List of publications: April 1982 to March 1983

International Nuclear Information System (INIS)

1983-06-01

All scientific and technical publications of Atomic Energy of Canada Ltd. issued from April 1982 to March 1983 are listed in ten broad categories. Each entry includes the AECL report series number, author(s), title, journal citation (if a reprint), pagination, issue date, and price. There are indexes by AECL and other report numbers, and authors. Directions for ordering AECL reports and a list of depository libraries are appended

The marginal cost of public funds

DEFF Research Database (Denmark)

Kleven, Henrik Jacobsen; Kreiner, Claus Thustrup

2006-01-01

This paper extends the theory and measurement of the marginal cost of public funds (MCF) to account for labor force participation responses. Our work is motivated by the emerging consensus in the empirical literature that extensive (participation) responses are more important than intensive (hours...... of work) responses. In the modelling of extensive responses, we argue that it is crucial to account for the presence of non-convexities created by fixed work costs. In a non-convex framework, tax and transfer reforms give rise to discrete participation responses generating first-order effects...

Public sector cost management practices in The Netherlands

NARCIS (Netherlands)

Verbeeten, Frank H.m.

2011-01-01

Purpose – The purpose of this research project is to validate the claim that recent developments in the public sector have increased the demand for and use of cost management information in public sector organizations. Design/methodology/approach – The approach taken is a survey of financial

Identifying an Australian ‘Shadow’ Benefit / Cost Ratio for Public Projects

OpenAIRE

Lawrence, Craig

2009-01-01

This paper examines the social opportunity cost of a hypothetical public project in Australia and compares these values with the cost of the project as measured by factor prices. Since 2001, the Australian taxation system has included an ad valorem tax, the Goods and Services Tax, however relatively little analysis of the impact of this tax on public project evaluation methods has been undertaken. This tax creates divergences between social opportunity cost and conventional cost measures. The...

Costs and benefits with public and investor-owned electric systems

International Nuclear Information System (INIS)

Bronner, K.M.

1990-01-01

This article discusses the analysis of the costs and benefits associated with public ownership of major utility projects and systems as opposed to private ownership. The topics discussed include the alleged benefits of public power systems, principles of cost benefit analysis, tax-exempt debt, state and local taxes and federal income taxes, benefit of 100 percent debt financing

Cost Accounting as a Possible Solution for Financial Sustainability of Croatian Public Hospitals

Directory of Open Access Journals (Sweden)

Ivana Dražić Lutilsky

2016-12-01

Full Text Available The purpose of this paper is to present the current usage of cost accounting methodology in Croatian public hospitals through conducted empirical research and to provide opinions of accountants and financial officers regarding possible implementation of cost accounting methodology in public hospitals. In the paper, the authors analyze the accounting system in Croatian public hospitals, identifying the flaws of the current accounting system with regard to the recording and allocation of costs. National healthcare systems of different European countries provide a theoretical background for the usage of accrual accounting basis and cost accounting methodologies, showing better governance and financial sustainability of public hospitals which have introduced cost accounting methodology. The conducted empirical research shows that accountants and financial officers believe that the healthcare system in Croatia is ready for a change in the current accounting system based on the modified accrual basis through the implementation of accrual accounting basis and full costing approach to cost allocation. Full costing approach is also known as activity-based accounting method for cost allocation. The authors also recommend some initial steps for implementation of the new cost accounting system in Croatian public hospitals.

48 CFR 31.205-1 - Public relations and advertising costs.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Public relations and... Organizations 31.205-1 Public relations and advertising costs. (a) Public relations means all functions and...; or (2) Maintaining or promoting reciprocal understanding and favorable relations with the public at...

24 CFR Appendix to Part 972 - Methodology of Comparing Cost of Public Housing With the Cost of Tenant-Based Assistance

Science.gov (United States)

2010-04-01

... useful life. The estimated cost for the continued operation of the development as public housing shall be... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Methodology of Comparing Cost of Public Housing With the Cost of Tenant-Based Assistance Appendix to Part 972 Housing and Urban...

Targeting the probability versus cost of feared outcomes in public speaking anxiety.

Science.gov (United States)

Nelson, Elizabeth A; Deacon, Brett J; Lickel, James J; Sy, Jennifer T

2010-04-01

Cognitive-behavioral theory suggests that social phobia is maintained, in part, by overestimates of the probability and cost of negative social events. Indeed, empirically supported cognitive-behavioral treatments directly target these cognitive biases through the use of in vivo exposure or behavioral experiments. While cognitive-behavioral theories and treatment protocols emphasize the importance of targeting probability and cost biases in the reduction of social anxiety, few studies have examined specific techniques for reducing probability and cost bias, and thus the relative efficacy of exposure to the probability versus cost of negative social events is unknown. In the present study, 37 undergraduates with high public speaking anxiety were randomly assigned to a single-session intervention designed to reduce either the perceived probability or the perceived cost of negative outcomes associated with public speaking. Compared to participants in the probability treatment condition, those in the cost treatment condition demonstrated significantly greater improvement on measures of public speaking anxiety and cost estimates for negative social events. The superior efficacy of the cost treatment condition was mediated by greater treatment-related changes in social cost estimates. The clinical implications of these findings are discussed. Published by Elsevier Ltd.

In search of financial sufficiency in the Spanish public university: From financing to the cost control and cost management

Directory of Open Access Journals (Sweden)

Santiago Aguilà

2016-02-01

Full Text Available Purpose: The current socio-economic context characterized by restrictive budgetary policies in the countries of the European Union has led to a reduction in public funding in the Spanish public university raising the deficit in many universities. That is why, while they are completing the implementation of a cost accounting model (Modelo Canoa to quantify their real financial needs, are also increasing academic rates with the limits established in the Decree-Law 14/2012 of 20 April as practically the only resource. This fact may ultimately affect demand. It is urgent to find therefore new sources of private funding as well as implementing techniques to control and reduce costs justified by the extreme financial situations of some universities. Design/methodology: These new sources of private funding as well as the specific techniques of control and cost management that are used in public universities outside of Spain are described. It has also made a poll to the managers of the Spanish public universities considering the diversification of funding sources and the feasibility of adopting specific techniques of control and cost management to help the achievement of financial sufficiency. Findings: Especially in the US universities, financing is more diversified and not depend so much of the increase in public rates. Specific techniques of control and cost management are also used and they are applicable to the Spanish case according to the opinion of the managers. Research limitations/implications: 82% of managers have completed the proposed poll. Originality/value: Identifying sources of private funding and specific techniques of control and cost management applicable to the Spanish public universities.

Tobacco litter costs and public policy: a framework and methodology for considering the use of fees to offset abatement costs.

Science.gov (United States)

Schneider, John E; Peterson, N Andrew; Kiss, Noemi; Ebeid, Omar; Doyle, Alexis S

2011-05-01

Growing concern over the costs, environmental impact and safety of tobacco product litter (TPL) has prompted states and cities to undertake a variety of policy initiatives, of which litter abatement fees are part. The present work describes a framework and methodology for calculating TPL costs and abatement fees. Abatement is associated with four categories of costs: (1) mechanical and manual abatement from streets, sidewalks and public places, (2) mechanical and manual abatement from storm water and sewer treatment systems, (3) the costs associated with harm to the ecosystem and harm to industries dependent on clean and healthy ecosystems, and (4) the costs associated with direct harm to human health. The experiences of the City of San Francisco's recently proposed tobacco litter abatement fee serve as a case study. City and municipal TPL costs are incurred through manual and mechanical clean-up of surfaces and catchment areas. According to some studies, public litter abatement costs to US cities range from US$3 million to US$16 million. TPL typically comprises between 22% and 36% of all visible litter, implying that total public TPL direct abatement costs range from about US$0.5 million to US$6 million for a city the size of San Francisco. The costs of mitigating the negative externalities of TPL in a city the size of San Francisco can be offset by implementing a fee of approximately US$0.20 per pack. Tobacco litter abatement costs to cities can be substantial, even when the costs of potential environmental pollution and tourism effects are excluded. One public policy option to address tobacco litter is levying of fees on cigarettes sold. The methodology described here for calculating TPL costs and abatement fees may be useful to state and local authorities who are considering adoption of this policy initiative.

The cost-effectiveness of public postsecondary education subsidies.

Science.gov (United States)

Muennig, P; Fahs, M

2001-02-01

Although educational attainment is a well-recognized covariate of health status, it is rarely thought of as a tool to be used to improve health. Since fewer than 40% of U.S. citizens have a college degree, it may be possible for the government to improve the health status of the population by assuming a larger burden of the cost of postsecondary education. This paper examines the costs and health effects of a government subsidy for public postsecondary education institutions. All high school graduates in 1997 were included in a decision analysis model as a hypothetical cohort. Data from the U.S. Department of Education, the World Health Organization, and the National Center for Health Statistics were used as model inputs. Results. Relative to the present educational system, a federal subsidy for public and private colleges equal to the amount now paid by students for tuition and living expenses would save $6,176 and avert 0.0018 of a disability-adjusted life-year (DALY) per person annually if enrollment increased 5%. The overall savings among 1997 high school graduates would be $17.1 billion and 4,992 DALYs would be averted per year relative to the present educational system. If enrollment increased by just 3%, $3,743 would be saved and 0.0011 DALYs would be averted per person. An enrollment increase of 7% would lead to savings of $8,610 and 0.0025 DALYs would be averted per person relative to the present educational system. If the government were to offer a full subsidy for college tuition at public universities, both lives and money would be saved, so long as enrollment levels increased. Providing a free postsecondary education for students attending public schools may be more cost-effective than most health investments. Copyright 2001 American Health Foundation and Academic Press.

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

Directory of Open Access Journals (Sweden)

Diego M. Castro

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

Costs of decommissioning nuclear power plants as reported to the public to date

International Nuclear Information System (INIS)

Strasma, J.D.

1982-01-01

This paper attempts to determine what information has been available to the public, in the United States, concerning the cost of decommissioning nuclear power plants. The search was conducted in the Television News Index and Abstracts, in the annual indexes to The Reader's Digest, and in two computer-based bibliographic retrieval systems, Lockheed's DIALOG Magazine Index and the New York Times Information Bank. Fewer than ten articles appeared in widely read places, with none at all in the Reader's Digest and none on the evening TV news, from 1974 to date. The cost of decommissioning nuclear power plants was reported in various ways, with a wide range of estimates and relatively little actual experience. Costs were given in dollars of different years, in percentages of construction costs, in cost per KWH as per month to the consumer, etc., making the range of reported costs seem even wider than it really was. It is not surprising that the public fears that decommissioning costs will be alarmingly high. The public debate on energy policy might be more rational with better information on decommissioning costs. 16 references

Containing costs in public sector hospitals - a strategy for the future ...

African Journals Online (AJOL)

Containing costs in public sector hospitals - a strategy for the future. ... is increasing concern about expenditure in the public and the private health care sectors. ... at the micro-level comparison of expenditure over a 14-year period in one major ...

Financing and cost-effectiveness analysis of public-private partnerships: provision of tuberculosis treatment in South Africa

Directory of Open Access Journals (Sweden)

Kumaranayake Lilani

2006-06-01

Full Text Available Abstract Background Public-private partnerships (PPP could be effective in scaling up services. We estimated cost and cost-effectiveness of different PPP arrangements in the provision of tuberculosis (TB treatment, and the financing required for the different models from the perspective of the provincial TB programme, provider, and the patient. Methods Two different models of TB provider partnerships are evaluated, relative to sole public provision: public-private workplace (PWP and public-private non-government (PNP. Cost and effectiveness data were collected at six sites providing directly observed treatment (DOT. Effectiveness for a 12-month cohort of new sputum positive patients was measured using cure and treatment success rates. Provider and patient costs were estimated, and analysed according to sources of financing. Cost-effectiveness is estimated from the perspective of the provider, patient and society in terms of the cost per TB case cured and cost per case successfully treated. Results Cost per case cured was significantly lower in PNP (US $354–446, and comparable between PWP (US $788–979 and public sites (US $700–1000. PPP models could significantly reduce costs to the patient by 64–100%. Relative to pure public sector provision and financing, expansion of PPPs could reduce government financing required per TB patient treated from $609–690 to $130–139 in PNP and $36–46 in PWP. Conclusion There is a strong economic case for expanding PPP in TB treatment and potentially for other types of health services. Where PPPs are tailored to target groups and supported by the public sector, scaling up of effective services could occur at much lower cost than solely relying on public sector models.

[Cost of assisted reproduction technology in a public hospital].

Science.gov (United States)

Navarro Espigares, José Luis; Martínez Navarro, Luis; Castilla Alcalá, José Antonio; Hernández Torres, Elisa

2006-01-01

Most studies on the costs of assisted reproductive technologies (ART) identify the total cost of the procedure with the direct cost, without considering important items such as overhead or intermediate costs. The objective of this study was to determine the cost per ART procedure in a public hospital in 2003 and to compare the results with those in the same hospital in 1998. Data from the Human Reproduction Unit of the Virgen de las Nieves University Hospital in Granada (Spain) from 1998 and 2003 were analyzed. Since the total costs of the unit were known, the cost of the distinct ART procedures performed in the hospital was calculated by means of a methodology for cost distribution. Between 1998 and 2003, the activity and costs of the Human Reproduction Unit analyzed evolved differently. Analysis of activity showed that some techniques, such as intracytoplasmic sperm injection, were consolidated while others, such as stimulation without assisted reproduction or intracervical insemination were abandoned. In all procedures, unit costs per cycle and per delivery decreased in the period analyzed. Important changes took place in the structure of costs of ART in the Human Reproduction Unit of the Virgen de las Nieves University Hospital between 1998 and 2003. Some techniques were discontinued, while others gained importance. Technological advances and structural innovations, together with a "learning effect," modified the structure of ART-related costs.

Are Public Master's Institutions Cost Efficient? A Stochastic Frontier and Spatial Analysis

Science.gov (United States)

Titus, Marvin A.; Vamosiu, Adriana; McClure, Kevin R.

2017-01-01

The current study examines costs, measured by educational and general (E&G) spending, and cost efficiency at 252 public master's institutions in the United States over a nine-year (2004-2012) period. We use a multi-product quadratic cost function and results from a random-effects model with a first-order autoregressive (AR1) disturbance term…

Cost estimation using ministerial regulation of public work no. 11/2013 in construction projects

Science.gov (United States)

Arumsari, Putri; Juliastuti; Khalifah Al'farisi, Muhammad

2017-12-01

One of the first tasks in starting a construction project is to estimate the total cost of building a project. In Indonesia there are several standards that are used to calculate the cost estimation of a project. One of the standards used in based on the Ministerial Regulation of Public Work No. 11/2013. However in a construction project, contractor often has their own cost estimation based on their own calculation. This research aimed to compare the construction project total cost using calculation based on the Ministerial Regulation of Public Work No. 11/2013 against the contractor’s calculation. Two projects were used as case study to compare the results. The projects were a 4 storey building located in Pantai Indah Kapuk area (West Jakarta) and a warehouse located in Sentul (West Java) which was built by 2 different contractors. The cost estimation from both contractors’ calculation were compared to the one based on the Ministerial Regulation of Public Work No. 11/2013. It is found that there were differences between the two calculation around 1.80 % - 3.03% in total cost, in which the cost estimation based on Ministerial Regulation was higher than the contractors’ calculations.

Indirect costs of diabetes and its impact on the public finance: the case of Poland.

Science.gov (United States)

Torój, Andrzej; Mela, Aneta

2018-02-01

Growing public and private expenditure on healthcare results i.a. from the spreading of chronic diseases. Diabetes belongs to the most frequent ones, beyond neoplasms and cardiological diseases, and hence generates a significant burden for the public finance in terms of the direct costs. However, the economy suffers also from the indirect cost of diabetes that manifests itself in the loss in Gross Domestic Product (GDP) and general government revenues. This paper aims to measure this indirect cost, both in terms of GDP drop (social perspective) and public revenue drop (public finance perspective), in the case of Poland in 2012-2014. We use a modified human capital approach and unique dataset provided by the Social Security institution in Poland and the Polish Central Statistical Office. Diabetes is a substantial and growing burden for the Polish economy. In the years 2012, 2013 and 2014 the indirect cost (output loss) amounted to 1.85 bn USD, 1.94 bn USD and 2.00 bn USD respectively. Estimated indirect cost of diabetes can be a useful input for health technology analyses of drugs or economic impact assessments of public health programmes.

An empirical analysis of fiscal federalism implementation and of cost accounting in Italian public administrations

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Pina Puntillo

2012-09-01

Full Text Available The concept of cost has been introduced in Italian Administration since the early nineties. There is a copious legislation referring directly or indirectly, to the need, as well as to the utility of measuring the costs of public administration, in deference, to a renewed interpretation of the constitutional principle of Good Performance in pursuance of Article. 97 of the Italian Constitution. The most recent and probably the most significant intervention at institutional level, is the implementation of fiscal federalism as provided by Law. 42, 2009. The core features of fiscal federalism are the transition from historical expenditure to standard costs as a criterion for determining financial needs of public bodies, together with the attempt to establish more meaningful accountability mechanisms, both to policy makers and to public management. The measurement of standard costs represents one of the pillars of fiscal federalism and it will be pursued using the mechanism of "best practice". Full implementation of fiscal federalism, therefore, requires the verification of the operating costs of all public administrations. According to statutory law, regions are also required to provide verification of operating costs, for the successful pursuing of fiscal federalism. The present research is going to assess the level of diffusion of cost accounting in Italian regional public administrations. The methodology used for this paper includes the analysis of regional law as well as interviews to the officials of accounting and auditing offices

[Associated costs with dental studies in a public Mexican university].

Science.gov (United States)

Medina-Solís, Carlo Eduardo; Medina-Solís, June Janette; Sánchez-de la Cruz, Alicia; Ascencio-Villagrán, Arturo; de la Rosa-Santillana, Rubén; Mendoza-Rodríguez, Martha; Maupomé, Gerardo

2014-01-01

To calculate associated costs with dental studies (ACDS) in a public university. We performed a cross-sectional study using a costing system on a random sample of 376 dental students enrolled at any semester in a public university. To calculate ACDS (Mexican pesos of 2009-1), we used a questionnaire divided into eight sections. Sociodemographic and socioeconomic variables, housing costs, food, transportation, instruments and equipment, as well as remunerations associated with patient care along 16 weeks of classes in each semester were included. We used linear regression. The average of ACDS was of 18,357.54 ± 12,746.81 Mexican pesos. The largest percentage of ACDS (30.2 %) was for clinical instruments (5,537.66 ± 6,260.50). Students also spent funds in paying to patients for their time during care delivered (2,402.11 ± 4,796.50). Associated variables (p 〈 0.001) with the ACDS were having completed at least one clinical course or one theoretical-practical course, living within the state or out of state (compared to students who live in the city where dental studies take place), and being enrolled in the more advanced dental studies. The results indicate that a significant percentage of the cost to students (13.1 %) is related with clinical care delivery.

Analysis of public costs and risks in the Canadian nuclear industry

International Nuclear Information System (INIS)

Cantor, R.A.

1985-01-01

This dissertation evaluates selected aspects of the Canadian nuclear program in terms of their contribution to economic welfare. It concentrates on the diffusion of nuclear power in Canada, and measures the welfare implications within an ex post benefit-cost framework of the current generation of operating plants. This approach differs most significantly from prior research by focusing on the investment of public resources to pursue the management of the technological change and the importance of specific areas of uncertainty associated with the use of the technology. These areas of uncertainty are important for the understanding of policy actions which have altered the distribution of costs and risks in the industry, and would affect the relevance of the policies in another economic environment. The results of the benefit-cost analysis indicate that while the program has produced some possible regulatory outcomes, the social opportunity costs of the public investment have not been balanced by social benefits in the form of lower energy costs. Even under the most favorable assumptions used regarding the nuclear plants, the net social costs of the program are shown to be $10 billion in constant 1978 dollars and it is unlikely that the net benefits that have not been included in the analysis will yield a positive social gain in a welfare sense

Costs of genetic testing: Supporting Brazilian Public Policies for the incorporating of molecular diagnostic technologies

Directory of Open Access Journals (Sweden)

Rosane Paixão Schlatter

2015-09-01

Full Text Available This study identifies and describes the operating costs associated with the molecular diagnosis of diseases, such as hereditary cancer. To approximate the costs associated with these tests, data informed by Standard Operating Procedures for various techniques was collected from hospital software and a survey of market prices. Costs were established for four scenarios of capacity utilization to represent the possibility of suboptimal use in research laboratories. Cost description was based on a single site. The results show that only one technique was not impacted by rising costs due to underutilized capacity. Several common techniques were considerably more expensive at 30% capacity, including polymerase chain reaction (180%, microsatellite instability analysis (181%, gene rearrangement analysis by multiplex ligation probe amplification (412%, non-labeled sequencing (173%, and quantitation of nucleic acids (169%. These findings should be relevant for the definition of public policies and suggest that investment of public funds in the establishment of centralized diagnostic research centers would reduce costs to the Public Health System.

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.

Opportunities for the improvement of cost accounting systems in public hospitals in Italy and Croatia: A case study

Directory of Open Access Journals (Sweden)

Michele Bertoni

2017-01-01

Full Text Available The purpose of this paper is to highlight similarities and differences between one Croatian and one Italian public hospital regarding the implementation of cost accounting and full costing method in their accounting systems. Moving from the theoretical background, it is evident that cost accounting methods introduced in healthcare sector bring benefits to the whole society through an increased efficiency of the healthcare services provided. It primarily ensures better governing of hospital’s resources allowing more transparency in spending public funds. The main topic is that with the introduction of cost accounting system for internal purposes in public hospitals, the management would be able to govern them in a more efficient and effective way while reducing costs. The research for this paper was conducted through the interview of accounting officers in one Croatian and one Italian public hospital. The main results show that there are differences in legislation background regarding how they record costs, but also how they allocate costs to the cost objects and in how they use cost information in their decision-making process. In order to successfully manage public hospitals, it is crucial that true, timely and valid information are obtained as a base for the decision-making process. The cost accounting methodology is therefore essential to the management of public hospitals. It must provide information on the type and amount of resources spent, and thus enable the preconditions for control, management and potential reduction of costs.

Direct healthcare cost of obesity in brazil: an application of the cost-of-illness method from the perspective of the public health system in 2011.

Science.gov (United States)

de Oliveira, Michele Lessa; Santos, Leonor Maria Pacheco; da Silva, Everton Nunes

2015-01-01

Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems. To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011. Public hospitals and outpatient care. A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web. Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men. The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.

Exploring public attitudes towards approaches to discussing costs in the clinical encounter.

Science.gov (United States)

Danis, Marion; Sommers, Roseanna; Logan, Jean; Weidmer, Beverly; Chen, Shirley; Goold, Susan; Pearson, Steven; Donley, Greer; McGlynn, Elizabeth

2014-01-01

Patients' willingness to discuss costs of treatment alternatives with their physicians is uncertain. To explore public attitudes toward doctor-patient discussions of insurer and out-of-pocket costs and to examine whether several possible communication strategies might enhance patient receptivity to discussing costs with their physicians. Focus group discussions and pre-discussion and post-discussion questionnaires. Two hundred and eleven insured individuals with mean age of 48 years, 51 % female, 34 % African American, 27 % Latino, and 50 % with incomes below 300 % of the federal poverty threshold, participated in 22 focus groups in Santa Monica, CA and in the Washington, DC metro area. Attitudes toward discussing out-of-pocket and insurer costs with physicians, and towards physicians' role in controlling costs; receptivity toward recommended communication strategies regarding costs. Participants expressed more willingness to talk to doctors about personal costs than insurer costs. Older participants and sicker participants were more willing to talk to the doctor about all costs than younger and healthier participants (OR = 1.8, p = 0.004; OR = 1.6, p = 0.027 respectively). Participants who face cost-related barriers to accessing health care were in greater agreement than others that doctors should play a role in reducing out-of-pocket costs (OR = 2.4, p = 0.011). Participants did not endorse recommended communication strategies for discussing costs in the clinical encounter. In contrast, participants stated that trust in one's physician would enhance their willingness to discuss costs. Perceived impediments to discussing costs included rushed, impersonal visits, and clinicians who are insufficiently informed about costs. This study suggests that trusting relationships may be more conducive than any particular discussion strategy to facilitating doctor-patient discussions of health care costs. Better public understanding of how medical

The influence of proprietary disclosure costs on the decision to go public

NARCIS (Netherlands)

Marra, T.A.

2001-01-01

This thesis studies the influence of proprietary disclosure costs related to informing product market competitors on management communication with investors. In doing so it focuses on the firm's decision to go public. A firm that goes public not only experiences a change in its financial and

The impact of local public services and geographical cost of living differences on poverty estimates

OpenAIRE

Aaberge, Rolf; Langørgen, Audun; Mogstad, Magne; Østensen, Marit

2008-01-01

Abstract: Despite a broad consensus on the need to account for the value of public services and geographical cost of living differences on the measurement of poverty, there is little reliable evidence on how these factors actually affect poverty estimates. Unlike the standard approach in studies of the distribution of public services, this paper employs a method for valuing sector-specific local public services that accounts for differences between municipalities in the costs and capacity ...

Cost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists.

Science.gov (United States)

van Katwyk, Sasha; Jin, Ya-Ping; Trope, Graham E; Buys, Yvonne; Masucci, Lisa; Wedge, Richard; Flanagan, John; Brent, Michael H; El-Defrawy, Sherif; Tu, Hong Anh; Thavorn, Kednapa

2017-09-01

Diabetic retinopathy (DR) is one of the leading causes of vision loss and blindness in Canada. Eye examinations play an important role in early detection. However, DR screening by optometrists is not always universally covered by public or private health insurance plans. This study assessed whether expanding public health coverage to include diabetic eye examinations for retinopathy by optometrists is cost-effective from the perspective of the health care system. We conducted a cost-utility analysis of extended coverage for diabetic eye examinations in Prince Edward Island to include examinations by optometrists, not currently publicly covered. We used a Markov chain to simulate disease burden based on eye examination rates and DR progression over a 30-year time horizon. Results were presented as an incremental cost per quality-adjusted life year (QALY) gained. A series of one-way and probabilistic sensitivity analyses were performed. Extending public health coverage to eye examinations by optometrists was associated with higher costs ($9,908,543.32) and improved QALYs (156,862.44), over 30 years, resulting in an incremental cost-effectiveness ratio of $1668.43/QALY gained. Sensitivity analysis showed that the most influential determinants of the results were the cost of optometric screening and selected utility scores. At the commonly used threshold of $50,000/QALY, the probability that the new policy was cost-effective was 99.99%. Extending public health coverage to eye examinations by optometrists is cost-effective based on a commonly used threshold of $50,000/QALY. Findings from this study can inform the decision to expand public-insured optometric services for patients with diabetes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Trends in childhood vaccine purchase costs in the US public sector: 1996-2014.

Science.gov (United States)

Chen, Weiwei; Messonnier, Mark; Zhou, Fangjun

2016-09-07

While vaccination remains as one of the most cost-effective preventive strategies, the cost of fully immunizing a child has grown considerably over the last few decades. This study examines trends in non-influenza childhood vaccine purchase costs in the public sector from 1996 to 2014. Non-influenza vaccine purchase cost per child for children aged 0 through 18years was calculated based on public-sector purchase prices. Purchase cost changes were then decomposed into changes attributable to recommendation updates and changes attributable to price variation. The study analyzed the growth rate of combination vaccine prices separately and compared these prices with the sum of prices of component vaccines. It is found that the average annual growth rate of non-influenza vaccine purchase cost per child during 1996-2014 was 12.6%. The growth rate attributable to price changes was 1.0% on average. Combination vaccine prices showed greater variation. The study concludes that vaccine price variation was one but a minor reason for purchase cost changes. Recommendation updates, particularly the introduction of new vaccines, played a much larger role in raising the purchase costs. If the 12.6% annual growth rate found during 1996-2014 in the study continues to apply, the purchase costs of childhood vaccines may more than double by 2020. Copyright © 2016 Elsevier Ltd. All rights reserved.

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....

Private dentists assess treatment required as more extensive, demanding and costly, than public sector dentists.

Science.gov (United States)

Tuominen, Risto; Eriksson, Anna-Leena; Vahlberg, Tero

2012-08-01

The aim was to evaluate whether contracted private practitioners assess required treatment more extensive, demanding and economically more rewarding than mainly salaried public sector dentists and to estimate the cost consequences of using these alternative providers. All dental services included in comprehensive treatments funded by the city of Turku and provided to adult patients during the year 2009 were recorded. Patients were distributed randomly without any determination of treatment needs before appointing them to different dentists. Treatment courses for 7432 patients in public clinics included 63 906 procedures and for 2932 patients assigned to treatment by contracted private practitioners included 21 194 procedures. Public sector dentists were mainly salaried with production incentives, and private practitioners worked purely on a fee-for-service basis. The cost estimates were based on the distributions of competence classifications recorded by the providers, which also formed the basis for reimbursement. For each studied treatment category with more than one competence classification, private contractors were less likely than their public sector counterparts to give an assessment of simple or less demanding: 8% versus 29% of examinations, 46% versus 69% of periodontal treatments, 63% versus 85% of extractions, 31% versus 46% of fillings, 18% versus 35% of root canals. The excess cost to society varied from 7.0% for root canal treatments to 21.3% for extractions, causing on average 14.4% higher cost level from use of private practitioners compared with public sector dentists. Private practitioners systematically classified the treatment procedures they provided as more demanding, and therefore more economically rewarding, than their public sector counterparts. The findings indicate that the costs of publicly funded dental care may be increased by the use of private dental contractors. © 2012 John Wiley & Sons A/S.

Public Perceptions of Regulatory Costs, Their Uncertainty and Interindividual Distribution.

Science.gov (United States)

Johnson, Branden B; Finkel, Adam M

2016-06-01

Public perceptions of both risks and regulatory costs shape rational regulatory choices. Despite decades of risk perception studies, this article is the first on regulatory cost perceptions. A survey of 744 U.S. residents probed: (1) How knowledgeable are laypeople about regulatory costs incurred to reduce risks? (2) Do laypeople see official estimates of cost and benefit (lives saved) as accurate? (3) (How) do preferences for hypothetical regulations change when mean-preserving spreads of uncertainty replace certain cost or benefit? and (4) (How) do preferences change when unequal interindividual distributions of hypothetical regulatory costs replace equal distributions? Respondents overestimated costs of regulatory compliance, while assuming agencies underestimate costs. Most assumed agency estimates of benefits are accurate; a third believed both cost and benefit estimates are accurate. Cost and benefit estimates presented without uncertainty were slightly preferred to those surrounded by "narrow uncertainty" (a range of costs or lives entirely within a personally-calibrated zone without clear acceptance or rejection of tradeoffs). Certain estimates were more preferred than "wide uncertainty" (a range of agency estimates extending beyond these personal bounds, thus posing a gamble between favored and unacceptable tradeoffs), particularly for costs as opposed to benefits (but even for costs a quarter of respondents preferred wide uncertainty to certainty). Agency-acknowledged uncertainty in general elicited mixed judgments of honesty and trustworthiness. People preferred egalitarian distributions of regulatory costs, despite skewed actual cost distributions, and preferred progressive cost distributions (the rich pay a greater than proportional share) to regressive ones. Efficient and socially responsive regulations require disclosure of much more information about regulatory costs and risks. © 2016 Society for Risk Analysis.

Cost Behavior: Mapping and Systemic Analysis of International Publications

Directory of Open Access Journals (Sweden)

Fernando Richartz

2014-12-01

Full Text Available This article has as objective mapping of scientific researches into costs behavior to identify its current scenario. The research on database provided a selection of relevant bibliographic portfolio, which had as a result 29 articles according to the research criteria defined in the study. From those, the articles from Anderson, Banker e Janakiraman (2003 were highlighted. Furthermore, Banker is considered to be the main author about costs behavior, its importance is noticed not only in the portfolio itself, but also, in its references. The most important periodic, either for its impact, or related to its number of articles publicized, is The Accounting Review. Finally, from the relationship between the most important articles about bibliometric analysis, featuring systemic analysis, the conclusion is that an important article about cost behavior has a quantitative approach (with the use of robust regression, recognize the existence of Sticky Costs (no matter which approach is in use, makes use of a variety of explanations (internal & external and add some variable or information for scientific evolution of the subject.

Costs, benefits, and the malleability of public support for “Fracking”

International Nuclear Information System (INIS)

Christenson, Dino P.; Goldfarb, Jillian L.; Kriner, Douglas L.

2017-01-01

Public opinion plays an important role in shaping the policy debate over hydraulic fracturing at both the state and national level. However, most Americans report having little to no information about this controversial practice that has transformed the U.S. energy market. Employing an experiment embedded on a nationally representative survey, we examine how citizens respond to arguments concerning the costs and benefits of fracking, and incorporate them into their policy preferences. Arguments emphasizing the economic benefits of fracking bolster support for the technique; however, these gains are completely canceled if paired with a discussion of fracking's environmental costs. Additionally, we find mixed evidence of partisan motivated reasoning in how this information is processed. Individuals whose partisan attachments and preexisting beliefs about global climate change conflict are particularly responsive to arguments about the benefits and costs of fracking. Our results have important implications for scholars and policymakers concerned with partisan polarization in public opinion toward energy and environmental policy. - Highlights: • Nationally representative survey experiment on factors influencing fracking support. • Information about economic and environmental benefits of fracking increase support. • These gains are neutralized by providing information about environmental costs. • Limited evidence of partisan motivated reasoning. • Effects are largest for those whose partisanship and climate change beliefs conflict.

Cost Savings From the Provision of Specific Methods of Contraception in a Publicly Funded Program

Science.gov (United States)

Rostovtseva, Daria P.; Brindis, Claire D.; Biggs, M. Antonia; Hulett, Denis; Darney, Philip D.

