WorldWideScience

Sample records for health damage costs

  1. 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.

  2. NOx emissions from large point sources: variability in ozone production, resulting health damages and economic costs

    International Nuclear Information System (INIS)

    Mauzerall, D.L.; Namsoug Kim

    2005-01-01

    We present a proof-of-concept analysis of the measurement of the health damage of ozone (O 3 ) produced from nitrogen oxides (NO x =NO+NO 2 ) emitted by individual large point sources in the eastern United States. We use a regional atmospheric model of the eastern United States, the Comprehensive Air quality Model with Extensions (CAMx), to quantify the variable impact that a fixed quantity of NO x emitted from individual sources can have on the downwind concentration of surface O 3 , depending on temperature and local biogenic hydrocarbon emissions. We also examine the dependence of resulting O 3 -related health damages on the size of the exposed population. The investigation is relevant to the increasingly widely used 'cap and trade' approach to NO x regulation, which presumes that shifts of emission over time and space, holding the total fixed over the course of the summer O 3 season, will have minimal effect on the environmental outcome. By contrast, we show that a shift of a unit of NO x emissions from one place or time to another could result in large changes in resulting health effects due to O 3 formation and exposure. We indicate how the type of modeling carried out here might be used to attach externality-correcting prices to emissions. Charging emitters fees that are commensurate with the damage caused by their NO x emissions would create an incentive for emitters to reduce emissions at times and in locations where they cause the largest damage. (author)

  3. Air pollution policies in Europe: efficiency gains from integrating climate effects with damage costs to health and crops

    International Nuclear Information System (INIS)

    Tollefsen, Petter; Rypdal, Kristin; Torvanger, Asbjorn; Rive, Nathan

    2009-01-01

    Emissions of air pollutants cause damage to health and crops, but several air pollutants also have an effect on climate through radiative forcing. We investigate efficiency gains achieved by integrating climate impacts of air pollutants into air quality strategies for the EU region. The pollutants included in this study are SO 2 , NH 3 , VOC, CO, NO x , black carbon, organic carbon, PM 2.5 , and CH 4 . We illustrate the relative importance of climate change effects compared to damage to health and crops, as well as monetary gains of including climate change contributions. The analysis considers marginal abatement costs and compares air quality and climate damage in Euros. We optimize abatement policies with respect to both climate and health impacts, which imply implementing all measures that yield a net benefit. The efficiency gains of the integrated policy are in the order of 2.5 billion Euros, compared to optimal abatement based on health and crop damage only, justifying increased abatement efforts of close to 50%. Climate effect of methane is the single most important factor. If climate change is considered on a 20- instead of a 100-year time-scale, the efficiency gain almost doubles. Our results indicate that air pollution policies should be supplemented with climate damage considerations.

  4. Cost and benefit including value of life, health and environmental damage measured in time units

    DEFF Research Database (Denmark)

    Ditlevsen, Ove Dalager; Friis-Hansen, Peter

    2009-01-01

    Key elements of the authors' work on money equivalent time allocation to costs and benefits in risk analysis are put together as an entity. This includes the data supported dimensionless analysis of an equilibrium relation between total population work time and gross domestic product leading...... of this societal value over the actual costs, used by the owner for economically optimizing an activity, motivates a simple risk accept criterion suited to be imposed on the owner by the public. An illustration is given concerning allocation of economical means for mitigation of loss of life and health on a ferry...

  5. DIDEM - An integrated model for comparative health damage costs calculation of air pollution

    Science.gov (United States)

    Ravina, Marco; Panepinto, Deborah; Zanetti, Maria Chiara

    2018-01-01

    Air pollution represents a continuous hazard to human health. Administration, companies and population need efficient indicators of the possible effects given by a change in decision, strategy or habit. The monetary quantification of health effects of air pollution through the definition of external costs is increasingly recognized as a useful indicator to support decision and information at all levels. The development of modelling tools for the calculation of external costs can provide support to analysts in the development of consistent and comparable assessments. In this paper, the DIATI Dispersion and Externalities Model (DIDEM) is presented. The DIDEM model calculates the delta-external costs of air pollution comparing two alternative emission scenarios. This tool integrates CALPUFF's advanced dispersion modelling with the latest WHO recommendations on concentration-response functions. The model is based on the impact pathway method. It was designed to work with a fine spatial resolution and a local or national geographic scope. The modular structure allows users to input their own data sets. The DIDEM model was tested on a real case study, represented by a comparative analysis of the district heating system in Turin, Italy. Additional advantages and drawbacks of the tool are discussed in the paper. A comparison with other existing models worldwide is reported.

  6. Structural Health and Prognostics Management for Offshore Wind Turbines: Sensitivity Analysis of Rotor Fault and Blade Damage with O&M Cost Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Myrent, Noah J. [Vanderbilt Univ., Nashville, TN (United States). Lab. for Systems Integrity and Reliability; Barrett, Natalie C. [Vanderbilt Univ., Nashville, TN (United States). Lab. for Systems Integrity and Reliability; Adams, Douglas E. [Vanderbilt Univ., Nashville, TN (United States). Lab. for Systems Integrity and Reliability; Griffith, Daniel Todd [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Wind Energy Technology Dept.

    2014-07-01

    Operations and maintenance costs for offshore wind plants are significantly higher than the current costs for land-based (onshore) wind plants. One way to reduce these costs would be to implement a structural health and prognostic management (SHPM) system as part of a condition based maintenance paradigm with smart load management and utilize a state-based cost model to assess the economics associated with use of the SHPM system. To facilitate the development of such a system a multi-scale modeling and simulation approach developed in prior work is used to identify how the underlying physics of the system are affected by the presence of damage and faults, and how these changes manifest themselves in the operational response of a full turbine. This methodology was used to investigate two case studies: (1) the effects of rotor imbalance due to pitch error (aerodynamic imbalance) and mass imbalance and (2) disbond of the shear web; both on a 5-MW offshore wind turbine in the present report. Sensitivity analyses were carried out for the detection strategies of rotor imbalance and shear web disbond developed in prior work by evaluating the robustness of key measurement parameters in the presence of varying wind speeds, horizontal shear, and turbulence. Detection strategies were refined for these fault mechanisms and probabilities of detection were calculated. For all three fault mechanisms, the probability of detection was 96% or higher for the optimized wind speed ranges of the laminar, 30% horizontal shear, and 60% horizontal shear wind profiles. The revised cost model provided insight into the estimated savings in operations and maintenance costs as they relate to the characteristics of the SHPM system. The integration of the health monitoring information and O&M cost versus damage/fault severity information provides the initial steps to identify processes to reduce operations and maintenance costs for an offshore wind farm while increasing turbine availability

  7. Damage cost of the Dan River coal ash spill

    International Nuclear Information System (INIS)

    Dennis Lemly, A.

    2015-01-01

    The recent coal ash spill on the Dan River in North Carolina, USA has caused several negative effects on the environment and the public. In this analysis, I report a monetized value for these effects after the first 6 months following the spill. The combined cost of ecological damage, recreational impacts, effects on human health and consumptive use, and esthetic value losses totals $295,485,000. Because the environmental impact and associated economic costs of riverine coal ash spills can be long-term, on the order of years or even decades, this 6-month assessment should be viewed as a short-term preview. The total cumulative damage cost from the Dan River coal ash spill could go much higher. - Highlights: • Six-month post-spill damage cost exceeded $295,000,000. • Components of cost include ecological, recreational, human health, property, and aesthetic values. • Attempts by the electric utility to “clean” the river left over 95% of coal ash behind. • Long-term impacts will likely drive the total damage cost much higher. - Damage costs of the Dan River coal ash spill are extensive and growing. The 6-month cost of that spill is valued at $295,485,000, and the long-term total cost is likely to rise substantially

  8. 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...

  9. Calculating externalities from damages in occupational health and safety

    Energy Technology Data Exchange (ETDEWEB)

    Burtraw, D; Shefftz, J

    1994-07-01

    This paper surveys the theoretical basis for the possibility that coal miner occupational health and safety damages are not adequately internalized into the production cost of mining coal and thereby impose an external cost on society.

  10. Calculating externalities from damages in occupational health and safety

    International Nuclear Information System (INIS)

    Burtraw, D.; Shefftz, J.

    1994-01-01

    This paper surveys the theoretical basis for the possibility that coal miner occupational health and safety damages are not adequately internalized into the production cost of mining coal and thereby impose an external cost on society

  11. 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…

  12. Environmental damage costs in Iran by the energy sector

    International Nuclear Information System (INIS)

    Shafie-Pour, Majid; Ardestani, Mojtaba

    2007-01-01

    On the basis of the energy supply and demand, this paper assesses the environmental damage from air pollution in Iran using the Extern-E study that has extended over 10 years and is still in progress in the European Union (EU) commission. Damage costs were transferred from Western European practice to the conditions of Iran by scaling according to GDP per capital measured in PPP terms. Using this approach, the total health damage from air pollution in 2001 is assessed at about $7 billion; equivalent to 8.4% of nominal GDP. In the absence of price reform and control policies, it is estimated that damage in Iran will grow to $9 billion by 2019, in the money of 2001. This is equivalent to 10.9% of nominal GDP, i.e. a larger percentage of a larger GDP. Of this total, $8.4 billion comes from the transport sector. The damage cost to the global environment from the flaring of natural gas, assessed on the basis of a carbon price of $10/ton CO 2 and found to be approximately $600 million per year. This is equal to a little less than 1% of current GDP. There are larger costs associated with recovery and use of such gas, but equally there are large potential benefits

  13. Genetic doping and health damages.

    Science.gov (United States)

    Fallahi, Aa; Ravasi, Aa; Farhud, Dd

    2011-01-01

    Use of genetic doping or gene transfer technology will be the newest and the lethal method of doping in future and have some unpleasant consequences for sports, athletes, and outcomes of competitions. The World Anti-Doping Agency (WADA) defines genetic doping as "the non-therapeutic use of genes, genetic elements, and/or cells that have the capacity to enhance athletic performance ". The purpose of this review is to consider genetic doping, health damages and risks of new genes if delivered in athletes. This review, which is carried out by reviewing relevant publications, is primarily based on the journals available in GOOGLE, ELSEVIER, PUBMED in fields of genetic technology, and health using a combination of keywords (e.g., genetic doping, genes, exercise, performance, athletes) until July 2010. There are several genes related to sport performance and if they are used, they will have health risks and sever damages such as cancer, autoimmunization, and heart attack.

  14. Determinants of the property damage costs of tanker accidents

    International Nuclear Information System (INIS)

    Talley, W.K.

    1999-01-01

    This study investigates determinants of the vessel, oil cargo spillage, and other-property damage costs of tanker accidents. Tobit estimation of a three-equation recursive model suggests that, among types of tanker accidents, fire/explosion accidents incur the largest vessel damage costs, but the smallest oil cargo spillage costs. Alternatively, grounding accidents incur the smallest vessel damage costs, but the largest oil cargo spillage costs, reflecting the difficulty of controlling oil cargo spillage subsequent to such accidents. Also, oil cargo spillage costs are lower for US flag tanker accidents. A dollar of vessel damage cost increases other-property damage cost by 0.06 dollars, whereas a dollar of oil cargo spillage increases this cost by 1.55 dollars

  15. Passenger vehicles that minimize the costs of ownership and environmental damages in the Indian market

    International Nuclear Information System (INIS)

    Gilmore, Elisabeth A.; Patwardhan, Anand

    2016-01-01

    Highlights: • Full costs (private and social) are evaluated for Indian passenger cars. • Diesel has low ownership costs, but higher climate and health damages. • Compressed natural gas cars have lower costs and damages than petrol cars. • Electric cars have higher damages due to electricity generation emissions. • CNG and less carbon intensive electricity minimizes Indian cars’ full cost. - Abstract: Rapid expansion of population and income growth in developing countries, such as India, is increasing the demand for many goods and services, including four-wheeled passenger cars. Passenger cars provide personal mobility; however, they also have negative implications for human wellbeing from increased air pollutants and greenhouse gases (GHG). Here, we evaluate the range of passenger vehicles available in the Indian market to identify options that minimize costs, human health effects and climate damages. Our approach is to compare alternative fuel/powertrain vehicles with similar conventional gasoline fueled vehicles and assess the differences in full (private and societal) costs for each pair. Private costs are the combination of capital costs and the discounted expected future fuel costs over the vehicle lifetime. The costs to human health from air quality are calculated using intake fractions to estimate exposure and literature values for the damage costs adjusted by benefits transfer methods. We use the Social Cost of Carbon to estimate climate damages. We find that, on average, the net present value (NPV) of the full costs of compressed natural gas (CNG) vehicles are lower than comparable gasoline vehicles, while, diesel vehicles have higher costs. Presently, electric vehicles have higher private costs (due to high capital costs) and societal costs (due to electricity generation emissions). Either a less carbon intensive electricity grid or an increase in the CNG fleet would minimize total costs, human health effects and GHG emissions from the

  16. Health effects of radiation damage

    International Nuclear Information System (INIS)

    Gasimova, K; Azizova, F; Mehdieva, K.

    2012-01-01

    Full text : A summary of the nature of radiactive contamination would be incomplete without some mention of the human health effects relatied to radioactivity and radioactive materials. Several excellent reviews at the variety of levels of detail have been written and should be consulted by the reader. Internal exposures of alpha and beta particles are important for ingested and inhaled radionuclides. Dosimetry models are used to estimate the dose from internally deposited radioactive particles. As mentioned above weighting parameters that take into account the radiation type, the biological half-life and the tissue or organ at risk are used to convert the physically absorbed dose in units of gray (or red) to the biologically significant committed equivalent dose and effective dose, measured in units of Sv (or rem). There is considerable controversy over the shape of the dose-response curve at the chronic low dose levels important for enviromental contamination. Proposed models include linear models, non-linear models and threshold models. Because risks at low dose must be extrapolated from available date at high doses, the shape of the dose-response curve has important implications for the environmental regulations used to protect the general public. The health effect of radiation damage depends on a combination of events of on the cellular, tissue and systemic levels. These lead to mutations and cellular of the irradiated parent cell. The dose level at which significant damage occurs depends on the cell type. Cells that reproduce rapidily, such as those found in bone marrow or the gastrointestinal tract, will be more sensitive to radiation than those that are longer lived, such as striated muscle or nerve cells. The effects of high radiation doses on an organ depends on the various cell types it contains

  17. 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 ...

  18. Integrated analysis considered mitigation cost, damage cost and adaptation cost in Northeast Asia

    Science.gov (United States)

    Park, J. H.; Lee, D. K.; Kim, H. G.; Sung, S.; Jung, T. Y.

    2015-12-01

    Various studies show that raising the temperature as well as storms, cold snap, raining and drought caused by climate change. And variety disasters have had a damage to mankind. The world risk report(2012, The Nature Conservancy) and UNU-EHS (the United Nations University Institute for Environment and Human Security) reported that more and more people are exposed to abnormal weather such as floods, drought, earthquakes, typhoons and hurricanes over the world. In particular, the case of Korea, we influenced by various pollutants which are occurred in Northeast Asian countries, China and Japan, due to geographical meteorological characteristics. These contaminants have had a significant impact on air quality with the pollutants generated in Korea. Recently, around the world continued their effort to reduce greenhouse gas and to improve air quality in conjunction with the national or regional development goals priority. China is also working on various efforts in accordance with the international flows to cope with climate change and air pollution. In the future, effect of climate change and air quality in Korea and Northeast Asia will be change greatly according to China's growth and mitigation policies. The purpose of this study is to minimize the damage caused by climate change on the Korean peninsula through an integrated approach taking into account the mitigation and adaptation plan. This study will suggest a climate change strategy at the national level by means of a comprehensive economic analysis of the impacts and mitigation of climate change. In order to quantify the impact and damage cost caused by climate change scenarios in a regional scale, it should be priority variables selected in accordance with impact assessment of climate change. The sectoral impact assessment was carried out on the basis of selected variables and through this, to derive the methodology how to estimate damage cost and adaptation cost. And then, the methodology was applied in Korea

  19. The cost of the radiation damage by the ALARA conception

    International Nuclear Information System (INIS)

    Kononovich, A.L.; Nosov, A.V.; Ivanov, A.V.; Pechkurov, A.V.

    2000-01-01

    A basis for the determination of the cost of the radiation risk as a method for its optimization are given. The correlation between different components of the risk is considered. The aim for optimization as a requirement on decrease of the cumulative risk is formulated. The reliability in the use of mathematic modelling on the determination of the cost of the risk and damage is noted. The lines of approach to determination of the cost of the risk based on the direct analysis of financial expenses are proposed. The results of estimation of the cost of the risk are given. The use of suggested approach is demonstrated on a hypothetical example [ru

  20. Estimation of Damage Costs Associated with Flood Events

    Science.gov (United States)

    Andrews, T. A.; Wauthier, C.; Zipp, K.

    2017-12-01

    This study investigates the possibility of creating a mathematical function that enables the estimation of flood-damage costs. We begin by examining the costs associated with past flood events in the United States. The data on these tropical storms and hurricanes are provided by the National Oceanic and Atmospheric Administration. With the location, extent of flooding, and damage reparation costs identified, we analyze variables such as: number of inches rained, land elevation, type of landscape, region development in regards to building density and infrastructure, and population concentration. We seek to identify the leading drivers of high flood-damage costs and understand which variables play a large role in the costliness of these weather events. Upon completion of our mathematical analysis, we turn out attention to the 2017 natural disaster of Texas. We divide the region, as we did above, by land elevation, type of landscape, region development in regards to building density and infrastructure, and population concentration. Then, we overlay the number of inches rained in those regions onto the divided landscape and apply our function. We hope to use these findings to estimate the potential flood-damage costs of Hurricane Harvey. This information is then transformed into a hazard map that could provide citizens and businesses of flood-stricken zones additional resources for their insurance selection process.

  1. 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

  2. Reducing Wildlife Damage with Cost-Effective Management Programmes.

    Directory of Open Access Journals (Sweden)

    Cheryl R Krull

    Full Text Available Limiting the impact of wildlife damage in a cost effective manner requires an understanding of how control inputs change the occurrence of damage through their effect on animal density. Despite this, there are few studies linking wildlife management (control, with changes in animal abundance and prevailing levels of wildlife damage. We use the impact and management of wild pigs as a case study to demonstrate this linkage. Ground disturbance by wild pigs has become a conservation issue of global concern because of its potential effects on successional changes in vegetation structure and composition, habitat for other species, and functional soil properties. In this study, we used a 3-year pig control programme (ground hunting undertaken in a temperate rainforest area of northern New Zealand to evaluate effects on pig abundance, and patterns and rates of ground disturbance and ground disturbance recovery and the cost effectiveness of differing control strategies. Control reduced pig densities by over a third of the estimated carrying capacity, but more than halved average prevailing ground disturbance. Rates of new ground disturbance accelerated with increasing pig density, while rates of ground disturbance recovery were not related to prevailing pig density. Stochastic simulation models based on the measured relationships between control, pig density and rate of ground disturbance and recovery indicated that control could reduce ground disturbance substantially. However, the rate at which prevailing ground disturbance was reduced diminished rapidly as more intense, and hence expensive, pig control regimes were simulated. The model produced in this study provides a framework that links conservation of indigenous ecological communities to control inputs through the reduction of wildlife damage and suggests that managers should consider carefully the marginal cost of higher investment in wildlife damage control, relative to its marginal conservation

  3. Atmospheric and geological CO2 damage costs in energy scenarios

    International Nuclear Information System (INIS)

    Smekens, K.E.L.; Van der Zwaan, B.C.C.

    2006-05-01

    Geological carbon dioxide capture and storage (CCS) is currently seriously considered for addressing, in the near term, the problem of climate change. CCS technology is available today and is expected to become an increasingly affordable CO2 abatement alternative. Whereas the rapidly growing scientific literature on CCS as well as experimental and commercial practice demonstrate the technological and economic feasibility of implementing this clean fossil fuel option on a large scale, relatively little attention has been paid so far to the risks and environmental externalities of geological storage of CO2. This paper assesses the effects of including CCS damage costs in a long-term energy scenario analysis for Europe. An external cost sensitivity analysis is performed with a bottom-up energy technology model that accounts not only for CCS technologies but also for their external costs. Our main conclusion is that in a business-as-usual scenario (i.e. without climate change intervention or externality internalisation), CCS technologies are likely to be deployed at least to some extent, mainly in the power generation sector, given the economic benefits of opportunities such as enhanced coal bed methane, oil and gas recovery. Under a strict climate (CO2 emissions) constraint, CCS technologies are deployed massively. With the simultaneous introduction of both CO2 and CCS taxation in the power sector, designed to internalise the external atmospheric and geological effects of CO2 emissions and storage, respectively, we find that CCS will only be developed if the climate change damage costs are at least of the order of 100 euro/t CO2 or the CO2 storage damage costs not more than a few euro/t CO2. When the internalised climate change damage costs are as high as 67 euro/t CO2, the expensive application of CCS to biomass-fuelled power plants (with negative net CO2 emissions) proves the most effective CCS alternative to reduce CO2 emissions, rather than CCS applied to fossil

  4. Damage costs due to automotive air pollution and the influence of street canyons

    International Nuclear Information System (INIS)

    Spadaro, Joseph V.; Rabl, Ari

    2001-01-01

    Using the methodology of the ExternE Project of the European Commission, we have evaluated the damage costs of automotive air pollution by way of two case studies in France: a trip across Paris, and a trip from Paris to Lyon. This methodology involves an analysis of the impact pathways, starting with the emissions (e.g., g/km of particles form tailpipe), followed by local and regional dispersion (e.g., incremental μg/m 3 of particles), calculation of the physical impacts using exposure-response functions (e.g., cases of respiratory hospital admissions), and finally multiplication by unit costs factors (e.g., ε per hospital admission). Damages are aggregated over all affected receptors in Europe. In addition to the local and regional dispersion calculations carried out so far by ExternE, we also consider the increased microscale impacts due to the trapping of pollutants in street canyons, using numerical simulations with the FLUENT software. We have evaluated impacts to human health, agricultural crops and building materials, due to particles, NO x , CO, HC and CO 2 . Health impacts, especially reduced life expectancy, dominate in terms of cost. Damages for older cars (before 1997) range from 2 to 41Euro cents/km, whereas for newer cars (since 1997), the range 1-9 Euro cents/km, and there is continuing progress in reducing the emissions further. In large cities, the particulate emissions of diesel cars lead to the highest damages, exceeding those of gasoline cars by a factor of 7. For cars before 1997 the order of magnitude of the damage costs is comparable to the price of gasoline, and the loss of life expectancy is comparable to that from traffic accidents. (Author)

  5. Equity weighting and the marginal damage costs of climate change

    Energy Technology Data Exchange (ETDEWEB)

    Anthoff, David [The Economic and Social Research Institute, Dublin (Ireland)]|[International Max Planck Research School on Earth System Modelling, Hamburg (Germany)]|[Research Unit Sustainability and Global Change, Hamburg University and Centre for Marine and Atmospheric Science, Hamburg (Germany); Hepburn, Cameron [Smith School of Enterprise and the Environment, and James Martin Institute, Said Business School, University of Oxford, and New College, Oxford (United Kingdom); Tol, Richard S.J. [The Economic and Social Research Institute, Dublin (Ireland)]|[Research Unit Sustainability and Global Change, Hamburg University and Centre for Marine and Atmospheric Science, Hamburg (Germany)]|[Institute for Environmental Studies, Vrije Universiteit, Amsterdam (Netherlands)]|[Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA (United States)

    2009-01-15

    Climate change will give rise to different impacts in different countries, and different countries have different levels of development. Equity-weighted estimates of the (marginal) impact of greenhouse gas emissions reflect these differences. This paper analyses the impact of equity weighting on the marginal damage cost of carbon dioxide emissions, and reaches four main conclusions. First, equity-weighted estimates are substantially higher than estimates without equity-weights; equity-weights may even change the sign of the social cost estimates. Second, estimates differ by two orders of magnitude depending on the region to which the equity weights are normalised. Third, equity-weighted estimates are sensitive to the resolution of the impact estimates. Depending on the assumed intra-regional income distribution, estimates may be more than twice as high if national rather than regional impacts are aggregated. Fourth, variations in the assumed inequality aversion have different impacts in different scenarios, not only because different scenarios have different emissions and hence warming, but also because different scenarios have different income differences, different growth rates, and different vulnerabilities. (author)

  6. Equity weighting and the marginal damage costs of climate change

    International Nuclear Information System (INIS)

    Anthoff, David; Hepburn, Cameron; Tol, Richard S.J.

    2009-01-01

    Climate change will give rise to different impacts in different countries, and different countries have different levels of development. Equity-weighted estimates of the (marginal) impact of greenhouse gas emissions reflect these differences. This paper analyses the impact of equity weighting on the marginal damage cost of carbon dioxide emissions, and reaches four main conclusions. First, equity-weighted estimates are substantially higher than estimates without equity-weights; equity-weights may even change the sign of the social cost estimates. Second, estimates differ by two orders of magnitude depending on the region to which the equity weights are normalised. Third, equity-weighted estimates are sensitive to the resolution of the impact estimates. Depending on the assumed intra-regional income distribution, estimates may be more than twice as high if national rather than regional impacts are aggregated. Fourth, variations in the assumed inequality aversion have different impacts in different scenarios, not only because different scenarios have different emissions and hence warming, but also because different scenarios have different income differences, different growth rates, and different vulnerabilities. (author)

  7. 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...

  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. Valuing the human health damage caused by the fraud of Volkswagen

    International Nuclear Information System (INIS)

    Oldenkamp, Rik; Zelm, Rosalie van; Huijbregts, Mark A.J.

    2016-01-01

    Recently it became known that Volkswagen Group has been cheating with emission tests for diesel engines over the last six years, resulting in on-road emissions vastly exceeding legal standards for nitrogen oxides in Europe and the United States. Here, we provide an estimate of the public health consequences caused by this fraud. From 2009 to 2015, approximately nine million fraudulent Volkswagen cars, as sold in Europe and the US, emitted a cumulative amount of 526 ktonnes of nitrogen oxides more than was legally allowed. These fraudulent emissions are associated with 45 thousand disability-adjusted life years (DALYs) and a value of life lost of at least 39 billion US dollars, which is approximately 5.3 times larger than the 7.3 billion US dollars that Volkswagen Group has set aside to cover worldwide costs related to the diesel emissions scandal. - Highlights: • Health damages from Volkswagen's emission fraud are estimated in the USA and Europe. • Combined health damages in the USA and Europe are estimated at 45 thousand DALYs. • Health damages will further increase to 119 thousand DALYs if cars are not recalled. • Combined health costs in the USA and Europe are estimated at 39 billion US dollars. • Costs will further increase to 102 billion US dollars if cars are not recalled. - The diesel emission fraud committed by Volkswagen Group has led to substantial unforeseen emissions of nitrogen oxides and subsequent health damage costs in Europe and the US.

  10. 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...

  11. 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.

  12. 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. ​

  13. 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...

  14. 76 FR 65182 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2011-10-20

    ... determined that the most appropriate indirect allocation method continues to be the Direct Labor Cost Base... Cost Base is the most appropriate indirect allocation method for the development of the FY 2009 and FY... the Direct Labor Cost Base allocation methodology. The FY 2009 rates will be applied to all damage...

  15. Alleviating inequality in climate policy costs: an integrated perspective on mitigation, damage and adaptation

    Science.gov (United States)

    De Cian, E.; Hof, A. F.; Marangoni, G.; Tavoni, M.; van Vuuren, D. P.

    2016-07-01

    Equity considerations play an important role in international climate negotiations. While policy analysis has often focused on equity as it relates to mitigation costs, there are large regional differences in adaptation costs and the level of residual damage. This paper illustrates the relevance of including adaptation and residual damage in equity considerations by determining how the allocation of emission allowances would change to counteract regional differences in total climate costs, defined as the costs of mitigation, adaptation, and residual damage. We compare emission levels resulting from a global carbon tax with two allocations of emission allowances under a global cap-and-trade system: one equating mitigation costs and one equating total climate costs as share of GDP. To account for uncertainties in both mitigation and adaptation, we use a model-comparison approach employing two alternative modeling frameworks with different damage, adaptation cost, and mitigation cost estimates, and look at two different climate goals. Despite the identified model uncertainties, we derive unambiguous results on the change in emission allowance allocation that could lessen the unequal distribution of adaptation costs and residual damages through the financial transfers associated with emission trading.

  16. 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.

  17. 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…

  18. 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.

  19. 75 FR 64717 - Convention on Supplementary Compensation for Nuclear Damage Contingent Cost Allocation

    Science.gov (United States)

    2010-10-20

    ... DEPARTMENT OF ENERGY Convention on Supplementary Compensation for Nuclear Damage Contingent Cost... Supplementary Compensation for Nuclear Damage (``CSC'') including its obligation to contribute to an international supplementary fund in the event of certain nuclear incidents. The NOI provided a September 27...

  20. 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.

  1. Aircraft ground damage and the use of predictive models to estimate costs

    Science.gov (United States)

    Kromphardt, Benjamin D.

    Aircraft are frequently involved in ground damage incidents, and repair costs are often accepted as part of doing business. The Flight Safety Foundation (FSF) estimates ground damage to cost operators $5-10 billion annually. Incident reports, documents from manufacturers or regulatory agencies, and other resources were examined to better understand the problem of ground damage in aviation. Major contributing factors were explained, and two versions of a computer-based model were developed to project costs and show what is possible. One objective was to determine if the models could match the FSF's estimate. Another objective was to better understand cost savings that could be realized by efforts to further mitigate the occurrence of ground incidents. Model effectiveness was limited by access to official data, and assumptions were used if data was not available. However, the models were determined to sufficiently estimate the costs of ground incidents.

  2. A Study on health damage due to air pollution

    Energy Technology Data Exchange (ETDEWEB)

    Han, Hwa Jin; Oh, So Young [Korea Environment Institute, Seoul (Korea)

    1998-12-01

    According to the domestic and foreign change in given conditions of air preservation policy, the air preservation policy in Korea should be implemented scientifically and reasonably. A gradual turnover to receptor-oriented reflecting human health and ecological effect is needed to establish and promote the air preservation policy systemically and in a long-term basis. Based on the quantified health damage of a people, air preservation policy in Korea should develop as a management policy to develop and implement an optimum management mechanism to minimized health damage of receptor. 19 refs., 2 figs., 25 tabs.

  3. Alleviating inequality in climate policy costs : An integrated perspective on mitigation, damage and adaptation

    NARCIS (Netherlands)

    De Cian, E.; Hof, A. F.; Marangoni, G.; Tavoni, M.; van Vuuren, Detlef

    2016-01-01

    Equity considerations play an important role in international climate negotiations. While policy analysis has often focused on equity as it relates to mitigation costs, there are large regional differences in adaptation costs and the level of residual damage. This paper illustrates the relevance of

  4. 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)

  5. Damage and protection cost curves for coastal floods within the 600 largest European cities

    Science.gov (United States)

    Prahl, Boris F.; Boettle, Markus; Costa, Luís; Kropp, Jürgen P.; Rybski, Diego

    2018-01-01

    The economic assessment of the impacts of storm surges and sea-level rise in coastal cities requires high-level information on the damage and protection costs associated with varying flood heights. We provide a systematically and consistently calculated dataset of macroscale damage and protection cost curves for the 600 largest European coastal cities opening the perspective for a wide range of applications. Offering the first comprehensive dataset to include the costs of dike protection, we provide the underpinning information to run comparative assessments of costs and benefits of coastal adaptation. Aggregate cost curves for coastal flooding at the city-level are commonly regarded as by-products of impact assessments and are generally not published as a standalone dataset. Hence, our work also aims at initiating a more critical discussion on the availability and derivation of cost curves. PMID:29557944

  6. Damage and protection cost curves for coastal floods within the 600 largest European cities

    Science.gov (United States)

    Prahl, Boris F.; Boettle, Markus; Costa, Luís; Kropp, Jürgen P.; Rybski, Diego

    2018-03-01

    The economic assessment of the impacts of storm surges and sea-level rise in coastal cities requires high-level information on the damage and protection costs associated with varying flood heights. We provide a systematically and consistently calculated dataset of macroscale damage and protection cost curves for the 600 largest European coastal cities opening the perspective for a wide range of applications. Offering the first comprehensive dataset to include the costs of dike protection, we provide the underpinning information to run comparative assessments of costs and benefits of coastal adaptation. Aggregate cost curves for coastal flooding at the city-level are commonly regarded as by-products of impact assessments and are generally not published as a standalone dataset. Hence, our work also aims at initiating a more critical discussion on the availability and derivation of cost curves.

  7. Estimating the uncertainty of damage costs of pollution: A simple transparent method and typical results

    International Nuclear Information System (INIS)

    Spadaro, Joseph V.; Rabl, Ari

    2008-01-01

    Whereas the uncertainty of environmental impacts and damage costs is usually estimated by means of a Monte Carlo calculation, this paper shows that most (and in many cases all) of the uncertainty calculation involves products and/or sums of products and can be accomplished with an analytic solution which is simple and transparent. We present our own assessment of the component uncertainties and calculate the total uncertainty for the impacts and damage costs of the classical air pollutants; results for a Monte Carlo calculation for the dispersion part are also shown. The distribution of the damage costs is approximately lognormal and can be characterized in terms of geometric mean μ g and geometric standard deviation σ g , implying that the confidence interval is multiplicative. We find that for the classical air pollutants σ g is approximately 3 and the 68% confidence interval is [μ g / σ g , μ g σ g ]. Because the lognormal distribution is highly skewed for large σ g , the median is significantly smaller than the mean. We also consider the case where several lognormally distributed damage costs are added, for example to obtain the total damage cost due to all the air pollutants emitted by a power plant, and we find that the relative error of the sum can be significantly smaller than the relative errors of the summands. Even though the distribution for such sums is not exactly lognormal, we present a simple lognormal approximation that is quite adequate for most applications

  8. 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

  9. Economics of social trade-off: Balancing wastewater treatment cost and ecosystem damage.

    Science.gov (United States)

    Jiang, Yu; Dinar, Ariel; Hellegers, Petra

    2018-04-01

    We have developed a social optimization model that integrates the financial and ecological costs associated with wastewater treatment and ecosystem damage. The social optimal abatement level of water pollution is determined by finding the trade-off between the cost of pollution control and its resulting ecosystem damage. The model is applied to data from the Lake Taihu region in China to demonstrate this trade-off. A wastewater treatment cost function is estimated with a sizable sample from China, and an ecological damage cost function is estimated following an ecosystem service valuation framework. Results show that the wastewater treatment cost function has economies of scale in facility capacity, and diseconomies in pollutant removal efficiency. Results also show that a low value of the ecosystem service will lead to serious ecological damage. One important policy implication is that the assimilative capacity of the lake should be enhanced by forbidding over extraction of water from the lake. It is also suggested that more work should be done to improve the accuracy of the economic valuation. Copyright © 2018 Elsevier Ltd. All rights reserved.

  10. Stochastic renewal process models for estimation of damage cost over the life-cycle of a structure

    NARCIS (Netherlands)

    Pandey, Mahesh D.; van der Weide, J.A.M.

    2017-01-01

    In the life-cycle cost analysis of a structure, the total cost of damage caused by external hazards like earthquakes, wind storms and flood is an important but highly uncertain component. In the literature, the expected damage cost is typically analyzed under the assumption of either the

  11. Harvest operations for density management: planning requirements, production, costs, stand damage, and recommendations

    Science.gov (United States)

    Loren D. Kellogg; Stephen J. Pilkerton

    2013-01-01

    Since the early 1990s, several studies have been undertaken to determine the planning requirements, productivity, costs, and residual stand damage of harvest operations in thinning treatments designed to promote development of complex forest structure in order to enhance ecological functioning and biological diversity. Th ese studies include the Oregon State...

  12. Potential damage costs of Diabrotica virgifera virgifera infestation in Europe - the 'no control' scenario

    NARCIS (Netherlands)

    Wesseler, J.H.H.; Fall, E.H.

    2010-01-01

    he Western Corn Rootworm (WCR or Dvv., Diabrotica virgifera virgifera Le Conte) was first detected in Europe in the early nineties in Serbia. Since then the beetle has spread to more than 15 European countries. We assess the potential damage costs of the invasive species Diabrotica virgifera

  13. Costs for insurance of civil responsibility for nuclear damage during transportation of nuclear materials

    International Nuclear Information System (INIS)

    Amelina, M.E.; Arsent'ev, S.V.; Molchanov, A.S.

    2009-01-01

    The article considers the method of calculation of rates for insurance of civil responsibility for nuclear damage during transportation of nuclear materials, which can minimize the insurer's costs for this type of insurance in situation when there is no statistics available and it is not possible to calculate the insurance rate by the traditional means using the probability theory

  14. Structural Health Monitoring for Impact Damage in Composite Structures.

    Energy Technology Data Exchange (ETDEWEB)

    Roach, Dennis P.; Raymond Bond (Purdue); Doug Adams (Purdue)

    2014-08-01

    context of structural stiffness reductions and impact damage. A method by which the sensitivity to damage could be increased for simple structures was presented, and the challenges of applying that technique to a more complex structure were identi fi ed. The structural dynamic changes in a weak adhesive bond were investigated, and the results showed promise for identifying weak bonds that show little or no static reduction in stiffness. To address these challenges in identifying highly localized impact damage, the possi- bility of detecting damage through nonlinear dynamic characteristics was also identi fi ed, with a proposed technique which would leverage impact location estimates to enable the detection of impact damage. This nonlinear damage identi fi cation concept was evaluated on a composite panel with a substructure disbond, and the results showed that the nonlinear dynamics at the damage site could be observed without a baseline healthy reference. By further developing impact load identi fi cation technology and combining load and damage estimation techniques into an integrated solution, the challenges associated with impact detection in composite struc- tures can be effectively solved, thereby reducing costs, improving safety, and enhancing the operational readiness and availability of high value assets.

  15. 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 ...

  16. Design of a piezoelectric-based structural health monitoring system for damage detection in composite materials

    Science.gov (United States)

    Kessler, Seth S.; Spearing, S. Mark

    2002-07-01

    Cost-effective and reliable damage detection is critical for the utilization of composite materials. This paper presents the conclusions of an experimental and analytical survey of candidate methods for in-situ damage detection in composite structures. Experimental results are presented for the application of modal analysis and Lamb wave techniques to quasi-isotropic graphite/epoxy test specimens containing representative damage. Piezoelectric patches were used as actuators and sensors for both sets of experiments. Modal analysis methods were reliable for detecting small amounts of global damage in a simple composite structure. By comparison, Lamb wave methods were sensitive to all types of local damage present between the sensor and actuator, provided useful information about damage presence and severity, and present the possibility of estimating damage type and location. Analogous experiments were also performed for more complex built-up structures. These techniques are suitable for structural health monitoring applications since they can be applied with low power conformable sensors and can provide useful information about the state of a structure during operation. Piezoelectric patches could also be used as multipurpose sensors to detect damage by a variety of methods such as modal analysis, Lamb wave, acoustic emission and strain based methods simultaneously, by altering driving frequencies and sampling rates. This paper present guidelines and recommendations drawn from this research to assist in the design of a structural health monitoring system for a vehicle. These systems will be an important component in future designs of air and spacecraft to increase the feasibility of their missions.

  17. Mathematical models for estimating earthquake casualties and damage cost through regression analysis using matrices

    International Nuclear Information System (INIS)

    Urrutia, J D; Bautista, L A; Baccay, E B

    2014-01-01

    The aim of this study was to develop mathematical models for estimating earthquake casualties such as death, number of injured persons, affected families and total cost of damage. To quantify the direct damages from earthquakes to human beings and properties given the magnitude, intensity, depth of focus, location of epicentre and time duration, the regression models were made. The researchers formulated models through regression analysis using matrices and used α = 0.01. The study considered thirty destructive earthquakes that hit the Philippines from the inclusive years 1968 to 2012. Relevant data about these said earthquakes were obtained from Philippine Institute of Volcanology and Seismology. Data on damages and casualties were gathered from the records of National Disaster Risk Reduction and Management Council. This study will be of great value in emergency planning, initiating and updating programs for earthquake hazard reduction in the Philippines, which is an earthquake-prone country.

  18. 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.

  19. First estimates of the potential cost and cost saving of protecting childhood hearing from damage caused by congenital CMV infection.

    Science.gov (United States)

    Williams, Eleri J; Gray, Joanne; Luck, Suzanne; Atkinson, Claire; Embleton, Nicholas D; Kadambari, Seilesh; Davis, Adrian; Griffiths, Paul; Sharland, Mike; Berrington, Janet E; Clark, Julia E

    2015-11-01

    Congenital cytomegalovirus (cCMV) is an important cause of childhood deafness, which is modifiable if diagnosed within the first month of life. Targeted screening of infants who do not pass their newborn hearing screening tests in England is a feasible approach to identify and treat cases to improve hearing outcome. To conduct a cost analysis of targeted screening and subsequent treatment for cCMV-related sensorineural hearing loss (SNHL) in an, otherwise, asymptomatic infant, from the perspective of the UK National Health Service (NHS). Using data from the newborn hearing screening programme (NHSP) in England and a recent study of targeted screening for cCMV using salivary swabs within the NHSP, we estimate the cost (in UK pounds (£)) to the NHS. The cost of screening (time, swabs and PCR), assessing, treating and following up cases is calculated. The cost per case of preventing hearing deterioration secondary to cCMV with targeted screening is calculated. The cost of identifying, assessing and treating a case of cCMV-related SNHL through targeted cCMV screening is estimated to be £6683. The cost of improving hearing outcome for an infant with cCMV-related SNHL through targeted screening and treatment is estimated at £14 202. The costs of targeted screening for cCMV using salivary swabs integrated within NHSP resulted in an estimate of cost per case that compares favourably with other screening programmes. This could be used in future studies to estimate the full economic value in terms of incremental costs and incremental health benefits. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. 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...

