WorldWideScience

Sample records for health costs reduction

  1. A cooperative reduction model for regional air pollution control in China that considers adverse health effects and pollutant reduction costs.

    Science.gov (United States)

    Xie, Yujing; Zhao, Laijun; Xue, Jian; Hu, Qingmi; Xu, Xiang; Wang, Hongbo

    2016-12-15

    How to effectively control severe regional air pollution has become a focus of global concern recently. The non-cooperative reduction model (NCRM) is still the main air pollution control pattern in China, but it is both ineffective and costly, because each province must independently fight air pollution. Thus, we proposed a cooperative reduction model (CRM), with the goal of maximizing the reduction in adverse health effects (AHEs) at the lowest cost by encouraging neighboring areas to jointly control air pollution. CRM has two parts: a model of optimal pollutant removal rates using two optimization objectives (maximizing the reduction in AHEs and minimizing pollutant reduction cost) while meeting the regional pollution control targets set by the central government, and a model that allocates the cooperation benefits (i.e., health improvement and cost reduction) among the participants according to their contributions using the Shapley value method. We applied CRM to the case of sulfur dioxide (SO 2 ) reduction in Yangtze River Delta region. Based on data from 2003 to 2013, and using mortality due to respiratory and cardiovascular diseases as the health endpoints, CRM saves 437 more lives than NCRM, amounting to 12.1% of the reduction under NCRM. CRM also reduced costs by US $65.8×10 6 compared with NCRM, which is 5.2% of the total cost of NCRM. Thus, CRM performs significantly better than NCRM. Each province obtains significant benefits from cooperation, which can motivate them to actively cooperate in the long term. A sensitivity analysis was performed to quantify the effects of parameter values on the cooperation benefits. Results shown that the CRM is not sensitive to the changes in each province's pollutant carrying capacity and the minimum pollutant removal capacity, but sensitive to the maximum pollutant reduction capacity. Moreover, higher cooperation benefits will be generated when a province's maximum pollutant reduction capacity increases. Copyright

  2. The impact of BPO on cost reduction in mid-sized health care systems.

    Science.gov (United States)

    Perry, Andy; Kocakülâh, Mehmet C

    2010-01-01

    At the convergence of two politico-economic "hot topics" of the day--outsourcing and the cost of health care-lie opportunities for mid-sized health systems to innovate, collaborate, and reduce overhead. Competition in the retail health care market can serve as both an impetus and an inhibitor to such measures, though. Here we are going to address the motivations, influences, opportunities, and limitations facing mid-sized, US non-profit health systems in business process outsourcing (BPO). Advocates cite numerous benefits to BPO, particularly in cost reduction and strategy optimization. BPO can elicit cost savings due to specialization among provider firms, returns to scale and technology, standardization and automation, and gains in resource arbitrage (off-shoring capabilities). BPO can also free an organization of non-critical tasks and focus resources on core competencies (treating patients). The surge in BPO utilization has rarely extended to the back-office functions of many mid-sized health systems. Health care providers, still a largely fragmented bunch with many rural, independent non-profit systems, have not experienced the consolidation and organizational scale growth to make BPO as attractive as other industries. Smaller firms, spurning merger and acquisition pressure from large, tertiary health systems, often wish to retain their autonomy and identity; hence, they face a competitive cost disadvantage compared to their larger competitors. This article examines the functional areas for these health systems in which BPO is not currently utilized and dissects the various methods available in which to practice BPO. We assess the ongoing adoption of BPO in these areas as well as the barriers to adoption, and identify the key processes that best represent opportunity for success. An emphasis is placed on a collaborative model with other health systems compared to a single system, unilateral BPO arrangement.

  3. A Cost Benefit Analysis of an Active Travel Intervention with Health and Carbon Emission Reduction Benefits

    Science.gov (United States)

    Grams, Mark; Witten, Karen; Woodward, Alistair

    2018-01-01

    Active travel (walking and cycling) is beneficial for people’s health and has many co-benefits, such as reducing motor vehicle congestion and pollution in urban areas. There have been few robust evaluations of active travel, and very few studies have valued health and emissions outcomes. The ACTIVE before-and-after quasi-experimental study estimated the net benefits of health and other outcomes from New Zealand’s Model Communities Programme using an empirical analysis comparing two intervention cities with two control cities. The Programme funded investment in cycle paths, other walking and cycling facilities, cycle parking, ‘shared spaces’, media campaigns and events, such as ‘Share the Road’, and cycle-skills training. Using the modified Integrated Transport and Health Impacts Model, the Programme’s net economic benefits were estimated from the changes in use of active travel modes. Annual benefits for health in the intervention cities were estimated at 34.4 disability-adjusted life years (DALYs) and two lives saved due to reductions in cardiac disease, diabetes, cancer, and respiratory disease. Reductions in transport-related carbon emissions were also estimated and valued. Using a discount rate of 3.5%, the estimated benefit/cost ratio was 11:1 and was robust to sensitivity testing. It is concluded that when concerted investment is made in active travel in a city, there is likely to be a measurable, positive return on investment. PMID:29751618

  4. Practical approach to lung health in Nepal: better prescribing and reduction of cost.

    NARCIS (Netherlands)

    Shrestha, N.; Samir, K.C.; Baltussen, R.M.P.M.; Kafle, K.K.; Bishai, D.; Niessen, L.

    2006-01-01

    OBJECTIVES: To assess the impact of Practical Approach to Lung Health (PAL) guidelines on prescription behaviour and the total cost of prescription for patients with asthma, chronic obstructive pulmonary disease and pneumonia. METHODS: Pre- and post-intervention comparison in a cluster randomized

  5. Telecommuting and health care: a potential for cost reductions and productivity gains.

    Science.gov (United States)

    Jacobs, S M; Pelfrey, S; Van Sell, M

    1995-12-01

    Health care administrators are striving to maintain positive operating margins while remaining responsive to community needs. As they look for ways to reduce costs and improve productivity, they may consider the benefits associated with telecommuting. Telecommuting refers to the work performed by organizational employees who use computers and telecommunication equipment to work at home or at remote sites one or more days a week. Benefits to the health care industry include release of valuable hospital space, reduced employee turnover, and increased productivity. The time away from the institution may provide administrators with valuable planning time, free from interruptions.

  6. The health gains and cost savings of dietary salt reduction interventions, with equity and age distributional aspects

    Directory of Open Access Journals (Sweden)

    Nhung Nghiem

    2016-05-01

    Full Text Available Abstract Background A “diet high in sodium” is the second most important dietary risk factor for health loss identified in the Global Burden of Disease Study 2013. We therefore aimed to model health gains and costs (savings of salt reduction interventions related to salt substitution and maximum levels in bread, including by ethnicity and age. We also ranked these four interventions compared to eight other modelled interventions. Methods A Markov macro-simulation model was used to estimate QALYs gained and net health system costs for four dietary sodium reduction interventions, discounted at 3 % per annum. The setting was New Zealand (NZ (2.3 million adults, aged 35+ years which has detailed individual-level administrative cost data. Results The health gain was greatest for an intervention where most (59 % of the sodium in processed foods was replaced by potassium and magnesium salts. This intervention gained 294,000 QALYs over the remaining lifetime of the cohort (95 % UI: 238,000 to 359,000; 0.13 QALY per 35+ year old. Such salt substitution also produced the highest net cost-savings of NZ$ 1.5 billion (US$ 1.0 billion (95 % UI: NZ$ 1.1 to 2.0 billion. All interventions generated relatively larger per capita QALYs for men vs women and for the indigenous Māori population vs non-Māori (e.g., 0.16 vs 0.12 QALYs per adult for the 59 % salt substitution intervention. Of relevance to workforce productivity, in the first 10 years post-intervention, 22 % of the QALY gain was among those aged <65 years (and 37 % for those aged <70. Conclusions The benefits are consistent with the international literature, with large health gains and cost savings possible from some, but not all, sodium reduction interventions. Health gain appears likely to occur among working-age adults and all interventions contributed to reducing health inequalities.

  7. Cost reduction through system integration

    International Nuclear Information System (INIS)

    Helsing, P.

    1994-01-01

    In resent years cost reduction has been a key issue in the petroleum industry. Several findings are not economically attractive at the current cost level, and for this and other reasons some of the major oil companies require the suppliers to have implemented a cost reduction programme to prequalify for projects. The present paper addresses cost reduction through system design and integration in both product development and working methods. This is to be obtained by the combination of contracts by reducing unnecessary coordination and allow re-use of proven interface designs, improve subsystem integration by ''top down'' system design, and improve communication and exchange of experience. 3 figs

  8. Heliostat cost reduction study.

    Energy Technology Data Exchange (ETDEWEB)

    Jones, Scott A.; Lumia, Ronald. (University of New Mexico, Albuquerque, NM); Davenport, Roger (Science Applications International Corporation, San Diego, CA); Thomas, Robert C. (Advanced Thermal Systems, Centennial, CO); Gorman, David (Advanced Thermal Systems, Larkspur, CO); Kolb, Gregory J.; Donnelly, Matthew W.

    2007-06-01

    Power towers are capable of producing solar-generated electricity and hydrogen on a large scale. Heliostats are the most important cost element of a solar power tower plant. Since they constitute {approx} 50% of the capital cost of the plant it is important to reduce heliostat cost as much as possible to improve the economic performance of power towers. In this study we evaluate current heliostat technology and estimate a price of $126/m{sup 2} given year-2006 materials and labor costs for a deployment of {approx}600 MW of power towers per year. This 2006 price yields electricity at $0.067/kWh and hydrogen at $3.20/kg. We propose research and development that should ultimately lead to a price as low as $90/m{sup 2}, which equates to $0.056/kWh and $2.75/kg H{sup 2}. Approximately 30 heliostat and manufacturing experts from the United States, Europe, and Australia contributed to the content of this report during two separate workshops conducted at the National Solar Thermal Test Facility.

  9. [Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

    Science.gov (United States)

    Bergholz, W

    2008-11-01

    In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

  10. Reduction of LNG FOB cost

    International Nuclear Information System (INIS)

    Aoki, Ichizo; Kikkawa, Yoshitsugi

    1997-01-01

    To achieve a competitive LNG price for the consumers against other energy sources, reduction of LNG FOB (Free on Board) cost i.e. LNG cost at LNG ship flange, will be the key item. It is necessary to perform a many optimization studies (or value engineering) for each stage of the LNG project. These stages are: Feasibility study; Conceptual design - FEED (Front End Engineering and Design); EPC (Engineering, Procurement and Construction); Operation and maintenance. Since the LNG plant forms one part of the LNG chain, starting from gas production to LNG receiving, and requires several billion US dollar of investment, the consequences of a plant shut down on the LNG chain are clear, it is, therefore, important to get high availability which will also contribute the reduction of LNG FOB cost. (au) 25 refs

  11. Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada.

    Science.gov (United States)

    Joffres, Michel R; Campbell, Norm R C; Manns, Braden; Tu, Karen

    2007-05-01

    Hypertension is the leading risk factor for mortality worldwide. One-quarter of the adult Canadian population has hypertension, and more than 90% of the population is estimated to develop hypertension if they live an average lifespan. Reductions in dietary sodium additives significantly lower systolic and diastolic blood pressure, and population reductions in dietary sodium are recommended by major scientific and public health organizations. To estimate the reduction in hypertension prevalence and specific hypertension management cost savings associated with a population-wide reduction in dietary sodium additives. Based on data from clinical trials, reducing dietary sodium additives by 1840 mg/day would result in a decrease of 5.06 mmHg (systolic) and 2.7 mmHg (diastolic) blood pressures. Using Canadian Heart Health Survey data, the resulting reduction in hypertension was estimated. Costs of laboratory testing and physician visits were based on 2001 to 2003 Ontario Health Insurance Plan data, and the number of physician visits and costs of medications for patients with hypertension were taken from 2003 IMS Canada. To estimate the reduction in total physician visits and laboratory costs, current estimates of aware hypertensive patients in Canada were used from the Canadian Community Health Survey. Reducing dietary sodium additives may decrease hypertension prevalence by 30%, resulting in one million fewer hypertensive patients in Canada, and almost double the treatment and control rate. Direct cost savings related to fewer physician visits, laboratory tests and lower medication use are estimated to be approximately $430 million per year. Physician visits and laboratory costs would decrease by 6.5%, and 23% fewer treated hypertensive patients would require medications for control of blood pressure. Based on these estimates, lowering dietary sodium additives would lead to a large reduction in hypertension prevalence and result in health care cost savings in Canada.

  12. Reduction of mesqa improvement costs

    Directory of Open Access Journals (Sweden)

    Mohamed Ahmed Saad ElFetyany

    2017-10-01

    Results show that using the revised approach brings down the cost of mesqa improvement from nearly 10,000LE/fed at present to about 6000LE/fed. These reductions based on the analyses of different mesqa modelling through the adoption of certain parameters such as feasibility of the revised design, effective application of continuous flow for water distribution, and downsizing of the capacity of improved mesqas.

  13. Health Clinic Cost Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Healthcare Cost Report Information System (HCRIS) Dataset - Independent Rural Health Clinic and Freestanding Federally Qualified Health Center (HCLINIC).This data...

  14. PV O&M Cost Model and Cost Reduction

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Andy

    2017-03-15

    This is a presentation on PV O&M cost model and cost reduction for the annual Photovoltaic Reliability Workshop (2017), covering estimating PV O&M costs, polynomial expansion, and implementation of Net Present Value (NPV) and reserve account in cost models.

  15. Multiple cost criteria for occupational dose reduction

    International Nuclear Information System (INIS)

    James, J.Z.

    1983-01-01

    This paper describes a simple, feasible procedure for deciding if a proposed dose reduction measure is justified under ALARA, based on engineering economic principles of project feasibility analysis. Particular attention is given to the fixing of cost criteria: the importance of melding disparate objectives into a single parameter, and the distinction between a cost criterion and a cost consideration. (author)

  16. Controlling Health Care Costs

    Science.gov (United States)

    Dessoff, Alan

    2009-01-01

    This article examines issues on health care costs and describes measures taken by public districts to reduce spending. As in most companies in America, health plan designs in public districts are being changed to reflect higher out-of-pocket costs, such as higher deductibles on visits to providers, hospital stays, and prescription drugs. District…

  17. Cost reduction of LWRs - The main features

    International Nuclear Information System (INIS)

    Board, J.A.; Norman, D.

    1991-01-01

    For effective generation cost reductions to be achieved while maintaining safety levels, the impact of each of the above element and their interactions must be fully assessed, together with the effects of uncertainty on commercial risk. the amount of interest during construction which must be paid can be minimised by adopting designs, output ratings (unit size), and construction methods which minimise construction time. However this must be done without unduly increasing specific capital cost. Total capital costs can be reduced by sharing design and project launching costs and front-end design and licensing costs, across a series of identical plants. The paper is reviewing costs and performance factors such as those above with the aim of identifying the strategies which might be necessary within and between countries in order to create an environment which would enable cost reductions on LWRs to be made. (author)

  18. Chronic care model and cost reduction in initial health: a new approach for satisfaction and improvement of chronicity

    Directory of Open Access Journals (Sweden)

    Stefano Marcelli

    2017-10-01

    Full Text Available Nowadays, the number of elderly is growing, with consequent increase of chronic diseases. An effective approach to reduce the costs incurred is required. The Chronic Care Model has proven to be a good starting point for a better management of economic and human resources.

  19. Spreadsheet tool for estimating noise reduction costs

    International Nuclear Information System (INIS)

    Frank, L.; Senden, V.; Leszczynski, Y.

    2009-01-01

    The Northeast Capital Industrial Association (NCIA) represents industry in Alberta's industrial heartland. The organization is in the process of developing a regional noise management plan (RNMP) for their member companies. The RNMP includes the development of a noise reduction cost spreadsheet tool to conduct reviews of practical noise control treatments available for individual plant equipment, inclusive of ranges of noise attenuation achievable, which produces a budgetary prediction of the installed cost of practical noise control treatments. This paper discussed the noise reduction cost spreadsheet tool, with particular reference to noise control best practices approaches and spreadsheet tool development such as prerequisite, assembling data required, approach, and unit pricing database. Use and optimization of the noise reduction cost spreadsheet tool was also discussed. It was concluded that the noise reduction cost spreadsheet tool is an easy interactive tool to estimate implementation costs related to different strategies and options of noise control mitigating measures and was very helpful in gaining insight for noise control planning purposes. 2 tabs.

  20. REDUCTION OF THE PRODUCTION COST. EXPERIENCE OF THE COSTS REDUCTION AT RUP “BMZ”

    Directory of Open Access Journals (Sweden)

    S. S. Sereda

    2004-01-01

    Full Text Available The method of the daily operative monitoring of the costs for reduction of net cost and reinforcement of control on the costs has been applied for the first time in 2003 in RB at RUP “BMZ”, that allowed for the enterprise to control the costs in regime of real time.

  1. 26 CFR 1.420-1 - Significant reduction in retiree health coverage during the cost maintenance period.

    Science.gov (United States)

    2010-04-01

    ... sale or other transfer in connection with which the employees of a trade or business of the employer... of the trade or business. (d) Examples. The following examples illustrate the application of this... individuals died in Year 2. During Year 3, Employer W amends its health plan to eliminate coverage for 5...

  2. Further Cost Reduction of Battery Manufacturing

    Directory of Open Access Journals (Sweden)

    Amir A. Asif

    2017-06-01

    Full Text Available The demand for batteries for energy storage is growing with the rapid increase in photovoltaics (PV and wind energy installation as well as electric vehicle (EV, hybrid electric vehicle (HEV and plug-in hybrid electric vehicle (PHEV. Electrochemical batteries have emerged as the preferred choice for most of the consumer product applications. Cost reduction of batteries will accelerate the growth in all of these sectors. Lithium-ion (Li-ion and solid-state batteries are showing promise through their downward price and upward performance trends. We may achieve further performance improvement and cost reduction for Li-ion and solid-state batteries through reduction of the variation in physical and electrical properties. These properties can be improved and made uniform by considering the electrical model of batteries and adopting novel manufacturing approaches. Using quantum-photo effect, the incorporation of ultra-violet (UV assisted photo-thermal processing can reduce metal surface roughness. Using in-situ measurements, advanced process control (APC can help ensure uniformity among the constituent electrochemical cells. Industrial internet of things (IIoT can streamline the production flow. In this article, we have examined the issue of electrochemical battery manufacturing of Li-ion and solid-state type from cell-level to battery-level process variability, and proposed potential areas where improvements in the manufacturing process can be made. By incorporating these practices in the manufacturing process we expect reduced cost of energy management system, improved reliability and yield gain with the net saving of manufacturing cost being at least 20%.

  3. Achieving Cost Reduction Through Data Analytics.

    Science.gov (United States)

    Rocchio, Betty Jo

    2016-10-01

    The reimbursement structure of the US health care system is shifting from a volume-based system to a value-based system. Adopting a comprehensive data analytics platform has become important to health care facilities, in part to navigate this shift. Hospitals generate plenty of data, but actionable analytics are necessary to help personnel interpret and apply data to improve practice. Perioperative services is an important revenue-generating department for hospitals, and each perioperative service line requires a tailored approach to be successful in managing outcomes and controlling costs. Perioperative leaders need to prepare to use data analytics to reduce variation in supplies, labor, and overhead. Mercy, based in Chesterfield, Missouri, adopted a perioperative dashboard that helped perioperative leaders collaborate with surgeons and perioperative staff members to organize and analyze health care data, which ultimately resulted in significant cost savings. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  4. Understanding your health care costs

    Science.gov (United States)

    ... ency/patientinstructions/000878.htm Understanding your health care costs To use the sharing features on this page, ... on out-of-pocket costs. Out-of-Pocket Costs The good news is there is a limit ...

  5. Energy cost reduction in oil pipeline

    Energy Technology Data Exchange (ETDEWEB)

    Limeira, Fabio Machado; Correa, Joao Luiz Lavoura; Costa, Luciano Macedo Josino da; Silva, Jose Luiz da; Henriques, Fausto Metzger Pessanha [Petrobras Transporte S.A. (TRANSPETRO), Rio de Janeiro, RJ (Brazil)

    2012-07-01

    One of the key questions of modern society consists on the rational use of the planet's natural resources and energy. Due to the lack of energy, many companies are forced to reduce their workload, especially during peak hours, because residential demand reaches its top and there is not enough energy to fulfill the needs of all users, which affects major industries. Therefore, using energy more wisely has become a strategic issue for any company, due to the limited supply and also for the excessive cost it represents. With the objective of saving energy and reducing costs for oil pipelines, it has been identified that the increase in energy consumption is primordially related to pumping stations and also by the way many facilities are operated, that is, differently from what was originally designed. Realizing this opportunity, in order to optimize the process, this article intends to examine the possibility of gains evaluating alternatives regarding changes in the pump scheme configuration and non-use of pump stations at peak hours. Initially, an oil pipeline with potential to reduce energy costs was chosen being followed by a history analysis, in order to confirm if there was sufficient room to change the operation mode. After confirming the pipeline choice, the system is briefly described and the literature is reviewed, explaining how the energy cost is calculated and also the main characteristics of a pumping system in series and in parallel. In that sequence, technically feasible alternatives are studied in order to operate and also to negotiate the energy demand contract. Finally, costs are calculated to identify the most economical alternative, that is, for a scenario with no increase in the actual transported volume of the pipeline and for another scenario that considers an increase of about 20%. The conclusion of this study indicates that the chosen pipeline can achieve a reduction on energy costs of up to 25% without the need for investments in new

  6. Cost reduction in deep water production systems

    International Nuclear Information System (INIS)

    Beltrao, R.L.C.

    1995-01-01

    This paper describes a cost reduction program that Petrobras has conceived for its deep water field. Beginning with the Floating Production Unit, a new concept of FPSO was established where a simple system, designed to long term testing, can be upgraded, on the location, to be the definitive production unit. Regarding to the subsea system, the following projects will be considered. (1) Subsea Manifold: There are two 8-well-diverless manifolds designed for 1,000 meters presently under construction and after a value analysis, a new design was achieved for the next generation. Both projects will be discussed and a cost evaluation will also be provided. (2) Subsea Pipelines: Petrobras has just started a large program aiming to reduce cost on this important item. There are several projects such as hybrid (flexible and rigid) pipes for large diameter in deep water, alternatives laying methods, rigid riser on FPS, new material...etc. The authors intend to provide an overview of each project

  7. Cost reduction with maintenance ECT in refractory bipolar disorder.

    Science.gov (United States)

    Bonds, C; Frye, M A; Coudreaut, M F; Cunningham, M; Spearing, M; McGuire, M; Guze, B

    1998-03-01

    A case report of outpatient maintenance electroconvulsive therapy (ECT) is presented in a patient with bipolar disorder type I refractory to conventional medication treatment but responsive to ECT. A cost comparison is made showing substantial savings when outpatient maintenance ECT is used in lieu of inpatient hospitalization with ECT. A detailed life chart illustrating multiple medication trials that failed to stabilize the patient accompanies the financial summary. This case highlights the advantages of outpatient maintenance ECT for bipolar depression particularly with regard to safety, efficacy, and significant health care cost reduction.

  8. [Calculation of workers' health care costs].

    Science.gov (United States)

    Rydlewska-Liszkowska, Izabela

    2006-01-01

    In different health care systems, there are different schemes of organization and principles of financing activities aimed at ensuring the working population health and safety. Regardless of the scheme and the range of health care provided, economists strive for rationalization of costs (including their reduction). This applies to both employers who include workers' health care costs into indirect costs of the market product manufacture and health care institutions, which provide health care services. In practice, new methods of setting costs of workers' health care facilitate regular cost control, acquisition of detailed information about costs, and better adjustment of information to planning and control needs in individual health care institutions. For economic institutions and institutions specialized in workers' health care, a traditional cost-effect calculation focused on setting costs of individual products (services) is useful only if costs are relatively low and the output of simple products is not very high. But when products form aggregates of numerous actions like those involved in occupational medicine services, the method of activity based costing (ABC), representing the process approach, is much more useful. According to this approach costs are attributed to the product according to resources used during different activities involved in its production. The calculation of costs proceeds through allocation of all direct costs for specific processes in a given institution. Indirect costs are settled on the basis of resources used during the implementation of individual tasks involved in the process of making a new product. In this method, so called map of processes/actions consisted in the manufactured product and their interrelations are of particular importance. Advancements in the cost-effect for the management of health care institutions depend on their managerial needs. Current trends in this regard primarily depend on treating all cost reference

  9. Reduction of Direct Health Costs Associated with Pertussis Vaccination with Acellular Vaccines in Children Aged 0-9 Years with Pertussis in Catalonia (Spain).

    Science.gov (United States)

    Plans-Rubió, Pedro; Navas, Encarna; Godoy, Pere; Carmona, Gloria; Domínguez, Angela; Jané, Mireia; Muñoz-Almagro, Carmen; Brotons, Pedro

    2018-05-14

    The aim of this study was to assess direct health costs in children with pertussis aged 0-9 years who were vaccinated, partially vaccinated, and unvaccinated during childhood, and to assess the association between pertussis costs and pertussis vaccination in Catalonia (Spain) in 2012-2013. Direct healthcare costs included pertussis treatment, pertussis detection, and preventive chemotherapy of contacts. Pertussis patients were considered vaccinated when they had received 4-5 doses, and unvaccinated or partially vaccinated when they had received 0-3 doses of vaccine. The Chi square test and the odds ratios were used to compare percentages and the t test was used to compare mean pertussis costs in different groups, considering a p case after taking into account the effect of other study variables, and €200 per case after taking into account pertussis severity. Direct healthcare costs were lower in children with pertussis aged 0-9 years vaccinated with 4-5 doses of acellular vaccines than in unvaccinated or partially vaccinated children with pertussis of the same age.

  10. Model reduction by weighted Component Cost Analysis

    Science.gov (United States)

    Kim, Jae H.; Skelton, Robert E.

    1990-01-01

    Component Cost Analysis considers any given system driven by a white noise process as an interconnection of different components, and assigns a metric called 'component cost' to each component. These component costs measure the contribution of each component to a predefined quadratic cost function. A reduced-order model of the given system may be obtained by deleting those components that have the smallest component costs. The theory of Component Cost Analysis is extended to include finite-bandwidth colored noises. The results also apply when actuators have dynamics of their own. Closed-form analytical expressions of component costs are also derived for a mechanical system described by its modal data. This is very useful to compute the modal costs of very high order systems. A numerical example for MINIMAST system is presented.

  11. Adherence and health care costs

    Directory of Open Access Journals (Sweden)

    Iuga AO

    2014-02-01

    Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

  12. Cost reductions in nickel-hydrogen battery

    Science.gov (United States)

    Beauchamp, Richard L.; Sindorf, Jack F.

    1987-01-01

    Significant progress was made toward the development of a commercially marketable hydrogen nickel oxide battery. The costs projected for this battery are remarkably low when one considers where the learning curve is for commercialization of this system. Further developmental efforts on this project are warranted as the H2/NiO battery is already cost competitive with other battery systems.

  13. Distributed Wind Cost Reduction: Learning from Solar

    Energy Technology Data Exchange (ETDEWEB)

    Tegen, Suzanne

    2016-02-23

    The distributed wind energy industry can learn several lessons from the solar industry regarding reducing soft costs. Suzanne Tegen presented this overview at the 2016 Distributed Wind Energy Association Business Conference in Washington, D.C., on February 23, 2016.

  14. Systemic cost-effectiveness analysis of food hazard reduction

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Lawson, Lartey Godwin; Lund, Mogens

    2015-01-01

    stage are considered. Cost analyses are conducted for different risk reduction targets and for three alternative scenarios concerning the acceptable range of interventions. Results demonstrate that using a system-wide policy approach to risk reduction can be more cost-effective than a policy focusing...

  15. Low-Cost Radon Reduction Pilot Study

    Energy Technology Data Exchange (ETDEWEB)

    Rose, William B. [Partnership for Advanced Residential Retrofit, Champaign, IL (United States); Francisco, Paul W. [Partnership for Advanced Residential Retrofit, Champaign, IL (United States); Merrin, Zachary [Partnership for Advanced Residential Retrofit, Champaign, IL (United States)

    2015-09-01

    The aim of the research was to conduct a primary scoping study on the impact of air sealing between the foundation and the living space on radon transport reduction across the foundation-living space floor assembly. Fifteen homes in the Champaign, Illinois area participated in the study. These homes were instrumented for hourly continuous radon measurements and simultaneous temperature and humidity the foundation was improved. However, this improved isolation did not lead to significant reductions in radon concentration in the living space. Other factors such as outdoor temperature were shown to have an impact on radon concentration.

  16. Cost reduction at NSP using IPE results

    International Nuclear Information System (INIS)

    Asmus, T.J.

    1995-01-01

    Operating nuclear power generating facilities are under increasing pressure to reduce costs to be able to compete successfully in the competitive electric sales market of today. With the completion of the individual plant evaluations (IPEs), numerous opportunities exist for application of probabilistic risk assessment methodology to reduce production costs. This paper presents two nontraditional methods in which IPE results can be used to help reduce nuclear insurance coverage limits and local property taxes. Significant savings can be realized through use of either of these two methods

  17. Health economic potential of early nutrition programming: a model calculation of long-term reduction in blood pressure and related morbidity costs by use of long-chain polyunsaturated fatty acid-supplemented formula.

    Science.gov (United States)

    Straub, Niels; Grunert, Philipp; von Kries, Rüdiger; Koletzko, Berthold

    2011-12-01

    The reported effect sizes of early nutrition programming on long-term health outcomes are often small, and it has been questioned whether early interventions would be worthwhile in enhancing public health. We explored the possible health economic consequences of early nutrition programming by performing a model calculation, based on the only published study currently available for analysis, to evaluate the effects of supplementing infant formula with long-chain polyunsaturated fatty acids (LC-PUFAs) on lowering blood pressure and lowering the risk of hypertension-related diseases in later life. The costs and health effects of LC-PUFA-enriched and standard infant formulas were compared by using a Markov model, including all relevant direct and indirect costs based on German statistics. We assessed the effect size of blood pressure reduction from LC-PUFA-supplemented formula, the long-term persistence of the effect, and the effect of lowered blood pressure on hypertension-related morbidity. The cost-effectiveness analysis showed an increased life expectancy of 1.2 quality-adjusted life-years and an incremental cost-effectiveness ratio of -630 Euros (discounted to present value) for the LC-PUFA formula in comparison with standard formula. LC-PUFA nutrition was the superior strategy even when the blood pressure-lowering effect was reduced to the lower 95% CI. Breastfeeding is the recommended feeding practice, but infants who are not breastfed should receive an appropriate infant formula. Following this model calculation, LC-PUFA supplementation of infant formula represents an economically worthwhile prevention strategy, based on the costs derived from hypertension-linked diseases in later life. However, because our analysis was based on a single randomized controlled trial, further studies are required to verify the validity of this thesis.

  18. Cost reduction through improved seismic design

    International Nuclear Information System (INIS)

    Severud, L.K.

    1984-01-01

    During the past decade, many significnt seismic technology developments have been accomplished by the United States Department of Energy (USDOE) programs. Both base technology and major projects, such as the Fast Flux Test Facility (FFTF) and the Clinch River Breeder Reactor (CRBR) plant, have contributed to seismic technology development and validation. Improvements have come in the areas of ground motion definitions, soil-structure interaction, and structural analysis methods and criteria for piping, equipment, components, reactor core, and vessels. Examples of some of these lessons learned and technology developments are provided. Then, the highest priority seismic technology needs, achievable through DOE actions and sponsorship are identified and discussed. Satisfaction of these needs are expected to make important contributions toward cost avoidances and reduced capital costs of future liquid metal nuclear plants. 23 references, 12 figures

  19. Costs, emissions reductions, and vehicle repair: evidence from Arizona.

    Science.gov (United States)

    Ando, A; McConnell, V; Harrington, W

    2000-04-01

    The Arizona inspection and maintenance (I/M) program provides one of the first opportunities to examine the costs and effectiveness of vehicle emission repair. This paper examines various aspects of emission reductions, fuel economy improvements, and repair costs, drawing data from over 80,000 vehicles that failed the I/M test in Arizona between 1995 and the first half of 1996. We summarize the wealth of data on repair from the Arizona program and highlight its limitations. Because missing or incomplete cost information has been a serious shortcoming for the evaluation of I/M programs, we develop a method for estimating repair costs when they are not reported. We find surprising evidence that almost one quarter of all vehicles that take the I/M test are never observed to pass the test. Using a statistical analysis, we provide some information about the differences between the vehicles that pass and those that do not. Older, more polluting vehicles are much more likely never to pass the I/M test, and their expected repair costs are much higher than those for newer cars. This paper summarizes the evidence on costs and emission reductions in the Arizona program, comparing costs and emissions reductions between cars and trucks. Finally, we examine the potential for more cost-effective repair, first through an analysis of tightening I/M cut points and then by calculating the cost savings of achieving different emission reduction goals when the most cost-effective repairs are made first.

  20. The relationship between health risks and health and productivity costs among employees at Pepsi Bottling Group.

    Science.gov (United States)

    Henke, Rachel M; Carls, Ginger S; Short, Meghan E; Pei, Xiaofei; Wang, Shaohung; Moley, Susan; Sullivan, Mark; Goetzel, Ron Z

    2010-05-01

    To evaluate relationships between modifiable health risks and costs and measure potential cost savings from risk reduction programs. Health risk information from active Pepsi Bottling Group employees who completed health risk assessments between 2004 and 2006 (N = 11,217) were linked to medical care, workers' compensation, and short-term disability cost data. Ten health risks were examined. Multivariate analyses were performed to estimate costs associated with having high risk, holding demographics, and other risks constant. Potential savings from risk reduction were estimated. High risk for weight, blood pressure, glucose, and cholesterol had the greatest impact on total costs. A one-percentage point annual reduction in the health risks assessed would yield annual per capita savings of $83.02 to $103.39. Targeted programs that address modifiable health risks are expected to produce substantial cost reductions in multiple benefit categories.

  1. Low-cost Radon Reduction Pilot Study

    Energy Technology Data Exchange (ETDEWEB)

    Rose, William B. [Univ. of Illinois, Urbana-Champaign, IL (United States); Francisco, Paul W. [Univ. of Illinois, Urbana-Champaign, IL (United States); Merrin, Zachary [Univ. of Illinois, Urbana-Champaign, IL (United States)

    2015-09-01

    The U.S. Department of Energy's Building America research team Partnership for Advanced Residential Retrofits conducted a primary scoping study on the impact of air sealing between the foundation and the living space on radon transport reduction across the foundation and living space floor assembly. Fifteen homes in the Champaign, Illinois, area participated in the study. These homes were instrumented for hourly continuous radon measurements and simultaneous temperature and humidity measurements. Blower door and zone pressure diagnostics were conducted at each house. The treatments consisted of using air-sealing foams at the underside of the floor that separated the living space from the foundation and providing duct sealing on the ductwork that is situated in the foundation area. The hypothesis was that air sealing the floor system that separated the foundation from the living space should better isolate the living space from the foundation; this isolation should lead to less radon entering the living space from the foundation. If the hypothesis had been proven, retrofit energy-efficiency programs may have chosen to adopt these isolation methods for enhanced radon protection to the living space.

  2. Design features and cost reduction potential of JSFR

    International Nuclear Information System (INIS)

    Katoh, Atsushi; Hayafune, Hiroki; Kotake, Shoji

    2014-01-01

    Highlights: • Japan Sodium Cooled Fast Reactor (JSFR) is designed to reduce plant commodity. • Cost reduction effectiveness by innovative designs is estimated by bottom up method. • JSFR achieves 76% construction cost reduction compared with Monju by design effort. • Commercial JSFR construction cost could be less than that of conventional LWR. - Abstract: To improve the economic competitiveness of the Japan Sodium-cooled Fast Reactor (JSFR), several innovative designs have been introduced, e.g. reduction of number of main cooling loop, shorter pipe arrangement by adopting thermally durable material, in fact high chromium ferrite steel, a compact reactor vessel (RV), integration of a primary pump and an intermediate heat exchanger (IHX). Since they had not been introduced in the past and existing reactors, a new approach for construction cost estimation has been introduced to handle innovative technologies, for example, concerning different kinds of material, fabrication processes of equipment etc. As results of JSFR construction cost estimations based on the new method and the latest conceptual JSFR design, economic goals of Generation IV nuclear energy systems can be achieved by expecting the following cost reduction effects: commodity reduction by adopting innovative design, an economy of scale by power generation increase, learning effect etc. It is well analyzed quantitatively that feasibility of innovative designs is essential for economic competitiveness of JSFR

  3. Design features and cost reduction potential of JSFR

    Energy Technology Data Exchange (ETDEWEB)

    Katoh, Atsushi, E-mail: kato.atsushi@jaea.go.jp [Japan Atomic Energy Agency, 4002 Narita, Oarai-machi, Higashi-ibaraki-gun, Ibaraki-ken 311-1393 (Japan); Hayafune, Hiroki [Japan Atomic Energy Agency, 4002 Narita, Oarai-machi, Higashi-ibaraki-gun, Ibaraki-ken 311-1393 (Japan); Kotake, Shoji [The Japan Atomic Power Company, 1-1 Kanda-midoricyo, Chiyoda-ku, Tokyo-to 101-0053 (Japan)

    2014-12-15

    Highlights: • Japan Sodium Cooled Fast Reactor (JSFR) is designed to reduce plant commodity. • Cost reduction effectiveness by innovative designs is estimated by bottom up method. • JSFR achieves 76% construction cost reduction compared with Monju by design effort. • Commercial JSFR construction cost could be less than that of conventional LWR. - Abstract: To improve the economic competitiveness of the Japan Sodium-cooled Fast Reactor (JSFR), several innovative designs have been introduced, e.g. reduction of number of main cooling loop, shorter pipe arrangement by adopting thermally durable material, in fact high chromium ferrite steel, a compact reactor vessel (RV), integration of a primary pump and an intermediate heat exchanger (IHX). Since they had not been introduced in the past and existing reactors, a new approach for construction cost estimation has been introduced to handle innovative technologies, for example, concerning different kinds of material, fabrication processes of equipment etc. As results of JSFR construction cost estimations based on the new method and the latest conceptual JSFR design, economic goals of Generation IV nuclear energy systems can be achieved by expecting the following cost reduction effects: commodity reduction by adopting innovative design, an economy of scale by power generation increase, learning effect etc. It is well analyzed quantitatively that feasibility of innovative designs is essential for economic competitiveness of JSFR.

  4. New approaches to cost reduction on the UK continental shelf

    Energy Technology Data Exchange (ETDEWEB)

    Curtis, M I

    1994-12-31

    The conference paper deals with cost reduction on the UK continental shelf. New approaches on the reduction of field development costs are compared with the cases if traditional approaches had been followed. Field developments where success in aligning the goals and objectives of the contractors and owners which led to projects being delivered on time but more than 20% below budget, are exemplified. The contractors in the alliance received 55% of the savings in addition to their normal profit. The procedure to follow in such cases, is discussed

  5. New approaches to cost reduction on the UK continental shelf

    International Nuclear Information System (INIS)

    Curtis, M.I.

    1994-01-01

    The conference paper deals with cost reduction on the UK continental shelf. New approaches on the reduction of field development costs are compared with the cases if traditional approaches had been followed. Field developments where success in aligning the goals and objectives of the contractors and owners which led to projects being delivered on time but more than 20% below budget, are exemplified. The contractors in the alliance received 55% of the savings in addition to their normal profit. The procedure to follow in such cases, is discussed

  6. Evaluating a Health Risk Reduction Program.

    Science.gov (United States)

    Nagelberg, Daniel B.

    1981-01-01

    A health risk reduction program at Bowling Green State University (Ohio) tested the efficacy of peer education against the efficacy of returning (by mail) health questionnaire results. A peer health education program did not appear to be effective in changing student attitudes or lifestyles; however, the research methodology may not have been…

  7. Cost and schedule reduction for next-generation Candu

    International Nuclear Information System (INIS)

    Hopwood, J.M.; Yu, S.; Pakan, M.; Soulard, M.

    2002-01-01

    AECL has developed a suite of technologies for Candu R reactors that enable the next step in the evolution of the Candu family of heavy-water-moderated fuel-channel reactors. These technologies have been combined in the design for the Advanced Candu Reactor TM1 (ACRTM), AECL's next generation Candu power plant. The ACR design builds extensively on the existing Candu experience base, but includes innovations, in design and in delivery technology, that provide very substantial reductions in capital cost and in project schedules. In this paper, main features of next generation design and delivery are summarized, to provide the background basis for the cost and schedule reductions that have been achieved. In particular the paper outlines the impact of the innovative design steps for ACR: - Selection of slightly enriched fuel bundle design; - Use of light water coolant in place of traditional Candu heavy water coolant; - Compact core design with unique reactor physics benefits; - Optimized coolant and turbine system conditions. In addition to the direct cost benefits arising from efficiency improvement, and from the reduction in heavy water, the next generation Candu configuration results in numerous additional indirect cost benefits, including: - Reduction in number and complexity of reactivity mechanisms; - Reduction in number of heavy water auxiliary systems; - Simplification in heat transport and its support systems; - Simplified human-machine interface. The paper also describes the ACR approach to design for constructability. The application of module assembly and open-top construction techniques, based on Candu and other worldwide experience, has been proven to generate savings in both schedule durations and overall project cost, by reducing premium on-site activities, and by improving efficiency of system and subsystem assembly. AECL's up-to-date experience in the use of 3-D CADDS and related engineering tools has also been proven to reduce both engineering and

  8. Extreme Cost Reductions with Multi-Megawatt Centralized Inverter Systems

    Energy Technology Data Exchange (ETDEWEB)

    Schwabe, Ulrich [Alencon LLC; Fishman, Oleg [Alencon LLC

    2015-03-20

    The objective of this project was to fully develop, demonstrate, and commercialize a new type of utility scale PV system. Based on patented technology, this includes the development of a truly centralized inverter system with capacities up to 100MW, and a high voltage, distributed harvesting approach. This system promises to greatly impact both the energy yield from large scale PV systems by reducing losses and increasing yield from mismatched arrays, as well as reduce overall system costs through very cost effective conversion and BOS cost reductions enabled by higher voltage operation.

  9. Least cost planning for CO2-reduction strategies

    International Nuclear Information System (INIS)

    Seifritz, W.

    1990-01-01

    A first recommendation for the determination of the minimum costs for a carbon-dioxide reduction strategy is presented. For this, the tabulation of so-called, 'CO 2 -ranking-lists', containing the relationship between the costs of a distinct measure to avoid the emission of certain amount of CO 2 (in dollar/t CO 2 ) versus its potential (in t CO 2 /yr), is indispensable. Some basic aspects of this approach are discussed and a first guess of the costs of some measures to avoid CO 2 -emissions into the atmosphere is presented. (orig.) [de

  10. Health care costs, wages, and aging

    OpenAIRE

    Louise Sheiner

    1999-01-01

    While economists generally agree that workers pay for their health insurance costs through reduced wages, there has been little thought devoted to the level at which these costs are passed on: Is each employee's wage reduced by the amount of his or her own health costs, by the average health costs of employees in the firm, or by some amount in between? This paper analyzes one dimension of the question of how firms pass health costs to workers. Using cross-city variation in health costs, I tes...

  11. The ranking of negative-cost emissions reduction measures

    International Nuclear Information System (INIS)

    Taylor, Simon

    2012-01-01

    A flaw has been identified in the calculation of the cost-effectiveness in marginal abatement cost curves (MACCs). The problem affects “negative-cost” emissions reduction measures—those that produce a return on investment. The resulting ranking sometimes favours measures that produce low emissions savings and is therefore unreliable. The issue is important because incorrect ranking means a potential failure to achieve the best-value outcome. A simple mathematical analysis shows that not only is the standard cost-effectiveness calculation inadequate for ranking negative-cost measures, but there is no possible replacement that satisfies reasonable requirements. Furthermore, the concept of negative cost-effectiveness is found to be unsound and its use should be avoided. Among other things, this means that MACCs are unsuitable for ranking negative-cost measures. As a result, MACCs produced by a range of organizations including UK government departments may need to be revised. An alternative partial ranking method has been devised by making use of Pareto optimization. The outcome can be presented as a stacked bar chart that indicates both the preferred ordering and the total emissions saving available for each measure without specifying a cost-effectiveness. - Highlights: ► Marginal abatement cost curves (MACCs) are used to rank emission reduction measures. ► There is a flaw in the standard ranking method for negative-cost measures. ► Negative values of cost-effectiveness (in £/tC or equivalent) are invalid. ► There may be errors in published MACCs. ► A method based on Pareto principles provides an alternative ranking method.

  12. Levelized cost-risk reduction prioritization of waste disposal options

    International Nuclear Information System (INIS)

    Wilkinson, V.K.; Young, J.M.

    1992-01-01

    The prioritization of solid waste disposal options in terms of reduced risk to workers, the public, and the environment has recently generated considerable governmental and public interest. In this paper we address the development of a methodology to establish priorities for waste disposal options, such as incineration, landfills, long-term storage, waste minimization, etc. The study is one result of an overall project to develop methodologies for Probabilistic Risk Assessments (PRAs) of non-reactor nuclear facilities for the US Department of Energy. Option preferences are based on a levelized cost-risk reduction analysis. Option rankings are developed as functions of disposal option cost and timing, relative long- and short-term risks, and possible accident scenarios. We examine the annual costs and risks for each option over a large number of years. Risk, in this paper, is defined in terms of annual fatalities (both prompt and long-term) and environmental restoration costs that might result from either an accidental release or long-term exposure to both plant workers and the public near the site or facility. We use event timing to weigh both costs and risks; near-term costs and risks are discounted less than future expenditures and fatalities. This technique levels the timing of cash flows and benefits by converting future costs and benefits to present value costs and benefits. We give an example Levelized Cost-Benefit Analysis of incinerator location options to demonstrate the methodology and required data

  13. Who pays for public employee health costs?

    Science.gov (United States)

    Clemens, Jeffrey; Cutler, David M

    2014-12-01

    We analyze the incidence of public-employee health benefits. Because these benefits are negotiated through the political process, relevant labor market institutions deviate significantly from the competitive, private-sector benchmark. Empirically, we find that roughly 15 percent of the cost of recent benefit growth was passed onto school district employees through reductions in wages and salaries. Strong teachers' unions were associated with relatively strong linkages between benefit growth and growth in total compensation. Our analysis is consistent with the view that the costs of public workers' benefits are difficult to monitor, contributing to benefit oriented, and often under-funded, compensation schemes. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. Cost-effectiveness of reduction of off-site dose

    International Nuclear Information System (INIS)

    McGrath, J.J.; Macphee, R.; Arbeau, N.; Miskin, J.; Scott, C.K.; Winters, E.

    1988-03-01

    Since the early 1970's, nuclear power plants have been designed and operated with a target of not releasing more than one percent of the licensed limits (derived emission limits) in liquid and gaseous effluents. The AECB initiated this study of the cost-effectiveness of the reduction of off-site doses as part of a review to determine if further measures to reduce off-site doses might be reasonably achievable. Atlantic Nuclear has estimated the cost of existing technology options that can be applied for a further reduction of radioactive effluents from future CANDU nuclear power plants. Detritiation, filtration, ion exchange and evaporation are included in the assessment. The costs are presented in 1987 Canadian dollars, and include capital and operating costs for a reference 50 year plant life. Darlington NGS and Point Lepreau NGS are the reference nuclear power plant types and locations. The effect resulting from the hypothetical application of each technology has been calculated as the resulting reduction in world collective radiation dose detriment. The CSA N288.1 procedure was used for local pathway analysis and the global dispersion model developed by the NEA (OECD) group of experts was used for dose calculations. The reduction in the 'collective effective dose equivalent commitment' was assumed to exist for 10,000 years, the expected life-span of solid waste repositories. No attempt was made to model world population dynamics. The collective dose reductions were calculated for a nominal world population of 10 billion persons. The estimated cost and effect of applying the technology options are summarized in a tabular form for input to further consideration of 'reasonably achievable off-site dose levels'

  15. Quantifying the emissions reduction effectiveness and costs of oxygenated gasoline

    International Nuclear Information System (INIS)

    Lyons, C.E.

    1993-01-01

    During the fall, winter, and spring of 1991-1992, a measurement program was conducted in Denver, Colorado to quantify the technical and economic effectiveness of oxygenated gasoline in reducing automobile carbon monoxide (CO) emissions. Emissions from 80,000 vehicles under a variety of operating conditions were measured before, during, and after the seasonal introduction of oxygenated gasoline into the region. Gasoline samples were taken from several hundred vehicles to confirm the actual oxygen content of the fuel in use. Vehicle operating conditions, such as cold starts and warm operations, and ambient conditions were characterized. The variations in emissions attributable to fuel type and to operating conditions were then quantified. This paper describes the measurement program and its results. The 1991-1992 Colorado oxygenated gasoline program contributed to a reduction in carbon monoxide (CO) emissions from gasoline-powered vehicles. The measurement program demonstrated that most of the reduction is concentrated in a small percentage of the vehicles that use oxygenated gasoline. The remainder experience little or not reduction in emissions. The oxygenated gasoline program outlays are approximately $25 to $30 million per year in Colorado. These are directly measurable costs, incurred through increased government expenditures, higher costs to private industry, and losses in fuel economy. The measurement program determined the total costs of oxygenated gasoline as an air pollution control strategy for the region. Costs measured included government administration and enforcement, industry production and distribution, and consumer and other user costs. This paper describes the ability of the oxygenated gasoline program to reduce pollution; the overall cost of the program to government, industry, and consumers; and the effectiveness of the program in reducing pollution compared to its costs

  16. Cost effective snubber reduction program for nuclear power plants

    International Nuclear Information System (INIS)

    Adams, T.M.; Antaki, G.A.; Chang, K.C.

    1985-01-01

    Due to the stringent seismic requirements imposed on nuclear power plants, piping engineers have resorted to the extensive use of snubbers to support nuclear piping systems. The advantage of snubbers is that they provide dynamic restraint while allowing free thermal growth of the pipe. Unfortunately, as more plants go into operation, utilities have to face the costs of strict in-service inspection requirements and risks of unscheduled or extended plant outages associated with snubber failures. The snubber inspection requirements, defined in plant Technical Specifications, require periodic visual inspections of all snubbers and functional tests of a percentage of the plant snubbers, during refueling outages. For a typical 1000 Mw unit this represents from 50 to several hundred snubbers to be functionally tested at each refueling outage. Should failures occur during testing, the sample size must be further increased. Very quickly the costs and risks of extended shutdowns have led the industry to consider, and in many cases implement, snubber reduction programs. At the same time several changes in seismic design criteria have greatly facilitated the reduction of snubbers, making snubber elimination economically and technically attractive. In this paper we examine the costs and benefits of snubber reduction programs and propose a method for evaluating their cost benefits

  17. Cost-effective reduction of fine primary particulate matter emissions in Finland

    International Nuclear Information System (INIS)

    Karvosenoja, Niko; Klimont, Zbigniew; Tohka, Antti; Johansson, Matti

    2007-01-01

    Policies to reduce adverse health impacts of fine particulate matter (PM 2.5 ) require information on costs of abatement and associated costs. This paper explores the potential for cost-efficient control of anthropogenic primary PM 2.5 emissions in Finland. Based on a Kyoto-compliant energy projection, two emission control scenarios for 2020 were developed. 'Baseline' assumes implementation of PM controls in compliance with existing legislation. 'Reduction' assumes ambitious further reductions. Emissions for 2020 were estimated at 26 and 18.6 Gg a -1 for 'Baseline' and 'Reduction', respectively. The largest abatement potential, 3.0 Gg a -1 , was calculated for power plants and industrial combustion. The largest potential with marginal costs below 5000 Euro MG(PM 2.5 ) -1 was for domestic wood combustion, 1.7 Gg a -1 . For traffic the potential was estimated at 1.0 Gg a -1 , but was associated with high costs. The results from this paper are used in the policy-driven national integrated assessment modeling that explores cost-efficient reductions of the health impacts of PM

  18. Cost reduction potentials in the German market for balancing power

    International Nuclear Information System (INIS)

    Flinkerbusch, Kai; Heuterkes, Michael

    2010-01-01

    This article examines potential cost reductions in the market for balancing power by pooling all four German control areas. In a united control area both the procurement and the production of balancing power may be more efficient than in four separated control areas. Our data contain bids on energy procurement as well as balancing power flows in the period from December 2007 to November 2008. A reference scenario simulates the market results for secondary and tertiary balancing power. Subsequently, we simulate a united control area. We show that in the period under review the total costs of balancing power are reduced by 17%. (author)

  19. Seeking the competitive advantage: it's more than cost reduction.

    Science.gov (United States)

    South, S F

    1999-01-01

    Most organizations focus considerable time and energy on reducing operating costs as a way to attain marketplace advantage. This strategy was not inappropriate in the past. To be competitive in the future, however, focus must be placed on other issues, not just cost reduction. The near future will be dominated by service industries, knowledge management, and virtual partnerships, with production optimization and flexibility, innovation, and strong partnerships defining those organizations that attain competitive advantage. Competitive advantage will reside in clarifying the vision and strategic plan, reviewing and redesigning work processes to optimize resources and value-added work, and creating change-ready environments and empowered workforces.

  20. Time-driven activity-based costing to identify opportunities for cost reduction in pediatric appendectomy.

    Science.gov (United States)

    Yu, Yangyang R; Abbas, Paulette I; Smith, Carolyn M; Carberry, Kathleen E; Ren, Hui; Patel, Binita; Nuchtern, Jed G; Lopez, Monica E

    2016-12-01

    As reimbursement programs shift to value-based payment models emphasizing quality and efficient healthcare delivery, there exists a need to better understand process management to unearth true costs of patient care. We sought to identify cost-reduction opportunities in simple appendicitis management by applying a time-driven activity-based costing (TDABC) methodology to this high-volume surgical condition. Process maps were created using medical record time stamps. Labor capacity cost rates were calculated using national median physician salaries, weighted nurse-patient ratios, and hospital cost data. Consumable costs for supplies, pharmacy, laboratory, and food were derived from the hospital general ledger. Time-driven activity-based costing resulted in precise per-minute calculation of personnel costs. Highest costs were in the operating room ($747.07), hospital floor ($388.20), and emergency department ($296.21). Major contributors to length of stay were emergency department evaluation (270min), operating room availability (395min), and post-operative monitoring (1128min). The TDABC model led to $1712.16 in personnel costs and $1041.23 in consumable costs for a total appendicitis cost of $2753.39. Inefficiencies in healthcare delivery can be identified through TDABC. Triage-based standing delegation orders, advanced practice providers, and same day discharge protocols are proposed cost-reducing interventions to optimize value-based care for simple appendicitis. II. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Health risk reduction programs in employer-sponsored health plans: Part II-law and ethics.

    Science.gov (United States)

    Rothstein, Mark A; Harrell, Heather L

    2009-08-01

    We sought to examine the legal and ethical implications of workplace health risk reduction programs (HRRPs) using health risk assessments, individually focused risk reduction, and financial incentives to promote compliance. We conducted a literature review, analyzed relevant statutes and regulations, and considered the effects of these programs on employee health privacy. A variety of laws regulate HRRPs, and there is little evidence that employer-sponsored HRRPs violate these provisions; infringement on individual health privacy is more difficult to assess. Although current laws permit a wide range of employer health promotion activities, HRRPs also may entail largely unquantifiable costs to employee privacy and related interests.

  2. Health Risk Reduction Programs in Employer-Sponsored Health Plans: Part II—Law and Ethics

    Science.gov (United States)

    Rothstein, Mark A.; Harrell, Heather L.

    2011-01-01

    Objective We sought to examine the legal and ethical implications of workplace health risk reduction programs (HRRPs) using health risk assessments, individually focused risk reduction, and financial incentives to promote compliance. Methods We conducted a literature review, analyzed relevant statutes and regulations, and considered the effects of these programs on employee health privacy. Results A variety of laws regulate HRRPs, and there is little evidence that employer-sponsored HRRPs violate these provisions; infringement on individual health privacy is more difficult to assess. Conclusion Although current laws permit a wide range of employer health promotion activities, HRRPs also may entail largely unquantifiable costs to employee privacy and related interests. PMID:19625971

  3. Cost reduction potentials of offshore wind power in Germany

    International Nuclear Information System (INIS)

    Hobohm, Jens; Krampe, Leonard; Peter, Frank

    2014-01-01

    Offshore wind power is a major hope for the German energy turnaround. However, it will only be possible to tap its cost reduction potentials if industry, the political leadership and the administrative authorities join forces to create the necessary preconditions. An important requirement for this capital-intensive technology are stable legal and political framework conditions. A recent study on the future shows what needs to be done.

  4. Pipeline cost reduction through effective project management and applied technology

    Energy Technology Data Exchange (ETDEWEB)

    Jenkins, A. [TransCanada Pipeline Ltd., Alberta (Canada); Babuk, T. [Empress International Inc., Westwood, NJ (United States); Mohitpour, M. [Tempsys Pipeline Solutions Inc., Vancouver, BC (Canada); Murray, M.A. [National Energy Board of Canada (Canada)

    2005-07-01

    Pipelines are regarded by many as passive structures with the technology involved in their construction and operation being viewed as relatively simple and stable. If such is the case how can there be much room for cost improvement? In reality, there have been many technological and regulatory innovations required within the pipeline industry to meet the challenges posed by ever increasing consumer demand for hydrocarbons, the effects of aging infrastructure and a need to control operating and maintenance expenditures. The importance of technology management, as a subset of overall project management, is a key element of life cycle cost control. Assurance of public safety and the integrity of the system are other key elements in ensuring a successful pipeline project. The essentials of best practise project management from an owner/ operator's perspective are set out in the paper. Particular attention is paid to the appropriate introduction of new technology, strategic procurement practice and material selection, indicating that capital cost savings of up to 15% are achievable without harming life cycle cost. The value of partnering leading to technical innovation, cost savings and improved profitability for all the participants is described. Partnering also helps avoid duplicated effort through the use of common tools for design, planning schedule tracking and reporting. Investing in appropriate technology development has been a major source of cost reduction in recent years and the impact of a number of these recently introduced technologies in the areas of materials, construction processes and operation and maintenance are discussed in the paper. (author)

  5. Beyond the learning curve: factors influencing cost reductions in photovoltaics

    International Nuclear Information System (INIS)

    Nemet, Gregory F.

    2006-01-01

    The extent and timing of cost-reducing improvements in low-carbon energy systems are important sources of uncertainty in future levels of greenhouse-gas emissions. Models that assess the costs of climate change mitigation policy, and energy policy in general, rely heavily on learning curves to include technology dynamics. Historically, no energy technology has changed more dramatically than photovoltaics (PV), the cost of which has declined by a factor of nearly 100 since the 1950s. Which changes were most important in accounting for the cost reductions that have occurred over the past three decades? Are these results consistent with the notion that learning from experience drove technical change? In this paper, empirical data are assembled to populate a simple model identifying the most important factors affecting the cost of PV. The results indicate that learning from experience, the theoretical mechanism used to explain learning curves, only weakly explains change in the most important factors-plant size, module efficiency, and the cost of silicon. Ways in which the consideration of a broader set of influences, such as technical barriers, industry structure, and characteristics of demand, might be used to inform energy technology policy are discussed

  6. Flying Lessons: Learning from Ryanair's Cost Reduction Culture

    Science.gov (United States)

    Lawton, Thomas C.

    2000-01-01

    Through radically improving the value equation for airline customers, Ryanair has served to shake-up established norms and practices in European aviation. Underpinning its price leadership and market success is a vigorous and relentless cost reduction ethos and resultant low break-even load factor. Ryanair has lowered European airline cost structures considerably, shattering existing cost floors. Few competitors are able to follow, either because they do not know how or they are unable due to social settlement obligations or service commitments. At the same time, the company has maintained high average load factors on its flights. Taken in conjunction with its low break-even load factor, this results in consistently high overall profit margins. On this basis, Ryanair is likely to remain a significant competitor and increase its market presence and success across Europe.

  7. Low-cost risk reduction strategy for small workplaces: how can we spread good practices?

    Science.gov (United States)

    Kogi, K

    2006-01-01

    Recent advances in health risk reduction approaches are examined based on inter-country networking experiences. A noteworthy progress is the wider application of low-cost improvements to risk reduction particularly in small enterprises and agriculture in both industrially developing and developed countries. This is helped by the readiness of managers and workers to implement these improvements despite many constraints. Typical improvements include mobile racks, simple workstation changes, screening hazards, better welfare facilities and teamwork arrangements. In view of the complex circumstances of work-related health risks, it is important to know whether a low-cost strategy can advance risk reduction practices effectively and what support measures are necessary. It is confirmed that the strategy can overcome related constraints through its advantages. Main advantages lie in (a) the facilitation of improved practices in multiple technical areas, (b) the strengthening of realistic stepwise risk reduction, and (c) the enhanced multiplier effects through training of local trainers. Action-oriented risk assessment tools, such as action checklists and low-cost improvement guides, can encourage risk-reducing measures adjusted to each local situation. It is suggested to spread the low-cost risk reduction strategy for improving small workplaces in diversified settings with the support of these locally tailored tools.

