform work. Methods: Data analysis and Literature study were used. Results:Chinese medical resources were in the middle level in the BRICs, but per capita hospital beds were relatively high; the total health expenditure, total health expenditure and health expenditure per capita growth rate ranked the first; the total health expenditure accounted for a low proportion of GDP, and the growth rate was slow;the government health expenditure accounted for the proportion of total health expenses increase was rapidly. Conclusion: On the basis of increasing health investment, China should adjust the structure of medical resources, change the health service model, take the preference for prevention, cure and prevention cooperation, implementing the mechanism of personnel training, compensation and performance appraisal system, focus on the system innovation, pay attention to the support of science and technology, strive to build upgraded version of China’s health care reform and

  20. 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 Section 403.750 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...-Benefits, Conditions of Participation, and Payment § 403.750 Estimate of expenditures and adjustments....

  1. 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

  2. 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...

  3. 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

  4. 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...

  5. 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

  6. 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

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

    OpenAIRE

    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...

  8. El gasto en salud relacionado con la condición de discapacidad: un análisis en población pobre de México Health expenditure related to disability: a study with poor population in Mexico

    Directory of Open Access Journals (Sweden)

    José E Urquieta-Salomón

    2008-04-01

    Full Text Available OBJETIVO: Estimar la relación entre discapacidad y gasto en salud en hogares pobres urbanos de México. MATERIAL Y MÉTODOS: Con la Encuesta de Evaluación Urbana 2002 del Programa Oportunidades se identificaron hogares donde había personas con discapacidad estructural o con alguna limitación de actividades por enfermedad, y se estimó el gasto en salud ambulatorio y hospitalario. RESULTADOS: De 15314 hogares estudiados, 10.1% incluyó a personas con discapacidad estructural y 13.4% con limitación de actividades moderada o grave. La discapacidad estructural en el hogar no se asoció con un mayor gasto en salud. Hogares donde había personas con limitaciones graves o moderadas para realizar sus actividades gastaron 97% más en atención ambulatoria que los hogares sin personas incapacitadas. Los hogares más pobres gastan más en atención médica que los hogares menos pobres. CONCLUSIONES: Los resultados indican que la incapacidad para desarrollar actividades diarias tiene un importante efecto sobre el gasto de bolsillo, sobre todo en los hogares más pobres.OBJECTIVE: To estimate the effect of disability and incapacity in health expenditure in poor households in Mexico. MATERIAL AND METHODS: This is an analysis of baseline survey of the Oportunidades evaluation. Households with siblings with structural disability or incapacity were identified, and health expenditure was estimated. RESULTS: In 15314 households analyzed, 10.1% had a sibling with structural disability, and 13.4% with mild or severe incapacity. The presence of structural disability was not associated with a higher expenditure in health care. The presence of mild or severe incapacity was associated with 97% higher expenditure in ambulatory care compared with households without incapacity. The poor households have higher health related expenditures. CONCLUSIONS: These results indicate that the incapacity to develop day to day activities has a significant impact on the out of

  9. 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].

  10. 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

  11. 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。

  12. 某市社区居民口腔医疗服务费用分析%An analysis of the oral health care expenditure of residents in a city

    Institute of Scientific and Technical Information of China (English)

    秦建勇

    2012-01-01

    Objective To analyze the dental care expenditure of residents in Dongying of Shandong. Methods 12 860 people were selected by cluster random sampling,and the data of dental care expenditure were collected by using self made survey ques tionnaire. The expenditure of different community with different social and economic background were analyzed, and the influential factors of dental care expenditure were analyzed by Multivariate analysis. Results The number of the people who visited a dentist in a year were small but the expenditure for oral health care per visit were quite high. There were differences on the expenditure a mong those with different demographic, social, economic backgrounds. Multivariate analysis showed that educational background, toothache, income, 30 ?64 years old or not, dental prosthetics, more than 65 years old, deposit, business services and doctor and teacher were the most influencing factors of dental care expenditure. Conclusion The research will provide some references for the revision of dental medical insurance system and the forecast of dental medical service expenses.%目的 调查该市社区居民口腔医疗服务费用情况.方法 采用随机抽样法,自制调查问卷对该市12 860名社区居民口腔医疗服务费用情况进行调查,对不同人口社会经济特征的社区居民的疗效费进行分析,采用单因素Logistic回归对影响口腔医疗服务费用的因素进行分析.结果 社区居民就诊率较低,但是次均费用较高.不同人口社会经济学特征的居民口腔医疗费用具有显著差异.文化程度、是否牙痛、收入、是否30~64岁、是否镶牙、是否大于64岁、储蓄、是否商业服务和是否医生或教师是影响口腔医疗费用的关键因素.结论 为该市口腔医疗保障制度及口腔医疗卫生服务费用预测提供一定的参考依据.

  13. Energy Expenditure and Intake Methods

    NARCIS (Netherlands)

    Westerterp, K.R.

    2015-01-01

    The main components of total energy expenditure are energy expenditure for maintenance or basal metabolic rate, the thermic effect of food or diet-induced energy expenditure (DEE), and the energy cost of physical activity or activity-induced energy expenditure (AEE). This chapter describes methods t

  14. Prescripción, acceso y gasto en medicamentos entre usuarios de servicios de salud en México Medical prescription, drug access and drug expenditure among health service users in Mexico

    Directory of Open Access Journals (Sweden)

    RENÉ LEYVA-FLORES

    1998-01-01

    Full Text Available Objetivo. Analizar la prescripción, el acceso y el gasto en medicamentos entre usuarios de servicios de salud a partir de la Encuesta Nacional de Salud en México, 1994. Material y métodos. Se realizó un análisis descriptivo del acceso y gasto en medicamentos, y se identificaron factores relacionados con la prescripción mediante una regresión logística en 3 324 usuarios. Resultados. El 78% de usuarios recibieron prescripción de medicamentos. El 92% de los usuarios de la seguridad social y 35% de la Secretaría de Salud obtuvieron los medicamentos sin pago directo (p =0.000. La región con mayor índice de pobreza presentó menor acceso gratuito a los medicamentos. Entre los usuarios que gastaron en medicamentos, la mediana del gasto fue de 40.00 pesos (12.50 dólares, lo que resultó mayor en instituciones privadas que en públicas. Conclusiones. El acceso y el gasto en medicamentos se encuentran relacionados con las características socioeconómicas de los grupos de población y con las instituciones donde estos últimos se atendieron. Lograr mayor equidad en el acceso a medicamentos representa uno de los retos del sistema de salud en México.Objective. To analyze the medical prescription, drug access and drug expenditure by patients based on the National Health Survey in Mexico, 1994. Materials and methods. A descriptive analysis of drug access and expenditure was undertaken and predictive factors for medical prescription were identified by logistic regression for 3 324 patients. Results. 78% of the patients received drug prescriptions. 92% of the Social Security patients and 35% of the Ministry of Health patients received drugs free of charge (p =0.000. The region with the highest poverty index received the least amount of drugs free of charge. Regarding drug expenditure of patients who purchased drugs, median expenditure was 40.00 pesos (12.50 USD. Private health service patients spent significantly more than public health service

  15. 我国政府医疗卫生支出相对不足的计量检验%Econometric Test on the Government Health Expenditure Relative Deficiency in China

    Institute of Scientific and Technical Information of China (English)

    徐晓飞; 杨卫华

    2014-01-01

    Along with the gradual vanishing demographic dividend , China is faced with the challenge of serious popula-tion aging .The aggravated population aging will require medical and health service support services .Using the panel da-ta of 1997-2011 China′s 31 regions and the system GMM dynamic panel estimation method estimates the relationship between the population aging and government health expenditure .Through the analysis we can see that the government health expenditure is relatively insufficient , can not fully meet the needs of the aging population .The introduction of pub-lic-private partnerships not only can make up for the lack of government health expenditure , but also can make the pop-ulation aging supporting service system more perfect .%伴随着人口红利的逐步消逝,我国面临着严重的人口老龄化挑战。人口老龄化的加剧必然要求医疗卫生服务的进一步完善。本文运用1997-2011年我国31个地区的面板数据,采用系统GMM动态面板估计方法对人口老龄化与政府医疗卫生支出的关系进行估计,发现我国应对人口老龄化的政府医疗卫生支出相对不足,不能完全满足老龄人口的需要,而引入公私伙伴关系不仅可以弥补政府医疗卫生支出的不足,而且能够使人口老龄化的配套服务体系更加完善。

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

    Science.gov (United States)

    Shimura, Tsutomu; Yamaguchi, Ichiro; Terada, Hiroshi; Okuda, Kengo; Svendsen, Erik Robert; Kunugita, Naoki

    2015-05-01

    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 deaths 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 diseases. 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.

  17. 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

  18. Catastrophizing and perceived partner responses to pain.

    Science.gov (United States)

    Boothby, Jennifer L; Thorn, Beverly E; Overduin, Lorraine Y; Ward, L Charles

    2004-06-01

    This study examined the relationship between catastrophizing and patient-perceived partner responses to pain behaviors. The Catastrophizing subscale of the Cognitive Coping Strategy Inventory and the West Haven-Yale Multidimensional Pain Inventory were completed by 62 adult chronic pain patients. Consistent with past research, catastrophizing and patient-perceived solicitous partner behaviors were positively correlated with negative pain outcomes. The communal coping theory of catastrophizing suggests that catastrophizing might be undertaken to solicit support and empathy from others. However, catastrophizing was not related to perceived solicitous partner behavior in this study. Rather, catastrophizing was associated with perceived punishing partner responses. Implications are that catastrophizing and perceived solicitous partner behaviors are independently associated with pain and that catastrophizing may not be reinforced by empathy from significant others.

  19. Student Service Expenditures Matter

    Science.gov (United States)

    Ehrenberg, Ronald G.; Webber, Douglas A.

    2010-01-01

    The "Great Recession" has caused a fiscal crisis in both public and private higher education that is unmatched in recent memory. Institutions' attention is focused on what they can cut out of their budgets. Student-service expenditures are often seen as discretionary in institutional budgets; they are viewed by some critics as…

  20. Accounting and Analysis on Public Health Expenditures in County-Level Centers for Disease Control%县级疾病控制机构公共卫生费用核算与分析

    Institute of Scientific and Technical Information of China (English)

    高熹; 刘国祥; 张歆; 吕丽丽; 刘加卓

    2013-01-01

    目的:通过核算与分析县级疾病控制机构公共卫生费用,为政府制定和完善公共卫生政策提供科学依据。方法:采用卫生费用核算方法中的功能法进行公共卫生费用核算。结果:界定了县级疾病控制机构公共卫生服务项目内涵和外延,并确定了其分类及内容;进行了县级疾病控制机构公共卫生费用核算及分析。结论:完善财政补偿机制,增加财政投入;合理调整财政投入结构,确保基本公共卫生服务的提供质量;加强政府监管,调整县级疾病控制机构的工作重点。%Objective: Through accounting and analyzing public health expenditures of county-level centers for disease control (CDC), to provide government scientific references for making and implementing public health policies. Methods: The functional approach of health care accounting methods is used to account the public health expenditures. Results: The connotation and scale of public health care activities of county-level CDC are defined, and the items and contents of public health services are presented; the public health expenditures of county-level CDC were calculated and analyzed. Conclusion: The compensation mechanism should be perfected, and the financial investment in public health needs to be raised;the structure of financial input ought to be rationally adjusted so as to guarantee the basic public health services quality, and government supervision needs to be strengthened to adjust the key projects of county-level CDC.

  1. 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.

  2. Guidance for Catastrophic Emergency Situations Involving Asbestos

    Science.gov (United States)

    This document addresses the types of asbestos issues that may arise during catastrophic events and how EPA has addressed such issues. It replaces the Guidelines for Catastrophic Emergency Situations Involving Asbestos which was issued in 1992.

  3. 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

  4. 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

  5. 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.

  6. Energy expenditure in caving.

    Science.gov (United States)

    Antoni, Giorgia; Marini, Elisabetta; Curreli, Nicoletta; Tuveri, Valerio; Comandini, Ornella; Cabras, Stefano; Gabba, Silvia; Madeddu, Clelia; Crisafulli, Antonio; Rinaldi, Andrea C

    2017-01-01

    The aim of this study was to determine the energy expenditure of a group of cavers of both genders and different ages and experience during a 10 hour subterranean exploration, using portable metabolimeters. The impact of caving activity on body composition and hydration were also assessed through bioelectrical impedance, and nutritional habits of cavers surveyed. During cave activity, measured total energy expenditure (TEE) was in the range 225-287 kcal/h for women-men (MET = 4.1), respectively; subjects had an energy intake from food in the range 1000-1200 kcal, thus inadequate to restore lost calories. Bayesian statistical analysis estimated the effect of predictive variables on TEE, revealing that experienced subjects had a 5% lower TEE than the less skilled ones and that women required a comparatively larger energy expenditure than men to perform the same task. BIVA (bioelectrical impedance vector analysis) showed that subjects were within the range of normal hydration before and after cave activity, but bioelectrical changes indicated a reduction of extracellular water in men, which might result in hypo-osmolal dehydration in the case of prolonged underground exercise. All these facts should be considered when planning cave explorations, preparing training programs for subjects practising caving, and optimizing a diet for cavers. Further, information gathered through this study could be of value to reduce accidents in caves related to increase in fatigue.

  7. 5. Nonmalignant diseases after the Chernobyl catastrophe.

    Science.gov (United States)

    Yablokov, Alexey V

    2009-11-01

    This section describes the spectrum and the scale of the nonmalignant diseases that have been found among exposed populations. Adverse effects as a result of Chernobyl irradiation have been found in every group that has been studied. Brain damage has been found in individuals directly exposed--liquidators and those living in the contaminated territories, as well as in their offspring. Premature cataracts; tooth and mouth abnormalities; and blood, lymphatic, heart, lung, gastrointestinal, urologic, bone, and skin diseases afflict and impair people, young and old alike. Endocrine dysfunction, particularly thyroid disease, is far more common than might be expected, with some 1,000 cases of thyroid dysfunction for every case of thyroid cancer, a marked increase after the catastrophe. There are genetic damage and birth defects especially in children of liquidators and in children born in areas with high levels of radioisotope contamination. Immunological abnormalities and increases in viral, bacterial, and parasitic diseases are rife among individuals in the heavily contaminated areas. For more than 20 years, overall morbidity has remained high in those exposed to the irradiation released by Chernobyl. One cannot give credence to the explanation that these numbers are due solely to socioeconomic factors. The negative health consequences of the catastrophe are amply documented in this chapter and concern millions of people.

  8. 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.

  9. The impact of population ageing on future Danish drug expenditure

    DEFF Research Database (Denmark)

    Kildemoes, Helle Wallach

    Background Population ageing is likely to place an increasing burden on future health care budgets. Several studies have demonstrated that the impact of ageing on future hospital expenditures will be overestimated when not accounting for proximity to death. This is because greater health care...... expenditure among the elderly partly is due the high "costs of dying". Aims The aim of this study was to estimate the impact of the ageing Danish population on future total expenditures on out-of-hospital prescription drugs and to describe the association between age and drug expenditure among survivors...... compared to that of decedents. Methods Taking expenditure during the last year of life and the changes in mortality rates into account, future drug expenditure was projected by multiplying estimated mean annual drug expenditure according to age, gender and survival status by the predicted future number...

  10. 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

  11. An Expenditure Analysis of the Maternal and Child Health Poverty Alleviation Fund Services in China%世界银行-云南省妇幼卫生扶贫资金服务费用案例分析

    Institute of Scientific and Technical Information of China (English)

    唐松源; 柴本福; 胡守敬; 卢韬; 江汀

    2001-01-01

    An expenditure analysis for hospital delivery at different health settings has been utilized in the Maternal and Child Health Poverty Alleviation Fund (MCHPAF) project. The result reveals that: (1)There is high gap of hospital service expenditure per case among county and town-ship (town) health settings; (2)Treatment fee and drug fee are the two major components contributed to the whole expenditure; (3)The extra feepaid by clients for county hospital service is higher than the ene for township(town) hospital service.%对世界银行-妇幼卫生扶贫资金项目提供的特困高危孕产妇住院分娩服务的实际费用、例均费用、费用构成以及不同医疗卫生机构的服务费用等方面进行了较为深入的比较、分析。分析结果表明:(1)南华、南涧县特困高危孕产妇在不同医疗卫生机构住院分娩的例均费用相差较大,其补助比例相差也较大;(2)治疗费、针药费是构成2县特困高危孕产妇住院分娩服务费用的主要分项费用,且不同医疗卫生机构的这两项费用占总费用的比例存在较大的差异;(3)两县特困高危孕产妇在县级卫生机构住院分娩需自付的费用远高于在乡(镇)卫生院住院分娩的费用。

  12. 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

    2016-02-08

    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.

  13. Assessing the effect of the 2001-06 Mexican health reform: an interim report card.

    Science.gov (United States)

    Gakidou, Emmanuela; Lozano, Rafael; González-Pier, Eduardo; Abbott-Klafter, Jesse; Barofsky, Jeremy T; Bryson-Cahn, Chloe; Feehan, Dennis M; Lee, Diana K; Hernández-Llamas, Hector; Murray, Christopher J L

    2006-11-25

    Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over 7 years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, we used a wide range of datasets to assess the effect of this reform on different dimensions of the health system. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affiliates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.

  14. [Assessing the effect of the 2001-06 Mexican health reform: an interim report card].

    Science.gov (United States)

    Gakidou, Emmanuela; Lozano, Rafael; González-Pier, Eduardo; Abbott-Klafter, Jesse; Barofsky, Jeremy T; Bryson-Cahn, Chloe; Feehan, Dennis M; Lee, Diana K; Hernández-Llamas, Héctor; Murray, Christopher J L

    2007-01-01

    Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over seven years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, a wide range of datasets to assess the effect of this reform on different dimensions of the health system was used. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affilates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.

  15. 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......” within the realm of public climate change communication. For that reason, the essay centers on the interplay between news media and entertainment. It argues that blockbuster disaster films represent an inversion of traditional risk and disaster news....

  16. Is Geothermal Simulation a "Catastrophe"?

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, V.V.; Pinder, George F.

    1980-12-16

    All numerical simulators of geothermal reservoirs depend upon an accurate representation of the thermodynamics of steam-water systems. These relationships are required to render tractable the system of balance equations derived from the physics of flow through porous media. While it is generally recognized that the steam-water system (i.e. two phase) is not in thermodynamic equilibrium, equihbrium thermodynamics are employed in its description. In this paper, we present an alternative view based on non-equilibrium thermodynamics. The underpinnings of this approach are found in a branch of topology generally referred to as "catastrophe theory". [Thom, 1975

  17. 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.

  18. 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

  19. 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.

  20. Energy expenditure, nutrition and growth.

    Science.gov (United States)

    Wiskin, A E; Davies, J H; Wootton, S A; Beattie, R M

    2011-06-01

    Fundamental to appropriate nutritional prescription is an understanding of the conditions necessary for growth that include the requirements for energy in health and illness. Energy requirements need to be met by the dietary intake to prevent weight loss. A positive energy balance will result in weight gain. Energy requirement includes several components; the largest is the basal metabolic rate, although physical activity level and the energy needs of growth are important components. All aspects of energy metabolism are likely to be influenced by illness and impact on energy balance. Changes in dietary intake and physical activity are observed clinically but poorly described in most childhood illnesses. Changes in metabolic rate are poorly described in part owing to methodological problems. This review explores changes in energy expenditure associated with health and disease, highlights the lack of evidence underpinning this aspect of practical nutritional support and provides the clinician with a guide to the factors involved in estimating energy requirements, emphasising the importance of measuring the child's response to nutritional support.

