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...
Poehlein, Gary W.; And Others
Illustrates a system of calculating dollar expenditures over periods of time in terms of present value. The system enables planners, school boards, and administrators to compare expenditure alternatives as a decisionmaking factor. (Author)
The primary objective of the Public Expenditure Review (PER) is to assist the Ministry of Finance (MOF) in identifying opportunities for efficiency gains in some key categories of government expenditure. In this context, policy makers face two related fiscal dilemmas. First, how can expenditure efficiency are increased to provide public services with fewer resources? Second, how can the fi...
Full Text Available The tax system of the Republic of Croatia contains a large number of very diverse kinds of tax expenditures whose the declared aim is to achieve certain social and economic objectives. This paper considers all the items that constitute tax expenditures in Croatia, within the systems of the personal income tax, corporate income tax, and real estate transfer tax and value added tax. The objective of the article is to determine the real level of tax expenditures per form of tax in the 2001-2004 period. We hypothesised that the tax expenditures in the analysed forms of tax are both high and growing, which was ultimately borne out, for almost all the analysed items in the tax forms considered are growing.
Hoffman, James M; Shah, Nilay D; Vermeulen, Lee C; Doloresco, Fred; Martin, Patrick K; Blake, Sharon; Matusiak, Linda; Hunkler, Robert J; Schumock, Glen T
Drug expenditure trends in 2007 and 2008, projected drug expenditures for 2009, and factors likely to influence drug expenditures are discussed. Various factors are likely to influence drug expenditures in 2009, including drugs in development, the diffusion of new drugs, drug safety concerns, generic drugs, Medicare Part D, and changes in the drug supply chain. The increasing availability of important generic drugs and drug safety concerns continue to moderate growth in drug expenditures. The drug supply chain remains dynamic and may influence drug expenditures, particularly in specialized therapeutic areas. Initial data suggest that the Medicare Part D benefit has influenced drug expenditures, but the ultimate impact of the benefit on drug expenditures remains unclear. From 2006 to 2007, total U.S. drug expenditures increased by 4.0%, with total spending rising from $276 billion to $287 billion. Drug expenditures in clinics continue to grow more rapidly than in other settings, with a 9.9% increase from 2006 to 2007. Hospital drug expenditures increased at a moderate rate of only 1.6% from 2006 to 2007; through the first nine months of 2008, hospital drug expenditures increased by only 2.8% compared with the same period in 2007. In 2009, we project a 0-2% increase in drug expenditures in outpatient settings, a 1-3% increase in expenditures for clinic-administered drugs, and a 1-3% increase in hospital drug expenditures.
Ketchum, K; Lavigne, R.; Plummer, R.
The oil sands are a strategic Canadian resource for which federal and provincial governments provide financial incentives to develop and exploit. This report describes the Oil Sands Tax Expenditure Model (OSTEM) developed to estimate the size of the federal income tax expenditure attributed to the oil sands industry. Tax expenditures are tax concessions which are used as alternatives to direct government spending for achieving government policy objectives. The OSTEM was developed within the business Income Tax Division of Canada's Department of Finance. Data inputs for the model were obtained from oil sands developers and Natural Resources Canada. OSTEM calculates annual revenues, royalties and federal taxes at project levels using project-level projections of capital investment, operating expenses and production. OSTEM calculates tax expenditures by comparing taxes paid under different tax regimes. The model also estimates the foregone revenue as a percentage of capital investment. Total tax expenditures associated with investment in the oil sands are projected to total $820 million for the period from 1986 to 2030, representing 4.6 per cent of the total investment. 10 refs., 2 tabs., 7 figs
Full Text Available To what extent do frequently cited determinants of military spending allow us to predict and forecast future levels of expenditure? The authors draw on the data and specifications of a recent model on military expenditure and assess the predictive power of its variables using in-sample predictions, out-of-sample forecasts and Bayesian model averaging. To this end, this paper provides guidelines for prediction exercises in general using these three techniques. More substantially, however, the findings emphasize that previous levels of military spending as well as a country’s institutional and economic characteristics particularly improve our ability to predict future levels of investment in the military. Variables pertaining to the international security environment also matter, but seem less important. In addition, the results highlight that the updated model, which drops weak predictors, is not only more parsimonious, but also slightly more accurate than the original specification.
Full Text Available 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.
This paper studies the effect of a change in the marginal costs of advertising on advertising expenditures of firms and consumer prices across industries. It makes use of a unique policy change that caused a decrease of the taxation on advertising expenditures in parts of Austria and a simultaneous increase in other parts. Advertising expenditures move immediately in the opposite direction to the marginal costs of advertising. Simultaneously the price reaction to advertising is negative in so...
Urbinati, Duccio; Rémuzat, Cécile; Kornfeld, Åsa; Vataire, Anne-Lise; Cetinsoy, Laurent; Aballéa, Samuel; Mzoughi, Olfa; Toumi, Mondher
, Germany (-€831 million), Greece (-€808 million), Portugal (-€243 million), and Hungary (-€84 million). The main source of savings came from the cardiovascular, central nervous system, and respiratory areas and from biosimilar entries. Oncology, immunology, and inflammation, in contrast, lead to additional expenditure. The model was particularly sensitive to the time to market of branded products, generic prices, generic penetration, and the distribution of biosimilars. The results of this forecast suggested a decrease in pharmaceutical expenditure in the studied period. The model was sensitive to pharmaceutical policy decisions.
Ammar Ben Zaed
Full Text Available This article aims to analyze and interpret the phenomenon of increased public expenditures and test explanatory theories as well as to analyze Abstract the relationship between public spending and GDP in the short and long term where you see the Wagner hypothesis that causal heading of GDP to government spending while there is a causal relationship analysis positive trending of government spending to GDP according to the Keynesian hypothesis in this study will be used descriptive analytical method to validate these hypotheses. Results in the short and long term made it clear that there is a difference in the outcome of Applied Studies where we find that each supports a relationship Wagner in the sense that the causal trending of real GDP to government spending and more precisely to increase the economic growth lead to increased aggregate demand which leads in turn increasing the need to increase government spending and to increase the resources available to the government sector to finance the increase in spending by the additional resources resulting from the economic growth while others opines opposes the existence of the relationship.
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.
Aizenman, Joshua; Glick, Reuven
This paper clarifies one of the puzzling results of the economic growth literature: the impact of military expenditure is frequently found to be non-significant or negative, yet most countries spend a large fraction of their GDP on defense and the military. We start by empirical evaluation of the non- linear interactions between military expenditure, external threats, corruption, and other relevant controls. While growth falls with higher levels of military spending, given the values of the o...
U.S. Department of Health & Human Services — This dataset reports summary level expenditure data associated with the new adult group established under the Affordable Care Act. These state expenditures are...
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
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.
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
The purpose of this supplement to the Household Energy Consumption and Expenditures 1990 report is to provide information on the use of energy in residential housing units, specifically at the four Census regions and nine Census division levels. This report includes household energy consumption, expenditures, and prices for natural gas, electricity, fuel oil, liquefied petroleum gas (LPG), and kerosene as well as household wood consumption. For national-level data, see the main report, Household Energy Consumption and Expenditures 1990
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,...
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,...
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,...
The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 States and the District of Columbia and in aggregate for the United States. The estimates are provided by energy source and economic sector. This report is an update of the State Energy Price and Expenditure Report 1989 published in September 1991. Energy price and expenditure estimates are published for the years 1970, 1975, 1980, and 1985 through 1990. Documentation follows the tables and describes how the price estimates are developed, including sources of data, methods of estimation, and conversion factors applied
Full Text Available The purpose of the paper is to provide a prognosis of total public expenditure and types of expenditures, starting from the evolution in time of total public expenditure and spending on public services, defense, public order and safety, economic affairs, environmental protection, housing and community amenities, health, recreation, culture and religion, education and social protection.
Buchowski, MS; Majchrzak, KM; Blomquist, K; Chen, KY; Byrne, DW; Bachorowski, J-A
Objective To measure energy expenditure (EE) and heart rate (HR) during genuine laughter. Design Experimental trial of viewing film clips in four cycles either intended to evoke laughter (humorous −10 min) or unlikely to elicit laughter (not humorous −5 min) under strictly controlled conditions of a whole-room indirect calorimeter equipped with audio recording system. Participants Forty five adult friend dyads in either same-sex male (n=7), same-sex female (n=21) and mix-sex male-female (n=17); age 18–34 years; body mass index 24.7±4.9 (range 17.9–41.1). Measurements Energy expenditure in a whole-room indirect calorimeter, HR using Polar HR monitor. Laugh rate, duration and type from digitized audio data using a computerized system and synchronized with HR and EE results. Results Laughter EE was 0.79±1.30 kJ/min (0.19±0.31 kcal/min) higher than resting EE (Plaughter segments increased above resting by 2.1±3.8 beats/min, ranging from −7.6 to 26.8 beats/min. Laughter EE was correlated with HR (rs=0.250, Plaughter EE and HR were positively correlated with laughter duration (rs=0.282 and 0.337, both Plaughter causes a 10–20% increase in EE and HR above resting values, which means that 10–15 min of laughter per day could increase total EE by 40–170 kJ (10–40 kcal). PMID:16652129
... OF HOMELAND SECURITY PREPAREDNESS NATIONAL EARTHQUAKE HAZARDS REDUCTION ASSISTANCE TO STATE AND LOCAL GOVERNMENTS Earthquake Hazards Reduction Assistance Program § 361.8 Ineligible expenditures. (a) Expenditures... for the purchase or rental of any equipment such as radio/telephone communications equipment, warning...
Catal, Cagatay; Akbulut, Akhan
Background and objective: It is crucial to predict the human energy expenditure in any sports activity and health science application accurately to investigate the impact of the activity. However, measurement of the real energy expenditure is not a trivial task and involves complex steps. The
Levy Douglas E
Full Text Available Abstract Background Children's exposure to secondhand smoke is associated with increased morbidity. We estimated Medicaid expenditures for children living with smokers compared to those living with no smokers in the United States. Methods Data were overall and service-specific (i.e., inpatient, ambulatory, emergency department, prescription drug, and dental annual Medicaid expenditures for children 0-11 years old from the 2000-2007 Medical Expenditures Panel Surveys. Smokers' presence in households was determined by adult respondents' self reports. There were 25,835 person-years of observation. We used multivariate analyses to adjust for child, parent, and geographic characteristics. Results Children with Medicaid expenditures were nearly twice as likely to live with a smoker as other children in the U.S. population. Adjusted analyses revealed no detectable differences in children's overall Medicaid expenditures by presence of smokers in the household. Medicaid children who lived with smokers on average had $10 (95% CI $3, $18 higher emergency department expenditures per year than those living with no smokers. Conclusions Living with at least one smoker (a proxy for secondhand smoke exposure is unrelated to children's overall short-term Medicaid expenditures, but has a modest impact on emergency department expenditures. Additional research is necessary to understand the relationship between secondhand smoke exposure and long-term health and economic outcomes.
The relationship between military expenditure and the stimulation of aggregate demand, inflation, investment, trade balance, foreign exchange, the improvement of taxation, and employment creation and industrialization in the Third World is analyzed. To some extent military expenditure does promote economic growth, but it does not automatically…
The empirical part of the result shows that there is unidirectional relationship between education and economic growth with causality running from education expenditure to economic growth. The result therefore suggests that policy makers should boost expenditure on education as it will further improve economic growth in ...
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
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.
Liu, Meng; Wang, Guirong; Wang, Huijun
Consumption expenditure of rural residents can be divided into eight types of indices, such as food consumption expenditure, clothing consumption expenditure, household equipment and service consumption expenditure, health care consumption expenditure, transportation and communication consumption expenditure, cultural and educational entertainment and service consumption expenditure, housing consumption expenditure, and other goods and services consumption expenditure. Changes in structures o...
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.
Bender, Alex C; Austin, Andrea M; Grodstein, Francine; Bynum, Julie P W
We examined the relationship between health care expenditures and cognition, focusing on differences across cognitive systems defined by global cognition, executive function, or episodic memory. We used linear regression models to compare annual health expenditures by cognitive status in 8125 Nurses' Health Study participants who completed a cognitive battery and were enrolled in Medicare parts A and B. Adjusting for demographics and comorbidity, executive impairment was associated with higher total annual expenditures of $1488 per person (P episodic memory impairment was found. Expenditures exhibited a linear relationship with executive function, but not episodic memory ($584 higher for every 1 standard deviation decrement in executive function; P < .01). Impairment in executive function is specifically and linearly associated with higher health care expenditures. Focusing on management strategies that address early losses in executive function may be effective in reducing costly services. Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
Yuxiang, Karl; Chen, Zhongchang
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)
Chen, Jie; Vargas-Bustamante, Arturo; Ortega, Alexander N
Using two nationally representative data sets, this study examined health care expenditure disparities between Caucasians and different Asian American subgroups. Multivariate analyses demonstrate that Asian Americans, as a group, have significantly lower total expenditures compared with Caucasians. Results also point to considerable heterogeneities in health care spending within Asian American subgroups. Findings suggest that language assistance programs would be effective in reducing disparities among Caucasians and Asian American subgroups with the exception of Indians and Filipinos, who tend to be more proficient in English. Results also indicate that citizenship and nativity were major factors associated with expenditure disparities. Socioeconomic status, however, could not explain expenditure disparities. Results also show that Asian Americans have lower physician and pharmaceutical costs but not emergency department or hospital expenditures. These findings suggest the need for culturally competent policies specific to Asian American subgroups and the necessity to encourage cost-effective treatments among Asian Americans.
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.
Stojchev, D.; Kynev, K.
Technical and economical problems of marginal analysis methodology, its application procedure in energy sector and marginal expenditures determination are outlined. A comparative characteristics of the application is made for different periods of time. The differences in calculation of the marginal expenditures and prices are discussed. The operational costs, investments and inflation are analyzed. The mechanism of application of this approach in different planing horizon is outlined. The role of the change in the costs in time, the time unit, volume, the scope of application, etc. are determined. The areas of transition from one to other form of marginal expenditures are shown. 4 refs. (orig.)
This report, Household Energy Consumption and Expenditures 1990, is based upon data from the 1990 Residential Energy Consumption Survey (RECS). Focusing on energy end-use consumption and expenditures of households, the 1990 RECS is the eighth in a series conducted since 1978 by the Energy Information Administration (EIA). Over 5,000 households were surveyed, providing information on their housing units, housing characteristics, energy consumption and expenditures, stock of energy-consuming appliances, and energy-related behavior. The information provided represents the characteristics and energy consumption of 94 million households nationwide
National Oceanic and Atmospheric Administration, Department of Commerce — A series of expenditure surveys have been done both regionally and nationally. This data pertains to the Northeast U.S. states that was collected in 1998....
Teske, J A; Billington, C J; Kotz, C M
The hypocretins or orexins are endogenous neuropeptides synthesized in discrete lateral, perifornical and dorsal hypothalamic neurones. These multi-functional neuropeptides modulate energy homeostasis, arousal, stress, reward, reproduction and cardiovascular function. This review summarizes the role of hypocretins in modulating non-sleep-related energy expenditure with specific focus on the augmentation of whole body energy expenditure as well as hypocretin-induced physical activity and sympathetic outflow. We compare the efficacy of hypocretin-1 and 2 on energy expenditure and evaluate whether the literature implicates hypocretin signalling though the hypocretin-1 and -2 receptor as having shared and or functionally specific physiological effects. Thus far data suggest that hypocretin-1 has a more robust stimulatory effect relative to hypocretin-2. Furthermore, hypocretin-1 receptor predominantly mediates behaviours known to influence energy expenditure. Further studies on the hypocretin-2 receptor are needed.
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, meals,...
poverty and government expenditure on growth strategies that have been implemented in Tanzania since the mid 2000s. The paper shows that despite impressive economic growth of about 6 percent per annum that the country has enjoyed in ...
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...
government expenditure within the framework of the Ethiopian Economy. This was done with the view that .... macroeconomic stability and current account balance. The need for efficient ... instability, boarder conflict and civil war. The revenue ...
Vataire, Anne-Lise; Cetinsoy, Laurent; Aball?a, Samuel; R?muzat, C?cile; Urbinati, Duccio; Kornfeld, ?sa; Mzoughi, Olfa; Toumi, Mondher
Background and objective: The value appreciation of new drugs across countries today features a disruption that is making the historical data that are used for forecasting pharmaceutical expenditure poorly reliable. Forecasting methods rarely addressed uncertainty. The objective of this project was to propose a methodology to perform pharmaceutical expenditure forecasting that integrates expected policy changes and uncertainty (developed for the European Commission as the ‘EU Pharmaceutical e...
... 42 Public Health 2 2010-10-01 2010-10-01 false Monitoring expenditure level. 403.754 Section 403..., Conditions of Participation, and Payment § 403.754 Monitoring expenditure level. (a) Tracking expenditures... between the trigger level and Medicare expenditures for a FFY results in a carry forward that either...
Canikalp, Ebru; Unlukaplan, Ilter
A view prominently expounded is that the interaction between the composition and the volume of public expenditures is directly affected by political, institutional, psephological and ideological indicators. A crucial component of public expenditures, social expenditures play an important role in the economy as they directly and indirectly affect the distribution of income and wealth. Social expenditures aim at reallocating income and wealth unequal distribution. These expenditures comprise ca...
Swift, Zhicheng Li
Tax expenditures, in the form of tax provisions, are government expenditures. They are conceptually and functionally distinct from those tax provisions whose purpose is to raise revenue. Tax expenditure programs are comparable to entitlement programs. Therefore, tax expenditures must be analyzed in spending terms and integrated into the budgetary process to ensure fiscal accountability. In addition, tax expenditures must be audited for performance and the information must be published (with c...
Swift, Zhicheng Li
Tax expenditures, in the form of tax provisions, are government expenditures. They are conceptually and functionally distinct from those tax provisions whose purpose is to raise revenue. Tax expenditure programs are comparable to entitlement programs. Therefore, tax expenditures must be analyzed in spending terms and integrated into the budgetary process to ensure fiscal accountability. In addition, tax expenditures must be audited for performance and the information must be published (with c...
In 2013, households, private corporations and general government spent Euro 47.2 billion for environmental protection, an increase of 1.8% over 2012. For the 2000-2013 period on the whole, this expenditure has been rising faster than the gross domestic product (GDP): +4% on an annual average for the environmental protection expenditure compared with +2.8% for the GDP. In connection with the growing environmental concerns of society, public policy contributed to this steady increase through economic incentives ('bonus/malus' system, for instance) and regulation. In particular, the latter led to a technical improvement of processes (selective collection of waste, bringing up to standard of water treatment plants) which participated in the growth of expenditure. Wastewater and waste managements are the two main environmental protection expenditure domains. Furthermore, they are connected with topics related to resource management: drinking water supply and materials recovery. However, the expenditure for the materials recovery sector is decreasing in 2013, due to declines in raw materials prices. Expenditure for renewable energies - another topic related to environment - is considerably growing in 2013. Electricity production notably from water power is rising sharply, as a result of a particularly rainy spring. Nevertheless, the growth of environmental expenditures does not impact the corresponding employment in a systematic way. Thus, even if value added of the environmental goods and services sector (EGSS) increased by 1.8% in 2013, employment decreased by 0.3%. And the labor market in the green economy has been in decay since 2011, at a practically similar rate as for the economy as a whole
Buchmueller, Thomas C; Johar, Meliyanni
Rising rates of obesity are a public health concern in every industrialized country. This study investigates the relationship between obesity and health care expenditure in Australia, where the rate of obesity has tripled in the last three decades. Now one in four Australians is considered obese, defined as having a body mass index (BMI, kg/m(2)) of 30 or over. The analysis is based on a random sample survey of over 240,000 adults aged 45 and over that is linked at the individual-level to comprehensive administrative health care claims for the period 2006-2009. This sub-population group has an obesity rate that is nearly 30% and is a major consumer of health services. Relative to the average annual health expenditures of those with normal weight, we find that the health expenditures of those with a BMI between 30 and 35 (obese type I) are 19% higher and expenditures of those with BMI greater than 35 (obese type II/III) are 51% higher. We find large and significant differences in all types of care: inpatient, emergency department, outpatient and prescription drugs. The obesity-related health expenditures are higher for obese type I women than men, but in the obese type II/III state, obesity-related expenditures are higher for men. When we stratify further by age groups, we find that obesity has the largest impact among men over age 75 and women aged 60-74 years old. In addition, we find that obesity impacts health expenditures not only through its link to chronic diseases, but also because it increases the cost of recovery from acute health shocks. Copyright © 2015 Elsevier B.V. All rights reserved.
... begins an active trade or business, an amount equal to the lesser of (1) the amount of the start-up... begins. All start-up expenditures that relate to the active trade or business are considered in... active trade or business to which the expenditures relate begins. The election either to amortize start...
Cascaes, Andreia Morales; de Camargo, Maria Beatriz Junqueira; de Castilhos, Eduardo Dickie; Silva, lexandre Emídio Ribeiro; Barros, Aluísio J D
ABSTRACT OBJECTIVE To quantify the household expenditure per capita and to estimate the percentage of Brazilian households that have spent with dental insurance. METHODS We analyzed data from 55,970 households that participated in the research Pesquisa de Orçamentos Familiares in 2008–2009. We have analyzed the annual household expenditure per capita with dental insurance (business and private) according to the Brazilian states and the socioeconomic and demographic characteristics of the households (sex, age, race, and educational level of the head of the household, family income, and presence of an older adult in the household). RESULTS Only 2.5% of Brazilian households have reported spending on dental insurance. The amount spent per capita amounted to R$5.10 on average, most of which consisted of private dental insurance (R$4.70). Among the characteristics of the household, higher educational level and income were associated with higher spending. São Paulo was the state with the highest household expenditure per capita (R$10.90) and with the highest prevalence of households with expenditures (4.6%), while Amazonas and Tocantins had the lowest values, in which both spent less than R$1.00 and had a prevalence of less than 0.1% of households, respectively. CONCLUSIONS Only a small portion of the Brazilian households has dental insurance expenditure. The market for supplementary dentistry in oral health care covers a restricted portion of the Brazilian population. PMID:29489995
Full Text Available This paper entitled "Public expenditure on health in local budgets" aims analysing and deepening major spending categories that public authorities finance at local level, namely health expenditure. In the first part of the article we have specified the content and role of this category of expenditure in local budgets and also made some feedback on decentralization in health. In the second part of the work, based on data available in Statistical Yearbook of Romania, we have carried out an analysis of the dynamics of health spending from local budgets to emphasize their place and role in the health care expenses. The research carried out follows that the evolution and structure of health expenditure financed from local budgets is determined, along with the legislative framework in the field, by several variables that differ from one territorial administrative unit to another: the existence of sanitary units, their type, the involving of local public authorities in their development and modernization, the number and the social structure of the population. The research shows that over the period 1993-2015, the dynamics of the share of health spending in total expenditures of local budgets is sinusoidal, with a minimum threshold in 2000 of only 0.3%.
Deb, Partha; Norton, Edward C
Health care expenditures and use are challenging to model because these dependent variables typically have distributions that are skewed with a large mass at zero. In this article, we describe estimation and interpretation of the effects of a natural experiment using two classes of nonlinear statistical models: one for health care expenditures and the other for counts of health care use. We extend prior analyses to test the effect of the ACA's young adult expansion on three different outcomes: total health care expenditures, office-based visits, and emergency department visits. Modeling the outcomes with a two-part or hurdle model, instead of a single-equation model, reveals that the ACA policy increased the number of office-based visits but decreased emergency department visits and overall spending.
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.
Abolhallaje, M; Hasani, Sa; Bastani, P; Ramezanian, M; Kazemian, M
This study will provide detailed specification of those variables and determinants of unpredictable health expenditure in Iran, and the requirements to reduce extensive effects of the factors affecting households' payments for health and other goods and services inappropriately. This study aims to identify measures of fair financing of health services and determinants of fair financing contribution, regarding the required share of households that prevents their catastrophic payments. In this regard, analysis of shares of households' expenditures on main groups of goods and services in urban and rural areas and in groups of deciles in the statistics from households' expenditure surveys was applied. The growth of spending in nominal values within the years 2002-2008 was considerably high and the rate for out-of-pocket payments is nearly the same or greater than the rate for total health expenditure. In 2008, urban and rural households in average pay 6.4% and 6.35% of their total expenditure on health services. Finally three categories of determinants of unfair and catastrophic payments by households were recognized in terms of households' socio-economic status, equality/inequality conditions of the distribution of risk of financing, and economic aspects of health expenditure distribution. While extending the total share of government and prepayment sources of financing health services are considered as the simplest policy for limiting out-of-pocket payments, indicators and policies introduced in this study could also be considered important and useful for the development of health sector and easing access to health services, irrespective of health financing fairness.
Maurício C. Coutinho
Full Text Available This paper presents Adam Smiths 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 Smiths income and price theory (and the incidence hypothesis, provided due attention is paid to the guiding role of the "maxims".
De La Rue, S; Draper, Stephen B; Potter, Christopher R; Smith, M.
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...
In the 1960s, a ânewâ marketing concept known as "four Ps marketing mix" appeared and shifted the focus from the product to the customer. The objective of the new concept was not only profit, and the means of achieving the objective expanded to include the entire âmarketing mixâ: product, price, promotion, and place (channels and distribution). Expenditures of marketing in a company should be explored from these mixes, because each mix would have an impact on the total marketing expenditures....
Adequate sleep is crucial during childhood for metabolic health, and physical and cognitive development. Inadequate sleep can disrupt metabolic homeostasis and alter sleeping energy expenditure (SEE). Functional data analysis methods were applied to SEE data to elucidate the population structure of ...
Catal, Cagatay; Akbulut, Akhan
It is crucial to predict the human energy expenditure in any sports activity and health science application accurately to investigate the impact of the activity. However, measurement of the real energy expenditure is not a trivial task and involves complex steps. The objective of this work is to improve the performance of existing estimation models of energy expenditure by using machine learning algorithms and several data from different sensors and provide this estimation service in a cloud-based platform. In this study, we used input data such as breathe rate, and hearth rate from three sensors. Inputs are received from a web form and sent to the web service which applies a regression model on Azure cloud platform. During the experiments, we assessed several machine learning models based on regression methods. Our experimental results showed that our novel model which applies Boosted Decision Tree Regression in conjunction with the median aggregation technique provides the best result among other five regression algorithms. This cloud-based energy expenditure system which uses a web service showed that cloud computing technology is a great opportunity to develop estimation systems and the new model which applies Boosted Decision Tree Regression with the median aggregation provides remarkable results. Copyright © 2018 Elsevier B.V. All rights reserved.
Rouwendal, J.; van Loon, R.R.
The authors study the probability of taking a vacation, foreign or domestic, and the expenditures of Dutch households on vacations. The paper first provides a brief review of Dutch vacation behaviour over the past 30 years. It then presents the results of statistical models for destination choice
... part for labor, weatherization materials, and related matters for a renewable energy system, shall not... beginning in calendar year 2010 and the $3,000 average for renewable energy systems will be adjusted... 10 Energy 3 2010-01-01 2010-01-01 false Allowable expenditures. 440.18 Section 440.18 Energy...
ALSEM, KJ; LEEFLANG, PSH
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
Sherman, Sally A; Rogers, Renee J; Davis, Kelliann K; Minster, Ryan L; Creasy, Seth A; Mullarkey, Nicole C; O'Dell, Matthew; Donahue, Patrick; Jakicic, John M
Whether the energy cost of vinyasa yoga meets the criteria for moderate-to-vigorous physical activity has not been established. To compare energy expenditure during acute bouts of vinyasa yoga and 2 walking protocols. Participants (20 males, 18 females) performed 60-minute sessions of vinyasa yoga (YOGA), treadmill walking at a self-selected brisk pace (SELF), and treadmill walking at a pace that matched the heart rate of the YOGA session (HR-Match). Energy expenditure was assessed via indirect calorimetry. Energy expenditure was significantly lower in YOGA compared with HR-Match (difference = 79.5 ± 44.3 kcal; P YOGA = 3.6 ± 0.6; P YOGA, showed energy expenditure was significantly lower in YOGA compared with HR-Match (difference = 68.0 ± 40.1 kcal; P YOGA meets the criteria for moderate-intensity physical activity. Thus, YOGA may be a viable form of physical activity to achieve public health guidelines and to elicit health benefits.
Aug 4, 1990 ... This paper considers the distribution of health expenditure between the public ... An understanding of past health care expenditure patterns is a prerequisite to any .... of this total and local government for 8% in the same year.
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.
Nordsborg, Nikolai Baastrup; Espinosa, Hugo G.; Van Thiel, David H
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 oxy...
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.
Kenayathulla, Husaina Banu
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,…
... turnout, or voter education constitute other expenses, treated as political expenditures by reason of... 26 Internal Revenue 17 2010-04-01 2010-04-01 false Tax on political expenditures. 53.4955-1... Tax on political expenditures. (a) Relationship between section 4955 excise taxes and substantive...
... Insurance Program expenditures. 457.618 Section 457.618 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS... Children's Health Insurance Program expenditures. (a) Expenditures. (1) Primary expenditures are...
... 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... attempting to influence legislation, (except as otherwise provided in subsection (h)).” This requirement is...
... State or local tax credits allowable expenditures for TANF-related purposes? (a) To be an allowable expenditure for TANF-related purposes, any tax credit program must be reasonably calculated to accomplish one... credit to be an allowable expenditure. (2) Under a State Earned Income Tax Credit (EITC) program, the...
Maurício C. Coutinho
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”.
Leon Berkelmans; Gareth Spence
The Australian Bureau of Statistics capital expenditure survey is one of the inputs into the Reserve Bank’s forecasts for private business investment. This article considers several methods for interpreting the expectations data from this survey and evaluates these methods using out-of-sample forecasts. Forecasts based on long-run average realisation ratios are found to be the most accurate of the options considered, although the use of these forecasts for predicting investment in the nationa...
Laurence J. Kotlikoff
This paper discusses conceptual problems of distinguishing "expenditure" policy from "tax" policy and "deficit" policy. The paper argues that each of these concepts is ill-defined and does not provide a useful basis for examining the government" underlying fiscal policies. The fundamentals of fiscal policy involve changes in marginal incentives, inframarginal intra- and intergenerational redistribution, and direct government consumption. The paper reviews some of the effects of these fundamen...
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 Energ...
Glenn Jenkins; Chun-Yan Kuo
This paper takes a broad approach in the sense that only the fundamental structure elements of each tax system are considered as part of the benchmark tax system. Moreover, this paper will go beyond the traditional tax expenditure reporting by taking into account an ideal tax system with minor distortions as part of the benchmark. Because of having an ideal tax system as a norm, the report makes some judgments about the appropriateness of the ideal tax structure in the Dominican Republic and ...
Full Text Available Natural disasters have increased in their frequency, and the intensity of their destruction over the last ten years in Indonesia. Households usually respond to these difficulties by cutting their consump-tion, especially for non-essential goods. Arguably natural disasters are exogenous events, so this paper uses the exogenous variation from natural disasters as a natural experiment design to estimate the effect of disasters on household expenditure. When a certain group is exposed to the causal variable of interest, such as a disaster, and other groups are not, the Difference In Difference model (DID can be used for estimation. Using a micro level survey data set from the Indonesian Family Life Survey (IFLS which covers approximately 83 percent of the Indonesian population within the survey area, this paper examines the effects of natural disasters on household expenditure. This paper also examines whether there are any different impacts from different types of disasters. The finding is there are no significant effects of disasters on total household expenditure for households living in disaster regions, whether they are affected directly or not by the disaster.
Illustrated by several graphs, this publication comments the evolution of public expenditure for the protection of the environment, compares the current expenditure and the capital expenditure. It comments the share of waste management and wastewater sanitation with respect to the global expenditure (it represents 62 pc of it) and the evolutions of the expenditures for each domain of the environment (protection of the environment and ecosystems, waste management and struggle against noise pollution, research and development, public actions for regulation and administration). It comments the increase of prices of sanitation services and the decrease of consumed volumes of water, the increase of R and D expenditure, the influence of the legal context on the increase of industry investments for air protection. The expenditures for the protection of the environment in the European countries are indicated and compared
Kildemoes, Helle Wallach
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......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...... 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...
Vataire, Anne-Lise; Cetinsoy, Laurent; Aballéa, Samuel; Rémuzat, Cécile; Urbinati, Duccio; Kornfeld, Åsa; Mzoughi, Olfa; Toumi, Mondher
The value appreciation of new drugs across countries today features a disruption that is making the historical data that are used for forecasting pharmaceutical expenditure poorly reliable. Forecasting methods rarely addressed uncertainty. The objective of this project was to propose a methodology to perform pharmaceutical expenditure forecasting that integrates expected policy changes and uncertainty (developed for the European Commission as the 'EU Pharmaceutical expenditure forecast'; see http://ec.europa.eu/health/healthcare/key_documents/index_en.htm). 1) Identification of all pharmaceuticals going off-patent and new branded medicinal products over a 5-year forecasting period in seven European Union (EU) Member States. 2) Development of a model to estimate direct and indirect impacts (based on health policies and clinical experts) on savings of generics and biosimilars. Inputs were originator sales value, patent expiry date, time to launch after marketing authorization, price discount, penetration rate, time to peak sales, and impact on brand price. 3) Development of a model for new drugs, which estimated sales progression in a competitive environment. Clinical expected benefits as well as commercial potential were assessed for each product by clinical experts. Inputs were development phase, marketing authorization dates, orphan condition, market size, and competitors. 4) Separate analysis of the budget impact of products going off-patent and new drugs according to several perspectives, distribution chains, and outcomes. 5) Addressing uncertainty surrounding estimations via deterministic and probabilistic sensitivity analysis. This methodology has proven to be effective by 1) identifying the main parameters impacting the variations in pharmaceutical expenditure forecasting across countries: generics discounts and penetration, brand price after patent loss, reimbursement rate, the penetration of biosimilars and discount price, distribution chains, and the time
Ess, Silvia M; Schneeweiss, Sebastian; Szucs, Thomas D
In the last 20 years, expenditures on pharmaceuticals - as well as total health expenditures - have grown faster than the gross national product in all European countries. The aim of this paper was to review policies that European governments apply to reduce or at least slow down public expenditure on pharmaceutical products. Such policies can target the industry, the wholesalers and retailers, prescribers, and patients. The objectives of pharmaceutical policies are multidimensional and must take into account issues relating to public health, public expenditure and industrial incentives. Both price levels and consumption patterns determine the level of total drug expenditure in a particular country, and both factors vary greatly across countries. Licensing and pricing policies intend to influence the supply side. Three types of pricing policies can be recognised: product price control, reference pricing and profit control. Profit control is mainly used in the UK. Reference pricing systems were first used in Germany and The Netherlands and are being considered in other countries. Product price control is still the most common method for establishing the price of drugs. For the aim of fiscal consolidation, price-freeze and price-cut measures have been frequently used in the 1980s and 1990s. They have affected all types of schemes. For drug wholesalers and retailers, most governments have defined profit margins. The differences in price levels as well as the introduction of a Single European Pharmaceutical Market has led to the phenomenon of parallel imports among member countries of the European Union. This may be facilitated by larger and more powerful wholesalers and the vertical integration between wholesalers and retailers. To control costs, the use of generic drugs is encouraged in most countries, but only few countries allow pharmacists to substitute generic drugs for proprietary brands. Various interventions are used to reduce the patients' demand for drugs by
Moreno-Ramírez, David; Ferrándiz, Lara; Ramírez-Soto, Gabriel; Muñoyerro, M Dolores
Variability in adjusted drug expenditures among clinical departments raises the possibility of difficult access to certain therapies at the time that avoidable expenditures may also exist. Nevertheless, drug expenditures are not usually applied to clinical practice variability analysis. To identify and quantify variability in drug expenditures in comparable dermatology department of the Servicio Andaluz de Salud. Comparative economic analysis regarding the drug expenditures adjusted to population and health care production in 18 dermatology departments of the Servicio Andaluz de Salud. The 2012 cost and production data (homogeneous production units -HPU-)were provided by Inforcoan, the cost accounting information system of the Servicio Andaluz de Salud. The observed drug expenditure ratio ranged from 0.97?/inh to 8.90?/inh and from 208.45?/HPU to 1,471.95?/ HPU. The Pearson correlation between drug expenditure and population was 0.25 and 0.35 for the correlation between expenditure and homogeneous production (p=0.32 and p=0,15, respectively), both Pearson coefficients confirming the lack of correlation and arelevant degree of variability in drug expenditures. The quantitative analysis of variability performed through Pearson correlation has confirmed the existence of drug expenditure variability among comparable dermatology departments. Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.
Full Text Available In the 1960s, a ânewâ marketing concept known as "four Ps marketing mix" appeared and shifted the focus from the product to the customer. The objective of the new concept was not only profit, and the means of achieving the objective expanded to include the entire âmarketing mixâ: product, price, promotion, and place (channels and distribution. Expenditures of marketing in a company should be explored from these mixes, because each mix would have an impact on the total marketing expenditures. 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 âfeesâ policy rather than both product innovation and promotion is also interesting. Big percentage of the responding contractors assumes these âfeesâ 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.
Body energy balance is regulated in adults. The accuracy of the phenomenon is particularly evident in laboratory animals under steady conditions. Moreover, it has been repeatedly demonstrated that this balance is maintained in spite of fluctuations in food intake or energy expenditure. When animals such as rats, dogs or rabbits are presented with a diluted or concentrated version of familiar food, they compensate rapidly by increasing or decreasing their ponderal intake. This is achieved first by a change in meal frequency, then meal size adapts to the new caloric content and meal frequency returns to the original pattern. This adaptation is based on the learning of post-ingestive cues. Hypo or hyperphagia leads to reduced or increased energy expenditure, as the case may be; the basal metabolic rate is modulated by thyroid hormones and diet-induced thermogenesis by the sympathetic system. These variations are partly regulatory. In a cold environment, the increase in energy expenditure caused by increased thermogenesis is rapidly compensated by increased caloric intake. Physical activity activates the sympathetic system responsible for numerous hormonal changes, the most important of which is insulin hyposecretion. In animals or humans, moderate aerobic exercise induces a small weight loss; afterwards, weight gain is normalized and increased caloric intake compensates for energy expenditures such as exercise, increased basal metabolic rate and diet-induced thermogenesis. Extreme changes in body weight and fat are produced by gestation and lactation; they are satisfactorily explained by concomitant hormonal changes. Especially during lactation, food intake is regulated so that it allows body weight to return to pregestation level. Studies on the mechanisms implicated in the regulation of body energy balance are still in progress. Friedman and Ramirez (1985) suggest that the way fatty acids are utilized is important. Kasser et al. (1985) show a striking difference in
Echouffo-Tcheugui, Justin B; Bishu, Kinfe G; Fonarow, Gregg C; Egede, Leonard E
Population-based national data on the trends in expenditures related to heart failure (HF) are scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition. Using 10-year data (2002-2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194US adults aged ≥18years) and a 2-part model (adjusting for demographics, comorbidities, and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency department, inpatient hospital, pharmacy, home health care, and other medical expenditures). Compared with expenditures for individuals without HF ($5511 [95% CI 5405-5617]), individuals with HF had a 4-fold higher mean expenditures of ($23,854 [95% CI 21,733-25,975]). Individuals with HF had $3446 (95% CI 2592-4299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95% CI 18,359-24,272) in 2002/2003 to $27,152 (95% CI 20,066-34,237) in 2010/2011, and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/y and the adjusted total incremental expenditure was $5.8 billion/y. Heart failure is costly and over a recent 10-year period, and direct expenditure related to HF increased markedly, mainly driven by inpatient costs. Copyright © 2017 Elsevier Inc. All rights reserved.
... 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... party for the purchase or construction of an office building. See 11 CFR 300.10 and 300.35. (e...
This research analyzes the influence of fiscal decentralization on capital expenditure, economic growth, and social welfare of 29 regencies and 6 cities in Central Java Province based on the data of year 2004 to 2008. The method used to analyze the hypotheses is the Partial Least Square. The results showes that fiscal decentralization has no significant effect on capital expenditure; fiscal decentralization has significant effect on economic growth and social welfare; capital expenditure has ...
Tang, Chor-Foon; Lau, Evan
The present study attempts to re-investigate the behaviour of disaggregated public expenditures data and national income for Malaysia. This study covers the sample period of annual data from 1960 to 2007. The Bartlett-corrected trace tests proposed by Johansen (2002) were used to ascertain the presence of long run equilibrium relationship between public expenditures and national income. The results show one cointegrating vector for each specification of public expenditures. The relatively new...
Lisa Farrell; Michael A. Shields
We investigate expenditure behaviour of school-aged children using child diary information contained in the British Family Expenditure Survey. The estimates from an Almost Ideal Demand System (AIDS) for child expenditure suggest that drinks, sweets, books, and toys are `normal' goods for children, but clothes, travel, leisure and vice products are `luxury' items with income elasticities greater than one. Being a lone-parent child and having a working mother are important factors in determinin...
This article begins by emphasizing that the number and intensity of armed conflict has fallen substantially but that military expenditure levels in sub-Saharan Africa have nonetheless increased, largely as a result of South African expenditure. The article attempts to answer two questions. First, how can the budget of the security sector be allocated so as to result in effective and efficient security outcomes? Second, how can an appropriate level of military expenditure for a country be dete...
Yen, Steven T.; Kasteridis, Panagiotis P.; Riley, John B.
This study investigates the differentiated effects of economic and socio-demographic variables on food away from home (FAFH) expenditures by type of facility among elderly households in the United States. Using data from the 2008–2010 Consumer Expenditure Surveys, the systems of expenditures on full-service, fast food, and other restaurants are estimated with a multivariate sample selection estimator which also accommodates heteroscedasticity in the error distribution. Statistical significanc...
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.