2009-01-01

Objectives. We examined the cost-effectiveness of contraceptive methods dispensed in 2003 to 955 000 women in Family PACT (Planning, Access, Care and Treatment), California's publicly funded family planning program. Methods. We estimated the number of pregnancies averted by each contraceptive method and compared the cost of providing each method with the savings from averted pregnancies. Results. More than half of the 178 000 averted pregnancies were attributable to oral contraceptives, one fifth to injectable methods, and one tenth each to the patch and barrier methods. The implant and intrauterine contraceptives were the most cost-effective, with cost savings of more than $7.00 for every $1.00 spent in services and supplies. Per $1.00 spent, injectable contraceptives yielded savings of $5.60; oral contraceptives, $4.07; the patch, $2.99; the vaginal ring, $2.55; barrier methods, $1.34; and emergency contraceptives, $1.43. Conclusions. All contraceptive methods were cost-effective—they saved more in public expenditures for unintended pregnancies than they cost to provide. Because no single method is clinically recommended to every woman, it is medically and fiscally advisable for public health programs to offer all contraceptive methods. PMID:18703437

Sharing the Costs of Access to a Set of Public Goods

DEFF Research Database (Denmark)

Hougaard, Jens Leth

2018-01-01

A group of agents share assess to a set of public goods. Each good has a cost and the total cost of all goods must be shared among the agents. Agents preferences are described by subsets of goods that provides the agent with service. As such, demands are binary, and it is further assumed...... that agents prefer a low cost share, but other differences in their individual preferences are irrelevant, making demand fully inelastic. The model captures central aspects of several classes of practical problems and therefore has many potential applications. The paper surveys some recent axiomatic...

A study on moral hazard in dentistry: costs of care in the private and the public sector.

Science.gov (United States)

Tuominen, Risto; Eriksson, Anna-Leena

2011-10-01

The aim of this study was to evaluate the costs of subsidized care for an adult population provided by private and public sector dentists. A sample of 210 patients was drawn systematically from the waiting list for nonemergency dental treatment in the city of Turku. Questionnaire data covering sociodemographic background, dental care utilization and marginal time cost estimates were combined with data from patient registers on treatment given. Information was available on 104 patients (52 from each of the public and the private sectors). The overall time taken to provide treatment was 181 days in the public sector and 80 days in the private sector (Ppublic sector patients had significantly (P private sector patients (3.47), which caused higher visiting fees. In addition, patients in the public sector also had higher other out-of-pocket costs than in the private sector. Those who needed emergency dental treatment during the waiting time for comprehensive care had significantly more costly treatment and higher total costs than the other patients. Overall time required for dental visits significantly increased total costs. The total cost of dental care in the public sector was slightly higher (Pprivate sector. There is no direct evidence of moral hazard on the provider side from this study. The observed cost differences between the two sectors may indicate that private practitioners could manage their publicly funded patients more quickly than their private paying patients. On the other hand, private dentists providing more treatment per visit could be explained by private dentists providing more than is needed by increasing the content per visit. © 2011 John Wiley & Sons A/S.

The High Cost of Failing to Reform Public Education in Indiana. School Choice Issues in the State

Science.gov (United States)

Gottlob, Brian J.

2006-01-01

This study documents the public costs of high school dropouts in Indiana, and examines how school choice would provide large public benefits by increasing the graduation rate in Indiana public schools. It calculates the annual cost of high school dropouts in Indiana due to lower state income tax payments, increased reliance on Medicaid, and…

Robotic and open radical prostatectomy in the public health sector: cost comparison.

Science.gov (United States)

Hall, Rohan Matthew; Linklater, Nicholas; Coughlin, Geoff

2014-06-01

During 2008, the Royal Brisbane and Women's Hospital became the first public hospital in Australia to have a da Vinci Surgical Robot purchased by government funding. The cost of performing robotic surgery in the public sector is a contentious issue. This study is a single centre, cost analysis comparing open radical prostatectomy (RRP) and robotic-assisted radical prostatectomy (RALP) based on the newly introduced pure case-mix funding model. A retrospective chart review was performed for the first 100 RALPs and the previous 100 RRPs. Estimates of tangible costing and funding were generated for each admission and readmission, using the Royal Brisbane Hospital Transition II database, based on pure case-mix funding. The average cost for admission for RRP was A$13 605, compared to A$17 582 for the RALP. The average funding received for a RRP was A$11 781 compared to A$5496 for a RALP based on the newly introduced case-mix model. The average length of stay for RRP was 4.4 days (2-14) and for RALP, 1.2 days (1-4). The total cost of readmissions for RRP patients was A$70 487, compared to that of the RALP patients, A$7160. These were funded at A$55 639 and A$7624, respectively. RALP has shown a significant advantage with respect to length of stay and readmission rate. Based on the case-mix funding model RALP is poorly funded compared to its open equivalent. Queensland Health needs to plan on how robotic surgery is implemented and assess whether this technology is truly affordable in the public sector. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

[Costs of chronic dialysis in a public hospital: myths and realities].

Science.gov (United States)

Lamas, J; Alonso, M; Saavedra, J; García-Trío, G; Rionda, M; Ameijeiras, M

2001-01-01

In this study regular dialysis treatment costs during 1998 and 1999 in a public hospital, which is responsible for a population of 178,000, has been analysed. Hemodialysis (HD) and peritoneal dialysis (PD) costs have been differentiated and compared with those of external providers. The best technical and productive efficiency of both treatments have been estimated by analyzing the "treatment cost/human resources of the community utilized" relationship. The HD treatment costs per patient per year were 20,343 and 18,871 euros in 1988 and 1,999, respectively, lower than the costs reported in other studies. In 1999 these costs were similar to those of external providers and lower than the PD treatment costs (23,295 euros). HD retains its advantage even after costs of erythropoietin, hospital admissions and transport are included. In the hospital studied, the best technical efficiency in HD would be reached with 64 patients on treatment (17,851 euros per patient per year) and in PD with 48 patients (21,167 euros per patient per year). If we take into account our population characteristics and consider a patient distribution of 70% on HD and 30% on PD, the best productive efficiency would be reached with 56 patients on HD (17,916 euros per patient per year) and 24 patients on PD (21,813 euros per patient per year). HD confers the greatest economic and social benefits on the population supplied by the hospital since it provides the community with more jobs than PD in relation to treatment costs while the two yield the same clinical results. In conclusion, HD in a public hospital, at least in our environment, may be efficient and competitive with HD from external providers and it may be more efficient and provide a bigger economic and social profit for the population serviced by the hospital than PD, at least while the current supply systems for this treatment in our country are maintained.

Performance management and cost effectiveness of public services : empirical evidence from Dutch municipalities

NARCIS (Netherlands)

de Groot, Hans; van Hulst, B.L.

2011-01-01

The performance of public organizations is one of the key topics in public administration research. Cost-effectiveness as a dimension of performance has hardly been studied in this literature, however. Many governments currently are cutting budgets on an unprecedented scale after the world-wide

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

76 FR 60031 - Notice of Order: Revisions to Enterprise Public Use Database Incorporating High-Cost Single...

Science.gov (United States)

2011-09-28

... single-family matrix in FHFA's Public Use Database (PUDB) to include data fields for the high-cost single... Use Database Incorporating High-Cost Single-Family Securitized Loan Data Fields and Technical Data... amended, it is necessary to revise the single-family matrix of FHFA's Public Use Database (PUDB) by adding...

The marginal cost of public funds is one at the optimal tax system

NARCIS (Netherlands)

B. Jacobs (Bas)

2018-01-01

textabstractThis paper develops a Mirrlees framework with skill and preference heterogeneity to analyze optimal linear and nonlinear redistributive taxes, optimal provision of public goods, and the marginal cost of public funds (MCF). It is shown that the MCF equals one at the optimal tax system,

Costs at Public Universities: How Does California Compare with Other States? Report 10-12

Science.gov (United States)

Fuller, Ryan

2010-01-01

The cost of attending the University of California (UC) and California State University (CSU) has increased in recent years as UC and CSU have raised fees in response to reduced state funding. Fees are generally lower than fees at public universities in other states, but with California's higher living costs, the overall cost of attendance at UC…

Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka.

Science.gov (United States)

Thalagala, Neil; Tissera, Hasitha; Palihawadana, Paba; Amarasinghe, Ananda; Ambagahawita, Anuradha; Wilder-Smith, Annelies; Shepard, Donald S; Tozan, Yeşim

2016-02-01

Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector. We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health's perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches. The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216-609 for pediatric cases and between US$196-866 for adult cases according to disease severity and treatment setting. This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka.

Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka

Science.gov (United States)

Thalagala, Neil; Tissera, Hasitha; Palihawadana, Paba; Amarasinghe, Ananda; Ambagahawita, Anuradha; Wilder-Smith, Annelies; Shepard, Donald S.; Tozan, Yeşim

2016-01-01

Background Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector. Methods We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health’s perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches. Results The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216–609 for pediatric cases and between US$196–866 for adult cases according to disease severity and treatment setting. Conclusions This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka. PMID:26910907

Collecting and analysing cost data for complex public health trials: reflections on practice

Directory of Open Access Journals (Sweden)

Neha Batura

2014-02-01

Full Text Available Background: Current guidelines for the conduct of cost-effectiveness analysis (CEA are mainly applicable to facility-based interventions in high-income settings. Differences in the unit of analysis and the high cost of data collection can make these guidelines challenging to follow within public health trials in low- and middle- income settings. Objective: This paper reflects on the challenges experienced within our own work and proposes solutions that may be useful to others attempting to collect, analyse, and compare cost data between public health research sites in low- and middle-income countries. Design: We describe the generally accepted methods (norms for collecting and analysing cost data in a single-site trial from the provider perspective. We then describe our own experience applying these methods within eight comparable cluster randomised, controlled, trials. We describe the strategies used to maximise adherence to the norm, highlight ways in which we deviated from the norm, and reflect on the learning and limitations that resulted. Results: When the expenses incurred by a number of small research sites are used to estimate the cost-effectiveness of delivering an intervention on a national scale, then deciding which expenses constitute ‘start-up’ costs will be a nontrivial decision that may differ among sites. Similarly, the decision to include or exclude research or monitoring and evaluation costs can have a significant impact on the findings. We separated out research costs and argued that monitoring and evaluation costs should be reported as part of the total trial cost. The human resource constraints that we experienced are also likely to be common to other trials. As we did not have an economist in each site, we collaborated with key personnel at each site who were trained to use a standardised cost collection tool. This approach both accommodated our resource constraints and served as a knowledge sharing and capacity

Collecting and analysing cost data for complex public health trials: reflections on practice

Science.gov (United States)

Batura, Neha; Pulkki-Brännström, Anni-Maria; Agrawal, Priya; Bagra, Archana; Haghparast-Bidgoli, Hassan; Bozzani, Fiammetta; Colbourn, Tim; Greco, Giulia; Hossain, Tanvir; Sinha, Rajesh; Thapa, Bidur; Skordis-Worrall, Jolene

2014-01-01

Background Current guidelines for the conduct of cost-effectiveness analysis (CEA) are mainly applicable to facility-based interventions in high-income settings. Differences in the unit of analysis and the high cost of data collection can make these guidelines challenging to follow within public health trials in low- and middle- income settings. Objective This paper reflects on the challenges experienced within our own work and proposes solutions that may be useful to others attempting to collect, analyse, and compare cost data between public health research sites in low- and middle-income countries. Design We describe the generally accepted methods (norms) for collecting and analysing cost data in a single-site trial from the provider perspective. We then describe our own experience applying these methods within eight comparable cluster randomised, controlled, trials. We describe the strategies used to maximise adherence to the norm, highlight ways in which we deviated from the norm, and reflect on the learning and limitations that resulted. Results When the expenses incurred by a number of small research sites are used to estimate the cost-effectiveness of delivering an intervention on a national scale, then deciding which expenses constitute ‘start-up’ costs will be a nontrivial decision that may differ among sites. Similarly, the decision to include or exclude research or monitoring and evaluation costs can have a significant impact on the findings. We separated out research costs and argued that monitoring and evaluation costs should be reported as part of the total trial cost. The human resource constraints that we experienced are also likely to be common to other trials. As we did not have an economist in each site, we collaborated with key personnel at each site who were trained to use a standardised cost collection tool. This approach both accommodated our resource constraints and served as a knowledge sharing and capacity building process within the

Economic impact of malignant mesothelioma in Italy: an estimate of the public and social costs.

Science.gov (United States)

Buresti, Giuliana; Colonna, Fabrizio; Corfiati, Marisa; Valenti, Antonio; Persechino, Benedetta; Marinaccio, Alessandro; Rondinone, Bruna Maria; Iavicoli, Sergio

2017-10-27

Despite their considerable interest for public health policies and for occupational disease management and assessment, the economic costs of asbestos-related diseases (ARDs) for society have not been fully estimated or even frequently discussed. The aim of this study was to estimate the economic burden of mesothelioma in Italy by assessing the overall societal cost of the disease, applying an econometric model. We analyzed two main cost groups, public and social. The first includes expenditure borne by the State and other public bodies (medical care costs, insurance, tax and benefits), while the latter uses the human capital approach to measure the loss of productivity suffered by the economy as a whole. We provide an estimate of euro 33,000 per patient for medical care costs and euro 25,000 for insurance and compensation; tax and benefits seem to roughly compensate. We estimated a loss of more than euro 200,000 per patient, in terms of loss of production. This study offers a practical approach for estimating the economic impact of mesothelioma, and provides empirical evidence of the huge economic burden linked to this disease, with its high etiologic fraction.

Cost-Benefit Analysis for Energy Management in Public Buildings: Four Italian Case Studies

OpenAIRE

Davide Astiaso Garcia; Fabrizio Cumo; Mariagrazia Tiberi; Valentina Sforzini; Giuseppe Piras

2016-01-01

Improving energy efficiency in public buildings is one of the main challenges for a sustainable requalification of energy issues and a consequent reduction of greenhouse gas (GHG) emissions. This paper aims to provide preliminary information about economic costs and energy consumption reductions (benefits) of some considered interventions in existing public buildings. Methods include an analysis of some feasible interventions in four selected public buildings. Energy efficiency improvements h...

Assessing Tax Form Distribution Costs: A Proposed Method for Computing the Dollar Value of Tax Form Distribution in a Public Library.

Science.gov (United States)

Casey, James B.

1998-01-01

Explains how a public library can compute the actual cost of distributing tax forms to the public by listing all direct and indirect costs and demonstrating the formulae and necessary computations. Supplies directions for calculating costs involved for all levels of staff as well as associated public relations efforts, space, and utility costs.…

Real Cost-Benefit Analysis Is Needed in American Public Education

Science.gov (United States)

Stoneberg, Bert D.

2015-01-01

Public school critics often point to rising expenditures and relatively flat test scores to justify their school reform agendas. The claims are flawed because their analyses fail to account for the difference in data types between dollars (ratio) and test scores (interval). A cost-benefit analysis using dollars as a common metric for both costs…

External Cost Assessment of Nuclear Power Plant Accident considering Public Risk Aversion Behavior: the Korean Case

Energy Technology Data Exchange (ETDEWEB)

Lee, Sang Hun; Kang, Hyun Gook [KAIST, Daejeon (Korea, Republic of)

2016-05-15

The conventional approach for monetary valuation of NPP accident consequence consists of calculating the expected value of various accident scenarios. However, the main criticism of the conventional approach is that there is a discrepancy between the social acceptability of the risk and the estimated expected value of NPP accident. Therefore, an integrated framework for the estimation of the external cost associated with an NPP accident considering the public risk aversion behavior was proposed in this study based on the constructed theoretical framework for estimating both the value of statistical life (VSL) and the risk aversion coefficient associated with an NPP accident to take account of the accident cost into the unit electricity generation cost of NPP. To estimate both parameters, an individual-level survey was conducted on a sample of 1,364 participants in Korea. Based on the collected survey responses, both parameters were estimated based on the proposed framework and the external cost of NPP accident was estimated based on the consequence analysis and considering the direct cost factors for NPP accident. Internalization of external costs into the comprehensive energy production cost has been considered as a potentially efficient policy instrument for a more sustainable energy supply and use. However, the internalization of externalities, such as public health damage, have raised a number of generic policy issues in a nuclear energy sector, with specific challenges resulting from the distinct characteristics of external cost estimation. Especially, the major challenge remained to address the public safety concerns regarding a nuclear accident, which can be specified as low-probability high-consequence accident, driven by the aspects of public risk aversion.

External Cost Assessment of Nuclear Power Plant Accident considering Public Risk Aversion Behavior: the Korean Case

International Nuclear Information System (INIS)

Lee, Sang Hun; Kang, Hyun Gook

2016-01-01

The conventional approach for monetary valuation of NPP accident consequence consists of calculating the expected value of various accident scenarios. However, the main criticism of the conventional approach is that there is a discrepancy between the social acceptability of the risk and the estimated expected value of NPP accident. Therefore, an integrated framework for the estimation of the external cost associated with an NPP accident considering the public risk aversion behavior was proposed in this study based on the constructed theoretical framework for estimating both the value of statistical life (VSL) and the risk aversion coefficient associated with an NPP accident to take account of the accident cost into the unit electricity generation cost of NPP. To estimate both parameters, an individual-level survey was conducted on a sample of 1,364 participants in Korea. Based on the collected survey responses, both parameters were estimated based on the proposed framework and the external cost of NPP accident was estimated based on the consequence analysis and considering the direct cost factors for NPP accident. Internalization of external costs into the comprehensive energy production cost has been considered as a potentially efficient policy instrument for a more sustainable energy supply and use. However, the internalization of externalities, such as public health damage, have raised a number of generic policy issues in a nuclear energy sector, with specific challenges resulting from the distinct characteristics of external cost estimation. Especially, the major challenge remained to address the public safety concerns regarding a nuclear accident, which can be specified as low-probability high-consequence accident, driven by the aspects of public risk aversion

The application of cost-benefit analysis to the radiological protection of the public

International Nuclear Information System (INIS)

1980-03-01

The subject of this document is the quantification of the potential harm caused to the general public by ionising radiation in normal operating circumstances. The object is to enable the health detriment from a practice involving exposure to ionising radiation to be directly compared with the costs of keeping the ensuing doses as low as reasonably achievable. Chapter headings include: development of radiological protection criteria; principles underlying the valuation of harm from radiation exposure; risk evaluation approach to costing of detriment; monetary valuations; distribution of costs and risk in time. Appendices cover the following: cost benefit analysis (principles); recommendations of ICRP on the use of cost benefit analysis; life valuation studies (review); application of cost benefit analysis to the value of the man sievert. (U.K.)

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.

Cost and efficiency of public sector sexually transmitted infection clinics in Andhra Pradesh, India

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Ramesh YK

2005-11-01

Full Text Available Abstract Background Control of sexually transmitted infections (STIs is an important part of the effort to reduce the risk of HIV/AIDS. STI clinics in the government hospitals in India provide services predominantly to the poor. Data on the cost and efficiency of providing STI services in India are not available to help guide efficient use of public resources for these services. Methods Standardised methods were used to obtain detailed cost and output data for the 2003–2004 fiscal year from written records and interviews in 14 government STI clinics in the Indian state of Andhra Pradesh. The economic cost per patient receiving STI treatment was calculated, and the variations of total and unit costs across the STI clinics analysed. Multivariate regression technique was used to estimate incremental unit costs. The optimal number of STIs that could be handled by the clinics was estimated. Results 18807 STIs were diagnosed and treated at the 14 STI clinics in fiscal year 2003–2004 (range 323–2784, median 1199. The economic cost of treating each STI varied 5-fold from Indian Rupees (INR 225.5 (US$ 4.91 to INR 1201.5 (US$ 26.15 between 13 clinics, with one other clinic having a very high cost of INR 2478.5 (US$ 53.94. The average cost per STI treated for all 14 clinics combined was INR 729.5 (US$ 15.88. Personnel salaries made up 76.2% of the total cost. The number of STIs treated per doctor full-time equivalent and cost-efficiency for each STI treated had a significant direct non-linear relation (p 2 = 0.81; power function. With a multiple regression model, apart from the fixed costs, the incremental cost for each STI detected and cost of treatment was INR 55.57 (US$ 1.21 and for each follow-up visit was INR 3.75 (US$ 0.08. Based on estimates of optimal STI cases that could be handled without compromising quality by each doctor full-time equivalent available, it was projected that at 8 of the 14 clinics substantially more STI cases could be

Payment schemes and cost efficiency: evidence from Swiss public hospitals.

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Meyer, Stefan

2015-03-01

This paper aims at analysing the impact of prospective payment schemes on cost efficiency of acute care hospitals in Switzerland. We study a panel of 121 public hospitals subject to one of four payment schemes. While several hospitals are still reimbursed on a per diem basis for the treatment of patients, most face flat per-case rates-or mixed schemes, which combine both elements of reimbursement. Thus, unlike previous studies, we are able to simultaneously analyse and isolate the cost-efficiency effects of different payment schemes. By means of stochastic frontier analysis, we first estimate a hospital cost frontier. Using the two-stage approach proposed by Battese and Coelli (Empir Econ 20:325-332, 1995), we then analyse the impact of these payment schemes on the cost efficiency of hospitals. Controlling for hospital characteristics, local market conditions in the 26 Swiss states (cantons), and a time trend, we show that, compared to per diem, hospitals which are reimbursed by flat payment schemes perform better in terms of cost efficiency. Our results suggest that mixed schemes create incentives for cost containment as well, although to a lesser extent. In addition, our findings indicate that cost-efficient hospitals are primarily located in cantons with competitive markets, as measured by the Herfindahl-Hirschman index in inpatient care. Furthermore, our econometric model shows that we obtain biased estimates from frontier analysis if we do not account for heteroscedasticity in the inefficiency term.

Guidebook : managing operating costs for rural and small urban public transit systems.

Science.gov (United States)

2013-05-01

This guidebook is a resource for rural and small urban transit agency managers to use in better understanding, predicting, and managing operational costs. Doing so can improve the efficiency, effectiveness, and sustainability of public transit in the...

Financing end-use solar technologies in a restructured electricity industry: Comparing the cost of public policies

International Nuclear Information System (INIS)

Jones, E.; Eto, J.

1997-09-01

Renewable energy technologies are capital intensive. Successful public policies for promoting renewable energy must address the significant resources needed to finance them. Public policies to support financing for renewable energy technologies must pay special attention to interactions with federal, state, and local taxes. These interactions are important because they can dramatically increase or decrease the effectiveness of a policy, and they determine the total cost of a policy to society as a whole. This report describes a comparative analysis of the cost of public policies to support financing for two end-use solar technologies: residential solar domestic hot water heating (SDHW) and residential rooftop photovoltaic (PV) systems. The analysis focuses on the cost of the technologies under five different ownership and financing scenarios. Four scenarios involve leasing the technologies to homeowners in return for a payment that is determined by the financing requirements of each form of ownership. For each scenario, the authors examine nine public policies that might be used to lower the cost of these technologies: investment tax credits (federal and state), production tax credits (federal and state), production incentives, low-interest loans, grants (taxable and two types of nontaxable), direct customer payments, property and sales tax reductions, and accelerated depreciation

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

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Bergholz, W

2008-11-01

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

Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

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Zhao, Lue-Ping; Yu, Guo-Pei; Liu, Hui; Ma, Xie-Min; Wang, Jing; Kong, Gui-Lan; Li, Yi; Ma, Wen; Cui, Yong; Xu, Beibei; Yu, Na; Bao, Xiao-Yuan; Guo, Yu; Wang, Fei; Zhang, Jun; Li, Yan; Xie, Xue-Qin; Jiang, Bao-Guo; Ke, Yang

2013-01-01

With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS), cost per day (CPD), inpatient mortality rate (IMR), and length of stay (LOS), using a generalized additive model. There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (Phospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role. However, purely market-oriented health-care reform could also misguide future healthcare reform.

A cost management model for hospital food and nutrition in a public hospital.

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Neriz, Liliana; Núñez, Alicia; Ramis, Francisco

2014-11-13

In Chile, the use of costing systems in the public sector is limited. The Ministry of Health requires hospitals to manage themselves with the aim of decentralizing health care services and increasing their quality. However, self-management with a lack of accounting information is almost impossible. On the other hand, nutrition department costs have barely been studied before, and there are no studies specifically for activity based costing (ABC) systems. ABC focuses on the process and traces health care activities to gain a more accurate measurement of the object costs and the financial performance of an organization. This paper uses ABC in a nutrition unit of a public hospital of high complexity to determine costs associated with the different meals for inpatients. The paper also provides an activity based management (ABM) analysis for this unit. The results show positive effects on the reduction of costs for the nutrition department after implementing ABC/ABM. Therefore, there are opportunities to improve the profitability of the area and the results could also be replicated to other areas in the hospital. ABC shed light on the amount of nutritionist time devoted to completing paperwork, and as a result, system changes were introduced to reduce this burden and allow them to focus on more relevant activities. Additional efficiencies were achieved through the elimination of non-value adding activities and automation of reports. ABC reduced the cost of the nutrition department and could produce similar results in other areas of the hospital. This is a practical application of a financial management tool, ABC, which would be useful for hospital managers to reduce costs and improve the management of the unit. This paper takes ABC and examines its use in an area, which has had little exposure to the benefits of this tool.

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

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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

Eliciting road traffic injuries cost among Iranian drivers’ public vehicles using willingness to pay method

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Ainy, Elaheh; Soori, Hamid; Ganjali, Mojtaba; Baghfalaki, Taban

2015-01-01

Background and Aim: To allocate resources at the national level and ensure the safety level of roads with the aim of economic efficiency, cost calculation can help determine the size of the problem and demonstrate the economic benefits resulting from preventing such injuries. This study was carried out to elicit the cost of traffic injuries among Iranian drivers of public vehicles. Materials and Methods: In a cross-sectional study, 410 drivers of public vehicles were randomly selected from all the drivers in city of Tehran, Iran. The research questionnaire was prepared based on the standard for willingness to pay (WTP) method (stated preference (SP), contingent value (CV), and revealed preference (RP) model). Data were collected along with a scenario for vehicle drivers. Inclusion criteria were having at least high school education and being in the age range of 18 to 65 years old. Final analysis of willingness to pay was carried out using Weibull model. Results: Mean WTP was 3,337,130 IRR among drivers of public vehicles. Statistical value of life was estimated 118,222,552,601,648 IRR, for according to 4,694 dead drivers, which was equivalent to 3,940,751,753 $ based on the dollar free market rate of 30,000 IRR (purchase power parity). Injury cost was 108,376,366,437,500 IRR, equivalent to 3,612,545,548 $. In sum, injury and death cases came to 226,606,472,346,449 IRR, equivalent to 7,553,549,078 $. Moreover in 2013, cost of traffic injuries among the drivers of public vehicles constituted 1.25% of gross national income, which was 604,300,000,000$. WTP had a significant relationship with gender, daily payment, more payment for time reduction, more pay to less traffic, and minibus drivers. Conclusion: Cost of traffic injuries among drivers of public vehicles included 1.25% of gross national income, which was noticeable; minibus drivers had less perception of risk reduction than others. PMID:26157655

Eliciting road traffic injuries cost among Iranian drivers' public vehicles using willingness to pay method.

Science.gov (United States)

Ainy, Elaheh; Soori, Hamid; Ganjali, Mojtaba; Baghfalaki, Taban

2015-01-01

To allocate resources at the national level and ensure the safety level of roads with the aim of economic efficiency, cost calculation can help determine the size of the problem and demonstrate the economic benefits resulting from preventing such injuries. This study was carried out to elicit the cost of traffic injuries among Iranian drivers of public vehicles. In a cross-sectional study, 410 drivers of public vehicles were randomly selected from all the drivers in city of Tehran, Iran. The research questionnaire was prepared based on the standard for willingness to pay (WTP) method (stated preference (SP), contingent value (CV), and revealed preference (RP) model). Data were collected along with a scenario for vehicle drivers. Inclusion criteria were having at least high school education and being in the age range of 18 to 65 years old. Final analysis of willingness to pay was carried out using Weibull model. Mean WTP was 3,337,130 IRR among drivers of public vehicles. Statistical value of life was estimated 118,222,552,601,648 IRR, for according to 4,694 dead drivers, which was equivalent to 3,940,751,753 $ based on the dollar free market rate of 30,000 IRR (purchase power parity). Injury cost was 108,376,366,437,500 IRR, equivalent to 3,612,545,548 $. In sum, injury and death cases came to 226,606,472,346,449 IRR, equivalent to 7,553,549,078 $. Moreover in 2013, cost of traffic injuries among the drivers of public vehicles constituted 1.25% of gross national income, which was 604,300,000,000$. WTP had a significant relationship with gender, daily payment, more payment for time reduction, more pay to less traffic, and minibus drivers. Cost of traffic injuries among drivers of public vehicles included 1.25% of gross national income, which was noticeable; minibus drivers had less perception of risk reduction than others.

Cost comparison between private and public collection of residual household waste: Multiple case studies in the Flemish region of Belgium

International Nuclear Information System (INIS)

Jacobsen, R.; Buysse, J.; Gellynck, X.

2013-01-01

Highlights: ► The goal is to compare collection costs for residual household waste. ► We have clustered all municipalities in order to find mutual comparable pairs. ► Each pair consists of one private and one public operating waste collection program. ► All cases show that private service has lower costs than public service. ► Municipalities were contacted to identify the deeper causes for the waste management program. - Abstract: The rising pressure in terms of cost efficiency on public services pushes governments to transfer part of those services to the private sector. A trend towards more privatizing can be noticed in the collection of municipal household waste. This paper reports the findings of a research project aiming to compare the cost between the service of private and public collection of residual household waste. Multiple case studies of municipalities about the Flemish region of Belgium were conducted. Data concerning the year 2009 were gathered through in-depth interviews in 2010. In total 12 municipalities were investigated, divided into three mutual comparable pairs with a weekly and three mutual comparable pairs with a fortnightly residual waste collection. The results give a rough indication that in all cases the cost of private service is lower than public service in the collection of household waste. Albeit that there is an interest in establishing whether there are differences in the costs and service levels between public and private waste collection services, there are clear difficulties in establishing comparisons that can be made without having to rely on a large number of assumptions and corrections. However, given the cost difference, it remains the responsibility of the municipalities to decide upon the service they offer their citizens, regardless the cost efficiency: public or private.

Cost comparison between private and public collection of residual household waste: Multiple case studies in the Flemish region of Belgium

Energy Technology Data Exchange (ETDEWEB)

Jacobsen, R., E-mail: ray.jacobsen@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium); Buysse, J., E-mail: j.buysse@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium); Gellynck, X., E-mail: xavier.gellynck@ugent.be [Department of Agricultural Economics, Ghent University, Coupure Links 653, B-9000 Ghent (Belgium)

2013-01-15

Highlights: Black-Right-Pointing-Pointer The goal is to compare collection costs for residual household waste. Black-Right-Pointing-Pointer We have clustered all municipalities in order to find mutual comparable pairs. Black-Right-Pointing-Pointer Each pair consists of one private and one public operating waste collection program. Black-Right-Pointing-Pointer All cases show that private service has lower costs than public service. Black-Right-Pointing-Pointer Municipalities were contacted to identify the deeper causes for the waste management program. - Abstract: The rising pressure in terms of cost efficiency on public services pushes governments to transfer part of those services to the private sector. A trend towards more privatizing can be noticed in the collection of municipal household waste. This paper reports the findings of a research project aiming to compare the cost between the service of private and public collection of residual household waste. Multiple case studies of municipalities about the Flemish region of Belgium were conducted. Data concerning the year 2009 were gathered through in-depth interviews in 2010. In total 12 municipalities were investigated, divided into three mutual comparable pairs with a weekly and three mutual comparable pairs with a fortnightly residual waste collection. The results give a rough indication that in all cases the cost of private service is lower than public service in the collection of household waste. Albeit that there is an interest in establishing whether there are differences in the costs and service levels between public and private waste collection services, there are clear difficulties in establishing comparisons that can be made without having to rely on a large number of assumptions and corrections. However, given the cost difference, it remains the responsibility of the municipalities to decide upon the service they offer their citizens, regardless the cost efficiency: public or private.

Present-value analysis: A systems approach to public decisionmaking for cost effectiveness

Science.gov (United States)

Herbert, T. T.

1971-01-01

Decision makers within Governmental agencies and Congress must evaluate competing (and sometimes conflicting) proposals which seek funding and implementation. Present value analysis can be an effective decision making tool by enabling the formal evaluation of the effects of competing proposals on efficient national resource utilization. A project's costs are not only its direct disbursements, but its social costs as well. How much does it cost to have those funds diverted from their use and economic benefit by the private sector to the public project? Comparisons of competing projects' social costs allow decision makers to expand their decision bases by quantifying the projects' impacts upon the economy and the efficient utilization of the country's limited national resources. A conceptual model is established for the choosing of the appropriate discount rate to be used in evaluation decisions through the technique.

The costs of breast cancer in a Mexican public health institution

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Jacobo Alejandro Gómez-Rico

2008-11-01

Full Text Available Jacobo Alejandro Gómez-Rico1, Marina Altagracia-Martínez1, Jaime Kravzov-Jinich1, Rosario Cárdenas-Elizalde1, Consuelo Rubio-Poo21Universidad Autónoma Metropolitano–Xochimilco (UAM-X, Departments: Biological Systems and Healthcare, Biological and Health Sciences Division (DCBS; 2Universidad Nacional Autónoma de México (UNAM, Faculty of Professional Studies-Zaragoza (FES-ZaragozaAbstract: Breast cancer (BC is the second leading cause of death as a result of neoplasia in Mexico. This study aimed to identify the direct and indirect costs of treating female outpatients diagnosed with BC at a Mexican public hospital. A cross-sectional, observational, analytical study was conducted. A total of 506 medical records were analyzed and 102 were included in the cost analysis. The micro-costing process was used to estimate treatment costs. A 17-item questionnaire was used to obtain information on direct and indirect costs. Of the 102 women with BC included in the study, 92.2% (94 were at Stage II, and only 7.8% at Stage I. Total direct costs over six months for the 82 women who had modified radical mastectomy (MRM surgury were US$733,821.15. Total direct costs for the 15 patients with conservative surgery (CS were US$138,190.39. We found that the total economic burden in the study population was much higher for patients with MRM than for patients with CS.Keywords: breast cancer, Mexican women, direct and indirect costs

Corporation Income Tax and Administrative Costs of the Public Sector

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Břetislav Andrlík

2015-01-01

Full Text Available This contribution examines the issues of measurement of corporate income tax effectiveness in the circumstances of the Czech Republic, referred to as the tax on income of legal persons. The tax on income of legal persons represents a significant part of the public budget revenue, with the volume of collection of CZK 128,002 million in 2012. The theoretical basis for this contribution is the principle of tax system effectiveness, which is one of the principles characterizing a good tax system and is related to costs inherent in a tax system. The contribution defines two existing types of costs expended on the collection of taxes, i. e. administrative costs (direct or indirect and in theory describes excessive tax burden. In this contribution we shall focus on the measurement of direct administrative costs. The measurement of effectiveness of corporation income tax is performed with the use of the full-time equivalent (FTE method, which is based on the classification of revenue authorities’ staff according to their jobs and on the determination of conversion coefficients in order to identify costs related to the collection of a particular tax.A separate part of the article deals with measurement of administrative costs performed by the Organisation for Economic Co-operation and Development on the timeline ranging from year 2009 to 2011. The author of this article performed his own measurements concerning the direct administrative costs related to the collection of tax on income of legal persons in the Czech Republic. Results achieved in the respective monitored years are lower by the average (in the Czech Republic 2 percentage of ca 1.66 percentage points in relation to the average value of direct administrative costs of the Czech tax system.