  1. 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...

  2. 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...

  3. 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.

  4. 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...

  5. 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.

  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. Catastrophic Disruption of Comet ISON

    Science.gov (United States)

    Keane, Jacqueline V.; Milam, Stefanie N.; Coulson, Iain M.; Kleyna, Jan T.; Sekanina, Zdenek; Kracht, Rainer; Riesen, Timm-Emmanuel; Meech, Karen J.; Charnley, Steven B.

    2016-01-01

    We report submillimeter 450 and 850 microns dust continuum observations for comet C/2012 S1 (ISON) obtained at heliocentric distances 0.31-0.08 au prior to perihelion on 2013 November 28 (rh?=?0.0125 au). These observations reveal a rapidly varying dust environment in which the dust emission was initially point-like. As ISON approached perihelion, the continuum emission became an elongated dust column spread out over as much as 60? (greater than 10(exp 5) km in the anti-solar direction. Deconvolution of the November 28.04 850 microns image reveals numerous distinct clumps consistent with the catastrophic disruption of comet ISON, producing approximately 5.2?×?10(exp 10) kg of submillimeter-sized dust. Orbital computations suggest that the SCUBA-2 emission peak coincides with the comet's residual nucleus.

  8. 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...

  9. 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.

  10. 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.

  11. Does catastrophic thinking enhance oesophageal pain sensitivity?

    DEFF Research Database (Denmark)

    Martel, M O; Olesen, A E; Jørgensen, D;

    2016-01-01

    that catastrophic thinking exerts an influence on oesophageal pain sensitivity, but not necessarily on the magnitude of acid-induced oesophageal sensitization. WHAT DOES THIS STUDY ADD?: Catastrophizing is associated with heightened pain sensitivity in the oesophagus. This was substantiated by assessing responses...

  12. 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

  13. 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.

  14. Evaluación del gasto en la construcción de unidades de salud: ejemplo de participación comunitaria Expenditure evaluation of the construction of health units: example of community participation

    Directory of Open Access Journals (Sweden)

    José Antonio Tapia-Cruz

    2003-12-01

    ón con otros programas de construcción. Debe valorarse la viabilidad de emplear participación comunitaria en otras actividades normales de los servicios de salud.OBJECTIVE: Demonstrate the economic benefits that community participation may render in the construction of health units. MATERIALS AND METHODS: The purpose of this study was to analyze the efficiency in the construction of 21 auxiliary health units and 81 rural health built through the Program to Support the Development of Health Services for the Non-Insured Population (PASSPA through three different construction models (national public bidding, restricted invitation and community participation. Comparisons were also made with the units built through regular construction procedures of the Ministry of Health and other institutions. To evaluate the expenditure/m², a univariate analysis using non-parametric statistics and a mathematical model of bootstrapping were used. RESULTS: The median expenditure/m² and the delivery times for auxiliary health units, and the median expenditure/m² for rural health units were smaller when using community participation. The expenditure/m² of those units built through PASSPA was considerably lower than that of health units built through regular construction procedures. CONCLUSIONS: The use of community participation in the construction of auxiliary health units and rural health units may impact positively the resource investment and the delivery times when compared with units built through national public biddings and restricted invitations. The possibility of using community participation in other health activities (supervision, maintenance should be evaluated.

  15. 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.

  16. 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

  17. 中国糖尿病患者药品费用负担公平性和影响因素研究%Research on Equity and Influential Factors of Medicine Expenditure Affordability for Diabetes Patients in China

    Institute of Scientific and Technical Information of China (English)

    管晓东; 李晗; 信枭雄; 郭志刚; 马莉莉; 韩晟; 史录文

    2015-01-01

    目的:评价我国糖尿病患者治疗药品费用负担的公平性和影响因素。方法:对北京、江苏、黑龙江、四川和云南等地的居民进行问卷调查,采用灾难性支出评价法对我国糖尿病患者药品费用负担的公平性进行研究,运用Logistics回归方法分析导致陷入灾难性支出的影响因素。结果与结论:最贫困组陷入灾难性支出人口数量最多,占该组别总体人口数量的91%;最富裕组最少,占31.1%。陷入灾难性支出的影响因素有药品治疗费用、收入水平、教育程度和医保覆盖类型。中国糖尿病患者药品费用负担存在不公平性,需要继续推进医疗保障统一,加大报销力度,减少因病致贫和因病返贫。%Objective: To evaluate the equity and inlfuential factors of medicine expenditure affordability for diabetes.Methods: Based on questionnaire conducted in Beijing, Jiangsu, Heilongjiang, Sichuan and Yunnan, logistics regression is used to analyze factors which lead to catastrophic expenditures.Results and Conclusion:The poorest group shares the largest amount of people who are faced with catastrophic expenditures and occupy 91% of this group. The richest group only shares 31.1%. Thus, the factors inlfuencing catastrophic expenditures include medication cost, income level, education level and the type of insurance patients participate. The existence of inequity of diabetes medication affordability in China needs us to promote a united health care system. And authority should reinforce reimbursement to reduce poverty caused by illness.

  18. 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...

  19. PROFITABILITY OF INCREMENTAL EXPENDITURE ON FIBRE PROMOTION

    OpenAIRE

    Hill, Debbie J.; Piggott, Roley R.; Griffith, Garry R.

    1996-01-01

    In this paper the impact of changes in wool promotion expenditure and changes in expenditure on the promotion of competing fibres are examined using an equilibrium displacement model. The emphasis is on examining impacts on producer profits net of promotion expenditure and on benefit-cost ratios measuring changes in producer surplus relative to changes in promotion expenditure. It was found, for example, that incremental expenditure on apparel wool promotion on the domestic market is unprofit...

  20. Economic Analysis of the Public Expenditures in Norway: 2000-2013

    Directory of Open Access Journals (Sweden)

    Süleyman Dikmen

    2015-12-01

    Full Text Available AbstractIn this study, it is aimed to make an economic analysis of the public expenditures in Norway having a buoyant private sector, a robust public economy and a developed mixed economic system. The analyses encompasses the period of 2000-2013. In the study, public expenditures are examined considering the functional and economic classification of general government, central government and local administrations. It is determined that public expenditures in Norway follow a stabile course between 2000 and 2013, there is a settled fiscal structure, reforms are made in public administration for the quality of services released to the public to be increased, and the country is not affected from the global financial crisis. The perception of robust social state has a crucial share in public expenditures. In the period 2000-2013 expenditures for social protection, health and education constitute 68% of total expenditures on average. It is also seen that local administrations have a robust structure and in the aforementioned period they made 30% of the total expenditures on average. Keywords: Public Expenditures, Public Expenditures of Norway, Social ExpendituresJEL Classification Codes: H70, H72, H76

  1. 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.

  2. An explanatory model for state Medicaid per capita prescription drug expenditures.

    Science.gov (United States)

    Roy, Sanjoy; Madhavan, S Suresh

    2012-01-01

    Rising prescription drug expenditure is a growing concern for publicly funded drug benefit programs like Medicaid. To be able to contain drug expenditures in Medicaid, it is important that cause(s) for such increases are identified. This study attempts to establish an explanatory model for Medicaid prescription drugs expenditure based on the impacts of key influencers/predictors identified using a comprehensive framework of drug utilization. A modified Andersen's behavior model of health services utilization is employed to identify potential determinants of pharmaceutical expenditures in state Medicaid programs. Level of federal matching funds, access to primary care, severity of diseases, unemployment, and education levels were found to be key influencers of Medicaid prescription drug expenditure. Increases in all, except education levels, were found to result in increases in drug expenditures. Findings from this study could better inform intervention policies and cost-containment strategies for state Medicaid drug benefit programs.

  3. 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.

  4. Catastrophic antiphospholipid syndrome: task force report summary.

    Science.gov (United States)

    Cervera, R; Rodríguez-Pintó, I

    2014-10-01

    The Task Force on Catastrophic Antiphospholipid Syndrome (CAPS) aimed to assess the current knowledge on pathogenesis, clinical and laboratory features, diagnosis and classification, precipitating factors and treatment of CAPS. This article summarizes the main aspects of its final report.

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. Creating catastrophes in the classroom

    Science.gov (United States)

    Andersson, Thommy

    2013-04-01

    Buildings, infrastructure and human life are being destroyed by wind and landslides. To interest and motivate pupils and to help them understand abstract knowledge, a practical experiment could be useful. These experiments will show why strong winds circulate around tropical cyclones and how fluvial geological processes affect nature and communities. The experiments are easy to set up and the equipment is not expensive. Experiment 1: Exogenic processes of water are often slow processes. This experiment will simulate water processes that can take thousands of years, in less than 40 minutes. This experiment can be presented for and understood by pupils at all levels. Letting the pupils build up the scenery will make them more curious about the course of events. During that time they will see the geomorphological genesis of landforms such as landslides, sandurs, deltas, canyons sedimentations, selective erosions. Placing small houses, bridges etc. we can lead to discussions about natural catastrophes and community planning. Material needed for the experiment is a water bucket, erosion gutter, clay (simulating rock), sand and smaller pebbles (simulating the soil), houses of "Monopoly" size and tubes. By using a table with wheels it is easy to reuse the result for other lessons. Installation of a pump can make the experiment into a closed loop system. This installation can be used for presentations outside the classroom. Experiment 2: The Coriolis Effect explains why the wind (moving objects) deflects when moving. In the northern hemisphere the deflection is clockwise and anti-clockwise in the southern hemisphere. This abstract effect is often hard for upper secondary pupils to understand. This experiment will show the effect and thus make the theory real and visible. Material needed for this experiment is a bucket, pipes, a string. At my school we had cooperation with pupils from the Industrial Technology programme who made a copper pipe construction. During the

  10. 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.

  11. 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...

  12. Pacific Marine Recreational Fishing Expenditure Survey 2000

    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 West coast states . Expenditures on trips by mode (for-hire,...

  13. 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...

  14. 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...

  15. 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.

  16. 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.

  17. On a new global catastrophic ICT model

    DEFF Research Database (Denmark)

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

    2011-01-01

    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....

  18. The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China

    Directory of Open Access Journals (Sweden)

    Zhang Hong

    2010-02-01

    Full Text Available Abstract Background The New Rural Cooperative Medical Scheme (NRCMS, voluntary health insurance and the Medical Financial Assistance (MFA, financial relief program were established in 2003 for rural China. The aim of this study was to document their coverage, assess their effectiveness on access to in-patient care and protection against financial catastrophe and household impoverishment due to health spending, and identify the factors predicting impoverishment with and without these schemes. Methods A cross-sectional household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Information on personal demographic characteristics, chronic illness status, health care use, household expenditure, and household health spending were collected by interview. Results NRCMS covered 90.8% of the studied individuals and among the designated poor, 7.6% had their premiums paid by MFA. Of those referred for hospitalization in the year prior to the interview, 34.3% failed to comply, mostly (80.2% owing to financial constraints. There was no significant difference in the unmet need for admission between the insured with NRCMS and the uninsured. Before reimbursement, the incidence of catastrophic health payment (household health spending more than 40% of household's capacity to pay and medical impoverishment (household per capita income falling below the poverty line due to medical expense was 14.3% and 8.2%, respectively. NRCMS prevented 9.9% of the households from financial catastrophe and 7.7% from impoverishment, whereas MFA kept just one household from impoverishment and had no effect on financial catastrophe. Household per capita expenditure and household chronic disease proportion (proportion of members of a household with chronic illness were the most important determinants of the unmet need for admission, risk of being impoverished and the chance of not being saved

  19. 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.

  20. 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...

  1. 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.

  2. The ACTIVE cognitive training trial and predicted medical expenditures

    Directory of Open Access Journals (Sweden)

    Smith David M

    2009-06-01

    Full Text Available Abstract Background Health care expenditures for older adults are disproportionately high and increasing at both the individual and population levels. We evaluated the effects of the three cognitive training interventions (memory, reasoning, or speed of processing in the ACTIVE study on changes in predicted medical care expenditures. Methods ACTIVE was a multisite randomized controlled trial of older adults (≥ 65. Five-year follow-up data were available for 1,804 of the 2,802 participants. Propensity score weighting was used to adjust for potential attrition bias. Changes in predicted annualmedical expenditures were calculated at the first and fifth annual follow-up assessments using a new method for translating functional status scores. Multiple linear regression methods were used in this cost-offset analysis. Results At one and five years post-training, annual predicted expenditures declinedby $223 (p = .024 and $128 (p = .309, respectively, in the speed of processing treatment group, but there were no statistically significant changes in the memory or reasoning treatment groups compared to the no-contact control group at either period. Statistical adjustment for age, race, education, MMSE scores, ADL and IADL performance scores, EPT scores, chronic condition counts, and the SF-36 PCS and MCS scores at baseline did not alter the one-year ($244; p = .012 or five-year ($143; p = .250 expenditure declines in the speed of processing treatment group. Conclusion The speed of processing intervention significantly reduced subsequent annual predicted medical care expenditures at the one-year post-baseline comparison, but annual savings were no longer statistically significant at the five-year post-baseline comparison.

  3. 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)

  4. 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

  5. Catastrophizing and Causal Beliefs in Whiplash

    NARCIS (Netherlands)

    Buitenhuis, J.; de Jong, P. J.; Jaspers, J. P. C.; Groothoff, J. W.

    2008-01-01

    Study Design. Prospective cohort study. Objective. This study investigates the role of pain catastrophizing and causal beliefs with regard to severity and persistence of neck complaints after motor vehicle accidents. Summary of Background Data. In previous research on low back pain, somatoform disor

  6. Extension of catastrophe theory to Dulac unfoldings

    NARCIS (Netherlands)

    Broer, HW; Naudot, [No Value; Roussarie, R; Dumortier, F; Broer, H; Mawhin, J; Vanderbauwhede, A; Lunel, SV

    2005-01-01

    We consider a perturbation of a Hamiltonian planar vector field. The bifurcation set of limit cycles is studied. If the vector field is defined in an annulus, limit cycles are in one to one correspondence to the zeros of a polynomial. Catastrophe theory is relevant for the study of the ensuing bifur

  7. Thoracic aortic catastrophes : towards the endovascular solution

    NARCIS (Netherlands)

    Jonker, F.H.W.

    2010-01-01

    Descending thoracic aortic catastrophes include a variety of acute pathologies of the descending thoracic aorta, which are all associated with high morbidity and mortality rates, requiring immediate intervention. For this thesis, we explored the management and outcomes of several thoracic aortic cat

  8. Expenditure patterns of older Americans, 2001-2009.

    Science.gov (United States)

    Banerjee, Sudipto

    2012-02-01

    PRE- AND POSTRETIREMENT EXPENSES: Before retirement, people pay FICA taxes, incur work-related expenses, and set aside money for retirement. But after retirement, most people have different financial obligations, and, as a result, retirees may still be able to maintain their level of preretirement well-being with very different income levels. Studying income, expenditures, and wealth-holding patterns together provides a more complete idea of how people are doing in terms of being able to afford retirement than arbitrary estimates such as income replacement ratios. UNIQUE DATA: This Issue Brief examines the expenditure patterns of the older section of the population. It uses data from the Consumption and Activities Mail Survey (CAMS), a supplement to the Health and Retirement Study (HRS), conducted by the Institute for Social Research at the University of Michigan, contains detailed expenditure data on 32 categories, and follows the same group of individuals over eight years In addition, the income and wealth data available in the HRS are used to establish the financial standing of older households. DECLINING EXPENSES: Household expenses steadily decline with age. With the age 65 expenditure as a benchmark, household expenditure falls by 19 percent by age 75, 34 percent by age 85, and 52 percent by age 95. HOME EXPENSES: Home and home-related expenses remain the single largest spending category for older Americans. On average, those over age 50 spend around 40-45 percent of their budget on home and home-related items. RISING HEALTH CARE EXPENSES: Health-related expenses are the second-largest component in the budget of older Americans. It is the only component which steadily increases with age. Health care expenses capture around 10 percent of the budget for those between 50-64, but increase to about 20 percent for those age 85 and over. DEMOGRAPHIC GROUPS: Singles, blacks, and high school dropouts do not have a sound financial standing in retirement. Their

  9. 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

  10. 基于LSTR模型的个人卫生支出与经济增长关系研究%Estimation on the Relationship between Personal Health Expenditure and Economic Growth in China Based on the Logistic Smooth Transition Regression Model

    Institute of Scientific and Technical Information of China (English)

    唐波; 闫彬彬

    2014-01-01

    目的:刻画我国个人现金卫生支出与经济增长的非线性关系。方法:建立Logistic平滑转换模型,分析政府卫生支出对个人现金卫生支出与经济增长的非线性关系的影响。结果:经济增长对个人现金卫生支出的影响划分为3个阶段:1978-1996年处于高机制状态,1997-2008年处于机制转换时期,2009年至今处于低机制状态。结论:继续深化医药卫生体制改革,降低个人卫生支出负担。%Objective: To describe the non-linear relationship between out-of-pocket ( OOP ) payment and economic growth . Methods: Using logistic smooth transition regression model to analyze the impact of government health expenditure on the non-liner relationship between OOP payment and economic growth. Results:The impact of economic growth on OOP health expenditure is divided into 3 stages:from 1978 to 1996, the influence of economic growth on out-of-pocket payment approaches to highly-efficient mechanism operation;from 1997 to 2008 belongs to the transition period, it stays as low-efficient mechanism operation since 2009. Conclusion: To continue deepening the medical and health system reform and reduce the burden of personal health expenditure.

  11. 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

  12. On the governance of global and catastrophic risks

    DEFF Research Database (Denmark)

    Faber, Michael Havbro

    2011-01-01

    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.......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...

  13. 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.

  14. 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.

  15. 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,...

  16. 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,...

  17. 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,...

  18. 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,...

  19. 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,...

  20. 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,...

  1. 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,...

  2. 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,...

  3. 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,...

  4. 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,...

  5. 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,...

  6. 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,...

  7. 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,...

  8. 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,...

  9. 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,...

  10. 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,...

  11. 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,...

  12. 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,...

  13. Iodine and thyroid gland with or without nuclear catastrophe

    Directory of Open Access Journals (Sweden)

    Kovačev-Zavišić Branka

    2012-01-01

    Full Text Available Introduction. Iodine, as a trace element, is a necessary and limiting substrate for thyroid gland hormone synthesis. It is an essential element that enables the thyroid gland to produce thyroid hormones thyroxine (T4 and triiodothyronine (T3. Synthesis of Thyroid Hormones and Iodine Metabolism. Three iodine molecules are added to make triiodothyronine, and four for thyroxine - the two key hormones produced by the thyroid gland. Iodine deficiency. The proper daily amount of iodine is required for optimal thyroid function. Iodine deficiency can cause hypothyroidism, developmental brain disorders and goiter. Iodine deficiency is the single most common cause of preventable mental retardation and brain damage in the world. It also decreases child survival, causes goiters, and impairs growth and development. Iodine deficiency disorders in pregnant women cause miscarriages, stillbirths, and other complications. Children with iodine deficiency disorders can grow up stunted, apathetic, mentally retarded, and incapable of normal movements, speech or hearing. Excessive Iodine Intake. Excessive iodine intake, which can trigger autoimmune thyroid disease and dysfunction, is on the other side. Iodine use in Case of Nuclear Catastrophe. In addition to other severe consequences of radioactivity, high amount of radioactive iodine causes significant increase in incidence of thyroid gland carcinoma after some of the nuclear catastrophes (Hiroshima, Nagasaki, Chernobyl, Fukushima. The incidence of thyroid carcinoma was increased mostly in children. This paper was aimed at clarifying some of the possibilities of prevention according to the recommendations given by the World Health Organization.