  8. Cost-effectiveness analysis of cochlear dose reduction by proton beam therapy for medulloblastoma in childhood

    International Nuclear Information System (INIS)

    Hirano, Emi; Kawabuchi, Koichi; Fuji, Hiroshi; Onoe, Tsuyoshi; Kumar, Vinay; Shirato, Hiroki

    2014-01-01

    The aim of this study is to evaluate the cost-effectiveness of proton beam therapy with cochlear dose reduction compared with conventional X-ray radiotherapy for medulloblastoma in childhood. We developed a Markov model to describe health states of 6-year-old children with medulloblastoma after treatment with proton or X-ray radiotherapy. The risks of hearing loss were calculated on cochlear dose for each treatment. Three types of health-related quality of life (HRQOL) of EQ-5D, HUI3 and SF-6D were used for estimation of quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) for proton beam therapy compared with X-ray radiotherapy was calculated for each HRQOL. Sensitivity analyses were performed to model uncertainty in these parameters. The ICER for EQ-5D, HUI3 and SF-6D were $21 716/QALY, $11 773/QALY, and $20 150/QALY, respectively. One-way sensitivity analyses found that the results were sensitive to discount rate, the risk of hearing loss after proton therapy, and costs of proton irradiation. Cost-effectiveness acceptability curve analysis revealed a 99% probability of proton therapy being cost effective at a societal willingness-to-pay value. Proton beam therapy with cochlear dose reduction improves health outcomes at a cost that is within the acceptable cost-effectiveness range from the payer's standpoint. (author)

  9. Reduction of cost of poor quality in nuclear fuel manufacturing

    International Nuclear Information System (INIS)

    Holmqvist, B.

    2000-01-01

    Within ABB reduction of Cost of Poor Quality (COPQ) has become an important process to focus quality improvement initiatives on bottom-line results. The process leads to improved bottom-line results, through cost savings, but it also leads to quality improvements in our processes, products and services. The traditional way of measuring and controlling COPQ in the production workshops is not enough. It is of vital importance to include other non-value creating costs as well, both internally, e.g. in the engineering work, and externally, in delivered products and purchased goods. ABB Atom has since a number of years used the COPQ process in the various steps of nuclear fuel manufacturing. The definition has been expanded to cover, for instance: Scrap, rework and deviations; Margin slippage; Warranty costs; Lack of supplier performance; Excess and obsolete inventory. Each of the COPQ elements has a responsible 'owner' within the management of the Nuclear Fuel Division. The owners form a COPQ task force, which is responsible for analyzing results, setting goals and initiating improvement actions. The COPQ result is updated each month and is presented to all employees in several ways, such as Intranet. For the various COPQ elements improvement initiatives have been implemented. The presentation will describe some of them, such as reduction of: Scrap, rework and deviations through a process with zero defect meetings, high level of process automation, statistical methods; Margin slippage through business process re-engineering; Warranty costs through an improved design review process and expanded testing of new products; Costs for lack in supplier performance through a new concept for supplier QA/QC. It is our strong belief that both ABB Atom and our Customers will benefit from the COPQ process since it leads to a higher quality for nuclear fuel and control rods and facilitates lower product prices. (author)

  10. A Model of Cost Reduction and Standardization: Improved Cost Savings While Maintaining the Quality of Care.

    Science.gov (United States)

    Guzman, Michael J; Gitelis, Matthew E; Linn, John G; Ujiki, Michael B; Waskerwitz, Matthew; Umanskiy, Konstantin; Muldoon, Joseph P

    2015-11-01

    Surgeon instrument choices are influenced by training, previous experience, and established preferences. This causes variability in the cost of common operations, such as laparoscopic appendectomy. Many surgeons are unaware of the impact that this has on healthcare spending. We sought to educate surgeons on their instrument use and develop standardized strategies for operating room cost reduction. We collected the individual surgeon instrument cost for performing a laparoscopic appendectomy. Sixteen surgeons were educated about these costs and provided with cost-effective instruments and techniques. This study was conducted in a university-affiliated hospital system. Patients included those undergoing a laparoscopic appendectomy within the hospital system. Patient demographics, operating room costs, and short-term outcomes for the fiscal year before and after the education program were then compared. During fiscal year 2013, a total of 336 laparoscopic appendectomies were performed compared with 357 in 2014. Twelve surgeons had a ≥5% reduction in average cost per case. Overall, the average cost per case was reduced by 17% (p day readmissions, postoperative infections, operating time, or reoperations. This retrospective study is subject to the accuracy of the medical chart system. In addition, specific instrument costs are based on our institution contracts and vary compared with other institutions. In this study we demonstrate that operative instrument costs for laparoscopic appendectomy can be significantly reduced by informing the surgeons of their operating room costs compared with their peers and providing a low-cost standardized instrument tray. Importantly, this can be realized without any incentive or punitive measures and does not negatively impact outcomes. Additional work is needed to expand these results to more operations, hospital systems, and training programs.

  11. The importance of capital cost reduction in improving nuclear economics

    International Nuclear Information System (INIS)

    Langmo, A.; Braun, C.

    1996-01-01

    In the developed countries having existing nuclear programs, the situation necessitates lower total power generation cost. The restructuring of utility industry due to the deregulation causes to reorganize the ownership of some nuclear plants, and the overall economics of nuclear plants in relation to their local competition is reexamined. The reluctance to make any new long term capital cost commitment arises, and it makes new plant construction less likely in near future, and plant upgrading and improvement to be put to intense scrutiny. The capital cost recovery in existing nuclear plants in USA is discussed. It is important to recognize that there is very little that can be done to affect already expended capital, and only that can be done is to improve plant capacity factors, besides write-off. The roles of architects and engineers in improved plant economics are now evaluated by the various organizations which are interested in the participation in new nuclear industry reorganization and restructuring. The reduction of operation and maintenance costs and capital investment, and the improvement of capacity factor are reported. In new ALWR construction program, architects and engineers can significantly support the control of plant capital costs by the selection of the plant design and the sites, and the strategies of procurement and contract, construction schedule and others. (K.I.)

  12. Cost effective reductions in the agricultural load of nitrogen to the Baltic Sea

    Energy Technology Data Exchange (ETDEWEB)

    Elofsson, K.

    1997-11-01

    To restore the health of the Baltic Sea, the Helsinki Commission, HELCOM, suggests that the nitrogen load should be reduced by 50%. The agricultural sector accounts for about 1/3 of the total load of nitrogen to the Baltic Sea, while point sources account for about 1/4. The remaining load reaches the Baltic as atmospheric deposition. The purpose of this study is to calculate cost effective reductions in the agricultural load of nitrogen to the Baltic Sea coastal waters. The Baltic Sea drainage basin is divided into 17 regions, which differ with respect to costs, leaching and nitrogen retention. For each region, cost functions are estimated for 11 nitrogen abatement measures in the agricultural sector. It is difficult to find reliable data on both costs and biological parameters for all regions included, and several assumptions are made to obtain the cost functions. In this paper the total cost of a 50% reduction of the nitrogen load from arable land is estimated to 11,700 million SEK per year. A decrease in the use of fertilizer nitrogen is the most important measure in a cost effective policy. Other measures included in the cost effective solution are changes in land-use and in manure management practices. If, instead, each country is required to reduce its load by 50%, the total cost will increase by nearly 60%. Three out of nine countries around the Baltic Sea would gain from separate reduction targets, while all others lose by such a policy. The results are sensitive to assumptions about the biological parameters and the shape of the cost functions for reductions in chemical fertilizer. 75 refs, 3 figs, 11 tabs

  13. Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction.

    Science.gov (United States)

    Warner, Courtney J; Horvath, Alexander J; Powell, Richard J; Columbo, Jesse A; Walsh, Teri R; Goodney, Philip P; Walsh, Daniel B; Stone, David H

    2015-08-01

    Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care systems. Copyright © 2015 Society for

  14. Cost reduction has priority in solar cell research

    International Nuclear Information System (INIS)

    Van Zolingen, R.J.C.; Sinke, W.C.

    1993-01-01

    The main topic in the research and development of photovoltaic cells is cost reduction. Although new materials, improved techniques and increasing efficiency are promising aspects of the clean and sustainable option of a photovoltaic conversion of sunlight to produce electricity at a large scale, the high prices form an obstacle. Photovoltaic conversion is at least a factor three too expensive compared to the conventional power generation techniques by means of fossil fuels. Attention is paid to the theoretical maximum efficiency of photovoltaic conversion, the efficiencies realized sofar, the importance of thin film solar cells, the payback period of photovoltaic modules, the environmental impacts of using photovoltaic cells, and finally the costs. 2 figs., 1 ill., 2 tabs., 6 refs

  15. Community Mental Health Clinic Cost Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — Healthcare Cost Report Information System (HCRIS) Dataset - Community Mental Health Center (CMHC). This data was reported on form CMS-2088-92. The data in this...

  16. Reduction in Fabrication Costs of Gas Diffusion Layers

    Energy Technology Data Exchange (ETDEWEB)

    Jason Morgan; Donald Connors; Michael Hickner

    2012-07-10

    Ballard Material Products (BMP) performed a pre-design technical and cost analysis of state of the art production technologies feasible for high volume GDL manufacturing. Based upon criteria that also included environmental health and safety, customer quality requirements, and future needs, BMP selected technologies that can be integrated into its current manufacturing process. These selections included Many-At-A-Time (MAAT) coating and continuous mixing technologies, as well as various on-line process control tools. These processes have allowed BMP to produce high performance GDLs at lower cost for near-term markets, as well as to define the inputs needed to develop a conceptual Greenfield facility to meet the cost targets for automotive volumes of 500,000 vehicles per year.

  17. Development of pollution reduction strategies for Mexico City: Estimating cost and ozone reduction effectiveness

    International Nuclear Information System (INIS)

    Thayer, G.R.; Hardie, R.W.; Barrera-Roldan, A.

    1993-01-01

    This reports on the collection and preparation of data (costs and air quality improvement) for the strategic evaluation portion of the Mexico City Air Quality Research Initiative (MARI). Reports written for the Mexico City government by various international organizations were used to identify proposed options along with estimates of cost and emission reductions. Information from appropriate options identified by SCAQMD for Southem California were also used in the analysis. A linear optimization method was used to select a group of options or a strategy to be evaluated by decision analysis. However, the reduction of ozone levels is not a linear function of the reduction of hydrocarbon and NO x emissions. Therefore, a more detailed analysis was required for ozone. An equation for a plane on an isopleth calculated with a trajectory model was obtained using two endpoints that bracket the expected total ozone precursor reductions plus the starting concentrations for hydrocarbons and NO x . The relationship between ozone levels and the hydrocarbon and NO x concentrations was assumed to lie on this plane. This relationship was used in the linear optimization program to select the options comprising a strategy

  18. Review comments on Environmental Analysis Cost Reduction Proposals (WIPP-DOE-136), July 1982

    International Nuclear Information System (INIS)

    Channell, J.K.

    1982-11-01

    The cost reduction proposals have the laudable goal of significantly reducing the total capital And operating cost connected with WIPP. Furthermore, since the proposed changes would reduce the size and operating rate of the project, they would be expected to have decreased environmental And socioeconomic impacts. However, some of these cost reduction proposals do decrease factors of safety in various components of the project or trade off one type of environmental detriment for another. The report does not contain sufficient detail to justify all of the conclusions reached; more discussion and quantitative information (including costs) is necessary in some cases. Also, there are places where the report is unclear or contradictory. Without a more detailed evaluation, EEG is unable to conclude that each of these cost reduction proposals either has a net environmental/health and safety benefit or a cost savings that justifies a net detriment. A revised Environmental Analysis (EA) should either include additional information or specifically reference backup documents where these conclusions have been justified. In addition, the EA needs to be revised to include the effect of the recently announced (11/18/82) decision by DOE to relocate the underground waste storage areas of the repository to the south

  19. Health Services Cost Analyzing in Tabriz Health Centers 2008

    Directory of Open Access Journals (Sweden)

    Massumeh gholizadeh

    2015-08-01

    Full Text Available Background and objectives : Health Services cost analyzing is an important management tool for evidence-based decision making in health system. This study was conducted with the purpose of cost analyzing and identifying the proportion of different factors on total cost of health services that are provided in urban health centers in Tabriz. Material and Methods : This study was a descriptive and analytic study. Activity Based Costing method (ABC was used for cost analyzing. This cross–sectional survey analyzed and identified the proportion of different factors on total cost of health services that are provided in Tabriz urban health centers. The statistical population of this study was comprised of urban community health centers in Tabriz. In this study, a multi-stage sampling method was used to collect data. Excel software was used for data analyzing. The results were described with tables and graphs. Results : The study results showed the portion of different factors in various health services. Human factors by 58%, physical space 8%, medical equipment 1.3% were allocated with high portion of expenditures and costs of health services in Tabriz urban health centers. Conclusion : Based on study results, since the human factors included the highest portion of health services costs and expenditures in Tabriz urban health centers, balancing workload with staff number, institutionalizing performance-based management and using multidisciplinary staffs may lead to reduced costs of services. ​

  20. Accounting for Health and Safety costs

    DEFF Research Database (Denmark)

    Rikhardsson, Pall M.

    A part of the emerging sustainability management accounting is corporate health and safety performance. One performance dimension is the costs of occupational accidents in companies. The underlying logic for calculating these costs is that if occupational accidents are prevented then these costs...... could be avoided. This chapter presents and discusses selected methods for calculating the costs of occupational accidents. The focus is on presenting the characteristics of each method and disclosing the benefits and drawbacks of each method...

  1. High and rising health care costs.

    Science.gov (United States)

    Ginsburg, Paul B

    2008-10-01

    The U.S. is spending a growing share of the GDP on health care, outpacing other industrialized countries. This synthesis examines why costs are higher in the U.S. and what is driving their growth. Key findings include: health care inefficiency, medical technology and health status (particularly obesity) are the primary drivers of rising U.S. health care costs. Health payer systems that reward inefficiencies and preempt competition have impeded productivity gains in the health care sector. The best evidence indicates medical technology accounts for one-half to two-thirds of spending growth. While medical malpractice insurance and defensive medicine contribute to health costs, they are not large enough factors to significantly contribute to a rise in spending. Research is consistent that demographics will not be a significant factor in driving spending despite the aging baby boomers.

  2. Sustainable cost reduction by lean management in metallurgical processes

    Directory of Open Access Journals (Sweden)

    A. V. Todorut

    2016-10-01

    Full Text Available This paper focuses on the need for sustainable cost reduction in the metallurgical industry by applying Lean Management (LM tools and concepts in metallurgical production processes leading to increased competitiveness of corporations in a global market. The paper highlights that Lean Management is a novel way of thinking, adapting to change, reducing waste and continuous improvement, leading to sustainable development of companies in the metallurgical industry. The authors outline the main Lean Management instruments based on recent scientific research and include a comparative analysis of other tools, such as Sort, Straighten, Shine, Standardize, Sustain (5S, Visual Management (VM, Kaizen, Total Productive Maintenance (TPM, Single-Minute Exchange of Dies (SMED, leading to a critical appraisal of their application in the metallurgical industry.

  3. Low cost biological lung volume reduction therapy for advanced emphysema

    Directory of Open Access Journals (Sweden)

    Bakeer M

    2016-08-01

    Full Text Available Mostafa Bakeer,1 Taha Taha Abdelgawad,1 Raed El-Metwaly,1 Ahmed El-Morsi,1 Mohammad Khairy El-Badrawy,1 Solafa El-Sharawy2 1Chest Medicine Department, 2Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt Background: Bronchoscopic lung volume reduction (BLVR, using biological agents, is one of the new alternatives to lung volume reduction surgery.Objectives: To evaluate efficacy and safety of biological BLVR using low cost agents including autologous blood and fibrin glue.Methods: Enrolled patients were divided into two groups: group A (seven patients in which autologous blood was used and group B (eight patients in which fibrin glue was used. The agents were injected through a triple lumen balloon catheter via fiberoptic bronchoscope. Changes in high resolution computerized tomography (HRCT volumetry, pulmonary function tests, symptoms, and exercise capacity were evaluated at 12 weeks postprocedure as well as for complications.Results: In group A, at 12 weeks postprocedure, there was significant improvement in the mean value of HRCT volumetry and residual volume/total lung capacity (% predicted (P-value: <0.001 and 0.038, respectively. In group B, there was significant improvement in the mean value of HRCT volumetry and (residual volume/total lung capacity % predicted (P-value: 0.005 and 0.004, respectively. All patients tolerated the procedure with no mortality.Conclusion: BLVR using autologous blood and locally prepared fibrin glue is a promising method for therapy of advanced emphysema in term of efficacy, safety as well as cost effectiveness. Keywords: BLVR, bronchoscopy, COPD, interventional pulmonology

  4. Health Advocacy--Counting the Costs

    Science.gov (United States)

    Dyall, Lorna; Marama, Maria

    2010-01-01

    Access to, and delivery of, safe and culturally appropriate health services is increasingly important in New Zealand. This paper will focus on counting the costs of health advocacy through the experience of a small non government charitable organisation, the Health Advocates Trust, (HAT) which aimed to provide advocacy services for a wide range of…

  5. The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model.

    Science.gov (United States)

    Laramée, Philippe; Brodtkorb, Thor-Henrik; Rahhali, Nora; Knight, Chris; Barbosa, Carolina; François, Clément; Toumi, Mondher; Daeppen, Jean-Bernard; Rehm, Jürgen

    2014-09-16

    To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths. Decision modelling using Markov chains compared costs and effects over 5 years. The analysis was from the perspective of the National Health Service (NHS) in England and Wales. The model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment. We modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources. We measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided. Nalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20,000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100,000 patients compared to psychosocial support alone over the course of 5 years. Nalmefene can be seen as a cost-effective treatment for alcohol dependence, with substantial public

  6. The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model

    Science.gov (United States)

    Laramée, Philippe; Brodtkorb, Thor-Henrik; Rahhali, Nora; Knight, Chris; Barbosa, Carolina; François, Clément; Toumi, Mondher; Daeppen, Jean-Bernard; Rehm, Jürgen

    2014-01-01

    Objectives To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths. Design Decision modelling using Markov chains compared costs and effects over 5 years. Setting The analysis was from the perspective of the National Health Service (NHS) in England and Wales. Participants The model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment. Data sources We modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources. Main outcome measures We measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided. Results Nalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20 000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100 000 patients compared to psychosocial support alone over the course of 5 years. Conclusions

  7. COST OF PRIMARY HEALTH CARE IN PAKISTAN.

    Science.gov (United States)

    Malik, Muhammad Ashar; Gul, Wahid; Iqbal, Saleem Perwaiz; Abrejo, Farina

    2015-01-01

    Detailed cost analysis is an important tool for review of health policy and reforms. We provide an estimate of cost of service and its detailed breakup on out-door patient visits (OPV) to basic health units (BHU) in Pakistan. Six BHUs were randomly selected from each of the five districts in Khyber Pukhtonkhawa (KPK) and two agencies in Federally Administered Tribal Areas (FATA) of Pakistan for this study. Actual expenditure data and utilization data in the year 2005-06 of 42 BHUs was collected from selected district health offices in KPK and FATA. Costs were estimated for outpatient visits to BHUs. Perspective on cost estimates was district-based health planning and management of BHUs. Average recurring cost was PKR.245 (USD 4.1) per OPV to BHU. Staff salaries constituted 90% of recurrent cost. On the average there were 16 OPV per day to the BHUs. CONCLUDION: Recurrent cost per OPV has doubled from the previous estimates of cost of OPV in Baluchistan. The estimated recurrent cost was six times higher than average consultation charges with the private general practitioner (GP) in the country (i.e., PKR 50/ GP consultation). Performance of majority of the BHUs was much lower than the performance target (50 patients per day) set in the sixth five-year plan of the government of Pakistan. The Government of Pakistan may use these analyses to revisit the performance target, staffinL and location of BHUs.

  8. Vehicle Lightweighting: Mass Reduction Spectrum Analysis and Process Cost Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Mascarin, Anthony [IBIS Associates, Inc., Waltham, MA (United States); Hannibal, Ted [IBIS Associates, Inc., Waltham, MA (United States); Raghunathan, Anand [Energetics Inc., Columbia, MD (United States); Ivanic, Ziga [Energetics Inc., Columbia, MD (United States); Clark, Michael [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2016-03-01

    The U.S. Department of Energy’s Vehicle Technologies Office, Materials area commissioned a study to model and assess manufacturing economics of alternative design and production strategies for a series of lightweight vehicle concepts. In the first two phases of this effort examined combinations of strategies aimed at achieving strategic targets of 40% and a 45% mass reduction relative to a standard North American midsize passenger sedan at an effective cost of $3.42 per pound (lb) saved. These results have been reported in the Idaho National Laboratory report INL/EXT-14-33863 entitled Vehicle Lightweighting: 40% and 45% Weight Savings Analysis: Technical Cost Modeling for Vehicle Lightweighting published in March 2015. The data for these strategies were drawn from many sources, including Lotus Engineering Limited and FEV, Inc. lightweighting studies, U.S. Department of Energy-funded Vehma International of America, Inc./Ford Motor Company Multi-Material Lightweight Prototype Vehicle Demonstration Project, the Aluminum Association Transportation Group, many United States Council for Automotive Research’s/United States Automotive Materials Partnership LLC lightweight materials programs, and IBIS Associates, Inc.’s decades of experience in automotive lightweighting and materials substitution analyses.

  9. Disaster risk reduction in developing countries: costs, benefits and institutions.

    Science.gov (United States)

    Kenny, Charles

    2012-10-01

    Some 60,000 people worldwide die annually in natural disasters, mostly due to the collapse of buildings in earthquakes, and primarily in the developing world. This is despite the fact that engineering solutions exist that can eliminate almost completely the risk of such deaths. Why is this? The solutions are expensive and technically demanding, so their cost-benefit ratio often is unfavourable as compared to other interventions. Nonetheless, there are various public disaster risk reduction interventions that are highly cost-effective. That such interventions frequently remain unimplemented or ineffectively executed points to a role for issues of political economy. Building regulations in developing countries appear to have limited impact in many cases, perhaps because of inadequate capacity and corruption. Public construction often is of low quality, perhaps for similar reasons. This suggests the need for approaches that emphasise simple and limited disaster risk regulation covering only the most at-risk structures-and that, preferably, non-experts can monitor-as well as numerous transparency and oversight mechanisms for public construction projects. © 2012 The Author(s). Journal compilation © Overseas Development Institute, 2012.

  10. Vehicle Lightweighting: Mass Reduction Spectrum Analysis and Process Cost Modeling

    International Nuclear Information System (INIS)

    Mascarin, Anthony; Hannibal, Ted; Raghunathan, Anand; Ivanic, Ziga; Clark, Michael

    2016-01-01

    The U.S. Department of Energy's Vehicle Technologies Office, Materials area commissioned a study to model and assess manufacturing economics of alternative design and production strategies for a series of lightweight vehicle concepts. In the first two phases of this effort examined combinations of strategies aimed at achieving strategic targets of 40% and a 45% mass reduction relative to a standard North American midsize passenger sedan at an effective cost of $3.42 per pound (lb) saved. These results have been reported in the Idaho National Laboratory report INL/EXT-14-33863 entitled Vehicle Lightweighting: 40% and 45% Weight Savings Analysis: Technical Cost Modeling for Vehicle Lightweighting published in March 2015. The data for these strategies were drawn from many sources, including Lotus Engineering Limited and FEV, Inc. lightweighting studies, U.S. Department of Energy-funded Vehma International of America, Inc./Ford Motor Company Multi-Material Lightweight Prototype Vehicle Demonstration Project, the Aluminum Association Transportation Group, many United States Council for Automotive Research's/United States Automotive Materials Partnership LLC lightweight materials programs, and IBIS Associates, Inc.'s decades of experience in automotive lightweighting and materials substitution analyses.

  11. Implementation of activity-based costing (ABC) to drive cost reduction efforts in a semiconductor manufacturing operation

    Science.gov (United States)

    Naguib, Hussein; Bol, Igor I.; Lora, J.; Chowdhry, R.

    1994-09-01

    This paper presents a case study on the implementation of ABC to calculate the cost per wafer and to drive cost reduction efforts for a new IC product line. The cost reduction activities were conducted through the efforts of 11 cross-functional teams which included members of the finance, purchasing, technology development, process engineering, equipment engineering, production control, and facility groups. The activities of these cross functional teams were coordinated by a cost council. It will be shown that these activities have resulted in a 57% reduction in the wafer manufacturing cost of the new product line. Factors contributed to successful implementation of an ABC management system are discussed.

  12. American business ethics and health care costs.

    Science.gov (United States)

    Garrett, T M; Klonoski, R J; Baillie, H W

    1993-01-01

    The health care industry operates in the margin between market competition and social welfare programs. Violations of business ethics on the market side add considerably to costs. When the inefficient use of resources and market distortions due to power and ignorance as well as legal and subsidized monopolies are added, increased costs can approach $100 billion. Modest remedies are suggested.

  13. Reductions in employee productivity impairment observed after implementation of web-based worksite health promotion programs.

    Science.gov (United States)

    Silberman, Jordan; Schwartz, Steven; Giuseffi, Danielle L; Wang, Chun; Nevedal, Dana; Bedrosian, Richard

    2011-12-01

    To assess changes in employee productivity impairment observed after the implementation of several Web-based health promotion programs. Health risk assessments and self-report measures of productivity impairment were administered on-line to more than 43,000 participants of Web-based health promotion programs. Reductions in productivity impairment were observed after 1 month of program utilization. Productivity impairment at 90- and 180-day follow-ups also decreased relative to baseline. Improvements in employee health were associated with reductions in employee productivity impairment. The use of Web-based health promotion programs was associated with reductions in productivity impairment and improvements in employee health. After the implementation of Web-based health promotion programs, reductions in productivity impairment may be observed before reductions in direct health care costs.

  14. Lean-Six Sigma: tools for rapid cycle cost reduction.

    Science.gov (United States)

    Caldwell, Chip

    2006-10-01

    Organizational costs can be grouped as process cost, cost of quality, and cost of poor quality. Providers should train managers in the theory and application of Lean-Six Sigma, including the seven categories of waste and how to remove them. Healthcare financial executives should work with managers in eliminating waste to improve service and reduce costs.

  15. 48 CFR 970.5215-4 - Cost reduction.

    Science.gov (United States)

    2010-10-01

    .... Development cost is the Contractor cost of up-front planning, engineering, prototyping, and testing of a... contractual arrangement and the justification for its use; and (ii) A detailed cost/price estimate and...

  16. Feasibility of fractionating Myoview cold kits for cost reduction

    International Nuclear Information System (INIS)

    Penglis, S.; Tsopelas, C.

    1999-01-01

    Full text: Myoview is a freeze-dried ethylene diphosphine ligand that upon reconstitution with 99 Tc m -pertechnetate yields a preparation containing the lipophilic cationic myocardial imaging agent 99 Tc m -tetrofosmin (Tf). The aim of this study was to determine the feasibility of fractionating Myoview kits to reduce the cost of the kit, currently A$350 per vial. Myoview vials were reconstituted with N 2 -flushed saline and split into 4 or 5 aliquots of 0.5 ml, then stored at -80 deg C in N 2 -filled vials for up to 3 months. 99 Tc m -Tf was prepared by the addition of varying volumes of 99 Tc m -pertechnetate (1.1 GBq.ml- 1 ) to give a final ligand concentration of 14.4 μg.ml- 1 , followed by a 15 min incubation at room temperature. Radiochemical purity (RCP) was examined at 0, 1, 2 and 3 months post-fractionation. At each time point, RCP was determined at 0,1, 2, 4, 6 and 24 h post-reconstitution. RCP was measured using the thin layer chromatography method according to the manufacturer's instructions. Over the 3 month evaluation period, RCP was maintained at 96.4 ± 1.7% (n = 48) over 24 h at room temperature. Animal biodistribution studies were used to validate the final product from the full cold kit to that from the fractionated kits. In conclusion, these results show that Myoview kits can be successfully fractionated and stored for up to 3 months. The subsequent 99 Tc m -Tf can be used to provide significant cost reductions, especially when only 1 patient dose is required

  17. The Role of Logistics in Practical Levelized Cost of Energy Reduction Implementation and Government Sponsored Cost Reduction Studies: Day and Night in Offshore Wind Operations and Maintenance Logistics

    DEFF Research Database (Denmark)

    Poulsen, Thomas; Hasager, Charlotte Bay; Jensen, Christian Munk

    2017-01-01

    This paper reveals that logistics make up at least 17% of annual operational expenditure costs for offshore wind farms. Annual operational expenditure is found to vary by a factor of 9.5, making its share of levelized cost of energy for offshore wind range from 13% to 57%. These are key findings...... contrast to the shore-based office personnel who develop studies directing cost reduction efforts. This paper details the company motivation to join industry-wide cost reduction initiatives. A business case for offshore wind operations and maintenance logistics yielding 1% savings in levelized cost...... of a 20-month research project targeting cost reduction initiatives for offshore wind systems. The findings reveal that cost-out measures are difficult to implement due to cultural differences. Implementation efforts are rendered by personnel located offshore in a harsh sea environment which is in stark...

  18. Cost-effectiveness analysis of salt reduction policies to reduce coronary heart disease in Syria, 2010-2020.

    Science.gov (United States)

    Wilcox, Meredith L; Mason, Helen; Fouad, Fouad M; Rastam, Samer; al Ali, Radwan; Page, Timothy F; Capewell, Simon; O'Flaherty, Martin; Maziak, Wasim

    2015-01-01

    This study presents a cost-effectiveness analysis of salt reduction policies to lower coronary heart disease in Syria. Costs and benefits of a health promotion campaign about salt reduction (HP); labeling of salt content on packaged foods (L); reformulation of salt content within packaged foods (R); and combinations of the three were estimated over a 10-year time frame. Policies were deemed cost-effective if their cost-effectiveness ratios were below the region's established threshold of $38,997 purchasing power parity (PPP). Sensitivity analysis was conducted to account for the uncertainty in the reduction of salt intake. HP, L, and R+HP+L were cost-saving using the best estimates. The remaining policies were cost-effective (CERs: R=$5,453 PPP/LYG; R+HP=$2,201 PPP/LYG; R+L=$2,125 PPP/LYG). R+HP+L provided the largest benefit with net savings using the best and maximum estimates, while R+L was cost-effective with the lowest marginal cost using the minimum estimates. This study demonstrated that all policies were cost-saving or cost effective, with the combination of reformulation plus labeling and a comprehensive policy involving all three approaches being the most promising salt reduction strategies to reduce CHD mortality in Syria.

  19. Home Health Care: Services and Cost

    Science.gov (United States)

    Widmer, Geraldine; And Others

    1978-01-01

    Findings from a study of home care services in one New York district document the value and relatively modest costs of home health care for the chronically ill and dependent elderly. Professional nurses coordinated the care, but most of the direct services were provided by home health aides and housekeepers. (MF)

  20. Containing health costs in the Americas.

    Science.gov (United States)

    Márquez, P

    1990-01-01

    In recent years, a series of policy measures affecting both demand and supply components of health care have been adopted in different Latin American and Caribbean countries, as well as in Canada and the United States. In applying these measures various objectives have been pursued, among them: to mobilize additional resources to increase operating budgets; to reduce unnecessary utilization of health services and consumption of pharmaceuticals; to control increasing production costs; and to contain the escalation of health care expenditures. In terms of demand management, some countries have established cost-recovery programmes in an attempt to offset declining revenues. These measures have the potential to generate additional operating income in public facilities, particularly if charges are levied on hospital care. However, only scant information is available on the effects of user charges on demand, utilization, or unit costs. In terms of supply management, corrective measures have concentrated on limiting the quantity and the relative prices of different inputs and outputs. Hiring freezes, salary caps, limitations on new construction and equipment, use of drug lists, bulk procurement of medicines and vaccines, and budget ceilings are among the measures utilized to control production costs in the health sector. To moderate health care expenditures, various approaches have been followed to subject providers to 'financial discipline'. Among them, new reimbursement modalities such as prospective payment systems offer an array of incentives to modify medical practice. Cost-containment efforts have also spawned innovations in the organization and delivery of health services. Group plans have been established on the basis of prepaid premiums to provide directly much or all health care needs of affiliates and their families. The issue of intrasectorial co-ordination, particularly between ministries of health and social security institutions, has much relevance for cost

  1. Possibility of material cost reduction toward development of low-cost second-generation superconducting wires

    Science.gov (United States)

    Ichinose, Ataru; Horii, Shigeru; Doi, Toshiya

    2017-10-01

    Two approaches to reducing the material cost of second-generation superconducting wires are proposed in this paper: (1) instead of the electrical stabilizing layers of silver and copper presently used on the superconducting layer, a Nb-doped SrTiO3 conductive buffer layer and cube-textured Cu are proposed as an advanced architecture, and (2) the use of an electromagnetic (EM) steel tape as a metal substrate of coated conductors in a conventional architecture. In structures fabricated without using electrical stabilizing layers on the superconducting layer, the critical current density achieved at 77 K in a self-field was approximately 2.6 MA/cm2. On the other hand, in the case of using EM steel tapes, although the critical current density was far from practical at the current stage, the biaxial alignment of YBa2Cu3O y (YBCO) and buffer layers was realized without oxidation on the metal surface. In this study, the possibility of material cost reduction has been strongly indicated toward the development of low-cost second-generation superconducting wires in the near future.

  2. SWaP Reduction for Lost-Cost Star Tracker

    Data.gov (United States)

    National Aeronautics and Space Administration — In the last two years, a low-cost star tracker has been developed for suborbital applications. Currently the system weighs ~9 lbm, uses ~16W and has a parts cost of...

  3. Quantified, localized health benefits of accelerated carbon dioxide emissions reductions

    Science.gov (United States)

    Shindell, Drew; Faluvegi, Greg; Seltzer, Karl; Shindell, Cary

    2018-04-01

    Societal risks increase as Earth warms, and increase further for emissions trajectories accepting relatively high levels of near-term emissions while assuming future negative emissions will compensate, even if they lead to identical warming as trajectories with reduced near-term emissions1. Accelerating carbon dioxide (CO2) emissions reductions, including as a substitute for negative emissions, hence reduces long-term risks but requires dramatic near-term societal transformations2. A major barrier to emissions reductions is the difficulty of reconciling immediate, localized costs with global, long-term benefits3,4. However, 2 °C trajectories not relying on negative emissions or 1.5 °C trajectories require elimination of most fossil-fuel-related emissions. This generally reduces co-emissions that cause ambient air pollution, resulting in near-term, localized health benefits. We therefore examine the human health benefits of increasing 21st-century CO2 reductions by 180 GtC, an amount that would shift a `standard' 2 °C scenario to 1.5 °C or could achieve 2 °C without negative emissions. The decreased air pollution leads to 153 ± 43 million fewer premature deaths worldwide, with 40% occurring during the next 40 years, and minimal climate disbenefits. More than a million premature deaths would be prevented in many metropolitan areas in Asia and Africa, and >200,000 in individual urban areas on every inhabited continent except Australia.

  4. Quantified, Localized Health Benefits of Accelerated Carbon Dioxide Emissions Reductions.

    Science.gov (United States)

    Shindell, Drew; Faluvegi, Greg; Seltzer, Karl; Shindell, Cary

    2018-01-01

    Societal risks increase as Earth warms, but also for emissions trajectories accepting relatively high levels of near-term emissions while assuming future negative emissions will compensate even if they lead to identical warming [1]. Accelerating carbon dioxide (CO 2 ) emissions reductions, including as a substitute for negative emissions, hence reduces long-term risks but requires dramatic near-term societal transformations [2]. A major barrier to emissions reductions is the difficulty of reconciling immediate, localized costs with global, long-term benefits [3, 4]. However, 2°C trajectories not relying on negative emissions or 1.5°C trajectories require elimination of most fossil fuel related emissions. This generally reduces co-emissions that cause ambient air pollution, resulting in near-term, localized health benefits. We therefore examine the human health benefits of increasing ambition of 21 st century CO 2 reductions by 180 GtC; an amount that would shift a 'standard' 2°C scenario to 1.5°C or could achieve 2°C without negative emissions. The decreased air pollution leads to 153±43 million fewer premature deaths worldwide, with ~40% occurring during the next 40 years, and minimal climate disbenefits. More than a million premature deaths would be prevented in many metropolitan areas in Asia and Africa, and >200,000 in individual urban areas on every inhabited continent except Australia.

  5. Cost-Reduction Roadmap for Residential Solar Photovoltaics (PV),

    Science.gov (United States)

    Office (SETO) residential 2030 photovoltaics (PV) cost target of $0.05 per kilowatt-hour by identifying could influence system costs in key market segments. This report examines two key market segments that demonstrate significant opportunities for cost savings and market growth: installing PV at the time of roof

  6. Reduction of capital costs of nuclear power plants

    International Nuclear Information System (INIS)

    2000-01-01

    The competitiveness of nuclear power plants depends largely on their capital costs represent some 60 per cent of their total generation costs. Reviewing and analysing ways and means to reduce capital costs of nuclear power plants are essential to enhance the economic viability of the nuclear option. The report is based upon cost information and data provided by experts from NEA Member countries. It investigates the efficiency of alternative methods for reducing capital costs of nuclear units. It will provide stakeholders from the industry and governmental agencies with relevant elements in support of policy making. (author)

  7. COST OF SELECTIVE CATALYTIC REDUCTION (SCR) APPLICATION FOR NOX CONTROL ON COAL-FIRED BOILERS

    Science.gov (United States)

    The report provides a methodology for estimating budgetary costs associated with retrofit applications of selective catalytic reduction (SCR) technology on coal-fired boilers. SCR is a postcombustion nitrogen oxides (NOx) control technology capable of providing NOx reductions >90...

  8. A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

    Directory of Open Access Journals (Sweden)

    Helen Mason

    Full Text Available BACKGROUND: Coronary Heart Disease (CHD is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. METHODS AND FINDINGS: Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy. All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30% resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. CONCLUSION: Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives.

  9. A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

    Science.gov (United States)

    Mason, Helen; Shoaibi, Azza; Ghandour, Rula; O'Flaherty, Martin; Capewell, Simon; Khatib, Rana; Jabr, Samer; Unal, Belgin; Sözmen, Kaan; Arfa, Chokri; Aissi, Wafa; Romdhane, Habiba Ben; Fouad, Fouad; Al-Ali, Radwan; Husseini, Abdullatif

    2014-01-01

    Background Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Conclusion Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives. PMID:24409297

  10. Evaluation of cost reduction method for manufacturing ODS ferritic claddings

    International Nuclear Information System (INIS)

    Fujiwara, Masayuki; Mizuta, Shunji; Ukai, Shigeharu

    2000-04-01

    For evaluating the fast reactor system technology, it is important to evaluate the practical feasibility of ODS ferritic claddings, which is the most promising materials to attain the goal of high coolant temperature and more than 150 GWd/t. Based on the results of their technology development, mass production process with highly economically benefit as well as manufacturing cost estimation of ODS ferritic claddings were preliminarily conducted. From the view point of future utility scale, the cost for manufacturing mother tubes has a dominant factor in the total manufacturing cost. The method to reduce the cost of mother tube manufacturing was also preliminarily investigated. (author)

  11. Proton pump inhibitors: potential cost reductions by applying prescribing guidelines.

    LENUS (Irish Health Repository)

    Cahir, Caitriona

    2012-01-01

    There are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care. This study aims to establish potential cost savings in a community drug scheme for a one year period according to published clinical and cost-effective guidelines for PPI prescribing.

  12. Buying Health: The Costs of Commercialization and an Alternative Philosophy

    Directory of Open Access Journals (Sweden)

    Larry Churchill

    2013-01-01

    Full Text Available This paper argues that commercial forces have steadily encroached into our understanding of medicine and health in modern industrial societies. The impact on the delivery of personal medical services and on common ideas about food and nutrition is profound and largely deleterious to public health. A key component of commercialization is reductionism of medical services, health products and nutritional components into small, marketable units. This reductive force makes both medical services and nutritional components more costly and is corrosive to more holistic concepts of health. We compare commercial and holistic approaches to nutrition in detail and offer an alternative philosophy. Adopting this alternative will require sound public policies that rely less on marketing as a distribution system and that enfranchise individuals to be reflective on their use of medical services, their food and nutrition choices, and their larger health needs.

  13. The Non-Linear Relationship between BMI and Health Care Costs and the Resulting Cost Fraction Attributable to Obesity.

    Science.gov (United States)

    Laxy, Michael; Stark, Renée; Peters, Annette; Hauner, Hans; Holle, Rolf; Teuner, Christina M

    2017-08-30

    This study aims to analyse the non-linear relationship between Body Mass Index (BMI) and direct health care costs, and to quantify the resulting cost fraction attributable to obesity in Germany. Five cross-sectional surveys of cohort studies in southern Germany were pooled, resulting in data of 6757 individuals (31-96 years old). Self-reported information on health care utilisation was used to estimate direct health care costs for the year 2011. The relationship between measured BMI and annual costs was analysed using generalised additive models, and the cost fraction attributable to obesity was calculated. We found a non-linear association of BMI and health care costs with a continuously increasing slope for increasing BMI without any clear threshold. Under the consideration of the non-linear BMI-cost relationship, a shift in the BMI distribution so that the BMI of each individual is lowered by one point is associated with a 2.1% reduction of mean direct costs in the population. If obesity was eliminated, and the BMI of all obese individuals were lowered to 29.9 kg/m², this would reduce the mean direct costs by 4.0% in the population. Results show a non-linear relationship between BMI and health care costs, with very high costs for a few individuals with high BMI. This indicates that population-based interventions in combination with selective measures for very obese individuals might be the preferred strategy.

  14. Reduction of costs for anemia-management drugs associated with the use of ferric citrate

    Directory of Open Access Journals (Sweden)

    Thomas A

    2014-05-01

    Full Text Available Anila Thomas,1 Leif E Peterson2 1Clinical Pharmacy Services, Houston Methodist Hospital, Houston, TX, USA; 2Center for Biostatistics, Houston Methodist Research Institute, Houston, TX, USA Background: Ferric citrate is a novel phosphate binder which has the potential to reduce usage of erythropoietin-stimulating agents (ESAs and intravenous (IV iron used for anemia management during hemodialysis (HD among patients with end-stage renal disease (ESRD. Currently, the potential health care cost savings on a national scale due to the use of ferric citrate in ESRD are undetermined. Methods: Per-patient-per-year costs of ESAs (Epogen® and Aranesp® [Amgen Inc., CA, USA] and IV iron (Venofer® [American Regent, Inc., NY, USA] and Ferrlecit® [Sanofi US, Bridgewater, NJ, USA] were based on RED BOOK™ (Truven Health Analytics New York, NY, USA costs combined with the Centers for Medicare and Medicaid Services (CMS base rate and actual usage in 2011 for the four drugs. The annual number of outpatients undergoing HD in the US was based on frequencies reported by the USRDS (United States Renal Data System. Monte Carlo uncertainty analysis was performed to determine total annual costs and cost reduction based on ferric citrate usage. Results: Total annual cost of ESAs and IV iron for anemia management in ESRD determined by Monte Carlo analysis assuming CMS base rate value was 5.127 (3.664–6.260 billion USD. For actual utilization in 2011, total annual cost of ESAs and IV iron was 3.981 (2.780–4.930 billion USD. If ferric citrate usage reduced ESA utilization by 20% and IV iron by 40%, then total cost would be reduced by 21.2% to 4.038 (2.868–4.914 billion USD for the CMS base rate, and by 21.8% to 3.111 (2.148–3.845 billion USD, based on 2011 actual utilization. Conclusion: It is likely that US health care costs for anemia-management drugs associated with ESRD among HD patients can be reduced by using ferric citrate as a phosphate binder. Keywords

  15. Biological waste by-production costs in forest management and possibilities for their reduction

    Directory of Open Access Journals (Sweden)

    Jiří Kadlec

    2004-01-01

    Full Text Available Biological wastes in forestry were observed from view of their by-production in silvicultural and logging operations. There were identified points where biological waste was produced in this paper, waste costs ratio for silvicultural and logging operations and were made suggestions for reduction of these costs. Biological waste costs give 34.4% of total costs of silvicultural operations and 30% of total costs of logging operations. Natural regeneration and minor forest produce operations are opportunities for reduction of these costs.

  16. Grouping eucalyptus species in kraft pulp process for cost reduction

    Directory of Open Access Journals (Sweden)

    Apiwan Pichayadecha

    2014-12-01

    Full Text Available The objective of this research is to study the level of the important factors that can decrease total cost of pulp production. First of all, experts and experienced users identify the factors that affect the total production cost by applying the principle of 4M 1E cause and effect diagram. Then the primary factors were chosen based on 80% of their significance and tested by hypothesis for two population means. It was found that at the 95% confidence level the significant factors that have effects on the total production cost are amount of Effective alkali in white liquor and Kappa number. However, the proportion of easy delignification according to Eucalyptus species is considered as a significant factor based on various studies. Box-Behnken experiment is designed with respect to 3 mentioned factors and 3 levels of each factor. The response surface method (RSM is employed to determine the non-linear relation between the total cost as the response and the proportion of easy delignification, amount of Effective alkali in white liquor and Kappa number. To minimize the total cost, the optimal values of each factor are 75% of easy delignification, 112 grams per liter of Effective alkali in white liquor and 13.5 of kappa number. Under this optimal condition, the average total cost per ton of Eucalyptus is 13,393.91 Baht which is significantly less than the total cost of 15,517.06 Baht per ton before improvement.

  17. Marginal cost curves for water footprint reduction in irrigated agriculture: guiding a cost-effective reduction of crop water consumption to a permit or benchmark level

    Directory of Open Access Journals (Sweden)

    A. D. Chukalla

    2017-07-01

    Full Text Available Reducing the water footprint (WF of the process of growing irrigated crops is an indispensable element in water management, particularly in water-scarce areas. To achieve this, information on marginal cost curves (MCCs that rank management packages according to their cost-effectiveness to reduce the WF need to support the decision making. MCCs enable the estimation of the cost associated with a certain WF reduction target, e.g. towards a given WF permit (expressed in m3  ha−1 per season or to a certain WF benchmark (expressed in m3  t−1 of crop. This paper aims to develop MCCs for WF reduction for a range of selected cases. AquaCrop, a soil-water-balance and crop-growth model, is used to estimate the effect of different management packages on evapotranspiration and crop yield and thus the WF of crop production. A management package is defined as a specific combination of management practices: irrigation technique (furrow, sprinkler, drip or subsurface drip; irrigation strategy (full or deficit irrigation; and mulching practice (no, organic or synthetic mulching. The annual average cost for each management package is estimated as the annualized capital cost plus the annual costs of maintenance and operations (i.e. costs of water, energy and labour. Different cases are considered, including three crops (maize, tomato and potato; four types of environment (humid in UK, sub-humid in Italy, semi-arid in Spain and arid in Israel; three hydrologic years (wet, normal and dry years and three soil types (loam, silty clay loam and sandy loam. For each crop, alternative WF reduction pathways were developed, after which the most cost-effective pathway was selected to develop the MCC for WF reduction. When aiming at WF reduction one can best improve the irrigation strategy first, next the mulching practice and finally the irrigation technique. Moving from a full to deficit irrigation strategy is found to be a no-regret measure: it reduces the WF

  18. Marginal cost curves for water footprint reduction in irrigated agriculture: guiding a cost-effective reduction of crop water consumption to a permit or benchmark level

    Science.gov (United States)

    Chukalla, Abebe D.; Krol, Maarten S.; Hoekstra, Arjen Y.

    2017-07-01

    Reducing the water footprint (WF) of the process of growing irrigated crops is an indispensable element in water management, particularly in water-scarce areas. To achieve this, information on marginal cost curves (MCCs) that rank management packages according to their cost-effectiveness to reduce the WF need to support the decision making. MCCs enable the estimation of the cost associated with a certain WF reduction target, e.g. towards a given WF permit (expressed in m3  ha-1 per season) or to a certain WF benchmark (expressed in m3  t-1 of crop). This paper aims to develop MCCs for WF reduction for a range of selected cases. AquaCrop, a soil-water-balance and crop-growth model, is used to estimate the effect of different management packages on evapotranspiration and crop yield and thus the WF of crop production. A management package is defined as a specific combination of management practices: irrigation technique (furrow, sprinkler, drip or subsurface drip); irrigation strategy (full or deficit irrigation); and mulching practice (no, organic or synthetic mulching). The annual average cost for each management package is estimated as the annualized capital cost plus the annual costs of maintenance and operations (i.e. costs of water, energy and labour). Different cases are considered, including three crops (maize, tomato and potato); four types of environment (humid in UK, sub-humid in Italy, semi-arid in Spain and arid in Israel); three hydrologic years (wet, normal and dry years) and three soil types (loam, silty clay loam and sandy loam). For each crop, alternative WF reduction pathways were developed, after which the most cost-effective pathway was selected to develop the MCC for WF reduction. When aiming at WF reduction one can best improve the irrigation strategy first, next the mulching practice and finally the irrigation technique. Moving from a full to deficit irrigation strategy is found to be a no-regret measure: it reduces the WF by reducing water

  19. Reducing health care costs - potential and limitations of local ...

    African Journals Online (AJOL)

    Reducing health care costs - potential and limitations of local authority health services. ... both the quality and the cost-effectiveness of health care would be improved. ... LAs offer an appropriate structure for effective community control over the ...

  20. REDUCTION OF COST AND TIME CONSUMPTION IN WELL-CONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Mladen Zelenika

    1998-12-01

    Full Text Available A Contractor usually utilizes the available drilling equipment when constructing just one single well. Drilling cost and time consumption in constructing the well MB-1, using the percussion method, and the well MB-2, using the conventional rotary drilling method, call for a separate analysis in order to justify the investment cost for the acquisition of additional equipment for a single well only. The wells, located in a karst vrtača close to an estavelle near Tomislavgrad, with a diameter of 500 mm and approximately 80 m deep, have been accomplished with a low rate of penetration using the conventional Cable tool and resp. Rotary Drilling Method. In this paper results of analyses for the given circumstances are shown: both the efficiency and cost of the mentioned drilling methods performed by the crews of »Geotehnika d.d.« Zagreb, as well as the justifiability of investments in new equipment are evaluated.

  1. Cost reduction through combined solutions?; Kostensenkung durch Kombinationsloesungen?

    Energy Technology Data Exchange (ETDEWEB)

    Bilitewski, B. [Technische Univ. Dresden (Germany). Inst. fuer Abfallwirtschaft und Altlasten

    1998-09-01

    The implementation of material-specific residue treatment processes requires reconstruction measures both in the case of mechanical-biological and in that of thermal treatment plants. Such measures involves great uncertainties and wide variation in cost prediction. The present paper deals with various factors that influence the costs of residual waste treatment. [Deutsch] Zur Umsetzung der stoffspezifischen Restabfallbehandlung sind Anpassungen sowohl der derzeit betriebenen mechanisch-biologischen als auch der thermischen Anlagen erforderlich, was zu Unsicherheiten und grossen Schwankungsbreiten bei den Kostenprognosen fuehrt. Der Bericht beleuchtet verschiedene Einflussgroessen auf die Kosten der Behandlung des Restabfalls. (orig./SR)

  2. Launch vehicle operations cost reduction through artificial intelligence techniques

    Science.gov (United States)

    Davis, Tom C., Jr.

    1988-01-01

    NASA's Kennedy Space Center has attempted to develop AI methods in order to reduce the cost of launch vehicle ground operations as well as to improve the reliability and safety of such operations. Attention is presently given to cost savings estimates for systems involving launch vehicle firing-room software and hardware real-time diagnostics, as well as the nature of configuration control and the real-time autonomous diagnostics of launch-processing systems by these means. Intelligent launch decisions and intelligent weather forecasting are additional applications of AI being considered.

  3. Fog-Assisted Operational Cost Reduction for Cloud Data Centers

    OpenAIRE

    Yu, Liang; Jiang, Tao; Zou, Yulong

    2017-01-01

    In this paper, we intend to reduce the operational cost of cloud data centers with the help of fog devices, which can avoid the revenue loss due to wide-area network propagation delay and save network bandwidth cost by serving nearby cloud users. Since fog devices may not be owned by a cloud service provider, they should be compensated for serving the requests of cloud users. When taking economical compensation into consideration, the optimal number of requests processed locally by each fog d...

  4. Distance education for tobacco reduction with Inuit frontline health workers.

    Science.gov (United States)

    Collins, Rob; Hammond, Merryl; Carry, Catherine L; Kinnon, Dianne; Killulark, Joan; Nevala, Janet

    2013-01-01

    Tobacco reduction is a major priority in Canadian Inuit communities. However, many Inuit frontline health workers lacked the knowledge, confidence and support to address the tobacco epidemic. Given vast distances, high costs of face-to-face training and previous successful pilots using distance education, this method was chosen for a national tobacco reduction course. To provide distance education about tobacco reduction to at least 25 frontline health workers from all Inuit regions of Canada. Promising practices globally were assessed in a literature survey. The National Inuit Tobacco Task Group guided the project. Participants were selected from across Inuit Nunangat. They chose a focus from a "menu" of 6 course options, completed a pre-test to assess individual learning needs and chose which community project(s) to complete. Course materials were mailed, and trainers provided intensive, individualized support through telephone, fax and e-mail. The course ended with an open-book post-test. Follow-up support continued for several months post-training. Of the 30 participants, 27 (90%) completed the course. The mean pre-test score was 72% (range: 38-98%). As the post-test was done using open books, everyone scored 100%, with a mean improvement of 28% (range: 2-62%). Although it was often challenging to contact participants through phone, a distance education approach was very practical in a northern context. Learning is more concrete when it happens in a real-life context. As long as adequate support is provided, we recommend individualized distance education to others working in circumpolar regions.

  5. A capital cost reduction study on the fast breeder reactor plant

    International Nuclear Information System (INIS)

    Taniyama, H.; Kamei, M.; Moriyama, M.

    1991-01-01

    A capital cost reduction study has been performed for large fast breeder reactor designs. The primary objective of this study is to show a trend of capital cost reduction between FBR plants at the prototype stage, the demonstration stage, and the future commercialization stage. For the FBR plant at the demonstration stage a construction cost comparison with a light water reactor has also been performed, and the target cost of FBR of below 1.5 times that of the light water reactor cost was achieved. To extend the capital cost reduction study, a feasibility study was made to achieve a capital cost of an FBR less than that of a light water reactor. The recommended design is shown as a future commercialization FBR design concept. (author)

  6. The Role of Logistics in Practical Levelized Cost of Energy Reduction Implementation and Government Sponsored Cost Reduction Studies: Day and Night in Offshore Wind Operations and Maintenance Logistics

    Directory of Open Access Journals (Sweden)

    Thomas Poulsen

    2017-04-01

    Full Text Available This paper reveals that logistics make up at least 17% of annual operational expenditure costs for offshore wind farms. Annual operational expenditure is found to vary by a factor of 9.5, making its share of levelized cost of energy for offshore wind range from 13% to 57%. These are key findings of a 20-month research project targeting cost reduction initiatives for offshore wind systems. The findings reveal that cost-out measures are difficult to implement due to cultural differences. Implementation efforts are rendered by personnel located offshore in a harsh sea environment which is in stark contrast to the shore-based office personnel who develop studies directing cost reduction efforts. This paper details the company motivation to join industry-wide cost reduction initiatives. A business case for offshore wind operations and maintenance logistics yielding 1% savings in levelized cost of energy is included on how to expand working hours from daytime to also work at night.

  7. GTHTR300 cost reduction through design upgrade and cogeneration

    Energy Technology Data Exchange (ETDEWEB)

    Yan, Xing L., E-mail: yan.xing@jaea.go.jp; Sato, Hiroyuki; Kamiji, Yu; Imai, Yoshiyuki; Terada, Atsuhiko; Tachibana, Yukio; Kunitomi, Kazuhiko

    2016-09-15

    Japan Atomic Energy Agency began design and development of the Gas Turbine High Temperature Reactor of 300MWe nominal output (GTHTR300) in 2001. The reactor baseline design completed three years later was based on 850 °C core outlet temperature and a direct cycle gas turbine balance of plant. It attained 45.6% net power generation efficiency and 3.5 US¢/kW h cost of electricity. The cost was estimated 20% lower than LWR. The latest design upgrade has incorporated several major technological advances made in the past ten years to both reactor and balance of plant. As described in this paper, these advances have enabled raising the design basis reactor core outlet temperature to 950 °C and increasing power generating efficiency by nearly 5% point. Further implementation of seawater desalination cogeneration is made through employing a newly-proposed multi-stage flash process. Through efficient waste heat recovery of the reactor gas turbine power conversion cycle, a large cost credit is obtained against the conventionally produced water prices. Together, the design upgrade and the cogeneration are shown to reduce the GTHTR300 cost of electricity to under 2.7 US¢/kW h.

  8. Virginia Offshore Wind Cost Reduction Through Innovation Study (VOWCRIS) (Poster)

    Energy Technology Data Exchange (ETDEWEB)

    Maples, B.; Campbell, J.; Arora, D.

    2014-10-01

    The VOWCRIS project is an integrated systems approach to the feasibility-level design, performance, and cost-of-energy estimate for a notional 600-megawatt offshore wind project using site characteristics that apply to the Wind Energy Areas of Virginia, Maryland and North Carolina.

  9. GTHTR300 cost reduction through design upgrade and cogeneration

    International Nuclear Information System (INIS)

    Yan, Xing L.; Sato, Hiroyuki; Kamiji, Yu; Imai, Yoshiyuki; Terada, Atsuhiko; Tachibana, Yukio; Kunitomi, Kazuhiko

    2014-01-01

    Japan Atomic Energy Agency began design and development of the Gas Turbine High Temperature Reactor of 300MWe nominal output (GTHTR300) in 2001. The reactor baseline design completed three years later was based on 850°C core outlet temperature and a direct cycle gas turbine balance of plant. It attained 45.6% net power generation efficiency and 3.5US¢/KWh cost of electricity. The cost was estimated 20% lower than LWR. The latest design upgrade has incorporated several major technological advances made in the past ten years to both reactor and balance of plant. As described in this paper, these advances have enabled raising the design basis reactor core outlet temperature to 950°C and increasing power generating efficiency by nearly 5% point. Further implementation of seawater desalination cogeneration is made through employing a newly-proposed multi-stage flash process. Through efficient waste heat recovery of the reactor gas turbine power conversion cycle, a large cost credit is obtained against the conventionally produced water prices. Together, the design upgrade and the cogeneration are shown to reduce the GTHTR300 cost of electricity to under 2.7 US¢/KWh. (author)

  10. Dynamics of Anthropomorphic Painting Robot: Quality Analysis and Cost Reduction

    NARCIS (Netherlands)

    Potkonjak, V.; Djordjevic, G.; Kostic, D.; Rasic, M.

    2000-01-01

    Application of robots in spray-painting tasks results in low-cost production, persistent quality and protects humans from a hostile working environment. Automated planning of applicator’s trajectory requires a model of paint deposition onto the treated surface and formulation of an appropriate

  11. The Impact of Accounting Methods on Cost Reduction Rates in Defense Aerospace Weapons System Programs

    Science.gov (United States)

    1988-12-01

    and adhered to in U.S. industry, allow some flexibility in accounting. Under GAAP , accounting areas such as depreciation , inventory, investment tax... depreciation , inventory and investment tax credit) in predicting cost reduction rates are studied. Of the three accounting variables, only inventory...RATES .. ................. ........... 5 1. Depreciation ........ ............... 6 2. Capitalizing or Expensing of Costs . . .. 6 3. Material Costs

  12. Class Size Reduction or Rapid Formative Assessment?: A Comparison of Cost-Effectiveness

    Science.gov (United States)

    Yeh, Stuart S.

    2009-01-01

    The cost-effectiveness of class size reduction (CSR) was compared with the cost-effectiveness of rapid formative assessment, a promising alternative for raising student achievement. Drawing upon existing meta-analyses of the effects of student-teacher ratio, evaluations of CSR in Tennessee, California, and Wisconsin, and RAND cost estimates, CSR…

  13. The impact of unit cost reductions on gross profit: Increasing or decreasing returns?

    Directory of Open Access Journals (Sweden)

    Ely Dahan

    2011-09-01

    Full Text Available We suggest that marketers actively participate in reducing unit costs during new product development, consistent with the theme of integrated marketing and manufacturing. Most marketing managers misjudge the impact on gross profit of reducing variable unit manufacturing costs, mistakenly believing that such cost reductions yield decreasing or linear returns while they actually generate increasing returns.

  14. Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use.

    Science.gov (United States)

    Ruiz, Sarah; Snyder, Lynne Page; Rotondo, Christina; Cross-Barnet, Caitlin; Colligan, Erin Murphy; Giuriceo, Katherine

    2017-03-01

    While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or both for beneficiaries relative to comparators. These findings present a strong case for the potential value of home visits by practice-extender teams to reduce Medicare expenditures and service use in a particularly vulnerable and costly segment of the Medicare population. Project HOPE—The People-to-People Health Foundation, Inc.

  15. Marginal CO2 reduction cost in ENERGY 2000 development. A socio-economic evaluation of the marginal cost for the alternative reduction methods

    International Nuclear Information System (INIS)

    Maeng, H.

    1995-01-01

    The official Danish environmental plan involves a reduction of CO 2 within the next 30-50 years. This report describes the analysis of socio-economic cost/consequences of marginal CO 2 reduction by means of various technical solution models. Calculations by means of the special program subroutine SAMFOKO are based on energy balance in annual, monthly, daily and hourly scale. Heat and power savings as well as the development of decentralized power plants are considered in the supply model. Socio-economic consequences in form of charges and cost are discussed. (EG)

  16. Coal contract cost reduction through resale of coal

    International Nuclear Information System (INIS)

    Simon, R.

    1990-01-01

    The weak coal market of the 1980's has enabled utilities and other users of coal to enjoy stable or falling prices for coal supplies. Falling prices for coal stimulated the renegotiation of numerous coal contracts in recent years, as buyers look to take advantage of lower fuel prices available in the marketplace. This paper examines the use of coal resale transactions as a means of reducing fuel costs, and analyzes the benefits and risks associated with such transactions

  17. Reduction in O and M costs in training

    International Nuclear Information System (INIS)

    Schaffer, R.E.