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

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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

Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

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Lue-Ping Zhao

Full Text Available BACKGROUND: With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. METHODS: We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS, cost per day (CPD, inpatient mortality rate (IMR, and length of stay (LOS, using a generalized additive model. FINDINGS: There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001, from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. INTERPRETATIONS: These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role

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

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.

Potential travel cost saving in urban public-transport networks using smartphone guidance

Science.gov (United States)

2018-01-01

Public transport (PT) is a key element in most major cities around the world. With the development of smartphones, available journey planning information is becoming an integral part of the PT system. Each traveler has specific preferences when undertaking a trip, and these preferences can also be reflected on the smartphone. This paper considers transit assignment in urban public-transport networks in which the passengers receive smartphone-based information containing elements that might influence the travel decisions in relation to line loads, as well as passenger benefits, and the paper discusses the transition from the current widespread choosing approach to a personalized decision-making approach based on smartphone information. The approach associated with smartphone guidance that considers passengers’ preference on travel time, waiting time and transfer is proposed in the process of obtaining his/her preferred route from the potential travel routes generated by the Deep First Search (DFS) method. Two other approaches, based on the scenarios reflecting reality, include passengers with access to no real time information, and passengers that only have access to the arrival time at the platform are used as comparisons. For illustration, the same network proposed by Spiess and Florian is utilized on the experiments in an agent-based model. Two experiments are conducted respectively according to whether each passenger’s choosing method is consistent. As expected, the results in the first experiment showed that the travel for consistent passengers with smartphone guidance was clearly shorter and that it can reduce travel time exceeding 15% and weighted cost exceeding 20%, and the average saved time approximated 3.88 minutes per passenger. The second experiment presented that travel cost, as well as cost savings, gradually decreased by employing smartphone guidance, and the maximum cost savings accounted for 14.2% of the total weighted cost. PMID:29746528

Potential travel cost saving in urban public-transport networks using smartphone guidance.

Science.gov (United States)

Song, Cuiying; Guan, Wei; Ma, Jihui

2018-01-01

Public transport (PT) is a key element in most major cities around the world. With the development of smartphones, available journey planning information is becoming an integral part of the PT system. Each traveler has specific preferences when undertaking a trip, and these preferences can also be reflected on the smartphone. This paper considers transit assignment in urban public-transport networks in which the passengers receive smartphone-based information containing elements that might influence the travel decisions in relation to line loads, as well as passenger benefits, and the paper discusses the transition from the current widespread choosing approach to a personalized decision-making approach based on smartphone information. The approach associated with smartphone guidance that considers passengers' preference on travel time, waiting time and transfer is proposed in the process of obtaining his/her preferred route from the potential travel routes generated by the Deep First Search (DFS) method. Two other approaches, based on the scenarios reflecting reality, include passengers with access to no real time information, and passengers that only have access to the arrival time at the platform are used as comparisons. For illustration, the same network proposed by Spiess and Florian is utilized on the experiments in an agent-based model. Two experiments are conducted respectively according to whether each passenger's choosing method is consistent. As expected, the results in the first experiment showed that the travel for consistent passengers with smartphone guidance was clearly shorter and that it can reduce travel time exceeding 15% and weighted cost exceeding 20%, and the average saved time approximated 3.88 minutes per passenger. The second experiment presented that travel cost, as well as cost savings, gradually decreased by employing smartphone guidance, and the maximum cost savings accounted for 14.2% of the total weighted cost.

Interactive publications: creation and usage

Science.gov (United States)

Thoma, George R.; Ford, Glenn; Chung, Michael; Vasudevan, Kirankumar; Antani, Sameer

2006-02-01

As envisioned here, an "interactive publication" has similarities to multimedia documents that have been in existence for a decade or more, but possesses specific differentiating characteristics. In common usage, the latter refers to online entities that, in addition to text, consist of files of images and video clips residing separately in databases, rarely providing immediate context to the document text. While an interactive publication has many media objects as does the "traditional" multimedia document, it is a self-contained document, either as a single file with media files embedded within it, or as a "folder" containing tightly linked media files. The main characteristic that differentiates an interactive publication from a traditional multimedia document is that the reader would be able to reuse the media content for analysis and presentation, and to check the underlying data and possibly derive alternative conclusions leading, for example, to more in-depth peer reviews. We have created prototype publications containing paginated text and several media types encountered in the biomedical literature: 3D animations of anatomic structures; graphs, charts and tabular data; cell development images (video sequences); and clinical images such as CT, MRI and ultrasound in the DICOM format. This paper presents developments to date including: a tool to convert static tables or graphs into interactive entities, authoring procedures followed to create prototypes, and advantages and drawbacks of each of these platforms. It also outlines future work including meeting the challenge of network distribution for these large files.

Cost comparison between private and public collection of residual household waste: multiple case studies in the Flemish region of Belgium.

Science.gov (United States)

Jacobsen, R; Buysse, J; Gellynck, X

2013-01-01

The rising pressure in terms of cost efficiency on public services pushes governments to transfer part of those services to the private sector. A trend towards more privatizing can be noticed in the collection of municipal household waste. This paper reports the findings of a research project aiming to compare the cost between the service of private and public collection of residual household waste. Multiple case studies of municipalities about the Flemish region of Belgium were conducted. Data concerning the year 2009 were gathered through in-depth interviews in 2010. In total 12 municipalities were investigated, divided into three mutual comparable pairs with a weekly and three mutual comparable pairs with a fortnightly residual waste collection. The results give a rough indication that in all cases the cost of private service is lower than public service in the collection of household waste. Albeit that there is an interest in establishing whether there are differences in the costs and service levels between public and private waste collection services, there are clear difficulties in establishing comparisons that can be made without having to rely on a large number of assumptions and corrections. However, given the cost difference, it remains the responsibility of the municipalities to decide upon the service they offer their citizens, regardless the cost efficiency: public or private. Copyright © 2012 Elsevier Ltd. All rights reserved.

Application and importance of cost-benefit analysis in energy efficiency projects implemented in public buildings: The case of Serbia

Directory of Open Access Journals (Sweden)

Đurovic Dejan M.

2012-01-01

Full Text Available The main objective of this paper is to present the advantages of using Cost-Benefit analysis in energy efficiency projects implemented in public buildings, and to prove the hypothesis that Cost-Benefit analysis boosts the effectiveness and efficiency of the said type of projects. The paper offers theoretical and practical explanation of the implementation of Cost-Benefit analysis in the relevant area. Since energy efficiency projects in public buildings usually represent a part of a broader portfolio of similar projects and their implementation demands allocation of substantial financial resources, communities are often be interested in achieving maximal economic and non-economic benefits. This paper aims to demonstrate that Cost-Benefit analysis can represent an excellent contribution when attempting to select the projects for implementation within a broader portfolio of energy efficiency projects in public buildings. This hypothesis was demonstrated by putting a greater emphasis on non-economic benefits and the costs arising from implementation of the aforementioned types of projects. In addition, a practical test of this hypothesis was performed through the implementation of an energy efficiency portfolio in public buildings, worth several tens of millions of dollars - the Serbian Energy Efficiency Project. The paper concludes that the use of Cost-Benefit analysis can help us to effectively evaluate and manage projects of this type aimed at achieving maximum benefits for the community in question.

Analyzing the Cost-Effectiveness of Instruction Expenditures towards High School Completion among Oahu's Public School Districts

Science.gov (United States)

Ng, Larson S. W. M.

2011-01-01

The following study attempted to ascertain the instructional cost-effectiveness of public high school teachers towards high school completion through a financially based econometric analysis. Essentially, public high school instruction expenditures and completer data were collected from 2000 to 2007 and bivariate interaction analyzed through a…

76 FR 77533 - Notice of Order: Revisions to Enterprise Public Use Database Incorporating High-Cost Single...

Science.gov (United States)

2011-12-13

..., regarding FHFA's adoption of an Order revising FHFA's Public Use Database matrices to include certain data... FEDERAL HOUSING FINANCE AGENCY [No. 2011-N-13] Notice of Order: Revisions to Enterprise Public Use Database Incorporating High-Cost Single-Family Securitized Loan Data Fields and Technical Data Field...

Government regulation and public opposition create high additional costs for field trials with GM crops in Switzerland.

Science.gov (United States)

Bernauer, Thomas; Tribaldos, Theresa; Luginbühl, Carolin; Winzeler, Michael

2011-12-01

Field trials with GM crops are not only plant science experiments. They are also social experiments concerning the implications of government imposed regulatory constraints and public opposition for scientific activity. We assess these implications by estimating additional costs due to government regulation and public opposition in a recent set of field trials in Switzerland. We find that for every Euro spent on research, an additional 78 cents were spent on security, an additional 31 cents on biosafety, and an additional 17 cents on government regulatory supervision. Hence the total additional spending due to government regulation and public opposition was around 1.26 Euros for every Euro spent on the research per se. These estimates are conservative; they do not include additional costs that are hard to monetize (e.g. stakeholder information and dialogue activities, involvement of various government agencies). We conclude that further field experiments with GM crops in Switzerland are unlikely unless protected sites are set up to reduce these additional costs.

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

Cost-effectiveness analysis of public education and incentive programs for controlling radon in the home. Final report

International Nuclear Information System (INIS)

Bierma, T.J.; Swartzman, D.

1988-12-01

The objective of this study was to evaluate the cost-effectiveness in Illinois of five radon public education and incentive program options. Programs evaluated included (1) no program, (2) a toll-free hotline and information packet, (3) free short-term monitors, (4) free confirmatory monitors, and (5) low-interest loans. Existing literature and expert opinion were used to estimate program costs and public responses under the various programs. Computer simulation, with Monte Carlo sampling, was used for uncertainty and sensitivity analysis. The cost-effectiveness model was analyzed based on assumed radon exposures to Illinois citizens. Results for standard conditions indicate that budget levels under approximately $30,000 do not warrant a radon education and incentive program. For budget levels of approximately $30,000 to $1 million, Program 2 was most effective, and Program 3 was most effective above this level. Sensitivity analyses indicate the results are relatively insensitive to input variable assumptions with the exception of public-response estimates. Study results suggest that all of the programs evaluated are likely to be relatively ineffective. Considerable improvement may be possible using more innovative approaches to public education

Underestimating Costs in Public Works Projects

DEFF Research Database (Denmark)

Flyvbjerg, Bent; Holm, Mette K. Skamris; Buhl, Søren L.

2002-01-01

This article presents results from the first statistically significant study of cost escalation in transportation infrastructure projects. Based on a sample of 258 transportation infrastructure projects worth $90 billion (U.S.), it is found with overwhelming statistical significance that the cost...... honest numbers should not trust the cost estimates and cost-benefit analyses produced by project promoters and their analysts. Independent estimates and analyses are needed as are institutional checks and balances to curb deception.......This article presents results from the first statistically significant study of cost escalation in transportation infrastructure projects. Based on a sample of 258 transportation infrastructure projects worth $90 billion (U.S.), it is found with overwhelming statistical significance that the cost...... estimates used to decide whether important infrastructure should be built are highly and systematically misleading. The result is continuous cost escalation of billions of dollars. The sample used in the study is the largest of its kind, allowing for the first time statistically valid conclusions regarding...

Cost Underestimation in Public Works Projects

DEFF Research Database (Denmark)

Flyvbjerg, Bent; Holm, Mette K. Skamris; Buhl, Søren L.

This article presents results from the first statistically significant study of cost escalation in transportation infrastructure projects. Based on a sample of 258 transportation infrastructure projects worth $90 billion (U.S.), it is found with overwhelming statistical significance that the cost...... honest numbers should not trust the cost estimates and cost-benefit analyses produced by project promoters and their analysts. Independent estimates and analyses are needed as are institutional checks and balances to curb deception.......This article presents results from the first statistically significant study of cost escalation in transportation infrastructure projects. Based on a sample of 258 transportation infrastructure projects worth $90 billion (U.S.), it is found with overwhelming statistical significance that the cost...... estimates used to decide whether important infrastructure should be built are highly and systematically misleading. The result is continuous cost escalation of billions of dollars. The sample used in the study is the largest of its kind, allowing for the first time statistically valid conclusions regarding...

Cost benefit for assessment of intermediate coronary stenosis with fractional flow reserve in public and private sectors in australia.

Science.gov (United States)

Murphy, J C; Hansen, P S; Bhindi, R; Figtree, G A; Nelson, G I C; Ward, M R

2014-09-01

Fractional Flow Reserve (FFR) is a proven technology for guiding percutaneous coronary intervention (PCI), but is not reimbursed despite the fact that it is frequently used to defer PCI. Costs incurred with use of FFR were compared in both the public and private sectors with the costs that would have been incurred if the technology was not available using consecutive cases over a two year period in a public teaching hospital and its co-located private hospital. FFR was performed on 143 lesions in 120 patients. FFR was cost of $A1200 per wire, FFR actually saved money. Mean savings in the public sector were $1200 per patient while in the private sector the savings were $5000 per patient. FFR use saves money for the Federal Government in the public sector and for the Private Health Funds in the private sector. These financial benefits are seen in addition to the improved outcomes seen with this technology. Copyright © 2014. Published by Elsevier B.V.

Governmental costs and revenues associated with geothermal energy development in Imperial County. Special Publication 3241

Energy Technology Data Exchange (ETDEWEB)

Goldman, G.; Strong, D.

1977-10-01

This study estimates the cost and revenue impacts to local governments of three geothermal energy growth scenarios in Imperial County. The level of geothermal energy potential for the three development scenarios tested is 2,000, 4,000 and 8,000 MW--enough power to serve 270,000 to 1,000,000 people. The government agencies involved do not expect any substantial additional capital costs due to geothermal energy development; therefore, average costing techniques have been used for projecting public service costs and government revenues. The analysis of the three growth scenarios tested indicates that county population would increase by 3, 7 and 19 percent and assessed values would increase by 20, 60, and 165 percent for Alternatives No. 1, No. 2 and No. 3 respectively. Direct and indirect effects would increase new jobs in the county by 1,000, 3,000 and 8,000. Government revenues would tend to exceed public service costs for county and school districts, while city costs would tend to exceed revenues. In each of the alternatives, if county, cities and school districts are grouped together, the revenues exceed costs by an estimated $1,600 per additional person either directly or indirectly related to geothermal energy development in the operational stages. In the tenth year of development, while facilities are still being explored, developed and constructed, the revenues would exceed costs by an approximate $1,000 per additional person for each alternative. School districts with geothermal plants in their boundaries would be required by legislation SB 90 to reduce their tax rates by 15 to 87 percent, depending on the level of energy development. Revenue limits and school taxing methods will be affected by the Serrano-Priest decision and by new school legislation in process.

Utilities Cost Comparison Analysis between a Public Work Center and the Non-DoD Sector

Science.gov (United States)

1992-12-01

construction, consider innovative financing and 14 management arrangements (e.g. cost-sharing, public-private venture, leasing). Integrate...and services by financing all incurred costs. 27 Cash is put back into the working capital fund when customers pay cash from their O&M,N funds for the...firms, and other significantly sized business firms. The actual participants of the study may or may not be included in this listing. Disneyland was

Cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia in the Brazilian public health system

Directory of Open Access Journals (Sweden)

Luciana Ribeiro Bahia

2012-10-01

Full Text Available OBJECTIVE: To perform a cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia (BPH under Brazilian public health system perspective (Unified Health System - "Sistema Único de Saúde (SUS". MATERIAL AND METHODS: A revision of the literature of the medical treatment of BPH using alpha-blockers, 5-alpha-reductase inhibitors and combinations was carried out. A panel of specialists defined the use of public health resources during episodes of acute urinary retention (AUR, the treatment and the evolution of these patients in public hospitals. A model of economic analysis(Markov predicted the number of episodes of AUR and surgeries (open prostatectomy and transurethral resection of the prostate related to BPH according to stages of evolution of the disease. Brazilian currency was converted to American dollars according to the theory of Purchasing Power Parity (PPP 2010: US$ 1 = R$ 1.70. RESULTS: The use of finasteride reduced 59.6% of AUR episodes and 57.9% the need of surgery compared to placebo, in a period of six years and taking into account a treatment discontinuity rate of 34%. The mean cost of treatment was R$ 764.11 (US$449.78 and R$ 579.57 (US$ 340.92 per patient in the finasteride and placebo groups, respectively. The incremental cost-effectiveness ratio (ICERs was R$ 4.130 (US$ 2.429 per episode of AUR avoided and R$ 2.735 (US$ 1.609 per episode of surgery avoided. The comparison of finasteride + doxazosine to placebo showed a reduction of 75.7% of AUR episodes and 66.8% of surgeries in a 4 year time horizon, with a ICERs of R$ 21.191 (US$ 12.918 per AUR episodes avoided and R$ 11.980 (US$ 7.047 per surgery avoided. In the sensitivity analysis the adhesion rate to treatment and the cost of finasteride were the main variables that influenced the results. CONCLUSIONS: These findings suggest that the treatment of BPH with finasteride is cost-effective compared to placebo in the Brazilian public health system

REDUCING COSTS OF TAX COMPLIANCE AND INVESTMENTS IN PUBLIC SYSTEM OF DIGITAL BOOKKEEPING – SPED – IN BRAZIL

Directory of Open Access Journals (Sweden)

Edson Sampaio de Lima

2016-04-01

Full Text Available The Public System of Digital Bookkeeping – SPED was developed with the intention of further integration between the tax administrations themselves, then between them and the taxpayers, through the use of technology and, consequently, socioeconomic data standard, in a single environment, raising the tax collection efficiency and reducing the costs of administration and compliance. This article intends to contribute to the analysis of public investments directed to the establishment and maintenance of the project, effectively resulted in a reduction in the costs of tax compliance, temporary and permanent. Survey method was used as a non-random mechanism for data collection, with a developed questionnaire containing 22 questions based on the prediction model regulatory impact developed and applied by the Australian Taxation Office – ATO in your country, adapted to identify cost reduction compliance related to three specific organizational aspects: People, Technology and Procurement of Consulting Services. The questionnaire was emailed to 20 people with executive position or managers directly involved in the project in SPED size businesses and distinct segment. Responded to the survey 20 of the 20 companies. The data collected were analyzed through descriptive and exploratory, in the latter case using the cluster analysis. The survey approach has met both the qualitative and the quantitative research. The results indicate that the SPED caused an increase in compliance costs temporary and permanent, mainly due to the implementation strategy defined and applied solely by the public administration. The analysis also allowed evidence that even if public investments directed to the implementation and maintenance of SPED are not comparatively similar to private investments directed to the same end, it shows a tendency to shift costs of administration for compliance costs for taxpayers.

Investment Success in Public Health: An Analysis of the Cost-Effectiveness and Cost-Benefit of the Global Programme to Eliminate Lymphatic Filariasis

Science.gov (United States)

Bettis, Alison A.; Chu, Brian K.; McFarland, Deborah A.; Hooper, Pamela J.; Mante, Sunny D.; Fitzpatrick, Christopher; Bradley, Mark H.

2017-01-01

Abstract Background. It has been estimated that $154 million per year will be required during 2015–2020 to continue the Global Programme to Eliminate Lymphatic Filariasis (GPELF). In light of this, it is important to understand the program’s current value. Here, we evaluate the cost-effectiveness and cost-benefit of the preventive chemotherapy that was provided under the GPELF between 2000 and 2014. In addition, we also investigate the potential cost-effectiveness of hydrocele surgery. Methods. Our economic evaluation of preventive chemotherapy was based on previously published health and economic impact estimates (between 2000 and 2014). The delivery costs of treatment were estimated using a model developed by the World Health Organization. We also developed a model to investigate the number of disability-adjusted life years (DALYs) averted by a hydrocelectomy and identified the cost threshold under which it would be considered cost-effective. Results. The projected cost-effectiveness and cost-benefit of preventive chemotherapy were very promising, and this was robust over a wide range of costs and assumptions. When the economic value of the donated drugs was not included, the GPELF would be classed as highly cost-effective. We projected that a typical hydrocelectomy would be classed as highly cost-effective if the surgery cost less than $66 and cost-effective if less than $398 (based on the World Bank’s cost-effectiveness thresholds for low income countries). Conclusions. Both the preventive chemotherapy and hydrocele surgeries provided under the GPELF are incredibly cost-effective and offer a very good investment in public health. PMID:27956460

Data-Driven Transition: Joint Reporting of Subscription Expenditure and Publication Costs

Directory of Open Access Journals (Sweden)

Irene Barbers

2018-04-01

Full Text Available The transition process from the subscription model to the open access model in the world of scholarly publishing brings a variety of challenges to libraries. Within this evolving landscape, the present article takes a focus on budget control for both subscription and publication expenditure with the opportunity to enable the shift from one to the other. To reach informed decisions with a solid base of data to be used in negotiations with publishers, the diverse already-existing systems for managing publications costs and for managing journal subscriptions have to be adapted to allow comprehensive reporting on publication expenditure and subscription expenditure. In the case presented here, two separate systems are described and the establishment of joint reporting covering both these systems is introduced. Some of the results of joint reporting are presented as an example of how such a comprehensive monitoring can support management decisions and negotiations. On a larger scale, the establishment of the National Open Access Monitor in Germany is introduced, bringing together a diverse range of data from several already-existing systems, including, among others, holdings information, usage data, and data on publication fees. This system will enable libraries to access all relevant data with a single user interface.

Public financing of the Medicare program will make its uniform structure increasingly costly to sustain.

Science.gov (United States)

Baicker, Katherine; Shepard, Mark; Skinner, Jonathan

2013-05-01

The US Medicare program consumes an ever-rising share of the federal budget. Although this public spending can produce health and social benefits, raising taxes to finance it comes at the cost of slower economic growth. In this article we describe a model incorporating the benefits of public programs and the cost of tax financing. The model implies that the "one-size-fits-all" Medicare program, with everyone covered by the same insurance policy, will be increasingly difficult to sustain. We show that a Medicare program with guaranteed basic benefits and the option to purchase additional coverage could lead to more unequal health spending but slower growth in taxation, greater overall well-being, and more rapid growth of gross domestic product. Our framework highlights the key trade-offs between Medicare spending and economic prosperity.

The Relative Patient Costs and Availability of Dental Services, Materials and Equipment in Public Oral Care Facilities in Tanzania.

OpenAIRE

Nyamuryekung'e, Kasusu K; Lahti, Satu M; Tuominen, Risto J

2015-01-01

Background Patient charges and availability of dental services influence utilization of dental services. There is little available information on the cost of dental services and availability of materials and equipment in public dental facilities in Africa. This study aimed to determine the relative cost and availability of dental services, materials and equipment in public oral care facilities in Tanzania. The local factors affecting availability were also studied. Methods A survey of all dis...

Niche public transport operational and capital investment strategies to minimize fares in the light of increased energy costs

CSIR Research Space (South Africa)

Letebele, MO

2009-07-01

Full Text Available Fuel costs are a significant component of a public transport fare. It is therefore of critical importance for measures aimed at containing household public transport expenditure to explore alternative ways of reducing fuel consumption or fuel...

Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system: results from a 5-year follow-up cohort study.

Science.gov (United States)

Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra; Ziebe, Søren; Mikkelsen Englund, Anne L; Hald, Finn; Boivin, Jacky; Schmidt, Lone

2014-01-01

To examine the costs to the public health care system of couples in medically assisted reproduction. Longitudinal cohort study of infertile couples initiating medically assisted reproduction treatment. Specialized public fertility clinics in Denmark. Seven hundred and thirty-nine couples having no child at study entry and with data on kind of treatment and live birth (yes/no) for each treatment attempt at the specialized public fertility clinic. Treatment data for medically assisted reproduction attempts conducted at the public fertility clinics were abstracted from medical records. Flow diagrams were drawn for different standard treatment cycles and direct costs at each stage in the flow charts were measured and valued by a bottom-up procedure. Indirect costs were distributed to each treatment cycle on the basis of number of visits as basis. Costs were adjusted to 2012 prices using a constructed medical price index. Live birth, costs. Total costs per live birth in 2012 prices were estimated to 10,755€. Costs per treated couple - irrespective of whether the treatment was terminated by a live birth or not - were estimated at 6607€. Costs per live birth of women <35 years at treatment initiation were 9338€ and 15,040€ for women ≥35 years. The public costs for live births after conception with medically assisted reproduction treatment are relatively modest. The results can be generalized to public fertility treatment in Denmark and to other public treatment settings with similar limitations in numbers of public treatment cycles offered. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Investment Success in Public Health: An Analysis of the Cost-Effectiveness and Cost-Benefit of the Global Programme to Eliminate Lymphatic Filariasis.

Science.gov (United States)

Turner, Hugo C; Bettis, Alison A; Chu, Brian K; McFarland, Deborah A; Hooper, Pamela J; Mante, Sunny D; Fitzpatrick, Christopher; Bradley, Mark H

2017-03-15

It has been estimated that $154 million per year will be required during 2015-2020 to continue the Global Programme to Eliminate Lymphatic Filariasis (GPELF). In light of this, it is important to understand the program's current value. Here, we evaluate the cost-effectiveness and cost-benefit of the preventive chemotherapy that was provided under the GPELF between 2000 and 2014. In addition, we also investigate the potential cost-effectiveness of hydrocele surgery. Our economic evaluation of preventive chemotherapy was based on previously published health and economic impact estimates (between 2000 and 2014). The delivery costs of treatment were estimated using a model developed by the World Health Organization. We also developed a model to investigate the number of disability-adjusted life years (DALYs) averted by a hydrocelectomy and identified the cost threshold under which it would be considered cost-effective. The projected cost-effectiveness and cost-benefit of preventive chemotherapy were very promising, and this was robust over a wide range of costs and assumptions. When the economic value of the donated drugs was not included, the GPELF would be classed as highly cost-effective. We projected that a typical hydrocelectomy would be classed as highly cost-effective if the surgery cost less than $66 and cost-effective if less than $398 (based on the World Bank's cost-effectiveness thresholds for low income countries). Both the preventive chemotherapy and hydrocele surgeries provided under the GPELF are incredibly cost-effective and offer a very good investment in public health. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

Measuring cost efficiency in the Nordic hospitals--a cross-sectional comparison of public hospitals in 2002

DEFF Research Database (Denmark)

Linna, Miika; Häkkinen, Unto; Peltola, Mikko

2010-01-01

The aim of this study was to compare the performance of hospital care in four Nordic countries: Norway, Finland, Sweden and Denmark. Using national discharge registries and cost data from hospitals, cost efficiency in the production of somatic hospital care was calculated for public hospitals. Data......, average efficiency was markedly higher in Finland compared to Norway and Sweden. This study found differences in cost efficiency that cannot be explained by input prices or differences in coding practices. More analysis is needed to reveal the causes of large efficiency disparities between Nordic...

Managerial performance and cost efficiency of Japanese local public hospitals: a latent class stochastic frontier model.

Science.gov (United States)

Besstremyannaya, Galina

2011-09-01

The paper explores the link between managerial performance and cost efficiency of 617 Japanese general local public hospitals in 1999-2007. Treating managerial performance as unobservable heterogeneity, the paper employs a panel data stochastic cost frontier model with latent classes. Financial parameters associated with better managerial performance are found to be positively significant in explaining the probability of belonging to the more efficient latent class. The analysis of latent class membership was consistent with the conjecture that unobservable technological heterogeneity reflected in the existence of the latent classes is related to managerial performance. The findings may support the cause for raising efficiency of Japanese local public hospitals by enhancing the quality of management. Copyright © 2011 John Wiley & Sons, Ltd.

Direct costs of dengue hospitalization in Brazil: public and private health care systems and use of WHO guidelines.

Science.gov (United States)

Vieira Machado, Alessandra A; Estevan, Anderson Oliveira; Sales, Antonio; Brabes, Kelly Cristina da Silva; Croda, Júlio; Negrão, Fábio Juliano

2014-09-01

Dengue, an arboviral disease, is a public health problem in tropical and subtropical regions worldwide. In Brazil, epidemics have become increasingly important, with increases in the number of hospitalizations and the costs associated with the disease. This study aimed to describe the direct costs of hospitalized dengue cases, the financial impact of admissions and the use of blood products where current protocols for disease management were not followed. To analyze the direct costs of dengue illness and platelet transfusion in Brazil based on the World Health Organization (WHO) guidelines, we conducted a retrospective cross-sectional census study on hospitalized dengue patients in the public and private Brazilian health systems in Dourados City, Mato Grosso do Sul State, Brazil. The analysis involved cases that occurred from January through December during the 2010 outbreak. In total, we examined 8,226 mandatorily reported suspected dengue cases involving 507 hospitalized patients. The final sample comprised 288 laboratory-confirmed dengue patients, who accounted for 56.8% of all hospitalized cases. The overall cost of the hospitalized dengue cases was US $210,084.30, in 2010, which corresponded to 2.5% of the gross domestic product per capita in Dourados that year. In 35.2% of cases, blood products were used in patients who did not meet the blood transfusion criteria. The overall median hospitalization cost was higher (p = 0.002) in the group that received blood products (US $1,622.40) compared with the group that did not receive blood products (US $550.20). The comparative costs between the public and the private health systems show that both the hospitalization of and platelet transfusion in patients who do not meet the WHO and Brazilian dengue guidelines increase the direct costs, but not the quality, of health care.

The High Cost of Failing to Reform Public Education in Texas. School Choice Issues in the State

Science.gov (United States)

Gottlob, Brian J.

2008-01-01

Research has documented a crisis in Texas high school graduation rates. Only 67 percent of Texas students graduate from high school, and some large urban districts have graduation rates of 50 percent or lower. This study documents the public costs of high school dropouts in Texas and examines how school choice could provide large public benefits…

Why do bacteria regulate public goods by quorum sensing?-How the shapes of cost and benefit functions determine the form of optimal regulation

DEFF Research Database (Denmark)

Heilmann, Silja; Krishna, Sandeep; Kerr, Benjamin

2015-01-01

as a function of population size (the optimal production curve, OPC) depends crucially on the cost and benefit functions of the public good and that the OPC will fall into one of two categories: Either it is continuous or it jumps from zero discontinuously at a critical population size. If, e.g., the public...... good has accelerating returns and linear cost, then the OPC is discontinuous and the best strategy thus to ramp up production sharply at a precise population size. By using the example of public goods with accelerating and diminishing returns (and linear cost) we are able to determine how the two......Many bacteria secrete compounds which act as public goods. Such compounds are often under quorum sensing (QS) regulation, yet it is not understood exactly when bacteria may gain from having a public good under QS regulation. Here, we show that the optimal public good production rate per cell...

An extended cost-effectiveness analysis of schizophrenia treatment in India under universal public finance.

Science.gov (United States)

Raykar, Neha; Nigam, Aditi; Chisholm, Dan

2016-01-01

Schizophrenia remains a priority condition in mental health policy and service development because of its early onset, severity and consequences for affected individuals and households. This paper reports on an 'extended' cost-effectiveness analysis (ECEA) for schizophrenia treatment in India, which seeks to evaluate through a modeling approach not only the costs and health effects of intervention but also the consequences of a policy of universal public finance (UPF) on health and financial outcomes across income quintiles. Using plausible values for input parameters, we conclude that health gains from UPF are concentrated among the poorest, whereas the non-health gains in the form of out-of-pocket private expenditures averted due to UPF are concentrated among the richest income quintiles. Value of insurance is the highest for the poorest quintile and declines with income. Universal public finance can play a crucial role in ameliorating the adverse economic and social consequences of schizophrenia and its treatment in resource-constrained settings where health insurance coverage is generally poor. This paper shows the potential distributional and financial risk protection effects of treating schizophrenia.

Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India.

OpenAIRE

Floyd, Katherine; Arora, V. K.; Murthy, K. J. R.; Lonnroth, Knut; Singla, Neeta; Akbar, Y.; Zignol, Matteo; Uplekar, Mukund

2006-01-01

OBJECTIVE: To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India. METHODS: We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews. The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector. Costs for 2002 in US$ were assessed for the publ...

Environmental Public Health Tracking: a cost-effective system for characterizing the sources, distribution and public health impacts of environmental hazards.

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Saunders, P J; Middleton, J D; Rudge, G

2017-09-01

The contemporary environment is a complex of interactions between physical, biological, socio-economic systems with major impacts on public health. However, gaps in our understanding of the causes, extent and distribution of these effects remain. The public health community in Sandwell West Midlands has collaborated to successfully develop, pilot and establish the first Environmental Public Health Tracking (EPHT) programme in Europe to address this 'environmental health gap' through systematically linking data on environmental hazards, exposures and diseases. Existing networks of environmental, health and regulatory agencies developed a suite of innovative methods to routinely share, integrate and analyse data on hazards, exposures and health outcomes to inform interventions. Effective data sharing and horizon scanning systems have been established, novel statistical methods piloted, plausible associations framed and tested, and targeted interventions informed by local concerns applied. These have influenced changes in public health practice. EPHT is a powerful tool for identifying and addressing the key environmental public health impacts at a local level. Sandwell's experience demonstrates that it can be established and operated at virtually no cost. The transfer of National Health Service epidemiological skills to local authorities in 2013 provides an opportunity to expand the programme to fully exploit its potential. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Recovery Risk and Labor Costs in Public-Private Partnerships : Contractual Choice in the US Water industry

OpenAIRE

Albalate, Daniel, 1980-; Bel i Queralt, Germà, 1963-; Geddes, R. Richard

2012-01-01

We use an ordered logistic model to empirically examine the factors that explain varying degrees of private involvement in the U.S. water sector through public-private partnerships. Our estimates suggest that a variety of factors help explain greater private participation in this sector. We find that the risk to private participants regarding cost recovery is an important driver of private participation. The relative cost of labor is also a key factor in determining the degree of private invo...