  14. Changing BMI Categories and Healthcare Expenditures Among Elderly Medicare Beneficiaries

    OpenAIRE

    Wilkins, Tricia Lee; Rust, George S.; Sambamoorthi, Usha

    2011-01-01

    To examine the association between changes in BMI categories and health-care expenditures among elderly Medicare beneficiaries using longitudinal data of the Medicare Current Beneficiary Survey (MCBS) 2000–2005. Changes in BMI were (i) Stayed Normal: individuals with a normal BMI at baseline and follow-up; (ii) Stayed Overweight individuals with overweight BMI at baseline and follow-up; (iii) Stayed Obese individuals with obese BMI at baseline and follow-up; (iv) Normal-Overweight: individual...

  15. Machine Learning and Sensor Fusion for Estimating Continuous Energy Expenditure

    OpenAIRE

    Vyas, Nisarg; BodyMedia, Inc.; Farringdon, Jonathan; BodyMedia Inc.; Andre, David; Cerebellum Capital, Inc.; Stivoric, John Ivo; BodyMedia

    2012-01-01

    In this article we provide insight into the BodyMedia FIT armband system — a wearable multi-sensor technology that continuously monitors physiological events related to energy expenditure for weight management using machine learning and data modeling methods. Since becoming commercially available in 2001, more than half a million users have used the system to track their physiological parameters and to achieve their individual health goals including weight-loss. We describe several challenges...

  16. 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...

  17. Fitting the Cusp Catastrophe in R: A cusp Package Primer

    Directory of Open Access Journals (Sweden)

    Raoul P. P. P. Grasman

    2009-11-01

    Full Text Available Of the seven elementary catastrophes in catastrophe theory, the “cusp” model is the most widely applied. Most applications are however qualitative. Quantitative techniques for catastrophe modeling have been developed, but so far the limited availability of flexible software has hindered quantitative assessment. We present a package that implements and extends the method of Cobb (Cobb and Watson 1980; Cobb, Koppstein, and Chen 1983, and makes it easy to quantitatively fit and compare different cusp catastrophe models in a statistically principled way. After a short introduction to the cusp catastrophe, we demonstrate the package with two instructive examples.

  18. 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 ...

  19. Performance studies – the theory of catastrophes?

    Directory of Open Access Journals (Sweden)

    Konrad Wojnowski

    2014-01-01

    Full Text Available The author of Performatyka – teoria katastrof? [“Performance studies – the theory of catastrophes?”], which is a cross-sectional investigation into performance studies, tracks the trains of thought about catastrophes in different theories of performativity, ranging from J. L. Austin’s to Jon McKenzie’s ideas. Of particular interest is how particular theoreticians integrate the term ‘catastrophe’ into their conceptual frameworks and how they evaluate it. By criticizing the approach taken by Judith Butler, who postulates “melancholic performance studies”, which brings to mind Adorno’s idea that is explicated in Minima Moralia (traurige Wissenschaft, the author tries to show how we can productively use Austin’s theses that are presented in the first chapters of his famous How to Do Things with Words. In the author’s opinion, Austin allows us to approach communicational catastrophes from a different perspective, which is often forgotten, i.e. of the functioning of contextual systems. It is shown that the tension between felicity and infelicity may be at the core of the popularity of performativity which is understood as a tool for researching contemporary cultural phenomena.

  20. 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...

  1. 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.

  2. 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.

  3. Fire phenomena and nonlinearity (II). Catastrophic fire dynamics

    Energy Technology Data Exchange (ETDEWEB)

    Xie, Z. [University of Science and Technology, Hefei (China). State Key Laboratory of Fire Science

    2000-09-01

    As one of the most important non-linear mechanisms to cause fire or exacerbate fire disaster, there is a great deal of catastrophe behaviours existing in fire processes. The main tasks of the study of catastrophic fire dynamics are: 1) analysis of the catastrophe mechanisms of discontinuity behaviours in fire systems; 2) investigation of the controlling methods of discontinuity behaviours of fire system; 3) qualitative analysis of the dynamical characteristics of fire systems; and 4) catastrophe classifying of discontinuity phenomena in fire system. The other disciplines, such as physics, chemistry, biology, geoscience, astronomy, or even social sciences (for instance, political, economics, strategics and management science), may also take the similar method to establish the corresponding branch discipline of catastrophe science and catastrophe classification method. It is pointed out that an ignition behaviour of the uniform temperature thermal explosion system under the control of radiation has cusp catastrophe mechanism. 10 refs., 3 figs.

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

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    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.

  5. 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.

  6. High quality nutrient intake is associated with higher household expenditures by Japanese adults.

    Science.gov (United States)

    Fukuda, Yoshiharu; Hiyoshi, Ayako

    2012-08-01

    There is little evidence of socioeconomic differences in dietary intake in the Japanese population. This study examined the association between household expenditures and dietary intake using nationally representative surveys of Japan. We analyzed data from the Comprehensive Survey of Living Conditions and National Health and Nutrition Survey, 2003-2007. For subjects ages 18 to 74 years (11,240 men and 11,472 women), the sex-specific association between household expenditure quartiles and selected nutrient intake was examined using comparison of means and prevalence of a healthy intake. Higher household expenditures were associated with an increase in the mean levels of total energy, fat, protein, carbohydrates, calcium, vitamins A and C, niacin, and fiber for both men and women and salt for men. Prevalence comparison indicated that most of the recommendations for dietary intake were met for people with higher household expenditures than for those with lower household expenditures. There was no clear association between fat intake and expenditures. Higher household expenditures were associated with a healthy and balanced nutrient intake in Japanese adults. The findings suggest that socioeconomic differences in dietary patterns contribute to socioeconomic inequalities in mortality and morbidity in Japan.

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

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    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

  8. 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.

  9. 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)

  10. 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

  11. Catastrophizing and symptoms of sleep disturbances in children.

    Science.gov (United States)

    Gregory, Alice M; Noone, Deirdre M; Eley, Thalia C; Harvey, Allison G

    2010-03-01

    Catastrophizing about sleeplessness is a cognitive process associated with sleep disturbance in adults. This study aimed to (1) examine whether children catastrophize about the consequences of not sleeping; (2) define the topics that children catastrophize about; (3) assess whether there is a link between catastrophizing and sleep disturbance in children; and (4) examine whether an association between catastrophizing and sleep in children is mediated by anxiety and depression symptoms. Children completed the sleep self-report and a catastrophizing interview. Testing took place in two inner-city schools in London, UK and participants comprised 123 children aged between 8 and 10 years (49% male). Thirty-four (28%) participants reported concerns in response to the catastrophizing questionnaire. The main topics being catastrophized were concerns about sleep, physiological issues and one's own emotions. Catastrophes predicted sleep disturbance after controlling for age and sex (beta = 0.35, P anxiety and depression symptoms (beta = 0.15, P = 0.106). Symptoms of anxiety (Sobel test = 3.30, P sleep. A proportion of children catastrophized about the consequences of sleeplessness and this was associated with sleep disturbance, an association which was mediated through anxiety and depression symptoms.

  12. 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

  13. Bladder Pneumatosis From a Catastrophic Vascular Event

    Directory of Open Access Journals (Sweden)

    Ian J. Cooke

    2016-09-01

    Full Text Available Air within the bladder wall, or bladder pneumatosis, is a very rare finding typically resulting from an infectious etiology, as in emphysematous cystitis (EC. However, there have been reports of bladder pneumatosis occurring without clear infectious origins. We present a case of a female patient found to have concurrent bladder and ileal pneumatosis secondary to a catastrophic vascular event. Prompt recognition of non-infectious etiologies of bladder pneumatosis is essential as this distinction may dramatically alter clinical decision-making.

  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. 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.

  16. 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.

  17. Energy expenditure and sex differences of golf playing.

    Science.gov (United States)

    Zunzer, Stefan C; von Duvillard, Serge P; Tschakert, Gerhard; Mangus, Brent; Hofmann, Peter

    2013-01-01

    The purpose of the study was to assess the average physical intensity and energy expenditure during a single round of golf on hilly and flat courses in a heterogeneous group of healthy men and women of varying age and golf handicap. Forty-two males and 24 females completed an incremental cycle-ergometer exercise test to determine exercise performance markers. The heart rate (HR), duration, distance, walking speed, ascent and descent were measured via a global positioning system (GPS)/HR monitor during the game and energy expenditure was calculated. Playing 9 or 18-holes of golf, independent of the golf course design, the average HR was not significantly different between sexes or the subgroups. The intensities were light with respect to the percentage of maximal HR and metabolic equivalents of task (METs). Total energy expenditure of all participants was not significantly different for hilly (834 ± 344 kcal) vs. flat courses (833 ± 295 kcal) whereas male players expended significantly greater energy than female players (926 ± 292 vs. 556 ± 180 kcal), but did not have significantly greater relative energy expenditure (2.8 ± 0.8 vs. 2.2 ± 0.7 METs). As a high volume physical activity, playing golf is suggested to yield health benefits. Since the intensity was well below recommended limits, golf may have health related benefits unrelated to the intensity level of the activity.

  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. 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

  20. Energy expenditure of acutely ill hospitalised patients

    Directory of Open Access Journals (Sweden)

    Gariballa Salah

    2006-03-01

    Full Text Available Abstract Objective To measure energy expenditure of acutely ill elderly patients in hospital and following discharge in the community. Design Sixty-three consecutive hospitalised acutely ill elderly patients were recruited. Eight patients were studied to assess the reliability of the Delta Tract Machine as a measure of energy expenditure; 35 patients had their energy expenditure studied in hospital on two occasions and 20 patients had their energy expenditure measured in hospital and at 6 weeks in the community Results Men had higher basal energy expenditure (BMR values compared to women however the difference was not statistically significant [Men, mean (SD 1405 (321 Kcal, women 1238 (322 kcal; mean difference (95% CI 166 kcal (-17 to 531, p = 0.075]. After adjusting for age, gender and body mass index both medication and C-reactive protein (CRP, concentrations showed significant correlation with measured energy expenditure in hospital, (r = -0.36, "p Conclusion Tissue inflammation and medications were associated with change in measured energy expenditure in acutely ill patients.

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

    OpenAIRE

    Muris, Peter; Meesters, Cor; van den Hout, Mari F. C. M.; Wessels, Sylvia; Franken, Ingmar; 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 for Children, as well as scales for measuring sensitivity of the behavioral inhibition and behavioral activation systems (BIS-BAS), and various reactive and regulative temperament traits. Results de...

  2. 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.

  3. Death, Catastrophe, and the Significance of Tragedy

    Directory of Open Access Journals (Sweden)

    Jennifer Ballengee

    2014-05-01

    Full Text Available This NANO note will examine the tension between representation, memorial, and the catastrophe of death that emerges in the space of tragedy, as the problem arises in two quite different works: Oedipus at Colonus, a fairly typical fifth-century Greek tragedy, and Falling Man, Don DeLillo’s novel that, in its attempt to address the events of 9/11, reflects in form and subject matter many of Aristotle’s terms of tragic representation. It is not the intent of this note to engage with the recent proliferation of work in “performance theory.” Rather than being concerned with an imagined exchange between audience and actor, this study examines how the supplementary relationship of gesture and speech in tragedy disrupts the public/private distinction, and how this articulation effects and enables the public memorialization of death. Thus, this paper will consider the representation of death as an event whose catastrophic, and somewhat mysterious, collision of the public and the private lends it its tragic significance.

  4. 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.

  5. 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.

  6. The impact of obesity on medication use and expenditures among nonelderly adults with asthma.

    Science.gov (United States)

    Sarpong, Eric M

    2014-08-01

    Obesity contributes substantially to health resource use and costs. This study examines the impact of obesity on medication use and expenditures among nonelderly adults with asthma using the Medical Expenditure Panel Survey. Obese classes II/III individuals were more likely to have current asthma, seek treatment for asthma, use more medications, and have higher medication and health care expenditures compared with normal weight individuals. Multivariate results indicate that if obese classes II/III were normal weight the probability of asthma treatment would decrease by 8.0 percentage points. Conditional on any asthma treatment, if obese classes II/III were normal weight the mean number of total prescribed medications would decrease by 19.42 fills, and expected expenditures on total prescribed medications and health care would decrease by $1,738.68 and $3,682.58, respectively. These results suggest that, all else equal, reduction in body weight may help reduce health resource use and expenditures for nonelderly adults with asthma.

  7. Virtual reality exposure therapy as treatment for pain catastrophizing in fibromyalgia patients: proof-of-concept study (Study Protocol

    Directory of Open Access Journals (Sweden)

    Spottiswoode Bruce

    2011-04-01

    in FMS patients. Proof-of-concept will either be established or negated. The results of this project are envisaged to revolutionize FMS and pain catastrophizing research and in the future, assist health professionals and FMS patients in reducing despondency regarding FMS management. Trial registration PACTR201011000264179

  8. 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

  9. 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...

  10. 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,...

  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. World Public Expenditure: Education and Armaments, 1965-74

    Science.gov (United States)

    Carceles, Gabriel

    1977-01-01

    The latest data on public expenditures show that since 1973 world expenditures on education have exceeded military expenditures in developed nations, but that the opposite situation prevails in developing nations. Beginning with 1965, this article summarizes these expenditures for the world as a whole, including developed and developing nations.…

  13. Energy expenditure in HIV infection123

    OpenAIRE

    Kosmiski, Lisa

    2011-01-01

    Energy intake recommendations for adults should be based preferably on direct measurements of total daily energy expenditure (TDEE) in corresponding populations who are maintaining healthy body weight and satisfactory physical activity levels. During adolescence, pregnancy, and lactation, energy requirements should be based on TDEE plus the additional energy required to advance these physiologic states. With illness, energy expenditure and energy intake change, but nutritional intervention is...

  14. 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.

  15. Energy expenditure in rock/pop drumming.

    Science.gov (United States)

    De La Rue, S E; Draper, S B; Potter, C R; Smith, M S

    2013-10-01

    Despite the vigorous nature of rock/pop drumming, there are no precise data on the energy expenditure of this activity. The aim of this study was to quantify the energy cost of rock/pop drumming. Fourteen male drummers (mean±SD; age 27±8 yrs.) completed an incremental drumming test to establish the relationship between energy expenditure and heart rate for this activity and a ramped cycle ergometer test to exhaustion as a criterion measure for peak values (oxygen uptake and heart rate). During live concert performance heart rate was continuously measured and used to estimate energy expenditure (from the energy expenditure vs. heart rate data derived from the drumming test). During concert performance, estimated energy expenditure (mean±SD) was 623±168 kcal.h⁻¹ (8.1±2.2 METs) during performances of 38.6±15.6 min, and drummers achieved a peak heart rate of 186±16 b.min⁻¹. During the drumming test participants attained 78.7±8.3% of the cycle ergometer peak oxygen uptake. Rock/pop drumming represents a relatively high-intensity form of physical activity and as such involves significant energy expenditure. Rock/pop drumming should be considered as a viable alternative to more traditional forms of physical activity.

  16. Catastrophic Consequences of Kicking the Chameleon

    CERN Document Server

    Erickcek, Adrienne L; 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 consequences for the chameleon during the Universe's first minutes. The chameleon couples to the trace of the stress-energy tensor, which is temporarily non-zero in a radiation-dominated universe whenever a particle species becomes non-relativistic. These "kicks" impart a significant velocity to the chameleon field, causing its effective mass to vary non-adiabatically and resulting in the copious production of quantum fluctuations. Dissipative effects strongly modify the background evolution of the chameleon field, invalidati...

  17. Simple scaling of catastrophic landslide dynamics.

    Science.gov (United States)

    Ekström, Göran; Stark, Colin P

    2013-03-22

    Catastrophic landslides involve the acceleration and deceleration of millions of tons of rock and debris in response to the forces of gravity and dissipation. Their unpredictability and frequent location in remote areas have made observations of their dynamics rare. Through real-time detection and inverse modeling of teleseismic data, we show that landslide dynamics are primarily determined by the length scale of the source mass. When combined with geometric constraints from satellite imagery, the seismically determined landslide force histories yield estimates of landslide duration, momenta, potential energy loss, mass, and runout trajectory. Measurements of these dynamical properties for 29 teleseismogenic landslides are consistent with a simple acceleration model in which height drop and rupture depth scale with the length of the failing slope.

  18. Neurosurgical management for complicated catastrophic antiphospholipid syndrome.

    Science.gov (United States)

    Drazin, Doniel; Westley Phillips, H; Shirzadi, Ali; Drazin, Noam; Schievink, Wouter

    2014-04-01

    Antiphospholipid syndrome (APS) is an autoimmune condition involving arterial and venous thrombosis. An unusual APS variant, catastrophic antiphospholipid syndrome (CAPS), includes rapid multi-organ failure from widespread small vessel thrombosis. Central nervous system complications arise in one-third of CAPS patients. In rare cases, CAPS co-manifests with cerebellar hemorrhage presenting a neurosurgical emergency. We present a 65-year-old woman with CAPS-related cerebellar hematoma, co-morbid idiopathic thrombocytopenic purpura, deep vein thrombosis and altered mental status, with treatment complicated by thrombocytopenia. The patient suddenly deteriorated, secondary to a cerebellar subdural hematoma, and underwent decompression and excision of the hematoma. After recovery in the intensive care unit, she developed a new spontaneous epidural hematoma requiring additional surgery. Management of these patients is hematologically complex and often requires a multi-disciplinary team of physicians. This patient provides an important learning point for clinicians - consider CAPS when hemorrhage and thrombosis are present.

  19. 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

  20. 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.

  1. Toward a Hierarchical Bayesian Framework for Modelling the Effect of Regional Diversity on Household Expenditure

    Directory of Open Access Journals (Sweden)

    Brodjol Sutijo Supri Ulama

    2012-01-01

    Full Text Available Problem statement: Household expenditure analysis was highly demanding for government in order to formulate its policy. Since household data was viewed as hierarchical structure with household nested in its regional residence which varies inter region, the contextual welfare analysis was needed. This study proposed to develop a hierarchical model for estimating household expenditure in an attempt to measure the effect of regional diversity by taking into account district characteristics and household attributes using a Bayesian approach. Approach: Due to the variation of household expenditure data which was captured by the three parameters of Log-Normal (LN3 distribution, the model was developed based on LN3 distribution. Data used in this study was household expenditure data in Central Java, Indonesia. Since, data were unbalanced and hierarchical models using a classical approach work well for balanced data, thus the estimation process was done by using Bayesian method with MCMC and Gibbs sampling. Results: The hierarchical Bayesian model based on LN3 distribution could be implemented to explain the variation of household expenditure using district characteristics and household attributes. Conclusion: The model shows that districts characteristics which include demographic and economic conditions of districts and the availability of public facilities which are strongly associated with a dimension of human development index, i.e., economic, education and health, do affect to household expenditure through its household attributes."

  2. 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

  3. Catastrophe, gender and urban experience 1648-1920

    DEFF Research Database (Denmark)

    Employing a broad definition of catastrophe, this book examines how urban communities conceived, adapted to and were transformed by catastrophes. Competing views of gender figure in the telling and retelling of these trag- edies, which are mediated by myth and memory. This is a nuanced account...