    1991-01-01

    In 1988, PSE and G undertook a major effort to identify methods to reduce O and M costs throughout the company. The Nuclear Training Department participated in this project by identifying three management level people to act as analysts. These analysts were responsible for breaking all portions of jobs performed at the training center down to their component parts, identifying tasks which were not essential to meeting the regulatory requirements and the company's business plan, and rolling these task back up into full-time equivalent positions. As a concurrent effort, brain-storming sessions were held with the staff to identify ways to reduce O and M costs, to separate wants from needs, and to work smarter. All these efforts were required to identify a stretch target of 40% savings in the current O and M budget. In addition, ideas from other units in the company which affected training were transmitted to the training department and were reviewed for potential savings. The ideas were assessed for risk, start-up cost and practicality. They were classified as Go, No-go or Further study and were then presented to the company executives. The final results for the Nuclear Training Department showed a total savings potential of 51.4%, of which 12.1% were Go and another 13.6% merited further study

  18. Report Tunneling Cost Reduction Study prepared for Fermilab

    International Nuclear Information System (INIS)

    Not Available

    1999-01-01

    Fermi National Accelerator Laboratories has a need to review the costs of constructing the very long tunnels which would be required for housing the equipment for the proposed Very Large Hadron Collider (VLHC) project. Current tunneling costs are high, and the identification of potential means of significantly reducing them, and thereby helping to keep overall project costs within an acceptable budget, has assumed great importance. Fermilab has contracted with The Robbins Company to provide an up-to-date appraisal of tunneling technology, and to review the potential for substantially improving currently the state-of-practice performance and construction costs in particular. The Robbins Company was chosen for this task because of its long and successful experience in hard rock mechanical tunnel boring. In the past 40 years, Robbins has manufactured over 250 tunneling machines, the vast majority for hard rock applications. In addition to also supplying back-up equipment, Robbins has recently established a division dedicated to the manufacture of continuous conveying equipment for the efficient support of tunneling operations. The study extends beyond the tunnel boring machine (TBM) itself, and into the critical area of the logistics of the support of the machine as it advances, including manpower. It is restricted to proven methods using conventional technology, and its potential for incremental but meaningful improvement, rather than examining exotic and undeveloped means of rock excavation that have been proposed from time to time by the technical community. This is the first phase of what is expected to be a number of studies in increasing depth of technical detail, and as such has been restricted to the issues connected with the initial 34 kilometer circumference booster tunnel, and not the proposed 500 kilometer circumference tunnel housing the VLHC itself. The booster tunnel is entirely sited within low to medium strength limestone and dolomite formations

  19. Cost reductions on a site producing soap and detergents

    Energy Technology Data Exchange (ETDEWEB)

    Clayton, R.W. (UKAEA Harwell Lab. (UK). Energy Technology Div.)

    1986-05-01

    The company, which is a subsidiary of the multinational Procter and Gamble Company, manufactures soap and detergent products at two UK sites. A process integration study of the West Thurrock site was undertaken with the help of the Energy and Process Integration Service (EPI). This organisation offers a specialist process integration consultancy service. The study cost around Pound 45,000, including consultancy fees and Procter and Gamble staff time. It was completed in 12 months. The study established that the consumption of process energy could be reduced by around 25% if the site was fully integrated. (author).

  20. Modelled Cost-Effectiveness of a Package Size Cap and a Kilojoule Reduction Intervention to Reduce Energy Intake from Sugar-Sweetened Beverages in Australia

    Science.gov (United States)

    Mantilla Herrera, Ana Maria; Neal, Bruce; Zheng, Miaobing; Lal, Anita; Sacks, Gary

    2017-01-01

    Interventions targeting portion size and energy density of food and beverage products have been identified as a promising approach for obesity prevention. This study modelled the potential cost-effectiveness of: a package size cap on single-serve sugar sweetened beverages (SSBs) >375 mL (package size cap), and product reformulation to reduce energy content of packaged SSBs (energy reduction). The cost-effectiveness of each intervention was modelled for the 2010 Australia population using a multi-state life table Markov model with a lifetime time horizon. Long-term health outcomes were modelled from calculated changes in body mass index to their impact on Health-Adjusted Life Years (HALYs). Intervention costs were estimated from a limited societal perspective. Cost and health outcomes were discounted at 3%. Total intervention costs estimated in AUD 2010 were AUD 210 million. Both interventions resulted in reduced mean body weight (package size cap: 0.12 kg; energy reduction: 0.23 kg); and HALYs gained (package size cap: 73,883; energy reduction: 144,621). Cost offsets were estimated at AUD 750.8 million (package size cap) and AUD 1.4 billion (energy reduction). Cost-effectiveness analyses showed that both interventions were “dominant”, and likely to result in long term cost savings and health benefits. A package size cap and kJ reduction of SSBs are likely to offer excellent “value for money” as obesity prevention measures in Australia. PMID:28878175

  1. Explaining the experience curve: Cost reductions of Brazilian ethanol from sugarcane

    International Nuclear Information System (INIS)

    van den Wall Bake, J.D.; Junginger, M.; Faaij, A.; Poot, T.; Walter, A.

    2009-01-01

    Production costs of bio-ethanol from sugarcane in Brazil have declined continuously over the last three decades. The aims of this study are to determine underlying reasons behind these cost reductions, and to assess whether the experience curve concept can be used to describe the development of feedstock costs and industrial production costs. The analysis was performed using average national costs data, a number of prices (as a proxy for production costs) and data on annual Brazilian production volumes. Results show that the progress ratio (PR) for feedstock costs is 0.68 and 0.81 for industrial costs (excluding feedstock costs). The experience curve of total production costs results in a PR of 0.80. Cost breakdowns of sugarcane production show that all sub-processes contributed to the total, but that increasing yields have been the main driving force. Industrial costs mainly decreased because of increasing scales of the ethanol plants. Total production costs at present are approximately 340 US$/m ethanol 3 (16 US$/GJ). Based on the experience curves for feedstock and industrial costs, total ethanol production costs in 2020 are estimated between US$ 200 and 260/m 3 (9.4-12.2 US$/GJ). We conclude that using disaggregated experience curves for feedstock and industrial processing costs provide more insights into the factors that lowered costs in the past, and allow more accurate estimations for future cost developments. (author)

  2. Cost effectiveness of a screen-and-treat program for asymptomatic vaginal infections in pregnancy: towards a significant reduction in the costs of prematurity.

    Science.gov (United States)

    Kiss, H; Pichler, Eva; Petricevic, L; Husslein, P

    2006-08-01

    The purpose of this investigation was to determine the cost-saving potential of a simple screen-and-treat program for vaginal infection, which has previously been shown to lead to a reduction of 50% in the rate of preterm births. To determine the potential cost savings, we compared the direct costs of preterm delivery of infants with a birth weight below 1900g with the costs of the screen-and-treat program. We used a cut-off birth weight of 1900g because, in our population, all infants with a birth weight below 1900g were transferred to the neonatal intensive care unit. The direct costs associated with preterm delivery were defined to include the costs of the initial hospitalization of both mother and infant and the costs of outpatient follow-up throughout the first 6 years of life of the former preterm infant. The costs of the screen-and-treat program were defined to include the costs of the screening examination and the resulting costs of antimicrobial treatment and follow-up. All calculations were based on health-economic data obtained in the metropolitan area of Vienna, Austria. The number of preterm infants with a birth weight below 1900g was 12 (0.5%) in the intervention group (N=2058) and 29 (1.3%) in the control group (N=2097). The direct costs per preterm birth were found to amount to EUR (euro) 60262. Overall, the expected total savings in direct costs achieved by the screen-and-treat program and the ensuing 50% reduction in the number preterm births with a birth weight below 1900g amounted to more than euro 11 million. The costs of screening and treatment were found to amount to merely 7% of the direct costs saved as a result of the screen-and-treat program. A simple preterm prevention program, consisting of screening and antimicrobial treatment and follow-up of women with asymptomatic vaginal infection, leads not only to a significant reduction in the rate of preterm births but also to substantial savings in the direct costs associated with prematurity.

  3. Cost reduction for web-based data imputation

    KAUST Repository

    Li, Zhixu

    2014-01-01

    Web-based Data Imputation enables the completion of incomplete data sets by retrieving absent field values from the Web. In particular, complete fields can be used as keywords in imputation queries for absent fields. However, due to the ambiguity of these keywords and the data complexity on the Web, different queries may retrieve different answers to the same absent field value. To decide the most probable right answer to each absent filed value, existing method issues quite a few available imputation queries for each absent value, and then vote on deciding the most probable right answer. As a result, we have to issue a large number of imputation queries for filling all absent values in an incomplete data set, which brings a large overhead. In this paper, we work on reducing the cost of Web-based Data Imputation in two aspects: First, we propose a query execution scheme which can secure the most probable right answer to an absent field value by issuing as few imputation queries as possible. Second, we recognize and prune queries that probably will fail to return any answers a priori. Our extensive experimental evaluation shows that our proposed techniques substantially reduce the cost of Web-based Imputation without hurting its high imputation accuracy. © 2014 Springer International Publishing Switzerland.

  4. Cost reduction in abdominal CT by weight-adjusted dose

    International Nuclear Information System (INIS)

    Arana, Estanislao; Marti-Bonmati, Luis; Tobarra, Eva; Sierra, Consuelo

    2009-01-01

    Aim: To analyze the influence of contrast dose adjusted by weight vs. fixed contrast dose in the attenuation and cost of abdominal computed tomography (CT). Materials and methods: A randomised, consecutive, parallel group study was conducted in 151 patients (74 men and 77 women, age range 22-67 years), studied with the same CT helical protocol. A dose at 1.75 ml/kg was administered in 101 patients while 50 patients had a fixed dose of 120 ml of same non-ionic contrast material (320 mg/ml). Mean enhancements were measured at right hepatic lobe, superior abdominal aorta and inferior cava vein. Statistical analysis was weight-stratified ( 81 kg). Results: Aortic attenuation was significantly superior (p 61 kg in dose-adjusted group, presented higher hepatic attenuation, being statistically significant in those >81 kg (p 80 kg, there was an over cost of Euro 10.7 per patient. Conclusions: An injection volume of 1.75 ml/kg offers an optimal diagnostic quality with a global savings of Euro 1.34 per patient.

  5. Cost reduction in abdominal CT by weight-adjusted dose.

    Science.gov (United States)

    Arana, Estanislao; Martí-Bonmatí, Luis; Tobarra, Eva; Sierra, Consuelo

    2009-06-01

    To analyze the influence of contrast dose adjusted by weight vs. fixed contrast dose in the attenuation and cost of abdominal computed tomography (CT). A randomised, consecutive, parallel group study was conducted in 151 patients (74 men and 77 women, age range 22-67 years), studied with the same CT helical protocol. A dose at 1.75 ml/kg was administered in 101 patients while 50 patients had a fixed dose of 120 ml of same non-ionic contrast material (320 mg/ml). Mean enhancements were measured at right hepatic lobe, superior abdominal aorta and inferior cava vein. Statistical analysis was weight-stratified (81 kg). Aortic attenuation was significantly superior (p61 kg in dose-adjusted group, presented higher hepatic attenuation, being statistically significant in those >81 kg (p80 kg, there was an over cost of euro 10.7 per patient. An injection volume of 1.75 ml/kg offers an optimal diagnostic quality with a global savings of euro 1.34 per patient.

  6. Cost reduction possibilities for a heavy-ion accelerator for inertial confinement fusion

    International Nuclear Information System (INIS)

    Thayer, G.R.; Sims, J.R.; Henke, M.D.; Harris, D.B.; Dudziak, D.J.; Phillips, N.R.

    1987-10-01

    A design was produced for a single module in a cost-optimized accelerator appropriate for a commercial heavy-ion power plant. The goal of the study was to determine if the cost of the accelerator module could be reduced through design options, selection of materials, and manufacturing techniques. Independent cost estimates were obtained for the three main components of the module, and cost reductions of 20% from the cost calculated by the heavy-ion accelerator design/cost-minimization computer code LIACEP were identified. 3 refs., 23 figs

  7. A business perspective on environmental risk and cost reduction

    International Nuclear Information System (INIS)

    Roper, U.V.

    1998-01-01

    The ways in which the petrochemical industry can enjoy successful business partnerships with environmental service companies was discussed. The petrochemical industry has traditionally viewed environmental service companies as an inherent cost in the context of risk management, and not in the context of business opportunity. Today, as environmental issues are integrated into business operations, there is a new potential for creating business opportunities in a number of operational areas, among them : (1) energy efficiency, (2) process efficiency, (3) waste minimization, (4) waste recycling, and (5) operational pooling. As environmental service companies became more competitive, they have become more attractive business partners. They are providing more diversified services and are better aligned with core competencies required to exploit business opportunities that are too small for major players in the oil,natural gas and petro-chemical industry. They also offer public recognition and financial upside for industry. Some examples of successful business partnerships along these lines are briefly described

  8. Reduction of operations and maintenance costs at geothermal power plants

    Energy Technology Data Exchange (ETDEWEB)

    Bruton, C.J.; Stevens, C.G.; Rard, J.A.; Kasameyer, P.W. [Lawrence Livermore National Lab., CA (United States)

    1997-12-31

    To reduce chemical costs at geothermal power plants, we are investigating: (a) improved chemical processes associated with H{sub 2}S abatement techniques, and (b) the use of cross dispersive infrared spectrometry to monitor accurately, reliably, and continuously H{sub 2}S emissions from cooling towers. The latter is a new type of infrared optical technology developed by LLNL for non-proliferation verification. Initial work is focused at The Geysers in cooperation with Pacific Gas and Electric. Methods for deploying the spectrometer on-site at The Geysers are being developed. Chemical analysis of solutions involved in H{sub 2}S abatement technologies is continuing to isolate the chemical forms of sulfur produced.

  9. Feasibility of fractionating MIBI cold kits for cost reduction

    Energy Technology Data Exchange (ETDEWEB)

    Penglis, S.; Tsopelas, C. [Royal Adelaide Hospital. SA (Australia)

    1998-06-01

    Full text: Recently {sup 99m}Tc-MIBI become the first 99mTc-labelled myocardial perfusion imaging agent commercially available in Australia. After labelling each vial is sufficient for three to four patient doses. However, it becomes very expensive when only a single patient dose is required (up to $350 per dose). Our goal in this study was to subdivide the MIBI kit into fractions to establish the stability of these split kits. If successful, this would reduce the expense and make the product more cost-effective. After dissolving the Iyophilised ingredients of a MIBI vial with 5 mL of N2-purged normal saline, 1 mL aliquots of the resultant solution were dispensed into N2-filled vials under aseptic conditions. The vials were then stored frozen at -70 deg C. 99mTc-MIBI was prepared by the addition of 2 GBq of {sup 99m}Tc-pertechnetate in I mL of normal saline to the fractionated kit, followed by heating at 100 deg C for 10 minutes at 0, 2, 4 and 8 weeks post-fractionation. The product was allowed to cool before testing for radiochemical purity (RCP) for up to six hours post-labelling. The RCP of each vial was determined using aluminium oxide coated aluminium TLC strips (Merck) run in 100% ethanol. Over the eight-week evaluation period RCP was maintained at 94.2 + 1.3% over six hours (n = 16), which is greater than the minimum recommended RCP (90%) for patient use. These results show that fractionation of MIBI cold kits and sub-frozen storage under an N{sub 2} atmosphere provides a stable and economical multidose product. Using this method the cost of a single patient dose can be reduced considerably from $350, even allowing for the labour involved in the fractionation

  10. Feasibility of fractionating MIBI cold kits for cost reduction

    International Nuclear Information System (INIS)

    Penglis, S.; Tsopelas, C.

    1998-01-01

    Full text: Recently 99m Tc-MIBI become the first 99mTc-labelled myocardial perfusion imaging agent commercially available in Australia. After labelling each vial is sufficient for three to four patient doses. However, it becomes very expensive when only a single patient dose is required (up to $350 per dose). Our goal in this study was to subdivide the MIBI kit into fractions to establish the stability of these split kits. If successful, this would reduce the expense and make the product more cost-effective. After dissolving the Iyophilised ingredients of a MIBI vial with 5 mL of N2-purged normal saline, 1 mL aliquots of the resultant solution were dispensed into N2-filled vials under aseptic conditions. The vials were then stored frozen at -70 deg C. 99mTc-MIBI was prepared by the addition of 2 GBq of 99m Tc-pertechnetate in I mL of normal saline to the fractionated kit, followed by heating at 100 deg C for 10 minutes at 0, 2, 4 and 8 weeks post-fractionation. The product was allowed to cool before testing for radiochemical purity (RCP) for up to six hours post-labelling. The RCP of each vial was determined using aluminium oxide coated aluminium TLC strips (Merck) run in 100% ethanol. Over the eight-week evaluation period RCP was maintained at 94.2 + 1.3% over six hours (n = 16), which is greater than the minimum recommended RCP (90%) for patient use. These results show that fractionation of MIBI cold kits and sub-frozen storage under an N 2 atmosphere provides a stable and economical multidose product. Using this method the cost of a single patient dose can be reduced considerably from $350, even allowing for the labour involved in the fractionation

  11. Lower Costs, Better Care- Reforming Our Health Care Delivery

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...

  12. Implantable cardioverter defibrillator specific rehabilitation improves health cost outcomes

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Zwisler, Ann-Dorthe; Koch, Mette Bjerrum

    2015-01-01

    OBJECTIVE: The Copenhagen Outpatient ProgrammE - implantable cardioverter defibrillator (COPE-ICD) trial included patients with implantable cardioverter defibrillators in a randomized controlled trial of rehabilitation. After 6-12 months significant differences were found in favour of the rehabil...... was -6,789 USD/-5,593 Euro in favour of rehabilitation. CONCLUSION: No long-term health outcome benefits were found for the rehabilitation programme. However, the rehabilitation programme resulted in a reduction in total attributable direct costs....... of the rehabilitation group for exercise capacity, general and mental health. The aim of this paper is to explore the long-term health effects and cost implications associated with the rehabilitation programme; more specifically, (i) to compare implantable cardioverter defibrillator therapy history and mortality...... between rehabilitation and usual care groups; (ii) to examine the difference between rehabilitation and usual care groups in terms of time to first admission; and (iii) to determine attributable direct costs. METHODS: Patients with first-time implantable cardioverter defibrillator implantation (n = 196...

  13. Reduction of Total Ownership Costs (R-TOC) Best Practices Guide

    National Research Council Canada - National Science Library

    Reed, Danny

    2003-01-01

    The purpose of the Reduction of Total Ownership Costs (R-TOC) program is to achieve readiness improvements in weapon systems by improving the reliability of the systems or the efficiency of the processes used to support...

  14. The predictive validity of the HERO Scorecard in determining future health care cost and risk trends.

    Science.gov (United States)

    Goetzel, Ron Z; Henke, Rachel Mosher; Benevent, Richele; Tabrizi, Maryam J; Kent, Karen B; Smith, Kristyn J; Roemer, Enid Chung; Grossmeier, Jessica; Mason, Shawn T; Gold, Daniel B; Noeldner, Steven P; Anderson, David R

    2014-02-01

    To determine the ability of the Health Enhancement Research Organization (HERO) Scorecard to predict changes in health care expenditures. Individual employee health care insurance claims data for 33 organizations completing the HERO Scorecard from 2009 to 2011 were linked to employer responses to the Scorecard. Organizations were dichotomized into "high" versus "low" scoring groups and health care cost trends were compared. A secondary analysis examined the tool's ability to predict health risk trends. "High" scorers experienced significant reductions in inflation-adjusted health care costs (averaging an annual trend of -1.6% over 3 years) compared with "low" scorers whose cost trend remained stable. The risk analysis was inconclusive because of the small number of employers scoring "low." The HERO Scorecard predicts health care cost trends among employers. More research is needed to determine how well it predicts health risk trends for employees.

  15. Technological cost-reduction pathways for attenuator wave energy converters in the marine hydrokinetic environment.

    Energy Technology Data Exchange (ETDEWEB)

    Bull, Diana L; Ochs, Margaret Ellen

    2013-09-01

    This report considers and prioritizes the primary potential technical costreduction pathways for offshore wave activated body attenuators designed for ocean resources. This report focuses on technical research and development costreduction pathways related to the device technology rather than environmental monitoring or permitting opportunities. Three sources of information were used to understand current cost drivers and develop a prioritized list of potential costreduction pathways: a literature review of technical work related to attenuators, a reference device compiled from literature sources, and a webinar with each of three industry device developers. Data from these information sources were aggregated and prioritized with respect to the potential impact on the lifetime levelized cost of energy, the potential for progress, the potential for success, and the confidence in success. Results indicate the five most promising costreduction pathways include advanced controls, an optimized structural design, improved power conversion, planned maintenance scheduling, and an optimized device profile.

  16. An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada

    Science.gov (United States)

    2014-01-01

    Background Interest in the impact of burnout on physicians has been growing because of the possible burden this may have on health care systems. The objective of this study is to estimate the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada. Methods Using an economic model, the costs related to early retirement and reduction in clinical hours of physicians were compared for those who were experiencing burnout against a scenario in which they did not experience burnout. The January 2012 Canadian Medical Association Masterfile was used to determine the number of practicing physicians. Transition probabilities were estimated using 2007–2008 Canadian Physician Health Survey and 2007 National Physician Survey data. Adjustments were also applied to outcome estimates based on ratio of actual to planned retirement and reduction in clinical hours. Results The total cost of burnout for all physicians practicing in Canada is estimated to be $213.1 million ($185.2 million due to early retirement and $27.9 million due to reduced clinical hours). Family physicians accounted for 58.8% of the burnout costs, followed by surgeons for 24.6% and other specialists for 16.6%. Conclusion The cost of burnout associated with early retirement and reduction in clinical hours is substantial and a significant proportion of practicing physicians experience symptoms of burnout. As health systems struggle with human resource shortages and expanding waiting times, this estimate sheds light on the extent to which the burden could be potentially decreased through prevention and promotion activities to address burnout among physicians. PMID:24927847

  17. Understanding the reductions in US corn ethanol production costs: An experience curve approach

    International Nuclear Information System (INIS)

    Hettinga, W.G.; Junginger, H.M.; Dekker, S.C.; Hoogwijk, M.; McAloon, A.J.; Hicks, K.B.

    2009-01-01

    The US is currently the world's largest ethanol producer. An increasing percentage is used as transportation fuel, but debates continue on its costs competitiveness and energy balance. In this study, technological development of ethanol production and resulting cost reductions are investigated by using the experience curve approach, scrutinizing costs of dry grind ethanol production over the timeframe 1980-2005. Cost reductions are differentiated between feedstock (corn) production and industrial (ethanol) processing. Corn production costs in the US have declined by 62% over 30 years, down to 100$ 2005 /tonne in 2005, while corn production volumes almost doubled since 1975. A progress ratio (PR) of 0.55 is calculated indicating a 45% cost decline over each doubling in cumulative production. Higher corn yields and increasing farm sizes are the most important drivers behind this cost decline. Industrial processing costs of ethanol have declined by 45% since 1983, to below 130$ 2005 /m 3 in 2005 (excluding costs for corn and capital), equivalent to a PR of 0.87. Total ethanol production costs (including capital and net corn costs) have declined approximately 60% from 800$ 2005 /m 3 in the early 1980s, to 300$ 2005 /m 3 in 2005. Higher ethanol yields, lower energy use and the replacement of beverage alcohol-based production technologies have mostly contributed to this substantial cost decline. In addition, the average size of dry grind ethanol plants increased by 235% since 1990. For the future it is estimated that solely due to technological learning, production costs of ethanol may decline 28-44%, though this excludes effects of the current rising corn and fossil fuel costs. It is also concluded that experience curves are a valuable tool to describe both past and potential future cost reductions in US corn-based ethanol production

  18. Quantifying costs and benefits of integrated environmental strategies of air quality management and greenhouse gas reduction in the Seoul Metropolitan Area

    International Nuclear Information System (INIS)

    Chae, Yeora; Park, Jeongim

    2011-01-01

    This study quantifies the costs and benefits of Integrated Environmental Strategies (IES) of reducing air pollutants and greenhouse gas (GHG) emissions at a minimal cost in the Seoul Metropolitan Area (SMPA) for the year 2014 and compares with current air quality management plans and greenhouse gas (GHG) mitigation plans. The results estimated health benefits from prevention of premature mortality under the IES scenario as 14 trillion Korean won (won) and associated cost as -3.6 trillion won, yielding total benefit, difference of benefits and costs, of 18 trillion won. With the inclusion of benefits from GHG reductions, the total benefits result in 147 trillion won. The difference of human health benefits and costs of air quality management plan and GHG reduction strategies result in 14 trillion won and 8 trillion won, respectively. The research shows that benefits of integrating air quality management and GHG reduction measures are greater than those obtained by air quality management and GHG reduction measures individually. - Highlights: → The costs and benefits of Integrated Environmental Strategies (IES) are quantified.→ Benefit under IES is 14 trillion Korean won and cost is -3.6 trillion won.→ Benefit of air quality management is 14 trillion won and cost is -0.3 trillion won.→ Benefit under GHG reduction is 1.5 trillion won and cost is -6.4 trillion won.→ Benefits of IES are greater than those obtained by each measure individually.

  19. Quantifying costs and benefits of integrated environmental strategies of air quality management and greenhouse gas reduction in the Seoul Metropolitan Area

    Energy Technology Data Exchange (ETDEWEB)

    Chae, Yeora, E-mail: yrchae@kei.re.kr [Korea Environment Institute, 290 Jinheungno, Eunpyeong-Gu, Seoul 122-706 (Korea, Republic of); Park, Jeongim [Department of Environmental Health Science, Soonchunhyang University, Asan, Chungnam 336-745 (Korea, Republic of)

    2011-09-15

    This study quantifies the costs and benefits of Integrated Environmental Strategies (IES) of reducing air pollutants and greenhouse gas (GHG) emissions at a minimal cost in the Seoul Metropolitan Area (SMPA) for the year 2014 and compares with current air quality management plans and greenhouse gas (GHG) mitigation plans. The results estimated health benefits from prevention of premature mortality under the IES scenario as 14 trillion Korean won (won) and associated cost as -3.6 trillion won, yielding total benefit, difference of benefits and costs, of 18 trillion won. With the inclusion of benefits from GHG reductions, the total benefits result in 147 trillion won. The difference of human health benefits and costs of air quality management plan and GHG reduction strategies result in 14 trillion won and 8 trillion won, respectively. The research shows that benefits of integrating air quality management and GHG reduction measures are greater than those obtained by air quality management and GHG reduction measures individually. - Highlights: > The costs and benefits of Integrated Environmental Strategies (IES) are quantified.> Benefit under IES is 14 trillion Korean won and cost is -3.6 trillion won.> Benefit of air quality management is 14 trillion won and cost is -0.3 trillion won.> Benefit under GHG reduction is 1.5 trillion won and cost is -6.4 trillion won.> Benefits of IES are greater than those obtained by each measure individually.

  20. Understanding the reductions in US corn ethanol production costs: an experience curve approach

    NARCIS (Netherlands)

    Hettinga, W.; Junginger, H.M.; Dekker, S.C.; Hoogwijk, M.; McAloon, A.; Hicks, K.

    2009-01-01

    The US is currently the world's largest ethanol producer. An increasing percentage is used as transportation fuel, but debates continue on its costs competitiveness and energy balance. In this study, technological development of ethanol production and resulting cost reductions are investigated by

  1. COMPARISON OF WEST GERMAN AND U.S. FLUE GAS DESULFURIZATION AND SELECTIVE CATALYTIC REDUCTION COSTS

    Science.gov (United States)

    The report documents a comparison of the actual cost retrofitting flue gas desulfurization (FGD) and selective catalytic reduction (SCR) on Federal Republic of German (FRG) boilers to cost estimating procedures used in the U.S. to estimate the retrofit of these controls on U.S. b...

  2. 48 CFR 52.215-10 - Price Reduction for Defective Certified Cost or Pricing Data.

    Science.gov (United States)

    2010-10-01

    ... Defective Certified Cost or Pricing Data. 52.215-10 Section 52.215-10 Federal Acquisition Regulations System... Text of Provisions and Clauses 52.215-10 Price Reduction for Defective Certified Cost or Pricing Data... or Pricing Data (OCT 2010) (a) If any price, including profit or fee, negotiated in connection with...

  3. Cost-Reduction Roadmap for Residential Solar Photovoltaics (PV), 2017-2030

    Energy Technology Data Exchange (ETDEWEB)

    Cook, Jeffrey J. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Ardani, Kristen B. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Margolis, Robert M. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Fu, Ran [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2018-01-03

    The installed cost of solar photovoltaics (PV) has fallen rapidly in recent years and is expected to continue declining in the future. In this report, we focus on the potential for continued PV cost reductions in the residential market. From 2010 to 2017, the levelized cost of energy (LCOE) for residential PV declined from 52 cents per kilowatt-hour (cents/kWh) to 16 cents/kWh (Fu et al. 2017). The U.S. Department of Energy's (DOE's) Solar Energy Technologies Office (SETO) recently set new LCOE targets for 2030, including a target of 5 cents/kWh for residential PV. We present a roadmap for achieving the SETO 2030 residential PV target. Because the 2030 target likely will not be achieved under business-as-usual trends (NREL 2017), we examine two key market segments that demonstrate significant opportunities for cost savings and market growth: installing PV at the time of roof replacement and installing PV as part of the new home construction process. Within both market segments, we identify four key cost-reduction opportunities: market maturation, business model integration, product innovation, and economies of scale. To assess the potential impact of these cost reductions, we compare modeled residential PV system prices in 2030 to the National Renewable Energy Laboratory's (NREL's) quarter one 2017 (Q1 2017) residential PV system price benchmark (Fu et al. 2017). We use a bottom-up accounting framework to model all component and project-development costs incurred when installing a PV system. The result is a granular accounting for 11 direct and indirect costs associated with installing a residential PV system in 2030. All four modeled pathways demonstrate significant installed-system price savings over the Q1 2017 benchmark, with the visionary pathways yielding the greatest price benefits. The largest modeled cost savings are in the supply chain, sales and marketing, overhead, and installation labor cost categories. When we translate these

  4. Does mitigation save? Reviewing cost-benefit analyses of disaster risk reduction

    OpenAIRE

    Shreve, Cheney M.; Kelman, Ilan

    2014-01-01

    The benefit-cost-ratio (BCR), used in cost-benefit analysis (CBA), is an indicator that attempts to summarize the overall value for money of a project. Disaster costs continue to rise and the demand has increased to demonstrate the economic benefit of disaster risk reduction (DRR) to policy makers. This study compiles and compares original CBA case studies reporting DRR BCRs, without restrictions as to hazard type, location, scale, or other parameters. Many results were identified supporting ...

  5. Health and economic impacts of eight different dietary salt reduction interventions.

    Directory of Open Access Journals (Sweden)

    Nhung Nghiem

    Full Text Available Given the high importance of dietary sodium (salt as a global disease risk factor, our objective was to compare the impact of eight sodium reduction interventions, including feasible and more theoretical ones, to assist prioritisation.Epidemiological modelling and cost-utility analysis were performed using a Markov macro-simulation model. The setting was New Zealand (NZ (2.3 million citizens, aged 35+ years which has detailed individual-level administrative cost data.Of the most feasible interventions, the largest health gains were from (in descending order: (i mandatory 25% reduction in sodium levels in all processed foods; (ii the package of interventions performed in the United Kingdom (UK; (iii mandatory 25% reduction in sodium levels in bread, processed meats and sauces; (iv media campaign (as per a previous UK one; (v voluntary food labelling as currently used in NZ; (vi dietary counselling as currently used in NZ. Even larger health gains came from the more theoretical options of a "sinking lid" on the amount of food salt released to the national market to achieve an average adult intake of 2300 mg sodium/day (211,000 QALYs gained, 95% uncertainty interval: 170,000-255,000, and from a salt tax. All the interventions produced net cost savings (except counseling--albeit still cost-effective. Cost savings were especially large with the sinking lid (NZ$ 1.1 billion, US$ 0.7 billion. Also the salt tax would raise revenue (up to NZ$ 452 million/year. Health gain per person was greater for Māori (indigenous population men and women compared to non-Māori.This study substantially expands on the range of previously modelled salt reduction interventions and suggests that some of these might achieve major health gains and major cost savings (particularly the regulatory interventions. They could also reduce ethnic inequalities in health.

  6. Solar cost reduction through technical improvements: the concepts of learning and experience

    Energy Technology Data Exchange (ETDEWEB)

    Krawiec, F.; Flaim, T.

    1979-10-01

    The concepts of learning and experience are reviewed and their usefulness for predicting the future costs of solar technologies are evaluated. The literature review indicated that the cost estimates for solar energy technologies are typically made assuming a fixed production process, characterized by standard capacity factors, overhead, and labor costs. The learning curve is suggested as a generalization of the costs of potential solar energy systems. The concept of experience is too ambiguous to be useful for cost estimation. There is no logical reason to believe that costs will decline purely as a function of cumulative production, and experience curves do not allow the analyst to identify logical sources of cost reduction directly. The procedures for using learning and aggregated cost curves to estimate the costs of solar technologies are outlined. It is recommended that production histories of analogous products and processes are analyzed and the learning and cost curves for these surrogates are estimated. These curves, if judged applicable, can be used to predict the cost reductions in manufacturing solar energy technologies.

  7. Aneurysm coil embolization: cost per volumetric filling analysis and strategy for cost reduction.

    Science.gov (United States)

    Wang, Charlie; Ching, Esteban Cheng; Hui, Ferdinand K

    2016-05-01

    One of the primary device expenditures associated with the endovascular treatment of aneurysms is that of detachable coils. Analyzing the cost efficiency of detachable coils is difficult, given the differences in design, implantable volume, and the presence of additives. However, applying a volume per cost metric may provide an index analogous to unit price found in grocery stores. The price information for 509 different coils belonging to 31 different coil lines, available as of September 2013, was obtained through the inventory management system at the study site, and normalized to the price of the least expensive coil. Values were used to calculate the logarithmic ratio of volume over cost. Operator choice among coil sizes can vary the material costs by five-fold in a hypothetical aneurysm. The difference in coil costs as a function of cost per volume of coil can vary tremendously. Using the present pricing algorithms, using the longest available length at a particular helical dimension and system yields improved efficiency. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  8. Patient education after stoma creation may reduce health-care costs.

    Science.gov (United States)

    Danielsen, Anne Kjærgaard; Rosenberg, Jacob

    2014-04-01

    Researchers are urged to include health-economic assessments when exploring the benefits and drawbacks of a new treatment. The aim of the study was to assess the costs associated with the establishment of a new patient education programme for patients with a stoma. Following a previous case-control study that explored the effect of patient education for stoma patients, we set out to examine the costs related to such a patient education programme. The primary outcome was disease-specific health-related quality of life measured with the Ostomy Adjustment Scale six months after surgery. The secondary outcome was generic health-related quality of life measured with Short Form (SF)-36. In this secondary analysis, we calculated direct health-care costs for the first six months post-operatively from the perspective of the health-care system, including costs related to the hospital as well as primary health care. The overall cost related to establishing a patient education programme showed no significant increase in the overall average costs. However, we found a significant reduction in costs related to unplanned readmissions (p = 0.01) as well as a reduction in visits to the general practitioner (p = 0.05). Establishing a patient education programme - which increased quality of life - will probably not increase the overall costs associated with the patient course. The study received financial support from Søster Inge Marie Dahlgaards Fond, Diakonissestiftelsen, Denmark, and from Aase and Ejnar Danielsens Foundation, Denmark. NCT01154725.

  9. Carbon Emission Reduction with Capital Constraint under Greening Financing and Cost Sharing Contract.

    Science.gov (United States)

    Qin, Juanjuan; Zhao, Yuhui; Xia, Liangjie

    2018-04-13

    Motivated by the industrial practices, this work explores the carbon emission reductions for the manufacturer, while taking into account the capital constraint and the cap-and-trade regulation. To alleviate the capital constraint, two contracts are analyzed: greening financing and cost sharing. We use the Stackelberg game to model four cases as follows: (1) in Case A1, the manufacturer has no greening financing and no cost sharing; (2) in Case A2, the manufacturer has greening financing, but no cost sharing; (3) in Case B1, the manufacturer has no greening financing but has cost sharing; and, (4) in Case B2, the manufacturer has greening financing and cost sharing. Then, using the backward induction method, we derive and compare the equilibrium decisions and profits of the participants in the four cases. We find that the interest rate of green finance does not always negatively affect the carbon emission reduction of the manufacturer. Meanwhile, the cost sharing from the retailer does not always positively affect the carbon emission reduction of the manufacturer. When the cost sharing is low, both of the participants' profits in Case B1 (under no greening finance) are not less than that in Case B2 (under greening finance). When the cost sharing is high, both of the participants' profits in Case B1 (under no greening finance) are less than that in Case B2 (under greening finance).

  10. Carbon Emission Reduction with Capital Constraint under Greening Financing and Cost Sharing Contract

    Science.gov (United States)

    Qin, Juanjuan; Zhao, Yuhui; Xia, Liangjie

    2018-01-01

    Motivated by the industrial practices, this work explores the carbon emission reductions for the manufacturer, while taking into account the capital constraint and the cap-and-trade regulation. To alleviate the capital constraint, two contracts are analyzed: greening financing and cost sharing. We use the Stackelberg game to model four cases as follows: (1) in Case A1, the manufacturer has no greening financing and no cost sharing; (2) in Case A2, the manufacturer has greening financing, but no cost sharing; (3) in Case B1, the manufacturer has no greening financing but has cost sharing; and, (4) in Case B2, the manufacturer has greening financing and cost sharing. Then, using the backward induction method, we derive and compare the equilibrium decisions and profits of the participants in the four cases. We find that the interest rate of green finance does not always negatively affect the carbon emission reduction of the manufacturer. Meanwhile, the cost sharing from the retailer does not always positively affect the carbon emission reduction of the manufacturer. When the cost sharing is low, both of the participants’ profits in Case B1 (under no greening finance) are not less than that in Case B2 (under greening finance). When the cost sharing is high, both of the participants’ profits in Case B1 (under no greening finance) are less than that in Case B2 (under greening finance). PMID:29652859

  11. Health services utilization and costs of the insured and uninsured ...

    African Journals Online (AJOL)

    Background: Health insurance is a social security system that aims to facilitate fair financing of health costs through pooling and judicious utilization of financial resources, in order to provide financial risk protections and cost burden sharing for people against high cost of healthcare through various prepayment methods ...

  12. A supply chain cost reduction framework for the South African mobile phone industry

    Directory of Open Access Journals (Sweden)

    Musenga F. Mpwanya

    2017-03-01

    Aim: The purpose of this study is to explore supply chain costs in the South African mobile phone industry, and to develop a supply chain cost-reduction framework for the South African mobile phone industry. Setting: This study explores supply chain costs in four mobile phone companies operating in the South African mobile phone industry, of which three mobile network operators and one mobile retailing group. It uses semi-structured interview data collected in 2011. Method: This study adopted a qualitative case study design to understand supply chain costs and develop a supply chain cost-reduction framework for the South African mobile phone industry. Eight semi-structured interviews with managers of mobile phone companies were conducted. The data were analysed with the help of Atlas.ti, using an adapted three-phased analytical framework as suggested by Miles and Huberman (1994 and O’ Dwyer (2004. Results: The study found that consolidation of strategic relationships through collaboration and strategic alliances between MNOs and other supply chain players is one of the ways to drive costs down across the supply chain. Outsourcing of some of the support activities and retailers’ direct purchasing transactions from device manufacturers were also found to be other avenues for reducing supply chain costs in the industry. Conclusion: The study suggests that mobile network operators (MNOs need to consolidate their strategic relationships by increasing the share of the network infrastructure, and emphasising the need to strive for operational efficiencies. This combined effort should result in significant cost reductions across the supply chain. The findings of this study provided some avenues that managers of mobile-phone companies could consider to drive costs down supply chain-wide and service end-users at lower rates. The findings of this study could also help regulating authorities to get insights into supply chain cost reduction and develop appropriate

  13. Redesign of an in-market food processor for manufacturing cost reduction using DFMA methodology

    Directory of Open Access Journals (Sweden)

    Akshay Harlalka

    2016-01-01

    Full Text Available Reducing the time and cost involved in the product development is very important to stay competitive in the market. Design for Manufacturing and Assembly (DFMA is a cost-reduction framework for designers to evaluate manufacturing aspects of a product design. A case study on an in-market food processor, this paper aims to demonstrate the significance of DFMA implementation on an Indian consumer product. Even though many DFMA case studies have been published till date, very few have dealt with the Indian consumer durables category. In this paper, various cost-reduction opportunities are identified in the design of a food processor manufactured by a reputed company in India. Using the DFMA study, design ideas are developed with an objective of reducing the overall manufacturing cost of the product. As a result of DFMA implementation, significant improvement in terms of the product’s architecture, assembly time and design efficiency is identified. Overall cost reduction of 0.25 USD (United States Dollar was achieved and an improvement in the Design for Assembly (DFA index from 15.99 to 19.93 is reported. This procedure utilized in this paper can be adopted for any consumer durable products of similar type and design improvements and cost reduction can be achieved.

  14. The importance of health co-benefits in macroeconomic assessments of UK Greenhouse Gas emission reduction strategies

    DEFF Research Database (Denmark)

    Jensen, Henning Tarp; Keogh-Brown, Marcus R.; Smith, Richard D.

    2013-01-01

    . In contrast to previous assessment studies, our main focus is on health co-benefits additional to those from reduced local air pollution. We employ a conservative cost-effectiveness methodology with a zero net cost threshold. Our urban transport strategy (with cleaner vehicles and increased active travel......) brings important health co-benefits and is likely to be strongly cost-effective; our food and agriculture strategy (based on abatement technologies and reduction in livestock production) brings worthwhile health co-benefits, but is unlikely to eliminate net costs unless new technological measures...... to achieve future emission targets and longer-term benefits from GHG reduction. Cost-effectiveness of GHG strategies is likely to require technological mitigation interventions and/or demand-constraining interventions with important health co-benefits and other efficiency-enhancing policies that promote...

  15. Expansion of health insurance in Moldova and associated improvements in access and reductions in direct payments.

    Science.gov (United States)

    Hone, Thomas; Habicht, Jarno; Domente, Silviu; Atun, Rifat

    2016-12-01

    achieved improvements in health insurance coverage with reductions in OOP for services, which are modest but are eroded by increasing likelihood of OOP for medicines. Insurance coverage was an important determinant for health care costs incurred by patients and patients forgoing health care. Improvements notwithstanding, there is an unfinished agenda of attaining universal health coverage in Moldova to protect individuals from health care costs.

  16. Cost reductions of fuel cells for transport applications: fuel processing options

    Energy Technology Data Exchange (ETDEWEB)

    Teagan, W P; Bentley, J; Barnett, B [Arthur D. Little, Inc., Cambridge, MA (United States)

    1998-03-15

    The highly favorable efficiency/environmental characteristics of fuel cell technologies have now been verified by virtue of recent and ongoing field experience. The key issue regarding the timing and extent of fuel cell commercialization is the ability to reduce costs to acceptable levels in both stationary and transport applications. It is increasingly recognized that the fuel processing subsystem can have a major impact on overall system costs, particularly as ongoing R and D efforts result in reduction of the basic cost structure of stacks which currently dominate system costs. The fuel processing subsystem for polymer electrolyte membrane fuel cell (PEMFC) technology, which is the focus of transport applications, includes the reformer, shift reactors, and means for CO reduction. In addition to low cost, transport applications require a fuel processor that is compact and can start rapidly. This paper describes the impact of factors such as fuel choice operating temperature, material selection, catalyst requirements, and controls on the cost of fuel processing systems. There are fuel processor technology paths which manufacturing cost analyses indicate are consistent with fuel processor subsystem costs of under $150/kW in stationary applications and $30/kW in transport applications. As such, the costs of mature fuel processing subsystem technologies should be consistent with their use in commercially viable fuel cell systems in both application categories. (orig.)

  17. Health Costs Attributable to Smoking in Viet Nam | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Health Costs Attributable to Smoking in Viet Nam ... and the government has a particular interest in the economic costs associated with high tobacco consumption. ... IWRA/IDRC webinar on climate change and adaptive water management.

  18. Plant evaluation activities and O and M cost reduction in U.S

    International Nuclear Information System (INIS)

    Itoh, Takeshi

    1998-01-01

    Although some nuclear power plants face the possibility of premature retirement, most nuclear power plants have achieved substantial reductions in costs, mainly in O and M costs, and appear to be competitive with new gas and coal fired power plants. Improving competitiveness of existing nuclear power plants in the United States has primarily been driven by the electric utility self assessment activities. However, the background of this activity has been provided by the activities of NRC, INPO, NEI, EUCG and other activities being conducted for improvement of the nuclear power industry as a whole. Utility companies that are in the forefront of this activity have already achieved the reductions in staffing and outage time that are generally known to be effective for reducing O and M costs and are moving forward with rationalization and cost reductions in other areas. However, these electric utility companies are also achieving high safety and reliability. The staff of these electric utility companies have a high degree of autonomy, self motivation and self critical attitude and the staffing of these companies is a numerically small elite. This culture is supported by the self evaluation activity established by each company and is nurtured and supported by the management system. This appears to be one of the major elements in cost reduction. As this is based on U.S. information, differences in the system, society and culture in other nations mean that these findings may not be directly applicable. However, from the point of view of the prospects of nuclear power, these findings have an important meaning. This meaning is that the achievements in the United States of cost reduction activities centering on O and M costs are an important experience for other countries including Japan in reestablishing the economic competitiveness of nuclear power. (author)

  19. Supplier’s Joint Investments in Cost Reduction and Quality Improvement in a Decentralized Supply Chain

    Directory of Open Access Journals (Sweden)

    Hengyun Zhang

    2017-01-01

    Full Text Available We consider a decentralized supply chain with a downstream manufacturer and an upstream supplier. The upstream supplier sells a product to the manufacturer, who faces a quality and price sensitive demand. The supplier has a chance to invest in both cost reduction and quality improvement of its product. We derive the optimal investment and pricing decisions for the supply chain members. We do so in both the centralized and the decentralized supply chains. We show that the optimal investment and pricing decisions in the decentralized supply chain may deviate from that in the centralized supply chain. We develop a mechanism to coordinate the decentralized supply chain. The developed mechanism contains four policies: wholesale price, sharing of revenue, sharing of cost reduction investment cost, and sharing of quality improvement investment cost. We also show that the developed coordination mechanism can lead to Pareto improvement.

  20. Major cost savings associated with biologic dose reduction in patients with inflammatory arthritis.

    LENUS (Irish Health Repository)

    Murphy, C L

    2015-01-01

    The purpose of this study was to explore whether patients with Inflammatory Arthritis (IA) (Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS)) would remain in remission following a reduction in biologic dosing frequency and to calculate the cost savings associated with dose reduction. This prospective non-blinded non-randomised study commenced in 2010. Patients with Inflammatory Arthritis being treated with a biologic agent were screened for disease activity. A cohort of those in remission according to standardized disease activity indices (DAS28 < 2.6, BASDAI < 4) was offered a reduction in dosing frequency of two commonly used biologic therapies (etanercept 50 mg once per fortnight instead of weekly, adalimumab 40 mg once per month instead of fortnightly). Patients were assessed for disease activity at 3, 6, 12, 18 and 24 months following reduction in dosing frequency. Cost saving was calculated. 79 patients with inflammatory arthritis in remission were recruited. 57% had rheumatoid arthritis (n = 45), 13% psoriatic arthritis (n = 10) and 30% ankylosing spondylitis (n = 24). 57% (n = 45) were taking etanercept and 43% (n = 34) adalimumab. The percentage of patients in remission at 24 months was 56% (n = 44). This resulted in an actual saving to the state of approximately 600,000 euro over two years. This study demonstrates the reduction in biologic dosing frequency is feasible in Inflammatory Arthritis. There was a considerable cost saving at two years. The potential for major cost savings in biologic usage should be pursued further.

  1. Capacity utilization and the cost of primary care visits: Implications for the costs of scaling up health interventions

    Directory of Open Access Journals (Sweden)

    Johns Benjamin

    2008-11-01

    Full Text Available Abstract Objective A great deal of international attention has been focussed recently on how much additional funding is required to scale up health interventions to meet global targets such as the Millennium Development Goals (MDGs. Most of the cost estimates that have been made in response have assumed that unit costs of delivering services will not change as coverage increases or as more and more interventions are delivered together. This is most unlikely. The main objective of this paper is to measure the impact of patient load on the cost per visit at primary health care facilities and the extent to which this would influence estimates of the costs and financial requirements to scale up interventions. Methods Multivariate regression analysis was used to explore the determinants of variability in unit costs using data for 44 countries with a total of 984 observations. Findings Controlling for other possible determinants, we find that the cost of an outpatient visit is very sensitive to the number of patients seen by providers each day at primary care facilities. Each 1% increase in patient through-put results, on average, in a 27% reduction in the cost per visit (p Conclusion Variability in capacity utilization, therefore, need to be taken into account in cost estimates, and the paper develops a method by which this can be done.

  2. Understanding Health Care Costs in a Wisconsin Acute Leukemia Population

    Directory of Open Access Journals (Sweden)

    Patricia Steinert

    2016-08-01

    Full Text Available Purpose: We investigated factors driving health care costs of patients with a diagnosis of acute myeloid and acute lymphoblastic leukemia. Methods: Standard costs identified in insurance claims data obtained from the Wisconsin Health Information Organization were used in a sample of 837 acute leukemia patients from April 2009 to June 2011. The Andersen behavioral model of health care utilization guided selection of patient and community factors expected to influence health care costs. A generalized linear model fitting gamma-distributed data with log-link technique was used to analyze cost. Results: Type of treatment received and disease severity represented significant cost drivers, and patients receiving at least some of their treatment from academic medical centers experienced higher costs. Inpatient care and pharmacy costs of patients who received treatment from providers located in areas of higher poverty experienced lower costs, raising questions of potential treatment and medical practice disparities between provider locations. Directions of study findings were not consistent between different types of services received and underscore the complexity of investigating health care cost. Conclusions: While prevalence of acute leukemia in the United States is low compared to other diseases, its extreme high cost of treatment is not well understood and potentially influences treatment decisions. Acute leukemia health care costs may not follow expected patterns; further exploration of the relationship between cost and the treatment decision, and potential treatment disparities between providers in different socioeconomic locations, is needed.

  3. Health costs in anthroposophic therapy users: a two-year prospective cohort study

    Directory of Open Access Journals (Sweden)

    Willich Stefan N

    2006-06-01

    Full Text Available Abstract Background Anthroposophic therapies (counselling, special medication, art, eurythmy movement, and rhythmical massage aim to stimulate long-term self-healing processes, which theoretically could lead to a reduction of healthcare use. In a prospective two-year cohort study, anthroposophic therapies were followed by a reduction of chronic disease symptoms and improvement of quality of life. The purpose of this analysis was to describe health costs in users of anthroposophic therapies. Methods 717 consecutive outpatients from 134 medical practices in Germany, starting anthroposophic therapies for chronic diseases, participated in a prospective cohort study. We analysed direct health costs (anthroposophic therapies, physician and dentist consultations, psychotherapy, medication, physiotherapy, ergotherapy, hospital treatment, rehabilitation and indirect costs (sick leave compensation in the pre-study year and the first two study years. Costs were calculated from resource utilisation, documented by patient self-reporting. Data were collected from January 1999 to April 2003. Results Total health costs in the first study year (bootstrap mean 3,297 Euro; 95% confidence interval 95%-CI 3,157 Euro to 3,923 Euro did not differ significantly from the pre-study year (3,186 Euro; 95%-CI 3,037 Euro to 3,711 Euro, whereas in the second year, costs (2,771 Euro; 95%-CI 2,647 Euro to 3,256 Euro were significantly reduced by 416 Euro (95%-CI 264 Euro to 960 Euro compared to the pre-study year. In each period hospitalisation and sick-leave together amounted to more than half of the total health costs. Anthroposophic therapies and medication amounted to 3%, 15%, and 8% of total health costs in the pre-study year, first year, and second study year, respectively. The cost reduction in the second year was largely accounted for by a decrease of inpatient hospitalisation, leading to a hospital cost reduction of 519 Euro (95%-CI 377 Euro to 904 Euro compared to the

  4. Public risk-reduction measures: cost-effectiveness from a global point-of-view

    International Nuclear Information System (INIS)

    Oliveira, L.F.S. de; Motta Barros, E.B. da; Fleming, P.V.; Rosa, L.P.

    1985-05-01

    A review of systemic or global approach to cost-effectiveness analysis of risk-reduction measures is presented, and its advantages and limitations are discussed. The method is applied for problem of the cost-effectiveness of increasing the Angra 3 reactor containment wall thickness from 60cm to 180cm thick, in case of a direct commercial aircraft crash on it. (Author) [pt

  5. UMTRA Project-Level Cost Reduction/Productivity Improvement Program manual

    International Nuclear Information System (INIS)

    1995-06-01

    Mission of the Uranium Mill Tailings Remedial Action (UMTRA) Project Cost Reduction/Productivity Improvement Program (CR/PIP) is to contribute to the UMTRA Project's environmental restoration mission by providing the means to achieve and recognize continuous improvements and cost savings. This manual includes program definition, description of UMTRA project organizational responsibilities and interfaces with existing project functions, guidance to contractors, and definition of project-level functions

  6. Cost reduction study for the LANL KrF laser-driven LMF design

    International Nuclear Information System (INIS)

    1989-01-01

    This report is in fulfillment of the deliverable requirements for the optical components portions of the LANL-KrF Laser-Driven LMF Design Cost Reduction Study. This report examines the future cost reductions that may accrue through the use of mass production, innovative manufacturing techniques, and new materials. Results are based on data collection and survey of optical component manufacturers, BDM experience, and existing cost models. These data provide a good representation of current methods and technologies from which future estimates can be made. From these data, a series of scaling relationships were developed to project future costs for a selected set of technologies. The scaling relationships are sensitive to cost driving parameters such as size and surface figure requirements as well as quantity requirements, production rate, materials, and manufacturing processes. In addition to the scaling relationships, descriptions of the selected processes were developed along with graphical representations of the processes. This report provides a useful tool in projecting the costs of advanced laser concepts at the component level of detail. A mix of the most diverse yet comparable technologies was chosen for this study. This yielded a useful, yet manageable number of variables to examine. The study has resulted in a first-order cost model which predicts the relative cost behavior of optical components within different variable constraints

  7. A probabilistic production costing analysis of SO2 emissions reduction strategies for Ohio: emissions, costs and employment tradeoffs

    International Nuclear Information System (INIS)

    Heslin, J.S.; Hobbs, B.F.

    1991-01-01

    A new approach for state- and utility-level analysis of the cost and regional economic impacts of strategies for reducing utility SO 2 emissions is summarized and applied to Ohio. The methodology is based upon probabilistic production costing and economic input-output analysis. It is an improvement over previous approaches because it: (1) accurately models random outages of generating units, 'must-run' constraints on unit output, and the distribution of power demands; and (2) runs quickly on a microcomputer and yet considers the entire range of potential control strategies from a systems perspective. The input-output analysis considers not only the economic effects of utility fuel use and capital investment, but also those of increased electric rates. Two distinct strategies are found to be most attractive for Ohio. The first, more flexible one, consists of emissions dispatching (ED) alone to meet short run emissions reduction targets. A 75 percent reduction can then be achieved by the turn of the century by combining ED and fuel switching (FS) with flue gas desulfurization, limestone injection multistage burners, and physical coal cleaning at selected plants. The second is a scrubber-based strategy which includes ED. By the year 2000, energy conservation becomes a cost effective component of these strategies. In order to minimize compliance costs, acid rain legislation which facilitates emission trading and places regional tonnage limits on emissions is desirable

  8. Perceptions of managers regarding supply chain cost reduction in the South African mobile phone industry

    Directory of Open Access Journals (Sweden)

    Musenga F. Mpwanya

    2015-06-01

    Full Text Available Background: Many industries, including the mobile phone industry, experience a surge in supply chain (SC costs in the provision of products and services to their customers. Despite this, only a few studies have been conducted on SC cost reduction in South Africa and globally. Objective: This study seeks to understand the perceptions of managers regarding cost reduction in the South African mobile phone SC. Method: A qualitative case study was conducted, involving eight willing managers and using semi-structured interviews, observation and documents. Interviews transcripts were analysed thematically with the help of Atlas.ti and a threefold process was followed, comprising data reduction, data display and data interpretation and conclusion drawing. Results: The findings suggest that mobile phone companies should consolidate their strategic relationships and be efficient, in order to effectively reduce costs in the South African mobile phone SC. To achieve this, whilst South African mobile network operators have to share more and more infrastructure and outsource their operations, other mobile phone companies should re-engineer their operational processes and their reduce costs across the SC. Conclusion: The knowledge generated from this study should assist South African mobile phone companies to reduce their SC costs and address high-priced mobile services. On the other hand, this study should assist regulating authorities (the Department of Communications and the Independent Communication Authority of South Africa to gain insights into the challenges faced by the mobile phone industry in South Africa and, therefore, to make appropriate and adequate mobile telecommunication policies.

  9. Investigation of different modifications of the modular high temperature reactor for cost reduction

    International Nuclear Information System (INIS)

    Heek, A. van.

    1993-06-01

    Regarding the specific costs reactor with low power output have disadvantages compared to large reactors. In this study it was investigated for the HTR Module how to reduce the specific investment costs and consequently the electricity production costs by modification of the reactor and the power plant design. To reduce the investment costs different design changes were investigated, e.g. possible alternatives for the arrangement of the reactors and the steam generators and a different building layout. The cost reduction gained by a more compact type of construction and a reduction of the number of large components remains below 10%. The use of a gas turbine instead of a steam turbine with steam generator would result in a more efficient cost reduction. The increase in the power output has a much bigger potential to reduce the electricity production costs. The best way to realize this is the changing of the core geometry from cylindric to annular. A module concept with a power maximized under certain boundary conditions (limitation of the core temperatures in case of accident, use of proven technology) was worked out in detail. The optimum core geometry and power density, determined by tolerable accident temperatures and core pressure loss, make a thermal power of 350 MW possible. The physical properties and the accident behaviour in case of pressure release and water ingress were investigated. The specific investment costs and the electricity production costs of a 4-Modular Plant for pure electricity production are reduced about 28% resp. 19% compared with the 200 MWth-Module (KWU/Interatom). (orig.) [de

  10. A perspective on cost-effectiveness of greenhouse gas reduction solutions in water distribution systems

    International Nuclear Information System (INIS)

    Hendrickson, Thomas P; Horvath, Arpad

    2014-01-01

    Water distribution systems (WDSs) face great challenges as aging infrastructures require significant investments in rehabilitation, replacement, and expansion. Reducing environmental impacts as WDSs develop is essential for utility managers and policy makers. This study quantifies the existing greenhouse gas (GHG) footprint of common WDS elements using life-cycle assessment (LCA) while identifying the greatest opportunities for emission reduction. This study addresses oversights of the related literature, which fails to capture several WDS elements and to provide detailed life-cycle inventories. The life-cycle inventory results for a US case study utility reveal that 81% of GHGs are from pumping energy, where a large portion of these emissions are a result of distribution leaks, which account for 270 billion l of water losses daily in the United States. Pipe replacement scheduling is analyzed from an environmental perspective where, through incorporating leak impacts, a tool reveals that optimal replacement is no more than 20 years, which is in contrast to the US average of 200 years. Carbon abatement costs (CACs) are calculated for different leak reduction scenarios for the case utility that range from −$130 to $35 t −1  CO 2(eq) . Including life-cycle modeling in evaluating pipe materials identified polyvinyl chloride (PVC) and cement-lined ductile iron (DICL) as the Pareto efficient options, however; utilizing PVC presents human health risks. The model developed for the case utility is applied to California and Texas to determine the CACs of reducing leaks to 5% of distributed water. For California, annual GHG savings from reducing leaks alone (3.4 million tons of CO 2(eq) ) are found to exceed California Air Resources Board’s estimate for energy efficiency improvements in the state’s water infrastructure. (paper)

  11. Costs of health care across primary care models in Ontario.

    Science.gov (United States)

    Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

    2017-08-01

    The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the

  12. Cost-effectiveness and the socialization of health care.

    Science.gov (United States)

    Musgrove, P

    1995-01-01

    The more health care is socialized, the more cost-effectiveness is an appropriate criterion for expenditure. Utility-maximizing individuals, facing divisibility of health care purchases and declining marginal health gains, and complete information about probable health improvements, should buy health care according to its cost-effectiveness. Absent these features, individual health spending will not be cost-effective; and in any case, differences in personal utilities and risk aversion will not lead to the same ranking of health care interventions for everyone. Private insurance frees consumers from concern for cost, which undermines cost-effectiveness, but lets them emphasize effectiveness, which favors value for money. This is most important for costly and cost-effective interventions, especially for poor people. Cost-effectiveness is more appropriate and easier to achieve under second-party insurance. More complete socialization of health care, via public finance, can yield greater efficiency by making insurance compulsory. Cost-effectiveness is also more attractive when taxpayers subsidize others' care: needs (effectiveness) take precedence over wants (utility). The gain in effectiveness may be greater, and the welfare loss from Pareto non-optimality smaller, in poor countries than in rich ones.

  13. Health services utilization and costs of the insured and uninsured ...

    African Journals Online (AJOL)

    2013-07-05

    Jul 5, 2013 ... Background: Health insurance is a social security system that aims to ... civil servants have no appreciable advantage in terms of access to and cost of health .... self‑medication, pharmaceutical shops, traditional healers,.

  14. Does Prevention Pay? Costs and Potential Cost-savings of School Interventions Targeting Children with Mental Health Problems.

