WorldWideScience

Sample records for publication pagination cost

  1. La nuova sfida di SEAT Pagine Gialle

    Directory of Open Access Journals (Sweden)

    Leonardo Landini

    2008-03-01

    Full Text Available SEAT Pagine Gialle’s new challengeSEAT Pagine Gialle is a company that for over 80 years has provided information services, search and communication tools.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.

  2. Public power costs less

    International Nuclear Information System (INIS)

    Moody, D.

    1993-01-01

    The reasons why residential customers of public power utilities paid less for power than private sector customers is discussed. Residential customers of investor-owned utilities (IOU's) paid average rates that were 28% above those paid by customers by possibly owned systems during 1990. The reasons for this disparity are that management costs faced by public power systems are below those of private power companies, indicating a greater efficiency of management among public power systems, and customer accounts expenses averaged $33.00 per customer for publicly owned electric utilities compared to $39.00 per customer for private utilities

  3. Cost Efficiency in Public Higher Education.

    Science.gov (United States)

    Robst, John

    This study used the frontier cost function framework to examine cost efficiency in public higher education. The frontier cost function estimates the minimum predicted cost for producing a given amount of output. Data from the annual Almanac issues of the "Chronicle of Higher Education" were used to calculate state level enrollments at two-year and…

  4. J. Genet. classic 227 NOTE: The pagination in the original included ...

    Indian Academy of Sciences (India)

    Unknown

    , December 2005. 227. NOTE: The pagination in the original included the reverse of plate 1 on p. 445, which was a blank. The blank is not included here, but the original page numbers have been retained.

  5. I racconti votivi contemporanei: pagine di un continuo liber miraculorum

    Directory of Open Access Journals (Sweden)

    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.

  6. 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...

  7. Who pays for public employee health costs?

    Science.gov (United States)

    Clemens, Jeffrey; Cutler, David M

    2014-12-01

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

  8. Shadow Cost of Public Funds and Privatization Policies

    OpenAIRE

    Sato, Susumu; Matsumura, Toshihiro

    2017-01-01

    We investigate the optimal privatization policy in mixed oligopolies with shadow cost of public funds (excess burden of taxation). The government is concerned with both the total social surplus and the revenue obtained by the privatization of a public firm. We find that the relationship between the shadow cost of public funds and the optimal privatization policy is non-monotone. When the cost is moderate, then higher the cost is, the lower is the optimal degree of privatization. ...

  9. Costs in Swedish Public Transport : An analysis of cost drivers and cost efficiency in public transport contracts

    OpenAIRE

    Vigren, Andreas

    2015-01-01

    During the last seven years, the total cost for Swedish public transport provision has increased by over 30 percent in real terms according to figures from the government agency Transport Analysis. A similar pattern is found if considering a longer time span. Part of the cost increase can be attributed to an increased supply, and part is due to price increases on input factors that are measured by an industry index produced by the public transport industry. The fact that about half of the cos...

  10. Moche CAPE Formula: Cost Analysis of Public Education.

    Science.gov (United States)

    Moche, Joanne Spiers

    The Moche Cost Analysis of Public Education (CAPE) formula was developed to identify total and per pupil costs of regular elementary education, regular secondary education, elementary special education, and secondary special education. Costs are analyzed across five components: (1) comprehensive costs (including transportation and supplemental…

  11. Methodological aspects of accounting production cost of public sector entities

    Directory of Open Access Journals (Sweden)

    Людмила Геннадіївна Ловінська

    2015-09-01

    Full Text Available The necessity of obtaining objective information about the activities of the public sector in various areas of the production is defined. It is proved an expediency of development the Project of «Guidelines for the structure of production costs» on the basis of the approved in the public sector NP(SAPS 135 "Costs". The need for accounting costs by type of activity (operational, financial and investment is marked. The composition of production costs is defined

  12. 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...

  13. 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...

  14. 48 CFR 30.102 - Cost Accounting Standards Board publication.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost Accounting Standards... REGULATION GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION General 30.102 Cost Accounting Standards Board publication. Copies of the CASB Standards and Regulations are printed in title 48...

  15. Interim monitoring of cost dynamics for publicly supported energy technologies

    Energy Technology Data Exchange (ETDEWEB)

    Nemet, Gregory F. [La Follette School of Public Affairs, University of Wisconsin, 1225 Observatory Drive, Madison, WI 53706 (United States)]|[Nelson Institute for Environmental Studies, University of Wisconsin, Madison, WI 53726 (United States)

    2009-03-15

    The combination of substantial public funding of nascent energy technologies and recent increases in the costs of those that have been most heavily supported has raised questions about whether policy makers should sustain, alter, enhance, or terminate such programs. This paper uses experience curves for photovoltaics (PV) and wind to (1) estimate ranges of costs for these public programs and (2) introduce new ways of evaluating recent cost dynamics. For both technology cases, the estimated costs of the subsidies required to reach targets are sensitive to the choice of time period on which cost projections are based. The variation in the discounted social cost of subsidies exceeds an order of magnitude. Vigilance is required to avoid the very expensive outcomes contained within these distributions of social costs. Two measures of the significance of recent deviations are introduced. Both indicate that wind costs are within the expected range of prior forecasts but that PV costs are not. The magnitude of the public funds involved in these programs heightens the need for better analytical tools with which to monitor and evaluate cost dynamics. (author)

  16. 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

  17. Cost system design and cost management in the Spanish public sector

    OpenAIRE

    Boned, Josep Lluís; Bagur, Llorenç; Tayles, Mike

    2006-01-01

    Cost systems have been shown to have developed considerably in recent years and activity-based costing (ABC) has been shown to be a contribution to cost management, particularly in service businesses. The public sector is composed to a very great extent of service functions, yet considerably less has been reported of the use of ABC to support cost management in this sector. In Spain, cost systems are essential for city councils as they are obliged to calculate the cost of the services subject...

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

    Science.gov (United States)

    Mercer, Nicola J

    2009-01-01

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

  19. Public Choices, Private Costs: An Analysis of Spending and Achievement in Ohio Public Schools.

    Science.gov (United States)

    Damask, James; Lawson, Robert

    This report sets up a structure for examining the real costs of public education. It defines three approaches of gathering and reporting cost information: narrow (salaries and current expenditures, excluding capital outlays); generally accepted accounting principles (GAAP) (costs are recorded during the period in which they occur); and broad (all…

  20. 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.

  1. [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.

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

    Science.gov (United States)

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

    2017-12-28

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

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

    Science.gov (United States)

    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.

  4. [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.

  5. Corporation Income Tax and Administrative Costs of the Public Sector

    Directory of Open Access Journals (Sweden)

    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.

  6. 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.

  7. Cost-Benefit Analysis and the Marginal Cost of Public Funds

    OpenAIRE

    Lundholm, Michael

    2005-01-01

    The marginal cost of public funds defined as the ratio between the shadow price of tax revenues and the population average of the social marginal utility of income, is analysed within an explicit cost–benefit context. It is shown that for an optimal tax system the measure is always equal to one. Benefit and cost measures congruent with this definition are derived. Under optimal taxes a positive net social benefit is a necessary and sufficient condition for a project that passes the cost–benef...

  8. 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.

  9. 48 CFR 1631.205-70 - FEHBP public relations and advertising costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true FEHBP public relations and... COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 1631.205-70 FEHBP public relations and advertising costs. (a) The cost of media messages that are directed at advising current FEHBP...

  10. 48 CFR 231.205-1 - Public relations and advertising costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Public relations and... PROCEDURES Contracts With Commercial Organizations 231.205-1 Public relations and advertising costs. (e) See... public relations and advertising costs also include monies paid to the Government associated with the...

  11. 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.

  12. 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

  13. 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...

  14. Benefits and Costs of For-Profit Public Education

    Directory of Open Access Journals (Sweden)

    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.

  15. 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.

  16. PR for Pennies: Low-Cost Library Public Relations.

    Science.gov (United States)

    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…

  17. 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...

  18. Public Involvement in Decisions to Avoid Costly Consequences Later

    Energy Technology Data Exchange (ETDEWEB)

    Treichel, Judy [Nevada Nuclear Waste Task Force, Las Vegas, NV (United States)

    2006-09-15

    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

  19. 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

  20. 48 CFR 2131.205-1 - Public relations and advertising costs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Public relations and... REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES Contracts With Commercial Organizations 2131.205-1 Public relations and advertising costs. The provisions of FAR 31.205-1 shall be modified to include the following...

  1. 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…

  2. 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…

  3. The marginal cost of public funds: theory and applications

    National Research Council Canada - National Science Library

    Dahlby, Bev

    2008-01-01

    ... with Externalities 3.4.1 Environmental Externalities 3.4.2 Public Expenditure Externalities 3.5 The MCF with Imperfect Competition in Commodity Markets 3.5.1 The MCF under Monopoly 51 54 55 58 63 63 ...

  4. 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 ...

  5. 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.

  6. 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.

  7. Economics of Sustainable Technologies : Private and Public Costs and Benefits

    NARCIS (Netherlands)

    Krozer, Yoram; Abraham, Martin

    2017-01-01

    This article is focused on the economics of sustainable technologies from the mainstream and heterodox perspectives. The aim is to present major concepts, methodologies, and debates for public use. The paper is focused on decision making aiming at the development and use of sustainable technologies.

  8. 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...

  9. Bangladesh : Fiscal Costs of Non-Financial Public Corporations

    OpenAIRE

    Kojo, Naoko C.

    2010-01-01

    The overall fiscal position of Bangladesh looks sustainable, but there are concerns that the country may be trapped in a low revenue-low capital spending equilibrium, which is holding back Bangladesh’s growth potential. Eliminating wasteful spending and halting fiscal drains through inefficient non-financial public corporations (NFPCs) are important ways to create fiscal space, particularly in the area of infrastructure. This paper reviews the financial performance of the NFPC ...

  10. 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...

  11. 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....

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

    Directory of Open Access Journals (Sweden)

    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

  13. Costs and utilization of public sector family planning services in Pakistan.

    Science.gov (United States)

    Abbas, Khadija; Khan, Adnan Ahmad; Khan, Ayesha

    2013-04-01

    The public sector provides a third of family planning (FP) services in Pakistan. However, these services are viewed as being underutilized and expensive. We explored the utilization patterns and costs of FP services in the public sector. We used overall budgets and time allocation by health and population departments to estimate the total costs of FP by these departments, costs per woman served, and costs per couple-year of protection (CYP). The public sector is the predominant provider of FP to the poorest and is the main provider of female sterilization services. The overall costs of FP in the public sector are USD 55 per woman served, annually (USD 17 per CYP). Within the public sector, the population welfare departments provide services at USD 72 per woman served, annually (USD 17 per CYP) and the health departments at USD 39 per woman per year (USD 29 per CYP). While the public sector has a critical niche in serving the poor and providing female sterilization, its services are considerably more expensive compared to international and even some Pakistani non-government organization (NGO) costs. This reflects inefficiencies in services provided, client mistrust in the quality of services provided, and inadequate referrals, and will require specific actions for improving referrals and the quality of services.

  14. 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...

  15. 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.

  16. 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,

  17. 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

  18. 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 ...

  19. 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

  20. 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

  1. To the public procurement cost-effectiveness evaluation in Russia

    Directory of Open Access Journals (Sweden)

    Timur V. Kramin

    2017-12-01

    Full Text Available Objective to search for and substantiate the single criterion of economic efficiency of state purchases in Russia. Methods econometric modelling benchmarking. Results the article identifies the need to assess the effectiveness of the state purchases system in Russia under the conditions of its reforming. The studies are analyzed which are devoted to the approaches to estimating the state purchases efficiency and the problems of ensuring the transparency of purchasing procedures. Special attention is paid to the analysis of studying the benchmarking of state purchases which helped to identify the key areas of benchmarking focusing on certain performance indicators. To implement the research objective the purchases effectiveness was analyzed from the viewpoint of the savings achieved. For this we studied the evaluation of savings in purchases as reflected in various sources of information including the data of the state statistics authorities audit and monitoring of purchases. As a result of the data systematization and generalization we identified a functional relationship between savings in purchases and the average number of participants in the purchasing process. A similar conclusion was formulated according to the analysis of indicators of the national rating of purchases transparency. There was also built a functional dependency of the discount on increasing the number of purchasing participants up to five for different ways of determining the provider. A slowdown of the discount to the initial price was revealed as the number of eligible applications grows. Based on the regional rating of the public purchases ldquoPurchases 360rdquo a factor analysis of differences of the Russian constituent entities was carried out in terms of savings. The analysis confirmed the hypothesis about the existence of a relationship between savings and the level of competition in purchases. The study also identified other factors that determine the level of

  2. 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...