  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. 'Performative narrativity': Palestinian identity and the performance of catastrophe

    NARCIS (Netherlands)

    Saloul, I.

    2008-01-01

    The day Israel annually celebrates as its "Day of Independence" Palestinians commemorate as their day of catastrophe (al-nakba). To most Palestinians, the catastrophic loss of Palestine in 1948 represents the climactic formative event of their lives. In the aftermath of this loss, the Palestinian so

  6. Implementing health insurance for migrants, Thailand

    Science.gov (United States)

    Thwin, Aye Aye; Patcharanarumol, Walaiporn

    2017-01-01

    Abstract Problem Undocumented migrant workers are generally ineligible for state social security schemes, and either forego needed health services or pay out of pocket. Approach In 2001, the Thai Ministry of Public Health introduced a policy on migrant health. Migrant health insurance is a voluntary scheme, funded by an annual premium paid by workers. It enables access to health care at public facilities and reduces catastrophic health expenditures for undocumented migrants and their dependants. A range of migrant-friendly services, including trained community health volunteers, was introduced in the community and workplace. In 2014, the government introduced a multisectoral policy on migrants, coordinated across the interior, labour, public health and immigration ministries. Local setting In 2011, around 0.3 million workers, less than 9% of the estimated migrant labour force of 3.5 million, were covered by Thailand’s social security scheme. Relevant changes A review of the latest data showed that from April to July 2016, 1 146 979 people (33.7% of the total estimated migrant labourers of 3 400 787) applied, were screened and were enrolled in the migrant health insurance scheme. Health volunteers, recruited from migrant communities and workplaces are appreciated by local communities and are effective in promoting health and increasing uptake of health services by migrants. Lessons learnt The capacity of the health ministry to innovate and manage migrant health insurance was a crucial factor enabling expanded health insurance coverage for undocumented migrants. Continued policy support will be needed to increase recruitment to the insurance scheme and to scale-up migrant-friendly services. PMID:28250516

  7. 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...

  8. 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...

  9. 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.

  10. 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.

  11. 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

  12. 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).

  13. Empirical Bayes Credibility Models for Economic Catastrophic Losses by Regions

    Directory of Open Access Journals (Sweden)

    Jindrová Pavla

    2017-01-01

    Full Text Available Catastrophic events affect various regions of the world with increasing frequency and intensity. The number of catastrophic events and the amount of economic losses is varying in different world regions. Part of these losses is covered by insurance. Catastrophe events in last years are associated with increases in premiums for some lines of business. The article focus on estimating the amount of net premiums that would be needed to cover the total or insured catastrophic losses in different world regions using Bühlmann and Bühlmann-Straub empirical credibility models based on data from Sigma Swiss Re 2010-2016. The empirical credibility models have been developed to estimate insurance premiums for short term insurance contracts using two ingredients: past data from the risk itself and collateral data from other sources considered to be relevant. In this article we deal with application of these models based on the real data about number of catastrophic events and about the total economic and insured catastrophe losses in seven regions of the world in time period 2009-2015. Estimated credible premiums by world regions provide information how much money in the monitored regions will be need to cover total and insured catastrophic losses in next year.

  14. The relation between catastrophizing and the communication of pain experience.

    Science.gov (United States)

    Sullivan, M J L; Martel, M O; Tripp, D; Savard, A; Crombez, G

    2006-06-01

    The Communal Coping Model of pain catastrophizing proposes that pain catastrophizers enact pain behaviors in order to solicit support or empathy from their social environment. By this account, pain catastrophizers might be expected to engage in behavior aimed at maximizing the probability that their pain will be perceived by others in their social environment. To test this prediction, 40 undergraduates were videotaped during a cold pressor procedure. A separate sample of 20 (10 men, 10 women) undergraduates were asked to view the video sequences and infer the pain ratings of the cold pressor participants. Correlational analyses revealed that higher levels of pain catastrophizing of the cold pressor participants were associated with observer inferences of more intense pain, r=.39, ppain catastrophizing and observer inferences of pain intensity was mediated by the cold pressor participants' pain behavior. Although pain catastrophizing was associated with observers' inferences of more intense pain, cold pressor participants' level of pain catastrophizing was not associated with observers' accuracy in inferring self-reported pain. Implications of the findings for theory and clinical practice are addressed.

  15. Política de Saúde Mental no Brasil: evolução do gasto federal entre 2001 e 2009 Política de Salud Mental en Brasil: evolución del gasto federal entre 2001 y 2009 Mental Health Policy in Brazil: federal expenditure evolution between 2001 and 2009

    Directory of Open Access Journals (Sweden)

    Renata Weber Gonçalves

    2012-02-01

    gastos de 2001 a 2009. Los valores de los gastos fueron actualizados en valores en reales de 2009 por medio de la aplicación del Índice de Precios al Consumidor Amplio. Se calculó el valor per capita/año del gasto federal en salud mental. RESULTADOS: Se observó el crecimiento real de 51,3% del gasto en salud mental en el período. La separación del gasto reveló aumento expresivo del valor extra-hospitalario (404,2% y disminución del hospitalario (-39,5%. El gasto per capita tuvo un crecimiento real menor, aunque expresivo (36,2%. La serie histórica del gasto per capita separado mostró que en 2006, por primera vez, el gasto extra-hospitalario fue mayor que el hospitalario. El valor per capita extra-hospitalario tuvo un crecimiento real de 354,0%; el valor per capita hospitalario disminuyó 45,5%. CONCLUSIONES: hubo crecimiento real de los recursos federales invertidos en salud mental entre 2001 y 2009 e inversión expresiva en las acciones extra-hospitalarias. hubo inversión en el direccionamiento de los recursos, a partir de 2006, en los servicios comunitarios. el componente del financiamiento tuvo papel crucial como inductor del cambio de modelo de atención en salud mental. el desafío para los próximos años es sustentar y aumentar los recursos para la salud mental en el contexto del desfinanciamiento del sistema único de salud.OBJECTIVE: To analyze the evolution of estimates of federal spending in Brazil's Mental Health Program since the promulgation of the national mental health law. METHODS: The total federal outlay of the Mental Health Program and its components of hospital and extra-hospital expenses were estimated based on 21 expenses categories from 2001 to 2009. The expenses amount was updated to values in reais of 2009 by means of the use of the Índice de Preços ao Consumidor Amplo (Broad Consumer Price Index. The per capita/year value of the federal expenditure on mental health was calculated. RESULTS: The outlay on mental health rose 51.3% in

  16. 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...

  17. 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.

  18. Remote personal health monitoring with radio waves

    Science.gov (United States)

    Nguyen, Andrew

    2008-03-01

    We present several techniques utilizing radio-frequency identification (RFID) technology for personal health monitoring. One technique involves using RFID sensors external to the human body, while another technique uses both internal and external RFID sensors. Simultaneous monitoring of many patients in a hospital setting can also be done using networks of RFID sensors. All the monitoring are done wirelessly, either continuously or periodically in any interval, in which the sensors collect information on human parts such as the lungs or heart and transmit this information to a router, PC or PDA device connected to the internet, from which patient's condition can be diagnosed and viewed by authorized medical professionals in remote locations. Instantaneous information allows medical professionals to intervene properly and timely to prevent possible catastrophic effects to patients. The continuously monitored information provides medical professionals more complete and long-term studies of patients. All of these result in not only enhancement of the health treatment quality but also significant reduction of medical expenditure. These techniques demonstrate that health monitoring of patients can be done wirelessly at any time and any place without interfering with the patients' normal activities. Implementing the RFID technology would not only help reduce the enormous and significantly growing medical costs in the U.S.A., but also help improve the health treatment capability as well as enhance the understanding of long-term personal health and illness.

  19. The Potential for Space Intervention in Global Catastrophes

    Science.gov (United States)

    Hempsell, M.

    There is a growing understanding of the risks facing mankind of global catastrophe, which is defined as an event that kills a quarter the world population and risks destruction of organised society. Such catastrophes can be triggered by either naturally occurring, or arthropogenic, initiating events. And history shows that catastrophes with a natural origin do occur, with a mean separation time of around 1000 years. Anthropogenic initiated events are a recent possibility resulting from an expansion of technology capabilities, economic activity and population and, while they clearly significantly increase the total risk level above the natural background, it is more difficult to determine quantitatively by how much. Some initiating events and be directly tackled by an appropriate space capability. For example intercepting Near Earth Object before collision, or using Solar Power Satellites to eliminating carbon dioxide production in the power generation process to which many attribute global warming. Obviously prevention is the preferred option and so, not surprisingly, these particular uses of space as a means of preventing global catastrophe have received considerable attention. However space capability has a much wider potential for intervention in global catastrophes, even in those where the initiating event itself cannot be prevented. Previous work highlighting the risks through consideration of historic catastrophes has identified that global catastrophes have a complex structure with the initiating event triggering chains of vectors, which in turn trigger death causing agents. The work also highlighted that the vectors and agents during a catastrophe are similar regardless of the initiating event. This opens the possibility that space systems capable of addressing generic vectors and agents on a global scale can help deal with any global catastrophe regardless of its cause. The paper lists known (and credible) components to global catastrophes and highlight

  20. 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.

  1. 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.

  2. Pain acceptance potentially mediates the relationship between pain catastrophizing and post-surgery outcomes among compensated lumbar fusion patients

    Directory of Open Access Journals (Sweden)

    Dance C

    2016-12-01

    Full Text Available Cassie Dance,1 M. Scott DeBerard,1 Jessica Gundy Cuneo2 1Department of Psychology, Utah State University, Logan, UT, 2Department of Psychiatry, University of California, San Diego, CA, USA Purpose: Chronic low back pain is highly prevalent and often treatment recalcitrant condition, particularly among workers’ compensation patients. There is a need to identify psychological factors that may predispose such patients to pain chronicity. The primary aim of this study was to examine whether pain acceptance potentially mediated the relationship between pain catastrophizing and post-surgical outcomes in a sample of compensated lumbar fusion patients.Patients and methods: Patients insured with the Workers Compensation Fund of Utah and who were at least 2 years post-lumbar fusion surgery completed an outcome survey. These data were obtained from a prior retrospective-cohort study that administered measures of pain catastrophizing, pain acceptance, mental and physical health, and disability.Results: Of the 101 patients who completed the outcome survey, 75.2% were male with a mean age of 42.42 years and predominantly identified as White (97.0%. The majority of the participants had a posterior lumbar interbody fusion surgery. Pain acceptance, including activity engagement and pain willingness, was significantly correlated with better physical health and mental health, and lower disability rates. Pain catastrophizing was inversely correlated with measures of pain acceptance (activity engagement r=–0.67, p<0.01, pain willingness r=–0.73, p<0.01 as well as the outcome measures: mental health, physical health, and disability. Pain acceptance significantly mediated the relationship between pain catastrophizing and both mental and physical health and also the relationship between pain catastrophizing and disability. Conclusion: This study demonstrated that the relationship between pain catastrophizing and negative patient outcomes was potentially mediated

  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.

  4. 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".

  5. The political economy of the public-private mix in heath expenditure: an empirical review of thirteen OECD countries.

    Science.gov (United States)

    Mou, Haizhen

    2013-12-01

    This study investigates the factors that may have influenced the public-private mix of health expenditure in 13 OECD countries from 1981 to 2007. The degree to which health services are socialized is regarded as the product of a trade-off between the desire to redistribute income through the fiscal system and the losses some citizens will incur when the public health care system expands. The estimation results show that, greater income inequality and population aging are associated with a smaller share of public health expenditure in total health expenditure. The more ideologically left-leaning the electorate is, the larger the share of public health expenditure. Private health insurance tends to erode the political support for the public health care systems in countries with private duplicate health insurance, but not in countries with private primary health insurance. The findings suggest that the role of private sources of funding for health care is likely to grow in developed countries. The expansion of public coverage to include pharmaceuticals and long-term care in some countries may (theoretically) encounter less opposition if the current insurance holders have no duplicate coverage, if the voters as a whole share more left-leaning political ideology, and if low-income voters are more politically mobilized.

  6. 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.

  7. Government Expenditure, Defense Expenditure and Economic Growth: a Causality Analysis for BRICS

    Directory of Open Access Journals (Sweden)

    Salman Ali Shah

    2016-12-01

    Full Text Available This paper empirically examines the effects of civilian and military portions of government expenditure on economic growth of five key emerging economies Brazil, Russia, India, China and South Africa (BRICS. We ran separate Cointegration and Granger causality tests for each country using data taken from WDI and SIPRI while taking account of the limitations of time series data. We got interestingly different effects of military expenditure on economic growth across countries especially for the three nuclear powers Russia, India and China. India and Brazil showed negative, Russia and China showed positive while South Arica showed no effect on economic growth in terms of government civilian expenditure.

  8. Gradient catastrophe and Fermi-edge resonances in Fermi gas.

    Science.gov (United States)

    Bettelheim, E; Kaplan, Y; Wiegmann, P

    2011-04-22

    Any smooth spatial disturbance of a degenerate Fermi gas inevitably becomes sharp. This phenomenon, called the gradient catastrophe, causes the breakdown of a Fermi sea to multiconnected components characterized by multiple Fermi points. We argue that the gradient catastrophe can be probed through a Fermi-edge singularity measurement. In the regime of the gradient catastrophe the Fermi-edge singularity problem becomes a nonequilibrium and nonstationary phenomenon. We show that the gradient catastrophe transforms the single-peaked Fermi-edge singularity of the tunneling (or absorption) spectrum to a sequence of multiple asymmetric singular resonances. An extension of the bosonic representation of the electronic operator to nonequilibrium states captures the singular behavior of the resonances.

  9. 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.

  10. Catastrophic antiphospholipid antibody syndrome in a child with thrombotic microangiopathy.

    Science.gov (United States)

    Prasad, N; Bhadauria, D; Agarwal, N; Gupta, A; Gupta, P; Jain, M; Lal, H

    2012-07-01

    Thrombotic microangiopathic hemolytic anemia (TMHA) is not uncommon in clinical nephrology practice while antiphospholipid syndrome (APS) is uncommon. Although less than 1% of patients with APS develop catastrophic APS (CAPS), its potential lethal outcome because of thrombosis in multiple organs and subsequent multiorgan failure emphasizes its importance in nephrology practice. Here is a case of catastrophic APS in a 7-year-old girl, who presented to us with TMHA associated with antiphospholipid antibodies and subsequently died because of CAPS.

  11. Pain frequency moderates the relationship between pain catastrophizing and pain

    OpenAIRE

    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 frequen...

  12. Pain frequency moderates the relationship between pain catastrophizing and pain

    OpenAIRE

    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...

  13. 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

  14. 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.

  15. Estimating energy expenditure during front crawl swimming using accelerometers

    DEFF Research Database (Denmark)

    Nordsborg, Nikolai Baastrup; Espinosa, Hugo G.; Van Thiel, David H

    2014-01-01

    The determination of energy expenditure is of major interest in training load and performance assessment. Small, wireless accelerometer units have the potential to characterise energy expenditure during swimming. The correlation between absorbed oxygen versus flume swimming speed and absorbed...

  16. Disability Compensation and Patient Expenditures: FY2000 to FY2013

    Data.gov (United States)

    Department of Veterans Affairs — This report contains FY2000 through FY2013 data on disability compensation expenditures and recipients and on VA healthcare system patients and patient expenditures.

  17. 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

  18. PREDICTING ADVERTISING EXPENDITURES USING INTENTION SURVEYS

    NARCIS (Netherlands)

    ALSEM, KJ; LEEFLANG, PSH

    1994-01-01

    In this article we study the use of intention surveys to predict the effects of a possible entrant. The case under investigation deals with the introduction of private broadcasting in the Netherlands. Several predictions of the advertising expenditures in various media are given which depend on a nu

  19. School Financing: Movement Toward Equality of Expenditures?

    Science.gov (United States)

    Amato, Josephine

    In this paper, the political and economic forces influencing attempts to reduce the inequalities in education expenditures are examined. Current programs for financing public education (local, State, and Federal) are compared. In general, State-local tax systems are found to be regressive and improvements are suggested. Inequitability of State aid…

  20. Revenue and Expenditure Nexus: A Case Study of Romania

    Directory of Open Access Journals (Sweden)

    Qazi Muhammad Adnan HYE

    2010-07-01

    Full Text Available This study determines the causal relationship between the expenditure and revenue of government in the case of Romania by using the autoregressive distributive lag approach to cointegration, variance decomposition and rolling regression method. The results indicate that bidirectional long run relationship exist between expenditure and revenue of government. The variance decomposition method suggests government revenue shock has more sharply impact on the government expenditure as compared to the shock in government expenditure and response of government revenue collection.

  1. Resting energy expenditure is not influenced by classical music

    Directory of Open Access Journals (Sweden)

    Slinde Frode

    2005-08-01

    Full Text Available Abstract Obesity shows an increasing prevalence worldwide and a decrease in energy expenditure has been suggested to be one of the risk factors for developing obesity. An increase in resting energy expenditure would have a great impact on total energy expenditure. This study shows that classical music do not influence resting energy expenditure compared to complete silence. Further studies should be performed including other genres of music and other types of stress-inductors than music.

  2. Pharmaceutical expenditure changes in Serbia and Greece during the global economic recession

    Directory of Open Access Journals (Sweden)

    Mihajlo Jakovljevic

    2016-04-01

    Full Text Available 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 crisis in the post-war economic history hit the global economy. Methods: Exchange rates, purchase-power-parities (PPP and price indices were used for the bilateral review of health and pharmaceutical expenditure dynamics during 2007-2012. Prescription and dispensing changes were also studied taking into account the anatomical therapeutic chemical (ATC structure of drugs consumed. Results: Greece was forced to cut down its total health care and pharmaceutical expenditure and mainly its out-of-pocket payments were more seriously affected by the recession. Surprisingly, emerging market of Serbia, although severely damaged by global recession, succeeded to maintain 19% growth of its per capita health expenditure and even 25% increase of its per capita spending on pharmaceuticals. Innovative pharmaceuticals showed an upward trend in both countries. Conclusions: These two countries might serve as an example of two distinct pathways of mature and emerging health care markets during financial constraints caused by global recession. Our findings show that producing disease-based feedback, in the long run, may empower the assessment of the return on investment on medical technology and healthcare systems’ cost-effectiveness.