  1. Is reproduction costly? No increase of oxidative damage in breeding bank voles.

    Science.gov (United States)

    Ołdakowski, Łukasz; Piotrowska, Zaneta; Chrzaácik, Katarzyna M; Sadowska, Edyta T; Koteja, Paweł; Taylor, Jan R E

    2012-06-01

    According to life-history theory, investment in reproduction is associated with costs, which should appear as decreased survival to the next reproduction or lower future reproductive success. It has been suggested that oxidative stress may be the proximate mechanism of these trade-offs. Despite numerous studies of the defense against reactive oxygen species (ROS) during reproduction, very little is known about the damage caused by ROS to the tissues of wild breeding animals. We measured oxidative damage to lipids and proteins in breeding bank vole (Myodes glareolus) females after rearing one and two litters, and in non-breeding females. We used bank voles from lines selected for high maximum aerobic metabolic rates (which also had high resting metabolic rates and food intake) and non-selected control lines. The oxidative damage was determined in heart, kidneys and skeletal muscles by measuring the concentration of thiobarbituric acid-reactive substances, as markers of lipid peroxidation, and carbonyl groups in proteins, as markers of protein oxidation. Surprisingly, we found that the oxidative damage to lipids in kidneys and muscles was actually lower in breeding than in non-breeding voles, and it did not differ between animals from the selected and control lines. Thus, contrary to our predictions, females that bred suffered lower levels of oxidative stress than those that did not reproduce. Elevated production of antioxidant enzymes and the protective role of sex hormones may explain the results. The results of the present study do not support the hypothesis that oxidative damage to tissues is the proximate mechanism of reproduction costs.

  2. The external costs of low probability-high consequence events: Ex ante damages and lay risks

    International Nuclear Information System (INIS)

    Krupnick, A.J.; Markandya, A.; Nickell, E.

    1994-01-01

    This paper provides an analytical basis for characterizing key differences between two perspectives on how to estimate the expected damages of low probability - high consequence events. One perspective is the conventional method used in the U.S.-EC fuel cycle reports [e.g., ORNL/RFF (1994a,b]. This paper articulates another perspective, using economic theory. The paper makes a strong case for considering this, approach as an alternative, or at least as a complement, to the conventional approach. This alternative approach is an important area for future research. I Interest has been growing worldwide in embedding the external costs of productive activities, particularly the fuel cycles resulting in electricity generation, into prices. In any attempt to internalize these costs, one must take into account explicitly the remote but real possibilities of accidents and the wide gap between lay perceptions and expert assessments of such risks. In our fuel cycle analyses, we estimate damages and benefits' by simply monetizing expected consequences, based on pollution dispersion models, exposure-response functions, and valuation functions. For accidents, such as mining and transportation accidents, natural gas pipeline accidents, and oil barge accidents, we use historical data to estimate the rates of these accidents. For extremely severe accidents--such as severe nuclear reactor accidents and catastrophic oil tanker spills--events are extremely rare and they do not offer a sufficient sample size to estimate their probabilities based on past occurrences. In those cases the conventional approach is to rely on expert judgments about both the probability of the consequences and their magnitude. As an example of standard practice, which we term here an expert expected damage (EED) approach to estimating damages, consider how evacuation costs are estimated in the nuclear fuel cycle report

  3. The external costs of low probability-high consequence events: Ex ante damages and lay risks

    Energy Technology Data Exchange (ETDEWEB)

    Krupnick, A J; Markandya, A; Nickell, E

    1994-07-01

    This paper provides an analytical basis for characterizing key differences between two perspectives on how to estimate the expected damages of low probability - high consequence events. One perspective is the conventional method used in the U.S.-EC fuel cycle reports [e.g., ORNL/RFF (1994a,b]. This paper articulates another perspective, using economic theory. The paper makes a strong case for considering this, approach as an alternative, or at least as a complement, to the conventional approach. This alternative approach is an important area for future research. I Interest has been growing worldwide in embedding the external costs of productive activities, particularly the fuel cycles resulting in electricity generation, into prices. In any attempt to internalize these costs, one must take into account explicitly the remote but real possibilities of accidents and the wide gap between lay perceptions and expert assessments of such risks. In our fuel cycle analyses, we estimate damages and benefits' by simply monetizing expected consequences, based on pollution dispersion models, exposure-response functions, and valuation functions. For accidents, such as mining and transportation accidents, natural gas pipeline accidents, and oil barge accidents, we use historical data to estimate the rates of these accidents. For extremely severe accidents--such as severe nuclear reactor accidents and catastrophic oil tanker spills--events are extremely rare and they do not offer a sufficient sample size to estimate their probabilities based on past occurrences. In those cases the conventional approach is to rely on expert judgments about both the probability of the consequences and their magnitude. As an example of standard practice, which we term here an expert expected damage (EED) approach to estimating damages, consider how evacuation costs are estimated in the nuclear fuel cycle report.

  4. 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 ...

  5. As Bad as it Gets: How Climate Damage Functions Affect Growth and the Social Cost of Carbon

    OpenAIRE

    Bretschger, Lukas; Pattakou, Aimilia

    2017-01-01

    The paper analyzes the effects of varying climate impacts on the social cost of carbon and economic growth. We use polynomial damage functions in a model of an endogenously growing two-sector economy. The framework includes nonrenewable natural resources which cause greenhouse gas emissions; pollution stock harms capital and reduces economic growth. We find a big effect of the selected damage function on the social cost of carbon and a significant impact on the growth rate. In our calibration...

  6. Climate change adaptation, damages and fossil fuel dependence. An RETD position paper on the costs of inaction

    Energy Technology Data Exchange (ETDEWEB)

    Katofsky, Ryan; Stanberry, Matt; Hagenstad, Marca; Frantzis, Lisa

    2011-07-15

    The Renewable Energy Technology Deployment (RETD) agreement initiated this project to advance the understanding of the ''Costs of Inaction'', i.e. the costs of climate change adaptation, damages and fossil fuel dependence. A quantitative estimate was developed as well as a better understanding of the knowledge gaps and research needs. The project also included some conceptual work on how to better integrate the analyses of mitigation, adaptation, damages and fossil fuel dependence in energy scenario modelling.

  7. Modeling of response, socioeconomic, and natural resource damage costs for hypothetical oil spill scenarios in San Francisco Bay

    International Nuclear Information System (INIS)

    Etkin, D.S.; French McCay, D.; Whittier, N.; Sankaranarayanan, S.; Jennings, J.

    2002-01-01

    A study was conducted to determine the influence of oil type, spill size, response strategy and location factors on oil spill response costs, with particular reference to the cost benefits of the use of dispersants. Modeling has been conducted for a hypothetical oil spill in San Francisco Bay to determine biological impacts, damages to natural resources and response costs. The SIMAP modeling software by the Applied Science Associates was used to model 3 spill sizes (20, 50 and 95 percentile by volume) and 4 types of oil (gasoline, diesel, heavy fuel oil, and crude oil). Response costs, natural resource damages and socioeconomic impact were determined based on spill trajectory and fate. Mechanical recovery-based operations carry higher response costs than dispersant-based operations. Response costs for diesel and gasoline spills make up 20 per cent of the total costs, compared to 43 per cent for crude and heavy fuel oil spills. Damages to natural resources are higher for spills of toxic lighter fuels such as gasoline and diesel because gasoline has a greater impact on the water column with less shoreline oiling, resulting in more damages to natural resources. Heavier oils have a greater impact on shorelines and higher response and socioeconomic costs. Although socioeconomic costs varied by location, they tend to be greater than response costs and natural resource damage costs. Proportions of the different costs were described with reference to various spill factors. Socioeconomic costs are 61, 76, 45 and 53 per cent respectively for gasoline, diesel, crude oil, and heavy fuel oil spills. 27 refs., 23 tabs., 5 figs

  8. 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.

  9. Damage Cost of Drying of Aflaj in the Sultanate of Oman

    Directory of Open Access Journals (Sweden)

    Slim Zekri1

    2012-01-01

    Full Text Available Life style changes, population and economic growth, and lack of institutional innovations are causing noticeable damage to the rural communities living in and around Aflaj. The Ministry of Regional Municipalities and Water Resources (MRMWR reported more than 1,000 dried-up Aflaj out of 4,112 in 1996. This paper presents an estimation of the damage caused to the rural communities due to Aflaj dry-up. The production function method and the cost based method are used to estimate the direct losses incurred by farmers and the local communities. These are related to (1 losses in marketed agricultural products, (2 increase in domestic water expenditures per household and (3 capital losses related to changes in house and land values. The study considered 33 dried-up Aflaj among the 1029 monitored by the MRMWR. Our results show that on average each family in the dried-up Falaj has lost an income equivalent of O.R 320 per month. This highlights the importance of Aflaj as an income generator in the remote rural areas. Live Aflaj provide fresh vegetables and healthy food as well as drinking water to the rural population without the need for governmental intervention. The contribution of the supporting wells, whenever provided by the MRMWR, is estimated at O.R 1,478 per family per year. On average the annual financial loss per family due to dry-up is estimated at O.R 3,301 per year. The total damage cost of dried-up Aflaj, at the Sultanate level, is estimated at more than O.R 59 million per year.

  10. 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.

  11. Health and cost impact of air pollution from biomass burning over the United States

    Science.gov (United States)

    Eslami, E.; Sadeghi, B.; Choi, Y.

    2017-12-01

    Effective assessment of health and cost effects of air pollution associated with wildfire events is critical for supporting sustainable management and policy analysis to reduce environmental damages. Since biomass burning events result in higher ozone, PM2.5, and NOx concentration values in urban regions due to long-range transport, preliminary results indicated that wildfire events cause a considerable increase in incident estimates and costs. This study aims to evaluate the health and cost impact of biomass burning events over the continental United States using combined air quality and health impact modeling. To meet this goal, a comprehensive air quality modeling scenarios containing biomass burning emissions were conducted using the Community Multiscale Air Quality (CMAQ) modeling system from 2011 to 2014 with a spatial resolution of 12 km. The modeling period includes fire seasons between April and October over the course of four years. By using modeled pollutants concentrations, the USEPA's GIS-based computer program Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) provides an inclusive figure of health and cost impact caused by changing gaseous and particulate air pollution due to fire events. The basis of BenMAP-CE is the use of a damage-function approach to estimate the health impact of an applied change in air quality by comparing a biomass burning scenario (the one that includes wildfire events) with a baseline scenario (without biomass emissions). This approach considers several factors containing population, exposure to the pollutants, adverse health effects of a particular pollutant, and economic costs. Hence, this study made it capable of showing how biomass burning across U.S. influences people's health in different months, seasons, and regions. Besides, the cost impact of the wildfire events during study periods has also been estimated at both national and regional levels. The results of this study demonstrate the

  12. Guidance on the scientific requirements for health claims related to antioxidants, oxidative damage and cardiovascular health

    DEFF Research Database (Denmark)

    Tetens, Inge

    2011-01-01

    The Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked by the European Food Safety Authority (EFSA) t to draft guidance on scientific requirements for health claims related to antioxidants, oxidative damage and cardiovascular health. This guidance has been drawn from scientific...... opinions of the NDA Panel on such health claims. Thus, this guidance document represents the views of the NDA Panel based on the experience gained to date with the evaluation of health claims in these areas. It is not intended that the document should include an exhaustive list of beneficial effects...

  13. The Social Cost of Trading: Measuring the Increased Damages from Sulfur Dioxide Trading in the United States

    Science.gov (United States)

    Henry, David D., III; Muller, Nicholas Z.; Mendelsohn, Robert O.

    2011-01-01

    The sulfur dioxide (SO[subscript 2]) cap and trade program established in the 1990 Clean Air Act Amendments is celebrated for reducing abatement costs ($0.7 to $2.1 billion per year) by allowing emissions allowances to be traded. Unfortunately, places with high marginal costs also tend to have high marginal damages. Ton-for-ton trading reduces…

  14. Flood damage in Italy: towards an assessment model of reconstruction costs

    Science.gov (United States)

    Sterlacchini, Simone; Zazzeri, Marco; Genovese, Elisabetta; Modica, Marco; Zoboli, Roberto

    2016-04-01

    Recent decades in Italy have seen a very rapid expansion of urbanisation in terms of physical assets, while demographics have remained stable. Both the characteristics of Italian soil and anthropic development, along with repeated global climatic stress, have made the country vulnerable to floods, the intensity of which is increasingly alarming. The combination of these trends will contribute to large financial losses due to property damage in the absence of specific mitigation strategies. The present study focuses on the province of Sondrio in Northern Italy (area of about 3,200 km²), which is home to more than 180,000 inhabitants and the population is growing slightly. It is clearly a hot spot for flood exposure, as it is primarily a mountainous area where floods and flash floods hit frequently. The model we use for assessing potential flood damage determines risk scenarios by overlaying flood hazard maps and economic asset data. In Italy, hazard maps are provided by Regional Authorities through the Hydrogeological System Management Plan (PAI) based on EU Flood Directive guidelines. The PAI in the study area includes both the large plain and the secondary river system and considers three hazard scenarios of Low, Medium and High Frequency associated with return periods of 20, 200 and 500 years and related water levels. By an overlay of PAI maps and residential areas, visualized on a GIS, we determine which existing built-up areas are at risk for flood according to each scenario. Then we investigate the value of physical assets potentially affected by floods in terms of market values, using the database of the Italian Property Market Observatory (OMI), and in terms of reconstruction costs, by considering synthetic cost indexes of predominant building types (from census information) and PAI water height. This study illustrates a methodology to assess flood damage in urban settlements and aims to determine general guidelines that can be extended throughout Italy

  15. 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

  16. 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.

  17. 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,.

  18. 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.

  19. Evaluating external costs of human health and environmental impacts using IAEA model SIMPACTS

    International Nuclear Information System (INIS)

    Bobric, Elena; Jelev, Adrian

    2005-01-01

    SIMPACTS (Simplified Approach for Estimating Impacts and External Costs of Electricity Generation) model developed at the International Atomic Energy Agency is a powerful and convenient tool for evaluating external costs induced by different energy sources. The model was developed for industrial countries and for developing countries as well where studies of alternatives of sustainable energy policies are conducted. The SIMPACTS allow the decision making factors involved in energy policy to have reasonable estimates of environment impacts and relating costs appealing to a rather low number of input parameters. The paper aims at analyzing by means of SIMPACTS the environmental impact produced by Cernavoda NPP operation in two cases: a) the impact of the Cernavoda NPP itself; b) the impact of an hypothetical coal based power plant of the same power level and located on the Cernavoda NPP site. The SIMPACTS modules AIRPACTS and NUCPACTS were applied to assess the impacts on human health, agricultural crops and building materials from exposure to routine atmospheric emissions and as well to quantify and value the adverse effects on human health due to routine atmospheric release of radionuclides from the NPP, via radioactive waste ground disposal or resulting from accidents in nuclear facility, respectively. The conclusion of this study based on SIMPACTS model application to assess the health effects and damage cost per year is that the Cernavoda NPP presents the lower health effects and damage cost comparing with power plants of other types

  20. Uncertainty Evaluation in the Design of Structural Health Monitoring Systems for Damage Detection†

    Directory of Open Access Journals (Sweden)

    Christine Schubert Kabban

    2018-04-01

    Full Text Available The validation of structural health monitoring (SHM systems for aircraft is complicated by the extent and number of factors that the SHM system must demonstrate for robust performance. Therefore, a time- and cost-efficient method for examining all of the sensitive factors must be conducted. In this paper, we demonstrate the utility of using the simulation modeling environment to determine the SHM sensitive factors that must be considered for subsequent experiments, in order to enable the SHM validation. We demonstrate this concept by examining the effect of SHM system configuration and flaw characteristics on the response of a signal from a known piezoelectric wafer active sensor (PWAS in an aluminum plate, using simulation models of a particular hot spot. We derive the signal responses mathematically and through the statistical design of experiments, we determine the significant factors that affect the damage indices that are computed from the signal, using only half the number of runs that are normally required. We determine that the transmitter angle is the largest source of variation for the damage indices that are considered, followed by signal frequency and transmitter distance to the hot spot. These results demonstrate that the use of efficient statistical design and simulation may enable a cost- and time-efficient sequential approach to quantifying sensitive SHM factors and system validation.

  1. 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.

  2. 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

  3. Tornadoes and related damage costs: statistical modelling with a semi-Markov approach

    Directory of Open Access Journals (Sweden)

    Guglielmo D’Amico

    2016-09-01

    Full Text Available We propose a statistical approach to modelling for predicting and simulating occurrences of tornadoes and accumulated cost distributions over a time interval. This is achieved by modelling the tornado intensity, measured with the Fujita scale, as a stochastic process. Since the Fujita scale divides tornado intensity into six states, it is possible to model the tornado intensity by using Markov and semi-Markov models. We demonstrate that the semi-Markov approach is able to reproduce the duration effect that is detected in tornado occurrence. The superiority of the semi-Markov model as compared to the Markov chain model is also affirmed by means of a statistical test of hypothesis. As an application, we compute the expected value and the variance of the costs generated by the tornadoes over a given time interval in a given area. The paper contributes to the literature by demonstrating that semi-Markov models represent an effective tool for physical analysis of tornadoes as well as for the estimation of the economic damages to human things.

  4. The health and social costs of chronic kidney disease in Italy

    Directory of Open Access Journals (Sweden)

    Americo Cicchetti

    2011-03-01

    Full Text Available Chronic kidney disease is growing as a global public health problem throughout the world. In Italy, CKD is becoming increasingly common with 52,777 patients treated with dialysis in 2010, about 10,000 new patients/years in dialysis from 2010.  The impact on the health care system includes € 2.1 billion/year for dialysis plus € 338 million for indirect costs. Aim of the present analysis was to explore socio-economical variables in the management of CKD, and assess direct and indirect health costs and NHS resources consumption. The overall cost for patients in dialysis is about 44,000 €/years for hemodialysis and 30,000 €/years for peritoneal dialysis with different resources consumption over the different stage disease. The possibility of reducing the progression of renal damaging and beginning of dialysis may induce a low expenditure for the Italian NHS.

  5. The assessment of damages due to climate change in a situation of uncertainty: the contribution of adaptation cost modelling

    International Nuclear Information System (INIS)

    Dumas, P.

    2006-01-01

    The aim of this research is to introduce new elements for the assessment of damages due to climate changes within the frame of compact models aiding the decision. Two types of methodologies are used: sequential optimisation stochastic models and simulation stochastic models using optimal assessment methods. The author first defines the damages, characterizes their different categories, and reviews the existing assessments. Notably, he makes the distinction between damages due to climate change and damages due to its rate. Then, he presents the different models used in this study, the numerical solutions, and gives a rough estimate of the importance of the considered phenomena. By introducing a new category of capital in an optimal growth model, he tries to establish a framework allowing the representation of adaptation and of its costs. He introduces inertia in macro-economical evolutions, climatic variability, detection of climate change and damages due to climate hazards

  6. Guidance for the scientific requirements for health claims related to antioxidants, oxidative damage and cardiovascular health (Revision 1)

    DEFF Research Database (Denmark)

    Sjödin, Anders Mikael

    2018-01-01

    of additional health claim applications related to antioxidants, oxidative damage and cardiovascular health, and the information collected from a Grant launched in 2014. This guidance is intended to assist applicants in preparing applications for the authorisation of health claims related to the antioxidants......EFSA asked the Panel on Dietetic Products, Nutrition and Allergies (NDA) to update the guidance on the scientific requirements for health claims related to antioxidants, oxidative damage and cardiovascular health published in 2011. The update takes into accounts experiences gained with evaluation......, oxidative damage and cardiovascular health. The document was subject to public consultation (from 12 July to 3 September 2017). This document supersedes the guidance on the scientific requirements for health claims related to antioxidants, oxidative damage and cardiovascular health published in 2011...

  7. Assessment of the economic costs of damage caused by air pollution

    International Nuclear Information System (INIS)

    Holland, M.R.

    1995-01-01

    Cost-benefit analysis is one of the fundamental tools for the development of economic instruments for pollution control. The costs of various abatement measures are reasonably well characterised. However, assessment of the economic costs of pollutant impacts is less well developed. This paper reports on two studies carried out for DGXII of the European Commission, the ExternE-Project and the Green Accounting Research Project. Both studies have been performed by international, multi-disciplinary research teams. Analysis of the effects of emissions of PM 10 , SO 2 , NO x and VOCs (as ozone precursors) has included assessment of human health, materials, crops and other terrestrial ecosystems, and freshwater fisheries. The analysis follows the 'impact pathway' approach, linking dose-response functions, valuation data and other models. It differs significantly to earlier 'top-down' approaches that made only very limited use of the wealth of scientific data available. Most success has been achieved in analysis of impacts on human health, building materials and crops. Significant uncertainties exist for these receptors, though these have been identified and are now being addressed. Assessment of impacts on other receptors, perhaps most notably forests, is more limited. The methodology is particularly applicable for analysis of impacts on receptors for which the critical loads approach is not appropriate. 7 refs., 3 figs., 1 tab

  8. Assessing the Economic Cost of Landslide Damage in Low-Relief Regions: Case Study Evidence from the Flemish Ardennes (Belgium)

    Science.gov (United States)

    Vranken, L.; Van Turnhout, P.; Van Den Eeckhaut, M.; Vandekerckhove, L.; Vantilt, G.; Poesen, J.

    2012-04-01

    Several regions around the globe are at risk to incur damage from landslides. These landslides cause significant structural and functional damage to public and private buildings and infrastructure. Numerous studies investigated how natural factors and human activities control the (re-)activation of landslides. However, few studies have concentrated on a quantitative estimate of the overall damage caused by landslides at a regional scale. This study therefore starts with a quantitative economic assessment of the direct and indirect damage caused by landslides in the Flemish Ardennes (Belgium), a low-relief region (area=ca. 700 km2) susceptible to landslides. Based on focus interviews as well as on semi-structured interviews with homeowners, civil servants (e.g. from the technical services from the various towns), or with the owners and providers of lifelines such as electricity and sewage, we have quantitatively estimated the direct and indirect damage induced by landsliding and this for a 10 to 30 year period (depending on the type of infrastructure or buildings). Economic damage to public infrastructure and buildings was estimated for the entire region, while for private damage 10 cases with severe to small damage were quantified. For example, in the last 10 year, costs of road repair augmented to 814 560 €. Costs to repair damaged roads that have not yet been repaired, were estimated at 669 318 €. In the past 30 years, costs of measures to prevent road damage augmented to at least 14 872 380 €. More than 90% of this budget for preventive measures was spent 30 years ago, when an important freeway was damaged and had to be repaired. These preventive measures (building a grout wall and improving the drainage system) were effective as no further damage has been reported until present. To repair and prevent damage to waterworks and sewage systems, expenditures amounted to 551 044 € and this for the last 30 years. In the past 10 years, a new railway line

  9. 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.

  10. Structural Health Monitoring: Numerical Damage Predictor for Composite Structures

    National Research Council Canada - National Science Library

    Lannamann, Daniel

    2001-01-01

    .... Wide use of composites is found in aircraft, armored vehicles, ships and civil structures This present research demonstrates the ability to numerically detect damage in a composite sandwich structure...

  11. Damage Detection Using Lamb Waves for Structural Health Monitoring

    National Research Council Canada - National Science Library

    Crider II, Jeffrey S

    2007-01-01

    .... This study evaluates Lamb wave approaches used to detect simulated cracks in laboratory experiments on thin plates to detect more realistic damage in a test article representing the complex geometry...

  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. 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…

  15. 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.

  16. 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)

  17. 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.

  18. Development of a wireless, self-sustaining damage detection sensor system based on chemiluminescence for structural health monitoring

    Science.gov (United States)

    Kuang, K. S. C.

    2014-03-01

    A novel application of chemiluminescence resulting from the chemical reaction in a glow-stick as sensors for structural health monitoring is demonstrated here. By detecting the presence of light emitting from these glow-sticks, it is possible to develop a low-cost sensing device with the potential to provide early warning of damage in a variety of engineering applications such as monitoring of cracks or damage in concrete shear walls, detecting of ground settlement, soil liquefaction, slope instability, liquefaction-related damage of underground structure and others. In addition, this paper demonstrates the ease of incorporating wireless capability to the sensor device and the possibility of making the sensor system self-sustaining by means of a renewable power source for the wireless module. A significant advantage of the system compared to previous work on the use of plastic optical fibre (POF) for damage detection is that here the system does not require an electrically-powered light source. Here, the sensing device, embedded in a cement host, is shown to be capable of detecting damage. A series of specimens with embedded glow-sticks have been investigated and an assessment of their damage detection capability will be reported. The specimens were loaded under flexure and the sensor responses were transmitted via a wireless connection.

  19. 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 ...

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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

  5. 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.

  6. Radiation in relation to mutation rate, mutational damage and human ill-health

    International Nuclear Information System (INIS)

    Roberts, P.B.

    1976-09-01

    The effect of radiation in increasing the frequency of gene mutations is now reasonably understood. We discuss first how an increase in the mutation rate is reflected in the mutational damage expressed in populations. It is shown that the mutational damage, assessed by the loss of fitness in a population or the number of eventual gene extinctions, is equal to the number of new mutations arising per generation or the mutation rate. In a population of stable size, a dose of 1 rem given to 10 6 people leads to roughly 600 gene extinctions when summed over all ensuing generations if the dose is applied to only one generation; this number of extinctions will occur in each succeeding generation if the dose is given to every generation. However, the concept of genetic extinction, although quantifiable, is of limited value in assessing radiation risks since its impact on human ill-health is very speculative. In particular, no estimate can be made of the total cost of effects which are minor in each individual in which they arise, but which, because they are so minor, persist in the population for many generations. The best current estimate is for 14-140 obvious defects in the first few generations following exposure of 10 6 people to a dose of 1 rem. (auth.)

  7. 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 ...

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. Low-cost teleoperator-controlled vehicle for damage assessment and radiation dose measurement

    International Nuclear Information System (INIS)

    Tyree, W.H.

    1991-01-01

    A low-cost, disposable, radio-controlled, remote-reading, ionizing radiation and surveillance teleoperator re-entry vehicle has been built. The vehicle carries equipment, measures radiation levels, and evaluates building conditions. The basic vehicle, radio control with amplifiers, telemetry, elevator, and video camera with monitor cost less than $2500. Velcro-mounted alpha, beta-gamma, and neutron sensing equipment is used in the present system. Many types of health physics radiation measuring equipment may be substituted on the vehicle. The system includes a black-and-white video camera to observe the environment surrounding the vehicle. The camera is mounted on a vertical elevator extendible to 11 feet above the floor. The present vehicle uses a video camera with an umbilical cord between the vehicle and the operators. Preferred operation would eliminate the umbilical. Video monitoring equipment is part of the operator control system. Power for the vehicle equipment is carried on board and supplied by sealed lead-acid batteries. Radios are powered by 9-V alkaline batteries. The radio control receiver, servo drivers, high-power amplifier and 49-MHz FM transceivers were irradiated at moderate rates with neutron and gamma doses to 3000 Rem and 300 Rem, respectively, to ensure system operation

  18. 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

  19. 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.

  20. 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.

  1. World Health Organization cardiovascular risk stratification and target organ damage.

    Science.gov (United States)

    Piskorz, D; Bongarzoni, L; Citta, L; Citta, N; Citta, P; Keller, L; Mata, L; Tommasi, A

    2016-01-01

    Prediction charts allow treatment to be targeted according to simple markers of cardiovascular risk; many algorithms do not recommend screening asymptomatic target organ damage which could change dramatically the assessment. To demonstrate that target organ damage is present in low cardiovascular risk hypertensive patients and it is more frequent and severe as global cardiovascular risk increases. Consecutive hypertensive patients treated at a single Latin American center. Cardiovascular risk stratified according to 2013 WHO/ISH risk prediction chart America B. Left ventricular mass assessed by Devereux method, left ventricular hypertrophy considered >95g/m(2) in women and >115g/m(2) in men. Transmitral diastolic peak early flow velocity to average septal/lateral peak early diastolic relaxation velocity (E/e' ratio) measured cut off value >13. Systolic function assessed by tissue Doppler average interventricular septum/lateral wall mitral annulus rate systolic excursion (s wave). A total of 292 patients were included of whom 159 patients (54.5%) had cardiovascular risk of 20%. Left ventricular hypertrophy was detected in 17.6% low risk patients, 27.8% in medium risk and 23.3% in high risk (p<0.05), abnormal E/e' ratio was found in 13.8%, 31.1% and 27.9%, respectively (p<0.05). Mean s wave was 8.03+8, 8.1+9 and 8.7+1cm/s for low, intermediate and high risk patients, respectively (p<0.025). Target organ damage is more frequent and severe in high risk; one over four subjects was misclassified due to the presence of asymptomatic target organ damage. Copyright © 2015 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

  2. 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…

  3. 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 ...

  4. 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.

  5. 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.

  6. 78 FR 53425 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2013-08-29

    ... method continues to be the Direct Labor Cost Base for all three DARRP component organizations. The Direct... allocation method for the development of the FY 2012 indirect cost rates. The DARRP's Indirect Cost Rates and... accounting system and allocation practices; recommend the appropriate indirect cost allocation methodology...

  7. 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

  8. Strain-Based Damage Determination Using Finite Element Analysis for Structural Health Management

    Science.gov (United States)

    Hochhalter, Jacob D.; Krishnamurthy, Thiagaraja; Aguilo, Miguel A.

    2016-01-01

    A damage determination method is presented that relies on in-service strain sensor measurements. The method employs a gradient-based optimization procedure combined with the finite element method for solution to the forward problem. It is demonstrated that strains, measured at a limited number of sensors, can be used to accurately determine the location, size, and orientation of damage. Numerical examples are presented to demonstrate the general procedure. This work is motivated by the need to provide structural health management systems with a real-time damage characterization. The damage cases investigated herein are characteristic of point-source damage, which can attain critical size during flight. The procedure described can be used to provide prognosis tools with the current damage configuration.

  9. 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

  10. 41 CFR 301-10.451 - May I be reimbursed for the cost of collision damage waiver (CDW) or theft insurance?

    Science.gov (United States)

    2010-07-01

    ... the cost of collision damage waiver (CDW) or theft insurance? 301-10.451 Section 301-10.451 Public... I be reimbursed for the cost of collision damage waiver (CDW) or theft insurance? (a) General rule—no. You will not be reimbursed for CDW or theft insurance for travel within CONUS for the following...

  11. 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.

  12. 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.

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. Structural Health Management of Damaged Aircraft Structures Using the Digital Twin Concept

    Science.gov (United States)

    Seshadri, Banavara R.; Krishnamurthy, Thiagarajan

    2017-01-01

    The development of multidisciplinary integrated Structural Health Management (SHM) tools will enable accurate detection, and prognosis of damaged aircraft under normal and adverse conditions during flight. As part of the digital twin concept, methodologies are developed by using integrated multiphysics models, sensor information and input data from an in-service vehicle to mirror and predict the life of its corresponding physical twin. SHM tools are necessary for both damage diagnostics and prognostics for continued safe operation of damaged aircraft structures. The adverse conditions include loss of control caused by environmental factors, actuator and sensor faults or failures, and structural damage conditions. A major concern in these structures is the growth of undetected damage/cracks due to fatigue and low velocity foreign object impact that can reach a critical size during flight, resulting in loss of control of the aircraft. To avoid unstable, catastrophic propagation of damage during a flight, load levels must be maintained that are below a reduced load-carrying capacity for continued safe operation of an aircraft. Hence, a capability is needed for accurate real-time predictions of damage size and safe load carrying capacity for structures with complex damage configurations. In the present work, a procedure is developed that uses guided wave responses to interrogate damage. As the guided wave interacts with damage, the signal attenuates in some directions and reflects in others. This results in a difference in signal magnitude as well as phase shifts between signal responses for damaged and undamaged structures. Accurate estimation of damage size, location, and orientation is made by evaluating the cumulative signal responses at various pre-selected sensor locations using a genetic algorithm (GA) based optimization procedure. The damage size, location, and orientation is obtained by minimizing the difference between the reference responses and the

  19. 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.

  20. 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.

  1. Urban seismic risk assessment: statistical repair cost data and probable structural losses based on damage scenario—correlation analysis

    Science.gov (United States)

    Eleftheriadou, Anastasia K.; Baltzopoulou, Aikaterini D.; Karabinis, Athanasios I.

    2016-06-01

    The current seismic risk assessment is based on two discrete approaches, actual and probable, validating afterwards the produced results. In the first part of this research, the seismic risk is evaluated from the available data regarding the mean statistical repair/strengthening or replacement cost for the total number of damaged structures (180,427 buildings) after the 7/9/1999 Parnitha (Athens) earthquake. The actual evaluated seismic risk is afterwards compared to the estimated probable structural losses, which is presented in the second part of the paper, based on a damage scenario in the referring earthquake. The applied damage scenario is based on recently developed damage probability matrices (DPMs) from Athens (Greece) damage database. The seismic risk estimation refers to 750,085 buildings situated in the extended urban region of Athens. The building exposure is categorized in five typical structural types and represents 18.80 % of the entire building stock in Greece. The last information is provided by the National Statistics Service of Greece (NSSG) according to the 2000-2001 census. The seismic input is characterized by the ratio, a g/ a o, where a g is the regional peak ground acceleration (PGA) which is evaluated from the earlier estimated research macroseismic intensities, and a o is the PGA according to the hazard map of the 2003 Greek Seismic Code. Finally, the collected investigated financial data derived from different National Services responsible for the post-earthquake crisis management concerning the repair/strengthening or replacement costs or other categories of costs for the rehabilitation of earthquake victims (construction and function of settlements for earthquake homeless, rent supports, demolitions, shorings) are used to determine the final total seismic risk factor.

  2. Quantifying the costs and benefits of privacy-preserving health data publishing.

    Science.gov (United States)

    Khokhar, Rashid Hussain; Chen, Rui; Fung, Benjamin C M; Lui, Siu Man

    2014-08-01

    Cost-benefit analysis is a prerequisite for making good business decisions. In the business environment, companies intend to make profit from maximizing information utility of published data while having an obligation to protect individual privacy. In this paper, we quantify the trade-off between privacy and data utility in health data publishing in terms of monetary value. We propose an analytical cost model that can help health information custodians (HICs) make better decisions about sharing person-specific health data with other parties. We examine relevant cost factors associated with the value of anonymized data and the possible damage cost due to potential privacy breaches. Our model guides an HIC to find the optimal value of publishing health data and could be utilized for both perturbative and non-perturbative anonymization techniques. We show that our approach can identify the optimal value for different privacy models, including K-anonymity, LKC-privacy, and ∊-differential privacy, under various anonymization algorithms and privacy parameters through extensive experiments on real-life data. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Global health impacts and costs due to mercury emissions.

    Science.gov (United States)

    Spadaro, Joseph V; Rabl, Ari

    2008-06-01

    Since much of the emission is in the form of metallic Hg whose atmospheric residence time is long enough to cause nearly uniform mixing in the hemisphere, much of the impact is global. This article presents a first estimate of global average neurotoxic impacts and costs by defining a comprehensive transfer factor for ingestion of methyl-Hg as ratio of global average dose rate and global emission rate. For the dose-response function (DRF) we use recent estimates of IQ decrement as function of Hg concentration in blood, as well as correlations between blood concentration and Hg ingestion. The cost of an IQ point is taken as $18,000 in the United States and applied in other countries in proportion to per capita GDP, adjusted for purchase power parity. The mean estimate of the global average of the marginal damage cost per emitted kg of Hg is about $1,500/kg, if one assumes a dose threshold of 6.7 mug/day of methyl-Hg per person, and $3,400/kg without threshold. The average global lifetime impact and cost per person at current emission levels are 0.02 IQ points lost and $78 with and 0.087 IQ points and $344 without threshold. These results are global averages; for any particular source and emission site the impacts can be quite different. An assessment of the overall uncertainties indicates that the damage cost could be a factor 4 smaller or larger than the median estimate (the uncertainty distribution is approximately log normal and the ratio median/mean is approximately 0.4).

  4. 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...

  5. 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.

  6. 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.

  7. 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

  8. Heat savings and heat generation technologies: Modelling of residential investment behaviour with local health costs

    International Nuclear Information System (INIS)

    Zvingilaite, Erika; Klinge Jacobsen, Henrik

    2015-01-01

    The trade-off between investing in energy savings and investing in individual heating technologies with high investment and low variable costs in single family houses is modelled for a number of building and consumer categories in Denmark. For each group the private economic cost of providing heating comfort is minimised. The private solution may deviate from the socio-economical optimal solution and we suggest changes to policy to incentivise the individuals to make choices more in line with the socio-economic optimal mix of energy savings and technologies. The households can combine their primary heating source with secondary heating e.g. a woodstove. This choice results in increased indoor air pollution with fine particles causing health effects. We integrate health cost due to use of woodstoves into household optimisation of heating expenditures. The results show that due to a combination of low costs of primary fuel and low environmental performance of woodstoves today, included health costs lead to decreased use of secondary heating. Overall the interdependence of heat generation technology- and heat saving-choice is significant. The total optimal level of heat savings for private consumers decrease by 66% when all have the option to shift to the technology with lowest variable costs. - Highlights: • Heat saving investment and heat technology choice are interdependent. • Health damage costs should be included in private heating choice optimisation. • Flexibility in heating technology choice reduce the optimal level of saving investments. • Models of private and socioeconomic optimal heating produce different technology mix. • Rebound effects are moderate but varies greatly among consumer categories

  9. 76 FR 61089 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2011-10-03

    ... method continues to be the Direct Labor Cost Base for all three DARRP component organizations. The Direct....gov . Cotton reaffirmed that the Direct Labor Cost Base is the most appropriate indirect allocation... Natural Resources (GCNR).... 83.93 49.49 These rates are based on the Direct Labor Cost Base allocation...

  10. 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.

  11. 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 ...

  12. 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.

  13. 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.

  14. 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.

  15. The assessment of health damage caused by air pollution and its implication for policy making in Taiyuan, Shanxi, China

    International Nuclear Information System (INIS)

    Zhang Daisheng; Aunan, Kristin; Seip, Hans Martin; Larssen, Steinar; Liu Jianhui; Zhang Dingsheng

    2010-01-01

    We establish the link between energy use, air pollution, and public health impacts in Taiyuan for 2000, and for 2010 and 2015 under alternative scenarios. We find that in year 2000 more than 2200 excess deaths may have been caused by particulate matter (PM) pollution. Using alternative methods for monetization of health impacts the total health damage amounts to 0.8-1.7 billion Yuan, which is 2.4-4.9% of the city's GDP in 2000. Compared to the business-as-usual scenario, scenarios assuming extensive fuel switch in low-and-medium-stack pollution sources and extension of the district heating system could prevent 200-1100 PM 10 -related premature deaths in 2010 and substantially reduce population morbidity. The actual PM pollution in 2007 was lower than modeled in these two scenarios. We also find that if air quality in urban Taiyuan were to reach the Chinese National Grade II Standard in 2015, the number of premature deaths would still be around 1330 and the economic cost about 1-2% of the city's GDP in 2015. Our results imply that there are large health benefits to be gained by setting stricter standards for the future in China, and that targeting low-and-medium-stack source effectively reduces health damage.

  16. 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).

  17. 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

  18. Optimizing power plant cycling operations while reducing generating plant damage and costs

    Energy Technology Data Exchange (ETDEWEB)

    Lefton, S.A.; Besuner, P.H.; Grimsrud, P. [Aptech Engineering Services, Inc., Sunnyvale, CA (United States); Bissel, A. [Electric Supply Board, Dublin (Ireland)

    1998-12-31

    This presentation describes a method for analyzing, quantifying, and minimizing the total cost of fossil, combined cycle, and pumped hydro power plant cycling operation. The method has been developed, refined, and applied during engineering studies at some 160 units in the United States and 8 units at the Irish Electric Supply Board (ESB) generating system. The basic premise of these studies was that utilities are underestimating the cost of cycling operation. The studies showed that the cost of cycling conventional boiler/turbine fossil power plants can range from between $2,500 and $500,000 per start-stop cycle. It was found that utilities typically estimate these costs by factors of 3 to 30 below actual costs and, thus, often significantly underestimate their true cycling costs. Knowledge of the actual, or total, cost of cycling will reduce power production costs by enabling utilities to more accurately dispatch their units to manage unit life expectancies, maintenance strategies and reliability. Utility management responses to these costs are presented and utility cost savings have been demonstrated. (orig.) 7 refs.