The direct and indirect employment and employment income that can result from lifting the moratorium on British Columbia's west coast were estimated. Jobs and income are the two socio-economic benefits that generate the most concern at the local, provincial and national levels. The estimates are based on the development scenarios of one natural gas project in the Hecate Strait, and one oil project in the Queen Charlotte Sound. It was noted that a significant component of the potential socio-economic benefits from offshore development in British Columbia will result from project investment expenditures. Statistics Canada's Input-Output Model was used to assess the total expenditure impacts at the national and provincial levels. The indirect impacts are relatively more important to the local economy because they deal mainly with accommodation, food, beverage, and transportation. The total impacts can be measured in terms of total revenues, gross domestic product, and wages and salaries. The nature of supplier services that may be required were also identified. It was estimated that with the combined impacts of construction and operations, the total Canadian gross domestic product will increase by $3.0 billion, most of which will accrue to British Columbia. refs., tabs., figs
Between 1991 and 1993, the natural gas industry will invest $28.297 billion to install additional facilities for natural gas production and storage, transmission, underground storage, gas distribution and for other general expenditures, estimates the American Gas Association as shown in the 1990 Gas Facts. This is a 38% investment increase from the forecasts in the 1989 Gas Facts. This issue forecasts investments of $13.303 billion for 1991 and $18.396 billion for 1992. This issue does not include investments for 1993. In 1989, (the last figures released) the gas industry invested $7,341 billion for new transmission lines, distribution mains, underground storage, production and storage and general facilities. Included in the 1989 expenditures are: $3.980 billion in distribution facilities; $2.081 billion in gas transmission systems and $159 million in underground storage facilities. Investment in new distribution facilities in 1991 and $4.550 billion in 1993. This is a steady increase for these three years. Investments in natural gas transmission facilities show a steady increase also. In 1991, pipe line operating companies will invest $9.391 billion for new facilities, $9.005 in 1992 and $9.901 billion in 1993
Monteon, F J; Laidlaw, S A; Shaib, J K; Kopple, J D
Although nondialyzed, chronically uremic patients and patients undergoing maintenance hemodialysis often show evidence for wasting and calorie malnutrition and have low dietary energy intakes, their energy expenditure has never been systematically evaluated. It is possible that low energy intakes are an adaptive response to reduced energy needs; alternatively, energy expenditure could be normal or high and the low energy intakes would be inappropriate. Energy expenditure was therefore measured by indirect calorimetry in 12 normal individuals, 10 nondialyzed patients with chronic renal failure, and 16 patients undergoing maintenance hemodialysis. Energy expenditure was measured in the resting state, during quiet sitting, during controlled exercise on an exercise bicycle, and for four hours after ingestion of a test meal. Resting energy expenditure (kcal/min/1.73 m2) in the normal subjects, chronically uremic patients and hemodialysis patients was, respectively, 0.94 +/- 0.24 (SD), 0.91 +/- 0.20, and 0.97 +/- 0.10. There was also no difference among the three groups in energy expenditure during sitting, exercise, or the postprandial state. Within each group, energy expenditure during resting and sitting was directly correlated. During bicycling, energy expenditure was directly correlated with work performed, and the regression equation for this relationship was similar in each of the three groups. These findings suggest that for a given physical activity, energy expenditure in nondialyzed, chronically uremic patients and maintenance hemodialysis patients is not different from normal. The low energy intakes of many of these patients may be inadequate for their needs.
Shah, Rachana; Tershakovec, Andy M.; Zemel, Babette S.; Sutton, Leslie N.; Grimberg, Adda; Moshang, Thomas
Background and purpose Obesity is a common yet incompletely understood complication of childhood craniopharyngioma. We hypothesized that craniopharyngioma is associated with specific defects in energy balance compared to obese control children. Methods Eleven craniopharyngioma patients were recruited for a study on body composition and energy balance. Eight subjects were obese. The obese craniopharyngioma patients had a mean age (±SD) of 11.2±1.7 years. The average body mass index z score was 2.33 (±0.32). A previously studied group of obese children (BMI z score 2.46±0.46) served as controls. Resting energy expenditure (REE) was determined by indirect calorimetry and body composition by dual energy X-ray absorptiometry in all children. Results Obese craniopharyngioma patient subjects had increased mean (±standard error) fat-free mass compared to obese controls (57%±0.88 % vs 50.0%±0.87%, p=0.02). The obese craniopharyngioma patients had a 17% lower REE compared to values expected from the World Health Organization equation (1,541±112.6 vs 1,809±151.8 kcal; p=0.01). In contrast, the obese control children had measured REE within 1% of predicted (1,647±33.2 vs. 1,652±40.2; p=0.8). In a linear regression model, REE remained significantly lower than predicted after controlling for FFM. Conclusions Lower REE may be a factor contributing to obesity in children with craniopharyngioma. Further study is needed into the mechanisms for reduced energy expenditure in patients with craniopharyngioma. PMID:20107994
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.
... 25 Indians 1 2010-04-01 2010-04-01 false Diligence; annual expenditures; mining records. 214.13... OSAGE RESERVATION LANDS, OKLAHOMA, FOR MINING, EXCEPT OIL AND GAS § 214.13 Diligence; annual expenditures; mining records. (a) Lessees shall exercise diligence in the conduct of prospecting and mining...
Therefore, based on overall results it is concluded that, the PLSP is technically more appropriate technology or method for reducing energy expenditure and for increasing productivity during timber harvesting in agroforestry farms. Keywords: Productivity, Energy expenditure, Pitsawing and Portable log sawing. Rwanda ...
CONCLUSION: The relationship between expenditure and use of different vector control depends on the geographic location of respondents. People living in the rural areas spend more to have access to malaria control tools. Location of respondent has a positive effect on expenditures and use of malaria control tools.
Erik Thibaut; Steven Vos; Jeroen Scheerder
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
Full Text Available This paper has made an attempt to examine relationship between military expenditure and economic growth using 56 country panel data spanning over 1995—2011. Panel fixed effect model has been estimated for all 56 countries and sub-groups classified on the basis of World Bank income criteria. The results of this study indicate a positive effect of military expenditure on economic growth but this positive effect is negligible compared to the alternative uses of scare resources on non-military expenditure. Thus, the effect of military expenditure on economic growth is very low compared to the effect of expenditure on capital formation, hence military expenditure as a sub-optimal means of increasing economic growth compared to alternative uses of government spending on formation of fixed capital. This study raises an important argument of huge opportunity cost of military expenditure. The present study concludes that the boosting of economic growth through higher military expenditure is neither effective nor efficient way of achieving higher growth in the economy.
Full Text Available A view prominently expounded is that the interaction between the composition and the volume of public expenditures is directly affected by political, institutional, psephological and ideological indicators. A crucial component of public expenditures, social expenditures play an important role in the economy as they directly and indirectly affect the distribution of income and wealth. Social expenditures aim at reallocating income and wealth unequal distribution. These expenditures comprise cash benefits, direct in-kind provision of goods and services, and tax breaks with social purposes.The aim of this study is to determine the relationship between political structure, i.e. government fragmentation, ideological composition, elections and so on, and the social expenditures in Greece. Employing data from the Comparative Political Dataset (CPDS and the OECD Social Expenditure Database (SOCX, a time series analysis was conducted for Greece for the 1980-2014 period. The findings of the study indicate that voter turnout, spending on the elderly population and the number of government changes have positive and statistically significant effects on social expenditures in Greece while debt stock and cabinet composition have negative effects.
Linnemann, L.; Schabert, A.
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'
Finally Generalized Methods of Moments (GMM) is applied to answer the two research questions. The results demonstrate that increasing government expenditure accelerates economic growth of low income countries in Sub Saharan Africa. However, when government expenditure is interacted with government efficiency ...
... property which is neither a capital asset nor property described in section 1231. (iii) If a taxpayer pays...) Allocation of certain expenditures. A project area consists of that territory which the taxpayer has... available) can be explored advantageously as a single integrated operation. If exploration expenditures are...
... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Budget and expenditure. 982.157... and PHA Administration of Program § 982.157 Budget and expenditure. (a) Budget submission. Each PHA fiscal year, the PHA must submit its proposed budget for the program to HUD for approval at such time and...
Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 1997 dollars using the Consumer Price Index. Data and…
Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 1999 dollars using the Consumer Price Index. Data and…
Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 1998 dollars using the Consumer Price Index. Data and…
Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 2000 dollars using the Consumer Price Index. Data and…
Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 2001 dollars using the Consumer Price Index. Data and…
Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 2002 dollars using the Consumer Price Index. Data and…
Zhang, Liang; Ehrenberg, Ronald G.
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…
Trogdon, Justin G; Finkelstein, Eric A; Hoerger, Thomas J
To investigate the use of regression models to calculate disease-specific shares of medical expenditures. Medical Expenditure Panel Survey (MEPS), 2000-2003. Theoretical investigation and secondary data analysis. Condition files used to define the presence of 10 medical conditions. Incremental effects of conditions on expenditures, expressed as a fraction of total expenditures, cannot generally be interpreted as shares. When the presence of one condition increases treatment costs for another condition, summing condition-specific shares leads to double-counting of expenditures. Condition-specific shares generated from multiplicative models should not be summed. We provide an algorithm that allows estimates based on these models to be interpreted as shares and summed across conditions.
Full Text Available The paper deals with development and changes in consumption expenditures of population. It uses secondary data to analyze consumption expenditures of EU-25 and the Czech Republic and concetrates on changes in the expenditure groups over the period of past years. Other part of this paper is devoted to primary data analysis. Primary data were obtained in a questionnaire survey. Primary data analysis is based on statistical methods and it investigates changes in the structure of consumption expenditures of households in relation to changes in household income. By using dependency analysis the paper verifies dependency of surveyed groups of consumption expenditures and groups of households sorted by identification characteristics. Additionally, also based on the primary research, the paper tries to find out the way households allocate money surplus remaining after covering all the adequate expenses.
Full Text Available The age of household members is an important factor for expenditures. The aim of the study is to investigate the level of expenditure on restaurants and hotels incurred in Polish households of the elderly in 2004-2013 and to identify the factors affecting such expenditures. The source of information used in the study was the household budget survey of the Central Statistical Office of Poland. The main methods used in this study were variance analysis and regression analysis. Restaurants and hotels expenditure increases every year together with their share in total household expenditure. The most important factors affecting the restaurants and hotels spending in Polish households of the elderly are: income per capita and the level of education of the head of the family. The study on consumption determinants at different groups leads to better understanding of consumer behavior circumstances and thereby ensuring a good quality of life for the people of the elderly.
Arterburn, D E; Maciejewski, M L; Tsevat, J
Morbid obesity (body mass index (BMI) > or =40 kg/m2) is associated with substantially increased morbidity and mortality from chronic health conditions and with poorer health-related quality of life; however, less is known about the impact of morbid obesity on healthcare expenditures. To examine the impact of morbid obesity on healthcare expenditures using a nationally representative sample of US adults. We performed a cross-sectional analysis of 16 262 adults from the 2000 Medical Expenditure Panel Survey, a nationally representative survey of the noninstitutionalized civilian population of the United States. Per capita healthcare expenditures were calculated for National Institutes of Health BMI categories, based on self-reported height and weight, using a two-part, multivariable model adjusted for age, gender, race, income, education level, type of health insurance, marital status, and smoking status. Odds of incurring any healthcare expenditure and per capita healthcare expenditures associated with morbid obesity in 2000. When compared with normal-weight adults, the odds of incurring any healthcare expenditure in 2000 were two-fold greater among adults with morbid obesity. Per capita healthcare expenditures for morbidly obese adults were 81% (95% confidence interval (CI): 48-121%) greater than normal-weight adults, 65% (95% CI: 37-110%) greater than overweight adults, and 47% (95% CI: 11-96%) greater than adults with class I obesity. Excess costs among morbidly obese adults resulted from greater expenditures for office-based visits, outpatient hospital care, in-patient care, and prescription drugs. Aggregate US healthcare expenditures associated with excess body weight among morbidly obese US adults exceeded $11 billion in 2000. The economic burden of morbid obesity among US adults is substantial. Further research is needed to identify interventions to reduce the incidence and prevalence of morbid obesity and improve the health and economic outcomes of morbidly
Patients with Parkinson's disease (PD) commonly exhibit weight loss, which investigators attribute to various factors, including elevated resting energy expenditure. We tested the hypothesis that daily energy expenditure (DEE) and its components, resting energy expenditure (REF) and physical activit...
Kerkhof, Annemarie C.; Nonhebel, Sanderine; Moll, Henri C.
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
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...
Armour, Brian S; Finkelstein, Eric A; Fiebelkorn, Ian C
Medicaid recipients are disproportionately affected by tobacco-related disease because their smoking prevalence is approximately 53% greater than that of the overall US adult population. This study estimates state-level smoking-attributable Medicaid expenditures. We used state-level and national data and a 4-part econometric model to estimate the fraction of each state's Medicaid expenditures attributable to smoking. These fractions were multiplied by state-level Medicaid expenditure estimates obtained from the Centers for Medicare and Medicaid Services to estimate smoking-attributable expenditures. The smoking-attributable fraction for all states was 11.0% (95% confidence interval, 0.4%-17.0%). Medicaid smoking-attributable expenditures ranged from $40 million (Wyoming) to $3.3 billion (New York) in 2004 and totaled $22 billion nationwide. Cigarette smoking accounts for a sizeable share of annual state Medicaid expenditures. To reduce smoking prevalence among recipients and the growth rate in smoking-attributable Medicaid expenditures, state health departments and state health plans such as Medicaid are encouraged to provide free or low-cost access to smoking cessation counseling and medication.
Full Text Available The development of technology in recent decades has forced the transition from the industrialized society, where the main role was occupied by tangible assets, to an information society, where the essential place is played by intangible assets. These are assets that can not be touched or felt, but are very important to produce wealth and to maintain competitiveness. Within these, development expenditure occupies an important place because it influences the analysis of an entity and its future. The accounting practices applicable to development expenditure are based on theoretical fundamentals and ambiguous typologies. The purpose of the article is to present the controversies about recognizing and evaluating development expenditure. Although development expenditure involves large initial investments, it generates, on medium and long term, significant savings. Depending on the purpose for which it is carried out, research and development expenditure can in time generate identifiable intangible assets but also intangible unidentifiable assets. An optimistic attitude regarding the chances of success of a development project will lead to the capitalization of development expenditure. Capitalizing development expenditures, the usefulness of financial statements is increased, which is generally measured in the ability to explain stock prices through earnings and accounting values.
Keane, Michael; Stavrunova, Olena
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. Copyright © 2011 John Wiley & Sons, Ltd.
Paphangkorakit, Jarin; Leelayuwat, Naruemon; Boonyawat, Nattawat; Parniangtong, Auddamar; Sripratoom, Jindamanee
The aim of the study was to investigate the effect of rate of chewing on energy expenditure in human subjects. Fourteen healthy subjects (aged 18-24 years) within the normal range of BMI participated in a cross-over experiment consisting of two 6-min sessions of gum chewing, slow (∼60 cycles/min) and fast (∼120 cycles/min) chewing. The resting energy expenditure (REE) and during gum chewing was measured using a ventilated hood connected to a gas analyzer system. The normality of data was explored using the Shapiro-Wilk test. The energy expenditure rate during chewing and the energy expenditure per chewing cycle were compared between the two chewing speeds using Wilcoxon signed ranks tests. The energy expenditure per chewing cycle during slow chewing (median 1.4, range 5.2 cal; mean 2.1±1.6 cal) was significantly higher than that during fast chewing (median 0.9, range 2.2 cal; mean 1.0±0.7 cal) (p chewing speeds (p > 0.05). The results of this study suggest that chewing at a slower speed could increase the energy expenditure per cycle and might affect the total daily energy expenditure.
Chahoud, Jad; Semaan, Adele; Rieber, Alyssa
The US health care system is characterized by high health expenditures with penultimate outcomes. This ecological study evaluates the associations between wealth, health expenditure, and cancer outcomes at the state level. We extracted gross domestic product (GDP) and health expenditure per capita from the 2009 Bureau of Economic Analysis and the Centers for Medicare & Medicaid Services, respectively. Using data from the NCI, we retrieved colorectal cancer (CRC), breast cancer, and all-cancer age-adjusted rates and computed mortality/incidence (M/I) ratios. We used the Spearman's rank correlation to determine the association between the financial indicators and cancer outcomes, and we constructed geographic distribution maps to describe these associations. GDP per capita significantly correlated with lower M/I ratios for all cancers, breast cancer, and CRC. As for health expenditure per capita, preliminary analysis highlighted a rift between the Northeastern and Southern states, which translated into worse breast and all-cancer outcomes in Southern states. Further analysis showed that higher health expenditure significantly correlated with decreased breast cancer M/I ratio. However, CRC outcomes were not significantly affected by health expenditure, nor were all-cancer outcomes. All cancers, breast cancer, and CRC outcomes significantly correlated with wealth, whereas only breast cancer correlated with higher health expenditure. Future research is needed to evaluate the potential role of policies in optimizing resource allocation in the states' efforts against CRC and minimizing disparities in interstate cancer outcomes. Copyright © 2016 by the National Comprehensive Cancer Network.
Full Text Available The aim of this paper is to discuss the Romanian public expenditures policy promoted in the context of the economic and financial crisis. Firstly, we present a brief introduction on the effects of public expenditures policy to economic growth and the role of automatic stabilizers in times of economic recessions. Secondly, the paper analyzes the evolution of current and capital public expenditures before and during the economic and financial crisis, according to which unproductive spending prevailed, in detriment of productive investments which can stimulate the economic recovery.
Fehime Korkmaz Bingöl
Full Text Available Increasing tourist expenditure is a means to increase tourism income, which is extremely important for local economies. The purpose of this study is to understand the expending pattern of tourists coming to Mugla Region and provide empirical background for the policies to increase per tourist expenditure. The survey conducted at Dalaman International Airport and the data has been analyzed using OLS method. Nationality, age, accommodation type, pension type, credit card usage, availability of shopping facilities, standard of night life and entertainment, quality of food and beverage, length of holiday and group size has been found as significant factors affecting tourist expenditure
Molla, Azaher Ali; Chi, Chunhuei; Mondaca, Alicia Lorena Núñez
Predictors of high out-of-pocket household healthcare expenditure are essential for creating effective health system finance policy. In Bangladesh, 63.3% of health expenditure is out-of-pocket and born by households. It is imperative to know what determines household health expenditure. This study aims to investigate the predicting factors of high out-of-pocket household healthcare expenditure targeting to put forward policy recommendations on equity in financial burden. Bangladesh household income and expenditure survey 2010 provides data for this study. Predictors of high out-of-pocket household healthcare expenditure were analyzed using multiple linear regressions. We have modeled non-linear relationship using logarithmic form of linear regression. Heteroscedasticity and multicollinearity were checked using Breusch-Pagan/Cook-Weishberg and VIF tests. Normality of the residuals was checked using Kernel density curve. We applied required adjustment for survey data, so that standard errors and parameters estimation are valid. Presence of chronic disease and household income were found to be the most influential and statistically significant (p financing in Bangladesh to minimize the burden of high OOP healthcare expenditure.
National Oceanic and Atmospheric Administration, Department of Commerce — This is a time-series dataset of trip expenditure data for the Hawaii-based longline fleet for the period August 2004 to present. The data collection includes 10...
Results: The mean expenditure for laboratory tests and treatment by women with RTI ... policy relevant questions on equity pertaining to poverty, ... was employed to collect household level data on ..... educational enrollments in states of India.
... materials, services or activities which contribute to the well-being or morale of patients, including but... the actual obligation or expenditure of such monies. (b) Only those officers or employees specifically...
Nghiem, Son Hong; Connelly, Luke Brian
This study examines the trend and determinants of health expenditures in OECD countries over the 1975-2004 period. Based on recent developments in the economic growth literature we propose and test the hypothesis that health care expenditures in countries of similar economic development level may converge. We hypothesise that the main drivers for growth in health care costs include: aging population, technological progress and health insurance. The results reveal no evidence that health expenditures among OECD countries converge. Nevertheless, there is evidence of convergence among three sub-groups of countries. We found that the main driver of health expenditure is technological progress. Our results also suggest that health care is a (national) necessity, not a luxury good as some other studies in this field have found.
The research measured the impact of Georgia Department of Transportations highway : expenditures on economic activity in the State. The analysis covered awards made between January 2009 : and April 2013. The research is unique in that it not only ...
Choong Chee Keong. 6 and Lau Lin Sea. 7 ... Corresponding Author, Department of Economics, Faculty of Business and Finance, UTAR, Malaysia. .... the taxation system and assert that if country's government expenditure is greater than.
van der Wurff, R.; Bakker, P.; Picard, R.G.
Newspaper advertising expenditures depend more strongly on economic development than advertising spent in other media. Gross domestic product (GDP), therefore, predicts ad spending better in countries where newspapers are an important advertising medium. GDP also predicts ad spending better in
Full Text Available The decentralization process was continuous in Romania starting with 1990, generating the implication of local authorities in local public finance, as a result of exclusives, shared and delegate competences and, so, the necessity of ensuring a good management of resources and expenditures. Therefore, the decentralization of competences / responsibilities from State to local governments was a major Romanian political theme and a first rank component of management of local public finance, as main driving instrument for local development. Specific legal framework of local responsibilities is established both to European and national level. Researchers based on regulation and practice have tried to quantify the responsibilities developing different models to measure local revenue and expenditures autonomy. The paper aims is to identify some models for measuring local expenditure autonomy and to apply for Romania. The study is oriented to measure local expenditure autonomy in Romania using Bell, Ebel, Kaiser and Rojchaichainthorn's model.
Ahmad Danu Prasetyo
Full Text Available In this paper, we investigate the efficiency level of government expenditure in 82 countries towards the human development and peace index of the respective countries by using Data Envelopment Analysis (DEA approach during 2007-2011. We found that only few countries that always being positioned in the efficient frontier during the sample period, namely: Japan, Nigeria, and Norway. By using Malmquist index approach, we also found that Cyprus has the largest government expenditure efficiency improvement.Keywords: Government Expenditure Efficiencies, Human Development Index, Global Peace Indexdoi:10.12695/ajtm.2013.6.2.3 How to cite this article:Prasetyo, A.D., and Pudjono, A.N.S. (2013. Measuring Government Expenditure Efficiencies Towards Peace and Human Development. The Asian Journal of Technology Management 6 (2: 82-91. Print ISSN: 1978-6956; Online ISSN: 2089-791X. doi:10.12695/ajtm.2013.6.2.3
National Oceanic and Atmospheric Administration, Department of Commerce — This is a time-series dataset for trip expenditure data for the American Samoa-based longline fleet from August 2006 to present. The dataset includes 10 variable...
Juyani, Yaser; Hamedi, Dorsa; Hosseini Jebeli, Seyede Sedighe; Qasham, Maryam
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. 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. 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. 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.
Full Text Available Along with the expenditures for social protection, social security funds finance administrative direction, which should correspond to the amount of functions performed by a particular fund. The purpose of the paper is to determine ways to reduce administrative expenditures of state social security funds in the conditions of reforming Ukrainian economy. For this purpose, the authors investigate distribution of the expenditures between social security funds, analyse dynamics and structure of assignments for fund administration, and suggest possible ways to rationalize maintenance cost for these institutions. Methodology. Administrative expenditures are an integral part of the cost of social security funds and include particular items of expenses in the budget of these institutions. Applying a systematic approach to calculating the administrative costs of social security funds of Ukraine the authors have taken into account the expenditures related to funding management, support for information systems, and organization of work with insured people. Results of the survey showed that in 2007–2016 Pension Fund of Ukraine incurred the largest part of social expenditures (more than 90% compared with other social insurance funds (less than 10%. At the same time, the administrative expenses were divided approximately into two halves between Pension Fund and other social security funds. In 2015, the government launched a reform of social insurance funds that aimed to reduce funds to three institutions but a decrease in the total amount of administrative expenditures has not been achieved yet. In addition, Pension Fund of Ukraine was least burdened with administrative expenses, while other social security funds with a relatively small share of social expenditures were burdened with administrative expenditures much more. Practical implications. Research showed that nowadays the existence of several social security funds in Ukraine is economically
The paper questions the view that international tax relations had a decisive impact on the dismissal of expenditure tax scenarios as guidelines for recent national tax reforms in industrialized countries. It is argued that the introduction of consumption-type value-added tax systems must be regarded a step towards expenditure taxation favoured by international agreements and that double taxation treaties should not be regarded as a specific obstacle against a reform of national enterprise tax...
Carroll, Christopher D.; Parker, Jonathan A.; Souleles, Nicholas S.
This paper explains why the collection of panel (reinterview) data on a comprehensive measure of household expenditures is of great value both for measuring budget shares (the core mission of a Consumer Expenditure survey) and for the most important research and public policy uses to which CE data can be applied, including construction of spending-based measures of poverty and inequality and estimating the effects of fiscal policy.
Natasha Cassidy; Emma Doherty; Troy Gill
Business investment is a key driver of economic growth and is currently around record highs in Australia as a share of GDP. In compiling forecasts for business investment, the Reserve Bank uses a variety of different indicators, including information from liaison as well as survey measures of firms’ investment intentions. The most comprehensive survey is the Australian Bureau of Statistics’ (ABS) quarterly survey of Private New Capital Expenditure and Expected Expenditure (Capex survey). Whil...
Schjerning, Bertel; Sørensen, Anders
This paper studies conversion factors based on the expenditure approach and evaluates the appropriateness for international comparisons of output levels in manufacturing. We apply a consistency check based on the insight that relative productivity levels should be invariant to the choice of base....... The conclusion is insensitive to the applied method for developing conversion factors. The implication is that we cannot measure relative productivity levels in manufacturing across countries using the expenditure approach....
David E. Sahn; Stephen D. Younger
This paper examines the progressivity of social sector expenditures and taxes in eight sub-Saharan African countries. It uses dominance tests to determine whether health and education expenditures redistribute resources to the poor. The paper finds that social services are poorly targeted. Among the services examined, primary education tends to be most progressive, and university education is least progressive. The paper finds that many taxes are progressive as well as efficient, including so...
Against the background of recovering growth and remaining fiscal consolidation needs, reforming tax expenditures may offer a promising avenue to raise revenue and, at the same time, improve efficiency of the tax systems. The workshop, held by DG ECFIN on 23 October 2013, addressed the economic and budgetary aspects of tax expenditures, including reporting practices, and discussed the rationale for business tax incentives and the distributional effects of tax reliefs in personal income taxatio...
Graf, Diana L; Pratt, Lauren V; Hester, Casey N; Short, Kevin R
To compare energy expenditure rates in children playing the physically active video games, Dance Dance Revolution (DDR) and Nintendo's Wii Sports in relation to treadmill walking. Energy expenditure, heart rate, step rate, and perceived exertion were measured in 14 boys and 9 girls (ages 10-13 years; BMI at 3-98th percentile for age and gender) while watching television at rest, playing DDR at 2 skill levels, playing Wii bowling and boxing, and walking at 2.6, 4.2, and 5.7 km/h. Arterial elasticity was measured at rest and immediately after gaming. Compared with watching television, energy expenditure while gaming or walking increased 2- to 3-fold. Similarly, high rates of energy expenditure, heart rate, and perceived exertion were elicited from playing Wii boxing, DDR level 2, or walking at 5.7 km/h. This occurred despite variations in step rate among activities, reflecting greater use of upper body during Wii play (lowest step rate) than during walking (highest step rate) or DDR play. Wii bowling and beginner level DDR elicited a 2-fold increase in energy expenditure compared to television watching. Large-artery elasticity declined immediately after both DDR and Wii. The change was inversely related to the increment in energy expenditure above rest achieved during the activity. Energy expenditure during active video game play is comparable to moderate-intensity walking. Thus, for children who spend considerable time playing electronic screen games for entertainment, physically active games seem to be a safe, fun, and valuable means of promoting energy expenditure.
Burgess, Philip; Pirkis, Jane; Buckingham, Bill; Burns, Jane; Eagar, Kathy; Eckstein, Gary
Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.
García-Cornejo, Beatriz; Pérez-Méndez, José A
To analyze the relationship between the degree of development of hospital cost systems (CS) implemented by the regional health services (RHS) and the variation in unit cost of hospitals in Spanish National Health Service (NHS) between 2010 and 2013 and to identify other explanatory factors of this variation. A database of NHS hospitals was constructed from exclusively public sources. Using a multilevel regression model, explaining factors of the variation in unit cost (cost per weighted unit of activity [WAU]) of a sample of 170 hospitals were analyzed. The variables representative of the degree of development of CS are associated in a negative and significant way with the variation of the cost per WAU. It is observed that if a high-level development CS is used the cost variation per WAU would be reduced by close to 3.2%. There is also a negative and significant relationship between the variation in the cost per WAU and the variations in the percentage of high technology and the hospital occupancy rate. On the other hand, the variations in the average cost of personnel and in the number of workers per 100 beds are associated in a positive and significant way with the variation of the cost per WAU. In the period analysed, during which the main health expenditure adjustment was made, the control in hospital unit cost is associated not only with spending cuts but also with aspects related to their management, such as the implementation of more developed CS. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
Lee, Jong Soo; Zakeri, Issa F; Butte, Nancy F
Adequate sleep is crucial during childhood for metabolic health, and physical and cognitive development. Inadequate sleep can disrupt metabolic homeostasis and alter sleeping energy expenditure (SEE). Functional data analysis methods were applied to SEE data to elucidate the population structure of SEE and to discriminate SEE between obese and non-obese children. Minute-by-minute SEE in 109 children, ages 5-18, was measured in room respiration calorimeters. A smoothing spline method was applied to the calorimetric data to extract the true smoothing function for each subject. Functional principal component analysis was used to capture the important modes of variation of the functional data and to identify differences in SEE patterns. Combinations of functional principal component analysis and classifier algorithm were used to classify SEE. Smoothing effectively removed instrumentation noise inherent in the room calorimeter data, providing more accurate data for analysis of the dynamics of SEE. SEE exhibited declining but subtly undulating patterns throughout the night. Mean SEE was markedly higher in obese than non-obese children, as expected due to their greater body mass. SEE was higher among the obese than non-obese children (p0.1, after post hoc testing). Functional principal component scores for the first two components explained 77.8% of the variance in SEE and also differed between groups (p = 0.037). Logistic regression, support vector machine or random forest classification methods were able to distinguish weight-adjusted SEE between obese and non-obese participants with good classification rates (62-64%). Our results implicate other factors, yet to be uncovered, that affect the weight-adjusted SEE of obese and non-obese children. Functional data analysis revealed differences in the structure of SEE between obese and non-obese children that may contribute to disruption of metabolic homeostasis.
Strath Scott J
Full Text Available Abstract Background Advances in technology, social influences and environmental attributes have resulted in substan-tial portions of the day spent in sedentary pursuits. Sedentary behavior may be a cause of many chronic diseases including obesity, insulin resistance, type 2 diabetes and the metabolic syndrome. Research demonstrated that breaking up sedentary time was beneficially associated with markers of body composition, cardiovascular health and type 2 diabetes. Therefore, the purpose of this study was to quantify the total energy expenditure of three different durations of physical activity within a 30-minute sedentary period and to examine the potential benefits of interrupting sedentary behavior with physical activity for weight control. Methods Participants completed four consecutive 30-minute bouts of sedentary behavior (reading, working on the computer, or doing other desk activities with and without interruptions of walking at a self-selected pace. Bout one contained no walking interruptions. Bout two contained a 1-minute walking period. Bout three contained a 2-minute walking period. Bout four contained a 5-minute walking period. Body composition and resting metabolic rate were assessed. Result Twenty males and females (18-39 years completed this study. Results of the repeated measures analysis of variance with post-hoc testing showed that significantly more energy was expended during each 30 minute sedentary bout with a walking break than in the 30 minute sedentary bout (p Conclusions This study demonstrated that making small changes, such as taking a five minute walking break every hour could yield beneficial weight control or weight loss results. Therefore, taking breaks from sedentary time is a potential outlet to prevent obesity and the rise of obesity in developed countries.
Full Text Available Cruise tourism generates different types of cruise consumption and related indirect, direct and induced expenditure effects, in homeports as well as in ports of call. Cruise passengers’ expenditures produce positive economic effects for destinations, from increasing the incomes and employment, to tax incomes, duties, etc. Therefore, it is no doubt that cruise stakeholders and local economies can benefit from increased cruise passenger consumption. To stimulate higher consumption and passengers’ satisfaction, it is necessary to design the supportive policy framework and build appropriate quality of products and services. Identifying influential variables of cruise passengers’ expenditures in this sense enables the design of appropriate policies and measures. In the current research, based on a survey of 357 cruise passengers, several variables included in a new theoretical model of the expenditures determinants, such as gender, nationality, frequency of cruising and frequency of visits, were found to be statistically significantly associated with cruise passengers’ expenditures. Several conclusions and suggestions to stimulate cruise passenger expenditures based on research findings are provided.
Cohen, Eyal; Hall, Matt; Lopert, Ruth; Bruen, Brian; Chamberlain, Lisa J; Bardach, Naomi; Gedney, Jennifer; Zima, Bonnie T; Berry, Jay G
Medication use may be a target for quality improvement, cost containment, and research. We aimed to identify medication classes associated with the highest expenditures among pediatric Medicaid enrollees and to characterize the demographic, clinical, and health service use of children prescribed these medications. Retrospective, cross-sectional study of 3 271 081 Medicaid-enrolled children. Outpatient medication spending among high-expenditure medication classes, defined as the 10 most expensive among 261 mutually exclusive medication classes, was determined by using transaction prices paid to pharmacies by Medicaid agencies and managed care plans among prescriptions filled and dispensed in 2013. Outpatient medications accounted for 16.6% of all Medicaid expenditures. The 10 most expensive medication classes accounted for 63.9% of all medication expenditures. Stimulants (amphetamine-type) accounted for both the highest proportion of expenditures (20.6%) and days of medication use (14.0%) among medication classes. Users of medications in the 10 highest-expenditure classes were more likely to have a chronic condition of any complexity (77.9% vs 41.6%), a mental health condition (35.7% vs 11.9%), or a complex chronic condition (9.8% vs 4.3%) than other Medicaid enrollees (all P costs may benefit from better delineation of the appropriate prescription of these medications. Copyright © 2017 by the American Academy of Pediatrics.
Shrestha, Sundar S; Zhang, Ping; Thompson, Theodore J; Gregg, Edward W; Albright, Ann; Imperatore, Giuseppina
Information on diabetes-related excess medical expenditures for youth is important to understand the magnitude of financial burden and to plan the health care resources needed for managing diabetes. However, diabetes-related excess medical expenditures for youth covered by Medicaid program have not been investigated recently. To estimate excess diabetes-related medical expenditures among youth aged below 20 years enrolled in Medicaid programs in the United States. We analyzed data from 2008 to 2012 MarketScan multistate Medicaid database for 6502 youths with diagnosed diabetes and 6502 propensity score matched youths without diabetes, enrolled in fee-for-service payment plans. We stratified analysis by Medicaid eligibility criteria (poverty or disability). We used 2-part regression models to estimate diabetes-related excess medical expenditures, adjusted for age, sex, race/ethnicity, year of claims, depression status, asthma status, and interaction terms. For poverty-based Medicaid enrollees, estimated annual diabetes-related total medical expenditure was $9046 per person [$3681 (no diabetes) vs. $12,727 (diabetes); PMedicaid enrollees, the estimated annual diabetes-related total medical expenditure was $9944 per person ($14,149 vs. $24,093; PMedicaid programs are substantial, which is larger among those with disabilities than without disabilities. Identifying cost-effective ways of managing diabetes in this vulnerable segment of the youth population is needed.
Leuck, Marlene; Levandovski, Rosa; Harb, Ana; Quiles, Caroline; Hidalgo, Maria Paz
This study aimed to evaluate the effect of continuous and intermittent methods of enteral nutrition (EN) administration on circadian rhythm. Thirty-four individuals, aged between 52 and 80 years, were fed through a nasoenteric tube. Fifteen individuals received a continuous infusion for 24 hours/d, and 19 received an intermittent infusion in comparable quantities, every 4 hours from 8:00 to 20:00. In each patient, 4 indirect calorimetric measurements were carried out over 24 hours (A: 7:30, B: 10:30, C: 14:30, and D: 21:30) for 3 days. Energy expenditure and oxygen consumption were significantly higher in the intermittent group than in the continuous group (1782 ± 862 vs 1478 ± 817 kcal/24 hours, P = .05; 257 125 vs 212 117 ml/min, P = .048, respectively). The intermittent group had higher levels of energy expenditure and oxygen consumption at all the measured time points compared with the continuous group. energy expenditure and oxygen consumption in both groups were significantly different throughout the day for 3 days. There is circadian rhythm variation of energy expenditure and oxygen consumption with continuous and intermittent infusion for EN. This suggests that only one indirect daily calorimetric measurement is not able to show the patient's true needs. Energy expenditure is higher at night with both food administration methods. Moreover, energy expenditure and oxygen consumption are higher with the intermittent administration method at all times.
Bernard, Didem; Cowan, Cathy; Selden, Thomas; Cai, Liming; Catlin, Aaron; Heffler, Stephen
Provide a comparison of health care expenditure estimates for 2007 from the Medical Expenditure Panel Survey (MEPS) and the National Health Expenditure Accounts (NHEA). Reconciling these estimates serves two important purposes. First, it is an important quality assurance exercise for improving and ensuring the integrity of each source's estimates. Second, the reconciliation provides a consistent baseline of health expenditure data for policy simulations. Our results assist researchers to adjust MEPS to be consistent with the NHEA so that the projected costs as well as budgetary and tax implications of any policy change are consistent with national health spending estimates. The Medical Expenditure Panel Survey produced by the Agency for Healthcare Research and Quality, and the National Health Center for Health Statistics and the National Health Expenditures produced by the Centers for Medicare & Medicaid Service's Office of the Actuary. In this study, we focus on the personal health care (PHC) sector, which includes the goods and services rendered to treat or prevent a specific disease or condition in an individual. The official 2007 NHEA estimate for PHC spending is $1,915 billion and the MEPS estimate is $1,126 billion. Adjusting the NHEA estimates for differences in underlying populations, covered services, and other measurement concepts reduces the NHEA estimate for 2007 to $1,366 billion. As a result, MEPS is $240 billion, or 17.6 percent, less than the adjusted NHEA total.
Full Text Available OBJECTIVE: To determine energy expenditure in kilocalories (kcal during sexual activity in young healthy couples in their natural environment and compare it to a session of endurance exercise. METHODS: The study population consisted of twenty one heterosexual couples (age: 22.6 ± 2.8 years old from the Montreal region. Free living energy expenditure during sexual activity and the endurance exercise was measured using the portable mini SenseWear armband. Perceived energy expenditure, perception of effort, fatigue and pleasure were also assessed after sexual activity. All participants completed a 30 min endurance exercise session on a treadmill at a moderate intensity. RESULTS: Mean energy expenditure during sexual activity was 101 kCal or 4.2 kCal/min in men and 69.1 kCal or 3.1 kCal/min in women. In addition, mean intensity was 6.0 METS in men and 5.6 METS in women, which represents a moderate intensity. Moreover, the energy expenditure and intensity during the 30 min exercise session in men was 276 kCal or 9.2 kCal/min and 8.5 METS, respectively and in women 213 kCal or 7.1 kCal/min and 8.4 METS, respectively. Interestingly, the highest range value achieved by men for absolute energy expenditure can potentially be higher than that of the mean energy expenditure of the 30 min exercise session (i.e. 306.1 vs. 276 kCal, respectively whereas this was not observed in women. Finally, perceived energy expenditure during sexual activity was similar in men (100 kCal and in women (76.2 kCal when compared to measured energy expenditure. CONCLUSION: The present study indicates that energy expenditure during sexual activity appears to be approximately 85 kCal or 3.6 kCal/min and seems to be performed at a moderate intensity (5.8 METS in young healthy men and women. These results suggest that sexual activity may potentially be considered, at times, as a significant exercise.
Hasnul, Al Gifari
The relationship between government expenditure and economic growth has been debated for decades and has not clearly stated yet. This paper gives a further evidence on the relationship between government expenditure and economic growth in the case of Malaysia. In this study, the government expenditure has been disaggregated in to the government operating and development expenditure. We also classified the government expenditure based on the sector of which it expensed. We used OLS technique t...
Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Barros, Aluísio Jardim Dornellas de; Posenato, Leila Garcia; Peres, Karen Glazer
To analyze the evolution of catastrophic health expenditure and the inequalities in such expenses, according to the socioeconomic characteristics of Brazilian families. Data from the National Household Budget 2002-2003 (48,470 households) and 2008-2009 (55,970 households) were analyzed. Catastrophic health expenditure was defined as excess expenditure, considering different methods of calculation: 10.0% and 20.0% of total consumption and 40.0% of the family's capacity to pay. The National Economic Indicator and schooling were considered as socioeconomic characteristics. Inequality measures utilized were the relative difference between rates, the rates ratio, and concentration index. The catastrophic health expenditure varied between 0.7% and 21.0%, depending on the calculation method. The lowest prevalences were noted in relation to the capacity to pay, while the highest, in relation to total consumption. The prevalence of catastrophic health expenditure increased by 25.0% from 2002-2003 to 2008-2009 when the cutoff point of 20.0% relating to the total consumption was considered and by 100% when 40.0% or more of the capacity to pay was applied as the cut-off point. Socioeconomic inequalities in the catastrophic health expenditure in Brazil between 2002-2003 and 2008-2009 increased significantly, becoming 5.20 times higher among the poorest and 4.17 times higher among the least educated. There was an increase in catastrophic health expenditure among Brazilian families, principally among the poorest and those headed by the least-educated individuals, contributing to an increase in social inequality.
Hurkmans, Henri L; van den Berg-Emons, Rita J; Stam, Henk J
To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing. Cross-sectional study. University medical center. Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers. Participants played Wii Sports tennis and boxing, each for 15 minutes in random order. By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (Vo(2)) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as Vo(2) during Wii Sports play divided by Vo(2) during sitting. Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing. Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels. Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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.
Smith, Alden; Handorf, Elizabeth; Arjmand, Ellis; Lango, Miriam N
To describe geographic variation in spending and evaluate regional Medicare expenditures for otolaryngologist services with population- and beneficiary-related factors, physician supply, and hospital system factors. Cross-sectional study. The average regional expenditures for otolaryngology physician services were defined as the total work relative value units (wRVUs) collected by otolaryngologists in a hospital referral region (HRR) per thousand Medicare beneficiaries in the HRR. A multivariable linear regression model tested associations with regional sociodemographics (age, sex, race, income, education), the physician and hospital bed supply, and the presence of an otolaryngology residency program. In 2012, the mean Medicare expenditure for otolaryngology provider services across HRRs was 224 wRVUs per thousand Medicare beneficiaries (standard deviation [SD] 104), ranging from 31 to 604 wRVUs per thousand Medicare beneficiaries. In 2013, the average Medicare expenditures for each HRR was highly correlated with expenditures collected in 2012 (Pearson correlation coefficient .997, P = .0001). Regional Medicare expenditures were independently and positively associated with otolaryngology, medical specialist, and hospital bed supply in the region, and were negatively associated with the supply of primary care physicians and presence of an otolaryngology residency program after adjusting for other factors. The magnitude of associations with physician supply and hospital factors was stronger than any population or Medicare beneficiary factor. Wide variations in regional Medicare expenditures for otolaryngology physician services, highly stable over 2 years, were strongly associated with regional health system factors. Changes in health policy for otolaryngology care may require coordination with other physician specialties and integrated hospital systems. NA. Laryngoscope, 127:1312-1317, 2017. © 2016 The American Laryngological, Rhinological and Otological Society
Chor Foon TANG
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.
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.
Osula, D.O.A.; Adebisi, O.