  3. Intergenerational enrollment and expenditure changes in Medicaid: trends from 1991 to 2005

    Directory of Open Access Journals (Sweden)

    Patrick Stephen W

    2012-09-01

    Full Text Available Abstract Background From its inception, Medicaid was aimed at providing insurance coverage for low income children, elderly, and disabled. Since this time, children have become a smaller proportion of the US population and Medicaid has expanded to additional eligibility groups. We sought to evaluate relative growth in spending in the Medicaid program between children and adults from 1991-2005. We hypothesize that this shifting demographic will result in fewer resources being allocated to children in the Medicaid program. Methods We utilized retrospective enrollment and expenditure data for children, adults and the elderly from 1991 to 2005 for both Medicaid and Children’s Health Insurance Program Medicaid expansion programs. Data were obtained from the Centers for Medicare and Medicaid Services using their Medicaid Statistical Information System. Results From 1991 to 2005, the number of enrollees increased by 83% to 58.7 million. This includes increases of 33% for children, 100% for adults and 50% for the elderly. Concurrently, total expenditures nationwide rose 150% to $273 billion. Expenditures for children increased from $23.4 to $65.7 billion, adults from $46.2 to $123.6 billion, and elderly from $39.2 to $71.3 billion. From 1999 to 2005, Medicaid spending on long-term care increased by 31% to $84.3 billion. Expenditures on the disabled grew by 61% to $119 billion. In total, the disabled account for 43% and long-term care 31%, of the total Medicaid budget. Conclusion Our study did not find an absolute decrease in the overall resources being directed toward children. However, increased spending on adults on a per-capita and absolute basis, particularly disabled adults, is responsible for much of the growth in spending over the past 15 years. Medicaid expenditures have grown faster than inflation and overall national health expenditures. A national strategy is needed to ensure adequate coverage for Medicaid recipients while dealing with the

  4. Public Expenditures, Budgetary Sustainability and the Assessment of Management of Public Expenditures in Kosovo

    Directory of Open Access Journals (Sweden)

    Behxhet Brajshori

    2009-05-01

    Full Text Available 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 present the main instruments for achieving economic and social effects through the policy of public expenditures, whilst in conjectural economies; the effect of public expenditures is large and is realized through the mechanism of multiplicators which are used when the economy is in the state of economic stagnation and recession. After the war, Kosovo built a new fiscal system according to the best international practices. The tax system consists of some taxes, it has a wide spread of tax charges and applies relatively low tax rates. Both budgetary revenues and budgetary consumption have marked certain variations in relation to GDP. Currently, The Kosovo Consolidated Budget (KCB is completely fulfilled by domestic revenues. It is considered that, even if the budgetary consumption increases up to 30-34% of GDP, this raise will not endanger budgetary sustainability of the country. According to the World Bank assessment (PEFA document- 2006 on the Effectiveness of Management of Public Expenditures in Kosovo, based on the performance of main indicators of management of public finances, the effectiveness of management of public expenditures in Kosovo is relatively satisfactory. According to the draft-document of the World Bank and the Government of Kosovo (PEFA-2008, the quality of management of public expenditures in 2008 has been profoundly improved.

  5. Household Expenditures on Private Tutoring: Emerging Evidence from Malaysia

    Science.gov (United States)

    Kenayathulla, Husaina Banu

    2013-01-01

    Private tutoring has been a burgeoning phenomenon in Malaysia for decades. This study examines the determinants of private tutoring expenditures in Malaysia using the 2004/2005 Household Expenditures Survey and applies hurdle regression models to the data. The results indicate that total household expenditures, household head's level of…

  6. Household Expenditures on Private Tutoring: Emerging Evidence from Malaysia

    Science.gov (United States)

    Kenayathulla, Husaina Banu

    2013-01-01

    Private tutoring has been a burgeoning phenomenon in Malaysia for decades. This study examines the determinants of private tutoring expenditures in Malaysia using the 2004/2005 Household Expenditures Survey and applies hurdle regression models to the data. The results indicate that total household expenditures, household head's level of education,…

  7. 26 CFR 53.4945-1 - Taxes on taxable expenditures.

    Science.gov (United States)

    2010-04-01

    ... any one taxable expenditure shall be $5,000, and the maximum aggregate amount of tax collectible under... 26 Internal Revenue 17 2010-04-01 2010-04-01 false Taxes on taxable expenditures. 53.4945-1...) MISCELLANEOUS EXCISE TAXES (CONTINUED) FOUNDATION AND SIMILAR EXCISE TAXES Taxes on Taxable Expenditures §...

  8. 11 CFR 110.8 - Presidential candidate expenditure limitations.

    Science.gov (United States)

    2010-01-01

    ... the aggregate of expenditures under this paragraph in any one State shall not exceed the greater of 16... CFR 110.18. (b) The expenditure limitations shall not be considered violated if, after the date of the... expenditure limitation under 11 CFR 9035.1. (d)(1) If an individual is a candidate for more than one...

  9. Educational Expenditures in Thailand: Development, Trends, and Distribution

    Science.gov (United States)

    Sagarik, Danuvas

    2014-01-01

    This article aims to investigate the trends of education expenditure policy during the past few decades, as well as the recent allocation and distribution of education expenditure in Thailand. It also focuses on the development of the substance of education policy in Thailand. Political connection with the education expenditure policy is also…

  10. Catastrophic antiphospholipid syndrome in obstetric practice

    Directory of Open Access Journals (Sweden)

    Валерий Николаевич Запорожан

    2015-05-01

    Full Text Available Thus, the Catastrophic antiphospholipid syndrome (CAPS is much more common than has been assumed until now, in all patients the authors strongly recommend screening for AFA. Furthermore, eclampsia, HELLP-syndrome premature detachment of normally located placentae (PDNSP can develop in the presence of other defects of hemostasis, in particular in mutation FV Leiden, MTHFR C677T, deficiency of protein C (PC, protein S (PS. The combination of acquired thrombophilia due to APS, with genetic defects worsen hemostasis during the pathological process leading to the development of thrombotic complications. Perhaps a combination of hereditary thrombophilia and APS creates a favorable environment in which, under certain conditions, possible decompensation of the hemostatic system and the development of CAPS. Patients with APS constitute a group of very high risk of thromboembolic complications in the perioperative period. Even a minimally invasive intervention (biopsy, curettage, tooth extraction may trigger the development of CAPS. Thus, according to Erkan et al. (2003, 40% of patients develop CAPS was provoked by surgery. The main reasons for the development of thrombotic complications in connection with surgical intervention is the damage to the vessel wall, blood stasis and the abolition of indirect anticoagulants. In the study on the presence of genetic thrombophilia was found heterozygous form of FV Leiden mutation and homozygous mutation of MTHFR C677T. He was diagnosed with pregnancy 14 weeks, APS, mixed form of thrombophilia (a combination of acquisitions and multigenic thrombophilia, hyperhomocysteinemia, weighed down by obstetric and somatic history.It is very urgent and important problem remains diagnosis CAPS, which is inconceivable without the determination of AFA. The latter should be mandatory for all pregnant women with preeclampsia habitual miscarriage, Premature detachment of normally situated placenta (PDNSP, genital herpes history

  11. Progressivity of health care financing and incidence of service benefits in Ghana.

    Science.gov (United States)

    Akazili, James; Garshong, Bertha; Aikins, Moses; Gyapong, John; McIntyre, Di

    2012-03-01

    The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana's health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care.

  12. 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

  13. Healthcare expenditures for males with haemophilia and employer-sponsored insurance in the United States, 2008

    OpenAIRE

    2011-01-01

    Although hemophilia has a potentially high economic impact, published estimates of health care costs for Americans with hemophilia are sparse and non-specific as to the non-bleeding complications of the disease. The objective of this study is to estimate average annual health care expenditures for people with hemophilia covered by employer-sponsored insurance, stratified according to the influence of age, type of hemophilia [A (factor VIII deficiency) versus B (factor IX)], presence of neutra...

  14. Use of food expenditure data to estimate household nutrient accessibility.

    Science.gov (United States)

    Simeon, D T; Patterson, A W

    1996-03-01

    The nutritional status of at-risk groups is usually monitored using health statistics. This approach has limitations as individuals are identified only after they have been afflicted by morbidity. In Jamaica, national surveys are carried out in which expenditure data on all consumption items are collected. We used these data to monitor food accessibility in at-risk groups. The identification of decreases in accessibility levels relative to requirements would enable timely intervention before there is a deterioration in nutritional status. We analysed the data from the survey of 3861 households conducted by Statistical and Planning Institutes of Jamaica in 1989. Using the food expenditure data, per capita energy and protein accessibility levels were determined. The mean energy and protein accessibility levels for the sample were 2170 Cals and 64 g, respectively. The results showed that the per capita accessibility levels of 20% and 9% of the households were less than half of requirements for energy and protein, respectively. The situation was worse in rural areas than in urban centres. However, the accessibility levels may have been underestimated as the data did not include meals bought and consumed away from the home, which may be significant to some households. We believe that the use of data from these surveys is a cost-effective way to monitor nutrient accessibility in Jamaica.

  15. Labelled drug-related public expenditure in relation to gross domestic product (GDP) in Europe: a luxury good?

    Science.gov (United States)

    Prieto, Luis

    2010-05-17

    "Labelled drug-related public expenditure" is the direct expenditure explicitly labelled as related to illicit drugs by the general government of the state. As part of the reporting exercise corresponding to 2005, the European Monitoring Centre for Drugs and Drug Addiction's network of national focal points set up in the 27 European Union (EU) Member States, Norway, and the candidates countries to the EU, were requested to identify labelled drug-related public expenditure, at the country level. This was reported by 10 countries categorised according to the functions of government, amounting to a total of EUR 2.17 billion. Overall, the highest proportion of this total came within the government functions of Health (66%), and Public Order and Safety (POS) (20%). By country, the average share of GDP was 0.023% for Health, and 0.013% for POS. However, these shares varied considerably across countries, ranging from 0.00033% in Slovakia, up to 0.053% of GDP in Ireland in the case of Health, and from 0.003% in Portugal, to 0.02% in the UK, in the case of POS; almost a 161-fold difference between the highest and the lowest countries for Health, and a 6-fold difference for POS. Why do Ireland and the UK spend so much in Health and POS, or Slovakia and Portugal so little, in GDP terms? To respond to this question and to make a comprehensive assessment of drug-related public expenditure across countries, this study compared Health and POS spending and GDP in the 10 reporting countries. Results found suggest GDP to be a major determinant of the Health and POS drug-related public expenditures of a country. Labelled drug-related public expenditure showed a positive association with the GDP across the countries considered: r = 0.81 in the case of Health, and r = 0.91 for POS. The percentage change in Health and POS expenditures due to a one percent increase in GDP (the income elasticity of demand) was estimated to be 1.78% and 1.23% respectively. Being highly income elastic

  16. Labelled drug-related public expenditure in relation to gross domestic product (GDP) in Europe: a luxury good?

    LENUS (Irish Health Repository)

    Prieto, Luis

    2010-01-01

    "Labelled drug-related public expenditure" is the direct expenditure explicitly labelled as related to illicit drugs by the general government of the state. As part of the reporting exercise corresponding to 2005, the European Monitoring Centre for Drugs and Drug Addiction\\'s network of national focal points set up in the 27 European Union (EU) Member States, Norway, and the candidates countries to the EU, were requested to identify labelled drug-related public expenditure, at the country level. This was reported by 10 countries categorised according to the functions of government, amounting to a total of EUR 2.17 billion. Overall, the highest proportion of this total came within the government functions of Health (66%), and Public Order and Safety (POS) (20%). By country, the average share of GDP was 0.023% for Health, and 0.013% for POS. However, these shares varied considerably across countries, ranging from 0.00033% in Slovakia, up to 0.053% of GDP in Ireland in the case of Health, and from 0.003% in Portugal, to 0.02% in the UK, in the case of POS; almost a 161-fold difference between the highest and the lowest countries for Health, and a 6-fold difference for POS. Why do Ireland and the UK spend so much in Health and POS, or Slovakia and Portugal so little, in GDP terms? To respond to this question and to make a comprehensive assessment of drug-related public expenditure across countries, this study compared Health and POS spending and GDP in the 10 reporting countries. Results found suggest GDP to be a major determinant of the Health and POS drug-related public expenditures of a country. Labelled drug-related public expenditure showed a positive association with the GDP across the countries considered: r = 0.81 in the case of Health, and r = 0.91 for POS. The percentage change in Health and POS expenditures due to a one percent increase in GDP (the income elasticity of demand) was estimated to be 1.78% and 1.23% respectively. Being highly income elastic

  17. 26 CFR 1.501(h)-1 - Application of the expenditure test to expenditures to influence legislation; introduction.

    Science.gov (United States)

    2010-04-01

    ... expenditures to influence legislation; introduction. 1.501(h)-1 Section 1.501(h)-1 Internal Revenue INTERNAL...) Exempt Organizations § 1.501(h)-1 Application of the expenditure test to expenditures to influence..., (except as otherwise provided in subsection (h)).” This requirement is called the substantial part...

  18. Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India.

    Science.gov (United States)

    Garg, Charu C; Karan, Anup K

    2009-03-01

    Out-of-pocket (OOP) expenditure on health care has significant implications for poverty in many developing countries. This paper aims to assess the differential impact of OOP expenditure and its components, such as expenditure on inpatient care, outpatient care and on drugs, across different income quintiles, between developed and less developed regions in India. It also attempts to measure poverty at disaggregated rural-urban and state levels. Based on Consumer Expenditure Survey (CES) data from the National Sample Survey (NSS), conducted in 1999-2000, the share of households' expenditure on health services and drugs was calculated. The number of individuals below the state-specific rural and urban poverty line in 17 major states, with and without netting out OOP expenditure, was determined. This also enabled the calculation of the poverty gap or poverty deepening in each region. Estimates show that OOP expenditure is about 5% of total household expenditure (ranging from about 2% in Assam to almost 7% in Kerala) with a higher proportion being recorded in rural areas and affluent states. Purchase of drugs constitutes 70% of the total OOP expenditure. Approximately 32.5 million persons fell below the poverty line in 1999-2000 through OOP payments, implying that the overall poverty increase after accounting for OOP expenditure is 3.2% (as against a rise of 2.2% shown in earlier literature). Also, the poverty headcount increase and poverty deepening is much higher in poorer states and rural areas compared with affluent states and urban areas, except in the case of Maharashtra. High OOP payment share in total health expenditures did not always imply a high poverty headcount; state-specific economic and social factors played a role. The paper argues for better methods of capturing drugs expenditure in household surveys and recommends that special attention be paid to expenditures on drugs, in particular for the poor. Targeted policies in just five poor states to reduce

  19. Adam Smith on public expenditure and taxation

    Directory of Open Access Journals (Sweden)

    Maurício C. Coutinho

    2009-05-01

    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”.

  20. Advertising Expenditures in the Developing World

    OpenAIRE

    Leff, Nathaniel H; John U Farley

    1980-01-01

    Relative to market size, would one expect advertising expenditures to be higher or lower in the developing countries as compared with the more developed countries? This paper discusses some features of the marketing environment in the developing countries in order to clarify some of the conceptual issues which advertising raises for optimizing marketing and public policy decisions in the LDCs. In addition, new measures of advertising intensity in less developed and more developed countries ar...

  1. A simple model of aggregate pension expenditure

    OpenAIRE

    Fuente, Ángel de la

    2011-01-01

    This paper develops a simple model that can be used to analyze the long-term sustainability of the contributive pension system and the steady-state response of pension expenditure to changes in some key demographic and economic variables, in the characteristics of the average pensioner an d in the parameters that describe how pensions are calculated in Spain as a function of workers’ Social Security contribution histories.

  2. Activities Contributing to Total Energy Expenditure in the United States: Results from the NHAPS Study

    Directory of Open Access Journals (Sweden)

    Block Gladys

    2004-02-01

    Full Text Available Abstract Background Physical activity is increasingly recognized as an important factor influencing health and disease status. Total energy expenditure, both low-intensity and high-intensity, contributes to maintenance of healthy body weight. This paper presents the results of a quantitative approach to determining the activities that contribute to total energy expenditure in the United States. Methods Data from the National Human Activity Pattern Survey (NHAPS were used. In 1992–1994 the NHAPS sampled 4,185 females and 3,330 males, aged 18 years and over, weighted to be representative of the 48 contiguous United States. A detailed report of each activity performed in the previous 24 hours was obtained. A score was created for each activity, by multiplying duration and intensity for each individual and summing across individuals. This score was then used to rank each activity according to its contribution to total population energy expenditure, for the total sample and separately for each gender, race, age, region, and season. Results This analysis reveals our society to be primarily sedentary; leisure time physical activity contributed only approximately 5% of the population's total energy expenditure. Not counting sleeping, the largest contributor to energy expenditure was "Driving a car", followed by "Office work" and "Watching TV". Household activities accounted for 20.1% and 33.3% of energy expenditure for males and females respectively. Conclusion The information presented in this paper may be useful in identifying common activities that could be appropriate targets for behavioral interventions to increase physical activity.

  3. Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

    Science.gov (United States)

    Shrestha, Sundar S.; Zhang, Ping; Li, Rui; Thompson, Theodore J.; Chapman, Daniel P.; Barker, Lawrence

    2017-01-01

    Aim We aimed at estimating excess medical expenditures associated with major depressive disorder (MDD) among working-age adults diagnosed with diabetes, disaggregated by treatment mode: insulin-treated diabetes (ITDM) or non-insulin-treated diabetes (NITDM). Methods We analyzed data for over 500,000 individuals with diagnosed diabetes from the 2008 U.S. MarketScan claims database. We grouped diabetic patients first by treatment mode (ITDM or NITDM), then by MDD status (with or without MDD), and finally by whether those with MDD used antidepressant medication. We estimated annual mean excess outpatient, inpatient, prescription drug, and total expenditures using regression models, controlling for demographics, types of health coverage, and comorbidities. Results Among persons having ITDM, the estimated annual total mean expenditure for those with no MDD (the comparison group) was $19,625. For those with MDD, the expenditures were $12,406 (63%) larger if using antidepressant medication and $7322 (37%) larger if not using antidepressant medication. Among persons having NITDM, the corresponding estimated expenditure for the comparison group was $10,746, the excess expenditures were $10,432 (97%) larger if using antidepressant medication and $5579 (52%) larger if not using antidepressant medication, respectively. Inpatient excess expenditures were the largest of total excess expenditure for those with ITDM and MDD treated with antidepressant medication; for all others with diabetes and MDD, outpatient expenditures were the largest excess expenditure. Conclusions Among working-age adults with diabetes, MDD was associated with substantial excess medical expenditures. Implementing the effective interventions demonstrated in clinical trials and treatment guidelines recommended by professional organizations might reduce the economic burden of MDD in this population. PMID:23490596

  4. The effect of recessions on gambling expenditures.

    Science.gov (United States)

    Horváth, Csilla; Paap, Richard

    2012-12-01

    This 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 period 1959.01-2010.08. Among the three gambling activities only lottery consumption appears to be recession-proof. This series is characterized by a vast and solid growth that exceeds the growth in income and the growth in other gambling sectors. Casino gambling expenditures show a positive growth during expansions and no growth during recessions. Hence, the loss in income during recessions affects casino gambling. However, income shocks which are not directly related to the business cycle do not influence casino gambling expenditures. Pari-mutuel wagering displays an overall negative trend and its average growth rate is smaller than the growth in income, especially during recessions. The findings of this article provide important implications for the gambling industry and for local governments.

  5. Implications of the introduction of laboratory demand management at primary care clinics in South Africa on laboratory expenditure

    Directory of Open Access Journals (Sweden)

    Ozayr H. Mahomed

    2016-02-01

    Full Text Available Background: Diagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes.Objectives: This study aimed to analyse current laboratory expenditures at the primary healthcare (PHC level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management.Methods: A retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software.Results: Approximately R35 million South African Rand (10% of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment.Conclusions: Considerable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented.

  6. 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.

  7. 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...

  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. Stagewise cognitive development: an application of catastrophe theory.

    Science.gov (United States)

    van der Maas, H L; Molenaar, P C

    1992-07-01

    In this article an overview is given of traditional methodological approaches to stagewise cognitive developmental research. These approaches are evaluated and integrated on the basis of catastrophe theory. In particular, catastrophe theory specifies a set of common criteria for testing the discontinuity hypothesis proposed by Piaget. Separate criteria correspond to distinct methods used in cognitive developmental research. Such criteria are, for instance, the detection of spurts in development, bimodality of test scores, and increased variability of responses during transitional periods. When a genuine stage transition is present, these criteria are expected to be satisfied. A revised catastrophe model accommodating these criteria is proposed for the stage transition in cognitive development from the preoperational to the concrete operational stage.