Kirsten Fudeman, Aaron Lawson, Carol Rosen and Devon Strolovitch (Editors, Cornell Working Papers in Linguistics, Romance Philology 17, Cornell Universitiy, Ithaca, NY 1999, 196 pagine

Directory of Open Access Journals (Sweden)

Pavao Tekavčić

2015-08-01

Full Text Available Sotto questo titolo è apparsa nell'autunno del 1999 un'antologia curata dai quattro editori„ contenente 29 brani (ad opera dei curatori e altri collaboratori. Le linee direttrici sono esposte nella prefazione (Preface, 2 pagine introduttive fuori paginazione. La base è l'antologia Early Romance Texts: An Anthology (1980 di Rodney Sampson, definita invaluable, ma ormai di difficile accesso. Perciò, con la presente scelta di testi si cerca di ovviare a questa situazione. Ci sono pero determinati limiti: infatti, sono stati tralasciati i testi più noti, canonici, già bene studiati, ma nel contempo si è desistito anche dall'includere soltanto testi finora non pubblicati. In tal modo si è scelta una via di mezzo, includendo i testi meno noti e meno discussi, tutti pubblicati, è vero, già prima ma in places now considered relatively obscure e parecchio tempo (perfino tutto un secolo fa. La struttura di tutti i contributi è identica: ad una succinta introduzione (dati essenziali sul relativo testo seguono il brano, i commenti, la bibliografia e la traduzione inglese. In tal modo l'antologia è coerente, di facile orientamento ed altrettanto facili confronti tra i singoli testi, il che è di notevole

Return on investment: a fuller assessment of the benefits and cost savings of the US publicly funded family planning program.

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Frost, Jennifer J; Sonfield, Adam; Zolna, Mia R; Finer, Lawrence B

2014-12-01

Policy Points: The US publicly supported family planning effort serves millions of women and men each year, and this analysis provides new estimates of its positive impact on a wide range of health outcomes and its net savings to the government. The public investment in family planning programs and providers not only helps women and couples avoid unintended pregnancy and abortion, but also helps many thousands avoid cervical cancer, HIV and other sexually transmitted infections, infertility, and preterm and low birth weight births. This investment resulted in net government savings of $13.6 billion in 2010, or $7.09 for every public dollar spent. Each year the United States' publicly supported family planning program serves millions of low-income women. Although the health impact and public-sector savings associated with this program's services extend well beyond preventing unintended pregnancy, they never have been fully quantified. Drawing on an array of survey data and published parameters, we estimated the direct national-level and state-level health benefits that accrued from providing contraceptives, tests for the human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), Pap tests and tests for human papillomavirus (HPV), and HPV vaccinations at publicly supported family planning settings in 2010. We estimated the public cost savings attributable to these services and compared those with the cost of publicly funded family planning services in 2010 to find the net public-sector savings. We adjusted our estimates of the cost savings for unplanned births to exclude some mistimed births that would remain publicly funded if they had occurred later and to include the medical costs for births through age 5 of the child. In 2010, care provided during publicly supported family planning visits averted an estimated 2.2 million unintended pregnancies, including 287,500 closely spaced and 164,190 preterm or low birth weight (LBW) births, 99

Toward a treaty on safety and cost-effectiveness of pharmaceuticals and medical devices: enhancing an endangered global public good

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Faunce Thomas

2006-03-01

Full Text Available Abstract • Expert evaluations of the safety, efficacy and cost-effectiveness of pharmaceutical and medical devices, prior to marketing approval or reimbursement listing, collectively represent a globally important public good. The scientific processes involved play a major role in protecting the public from product risks such as unintended or adverse events, sub-standard production and unnecessary burdens on individual and governmental healthcare budgets. • Most States now have an increasing policy interest in this area, though institutional arrangements, particularly in the area of cost-effectiveness analysis of medical devices, are not uniformly advanced and are fragile in the face of opposing multinational industry pressure to recoup investment and maintain profit margins. • This paper examines the possibility, in this context, of States commencing negotiations toward bilateral trade agreement provisions, and ultimately perhaps a multilateral Treaty, on safety, efficacy and cost-effectiveness analysis of pharmaceuticals and medical devices. Such obligations may robustly facilitate a conceptually interlinked, but endangered, global public good, without compromising the capacity of intellectual property laws to facilitate local product innovations.

Does public insurance provide better financial protection against rising health care costs for families of children with special health care needs?

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Yu, Hao; Dick, Andrew W; Szilagyi, Peter G

2008-10-01

Health care costs grew rapidly since 2001, generating substantial economic pressures on families, especially those with children with special health care needs (CSHCN). To examine how the growth of health care costs affected financial burden for families of CSHCN between 2001 and 2004 and to determine the extent to which health insurance coverage protected families of CSHCN against financial burden. In 2001-2004, 5196 families of CSHCN were surveyed by the national Medical Expenditure Panel Survey (MEPS). The main outcome was financial burden, defined as the proportion of family income spent on out-of-pocket (OOP) health care expenditures for all family members, including OOP costs and premiums. Family insurance coverage was classified as: (1) all members publicly insured, (2) all members privately insured, (3) all members uninsured, (4) partial coverage, and (5) a mix of public and private with no uninsured periods. An upward trend in financial burden for families of CSHCN occurred and was associated with growth of economy-wide health care costs. A multivariate analysis indicated that, given the economy-wide increase in medical costs between 2001 and 2004, a family with CSHCN was at increased risk in 2004 for having financial burden exceeding 10% of family income [odds ratio (OR) = 1.39; P financial burden exceeding 20% of family income. Over 15% of families with public insurance had financial burden exceeding 10% of family income compared with 20% of families with private insurance (P financial burden of >10% or 20% of family income than privately-insured families. Rising health care costs increased financial burden on families of CSHCN in 2001-2004. Public insurance coverage provided better financial protection than private insurance against the rapidly rising health care costs for families of CSHCN.

42 CFR 423.6 - Cost-sharing in beneficiary education and enrollment-related costs.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Cost-sharing in beneficiary education and enrollment-related costs. 423.6 Section 423.6 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... BENEFIT General Provisions § 423.6 Cost-sharing in beneficiary education and enrollment-related costs. The...

Costs Systems: Relevance, Feasibility And Usefulness According To Public Officials In The State Of Paraná (Brazil

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Luciane Maria Gonçalves Franco

2013-06-01

Full Text Available The aim in this study is to get to know the level of understanding and adoption of cost systems in cities in the State of Paraná. A descriptive study with a qualitative approach was undertaken. Data were collected through the application of a questionnaire in 67 cities in the State of Paraná. Descriptive analysis was used and Spearman’s correlation coefficient was applied to achieve the research objective. Among the study results, the following stand out: the incipient nature of knowledge about the relevance, feasibility and usefulness of a cost system; resulting from public officials’ limited knowledge, mainly about topics related to the budgetary and financial feasibility of adopting cost systems; an environment for the cost system, implemented costs systems and operating systems; although the answers obtained to proposals about cost information and control were significantly coherent.

Effects of County Public Hospital Reform on Procurement Costs and Volume of Antibiotics: A Quasi-Natural Experiment in Hubei Province, China.

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Tang, Yuqing; Liu, Chaojie; Liu, Junjie; Zhang, Xinping; Zuo, Keyuan

2018-04-18

The overuse of antibiotics has become a major public health challenge worldwide, especially in low- and middle-income countries, including China. In 2009, the Chinese government launched a series of measures to de-incentivise over-prescription in public health facilities, including decoupling the link between facility income and the sale of medicines. We evaluated the effects of these measures on procurement costs and the volume of antibiotics in county public hospitals. The study was undertaken in the Hubei province of China, where 64 county public hospitals implemented the reform in sequence at three different stages. A quasi-natural experiment design was employed. We performed generalised linear regressions with a difference-in-differences approach using 22,713 procurement records of antibiotics from November 2014 to December 2016. The regression results showed that the reform contributed to a 14.79% increase in total costs for antibiotics (p = 0.013), particularly costs for injectable antibiotics (p = 0.022) and first-line antibiotics (p = 0.030). The procurement prices for antibiotics remained largely comparable to those in the control group, but the reform led to a 17.30% increase in the procurement volume (expressed as defined daily doses) of second-line antibiotics (p = 0.032). County public hospitals procured more antibiotics and greater numbers of expensive antibiotics, such as those administered via injection, to compensate for the loss of income from the sale of medicines, leading to an increased total cost of antibiotics.

Gauging the Purported Costs of Public Data Archiving for Long-Term Population Studies.

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Evans, Simon Robin

2016-04-01

It was recently proposed that long-term population studies be exempted from the expectation that authors publicly archive the primary data underlying published articles. Such studies are valuable to many areas of ecological and evolutionary biological research, and multiple risks to their viability were anticipated as a result of public data archiving (PDA), ultimately all stemming from independent reuse of archived data. However, empirical assessment was missing, making it difficult to determine whether such fears are realistic. I addressed this by surveying data packages from long-term population studies archived in the Dryad Digital Repository. I found no evidence that PDA results in reuse of data by independent parties, suggesting the purported costs of PDA for long-term population studies have been overstated.

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

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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.

I racconti votivi contemporanei: pagine di un continuo liber miraculorum

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Vincenzo Spera

2017-07-01

Full Text Available The article is based on documentations collected in field research conducted in sanctuaries and places of worship in South and Central Italy, since the early Seventies of last century until the first decade of the present one. The article presents an interpretation of the ex voto like a kind of storytelling of the experience lived by the devotee who claims to have had contact with the powerful Otherness. These votive tales, packed with painted images, photos, installations of various materials, written texts, are compared to the hagiographies of the Saints and exemplary stories which the devotee takes as specimen to present and tell publicly his own story of suffering and salvation.

Public Concepts of the Values and Costs of Higher Education, 1963-1974. A Preliminary Analysis.

Science.gov (United States)

Minor, Michael J.; Murray, James R.

Statistical data are presented on interviews conducted through the Continuous National Survey (CNS) at the National Opinion Research Center in Chicago and based on results reprinted from "Public Concepts of the Values and Costs of Higher Education," by Angus Campbell and William C. Eckerman. The CNS results presented in this report are…

[Evaluation of financial status of public hospitals considering the updated costs of their services].

Science.gov (United States)

Cid P, Camilo; Bastías S, Gabriel

2014-02-01

In 2011 the Chilean National Health Fund (FONASA) commissioned a study to assess the costs of the 120 most relevant hospital care services with an established fee, in a large sample of public hospitals. We herein report the cost evaluation results of such study, considering the financial condition of those hospitals in the year of the study. Based on the premise that the expenses derived from the provision of institutional and appraised hospital services should be identical to the billing of hospitals to FONASA, the prices are undervalued, since they cover only 56% of billing, generating a gap between expenses and invoicing. This gap shows an important limitation of tariffs, since their prices do not cover the real costs. However not all hospitals behave in the same way. While the provision of services of some hospitals is even higher than their billing, most hospitals do not completely justify their invoicing. These assumptions would imply that, generally speaking, hospital debts are justified by the costs incurred. However, hospitals have heterogeneous financial situations that need to be analyzed carefully. In particular, nothing can be said about their relative efficiency if cost estimations are not adjusted by the complexity of patients attended and comparison groups are not defined.

Applying a private sector capitation model to the management of type 2 diabetes in the South African public sector: a cost-effectiveness analysis.

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Volmink, Heinrich C; Bertram, Melanie Y; Jina, Ruxana; Wade, Alisha N; Hofman, Karen J

2014-09-30

Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector. Cost-effectiveness analysis was undertaken with a public sector model of the DMP as the intervention and a usual practice model as the comparator. Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome. Secondary data were used to design the model while cost information was obtained from various sources, taking into account public sector billing. Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model. This fell substantially below the Willingness-to-Pay threshold with bootstrapping analysis. Furthermore, a national implementation of the intervention could potentially result in an estimated cumulative gain of 96 997 years of life (95% CI 71 073 years - 113 994 years). Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG. Piloting the service within the public sector is recommended as an initial step, as this would provide data for more accurate economic evaluation, and would also allow for qualitative analysis of the programme.

"Factors associated with non-small cell lung cancer treatment costs in a Brazilian public hospital".

Science.gov (United States)

de Barros Reis, Carla; Knust, Renata Erthal; de Aguiar Pereira, Claudia Cristina; Portela, Margareth Crisóstomo

2018-02-17

The present study estimated the cost of advanced non-small cell lung cancer care for a cohort of 251 patients enrolled in a Brazilian public hospital and identified factors associated with the cost of treating the disease, considering sociodemographic, clinical and behavioral characteristics of patients, service utilization patterns and survival time. Estimates were obtained from the survey of direct medical cost per patient from the hospital's perspective. Data was collected from medical records and available hospital information systems. The ordinary least squares (OLS) method with logarithmic transformation of the dependent variable for the analysis of cost predictors was used to take into account the positive skewness of the costs distribution. The average cost of NSCLC was US$ 5647 for patients, with 71% of costs being associated to outpatient care. The main components of cost were daily hospital bed stay (22.6%), radiotherapy (15.5%) and chemotherapy (38.5%). The OLS model reported that, with 5% significance level, patients with higher levels of education, with better physical performance and less advanced disease have higher treatment costs. After controlling for the patient's survival time, only education and service utilization patterns were statistically significant. Individuals who were hospitalized or made use of radiotherapy or chemotherapy had higher costs. The use of these outpatient and hospital services explained most of the treatment cost variation, with a significant increase of the adjusted R 2 of 0.111 to 0.449 after incorporation of these variables in the model. The explanatory power of the complete model reached 62%. Inequities in disease treatment costs were observed, pointing to the need for strategies that reduce lower socioeconomic status and population's hurdles to accessing cancer care services.

A Cost-Effectiveness Analysis of India’s 2008 Prohibition of Smoking in Public Places in Gujarat

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Bhavesh Modi

2011-04-01

Full Text Available Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and premature mortality in low and middle-income countries. The aim of this study was to assess the cost-effectiveness of implementing India’s Prohibition of Smoking in Public Places Rules in the state of Gujarat, compared to implementation of a complete smoking ban. Using standard cost-effectiveness analysis methods, the cost of implementing the alternatives was evaluated against the years of life saved and cases of acute myocardial infarction averted by reductions in smoking prevalence and secondhand smoke exposure. After one year, it is estimated that a complete smoking ban in Gujarat would avert 17,000 additional heart attacks and gain 438,000 life years (LY. A complete ban is highly cost-effective when key variables including legislation effectiveness were varied in the sensitivity analyses. Without including medical treatment costs averted, the cost-effectiveness ratio ranges from $2 to $112 per LY gained and $37 to $386 per acute myocardial infarction averted. Implementing a complete smoking ban would be a cost saving alternative to the current partial legislation in terms of reducing tobacco-attributable disease in Gujarat.

42 CFR 417.540 - Enrollment costs.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Enrollment costs. 417.540 Section 417.540 Public... PLANS Medicare Payment: Cost Basis § 417.540 Enrollment costs. (a) Principle. Enrollment costs are... of costs included. Enrollment costs include, but are not limited to, reasonable costs incurred in...

Why do bacteria regulate public goods by quorum sensing? - How the shapes of cost and benefit functions determine the form of optimal regulation

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Silja eHeilmann

2015-07-01

Full Text Available Many bacteria secrete compounds, which act as public goods. Such compounds are often under quorum sensing (QS regulation, yet it is not understood exactly when bacteria may gain from having a public good under QS regulation.Here, we show that the optimal public good production rate per cell as a function of population size (the optimal production curve, OPC depend crucially on the cost and benefit functions of the public good and that the OPC will fall into one of two categories: Either it is continuous or it jumps from zero discontinuously at a critical population size.If, e.g., the public good has accelerating returns and linear cost, then the OPC is discontinuous and the best strategy thus to ramp up production sharply at a precise population size.By using the example of public goods with accelerating and diminishing returns (and linear cost we are able to determine how the two different categories of OPSs, can best be matched by production regulated through a QS signal feeding back on its own production. We find that the optimal QS parameters are different for the two categories and specifically that public goods, which provide accelerating returns, call for stronger positive signal feedback.

Public finance of rotavirus vaccination in India and Ethiopia: an extended cost-effectiveness analysis.

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Verguet, Stéphane; Murphy, Shane; Anderson, Benjamin; Johansson, Kjell Arne; Glass, Roger; Rheingans, Richard

2013-10-01

An estimated 4% of global child deaths (approximately 300,000 deaths) were attributed to rotavirus in 2010. About a third of these deaths occurred in India and Ethiopia. Public finance of rotavirus vaccination in these two countries could substantially decrease child mortality and also reduce rotavirus-related hospitalizations, prevent health-related impoverishment and bring significant cost savings to households. We use a methodology of 'extended cost-effectiveness analysis' (ECEA) to evaluate a hypothetical publicly financed program for rotavirus vaccination in India and Ethiopia. We measure program impact along four dimensions: 1) rotavirus deaths averted; 2) household expenditures averted; 3) financial risk protection afforded; 4) distributional consequences across the wealth strata of the country populations. In India and Ethiopia, the program would lead to a substantial decrease in rotavirus deaths, mainly among the poorer; it would reduce household expenditures across all income groups and it would effectively provide financial risk protection, mostly concentrated among the poorest. Potential indirect benefits of vaccination (herd immunity) would increase program benefits among all income groups, whereas potentially decreased vaccine efficacy among poorer households would reduce the equity benefits of the program. Our approach incorporates financial risk protection and distributional consequences into the systematic economic evaluation of vaccine policy, illustrated here with the case study of public finance for rotavirus vaccination. This enables selection of vaccine packages based on the quantitative inclusion of information on equity and on how much financial risk protection is being bought per dollar expenditure on vaccine policy, in addition to how much health is being bought. Copyright © 2013 Elsevier Ltd. All rights reserved.

Kirsten Fudeman, Aaron Lawson, Carol Rosen and Devon Strolovitch (Editors, Cornell Working Papers in Linguistics, Romance Philology 17, Cornell University, Ithaca, NY 1999, 196 pagine

Directory of Open Access Journals (Sweden)

Pavao Tekavčić

2000-12-01

Full Text Available Sotto questo titolo è apparsa nell'autunno del 1999 un'antologia curata dai quattro editori,. contenente 29 brani ( ad opera dei curatori e altri collaboratori. Le linee direttrici sono esposte nella prefazione (Preface, 2 pagine introduttive fuori paginazione. La base è l'antologia Early Romance Texts: An Anthology (1980 di Rodney Sampson, definita invaluable, ma ormai di difficile accesso. Perciò, con la presente scelta di testi si cerca di ovviare a questa situazione. Ci sono però determinati limiti: infatti, sono stati tralasciati i testi più noti, canonici, già bene studiati, ma nel contempo si è desistito anche dall'includere soltanto testi finora non pubblicati. In tal modo si è scelta una via di mezzo, includendo i testi meno noti e meno discussi, tutti pubblicati, è vero, già prima ma in places now considered relatively obscure e parecchio tempo (perfino tutto un secolo fa. La struttura di tutti i contributi è identica: ad una succinta introduzione (dati essenziali sul relativo testo seguono il brano, i commenti, la bibliografia e la traduzione inglese. In tal modo l'antologia è coerente, di facile orientamento ed altrettanto facili confronti tra i singoli testi, il che è di notevole importanza scientifica e pedagogica. Infine, i curatori fanno risaltare il ruolo delle ricerche filologiche negli studi più propriamente linguistici.

The cost risk implementation on design-build project of integrated public spaces child friendly in capital of Jakarta

Science.gov (United States)

Mardiaman, Mubarok, Abdul

2017-11-01

Jakarta area of 662.33 km2 with a population of 10,075,030 inhabitants and green open spaces 9.98%. The Jakarta government built a child-friendly integrated open space as facilities for playing. Providing of facilities was hoped suitable with time, cost, quality, accountability and proper financial governance. Based on the PU ministerial regulation number 19/PRT/M/2015 on the standards and guidelines for procurement the design and construction work on the integrated build and the PU ministerial regulation No. 07/PRT/M/2011 on standards and guidelines for procurement of construction works and consulting services of public works and the ministry of housing. RPTRA development at 123 locations in Jakarta was implemented base on the contract of design and build. The design study was influenced by the cost elements; the main strength (expert), skilled personnel, support personnel, major equipment and support. The construction fee relies on; expert implementation, hardware implementation, preparation work, land, buildings, courtyards, fences, complementary and governance capabilities for human resources in completing the construction activities to minimize the cost risk. Montecarlo simulations was conducted to determine the average unit price, model and analyze systems. In the cost contract, the percentage of design work stipulated 2.5%, build 97.5%. Base on regulation the minister of public work for design work cost 2.72%, build 97.28%. Then, actual cost for design 2.67% and build 97.33%. From the three reference was shown that there are differentiation one another. The acceleration of planning able to make the cost and time more efficient that impact on the implementation margin.

Support of Publication Costs, Atlantic Meridional Overturning Circulation Special Issue of Deep Sea Research II Journal

Energy Technology Data Exchange (ETDEWEB)

Amy Honchar

2012-11-12

The contribution of funds from DOE supported publication costs of a special issue of Deep Sea Research arising from presentations at the First U.S. Atlantic Meridional Overturning Circulation (AMOC) Meeting held 4-6 May, 2009 to review the US implementation plan and its coordination with other monitoring activities. The special issue includes a total of 16 papers, including publications from three DOE-supported investigators (ie Sevellec, F., and A.V. Fedorov; Hu et. al., and Wan et. al.,). The special issue addresses DOE interests in understanding and simulation/modeling of abrupt climate change.

Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media Campaigns Implemented in New South Wales, Australia.

Science.gov (United States)

Doran, Christopher M; Ling, Rod; Byrnes, Joshua; Crane, Melanie; Shakeshaft, Anthony P; Searles, Andrew; Perez, Donna

2016-01-01

Public education mass media campaigns are an important intervention for influencing behaviour modifications. However, evidence on the effectiveness of such campaigns to encourage the population to reduce sun exposure is limited. This study investigates the benefits and costs of three skin cancer campaigns implemented in New South Wales from 2006-2013. This analysis uses Australian dollars (AUD) and 2010-11 as the currency and base year, respectively. Historical data on skin cancer were used to project skin cancer rates for the period 2006-2020. The expected number of skin cancer cases is derived by combining skin cancer rates, sunburn rates and relative risk of skin cancers due to sun exposure. Counterfactual estimates are based on sunburn exposure in the absence of the campaigns. Monetary values are attached to direct (treatment) and indirect (productivity) costs saved due to fewer skin cancer cases. Monetary benefits are compared with the cost of implementing the campaigns and are presented in the form of a benefit-cost ratio. Relative to the counterfactual (i.e., no campaigns) there are an estimated 13,174 fewer skin cancers and 112 averted deaths over the period 2006-2013. The net present value of these benefits is $60.17 million and the campaign cost is $15.63 million. The benefit cost ratio is 3.85, suggesting that for every $1 invested a return of $3.85 is achieved. Skin cancer public education mass media campaigns are a good investment given the likely extent to which they reduce the morbidity, mortality and economic burden of skin cancer.

Benefit Cost Analysis of Three Skin Cancer Public Education Mass-Media Campaigns Implemented in New South Wales, Australia

Science.gov (United States)

2016-01-01

Public education mass media campaigns are an important intervention for influencing behaviour modifications. However, evidence on the effectiveness of such campaigns to encourage the population to reduce sun exposure is limited. This study investigates the benefits and costs of three skin cancer campaigns implemented in New South Wales from 2006–2013. This analysis uses Australian dollars (AUD) and 2010–11 as the currency and base year, respectively. Historical data on skin cancer were used to project skin cancer rates for the period 2006–2020. The expected number of skin cancer cases is derived by combining skin cancer rates, sunburn rates and relative risk of skin cancers due to sun exposure. Counterfactual estimates are based on sunburn exposure in the absence of the campaigns. Monetary values are attached to direct (treatment) and indirect (productivity) costs saved due to fewer skin cancer cases. Monetary benefits are compared with the cost of implementing the campaigns and are presented in the form of a benefit-cost ratio. Relative to the counterfactual (i.e., no campaigns) there are an estimated 13,174 fewer skin cancers and 112 averted deaths over the period 2006–2013. The net present value of these benefits is $60.17 million and the campaign cost is $15.63 million. The benefit cost ratio is 3.85, suggesting that for every $1 invested a return of $3.85 is achieved. Skin cancer public education mass media campaigns are a good investment given the likely extent to which they reduce the morbidity, mortality and economic burden of skin cancer. PMID:26824695

Universal public finance of tuberculosis treatment in India: an extended cost-effectiveness analysis.

Science.gov (United States)

Verguet, Stéphane; Laxminarayan, Ramanan; Jamison, Dean T

2015-03-01

Universal public finance (UPF)-government financing of an intervention irrespective of who is receiving it-for a health intervention entails consequences in multiple domains. First, UPF increases intervention uptake and hence the extent of consequent health gains. Second, UPF generates financial consequences including the crowding out of private expenditures. Finally, UPF provides insurance either by covering catastrophic expenditures, which would otherwise throw households into poverty or by preventing diseases that cause them. This paper develops a method-extended cost-effectiveness analysis (ECEA)-for evaluating the consequences of UPF in each of these domains. It then illustrates ECEA with an evaluation of UPF for tuberculosis treatment in India. Using plausible values for key parameters, our base case ECEA concludes that the health gains and insurance value of UPF would accrue primarily to the poor. Reductions in out-of-pocket expenditures are more uniformly distributed across income quintiles. A variant on our base case suggests that lowering costs of borrowing for the poor could potentially achieve some of the health gains of UPF, but at the cost of leaving the poor more deeply in debt. © 2014 The Authors. Health Economics published by John Wiley Ltd.

Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing burch and synthetic sling techniques.

Science.gov (United States)

Limberger, Leo Francisco; Faria, Fernanda Pacheco; Campos, Luciana Silveira; Anzolch, Karin Marise Jaeger; Fornari, Alexandre

2018-01-01

Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (pCost was significantly lower in patients submitted to sling in all items, except for time spent in recovery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (pcost of the synthetic sling was considered. Copyright® by the International Brazilian Journal of Urology.

Cost-effectiveness and public health impact of alternative influenza vaccination strategies in high-risk adults.

Science.gov (United States)

Raviotta, Jonathan M; Smith, Kenneth J; DePasse, Jay; Brown, Shawn T; Shim, Eunha; Nowalk, Mary Patricia; Wateska, Angela; France, Glenson S; Zimmerman, Richard K

2017-10-09

High-dose trivalent inactivated influenza vaccine (HD-IIV3) or recombinant trivalent influenza vaccine (RIV) may increase influenza vaccine effectiveness (VE) in adults with conditions that place them at high risk for influenza complications. This analysis models the public health impact and cost-effectiveness (CE) of these vaccines for 50-64year-olds. Markov model CE analysis compared 5 strategies in 50-64year-olds: no vaccination; only standard-dose IIV3 offered (SD-IIV3 only), only quadrivalent influenza vaccine offered (SD-IIV4 only); high-risk patients receiving HD-IIV3, others receiving SD-IIV3 (HD-IIV3 & SD-IIV3); and high-risk patients receiving HD-IIV3, others receiving SD-IIV4 (HD-IIV3 & SD-IIV4). In a secondary analysis, RIV replaced HD-IIV3. Parameters were obtained from U.S. databases, the medical literature and extrapolations from VE estimates. Effectiveness was measured as 3%/year discounted quality adjusted life year (QALY) losses avoided. The least expensive strategy was SD-IIV3 only, with total costs of $99.84/person. The SD-IIV4 only strategy cost an additional $0.91/person, or $37,700/QALY gained. The HD-IIV3 & SD-IIV4 strategy cost $1.06 more than SD-IIV4 only, or $71,500/QALY gained. No vaccination and HD-IIV3 & SD-IIV3 strategies were dominated. Results were sensitive to influenza incidence, vaccine cost, standard-dose VE in the entire population and high-dose VE in high-risk patients. The CE of RIV for high-risk patients was dependent on as yet unknown parameter values. Based on available data, using high-dose influenza vaccine or RIV in middle-aged, high-risk patients may be an economically favorable vaccination strategy with public health benefits. Clinical trials of these vaccines in this population may be warranted. Copyright © 2017 Elsevier Ltd. All rights reserved.

REDUCING COSTS OF TAX COMPLIANCE AND INVESTMENTS IN PUBLIC SYSTEM OF DIGITAL BOOKKEEPING – SPED – IN BRAZIL

OpenAIRE

Edson Sampaio de Lima; Napoleão Verardi Galegale; Carlos Hideo Arima; Pedro Luiz Côrtes

2016-01-01

The Public System of Digital Bookkeeping – SPED was developed with the intention of further integration between the tax administrations themselves, then between them and the taxpayers, through the use of technology and, consequently, socioeconomic data standard, in a single environment, raising the tax collection efficiency and reducing the costs of administration and compliance. This article intends to contribute to the analysis of public investments directed to the establishment and mainten...

Cost-Efficacy Analysis of Out-of-District Special Education Placements: An Evaluative Measure of Behavior Support Intervention in Public Schools.

Science.gov (United States)

Putnam, Robert F.; Luiselli, James K.; Sennett, Kenneth; Malonson, Joanne

2002-01-01

Evaluation of out-of-district special education placement costs in the 15 largest Massachusetts public school districts found the criterion school district (which had developed a system-wide approach to behavioral intervention) had the lowest per capita cost, lowest percentage of total school budget consumed by out-of-district placements, and the…

Youth's Awareness of and Reactions to The Real Cost National Tobacco Public Education Campaign.

Directory of Open Access Journals (Sweden)

Jennifer C Duke

Full Text Available In 2014, the Food and Drug Administration (FDA launched its first tobacco-focused public education campaign, The Real Cost, aimed at reducing tobacco use among 12- to 17-year-olds in the United States. This study describes The Real Cost message strategy, implementation, and initial evaluation findings. The campaign was designed to encourage youth who had never smoked but are susceptible to trying cigarettes (susceptible nonsmokers and youth who have previously experimented with smoking (experimenters to reassess what they know about the "costs" of tobacco use to their body and mind. The Real Cost aired on national television, online, radio, and other media channels, resulting in high awareness levels. Overall, 89.0% of U.S. youth were aware of at least one advertisement 6 to 8 months after campaign launch, and high levels of awareness were attained within the campaign's two targeted audiences: susceptible nonsmokers (90.5% and experimenters (94.6%. Most youth consider The Real Cost advertising to be effective, based on assessments of ad perceived effectiveness (mean = 4.0 on a scale from 1.0 to 5.0. High levels of awareness and positive ad reactions are requisite proximal indicators of health behavioral change. Additional research is being conducted to assess whether potential shifts in population-level cognitions and/or behaviors are attributable to this campaign. Current findings demonstrate that The Real Cost has attained high levels of ad awareness which is a critical first step in achieving positive changes in tobacco-related attitudes and behaviors. These data can also be used to inform ongoing message and media strategies for The Real Cost and other U.S. youth tobacco prevention campaigns.

Youth's Awareness of and Reactions to The Real Cost National Tobacco Public Education Campaign.

Science.gov (United States)

Duke, Jennifer C; Alexander, Tesfa N; Zhao, Xiaoquan; Delahanty, Janine C; Allen, Jane A; MacMonegle, Anna J; Farrelly, Matthew C

2015-01-01

In 2014, the Food and Drug Administration (FDA) launched its first tobacco-focused public education campaign, The Real Cost, aimed at reducing tobacco use among 12- to 17-year-olds in the United States. This study describes The Real Cost message strategy, implementation, and initial evaluation findings. The campaign was designed to encourage youth who had never smoked but are susceptible to trying cigarettes (susceptible nonsmokers) and youth who have previously experimented with smoking (experimenters) to reassess what they know about the "costs" of tobacco use to their body and mind. The Real Cost aired on national television, online, radio, and other media channels, resulting in high awareness levels. Overall, 89.0% of U.S. youth were aware of at least one advertisement 6 to 8 months after campaign launch, and high levels of awareness were attained within the campaign's two targeted audiences: susceptible nonsmokers (90.5%) and experimenters (94.6%). Most youth consider The Real Cost advertising to be effective, based on assessments of ad perceived effectiveness (mean = 4.0 on a scale from 1.0 to 5.0). High levels of awareness and positive ad reactions are requisite proximal indicators of health behavioral change. Additional research is being conducted to assess whether potential shifts in population-level cognitions and/or behaviors are attributable to this campaign. Current findings demonstrate that The Real Cost has attained high levels of ad awareness which is a critical first step in achieving positive changes in tobacco-related attitudes and behaviors. These data can also be used to inform ongoing message and media strategies for The Real Cost and other U.S. youth tobacco prevention campaigns.

Determinants of the direct cost of heart failure hospitalization in a public tertiary hospital.

Science.gov (United States)

Parissis, John; Athanasakis, Kostas; Farmakis, Dimitrios; Boubouchairopoulou, Nadia; Mareti, Christina; Bistola, Vasiliki; Ikonomidis, Ignatios; Kyriopoulos, John; Filippatos, Gerasimos; Lekakis, John

2015-02-01

Heart failure (HF) is the first reason for hospital admission in the elderly and represents a major financial burden, the greatest part of which results from hospitalization costs. We sought to analyze current HF hospitalization-related expenditure and identify predictors of cost in a public tertiary hospital in Europe. We performed a retrospective chart review of 197 consecutive patients, aged 56±16years, 80% male, with left ventricular ejection fraction (LVEF) of 30±10%, hospitalized for HF in a major university hospital in Athens, Greece. The survey involved the number of hospitalization days, laboratory investigations and medical therapies. Patients who were hospitalized in CCU/ICU or underwent interventional procedures or device implantations were excluded from analysis. Costs were estimated based on the Greek healthcare system perspective in 2013. Patients were hospitalized for a median of 7 days with a total direct cost of €3198±3260/patient. The largest part of the expenses (79%) was attributed to hospitalization (ward), while laboratory investigations and medical treatment accounted for 17% and 4%, respectively. In multivariate analysis, pre-admission New York Heart Association NYHA class (p=0.001), serum creatinine (p=0.003) and NT-proBNP (p=0.004) were significant independent predictors of hospitalization cost. Direct cost of HF hospitalization is high particularly in patients with more severe symptoms, profound neurohormonal activation and renal dysfunction. Strategies to lower hospitalization rates are warranted in the current setting of financial constraints faced by many European countries. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?