A report is presented on a study carried out to develop a functional form for travel money expenditure in a Nigerian setting, and test its stability against energy policy change, specifically the fuel price increase of October 1994. The Box-Cox transformation regression approach was adopted in the modelling exercise in order to evolve a data-defined functional form and ensure a more rational basis for the stability test. The results of the modelling exercise show that while statistically significant functional forms were estimated for the 'before' and 'after' fuel price increase periods, the functional forms estimated are not stable across the periods. Thus 'travel budget' is as yet not usable as a term for travel expenditures in Nigeria. The implication of this for travel demand modelling in Nigeria is that, at least till other evidences prove otherwise, there is as yet no basis for using the 'Universal Mechanism of Travel' model developed by Zahavi (The UMOT Project. Report No. DOT-RSPA-DPB-20-79-3; The UMOT Travel Model II Report No. DOT-RSPA-DPB-50-82-11). Of disposable income and total expenditure, the former has proved to be more appropriate for use as 'available money' for the estimation of travel expenditures in Nigeria in the 'before' energy policy change period, while total expenditure proved appropriate in the 'after' period. (author)
Georges, Marjolaine; Morélot-Panzini, Capucine; Similowski, Thomas; Gonzalez-Bermejo, Jesus
Amyotrophic lateral sclerosis (ALS) leads to chronic respiratory failure. Diaphragmatic dysfunction, a major driver of dyspnea and mortality, is associated with a shift of the burden of ventilation to extradiaphragmatic inspiratory muscles, including neck muscles. Besides, energy expenditure is often abnormally high in ALS, and this is associated with a negative prognostic value. We hypothesized that noninvasive ventilation (NIV) would relieve inspiratory neck muscles and reduce resting energy expenditure (REE). Using indirect calorimetry, we measured REE during spontaneous breathing (REESB) and NIV (REENIV) in 16 ALS patients with diaphragmatic dysfunction, during the first 3 months of NIV. Measured values were compared with predicted REE (REEpred)(Harris-Benedict equation). NIV abolished inspiratory neck muscle activity. Even though our patients were not hypermetabolic, on the contrary, with a REESB that was lower than REEpred (average 11%), NIV did reduce energy expenditure. Indeed, median REENIV, in this population with a mean body mass index of 21.4 kg.m-2, was 1149 kcal/24 h [interquartile 970-1309], lower than REESB (1197 kcal/24 h, 1054-1402; mean difference 7%; p = 0.03, Wilcoxon). REESB and REENIV were correlated with forced vital capacity and maximal inspiratory pressure. NIV can reduce energy expenditure in ALS patients probably by alleviating the ventilatory burden imposed on inspiratory neck muscles to compensate diaphragm weakness. It remains to be elucidated whether or not, in which population, and to what extent, NIV can be beneficial in ALS through the corresponding reduction in energy expenditure.
A. N. Shmakov
Full Text Available Purpose. With the aid of indirect calorimetry, to evaluate whether the nosological factors affect energy exchange in severely ill newborns.Materials and methods. Indirect calorimetry was employed to determine the true energy expenditure in new borns under the mechanical ventilation because of intranatal postanoxia encephalopathy (n=19, severe sepsis (n=18, and urgent surgery (n=19. Energy expenditure at rest was estimated at the beginning of intensive therapy and in in 48 hours. Sedation in groups was similar.Results. At the first stage, the energy exchange in all newborns was characterized by hypometabolism. In cases of damage of the central nervous system the anaerobic metabolism was increased, and the principal used substrate was glucose; the most prolonged hypometabolism was revealed in newborns with sepsis, in which the utilization of lactate was decreased, and the main energetic substrate were lipids; in early postoperative period, the decrease in energy expenditure was not associated with preferential oxidation of glucose or lipids, and disappeared due to elimination of anesthetics.Conclusion. Energetic hypometabolism can be considered as a main reaction of the newborn organism to previous invasion. Acute posthypoxic brain damage in newborns is characterized by high activity of peroxidation associated with hypometabolism. For newborns with severe sepsis a slow recovery of aerobic metabolism and intensity of energy expenditure were evident. Early postoperative period in newborns was characterized by profound iatrogenic hypometabolism with fast normalization of energy expenditure.
Ben-Aharon, Omer; Shavit, Oren; Magnezi, Racheli
Increasing health costs in developed countries are a major concern for decision makers. A variety of cost containment tools are used to control this trend, including maximum price regulation and reimbursement methods for health technologies. Information regarding expenditure-related outcomes of these tools is not available. To evaluate the association between different cost-regulating mechanisms and national health expenditures in selected countries. Price-regulating and reimbursement mechanisms for prescription drugs among OECD countries were reviewed. National health expenditure indices for 2008-2012 were extracted from OECD statistical sources. Possible associations between characteristics of different systems for regulation of drug prices and reimbursement and health expenditures were examined. In most countries, reimbursement mechanisms are part of publicly financed plans. Maximum price regulation is composed of reference-pricing, either of the same drug in other countries, or of therapeutic alternatives within the country, as well as value-based pricing (VBP). No association was found between price regulation or reimbursement mechanisms and healthcare costs. However, VBP may present a more effective mechanism, leading to reduced costs in the long term. Maximum price and reimbursement mechanism regulations were not found to be associated with cost containment of national health expenditures. VBP may have the potential to do so over the long term.
Full Text Available This study analyzes the satisfaction of the Nevadans with respect to their highway transportation system and the corresponding expenditures of Nevada Department of Transportation (NDOT. A survey questionnaire was designed to capture the opinions of the Nevadans (customers about a number of characteristics of their transportation system. Data from the financial data warehouse of the NDOT was used to evaluate expenditures. Multinomial probit models were estimated to study the correlations between customers’ opinion and the government expenditures in transportation. The results indicate the customer satisfaction is decreasing with respect to traffic safety throughout Northwestern and Southern Nevada highways. In addition, users of Northwestern highways are more likely to be satisfied, compared to their counterparts, with increasing construction spending to reduce the time taken to complete construction projects. In Southern Nevada highways, customers’ satisfaction increases with the expenditures associated with reduction of congestion. These insights are examples of the conclusions that were obtained as a consequence of simultaneously considering customer satisfaction and the corresponding expenditures in transportation.
Osula, D.O.A.; Adebisi, O. [Ahmadu Bello University, Zaria (Nigeria). Department of Civil Engineering
A report is presented on a study carried out to develop a functional form for travel money expenditure in a Nigerian setting, and test its stability against energy policy change, specifically the fuel price increase of October 1994. The Box-Cox transformation regression approach was adopted in the modelling exercise in order to evolve a data-defined functional form and ensure a more rational basis for the stability test. The results of the modelling exercise show that while statistically significant functional forms were estimated for the 'before' and 'after' fuel price increase periods, the functional forms estimated are not stable across the periods. Thus 'travel budget' is as yet not usable as a term for travel expenditures in Nigeria. The implication of this for travel demand modelling in Nigeria is that, at least till other evidences prove otherwise, there is as yet no basis for using the 'Universal Mechanism of Travel' model developed by Zahavi (The UMOT Project. Report No. DOT-RSPA-DPB-20-79-3; The UMOT Travel Model II Report No. DOT-RSPA-DPB-50-82-11). Of disposable income and total expenditure, the former has proved to be more appropriate for use as 'available money' for the estimation of travel expenditures in Nigeria in the 'before' energy policy change period, while total expenditure proved appropriate in the 'after' period. (author)
Taghadomi Masoumi, Zahra; Eshraghian, Mohammad Reza; Hedayati, Mahdi; Pishva, Hamideh
Obesity is recognized as the most prevalent metabolic disease worldwide. Decreases in energy expenditure may increase risk of obesity. One of the key regulators of energy balance is uncoupling protein2 (UCP2), a transporter protein presents in mitochondrial inner membrane. Moreover, adiponectin is the most abundant adipocytokine, it may play a role in energy metabolism and gene expression of UCP2. The aim of this study was to investigate potential associations between the level of uncoupling protein 2 and adiponectin and their relationship with REE (Resting Energy Expenditure) in obese women with normal and low resting energy expenditure. A total of 49 subjects (women, 25-50 years old), were included in current study, 16 subjects with BMI > 30 and low resting energy expenditure, 17 subjects with BMI > 30 and normal resting energy expenditure and 16 non-obese subjects as a control group. Anthropometric, body composition parameters and resting energy expenditure were measured. Plasma adiponectin, UCP2 protein and total protein in PBMC were determined. Measured resting energy expenditure in obese subjects with low REE was significantly lower than other groups. Plasma adiponectin in the obese subjects with low REE was significantly lower compared to normal weight group. There was a significant relationship between 'UCP2 protein/Total protein' ratio and plasma adiponectin in obese group with low REE and in three groups when we pooled. There was a significant association between REE and plasma adiponectin in three groups when we pooled. There was a significant association between plasma adiponectin and REE. Moreover, there was a significant relationship between UCP2 and REE.
In fiscal 1982 (April to March, 1983), the research and development on nuclear power should be promoted actively and extensively by taking the appropriate measures. In view of the importance, the budgetary expenditures are to be estimated duly for the purpose, considering also the stringent financial situation. The budgetary expenditures for nuclear power estimated for the fiscal year 1982 are about 292,800 Million in total and the obligation act limit is about 139,900 Million. The following matters are described: nuclear power-related measures for securing nuclear power safety, promotion of nuclear power generation, establishment of the nuclear fuel cycle, development of power reactors, research on nuclear fusion, strengthening of the foundation in nuclear power research, development and utilization, promotion of international cooperation, etc.; estimated budgetary expenditures; tables of budgetary demands in various categories. (J.P.N.)
Bonke, Jens; Browning, Martin
We report on a new data initiative that is designed to address the question of “who gets what” within the household. The data consists of supplements to the Danish Expenditure Survey (DES) which is a traditional nationally representative, diary based survey of expenditures. We collect supplementary...... data of two kinds for all couples (with or without children) in the survey. The first addition is that respondents report on the intra-household allocation of each item of expenditure (‘joint’, ‘her’, ‘him’, ‘children’ and ‘outside’). The second addition is an extra set of ‘sociological’ questions...... concerning household management, autonomy and family background. These types of information for the same respondents may facilitate research bridging the divergent views of economist and sociologists concerning the allocation of resources within the household. The paper focuses on the survey design and gives...
Moreno-Macías, Lidia; Palma-Solís, Marco; Zapata-Vázquez, Rita E
The status of undernourishment in children under the age of five in Mexico is open to debate. Linked to poverty, underweight and stunting, the rates of undernourishment are reported to be diminishing, although poverty remains an incessant problem. This study was done to determine whether there is an association between public expenditure and underweight and stunting distribution in Mexico based on data from the 2006 health and population census and from macroeconomic, social, and demographic variables. We used principal component analysis to reduce the number of variables and analyze their behavior. Multiple regressions showed that underweight and stunting are significantly associated with the marginalization index, support from the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) supplies and breakfast program, the gross domestic product per capita, and expenditure from the Opportunities program. Further, public expenditure aimed to combat undernourishment is inadequately oriented to address the needs of the poor.
Duddy Roesmara Donna
Full Text Available The aim of this study is to estimate and analize the characteristics of Indonesian household expenditure on goods and services, for example food, clothes, household utensils, housing, medical care, education, oil and transportation, gas, electricity and communication. Linear Expenditure System (LES model and seemingly uncorrelated regression (SUR estimation method were applied. This study has some conclusions. First, if ones have more incomes, they will proportionally allocate them for housing, oil and transportation, education, food, and medical care. Second, medical care, education and communication are categorized as superior or deluxe commodities. Third, the approximation of minimum living expenditure to survive is Rp 147.236 for a household per week.
Hinton, C A; Cullen, K E
Thirteen normal male college students were studied during unassisted ambulation and nonweight-bearing ambulation with Ortho crutches and axillary crutches to determine energy expenditure. Subjects walked at self-selected velocities. Energy expenditure was determined by analyzing expired air collected by a calorimeter. Heart rate was monitored by telemetry. During the first 2.5 minutes of walking, heart rate and energy expenditure were significantly greater for ambulation with axillary crutches than with Ortho crutches. After 11.5 minutes of walking, no difference in energy cost was found between crutch types; however, heart rate increased significantly (p less than .01) during ambulation with axillary crutches. Differences in energy cost and heart rate were attributed to increased upper extremity work performed when using axillary crutches. We concluded that during nonweight-bearing ambulation for short periods of time or over a short distance, the Ortho crutch is less taxing in terms of energy cost and heart rate demands.
Khosravi, Bahman; Soltani, Shahin; Javan-Noughabi, Javad; Faramarzi, Ahmad
Background: In all countries, health expenditures are a main part of government expenditure, and governments try to find policies and strategies to reduce this expenditure. Overall expenditure index has been raised 30 times during the past 20 years in Iran, while in the health sector, the growth in health expenditures index has been 71 times. The present study aimed at examining health care expenditure in the Islamic Republic of Iran versus other high spending countries. Methods: A comparative panel study was conducted in selected countries with the high mean of health expenditure per capita. Data were collected from the WORLD BANK. Out- of- pocket (OOP), health expenditure per capita, public and private health expenditure, and total health expenditure were compared among the selected counties. Results: Iran has the lowest health expenditure per capita compared to other countries and the USA has the highest health expenditures per capita. In Iran, out- of- pocket expenditure, with more than 50%, was the most cost, while in Luxembourg it was the least cost during 2004 to 2014, with less than 12%. Conclusion: Our findings revealed that politicians and health care executives should find a stable source to finance the health system. Stable sources of financing lead to having a steady trend in health expenditure.
Fizaine, Florian; Court, Victor
We estimate energy expenditure for the US and world economies from 1850 to 2012. Periods of high energy expenditure relative to GDP (from 1850 to 1945), or spikes (1973–74 and 1978–79) are associated with low economic growth rates, and periods of low or falling energy expenditure are associated with high and rising economic growth rates (e.g. 1945–1973). Over the period 1960–2010 for which we have continuous year-to-year data for control variables (capital formation, population, and unemployment rate) we estimate that, statistically, in order to enjoy positive growth, the US economy cannot afford to spend more than 11% of its GDP on energy. Given the current energy intensity of the US economy, this translates in a minimum societal EROI of approximately 11:1 (or a maximum tolerable average price of energy of twice the current level). Granger tests consistently reveal a one way causality running from the level of energy expenditure (as a fraction of GDP) to economic growth in the US between 1960 and 2010. A coherent economic policy should be founded on improving net energy efficiency. This would yield a “double dividend”: increased societal EROI (through decreased energy intensity of capital investment), and decreased sensitivity to energy price volatility. - Highlights: •We estimate energy expenditures as a fraction of GDP for the US, the world (1850–2012), and the UK (1300–2008). •Statistically speaking, the US economy cannot afford to allocate more than 11% of its GDP to energy expenditures in order to have a positive growth rate. •This corresponds to a maximum tolerable average price of energy of twice the current level. •In the same way, US growth is only possible if its primary energy system has at least a minimum EROI of approximately 11:1.
Gomes, B B; Mourão, L; Massart, A; Figueiredo, P; Vilas-Boas, J P; Santos, A M C; Fernandes, R J
We purposed to study energy expenditure, power output and gross efficiency during kayak ergometer exercise in 12 elite sprint kayakers. 6 males (age 24.2±4.8 years, height 180.4±4.8 cm, body mass 79.7±8.5 kg) and 6 females (age 24.3±4.5 years, height 164.5±3.9 cm, body mass 65.4±3.5 kg), performed an incremental intermittent protocol on kayak ergometer with VO2 and blood lactate concentration assessment, a non-linear increase between power output and energy expenditure being observed. Paddling power output, energy expenditure and gross efficiency corresponding to VO2max averaged 199.92±50.41 W, 75.27±6.30 ml.kg - 1.min - 1, and 10.10±1.08%. Male kayakers presented higher VO2max, power output and gross efficiency at the VO2max, and lower heart rate and maximal lactate concentration than females, but no differences were found between genders regarding energy expenditure at VO2max. Aerobic and anaerobic components of energy expenditure evidenced a significant contribution of anaerobic energy sources in sprint kayak performance. Results also suggested the dependence of the gross efficiency on the changes in the amount of the aerobic and anaerobic contributions, at heavy and severe intensities. The inter-individual variance of the relationship between energy expenditure and the corresponding paddling power output revealed a relevant tracking for females (FDγ=0.73±0.06), conversely to the male group (FDγ=0.27±0.08), supporting that some male kayakers are more skilled in some paddling intensities than others. © Georg Thieme Verlag KG Stuttgart · New York.
Mohanty, Sanjay K; Srivastava, Akanksha
Though promotion of institutional delivery is used as a strategy to reduce maternal and neonatal mortality, about half of the deliveries in India are conducted at home without any medical care. Among women who deliver at home, one in four cites cost as barrier to facility-based care. The relative share of deliveries in private health centres has increased over time and the associated costs are often catastrophic for poor households. Though research has identified socio-economic, demographic and geographic barriers to the utilization of maternal care, little is known on the cost differentials in delivery care in India. The objective of this paper is to understand the regional pattern and socio-economic differentials in out-of-pocket (OOP) expenditure on institutional delivery by source of provider in India. The study utilizes unit data from the District Level Household and Facility Survey (DLHS-3), conducted in India during 2007-08. Descriptive statistics, principal component analyses and a two-part model are used in the analyses. During 2004-08, the mean OOP expenditure for a delivery in a public health centre in India was US$39 compared with US$139 in a private health centre. The predicted expenditure for a caesarean delivery was six times higher than for a normal delivery. With an increase in the economic status and educational attainment of mothers, the propensity and rate of OOP expenditure increases, linking higher OOP expenditure to quality of care. The OOP expenditure in public health centres, adjusting for inflation, has declined over time, possibly due to increased spending under the National Rural Health Mission. Based on these findings, we recommend that facilities in public health centres of poorly performing states are improved and that public-private partnership models are developed to reduce the economic burden for households of maternal care in India.
Full Text Available Budget deficits and the debate on the sources of deficit finance have been on the agenda of public economics ever since the 1980s. However recently in the post-communist countries fiscal imbalances appear to be an important problem due to prolonged periods of growing poverty resulting from the transition process. Poverty alleviation policies considerably affect the revenue and expenditure decisions of governments, which are subject to hard budget constraints in an open transitional economy and do not have room for departing from sound fiscal policies. The public finance literature provides a vast number of studies analyzing the relationship between public revenues and expenditures. These studies are mostly characterized by efforts to reveal the attitude of the fiscal authority towards maintaining the budget balance. In this respect, budgetary dynamics in which past government revenues have predictive power on the current level of government expenditures are accepted as evidence of the so-called tax-and-spend hypothesis. On the other hand, the revenue-expenditure nexus running from expenditures to revenues is known in the literature as the spend-and-tax hypothesis. The objective of this study is to analyze empirically the relationship between government revenues and expenditures in four of the transitional economies, i.e. Belarus, Kazakhstan, the Kyrgyz Republic and the Russian Federation. The empirical findings of this study, which are based on Granger causality tests, indicate evidence supporting the tax-and-spend hypothesis in Belarus and the Russian Federation and fiscal synchronization in Kazakhstan and the Kyrgyz Republic. The empirical support for the tax-and-spend hypothesis in these economies implies that increasing government revenues may not end up with lower budget deficits due to their stimulating effect on the demand for public goods and services.
Traynor, Laura; Lange, Ian; Moro, Mirko [Stirling Univ. (United Kingdom). Division of Economics
In the UK, the largest proportion of household energy use is for space heating. Popular media make claims of a green hypocrisy: groups which have the strongest attitude towards the environment have the highest emissions. This study examines whether environmental attitudes and behaviours are associated with space heating energy use using data from the British Household Panel Survey. Results find that environmentally friendly attitudes generally do not lead to lower heating expenditures though environmentally friendly behaviours are associated with lower heating expenditure. Also, the effect of these attitudes and behaviours do not change as income increase.
Gade, Rikke; Larsen, Ryan Godsk; Moeslund, Thomas B.
Estimation of human energy expenditure in sports and exercise contributes to performance analyses and tracking of physical activity levels. The focus of this work is to develop a video-based method for estimation of energy expenditure in athletes. We propose a method using thermal video analysis...... to automatically extract the cyclic motion pattern, in walking and running represented as steps, and analyse the frequency. Experiments are performed with one subject in two different tests, each at 5, 8, 10, and 12 km/h. The results of our proposed video-based method is compared to concurrent measurements...
Mudd, Lanay M; Rafferty, Ann P; Reeves, Mathew J; Pivarnik, James M
Most adults do not meet the American College of Sports Medicine and Centers for Disease Control and Prevention (ACSM/CDC) physical activity recommendations. Even fewer meet the more extreme Institute of Medicine (IOM) physical activity recommendations. Compliance with either recommendation has been conventionally assessed by combining frequencies and durations of self-reported activities. Leisure-time energy expenditure is a cumulative measure of activity that offers an alternative method of defining compliance. To calculate the leisure-time energy expenditure of adults complying with the ACSM/CDC or the IOM physical activity recommendations determined by conventional measures and to reexamine compliance with the IOM recommendation using energy expenditure criteria. National, cross-sectional data from the 2000 Behavioral Risk Factor Surveillance System determined the mode, frequency, and duration of up to two leisure-time activities performed by adults. Four mutually exclusive activity groups (Non-, Low-, ACSM/CDC-, and IOM-Active) were defined on the basis of frequencies and durations of reported activities. Leisure-time energy expenditure (kcal x kg(-1) x wk(-1)) was calculated per respondent. The energy expenditure threshold for meeting the IOM recommendation was calculated as 21 kcal x kg(-1) x wk(-1). Of the 162,669 respondents included in the analyses, 29.9% were Nonactive, whereas 42.3%, 23.3%, and 4.5% were Low-, ACSM/CDC-, and IOM-Active, respectively. Median leisure-time energy expenditure values were 9.0, 27.4, and 63.0 kcal x kg(-1) x wk(-1) for Low-, ACSM/CDC-, and IOM-Active groups, respectively. When using energy expenditure criteria, compliance with the IOM recommendation rose to 27.7% of respondents. Compliance with the IOM physical activity recommendation dramatically increased when assessed by energy expenditure compared with conventional criteria, thereby highlighting the potential bias of conventional methods. A significant proportion of adults
This bulletin presents 1960-81 data on per capita food consumption, prices, nutrient availability, food expenditures and marketing costs, and U.S. income and population. Retail food prices rose 7.9 percent, aggregate food consumption fell 1.0 percent, and personal consumption expenditures for food rose 9.7 percent. Per capita meat consumption was down 2.5 pounds in 1981, hut poultry usage rose 1.8 pounds. Dairy consumption per person was lower. Fresh fruit consumption rose 1.6 pounds per pers...
This bulletin ,presents 1962-82 data on per capita food consumption, prices, nutrient availability,food expenditures and marketing costs, and U.S. income and population. Retail food prices in 1982 rose 4.0 percent, aggregate food consumption fell 0.4 percent, and personal food, consumption expenditures rose 6.3 percent from 1981. Per, capita red meat consumption was down 5.8 pounds, but poultry use rose 1.3 pounds. Dairy product consumption per person decreased. Fresh fruit consumption fell 3...
This paper identifies some major drivers of per capita public health expenditure growth in Tanzania using nationally representative annual data between 1995 and 2014. It used Bayesian model based on Markov Chain Monte Carlo (MCMC) simulation. The empirical result shows that both the real GDP per capita and ...
The aim of this paper is to investigate the expenditure incurred by health insurers arising from the provision of benefits during the 12 months preceding a beneficiary's death. Concern is expressed in parts of the international literature about the extent of resources directed towards those at the end of life, particularly given ...
Lows, Raymond L.; Ho, Fanny
This study examines the relationships between various elements of property wealth and operating expenditures per pupil by types of school district--elementary (K-8), high (9-12), and unit (K-12). Elements of property wealth were defined as the equalized assessed valuation per pupil for each of the following property tax classifications:…
Pandit, R.; Beerens, S.; Adan, R. A.H.
The adipocyte-derived hormone leptin is a peripheral signal that informs the brain about the metabolic status of an organism. Although traditionally viewed as an appetite-suppressing hormone, studies in the past decade have highlighted the role of leptin in energy expenditure. Leptin has been shown
The Granger causality test was performed within vector error correction model and the results revealed strong support for both Wagner's law and Keynesian hypothesis when ... Wagner's law was only supported in one instance where causality runs from economic growth to development expenditure from domestic sources.
van Klaveren, C.; Ghysels, J.
In this study we examine the collective labor supply choices of dual-earner parents and take into account child care expenditures. We find that the individual labor supplies are hardly affected by changes in the prices of child care services. In addition, the child care price effects on the
Shaoul, Jean; Stafford, Anne; Stapleton, Pamela
This paper examines the disclosure and reporting of expenditure under the UK government's "Building Schools for the Future" programme. The study finds that there is little detailed and useful financial reporting, and the public's right to know under Freedom of Information Act 2000 is very limited. The lack of such information makes it…
Graves, Lee; Stratton, Gareth; Ridgers, N D; Cable, N T
To compare the energy expenditure of adolescents when playing sedentary and new generation active computer games. Cross sectional comparison of four computer games. Setting Research laboratories. Six boys and five girls aged 13-15 years. Participants were fitted with a monitoring device validated to predict energy expenditure. They played four computer games for 15 minutes each. One of the games was sedentary (XBOX 360) and the other three were active (Wii Sports). Predicted energy expenditure, compared using repeated measures analysis of variance. Mean (standard deviation) predicted energy expenditure when playing Wii Sports bowling (190.6 (22.2) kl/kg/min), tennis (202.5 (31.5) kl/kg/min), and boxing (198.1 (33.9) kl/kg/min) was significantly greater than when playing sedentary games (125.5 (13.7) kl/kg/min) (Pgames. Playing new generation active computer games uses significantly more energy than playing sedentary computer games but not as much energy as playing the sport itself. The energy used when playing active Wii Sports games was not of high enough intensity to contribute towards the recommended daily amount of exercise in children.
Wieringa, Jaap E.; Leeflang, Peter S. H.
The successful innovation of pharmaceuticals requires a substantial amount of marketing support, despite concerns about the effects of these marketing efforts. This study considers prior findings that indicate that higher marketing expenditures for a brand reduce its price elasticity of demand,
Maria Letitia Andronic (Bratulescu
Full Text Available The process of local public spending optimization is extensively studied by those who have the power of decision towards saving. Even if the goal is to adjust the imbalance revenues/expenditures, the trend to spend more than accumulated is still a matter of concern. Our objective is that of analyzing the local governments’ functional expenditures by measuring the degree of decentralization/autonomy. The value of the paper is given by the model we applied for Romania which is based on spending management. By analyzing different types of expenses, we have highlighted that local expenditures represent instruments of strengthening or weakening local autonomy. The indicators measure the effectiveness of local expenditures by using the model published by The World Bank in 2006. We gathered information through interviewing different Town-Hall representatives from Brasov County and then we gave scores and established ranks. As the degree of autonomy reached a score of about 3 on a scale of 1-4, we identified that the class in which Romania is placed (B is mostly defined in terms of delegated powers and not decentralized competences. The study is significant for politicians, for those responsible for implementing decentralization, but also for the taxpayers who deserve the best public services.
... the recipient achieves them, are reliable indicators of the amount of effort the recipient expended. However, the estimate of the required expenditures need not be a precise dollar amount, as illustrated by the example in paragraph (b) of this section, if: (1) The recipient is contributing a substantial...
C. Fillat; J.F. François (Joseph)
textabstractWe examine linkages between aggregate household income, distribution of that income, and aggregate cross-country expenditure patterns. We are able to decompose income effects into international income dispersion effects (from variations in average income) and national income dispersion
... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Research, development, or... COMPANIES, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 4. Deferred Debits § 256.188 Research, development, or... of all expenditures for research, development or demonstration undertaken by or sponsored through the...
Energy utilisation at work in the labour-intensive building industry is of prime importance to contractors who match people to jobs. This paper provides an insight into modelling energy expenditure in a specific task, namely brick laying in various postures. It therefore takes previous “generic” biomechanical-energy prediction ...
... (b) of this section, be qualified campaign expenses and be reported by the candidate's authorized... or speech made, will also be considered in determining whether a stop is campaign-related. (3) For... qualified campaign expense and shall be reported by the committee as an expenditure. (i) If the trip is by...
... (b) of this section, be qualified campaign expenses and be reported by the candidate's authorized... or speech made, will also be considered in determining whether a stop is campaign-related. (3) For... purposes will be a qualified campaign expense and shall be reported by the committee as an expenditure. (i...
Lahat, Sharon; Mimouni, Francis B; Ashbel, Gina; Dollberg, Shaul
Massage therapy has been consistently shown to increase weight gain in preterm infants. The mechanism of this presumed improved metabolic efficiency is unknown. We conducted the following trial to test the hypothesis that massage therapy reduces energy expenditure in growing healthy preterm infants. A prospective, randomized, cross-over design study was conducted in 10 healthy, appropriate weights for gestational age, gavage fed preterm infants. Each infant was studied twice: after a period of either 5 days of massage therapy, or after a period of 5 days without massage therapy. Infants were randomized to 5 days of massage followed by 5 days of no massage (n = 5) or the opposite sequence (n = 5). During the massage therapy period, massage was provided daily for three 15 minute periods at the beginning of each 3 hour period every morning. Metabolic measurements were performed by indirect calorimetry, using the Deltatrac II Metabolic cart. Energy expenditure was significantly lower in infants after the 5 day massage therapy period (59.6 +/- 3.6 Kcal/Kg/ 24 hours) than after the period without (63.1 +/- 5.4 Kcal/Kg/ 24 hours) (p = 0.05). Energy expenditure is significantly lowered by 5 days of massage therapy in metabolically and thermally stable preterm infants. This decrease in energy expenditure may be in part responsible for the enhanced growth caused by massage therapy.
... needle exchange program would be effective in reducing drug abuse and the risk that the public will become infected with the etiologic agent for AIDS. (b) The State shall limit expenditures on the... support paragraph (d)(1) of this section, such as local needs assessments, waiting lists, survey data and...
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. Copyright © 2012 Elsevier B.V. All rights reserved.
Meier, Helena [Department of Economics, University of Hamburg, Von Melle Park 5, 20146 Hamburg (Germany); Rehdanz, Katrin [Department of Economics, University of Kiel, Olshausenstrasse 40, 24118 Kiel (Germany)
In Great Britain, several policy measures have been implemented in order to increase energy efficiency and reduce carbon emissions. In the domestic sector, this could, for example, be achieved by improving space heating efficiency and thus decreasing heating expenditure. However, in order to efficiently design and implement such policy measures, a better understanding of the determinants affecting heating expenditure is needed. In this paper we examine the following determinants: socio-economic factors, building characteristics, heating technologies and weather conditions. In contrast to most other studies we use panel data to investigate household demand for heating in Great Britain. Our data sample is the result of an annual set of interviews with more than 5000 households, starting in 1991 and ending in 2005. The sample represents a total of 64,000 observations over the fifteen-year period. Our aim is to derive price and income elasticities both for Britain as a whole and for different types of household. Our results suggest that differences exist between owner-occupied and renter households. These households react differently to changes in income and prices. Our results also imply that a number of socio-economic criteria have a significant influence on heating expenditure, independently of the fuel used for heating. Understanding the impacts of different factors on heating expenditure and impact differences between types of household is helpful in designing target-oriented policy measures. (author)
... 26 Internal Revenue 7 2010-04-01 2010-04-01 true Pre-1970 exploration expenditures. 1.615-1 Section 1.615-1 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME... before January 1, 1970) for ascertaining the existence, location, extent, or quality of any deposit of...
The paper examined the significance of the determinants of total government health expenditure in Nigeria. The various literature show that improvement of health sector is sine-qua-non to sustainable economic growth and development. Using regression analysis on macroeconomic data gathered, the results showed that ...
Ontario Hydro's demand side management (DSM) plan comprises reduction of load, load shifting, and peak shaving. It includes an accounting policy applied only to measures which reduce demand by the increase in the efficiency of electricity of utilization or by the shifting of load from peak periods to off-peak periods. In order to choose the pertinent periods for which the DSM expenditures should be recovered, the utility has considered three accounting options: expensing all DSM expenditures as incurred; deferring all DSM expenditures; or deferring only those DSM expenditures that meet specified criteria. Ontario Hydro has chosen the last option, since it is in conformity with generally accepted accounting principles. This option is based on the matching principle, under which costs and revenues that are linked to each other in a cause-and-effect relationship should be recognized in the same accounting period. It has also been judged advantageous to amortize the deferred expenses corresponding to each measure over appropriate periods. It has also been established that the amortization period should begin immediately after each measure has been put into operation. This accounting policy ensures that expenses relating to DSM are accounted in a pertinent and uniform manner. 6 refs
Sven Skjenneberg (ed.
Full Text Available The thesis Factors affecting energy expenditure in reindeer by Kjell J. Nilssen was approved for the Phil, dr's degree at the University of Tromsø. The dissertation took place in Tromsø December 15.1984.
... Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Homeowners Associations § 1.528-6 Expenditure test. (a) In general. An...) Insurance premiums on association property; (11) Accountant's fees; (12) Improvement of private property to...
Measurement of basal metabolic rate (BMR) provides an important baseline for the determination of an individual's total energy requirement. The study sought to establish human energy expenditure of rural farmers in Magubike village in Tanzania, through determination of BMR, physical activity level (PAL) and total energy ...
Chen, Xian-Bao; Gao, Feng
Robots driven by batteries are clean, quiet, and can work indoors or in space. However, the battery endurance is a great problem. A new gait parameter design energy saving strategy to extend the working hours of the quadruped robot is proposed. A dynamic model of the robot is established to estimate and analyze the energy expenditures during trotting. Given a trotting speed, optimal stride frequency and stride length can minimize the energy expenditure. However, the relationship between the speed and the optimal gait parameters is nonlinear, which is difficult for practical application. Therefore, a simplified gait parameter design method for energy saving is proposed. A critical trotting speed of the quadruped robot is found and can be used to decide the gait parameters. When the robot is travelling lower than this speed, it is better to keep a constant stride length and change the cycle period. When the robot is travelling higher than this speed, it is better to keep a constant cycle period and change the stride length. Simulations and experiments on the quadruped robot show that by using the proposed gait parameter design approach, the energy expenditure can be reduced by about 54% compared with the 100 mm stride length under 500 mm/s speed. In general, an energy expenditure model based on the gait parameter of the quadruped robot is built and the trotting gait parameters design approach for energy saving is proposed.
... in the case of self-constructed property) for construction of progress expenditure property. The... time when physical work on construction commences is based on the facts and circumstances of each case.... Taxpayers should refer to normal industry practice in estimating the normal construction period of...
Rasu, Rafia S; Bawa, Walter Agbor; Suminski, Richard; Snella, Kathleen; Warady, Bradley
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. 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 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 P value 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. 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 healthcare utilization and expenditure. Individuals with below basic or basic HLL have greater healthcare
Ezebuilo Romanus Ukwueze
Full Text Available Analysis of public expenditure constitutes a central issue in public sector economics and public finance literature. Understanding the reasons for government spending growth has been a central concern of public sector economists. This is due to the fact that most economies of the world have consistently had increased government expenditures. Nigeria is not an exception. There is need to ascertain the determinants of size of government expenditure in Nigeria. Short-Run Error Correction Model and long-run static equation were used for comparing the influence of those variables on the size of government spending. The long-run static equation served as a test to compare short-run dynamics with the long-run relationships. Ordinary least squares (OLS estimation technique was used. The stationarity tests showed that none of the variables was stationary at level form, but only after their first difference. The results of this study show that the size of revenue and growth rate of national income (output and private investment significantly influence the size of public expenditure both in the short run and long run. External and domestic debts significantly influence the size of government expenditure only in the short run. It is recommended that the revenue base should be expanded; conducive environment should be created for private investment to thrive, and debt accumulation should be reduced and used for stabilization only in the short run. The conclusion to draw from this study is that revenue, private investment, and income boost public spending while public debts might be counterproductive.
Buigut, Steven; Ettarh, Remare; Amendah, Djesika D
In Kenya, where 60 to 80% of the urban residents live in informal settlements (frequently referred to as slums), out-of-pocket (OOP) payments account for more than a third of national health expenditures. However, little is known on the extent to which these OOP payments are associated with personal or household financial catastrophe in the slums. This paper seeks to examine the incidence and determinants of catastrophic health expenditure among urban slum communities in Kenya. We use a unique dataset on informal settlement residents in Kenya and various approaches that relate households OOP payments for healthcare to total expenditures adjusted for subsistence, or income. We classified households whose OOP was in excess of a predefined threshold as facing catastrophic health expenditures (CHE), and identified the determinants of CHE using multivariate logistic regression analysis. The results indicate that the proportion of households facing CHE varies widely between 1.52% and 28.38% depending on the method and the threshold used. A core set of variables were found to be key determinants of CHE. The number of working adults in a household and membership in a social safety net appear to reduce the risk of catastrophic expenditure. Conversely, seeking care in a public or private hospital increases the risk of CHE. This study suggests that a substantial proportion of residents of informal settlements in Kenya face CHE and would likely forgo health care they need but cannot afford. Mechanisms that pool risk and cost (insurance) are needed to protect slum residents from CHE and improve equity in health care access and payment.
Véliz, Karina D.; Kaufmann, Robert K.; Cleveland, Cutler J.; Stoner, Anne M.K.
Climate change affects consumer expenditures by altering the consumption of and price for electricity. Previous analyses focus solely on the former, which implicitly assumes that climate-induced changes in consumption do not affect price. But this assumption is untenable because a shift in demand alters quantity and price at equilibrium. Here we present the first empirical estimates for the effect of climate change on electricity prices. Translated through the merit order dispatch of existing capacity for generating electricity, climate-induced changes in daily and monthly patterns of electricity consumption cause non-linear changes in electricity prices. A 2 °C increase in global mean temperature increases the prices for and consumption of electricity in Massachusetts USA, such that the average household’s annual expenditures on electricity increase by about 12%. Commercial customers incur a 9% increase. These increases are caused largely by higher prices for electricity, whose impacts on expenditures are 1.3 and 3.6 fold larger than changes in residential and commercial consumption, respectively. This suggests that previous empirical studies understate the effects of climate change on electricity expenditures and that policy may be needed to ensure that the market generates investments in peaking capacity to satisfy climate-driven changes in summer-time consumption. - Highlights: • Climate change increases summer peak of load curve in US state of Massachusetts. • Climate change increases electricity prices more than consumption. • Previous studies understate the effect of climate change on electricity expenditures. • Adaptation that reduces electricity demand may reduce the price effect. • Adaptation may raise prices by increasing capacity but lowering utilization rate.
Coughlan, Diarmuid; Yeh, Susan T; O'Neill, Ciaran; Frick, Kevin D
To inform policymakers of the importance of evaluating various methods for estimating the direct medical expenditures for a low-incidence condition, head and neck cancer (HNC). Four methods of estimation have been identified: 1) summing all health care expenditures, 2) estimating disease-specific expenditures consistent with an attribution approach, 3) estimating disease-specific expenditures by matching, and 4) estimating disease-specific expenditures by using a regression-based approach. A literature review of studies (2005-2012) that used the Medical Expenditure Panel Survey (MEPS) was undertaken to establish the most popular expenditure estimation methods. These methods were then applied to a sample of 120 respondents with HNC, derived from pooled data (2003-2008). The literature review shows that varying expenditure estimation methods have been used with MEPS but no study compared and contrasted all four methods. Our estimates are reflective of the national treated prevalence of HNC. The upper-bound estimate of annual direct medical expenditures of adult respondents with HNC between 2003 and 2008 was $3.18 billion (in 2008 dollars). Comparable estimates arising from methods focusing on disease-specific and incremental expenditures were all lower in magnitude. Attribution yielded annual expenditures of $1.41 billion, matching method of $1.56 billion, and regression method of $1.09 billion. This research demonstrates that variation exists across and within expenditure estimation methods applied to MEPS data. Despite concerns regarding aspects of reliability and consistency, reporting a combination of the four methods offers a degree of transparency and validity to estimating the likely range of annual direct medical expenditures of a condition. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Published by International Society for Pharmacoeconomics and Outcomes Research (ISPOR) All rights reserved.
Department of Veterans Affairs — The Geographic Distribution of VA Expenditures (GDX) is an annual report that shows estimated VA expenditures for major programmatic areas by geographic area (state,...
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...
Department of Veterans Affairs — The Geographic Distribution of VA Expenditures (GDX) is an annual report that shows estimated VA expenditures for major programmatic areas by geographic area (state,...
Department of Veterans Affairs — The Geographic Distribution of VA Expenditures (GDX) is an annual report that shows estimated VA expenditures for major programmatic areas by geographic area (state,...
... determinations made on the basis of such excessive expenditures. (2) Expenditures made using a credit card for which the candidate is jointly or solely liable will count against the limits of this section to the...
Schrack, Jennifer A.; Zipunnikov, Vadim; Goldsmith, Jeff; Bandeen-Roche, Karen; Crainiceanu, Ciprian M.; Ferrucci, Luigi
Background Accurate measurement of free-living energy expenditure is vital to understanding changes in energy metabolism with aging. The efficacy of heart rate as a surrogate for energy expenditure is rooted in the assumption of a linear function between heart rate and energy expenditure, but its validity and reliability in older adults remains unclear. Objective To assess the validity and reliability of the linear function between heart rate and energy expenditure in older adults using diffe...
Tataranni, P A; Harper, I T; Snitker, S
Obesity results from a chronic imbalance between energy intake and energy expenditure. However, experimental evidence of the relative contribution of interindividual differences in energy intake and expenditure (resting or due to physical activity) to weight gain is limited.......Obesity results from a chronic imbalance between energy intake and energy expenditure. However, experimental evidence of the relative contribution of interindividual differences in energy intake and expenditure (resting or due to physical activity) to weight gain is limited....
... 32 National Defense 1 2010-07-01 2010-07-01 false When would I use an expenditure-based TIA? 37... Technology Investment Agreements § 37.310 When would I use an expenditure-based TIA? In general, you must use an expenditure-based TIA under conditions other than those described in § 37.305. Reasons for any...
... 10 Energy 4 2010-01-01 2010-01-01 false Use of an expenditure-based TIA. 603.310 Section 603.310 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS... expenditure-based TIA. In general, the contracting officer must use an expenditure-based TIA under conditions...
... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Expenditures for advertising or promotion of... and Corporations § 1.162-14 Expenditures for advertising or promotion of good will. A corporation... expenditures for advertising or the promotion of good will which it seeks to deduct in the taxable year may not...
van Loon, Ruben; Rouwendal, Jan
This study examines the expenditure patterns of urban tourists with different trip purposes including visiting cultural heritage. Expenditure categories include museums and theatres. We use a two-step approach, in which we first analyse the total daily amount of expenditure and then the budget
C.A.M. de Meijer (Claudine); M.A. Koopmanschap (Marc); O.A. O'Donnell (Owen); E.K.A. van Doorslaer (Eddy)
textabstractExplanations of growth in health expenditures have restricted attention to the mean. We explain change throughout the distribution of expenditures, providing insight into how growth and its explanation differ along the distribution. We analyse Dutch data on actual health expenditures
... 11 Federal Elections 1 2010-01-01 2010-01-01 false Campaign expenditure limitation; compliance and... ELECTION CAMPAIGN FUND: PRESIDENTIAL PRIMARY MATCHING FUND EXPENDITURE LIMITATIONS § 9035.1 Campaign... campaign for nomination, which expenditures, in the aggregate, exceed $10,000,000 (as adjusted under 2 U.S...