  11. 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.

  12. 76 FR 50929 - Catastrophic Risk Protection Endorsement

    Science.gov (United States)

    2011-08-17

    ... received by mail, will be posted without change to http://www.regulations.gov , including any personal... text and not as an image, thus allowing FCIC to search and copy certain portions of your submissions... economic impact on the quality of the human environment, health, or safety. Therefore, neither...

  13. A critical look at risk assessments for global catastrophes.

    Science.gov (United States)

    Kent, Adrian

    2004-02-01

    Recent articles by Busza et al. (BJSW) and Dar et al. (DDH) argue that astrophysical data can be used to establish small bounds on the risk of a "killer strangelet" catastrophe scenario in the RHIC and ALICE collider experiments. The case for the safety of the experiments set out by BJSW does not rely solely on these bounds, but on theoretical arguments, which BJSW find sufficiently compelling to firmly exclude any possibility of catastrophe. Nonetheless, DDH and other commentators (initially including BJSW) suggested that these empirical bounds alone do give sufficient reassurance. This seems unsupportable when the bounds are expressed in terms of expectation value-a good measure, according to standard risk analysis arguments. For example, DDH's main bound, p(catastrophe) future generations, a catastrophe risk no higher than approximately 10(-15) per year would be required for consistency with established policy for radiation hazard risk minimization. Allowing for risk aversion and for future lives, a respectable case can be made for requiring a bound many orders of magnitude smaller. In summary, the costs of small risks of catastrophe have been significantly underestimated by BJSW (initially), by DDH, and by other commentators. Future policy on catastrophe risks would be more rational, and more deserving of public trust, if acceptable risk bounds were generally agreed upon ahead of time and if serious research on whether those bounds could indeed be guaranteed was carried out well in advance of any hypothetically risky experiment, with the relevant debates involving experts with no stake in the experiments under consideration.

  14. Application of Catastrophe Theory in 3D Seismic Data Interpretation of Coal Mine

    Institute of Scientific and Technical Information of China (English)

    ZHAO Mu-hua; YANG Wen-qiang; CUI Hui-xia

    2005-01-01

    In order to detect fault exactly and quickly, cusp catastrophe theory is used to interpret 3D coal seismic data in this paper. By establishing a cusp model, seismic signal is transformed into standard form of cusp catastrophe and catastrophe parameters, including time-domain catastrophe potential, time-domain catastrophe time, frequency-domain catastrophe potential and frequency- domain degree, are calculated. Catastrophe theory is used in 3D seismic structural interpretation in coal mine. The results show that the position of abnormality of the catastrophe parameter profile or curve is related to the location of fault, and the cusp catastrophe theory is effective to automatically pick up geology information and improve the interpretation precision in 3D seismic data.

  15. Heritability of pain catastrophizing and associations with experimental pain outcomes: a twin study.

    Science.gov (United States)

    Trost, Zina; Strachan, Eric; Sullivan, Michael; Vervoort, Tine; Avery, Ally R; Afari, Niloofar

    2015-03-01

    This study used a twin paradigm to examine genetic and environmental contributions to pain catastrophizing and the observed association between pain catastrophizing and cold-pressor task (CPT) outcomes. Male and female monozygotic (n = 206) and dizygotic twins (n = 194) from the University of Washington Twin Registry completed a measure of pain catastrophizing and performed a CPT challenge. As expected, pain catastrophizing emerged as a significant predictor of several CPT outcomes, including cold-pressor Immersion Tolerance, Pain Tolerance, and Delayed Pain Rating. The heritability estimate for pain catastrophizing was found to be 37% with the remaining 63% of variance attributable to unique environmental influence. Additionally, the observed associations between pain catastrophizing and CPT outcomes were not found attributable to shared genetics or environmental exposure, which suggests a direct relationship between catastrophizing and experimental pain outcomes. This study is the first to examine the heritability of pain catastrophizing and potential processes by which pain catastrophizing is related to experimental pain response.

  16. 人口老龄化与医疗卫生费用关系的地区间比较%Interregional Comparative Analysis of Relationship between Population Ageing and Health Care Expenditure

    Institute of Scientific and Technical Information of China (English)

    王华

    2012-01-01

    通过比较分析我国不同地区人口老龄化程度与医疗卫生费用之间的关系,发现随着人口老龄化程度的提升,医疗卫生费用占用社会经济资源的比重并不一定上升;只要经济增长能够持续,人口老龄化程度对医疗卫生费用的压力并不可怕,可怕的是经济增长赶不上人口老龄化对医疗卫生费用的需求.在老龄化进程中,发达地区医疗卫生费用的投入效率比中等发达地区和欠发达地区高,但发达地区面临更大的环境质量对居民健康水平所造成负面影响的压力.欠发达地区医疗卫生费用占GDP的比重比发达地区和中等发达地区高,但居民的健康水平却低于这两类地区,因此在人口老龄化进程中,欠发达地区应更加注重提高医疗卫生投入的效率问题.%This paper compares and analyzes the relationship between the population aging and health care costs in different regions of China. The results showed that,with the acceleration of the process of population aging, the proportion of health care costs taking up social and economic resources does not necessarily rise, and as long as the economic growth continues, the pressure of population aging on health care costs is not terrible, the horrible thing is that economic growth cannot meet the needs of population aging on health care costs. The same time, this study also showed that in the aging process, the efficiency of the developed areas of health care costs of inputs is higher than the middle-income areas and less developed regions. But in developed areas, the negative impact of the environment on the level of the health of residents is greater. The less proportion of the developed areas of health care expenses as a percentage of GDP than the developed areas and moderately developed areas, but the level of the health of residents is lower than these two types of regions, in the process of population aging, less developed areas should be more focus on

  17. Cross-cultural adaptation and validation of the Turkish version of the pain catastrophizing scale among patients with ankylosing spondylitis.

    Science.gov (United States)

    İlçin, Nursen; Gürpınar, Barış; Bayraktar, Deniz; Savcı, Sema; Çetin, Pınar; Sarı, İsmail; Akkoç, Nurullah

    2016-01-01

    [Purpose] This study describes the cultural adaptation, validation, and reliability of the Turkish version of the Pain Catastrophizing Scale in patients with ankylosing spondylitis. [Methods] The validity of the Turkish version of the Pain Catastrophizing Scale was assessed by evaluating data quality (missing data and floor and ceiling effects), principal components analysis, internal consistency (Cronbach's alpha), and construct validity (Spearman's rho). Reproducibility analyses included standard measurement error, minimum detectable change, limits of agreement, and intraclass correlation coefficients. [Results] Sixty-four adult patients with ankylosing spondylitis with a mean age of 42.2 years completed the study. Factor analysis revealed that all questionnaire items could be grouped into two factors. Excellent internal consistency was found, with a Chronbach's alpha value of 0.95. Reliability analyses showed an intraclass correlation coefficient (95% confidence interval) of 0.96 for the total score. There was a low correlation coefficient between the Turkish version of the Pain Catastrophizing Scale and body mass index, pain levels at rest and during activity, health-related quality of life, and fear and avoidance behaviors. [Conclusion] The results of this study indicate that the Turkish version of the Pain Catastrophizing Scale is a valid and reliable clinical and research tool for patients with ankylosing spondylitis.

  18. Catastrophic antiphospholipid syndrome presenting as fever of unknown origin

    Directory of Open Access Journals (Sweden)

    Fatma I Al-Beladi

    2012-01-01

    Full Text Available Antiphospholipid syndrome is characterized by the presence of antiphospholipid antibodies with characteristic clinical manifestation, which include venous, arterial thrombosis, thrombotic microangiopathy, and recurrent fetal loss. The syndrome can be secondary to many causes including systemic lupus erythematosus (SLE or "primary" antiphospholipid syndrome (APLS. We report a case of a man with catastrophic antiphospholipid syndrome (CAPS, which occurs when three or more organ systems are affected by thrombosis in less than a week. Catastrophic antiphospholipid syndrome is uncommon but often fatal. The patient received a successful treatment that controlled this disease and included intravenous heparin, antiplatelet, intravenous corticosteroid, and plasmapheresis.

  19. Catastrophic antiphospholipid syndrome presenting as fever of unknown origin.

    Science.gov (United States)

    Al-Beladi, Fatma I

    2012-01-01

    Antiphospholipid syndrome is characterized by the presence of antiphospholipid antibodies with characteristic clinical manifestation, which include venous, arterial thrombosis, thrombotic microangiopathy, and recurrent fetal loss. The syndrome can be secondary to many causes including systemic lupus erythematosus (SLE) or "primary" antiphospholipid syndrome (APLS). We report a case of a man with catastrophic antiphospholipid syndrome (CAPS), which occurs when three or more organ systems are affected by thrombosis in less than a week. Catastrophic antiphospholipid syndrome is uncommon but often fatal. The patient received a successful treatment that controlled this disease and included intravenous heparin, antiplatelet, intravenous corticosteroid, and plasmapheresis.

  20. Predicting catastrophes in nonlinear dynamical systems by compressive sensing.

    Science.gov (United States)

    Wang, Wen-Xu; Yang, Rui; Lai, Ying-Cheng; Kovanis, Vassilios; Grebogi, Celso

    2011-04-15

    An extremely challenging problem of significant interest is to predict catastrophes in advance of their occurrences. We present a general approach to predicting catastrophes in nonlinear dynamical systems under the assumption that the system equations are completely unknown and only time series reflecting the evolution of the dynamical variables of the system are available. Our idea is to expand the vector field or map of the underlying system into a suitable function series and then to use the compressive-sensing technique to accurately estimate the various terms in the expansion. Examples using paradigmatic chaotic systems are provided to demonstrate our idea.

  1. Predicting catastrophes in nonlinear dynamical systems by compressive sensing

    CERN Document Server

    Wang, Wen-Xu; Lai, Ying-Cheng; Kovanis, Vassilios; Grebogi, Celso

    2011-01-01

    An extremely challenging problem of significant interest is to predict catastrophes in advance of their occurrences. We present a general approach to predicting catastrophes in nonlinear dynamical systems under the assumption that the system equations are completely unknown and only time series reflecting the evolution of the dynamical variables of the system are available. Our idea is to expand the vector field or map of the underlying system into a suitable function series and then to use the compressive-sensing technique to accurately estimate the various terms in the expansion. Examples using paradigmatic chaotic systems are provided to demonstrate our idea.

  2. Global Catastrophes in Perspective: Asteroid Impacts vs Climate Change

    Science.gov (United States)

    Boslough, M. B.; Harris, A. W.

    2008-12-01

    When allocating resources to address threats, decision makers are best served by having objective assessments of the relative magnitude of the threats in question. Asteroids greater than about 1 km in diameter are assumed by the planetary impact community to exceed a "global catastrophe threshold". Impacts from smaller objects are expected to cause local or regional destruction, and would be the proximate cause of most associated fatalities. Impacts above the threshold would be expected to alter the climate, killing billions of people and causing a collapse of civilization. In this apocalyptic scenario, only a small fraction of the casualties would be attributable to direct effects of the impact: the blast wave, thermal radiation, debris, ground motion, or tsunami. The vast majority of deaths would come later and be due to indirect causes: starvation, disease, or violence as a consequence of societal disruption related to the impact-induced global climate change. The concept of a catastrophe threshold comes from "nuclear winter" studies, which form the basis for quantitative estimates of the consequences of a large impact. The probability estimates come from astronomical observations and statistical analysis. Much of the impact threat, at its core, is a climate-change threat. Prior to the Spaceguard Survey of Near-Earth Objects (NEOs), the chance of dying from an asteroid impact was estimated to be 1 in 25,000 (Chapman & Morrison, 1994). Most of the large asteroids have now been discovered, and none is on an impact trajectory. Moreover, new data show that mid-sized asteroids (tens to hundreds of meters across) are less abundant than previously thought, by a factor of three. We now estimate that the lifetime odds of being killed by the impact of one of the remaining undiscovered NEOs are about one in 720,000 for individuals with a life expectancy of 80 years (Harris, 2008). One objective way to compare the relative magnitude of the impact threat to that of

  3. Pain catastrophizing predicts verbal expression among children with chronic pain and their mothers

    Directory of Open Access Journals (Sweden)

    Shelby L Langer

    2016-03-01

    Full Text Available This study examined intra- and inter-personal associations between pain catastrophizing and verbal expression in 70 children with recurrent abdominal pain and their mothers. Participants independently completed the Pain Catastrophizing Scale. Mothers and children then talked about the child’s pain. Speech was categorized using a linguistic analysis program. Catastrophizing was positively associated with the use of negative emotion words by both mothers and children. In addition, mothers’ catastrophizing was positively associated with both mothers’ and children’s anger word usage, whereas children’s catastrophizing was inversely associated with mothers’ anger word usage. Findings extend the literature on behavioral and interpersonal aspects of catastrophizing.

  4. Hypertension and medical expenditure in the Japanese population:Review of prospective studies

    Institute of Scientific and Technical Information of China (English)

    Koshi; Nakamura; Tomonori; Okamura; Katsuyuki; Miura; Akira; Okayama

    2014-01-01

    Hypertension is a major determinant of health and is likely to have an effect on medical economics.The economic burden due to hypertension may be attributable not only to antihypertensive medication but also to the very expensive procedures required for cases of cardiovascular disease that occur more frequently in hypertensive compared with normotensive individuals.The objective of this article was to review articles published on prospective cohort studies that measured medical expenditure attributable to hypertension in community-dwelling populations in Japan.Many medical services in these populations are provided under the medical insurance system that requires the enrolment of all Japanese residents.Personal medical expenditure attributable to hypertension increases with worsening severity of the condition.Medical expenditure was increased further in cases of hypertensive patients who have another concomitant cardiovascular risk factor.In particular,hypertension,especially moderate-to-severe untreated hypertension,increases the risk of long-term hospitalization resulting in considerably higher medical expenditure,compared with non-hospitalized cases.Therefore,assuming that the use of antihypertensive medication is essential for hypertensive patients to prevent serious vascular diseases,a cost-effective highrisk strategy needs to be considered to reduce both ill-health and the economic burden due to hypertension.However,from a population perspective,medical expenditure attributable to hypertension comes mainly from pre-to-mild hypertension.Therefore,there is also a need to consider a population strategy that aims to shift the entire population to lower levels of blood pressure.

  5. Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda

    Science.gov (United States)

    Shrime, Mark G.; Sekidde, Serufusa; Linden, Allison; Cohen, Jessica L.; Weinstein, Milton C.; Salomon, Joshua A.

    2016-01-01

    Background The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. Methods Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. Findings Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term “surgical mission trip”. These results are robust to scenario and sensitivity analyses. Interpretation The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries

  6. Concrete ensemble Kalman filters with rigorous catastrophic filter divergence.

    Science.gov (United States)

    Kelly, David; Majda, Andrew J; Tong, Xin T

    2015-08-25

    The ensemble Kalman filter and ensemble square root filters are data assimilation methods used to combine high-dimensional, nonlinear dynamical models with observed data. Ensemble methods are indispensable tools in science and engineering and have enjoyed great success in geophysical sciences, because they allow for computationally cheap low-ensemble-state approximation for extremely high-dimensional turbulent forecast models. From a theoretical perspective, the dynamical properties of these methods are poorly understood. One of the central mysteries is the numerical phenomenon known as catastrophic filter divergence, whereby ensemble-state estimates explode to machine infinity, despite the true state remaining in a bounded region. In this article we provide a breakthrough insight into the phenomenon, by introducing a simple and natural forecast model that transparently exhibits catastrophic filter divergence under all ensemble methods and a large set of initializations. For this model, catastrophic filter divergence is not an artifact of numerical instability, but rather a true dynamical property of the filter. The divergence is not only validated numerically but also proven rigorously. The model cleanly illustrates mechanisms that give rise to catastrophic divergence and confirms intuitive accounts of the phenomena given in past literature.

  7. A case of seronegative catastrophic antiphospholipid antibody syndrome.

    Science.gov (United States)

    Shreders, Amanda; Bar, Michael

    2013-02-01

    Catastrophic antiphospholipid antibody syndrome (CAPS) is a rare syndrome associated with multiorgan failure that carries a high mortality rate. It has been defined previously by the presence of autoantibodies in a patient with acute multiorgan failure as a result of small vessel occlusion by multiple thrombi. We report a patient who meets all criteria of CAPS except for persistent seronegativity.

  8. The Application of Catastrophe Theory to Medical Image Analysis

    NARCIS (Netherlands)

    Kuijper, Arjan; Florack, L.M.J.

    2002-01-01

    In order to investigate the deep structure of Gaussian scale space images, one needs to understand the behaviour of critical points under the influence of blurring. We show how the mathematical framework of catastrophe theory can be used to describe the various different types of annihilations and c

  9. Enabling Unity of Effort in Response Activities during Complex Catastrophes

    Science.gov (United States)

    2013-03-01

    catastrophe (including any hurricane, tornado, storm, high water , winddriven water , tidal wave, tsunami, earthquake, volcanic eruption , landslide...the Insurrection Act, and the Stafford Act. Perhaps the most efficient means to achieve unity of effort would be to consolidate all forces under a...possible under our federalist system of government, where respective authorities are divided between federal, state and local jurisdictions. The most

  10. Alignment of Lyapunov Vectors: A Quantitative Criterion to Predict Catastrophes?

    Science.gov (United States)

    Beims, Marcus W.; Gallas, Jason A. C.

    2016-11-01

    We argue that the alignment of Lyapunov vectors provides a quantitative criterion to predict catastrophes, i.e. the imminence of large-amplitude events in chaotic time-series of observables generated by sets of ordinary differential equations. Explicit predictions are reported for a Rössler oscillator and for a semiconductor laser with optoelectronic feedback.

  11. Catastrophe Theory: A Unified Model for Educational Change.

    Science.gov (United States)

    Cryer, Patricia; Elton, Lewis

    1990-01-01

    Catastrophe Theory and Herzberg's theory of motivation at work was used to create a model of change that unifies and extends Lewin's two separate stage and force field models. This new model is used to analyze the behavior of academics as they adapt to the changing university environment. (Author/MLW)

  12. Vaginismus : Heightened Harm Avoidance and Pain Catastrophizing Cognitions

    NARCIS (Netherlands)

    Borg, Charmaine; Peters, Madelon L.; Schultz, Willibrord Weijmar; de Jong, Peter J.

    2012-01-01

    Introduction. Catastrophic appraisal of experienced pain may promote hypervigilance and intense pain, while the personality trait of harm avoidance (HA) might prevent the occurrence of correcting such experiences. Women inflicted with vaginismus may enter a self-perpetuating downward spiral of incre

  13. Catastrophic fire deaths: the numbers are back up.

    Science.gov (United States)

    Tremblay, K J

    1994-01-01

    The number of catastrophic multiple-death fires in the United States rose in 1993 from the record low of 1992 to a level more consistent with that of recent years. Despite our efforts to highlight risk factors, we continue to see the same problems year after year.

  14. 7 CFR 402.4 - Catastrophic Risk Protection Endorsement Provisions.

    Science.gov (United States)

    2010-01-01

    ... total household income at or below the national poverty level for a family of four, or less than 50..., provided that you execute a High Risk Land Exclusion Option and obtain a catastrophic risk protection... the landowners must agree in writing to such arrangement and have their social security number...