  19. Optimizing power plant cycling operations while reducing generating plant damage and costs

    Energy Technology Data Exchange (ETDEWEB)

    Lefton, S A; Besuner, P H; Grimsrud, P [Aptech Engineering Services, Inc., Sunnyvale, CA (United States); Bissel, A [Electric Supply Board, Dublin (Ireland)

    1999-12-31

    This presentation describes a method for analyzing, quantifying, and minimizing the total cost of fossil, combined cycle, and pumped hydro power plant cycling operation. The method has been developed, refined, and applied during engineering studies at some 160 units in the United States and 8 units at the Irish Electric Supply Board (ESB) generating system. The basic premise of these studies was that utilities are underestimating the cost of cycling operation. The studies showed that the cost of cycling conventional boiler/turbine fossil power plants can range from between $2,500 and $500,000 per start-stop cycle. It was found that utilities typically estimate these costs by factors of 3 to 30 below actual costs and, thus, often significantly underestimate their true cycling costs. Knowledge of the actual, or total, cost of cycling will reduce power production costs by enabling utilities to more accurately dispatch their units to manage unit life expectancies, maintenance strategies and reliability. Utility management responses to these costs are presented and utility cost savings have been demonstrated. (orig.) 7 refs.

  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. Cost and economic impact of obstructive sleep apnea-hypopnea syndrome (OSAHS on public health

    Directory of Open Access Journals (Sweden)

    David Ingram

    2017-08-01

    Full Text Available Untreated obstructive sleep apnea-hypopnea syndrome (OSAHS is associated with significant direct and indirect medical costs. This disorder also has a significant negative impact on work performance and safety, and is implicated in a substantial proportion of motor vehicular crashes. Timely diagnosis and optimal therapy have shown a lower utilization rate related to health care systems and reduced costs, while adverse risks are mitigated at the same time. Prompt diagnosis and optimal therapy have shown to decrease heath care utilizaton and costs, as well as mitigating these adverse risks. Similarly, untreated OSAHS is associated with higher unemployment rates. For health care professionals, having a patient with OSAHS involved in a MVC is of paramount importance for a several reasons, including personal and public damage, as well as the potential physical disability that may be caused by the accident. In Latin America, measuring direct and indirect costs is necessary considering the public health problem associated with OSAHS and the implications mentioned above.

  2. 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.

  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. Damage Detection and Verification System (DDVS) for In-Situ Health Monitoring

    Science.gov (United States)

    Williams, Martha K.; Lewis, Mark; Szafran, J.; Shelton, C.; Ludwig, L.; Gibson, T.; Lane, J.; Trautwein, T.

    2015-01-01

    Project presentation for Game Changing Program Smart Book Release. Detection and Verification System (DDVS) expands the Flat Surface Damage Detection System (FSDDS) sensory panels damage detection capabilities and includes an autonomous inspection capability utilizing cameras and dynamic computer vision algorithms to verify system health. Objectives of this formulation task are to establish the concept of operations, formulate the system requirements for a potential ISS flight experiment, and develop a preliminary design of an autonomous inspection capability system that will be demonstrated as a proof-of-concept ground based damage detection and inspection system.

  5. 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

  6. 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

  7. Damage Detection with Streamlined Structural Health Monitoring Data

    OpenAIRE

    Li, Jian; Deng, Jun; Xie, Weizhi

    2015-01-01

    The huge amounts of sensor data generated by large scale sensor networks in on-line structural health monitoring (SHM) systems often overwhelms the systems’ capacity for data transmission and analysis. This paper presents a new concept for an integrated SHM system in which a streamlined data flow is used as a unifying thread to integrate the individual components of on-line SHM systems. Such an integrated SHM system has a few desirable functionalities including embedded sensor data compressio...

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. Fish Health Study Ashtabula River Natural Resource Damage Assessment

    Science.gov (United States)

    Blazer, V.S.; Iwanowicz, L.R.; Baumann, P.C.

    2006-01-01

    INTRODUCTION The Ashtabula River is located in northeast Ohio, flowing into Lake Erie at Ashtabula, Ohio. Tributaries include Fields Brook, Hubbard Run, Strong Brook, and Ashtabula Creek. The bottom sediments, bank soils and biota of Fields Brook have been severely contaminated by unregulated discharges of hazardous substances. Hazardous substances have migrated downstream from Fields Brook to the Ashtabula River and Harbor, contaminating bottom sediments, fish and wildlife. There are presently more than 1,000,000 cubic yards of contaminated sediment in the Ashtabula River and Harbor, much of which originated from Fields Brook. Contaminants include polychlorinated biphenyls (PCBs), chlorinated benzenes, chlorinated ethenes, hexachlorobutadiene, polyaromatic hydrocarbons (PAHs), other organic chemicals, heavy metals and low level radionuclides. A Preassessment Screen, using existing data, was completed for the Ashtabula River and Harbor on May 18, 2001. Among the findings was that the fish community at Ashtabula contained approximately 45 percent fewer species and 52 percent fewer individuals than the Ohio EPA designated reference area, Conneaut Creek. The Ashtabula River and Conneaut Creek are similar in many respects, with the exception of the presence of contamination at Ashtabula. The difference in the fish communities between the two sites is believed to be at least partially a result of the hazardous substance contamination at Ashtabula. In order to investigate this matter further, the Trustees elected to conduct a study of the status and health of the aquatic biological communities of the Ashtabula River and Conneaut Creek in 2002-2004. The following document contains brief method descriptions (more detail available in attached Appendix A) and a summary of the data used to evaluate the health status of brown bullheads (Ameiurus nebulosus) and largemouth bass (Micropterus salmoides) collected from the above sites.

  13. Harnessing the best of Europe to understand and solve Keel Bone Damage: An ongoing EU-COST Action

    DEFF Research Database (Denmark)

    Riber, Anja Brinch; Sandilands, Victoria; Toscano, M.

    2017-01-01

    on a specific topic, i.e., the causes of KBD and solutions to reduce their severity and frequency. The Action brings various participants with a diverse mix of disciplines together to facilitate novel and trans-disciplinary discussions that will lead to definitive and quantifiable outputs. In addition......The KeelBoneDamage COST Action seeks to provide the European laying hen industry with the innovations in breeding, nutrition, and management necessary to resolve the problem of keel bone damage (KBD) in order to meet the high standards of welfare and productivity demanded by the European community...... to pursuing these research objectives, the Action also seeks to strengthen European research capacity by connecting relevant scientific communities and providing networking opportunities for young scientists. Activities are performed in concert with industrial partners whom are leaders in the field ensuring...

  14. Assessing damage cost estimation of urban pluvial flood risk as a mean of improving climate change adaptations investments

    DEFF Research Database (Denmark)

    Skovgård Olsen, Anders; Zhou, Qianqian; Linde, Jens Jørgen

    Estimating the expected annual damage (EAD) due to flooding in an urban area is of great interest for urban water managers and other stakeholders. It is a strong indicator for a given area showing how it will be affected by climate change and how much can be gained by implementing adaptation...... measures. This study investigates three different methods for estimating the EAD based on a loglinear relation between the damage costs and the return periods, one of which has been used in previous studies. The results show with the increased amount of data points there appears to be a shift in the log......-linear relation which could be contributed by the Danish design standards for drainage systems. Three different methods for estimating the EAD were tested and the choice of method is less important than accounting for the log-linear shift. This then also means that the statistical approximation of the EAD used...

  15. 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.

  16. 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.

  17. Damage Detection with Streamlined Structural Health Monitoring Data

    Directory of Open Access Journals (Sweden)

    Jian Li

    2015-04-01

    Full Text Available The huge amounts of sensor data generated by large scale sensor networks in on-line structural health monitoring (SHM systems often overwhelms the systems’ capacity for data transmission and analysis. This paper presents a new concept for an integrated SHM system in which a streamlined data flow is used as a unifying thread to integrate the individual components of on-line SHM systems. Such an integrated SHM system has a few desirable functionalities including embedded sensor data compression, interactive sensor data retrieval, and structural knowledge discovery, which aim to enhance the reliability, efficiency, and robustness of on-line SHM systems. Adoption of this new concept will enable the design of an on-line SHM system with more uniform data generation and data handling capacity for its subsystems. To examine this concept in the context of vibration-based SHM systems, real sensor data from an on-line SHM system comprising a scaled steel bridge structure and an on-line data acquisition system with remote data access was used in this study. Vibration test results clearly demonstrated the prominent performance characteristics of the proposed integrated SHM system including rapid data access, interactive data retrieval and knowledge discovery of structural conditions on a global level.

  18. Damage detection with streamlined structural health monitoring data.

    Science.gov (United States)

    Li, Jian; Deng, Jun; Xie, Weizhi

    2015-04-15

    The huge amounts of sensor data generated by large scale sensor networks in on-line structural health monitoring (SHM) systems often overwhelms the systems' capacity for data transmission and analysis. This paper presents a new concept for an integrated SHM system in which a streamlined data flow is used as a unifying thread to integrate the individual components of on-line SHM systems. Such an integrated SHM system has a few desirable functionalities including embedded sensor data compression, interactive sensor data retrieval, and structural knowledge discovery, which aim to enhance the reliability, efficiency, and robustness of on-line SHM systems. Adoption of this new concept will enable the design of an on-line SHM system with more uniform data generation and data handling capacity for its subsystems. To examine this concept in the context of vibration-based SHM systems, real sensor data from an on-line SHM system comprising a scaled steel bridge structure and an on-line data acquisition system with remote data access was used in this study. Vibration test results clearly demonstrated the prominent performance characteristics of the proposed integrated SHM system including rapid data access, interactive data retrieval and knowledge discovery of structural conditions on a global level.

  19. 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.

  20. 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.

  1. Efficient Phase Locking of Fiber Amplifiers Using a Low-Cost and High-Damage-Threshold Phase Control System

    International Nuclear Information System (INIS)

    Pu, Zhou; Yan-Xing, Ma; Xiao-Lin, Wang; Hao-Tong, Ma; Xiao-Jun, Xu; Ze-Jin, Liu

    2010-01-01

    We propose a low-cost and high-damage-threshold phase control system that employs a piezoelectric ceramic transducer modulator controlled by a stochastic parallel gradient descent algorithm. Efficient phase locking of two fiber amplifiers is demonstrated. Experimental results show that energy encircled in the target pinhole is increased by a factor of 1.76 and the visibility of the fringe pattern is as high as 90% when the system is in close-loop. The phase control system has potential in phase locking of large-number and high-power fiber laser endeavors. (fundamental areas of phenomenology (including applications))

  2. 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.

  3. Damage assessment using flexibility and flexibility-based curvature for structural health monitoring

    International Nuclear Information System (INIS)

    Catbas, F N; Gul, M; Burkett, J L

    2008-01-01

    As a result of the recent advances in sensors, information technologies and material science, a considerable amount of research has been conducted in the area of smart infrastructures. While there are many important components of a smart infrastructure, an automated and continuous structural health monitoring (SHM) system is a critical one. SHM is typically used to track and evaluate the performance of a structure, symptoms of operational incidents, anomalies due to deterioration and damage during regular operation as well as after an extreme event. Successful health monitoring applications can be achieved by integrating experimental, analytical and information technologies on real-life operating structures. However, real-life investigations must be backed up by laboratory benchmark studies for validating theory, concepts, and new technologies. For this reason, a physical bridge model is developed to implement SHM methods and technologies. In this study, different aspects of model development are outlined in terms of design considerations, instrumentation, finite element modeling, and simulating damage scenarios. Different damage detection methods are evaluated using the numerical and the physical models. Modal parameter estimation studies are carried out to reliably identify the eigenvalues, eigenvectors and modal scaling from the measurement data. To assess the simulated damage, modal flexibility-based displacements and curvatures are employed. Structural behavior after damage is evaluated by inspecting the deflected shapes obtained using modal flexibility. More localized damage simulations such as stiffness reduction at a joint yield a very subtle stiffness decrease. In this case, the writers use a baseline to identify damage and also investigate the use of curvature as a complementary index. Curvature is advantageous for certain cases where the displacement results do not provide substantial changes. Issues related to using curvature as a damage identification

  4. 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.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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...

  10. 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...

  11. The Marginal Damage Costs of Different Greenhouse Gases: An Application of FUND

    NARCIS (Netherlands)

    Waldhoff, S.; Anthoff, D.; Rose, S.; Tol, R.S.J.

    2014-01-01

    The authors use FUND 3.9 to estimate the social cost of four greenhouse gases—carbon dioxide, methane, nitrous oxide, and sulphur hexafluoride—with sensitivity tests for carbon dioxide fertilization, terrestrial feedbacks, climate sensitivity, discounting, equity weighting, and socioeconomic and

  12. 77 FR 57074 - Indirect Cost Rates for the Damage Assessment, Remediation, and Restoration Program for Fiscal...

    Science.gov (United States)

    2012-09-17

    ... information on these rates and the DARRP policy can be found at the DARRP web site at: http://www.darrp.noaa.gov/library/12_b.html FOR FURTHER INFORMATION CONTACT: For further information, contact LaTonya... develop indirect cost rates for its component organizations and formulate policies on the recovery of...

  13. Predicting the economic costs and property value losses attributed to sudden oak death damage in California (2010-2020).

    Science.gov (United States)

    Kovacs, Kent; Václavík, Tomáš; Haight, Robert G; Pang, Arwin; Cunniffe, Nik J; Gilligan, Christopher A; Meentemeyer, Ross K

    2011-04-01

    Phytophthora ramorum, cause of sudden oak death, is a quarantined, non-native, invasive forest pathogen resulting in substantial mortality in coastal live oak (Quercus agrifolia) and several other related tree species on the Pacific Coast of the United States. We estimate the discounted cost of oak treatment, removal, and replacement on developed land in California communities using simulations of P. ramorum spread and infection risk over the next decade (2010-2020). An estimated 734 thousand oak trees occur on developed land in communities in the analysis area. The simulations predict an expanding sudden oak death (SOD) infestation that will likely encompass most of northwestern California and warrant treatment, removal, and replacement of more than 10 thousand oak trees with discounted cost of $7.5 million. In addition, we estimate the discounted property losses to single family homes of $135 million. Expanding the land base to include developed land outside as well as inside communities doubles the estimates of the number of oak trees killed and the associated costs and losses. The predicted costs and property value losses are substantial, but many of the damages in urban areas (e.g. potential losses from increased fire and safety risks of the dead trees and the loss of ecosystem service values) are not included. Copyright © 2010 Elsevier Ltd. All rights reserved.

  14. 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.

  15. 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.

  16. Consequences and Possible Predictors of Health-damaging Behaviors and Mental Health Problems in Pregnancy - A Review.

    Science.gov (United States)

    Ulrich, F; Petermann, F

    2016-11-01

    In recent decades, the understanding of the short and longer term effects of health-damaging behaviors and mental health problems in pregnant women and the underlying mechanisms of these behaviors and illnesses has significantly increased. In contrast, little is known about the factors affecting individual pregnant women which contribute to health-damaging behaviors and mental illness. The aim of this paper was therefore to summarize the current state of research into the consequences of nicotine and alcohol consumption, malnutrition, excessive weight gain or obesity, and impaired mental health (depression and anxiety) during pregnancy. In addition, the characteristics of pregnant women which increase their risk of developing such behaviors or mental disorders are described. A better knowledge of these risks should make it easier for clinicians to identify cases at risk early on and put measures of support in place. A review of the literature has shown that certain characteristics of pregnant women (e.g. her relationship with her partner, a previous history of mental illness prior to pregnancy) are associated with various health-damaging behaviors as well as with impaired mental health. Affected women often show an accumulated psychosocial stress which was already present prior to the pregnancy and which may persist even after the birth of the child.

  17. 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...

  18. 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...

  19. Tornadoes and related damage costs: statistical modeling with a semi-Markov approach

    OpenAIRE

    Corini, Chiara; D'Amico, Guglielmo; Petroni, Filippo; Prattico, Flavio; Manca, Raimondo

    2015-01-01

    We propose a statistical approach to tornadoes modeling for predicting and simulating occurrences of tornadoes and accumulated cost distributions over a time interval. This is achieved by modeling the tornadoes intensity, measured with the Fujita scale, as a stochastic process. Since the Fujita scale divides tornadoes intensity into six states, it is possible to model the tornadoes intensity by using Markov and semi-Markov models. We demonstrate that the semi-Markov approach is able to reprod...

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. Human health cost of hydrogen sulfide air pollution from an oil and gas Field.

    Science.gov (United States)

    Kenessary, Dinara; Kenessary, Almas; Kenessariyev, Ussen Ismailovich; Juszkiewicz, Konrad; Amrin, Meiram Kazievich; Erzhanova, Aya Eralovna

    2017-06-08

    Introduction and objective. The Karachaganak oil and gas condensate field (KOGCF), one of the largest in the world, located in the Republic of Kazakhstan (RoK) in Central Asia, is surrounded by 10 settlements with a total population of 9,000 people. Approximately73% of this population constantly mention a specific odour of rotten eggs in the air, typical for hydrogen sulfide (H2S) emissions, and the occurrence of low-level concentrations of hydrogen sulfide around certain industrial installations (esp. oil refineries) is a well known fact. Therefore, this study aimed at determining the impact on human health and the economic damage to the country due to H2S emissions. Materials and method. Dose-response dependency between H2S concentrations in the air and cardiovascular morbidity using multiple regression analysis was applied. Economic damage from morbidity was derived with a newly-developed method, with Kazakhstani peculiarities taken into account. Results.Hydrogen sulfide air pollution due to the KOGCF activity costs the state almost $60,000 per year. Moreover, this is the reason for a more than 40% rise incardiovascular morbidity in the region. Conclusion. The reduction of hydrogen sulfide emissions into the air is recommended, as well as successive constant ambient air monitoring in future. Economic damage evaluation should be made mandatory, on a legal basis, whenever an industrial facility operation results in associated air pollution.

  5. 26 CFR 301.7430-8 - Administrative costs incurred in damage actions for violations of section 362 or 524 of the...

    Science.gov (United States)

    2010-04-01

    ...) In general. The Internal Revenue Service may grant a taxpayer's request for recovery of reasonable... Revenue Service or recovery of damages from the Internal Revenue Service under § 301.7433-2(e). (d) Costs... administrative costs within six months after such request is filed, the Internal Revenue Service's failure to...

  6. Contribution of insurance data to cost assessment of coastal flood damage to residential buildings: insights gained from Johanna (2008 and Xynthia (2010 storm events

    Directory of Open Access Journals (Sweden)

    C. André

    2013-08-01

    Full Text Available There are a number of methodological issues involved in assessing damage caused by natural hazards. The first is the lack of data, due to the rarity of events and the widely different circumstances in which they occur. Thus, historical data, albeit scarce, should not be neglected when seeking to build ex-ante risk management models. This article analyses the input of insurance data for two recent severe coastal storm events, to examine what causal relationships may exist between hazard characteristics and the level of damage incurred by residential buildings. To do so, data was collected at two levels: from lists of about 4000 damage records, 358 loss adjustment reports were consulted, constituting a detailed damage database. The results show that for flooded residential buildings, over 75% of reconstruction costs are associated with interior elements, with damage to structural components remaining very localised and negligible. Further analysis revealed a high scatter between costs and water depth, suggesting that uncertainty remains high in drawing up damage functions with insurance data alone. Due to the paper format of the loss adjustment reports, and the lack of harmonisation between their contents, the collection stage called for a considerable amount of work. For future events, establishing a standardised process for archiving damage information could significantly contribute to the production of such empirical damage functions. Nevertheless, complementary sources of data on hazards and asset vulnerability parameters will definitely still be necessary for damage modelling; multivariate approaches, crossing insurance data with external material, should also be investigated more deeply.

  7. Contribution of insurance data to cost assessment of coastal flood damage to residential buildings: insights gained from Johanna (2008) and Xynthia (2010) storm events

    Science.gov (United States)

    André, C.; Monfort, D.; Bouzit, M.; Vinchon, C.

    2013-08-01

    There are a number of methodological issues involved in assessing damage caused by natural hazards. The first is the lack of data, due to the rarity of events and the widely different circumstances in which they occur. Thus, historical data, albeit scarce, should not be neglected when seeking to build ex-ante risk management models. This article analyses the input of insurance data for two recent severe coastal storm events, to examine what causal relationships may exist between hazard characteristics and the level of damage incurred by residential buildings. To do so, data was collected at two levels: from lists of about 4000 damage records, 358 loss adjustment reports were consulted, constituting a detailed damage database. The results show that for flooded residential buildings, over 75% of reconstruction costs are associated with interior elements, with damage to structural components remaining very localised and negligible. Further analysis revealed a high scatter between costs and water depth, suggesting that uncertainty remains high in drawing up damage functions with insurance data alone. Due to the paper format of the loss adjustment reports, and the lack of harmonisation between their contents, the collection stage called for a considerable amount of work. For future events, establishing a standardised process for archiving damage information could significantly contribute to the production of such empirical damage functions. Nevertheless, complementary sources of data on hazards and asset vulnerability parameters will definitely still be necessary for damage modelling; multivariate approaches, crossing insurance data with external material, should also be investigated more deeply.

  8. Emergency planning. Can the cost of remedial actions be compared to the value of the health effects they save

    International Nuclear Information System (INIS)

    Frittelli, L.; Tamburrano, A.

    1981-01-01

    When an accidental release of radioactive material occurs the exposure of the people concerned can be reduced only by remedial actions, applied to individuals (evacuation) or their environment (e.g. by land interdiction, by impoundment of contaminated products). The adoption of remedial actions should be based on a balance between the damage they cause and the reduction in health effects they can achieve. In this paper a 'cost-effectiveness' analysis is attempted by comparing the costs of remedial actions with the monetary value of the collective dose avoided by them. Remedial actions are undertaken to prevent non-stochastic effects in the exposed population and to limit stochastic effects therein. The damage caused by the remedial actions is evaluated by taking into account the loss of value of interdicted property, the costs for decontaminating land and structures, the loss of income of evacuated people. The options in remedial actions (interdiction, decontamination, goods removal) which minimize the total costs are supposed to be adopted at every location. The collective effective dose equivalent avoided by the remedial actions is computed by taking into account the external exposure from the cloud and from the contaminated ground, and the internal exposure from material inhaled from the passing cloud or inhaled from matter resuspended after deposition on the ground. The extent of the resulting total damage (both economic and health aspects) is partly determined by the intervention level chosen for defining the time and space features of remedial actions. As a result, the total damage has a lower value for an intervention level of about 0.1 Sv for large and medium releases from a nuclear power plant in a not very highly developed site. For a contained release no value of the intervention level optimizes the balance between health and economic consequences. (author)

  9. 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.

  10. 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.

  11. A self-synchronizing and low-cost structural health monitoring scheme based on zero crossing detection

    International Nuclear Information System (INIS)

    Guyomar, Daniel; Lallart, Mickaël; Li, Kaixiang; Gauthier, Jean-Yves; Monnier, Thomas

    2010-01-01

    Owing to their high specific strength and stiffness, composite materials are increasingly being used in aeronautics and astronautics, but such materials are vulnerable to impact damage and delamination. Structural health monitoring (SHM) techniques have been developed for detecting such defects in recent years. In situ, self-powered and low-cost SHM systems are a developmental tendency of this technique. This paper introduces the principles of a low-cost and self-synchronizing scheme for SHM. Based on the Lamb wave interactions with the structure, the proposed technique relies on detecting zero crossing time instants in order to derive an estimation of the structural state. It is shown that such a method provides a very simple and low-cost way to assess the structural integrity while being computationally efficient. Experimental investigations carried out on a composite plate with an increasing penetration hold validating the proposed technique show its effectiveness for detecting the damage. The proposed approach has also been applied on an aircraft outboard flap to detect the impact damage. The robustness is discussed versus time-shift and magnitude jitter assumptions by using the plate case. The temperature effect is also considered by defining a coefficient array in order to compensate for the material property changes. Finally, an embedded implementation of such a SHM technique is presented by using the proposed damage index

  12. 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.

  13. Health-related external cost assessment in Europe: methodological developments from ExternE to the 2013 Clean Air Policy Package.

    Science.gov (United States)

    van der Kamp, Jonathan; Bachmann, Till M

    2015-03-03

    "Getting the prices right" through internalizing external costs is a guiding principle of environmental policy making, one recent example being the EU Clean Air Policy Package released at the end of 2013. It is supported by impact assessments, including monetary valuation of environmental and health damages. For over 20 years, related methodologies have been developed in Europe in the Externalities of Energy (ExternE) project series and follow-up activities. In this study, we aim at analyzing the main methodological developments over time from the 1990s until today with a focus on classical air pollution-induced human health damage costs. An up-to-date assessment including the latest European recommendations is also applied. Using a case from the energy sector, we identify major influencing parameters: differences in exposure modeling and related data lead to variations in damage costs of up to 21%; concerning risk assessment and monetary valuation, differences in assessing long-term exposure mortality risks together with assumptions on particle toxicity explain most of the observed changes in damage costs. These still debated influencing parameters deserve particular attention when damage costs are used to support environmental policy making.

  14. 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.

  15. [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

  16. 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....

  17. Compensation for damage to workers health exposed to ionizing radiation in Argentina

    CERN Document Server

    Sobehart, L J

    2003-01-01

    The objective of this report is to analyze the possibility to establish a scheme to compensate damage to workers health exposed to ionizing radiation in Argentina for those cases in which it is possible to assume that the exposure to ionizing radiation is the cause of the cancer suffered by the worker. The proposed scheme is based on the recommendations set out in the 'International Conference on Occupational Radiation Protection: Protecting Workers against Exposure to Ionization Radiation, held in Geneva, Switzerland, August 26-30, 2002. To this end, the study analyzes the present state of scientific knowledge on cancer causation due to genotoxic factors, and the accepted form of the doses-response curve, for the human beings exposure to ionization radiation at low doses with low doses rates. Finally, the labor laws and regulations related to damage compensation; in particular the present Argentine Labor Law; the National Russian Federal Occupational Radiological Health Impairment and Workmen Compensation, t...

  18. 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.

  19. 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

  20. 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

  1. [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.

  2. 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.

  3. 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.

  4. 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

  5. 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

  6. Estimation of health damage due to emission of air pollutants by cars: the canyon effect

    Energy Technology Data Exchange (ETDEWEB)

    Spadaro, J.V. [Ecole des Mines, Centre d' Energetique, Paris, 75 (France); Rabl, A.

    1999-07-01

    Since current epidemiological evidence suggests that air pollution has harmful effects even at typical ambient concentrations and the dispersion is significant over hundreds to thousands of km, the estimation of total health damage involves consideration of local and regional effects. In recent years, several estimates have been published of health damage due to air pollution from cars, in particular by Delucchi et al of UC Davis and by the ExternE Project of the European Commission. To capture the geographic extent of pollutant dispersion, local and regional models have been used in combination. The present paper addresses a potentially significant contribution of the total damage, not yet taken into account in these studies: the increased concentration of pollutants inside urban street canyons. This canyon effect is appreciable only for primary pollutants, the time constants for the formation of secondary pollutants being long compared to the residence time in the canyon. We assumed linearity of incremental health impact with incremental concentration, in view of the lack of epidemiological evidence for no-effect thresholds or significant deviations from linearity at typical ambient concentrations; therefore, only long term average concentrations matter. We use the FLUENT software to model the dispersion inside a street canyon for a wide range of rectangular geometries and wind velocities. Our results suggest that the canyon effect is of marginal significance for total damages, the contribution of the canyon effect being roughly 10 to 20% of the total. The relative importance of the canyon effect is, of course, highly variable with local conditions; it could be much smaller but it is unlikely to add more than 100% to the flat terrain estimate. (Author)

  7. Artificial immune pattern recognition for damage detection in structural health monitoring sensor networks

    Science.gov (United States)

    Chen, Bo; Zang, Chuanzhi

    2009-03-01

    This paper presents an artificial immune pattern recognition (AIPR) approach for the damage detection and classification in structures. An AIPR-based Structure Damage Classifier (AIPR-SDC) has been developed by mimicking immune recognition and learning mechanisms. The structure damage patterns are represented by feature vectors that are extracted from the structure's dynamic response measurements. The training process is designed based on the clonal selection principle in the immune system. The selective and adaptive features of the clonal selection algorithm allow the classifier to generate recognition feature vectors that are able to match the training data. In addition, the immune learning algorithm can learn and remember various data patterns by generating a set of memory cells that contains representative feature vectors for each class (pattern). The performance of the presented structure damage classifier has been validated using a benchmark structure proposed by the IASC-ASCE (International Association for Structural Control - American Society of Civil Engineers) Structural Health Monitoring Task Group. The validation results show a better classification success rate comparing to some of other classification algorithms.

  8. 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

  9. 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

  10. 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…

  11. Damage Detection Sensitivity of a Vehicle-based Bridge Health Monitoring System

    Science.gov (United States)

    Miyamoto, Ayaho; Yabe, Akito; Lúcio, Válter J. G.

    2017-05-01

    As one solution to the problem for condition assessment of existing short and medium span (10-30m) reinforced/prestressed concrete bridges, a new monitoring method using a public bus as part of a public transit system (called “Bus monitoring system”) was proposed, along with safety indices, namely, “characteristic deflection”, which is relatively free from the influence of dynamic disturbances due to such factors as the roughness of the road surface, and a structural anomaly parameter. In this study, to evaluate the practicality of the newly developed bus monitoring system, it has been field-tested over a period of about four years by using an in-service fixed-route bus operating on a bus route in the city of Ube, Yamaguchi Prefecture, Japan. In here, although there are some useful monitoring methods for short and medium span bridges based on the qualitative or quantitative information, the sensitivity of damage detection was newly discussed for safety assessment based on long term health monitoring data. The verification results thus obtained are also described in this paper, and also evaluates the sensitivity of the “characteristic deflection”, which is a bridge (health) condition indicator used by the bus monitoring system, in damage detection. Sensitivity of “characteristic deflection” is verified by introducing artificial damage into a bridge that has ended its service life and is awaiting removal. Furthermore, the sensitivity of “characteristic deflection” is verified by 3D FEM analysis.

  12. Electricity and risk of public health center had measles vaccine damage in Indonesia

    Directory of Open Access Journals (Sweden)

    Anggita Bunga Anggraini

    2016-03-01

    related to PHC hadmeasles damage vaccines.Methods: The analysis used a part of the data of Research Health Facilities (Rifaskes in 2011. The Rifaskeswas conducted in all health centers in all (33 provinces in Indonesia. Furthermore, this analysis uses dataonly health center in the province who have measles immunization coverage the national prevalence rate(81.6% or more, and health centers that have measles prevalence rate above the national prevalence rate(1.18% or more. Statistical data analysis performed using logistic regression analysis to determine someof the risk factors related to the health center had has measles vaccine damaged.Results: A number of 7 provinces (Riau, Jakarta, West Nusa Tenggara, East Nusa Tenggara, CentralSulawesi, South Sulawesi, Gorontalo with 1259 PHC met the inclusion criteria. Health centers locatedin rural areas compared with urban areas had 3.4-fold risk of a PHC that had measles damage vaccines[adjusted odds ratio (ORa = 3.37; 95% confidence interval (CI = 1.34 - 8.26]. Furthermore, the healthcenter with the availability of the electricity for less than 24 hours compared with available 24 hours had2.1-fold risk of PHC that had measles damage vaccines (ORa = 2.10; 95% CI = 1.02 - 4.33.Conclusion: Public health center in rural areas, or did not have not have commercial electric power, ordid not have the availability of day-to-day electricity less than 24 hours had more risk of a PHC that hadmeasles damage vaccines. (Health Science Journal of Indonesia 2015;6:116-20Keywords: measles, public health center, vaccine

  13. 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...

  14. 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

  15. 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.

  16. 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.

  17. 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:

  18. 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

  19. 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

  20. Characterization of Aircraft Structural Damage Using Guided Wave Based Finite Element Analysis for In-Flight Structural Health Management

    Science.gov (United States)

    Seshadri, Banavara R.; Krishnamurthy, Thiagarajan; Ross, Richard W.

    2016-01-01

    The development of multidisciplinary Integrated Vehicle Health Management (IVHM) tools will enable accurate detection, diagnosis and prognosis of damage under normal and adverse conditions during flight. The adverse conditions include loss of control caused by environmental factors, actuator and sensor faults or failures, and structural damage conditions. A major concern is the growth of undetected damage/cracks due to fatigue and low velocity foreign object impact that can reach a critical size during flight, resulting in loss of control of the aircraft. To avoid unstable catastrophic propagation of damage during a flight, load levels must be maintained that are below the load-carrying capacity for damaged aircraft structures. Hence, a capability is needed for accurate real-time predictions of safe load carrying capacity for aircraft structures with complex damage configurations. In the present work, a procedure is developed that uses guided wave responses to interrogate damage. As the guided wave interacts with damage, the signal attenuates in some directions and reflects in others. This results in a difference in signal magnitude as well as phase shifts between signal responses for damaged and undamaged structures. Accurate estimation of damage size and location is made by evaluating the cumulative signal responses at various pre-selected sensor locations using a genetic algorithm (GA) based optimization procedure. The damage size and location is obtained by minimizing the difference between the reference responses and the responses obtained by wave propagation finite element analysis of different representative cracks, geometries and sizes.

  1. Cost Analysis of the STONE Randomized Trial: Can Health Care Costs be Reduced One Test at a Time?

    Science.gov (United States)

    Melnikow, Joy; Xing, Guibo; Cox, Ginger; Leigh, Paul; Mills, Lisa; Miglioretti, Diana L; Moghadassi, Michelle; Smith-Bindman, Rebecca

    2016-04-01

    Decreasing the use of high-cost tests may reduce health care costs. To compare costs of care for patients presenting to the emergency department (ED) with suspected kidney stones randomized to 1 of 3 initial imaging tests. Patients were randomized to point-of-care ultrasound (POC US, least costly), radiology ultrasound (RAD US), or computed tomography (CT, most costly). Subsequent testing and treatment were the choice of the treating physician. A total of 2759 patients at 15 EDs were randomized to POC US (n=908), RAD US, (n=893), or CT (n=958). Mean age was 40.4 years; 51.8% were male. All medical care documented in the trial database in the 7 days following enrollment was abstracted and coded to estimate costs using national average 2012 Medicare reimbursements. Costs for initial ED care and total 7-day costs were compared using nonparametric bootstrap to account for clustering of patients within medical centers. Initial ED visit costs were modestly lower for patients assigned to RAD US: $423 ($411, $434) compared with patients assigned to CT: $448 ($438, $459) (Pcosts were not significantly different between groups: $1014 ($912, $1129) for POC US, $970 ($878, $1078) for RAD US, and $959 ($870, $1044) for CT. Hospital admissions contributed over 50% of total costs, though only 11% of patients were admitted. Mean total costs (and admission rates) varied substantially by site from $749 to $1239. Assignment to a less costly test had no impact on overall health care costs for ED patients. System-level interventions addressing variation in admission rates from the ED might have greater impact on costs.

  2. Making choices in health: WHO guide to cost effectiveness analysis

    National Research Council Canada - National Science Library

    Tan Torres Edejer, Tessa

    2003-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 6. Uncertainty in cost-effectiveness analysis . . . . . . . . . . . . . . . . . . 73 7. 8. Policy uses of Generalized CEA...

  3. Intangible asset valuation, damages, and transfer price analyses in the health care industry.

    Science.gov (United States)

    Reilly, Robert F

    2010-01-01

    Most health care industry participants own and operate intangible assets. These intangible assets can be industry-specific (e.g., patient charts and records, certificates of need, professional and other licenses), or they can be general commercial intangible assets (e.g., trademarks, systems and procedures, an assembled workforce). Many industry participants have valued their intangible assets for financial accounting or other purposes. This article summarizes the intangible assets that are common to health care industry participants. This article describes the different types of intangible asset analyses (including valuation, transfer price, damages estimates, etc.), and explains the many different transaction, accounting, taxation, regulatory, litigation, and other reasons why industry participants may wish to value (or otherwise analyze) health care intangible assets.

  4. Update of the Dutch manual for costing studies in health care.

    Directory of Open Access Journals (Sweden)

    Tim A Kanters

    Full Text Available Dutch health economic guidelines include a costing manual, which describes preferred research methodology for costing studies and reference prices to ensure high quality studies and comparability between study outcomes. This paper describes the most important revisions of the costing manual compared to the previous version.An online survey was sent out to potential users of the costing manual to identify topics for improvement. The costing manual was aligned with contemporary health economic guidelines. All methodology sections and parameter values needed for costing studies, particularly reference prices, were updated. An expert panel of health economists was consulted several times during the review process. The revised manual was reviewed by two members of the expert panel and by reviewers of the Dutch Health Care Institute.The majority of survey respondents was satisfied with content and usability of the existing costing manual. Respondents recommended updating reference prices and adding some particular commonly needed reference prices. Costs categories were adjusted to the international standard: 1 costs within the health care sector; 2 patient and family costs; and 3 costs in other sectors. Reference prices were updated to reflect 2014 values. The methodology chapter was rewritten to match the requirements of the costing manual and preferences of the users. Reference prices for nursing days of specific wards, for diagnostic procedures and nurse practitioners were added.The usability of the costing manual was increased and parameter values were updated. The costing manual became integrated in the new health economic guidelines.

  5. Update of the external cost for environmental damage (for Flanders) with regard to air pollution and climatic change; Actualisering van de externe milieuschadekosten (algemeen voor Vlaanderen) met betrekking tot luchtverontreiniging en klimaatverandering

    Energy Technology Data Exchange (ETDEWEB)

    De Nocker, L.; Michiels, H.; Deutsch, F.; Lefebvre, W.; Buekers, J.; Torfs, R. [Unit Ruimtelijke Milieuaspecten, VITO, Mol (Belgium)

    2010-12-15

    This report contains a set of indicators for calculating external costs of air-polluting substances and greenhouse gases. The external costs of environmental damage relate to the damage to human health, eco systems, buildings and economy as a result of an activity. This leads to loss of welfare for inhabitants in Flanders and abroad for the current and future generations. The magnitude and evolution of the external or environmental damage cost resulting from air pollution is one of the indicators for the MIRA report that translates the state of the environment into consequences for man and economy. [Dutch] Dit rapport bevat een set van kengetallen voor de berekening van de externe kosten van luchtverontreinigende stoffen en broeikasgassen. De externe kosten of milieuschadekosten hebben betrekking op de schade aan menselijke gezondheid, ecosystemen, gebouwen en economie als gevolg van een activiteit. Dit leidt tot een verlies aan welvaart voor inwoners in Vlaanderen en het buitenland, voor deze en toekomstige generaties. De omvang en evolutie van de externe of milieuschadekosten ten gevolge van luchtverontreiniging ia 1 van de indicatoren voor het MIRA rapport die de toestand van het milieu vertaalt naar gevolgen voor mens en economie.

  6. Psychological health damage as an environmental effect: Metropolitan Edison Co. v. People Against Nuclear Energy

    International Nuclear Information System (INIS)

    Hoff, E.H.

    1984-01-01

    The Supreme court took a narrow view of the term environmental in Metropolitan Edison Co. v. People Against Nuclear Energy when it stated that the purpose of the National Environmental Policy Act (NEPA) is to protect the physical environment. Psychological health damage caused by the perception of the risk of a nuclear accident is not an environmental effect cognizable under NEPA unless their is a demonstrable relationship. Litigants seeking the protection of NEPA must carefully examine the origin and nature of alleged psychological harms and frame their complains to establish a close relationship between a change in the physical environment and the alleged psychological harm

  7. A time reversal damage imaging method for structure health monitoring using Lamb waves

    International Nuclear Information System (INIS)

    Zhang Hai-Yan; Cao Ya-Ping; Sun Xiu-Li; Chen Xian-Hua; Yu Jian-Bo

    2010-01-01

    This paper investigates the Lamb wave imaging method combining time reversal for health monitoring of a metallic plate structure. The temporal focusing effect of the time reversal Lamb waves is investigated theoretically. It demonstrates that the focusing effect is related to the frequency dependency of the time reversal operation. Numerical simulations are conducted to study the time reversal behaviour of Lamb wave modes under broadband and narrowband excitations. The results show that the reconstructed time reversed wave exhibits close similarity to the reversed narrowband tone burst signal validating the theoretical model. To enhance the similarity, the cycle number of the excited signal should be increased. Experiments combining finite element model are then conducted to study the imaging method in the presence of damage like hole in the plate structure. In this work, the time reversal technique is used for the recompression of Lamb wave signals. Damage imaging results with time reversal using broadband and narrowband excitations are compared to those without time reversal. It suggests that the narrowband excitation combined time reversal can locate and determine the size of structural damage more precisely, but the cycle number of the excited signal should be chosen reasonably

  8. Update of the Dutch manual for costing studies in health care

    NARCIS (Netherlands)

    T.A. Kanters (Tim A.); C.A.M. Bouwmans-Frijters (Clazien); N. van der Linden (Naomi); S.S. Tan (Siok Swan); L. van Hakkaart-van Roijen (Leona)

    2017-01-01

    markdownabstract__Objectives__ Dutch health economic guidelines include a costing manual, which describes preferred research methodology for costing studies and reference prices to ensure high quality studies and comparability between study outcomes. This paper describes the most

  9. What does primary health care cost and can we afford to find out ...

    African Journals Online (AJOL)

    Accurate information on the costs of providing priInary health care (PHC) ... if the Government's stated commitment to an adequate PHC system is to be realised. ... to generate accurate cost accounting information is a serious shortcoIDing.

  10. External costs of PM2.5 pollution in Beijing, China: Uncertainty analysis of multiple health impacts and costs

    DEFF Research Database (Denmark)

    Hao, Yin; Pizzol, Massimo; Xu, Linyu

    2017-01-01

    Some cities in China are facing serious air pollution problems including high concentrations of particles, SO2 and NOx. 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...

  11. Cost-Effectiveness of a School-Based Emotional Health Screening Program

    Science.gov (United States)

    Kuo, Elena; Stoep, Ann Vander; McCauley, Elizabeth; Kernic, Mary A.