  3. 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...

  4. 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

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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.)

  10. 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

  11. 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.

  12. 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.

  13. 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

  14. 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

  15. 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.

  16. 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.

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

    Science.gov (United States)

    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.

  18. 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

  19. 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...

  20. 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.

  1. 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…

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

    Directory of Open Access Journals (Sweden)

    Le HH

    2014-07-01

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

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

    Directory of Open Access Journals (Sweden)

    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

  4. "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.

  5. 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

  6. 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…

  7. 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…

  8. 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.

  9. 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

  10. 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

  11. [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.

  12. 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

  13. 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.

  14. 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...

  15. 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.

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

    Science.gov (United States)

    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.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    Maurílio de Souza Cazarim

    2017-11-01

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

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

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    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.

  20. 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

  1. 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.

  2. 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

  3. 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.

  4. 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 ...

  5. 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.

  6. 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.

  7. 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...

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. 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

    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

  14. 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.

  15. [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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. 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

  2. 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.

  3. 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.…

  4. 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.

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

    Science.gov (United States)

    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

  6. 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.

  7. 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

  8. 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.

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

    Science.gov (United States)

    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.

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. 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...

  17. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  2. 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.

  3. 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.

  4. 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…

  5. 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...

  6. 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…

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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

  13. A cost-effective method of achieving meaningful citizen participation in public roadway pipeline studies

    Energy Technology Data Exchange (ETDEWEB)

    Buszynski, M.E.

    1996-12-31

    Many proponents of gas pipeline studies using the public roadway for their facilities have trouble encouraging public participation. Problems resulting from a lack of public involvement are documented. A public participation process designed to gather meaningful public input is presented through a case study of a public roadway pipeline study in southern Ontario. Techniques are outlined to effectively stimulate public interest and document the public involvement process. Recommendations are made as to the transferability of this process to other jurisdictions.

  14. 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

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 24 CFR Appendix to Part 971 - Methodology of Comparing Cost of Public Housing With Cost of Tenant-Based Assistance

    Science.gov (United States)

    2010-04-01

    ... remain a walkup structure containing five hundred two-bedroom occupied and five hundred three-bedroom... occupancy rate, tenant composition, physical configuration and management structure of the revitalized....T.) and $100,000 monthly in utility costs paid by the authority and $50,000 monthly in utility...

  18. The Real Cost of "Cosmetic Tourism" Cost Analysis Study of "Cosmetic Tourism" Complications Presenting to a Public Hospital.

    Science.gov (United States)

    Livingston, Ryan; Berlund, Paul; Eccles-Smith, Jade; Sawhney, Raja

    2015-01-01

    "Cosmetic Tourism," the process of traveling overseas for cosmetic procedures, is an expanding global phenomenon. The model of care by which these services are delivered can limit perioperative assessment and postoperative follow-up. Our aim was to establish the number and type of complications being treated by a secondary referral hospital resulting from "cosmetic tourism" and the cost that has been incurred by the hospital in a 1-year period. Retrospective cost analysis and chart review of patients admitted to the hospital between the financial year of 2012 and 2013 were performed. Twelve "cosmetic tourism" patients presented to the hospital, requiring admission during the study period. Breast augmentation was the most common procedure and infected prosthesis was the most common complication (n = 4). Complications ranged from infection, pulmonary embolism to penile necrosis. The average cost of treating these patients was $AUD 12 597.71. The overall financial burden of the complication to the hospital was AUD$151 172.52. The "cosmetic tourism" model of care appears to be, in some cases, suboptimal for patients and their regional hospitals. In the cases presented in this study, it appears that care falls on the patient local hospital and home country to deal with the complications from their surgery abroad. This incurs a financial cost to that hospital in addition to redirecting medical resources that would otherwise be utilized for treating noncosmetic complications, without any remuneration to the local provider.

  19. 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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    2016-01-01

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

  2. 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...

  3. Estimating study costs for use in VOI, a study of dutch publicly funded drug related research

    NARCIS (Netherlands)

    Van Asselt, A.D.; Ramaekers, B.L.; Corro Ramos, I.; Joore, M.A.; Al, M.J.; Lesman-Leegte, I.; Postma, M.J.; Vemer, P.; Feenstra, T.F.

    2016-01-01

    Objectives: To perform value of information (VOI) analyses, an estimate of research costs is needed. However, reference values for such costs are not available. This study aimed to analyze empirical data on research budgets and, by means of a cost tool, provide an overview of costs of several types

  4. Assessment of Costs for a Global Climate Fund Against Public Sector Disaster Risks

    Science.gov (United States)

    Hochrainer-Stigler, Stefan; Mechler, Reinhard; Pflug, Georg; Williges, Keith

    2013-04-01

    National governments are key actors in managing climate variability and change, yet, many countries, faced with exhausted tax bases, high levels of indebtedness and limited donor assistance, have been unable to raise sufficient and timely capital to replace or repair damaged assets and restore livelihoods following major disasters exacerbating the impacts of disaster shocks on poverty and development. For weather extremes, which form a subset of the adaptation challenge and are supposed to increase in intensity and frequency with a changing climate, we conduct an assessment of the costs of managing and financing today's public sector risks on a global scale for more than 180 countries. A countries financial vulnerability is defined as a function of its financial resilience and its exposure to disaster risk. While disaster risk is estimated in terms of asset loss distributions based on catastrophe modeling approaches, financial resilience is operationalized as the public sector's ability to pay for relief to the affected population and support the reconstruction of affected assets and infrastructure for a given event. We consider governments financially vulnerable to disasters if they cannot access sufficient funding after a disaster to cover their liabilities. We operationalize this concept by the term resource gap, which we define the net loss associated with a disaster event after exhausting all possible ex-post and ex ante financing sources. Extending this approach for all possible disaster events, the risk that a resource gap will occur over a given time-span can be calculated for each country individually and dependent on the risk level different risk instruments may have to be applied. Furthermore, our estimates may inform decisions pertaining to a "climate insurance fund" absorbing "high level" country risks exceeding the ability of any given country to pay in the case of an extreme event. Our estimates relate to today's climate, yet we suggest that

  5. 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...

  6. 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...

  7. 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

  8. 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

  9. Experiences related to the role of a cost centre manager in a public ...

    African Journals Online (AJOL)

    A cost centre in a hospital setting is an identifiable department, for example a nursing care unit, which has been practically assigned an account number in the hospital accounting system. The purpose of a cost centre is to control clinical and administrative costs, as well as accumulated expenses by that identified ...

  10. Research Costs Investigated: A Study Into the Budgets of Dutch Publicly Funded Drug-Related Research

    NARCIS (Netherlands)

    T. van Asselt (Thea); B.L.T. Ramaekers (Bram); I. Corro Ramos (Isaac); M.A. Joore (Manuela); M.J. Al (Maiwenn); Lesman-Leegte, I. (Ivonne); M.J. Postma (Maarten); P. Vemer (Pepijn); T.L. Feenstra (Talitha)

    2017-01-01

    textabstractBackground: The costs of performing research are an important input in value of information (VOI) analyses but are difficult to assess. Objective: The aim of this study was to investigate the costs of research, serving two purposes: (1) estimating research costs for use in VOI analyses;

  11. Research Costs Investigated : A Study Into the Budgets of Dutch Publicly Funded Drug-Related Research

    NARCIS (Netherlands)

    van Asselt, Thea; Ramaekers, Bram; Corro Ramos, Isaac; Joore, Manuela; Al, Maiwenn; Lesman-Leegte, Ivonne; Postma, Maarten; Vemer, Pepijn; Feenstra, Talitha

    BACKGROUND: The costs of performing research are an important input in value of information (VOI) analyses but are difficult to assess. OBJECTIVE: The aim of this study was to investigate the costs of research, serving two purposes: (1) estimating research costs for use in VOI analyses; and (2)

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

  14. 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.

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

    Science.gov (United States)

    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

  16. 76 FR 49841 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

    Science.gov (United States)

    2011-08-11

    ... Commission-approved RTOs and ISOs. The Commission stated that it expected all non-public utility transmission... transmission planning processes that public utility transmission providers in regions outside of RTOs and ISOs...

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

    Science.gov (United States)

    Bergholz, W

    2008-11-01

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

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

    Science.gov (United States)

    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

  19. Utilisation of Cost Type Information in Decision Making Process Approaches on Public Establishments

    OpenAIRE

    Mihai (Andreescu) Gabriela; Ionescu (Eftene) Nicoleta; Uta Tatiana

    2011-01-01

    Managerial decisions and decision making process stand for the key issues of each entity around which all activities of financial information collection, processing, review, construing, summarizing, and not only, gravitate within every organisation. Moreover, costs (calculation, review and optimization of such) are important as the whole activity of an organisation reflects itself in costs, respectively based on information concerning costs based on which managers may decide on purchasing, pr...

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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

  2. 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.

  3. 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.

  4. 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

  5. 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, ...

  6. 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

  7. An Introduction to Cost-of-Living Adjustments in Public Retirement Plans: Details Matter

    Science.gov (United States)

    Jennings, Penelope R.; Jennings, William P.; Phillips, G. Michael

    2016-01-01

    While financial planning students are expected to be able to understand client retirement plans, subtle differences in cost-of-living adjustments can have major impact on the success of client retirement plans. This teaching note compares the cost-of-living adjustments in the largest government sponsored retirement systems and a hypothetical…

  8. Public policy intervention in freight transport costs: effects on printed media logistics in the Netherlands

    NARCIS (Netherlands)

    Runhaar, H.A.C.; Heijden, R. van der

    2005-01-01

    Trends in contemporary logistics management have led to an increased transport-intensity of production and distribution activities. Transport costs are increasingly traded off against other logistical costs and seem to have lost importance in strategic decision-making. At the same time, in Europe,

  9. 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.

  10. Direct medical cost and utility analysis of diabetics outpatient at Karanganyar public hospital

    Science.gov (United States)

    Eristina; Andayani, T. M.; Oetari, R. A.

    2017-11-01

    Diabetes Mellitus is a high cost disease, especially in long-term complication treatment. Long-term complication treatment cost was a problem for the patient, it can affect patients quality of life stated with utility value. The purpose of this study was to determine the medical cost, utility value and leverage factors of diabetics outpatient. This study was cross sectional design, data collected from retrospective medical record of the financial and pharmacy department to obtain direct medical cost, utility value taken from EQ-5D-5L questionnaire. Data analyzed by Mann-Whitney and Kruskal-Wallis test. Results of this study were IDR 433,728.00 for the direct medical cost and pharmacy as the biggest cost. EQ-5D-5L questionnaire showed the biggest proportion on each dimension were 61% no problem on mobility dimension, 89% no problems on self-care dimension, 54% slight problems on usual activities dimension, 41% moderate problems on pain/discomfort dimension and 48% moderate problems on anxiety/depresion dimension. Build upon Thailand value set, utility value was 0.833. Direct medical cost was IDR 433,728.00 with leverage factors were pattern therapy, blood glucose level and complication. Utility value was 0.833 with leverage factors were patients characteristic, therapy pattern, blood glucose level and complication.

  11. Research Costs Investigated: A Study Into the Budgets of Dutch Publicly Funded Drug-Related Research.

    Science.gov (United States)

    van Asselt, Thea; Ramaekers, Bram; Corro Ramos, Isaac; Joore, Manuela; Al, Maiwenn; Lesman-Leegte, Ivonne; Postma, Maarten; Vemer, Pepijn; Feenstra, Talitha

    2018-01-01

    The costs of performing research are an important input in value of information (VOI) analyses but are difficult to assess. The aim of this study was to investigate the costs of research, serving two purposes: (1) estimating research costs for use in VOI analyses; and (2) developing a costing tool to support reviewers of grant proposals in assessing whether the proposed budget is realistic. For granted study proposals from the Netherlands Organization for Health Research and Development (ZonMw), type of study, potential cost drivers, proposed budget, and general characteristics were extracted. Regression analysis was conducted in an attempt to generate a 'predicted budget' for certain combinations of cost drivers, for implementation in the costing tool. Of 133 drug-related research grant proposals, 74 were included for complete data extraction. Because an association between cost drivers and budgets was not confirmed, we could not generate a predicted budget based on regression analysis, but only historic reference budgets given certain study characteristics. The costing tool was designed accordingly, i.e. with given selection criteria the tool returns the range of budgets in comparable studies. This range can be used in VOI analysis to estimate whether the expected net benefit of sampling will be positive to decide upon the net value of future research. The absence of association between study characteristics and budgets may indicate inconsistencies in the budgeting or granting process. Nonetheless, the tool generates useful information on historical budgets, and the option to formally relate VOI to budgets. To our knowledge, this is the first attempt at creating such a tool, which can be complemented with new studies being granted, enlarging the underlying database and keeping estimates up to date.