Science.gov (United States)

Than, Thet Mon; Saw, Yu Mon; Khaing, Moe; Win, Ei Mon; Cho, Su Myat; Kariya, Tetsuyoshi; Yamamoto, Eiko; Hamajima, Nobuyuki

2017-09-19

Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015-2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the

Collaboration across private and public sector primary health care services: benefits, costs and policy implications.

Science.gov (United States)

McDonald, Julie; Powell Davies, Gawaine; Jayasuriya, Rohan; Fort Harris, Mark

2011-07-01

Ongoing care for chronic conditions is best provided by interprofessional teams. There are challenges in achieving this where teams cross organisational boundaries. This article explores the influence of organisational factors on collaboration between private and public sector primary and community health services involved in diabetes care. It involved a case study using qualitative methods. Forty-five participants from 20 organisations were purposively recruited. Data were collected through semi-structured interviews and from content analysis of documents. Thematic analysis was used employing a two-level coding system and cross case comparisons. The patterns of collaborative patient care were influenced by a combination of factors relating to the benefits and costs of collaboration and the influence of support mechanisms. Benefits lay in achieving common or complementary health or organisational goals. Costs were incurred in bridging differences in organisational size, structure, complexity and culture. Collaboration was easier between private sector organisations than between private and public sectors. Financial incentives were not sufficient to overcome organisational barriers. To achieve more coordinated primary and community health care structural changes are also needed to better align funding mechanisms, priorities and accountabilities of the different organisations.

Estimated costs of advanced lung cancer care in a public reference hospital.

Science.gov (United States)

Knust, Renata Erthal; Portela, Margareth Crisóstomo; Pereira, Claudia Cristina de Aguiar; Fortes, Guilherme Bastos

2017-08-17

To estimate the direct medical costs of advanced non-small cell lung cancer care. We assessed a cohort of 277 patients treated in the Brazilian National Cancer Institute in 2011. The costs were estimated from the perspective of the hospital as a service provider of reference for the Brazilian Unified Health System. The materials and procedures used were identified and quantified, per patient, and we assigned to them monetary values, consolidated in phases of the assistance defined. The analyses had a descriptive character with costs in Real (R$). Overall, the cohort represented a cost of R$2,473,559.91, being 71.5% related to outpatient care and 28.5% to hospitalizations. In the outpatient care, costs with radiotherapy (34%) and chemotherapy (22%) predominated. The results pointed to lower costs in the initial phase of treatment (7.2%) and very high costs in the maintenance phase (61.6%). Finally, we identified statistically significant differences of average cost by age groups, education levels, physical performance, and histological type. This study provides a current, useful, and relevant picture of the costs of patients with non-small cell lung cancer treated in a public hospital of reference and it provides information on the magnitude of the problem of cancer in the context of public health. The results confirm the importance of radiation treatment and hospitalizations as the main components of the cost of treatment. Despite some losses of follow-up, we assess that, for approximately 80% of the patients included in the study, the estimates presented herein are satisfactory for the care of the disease, from the perspective of a service provider of reference of the Brazilian Unified Health System, as it provides elements for the management of the service, as well as for studies that result in more rational forms of resource allocation. Estimar os custos médicos diretos da assistência ao câncer de pulmão não pequenas células avançado. Foi avaliada uma

42 CFR 417.542 - Reinsurance costs.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Reinsurance costs. 417.542 Section 417.542 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... PLANS Medicare Payment: Cost Basis § 417.542 Reinsurance costs. Reinsurance costs are not allowable. ...

Measuring cost efficiency in the Nordic hospitals--a cross-sectional comparison of public hospitals in 2002.

Science.gov (United States)

Linna, Miika; Häkkinen, Unto; Peltola, Mikko; Magnussen, Jon; Anthun, Kjartan S; Kittelsen, Sverre; Roed, Annette; Olsen, Kim; Medin, Emma; Rehnberg, Clas

2010-12-01

The aim of this study was to compare the performance of hospital care in four Nordic countries: Norway, Finland, Sweden and Denmark. Using national discharge registries and cost data from hospitals, cost efficiency in the production of somatic hospital care was calculated for public hospitals. Data were collected using harmonized definitions of inputs and outputs for 184 hospitals and data envelopment analysis was used to calculate Farrell efficiency estimates for the year 2002. Results suggest that there were marked differences in the average hospital efficiency between Nordic countries. In 2002, average efficiency was markedly higher in Finland compared to Norway and Sweden. This study found differences in cost efficiency that cannot be explained by input prices or differences in coding practices. More analysis is needed to reveal the causes of large efficiency disparities between Nordic hospitals.

45 CFR 1180.56 - Allowable costs.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Allowable costs. 1180.56 Section 1180.56 Public... by a Grantee General Administrative Responsibilities § 1180.56 Allowable costs. (a) Determination of costs allowable under a grant is made in accordance with government-wide cost principles in applicable...

Costs of publicly provided maternity services in Rosario, Argentina

Directory of Open Access Journals (Sweden)

Borghi Josephine

2003-01-01

Full Text Available OBJECTIVE: This study estimates the costs of maternal health services in Rosario, Argentina. MATERIAL AND METHODS: The provider costs (US$ 1999 of antenatal care, a normal vaginal delivery and a caesarean section, were evaluated retrospectively in two municipal hospitals. The cost of an antenatal visit was evaluated in two health centres and the patient costs associated with the visit were evaluated in a hospital and a health centre. RESULTS: The average cost per hospital day is $114.62. The average cost of a caesarean section ($525.57 is five times greater than that of a normal vaginal delivery ($105.61. A normal delivery costs less at the general hospital and a c-section less at the maternity hospital. The average cost of an antenatal visit is $31.10. The provider cost is lower at the health centre than at the hospital. Personnel accounted for 72-94% of the total cost and drugs and medical supplies between 4-26%. On average, an antenatal visit costs women $4.70. Direct costs are minimal compared to indirect costs of travel and waiting time. CONCLUSIONS: These results suggest the potential for increasing the efficiency of resource use by promoting antenatal care visits at the primary level. Women could also benefit from reduced travel and waiting time. Similar benefits could accrue to the provider by encouraging normal delivery at general hospitals, and complicated deliveries at specialised maternity hospitals.

Youth's Awareness of and Reactions to The Real Cost National Tobacco Public Education Campaign

Science.gov (United States)

Duke, Jennifer C.; Alexander, Tesfa N.; Zhao, Xiaoquan; Delahanty, Janine C.; Allen, Jane A.; MacMonegle, Anna J.; Farrelly, Matthew C.

2015-01-01

In 2014, the Food and Drug Administration (FDA) launched its first tobacco-focused public education campaign, The Real Cost, aimed at reducing tobacco use among 12- to 17-year-olds in the United States. This study describes The Real Cost message strategy, implementation, and initial evaluation findings. The campaign was designed to encourage youth who had never smoked but are susceptible to trying cigarettes (susceptible nonsmokers) and youth who have previously experimented with smoking (experimenters) to reassess what they know about the “costs” of tobacco use to their body and mind. The Real Cost aired on national television, online, radio, and other media channels, resulting in high awareness levels. Overall, 89.0% of U.S. youth were aware of at least one advertisement 6 to 8 months after campaign launch, and high levels of awareness were attained within the campaign’s two targeted audiences: susceptible nonsmokers (90.5%) and experimenters (94.6%). Most youth consider The Real Cost advertising to be effective, based on assessments of ad perceived effectiveness (mean = 4.0 on a scale from 1.0 to 5.0). High levels of awareness and positive ad reactions are requisite proximal indicators of health behavioral change. Additional research is being conducted to assess whether potential shifts in population-level cognitions and/or behaviors are attributable to this campaign. Current findings demonstrate that The Real Cost has attained high levels of ad awareness which is a critical first step in achieving positive changes in tobacco-related attitudes and behaviors. These data can also be used to inform ongoing message and media strategies for The Real Cost and other U.S. youth tobacco prevention campaigns. PMID:26679504

Guide for Conducting Benefit-Cost Evaluation of Realized Impacts of Public R&D Programs

Energy Technology Data Exchange (ETDEWEB)

Ruegg, Rosalie [TIA Consulting, Inc., Emerald Isle, NC (United States); Jordan, Gretchen B. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2011-08-01

This document provides guidance for evaluators who conduct impact assessments to determine the “realized” economic benefits and costs, energy, environmental benefits, and other impacts of the Office of Energy Efficiency and Renewable Energy’s (EERE) R&D programs. The focus of this Guide is on realized outcomes or impacts of R&D programs actually experienced by American citizens, industry, and others. Retrospective evaluations may be contrasted to prospective evaluations that reflect expected or potential outcomes only if assumptions hold. The retrospective approach described in this Guide is based on realized results only and the extent they can be attributed to the efforts of an R&D program. While it has been prepared specifically to guide retrospective benefit-cost analysis of EERE R&D Programs, this report may be used for similar analysis of other public R&D organizations.

42 CFR 417.802 - Allowable costs.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Allowable costs. 417.802 Section 417.802 Public... PLANS Health Care Prepayment Plans § 417.802 Allowable costs. (a) General rule. The costs that are considered allowable for HCPP reimbursement are the same as those for reasonable cost HMOs and CMPs specified...

Age-specific cost and public funding of a live birth following assisted reproductive treatment in Japan.

Science.gov (United States)

Maeda, Eri; Ishihara, Osamu; Saito, Hidekazu; Kuwahara, Akira; Toyokawa, Satoshi; Kobayashi, Yasuki

2014-05-01

The aim of this study was to calculate and assess the cost of assisted reproductive technology (ART) treatment cycles and live-birth events in Japan in 2010. We performed a retrospective analysis of 238,185 ART cycles, registered with the national registry of assisted reproductive treatment during 2010. Costs were calculated, using a decision analysis model. The average cost per live birth was ¥1,974,000. This varied from ¥1,155,000 in women aged birth was ¥442,000. This was ¥6,118,000 in women aged ≥ 45, 15.4 times higher than that of the 35-39-year-old age group. The costs and public funding of a live birth after ART treatment rises with age due to the lower success rates in older women. It may provide economic background to improve the current subsidy system for ART and to provide practical knowledge about fertility for the general population. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Economic costs of obesity in Thailand: a retrospective cost-of-illness study.

Science.gov (United States)

Pitayatienanan, Paiboon; Butchon, Rukmanee; Yothasamut, Jomkwan; Aekplakorn, Wichai; Teerawattananon, Yot; Suksomboon, Naeti; Thavorncharoensap, Montarat

2014-04-02

Over the last decade, the prevalence of obesity (BMI ≥ 25 kg/m2) in Thailand has been rising rapidly and consistently. Estimating the cost of obesity to society is an essential step in setting priorities for research and resource use and helping improve public awareness of the negative economic impacts of obesity. This prevalence-based, cost-of-illness study aims to estimate the economic costs of obesity in Thailand. The estimated costs in this study included health care cost, cost of productivity loss due to premature mortality, and cost of productivity loss due to hospital-related absenteeism. The Obesity-Attributable Fraction (OAF) was used to estimate the extent to which the co-morbidities were attributable to obesity. The health care cost of obesity was further estimated by multiplying the number of patients in each disease category attributable to obesity by the unit cost of treatment. The cost of productivity loss was calculated using the human capital approach. The health care cost attributable to obesity was estimated at 5,584 million baht or 1.5% of national health expenditure. The cost of productivity loss attributable to obesity was estimated at 6,558 million baht - accounting for 54% of the total cost of obesity. The cost of hospital-related absenteeism was estimated at 694 million baht, while the cost of premature mortality was estimated at 5,864 million baht. The total cost of obesity was then estimated at 12,142 million baht (725.3 million US$PPP, 16.74 baht =1 US$PPP accounting for 0.13% of Thailand's Gross Domestic Product (GDP). Obesity imposes a substantial economic burden on Thai society especially in term of health care costs. Large-scale comprehensive interventions focused on improving public awareness of the cost of and problems associated with obesity and promoting a healthy lifestyle should be regarded as a public health priority.

Peculiarities of Calculating the Cost of Public Goods (from the Necessary to the Desired: Domestic Realities and European Experience

Directory of Open Access Journals (Sweden)

Aleksieieva N. I.

2015-11-01

Full Text Available Social needs and instruments for their satisfaction — public goods — have been studied. Attention is drawn to the fact that social needs are composed of individual and collective needs of economic entities. They are interrelated and complementary. An important difference between individual and collective needs is in their personification (individualization and divisibility. Proper consideration has been paid to concepts related to the needs of society — the public interest (as a form of social needs, public goods (all the goods, services that can satisfy social needs. For studying social needs and benefits in this work there was taken one of the most popular of their classification, which lies in their division into primary and secondary ones. Emphasis is placed on importance of its use in determining the priority of financing public goods. The focus is on the approach to calculating the cost of public goods. It is regarded as one of the stages in satisfying social needs (along with planning and analysis of the degree for their satisfaction. An approach to determining the structure of financing the total volume of public goods, calculating minimum admissible and desired volume of financing has been presented. The current interest in the European experience prompted the authors to analyze the cost and structure of financing public goods in France, the available statistical base allowing it to be implemented. The determined dependence between the indicators enabled conducting calculations of the desired volumes of financing the public needs per person according to three scenarios: optimistic, satisfactory and critical relevant to phases of the economic cycle. This simulation is aimed at being used in management decisionmaking, development of social and economic policy, etc. There have been noted serious shortcomings related to the lack of quality and reliable statistical information on Ukraine, which hamper the calculation and consideration

The hidden costs of nuclear power

International Nuclear Information System (INIS)

Keough, C.

1981-01-01

The two basic hidden costs of nuclear power are public money and public health. Nuclear power appears to be economical because many of the costs of producins electricity in these plants are paid by the federal government. So, like it or not, the citizens are footing the bill with their taxes. Design and development of plants have been paid for with public money, and disposal and cleanup costs will also be paid in this manner. The economic and health costs associated with nuclear accidents are staggering

Promoting Organ Donor Registries Through Public Education: What Is the Cost of Securing Organ Donors?

Science.gov (United States)

Razdan, Manik; Smith, Kenneth J; Bryce, Cindy L; Degenholtz, Howard B

2016-06-01

Transplant medicine's impact on America's public health is seriously limited by acute shortage of transplantable organs. Consequently, the United Sates has witnessed considerable investment in the promotion of organ donor registries. Although there is no evidence to support that donor registry promotion alleviates organ shortage, this belief continues to drive investments into registry promotion. In this study, return on investment in donor registry promotion was examined using cost-outcomes analysis. Cost of promoting the donor registry was estimated in US dollars whereas the outcome was measured as the number of individuals who join the registry (registrants) and their value in terms of organ donors. The study was conducted from the perspective of a regional Organ Procurement Organization (OPO). Costs were directly obtained from the OPO. The number of new registrants was obtained from the OPO and the departments of motor vehicles that maintain the donor registry. The value of registrants in terms of organ donors was computed based on a registrant's age-dependent risk of dying and age-dependent probability of becoming an organ donor. Six thousand seven hundred eight individuals joined the organ donor registry (95% confidence interval [95% CI], 5429-7956) at a cost of $455 per registrant (95% CI, US $383-US $562). These individuals result in 4.2 present-day donors (95% CI, 2.5-6.6) at a cost of US $726 000 (95% CI, US $462000-US $1.2 million). Because the cost per registrant and cost per donor is less than society's willingness to pay, donor registry promotion offers positive return on investment. Investment in registry promotion should at the minimum be maintained at current levels.

Improving the quality of percutaneous revascularisation in patients with multivessel disease in Australia: cost-effectiveness, public health implications, and budget impact of FFR-guided PCI.

Science.gov (United States)

Siebert, Uwe; Arvandi, Marjan; Gothe, Raffaella M; Bornschein, Bernhard; Eccleston, David; Walters, Darren L; Rankin, James; De Bruyne, Bernard; Fearon, William F; Pijls, Nico H; Harper, Richard

2014-06-01

The international multicentre FAME Study (n=1,005) demonstrated significant health benefits for patients undergoing multivessel percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurement compared with angiography guidance alone (ANGIO). We determined the cost-effectiveness and the public health/budget impact for Australia. We performed a prospective economic evaluation comparing FFR vs. ANGIO in patients with multivessel disease based on original patient-level FAME data. We used Australian utilities (EQ-5D) and costs to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness adopting the societal perspective. The public health and budget impact from the payer's perspective was based on Australian PCI registries. Uncertainty was explored using deterministic sensitivity analyses and the bootstrap method (n=5,000 samples). The cost-effectiveness analysis showed that FFR was cost-saving and reduces costs by 1,776 AUD per patient during one year. Over a two-year time horizon, the public health impact ranged from 7.8 to 73.9 QALYs gained and the budget impact from 1.8 to 14.5 million AUD total cost savings. Sensitivity analyses demonstrated that FFR was cost-saving over a wide range of assumptions. FFR-guided PCI in patients with multivessel coronary disease substantially reduces cardiac events, improves QALYs and is cost-saving in the Australian health care system. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

nelle pagine di dolores prato

African Journals Online (AJOL)

User

il libro possa vedere la luce. Passeranno altri diciassette anni prima dell'uscita dell'edizione integrale del testo, curata da Giorgio Zampa sul dattiloscritto originale. 3. Cfr. a riguardo Veschi (2008:82) che, nel sottolineare l'importanza dell'organizzazione. «spaziale» del libro, individua nella casa degli zii il primo di una serie ...

Utilisation and costs of nursing agencies in the South African public health sector, 2005-2010.

Science.gov (United States)

Rispel, Laetitia C; Angelides, George

2014-01-01

Globally, insufficient information exists on the costs of nursing agencies, which are temporary employment service providers that supply nurses to health establishments and/or private individuals. The aim of the study was to determine the utilisation and direct costs of nursing agencies in the South African public health sector. A survey of all nine provincial health departments was conducted to determine utilisation and management of nursing agencies. The costs of nursing agencies were assumed to be equivalent to expenditure. Provincial health expenditure was obtained for five financial years (2005/6-2009/10) from the national Basic Accounting System database, and analysed using Microsoft Excel. Each of the 166,466 expenditure line items was coded. The total personnel and nursing agency expenditure was calculated for each financial year and for each province. Nursing agency expenditure as a percentage of the total personnel expenditure was then calculated. The nursing agency expenditure for South Africa is the total of all provincial expenditure. The 2009/10 annual government salary scales for different categories of nurses were used to calculate the number of permanent nurses who could have been employed in lieu of agency expenditure. All expenditure is expressed in South African rands (R; US$1 ∼ R7, 2010 prices). Only five provinces reported utilisation of nursing agencies, but all provinces showed agency expenditure. In the 2009/10 financial year, R1.49 billion (US$212.64 million) was spent on nursing agencies in the public health sector. In the same year, agency expenditure ranged from a low of R36.45 million (US$5.20 million) in Mpumalanga Province (mixed urban-rural) to a high of R356.43 million (US$50.92 million) in the Eastern Cape Province (mixed urban-rural). Agency expenditure as a percentage of personnel expenditure ranged from 0.96% in KwaZulu-Natal Province (mixed urban-rural) to 11.96% in the Northern Cape Province (rural). In that financial year

Public and private hospital services reform using data envelopment analysis to measure technical, scale, allocative, and cost efficiencies.

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Sheikhzadeh, Yaghoub; Roudsari, Abdul V; Vahidi, Reza Gholi; Emrouznejad, Ali; Dastgiri, Saeed

2012-01-01

The aim of this study was to suggest a suitable context to develop efficient hospital systems while maintaining the quality of care at minimum expenditures. This research aimed to present a model of efficiency for selected public and private hospitals of East Azerbaijani Province of Iran by making use of Data Envelopment Analysis approach in order to recognize and suggest the best practice standards. Among the six inefficient hospitals, 2 (33%) had a technical efficiency score of less than 50% (both private), 2 (33%) between 51 and 74% (one private and one public) and the rest (2, 33%) between 75 and 99% (one private and one public). In general, the public hospitals are relatively more efficient than private ones; it is recommended for inefficient hospitals to make use of the followings: transferring, selling, or renting idle/unused beds; transferring excess doctors and nurses to the efficient hospitals or other health centers; pensioning off, early retirement clinic officers, technicians/technologists, and other technical staff. The saving obtained from the above approaches could be used to improve remuneration for remaining staff and quality of health care services of hospitals, rural and urban health centers, support communities to start or sustain systematic risk and resource pooling and cost sharing mechanisms for protecting beneficiaries against unexpected health care costs, compensate the capital depreciation, increasing investments, and improve diseases prevention services and facilities in the provincial level.

Controlling Health Care Costs

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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…

The relative patient costs and availability of dental services, materials and equipment in public oral care facilities in Tanzania.

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Nyamuryekung'e, Kasusu K; Lahti, Satu M; Tuominen, Risto J

2015-07-01

Patient charges and availability of dental services influence utilization of dental services. There is little available information on the cost of dental services and availability of materials and equipment in public dental facilities in Africa. This study aimed to determine the relative cost and availability of dental services, materials and equipment in public oral care facilities in Tanzania. The local factors affecting availability were also studied. A survey of all district and regional dental clinics in selected regions was conducted in 2014. A total of 28/30 facilities participated in the study. A structured interview was undertaken amongst practitioners and clinic managers within the facilities. Daily resources for consumption (DRC) were used for estimation of patients' relative cost. DRC are the quantified average financial resources required for an adult Tanzanian's overall consumption per day. Tooth extractions were found to cost four times the DRC whereas restorations were 9-10 times the DRC. Studied facilities provided tooth extractions (100%), scaling (86%), fillings (79%), root canal treatment (46%) and fabrication of removable partial dentures (32%). The ratio of tooth fillings to extractions in the facilities was 1:16. Less than 50% of the facilities had any of the investigated dental materials consistently available throughout the year, and just three facilities had all the investigated equipment functional and in use. Dental materials and equipment availability, skills of the practitioners and the cost of services all play major roles in provision and utilization of comprehensive oral care. These factors are likely to be interlinked and should be taken into consideration when studying any of the factors individually.

Benefits and Costs of For-Profit Public Education

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Alex Molnar

2001-04-01

Full Text Available As a policy initiative, for-profit operation of public schools has not lived up to the claims of its proponents. An examination of issues such as teaching methods, academic achievement, autonomy, local control, and the image and influence of for-profit public schools suggests that "for-profits" are unlikely to succeed in the long term in improving the overall quality of public education. They do, however, seem capable of harming public schools.

The household costs of health care in rural South Africa with free public primary care and hospital exemptions for the poor.

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Goudge, Jane; Gilson, Lucy; Russell, Steve; Gumede, Tebogo; Mills, Anne

2009-04-01

To measure the direct cost burdens (health care expenditure as a percent of total household expenditure) for households in rural South Africa, and examine the expenditure and use patterns driving those burdens, in a setting with free public primary health care and hospital exemptions for the poor. Data on illness events, treatment patterns and health expenditure in the previous month were assessed from a cross-sectional survey of 280 households conducted in the Agincourt Health and Demographic Surveillance site, South Africa. On average, a household experiencing illness incurred a direct cost burden of 4.5% of total household expenditure. A visit to a public clinic generated a mean burden of 1.3%. Complex sequences of treatments led 20% of households to incur a burden over 10%, with transport costs generating 42% of this burden. An outpatient public hospital visit generated a burden of 8.2%, as only 58% of those eligible obtained an exemption; inpatient stays incurred a burden of 45%. Consultations with private providers incurred a mean burden of 9.5%. About 38% of individuals who reported illness did not take any treatment action, 55% of whom identified financial and perceived supply-side barriers as reasons. The low overall mean cost burden of 4.5% suggests that free primary care and hospital exemptions provided financial protection. However, transport costs, the difficulty of obtaining hospital exemptions, use of private providers, and complex treatment patterns meant state-provided protection had limitations. The significant non-use of care shows the need for other measures such as more outreach services and more exemptions in rural areas. The findings also imply that fee removal anywhere must be accompanied by wider measures to ensure improved access.

Fee-Free Public or Low-Fee Private Basic Education in Rural Ghana: How Does the Cost Influence the Choice of the Poor?

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Akaguri, Luke

2014-01-01

The paper uses data from a household survey of three rural communities and interviews in the Mfantseman Municipality in the Central Region of Ghana to investigate the costs incurred by households that choose either fee-free public schools or low-fee private schools. The paper shows that both provisions impose costs that place those with lower…

The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals

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Laetitia C. Rispel

2015-05-01

Full Text Available Background: Globally, flexible work arrangements – through the use of temporary nursing staff – are an important strategy for dealing with nursing shortages in hospitals. Objective: The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Methods: Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices. Results: In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million. The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467 and at Hospital 2 the value was R300,121 (US$42,874, thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Conclusion

The indirect costs of agency nurses in South Africa: a case study in two public sector hospitals.

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Rispel, Laetitia C; Moorman, Julia

2015-01-01

Globally, flexible work arrangements - through the use of temporary nursing staff - are an important strategy for dealing with nursing shortages in hospitals. The objective of the study was to determine the direct and indirect costs of agency nurses, as well as the advantages and the problems associated with agency nurse utilisation in two public sector hospitals in South Africa. Following ethical approval, two South African public sector hospitals were selected purposively. Direct costs were determined through an analysis of hospital expenditure information for a 5-year period from 2005 until 2010, obtained from the national transversal Basic Accounting System database. At each hospital, semi-structured interviews were conducted with the chief executive officer, executive nursing services manager, the maternity or critical care unit nursing manager, the human resource manager, and the finance manager. Indirect costs measured were the time spent on pre-employment checks, and nurse recruitment, orientation, and supervision. All expenditure is expressed in South African Rands (R: 1 USD=R7, 2010 prices). In the 2009/10 financial year, Hospital 1 spent R38.86 million (US$5.55 million) on nursing agencies, whereas Hospital 2 spent R10.40 million (US$1.49 million). The total estimated time spent per week on indirect cost activities at Hospital 1 was 51.5 hours, and 60 hours at Hospital 2. The estimated monetary value of this time at Hospital 1 was R962,267 (US$137,467) and at Hospital 2 the value was R300,121 (US$42,874), thus exceeding the weekly direct costs of nursing agencies. Agency nurses assisted the selected hospitals in dealing with problems of nurse recruitment, absenteeism, shortages, and skills gaps in specialised clinical areas. The problems experienced with agency nurses included their perceived lack of commitment, unreliability, and providing sub-optimal quality of patient care. Hospital managers and policy-makers need to address the effective

Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa

DEFF Research Database (Denmark)

Phillips, Andrew N; Cambiano, Valentina; Nakagawa, Fumiyo

2018-01-01

BACKGROUND: There is concern over increasing prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance in people initiating antiretroviral therapy (ART) in low-income and middle-income countries. We assessed the effectiveness and cost-effectiveness of alternative public health...... sources and considers specific drugs and resistance mutations. We used this model to generate multiple setting scenarios mimicking those in sub-Saharan Africa and considered the prevalence of pretreatment NNRTI drug resistance in 2017. We then compared effectiveness and cost-effectiveness of alternative...... policy options. We took a 20 year time horizon, used a cost effectiveness threshold of US$500 per DALY averted, and discounted DALYs and costs at 3% per year. FINDINGS: A transition to use of a dolutegravir as a first-line regimen in all new ART initiators is the option predicted to produce the most...

Comparative costs and cost-effectiveness of behavioural interventions as part of HIV prevention strategies.

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Hsu, Justine; Zinsou, Cyprien; Parkhurst, Justin; N'Dour, Marguerite; Foyet, Léger; Mueller, Dirk H

2013-01-01

Behavioural interventions have been widely integrated in HIV/AIDS social marketing prevention strategies and are considered valuable in settings with high levels of risk behaviours and low levels of HIV/AIDS awareness. Despite their widespread application, there is a lack of economic evaluations comparing different behaviour change communication methods. This paper analyses the costs to increase awareness and the cost-effectiveness to influence behaviour change for five interventions in Benin. Cost and cost-effectiveness analyses used economic costs and primary effectiveness data drawn from surveys. Costs were collected for provider inputs required to implement the interventions in 2009 and analysed by 'person reached'. Cost-effectiveness was analysed by 'person reporting systematic condom use'. Sensitivity analyses were performed on all uncertain variables and major assumptions. Cost-per-person reached varies by method, with public outreach events the least costly (US$2.29) and billboards the most costly (US$25.07). Influence on reported behaviour was limited: only three of the five interventions were found to have a significant statistical correlation with reported condom use (i.e. magazines, radio broadcasts, public outreach events). Cost-effectiveness ratios per person reporting systematic condom use resulted in the following ranking: magazines, radio and public outreach events. Sensitivity analyses indicate rankings are insensitive to variation of key parameters although ratios must be interpreted with caution. This analysis suggests that while individual interventions are an attractive use of resources to raise awareness, this may not translate into a cost-effective impact on behaviour change. The study found that the extensive reach of public outreach events did not seem to influence behaviour change as cost-effectively when compared with magazines or radio broadcasts. Behavioural interventions are context-specific and their effectiveness influenced by a

PR for Pennies: Low-Cost Library Public Relations.

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Baeckler, Virginia Van Wynen

This manual is designed to demystify a number of public relations techniques for those who wish to start producing their own materials with a minimum of time and money. Chapters focus on public relations; the library stereotype; words, ideas, and pictures; offset printing; creative print distribution; exhibits and posters; public speaking; and the…

Direct healthcare costs and cost-effectiveness of acute coronary syndrome secondary prevention with ticagrelor compared to clopidogrel: economic evaluation from the public payer's perspective in Poland based on the PLATO trial results.

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Pawęska, Justyna; Macioch, Tomasz; Perkowski, Piotr; Budaj, Andrzej; Niewada, Maciej

2014-01-01

Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist designed to reduce clinical thrombotic events in patients with acute coronary syndrome (ACS). Compared to clopidogrel, ticagrelor has been proven to significantly reduce the rate of death from vascular causes, myocardial infarction (MI), or stroke without an increase in the rate of overall major bleeding in patients who have an ACS with or without ST-segment elevation (STEMI and NSTEMI) or unstable angina (UA). To evaluate the cost-effectiveness and healthcare costs associated with secondary prevention of ACS using ticagrelor or clopidogrel in patients after STEMI, NSTEMI and UA. An economic model based on results from the PLATO trial was used to evaluate the cost-effectiveness of one-year therapy with ticagrelor or clopidogrel. The structure of the model consisted of two parts, i.e. the decision tree with one-year PLATO results and the Markov model with lifelong estimations, which exceeded PLATO follow-up data. The model was adjusted to Polish settings with country-specific data on death rates in the general population and direct medical costs calculated from the public payer's perspective. Costs were derived from the National Health Fund (NHF) and the Ministry of Health and presented in PLN 2013 values. Annual mean costs of second and subsequent years after stroke or MI were obtained from the literature. Uncertainty of assumed parameters was tested in scenarios and probabilistic sensitivity analyses. The adopted model allowed the estimation of an incremental cost-effectiveness ratio for life years gained (LYG) and an incremental cost-utility ratio for quality adjusted life years (QALY). Total direct medical costs to the public payer at a one year horizon were 2,905 PLN higher with ticagrelor than with clopidogrel. However, mean healthcare costs at a one year horizon (excluding drug costs and concomitant drugs) were 690 PLN higher for patients treated with clopidogrel. In a lifetime horizon

The development of a public optometry system in Mozambique: a Cost Benefit Analysis.

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Thompson, Stephen; Naidoo, Kovin; Harris, Geoff; Bilotto, Luigi; Ferrão, Jorge; Loughman, James

2014-09-23

The economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem. The Mozambique Eyecare Project (MEP) has established the first optometry training and human resource deployment initiative to address the burden of URE in Lusophone Africa. The nature of the MEP programme provides the opportunity to determine, using Cost Benefit Analysis (CBA), whether investing in the establishment and delivery of a comprehensive system for optometry human resource development and public sector deployment is economically justifiable for Lusophone Africa. A CBA methodology was applied across the period 2009-2049. Costs associated with establishing and operating a school of optometry, and a programme to address uncorrected refractive error, were included. Benefits were calculated using a human capital approach to valuing sight. Disability weightings from the Global Burden of Disease study were applied. Costs were subtracted from benefits to provide the net societal benefit, which was discounted to provide the net present value using a 3% discount rate. Using the most recently published disability weightings, the potential exists, through the correction of URE in 24.3 million potentially economically productive persons, to achieve a net present value societal benefit of up to $1.1 billion by 2049, at a Benefit-Cost ratio of 14:1. When CBA assumptions are varied as part of the sensitivity analysis, the results suggest the societal benefit could lie in the range of $649 million to $9.6 billion by 2049. This study demonstrates that a programme designed to address the burden of refractive error in Mozambique is economically justifiable in terms of the increased productivity that would result due to its implementation.

The Hidden Cost of Regulation: The Administrative Cost of Reporting Serious Reportable Events.