Conclusions: OOP health expenditure of patients with UEBMI was significantly more than that of patients without medical insurance. However, for any other medical insurance, there was no difference between OOP health expenditure of the insured patients and patients without insurance. The current reimbursement policies have increased the equity of health expenditure, but are biased toward high-income people.
... 188, Research, development, or demonstration expenditures. (a) This account must be charged with the cost of all expenditures coming within the meaning of research, development and demonstration (RD&D) of..., development, and demonstration expenditures that are nonrecurring and that would distort the annual research...
... business, or $5,000 (reduced (but not below zero) by the amount by which the start-up expenditures exceed... beginning with the month in which the active trade or business begins. All start-up expenditures that relate to the active trade or business are considered in determining whether the start-up expenditures...
... deduct start-up expenditures in the taxable year in which the active trade or business begins. The amount... begins. All start-up expenditures that relate to the active trade or business are considered in...(b) to amortize start-up expenditures for the taxable year in which the active trade or business to...
Hassan, Sallahuddin; Othman, Zalila; Sabudin, Noor Sa'adah; Mohaideen, Zalina Mohd; Hidthir, Mohamad Helmi
This study examines the potential impact from the expenditure patterns of UUM international students in Changlun on local development particularly among Changlun businesses. For this purpose, the international students' expenditure patterns in Changlun are examined in terms of the estimated monthly expenditure, the location of spending and the…
Rémuzat, Cécile; Urbinati, Duccio; Kornfeld, Åsa; Vataire, Anne-Lise; Cetinsoy, Laurent; Aballéa, Samuel; Mzoughi, Olfa; Toumi, Mondher
With constant incentives for healthcare payers to contain their pharmaceutical budgets, modelling policy decision impact became critical. The objective of this project was to test the impact of various policy decisions on pharmaceutical budget (developed for the European Commission for the project 'European Union (EU) Pharmaceutical expenditure forecast' - http://ec.europa.eu/health/healthcare/key_documents/index_en.htm). A model was built to assess policy scenarios' impact on the pharmaceutical budgets of seven member states of the EU, namely France, Germany, Greece, Hungary, Poland, Portugal, and the United Kingdom. The following scenarios were tested: expanding the UK policies to EU, changing time to market access, modifying generic price and penetration, shifting the distribution chain of biosimilars (retail/hospital). Applying the UK policy resulted in dramatic savings for Germany (10 times the base case forecast) and substantial additional savings for France and Portugal (2 and 4 times the base case forecast, respectively). Delaying time to market was found be to a very powerful tool to reduce pharmaceutical expenditure. Applying the EU transparency directive (6-month process for pricing and reimbursement) increased pharmaceutical expenditure for all countries (from 1.1 to 4 times the base case forecast), except in Germany (additional savings). Decreasing the price of generics and boosting the penetration rate, as well as shifting distribution of biosimilars through hospital chain were also key methods to reduce pharmaceutical expenditure. Change in the level of reimbursement rate to 100% in all countries led to an important increase in the pharmaceutical budget. Forecasting pharmaceutical expenditure is a critical exercise to inform policy decision makers. The most important leverages identified by the model on pharmaceutical budget were driven by generic and biosimilar prices, penetration rate, and distribution. Reducing, even slightly, the prices of
Rémuzat, Cécile; Urbinati, Duccio; Kornfeld, Åsa; Vataire, Anne-Lise; Cetinsoy, Laurent; Aballéa, Samuel; Mzoughi, Olfa; Toumi, Mondher
Background and objective With constant incentives for healthcare payers to contain their pharmaceutical budgets, modelling policy decision impact became critical. The objective of this project was to test the impact of various policy decisions on pharmaceutical budget (developed for the European Commission for the project ‘European Union (EU) Pharmaceutical expenditure forecast’ – http://ec.europa.eu/health/healthcare/key_documents/index_en.htm). Methods A model was built to assess policy scenarios’ impact on the pharmaceutical budgets of seven member states of the EU, namely France, Germany, Greece, Hungary, Poland, Portugal, and the United Kingdom. The following scenarios were tested: expanding the UK policies to EU, changing time to market access, modifying generic price and penetration, shifting the distribution chain of biosimilars (retail/hospital). Results Applying the UK policy resulted in dramatic savings for Germany (10 times the base case forecast) and substantial additional savings for France and Portugal (2 and 4 times the base case forecast, respectively). Delaying time to market was found be to a very powerful tool to reduce pharmaceutical expenditure. Applying the EU transparency directive (6-month process for pricing and reimbursement) increased pharmaceutical expenditure for all countries (from 1.1 to 4 times the base case forecast), except in Germany (additional savings). Decreasing the price of generics and boosting the penetration rate, as well as shifting distribution of biosimilars through hospital chain were also key methods to reduce pharmaceutical expenditure. Change in the level of reimbursement rate to 100% in all countries led to an important increase in the pharmaceutical budget. Conclusions Forecasting pharmaceutical expenditure is a critical exercise to inform policy decision makers. The most important leverages identified by the model on pharmaceutical budget were driven by generic and biosimilar prices, penetration rate
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
Yussof, Salwa Hana
Tax expenditures are government indirect spending, hidden in the tax system, often used to support government’s social and economic objectives. Instead of directly allocating money for a particular objective, the government forgoes tax revenues from those who undertake activities that could achieve the objective. Therefore, tax expenditures should be analysed as government spending programs. Tax expenditure reporting and analysis has been a regular practice among many countries in the worl...
Meraya, Abdulkarim M; Raval, Amit D; Sambamoorthi, Usha
Little is known about how combinations of chronic conditions in adults affect total health care expenditures. Our objective was to estimate the annual average total expenditures and out-of-pocket spending burden among US adults by combinations of conditions. We conducted a cross-sectional study using 2009 and 2011 data from the Medical Expenditure Panel Survey. The sample consisted of 9,296 adults aged 21 years or older with at least 2 of the following 4 highly prevalent chronic conditions: arthritis, diabetes mellitus, heart disease, and hypertension. Unadjusted and adjusted regression techniques were used to examine the association between chronic condition combinations and log-transformed total expenditures. Logistic regressions were used to analyze the relationship between chronic condition combinations and high out-of-pocket spending burden. Among adults with chronic conditions, adults with all 4 conditions had the highest average total expenditures ($20,016), whereas adults with diabetes/hypertension had the lowest annual total expenditures ($7,116). In adjusted models, adults with diabetes/hypertension and hypertension/arthritis had lower health care expenditures than adults with diabetes/heart disease (P expenditures compared with those with diabetes and heart disease. However, the difference was only marginally significant (P = .04). Among adults with arthritis, diabetes, heart disease, and hypertension, total health care expenditures differed by type of chronic condition combinations. For individuals with multiple chronic conditions, such as heart disease and diabetes, new models of care management are needed to reduce the cost burden on the payers.
Scott Christopher B
Full Text Available Abstract Heat production serves as the standard measurement for the determination of energy expenditure and efficiency in animals. Estimations of metabolic heat production have traditionally focused on gas exchange (oxygen uptake and carbon dioxide production although direct heat measurements may include an anaerobic component particularly when carbohydrate is oxidized. Stoichiometric interpretations of the ratio of carbon dioxide production to oxygen uptake suggest that both anaerobic and aerobic heat production and, by inference, all energy expenditure – can be accounted for with a measurement of oxygen uptake as 21.1 kJ per liter of oxygen. This manuscript incorporates contemporary bioenergetic interpretations of anaerobic and aerobic ATP turnover to promote the independence of these disparate types of metabolic energy transfer: each has different reactants and products, uses dissimilar enzymes, involves different types of biochemical reactions, takes place in separate cellular compartments, exploits different types of gradients and ultimately each operates with distinct efficiency. The 21.1 kJ per liter of oxygen for carbohydrate oxidation includes a small anaerobic heat component as part of anaerobic energy transfer. Faster rates of ATP turnover that exceed mitochondrial respiration and that are supported by rapid glycolytic phosphorylation with lactate production result in heat production that is independent of oxygen uptake. Simultaneous direct and indirect calorimetry has revealed that this anaerobic heat does not disappear when lactate is later oxidized and so oxygen uptake does not adequately measure anaerobic efficiency or energy expenditure (as was suggested by the "oxygen debt" hypothesis. An estimate of anaerobic energy transfer supplements the measurement of oxygen uptake and may improve the interpretation of whole-body energy expenditure.
Karchevskij, A.I.; Potanin, E.P.
The estimations are performed of specific energy expenditares in isotope separation of binary mixtures in different plasma systems with weak medium ionization (plasma centrifuge, gas discharge system with travelling magnetic field, direct current discharge). Potential advantages of plasma centrifuge over other gas discharge facilities are pointed out. The comparison of specific energy expenditure values in case of using plasma and conventional methods of isotope separation is carried out
Traynor, Laura; Lange, Ian A.; Moro, Mirko
In the UK, the largest proportion of household energy use is for space heating. Popular media make claims of a green hypocrisy: groups which have the strongest attitude towards the environment have the highest emissions. This study examines whether environmental attitudes and behaviours are associated with space heating energy use using data from the British Household Panel Survey. Results find that environmentally friendly attitudes generally do not lead to lower heating expenditures though ...
Pan, Jay; Wang, Peng; Qin, Xuezheng; Zhang, Shufang
The huge regional disparity in government health expenditures (GHE) is a major policy concern in China. This paper addresses whether provincial GHE converges in China from 1997 to 2009 using the economic convergence framework based on neoclassical economic growth theory. Our empirical investigation provides compelling evidence of long-term convergence in provincial GHE within China, but not in short-term. Policy implications of these empirical results are discussed.
Full Text Available The huge regional disparity in government health expenditures (GHE is a major policy concern in China. This paper addresses whether provincial GHE converges in China from 1997 to 2009 using the economic convergence framework based on neoclassical economic growth theory. Our empirical investigation provides compelling evidence of long-term convergence in provincial GHE within China, but not in short-term. Policy implications of these empirical results are discussed.
Kim, Young Dae; Jung, Yo Han; Norrving, Bo; Ovbiagele, Bruce; Saposnik, Gustavo
Background Expenditure on research and development is a macroeconomic indicator representative of national investment. International organizations use this indicator to compare international research and development activities. Aim We investigated whether differences in expenditures on research and development at the country level may influence the incidence of stroke and stroke mortality. Methods We compared stroke metrics with absolute amount of gross domestic expenditure on R&D (GERD) per-capita adjusted for purchasing power parity (aGERD) and relative amount of GERD as percent of gross domestic product (rGERD). Sources included official data from the UNESCO, the World Health Organization, the World Bank, and population-based studies. We used correlation analysis and multivariable linear regression modeling. Results Overall, data on stroke mortality rate and GERD were available from 66 countries for two periods (2002 and 2008). Age-standardized stroke mortality rate was associated with aGERD (r = -0.708 in 2002 and r = -0.730 in 2008) or rGERD (r = -0.545 in 2002 and r = -0.657 in 2008) (all p < 0.001). Multivariable analysis showed a lower aGERD and rGERD were independently and inversely associated with higher stroke mortality (all p < 0.05). The estimated prevalence of hypertension, diabetes, or obesity was higher in countries with lower aGERD. The analysis of 27 population-based studies showed consistent inverse associations between aGERD or rGERD and incident risk of stroke and 30-day case fatality. Conclusions There is higher stroke mortality among countries with lower expenditures in research and development. While this study does not prove causality, it suggests a potential area to focus efforts to improve global stroke outcomes.
Alejandra Cattaneo; Stefan C. Wolter
Empirical research has given cause to fear that the demographic ageing in industrialized countries is likely to exert a negative impact on educational spending. These papers have linked the share of the elderly with the per capita or per pupil spending on education at the local, state-wide or national level, trying to control for other exogenous effects. Although this line of research shows in many cases a negative correlation between the shares of elderly people and educational expenditures,...
R?muzat, C?cile; Urbinati, Duccio; Kornfeld, ?sa; Vataire, Anne-Lise; Cetinsoy, Laurent; Aball?a, Samuel; Mzoughi, Olfa; Toumi, Mondher
Background and objective: With constant incentives for healthcare payers to contain their pharmaceutical budgets, modelling policy decision impact became critical. The objective of this project was to test the impact of various policy decisions on pharmaceutical budget (developed for the European Commission for the project ‘European Union (EU) Pharmaceutical expenditure forecast’ – http://ec.europa.eu/health/healthcare/key_documents/index_en.htm).Methods: A model was built to assess policy sc...
Zunzer, Stefan C; von Duvillard, Serge P; Tschakert, Gerhard; Mangus, Brent; Hofmann, Peter
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.
Georges , Marjolaine; Morélot-Panzini , Capucine; Similowski , Thomas; Gonzalez-Bermejo , Jesus
International audience; BackgroundAmyotrophic lateral sclerosis (ALS) leads to chronic respiratory failure. Diaphragmatic dysfunction, a major driver of dyspnea and mortality, is associated with a shift of the burden of ventilation to extradiaphragmatic inspiratory muscles, including neck muscles. Besides, energy expenditure is often abnormally high in ALS, and this is associated with a negative prognostic value. We hypothesized that noninvasive ventilation (NIV) would relieve inspiratory nec...
Dadgostar, Bahram; Mirabelli, Frank
Does the provision of Canadian government capital expenditures and government deficits displace private economic activity? In the U.S., Erenburg (1993) found that private sector investment spending is enhanced by expected increases in public spending on infrastructure, while also showing that deficit spending has no significant effect on private investment. There is no empirical study to date that addresses the relationship between government capital investment and government debt on private ...
Fernando Alvarez; Francesco Lippi
We consider an inventory model for a liquid asset where the per-period net expenditures have two components: one that is frequent and small and another that is infrequent and large. We give a theoretical characterization of the optimal management of liquid asset as well as of the implied observable statistics. We use our characterization to interpret some aspects of households' currency management in Austria, as well as the management of demand deposits by a large sample of Italian investors.
Guidara, Rihab; Boujelbene, Younes
Research and development (R&D) investments reduce current-period earnings while the benefits associated with the investments occur in the future. This problem implies an earnings management tool to boost short-term performance. While there is much evidence regarding managerial discretion through R&D capitalization, empirical studies that directly examine managerial discretion through R&D expenditure adjusting have not been widely provided in the European context. This paper seeks ...
Guidara, Rihab; Boujelbene, Younes
Research and development (R&D) investments reduce current-period earnings while the benefits associated with the investments occur in the future. This problem implies an earnings management tool to boost short-term performance. While there is much evidence regarding managerial discretion through R&D capitalization, empirical studies that directly examine managerial discretion through R&D expenditure adjusting have not been widely provided in the European context. This ...
Poudel, Jagdish; Munn, Ian A.; Henderson, James E.
Hunting, fishing and wildlife-associated recreation expenditures have played an important role in the U.S economy and help promote conservation and environmental goals. The 2006 U.S Fish and Wildlife Service (USFWS) survey reported 87.5 million people aged 16 and above participated in wildlife-associated recreation activities, spending $122.4 billion on trips and equipment. This spending is a 13 percent increase since 2001. The recently released 2011 National Survey of Fishing, Hunting and Wi...
In today's world, globalization has reached to such an extent that, investment in information and technology is inevitable to be integrated with global system and increase competitive power. Therefore, R&D investments are of high importance and priority for growth process of economy. This paper investigates the long-run relationship between R&D expenditure and economic growth using the Johansen co-integration and the vector error correction models. The research findings indicate that there is...
Zazovskiy, F Ya; Soltysyak, T I
The operational efficiency of drilling services operations management are examined. The structure of time expenditure is analyzed for repair operations according to equipment type employed by the Ivano-Frankovsk Drilling Management under the Ukrneft' enterprise during 1977. The results of this analysis are weighed against a series of service operations carried out at industrial enterprises and connected with technical disruptions. Some of the cases examined include service competion operations outside of the industrial units when technical processes are disrupted only for the change of equipment which has outlived its usefulness and is no longer in series production. First of all, time expended for repair work can be reduced to zero during the drilling of shallow wells which do not require extensive drilling time. The actual savings, both in time and money, as far as repair work is concerned, hinges on the actual time factor for total oil depetion. An equation is provided for optimal time expenditure necessary for repair work and equipment replacement. An actual example is given from the Dolinsk UBR (Drillin Management) under the Ukrneft' enterprise where time spent on actual service operations has appeared to be less than the optimal figure cited in the above material. This is possible because of increased capital expenditures.
You, Xiaohui; Okunade, Albert A
The roles of income and technology as the major determinants of aggregate healthcare expenditure (HEXP) continue to interest economists and health policy researchers. Concepts and measures of medical technologies remain complex; however, income (on the demand side) and technology (on the supply side) are important drivers of HEXP. This paper presents analysis of Australia's HEXP, using time-series econometrics modeling techniques applied to 1971-2011 annual aggregate data. Our work fills two important gaps in the literature. First, we model the determinants of Australia's HEXP using the latest and longest available data series. Second, this novel study investigates several alternative technology proxies (input and output measures), including economy-wide research and development expenditures, hospital research expenditures, mortality rate, and two technology indexes based on medical devices. We then apply the residual component method and the technology proxy approach to quantify the technology effects on HEXP. Our empirical results suggest that Australian aggregate healthcare is a normal good and a technical necessity with the income elasticity estimates ranging from 0.51 to 0.97, depending on the model. The estimated technology effects on HEXP falling in the 0.30-0.35 range and mimicking those in the literature using the US data, reinforce the global spread of healthcare technology. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Lyons, Elizabeth J; Tate, Deborah F; Ward, Dianne S; Ribisl, Kurt M; Bowling, J Michael; Kalyanaraman, Sriram
Playing active video games can produce moderate levels of physical activity, but little is known about how these games motivate players to be active. Several psychological predictors, such as perceptions of competence, control, and engagement, may be associated with enjoyment of a game, which has in turn been hypothesized to predict energy expended during play. However, these relationships have yet to be tested in active video games. Young adults aged 18-35 (N = 97, 50 female) game for 13 minutes while energy expenditure was measured using indirect calorimetry. Self-reported measures of engagement, perceived competence, perceived control, and enjoyment were taken immediately afterward. Mediation was analyzed using path analysis. A path model in which enjoyment mediated the effects of engagement, perceived competence, and perceived control on energy expenditure and BMI directly affected energy expenditure was an adequate fit to the data, χ(2)(1, N = 97) = .199, p = .655; CFI = 1.00; RMSEA video game play. Games that are more enjoyable and engaging may produce greater intensity activity. Developers, practitioners, and researchers should consider characteristics that influence these predictors when creating or recommending active video games. PsycINFO Database Record (c) 2014 APA, all rights reserved.
Derkson, W.W.; Shurvell, S.J.
This document reports on a study undertaken at the request of the United Grain Growers regarding government fuel tax revenue and the relationship to expenditures on roads. The account of fuel tax revenues was compiled from data collected from several different sources, as was the case for the road expenditures at the federal, provincial, local and modal levels. The emphasis was placed on the effects of fuel taxes on grain handling and transportation in the Prairie provinces. The authors presented fuel tax revenues broken down by mode of transportation and by province. The document was divided as follows: the first part was the introduction with the second part dealing with fuel tax rates and policies. In the third part, the topic of fuel tax and road related revenues was examined. Part four discussed road expenditures. The authors concluded that Transport Canada has traditionally represented the most important federal link to provincial highway infrastructure. It was noted that 4.2 billion dollars in road fuel taxes were collected by the federal government in 1998/1999, and of that amount, 198 million dollars, or 4.7 per cent, was reinvested in the National Highway System in programs managed by Transport Canada. Nearly one dollar on roads is spent by provincial governments on a Prairie-wide basis for every dollar collected in road fuel taxes, with Alberta spending the most and Saskatchewan spending the least. 15 tabs
Pilastro, Andrea; Scaggiante, Marta; Rasotto, Maria B
Sperm competition theory predicts that males should strategically allocate their sperm reserves according to the level of sperm competition, defined as the probability that the sperm of two males compete for fertilizing a given set of ova. Substantial evidence from numerous animal taxa suggests that, at the individual level, sperm expenditure increases when the risk of sperm competition is greater. In contrast, according to the "intensity model" of sperm competition [Parker, G. A., Ball, M. A., Stockley, P. & Gage, M. J. G. (1996) Proc. R. Soc. London Ser. B 263, 1291-1297], when more than two ejaculates compete during a given mating event, sperm expenditure should decrease as the number of competing males increases. Empirical evidence supporting this prediction, however, is still lacking. Here we measured sperm expenditure in two gobiid fishes, the grass (Zosterisessor ophiocephalus) and black goby (Gobius niger), in which up to six sneakers can congregate around the nest of territorial males and release their sperm when females spawn. We show that, in accordance with theory, sneaker males of both species release fewer sperm as the number of competitors increases.
Anderson, Wayne L; Wiener, Joshua M; Khatutsky, Galina; Armour, Brian S
This study estimates additional average health care expenditures for overweight and obesity for adults with disabilities vs. without. Descriptive and multivariate methods were used to estimate additional health expenditures by service type, age group, and payer using 2004-2007 Medical Expenditure Panel Survey data. In 2007, 37% of community-dwelling Americans with disabilities were obese vs. 27% of the total population. People with disabilities had almost three times ($2,459) the additional average obesity cost of people without disabilities ($889). Prescription drug expenditures for obese people with disabilities were three times as high and outpatient expenditures were 74% higher. People with disabilities in the 45- to 64-year age group had the highest obesity expenditures. Medicare had the highest additional average obesity expenditures among payers. Among people with prescription drug expenditures, obese people with disabilities had nine times the prevalence of diabetes as normal weight people with disabilities. Overweight people with and without disabilities had lower expenditures than normal-weight people with and without disabilities. Obesity results in substantial additional health care expenditures for people with disabilities. These additional expenditures pose a serious current and future problem, given the potential for higher obesity prevalence in the coming decade. Copyright © 2013 The Obesity Society.
Full Text Available This study tests the relevance of the Wagner’s theory in explaining the health expenditure in Botswana. There is no consensus yet when it comes to the causality relationship between health expenditure and economy. At the moment, there are four dominant schools of thought explaining the causality relationship between health expenditure and economy. The first school of thought is that health expenditure spurs the economy whilst the second school of thought says that the economy drives health expenditure. The third school of thought maintains that there is a feedback effect between health expenditure and the economy whilst the fourth mentions that there is no causality at all between the two variables. However, this study found out that there is no causality relationship between health expenditure and GDP in Botswana thereby dismissing the relevance of the Wagner’s theory.
Zalilah, M S; Khor, G L; Mirnalini, K; Norimah, A K; Ang, M
Paediatric obesity is a public health concern worldwide as it can track into adulthood and increase the risk of adult morbidity and mortality. While the aetiology of obesity is multi-factorial, the roles of diet and physical activity are controversial. Thus, the purpose of this study was to report on the differences in energy intake, diet composition, time spent doing physical activity and energy expenditure among underweight (UW), normal weight (NW) and at-risk of overweight (OW) Malaysian adolescents (317 females and 301 males) aged 11-15 years. This was a cross-sectional study with 6,555 adolescents measured for weights and heights for body mass index (BMI) categorisation. A total of 618 subjects were randomly selected from each BMI category according to gender. The subjects' dietary intake and physical activity were assessed using self-reported three-day food and activity records, respectively. Dietary intake components included total energy and macronutrient intakes. Energy expenditure was calculated as a sum of energy expended for basal metabolic rate and physical activity. Time spent (in minutes) in low, medium and high intensity activities was also calculated. The OW adolescents had the highest crude energy intake and energy expenditure. However, after adjusting for body weight, the OW subjects had the lowest energy intake and energy expenditure (p-value is less than 0.001). The study groups did not differ significantly in time spent for low, medium and high intensity activities. Macronutrient intakes differed significantly only among the girls where the OW group had the highest intakes compared to UW and NW groups (p-value is less than 0.05). All study groups had greater than 30 percent and less than 55 percent of energy intake from fat and carbohydrate, respectively. The data suggested that a combination of low energy expenditure adjusted for body weight and high dietary fat intake may be associated with overweight and obesity among adolescents. To
Ahmed, Rebekah M; Landin-Romero, Ramon; Collet, Tinh-Hai; van der Klaauw, Agatha A; Devenney, Emma; Henning, Elana; Kiernan, Matthew C; Piguet, Olivier; Farooqi, I Sadaf; Hodges, John R
Abstract See Finger (doi:10.1093/aww312) for a scientific commentary on this article. Abnormal eating behaviour and metabolic parameters including insulin resistance, dyslipidaemia and body mass index are increasingly recognized as important components of neurodegenerative disease and may contribute to survival. It has previously been established that behavioural variant frontotemporal dementia is associated with abnormal eating behaviour characterized by increased sweet preference. In this study, it was hypothesized that behavioural variant frontotemporal dementia might also be associated with altered energy expenditure. A cohort of 19 patients with behavioural variant frontotemporal dementia, 13 with Alzheimer’s disease and 16 (age- and sex-matched) healthy control subjects were studied using Actiheart devices (CamNtech) to assess resting and stressed heart rate. Actiheart devices were fitted for 7 days to measure sleeping heart rate, activity levels, and resting, active and total energy expenditure. Using high resolution structural magnetic resonance imaging the neural correlates of increased resting heart rate were investigated including cortical thickness and region of interest analyses. In behavioural variant frontotemporal dementia, resting (P = 0.001), stressed (P = 0.037) and sleeping heart rate (P = 0.038) were increased compared to control subjects, and resting heart rate (P = 0.020) compared to Alzheimer disease patients. Behavioural variant frontotemporal dementia was associated with decreased activity levels compared to controls (P = 0.002) and increased resting energy expenditure (P = 0.045) and total energy expenditure (P = 0.035). Increased resting heart rate correlated with behavioural (Cambridge Behavioural Inventory) and cognitive measures (Addenbrooke’s Cognitive Examination). Increased resting heart rate in behavioural variant frontotemporal dementia correlated with atrophy involving the mesial temporal cortex, insula, and amygdala
Barr, Sadie B; Wright, Jonathan C
Empirical evidence has shown that rising obesity rates closely parallel the increased consumption of processed foods (PF) consumption in USA. Differences in postprandial thermogenic responses to a whole-food (WF) meal vs. a PF meal may be a key factor in explaining obesity trends, but currently there is limited research exploring this potential link. The goal was to determine if a particular PF meal has a greater thermodynamic efficiency than a comparable WF meal, thereby conferring a greater net-energy intake. Subjective satiation scores and postprandial energy expenditure were measured for 5-6 h after isoenergetic meals were ingested. The meals were either 'whole' or 'processed' cheese sandwiches; multi-grain bread and cheddar cheese were deemed whole, while white bread and processed cheese product were considered processed. Meals were comparable in terms of protein (15-20%), carbohydrate (40-50%), and fat (33-39%) composition. Subjects were healthy women (n=12) and men (n=5) studied in a crossover design. There were no significant differences in satiety ratings after the two meals. Average energy expenditure for the WF meal (137+/-14.1 kcal, 19.9% of meal energy) was significantly larger than for the PF meal (73.1+/-10.2 kcal, 10.7% of meal energy). Ingestion of the particular PF meal tested in this study decreases postprandial energy expenditure by nearly 50% compared with the isoenergetic WF meal. This reduction in daily energy expenditure has potential implications for diets comprised heavily of PFs and their associations with obesity.
Sadie B. Barr
Full Text Available Background: Empirical evidence has shown that rising obesity rates closely parallel the increased consumption of processed foods (PF consumption in USA. Differences in postprandial thermogenic responses to a whole-food (WF meal vs. a PF meal may be a key factor in explaining obesity trends, but currently there is limited research exploring this potential link. Objective: The goal was to determine if a particular PF meal has a greater thermodynamic efficiency than a comparable WF meal, thereby conferring a greater net-energy intake. Design: Subjective satiation scores and postprandial energy expenditure were measured for 5–6 h after isoenergetic meals were ingested. The meals were either ‘whole’ or ‘processed’ cheese sandwiches; multi-grain bread and cheddar cheese were deemed whole, while white bread and processed cheese product were considered processed. Meals were comparable in terms of protein (15–20%, carbohydrate (40–50%, and fat (33–39% composition. Subjects were healthy women (n=12 and men (n=5 studied in a crossover design. Results: There were no significant differences in satiety ratings after the two meals. Average energy expenditure for the WF meal (137±14.1 kcal, 19.9% of meal energy was significantly larger than for the PF meal (73.1±10.2 kcal, 10.7% of meal energy. Conclusion: Ingestion of the particular PF meal tested in this study decreases postprandial energy expenditure by nearly 50% compared with the isoenergetic WF meal. This reduction in daily energy expenditure has potential implications for diets comprised heavily of PFs and their associations with obesity.
Salami, Joseph A; Valero-Elizondo, Javier; Ogunmoroti, Oluseye; Spatz, Erica S; Rana, Jamal S; Virani, Salim S; Blankstein, Ron; Younus, Adnan; Arrieta, Alejandro; Blaha, Michael J; Veledar, Emir; Nasir, Khurram
Atherosclerotic cardiovascular disease (ASCVD) causes most deaths in the United States and accounts for the highest healthcare spending. The association between the modifiable risk factors (MRFs) of ASCVD and pharmaceutical expenditures are largely unknown. We examined the association between MRFs and pharmaceutical expenditures among adults with ASCVD using the 2012 and 2013 Medical Expenditure Panel Survey. A 2-part model was used while accounting for the survey's complex design to obtain nationally representative results. All costs were adjusted to 2013 US dollars using the gross domestic product deflator. The annual total pharmaceutical expenditure among those with ASCVD was $71.6 billion, 33% of which was for medications for cardiovascular disease and 14% medications for diabetes mellitus. The adjusted relationship between MRFs and pharmaceutical expenditures showed significant marginal increase in average annual pharmaceutical expenditure associated with inadequate physical activity ($519 [95% confidence interval (CI), $12-918; P =0.011]), dyslipidemia ($631 [95% CI, $168-1094; P =0.008]), hypertension: ($1078 [95% CI, $697-1460; P expenditures among patients with established ASCVD regardless of non-ASCVD comorbidity. In-depth studies of the roles played by other factors in this association can help reduce medication-related expenditures among ASCVD patients. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Saito, Eiko; Gilmour, Stuart; Rahman, Md Mizanur; Gautam, Ghan Shyam; Shrestha, Pradeep Krishna; Shibuya, Kenji
To determine the incidence of - and illnesses commonly associated with - catastrophic household expenditure on health in Nepal. We did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household surveyed, out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household's total expenditure over the same period was considered to be catastrophic. We estimated the incidence and intensity of catastrophic health expenditure. We identified the illnesses most commonly associated with such expenditure using a Poisson regression model and assessed the distribution of expenditure by economic quintile of households using the concentration index. Overall, 284 of the 1997 households studied in Kathmandu, i.e. 13.8% after adjustment by sampling weight, reported catastrophic health expenditure in the 30 days before the survey. After adjusting for confounders, this expenditure was found to be associated with injuries, particularly those resulting from road traffic accidents. Catastrophic expenditure by households in the poorest quintile were associated with at least one episode of diabetes, asthma or heart disease. In an urban area of Nepal, catastrophic household expenditure on health was mostly associated with injuries and noncommunicable diseases such as diabetes and asthma. Throughout Nepal, interventions for the control and management of noncommunicable diseases and the prevention of road traffic accidents should be promoted. A phased introduction of health insurance should also reduce the incidence of catastrophic household expenditure.
Full Text Available The capital expenditures are part of direct expenditure in the regional budget. The other elements of capital expenditures are: personnel expenditure, and spending on goods and services. Planning and realization for capital expenditure in the regional budget for each Government Regional Work Units is a part of policy regional financial management in fiscal decentralization policy which need be increased to achieve value significantly over time. Increasing in planning and realization of capital expenditures is directly related to the amount of capital expenditure element that strengthens physical infrastructure which would strengthen economic growth for social welfare, regional competitiveness for facilitation and liberalization a single market and production base in AEC era. This study examines the role of agency theory and institutional theory in relation with planning and realization of capital expenditures of 82 (Eighty Two Government Work Units of 3 (Three regional government, namely Banjarmasin City, Banjar District, and Tanah Laut District in South Kalimantan Province. This study contributes to the accounting literature to assess role of conceptual framework with agency theory and institutional theory. The result of study showed: there are differences in the implementation of capital expenditure to meet AEC pillars and social welfare purposes by increasing capital expenditure through the role of the agency theory, and institutional theory. Relationship of agency theory and institutional theory with social welfare and AEC with the amount of C Contingency coefficient 0,313 and Cramer Coefficient of Association 0.191 indicates there are Moderate correlation: substantial relationship and Small correlation; Lower relationship association.
Tang, W; Aggarwal, A; Liu, Z; Acheson, M; Rehm, C D; Moudon, A V; Drewnowski, A
To compare objective food store and eating-out receipts with self-reported household food expenditures. The Seattle Obesity Study II was based on a representative sample of King County adults, Washington, USA. Self-reported household food expenditures were modeled on the Flexible Consumer Behavior Survey (FCBS) Module from 2007 to 2009 National Health and Nutrition Examination Survey (NHANES). Objective food expenditure data were collected using receipts. Self-reported food expenditures for 447 participants were compared with receipts using paired t-tests, Bland-Altman plots and κ-statistics. Bias by sociodemographics was also examined. Self-reported expenditures closely matched with objective receipt data. Paired t-tests showed no significant differences between receipts and self-reported data on total food expenditures, expenditures at food stores or eating out. However, the highest-income strata showed weaker agreement. Bland-Altman plots confirmed no significant bias across both methods-mean difference: 6.4; agreement limits: -123.5 to 143.4 for total food expenditures, mean difference 5.7 for food stores and mean difference 1.7 for eating out. The κ-statistics showed good agreement for each (κ 0.51, 0.41 and 0.49 respectively. Households with higher education and income had significantly more number of receipts and higher food expenditures. Self-reported food expenditures using NHANES questions, both for food stores and eating out, serve as a decent proxy for objective household food expenditures from receipts. This method should be used with caution among high-income populations, or with high food expenditures. This is the first validation of the FCBS food expenditures question using food store and eating-out receipts.
Myers, S D; Leamon, S M; Nevola, V R; Llewellyn, M G L
The popularity of sports that expose people to consecutive days of high-intensity physical activity continues to increase. The ability to adequately nourish the human body to sustain the required level of competitive performance may be a key contributor to success in such events. The energy expenditure of a male competitor in a single-handed, transatlantic race (Transat 2004) was assessed using the doubly-labelled water technique. Mean total daily energy expenditure (TDEE) during the race (13 days) was 14.5 MJ/day with a peak expenditure of 18.6 MJ during the most physically demanding 24-hour period. This mean TDEE was approximately 25% lower than that reported in a previous study (14.5 vs. 19.3 MJ/day) for a 13-day leg of a fully crewed offshore race. The difference in results was probably due to the fact that in the previous study, the crew operated in "watches" (work shifts), affording each crew member greater opportunity to eat, rest and sleep. Effective planning and efficient management of resources is essential to the success of the solo sailor. However, the extent to which maintenance of energy balance underpins competitive success remains to be established. To maintain energy balance during the race, a mean daily energy intake of 14.5 MJ/day was necessary for the subject in this study. However, this mean value for energy intake would have been inadequate to match the peak energy expended during the most physically demanding 24 hours of the race.
Melbye, Molly L R; Chi, Donald L; Milgrom, Peter; Huebner, Colleen E; Grembowski, David
To identify factors associated with dental utilization and expenditures for children enrolled in Washington State (WA) foster care (FC). This cross-sectional study used 2008 Medicaid enrollment and claims files for children ages WA FC program for ≥11 months (N = 10,177). Regression models were used to examine associations between utilization and expenditures and sex, race, age group, Supplemental Security Income (SSI) (i.e., disability), substance abuse, behavior problems, placement setting (Foster Home Care, Kinship Care, Group Care, Other), and urbanicity. Only 43 percent of the children utilized any dental care; the adjusted mean expenditure was $198.35 [95% confidence interval (CI) $181.35, $215.36]. Fewer utilized diagnostic (41 percent), preventive (39 percent), restorative (11 percent), or complex (5 percent) services. Associated with utilization (P ≤ 0.01) were: female [ARR = 1.05, 95% CI(1.01, 1.10)]; 0-2 years [ARR = 0.18, 95% CI(0.15, 0.21)], [3-5 years ARR = 0.78, 95% CI(0.74, 0.83)]; Native American [ARR = 0.85, 95% CI(0.80, 0.91)]; SSI [ARR = 1.10, 95% CI(1.04, 1.17)]; Kinship Care [ARR = 0.94, 95% CI(0.90, 0.98)]; Group Care [ARR = 1.25 95% CI(1.15, 1.37)]; and urban/rural urbanicity with population WA FC for ≥11 months during 2008 did not receive dental care. Research is needed to determine the level of unmet need among children in FC and interventions to improve access to oral health of the children. Enforcement of existing federal legislation is needed. © 2013 American Association of Public Health Dentistry.
Cabrera de León, Antonio; Rodríguez-Pérez, María del C; Rodríguez-Benjumeda, Luis M; Anía-Lafuente, Basilio; Brito-Díaz, Buenaventura; Muros de Fuentes, Mercedes; Almeida-González, Delia; Batista-Medina, Marta; Aguirre-Jaime, Armando
To compare different definitions of a sedentary lifestyle and to determine which is the most appropriate for demonstrating its relationship with the metabolic syndrome and other cardiovascular risk factors. A cross-sectional study of 5814 individuals was carried out. Comparisons were made between two definitions of a sedentary lifestyle: one based on active energy expenditure being less than 10% of total energy expenditure, and the other, on performing less than 25-30 minutes of physical activity per day. Reported levels of physical activity, anthropometric measurements, and biochemical markers of cardiovascular risk were recorded. The associations between a sedentary lifestyle and metabolic syndrome and other risk factors were adjusted for gender, age and tobacco use. The prevalence of a sedentary lifestyle was higher in women (70%) than in men (45-60%, according to the definition used). The definitions based on physical activity duration and on energy expenditure were equally useful: there were direct associations between a sedentary lifestyle and metabolic syndrome, body mass index, abdominal and pelvic circumferences, systolic blood pressure, heart rate, apolipoprotein B, and triglycerides, and inverse associations with high-density lipoprotein cholesterol and paraoxonase activity, which demonstrated the greatest percentage difference between sedentary and active individuals. An incidental finding was that both definitions of a sedentary lifestyle were more strongly associated with the metabolic syndrome as defined by International Diabetes Federation criteria than by Adult Treatment Panel III criteria. Given that it is relatively easy to determine whether a patient performs less than 25 minutes of physical activity per day, use of this definition of a sedentary lifestyle is recommended for clinical practice. The serum paraoxonase activity level could provide a useful marker for studying sedentary lifestyles.
The percentage of GDP expenses for Research in Italy is commonly thought paltry but it is not so easy to establish which level of expenditure is reasonable for our industrial development and our international role. A direct comparison with other different economic systems can be misleading and the simple claim for an adjustment to the percentages of the greater investors can turn out to be too much ambitious and also ineffective objective. In order to stimulate a debate on such important topic, just as basic argument, it is proposed a simple model developed starting from projects profitability [it
Getzen, Thomas E; Okunade, Albert A
Significant contributions have been made since the World Health Organization published Brian Abel-Smith's pioneering comparative study of national health expenditures more than 50 years ago. There have been major advances in theories, model specifications, methodological approaches, and data structures. This introductory essay provides a historical context for this line of work, highlights four newly published studies that move health economics research forward, and indicates several important areas of challenging but potentially fruitful research to strengthen future contributions to the literature and make empirical findings more useful for evaluating health policy decisions. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Jiutian Zhang; Ying Fan; Yiming Wei
This paper focuses on the government R and D expenditures and analyses the dynamic reaction patterns of energy R and D in several countries to oil shocks and shows that the oil shocks served as a strong incentive to promote energy R and D. But on the other hand, it suggests the myopic behaviour of government in energy R and D. We further analyse the trends of energy R and D portfolio in both technology dimension and country. The result shows a trend of technological variety, but fewer countries have invested in energy R and D, and those countries tend to invest in their favoured technologies. (Author)
Alexandra Crispim Boing
Full Text Available OBJECTIVE To analyze the variation in the proportion of households living below the poverty line in Brazil and the factors associated with their impoverishment. METHODS Income and expenditure data from the Household Budget Survey, which was conducted in Brazil between 2002-2003 (n = 48,470 households and 2008-2009 (n = 55,970 households with a national sample, were analyzed. Two cutoff points were used to define poverty. The first cutoff is a per capita monthly income below R$100.00 in 2002-2003 and R$140.00 in 2008-2009, as recommended by the Bolsa Família Program. The second, which is proposed by the World Bank and is adjusted for purchasing power parity, defines poverty as per capita income below US$2.34 and US$3.54 per day in 2002-2003 and 2008-2009, respectively. Logistic regression was used to identify the sociodemographic factors associated with the impoverishment of households. RESULTS After subtracting health expenditures, there was an increase in households living below the poverty line in Brazil. Using the World Bank poverty line, the increase in 2002-2003 and 2008-2009 was 2.6 percentage points (6.8% and 2.3 percentage points (11.6%, respectively. Using the Bolsa Família Program poverty line, the increase was 1.6 (11.9% and 1.3 (17.3% percentage points, respectively. Expenditure on prescription drugs primarily contributed to the increase in poor households. According to the World Bank poverty line, the factors associated with impoverishment include a worse-off financial situation, a household headed by an individual with low education, the presence of children, and the absence of older adults. Using the Bolsa Família Program poverty line, the factors associated with impoverishment include a worse-off financial situation and the presence of children. CONCLUSIONS Health expenditures play an important role in the impoverishment of segments of the Brazilian population, especially among the most disadvantaged.
HOLT ALINA GEORGIANA
Full Text Available Air and water quality are vital for human life and our societies devote large sums of money to reduce pollution and conserve a healthy environment. Much of the financial resources mobilized to finance environmental protection come from private sources - entrepreneurs pay to eliminate environmentally harmful waste safely, or to mitigate the effects of polluting production processes. But while technology standards, environmental permits, pollution taxes play an important role in correcting the behavior of society, public expenditure presents also a very important variable in efforts to support the environment.
Leatherdale, Scott T; Woodruff, Sarah J; Manske, Stephen R
To examine energy expenditure (EE) when playing active and inactive videogames (VG). Predicted EE was measured among 51 undergraduate students while playing active and inactive VG (Ontario, Canada). Predicted EE was significantly higher playing the active VG compared to the inactive VG according to heart rate monitor (97.4 kcal vs 64.7 kcal) and SenseWear armband (192.4 kcal vs 42.3 kcal) estimates. Active VG may be a viable intervention tool for increasing EE among students who would otherwise be spending time in sedentary screen-based behaviors.
Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Posenato, Leila Garcia; Peres, Karen Glazer
To analyze the variation in the proportion of households living below the poverty line in Brazil and the factors associated with their impoverishment. Income and expenditure data from the Household Budget Survey, which was conducted in Brazil between 2002-2003 (n = 48,470 households) and 2008-2009 (n = 55,970 households) with a national sample, were analyzed. Two cutoff points were used to define poverty. The first cutoff is a per capita monthly income below R$100.00 in 2002-2003 and R$140.00 in 2008-2009, as recommended by the Bolsa Família Program. The second, which is proposed by the World Bank and is adjusted for purchasing power parity, defines poverty as per capita income below US$2.34 and US$3.54 per day in 2002-2003 and 2008-2009, respectively. Logistic regression was used to identify the sociodemographic factors associated with the impoverishment of households. After subtracting health expenditures, there was an increase in households living below the poverty line in Brazil. Using the World Bank poverty line, the increase in 2002-2003 and 2008-2009 was 2.6 percentage points (6.8%) and 2.3 percentage points (11.6%), respectively. Using the Bolsa Família Program poverty line, the increase was 1.6 (11.9%) and 1.3 (17.3%) percentage points, respectively. Expenditure on prescription drugs primarily contributed to the increase in poor households. According to the World Bank poverty line, the factors associated with impoverishment include a worse-off financial situation, a household headed by an individual with low education, the presence of children, and the absence of older adults. Using the Bolsa Família Program poverty line, the factors associated with impoverishment include a worse-off financial situation and the presence of children. Health expenditures play an important role in the impoverishment of segments of the Brazilian population, especially among the most disadvantaged.
Echouffo-Tcheugui, Justin B.; Bishu, Kinfe G.; Fonarow, Gregg C; Egede, Leonard E.
Background Population-based national data on the trends in expenditures related to heart failure (HF) is scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition. Methods Using 10-year data (2002–2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194 U.S adults aged ≥18 years) and a two-part model (adjusting for demographics, comorbidities and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures). Results Compared to expenditures for individuals without HF ($5,511 [95% confidence interval (CI): 5,405–5,617]), individuals with HF had a four-fold higher mean expenditures of ($23,854 [95%CI: 21,733–25,975]). Individuals with HF had $3,446 (95%CI: 2,592–4,299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95%CI: 18,359–24,272) in 2002/2003 to $27,152 (95%CI: 20,066–34,237) in 2010/2011; and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/year and the adjusted total incremental expenditure $5.8 billion/year. Conclusions Heart failure is costly and over a recent 10-year period, direct expenditure related to HF increased markedly, mainly driven by inpatient costs. PMID:28454834
de Meijer, Claudine; O'Donnell, Owen; Koopmanschap, Marc; van Doorslaer, Eddy
Explanations of growth in health expenditures have restricted attention to the mean. We explain change throughout the distribution of expenditures, providing insight into how expenditure growth and its explanation differ along the distribution. We analyse Dutch data on actual health expenditures linked to hospital discharge and mortality registers. Full distribution decomposition delivers findings that would be overlooked by examination of changes in the mean alone. The growth rate of hospital expenditures is greatest at the middle of the distribution and is driven mainly by changes in the distributions of determinants. Pharmaceutical expenditures increase most rapidly at the top of the distribution and are mainly attributable to structural changes, including technological progress, making treatment of the highest cost cases even more expensive. Changes in hospital practice styles make the largest contribution of all determinants to increased spending not only on hospital care but also on pharmaceuticals, suggesting important spill over effects. Copyright © 2012 Elsevier B.V. All rights reserved.
CLEMENT A.U. IGHODARO
Full Text Available While previous studies to test Wagner’s hypothesis for Nigeria usedtotal government expenditure, this paper in addition to total government expenditure used adisaggregated government expenditure data from 1961 - 2007, specifically; expenditure ongeneral administration and that of community and social services to determine the specificgovernment expenditure that economic growth may have significant impact on. Economicconditions and policies change implying that it is not only economic growth that can affectgovernment expenditure hence the inclusion of other fiscal policy variable and politicalfreedom to augment the functional form of Wagner’s law. All the variables used were found tobe I(1 and long run relationship exist between the dependent and the independent variablesexcept in the case where only GDP was used as the independent variable. Wagner’s hypothesisdoes not hold in all the estimations rather Keynesian hypothesis was validated in all theestimation. Elasticity estimates and Granger causality results are in agreement.
Kerkhof, Annemarie C.; Nonhebel, Sanderine; Moll, Henri C.
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 examined with regression analysis, and are compared and interpreted on the basis of insight at the product level. With data from the Netherlands in the year 2000, we find that environmental impact increases with increasing household expenditures, although the degree to which the environmental impact increases differs per impact category. Climate change and eutrophication increase less than proportionally with increasing expenditures. Acidification increases nearly proportionally with increasing expenditures, whereas smog formation increases more than proportionally. It appears that the mix of necessities and luxuries to which an environmental impact is related is essential in explaining the relationship. (author)
Full Text Available Tax expenditure analyses have been an important element in the supervision of reform processes linked to implementing different kinds of tax incentive and the management of a correct tax policy. The paper provides an evaluation of tax expenditure in Slovenia relating to personal income tax and corporate income tax. Four consecutive tax years were selected for the calculation of the tax expenditure on personal income tax (2006-09, while three consecutive years were selected for the corporate income tax calculation (2008-10. The tax expenditure calculated for personal income tax was highest in 2006 and reached 5.2% of GDP. After several changes in personal income tax, expenditures decreased to around 3% of GDP in the following three years. The tax expenditure calculated for corporate income tax was much lower as compared to GDP than for personal income tax, reaching around 0.2% of GDP.
Van der Heyden, Johan; Van Oyen, Herman; Berger, Nicolas; De Bacquer, Dirk; Van Herck, Koen
Disability and chronic conditions both have an impact on health expenditures and although they are conceptually related, they present different dimensions of ill-health. Recent concepts of disability combine a biological understanding of impairment with the social dimension of activity limitation and resulted in the development of the Global Activity Limitation Indicator (GALI). This paper reports on the predictive value of the GALI on health care expenditures in relation to the presence of chronic conditions. Data from the Belgian Health Interview Survey 2008 were linked with data from the compulsory national health insurance (n = 7,286). The effect of activity limitation on health care expenditures was assessed via cost ratios from multivariate linear regression models. To study the factors contributing to the difference in health expenditure between persons with and without activity limitations, the Blinder-Oaxaca decomposition method was used. Activity limitations are a strong determinant of health care expenditures. People with severe activity limitations (5.1%) accounted for 16.9% of the total health expenditure, whereas those without activity limitations (79.0%), were responsible for 51.5% of the total health expenditure. These observed differences in health care expenditures can to some extent be explained by chronic conditions, but activity limitations also contribute substantially to higher health care expenditures in the absence of chronic conditions (cost ratio 2.46; 95% CI 1.74-3.48 for moderate and 4.45; 95% CI 2.47-8.02 for severe activity limitations). The association between activity limitation and health care expenditures is stronger for reimbursed health care costs than for out-of-pocket payments. In the absence of chronic conditions, activity limitations appear to be an important determinant of health care expenditures. To make projections on health care expenditures, routine data on activity limitations are essential and complementary to data
Title: Comparison of energy expenditure when moving on wet and dry clothes. Objectives: The aim of this study is to compare energy expenditure based on heart rate when moving in dryand wet clothes in different speeds. Methods: Quantitative research and subsequent intra-individual comparison of pulse frequency and energy expenditure when moving in dry and wet clothes. Movements were conducted on a treadmill and heart rate was measured by using sporttesters. Results: From the results we can ded...
Basu, Rituparna; Franzini, Luisa; Krueger, Patrick M; Lairson, David R
We sought to examine and attempt to explain gender disparities in hypertension-attributable expenditure among noninstitutionalized individuals in the United States. Using the 2001-2004 Medical Expenditure Panel Survey and the Aday and Andersen health care use model, we estimated hypertension-attributable health care expenditures for inpatient stay, outpatient visits, prescription drugs, office visits, and emergency room (ER) visits among men and women by applying the method of recycled prediction. Hypertensive individuals were identified using International Classification of Diseases, 9th edition, codes or self-report of a diagnosis of hypertension. The adjusted mean hypertension-attributable expenditure per individual was significantly higher for women than for men for prescription drugs, inpatient stays, office visits, outpatient visits and ER visits expenditures. However, as age increased, the gender difference in adjusted mean expenditures became smaller and eventually reversed. This reversal occurred at different ages for different expenditures. For prescription drugs, office visits and outpatient expenditures, the reversal in expenditures occurred around age 50 to 59. The maximum difference was observed in outpatient expenditures, where women's average expenditure was $102 more than men's below age 45 but $103 less than men's above age 75. These differences remained significant even after controlling for predisposing, enabling, and need predictors of health care use. Our findings imply that there are gender disparities in hypertension-related expenditures, but that this disparity depends on age. These findings support recent findings on gender disparities in heart diseases and raise the question of physicians' bias in their diagnostic or prognostic approaches to hypertension in men and women. Copyright 2010 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
Andrew P Hills; Andrew P Hills; Najat eMokhtar; Nuala M Byrne
The ability to assess energy expenditure and estimate physical activity in free-living individuals is extremely important in the global context of non-communicable diseases including malnutrition, overnutrition (obesity) and diabetes. It is also important to appreciate that physical activity and energy expenditure are different constructs with physical activity defined as any bodily movement that results in energy expenditure and accordingly, energy is expended as a result of physical activit...
Pechey, Rachel; Monsivais, Pablo
Investigations of the contribution of food costs to socioeconomic inequalities in diet quality may have been limited by the use of estimated (vs. actual) food expenditures, not accounting for where individuals shop, and possible reverse mediation between food expenditures and healthiness of food choices. This study aimed to explore the extent to which food expenditure mediates socioeconomic inequalities in the healthiness of household food choices. Observational panel data on take-home food a...
Tapper, Alan; Phillimore, John
Australian government health expenditure per capita has grown steadily across the past few decades, but little is known about trends in the age distribution of health expenditure. In this paper, the Australian Bureau of Statistics (ABS) fiscal incidence studies, which track expenditure at the household level between 1984 and 2010, are used to shed light on this topic. The main finding was that spending has shifted focus from the younger half to the older half of the population. This shift is evident in three areas: (1) acute care (hospitals); (2) community health services (doctors); and (3) pharmaceuticals. Together, these areas account for approximately 88% of expenditure. The trend is independent of demographic aging. It is unlikely to reflect changes in population health. Its explanation is open to debate. Growth in expenditure per household has been more than threefold faster for elderly than young households. Across this period, expenditure per household per week has increased by 51% for the young, by 79% for the middle aged and by 179% for the elderly. This age-related growth is most prominent in expenditure on acute care, community health services and pharmaceuticals. WHAT IS KNOWN ABOUT THE TOPIC?: The Productivity Commission has published figures that relate age and Australian heath expenditure. However, there has been no published study of age-related trends in Australian health expenditure. WHAT DOES THIS PAPER ADD?: In addition to tracking age-related trends across 26 years, this paper adds a breakdown of those trends into four categories of expenditure, namely acute care, community health services, pharmaceutical benefits, and other. This breakdown shows that the trends vary by expenditure type. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: The paper shows that forward projections in health expenditure need to take into account age-related trends as well as demographic trends.
Describing and predicting consumer expenditure on a country or cross-national level has a long tradition in theoretical and applied economics and econometrics. This paper is a first attempt in describing aggregate eCommerce consumer expenditure among European Commission (EC) countries. After brief introduction of possible theoretical models which explain the variation in eCommerce consumer expenditure among observed countries, a list of important predictors has been discussed. The results gen...
Powell, Lisa M.; Harris, Jennifer L.; Fox, Tracy
In response to concerns about childhood obesity, the Federal Trade Commission (FTC) released two reports documenting food and beverage marketing expenditures to children and adolescents. The recently released 2012 report found an inflation-adjusted 19.5% reduction in marketing expenditures targeted to youth from $2.1 billion in 2006 to $1.8 billion in 2009. The current article highlights features of the FTC’s analysis, examines how expenditures relate to youth exposure to food marketing, and ...
Pontzer, Herman; Raichlen, David A; Wood, Brian M; Emery Thompson, Melissa; Racette, Susan B; Mabulla, Audax Z P; Marlowe, Frank W
Studies of total energy expenditure, (TEE; kcal/day) among traditional populations have challenged current models relating habitual physical activity to daily energy requirements. Here, we examine the relationship between physical activity and TEE among traditional Hadza hunter-gatherers living in northern Tanzania. Hadza adults were studied at two camps, with minimal intervention so as to monitor energy expenditure and activity during normal daily life. We measured daily walking distance and walking speed using wearable GPS units for 41 adults. For a subset of 30 adults, we measured TEE using doubly labeled water, three indices of work load (foraging return rate, maternal status, and number of dependent children), and urinary biomarkers of metabolic activity and stress (8-hydroxydeoxyguanosine, cortisol, and testosterone). Fat-free mass was the single strongest predictor of TEE among Hadza adults (r(2) = 0.66, P < 0.001). Hadza men used greater daily walking distances and faster walking speeds compared with that of Hadza women, but neither sex nor any measure of physical activity or work load were correlated with TEE in analyses controlling for fat-free mass. Compared with developed, industrial populations, Hadza adults had similar TEE but elevated levels of metabolic stress as measured by 8-hydroxydeoxyguanosine. Our results indicate that daily physical activity may not predict TEE within traditional hunter-gatherer populations like the Hadza. Instead, adults with high levels of habitual physical activity may adapt by reducing energy allocation to other physiological activity. © 2015 Wiley Periodicals, Inc.
Full Text Available The main aim of this paper is to provide a systematic overview of value added taxation in Croatia along with main changes in relevant legislation and to estimate total amount of tax expenditures. Results show that the proportion of tax expenditures in GDP in Croatia in 2010 amounted to less than 4%, a proportion lower than in any of the EU new member states, as well as almost twice as low as the EU-27 average. It can be concluded that the Croatian value added taxation system is efficient in this way, as was additionally shown by an analysis according to which Croatia in 2010 had better efficiency indicators than all the observed EU member states. The Croatian VAT system is mainly harmonized with EU directives, but abolition of the zero rate is still expected; this will increase government revenue by approximately 0.4-0.8% of GDP, depending on a chosen scenario. It has been suggested that a detailed analysis of the overall value added taxation system should be initiated, with the aim of optimizing cost-benefits. The main focus should be placed on the determination of the optimal VAT registration threshold, the costs and benefits of the introduced reliefs and exemptions in the tax system and the potential effects of the repeal of the zero rate.
Sévigny, Serge; Ladouceur, Robert; Jacques, Christian; Cantinotti, Michael
Two studies investigated the relationship between casino proximity and gambling participation, expenditure, and pathology. In Study 1, 8,842 participants were categorized into 1 of 4 driving distances from their home to the nearest casino in the province of Quebec: 0-100 km, 100.01-200 km, 200.01-300 km, or 300.01-981 km. In Study 2, 5,158 participants, who lived within a 100-km driving distance from the Montreal casino, were classified into 1 of 5 equidistant, 20-km driving distances. A survey company interviewed participants regarding their gambling habits. Results indicated a positive link between casino proximity and gambling participation (at the provincial and Montreal levels) and expenditure (at the provincial level only) but no link with the current prevalence rate of probable pathological gambling or of problem gambling. In a setting in which many types of gambling activities are available, casino proximity in itself does not appear to explain the rate of gambling-related problems. It is necessary to continue prospective research on exposure and adaptation theories as potential explanations for the development of pathological gambling. 2008 APA
Zarling, E J; Grande, A; Hano, J
In patients with intra-abdominal fluid collection, caloric needs are based on an estimated dry weight. This is done because intra-abdominal fluid has been assumed to be metabolically inactive. One recent study of patients with slowly resolving ascites suggested otherwise. In our study, the effect of intra-abdominal fluid on the resting energy expenditure (REE) and apparent lean body mass was determined in 10 stable patients requiring peritoneal dialysis. For each subject, in both the empty and full state, we measured REE by indirect calorimetry, and body composition by the bioelectric impedance method. In the full state, the VCO2 was significantly increased (210 +/- 11 versus 197 +/- 9 mL/min, P empty state. This caused an increase in the calculated resting energy expenditure (1531 +/- 88 kcal/d empty versus 1593 +/- 94 kcal/d full, P calories derived from glucose absorbed out of the dialysate. Estimates of body fat, lean body mass, and total water also were not affected by the intra-abdominal fluid. We conclude that intra-abdominal fluid will not affect the measured REE and hence may be considered to be metabolically inactive.
Gams, Andrej; Petric, Tadej; Debevec, Tadej; Babic, Jan
A number of studies discuss the design and control of various exoskeleton mechanisms, yet relatively few address the effect on the energy expenditure of the user. In this paper, we discuss the effect of a performance augmenting exoskeleton on the metabolic cost of an able-bodied user/pilot during periodic squatting. We investigated whether an exoskeleton device will significantly reduce the metabolic cost and what is the influence of the chosen device control strategy. By measuring oxygen consumption, minute ventilation, heart rate, blood oxygenation, and muscle EMG during 5-min squatting series, at one squat every 2 s, we show the effects of using a prototype robotic knee exoskeleton under three different noninvasive control approaches: gravity compensation approach, position-based approach, and a novel oscillator-based approach. The latter proposes a novel control that ensures synchronization of the device and the user. Statistically significant decrease in physiological responses can be observed when using the robotic knee exoskeleton under gravity compensation and oscillator-based control. On the other hand, the effects of position-based control were not significant in all parameters although all approaches significantly reduced the energy expenditure during squatting.
Full Text Available ABSTRACT This paper discusses the role of institutions and structural change in shaping income inequality. It is argued that while social expenditure and direct redistribution are crucial for improving income distribution, sustainable equality requires structural change. The relative importance of these variables in different countries is analyzed and a typology suggested. It is argued that the most equal countries in the world combine strong institutions in favor of redistribution and knowledge-intensive production structures that sustain growth and employment in the long run. Both institutions and the production structure in Latin America fail to foster equality and this explains its extremely high levels of inequality. The paper presents empirical evidence that supports this view, based on a sample of developed and developing countries for the period 1990-2010. Institutions for redistribution are captured through social expenditures as a percentage of GDP, while the role of structural change is captured by indicators of the technological intensity of production and the evolution of labor productivity. The technological intensity of the production structure is proxied through two indicators, the Economic Complexity Index and the ECLAC Index of Technological Intensity.
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
Full Text Available Economic and debt crisis has increased the attention paid to the development of government expenditure in problematic regions in the European Union. The goal of the article is to provide direct empirical evidence on cyclicality and the long-term and short-term relationship between government expenditure and output in the Portugal, Ireland, Italy, Greece and Spain in a period 1995–2011. We have applied Johansen cointegration test and the error correction model on adjusted annual data of GDP and government expenditure in compliance with the COFOG international standard. Research confirms procyclical development of government expenditure functions on GDP in the selected countries; this procyclicality is in line with development typical for developing countries. Moreover, output and government expenditure are cointegrated for at least six of the expenditure categories in every country and it implies a long-term relationship between government expenditure and output consistent with Wagner’s law. The values of the coefficients for the short-run relationship between expenditure and output confirm the voracity hypothesis, as they suggest that in response to a given shock to real GDP, government expenditure rises by even more in percentage points.
Full Text Available This paper empirically examines the effect of corruption on the allocation of government expenditures by function. Equations using pooled panel dataset for 21 OECD countries between 1998 and 2011 were tested, and the findings show that government expenditure on defense and general public services increase, while government expenditures on education, health, recreation, culture and religion decline with higher levels of corruption. This paper presents new results and new evidence on the link between corruption and allocation of government expenditures in OECD countries.
Andrew P Hills
Full Text Available The ability to assess energy expenditure and estimate physical activity in free-living individuals is extremely important in the global context of non-communicable diseases including malnutrition, overnutrition (obesity and diabetes. It is also important to appreciate that physical activity and energy expenditure are different constructs with physical activity defined as any bodily movement that results in energy expenditure and accordingly, energy is expended as a result of physical activity. However, total energy expenditure, best assessed using the criterion doubly labelled water technique, includes components in addition to physical activity energy expenditure, namely resting energy expenditure and the thermic effect of food. Given the large number of assessment techniques currently used to estimate physical activity in humans, it is imperative to understand the relative merits of each. The goal of this review is to provide information on the utility and limitations of a range of objective measures of physical activity and their relationship with energy expenditure. The measures discussed include those based on energy expenditure or oxygen uptake including doubly labelled water, activity energy expenditure, physical activity level, and metabolic equivalent; those based on heart rate monitoring and motion sensors; and because of their widespread use, selected subjective measures.
Full Text Available In our daily existence, troubled and changing, economy occupies a large space. Increasingly, more economic concepts such as public budget and public expenditures enter within our daily language. Increasingly, we are assailed with data information about the sustainability of expenditure, about how and when budget allows us to make certain expenditures. Thus, an insight into the functional mechanism and a public institutional budget is always a topical issue. About the budget, as a financial and management tool of a public, we can not discuss without reference to economic classifiers public spending. Budget public institution acquires through economic classification of expenditure substance and reality.
...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS EMERGING..., unreasonable expenditures, or any cost of: (1) Branded product promotions—in-store, restaurant advertising...
Humphries, Debbie L; Behrman, Jere R; Crookston, Benjamin T; Dearden, Kirk A; Schott, Whitney; Penny, Mary E
Relative to plant-based foods, animal source foods (ASFs) are richer in accessible protein, iron, zinc, calcium, vitamin B-12 and other nutrients. Because of their nutritional value, particularly for childhood growth and nutrition, it is important to identify factors influencing ASF consumption, especially for poorer households that generally consume less ASFs. To estimate differential responsiveness of ASF consumption to changes in total household expenditures for households with different expenditures in a middle-income country with substantial recent income increases. The Peruvian Young Lives household panel (n = 1750) from 2002, 2006 and 2009 was used to characterize patterns of ASF expenditures. Multivariate models with controls for unobserved household fixed effects and common secular trends were used to examine nonlinear relationships between changes in household expenditures and in ASF expenditures. Households with lower total expenditures dedicated greater percentages of expenditures to food (58.4% vs.17.9% in 2002 and 24.2% vs. 21.5% in 2009 for lowest and highest quintiles respectively) and lower percentages of food expenditures to ASF (22.8% vs. 33.9% in 2002 and 30.3% vs. 37.6% in 2009 for lowest and highest quintiles respectively). Average percentages of overall expenditures spent on food dropped from 47% to 23.2% between 2002 and 2009. Households in the lowest quintiles of expenditures showed greater increases in ASF expenditures relative to total consumption than households in the highest quintiles. Among ASF components, meat and poultry expenditures increased more than proportionately for households in the lowest quintiles, and eggs and fish expenditures increased less than proportionately for all households. Increases in household expenditures were associated with substantial increases in consumption of ASFs for households, particularly households with lower total expenditures. Increases in ASF expenditures for all but the top quintile of
Murphy, Louise B; Cisternas, Miriam G; Pasta, David J; Helmick, Charles G; Yelin, Edward H
We estimated the economic impact of arthritis using 2013 US Medical Expenditure Panel Survey (MEPS) data. We calculated arthritis-attributable and all-cause medical expenditures for adults age ≥18 years and arthritis-attributable earnings losses among those ages 18-64 years who had ever worked. We calculated arthritis-attributable costs using multistage regression-based methods, and conducted sensitivity analyses to estimate costs for 2 other arthritis definitions in MEPS. In 2013, estimated total national arthritis-attributable medical expenditures were $139.8 billion (range $135.9-$157.5 billion). Across expenditure categories, ambulatory care expenditures accounted for nearly half of arthritis-attributable expenditures. All-cause expenditures among adults with arthritis represented 50% of the $1.2 trillion national medical expenditures among all US adults in MEPS. Estimated total national arthritis-attributable earning losses were $163.7 billion (range $163.7-$170.0 billion). The percentage with arthritis who worked in the past year was 7.2 percentage points lower than those without arthritis (76.8% [95% confidence interval (95% CI)] 75.0-78.6 and 84.0% [95% CI 82.5-85.5], respectively, adjusted for sociodemographics and chronic conditions). Total arthritis-attributable medical expenditures and earnings losses were $303.5 billion (range $303.5-$326.9 billion). Total national arthritis-attributable medical care expenditures and earnings losses among adults with arthritis were $303.5 billion in 2013. High arthritis-attributable medical expenditures might be reduced by greater efforts to reduce pain and improve function. The high earnings losses were largely attributable to the substantially lower prevalence of working among those with arthritis compared to those without, signaling the need for interventions that keep people with arthritis in the workforce. © 2017, American College of Rheumatology.
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
Ouyang, Wenjing; Hilsenrath, Peter E.
Investment, especially through merger and acquisition (M&A), is a leading topic of concern among health care managers. In addition, the implications of this activity for organization and market concentration are of great interest to policy makers. Using a sample of 2256 firm-year observations in the health care industry during the period from 1985 to 2011, this article provides novel evidence that managers learn from financial markets in making capital expenditure (CAPEX) and M&A investment decisions. Within the industry, managers in the Drugs subsector are most likely to do so, whereas managers in the Medical Equipment and Supplies are least likely to do so. We find informative stock prices improve firm financial performance. This article highlights the importance of financial markets for real economic activity in the health care industry. PMID:28220717
Miller, T R; Levy, D T
We examine interstate variations in the cost of claims for physician care using injury claims from Worker's Compensation, and consider some of the factors that may explain cost differences. Multivariate regression analysis is used to isolate state variations, while controlling for personal and injury characteristics, and state characteristics. Statistical analyses reveal considerable variation in expenditures for physician care of injuries across states, even after controlling for case mix and state characteristics. We also find that the presence of HMOs and of general practitioners as a percent of physicians are associated with lower claims, and that the percent of the state that is urban is associated with higher claims. The large variation in costs suggests a potential to affect the costs of physician care for work-related injuries.
Full Text Available The International Monetary Fund (IMF was established in 1944 to supervise the international monetary system that collapsed in 1971. Since then, the Fund has reinvented itself as some sort of a “development agency,” providing loans with strings attached. Any country that wishes to obtain loans must follow the IMF-prescribed policies that reflect the neoliberal ideas of the Washington Consensus. As these policies are typically contractionary and involve austerity, the IMF has been accused of pursuing policies that exhibit a negative impact on health expenditure, with dire consequences for the population. Although the empirical evidence on this issue is mixed, it is well known that the IMF operations are more likely to exert a negative effect than a positive effect on government spending on health.
BÂLDAN FLORENTINA CRISTINA
Full Text Available The paper „Analysis of consumption expenditure in Romania, period 2009-2015” is highlighting a very important phenomenon for the Romanian economy, consumption. The financial and economic crisis determined a change in the income repartition for the basic products and services. The most influent stimulus at which the Romanian consumers are deciding a product acquisition is the price, therefore they were migrating to product segments with low prices, the quality of life being on a decreasing trend. The level of alimentary products consumption depends in a big extent on the macroeconomic policies, that through numerous leverages is influencing the population consumption behavior. From these leverages we may document the income policy, loan policy, monetary and exchange rate policies, social assistance policy, etc.
Konan, Denise Eby; Chan, Hing Ling
This paper focuses on petroleum use and greenhouse gas emissions associated with economic activities in Hawaii. Data on economic activity, petroleum consumption by type (gasoline, diesel, aviation fuel, residual, propane), and emissions factors are compiled and analyzed. In the baseline year 1997, emissions are estimated to total approximately 23.2 million metric tons of carbon, 181 thousand metric tons of nitrous oxide, and 31 thousand metric tons of methane in terms of carbon-equivalent global warming potential over a 100-year horizon. Air transportation, electricity, and other transportation are the key economic activity responsible for GHG emissions associated with fossil fuel use. More than 22% of total emissions are attributed to visitor expenditures. On a per person per annum basis, emission rates generated by visitor demand are estimated to be higher than that of residents by a factor of 4.3 for carbon, 3.2 for methane, and 4.8 for nitrous oxide. (author)
Rogers, M M
Competition for health care capital dollars has increased as third-party and government reimbursement decreases, patient volume decreases, and alternative services increase. Given this rationing situation, it is more important than ever that the health care supervisor carefully document and present a capital expenditure request. This request should outline skillfully the benefits and costs of undertaking a new service or replacing an old asset. A supervisor who can quantify the costs and benefits of a project and utilize one of the four common capital budgeting techniques: payback period, net present value, profitability index, or internal rate of return, will certainly be taking a step in the right direction for ensuring a serious evaluation of his or her proposal. This article attempts to explain this process using both narrative and quantitative examples.
Răbonţu Cecilia Irina
Full Text Available In Romania, scale sports tourism gets well deserved lately. Tourism and sport has a close relationship since the beginning of their existence, and today we are witnessing a strengthening of it, because we talk about quality of life and greatly enhanced awareness of the beneficial effects of tourism and sport, both contributing to the restoration of working capacity, to increase the health of the population and spending free time pleasant and useful. We have proposed in this paper to analyze consumer behavior of sports tourism in Romania but also places where the cost of sports activities in total expenditures grouped according to several criteria. We conducted a preliminary conceptualization of the notion of tourism and tourist sports, controversial and difficult concept to define. We used for this purpose an extensive bibliographic material and statistical data provided by the National Institute of Statistics of Romania.
Chang, David C; Anderson, Jamie E; Kobayashi, Leslie; Coimbra, Raul; Bickler, Stephen W
The lifetime risk and expected cost of trauma care would be valuable for health policy planners, but this information is currently unavailable. The cumulative incidence rates methodology, based on a cross-sectional population analysis, offers an alternative approach to prohibitively costly prospective cohort studies. Retrospective analysis of the California Office of Statewide Health Planning and Development (OSHPD) database was performed for 2008. Trauma admissions were identified by ICD-9 primary diagnosis codes 800-959, with certain exclusions. Cumulative incidence rates were calculated as the cumulative summation of incidence risks sequentially across age groups. A total of 2.2 million admissions were identified, with mean age of 63.8 y, 49.6% men, 82.8% Whites, 5.7% Blacks, 11.3% Hispanics, and 3.1% Asians. The cumulative incidence rate for patients older than age 85 y was 1119 per 10,000 people, with the majority of risk in the elderly, compared with 24,325 per 10,000 people for all-cause hospitalizations. The rates were 946 for men, 1079 for women, 999 for non-Hispanic Whites, 568 for Blacks, 577 for Hispanics, and 395 for Asians, per 10,000 population. The cumulative expected hospital charge was $6538, compared with $81,257 for all-cause hospitalizations. The cumulative lifetime risk of trauma/injury requiring hospitalization for a person living to age 85 y in California is 11.2%, accounting for 4.6% of expected lifetime hospitalizations, but accounting for 8.0% of expected lifetime hospital expenditures. Risk of trauma is significant in the elderly. The total expenditure for all trauma hospitalizations in California was $7.62 billion in 2008. Copyright © 2012 Elsevier Inc. All rights reserved.
Egro, Francesco M; Manders, Ernest C; Manders, Ernest K
Historically, estimated energy expenditure (EEE) has been related to the percent of body surface area burned. Subsequent evaluations of these estimates have indicated that the earlier formulas may overestimate the amount of caloric support necessary for burn-injured patients. Ireton-Jones et al derived 2 equations for determining the EEE required to support burn patients, 1 for ventilator-dependent patients and 1 for spontaneously breathing patients. Evidence has proved their reliability, but they remain challenging to apply in a clinical setting given the difficult and cumbersome mathematics involved. This study aims to introduce a graphical calculation of EEE in burn patients that can be easily used in the clinical setting. The multivariant linear regression analysis from Ireton-Jones et al yielded equations that were rearranged into the form of a simple linear equation of the type y = mx + b. By choosing an energy expenditure and the age of the subject, the weight was calculated. The endpoints were then calculated, and a graph was mapped by means of Adobe FrameMaker. A graphical representation of Ireton-Jones et al's equations was obtained by plotting the weight (kg) on the y axis, the age (years) on the x axis, and a series of parallel lines representing the EEE in burn patients. The EEE has been displayed graphically on a grid to allow rapid determination of the EEE needed for a given patient of a designated weight and age. Two graphs were plotted: 1 for ventilator-dependent patients and 1 for spontaneously breathing patients. Correction factors for sex, the presence of additional trauma, and obesity are indicated on the graphical calculators. We propose a graphical tool to calculate caloric requirements in a fast, easy, and portable manner.
Full Text Available This study aimed to assess total energy expenditure (TEE and specific habitual physical activities in adolescent sprint athletes. Two methods used to estimate TEE, an activity diary (AD and SenseWear armband (SWA, were compared. Sixteen athletes (6 girls, 10 boys, mean age 16.5 ± 1.6 yr simultaneously wore a SWA and completed an AD and food diary during one week. Basal energy expenditure as given by the SWA when taken off was corrected for the appropriate MET value using the AD. TEE as estimated by the AD and SWA was comparable (3196 ± 590 kcal and 3012 ± 518 kcal, p = 0.113 without day-to-day variations in TEE and energy expended in activities of high intensity. Daily energy intake (2569 ± 508 kcal did not match TEE according to both the AD and SWA (respectively p < 0.001 and p = 0.007. Athletes were in a supine position for a longer time on weekend days than on week days and slept longer on Sundays. Athletes reported a longer time of high-intensive physical activities in the AD than registered by the SWA on 4 out of 7 days. In addition to specific sprint activities on 3 to 7 days per week, 11 out of 16 athletes actively commuted to school where they participated in sports once or twice per week. The AD and the SWA are comparable in the estimation of TEE, which appears realistic and sustainable. The SWA offers an appropriate and objective method in the assessment of TEE, sleeping and resting in adolescent athletes on the condition that detailed information is given for the times the armband is not worn. The AD offers activity specific information but relies on the motivation, compliance and subjectivity of the individual, especially considering high-intensive intermittent training
Neilson, Heather K; Robson, Paula J; Friedenreich, Christine M; Csizmadi, Ilona
Activity energy expenditure (AEE) is the modifiable component of total energy expenditure (TEE) derived from all activities, both volitional and nonvolitional. Because AEE may affect health, there is interest in its estimation in free-living people. Physical activity questionnaires (PAQs) could be a feasible approach to AEE estimation in large populations, but it is unclear whether or not any PAQ is valid for this purpose. Our aim was to explore the validity of existing PAQs for estimating usual AEE in adults, using doubly labeled water (DLW) as a criterion measure. We reviewed 20 publications that described PAQ-to-DLW comparisons, summarized study design factors, and appraised criterion validity using mean differences (AEE(PAQ) - AEE(DLW), or TEE(PAQ) - TEE(DLW)), 95% limits of agreement, and correlation coefficients (AEE(PAQ) versus AEE(DLW) or TEE(PAQ) versus TEE(DLW)). Only 2 of 23 PAQs assessed most types of activity over the past year and indicated acceptable criterion validity, with mean differences (TEE(PAQ) - TEE(DLW)) of 10% and 2% and correlation coefficients of 0.62 and 0.63, respectively. At the group level, neither overreporting nor underreporting was more prevalent across studies. We speculate that, aside from reporting error, discrepancies between PAQ and DLW estimates may be partly attributable to 1) PAQs not including key activities related to AEE, 2) PAQs and DLW ascertaining different time periods, or 3) inaccurate assignment of metabolic equivalents to self-reported activities. Small sample sizes, use of correlation coefficients, and limited information on individual validity were problematic. Future research should address these issues to clarify the true validity of PAQs for estimating AEE.
Wade, Charles E.; Moran, Megan M.; Oyama, Jiro
BACKGROUND: The use of centrifugation at 1 G has been advocated as a control condition during spaceflight and as a countermeasure to compensate for the adverse effects of spaceflight. Rodents are the primary animal model for the study of the effects of spaceflight and will be used in the evaluation of centrifugation as a countermeasure and means of control at 1 G during flight. HYPOTHESIS: The present study was designed to assess whether resting energy expenditure (EER) of male rats was increased in relation to the magnitude of the level of gravity to which the animals were exposed. The influence of body mass and age on resting energy expenditure (EER) of male rats (n = 42, age 40-400 d) was determined following 2 wk of acclimation to 1, 2.3, or 4.1 G. Hypergravity environments were created by centrifugation. Measurements were made at the gravity level to which the animal was acclimated and during the lights-on period. RESULTS: In rats matched for body mass (approximately 400 g), mean O2 consumption and CO2 production were higher (18% and 27%, respectively) in the 2.3- and 4.1 -G groups than controls. Mean respiratory exchange ratio (RER) increased from 0.80 to 0.87. EER was increased from 47 +/- 0.1 kcal x d(-1) at 1 G, to 57 +/- 1.5 and 58 +/- 2.2 kcal x d(-1) at 2.3 and 4.1 G, respectively. There was no difference in EER between the hypergravity groups. When age differences were considered, EER (kcal x kg(-1) x d(-1)) with increased gravity was 40% higher than at 1 G. The increase in EER was not proportional over gravity levels. CONCLUSION: Acclimation of rats to hypergravity increases their EER, dependent on body mass and age, and may alter substrate metabolism. The increase in EER was not related to the level of gravity increase.
FOZIEH JEYHOON TABAR
Full Text Available ABSTRACT Using the annual data of Iran’s economy from 1981-2012, this study examines Wagner’s law and the Keynesian hypothesis about the relationship between the real government expenditure and the real GDP. In this regard, this paper investigated the relationship between the total government expenditure, the GDP and the relationship between government educational expenditure and GDP using bivariate and multivariate models. The multivariate model is used to reduce the specified error issues that has not been considered in many studies. The co-integration was examined using the auto regressive distributive lag method (ARDL of both long-term and short-term relationships. In making the estimations of the Wagner’s view, the variables: real GDP, capital stock and labor force stock respectively, had a positive, a negative, and a positive impact on total government expenditure and the long-term relationship is true in this regard. Additionally, in the estimation of Keynesian model, the educational expenditures, unlike real expenditures of government, had a long-term relationship. In addition, the variable, capital, in both models had a similar effect on the real GDP, and the labor force coefficient in the presence of the total expenditures and educational expenditures were negative and positive respectively.
Gose, Frank J.
In 1980, the Constitution of the State of Arizona was amended to establish expenditure limits for a number of political entities, including community colleges. Limits were also established on revenue derived from local tax levies. Concern that limitations on revenue and expenditures could place real constraints on community college operations…
Lin, Jin-Ding; Lin, Lan-Ping
The purposes of the present study were to describe the welfare expenditure for people with disabilities and examine its relation to national economic growth from 1991 to 2006 in Taiwan. We analyzed data mainly from the information of population with disabilities, disability welfare expenditure and national economic growth and gross national…
Sabau-Popa Diana Claudia
Full Text Available This article analyzes the main trends of public expenditures in the New Member States 12 in the last decade. We develop a synthetic analysis of the total public expenditures and also an analytical inquiry of major categories of public expenditures according to COFOG. Based on data provided by Eurostat from 2000 to 2010 we try to capture the impact of global financial crisis on the major trends of the public expenditures for new member states. Our purpose is to reveal a global view of the state of public expenditures in this group of EU countries and also we try to make a comparison between Romania and these countries considering that the stance of public finance is quite similar to the new member states. The major findings of this study are the high increase of the public expenditures for all the countries especially in 2009, due to a huge increase of the social protection expenditures. In this context we underline some correlations between the public expenditures evolution and economic growth.
... 26 Internal Revenue 3 2010-04-01 2010-04-01 false Expenditures for advertising or promotion of... advertising or promotion of good will. See § 1.162-14 for the rules applicable to a corporation which has elected to capitalize expenditures for advertising or the promotion of good will under the provisions of...
Galvani, C; Ardigò, L P; Alberti, M; Daniele, F; Capelli, C
The aim of the present study was to quantify total energy expenditure, activity energy expenditure and time spent at three levels of physical activity (low, moderate, high intensity) in four two-person crews during a 500-mile double-handed sailing regatta. Physical activity intensity and energy expenditure were assessed during a 500-nautical-mile double-handed offshore competition in eight male sailors (46.3±3.4 years; 180±13 cm; 85.4±12.5 kg). During the whole regatta, they wore an activity monitor that estimated energy expenditure and minutes spent at each level of intensity (sedentary, 6.0 METs). The sailors spent longer periods (Penergy expenditure was 14.26±1.89 MJ/day and the activity energy expenditure was 5.06±1.42 MJ/day. Activity energy expenditure was significantly correlated with total sleep time, boat speed, and distance covered each day (Penergy expenditure was more likely a consequence of the short and rare periods of sleep during the competition rather than of the bouts of moderate and vigorous physical activities.
... 42 Public Health 3 2010-10-01 2010-10-01 false Base expenditure target for calendar year 1999. 419.30 Section 419.30 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Services § 419.30 Base expenditure target for calendar year 1999. (a) CMS estimates the aggregate amount...
... 26 Internal Revenue 3 2010-04-01 2010-04-01 false Definition of soil and water conservation... (continued) § 1.175-2 Definition of soil and water conservation expenditures. (a) Expenditures treated as a... of soil or water conservation in respect of land used in farming, or for the prevention of erosion of...
Odhiambo, Nicholas M.; Ntenga, Lydia
The trends and the trajectory of higher education research expenditure in South Africa since the introduction of the New Funding Formula in 2004 have been analysed. The paper also compares the level of South Africa's total gross expenditure on research and development with those of other selected economies. The findings show that following…
Armour, H.O.; Teece, D.J.
The authors find that a significant relationship exists between vertical integration and expenditures for basic and applied research for the US petroleum industry, 1954-1975. They advance several hypotheses consistent with this finding, and conclude that organizational structure influences expenditures on research in the modern business enterprise.
Berkowitz, Seth A; Basu, Sanjay; Meigs, James B; Seligman, Hilary K
To determine whether food insecurity, limited or uncertain food access owing to cost, is associated with greater health care expenditures. Nationally representative sample of the civilian noninstitutionalized population of the United States (2011 National Health Interview Survey [NHIS] linked to 2012-2013 Medication Expenditure Panel Survey [MEPS]). Longitudinal retrospective cohort. A total of 16,663 individuals underwent assessment of food insecurity, using the 10-item adult 30-day food security module, in the 2011 NHIS. Their total health care expenditures in 2012 and 2013 were recorded in MEPS. Expenditure data were analyzed using zero-inflated negative binomial regression and adjusted for age, gender, race/ethnicity, education, income, insurance, and residence area. Fourteen percent of individuals reported food insecurity, representing 41,616,255 Americans. Mean annualized total expenditures were $4,113 (standard error $115); 9.2 percent of all individuals had no health care expenditures. In multivariable analyses, those with food insecurity had significantly greater estimated mean annualized health care expenditures ($6,072 vs. $4,208, p insecurity was associated with greater subsequent health care expenditures. Future studies should determine whether food insecurity interventions can improve health and reduce health care costs. © Health Research and Educational Trust.
... 26 Internal Revenue 17 2010-04-01 2010-04-01 false Black lung trusts-taxes on taxable expenditures... (CONTINUED) MISCELLANEOUS EXCISE TAXES (CONTINUED) FOUNDATION AND SIMILAR EXCISE TAXES Black Lung Benefit Trust Excise Taxes § 53.4952-1 Black lung trusts—taxes on taxable expenditures. (a) In general. Section...
Why is the urban-rural gap in child malnutrition increasing in Peru despite government efforts to improve the provision of public services? To answer this question, the impact of regional public expenditure in Peru on young children's nutritional outcomes is examined. To account for policy endogeneity, public expenditures are instrumented using unanticipated regional mining revenues. Even ...