  12. 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)

  13. The Costs of Public and Private Gas Enterprises in Late 19th Century Britain.

    OpenAIRE

    Millward, Robert; Ward, Robert

    1987-01-01

    Data for a sample of thirty-five U.K. gas undertakings for 1898 was used to estimate a translog cost function. Labor accou nted for less than 15 percent of total costs. Changes in outlays on c oal have significant effects on total costs. Economies of scale exist but tend to disappear at production volumes which are near to averag e for the provincial gas undertakings. After controlling for factor p rices, population density, and output levels, municipal enterprises a re shown to have lower co...

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

    Directory of Open Access Journals (Sweden)

    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.

  15. 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.

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

    Science.gov (United States)

    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.

  17. 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.

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

    International Nuclear Information System (INIS)

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

    1985-05-01

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

  19. Public synthesis of the reference costs study of the electric power production

    International Nuclear Information System (INIS)

    2008-01-01

    Every 3 or 5 years, the DGEC published the reference costs study of the electric power production which evaluates, in a theoretical framework, the total cost of an electrical MWh, from different production ways. These studies bring information for the definition of the energy policy and the elaboration of the investments program. because of the great competition of the market, it was decided not to publish the absolute value of the hypothesis and the results but under indexed form. (A.L.B.)

  20. 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

  1. 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.

  2. The Cost of Medicaid Savings: The Potential Detrimental Public Health Impact of Neonatal Circumcision Defunding

    Directory of Open Access Journals (Sweden)

    Annie L. Andrews

    2012-01-01

    Full Text Available Objective. To project the increased incidence of HIV and subsequent costs resulting from the expected decreased rate of circumcision due to Medicaid defunding in one southeastern state. Methods. Using 2009 South Carolina (SC Medicaid birth cohort (n=29,316, we calculated expected heterosexually acquired HIV cases at current circumcision rates. To calculate age/race/gender specific HIV incidence rates, we used 2009 South Carolina Department of Health and Environmental Control reported gender and race specific HIV cases, CDC reported age distribution of HIV cases, and 2009 S.C. population data. Accounting for current circumcision rates, we calculated the change in incidence of heterosexually acquired HIV assuming circumcision provides 60% protection against HIV transmission to males and 46% protection against male to female transmission. Published lifetime cost of HIV was used to calculate the cost of additional HIV cases. Results. Assuming Medicaid circumcision rates decrease from current nationally reported levels to zero secondary to defunding, we project an additional 55 male cases of HIV and 47 female cases of HIV among this birth cohort. The total cost discounted to time of infection of these additional HIV cases is $20,924,400 for male cases and $17,711,400 for female cases. The cost to circumcise males in this birth cohort at currently reported rates is $4,856,000. Conclusions. For every year of decreased circumcision rates due to Medicaid defunding, we project over 100 additional HIV cases and $30,000,000 in net medical costs.

  3. 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.

  4. 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

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Andreu-Crespo À

    2015-08-01

    Full Text Available Àngels Andreu-Crespo,1,* Josep M Llibre,2,3,* Glòria Cardona-Peitx,1 Ferran Sala-Piñol,1 Bonaventura Clotet,2,4 Xavier Bonafont-Pujol1 1Pharmacy Department, 2HIV Unit and “Lluita contra la SIDA” Foundation, University Hospital Germans Trias i Pujol, Badalona, 3Universitat Autònoma de Barcelona, 4Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC, Vic, Barcelona, Spain *These authors contributed equally to the work Abstract: 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. Keywords: antiretroviral treatment, cost efficacy, drug packaging, treatment change

  7. A guideline for public entities on cost-efficient procurement of PV assets

    CSIR Research Space (South Africa)

    Bischof-Niemz, T

    2015-09-01

    Full Text Available Traditionally, when public entities buy an asset under an Engineering, Procurement and Construction (EPC) contract, the screening of the responses to the request for proposals is done in two stages: In a filter stage, all proposals...

  8. [Proposal of a costing method for the provision of sterilization in a public hospital].

    Science.gov (United States)

    Bauler, S; Combe, C; Piallat, M; Laurencin, C; Hida, H

    2011-07-01

    To refine the billing to institutions whose operations of sterilization are outsourced, a sterilization cost approach was developed. The aim of the study is to determine the value of a sterilization unit (one point "S") evolving according to investments, quantities processed, types of instrumentation or packaging. The time of preparation has been selected from all sub-processes of sterilization to determine the value of one point S. The time of preparation of sterilized large and small containers and pouches were raised. The reference time corresponds to one bag (equal to one point S). Simultaneously, the annual operating cost of sterilization was defined and divided into several areas of expenditure: employees, equipments and building depreciation, supplies, and maintenance. A total of 136 crossing times of containers were measured. Time to prepare a pouch has been estimated at one minute (one S). A small container represents four S and a large container represents 10S. By dividing the operating cost of sterilization by the total number of points of sterilization over a given period, the cost of one S can be determined. This method differs from traditional costing method in sterilizing services, considering each item of expenditure. This point S will be the base for billing of subcontracts to other institutions. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

  10. 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

  11. 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.

  12. 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

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

    Science.gov (United States)

    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.

  14. An analysis of the cost of incomplete abortion to the public health ...

    African Journals Online (AJOL)

    The total estimated cost of treatment for 1994 is the sum ... urban and rural practice settings located in 7 of the 9 ..... likely to be related to the size of hospital and its staff (data .... comprehensive, pro-active strategy on reproductive health.

  15. [Myocardial perfusion scintigraphy. Exact and cost-effective coronary disease imaging - secondary publication

    DEFF Research Database (Denmark)

    Hesse, B.; Petersen, C.L.; Marcassa, C.

    2008-01-01

    Mortality rates due to coronary arterial disease (CAD) have declined as result of improved prevention, diagnosis and management, but CAD remains the leading cause of death. Myocardial perfusion scintigraphy (MPS) provides a cost-effective tool for early detection of CAD in symptomatic individuals...

  16. The Cost Efficiency Impact of the University Operation Fund on Public Universities in Taiwan

    Science.gov (United States)

    Kuo, Jenn-Shyong; Ho, Yi-Cheng

    2008-01-01

    This study uses the stochastic frontier multiple-product cost function that is modeled after Battese and Coelli [Battese, G. E., & Coelli, T. J. (1995). "A model for technical inefficiency effects in a stochastic frontier production for panel data." "Empirical Economics" 20(2), 325-332.] in order to empirically measure the…

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

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    2017-01-01

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

  18. Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

    Directory of Open Access Journals (Sweden)

    David Provenzale Titinger

    2015-01-01

    Full Text Available Abstract Background: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS. Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001, as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006. Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001. The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001. SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001. However, as the EuroSCORE increased, there was significant difference (p < 0.0001 between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.

  19. 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

  20. Cost-benefit analysis in the public sector. Kosten-Nutzen-Analyse in der oeffentlichen Versorgung

    Energy Technology Data Exchange (ETDEWEB)

    Schoeller, A [comp.

    1986-01-01

    The publications in the 'IRB Literaturauslesen' contain citations of journal articles, scientific books, periodicals, research reports and projects, dissertations, company publications, institutes' reports, construction standards, documentation services, and so-called 'grey' literature (i.e. unpublished literature that is difficult to access) on the title subject. The information is derived from the databases of Informationszentrum Raum und Bau of the Fraunhofer-Gesellschaft (IRB). The issue abstracted deals with energy supply systems, the processing of drinking water, waste water treatment, and alternative technologies. With 43 refs..

  1. 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

  2. Cost-benefit analysis in optimising the radiological protection of the public: a provisional framework

    International Nuclear Information System (INIS)

    1981-07-01

    The advice given is concerned solely with the application of a quantitative framework to the optimisation of protection of members of the public, exposed as a result of routine releases of radionuclides to the environment or emissions of radiation in normal operating conditions. (author)

  3. 75 FR 62023 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

    Science.gov (United States)

    2010-10-07

    ... transmission needs driven by public policy requirements established by state or federal laws or regulations... facilities; and remove from Commission-approved tariffs or agreements a right of first refusal created by..., as a result of a Commission- approved tariff or agreement, receive different treatment in a regional...

  4. A guideline for public entities on cost-efficient procurement of PV assets

    CSIR Research Space (South Africa)

    Bischof-Niemz, Thomas

    2015-09-01

    Full Text Available for a public entity is done using evaluation criteria based on installed capacity in kW, quality criteria and other user-defined specifications, while the final decision is based on total EPC price. This forces contractors to offer the minimum...

  5. AGENCY COST TERHADAP KEBIJAKAN DIVIDEN PADA PERUSAHAAN MANUFAKTUR DAN JASA YANG GO PUBLIC DI INDONESIA

    Directory of Open Access Journals (Sweden)

    Triani Pujiastuti

    2017-03-01

    Full Text Available This analysis developed to reach empirical evidence of the effect of agency costfactors toward evidence policy. In another hand this analysis wished to prove whether theagency problem able to be decreased through dividend payment mechanism withinmanufactures and services company in BEI, Indonesia, in 2000-2005. Agency cost variable hasbeing represented by Insider Ownership, Shareholder dispersion, Collateral Assets, debt andFree Cash Flow. The model which ran in this analysis was Multiple Linier Regressions. Theresult of analysis showed that agency problem able to be decreased through dividend paymentmechanism, from Insider Ownership which gives negative effect, Shareholders Dispersion whichgives positive effect, and Debt which gives negative effect toward dividend policy, whilecollateral assets and free cash flow not significant affecting to dividend policy within agencyconflict. Agency cost variable significant affected the dividend policy within agency conflictsimultaneously, with the sum of the effect was 18%.

  6. Investigating the In-Vehicle Crowding Cost Functions for Public Transit Modes

    OpenAIRE

    Qin, Feifei

    2014-01-01

    In the densely populated metropolitan area, empirical studies have found that overcrowding inside transit vehicles has become substantially worse and worse over recent years. Chronic in-vehicle crowding is not only caused by a lack of physical infrastructure, but also triggered by inadequate service provisions. Given the prevalence of overcrowded transit vehicles, this paper conducts both quantitative and qualitative studies, especially focusing on remodeling the in-vehicle crowding cost func...

  7. Exploring No-Cost Opportunities for Public Sector Information Systems Energy Efficiency: A Tennessee Application

    Directory of Open Access Journals (Sweden)

    Kendra Abkowitz Brooks

    2015-11-01

    Full Text Available The Tennessee Department of Environment and Conservation (TDEC completed a pilot project within its Central Office spaces to test the utilization of computer power management (CPM technologies to implement power saving settings on state-owned, network-connected computer equipment. Currently, the State of Tennessee has no clear protocol regarding energy-conserving power settings on state-owned machines. Activation of monitor sleep modes and system standby and hibernation modes on 615 Central Office computers over an 18-month period reduced energy consumption by an estimated 8093 kWh and $526 per month, amounting to approximately $6312 in cost savings for Tennessee annually. If implemented throughout State of Tennessee executive agencies across the state, energy cost savings could amount to an estimated $323,341 annually. The research endeavored to understand both positive and negative impacts that strategic power management approaches can have on energy consumption, worker productivity, network security, and state budgets. Nearly all impacts discussed were positive. Based on successful results within TDEC Central Office spaces in Tennessee Tower, and considering the potential cost savings that could be achieved, expansion of the implementation of computer power management policies to machines in offices across the state was recommended.

  8. 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.

  9. 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...

  10. Publicity.

    Science.gov (United States)

    Chisholm, Joan

    Publicity for preschool cooperatives is described. Publicity helps produce financial support for preschool cooperatives. It may take the form of posters, brochures, newsletters, open house, newspaper coverage, and radio and television. Word of mouth and general good will in the community are the best avenues of publicity that a cooperative nursery…

  11. 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.

  12. 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.

  13. 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.