    2009-01-01

    Background: School-based screening for health conditions can help extend the reach of health services to underserved populations. Screening for mental health conditions is growing in acceptability, but evidence of cost-effectiveness is lacking. This study assessed costs and effectiveness associated with the Developmental Pathways Screening…

  12. Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden.

    Science.gov (United States)

    Virta, Lena; Joranger, Pål; Brox, Jens Ivar; Eriksson, Rikard

    2012-02-10

    Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden. The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model. 204 (103 women) patients, mean age 48 (SD 11) years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16%) remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389) during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third. The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted.

  13. Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden

    Directory of Open Access Journals (Sweden)

    Virta Lena

    2012-02-01

    Full Text Available Abstract Background Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden. Methods The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model. Results 204 (103 women patients, mean age 48 (SD 11 years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16% remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389 during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third. Conclusions The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted.

  14. Pediatric cryptosporidiosis: An evaluation of health care and societal costs in Peru, Bangladesh and Kenya

    OpenAIRE

    Rafferty, Ellen R.; Schurer, Janna M.; Arndt, Michael B.; Choy, Robert K. M.; de Hostos, Eugenio L.; Shoultz, David; Farag, Marwa

    2017-01-01

    Cryptosporidium is a leading cause of pediatric diarrhea in resource-limited settings; yet, few studies report the health care costs or societal impacts of this protozoan parasite. Our study examined direct and indirect costs associated with symptomatic cryptosporidiosis in infants younger than 12 months in Kenya, Peru and Bangladesh. Inputs to the economic burden model, such as disease incidence, population size, health care seeking behaviour, hospital costs, travel costs, were extracted fro...

  15. Costing in Radiology and Health Care: Rationale, Relativity, Rudiments, and Realities.

    Science.gov (United States)

    Rubin, Geoffrey D

    2017-02-01

    Costs direct decisions that influence the effectiveness of radiology in the care of patients on a daily basis. Yet many radiologists struggle to harness the power of cost measurement and cost management as a critical path toward establishing their value in patient care. When radiologists cannot articulate their value, they risk losing control over how imaging is delivered and supported. In the United States, recent payment trends directing value-based payments for bundles of care advance the imperative for radiology providers to articulate their value. This begins with the development of an understanding of the providers' own costs, as well as the complex interrelationships and imaging-associated costs of other participants across the imaging value chain. Controlling the costs of imaging necessitates understanding them at a procedural level and quantifying the costs of delivering specific imaging services. Effective product-level costing is dependent on a bottom-up approach, which is supported through recent innovations in time-dependent activity-based costing. Once the costs are understood, they can be managed. Within the high fixed cost and high overhead cost environment of health care provider organizations, stakeholders must understand the implications of misaligned top-down cost management approaches that can both paradoxically shift effort from low-cost workers to much costlier professionals and allocate overhead costs counterproductively. Radiology's engagement across a broad spectrum of care provides an excellent opportunity for radiology providers to take a leading role within the health care organizations to enhance value and margin through principled and effective cost management. Following a discussion of the rationale for measuring costs, this review contextualizes costs from the perspectives of a variety of stakeholders (relativity), discusses core concepts in how costs are classified (rudiments), presents common and improved methods for measuring

  16. Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records.

    Science.gov (United States)

    Gulliford, Martin C; Charlton, Judith; Prevost, Toby; Booth, Helen; Fildes, Alison; Ashworth, Mark; Littlejohns, Peter; Reddy, Marcus; Khan, Omar; Rudisill, Caroline

    2017-01-01

    To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  17. Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening.

    Science.gov (United States)

    Balabanova, Dina; Mills, Anne; Conteh, Lesong; Akkazieva, Baktygul; Banteyerga, Hailom; Dash, Umakant; Gilson, Lucy; Harmer, Andrew; Ibraimova, Ainura; Islam, Ziaul; Kidanu, Aklilu; Koehlmoos, Tracey P; Limwattananon, Supon; Muraleedharan, V R; Murzalieva, Gulgun; Palafox, Benjamin; Panichkriangkrai, Warisa; Patcharanarumol, Walaiporn; Penn-Kekana, Loveday; Powell-Jackson, Timothy; Tangcharoensathien, Viroj; McKee, Martin

    2013-06-15

    In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some countries or regions achieve better health and social outcomes than do others at a similar level of income and to show the role of political will and socially progressive policies. 25 years on, the Good Health at Low Cost project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand, and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in health or access to services or implemented innovative health policies relative to their neighbours. A series of comparative case studies (2009-11) looked at how and why each region accomplished these changes. Attributes of success included good governance and political commitment, effective bureaucracies that preserve institutional memory and can learn from experience, and the ability to innovate and adapt to resource limitations. Furthermore, the capacity to respond to population needs and build resilience into health systems in the face of political unrest, economic crises, and natural disasters was important. Transport infrastructure, female empowerment, and education also played a part. Health systems are complex and no simple recipe exists for success. Yet in the countries and regions studied, progress has been assisted by institutional stability, with continuity of reforms despite political and economic turmoil, learning lessons from experience, seizing windows of opportunity, and ensuring sensitivity to context. These experiences show that improvements in health can still be achieved in countries with relatively few resources, though strategic investment is necessary to address new challenges such as complex chronic diseases and growing population expectations. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Comment 2 on workshop in economics - issues in benefit-cost analysis: Amplification channels and discounting long-term environmental damages

    International Nuclear Information System (INIS)

    Hanson, D.A.

    1992-01-01

    Many environmental problems have long-term effects. Acid rain has long-term effects on soils, forests, and exposed materials. Global climate change has even longer-term effects. This difference in timing - between the near-term cost of environmental protection and the long-term environmental effects - makes it difficult to conduct a cost-benefit analysis of any program designed to abate environmental damages. The rate at which to discount long-term environmental damages becomes a key question in comparisons of benefits and costs. This comment points out an important facet of the discounting issue. The discount rate for calculating the present value of future environmental benefits may be much lower than the rate of return on investment. Cost-benefit analysis is a framework in which to evaluate policies and decisions. Because global climate change is a complex problem, extensions of cost-benefit theory can be expected to add additional insights, particularly in the following areas: distinguishing distributional effects among nations, over time, and among generations; determining the rate of discount that is appropriate for long-term environmental damages and separating risk aspects from the rate of discount; and assessing amplification effects when policies involve large expenditures relative to the economy or when affected sectors are significant sectors of the economy

  19. The cost of child health inequalities in Aotearoa New Zealand: a preliminary scoping study

    Directory of Open Access Journals (Sweden)

    Mills Clair

    2012-05-01

    Full Text Available Abstract Background Health inequalities have been extensively documented, internationally and in New Zealand. The cost of reducing health inequities is often perceived as high; however, recent international studies suggest the cost of “doing nothing” is itself significant. This study aimed to develop a preliminary estimate of the economic cost of health inequities between Māori (indigenous and non-Māori children in New Zealand. Methods Standard quantitative epidemiological methods and “cost of illness” methodology were employed, within a Kaupapa Māori theoretical framework. Data were obtained from national data collections held by the New Zealand Health Information Service and other health sector agencies. Results Preliminary estimates suggest child health inequities between Māori and non-Māori in New Zealand are cost-saving to the health sector. However the societal costs are significant. A conservative “base case” scenario estimate is over $NZ62 million per year, while alternative costing methods yield larger costs of nearly $NZ200 million per annum. The total cost estimate is highly sensitive to the costing method used and Value of Statistical Life applied, as the cost of potentially avoidable deaths of Māori children is the major contributor to this estimate. Conclusions This preliminary study suggests that health sector spending is skewed towards non-Māori children despite evidence of greater Māori need. Persistent child health inequities result in significant societal economic costs. Eliminating child health inequities, particularly in primary care access, could result in significant economic benefits for New Zealand. However, there are conceptual, ethical and methodological challenges in estimating the economic cost of child health inequities. Re-thinking of traditional economic frameworks and development of more appropriate methodologies is required.

  20. A cost function analysis of child health services in four districts in Malawi.

    Science.gov (United States)

    Johns, Benjamin; Munthali, Spy; Walker, Damian G; Masanjala, Winford; Bishai, David

    2013-05-10

    Recent analyses show that donor funding for child health is increasing, but little information is available on actual costs to deliver child health care services. Understanding how unit costs scale with service volume in Malawi can help planners allocate budgets as health services expand. Data on facility level inputs and outputs were collected at 24 health centres in four districts of Malawi visiting a random sample of government and a convenience sample of Christian Health Association of Malawi (CHAM) health centres. In the cost function, total outputs, quality, facility ownership, average salaries and case mix are used to predict total cost. Regression analysis identifies marginal cost as the coefficient relating cost to service volume intensity. The marginal cost per patient seen for all health centres surveyed was US$ 0.82 per additional patient visit. Average cost was US$ 7.16 (95% CI: 5.24 to 9.08) at government facilities and US$ 10.36 (95% CI: 4.92 to 15.80) at CHAM facilities per child seen for any service. The first-line anti-malarial drug accounted for over 30% of costs, on average, at government health centres. Donors directly financed 40% and 21% of costs at government and CHAM health centres, respectively. The regression models indicate higher total costs are associated with a greater number of outpatient visits but that many health centres are not providing services at optimal volume given their inputs. They also indicate that CHAM facilities have higher costs than government facilities for similar levels of utilization. We conclude by discussing ways in which efficiency may be improved at health centres. The first option, increasing the total number of patients seen, appears difficult given existing high levels of child utilization; increasing the volume of adult patients may help spread fixed and semi-fixed costs. A second option, improving the quality of services, also presents difficulties but could also usefully improve performance.

  1. The cost of child health inequalities in Aotearoa New Zealand: a preliminary scoping study.

    Science.gov (United States)

    Mills, Clair; Reid, Papaarangi; Vaithianathan, Rhema

    2012-05-28

    Health inequalities have been extensively documented, internationally and in New Zealand. The cost of reducing health inequities is often perceived as high; however, recent international studies suggest the cost of "doing nothing" is itself significant. This study aimed to develop a preliminary estimate of the economic cost of health inequities between Māori (indigenous) and non-Māori children in New Zealand. Standard quantitative epidemiological methods and "cost of illness" methodology were employed, within a Kaupapa Māori theoretical framework. Data were obtained from national data collections held by the New Zealand Health Information Service and other health sector agencies. Preliminary estimates suggest child health inequities between Māori and non-Māori in New Zealand are cost-saving to the health sector. However the societal costs are significant. A conservative "base case" scenario estimate is over $NZ62 million per year, while alternative costing methods yield larger costs of nearly $NZ200 million per annum. The total cost estimate is highly sensitive to the costing method used and Value of Statistical Life applied, as the cost of potentially avoidable deaths of Māori children is the major contributor to this estimate. This preliminary study suggests that health sector spending is skewed towards non-Māori children despite evidence of greater Māori need. Persistent child health inequities result in significant societal economic costs. Eliminating child health inequities, particularly in primary care access, could result in significant economic benefits for New Zealand. However, there are conceptual, ethical and methodological challenges in estimating the economic cost of child health inequities. Re-thinking of traditional economic frameworks and development of more appropriate methodologies is required.

  2. Compensation for damage to workers health exposed to ionizing radiation in Argentina

    International Nuclear Information System (INIS)

    Sobehart, Leonardo J.

    2003-01-01

    The objective of this report is to analyze the possibility to establish a scheme to compensate damage to workers health exposed to ionizing radiation in Argentina for those cases in which it is possible to assume that the exposure to ionizing radiation is the cause of the cancer suffered by the worker. The proposed scheme is based on the recommendations set out in the 'International Conference on Occupational Radiation Protection: Protecting Workers against Exposure to Ionization Radiation, held in Geneva, Switzerland, August 26-30, 2002. To this end, the study analyzes the present state of scientific knowledge on cancer causation due to genotoxic factors, and the accepted form of the doses-response curve, for the human beings exposure to ionization radiation at low doses with low doses rates. Finally, the labor laws and regulations related to damage compensation; in particular the present Argentine Labor Law; the National Russian Federal Occupational Radiological Health Impairment and Workmen Compensation, the United Kingdom Compensation Scheme for Radiation-linked Diseases and the United States Energy Employees Occupational Illness Compensation Program are described. (author)

  3. A Water-Damaged Home and Health of Occupants: A Case Study

    International Nuclear Information System (INIS)

    Thrasher, J.D.; Gray, M.R.; Kilburn, K.H.; Kilburn, K.H.; Dennis, D.P.; Yu, A.

    2012-01-01

    A family of five and pet dog who rented a water-damaged home and developed multiple health problems. The home was analyzed for species of mold and bacteria. The diagnostics included MRI for chronic sinusitis with ENT and sinus surgery, and neurological testing for neuro cognitive deficits. Bulk samples from the home, tissue from the sinuses, urine, nasal secretions, placenta, umbilical cord, and breast milk were tested for the presence of trichothecene, aflatoxins, and Ochratoxin A. The family had the following diagnosed conditions: chronic sinusitis, neurological deficits, coughing with wheeze, nose bleeds, and fatigue among other symptoms. An infant was born with a total body flare, developed multiple Cafe-au-Lait pigmented skin spots and diagnoses with NF1 at age 2. The mycotoxins were detected in bulk samples, urine and nasal secretions, breast milk, placenta, and umbilical cord. Pseudomonas aueroginosa, Acinetobacter, Penicillium, and Aspergillus fumigatus were cultured from nasal secretions (father and daughter). RT-PCR revealed A. fumigatus DNA in sinus tissues of the daughter. The dog had 72 skin lesions (sebaceous glands and lipomas) from which trichothecene and ochratoxin A. were detected. The health of the family is discussed in relation to the most recent published literature regarding microbial contamination and toxic by-products present in water-damaged buildings.

  4. Oxytetracycline induces DNA damage and epigenetic changes: a possible risk for human and animal health?

    Science.gov (United States)

    Gallo, Adriana; Landi, Rosaria; Rubino, Valentina; Di Cerbo, Alessandro; Giovazzino, Angela; Palatucci, Anna Teresa; Centenaro, Sara; Guidetti, Gianandrea; Canello, Sergio; Cortese, Laura; Ruggiero, Giuseppina; Alessandrini, Andrea; Terrazzano, Giuseppe

    2017-01-01

    Oxytetracycline (OTC), which is largely employed in zootechnical and veterinary practices to ensure wellness of farmed animals, is partially absorbed within the gastrointestinal tract depositing in several tissues. Therefore, the potential OTC toxicity is relevant when considering the putative risk derived by the entry and accumulation of such drug in human and pet food chain supply. Despite scientific literature highlights several OTC-dependent toxic effects on human and animal health, the molecular mechanisms of such toxicity are still poorly understood. Here, we evaluated DNA damages and epigenetic alterations by quantitative reverse transcription polymerase chain reaction, quantitative polymerase chain reaction, chromatin immuno-precipitation and Western blot analysis. We observed that human peripheral blood mononuclear cells (PBMCs) expressed DNA damage features (activation of ATM and p53, phosphorylation of H2AX and modifications of histone H3 methylation of lysine K4 in the chromatin) after the in vitro exposure to OTC. These changes are linked to a robust inflammatory response indicated by an increased expression of Interferon (IFN)- γ and type 1 superoxide dismutase (SOD1). Our data reveal an unexpected biological in vitro activity of OTC able to modify DNA and chromatin in cultured human PBMC. In this regard, OTC presence in foods of animal origin could represent a potential risk for both the human and animal health.

  5. A Water-Damaged Home and Health of Occupants: A Case Study

    Directory of Open Access Journals (Sweden)

    Jack Dwayne Thrasher

    2012-01-01

    Full Text Available A family of five and pet dog who rented a water-damaged home and developed multiple health problems. The home was analyzed for species of mold and bacteria. The diagnostics included MRI for chronic sinusitis with ENT and sinus surgery, and neurological testing for neurocognitive deficits. Bulk samples from the home, tissue from the sinuses, urine, nasal secretions, placenta, umbilical cord, and breast milk were tested for the presence of trichothecenes, aflatoxins, and Ochratoxin A. The family had the following diagnosed conditions: chronic sinusitis, neurological deficits, coughing with wheeze, nose bleeds, and fatigue among other symptoms. An infant was born with a total body flare, developed multiple Cafe-au-Lait pigmented skin spots and diagnoses with NF1 at age 2. The mycotoxins were detected in bulk samples, urine and nasal secretions, breast milk, placenta, and umbilical cord. Pseudomonas aueroginosa, Acinetobacter, Penicillium, and Aspergillus fumigatus were cultured from nasal secretions (father and daughter. RT-PCR revealed A. fumigatus DNA in sinus tissues of the daughter. The dog had 72 skin lesions (sebaceous glands and lipomas from which trichothecenes and ochratoxin A. were detected. The health of the family is discussed in relation to the most recent published literature regarding microbial contamination and toxic by-products present in water-damaged buildings.

  6. 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.

  7. 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

    In Sweden, the local government is responsible for funding schools in their district. One funding initiative is for schools to provide students with mental health problems with additional support via extra teachers, personal assistants, and special education classes. There are evidence-based preventive interventions delivered in schools, which have been shown to decrease the levels of students' mental health problems. However, little is known about how much the local government currently spends on students' mental health support and if evidence-based interventions could be financially beneficial. The aim of this study was to estimate the costs of providing additional support for students' mental health problems and the potential cost-offsets, defined as reduced school-based additional support, if two evidence-based school interventions targeting children's mental health problems were implemented in routine practice. This study uses data on the additional support students with mental health problems received in schools. Data was collected from one school district for students aged 6 to 16 years. We modeled two Swedish school interventions, Comet for Teachers and Social and Emotional Training (SET), which both had evidence of reducing mental health problems. We used a cost-offset analysis framework, assuming both interventions were fully implemented throughout the whole school district. Based on the published studies, the expected effects and the costs of the interventions were calculated. We defined the cost-offsets as the amount of predicted averted additional support for students with ongoing mental health problems who might no longer require receiving services such as one-on-one time with an extra teacher, a personal assistant, or to be placed in a special education classroom. A cost-offset analysis, from a payer's perspective (the local government responsible for school financing), was conducted comparing the costs of both interventions with the potential cost

  8. Health Outcomes and Costs of Social Work Services: A Systematic Review.

    Science.gov (United States)

    Steketee, Gail; Ross, Abigail M; Wachman, Madeline K

    2017-12-01

    Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US health care system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession's person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes. To systematically review international studies of the effect of social work-involved health services on health and economic outcomes. We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using "social work" AND "cost" and "health" for trials published from 1990 to 2017. Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes. Average study quality was fair. Studies of 7 social work-led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies. Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to examine the health and cost effects of specific services delivered by social workers independently and through interprofessional team

  9. The health care cost analysis for VZP clients during their last year of life

    OpenAIRE

    Jirsová, Karolína

    2017-01-01

    The health care cost analysis for VZP clients during their last year of life Abstract Objective of this thesis is a health care cost analysis for VZP clients, who died in 2014. An analysis of cost has been approached from a few different aspects, but mainly by segmentation of health care providers and chapters of diagnosis by ICD-10. Following analysis has been also processed in this thesis - the analysis of average health care costs of one day in life and the regional analysis of average hea...

  10. Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage

    DEFF Research Database (Denmark)

    Eaton, Jeffrey W; Menzies, Nicolas A; Stover, John

    2014-01-01

    therapy accordingly. We aimed to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy and expanded treatment coverage. METHODS: We used several independent mathematical models in four settings-South Africa (generalised...... epidemic, moderate antiretroviral therapy coverage), Zambia (generalised epidemic, high antiretroviral therapy coverage), India (concentrated epidemic, moderate antiretroviral therapy coverage), and Vietnam (concentrated epidemic, low antiretroviral therapy coverage)-to assess the potential health benefits......, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy under scenarios of existing and expanded treatment coverage, with results projected over 20 years. Analyses assessed the extension of eligibility to include individuals with CD4 counts of 500 cells per μ...

  11. Validation of simple and cost-effective stains to assess acrosomal status, DNA damage and mitochondrial activity in rooster spermatozoa.

    Science.gov (United States)

    Rui, Bruno R; Angrimani, Daniel S R; Losano, João Diego A; Bicudo, Luana de Cássia; Nichi, Marcílio; Pereira, Ricardo J G

    2017-12-01

    Several methods have been developed to evaluate spermatozoa function in birds but many of these are sometimes complicated, costly and not applicable to field studies (i.e., performed within poultry breeding facilities). The objective was, therefore, to validate efficient, practical and inexpensive procedures to determine DNA fragmentation, acrosomal integrity, and mitochondrial activity in poultry spermatozoa. Initially, ejaculates were individually diluted and divided into control (4°C, 4h) and UV-irradiated aliquots (room temperature, 4h), and then samples containing different percentages of DNA-damaged spermatozoa (0%, 25%, 50%, 75% and 100%) were subjected to Toluidine Blue (TB) and Sperm Chromatin Dispersion assessments (SCD). Fast Green-Rose Bengal (FG-RB) and FITC-PSA staining protocols were subsequently used to assess acrosome status in aliquots comprising assorted amounts of acrosome-reacted spermatozoa. Furthermore, to validate 3,3'-diaminobenzidine (DAB) assay, ejaculates containing different gradients of spermatozoa with great amounts of mitochondrial activity were concurrently evaluated using DAB and JC-1 stains. The proportion of spermatozoa with abnormal DNA integrity when evaluated using the TB assessment correlated significantly with the expected percentages of UV-irradiated spermatozoa and with SCD results. A significant linear regression coefficient was also observed between expected amounts of acrosome-intact spermatozoa and FG-RB readings, and there was a significant correlation of the data when FG-RB and FITC-PSA were used. Likewise, the use of the DAB assay enabled for accurately ascertaining percentages of rooster spermatozoa with greater and lesser mitochondrial function, and results were highly correlated to results with staining with JC-1. Altogether, findings of the present study indicate acrosomal status, DNA integrity and mitochondrial activity in rooster spermatozoa can be easily and reliably determined using FG-RB, TB and DAB stains

  12. Unpacking the financial costs of "bariatric tourism" gone wrong: Who holds responsibility for costs to the Canadian health care system?

    Science.gov (United States)

    Snyder, Jeremy C; Silva, Diego S; Crooks, Valorie A

    2016-12-01

    Canadians are motivated to travel abroad for bariatric surgery owing to wait times for care and restrictions on access at home for various reasons. While such surgery abroad is typically paid for privately, if "bariatric tourists" experience complications or have other essential medical needs upon their return to Canada, these costs are borne by the publicly funded health system. In this commentary, we discuss why assigning responsibility for the costs of complications stemming from bariatric tourism is complicated and contextual.

  13. Fundamentals for remote structural health monitoring of wind turbine blades - a preproject. Annex A. Cost-benefit for embedded sensors in large wind turbine blades

    OpenAIRE

    Hansen, L.G.; Lading, Lars

    2002-01-01

    This report contains the results of a cost-benefit analysis for the use of embed-ded sensors for damage detection in large wind turbine blades - structural health monitoring - (in connection with remote surveillance) of large wind turbine placedoff-shore. The total operating costs of a three-bladed 2MW turbine placed offshore either without sensors or with sensors are compared. The price of a structural health monitoring system of a price of 100 000 DKK (per tur-bine) results in a break-event...

  14. Health care costs, work productivity and activity impairment in non-malignant chronic pain patients

    DEFF Research Database (Denmark)

    Kronborg, Christian; Handberg, Gitte; Axelsen, Flemming

    2009-01-01

    This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs be...... before pain onset. The majority of chronic pain patients incur the costs of alternative treatments. Chronic pain causes production losses at work, as well as impairment of non-work activities.......This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs...

  15. Health care and lost productivity costs of overweight and obesity in New Zealand.

    Science.gov (United States)

    Lal, Anita; Moodie, Marj; Ashton, Toni; Siahpush, Mohammad; Swinburn, Boyd

    2012-12-01

    To estimate the costs of health care and lost productivity attributable to overweight and obesity in New Zealand (NZ) in 2006. A prevalence-based approach to costing was used in which costs were calculated for all cases of disease in the year 2006. Population attributable fractions (PAFs) were calculated based on the relative risks obtained from large cohort studies and the prevalence of overweight and obesity. For each disease, the PAF was multiplied by the total health care cost. The costs of lost productivity associated with premature mortality were estimated using both the Human Capital approach (HCA) and Friction Cost approach (FCA). Health care costs attributable to overweight and obesity were estimated to be NZ$686m or 4.5% of New Zealand's total health care expenditure in 2006. The costs of lost productivity using the FCA were estimated to be NZ$98m and NZ$225m using the HCA. The combined costs of health care and lost productivity using the FCA were $784m and $911m using the HCA. The cost burden of overweight and obesity in NZ is considerable. Policies and interventions are urgently needed to reduce the prevalence of obesity thereby decreasing these substantial costs. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

  16. MINIMIZING RESIDUAL STAND DAMAGE AND FELLING COST USING LOWEST POSSIBLE FELLING TECHNIQUE (A case study in one logging company in West Kalimantan

    Directory of Open Access Journals (Sweden)

    Sona Suhartana

    2005-03-01

    Full Text Available The implementation of felling technique in logging companies is not yet carried out efficiently and appropriately. Study on the lowest possible felling technique (LPFf is considered  to be important to  reduce residual  stand damage and felling cost. This study was carried out in a logging company in West Kalimantan in 2004. The aim of this study was to  determine the effect of LPFT on residual stand damage and felling cost. Data collected in this research include: residual stand damage, working time, timber  volume, productivity,  efficiency,  stump   height  and  felling cost.  Two categories  data were analyzed with  respect  to  their  possible  differences  using  T-test.    The  result  showed  that  the implementation   of  LPFT  was more advantage impact compared  to   that of  conventional felling technique, which is  indicated by the following factors:  (1  Trees damage decreased 2.96%;  (2 Poles damage decreased 4.75%;  (3 Felling productivity decreased 17.16%; (4 Felling efficiency  increased approximately  3.2%;  (5 Felling cost increased about Rp 327.07 /  m'; and (6 in average stump height was 40.60 cm lower.

  17. Private costs almost equal health care costs when intervening in mild Alzheimer's: a cohort study alongside the DAISY trial

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Sørensen, Jan; Waldorff, Frans B

    2009-01-01

    BACKGROUND: Alzheimer's disease is the leading cause of dementia and affects about 25 million people worldwide. Recent studies have evaluated the effect of early interventions for dementia, but few studies have considered private time and transportation costs associated with the intervention. Thi...... in access to health care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN74848736....... of counselling sessions, courses and informational packages. The typical duration of the intervention was 7 months. A micro-costing approach was applied using prospectively collected data on resource utilisation that included estimates of participant time and transportation. Precision estimates were calculated...... using a bootstrapping technique and structural uncertainty was assessed with sensitivity analysis. RESULTS: The direct intervention cost was estimated at EUR 1,070 (95% CI 1,029;1,109). The total cost (including private costs) was estimated at EUR 2,020 (95% CI 1,929;2,106) i.e. the ratio of private...

  18. 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

    2016-07-21

    To estimate the investments to implement and operational costs of a type I Oral Health Care Team in the Family Health Care Strategy. 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. 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%. 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 team's operational cost. Estimar os investimentos

  19. Integrating cost information with health management support system: an enhanced methodology to assess health care quality drivers.

    Science.gov (United States)

    Kohli, R; Tan, J K; Piontek, F A; Ziege, D E; Groot, H

    1999-08-01

    Changes in health care delivery, reimbursement schemes, and organizational structure have required health organizations to manage the costs of providing patient care while maintaining high levels of clinical and patient satisfaction outcomes. Today, cost information, clinical outcomes, and patient satisfaction results must become more fully integrated if strategic competitiveness and benefits are to be realized in health management decision making, especially in multi-entity organizational settings. Unfortunately, traditional administrative and financial systems are not well equipped to cater to such information needs. This article presents a framework for the acquisition, generation, analysis, and reporting of cost information with clinical outcomes and patient satisfaction in the context of evolving health management and decision-support system technology. More specifically, the article focuses on an enhanced costing methodology for determining and producing improved, integrated cost-outcomes information. Implementation issues and areas for future research in cost-information management and decision-support domains are also discussed.

  20. A tutorial on activity-based costing of electronic health records.

    Science.gov (United States)

    Federowicz, Marie H; Grossman, Mila N; Hayes, Bryant J; Riggs, Joseph

    2010-01-01

    As the American Recovery and Restoration Act of 2009 allocates $19 billion to health information technology, it will be useful for health care managers to project the true cost of implementing an electronic health record (EHR). This study presents a step-by-step guide for using activity-based costing (ABC) to estimate the cost of an EHR. ABC is a cost accounting method with a "top-down" approach for estimating the cost of a project or service within an organization. The total cost to implement an EHR includes obvious costs, such as licensing fees, and hidden costs, such as impact on productivity. Unlike other methods, ABC includes all of the organization's expenditures and is less likely to miss hidden costs. Although ABC is used considerably in manufacturing and other industries, it is a relatively new phenomenon in health care. ABC is a comprehensive approach that the health care field can use to analyze the cost-effectiveness of implementing EHRs. In this article, ABC is applied to a health clinic that recently implemented an EHR, and the clinic is found to be more productive after EHR implementation. This methodology can help health care administrators assess the impact of a stimulus investment on organizational performance.

  1. A practical approach for calculating reliable cost estimates from observational data: application to cost analyses in maternal and child health.

    Science.gov (United States)

    Salemi, Jason L; Comins, Meg M; Chandler, Kristen; Mogos, Mulubrhan F; Salihu, Hamisu M

    2013-08-01

    Comparative effectiveness research (CER) and cost-effectiveness analysis are valuable tools for informing health policy and clinical care decisions. Despite the increased availability of rich observational databases with economic measures, few researchers have the skills needed to conduct valid and reliable cost analyses for CER. The objectives of this paper are to (i) describe a practical approach for calculating cost estimates from hospital charges in discharge data using publicly available hospital cost reports, and (ii) assess the impact of using different methods for cost estimation in maternal and child health (MCH) studies by conducting economic analyses on gestational diabetes (GDM) and pre-pregnancy overweight/obesity. In Florida, we have constructed a clinically enhanced, longitudinal, encounter-level MCH database covering over 2.3 million infants (and their mothers) born alive from 1998 to 2009. Using this as a template, we describe a detailed methodology to use publicly available data to calculate hospital-wide and department-specific cost-to-charge ratios (CCRs), link them to the master database, and convert reported hospital charges to refined cost estimates. We then conduct an economic analysis as a case study on women by GDM and pre-pregnancy body mass index (BMI) status to compare the impact of using different methods on cost estimation. Over 60 % of inpatient charges for birth hospitalizations came from the nursery/labor/delivery units, which have very different cost-to-charge markups (CCR = 0.70) than the commonly substituted hospital average (CCR = 0.29). Using estimated mean, per-person maternal hospitalization costs for women with GDM as an example, unadjusted charges ($US14,696) grossly overestimated actual cost, compared with hospital-wide ($US3,498) and department-level ($US4,986) CCR adjustments. However, the refined cost estimation method, although more accurate, did not alter our conclusions that infant/maternal hospitalization costs

  2. Comparison of the Ministry of Health's tariffs with the cost of radiology services using the activity-based costing method.

    Science.gov (United States)

    Kalhor, Rohollah; Amini, Saeed; Emami, Majid; Kakasoltani, Keivan; Rhamani, Nasim; Kalhor, Leila

    2016-02-01

    Efficient use of resources in organizations is one of the most important duties of managers. Appropriate allocation of resources can help managers to do this well. The aim of this study was to determine the cost of radiology services and to compare it with governmental tariffs (introduced by the Ministry of Health in Iran). This was a descriptive and applied study that was conducted using the retrospective approach. First, activity centers were identified on the basis of five main groups of hospital activities. Then, resources and resource drivers, activities, and hospital activity drivers were identified. At the next step, the activities related to the delivery of radiology process were identified. Last, through allocation of activities cost to the cost objects, the cost price of 66 services that were delivered in the radiology department were calculated. The data were collected by making checklists, using the hospital's information system, observations, and interviews. Finally, the data were analyzed using the non-parametric Wilcoxon test, Microsoft Excel, and SPSS software, version 18. The findings showed that from the total cost of wages, materials, and overhead obtained, the unit cost of the 66 cost objects (delivered services) in the Radiology Department were calculated using the ABC method (Price of each unit of Nephrostogram obtained $15.8 and Cystogram obtained $18.4). The Kolmogorov-Smirnov test indicated that the distribution of data of cost price using the ABC method was not normal (p = 0.000). The Wilcoxon test showed that there was a significant difference between the cost of services and the tariff of radiology services (p = 0.000). The cost of delivered services in radiology departments was significantly higher than approved tariffs of the Ministry of Health, which can have a negative impact on the quality of services.

  3. 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.

  4. Use of damage surveys and field inventories to evaluate oak and sugar maple health in the northern United States

    Science.gov (United States)

    Randall S Morin; Christopher W. Woodall; Jim Steinman; Charles H. Perry

    2009-01-01

    Oak species (Quercus spp.) and sugar maple (Acer saccharum) are substantial components of the forest ecosystems in the 24-state region spanning the northern U.S. During recent decades, both damage surveys and forest inventories have documented declines of sugar maple and oak health. In order to more fully assess the status of oak and sugar maple health, we examined...

  5. Public Attitudes about Health Information Technology, and Its Relationship to Health Care Quality, Costs, and Privacy

    Science.gov (United States)

    Gaylin, Daniel S; Moiduddin, Adil; Mohamoud, Shamis; Lundeen, Katie; Kelly, Jennifer A

    2011-01-01

    Objective To understand Americans' attitudes concerning health information technology's (IT's) potential to improve health care and differences in those attitudes based on demographics and technological affinity. Data Sources/Study Setting A random-digit-dial sample with known probability of selection for every household in the United States with a telephone, plus a supplemental sample of cell phone users. Telephone interviews were conducted from August 2009 through November 2009. Study Design Data were analyzed to present univariate estimates of Americans' opinions of health IT, as well as multivariate logistic regressions to assess hypotheses relating individuals' characteristics to their opinions. Characteristics used in our model include age, race, ethnicity, gender, income, and affinity to technology. Findings A large majority (78 percent) favor use of electronic medical records (EMRs); believe EMRs could improve care and reduce costs (78 percent and 59 percent, respectively); believe benefits of EMR use outweigh privacy risks (64 percent); and support health care information sharing among providers (72 percent). Regression analyses show more positive attitudes among those with higher incomes and greater comfort using electronic technologies. Conclusion The findings suggest that American's believe that health IT adoption is an effective means to improve the quality and safety of health care. PMID:21275986

  6. Health Outcomes and Costs of Social Work Services: A Systematic Review

    Science.gov (United States)

    Ross, Abigail M.; Wachman, Madeline K.

    2017-01-01

    Background. Efforts to reduce expensive health service utilization, contain costs, improve health outcomes, and address the social determinants of health require research that demonstrates the economic value of health services in population health across a variety of settings. Social workers are an integral part of the US health care system, yet the specific contributions of social work to health and cost-containment outcomes are unknown. The social work profession’s person-in-environment framework and unique skillset, particularly around addressing social determinants of health, hold promise for improving health and cost outcomes. Objectives. To systematically review international studies of the effect of social work–involved health services on health and economic outcomes. Search Methods. We searched 4 databases (PubMed, PsycINFO, CINAHL, Social Science Citation Index) by using “social work” AND “cost” and “health” for trials published from 1990 to 2017. Selection Criteria. Abstract review was followed by full-text review of all studies meeting inclusion criteria (social work services, physical health, and cost outcomes). Data Collection and Analysis. Of the 831 abstracts found, 51 (6.1%) met criteria. Full text review yielded 16 studies involving more than 16 000 participants, including pregnant and pediatric patients, vulnerable low-income adults, and geriatric patients. We examined study quality, health and utilization outcomes, and cost outcomes. Main Results. Average study quality was fair. Studies of 7 social work–led services scored higher on quality ratings than 9 studies of social workers as team members. Most studies showed positive effects on health and service utilization; cost-savings were consistent across nearly all studies. Conclusions. Despite positive overall effects on outcomes, variability in study methods, health problems, and cost analyses render generalizations difficult. Controlled hypothesis-driven trials are needed to

  7. Performance and cost evaluation of health information systems using micro-costing and discrete-event simulation.

    Science.gov (United States)

    Rejeb, Olfa; Pilet, Claire; Hamana, Sabri; Xie, Xiaolan; Durand, Thierry; Aloui, Saber; Doly, Anne; Biron, Pierre; Perrier, Lionel; Augusto, Vincent

    2018-06-01

    Innovation and health-care funding reforms have contributed to the deployment of Information and Communication Technology (ICT) to improve patient care. Many health-care organizations considered the application of ICT as a crucial key to enhance health-care management. The purpose of this paper is to provide a methodology to assess the organizational impact of high-level Health Information System (HIS) on patient pathway. We propose an integrated performance evaluation of HIS approach through the combination of formal modeling using the Architecture of Integrated Information Systems (ARIS) models, a micro-costing approach for cost evaluation, and a Discrete-Event Simulation (DES) approach. The methodology is applied to the consultation for cancer treatment process. Simulation scenarios are established to conclude about the impact of HIS on patient pathway. We demonstrated that although high level HIS lengthen the consultation, occupation rate of oncologists are lower and quality of service is higher (through the number of available information accessed during the consultation to formulate the diagnostic). The provided method allows also to determine the most cost-effective ICT elements to improve the care process quality while minimizing costs. The methodology is flexible enough to be applied to other health-care systems.

  8. Cost recovery of NGO primary health care facilities: a case study in Bangladesh

    OpenAIRE

    Alam, Khurshid; Ahmed, Shakil

    2010-01-01

    Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Give...

  9. External costs of PM2.5 pollution in Beijing, China: Uncertainty analysis of multiple health impacts and costs.

    Science.gov (United States)

    Yin, Hao; Pizzol, Massimo; Xu, Linyu

    2017-07-01

    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. Copyright © 2017

  10. Basing care reforms on evidence: the Kenya health sector costing model.

    Science.gov (United States)

    Flessa, Steffen; Moeller, Michael; Ensor, Tim; Hornetz, Klaus

    2011-05-27

    The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health care costs proportionally. Instead

  11. Basing care reforms on evidence: The Kenya health sector costing model

    Science.gov (United States)

    2011-01-01

    Background The Government of the Republic of Kenya is in the process of implementing health care reforms. However, poor knowledge about costs of health care services is perceived as a major obstacle towards evidence-based, effective and efficient health care reforms. Against this background, the Ministry of Health of Kenya in cooperation with its development partners conducted a comprehensive costing exercise and subsequently developed the Kenya Health Sector Costing Model in order to fill this data gap. Methods Based on standard methodology of costing of health care services in developing countries, standard questionnaires and analyses were employed in 207 health care facilities representing different trustees (e.g. Government, Faith Based/Nongovernmental, private-for-profit organisations), levels of care and regions (urban, rural). In addition, a total of 1369 patients were randomly selected and asked about their demand-sided costs. A standard step-down costing methodology was applied to calculate the costs per service unit and per diagnosis of the financial year 2006/2007. Results The total costs of essential health care services in Kenya were calculated as 690 million Euros or 18.65 Euro per capita. 54% were incurred by public sector facilities, 17% by Faith Based and other Nongovernmental facilities and 23% in the private sector. Some 6% of the total cost is due to the overall administration provided directly by the Ministry and its decentralised organs. Around 37% of this cost is absorbed by salaries and 22% by drugs and medical supplies. Generally, costs of lower levels of care are lower than of higher levels, but health centres are an exemption. They have higher costs per service unit than district hospitals. Conclusions The results of this study signify that the costs of health care services are quite high compared with the Kenyan domestic product, but a major share are fixed costs so that an increasing coverage does not necessarily increase the health

  12. [Inhalation of gasoline and damage to health in workers at gas stations].

    Science.gov (United States)

    Pranjić, Nurka; Mujagić, H; Pavlović, S

    2003-01-01

    The aim of this study was to made assessment of chronic health effects in 37 workers exposed to gasoline, and its constituents at gasoline stations between 1985 and 1996. By the study we have involved thirty-seven persons who had been exposed to gasoline for more than five years were examined. The evaluation included a medical/occupational history, hematological and biochemical examination, a physical exam, standardized psychological tests, and ultrasound examination of kidneys and liver. The groups were identical in other common parameters including age, gender (all men), and level of education (P gasoline unexposed controls and 25 workers at gasoline stations exposed to organic lead for only nine months. Peripheral smear revealed basophilic punctuated eritrocytes and reticulocytosis. We found in chronic exposed gasoline workers haematological disorders: mild leukocytosis (7 of 37), lymphocytosis (20 of 37), mild lymhocytopenia (3 of 37), decrease of red blood cells count (11 of 37). Results indicated that they have suffered from liver disorders: lipoid degeneration of liver (14 of 37), chronic functional damages of liver (3 of 37), cirrhosis (1 of 37). Ultrasound examination indicated chronic kidney damages (8 of 37). These results significantly differed from those of controls (P gasoline stations exposed to gasoline for more than 5 years the symptom of depression and decreased reaction time and motor abilities were identified. The summary of diseases of workers exposed to organic lead and gasoline are discussed.

  13. Vibration based structural health monitoring of an arch bridge: From automated OMA to damage detection

    Science.gov (United States)

    Magalhães, F.; Cunha, A.; Caetano, E.