Pugh, G.; Mangan, J.; Blackburn, V.; Radicic, D.
This article estimates the effects of school expenditure on school performance in government secondary schools in New South Wales, Australia over the period 2006-2010. It uses dynamic panel analysis to exploit time series data on individual schools that only recently has become available. We find a significant but small effect of expenditure on…
Wang, De; Fu, Meiying
Along with the reform of Chinese Government public finance, higher education belongs to the public product, gradually changes from "fund investment management" to the "expenditure performance management". The evaluation of expenditure performance system becomes the key point of higher education investment mechanism reform. This…
This paper described a method for analyzing the efficiency of exploration investment, which can improve corporate planning. Exploration expenditure is held to be a main indicator of economic activities in the oil and gas industry because exploration is supposed to lead to booking more reserves and increased production. A model was developed for analyzing the correlation between exploration expenditure and producer's reserves and production for conventional and unconventional gas plays in the United States. The model was used to quantitatively assess the exploration expenditures production and reserves of different producers for various conventional and unconventional gas plays. Producer's booked reserves, production from public sources, and reserves and production forecasts were incorporated into the model, which was used to analyze different types of exploration expenditure (land, drilling, and seismic) incurred at various times prior to reserves and production being booked. There was an overall positive correlation between exploration expenditure and reserves and production, but there was significant variance in the correlation between various producers operating in different plays. Unproved land acquisition was strongly correlated to the booking of proved reserves, but there was no correlation between unproved land acquisition and exploration expenditure ratio, reserves, or production. A number of companies had a high exploration expenditure to overall expenditure ratio, but the resulting payoffs were inconsistent. 6 refs., 1 tab., 6 figs.
Nam, Kiil; Chang, Daejun; Chang, Kwangpil; Rhee, Taejin; Lee, In-Beum
This study proposed a new LCC (life cycle cost) methodology with the risk expenditure taken into account for comparative evaluation of offshore process options at their conceptual design stage. The risk expenditure consisted of the failure risk expenditure and the accident risk expenditure. The former accounted for the production loss and the maintenance expense due to equipment failures while the latter reflected the asset damage and the fatality worth caused by disastrous accidents such as fire and explosion. It was demonstrated that the new LCC methodology was capable of playing the role of a process selection basis in choosing the best of the liquefaction process options including the power generation systems for a floating LNG (Liquefied natural gas) production facility. Without the risk expenditure, a simple economic comparison apparently favored the mixed refrigerant cycle which had the better efficiency. The new methodology with the risk expenditure, however, indicated that the nitrogen expansion cycle driven by steam turbines should be the optimum choice, mainly due to its better availability and safety. -- Highlights: → The study presented the methodology of the LCC with the risk expenditure for the conceptual design of offshore processes. → The proposed methodology demonstrated the applicability of the liquefaction unit with the power generation system of LNG FPSO. → Without the risk expenditure, a simple economic comparison apparently favored the mixed refrigerant cycle which had the better efficiency. → The new methodology indicated that the nitrogen expansion cycle driven by steam turbines is the optimum choice due to its better availability and safety.
Full Text Available It has been demonstrated that a vegetarian diet may be effective in reducing body weight, however, the underlying mechanisms are not entirely clear. We investigated whether there is a difference in resting energy expenditure between 26 vegetarians and 26 non-vegetarians and the correlation between some nutritional factors and inflammatory markers with resting energy expenditure. In this cross-sectional study, vegetarians and non-vegetarians were matched by age, body mass index and gender. All underwent instrumental examinations to assess the difference in body composition, nutrient intake and resting energy expenditure. Biochemical analyses and 12 different cytokines and growth factors were measured as an index of inflammatory state. A higher resting energy expenditure was found in vegetarians than in non-vegetarians (p = 0.008. Furthermore, a higher energy from diet, fibre, vegetable fats intake and interleukin-β (IL-1β was found between the groups. In the univariate and multivariable analysis, resting energy expenditure was associated with vegetarian diet, free-fat mass and vegetable fats (p < 0.001; Slope in statistic (B = 4.8; β = 0.42. After adjustment for cytokines, log10 interleukin-10 (IL-10 still correlated with resting energy expenditure (p = 0.02. Resting energy expenditure was positively correlated with a specific component of the vegetarian’s diet, i.e., vegetable fats. Furthermore, we showed that IL-10 was positively associated with resting energy expenditure in this population.
The purposes of this study were to compare the responsiveness of educational expenditures per pupil in Ontario, first, to changes in instructional expenditures per pupil during 1971-77, and, second, to changes in proxy measures of educational quality and price levels of teacher services for 1974-77. Variables used to represent quality and price…
Michael S. Hand; Matthew P. Thompson; Dave Calkin
Increasing costs of wildfire management have highlighted the need to better understand suppression expenditures and potential tradeoffs of land management activities that may affect fire risks. Spatially and temporally descriptive data is used to develop a model of wildfire suppression expenditures, providing new insights into the role of spatial and temporal...
... an expenditure limitation for each general election held to fill a seat in the House of... limitation for 2013 general elections for House candidates in these states is $46,600. \\1\\ Currently, these... Congressional District Both the national and state party committees have an expenditure limitation for a general...
... agents, or a political party committee or its agents. A communication is “made in cooperation... independent expenditure means an expenditure by a person for a communication expressly advocating the election... committee, or their agents, or a political party committee or its agents” if it is a coordinated...
Gomberg, Irene L.; Atelsek, Frank J.
At the request of the National Science Foundation (NSF), the Higher Education Panel (a stratified sample of 760 colleges and universities) collected information on the level of institutional expenditures for research equipment, the federal contribution to those expenditures, and the share of funds expended for high-cost items. The data were…
Full Text Available The aim of this study is to analyze the healthcare expenditures in seven South Asian countries namely, India, Pakistan, Sri Lanka, Maldives, Bhutan, Bangladesh and Nepal. The longitudinal data has been taken for 19 years from 1995 to 2013. We specifically examine the out-of-pocket healthcare expenditure in these countries. The per-capita health expenditure differences have been compared. We also develop panel data pooled OLS model for out-of-pocket expenditure with the factors affecting it, i.e. per capita health expenditure, household final consumption expenditure and public health expenditure. The work is in line with the earlier studies of determinants of out-of-pocket health expenditures. The results suggest that Maldives has the highest per capita health expenditure while out-of-pocket health expenditure as a percentage of total expenditure on health is highest for the India. The fixed and random effect is evidenced on health expenses across the years and cross section based on various determinants. The novel aspect of the work is that, this is an attempt to explain healthcare financing in the developing economies. The key determinant of out-of-pocket expenditure is the final household expenditures as the percentage of gross domestic product.
Full Text Available According to Wagner’s law there is unidirectional relationship from economic growth to public expenditure. Wagner’s states that increase of national income leads to faster growth of public expenditure. In other words, out of economic and social development in the country, people will demand more public goods and it will increase public expenditure at a faster rate than national income. This study is analyzing the long term and causality relationship between public expenditure and economic growth in Kyrgyzstan and tests the validity of Wagner's law in Kyrgyz economy by using an ARDL and Error Correction models over the period 1995 to 2014. Empirical results showed that there is an unidirectional causality relationship between economic growth and public expenditure in long term. Empirical evidence is support the validity of Wagner’s law in Kyrgyz economy.
Jamile S. Codogno
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.
Raghavan, Ramesh; Brown, Derek S; Allaire, Benjamin T; Ross, Raven E; Landsverk, John
This study examined relationships between various measures of the severity of child maltreatment and expenditures on psychotropic drugs among children in the welfare system. Child participants (N=4,453) in the first National Survey of Child and Adolescent Well-Being (NSCAW) were linked to their Medicaid claims from 36 states. Three specifications for severity of maltreatment were developed. A two-part regression of logistic and generalized linear models of expenditures on psychotropic medications was estimated for each specification. Physically abused children had higher odds (odds ratio [OR]=1.34) and neglected children had lower odds (OR=.76) of incurring psychotropic drug expenditures. Children who experienced the most severe level of harm had higher odds (OR=1.33) of medication use, compared with children without appreciable harm. No maltreatment specifications were associated with increased expenditures on psychotropic drugs. The magnitude of maltreatment affected odds of use of psychotropic drugs but had no effect on Medicaid expenditures for these drugs.
Full Text Available This empirical study examines the long-run relationship between inflation and its determinants in South Africa. Three models of inflation involving money supply, bank credit and expenditure components are tested using the unrestricted error correction models of Pesaran et al. (2001. Unlike other existing studies on the subject, one of the models in the present study considers various components of real income as determinants. The disaggregated components are final consumption expenditure, expenditure on investment goods and exports. Based on ‘bounds’ testing, the presence of a long-run equilibrium relationship between inflation and its determinants is confirmed for all three models. The study found that the major causes of inflation in South Africa are import prices, real income, and final consumption expenditure. The relationship is elastic for import prices and final consumption expenditure. Monetary variables, money supply and bank credit are found to have an indirect effect on inflation.
Waldfogel, Jane; Zhai, Fuhua
This study examines the effects of public preschool expenditures on the math and science scores of 4th graders, holding constant child, family, and school characteristics, other relevant social expenditures, and country and year effects, in seven Organization for Economic Co-operation and Development (OECD) countries -- Australia, Japan, Netherlands, New Zealand, Norway, U.K., and U.S -- using data from the 1995 and 2003 Trends in International Mathematics and Science Study (TIMSS). Our results indicate that there are small but significant positive effects of public preschool expenditures on the math and science scores of 4th graders and preschool expenditures reduce the risk of children scoring at the low level of proficiency. We also find some evidence that children from low-resource homes and homes where the test language is not always spoken may tend to gain more from increased public preschool expenditures than other children,. PMID:21442008
Waldfogel, Jane; Zhai, Fuhua
This study examines the effects of public preschool expenditures on the math and science scores of 4(th) graders, holding constant child, family, and school characteristics, other relevant social expenditures, and country and year effects, in seven Organization for Economic Co-operation and Development (OECD) countries -- Australia, Japan, Netherlands, New Zealand, Norway, U.K., and U.S -- using data from the 1995 and 2003 Trends in International Mathematics and Science Study (TIMSS). Our results indicate that there are small but significant positive effects of public preschool expenditures on the math and science scores of 4(th) graders and preschool expenditures reduce the risk of children scoring at the low level of proficiency. We also find some evidence that children from low-resource homes and homes where the test language is not always spoken may tend to gain more from increased public preschool expenditures than other children,.
Sun, M; Reed, G W; Hill, J O
Whole room indirect calorimeters are among the most accurate devices for measurement of human energy expenditure and have provided useful data about determinants of total daily energy expenditure. However, a limitation of whole room indirect calorimeters has been the inability to detect acute (usually calorimeter (respiratory chamber) to allow accurate measurement of energy expenditure over time periods as short as 1 min. The modifications involve changes in the system design and use of signal processing techniques. With these modifications, we can measure energy expenditure in 1-min intervals throughout the day. This allows accurate study of the acute effects of food, exercise, or drugs on energy expenditure in subjects moving freely inside the respiratory chamber. The ability to use respiratory chambers for these types of studies should improve our understanding of how body weight is regulated.
Full Text Available Introduction: Alcohol use and alcohol-related problems are on the rise in low- and middle-income countries. Expenditure on alcohol is an important problem for families and communities and needs to be assessed. Aim: This study examines level of alcohol consumption and expenditure on alcohol in a district in Vietnam. Methods: A cross-sectional survey was conducted in a rural district in northern Vietnam. Multi-stage sampling was employed to randomly select participants from 20 communities and a town in the same district. One thousand five hundred and sixty-four adults (765 males and 799 females aged 18–60 years were interviewed. Information about alcohol use as well as expenditure on alcohol consumption four weeks prior to the interview was gathered. Non-parametric tests and log-linear regression were employed to compare expenditure on alcohol consumption across socioeconomic groups. Results: The prevalence of alcohol use one month prior to interview was 35% (66% among men and 5% among women. The median alcohol consumption among those who reported use of alcohol in the week prior to the interview was 7.9 standard drinks. Excessive drinking (more than 14 standard drinks per week for men and more than seven standard drinks per week for women occurred among 35% of those who used alcohol. Median expenditure for alcohol consumption during one month by those who drank alcohol was USD 3.5, accounting for 4.6% of household food expenditure, 2.7% of total household expenditure, and 1.8% of household income. The differences in alcohol consumption and expenditure between sexes and between socioeconomic groups are also presented. Conclusion: Our study confirms that alcohol consumption and alcohol-related problems are common among men in Vietnam. The share of alcohol expenditure in total household expenditure is substantial, especially among poor households. This should be considered an important public health issue, which needs to be taken into account in
Giang, Kim Bao; Van Minh, Hoang; Allebeck, Peter
Alcohol use and alcohol-related problems are on the rise in low- and middle-income countries. Expenditure on alcohol is an important problem for families and communities and needs to be assessed. This study examines level of alcohol consumption and expenditure on alcohol in a district in Vietnam. A cross-sectional survey was conducted in a rural district in northern Vietnam. Multi-stage sampling was employed to randomly select participants from 20 communities and a town in the same district. One thousand five hundred and sixty-four adults (765 males and 799 females) aged 18-60 years were interviewed. Information about alcohol use as well as expenditure on alcohol consumption four weeks prior to the interview was gathered. Non-parametric tests and log-linear regression were employed to compare expenditure on alcohol consumption across socioeconomic groups. The prevalence of alcohol use one month prior to interview was 35% (66% among men and 5% among women). The median alcohol consumption among those who reported use of alcohol in the week prior to the interview was 7.9 standard drinks. Excessive drinking (more than 14 standard drinks per week for men and more than seven standard drinks per week for women) occurred among 35% of those who used alcohol. Median expenditure for alcohol consumption during one month by those who drank alcohol was USD 3.5, accounting for 4.6% of household food expenditure, 2.7% of total household expenditure, and 1.8% of household income. The differences in alcohol consumption and expenditure between sexes and between socioeconomic groups are also presented. Our study confirms that alcohol consumption and alcohol-related problems are common among men in Vietnam. The share of alcohol expenditure in total household expenditure is substantial, especially among poor households. This should be considered an important public health issue, which needs to be taken into account in the alcohol policy debate.
Zhang, James X; Rathouz, Paul J; Chin, Marshall H
To examine comorbidity and concentration of healthcare expenditures in older patients with heart failure (HF) in the Medicare program. Retrospective analysis of older fee-for-service HF patients, using the 1996 Medicare Current Beneficiary Survey and linked Medicare claims. Variety of clinical settings. One thousand two hundred sixty-six older HF patients from a nationally representative survey. Medicare expenditure per person and by types of healthcare services, prevalence of comorbid conditions, and multivariate regression on the association between comorbidities and healthcare expenditure. Medicare spent an average of 16,514 dollars on medical reimbursement for each HF patient in 1996. Eighty-one percent of patients had one or more comorbid diseases according to a 17-disease grouping index. The top 20% of HF patients accounted for 63% of total expenditure. Comorbidity was associated with significantly higher Medicare expenditure. HF patients with more-expensive comorbidities included those with peripheral vascular disease (24% of patients, mean total expenditure 26,954 dollars), myocardial infarction (16% of patients, mean total expenditure 29,867 dollars), renal disease (8% of patients, mean total expenditure 33,014 dollars), and hemiplegia or paraplegia (5% of patients, mean total expenditure 33,234 dollars). Diseases and disorders other than heart failure constituted a significant fraction of the causes of inpatient admissions. Comorbid conditions were more likely to be associated with expensive inpatient care, and patients with these diseases were more likely to spend more overall and more on other types of Medicare services including home health aid, skilled nursing facility, and hospice care. Disease management should consider comorbid conditions for improving care and reducing expenditures in older patients with HF.
... TECHNOLOGY INVESTMENT AGREEMENTS Requirements for Expenditure-Based and Fixed-Support Technology Investment... requirements in this subpart. The fundamental difference between an expenditure-based and a fixed-support TIA...
Kildemoes, Helle Wallach; Andersen, Morten; Støvring, Henrik
To develop a method for projecting the impact of ageing and changing drug utilization patterns on future drug expenditure.......To develop a method for projecting the impact of ageing and changing drug utilization patterns on future drug expenditure....
... SECRETARY OF DEFENSE DoD GRANT AND AGREEMENT REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS Expenditure-Based and Fixed-Support Technology Investment Agreements § 37.300 What is the difference between an expenditure-based and fixed-support TIA? The fundamental difference between an expenditure-based and fixed...
>Interpretation & conclusions: Our findings showed that hospitalization resulted in significant OOP expenditure, leading to CHEs and impoverishment of households. Impact of OOP expenditures was inequitably more on the vulnerable groups. OOP expenditure may be curtailed through provision of free medicines and diagnostics and removal of any form of user charges.
Polackova Brixi, Hana; Valenduc, Christian M.A.; Swift, Zhicheng Li
Recently developing countries have focused attention on the usefulness of tax expenditures' in shaping prudent and transparent fiscal policy. In adopting a market economy, developing countries commonly use tax expenditures as major fiscal policy instruments. However, with limited theoretical understanding of, and ad hoc experience with, applying tax expenditures, developing countries now c...
... whether the independent expenditure is made in support of, or in opposition to, the candidate involved. In... of State for the State in which the candidate is seeking election. (3) For independent expenditures... 11 Federal Elections 1 2010-01-01 2010-01-01 false Independent expenditures by political...
Xu, Guo-Chao; Luo, Yun; Li, Qian; Wu, Meng-Fan; Zhou, Zi-Jun
In recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services. This study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination. We found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups. We argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures.
Full Text Available Weight loss/weight control is a major concern in prevention of cardiovascular disease and the realm of health promotion. The primary aim of this study was to investigate the effect of neuromuscular electrical stimulation (NMES at different intensities on energy expenditure (oxygen and calories in healthy adults. The secondary aim was to develop a generalized linear regression (GEE model to predict the increase of energy expenditure facilitated by NMES and identify factors (NMES stimulation intensity level, age, body mass index, weight, body fat percentage, waist/hip ratio, and gender associated with this NMES-induced increase of energy expenditure. Forty sedentary healthy adults (18 males and 22 females participated. NMES was given at the following stimulation intensities for 10 minutes each: sensory level (E1, motor threshold (E2, and maximal intensity comfortably tolerated (E3. Cardiopulmonary gas exchange was evaluated during rest, NMES, and recovery stage. The results revealed that NMES at E2 and E3 significantly increased energy expenditure and the energy expenditure at recovery stage was still significantly higher than baseline. The GEE model demonstrated that a linear dose-response relationship existed between the stimulation intensity and the increase of energy expenditure. No subject’s demographic or anthropometric characteristics tested were significantly associated with the increase of energy expenditure. This study suggested NMES may be used to serve as an additional intervention for weight loss programs. Future studies to develop electrical stimulators or stimulation electrodes to maximize the comfort of NMES are recommended.
Feldens, C A; Rodrigues, P H; Rauber, F; Chaffee, B W; Vitolo, M R
Family expenditures on food for children may represent an important barrier to the adoption of healthy feeding practices in populations of low socioeconomic status. The aim of this study was to explore the relationship between cariogenic feeding practices, expenditures on food for children and dental caries. This cross-sectional study included 329 four-year-old children from São Leopoldo in southern Brazil. Cariogenic dietary practices were assessed at 4 years of age using two 24-hour recalls conducted with the children's mothers. Expenditures on food for children were estimated based on all reported food items and the respective amounts ingested. Early childhood caries and severe early childhood caries were assessed by clinical examination at 4 years of age. Cariogenic dietary habits were not associated with lower food expenditures. On the contrary, in multivariable regression analysis, the intake of chocolate (p = 0.007), soft drinks (p = 0.027) and a higher number of meals and snacks per day (p food for children. No statistically significant differences were observed in food expenditures or in the proportion of household income spent on feeding children between caries-free children, those with early childhood caries and those with severe early childhood caries. In conclusion, keeping children free of dental caries does not necessarily increase food expenditures or the proportion of household income spent on feeding children in low-socioeconomic status populations. Some cariogenic dietary practices were associated with greater expenditures on child feeding. Copyright © 2013 S. Karger AG, Basel.
Lanningham-Foster, Lorraine; Jensen, Teresa B; Foster, Randal C; Redmond, Aoife B; Walker, Brian A; Heinz, Dieter; Levine, James A
We examined the effect of activity-enhancing screen devices on children's energy expenditure compared with performing the same activities while seated. Our hypothesis was that energy expenditure would be significantly greater when children played activity-promoting video games, compared with sedentary video games. Energy expenditure was measured for 25 children aged 8 to 12 years, 15 of whom were lean, while they were watching television seated, playing a traditional video game seated, watching television while walking on a treadmill at 1.5 miles per hour, and playing activity-promoting video games. Watching television and playing video games while seated increased energy expenditure by 20 +/- 13% and 22 +/- 12% above resting values, respectively. When subjects were walking on the treadmill and watching television, energy expenditure increased by 138 +/- 40% over resting values. For the activity-promoting video games, energy expenditure increased by 108 +/- 40% with the EyeToy (Sony Computer Entertainment) and by 172 +/- 68% with Dance Dance Revolution Ultramix 2 (Konami Digital Entertainment). Energy expenditure more than doubles when sedentary screen time is converted to active screen time. Such interventions might be considered for obesity prevention and treatment.
Fazaeli, Ali Akbar; Ghaderi, Hossein; Salehi, Masoud; Fazaeli, Ali Reza
There is a large body of literature examining income in relation to health expenditures. The share of expenditures in health sector from GDP in developed countries is often larger than in non-developed countries, suggesting that as the level of economic growth increases, health spending increase, too. This paper estimates long-run relationships between health expenditures and GDP based on panel data of a sample of 12 countries of the Organization of the Petroleum Exporting Countries (OPEC), using data for the period 1995-2012. We use panel data unit root tests, cointegration analysis and ECM model to find long-run and short-run relation. This study examines whether health is a luxury or a necessity for OPEC countries within a unit root and cointegration framework. Panel data analysis indicates that health expenditures and GDP are co-integrated and have Engle and Granger causality. In addition, in oil countries that have oil export income, the share of government expenditures in the health sector is often greater than in private health expenditures similar developed countries. The findings verify that health care is not a luxury good and income has a robust relationship to health expenditures in OPEC countries.
Hsu, Miao-Ju; Wei, Shun-Hwa; Chang, Ya-Ju
Weight loss/weight control is a major concern in prevention of cardiovascular disease and the realm of health promotion. The primary aim of this study was to investigate the effect of neuromuscular electrical stimulation (NMES) at different intensities on energy expenditure (oxygen and calories) in healthy adults. The secondary aim was to develop a generalized linear regression (GEE) model to predict the increase of energy expenditure facilitated by NMES and identify factors (NMES stimulation intensity level, age, body mass index, weight, body fat percentage, waist/hip ratio, and gender) associated with this NMES-induced increase of energy expenditure. Forty sedentary healthy adults (18 males and 22 females) participated. NMES was given at the following stimulation intensities for 10 minutes each: sensory level (E1), motor threshold (E2), and maximal intensity comfortably tolerated (E3). Cardiopulmonary gas exchange was evaluated during rest, NMES, and recovery stage. The results revealed that NMES at E2 and E3 significantly increased energy expenditure and the energy expenditure at recovery stage was still significantly higher than baseline. The GEE model demonstrated that a linear dose-response relationship existed between the stimulation intensity and the increase of energy expenditure. No subject's demographic or anthropometric characteristics tested were significantly associated with the increase of energy expenditure. This study suggested NMES may be used to serve as an additional intervention for weight loss programs. Future studies to develop electrical stimulators or stimulation electrodes to maximize the comfort of NMES are recommended.
Full Text Available This study estimated excess home healthcare use and expenditures among elderly Medicare beneficiaries (age ≥ 65 years with Parkinson’s disease (PD compared to those without PD and analyzed the extent to which predisposing, enabling, need factors, personal health choice, and external environment contribute to the excess home healthcare use and expenditures among individuals with PD. A retrospective, observational, cohort study design using Medicare 5% sample claims for years 2006-2007 was used for this study. Logistic regressions and Ordinary Least Squares regressions were used to assess the association of PD with home health use and expenditures, respectively. Postregression nonlinear and linear decomposition techniques were used to understand the extent to which differences in home healthcare use and expenditures among elderly Medicare beneficiaries with and without PD can be explained by individual-level factors. Elderly Medicare beneficiaries with PD had higher home health use and expenditures compared to those without PD. 27.5% and 18% of the gap in home health use and expenditures, respectively, were explained by differences in characteristics between the PD and no PD groups. A large portion of the differences in home healthcare use and expenditures remained unexplained.
Powell, Lisa M.; Harris, Jennifer L.; Fox, Tracy
In response to concerns about childhood obesity, the Federal Trade Commission (FTC) released two reports documenting food and beverage marketing expenditures to children and adolescents. The recently released 2012 report found an inflation-adjusted 19.5% reduction in marketing expenditures targeted to youth from $2.1 billion in 2006 to $1.8 billion in 2009. The current article highlights features of the FTC’s analysis, examines how expenditures relate to youth exposure to food marketing, and assesses changes in the nutritional content of marketed products. Of the $304.0 million decline in expenditures, $117.8 million (38.7%) was from a decline in premium (i.e., restaurant children’s meal toys) expenditures rather than direct marketing. Although inflation-adjusted TV expenditures fell by 19.4%, children and teens still see 12–16 TV advertisements (ads)/day for products generally high in saturated fat, sugar or sodium. In addition, newer digital forms of unhealthy food and beverage marketing to youths are increasing; the FTC reported an inflation-adjusted 50.7% increase in new media marketing expenditures. The self-regulatory Children’s Food and Beverage Advertising Initiative (CFBAI) is limited in scope and effectiveness: expenditures increased for many noncovered marketing techniques (i.e., product placement, movie/video, cross-promotion licenses, athletic sponsorship, celebrity fees, events, philanthropy, and other); only two restaurants are members of CFBAI, and nonpremium restaurant marketing expenditures were up by $86.0 million (22.5% inflation-adjusted increase); industry pledges do not protect children aged >11 years, and some marketing appears to have shifted to older children; and, nutritional content remains poor. Continued monitoring of and improvements to food marketing to youth are needed. PMID:24050422
Powell, Lisa M; Harris, Jennifer L; Fox, Tracy
In response to concerns about childhood obesity, the Federal Trade Commission (FTC) released two reports documenting food and beverage marketing expenditures to children and adolescents. The recently released 2012 report found an inflation-adjusted 19.5% reduction in marketing expenditures targeted to youth from $2.1 billion in 2006 to $1.8 billion in 2009. The current article highlights features of the FTC's analysis, examines how expenditures relate to youth exposure to food marketing, and assesses changes in the nutritional content of marketed products. Of the $304.0 million decline in expenditures, $117.8 million (38.7%) was from a decline in premium (i.e., restaurant children's meal toys) expenditures rather than direct marketing. Although inflation-adjusted TV expenditures fell by 19.4%, children and teens still see 12-16 TV advertisements (ads)/day for products generally high in saturated fat, sugar, or sodium. In addition, newer digital forms of unhealthy food and beverage marketing to youths are increasing; the FTC reported an inflation-adjusted 50.7% increase in new media marketing expenditures. The self-regulatory Children's Food and Beverage Advertising Initiative (CFBAI) is limited in scope and effectiveness: expenditures increased for many noncovered marketing techniques (i.e., product placement, movie/video, cross-promotion licenses, athletic sponsorship, celebrity fees, events, philanthropy, and other); only two restaurants are members of CFBAI, and nonpremium restaurant marketing expenditures were up by $86.0 million (22.5% inflation-adjusted increase); industry pledges do not protect children aged >11 years, and some marketing appears to have shifted to older children; and, nutritional content remains poor. Continued monitoring of and improvements to food marketing to youth are needed. © 2013 American Journal of Preventive Medicine.
Crovetto, Mirta; Uauy, Ricardo
During recent decades household incomes have increased steadily, leading to changes in dietary habits and food expenditure. To report changes in household food expenditure focusing on trends in processed food across income quintiles in Metropolitan Santiago. Information obtained from the Fourth (1986-1987), Fifth (1996-1997) and Sixth National Institute of Statistics (INE) Surveys (2006-2007) were used. Food expenditure data over the study periods was extracted from household expenditure surveys (HES) after verifying and adjusting food prices registered by the INE to current 2007 prices. Absolute food expenditure over the study period increased for all groups; the largest increase was found in lowest income quintiles; however, the proportion of total family budget spent on food decreased in all groups. The largest increases in food expenditure corresponded to sweetened beverages, processed fruit juices, alcoholic drinks, ready meals and "eating out". Expenditure on fish rose slightly whereas the absolute spending on legumes, eggs and oils decreased. Expenditure in processed food as percentage of total food expenditure increased from 42% to 57% of total for mean household. For the 2nd quintile it rose from 31% to 48% and for the lowest quintile increased from 53% to 68% over the three decades (1987-2007). Changes were greatest in energy rich processed foods such as bread, pastries, confectioneries and granulated sugar. These particular foods are of high energy density and contain high amounts of saturated fat, sodium and added sugars. These results confirm that food consumption patterns over the past decades have progressively departed from the recommended dietary guidelines given by national and international health organizations.
Kirkland, Elizabeth B; Heincelman, Marc; Bishu, Kinfe G; Schumann, Samuel O; Schreiner, Andrew; Axon, R Neal; Mauldin, Patrick D; Moran, William P
One in 3 US adults has high blood pressure, or hypertension. As prior projections suggest hypertension is the costliest of all cardiovascular diseases, it is important to define the current state of healthcare expenditures related to hypertension. We used a nationally representative database, the Medical Expenditure Panel Survey, to calculate the estimated annual healthcare expenditure for patients with hypertension and to measure trends in expenditure longitudinally over a 12-year period. A 2-part model was used to estimate adjusted incremental expenditures for individuals with hypertension versus those without hypertension. Sex, race/ethnicity, education, insurance status, census region, income, marital status, Charlson Comorbidity Index, and year category were included as covariates. The 2003-2014 pooled data include a total sample of 224 920 adults, of whom 36.9% had hypertension. Unadjusted mean annual medical expenditure attributable to patients with hypertension was $9089. Relative to individuals without hypertension, individuals with hypertension had $1920 higher annual adjusted incremental expenditure, 2.5 times the inpatient cost, almost double the outpatient cost, and nearly triple the prescription medication expenditure. Based on the prevalence of hypertension in the United States, the estimated adjusted annual incremental cost is $131 billion per year higher for the hypertensive adult population compared with the nonhypertensive population. Individuals with hypertension are estimated to face nearly $2000 higher annual healthcare expenditure compared with their nonhypertensive peers. This trend has been relatively stable over 12 years. Healthcare costs associated with hypertension account for about $131 billion. This warrants intense effort toward hypertension prevention and management. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Schrack, Jennifer A; Zipunnikov, Vadim; Goldsmith, Jeff; Bandeen-Roche, Karen; Crainiceanu, Ciprian M; Ferrucci, Luigi
Accurate measurement of free-living energy expenditure is vital to understanding changes in energy metabolism with aging. The efficacy of heart rate as a surrogate for energy expenditure is rooted in the assumption of a linear function between heart rate and energy expenditure, but its validity and reliability in older adults remains unclear. To assess the validity and reliability of the linear function between heart rate and energy expenditure in older adults using different levels of calibration. Heart rate and energy expenditure were assessed across five levels of exertion in 290 adults participating in the Baltimore Longitudinal Study of Aging. Correlation and random effects regression analyses assessed the linearity of the relationship between heart rate and energy expenditure and cross-validation models assessed predictive performance. Heart rate and energy expenditure were highly correlated (r=0.98) and linear regardless of age or sex. Intra-person variability was low but inter-person variability was high, with substantial heterogeneity of the random intercept (s.d. =0.372) despite similar slopes. Cross-validation models indicated individual calibration data substantially improves accuracy predictions of energy expenditure from heart rate, reducing the potential for considerable measurement bias. Although using five calibration measures provided the greatest reduction in the standard deviation of prediction errors (1.08 kcals/min), substantial improvement was also noted with two (0.75 kcals/min). These findings indicate standard regression equations may be used to make population-level inferences when estimating energy expenditure from heart rate in older adults but caution should be exercised when making inferences at the individual level without proper calibration.
Agarwal, Parul; Sambamoorthi, Usha
Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.
Pechey, Rachel; Monsivais, Pablo
Investigations of the contribution of food costs to socioeconomic inequalities in diet quality may have been limited by the use of estimated (vs. actual) food expenditures, not accounting for where individuals shop, and possible reverse mediation between food expenditures and healthiness of food choices. This study aimed to explore the extent to which food expenditure mediates socioeconomic inequalities in the healthiness of household food choices. Observational panel data on take-home food and beverage purchases, including expenditure, throughout 2010 were obtained for 24,879 UK households stratified by occupational social class. Purchases of (1) fruit and vegetables and (2) less-healthy foods/beverages indicated healthiness of choices. Supermarket choice was determined by whether households ever visited market-defined high-price and/or low-price supermarkets. Results showed that higher occupational social class was significantly associated with greater food expenditure, which was in turn associated with healthier purchasing. In mediation analyses, 63% of the socioeconomic differences in choices of less-healthy foods/beverages were mediated by expenditure, and 36% for fruit and vegetables, but these figures were reduced to 53% and 31% respectively when controlling for supermarket choice. However, reverse mediation analyses were also significant, suggesting that 10% of socioeconomic inequalities in expenditure were mediated by healthiness of choices. Findings suggest that lower food expenditure is likely to be a key contributor to less-healthy food choices among lower socioeconomic groups. However, the potential influence of cost may have been overestimated previously if studies did not account for supermarket choice or explore possible reverse mediation between expenditure and healthiness of choices. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
Khan Suhaila H
Full Text Available Abstract Objective This study investigated a the amount and types of out-of-pocket expenditures by patients for nominally free services in a large public hospital in Bangladesh, b the factors influencing these expenses, and c the impact of these expenses on household income. Methods Eighty-one maternity patients were interviewed during their hospitalization in the Dhaka Medical College Hospital. Patients were selected by quota sample to match the distribution of maternity patient categories in the hospital. Patients were interviewed with a semi-structured, in-depth questionnaire. Results All interviewees incurred substantial out-of-pocket expenditures for travel, hospital admission fees, medicine, tests, food, and tips. Only two of the expenditures, travel expenses and admission fees, were not supposed to be provided free of charge by the hospital. The median total per-patient expenditure was $65 (range $2–$350, equivalent to 7% (range 0.04%–225% of annual household income. Half of all patients reported that their families had to borrow to pay for care at interest rates of 5%–30% per month. A third of these families reported selling jewelry, land or household items to moneylenders. The rural patients reported more difficulty in paying for care than the urban patients. Factors increasing the expenditures were duration of hospitalization, rural residence, and necessary (e.g. C-section, hysterectomy and unnecessary (e.g. episiotomy medical procedures. Conclusion Free maternity services in Bangladesh impose large out-of-pocket expenditures on patients. Authorities could reduce the burden by reducing the duration of hospital stays, limiting use of medical procedures, eliminating tips, and moving routine services closer to potential users. Fee for service could reduce unofficial expenditures if the fee were lower than and replaced typical unofficial expenditures, otherwise adding service fees without reform of current hospital practices would
Full Text Available Going by Adolph Wagner’s theory, increased in public expenditure would have a significant influence growth. However, the endogenous growth theories posit that public sector either has direct or indirect impacts on economic growth. It is on this premise, we seek to examine and validate Wagner’s theory on the impact of current, investment and transfer expenditures on economic growth over the periods 1975-2014 for Turkey, using Johansen co-integration test and Granger causality test. Findings confirm Wagner’s law through the existence of a long term relationship between the variables, while public expenditures display a significant positive impact on economic growth.
Morrison, W. [Boston Univ., MA (United States); Mendelsohn, R. [Yale Univ., New Haven, CT (United States). School of Forestry and Environmental Studies
This paper develops a theoretical model to measure the climate change impacts to the energy sector. Welfare effects are approximately equal to the resulting change in expenditures on energy and buildings. Using micro data on individuals and firms across the United States, energy expenditures are regressed on climate and other control variables to estimate both short-run and long-run climate response functions. The analysis suggests that energy expenditures have a quadratic U-shaped relationship with respect to temperature. Future warming of 2 C is predicted to cause annual damages of about $6 billion but increases of 5 C would increase damages to almost $30 billion.
Crivelli, Luca; Filippini, Massimo; Mosca, Ilaria
Switzerland (7.2 million inhabitants) is a federal state composed of 26 cantons. The autonomy of cantons and a particular health insurance system create strong heterogeneity in terms of regulation and organisation of health care services. In this study we use a single-equation approach to model the per capita cantonal expenditures on health care services and postulate that per capita health expenditures depend on some economic, demographic and structural factors. The empirical analysis demonstrates that a larger share of old people tends to increase health costs and that physicians paid on a fee-for-service basis swell expenditures, thus highlighting a possible phenomenon of supply-induced demand.
Michael Adebayo Ajayi
Full Text Available The relationship between government expenditure and economic growth has been an issue of debate over the years. This study investigates the causality between government expenditure and economic growth in Nigeria between 1985 and 2014. Following the Toda-Yamamoto non-Granger causality testing approach, it finds that government expenditure and economic growth have no causal effect on each other. This offers evidence to invalidate Wagner’s law and the Keynesian proposition in Nigeria. This study recommends that government should strengthen its efforts to curtail corruption as well as introduce stricter checks and controls to reduce or eliminate the profligacy of public funds.
Xin, Xiao-Xiong; Zhao, Liang; Guan, Xiao-Dong; Shi, Lu-Wen
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. 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. 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. OOP health expenditure of patients with UEBMI was significantly more than that of
Morrison, W.; Mendelsohn, R.
This paper develops a theoretical model to measure the climate change impacts to the energy sector. Welfare effects are approximately equal to the resulting change in expenditures on energy and buildings. Using micro data on individuals and firms across the United States, energy expenditures are regressed on climate and other control variables to estimate both short-run and long-run climate response functions. The analysis suggests that energy expenditures have a quadratic U-shaped relationship with respect to temperature. Future warming of 2 C is predicted to cause annual damages of about $6 billion but increases of 5 C would increase damages to almost $30 billion
Efforts to control medical care costs depend critically on how individuals respond to prices. I estimate the price elasticity of expenditure on medical care using a censored quantile instrumental variable (CQIV) estimator. CQIV allows estimates to vary across the conditional expenditure distribution, relaxes traditional censored model assumptions, and addresses endogeneity with an instrumental variable. My instrumental variable strategy uses a family member's injury to induce variation in an individual's own price. Across the conditional deciles of the expenditure distribution, I find elasticities that vary from -0.76 to -1.49, which are an order of magnitude larger than previous estimates.
Rein, David B
According to recent studies, visual problems represent one of the top contributors to economic health burden in the United States. This burden is divided nearly equally between direct expenditures for the care and treatment of visual problems, and the indirect costs of outcomes caused by low vision, including productivity losses, the cost of care, and incremental nursing home placements. A large amount of academic research is devoted to visual science, the biology of the visual system, and the medical treatment of visual disorders. Compared to the burden, a disproportionate share of this research is devoted to the study of retinal disorders and glaucoma. This is understandable, as research into the retina and optic nerve has the potential to unlock fundamental insights into the nature of sight and visual cognition. However, population visual health and the functionality that depends upon it also may benefit greatly from additional research into areas of prevention, rehabilitation, and adaptation. In addition, comparative research into the benefits of resource allocation across prevention, treatment, and rehabilitative resources could lead to improvements in population health.
Miller, T R; Levy, D T
Past literature finds considerable variation in the cost of physician care and in the utilization of medical procedures. Variation in the cost of hospitalized care has received little attention. We examine injury costs of hospitalized claims across states. Multivariate regression analysis is used to isolate state variations, while controlling for personal and injury characteristics, and state characteristics. Injuries to workers filing Workers' Compensation lost workday claims. About 35,000 randomly sampled Workers' Compensation claims from 17 states filed between 1979 and 1988. Medical payments per episode of three injury groups: upper and lower extremity fractures and dislocations, other upper extremity injuries, and back strains and sprains. Statistical analyses reveal considerable variation in expenditures for hospitalized injuries across states, even after controlling for case mix and state characteristics. A substantial portion of the variation is explained by state rate regulations; regulated states have lower costs. The large variation in costs suggests a potential to affect the costs of hospitalized care. Efforts should be directed at those areas that have higher costs without sufficient input price, quality, or case mix justification.
Joachim T Geaney
Full Text Available Research in motivation and emotion has been increasingly influenced by the perspective that processes underpinning the motivated approach of rewarding goals are distinct from those underpinning enjoyment during reward consummation. This distinction recently inspired the construction of the Temporal Experience of Pleasure Scale (TEPS, a self-report measure that distinguishes trait anticipatory pleasure (pre-reward feelings of desire from consummatory pleasure (feelings of enjoyment and gratification upon reward attainment. In a university community sample (N = 97, we examined the TEPS subscales as predictors of (1 the willingness to expend effort for monetary rewards, and (2 affective responses to a pleasant mood induction procedure. Results showed that both anticipatory pleasure and a well-known trait measure of reward motivation predicted effort-expenditure for rewards when the probability of being rewarded was relatively low. Against expectations, consummatory pleasure was unrelated to induced pleasant affect. Taken together, our findings provide support for the validity of the TEPS anticipatory pleasure scale, but not the consummatory pleasure scale.
Swistak, Piotr; Błońska-Fajfrowska, Barbara
The general purpose of the study, carried out in the group of pensioners was to determine the relation between drug prices, household income and amounts of money spent on drugs in the years 1997-2000. The study was based on representative data gathered from annual household budgets review by Polish Statistical Office and data from pharmaceutical market published in 'Vitamina C++' magazine. The used method combined descriptive, comparative, table-descriptive analysis with graphical analysis. During studied period the real value of expenses on drugs in pensioners' households rose by 39.3% and available income decreased by 5.8%. Increased expenses on drugs caused the rise of the proportion of on spending on drugs in total household expenditure. It rose from 3.9% in 1997 to 5.2% in 2000. Throughout this time period the drug prices increased in real terms: the highest growth (approx. 49%) was noticed in patients' co-payment to reimbursed drugs. Despite rise in spending on drugs, due to the increase in drug retail prices and increasing patients co-payment, pensioners in comparison with 1997, could buy only approx. 93% units of reimbursed drugs in 2000. The possibility of buying drugs within OTC group increased by 18%.