    Science.gov (United States)

    Wellander, Lisa; Wells, Michael B; Feldman, Inna

    2016-06-01

    -savings due to a reduction in the prevalence of mental health problems and averted additional support required. The school district was comprised of 6,256 students, with 310 students receiving additional support for their mental health problems. Of these, 143 received support in their original school due to either having ADHD (n = 111), psychosocial problems (n = 26), or anxiety/depression (n = 6). The payers' total cost of additional support was 2,637,850 Euro per school year (18,447 Euro per student). The cost of running both interventions for the school district was 953,643 Euro for one year, while the potential savings for these interventions were estimated to be 627,150 Euro. The estimated effects showed that there would be a reduction of students needing additional support (25 for ADHD, eight for psychosocial problems, and one for anxiety/depression), and the payer would receive a return on their invested resources in less than two years (1.5 years) after implementation. Preventive school interventions can both improve some children's mental health problems and be financially beneficial for the payer. However, they are still limited in their scope of reducing all students' mental health statuses to below clinical cut-offs; therefore, the preventive school interventions should be used as a supplement, but not a replacement, to current practices. The findings have political and societal implications, in that payers can reallocate their funds toward preventive measures targeting students' mental health problems, while reducing the costs. When evaluating public health actions, it is necessary to consider their economic impact. The resources are scarce and the decision makers need knowledge on how to allocate their resources in an efficient way. Cost-offset analysis is seen as one way for decision makers to comprehend research findings; however, such analyses tend to not include the full benefits of the interventions, and actual impacts need to be fully evaluated in routine

  15. Health economic studies: an introduction to cost-benefit, cost-effectiveness, and cost-utility analyses.

    Science.gov (United States)

    Angevine, Peter D; Berven, Sigurd

    2014-10-15

    Narrative overview. To provide clinicians with a basic understanding of economic studies, including cost-benefit, cost-effectiveness, and cost-utility analyses. As decisions regarding public health policy, insurance reimbursement, and patient care incorporate factors other than traditional outcomes such as satisfaction or symptom resolution, health economic studies are increasingly prominent in the literature. This trend will likely continue, and it is therefore important for clinicians to have a fundamental understanding of the common types of economic studies and be able to read them critically. In this brief article, the basic concepts of economic studies and the differences between cost-benefit, cost-effectiveness, and cost-utility studies are discussed. An overview of the field of health economic analysis is presented. Cost-benefit, cost-effectiveness, and cost-utility studies all integrate cost and outcome data into a decision analysis model. These different types of studies are distinguished mainly by the way in which outcomes are valued. Obtaining accurate cost data is often difficult and can limit the generalizability of a study. With a basic understanding of health economic analysis, clinicians can be informed consumers of these important studies.

  16. Technology learning for fuel cells. An assessment of past and potential cost reductions

    International Nuclear Information System (INIS)

    Schoots, K.; Van der Zwaan, B.C.C.; Kramer, G.J.

    2010-01-01

    Fuel cells have gained considerable interest as a means to efficiently convert the energy stored in gases like hydrogen and methane into electricity. Further developing fuel cells in order to reach cost, safety and reliability levels at which their widespread use becomes feasible is an essential prerequisite for the potential establishment of a 'hydrogen economy'. A major factor currently obviating the extensive use of fuel cells is their relatively high costs. At present we estimate these at about 1100 EUR(2005)W for an 80 kW fuel cell system but notice that specific costs vary markedly with fuel cell system power capacity. We analyze past fuel cell cost reductions for both individual manufacturers and the global market. We determine learning curves, with fairly high uncertainty ranges, for three different types of fuel cell technology - AFC, PAFC and PEMFC - each manufactured by a different producer. For PEMFC technology we also calculate a global learning curve, characterised by a learning rate of 21% with an error margin of 4%. Given their respective uncertainties, this global learning rate value is in agreement with those we find for different manufacturers. In contrast to some other new energy technologies, R and D still plays a major role in today's fuel cell improvement process and hence probably explains a substantial part of our observed cost reductions. The remaining share of these cost reductions derives from learning-by-doing proper. Since learning-by-doing usually involves a learning rate of typically 20%, the residual value for pure learning we find for fuel cells is relatively low. In an ideal scenario for fuel cell technology we estimate a bottom-line for specific (80 kW system) manufacturing costs of 95 EUR(2005)W. Although learning curves observed in the past constitute no guarantee for sustained cost reductions in the future, when we assume global total learning at the pace calculated here as the only cost reduction mechanism, this ultimate cost

  17. Cost-Effectiveness of Emissions Reduction through Vehicle Repair Compared to CNG Conversion.

    Science.gov (United States)

    Guenther, Paul L; Lesko, Jon M; Stedman, Donald H

    1996-10-01

    In return for a temporary waiver from converting five vehicles to operate on compressed natural gas (CNG) for the Denver Clean Fuels program, the University of Denver identified, tested, repaired, and retested nine employee commuter vehicles. The results of the study validated the concept that employer-based identification and repair programs can be carried out in a cost-effective way. On average, each repaired vehicle removed fifty times more carbon monoxide (CO) emissions from Denver air than each CNG conversion. The average cost of each repair was eight times less than the average cost of each conversion. The average fuel economy benefit from the repairs was enough to pay for the average cost of repairs in less than three years of normal driving. When the expected lifetimes of repairs and conversions are included, the targeted repair program appears to be over sixty times more cost-effective as a CO emissions reduction strategy than CNG conversion.

  18. Consequent use of IT tools as a driver for cost reduction and quality improvements

    Science.gov (United States)

    Hein, Stefan; Rapp, Roberto; Feustel, Andreas

    2013-10-01

    The semiconductor industry drives a lot of efforts in the field of cost reductions and quality improvements. The consequent use of IT tools is one possibility to support these goals. With the extensions of its 150mm Fab to 200mm Robert Bosch increased the systematic use of data analysis and Advanced Process Control (APC).

  19. Annual Energy Usage Reduction and Cost Savings of a School: End-Use Energy Analysis

    Science.gov (United States)

    Alghoul, M. A.; Bakhtyar, B.; Asim, Nilofar; Sopian, K.

    2014-01-01

    Buildings are among the largest consumers of energy. Part of the energy is wasted due to the habits of users and equipment conditions. A solution to this problem is efficient energy usage. To this end, an energy audit can be conducted to assess the energy efficiency. This study aims to analyze the energy usage of a primary school and identify the potential energy reductions and cost savings. A preliminary audit was conducted, and several energy conservation measures were proposed. The energy conservation measures, with reference to the MS1525:2007 standard, were modelled to identify the potential energy reduction and cost savings. It was found that the school's usage of electricity exceeded its need, incurring an excess expenditure of RM 2947.42. From the lighting system alone, it was found that there is a potential energy reduction of 5489.06 kWh, which gives a cost saving of RM 2282.52 via the improvement of lighting system design and its operating hours. Overall, it was found that there is a potential energy reduction and cost saving of 20.7% when the energy conservation measures are earnestly implemented. The previous energy intensity of the school was found to be 50.6 kWh/m2/year, but can theoretically be reduced to 40.19 kWh/mm2/year. PMID:25485294

  20. A sensitivity analysis of timing and costs of greenhouse gas emission reductions

    NARCIS (Netherlands)

    Gerlagh, R.; van der Zwaan, B.C.C.

    2004-01-01

    This paper analyses the optimal timing and macro-economic costs of carbon emission reductions that mitigate the global average atmospheric temperature increase. We use a macro-economic model in which there are two competing energy sources, fossil-fuelled and non-fossil-fuelled. Technological change

  1. Cost-effectiveness analysis of risk reduction at nuclear power plants

    International Nuclear Information System (INIS)

    Lochard, J.; Maccia, C.; Pages, P.

    1985-01-01

    Cost-effectiveness analysis of risk reduction is now widely accepted as a rational analytical framework to consistently address the resource allocation problem underlying any risk management process. This paper presents how this technique can be usefully applied to complex systems such as the management of radioactive releases from nuclear power plants into the environment. (orig.) [de

  2. The Cost of Class Size Reduction: Advice for Policymakers. RAND Graduate School Dissertation.

    Science.gov (United States)

    Reichardt, Robert E.

    This dissertation provides information to state-level policymakers that will help them avoid two implementation problems seen in the past in California's class-size-reduction (CSR) reform. The first problem was that flat, per student reimbursement did not adequately cover costs in districts with larger pre-CSR class-sizes or smaller schools. The…

  3. Cost-Effectiveness of Emission Reduction for the Indonesian Coal-Fired Power Plants

    NARCIS (Netherlands)

    Handayani, Kamia; Krozer, Yoram

    2014-01-01

    This paper presents the result of research on the cost-effectiveness of emission reduction in the selected coal-fired power plants (CFPPs) in Indonesia. The background of this research is the trend of more stringent environmental regulation regarding air emission from coal-fired power plants (CFPPs)

  4. Reductions in greenhouse gas emissions and cost by shipping at lower speeds

    International Nuclear Information System (INIS)

    Lindstad, Haakon; Asbjornslett, Bjorn E.; Stromman, Anders H.

    2011-01-01

    CO 2 emissions from maritime transport represent a significant part of total global greenhouse gas (GHG) emissions. According to the International Maritime Organization (), maritime transport emitted 1046 million tons (all tons are metric) of CO 2 in 2007, representing 3.3% of the world's total CO 2 emissions. The International Maritime Organization (IMO) is currently debating both technical and market-based measures for reducing greenhouse gas emissions from shipping. This paper presents investigations on the effects of speed reductions on the direct emissions and costs of maritime transport, for which the selection of ship classes was made to facilitate an aggregated representation of the world fleet. The results show that there is a substantial potential for reducing CO 2 emissions in shipping. Emissions can be reduced by 19% with a negative abatement cost (cost minimization) and by 28% at a zero abatement cost. Since these emission reductions are based purely on lower speeds, they can in part be performed now. - Highlights: → We investigates the effects of speed reductions for maritime transport. → The selection of ship classes represent the words fleet. → The transport volumes are kept constant. → The model includes both cost and emissions as a function of speed. → The results show that there is a substantial potential for reducing CO 2 emissions from shipping.

  5. Socio-economic and Engineering Assessments of Renewable Energy Cost Reduction Potential

    Science.gov (United States)

    Seel, Joachim

    This dissertation combines three perspectives on the potential of cost reductions of renewable energy--a relevant topic, as high energy costs have traditionally been cited as major reason to vindicate developments of fossil fuel and nuclear power plants, and to justify financial support mechanisms and special incentives for renewable energy generators. First, I highlight the role of market and policy drivers in an international comparison of upfront capital expenses of residential photovoltaic systems in Germany and the United States that result in price differences of a factor of two and suggest cost reduction opportunities. In a second article I examine engineering approaches and siting considerations of large-scale photovoltaic projects in the United States that enable substantial system performance increases and allow thus for lower energy costs on a levelized basis. Finally, I investigate future cost reduction options of wind energy, ranging from capital expenses, operating expenses, and performance over a project's lifetime to financing costs. The assessment shows both substantial further cost decline potential for mature technologies like land-based turbines, nascent technologies like fixed-bottom offshore turbines, and experimental technologies like floating offshore turbines. The following paragraphs summarize each analysis: International upfront capital cost comparison of residential solar systems: Residential photovoltaic (PV) systems were twice as expensive in the United States as in Germany in 2012. This price discrepancy stems primarily from differences in non-hardware or "soft" costs between the two countries, of which only 35% be explained by differences in cumulative market size and associated learning. A survey of German PV installers was deployed to collect granular data on PV soft costs in Germany, and the results are compared to those of a similar survey of U.S. PV installers. Non-module hardware costs and all analyzed soft costs are lower in

  6. The Cost of Health Services Delivery in Health Houses of Alborz: A Case Study

    Directory of Open Access Journals (Sweden)

    Javad Ghoddousinejad

    2015-07-01

    Full Text Available Background and Objectives : Health houses play an active role to improve health status of rural population.Furthermore, it is important to know the costs of provided services. This research was designed to determine the costs of healthcare delivery in health houses of ALBORZ district. Material and Methods : In this cross-sectional descriptive study, Activity Based Costing (ABC was used to analyze the costs of services. Results : The average Direct Costs (DC of healthcare delivery in health houses was estimated 37033365 Rials. Direct and Indirect Costs (IC of service delivery in health houses were 65.91% and 34.09% of Total Costs (TC respectively. Conclusion : Since human resources play the most important role in determining the costs of health services delivery in healthcare, reforming payment mechanisms would be a suitable solution to reduce extra costs. Moreover, in order to decrease extra costs, it is essential to modify activities and eliminate parallel tasks.

  7. Projected reduction in healthcare costs in Belgium after optimization of iodine intake: impact on costs related to thyroid nodular disease.

    Science.gov (United States)

    Vandevijvere, Stefanie; Annemans, Lieven; Van Oyen, Herman; Tafforeau, Jean; Moreno-Reyes, Rodrigo

    2010-11-01

    Several surveys in the last 50 years have repeatedly indicated that Belgium is affected by mild iodine deficiency. Within the framework of the national food and health plan in Belgium, a selective, progressive, and monitored strategy was proposed in 2009 to optimize iodine intake. The objective of the present study was to perform a health economic evaluation of the consequences of inadequate iodine intake in Belgium, focusing on undisputed and measurable health outcomes such as thyroid nodular disease and its associated morbidity (hyperthyroidism). For the estimation of direct, indirect, medical, and nonmedical costs related to thyroid nodular diseases in Belgium, data from the Federal Public Service of Public Health, Food Chain Safety and Environment, the National Institute for Disease and Disability Insurance (RIZIV/INAMI), the Information Network about the prescription of reimbursable medicines (FARMANET), Intercontinental Marketing Services, and expert opinions were used. These costs translate into savings after implementation of the iodization program and are defined as costs due to thyroid nodular disease throughout the article. Costs related to the iodization program are referred to as program costs. Only figures dating from before the start of the intervention were exploited. Only adult and elderly people (≥18 years) were taken into account in this study because thyroid nodular diseases predominantly affect this age group. The yearly costs due to thyroid nodular diseases caused by mild iodine deficiency in the Belgian adult population are ∼€38 million. It is expected that the iodization program will result in additional costs of ∼€54,000 per year and decrease the prevalence of thyroid nodular diseases by 38% after a 4-5-year period. The net savings after establishment of the program are therefore estimated to be at least €14 million a year. Optimization of iodine intake in Belgium should be quite cost effective, if only considering its impact on

  8. Dietary fibre intakes and reduction in functional constipation rates among Canadian adults: a cost-of-illness analysis

    Directory of Open Access Journals (Sweden)

    Mohammad M. H. Abdullah

    2015-12-01

    Full Text Available Background: Evidence-based research highlights beneficial impacts of dietary fibre on several aspects of the gut pathophysiology that are accompanied by a considerable financial burden in healthcare services. Recommended intakes of dietary fibre may thus associate with financial benefits at a population level. Objective: We sought to systematically assess the potential annual savings in healthcare costs that would follow the reduction in rates of functional constipation and irregularity with increased dietary fibre intakes among Canadian adults. Design: A cost-of-illness analysis was developed on the basis of current and recommended levels of fibre intake in Canada, constipation reduction per 1 g fibre intake, proportion of adults who are likely to consume fibre-rich diets, and population expected to respond to fibre intake. Sensitivity analyses covering a range of assumptions were further implemented within the economic simulation. Results: Our literature searches assumed a 1.8% reduction in constipation rates with each 1 g/day increase in fibre intake. With intakes corresponding to the Institute of Medicine's adequate levels of 38 g/day for men and 25 g/day for women, among 5 and 100% of the adult populations, anywhere between CAD$1.5 and CAD$31.9 million could be saved on constipation-related healthcare costs annually. Each 1 g/day increase in dietary fibre was estimated to result in total annual healthcare cost savings that ranged between CAD$0.1 and CAD$2.5 million. Conclusions: The present research suggests an economic value of increasing dietary fibre intake beyond its well-known health benefits. Healthy-eating behaviours consistent with the recommended intakes of dietary fibre by the general public should hence be advocated as a practical approach for reducing costs associated with the management of constipation in Canada.

  9. Health Care Analysis for the MCRMC Insurance Cost Model

    Science.gov (United States)

    2015-06-01

    incentive to reduce utilization  Subsidy to leave TRICARE and use other private health insurance  Increases in TRICARE premiums and co-pays  This...analysis develops the estimated cost of providing health care through a premium -based insurance model consistent with an employer-sponsored benefit...State  Income  Plan premium data  Contract cost data 22 May 2015 9 Agenda  Overview  Background  Data  Insurance Cost Estimate Methodology

  10. Cost analysis of soil-depressurization techniques for indoor radon reduction

    International Nuclear Information System (INIS)

    Henschel, D.B.

    1991-01-01

    The article discusses a parametric cost analysis to evaluate active soil depressurization (ASD) systems for indoor radon reduction in houses. The analysis determined the relative importance of 14 ASD design variables and 2 operating variables on the installation and operating costs of residential ASD systems in several types of houses. Knowledge of the most important variables would enable EPA's research and development efforts to be more effectively directed at ways to reduce ASD costs and thus to increase utilization of the technology. Parameters offering the greatest potential for reductions in installation costs included three dealing with houses with poor subslab communication: (1) reducing the number of subslab depressurization pipes; (2) eliminating excavation of large subslab pits beneath the suction pipes to improve suction field extension; and (3) improving the effectiveness of premitigation subslab communication diagnostic testing in achieving simpler, less expensive ASD system designs. In addition, determining acceptable conditions for discharging ASD exhaust at grade level would reduce installation costs. Better design guidance for crawl-space submembrane depressurization (SMD) systems could reduce installation costs, if difficult membrane sealing steps and complete coverage of the crawl-space floor by the membrane can be avoided

  11. 48 CFR 52.215-11 - Price Reduction for Defective Certified Cost or Pricing Data-Modifications.

    Science.gov (United States)

    2010-10-01

    ... accordingly and the contract shall be modified to reflect the reduction. This right to a price reduction is... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Price Reduction for... CONTRACT CLAUSES Text of Provisions and Clauses 52.215-11 Price Reduction for Defective Certified Cost or...

  12. Blood pressure reduction, persistence and costs in the evaluation of antihypertensive drug treatment – a review

    Directory of Open Access Journals (Sweden)

    Hasford Joerg

    2009-03-01

    Full Text Available Abstract Background Blood pressure lowering drugs are usually evaluated in short term trials determining the absolute blood pressure reduction during trough and the duration of the antihypertensive effect after single or multiple dosing. A lack of persistence with treatment has however been shown to be linked to a worse cardiovascular prognosis. This review explores the blood pressure reduction and persistence with treatment of antihypertensive drugs and the cost consequences of poor persistence with pharmaceutical interventions in arterial hypertension. Methods We have searched the literature for data on blood pressure lowering effects of different antihypertensive drug classes and agents, on persistence with treatment, and on related costs. Persistence was measured as patients' medication possession rate. Results are presented in the form of a systematic review. Results Angiotensin II receptor blocker (ARBs have a competitive blood pressure lowering efficacy compared with ACE-inhibitors (ACEi and calcium channel blockers (CCBs, beta-blockers (BBs and diuretics. 8 studies describing the persistence with treatment were identified. Patients were more persistent on ARBs than on ACEi and CCBs, BBs and diuretics. Thus the product of blood pressure lowering and persistence was higher on ARBs than on any other drug class. Although the price per tablet of more recently developed drugs (ACEi, ARBs is higher than that of older ones (diuretics and BBs, the newer drugs result in a more favourable cost to effect ratio when direct drug costs and indirect costs are also considered. Conclusion To evaluate drugs for the treatment of hypertension several key variables including the blood pressure lowering effect, side effects, compliance/persistence with treatment, as well as drug costs and direct and indirect costs of medical care have to be considered. ARBs, while nominally more expensive when drug costs are considered only, provide substantial cost savings

  13. Health gain by salt reduction in europe: a modelling study.

    Directory of Open Access Journals (Sweden)

    Marieke A H Hendriksen

    Full Text Available Excessive salt intake is associated with hypertension and cardiovascular diseases. Salt intake exceeds the World Health Organization population nutrition goal of 5 grams per day in the European region. We assessed the health impact of salt reduction in nine European countries (Finland, France, Ireland, Italy, Netherlands, Poland, Spain, Sweden and United Kingdom. Through literature research we obtained current salt intake and systolic blood pressure levels of the nine countries. The population health modeling tool DYNAMO-HIA including country-specific disease data was used to predict the changes in prevalence of ischemic heart disease and stroke for each country estimating the effect of salt reduction through its effect on blood pressure levels. A 30% salt reduction would reduce the prevalence of stroke by 6.4% in Finland to 13.5% in Poland. Ischemic heart disease would be decreased by 4.1% in Finland to 8.9% in Poland. When salt intake is reduced to the WHO population nutrient goal, it would reduce the prevalence of stroke from 10.1% in Finland to 23.1% in Poland. Ischemic heart disease would decrease by 6.6% in Finland to 15.5% in Poland. The number of postponed deaths would be 102,100 (0.9% in France, and 191,300 (2.3% in Poland. A reduction of salt intake to 5 grams per day is expected to substantially reduce the burden of cardiovascular disease and mortality in several European countries.

  14. Compendium of cost-effectiveness evaluations of modifications for dose reduction at nuclear power plants

    International Nuclear Information System (INIS)

    Baum, J.W.; Matthews, G.R.

    1985-12-01

    This report summarizes available information on cost effectiveness of engineering modifications potentially valuable for dose reduction at nuclear power plants. Data were gathered from several US utilities, published literature, equipment and service suppliers, and recent technical meetings. Five simplified econometric models were employed to evaluate data and arrive at a value for cost effectiveness expressed in either (a) dollars/rem, or (b) total dollar savings calculated using a nominal value of $1000/rem. Models employed were: a basic model with no consideration given to the time value of money; two models in which discounting was used to evaluate costs and savings in terms of present values; and two models in which income taxes and revenue requirements were considered. Results from different models varied by as much as a factor of 10, and were generally lowest for the basic model and highest for the before-tax revenue requirements model. Results for 151 evaluations employing different assumptions concerning number of plants per site and outage impacts were tabulated in order of decreasing cost effectiveness. Twenty-five evaluations were identified as exceptionally cost effective since both costs and dose were saved. Forty evaluations indicated highly cost-effective changes based on costs below $1000/rem saved using results of the present-worth model that included discounting of future dose savings

  15. Analyses on Cost Reduction and CO2 Mitigation by Penetration of Fuel Cells to Residential Houses

    Science.gov (United States)

    Aki, Hirohisa; Yamamoto, Shigeo; Kondoh, Junji; Murata, Akinobu; Ishii, Itaru; Maeda, Tetsuhiko

    This paper presents analyses on the penetration of polymer electrolyte fuel cells (PEFC) into a group of 10 residential houses and its effects of CO2 emission mitigation and consumers’ cost reduction in next 30 years. The price is considered to be reduced as the penetration progress which is expected to begin in near future. An experimental curve is assumed to express the decrease of the price. Installation of energy interchange systems which involve electricity, gas and hydrogen between a house which has a FC and contiguous houses is assumed to utilize both electricity and heat more efficiently, and to avoid start-stop operation of fuel processor (reformer) as much as possible. A multi-objective model which considers CO2 mitigation and consumers’ cost reduction is constructed and provided a Pareto optimum solution. A solution which simultaneously realizes both CO2 mitigation and consumers’ cost reduction appeared in the Pareto optimum solution. Strategies to reduce CO2 emission and consumers’ cost are suggested from the results of the analyses. The analyses also revealed that the energy interchange systems are effective especially in the early stage of the penetration.

  16. Cost-Optimal Pathways to 75% Fuel Reduction in Remote Alaskan Villages: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Simpkins, Travis; Cutler, Dylan; Hirsch, Brian; Olis, Dan; Anderson, Kate

    2015-10-28

    There are thousands of isolated, diesel-powered microgrids that deliver energy to remote communities around the world at very high energy costs. The Remote Communities Renewable Energy program aims to help these communities reduce their fuel consumption and lower their energy costs through the use of high penetration renewable energy. As part of this program, the REopt modeling platform for energy system integration and optimization was used to analyze cost-optimal pathways toward achieving a combined 75% reduction in diesel fuel and fuel oil consumption in a select Alaskan village. In addition to the existing diesel generator and fuel oil heating technologies, the model was able to select from among wind, battery storage, and dispatchable electric heaters to meet the electrical and thermal loads. The model results indicate that while 75% fuel reduction appears to be technically feasible it may not be economically viable at this time. When the fuel reduction target was relaxed, the results indicate that by installing high-penetration renewable energy, the community could lower their energy costs by 21% while still reducing their fuel consumption by 54%.

  17. Introduction to cost-effectiveness analysis of risk reduction measures in energy systems

    International Nuclear Information System (INIS)

    1986-07-01

    The aim of this report is to introduce readers to methods of cost-effectiveness analysis and their application in risk reduction, especially in connection with the energy-producing industries. The background to the assessment of risk and the problems in estimating it quantitatively are outlined. The methodology of cost-effectiveness analysis is then described, particular attention being given to the way in which results are derived and the overall use that can be made of them. This is followed by a discussion of quantitative applications and an outline of the methods that may be used to derive estimates both of risk and the cost of reducing it. The use of cost-effectiveness analysis is illustrated in an appendix, which gives as a worked example a case study on the reduction of public risk associated with radioactive releases during normal operation of a PWR. After drawing some general conclusions the report recommends that such analyses should normally be used as an aid to risk management whenever several alternative risk reduction measures are under consideration

  18. How Expensive Is Expensive Enough? Opportunities for Cost Reductions in Offshore Wind Energy Logistics

    DEFF Research Database (Denmark)

    Poulsen, Thomas; Hasager, Charlotte Bay

    2016-01-01

    This paper reveals that logistics may conservatively amount to 18% of the levelized cost of energy for offshore wind farms. This is the key finding from an extensive case study carried out within the organization of the world’s leading offshore wind farm developer and operator. The case study aimed...... to, and produced, a number of possible opportunities for offshore wind cost reductions through logistics innovation; however, within the case study company, no company-wide logistics organization existed to focus horizontally on reducing logistics costs in general. Logistics was not well defined...... within the case study company, and a logistics strategy did not exist. With full life-cycle costs of offshore wind farms still high enough to present a political challenge within the European Union in terms of legislation to ensure offshore wind diffusion beyond 2020, our research presents logistics...

  19. Uranium Mill Tailings Remedial Action Project: Cost Reduction and Productivity Improvement Program Project Plan

    International Nuclear Information System (INIS)

    1991-11-01

    The purpose of the Cost Reduction/Productivity Improvement Program Plan is to formalize and improve upon existing efforts to control costs which have been underway since project inception. This program plan has been coordinated with the Department of Energy (DOE) Office of Environmental Management (EM) and the DOE Field Office, Albuquerque (AL). It incorporates prior Uranium Mill Tallings Remedial Action (UMTRA) Project Office guidance issued on the subject. The opportunities for reducing cosh and improving productivity are endless. The CR/PIP has these primary objectives: Improve productivity and quality; heighten the general cost consciousness of project participants, at all levels of their organizations; identify and implement specific innovative employee ideas that extend beyond what is required through existing processes and procedures; emphasize efforts that create additional value for the money spent by maintaining the project Total Estimated Cost (TEC) at the lowest possible level

  20. Cost reduction and safety design features of new nuclear power plants in India. Annex 13

    International Nuclear Information System (INIS)

    Sharma, V.K.

    2002-01-01

    Indian Nuclear Power Programme is designed to exploit limited reserves of uranium and extensive resource of thorium. Pressurised heavy water reactors are found most suitable and form the main stay of the first stage of the programme. Thorium utilisation is achieved in the second and third stages. Today India has total installed capacity of 2720 MWe of PHWRs which are operating with high plant load factors of over 80%. Rich experience of construction and operation of over 150 reactor years is being utilised in effecting cost reduction and safety improvements. Standardisation and reduction in gestation period by preproject activities, advance procurement and work packages of engineer, procure, construct and commission are some of the techniques being adopted for cost reduction in the new projects. But the cost of safety is rising. Design basis event of double ended guillotine rupture of primary pressure boundary needs a relook based on current knowledge of material behaviour. This event appears improbable. Similarly some of the safety related systems like closed loop cooling water operating at low temperature and pressure, and low usage factors may be designed as per standard codes without invoking special nuclear requirements. The paper will address these issues and highlight the possible areas for cost reduction both in operating and safety systems. Modern construction and project management techniques are being employed. Gestation period of 5 years and cost of less than US $1400 per KWe are the present targets. In Indian environment nuclear power is found to be competitive with thermal power plants at distances of about 800 Kms from the coal mines. (author)

  1. Explaining the reductions in US corn ethanol processing costs: Testing competing hypotheses

    International Nuclear Information System (INIS)

    Chen Xiaoguang; Khanna, Madhu

    2012-01-01

    The processing costs of US corn ethanol have declined by 45% since 1983 as production volumes have increased seventeen-fold. We investigate the role of various factors that could explain this, including economies of scale, cumulative experience, induced innovation in response to rising input prices, an autonomous technological change, and trade induced competition from imported ethanol. Using data on dry-mill ethanol processing costs over the 1983–2005 period, we find evidence to show that US corn ethanol production exhibited decreasing returns to scale, that learning by doing played an important role in reducing these processing costs with a learning rate of 0.25, and that sugarcane ethanol imports contributed to making the corn ethanol industry more competitive. Other factors such as the rising prices of energy and labor did induce lower processing costs, but the effect is not statistically significant. The inclusion of these competing explanations for the reduction in processing costs of US corn ethanol lead to a significantly higher learning rate than otherwise, and this learning rate is found to be robust across specifications. - Highlights: ► We investigate the role of various factors that could explain the reduction in US corn ethanol processing costs over the period 1983–2005. ► We find that US corn ethanol production exhibited decreasing returns to scale. ► Learning by doing played an important role in reducing these costs with a learning rate of 0.25. ► Sugarcane ethanol imports contributed to making the corn ethanol industry more competitive. ► Rising prices of energy and labor did induce lower processing costs, but the effect is not statistically significant.

  2. Health Insurance Costs and Employee Compensation: Evidence from the National Compensation Survey.

    Science.gov (United States)

    Anand, Priyanka

    2017-12-01

    This paper examines the relationship between rising health insurance costs and employee compensation. I estimate the extent to which total compensation decreases with a rise in health insurance costs and decompose these changes in compensation into adjustments in wages, non-health fringe benefits, and employee contributions to health insurance premiums. I examine this relationship using the National Compensation Survey, a panel dataset on compensation and health insurance for a sample of establishments across the USA. I find that total hourly compensation reduces by $0.52 for each dollar increase in health insurance costs. This reduction in total compensation is primarily in the form of higher employee premium contributions, and there is no evidence of a change in wages and non-health fringe benefits. These findings show that workers are absorbing at least part of the increase in health insurance costs through lower compensation and highlight the importance of examining total compensation, and not just wages, when examining the relationship between health insurance costs and employee compensation. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  3. Cost reductions for offshore wind power. Exploring the balance between scaling, learning and R and D

    International Nuclear Information System (INIS)

    Van der Zwaan, B.; Rivera-Tinoco, R.; Lensink, S.; Van den Oosterkamp, P.

    2012-01-01

    Offshore wind electricity generation is prospected to increase substantially in the near future at a number of locations, like in the Baltic, Irish and North Sea, and emerge at several others. The global growth of offshore wind technology is likely to be accompanied by reductions in wind park construction costs, both as a result of scaling and learning effects. Since 2005, however, significant cost increases have been observed. A recent surge in commodity prices proves to constitute one of the main drivers of these cost increases. This observation begs the question whether wind turbine manufacturers should return to the laboratory for undertaking R and D that explores the use of alternative materials and bring offshore wind energy closer to competitiveness. It is demonstrated that if one abstracts from material price fluctuations, in particular for metals such as copper and steel, turbine production plus installation cost data publicly available for a series of offshore wind park projects (realized in several European countries since the 1990's) show a cost reduction trend. Hence various other sources of cost increases, such as due to the progressively larger distances from the shore (and correspondingly greater depths at sea) at which wind parks have been (and will be) built, are outshadowed by cost reduction effects. When one expresses the overall cost development for offshore wind energy capacity as an experience curve, a learning rate is found of 3%, which reflects a mixture of economies-of-scale and learning-by-doing mechanisms. Also the impact is quantified on offshore wind power construction costs from the recent tightness in the market for turbine manufacturing and installation services: without the demand-supply response inertia at the origin of this tightness it is estimated that the learning rate would be 5%. Since these learning rates are relatively low - in comparison to those observed for other technologies, and in view of the high current capacity

  4. Costs of certified emission reductions under the Clean Development Mechanism of the Kyoto Protocol

    International Nuclear Information System (INIS)

    Rahman, Shaikh M.; Kirkman, Grant A.

    2015-01-01

    This paper examines the cost structure of certified emission reductions (CERs) through various types of projects under the Clean Development Mechanism (CDM) of the Kyoto Protocol. Using the CDM project data, the costs of CERs and their variation across technology and over time and space are estimated by applying alternative functional forms and specifications. Results show that the average cost of CERs decreases with the project scale and duration, scale and duration effects significantly vary across project types, and there is an upward trend in costs. The results also show that the distribution of the projects in the CDM portfolio or a given location does not strictly follow the relative cost structure, nor does the distribution of the CDM projects in different host countries follow the principle of comparative advantage. More than 84% of the CDM portfolio consists of various energy projects with substantially higher costs of CERs than afforestation and reforestation, industrial and landfill gas reduction, and methane avoidance projects, which are only 12% of all projects. While per unit cost of abatement plays an important role in the bottom-up and top-down models to evaluate emission reduction potential and analyze policy alternatives, the findings contradict the presumption of such models that project investors seek out low-cost opportunities. At the aggregate level, the cost of CER by the projects in Asia and Europe is similar but higher than those hosted in Africa, Americas, and Oceania. Yet more than 83% of the projects in the CDM portfolio are located in Asia; more than 69% of the projects are in China and India alone. China appears to have a comparative advantage (i.e., lowest opportunity cost) in energy efficiency projects, while India has a comparative advantage in hydro power projects and Brazil has a comparative advantage in wind power projects. In contrast, energy efficiency category accounts for only 8% of the CDM projects in China, hydro power

  5. How Expensive Is Expensive Enough? Opportunities for Cost Reductions in Offshore Wind Energy Logistics

    Directory of Open Access Journals (Sweden)

    Thomas Poulsen

    2016-06-01

    Full Text Available This paper reveals that logistics may conservatively amount to 18% of the levelized cost of energy for offshore wind farms. This is the key finding from an extensive case study carried out within the organization of the world’s leading offshore wind farm developer and operator. The case study aimed to, and produced, a number of possible opportunities for offshore wind cost reductions through logistics innovation; however, within the case study company, no company-wide logistics organization existed to focus horizontally on reducing logistics costs in general. Logistics was not well defined within the case study company, and a logistics strategy did not exist. With full life-cycle costs of offshore wind farms still high enough to present a political challenge within the European Union in terms of legislation to ensure offshore wind diffusion beyond 2020, our research presents logistics as a next frontier for offshore wind constituencies. This important area of the supply chain is ripe to academically and professionally cultivate and harvest in terms of offshore wind energy cost reductions. Our paper suggests that a focused organizational approach for logistics both horizontally and vertically within the company organizations could be the way forward, coupled with a long-term legislative environment to enable the necessary investments in logistics assets and transport equipment.

  6. Health care costs: saving in the private sector.

    Science.gov (United States)

    Robeson, F E

    1979-01-01

    Robeson offers a number of options to employers to help reduce the impact of increasing health care costs. He points out that large organizations which employ hundreds of people have considerable market power which can be exerted to contain costs. It is suggested that the risk management departments assume the responsibility for managing the effort to reduce the costs of medical care and of the health insurance programs of these organizations since that staff is experienced at evaluating premiums and negotiating with third-party payors. The article examines a number of short-run strategies for firms to pursue to contain health care costs: (1) use alternative delivery systems such as health maintenance organizations (HMOs) which have cost-cutting potential but require marketing efforts to persuade employees of their desirability; (2) contracts with third-party payors which require a second opinion (peer review), a practice which saved one labor union over $2 million from 1972 to 1976; (3) implementation of insurance coverage for less expensive outpatient care; and (4) the use of claims review. These strategies are compared in terms of four criteria: supply of demand for health services; management effort; cost; and time necessary for realized savings. Robeson concludes that development of a management plan for containing health care costs requires an extensive analysis of alternatives, organizational objectives, existing policies, and resources, and offers a table summarizing the cost-containment strategies that a firm should consider.

  7. Cost-effectiveness of insulin analogs from the perspective of the Brazilian public health system

    Directory of Open Access Journals (Sweden)

    Maurílio de Souza Cazarim

    2017-11-01

    Full Text Available ABSTRACT Human insulin is provided by the Brazilian Public Health System (BPHS for the treatment of diabetes, however, legal proceedings to acquire insulin analogs have burdened the BPHS health system. The aim of this study was to perform a cost-effectiveness analysis to compare insulin analogs and human insulins. This is a pharmacoeconomic study of cost-effectiveness. The direct medical cost related to insulin extracted from the Ministry of Health drug price list was considered. The clinical results, i.e. reduction in glycated hemoglobin (HbA1c, were extracted by meta-analysis. Different scenarios were structured to measure the uncertainties regarding the costs and reduction in HbA1c. Decision tree was developed for sensitivity of Incremental Cost Effectiveness Ratio (ICER. A total of fifteen scenarios were structured. Given the best-case scenario for the insulin analogs, the insulins aspart, lispro, glargine and detemir showed an ICER of R$ 1,768.59; R$ 3,308.54; R$ 11,718.75 and R$ 2,685.22, respectively. In all scenarios in which the minimum effectiveness was proposed, lispro, glargine and detemir were dominant strategies. Sensitivity analysis showed that the aspart had R$ 3,066.98 [95 % CI: 2339.22; 4418.53] and detemir had R$ 6,163.97 [95% CI: 3919.29; 11401.57] for incremental costs. We concluded there was evidence that the insulin aspart is the most cost-effective.

  8. Cost-benefit comparison of nuclear and nonnuclear health and safety protective measures and regulations

    International Nuclear Information System (INIS)

    O'Donnell, E.P.; Mauro, J.J.

    1979-01-01

    This article compares the costs and benefits of health and safety measures and regulations in the nuclear and nonnuclear fields. A cost-benefit methodology for nuclear safety concerns is presented and applied to existing nuclear plant engineered safety features. Comparisons in terms of investment costs to achieve reductions in mortality rates are then made between nuclear plant safety features and the protective measures and regulations associated with nonnuclear risks, particularly with coal-fired power plants. These comparisons reveal a marked inconsistency in the cost effectiveness of health and safety policy, in which nuclear regulatory policy requires much greater investments to reduce the risk of public mortality than is required in nonnuclear areas where reductions in mortality rates could be achieved at much lower cost. A specific example of regulatory disparity regarding gaseous effluent limits for nuclear and fossil-fuel power plants is presented. It is concluded that a consistent health and safety regulatory policy based on uniform risk and cost-benefit criteria should be adopted and that future proposed Nuclear Regulatory Commission regulatory requirements should be critically evaluated from a cost-benefit viewpoint

  9. Schedule and cost reduction of nuclear generating facilities in Ontario study overview

    International Nuclear Information System (INIS)

    Huterer, J.

    1991-01-01

    During the five year period 1985 to 1990, Ontario Hydro conducted a major study with the objective to reduce the cost and construction duration for future nuclear generating facilities in Ontario. This paper reports on the study called Major Projects: Schedule and Cost Reduction Study (SCRS). Ontario Hydro is a public utility with the responsibility for meeting electricity need for the province of Ontario with a population of 9.6 million. In order to adequately address future electricity needs, Ontario Hydro has developed and submitted a demand/supply plan which covers the next 25 years. The SCRS for major projects contributed to this demand/supply plan

  10. Optimal scenario balance of reduction in costs and greenhouse gas emissions for municipal solid waste management

    Institute of Scientific and Technical Information of China (English)

    邓娜; 张强; 陈广武; 齐长青; 崔文谦; 张于峰; 马洪亭

    2015-01-01

    To reduce carbon intensity, an improved management method balancing the reduction in costs and greenhouse gas (GHG) emissions is required for Tianjin’s waste management system. Firstly, six objective functions, namely, cost minimization, GHG minimization, eco-efficiency minimization, cost maximization, GHG maximization and eco-efficiency maximization, are built and subjected to the same constraints with each objective function corresponding to one scenario. Secondly, GHG emissions and costs are derived from the waste flow of each scenario. Thirdly, the range of GHG emissions and costs of other potential scenarios are obtained and plotted through adjusting waste flow with infinitely possible step sizes according to the correlation among the above six scenarios. And the optimal scenario is determined based on this range. The results suggest the following conclusions. 1) The scenarios located on the border between scenario cost minimization and GHG minimization create an optimum curve, and scenario GHG minimization has the smallest eco-efficiency on the curve;2) Simple pursuit of eco-efficiency minimization using fractional programming may be unreasonable; 3) Balancing GHG emissions from incineration and landfills benefits Tianjin’s waste management system as it reduces GHG emissions and costs.

  11. How can health care organisations make and justify decisions about risk reduction? Lessons from a cross-industry review and a health care stakeholder consensus development process

    International Nuclear Information System (INIS)

    Sujan, Mark A.; Habli, Ibrahim; Kelly, Tim P.; Gühnemann, Astrid; Pozzi, Simone; Johnson, Christopher W.

    2017-01-01

    Interventions to reduce risk often have an associated cost. In UK industries decisions about risk reduction are made and justified within a shared regulatory framework that requires that risk be reduced as low as reasonably practicable. In health care no such regulatory framework exists, and the practice of making decisions about risk reduction is varied and lacks transparency. Can health care organisations learn from relevant industry experiences about making and justifying risk reduction decisions? This paper presents lessons from a qualitative study undertaken with 21 participants from five industries about how such decisions are made and justified in UK industry. Recommendations were developed based on a consensus development exercise undertaken with 20 health care stakeholders. The paper argues that there is a need in health care to develop a regulatory framework and an agreed process for managing explicitly the trade-off between risk reduction and cost. The framework should include guidance about a health care specific notion of acceptable levels of risk, guidance about standardised risk reduction interventions, it should include regulatory incentives for health care organisations to reduce risk, and it should encourage the adoption of an approach for documenting explicitly an organisation's risk position. - Highlights: • Empirical description of industry perceptions on making risk reduction decisions. • Health care consensus development identified five recommendations. • Risk concept should be better integrated into safety management. • Education and awareness about risk concept are required. • Health systems need to start a dialogue about acceptable levels of risk.

  12. COSTS OF THE HEALTH CARE IN RUSSIA ASSOCIATED WITH SMOKING

    Directory of Open Access Journals (Sweden)

    A. V. Kontsevaya

    2011-01-01

    Full Text Available Aim. To analyze costs of health care in Russia associated with smoking in 2009. Material and methods. Cardiovascular diseases, cancers and chronic obstructive pulmonary diseases (COPD were included in the analysis. Calculation was performed on the basis of the relative risks of diseases associated with smoking, and obtained from foreign surveys, official statistics on morbidity and health system resources expenditure, and costs of health-seeking in line with state program of guaranteed free medical care.  Results. In 2009 total costs of the health care system associated with smoking exceeded RUR 35.8 bln. It corresponded to 0.1% of gross domestic product in Russia in 2009. The costs structure was the following: hospitalization – RUR 26.2 bln, emergency calls – RUR 1.4 bln, and outpatient health-seeking – RUR 8.2 bln. Costs of outpatient pharmacotherapy were not included into analysis because of lack of baseline data needed for calculations. Cardiovascular diseases caused 62% of the health care costs associated with smoking, cancers – 20.2%, and COPD – 17.8%. Conclusion. The smoking in Russia is associated with significant health care costs. It makes needed resources investment in preventive programs to reduce smoking prevalence.

  13. Assessing the cost of electronic health records: a review of cost indicators.

    Science.gov (United States)

    Gallego, Ana Isabel; Gagnon, Marie-Pierre; Desmartis, Marie

    2010-11-01

    We systematically reviewed PubMed and EBSCO business, looking for cost indicators of electronic health record (EHR) implementations and their associated benefit indicators. We provide a set of the most common cost and benefit (CB) indicators used in the EHR literature, as well as an overall estimate of the CB related to EHR implementation. Overall, CB evaluation of EHR implementation showed a rapid capital-recovering process. On average, the annual benefits were 76.5% of the first-year costs and 308.6% of the annual costs. However, the initial investments were not recovered in a few studied implementations. Distinctions in reporting fixed and variable costs are suggested.

  14. Elimination of maintenance outage and cost reduction by development of outage-free maintenance techniques

    International Nuclear Information System (INIS)

    Jakabe, Hideo; Maruyama, Yoshinaga

    1996-01-01

    The development program of KEPCO on outage-free maintenance techniques for distribution line work since 1984 is overviewed. It has succeeded in eliminating maintenance outages since 1989. The original aim was to improve customer satisfaction. However, in all, four benefits were realised through the development. These are cost reduction, securing of worker safety, improvement of customer service, and advancement of distribution techniques and morale in KEPCO. The introduction of robotic techniques for maintenance work and manipulator techniques for repair work is planned for further modernization. These new techniques are helping in both work safety and work efficiency improvement. Cost reduction and advancement of distribution line work techniques is also considered. (R.P.)

  15. Prospective Health: Duke's Approach to Improving Employee Health and Managing Health Care Costs

    Science.gov (United States)

    Davidson, H. Clint, Jr.

    2004-01-01

    If developing a healthy workforce is critical to reining in the skyrocketing cost of health care, then why have so many attempts at preventive health or disease management fallen short? How can employers connect with employees to engage them in changing unhealthy habits or lifestyles? Duke University has launched an innovative new approach called…

  16. Hypertension education and adherence in South Africa: a cost-effectiveness analysis of community health workers.

    Science.gov (United States)

    Gaziano, Thomas A; Bertram, Melanie; Tollman, Stephen M; Hofman, Karen J

    2014-03-10

    To determine whether training community health workers (CHWs) about hypertension in order to improve adherence to medications is a cost-effective intervention among community members in South Africa. We used an established Markov model with age-varying probabilities of cardiovascular disease (CVD) events to assess the benefits and costs of using CHW home visits to increase hypertension adherence for individuals with hypertension and aged 25-74 in South Africa. Subjects considered for CHW intervention were those with a previous diagnosis of hypertension and on medications but who had not achieved control of their blood pressure. We report our results in incremental cost-effectiveness ratios (ICERs) in US dollars per disability-adjusted life-year (DALY) averted. The annual cost of the CHW intervention is about $8 per patient. This would lead to over a 2% reduction in CVD events over a life-time and decrease DALY burden. Due to reductions in non-fatal CVD events, lifetime costs are only $6.56 per patient. The CHW intervention leads to an incremental cost-effectiveness ratio of $320/DALY averted. At an annual cost of $6.50 or if the blood pressure reduction is 5 mmHg or greater per patient the intervention is cost-saving. Additional training for CHWs on hypertension management could be a cost-effective strategy for CVD in South Africa and a very good purchase according to World Health Organization (WHO) standards. The intervention could also lead to reduced visits at the health centres freeing up more time for new patients or reducing the burden of an overworked staff at many facilities.

  17. New Zealand cuts health spending to control costs

    OpenAIRE

    2010-01-01

    New Zealand’s health-care system is undergoing a series of cutbacks to reduce costs, but critics are concerned that the health of people on low incomes and in some population groups may suffer. Rebecca Lancashire reports in our series on health financing.

  18. Wellness Programs: Preventive Medicine to Reduce Health Care Costs.

    Science.gov (United States)

    Martini, Gilbert R., Jr.

    1991-01-01

    A wellness program is a formalized approach to preventive health care that can positively affect employee lifestyle and reduce future health-care costs. Describes programs for health education, smoking cessation, early detection, employee assistance, and fitness, citing industry success figures. (eight references) (MLF)

  19. A Review of Last Mile Logistics Innovations in an Externalities Cost Reduction Vision

    Directory of Open Access Journals (Sweden)

    Luigi Ranieri

    2018-03-01

    Full Text Available In this paper, a review of the recent scientific literature contributions on innovative strategies for last mile logistics, focusing on externalities cost reduction, is presented. Transport is causing problems in urban areas, in particular in freight transport: modern cities need solutions to reduce externalities costs such as congestion, pollution and others, which have increased in the last few years, especially due to the growth of goods delivery. Online sales and globalization lead to new trends in freight transport, and moreover, a larger quantity of goods is expected to be delivered in the next future. In this context, most of the delivered goods end up in the city centers. Last mile logistics is the least efficient stage of the supply chain and comprises up to 28% of the total delivery cost. Therefore, the improvement of last mile logistics and a significant externalities reduction are very important challenges for researchers. New technologies and transport means, innovative techniques and organizational strategies allow handling in a more effective way the last mile delivery in urban areas. Based on the Systematic Literature Review (SLR method, recent papers that significantly contributed, with original proposals, to the reduction of externalities in urban logistics are identified and analyzed in this work. Furthermore, a classification of the papers dealing with the externality reduction problem is presented. It is consistent with a general formulation proposed to evaluate external costs in urban area. The innovative contributions are classified into five main categories: innovative vehicles, proximity stations or points, collaborative and cooperative urban logistics, optimization of transport management and routing, innovations in public policies and infrastructures. The new paradigm of smart logistics is based on the combination of these concepts and on the proposed innovations.

  20. PowerFilm PowerShade Fixed Site Solar System Cost Reduction Plan

    Science.gov (United States)

    2014-07-31

    system was designed which adds capability of grid tie connection to the standalone function. This battery operating system has built-in intelligence...goal concerning alternative conductive grid inks was to reduce the cost of the silver ink layer without a reduction in PV power with experimentation... system . To overcome this loss, a new BOS unit with higher power transfer efficiency has been developed. This system also has grid tie

  1. Cost reduction potentials of offshore wind power in Germany; Kostensenkungspotenziale der Offshore-Windenergie in Deutschland

    Energy Technology Data Exchange (ETDEWEB)

    Hobohm, Jens; Krampe, Leonard; Peter, Frank [Prognos AG, Berlin (Germany). Bereich Energiewirtschaft

    2014-01-15

    Offshore wind power is a major hope for the German energy turnaround. However, it will only be possible to tap its cost reduction potentials if industry, the political leadership and the administrative authorities join forces to create the necessary preconditions. An important requirement for this capital-intensive technology are stable legal and political framework conditions. A recent study on the future shows what needs to be done.

  2. Valuing health for regulatory cost-effectiveness analysis

    National Research Council Canada - National Science Library

    Miller, Wilhelmine; Robinson, Lisa A; Lawrence, Robert S

    2006-01-01

    ...; and minimizing exposure to toxic chemicals. Estimating the magnitude of the expected health and longevity benefits and reductions in mortality, morbidity, and injury risks helps policy makers decide whether particular interventions merit...

  3. Reduction of inequalities in health: assessing evidence-based tools

    Directory of Open Access Journals (Sweden)

    Shea Beverley

    2006-09-01

    Full Text Available Abstract Background The reduction of health inequalities is a focus of many national and international health organisations. The need for pragmatic evidence-based approaches has led to the development of a number of evidence-based equity initiatives. This paper describes a new program that focuses upon evidence- based tools, which are useful for policy initiatives that reduce inequities. Methods This paper is based on a presentation that was given at the "Regional Consultation on Policy Tools: Equity in Population Health Reports," held in Toronto, Canada in June 2002. Results Five assessment tools were presented. 1. A database of systematic reviews on the effects of educational, legal, social, and health interventions to reduce unfair inequalities is being established through the Cochrane and Campbell Collaborations. 2 Decision aids and shared decision making can be facilitated in disadvantaged groups by 'health coaches' to help people become better decision makers, negotiators, and navigators of the health system; a pilot study in Chile has provided proof of this concept. 3. The CIET Cycle: Combining adapted cluster survey techniques with qualitative methods, CIET's population based applications support evidence-based decision making at local and national levels. The CIET map generates maps directly from survey or routine institutional data, to be used as evidence-based decisions aids. Complex data can be displayed attractively, providing an important tool for studying and comparing health indicators among and between different populations. 4. The Ottawa Equity Gauge is applying the Global Equity Gauge Alliance framework to an industrialised country setting. 5 The Needs-Based Health Assessment Toolkit, established to assemble information on which clinical and health policy decisions can be based, is being expanded to ensure a focus on distribution and average health indicators. Conclusion Evidence-based planning tools have much to offer the

  4. How to solve the cost crisis in health care.

    Science.gov (United States)

    Kaplan, Robert S; Porter, Michael E

    2011-09-01

    U.S. health care costs currently exceed 17% of GDP and continue to rise. One fundamental reason that providers are unable to reverse the trend is that they don't understand what it costs to deliver patient care or how those costs compare with outcomes. To put it bluntly, few health care providers measure the actual costs for treating a given patient with a given medical condition over a full cycle of care, or compare the costs they incur with the outcomes they achieve. What isn't measured cannot be managed or improved, and this is all too true in health care, where poor costing systems mean that effective and efficient providers go unrewarded, and inefficient ones have little incentive to improve. But all this can be remedied by exploring the concept of value in health care and carefully measuring costs. This article describes a new way to analyze costs that uses patients and their conditions--not organizational units or narrow diagnostic treatment groups--as the fundamental unit of analysis for measuring costs and outcomes. The new approach, called time-driven activity-cased costing, is currently being implemented in pilots at the Head and Neck Center at MD Anderson, the Cleft Lip and Palate Program at Children's Hospital in Boston, and units performing knee replacements at Schön Klinik in Germany and Brigham & Women's Hospital in Boston. As providers and payors better understand costs, they will be positioned to achieve a true "bending of the cost curve" from within the system, not in response to top-down mandates. Accurate costing also unlocks a whole cascade of opportunities, such as process improvement, better organization of care, and new reimbursement approaches that will accelerate the pace of innovation and value creation.

  5. 8 ways to cut health care costs

    Science.gov (United States)

    ... care include strep throat, bladder infection, or a dog bite. You will save both time and money ... health services. www.healthcare.gov/coverage/preventive-care-benefits . Accessed October 18, 2016. U.S. Preventive Services Taskforce ...

  6. Valuation of the health detriment cost

    International Nuclear Information System (INIS)

    Lombard, J.

    1986-09-01

    To estimate the efficiency of radiological protection systems we have to compare the cost involved in putting each system into operation (cost of protection) to the collective dose that can thus be avoided. This comparison is facilitated if a man-Sievert monetary value is available. The man-Sievert value can be estimated from various detriments that can be attributed to this unitary exposure: whether there are lethal or non-lethal somatic effects, genetic effects and psycho-social effects. ICRP recommends, in its publication 37, to break down the cost of radiological detriment Y into two parts. The first part, Y1=αS, corresponds to the somatic and genetic effects; the second part, Y2=β ΣN j f(Hj), corresponds to the relevant effects of psycho-social considerations. This breakdown leads to the definition of two man-Sievert value components: α, which reflects somatic and genetic detriments; and β, which reflects the psycho-social effects. Several different methods can be used to determine α and β. Here, we will analyse the following: the a priori evaluation based on the Value of Human Life (VHL) or the costs of repair (for non-lethal effects); the a priori evaluation based on the loss of life expectancy; the evaluation based on what an individual would agree to give up to reduce the risk associated to a man Sievert-dose; the evaluation based on the expenses effectively incurred in the past to reduce the risk associated to a man-Sievert dose

  7. Home modification to reduce falls at a health district level: Modeling health gain, health inequalities and health costs.

    Directory of Open Access Journals (Sweden)

    Nick Wilson

    Full Text Available There is some evidence that home safety assessment and modification (HSAM is effective in reducing falls in older people. But there are various knowledge gaps, including around cost-effectiveness and also the impacts at a health district-level.A previously established Markov macro-simulation model built for the whole New Zealand (NZ population (Pega et al 2016, Injury Prevention was enhanced and adapted to a health district level. This district was Counties Manukau District Health Board, which hosts 42,000 people aged 65+ years. A health system perspective was taken and a discount rate of 3% was used for both health gain and costs. Intervention effectiveness estimates came from a systematic review, and NZ-specific intervention costs were extracted from a randomized controlled trial. In the 65+ age-group in this health district, the HSAM program was estimated to achieve health gains of 2800 quality-adjusted life-years (QALYs; 95% uncertainty interval [UI]: 547 to 5280. The net health system cost was estimated at NZ$8.44 million (95% UI: $663 to $14.3 million. The incremental cost-effectiveness ratio (ICER was estimated at NZ$5480 suggesting HSAM is cost-effective (95%UI: cost saving to NZ$15,300 [equivalent to US$10,300]. Targeting HSAM only to people age 65+ or 75+ with previous injurious falls was estimated to be particularly cost-effective (ICERs: $700 and $832, respectively with the latter intervention being cost-saving. There was no evidence for differential cost-effectiveness by sex or by ethnicity: Māori (Indigenous population vs non-Māori.This modeling study suggests that a HSAM program could produce considerable health gain and be cost-effective for older people at a health district level. Nevertheless, comparisons may be desirable with other falls prevention interventions such as group exercise programs, which also provide social contact and may prevent various chronic diseases.

  8. Wealth and Health Behavior: Testing the Concept of a Health Cost.

    Science.gov (United States)

    van Kippersluis, Hans; Galama, Titus J

    2014-11-01

    Wealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by exploiting both inheritances and lottery winnings to test a theory of health behavior. We distinguish between the direct monetary cost and the indirect health cost (value of health lost) of unhealthy consumption. The health cost increases with wealth and the degree of unhealthiness, leading wealthier individuals to consume more healthy and moderately unhealthy, but fewer severely unhealthy goods. The empirical evidence presented suggests that differences in health costs may indeed partially explain behavioral differences, and ultimately health outcomes, between wealth groups.

  9. Simulating greenhouse gas (GHG) allowance cost and GHG emission reduction in Western Europe

    International Nuclear Information System (INIS)

    Delarue, Erik; Lamberts, Hans; D'haeseleer, William

    2007-01-01

    Due to the growing concern for global warming, the EU25 have implemented the European Union Greenhouse Gas Emission Trading Scheme (EU ETS). In the first trading period (2005-2007), part of the targeted GHG emission reductions presumably will have to result from a switch from coal fired electricity generation to gas fired electricity generation. It is possible to calculate the allowance cost necessary to switch a certain coal fired plant with a certain gas fired plant in the merit order. The allowance cost obtained is a so called switching point. When comparing historic European Union Allowance (EUA) prices (2005) with the corresponding historic switching points, the EUA prices were found high enough to cause a certain switch in the summer season. This finding leads to the use of switching points in establishing allowance cost profiles for several scenarios. A variable gas price profile is used in the simulation tool E-Simulate to simulate electricity generation and related GHG emissions in an eight zonal model representing Western Europe. Several GHG allowance cost profile scenarios are examined. For each scenario, electricity generation in the considered countries is clarified. The focus however lies on the GHG emission reduction potentials. These potentials are addressed for each scenario

  10. Cost reduction for large turbine generator Pedestal in high seismic zone

    International Nuclear Information System (INIS)

    Sawhney, P.S.; Irani, P.; Pusheck, B.N.

    1985-01-01

    Turbine Generator Pedestals have generally been designed using reinforced concrete. For present day large turbine generators (1100 MWe class and above) with tall (about 80 feet) pedestals, the amount of reinforcing steel becomes quite large, especially for plants in high seismic zones. With the prime objective of cost reduction, an approach using steel/concrete composite design has been studied for a large BWR Turbine Generator pedestal with 0.3g peak ground acceleration. Large prefabricated steel modules were adopted for composite design and simplified construction. Design was based on the ACI and AISC codes. Costs and schedules were developed and compared with those for a conventionally designed reinforced concrete pedestal. Composite design was found to give considerable cost and schedule advantage over the conventional reinforced concrete design

  11. Potential Cost Savings From Reduction of Regional Variation in Medicare Spending

    Directory of Open Access Journals (Sweden)

    Yunjie Song

    2016-04-01

    Full Text Available Potential cost savings estimated from reduction of regional variation in Medicare spending are considerable but questioned. This article evaluates the validity of the principal methods that have been used in the estimations of the potential savings. Three estimation approaches were identified. The first approach uses adjusted expenditures to calculate avoidable costs, but adjusted expenditures can be independent of avoidable costs, and measurement errors are not controlled. The second approach uses an outcome variable to replace its causal factors, and is not acceptable because the association between the outcomes and the causes is untestable. The final approach uses surveys to directly measure physician beliefs and patient preferences, but the sole study using this approach is weakened by sample selection biases and incomplete controls. A development of reliable measures and a switch of observation from clinic settings to geographic contexts could make the estimations more convincing.

  12. Reduction of wind powered generator cost by use of a one bladed rotor

    Energy Technology Data Exchange (ETDEWEB)

    Pruyn, R R; Wiesner, W; Ljungstroem, O [ed.

    1976-01-01

    Cost analysis supported by preliminary design studies of one and two bladed wind powered generator units shows that a 30% reduction in acquisition cost can be achieved with a one bladed design. Designs studied were sized for an output power of 1000 kilowatts. The one bladed design has the potential for reducing acquisition cost to $680 per available kilowatt if the unit is located in a region with mean surface winds of 15 mph. Vibratory loads of the one bladed design are significant and will require considerable design attention. The one per rev Coriolis torque caused by blade flapping is the most significant problem. The major source of blade flapping will be the velocity gradient of the ground boundary layer. A torsional vibration isolating coupling may be required in the generator drive to reduce the loads due to this vibratory torque. An inclined flapping hinge also is desirable to cause pitch-flap coupling that will suppress blade flap motions.

  13. The importance of fixed costs in animal health systems.

    Science.gov (United States)

    Tisdell, C A; Adamson, D

    2017-04-01

    In this paper, the authors detail the structure and optimal management of health systems as influenced by the presence and level of fixed costs. Unlike variable costs, fixed costs cannot be altered, and are thus independent of the level of veterinary activity in the short run. Their importance is illustrated by using both single-period and multi-period models. It is shown that multi-stage veterinary decision-making can often be envisaged as a sequence of fixed-cost problems. In general, it becomes clear that, the higher the fixed costs, the greater the net benefit of veterinary activity must be, if such activity is to be economic. The authors also assess the extent to which it pays to reduce fixed costs and to try to compensate for this by increasing variable costs. Fixed costs have major implications for the industrial structure of the animal health products industry and for the structure of the private veterinary services industry. In the former, they favour market concentration and specialisation in the supply of products. In the latter, they foster increased specialisation. While cooperation by individual farmers may help to reduce their individual fixed costs, the organisational difficulties and costs involved in achieving this cooperation can be formidable. In such cases, the only solution is government provision of veterinary services. Moreover, international cooperation may be called for. Fixed costs also influence the nature of the provision of veterinary education.