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Blanchfield, Bonnie B; Acharya, Bijay; Mort, Elizabeth

2018-04-01

More than half of the 50 states (27) and the District of Columbia require reporting of Serous Reportable Events (SREs). The goal is to hold providers accountable and improve patient safety, but there is little information about the administrative cost of this reporting requirement. This study was conducted to identify costs associated with investigating and reporting SREs. This qualitative study used case study methods that included interviewing staff and review of data and documents to investigate each SRE occurring at one academic medical center during fiscal year 2013. A framework of tasks and a model to categorize costs was created. Time was summarized and costs were estimated for each SRE. The administrative cost to process 44 SREs was estimated at $353,291, an average cost of $8,029 per SRE, ranging $6,653 for an environmental-related SRE to $21,276 for a device-related SRE. Care management SREs occurred most frequently, costing an average $7,201 per SRE. Surgical SREs, the most expensive on average, cost $9,123 per SRE. Investigation of events accounted for 64.5% of total cost; public reporting, 17.2%; internal reporting, 10.2%; finance and administration, 6.0%; and 2.1%, other. Even with 26 states mandating reporting, the 17.2% incremental cost of public reporting is substantial. Policy makers should consider the opportunity costs of these resources, averaging $8,029 per SRE, when mandating reporting. The benefits of public reporting should be collectively reviewed to ensure that the incremental costs in this resource-constrained environment continue to improve patient safety and that trade-offs are acknowledged. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Cost and resource use of patients on antiretroviral therapy in the urban and semiurban public sectors of South Africa.

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Meyer-Rath, Gesine; Miners, Alec; Santos, Andreia C; Variava, Ebrahim; Venter, Willem Daniel Francois

2012-11-01

South Africa has the world's largest number of patients on antiretroviral treatment (ART). As coverage expands beyond urban environments, the cost of care is becoming increasingly important. Health care cost data for the first year after initiation were analyzed for cohorts of patients in a semiurban and an urban public sector ART clinic in South Africa. We compared mean cost by CD4 cell count and time on ART between clinics. Patients in both clinics had comparable CD4 cell counts at initiation and under treatment. In the urban clinic, mean cost per patient-year on ART in 2011 USD was $1040 [95% confidence interval (CI): $800 to $1280], of which outpatient cost was $692 (67%) and inpatient cost was $348 (33%). Fourteen percent of urban patients required inpatient care at a mean length of stay of 9 days and mean cost per hospitalized patient of $1663 (95% CI: $1103 to $2041). In the semiurban clinic, mean cost per patient-year on ART was $1115 (95% CI: $776 to $1453), of which outpatient cost was $697 (63%) and inpatient cost $418 (37%). Seven percent of semiurban patients required inpatient care at a mean length of stay of 28 days and mean cost per hospitalized patient of $3824 (95% CI: $1143 to $6505). Outpatient ART provision in the semiurban setting cost the same as in the urban setting, but inpatient costs are higher in the semiurban clinic because of longer hospitalizations. Cost in both clinics was highest in the first 3 months on ART and at CD4 cell counts <50 cells/μL.

Are Public-Private Partnerships an Appropriate Governance Structure for Power Plants? A Transaction Cost Analysis

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Ho, S. Ping; Hsu, Yaowen

2015-04-01

In order to meet the requirements of the rapid economic growth, many countries demand an increasing number of power plants to meet the increasing electricity usage. Since high capital requirements of power plants present a big issue for these countries, PPPs have been considered an alternative to provide power plant infrastructure. In particular, in emerging or developing countries, PPPs may be the fastest way to provide the infrastructure needed. However, while PPPs are a promising alternative to providing various types of infrastructure, many failed power plant PPP projects have made it evident that PPPs, under certain situations, can be very costly or even a wrong choice of governance structure. While the higher efficiency due to better pooling of resources is greatly emphasized in Public-Private Partnerships (PPPs), the embedded transaction inefficiencies are often understated or even ignored. Through the lens of Transaction Cost Economics (TCE), this paper aims to answer why and when PPPs may become a costly governance structure for power plants. Specifically, we develop a TCE-based theory of PPPs as a governance structure. This theory suggests that three major opportunism problems embedded in infrastructure PPPs are possible to cause substantial transaction costs and render PPPs a costly governance structure. The three main opportunism problems are principal-principal problem, firm's hold-up problem, and government-led hold-up problem. Moreover, project and institutional characteristics that may lead to opportunism problems are identified. Based on these characteristics, an opportunism-focused transaction cost analysis (OTCA) for PPPs as a governance structure is proposed to supplement the current practice of PPP feasibility analysis. As a part of theory development, a case study of PPP power plants is performed to evaluate the proposed theory and to illustrate how the proposed OTCA can be applied in practice. Policies and administration strategies for power

The impact of cost and network topology on urban mobility: a study of public bicycle usage in 2 U.S. cities.

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Jurdak, Raja

2013-01-01

Understanding the drivers of urban mobility is vital for epidemiology, urban planning, and communication networks. Human movements have so far been studied by observing people's positions in a given space and time, though most recent models only implicitly account for expected costs and returns for movements. This paper explores the explicit impact of cost and network topology on mobility dynamics, using data from 2 city-wide public bicycle share systems in the USA. User mobility is characterized through the distribution of trip durations, while network topology is characterized through the pairwise distances between stations and the popularity of stations and routes. Despite significant differences in station density and physical layout between the 2 cities, trip durations follow remarkably similar distributions that exhibit cost sensitive trends around pricing point boundaries, particularly with long-term users of the system. Based on the results, recommendations for dynamic pricing and incentive schemes are provided to positively influence mobility patterns and guide improved planning and management of public bicycle systems to increase uptake.

The Hepatitis C Genotype 1 Paradox: Cost per Treatment Is Increasing, but Cost per Cure Is Decreasing

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Stephen D Shafran

2015-01-01

Full Text Available Significant attention has been focused on the perceived increase in the cost of antiviral treatment for hepatitis C genotype 1 infection since the approval of the first direct-acting antiviral agents in 2011. Using Canadian list prices, the present analysis points out a paradox: while the cost per antiviral regimen is increasing, the cost per cure is decreasing, especially with interferon-free therapy. In a publicly funded health care system, the lowest cost per cure is a more valuable measure of value for public money than the cost per regimen.

The hepatitis C genotype 1 paradox: cost per treatment is increasing, but cost per cure is decreasing.

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Shafran, Stephen D

2015-01-01

Significant attention has been focused on the perceived increase in the cost of antiviral treatment for hepatitis C genotype 1 infection since the approval of the first direct-acting antiviral agents in 2011. Using Canadian list prices, the present analysis points out a paradox: while the cost per antiviral regimen is increasing, the cost per cure is decreasing, especially with interferon-free therapy. In a publicly funded health care system, the lowest cost per cure is a more valuable measure of value for public money than the cost per regimen.

Cost-effectiveness of cognitive-behavioural therapy for mental disorders: implications for public health care funding policy in Canada.

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Myhr, Gail; Payne, Krista

2006-09-01

Publicly funded cognitive-behavioural therapy (CBT) for mental disorders is scarce in Canada, despite proven efficacy and guidelines recommending its use. This paper reviews published data on the economic impact of CBT to inform recommendations for current Canadian mental health care funding policy. We searched the literature for economic analyses of CBT in the treatment of mental disorders. We identified 22 health economic studies involving CBT for mood, anxiety, psychotic, and somatoform disorders. Across health care settings and patient populations, CBT alone or in combination with pharmacotherapy represented acceptable value for health dollars spent, with CBT costs offset by reduced health care use. International evidence suggests CBT is cost-effective. Greater access to CBT would likely improve outcomes and result in cost savings. Future research is warranted to evaluate the economic impact of CBT in Canada.

Excess control rights: a study about its reflex on the cost of debt of publicly traded Brazilian companies

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Jonatan Marlon Konraht

2016-08-01

Full Text Available This study analyzes the effect of excess control on the cost of debt in publicly traded Brazilian companies. Its objective is to determine whether a higher misalignment between voting rights and cash flow rights held by controlling shareholder causes an increase in agency cost of debt. For the analysis of the research problem, it was used panel data regression with random effects, in which was compared the level of excess control and the firms cost of debt. The results indicate that there is a positive and statistically significant association between excess control and the cost of debt. This suggests that creditors interpret this misalignment as a control entrenchment, which increases the credit risk, and thereby, increases the cost of debt. From the scientific point of view, the contribution to the literature provided by this study is the finding that ownership structure bears an impact in the creditor perceptions of risk, and thus, the cost of debt. These results can assist in developing actions to reduce the cost of debt, which implies the maximization of the economic performance of firms that have third-party capital in its capital structure. Its social contribution is the distinction of the firms exposed to a higher level of cost of debt, identifying ways to maximize resources, that is a relevant aspect especially in times of crisis whose effects can be very varied, such as bankruptcies, massive layoffs and default.

The implementation of the Quality Costs Methodology in the Public Transport Enterprise in Macedonia

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Elizabeta Mitreva

2017-02-01

Full Text Available The implementation of TQM (Total Quality Management strategy in the public transport enterprises in Macedonia means improving the quality of services through examination of business processes not just in terms of defining, improvement and design of the process, but also improvement of productivity and optimization of the costs of quality. The purpose of this study is to point out the importance of determining the quality of the transport services, its methods, and techniques for measurement of the optimization of business processes in particular. The analysis of the quality costs when providing transport services can help managers to understand the impact of poor quality on the financial results and the bad image it gives to the enterprise. In this study, we proposed and applied the model for better performance and higher efficiency of the transport enterprise, through the optimization of business processes, change in the corporate culture and use of the complete business potentials. The need for this methodology was imposed as a result of the analysis made in the company in terms of whether is it doing an analysis on the costs of quality or not. The benefits from the utilization of this model will not only lead to increasing the business performance of the transport enterprise, but this model will also serve as a driving force for continuous improvements to the satisfaction of all stakeholders.

Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda

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Strachan Daniel

2010-04-01

Full Text Available Abstract Background In Uganda, long-lasting insecticidal nets (LLIN have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC services. Their combination in a mixed-model strategy is being advocated to quickly increase LLIN coverage and maintain it over time, but there is little evidence on the efficiency of each system. This study evaluated the two delivery channels regarding LLIN retention and use, and estimated the associated costs, to contribute towards the evidence-base on LLIN delivery channels in Uganda. Methods Household surveys were conducted 5-7 months after LLIN distribution, combining questionnaires with visual verification of LLIN presence. Focus groups and interviews were conducted to further investigate determinants of LLIN retention and use. Campaign distribution was evaluated in Jinja and Adjumani while ANC distribution was evaluated only in the latter district. Costs were calculated from the provider perspective through retrospective analysis of expenditure data, and effects were estimated as cost per LLIN delivered and cost per treated-net-year (TNY. These effects were calculated for the total number of LLINs delivered and for those retained and used. Results After 5-7 months, over 90% of LLINs were still owned by recipients, and between 74% (Jinja and 99% (ANC Adjumani were being used. Costing results showed that delivery was cheapest for the campaign in Jinja and highest for the ANC channel, with economic delivery cost per net retained and used of USD 1.10 and USD 2.31, respectively. Financial delivery costs for the two channels were similar in the same location, USD 1.04 for campaign or USD 1.07 for ANC delivery in Adjumani, but differed between locations (USD 0.67 for campaign delivery in Jinja. Economic cost for ANC distribution were considerably higher (USD 2.27 compared to campaign costs (USD 1.23 in Adjumani. Conclusions Targeted campaigns and routine ANC

Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda.

Science.gov (United States)

Kolaczinski, Jan H; Kolaczinski, Kate; Kyabayinze, Daniel; Strachan, Daniel; Temperley, Matilda; Wijayanandana, Nayantara; Kilian, Albert

2010-04-20

In Uganda, long-lasting insecticidal nets (LLIN) have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC) services. Their combination in a mixed-model strategy is being advocated to quickly increase LLIN coverage and maintain it over time, but there is little evidence on the efficiency of each system. This study evaluated the two delivery channels regarding LLIN retention and use, and estimated the associated costs, to contribute towards the evidence-base on LLIN delivery channels in Uganda. Household surveys were conducted 5-7 months after LLIN distribution, combining questionnaires with visual verification of LLIN presence. Focus groups and interviews were conducted to further investigate determinants of LLIN retention and use. Campaign distribution was evaluated in Jinja and Adjumani while ANC distribution was evaluated only in the latter district. Costs were calculated from the provider perspective through retrospective analysis of expenditure data, and effects were estimated as cost per LLIN delivered and cost per treated-net-year (TNY). These effects were calculated for the total number of LLINs delivered and for those retained and used. After 5-7 months, over 90% of LLINs were still owned by recipients, and between 74% (Jinja) and 99% (ANC Adjumani) were being used. Costing results showed that delivery was cheapest for the campaign in Jinja and highest for the ANC channel, with economic delivery cost per net retained and used of USD 1.10 and USD 2.31, respectively. Financial delivery costs for the two channels were similar in the same location, USD 1.04 for campaign or USD 1.07 for ANC delivery in Adjumani, but differed between locations (USD 0.67 for campaign delivery in Jinja). Economic cost for ANC distribution were considerably higher (USD 2.27) compared to campaign costs (USD 1.23) in Adjumani. Targeted campaigns and routine ANC services can both achieve high LLIN retention and use among

Costing the supply chain for delivery of ACT and RDTs in the public sector in Benin and Kenya.

Science.gov (United States)

Shretta, Rima; Johnson, Brittany; Smith, Lisa; Doumbia, Seydou; de Savigny, Don; Anupindi, Ravi; Yadav, Prashant

2015-02-05

Studies have shown that supply chain costs are a significant proportion of total programme costs. Nevertheless, the costs of delivering specific products are poorly understood and ballpark estimates are often used to inadequately plan for the budgetary implications of supply chain expenses. The purpose of this research was to estimate the country level costs of the public sector supply chain for artemisinin-based combination therapy (ACT) and rapid diagnostic tests (RDTs) from the central to the peripheral levels in Benin and Kenya. A micro-costing approach was used and primary data on the various cost components of the supply chain was collected at the central, intermediate, and facility levels between September and November 2013. Information sources included central warehouse databases, health facility records, transport schedules, and expenditure reports. Data from document reviews and semi-structured interviews were used to identify cost inputs and estimate actual costs. Sampling was purposive to isolate key variables of interest. Survey guides were developed and administered electronically. Data were extracted into Microsoft Excel, and the supply chain cost per unit of ACT and RDT distributed by function and level of system was calculated. In Benin, supply chain costs added USD 0.2011 to the initial acquisition cost of ACT and USD 0.3375 to RDTs (normalized to USD 1). In Kenya, they added USD 0.2443 to the acquisition cost of ACT and USD 0.1895 to RDTs (normalized to USD 1). Total supply chain costs accounted for more than 30% of the initial acquisition cost of the products in some cases and these costs were highly sensitive to product volumes. The major cost drivers were found to be labour, transport, and utilities with health facilities carrying the majority of the cost per unit of product. Accurate cost estimates are needed to ensure adequate resources are available for supply chain activities. Product volumes should be considered when costing supply chain

78 FR 61227 - Public Assistance Cost Estimating Format for Large Projects

Science.gov (United States)

2013-10-03

... equipment. The base cost (construction costs) plus nonconstruction costs equal the total eligible cost... included the estimated base cost plus the estimated nonconstruction costs. Under the traditional method... total cost of completing the project. This ``forward- pricing'' methodology provides an estimate of the...

Coste de las técnicas de reproducción asistida en un hospital público Cost of assisted reproduction technology in a public hospital

Directory of Open Access Journals (Sweden)

José Luis Navarro Espigares

2006-10-01

Full Text Available Objetivos: La mayoría de trabajos sobre costes de las técnicas de reproducción asistida (TRA identifican el coste directo del procedimiento, sin considerar elementos como los costes estructurales o intermedios, de gran importancia. El objetivo de este trabajo es calcular el coste por proceso de las TRA realizadas en un hospital público en 2003 y compararlo con los resultados de 1998 en el mismo centro. Métodos: El estudio se realiza en la Unidad de Reproducción Humana (URH del Hospital Universitario Virgen de las Nieves de Granada en 1998 y 2003. Partiendo de los costes totales de dicha unidad, y mediante una metodología de distribución de costes basada en la estructura de costes, calculamos el coste por proceso de las TRA realizadas en este centro, considerando los costes completos. Resultados: Entre 1998 y 2003, la actividad y los costes de la URH analizada evolucionan de forma distinta. El análisis de la actividad muestra la consolidación de técnicas, como la microinyección espermática (ICSI y la desaparición de otras (ciclo sin reproducción asistida e inseminación artificial conyugal intracervical. En todos los procesos, los costes unitarios por ciclo y por embarazo disminuyen en el período analizado. Conclusiones: Se han producido importantes cambios en la estructura de costes de las TRA de la URH-HUVN entre 1998-2003. Mientras algunos procesos desaparecen, otros se consolidan con una elevada actividad. Los avances técnicos y las innovaciones organizativas, junto con un «efecto aprendizaje», han alterado la estructura de costes de las TRA.Objectives: Most studies on the costs of assisted reproductive technologies (ART identify the total cost of the procedure with the direct cost, without considering important items such as overhead or intermediate costs. The objective of this study was to determine the cost per ART procedure in a public hospital in 2003 and to compare the results with those in the same hospital in 1998

Incremental cost-effectiveness of percutaneous versus surgical closure of atrial septal defects in children under a public health system perspective in Brazil.

Science.gov (United States)

Costa, Rodrigo; Pedra, Carlos A C; Ribeiro, Marcelo; Pedra, Simone; Ferreira-Da-Silva, André Luis; Polanczyk, Carisi; Berwanger, Otávio; Biasi, Alexandre; Ribeiro, Rodrigo

2014-11-01

Cost-effectiveness (CE) studies of percutaneous (PC) versus surgical (SC) atrial septal defect closure are lacking. A systematic literature review in children and a CE analysis based on a model of long-term outcomes were performed. Direct costs of PC and SC were US$8700 (defined arbitrarily) and US$5700 (actually paid), respectively. Three-times the Brazilian GDI (US$28,700) per year of life saved (with a discount rate of 5%) was used as a limit for willingness-to-pay. PC had a high (US$104,500) incremental CE ratio despite lower complication rates, shorter hospital stay and better (nonsignificant) adjusted life expectancy. PC would be cost-effective if it cost US$6400 or SC had an 8% loss of utility or its indirect costs were US$2250. Costs of PC should be reduced to be cost-effective in the Brazilian public health system. Indirect costs and impact on quality of life should be further assessed.

A model to estimate the cost of the National Essential Public Health Services Package in Beijing, China.

Science.gov (United States)

Yin, Delu; Wong, Sabrina T; Chen, Wei; Xin, Qianqian; Wang, Lihong; Cui, Mingming; Yin, Tao; Li, Ruili; Zheng, Xiaoguo; Yang, Huiming; Yu, Juanjuan; Chen, Bowen; Yang, Weizhong

2015-06-06

In order to address several health challenges, the Chinese government issued the National Essential Public Health Services Package (NEPHSP) in 2009. In China's large cities, the lack of funding for community health centers and consequent lack of comprehensive services and high quality care has become a major challenge. However, no study has been carried out to estimate the cost of delivering the services in the package. This project was to develop a cost estimation approach appropriate to the context and use it to calculate the cost of the NEPHSP in Beijing in 2011. By adjusting models of cost analysis of primary health care and workload indicators of staffing need developed by the World Health Organization, a model was developed to estimate the cost of the services in the package through an intensive interactive process. A total of 17 community health centers from eight administrative districts in Beijing were selected. Their service volume and expenditure data in 2010 were used to evaluate the costs of providing the NEPHSP in Beijing based on the applied model. The total workload of all types of primary health care in 17 sample centers was equivalent to the workload requirement for 14,056,402 standard clinic visits. The total expenditure of the 17 sample centers was 26,329,357.62 USD in 2010. The cost of the workload requirement of one standard clinic visit was 1.87 USD. The workload of the NEPHSP was equivalent to 5,514,777 standard clinic visits (39.23 % of the total workload). The model suggests that the cost of the package in Beijing was 7.95 USD per capita in 2010. The cost of the NEPHSP in urban areas was lower than suburban areas: 7.31 and 8.65 USD respectively. The average investment of 3.97 USD per capita in NEPHSP was lower than the amount needed to meet its running costs. NEPHSP in Beijing is therefore underfunded. Additional investment is needed, and a dynamic cost estimate mechanism should be introduced to ensure services remain adequately funded.

The Cost of Astronomy

DEFF Research Database (Denmark)

Dorch, Bertil F.

Using Scopus and national sources, I have investigated the evolution of the cost of publishing in Danish astronomy on a fine scale over a number of years. I find that the number of publications per year from Danish astronomers increased by a factor of four during 15 years: naturally, the correspo......Using Scopus and national sources, I have investigated the evolution of the cost of publishing in Danish astronomy on a fine scale over a number of years. I find that the number of publications per year from Danish astronomers increased by a factor of four during 15 years: naturally......, the corresponding potential cost of publishing must have increased similarly. The actual realized cost of publishing in core journals are investigated for a high profile Danish astronomy research institutions. I argue that the situation is highly unstable if the current cost scenario continues, and I speculate...... that Danish astronomy is risking a scholarly communication collapse due to the combination of increasing subscription cost, increased research output, and increased direct publishing costs related to Open access and other page charges....

The cost of publishing in Danish astronomy

DEFF Research Database (Denmark)

Dorch, Bertil F.

I investigate the cost of publishing in Danish astronomy on a fine scale, including all direct publication costs: The figures show how the annual number of publications with authors from Denmark in astronomy journals increased by a factor approximately four during 15 years (Elsevier’s Scopus...... database), and the increase of the corresponding potential (maximum) cost of publishing....

Impact of quadrivalent influenza vaccine on public health and influenza-related costs in Australia

Directory of Open Access Journals (Sweden)

Aurélien Jamotte

2016-07-01

Full Text Available Abstract Background Annual trivalent influenza vaccines (TIV containing three influenza strains (A/H1N1, A/H3N2, and one B have been recommended for the prevention of influenza. However, worldwide co-circulation of two distinct B lineages (Victoria and Yamagata and difficulties in predicting which lineage will predominate each season have led to the development of quadrivalent influenza vaccines (QIV, which include both B lineages. Our analysis evaluates the public health benefit and associated influenza-related costs avoided which would have been obtained by using QIV rather than TIV in Australia over the period 2002–2012. Methods A static model stratified by age group was used, focusing on people at increased risk of influenza as defined by the Australian vaccination recommendations. B-lineage cross-protection was accounted for. We calculated the potential impact of QIV compared with TIV over the seasons 2002–2012 (2009 pandemic year excluded using Australian data on influenza circulation, vaccine coverage, hospitalisation and mortality rates as well as unit costs, and international data on vaccine effectiveness, influenza attack rate, GP consultation rate and working days lost. Third-party payer and societal influenza-related costs were estimated in 2014 Australian dollars. Sensitivity analyses were conducted. Results Using QIV instead of TIV over the period 2002–2012 would have prevented an estimated 68,271 additional influenza cases, 47,537 GP consultations, 3,522 hospitalisations and 683 deaths in the population at risk of influenza. These results translate into influenza-related societal costs avoided of $46.5 million. The estimated impact of QIV was higher for young children and the elderly. The overall impact of QIV depended mainly on vaccine effectiveness and the influenza attack rate attributable to the mismatched B lineage. Conclusion The broader protection offered by QIV would have reduced the number of influenza infections

Case study of the effects of public safety regulation on the construction costs of coal-fired and nuclear power plants

International Nuclear Information System (INIS)

Morris, C.D.

1987-01-01

Regulations intended to reduce the number of accidents at nuclear plants and the discharge of sulfur and particulate wastes at coal-fired power plants have become an important cause of construction cost escalation. Measuring the costs of these regulatory interventions is a difficult research task. The three-unit Bruce Mansfield coal-fired plant and the two-unit Beaver Valley nuclear power station located in Shippingport, Pennsylvania, provide a unique opportunity for a case study of the costs of regulation in the construction of both kinds of plants. The units of each plant were built sequentially over a period of intensifying regulation. The method used to measure the costs of public safety regulation in the construction of each kind of plant is to determine the connections between the issuances of the regulatory agencies (EPA and NRC) and cost escalations of succeeding units. The small cost escalations of the Mansfield 3 unit, in comparison to the massive costs of the Beaver Valley 2 unit, suggest that the design and construction of new coal-fired plants are not disrupted by regulatory interventions nearly as extensively as are nuclear units. Certain technical features of Beaver Valley 2, especially its small size and a design that is identical to the first unit's, further contribute to its cost escalations

Offshore wind power grid connection-The impact of shallow versus super-shallow charging on the cost-effectiveness of public support

International Nuclear Information System (INIS)

Weissensteiner, Lukas; Haas, Reinhard; Auer, Hans

2011-01-01

Public support for electricity generation from renewable energy sources is commonly funded by non-voluntary transfers from electricity consumers to producers. Apparently, the cost-effective disposition of funds in terms of induced capacity deployment has to be regarded a key criterion for the success of renewable energy policy. Grid connection costs are a major cost component in the utilization of offshore wind energy for electricity generation. In this paper, the effect of different attribution mechanisms of these costs on overall cost-effectiveness from consumers' perspective is analyzed. The major result of this investigation is that an attribution of grid connection costs to grid operators - as against to generators - leads to a smaller producer surplus and, hence, to lower transfer costs for electricity consumers. Applying this approach to the deployment of UK Rounds II and III offshore wind farms could lead to annual savings of social transfers of Pounds 1.2b and an equal reduction of producer surplus. This amount would be sufficient to finance the deployment of additional 10% of the capacity under consideration. - Highlights: → Grid connection costs of marginal wind farm add to submarginal producer surplus. → Overall producer surplus to be paid for by electricity consumers (transfer costs). → Allocating grid connection costs to grid operators leads to transfer cost savings. → Savings for UK Rounds II and III offshore wind farm projects may reach Pounds 1.2b per year. → These savings could finance additional 10% capacity (+3.3 GW).

Optimal public rationing and price response.

Science.gov (United States)

Grassi, Simona; Ma, Ching-To Albert

2011-12-01

We study optimal public health care rationing and private sector price responses. Consumers differ in their wealth and illness severity (defined as treatment cost). Due to a limited budget, some consumers must be rationed. Rationed consumers may purchase from a monopolistic private market. We consider two information regimes. In the first, the public supplier rations consumers according to their wealth information (means testing). In equilibrium, the public supplier must ration both rich and poor consumers. Rationing some poor consumers implements price reduction in the private market. In the second information regime, the public supplier rations consumers according to consumers' wealth and cost information. In equilibrium, consumers are allocated the good if and only if their costs are below a threshold (cost effectiveness). Rationing based on cost results in higher equilibrium consumer surplus than rationing based on wealth. Copyright © 2011 Elsevier B.V. All rights reserved.

Jean-Philippe Costes, Les subversifs hollywoodiens. L’esprit critique du cinéma grand public

OpenAIRE

Dubois, François-Ronan

2015-01-01

À l’idée largement répandue que le cinéma grand public produit dans les studios d’Hollywood représente une machine de propagande étasunienne ou, à tout le moins, capitaliste, Jean-Philippe Costes entend opposer une lecture à contre-courant d’un corpus cinématographique fait de grands classiques et de grands oubliés. Hollywood, à ses yeux, ne saurait se réduire au véhicule médiatique d’une idéologie uniforme et oppressive qui serait, au gré des analyses, celle du capital, du patriotisme améric...

National guidelines for high-cost drugs in Brazil: achievements and constraints of an innovative national evidence-based public health policy.

Science.gov (United States)

Picon, Paulo D; Beltrame, Alberto; Banta, David

2013-04-01

The translation of best evidence into practice has become an important purpose of policy making in health care. In Brazil, a country of continental dimensions with widespread regional and social inequalities, the dissemination and use of the best-evidence in policy making is a critical issue for the healthcare system. The main purpose of this study is to describe an evidence-based public health policy with special emphasis on guidelines creation for high-cost medicines. We also describe how that strategy was diffused to the judiciary system and to other parts of the healthcare system. We present an 11-year follow-up of a national project for creating and updating guidelines for high-cost medicines in Brazil. A total of 109 national guidelines were published (new or updated versions) for 66 selected diseases, the first such effort in Brazilian history. The project influenced the Brazilian legislature, which has recently established a Federal Law requiring national guidelines for any new technology listed for payment by the Brazilian public healthcare system. We were able to involve many different stakeholders in a partnership between academia and policy makers, which made possible the widespread dissemination of the clinical practice guidelines. Problems and constraints were also encountered. This evolving public health strategy might be useful for other developing countries.

Cost of schizophrenia in England.

Science.gov (United States)

Mangalore, Roshni; Knapp, Martin

2007-03-01

Despite the wide-ranging financial and social burdens associated with schizophrenia, there have been few cost-of-illness studies of this illness in the UK. To provide up-to-date, prevalence based estimate of all costs associated with schizophrenia for England. A bottom-up approach was adopted. Separate cost estimates were made for people living in private households, institutions, prisons and for those who are homeless. The costs included related to: health and social care, informal care, private expenditures, lost productivity, premature mortality, criminal justice services and other public expenditures such as those by the social security system. Data came from many sources, including the UK-SCAP (Schizophrenia Care and Assessment Program) survey, Psychiatric Morbidity Surveys, Department of Health and government publications. The estimated total societal cost of schizophrenia was 6.7 billion pounds in 2004/05. The direct cost of treatment and care that falls on the public purse was about 2 billion pounds; the burden of indirect costs to the society was huge, amounting to nearly 4.7 billion pounds. Cost of informal care and private expenditures borne by families was 615 million pounds. The cost of lost productivity due to unemployment, absence from work and premature mortality of patients was 3.4 billion pounds. The cost of lost productivity of carers was 32 million pounds. Estimated cost to the criminal justice system was about 1 million pounds. It is estimated that about 570 million pounds will be paid out in benefit payments and the cost of administration associated with this is about 14 million pounds. It is difficult to compare estimates from previous cost-of-illness studies due to differences in the methods, scope of analyses and the range of costs covered. Costs estimated in this study are detailed, cover a comprehensive list of relevant items and allow for different levels of disaggregation. The main limitation of the study is that data came from a

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.

Cost-of-illness studies.

Science.gov (United States)

Oderda, Gary M

2003-01-01

Cost-of-illness studies measure the overall economic impact of a disease on society. Such studies are important in setting public health priorities and for economic evaluation of new treatments. These studies should take the societal perspective and include both direct and indirect costs. Often indirect costs exceed direct costs. Comparison of cost-of-illness studies from different countries is difficult because of differences in population, currency, the way health care is provided, and other social and political factors.

The cost of occupational dose

International Nuclear Information System (INIS)

Fleishman, A.B.; Clark, M.J.

1980-01-01

The optimization of radiological protection will routinely involve the balancing of public and occupational exposure, particularly within the nuclear fuel cycle. For example the reduction of public exposure from an effluent stream could lead to increases in occupational exposure from treatment, storage and disposal operations. A methodology is propased for the estimation of the cost of occupational exposure in the UK (Pound man-Sv -1 ) based on valuations of changes in risk. A variable value for the cost of the occupational man-Sv is obtained depending on per caput dose levels. The values at particular per caput dose levels are different for occupational workers and the general public, because of different demography and assumptions on risk perception and aversion. They are however approximately the same when the per caput doses are expressed as percentages of the dose limits for workers and the general public respectively. An example of the application of the derived cost of the occupational man-Sv to an optimisation problem is given. (author)

Counting the costs of accreditation in acute care: an activity-based costing approach.

Science.gov (United States)

Mumford, Virginia; Greenfield, David; Hogden, Anne; Forde, Kevin; Westbrook, Johanna; Braithwaite, Jeffrey

2015-09-08

To assess the costs of hospital accreditation in Australia. Mixed methods design incorporating: stakeholder analysis; survey design and implementation; activity-based costs analysis; and expert panel review. Acute care hospitals accredited by the Australian Council for Health Care Standards. Six acute public hospitals across four States. Accreditation costs varied from 0.03% to 0.60% of total hospital operating costs per year, averaged across the 4-year accreditation cycle. Relatively higher costs were associated with the surveys years and with smaller facilities. At a national level these costs translate to $A36.83 million, equivalent to 0.1% of acute public hospital recurrent expenditure in the 2012 fiscal year. This is the first time accreditation costs have been independently evaluated across a wide range of hospitals and highlights the additional cost burden for smaller facilities. A better understanding of the costs allows policymakers to assess alternative accreditation and other quality improvement strategies, and understand their impact across a range of facilities. This methodology can be adapted to assess international accreditation programmes. 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.

The Cost of Being Accountable: An Objective-Referenced Program Cost Model for Educational Management--A Maryland Perspective.

Science.gov (United States)

Holowenzak, Stephen P.; Stagmer, Robert A.

This publication describes in detail an objective-referenced program cost model for educational management that was developed by the Maryland State Department of Education. Primary purpose of the publication is to aid educational decision-makers in developing and refining their own method of cost-pricing educational programs for use in state and…

42 CFR 457.1015 - Cost-effectiveness.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Cost-effectiveness. 457.1015 Section 457.1015... Waivers: General Provisions § 457.1015 Cost-effectiveness. (a) Definition. For purposes of this subpart... may demonstrate cost-effectiveness by comparing the cost of coverage for the family to the cost of...