    2012-04-01

    In order to evaluate the usefulness of approaches based on modal parameters tracking for structural health monitoring of bridges, in September of 2007, a dynamic monitoring system was installed in a concrete arch bridge at the city of Porto, in Portugal. The implementation of algorithms to perform the continuous on-line identification of modal parameters based on structural responses to ambient excitation (automated Operational Modal Analysis) has permitted to create a very complete database with the time evolution of the bridge modal characteristics during more than 2 years. This paper describes the strategy that was followed to minimize the effects of environmental and operational factors on the bridge natural frequencies, enabling, in a subsequent stage, the identification of structural anomalies. Alternative static and dynamic regression models are tested and complemented by a Principal Components Analysis. Afterwards, the identification of damages is tried with control charts. At the end, it is demonstrated that the adopted processing methodology permits the detection of realistic damage scenarios, associated with frequency shifts around 0.2%, which were simulated with a numerical model.

  14. [Evaluating cost/equity in the Colombian health system, 1998-2005].

    Science.gov (United States)

    Eslava-Schmalbach, Javier; Barón, Gilberto; Gaitán-Duarte, Hernando; Alfonso, Helman; Agudelo, Carlos; Sánchez, Carolina

    2008-01-01

    An economic analysis of cost-equity (from society's viewpoint) for evaluating the impact of Law 100/93 in Colombia between 1998 and 2005. An economic analysis compared costs and equity in health in Colombia between 1998 and 2005. Data was taken from the Colombian Statistics' Administration Department ( Departamento Administrativo Nacional de Estadistica - DANE) and from national demographic and health surveys carried out in 2000 and 2005. Information regarding costs was taken from the National Health Accounts' System. Inequity in Health was considered in line with the Inequity in Health Index (IHI). Incremental and average cost-equity analysis covered three sub-periods; 1998-1999 (during which time per capita gross internal product became reduced in Colombia ), 2000-2001 (during which time total health expense became reduced) and 2001 -2005. An unstable tendency for inequity in health becoming reduced during the period was revealed. There was an inverse relationship between IHI and public health spending and a direct relationship between out-of-pocket spending on health and equity in health (Spearman, p<0.05). The second period had the best incremental cost-equity ratio. Fluctuations in IHI and marginal cost-equity during the periods being analysed suggested that health spending depended on equity in health in Colombia during the period being studied.

  15. Financial costs due to excess health risks among active employees of a utility company.

    Science.gov (United States)

    Yen, Louis; Schultz, Alyssa; Schnueringer, Elaine; Edington, Dee W

    2006-09-01

    The objective of this study was to examine the health risk-related excess costs of time away from work, medical claims, pharmacy claims, and total costs with and without considering the prevalence of health risks. A total of 2082 of 4266 employees of a Midwest utility participated in a health risk appraisal (HRA). Individuals were classified by their HRA participation status and also by 15 health risks. Total and excess costs were analyzed for all employees. There were significant excess costs due to individual risks and overall excess health risks in all cost measures. Both excess cost per risk and prevalence of the risk were important factors in determining the excess costs in the population. As compared with low-risk participants, HRA nonparticipants and the medium- and high-risk participants were 1.99, 2.22, and 3.97 times more likely to be high cost status. Approximately one third of corporate costs in medical claims, pharmacy claims, and time away from work could be defined as excess costs associated with excess health risks.

  16. Transaction costs, externalities and information technology in health care.

    Science.gov (United States)

    Ferguson, B; Keen, J

    1996-01-01

    This paper discusses some of the economic issues which underpin the rationale for investment in information and communications technologies (ICTs). Information imperfections lead to significant transaction costs (search, negotiating and monitoring) which in turn confer a negative externality on parties involved in exchange. This divergence in private and social costs leads to a degree of resource misallocation (efficiency loss) which, uncorrected, results in a sub-optimal outcome. Traditional solutions to this problem are to rely upon direct government action to reduce the costs of transacting between market agents, or to employ tax/subsidy measures and other legislative action to achieve the desired market outcome. Three key policy questions are raised in the context of the NHS purchaser/provider relationship. Firstly, what is the optimum level of transaction costs; secondly, can ICTs assist in lowering the level of transaction costs to the optimum level; thirdly, who should bear the investment cost in reducing the level of transaction costs? The issue of property rights in different information systems is discussed and raises interesting policy questions about how much investment should be undertaken centrally rather than devolved to a more local level. In some ways this economic framework offers a post hoc justification of why different ICT systems have been introduced at various levels of the NHS. Essentially this reduces to the problem of externalities: providing good information confers a positive externality: not providing relevant, timely and accurate information confers a negative externality, by increasing further the level of transaction costs. The crucial role which ICT systems can play lies in attempting to reduce the level of transaction costs and driving the market towards what Dahlman has described as the transaction-cost-constrained equilibrium.

  17. What does pritnary health care cost and can we afford to find out?

    African Journals Online (AJOL)

    cost infonnation is a critical management tool for both public and private sector providers. Without ... COSt infonnation is also vital if appropriate user charges are to be levied.2. Effons to generate accurate cost accounting informa- tion are obviously the primary responsibility of health planners and managers, who require this ...

  18. Understanding fear of cancer recurrence in terms of damage to 'everyday health competence'.

    Science.gov (United States)

    Horlick-Jones, Tom

    2011-09-01

    Advances in clinical treatments are resulting in cancer patients living longer, but with the threat of the disease returning at some later date. Anxiety associated with this fear of recurrence, which seems widespread among patients, can lead to an enhanced bodily awareness and a pronounced tendency to interpret mundane sensations as symptoms of pathology. Relatively little sociological work has been done to systematically document, understand, and find ways of addressing, this syndrome and its impact on the quality of patients' lives. It is argued that this syndrome is best understood not in cognitive terms, as a form of irrationality, but rather as resulting from damage to certain aspects of social competence, namely one's 'everyday health competence'. In investigating this issue, the author draws upon his personal experience of breast cancer diagnosis, surgery and adjuvant therapy; and on a broadly phenomenological approach to examining the relationship between bodily sensations and practical reasoning about experience. The implications for clinical practice are considered briefly. © 2011 The Author. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  19. An application of cost-effectiveness analysis to restrict the damage caused by an accidental release of radioactive material to the environment

    International Nuclear Information System (INIS)

    Frittelli, L.; Tamburrano, A.

    1980-01-01

    When an accidental release of radioactive material occurs health effects in the exposed population can be mitigated by remedial actions applied to individuals or their environment. A cost-effectiveness analysis is performed by comparing the cost of remedial action with the monetary value of the collective dose avoided. (H.K.)

  20. Cost-of-illness of cholera to households and health facilities in rural Malawi.

    Directory of Open Access Journals (Sweden)

    Patrick G Ilboudo

    Full Text Available Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$ 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

  1. Cost-of-illness of cholera to households and health facilities in rural Malawi.

    Science.gov (United States)

    Ilboudo, Patrick G; Huang, Xiao Xian; Ngwira, Bagrey; Mwanyungwe, Abel; Mogasale, Vittal; Mengel, Martin A; Cavailler, Philippe; Gessner, Bradford D; Le Gargasson, Jean-Bernard

    2017-01-01

    Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

  2. The Current and Projected Taxpayer Shares of US Health Costs.

    Science.gov (United States)

    Himmelstein, David U; Woolhandler, Steffie

    2016-03-01

    We estimated taxpayers' current and projected share of US health expenditures, including government payments for public employees' health benefits as well as tax subsidies to private health spending. We tabulated official Centers for Medicare and Medicaid Services figures on direct government spending for health programs and public employees' health benefits for 2013, and projected figures through 2024. We calculated the value of tax subsidies for private spending from official federal budget documents and figures for state and local tax collections. Tax-funded health expenditures totaled $1.877 trillion in 2013 and are projected to increase to $3.642 trillion in 2024. Government's share of overall health spending was 64.3% of national health expenditures in 2013 and will rise to 67.1% in 2024. Government health expenditures in the United States account for a larger share of gross domestic product (11.2% in 2013) than do total health expenditures in any other nation. Contrary to public perceptions and official Centers for Medicare and Medicaid Services estimates, government funds most health care in the United States. Appreciation of government's predominant role in health funding might encourage more appropriate and equitable targeting of health expenditures.

  3. Economic Cost of Malaria Treatment under the Health Insurance ...

    African Journals Online (AJOL)

    The paper discusses the findings of a survey which explored the implications of ..... this framework, opportunity costs of work or loss of productivity are treated as ..... found in the informal sector, it would be imperative to introduce flexible pre-.

  4. The Impact of Electronic Health Records on Ambulatory Costs

    Data.gov (United States)

    U.S. Department of Health & Human Services — Our nation is in the midst of an unprecedented investment in IT to support healthcare delivery. The centerpiece of the 2009 Health Information Technology for...

  5. Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India.

    Science.gov (United States)

    Prinja, Shankar; Gupta, Aditi; Verma, Ramesh; Bahuguna, Pankaj; Kumar, Dinesh; Kaur, Manmeet; Kumar, Rajesh

    2016-01-01

    With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc. We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology. The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630-10,294,065) and INR 26.9 million (95% CI: 22,225,159.3-32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6-208.3) and INR162.1 (95% CI: 112-219.1), respectively. The study estimates can be used

  6. Switching benefits and costs in the Irish health insurance market: an analysis of consumer surveys

    OpenAIRE

    KEEGAN, CONOR; Teljeur, Conor; Turner, Brian; THomas, Steve

    2018-01-01

    PUBLISHED Relatively little analysis has taken place internationally on the consumer-reported benefits and costs to switching insurer in multi-payer health insurance markets. Ideally, consumers should be willing to switch out of consideration for price and quality and switching should be able to take place without incurring significant switching costs. Costs to switching come in many forms and understanding the nature of these costs is necessary if policy interventions to improve market co...

  7. The Social Costs of Health-related Early Retirement in Germany

    DEFF Research Database (Denmark)

    Hostenkamp, Gisela; Stolpe, Michael

    2012-01-01

    Using data from the German Socio-economic Panel, we study how stratification in health and income contributes to the social cost of health-related early retirement, the balance of lost labour income and health benefits. On average, early retirees improve their health by almost two thirds...... of the loss suffered during the last four working years. We calibrate counterfactual scenarios and find keeping all workers in very good health, the highest of five categories of self-assessed health, would delay the average retirement age by more than three years and reduce the social costs by more than 20...

  8. Net costs of health worker rural incentive packages: an example from the Lao People's Democratic Republic.

    Science.gov (United States)

    Keuffel, Eric; Jaskiewicz, Wanda; Paphassarang, Chanthakhath; Tulenko, Kate

    2013-11-01

    Many developing countries are examining whether to institute incentive packages that increase the share of health workers who opt to locate in rural settings; however, uncertainty exists with respect to the expected net cost (or benefit) from these packages. We utilize the findings from the discrete choice experiment surveys applied to students training to be health professionals and costing analyses in Lao People's Democratic Republic to model the anticipated effect of incentive packages on new worker location decisions and direct costs. Incorporating evidence on health worker density and health outcomes, we then estimate the expected 5-year net cost (or benefit) of each incentive packages for 3 health worker cadres--physicians, nurses/midwives, and medical assistants. Under base case assumptions, the optimal incentive package for each cadre produced a 5-year net benefit (maximum net benefit for physicians: US$ 44,000; nurses/midwives: US$ 5.6 million; medical assistants: US$ 485,000). After accounting for health effects, the expected net cost of select incentive packages would be substantially less than the original estimate of direct costs. In the case of Lao People's Democratic Republic, incentive packages that do not invest in capital-intensive components generally should produce larger net benefits. Combining discrete choice experiment surveys, costing surveys and cost-benefit analysis methods may be replicated by other developing countries to calculate whether health worker incentive packages are viable policy options.

  9. The cost of universal health care in India: a model based estimate.

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    Full Text Available INTRODUCTION: As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. METHODS: We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. RESULTS: We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18-73 per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%-6.8% of the GDP for universalizing health care services. CONCLUSION: The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

  10. The cost of universal health care in India: a model based estimate.

    Science.gov (United States)

    Prinja, Shankar; Bahuguna, Pankaj; Pinto, Andrew D; Sharma, Atul; Bharaj, Gursimer; Kumar, Vishal; Tripathy, Jaya Prasad; Kaur, Manmeet; Kumar, Rajesh

    2012-01-01

    As high out-of-pocket healthcare expenses pose heavy financial burden on the families, Government of India is considering a variety of financing and delivery options to universalize health care services. Hence, an estimate of the cost of delivering universal health care services is needed. We developed a model to estimate recurrent and annual costs for providing health services through a mix of public and private providers in Chandigarh located in northern India. Necessary health services required to deliver good quality care were defined by the Indian Public Health Standards. National Sample Survey data was utilized to estimate disease burden. In addition, morbidity and treatment data was collected from two secondary and two tertiary care hospitals. The unit cost of treatment was estimated from the published literature. For diseases where data on treatment cost was not available, we collected data on standard treatment protocols and cost of care from local health providers. We estimate that the cost of universal health care delivery through the existing mix of public and private health institutions would be INR 1713 (USD 38, 95%CI USD 18-73) per person per annum in India. This cost would be 24% higher, if branded drugs are used. Extrapolation of these costs to entire country indicates that Indian government needs to spend 3.8% (2.1%-6.8%) of the GDP for universalizing health care services. The cost of universal health care delivered through a combination of public and private providers is estimated to be INR 1713 per capita per year in India. Important issues such as delivery strategy for ensuring quality, reducing inequities in access, and managing the growth of health care demand need be explored.

  11. The impact of antipsychotic polytherapy costs in the public health care in Sao Paulo, Brazil.

    Science.gov (United States)

    Razzouk, Denise; Kayo, Monica; Sousa, Aglaé; Gregorio, Guilherme; Cogo-Moreira, Hugo; Cardoso, Andrea Alves; Mari, Jair de Jesus

    2015-01-01

    Guidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce. To estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil. A cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider's perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated. 147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs. Antipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle

  12. The Cost analysis of cervical cancer screening services provided by Damavand health center in 2013

    Directory of Open Access Journals (Sweden)

    Arezoo Chouhdari

    2015-03-01

    Full Text Available Background: Today, the health sector in many countries is facing with severe resource constraints; hence it is absolutely necessary that cost-benefit and cost-effectiveness assessment have a major role in design of health services. The purpose of this study was to evaluate the cost-benefit and effectiveness of cervical cancer screening service (Pap smear test done by the health centers in Damavand County in 2013.  Methods: This is a descriptive study with cross-sectional method. All data was extracted from existing documents in Damavand health network.Cost of service screening for doing Pap smear test (manpower costs of performing the service, the cost of transferring samples, water, electricity, telephone and gas was estimated in all health centers then results, were compared with the incomes of this service.  Results: Screening program coverage was 22.3%, 6.9% and 6.05% in 2011, 2012 and 2013 respectively. All costs and incomes of units performing Pap smear screening test were calculated. Entire costs and incomes of this service during 2013 were respectively 303,009,000 and 11,640,000 RLS equal $12,227 and $496.73. Therefore, the cost-benefit ratio of this screening test was approximately 0.040.  Conclusion: The costs of units performing cervical cancer screening test in Damavand Health Center were much more than this benefit and because of a none-positive Pap smear test in spite of high cost, performing this test in Damavand health centers was not cost effective.

  13. Estimating the cost-savings associated with bundling maternal and child health interventions: a proposed methodology.

    Science.gov (United States)

    Adesina, Adebiyi; Bollinger, Lori A

    2013-01-01

    There is a pressing need to include cost data in the Lives Saved Tool (LiST). This paper proposes a method that combines data from both the WHO CHOosing Interventions that are Cost-Effective (CHOICE) database and the OneHealth Tool (OHT) to develop unit costs for delivering child and maternal health services, both alone and bundled. First, a translog cost function is estimated to calculate factor shares of personnel, consumables, other direct (variable or recurrent costs excluding personnel and consumables) and indirect (capital or investment) costs. Primary source facility level data from Kenya, Namibia, South Africa, Uganda, Zambia and Zimbabwe are utilized, with separate analyses for hospitals and health centres. Second, the resulting other-direct and indirect factor shares are applied to country unit costs from the WHO CHOICE unit cost database to calculate those portions of unit cost. Third, the remainder of the costs is calculated using default data from the OHT. Fourth, we calculate the effect of bundling services by assuming that a LiST intervention visit takes an average of 20 minutes when delivered alone but only incremental time in addition to the basic visit when delivered in a bundle. Personnel costs account for the greatest share of costs for both hospitals and health centres at 50% and 38%, respectively. The percentages differ between hospitals and health centres for consumables (21% versus 17%), other direct (7.5% versus 6.75%), and indirect (22% versus 23%) costs. Combining the other-direct and indirect factor shares with the WHO CHOICE database and the other costs from OHT provides a comprehensive cost estimate of LiST interventions. Finally, the cost of six recommended antenatal care (ANC) interventions is $69.76 when delivered alone, but $61.18 when delivered as a bundle, a savings of $8.58 (12.2%). This paper proposes a method for estimating a comprehensive cost of providing child and maternal health interventions by combining labor

  14. The economic costs of radiation-induced health effects: Estimation and simulation

    International Nuclear Information System (INIS)

    Nieves, L.A.; Tawil, J.J.

    1988-08-01

    This effort improves the quantitative information available for use in evaluating actions that alter health risks due to population exposure to ionizing radiation. To project the potential future costs of changes in health effects risks, Pacific Northwest Laboratory (PNL) constructed a probabilistic computer model, Health Effects Costs Model (HECOM), which utilizes the health effect incidence estimates from accident consequences models to calculate the discounted sum of the economic costs associated with population exposure to ionizing radiation. Application of HECOM to value-impact and environmental impact analyses should greatly increase the quality of the information available for regulatory decision making. Three major types of health effects present risks for any population sustaining a significant radiation exposure: acute radiation injuries (and fatalities), latent cancers, and impairments due to genetic effects. The literature pertaining to both incidence and treatment of these health effects was reviewed by PNL and provided the basis for developing economic cost estimates. The economic costs of health effects estimated by HECOM represent both the value of resources consumed in diagnosing, treating, and caring for the patient and the value of goods not produced because of illness or premature death due to the health effect. Additional costs to society, such as pain and suffering, are not included in the PNL economic cost measures since they do not divert resources from other uses, are difficult to quantify, and do not have a value observable in the marketplace. 83 refs., 3 figs., 19 tabs

  15. The economic costs of radiation-induced health effects: Estimation and simulation

    Energy Technology Data Exchange (ETDEWEB)

    Nieves, L.A.; Tawil, J.J.

    1988-08-01

    This effort improves the quantitative information available for use in evaluating actions that alter health risks due to population exposure to ionizing radiation. To project the potential future costs of changes in health effects risks, Pacific Northwest Laboratory (PNL) constructed a probabilistic computer model, Health Effects Costs Model (HECOM), which utilizes the health effect incidence estimates from accident consequences models to calculate the discounted sum of the economic costs associated with population exposure to ionizing radiation. Application of HECOM to value-impact and environmental impact analyses should greatly increase the quality of the information available for regulatory decision making. Three major types of health effects present risks for any population sustaining a significant radiation exposure: acute radiation injuries (and fatalities), latent cancers, and impairments due to genetic effects. The literature pertaining to both incidence and treatment of these health effects was reviewed by PNL and provided the basis for developing economic cost estimates. The economic costs of health effects estimated by HECOM represent both the value of resources consumed in diagnosing, treating, and caring for the patient and the value of goods not produced because of illness or premature death due to the health effect. Additional costs to society, such as pain and suffering, are not included in the PNL economic cost measures since they do not divert resources from other uses, are difficult to quantify, and do not have a value observable in the marketplace. 83 refs., 3 figs., 19 tabs.

  16. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions.

    Science.gov (United States)

    Owens, Douglas K; Qaseem, Amir; Chou, Roger; Shekelle, Paul

    2011-02-01

    Health care costs in the United States are increasing unsustainably, and further efforts to control costs are inevitable and essential. Efforts to control expenditures should focus on the value, in addition to the costs, of health care interventions. Whether an intervention provides high value depends on assessing whether its health benefits justify its costs. High-cost interventions may provide good value because they are highly beneficial; conversely, low-cost interventions may have little or no value if they provide little benefit. Thus, the challenge becomes determining how to slow the rate of increase in costs while preserving high-value, high-quality care. A first step is to decrease or eliminate care that provides no benefit and may even be harmful. A second step is to provide medical interventions that provide good value: medical benefits that are commensurate with their costs. This article discusses 3 key concepts for understanding how to assess the value of health care interventions. First, assessing the benefits, harms, and costs of an intervention is essential to understand whether it provides good value. Second, assessing the cost of an intervention should include not only the cost of the intervention itself but also any downstream costs that occur because the intervention was performed. Third, the incremental cost-effectiveness ratio estimates the additional cost required to obtain additional health benefits and provides a key measure of the value of a health care intervention.

  17. The effects of age, gender, and crash types on drivers' injury-related health care costs.

    Science.gov (United States)

    Shen, Sijun; Neyens, David M

    2015-04-01

    There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers' age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers' age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Cost Benefit of Comprehensive Primary and Preventive School-Based Health Care.

    Science.gov (United States)

    Padula, William V; Connor, Katherine A; Mueller, Josiah M; Hong, Jonathan C; Velazquez, Gabriela Calderon; Johnson, Sara B

    2018-01-01

    The Rales Health Center is a comprehensive school-based health center at an urban elementary/middle school. Rales Health Center provides a full range of pediatric services using an enriched staffing model consisting of pediatrician, nurse practitioner, registered nurses, and medical office assistant. This staffing model provides greater care but costs more than traditional school-based health centers staffed by part-time nurses. The objective was to analyze the cost benefit of Rales Health Center enhanced staffing model compared with a traditional school-based health center (standard care), focusing on asthma care, which is among the most prevalent chronic conditions of childhood. In 2016, cost-benefit analysis using a decision tree determined the net social benefit of Rales Health Center compared with standard care from the U.S. societal perspective based on the 2015-2016 academic year. It was assumed that Rales Health Center could handle greater patient throughput related to asthma, decreased prescription costs, reduced parental resources in terms of missed work time, and improved student attendance. Univariate and multivariate probabilistic sensitivity analyses were conducted. The expected cost to operate Rales Health Center was $409,120, compared with standard care cost of $172,643. Total monetized incremental benefits of Rales Health Center were estimated to be $993,414. The expected net social benefit for Rales Health Center was $756,937, which demonstrated substantial societal benefit at a return of $4.20 for every dollar invested. This net social benefit estimate was robust to sensitivity analyses. Despite the greater cost associated with the Rales Health Center's enhanced staffing model, the results of this analysis highlight the cost benefit of providing comprehensive, high-quality pediatric care in schools, particularly schools with a large proportion of underserved students. Copyright © 2018 American Journal of Preventive Medicine. Published by

  19. Cost analysis and exploratory cost-effectiveness of youth-friendly sexual and reproductive health services in the Republic of Moldova

    NARCIS (Netherlands)

    Kempers, J.; Ketting, E.; Lesco, G.

    2014-01-01

    BACKGROUND: Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of

  20. The health system cost of post-abortion care in Rwanda

    Science.gov (United States)

    Vlassoff, Michael; Musange, Sabine F; Kalisa, Ina R; Ngabo, Fidele; Sayinzoga, Felix; Singh, Susheela; Bankole, Akinrinola

    2015-01-01

    Based on research conducted in 2012, we estimate the cost to the Rwandan health-care system of providing post-abortion care (PAC) due to unsafe abortions, a subject of policy importance not studied before at the national level. Thirty-nine public and private health facilities representing three levels of health care were randomly selected for data collection from key care providers and administrators for all five regions. Using an ingredients approach to costing, data were gathered on drugs, supplies, material, personnel time and hospitalization. Additionally, direct non-medical costs such as overhead and capital costs were also measured. We found that the average annual PAC cost per client, across five types of abortion complications, was $93. The total cost of PAC nationally was estimated to be $1.7 million per year, 49% of which was expended on direct non-medical costs. Satisfying all demands for PAC would raise the national cost to $2.5 million per year. PAC comprises a significant share of total expenditure in reproductive health in Rwanda. Investing more resources in provision of contraceptive services to prevent unwanted or mistimed pregnancies would likely reduce health systems costs. PMID:24548846

  1. The cost conundrum: financing the business of health care insurance.

    Science.gov (United States)

    Kelly, Annemarie

    2013-01-01

    Health care spending in both the governmental and private sectors skyrocketed over the last century. This article examines the rapid growth of health care expenditures by analyzing the extent of this financial boom as well some of the reasons why health care financing has become so expensive. It also explores how the market concentration of insurance companies has led to growing insurer profits, fewer insurance providers, and less market competition. Based on economic data primarily from the Government Accountability Office, the Kaiser Family Foundation, and the American Medical Associa tion, it has become clear that this country needs more competitive rates for the business of health insurance. Because of the unique dynamics of health insurance payments and financing, America needs to promote affordability and innovation in the health insurance market and lower the market's high concentration levels. In the face of booming insurance profits, soaring premiums, many believe that in our consolidated health insurance market, the "business of insurance" should not be exempt from antitrust laws. All in all, it is in our nation's best interest that Congress restore the application of antitrust laws to health sector insurers by passing the Health Insurance Industry Antitrust Enforcement Act as an amendment to the McCarran-Ferguson Act's "business of insurance" provision.

  2. [Financing, organization, costs and services performance of the Argentinean health sub-systems.

    Science.gov (United States)

    Yavich, Natalia; Báscolo, Ernesto Pablo; Haggerty, Jeannie

    2016-01-01

    To analyze the relationship between health system financing and services organization models with costs and health services performance in each of Rosario's health sub-systems. The financing and organization models were characterized using secondary data. Costs were calculated using the WHO/SHA methodology. Healthcare quality was measured by a household survey (n=822). Public subsystem:Vertically integrated funding and primary healthcare as a leading strategy to provide services produced low costs and individual-oriented healthcare but with weak accessibility conditions and comprehensiveness. Private subsystem: Contractual integration and weak regulatory and coordination mechanisms produced effects opposed to those of the public sub-system. Social security: Contractual integration and strong regulatory and coordination mechanisms contributed to intermediate costs and overall high performance. Each subsystem financing and services organization model had a strong and heterogeneous influence on costs and health services performance.

  3. Mobile Health Insurance System and Associated Costs: A Cross-Sectional Survey of Primary Health Centers in Abuja, Nigeria.

    Science.gov (United States)

    Chukwu, Emeka; Garg, Lalit; Eze, Godson

    2016-05-17

    Nigeria contributes only 2% to the world's population, accounts for 10% of the global maternal death burden. Health care at primary health centers, the lowest level of public health care, is far below optimal in quality and grossly inadequate in coverage. Private primary health facilities attempt to fill this gap but at additional costs to the client. More than 65% Nigerians still pay out of pocket for health services. Meanwhile, the use of mobile phones and related services has risen geometrically in recent years in Nigeria, and their adoption into health care is an enterprise worth exploring. The purpose of this study was to document costs associated with a mobile technology-supported, community-based health insurance scheme. This analytic cross-sectional survey used a hybrid of mixed methods stakeholder interviews coupled with prototype throw-away software development to gather data from 50 public primary health facilities and 50 private primary care centers in Abuja, Nigeria. Data gathered documents costs relevant for a reliable and sustainable mobile-supported health insurance system. Clients and health workers were interviewed using structured questionnaires on services provided and cost of those services. Trained interviewers conducted the structured interviews, and 1 client and 1 health worker were interviewed per health facility. Clinic expenditure was analyzed to include personnel, fixed equipment, medical consumables, and operation costs. Key informant interviews included a midmanagement staff of a health-management organization, an officer-level staff member of a mobile network operator, and a mobile money agent. All the 200 respondents indicated willingness to use the proposed system. Differences in the cost of services between public and private facilities were analyzed at 95% confidence level (Phealth care facilities is significantly higher than at public primary health care facilities. Key informant interviews with a health management organizations

  4. 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.

  5. Cost of delivering secondary-level health care services through public sector district hospitals in India

    Science.gov (United States)

    Prinja, Shankar; Balasubramanian, Deepak; Jeet, Gursimer; Verma, Ramesh; Kumar, Dinesh; Bahuguna, Pankaj; Kaur, Manmeet; Kumar, Rajesh

    2017-01-01

    Background & objectives: Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. Methods: Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. Results: The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was 844 (USD 15.5), i; 3481 (USD 64) and 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was 139 (USD 2.5). Interpretation & conclusions: The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India. PMID:29355142

  6. Cost of delivering secondary-level health care services through public sector district hospitals in India.

    Science.gov (United States)

    Prinja, Shankar; Balasubramanian, Deepak; Jeet, Gursimer; Verma, Ramesh; Kumar, Dinesh; Bahuguna, Pankaj; Kaur, Manmeet; Kumar, Rajesh

    2017-09-01

    Despite an impetus for strengthening public sector district hospitals for provision of secondary health care in India, there is lack of robust evidence on cost of services provided through these district hospitals. In this study, an attempt was made to determine the unit cost of an outpatient visit consultation, inpatient bed-day of hospitalization, surgical procedure and overall per-capita cost of providing secondary care through district hospitals. Economic costing of five randomly selected district hospitals in two north Indian States - Haryana and Punjab, was undertaken. Cost analysis was done using a health system perspective and employing bottom-up costing methodology. Quantity of all resources - capital or recurrent, used for delivering services was measured and valued. Median unit costs were estimated along with their 95 per cent confidence intervals. Sensitivity analysis was undertaken to assess the effect of uncertainties in prices and other assumptions; and to generalize the findings for Indian set-up. The overall annual cost of delivering secondary-level health care services through a public sector district hospital in north India was ' 11,44,13,282 [US Dollars (USD) 2,103,185]. Human resources accounted for 53 per cent of the overall cost. The unit cost of an inpatient bed-day, surgical procedure and outpatient consultation was ' 844 (USD 15.5), ' 3481 (USD 64) and ' 170 (USD 3.1), respectively. With the current set of resource allocation, per-capita cost of providing health care through district hospitals in north India was ' 139 (USD 2.5). The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India.

  7. Under Pressure: Tackling Pension and Health Care Costs

    Science.gov (United States)

    Friery, John

    2010-01-01

    Fueled by declining revenue from the housing crisis, skyrocketing energy costs, and an economy in general disarray, the public is pressuring school administrators to make broader and deeper cuts in their operating budgets. As the baby boomers retire, put their houses on the market, and downsize, one will see more downward price pressure on home…

  8. Lifetime health effects and costs of diabetes treatment

    NARCIS (Netherlands)

    L.W. Niessen (Louis Wilhelmus); R. Dijkstra; R.C.W. Hutubessy (Raymond); G.E.H.M. Rutten (Guy); A.F. Casparie (Anton)

    2003-01-01

    textabstractBACKGROUND: This article presents cost-effectiveness analyses of the major diabetes interventions as formulated in the revised Dutch guidelines for diabetes type 2 patients in primary and secondary care. The analyses consider two types of care: diabetes control and the

  9. Cost escalation in health-care technology - possible solutions

    African Journals Online (AJOL)

    and its application to rural health care is cited as an exaIllple ofa ... other sources of information in our health-care planning process. ... chances with unproven devices from unknown manufac- turers. ... ment, and the high training level and relatively large number of ... would provide jobs and also stimulate the economy. It.

  10. International portability of health-cost coverage : concepts and experience

    OpenAIRE

    Werding, Martin; McLennan, Stuart

    2011-01-01

    Social insurance and other arrangements for funding health-care benefits often establish long-term relationships, effectively providing insurance against lasting changes in an individual's health status, engaging in burden-smoothing over the life cycle, and entailing additional elements of redistribution. International portability regarding this type of cover is, therefore, difficult to es...

  11. Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review.

    Science.gov (United States)

    de la Torre-Díez, Isabel; López-Coronado, Miguel; Vaca, Cesar; Aguado, Jesús Saez; de Castro, Carlos

    2015-02-01

    A systematic review of cost-utility and cost-effectiveness research works of telemedicine, electronic health (e-health), and mobile health (m-health) systems in the literature is presented. Academic databases and systems such as PubMed, Scopus, ISI Web of Science, and IEEE Xplore were searched, using different combinations of terms such as "cost-utility" OR "cost utility" AND "telemedicine," "cost-effectiveness" OR "cost effectiveness" AND "mobile health," etc. In the articles searched, there were no limitations in the publication date. The search identified 35 relevant works. Many of the articles were reviews of different studies. Seventy-nine percent concerned the cost-effectiveness of telemedicine systems in different specialties such as teleophthalmology, telecardiology, teledermatology, etc. More articles were found between 2000 and 2013. Cost-utility studies were done only for telemedicine systems. There are few cost-utility and cost-effectiveness studies for e-health and m-health systems in the literature. Some cost-effectiveness studies demonstrate that telemedicine can reduce the costs, but not all. Among the main limitations of the economic evaluations of telemedicine systems are the lack of randomized control trials, small sample sizes, and the absence of quality data and appropriate measures.

  12. Measuring population health: costs of alternative survey approaches in the Nouna Health and Demographic Surveillance System in rural Burkina Faso

    Directory of Open Access Journals (Sweden)

    Henrike Lietz

    2015-08-01

    Full Text Available Background: There are more than 40 Health and Demographic Surveillance System (HDSS sites in 19 different countries. The running costs of HDSS sites are high. The financing of HDSS activities is of major importance, and adding external health surveys to the HDSS is challenging. To investigate the ways of improving data quality and collection efficiency in the Nouna HDSS in Burkina Faso, the stand-alone data collection activities of the HDSS and the Household Morbidity Survey (HMS were integrated, and the paper-based questionnaires were consolidated into a single tablet-based questionnaire, the Comprehensive Disease Assessment (CDA. Objective: The aims of this study are to estimate and compare the implementation costs of the two different survey approaches for measuring population health. Design: All financial costs of stand-alone (HDSS and HMS and integrated (CDA surveys were estimated from the perspective of the implementing agency. Fixed and variable costs of survey implementation and key cost drivers were identified. The costs per household visit were calculated for both survey approaches. Results: While fixed costs of survey implementation were similar for the two survey approaches, there were considerable variations in variable costs, resulting in an estimated annual cost saving of about US$45,000 under the integrated survey approach. This was primarily because the costs of data management for the tablet-based CDA survey were considerably lower than for the paper-based stand-alone surveys. The cost per household visit from the integrated survey approach was US$21 compared with US$25 from the stand-alone surveys for collecting the same amount of information from 10,000 HDSS households. Conclusions: The CDA tablet-based survey method appears to be feasible and efficient for collecting health and demographic data in the Nouna HDSS in rural Burkina Faso. The possibility of using the tablet-based data collection platform to improve the quality

  13. Pre-fracture individual characteristics associated with high total health care costs after hip fracture.

    Science.gov (United States)

    Schousboe, J T; Paudel, M L; Taylor, B C; Kats, A M; Virnig, B A; Dowd, B E; Langsetmo, L; Ensrud, K E

    2017-03-01

    Older women with pre-fracture slow walk speed, high body mass index, and/or a high level of multimorbidity have significantly higher health care costs after hip fracture compared to those without those characteristics. Studies to investigate if targeted health care interventions for these individuals can reduce hip fracture costs are warranted. The aim of this study is to estimate the associations of individual pre-fracture characteristics with total health care costs after hip fracture, using Study of Osteoporotic Fractures (SOF) cohort data linked to Medicare claims. Our study population was 738 women age 70 and older enrolled in Medicare Fee for Service (FFS) who experienced an incident hip fracture between January 1, 1992 and December 31, 2009. We assessed pre-fracture individual characteristics at SOF study visits and estimated costs of hospitalizations, skilled nursing facility and inpatient rehabilitation stays, home health care visits, and outpatient utilization from Medicare FFS claims. We used generalized linear models to estimate the associations of predictor variables with total health care costs (2010 US dollars) after hip fracture. Median total health care costs for 1 year after hip fracture were $35,536 (inter-quartile range $24,830 to $50,903). Multivariable-adjusted total health care costs for 1 year after hip fracture were 14 % higher ($5256, 95 % CI $156 to $10,356) in those with walk speed total health care costs after hip fracture in older women. Studies to investigate if targeted health care interventions for these individuals can reduce the costs of hip fractures are warranted.

  14. [Prevention and control of air pollution needs to strengthen further study on health damage caused by air pollution].

    Science.gov (United States)

    Wu, T C

    2016-08-06

    Heath issues caused by air pollution such as particulate matter (PM) are much concerned and focused among air, water and soil pollutions because human breathe air for whole life span. Present comments will review physical and chemical characteristics of PM2.5 and PM10; Dose-response associations of PM10, PM2.5 and their components with mortality and risk of cardiopulmonary diseases, early health damages such as the decrease of lung functions and heart rate variability, DNA damage; And the roles of genetic variations and epigenetic changes in lung functions and heart rate variability, DNA damage related to PMs and their components. This comments list some limitations and perspectives about the associations of air pollution with health.

  15. Health care development: integrating transaction cost theory with social support theory.

    Science.gov (United States)

    Hajli, M Nick; Shanmugam, Mohana; Hajli, Ali; Khani, Amir Hossein; Wang, Yichuan

    2014-07-28

    The emergence of Web 2.0 technologies has already been influential in many industries, and Web 2.0 applications are now beginning to have an impact on health care. These new technologies offer a promising approach for shaping the future of modern health care, with the potential for opening up new opportunities for the health care industry as it struggles to deal with challenges including the need to cut costs, the increasing demand for health services and the increasing cost of medical technology. Social media such as social networking sites are attracting more individuals to online health communities, contributing to an increase in the productivity of modern health care and reducing transaction costs. This study therefore examines the potential effect of social technologies, particularly social media, on health care development by adopting a social support/transaction cost perspective. Viewed through the lens of Information Systems, social support and transaction cost theories indicate that social media, particularly online health communities, positively support health care development. The results show that individuals join online health communities to share and receive social support, and these social interactions provide both informational and emotional support.

  16. [Costs of health. Costs-effectiveness in case of lifestyle changes].

    Science.gov (United States)

    Apor, Péter

    2010-05-09

    Economical burden for the individuals and for the national budgets of chronic cardio-vasculo-metabolic diseases is high and is rapidly increasing. Costs of treatments and prevention are very different in countries of diverse culture, ethnicity, social-economical situations, but prevention with healthy foods and with adequate physical activity are cheaper than medicines anywhere in the world. A great couple of studies approved cost-effectiveness of interventions directed to the change of life style factors. Cheaper is to influence the whole, yet healthy population, but interventions on people with high risk are more target-specific and usually more expensive. Enhanced physical activity (minimum 30 minutes five times per week with low-medium intensity, plus resistance exercises for maintain the muscle mass and force, plus stretching and calisthenics to maintain joints motility) can be promoted by few hundred-few ten hundred euros or dollars. Price of gain in Quality/Disability-Adjusted Life Years expressed as Incremental Cost Effectiveness/Utility Ratio is known, estimated or modelled, and offers a good value of money.

  17. Health-care costs of underweight, overweight and obesity: Australian population-based study.

    Science.gov (United States)

    Clifford, Susan A; Gold, Lisa; Mensah, Fiona K; Jansen, Pauline W; Lucas, Nina; Nicholson, Jan M; Wake, Melissa

    2015-12-01

    Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. biennial BMI measurements over the same period. Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  18. Modal content based damage indicators and phased array transducers for structural health monitoring of aircraft structures using ultrasonic guided waves

    Science.gov (United States)

    Ren, Baiyang

    Composite materials, especially carbon fiber reinforced polymers (CFRP), have been widely used in the aircraft industry because of their high specific strength and stiffness, resistance to corrosion and good fatigue life. Due to their highly anisotropic material properties and laminated structures, joining methods like bolting and riveting are no longer appropriate for joining CFRP since they initiate defects during the assembly and severely compromise the integrity of the structure; thus new techniques for joining CFRP are highly demanded. Adhesive bonding is a promising method because it relieves stress concentration, reduces weight and provides smooth surfaces. Additionally, it is a low-cost alternative to the co-cured method which is currently used to manufacture components of aircraft fuselage. Adhesive defects, disbonds at the interface between adherend and adhesive layer, are focused on in this thesis because they can be initialized by either poor surface preparation during the manufacturing or fatigue loads during service. Aircraft need structural health monitoring (SHM) systems to increase safety and reduce loss, and adhesive bonds usually represent the hotspots of the assembled structure. There are many nondestructive evaluation (NDE) methods for bond inspection. However, these methods cannot be readily integrated into an SHM system because of the bulk size and weight of the equipment and requirement of accessibility to one side of the bonded joint. The first objective of this work is to develop instruments, actuators, sensors and a data acquisition system for SHM of bond lines using ultrasonic guided waves which are well known to be able to cover large volume of the structure and inaccessible regions. Different from widely used guided wave sensors like PZT disks, the new actuators, piezoelectric fiber composite (PFC) phased array transducers0 (PAT), can control the modal content of the excited waves and the new sensors, polyvinylidene fluoride (PVDF

  19. Willingness to pay and cost of illness for changes in health capital depreciation.

    Science.gov (United States)

    Ried, W

    1996-01-01

    The paper investigates the relationship between the willingness to pay and the cost of illness approach with respect to the evaluation of economic burden due to adverse health effects. The basic intertemporal framework is provided by Grossman's pure investment model, while effects on individual morbidity are taken to be generated by marginal changes in the rate of health capital depreciation. More specifically, both the simple example of purely temporary changes and the more general case of persistent variations in health capital depreciation are discussed. The analysis generates two principal findings. First, for a class of identical individuals cost as measured by the cost of illness approach is demonstrated to provide a lower bound on the true welfare cost to the individual, i.e. cost as given by the willingness to pay approach. Moreover, the cost of illness is increasing in the size of the welfare loss. Second, if one takes into account the possible heterogeneity of individuals, a clear relationship between the cost values supplied by the two approaches no longer exists. As an example, the impact of variations in either financial wealth or health capital endowment is discussed. Thus, diversity in individual type turns out to blur the link between cost of illness and the true economic cost.