  14. Cost-effectiveness of clinical decision support system in improving maternal health care in Ghana.

    Directory of Open Access Journals (Sweden)

    Maxwell Ayindenaba Dalaba

    Full Text Available This paper investigated the cost-effectiveness of a computer-assisted Clinical Decision Support System (CDSS in the identification of maternal complications in Ghana.A cost-effectiveness analysis was performed in a before- and after-intervention study. Analysis was conducted from the provider's perspective. The intervention area was the Kassena- Nankana district where computer-assisted CDSS was used by midwives in maternal care in six selected health centres. Six selected health centers in the Builsa district served as the non-intervention group, where the normal Ghana Health Service activities were being carried out.Computer-assisted CDSS increased the detection of pregnancy complications during antenatal care (ANC in the intervention health centres (before-intervention = 9 /1,000 ANC attendance; after-intervention = 12/1,000 ANC attendance; P-value = 0.010. In the intervention health centres, there was a decrease in the number of complications during labour by 1.1%, though the difference was not statistically significant (before-intervention =107/1,000 labour clients; after-intervention = 96/1,000 labour clients; P-value = 0.305. Also, at the intervention health centres, the average cost per pregnancy complication detected during ANC (cost -effectiveness ratio decreased from US$17,017.58 (before-intervention to US$15,207.5 (after-intervention. Incremental cost -effectiveness ratio (ICER was estimated at US$1,142. Considering only additional costs (cost of computer-assisted CDSS, cost per pregnancy complication detected was US$285.Computer -assisted CDSS has the potential to identify complications during pregnancy and marginal reduction in labour complications. Implementing computer-assisted CDSS is more costly but more effective in the detection of pregnancy complications compared to routine maternal care, hence making the decision to implement CDSS very complex. Policy makers should however be guided by whether the additional benefit is worth

  15. Direct health care costs associated with asthma in British Columbia

    Science.gov (United States)

    Sadatsafavi, Mohsen; Lynd, Larry; Marra, Carlo; Carleton, Bruce; Tan, Wan C; Sullivan, Sean; FitzGerald, J Mark

    2010-01-01

    BACKGROUND: A better understanding of health care costs associated with asthma would enable the estimation of the economic burden of this increasingly common disease. OBJECTIVE: To determine the direct medical costs of asthma-related health care in British Columbia (BC). METHODS: Administrative health care data from the BC Linked Health Database and PharmaNet database from 1996 to 2000 were analyzed for BC residents five to 55 years of age, including the billing information for physician visits, drug dispensations and hospital discharge records. A unit cost was assigned to physician/emergency department visits, and government reimbursement fees for prescribed medications were applied. The case mix method was used to calculate hospitalization costs. All costs were reported in inflation-adjusted 2006 Canadian dollars. RESULTS: Asthma resulted in $41,858,610 in annual health care-related costs during the study period ($331 per patient-year). The major cost component was medications, which accounted for 63.9% of total costs, followed by physician visits (18.3%) and hospitalization (17.8%). When broader definitions of asthma-related hospitalizations and physician visits were used, total costs increased to $56,114,574 annually ($444 per patient-year). There was a statistically significant decrease in the annual per patient cost of hospitalizations (P<0.01) over the study period. Asthma was poorly controlled in 63.5% of patients, with this group being responsible for 94% of asthma-related resource use. CONCLUSION: The economic burden of asthma is significant in BC, with the majority of the cost attributed to poor asthma control. Policy makers should investigate the reason for lack of proper asthma control and adjust their policies accordingly to improve asthma management. PMID:20422063

  16. Cost analysis of public health influenza vaccine clinics in Ontario.

    Science.gov (United States)

    Mercer, Nicola J

    2009-01-01

    Public health in Ontario delivers, promotes and provides each fall the universal influenza immunization program. This paper addresses the question of whether Ontario public health agencies are able to provide the influenza immunization program within the Ministry of Health fiscal funding envelope of $5 per dose. Actual program delivery data from the 2006 influenza season of Wellington-Dufferin-Guelph Public Health (WDGPH) were used to create a model template for influenza clinics capturing all variable costs. Promotional and administrative costs were separated from clinic costs. Maximum staff workloads were estimated. Vaccine clinics were delivered by public health staff in accordance with standard vaccine administration practices. The most significant economic variables for influenza clinics are labour costs and number of vaccines given per nurse per hour. The cost of facility rental was the only other significant cost driver. The ability of influenza clinics to break even depended on the ability to manage these cost drivers. At WDGPH, weekday flu clinics required the number of vaccines per nurse per hour to exceed 15, and for weekend flu clinics this number was greater than 21. We estimate that 20 vaccines per hour is at the limit of a safe workload over several hours. Managing cost then depends on minimizing hourly labour costs. The results of this analysis suggest that by managing the labour costs along with planning the volume of patients and avoiding expensive facilities, flu clinics can just break even. However, any increased costs, including negotiated wage increases or the move to safety needles, with a fixed revenue of $5.00 per dose will negate this conclusion.

  17. Short-Term Medical Costs of a VHA Health Information Exchange: A CHEERS-Compliant Article

    Science.gov (United States)

    French, Dustin D.; Dixon, Brian E.; Perkins, Susan M.; Myers, Laura J.; Weiner, Michael; Zillich, Allan J.; Haggstrom, David A.

    2016-01-01

    Abstract The Virtual Lifetime Electronic Record (VLER) Health program provides the Veterans Health Administration (VHA) a framework whereby VHA providers can access the veterans’ electronic health record information to coordinate healthcare across multiple sites of care. As an early adopter of VLER, the Indianapolis VHA and Regenstrief Institute implemented a regional demonstration program involving bi-directional health information exchange (HIE) between VHA and non-VHA providers. The aim of the study is to determine whether implementation of VLER HIE reduces 1 year VHA medical costs. A cohort evaluation with a concurrent control group compared VHA healthcare costs using propensity score adjustment. A CHEERs compliant checklist was used to conduct the cost evaluation. Patients were enrolled in the VLER program onsite at the Indianapolis VHA in outpatient clinics or through the release-of-information office. VHA cost data (in 2014 dollars) were obtained for both enrolled and nonenrolled (control) patients for 1 year prior to, and 1 year after, the index date of patient enrollment. There were 6104 patients enrolled in VLER and 45,700 patients in the control group. The annual adjusted total cost difference per patient was associated with a higher cost for VLER enrollees $1152 (95% CI: $807–1433) (P < 0.01) (in 2014 dollars) than VLER nonenrollees. Short-term evaluation of this demonstration project did not show immediate reductions in healthcare cost as might be expected if HIE decreased redundant medical tests and treatments. Cost reductions from shared health information may be realized with longer time horizons. PMID:26765453

  18. Health Care Costs Attributable to Tobacco in Cambodia | CRDI ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    There is strong evidence from other countries that smoking increases the TB infection rate and reduces tuberculosis survival rates. Cambodia has high TB and smoking rates, so the cost of tobacco use will also include the cost of excess tuberculosis-related deaths. Cambodia's health information systems are weak and ...

  19. Health insurance, cost expectations, and adverse job turnover.

    Science.gov (United States)

    Ellis, Randall P; Albert Ma, Ching-To

    2011-01-01

    Because less healthy employees value health insurance more than the healthy ones, when health insurance is newly offered job turnover rates for healthier employees decline less than turnover rates for the less healthy. We call this adverse job turnover, and it implies that a firm's expected health costs will increase when health insurance is first offered. Health insurance premiums may fail to adjust sufficiently fast because state regulations restrict annual premium changes, or insurers are reluctant to change premiums rapidly. Even with premiums set at the long run expected costs, some firms may be charged premiums higher than their current expected costs and choose not to offer insurance. High administrative costs at small firms exacerbate this dynamic selection problem. Using 1998-1999 MEDSTAT MarketScan and 1997 Employer Health Insurance Survey data, we find that expected employee health expenditures at firms that offer insurance have lower within-firm and higher between-firm variance than at firms that do not. Turnover rates are systematically higher in industries in which firms are less likely to offer insurance. Simulations of the offer decision capturing between-firm health-cost heterogeneity and expected turnover rates match the observed pattern across firm sizes well. 2010 John Wiley & Sons, Ltd.

  20. The importance of marginal cost electricity pricing to the success of greenhouse gas reduction programs

    International Nuclear Information System (INIS)

    Friedman, Lee S.

    2011-01-01

    The efficient reduction of GHG emissions requires appropriate retail pricing of off-peak electricity. However, off-peak electricity for residential consumers is priced at 331% above its marginal cost in the United States as a whole (June 2009). Even for the 1% of residences that are on some form of time-of-use (TOU) rate schedule, the off-peak rate is almost three times higher than the marginal cost. A barrier to marginal-cost based TOU rates is that less than 9% of U.S. households have the 'smart' meters in place that can measure and record the time of consumption. Policies should be put in place to achieve full deployment. Another important barrier is consumer concern about TOU rate design. Two TOU rate designs (baseline and two-part tariff) are described that utilize marginal-cost based rates, ensure appropriate cost recovery, and minimize bill changes from current rate structures. A final barrier is to get residences on to these rates. Should a marginal-cost based TOU rate design remain an alternative for which residences could 'opt-in,' or become the default choice, or become mandatory? Time-invariant rates are a historical anachronism that subsidize very costly peak-period consumption and penalize off-peak usage to our environmental detriment. They should be phased out. - Highlights: → Off-peak electricity for residences is priced at 331% above marginal cost in the US. → This inefficiently deters vehicle electrification that could reduce GHG emissions. → 9% of U.S. households have the 'smart' meters necessary for time-of-use rates. → Time-invariant rates cause substantial environmental harm and should be phased out.

  1. Reward Pays the Cost of Noise Reduction in Motor and Cognitive Control.

    Science.gov (United States)

    Manohar, Sanjay G; Chong, Trevor T-J; Apps, Matthew A J; Batla, Amit; Stamelou, Maria; Jarman, Paul R; Bhatia, Kailash P; Husain, Masud

    2015-06-29

    Speed-accuracy trade-off is an intensively studied law governing almost all behavioral tasks across species. Here we show that motivation by reward breaks this law, by simultaneously invigorating movement and improving response precision. We devised a model to explain this paradoxical effect of reward by considering a new factor: the cost of control. Exerting control to improve response precision might itself come at a cost--a cost to attenuate a proportion of intrinsic neural noise. Applying a noise-reduction cost to optimal motor control predicted that reward can increase both velocity and accuracy. Similarly, application to decision-making predicted that reward reduces reaction times and errors in cognitive control. We used a novel saccadic distraction task to quantify the speed and accuracy of both movements and decisions under varying reward. Both faster speeds and smaller errors were observed with higher incentives, with the results best fitted by a model including a precision cost. Recent theories consider dopamine to be a key neuromodulator in mediating motivational effects of reward. We therefore examined how Parkinson's disease (PD), a condition associated with dopamine depletion, alters the effects of reward. Individuals with PD showed reduced reward sensitivity in their speed and accuracy, consistent in our model with higher noise-control costs. Including a cost of control over noise explains how reward may allow apparent performance limits to be surpassed. On this view, the pattern of reduced reward sensitivity in PD patients can specifically be accounted for by a higher cost for controlling noise. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  2. Mental health services costs within the Alberta criminal justice system.

    Science.gov (United States)

    Jacobs, Philip; Moffatt, Jessica; Dewa, Carolyn S; Nguyen, Thanh; Zhang, Ting; Lesage, Alain

    2016-01-01

    Mental illness has been widely cited as a driver of costs in the criminal justice system. The objective of this paper is to estimate the additional mental health service costs incurred within the criminal justice system that are incurred because of people with mental illnesses who go through the system. Our focus is on costs in Alberta. We set up a model of the flow of all persons through the criminal justice system, including police, court, and corrections components, and for mental health diversion, review, and forensic services. We estimate the transitional probabilities and costs that accrue as persons who have been charged move through the system. Costs are estimated for the Alberta criminal justice system as a whole, and for the mental illness component. Public expenditures for each person diverted or charged in Alberta in the criminal justice system, including mental health costs, were $16,138. The 95% range of this estimate was from $14,530 to $19,580. Of these costs, 87% were for criminal justice services and 13% were for mental illness-related services. Hospitalization for people with mental illness who were reviewed represented the greatest additional cost associated with mental illnesses. Treatment costs stemming from mental illnesses directly add about 13% onto those in the criminal justice system. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Estimating the mental health costs of racial discrimination

    Directory of Open Access Journals (Sweden)

    Amanuel Elias

    2016-11-01

    Full Text Available Abstract Background Racial discrimination is a pervasive social problem in several advanced countries such as the U.S., U.K., and Australia. Public health research also indicates a range of associations between exposure to racial discrimination and negative health, particularly, mental health including depression, anxiety, and post-traumatic stress disorder (PTSD. However, the direct negative health impact of racial discrimination has not been costed so far although economists have previously estimated indirect non-health related productivity costs. In this study, we estimate the burden of disease due to exposure to racial discrimination and measure the cost of this exposure. Methods Using prevalence surveys and data on the association of racial discrimination with health outcomes from a global meta-analysis, we apply a cost of illness method to measure the impact of racial discrimination. This estimate indicates the direct health cost attributable to racial discrimination and we convert the estimates to monetary values based on conventional parameters. Results Racial discrimination costs the Australian economy 235,452 in disability adjusted life years lost, equivalent to $37.9 billion per annum, roughly 3.02% of annual gross domestic product (GDP over 2001–11, indicating a sizeable loss for the economy. Conclusion Substantial cost is incurred due to increased prevalence of racial discrimination as a result of its association with negative health outcomes (e.g. depression, anxiety and PTSD. This implies that potentially significant cost savings can be made through measures that target racial discrimination. Our research contributes to the debate on the social impact of racial discrimination, with implications for policies and efforts addressing it.

  4. Estimating the Cost of Providing Foundational Public Health Services.

    Science.gov (United States)

    Mamaril, Cezar Brian C; Mays, Glen P; Branham, Douglas Keith; Bekemeier, Betty; Marlowe, Justin; Timsina, Lava

    2017-12-28

    To estimate the cost of resources required to implement a set of Foundational Public Health Services (FPHS) as recommended by the Institute of Medicine. A stochastic simulation model was used to generate probability distributions of input and output costs across 11 FPHS domains. We used an implementation attainment scale to estimate costs of fully implementing FPHS. We use data collected from a diverse cohort of 19 public health agencies located in three states that implemented the FPHS cost estimation methodology in their agencies during 2014-2015. The average agency incurred costs of $48 per capita implementing FPHS at their current attainment levels with a coefficient of variation (CV) of 16 percent. Achieving full FPHS implementation would require $82 per capita (CV=19 percent), indicating an estimated resource gap of $34 per capita. Substantial variation in costs exists across communities in resources currently devoted to implementing FPHS, with even larger variation in resources needed for full attainment. Reducing geographic inequities in FPHS may require novel financing mechanisms and delivery models that allow health agencies to have robust roles within the health system and realize a minimum package of public health services for the nation. © Health Research and Educational Trust.

  5. Cost Analysis of a Digital Health Care Model in Sweden.

    Science.gov (United States)

    Ekman, Björn

    2017-09-22

    Digital technologies in health care are expected to increase in scope and to affect ever more parts of the health care system. It is important to enhance the knowledge of whether new digital methods and innovations provide value for money compared with traditional models of care. The objective of the study was to evaluate whether a digital health care model for primary care is a less costly alternative compared with traditional in-office primary care in Sweden. Cost data for the two care models were collected and analyzed to obtain a measure in local currency per care contact. The comparison showed that the total economic cost of a digital consultation is 1960 Swedish krona (SEK) (SEK100 = US$11.29; February 2017) compared with SEK3348 for a traditional consultation at a health care clinic. Cost differences arose on both the provider side and on the user side. The digital health care model may be a less costly alternative to the traditional health care model. Depending on the rate of digital substitution, gross economic cost savings of between SEK1 billion and SEK10 billion per year could be realized if more digital consultations were made. Further studies are needed to validate the findings, assess the types of care most suitable for digital care, and also to obtain various quality-adjusted outcome measures.

  6. Non-Hardware ("Soft") Cost-Reduction Roadmap for Residential and Small Commercial Solar Photovoltaics, 2013-2020

    Energy Technology Data Exchange (ETDEWEB)

    Ardani, K.; Seif, D.; Margolis, R.; Morris, J.; Davidson, C.; Truitt, S.; Torbert, R.

    2013-08-01

    The objective of this analysis is to roadmap the cost reductions and innovations necessary to achieve the U.S. Department of Energy (DOE) SunShot Initiative's total soft-cost targets by 2020. The roadmap focuses on advances in four soft-cost areas: (1) customer acquisition; (2) permitting, inspection, and interconnection (PII); (3) installation labor; and (4) financing. Financing cost reductions are in terms of the weighted average cost of capital (WACC) for financing PV system installations, with real-percent targets of 3.0% (residential) and 3.4% (commercial).

  7. Reduction of capital costs of nuclear power plants. NEA-report

    International Nuclear Information System (INIS)

    2000-01-01

    Since the the mid-1980s, the declining real prices of fossil fuels and the significant improvements in thermal efficiencies of combined cycle power plants have eroded the economic competitiveness of nuclear power plants in most OECD countries. In order for nuclear power to remain a viable option for the next millennium, the cost of electricity from nuclear power plant must be greatly reduced to be competitive with alternative sources. Of the three major components of nuclear generation cost - capital, O and M and fuel - the capital cost component makes up approximately 60 per cent of the total. Therefore, identification of the means to reduce the capital costs of nuclear power plants is a high priority activity toward keeping nuclear power competitive. Among a number of capital cost reduction measures, the principal ones were agreed by the expert group as follows: Increased plant size, improved construction methods, reduced construction schedule, design improvement, improved procurement, organisation and contractual aspects, standardisation and construction in series, multiple unit construction, regulatory and policy reform. (orig.)

  8. Save water to save carbon and money: developing abatement costs for expanded greenhouse gas reduction portfolios.

    Science.gov (United States)

    Stokes, Jennifer R; Hendrickson, Thomas P; Horvath, Arpad

    2014-12-02

    The water-energy nexus is of growing interest for researchers and policy makers because the two critical resources are interdependent. Their provision and consumption contribute to climate change through the release of greenhouse gases (GHGs). This research considers the potential for conserving both energy and water resources by measuring the life-cycle economic efficiency of greenhouse gas reductions through the water loss control technologies of pressure management and leak management. These costs are compared to other GHG abatement technologies: lighting, building insulation, electricity generation, and passenger transportation. Each cost is calculated using a bottom-up approach where regional and temporal variations for three different California water utilities are applied to all alternatives. The costs and abatement potential for each technology are displayed on an environmental abatement cost curve. The results reveal that water loss control can reduce GHGs at lower cost than other technologies and well below California's expected carbon trading price floor. One utility with an energy-intensive water supply could abate 135,000 Mg of GHGs between 2014 and 2035 and save--rather than spend--more than $130/Mg using the water loss control strategies evaluated. Water loss control technologies therefore should be considered in GHG abatement portfolios for utilities and policy makers.

  9. Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    Directory of Open Access Journals (Sweden)

    MUHAMMAD AZAM ISHAQUE CHAUDHARY

    2017-07-01

    Full Text Available Focusing on health care systems can improve health outcomes now and in the future. Growing economies have serious concerns on the rising cost of health, whereas, in under developed countries like Pakistan, it is not emphasized yet at all. The research is conducted to improve a unique aspect of health care systems to provide effective, patient-centred, high-standard health care while maintaining the cost effectiveness. Research is being qualified in two paradigms qualitative and quantitative. In qualitative research, expert?s interviews have been taken to get the basic knowledge of radiology based testing and their prerequisites, in quantitative research ordered are being analysed to check the frequency and if they are unnecessary or qualified medical necessity guidelines as established in qualitative method. Analysis was made on the basis of the trinity relationship of diagnosis, symptoms and respected order to determine the necessity of the order to get its impact on cost of the overall health of those patients and point out more than 50% unnecessary orders are being performed in two government hospitals. The situation is alarming and policy makers should focus on unnecessary ordering to avoid out of pocket expenses and improve quality of care. The research helps in successful application of health care system modifications and policies pertaining to one aspect of health systems, i.e. cost-effectiveness of health care.

  10. Unit costs in international economic evaluations: resource costing of the Schizophrenia Outpatient Health Outcomes Study.

    Science.gov (United States)

    Urdahl, H; Knapp, M; Edgell, E T; Ghandi, G; Haro, J M

    2003-01-01

    We present unit costs corresponding to resource information collected in the Schizophrenia Outpatient Health Outcomes (SOHO) Study. The SOHO study is a 3-year, prospective, observational study of health outcomes associated with antipsychotic treatment in out-patients treated for schizophrenia. The study is being conducted across 10 European countries (Denmark, France, Germany, Greece, Ireland, Italy, the Netherlands, Portugal, Spain and the UK) and includes over 10,800 patients and over 1000 investigators. To identify the best available unit costs of hospital admissions, day care and psychiatrist out-patient visits, a tariff-based approach was used. Unit costs were obtained for nine of the 10 countries and were adjusted to 2000 price levels by consumer price indices and converted to US dollars using purchasing power parity rates (and on to Euro). The paper illustrates the need to balance the search for sound unit costs with pragmatic solutions in the costing of international economic evaluations.

  11. Population Aging in Iran and Rising Health Care Costs

    Directory of Open Access Journals (Sweden)

    Mohammad Mirzaie

    2017-09-01

    Conclusion Based on the results of this research, it can be said that people throughout their life cycle always allocate a percentage of their total spending to health care costs, but the percentage of this allocation is different at different ages. In a way the demand for healthcare costs increases with aging, it rises significantly in the old age. At the macro level, due to an increase in the percentage of elderly in the population over the next decade, there will also be an increase in the share of health care costs.

  12. Pro-poor health policies in poverty reduction strategies.

    Science.gov (United States)

    Laterveer, Leontien; Niessen, Louis W; Yazbeck, Abdo S

    2003-06-01

    Since 1999, the International Monetary Fund and World Bank have required low-income countries soliciting for debt relief and financial support to prepare a Poverty Reduction Strategy Paper (PRSP). The objective of this study is to arrive at a systematic assessment of the extent to which the first batch of interim PRSPs actually addresses the health of the poor and vulnerable. A literature study was used to design and test a semi-quantitative approach to assess the pro-poor focus of health policies in national documents. The approach was applied to the existing interim proposals for 23 Highly Indebted Poor Countries. Results show that a majority of proposals lack country-specific data on the distribution and composition of the burden of disease, a clear identification of health system constraints and an assessment of the impact of health services on the population. More importantly, they make little effort to analyze these issues in relation to the poor. Furthermore, only a small group explicitly includes the interests of the poor in health policy design. Attention to policies aiming at enhancing equity in public health spending is even more limited. Few papers that include expenditure proposals also show pro-poor focused health budgets. We conclude that our systematic assessment of a new international development policy instrument, PRSP, raises strong concerns about the attributed role of health in development and the limited emphasis on the poor, the supposed primary beneficiaries of this instrument. There is a need and an opportunity for the international development community to provide assistance and inputs as poor countries shift their policy thinking from an interim stage to fully developed national policies. This paper presents a menu of analytical and policy options that can be pursued.

  13. A COST-REDUCTION OF SELF-COMPACTING CONCRETE INCORPORATING RAW RICE HUSK ASH

    Directory of Open Access Journals (Sweden)

    H. AWANG

    2016-01-01

    Full Text Available The higher material cost of self-compacting concrete (SCC as compared to normal vibrated concrete is mainly due to its higher cement content. In order to produce economical SCC, a significant amount of cement should be replaced with cheaper material options, which are commonly found in byproduct materials such as limestone powder (LP, fly ash (FA and raw rice husk ash (RRHA. However, the use of these byproduct materials to replace the high volumes of cement in an SCC mixture will produce deleterious effects such as strength reduction. Thus, the objective of this paper is to investigate the optimum SCC mixture proportioning capable of minimizing SCC’s material cost. A total of fifteen mixes were prepared. This study showed that raw rice husk ash exhibited positive correlations with fly ash and fine limestone powder and were able to produce high compressive and comparable to normal concrete. The SCC-mix made with quaternary cement-blend comprising OPC/LP/FA/RRHA at 55/15/15/15 weight percentage ratio is found to be capable of maximizing SCC’s material-cost reduction to almost 19% as compared with the control mix

  14. The health-related social costs of alcohol in Belgium.

    Science.gov (United States)

    Verhaeghe, Nick; Lievens, Delfine; Annemans, Lieven; Vander Laenen, Freya; Putman, Koen

    2017-12-16

    Alcohol is associated with adverse health effects causing a considerable economic impact to society. A reliable estimate of this economic impact for Belgium is lacking. This is the aim of the study. A prevalence-based approach estimating the direct, indirect and intangible costs for the year 2012 was used. Attributional fractions for a series of health effects were derived from literature. The human capital approach was used to estimate indirect costs, while the concept of disability-adjusted life years was used to estimate intangible costs. Sensitivity and scenario analyses were conducted to assess the uncertainty around cost estimates and to evaluate the impact of alternative modelling assumptions. In 2012, total alcohol-attributable direct costs were estimated at €906.1 million, of which the majority were due to hospitalization (€743.7 million, 82%). The indirect costs amounted to €642.6 million, of which 62% was caused by premature mortality. Alcohol was responsible for 157,500 disability-adjusted life years representing €6.3 billion intangible costs. Despite a number of limitations intrinsic to this kind of research, the study can be considered as the most comprehensive analysis thus far of the health-related social costs of alcohol in Belgium.

  15. Self-reported Function, Health Resource Use, and Total Health Care Costs Among Medicare Beneficiaries With Glaucoma.

    Science.gov (United States)

    Prager, Alisa J; Liebmann, Jeffrey M; Cioffi, George A; Blumberg, Dana M

    2016-04-01

    The effect of glaucoma on nonglaucomatous medical conditions and resultant secondary health care costs is not well understood. To assess self-reported medical conditions, the use of medical services, and total health care costs among Medicare beneficiaries with glaucoma. Longitudinal observational study of 72,587 Medicare beneficiaries in the general community using the Medicare Current Beneficiary Survey (2004-2009). Coding to extract data started in January 2015, and analyses were performed between May and July 2015. Self-reported health, the use of health care services, adjusted mean annual total health care costs per person, and adjusted mean annual nonoutpatient costs per person. Participants were 72,587 Medicare beneficiaries 65 years or older with (n = 4441) and without (n = 68,146) a glaucoma diagnosis in the year before collection of survey data. Their mean age was 76.9 years, and 43.2% were male. Patients with glaucoma who responded to survey questions on visual disability were stratified into those with (n = 1748) and without (n = 2639) self-reported visual disability. Medicare beneficiaries with glaucoma had higher adjusted odds of inpatient hospitalizations (odds ratio [OR], 1.27; 95% CI, 1.17-1.39; P total health care costs and $2599 (95% CI, $1985-$3212; P total and nonoutpatient medical costs. Perception of vision loss among patients with glaucoma may be associated with depression, falls, and difficulty walking. Reducing the prevalence and severity of glaucoma may result in improvements in associated nonglaucomatous medical conditions and resultant reduction in health care costs.

  16. Wealth and health behavior: Testing the concept of a health cost

    NARCIS (Netherlands)

    J.L.W. van Kippersluis (Hans); T.J. Galama (Titus)

    2014-01-01

    textabstractWealthier individuals engage in healthier behavior. This paper seeks to explain this phenomenon by exploiting both inheritances and lottery winnings to test a theory of health behavior. We distinguish between the direct monetary cost and the indirect health cost (value of health lost) of

  17. Malaria community health workers in Myanmar: a cost analysis.

    Science.gov (United States)

    Kyaw, Shwe Sin; Drake, Tom; Thi, Aung; Kyaw, Myat Phone; Hlaing, Thaung; Smithuis, Frank M; White, Lisa J; Lubell, Yoel

    2016-01-25

    Myanmar has the highest malaria incidence and attributed mortality in South East Asia with limited healthcare infrastructure to manage this burden. Establishing malaria Community Health Worker (CHW) programmes is one possible strategy to improve access to malaria diagnosis and treatment, particularly in remote areas. Despite considerable donor support for implementing CHW programmes in Myanmar, the cost implications are not well understood. An ingredients based micro-costing approach was used to develop a model of the annual implementation cost of malaria CHWs in Myanmar. A cost model was constructed based on activity centres comprising of training, patient malaria services, monitoring and supervision, programme management, overheads and incentives. The model takes a provider perspective. Financial data on CHWs programmes were obtained from the 2013 financial reports of the Three Millennium Development Goal fund implementing partners that have been working on malaria control and elimination in Myanmar. Sensitivity and scenario analyses were undertaken to outline parameter uncertainty and explore changes to programme cost for key assumptions. The range of total annual costs for the support of one CHW was US$ 966-2486. The largest driver of CHW cost was monitoring and supervision (31-60% of annual CHW cost). Other important determinants of cost included programme management (15-28% of annual CHW cost) and patient services (6-12% of annual CHW cost). Within patient services, malaria rapid diagnostic tests are the major contributor to cost (64% of patient service costs). The annual cost of a malaria CHW in Myanmar varies considerably depending on the context and the design of the programme, in particular remoteness and the approach to monitoring and evaluation. The estimates provide information to policy makers and CHW programme planners in Myanmar as well as supporting economic evaluations of their cost-effectiveness.

  18. Reducing the cost of health care capital.

    Science.gov (United States)

    Silberman, R

    1984-08-01

    Although one may ask four financial experts their opinion on the future of the hospital capital market and receive five answers, the blatant need for financial strategic planning is evident. Clearly, the hospital or system with sound financial management will be better positioned to gain and/or maintain an edge in the competitive environment of the health care sector. The trends of the future include hospitals attempting to: Maximize the efficiency of invested capital. Use the expertise of Board members. Use alternative capital sources. Maximize rate of return on investments. Increase productivity. Adjust to changes in reimbursements. Restructure to use optimal financing for capital needs, i.e., using short-term to build up debt capacity if long-term financing is needed in the future. Take advantage of arbitrage (obtain capital and reinvest it until the funds are needed). Delay actual underwriting until funds are to be used. Better management of accounts receivable and accounts payable to avoid short-term financing for cash flow shortfalls. Use for-profit subsidiaries to obtain venture capital by issuing stock. Use product line management. Use leasing to obtain balance sheet advantages. These trends indicate a need for hospital executives to possess a thorough understanding of the capital formation process. In essence, the bottom line is that the short-term viability and long-term survival of a health care organization will greatly depend on the financial expertise of its decision-makers.

  19. Improving World Health: A Least Cost Strategy. Worldwatch Paper 59.

    Science.gov (United States)

    Chandler, William U.

    Least-cost health strategies designed to attack the world's leading causes of unnecessary death are explored. Section 1 emphasizes the value of primary health-care procedures--midwifery, maternal education on breastfeeding and weaning, vaccinations, oral rehydration of victims of diarrhea, and antibiotics against respiratory infections--in…

  20. Counting the opportunity cost of abandoning the omnibus Health ...

    African Journals Online (AJOL)

    Counting the opportunity cost of abandoning the omnibus Health Professions Authority ... Twenty two years of civil war ruined the healthcare system in South Sudan. Government provides only ... This regulatory vacuum is best resolved by establishing a Health Professions Authority to set the standards, and to supervise and ...

  1. Climate and Health Impacts of US Emissions Reductions Consistent with 2 C

    Science.gov (United States)

    Shindell, Drew T.; Lee, Yunha; Faluvegi, Greg

    2016-01-01

    An emissions trajectory for the US consistent with 2 C warming would require marked societal changes, making it crucial to understand the associated benefits. Previous studies have examined technological potentials and implementation costs and public health benefits have been quantified for less-aggressive potential emissions-reduction policies, but researchers have not yet fully explored the multiple benefits of reductions consistent with 2 C. We examine the impacts of such highly ambitious scenarios for clean energy and vehicles. US transportation emissions reductions avoid approx.0.03 C global warming in 2030 (0.15 C in 2100), whereas energy emissions reductions avoid approx.0.05-0.07 C 2030 warming (approx.0.25 C in 2100). Nationally, however, clean energy policies produce climate disbenefits including warmer summers (although these would be eliminated by the remote effects of similar policies if they were undertaken elsewhere). The policies also greatly reduce damaging ambient particulate matter and ozone. By 2030, clean energy policies could prevent approx.175,000 premature deaths, with approx.22,000 (11,000-96,000; 95% confidence) fewer annually thereafter, whereas clean transportation could prevent approx.120,000 premature deaths and approx.14,000 (9,000-52,000) annually thereafter. Near-term national benefits are valued at approx.US$250 billion (140 billion to 1,050billion) per year, which is likely to exceed implementation costs. Including longer-term, worldwide climate impacts, benefits roughly quintuple, becoming approx.5-10 times larger than estimated implementation costs. Achieving the benefits, however, would require both larger and broader emissions reductions than those in current legislation or regulations.

  2. Learning Together; part 2: training costs and health gain - a cost analysis.

    Science.gov (United States)

    Cullen, Katherine; Riches, Wendy; Macaulay, Chloe; Spicer, John

    2017-01-01

    Learning Together is a complex educational intervention aimed at improving health outcomes for children and young people. There is an additional cost as two doctors are seeing patients together for a longer appointment than a standard general practice (GP) appointment. Our approach combines the impact of the training clinics on activity in South London in 2014-15 with health gain, using NICE guidance and standards to allow comparison of training options. Activity data was collected from Training Practices hosting Learning Together. A computer based model was developed to analyse the costs of the Learning Together intervention compared to usual training in a partial economic evaluation. The results of the model were used to value the health gain required to make the intervention cost effective. Data were returned for 363 patients booked into 61 clinics across 16 Training Practices. Learning Together clinics resulted in an increase in costs of £37 per clinic. Threshold analysis illustrated one child with a common illness like constipation needs to be well for two weeks, in one Practice hosting four training clinics for the clinics to be considered cost effective. Learning Together is of minimal training cost. Our threshold analysis produced a rubric that can be used locally to test cost effectiveness at a Practice or Programme level.

  3. A Sensitivity Analysis of Timing and Costs of Greenhouse Gas Emission Reductions

    International Nuclear Information System (INIS)

    Gerlagh, R.; Van der Zwaan, B.

    2004-01-01

    This paper analyses the optimal timing and macro-economic costs of carbon emission reductions that mitigate the global average atmospheric temperature increase. We use a macro-economic model in which there are two competing energy sources, fossil-fuelled and non-fossil-fuelled. Technological change is represented endogenously through learning curves, and niche markets exist implying positive demand for the relatively expensive non-fossil-fuelled energy source. Under these conditions, with a temperature increase constraint of 2C, early abatement is found to be optimal, and, compared to the results of many existing top-down models, the costs of this strategy prove to be low. We perform an extensive sensitivity analysis of our results regarding the uncertainties that dominate various economic and technological modeling parameters. Uncertainties in the learning rate and the elasticity of substitution between the two different energy sources most significantly affect the robustness of our findings

  4. Coordinating a Supply Chain When Manufacturer Makes Cost Reduction Investment in Supplier

    Directory of Open Access Journals (Sweden)

    Shilei Huang

    2016-01-01

    Full Text Available We consider a supply chain consisting of an upstream supplier and a downstream manufacturer, in which the supplier provides a component to the manufacturer, facing a price-sensitive and uncertain demand. The manufacturer makes cost reduction investment in the supplier to improve the supplier’s production efficiency, which benefits the entire supply chain. We derive the optimal investment and operating decisions. Both the centralized and decentralized supply chains are studied. We show that the optimal investment and operating decisions in the decentralized setting may deviate from that in the centralized setting. To avoid the profit loss caused by such a deviation, we develop a coordination mechanism by introducing a combined policy of revenue-sharing policy and investment cost-sharing policy. We also show that the developed coordination mechanism can achieve Pareto improvement for the two players.

  5. Generation IV Nuclear Energy Systems Construction Cost Reductions Through the Use of Virtual Environments

    Energy Technology Data Exchange (ETDEWEB)

    Timothy Shaw; Vaugh Whisker

    2004-02-28

    The objective of this multi-phase project is to demonstrate the feasibility and effectiveness of using full-scale virtual reality simulation in the design, construction, and maintenance of future nuclear power plants. The project will test the suitability of immersive virtual reality technology to aid engineers in the design of the next generation nuclear power plant and to evaluate potential cost reductions that can be realized by optimization of installation and construction sequences. The intent is to see if this type of information technology can be used in capacities similar to those currently filled by full-scale physical mockups. This report presents the results of the completed project.

  6. UWB Wind Turbine Blade Deflection Sensing for Wind Energy Cost Reduction

    DEFF Research Database (Denmark)

    Zhang, Shuai; Jensen, Tobias Lindstrøm; Franek, Ondrej

    2015-01-01

    A new application of utilizing ultra-wideband (UWB) technology to sense wind turbine blade deflections is introduced in this paper for wind energy cost reduction. The lower UWB band of 3.1–5.3 GHz is applied. On each blade, there will be one UWB blade deflection sensing system, which consists...... is always of sufficient quality for accurate estimations under different deflections. The measured results reveal that the blade tip-root distance and blade deflection can be accurately estimated in the complicated and lossy wireless channels around a wind turbine blade. Some future research topics...

  7. Reduction of the radioactive waste volume from Belgian NPP: Reality, costs and goals

    International Nuclear Information System (INIS)

    Havard, P.; Lemmens, A.; Mannaerts, K.

    2001-01-01

    The growing awareness of the existence of waste generated by human activities and its environmental impact is one of the critical events of the late twentieth century. All industrial activities produce waste and nuclear industry is no exception. But nuclear power plants produce smaller amount of waste that makes it possible to treat it with particular care. This paper describes the reduction in the amount of waste, the consequences this has had on the associated costs and the action taken to control the development of both objectives. (author)

  8. Generation IV Nuclear Energy Systems Construction Cost Reductions Through the Use of Virtual Environments

    International Nuclear Information System (INIS)

    Timothy Shaw; Vaugh Whisker

    2004-01-01

    The objective of this multi-phase project is to demonstrate the feasibility and effectiveness of using full-scale virtual reality simulation in the design, construction, and maintenance of future nuclear power plants. The project will test the suitability of immersive virtual reality technology to aid engineers in the design of the next generation nuclear power plant and to evaluate potential cost reductions that can be realized by optimization of installation and construction sequences. The intent is to see if this type of information technology can be used in capacities similar to those currently filled by full-scale physical mockups. This report presents the results of the completed project

  9. [Costs with personnel and productivity analysis of family health program teams in Fortaleza, Ceará].

    Science.gov (United States)

    Rocha Filho, Fernando dos Santos; da Silva, Marcelo Gurgel Carlos

    2009-01-01

    The research verified the productivity and the operational personnel costs of eight teams of the Family Health Program (PSF) of two Basic Units of Family Health (UBASF) in Fortaleza, Ceará, through the methodology of costs by absorption, in 2004. The largest expenses were with personnel (75%), mainly with the PSF teams, and medicines (18%). The federal allocations received in September, 2004, by each PSF team, were R$ 9,543.33. The total cost by team was R$ 15,719.00. Some professionals of various PSF teams showed productivity above the set objectives, but the average productivity by doctor and nurse was below fifty per cent of objectives, with high idle time making the work onerous. The unity cost of home visits by doctor and prenatal attendance by nurses were checked, and, would be less expensive if the idle time were reduced. Various alternatives of cost reduction were observed, such as scale savings of some resources and services and re-negotiation of contracts with suppliers and cooperatives. The data obtained will contribute to more accurate planning for the installation and maintenance of PSF teams as well as alternatives of cost reductions, higher productivity, and better quality.

  10. Costs and Performance of English Mental Health Providers.

    Science.gov (United States)

    Moran, Valerie; Jacobs, Rowena

    2017-06-01

    Despite limited resources in mental health care, there is little research exploring variations in cost performance across mental health care providers. In England, a prospective payment system for mental health care based on patient needs has been introduced with the potential to incentivise providers to control costs. The units of payment under the new system are 21 care clusters. Patients are allocated to a cluster by clinicians, and each cluster has a maximum review period. The aim of this research is to explain variations in cluster costs between mental health providers using observable patient demographic, need, social and treatment variables. We also investigate if provider-level variables explain differences in costs. The residual variation in cluster costs is compared across providers to provide insights into which providers may gain or lose under the new financial regime. The main data source is the Mental Health Minimum Data Set (MHMDS) for England for the years 2011/12 and 2012/13. Our unit of observation is the period of time spent in a care cluster and costs associated with the cluster review period are calculated from NHS Reference Cost data. Costs are modelled using multi-level log-linear and generalised linear models. The residual variation in costs at the provider level is quantified using Empirical Bayes estimates and comparative standard errors used to rank and compare providers. There are wide variations in costs across providers. We find that variables associated with higher costs include older age, black ethnicity, admission under the Mental Health Act, and higher need as reflected in the care clusters. Provider type, size, occupancy and the proportion of formal admissions at the provider-level are also found to be significantly associated with costs. After controlling for patient- and provider-level variables, significant residual variation in costs remains at the provider level. The results suggest that some providers may have to increase

  11. Evaluation of potential cost reductions from improved amine-based CO2 capture systems

    International Nuclear Information System (INIS)

    Rao, Anand B.; Rubin, Edward S.; Keith, David W.; Granger Morgan, M.

    2006-01-01

    Technological innovations in CO 2 capture and storage technologies are being pursued worldwide under a variety of private and government-sponsored R and D programs. While much of this R and D is directed at novel concepts and potential breakthrough technologies, there are also substantial efforts to improve CO 2 capture technologies already in use. In this paper, we focus on amine-based CO 2 capture systems for power plants and other combustion-based applications. The current performance and cost of such systems have been documented in several recent studies. In this paper we examine the potential for future cost reductions that may result from continued process development. We used the formal methods of expert elicitation to understand what experts in this field believe about possible improvements in some of the key underlying parameters that govern the performance and cost of this technology. A dozen leading experts from North America, Europe and Asia participated in this study, providing their probabilistic judgments via a detailed questionnaire coupled with individual interviews. Judgments about detailed technical parameters were then used in an integrated power plant modeling framework (IECM-CS) developed for USDOE to evaluate the performance and costs of alternative carbon capture and sequestration technologies for fossil-fueled power plants. The experts' responses have allowed us to build a picture of how the overall performance and cost of amine-based systems might improve over the next decade or two. Results show how much the cost of CO 2 capture could be reduced via targeted R and D in key areas

  12. Final cost reduction study for the Geysers Recharge Alternative. Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-11-01

    The purpose of this study is to determine whether or not cost reduction opportunities exist for the Geysers Recharge Alternative as defined in the Santa Rosa Subregional Long-Term Wastewater Project EIR/EIS. The City of Santa Rosa has been directed to have a plan for reclaimed water disposal in place by 1999 which will meet future capacity needs under all weather conditions. A Draft EIR/EIS released in July 1996 and a Final EIR certified in June 1997 examine four primary alternatives plus the No Action Alternative. Two of the primary alternatives involve agricultural irrigation with reclaimed water, either in western or southern Sonoma County. Another involves increased discharge of reclaimed water into the Russian River. The fourth involves using reclaimed water to replenish the geothermal reservoir at the Geysers. The addition of this water source would enable the Geysers operators to produce more steam from the geothermal area and thereby prolong the life and economic production level of the steamfield and the geothermal power plants supplied by the steamfield. This study provides additional refined cost estimates for new scenarios which utilize an alternative pipeline alignment and a range of reclaimed water flows, which deliver less water to the Geysers than proposed in the EIR/EIS (by distributing flow to other project components). Also, electrical power rates were revised to reflect the recent changes in costs associated with deregulation of the power industry. In addition, this report provides information on sources of potential public and private funding available and future environmental documentation required if the cost reduction scenarios were to be selected by the City as part of their preferred alternative.

  13. Renewables vs. energy efficiency: The cost of carbon emissions reduction in Spain

    International Nuclear Information System (INIS)

    López-Peña, Álvaro; Pérez-Arriaga, Ignacio; Linares, Pedro

    2012-01-01

    While support instruments have succeeded to largely deploy renewables during the 1996–2008 period, little attention has been paid to energy efficiency measures, resulting in a high energy intensity and large growth of energy demand. Energy-related CO 2 emissions have increased significantly. At the same time, important investments in combined cycle gas turbines have taken place. This paper analyses whether, from a cost minimization viewpoint, renewable support has been the best policy for reducing emissions, when compared to the promotion of energy efficiency in sectors such as transportation or buildings. We use a model of the Spanish energy sector to examine its evolution in the time period considered under different policies. It is a bottom-up, static, partial equilibrium, linear programming model of the complete Spanish energy system. We conclude that demand side management (DSM) clearly dominates renewable energy (RE) support if the reduction of emissions at minimum cost is the only concern. We also quantify the savings that could have been achieved: a total of €5 billion per year, mainly in RE subsidies and in smaller costs of meeting the reduced demand (net of DSM implementation cost). - Highlights: ► Energy efficiency is cheaper than renewables for reducing carbon emissions. ► Energy efficiency measures could have saved more than €5 billion per year in Spain. ► Savings could have been bigger without overcapacity in gas combined cycles.

  14. Cost reduction in PV manufacturing. Impact on grid-connected and building-integrated markets

    International Nuclear Information System (INIS)

    Maycock, Paul D.

    1997-01-01

    In the past three years there have been several key events or changes that can lead to fully economic, massive deployment to the grid-connected and central PV markets. The factors discussed in this report include: (1) significant cost reduction in single crystal and polycrystal silicon so that modules profitably priced at $3.10-$3.30 per peak watt and installed grid-connected systems with installed cost of $5.50 per watt are being offered; (2) several new thin film plants - amorphous silicon, cadmium telluride, and copper indium diselenide are being built for 1996, 1997 production with greatly reduced costs; (3) government subsidized volume orders for PV in grid-connected houses (Japan, Germany, Switzerland, Italy, and the United States) provide volume (2000+ units per year) that lead to reduced costs; (4) environmental benefits for PV are being applied in Europe and Japan permitting 'early adopters' to enter the market; and (5) government and commercial acceptance of PV building integrated products, especially in Europe, are expanding PV markets. The combination of these forces lead to the prediction that an 'accelerated' market mode could start in the year 2000

  15. Impact of a Novel Cost-Saving Pharmacy Program on Pregabalin Use and Health Care Costs.

    Science.gov (United States)

    Martin, Carolyn; Odell, Kevin; Cappelleri, Joseph C; Bancroft, Tim; Halpern, Rachel; Sadosky, Alesia

    2016-02-01

    Pharmacy cost-saving programs often aim to reduce costs for members and payers by encouraging use of lower-tier or generic medications and lower-cost sales channels. In 2010, a national U.S. health plan began a novel pharmacy program directed at reducing pharmacy expenditures for targeted medications, including pregabalin. The program provided multiple options to avoid higher cost sharing: use mail order pharmacy or switch to a lower-cost alternative medication via mail order or retail. Members who did not choose any option eventually paid the full retail cost of pregabalin. To evaluate the impact of the pharmacy program on pregabalin and alternative medication use, health care costs, and health care utilization. This retrospective analysis of claims data included adult commercial health plan members with a retail claim for pregabalin in the first 13 months of the pharmacy program (identification [ID] period: February 1, 2010-February 28, 2011). Members whose benefit plan included the pharmacy program were assigned to the program cohort; all others were assigned to the nonprogram cohort. The program cohort index date was the first retail pregabalin claim during the ID period and after the program start; the nonprogram cohort index date was the first retail pregabalin claim during the ID period. All members were continuously enrolled for 12 months pre- and post-index and had at least 1 inpatient claim or ≥ 2 ambulatory visit claims for a pregabalin-indicated condition. Cohorts were propensity score matched (PSM) 1:1 with logistic regression on demographic and pre-index characteristics, including mail order and pregabalin use, comorbidity, health care costs, and health care utilization. Pregabalin, gabapentin and other alternative medication use, health care costs, and health care utilization were measured. The program cohort was also divided into 2 groups: members who changed to gabapentin post-index and those who did not. A difference-in-differences (Di

  16. Cost evaluation of clinical laboratory in Taiwan's National Health System by using activity-based costing.

    Science.gov (United States)

    Su, Bin-Guang; Chen, Shao-Fen; Yeh, Shu-Hsing; Shih, Po-Wen; Lin, Ching-Chiang

    2016-11-01

    To cope with the government's policies to reduce medical costs, Taiwan's healthcare service providers are striving to survive by pursuing profit maximization through cost control. This article aimed to present the results of cost evaluation using activity-based costing performed in the laboratory in order to throw light on the differences between costs and the payment system of National Health Insurance (NHI). This study analyzed the data of costs and income of the clinical laboratory. Direct costs belong to their respective sections of the department. The department's shared costs, including public expenses and administrative assigned costs, were allocated to the department's respective sections. A simple regression equation was created to predict profit and loss, and evaluate the department's break-even point, fixed cost, and contribution margin ratio. In clinical chemistry and seroimmunology sections, the cost per test was lower than the NHI payment and their major laboratory tests had revenues with the profitability ratio of 8.7%, while the other sections had a higher cost per test than the NHI payment and their major tests were in deficit. The study found a simple linear regression model as follows: "Balance=-84,995+0.543×income (R2=0.544)". In order to avoid deficit, laboratories are suggested to increase test volumes, enhance laboratory test specialization, and become marginal scale. A hospital could integrate with regional medical institutions through alliances or OEM methods to increase volumes to reach marginal scale and reduce laboratory costs, enhancing the level and quality of laboratory medicine.

  17. The burden of unintended pregnancies in Brazil: a social and public health system cost analysis

    Directory of Open Access Journals (Sweden)

    Le HH

    2014-07-01

    pregnancies and induced abortions, our estimates reflect the costs of UP for different pregnancy outcomes. The main costs associated with UP are in those carried to parturition. The health cost of abortion represents a small proportion of total costs as these are paid for outside of the public health system. Consequently, reductions in UP will generate not only cost savings, but reductions in woman and child morbidity and mortality. Keywords: unintended pregnancy, public health, Brazil, abortion

  18. Relational Climate and Health Care Costs: Evidence From Diabetes Care.

    Science.gov (United States)

    Soley-Bori, Marina; Stefos, Theodore; Burgess, James F; Benzer, Justin K

    2018-01-01

    Quality of care worries and rising costs have resulted in a widespread interest in enhancing the efficiency of health care delivery. One area of increasing interest is in promoting teamwork as a way of coordinating efforts to reduce costs and improve quality, and identifying the characteristics of the work environment that support teamwork. Relational climate is a measure of the work environment that captures shared employee perceptions of teamwork, conflict resolution, and diversity acceptance. Previous research has found a positive association between relational climate and quality of care, yet its relationship with costs remains unexplored. We examined the influence of primary care relational climate on health care costs incurred by diabetic patients at the U.S. Department of Veterans Affairs between 2008 and 2012. We found that better relational climate is significantly related to lower costs. Clinics with the strongest relational climate saved $334 in outpatient costs per patient compared with facilities with the weakest score in 2010. The total outpatient cost saving if all clinics achieved the top 5% relational climate score was $20 million. Relational climate may contribute to lower costs by enhancing diabetic treatment work processes, especially in outpatient settings.

  19. Cost of delivering health care services at primary health facilities in Ghana

    Directory of Open Access Journals (Sweden)

    Maxwell Ayindenaba Dalaba

    2017-11-01

    Full Text Available Abstract Background There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs and Community-based Health Planning and Services (CHPS in Ghana. Methods The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD attendance were estimated. Results The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC. The cost per OPD attendance was higher at CHPS (US$8.79 than at HCs (US$5.16. The average Internally Generated Funds (IGF recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS reimbursement was the main source of revenue accounting for over 90% total IGF. Conclusions The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar

  20. Soft-copy sonography: cost reduction sensitivity analysis in a pediatric hospital.

    Science.gov (United States)

    Don, S; Albertina, M J; Ammann, D

    1998-03-01

    Our objective was to determine whether interpreting sonograms of pediatric patients using soft-copy (computer workstation) instead of laser-printed film could reduce costs for a pediatric radiology department. We used theoretic models of growth to analyze costs. The costs of a sonographic picture archiving and communication system (three interface devices, two workstations, a network server, maintenance expenses, and storage media costs) were compared with the potential savings of eliminating film and increasing technologist efficiency or reducing the number of technologists. The model was based on historic trends and future capitation estimates that will reduce fee-for-service reimbursement. The effects of varying the study volume and reducing technologists' work hours were analyzed. By converting to soft-copy interpretation, we saved 6 min 32 sec per examination by eliminating film processing waiting time, thus reducing examination time from 30 min to 24 min. During an average day of 27 examinations, 176 min were saved. However, 33 min a day were spent retrieving prior studies from long-term storage; thus, 143 extra minutes a day were available for scanning. This improved efficiency could result in five more sonograms a day obtained by converting to soft-copy interpretation, using existing staff and equipment. Alternatively, five examinations a day would equate to one half of a full-time equivalent technologists position. Our analysis of costs considered that the hospital's anticipated growth of sonography and the depreciation of equipment during 5 years resulted in a savings of more than $606,000. Increasing the examinations by just 200 sonograms in the first year and no further growth resulted in a savings of more than $96,000. If the number of sonograms stayed constant, elimination of film printing alone resulted in a loss of approximately $157,000; reduction of one half of a full-time equivalent technologist's position would recuperate approximately $134

  1. Reducing patient drug acquisition costs can lower diabetes health claims.

    Science.gov (United States)

    Mahoney, John J

    2005-08-01

    Concerned about rising prevalence and costs of diabetes among its employees, Pitney Bowes Inc recently revamped its drug benefit design to synergize with ongoing efforts in its disease management and patient education programs. Specifically, based on a predictive model showing that low medication adherence was linked to subsequent increases in healthcare costs in patients with diabetes, the company shifted all diabetes drugs and devices from tier 2 or 3 formulary status to tier 1. The rationale was that reducing patient out-of-pocket costs would eliminate financial barriers to preventive care, and thereby increase adherence, reduce costly complications, and slow the overall rate of rising healthcare costs. This single change in pharmaceutical benefit design immediately made critical brand-name drugs available to most Pitney Bowes employees and their covered dependents for 10% coinsurance, the same coinsurance level as for generic drugs, versus the previous cost share of 25% to 50%. After 2 to 3 years, preliminary results in plan participants with diabetes indicate that medication possession rates have increased significantly, use of fixed-combination drugs has increased (possibly related to easier adherence), average total pharmacy costs have decreased by 7%, and emergency department visits have decreased by 26%. Hospital admission rates, although increasing slightly, remain below the demographically adjusted Medstat benchmark. Overall direct healthcare costs per plan participant with diabetes decreased by 6%. In addition, the rate of increase in overall per-plan-participant health costs at Pitney Bowes has slowed markedly, with net per-plan-participant costs in 2003 at about 4000 dollars per year versus 6500 dollars for the industry benchmark. This recent moderation in overall corporate health costs may be related to these strategic changes in drug benefit design for diabetes, asthma, and hypertension and also to ongoing enhancements in the company's disease

  2. Costs of the 'Hartslag Limburg' community heart health intervention

    Directory of Open Access Journals (Sweden)

    Ruland Erik

    2006-03-01

    Full Text Available Abstract Background Little is known about the costs of community programmes to prevent cardiovascular diseases. The present study calculated the economic costs of all interventions within a Dutch community programme called Hartslag Limburg, in such a way as to facilitate generalisation to other countries. It also calculated the difference between the economic costs and the costs incurred by the coordinating institution. Methods Hartslag Limburg was a large-scale community programme that consisted of many interventions to prevent cardiovascular diseases. The target population consisted of all inhabitants of the region (n = 180.000. Special attention was paid to reach persons with a low socio-economic status. Costs were calculated using the guidelines for economic evaluation in health care. An overview of the material and staffing input involved was drawn up for every single intervention, and volume components were attached to each intervention component. These data were gathered during to the implementation of the intervention. Finally, the input was valued, using Dutch price levels for 2004. Results The economic costs of the interventions that were implemented within the five-year community programme (n = 180,000 were calculated to be about €900,000. €555,000 was spent on interventions to change people's exercise patterns, €250,000 on improving nutrition, €50,000 on smoking cessation, and €45,000 on lifestyle in general. The coordinating agency contributed about 10% to the costs of the interventions. Other institutions that were part of the programme's network and external subsidy providers contributed the other 90% of the costs. Conclusion The current study calculated the costs of a community programme in a detailed and systematic way, allowing the costs to be easily adapted to other countries and regions. The study further showed that the difference between economic costs and the costs incurred by the coordinating agency can be very

  3. Health sector costs of self-reported food allergy in Europe: a patient-based cost of illness study

    NARCIS (Netherlands)

    Mugford, M.; Fox, M.; Voordouw, J.; Cornelisse-Vermaat, J.R.; Antonides, G.; Hoz Caballer, de la B.

    2013-01-01

    Introduction: Food allergy is a recognized health problem, but little has been reported on its cost for health services. The EuroPrevall project was a European study investigating the patterns, prevalence and socio-economic cost of food allergy. Aims: To investigate the health service cost for

  4. Health sector costs of self-reported food allergy in Europe : A patient-based cost of illness study

    NARCIS (Netherlands)

    Fox, Margaret; Mugford, Miranda; Voordouw, Jantine; Cornelisse-Vermaat, Judith; Antonides, Gerrit; de la Hoz Caballer, Belen; Cerecedo, Inma; Zamora, Javier; Rokicka, Ewa; Jewczak, Maciej; Clark, Allan B; Kowalski, Marek L; Papadopoulos, Nikos; Knulst, Anna C; Seneviratne, Suranjith; Belohlavkova, Simona; Asero, Roberto; de Blay, Frederic; Purohit, Ashok; Clausen, Michael; Flokstra de Blok, Bertine; Dubois, Anthony E; Fernandez-Rivas, Montserrat; Burney, Peter; Frewer, Lynn J; Mills, Clare E N

    2013-01-01

    Introduction: Food allergy is a recognized health problem, but little has been reported on its cost for health services. The EuroPrevall project was a European study investigating the patterns, prevalence and socio-economic cost of food allergy. Aims: To investigate the health service cost for

  5. Health insurance without provider influence: the limits of cost containment.

    Science.gov (United States)

    Goldberg, L G; Greenberg, W

    1988-01-01

    In our previous paper, we showed that market forces can play a significant role in controlling health care costs and that a considerable amount of cost containment effort was pursued by third-party insurers in Oregon in the 1930s and 1940s. Although physicians were able to thwart this cost-control effort, a 1986 Supreme Court decision, FTC v. Indiana Federation of Dentists, found that a boycott of insurers by dentists violated Section 5 of the Federal Trade Commission Act. Further investigation of recent developments, including the recent Wickline v. California decision, indicates that the primary barriers to cost containment today are not obstructive tactics by providers or provider-controlled health insurance plans. Rather, the primary barriers are increases in the development and diffusion of new technology and society's apparent preference for paying for new tests and procedures regardless of economic efficiency.

  6. Opportunity costs and local health service spending decisions: a qualitative study from Wales.

    Science.gov (United States)

    Karlsberg Schaffer, Sarah; Sussex, Jon; Hughes, Dyfrig; Devlin, Nancy

    2016-03-25

    All health care systems face the need to find the resources to meet new demands such as a new, cost-increasing health technology. In England and Wales, when a health technology is recommended by the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS) is mandated to provide the funding to accommodate it within three months of publication of the recommendation. Identifying what, in practice, is foregone when new cost-increasing technologies are introduced is important for understanding the effects of health technology assessment (HTA) decisions on the NHS or any other health care system. Our objective was to investigate how in practice local NHS commissioners in Wales accommodated financial "shocks" arising from technology appraisals (TAs) issued by NICE and from other cost pressures. Semi-structured interviews were conducted with Finance Directors and Medical Directors from all seven Local Health Boards (LHBs) in NHS Wales. These interviews covered prioritisation processes, as well as methods of financing NICE TAs and other financial shocks at each LHB. We then undertook a systematic identification of themes and topics from the information recorded. The study relates to the period October 2010 to March 2013. The financial impact of NICE TAs is generally anticipated and planned for in advance and the majority of LHBs have contingency funds available to cope with these and other financial shocks within-period. Efficiency savings (defined as reductions in costs with no assumed reductions in quality) were a source of funds for cost pressures of all kinds. Service displacements were not linkable to particular NICE TAs and there appears to be a general lack of explicit prioritisation activities. The Welsh Government has, on occasion, explicitly or implicitly acted as the funder of last resort. Services may be displaced as part of a response to the cumulative impact of all types of cost pressures, including cost-increasing health

  7. Energy savings, emission reductions, and health co-benefits of the green building movement.

    Science.gov (United States)

    P, MacNaughton; X, Cao; J, Buonocore; J, Cedeno-Laurent; J, Spengler; A, Bernstein; J, Allen

    2018-06-01

    Buildings consume nearly 40% of primary energy production globally. Certified green buildings substantially reduce energy consumption on a per square foot basis and they also focus on indoor environmental quality. However, the co-benefits to health through reductions in energy and concomitant reductions in air pollution have not been examined.We calculated year by year LEED (Leadership in Energy and Environmental Design) certification rates in six countries (the United States, China, India, Brazil, Germany, and Turkey) and then used data from the Green Building Information Gateway (GBIG) to estimate energy savings in each country each year. Of the green building rating schemes, LEED accounts for 32% of green-certified floor space and publically reports energy efficiency data. We employed Harvard's Co-BE Calculator to determine pollutant emissions reductions by country accounting for transient energy mixes and baseline energy use intensities. Co-BE applies the social cost of carbon and the social cost of atmospheric release to translate these reductions into health benefits. Based on modeled energy use, LEED-certified buildings saved $7.5B in energy costs and averted 33MT of CO 2 , 51 kt of SO 2 , 38 kt of NO x , and 10 kt of PM 2.5 from entering the atmosphere, which amounts to $5.8B (lower limit = $2.3B, upper limit = $9.1B) in climate and health co-benefits from 2000 to 2016 in the six countries investigated. The U.S. health benefits derive from avoiding an estimated 172-405 premature deaths, 171 hospital admissions, 11,000 asthma exacerbations, 54,000 respiratory symptoms, 21,000 lost days of work, and 16,000 lost days of school. Because the climate and health benefits are nearly equivalent to the energy savings for green buildings in the United States, and up to 10 times higher in developing countries, they provide an important and previously unquantified societal value. Future analyses should consider these co-benefits when weighing policy

  8. Reduction in energy consumption and operating cost in a dried corn warehouse using logistics techniques

    Directory of Open Access Journals (Sweden)

    Korrakot Y. Tippayawong

    2013-06-01

    Full Text Available Corn is one of the major economic crops in Thailand. Corn postharvest operation involves various practices that consume a large amount of energy. Different energy conservation measures have been implemented but logistics consideration is not normally employed. In this work, attempt has been made to demonstrate that logistics techniques can offer a significant reduction in energy and cost. The main objective of this work is to identify and demonstrate possible approaches to improving energy efficiency and reducing operating cost for a dried corn warehouse operator. Three main problems are identified: (i relatively high fuel consumption for internal transfer process, (ii low quality of dried corn, and (iii excess expenditure on outbound transportation. Solutions are proposed and implemented using logistics operations. Improvement is achieved using plant layout and shortest path techniques, resulting in a reduction of almost 50% in energy consumption for the internal transfer process. Installation of an air distributor in the grain storage unit results in a decrease in loss due to poor-quality dried corn from 17% to 10%. Excess expenditure on dried corn distribution is reduced by 6% with application of a global positioning system.