Cost effectiveness and quality of life assessment on dental filling and tooth extraction in Balongsari Public Health Center

Directory of Open Access Journals (Sweden)

Taufan Bramantoro

2011-03-01

Full Text Available Background: Dental health services program implementation in Balongsari Public Health Center during three years, 2006 until 2008, have a high average ratio of filling treatment compared to tooth extraction treatment (1:1.79 as compared to the standard set by the Ministry of Health (1:1. Cost effectiveness analysis and quality of life is needed as a form of economic evaluation of costs incurred by the consequences or impacts of health care programs, especially dental filling and tooth extraction, use to help in supporting the process of policy making in health care. The objective of this study was to assess cost effectiveness analysis (CEA and quality of life (QoL on dental filling and extraction treatment in Public Health Center. Methods: The study was conducted on 31 respondents who received filling treatment and 38 respondents who received tooth extraction. All of the respondents carried out to evaluate the total costs incurred in obtaining treatment and QoL between before and after treatment, which consist of the physical aspects, psychological, social, and economic. Results: The average total cost of dental filling treatment of the 31 respondents was Rp. 27,934.45, and in tooth extraction of the 38 respondents at Rp. 22,406.83. The average difference in the QoL, before and after dental filling treatment amounted to 121.25. In extractions, QoL difference in value before and after treatment at 132.36. Cost effectiveness ratio value in dental filling treatment amounted to 230.37, and in tooth extraction at 169.63. Conclusion: It is concluded that cost effectiveness ratio in the filling treatment is higher than the extraction, that the tooth extraction treatment is considered more cost effective than filling treatment.Latar belakang: Pelaksanaan program pelayanan kesehatan gigi di Puskesmas Balongsari selama tiga tahun, yaitu tahun 2006 hingga 2008, memiliki rata-rata rasio perbandingan perawatan tumpatan dengan pencabutan gigi (1:1,79 yang

Transportation Costs and Subsidy Distribution Model for Urban and Suburban Public Passenger Transport

Directory of Open Access Journals (Sweden)

Marko Ševrović

2015-03-01

Full Text Available Public transport (PT subsidy provides the means to impose the optimal combination of fare and Level of Service (LoS offered to passengers. In regions where one PT operator services multiple local communities on multiple lines it becomes hard to uniformly link the actual cost of a line and thus the LoS offered, to a particular local community. This leads to possible disproportions in the overall subsidy distribution that can result in being unfair to some local communities, mainly the ones that are sparsely populated or geographically isolated. In order to extricate this problem the appropriate level of PT subsidisation according to the average values in the European cities was investigated and the current subsidy policies in Croatia were investigated. Based on this research and the hypothesis that the offered LoS must be reflected in the subsidy amount a new subsidy distribution model was established that involves a series of analytical procedures and processes. This model introduces several factors used for the calculation of the actual share in costs. Thus, the amount of subsidies for individual lines in a region can be determined based on the actual service offered to the local community, The proposed model has been tested and successfully implemented in the Dubrovnik-Neretva County in the Republic of Croatia.

Why invest in a national public health program for stroke? An example using Australian data to estimate the potential benefits and cost implications.

Science.gov (United States)

Cadilhac, Dominique A; Carter, Robert C; Thrift, Amanda G; Dewey, Helen M

2007-10-01

Stroke is the world's second leading cause of death in people aged over 60 years. Approximately 50,000 strokes occur annually in Australia with numbers predicted to increase by about one third over 10-years. Our objectives were to assess the economic implications of a public health program for stroke by: (1) predicting what potential health-gains and cost-offsets could be achieved; and (2) determining the net level of annual investment that would offer value-for-money. Lifetime costs and outcomes were calculated for additional cases that would benefit if 'current practice' was feasibly improved, estimated for one indicative year using: (i) local epidemiological data, coverage rates and costs; and (ii) pooled effect sizes from systematic reviews. blood pressure lowering; warfarin for atrial fibrillation; increased access to stroke units; intravenous thrombolysis and aspirin for ischemic events; and carotid endarterectomy. Value-for-money threshold: AUD$30,000/DALY recovered. Improved, prevention and management could prevent about 27,000 (38%) strokes in 2015. In present terms (2004), about 85,000 DALYs and AUD$1.06 billion in lifetime cost-offsets could be recovered. The net level of annual warranted investment was AUD$3.63 billion. Primary prevention, in particular blood pressure lowering, was most effective. A public health program for stroke is warranted.

41 CFR 105-54.304 - Cost guidelines.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Cost guidelines. 105-54.304 Section 105-54.304 Public Contracts and Property Management Federal Property Management... Administration 54-ADVISORY COMMITTEE MANAGEMENT 54.3-Advisory Committee Procedures § 105-54.304 Cost guidelines...

24 CFR 700.115 - Program costs.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Program costs. 700.115 Section 700... PUBLIC AND INDIAN HOUSING PROGRAMS) CONGREGATE HOUSING SERVICES PROGRAM § 700.115 Program costs. (a) Allowable costs. (1) Allowable costs for direct provision of supportive services includes the provision of...

INSTRUCTIONAL MATERIALS CATALOG.

Science.gov (United States)

Ohio Vocational Agriculture Instructional Materials Service, Columbus.

THE TITLE, IDENTIFICATION NUMBER, DATE OF PUBLICATION, PAGINATION, A BRIEF DESCRIPTION, AND PRICE ARE GIVEN FOR EACH OF THE INSTRUCTIONAL MATERIALS AND AUDIOVISUAL AIDS INCLUDED IN THIS CATALOG. TOPICS COVERED ARE FIELD CORPS, HORTICULTURE, ANIMAL SCIENCE, SOILS, AGRICULTURAL ENGINEERING, AND FARMING PROGRAMS. AN ORDER FORM IS INCLUDED. (JM)

45 CFR 1336.71 - Administrative costs.

Science.gov (United States)

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Administrative costs. 1336.71 Section 1336.71... Administrative costs. Reasonable administrative costs of the RLF may be paid out of the loan fund. The grant award agreement between the Loan Administrator and ANA will set forth the allowable administrative costs...

Stated and Revealed Preferences for Funding New High-Cost Cancer Drugs: A Critical Review of the Evidence from Patients, the Public and Payers.

Science.gov (United States)

MacLeod, Tatjana E; Harris, Anthony H; Mahal, Ajay

2016-06-01

The growing focus on patient-centred care has encouraged the inclusion of patient and public input into payer drug reimbursement decisions. Yet, little is known about patient/public priorities for funding high-cost medicines, and how they compare to payer priorities applied in public funding decisions for new cancer drugs. The aim was to identify and compare the funding preferences of cancer patients and the general public against the criteria used by payers making cancer drug funding decisions. A thorough review of the empirical, peer-reviewed English literature was conducted. Information sources were PubMed, EMBASE, MEDLINE, Web of Science, Business Source Complete, and EconLit. Eligible studies (1) assessed the cancer drug funding preferences of patients, the general public or payers, (2) had pre-defined measures of funding preference, and (3) had outcomes with attributes or measures of 'value'. The quality of included studies was evaluated using a health technology assessment-based assessment tool, followed by extraction of general study characteristics and funding preferences, which were categorized using an established WHO-based framework. Twenty-five preference studies were retrieved (11 quantitative, seven qualitative, seven mixed-methods). Most studies were published from 2005 onward, with the oldest dating back to 1997. Two studies evaluated both patient and public perspectives, giving 27 total funding perspectives (41 % payer, 33 % public, 26 % patients). Of 41 identified funding criteria, payers consider the most (35), the general public considers fewer (23), and patients consider the fewest (12). We identify four unique patient criteria: financial protection, access to medical information, autonomy in treatment decision making, and the 'value of hope'. Sixteen countries/jurisdictions were represented. Our results suggest that (1) payers prioritize efficiency (health gains per dollar), while citizens (patients and the general public) prioritize

42 CFR 412.84 - Payment for extraordinarily high-cost cases (cost outliers).

Science.gov (United States)

2010-10-01

... obtains accurate data with which to calculate either an operating or capital cost-to-charge ratio (or both... outlier payments will be based on operating and capital cost-to-charge ratios calculated based on a ratio... outliers). 412.84 Section 412.84 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...

41 CFR 101-27.507 - Transportation and other costs.

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Transportation and other costs. 101-27.507 Section 101-27.507 Public Contracts and Property Management Federal Property... MANAGEMENT 27.5-Return of GSA Stock Items § 101-27.507 Transportation and other costs. Transportation costs...

Cost benefit analysis vs. referenda

OpenAIRE

Martin J. Osborne; Matthew A. Turner

2007-01-01

We consider a planner who chooses between two possible public policies and ask whether a referendum or a cost benefit analysis leads to higher welfare. We find that a referendum leads to higher welfare than a cost benefit analyses in "common value" environments. Cost benefit analysis is better in "private value" environments.

Cost-Benefit Analysis and the Democratic Ideal

OpenAIRE

Karine Nyborg; Inger Spangen

1997-01-01

In traditional cost-benefit analyses of public projects, every citizen’s willingness to pay for a project is given an equal weight. This is sometimes taken to imply that cost-benefit analysis is a democratic method for making public decisions, as opposed to, for example, political processes involving log-rolling and lobbying from interest groups. Politicians are frequently criticized for not putting enough emphasis on the cost-benefit analyses when making decisions. In this paper we discuss t...

A Model for Understanding the Relationship Between Transaction Costs and Acquisition Cost Breaches

Science.gov (United States)

2014-04-30

an assistant professor and received a BA in anthropology and a BA and MA in economics (2004) and a PhD in political economy and public policy (2008...between transaction costs and cost overruns. Biggs (2013) showed that as the EAC SE/PM cost ratio rises there is a statistically significant corresponding...Estimate at Completion ( EAC ) is the sum of the ACWP and the estimate to completion (ETC) for the remaining work. The ETC can be calculated using the cost

Decommissioning Cost Assessment

International Nuclear Information System (INIS)

Labor, Bea

2012-03-01

The future costs for dismantling, decommissioning and handling of associated radioactive waste of nuclear installations represents substantial liabilities. It is the generations that benefits from the use of nuclear installations that shall carry the financial burden. Nuclear waste programmes have occasionally encountered set-backs related to the trust from society. This has resulted in delayed, redirected or halted activities, which has the common denominator of costs increases. In modern democratic countries, information sharing, knowledge transfer and open communication about costs for the management of radioactive waste are prerequisites for the task to develop modern methods for public participation and thus to develop well-founded and justified confidence for further development of nuclear energy. Nuclear and radiation safety Authorities have a clear role to provide unbiased information on any health, safety, financial and environmental related issues. This task requires a good understanding of the values and opinion of the public, and especially those of the younger generation

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

Estimating the unit costs of public hospitals and primary healthcare centers.

Science.gov (United States)

Younis, Mustafa Z; Jaber, Samer; Mawson, Anthony R; Hartmann, Michael

2013-01-01

Many factors have affected the rise of health expenditures, such as high-cost medical technologies, changes in disease patterns and increasing demand for health services. All countries allocate a significant portion of resources to the health sector. In 2008, the gross domestic product of Palestine was estimated to be at $6.108bn (current price) or about $1697 per capita. Health expenditures are estimated at 15.6% of the gross domestic product, almost as much as those of Germany, Japan and other developed countries. The numbers of hospitals, hospital beds and primary healthcare centers in the country have all increased. The Ministry of Health (MOH) currently operates 27 of 76 hospitals, with a total of 3074 beds, which represent 61% of total beds of all hospitals in the Palestinian Authorities area. Also, the MOH is operating 453 of 706 Primary Health Care facilities. By 2007, about 40 000 people were employed in different sectors of the health system, with 33% employed by the MOH. This purpose of this study was to develop a financing strategy to help cover some or all of the costs involved in operating such institutions and to estimate the unit cost of primary and secondary programs and departments. A retrospective study was carried out on data from government hospitals and primary healthcare centers to identify and analyze the costs and output (patient-related services) and to estimate the unit cost of health services provided by hospitals and PHCs during the year 2008. All operating costs are assigned and allocated to the departments at MOH hospitals and primary health care centers (PPHCs) and are identified as overhead departments, intermediate-service and final-service departments. Intermediate-service departments provide procedures and services to patients in the final-service departments. The costs of the overhead departments are distributed to the intermediate-service and final-service departments through a step-down method, according to allocation

A workplace physical activity program at a public university in Mexico can reduce medical costs associated with type 2 diabetes and hypertension.

Science.gov (United States)

Méndez-Hernández, Pablo; Dosamantes-Carrasco, Darina; Siani, Carole; Flores, Yvonne N; Arredondo, Armando; Lumbreras-Delgado, Irma; Granados-García, Víctor M; Denova-Gutiérrez, Edgar; Gallegos-Carrillo, Katia; Salmerón, Jorge

2012-01-01

To assess the impact of a workplace leisure physical activity program on healthcare expenditures for type 2 diabetes and hypertension treatment. We assessed a workplace program's potential to reduce costs by multiplying the annual healthcare costs of patients with type 2 diabetes and hypertension by the population attributable risk fraction of non-recommended physical activity levels. Feasibility of a physical activity program was assessed among 425 employees of a public university in Mexico. If 400 sedentary employees engaged in a physical activity program to decrease their risk of diabetes and hypertension, the potential annual healthcare cost reduction would be 138 880 US dollars. Each dollar invested in physical activity could reduce treatment costs of both diseases by 5.3 dollars. This research meets the call to use health economics methods to re-appraise health priorities, and devise strategies for optimal allocation of financial resources in the health sector.

76 FR 39474 - Monthly Median Cost of Funds Reporting, and Publication of Cost of Funds Indices

Science.gov (United States)

2011-07-06

... Semiannual Cost of Funds Index (SCOF), and other related cost of funds ratios currently published monthly in... discussed in this notice, please contact Jim Caton, Managing Director--Economic and Industry Analysis, at... Thrift Financial Report (TFR): \\2\\ \\2\\ Copies of the reporting forms and instructions for the TFR (OMB No...

Cost-Effective Large-Scale Occupancy-Abundance Monitoring of Invasive Brushtail Possums (Trichosurus Vulpecula on New Zealand's Public Conservation Land.

Directory of Open Access Journals (Sweden)

Andrew M Gormley

Full Text Available There is interest in large-scale and unbiased monitoring of biodiversity status and trend, but there are few published examples of such monitoring being implemented. The New Zealand Department of Conservation is implementing a monitoring program that involves sampling selected biota at the vertices of an 8-km grid superimposed over the 8.6 million hectares of public conservation land that it manages. The introduced brushtail possum (Trichosurus Vulpecula is a major threat to some biota and is one taxon that they wish to monitor and report on. A pilot study revealed that the traditional method of monitoring possums using leg-hold traps set for two nights, termed the Trap Catch Index, was a constraint on the cost and logistical feasibility of the monitoring program. A phased implementation of the monitoring program was therefore conducted to collect data for evaluating the trade-off between possum occupancy-abundance estimates and the costs of sampling for one night rather than two nights. Reducing trapping effort from two nights to one night along four trap-lines reduced the estimated costs of monitoring by 5.8% due to savings in labour, food and allowances; it had a negligible effect on estimated national possum occupancy but resulted in slightly higher and less precise estimates of relative possum abundance. Monitoring possums for one night rather than two nights would provide an annual saving of NZ$72,400, with 271 fewer field days required for sampling. Possums occupied 60% (95% credible interval; 53-68 of sampling locations on New Zealand's public conservation land, with a mean relative abundance (Trap Catch Index of 2.7% (2.0-3.5. Possum occupancy and abundance were higher in forest than in non-forest habitats. Our case study illustrates the need to evaluate relationships between sampling design, cost, and occupancy-abundance estimates when designing and implementing large-scale occupancy-abundance monitoring programs.

Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study

Directory of Open Access Journals (Sweden)

Cristiana M. Toscano

2018-01-01

Full Text Available The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1 peripheral neuropathy without ulcer, (2 non-infected foot ulcer, (3 infected foot ulcer, and (4 clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP (1 Int$ = 1.748 BRL. We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13% was for inpatient, and Int$ 333.5 million (87% for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients

Annual Direct Medical Costs of Diabetic Foot Disease in Brazil: A Cost of Illness Study.

Science.gov (United States)

Toscano, Cristiana M; Sugita, Tatiana H; Rosa, Michelle Q M; Pedrosa, Hermelinda C; Rosa, Roger Dos S; Bahia, Luciana R

2018-01-08

The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we

25 CFR 215.12 - Advertising costs.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Advertising costs. 215.12 Section 215.12 Indians BUREAU... LEASES, QUAPAW AGENCY § 215.12 Advertising costs. All advertising costs, publication fees, expenses incurred for abstracts of lease title, and other expenses incurred in connection with the advertising and...

Towards a National Injury Costing System?:Lessons from a Public ...

African Journals Online (AJOL)

South Africa has extremely high incidence rates of fatal and non-fatal injuries due to interpersonal violence, pedestrian–motor vehicle collisions, burns, falls and other unintentional causes. While the actual cost associated with these injuries remains relatively unknown, the estimated direct cost of the medical treatment, ...

A parametric cost model for estimating operating and support costs of US Navy (non-nuclear) surface ships

OpenAIRE

Brandt, James M.

1999-01-01

Approved for public release; distribution is unlimited With few effective decision-making tools to assess the affordability of major weapon systems, management of total ownership costs is continually misunderstood. Cost analysis provides a quick and reliable assessment of affordability. Because there is no standardized method for calculating reliable estimates of operating and support (O&S) costs (the principal component of total ownership cost), this thesis formulates a parametric cost mo...

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

Strategic Thinking about How Costs and Goals Interact

Science.gov (United States)

Cavanaugh, John C.; Graves, William H.

2010-01-01

In the grand economic scheme, the intense public pressure to lower costs came late to higher education. No institution--public or private, non-profit or for-profit--has escaped the always difficult, sometimes protracted discussions of how to increase efficiency and lower costs. Although this intense pressure predates the recent great recession,…

Cost-effective conservation planning: lessons from economics.

Science.gov (United States)

Duke, Joshua M; Dundas, Steven J; Messer, Kent D

2013-08-15

Economists advocate that the billions of public dollars spent on conservation be allocated to achieve the largest possible social benefit. This is "cost-effective conservation"-a process that incorporates both monetized benefits and costs. Though controversial, cost-effective conservation is poorly understood and rarely implemented by planners. Drawing from the largest publicly financed conservation programs in the United States, this paper seeks to improve the communication from economists to planners and to overcome resistance to cost-effective conservation. Fifteen practical lessons are distilled, including the negative implications of limiting selection with political constraints, using nonmonetized benefit measures or benefit indices, ignoring development risk, using incomplete cost measures, employing cost measures sequentially, and using benefit indices to capture costs. The paper highlights interrelationships between benefits and complications such as capitalization and intertemporal planning. The paper concludes by identifying the challenges at the research frontier, including incentive problems associated with adverse selection, additionality, and slippage. Copyright © 2013 Elsevier Ltd. All rights reserved.

Costs of Illness Due to Endemic Cholera

Science.gov (United States)

Poulos, C.; Riewpaiboon, A.; Stewart, J.F.; Clemens, J.; Guh, S.; Agtini, M.; Sur, D.; Islam, Z.; Lucas, M.; Whittington, D.

2013-01-01

Summary Economic analyses of cholera immunization programmes require estimates of the costs of cholera. The Diseases of the Most Impoverished programme measured the public, provider, and patient costs of culture-confirmed cholera in four study sites with endemic cholera using a combination of hospital- and community-based studies. Families with culture-proven cases were surveyed at home 7 and 14 days after confirmation of illness. Public costs were measured at local health facilities using a micro-costing methodology. Hospital-based studies found that the costs of severe cholera were USD 32 and 47 in Matlab and Beira. Community-based studies in North Jakarta and Kolkata found that cholera cases cost between USD 28 and USD 206, depending on hospitalization. Patient costs of illness as a percentage of average monthly income were 21% and 65% for hospitalized cases in Kolkata and North Jakarta, respectively. This burden on families is not captured by studies that adopt a provider perspective. PMID:21554781

45 CFR 286.55 - What types of costs are subject to the administrative cost limit on Tribal Family Assistance...

Science.gov (United States)

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false What types of costs are subject to the... § 286.55 What types of costs are subject to the administrative cost limit on Tribal Family Assistance... tracking, data entry and monitoring, including personnel and other costs associated with the automation...

Cost of supplying energy from New Zealand resources

Energy Technology Data Exchange (ETDEWEB)

Norman, Robert G.

1977-10-15

The kinds of costs which face the community when a power project is promoted are broadly discussed. Sometimes, costs such as social, economic, and environmental impacts do not appear often in budgetary form. The growth of public participation is discussed. Components (investigation costs, development costs, distribution costs, social costs, environmental costs, etc.) which contribute to the cost of energy production and supply are examined in some detail.

Public and Private Hospital Services Reform Using Data Envelopment Analysis to Measure Technical, Scale, Allocative, and Cost Efficiencies

Directory of Open Access Journals (Sweden)

Ali Emrouznejad

2012-07-01

Full Text Available Background: The aim of this study was to suggest a suitable context to develop efficient hospitalsystems while maintaining the quality of care at minimum expenditures.Methods: This research aimed to present a model of efficiency for selected public and privatehospitals of East Azerbaijani Province of Iran by making use of Data Envelopment Analysis approachin order to recognize and suggest the best practice standards.Results: Among the six inefficient hospitals, 2 (33% had a technical efficiency score of lessthan 50% (both private, 2 (33% between 51 and 74% (one private and one public and the rest(2, 33% between 75 and 99% (one private and one public.Conclusion: In general, the public hospitals are relatively more efficient than private ones; it isrecommended for inefficient hospitals to make use of the followings: transferring, selling, orrenting idle/unused beds; transferring excess doctors and nurses to the efficient hospitals orother health centers; pensioning off, early retirement clinic officers, technicians/technologists,and other technical staff. The saving obtained from the above approaches could be used to improveremuneration for remaining staff and quality of health care services of hospitals, rural andurban health centers, support communities to start or sustain systematic risk and resource poolingand cost sharing mechanisms for protecting beneficiaries against unexpected health carecosts, compensate the capital depreciation, increasing investments, and improve diseases preventionservices and facilities in the provincial level.

Cost of provision of opioid substitution therapy provision in Tijuana, Mexico.

Science.gov (United States)

Burgos, Jose Luis; Cepeda, Javier A; Kahn, James G; Mittal, Maria Luisa; Meza, Emilio; Lazos, Raúl Rafael Palacios; Vargas, Psyché Calderón; Vickerman, Peter; Strathdee, Steffanie A; Martin, Natasha K

2018-05-23

Mexico recently enacted drug policy reform to decriminalize possession of small amounts of illicit drugs and mandated that police refer identified substance users to drug treatment. However, the economic implications of drug treatment expansion are uncertain. We estimated the costs of opioid substitution therapy (OST) provision in Tijuana, Mexico, where opioid use and HIV are major public health concerns. We adopted an economic health care provider perspective and applied an ingredients-based micro-costing approach to quantify the average monthly cost of OST (methadone maintenance) provision at two providers (one private and one public) in Tijuana, Mexico. Costs were divided by type of input (capital, recurrent personnel and non-personnel). We defined "delivery cost" as all costs except for the methadone and compared total cost by type of methadone (powdered form or capsule). Cost data were obtained from interviews with senior staff and review of expenditure reports. Service provision data were obtained from activity logs and senior staff interviews. Outcomes were cost per OST contact and cost per person month of OST. We additionally collected information on patient charges for OST provision from published rates. The total cost per OST contact at the private and public sites was $3.12 and $5.90, respectively, corresponding to $95 and $179 per person month of OST. The costs of methadone delivery per OST contact were similar at both sites ($2.78 private and $3.46 public). However, cost of the methadone itself varied substantially ($0.34 per 80 mg dose [powder] at the private site and $2.44 per dose [capsule] at the public site). Patients were charged $1.93-$2.66 per methadone dose. The cost of OST provision in Mexico is consistent with other upper-middle income settings. However, evidenced-based (OST) drug treatment facilities in Mexico are still unaffordable to most people who inject drugs.

Tax compliance costs in the public sector : a case study in a public company services.

OpenAIRE

Roberto Carvalho Pinto de Mesquita

2013-01-01

Tax compliance costs are sacrifices of resources to understand and comply with all formalities which are required by tax law. In Brazil, those formalities of the tax laws are among the most complex and bureaucratic in the world and this has a direct influence on business costs, either for the payment of taxes in itself, is to meet the requirements of the legislation. The theme has attracted scientific interest, with the relatively recent development of research in the world, yet there are few...

[Cost-Effectiveness and Cost-Utility Analyses of Antireflux Medicine].

Science.gov (United States)

Gockel, Ines; Lange, Undine Gabriele; Schürmann, Olaf; Jansen-Winkeln, Boris; Sibbel, Rainer; Lyros, Orestis; von Dercks, Nikolaus

2018-04-12

Laparoscopic antireflux surgery and medical therapy with proton pump inhibitors are gold standards of gastroesophageal reflux treatment. On account of limited resources and increasing healthcare needs and costs, in this analysis, not only optimal medical results, but also superiority in health economics of these 2 methods are evaluated. We performed an electronic literature survey in MEDLINE, PubMed, Cochrane Library, ISRCTN (International Standard Randomization Controlled Trial Number) as well as in the NHS Economic Evaluation Database, including studies published until 1/2017. Only studies considering the effect size of QALY (Quality-Adjusted Life Years) (with respect to different quality of life-scores) as primary outcome comparing laparoscopic fundoplication and medical therapy were included. Criteria of comparison were ICER (Incremental Cost-Effectiveness Ratio) and ICUR (Incremental Cost-Utility Ratio). Superiority of the respective treatment option for each publication was worked out. In total, 18 comparative studies were identified in the current literature with respect to above-mentioned search terms, qualifying for the defined inclusion criteria. Six studies were finally selected for analyses. Out of 6 publications, 3 showed superiority of laparoscopic fundoplication over long-term medical management based on current cost-effectiveness data. Limitations were related to different time intervals, levels of evidence of studies and underlying resources/costs of analyses, healthcare systems and applied quality of life instruments. Future prospective, randomized trials should examine this comparison in greater detail. Additionally, there is a large potential for further research in the health economics assessment of early diagnosis and prevention measures of reflux disease and Barrett's esophagus/carcinoma. © Georg Thieme Verlag KG Stuttgart · New York.

Cost effectiveness of tenofovir disoproxil fumarate for the treatment of chronic hepatitis B from a Canadian public payer perspective.

Science.gov (United States)

Dakin, Helen; Sherman, Morris; Fung, Scott; Fidler, Carrie; Bentley, Anthony

2011-12-01

Previous research has demonstrated that tenofovir disoproxil fumarate (DF) is the most cost-effective nucleos(t)ide treatment for chronic hepatitis B (CHB) in the UK, Spain, Italy and France. However, to our knowledge, no published studies have yet evaluated the cost effectiveness of any treatments for CHB in a Canadian setting, where relative prices and management of CHB differ from those in Europe. Our objective was to determine the cost effectiveness of tenofovir DF compared with other nucleos(t)ide therapies licensed for CHB in Canada from the perspective of publicly funded healthcare payers. A Markov model was used to calculate the costs and benefits of nucleos(t)ide therapy in three groups of patients with hepatitis B e antigen (HBeAg)-positive and -negative CHB: nucleos(t)ide-naive patients without cirrhosis; nucleos(t)ide-naive patients with compensated cirrhosis; and lamivudine-resistant patients. Disease progression was modelled as annual transitions between 18 disease states. Transition probabilities, quality of life and costs were based on published studies. Health benefits were measured in QALYs. The reference year for costs was 2007 and costs and outcomes were discounted at 5% per annum. First-line tenofovir DF was the most effective nucleos(t)ide strategy for managing CHB, generating 6.85-9.39 QALYs per patient. First-line tenofovir DF was also the most cost-effective strategy in all patient subgroups investigated, costing between $Can43,758 and $Can48,015 per QALY gained compared with lamivudine then tenofovir. First-line tenofovir DF strongly dominated first-line entecavir. Giving tenofovir DF monotherapy immediately after lamivudine resistance developed was less costly and more effective than any other active treatment strategy investigated for lamivudine-resistant CHB, including second-line use of adefovir or adefovir + lamivudine. Probabilistic sensitivity analysis demonstrated 50% confidence that first-line tenofovir DF is the most cost

Cost-effectiveness of anatomical and functional test strategies for stable chest pain: public health perspective from a middle-income country.

Science.gov (United States)

Bertoldi, Eduardo G; Stella, Steffen F; Rohde, Luis Eduardo P; Polanczyk, Carisi A

2017-05-04

The aim of this research is to evaluate the relative cost-effectiveness of functional and anatomical strategies for diagnosing stable coronary artery disease (CAD), using exercise (Ex)-ECG, stress echocardiogram (ECHO), single-photon emission CT (SPECT), coronary CT angiography (CTA) or stress cardiacmagnetic resonance (C-MRI). Decision-analytical model, comparing strategies of sequential tests for evaluating patients with possible stable angina in low, intermediate and high pretest probability of CAD, from the perspective of a developing nation's public healthcare system. Hypothetical cohort of patients with pretest probability of CAD between 20% and 70%. The primary outcome is cost per correct diagnosis of CAD. Proportion of false-positive or false-negative tests and number of unnecessary tests performed were also evaluated. Strategies using Ex-ECG as initial test were the least costly alternatives but generated more frequent false-positive initial tests and false-negative final diagnosis. Strategies based on CTA or ECHO as initial test were the most attractive and resulted in similar cost-effectiveness ratios (I$ 286 and I$ 305 per correct diagnosis, respectively). A strategy based on C-MRI was highly effective for diagnosing stable CAD, but its high cost resulted in unfavourable incremental cost-effectiveness (ICER) in moderate-risk and high-risk scenarios. Non-invasive strategies based on SPECT have been dominated. An anatomical diagnostic strategy based on CTA is a cost-effective option for CAD diagnosis. Functional strategies performed equally well when based on ECHO. C-MRI yielded acceptable ICER only at low pretest probability, and SPECT was not cost-effective in our analysis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Public opinion on water reuse options

International Nuclear Information System (INIS)

Bruvold, W.H.

1988-01-01

Public policy on waste water reuse options must be informed by public opinion because it is the public who must pay the cost of developing the option and who will be served by the option in the future. For public policy on reuse, guidance for innovative reuse is not as simple as first believed. It seems that public opinion regarding actual community reuse options is affected by the linkage of several factors, including water conservation, health protection, treatment and distribution costs, and environmental enhancement. Probability sampling was used in 7 studies to select respondents who were queried regarding their opinions on various reclaimed water uses such as ranging from cooling tower water to full domestic use. These 7 are briefly reviewed

41 CFR 105-60.608 - Fees, expenses, and costs.

Science.gov (United States)

2010-07-01

... Demands in Judicial or Administrative Proceedings § 105-60.608 Fees, expenses, and costs. (a) In... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Fees, expenses, and costs. 105-60.608 Section 105-60.608 Public Contracts and Property Management Federal Property...

48 CFR 9903.101 - Cost Accounting Standards.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost Accounting Standards. 9903.101 Section 9903.101 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD... ACCOUNTING STANDARDS CONTRACT COVERAGE General 9903.101 Cost Accounting Standards. Public Law 100-679 (41 U.S...

Economic costs of drug abuse: financial, cost of illness, and services.

Science.gov (United States)

Cartwright, William S

2008-03-01

This article examines costs as they relate to the financial costs of providing drug abuse treatment in private and public health plans, costs to society relating to drug abuse, and many smaller costing studies of various stakeholders in the health care system. A bibliography is developed from searches across PubMed, Web of Science, and other bibliographic sources. The review indicates that a wide collection of cost findings is available to policy makers. For example, the financial aspects of health plans have been dominated by considerations of actuarial costs of parity for drug abuse treatment. Cost-of-illness methods have been developed and extended to drug abuse costing to measure the national level of burden and are important to the economic evaluation of interventions at the program level. Costing is done in many small and focused studies, reflecting the interests of different stakeholders in the health care system. For costs in programs and health plans, as well as cost offsets of the impact of substance abuse treatment on medical expenditures, findings are surprisingly important to policy makers. Maintaining ongoing research that is highly policy relevant from the point of view of health services, more is needed on costing concepts and measurement applications.

Social costs of road crashes : an international analysis.

NARCIS (Netherlands)

Wijnen, W. & Stipdonk, H.L.

2016-01-01

This paper provides an international overview of the most recent estimates of the social costs of road crashes: total costs, value per casualty and breakdown in cost components. The analysis is based on publications about the national costs of road crashes of 17 countries, of which ten high income

Life Cycle Costing Model for Solid Waste Management

DEFF Research Database (Denmark)

Martinez-Sanchez, Veronica; Astrup, Thomas Fruergaard

2014-01-01

To ensure sustainability of solid waste management, there is a need for cost assessment models which are consistent with environmental and social assessments. However, there is a current lack of standardized terminology and methodology to evaluate economic performances and this complicates...... LCC, e.g. waste generator, waste operator and public finances and the perspective often defines the systemboundaries of the study, e.g. waste operators often focus on her/his own cost, i.e. technology based,whereas waste generators and public finances often focus on the entire waste system, i.......e. system based. Figure 1 illustrates the proposed modeling framework that distinguishes between: a) budget cost, b) externality costs and 3) transfers and defines unit costs of each technology (per ton of input waste). Unitcosts are afterwards combined with a mass balance to calculate the technology cost...

School Security: Planning and Costs.

Science.gov (United States)

Hunter, Richard C.; Mazingo, Terri H.

2003-01-01

Describes efforts by two school districts to address the potential threats of shootings and other school disruptions: Baltimore City Public Schools in Maryland and Charlotte-Mecklenburg Public Schools in North Carolina. Also describes the growing costs of providing safety and security in elementary and secondary schools. (Contains 13 references.)…

Costs and benefits of employment transportation for low-wage workers: an assessment of job access public transportation services.

Science.gov (United States)

Thakuriah Vonu, Piyushimita; Persky, Joseph; Soot, Siim; Sriraj, P S

2013-04-01

This paper focuses on an evaluation of public transportation-based employment transportation (ET) services to transport low-wage workers to jobs in the US. We make an attempt to capture a more comprehensive range of intended and unintended outcomes of ET services than those traditionally considered in the case of public transportation services. Using primary data from 23 locations across the country, we present a framework to evaluate how transportation improvements, in interaction with labor markets, can affect users' short-run economic welfare, users' long-run human capital accumulation and non-users' short-run economic welfare. These services were partially funded by a specialized program - the Job Access and Reverse Commute (JARC) program - which was consolidated into larger transit funding programs by recent legislation. In the sites examined, we found that low wage users benefited from self-reported increased access to jobs, improvements in earnings potential, as well as from savings in transport cost and time. Simulations show the potential of users to accrue long-term worklife benefits. At the same time, users may have accrued changes in leisure time as a result of transitioning from unemployment to employment, and generated a range of societal impacts on three classes of non-users: the general tax-paying public, the general commuting public in the service operating area and other low-wage workers in local labor markets. Copyright © 2012 Elsevier Ltd. All rights reserved.

24 CFR 965.402 - Benefit/cost analysis.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Benefit/cost analysis. 965.402...-Owned Projects § 965.402 Benefit/cost analysis. (a) A benefit/cost analysis shall be made to determine... (Continued) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN...

[Hospital costs estimation by micro and gross-costing approaches].