Charlot, Keyne; Borne, Rachel; Richalet, Jean-Paul; Chapelot, Didier; Pichon, Aurélien; Cornolo, Jérémy; Brugniaux, Julien Vincent
We aimed to develop new equations that predict exercise-induced energy expenditure (EE) more accurately than previous ones during running by including new parameters as fitness level, body composition and/or running intensity in addition to heart rate (HR). Original equations predicting EE were created from data obtained during three running intensities (25%, 50% and 70% of HR reserve) performed by 50 subjects. Five equations were conserved according to their accuracy assessed from error rates, interchangeability and correlations analyses: one containing only basic parameters, two containing VO 2max or speed at VO 2max and two including running speed with or without HR. Equations accuracy was further tested in an independent sample during a 40 min validation test at 50% of HR reserve. It appeared that: (1) the new basic equation was more accurate than pre-existing equations (R 2 0.809 versus. 0,737 respectively); (2) the prediction of EE was more accurate with the addition of VO 2max (R 2 = 0.879); and (3) the equations containing running speed were the most accurate and were considered to have good agreement with indirect calorimetry. In conclusion, EE estimation during running might be significantly improved by including running speed in the predictive models, a parameter readily available with treadmill or GPS. (paper)
Karlsberg Schaffer, Sarah; Sussex, Jon; Devlin, Nancy; Walker, Andrew
In the UK, approval decisions by Health Technology Assessment bodies are made using a cost per quality-adjusted life year (QALY) threshold, the value of which is based on little empirical evidence. We test the feasibility of estimating the "true" value of the threshold in NHS Scotland using information on marginal services (those planned to receive significant (dis)investment). We also explore how the NHS makes spending decisions and the role of cost per QALY evidence in this process. We identify marginal services using NHS Board-level responses to the 2012/13 Budget Scrutiny issued by the Scottish Government, supplemented with information on prioritisation processes derived from interviews with Finance Directors. We search the literature for cost-effectiveness evidence relating to marginal services. The cost-effectiveness estimates of marginal services vary hugely and thus it was not possible to obtain a reliable estimate of the threshold. This is unsurprising given the finding that cost-effectiveness evidence is rarely used to justify expenditure plans, which are driven by a range of other factors. Our results highlight the differences in objectives between HTA bodies and local health service decision makers. We also demonstrate that, even if it were desirable, the use of cost-effectiveness evidence at local level would be highly challenging without extensive investment in health economics resources. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Marwan El Ghoch
Full Text Available Introduction. Aim of this study was to compare the resting energy expenditure (REE measured by the Douglas bag method with the REE estimated with the FitMate method, the Harris-Benedict equation, and the Müller et al. equation for individuals with BMI < 18.5 kg/m2 in a severe group of underweight patients with anorexia nervosa (AN. Methods. 15 subjects with AN participated in the study. The Douglas bag method and the FitMate method were used to measure REE and the dual energy X-ray absorptiometry to assess body composition after one day of refeeding. Results. FitMate method and the Müller et al. equation gave an accurate REE estimation, while the Harris-Benedict equation overestimated the REE when compared with the Douglas bag method. Conclusion. The data support the use of the FitMate method and the Müller et al. equation, but not the Harris-Benedict equation, to estimate REE in AN patients after short-term refeeding.
Full Text Available Although national dental care expenditure has not changed, the number of dental clinics has increased. Mass media has been reporting on the financial difficulties of dental clinics. To address this issue, we reviewed articles that showed the distribution and changes in net income, that is, total expenses subtracted from total income, of private dental clinics in Japan using data from a survey conducted by the Japan Dental Association. We also reviewed articles analyzing the factors relating to the net income. The results of the articles showed that distribution of net income has become positively skewed, with the mean dragged to the right by a few high scores. This means that the median is more appropriate than the mean as a measure of central tendency of net income. Factors relating to net income of private dental clinics have changed: private dental clinics that were opened after 1989 (new and had dental hygienists, who may conduct dental maintenance, had high net income, suggesting that they are well-managed or having a different type of patient mix in recent years. These analyses provide important and useful information for not only better management of private dental clinics but also policy-making in dental health care.
Faria, I E
The cyclist's ability to maintain an extremely high rate of energy expenditure for long durations at a high economy of effort is dependent upon such factors as the individual's anaerobic threshold, muscle fibre type, muscle myoglobin concentration, muscle capillary density and certain anthropometric dimensions. Although laboratory tests have had some success predicting cycling potential, their validity has yet to be established for trained cyclists. Even in analysing the forces producing propulsive torque, cycling effectiveness cannot be based solely on the orientation of applied forces. Innovations of shoe and pedal design continue to have a positive influence on the biomechanics of pedalling. Although muscle involvement during a complete pedal revolution may be similar, economical pedalling rate appears to differ significantly between the novice and racing cyclist. This difference emanates, perhaps, from long term adaptation. Air resistance is by far the greatest retarding force affecting cycling. The aerodynamics of the rider and the bicycle and its components are major contributors to cycling economy. Correct body posture and spacing between riders can significantly enhance speed and efficiency. Acute and chronic responses to cycling and training are complex. To protect the safety and health of the cyclist there must be close monitoring and cooperation between the cyclist, coach, exercise scientist and physician.
Codogno, J.S.; Turi, B.C.; Kemper, H.C.G.; Fernandes, R.A.; Christofaro, D.G.D.; Monteiro, H.L.
Objectives: To analyze the association between physical inactivity in different domains and direct public healthcare expenditures in adults and to identify whether the clustering of physical inactivity in different domains would contribute to increased public healthcare. Methods: The sample composed
Full Text Available This paper studies impact of government expenditures shocks on Gross DomesticProduct (GDP, personal consumption, trade balanceand effective exchange rate.To the purpose, time series data of Iranian macroeconomic variables were usedcovering from 1976 to 2007. Vector autoregressive (VAR model, forecast errorvariance decomposition and momentary reaction functions were used in order tostudy the impact of government expenditures shockson macroeconomic variablesof Iranian economy. Extracted results from the estimate of VAR model andanalyses of forecast error variance decomposition showed that: positive shocks ofthe government expenditures increase GDP and personal consumption butdecrease trade balance. Impact of government expenditures positive shocksdecrease effective exchange rate only in first yearthen government expendituresshocks had positive but very little impact on effective exchange rate.
Adefeso Hammed Adetola
Full Text Available This study examined the effect of government expenditure on its disaggregated level on economic growth in a sample of 20 sub-Saharan African Countries over the period of 1980-2010 in a dynamic panel data model. The result from Generalised Method of Moments (GMM revealed an inverse relationship between productive government expenditure and economic growth in sub-Sahara Africa. Also, productive government expenditures were not actually productive most especially when financed by non-distortonary government tax revenue in sub-Saharan African countries. The study concluded that the productive government expenditure and its corresponding source of the mode of financing were counterproductive for economic performance in the African countries.
... independent expenditure communications for both individual and organizational Filers. \\1\\ This notice focuses... provisions of the Regulatory Flexibility Act, which apply when notice and comment are required by the...
Subanti, S.; Respatiwulan; Hakim, A. R.; Handajani, S. S.; Hakim, I. M.
The purpose of our paper want to determine the factors of household tourism expenditure in Central Java Province, Indonesia. This paper used ordinary least squares regression. The findings from this paper, (1) the significant factors that affecting household tourism expenditure are marital status, sex, household income per capita, education for head of household, education for member of household, number of household, urbanrural, and industrial origin for head of household; (2) For variables which have positive relationship with household tourism expenditure, the variable of marital status has a biggest value from others; and (3) For variables which have negative relationship with household tourism expenditure, the variable of industrial origin for head household has a biggest value from others.
Lower relative rates of energy expenditure (EE), increased energetic efficiency, and altered fuel utilization purportedly associated with obesity have not been demonstrated indisputably in overweight children. We hypothesized that differences in energy metabolism between nonoverweight and overweight...
Haile, H.B.; Bock, B.B.
This paper is attempted to explore the potential effects of microfinance targeted at married women on intra-household expenditure roles and women’s economic power taking the cases of two microfinance institutions in Ethiopia
Sugawara, Shinya; Wu, Tianyi; Yamanishi, Kenji
This study proposes a novel statistical methodology to analyze expenditure on multiple medical sectors using consumer data. Conventionally, medical expenditure has been analyzed by two-part models, which separately consider purchase decision and amount of expenditure. We extend the traditional two-part models by adding the step of basket analysis for dimension reduction. This new step enables us to analyze complicated interdependence between multiple sectors without an identification problem. As an empirical application for the proposed method, we analyze data of 13 medical sectors from the Medical Expenditure Panel Survey. In comparison with the results of previous studies that analyzed the multiple sector independently, our method provides more detailed implications of the impacts of individual socioeconomic status on the composition of joint purchases from multiple medical sectors; our method has a better prediction performance.
Giansante, C.; Ferrari, V.
In economics literature the expenditure system specification is a well known subject. The problem is to define a coherent representation of consumer behaviour through functional forms easy to calculate. In this work it is used the Stone-Geary Linear Expenditure System and its multi-level decision process version. The Linear Expenditure system is characterized by an easy calculating estimation procedure, and its multi-level specification allows substitution and complementary relations between goods. Moreover, the utility function separability condition on which the Utility Tree Approach is based, justifies to use an estimation procedure in two or more steps. This allows to use an high degree of expenditure categories disaggregation, impossible to reach the Linear Expediture System. The analysis is applied to energy sectors
National Oceanic and Atmospheric Administration, Department of Commerce — This is a time-series dataset of trip expenditure data including actual fishing trip expenses, input usage, and input prices, for boat-based reef fish, bottomfish,...
Rieken, Rob; van Goudoever, Johannes B.; Schierbeek, Henk; Willemsen, Sten P.; Calis, Elsbeth A. C.; Tibboel, Dick; Evenhuis, Heleen M.; Penning, Corine
Accurate prediction equations for estimating body composition and total energy expenditure (TEE) in children with severe neurologic impairment and intellectual disability are currently lacking. The objective was to develop group-specific equations to predict body composition by using
Health care expenditures in low-income countries are analysed for the years 1990 and 1995 using four key indicators. Key findings include a substantial reduction in public spending per capita across low-income countries between 1990-95; a significant shift towards private expenditures, which appears increasingly to be substituting rather than supplementing public expenditures; a fall in total and public health spending in many countries despite growth in national income, contradicting the relationship found in other studies. Two possible explanations are put forward. First that the patterns found are a direct result of the structural adjustment policies adopted by many low-income countries, which aim to control and often cut public financing, whilst promoting private health expenditures. Secondly, that following the wave of privatization of state industries, many governments are finding problems adapting to their new role as a tax collector, and are thus not benefiting from economic growth to the extent that might be expected.
van den Putte, B.
Three main factors determine the effect of advertising campaigns: message content strategy, advertising expenditure and previous consumer behaviour. This study investigates the relative strength of each of these influences. Four possible campaign targets are taken into account: campaign recall,
... fashion, expenditures for advertising which presents views on economic, financial, social, or other... consumer may reduce the demand for them. Legislation which would provide an income tax credit or exclusion...
Full Text Available This study examines the relationship between public expenditure within regional autonomy policy and economic growth in West Papua and Papua provinces. We distinguish two kinds of expenditure’s decentralization – operational and capital – and also private expenditures. We use an unbalanced panel data over the period of 2007-2010 to investigate those expenditures, whether they enhance regional economic growth or not. We find that the government’s operating and private expenditures have a positive effect on local economic growth, but there is no relationship between capital expenditure’s decentralization on economic growth. The findings did not conform to a-priori efficiency expectations, which suggest needing to reform regional autonomy and fiscal decentralization policy in both provinces.
... CANDIDATES TO PAYMENTS; USE OF PAYMENTS § 9004.6 Expenditures for transportation and services made available... by independent contractors. (d) Disposal of excess reimbursements. If the committee receives...
Nataša Slak Valek
Full Text Available Understanding how tourists move through time and space has become especially important since tourist has become more attentive to prices. This paper explores the issue of changing expenditures as part of understanding tourist’s travel patterns and their role in booking accommodation. The State tourism survey containing information from a sample of 497,466 foreign tourists who visited Slovenia in 2009 and 639,756 who visited in 2012 was used to ensure the representativeness. Analysis of variance was used to test the differences in expenditure made by foreign tourists traveling to Slovenian in 2009 and 2012. The results show that transportation expenditure has increased dramatically, but tourism expenditures on accommodation showed a significant downtrend. Beside the fuel prices other causes of these trends and future implications are discussed. Planners may use data presented here to understand how economic trends will affect future transport activity in relation to booking options.
... DEPARTMENT OF LABOR Employment and Training Administration Comment Request for Information Collection for the ETA 191, Statement of Expenditures and Financial Adjustments of Federal Funds for Unemployment Compensation for Federal Employees and Ex- Servicemembers Report, Extension Without Revisions...
Mara, Jocelyn K; Thompson, Kevin G; Pumpa, Kate L
The aim of this study was to assess the total and exercise energy expenditure of elite female soccer players during a training week. Eight elite female soccer players wore SenseWear Mini Armbands (SWAs) for 7 consecutive days during the preseason phase of a national league competition. In addition, players wore 15-Hz GPSports tracking devices during 4 training sessions and a friendly game. Total energy expenditure, exercise energy expenditure, and training and game demands were collected from the SWA and GPSports devices. Mean daily energy expenditure for the game day, training days, and rest days were 12,242 kJ (SD = 603 kJ), 11,692 (SD = 274 kJ), and 9,516 (SD = 369 kJ), respectively, with significant differences shown between activities (p soccer players. Nutritional intake should be adjusted accordingly to avoid energy imbalances for optimal performance and recovery.
... MANAGEMENT CIVIL SERVICE REGULATIONS ALLOWANCES AND DIFFERENTIALS Cost-of-Living Allowance and Post Differential-Nonforeign Areas Cost-Of-Living Allowances § 591.222 How does OPM use the expenditure weights to...
Full Text Available This study reviewed literature studies on the determinants of government expenditure for the period 1995 to 2016. The research for the studies was conducted on the internet by combining government expenditure and determinants such as economic growth, government revenue, trade openness, poverty, public debt, dependency ratio, population, and urbanisation on the search engine. The finding of the literature provides conflicting results concerning the determinants of government expenditure. The results indicate that the government expenditure relationship with its determinants is significantly positive but in some instances it was found to be negative. The study recommends that future studies use the newly developed econometric techniques on previous studies to see whether they can provide different results.
The paper discusses how the principal-agent theory of economics may provide a suitable analytical framework and interesting lessons for the targeting of public expenditure management reforms in Pacific island economies Peer reviewed
Malaysia is a developing Islamic state that faced budget deficit since 1998. But it is not accepted by all and hopes that state should be in a position of either balance budget or surplus budget. The optimum level of Government budget is the state where government expenditure is totally offset by source of government revenue and that can be achieved through increasing tax revenue or decreasing expenditure. The aim of this study to find out the theoretical relationship betwee...
Full Text Available Leprosy is a major public health problem in many low and middle income countries, especially in India, and contributes considerably to the global burden of the disease. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. However, evidence on patient's expenditure is scarce. In this study, we estimate the expenditure in primary care (outpatient by leprosy households in two different public health settings.We performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators. The mean direct expenditure was USD 6.5 (95% CI: 2.4-17.9 in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8-7.9 per visit in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2-10.6 in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0-21.9 in Umbergaon. The age of the leprosy patients and type of health facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, the higher the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients.An enhanced public health system reduces the patient's expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy.
Tiwari, Anuj; Suryawanshi, Pramilesh; Raikwar, Akash; Arif, Mohammad; Richardus, Jan Hendrik
Leprosy is a major public health problem in many low and middle income countries, especially in India, and contributes considerably to the global burden of the disease. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. However, evidence on patient's expenditure is scarce. In this study, we estimate the expenditure in primary care (outpatient) by leprosy households in two different public health settings. We performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH) survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators. The mean direct expenditure was USD 6.5 (95% CI: 2.4-17.9) in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8-7.9) per visit in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2-10.6) in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0-21.9) in Umbergaon. The age of the leprosy patients and type of health facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, the higher the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients. An enhanced public health system reduces the patient's expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy.
Gary Erickson; Robert Jacobson
We explore the extent to which R&D and advertising expenditures generate a comparative advantage that allows firms to earn supranormal profits. After controlling for unobserved firm-specific factors and the feedback between discretionary expenditures and profitability, our results suggest substantially lower accounting and stock market returns to R&D and advertising than indicated in previous research. Isolating mechanisms, which prevent imitation, do not appear sufficient for either R&D or a...
Shmueli, Amir; Israeli, Avi
Compared to OECD countries, Israel has a remarkably low percentage of GDP and of government expenditure spent on health, which are not reflected in worse national outcomes. Israel is also characterized by a relatively high share of GDP spent on security expenses and payment of public debt. To determine to what extent differences between Israel and the OECD countries in security expenses and payment of the public debt might account for the gaps in the percentage of GDP and of government expenditures spent on health. We compare the percentages of GDP and of government expenditures spent on health in the OECD countries with the respective percentages when using primary civilian GDP and government expenditures (i.e., when security expenses and interest payment are deducted). We compared Israel with the OECD average and examined the ranking of the OECD countries under the two measures over time. While as a percentage of GDP, the national expenditure on health in Israel was well below the average of the OECD countries, as a percentage of primary civilian GDP it was above the average until 2003 and below the average thereafter. When the OECD countries were ranked according to decreasing percent of GDP and of government expenditure spent on health, adjusting for security and debt payment expenditures changed the Israeli rank from 23rd to 17th and from 27th to 25th, respectively. Adjusting for security expenditures and interest payment, Israel's low spending on health as a percentage of GDP and as a percentage of government's spending increases and is closer to the OECD average. Further analysis should explore the effect of additional population and macroeconomic differences on the remaining gaps.
Full Text Available Abstract Background Compared to OECD countries, Israel has a remarkably low percentage of GDP and of government expenditure spent on health, which are not reflected in worse national outcomes. Israel is also characterized by a relatively high share of GDP spent on security expenses and payment of public debt. Objectives To determine to what extent differences between Israel and the OECD countries in security expenses and payment of the public debt might account for the gaps in the percentage of GDP and of government expenditures spent on health. Methods We compare the percentages of GDP and of government expenditures spent on health in the OECD countries with the respective percentages when using primary civilian GDP and government expenditures (i.e., when security expenses and interest payment are deducted. We compared Israel with the OECD average and examined the ranking of the OECD countries under the two measures over time. Results While as a percentage of GDP, the national expenditure on health in Israel was well below the average of the OECD countries, as a percentage of primary civilian GDP it was above the average until 2003 and below the average thereafter. When the OECD countries were ranked according to decreasing percent of GDP and of government expenditure spent on health, adjusting for security and debt payment expenditures changed the Israeli rank from 23rd to 17th and from 27th to 25th, respectively. Conclusions Adjusting for security expenditures and interest payment, Israel's low spending on health as a percentage of GDP and as a percentage of government's spending increases and is closer to the OECD average. Further analysis should explore the effect of additional population and macroeconomic differences on the remaining gaps.
K. P. K. S. Lahirushan; W. G. V. Gunasekara
Main purpose of this study is to identify the impact of government expenditure on economic growth in Asian Countries. Consequently, main objective is to analyze whether government expenditure causes economic growth in Asian countries vice versa and then scrutinizing long-run equilibrium relationship exists between them. The study completely based on secondary data. The methodology being quantitative that includes econometrical techniques of cointegration, panel fixed effe...
Farhana Binti MAHARUDIN; Zahariah Binti Mohd ZAIN; Irfah Najihah Binti Basir MALAN
The main purpose of this study is to investigate the long-run relationship between public health care expenditure and income in Malaysia. There are many factors that affect health care expenditure positively such as income per head, population, the ageing population and national saving. The public health care is essential for economic growth and hence needs greater government involvement. The results of the unit root test indicated that all variables involved are stationary. The Johansen coin...
Full Text Available Public expenditures are a huge problem in contemporary states. In the conditions of a global economic crisis and the circumstances involving high level of citizen dissatisfaction related to the former methods of funding and managing the public sector (reflected in ruining the funding sources, irrational spending of public expenditure funds, increase in the budget deficit and the level of public debt, the changes in the domain of managing public expenditures have become a priority. By their nature, these changes are complex and long-lasting, and they should bring significant improvements in the field of public expenditure; they have to provide for lawful and purposeful spending of public funds. It is expected to lower the needed public incomes for financing public expenditure, to improve production and competition in the market economy, and to increase personal consumption, living standard and the quality of life of the population. Regardless of the social, economic, legal or political environment in each of state, the topical issue of reforming the management of public expenditures seems to imply a return to a somewhat neglected need for the public sector to function within its own financial possibilities. The state modernisation processes and advancement in the process of managing public expenditures call for a realistic evaluation of the existing condition and circumstances in which these processes occur, as well as the assessment of potential and actual risks that may hinder their effectiveness. Otherwise, it seems that the establishment of a significant level of responsibility in spending the budget funds and a greater transparency of public expenditure may be far-fetched goals.
Kristensen, Troels; Olsen, Kim Rose; Schroll, Henrik
BACKGROUND: In primary care, fee-for-services (FFS) tariffs are often based on political negotiation rather than costing systems. The potential for comprehensive measures of patient morbidity to explain variation in negotiated FFS expenditures has not previously been examined. OBJECTIVES...... fees are based on average costing. However, our results indicate that there may be room for improvement of the association between politically negotiated FFS expenditures and morbidity in primary care....
The development of transport networks requires public investments, in terms of government expenditure, on several types of (road, rail, port, airport, and urban public transport) infrastructure, including their operational and maintenance services. This paper develops and implements a system-wide spatioeconomic model to analyze the expenditure competition among different types of investment in the Greek transport sector. The suggested approach can offer valuable insight into the economies of ...
Anderson, Wayne L; Armour, Brian S; Finkelstein, Eric A; Wiener, Joshua M
We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002-2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. The DAHE for all U.S. adults totaled $397.8 billion in 2006, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total, the DAHE were $118.9 billion for the Medicare population, $161.1 billion for Medicaid recipients, and $117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.
Stein, T.P.; Johnston, F.E.; Greiner, L.
The energy expenditure of lower (group 1) and upper socioeconomic group females (group 2) from a marginal community in Guatemala City was determined by using the doubly labelled water method. Energy expenditure values were 1925 +/- 66 (mean, SEM) kcal/d (group 1) and 2253 +/- 145 kcal/d group 2 (p less than 0.03). About half of this difference can be attributed to size
Bruna Camilo Turi
Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: One of the big challenges facing governments worldwide is the financing of healthcare systems. Thus, it is necessary to understand the factors and key components associated with healthcare expenditure. The aim here was to identify demographic, socioeconomic, lifestyle and clinical factors associated with direct healthcare expenditure within primary care, among adults attended through the Brazilian National Health System in the city of Bauru. DESIGN AND SETTING: Cross-sectional study conducted in five primary care units in Bauru (SP, Brazil. METHODS: Healthcare expenditure over the last 12 months was assessed through medical records of adults aged 50 years or more. Annual healthcare expenditure was assessed in terms of medication, laboratory tests, medical consultations and the total. Body mass index, waist circumference, hypertension, age, sex, physical activity and smoking were assessed through face-to-face interviews. RESULTS: The total healthcare expenditure for 963 participants of this survey was US$ 112,849.74 (46.9% consultations, 35.2% medication and 17.9% laboratory tests. Expenditure on medication was associated with overweight (odds ratio, OR = 1.80; 95% confidence interval, CI: 1.07-3.01, hypertension (OR = 3.04; 95% CI: 1.91-4.82 and moderate physical activity (OR = 0.56; 95% CI: 0.38-0.81. Expenditure on consultations was associated with hypertension (OR = 1.67; 95% CI: 1.12-2.47 and female sex (OR = 1.70; 95% CI: 1.14-2.55. CONCLUSIONS: Our results showed that overweight, lower levels of physical activity and hypertension were independent risk factors associated with higher healthcare expenditure within primary care.
Ricci, P; Mezzarobba, M; Blotière, P O; Polton, D
To measure the reimbursed health expenditures in the last year of life and the proportion it represents in total reimbursement costs in 2008, to analyse the structure of such expenditures and to identify costs by cause of death. Data were obtained from the French national insurance information system (SNIIRAM). Data from the national hospital discharge database were linked to the outpatient reimbursement database for patients covered by the general health insurance scheme (n=49 million persons). The cost of the last year of life was calculated for the exhaustive population (361,328 deaths in 2008). The supposed cause of death was mainly derived from the primary diagnosis of the last hospital stay during which the patient died. The average reimbursed expenses during the last year of life were estimated at 22,000 € per person in 2008, with 12,500 € accounting for public hospital costs. Reimbursed health expenditures varied according to different medical causes of death: 52,300 € for HIV disease and about 40,000 € for tumors. A negative effect of age on the expenditure during the last year of life was observed. Health care spending increased with shorter time before death, the last month of life corresponding to 28% of reimbursed expenditures during the last year of life. Health care use in the last year of life represented 10.5% of the total health expenditures in 2008. This study found results similar to those observed in the past or in other countries. Our results show in particular that the weight of health expenditures during the last year of life on total health expenditures remains stable over the years. Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Kim, Annice E; Arnold, Kristin Y; Makarenko, Olga
Electronic cigarettes (e-cigarettes) are growing in popularity, but little is known about the extent to which these products are advertised to consumers. To estimate expenditures for e-cigarette advertising in magazines, TV, the Internet, newspapers, and radio in the U.S. from 2011 to 2012. E-cigarette advertising data were obtained from leading media intelligence companies, Kantar Media and Nielsen. Estimated e-cigarette advertising expenditures were summarized across media channels for 2011 and 2012. Additional information on brands advertised and market-level buys (i.e., local versus national) also was examined. Overall, e-cigarette advertising expenditures across media channels tripled from $6.4 million in 2011 to $18.3 million in 2012. Expenditures were highest in magazines and TV and lowest in newspapers and on the Internet. More than 80 unique brands were advertised, but blu eCigs dominated ad spending, comprising 76.7% of all e-cigarette advertising expenditures in 2012. National markets were increasingly targeted from 54.9% of ad buys in 2011 to 87.0% of ad buys in 2012. E-cigarette advertising expenditures are increasing, with a greater focus on national markets and TV ads, which will likely increase consumer awareness and use of e-cigarettes in the future. Federal-level efforts are needed to mandate that e-cigarette companies report their advertising expenditures. Future studies should examine how e-cigarette advertising expenditures and message content influence consumer awareness of, interest in, and use of e-cigarettes. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.
Ardanaz, Martin; Maldonado, Stanislao
We study the role of natural resource windfalls in explaining the efficiency of public expenditures. Using a rich dataset of expenditures and public good provision for 1,836 municipalities in Peru for period 2001-2010, we estimate a non-monotonic relationship between the efficiency of public good provision and the level of natural resource transfers. Local governments that were extremely favored by the boom of mineral prices were more efficient in using fiscal windfalls whereas those benefite...
Higgins, Paul A; Alderman, Harold; DEC
Economic approaches to health and nutrition have focused largely on measures of child nutrition and related variables (such as birth weight) as indicators of household production of nutritional outcomes. But when dealing with adult nutrition, economists have to address an issue that has generated tremendous controversy in the clinical nutrition literature. That issue is heterogeneity in an individual's energy expenditures. Preschoolers'energy expenditure also differs, but the differences are ...
Paolo Pellizzari; Dino Rizzi
In this paper we present a model of tax compliance with heterogeneous agents who maximize their individual utility based on income and the conjectured level of per capita public expenditure. We formally include psychological drivers in this model. These drivers affect individual behavior, such as risk aversion, together with appreciation of public expenditure, expectations about peers� compliance and a natural inclination to comply, all of which we summarize in a quality termed �citizenship�....
Watson, Samuel I.; Arulampalam, Wiji; Petrou, Stavros; HASH(0x55897e290a30)
The relationship between health care expenditure and health outcomes has been the subject of recent academic inquiry in order to inform cost-effectiveness thresholds for health technology assessment agencies. Previous studies in public health systems have relied upon data aggregated at the national or regional level; however, there remains debate about whether the supply side effect of changes to expenditure are identifiable using data at this level of aggregation. We use detailed patient dat...
Lischka, Juliane A; Kienzler, Stephanie; Mellmann, Ulrike
The relation between sales and advertising is both complex and diverse. Whether advertising activities drive or follow sales is still unclear. We uncover this relation distinguishing between consumer packaged goods (CPG) and durable consumer goods (DCG) industries. We fit vector autoregressive models to sales and advertising expenditures of four CPG and three DCG industries in Germany from 1991 q1 to 2009 q4. Findings reveal that advertising expenditures do not increase total sales of industr...
Canabrava, Karina L. R.; Faria, Fernanda R.; de Lima, Jorge R. P.; Guedes, Dartagnan P.; Amorim, Paulo R. S.
Purpose: This study aimed to compare the energy expenditure and intensity of active video games to that of treadmill walking in children and adolescents. Method: Seventy-two boys and girls (aged 8-13 years) were recruited from local public schools. Energy expenditure and heart rate were measured during rest, during 3-km/hr, 4-km/hr, and 5-km/hr…
Ravena Santos Raulino
Full Text Available INTRODUCTION AND OBJECTIVE: the aim of this study was to investigate whether the addition of vibration during interval training would raise oxygen consumption VO2 to the extent necessary for weight management and to evaluate the influence of the intensity of the vibratory stimulus for prescribing the exercise program in question. METHODS: VO2, measured breath by breath, was evaluated at rest and during the four experimental conditions to determine energy expenditure, metabolic equivalent MET, respiratory exchange ratio RER, % Kcal from fat, and rate of fat oxidation. Eight young sedentary females age 22±1 years, height 163.88± 7.62 cm, body mass 58.35±10.96 kg, and VO2 max 32.75±3.55 mLO2.Kg-1.min-1 performed interval training duration = 13.3 min to the upper and lower limbs both with vibration 35 Hz and 2 mm, 40 Hz and 2 mm, 45 Hz and 2 mm and without vibration. The experimental conditions were randomized and balanced at an interval of 48 hours. RESULTS: the addition of vibration to exercise at 45 Hz and 2 mm resulted in an additional increase of 17.77±12.38% of VO2 compared with exercise without vibration. However, this increase did not change the fat oxidation rate p=0.42 because intensity of exercise 29.1±3.3 %VO2max, 2.7 MET was classified as mild to young subjects. CONCLUSION: despite the influence of vibration on VO2 during exercise, the increase was insufficient to reduce body weight and did not reach the minimum recommendation of exercise prescription for weight management for the studied population.
Binder, Gerhard; Frank, Laura; Ziegler, Julian; Blumenstock, Gunnar; Schweizer, Roland
Knowledge concerning energy metabolism in Turner syndrome (TS) is lacking. We compared the resting energy expenditure per fat-free mass (REE/FFM) in TS with other girls with short stature treated with growth hormone (GH) and age-related controls. We measured prospectively REE by spirometry under fasting conditions in the morning in 85 short prepubertal girls at the start of GH treatment. Diagnoses were TS (n=20), GH deficiency (GHD) (n=38) and small for gestational age (SGA) short stature (n=27). Additionally, 20 age-related controls were studied. Mean ages were 8.3 (TS), 7.1 (GHD), 6.9 (SGA) and 8.5 years (controls). Mean heights were -2.90 (TS), -3.32 (GHD), -3.69 (SGA) and -0.03 standard deviation scores (SDS) (controls). FFM was measured by bioelectrical impedance analysis (BIA). At the start of GH girls with TS showed insignificantly higher REE per FFM (REE/FFM) (mean±SD; 65±9 kcal/kg×day) than did the other female patients (62±9 kcal/kg×day) (p>0.23). The healthy controls had significantly lower REE/FFM (35±4 kcal/kg×day) (p<0.001). Follow-up examination of the patients after 6 or 12 months revealed decreasing REE/FFM in TS (62±9 kcal/kg×day) resulting in comparable REE/FFM in all three patient groups. At baseline short girls with TS had insignificantly higher REE/FFM than short children with SGA or GHD, but in follow-up this difference was not detectable any more. Future studies are necessary to understand this observation.
Kim, Hyoungyoung; Cho, Soo-Kyung; Kim, Daehyun; Kim, Dalho; Jung, Sun-Young; Jang, Eun Jin; Sung, Yoon-Kyoung
Osteoarthritis (OA) is a disease of old age whose prevalence is increasing. This study explored the impact of OA on household catastrophic health expenditure (CHE) in Korea. We used data on 5,200 households from the Korea Health Panel Survey in 2013 and estimated annual living expenses and out-of-pocket (OOP) payments. Household CHE was defined when a household's total OOP health payments exceeded 10%, 20%, 30%, or 40% of the household's capacity to pay. To compare the OOP payments of households with OA individuals and those without OA, OA households were matched 1:1 with households containing a member with other chronic disease such as neoplasm, hypertension, heart disease, cerebrovascular disease, diabetes, or osteoporosis. The impact of OA on CHE was determined by multivariable logistic analysis. A total of 1,289 households were included, and households with and without OA patients paid mean annual OOP payments of $2,789 and $2,607, respectively. The prevalence of household CHE at thresholds of 10%, 20%, 30%, and 40% were higher in households with OA patients than in those without OA patients ( P < 0.001). The presence of OA patients in each household contributed significantly to CHE at thresholds of 10% (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16-1.87), 20% (OR, 1.29; 95% CI, 1.01-1.66), and 30% (OR, 1.37; 95% CI, 1.05-1.78), but not of 40% (OR, 1.17; 95% CI, 0.87-1.57). The presence of OA patients in Korean households is significantly related to CHE. Policy makers should try to reduce OOP payments in households with OA patients.
Cooper, Jamie A; Nguyen, David D; Ruby, Brent C; Schoeller, Dale A
Migrating birds have been able to sustain an energy expenditure (EE) that is five times their basal metabolic rate. Although humans can readily reach these levels, it is not yet clear what levels can be sustained for several days. The study's purposes were 1) to determine the upper limits of human EE and whether or not those levels can be sustained without inducing catabolism of body tissues and 2) to determine whether initial body weight is related to the levels that can be sustained. We compiled data on documented EE as measured by doubly labeled water during high levels of physical activity (minimum of five consecutive days). We calculated the physical activity level (PAL) of each individual studied (PAL = total EE / basal metabolic rate) from the published data. Correlations were run to examine the relationship between initial body weight and body weight lost with both total EE and PAL. The uppermost limit of EE was a peak PAL of 6.94 that was sustained for 10 consecutive days of a 95-d race. Only two studies reported PALs above 5.0; however, significant decreases in body mass were found in each study (0.45-1.39 kg·wk(-1) of weight loss). To test whether initial weight affects the ability to sustain high PALs, we found a significant positive correlation between TEE and initial body weight (r = 0.46, P body weight (r = 0.27, not statistically significant). Some elite humans are able to sustain PALs above 5.0 for a minimum of 10 d. Although significant decreases in body weight occur at this level, catabolism of body tissue may be preventable in situations with proper energy intake. Further, initial body weight does not seem to affect the sustainability of PALs.
Loftin, Mark; Sothern, Melinda; Koss, Cathie; Tuuri, Georgianna; Vanvrancken, Connie; Kontos, Anthony; Bonis, Marc
This study examined energy expenditure and physiologic determinants for marathon performance in recreational runners. Twenty recreational marathon runners participated (10 males aged 41 +/- 11.3 years, 10 females aged 42.7 +/- 11.7 years). Each subject completed a V(.-)O2max and a 1-hour treadmill run at recent marathon pace, and body composition was indirectly determined via dual energy X-ray absorptiometry. The male runners exhibited higher V(.-)O2max (ml x kg(-1) x min(-1)) values (52.6 +/- 5.5) than their female counterparts (41.9 +/- 6.6), although ventilatory threshold (T-vent) values were similar between groups (males: 76.2 +/- 6.1 % of V(.-)O2max, females: 75.1 +/- 5.1%). The male runners expended more energy (2,792 +/- 235 kcal) for their most recent marathon as calculated from the 1-hour treadmill run at marathon pace than the female runners (2,436 +/- 297 kcal). Body composition parameters correlated moderately to highly (r ranging from 0.50 to 0.87) with marathon run time. Also, V(.-)O2max (r = -0.73) and ventilatory threshold (r = -0.73) moderately correlated with marathon run time. As a group, the participants ran near their ventilatory threshold for their most recent marathon (r = 0.74). These results indicate the influence of body size on marathon run performance. In general, the larger male and female runners ran slower and expended more kilocalories than smaller runners. Regardless of marathon finishing time, the runners maintained a pace near their T-vent, and as T-vent or V(.-)O2max increased, marathon performance time decreased.
Böhm, Birgit; Hartmann, Michael; Böhm, Harald
Energy expenditure (EE) in active videogames (AVGs) is a component for assessing its benefit for cardiovascular health. Existing evidence suggests that AVGs are able to increase EE above rest and when compared with playing passive videogames. However, the association between body movement and EE remains unclear. Furthermore, for goal-directed game design, it is important to know the contribution of body segments to EE. This knowledge will help to acquire a certain level of exercise intensity during active gaming. Therefore, the purpose of this study was to determine the best predictors of EE from body segment energies, acceleration, and heart rate during different game situations. EE and body segment movement of 17 subjects, aged 22.1 ± 2.5 years, were measured in two different AVGs. In randomized order, the subjects played a handheld-controlled Nintendo(®) Wii™ tennis (NWT) game and a whole body-controlled Sony EyeToy(®) waterfall (ETW) game. Body segment movement was analyzed using a three-dimensional motion capture system. From the video data, mean values of mechanical energy change and acceleration of 10 body segments were analyzed. Measured EE was significantly higher in ETW (7.8 ± 1.4 metabolic equivalents [METs]) than in NWT (3.4 ± 1.0 METs). The best prediction parameter for the more intense ETW game was the energy change of the right thigh and for the less intense hand-controlled NWT game was the energy change of the upper torso. Segment acceleration was less accurate in predicting EE. The best predictors of metabolic EE were the thighs and the upper torso in whole body and handheld-controlled games, respectively. Increasing movement of these body segments would lead to higher physical activity intensity during gaming, reducing sedentary behavior.
Mielgo-Ayuso, Juan; Maroto-Sánchez, Beatriz; Luzardo-Socorro, Raquel; Palacios, Gonzalo; Palacios Gil-Antuñano, Nieves; González-Gross, Marcela
Continuous physical exercise leads the athlete to maintain an unstable balance between dietary intake, energy expenditure and the additional demands of a high amount of physical activity. Thus, an accurate assessment of nutritional status is essential to optimize the performance, since it affects health, body composition, and the recovery of the athlete. Specific aspects like the type of sport, specialty or playing position, training schedule and competition calendar, category, specific objectives, which differ from the general population, must be considered. A biochemical assessment can give us a general idea of the nutritional status, lipid profile, liver or kidney function, if diet is too high in proteins or fats, as well as possible nutritional deficiencies and the need for supplementation. Sport kinanthropometry has great utility that enables the assessment of body mass, height, length, diameter, perimeter and skinfolds, where information is processed by applying different equations, obtaining information on somatotype, body composition, and the proportionality of different parts of the body. To give proper nutritional counselling, energy needs of the athlete must be known. If objective measurement is not possible, there are tables including theoretically established energy requirements of different sports. Dietary assessment should include information about food consumption and nutrient intake to establish the relationship between diet, health status and athlete's performance. On the other hand, an adequate hydration status in athletes is essential to maintain adequate performance. Hence, the knowledge of fluid intake by the athlete is a matter of the utmost importance. Dehydration can cause harmful effects on athletes' health. As there is no gold standard, urine gravidity and urine colour are the most extended methods for analyzing hydration status. There is consensus that due to complexity, the combination of different methods assures an effective data
Lau, Josephine S.; Adams, Sally H.; Boscardin, W. John; Irwin, Charles E.
Purpose Examine young adults' health care utilization and expenditures prior to the ACA. Methods We used 2009 Medical Expenditure Panel Survey (MEPS) to 1) compare young adults' health care utilization and expenditures of a full-spectrum of health services to children and adolescents and 2) identify disparities in young adults' utilization and expenditures, based on access (insurance and usual source of care) and other socio-demographic factors, including race/ethnicity and income. Results Young adults had: 1) significantly lower rates of overall utilization (72%) than other age groups (83-88%, Pyoung adults had high out-of-pocket expenses. Compared to the young adults with private insurance, the uninsured spent less than half on health care ($1,040 vs. $2,150/ person, Pyoung adults, we identified significant disparities in utilization and expenditures based on the presence/absence of a usual source of care, race/ethnicity, home language and sex. Conclusions Young adults may not be utilizing the health care system optimally by having low rates of office-based visits and high rates of ER visits. The ACA provision of insurance for those previously uninsured or under-insured will likely increase their utilization and expenditures and lower their out-of-pocket expenses. Further effort is needed to address non-insurance barriers and ensure equal access to health services. PMID:24702839
Chen, Jie; Vargas-Bustamante, Arturo; Mortensen, Karoline; Thomas, Stephen B
To examine the association between the Great Recession of 2007-2009 and health care expenditures along the health care spending distribution, with a focus on racial/ethnic disparities. Secondary data analyses of the Medical Expenditure Panel Survey (2005-2006 and 2008-2009). Quantile multivariate regressions are employed to measure the different associations between the economic recession of 2007-2009 and health care spending. Race/ethnicity and interaction terms between race/ethnicity and a recession indicator are controlled to examine whether minorities encountered disproportionately lower health spending during the economic recession. The Great Recession was significantly associated with reductions in health care expenditures at the 10th-50th percentiles of the distribution, but not at the 75th-90th percentiles. Racial and ethnic disparities were more substantial at the lower end of the health expenditure distribution; however, on average the reduction in expenditures was similar for all race/ethnic groups. The Great Recession was also positively associated with spending on emergency department visits. This study shows that the relationship between the Great Recession and health care spending varied along the health expenditure distribution. More variability was observed in the lower end of the health spending distribution compared to the higher end. © Health Research and Educational Trust.
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.
Hatam, Nahid; Tourani, Sogand; Homaie Rad, Enayatollah; Bastani, Peivand
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.
Full Text Available This study assessed the extent of household catastrophic expenditure in dental health care and its possible determinants in 41 low and middle income countries. Data from 182,007 respondents aged 18 years and over (69,315 in 18 low income countries, 59,645 in 15 lower middle income countries and 53,047 in 8 upper middle income countries who participated in the WHO World Health Survey (WHS were analyzed. Expenditure in dental health care was defined as catastrophic if it was equal to or higher than 40% of the household capacity to pay. A number of individual and country-level factors were assessed as potential determinants of catastrophic dental health expenditure (CDHE in multilevel logistic regression with individuals nested within countries. Up to 7% of households in low and middle income countries faced CDHE in the last 4 weeks. This proportion rose up to 35% among households that incurred some dental health expenditure within the same period. The multilevel model showed that wealthier, urban and larger households and more economically developed countries had higher odds of facing CDHE. The results of this study show that payments for dental health care can be a considerable burden on households, to the extent of preventing expenditure on basic necessities. They also help characterize households more likely to incur catastrophic expenditure on dental health care. Alternative health care financing strategies and policies targeted to improve fairness in financial contribution are urgently required in low and middle income countries.