  20. Time-driven activity-based costing in health care: A systematic review of the literature.

    Science.gov (United States)

    Keel, George; Savage, Carl; Rafiq, Muhammad; Mazzocato, Pamela

    2017-07-01

    Health care organizations around the world are investing heavily in value-based health care (VBHC), and time-driven activity-based costing (TDABC) has been suggested as the cost-component of VBHC capable of addressing costing challenges. The aim of this study is to explore why TDABC has been applied in health care, how its application reflects a seven-step method developed specifically for VBHC, and implications for the future use of TDABC. This is a systematic review following the PRISMA statement. Qualitative methods were employed to analyze data through content analyses. TDABC is applicable in health care and can help to efficiently cost processes, and thereby overcome a key challenge associated with current cost-accounting methods The method's ability to inform bundled payment reimbursement systems and to coordinate delivery across the care continuum remains to be demonstrated in the published literature, and the role of TDABC in this cost-accounting landscape is still developing. TDABC should be gradually incorporated into functional systems, while following and building upon the recommendations outlined in this review. In this way, TDABC will be better positioned to accurately capture the cost of care delivery for conditions and to control cost in the effort to create value in health care. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  1. Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis.

    Science.gov (United States)

    Baggaley, Rebecca F; Irvine, Michael A; Leber, Werner; Cambiano, Valentina; Figueroa, Jose; McMullen, Heather; Anderson, Jane; Santos, Andreia C; Terris-Prestholt, Fern; Miners, Alec; Hollingsworth, T Déirdre; Griffiths, Chris J

    2017-10-01

    Early HIV diagnosis reduces morbidity, mortality, the probability of onward transmission, and their associated costs, but might increase cost because of earlier initiation of antiretroviral treatment (ART). We investigated this trade-off by estimating the cost-effectiveness of HIV screening in primary care. We modelled the effect of the four-times higher diagnosis rate observed in the intervention arm of the RHIVA2 randomised controlled trial done in Hackney, London (UK), a borough with high HIV prevalence (≥0·2% adult prevalence). We constructed a dynamic, compartmental model representing incidence of infection and the effect of screening for HIV in general practices in Hackney. We assessed cost-effectiveness of the RHIVA2 trial by fitting model diagnosis rates to the trial data, parameterising with epidemiological and behavioural data from the literature when required, using trial testing costs and projecting future costs of treatment. Over a 40 year time horizon, incremental cost-effectiveness ratios were £22 201 (95% credible interval 12 662-132 452) per quality-adjusted life-year (QALY) gained, £372 207 (268 162-1 903 385) per death averted, and £628 874 (434 902-4 740 724) per HIV transmission averted. Under this model scenario, with UK cost data, RHIVA2 would reach the upper National Institute for Health and Care Excellence cost-effectiveness threshold (about £30 000 per QALY gained) after 33 years. Scenarios using cost data from Canada (which indicate prolonged and even higher health-care costs for patients diagnosed late) suggest this threshold could be reached in as little as 13 years. Screening for HIV in primary care has important public health benefits as well as clinical benefits. We predict it to be cost-effective in the UK in the medium term. However, this intervention might be cost-effective far sooner, and even cost-saving, in settings where long-term health-care costs of late-diagnosed patients in high

  2. Vitamin D and health care costs: Results from two independent population-based cohort studies.

    Science.gov (United States)

    Hannemann, A; Wallaschofski, H; Nauck, M; Marschall, P; Flessa, S; Grabe, H J; Schmidt, C O; Baumeister, S E

    2017-10-31

    Vitamin D deficiency is associated with higher morbidity. However, there is few data regarding the effect of vitamin D deficiency on health care costs. This study examined the cross-sectional and longitudinal associations between the serum 25-hydroxy vitamin D concentration (25OHD) and direct health care costs and hospitalization in two independent samples of the general population in North-Eastern Germany. We studied 7217 healthy individuals from the 'Study of Health in Pomerania' (SHIP n = 3203) and the 'Study of Health in Pomerania-Trend' (SHIP-Trend n = 4014) who had valid 25OHD measurements and provided data on annual total costs, outpatient costs, hospital stays, and inpatient costs. The associations between 25OHD concentrations (modelled continuously using factional polynomials) and health care costs were examined using a generalized linear model with gamma distribution and a log link. Poisson regression models were used to estimate relative risks of hospitalization. In cross-sectional analysis of SHIP-Trend, non-linear associations between the 25OHD concentration and inpatient costs and hospitalization were detected: participants with 25OHD concentrations of 5, 10 and 15 ng/ml had 226.1%, 51.5% and 14.1%, respectively, higher inpatient costs than those with 25OHD concentrations of 20 ng/ml (overall p-value = 0.001) in multivariable models. We found a relation between lower 25OHD concentrations and increased inpatient health care costs and hospitalization. Our results thus indicate an influence of vitamin D deficiency on health care costs in the general population. Copyright © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  3. The methodological convention 2,0 for the estimation of environmental costs. An economic evaluation of environmental damages; Methodenkonvention 2.0 zur Schaetzung von Umweltkosten. Oekonomische Bewertung von Umweltschaeden

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2012-08-15

    The reliable estimation of environmental damage costs requires a high degree of transparency of the objectives, assumptions and methods of assessment in order to ensure a correct classification and comparability of the cost factors. The methods convention under consideration aims to develop uniform standards for the technical evaluation of environmental costs and to improve the transparency of the estimates.

  4. Health care cost consequences of using robot technology for hysterectomy

    DEFF Research Database (Denmark)

    Laursen, Karin Rosenkilde; Hyldgård, Vibe Bolvig; Jensen, Pernille Tine

    2017-01-01

    The objective of this study is to examine the costs attributable to robotic-assisted laparoscopic hysterectomy from a broad healthcare sector perspective in a register-based longitudinal study. The population in this study were 7670 consecutive women undergoing hysterectomy between January 2006...... and August 2013 in public hospitals in Denmark. The interventions in the study were total and radical hysterectomy performed robotic-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), or open abdominal hysterectomy (OAH). Service use in the healthcare sector was evaluated 1...... year before to 1 year after the surgery. Tariffs of the activity-based remuneration system and the diagnosis-related grouping case-mix system were used for valuation of primary and secondary care, respectively. Costs attributable to RALH were estimated using a difference-in-difference analytical...

  5. 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...

  6. Research Shows Health Impacts and Economic Costs of Wildland Fires

    Science.gov (United States)

    Researchers at EPA and colleagues at NC State University, the University of Sydney and the University of Tasmania are advancing the science of understanding the public health burden associated with wildland fires.

  7. Cost accounting in health care: fad or fundamental?

    Science.gov (United States)

    Kaskiw, E A; Hanlon, P; Wulf, P

    1987-11-01

    The drastic changes in the environment affecting hospitals have caused management to look toward capturing and reporting cost information to make decisions. These decisions will, in part, shape the way hospitals continue to do business. This article focuses on the data requirements necessary to support product and operational management decisions facing today's hospitals. In addition, the difference in data needed to support product and operational management is explored.

  8. Social policy and costs of social protection and health

    OpenAIRE

    Koukoufilippou, Ioannis; Papavasileiou, Evanthia; Koinis, Aristotelis

    2016-01-01

    ABSTRACT The understanding of theoretical models and typologies of social systems is a prerequisite for the study and policy formulation in the health sector. The analysis of health expenditure in Greece in relation to the European Union-15 (EU-15) countries, is the first step for policymakers. Through literature review and Eurostat databases (ESSPROS) and the OECD (OECD), compiled and presented the necessary statistical and theoretical data reveal deviations of Greece from the average of...

  9. [Influence of obesity on health care costs and absenteeism among employees of a mining company].

    Science.gov (United States)

    Zarate, Aldo; Crestto, Marco; Maiz, Alberto; Ravest, Gonzalo; Pino, María Inés; Valdivia, Gonzalo; Moreno, Manuel; Villarroel, Luis

    2009-03-01

    The health associated costs of obesity can represent between 2% and 9% of the total health costs of a given country. To assess the impact of obesity on health care costs and absenteeism in a cohort of mine workers. Prospective study of 4.673 men, employees of a mining company, aged 49 +/- 7 years that were followed for 24 +/- 11 months. Total health care cost and days of sick leave were recordedfor each individual. The association between obesity and these variables was analyzed by logistic regression adjusting for co-morbidities, age and other variables. Mean annual health care costs for obese workers were 17% higher (p costs the most significant predictors were: presence of diabetes mellitus (Odds ratio (OR) 6.21, 95%o confidence intervals (95% CI) 4.9 to 7.9), hypertension (OR 3-99; 95% CI3-4 to 4.6) and severe and morbid obesity (OR 2.55, 95%o CI 1.9 to 3-4). For absenteeism the most significant predictors were: presence of diabetes mellitus (OR 1.58, 95%> CI 1.2 to 2.0), hypertension (OR 1,34, 95%> CI 1.2 to 1.6) and severe and morbid obesity (OR 1.50, 95%o CI 1.1 to 2.1). Obesity increases significantly health care costs and absenteeism.

  10. Production cost structure in US outpatient physical therapy health care.

    Science.gov (United States)

    Lubiani, Gregory G; Okunade, Albert A

    2013-02-01

    This paper investigates the technology cost structure in US physical therapy care. We exploit formal economic theories and a rich national data of providers to tease out implications for operational cost efficiencies. The 2008-2009 dataset comprising over 19 000 bi-weekly, site-specific physical therapy center observations across 28 US states and Occupational Employment Statistics data (Bureau of Labor Statistics) includes measures of output, three labor types (clinical, support, and administrative), and facilities (capital). We discuss findings from the iterative seemingly unrelated regression estimation system model. The generalized translog cost estimates indicate a well-behaved underlying technology structure. We also find the following: (i) factor demands are downwardly sloped; (ii) pair-wise factor relationships largely reflect substitutions; (iii) factor demand for physical therapists is more inelastic compared with that for administrative staff; and (iv) diminishing scale economies exist at the 25%, 50%, and 75% output (patient visits) levels. Our findings advance the timely economic understanding of operations in an increasingly important segment of the medical care sector that has, up-to-now (because of data paucity), been missing from healthcare efficiency analysis. Our work further provides baseline estimates for comparing operational efficiencies in physical therapy care after implementations of the 2010 US healthcare reforms. Copyright © 2012 John Wiley & Sons, Ltd.

  11. Cost-Effectiveness Thresholds in Global Health: Taking a Multisectoral Perspective.

    Science.gov (United States)

    Remme, Michelle; Martinez-Alvarez, Melisa; Vassall, Anna

    2017-04-01

    Good health is a function of a range of biological, environmental, behavioral, and social factors. The consumption of quality health care services is therefore only a part of how good health is produced. Although few would argue with this, the economic framework used to allocate resources to optimize population health is applied in a way that constrains the analyst and the decision maker to health care services. This approach risks missing two critical issues: 1) multiple sectors contribute to health gain and 2) the goods and services produced by the health sector can have multiple benefits besides health. We illustrate how present cost-effectiveness thresholds could result in health losses, particularly when considering health-producing interventions in other sectors or public health interventions with multisectoral outcomes. We then propose a potentially more optimal second best approach, the so-called cofinancing approach, in which the health payer could redistribute part of its budget to other sectors, where specific nonhealth interventions achieved a health gain more efficiently than the health sector's marginal productivity (opportunity cost). Likewise, other sectors would determine how much to contribute toward such an intervention, given the current marginal productivity of their budgets. Further research is certainly required to test and validate different measurement approaches and to assess the efficiency gains from cofinancing after deducting the transaction costs that would come with such cross-sectoral coordination. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  12. Agricultural losses related to frost events: use of the 850 hPa level temperature as an explanatory variable of the damage cost

    Science.gov (United States)

    Papagiannaki, K.; Lagouvardos, K.; Kotroni, V.; Papagiannakis, G.

    2014-09-01

    The objective of this study is the analysis of damaging frost events in agriculture, by examining the relationship between the daily minimum temperature in the lower atmosphere (at an isobaric level of 850 hPa) and crop production losses. Furthermore, the study suggests a methodological approach for estimating agriculture risk due to frost events, with the aim of estimating the short-term probability and magnitude of frost-related financial losses for different levels of 850 hPa temperature. Compared with near-surface temperature forecasts, temperature forecasts at the level of 850 hPa are less influenced by varying weather conditions or by local topographical features; thus, they constitute a more consistent indicator of the forthcoming weather conditions. The analysis of the daily monetary compensations for insured crop losses caused by weather events in Greece shows that, during the period 1999-2011, frost caused more damage to crop production than any other meteorological phenomenon. Two regions of different geographical latitudes are examined further, to account for the differences in the temperature ranges developed within their ecological environment. Using a series of linear and logistic regressions, we found that minimum temperature (at an 850 hPa level), grouped into three categories according to its magnitude, and seasonality, are significant variables when trying to explain crop damage costs, as well as to predict and quantify the likelihood and magnitude of damaging frost events.

  13. 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.

  14. Valuing the human health damage caused by the fraud of Volkswagen.

    Science.gov (United States)

    Oldenkamp, Rik; van Zelm, Rosalie; Huijbregts, Mark A J

    2016-05-01

    Recently it became known that Volkswagen Group has been cheating with emission tests for diesel engines over the last six years, resulting in on-road emissions vastly exceeding legal standards for nitrogen oxides in Europe and the United States. Here, we provide an estimate of the public health consequences caused by this fraud. From 2009 to 2015, approximately nine million fraudulent Volkswagen cars, as sold in Europe and the US, emitted a cumulative amount of 526 ktonnes of nitrogen oxides more than was legally allowed. These fraudulent emissions are associated with 45 thousand disability-adjusted life years (DALYs) and a value of life lost of at least 39 billion US dollars, which is approximately 5.3 times larger than the 7.3 billion US dollars that Volkswagen Group has set aside to cover worldwide costs related to the diesel emissions scandal. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Estimated hospital costs associated with preventable health care-associated infections if health care antiseptic products were unavailable

    Directory of Open Access Journals (Sweden)

    Schmier JK

    2016-05-01

    Full Text Available Jordana K Schmier,1 Carolyn K Hulme-Lowe,1 Svetlana Semenova,2 Juergen A Klenk,3 Paul C DeLeo,4 Richard Sedlak,5 Pete A Carlson6 1Health Sciences, Exponent, Inc., Alexandria, VA, 2EcoSciences, Exponent, Inc., Maynard, MA, 3Health Sciences, Exponent, Inc., Alexandria, VA, 4Environmental Safety, 5Technical and International Affairs, American Cleaning Institute, Washington, DC, 6Regulatory Affairs, Ecolab, Saint Paul, MN, USA Objectives: Health care-associated infections (HAIs pose a significant health care and cost burden. This study estimates annual HAI hospital costs in the US avoided through use of health care antiseptics (health care personnel hand washes and rubs; surgical hand scrubs and rubs; patient preoperative and preinjection skin preparations. Methods: A spreadsheet model was developed with base case inputs derived from the published literature, supplemented with assumptions when data were insufficient. Five HAIs of interest were identified: catheter-associated urinary tract infections, central line-associated bloodstream infections, gastrointestinal infections caused by Clostridium difficile, hospital- or ventilator-associated pneumonia, and surgical site infections. A national estimate of the annual potential lost benefits from elimination of these products is calculated based on the number of HAIs, the proportion of HAIs that are preventable, the proportion of preventable HAIs associated with health care antiseptics, and HAI hospital costs. The model is designed to be user friendly and to allow assumptions about prevention across all infections to vary or stay the same. Sensitivity analyses provide low- and high-end estimates of costs avoided. Results: Low- and high-end estimates of national, annual HAIs in hospitals avoided through use of health care antiseptics are 12,100 and 223,000, respectively, with associated hospital costs avoided of US$142 million and US$4.25 billion, respectively. Conclusion: The model presents a novel

  16. Cost and cost-effectiveness of smear-positive tuberculosis treatment by Health Extension Workers in Southern Ethiopia: a community randomized trial.

    Directory of Open Access Journals (Sweden)

    Daniel G Datiko

    Full Text Available UNLABELLED: Treatments by HEWs in the health posts and general health workers at health facility were compared along a community-randomized trial. Costs were analysed from societal perspective in 2007 in US $ using standard methods. We prospectively enrolled smear positive patients, and calculated cost-effectiveness as the cost per patient successfully treated. The total cost for each successfully treated smear-positive patient was higher in health facility ($158.9 compared with community ($61.7. Community-based treatment reduced the total, patient and caregiver cost by 61.2%, 68.1% and 79.8%, respectively. Involving HEWs added a total cost of $8.80 (14.3% of total cost on health service per patient treated in the community. CONCLUSIONS/SIGNIFICANCE: Community-based treatment by HEWs costs only 39% of what treatment by general health workers costs for similar outcomes. Involving HEWs in TB treatment is a cost effective treatment alternative to the health service, to the patients and the family. There is an economic and public health reason to consider involving HEWs in TB treatment in Ethiopia. However, community-based treatment requires initial investment to start its implementation, training and supervision. TRIAL REGISTRATION: ClinicalTrials.gov NCT00803322.

  17. Direct health care costs associated with obesity in Chinese population in 2011.

    Science.gov (United States)

    Shi, Jingcheng; Wang, Yao; Cheng, Wenwei; Shao, Hui; Shi, Lizheng

    2017-03-01

    Overweight and obesity are established major risk factors for type 2 diabetes, and major public health concerns in China. This study aims to assess the economic burden associated with overweight and obesity in the Chinese population ages 45 and older. The Chinese Health and Retirement Longitudinal Study (CHARLS) in 2011 included 13,323 respondents of ages 45 and older living in 450 rural and urban communities across China. Demographic information, height, weight, direct health care costs for outpatient visits, hospitalization, and medications for self-care were extracted from the CHARLS database. Health Care costs were calculated in 2011 Chinese currency. The body mass index (BMI) was used to categorize underweight, normal weight, overweight, and obese populations. Descriptive analyses and a two-part regression model were performed to investigate the association of BMI with health care costs. To account for non-normality of the cost data, we applied a non-parametric bootstrap approach using the percentile method to estimate the 95% confidence intervals (95% CIs). Overweight and obese groups had significantly higher total direct health care costs (RMB 2246.4, RMB 2050.7, respectively) as compared with the normal-weight group (RMB 1886.0). When controlling for demographic characteristics, overweight and obese adults were 15.0% and 35.9% more likely to incur total health care costs, and obese individuals had 14.2% higher total health care costs compared with the normal-weight group. Compared with the normal-weight counterparts, the annual total direct health care costs were significantly higher among obese adults in China. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Chronic obstructive pulmonary disease involves substantial health-care service and social benefit costs

    DEFF Research Database (Denmark)

    Jensen, Martin Bach; Fenger-Grøn, Morten; Fonager, Kirsten

    2013-01-01

    INTRODUCTION: The present study compared health carerelated costs and the use of social benefits and transfer payments in participants with and without chronic obstructive pulmonary disease (COPD), and related the costs to the severity of the COPD. MATERIAL AND METHODS: Spirometry data from...... a cohort study performed in Denmark during 2004-2006 were linked with national register data that identified the costs of social benefits and health-care services. The cohort comprised 546 participants with COPD (forced expiratory volume in the first sec. (FEV1)/forced vital capacity (FVC) ratio ....7 following bronchodilator administration] and 3,995 without COPD (in addition, 9,435 invited participants were non-responders and 331 were excluded). The costs were adjusted for gender, age, co-morbidity and educational level. RESULTS: Health care-related costs were 4,779 (2,404- 7,154) Danish kroner (DKK...

  19. Damage Evaluation and Analysis of Composite Pressure Vessels Using Fiber Bragg Gratings to Determine Structural Health

    National Research Council Canada - National Science Library

    Kunzler, Marley; Udd, Eric; Kreger, Stephen; Johnson, Mont; Henrie, Vaughn

    2005-01-01

    .... Using fiber Bragg gratings embedded into the weave structure of carbon fiber epoxy composites allow the capability to monitor these composites during manufacture, cure, general aging, and damage...

  20. Switching benefits and costs in the Irish health insurance market: an analysis of consumer surveys.

    Science.gov (United States)

    Keegan, Conor; Teljeur, Conor; Turner, Brian; Thomas, Steve

    2018-05-10

    Relatively little analysis has taken place internationally on the consumer-reported benefits and costs to switching insurer in multi-payer health insurance markets. Ideally, consumers should be willing to switch out of consideration for price and quality and switching should be able to take place without incurring significant switching costs. Costs to switching come in many forms and understanding the nature of these costs is necessary if policy interventions to improve market competition are to be successful. This study utilises data from consumer surveys of the Irish health insurance market collected between 2009 and 2013 (N [Formula: see text] 1703) to examine consumer-reported benefits and costs to switching insurer. Probit regression models are specified to examine the relationship between consumer characteristics and reported switching costs, and switching behaviour, respectively. Overall evidence suggests that switchers in the Irish market mainly did so out of consideration for price. Transaction cost was the most common switching cost identified, reported by just under 1 in 7 non-switchers. Psychological switching costs may also be impacting behaviour. Moreover, high-risk individuals were more likely to experience switching costs and this was reflected in actual switching behaviour. A recent information campaign launched by the market regulator may prove beneficial in reducing perceived transaction costs in the market, however, a more focused campaign aimed at high-risk consumers may be necessary to reduce inequalities. Policy-makers should also consider the impact insurer behaviour may have on decision-making.

  1. The Potential to Forgo Social Welfare Gains through Over reliance on Cost Effectiveness/Cost Utility Analyses in the Evidence Base for Public Health

    International Nuclear Information System (INIS)

    Cohen, D.R.; Patel, N.

    2010-01-01

    Economic evaluations of clinical treatments most commonly take the form of cost effectiveness or cost utility analyses. This is appropriate since the main sometimes the only benefit of such interventions is increased health. The majority of economic evaluations in public health, however, have also been assessed using these techniques when arguably cost benefit analyses would in many cases have been more appropriate, given its ability to take account of non health benefits as well. An examination of the non health benefits from a sample of studies featured in a recent review of economic evaluations in public health illustrates how over focusing on cost effectiveness/cost utility analyses may lead to forgoing potential social welfare gains from programmes in public health. Prior to evaluation, programmes should be considered in terms of the potential importance of non health benefits and where these are considerable would be better evaluated by more inclusive economic evaluation techniques.

  2. Comparison of Swiss basic health insurance costs of complementary and conventional medicine.

    Science.gov (United States)

    Studer, Hans-Peter; Busato, André

    2011-01-01

    From 1999 to 2005, 5 methods of complementary and alternative medicine (CAM) applied by physicians were provisionally included into mandatory Swiss basic health insurance. Between 2012 and 2017, this will be the case again. Within this process, an evaluation of cost-effectiveness is required. The goal of this study is to compare practice costs of physicians applying CAM with those of physicians applying solely conventional medicine (COM). The study was designed as a cross-sectional investigation of claims data of mandatory health insurance. For the years 2002 and 2003, practice costs of 562 primary care physicians with and without a certificate for CAM were analyzed and compared with patient-reported outcomes. Linear models were used to obtain estimates of practice costs controlling for different patient populations and structural characteristics of practices across CAM and COM. Statistical procedures show similar total practice costs for CAM and COM, with the exception of homeopathy with 15.4% lower costs than COM. Furthermore, there were significant differences between CAM and COM in cost structure especially for the ratio between costs for consultations and costs for medication at the expense of basic health insurance. Patients reported better quality of the patient-physician relationship and fewer adverse side effects in CAM; higher cost-effectiveness for CAM can be deduced from this perspective. This study uses a health system perspective and demonstrates at least equal or better cost-effectiveness of CAM in the setting of Swiss ambulatory care. CAM can therefore be seen as a valid complement to COM within Swiss health care. Copyright © 2011 S. Karger AG, Basel.

  3. Estimating the cost to U.S. health departments to conduct HIV surveillance.

    Science.gov (United States)

    Shrestha, Ram K; Sansom, Stephanie L; Laffoon, Benjamin T; Farnham, Paul G; Shouse, R Luke; MacMaster, Karen; Hall, H Irene

    2014-01-01

    HIV case surveillance is a primary source of information for monitoring HIV burden in the United States and guiding the allocation of prevention and treatment funds. While the number of people living with HIV and the need for surveillance data have increased, little is known about the cost of surveillance. We estimated the economic cost to health departments of conducting high-quality HIV case surveillance. We collected primary data on the unit cost and quantity of resources used to operate the HIV case surveillance program in Michigan, where HIV burden (i.e., the number of HIV cases) is moderate to high (n=14,864 cases). Based on Michigan's data, we projected the expected annual HIV surveillance cost for U.S., state, local, and territorial health departments. We based our cost projection on the variation in the number of new and established cases, area-specific wages, and potential economies of scale. We estimated the annual total HIV surveillance cost to the Michigan health department to be $1,286,524 ($87/case), the annual total cost of new cases to be $108,657 ($133/case), and the annual total cost of established cases to be $1,177,867 ($84/case). Our projected median annual HIV surveillance cost per health department ranged from $210,600 in low-HIV burden sites to $1,835,000 in high-HIV burden sites. Our analysis shows that a systematic approach to costing HIV surveillance at the health department level is feasible. For HIV surveillance, a substantial portion of total surveillance costs is attributable to maintaining established cases.

  4. The external costs of electricity generation. A comparison of environmental damage of silicon photovoltaic electricity, produced with different electricity mixes, vs natural gas and coal

    Energy Technology Data Exchange (ETDEWEB)

    Olson, C.L.; Veltkamp, A.C.; Sinke, W.C. [ECN Solar Energy, Petten (Netherlands)

    2012-09-15

    In this paper the environmental damages of crystalline silicon photovoltaics are calculated, using the most recent photovoltaics data, and compared with those of the prevalent conventional energy technologies. A life cycle assessment of selected environmental impacts of 1kWh of electricity generated by various technologies was performed using Simapro software (version 7.2.4) in conjunction with the Ecoinvent database (version 2.2). The environmental impacts were assessed using the ReCiPe methodology. Because of the important role of coal and natural gas in the global electricity generation portfolio, special attention is given to the comparison of PV with those technologies. The environmental consequences of manufacturing PV modules with renewable, UCTE or 100% coal electricity mixes are explored. A brief update of the estimated monetarization of damages due to coal and climate change is included. A rough estimate of the true cost of coal and PV electricity is made in 2011.

  5. 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

  6. Health care resource use and costs among patients with cushing disease.

    Science.gov (United States)

    Swearingen, Brooke; Wu, Ning; Chen, Shih-Yin; Pulgar, Sonia; Biller, Beverly M K

    2011-01-01

    To assess health care costs associated with Cushing disease and to determine changes in overall and comorbidity-related costs after surgical treatment. In this retrospective cohort study, patients with Cushing disease were identified from insurance claims databases by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for Cushing syndrome (255.0) and either benign pituitary adenomas (227.3) or hypophysectomy (07.6×) between 2004 and 2008. Each patient with Cushing disease was age- and sex-matched with 4 patients with nonfunctioning pituitary adenomas and 10 population control subjects. Comorbid conditions and annual direct health care costs were assessed within each calendar year. Postoperative changes in health care costs and comorbidity-related costs were compared between patients presumed to be in remission and those with presumed persistent disease. Of 877 identified patients with Cushing disease, 79% were female and the average age was 43.4 years. Hypertension, diabetes mellitus, and hyperlipidemia were more common among patients with Cushing disease than in patients with nonfunctioning pituitary adenomas or in control patients (PCushing disease had significantly higher total health care costs (2008: $26 440 [Cushing disease] vs $13 708 [nonfunctioning pituitary adenomas] vs $5954 [population control], Pdisease-related costs with remission. A significant increase in postoperative health care costs was observed in those patients not in remission. Patients with Cushing disease had more comorbidities than patients with nonfunctioning pituitary adenomas or control patients and incurred significantly higher annual health care costs; these costs decreased after successful surgery and increased after unsuccessful surgery.

  7. Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra

    2014-01-01

    To examine the costs to the public health care system of couples in medically assisted reproduction.......To examine the costs to the public health care system of couples in medically assisted reproduction....

  8. Cost-effectiveness of national health insurance programs in high-income countries: A systematic review.

    Directory of Open Access Journals (Sweden)

    Son Nghiem

    Full Text Available National health insurance is now common in most developed countries. This study reviews the evidence and synthesizes the cost-effectiveness information for national health insurance or disability insurance programs across high-income countries.A literature search using health, economics and systematic review electronic databases (PubMed, Embase, Medline, Econlit, RepEc, Cochrane library and Campbell library, was conducted from April to October 2015.Two reviewers independently selected relevant studies by applying screening criteria to the title and keywords fields, followed by a detailed examination of abstracts.Studies were selected for data extraction using a quality assessment form consisting of five questions. Only studies with positive answers to all five screening questions were selected for data extraction. Data were entered into a data extraction form by one reviewer and verified by another.Data on costs and quality of life in control and treatment groups were used to draw distributions for synthesis. We chose the log-normal distribution for both cost and quality-of-life data to reflect non-negative value and high skew. The results were synthesized using a Monte Carlo simulation, with 10,000 repetitions, to estimate the overall cost-effectiveness of national health insurance programs.Four studies from the United States that examined the cost-effectiveness of national health insurance were included in the review. One study examined the effects of medical expenditure, and the remaining studies examined the cost-effectiveness of health insurance reforms. The incremental cost-effectiveness ratio (ICER ranged from US$23,000 to US$64,000 per QALY. The combined results showed that national health insurance is associated with an average incremental cost-effectiveness ratio of US$51,300 per quality-adjusted life year (QALY. Based on the standard threshold for cost-effectiveness, national insurance programs are cost-effective interventions

  9. Use of health plan data to estimate cost and outcomes of a breast cancer population

    International Nuclear Information System (INIS)

    Konski, Andre

    1997-01-01

    Purpose/Objective: To compare insurance billing data with tumor registry data for estimating date of diagnosis and date of recurrence. To collect and estimate cost of treatment from billing data as a step towards performing cost-effective or cost-utility analysis. To correlate first year treatment cost first year with overall cost to enable the former to serve as a proxy for the latter for patients migrating out of insurance plans. Materials and Methods: Billing data for patients(pts.) diagnosed with breast cancer between 1990-1992 was obtained from Paramount Health Plans, a NCQA accredited health plan in Northwest Ohio. Tumor registry and hospital records were surveyed for the clinical data. Total cost of care received by pts., cost of care associated with treatment of breast cancer, and cost of care billed as breast cancer care was collected for each 12 month period from the date of diagnosis. Costs were measured from a payers, i.e. health plans, perspective. Net present value (NPV) costs discounted at a rate of 3% to the year of diagnosis are reported. Pts. were considered in the plan for the entire duration of the study if they were in the plan from the time of diagnosis to the end of the analysis, (12(96)). Students t-test was used to determined statistical differences between groups analyzed. Results: Paramount Health Plan was a small health plan with approximately 10,000-13,000 female enrolees during the study period. Breast cancer was diagnosed in 21 women during 1990-1992 with 18 pts. diagnosed while in the insurance plan and 3 diagnosed prior to entry into the plan. (12(18)) pts. were in the plan for the entire duration of the study. The mean deviation for the date of diagnosis as recorded from tumor registry data, compared to the first date that a diagnosis of breast cancer appears on the billing record is 18 days (range:0-158). Four pts. experienced a recurrence. A determination of a recurrence from insurance records was only possible in (1(4)) pts. who

  10. Health-related economic costs of the Three-Mile Island accident.

    Science.gov (United States)

    Hu, T W; Slaysman, K S

    1984-01-01

    On March 1979, a nuclear power station at Three-Mile Island (TMI) near Harrisburg, Pennsylvania, had a major breakdown. During the two-week period of the accident, about 150,000 residents were evacuated for reasons associated with safety and health. Many residents during and after the accident, regardless of whether they left or stayed, made mental and physical adjustments due to this accident. This paper is to estimate the economic costs incurred by individuals or communities as a result of a change in physical or mental health status and/or a change in health care services due to the TMI accident. The findings indicate that stress symptoms caused by the accident did affect the health-related behaviors of area residents. Of the costs examined, the economic costs of work days lost and physician visits are the largest cost items. There were some increases in consumption of alcohol, cigarettes, and tranquilizers immediately following the accident.

  11. Recyclable Nonfunctionalized Paper-Based Ultralow-Cost Wearable Health Monitoring System

    KAUST Repository

    Nassar, Joanna M.; Mishra, Kush; Lau, Kirklann; Aguirre-Pablo, Andres A.; Hussain, Muhammad Mustafa

    2017-01-01

    A wearable health monitor using low-cost and recyclable paper continuously supervises and assesses body vital conditions simultaneously and in real time, such as blood pressure, heart rate, body temperature, and skin hydration. The affordability

  12. Health Care Cost Growth and Demographic Trends Drive the Long-Term Fiscal Challenge

    National Research Council Canada - National Science Library

    2008-01-01

    ... health care costs and known demographic trends. In fact, the oldest members of the baby boom generation are now eligible for Social Security retirement benefits and will be eligible for Medicare benefits in less than 3 years...

  13. Low cost structural health monitoring of bridges using wireless sensors : research summary.

    Science.gov (United States)

    2012-05-01

    Problem: Structural health monitoring is critical to protecting bridges against aging, : failures, and potentially collapse. However, instrumentiation techniques : suffer from non-scalability due to the high cost of instrumentation devices : and inst...

  14. Regionalized life cycle impact assessment of air pollution on the global scale: Damage to human health and vegetation

    Science.gov (United States)

    van Zelm, Rosalie; Preiss, Philipp; van Goethem, Thomas; Van Dingenen, Rita; Huijbregts, Mark

    2016-06-01

    We developed regionalized characterization factors (CFs) for human health damage from particulate matter (PM2.5) and ozone, and for damage to vegetation from ozone, at the global scale. These factors can be used in the impact assessment phase of an environmental life cycle assessment. CFs express the overall damage of a certain pollutant per unit of emission of a precursor, i.e. primary PM2.5, nitrogen oxides (NOx), ammonia (NH3), sulfur dioxide (SO2) and non-methane volatile organic compounds (NMVOCs). The global chemical transport model TM5 was used to calculate intake fractions of PM2.5 and ozone for 56 world regions covering the whole globe. Furthermore, region-specific effect and damage factors were derived, using mortality rates, background concentrations and years of life lost. The emission-weighted world average CF for primary PM2.5 emissions is 629 yr kton-1, varying up to 3 orders of magnitude over the regions. Larger CFs were obtained for emissions in central Asia and Europe, and smaller factors in Australia and South America. The world average CFs for PM2.5 from secondary aerosols, i.e. NOx, NH3, and SO2, is 67.2 to 183.4 yr kton-1. We found that the CFs for ozone human health damage are 2-4 orders of magnitude lower compared to the CFs for damage due to primary PM2.5 and PM2.5 precursor emissions. Human health damage due to the priority air pollutants considered in this study was 1.7·10-2 yr capita-1 worldwide in year 2010, with primary PM2.5 emissions as the main contributor (62%). The emission-weighted world average CF for ecosystem damage due to ozone was 2.5 km2 yr kton-1 for NMVOCs and 8.7 m2 yr kg-1 for NOx emissions, varying 2-3 orders of magnitude over the regions. Ecosystem damage due to the priority air pollutants considered in this study was 1.6·10-4 km2 capita-1 worldwide in 2010, with NOx as the main contributor (72%). The spatial range in CFs stresses the importance of including spatial variation in life cycle impact assessment of

  15. Fundamentals for remote structural health monitoring of wind turbine blades - a preproject. Annex A. Cost-benefit for embedded sensors in large wind turbine blades

    DEFF Research Database (Denmark)

    Hansen, L.G.; Lading, Lars

    2002-01-01

    -bladed 2MW turbine placed offshore either without sensors or with sensors are compared. The price of a structural health monitoring system of a price of 100 000 DKK (per tur-bine) results in a break-eventime of about 3 years. For a price of 300 000 DKK the break-even time is about 8 years. However......This report contains the results of a cost-benefit analysis for the use of embed-ded sensors for damage detection in large wind turbine blades - structural health monitoring - (in connection with remote surveillance) of large wind turbine placedoff-shore. The total operating costs of a three......, the cost/benefit analysis has large uncertainties....

  16. Childhood Secondhand Smoke Exposure and ADHD-Attributable Costs to the Health and Education System

    Science.gov (United States)

    Max, Wendy; Sung, Hai-Yen; Shi, Yanling

    2014-01-01

    Background: Children exposed to secondhand smoke (SHS) have higher rates of behavioral and cognitive effects, including attention deficit hyperactivity disorder (ADHD), but the costs to the health care and education systems have not been estimated. We estimate these costs for school-aged children aged 5-15. Methods: The relative risk (RR) of ADHD…

  17. The economic cost of adverse health effects from wildfire-smoke exposure: A review

    Science.gov (United States)

    Ikuho Kochi; Geoffrey H. Donovan; Patricia A. Champ; John B. Loomis

    2010-01-01

    The economic costs of adverse health effects associated with exposure to wildfire smoke should be given serious consideration in determining the optimal wildfire management policy. Unfortunately, the literature in this research area is thin. In an effort to better understand the nature of these economic costs, we review and synthesise the relevant literature in three...

  18. Cost escalation in health - care technology possible solutions | Járos ...

    African Journals Online (AJOL)

    Solutions to cost escalation due to health-care technology are proposed. It is argued that proper systems analysis, technology assessment, and planning would result in net savings and itnproved cost-benefits. Identification of needs early in the technological life cycle can positively influence the final form of the chosen ...

  19. Update of the Dutch manual for costing studies in health care

    NARCIS (Netherlands)

    T.A. Kanters (Tim A.); C.A.M. Bouwmans-Frijters (Clazien); N. van der Linden (Naomi); S.S. Tan (Siok Swan); L. van Hakkaart-van Roijen (Leona)

    2017-01-01

    textabstractObjectives: Dutch health economic guidelines include a costing manual, which describes preferred research methodology for costing studies and reference prices to ensure high quality studies and comparability between study outcomes. This paper describes the most important revisions of the

  20. Health Cost Risk and Optimal Retirement Provision : A Simple Rule for Annuity Demand

    NARCIS (Netherlands)

    Peijnenburg, J.M.J.; Nijman, T.E.; Werker, B.J.M.

    2010-01-01

    We analyze the effect of health cost risk on optimal annuity demand and consumption/savings decisions. Many retirees are exposed to sizeable out-of-pocket medical expenses, while annuities potentially impair the ability to get liquidity to cover these costs and smooth consumption. We find that if

  1. An integrated approach to health care costs: the case of American Can.

    Science.gov (United States)

    Silvers, J B; Haslinger, J

    1984-01-01

    Faced with numerous health care options, corporations are searching for plans which provide necessary benefits while containing costs. This article examines the case of the American Can Company where, since 1978, a new approach has produced mutual economic gains and employee satisfaction. American Can's efforts involved differential pricing and encouraged responsible selection by employees. The company was one of several studied by the Health Systems Management Center at Case Western Reserve University under contract with the Business Roundtable Health Initiatives Task Force. Such studies provide insight for other companies seeking ways to attack burgeoning corporate health care costs. This article is one of a series reporting the results of these studies.

  2. 77 FR 801 - National Vaccine Injury Compensation Program: Revised Amount of the Average Cost of a Health...

    Science.gov (United States)

    2012-01-06

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration National Vaccine Injury Compensation Program: Revised Amount of the Average Cost of a Health Insurance Policy The Health Resources and Services Administration (HRSA) is publishing an updated monetary amount of the average cost of a health insurance policy as it...

  3. Multimorbidity in chronic disease: impact on health care resources and costs

    Directory of Open Access Journals (Sweden)

    McPhail SM

    2016-07-01

    Full Text Available Steven M McPhail1,2 1Centre for Functioning and Health Research, Metro South Health, 2Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia Abstract: Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied. There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to

  4. Emotion in health care: the cost of caring.

    Science.gov (United States)

    Brunton, Margaret

    2005-01-01

    The purpose of this paper is to understand the centrality of emotion, and how that emotion both created and contributed to meaning, in the communication of health professionals who worked in a regional pilot program for cancer screening. As the third phase of a larger study, thematic analysis of semi-structured interviews was carried out with the 19 members of the professional groups, which comprised the service. Brief comments were included from the questionnaire survey in phases 1 and 2 of the study to demonstrate the overflow effects on those served by the organization. Emotion was found to be a critical component in the communication interface between the groups. The complexity of the way in which emotion was managed with the client group overflowed into the management of the communication process between the professional groups in the organization. However, it was not always recognised, and thus created difficulties for a number of staff. Although the research was limited to one health-care organization, it is possible that other health professions are experiencing similar situations as they cope with the certainty of unending change. Also, although secondary interviews were carried out to ensure that themes were credible to participants, it is possible that carrying out the interviews in the work environment may have constrained some participants. Stresses the importance of the emotional component of communication and how it is recognised to facilitate effective working relationships and support staff coping with change and heavy workloads in health-care organizations.