Science.gov (United States)

Guerre, P; Hayes, N; Bertaux, A-C

2018-03-01

Cost analysis has become increasingly commonplace in healthcare facilities in recent years. Regardless of the aim, the first consideration for a hospital costing process is to determine the point of view, or perspective, to adopt. Should the cost figures reflect the healthcare facility's point of view or enlighten perspectives for the public health insurance system? Another consideration is in regard to the method to adopt, as there are several. The two most widely used methods to determine the costs of hospital treatments in France are the micro-costing method and the gross-costing method. The aims of this work are: (1) to describe each of these methods (e.g. data collection, assignment of monetary value to resource consumption) with their advantages and shortcomings as they relate to the difficulties encountered with their implementation in hospitals; (2) to present a review of the literature comparing the two methods and their possible combination; and (3) to propose ways to address the questions that need to be asked before compiling resource consumption data and assigning monetary value to hospital costs. A final diagram summarizes methodologies to be preferred according to the evaluation strategy and the impact on patient care. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

The social cost of drugs in France in 2010.

Science.gov (United States)

Kopp, Pierre; Ogrodnik, Marysia

2017-09-01

The social cost of drugs is the monetary cost of both the consequences of their trade and their consumption. In this paper, drugs considered are tobacco and alcohol, which are legal, plus those that are illegal. The social cost is the sum of the external cost: value of loss in quality of life, value of years of life lost and value of loss in productivity, plus public expenditure. Public expenditure consists of public spending on medical care, prevention, and law enforcement, minus savings from unpaid pensions and taxes levied on tobacco and alcohol. The parameters for the calculations have used the recommendations of a French governmental working group (2013) Quinet, L'évaluation socioéconomique des investissements publics [Internet], Centre d'Analyse Stratégique, 2013, http://www.strategie.gouv.fr/sites/strategie.gouv.fr/files/archives/CGSP_Evaluation_socioeconomique_17092013.pdf , and the health data were derived from the scientific literature. The social costs are €122 billion for tobacco, €118 billion for alcohol, and €8.7 billion for illegal drugs. The largest fraction of the costs (53, 56, and 31 %, respectively) derives from the number of deaths, 79,000 for tobacco, 49,000 for alcohol, and 1600 for illegal drugs, given the high cost of a year of life lost (€115,000). The external cost corresponds to 86, 97, and 68 % of the social cost, respectively, for tobacco, alcohol, and illegal drugs. The annual drug-related net expenditure represents €13.9, €3.0, and €2.3 billion, respectively, for tobacco, alcohol, and illegal drugs. The tax revenues on tobacco and alcohol, €10.4 and €3.2 billion, represent less than half of the corresponding healthcare costs, which are €25.9 and €7.7 billion.

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

41 CFR 105-50.303 - Cost basis in lieu of fees.

Science.gov (United States)

2010-07-01

... § 105-50.303 Cost basis in lieu of fees. Where the cost of services is to be recovered on other than a... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Cost basis in lieu of fees. 105-50.303 Section 105-50.303 Public Contracts and Property Management Federal Property...

Costs of Illness Due to Cholera, Costs of Immunization and Cost-Effectiveness of an Oral Cholera Mass Vaccination Campaign in Zanzibar

Science.gov (United States)

Schaetti, Christian; Weiss, Mitchell G.; Ali, Said M.; Chaignat, Claire-Lise; Khatib, Ahmed M.; Reyburn, Rita; Duintjer Tebbens, Radboud J.; Hutubessy, Raymond

2012-01-01

Background The World Health Organization (WHO) recommends oral cholera vaccines (OCVs) as a supplementary tool to conventional prevention of cholera. Dukoral, a killed whole-cell two-dose OCV, was used in a mass vaccination campaign in 2009 in Zanzibar. Public and private costs of illness (COI) due to endemic cholera and costs of the mass vaccination campaign were estimated to assess the cost-effectiveness of OCV for this particular campaign from both the health care provider and the societal perspective. Methodology/Principal Findings Public and private COI were obtained from interviews with local experts, with patients from three outbreaks and from reports and record review. Cost data for the vaccination campaign were collected based on actual expenditure and planned budget data. A static cohort of 50,000 individuals was examined, including herd protection. Primary outcome measures were incremental cost-effectiveness ratios (ICER) per death, per case and per disability-adjusted life-year (DALY) averted. One-way sensitivity and threshold analyses were conducted. The ICER was evaluated with regard to WHO criteria for cost-effectiveness. Base-case ICERs were USD 750,000 per death averted, USD 6,000 per case averted and USD 30,000 per DALY averted, without differences between the health care provider and the societal perspective. Threshold analyses using Shanchol and assuming high incidence and case-fatality rate indicated that the purchase price per course would have to be as low as USD 1.2 to render the mass vaccination campaign cost-effective from a health care provider perspective (societal perspective: USD 1.3). Conclusions/Significance Based on empirical and site-specific cost and effectiveness data from Zanzibar, the 2009 mass vaccination campaign was cost-ineffective mainly due to the relatively high OCV purchase price and a relatively low incidence. However, mass vaccination campaigns in Zanzibar to control endemic cholera may meet criteria for cost

42 CFR 417.538 - Enrollment and marketing costs.

Science.gov (United States)

2010-10-01

... PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.538 Enrollment and marketing costs. (a) Principle. Costs incurred by an HMO or CMP in performing the enrollment and marketing activities described in subpart k of... 42 Public Health 3 2010-10-01 2010-10-01 false Enrollment and marketing costs. 417.538 Section 417...

Comparison of approximate electrical energy generating costs in OECD countries

International Nuclear Information System (INIS)

Stevens, G.H.; Bertel, E.

1996-01-01

Costs of power generating in nuclear power plants have been predicted taking into account all factors connected with investment, maintenance, exploitation and decommissioning, basing on last OECD report. The costs have been compared with alternative solutions. In majority of OECD countries the direct costs of electricity generation are very close for nuclear fossil-fuel and gas power plants. All indirect costs such as environmental impact, public health hazard, waste management, accident risk and also public acceptance for nuclear power have been discussed. 13 refs, 5 tabs

Cost estimating for large nuclear projects

International Nuclear Information System (INIS)

Duggal, A.; Hunt, M.

2004-01-01

In today's market, the generation of electricity is a very competitive business, which is constantly under the watchful eye of the media and public. Nuclear power faces a lot of competition from other sources such as hydro, coal and gas. Controlling costs, monitoring costs, feedback, industry knowledge and up to date cost estimating tools are essential for a nuclear company to compete on a long term basis. This paper reviews the terminology and estimating principles used for the construction of new nuclear plants, lifetime operating costs, and the costs associated with refurbishment work. (author)

42 CFR 423.782 - Cost-sharing subsidy.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Cost-sharing subsidy. 423.782 Section 423.782... (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Premiums and Cost-Sharing Subsidies... cents. (c) When the out-of-pocket cost for a covered Part D drug under a Part D sponsor's plan benefit...

10 CFR 455.63 - Cost-effectiveness testing.

Science.gov (United States)

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Cost-effectiveness testing. 455.63 Section 455.63 Energy..., Hospitals, Units of Local Government, and Public Care Institutions § 455.63 Cost-effectiveness testing. (a... paragraph (a) of this section, if the State plan requires the cost effectiveness of an energy conservation...

42 CFR 417.536 - Cost payment principles.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Cost payment principles. 417.536 Section 417.536... PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.536 Cost payment principles. (a) Applicability. Unless otherwise specified in this subpart, the principles set forth in parts 412 and 413 of this chapter are...

75 FR 17462 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2010-04-06

... decision may be purchased by contacting the office of Public Assistance, Governmental Affairs, and...-2)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the second quarter 2010 Rail Cost...

Economic issues of the Sizewell B public enquiry

International Nuclear Information System (INIS)

Foster, C.

1987-01-01

The economic arguments and conclusions reached in the Layfield Report of the Sizewell-B public inquiry are restated. The key test for deciding whether Sizewell-B should be built was the net effective cost per kW per annum (the net cost of supplying electricity from a new power station including capital and operating costs) compared with the net avoidable cost (the cost of withdrawing a plant from the generating system). If the net effective cost is less than the net avoidable cost the construction is economically worthwhile. The effective cost calculations are given. The argument in favour not only had to show that nuclear was economically favourable over coal or any other fuel but that the pressurized water reactor design was preferable to the advanced gas-cooled reactor type. The price of coal, (at the time of the Inquiry and in the future) is tabulated. The changed economic situation between the end of the Inquiry and the publication of the Inquiry Report did not invalidate the decision made. There is only a one in seven chance that a coal-fired station will provide new capacity at lower cost than Sizewell-B. The figures used for CEGB's case to the Public Inquiry are given. (UK)

Mapping public policy on genetics.

Science.gov (United States)

Weisfeld, N E

2002-06-01

The mapping of the human genome and related advances in genetics are stimulating the development of public policies on genetics. Certain notions that currently prevail in public policy development overall--including the importance of protecting privacy of information, an interest in cost-effectiveness, and the power of the anecdote--will help determine the future of public policy on genetics. Information areas affected include discrimination by insurers and employers, confidentiality, genetic databanks, genetic testing in law enforcement, and court-ordered genetic testing in civil cases. Service issues address clinical standards, insurance benefits, allocation of resources, and screening of populations at risk. Supply issues encompass funding of research and clinical positions. Likely government actions include, among others: (1) Requiring individual consent for the disclosure of personal information, except when such consent would impose inordinate costs; (2) licensing genetic databases; (3) allowing courts to use personal information in cases where a refusal to use such information would offend the public; (4) mandating health insurers to pay for cost-effective genetic services; (5) funding pharmaceutical research to develop tailored products to prevent or treat diseases; and (6) funding training programs.

In-house training, formal education and public outreach

International Nuclear Information System (INIS)

Willis, Y.A.

1992-01-01

This paper assumes that a stronger national commitment to public education on nuclear energy and, most particularly radioactive waste management, it needed to overcome public resistance to nuclear projects. Effective public education must become the superordinate goal uniting industry, government, professional societies, national laboratories and the educational community. Since instruction is labor intensive, we must search for more cost effective ways of achieving results. Therefore, this paper proposes: Collaborative training and educational strategies involving as many of the stakeholders as possible; and Innovative tools to improve the credibility, quality and cost effectiveness of education. This win-win approach can reduce the collective expenditures through cost-sharing, as well as the sharing of resources and products. It can close gaps in both in-house training and formal education. Finally, in public outreach, the joint approach addresses the politics of sponsorship by providing checks and balances, and thus improving credibility and public acceptance

La nuova sfida di SEAT Pagine Gialle

Directory of Open Access Journals (Sweden)

Leonardo Landini

2008-03-01

The companies success and notoriety is built on a customer base of about 20 million families and 3 million professional operators with a continually updated technology with which it integrates with detailed geographical information that allows it to reach millions of users every day. The services the company offers include an advanced cartographic web-based search, satellite and aerial photos, the calculation of driving instructions, weather forecasts and traffic information, 360 degree views and the modelling of whole cities in 3D.

A study on cost-benefit analysis and development of numerical guideline for the radiation exposure(II)

International Nuclear Information System (INIS)

Kang, Chang Sun; Song, Jae Hyuk; Son, Ki Yoon; Park, Moon Soo; Kim, Chong Uk

1999-02-01

The radiation detrimental cost is a representative factor which is used in the cost-benefit analysis. It can be divided into the objective detrimental cost and the subjective detrimental cost. The objective detrimental cost can be quantified through converting human economic value into monetary unit and the subjective detrimental cost can be quantified by estimation of perceived risk of public. The objective of this study is the quantification of the radiation detrimental cost so that the objective detrimental cost and the subjective detrimental cost are estimated, respectively. The main emphasis is laid upon the conversion of human economic value into monetary unit in quantifying the objective detrimental cost. In case of the subjective detrimental cost, perceived risk of public for radiation exposure is measured according to dose levels by questionnaire. And the subjective detrimental costs are derived from the perceived risk for lay public and for occupational workers, respectively. In addition, is also investigated the cost of public acceptance for nuclear power generation

A study on cost-benefit analysis and development of numerical guideline for the radiation exposure(II)

Energy Technology Data Exchange (ETDEWEB)

Kang, Chang Sun; Song, Jae Hyuk; Son, Ki Yoon; Park, Moon Soo; Kim, Chong Uk [Seoul National Univ., Seoul (Korea, Republic of)

1999-02-15

The radiation detrimental cost is a representative factor which is used in the cost-benefit analysis. It can be divided into the objective detrimental cost and the subjective detrimental cost. The objective detrimental cost can be quantified through converting human economic value into monetary unit and the subjective detrimental cost can be quantified by estimation of perceived risk of public. The objective of this study is the quantification of the radiation detrimental cost so that the objective detrimental cost and the subjective detrimental cost are estimated, respectively. The main emphasis is laid upon the conversion of human economic value into monetary unit in quantifying the objective detrimental cost. In case of the subjective detrimental cost, perceived risk of public for radiation exposure is measured according to dose levels by questionnaire. And the subjective detrimental costs are derived from the perceived risk for lay public and for occupational workers, respectively. In addition, is also investigated the cost of public acceptance for nuclear power generation.

76 FR 59483 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2011-09-26

... the decision may be purchased by contacting the Office of Public Assistance, Governmental Affairs, and...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the fourth quarter 2011 Rail Cost Adjustment...

The service of public services performance management

DEFF Research Database (Denmark)

Lystbæk, Christian Tang

perspectives on the potential impact of public service performance measurement offer a range of contradictory propositions. Its alleged benefits include public assurance, better functioning of supply markets for public services, and direct improvements of public services. But the literature also demonstrates...... the existence of significant concern about the actual impact, the costs and unintended consequences associated with performance measurement.  Performance measurement and management have been part of the political agenda within the public sphere since their adoption in the post-Second World War period...... of political masters and their mistresses rather than public service. Another area of concern is the cost of performance measurement. Hood & Peters (2004:278) note that performance measurement is likely to “distract middle- and upper-level officials, create massive paperwork, and produce major unintended...

43 CFR 426.23 - Recovery of operation and maintenance (O&M) costs.

Science.gov (United States)

2010-10-01

... operation and maintenance (O&M) costs. (a) General. All new, amended, and renewed contracts shall provide... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Recovery of operation and maintenance (O&M) costs. 426.23 Section 426.23 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF...

Costs of and public funds for Natura 2000 in the Netherlands

NARCIS (Netherlands)

Leneman, H.; Bogaardt, M.J.; Roza, P.

2009-01-01

This report offers an estimate of the costs of maintaining or restoring the Natura-2000 network to a favourable status in the Netherlands. Also, an assessment is made of how many financial resources are potentially available to cover these costs from European funds, Dutch State funds and Dutch

The cost of children

DEFF Research Database (Denmark)

Nordström, Leif Jonas

, the opportunity cost of two children is estimated to 28-29 per cent of full income, which in monetary units is close to estimated income difference between women employed in the public and private sector. The opportunity cost of fatherhood is generally positive, but only significantly positive for men born......In this paper we estimate the opportunity cost of children. The underlying theoretical model is represented by a household production model. In the empirical analysis, we consider three different cohorts for men and women born between 1955 and 1970. For the women in the two oldest cohorts...

What Causes Cost Overrun in Transport Infrastructure Projects?

DEFF Research Database (Denmark)

Flyvbjerg, Bent; Holm, Mette K. Skamris; Buhl, Søren L.

cost escalation for three types of project ownership - private, state-owned enterprise and other public ownership - it is shown that the oft-seen claim that public ownership is problematic and private ownership effective in curbing cost escalation is an oversimplification. Type of accountability......This article presents results from the first statistically significant study of causes of cost escalation in transport infrastructure projects. The study is based on a sample of 258 rail, bridge, tunnel and roads projects worth US$90 billion. The focus is on the dependence of cost escalation on (1......) length of project implementation phase, (2) size of project and (3) type of project ownership. First, it is found with very high statistical significance that cost escalation is strongly dependent on length of implementation phase. The policy implications are clear: Decision makers and planners should...

The costs of the electronuclear sector. Thematic public report - January 2012

International Nuclear Information System (INIS)

2012-01-01

This report first proposes an analysis of the past expenses in the electronuclear sector (physical investments, research expenses from 1945 to 2010, the case of Superphenix), of the current expenses (operation costs for EDF, other types expenses), of the future expenses (dismantling of nuclear installations, management of used fuels, management of radioactive wastes), of expense provisions and actualization, of dedicated assets (regulatory and legal framework, application modalities of asset management for EDF, AREVA and the CEA), of the possible evolutions of future expenses (effect of reactor operation lifetime, future researches, EPR costs, scenarios), of costs which are difficult to precisely assess (externalities, nuclear risk and insurance)

Renewable Portfolio Standards: Understanding Costs and Benefits | Energy

Science.gov (United States)

considering the highest cost and lowest benefit outcomes. More Information: Fact Sheet Image of a report cover | Presentation Image of a report cover for A Survey of State-Level Cost and Benefit Estimates of Renewable Portfolio Standards: Understanding Costs and Benefits State policymakers, public utilities commissions, and

75 FR 80895 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2010-12-23

..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the first quarter 2011 Rail Cost Adjustment...

77 FR 37958 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2012-06-25

..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the third quarter 2012 rail cost adjustment...

78 FR 37660 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2013-06-21

..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board approves the third quarter 2013 Rail Cost Adjustment Factor...

78 FR 17764 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2013-03-22

..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the second quarter 2013 Rail Cost Adjustment...

76 FR 16037 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2011-03-22

..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the second quarter 2011 Rail Cost Adjustment...

75 FR 58019 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2010-09-23

..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, DOT. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the fourth quarter 2010 Rail Cost Adjustment...

Pharmaceutical cost-containment policies and sustainability: recent Irish experience.

Science.gov (United States)

Kenneally, Martin; Walshe, Valerie

2012-01-01

Our objective is to review and assess the main pharmaceutical cost-containment policies used in Ireland in recent years, and to highlight how a policy that improved fiscal sustainability but worsened economic sustainability could have improved both if an option-based approach was implemented. The main public pharmaceutical cost-containment policy measures including reducing the ex-factory price of drugs, pharmacy dispensing fees and community drug scheme coverage, and increasing patient copayments are outlined along with the resulting savings. We quantify the cost implications of a new policy that restricts the entitlement to free prescription drugs of persons older than 70 years and propose an alternative option-based policy that reduces the total cost to both the state and the patient. This set of policy measures reduced public spending on community drugs by an estimated €380m in 2011. The policy restricting free prescription drugs for persons older than 70 years, though effective in reducing public cost, increased the total cost of the drugs supplied. The policy-induced cost increase stems from a fees anomaly between the two main community drugs schemes which is circumvented by our alternative option-based policy. Our findings highlight the need for policymakers, even when absorbed with reducing cost, to design cost-containment policies that are both fiscally and economically sustainable. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Levelized cost-risk reduction prioritization of waste disposal options

International Nuclear Information System (INIS)

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

1992-01-01

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

Sharing the cost of redundant items

DEFF Research Database (Denmark)

Hougaard, Jens Leth; Moulin, Hervé

2014-01-01

We ask how to share the cost of finitely many public goods (items) among users with different needs: some smaller subsets of items are enough to serve the needs of each user, yet the cost of all items must be covered, even if this entails inefficiently paying for redundant items. Typical examples...... are network connectivity problems when an existing (possibly inefficient) network must be maintained. We axiomatize a family cost ratios based on simple liability indices, one for each agent and for each item, measuring the relative worth of this item across agents, and generating cost allocation rules...... additive in costs....

Solar Market Research and Analysis Publications | Solar Research | NREL

Science.gov (United States)

Market Research and Analysis Publications Solar Market Research and Analysis Publications NREL researchers and analysts publish a variety of documents related to solar market research and analysis achieving the SETO 2030 residential PV cost target of $0.05 /kWh by identifying and quantifying cost

Custo anual do manejo da cardiopatia isquêmica crônica no Brasil: perspectiva pública e privada Annual cost of ischemic heart disease in Brazil: public and private perspective

Directory of Open Access Journals (Sweden)

Rodrigo A. Ribeiro

2005-07-01

Full Text Available OBJETIVO: Estimar o custo anual do manejo da doença arterial coronária (DAC em valores do SUS e convênios. MÉTODOS: Estudo de coorte, incluindo pacientes ambulatoriais com DAC comprovada. Considerou-se para estimar custos diretos: consultas, exames, procedimentos, internações e medicamentos. Valores de consultas e exames foram obtidos da tabela SUS e da Lista de Procedimentos Médicos (LPM. Valores de eventos cardiovasculares foram obtidos de internações em hospital público e privado com estas classificações diagnósticas em 2002. O preço dos fármacos utilizado foi o de menor custo no mercado. RESULTADOS: Os 147 pacientes (65±12 anos, 63% homens, 69% hipertensos, 35% diabéticos e 59% com IAM prévio tiveram acompanhamento médio de 24±8 meses. O custo anual médio estimado por paciente foi de R$ 2.733,00, pelo SUS, e R$ 6.788,00, para convênios. O gasto com medicamentos ($ 1.154,00 representou 80% e 55% dos custos ambulatoriais, e 41% e 17% dos gastos totais, pelo SUS e para convênios, respectivamente. A ocorrência de evento cardiovascular teve grande impacto (R$ 4.626,00 vs. R$ 1.312,00, pelo SUS, e R$ 13.453,00 vs. R$ 1.789,00, para convênios, pOBJECTIVE: To estimate the annual cost of coronary artery disease (CAD management in Public Health Care System (SUS and HMOs values in Brazil. METHODS: Cohort study, including ambulatory patients with proven CAD. Clinic visits, exams, procedures, hospitalizations and medications were considered to estimate direct costs. Values of appointments and exams were obtained from the SUS and the Medical Procedure List (LPM 1999 reimbursement tables. Costs of cardiovascular events were obtained from admissions in public and private hospitals with similar diagnoses-related group classifications in 2002. The price of medications used was the lowest found in the market. RESULTS: The 147 patients (65±12 years old, 63% men, 69% hypertensive, 35% diabetic and 59% with previous AMI had an average

Public Involvement in Decisions to Avoid Costly Consequences Later

International Nuclear Information System (INIS)

Treichel, Judy

2006-01-01

There should be an agreement of goals in any project that could produce harm. Why are we developing this technology? Who benefits and who pays? What would a 'cleanup' entail? There must be consideration of alternatives with a focus on reducing harm rather than just meeting allowable limits or promising that they will be met in the future. When alternatives are weighed, the burden should be on the proponent of the activity to provide truthful information to the public and provide access and resources necessary for participation. There must be a formal, legal obligation or duty to consider science as well as non-scientific information. It should not be up to those harmed to prove the damage and force the responsible parties to make retribution. It should be the burden of the proponents to measure potential risks, and prove that the benefits to everyone outweigh the risks to everyone. The role of government in decision making should also be redefined. The considerations now seem to be limited to whether or not an action is 'legal' or if it is 'safe'. There should also be a determination that it is 'necessary'. That may seem to be a very difficult question but put simply, if there are alternatives then a thing is not 'necessary'. Governmental decision makers would say: 'We acknowledge that our world will never be free from risk. However, any risk that is unnecessary or not freely chosen is not acceptable'. There must be a move away from situations where prior, important decisions resulted in winners and losers; wealthy beneficiaries and underprivileged victims. There must be recognition that decision making needs to be inclusive, extensive and democratic and that the end products and final results are necessary and worthwhile before projects begin. They must be visible, accessible, and must reflect the cost of doing business which includes taking the time, finding the information and involving the people who will work together to make sure that harm is avoided and

Cost-effectiveness of a Nutrition Education Curriculum Intervention in Elementary Schools.

Science.gov (United States)

Graziose, Matthew M; Koch, Pamela A; Wang, Y Claire; Lee Gray, Heewon; Contento, Isobel R

2017-09-01

To estimate the long-term cost-effectiveness of an obesity prevention nutrition education curriculum (Food, Health, & Choices) as delivered to all New York City fifth-grade public school students over 1 year. This study is a standard cost-effectiveness analysis from a societal perspective, with a 3% discount rate and a no-intervention comparator, as recommended by the US Panel on Cost-effectiveness in Health and Medicine. Costs of implementation, administration, and future obesity-related medical costs were included. Effectiveness was based on a cluster-randomized, controlled trial in 20 public schools during the 2012-2013 school year and linked to published estimates of childhood-to-adulthood body mass index trajectories using a decision analytic model. The Food, Health, & Choices intervention was estimated to cost $8,537,900 and result in 289 fewer males and 350 fewer females becoming obese (0.8% of New York City fifth-grade public school students), saving 1,599 quality-adjusted life-years (QALYs) and $8,098,600 in direct medical costs. Food, Health, & Choices is predicted to be cost-effective at $275/QALY (95% confidence interval, -$2,576/QALY to $2,084/QALY) with estimates up to $6,029/QALY in sensitivity analyses. This cost-effectiveness model suggests that a nutrition education curriculum in public schools is effective and cost-effective in reducing childhood obesity, consistent with the authors' hypothesis and previous literature. Future research should assess the feasibility and sustainability of scale-up. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Publications | Page 197 | IDRC - International Development ...

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

... Mahan Research Fellowship Program to Assess the Impact of Public Access to ... How do you estimate the cost of adaptation to climate change on vulnerable communities, where stakeholders are involved in identifying costs and benefits?

Hospitalization costs of severe bacterial pneumonia in children: comparative analysis considering different costing methods.

Science.gov (United States)

Nunes, Sheila Elke Araujo; Minamisava, Ruth; Vieira, Maria Aparecida da Silva; Itria, Alexander; Pessoa, Vicente Porfirio; Andrade, Ana Lúcia Sampaio Sgambatti de; Toscano, Cristiana Maria

2017-01-01

To determine and compare hospitalization costs of bacterial community-acquired pneumonia cases via different costing methods under the Brazilian Public Unified Health System perspective. Cost-of-illness study based on primary data collected from a sample of 59 children aged between 28 days and 35 months and hospitalized due to bacterial pneumonia. Direct medical and non-medical costs were considered and three costing methods employed: micro-costing based on medical record review, micro-costing based on therapeutic guidelines and gross-costing based on the Brazilian Public Unified Health System reimbursement rates. Costs estimates obtained via different methods were compared using the Friedman test. Cost estimates of inpatient cases of severe pneumonia amounted to R$ 780,70/$Int. 858.7 (medical record review), R$ 641,90/$Int. 706.90 (therapeutic guidelines) and R$ 594,80/$Int. 654.28 (Brazilian Public Unified Health System reimbursement rates). Costs estimated via micro-costing (medical record review or therapeutic guidelines) did not differ significantly (p=0.405), while estimates based on reimbursement rates were significantly lower compared to estimates based on therapeutic guidelines (pmetodologias de custeio, na perspectiva do Sistema Único de Saúde. Estudo de custo, com coleta de dados primários de uma amostra de 59 crianças com 28 dias a 35 meses de idade hospitalizadas por pneumonia bacteriana. Foram considerados custos diretos médicos e não médicos. Três metodologias de custeio foram utilizadas: microcusteio por revisão de prontuários, microcusteio considerando diretriz terapêutica e macrocusteio por ressarcimento do Sistema Único de Saúde. Os custos estimados pelas diferentes metodologias foram comparados utilizando o teste de Friedman. Os custos hospitalares de crianças com pneumonia grave foram R$ 780,70 ($Int. 858.7) por revisão de prontuários, R$ 641,90 ($Int. 706.90) por diretriz terapêutica e R$ 594,80 ($Int. 654.28) por

77 FR 58910 - Quarterly Rail Cost Adjustment Factor

Science.gov (United States)

2012-09-24

..., http://www.stb.dot.gov . Copies of the decision may be purchased by contacting the Office of Public...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board. ACTION: Approval of rail cost adjustment factor. SUMMARY: The Board has approved the fourth quarter 2012 rail cost adjustment factor (RCAF...

The external costs of a sedentary life-style.

Science.gov (United States)

Keeler, E B; Manning, W G; Newhouse, J P; Sloss, E M; Wasserman, J

1989-01-01

Using data from the National Health Interview Survey and the RAND Health Insurance Experiment, we estimated the external costs (costs borne by others) of a sedentary life-style. External costs stem from additional payments received by sedentary individuals from collectively financed programs such as health insurance, sick-leave coverage, disability insurance, and group life insurance. Those with sedentary life-styles incur higher medical costs, but their life expectancy at age 20 is 10 months less so they collect less public and private pensions. The pension costs come late in life, as do some of the medical costs, and so the estimate of the external cost is sensitive to the discount rate used. At a 5 percent rate of discount, the lifetime subsidy from others to those with a sedentary life style is $1,900. Our estimate of the subsidy is also sensitive to the assumed effect of exercise on mortality. The subsidy is a rationale for public support of recreational facilities such as parks and swimming pools and employer support of programs to increase exercise. PMID:2502036

Globalization, tax distortions and public sector retrenchment

DEFF Research Database (Denmark)

Andersen, Torben M.; Sørensen, Allan

is strengthened by globalization, it is inferred that the marginal costs of public funds increase and a retrenchment of the public sector follows. We challenge whether these conclusions have support in a general equilibrium model featuring standard effects from open macroeconomics and trade theory. Even though...... income taxation unambiguously worsens wage competitiveness, it does not follow that marginal costs of public funds increase with product market integration due to gains from trade. Moreover, non-cooperative fiscal policies do not have a race-to-the-bottom bias despite that taxes harm competitiveness......It is widely perceived that globalization is a threat to tax financed public sector activities. The argument is that public activities (public consumption and transfers) financed by income taxes distort labour markets and cause higher wages and thus a loss of competitiveness. Since this link...

Cost-of-illness studies in chronic ulcers: a systematic review.

Science.gov (United States)

Chan, B; Cadarette, S; Wodchis, W; Wong, J; Mittmann, N; Krahn, M

2017-04-01

To systematically review the published academic literature on the cost of chronic ulcers. A literature search was conducted in MEDLINE, EMBASE, HealthSTAR, Econlit and CINAHL up to 12 May 2016 to identify potential studies for review. Cost search terms were based on validated algorithms. Clinical search terms were based on recent Cochrane reviews of interventions for chronic ulcers. Titles and abstracts were screened by two reviewers to determine eligibility for full text review. Study characteristics were summarised. The quality of reporting was evaluated using a modified cost-of-illness checklist. Mean costs were adjusted and inflated to 2015 $US and presented for different durations and perspectives. Of 2267 studies identified, 36 were eligible and included in the systematic review. Most studies presented results from the health-care public payer or hospital perspective. Many studies included hospital costs in the analysis and only reported total costs without presenting condition-specific attributable costs. The mean cost of chronic ulcers ranged from $1000 per year for patient out of pocket costs to $30,000 per episode from the health-care public payer perspective. Mean one year cost from a health-care public payer perspective was $44,200 for diabetic foot ulcer (DFU), $15,400 for pressure ulcer (PU) and $11,000 for leg ulcer (LU). There was large variability in study methods, perspectives, cost components and jurisdictions, making interpretation of costs difficult. Nevertheless, it appears that the cost for the treatment of chronic ulcers is substantial and greater attention needs to be made for preventive measures.

The benefits of integrating cost-benefit analysis and risk assessment

International Nuclear Information System (INIS)

Fisher, K.; Clarke-Whistler, K.

1995-01-01

It has increasingly been recognized that knowledge of risks in the absence of benefits and costs cannot dictate appropriate public policy choices. Recent evidence of this recognition includes the proposed EPA Risk Assessment and Cost-Benefit Analysis Act of 1995, a number of legislative changes in Canada and the US, and the increasing demand for field studies combining measures of impacts, risks, costs and benefits. Failure to consider relative environmental and human health risks, benefits, and costs in making public policy decisions has resulted in allocating scarce resources away from areas offering the highest levels of risk reduction and improvements in health and safety. The authors discuss the implications of not taking costs and benefits into account in addressing environmental risks, drawing on examples from both Canada and the US. The authors also present the results of their recent field work demonstrating the advantages of considering costs and benefits in making public policy and site remediation decisions, including a study on the benefits and costs of prevention, remediation and monitoring techniques applied to groundwater contamination; the benefits and costs of banning the use of chlorine; and the benefits and costs of Canada's concept of disposing of high-level nuclear waste. The authors conclude that a properly conducted Cost-Benefit Analysis can provide critical input to a Risk Assessment and can ensure that risk management decisions are efficient, cost-effective and maximize improvement to environmental and human health

Hidden costs of antiretroviral treatment: the public health efficiency of drug packaging.

Science.gov (United States)

Andreu-Crespo, Àngels; Llibre, Josep M; Cardona-Peitx, Glòria; Sala-Piñol, Ferran; Clotet, Bonaventura; Bonafont-Pujol, Xavier

2015-01-01

While the overall percentage of unused antiretroviral medicines returned to the hospital pharmacy is low, their cost is quite high. Adverse events, treatment failure, pharmacokinetic interactions, pregnancy, or treatment simplification are common reasons for unplanned treatment changes. Socially inefficient antiretroviral packages prevent the reuse of drugs returned to the hospital pharmacy. We defined antiretroviral package categories based on the excellence of drug packaging and analyzed the number of pills and costs of drugs returned during a period of 1 year in a hospital-based HIV unit attending to 2,413 treated individuals. A total of 6,090 pills (34% of all returned antiretrovirals) - with a cost of 47,139.91 € - would be totally lost, mainly due to being packed up in the lowest efficiency packages. Newer treatments are packaged in low-excellence categories of packages, thus favoring the maintenance of these hidden costs in the near future. Therefore, costs of this low-efficiency drug packaging, where medication packages are started but not completed, in high-cost medications are substantial and should be properly addressed. Any improvement in the packaging by the manufacturer, and favoring the choice of drugs supplied through efficient packages (when efficacy, toxicity, and convenience are similar), should minimize the treatment expenditures paid by national health budgets.

Tetanus: still a public health problem! Tétanos: ¡Todavía un problema de salud pública!

Directory of Open Access Journals (Sweden)

Augusto Quevedo Vélez

2008-06-01

rehabilitation. Tetanus is an acute illness of worldwide distribution, sporadic occurrence and low frequency in industrialized countries. Due to its high lethality rate it still is a public health problem, especially in regions with deficient preventive programs. This review presents up to date knowledge on different aspects of this important disease, with emphasis on its diagnosis and treatment.