  14. The public promotion of wind energy in Spain from the transaction costs perspective 1986-2007

    International Nuclear Information System (INIS)

    Perez, Yannick; Ramos-Real, Francisco Javier

    2009-01-01

    This paper analyzes the success of wind energy in Spain from 1986 to 2007. Certain special characteristics have emerged in Spain that provide credibility to the feed-in tariff (FIT) device to promote this energy source. To explain this success, the analysis will focus on the intrinsic characteristics of FIT using the concepts of the transaction cost theory (TCE). Nevertheless, in this framework, special attention is placed on the role that specific political and institutional factors have played in providing stability to this instrument. Thanks to an early start and an on-going and generous FIT device, wind energy promotion for electricity has become a political success story in Spain. The main implication of this analysis is that this success is mainly due to the trade-off between stability and flexibility in the use of Spanish FIT. (author)

  15. Is cost-effective healthcare compatible with publicly financed academic medical centres?

    Science.gov (United States)

    Chia, Whay Kuang; Toh, Han Chong

    2013-01-01

    Probably more than any country, Singapore has made significant investment into the biomedical enterprise as a proportion of its economy and size. This focus recently witnessed a shift towards a greater emphasis on translational and clinical development. Key to the realisation of this strategy will be Academic Medical Centres (AMCs), as a principal tool to developing and applying useful products for the market and further improving health outcomes. Here, we explore the principal value proposition of the AMC to Singapore society and its healthcare system. We question if the values inherent within academic medicine--that of inquiry, innovation, pedagogy and clinical exceptionalism--can be compatible with the seemingly paradoxical mandate of providing cost-effective or rationed healthcare.

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

    Science.gov (United States)

    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

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  19. 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.

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

    Science.gov (United States)

    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…

  1. 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…

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

    Science.gov (United States)

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

    2011-01-01

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

  3. Public health impact and cost effectiveness of routine childhood vaccination for hepatitis a in Jordan: a dynamic model approach.

    Science.gov (United States)

    Hayajneh, Wail A; Daniels, Vincent J; James, Cerise K; Kanıbir, Muhammet Nabi; Pilsbury, Matthew; Marks, Morgan; Goveia, Michelle G; Elbasha, Elamin H; Dasbach, Erik; Acosta, Camilo J

    2018-03-07

    As the socioeconomic conditions in Jordan have improved over recent decades the disease and economic burden of Hepatitis A has increased. The purpose of this study is to assess the potential health and economic impact of a two-dose hepatitis A vaccine program covering one-year old children in Jordan. We adapted an age-structured population model of hepatitis A transmission dynamics to project the epidemiologic and economic impact of vaccinating one-year old children for 50 years in Jordan. The epidemiologic model was calibrated using local data on hepatitis A in Jordan. These data included seroprevalence and incidence data from the Jordan Ministry of Health as well as hospitalization data from King Abdullah University Hospital in Irbid, Jordan. We assumed 90% of all children would be vaccinated with the two-dose regimen by two years of age. The economic evaluation adopted a societal perspective and measured benefits using the quality-adjusted life-year (QALY). The modeled vaccination program reduced the incidence of hepatitis A in Jordan by 99%, 50 years after its introduction. The model projected 4.26 million avoided hepatitis A infections, 1.42 million outpatient visits, 22,475 hospitalizations, 508 fulminant cases, 95 liver transplants, and 76 deaths over a 50 year time horizon. In addition, we found, over a 50 year time horizon, the vaccination program would gain 37,502 QALYs and save over $42.6 million in total costs. The vaccination program became cost-saving within 6 years of its introduction and was highly cost-effective during the first 5 years. A vaccination program covering one-year old children is projected to be a cost-saving intervention that will significantly reduce the public health and economic burden of hepatitis A in Jordan.

  4. Integrating and rationalizing public healthcare services as a source of cost containment in times of economic crises.

    Science.gov (United States)

    Pettoello-Mantovani, Massimo; Namazova-Baranova, Leyla; Ehrich, Jochen

    2016-02-24

    Serious concern has been raised about the sustainability of public health care systems of European Nations and ultimately about the health of European citizens, as a result of the economic crisis that has distressed Europe since 2008. The severe economic crisis of the Euro zone, which is still afflicting Europe in 2016, has in fact threatened to equally impact public health services of nations presenting either a weak or a strong domestic growth. On behalf of the European Paediatric Association, the Union of National European Societies and Associations, the authors of the Commentary debates the relationship between the effects of economic instability and health, through the report on an article recently published in the Italian Journal of Pediatrics, which emphasized the importance of integrating existing public health care services, otherwise independently provided by public hospitals, and Primary Care Paediatric networks. The interconnections between the effects of economic instability and health are briefly commented, following the observation that these two factors are not yet fully understood, and that the definition of proper solutions to be applied in circumstances, where health is negatively impacted by periods of economic distress, is still open for discussion. Furthermore it is noted that the pressure to "deliver more for less" often seems to be the driving force forging the political strategic decisions in the area of pediatric healthcare, rather than social, cultural, and economic sensitivity and competences. Thus, the delivery of appropriate pediatric healthcare seems not to be related exclusively to motivations aimed to the benefit of children, but more often to other intervening factors, including economic, and political rationales. The conclusions emphasize that local European experiences suggest that positive and cost effective healthcare programs are possible, and they could serve as a model in the development of effective cross-border regional

  5. 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...

  6. Theoretical analysis of the cumulative costs of different diesel bus alternatives for a public transport in the city of Belgrade

    Directory of Open Access Journals (Sweden)

    Jovanović Stevan S.

    2017-01-01

    Full Text Available This paper includes comparative analysis of the environmental, energetic, and financial costs of different bus propulsion, possibly applied on the public transport in the city of Belgrade. It considers the modern diesel bus, the trolleybus, the natural gas bus with the spark ignition engine, the electric bus using LiFePO4 battery, and the electric bus with ultra-capacitor. The results are presented according to the real data and the real electro-energetic situation in Serbia, with the dominantly used lignite coal as primary fuel. This model gives the exact exhaust emission of electric vehicles at the thermal power plant, enables its comparison to the internal combustion engine vehicles. The result in analysis shows that the natural gas bus is the most cost efficient in economical way with overall exploitation price of $87 per 100 km. The trolleybus is more economical then the natural gas powered bus only at high departures rate, higher than 230 per workday.

  7. Measuring the cost and effect of current community consultation and public disclosure techniques in emergency care research.

    Science.gov (United States)

    Matchett, Gerald; Ryan, Timothy J; Sunna, Mary C; Lee, Simon C; Pepe, Paul E

    2018-04-30

    U.S. federal regulations for research involving exception from informed consent (EFIC) include stipulations for community consultation (CC) and public disclosure (PD) (FDA 21 CFR 50.24). Published descriptions of PD campaigns include letters to community leaders, media outreach, paid advertising, and community meetings. Whether or not these activities provide measurable impact is unknown, as few prior works have evaluated PD activities with probabilistic polling. The aim of this study is to use polling to assess how much public awareness PD efforts generate. A 3-month PD campaign similar in scope and scale to PD campaigns described in several recent publications was implemented across a large urban county (pop. 2.55 million). PD included a study website (www.evktrial.org), letters to 300 community leaders/organizations, bilingual media outreach and also phased roll-outs, weeks apart, of newspaper advertisements, mass e-mail messaging, and paid advertising in Facebook ® and Twitter ® augmented by volunteer social media outreach. During PD we used repeated zip code-targeted online polling via Google Consumer Surveys ® to assess community awareness of the proposed EFIC study. Over 3-months all-source exposures to >1 million individuals were estimated, generating ∼5,000 website visits (12-month cumulative, ∼9000). However, general community awareness evaluated through repeated county-wide polling never rose above baseline measurements. CC/PD campaign costs were estimated at $60,000 (USD). A PD campaign in scope and scale common for EFIC studies may not provide measurable impact in a community. Investigators, review boards and regulators could consider these findings when re-examining and/or creating policies for PD for EFIC studies. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. 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).

  9. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  11. 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.

    Science.gov (United States)

    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

  12. 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.

  13. The SpikerBox: A Low Cost, Open-Source BioAmplifier for Increasing Public Participation in Neuroscience Inquiry

    Science.gov (United States)

    Marzullo, Timothy C.; Gage, Gregory J.

    2012-01-01

    Although people are generally interested in how the brain functions, neuroscience education for the public is hampered by a lack of low cost and engaging teaching materials. To address this, we developed an open-source tool, the SpikerBox, which is appropriate for use in middle/high school educational programs and by amateurs. This device can be used in easy experiments in which students insert sewing pins into the leg of a cockroach, or other invertebrate, to amplify and listen to the electrical activity of neurons. With the cockroach leg preparation, students can hear and see (using a smartphone oscilloscope app we have developed) the dramatic changes in activity caused by touching the mechanosensitive barbs. Students can also experiment with other manipulations such as temperature, drugs, and microstimulation that affect the neural activity. We include teaching guides and other resources in the supplemental materials. These hands-on lessons with the SpikerBox have proven to be effective in teaching basic neuroscience. PMID:22470415

  14. The SpikerBox: a low cost, open-source bioamplifier for increasing public participation in neuroscience inquiry.

    Directory of Open Access Journals (Sweden)

    Timothy C Marzullo

    Full Text Available Although people are generally interested in how the brain functions, neuroscience education for the public is hampered by a lack of low cost and engaging teaching materials. To address this, we developed an open-source tool, the SpikerBox, which is appropriate for use in middle/high school educational programs and by amateurs. This device can be used in easy experiments in which students insert sewing pins into the leg of a cockroach, or other invertebrate, to amplify and listen to the electrical activity of neurons. With the cockroach leg preparation, students can hear and see (using a smartphone oscilloscope app we have developed the dramatic changes in activity caused by touching the mechanosensitive barbs. Students can also experiment with other manipulations such as temperature, drugs, and microstimulation that affect the neural activity. We include teaching guides and other resources in the supplemental materials. These hands-on lessons with the SpikerBox have proven to be effective in teaching basic neuroscience.

  15. Unit Cost Analysis of PET-CT at an Apex Public Sector Health Care Institute in India.

    Science.gov (United States)

    Gajuryal, S H; Daga, A; Siddharth, V; Bal, C S; Satpathy, S

    2017-01-01

    PET/CT scan service is one of the capital intensive and revenue-generating centres of a tertiary care hospital. The cost associated with the provisioning of PET services is dependent upon the unit costs of the resources consumed. The study aims to determine the cost of providing PET/CT Scan services in a hospital. This descriptive and observational study was conducted in the Department of Nuclear Medicine at a tertiary apex teaching hospital in New Delhi, India in the year 2014-15. Traditional costing methodology was used for calculating the unit cost of PET/CT scan service. The cost was calculated under two heads that is capital and operating cost. Annualized cost of capital assets was calculated using methodology prescribed by WHO and operating costs was taken on an actual basis. Average number of PET/CT scan performed in a day is 30. The annual cost of providing PET/CT scan services was calculated to be 65,311,719 Indian Rupees (INR) (US$ 1,020,496), while the unit cost of PET scan was calculated to be 9625.92 INR (US$ 150). 3/4th cost was spent on machinery and equipment (75.3%) followed by healthcare personnel (11.37%), electricity (5%), consumables and supplies (4%) engineering maintenance (3.24%), building, furniture and HVAC capital cost (0.76%), and manifold cost (0.05%). Of the total cost, 76% was capital cost while the remaining was operating cost. Total cost for establishing PET/CT scan facility with cyclotron and chemistry module and PET/CT scan without cyclotron and chemistry module was calculated to be INR 610,873,517 (US$9944899) and 226,745,158 (US$3542893), respectively. (US$ 1=INR 64).

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  18. Parents, Quality, and School Choice: Why Parents in Nairobi Choose Low-Cost Private Schools over Public Schools in Kenya's Free Primary Education Era

    Science.gov (United States)

    Zuilkowski, Stephanie Simmons; Piper, Benjamin; Ong'ele, Salome; Kiminza, Onesmus

    2018-01-01

    Low-cost private schools (LCPS) are widespread in Kenya, particularly in urban areas. This study examines the reasons that parents send children to fee-charging schools in a context of free public primary education. Drawing on parent survey and interview data, as well as interviews with national policy makers, we found that parents who chose LCPS…

  19. 78 FR 11232 - Notification of a Public Meeting on the Use of Cost Comparisons in Federal Procurement

    Science.gov (United States)

    2013-02-15

    ... comparing the relative cost of performance by Federal employees versus contract performance in order to... organization and (b) address the full costs of government and private sector performance. 1. What additional... also can be used to compare the relative cost of each sector's performance without conducting a...

  20. Dust and airborne exposure to allergens derived from cockroach (Blattella germanica) in low-cost public housing in Strasbourg (France).