  5. Health Effects and Costs of Colorectal Cancer Screening

    NARCIS (Netherlands)

    J.A. Wilschut (Janneke)

    2012-01-01

    textabstractColorectal cancer (CRC) is a major public health problem, with over a million newly diagnosed cases per year worldwide. CRC occurs especially frequently in established market economies like Europe, the United States (US), Canada, Australia and Japan. The lifetime incidence in average

  6. Cost recovery of NGO primary health care facilities: a case study in Bangladesh

    Directory of Open Access Journals (Sweden)

    Alam Khurshid

    2010-06-01

    Full Text Available Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC, a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG targets the financial sustainability of such facilities is crucial. Methods The study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value. Sensitivity analysis was done using 3% discount rate. Results The cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient. Conclusion The cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase

  7. The effects of built environment attributes on physical activity-related health and health care costs outcomes in Australia.

    Science.gov (United States)

    Zapata-Diomedi, Belen; Herrera, Ana Maria Mantilla; Veerman, J Lennert

    2016-11-01

    Attributes of the built environment can positively influence physical activity of urban populations, which results in health and economic benefits. In this study, we derived scenarios from the literature for the association built environment-physical activity and used a mathematical model to translate improvements in physical activity to health-adjusted life years and health care costs. We modelled 28 scenarios representing a diverse range of built environment attributes including density, diversity of land use, availability of destinations, distance to transit, design and neighbourhood walkability. Our results indicated potential health gains in 24 of the 28 modelled built environment attributes. Health care cost savings due to prevented physical activity-related diseases ranged between A$1300 to A$105,355 per 100,000 adults per year. On the other hand, additional health care costs of prolonged life years attributable to improvements in physical activity were nearly 50% higher than the estimated health care costs savings. Our results give an indication of the potential health benefits of investing in physical activity-friendly built environments. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Impact of Chronic Diseases and Multimorbidity on Health and Health Care Costs: The Additional Role of Musculoskeletal Disorders

    NARCIS (Netherlands)

    Zee-Neuen, A. van der; Putrik, P.; Ramiro, S.; Keszei, A.; Bie, R. de; Chorus, A.; Boonen, A.

    2016-01-01

    Objective: Chronic diseases are increasingly prevalent and often occur as multimorbidity. This study compares the impact of musculoskeletal disorders (MSKDs) on health and health care costs with other chronic diseases, and assesses the additional impact of MSKDs on these outcomes when occurring as

  9. Effects of worksite health interventions involving reduced work hours and physical exercise on sickness absence costs.

    Science.gov (United States)

    von Thiele Schwarz, Ulrica; Hasson, Henna

    2012-05-01

    To investigate the effects of physical exercise during work hours (PE) and reduced work hours (RWH) on direct and indirect costs associated with sickness absence (SA). Sickness absence and related costs at six workplaces, matched and randomized to three conditions (PE, RWH, and referents), were retrieved from company records and/or estimated using salary conversion methods or value-added equations on the basis of interview data. Although SA days decreased in all conditions (PE, 11.4%; RWH, 4.9%; referents, 15.9%), costs were reduced in the PE (22.2%) and RWH (4.9%) conditions but not among referents (10.2% increase). Worksite health interventions may generate savings in SA costs. Costs may not be linear to changes in SA days. Combing the friction method with indirect cost estimates on the basis of value-added productivity may help illuminate both direct and indirect SA costs.

  10. Cost-effectiveness thresholds in health care: a bookshelf guide to their meaning and use.

    Science.gov (United States)

    Culyer, Anthony J

    2016-10-01

    There is misunderstanding about both the meaning and the role of cost-effectiveness thresholds in policy decision making. This article dissects the main issues by use of a bookshelf metaphor. Its main conclusions are as follows: it must be possible to compare interventions in terms of their impact on a common measure of health; mere effectiveness is not a persuasive case for inclusion in public insurance plans; public health advocates need to address issues of relative effectiveness; a 'first best' benchmark or threshold ratio of health gain to expenditure identifies the least effective intervention that should be included in a public insurance plan; the reciprocal of this ratio - the 'first best' cost-effectiveness threshold - will rise or fall as the health budget rises or falls (ceteris paribus); setting thresholds too high or too low costs lives; failure to set any cost-effectiveness threshold at all also involves avertable deaths and morbidity; the threshold cannot be set independently of the health budget; the threshold can be approached from either the demand side or the supply side - the two are equivalent only in a health-maximising equilibrium; the supply-side approach generates an estimate of a 'second best' cost-effectiveness threshold that is higher than the 'first best'; the second best threshold is the one generally to be preferred in decisions about adding or subtracting interventions in an established public insurance package; multiple thresholds are implied by systems having distinct and separable health budgets; disinvestment involves eliminating effective technologies from the insured bundle; differential weighting of beneficiaries' health gains may affect the threshold; anonymity and identity are factors that may affect the interpretation of the threshold; the true opportunity cost of health care in a community, where the effectiveness of interventions is determined by their impact on health, is not to be measured in money - but in health

  11. Cheaper fuel and higher health costs among the poor in rural Nepal

    Energy Technology Data Exchange (ETDEWEB)

    Pant, Krishna Prasad [Ministry of Agriculture and Cooperatives, Vidhya Lane, Devnagar, Kathmandu (Nepal)], email: kppant@yahoo.com

    2012-03-15

    Biomass fuels are used by the majority of resource poor households in low-income countries. Though biomass fuels, such as dung-briquette and firewood are apparently cheaper than the modern fuels indoor pollution from burning biomass fuels incurs high health costs. But, the health costs of these conventional fuels, mostly being indirect, are poorly understood. To address this gap, this study develops probit regression models using survey data generated through interviews from households using either dung-briquette or biogas as the primary source of fuel for cooking. The study investigates factors affecting the use of dung-briquette, assesses its impact on human health, and estimates the associated household health costs. Analysis suggests significant effects of dung-briquette on asthma and eye diseases. Despite of the perception of it being a cheap fuel, the annual health cost per household due to burning dung-briquette (US$ 16.94) is 61.3% higher than the annual cost of biogas (US$ 10.38), an alternative cleaner fuel for rural households. For reducing the use of dung-briquette and its indirect health costs, the study recommends three interventions: (1) educate women and aboriginal people, in particular, and make them aware of the benefits of switching to biogas; (2) facilitate tree planting in communal as well as private lands; and (3) create rural employment and income generation opportunities.

  12. 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.

  13. Depression in working adults: comparing the costs and health outcomes of working when ill.

    Directory of Open Access Journals (Sweden)

    Fiona Cocker

    Full Text Available Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill ("presenteeism" amongst employed Australians reporting lifetime major depression.Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs, captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar.Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism. However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover, and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only.Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to

  14. Depression in working adults: comparing the costs and health outcomes of working when ill.

    Science.gov (United States)

    Cocker, Fiona; Nicholson, Jan M; Graves, Nicholas; Oldenburg, Brian; Palmer, Andrew J; Martin, Angela; Scott, Jenn; Venn, Alison; Sanderson, Kristy

    2014-01-01

    Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill ("presenteeism") amongst employed Australians reporting lifetime major depression. Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs), captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar). Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism). However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover), and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only. Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to continue

  15. Effects of employer-sponsored health insurance costs on Social Security taxable wages.

    Science.gov (United States)

    Burtless, Gary; Milusheva, Sveta

    2013-01-01

    The increasing cost of employer contributions for employee health insurance reduces the share of compensation subject to the Social Security payroll tax. Rising insurance contributions can also have a more subtle effect on the Social Security tax base because they influence the distribution of money wages above and below the taxable maximum amount. This article uses the Medical Expenditure Panel Survey to analyze trends in employer health insurance contributions and the distribution of those costs up and down the wage distribution. Our analysis shows that employer health insurance contributions increased faster than overall compensation during 1996-2008, but such contributions grew only slightly faster among workers earning less than the taxable maximum than they did among those earning more. Because employer health insurance contributions represent a much higher percentage of compensation below the taxable maximum, health insurance cost trends exerted a disproportionate downward pressure on money wages below the taxable maximum.

  16. The health regionalization process from the perspective of the transation cost theory.

    Science.gov (United States)

    Sancho, Leyla Gomes; Geremia, Daniela Savi; Dain, Sulamis; Geremia, Fabiano; Leão, Cláudio José Silva

    2017-04-01

    This study analyzes the incidence of transaction costs in the regionalization process of health policies in the Brazilian federal system. In this work, regionalized health actions contracted and agreed between federal agencies have assumed a transactional nature. A conceptual theoretical essay of reflective nature was prepared with the purpose of questioning and proposing new approaches to improve the health regionalization process. The main considerations suggest that institutional management tools proposed by the standards and regulations of the Unified Health System have a low potential to reduce transaction costs, especially due to hardships in reconciling common goals among the entities, environment surrounded by uncertainty, asymmetries and incomplete information, bounded rationality and conflict of interest. However, regionalization can reduce the incidence of social and/or operational costs, through improved access to health and the construction of more efficient governance models.

  17. Cost-effectiveness analysis: adding value to assessment of animal health welfare and production.

    Science.gov (United States)

    Babo Martins, S; Rushton, J

    2014-12-01

    Cost-effectiveness analysis (CEA) has been extensively used in economic assessments in fields related to animal health, namely in human health where it provides a decision-making framework for choices about the allocation of healthcare resources. Conversely, in animal health, cost-benefit analysis has been the preferred tool for economic analysis. In this paper, the use of CEA in related areas and the role of this technique in assessments of animal health, welfare and production are reviewed. Cost-effectiveness analysis can add further value to these assessments, particularly in programmes targeting animal welfare or animal diseases with an impact on human health, where outcomes are best valued in natural effects rather than in monetary units. Importantly, CEA can be performed during programme implementation stages to assess alternative courses of action in real time.

  18. Cost analysis of consolidated federally provided health care

    Science.gov (United States)

    2017-06-01

    Government Accountability Office JIT just-in time KPO Kaizen promotion offices LT lead time MHS Military Health System MRI magnetic resonance...a hospital that is only large enough for one MRI unit may need to hold it idle much of the time to permit emergency testing; whereas, a hospital...Center San Diego and San Diego VA hospital both provide outpatient pharmaceutical services. Duplication and redundancy of operating two separate

  19. Health care utilization and cost among children with asthma who were enrolled in a health maintenance organization.

    Science.gov (United States)

    Lozano, P; Fishman, P; VonKorff, M; Hecht, J

    1997-06-01

    To measure the impact of asthma on the use and cost of health care by children in a managed care organization. Population-based historical cohort study. A medium-sized staff model health maintenance organization in western Washington state. All 71 818 children, between age 1 to 17 years, who were enrolled and used services during 1992. Children were identified with one or more asthma diagnoses during 1992 using automated encounter data. Nonurgent outpatient visits, pharmacy fills, urgent care visits, and hospital days, as well as associated costs were measured. All services were categorized as asthma care or nonasthma care. Multivariate regression analysis was used to compute marginal cost for asthma (difference in total cost between children with asthma and other children using services, adjusted for covariates). Treated prevalence of asthma was 4.9%. Children with asthma incurred 88% more costs ($1060.32 vs $563. 81/yr), filled 2.77 times as many prescriptions (11.59 vs 4.19/yr), made 65% more nonurgent outpatient visits (5.75 vs 3.48/yr), and had twice as many inpatient days (.23 vs .11/yr) compared with the general population of children using services. Asthma care represented 37% of all health care received by children with asthma, while the remaining 63% were for nonasthma services. Almost two-thirds of asthma-related costs were attributable to nonurgent outpatient care and prescriptions; only one third was attributable to urgent care and hospitalizations. Controlling for age, sex, and comorbidities, the marginal cost of asthma was $615.17/yr (95% confidence interval $502.73, $727.61), which includes asthma as well as nonasthma services. This marginal cost represents 58% of all health care costs for children with asthma. Children with asthma use significantly more health services (and incur significantly more costs) than other children using services, attributable largely to asthma care. The majority of all health care costs for children with asthma were for

  20. Price and utilization: why we must target both to curb health care costs.

    Science.gov (United States)

    Spiro, Topher; Lee, Emily Oshima; Emanuel, Ezekiel J

    2012-10-16

    The United States spends nearly $8000 per person on health care annually. Even for a wealthy country, this amount is substantially more than would be expected and 2.5 times the average spent by other Organization for Economic Cooperation and Development (OECD) countries. The growth rate of health care spending in the United States has also far outpaced that in all other high-income OECD countries since 1970, even accounting for population growth. This increase in health spending threatens to squeeze out critical investments in education and infrastructure. To successfully develop and implement policies that effectively address both the level and growth of U.S. health care costs, it is critical to first understand cost drivers. Many health policy and economics scholars have contributed to an ongoing debate on whether to blame high prices or high utilization of services for escalating health care spending in the United States. This paper argues that price and volume both contribute to high and increasing health care costs, along with high administrative costs, supply issues, and the fee-for-service payment system. Initial strategies to contain costs might include implementation and expansion of bundled payment systems and competitive bidding.

  1. Health co-benefits from air pollution and mitigation costs of the Paris Agreement: a modelling study.

    Science.gov (United States)

    Markandya, Anil; Sampedro, Jon; Smith, Steven J; Van Dingenen, Rita; Pizarro-Irizar, Cristina; Arto, Iñaki; González-Eguino, Mikel

    2018-03-01

    Although the co-benefits from addressing problems related to both climate change and air pollution have been recognised, there is not much evidence comparing the mitigation costs and economic benefits of air pollution reduction for alternative approaches to meeting greenhouse gas targets. We analysed the extent to which health co-benefits would compensate the mitigation cost of achieving the targets of the Paris climate agreement (2°C and 1·5°C) under different scenarios in which the emissions abatement effort is shared between countries in accordance with three established equity criteria. Our study had three stages. First, we used an integrated assessment model, the Global Change Assessment Model (GCAM), to investigate the emission (greenhouse gases and air pollutants) pathways and abatement costs of a set of scenarios with varying temperature objectives (nationally determined contributions, 2°C, or 1·5°C) and approaches to the distribution of climate change methods (capability, constant emission ratios, and equal per capita). The resulting emissions pathways were transferred to an air quality model (TM5-FASST) to estimate the concentrations of particulate matter and ozone in the atmosphere and the resulting associated premature deaths and morbidity. We then applied a monetary value to these health impacts by use of a term called the value of statistical life and compared these values with those of the mitigation costs calculated from GCAM, both globally and regionally. Our analysis looked forward to 2050 in accordance with the socioeconomic narrative Shared Socioeconomic Pathways 2. The health co-benefits substantially outweighed the policy cost of achieving the target for all of the scenarios that we analysed. In some of the mitigation strategies, the median co-benefits were double the median costs at a global level. The ratio of health co-benefit to mitigation cost ranged from 1·4 to 2·45, depending on the scenario. At the regional level, the costs of

  2. Economic context analysis in mental health care. Usability of health financing and cost of illness studies for international comparisons.

    Science.gov (United States)

    Salvador-Carulla, L; Hernández-Peña, P

    2011-03-01

    This paper discusses an integrated approach to mental health studies on Financing of Illness (FoI) and health accounting, Cost of Illness (CoI) and Burden of Disease (BoD). In order to expand the mental health policies, the following are suggested: (a) an international consensus on the standard scope, methods to collect and to analyse mental health data, as well as to report comparative information; (b) mathematical models are also to be validated and tested in an integrated approach, (c) a better knowledge transfer between clinicians and knowledge engineers, and between researchers and policy makers to translate economic analysis into practice and health planning.

  3. Tax-Assisted Approaches for Helping Canadians Meet Out-of-Pocket Health-Care Costs

    Directory of Open Access Journals (Sweden)

    J.C. Herbert Emery

    2016-06-01

    Full Text Available Canadians are not saving for the inevitable costs of drugs and long-term care which they will have to pay for out of pocket in their old age, and these costs could potentially be financially devastating for them. Later in life, when out-of-pocket health-care costs mount, those who previously enjoyed the security of a workplace insurance plan to cover such expenses will face a grim financial reality. Many aspects of care for older Canadians aren’t covered by this country’s single-payer health-care system. Besides prescription drugs, these include management of chronic conditions by ancillary health professionals, home care, long-term care, and dental and vision care. Statistics show that in 2012, Canadians’ private spending on health care totaled $60 billion, with private health insurance covering $24.5 billion of that amount. Coverage of health-care costs that don’t fall under Medicare’s purview is at present rather piecemeal. The non-refundable federal Medical Expense Tax Credit covers expenses only after the three-per-cent minimum, or first $2,171, of out-of-pocket costs have been paid by the individual. The Disability Tax Credit is available to those with a certified chronic disability, and these individuals are eligible for further support via the Registered Disability Savings Plan. A Caregiver Tax Credit is also available. The federal government has a golden opportunity to provide an incentive for Canadians to set aside money to pay not only for the often catastrophic medical and drug costs that can come with aging, but also to save so they can afford long-term care, or purchase private health insurance. Too many Canadians, unfortunately, believe that the federal government picks up the tab for long-term care. In fact, provincial subsidies are provided on a means-testing basis, thus leaving many better-off Canadians in the lurch when they can no longer live alone and must make the transition to long-term care. Providing more

  4. Quality-adjusted cost of care: a meaningful way to measure growth in innovation cost versus the value of health gains.

    Science.gov (United States)

    Lakdawalla, Darius; Shafrin, Jason; Lucarelli, Claudio; Nicholson, Sean; Khan, Zeba M; Philipson, Tomas J

    2015-04-01

    Technology drives both health care spending and health improvement. Yet policy makers rarely see measures of cost growth that account for both effects. To fill this gap, we present the quality-adjusted cost of care, which illustrates cost growth net of growth in the value of health improvements, measured as survival gains multiplied by the value of survival. We applied the quality-adjusted cost of care to two cases. For colorectal cancer, drug cost per patient increased by $34,493 between 1998 and 2005 as a result of new drug launches, but value from offsetting health improvements netted a modest $1,377 increase in quality-adjusted cost of care. For multiple myeloma, new therapies increased treatment cost by $72,937 between 2004 and 2009, but offsetting health benefits lowered overall quality-adjusted cost of care by $67,863. However, patients with multiple myeloma on established first-line therapies saw costs rise without corresponding benefits. All three examples document rapid cost growth, but they provide starkly different answers to the question of whether society got what it paid for. Project HOPE—The People-to-People Health Foundation, Inc.

  5. Health Risk Assessment and DNA Damage of Volatile Organic Compounds in Car Painting Houses

    Directory of Open Access Journals (Sweden)

    Patpida Siripongpokin

    2014-06-01

    Full Text Available Car painters who work near volatile organic compounds (VOCs sources, including paints, solvents and painting processes may be exposed to highly elevated VOCs levels. This study investigates air samples from car painting houses in Thailand to evaluate the health risks following inhalation exposure. Personal air samplings were obtained at nine garages in Phitsanulok, Thailand from June to September 2012. The concentrations of benzene, toluene, ethylbenzene, xylenes, and styrene in the air workplaces were significantly higher than in a control group of office workers (p < 0.05. Toluene, xylene and ethylbenzene were the most abundant species. However, all VOCs in these air samples were lower than TWA limit of Thailand and the OSHA standard. The lifetime cancer and non-cancer risks for the workers exposed to VOCs were also assessed. The average lifetime cancer risk was 41.0 (38.2-47.2 per million, which is in the acceptable risk. The average lifetime non-cancer risk, the HI, was 0.962 (0.643-1.397, which is well below the reference hazard level. Urine samples, collected after 8-h work periods which were analyzed for VOCs metabolites, including t,t muconic acid, hippuric acid, mandelic acid and m-hippuric acid, demonstrate that the average levels of metabolites in car painters and in controls were close. All VOCs metabolites in urine samples were lower than BEI of ACGIH standard. Blood samples, collected after 8-h work periods which were analyzed by single cell gel electrophoresis (comet assay. The DNA damage, assessed by tail moment, demonstrates that the average of tail moment in car painters were significantly higher than in the controls (p < 0.05.

  6. Health and economic costs of alternative energy sources

    Energy Technology Data Exchange (ETDEWEB)

    Hamilton, L D [Biomedical and Environmental Assessment Division, National Center for Analysis of Energy Systems, Brookhaven National Laboratory (United States); Manne, A S [Department of Operations Research, Stanford University (United States)

    1978-08-15

    Before the United States of America can arrive at a coherent national energy policy, several ongoing debates must be resolved - on environmental hazards, health impacts, and the direct economic consequences of alternative future energy options. No one strategy is obviously correct - or uniquely ethical. Each strategy has its drawbacks, each can be blocked by one or another coalition of interest groups. The public is poorly informed by the media. A single large coal-mine accident is far more extensively reported than a long series of isolated accidents at grade crossings for coal trains, and yet the latter causes more deaths each year. Similarly, the public debate on nuclear issues is focused on low-probability, high-consequence events. It is as though national policy were being framed by a gambler whose motto is 'it's only the stakes and not the odds that matter'. The two authors of this paper come from different disciplines, yet they both believe that the odds do matter. It is essential that the public be well informed about the health risks and the economic consequences of a moratorium on the civilian uses of nuclear energy in the USA. We think that such a moratorium would adversely affect health and the economy. These impacts although small in relation, say, to the overall death rate or to the overall gross national product are not small in an absolute sense The adverse consequences of a moratorium are much more certain, and surely outweigh the impacts of any plausible accident associated with the operation of power reactors.

  7. Health and economic costs of alternative energy sources

    International Nuclear Information System (INIS)

    Hamilton, L.D.; Manne, A.S.

    1978-01-01

    Before the United States of America can arrive at a coherent national energy policy, several ongoing debates must be resolved - on environmental hazards, health impacts, and the direct economic consequences of alternative future energy options. No one strategy is obviously correct - or uniquely ethical. Each strategy has its drawbacks, each can be blocked by one or another coalition of interest groups. The public is poorly informed by the media. A single large coal-mine accident is far more extensively reported than a long series of isolated accidents at grade crossings for coal trains, and yet the latter causes more deaths each year. Similarly, the public debate on nuclear issues is focused on low-probability, high-consequence events. It is as though national policy were being framed by a gambler whose motto is 'it's only the stakes and not the odds that matter'. The two authors of this paper come from different disciplines, yet they both believe that the odds do matter. It is essential that the public be well informed about the health risks and the economic consequences of a moratorium on the civilian uses of nuclear energy in the USA. We think that such a moratorium would adversely affect health and the economy. These impacts although small in relation, say, to the overall death rate or to the overall gross national product are not small in an absolute sense The adverse consequences of a moratorium are much more certain, and surely outweigh the impacts of any plausible accident associated with the operation of power reactors

  8. Can naturopathy provide answers to the escalating health care costs in India?

    Directory of Open Access Journals (Sweden)

    Jaya Prasad Tripathy

    2015-04-01

    Full Text Available There are substantial areas of overlap between naturopathy and public health, which include a focus on health rather than disease, a preventive approach, and an emphasis on health promotion and health education. Public health can look to naturopathy for answers to the emergence of chronic disease through natural therapies, many of which can take the role of primordial and primary prevention of several diseases. Some selected naturopathic therapies include nutrition, hydrotherapy, fasting therapy, yoga, behavioral therapy, and health promotion. We must reorient our focus on prevention and wellness to make a true impact on escalating health care costs. With the National Health Policy in India emphasizing the need for integrating the Indian Systems of Medicines with modern medicine, now is the right time for naturopathy and public health to come together to provide a holistic health care system.

  9. Health insurance coverage and its impact on medical cost: observations from the floating population in China.

    Directory of Open Access Journals (Sweden)

    Yinjun Zhao

    Full Text Available China has the world's largest floating (migrant population, which has characteristics largely different from the rest of the population. Our goal is to study health insurance coverage and its impact on medical cost for this population.A telephone survey was conducted in 2012. 644 subjects were surveyed. Univariate and multivariate analysis were conducted on insurance coverage and medical cost.82.2% of the surveyed subjects were covered by basic insurance at hometowns with hukou or at residences. Subjects' characteristics including age, education, occupation, and presence of chronic diseases were associated with insurance coverage. After controlling for confounders, insurance coverage was not significantly associated with gross or out-of-pocket medical cost.For the floating population, health insurance coverage needs to be improved. Policy interventions are needed so that health insurance can have a more effective protective effect on cost.

  10. Health Insurance Coverage and Its Impact on Medical Cost: Observations from the Floating Population in China

    Science.gov (United States)

    Zhao, Yinjun; Kang, Bowei; Liu, Yawen; Li, Yichong; Shi, Guoqing; Shen, Tao; Jiang, Yong; Zhang, Mei; Zhou, Maigeng; Wang, Limin

    2014-01-01

    Background China has the world's largest floating (migrant) population, which has characteristics largely different from the rest of the population. Our goal is to study health insurance coverage and its impact on medical cost for this population. Methods A telephone survey was conducted in 2012. 644 subjects were surveyed. Univariate and multivariate analysis were conducted on insurance coverage and medical cost. Results 82.2% of the surveyed subjects were covered by basic insurance at hometowns with hukou or at residences. Subjects' characteristics including age, education, occupation, and presence of chronic diseases were associated with insurance coverage. After controlling for confounders, insurance coverage was not significantly associated with gross or out-of-pocket medical cost. Conclusion For the floating population, health insurance coverage needs to be improved. Policy interventions are needed so that health insurance can have a more effective protective effect on cost. PMID:25386914

  11. A study of two unsupervised data driven statistical methodologies for detecting and classifying damages in structural health monitoring

    Science.gov (United States)

    Tibaduiza, D.-A.; Torres-Arredondo, M.-A.; Mujica, L. E.; Rodellar, J.; Fritzen, C.-P.

    2013-12-01

    This article is concerned with the practical use of Multiway Principal Component Analysis (MPCA), Discrete Wavelet Transform (DWT), Squared Prediction Error (SPE) measures and Self-Organizing Maps (SOM) to detect and classify damages in mechanical structures. The formalism is based on a distributed piezoelectric active sensor network for the excitation and detection of structural dynamic responses. Statistical models are built using PCA when the structure is known to be healthy either directly from the dynamic responses or from wavelet coefficients at different scales representing Time-frequency information. Different damages on the tested structures are simulated by adding masses at different positions. The data from the structure in different states (damaged or not) are then projected into the different principal component models by each actuator in order to obtain the input feature vectors for a SOM from the scores and the SPE measures. An aircraft fuselage from an Airbus A320 and a multi-layered carbon fiber reinforced plastic (CFRP) plate are used as examples to test the approaches. Results are presented, compared and discussed in order to determine their potential in structural health monitoring. These results showed that all the simulated damages were detectable and the selected features proved capable of separating all damage conditions from the undamaged state for both approaches.

  12. Low-Cost, Distributed Environmental Monitors for Factory Worker Health

    Directory of Open Access Journals (Sweden)

    Geb W. Thomas

    2018-05-01

    Full Text Available An integrated network of environmental monitors was developed to continuously measure several airborne hazards in a manufacturing facility. The monitors integrated low-cost sensors to measure particulate matter, carbon monoxide, ozone and nitrogen dioxide, noise, temperature and humidity. The monitors were developed and tested in situ for three months in several overlapping deployments, before a full cohort of 40 was deployed in a heavy vehicle manufacturing facility for a year of data collection. The monitors collect data from each sensor and report them to a central database every 5 min. The work includes an experimental validation of the particle, gas and noise monitors. The R2 for the particle sensor ranges between 0.98 and 0.99 for particle mass densities up to 300 μg/m3. The R2 for the carbon monoxide sensor is 0.99 for concentrations up to 15 ppm. The R2 for the oxidizing gas sensor is 0.98 over the sensitive range from 20 to 180 ppb. The noise monitor is precise within 1% between 65 and 95 dBA. This work demonstrates the capability of distributed monitoring as a means to examine exposure variability in both space and time, building an important preliminary step towards a new approach for workplace hazard monitoring.

  13. Costs of Maternal Health-related Complications in Bangladesh

    Science.gov (United States)

    Powell-Jackson, Timothy; Dasgupta, Sushil Kanta; Chowdhury, Mahbub Elahi; Koblinsky, Marge

    2012-01-01

    This paper assesses both out-of-pocket payments for healthcare and losses of productivity over six months postpartum among women who gave birth in Matlab, Bangladesh. The hypothesis of the study objective is that obstetric morbidity leads women to seek care at which time out-of-pocket expenditure is incurred. Second, a woman may also take time out from employment or from doing her household chores. This loss of resources places a financial burden on the household that may lead to reduced consumption of usual but less important goods and use of other services depending on the extent to which a household copes up by using savings, taking loans, and selling assets. Women were divided into three groups based on their morbidity patterns: (a) women with a severe obstetric complication (n=92); (b) women with a less-severe obstetric complication (n=127); and (c) women with a normal delivery (n=483). Data were collected from households of these women at two time-points—at six weeks and six months after delivery. The results showed that maternal morbidity led to a considerable loss of resources up to six weeks postpartum, with the greatest financial burden of cost of healthcare among the poorest households. However, families coped up with loss of resources by taking loans and selling assets, and by the end of six months postpartum, the households had paid back more than 40% of the loans. PMID:22838162

  14. Energy drinks: Getting wings but at what health cost?

    Science.gov (United States)

    Ibrahim, Nahla Khamis; Iftikhar, Rahila

    2014-01-01

    Energy drink consumption represents a global public health problem, especially among adolescents and young adults. The consumption of energy drinks has seen a substantial increase during the past few decades, especially in the Western and Asian countries. Although manufacturers of energy drinks claim that these beverages are beneficial in that they can boost energy, physical performance, and improve cognitive performance, there is insufficient scientific evidence to support these claims. The known and unknown pharmacology of the constituents of energy drinks, supplemented with reports of toxicity, raise concern for the potentially severe adverse events linked with energy drink use. Limited numbers of reviews have been published on this important subject..The aim of this review was to identify the major ingredients in energy drinks and to delineate the adverse effects related to their consumption. Electronic databases of PubMed, Clinical Key, and Google and Cochrane library were extensively searched for energy drink articles. More than hundred articles were reviewed, scrutinized and critically appraised and the most relevant forty articles were used Conclusion: Energy drinks & its ingredients are potentially dangerous to many aspects of health. Measures should be taken to improve awareness among adolescents and their parents regarding the potential hazards of energy drinks. Furthermore, the sale of energy drinks on college and university campuses and to adolescents below 16 years should be prohibited.

  15. [Self-owned versus accredited network: comparative cost analysis in a Brazilian health insurance provider].

    Science.gov (United States)

    Souza, Marcos Antônio de; Salvalaio, Dalva

    2010-10-01

    to analyze the cost of a self-owned network maintained by a Brazilian health insurance provider as compared to the price charged by accredited service providers, so as to identify whether or not the self-owned network is economically advantageous. for this exploratory study, the company's management reports were reviewed. The cost associated with the self-owned network was calculated based on medical and dental office visits and diagnostic/laboratory tests performed at one of the company's most representative facilities. The costs associated with third parties were derived from price tables used by the accredited network for the same services analyzed in the self-owned network. The full-cost method was used for cost quantification. Costs are presented as absolute values (in R$) and percent comparisons between self-owned network costs versus accredited network costs. overall, the self-owned network was advantageous for medical and dental consultations as well as diagnostic and laboratory tests. Pediatric and labor medicine consultations and x-rays were less costly in the accredited network. the choice of verticalization has economic advantages for the health care insurance operator in comparison with services provided by third parties.

  16. 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

  17. Examining the Influence of Cost Concern and Awareness of Low-cost Health Care on Cancer Screening among the Medically Underserved.

    Science.gov (United States)

    Best, Alicia L; Strane, Alcha; Christie, Omari; Bynum, Shalanda; Wiltshire, Jaqueline

    2017-01-01

    African Americans suffer a greater burden of mortality from breast, cervical, and colorectal cancers than other groups in the United States. Early detection through timely screening can improve survival outcomes; however, cost is frequently reported as a barrier to screening. Federally qualified health centers (FQHCs) provide preventive and primary care to underserved populations regardless of ability to pay, positioning them to improve cancer screening rates. The purpose of this study was to examine the influence of concern about health care cost (cost concern) and awareness of low-cost health care (awareness) on cancer screening among 236 African Americans within an FQHC service area using self-report surveys. Multiple logistic regression indicated that awareness was positively associated with cervical and colorectal cancer screening, while cost concern was negatively associated with mammography screening. Results indicate that improving awareness and understanding of low-cost health care could increase cancer screening among underserved African Americans.

  18. Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh

    Science.gov (United States)

    Ao, Trong T.; Rahman, Mahmudur; Haque, Farhana; Chakraborty, Apurba; Hossain, M. Jahangir; Haider, Sabbir; Alamgir, A.S.M.; Sobel, Jeremy; Luby, Stephen P.

    2016-01-01

    We assessed a media-based public health surveillance system in Bangladesh during 2010–2011. The system is a highly effective, low-cost, locally appropriate, and sustainable outbreak detection tool that could be used in other low-income, resource-poor settings to meet the capacity for surveillance outlined in the International Health Regulations 2005. PMID:26981877

  19. Health Services Use and Costs for Americans with Intellectual and Developmental Disabilities: A National Analysis

    Science.gov (United States)

    Fujiura, Glenn T.; Li, Henan; Magaña, Sandy

    2018-01-01

    Health services and associated costs for adults with intellectual and developmental disabilities (IDD) were nationally profiled and the predictors of high expense users statistically modeled. Using linked data from the National Health Interview Survey and Medical Expenditure Panel Survey for the years 2002 through 2011, the study found a mixed…

  20. Impact of cost sharing on utilization of primary health care Services ...

    African Journals Online (AJOL)

    impact of cost sharing on health-care utilization as viewed from both the providers and beneficiary ... Policy reform for user fees in public health care in poor countries was derived ..... 10,000 (equivalent to US$ 6.25) annually. In return, one gets.

  1. From intermediate to final behavioral endpoints : Modeling cognitions in (cost-)effectiveness analyses in health promotion

    NARCIS (Netherlands)

    Prenger, Hendrikje Cornelia

    2012-01-01

    Cost-effectiveness analyses (CEAs) are considered an increasingly important tool in health promotion and psychology. In health promotion adequate effectiveness data of innovative interventions are often lacking. In case of many promising interventions the available data are inadequate for CEAs due

  2. Cost-effectiveness analysis for sector-wide priority setting in health

    NARCIS (Netherlands)

    R.C.W. Hutubessy (Raymond)

    2003-01-01

    textabstractCost-effectiveness analysis (CEA) provides one means by which decision-makers may assess and potentially improve the performance of health systems. The process can help to ensure that resources devoted to health systems are achieving the maximum possible benefit in terms of outcomes

  3. Estimating the cost of accidents and ill-health at work : a review of methodologies

    NARCIS (Netherlands)

    Weerd, M. de; Tierney, R.; Duuren-Stuurman, B. van; Bertranou, E.

    2014-01-01

    What is the real price to pay for not investing in occupational safety and health? Many studies have previously tackled this question by evaluating the costs of poor or non-existent safety and health at work. This report reviews a selection of these studies and analyses the estimating methods used

  4. Cost of delivering secondary-level health care services through public sector district hospitals in India

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    2017-01-01

    Interpretation & conclusions: The estimates obtained in our study can be used for Fiscal planning of scaling up secondary-level health services. Further, these may be particularly useful for future research such as benefit-incidence analysis, cost-effectiveness analysis and national health accounts including disease-specific accounts in India.

  5. Predicting the economic costs and property value losses attributed to sudden oak death damage in California (2010-2020)

    Science.gov (United States)

    Kent Kovacs; Tomas Václavík; Robert G. Haight; Arwin Pang; Nik J. Cunniffe; Christopher A. Gilligan; Ross K. Meentemeyer

    2011-01-01

    Phytophthora ramorum, cause of sudden oak death, is a quarantined, non-native, invasive forest pathogen resulting in substantial mortality in coastal live oak (Quercus agrifolia) and several other related tree species on the Pacific Coast of the United States. We estimate the discounted cost of oak treatment, removal, and...

  6. Promoting mental health recovery after hurricanes Katrina and Rita: what can be done at what cost.

    Science.gov (United States)

    Schoenbaum, Michael; Butler, Brittany; Kataoka, Sheryl; Norquist, Grayson; Springgate, Benjamin; Sullivan, Greer; Duan, Naihua; Kessler, Ronald C; Wells, Kenneth

    2009-08-01

    Concerns about mental health recovery persist after the 2005 Gulf storms. We propose a recovery model and estimate costs and outcomes. To estimate the costs and outcomes of enhanced mental health response to large-scale disasters using the 2005 Gulf storms as a case study. Decision analysis using state-transition Markov models for 6-month periods from 7 to 30 months after disasters. Simulated movements between health states were based on probabilities drawn from the clinical literature and expert input. A total of 117 counties/parishes across Louisiana, Mississippi, Alabama, and Texas that the Federal Emergency Management Agency designated as eligible for individual relief following hurricanes Katrina and Rita. Hypothetical cohort, based on the size and characteristics of the population affected by the Gulf storms. Intervention Enhanced mental health care consisting of evidence-based screening, assessment, treatment, and care coordination. Morbidity in 6-month episodes of mild/moderate or severe mental health problems through 30 months after the disasters; units of service (eg, office visits, prescriptions, hospital nights); intervention costs; and use of human resources. Full implementation would cost $1133 per capita, or more than $12.5 billion for the affected population, and yield 94.8% to 96.1% recovered by 30 months, but exceed available provider capacity. Partial implementation would lower costs and recovery proportionately. Evidence-based mental health response is feasible, but requires targeted resources, increased provider capacity, and advanced planning.

  7. Opportunities and challenges for implementing cost accounting systems in the Kenyan health system

    Directory of Open Access Journals (Sweden)

    Elesban Kihuba

    2016-06-01

    Full Text Available Background: Low- and middle-income countries need to sustain efficiency and equity in health financing on their way to universal health care coverage. However, systems meant to generate quality economic information are often deficient in such settings. We assessed the feasibility of streamlining cost accounting systems within the Kenyan health sector to illustrate the pragmatic challenges and opportunities. Design: We reviewed policy documents, and conducted field observations and semi-structured interviews with key informants in the health sector. We used an adapted Human, Organization and Technology fit (HOT-fit framework to analyze the components and standards of a cost accounting system. Results: Among the opportunities for a viable cost accounting system, we identified a supportive broad policy environment, political will, presence of a national data reporting architecture, good implementation experience with electronic medical records systems, and the availability of patient clinical and resource use data. However, several practical issues need to be considered in the design of the system, including the lack of a framework to guide the costing process, the lack of long-term investment, the lack of appropriate incentives for ground-level staff, and a risk of overburdening the current health management information system. Conclusion: To facilitate the implementation of cost accounting into the health sector, the design of any proposed system needs to remain simple and attuned to the local context.

  8. Opportunities and challenges for implementing cost accounting systems in the Kenyan health system

    Science.gov (United States)

    Kihuba, Elesban; Gheorghe, Adrian; Bozzani, Fiammetta; English, Mike; Griffiths, Ulla K.

    2016-01-01

    Background Low- and middle-income countries need to sustain efficiency and equity in health financing on their way to universal health care coverage. However, systems meant to generate quality economic information are often deficient in such settings. We assessed the feasibility of streamlining cost accounting systems within the Kenyan health sector to illustrate the pragmatic challenges and opportunities. Design We reviewed policy documents, and conducted field observations and semi-structured interviews with key informants in the health sector. We used an adapted Human, Organization and Technology fit (HOT-fit) framework to analyze the components and standards of a cost accounting system. Results Among the opportunities for a viable cost accounting system, we identified a supportive broad policy environment, political will, presence of a national data reporting architecture, good implementation experience with electronic medical records systems, and the availability of patient clinical and resource use data. However, several practical issues need to be considered in the design of the system, including the lack of a framework to guide the costing process, the lack of long-term investment, the lack of appropriate incentives for ground-level staff, and a risk of overburdening the current health management information system. Conclusion To facilitate the implementation of cost accounting into the health sector, the design of any proposed system needs to remain simple and attuned to the local context. PMID:27357072

  9. Opportunities and challenges for implementing cost accounting systems in the Kenyan health system.

    Science.gov (United States)

    Kihuba, Elesban; Gheorghe, Adrian; Bozzani, Fiammetta; English, Mike; Griffiths, Ulla K

    2016-01-01

    Low- and middle-income countries need to sustain efficiency and equity in health financing on their way to universal health care coverage. However, systems meant to generate quality economic information are often deficient in such settings. We assessed the feasibility of streamlining cost accounting systems within the Kenyan health sector to illustrate the pragmatic challenges and opportunities. We reviewed policy documents, and conducted field observations and semi-structured interviews with key informants in the health sector. We used an adapted Human, Organization and Technology fit (HOT-fit) framework to analyze the components and standards of a cost accounting system. Among the opportunities for a viable cost accounting system, we identified a supportive broad policy environment, political will, presence of a national data reporting architecture, good implementation experience with electronic medical records systems, and the availability of patient clinical and resource use data. However, several practical issues need to be considered in the design of the system, including the lack of a framework to guide the costing process, the lack of long-term investment, the lack of appropriate incentives for ground-level staff, and a risk of overburdening the current health management information system. To facilitate the implementation of cost accounting into the health sector, the design of any proposed system needs to remain simple and attuned to the local context.

  10. Health Care Costs, Utilization and Patterns of Care following Lyme Disease

    Science.gov (United States)

    Adrion, Emily R.; Aucott, John; Lemke, Klaus W.; Weiner, Jonathan P.