How to manage energy expenditure for cyclist is very crucial part to achieve a good performance. As the tropical situation, the differences of temperature level might be contributed in energy expenditure and durability. The aim of the paper is to estimate and to analysis the configuration of energy expenditure for static cycling activity based on heart rate value in room with air conditioning (AC)/no AC treatment. The research is started with study literatures of climate factors, temperature impact on human body, and definition of energy expenditure. The next step is design the experiment for 5 participants in 2 difference models for 26.80C - 74% relative humidity (room no AC) and 23,80C - 54.8% relative humidity (room with AC). The participants’ heart rate and blood pressure are measured in rest condition and in cycling condition to know the impact of difference temperature in energy expenditure profile. According to the experiment results, the reducing of the temperature has significantly impact on the decreasing of energy expenditure at average 0.3 Kcal/minute for all 5 performers. Finally, the research shows that climate condition (temperature and relative humidity) are very important factors to manage and to reach a higher performance of cycling sport.
Melgar-Quinonez, Hugo R; Zubieta, Ana C; MkNelly, Barbara; Nteziyaremye, Anastase; Gerardo, Maria Filipinas D; Dunford, Christopher
This study examined the association between food insecurity, determined by a modified version of the U.S. Household Food Security Survey Module (US HFSSM), and total daily per capita (DPC) consumption (measured as household expenditures) in Bolivia, Burkina Faso, and the Philippines. Household food insecurity was determined by an adapted 9-item US HFSSM version. A short version of the World Bank's Living Standards Measurement Study (LSMS) consumption module measured household expenditures. Focus groups were used to adapt the survey instrument to each local context. The sample (n approximately 330 per country) includes residents of urban and rural areas. A 12-month food expenditure aggregate was generated as part of the total household expenditures calculation. DPC food expenditure, which represented over 60% of the total household consumption, as well as expenditures on specific food groups correlated with food insecurity both as a continuous Food Insecurity Score (FinSS) and a tricategorical food insecurity status variable. ANOVA and regression analysis were executed adjusting for social and demographic covariates. Food-secure households have significantly higher (P insecure households. The results offer evidence that the US HFSSM is able to discriminate between households at different levels of food insecurity status in diverse developing world settings.
Lo, Yuan-Ting C; Wahlqvist, Mark L; Chang, Yu-Hung; Lee, Meei-Shyuan
To examine whether chewing ability affects healthcare use and expenditure and whether improving dietary quality alleviates any such effects. Prospective cohort. The Elderly Nutrition and Health Survey in Taiwan (1999-2000), a nationwide community-based survey of people aged 65 and older. Individuals aged 65 and older (N = 1,793; 903 men, 890 women). Chewing ability (satisfactory or unsatisfactory) was assessed using a questionnaire, and dietary quality was assessed using a 24-hour dietary recall as a dietary diversity score. Data on annual medical use and expenditures from the interview date until December 31, 2006, were collected from National Health Insurance claims. Generalized linear models were used to assess the associations between chewing ability, dietary quality, and annual medical usage or expenditure. After 8 years of follow-up, older adults with unsatisfactory chewing ability had considerably higher emergency, hospitalization, and total medical expenditures. Older adults with unsatisfactory chewing ability and a poor diet used fewer annual preventive care and dental services than those with satisfactory chewing ability but had longer hospital stays and higher expenditures. After adjusting for covariates, unsatisfactory chewing ability resulted in significantly longer hospital stays in participants with a poor diet (β = 2.34, 95% confidence interval = 2.02-2.71, P chewing ability and a less-diverse diet together are associated with longer hospital stays and higher medical expenditures. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Bekemeier, Betty; Dunbar, Matthew; Bryan, Matthew; Morris, Michael E
As a part of the Public Health Activities and Service Tracking study and in collaboration with partners in 2 Public Health Practice-Based Research Network states, we examined relationships between local health department (LHD) maternal and child health (MCH) expenditures and local needs. We used a multivariate pooled time-series design to estimate ecologic associations between expenditures in 3 MCH-specific service areas and related measures of need from 2005 to 2010 while controlling for other factors. Retrospective expenditure data from LHDs and for 3 MCH services represented annual investments in (1) Special Supplemental Nutrition for Women, Infants, and Children (WIC), (2) family planning, and (3) a composite of Maternal, Infant, Child, and Adolescent (MICA) service. Expenditure data from all LHDs in Florida and Washington were then combined with "need" and control variables. Our sample consisted of the 102 LHDs in Florida and Washington and the county (or multicounty) jurisdictions they serve. Expenditures for WIC and for our composite of MICA services were strongly associated with need among LHDs in the sample states. For WIC, this association was positive, and for MICA services, this association was negative. Family planning expenditures were weakly associated, in a positive direction. Findings demonstrate wide variations across programs and LHDs in relation to need and may underscore differences in how programs are funded. Programs with financial disbursements based on guidelines that factor in local needs may be better able to provide service as local needs grow than programs with less needs-based funding allocations.
Holland-Fischer, Peter; Greisen, Jacob; Grøfte, Thorbjørn; Jensen, Troels S; Hansen, Peter O; Vilstrup, Hendrik
Tissue injury is accompanied by pain and results in increased energy expenditure, which may promote catabolism. The extent to which pain contributes to this sequence of events is not known. In a cross-over design, 10 healthy volunteers were examined on three occasions; first, during self-controlled nontraumatic electrical painful stimulus to the abdominal skin, maintaining an intensity of 8 on the visual analogue scale (0-10). Next, the electrical stimulus was reproduced during local analgesia and, finally, there was a control session without stimulus. Indirect calorimetry and blood and urine sampling was done in order to calculate energy expenditure and substrate utilization. During pain stimulus, energy expenditure increased acutely and reversibly by 62% (95% confidence interval, 43-83), which was abolished by local analgesia. Energy expenditure paralleled both heart rate and blood catecholamine levels. The energy expenditure increase was fuelled by all energy sources, with the largest increase in glucose utilization. The pain-related increase in energy expenditure was possibly mediated by adrenergic activity and was probably to a large extent due to increased muscle tone. These effects may be enhanced by cortical events related to the pain. The increase in glucose consumption favours catabolism. Our findings emphasize the clinical importance of pain management.
Montalcini, Tiziana; De Bonis, Daniele; Ferro, Yvelise; Carè, Ilaria; Mazza, Elisa; Accattato, Francesca; Greco, Marta; Foti, Daniela; Romeo, Stefano; Gulletta, Elio; Pujia, Arturo
It has been demonstrated that a vegetarian diet may be effective in reducing body weight, however, the underlying mechanisms are not entirely clear. We investigated whether there is a difference in resting energy expenditure between 26 vegetarians and 26 non-vegetarians and the correlation between some nutritional factors and inflammatory markers with resting energy expenditure. In this cross-sectional study, vegetarians and non-vegetarians were matched by age, body mass index and gender. All underwent instrumental examinations to assess the difference in body composition, nutrient intake and resting energy expenditure. Biochemical analyses and 12 different cytokines and growth factors were measured as an index of inflammatory state. A higher resting energy expenditure was found in vegetarians than in non-vegetarians (p = 0.008). Furthermore, a higher energy from diet, fibre, vegetable fats intake and interleukin-β (IL-1β) was found between the groups. In the univariate and multivariable analysis, resting energy expenditure was associated with vegetarian diet, free-fat mass and vegetable fats (p vegetarian's diet, i.e., vegetable fats. Furthermore, we showed that IL-10 was positively associated with resting energy expenditure in this population.
Full Text Available The aim of this paper is to investigate household spending by income deciles. Only the most important one among the expenditure categories was considered, food and non-alcoholic beverages. Research and analysis were based on the results of the Questionnaire on Household Expenditure in the Republic of Croatia. Adequate mathematical and statistical models of expenditure for food and non-alcoholic beverages by income deciles were established. The defined models were used in further research to calculate the coefficient of elasticity. The research showed that expenditure for food and non-alcoholic beverages is non-elastic, thus confirming the first Engel’s law. The obtained results can be used in planning household expenditure also in future periods, considering the fact that the model of expenditure by income deciles referring to the period 200 – 2009 was developed. A model for measuring elasticity was constructed as well. It refers to a 10-year period and can be used to forecast future coefficients of elasticity.
Carels, Robert A; Young, Kathleen M; Coit, Carissa; Clayton, Anna Marie; Spencer, Alexis; Wagner, Marissa
Research suggests that specific eating patterns (e.g., eating breakfast) may be related to favorable weight status. This investigation examined the relationship between eating patterns (i.e., skipping meals; consuming alcohol) and weight loss treatment outcomes (weight loss, energy intake, energy expenditure, and duration of exercise). Fifty-four overweight or obese adults (BMI> or =27 kg/m(2)) participated in a self-help or therapist-assisted weight loss program. Daily energy intake from breakfast, lunch, dinner, and alcoholic beverages, total daily energy intake, total daily energy expenditure, physical activity, and weekly weight loss were assessed. On days that breakfast or dinner was skipped, or alcoholic beverages were not consumed, less total daily energy was consumed compared to days that breakfast, dinner, or alcoholic beverages were consumed. On days that breakfast or alcohol was consumed, daily energy expenditure (breakfast only) and duration of exercise were higher compared to days that breakfast or alcohol was not consumed. Individuals who skipped dinner or lunch more often had lower energy expenditure and exercise duration than individuals who skipped dinner or lunch less often. Individuals who consumed alcohol more often had high daily energy expenditure than individuals who consumed alcohol less often. Skipping meals or consuming alcoholic beverages was not associated with weekly weight loss. In this investigation, weight loss program participants may have compensated for excess energy intake from alcoholic beverages and meals with greater daily energy expenditure and longer exercise duration.
Cornman, Stephen Q.; Zhou, Lei
This "First Look" contains national and state totals of revenues and expenditures for public elementary and secondary education for school year 2013-14. This "First Look" includes revenues by source and expenditures by function and object, including current expenditures per pupil and instructional expenditures per pupil. This…
The size of fiscal expenditure reflect the degree that government intervene in market, if government intervene in market too much, the action of government will lower economic growth. In order to choose optimal size of fiscal expenditure, the paper developed a endogenous growth model including government, and estimated the optimal size of fiscal expenditure in china from experience, the period is from 1978 to 2000. The conclusion is the optimal internal budget size of fiscal expenditure is 21.2% (fiscal expenditure relative to GDP), the total optimal size of fiscal expenditure is 24% (the total fiscal expenditure relative to GDP).
Zhai, Tiemin; Goss, John; Li, Jinjing
In past two decades, health expenditure in China grew at a rate of 11.6% per year, which is much faster than the growth of the country's economy (9.9% per year). As cost containment is a key aspect of China's new health system reform agenda, this study aims to identify the main drivers of past growth so that cost containment policies are focussed in the right areas. The analysis covered the period 1993-2012. To understand the drivers of past growth during this period, Das Gupta's decomposition method was used to decompose the changes in health expenditure by disease into five main components that include population growth, population ageing, disease prevalence rate, expenditure per case of disease, and excess health price inflation. Demographic data on population size and age-composition were obtained from the Department of Economic and Social Affairs of the United Nations. Age- and disease- specific expenditure and prevalence rates by age and disease were extracted from China's National Health Accounts studies and Global Burden of Disease 2013 studies of the Institute for Health Metrics and Evaluation, respectively. Growth in health expenditure in China was mainly driven by a rapid increase in real expenditure per prevalent case, which contributed 8.4 percentage points of the 11.6% annual average growth. Excess health price inflation and population growth contributed 1.3 and 1.3% respectively. The effect of population ageing was relatively small, contributing 0.8% per year. However, reductions in disease prevalence rates reduced the growth rate by 0.3 percentage points. Future policy in optimising growth in health expenditure in China should address growth in expenditure per prevalent case. This is especially so for neoplasms, and for circulatory and respiratory disease. And a focus on effective interventions to reduce the prevalence of disease in the country will ensure that changing disease rates do not lead to a higher growth in future health expenditure
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
Salami, Joseph A; Warraich, Haider J; Valero-Elizondo, Javier; Spatz, Erica S; Desai, Nihar R; Rana, Jamal S; Virani, Salim S; Blankstein, Ron; Khera, Amit; Blaha, Michael J; Blumenthal, Roger S; Katzen, Barry T; Lloyd-Jones, Donald; Krumholz, Harlan M; Nasir, Khurram
Evidence supporting nonstatin lipid-lowering therapy in atherosclerotic cardiovascular disease risk reduction is variable. We aim to examine nonstatin utilization and expenditures in the United States between 2002 and 2013. We used the Medical Expenditure Panel Survey database to estimate national trends in nonstatin use and cost (total and out-of-pocket, adjusted to 2013 US dollars using a gross domestic product deflator) among adults 40 years or older. Nonstatin users increased from 3 million (2.5%) in 2002-2003 (20.1 million prescriptions) to 8 million (5.6%) in 2012-2013 (45.8 million prescriptions). Among adults with atherosclerotic cardiovascular disease, nonstatin use increased from 7.5% in 2002-2003 to 13.9% in 2012-2013 after peaking at 20.3% in 2006-2007. In 2012-2013, 15.9% of high-intensity statin users also used nonstatins, versus 9.7% of low/moderate-intensity users and 3.6% of statin nonusers. Nonstatin use was significantly lower among women (odds ratio 0.80; 95% confidence interval 0.75-0.86), racial/ethnic minorities (odds ratio 0.41; 95% confidence interval 0.36-0.47), and the uninsured (odds ratio 0.47; 95% confidence interval 0.40-0.56). Total nonstatin expenditures increased from $1.7 billion (out-of-pocket cost, $0.7 billion) in 2002-2003 to $7.9 billion (out-of-pocket cost $1.6 billion) in 2012-2013, as per-user nonstatin expenditure increased from $550 to $992. Nonstatin expenditure as a proportion of all lipid-lowering therapy expenditure increased 4-fold from 8% to 32%. Between 2002 and 2013, nonstatin use increased by 124%, resulting in a 364% increase in nonstatin-associated expenditures. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Yang, Caijun; Shen, Qian; Cai, Wenfang; Zhu, Wenwen; Li, Zongjie; Wu, Lina; Fang, Yu
To assess the long-term effects of the introduction of China's zero-markup drug policy on hospitalisation expenditure and hospitalisation expenditures after reimbursement. An interrupted time series was used to evaluate the impact of the zero-markup drug policy on hospitalisation expenditure and hospitalisation expenditure after reimbursement at primary health institutions in Fufeng County of Shaanxi Province, western China. Two regression models were developed. Monthly average hospitalisation expenditure and monthly average hospitalisation expenditure after reimbursement in primary health institutions were analysed covering the period 2009 through to 2013. For the monthly average hospitalisation expenditure, the increasing trend was slowed down after the introduction of the zero-markup drug policy (coefficient = -16.49, P = 0.009). For the monthly average hospitalisation expenditure after reimbursement, the increasing trend was slowed down after the introduction of the zero-markup drug policy (coefficient = -10.84, P = 0.064), and a significant decrease in the intercept was noted after the second intervention of changes in reimbursement schemes of the new rural cooperative medical insurance (coefficient = -220.64, P markup drug policy in western China. However, hospitalisation expenditure and hospitalisation expenditure after reimbursement were still increasing. More effective policies are needed to prevent these costs from continuing to rise. © 2016 John Wiley & Sons Ltd.
Bellinger, Adam S; Elliott, Sean P; Yang, Liu; Wei, John T; Saigal, Christopher S; Smith, Alexandria; Wilt, Timothy J; Strope, Seth A
Benign prostatic hyperplasia creates significant expenses for the Medicare program. We determined expenditure trends for benign prostatic hyperplasia evaluative testing after urologist consultation and placed these trends in the context of overall Medicare expenditures. Using a 5% national sample of Medicare beneficiaries from 2000 to 2007 we developed a cohort of 40,253 with claims for new visits to urologists for diagnoses consistent with symptomatic benign prostatic hyperplasia. We assessed trends in initial inflation and geography adjusted expenditures within 12 months of diagnosis by evaluative test categories derived from the 2003 American Urological Association guideline on the management of benign prostatic hyperplasia. Using governmental reports on Medicare expenditure trends for benign prostatic hyperplasia we compared expenditures to overall and imaging specific Medicare expenditures. Comparisons were assessed by the Z-test and regression analysis for linear trends, as appropriate. Between 2000 and 2007 inflation adjusted total Medicare expenditures per patient for the initial evaluation of patients with benign prostatic hyperplasia seen by urologists increased from $255.44 to $343.98 (p inflation adjusted expenditures increased for benign prostatic hyperplasia related evaluations. This growth was slower than the overall growth in Medicare expenditures. The increase in BPH related imaging expenditures was restrained compared to that of the Medicare program as a whole. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Rising, Russell; Lifshitz, Fima
Sub-optimally nourished rats show reduced growth, biochemical and physiological changes. However, no one has assessed metabolic rate adaptations in rats subjected to chronic suboptimal nutrition (CSN). In this study energy expenditure (EE; kcal/100 g body weight) and physical activity (PA; oscillations in weight/min/kg body weight) were assessed in rats subjected to three levels of CSN. Body weight gain was diminished (76.7 +/- 12.0 and 61.6 +/- 11.0 g) in rats fed 70 and 60% of the ad-libitum fed controls which gained more weight (148.5 +/- 32.3 g). The rats fed 80% gained weight similarly to controls (136.3 +/- 10.5 g). Percent Fat-free body mass was reduced (143.8 +/- 8.7 and 142.0 +/- 7.6 g) in rats fed 70 and 60% of ad-libitum, but not in those fed 80% (200.8 +/- 17.5 g) as compared with controls (201.6 +/- 33.4 g). Body fat (g) decreased in rats fed 80% (19.7 +/- 5.3), 70% (15.3 +/- 3.5) and 60% (9.6 +/- 2.7) of ad-libitum in comparison to controls (26.0 +/- 6.7). EE and PA were also altered by CSN. The control rats increased their EE and PA during the dark periods by 1.4 +/- 0.8 and 1.7 +/- 1.1 respectively, as compared with light the period; whereas CSN rats fed 80 and 70% of ad-libitum energy intake had reduced EE and PA during the dark periods as compared with the light period EE(7.5 +/- 1.4 and 7.8 +/- 0.6 vs. 9.0 +/- 1.2 and 9.7 +/- 0.8; p vs. 4.1 +/- 0.9 and 2.4 +/- 0.4; p vs. 0.95 +/- 0.03 and 0.91 +/- 0.05 p light (7.1 +/- 1.4) and dark period (6.2 +/- 1.0) EE and PA (3.4 +/- 0.9 and 2.5 +/- 0.5 respectively) were reduced in rats fed 60% of ad-libitum energy intake. CSN rats adapt to mild energy restriction by reducing body fat, EE and PA mainly during the dark period while growth proceeds and lean body mass is preserved. At higher levels of energy restrictions there is decreased growth, body fat and lean mass. Moreover EE and PA are also reduced during both light and dark periods.
Full Text Available Abstract Background Sub-optimally nourished rats show reduced growth, biochemical and physiological changes. However, no one has assessed metabolic rate adaptations in rats subjected to chronic suboptimal nutrition (CSN. In this study energy expenditure (EE; kcal/100 g body weight and physical activity (PA; oscillations in weight/min/kg body weight were assessed in rats subjected to three levels of CSN. Results Body weight gain was diminished (76.7 ± 12.0 and 61.6 ± 11.0 g in rats fed 70 and 60% of the ad-libitum fed controls which gained more weight (148.5 ± 32.3 g. The rats fed 80% gained weight similarly to controls (136.3 ± 10.5 g. Percent Fat-free body mass was reduced (143.8 ± 8.7 and 142.0 ± 7.6 g in rats fed 70 and 60% of ad-libitum, but not in those fed 80% (200.8 ± 17.5 g as compared with controls (201.6 ± 33.4 g. Body fat (g decreased in rats fed 80% (19.7 ± 5.3, 70% (15.3 ± 3.5 and 60% (9.6 ± 2.7 of ad-libitum in comparison to controls (26.0 ± 6.7. EE and PA were also altered by CSN. The control rats increased their EE and PA during the dark periods by 1.4 ± 0.8 and 1.7 ± 1.1 respectively, as compared with light the period; whereas CSN rats fed 80 and 70% of ad-libitum energy intake had reduced EE and PA during the dark periods as compared with the light period EE(7.5 ± 1.4 and 7.8 ± 0.6 vs. 9.0 ± 1.2 and 9.7 ± 0.8; p Conclusion CSN rats adapt to mild energy restriction by reducing body fat, EE and PA mainly during the dark period while growth proceeds and lean body mass is preserved. At higher levels of energy restrictions there is decreased growth, body fat and lean mass. Moreover EE and PA are also reduced during both light and dark periods.
Lessan, Nader; Saadane, Ilham; Alkaf, Budour; Hambly, Catherine; Buckley, Adam J; Finer, Nick; Speakman, John R; Barakat, Maha T
Fasting during the month of Ramadan entails abstinence from eating and drinking between dawn and sunset and a major shift in meal times and patterns with associated changes in several hormones and circadian rhythms; whether there are accompanying changes in energy metabolism is unclear. We have investigated the impact of Ramadan fasting on resting metabolic rate (RMR), activity, and total energy expenditure (TEE). Healthy nonobese volunteers (n = 29; 16 women) fasting during Ramadan were recruited. RMR was measured with the use of indirect calorimetry. In subgroups of participants, activity (n = 11; 5 women) and TEE (n = 10; 5 women) in free-living conditions were measured with the use of accelerometers and the doubly labeled water technique, respectively. Body composition was measured with the use of bioelectrical impedance. Measurements were repeated after a wash-out period of between 1 and 2 mo after Ramadan. Nonparametric tests were used for comparative statistics. Ramadan fasting did not result in any change in RMR (mean ± SD: 1365.7 ± 230.2 compared with 1362.9 ± 273.6 kcal/d for Ramadan and post-Ramadan respectively, P = 0.713, n = 29). However, controlling for the effects of age, sex, and body weight, RMR was higher in the first week of Ramadan than in subsequent weeks. During Ramadan, the total number of steps walked were significantly lower (n = 11, P = 0.001), while overall sleeping time was reduced and different sleeping patterns were seen. TEE did not differ significantly between Ramadan and post-Ramadan (mean ± SD: 2224.1 ± 433.7 compared with 2121.0 ± 718.5 kcal/d for Ramadan and post-Ramadan, P = 0.7695, n = 10). Ramadan fasting is associated with reduced activity and sleeping time, but no significant change in RMR or TEE. Reported weight changes with Ramadan in other studies are more likely to be due to differences in food intake. This trial is registered at clinicaltrials.gov as NCT02696421. © 2018 American Society for Nutrition. All rights
Butler, Merlin G.; Theodoro, Mariana F.; Bittel, Douglas C.; Donnelly, Joseph E.
Prader–Willi syndrome (PWS) is a complex neurodevelopmental disorder characterized by hypotonia, suck and feeding difficulties, hypogonadism, small hands and feet, developmental delay, hyperphagia and early childhood obesity and a particular facial appearance. The obesity associated with PWS is the result of a chronic imbalance between energy intake and energy expenditure (EE) due to hyperphagia, decreased physical activity, reduced metabolic rate and an inability to vomit. EE is affected by body composition as well as exercise. Individuals with PWS have a lower lean body mass (LBM) compared with controls which may contribute to reduced basal level EE. To determine the relationship among body composition, activity levels and metabolic rates, dual energy X-ray absorptiometry (DEXA) and a whole-room respiration chamber were used to measure body composition, total EE (TEE), resting EE (REE), physical activity, and mechanical work (MW) during an 8 hr monitoring period. The chamber consisted of a live-in whole-room indirect calorimeter equipped with a force platform floor to allow simultaneous measurement of EE, physical activity, and work efficiency during spontaneous activities and standardized exercise. Participants with PWS (27 with 15q11–q13 deletion and 21 with maternal disomy 15 with an average age of 23 years) had significantly decreased TEE by 20% and reduced LBM compared to 24 obese subjects. Similarly, REE was significantly reduced by 16% in the individuals with PWS relative to the comparison subjects. Total MW performed during the 8 hr monitoring period was significantly reduced by 35% in the PWS group. The energy cost of physical activity is related to the duration, intensity and type of activity and the metabolic efficiency of the individual. After adjusting group differences in LBM by analysis of variance, TEE and REE were no longer different between the two groups. Our data indicate that there is a significant reduction of EE in individuals with PWS
Ankrah Odame, Emmanuel; Akweongo, Patricia; Yankah, Ben; Asenso-Boadi, Francis; Agyepong, Irene
Sustainability of public social welfare programmes has long been of concern in development circles. An important aspect of sustainability is the ability to sustain the recurrent financial costs of programmes. A free maternal care programme (FMCP) was launched under the Ghana National Health Insurance Scheme (NHIS) in 2008 with a start-up grant from the British Government. This article examines claims expenditure under the programme and the implications for the financial sustainability of the programme, and the lessons for donor and public financing of social welfare programmes. Records of reimbursement claims for services and medicines by women benefitting from the policy in participating facilities in one sub-metropolis in Ghana were analysed to gain an understanding of the expenditure on this programme at facility level. National level financial inflow and outflow (expenditure) data of the NHIS, related to implementation of this policy for 2008 and 2009, were reviewed to put the facility-based data in the national perspective. A total of US$936 450.94 was spent in 2009 by the scheme on FMCP in the sub-metropolis. The NHIS expenditure on the programme for the entire country in 2009 was US$49.25 million, exceeding the British grant of US$10.00 million given for that year. Subsequently, the programme has been entirely financed by the National Health Insurance Fund. The rapidly increasing, recurrent demands on this fund from the maternal delivery exemption programme-without a commensurate growth on the amounts generated annually-is an increasing threat to the sustainability of the fund. Provision of donor start-up funding for programmes with high recurrent expenditures, under the expectation that government will take over and sustain the programme, must be accompanied by clear long-term analysis and planning as to how government will sustain the programme.
Berggren, E K; O'Tierney-Ginn, P; Lewis, S; Presley, L; De-Mouzon, S Hauguel; Catalano, P M
There are significant variations in gestational weight gain, with many women gaining in excess of the Institute of Medicine guidelines. Unfortunately, efforts to improve appropriate gestational weight gain have had only limited success. To date, interventions have focused primarily on decreasing energy intake and/or increasing physical activity. Maternal resting energy expenditure, which comprises ∼60% of total energy expenditure compared with the ∼20% that comes from physical activity, may be an important consideration in understanding variations in gestational weight gain. Our objective was to quantify the changes in resting energy expenditure during pregnancy and their relationship to gestational weight gain and body composition changes among healthy women. We hypothesized that greater gestational weight gain, and fat mass accrual in particular, are inversely related to variations in resting energy expenditure. We conducted a secondary analysis of a prospective cohort studied before conception and late pregnancy (34-36 weeks). Body composition (estimated using hydrodensitometry) and resting energy expenditure (estimated using indirect calorimetry) were measured. The relationship between the changes in resting energy expenditure and gestational weight gain and the change in fat mass and fat-free mass were quantified. Resting energy expenditure was expressed as kilocalories per kilogram of fat-free mass per day (kilocalories per kilogram of fat-free mass -1 /day -1 ) and kilocalories per day. Correlations are reported as r. Among 51 women, preconception body mass index was 23.0 (4.7) kg/m 2 ; gestational weight gain was 12.8 (4.7) kg. Preconception and late pregnancy resting energy expenditure (kilocalories per day) correlated positively with the change in fat-free mass (r = 0.37, P = .008; r = 0.51, P = .001). Late-pregnancy resting energy expenditure (kilocalories per kilogram of fat-free mass -1 /day -1 ) was inversely associated with the change in fat
Yoo, Byung-Kwang; Bhattacharya, Jay; McDonald, Kathryn M; Garber, Alan M
To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries. Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000. Secondary data analysis, applying fixed- and random-effects models to time-series cross-sectional data. Outcome variables are inpatient or home heath LTC expenditures. Key explanatory variables are measures of the availability of informal caregivers, generosity in public funding for formal LTC, and the proportion of the elderly population in the total population. Aggregated macro data were obtained from OECD Health Data, United Nations Demographic Yearbooks, and U.S. Census Bureau International Data Base. Most of the 15 OECD countries experienced growth in LTC expenditures over the study period. The availability of a spouse caregiver, measured by male-to-female ratio among the elderly, is associated with a $28,840 (1995 U.S. dollars) annual reduction in formal LTC expenditure per additional elderly male. Availability of an adult child caregiver, measured by female labor force participation and full-time/part-time status shift, is associated with a reduction of $310 to $3,830 in LTC expenditures. These impacts on LTC expenditure vary across countries and across time within a country. The availability of an informal caregiver, particularly a spouse caregiver, is among the most important factors explaining variation in LTC expenditure growth. Long-term care policies should take into account behavioral responses: decreased public funding in LTC may lead working women to leave the labor force to provide more informal care.
Goli, Srinivas; Rammohan, Anu; Moradhvaj
The studies measured Out-of-Pocket Expenditure (OOPE) for hospital births previously suffer from serious data limitations. To overcome such limitations, we designed a hospital-based study for measuring the levels and factors of OOPE on maternity care for hospital births by its detailed components. Data were collected from women for non-complicated deliveries 24-h before the survey and complicated deliveries 48-h prior to the survey at the hospital settings in Uttar Pradesh, India during 2014. The simple random sampling design was used in the selection of respondents. Bivariate analyses were used to estimate mean expenditure on Antenatal care services (ANCs), Delivery care and Total Maternity Expenditure (TME). Multivariate linear regression was employed to examine the factor associated with the absolute and relative share of expenditure in couple's annual income on ANCs, delivery care, and TME. The findings show that average expenditure on maternal health care is high ($155) in the study population. Findings suggest that factors such as income, place, and number of ANCs, type, and place of institutional delivery are significantly associated with both absolute and relative expenditure on maternity care. The likelihood of incidence of catastrophic expenditure on maternity care is significantly higher for women delivered in private hospitals (β = 2.427, p maternity care for hospital births reported in this study is much higher as it was collected with a better methodology, although with smaller sample size. Therefore, ongoing maternity benefit scheme in India in general and Uttar Pradesh in particular need to consider the levels of OOPE on maternity care and demand-side and supply-side factors determining it for a more effective policy to reduce the catastrophic burden on households and help women to achieve better maternity health outcomes in poor regional settings like Uttar Pradesh in India.
Rashidul Alam Mahumud
Full Text Available Objectives As in many low-income and middle-income countries, out-of-pocket (OOP payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results The mean total OOP healthcare expenditures was US dollar (USD 27.66; while, the cost of medicines (USD 16.98 was the highest cost driver (61% of total OOP healthcare expenditure. In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.
Mahumud, Rashidul Alam; Sarker, Abdur Razzaque; Sultana, Marufa; Islam, Ziaul; Khan, Jahangir; Morton, Alec
As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.
Full Text Available This econometric study contributes to the ongoing debate about the costs and benefits of urban form by employing interdisciplinary means—urban planning, econometrics and public administration—to explore the relationship between urban form and urban public services expenditure. In China, particularly, rapid urbanization is accompanied by an increase of urban public services expenditure and a difference in efficiency, which undermines the promotion of urban public service development. The Chinese government has paid great attention to urban sustainable development and promoting urban public services performance; however, until recently there has been a lack of empirical studies exploring the relationship between urban public services expenditure and urban form. Thus, the present research aims to analyze this issue by using relevant indicators based on an econometric model. The results provide a promising basis for improving urban public services expenditure efficiency. Based on the urban area interpreted by remote sensing data and geographic information system, two urban form metrics, the compactness ratio and the elongation ratio, are selected and quantified to describe urban compactness and urban sprawl accurately. Panel data analyses are performed using a cross-sectional dataset of the 30 cities for the years 2007, 2010 and 2013 to assess the likelihood of association between indicators of urban form and urban public services expenditure, while controlling for other determinants, such as educational level, income per capita, degree of industrialization, and unemployment rate. The results indicate that urban elongation is positively correlated to per capita urban public services expenditure and urban compactness is insignificantly correlated to it. Thus, it is recommended that policymakers consider the relationship between urban form and public services expenditure as part of urban planning and on-going strategies to promote public service
Full Text Available Objectives: Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated. Methods: Suicides motivated by non-illness-related factors were identified using the investigator’s note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status. Results: Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women. Conclusions: Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.
Wirtz, Veronika J; Santa-Ana-Tellez, Yared; Servan-Mori, Edson; Avila-Burgos, Leticia
Given the importance of health insurance for financing medicines and recent policy changes designed to reduce health-related out-of-pocket expenditure (OOPE) in Mexico, our study examined and analyzed the effect of health insurance on the probability and amount of OOPE for medicines and the proportion spent from household available expenditure (AE) funds. We conducted a cross-sectional analysis by using the Mexican National Household Survey of Income and Expenditures for 2008. Households were grouped according to household medical insurance type (Social Security, Seguro Popular, mixed, or no affiliation). OOPE for medicines and health costs, and the probability of occurrence, were estimated with linear regression models; subsequently, the proportion of health expenditures from AE was calculated. The Heckman selection procedure was used to correct for self-selection of health expenditure; a propensity score matching procedure and an alternative procedure using instrumental variables were used to correct for heterogeneity between households with and without Seguro Popular. OOPE in medicines account for 66% of the total health expenditures and 5% of the AE. Households with health insurance had a lower probability of OOPE for medicines than their comparison groups. There was heterogeneity in the health insurance effect on the proportion of OOPE for medicines out of the AE, with a reduction of 1.7% for households with Social Security, 1.4% for mixed affiliation, but no difference between Seguro Popular and matched households without insurance. Medicines were the most prevalent component of health expenditures in Mexico. We recommend improving access to health services and strengthening access to medicines to reduce high OOPE. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Full Text Available This thesis takes listed pharmaceutical enterprises as examples. It applied spss17.0 software to construct regression model and made empirical research on the advertisement and R&D expenditure effect of listed pharmaceutical enterprises based on financial performance. The empirical research found that: for enterprise profitability, there’s no significant correlation between advertisement expenditure and enterprise profit capability. However, there’s significant positive correlation between R&D expenditure and enterprise profit capability. For the quality of assets, there’s no significant influence of advertisement expenditure left on the quality of assets. However, there’s negative influence of R&D expenditure left on the quality of assets with a gradually weakening trend. To study advertisement and R&D expenditure effect of listed pharmaceutical enterprises based on financial performance, this thesis chooses investment directions of pharmaceutical enterprises as the new angles to promote shift in development strategies of those enterprises.
Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Wong, Rebeca; Lugo-Palacios, David G; Méndez-Carniado, Oscar
To determine the impact of Seguro Popular (SPS) on catastrophic and impoverishing household expenditures and on the financial protection of the Mexican health system. The propensity score matching (PSM) method was applied to the population affiliated to SPS to determine the program's attributable effect on health expenditure. This analysis uses the National Household Income and Expenditure Survey (ENIGH) during 2004-2012, conducted by Mexico's National Institute of Statistics andGeography (INEGI). It was found that SPS has a significant effect on reducing the likelihood that households will incur impoverishing expenditures. A negative effect on catastrophic expenditures was also found, but it was not statistically significant. This paper shows the effect that SPS, in particular health insurance, has as an instrument of financial protection. Future studies using longer periods of ENIGH data should analyze the persistence of high out-of-pocket expenditure.
Robinson, James C; Miller, Kelly
Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3,065,551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693,254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and
Full Text Available Abstract Background Road traffic injuries (RTI are an increasing public health problem in India where out-of-pocket (OOP expenditures on health are among the highest in the world. We estimated the OOP expenses for RTI in a large city in India. Methods Information on medical and non-medical expenditure was documented for RTI cases of all ages that reported alive or dead to the emergency departments of two public hospitals and a large private hospital in Hyderabad. Differential risk of catastrophic OOP total expenditure (COPE-T and medical expenditure (COPE-M, and distress financing was assessed for 723 RTI cases that arrived alive at the study hospitals with multiple logistic regression. Catastrophic expenditure was defined as expenditure > 25% of the RTI patient’s annual household income. Variation in intensity of COPE-M in RTI was assessed using multiple classification analysis (MCA. Results The median OOP medical and non-medical expenditure was USD 169 and USD 163, respectively. The prevalence of COPE-M and COPE-T was 21.9% (95% CI 18.8-24.9 and 46% (95% CI 42–49.3, respectively. Only 22% had access to medical insurance. Being admitted to a private hospital (OR 5.2, 95% CI 2.7–9.9 and not having access to insurance (OR 3.8, 95% CI 1.9–7.6 were significantly associated with risk of having COPE – M. Similar results were seen for COPE - T. MCA analysis showed that the burden of OOP medical expenditure was mainly associated with in-patient days in hospital (Eta =0.191. Prevalence of distress financing was 69% (95% CI 65.5-72.3 with it being significantly higher for those reporting to the public hospitals (OR 2.8, 95% CI 1.7-4.6, those belonging to the lowest per capita annual household income quartile (OR 7.0, 95% CI 3.7-13.3, and for those without insurance access (OR 3.4, 95% CI 2.0-5.7. Conclusions This paper has outlined the high burden of out-of-pocket medical and total expenditure associated with RTI in India. These data
Kim, Tae Hyun; Lee, Eui-Kyung; Han, Euna
Overweight/obesity is a growing health risk in Korea. The impact of overweight/obesity on pharmaceutical expenditure can be larger if individuals have multiple risk factors and multiple comorbidities. The current study estimated the combined effects of overweight/obesity and other unhealthy behaviors on pharmaceutical expenditure. An instrumental variable quantile regression model was estimated using Korea Health Panel Study data. The current study extracted data from 3 waves (2009, 2010, and 2011). The final sample included 7148 person-year observations for adults aged 20 years or older. Overweight/obese individuals had higher pharmaceutical expenditure than their non-obese counterparts only at the upper quantiles of the conditional distribution of pharmaceutical expenditure (by 119% at the 90th quantile and 115% at the 95th). The current study found a stronger association at the upper quantiles among men (152%, 144%, and 150% at the 75th, 90th, and 95th quantiles, respectively) than among women (152%, 150%, and 148% at the 75th, 90th, and 95th quantiles, respectively). The association at the upper quantiles was stronger when combined with moderate to heavy drinking and no regular physical check-up, particularly among males. The current study confirms that the association of overweight/obesity with modifiable unhealthy behaviors on pharmaceutical expenditure is larger than with overweight/obesity alone. Assessing the effect of overweight/obesity with lifestyle risk factors can help target groups for public health intervention programs. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available Background: The paper examines the convergence of household expenditures, in terms of a possible usage of the standardized, rather than consumer-tailored marketing, mainly on a regional level. Objectives: The main goal of this research is to study the existence of consumption expenditure convergence in the EU-27 countries, in the period between 2000 and 2007. Methods/Approach: The analysis used the absolute β-convergence method, in order to investigate the existence of a negative correlation between the growth over time in the overall consumption expenditure in EU member- countries for each individual product and service category and the initial expenditure level. Results: According to the obtained results, in the period between 2000 and 2007, the EU-27 countries reached a high level of consumer expenditure convergence, which provides a basis for developing a regional concept of the standardized international marketing for these countries’ markets. Conclusions: The results provide an empirical contribution to claims on consumer convergence in the countries included into economic integrations. Also, the obtained results can be used to create a basis for defining and applying the regional marketing concept for companies focusing on the EU-27 countries’ market.
H. Alix Gallagher
Full Text Available This article addresses the question of how much is spent on teachers' professional development. A review of the literature finds two problems that have frequently led to inaccurate estimates of professional development spending: 1 the accounting codes that are used in many studies provide little description of spending, and 2 studies generally focus on district or state expenditures for professional development, but do not collect data on school-level spending. These problems are compounded by the fact that studies define professional development spending differently, and thus it is difficult to compare findings across studies. In an effort to begin to address this problem, this study utilizes a detailed cost structure to analyze both district and school site expenditures on professional development across cost categories. The study found that school-level expenditures were a significant source of professional development for teachers. This has implications for the methodologies used to estimate current professional development expenditures and what level of expenditures would be necessary to generate dramatic improvements in student achievement.
Full Text Available The current paper aims to analyze the performance of the public expenditure management based on the decrease of the administrative costs. The paper is grounded on the following premises: (1 Romania as an EU Member State is under a continuous process to harmonize its legislation with the EU legislation. (2 The integration of Romania in EU in 2007 has determined a significant change in the administrative expenditure amount. (3 Strengthening local autonomy through the decentralization and the devolution processes emphasizes clearer the need for improving the performance of the expenditure management at local level. (4 Internal order, flows of communication and transfer, synergy of the governance system assume administrative expenditure that can be determined. (5 The performance of public organizations in managing local governance issues depends directly also on the administrative expenditure level**. [** Paper accepted to be presented at the Fourth TransAtlantic Dialogue “The Status of Inter-Governmental Relations and Multi-Level Governance in Europe and the US”, Workshop 5: “Performance measurement and accountability in IGR-MLG”.
Pourat, Nadereh; Choi, Moonkyung Kate; Chen, Xiao
Preventive dental health services are intended to reduce the likelihood of development of tooth decay and the need for more intensive treatment overtime. The evidence on the effectiveness of preventive dental care in reducing treatment services and expenditures is lagging for adults, particularly those with lower incomes and chronic conditions. We assessed the impact of preventive dental services on dental treatment service use and expenditures overall and by category of service. We calculated the annual numbers of preventive (periodic diagnostic and prophylactic procedures) and treatment (restorative, surgery, prosthodontic, endodontic, and periodontic) services per beneficiary using Medicaid enrollment and claims data for beneficiaries with three categories of conditions (diabetes, heart disease, and respiratory disease) from 10 largest California counties. We used Cragg hurdle exponential regression models controlling for past service use, demographics, length of enrollment, and county. We found that using preventive services in 2005-2007 was associated with higher likelihood and number of treatment dental services used, but associated with lower treatment expenditures in 2008. The reduction in expenditures was noted only in restorative, prosthodontics, and periodontic services. The findings provide much needed evidence of the contribution of preventive dental care in maintaining oral health of low-income adults with chronic conditions and potential for savings to the Medicaid program. Providing lower cost preventive dental care to the individuals with chronic conditions would achieve better oral health and lower treatment expenditures. © 2018 American Association of Public Health Dentistry.
Full Text Available After the peace bonus era, global military expenditures have escalated sharply despite some worldwide declines in military personnel. Theories on the economic impacts of the military institution and escalated military spending greatly differ and include arguments that they either improve domestic economic performance or crowd out growth-inducing processes. Empirical findings on this matter are inconclusive, in part due to a failure to disentangle the various dimensions of military expenditures. We further suggest that modern sociology's relative inattention to such issues has contributed to these shortcomings. We explore a new dimension of military spending that clarifies this issuemilitary expenditures per soldier which captures the capital intensiveness of a countrys military organization. Our cross-national panel regression and causal analyses of developed and less developed countries from 1990 to 2003 show that military expenditures per soldier inhibit the growth of per capita GDP, net of control variables, with the most pronounced effects in least developed countries. These expenditures inhibit national development in part by slowing the expansion of the labor force. Labor-intensive militaries may provide a pathway for upward mobility, but comparatively capital-intensive military organizations limit entry opportunities for unskilled and under- or unemployed people. Deep investments in military hardware also reduce the investment capital available for more economically productive opportunities. We also find that arms imports have a positive effect on economic growth, but only in less developed countries.