    Science.gov (United States)

    de Blay, F; Sanchez, J; Hedelin, G; Perez-Infante, A; Vérot, A; Chapman, M; Pauli, G

    1997-01-01

    Although a strong association between allergy to cockroach (CR) and asthma has been observed in the United States and Asia, there are little data about the extent of exposure to CR allergen in Europe. To determine the levels of CR allergens in dust samples from apartments in Strasbourg and to determine the concentration and size of CR allergens in the air. Nine apartments in a public housing complex were chosen on the basis of visual evidence of CR infestation. Levels of CR allergens (Bla g 1 and Bla g 2) in kitchen and mattress dust samples were measured by immunoassay with the use of monoclonal antibodies. Air was sampled for 3 to 8 hours in the kitchen under undisturbed conditions, during artificial disturbance, and during normal domestic activity by using an impinger and a parallel glass fiber filter and at flow rates of 2 to 20 L/min. Airborne CR and mite allergens were measured concurrently in the bedroom of one apartment before, during, and after artificial disturbance. High levels of Bla g 1 and Bla g 2 were found in kitchen dust from the nine apartments (geometric means of 3919 U/gm [range 530 to 14306 U/gm] and 497 U/gm [range 73 to 1946 U/gm], respectively). Under undisturbed conditions, airborne CR allergens were not detectable in any of the apartments. During vigorous artificial disturbance, Bla g 1 and Bla g 2 were detectable in air samples from seven apartments (geometric means of 4.5 U/m3 [range 0.7 to 17.2 U/m3] and 1.0 U/m3 [range 0.4 to 3.4 U/m3], respectively). Both allergens were predominantly collected on the first stage of the impinger, and 76% to 80% of the airborne allergen was associated with particles greater than 10 microns in diameter. The levels were significantly higher than those collected on the second or third stages of the impinger (p low-cost public housing in Strasbourg can be as high as or higher than the levels measured in towns in the United States. CR allergens become airborne during disturbance and are primarily associated

  1. 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.

  2. 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

  3. The costs of heart failure in Poland from the public payer's perspective. Polish programme assessing diagnostic procedures, treatment and costs in patients with heart failure in randomly selected outpatient clinics and hospitals at different levels of care: POLKARD.

    Science.gov (United States)

    Czech, Marcin; Opolski, Grzegorz; Zdrojewski, Tomasz; Dubiel, Jacek S; Wizner, Barbara; Bolisęga, Dorota; Fedyk-Łukasik, Małgorzata; Grodzicki, Tomasz

    2013-01-01

    Heart failure (HF) is a chronic disease of great clinical and economic significance for both the healthcare system and patients themselves. To determine the consumption of medical resources for treatment and care of HF patients and to estimate the related costs. The study involved 400 primary care practices and 396 specialist outpatient clinics, as well as 259 hospitals at all reference levels. The sample was representative and supplemented with patient interview data. Based on the consumption of particular resources and the unit costs of services in 2011, costs of care for HF patients in Poland were estimated. Separate analyses were conducted depending on the stage of the disease (according to NYHA classification I-IV). The public payer's perspective and a one year time horizon were adopted. Direct annual costs of an HF patient's treatment in Poland may range between PLN 3,373.23 and 7,739.49 (2011), the main cost item being hospitalisation. The total costs for the healthcare system could be as high as PLN 1,703 million, which is 3.16% of the National Health Fund's budget (Ex. rate from 05.03.2012: 1 EUR = 4.14 PLN). The costs of treating heart failure in Poland are high; proper allocation of resources to diagnostic procedures and treatment may contribute to rationalisation of the relevant expenditure.

  4. 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...

  5. 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.

  6. The Cost of Health Service Waste Management of (HSWM: A Case Study of Intensive Care Unit of Infectious Diseases at a Public Hospital in São Paulo.

    Directory of Open Access Journals (Sweden)

    Chennyfer Dobbins Paes da Rosa

    2015-08-01

    Full Text Available The Health Service Waste Management is a set of technical and legal procedures for waste management in any type of health facilities. It is known about the limited resources, so reducing environmental costs can contribute to the management of hospital costs. The objective was to estimate the cost of the phases of HSWM to the Intensive Care Unit for public service. Data collecting was done through a script of questions and observations on site at the Emilio Ribas Infectious Diseases Institute in Sao Paulo. The ABC costing method was used. The most costly step was wrapping (40.68%, followed by segregation (40.17%, which is justified by both being associated with health workers’ salaries. The daily cost of the management of health care waste from segregation to final disposal in the ICU was R$ 4,288.81 a day, being R$ 314.80/bed-patient/day. To know the cost of an activity allows for the analysis of strategies for price negotiation. Health care waste is little remembered when pricing a daily ICU, many managers believe this value to be irrelevant; but< if not measured, it may bring losses to the institution.

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

    Science.gov (United States)

    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.

  8. Public health impact and cost effectiveness of mass vaccination with live attenuated human rotavirus vaccine (RIX4414) in India: model based analysis.

    Science.gov (United States)

    Rose, Johnie; Hawthorn, Rachael L; Watts, Brook; Singer, Mendel E

    2009-09-25

    To examine the public health impact of mass vaccination with live attenuated human rotavirus vaccine (RIX4414) in a birth cohort in India, and to estimate the cost effectiveness and affordability of such a programme. Decision analytical Markov model encompassing all direct medical costs. Infection risk and severity depended on age, number of previous infections, and vaccination history; probabilities of use of inpatient and outpatient health services depended on symptom severity. Published clinical, epidemiological, and economic data. When possible, parameter estimates were based on data specific for India. Population Simulated Indian birth cohort followed for five years. Decrease in rotavirus gastroenteritis episodes (non-severe and severe), deaths, outpatient visits, and admission to hospital; incremental cost effectiveness ratio of vaccination expressed as net cost in 2007 rupees per life year saved. In the base case, vaccination prevented 28,943 (29.7%) symptomatic episodes, 6981 (38.2%) severe episodes, 164 deaths (41.0%), 7178 (33.3%) outpatient visits, and 812 (34.3%) admissions to hospital per 100,000 children. Vaccination cost 8023 rupees (about pound100, euro113, $165) per life year saved, less than India's per capita gross domestic product, a common criterion for cost effectiveness. The net programme cost would be equivalent to 11.6% of the 2006-7 budget of the Indian Department of Health and Family Welfare. Model results were most sensitive to variations in access to outpatient care for those with severe symptoms. If this parameter was increased to its upper limit, the incremental cost effectiveness ratio for vaccination still fell between one and three times the per capita gross domestic product, meeting the World Health Organization's criterion for "cost effective" interventions. Uncertainty analysis indicated a 94.7% probability that vaccination would be cost effective according to a criterion of one times per capita gross domestic product per life

  9. 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

    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 bottomup procedure. Indirect costs were distributed to each treatment cycle on the basis of number of visits as basis...

  10. The Cost-Effectiveness of Undergraduate Education at Private Nondoctoral Colleges and Universities: Implications for Students and Public Policy

    Science.gov (United States)

    Zumeta, William; Huntington-Klein, Nick

    2015-01-01

    This study examines key aspects of the cost-effectiveness of private nondoctoral (PND) colleges as providers of baccalaureate degrees and explores how states might feasibly make better use of these colleges to produce more degrees efficiently. The study looks at degree production and cost in the PND sector relative to other higher education…

  11. Commentary on "Finance, Management, and Costs of Public and Private Schools in Indonesia" and "Do Local Contributions Affect the Efficiency of Public Primary Schools?"

    Science.gov (United States)

    Berger, Mark C.

    1996-01-01

    Studies on Indonesia and the Philippines in this special issue examine how local financial control affects costs of providing primary schooling. In both countries, schools with greater financial decentralization operated more efficiently. These results have important implications for U.S. schools, where decentralization reforms in Kentucky and…

  12. The art of alignment transaction cost economics and the provision of public services at the local level

    NARCIS (Netherlands)

    van Genugten, M.L.

    2008-01-01

    This book is situated against the background of the debate on recent institutional changes in the public sector. These changes concern the privatization, liberalization and autonomization of different kinds of public services. The main incentives for introducing such new modes of governance were,

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

    Science.gov (United States)

    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.

  14. 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.

  15. 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.

  16. Costs of publicly provided maternity services in Rosario, Argentina Los costos de servicios maternos públicos en Rosario, Argentina

    Directory of Open Access Journals (Sweden)

    Josephine Borghi

    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 $4.70. Direct costs are minimal compared to indirect costs of travel and waiting time. CONCLUSIONS: These results suggest the potential for increasing the efficiency of resource use by promoting antenatal care visits at the primary level. Women could also benefit from reduced travel and waiting time. Similar benefits could accrue to the provider by encouraging normal delivery at general hospitals, and complicated deliveries at specialised maternity hospitals.OBJETIVO: En este artículo se presenta una estimación de los costos de los servicios maternos en Rosario, Argentina. MATERIAL Y MÉTODOS: Evaluamos retrospectivamente el costo (US$ 1999 en dos hospitales municipales, de un parto normal vaginal, y de una cesárea y de una visita prenatal. El costo de atención prenatal fue evaluado en dos centros de salud y los costos asumidos por las pacientes fueron evaluados en un hospital y un centro de salud. RESULTADOS: El costo promedio por día-cama es de $114.62. El costo promedio de una ces

  17. Public health impact and cost-effectiveness of intranasal live attenuated influenza vaccination of children in Germany.

    Science.gov (United States)

    Damm, Oliver; Eichner, Martin; Rose, Markus Andreas; Knuf, Markus; Wutzler, Peter; Liese, Johannes Günter; Krüger, Hagen; Greiner, Wolfgang

    2015-06-01

    In 2011, intranasally administered live attenuated influenza vaccine (LAIV) was approved in the EU for prophylaxis of seasonal influenza in 2-17-year-old children. Our objective was to estimate the potential epidemiological impact and cost-effectiveness of an LAIV-based extension of the influenza vaccination programme to healthy children in Germany. An age-structured dynamic model of influenza transmission was developed and combined with a decision-tree to evaluate different vaccination strategies in the German health care system. Model inputs were based on published literature or were derived by expert consulting using the Delphi technique. Unit costs were drawn from German sources. Under base-case assumptions, annual routine vaccination of children aged 2-17 years with LAIV assuming an uptake of 50% would prevent, across all ages, 16 million cases of symptomatic influenza, over 600,000 cases of acute otitis media, nearly 130,000 cases of community-acquired pneumonia, nearly 1.7 million prescriptions of antibiotics and over 165,000 hospitalisations over 10 years. The discounted incremental cost-effectiveness ratio was 1,228 per quality-adjusted life year gained from a broad third-party payer perspective (including reimbursed direct costs and specific transfer payments), when compared with the current strategy of vaccinating primarily risk groups with the conventional trivalent inactivated vaccine. Inclusion of patient co-payments and indirect costs in terms of productivity losses resulted in discounted 10-year cost savings of 3.4 billion. In conclusion, adopting universal influenza immunisation of healthy children and adolescents would lead to a substantial reduction in influenza-associated disease at a reasonable cost to the German statutory health insurance system. On the basis of the epidemiological and health economic simulation results, a recommendation of introducing annual routine influenza vaccination of children 2-17 years of age might be taken into

  18. 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

  19. The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study

    Directory of Open Access Journals (Sweden)

    Bahia Luciana

    2012-06-01

    Full Text Available Abstract Background Obesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS. Methods Population attributable risk (PAR was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR ≥ 1.20 or RR ≥1.10 and  Results The estimated total costs in one year with all diseases related to overweight and obesity are US$ 2,1 billion; US$ 1,4 billion (68.4% of total costs due to hospitalizations and US$ 679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity. Conclusion The results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions.

  20. Modelling the cost-effectiveness of public awareness campaigns for the early detection of non-small-cell lung cancer.

    Science.gov (United States)

    Hinde, S; McKenna, C; Whyte, S; Peake, M D; Callister, M E J; Rogers, T; Sculpher, M

    2015-06-30

    Survival rates in lung cancer in England are significantly lower than in many similar countries. A range of Be Clear on Cancer (BCOC) campaigns have been conducted targeting lung cancer and found to improve the proportion of diagnoses at the early stage of disease. This paper considers the cost-effectiveness of such campaigns, evaluating the effect of both the regional and national BCOC campaigns on the stage distribution of non-small-cell lung cancer (NSCLC) at diagnosis. A natural history model of NSCLC was developed using incidence data, data elicited from clinical experts and model calibration techniques. This structure is used to consider the lifetime cost and quality-adjusted survival implications of the early awareness campaigns. Incremental cost-effectiveness ratios (ICERs) in terms of additional costs per quality-adjusted life-years (QALYs) gained are presented. Two scenario analyses were conducted to investigate the role of changes in the 'worried-well' population and the route of diagnosis that might occur as a result of the campaigns. The base-case theoretical model found the regional and national early awareness campaigns to be associated with QALY gains of 289 and 178 QALYs and ICERs of £13 660 and £18 173 per QALY gained, respectively. The scenarios found that increases in the 'worried-well' population may impact the cost-effectiveness conclusions. Subject to the available evidence, the analysis suggests that early awareness campaigns in lung cancer have the potential to be cost-effective. However, significant additional research is required to address many of the limitations of this study. In addition, the estimated natural history model presents previously unavailable estimates of the prevalence and rate of disease progression in the undiagnosed population.