    2015-01-01

    Background Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome – a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States. Objectives 1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization. Methods This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. Results Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, pLyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, pLyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care costs and utilization. PMID:25650808

  11. Use of Linear Programming to Develop Cost-Minimized Nutritionally Adequate Health Promoting Food Baskets

    DEFF Research Database (Denmark)

    Parlesak, A.; Tetens, Inge; Dejgård Jensen, Jørgen

    2016-01-01

    Food-Based Dietary Guidelines (FBDGs) are developed to promote healthier eating patterns, but increasing food prices may make healthy eating less affordable. The aim of this study was to design a range of cost-minimized nutritionally adequate health-promoting food baskets (FBs) that help prevent...... both micronutrient inadequacy and diet-related non-communicable diseases at lowest cost. Average prices for 312 foods were collected within the Greater Copenhagen area. The cost and nutrient content of five different cost-minimized FBs for a family of four were calculated per day using linear...... in each of the resulting five baskets was increased through limiting the relative share of individual foods. The one-day version of N contained only 12 foods at the minimum cost of DKK 27 (€ 3.6). The CA, DG, and DGN were about twice of this and the CAN cost ~DKK 81 (€ 10.8). The baskets with the greater...

  12. Damage mapping in structural health monitoring using a multi-grid architecture

    Energy Technology Data Exchange (ETDEWEB)

    Mathews, V. John [Dept. of Electrical and Computer Engineering, University of Utah, Salt Lake City, UT 84112 (United States)

    2015-03-31

    This paper presents a multi-grid architecture for tomography-based damage mapping of composite aerospace structures. The system employs an array of piezo-electric transducers bonded on the structure. Each transducer may be used as an actuator as well as a sensor. The structure is excited sequentially using the actuators and the guided waves arriving at the sensors in response to the excitations are recorded for further analysis. The sensor signals are compared to their baseline counterparts and a damage index is computed for each actuator-sensor pair. These damage indices are then used as inputs to the tomographic reconstruction system. Preliminary damage maps are reconstructed on multiple coordinate grids defined on the structure. These grids are shifted versions of each other where the shift is a fraction of the spatial sampling interval associated with each grid. These preliminary damage maps are then combined to provide a reconstruction that is more robust to measurement noise in the sensor signals and the ill-conditioned problem formulation for single-grid algorithms. Experimental results on a composite structure with complexity that is representative of aerospace structures included in the paper demonstrate that for sufficiently high sensor densities, the algorithm of this paper is capable of providing damage detection and characterization with accuracy comparable to traditional C-scan and A-scan-based ultrasound non-destructive inspection systems quickly and without human supervision.

  13. Structural health monitoring using DOG multi-scale space: an approach for analyzing damage characteristics

    Science.gov (United States)

    Guo, Tian; Xu, Zili

    2018-03-01

    Measurement noise is inevitable in practice; thus, it is difficult to identify defects, cracks or damage in a structure while suppressing noise simultaneously. In this work, a novel method is introduced to detect multiple damage in noisy environments. Based on multi-scale space analysis for discrete signals, a method for extracting damage characteristics from the measured displacement mode shape is illustrated. Moreover, the proposed method incorporates a data fusion algorithm to further eliminate measurement noise-based interference. The effectiveness of the method is verified by numerical and experimental methods applied to different structural types. The results demonstrate that there are two advantages to the proposed method. First, damage features are extracted by the difference of the multi-scale representation; this step is taken such that the interference of noise amplification can be avoided. Second, a data fusion technique applied to the proposed method provides a global decision, which retains the damage features while maximally eliminating the uncertainty. Monte Carlo simulations are utilized to validate that the proposed method has a higher accuracy in damage detection.

  14. Long-term socioeconomic consequences and health care costs of childhood and adolescent-onset epilepsy

    DEFF Research Database (Denmark)

    Jennum, Poul; Christensen, Jakob; Ibsen, Rikke

    2016-01-01

    . Income was lower from employment, which in part was compensated by social security, sick pay, disability pension and unemployment benefit, sick pay (public-funded), disability pension, and other public transfers. Predicted health care costs 30 years after epilepsy onset were significantly higher among......Objective: To estimate long-term socioeconomic consequences and health care costs of epilepsy with onset in childhood and adolescence. Methods: A historical prospective cohort study of Danish individuals with epilepsy, age up to 20 years at time of diagnosis between January 1981 and December 2012....... Information about marital status, parenthood, educational level, employment status, income, use of the health care system, and cost of medicine was obtained from nationwide administrative and health registers. Results: We identified 12,756 and 28,319 people with diagnosed with epilepsy, ages 0–5 and 6...

  15. Health care costs matter: a review of nutrition economics – is there a role for nutritional support to reduce the cost of medical health care?

    Directory of Open Access Journals (Sweden)

    Naberhuis JK

    2017-08-01

    Full Text Available Jane K Naberhuis,1 Vivienne N Hunt,2 Jvawnna D Bell,3 Jamie S Partridge,3 Scott Goates,3 Mark JC Nuijten4 1Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA; 2Abbott Nutrition, Research and Development, Singapore; 3Abbott Nutrition, Research and Development, Columbus, OH, USA; 4A2M (Ars Accessus Medica, Amsterdam, The Netherlands Background and aims: As policy-makers assess the value of money spent on health care, research in the field of health economics is expanding rapidly. This review covers a period of 10 years and seeks to characterize the publication of papers at the intersection of health economics and nutrition. Methods: Relevant publications on nutrition care were identified in the medical literature databases using predetermined search criteria. These included nutritional interventions linked to health economic terms with inclusion criteria requiring original research that included clinical outcomes and cost analyses, subjects’ ages ≥18 years, and publications in English between January 2004 and October 2014. Results: Of the 5,646 publications identified in first-round searches, 274 met the specified inclusion criteria. The number of publications linking nutrition to economic outcomes has increased markedly over the 10-year period, with a growing number of studies in both developed and developing countries. Most studies were undertaken in Europe (39% and the USA and Canada (28%. The most common study setting was hospital (62% followed by community/noninstitutional care (30%. Of all the studies, 12% involved the use of oral nutritional supplements, and 13% involved parenteral nutrition. The economic outcomes consistently measured were medical care costs (53% of the studies, hospital length of stay (48%, hospital readmission rates (9%, and mortality (25%. Conclusion: The number of publications focused on the economics of nutrition interventions has increased dramatically in recent years

  16. Ovarian Damage during Chemotherapy in Autoimmune Diseases: Broad Health Implications beyond Fertility

    Directory of Open Access Journals (Sweden)

    Wendy Marder

    2012-01-01

    Full Text Available Women with autoimmune diseases such as lupus, scleroderma, and vasculitis receiving cyclophosphamide for severe disease manifestations risk primary ovarian insufficiency (POI due to gonadotoxicity of this therapy. In addition to loss of reproductive potential, POI is associated with increased risk of morbidity and mortality. Practitioners caring for women requiring gonadotoxic therapies should be familiar with long-term health implications of POI and strategies for ovarian preservation. Accumulating evidence supports the effectiveness of adjunctive gonadotropin releasing hormone analog (GnRH-a for ovarian protection during gonadotoxic therapy in cancer and autoimmune populations. GnRH-a is less costly and invasive than assisted reproductive technologies used for achievement of future pregnancies, but is not Food and Drug Administration approved for ovarian preservation. This review focuses on POI comorbidities and strategies for mitigation of related sequelae, which can accumulate over decades of hypoesteogenism. These issues are arguably more pronounced for women with chronic autoimmune diseases, in whom superimposed POI further heightens risks of cardiovascular disease and osteoporosis. Therefore, even if future pregnancy is not desired, ovarian protection during gonadotoxic therapy should be a major goal of disease management.

  17. Health-resource use and costs associated with fibromyalgia in France, Germany, and the United States

    Science.gov (United States)

    Knight, Tyler; Schaefer, Caroline; Chandran, Arthi; Zlateva, Gergana; Winkelmann, Andreas; Perrot, Serge

    2013-01-01

    Background Fibromyalgia (FM) is a chronic disorder characterized by widespread, persistent pain. Prospective and retrospective studies have demonstrated substantial health-care costs associated with FM in a number of countries. This study evaluated and compared health-resource use (HRU) and associated costs related to FM in routine clinical practice across the US, France, and Germany. Methods Two separate, cross-sectional, observational studies of subjects with FM were conducted: one in the US and one in France and Germany. HRU related to prescription medication, physician office visits, diagnostic tests, and hospitalizations was abstracted from chart review; patient out-of-pocket costs and lost productivity were collected via subject self-report. Costs were assigned to HRU based on standard algorithms. Direct and indirect costs were evaluated and compared by simple linear regression. Results A total of 442 subjects (203 US, 70 France, 169 Germany) with FM were analyzed. The mean (standard deviation) age in the US, France, and Germany was 47.9 (10.9), 51.2 (9.5), and 49.2 (9.8), respectively (P = 0.085). Most subjects were female (95% US, 83% France, 80% Germany) (P < 0.001). Adjusted annual direct costs per subject for FM were significantly higher in the US ($7087) than in France ($481, P < 0.001) or Germany ($2417, P < 0.001). Adjusted mean annual indirect costs per subject for FM were lower in the US ($6431) than in France ($8718) or Germany ($10,001), but represented a significant proportion of total costs in all countries. Conclusion The significant HRU and costs associated with FM in the US, France, and Germany documented in this study highlight the substantial global economic burden of FM. Indirect costs represented a significant proportion of the total costs, particularly in Europe. Comparisons between the three countries show differences in HRU, with significantly higher direct costs in the US compared with France and Germany. PMID:23637545

  18. Genome health nutrigenomics and nutrigenetics--diagnosis and nutritional treatment of genome damage on an individual basis.

    Science.gov (United States)

    Fenech, Michael

    2008-04-01

    The term nutrigenomics refers to the effect of diet on gene expression. The term nutrigenetics refers to the impact of inherited traits on the response to a specific dietary pattern, functional food or supplement on a specific health outcome. The specific fields of genome health nutrigenomics and genome health nutrigenetics are emerging as important new research areas because it is becoming increasingly evident that (a) risk for developmental and degenerative disease increases with DNA damage which in turn is dependent on nutritional status and (b) optimal concentration of micronutrients for prevention of genome damage is also dependent on genetic polymorphisms that alter function of genes involved directly or indirectly in uptake and metabolism of micronutrients required for DNA repair and DNA replication. Development of dietary patterns, functional foods and supplements that are designed to improve genome health maintenance in humans with specific genetic backgrounds may provide an important contribution to a new optimum health strategy based on the diagnosis and individualised nutritional treatment of genome instability i.e. Genome Health Clinics.

  19. Health-resource use and costs associated with fibromyalgia in France, Germany, and the United States

    Directory of Open Access Journals (Sweden)

    Chandran A

    2013-04-01

    Full Text Available Tyler Knight,1 Caroline Schaefer,1 Arthi Chandran,2 Gergana Zlateva,2 Andreas Winkelmann,3 Serge Perrot4 1Health Economics and Outcomes Research, Covance Market Access Services, Gaithersburg, MD, USA; 2Primary Care Health Economics and Outcomes Research, Pfizer Global Health Economics, New York, NY, USA; 3Department of Physical Medicine and Rehabilitation, University Hospital Munich, Munich, Germany; 4Service de Médecine Interne et Thérapeutique, Université Paris Descartes, Paris, France Background: Fibromyalgia (FM is a chronic disorder characterized by widespread, persistent pain. Prospective and retrospective studies have demonstrated substantial health-care costs associated with FM in a number of countries. This study evaluated and compared health-resource use (HRU and associated costs related to FM in routine clinical practice across the US, France, and Germany. Methods: Two separate, cross-sectional, observational studies of subjects with FM were conducted: one in the US and one in France and Germany. HRU related to prescription medication, physician office visits, diagnostic tests, and hospitalizations was abstracted from chart review; patient out-of-pocket costs and lost productivity were collected via subject self-report. Costs were assigned to HRU based on standard algorithms. Direct and indirect costs were evaluated and compared by simple linear regression. Results: A total of 442 subjects (203 US, 70 France, 169 Germany with FM were analyzed. The mean (standard deviation age in the US, France, and Germany was 47.9 (10.9, 51.2 (9.5, and 49.2 (9.8, respectively (P = 0.085. Most subjects were female (95% US, 83% France, 80% Germany (P < 0.001. Adjusted annual direct costs per subject for FM were significantly higher in the US ($7087 than in France ($481, P < 0.001 or Germany ($2417, P < 0.001. Adjusted mean annual indirect costs per subject for FM were lower in the US ($6431 than in France ($8718 or Germany ($10,001, but represented

  20. Measuring rural allied health workforce turnover and retention: what are the patterns, determinants and costs?

    Science.gov (United States)

    Chisholm, Marita; Russell, Deborah; Humphreys, John

    2011-04-01

    To measure variations in patterns of turnover and retention, determinants of turnover, and costs of recruitment of allied health professionals in rural areas. Data were collected on health service characteristics, recruitment costs and de-identified individual-level employment entry and exit data for dietitians, occupational therapists, physiotherapists, podiatrists, psychologists, social workers and speech pathologists employed between 1 January 2004 and 31 December 2009. Health services providing allied health services within Western Victoria were stratified by geographical location and town size. Eighteen health services were sampled, 11 participated. Annual turnover rates, stability rates, median length of stay in current position, survival probabilities, turnover hazards and median costs of recruitment were calculated. Analysis of commencement and exit data from 901 allied health professionals indicated that differences in crude workforce patterns according to geographical location emerge 12 to 24 months after commencement of employment, although the results were not statistically significant. Proportional hazards modelling indicated profession and employee age and grade upon commencement were significant determinants of turnover risk. Costs of replacing allied health workers are high. An opportunity for implementing comprehensive retention strategies exists in the first year of employment in rural and remote settings. Benchmarks to guide workforce retention strategies should take account of differences in patterns of allied health turnover and retention according to geographical location. Monitoring allied health workforce turnover and retention through analysis of routinely collected data to calculate selected indicators provides a stronger evidence base to underpin workforce planning by health services and regional authorities. © 2011 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

  1. The costs of mergers and acquisitions in the U.S. health care sector.

    Science.gov (United States)

    Bond, P; Weissman, R

    1997-01-01

    Important trends are emerging from evidence of health care industry concentration in the United States. Some of these are the durable consumer concerns--cost, choice, and access--which have received attention throughout the introduction of managed care. But with the intensified industry concentration, these have been joined by concerns about pricing power, control and quality, integrity of health system and health policy-making, and clashing institutional mandates. Such trends are particularly evident in the hospital and pharmaceutical industries.

  2. Wage and Benefit Changes in Response to Rising Health Insurance Costs

    OpenAIRE

    Dana Goldman; Neeraj Sood; Arleen Leibowitz

    2005-01-01

    Many companies have defined-contribution benefit plans requiring employees to pay the full cost (before taxes) of more generous health insurance choices. Research has shown that employee decisions are quite responsive to these arrangements. What is less clear is how the total compensation package changes when health insurance premiums rise. This paper examines employee compensation decisions during a three-year period when health insurance premiums were rising rapidly. The data come from a si...

  3. Preventive Effect of the Korean Traditional Health Drink (Taemyeongcheong) on Acetaminophen-Induced Hepatic Damage in ICR Mice

    OpenAIRE

    Yi, Ruo-Kun; Song, Jia-Le; Lim, Yaung-Iee; Kim, Yong-Kyu; Park, Kun-Young

    2015-01-01

    This study was to investigate the preventive effect of taemyeongcheong (TMC, a Korean traditional health drink) on acetaminophen (APAP, 800 mg/kg BW)-induced hepatic damage in ICR mice. TMC is prepared from Saururus chinensis, Taraxacum officinale, Zingiber officinale, Cirsium setidens, Salicornia herbacea, and Glycyrrhizae. A high dose of TMC (500 mg/kg BW) was found to decrease APAP-induced increases in serum levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphata...

  4. 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.

  5. 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

  6. All-Cause and Acute Pancreatitis Health Care Costs in Patients With Severe Hypertriglyceridemia.

    Science.gov (United States)

    Rashid, Nazia; Sharma, Puza P; Scott, Ronald D; Lin, Kathy J; Toth, Peter P

    2017-01-01

    The aim of this study was to assess health care utilization and costs related to acute pancreatitis (AP) in patients with severe hypertriglyceridemia (sHTG) levels. Patients with sHTG levels 1000 mg/dL or higher were identified from January 1, 2007, to June 30, 2013. The first identified incident triglyceride level was labeled as index date. All-cause, AP-related health care visits, and mean total all-cause costs in patients with and without AP were compared during 12 months postindex. A generalized linear model regression was used to compare costs while controlling for patient characteristics and comorbidities. Five thousand five hundred fifty sHTG patients were identified, and 5.4% of these patients developed AP during postindex. Patients with AP had significantly (P < 0.05) more all-cause outpatient visits, hospitalizations, longer length of stays during the hospital visits, and emergency department visits versus patients without AP. Mean (SD) unadjusted all-cause health care costs in the 12 months postindex were $25,343 ($33,139) for patients with AP compared with $15,195 ($24,040) for patients with no AP. The regression showed annual all-cause costs were 49.9% higher (P < 0.01) for patients with AP versus without AP. Patients who developed AP were associated with higher costs; managing patients with sHTG at risk of developing AP may help reduce unnecessary costs.

  7. Solidarity and cost management: Swiss citizens' reasons for priorities regarding health insurance coverage.

    Science.gov (United States)

    Schindler, Mélinée; Danis, Marion; Goold, Susan D; Hurst, Samia A

    2018-04-14

    Approaches to priority-setting for scarce resources have shifted to public deliberation as trade-offs become more difficult. We report results of a qualitative analysis of public deliberation in Switzerland, a country with high health-care costs, an individual health insurance mandate and a strong tradition of direct democracy with frequent votes related to health care. We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex health-care allocation decisions into easily understandable choices, for use in Switzerland. We conducted focus groups in twelve Swiss cities, recruiting from a range of socio-economic backgrounds in the three language regions. Participants developed strategic arguments based on the importance of basic coverage for all, and of cost-benefit evaluation. They also expressed arguments relying on a principle of solidarity, in particular the importance of protection for vulnerable groups, and on the importance of medical care. They struggled with the place of personal responsibility in coverage decisions. In commenting on the exercise, participants found the degree of consensus despite differing opinions surprising and valuable. The Swiss population is particularly attentive to the costs of health care and means of reducing these costs. Swiss citizens are capable of making trade-offs and setting priorities for complex health issues. © 2018 The Authors Health Expectations published by John Wiley & Sons Ltd.

  8. 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

  9. Health care costs and work absenteeism in smokers: study in an urban community.

    Science.gov (United States)

    Suárez-Bonel, María Pilar; Villaverde-Royo, María Victoria; Nerín, Isabel; Sanz-Andrés, Concepción; Mezquida-Arno, Julia; Córdoba-García, Rodrigo

    2015-12-01

    Higher morbidity caused by smoking-related diseases could increase health costs. We analyzed differences in the use of healthcare resources, healthcare costs and days of work absenteeism among smokers and non-smokers. Cross-sectional study in smokers and non-smokers, aged between 45 and 74 years, from one urban health area. The variables studied were: age, sex, alcohol intake, physical activity, obesity, diseases, attendance at primary care clinics and hospital emergency rooms, days of hospitalization, prescription drug consumption and work absenteeism (in days). Annual cost according to the unit cost of each service (direct costs), and indirect costs according to the number of days missed from work was calculated. Crude and adjusted risks were calculated using logistic regression. Five hundred patients were included: 50% were smokers, 74% (372) men and 26% (128) women. Smokers used more healthcare resources, consumed more prescription drugs and had more days off work than non-smokers. Respective direct and indirect costs in smokers were 848.64 euros (IQ 25-75: 332.65-1517.10) and 2253.90 euros (IQ 25-75: 1024.50-13113.60), and in non-smokers were 474.71 euros (IQ 25-75: 172.88-979.59) and 1434.30 euros (IQ 25-75: 614.70-4712.70). The likelihood of generating high healthcare costs was more than double for smokers (OR=2.14; 95% CI: 1.44-3.19). More investment in programs for the prevention and treatment of smoking, as a health policy priority, could help to reduce the health and social costs of smoking. Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.

  10. Cost Comparison Model: Blended eLearning versus traditional training of community health workers.

    Science.gov (United States)

    Sissine, Mysha; Segan, Robert; Taylor, Mathew; Jefferson, Bobby; Borrelli, Alice; Koehler, Mohandas; Chelvayohan, Meena

    2014-01-01

    Another one million community healthcare workers are needed to address the growing global population and increasing demand of health care services. This paper describes a cost comparison between two training approaches to better understand costs implications of training community health workers (CHWs) in Sub-Saharan Africa. Our team created a prospective model to forecast and compare the costs of two training methods as described in the Dalburge Report - (1) a traditional didactic training approach ("baseline") and (2) a blended eLearning training approach ("blended"). After running the model for training 100,000 CHWs, we compared the results and scaled up those results to one million CHWs. A substantial difference exists in total costs between the baseline and blended training programs. RESULTS indicate that using a blended eLearning approach for training community health care workers could provide a total cost savings of 42%. Scaling the model to one million CHWs, the blended eLearning training approach reduces total costs by 25%. The blended eLearning savings are a result of decreased classroom time, thereby reducing the costs associated with travel, trainers and classroom costs; and using a tablet with WiFi plus a feature phone rather than a smartphone with data plan. The results of this cost analysis indicate significant savings through using a blended eLearning approach in comparison to a traditional didactic method for CHW training by as much as 67%. These results correspond to the Dalberg publication which indicates that using a blended eLearning approach is an opportunity for closing the gap in training community health care workers.

  11. Coronary Artery Bypass Graft Surgery Cost Coverage by the Brazilian Unified Health System (SUS

    Directory of Open Access Journals (Sweden)

    Gilmara Silveira da Silva

    Full Text Available Abstract Introduction: Cost management has been identified as an essential tool for the general control and evaluation of health organizations. Objectives: To identify the coverage percentage of transferred funds from the Unified Health System for coronary artery bypass grafts in a philanthropic hospital having a consolidated costing system in the municipality of São Paulo. Methods: A quantitative, descriptive and cross-sectional research with information provided from a database composed of 1913 patients undergoing coronary artery bypass graft from March 13 to September 30, 2012, including isolated elective coronary artery bypass graft with the use of extracorporeal circulation. It excluded 551 (28.8% patients, among them 76 (4.0% deaths and 8 hospitalized patients, since the cost was compared according to the length of hospital stay. Therefore, the sample consisted of 1362 patients. Results: The average total cost per patient was $7,992.55. The average fund transfer by the Unified Health System was $3,450.73 (48.66%, resulting in a deficit of $4,541.82 (51.34%. Conclusion: The Unified Health System transfers covered 48.66% of the average total cost of hospitalization. Although the amount transferred increased with increasing costs, it was not proportional to the total cost, resulting in a percentage difference in revenue that was increasingly negative for each increase in cost and hospital stay. Those hospitalized for longer than seven days presented higher costs, older age, higher percentage of diabetics and chronic kidney disease patients and more postoperative complications.

  12. 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

  13. Description and Evaluation of an Educational Intervention on Health Care Costs and Value.

    Science.gov (United States)

    Jonas, Jennifer A; Ronan, Jeanine C; Petrie, Ian; Fieldston, Evan S

    2016-02-01

    There is growing consensus that to ensure that health care dollars are spent efficiently, physicians need more training in how to provide high-value, cost-conscious care. Thus, in fiscal year 2014, The Children's Hospital of Philadelphia piloted a 9-part curriculum on health care costs and value for faculty in the Division of General Pediatrics. This study uses baseline and postintervention surveys to gauge knowledge, perceptions, and views on these issues and to assess the efficacy of the pilot curriculum. Faculty completed surveys about their knowledge and perceptions about health care costs and value and their views on the role physicians should play in containing costs and promoting value. Baseline and postintervention responses were compared and analyzed on the basis of how many of the sessions respondents attended. Sixty-two faculty members completed the baseline survey (71% response rate), and 45 faculty members completed the postintervention survey (63% response rate). Reported knowledge of health care costs and value increased significantly in the postintervention survey (P=.04 and Pvalue were 2.42 (confidence interval: 1.05-5.58) and 6.22 times greater (confidence interval: 2.29-16.90), respectively, postintervention. Reported knowledge of health care costs and value increased with number of sessions attended (P=.01 and Pvalue and initiated important discussions about the role physicians can play in containing costs and promoting value. Additional education, increased cost transparency, and more decision support tools are needed to help physicians translate knowledge into practice. Copyright © 2016 by the American Academy of Pediatrics.

  14. The real world cost and health resource utilization associated to manic episodes: The MANACOR study.

    Science.gov (United States)

    Hidalgo-Mazzei, Diego; Undurraga, Juan; Reinares, María; Bonnín, Caterina del Mar; Sáez, Cristina; Mur, María; Nieto, Evaristo; Vieta, Eduard

    2015-01-01

    Bipolar disorder is a relapsing-remitting condition affecting approximately 1-2% of the population. Even when the treatments available are effective, relapses are still very frequent. Therefore, the burden and cost associated to every new episode of the disorder have relevant implications in public health. The main objective of this study was to estimate the associated health resource consumption and direct costs of manic episodes in a real world clinical setting, taking into consideration clinical variables. Bipolar I disorder patients who recently presented an acute manic episode based on DSM-IV criteria were consecutively included. Sociodemographic variables were retrospectively collected and during the 6 following months clinical variables were prospectively assessed (YMRS,HDRS-17,FAST and CGI-BP-M). The health resource consumption and associate cost were estimated based on hospitalization days, pharmacological treatment, emergency department and outpatient consultations. One hundred sixty-nine patients patients from 4 different university hospitals in Catalonia (Spain) were included. The mean direct cost of the manic episodes was €4,771. The 77% (€3,651) was attributable to hospitalization costs while 14% (€684) was related to pharmacological treatment, 8% (€386) to outpatient visits and only 1% (€50) to emergency room visits. The hospitalization days were the main cost driver. An initial FAST score>41 significantly predicted a higher direct cost. Our results show the high cost and burden associated with BD and the need to design more cost-efficient strategies in the prevention and management of manic relapses in order to avoid hospital admissions. Poor baseline functioning predicted high costs, indicating the importance of functional assessment in bipolar disorder. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

  15. Breath tests sustainability in hospital settings: cost analysis and reimbursement in the Italian National Health System.

    Science.gov (United States)

    Volpe, M; Scaldaferri, F; Ojetti, V; Poscia, A

    2013-01-01

    The high demand of Breath Tests (BT) in many gastroenterological conditions in time of limited resources for health care systems, generates increased interest in cost analysis from the point of view of the delivery of services to better understand how use the money to generate value. This study aims to measure the cost of C13 Urea and other most utilized breath tests in order to describe key aspects of costs and reimbursements looking at the economic sustainability for the hospital. A hospital based cost-analysis of the main breath tests commonly delivery in an ambulatory setting is performed. Mean salary for professional nurses and gastroenterologists, drugs/preparation used and disposable materials, purchase and depreciation of the instrument and the testing time was used to estimate the cost, while reimbursements are based on the 2013 Italian National Health System ambulatory pricelist. Variables that could influence the model are considered in the sensitivity analyses. The mean cost for C13--Urea, Lactulose and Lactose BT are, respectively, Euros 30,59; 45,20 and 30,29. National reimbursement often doesn't cover the cost of the analysis, especially considering the scenario with lower number of exam. On the contrary, in high performance scenario all the reimbursement could cover the cost, except for the C13 Urea BT that is high influenced by the drugs cost. However, consideration about the difference between Italian Regional Health System ambulatory pricelist are done. Our analysis shows that while national reimbursement rates cover the costs of H2 breath testing, they do not cover sufficiently C13 BT, particularly urea breath test. The real economic strength of these non invasive tests should be considered in the overall organization of inpatient and outpatient clinic, accounting for complete diagnostic pathway for each gastrointestinal disease.

  16. Real energy cost

    International Nuclear Information System (INIS)

    Vinogradova, I.

    1992-01-01

    Different methods of calculating the real power cost in the USA taking account of damage brought to the environment, public health expenses etc., are considered. Application of complex methods allowing one to directly determine the costs linked with ecology has shown that the most expensive power is generated at the new NPPs and thermal plants using coal. Activities on power saving and increasing the capacity of the existing hydroelectrotechnical equipment are considered to be the most effective from the viewpoint of expenses

  17. Impact Of Health Care Delivery System Innovations On Total Cost Of Care.

    Science.gov (United States)

    Smith, Kevin W; Bir, Anupa; Freeman, Nikki L B; Koethe, Benjamin C; Cohen, Julia; Day, Timothy J

    2017-03-01

    Using delivery system innovations to advance health care reform continues to be of widespread interest. However, it is difficult to generalize about the success of specific types of innovations, since they have been examined in only a few studies. To gain a broader perspective, we analyzed the results of forty-three ambulatory care programs funded by the first round of the Center for Medicare and Medicaid Innovation's Health Care Innovations Awards. The innovations' impacts on total cost of care were estimated by independent evaluators using multivariable difference-in-differences models. Through the first two years, most of the innovations did not show a significant effect on total cost of care. Using meta-regression, we assessed the effects on costs of five common components of these innovations. Innovations that used health information technology or community health workers achieved the greatest cost savings. Savings were also relatively large in programs that targeted clinically fragile patients-clinically complex populations at risk for disease progression. While the magnitude of these effects was often substantial, none achieved conventional levels of significance in our analyses. Meta-analyses of a larger number of delivery system innovations are needed to more clearly establish their potential for patient care cost savings. Project HOPE—The People-to-People Health Foundation, Inc.

  18. The effect of health payment reforms on cost containment in Taiwan hospitals: the agency theory perspective.

    Science.gov (United States)

    Chang, Li

    2011-01-01

    This study aims to determine whether the Taiwanese government's implementation of new health care payment reforms (the National Health Insurance with fee-for-service (NHI-FFS) and global budget (NHI-GB)) has resulted in better cost containment. Also, the question arises under the agency theory whether the monitoring system is effective in reducing the risk of information asymmetry. This study uses panel data analysis with fixed effects model to investigate changes in cost containment at Taipei municipal hospitals before and after adopting reforms from 1989 to 2004. The results show that the monitoring system does not reduce information asymmetry to improve cost containment under the NHI-FFS. In addition, after adopting the NHI-GB system, health care costs are controlled based on an improved monitoring system in the policymaker's point of view. This may suggest that the NHI's fee-for-services system actually causes health care resource waste. The GB may solve the problems of controlling health care costs only on the macro side.

  19. A novel nonlinear damage resonance intermodulation effect for structural health monitoring

    Science.gov (United States)

    Ciampa, Francesco; Scarselli, Gennaro; Meo, Michele

    2017-04-01

    This paper is aimed at developing a theoretical model able to predict the generation of nonlinear elastic effects associated to the interaction of ultrasonic waves with the steady-state nonlinear response of local defect resonance (LDR). The LDR effect is used in nonlinear elastic wave spectroscopy to enhance the excitation of the material damage at its local resonance, thus to dramatically increase the vibrational amplitude of material nonlinear phenomena. The main result of this work is to prove both analytically and experimentally the generation of novel nonlinear elastic wave effects, here named as nonlinear damage resonance intermodulation, which correspond to a nonlinear intermodulation between the driving frequency and the LDR one. Beside this intermodulation effect, other nonlinear elastic wave phenomena such as higher harmonics of the input frequency and superharmonics of LDR frequency were found. The analytical model relies on solving the nonlinear equation of motion governing bending displacement under the assumption of both quadratic and cubic nonlinear defect approximation. Experimental tests on a damaged composite laminate confirmed and validated these predictions and showed that using continuous periodic excitation, the nonlinear structural phenomena associated to LDR could also be featured at locations different from the damage resonance. These findings will provide new opportunities for material damage detection using nonlinear ultrasounds.

  20. Association of Cost Sharing With Use of Home Health Services Among Medicare Advantage Enrollees.

    Science.gov (United States)

    Li, Qijuan; Keohane, Laura M; Thomas, Kali; Lee, Yoojin; Trivedi, Amal N

    2017-07-01

    Several policy proposals advocate introducing copayments for home health care in the Medicare program. To our knowledge, no prior studies have assessed this cost-containment strategy. To determine the association of home health copayments with use of home health services. A difference-in-differences case-control study of 18 Medicare Advantage (MA) plans that introduced copayments for home health care between 2007 and 2011 and 18 concurrent control MA plans. The study included 135 302 enrollees in plans that introduced copayment and 155 892 enrollees in matched control plans. Introduction of copayments for home health care between 2007 and 2011. Proportion of enrollees receiving home health care, annual numbers of home health episodes, and days receiving home health care. Copayments for home health visits ranged from $5 to $20 per visit, which were estimated to be associated with $165 (interquartile range [IQR], $45-$180) to $660 (IQR, $180-$720) in out-of-pocket spending for the average user of home health care. The increased copayment for home health care was not associated with the proportion of enrollees receiving home health care (adjusted difference-in-differences, -0.15 percentage points; 95% CI, -0.38 to 0.09), the number of home health episodes per user (adjusted difference-in-differences, 0.01; 95% CI, -0.01 to 0.03), and home health days per user (adjusted difference-in-differences, -0.19; 95% CI, -3.02 to 2.64). In both intervention and control plans and across all levels of copayments, we observed higher disenrollment rates among enrollees with greater baseline use of home health care. We found no evidence that imposing copayments reduced the use of home health services among older adults. More intensive use of home health services was associated with increased rates of disenrollment in MA plans. The findings raise questions about the potential effectiveness of this cost-containment strategy.

  1. Direct health services costs of providing assisted reproduction services in older women.

    Science.gov (United States)

    Maheshwari, Abha; Scotland, Graham; Bell, Jacqueline; McTavish, Alison; Hamilton, Mark; Bhattacharya, Siladitya

    2010-02-01

    To assess the total health service costs incurred for each live birth achieved by older women undergoing IVF compared with costs in younger women. Retrospective cross-sectional analysis. In vitro fertilization unit and maternity hospital in a tertiary care setting. Women who underwent their first cycle of IVF between 1997 and 2006. Bottom-up costs were calculated for all interventions in the IVF cycle. Early pregnancy and antenatal care costs were obtained from National Health Service reference costs, Information Services Division Scotland, and local departmental costs. Cost per live birth. The mean cost per live birth (95% confidence interval [CI]) in women undergoing IVF at the age of > or =40 years was pound 40,320 (pound 27,105- pound 65,036), which is >2.5 times higher than those aged 35-39 years (pound 17,096 [pound 15,635- pound 18,937]). The cost per ongoing pregnancy was almost three times in women aged > or =40 (pound 31,642 [pound 21,241- pound 58,979]) compared with women 35-39 years of age (pound 11,300 [pound 10,006- pound 12,938]). The cost of a live birth after IVF rises significantly at the age of 40 years owing to lower success rates. Most of the extra cost is due to the low success of IVF treatment, but some of it is due to higher rates of early pregnancy loss. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  2. Cost-effectiveness of health research study participant recruitment strategies: a systematic review.

    Science.gov (United States)

    Huynh, Lynn; Johns, Benjamin; Liu, Su-Hsun; Vedula, S Swaroop; Li, Tianjing; Puhan, Milo A

    2014-10-01

    A large fraction of the cost of conducting clinical trials is allocated to recruitment of participants. A synthesis of findings from studies that evaluate the cost and effectiveness of different recruitment strategies will inform investigators in designing cost-efficient clinical trials. To systematically identify, assess, and synthesize evidence from published comparisons of the cost and yield of strategies for recruitment of participants to health research studies. We included randomized studies in which two or more strategies for recruitment of participants had been compared. We focused our economic evaluation on studies that randomized participants to different recruitment strategies. We identified 10 randomized studies that compared recruitment strategies, including monetary incentives (cash or prize), direct contact (letters or telephone call), and medical referral strategies. Only two of the 10 studies compared strategies for recruiting participants to clinical trials. We found that allocating additional resources to recruit participants using monetary incentives or direct contact yielded between 4% and 23% additional participants compared to using neither strategy. For medical referral, recruitment of prostate cancer patients by nurses was cost-saving compared to recruitment by consultant urologists. For all underlying study designs, monetary incentives cost more than direct contact with potential participants, with a median incremental cost per recruitment ratio of Int$72 (Int$-International dollar, a theoretical unit of currency) for monetary incentive strategy compared to Int$28 for direct contact strategy. Only monetary incentives and source of referral were evaluated for recruiting participants into clinical trials. We did not review studies that presented non-monetary cost or lost opportunity cost. We did not adjust for the number of study recruitment sites or the study duration in our economic evaluation analysis. Systematic and explicit reporting of

  3. 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

    Full Text Available Hoa H Le,1 Mark P Connolly,1,2 Luis Bahamondes,3 Jose G Cecatti,3 Jingbo Yu,4 Henry X Hu4 1Department of Pharmacoeconomics and Pharmacoepidemiology, University of Groningen, Groningen, the Netherlands; 2Global Market Access Solutions, Saint-Prex, Switzerland; 3Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil; 4Merck & Co, Whitehouse Station, NJ, USA Background: Unintended pregnancy (UP is an unmet medical need with consequences worldwide. We evaluate the costs of UP based on pregnancies in Brazil from for the year 2010. Methods: The consequences of UP were evaluated using decision analysis based on pregnancy rates and outcomes as miscarriage, induced abortion, and live birth, which were factored into the analysis. The model discriminated between maternal and child outcomes and accounted for costs (in Brazilian currency [Real$, R$] within the Brazilian public health service attributed to preterm birth, neonatal admission, cerebral palsy, and neonatal and maternal mortality. Event probabilities were obtained from local resources. Results: We estimate that 1.8 million UPs resulted in 159,151 miscarriages, 48,769 induced abortions, 1.58 million live births, and 312 maternal deaths, including ten (3% attributed to unsafe abortions. The total estimated costs attributed to UP are R$4.1 billion annually, including R$32 million (0.8% and R$4.07 billion (99.2% attributed to miscarriages and births and complications, respectively. Direct birth costs accounted for approximately R$1.22 billion (30.0%, with labor and delivery responsible for most costs (R$988 million; 24.3% for the year 2010. The remainder of costs were for infant complications (R$2.84 billion; 72.3% with hospital readmission during the first year accounting for approximately R$2.15 billion (52.9%. Based on the national cost, we estimate the cost per UP to be R$2,293. Conclusion: Despite weaknesses in precise estimates in annual

  4. How health care reform can lower the costs of insurance administration.

    Science.gov (United States)

    Collins, Sara R; Nuzum, Rachel; Rustgi, Sheila D; Mika, Stephanie; Schoen, Cathy; Davis, Karen

    2009-07-01

    The United States leads all industrialized countries in the share of national health care expenditures devoted to insurance administration. The U.S. share is over 30 percent greater than Germany's and more than three times that of Japan. This issue brief examines the sources of administrative costs and describes how a private-public approach to health care reform--with the central feature of a national insurance exchange (largely replacing the present individual and small-group markets)--could substantially lower such costs. In three variations on that approach, estimated administrative costs would fall from 12.7 percent of claims to an average of 9.4 percent. Savings--as much as $265 billion over 2010-2020--would be realized through less marketing and underwriting, reduced costs of claims administration, less time spent negotiating provider payment rates, and fewer or standardized commissions to insurance brokers.

  5. The role of technology in reducing health care costs. Phase II and phase III.

    Energy Technology Data Exchange (ETDEWEB)

    Cilke, John F.; Parks, Raymond C.; Funkhouser, Donald Ray; Tebo, Michael A.; Murphy, Martin D.; Hightower, Marion Michael; Gallagher, Linda K.; Craft, Richard Layne, II; Garcia, Rudy John

    2004-04-01

    In Phase I of this project, reported in SAND97-1922, Sandia National Laboratories applied a systems approach to identifying innovative biomedical technologies with the potential to reduce U.S. health care delivery costs while maintaining care quality. The effort provided roadmaps for the development and integration of technology to meet perceived care delivery requirements and an economic analysis model for development of care pathway costs for two conditions: coronary artery disease (CAD) and benign prostatic hypertrophy (BPH). Phases II and III of this project, which are presented in this report, were directed at detailing the parameters of telemedicine that influence care delivery costs and quality. These results were used to identify and field test the communication, interoperability, and security capabilities needed for cost-effective, secure, and reliable health care via telemedicine.

  6. Changes in bacterial flora associated with skin damage on hands of health care personnel.

    Science.gov (United States)

    Larson, E L; Hughes, C A; Pyrek, J D; Sparks, S M; Cagatay, E U; Bartkus, J M

    1998-10-01

    In a prospective observational study of 40 nurses (20 with diagnosed hand irritation and 20 without), nurses with damaged hands did not have higher microbial counts (P = .63), but did have a greater number of colonizing species (means: 3.35 and 2.63, P = .03). Although numbers were small, nurses with damaged hands were significantly more likely to be colonized with Staphylococcus hominis (P = .03). Fifty-nine percent of S hominis isolates from nurses with damaged hands were resistant to methicillin compared with 27% of isolates from those with healthy skin (P = .14). Twenty percent of nurses with damaged hands were colonized with Staphylococcus aureus compared with none of the nurses with normal hands (P = .11). Nurses with damaged hands were also twice as likely to have gram-negative bacteria (P = .20), entercocci (P = .13), and Candida (P = .30) present on the hands. Antimicrobial resistance of the coagulase-negativ