  15. A catastrophe theory model of the conflict helix, with tests.

    Science.gov (United States)

    Rummel, R J

    1987-10-01

    Macro social field theory has undergone extensive development and testing since the 1960s. One of these has been the articulation of an appropriate conceptual micro model--called the conflict helix--for understanding the process from conflict to cooperation and vice versa. Conflict and cooperation are viewed as distinct equilibria of forces in a social field; the movement between these equilibria is a jump, energized by a gap between social expectations and power, and triggered by some minor event. Quite independently, there also has been much recent application of catastrophe theory to social behavior, but usually without a clear substantive theory and lacking empirical testing. This paper uses catastrophe theory--namely, the butterfly model--mathematically to structure the conflict helix. The social field framework and helix provide the substantive interpretation for the catastrophe theory; and catastrophe theory provides a suitable mathematical model for the conflict helix. The model is tested on the annual conflict and cooperation between India and Pakistan, 1948 to 1973. The results are generally positive and encouraging.

  16. Catastrophic Head Injuries in High School and Collegiate Sports.

    Science.gov (United States)

    Mueller, Frederick O.

    2001-01-01

    Describes the incidence of catastrophic head injuries within high school and college sports. Data from a national surveillance system indicated that a football-related fatality occurred every year except one from 1945-99, mainly related to head injuries. From 1984-99, 69 football head-related injuries resulted in permanent disability. Deaths and…

  17. The Application of Catastrophe Theory to Image Analysis

    NARCIS (Netherlands)

    Kuijper, Arjan; Florack, L.M.J.

    2002-01-01

    In order to investigate the deep structure of Gaussian scale space images, one needs to understand the behaviour of critical points under the in flence of blurring. We show how the mathematical framework of catastrophe theory can be used to describe the various different types of annihilations and t

  18. [Establishing the personal identity of the victims in aviation catastrophes].

    Science.gov (United States)

    Abramov, S S; Alekseev, I V; Gedygushev, I A; Zaĭtsev, A B; Isaev, Iu S; Nedel'ko, N F; Miller, V V; Proskurin, V N; Khaĭrulin, E G; Shilin, A V

    1999-01-01

    Algorithm of organization measures and expert investigations is proposed, based on experience gained in expert studies during liquidation of aircraft catastrophes. It permits effective classification, differentiation, and identification of victims and is based on traditional and high technological methods of investigation.

  19. Concrete ensemble Kalman filters with rigorous catastrophic filter divergence

    Science.gov (United States)

    Kelly, David; Majda, Andrew J.; Tong, Xin T.

    2015-01-01

    The ensemble Kalman filter and ensemble square root filters are data assimilation methods used to combine high-dimensional, nonlinear dynamical models with observed data. Ensemble methods are indispensable tools in science and engineering and have enjoyed great success in geophysical sciences, because they allow for computationally cheap low-ensemble-state approximation for extremely high-dimensional turbulent forecast models. From a theoretical perspective, the dynamical properties of these methods are poorly understood. One of the central mysteries is the numerical phenomenon known as catastrophic filter divergence, whereby ensemble-state estimates explode to machine infinity, despite the true state remaining in a bounded region. In this article we provide a breakthrough insight into the phenomenon, by introducing a simple and natural forecast model that transparently exhibits catastrophic filter divergence under all ensemble methods and a large set of initializations. For this model, catastrophic filter divergence is not an artifact of numerical instability, but rather a true dynamical property of the filter. The divergence is not only validated numerically but also proven rigorously. The model cleanly illustrates mechanisms that give rise to catastrophic divergence and confirms intuitive accounts of the phenomena given in past literature. PMID:26261335

  20. Advertising expenditures in the nursing home sector: evaluating the need for and purpose of advertising.

    Science.gov (United States)

    Kash, Bita A; Boyer, Gregory J

    2008-01-01

    Marketing and advertising activities in the nursing home sector have increased in recent years, following the example of hospitals and health systems. The reasons for this trend may be related to the growth in competition but are not clearly identified yet. Theoretically, advertising becomes necessary to gain an advantage over the competition. The purpose of this study was to identify the reasons for the variation in advertising expenditures among nursing homes in Texas. For this study, we merged 2003 data from the Texas Medicaid Nursing Facility Cost Report, the Texas Nursing Home Quality Reporting System, and the Area Resource File for Texas. Using the Herfindahl-Hirschman Index, we then examined the correlations between advertising expenses and the level of market concentration. We evaluated the association between advertising expenditures and market competition using two logistic and four linear regression models. Total advertising expenses in Texas nursing homes ranged from $0 to $165,000 per year. Higher advertising expenditures were associated with larger facilities, higher occupancy, and high Medicare census. Market competition, however, was not a significant predictor of such expenses. Advertising seems to be more resource-driven than market-driven. Therefore, some advertising expenditures may be unnecessary, may lack impact, and may even be wasteful. Reducing unnecessary advertising costs could free up resources, which may be allocated to necessary resident care activities.

  1. Obesity and medicare expenditure: accounting for age-related height loss.

    Science.gov (United States)

    Onwudiwe, Nneka C; Stuart, Bruce; Zuckerman, Ilene H; Sorkin, John D

    2011-01-01

    To determine the relationship between BMI and Medicare expenditure for adults 65-years and older and determine whether this relationship changes after accounting for misclassification due to age-related height loss. Using a cross sectional study design, the relationship between BMI and fee-for-service Medicare expenditure was examined among beneficiaries who completed the Medicare Current Beneficiary Survey (MCBS) in 2002, were not enrolled in Medicare Health Maintenance Organization, had a self-reported height and weight, and were 65 and older (n = 7,706). Subjects were classified as underweight, normal weight, overweight, obese (obese I), and severely obese (obese II/III). To adjust BMI for the artifactual increase associated with age-related height loss, the reported height was transformed by adding the sex-specific age-associated height loss to the reported height in MCBS. The main outcome variable was total Medicare expenditure. There was a significant U-shaped pattern between unadjusted BMI and Medicare expenditure: underweight $4,581 (P accounting for height loss: underweight $4,640 (P cost is not found at "normal" BMI, but rather in overweight subjects with higher spending in the obese and underweight categories. Adjusting for loss-of-height with aging had little affect on cost estimates.

  2. MARKETING EXPENDITURES IN THE INDONESIAN CONSTRUCTION INDUSTRY

    Directory of Open Access Journals (Sweden)

    Krishna Mochtar

    2004-01-01

    Full Text Available In the 1960s, a “new” 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 “marketing mix”: 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. These four mixes are the main aspects of marketing and thus, should represent almost all expenditures in marketing in a company. From this research it is discovered that the responding contractors have only average efforts to improve or innovate their service, mostly using the latest construction methods and management approach. Correlated to their policy in the fourth mix (Place, they are still national oriented and not international oriented in marketing their services, this may lead to the big question of their survival; their motivation to innovate is only average while their target market is only national market. Their attitude to use more intensive “fees” policy rather than both product innovation and promotion is also interesting. Big percentage of the responding contractors assumes these “fees” are regular marketing practices. This attitude may better be stopped to make the construction industry practices healthier. Attitude to use more product innovation and true promotion approach in marketing in construction must be encouraged systematically in the future, to improve competitiveness in the long term.

  3. Hospitals should pay more attention to health care expenditure arrears clearance between%定点医院应重视医保经费往来欠款的清理

    Institute of Scientific and Technical Information of China (English)

    陈富新

    2013-01-01

    Along with the steady advancement of medical reform, can be said to universal health care has come of age.In this context, the current fixed-point hospital medical insurance patients from medical consumption to local health departments as the third party security mode of payment settlement as the main body is a kind of impact and test.Because of the payment and settlement methods are paid after the system, but also restricted by the medical service agreement signed hospitals and local health agencies; and the part of inpatient person since the pay part of the bil is not timely, resulting in a lot of business.These arrears is reflected in the hospital financial account receivable account showing a tendency to increase year by year.If not cleaned in time, wil inevitably become a ledger and dead, bring financial risks and losses to the hospital, should earnestly study and countermeasures.%随着国家医药改革的稳步推进,可以说全民医保时代已经到来。在这种大背景下,对现阶段定点医院收治地方医保患者产生的医疗消耗以地方医保部门作为第三方付费结算为主体的保障模式更是一种冲击和考验。因这种结算支付方式大都属于后付制,而且受医院与地方医保经办机构签订医疗服务协议的制约;加之部分住院患者个人自付部分的结账不及时,导致产生大量往来欠款。这些欠款反映在医院财务账面应收账款科目明显呈现出逐年递增的倾向。如果清理不及时,难免会成为贻账和死账,给医院带来资金风险和损失,应该认真加以研究和探讨对策。

  4. Effects of Medicaid disease management programs on medical expenditures: Evidence from a natural experiment in Georgia.

    Science.gov (United States)

    Kranker, Keith

    2016-03-01

    In recent decades, most states' Medicaid programs have introduced disease management programs for chronically ill beneficiaries. Interventions assist beneficiaries and their health care providers to appropriately manage chronic health condition(s) according to established clinical guidelines. Cost containment has been a key justification for the creation of these programs despite mixed evidence they actually save money. This study evaluates the effects of a disease management program in Georgia by exploiting a natural experiment that delayed the introduction of high-intensity services for several thousand beneficiaries. Expenditures for medical claims decreased an average of $89 per person per month for the high- and moderate-risk groups, but those savings were not large enough to offset the total costs of the program. Impacts varied by the intensity of interventions, over time, and across disease groups. Heterogeneous treatment effect analysis indicates that decreases in medical expenditures were largest at the most expensive tail of the distribution.

  5. Development of a Compendium of Energy Expenditures for Youth

    OpenAIRE

    Ainsworth Barbara E; Ridley Kate; Olds Tim S

    2008-01-01

    Abstract Background This paper presents a Compendium of Energy Expenditures for use in scoring physical activity questionnaires and estimating energy expenditure levels in youth. Method/Results Modeled after the adult Compendium of Physical Activities, the Compendium of Energy Expenditures for Youth contains a list of over 200 activities commonly performed by youth and their associated MET intensity levels. A review of existing data collected on the energy cost of youth performing activities ...

  6. Expenditure Ceilings—A Survey

    OpenAIRE

    Gösta Ljungman

    2008-01-01

    This paper looks at the factors that have to be considered when designing an aggregate expenditure ceiling. It is argued that expenditure ceilings are effective in promoting fiscal discipline and sustainability, but that a number of trade-offs have to be made when setting up a fiscal framework that will survive in a politically charged environment. The paper illustrates the discussion with a case study of medium-term aggregate expenditure ceilings in three countries: Finland, the Netherlands ...

  7. Aggregate Import Demand and Expenditure Components in Nigeria

    OpenAIRE

    Philip Chimobi Omoke

    2012-01-01

    This study uses disaggregated expenditure components of total national income to determine the behaviour of imports demand in Nigeria using annual time series data and by applying the Johansen-Juselius multivariate cointegration technique tests to find out if the relevant economic variables are cointegrated in the long run. Variables used in the study are volume of imports of goods and services, consumption expenditure, expenditure on investment goods, relative prices and a dummy variable for...

  8. The Causality between Government Revenue and Government Expenditure in Iran

    OpenAIRE

    Elyasi, Yousef; Rahimi, Mohammad

    2012-01-01

    The causal relationship between government revenue and government expenditure is an important subject in public economics especially to the control of budget deficit. The purpose of this study is to investigate the relationship between government revenue and government expenditure in Iran by applying the bounds testing approach to cointegration. The results of the causality test show that there is a bidirectional causal relationship between government expenditure and revenues in both long run...

  9. The Relationship between Inflation and Defense Expenditures.

    Science.gov (United States)

    1979-12-01

    resources they would be bid up in the expanding sector. See Robert Solow , "Evaluation," in After the Phillips Curve: Persistence of High Inflation and...can be explained by the respective rates of growth of money supply per unit of national product. ’𔃼 IF’risch, op. cit., p. 1311. Robert J. Gordon...Statistical Approach for Forecasting Defense Expenditures in the Short-run," in William F. Butler, Robert A. Kavesh, and Robert B. Platt, eds., "Methods and

  10. Attitudes toward Education Expenditures in Japan: Comparisons with Social Security and Welfare Services Expenditures

    Science.gov (United States)

    Nakazawa, Wataru

    2015-01-01

    This paper examines people's attitudes toward public spending on education in Japan. It is well known that Japan has the smallest public education expenditure relative to GDP among the OECD countries, and this may yield unequal opportunities in education. The tax burden in Japan is small compared to those in OECD countries, and there may be no…

  11. 11 CFR 110.20 - Prohibition on contributions, donations, expenditures, independent expenditures, and...

    Science.gov (United States)

    2010-01-01

    ... participate in the decision-making process of any person, such as a corporation, labor organization, political... activities, such as decisions concerning the making of contributions, donations, expenditures, or... to political committees and organizations of political parties. A foreign national shall...

  12. Do Expenditures Other than Instructional Expenditures Affect Graduation and Persistence Rates in American Higher Education?

    Science.gov (United States)

    Webber, Douglas A.; Ehrenberg, Ronald G.

    2010-01-01

    During the last two decades, median instructional spending per full-time equivalent (FTE) student at American 4-year colleges and universities has grown at a slower rate than median spending per FTE student in a number of other expenditure categories, including academic support, student services and research. Our paper uses institutional level…

  13. IDENTIFYING THE PARAMETERS OF THE MATHEMATICAL EXPENDITURE SYSTEM MODEL

    Directory of Open Access Journals (Sweden)

    ANA-PETRINA PĂUN

    2013-10-01

    Full Text Available This chapter describes an optimum regulation model for the public expenditures system in Romania. The aim of this work is to design an optimal control system of public expenditures in Romania. It contains an offline identification of the total public expenditures system in Romania for a timespan of 15 years. The total public expenditures system is a MISO type one (Multiple Input – Single Output and is identified by the use of the lowest foursquare applied on an OE (Output Error type model.

  14. On age distribution of population, government expenditure and fiscal federalism.

    Science.gov (United States)

    Echevarria, C A

    1995-08-01

    "In this paper I build a simple model to analyze the consequences that population growth imposes on the relative needs of expenditure of governments in a fiscal federalism setup. I assume, first, that some government expenditure items can be classified according to the age of their recipient individuals and, second, that different levels of government are usually assigned different expenditure programs. The implication is that, for an initially given level of effective public good provision, changes in the size of population as well as in its age structure will influence the composition of public expenditure for different layers of administration in a different manner."

  15. Out-of-pocket expenditure on chronic non-communicable diseases in sub-Saharan Africa: the case of rural Malawi.

    Directory of Open Access Journals (Sweden)

    Qun Wang

    Full Text Available In Sub-Saharan Africa (SSA the disease burden of chronic non-communicable diseases (CNCDs is rising considerably. Given weaknesses in existing financial arrangements across SSA, expenditure on CNCDs is often borne directly by patients through out-of-pocket (OOP payments. This study explored patterns and determinants of OOP expenditure on CNCDs in Malawi. We used data from the first round of a longitudinal household health survey conducted in 2012 on a sample of 1199 households in three rural districts in Malawi. We used a two-part model to analyze determinants of OOP expenditure on CNCDs. 475 respondents reported at least one CNCD. More than 60% of the 298 individuals who reported seeking care incurred OOP expenditure. The amount of OOP expenditure on CNCDs comprised 22% of their monthly per capita household expenditure. The poorer the household, the higher proportion of their monthly per capita household expenditure was spent on CNCDs. Higher severity of disease was significantly associated with an increased likelihood of incurring OOP expenditure. Use of formal care was negatively associated with the possibility of incurring OOP expenditure. The following factors were positively associated with the amount of OOP expenditure: being female, Alomwe and household head, longer duration of disease, CNCDs targeted through active screening programs, higher socio-economic status, household head being literate, using formal care, and fewer household members living with a CNCD within a household. Our study showed that, in spite of a context where care for CNCDs should in principle be available free of charge at point of use, OOP payments impose a considerable financial burden on rural households, especially among the poorest. This suggests the existence of important gaps in financial protection in the current coverage policy.

  16. Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia and Thailand.

    Science.gov (United States)

    Seeberg, Jens; Pannarunothai, Supasit; Padmawati, Retna Siwi; Trisnantoro, Laksono; Barua, Nupur; Pandav, Chandrakant S

    2014-02-01

    This article presents a comparative analysis of socio-economic disparities in relation to treatment-seeking strategies and healthcare expenditures in poor neighbourhoods within larger health systems in four cities in India, Indonesia and Thailand. About 200 households in New Delhi, Bhubaneswar, Jogjakarta and Phitsanulok were repeatedly interviewed over 12 months to relate health problems with health seeking and health financing at household level. Quantitative data were complemented with ethnographic studies involving the same neighbourhoods and a number of private practitioners at each site. Within each site, the higher and lower income groups among the poor were compared. The lower income group was more likely than the higher income group to seek care from less qualified health providers and incur catastrophic health spending. The study recommends linking quality control mechanisms with universal health coverage (UHC) policies; to monitor the impact of UHC among the poorest; intervention research to reach the poorest with UHC; and inclusion of private providers without formal medical qualification in basic healthcare.

  17. 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

    Directory of Open Access Journals (Sweden)

    Evelyne Eugenia Rodríguez-Ortega

    2012-01-01

    Full Text Available 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 Oportunidades beneficiaries. RESULTS: About 63.3% of households spent an average annual amount of 3320 Mexican pesos (MEX$ on healthcare for beneficiary children. Between 4.3 and 11.6% of households experienced catastrophic spending, depending on the definition adopted. Due to economic trouble, 15.5% of households postponed and 10.0% cancelled medical care for their child. CONCLUSIONS: Even though children are affiliated to the SMNG, the economic burden associated with attending their health is still an issue for families.OBJETIVO: Analizar el gasto en salud y gasto catastrófico en los niños beneficiarios del Seguro Médico para una Nueva Generación (SMNG, programa creado en 2007 para niños sin seguridad social nacidos a partir del 1o de diciembre de 2006. MATERIAL Y MÉTODOS: Con información de la Encuesta Nacional del SMNG se calculó el gasto en salud y el gasto catastrófico de los hogares de acuerdo a varias definiciones. Los resultados se presentan por nivel socioeconómico, para zonas urbanas y rurales y por pertenencia al programa Oportunidades. RESULTADOS: El 63.3% de los hogares gastaron en la salud de los niños un promedio anual de 3320 pesos. Entre el 4.3 y el 11.6% de los hogares incurrieron en gasto catastrófico, dependiendo de la definición. Debido a problemas económicos, 15.5% pospuso y 10% no realizó la atención médica del niño. CONCLUSIONES: Aún cuando los hogares están afiliados al SMNG, todavía enfrentan restricciones econ

  18. Tobacco smoking patterns, awareness and expenditure: a cross-sectional overview from Surat City, India

    Directory of Open Access Journals (Sweden)

    Rajkumar Bansal

    2012-06-01

    Full Text Available BACKGROUND: As smoking is a major risk factor in India, the objective of present study was to assess smoking patterns, expenditure and awareness amongst smokers and to examine factors associated with the severity of smoking in Surat city.METHODS: Community-based cross-sectional study was conducted with the use of pre-structured questionnaire tool targeting 281 current smokers in the slums of 20 Urban Health Centers. Smokers were categorized based on pack-years, which means the number of packs smoked per day multiplied by the duration of smoking (mild 15, and based on the number of cigarette/bidis smoked per day without the duration component (mild 0.05. With the influence of friends (50%, about 60% smokers engage into this habit before the age of 20 years. Though only 20% of current smokers were not aware of the consequences of active smoking, more than 50% did not know about the same for passive smoking. The lowest socioeconomic class spends 44% of their income on tobacco products compared to 7% in the highest class.CONCLUSION: The study provides insights for information, education and counseling (IEC activities which should take into account health impact of bidi smoking, low awareness of health impact of passive smoking, and higher percentage of total monthly expenditure on tobacco among low-income household resulting in crowding out of expenditures on other needs.