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

    Science.gov (United States)

    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.

  2. 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.

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

    Science.gov (United States)

    Gottlob, Brian J.

    2006-01-01

    As a large body of high-quality research has emerged in the past few years showing that school choice benefits the students who use it, much of the debate has shifted to the "public" or "social" effects of school choice. This study examines how school choice in Missouri would raise high school graduation rates, and measures the…

  4. The impact of assumptions regarding vaccine-induced immunity on the public health and cost-effectiveness of hepatitis A vaccination: Is one dose sufficient?

    Science.gov (United States)

    Curran, Desmond; de Ridder, Marc; Van Effelterre, Thierry

    2016-01-01

    ABSTRACT Hepatitis A vaccination stimulates memory cells to produce an anamnestic response. In this study, we used a mathematical model to examine how long-term immune memory might convey additional protection against clinical/icteric infections. Dynamic and decision models were used to estimate the expected number of cases, and the costs and quality-adjusted life-years (QALYs), respectively. Several scenarios were explored by assuming: (1) varying duration of vaccine-induced immune memory, (2) and/or varying levels of vaccine-induced immune memory protection (IMP), (3) and/or varying levels of infectiousness in vaccinated individuals with IMP. The base case analysis assumed a time horizon of 25 y (2012 – 2036), with additional analyses over 50 and 75 y. The analyses were conducted in the Mexican public health system perspective. In the base case that assumed no vaccine-induced IMP, the 2-dose hepatitis A vaccination strategy was cost-effective compared with the 1-dose strategy over the 3 time horizons. However, it was not cost-effective if we assumed additional IMP durations of at least 10 y in the 25-y horizon. In the 50- and 75-y horizons, the 2-dose strategy was always cost-effective, except when 100% reduction in the probability of icteric Infections, 75% reduction in infectiousness, and mean durations of IMP of at least 50 y were assumed. This analysis indicates that routine vaccination of toddlers against hepatitis A virus would be cost-effective in Mexico using a single-dose vaccination strategy. However, the cost-effectiveness of a second dose depends on the assumptions of additional protection by IMP and the time horizon over which the analysis is performed. PMID:27428611

  5. [Cost effectiveness and budget impact analysis of inhaled nitric oxide in a neonatal unit from the perspective of the public health system].

    Science.gov (United States)

    Kilchemmann Fuentes, Carlos; Vallejos Vallejos, Carlos; Román Navarro, Andrés

    Inhaled nitric oxide (iNO) is currently the first-line therapy in severe hypoxaemic respiratory failure of the newborn. Most of regional neonatal centres in Chile do not have this therapeutic alternative. To determine the cost effectiveness of inhaled nitric oxide in the treatment of respiratory failure associated with pulmonary hypertension of the newborn compared to the usual care, including the transfer to a more complex unit. A clinical decision tree was designed from the perspective of Chilean Public Health Service. Incremental cost effectiveness rates (ICER) were calculated, deterministic sensitivity analysis was performed, and probabilistic budget impact was estimated using: TreeAge Pro Healthcare 2014 software. The iNO option leads to an increase in mean cost of $ 11.7 million Chilean pesos (€15,000) per patient treated, with an ICER compared with the usual care of $23 million pesos (€30,000) in case of death or ECMO avoided. By sensitising the results by incidence, it was found that from 7 cases and upwards treated annually, inhaled nitric oxide is less costly than the transfer to a more complex unit. From the perspective of a Chilean regional hospital, incorporating inhaled nitric oxide into the management of neonatal respiratory failure is the optimal alternative in most scenarios. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Comparison of two public sector tertiary care hospitals' management in reducing direct medical cost burden on breast carcinoma patients in Lahore, Pakistan.

    Science.gov (United States)

    Hameed Khaliq, Imran; Zahid Mahmood, Hafiz; Akhter, Naveed; Danish Sarfraz, Muhammad; Asim, Khadija; Masood Gondal, Khalid

    2018-01-01

    Breast cancer is one of the major causes of death incurring highest morbidity and mortality amongst women of Pakistan. The purpose of this study was to assess and compare the role of two public sector tertiary care hospitals' management in reducing out of pocket (OOP) expenses on direct medical costs borne by breast carcinoma patients' household from diagnosis through treatment. Moreover, the study intended to explore the reasons of opting private diagnostic facilities by the said patients during the services taken from the foresaid tertiary care centers. A purposive sample of 164 primary breast carcinoma patients was recruited for data collection of this cross-sectional study. Face to face interviews and semistructured questionnaires were adopted as method of data gathering tools. Major cost components of direct medical costs were used to compare the financial strain on the patients' households of both targeted hospitals. In addition, information was collected regarding the reasons of opting private diagnostic centers for investigations. Frequency, percentages, median and inter quartile range (IQR) were calculated for the data. Non-parametric variables were compared using the Mann-Whitney U test. It was observed that overall direct medical cost borne by the breast carcinoma patients' households in Jinnah hospital (median US$1153.93 / Rs. 118,589) was significantly higher than Mayo hospital (median US$427.93 /Rs. 43,978), pprivately opted investigations procedures was the common issue of the patients under treatment in both hospitals.

  7. 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.

  8. Micronutrient malnutrition and the impact of modern plant breeding on public health in India: How cost-effective is biofortification?

    OpenAIRE

    Stein, Alexander J.

    2006-01-01

    Millions of people worldwide suffer from micronutrient malnutrition or ?hidden hunger?. The related deficiencies can have devastating consequences for the life, health and well-being of the affected individuals, but they may also perpetuate a vicious circle of undernutrition, low economic productivity and poverty. Hence, in many developing countries vitamin and mineral deficiencies are public health problems of primary concern. While economic development and rising incomes can only address un...

  9. Cost-effectiveness analysis of offering free leisure centre memberships to physically inactive members of the public receiving state benefits: a case study.

    Science.gov (United States)

    Verhoef, Talitha I; Trend, Verena; Kelly, Barry; Robinson, Nigel; Fox, Paul; Morris, Stephen

    2016-07-22

    We evaluated the cost-effectiveness of the Give-it-a-Go programme, which offers free leisure centre memberships to physically inactive members of the public in a single London Borough receiving state benefits. A decision analytic Markov model was developed to analyse lifetime costs and quality-adjusted life-years (QALYs) of 1025 people recruited to the intervention versus no intervention. In the intervention group, people were offered 4 months of free membership at a leisure centre. Physical activity levels were assessed at 0 and 4 months using the International Physical Activity Questionnaire (IPAQ). Higher levels of physical activity were assumed to decrease the risk of coronary heart disease, stroke and diabetes mellitus type II, as well as improve mental health. Costs were assessed from a National Health Service (NHS) perspective. Uncertainty was assessed using one-way and probabilistic sensitivity analyses. One-hundred fifty nine participants (15.5 %) completed the programme by attending the leisure centre for 4 months. Compared with no intervention, Give it a Go increased costs by £67.25 and QALYs by 0.0033 (equivalent to 1.21 days in full health) per recruited person. The incremental costs per QALY gained were £20,347. The results were highly sensitive to the magnitude of mental health gain due to physical activity and the duration of the effect of the programme (1 year in the base case analysis). When the mental health gain was omitted from the analysis, the incremental cost per QALY gained increased to almost £1.5 million. In the probabilistic sensitivity analysis, the incremental costs per QALY gained were below £20,000 in 39 % of the 5000 simulations. Give it a Go did not significantly increase life-expectancy, but had a positive influence on quality of life due to the mental health gain of physical activity. If the increase in physical activity caused by Give it a Go lasts for more than 1 year, the programme would be cost-effective given a

  10. INITIAL PUBLIC OFFERING IN BRAZIL (2004-2006): A VALUATION APPROACH USING MULTIPLES AND COST OF EQUITY

    OpenAIRE

    FELIPE PRETTI CASOTTI

    2007-01-01

    A precificação das ações emitidas em ofertas públicas iniciais tem sido alvo de estudos em diversos países. Abordando o conceito de avaliação por múltiplos, este trabalho busca verificar se as ações das empresas estavam sub-avaliadas ou super-avaliadas no momento das suas Ofertas Públicas Iniciais (Initial Public Offerings). Posteriormente, são determinados os custos de capital próprio adotados na emissão, verificando-se a diferença entre betas utili...

  11. Level of satisfaction of clients of public pharmacies dispensing high-cost drugs in Espírito Santo, Brazil

    Directory of Open Access Journals (Sweden)

    Karla Oliveira dos Santos Cassaro

    Full Text Available ABSTRACT The aim of this study was to evaluate the level of satisfaction of pharmaceutical services and to determine the socioeconomic profile of public pharmacy clients. This is a cross-sectional observational study using a quantitative approach. The sample was calculated from the monthly number of patients seen in pharmacies and was stratified for each pharmacy. Data were analysed using SPSS 11.5 software and by observing the simple relative frequencies for qualitative variables. For the quantitative variables, the analysis of variance (ANOVA and post-hoc Fisher tests were performed. Data are expressed as mean ± standard deviation (SD. The results show that, in general, patients at "Farmácias cidadãs" are satisfied with the services. However, when stratified, we found that the greatest satisfaction was related only to structural and organizational aspects, while the pharmaceutical services are unsatisfactory. When relating satisfaction to the socioeconomic characteristics, a difference between waiting time (39.07 ± 19.53, attendance by pharmacist (8.91 ± 5.14 and education was observed. It is concluded that users are satisfied with the services of state "Farmácias cidadãs" of Espírito Santo, but there should be improvements in relation to pharmaceutical services and the interpersonal relationships between health professionals and users of the public health system in Brazil.

  12. Public Health Impact and Economic Costs of Volkswagen’s Lack of Compliance with the United States’ Emission Standards

    Directory of Open Access Journals (Sweden)

    Lifang Hou

    2016-09-01

    Full Text Available The U.S. Environmental Protection Agency (EPA recently issued a notice of violation against Volkswagen (VW for installing a defective device in certain models of diesel cars to circumvent emission tests for nitrogen oxides (NOx. We quantified the health and economic impacts of extra NOx emissions attributable to non-compliant vehicles in the U.S. using the EPA’s Co-Benefits Risk Assessment model. We estimated that the total extra NOx emitted over one year of operation would result in 5 to 50 premature deaths, 687 to 17,526 work days with restricted activity, and economic costs of $43,479,189 to $423,268,502, based on various assumptions regarding emission scenarios and risks. This study highlights the potential impacts of VW vehicles’ lack of compliance on the health and well-being of the U.S. population.

  13. Ignoring free, appropriate, public education, a costly mistake: the case of F.M. & L.G. versus Barbour County.

    Science.gov (United States)

    Easterbrooks, Susan R; Lytle, Linda R; Sheets, Patricia M; Crook, Bobbie S

    2004-01-01

    In 2000, the 11th Circuit Court provided the largest single award in special education history to date, approximately $2.5 million, to two teenaged students who were deaf. The students were judged to have been denied a free, appropriate public education (FAPE), having spent their academic careers in generic special education classes for students with multiple disabilities without the benefit of access to a communication system; the services of a certified, qualified teacher of the deaf; or related services. This article describes the case from the perspective of FAPE, least restrictive environment, and due process in the presence of guardians who did not understand the implications of the Individual Education Program (IEP) teams' decisions; presents a chronology of the case; explores the implications for various stakeholders; and discusses the catastrophic impact on the social, emotional, communication, and academic development and earning potential of the students.

  14. Modelling public transport passenger flows in the era of intelligent transport systems COST Action TU1004 (TransITs)

    CERN Document Server

    Noekel, Klaus

    2016-01-01

    This book shows how transit assignment models can be used to describe and predict the patterns of network patronage in public transport systems. It provides a fundamental technical tool that can be employed in the process of designing, implementing and evaluating measures and/or policies to improve the current state of transport systems within given financial, technical and social constraints. The book offers a unique methodological contribution to the field of transit assignment because, moving beyond “traditional” models, it describes more evolved variants that can reproduce: • intermodal networks with high- and low-frequency services; • realistic behavioural hypotheses underpinning route choice; • time dependency in frequency-based models; and • assumptions about the knowledge that users have of network conditions that are consistent with the present and future level of information that intelligent transport systems (ITS) can provide. The book also considers the practical perspective of practit...