  9. Health Monitoring System Technology Assessments: Cost Benefits Analysis

    Science.gov (United States)

    Kent, Renee M.; Murphy, Dennis A.

    2000-01-01

    The subject of sensor-based structural health monitoring is very diverse and encompasses a wide range of activities including initiatives and innovations involving the development of advanced sensor, signal processing, data analysis, and actuation and control technologies. In addition, it embraces the consideration of the availability of low-cost, high-quality contributing technologies, computational utilities, and hardware and software resources that enable the operational realization of robust health monitoring technologies. This report presents a detailed analysis of the cost benefit and other logistics and operational considerations associated with the implementation and utilization of sensor-based technologies for use in aerospace structure health monitoring. The scope of this volume is to assess the economic impact, from an end-user perspective, implementation health monitoring technologies on three structures. It specifically focuses on evaluating the impact on maintaining and supporting these structures with and without health monitoring capability.

  10. Factory '82 - 30% reduction of operation cost at short term. Fabrik '82. Kurzzeitig 30% der Betriebskosten beeinflussen

    Energy Technology Data Exchange (ETDEWEB)

    1982-01-01

    The present-day situation of many companies is characterized by a decreasing production volume. Consequences and effects of this phenomenon on production and ancillary branches are presented and analysed under aspects of cost, measures are described for influencing operation cost in an effective and continuing way at short term: cost of energy and disposal, heat insulation and heat recovery, cost reduction by computer application, cost reduction with material flow, operational cost analyses with detection of weak spots. Replanning factories and subsections which frequently have shown to be necessary - new planning projects have become more or less rare these days - is accounted for by the range of problem-related topics. Next to issues of CAD in factory planning, another approach is demonstrated which is still underutilized when designing and using factory buildings in keeping with cost: value-analysis factory planning.

  11. Association of antipsychotic polypharmacy with health service cost: a register-based cost analysis

    DEFF Research Database (Denmark)

    Baandrup, Lone; Sørensen, Jan; Lublin, Henrik Kai Francis

    2012-01-01

    at the two cross-sectional dates was recorded and used as proxy of polypharmacy exposure during the preceding year. A multivariate generalised linear model was fitted with total costs of primary and secondary health service use as dependent variable, and antipsychotic polypharmacy, diagnosis, age, gender......, disease duration, psychiatric inpatient admissions, and treatment site as covariates. RESULTS: The sample consisted of 736 outpatients with a diagnosis in the schizophrenia spectrum. Antipsychotic polypharmacy was associated with significantly higher total health service costs compared with monotherapy...

  12. Paternity leave in Sweden: costs, savings and health gains.

    Science.gov (United States)

    Månsdotter, Anna; Lindholm, Lars; Winkvist, Anna

    2007-06-01

    The initial objective is to examine the relationship between paternity leave in 1978-1979 and male mortality during 1981-2001, and the second objective is to calculate the cost-effectiveness of the 1974 parental insurance reform in Sweden. Based on a population of all Swedish couples who had their first child together in 1978 (45,801 males), the risk of death for men who took paternity leave, compared with men who did not, was estimated by odds ratios. The cost-effectiveness analysis considered costs for information, administration and production losses, minus savings due to decreased sickness leave and inpatient care, compared to health gains in life-years and quality-adjusted life-years (QALYs). It is demonstrated that fathers who took paternity leave have a statistically significant decreased death risk of 16%. Costs minus savings (discounted values) stretch from a net cost of EUR 19 million to a net saving of EUR 11 million, and the base case cost-effectiveness is EUR 8000 per QALY. The study indicates that that the right to paternity leave is a desirable reform based on commonly stated public health, economic, and feminist goals. The critical issue in future research should be to examine impact from health-related selection.

  13. Local health care expenditure plans and their opportunity costs.

    Science.gov (United States)

    Karlsberg Schaffer, Sarah; Sussex, Jon; Devlin, Nancy; Walker, Andrew

    2015-09-01

    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.

  14. The cost of health professionals' brain drain in Kenya

    Directory of Open Access Journals (Sweden)

    Gbary Akpa

    2006-07-01

    Full Text Available Abstract Background Past attempts to estimate the cost of migration were limited to education costs only and did not include the lost returns from investment. The objectives of this study were: (i to estimate the financial cost of emigration of Kenyan doctors to the United Kingdom (UK and the United States of America (USA; (ii to estimate the financial cost of emigration of nurses to seven OECD countries (Canada, Denmark, Finland, Ireland, Portugal, UK, USA; and (iii to describe other losses from brain drain. Methods The costs of primary, secondary, medical and nursing schools were estimated in 2005. The cost information used in this study was obtained from one non-profit primary and secondary school and one public university in Kenya. The cost estimates represent unsubsidized cost. The loss incurred by Kenya through emigration was obtained by compounding the cost of educating a medical doctor and a nurse over the period between the average age of emigration (30 years and the age of retirement (62 years in recipient countries. Results The total cost of educating a single medical doctor from primary school to university is US$ 65,997; and for every doctor who emigrates, a country loses about US$ 517,931 worth of returns from investment. The total cost of educating one nurse from primary school to college of health sciences is US$ 43,180; and for every nurse that emigrates, a country loses about US$ 338,868 worth of returns from investment. Conclusion Developed countries continue to deprive Kenya of millions of dollars worth of investments embodied in her human resources for health. If the current trend of poaching of scarce human resources for health (and other professionals from Kenya is not curtailed, the chances of achieving the Millennium Development Goals would remain bleak. Such continued plunder of investments embodied in human resources contributes to further underdevelopment of Kenya and to keeping a majority of her people in the vicious

  15. A systematic way for the cost reduction of density fitting methods

    International Nuclear Information System (INIS)

    Kállay, Mihály

    2014-01-01

    We present a simple approach for the reduction of the size of auxiliary basis sets used in methods exploiting the density fitting (resolution of identity) approximation for electron repulsion integrals. Starting out of the singular value decomposition of three-center two-electron integrals, new auxiliary functions are constructed as linear combinations of the original fitting functions. The new functions, which we term natural auxiliary functions (NAFs), are analogous to the natural orbitals widely used for the cost reduction of correlation methods. The use of the NAF basis enables the systematic truncation of the fitting basis, and thereby potentially the reduction of the computational expenses of the methods, though the scaling with the system size is not altered. The performance of the new approach has been tested for several quantum chemical methods. It is demonstrated that the most pronounced gain in computational efficiency can be expected for iterative models which scale quadratically with the size of the fitting basis set, such as the direct random phase approximation. The approach also has the promise of accelerating local correlation methods, for which the processing of three-center Coulomb integrals is a bottleneck

  16. Results and assessment of participation of VUPEK in coordinated research project of the IAEA ''Comparison of cost-effectiveness of risk reduction among different energy systems''

    International Nuclear Information System (INIS)

    Kadlec, J.; Horacek, P.

    1989-01-01

    The results and conclusions are summarized of the research programme ''Comparison of cost-effectiveness of risk reduction among different energy systems'' co-ordinated in 1983 to 1988 by the International Atomic Energy Agency. Institutes in 18 member states were involved which performed 33 case studies in the field of risk reduction in various power systems or their parts. A comparison with cost-effectiveness of risk reduction in other fields was made as well. The health risks (occupational, those of population) and the environmental risks were evaluated. The case studies cover various stages of the decision-making process and various decision makers. The solution resulted in 5 methodological studies and 16 models. 11 case studies and 1 methodological study were conducted by the Research Institute of the Fuel and Energy Complex. The experiences obtained, the questions so far unanswered and recommendations for those who will perform similar studies are given. (author). 1 fig., 2 tabs., 3 refs

  17. Cost and waste volume reduction in HEPA filter trains by effective pre-filtration

    International Nuclear Information System (INIS)

    Chadwick, Chris; Kaufman, Seth

    2006-01-01

    Data published elsewhere (Moore, et el 1992; Bergman et al 1997) suggests that the then costs of disposable type Glass Fibre HEPA filtration trains to the DOE was USD 55 million per year (based on an average usage of HEPA panels of 11,748 pieces per year between 1987 and 1990), USD 50 million of which was attributable to installation, testing, removal and disposal - although the life cycle costs are themselves based on estimates dating from 1987-1990. The same authors suggest that by 1995 the number of HEPA panels being used had dropped to an estimated 4000 pieces per year due to the ending of the Cold War. The yearly cost to the DOE of 4000 units per year was estimated to be USD 29.5 million using the same parameters that suggested the previously stated USD 55 million for the larger quantity. Within that cost estimate, USD 300 was the value given to the filter and USD 4,450 was given to peripheral activity per filter. Clearly, if the USD 4,450 component could be reduced, tremendous saving could result, in addition to a significant reduction in the legacy burden of waste volumes. This same cost is applied to both the 11,748 and 4000 usage figures. The work up to now has focussed on the development of a low cost, long life (cleanable) direct replacement of the traditional filter train, but this paper will review an alternative strategy, that of preventing the contaminating dust from reaching and blinding the HEPA filters, and thereby removing the need to replace them. What has become clear is that 'low cost' and 'stainless HEPA' are not compatible terms. The original Bergman et al work suggested that 1000 ft 3 /min stainless HEPAs could be commercially available for USD 5000 each after development (although the USD 70,000 development unit may be somewhat exaggerated - the authors have estimated that development units able to be retro-fitted into strengthened standard housings would be available for perhaps USD 30,000). The likely true cost of such an item produced

  18. ISS Operations Cost Reductions Through Automation of Real-Time Planning Tasks

    Science.gov (United States)

    Hall, Timothy A.; Clancey, William J.; McDonald, Aaron; Toschlog, Jason; Tucker, Tyson; Khan, Ahmed; Madrid, Steven (Eric)

    2011-01-01

    In 2007 the Johnson Space Center s Mission Operations Directorate (MOD) management team challenged their organizations to find ways to reduce the cost of operations for supporting the International Space Station (ISS) in the Mission Control Center (MCC). Each MOD organization was asked to define and execute projects that would help them attain cost reductions by 2012. The MOD Operations Division Flight Planning Branch responded to this challenge by launching several software automation projects that would allow them to greatly improve console operations and reduce ISS console staffing and intern reduce operating costs. These tasks ranged from improving the management and integration mission plan changes, to automating the uploading and downloading of information to and from the ISS and the associated ground complex tasks that required multiple decision points. The software solutions leveraged several different technologies including customized web applications and implementation of industry standard web services architecture; as well as engaging a previously TRL 4-5 technology developed by Ames Research Center (ARC) that utilized an intelligent agent-based system to manage and automate file traffic flow, archive data, and generate console logs. These projects to date have allowed the MOD Operations organization to remove one full time (7 x 24 x 365) ISS console position in 2010; with the goal of eliminating a second full time ISS console support position by 2012. The team will also reduce one long range planning console position by 2014. When complete, these Flight Planning Branch projects will account for the elimination of 3 console positions and a reduction in staffing of 11 engineering personnel (EP) for ISS.

  19. Reduction potential, shadow prices, and pollution costs of agricultural pollutants in China.

    Science.gov (United States)

    Tang, Kai; Gong, Chengzhu; Wang, Dong

    2016-01-15

    This paper analyses the reduction potential, shadow prices, and pollution costs of agricultural pollutants in China based on provincial panel data for 2001-2010. Using a parameterized quadratic form for the directional output distance function, we find that if agricultural sectors in all provinces were to produce on the production frontier, China could potentially reduce agricultural emissions of chemical oxygen demand (COD), total nitrogen (TN), and total phosphorus (TP) by 16.0%, 16.2%, and 20.4%, respectively. Additionally, our results show that the shadow price of TN increased rapidly and continuously, while that of COD and TP fluctuated for the whole period. For the whole country, the average shadow price of COD, TN, and TP are 8266 Yuan/tonne, 25,560 Yuan/tonne, and 10,160 Yuan/tonne, respectively. The regional shadow prices of agricultural pollutants are unbalanced. Furthermore, we show that the pollution costs from emissions of COD, TN, and TP are 6.09% of the annual gross output value of the agricultural sector and are highest in the Western and lowest in the Eastern provinces. Our estimates suggest that there is scope for further pollution abatement and simultaneous output expansion for China's agriculture if farmers promote greater efficiency in their production process. Policymakers are required to dynamically adjust the pollution tax rates and ascertain the initial permit price in an emission trading system. Policymakers should also consider the different pollution costs for each province when making the reduction allocations within the agricultural sector. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Spacecraft COst REduction Team (SCORE): TQM/CI on a massive scale

    Science.gov (United States)

    Bullard, Jerry D.

    1992-01-01

    The business of building satellites and space systems has matured. Few missions require, or can afford, excellent performance at any price. The new paradigm is doing more with less, providing quality systems at lower cost--in other words, doing our job 'Faster-Better-Cheaper.' The TRW Spacecraft COst REduction (SCORE) initiative was launched in 1990 by Daniel S. Goldin, then general manager of TRW's Space & Technology Group. The SCORE mission is to apply continuous improvement (CI) techniques to effect major reductions in the cost (our primary goal) and span time (as a corollary) required for the production of spacecraft. SCORE is a multi-year initiative that is having a profound effect on both the procedural and the cultural aspects of how we do business. The objectives of this initiative are being realized. The focus of this paper is not on the results of SCORE per se, but rather on the things we have leaned about how to do continuous improvement on a massive scale, with multilevel (hierarchical) CI teams. The following sections summarize the chronology of the SCORE initiative, from team formation to development of the year-end report for 1991. Lessons learned, the core of this presentation, are discussed--with particular focus on the unique aspects of SCORE. The SCORE initiative is continuing and, as a part of our evolving culture, will never end. It has resulted in profound insights into the way we do work and (the topic at hand) how to do CI for large and complex multidisciplinary development activities.

  1. The importance of health co-benefits in macroeconomic assessments of UK Greenhouse Gas emission reduction strategies.

    Science.gov (United States)

    Jensen, Henning Tarp; Keogh-Brown, Marcus R; Smith, Richard D; Chalabi, Zaid; Dangour, Alan D; Davies, Mike; Edwards, Phil; Garnett, Tara; Givoni, Moshe; Griffiths, Ulla; Hamilton, Ian; Jarrett, James; Roberts, Ian; Wilkinson, Paul; Woodcock, James; Haines, Andy

    We employ a single-country dynamically-recursive Computable General Equilibrium model to make health-focussed macroeconomic assessments of three contingent UK Greenhouse Gas (GHG) mitigation strategies, designed to achieve 2030 emission targets as suggested by the UK Committee on Climate Change. In contrast to previous assessment studies, our main focus is on health co-benefits additional to those from reduced local air pollution. We employ a conservative cost-effectiveness methodology with a zero net cost threshold. Our urban transport strategy (with cleaner vehicles and increased active travel) brings important health co-benefits and is likely to be strongly cost-effective; our food and agriculture strategy (based on abatement technologies and reduction in livestock production) brings worthwhile health co-benefits, but is unlikely to eliminate net costs unless new technological measures are included; our household energy efficiency strategy is likely to breakeven only over the long term after the investment programme has ceased (beyond our 20 year time horizon). We conclude that UK policy makers will, most likely, have to adopt elements which involve initial net societal costs in order to achieve future emission targets and longer-term benefits from GHG reduction. Cost-effectiveness of GHG strategies is likely to require technological mitigation interventions and/or demand-constraining interventions with important health co-benefits and other efficiency-enhancing policies that promote internalization of externalities. Health co-benefits can play a crucial role in bringing down net costs, but our results also suggest the need for adopting holistic assessment methodologies which give proper consideration to welfare-improving health co-benefits with potentially negative economic repercussions (such as increased longevity).

  2. Modeling Fuel Treatment Leverage: Encounter Rates, Risk Reduction, and Suppression Cost Impacts

    Directory of Open Access Journals (Sweden)

    Matthew P. Thompson

    2017-11-01

    Full Text Available The primary theme of this study is the cost-effectiveness of fuel treatments at multiple scales of investment. We focused on the nexus of fuel management and suppression response planning, designing spatial fuel treatment strategies to incorporate landscape features that provide control opportunities that are relevant to fire operations. Our analysis explored the frequency and magnitude of fire-treatment encounters, which are critical determinants of treatment efficacy. Additionally, we examined avoided area burned, avoided suppression costs, and avoided damages, and combined all three under the umbrella of leverage to explore multiple dimensions with which to characterize return on investment. We chose the Sierra National Forest, California, USA, as our study site, due to previous work providing relevant data and analytical products, and because it has the potential for large, long-duration fires and corresponding potential for high suppression expenditures. Modeling results generally confirmed that fire-treatment encounters are rare, such that median suppression cost savings are zero, but in extreme years, savings can more than offset upfront investments. Further, reductions in risk can expand areas where moderated suppression response would be appropriate, and these areas can be mapped in relation to fire control opportunities.

  3. Ordering Cost Reduction in Inventory Model with Defective Items and Backorder Price Discount

    Directory of Open Access Journals (Sweden)

    Karuppuchamy Annadurai

    2014-01-01

    Full Text Available In the real market, as unsatisfied demands occur, the longer the length of lead time is, the smaller the proportion of backorder would be. In order to make up for the inconvenience and even the losses of royal and patient customers, the supplier may offer a backorder price discount to secure orders during the shortage period. Also, ordering policies determined by conventional inventory models may be inappropriate for the situation in which an arrival lot contains some defective items. To compensate for the inconvenience of backordering and to secure orders, the supplier may offer a price discount on the stockout item. The purpose of this study is to explore a coordinated inventory model including defective arrivals by allowing the backorder price discount and ordering cost as decision variables. There are two inventory models proposed in this paper, one with normally distributed demand and another with distribution free demand. A computer code using the software Matlab 7.0 is developed to find the optimal solution and present numerical examples to illustrate the models. The results in the numerical examples indicate that the savings of the total cost are realized through ordering cost reduction and backorder price discount.

  4. Health Impacts and Economic Costs of Air Pollution in the Metropolitan Area of Skopje

    DEFF Research Database (Denmark)

    Sanchez Martinez, Gerardo; Spadaro, Joseph V.; Chapizanis, Dimitris

    2018-01-01

    the burden of disease attributable to PM and calculated the societal cost due to attributable mortality. In 2012, long-term exposure to PM2.5 (49.2 μg/m³) caused an estimated 1199 premature deaths (CI95% 821-1519). The social cost of the predicted premature mortality in 2012 due to air pollution...... was estimated at between 570 and 1470 million euros. Moreover, PM2.5 was also estimated to be responsible for 547 hospital admissions (CI95% 104-977) from cardiovascular diseases, and 937 admissions (CI95% 937-1869) for respiratory disease that year. Reducing PM2.5 levels to the EU limit (25 μg/m³) could have....... Besides its health impacts in terms of increased premature mortality and hospitalizations, air pollution entails significant economic costs to the population of Skopje. Reductions in PM2.5 concentrations could provide substantial health and economic gains to the city....

  5. Managing health care costs: strategies available to small businesses.

    Science.gov (United States)

    Higgins, C W; Finley, L; Kinard, J

    1990-07-01

    Although health care costs continue to rise at an alarming rate, small businesses can take steps to help moderate these costs. First, business firms must restructure benefits so that needless surgery is eliminated and inpatient hospital care is minimized. Next, small firms should investigate the feasibility of partial self-insurance options such as risk pooling and purchasing preferred premium plans. Finally, small firms should investigate the cost savings that can be realized through the use of alternative health care delivery systems such as HMOs and PPOs. Today, competition is reshaping the health care industry by creating more options and rewarding efficiency. The prospect of steadily rising prices and more choices makes it essential that small employers become prudent purchasers of employee health benefits. For American businesses, the issue is crucial. Unless firms can control health care costs, they will have to keep boosting the prices of their goods and services and thus become less competitive in the global marketplace. In that event, many workers will face a prospect even more grim than rising medical premiums: losing their jobs.

  6. Cost and waste volume reduction in HEPA filter trains by effective pre-filtration

    International Nuclear Information System (INIS)

    Chadwick, Chris

    2007-01-01

    Data published elsewhere (Moore, et al., 1992; Bergman et al., 1997) suggests that the then costs of disposable type Glass Fibre HEPA filtration trains to the DOE was $55 million per year (based on an average usage of HEPA panels of 11,748 pieces per year between 1987 and 1990), $50 million of which was attributable to installation, testing, removal and disposal. The same authors suggest that by 1995 the number of HEPA panels being used had dropped to an estimated 4000 pieces per year due to the ending of the Cold War. The yearly cost to the DOE of 4000 units per year was estimated to be $29.5 million using the same parameters that previously suggested the $55 million figure. Within that cost estimate, $300 each was the value given to the filter and $4,450 was given to peripheral activity per filter. Clearly, if the $4,450 component could be reduced, tremendous saving could result, in addition to a significant reduction in the legacy burden of waste volumes. This same cost is applied to both the 11,748 and 4000 usage figures. The work up to now has focussed on the development of a low cost, long life (cleanable), direct replacement of the traditional filter train. This paper will review an alternative strategy, that of preventing the contaminating dust from reaching and blinding the HEPA filters, and thereby removing the need to replace them. What has become clear is that 'low cost' and 'Metallic HEPA' are not compatible terms. The original Bergman et al., 1997 work suggested that 1000 cfm (cubic feet per minute) (1690 m 3 /hr) stainless HEPAs could be commercially available for $5000 each after development (although the $70,000 development unit may be somewhat exaggerated - the authors own company have estimated development units able to be retrofitted into strengthened standard housings would be available for perhaps $30,000). The likely true cost of such an item produced industrially in significant numbers may be closer to $15,000 each. That being the case, the

  7. To Your Health: NLM update transcript - U.S. health costs and care

    Science.gov (United States)

    ... https://medlineplus.gov/podcast/transcript052118.html To Your Health: NLM update Transcript U.S. health costs and care : 05/21/2018 To use ... is what's new this week in To Your Health, a consumer health-oriented podcast from NLM, that ...

  8. The economic cost of Alzheimer's disease: Family or public-health burden?

    Directory of Open Access Journals (Sweden)

    Diego M. Castro

    Full Text Available Abstract Alzheimer's disease (AD patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options.

  9. Risk management study for the Hanford Site facilities: Risk reduction cost comparison for the retired Hanford Site facilities

    International Nuclear Information System (INIS)

    Coles, G.A.; Egge, R.G.; Senger, E.; Shultz, M.W.; Taylor, W.E.

    1994-02-01

    This document provides a cost-comparison evaluation for implementing certain risk-reduction measures and their effect on the overall risk of the 100 and 200 Area retired, surplus facilities. The evaluation is based on conditions that existed at the time the risk evaluation team performed facility investigations, and does not acknowledge risk-reduction measures that occurred soon after risk identification. This evaluation is one part of an overall risk management study for these facilities. The retired facilities investigated for this evaluation are located in the 100 and 200 Areas of the 1450-km 2 Hanford Site. The Hanford Site is a semiarid tract of land in southeastern Washington State. The nearest population center is Richland, Washington, (population 32,000) 30 km southeast of the 200 Area. This cost-comparison evaluation (1) determines relative costs for reducing risk to acceptable levels; (2) compares the cost of reducing risk using different risk-reduction options; and (3) compares the cost of reducing risks at different facilities. The result is an identification of the cost effective risk-reduction measures. Supporting information required to develop costs of the various risk-reduction options also is included

  10. Risk management study for the Hanford Site facilities: Risk reduction cost comparison for the retired Hanford Site facilities. Volume 4

    Energy Technology Data Exchange (ETDEWEB)

    Coles, G.A.; Egge, R.G.; Senger, E.; Shultz, M.W.; Taylor, W.E.

    1994-02-01

    This document provides a cost-comparison evaluation for implementing certain risk-reduction measures and their effect on the overall risk of the 100 and 200 Area retired, surplus facilities. The evaluation is based on conditions that existed at the time the risk evaluation team performed facility investigations, and does not acknowledge risk-reduction measures that occurred soon after risk identification. This evaluation is one part of an overall risk management study for these facilities. The retired facilities investigated for this evaluation are located in the 100 and 200 Areas of the 1450-km{sup 2} Hanford Site. The Hanford Site is a semiarid tract of land in southeastern Washington State. The nearest population center is Richland, Washington, (population 32,000) 30 km southeast of the 200 Area. This cost-comparison evaluation (1) determines relative costs for reducing risk to acceptable levels; (2) compares the cost of reducing risk using different risk-reduction options; and (3) compares the cost of reducing risks at different facilities. The result is an identification of the cost effective risk-reduction measures. Supporting information required to develop costs of the various risk-reduction options also is included.

  11. Activity-based costing of health-care delivery, Haiti.

    Science.gov (United States)

    McBain, Ryan K; Jerome, Gregory; Leandre, Fernet; Browning, Micaela; Warsh, Jonathan; Shah, Mahek; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Gottlieb, Gary; Rhatigan, Joseph; Kaplan, Robert

    2018-01-01

    To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient's medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated.

  12. Reducing Health Cost: Health Informatics and Knowledge Management as a Business and Communication Tool

    Science.gov (United States)

    Gyampoh-Vidogah, Regina; Moreton, Robert; Sallah, David

    Health informatics has the potential to improve the quality and provision of care while reducing the cost of health care delivery. However, health informatics is often falsely regarded as synonymous with information management (IM). This chapter (i) provides a clear definition and characteristic benefits of health informatics and information management in the context of health care delivery, (ii) identifies and explains the difference between health informatics (HI) and managing knowledge (KM) in relation to informatics business strategy and (iii) elaborates the role of information communication technology (ICT) KM environment. This Chapter further examines how KM can be used to improve health service informatics costs, and identifies the factors that could affect its implementation and explains some of the reasons driving the development of electronic health record systems. This will assist in avoiding higher costs and errors, while promoting the continued industrialisation of KM delivery across health care communities.

  13. Cost of Tuberculosis Treatment: Evidence from Iran's Health System.

    Science.gov (United States)

    Bay, Vahid; Tabarsi, Payam; Rezapour, Aziz; Marzban, Sima; Zarei, Ehsan

    2017-10-01

    This study aimed to estimate the cost of smear-positive drug-susceptible pulmonary tuberculosis (TB) treatment of the patients in the Azadshahr district, Golestan Province, Iran. In this retrospective study, all new smear positive pulmonary TB patients who had been registered at the district's health network between April, 2013 and December, 2015 and had successfully completed their treatment were entered into the study (45 patients). Treatment costs were estimated from the provider's perspective using an activity-based costing (ABC) method. The cost of treating a new smear-positive pulmonary TB patient was US dollar (USD) 1,409.00 (Iranian Rial, 39,438,260), which can be divided into direct and indirect costs (USD 1,226.00 [87%] and USD 183.00 [13%], respectively). The highest cost (58.1%) was related to care and management of TB patients (including 46.1% human resources costs and 12% directly-observed treatment, short course implementation) and then respectively related to hospitalization (12.1%), supportive activity centers (11.4%), transportation (6.5%), medicines (5.3%), and laboratory tests and radiography (3.2%). Using disease-specific cost studies can help the healthcare system management to have correct insight into the financial burden created by the disease. This can subsequently be used in prioritization, planning, operational budgeting, economic evaluation of programs, interventions, and ultimately in disease management.

  14. Effect of improved glycemic control on health care costs and utilization.

    Science.gov (United States)

    Wagner, E H; Sandhu, N; Newton, K M; McCulloch, D K; Ramsey, S D; Grothaus, L C

    2001-01-10

    Because of the additional costs associated with improving diabetes management, there is interest in whether improved glycemic control leads to reductions in health care costs, and, if so, when such cost savings occur. To determine whether sustained improvements in hemoglobin A(1c) (HbA(1c)) levels among diabetic patients are followed by reductions in health care utilization and costs. Historical cohort study conducted in 1992-1997 in a staff-model health maintenance organization (HMO) in western Washington State. All diabetic patients aged 18 years or older who were continuously enrolled between January 1992 and March 1996 and had HbA(1c) measured at least once per year in 1992-1994 (n = 4744). Patients whose HbA(1c) decreased 1% or more between 1992 and 1993 and sustained the decline through 1994 were considered to be improved (n = 732). All others were classified as unimproved (n = 4012). Total health care costs, percentage hospitalized, and number of primary care and specialty visits among the improved vs unimproved cohorts in 1992-1997. Diabetic patients whose HbA(1c) measurements improved were similar demographically to those whose levels did not improve but had higher baseline HbA(1c) measurements (10.0% vs 7.7%; Pcosts were $685 to $950 less each year in the improved cohort for 1994 (P =.09), 1995 (P =.003), 1996 (P =.002), and 1997 (P =.01). Cost savings in the improved cohort were statistically significant only among those with the highest baseline HbA(1c) levels (>/=10%) for these years but appeared to be unaffected by presence of complications at baseline. Beginning in the year following improvement (1994), utilization was consistently lower in the improved cohort, reaching statistical significance for primary care visits in 1994 (P =.001), 1995 (Pcost savings within 1 to 2 years of improvement.

  15. Has cost containment after the National Health Insurance system been successful? Determinants of Taiwan hospital costs.

    Science.gov (United States)

    Hung, Jung-Hua; Chang, Li

    2008-03-01

    Taiwan implemented the National Health Insurance system (NHI) in 1995. After the NHI, the insurance coverage expanded and the quality of healthcare improved, however, the healthcare costs significantly escalated. The objective of this study is to determine what factors have direct impact on the increased costs after the NHI. Panel data analysis is used to investigate changes and factors affecting cost containment at Taipei municipal hospitals from 1990 to 2001. The results show that the expansion of insured healthcare coverage (especially to the elderly and the treatment of more complicated types of diseases), and the increased competition (requiring the growth of new technology and the longer average length of stay) are important driving forces behind the increase of hospital costs, directly influenced by the advent of the NHI. Therefore, policymakers should emphasize health prevention activities and disease management programs for the elderly to improve cost containment. In addition, hospital managers should find ways to improve the hospital efficiency (shorten the LOS) to reduce excess services and medical waste. They also need to better understand their market position and acquire suitable new-tech equipment earlier, to be a leader, not a follower. Finally, policymakers should establish related benchmark indices for what drivers up hospital costs (micro-aspect) and to control healthcare expenditures (macro-level).

  16. Views of US physicians about controlling health care costs.

    Science.gov (United States)

    Tilburt, Jon C; Wynia, Matthew K; Sheeler, Robert D; Thorsteinsdottir, Bjorg; James, Katherine M; Egginton, Jason S; Liebow, Mark; Hurst, Samia; Danis, Marion; Goold, Susan Dorr

    2013-07-24

    Physicians' views about health care costs are germane to pending policy reforms. To assess physicians' attitudes toward and perceived role in addressing health care costs. A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile. Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale. A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a "major responsibility" for reducing health care costs, whereas only 36% reported that practicing physicians have "major responsibility." Most were "very enthusiastic" for "promoting continuity of care" (75%), "expanding access to quality and safety data" (51%), and "limiting access to expensive treatments with little net benefit" (51%) as a means of reducing health care costs. Few expressed enthusiasm for "eliminating fee-for-service payment models" (7%). Most physicians reported being "aware of the costs of the tests/treatments [they] recommend" (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they "should be solely devoted to individual patients' best interests, even if that is expensive" (78%) and that "doctors need to take a more prominent role in limiting use of unnecessary tests" (89%). Most (85%) disagreed that they "should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more." In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for "eliminating fee for service" (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1

  17. The cost effectiveness of NHS physiotherapy support for occupational health (OH) services.

    Science.gov (United States)

    Phillips, Ceri J; Phillips Nee Buck, Rhiannon; Main, Chris J; Watson, Paul J; Davies, Shân; Farr, Angela; Harper, Christie; Noble, Gareth; Aylward, Mansel; Packman, Julie; Downton, Matt; Hale, Janine

    2012-02-23

    Musculoskeletal pain is detrimental to quality of life (QOL) and disruptive to activities of daily living. It also places a major economic burden on healthcare systems and wider society. In 2006, the Welsh Assembly Government (WAG) established a three tiered self-referral Occupational Health Physiotherapy Pilot Project (OHPPP) comprising: 1.) telephone advice and triage, 2.) face-to-face physiotherapy assessment and treatment if required, and 3.) workplace assessment and a return-to-work facilitation package as appropriate. This study aimed to evaluate the feasibility and cost-effectiveness of the pilot service. A pragmatic cohort study was undertaken, with all OHPPP service users between September 2008 and February 2009 being invited to participate. Participants were assessed on clinical status, yellow flags, sickness absence and work performance at baseline, after treatment and at 3 month follow up. Cost-effectiveness was evaluated from both top-down and bottom-up perspectives and cost per Quality Adjusted Life Year (cost/QALY) was calculated. The cost-effectiveness analysis assessed the increase in service cost that would be necessary before the cost-effectiveness of the service was compromised. A total of 515 patients completed questionnaires at baseline. Of these, 486 were referred for face to face assessment with a physiotherapist and were included in the analysis for the current study. 264 (54.3%) and 199 (40.9%) were retained at end of treatment and 3 month follow up respectively. An improvement was observed at follow up in all the clinical outcomes assessed, as well as a reduction in healthcare resource usage and sickness absence, and improvement in self-reported work performance. Multivariate regression indicated that baseline and current physical health were associated with work-related outcomes at follow up. The costs of the service were £194-£360 per service user depending on the method used, and the health gains contributed to a cost/QALY of £1386

  18. 48 CFR 1615.407-1 - Rate reduction for defective pricing or defective cost or pricing data.

    Science.gov (United States)

    2010-10-01

    ... defective pricing or defective cost or pricing data. 1615.407-1 Section 1615.407-1 Federal Acquisition... CONTRACTING METHODS AND CONTRACT TYPES CONTRACTING BY NEGOTIATION Contract Pricing 1615.407-1 Rate reduction for defective pricing or defective cost or pricing data. The clause set forth in section 1652.215-70...

  19. 48 CFR 1652.215-70 - Rate Reduction for Defective Pricing or Defective Cost or Pricing Data.

    Science.gov (United States)

    2010-10-01

    ... Defective Pricing or Defective Cost or Pricing Data. 1652.215-70 Section 1652.215-70 Federal Acquisition... CLAUSES AND FORMS CONTRACT CLAUSES Texts of FEHBP Clauses 1652.215-70 Rate Reduction for Defective Pricing or Defective Cost or Pricing Data. As prescribed in 1615.407-1, the following clause shall be...

  20. Links between social environment and health care utilization and costs.

    Science.gov (United States)

    Brault, Marie A; Brewster, Amanda L; Bradley, Elizabeth H; Keene, Danya; Tan, Annabel X; Curry, Leslie A

    2018-01-01

    The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.

  1. Climate change and health costs of air emissions from biofuels and gasoline

    Science.gov (United States)

    Hill, Jason; Polasky, Stephen; Nelson, Erik; Tilman, David; Huo, Hong; Ludwig, Lindsay; Neumann, James; Zheng, Haochi; Bonta, Diego

    2009-01-01

    Environmental impacts of energy use can impose large costs on society. We quantify and monetize the life-cycle climate-change and health effects of greenhouse gas (GHG) and fine particulate matter (PM2.5) emissions from gasoline, corn ethanol, and cellulosic ethanol. For each billion ethanol-equivalent gallons of fuel produced and combusted in the US, the combined climate-change and health costs are $469 million for gasoline, $472–952 million for corn ethanol depending on biorefinery heat source (natural gas, corn stover, or coal) and technology, but only $123–208 million for cellulosic ethanol depending on feedstock (prairie biomass, Miscanthus, corn stover, or switchgrass). Moreover, a geographically explicit life-cycle analysis that tracks PM2.5 emissions and exposure relative to U.S. population shows regional shifts in health costs dependent on fuel production systems. Because cellulosic ethanol can offer health benefits from PM2.5 reduction that are of comparable importance to its climate-change benefits from GHG reduction, a shift from gasoline to cellulosic ethanol has greater advantages than previously recognized. These advantages are critically dependent on the source of land used to produce biomass for biofuels, on the magnitude of any indirect land use that may result, and on other as yet unmeasured environmental impacts of biofuels. PMID:19188587

  2. Modeled effects of an improved building insulation scenario in Europe on air pollution, health and societal costs

    DEFF Research Database (Denmark)

    Bønløkke, Jakob Hjort; Holst, Gitte Juel; Sigsgaard, Torben

    2015-01-01

    scenario in Europe would have substantial benefits on health through improvements in air pollution. Health effects and societal cost savings may significantly counterbalance investment costs and should be taken into account when evaluating strategies for mitigation of global warming....... with extensions. Mean annual changes in the main air pollutants were derived for each country. World Health Organization (WHO) and European Union (EU) data on populations and on impacts of pollutants were used to derive health effects and costs. Effects on indoor air quality were not assessed. Results: Projected...... 78678 LY in Europe. A total of 7173 cases of persistent chronic bronchitis could be avoided annually. Several other health outcomes improved similarly. The saved societal costs totaled 6.64 billion € annually. Conclusions: In addition to carbon emission reductions, an improved building insulation...

  3. The Correlation of a Corporate Culture of Health Assessment Score and Health Care Cost Trend.

    Science.gov (United States)

    Fabius, Raymond; Frazee, Sharon Glave; Thayer, Dixon; Kirshenbaum, David; Reynolds, Jim

    2018-02-19

    Employers that strive to create a corporate environment that fosters a culture of health often face challenges when trying to determine the impact of improvements on health care cost trends. This study aims to test the stability of the correlation between health care cost trend and corporate health assessment scores (CHAS) using a culture of health measurement tool. Correlation analysis of annual health care cost trend and CHAS on a small group of employers using a proprietary CHAS tool. Higher CHAS scores are generally correlated with lower health care cost trend. For employers with several years of CHAS measurements, this correlation remains, although imperfectly. As culture of health scores improve, health care costs trends moderate. These findings provide further evidence of the inverse relationship between organizational CHAS performance and health care cost trend.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0.

  4. Investments and costs of oral health care for Family Health Care

    Directory of Open Access Journals (Sweden)

    Márcia Stefânia Ribeiro Macêdo

    2016-01-01

    Full Text Available ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities, besides the indirect fixed costs (cleaning, security, energy, and water. The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76. The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82 a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding

  5. Investments and costs of oral health care for Family Health Care

    Science.gov (United States)

    Macêdo, Márcia Stefânia Ribeiro; Chaves, Sônia Cristina Lima; Fernandes, Antônio Luis de Carvalho

    2016-01-01

    ABSTRACT OBJECTIVE To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. METHODS This is an economic assessment study, for analyzing the investments and operational costs of an oral health care team in the city of Salvador, BA, Northeastern Brazil. The amount worth of investments for its implementation was obtained by summing up the investments in civil projects and shared facilities, in equipments, furniture, and instruments. Regarding the operational costs, the 2009-2012 time series was analyzed and the month of December 2012 was adopted for assessing the monetary values in effect. The costs were classified as direct variable costs (consumables) and direct fixed costs (salaries, maintenance, equipment depreciation, instruments, furniture, and facilities), besides the indirect fixed costs (cleaning, security, energy, and water). The Ministry of Health’s share in funding was also calculated, and the factors that influence cost behavior were described. RESULTS The investment to implement a type I Oral Health Care Team was R$29,864.00 (US$15,236.76). The operational costs of a type I Oral Health Care Team were around R$95,434.00 (US$48,690.82) a year. The Ministry of Health’s financial incentives for investments accounted for 41.8% of the implementation investments, whereas the municipality contributed with a 59.2% share of the total. Regarding operational costs, the Ministry of Health contributed with 33.1% of the total, whereas the municipality, with 66.9%. Concerning the operational costs, the element of heaviest weight was salaries, which accounted for 84.7%. CONCLUSIONS Problems with the regularity in the supply of inputs and maintenance of equipment greatly influence the composition of costs, besides reducing the supply of services to the target population, which results in the service probably being inefficient. States are suggested to partake in funding, especially to cover the

  6. Strategies for cost-effective carbon reductions: A sensitivity analysis of alternative scenarios

    International Nuclear Information System (INIS)

    Gumerman, Etan; Koomey, Jonathan G.; Brown, Marilyn

    2001-01-01

    Analyses of alternative futures often present results for a limited set of scenarios, with little if any sensitivity analysis to identify the factors affecting the scenario results. This approach creates an artificial impression of certainty associated with the scenarios considered, and inhibits understanding of the underlying forces. This paper summarizes the economic and carbon savings sensitivity analysis completed for the Scenarios for a Clean Energy Future study (IWG, 2000). Its 19 sensitivity cases provide insight into the costs and carbon-reduction impacts of a carbon permit trading system, demand-side efficiency programs, and supply-side policies. Impacts under different natural gas and oil price trajectories are also examined. The results provide compelling evidence that policy opportunities exist to reduce carbon emissions and save society money

  7. Examples for cost reduction in the design of a WWER-1000 nuclear power plant

    International Nuclear Information System (INIS)

    Kukkola, T.

    1991-01-01

    In a design project during recent years, a version for Finnish conditions has been and is being developed based on the Soviet WWER-1000 PWR plant with four horizontal steam generators. The plant will have a double containment. The inner containment will be a dry full pressure prestressed concrete containment with liner and the secondary containment will be made of ordinary concrete. Four train safety approach is adopted. It is supposed that the plant is to be designed according to the present Finnish safety requirements, e.g. severe reactor accidents are considered. When striving at an economic plant no compromises are made as far as safety is concerned. This paper describes possible cost reduction by redesigning the main technical equipment. (author). 1 ref

  8. Cost reduction and safety design features of ABWR-II. Annex 5

    International Nuclear Information System (INIS)

    Koh, F.; Moriya, K.; Anegawa, T.

    2002-01-01

    The ABWR-II, which is aimed to be the next generation reactor following the latest BWR: Advanced Boiling Reactor (ABWR), is now under development jointly by the Japanese BWR utilities, General Electric Company, Hitachi Limited, and Toshiba Corporation. The key objectives of ABWR-II development include improvement in economics and further sophistication in safety for commercialization in the late 2010's and after. This paper summarizes the current status of ABWR-II development focusing on economics and safety. Plant power rating, fuel size, CRD rationalization and outage period are discussed from a cost reduction perspective. In terms of safety, the features such as diversification in emergency power sources and passive system application against severe accidents are being introduced. (author)

  9. Coupling of CORINAIR Data to Cost-effective Emission Reduction Strategies Based on Critical Thresholds

    International Nuclear Information System (INIS)

    Johansson, M.; Guardans, R.; Lindstrom, M.

    1999-12-01

    This report summarizes the results of a workshop held by the participants in the EU/LIFE project: Coupling of CORINAIR data to cost-effective emission reduction strategies based on critical thresholds. The project participants include FEI, Filand, NERI, Denmark, CIEMAT, Spain, Lund Univ. Sweden. EMEP/MSC-W, UN/ECE/WGE/CCE and IIASA. The main objective of the project is to support national activities in assessing the spatial and temporal details of emissions of sulphur, nitrogen oxides, ammonium and volatile organic compounds and the impacts of acidification, eutrophication and ground level ozone. The reproject workshop enabled participants to report preliminary results of the two main tasks, emissions and impacts and to agree on common solutions for the final results. (Author) 11 refs

  10. Cost-effectiveness analysis of computerized ECG interpretation system in an ambulatory health care organization.

    Science.gov (United States)

    Carel, R S

    1982-04-01

    The cost-effectiveness of a computerized ECG interpretation system in an ambulatory health care organization has been evaluated in comparison with a conventional (manual) system. The automated system was shown to be more cost-effective at a minimum load of 2,500 patients/month. At larger monthly loads an even greater cost-effectiveness was found, the average cost/ECG being about $2. In the manual system the cost/unit is practically independent of patient load. This is primarily due to the fact that 87% of the cost/ECG is attributable to wages and fees of highly trained personnel. In the automated system, on the other hand, the cost/ECG is heavily dependent on examinee load. This is due to the relatively large impact of equipment depreciation on fixed (and total) cost. Utilization of a computer-assisted system leads to marked reduction in cardiologists' interpretation time, substantially shorter turnaround time (of unconfirmed reports), and potential provision of simultaneous service at several remotely located "heart stations."

  11. [Harmful alcohol consumption: prevalence, trends, health burden, reduction strategy].

    Science.gov (United States)

    Грузева, Татьяна С; Дуфинец, Василий А; Замкевич, Виктория Б

    2016-01-01

    Harmful alcohol consumption constitutes a significant cause of the global burden of disease, causing more than 200 different diseases, 5.9% of all deaths worldwide, causing substantial medical and social costs, major economic loss, slowing progress towards the strategic goals of human development. to substantiate approaches to the formation of a national strategy to combat the harmful use of alcohol in Ukraine based on the analysis of the prevalence of alcohol consumption and related health and social problems and international experience and recommendations of WHO. The study was based on analysis of the extent and patterns of alcohol consumption in Ukraine, levels, structure and dynamics of morbidity and mortality from diseases associated with alcohol abuse; investigation of preventive activities in primary healthcare, the existing problems and doctors' needs for prevention alcohol abuse, national and international experience on this problem.This work usesbibliosemantic, medical, statistical, sociological, epidemiological methods. The information base are: European Health for All Database (HFA-DB)for 2000-2012,Center of Medical Statistics, Ministry of Health of Ukraine for 2000-2015, questionnaire survey of physicians in primary care, strategic and policy documents of WHO, WHO Regional Office for Europe. In Ukraine, as in most countries in the WHO European Region prevalence of alcohol is high. In the ranking of the WHO European Region Ukraine ranks fifth in alcohol consumption per capita. The structure of consumption of alcoholic drinks is dominated by strong spirits (48%). There has been a negative trend for this indicator from 5.4 liters in 2002 to 15.6 liters in 2012.The dominant pattern of alcohol consumption is characterized by early onset of alcohol consumption, significant frequency, large doses, mostly strong alcohol beverages, with significant share of low-quality alcohol. This factor contributes to high levels of morbidity. A total of546.3 thousandpeople

  12. Marginal cost curves for water footprint reduction in irrigated agriculture : Guiding a cost-effective reduction of crop water consumption to a permit or benchmark level

    NARCIS (Netherlands)

    Chukalla, Abebe D.; Krol, Maarten S.; Hoekstra, Arjen Y.

    2017-01-01

    Reducing the water footprint (WF) of the process of growing irrigated crops is an indispensable element in water management, particularly in water-scarce areas. To achieve this, information on marginal cost curves (MCCs) that rank management packages according to their cost-effectiveness to reduce

  13. Cost reduction in the production process using the ABC and Lean tools: Case Study in the refrigeration components industry

    Directory of Open Access Journals (Sweden)

    Levi da Silva Guimarães

    2015-03-01

    Full Text Available This paper focuses on production management with respect to operating costs that relate directly to the value of the product. For this study, three methods were used, ABC - Activity Based Costing, which provides accurate information about the knowledge of the real costs, VSM - Value Stream Mapping and Lean Manufacturing. The method adopted for this research was the case study. The study was conducted at a refrigeration components company in the Industrial Center of Manaus. The analyses and observations initially went through the process of mapping the value stream, measuring the current state of activities (cycle time, setup, etc.. After analysis it was possible to map the cost for each activity and finally calculate the cost of the product before and after the improvements resulting from the lean methodology. The results obtained in this study showed a 20% reduction in product costs resulting from operational improvements. The activity-based cost led to a discovery of the real costs of waste. The steps for this study include process mapping through the value stream, measuring the current state of activities (cycle time, setup, etc., establishing the cost driver for each activity, and finally calculating the cost of the product before and after the application of lean improvements. The paper was conducted through literature and descriptive review, and used a case study method. It describes the model that has been tested in a production line for a refrigeration components company from the Manaus Industrial Center, achieving a 20% reduction in product cost.

  14. 'EPRI tailored collaboration 2, Crystal River cost and volume reduction program'

    International Nuclear Information System (INIS)

    Genoa, P.H.

    1995-01-01

    During the fall of 1993. Florida Power Corporation joined the EPRI tailored collaboration on the low-level radioactive waste cost and volume reduction. In conjunction with an existing Radwaste Task Force, the EPRI team reviewed past and current waste management practices and developed a prioritized list of opportunities for improvement. In the first quarter of 1994, these opportunities were converted into Action Plans with responsibilities and due dates assigned to support a 60-day refueling outage beginning on April 7, 1994. The Action Plans focussed on: (1) Visible management support in the form of specific plant, department, and worker level radwaste reduction goals. (2) Heightened worker awareness in the form of training (formal and informal), signs, bulletins, and a radwaste awareness video. (3) Material changes from disposable to recyclables, non-incinerables to incinerables, liquid waste processing media replacements and filter use criteria. (4) Work practice changes to reduce valve leaks, reduce contaminated areas, reduce entries to contaminated areas, further segregation of waste streams including 'green is clean' wastes

  15. Tweedie distributions for fitting semicontinuous health care utilization cost data

    Directory of Open Access Journals (Sweden)

    Christoph F. Kurz

    2017-12-01

    Full Text Available Abstract Background The statistical analysis of health care cost data is often problematic because these data are usually non-negative, right-skewed and have excess zeros for non-users. This prevents the use of linear models based on the Gaussian or Gamma distribution. A common way to counter this is the use of Two-part or Tobit models, which makes interpretation of the results more difficult. In this study, I explore a statistical distribution from the Tweedie family of distributions that can simultaneously model the probability of zero outcome, i.e. of being a non-user of health care utilization and continuous costs for users. Methods I assess the usefulness of the Tweedie model in a Monte Carlo simulation study that addresses two common situations of low and high correlation of the users and the non-users of health care utilization. Furthermore, I compare the Tweedie model with several other models using a real data set from the RAND health insurance experiment. Results I show that the Tweedie distribution fits cost data very well and provides better fit, especially when the number of non-users is low and the correlation between users and non-users is high. Conclusion The Tweedie distribution provides an interesting solution to many statistical problems in health economic analyses.

  16. Improving health care costing with resource consumption accounting.

    Science.gov (United States)

    Ozyapici, Hasan; Tanis, Veyis Naci

    2016-07-11

    Purpose - The purpose of this paper is to explore the differences between a traditional costing system (TCS) and resource consumption accounting (RCA) based on a case study carried out in a hospital. Design/methodology/approach - A descriptive case study was first carried out to identify the current costing system of the case hospital. An exploratory case study was then conducted to reveal how implementing RCA within the case hospital assigns costs differently to gallbladder surgeries than the current costing system (i.e. a TCS). Findings - The study showed that, in contrast to a TCS, RCA considers the unused capacity, which is the difference between the work that can be performed based on current resources and the work that is actually being performed. Therefore, it assigns lower total costs to open and laparoscopic gallbladder surgeries. The study also showed that by separating costs into fixed and variable RCA allows managers to benefit from a pricing strategy based on the difference between the service's selling price and variable costs incurred in providing that service. Research limitations/implications - The limitation of this study is that, because of time constraints, the implementation was performed in the general surgery department only. However, since RCA is an advanced system that has the same application procedures for any department inside in a hospital, managers need only time gaps to implement this system to all parts of the hospital. Practical implications - This study concluded that RCA is better than a TCS for use in health care settings that have high overhead costs because it accurately assigns overhead costs to services by considering unused capacities incurred by a hospital. Consequently, this study provides insight into both measuring and managing unused capacities within the health care sector. This study also concluded that RCA helps health care administrators increase their competitive advantage by allowing them to determine the lowest

  17. Development of an innovative PWR for low cost fuel recycle and waste reduction

    International Nuclear Information System (INIS)

    Kanagawa, Takashi; Onoue, Masaaki

    2001-01-01

    In order to bear long-term and stable energy supply, it is important for nuclear power generation to realize establishment of energy security controlling dependence on natural resources and reduction of long-life radioactive wastes such as minor actinide elements (MA) and so on. For this, establishment of fast breeder reproducible on its fuel and of fuel recycling is essential and construction of the fuel recycling capable of repeatedly recycling of plutonium (Pu) and MA with low cost is required. Here were proposed a fuel recycling system combining recycling type PWR with advanced recycling system under development for Na cooling fast breeder reactor as a candidate filling such conditions, to show its characteristics and effects after its introduction. By this system, some facilities to realize flexible and low cost fuel recycling, to reduce longer-life radioactive wastes due to recycling burning of Pu and MA, and to realize an electric power supplying system independent on natural resources due to fuel breeding feature, were shown. (G.K.)

  18. The Impact of Green Supply Chain Management on Transportation Cost Reduction in Turkey

    Directory of Open Access Journals (Sweden)

    Mehmet SARIDOGAN

    2012-01-01

    Full Text Available Supply chain management (SCM has become an important competitive approach for organizations. The issue of green supply chain management is critical for the successful implementation of industrial ecosystems and industrial ecology. Organizations have a number of reasons for implementing these green supply chain policies, from reactive regulatory reasons, to proactive strategic and competitive advantage reasons. From an overall environmental and organizational perspective, it is important to understand the situation and what issues exist in this field. Many organizations worldwide have already experienced globalization and a shifting focus to competition among networks of companies in this environment. Multinational enterprises have established global networks of suppliers that take advantage of country-industry specific characteristics to build this competitive advantage. To success having this competitive advantage, logistics and supply chain managers have to balance efforts to reduce costs and innovate while maintaining good environmental (ecological performance (Pagell et al., 2004. Therefore, today, competition is not between companies, between supply chains. This study brings us the effect of Green Supply Chain Management (GSCM on the Transportation Cost Reduction (TCR.

  19. Evaluating the CO 2 emissions reduction potential and cost of power sector re-dispatch

    Energy Technology Data Exchange (ETDEWEB)

    Steinberg, Daniel C.; Bielen, David A.; Townsend, Aaron

    2018-01-01

    Prior studies of the U.S. electricity sector have recognized the potential to reduce carbon dioxide (CO2) emissions by substituting generation from coal-fired units with generation from under-utilized and lower-emitting natural gas-fired units; in fact, this type of 're-dispatch' was invoked as one of the three building blocks used to set the emissions targets under the Environmental Protection Agency's Clean Power Plan. Despite the existence of surplus natural gas capacity in the U.S., power system operational constraints not often considered in power sector policy analyses, such as transmission congestion, generator ramping constraints, minimum generation constraints, planned and unplanned generator outages, and ancillary service requirements, could limit the potential and increase the cost of coal-to-gas re-dispatch. Using a highly detailed power system unit commitment and dispatch model, we estimate the maximum potential for re-dispatch in the Eastern Interconnection, which accounts for the majority of coal capacity and generation in the U.S. Under our reference assumptions, we find that maximizing coal-to-gas re-dispatch yields emissions reductions of 230 million metric tons (Mt), or 13% of power sector emissions in the Eastern Interconnection, with a corresponding average abatement cost of $15-$44 per metric ton of CO2, depending on the assumed supply elasticity of natural gas.

  20. Health, Health Inequality, and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand.

    Directory of Open Access Journals (Sweden)

    Tony Blakely

    2015-07-01

    Full Text Available Countries are increasingly considering how to reduce or even end tobacco consumption, and raising tobacco taxes is a potential strategy to achieve these goals. We estimated the impacts on health, health inequalities, and health system costs of ongoing tobacco tax increases (10% annually from 2011 to 2031, compared to no tax increases from 2011 ["business as usual," BAU], in a country (New Zealand with large ethnic inequalities in smoking-related and noncommunicable disease (NCD burden.We modeled 16 tobacco-related diseases in parallel, using rich national data by sex, age, and ethnicity, to estimate undiscounted quality-adjusted life-years (QALYs gained and net health system costs over the remaining life of the 2011 population (n = 4.4 million. A total of 260,000 (95% uncertainty interval [UI]: 155,000-419,000 QALYs were gained among the 2011 cohort exposed to annual tobacco tax increases, compared to BAU, and cost savings were US$2,550 million (95% UI: US$1,480 to US$4,000. QALY gains and cost savings took 50 y to peak, owing to such factors as the price sensitivity of youth and young adult smokers. The QALY gains per capita were 3.7 times greater for Māori (indigenous population compared to non-Māori because of higher background smoking prevalence and price sensitivity in Māori. Health inequalities measured by differences in 45+ y-old standardized mortality rates between Māori and non-Māori were projected to be 2.31% (95% UI: 1.49% to 3.41% less in 2041 with ongoing tax rises, compared to BAU. Percentage reductions in inequalities in 2041 were maximal for 45-64-y-old women (3.01%. As with all such modeling, there were limitations pertaining to the model structure and input parameters.Ongoing tobacco tax increases deliver sizeable health gains and health sector cost savings and are likely to reduce health inequalities. However, if policy makers are to achieve more rapid reductions in the NCD burden and health inequalities, they will also

  1. Health, Health Inequality, and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand

    Science.gov (United States)

    Blakely, Tony; Cobiac, Linda J.; Cleghorn, Christine L.; Pearson, Amber L.; van der Deen, Frederieke S.; Kvizhinadze, Giorgi; Nghiem, Nhung; McLeod, Melissa; Wilson, Nick

    2015-01-01

    Background Countries are increasingly considering how to reduce or even end tobacco consumption, and raising tobacco taxes is a potential strategy to achieve these goals. We estimated the impacts on health, health inequalities, and health system costs of ongoing tobacco tax increases (10% annually from 2011 to 2031, compared to no tax increases from 2011 [“business as usual,” BAU]), in a country (New Zealand) with large ethnic inequalities in smoking-related and noncommunicable disease (NCD) burden. Methods and Findings We modeled 16 tobacco-related diseases in parallel, using rich national data by sex, age, and ethnicity, to estimate undiscounted quality-adjusted life-years (QALYs) gained and net health system costs over the remaining life of the 2011 population (n = 4.4 million). A total of 260,000 (95% uncertainty interval [UI]: 155,000–419,000) QALYs were gained among the 2011 cohort exposed to annual tobacco tax increases, compared to BAU, and cost savings were US$2,550 million (95% UI: US$1,480 to US$4,000). QALY gains and cost savings took 50 y to peak, owing to such factors as the price sensitivity of youth and young adult smokers. The QALY gains per capita were 3.7 times greater for Māori (indigenous population) compared to non-Māori because of higher background smoking prevalence and price sensitivity in Māori. Health inequalities measured by differences in 45+ y-old standardized mortality rates between Māori and non-Māori were projected to be 2.31% (95% UI: 1.49% to 3.41%) less in 2041 with ongoing tax rises, compared to BAU. Percentage reductions in inequalities in 2041 were maximal for 45–64-y-old women (3.01%). As with all such modeling, there were limitations pertaining to the model structure and input parameters. Conclusions Ongoing tobacco tax increases deliver sizeable health gains and health sector cost savings and are likely to reduce health inequalities. However, if policy makers are to achieve more rapid reductions in the NCD

  2. Thermoecological cost of electricity production in the natural gas pressure reduction process

    International Nuclear Information System (INIS)

    Kostowski, Wojciech J.; Usón, Sergio; Stanek, Wojciech; Bargiel, Paweł

    2014-01-01

    The paper presents a novel concept for thermodynamic evaluation of a selected energy system. The presented method has been developed by integration of the Thermo-Economic Analysis with the theory of Thermo-Ecological Cost. It can be applied as a thermodynamic evaluation method of rational resources management within any production system. It takes into account both the interrelation of irreversibility within the analyzed system and its influence on the global effects related to the depletion of non-renewable natural resources. The proposed method has been applied to evaluate the production of electricity in the process of natural gas transmission at pressure reduction stations. The expansion system is based on an existing plant integrated with a CHP module, characterized by a performance ratio of 89.5% and exergy efficiency of 49.2%. Within the paper, this expansion plant is supplied with natural gas transported from a natural deposit through a case-study transmission system with 4 compressor stations. The TEC (thermoecological cost) method was applied in conjunction with thermoeconomic analysis. As a result, TEC of the electricity generated in the expanders was determined at 2.42 kJ/kJ, TEC of electricity from the CHP module is 1.77, and the TEC of medium-pressure natural gas distributed to consumers is 1.022. - Highlights: • The chain of NG transmission with an exergy recovery expansion plant was analyzed. • New methodology coupling the TEC (thermoecological cost) and thermoeconomics. • Decomposition of the TEC formation process. • Case-study transmission system yields TEC of natural gas = 1.0222. • Expansion plant yields TEC of electricity 2.42 (expanders) and 1.77 (CHP module)

  3. Solar Energy Technology Office Portfolio Review: Promotion of PV Soft Cost Reductions in the Southeastern US

    Energy Technology Data Exchange (ETDEWEB)

    Fox, E. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2017-12-20

    From 2016-2021, the installed solar capacity in South Carolina will mushroom from less than 20 megawatts to more than 300 megawatts. Concurrently, the number of customer-sited, load-centered solar generation is expected to grow from less than 500 statewide to as many as 10,000 by 2021. This growth is anticipated to be the direct result of a landmark state policy initiative, Act 236, passed by the South Carolina General Assembly and signed into law by the Governor in June of 2014. Local policy makers in South Carolina are ill-equipped to handle the onslaught of solar permitting and zoning requests expected over the next five years. Similarly, the state’s building inspectors, first responders, and tax assessors know little about photovoltaic (PV) technology and best practices. Finally, South Carolina’s workforce and workforce trainers are underprepared to benefit from the tremendous opportunity created by the passage of Act 236. Each of these deficits in knowledge of and preparedness for solar PV translates into higher “soft costs” of installed solar PV in South Carolina. Currently, we estimate that the installed costs of residential rooftop solar are as much as 25 percent higher than the national average. The Savannah River National Laboratory (SRNL), together with almost a dozen electricity stakeholders in the Southeast, proposes to create a replicable model for solar PV soft cost reduction in South Carolina through human capacity-building at the local level and direct efforts to harmonize policy at the inter-county or regional level. The primary goal of this effort is to close the gap between South Carolina installed costs of residential rooftop solar and national averages. The secondary goal is to develop a portable and replicable model that can be applied to other jurisdictions in the Southeastern US.