  19. Tourism Expenditures and Environment in Thailand

    Directory of Open Access Journals (Sweden)

    Malliga Sompholkrang

    2014-09-01

    Full Text Available Tourism activities affect the environment of different destinations, which is influenced by different tourists’ consumption. The objective of this study is to examine the relationship between inbound tourist expenditures and three main environmental dimensions, which are carbon dioxide emission from transport, energy demand, and water usage, in Thailand. This paper employs Vector Autoregressive (VAR models to determine the relationship of variables. Data from Ministry of Energy, Bank of Thailand, Metropolitan Electricity Authority, Provincial Waterworks Authority, National Statistical Office, Department of Tourism, and Tourism Authority of Thailand between 1988 and 2012 have been applied in the model. Note that, energy demand is represented by total electricity consumption of hotel and accommodation sector in Thailand, while water usage is represented by the total water consumption of tourists. This study found the relationships among tourists’ expenditures, carbon dioxide emission from transport, energy demand, and water usage. Therefore, the policies recommendations may be essential to prepare the optimal schemes and budgets for encountering the environmental impacts from tourism business expansion.

  20. Medical Expenditure for Chronic Diseases in Mexico: The Case of Selected Diagnoses Treated by the Largest Care Providers.

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    Alejandro Figueroa-Lara

    Full Text Available Chronic diseases (CD are a public health emergency in Mexico. Despite concern regarding the financial burden of CDs in the country, economic studies have focused only on diabetes, hypertension, and cancer. Furthermore, these estimated financial burdens were based on hypothetical epidemiology models or ideal healthcare scenarios. The present study estimates the annual expenditure per patient and the financial burden for the nine most prevalent CDs, excluding cancer, for each of the two largest public health providers in the country: the Ministry of Health (MoH and the Mexican Institute of Social Security (IMSS.Using the Mexican National Health and Nutrition Survey 2012 (ENSANUT as the main source of data, health services consumption related to CDs was obtained from patient reports. Unit costs for each provided health service (e.g. consultation, drugs, hospitalization were obtained from official reports. Prevalence data was obtained from the published literature. Annual expenditure due to health services consumption was calculated by multiplying the quantity of services consumed by the unit cost of each health service.The most expensive CD in both health institutions was chronic kidney disease (CKD, with an annual unit cost for MoH per patient of US$ 8,966 while for IMSS the expenditure was US$ 9,091. Four CDs (CKD, arterial hypertension, type 2 diabetes, and chronic ischemic heart disease accounted for 88% of the total CDs financial burden (US$ 1.42 billion in MoH and 85% (US$ 3.96 billion in IMSS. The financial burden of the nine CDs analyzed represents 8% and 25% of the total annual MoH and IMSS health expenditure, respectively.The financial burden from the nine most prevalent CDs, excluding cancer, is already high in Mexico. This finding by itself argues for the need to improve health promotion and disease detection, diagnosis, and treatment to ensure CD primary and secondary prevention. If the status quo remains, the financial burden could be

  1. Effectiveness of the psychological and pharmacological treatment of catastrophization in patients with fibromyalgia: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Magallón Rosa

    2009-04-01

    Full Text Available Abstract Background Fibromyalgia is a prevalent and disabling disorder characterized by widespread pain and other symptoms such as insomnia, fatigue or depression. Catastrophization is considered a key clinical symptom in fibromyalgia; however, there are no studies on the pharmacological or psychological treatment of catastrophizing. The general aim of this study is to assess the effectiveness of cognitive-behaviour therapy and recommended pharmacological treatment for fibromyalgia (pregabalin, with duloxetine added where there is a comorbid depression, compared with usual treatment at primary care level. Method/design Design: A multi-centre, randomized controlled trial involving three groups: the control group, consisting of usual treatment at primary care level, and two intervention groups, one consisting of cognitive-behaviour therapy, and the other consisting of the recommended pharmacological treatment for fibromyalgia. Setting: 29 primary care health centres in the city of Zaragoza, Spain. Sample: 180 patients, aged 18–65 years, able to understand and read Spanish, who fulfil criteria for primary fibromyalgia, with no previous psychological treatment, and no pharmacological treatment or their acceptance to discontinue it two weeks before the onset of the study. Intervention: Psychological treatment is based on the manualized protocol developed by Prof. Escobar et al, from the University of New Jersey, for the treatment of somatoform disorders, which has been adapted by our group for the treatment of fibromyalgia. It includes 10 weekly sessions of cognitive-behaviour therapy. Pharmacological therapy consists of the recommended pharmacological treatment for fibromyalgia: pregabalin (300–600 mg/day, with duloxetine (60–120 mg/day added where there is a comorbid depression. Measurements: The following socio-demographic data will be collected: sex, age, marital status, education, occupation and social class. The diagnosis of psychiatric

  2. 45 CFR 95.10 - Time limit for claiming payment for expenditures made before October 1, 1979.

    Science.gov (United States)

    2010-10-01

    ... GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Time Limits for States To File Claims § 95.10 Time limit for... files a claim with us for that expenditure before January 1, 1981. Section 95.19 lists the exceptions...

  3. 42 CFR 435.1008 - 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... ISLANDS, AND AMERICAN SAMOA Federal Financial Participation Limitations on Ffp § 435.1008 FFP in... identity. Except for individuals described in § 435.406(a)(1)(v), FFP will not be available to a State...

  4. Renúncia de arrecadação fiscal: subsídios para discussão e formulação de uma política pública Tax expenditures on health care: contributions toward a public policy agenda

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    Maria de Fátima Siliansky de Andreazzi

    2007-01-01

    Full Text Available Este trabalho pretende investigar diversos aspectos relacionados aos incentivos governamentais que permitem o abatimento de parte dos gastos das famílias e empresas com assistência à saúde no imposto de renda. Como tais incentivos são deduzidos da renda tributável das pessoas físicas e do lucro tributável das pessoas jurídicas, a arrecadação fiscal do Estado é forçosamente reduzida. Segundo estimativa da Secretaria da Receita Federal, o valor desta renúncia, considerando as despesas com planos de saúde e os desembolsos diretos com assistência médico-hospitalar, girou em torno de R$ 2,8 bilhões em 2005. Em um quadro de subfinanciamento crônico do SUS, esta problemática será discutida à luz da eqüidade do financiamento e dos conflitos de interesse evidenciados no setor saúde.The work discusses the tax incentives with private medical expenses to families and workers in Brazil. The estimate presented by the Federal Fiscal Authority is R$ 2,8 billions in 2005. Initially, a review of concepts about the matter is performed that stressed the lack of consensus in the academic community, about the meaning of tax expenditures. It discussed, also, the relations between this fiscal policy and demand to private health insurance. After, the article presents the results of a documental research concerning political positions of relevant Brazilian social actors found in the 2000's. The discussion pointed to problems of equity and conflicts of interests that are involved with the changes in the rules that discipline these incentives.

  5. Hurdles for sport consumption? Determining factors of household sports expenditure

    NARCIS (Netherlands)

    Thibaut, Erik; Vos, Steven; Scheerder, Jeroen

    2013-01-01

    The purpose of this article is to explore the determining factors of household expenditures on sports participation. Due to a relatively large amount of zero-expenditures, simple regression methods are not suited. Because of methodological reasons, the two-step Heckman approach is used over the Tobi

  6. Educational Expenditures and Student Engagement: When Does Money Matter?

    Science.gov (United States)

    Pike, Gary R.; Smart, John C.; Kuh, George D.; Hayek, John C.

    2006-01-01

    The few studies focusing on the relationships between higher education expenditures and student outcomes have produced contradictory results. This study hypothesized that the lack of consistent relationships is a function of the fact that the effects of expenditures on outcomes are mediated by student engagement. Furthermore, it is expected that…

  7. Productive Government Expenditure in Monetary Business Cycle Models

    NARCIS (Netherlands)

    L. Linnemann; A. Schabert

    2006-01-01

    This paper assesses the transmission of fiscal policy shocks in a New Keynesian framework where government expenditures contribute to aggregate production. It is shown that even if the impact of government expenditures on production is small, this assumption helps to reconcile the models' prediction

  8. Faculty Employment and R&D Expenditures at Research Universities

    Science.gov (United States)

    Zhang, Liang; Ehrenberg, Ronald G.

    2010-01-01

    This study uses panel data to examine the relationship between faculty employment and external R&D expenditures at Research and Doctoral institutions over a 15-year period of time. On average, a 1% increase in the number of full-time faculty is associated with about 0.2% increase in total R&D expenditure. Further, a one percentage point increase…

  9. Public drug expenditure in the Republic of Ireland.

    Science.gov (United States)

    Barry, Michael; Usher, Cara; Tilson, Lesley

    2010-06-01

    In Ireland, expenditure on medicines in the community has increased over sixfold from 300 million euro in 1998 to 1.9 billion euro in 2008. The Health Service Executive has examined all aspects of the drugs supply chain in an attempt to obtain value for money. The 2006 agreement between the Health Service Executive and the Irish Pharmaceutical Healthcare Association resulted in a 35% reduction in the price of patent-expired medicines with estimated savings of 248 million euro. The agreement has been extended to 2012 providing a further 40% price reduction for those off-patent products. Reductions in wholesaler margins and pharmacy reimbursement will provide savings of 130 million euro per annum. Patient co-payment under the Drugs Payment Scheme increased to 120 euro per month and a new co-payment for medical card holders is to be introduced. Since September 2009, all new pharmaceutical products are considered for pharmacoeconomic assessment. Generic substitution and reference pricing are to be introduced in 2011.

  10. Catastrophic senescence and semelparity in the Penna aging model

    CERN Document Server

    Pinol, C M N

    2010-01-01

    The catastrophic senescence of the Pacific salmon is among the initial tests used to validate the Penna aging model. Based on the mutation accumulation theory, the sudden decrease in fitness following reproduction may be solely attributed to the semelparity of the species. In this work, we report other consequences of mutation accumulation. Contrary to earlier findings, such dramatic manifestation of aging depends not only on the choice of breeding strategy but also on the value of the reproduction age, R, and the mutation threshold, T. Senescence is catastrophic when T\\leq R. As the organism's tolerance for harmful genetic mutations increases, the aging process becomes more gradual. We observe senescence that is threshold dependent whenever T>R. That is, the sudden drop in survival rate occurs at age equal to the mutation threshold value.

  11. Relating the environmental impact of consumption to household expenditures : An input-output analysis

    NARCIS (Netherlands)

    Kerkhof, Annemarie C.; Nonhebel, Sanderine; Moll, Henri C.

    2009-01-01

    In this paper we evaluate the relationships between household expenditures and the environmental impact categories climate change, acidification, eutrophication and smog formation, by combining household expenditures with environmentally extended input–output analysis. Expenditure elasticities are e

  12. Daily energy expenditure, physical activity, and weight loss in Parkinson's disease patients

    Science.gov (United States)

    Patients with Parkinson's disease (PD) commonly exhibit weight loss (WL) which investigators attribute to various factors, including elevated energy expenditure. We tested the hypothesis that daily energy expenditure (DEE) and its components, resting energy expenditure (REE) and physical activity (P...

  13. Development of a Compendium of Energy Expenditures for Youth

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    Ainsworth Barbara E

    2008-09-01

    Full Text Available Abstract Background This paper presents a Compendium of Energy Expenditures for use in scoring physical activity questionnaires and estimating energy expenditure levels in youth. Method/Results Modeled after the adult Compendium of Physical Activities, the Compendium of Energy Expenditures for Youth contains a list of over 200 activities commonly performed by youth and their associated MET intensity levels. A review of existing data collected on the energy cost of youth performing activities was undertaken and incorporated into the compendium. About 35% of the activity MET levels were derived from energy cost data measured in youth and the remaining MET levels estimated from the adult compendium. Conclusion The Compendium of Energy Expenditures for Youth is useful to researchers and practitioners interested in identifying physical activity and energy expenditure values in children and adolescents in a variety of settings.

  14. Le gouvernement mondial des catastrophes « naturelles »

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    Sandrine Revet

    2015-01-01

    Full Text Available Depuis la fin des années 1980, une tentative de gouvernement international des catastrophes dites « naturelles » a progressivement vu le jour. Celui-ci prétend coordonner à l’échelle internationale des actions relevant à la fois de la prévention des risques et de la gestion de crise. L’article propose de décrire ce processus en en retraçant les grandes étapes, depuis la Décennie internationale pour la prévention des catastrophes naturelles de l’ONU (1990-1999 jusqu’aux négociations ayant mené au Cadre d’action de Hyogo (CAH, 2005-2015. Il mettra en lumière les grandes tensions qui ont animé ce processus et qui révèlent les différentes approches adoptées face aux catastrophes naturelles : mettre en place des politiques de prévention qui misent sur la transformation en profondeur des choix de développement ou insister sur les capacités technologiques de prévision, de communication de l’alerte et de gestion des crises provoquées par les catastrophes lorsqu’elles surviennent ? Nous nous intéresserons enfin aux enjeux qui seront soulevés en 2015 par les négociations du prochain cadre d’action international CAH2 lors de la conférence mondiale qui se tiendra à Sendaï au Japon.

  15. Public Expenditure Evolution in EU4 Countries

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    Daniela-Georgeta BEJU

    2014-11-01

    Full Text Available In contemporary society, the economy is the main pillar on which the state is based and life society is directly influenced by its evolution. So, development, or rather growth affects the smooth running of things, but this in turn is influenced by the decisions taken by individuals from government institutions, the ability of people to make profitable investments, but also to manage it more efficiently.The paper aims to highlight the importance of knowledge in public spending system, because the local communities or nations have to be awareness that nowhere can not consume more than they produce, and when this happens, the social-economic progress is endangered, so burden and poverty population are inevitable consequences. The study is based on analysis of public expenditure system in four Eastern European countries (Czech Republic, Romania, Slovakia, Hungary in the period 2000-2013.

  16. Modeling total expenditure on warranty claims

    CERN Document Server

    Mitra, Abhimanyu

    2010-01-01

    We approximate the distribution of total expenditure of a retail company over warranty claims incurred in a fixed period [0, T], say the following quarter. We consider two kinds of warranty policies, namely, the non-renewing free replacement warranty policy and the non-renewing pro-rata warranty policy. Our approximation holds under modest assumptions on the distribution of the sales process of the warranted item and the nature of arrivals of warranty claims. We propose a method of using historical data to statistically estimate the parameters of the approximate distribution. Our methodology is applied to the warranty claims data from a large car manufacturer for a single car model and model year.

  17. PUBLIC EXPENDITURES POLITICS ON A NATIONAL LEVEL

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    ANA-PETRINA PĂUN

    2013-10-01

    Full Text Available The development level of a society is closely related to the development state of its individuals. Ensuring a high level of welfare for individuals is done through public politics. In this work, the definition of public politics is presented through the synthesis of several authors` points of view. Starting from these visions, we have presented at a national level the public politics of public expenditures and those of public debt respectively. In regard to public debt politics, we have presented the „Public debt management (Management of government public debt and the authorisation and supervision of local public debt” politic along with its aim and objectives. Towards the final part of the document we have emphasised the objectives of the strategy regarding government public debt management on medium term for 2012-2014 (Strategy.

  18. Bifurcation and catastrophe of seepage flow system in broken rock

    Institute of Scientific and Technical Information of China (English)

    MIAO Xie-xing; LI Shun-cai; CHEN Zhan-qing

    2009-01-01

    The study of dynamical behavior of water or gas flows in broken rock is a basic research topic among a series of key projects about stability control of the surrounding rocks in mines and the prevention of some disasters such as water inrush or gas outburst and the protection of the groundwater resource. It is of great theoretical and engineering importance in respect of promo-tion of security in mine production and sustainable development of the coal industry. According to the non-Darcy property of seepage flow in broken rock dynamic equations of non-Darcy and non-steady flows in broken rock are established. By dimensionless transformation, the solution diagram of steady-states satisfying the given boundary conditions is obtained. By numerical analysis of low relaxation iteration, the dynamic responses corresponding to the different flow parameters have been obtained. The stability analysis of the steady-states indicate that a saddle-node bifurcaton exists in the seepage flow system of broken rock. Consequently, using catastrophe theory, the fold catastrophe model of seepage flow instability has been obtained. As a result, the bifurcation curves of the seepage flow systems with different control parameters are presented and the standard potential function is also given with respect to the generalized state variable for the fold catastrophe of a dynamic system of seepage flow in broken rock.

  19. Catastrophic subsidence: An environmental hazard, shelby county, Alabama

    Science.gov (United States)

    Lamoreaux, Philip E.; Newton, J. G.

    1986-03-01

    Induced sinkholes (catastrophic subsidence) are those caused or accelerated by human activities These sinkholes commonly result from a water level decline due to pumpage Construction activities in a cone of depression greatly increases the likelihood of sinkhole occurrence Almost all occur where cavities develop in unconsolidated deposits overlying solution openings in carbonate rocks. Triggering mechanisms resulting from water level declines are (1) loss of buoyant support of the water, (2) increased gradient and water velocity, (3) water-level fluctuations, and (4) induced recharge Construction activities triggering sinkhole development include ditching, removing overburden, drilling, movement of heavy equipment, blasting and the diversion and impoundment of drainage Triggering mechanisms include piping, saturation, and loading Induced sinkholes resulting from human water development/management activities are most predictable in a youthful karst area impacted by groundwater withdrawals Shape, depth, and timing of catastrophic subsidence can be predicted in general terms Remote sensing techniques are used in prediction of locations of catastrophic subsidence. This provides a basis for design and relocation of structures such as a gas pipeline, dam, or building Utilization of techniques and a case history of the relocation of a pipeline are described

  20. Evidence for Middle Amazonian catastrophic flooding and glaciation on Mars

    Science.gov (United States)

    Rodríguez, J. Alexis P.; Gulick, Virginia C.; Baker, Victor R.; Platz, Thomas; Fairén, Alberto G.; Miyamoto, Hideaki; Kargel, Jeffrey S.; Rice, James W.; Glines, Natalie

    2014-11-01

    Early geologic investigations of Mars revealed some of the largest channels in the Solar System (outflow channels), which appear to have mostly developed ∼3 byr ago. These channels have been the subject of much scientific inquiry since the 1970s and proposed formative processes included surface erosion by catastrophic floods, glaciers, debris flows and lava flows. Based on the analysis of newly acquired Mars Reconnaissance Orbiter (MRO) Context (CTX, 5.15-5.91 m/pixel) and High Resolution Imaging Science Experiment (HiRISE, 25-50 cm/pixel) image data, we have identified a few locations contained within relatively narrow canyons of the southern circum-Chryse outflow channels that retain well-preserved decameter/hectometer-scale landform assemblages. These terrains include landforms consistent in shape, dimension and overall assemblage to those produced by catastrophic floods, and at one location, to glacial morphologies. Impact crater statistics for four of these surfaces, located within upstream, midstream and downstream outflow channel surfaces, yield an age estimate of ∼600 myr. This suggests that the southern circum-Chryse outflow channels were locally resurfaced by some of the most recent catastrophic floods on the planet, and that these floods coexisted within regional glacier environments as recently as during the Middle Amazonian.