  15. Defending public interests in private lands: compliance, costs and potential environmental consequences of the Brazilian Forest Code in Mato Grosso.

    Science.gov (United States)

    Stickler, Claudia M; Nepstad, Daniel C; Azevedo, Andrea A; McGrath, David G

    2013-06-05

    Land-use regulations are a critical component of forest governance and conservation strategies, but their effectiveness in shaping landholder behaviour is poorly understood. We conducted a spatial and temporal analysis of the Brazilian Forest Code (BFC) to understand the patterns of regulatory compliance over time and across changes in the policy, and the implications of these compliance patterns for the perceived costs to landholders and environmental performance of agricultural landscapes in the southern Amazon state of Mato Grosso. Landholdings tended to remain in compliance or not according to their status at the beginning of the study period. The perceived economic burden of BFC compliance on soya bean and beef producers (US$3-5.6 billion in net present value of the land) may in part explain the massive, successful campaign launched by the farm lobby to change the BFC. The ecological benefits of compliance (e.g. greater connectivity and carbon) with the BFC are diffuse and do not compete effectively with the economic benefits of non-compliance that are perceived by landholders. Volatile regulation of land-use decisions that affect billions in economic rent that could be captured is an inadequate forest governance instrument; effectiveness of such regulations may increase when implemented in tandem with positive incentives for forest conservation.

  16. [Health impact and treatment costs of community-acquired pneumonia in children in the first level of public attention in Argentina].

    Science.gov (United States)

    Bernztein, Ricardo; Drake, Ignacio

    2009-04-01

    Community acquired pneumonia in children remains an important cause of childhood deaths throughout the world that can be prevented by the use of antibiotics and access to medical care. Both were reduced in 2001 when Argentina suffered a severe social crisis. Among the responses to the crisis, the Remediar Program provided free essential medicines to the socially vulnerable population. Assess the health impact and costs of the provision of free medicines at the first level of public attention for childhood pneumonia. Three designs: 1. Ecological study with cross comparisons of diagnoses, prescriptions, beneficiaries by individual provinces of Remediar forms. children under 15 years old attended at 6 thousand health centres in Argentina, encompassing 24 Argentine provinces from March 2005 until February 2006. 2. Counterfactual approach. 3. Calculation of drug costs per unit of outcome. Over 15 million prescriptions were identified, 2,420 children under 1 year, 19,205 of 1 to 4 years and 15,977 from 5 to 14 years old with pneumonia. 90% of beneficiaries received antibiotics, most often amoxicillin. In children's under 5 years of age, Remediar coverage was 27.8%, with greater impact in the poorest provinces. The likely impact was 4,322 lives saved or 310,325 years of life lost avoided if mortality without antibiotics was 20%. Indigents who had children with pneumonia saved by medicines 14.3% of their income. Each life saved could have cost US $ 6.46 and each year of life lost averted US $ 0.09. This work highlights the impact of a low-cost health program for the treatment of vulnerable populations with childhood pneumonia in Argentina.

  17. Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study.

    Science.gov (United States)

    Phillips, Andrew N; Cambiano, Valentina; Nakagawa, Fumiyo; Revill, Paul; Jordan, Michael R; Hallett, Timothy B; Doherty, Meg; De Luca, Andrea; Lundgren, Jens D; Mhangara, Mutsa; Apollo, Tsitsi; Mellors, John; Nichols, Brooke; Parikh, Urvi; Pillay, Deenan; Rinke de Wit, Tobias; Sigaloff, Kim; Havlir, Diane; Kuritzkes, Daniel R; Pozniak, Anton; van de Vijver, David; Vitoria, Marco; Wainberg, Mark A; Raizes, Elliot; Bertagnolio, Silvia

    2018-03-01

    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 responses in countries in sub-Saharan Africa where the prevalence of pretreatment drug resistance to NNRTIs is high. The HIV Synthesis Model is an individual-based simulation model of sexual HIV transmission, progression, and the effect of ART in adults, which is based on extensive published data 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. 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 health benefits, resulting in a reduction of about 1 death per year per 100 people on ART over the next 20 years in a situation in which more than 10% of ART initiators have NNRTI resistance. The negative effect on population health of postponing the transition to dolutegravir increases substantially with higher prevalence of HIV drug resistance to NNRTI in ART initiators. Because of the reduced risk of resistance acquisition with dolutegravir-based regimens and reduced use of expensive second-line boosted protease inhibitor regimens, this policy option is also predicted to lead to a reduction of overall programme cost. A future transition from first-line regimens containing efavirenz to regimens containing dolutegravir formulations in adult ART initiators is predicted to be effective and cost-effective in

  18. Spatial and temporal distribution of long term public policy costs under uncertainty, the case of climate change

    International Nuclear Information System (INIS)

    Lecocq, F.

    2000-07-01

    Because of the inertia of the climate system, policy makers cannot avoid making early decisions regarding climate change in a sea of uncertainties. In this context, the very legitimacy of economic analysis to tackle such questions, and in particular the underlying equity issues (who pays for climate mitigation? when?) faces widespread skepticism. This thesis aims at demonstrating how public economy still remains a powerful tool to try and put some rationale into the debate, by checking the internal consistency of the different discourses, and by providing robust insights, if not definitive answers, into climate decisions. We use a set of compact integrated climate policy optimization models to progressively introduce, articulate, and assess numerically the prominent issues at stake. We obtain three main results. We first demonstrate that the so-called timing debate between short term and long term action cannot be reduced to a mere dispute over discount rate. Given the high uncertainties surrounding climate change indeed, the margins of freedom we pass on to future generations, and in particular the technical and institutional systems we transmit, become more important than the discount rate value. Secondly, we apply the various emission quota allocation rules proposed in the literature for the enlargement of annex B to developing economies. We show that the distributive outcome of these rules depends critically on ex ante assumptions about future economic and emission growth. Therefrom, we conclude that a careful design of the institutions surrounding the tradable permits market is a necessary condition to enhance the systems robustness. Last, on a broader perspective, this thesis illustrates the complementarity between ethics and economics: though the economist does not have per se a superior word about what is fair, his toolbox is powerful enough to show how some intuitively appealing ideas, such as a zero discount rate to take care of both present and future

  19. Initial public offerings in Brazil (2004-2006: Valuation with the use of multiples and discounting of cash flows using the appropriate cost of equity

    Directory of Open Access Journals (Sweden)

    Luiz Felipe Jacques da Motta

    2008-10-01

    Full Text Available The pricing process of new shares in IPOs has been under study in several countries. This paper initially looks at the valuation process using multiples and seeks to classify the new shares under two categories: underpriced or overpriced at the time of the IPOs. Analysis of the cost of equity, comparing betas at the time of the offerings (usually calculated as the betas of comparable companies and the betas of the companies after 12 months of trading, is also carried out. Companies in the sample are those that went public between 2004 and 2006. Results indicated that companies were not undervalued, even after some high short-term returns. However there is no statistical evidence that they were overvalued. Finally, results indicated that betas after twelve months of trading are significantly higher than the comparable companies’ betas used at the time of the IPOs.

  20. Cost-effectiveness of safety measures to reduce public risk associated with the transportation of UF{sub 6} by truck and trains

    Energy Technology Data Exchange (ETDEWEB)

    Hubert, Philippe; Pages, Pierre

    1989-08-01

    The present case study deals with the problem of uranium hexafluoride transportation by truck and train. It consists of a probabilistic risk assessment of the potential hazards to the public that can arise from the traffic that will take place in France in 1990. The specificity of UF{sub 6} is that it presents both chemical and radiological hazards. But, whatever the transported material, road traffic entails a risk of its own. Thus three kinds of risks are assessed for natural, depleted and enriched uranium hexafluoride. These assessments are the basis of a cost-effectiveness analysis which deals with such safety measures as using a protective overpack, avoiding populated areas and escorting the trucks.

  1. Cost-effectiveness of safety measures to reduce public risk associated with the transportation of UF6 by truck and trains

    International Nuclear Information System (INIS)

    Hubert, Philippe; Pages, Pierre

    1989-01-01

    The present case study deals with the problem of uranium hexafluoride transportation by truck and train. It consists of a probabilistic risk assessment of the potential hazards to the public that can arise from the traffic that will take place in France in 1990. The specificity of UF 6 is that it presents both chemical and radiological hazards. But, whatever the transported material, road traffic entails a risk of its own. Thus three kinds of risks are assessed for natural, depleted and enriched uranium hexafluoride. These assessments are the basis of a cost-effectiveness analysis which deals with such safety measures as using a protective overpack, avoiding populated areas and escorting the trucks

  2. A Study of the Importance of Education and Cost Incentives on Individual Food Choices at the Harvard School of Public Health Cafeteria

    Science.gov (United States)

    Michels, Karin B.; Bloom, Barry R.; Riccardi, Paul; Rosner, Bernard A.; Willett, Walter C.

    2013-01-01

    Objectives To investigate the importance of cost and awareness of health- or disease-promoting properties of foods and meals for choices by customers of a cafeteria. Design A non-randomized intervention study. Setting A medium size cafeteria in the Harvard School of Public Health. Participants Customers of the cafeteria mainly consisting of public health students, faculty, and school staff and workers from the medical campus. Intervention The purchase of healthy foods and dishes was subsidized and their prices reduced by 20%. This promotion was accompanied by the distribution of educational material. Main Outcome Measures Change in consumption of healthy and less healthy foods. Analysis The geometric mean was used to calculate the change in consumption. Results During the intervention, we observed a 6% increase in the consumption of healthy foods (95% confidence interval [CI]; 5% to 8%), and a 2% decline in the consumption of less-healthy foods (95% CI; −1% to −4%). After the prices returned to their original levels, the consumption of healthy foods increased further to 17% (95% CI; 13% to 20%) and a 2% decline in the consumption of less-healthy foods (95% CI; % 1 to −5%) persisted. Conclusions Subsidizing healthful meals and educating consumers about the importance of a healthy diet can result in a modest increase in the selection of healthy foods and meals that can be maintained beyond the periods of subsidy and promotion. PMID:18460476

  3. A study of the importance of education and cost incentives on individual food choices at the Harvard School of Public Health cafeteria.

    Science.gov (United States)

    Michels, Karin B; Bloom, Barry R; Riccardi, Paul; Rosner, Bernard A; Willett, Walter C

    2008-02-01

    To investigate the importance of cost and awareness of health- or disease-promoting properties of foods and meals for choices by customers of a cafeteria. A non-randomized intervention study. A medium size cafeteria in the Harvard School of Public Health. Customers of the cafeteria mainly consisting of public health students, faculty, and school staff and workers from the medical campus. The purchase of healthy foods and dishes was subsidized and their prices reduced by 20%. This promotion was accompanied by the distribution of educational material. Change in consumption of healthy and less healthy foods. The geometric mean was used to calculate the change in consumption. During the intervention, we observed a 6% increase in the consumption of healthy foods (95% confidence interval [CI]; 5% to 8%), and a 2% decline in the consumption of less-healthy foods (95% CI; -1% to -4%). After the prices returned to their original levels, the consumption of healthy foods increased further to 17% (95% CI; 13% to 20%) and a 2% decline in the consumption of less-healthy foods (95% CI; % 1 to -5%) persisted. Subsidizing healthful meals and educating consumers about the importance of a healthy diet can result in a modest increase in the selection of healthy foods and meals that can be maintained beyond the periods of subsidy and promotion.

  4. COMPLEAT (Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies): A planning tool for publicly owned electric utilities. [Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies (Compleat)

    Energy Technology Data Exchange (ETDEWEB)

    1990-09-01

    COMPLEAT takes its name, as an acronym, from Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies. It is an electric utility planning model designed for use principally by publicly owned electric utilities and agencies serving such utilities. As a model, COMPLEAT is significantly more full-featured and complex than called out in APPA's original plan and proposal to DOE. The additional complexity grew out of a series of discussions early in the development schedule, in which it became clear to APPA staff and advisors that the simplicity characterizing the original plan, while highly desirable in terms of utility applications, was not achievable if practical utility problems were to be addressed. The project teams settled on Energy 20/20, an existing model developed by Dr. George Backus of Policy Assessment Associates, as the best candidate for the kinds of modifications and extensions that would be required. The remainder of the project effort was devoted to designing specific input data files, output files, and user screens and to writing and testing the compute programs that would properly implement the desired features around Energy 20/20 as a core program. This report presents in outline form, the features and user interface of COMPLEAT.