  4. Cost-of-illness analysis. What room in health economics?

    Science.gov (United States)

    Tarricone, Rosanna

    2006-06-01

    Cost-of-illness (COI) was the first economic evaluation technique used in the health field. The principal aim was to measure the economic burden of illness to society. Its usefulness as a decision-making tool has however been questioned since its inception. The main criticism came from welfare economists who rejected COIs because they were not grounded in welfare economics theory. Other attacks related to the use of the human capital approach (HCA) to evaluate morbidity and mortality costs since it was said that the HCA had nothing to do with the value people attach to their lives. Finally, objections were made that COI could not be of any help to decision makers and that other forms of economic evaluation (e.g. cost-effectiveness, cost-benefit analysis) would be much more useful to those taking decisions and ranking priorities. Conversely, it is here suggested that COI can be a good economic tool to inform decision makers if it is considered from another perspective. COI is a descriptive study that can provide information to support the political process as well as the management functions at different levels of the healthcare organisations. To do that, the design of the study must be innovative, capable of measuring the true cost to society; to estimate the main cost components and their incidence over total costs; to envisage the different subjects who bear the costs; to identify the actual clinical management of illness; and to explain cost variability. In order to reach these goals, COI need to be designed as observational bottom-up studies.

  5. Long-term, low-level radwaste volume-reduction strategies. Volume 4. Waste disposal costs. Final report

    International Nuclear Information System (INIS)

    Sutherland, A.A.; Adam, J.A.; Rogers, V.C.; Merrell, G.B.

    1984-11-01

    Volume 4 establishes pricing levels at new shallow land burial grounds. The following conclusions can be drawn from the analyses described in the preceding chapters: Application of volume reduction techniques by utilities can have a significant impact on the volumes of wastes going to low-level radioactive waste disposal sites. Using the relative waste stream volumes in NRC81 and the maximum volume reduction ratios provided by Burns and Roe, Inc., it was calculated that if all utilities use maximum volume reduction the rate of waste receipt at disposal sites will be reduced by 40 percent. When a disposal site receives a lower volume of waste its total cost of operation does not decrease by the same proportion. Therefore the average cost for a unit volume of waste received goes up. Whether the disposal site operator knows in advance that he will receive a smaller amount of waste has little influence on the average unit cost ($/ft) of the waste disposed. For the pricing algorithm postulated, the average disposal cost to utilities that volume reduce is relatively independent of whether all utilities practice volume reduction or only a few volume reduce. The general effect of volume reduction by utilities is to reduce their average disposal site costs by a factor of between 1.5 to 2.5. This factor is generally independent of the size of the disposal site. The largest absolute savings in disposal site costs when utilities volume reduce occurs when small disposal sites are involved. This results from the fact that unit costs are higher at small sites. Including in the pricing algorithm a factor that penalizes waste generators who contribute larger amounts of the mobile nuclides 3 H, 14 C, 99 Tc, and 129 I, which may be the subject of site inventory limits, lowers unit disposal costs for utility wastes that contain only small amounts of the nuclides and raises unit costs for other utility wastes

  6. Cost-Benefit Analysis of Green Infrastructures on Community Stormwater Reduction and Utilization: A Case of Beijing, China.

    Science.gov (United States)

    Liu, Wen; Chen, Weiping; Feng, Qi; Peng, Chi; Kang, Peng

    2016-12-01

    Cost-benefit analysis is demanded for guiding the plan, design and construction of green infrastructure practices in rapidly urbanized regions. We developed a framework to calculate the costs and benefits of different green infrastructures on stormwater reduction and utilization. A typical community of 54,783 m 2 in Beijing was selected for case study. For the four designed green infrastructure scenarios (green space depression, porous brick pavement, storage pond, and their combination), the average annual costs of green infrastructure facilities are ranged from 40.54 to 110.31 thousand yuan, and the average of the cost per m 3 stormwater reduction and utilization is 4.61 yuan. The total average annual benefits of stormwater reduction and utilization by green infrastructures of the community are ranged from 63.24 to 250.15 thousand yuan, and the benefit per m 3 stormwater reduction and utilization is ranged from 5.78 to 11.14 yuan. The average ratio of average annual benefit to cost of four green infrastructure facilities is 1.91. The integrated facilities had the highest economic feasibility with a benefit to cost ratio of 2.27, and followed by the storage pond construction with a benefit to cost ratio of 2.14. The results suggested that while the stormwater reduction and utilization by green infrastructures had higher construction and maintenance costs, their comprehensive benefits including source water replacements benefits, environmental benefits and avoided cost benefits are potentially interesting. The green infrastructure practices should be promoted for sustainable management of urban stormwater.

  7. Acute mental health care according to recent mental health legislation Part II. Activity-based costing.

    Science.gov (United States)

    Janse van Rensburg, A B; Jassat, W

    2011-03-01

    This is the second of three reports on the follow-up review of mental health care at Helen Joseph Hospital (HJH). Objectives for the review were to provide realistic estimates of cost for unit activities and to establish a quality assurance cycle that may facilitate cost centre management. The study described and used activity-based costing (ABC) as an approach to analyse the recurrent cost of acute in-patient care for the financial year 2007-08. Fixed (e.g. goods and services, staff salaries) and variable recurrent costs (including laboratory' 'pharmacy') were calculated. Cost per day, per user and per diagnostic group was calculated. While the unit accounted for 4.6% of the hospital's total clinical activity (patient days), the cost of R8.12 million incurred represented only 2.4% of the total hospital expenditure (R341.36 million). Fixed costs constituted 90% of the total cost. For the total number of 520 users that stayed on average 15.4 days, the average cost was R1,023.00 per day and R15748.00 per user. Users with schizophrenia accounted for the most (35%) of the cost, while the care of users with dementia was the most expensive (R23,360.68 per user). Costing of the application of World Health Organization norms for acute care staffing for the unit, projected an average increase of 103% in recurrent costs (R5.1 million), with the bulk (a 267% increase) for nursing. In the absence of other guidelines, aligning clinical activity with the proportion of the hospital's total budget may be an approach to determine what amount should be afforded to acute mental health in-patient care activities in a general regional hospital such as HJH. Despite the potential benefits of ABC, its continued application will require time, infrastructure and staff investment to establish the capacity to maintain routine annual cost analyses for different cost centres.

  8. Effect of laparoscopic surgery on health care utilization and costs in patients who undergo colectomy.

    Science.gov (United States)

    Crawshaw, Benjamin P; Chien, Hung-Lun; Augestad, Knut M; Delaney, Conor P

    2015-05-01

    an estimated 1.18-fold increase (95% CI, 1.04-1.35) in health care expenditures and an increase of 1.15 times (95% CI, 1.08-1.23) the number of health care utilization days compared with laparoscopy. Laparoscopic colectomy results in a significant reduction in health care costs and utilization in the short- and long-term postoperative periods.

  9. Productivity cost due to maternal ill health in Sri Lanka.

    Directory of Open Access Journals (Sweden)

    Suneth Agampodi

    Full Text Available BACKGROUND: The global impact of maternal ill health on economic productivity is estimated to be over 15 billion USD per year. Global data on productivity cost associated with maternal ill health are limited to estimations based on secondary data. Purpose of our study was to determine the productivity cost due to maternal ill health during pregnancy in Sri Lanka. METHODS AND FINDINGS: We studied 466 pregnant women, aged 24 to 36 weeks, residing in Anuradhapura, Sri Lanka. A two stage cluster sampling procedure was used in a cross sectional design and all pregnant women were interviewed at clinic centers, using the culturally adapted Immpact tool kit for productivity cost assessment. Of the 466 pregnant women studied, 421 (90.3% reported at least one ill health condition during the pregnancy period, and 353 (83.8% of them had conditions affecting their daily life. Total incapacitation requiring another person to carry out all their routine activities was reported by 122 (26.1% of the women. In this study sample, during the last episode of ill health, total number of days lost due to absenteeism was 3,356 (32.9% of total loss and the days lost due to presenteeism was 6,832.8 (67.1% of the total loss. Of the 353 women with ill health conditions affecting their daily life, 280 (60% had coping strategies to recover loss of productivity. Of the coping strategies used to recover productivity loss during maternal ill health, 76.8% (n = 215 was an intra-household adaptation, and 22.8% (n = 64 was through social networks. Loss of productivity was 28.9 days per episode of maternal ill health. The mean productivity cost due to last episode of ill health in this sample was Rs.8,444.26 (95% CI-Rs.6888.74-Rs.9999.78. CONCLUSIONS: Maternal ill health has a major impact on household productivity and economy. The major impact is due to, generally ignored minor ailments during pregnancy.

  10. Health impact and damage cost assessment of pesticides in Europe.

    Science.gov (United States)

    Fantke, Peter; Friedrich, Rainer; Jolliet, Olivier

    2012-11-15

    Health impacts from pesticide use are of continuous concern in the European population, requiring a constant evaluation of European pesticide policy. However, health impacts have never been quantified accounting for specific crops contributing differently to overall human exposure as well as accounting for individual substances showing distinct environmental behavior and toxicity. We quantify health impacts and related damage costs from exposure to 133 pesticides applied in 24 European countries in 2003 adding up to almost 50% of the total pesticide mass applied in that year. Only 13 substances applied to 3 crop classes (grapes/vines, fruit trees, vegetables) contribute to 90% of the overall health impacts of about 2000 disability-adjusted life years in Europe per year corresponding to annual damage costs of 78 million Euro. Considering uncertainties along the full impact pathway mainly attributable to non-cancer dose-response relationships and residues in treated crops, we obtain an average burden of lifetime lost per person of 2.6 hours (95% confidence interval between 22 seconds and 45.3 days) or costs per person over lifetime of 12 Euro (95% confidence interval between 0.03 Euro and 5142 Euro), respectively. 33 of the 133 assessed substances accounting for 20% of health impacts in 2003 are now banned from the European market according to current legislation. The main limitation in assessing human health impacts from pesticides is related to the lack of systematic application data for all used substances. Since health impacts can be substantially influenced by the choice of pesticides, the need for more information about substance application becomes evident. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Development of Manufacturing Technology to Accelerate Cost Reduction of Low Concentration and

    Energy Technology Data Exchange (ETDEWEB)

    Detrick, Adam [The Solaria Corporation, Fremont, CA (United States)

    2017-09-27

    The purpose of this project was to accelerate deployment of cost-effective US-based manufacturing of Solaria’s unique c-Si module technology. This effort successfully resulted in the development of US-based manufacturing technology to support two highly-differentiated, market leading product platforms. The project was initially predicated on developing Solaria’s low-concentration PV (LCPV) module technology which at the time of the award was uniquely positioned to exceed the SunShot price goal of $0.50/Wp for standard c-Si modules. The Solaria LCPV module is a 2.5x concentrator that leverages proven, high-reliability PV module materials and low silicon cell usage into a technology package that already had the lowest direct material cost and leading Levelized Cost of Electricity (LCOE). With over 25 MW commercially deployed globally, the Solaria module was well positioned to continue to lead in PV module cost reduction. Throughout the term of the contract, market conditions changed dramatically and so to did Solaria’s product offerings to support this. However, the manufacturing technology developed for the LCPV module was successfully leveraged and optimized to support two new and different product platforms. BIPV “PowerVision” and High-efficiency “PowerXT” modules. The primary barrier to enabling high-volume PV module manufacturing in the US is the high manual labor component in certain unique aspects of our manufacturing process. The funding was used to develop unique manufacturing automation which makes the manual labor components of these key processes more efficient and increase throughput. At the core of Solaria’s product offerings are its unique and proprietary techniques for dicing and re-arranging solar cells into modules with highly-differentiated characteristics that address key gaps in the c-Si market. It is these techniques that were successfully evolved and deployed into US-based manufacturing site with SunShot funding. Today, Solaria

  12. The Cost of Health Care for AIDS Patients in Saskatchewan

    Directory of Open Access Journals (Sweden)

    Kevin P Browne

    1990-01-01

    Full Text Available The medical records of 19 patients with acquired immune deficiency syndrome (aids were reviewed in an attempt to estimate their health care costs. The patients were all male, members of high risk groups and diagnosed between April 1985 and February 1988. Twelve of the patients died; they lived a mean of 240 days (range 0 to 580 after diagnosis, were admitted three times (range one to six to hospital for 65 total days (range one to 148 for a cost per patient of $33,721 (range $2,768 to $64,981 for inpatient care. They made five (range zero to 25 office visits per patient costing $196 per patient (range $0 to $4,999 for outpatient care. The seven survivors (one was lost to follow-up have lived 375 days (range 186 to 551 since diagnosis, have been admitted to hospital two times (range zero to seven for 30 total days (range zero to 86 for a total cost per patient of $14,223 (range $0 to $39,410 for inpatient care. They have made 11 office/emergency room visits (range zero to 46 costing in total $4322 (range $0 to $13,605 for outpatient care. The total expenditure was $546,332 ($28,754 per patient, of which total fees to physicians were $37,210 (6.8%, and estimated costs of laboratory tests $117,917 (21.6%, drugs $36,930 (6.7%, and medical imaging $20,794 (3.8%. Patients now deceased cost $416,445 (mean $34,704 per patient, accounting for 76.2% of overall expenditures. The average medical/surgical and drug costs per patient day in hospital were greater for aids patients than for the average medical/surgical patient in the authors’ institution.

  13. The high price of depression: Family members' health conditions and health care costs.

    Science.gov (United States)

    Ray, G Thomas; Weisner, Constance M; Taillac, Cosette J; Campbell, Cynthia I

    2017-05-01

    To compare the health conditions and health care costs of family members of patients diagnosed with a Major Depressive Disorder (MDD) to family members of patients without an MDD diagnosis. Using electronic health record data, we identified family members (n=201,914) of adult index patients (n=92,399) diagnosed with MDD between 2009 and 2014 and family members (n=187,011) of matched patients without MDD. Diagnoses, health care utilization and costs were extracted for each family member. Logistic regression and multivariate models were used to compare diagnosed health conditions, health services cost, and utilization of MDD and non-MDD family members. Analyses covered the 5years before and after the index patient's MDD diagnosis. MDD family members were more likely than non-MDD family members to be diagnosed with mood disorders, anxiety, substance use disorder, and numerous other conditions. MDD family members had higher health care costs than non-MDD family members in every period analyzed, with the highest difference being in the year before the index patient's MDD diagnosis. Family members of patients with MDD are more likely to have a number of health conditions compared to non-MDD family members, and to have higher health care cost and utilization. Copyright © 2017. Published by Elsevier Inc.

  14. Reflections on the cost of "low-cost" whole genome sequencing: framing the health policy debate.

    Directory of Open Access Journals (Sweden)

    Timothy Caulfield

    2013-11-01

    Full Text Available The cost of whole genome sequencing is dropping rapidly. There has been a great deal of enthusiasm about the potential for this technological advance to transform clinical care. Given the interest and significant investment in genomics, this seems an ideal time to consider what the evidence tells us about potential benefits and harms, particularly in the context of health care policy. The scale and pace of adoption of this powerful new technology should be driven by clinical need, clinical evidence, and a commitment to put patients at the centre of health care policy.

  15. Managing manpower and cutting costs in the health care industry.

    Science.gov (United States)

    Kocakülâh, Mehmet C; Wiggins, Laura M; Albin, Marvin

    2009-01-01

    The Bureau of Labor Statistics projects that health care services will account for one out of every six new jobs from 2002 to 2012. Based upon workload fluctuations, some companies in health care have opted to utilize "just-in-time" employees. Such an employee not only serves to stabilize the workforce but can also reduce employers' cost by allowing them to pay for labor only when they need it. Based on the analysis, a company should reduce reliance on casual staff, as the upfront cost per hire is far greater than hiring a temporary employee. Information presented points to fairly high turnover among casual employees, thus bolstering the argument against this staffing scheme when compared with temporary employee staffing.

  16. The economics of gasoline subsidy cost reduction policy: Case study of Indonesia

    Science.gov (United States)

    Akimaya, Muhammad I.

    only provides a subsidy for regular gasoline and in turn proposes an alternative policy that introduces a subsidy for premium gasoline at a lower rate to reduce the overall gasoline subsidy cost. There has yet to be any research that simulates price controls for gasoline with different grades. Simulations based on the calibrated demand are performed and the results confirm the existence of potential savings that are largely determined by the cross-price elasticities between regular and premium gasoline. The benchmark scenario, based on a recent study of substitutability between gasoline by grades, results in an 11.5% reduction in subsidy cost of around 950 million USD with a subsidy rate of Rp 2,254/liter. Furthermore, the optimal rate of subsidy for premium gasoline results in a reduction of inefficiency as consumers' welfare increase by 6.8 trillion rupiahs (or 560 million USD).

  17. ISS Operations Cost Reductions Through Automation of Real-Time Planning Tasks

    Science.gov (United States)

    Hall, Timothy A.

    2011-01-01

    In 2008 the Johnson Space Center s Mission Operations Directorate (MOD) management team challenged their organization to find ways to reduce the costs of International Space station (ISS) console operations in the Mission Control Center (MCC). Each MOD organization was asked to identify projects that would help them attain a goal of a 30% reduction in operating costs by 2012. The MOD Operations and Planning organization responded to this challenge by launching several software automation projects that would allow them to greatly improve ISS console operations and reduce staffing and operating costs. These projects to date have allowed the MOD Operations organization to remove one full time (7 x 24 x 365) ISS console position in 2010; with the plan of eliminating two full time ISS console support positions by 2012. This will account for an overall 10 EP reduction in staffing for the Operations and Planning organization. These automation projects focused on utilizing software to automate many administrative and often repetitive tasks involved with processing ISS planning and daily operations information. This information was exchanged between the ground flight control teams in Houston and around the globe, as well as with the ISS astronaut crew. These tasks ranged from managing mission plan changes from around the globe, to uploading and downloading information to and from the ISS crew, to even more complex tasks that required multiple decision points to process the data, track approvals and deliver it to the correct recipient across network and security boundaries. The software solutions leveraged several different technologies including customized web applications and implementation of industry standard web services architecture between several planning tools; as well as a engaging a previously research level technology (TRL 2-3) developed by Ames Research Center (ARC) that utilized an intelligent agent based system to manage and automate file traffic flow

  18. Long-term health and medical cost impact of smoking prevention in adolescence.

    Science.gov (United States)

    Wang, Li Yan; Michael, Shannon L

    2015-02-01

    To estimate smoking progression probabilities from adolescence to young adulthood and to estimate long-term health and medical cost impacts of preventing smoking in today's adolescents. Using data from the National Longitudinal Study of Adolescent Health (Add Health), we first estimated smoking progression probabilities from adolescence to young adulthood. Then, using the predicted probabilities, we estimated the number of adolescents who were prevented from becoming adult daily smokers as a result of a hypothetical 1 percentage point reduction in the prevalence of ever smoking in today's adolescents. We further estimated lifetime medical costs saved and quality-adjusted life years (QALYs) gained as a result of preventing adolescents from becoming adult daily smokers. All costs were in 2010 dollars. Compared with never smokers, those who had tried smoking at baseline had higher probabilities of becoming current or former daily smokers at follow-up regardless of baseline grade or sex. A hypothetical 1 percentage point reduction in the prevalence of ever smoking in 24.5 million students in 7th-12th grades today could prevent 35,962 individuals from becoming a former daily smoker and 44,318 individuals from becoming a current daily smoker at ages 24-32 years. As a result, lifetime medical care costs are estimated to decrease by $1.2 billion and lifetime QALYs is estimated to increase by 98,590. Effective smoking prevention programs for adolescents go beyond reducing smoking prevalence in adolescence; they also reduce daily smokers in young adulthood, increase QALYs, and reduce medical costs substantially in later life. This finding indicates the importance of continued investment in effective youth smoking prevention programs. Published by Elsevier Inc.

  19. Human health risks analysis: assessment of health costs of energy related pollutants

    International Nuclear Information System (INIS)

    Ginevan, M.E.; Grahn, D.; Lundy, R.T.; Brown, C.D.; Curtiss, J.B.

    1979-01-01

    This section contains a summary of research on the assessment of health costs of energy related pollutants. It includes the development of new statistical methodology, mathematical models, and data bases relevant to the assessment

  20. Patients find success haggling as health-care costs climb.

    Science.gov (United States)

    Costello, Daniel

    2002-01-01

    In small but growing numbers, Americans are taking an innovative approach to controlling health-care costs: They're haggling with their doctors. Fed up with mounting health bills, consumers ae getting as much as 30% off everything from eye exams to fertility procedures just by agreeing to pay upfront. Others are holding their doctors over a barrel by waiting a few months to pay the bill. Already, a new cottage industry of middlemen who negotiate healthcare bills for patients report their haggling business is up as much as 25% in the last two years.

  1. Reproductive Investment and Health Costs in Roma Women

    Directory of Open Access Journals (Sweden)

    Jelena Čvorović

    2017-11-01

    Full Text Available In this paper, we examine whether variation in reproductive investment affects the health of Roma women using a dataset collected through original anthropological fieldwork among Roma women in Serbia. Data were collected in 2014–2016 in several Roma semi-urban settlements in central Serbia. The sample consisted of 468 Roma women, averaging 44 years of age. We collected demographic data (age, school levels, socioeconomic status, risk behaviors (smoking and alcohol consumption, marital status, and reproductive history variables (the timing of reproduction, the intensity of reproduction, reproductive effort and investment after birth, in addition to self-reported health, height, and weight. Data analyses showed that somatic, short-term costs of reproduction were revealed in this population, while evolutionary, long-term costs were unobservable—contrariwise, Roma women in poor health contributed more to the gene pool of the next generation than their healthy counterparts. Our findings appear to be consistent with simple trade-off models that suggest inverse relationships between reproductive effort and health. Thus, personal sacrifice—poor health as an outcome—seems crucial for greater reproductive success.

  2. Delayed otolaryngology referral for voice disorders increases health care costs.

    Science.gov (United States)

    Cohen, Seth M; Kim, Jaewhan; Roy, Nelson; Courey, Mark

    2015-04-01

    Despite the accepted role of laryngoscopy in assessing patients with laryngeal/voice disorders, controversy surrounds its timing. This study sought to determine how increased time from first primary care to first otolaryngology outpatient visit affected the health care costs of patients with laryngeal/voice disorders. Retrospective analysis of a large, national administrative claims database was performed. Patients had an International Classification of Diseases, 9(th) Revision-coded diagnosis of a laryngeal/voice disorder; initially saw a primary care physician and, subsequently, an otolaryngologist as outpatients; and provided 6 months of follow-up data after the first otolaryngology evaluation. The outpatient health care costs accrued from the first primary care outpatient visit through the 6 months after the first otolaryngology outpatient visit were determined. There were 260,095 unique patients who saw a primary care physician as an outpatient for a laryngeal/voice disorder, with 8999 (3.5%) subsequently seeing an otolaryngologist and with 6 months postotolaryngology follow-up data. A generalized linear regression model revealed that, compared with patients who saw an otolaryngologist ≤1 month after the first primary care visit, patients in the >1-month and ≤3-months and >3-months time periods had relative mean cost increases of $271.34 (95% confidence interval $115.95-$426.73) and $711.38 (95% confidence interval $428.43-$993.34), respectively. Increased time from first primary care to first otolaryngology evaluation is associated with increased outpatient health care costs. Earlier otolaryngology examination may reduce health care expenditures in the evaluation and management of patients with laryngeal/voice disorders. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Costs of health care across primary care models in Ontario

    OpenAIRE

    Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

    2017-01-01

    Background The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients? primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Methods Utilization data for a one year period was measured using administrative databases for a 1...

  4. Cost-effectiveness analysis of risk reduction at nuclear power plants: What have we learned from experience

    International Nuclear Information System (INIS)

    Lochard, J.; Pages, P.

    1984-01-01

    Within the field of risk management techniques, cost-effectiveness analysis of risk reduction is now recognized as an adequate method for evaluating and defining the optimal allocation of protection and safety resources within large industrial systems. The paper considers some of the issues that arise in connection with cost-effectiveness analysis of risk reduction at nuclear power stations. Particular attention is called to both the interdependence between criteria that characterize risk reduction problems and the resulting aggregation and weighting procedures needed when the multidimensionality of criteria is explicitly taken into account. The discussion of these problems is illustrated with results of case studies on both public and occupational risk reduction at French PWRs during normal operation. (author)

  5. Palliative healthcare: cost reduction and quality enhancement using end-of-life survey methodology.

    Science.gov (United States)

    Falls, Christopher Edward

    2008-01-01

    American medical institutions throughout the 20th century prescribed high customer satisfaction, but when it came to death, largely ignored it. An accelerated accumulation of esoteric medical information and the application of this knowledge to affect new cures and longer lives instilled an unquestioning reverence for the medical community among the patient population. Diminishing marginal gains in life expectancy, escalating costs related to life sustaining technologies, and a psychographic shift in the dominant consumer base have challenged this traditional reverence. Armed with unprecedented access to medical information, a more knowledgeable and assertive patient population has emerged in the 21st century to institute its own standards of what constitutes quality health care. In terms of end of life care, this has meant recognition that the emotional needs of the dying have been largely underserved by the current American medical model. Patients and their families are no longer willing to accept the traditional medical perspective of death as failure and have numerous international palliative care models that serve as benchmarks of success when it comes to quality of dying. When cure is a possibility, Americans will pursue it at all costs, but when it is not a possibility, they want honest communication and the opportunity to say good-bye to their loved ones. In the context of these emergent needs, life review is offered as a solution. The value proposition targets not only dying patients and their families, but also society as a whole.

  6. A variation reduction allocation model for quality improvement to minimize investment and quality costs by considering suppliers’ learning curve

    Science.gov (United States)

    Rosyidi, C. N.; Jauhari, WA; Suhardi, B.; Hamada, K.

    2016-02-01

    Quality improvement must be performed in a company to maintain its product competitiveness in the market. The goal of such improvement is to increase the customer satisfaction and the profitability of the company. In current practice, a company needs several suppliers to provide the components in assembly process of a final product. Hence quality improvement of the final product must involve the suppliers. In this paper, an optimization model to allocate the variance reduction is developed. Variation reduction is an important term in quality improvement for both manufacturer and suppliers. To improve suppliers’ components quality, the manufacturer must invest an amount of their financial resources in learning process of the suppliers. The objective function of the model is to minimize the total cost consists of investment cost, and quality costs for both internal and external quality costs. The Learning curve will determine how the employee of the suppliers will respond to the learning processes in reducing the variance of the component.

  7. EPRI tailored collaboration 3 Calvert Cliffs cost and volume reduction program

    International Nuclear Information System (INIS)

    Rigsby, M.D.; Watson, B.A.

    1995-01-01

    Baltimore Gas ampersand Electric's (BGE) Calvert Cliffs Nuclear Power Plant (CCNPP) is a two unit PWR located approximately 60 miles south of Baltimore, Maryland on the Chesapeake Bay. Both units are of Combustion Engineering design, Unit 1 began commercial operation is 1975 and Unit 2 in 1978. BGE contracted with EPRI to participate in the industry initiative to reduce low-level waste volumes with the expectation to: (1) Reduce O ampersand M costs through LLRW reduction by lowering the volume requiring processing, transportation, and storage/disposal. (2) Manage responsibility available resources; i.e., material, equipment, personnel, etc., through segregation. decontamination, recycling and worker awareness. (3) Improve Calvert Cliff's positive image in the community by minimizing the impact on the environment through generating less LLRW. Baltimore Gas ampersand Electric is committed to effective management of low-level radioactive waste (LLRW) at the Calvert Cliffs Nuclear Power Plant. Established Nuclear Program Policies and Procedures support CCNPP's commitment to minimizing generation of low-level radioactive waste (LLRW). Since the mid 1980's, CCNPP has made progress in reducing the volume of LLRW generated and disposed. EPRI's onsite assessment and subsequent assistance pointed out several areas for improvement

  8. UWB Wind Turbine Blade Deflection Sensing for Wind Energy Cost Reduction.

    Science.gov (United States)

    Zhang, Shuai; Jensen, Tobias Lindstrøm; Franek, Ondrej; Eggers, Patrick C F; Olesen, Kim; Byskov, Claus; Pedersen, Gert Frølund

    2015-08-12

    A new application of utilizing ultra-wideband (UWB) technology to sense wind turbine blade deflections is introduced in this paper for wind energy cost reduction. The lower UWB band of 3.1-5.3 GHz is applied. On each blade, there will be one UWB blade deflection sensing system, which consists of two UWB antennas at the blade root and one UWB antenna at the blade tip. The detailed topology and challenges of this deflection sensing system are addressed. Due to the complexity of the problem, this paper will first realize the on-blade UWB radio link in the simplest case, where the tip antenna is situated outside (and on the surface of) a blade tip. To investigate this case, full-blade time-domain measurements are designed and conducted under different deflections. The detailed measurement setups and results are provided. If the root and tip antenna locations are properly selected, the first pulse is always of sufficient quality for accurate estimations under different deflections. The measured results reveal that the blade tip-root distance and blade deflection can be accurately estimated in the complicated and lossy wireless channels around a wind turbine blade. Some future research topics on this application are listed finally.

  9. The effects of utility cost reduction on residential energy consumption in Hungary – a decomposition analysis

    Directory of Open Access Journals (Sweden)

    Tekla Sebestyén Szép

    2017-01-01

    Full Text Available The residential energy consumption is influenced by a lot of factors. Understanding and calculating these factors is essential to making conscious energy policy decisions and feedbacks. Since 2013 the energy prices for households have been controlled by the government in Hungary and as a result of the utility cost reduction program a sharp decline can be observed in residential electricity, district heating and natural gas prices. This paper applies the LMDI (~Logarithmic Mean Division Index method to decompose the absolute change of the residential energy consumption during the period of 2010-2015. We calculate the price, the intensive structure (it means the change of energy expenditure share on energy sources, the extensive structure (it is in connection with the change of energy expenditure share in total expenditure, expenditure (it is the change of per capita total expenditure and population effect. All of that shows the impact of the specific factor on the residential energy consumption by income deciles. Our results have verified the preliminary expectations: the decreasing energy prices for households have a positive impact on energy use and it has been strengthened by the expenditure effect as well. However, the intensive structure, the extensive structure and the population effect have largely offset it.

  10. Sustainable Cost Models for mHealth at Scale: Modeling Program Data from m4RH Tanzania.

    Directory of Open Access Journals (Sweden)

    Emily R Mangone

    Full Text Available There is increasing evidence that mobile phone health interventions ("mHealth" can improve health behaviors and outcomes and are critically important in low-resource, low-access settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH, a national text-message (SMS based health communication service in Tanzania.We delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320 and at any possible break-even volume.In three of four scenarios, costs exceeded revenue by $94,596, $34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54%, 83%, and 58%, respectively from the 2014 program cost of $203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS was negotiated and users paid for all m4RH SMS sent or received, achieved a $5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs.These results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners

  11. Sustainable Cost Models for mHealth at Scale: Modeling Program Data from m4RH Tanzania.

    Science.gov (United States)

    Mangone, Emily R; Agarwal, Smisha; L'Engle, Kelly; Lasway, Christine; Zan, Trinity; van Beijma, Hajo; Orkis, Jennifer; Karam, Robert

    2016-01-01

    There is increasing evidence that mobile phone health interventions ("mHealth") can improve health behaviors and outcomes and are critically important in low-resource, low-access settings. However, the majority of mHealth programs in developing countries fail to reach scale. One reason may be the challenge of developing financially sustainable programs. The goal of this paper is to explore strategies for mHealth program sustainability and develop cost-recovery models for program implementers using 2014 operational program data from Mobile for Reproductive Health (m4RH), a national text-message (SMS) based health communication service in Tanzania. We delineated 2014 m4RH program costs and considered three strategies for cost-recovery for the m4RH program: user pay-for-service, SMS cost reduction, and strategic partnerships. These inputs were used to develop four different cost-recovery scenarios. The four scenarios leveraged strategic partnerships to reduce per-SMS program costs and create per-SMS program revenue and varied the structure for user financial contribution. Finally, we conducted break-even and uncertainty analyses to evaluate the costs and revenues of these models at the 2014 user volume (125,320) and at any possible break-even volume. In three of four scenarios, costs exceeded revenue by $94,596, $34,443, and $84,571 at the 2014 user volume. However, these costs represented large reductions (54%, 83%, and 58%, respectively) from the 2014 program cost of $203,475. Scenario four, in which the lowest per-SMS rate ($0.01 per SMS) was negotiated and users paid for all m4RH SMS sent or received, achieved a $5,660 profit at the 2014 user volume. A Monte Carlo uncertainty analysis demonstrated that break-even points were driven by user volume rather than variations in program costs. These results reveal that breaking even was only probable when all SMS costs were transferred to users and the lowest per-SMS cost was negotiated with telecom partners. While this

  12. Cost approach of health care entity intangible asset valuation.

    Science.gov (United States)

    Reilly, Robert F

    2012-01-01

    degree of marketability; and The degree of variation in the range of value indications. Valuation analysts value health care intangible assets for a number of reasons. In addition to regulatory compliance reasons, these reasons include various transaction, taxation, financing, litigation, accounting, bankruptcy, and planning purposes. The valuation analyst should consider all generally accepted intangible asset valuation approaches, methods, and procedures. Many valuation analysts are more familiar with market approach and income approach valuation methods. However, there are numerous instances when cost approach valuation methods are also applicable to the health care intangible asset valuation. This discussion summarized the analyst's procedures and considerations with regard to the cost approach. The cost approach is often applicable to the valuation of intangible assets in the health care industry. However, the cost approach is only applicable if the valuation analyst (1) appropriately considers all of the cost components and (2) appropriately identifies and quantifies all obsolescence allowances. Regardless of the health care intangible asset or the reason for the valuation, the analyst should be familiar with all generally accepted valuation approaches and methods. And, the valuation analyst should have a clear, convincing, and cogent rationale for (1) accepting each approach and method applied and (2) rejecting each approach and method not applied. That way, the valuation analyst will best achieve the purpose and objective of the health care intangible asset valuation.

  13. Tobacco retail outlet restrictions: health and cost impacts from multistate life-table modelling in a national population.

    Science.gov (United States)

    Pearson, Amber L; Cleghorn, Christine L; van der Deen, Frederieke S; Cobiac, Linda J; Kvizhinadze, Giorgi; Nghiem, Nhung; Blakely, Tony; Wilson, Nick

    2016-09-22

    Since there is some evidence that the density and distribution of tobacco retail outlets may influence smoking behaviours, we aimed to estimate the impacts of 4 tobacco outlet reduction interventions in a country with a smoke-free goal: New Zealand (NZ). A multistate life-table model of 16 tobacco-related diseases, using national data by sex, age and ethnicity, was used to estimate quality-adjusted life years (QALYs) gained and net costs over the remainder of the 2011 NZ population's lifetime. The outlet reduction interventions assumed that increased travel costs can be operationalised as equivalent to price increases in tobacco. All 4 modelled interventions led to reductions of >89% of current tobacco outlets after the 10-year phase-in process. The most effective intervention limited sales to half of liquor stores (and nowhere else) at 129 000 QALYs gained over the lifetime of the population (95% UI: 74 100 to 212 000, undiscounted). The per capita QALY gains were up to 5 times greater for Māori (indigenous population) compared to non-Māori. All interventions were cost-saving to the health system, with the largest saving for the liquor store only intervention: US$1.23 billion (95% UI: $0.70 to $2.00 billion, undiscounted). These tobacco outlet reductions reduced smoking prevalence, achieved health gains and saved health system costs. Effects would be larger if outlet reductions have additional spill-over effects (eg, smoking denormalisation). While these interventions were not as effective as tobacco tax increases (using the same model), these and other strategies could be combined to maximise health gain and to maximise cost-savings to the health system. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Estimating average inpatient and outpatient costs and childhood pneumonia and diarrhoea treatment costs in an urban health centre in Zambia

    Directory of Open Access Journals (Sweden)

    Chola Lumbwe

    2009-10-01

    Full Text Available Abstract Background Millions of children die every year in developing countries, from preventable diseases such as pneumonia and diarrhoea, owing to low levels of investment in child health. Investment efforts are hampered by a general lack of adequate information that is necessary for priority setting in this sector. This paper measures the health system costs of providing inpatient and outpatient services, and also the costs associated with treating pneumonia and diarrhoea in under-five children at a health centre in Zambia. Methods Annual economic and financial cost data were collected in 2005-2006. Data were summarized in a Microsoft excel spreadsheet to obtain total department costs and average disease treatment costs. Results The total annual cost of operating the health centre was US$1,731,661 of which US$1 284 306 and US$447,355 were patient care and overhead departments costs, respectively. The average cost of providing out-patient services was US$3 per visit, while the cost of in-patient treatment was US$18 per bed day. The cost of providing dental services was highest at US$20 per visit, and the cost of VCT services was lowest, with US$1 per visit. The cost per out-patient visit for under-five pneumonia was US$48, while the cost per bed day was US$215. The cost per outpatient visit attributed to under-five diarrhoea was US$26, and the cost per bed day was US$78. Conclusion In the face of insufficient data, a cost analysis exercise is a difficult but feasible undertaking. The study findings are useful and applicable in similar settings, and can be used in cost effectiveness analyses of health interventions.

  15. The multiplier effect of the health education-risk reduction program in 28 states and 1 territory.

    Science.gov (United States)

    Kreuter, M W; Christensen, G M; Divincenzo, A

    1982-01-01

    The multiplier effect of the Health Education-Risk Reduction (HE-RR) Grants Program funded by the Public Health Service is examined to identify outcomes for the period 1978-81. Responses to a questionnaire from the directors of health education of 28 States and 1 Territory supplied the information concerning new health promotion activities generated by the program. The directors were asked to identify and give cost estimates of new activities that resulted from State-level and local intervention projects. A method for calculating the extent to which the HE-RR program influenced new health promotion activities that were funded by alternate sources was devised. The calculation, termed the new activity rate, was applied to the survey data. Rates calculated for the HE-RR program revealed that it generated nearly $4 million in new health promotion activities, most of them funded by the private and voluntary segments of society.

  16. The effectiveness of health care cost management strategies: a review of the evidence.

    Science.gov (United States)

    Fronstin, P

    1994-10-01

    This Issue Brief discusses the evolution of the health care delivery and financing systems and its effects on health care cost management and describes the changes in the health care delivery system as they pertain to managed care. It presents empirical evidence on the effectiveness of managed care and concludes with an analysis of the potential of future health care reform to influence the evolution of the health care delivery system and affect health care costs. Between 1987 and 1993, total enrollment in health maintenance organizations (HMOs) increased from 28.6 million to 39.8 million, representing an additional 11.2 million individuals, or 4 percent of the U.S. population. At the same time, new forms of managed care organizations emerged. Enrollment in preferred provider organizations increased from 12.2 million individuals in 1987 to 58 million in 1992, and enrollment in point-of-service plans increased from virtually none in 1987 to 2.3 million individuals in 1992. In addition, the percentage of traditional fee-for-service plans with some form of utilization review increased to 95 percent in 1990 from 41 percent in 1987. Measuring the effects of the changing delivery system on the costs and quality of health care services has been a difficult task, resulting in considerable disagreement as to whether or not costs have been affected. In a recent report, the Congressional Budget Office recognizes two new major findings. First, managed care can provide cost-effective health care at a level of quality comparable with the care typically provided by a fee-for-service plan. Second, independent practice associations can be as effective as group- or staff-model HMOs under certain conditions. In the future, we are likely to see a continued movement of Americans into managed care arrangements, an increase in the number of physicians forming networks, a reduction in the number of insurers, an increase in the number of employers joining coalitions to purchase health care

  17. Estimate of the technological costs of CO{sub 2} emission reductions in passenger cars. Emission reduction potentials and their costs; Technikkostenschaetzung fuer die CO{sub 2}-Emissionsminderung bei Pkw. Emissionsminderungspotenziale und ihre Kosten

    Energy Technology Data Exchange (ETDEWEB)

    Herbener, Reinhard; Jahn, Helge; Wetzel, Frank [Umweltbundesamt, Dessau-Rosslau (Germany). Fachgebiet I 3.2 - Schadstoffminderung und Energieeinsparung im Verkehr

    2008-08-06

    The Federal Environmental Office intended to identify the current fuel consumption reduction potential and the cost of efficiency-enhancing measures on passenger cars. For this purpose, an extensive bibliographic search was carried out, and experts from research institutes and from the automobile supplier industry were asked for their opinion. The results are published in table form. (orig.)

  18. Health Impacts and Economic Costs of Air Pollution in the Metropolitan Area of Skopje.

    Science.gov (United States)

    Martinez, Gerardo Sanchez; Spadaro, Joseph V; Chapizanis, Dimitris; Kendrovski, Vladimir; Kochubovski, Mihail; Mudu, Pierpaolo

    2018-03-29

    Urban outdoor air pollution, especially particulate matter, remains a major environmental health problem in Skopje, the capital of the former Yugoslav Republic of Macedonia. Despite the documented high levels of pollution in the city, the published evidence on its health impacts is as yet scarce. we obtained, cleaned, and validated Particulate Matter (PM) concentration data from five air quality monitoring stations in the Skopje metropolitan area, applied relevant concentration-response functions, and evaluated health impacts against two theoretical policy scenarios. We then calculated the burden of disease attributable to PM and calculated the societal cost due to attributable mortality. In 2012, long-term exposure to PM 2.5 (49.2 μg/m³) caused an estimated 1199 premature deaths (CI95% 821-1519). The social cost of the predicted premature mortality in 2012 due to air pollution was estimated at between 570 and 1470 million euros. Moreover, PM 2.5 was also estimated to be responsible for 547 hospital admissions (CI95% 104-977) from cardiovascular diseases, and 937 admissions (CI95% 937-1869) for respiratory disease that year. Reducing PM 2.5 levels to the EU limit (25 μg/m³) could have averted an estimated 45% of PM-attributable mortality, while achieving the WHO Air Quality Guidelines (10 μg/m³) could have averted an estimated 77% of PM-attributable mortality. Both scenarios would also attain significant reductions in attributable respiratory and cardiovascular hospital admissions. Besides its health impacts in terms of increased premature mortality and hospitalizations, air pollution entails significant economic costs to the population of Skopje. Reductions in PM 2.5 concentrations could provide substantial health and economic gains to the city.

  19. Health Impacts and Economic Costs of Air Pollution in the Metropolitan Area of Skopje

    Directory of Open Access Journals (Sweden)

    Gerardo Sanchez Martinez

    2018-03-01

    Full Text Available Background: Urban outdoor air pollution, especially particulate matter, remains a major environmental health problem in Skopje, the capital of the former Yugoslav Republic of Macedonia. Despite the documented high levels of pollution in the city, the published evidence on its health impacts is as yet scarce. Methods: we obtained, cleaned, and validated Particulate Matter (PM concentration data from five air quality monitoring stations in the Skopje metropolitan area, applied relevant concentration-response functions, and evaluated health impacts against two theoretical policy scenarios. We then calculated the burden of disease attributable to PM and calculated the societal cost due to attributable mortality. Results: In 2012, long-term exposure to PM2.5 (49.2 μg/m3 caused an estimated 1199 premature deaths (CI95% 821–1519. The social cost of the predicted premature mortality in 2012 due to air pollution was estimated at between 570 and 1470 million euros. Moreover, PM2.5 was also estimated to be responsible for 547 hospital admissions (CI95% 104–977 from cardiovascular diseases, and 937 admissions (CI95% 937–1869 for respiratory disease that year. Reducing PM2.5 levels to the EU limit (25 μg/m3 could have averted an estimated 45% of PM-attributable mortality, while achieving the WHO Air Quality Guidelines (10 μg/m3 could have averted an estimated 77% of PM-attributable mortality. Both scenarios would also attain significant reductions in attributable respiratory and cardiovascular hospital admissions. Conclusions: Besides its health impacts in terms of increased premature mortality and hospitalizations, air pollution entails significant economic costs to the population of Skopje. Reductions in PM2.5 concentrations could provide substantial health and economic gains to the city.

  20. Preventive health screenings and health consultations in primary care increase life expectancy without increasing costs

    DEFF Research Database (Denmark)

    Rasmussen, Susanne R; Thomsen, Janus Laust; Kilsmark, Janni

    2007-01-01

    AIMS: The intention was to investigate whether preventive health checks and health discussions are cost effective. METHODS: In a randomized trial the authors compared two intervention groups (A and B) and one control group. In 1991 2,000 30- to 49-year-old persons were invited and those who...... were given fixed appointments for health consultations. The follow-up period was six years. Analysis was carried out on the "intention to treat" principle. Outcome parameters were life years gained, and direct and total health costs (including productivity costs), discounted by 3% annually. Costs were...... in average direct (3,255 euro (3,703 euro) versus 4,186 euro) and total costs (10,409 euro (9,399 euro) versus 10,667 euro). The effect in group B is, however, better than in group A with no significant differences in costs. The results are insensitive to a range of assumptions regarding costs, effects...

  1. Practice Innovation, Health Care Utilization and Costs in a Network of Federally Qualified Health Centers and Hospitals for Medicaid Enrollees.

    Science.gov (United States)

    Johnson, Tricia J; Jones, Art; Lulias, Cheryl; Perry, Anthony

    2018-06-01

    State Medicaid programs need cost-effective strategies to provide high-quality care that is accessible to individuals with low incomes and limited resources. Integrated delivery systems have been formed to provide care across the continuum, but creating a shared vision for improving community health can be challenging. Medical Home Network was created as a network of primary care providers and hospital systems providing care to Medicaid enrollees, guided by the principles of egalitarian governance, practice-level care coordination, real-time electronic alerts, and pay-for-performance incentives. This analysis of health care utilization and costs included 1,189,195 Medicaid enrollees. After implementation of Medical Home Network, a risk-adjusted increase of $9.07 or 4.3% per member per month was found over the 2 years of implementation compared with an increase of $17.25 or 9.3% per member per month, before accounting for the cost of care management fees and other financial incentives, for Medicaid enrollees within the same geographic area with a primary care provider outside of Medical Home Network. After accounting for care coordination fees paid to providers, the net risk-adjusted cost reduction was $11.0 million.

  2. 42 CFR 100.2 - Average cost of a health insurance policy.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Average cost of a health insurance policy. 100.2... VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of determining..., less certain deductions. One of the deductions is the average cost of a health insurance policy, as...

  3. The hidden cost of wildfires: Economic valuation of health effects of wildfire smoke exposure in Southern California

    Science.gov (United States)

    Richardson, L.A.; Champ, P.A.; Loomis, J.B.

    2012-01-01

    There is a growing concern that human health impacts from exposure to wildfire smoke are ignored in estimates of monetized damages from wildfires. Current research highlights the need for better data collection and analysis of these impacts. Using unique primary data, this paper quantifies the economic cost of health effects from the largest wildfire in Los Angeles County's modern history. A cost of illness estimate is $9.50 per exposed person per day. However, theory and empirical research consistently find that this measure largely underestimates the true economic cost of health effects from exposure to a pollutant in that it ignores the cost of defensive actions taken as well as disutility. For the first time, the defensive behavior method is applied to calculate the willingness to pay for a reduction in one wildfire smoke induced symptom day, which is estimated to be $84.42 per exposed person per day. ?? 2011.

  4. Establishment of reference costs for occupational health services and implementation of cost management in Japanese manufacturing companies.

    Science.gov (United States)

    Nagata, Tomohisa; Mori, Koji; Aratake, Yutaka; Ide, Hiroshi; Nobori, Junichiro; Kojima, Reiko; Odagami, Kiminori; Kato, Anna; Hiraoka, Mika; Shiota, Naoki; Kobayashi, Yuichi; Ito, Masato; Tsutsumi, Akizumi; Matsuda, Shinya

    2016-07-22

    We developed a standardized cost estimation method for occupational health (OH) services. The purpose of this study was to set reference OH services costs and to conduct OH services cost management assessments in two workplaces by comparing actual OH services costs with the reference costs. Data were obtained from retrospective analyses of OH services costs regarding 15 OH activities over a 1-year period in three manufacturing workplaces. We set the reference OH services costs in one of the three locations and compared OH services costs of each of the two other workplaces with the reference costs. The total reference OH services cost was 176,654 Japanese yen (JPY) per employee. The personnel cost for OH staff to conduct OH services was JPY 47,993, and the personnel cost for non-OH staff was JPY 38,699. The personnel cost for receipt of OH services-opportunity cost-was JPY 19,747, expense was JPY 25,512, depreciation expense was 34,849, and outsourcing cost was JPY 9,854. We compared actual OH services costs from two workplaces (the total OH services costs were JPY 182,151 and JPY 238,023) with the reference costs according to OH activity. The actual costs were different from the reference costs, especially in the case of personnel cost for non-OH staff, expense, and depreciation expense. Using our cost estimation tool, it is helpful to compare actual OH services cost data with reference cost data. The outcomes help employers make informed decisions regarding investment in OH services.

  5. Can health insurance improve employee health outcome and reduce cost? An evaluation of Geisinger's employee health and wellness program.

    Science.gov (United States)

    Maeng, Daniel D; Pitcavage, James M; Tomcavage, Janet; Steinhubl, Steven R

    2013-11-01

    To evaluate the impact of a health plan-driven employee health and wellness program (known as MyHealth Rewards) on health outcomes (stroke and myocardial infarction) and cost of care. A cohort of Geisinger Health Plan members who were Geisinger Health System (GHS) employees throughout the study period (2007 to 2011) was compared with a comparison group consisting of Geisinger Health Plan members who were non-GHS employees. The GHS employee cohort experienced a stroke or myocardial infarction later than the non-GHS comparison group (hazard ratios of 0.73 and 0.56; P employee health and wellness programs similarly designed as MyHealth Rewards can potentially have a desirable impact on employee health and cost.

  6. Utilizing big data to provide better health at lower cost.

    Science.gov (United States)

    Jones, Laney K; Pulk, Rebecca; Gionfriddo, Michael R; Evans, Michael A; Parry, Dean

    2018-04-01

    The efficient use of big data in order to provide better health at a lower cost is described. As data become more usable and accessible in healthcare, organizations need to be prepared to use this information to positively impact patient care. In order to be successful, organizations need teams with expertise in informatics and data management that can build new infrastructure and restructure existing infrastructure to support quality and process improvements in real time, such as creating discrete data fields that can be easily retrieved and used to analyze and monitor care delivery. Organizations should use data to monitor performance (e.g., process metrics) as well as the health of their populations (e.g., clinical parameters and health outcomes). Data can be used to prevent hospitalizations, combat opioid abuse and misuse, improve antimicrobial stewardship, and reduce pharmaceutical spending. These examples also serve to highlight lessons learned to better use data to improve health. For example, data can inform and create efficiencies in care and engage and communicate with stakeholders early and often, and collaboration is necessary to have complete data. To truly transform care so that it is delivered in a way that is sustainable, responsible, and patient-centered, health systems need to act on these opportunities, invest in big data, and routinely use big data in the delivery of care. Using data efficiently has the potential to improve the care of our patients and lower cost. Despite early successes, barriers to implementation remain including data acquisition, integration, and usability. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  7. Projected reduction in healthcare costs in Belgium after optimization of iodine intake: impact on costs related to thyroid nodular disease

    OpenAIRE

    Vandevijvere, Stefanie; Annemans, Lieven; Van Oyen, Herman; Tafforeau, Jean; Moreno-Reyes, Rodrigo

    2010-01-01

    Background: Several surveys in the last 50 years have repeatedly indicated that Belgium is affected by mild iodine deficiency. Within the framework of the national food and health plan in Belgium, a selective, progressive, and monitored strategy was proposed in 2009 to optimize iodine intake. The objective of the present study was to perform a health economic evaluation of the consequences of inadequate iodine intake in Belgium, focusing on undisputed and measurable health outcomes such as th...

  8. Innovation in technology for the least product price and cost - a new minimum cost relation for reductions during technological learning

    International Nuclear Information System (INIS)

    Duffey, R.B.

    2004-01-01

    By analogy with the concepts of human learning, we show and introduce a new method to obtain least product cost and price that includes the effect of innovation and technological learning in manufacturing and production. This key result is a new paradigm instead of the usual economic 'power law' formulation. The new analysis is based on extensive analysis of many technological systems, and is directly related to the presence of learning as experience is accumulated. The results agree with the observed data. By using a consistent basis, the method replaces previous empirical 'power law' descriptions of the technological learning curve with a new 'marginal minimum cost equation' (MCE). (author)

  9. In Brief: Hidden environment and health costs of energy

    Science.gov (United States)

    Showstack, Randy

    2009-10-01

    The hidden costs of energy production and use in the United States amounted to an estimated $120 billion in 2005, according to a 19 October report by the U.S. National Research Council. The report, “Hidden Costs of Energy: Unpriced Consequences of Energy Production and Use,” examines hidden costs, including the cost of air pollution damage to human health, which are not reflected in market prices of energy sources, electricity, or gasoline. The report found that in 2005, the total annual external damages from sulfur dioxide, nitrogen oxides, and particulate matter created by coal-burning power plants that produced 95% of the nation's coal-generated electricity were about $62 billion, with nonclimate damages averaging about 3.2 cents for every kilowatt-hour of energy produced. It is estimated that by 2030, nonclimate damages will fall to 1.7 cents per kilowatt-hour. The 2030 figure assumes that new policies already slated for implementation are put in place.

  10. Analysis of Fuel Cell Markets in Japan and the US: Experience Curve Development and Cost Reduction Disaggregation

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Max [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Smith, Sarah J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sohn, Michael D. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2016-07-15

    Fuel cells are both a longstanding and emerging technology for stationary and transportation applications, and their future use will likely be critical for the deep decarbonization of global energy systems. As we look into future applications, a key challenge for policy-makers and technology market forecasters who seek to track and/or accelerate their market adoption is the ability to forecast market costs of the fuel cells as technology innovations are incorporated into market products. Specifically, there is a need to estimate technology learning rates, which are rates of cost reduction versus production volume. Unfortunately, no literature exists for forecasting future learning rates for fuel cells. In this paper, we look retrospectively to estimate learning rates for two fuel cell deployment programs: (1) the micro-combined heat and power (CHP) program in Japan, and (2) the Self-Generation Incentive Program (SGIP) in California. These two examples have a relatively broad set of historical market data and thus provide an informative and international comparison of distinct fuel cell technologies and government deployment programs. We develop a generalized procedure for disaggregating experience-curve cost-reductions in order to disaggregate the Japanese fuel cell micro-CHP market into its constituent components, and we derive and present a range of learning rates that may explain observed market trends. Finally, we explore the differences in the technology development ecosystem and market conditions that may have contributed to the observed differences in cost reduction and draw policy observations for the market adoption of future fuel cell technologies. The scientific and policy contributions of this paper are the first comparative experience curve analysis of past fuel cell technologies in two distinct markets, and the first quantitative comparison of a detailed cost model of fuel cell systems with actual market data. The resulting approach is applicable to

  11. Cost-effective policy instruments for greenhouse gas emission reduction and fossil fuel substitution through bioenergy production in Austria

    International Nuclear Information System (INIS)

    Schmidt, Johannes; Leduc, Sylvain; Dotzauer, Erik; Schmid, Erwin

    2011-01-01

    Climate change mitigation and security of energy supply are important targets of Austrian energy policy. Bioenergy production based on resources from agriculture and forestry is an important option for attaining these targets. To increase the share of bioenergy in the energy supply, supporting policy instruments are necessary. The cost-effectiveness of these instruments in attaining policy targets depends on the availability of bioenergy technologies. Advanced technologies such as second-generation biofuels, biomass gasification for power production, and bioenergy with carbon capture and storage (BECCS) will likely change the performance of policy instruments. This article assesses the cost-effectiveness of energy policy instruments, considering new bioenergy technologies for the year 2030, with respect to greenhouse gas emission (GHG) reduction and fossil fuel substitution. Instruments that directly subsidize bioenergy are compared with instruments that aim at reducing GHG emissions. A spatially explicit modeling approach is used to account for biomass supply and energy distribution costs in Austria. Results indicate that a carbon tax performs cost-effectively with respect to both policy targets if BECCS is not available. However, the availability of BECCS creates a trade-off between GHG emission reduction and fossil fuel substitution. Biofuel blending obligations are costly in terms of attaining the policy targets. - Highlights: → Costs of energy policies and effects on reduction of CO 2 emissions and fossil fuel consumption. → Particular focus on new bioenergy production technologies such as second generation biofuels. → Spatially explicit techno-economic optimization model. → CO 2 tax: high costs for reducing fossil fuel consumption if carbon capture and storage is available. → Biofuel policy: no significant reductions in CO 2 emissions or fossil fuel consumption.

  12. Cost and risk reduction using upfront licensing in Canada. Annex 15

    International Nuclear Information System (INIS)

    Snell, V.G.

    2002-01-01

    The paper summarizes the use of 'up-front' licensing in Canada - how licensing requirements are defined, and met - in advance of a project commitment. The approach to licensing in Canada has allowed flexibility in development of new designs. Since licensing was originally risk-based, and current regulatory policy allows cost-benefit considerations as part of the decision making, risk can be and should be used in novel circumstances as a licensing tool. Since the licensing framework is non-prescriptive, innovative approaches to design can be introduced and dispositioned without changing the legal structure. This flexibility has been used in several up-front licensing reviews: a small urban heating reactor, repeat CANDU 6 generating station units, and the single unit CANDU 9 generating station. In the future we expect to apply it to advanced designs, as an essential part of risk reduction and customer confidence in the product. The important lessons learned in Canada include: Up-front licensing is essential to reduce the risk of licensing-related delays once a project has been committed. It requires a significant investment in time and effort from both the designer and the regulator; The most effective scope for up-front licensing is for the regulator to thoroughly assess novel concepts, test the design against changed domestic requirements, and follow-up on known difficult areas; and for the designer to ensure foreign requirements are incorporated. There is little benefit in certifying the design in detail; Although it would be satisfying to have legally-binding certification, in the end there can be no legal obligation on the regulator, and agreement is pursued on the basis of good faith that the regulator will not make arbitrary decisions and that the designer will meet agreed targets or requirements; In almost all circumstances, issues will arise that are beyond the current 'rules', however expressed. Rather than rushing to create new rules, one reaches a

  13. Workshop: Valuing Environmental Health Risk Reductions to Children (2003)

    Science.gov (United States)

    This two-day workshop on children's health valuation was co-sponsored by EPA's National Center for Environmental Economics, Office of Children's Health Protection, and National Center for Environmental Research as well as the University of Central Florida.

  14. Potential effect of salt reduction in processed foods on health

    NARCIS (Netherlands)

    Hendriksen, M.A.H.; Hoogenveen, R.T.; Hoekstra, J.; Geleijnse, J.M.; Boshuizen, H.C.; Raaij, van J.M.A.

    2014-01-01

    Background: Excessive salt intake has been associated with hypertension and increased cardiovascular disease morbidity and mortality. Reducing salt intake is considered an important public health strategy in the Netherlands. Objective: The objective was to evaluate the health benefits of

  15. Assessing the cost-effectiveness of seismic risk reduction options in oil industry

    International Nuclear Information System (INIS)

    Nasserasadi, K.; Ghafory-Ashtiany, M.

    2007-01-01

    An integrated probabilistic methodology for cost-efficiency estimation of different sort of seismic risk management measures are introduced by adding Cost Benefit Analysis (CBA) module to an integrated seismic risk assessment model. An oil refinery in Iran has been selected for case study and cost-efficiency of software and hardware mitigation measures are evaluated. The results have shown that: (1) software mitigation measures have more benefit than hardware ones, (2) considering indirect loss in CBA lead to more benefit-cost ratio and (3) although increase of discount ratio decreases the benefit-cost ratio, the arrangement of mitigation measures from benefit-cost viewpoint are constant. (authors)

  16. Cost reduction in the cold: heat generated by terrestrial locomotion partly substitutes for thermoregulation costs in Knot Calidris canutus

    NARCIS (Netherlands)

    Bruinzeel, L.W.; Piersma, T.

    1998-01-01

    To test whether heat generated during locomotion substitutes for the thermoregulation cost, oxygen consumption of four post-absorptive temperate-wintering Knot Calidris canutus was measured at air temperatures of 25 degrees C (thermoneutral) and 10 degrees C (c. 10 degrees below the lower critical

  17. Health care utilization, costs, and readmission rates associated with hyponatremia.

    Science.gov (United States)

    Deitelzweig, Steven; Amin, Alpesh; Christian, Rudell; Friend, Keith; Lin, Jay; Lowe, Timothy J

    2013-02-01

    Hyponatremia is associated with higher morbidity and mortality rates among hospitalized patients. Our study evaluated health care utilization and associated costs of patients hospitalized with a primary diagnosis of hyponatremia. Hospitalized patients with a primary discharge diagnosis of hyponatremia (aged ≥ 18 years) were identified from the Premier Perspective™ database (January 1, 2007-March 31, 2010) and matched to non-hyponatremic (non-HN) patients using a combination of exact patient characteristic matching and propensity score matching. Univariate and multivariate statistics were used to compare hospital resource usage, costs, and 30-day readmission rates between cohorts. Hospital length of stay (LOS) (± standard deviation) (3.78 ± 3.19 vs 3.54 ± 3.26 days; P ratio, 1.89, confidence limits, 1.72, 2.07; P ratio, 4.76; confidence limits, 4.31, 5.26; P profitability due to the increased likelihood of 30-day readmission.

  18. A Low Cost Sensor Controller for Health Monitoring

    Science.gov (United States)

    Birbas, M.; Petrellis, N.; Gioulekas, F.

    2015-09-01

    Aging population can benefit from health care systems that allow their health and daily life to be monitored by expert medical staff. Blood pressure, temperature measurements or more advanced tests like Electrocardiograms (ECG) can be ordered through such a healthcare system while urgent situations can be detected and alleviated on time. The results of these tests can be stored with security in a remote cloud or database. Such systems are often used to monitor non-life threatening patient health problems and their advantage in lowering the cost of the healthcare services is obvious. A low cost commercial medical sensor kit has been used in the present work, trying to improve the accuracy and stability of the sensor measurements, the power consumption, etc. This Sensor Controller communicates with a Gateway installed in the patient's residence and a tablet or smart phone used for giving instructions to the patient through a comprehensive user interface. A flexible communication protocol has been defined supporting any short or long term sensor sampling scenario. The experimental results show that it is possible to achieve low power consumption by applying apropriate sleep intervals to the Sensor Controller and by deactivating periodically some of its functionality.

  19. Costs and outcomes of improving population health through better social housing: a cohort study and economic analysis.

    Science.gov (United States)

    Bray, Nathan; Burns, Paul; Jones, Alice; Winrow, Eira; Edwards, Rhiannon Tudor

    2017-12-01

    We sought to determine the impact of warmth-related housing improvements on the health, well-being, and quality of life of families living in social housing. An historical cohort study design was used. Households were recruited by Gentoo, a social housing contractor in North East England. Recruited households were asked to complete a quality of life, well-being, and health service use questionnaire before receiving housing improvements (new energy-efficient boiler and double-glazing) and again 12 months afterwards. Data were collected from 228 households. The average intervention cost was £3725. At 12-month post-intervention, a 16% reduction (-£94.79) in household 6-month health service use was found. Statistically significant positive improvements were observed in main tenant and household health status (p cost-effective means of improving the health of social housing tenants and reducing health service expenditure, particularly in older populations.

  20. Cost reduction from resolution/improvement of carcinoid syndrome symptoms following treatment with above-standard dose of octreotide LAR.

    Science.gov (United States)

    Huynh, Lynn; Totev, Todor; Vekeman, Francis; Neary, Maureen P; Duh, Mei S; Benson, Al B

    2017-09-01

    To calculate the cost reduction associated with diarrhea/flushing symptom resolution/improvement following treatment with above-standard dose octreotide-LAR from the commercial payor's perspective. Diarrhea and flushing are two major carcinoid syndrome symptoms of neuroendocrine tumor (NET). Previously, a study of NET patients from three US tertiary oncology centers (NET 3-Center Study) demonstrated that dose escalation of octreotide LAR to above-standard dose resolved/improved diarrhea/flushing in 79% of the patients within 1 year. Time course of diarrhea/flushing symptom data were collected from the NET 3-Center Study. Daily healthcare costs were calculated from a commercial claims database analysis. For the patient cohort experiencing any diarrhea/flushing symptom resolution/improvement, their observation period was divided into days of symptom resolution/improvement or no improvement, which were then multiplied by the respective daily healthcare cost and summed over 1 year to yield the blended mean annual cost per patient. For patients who experienced no diarrhea/flushing symptom improvement, mean annual daily healthcare cost of diarrhea/flushing over a 1-year period was calculated. The economic model found that 108 NET patients who experienced diarrhea/flushing symptom resolution/improvement within 1 year had statistically significantly lower mean annual healthcare cost/patient than patients with no symptom improvement, by $14,766 (p = .03). For the sub-set of 85 patients experiencing resolution/improvement of diarrhea, their cost reduction was more pronounced, at $18,740 (p = .01), statistically significantly lower than those with no improvement; outpatient costs accounted for 56% of the cost reduction (p = .02); inpatient costs, emergency department costs, and pharmacy costs accounted for the remaining 44%. The economic model relied on two different sources of data, with some heterogeneity in the prior treatment and disease status of patients

  1. The National Shipbuilding Research Program: Producibility Cost Reductions through Alternative Materials and Processes

    National Research Council Canada - National Science Library

    Horsmon, Jr., Albert W; Johnson, Karl; Gans-Devney, Barbara

    1999-01-01

    This report describes research into the use of alternative materials and processes to reduce material and labor costs while also looking at the influence of these choices on the life cycle costs of the vessel...

  2. The Welfare Cost of Homicides in Brazil: Accounting for Heterogeneity in the Willingness to Pay for Mortality Reductions.

    Science.gov (United States)

    Cerqueira, Daniel; Soares, Rodrigo R

    2016-03-01

    This paper estimates the health dimension of the welfare cost of homicides in Brazil incorporating age, gender, educational, and regional heterogeneities. We use a marginal willingness to pay approach to assign monetary values to the welfare cost of increased mortality due to violence. Results indicate that the present discounted value of the welfare cost of homicides in Brazil corresponds to roughly 78% of the GDP or, in terms of yearly flow, 2.3%. The analysis also shows that reliance on aggregate data to perform such calculations can lead to biases of around 20% in the estimated social cost of violence. Copyright © 2014 John Wiley & Sons, Ltd.

  3. Health Care Utilization and Costs Associated with Pediatric Chronic Pain.

    Science.gov (United States)

    Tumin, Dmitry; Drees, David; Miller, Rebecca; Wrona, Sharon; Hayes, Don; Tobias, Joseph D; Bhalla, Tarun

    2018-03-30

    The population prevalence of pediatric chronic pain is not well characterized, in part due to lack of nationally representative data. Previous research suggests that pediatric chronic pain prolongs inpatient stay and increases costs, but the population-level association between pediatric chronic pain and health care utilization is unclear. We use the 2016 National Survey of Children's Health to describe the prevalence of pediatric chronic pain, and compare health care utilization among children ages 0-17 years according to the presence of chronic pain. Using a sample of 43,712 children, we estimate the population prevalence of chronic pain to be 6%. On multivariable analysis, chronic pain was not associated with increased odds of primary care or mental health care use, but was associated with greater odds of using other specialty care (OR=2.01, 95% CI: 1.62, 2.47; pcomplementary and alternative medicine (OR=2.32, 95% CI: 1.79, 3.03; pchronic pain were more likely to use specialty care but not mental health care. The higher likelihood of emergency care use in this group raises the question of whether better management of pediatric chronic pain could reduce emergency department use. Copyright © 2018. Published by Elsevier Inc.

  4. Microinsurance: innovations in low-cost health insurance.

    Science.gov (United States)

    Dror, David M; Radermacher, Ralf; Khadilkar, Shrikant B; Schout, Petra; Hay, François-Xavier; Singh, Arbind; Koren, Ruth

    2009-01-01

    Microinsurance--low-cost health insurance based on a community, cooperative, or mutual and self-help arrangements-can provide financial protection for poor households and improve access to health care. However, low benefit caps and a low share of premiums paid as benefits--both designed to keep these arrangements in business--perversely limited these schemes' ability to extend coverage, offer financial protection, and retain members. We studied three schemes in India, two of which are member-operated and one a commercial scheme, using household surveys of insured and uninsured households and interviews with managers. All three enrolled poor households and raised their use of hospital services, as intended. Financial exposure was greatest, and protection was least, in the commercial scheme, which imposed the lowest caps on benefits and where income was the lowest.

  5. [Cost-effectiveness in Dutch mental health care: future because of ROM?

    NARCIS (Netherlands)

    Agthoven, M. van; Kolk, A. van der; Knegtering, H.; Delespaul, P.A.; Arends, J.; Jeurissen, P.P.T.; Krabbe, P.F.M.; Huijsman, R.; Luijk, R.; Beurs, E. de; Hakkaart-van Roijen, L.; Bruggeman, R.

    2015-01-01

    BACKGROUND: The document reporting Dutch mental health care negotiations for 2014 - 2017 calls for a cost decrease based on cost-effectiveness. Thanks to rom, the Dutch mental health care seems well prepared for cost-effectiveness research.
    AIM: Evaluate how valid cost-effectiveness research

  6. Impact of the Prevention Plan on Employee Health Risk Reduction

    OpenAIRE

    Loeppke, Ronald; Edington, Dee W.; Bég, Sami

    2010-01-01

    This study evaluated the impact of The Prevention Plan™ on employee health risks after 1 year of integrated primary prevention (wellness and health promotion) and secondary prevention (biometric and lab screening as well as early detection) interventions. The Prevention Plan is an innovative prevention benefit that provides members with the high-tech/high-touch support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coach...

  7. Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology

    Energy Technology Data Exchange (ETDEWEB)

    Scott, Michael T. [Department of Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (United States); Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States); Todd, Kimberly E.; Oakley, Heather; Bradley, Julie A.; Rotondo, Ronny L.; Morris, Christopher G.; Klein, Stuart; Mendenhall, Nancy P. [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States); Indelicato, Daniel J., E-mail: dindelicato@floridaproton.org [Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida (United States)

    2016-10-01

    Purpose: To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. Methods and Materials: From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Results: Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P<.0001). With a >16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of “$[(anesthesia cost to payer during radiation therapy course/6) − (CCLS expense to payer/N)]” per child (N) treated with radiation

  8. Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology.

    Science.gov (United States)

    Scott, Michael T; Todd, Kimberly E; Oakley, Heather; Bradley, Julie A; Rotondo, Ronny L; Morris, Christopher G; Klein, Stuart; Mendenhall, Nancy P; Indelicato, Daniel J

    2016-10-01

    To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of "$[(anesthesia cost to payer during radiation therapy course/6) - (CCLS expense to payer/N)]" per child (N) treated with radiation therapy, where N equals the number of children aged 3 to 12

  9. Reducing Anesthesia and Health Care Cost Through Utilization of Child Life Specialists in Pediatric Radiation Oncology

    International Nuclear Information System (INIS)

    Scott, Michael T.; Todd, Kimberly E.; Oakley, Heather; Bradley, Julie A.; Rotondo, Ronny L.; Morris, Christopher G.; Klein, Stuart; Mendenhall, Nancy P.; Indelicato, Daniel J.

    2016-01-01

    Purpose: To analyze the effectiveness of a certified child life specialist (CCLS) in reducing the frequency of daily anesthesia at our institution, and to quantify the potential health care payer cost savings of CCLS utilization in the United States. Methods and Materials: From 2006 to 2014, 738 children (aged ≤21 years) were treated with radiation therapy at our institution. We retrospectively analyzed the frequency of daily anesthesia before and after hiring a CCLS in 2011 after excluding patients aged 0 to 2 and >12 years. In the analyzed cohort of 425 patients the median age was 7.6 years (range, 3-12.9 years). For the pre-CCLS period the overall median age was 7.5 years; for the post-CCLS period the median age was 7.7 years. An average 6-week course of pediatric anesthesia for radiation therapy costs $50,000 in charges to the payer. The average annual cost to employ one CCLS is approximately $50,000. Results: Before employing a CCLS, 69 of 121 children (57%) aged 3 to 12 years required daily anesthesia, including 33 of 53 children (62.3%) aged 5 to 8 years. After employing a CCLS, 124 of 304 children (40.8%) aged 3 to 12 years required daily anesthesia, including only 34 of 118 children (28.8%) aged 5 to 8 years (P 16% absolute reduction in anesthesia use after employment of a CCLS, the health care payer cost savings was approaching $50,000 per 6 children aged 3 to 12 years treated annually with radiation therapy in our institution. This reduction resulted in a total of only 6 children aged 3 to 12 years required anesthesia to be treated per year at our center to achieve nearly break-even cost savings to the health care payer if the payer were to subsidize the employment expense of a CCLS. Overall, the CCLS intervention can provide an average annualized health care payer cost savings of “$[(anesthesia cost to payer during radiation therapy course/6) − (CCLS expense to payer/N)]” per child (N) treated with radiation therapy, where N

  10. The total lifetime health cost savings of smoking cessation to society

    DEFF Research Database (Denmark)

    Rasmussen, Gitte Susanne; Prescott, Eva; Sørensen, Thorkild I A

    2005-01-01

    Smoking cessation has major immediate and long-term health benefits. However, ex-smokers' total lifetime health costs and continuing smokers' costs remain uncompared, and hence the economic savings of smoking cessation to society have not been determined.......Smoking cessation has major immediate and long-term health benefits. However, ex-smokers' total lifetime health costs and continuing smokers' costs remain uncompared, and hence the economic savings of smoking cessation to society have not been determined....

  11. A single-vendor and a single-buyer integrated inventory model with ordering cost reduction dependent on lead time

    Science.gov (United States)

    Vijayashree, M.; Uthayakumar, R.

    2017-09-01

    Lead time is one of the major limits that affect planning at every stage of the supply chain system. In this paper, we study a continuous review inventory model. This paper investigates the ordering cost reductions are dependent on lead time. This study addressed two-echelon supply chain problem consisting of a single vendor and a single buyer. The main contribution of this study is that the integrated total cost of the single vendor and the single buyer integrated system is analyzed by adopting two different (linear and logarithmic) types ordering cost reductions act dependent on lead time. In both cases, we develop effective solution procedures for finding the optimal solution and then illustrative numerical examples are given to illustrate the results. The solution procedure is to determine the optimal solutions of order quantity, ordering cost, lead time and the number of deliveries from the single vendor and the single buyer in one production run, so that the integrated total cost incurred has the minimum value. Ordering cost reduction is the main aspect of the proposed model. A numerical example is given to validate the model. Numerical example solved by using Matlab software. The mathematical model is solved analytically by minimizing the integrated total cost. Furthermore, the sensitivity analysis is included and the numerical examples are given to illustrate the results. The results obtained in this paper are illustrated with the help of numerical examples. The sensitivity of the proposed model has been checked with respect to the various major parameters of the system. Results reveal that the proposed integrated inventory model is more applicable for the supply chain manufacturing system. For each case, an algorithm procedure of finding the optimal solution is developed. Finally, the graphical representation is presented to illustrate the proposed model and also include the computer flowchart in each model.

  12. CO2 substitution potential and CO2 reduction costs of an energetic exploitation of solid biomasses in Germany

    International Nuclear Information System (INIS)

    Becher, S.

    1995-01-01

    For the reduction of the anthropogenic greenhouse effect, the CO 2 , emissions are clearly to be reduced in future, according to the resolution made by the Federal Republic. Against the background of this objective, possible contributions of the biogenous solid fuels for the reduction of the CO 2 release of fossil origin are presented and discussed. For that, first the existing potentials of biomass in Germany and their present use are shown. Based on this, the CO 2 emissions by the present use already avoided, as well as the existing unexploited potentials of the CO 2 reduction potentials still to be exploited are determined. In accordance with an 'integral' starting point, thereby all pre- and post-positioned processes are considered. Finally, the specific CO 2 reduction costs are analysed and compared with other options. (orig.) [de

  13. Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Helen Jack

    2013-05-01

    Full Text Available Background: Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes. Objective: To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS disorders and the cost-effectiveness of treatment interventions. Design: Narrative overview methodology. Results and conclusions: Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1 accurate and thorough assessment of the health burdens of MNS disorders, 2 design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3 information on the use and costs of traditional medicines, and 4 cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context.

  14. Closing the mental health treatment gap in South Africa: a review of costs and cost-effectiveness

    Science.gov (United States)

    Jack, Helen; Wagner, Ryan G.; Petersen, Inge; Thom, Rita; Newton, Charles R.; Stein, Alan; Kahn, Kathleen; Tollman, Stephen; Hofman, Karen J.

    2014-01-01

    Background Nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many low- and middle-income countries. Understanding the economic costs and consequences of prevention and packages of care is essential, particularly as South Africa considers scaling-up mental health services and works towards universal health coverage. Economic evaluations can inform how priorities are set in system or spending changes. Objective To identify and review research from South Africa and sub-Saharan Africa on the direct and indirect costs of mental, neurological, and substance use (MNS) disorders and the cost-effectiveness of treatment interventions. Design Narrative overview methodology. Results and conclusions Reviewed studies indicate that integrating mental health care into existing health systems may be the most effective and cost-efficient approach to increase access to mental health services in South Africa. Integration would also direct treatment, prevention, and screening to people with HIV and other chronic health conditions who are at high risk for mental disorders. We identify four major knowledge gaps: 1) accurate and thorough assessment of the health burdens of MNS disorders, 2) design and assessment of interventions that integrate mental health screening and treatment into existing health systems, 3) information on the use and costs of traditional medicines, and 4) cost-effectiveness evaluation of a range of specific interventions or packages of interventions that are tailored to the national context. PMID:24848654

  15. Alternatives for operational cost reduction in oil pipelines; Alternativas para reducao de custos energeticos operacionais em oleodutos

    Energy Technology Data Exchange (ETDEWEB)

    Krause, Philipe Barroso; Carneiro, Leonardo Motta; Pires, Luis Fernando Goncalves [Pontificia Universidade Catolica do Rio de Janeiro (SIMDUT/DEM/ PUC-Rio), RJ (Brazil). Dept. de Engenharia Mecancia. Nucleo de Simulacao Termo-Hidraulica de Dutos

    2012-07-01

    This paper intends to give a brief overview of some cost reduction alternatives in oil pipelines, to optimize the pipeline operation. Four different alternatives are presented, based on previous studies made on existing pipelines, to demonstrate the response obtained with these solutions. Pipeline operation, especially on mature ones, tends to have a high operational cost, be by tradition, the aging of the installation, change of operational characteristics - such as nominal flow, product, or even flow direction - for which the pipeline wasn't originally designed. The alternatives showed allow for an increase survival time of the pipeline, without resorting to major changes, such as replacement of pipes or adding pumping stations to the system. The alternative studied varies from no implementation cost to high installation cost or operational cost increase, depending on the system and the alternative chosen. From changing the pump arrays during operation or changing the products viscosity with different blends, that represent virtually no cost to the pipeline operation, to the use of VFDs, with a high installation cost or DRA, which increase the operational cost. (author)

  16. A Collaborative Approach to Poverty Reduction and Health ...

    African Journals Online (AJOL)

    proach to health improvement, and augmenting student's communication and organisational skills. Description. A key activity for student nurses is assessing the needs of local communities and creating effective responses. During their community placement 3rd year student nurses from KSNM carried out a health needs ...

  17. Abstract: A Collaborative Approach to Poverty Reduction and Health ...

    African Journals Online (AJOL)

    Active participation in a community initiative enabled students to become more reflective and responsive in their own practice. It also created a learning environment which empowered them to act collaboratively in order to improve the broader determinants of health. Key words: health improvement, collaborative working, ...

  18. Migration, mental health and costs consequences in Romania.

    Science.gov (United States)

    Miclutia, Ioana; Junjan, Veronica; Popescu, Codruta Alina; Tigan, Stefan

    2007-03-01

    Legal and illegal circulatory migration from Romania reached huge proportions after 2000, following the lifting of the visa requirements for EU Shengen countries. So far, the impact of migration on health has received scarce attention from Romanian authorities. To describe the socio-demographic and clinical profile of the migrants who have developed mental illness, estimate their services use in terms of hospitalization and to analyze the cost impact on the Romanian health system and on the migrants' co-payments, to discuss the possible relationships between migration and mental health. A semi-structured interview, designed by the authors, has been administered to 50 migrants admitted to the Second Psychiatric Clinic Cluj-Napoca, Romania, to investigate the following areas: immigration status, working conditions, income, housing, insurance and social bonds. The clinical symptomatology of these patients was assessed using the Brief Psychiatric Rating Scale (BPRS). The average cost of hospitalization per day per patient, the total costs of hospitalization and the migrants' co-payment through personal contribution to the insurance system were estimated. Most of the patients were young, single, with no previous experience abroad and with few social ties in the host country, with unqualified and insecure jobs. In this group, 45 out of 50 had schizophrenia spectrum disorders diagnoses. The hospitalization length of these patients was slightly shorter than the hospitalization of non-migrant patients with the same diagnosis. Individuals from rural areas had longer hospitalisation than those coming from urban areas. Those who left the country illegally and those who worked illegally had shorter hospitalisations. The average costs of hospitalization per day per patient were Euro 15.56; and the total costs were Euro 14,054.92. In order to cover the costs of hospitalization in the native country due to an illness with the onset abroad, a patient should work and contribute 4

  19. Acceptability of Mental Health Stigma-Reduction Training and Initial Effects on Awareness Among Military Personnel

    Science.gov (United States)

    2015-10-13

    experiences and attitudes may reduce stigma associated with seeking help for mental health con- cerns in a military population, although results from...Hurtado et al. SpringerPlus (2015) 4:606 DOI 10.1186/s40064-015-1402-z RESEARCH Acceptability of  mental health stigma -reduction training and...purpose of this paper is to report on the development of a mental health stigma reduction toolkit and training, and the acceptability and level of stigma

  20. Health Technology Assessment of pathogen reduction technologies applied to plasma for clinical use

    Science.gov (United States)

    Cicchetti, Americo; Berrino, Alexandra; Casini, Marina; Codella, Paola; Facco, Giuseppina; Fiore, Alessandra; Marano, Giuseppe; Marchetti, Marco; Midolo, Emanuela; Minacori, Roberta; Refolo, Pietro; Romano, Federica; Ruggeri, Matteo; Sacchini, Dario; Spagnolo, Antonio G.; Urbina, Irene; Vaglio, Stefania; Grazzini, Giuliano; Liumbruno, Giancarlo M.

    2016-01-01

    Although existing clinical evidence shows that the transfusion of blood components is becoming increasingly safe, the risk of transmission of known and unknown pathogens, new pathogens or re-emerging pathogens still persists. Pathogen reduction technologies may offer a new approach to increase blood safety. The study is the output of collaboration between the Italian National Blood Centre and the Post-Graduate School of Health Economics and Management, Catholic University of the Sacred Heart, Rome, Italy. A large, multidisciplinary team was created and divided into six groups, each of which addressed one or more HTA domains. Plasma treated with amotosalen + UV light, riboflavin + UV light, methylene blue or a solvent/detergent process was compared to fresh-frozen plasma with regards to current use, technical features, effectiveness, safety, economic and organisational impact, and ethical, social and legal implications. The available evidence is not sufficient to state which of the techniques compared is superior in terms of efficacy, safety and cost-effectiveness. Evidence on efficacy is only available for the solvent/detergent method, which proved to be non-inferior to untreated fresh-frozen plasma in the treatment of a wide range of congenital and acquired bleeding disorders. With regards to safety, the solvent/detergent technique apparently has the most favourable risk-benefit profile. Further research is needed to provide a comprehensive overview of the cost-effectiveness profile of the different pathogen-reduction techniques. The wide heterogeneity of results and the lack of comparative evidence are reasons why more comparative studies need to be performed. PMID:27403740

  1. The European Power System. Decarbonization and Cost Reduction: Lost in Transmissions?

    International Nuclear Information System (INIS)

    Jaureguy-Naudin, Maite

    2012-01-01

    Europe's energy policy is commonly defined by three axes of equal importance: security of supplies, competitiveness and sustainable development. The European Commission is mandated to develop the policy tools that allow the implementation of this common policy. Early on, challenges arose from the trade-offs to be made not only between these three pillars but also between a common European policy and national approaches. The European Commission has always had to struggle in attempting to keep a balanced line. Over the past twenty years, the EU has been engaged in the liberalization of the electricity and gas sector. For a long time, liberalization was the main objective of European energy policy. Liberalization of the electricity sector was supposed to bring many benefits. Foremost, these included the more efficient allocation of generation and transmission capacities, and the enhancement of the competitiveness of the European economy as a whole, through lower energy costs. The trading of electricity output between countries was part of this strategy. Interconnections are vital to facilitating electricity trade between Member States. It is in this context that interest in cross-border interconnections has increased. However, new constraints have emerged and have put climate change at the top of European agenda. In December 2008, as part of the fight against climate change, the European Union adopted its Energy and Climate package endorsing three objectives for 2020: i) a 20% increase in energy efficiency, ii) a 20% reduction in GHG emissions (compared to 1990), and iii) a 20% share of renewable energy sources in final energy consumption. A direct consequence of the later objective is that renewable energy sources (RES) in electricity generation are expected to expand from 20.3% of electricity output in 2010, to around 33%, in order to meet the objective set by the European Commission. Hydroelectric power has limited additional potential due to geographical

  2. Comparison of cost effectiveness of risk reduction among different energy systems: French case studies. Final report of the co-ordinated research programme

    International Nuclear Information System (INIS)

    Lochard, Jacques

    1989-08-01

    This report presents the three French case studies performed in the framework of the coordinated research program on 'Comparison of Cost-effectiveness of Risk Reduction among different Energy Systems': Cost effectiveness of robotics and remote tooling for occupational risk reduction at a nuclear fuel fabrication facility; Cost-effectiveness of protection actions to reduce occupational exposures in underground uranium mines; Cost-effectiveness of safety measures to reduce public risk associated with the transportation of UF 6 by truck and trains

  3. [Costs of maternal-infant care in an institutionalized health care system].

    Science.gov (United States)

    Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L

    1998-01-01

    Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.

  4. Remarks on the influence of enrichment reduction on fuel cycle costs

    International Nuclear Information System (INIS)

    Krull, W.

    1985-01-01

    The cost factors influencing the fuel cycle cost analysis for research reactors are discussed in detail with special emphasis on fuel element fabrication costs, burnup and reprocessing costs. Two different aspects for the conversion from HEU to LEU are considered: plus 14% U-235 weight per LEU fuel element and plus ca. 50 % U-235 weight per LEU fuel element. The cost factors and these conversion aspects were taken for calculating the changes in fuel cycle costs for the three different meat materials U 3 O 8 , U 3 Si 2 and U 3 Si. The results of these calculations can be summarized as following: - if in the HEU case the fuel loading and the burnup of a fuel element is low there will be some economic advantages in the LEU case; - if in the HEU case the fuel loading and the burnup of a fuel element is high there will be economic disadvantages in the LEU case. (author)

  5. Cost-income analysis of oral health units of health care centers in Yazd city

    Directory of Open Access Journals (Sweden)

    Hosein Fallahzadeh

    2012-01-01

    Full Text Available Background and Aims: Increasing demands for health care's services on one hand and limited resources on the other hand brings about pressure over governments to find out a mechanism for fair and appropriate distribution of resources. Economic analysis is one of the appropriate tools for policy making on this priority. The aim of this study was to assess capital and consumption of oral health units of health care centers in Yazd city and comparing it with revenue of these centers and determining of cost effectiveness.Materials and Methods: In this descriptive cross sectional study, all health care centers of Yazd city with active dentistry department were evaluated. The data has been extracted from current documents in health care center of county based issued receipts and daily information registers.Results: Expended cost for providing of oral hygiene services in second half of 2008 in 13 medical health centers of Yazd included active dentistry section was 557.887.500 Rials and revenue to cost ratio was about 34%. The most provided service was related to tooth extraction and the average of tooth restoration in each working day was 0.48.Conclusion: With attention to low tariffs of dentistry services in medical health centers and paying subsidy to target groups, expenses of oral hygiene are always more than its revenue.

  6. Reduction in sick leave and costs to society of patients with Meniere's disease after treatment of temporomandibular and cervical spine disorders: a controlled six-year cost-benefit study.

    Science.gov (United States)

    Bjorne, Assar; Agerberg, Göran

    2003-04-01

    This study compares the frequency of sick leave between the three-year period after and the three-year period before coordinated treatment of temporomandibular and cervical spine disorders in 24 patients (ten males and 14 females) diagnosed with Meniere's disease. The frequency of sick leave for the patients was also compared with the frequency of sick leave in a control group from the population. A cost-benefit analysis was made regarding the costs to society of sick leave related to the treatment costs of the patients. In a previous study the same patients were treated for their severe signs and symptoms of temporomandibular and cervical spine disorders, and they reported a substantial reduction in their vertigo, non-whirling dizziness, tinnitus, feeling of fullness in the ear, pain in the face and jaws, pain in the neck and shoulders, and headache. The number of days of sick leave and the year the patient began to receive disability pension due to the symptoms of Meniere's disease were obtained from the National Health Insurance Service in Sweden. Two of the patients received disability pension benefits due to Meniere's disease 17 years prior to their normal retirement pension. A third patient received disability pension for another reason and two were receiving a retirement pension. Data on the remaining 19 patients showed a considerable reduction in number of days of sick leave during the three-year period after coordinated treatment (270 days) compared with the three-year period before the treatment (1,536 days). The control subjects used a total of 14 days sick leave for the same symptoms during the same six-year period. Vertigo (nine days) was the dominant cause followed by pain in the neck and shoulders, and headache. The reduction in sick leave for the 19 nonretired patients and the treatment costs for the 24 patients can be used for a simple cost-benefit calculation for the subgroup of nonretired patients. During the first three years after treatment the

  7. Liberalised electricity markets, new bioenergy technologies, and GHG emission reductions: interactions and CO2 mitigation costs

    International Nuclear Information System (INIS)

    Gustavsson, L.; Madlener, R.

    1999-01-01

    We contrast recent developments in power and heat production with bioenergy, and natural-gas-fired condensing plants with and without decarbonisation, in the light of electricity market liberalisation. Our main focus is on CO 2 mitigation costs and carbon tax sensitivity of production costs. We find that CO 2 mitigation costs are lower for biomass systems using IGCC technology than for natural gas system using decarbonisation. However, based on current fuel prices natural-gas fired co-generation plants have the lowest production costs. Hence energy policy measures will be needed to promote biomass technologies and decarbonisation options on a liberalised market. (author)

  8. Do Statins Reduce the Health and Health Care Costs of Obesity?

    Science.gov (United States)

    Gaudette, Étienne; Goldman, Dana P; Messali, Andrew; Sood, Neeraj

    2015-07-01

    Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Because of the relationship between obesity and hypercholesterolaemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae. Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM)-an established dynamic microsimulation model of the health of Americans aged over 50 years-we estimate the changes in life expectancy, functional status and health care costs of obesity due to the introduction and widespread use of statins. Life expectancy gains of statins are estimated to be 5-6 % greater for obese individuals than for healthy-weight individuals, but most of these additional gains are associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and 2 obesity (body mass index [BMI] ≥30 and ≥35 kg/m(2), respectively) and they increase the costs of class 3 obesity (BMI ≥40 kg/m(2)) by 1.2 %. Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity.

  9. Preventing Obesity in the USA: Impact on Health Service Utilization and Costs.

    Science.gov (United States)

    Cecchini, Michele; Sassi, Franco

    2015-07-01

    With more than two-thirds of the US population overweight or obese, the obesity epidemic is a major threat for population health and the financial sustainability of the healthcare service. Whether, and to what extent, effective prevention interventions may offer the opportunity to 'bend the curve' of rising healthcare costs is still an object of debate. This study evaluates the potential economic impact of a set of prevention programmes, including education, counselling, long-term drug treatment, regulation (e.g. of advertising or labelling) and fiscal measures, on national healthcare expenditure and use of healthcare services in the USA. The study was carried out as a retrospective evaluation of alternative scenarios compared with a 'business as usual' scenario. An advanced econometric approach involving the use of logistic regression and generalized linear models was used to calculate the number of contacts with key healthcare services (inpatient, outpatient, drug prescriptions) and the associated cost. Analyses were carried out on the Medical Expenditure Panel Survey (1997-2010). In 2010, prevention interventions had the potential to decrease total healthcare expenditure by up to $US2 billion. This estimate does not include the implementation costs. The largest share of savings is produced by reduced use and costs of inpatient care, followed by reduced use of drugs. Reduction in expenditure for outpatient care would be more limited. Private insurance schemes benefit from the largest savings in absolute terms; however, public insurance schemes benefit from the largest cost reduction per patient. People in the lowest income groups show the largest economic benefits. Prevention interventions aimed at tackling obesity and associated risk factors may produce a significant decrease in the use of healthcare services and expenditure. Savings become substantial when a long-term perspective is taken.

  10. The cost effectiveness of NHS physiotherapy support for occupational health (OH services

    Directory of Open Access Journals (Sweden)

    Phillips Ceri J

    2012-02-01

    Full Text Available Abstract Background Musculoskeletal pain is detrimental to quality of life (QOL and disruptive to activities of daily living. It also places a major economic burden on healthcare systems and wider society. In 2006, the Welsh Assembly Government (WAG established a three tiered self-referral Occupational Health Physiotherapy Pilot Project (OHPPP comprising: 1. telephone advice and triage, 2. face-to-face physiotherapy assessment and treatment if required, and 3. workplace assessment and a return-to-work facilitation package as appropriate. This study aimed to evaluate the feasibility and cost-effectiveness of the pilot service. Methods A pragmatic cohort study was undertaken, with all OHPPP service users between September 2008 and February 2009 being invited to participate. Participants were assessed on clinical status, yellow flags, sickness absence and work performance at baseline, after treatment and at 3 month follow up. Cost-effectiveness was evaluated from both top-down and bottom-up perspectives and cost per Quality Adjusted Life Year (cost/QALY was calculated. The cost-effectiveness analysis assessed the increase in service cost that would be necessary before the cost-effectiveness of the service was compromised. Results A total of 515 patients completed questionnaires at baseline. Of these, 486 were referred for face to face assessment with a physiotherapist and were included in the analysis for the current study. 264 (54.3% and 199 (40.9% were retained at end of treatment and 3 month follow up respectively. An improvement was observed at follow up in all the clinical outcomes assessed, as well as a reduction in healthcare resource usage and sickness absence, and improvement in self-reported work performance. Multivariate regression indicated that baseline and current physical health were associated with work-related outcomes at follow up. The costs of the service were £194-£360 per service user depending on the method used, and the

  11. Health care quality, access, cost, workforce, and surgical education: the ultimate perfect storm.

    Science.gov (United States)

    Schwartz, Marshall Z

    2012-01-01

    The discussions on health care reform over the past two years have focused on cost containment while trying to maintain quality of care. Focusing on just cost and quality unfortunately does not address other very important factors that impact on our health care delivery system. Availability of a well-trained workforce, maintaining the sophisticated medical/surgical education system, and ultimately access to quality care by the public are critical to maintaining and enhancing our health care delivery system. Unfortunately, all five of these components are under at risk. Thus, we have evolving the ultimate perfect storm affecting our health care delivery system. Although not ideal and given the uniqueness of our population and their expectations, our current delivery system is excellent compared to other countries. However, the cost of our current system is rising at an alarming rate. Currently, health care consumes 17% of our gross domestic product. If our system is not revised this will continue to rise and by 2025 it will consume 48%. The dilemma, given the current state of our overall economy and rising debt, is how to address this major problem. Unfortunately, the Affordable Care Act, which is now law, does not address most of the issues and the cost was initially grossly under estimated. Furthermore, the law does not address the issues of workforce, maintaining our medical education system or ultimately, access. A major revision of our system will be necessary to truly create a system that protects and enhances all five of the components of our health care delivery system. To effectively accomplish this will require addressing those issues that lead to wasteful spending and diversion of our health care dollars to profit instead of care. Improved and efficient delivery systems that reduce complications, reduction of duplication of tertiary and quaternary programs or services within the same markets (i.e. regionalization of care), health insurance reform, and

  12. Costs, health effects and cost-effectiveness of alcohol and tobacco control strategies in Estonia.

    NARCIS (Netherlands)

    Lai, T.; Habicht, J.; Reinap, M.; Chisholm, D.; Baltussen, R.M.P.M.

    2007-01-01

    OBJECTIVE: To assess the population-level costs, effects and cost-effectiveness of different alcohol and tobacco control strategies in Estonia. DESIGN: A WHO cost-effectiveness modelling framework was used to estimate the total costs and effects of interventions. Costs were assessed in Estonian

  13. Insourcing as a Stratagy for Cost Reduction: a Methodology to Identifiy and Mensurate the Supporting Decition Factors

    Directory of Open Access Journals (Sweden)

    Geraldo Magela Ribeiro dos Santos

    2015-08-01

    Full Text Available The 2008, market crisis made the national siderurgy industry reconsider its cost structure in order to maintain its competitiveness. Among the adopted strategies, insourcing was used in order to reduce costs and improve its productive capacity from its people and equipments resulting from declining sales. This research has been developed within this context and has as its objective to quantify the results of this choice. In order to achieve this objective, an insourcing case study of mechanical maintenance at ArcelorMittal Tubarão (AMT was used. Among the main advantages of insourcing at AMT are: the reduction of 24, 41% in maintenance services costs; a reduction in the level of rework and the level of lost time injuries (LTI; increased productivity and the index for available time fulfillment on shutdown. The factors that most contributed for the services insourcing are: collective bargaining agreements of the contractors higher than those of contracting and the incidence of profit, management fees (rates administration and taxes on the cost of labor and benefits to employees. This research also concludes that if the service prices of third parties were only adjusted based upon the inflation index (INPC over the last ten years, the insourcing of services, if viewed from the costs standpoint, would have been unfeasible.

  14. Opportunities for cost reduction and improved environmental impact in the lead and lead/acid battery industries

    Science.gov (United States)

    Lewis, N.

    The opportunities for cost reduction through improved environmental performance exist in many companies, but often are not realized. This paper describes the efforts of a typical firm — Calder Industrial Materials (CIM) — that is experiencing ever-tighter environmental controls and profit erosion through the effects of new environmental legislation. At the same time, however, CIM sees opportunities to reduce its environmental burden and cut costs. As the story unfolds, readers may well discover many parallels with their own companies. It may even spur some into action, for remember, every £1000 saved requires ten times the turnover to generate the same profit.

  15. The economic perspective: demand and supply in the reduction of transaction costs in the ancient world

    NARCIS (Netherlands)

    Dari-Mattiacci, G.; Kehoe, D.P.; Ratzan, D.M.; Yiftach, U.

    2015-01-01

    In this chapter, I distill some elements of the demand and supply of institutions designed to reduce transaction costs in the ancient world. I some cases, contractual parties could reduce transaction cost by accurately designing contracts. In other cases, the failure of private coordination placed

  16. Health and economic costs of alternative energy sources

    International Nuclear Information System (INIS)

    Hamilton, L.D.; Manne, A.S.

    1977-01-01

    National energy policy requires realistic totaling of costs in assessing energy alternatives. The Biomedical and Environmental Assessment Division (BEAD) at Brookhaven is estimating biomedical and environmental costs of energy production and use. All forms of energy, including new technologies, are being considered. Beginning with a compilation of pollutants from the energy system, the various paths to man are traced and health effects evaluated. Excess mortality and morbidity in the U.S. attributable to a total fuel cycle to produce 6.6x10 9 kwh - about a year's production of a 1000-MWe power plant - are being estimated. Where enough information is available, estimates are quantitative. In some instances only the nature of the potential hazard can be described. This assessment aims at providing initial estimates of relative impacts to identify where the important health hazards in each fuel cycle arise, thereby identifying key areas for judging the total costs of alternative energy sources, and those areas of research likely to improve the accuracy of the estimates. It was thus estimated that the production of electric power from all sources in the U.S. in 1975 was associated with between two to nineteen thousand deaths and twenty-nine to fourty-eight thousand disabilities; this is roughly between 0.2 and 2% of total deaths in U.S. ages 1-74. The estimated health effects associated with a total fuel cycle standardized to produce 10 10 kwh electric power were: from coal estimated deaths 20-200, estimated disabilities 300-500; from oil estimated deaths 3-150, estimated disabilities 150-300; from gas estimated deaths 0.2, estimated disabilities 20; from nuclear estimated deaths 1-3, estimated disabilities 8-30. The differences in the year 2000 between health impacts of the U.S. energy system under normal growth expectations and under conditions of a nuclear moratorium were estimated. On the assumption that the nuclear moratorium would require 320 additional 1000-MWe

  17. Multi-strategy based quantum cost reduction of linear nearest-neighbor quantum circuit

    Science.gov (United States)

    Tan, Ying-ying; Cheng, Xue-yun; Guan, Zhi-jin; Liu, Yang; Ma, Haiying

    2018-03-01

    With the development of reversible and quantum computing, study of reversible and quantum circuits has also developed rapidly. Due to physical constraints, most quantum circuits require quantum gates to interact on adjacent quantum bits. However, many existing quantum circuits nearest-neighbor have large quantum cost. Therefore, how to effectively reduce quantum cost is becoming a popular research topic. In this paper, we proposed multiple optimization strategies to reduce the quantum cost of the circuit, that is, we reduce quantum cost from MCT gates decomposition, nearest neighbor and circuit simplification, respectively. The experimental results show that the proposed strategies can effectively reduce the quantum cost, and the maximum optimization rate is 30.61% compared to the corresponding results.

  18. Health benefits of PM10 reduction in Iran

    Science.gov (United States)

    Marzouni, Mohammad Bagherian; Moradi, Mahsa; Zarasvandi, Alireza; Akbaripoor, Shayan; Hassanvand, Mohammad Sadegh; Neisi, Abdolkazem; Goudarzi, Gholamreza; Mohammadi, Mohammad Javad; Sheikhi, Reza; Kermani, Majid; Shirmardi, Mohammad; Naimabadi, Abolfazl; Gholami, Moeen; Mozhdehi, Saeed Pourkarim; Esmaeili, Mehdi; Barari, Kian

    2017-08-01

    Air pollution contains a complex mixture of poisonous compounds including particulate matter (PM) which has wide spectrum of adverse health effects. The main purpose of this study was to estimate the potential health impacts or benefits due to any changes in annual PM10 level in four major megacities of Iran. The required data of PM10 for AirQ software was collected from air quality monitoring stations in four megacities of Iran. The preprocessing was carried out using macro coding in excel environment. The relationship between different presumptive scenarios and health impacts was determined. We also assessed the health benefits of reducing PM10 to WHO Air Quality Guidelines (WHO-AQGs) and National Ambient Air Quality Standards (NAAQSs) levels with regard to the rate of mortality and morbidity in studied cities. We found that the 10 μg/m3 increase in annual PM10 concentration is responsible for seven (95% CI 6-8) cases increase in total number of deaths per 2 × 105 person. We also found that 10.7, 7.2, 5.7, and 5.3% of total death is attributable to short-term exposure to air pollution for Ahvaz, Isfahan, Shiraz, and Tehran, respectively. We found that by attaining the WHO's proposed value for PM10, the potential health benefits of 89, 84, 79, and 78% were obtained in Ahvaz, Isfahan, Shiraz, and Tehran, respectively. The results also indicated that 27, 10, 3, and 1% of health impacts were attributed to dust storm days for Ahvaz, Isfahan, Shiraz, and Tehran, respectively.

  19. Modeling the cost-effectiveness of health care systems for alcohol use disorders: how implementation of eHealth interventions improves cost-effectiveness

    NARCIS (Netherlands)

    Smit, Filip; Lokkerbol, Joran; Riper, Heleen; Majo, Maria Cristina; Boon, Brigitte; Blankers, Matthijs

    2011-01-01

    Informing policy decisions about the cost-effectiveness of health care systems (ie, packages of clinical interventions) is probably best done using a modeling approach. To this end, an alcohol model (ALCMOD) was developed. The aim of ALCMOD is to estimate the cost-effectiveness of competing health

  20. What Contributes Most to High Health Care Costs? Health Care Spending in High Resource Patients.

    Science.gov (United States)

    Pritchard, Daryl; Petrilla, Allison; Hallinan, Shawn; Taylor, Donald H; Schabert, Vernon F; Dubois, Robert W

    2016-02-01

    U.S. health care spending nearly doubled in the decade from 2000-2010. Although the pace of increase has moderated recently, the rate of growth of health care costs is expected to be higher than the growth in the economy for the near future. Previous studies have estimated that 5% of patients account for half of all health care costs, while the top 1% of spenders account for over 27% of costs. The distribution of health care expenditures by type of service and the prevalence of particular health conditions for these patients is not clear, and is likely to differ from the overall population. To examine health care spending patterns and what contributes to costs for the top 5% of managed health care users based on total expenditures. This retrospective observational study employed a large administrative claims database analysis of health care claims of managed care enrollees across the full age and care spectrum. Direct health care expenditures were compared during calendar year 2011 by place of service (outpatient, inpatient, and pharmacy), payer type (commercially insured, Medicare Advantage, and Medicaid managed care), and therapy area between the full population and high resource patients (HRP). The mean total expenditure per HRP during calendar year 2011 was $43,104 versus $3,955 per patient for the full population. Treatment of back disorders and osteoarthritis contributed the largest share of expenditures in both HRP and the full study population, while chronic renal failure, heart disease, and some oncology treatments accounted for disproportionately higher expenditures in HRP. The share of overall expenditures attributed to inpatient services was significantly higher for HRP (40.0%) compared with the full population (24.6%), while the share of expenditures attributed to pharmacy (HRP = 18.1%, full = 21.4%) and outpatient services (HRP = 41.9%, full = 54.1%) was reduced. This pattern was observed across payer type. While the use of physician

  1. Cost and Performance Report for Reductive Anaerobic Biological in Situ Treatment Technology (RABITT) Treatability Testing

    National Research Council Canada - National Science Library

    Alleman, Bruce

    2003-01-01

    Enhanced biological reductive dechlorination (EBRD) shows a great deal of promise for efficiently treating groundwater contaminated with chlorinated solvents, but demonstration sites around the country were reporting mixed results...

  2. Reduction of medication costs after detoxification for medication-overuse headache.

    Science.gov (United States)

    Shah, Asif M; Bendtsen, Lars; Zeeberg, Peter; Jensen, Rigmor H

    2013-04-01

    To examine whether detoxifying patients with medication-overuse headache can reduce long-term medication costs. Direct costs of medications in medication-overuse headache have been reported to be very high but have never been calculated on the basis of exact register data. Long-term economic savings obtained by detoxification have never been investigated. We conducted a registry-based observational retrospective follow-up study on 336 medication-overuse headache patients treated and discharged from the Danish Headache Center over a 2-year period. By means of the Danish Register of Medicinal Product Statistics, we collected information on the costs and use of prescription-only medication 1 year before admission and 1 year after discharge from Danish Headache Center. The average medication costs per patient per year decreased with 24%, from US$971 before treatment to US$737 after (P = .001), and the average medication use decreased with 14.4% (P = .02). Savings were most pronounced for patients overusing triptans. In this group, the average medication costs per patient per year decreased with 43% (P headache at a tertiary headache center has a long-lasting effect on the medication costs and use, in particular among patients overusing triptans. The results may not be generalizable to all countries and may be sensitive to the costs of triptans. © 2012 American Headache Society.

  3. Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

    Science.gov (United States)

    Tucker, Larry A.; Clegg, Alan G.

    2002-01-01

    Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…

  4. Methodology and applications for the benefit cost analysis of the seismic risk reduction in building portfolios at broadscale

    OpenAIRE

    Valcarcel, Jairo A.; Mora, Miguel G.; Cardona, Omar D.; Pujades, Lluis G.; Barbat, Alex H.; Bernal, Gabriel A.

    2013-01-01

    This article presents a methodology for an estimate of the benefit cost ratio of the seismic risk reduction in buildings portfolio at broadscale, for a world region, allowing comparing the results obtained for the countries belonging to that region. This methodology encompasses (1) the generation of a set of random seismic events and the evaluation of the spectral accelerations at the buildings location; (2) the estimation of the buildings built area, the economic value, as well as the cla...

  5. Making choices in health: WHO guide to cost effectiveness analysis

    National Research Council Canada - National Science Library

    Tan Torres Edejer, Tessa

    2003-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . XXI PART ONE: METHODS COST-EFFECTIVENESS FOR GENERALIZED ANALYSIS 1. 2. What is Generalized Cost-Effectiveness Analysis? . . . . . . . . . . . . 3 Undertaking...

  6. Economic impact of hand and wrist injuries: Health-care costs and productivity costs in a population-based study

    NARCIS (Netherlands)

    C.E. de Putter (Dennis); R.W. Selles (Ruud); S. Polinder (Suzanne); M.J.M. Panneman (Martien); S.E.R. Hovius (Steven); E.F. van Beeck (Ed)

    2012-01-01

    textabstractBackground: Injuries to the hand and wrist account for approximately 20% of patient visits to emergency departments and may impose a large economic burden. The purpose of this study was to estimate the total health-care costs and productivity costs of injuries to the hand and wrist and

  7. Epilepsy in Sweden: health care costs and loss of productivity--a register-based approach.

    Science.gov (United States)

    Bolin, Kristian; Lundgren, Anders; Berggren, Fredrik; Källén, Kristina

    2012-12-01

    The objective was to estimate health care costs and productivity losses due to epilepsy in Sweden and to compare these estimates to previously published estimates. Register data on health care utilisation, pharmaceutical sales, permanent disability and mortality were used to calculate health care costs and costs that accrue due to productivity losses. By linkage of register information, we were able to distinguish pharmaceuticals prescribed against epilepsy from prescriptions that were prompted by other indications. The estimated total cost of epilepsy in Sweden in 2009 was 441 million, which corresponds to an annual per-patient cost of 8,275. Health care accounted for about 16% of the estimated total cost, and drug costs accounted for about 7% of the total cost. The estimated health care cost corresponded to about 0.2% of the total health care cost in Sweden in 2009. Indirect costs were estimated at 370 million, 84% of which was due to sickness absenteeism. Costs resulting from epilepsy-attributable premature deaths or permanent disability to work accounted for about 1% of the total indirect cost in Sweden in 2009. The per-patient cost of epilepsy is substantial. Thus, even though the prevalence of the illness is relatively small, the aggregated cost that epilepsy incurs on society is significant.

  8. Cooperation control strategies for China's cross-region pollution in a lake basin based on green reduction cost.

    Science.gov (United States)

    Li, Changmin; Sun, Dong; Xie, Xiaoqiang; Xue, Jian

    2016-05-01

    The cross-region water pollution issue has always been the widespread concern around the world. It becomes especially critical for China due to the imbalance relates to environmental costs that have accompanied rapid growth of economy. Though the government makes great efforts to improve it, the potential for water pollution conflict is still great. We consider the problem of determining combined control strategies for China's cross-region lake pollution based on the environmental green costs. The problem is first formulated as a generalized bilevel mathematical program where the upper level consists in each region that reduces environmental green costs including three parts: the reduction cost, pollution permit trade cost and cost of environment damage, while the lower level is represented by pollution permit equilibrium market. Finally, we take an empirical analysis in Taihu lake. The numerical study shows that the minimum costs of both total and regional are obviously superior to the current processing costs, which provides theoretical basis for the price of emission permits. Today, China's rapid gross domestic product (GDP) growth has come at a very high cost, as real estate prices have skyrocketed, the wealth gap has widened, and environmental pollution has worsened. China's central government is urged to correct the GDP-oriented performance evaluation system that is used to judge administrative region leaders. The cross-region water pollution issue has become a troubling issue that urgently needs to be resolved in China. This paper will not only actively aid efforts to govern Lake Taihu and other cross-region valleys, but it will also provide a supplement for theoretical research on cross-region pollution issues.

  9. Resolving the "Cost-Effective but Unaffordable" Paradox: Estimating the Health Opportunity Costs of Nonmarginal Budget Impacts.

    Science.gov (United States)

    Lomas, James; Claxton, Karl; Martin, Stephen; Soares, Marta

    2018-03-01

    Considering whether or not a proposed investment (an intervention, technology, or program of care) is affordable is really asking whether the benefits it offers are greater than its opportunity cost. To say that an investment is cost-effective but not affordable must mean that the (implicit or explicit) "threshold" used to judge cost-effectiveness does not reflect the scale and value of the opportunity costs. Existing empirical estimates of health opportunity costs are based on cross-sectional variation in expenditure and mortality outcomes by program budget categories (PBCs) and do not reflect the likely effect of nonmarginal budget impacts on health opportunity costs. The UK Department of Health regularly updates the needs-based target allocation of resources to local areas of the National Health Service (NHS), creating two subgroups of local areas (those under target allocation and those over). These data provide the opportunity to explore how the effects of changes in health care expenditure differ with available resources. We use 2008-2009 data to evaluate two econometric approaches to estimation and explore a range of criteria for accepting subgroup specific effects for differences in expenditure and outcome elasticities across the 23 PBCs. Our results indicate that health opportunity costs arising from an investment imposing net increases in expenditure are underestimated unless account is taken of likely nonmarginal effects. They also indicate the benefits (reduced health opportunity costs or increased value-based price of a technology) of being able to "smooth" these nonmarginal budget impacts by health care systems borrowing against future budgets or from manufacturers offering "mortgage" type arrangements. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  10. Costs and Cost-Effectiveness of Hypertension Screening and Treatment in Adults with Hypertension in Rural Nigeria in the Context of a Health Insurance Program.

    Directory of Open Access Journals (Sweden)

    Nicole T A Rosendaal

    Full Text Available High blood pressure is a leading risk factor for death and disability in sub-Saharan Africa (SSA. We evaluated the costs and cost-effectiveness of hypertension care provided within the Kwara State Health Insurance (KSHI program in rural Nigeria.A Markov model was developed to assess the costs and cost-effectiveness of population-level hypertension screening and subsequent antihypertensive treatment for the population at-risk of cardiovascular disease (CVD within the KSHI program. The primary outcome was the incremental cost per disability-adjusted life year (DALY averted in the KSHI scenario compared to no access to hypertension care. We used setting-specific and empirically-collected data to inform the model. We defined two strategies to assess eligibility for antihypertensive treatment based on 1 presence of hypertension grade 1 and 10-year CVD risk of >20%, or grade 2 hypertension irrespective of 10-year CVD risk (hypertension and risk based strategy and 2 presence of hypertension in combination with a CVD risk of >20% (risk based strategy. We generated 95% confidence intervals around the primary outcome through probabilistic sensitivity analysis. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the reference scenario.Screening and treatment for hypertension was potentially cost-effective but the results were sensitive to changes in underlying assumptions with a wide range of uncertainty. The incremental cost-effectiveness ratio for the first and second strategy respectively ranged from US$ 1,406 to US$ 7,815 and US$ 732 to US$ 2,959 per DALY averted, depending on the assumptions on risk reduction after treatment and compared to no access to antihypertensive treatment.Hypertension care within a subsidized private health insurance program may be cost-effective in rural Nigeria and public-private partnerships such as the KSHI program may provide opportunities

  11. A scoping study on the costs of indoor air quality illnesses:an insurance loss reduction perspective

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Allan; Vine, Edward L.

    1998-08-31

    The incidence of commercial buildings with poor indoor air quality (IAQ), and the frequency of litigation over the effects of poor IAQ is increasing. If so, these increases have ramifications for insurance carriers, which pay for many of the costs of health care and general commercial liability. However, little is known about the actual costs to insurance companies from poor IAQ in buildings. This paper reports on the results of a literature search of buildings-related, business and legal databases, and interviews with insurance and risk management representatives aimed at finding information on the direct costs to the insurance industry of poor building IAQ, as well as the costs of litigation. The literature search and discussions with insurance and risk management professionals reported in this paper turned up little specific information about the costs of IAQ-related problems to insurance companies. However, those discussions and certain articles in the insurance industry press indicate that there is a strong awareness and growing concern over the "silent crisis" of IAQ and its potential to cause large industry losses, and that a few companies are taking steps to address this issue. The source of these losses include both direct costs to insurers from paying health insurance and professional liability claims, as weIl as the cost of litigation. In spite of the lack of data on how IAQ-related health problems affect their business, the insurance industry has taken the anecdotal evidence about their reality seriously enough to alter their policies in ways that have lessened their exposure. We conclude by briefly discussing four activities that need to be addressed in the near future: (1) quantifying IAQ-related insurance costs by sector, (2) educating the insurance industry about the importance of IAQ issues, (3) examining IAQ impacts on the insurance industry in the residential sector, and (4) evaluating the relationship between IAQ improvements and their impact on

  12. OPTIMIZATION METHOD AND SOFTWARE FOR FUEL COST REDUCTION IN CASE OF ROAD TRANSPORT ACTIVITY

    Directory of Open Access Journals (Sweden)

    György Kovács

    2017-06-01

    Full Text Available The transport activity is one of the most expensive processes in the supply chain and the fuel cost is the highest cost among the cost components of transportation. The goal of the research is to optimize the transport costs in case of a given transport task both by the selecting the optimal petrol station and by determining the optimal amount of the refilled fuel. Recently, in practice, these two decisions have not been made centrally at the forwarding company, but they depend on the individual decision of the driver. The aim of this study is to elaborate a precise and reliable mathematical method for selecting the optimal refuelling stations and determining the optimal amount of the refilled fuel to fulfil the transport demands. Based on the elaborated model, new decision-supporting software is developed for the economical fulfilment of transport trips.

  13. External costs of PM2.5 pollution in Beijing, China: Uncertainty analysis of multiple health impacts and costs

    International Nuclear Information System (INIS)

    Yin, Hao; Pizzol, Massimo; Xu, Linyu

    2017-01-01

    Some cities in China are facing serious air pollution problems including high concentrations of particles, SO 2 and NO x . Exposure to PM2.5, one of the primary air pollutants in many cities in China, is highly correlated with various adverse health impacts and ultimately represents a cost for society. The aim of this study is to assess health impacts and external costs related to PM2.5 pollution in Beijing, China with different baseline concentrations and valuation methods. The idea is to provide a reasonable estimate of the total health impacts and external cost due to PM2.5 pollution, as well as a quantification of the relevant uncertainty. PM2.5 concentrations were retrieved for the entire 2012 period in 16 districts of Beijing. The various PM2.5 related health impacts were identified and classified to avoid double counting. Exposure-response coefficients were then obtained from literature. Both the value of statistical life (VSL) and the amended human capital (AHC) approach were applied for external costs estimation, which could provide the upper and lower bound of the external costs due to PM2.5. To fully understand the uncertainty levels, the external cost distribution was determined via Monte Carlo simulation based on the uncertainty of the parameters such as PM2.5 concentration, exposure-response coefficients, and economic cost per case. The results showed that the external costs were equivalent to around 0.3% (AHC, China's guideline: C 0  = 35 μg/m 3 ) to 0.9% (VSL, WHO guideline: C 0  = 10 μg/m 3 ) of regional GDP depending on the valuation method and on the assumed baseline PM2.5 concentration (C 0 ). Among all the health impacts, the economic loss due to premature deaths accounted for more than 80% of the overall external costs. The results of this study could help policymakers prioritizing the PM2.5 pollution control interventions and internalize the external costs through the application of economic policy instruments. - Highlights:

  14. Billing and insurance-related administrative costs in United States' health care: synthesis of micro-costing evidence.

    Science.gov (United States)

    Jiwani, Aliya; Himmelstein, David; Woolhandler, Steffie; Kahn, James G

    2014-11-13

    The United States' multiple-payer health care system requires substantial effort and costs for administration, with billing and insurance-related (BIR) activities comprising a large but incompletely characterized proportion. A number of studies have quantified BIR costs for specific health care sectors, using micro-costing techniques. However, variation in the types of payers, providers, and BIR activities across studies complicates estimation of system-wide costs. Using a consistent and comprehensive definition of BIR (including both public and private payers, all providers, and all types of BIR activities), we synthesized and updated available micro-costing evidence in order to estimate total and added BIR costs for the U.S. health care system in 2012. We reviewed BIR micro-costing studies across healthcare sectors. For physician practices, hospitals, and insurers, we estimated the % BIR using existing research and publicly reported data, re-calculated to a standard and comprehensive definition of BIR where necessary. We found no data on % BIR in other health services or supplies settings, so extrapolated from known sectors. We calculated total BIR costs in each sector as the product of 2012 U.S. national health expenditures and the percentage of revenue used for BIR. We estimated "added" BIR costs by comparing total BIR costs in each sector to those observed in existing, simplified financing systems (Canada's single payer system for providers, and U.S. Medicare for insurers). Due to uncertainty in inputs, we performed sensitivity analyses. BIR costs in the U.S. health care system totaled approximately $471 ($330 - $597) billion in 2012. This includes $70 ($54 - $76) billion in physician practices, $74 ($58 - $94) billion in hospitals, an estimated $94 ($47 - $141) billion in settings providing other health services and supplies, $198 ($154 - $233) billion in private insurers, and $35 ($17 - $52) billion in public insurers. Compared to simplified financing, $375

  15. A technical framework for costing health workforce retention schemes in remote and rural areas

    NARCIS (Netherlands)

    Zurn, P.; Vujicic, M.; Lemiere, C.; Juquois, M.; Stormont, L.; Campbell, J.; Rutten, M.M.; Braichet, J.M.

    2011-01-01

    Background: Increasing the availability of health workers in remote and rural areas through improved health workforce recruitment and retention is crucial to population health. However, information about the costs of such policy interventions often appears incomplete, fragmented or missing, despite

  16. Army Health Promotion, Risk Reduction, Suicide Prevention: Report 2010

    Science.gov (United States)

    2010-07-01

    tragedy or appear to be related to something as innocuous as a trip to the movies . Only after all the factors are examined does a complete and...leading Soldiers in garrison.  [All] Implement integration and reintegration programs at garrisons and units to ensure reception , integration and...post trailer . In Jan 09, the Soldier was medicated for back pain with tramadol (side effects include anxiety and confusion) (health transition). On