  5. Development of analysis method of material f low cost accounting using lean technique in food production: A case study of Universal Food Public (UFC Co.,Ltd.

    Directory of Open Access Journals (Sweden)

    Wichai Chattinnawat

    2015-06-01

    Full Text Available This research aims to apply Lean technique in conjunction with analysis of Material Flow Cost Accounting (MFCA to production process of canned sweet corn in order to increase process efficiency, eliminate waste and reduce cost of the production. This research develops and presents new type of MFCA analysis by incorporating value and non-value added activities into the MFCA cost allocation process. According to the simulation-based measurement of the process efficiency, integrated cost allocation based on activity types results in higher proportion of negative product cost in comparison to that computed from conventional MFCA cost allocation. Thus, considering types of activities and process efficiency have great impacts on cost structure especially for the negative product cost. The research leads to solutions to improve work procedures, eliminate waste and reduce production cost. The overall cost per unit decreases with higher proportion of positive product cost.

  6. 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.

  7. 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...

  8. Sustentabilidade empresarial e o impacto no custo de capital próprio das empresas de capital aberto Sustainable development and consequences for equity costs in public companies

    Directory of Open Access Journals (Sweden)

    Lílian Simone Aguiar da Silva

    2006-12-01

    Full Text Available Este trabalho apresenta o impacto no custo de capital próprio para as empresas brasileiras de capital aberto face à adoção dos princípios de sustentabilidade. O conceito de desenvolvimento sustentável tem se aprimorado num processo contínuo de reavaliação da relação existente entre: crescimento econômico, a sociedade civil e o meio ambiente. O triple-bottom-line das dimensões econômica, ambiental e social da sustentabilidade tem emergido como um modelo de interpretação pelas empresas, embora cada uma dessas dimensões represente um grande desafio. O segmento corporativo vem atendendo às demandas cada vez maiores da sociedade frente a essas questões, ficando a dúvida quanto à legitimidade dessas ações e o questionamento relativo ao papel das empresas na economia e na sociedade. Para avaliar o impacto no custo de capital próprio, foi implementado um modelo de decomposição do beta em medidas contábeis de risco, incluindo uma variável referente à sustentabilidade. O resultado confirma a expectativa de que ao aderir aos padrões de sustentabilidade a empresa reduz o risco corporativo medido pelo risco sistemático, determinando a redução do custo de capital e aumento do valor econômico.This article provides an analysis of equity costs in Brazilian public companies regarding the adoption of sustainability principles. The concept of sustainable development has evolved considering the relation among economic growth, the society and the environment. The triple-bottom-line of economic, environmental, and social dimensions has emerged as an interpretation model by companies, although each of these dimensions may present a challenge. The corporate sector has faced an increasing demand from society regarding these sustainability concepts, though the actions and the role to be played by companies within this context are still being questioned. Equity costs were analyzed by a multivariate regression of beta on accounting measures

  9. Non-technical factors impacting on the decision making processes in environmental remediation. Influences on the decision making process such as cost, planned land use and public perception

    International Nuclear Information System (INIS)

    2002-04-01

    The IAEA attaches great importance to the dissemination of information that can assist Member States with the development, implementation, maintenance and continuous improvement of systems, programmes and activities that support the nuclear fuel cycle and nuclear applications, including the legacy of past practices and accidents. In response to this, the IAEA has initiated a comprehensive programme of work covering all aspects of environmental remediation: factors important for formulating a strategy for environmental remediation; site characterisation techniques and strategies; assessment of remediation technologies; assessment of technical options for cleanup of contaminated media; post-restoration compliance monitoring; assessment of the costs of remediation measures; remediation of low-level disperse radioactive contaminations in the environment. While this project mainly focus on technological aspects, non-technical factors will be influencing the decision making process in remediation decisively. Often their influence is only tacitly accepted and not explicitly acknowledged by the responsible decision makers. This makes it difficult to trace the decision making process in the event that it has to be revisited. The present publication attempts to make these factors explicit and to present methods to include them consciously into the decision making process

  10. The Long-Term Safety, Public Health Impact, and Cost-Effectiveness of Routine Vaccination with a Recombinant, Live-Attenuated Dengue Vaccine (Dengvaxia): A Model Comparison Study.

    Science.gov (United States)

    Flasche, Stefan; Jit, Mark; Rodríguez-Barraquer, Isabel; Coudeville, Laurent; Recker, Mario; Koelle, Katia; Milne, George; Hladish, Thomas J; Perkins, T Alex; Cummings, Derek A T; Dorigatti, Ilaria; Laydon, Daniel J; España, Guido; Kelso, Joel; Longini, Ira; Lourenco, Jose; Pearson, Carl A B; Reiner, Robert C; Mier-Y-Terán-Romero, Luis; Vannice, Kirsten; Ferguson, Neil

    2016-11-01

    Large Phase III trials across Asia and Latin America have recently demonstrated the efficacy of a recombinant, live-attenuated dengue vaccine (Dengvaxia) over the first 25 mo following vaccination. Subsequent data collected in the longer-term follow-up phase, however, have raised concerns about a potential increase in hospitalization risk of subsequent dengue infections, in particular among young, dengue-naïve vaccinees. We here report predictions from eight independent modelling groups on the long-term safety, public health impact, and cost-effectiveness of routine vaccination with Dengvaxia in a range of transmission settings, as characterised by seroprevalence levels among 9-y-olds (SP9). These predictions were conducted for the World Health Organization to inform their recommendations on optimal use of this vaccine. The models adopted, with small variations, a parsimonious vaccine mode of action that was able to reproduce quantitative features of the observed trial data. The adopted mode of action assumed that vaccination, similarly to natural infection, induces transient, heterologous protection and, further, establishes a long-lasting immunogenic memory, which determines disease severity of subsequent infections. The default vaccination policy considered was routine vaccination of 9-y-old children in a three-dose schedule at 80% coverage. The outcomes examined were the impact of vaccination on infections, symptomatic dengue, hospitalised dengue, deaths, and cost-effectiveness over a 30-y postvaccination period. Case definitions were chosen in accordance with the Phase III trials. All models predicted that in settings with moderate to high dengue endemicity (SP9 ≥ 50%), the default vaccination policy would reduce the burden of dengue disease for the population by 6%-25% (all simulations: -3%-34%) and in high-transmission settings (SP9 ≥ 70%) by 13%-25% (all simulations: 10%- 34%). These endemicity levels are representative of the participating sites in

  11. The Long-Term Safety, Public Health Impact, and Cost-Effectiveness of Routine Vaccination with a Recombinant, Live-Attenuated Dengue Vaccine (Dengvaxia: A Model Comparison Study.

    Directory of Open Access Journals (Sweden)

    Stefan Flasche

    2016-11-01

    Full Text Available Large Phase III trials across Asia and Latin America have recently demonstrated the efficacy of a recombinant, live-attenuated dengue vaccine (Dengvaxia over the first 25 mo following vaccination. Subsequent data collected in the longer-term follow-up phase, however, have raised concerns about a potential increase in hospitalization risk of subsequent dengue infections, in particular among young, dengue-naïve vaccinees. We here report predictions from eight independent modelling groups on the long-term safety, public health impact, and cost-effectiveness of routine vaccination with Dengvaxia in a range of transmission settings, as characterised by seroprevalence levels among 9-y-olds (SP9. These predictions were conducted for the World Health Organization to inform their recommendations on optimal use of this vaccine.The models adopted, with small variations, a parsimonious vaccine mode of action that was able to reproduce quantitative features of the observed trial data. The adopted mode of action assumed that vaccination, similarly to natural infection, induces transient, heterologous protection and, further, establishes a long-lasting immunogenic memory, which determines disease severity of subsequent infections. The default vaccination policy considered was routine vaccination of 9-y-old children in a three-dose schedule at 80% coverage. The outcomes examined were the impact of vaccination on infections, symptomatic dengue, hospitalised dengue, deaths, and cost-effectiveness over a 30-y postvaccination period. Case definitions were chosen in accordance with the Phase III trials. All models predicted that in settings with moderate to high dengue endemicity (SP9 ≥ 50%, the default vaccination policy would reduce the burden of dengue disease for the population by 6%-25% (all simulations: -3%-34% and in high-transmission settings (SP9 ≥ 70% by 13%-25% (all simulations: 10%- 34%. These endemicity levels are representative of the

  12. Public telesurveillance service for frail elderly living at home, outcomes and cost evolution: a quasi experimental design with two follow-ups

    Directory of Open Access Journals (Sweden)

    Deaudelin Isabelle

    2006-07-01

    high. Caregivers' psychological burden decreased substantially. On a 3 months period, length of hospital stays dropped from 13 to 4 days, and home care services decreased from 18 to 10 visits/client. Total cost of health and social public services used per client dropped by 17% after the first 3 months and by 39% in the second 3 months. Conclusion The ratio of 0.50 calls per client to the call center for health events is three times higher than that reported in the literature. This difference is probably attributable to the fact that nurses rather than non-health professional personnel were available to answer the clients' questions about their health and medications. Cost evolution showed that registering older adults at a telesurveillance center staffed by nurses, upon a health professional recommendation, costs the health care system less and does not have any negative effects on the well-being of the individuals and their families. Telesurveillance for the elderly is effective and efficient.

  13. Cost-effectiveness analysis of introducing RDTs for malaria diagnosis as compared to microscopy and presumptive diagnosis in central and peripheral public health facilities in Ghana

    DEFF Research Database (Denmark)

    Ansah, Evelyn K; Epokor, Michael; Whitty, Christopher J M

    2013-01-01

    to replacing microscopy by RDT as the cost and proportion of correctly treated patients were similar. Results were sensitive to a decrease in the cost of RDTs, which cost GHS1.72 (US$1.17) per test at the time of the study and to improvements in adherence to negative tests that was just above 50% for both RDTs...

  14. The price of 'free'. Quantifying the costs incurred by rural residents attending publically funded outpatient clinics in rural and base hospitals.

    Science.gov (United States)

    Fearnley, David; Kerse, Ngaire; Nixon, Garry

    2016-09-01

    INTRODUCTION Rural living is associated with increased costs in many areas, including health care. However, there is very little local data to quantify these costs, and their unknown quantity means that costs are not always taken into account in health service planning and delivery. AIM The aim of this study was to calculate the average time and travel costs of attending rural and base hospital outpatient clinics for rural Central Otago residents. METHODS A survey of 51 people attending rural hospital outpatient clinics. Individual costs in terms of travel and time were quantified and an average cost of both rural and base hospital attendance was calculated. RESULTS The average travel and lost time cost of attending a rural outpatient clinic was NZ$182 and 61% of respondents reported this cost had a significant effect on their weekly budget. The average cost incurred by residents associated with a base hospital attendance in Dunedin was NZ$732. DISCUSSION This study data show that costs are substantial and probably higher than most people might expect for both rural and base hospital attendances. It seems likely that these costs are a potential barrier to service access. However, the full implications of the personal costs incurred by rural residents in accessing health services are largely unstudied and therefore remain unknown in New Zealand.

  15. Controlling Health Care Costs

    Science.gov (United States)

    Dessoff, Alan

    2009-01-01

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

  16. [Cost-effectiveness of the clinical treatment of Grave's disease in a public University Hospital: a retrospective analysis and prospective projection for a therapeutic approach].

    Science.gov (United States)

    Lima, Nicolau; Knobel, Meyer; Camargo, Rosalinda Y; Tomimori, Eduardo; Medeiros-Neto, Geraldo

    2005-08-01

    The aim of the present study was to evaluate a new proposal for increasing compliance to the clinical management of patients with Graves' disease (GD) in a large and public University Hospital. The patients were carefully selected (no previous GD treatment, goiter volume less than 6 mL must be living in the metro area of São Paulo), received medication at no cost, were contacted frequently by the social worker and alerted for the date of consultation and only referred to a single endocrinologist during all phases of treatment. We recruited 229 patients with GD that were initially treated with methimazole (MMI--60 mg q.d) in a single daily dose followed by a combination of MMI (20 mg) plus L-T4 (100 microg) daily for 24 months. Only 83 patients (36.2%) completed the protocol and were subdivided in: Group 1 (n= 34) that were in remission for 3 years after discontinuation of the MMI and Group 2 (n= 49) that presented recurrence of GD between 2 and 36 months without MMI. Predictive factors associated with remission were: decrease of the glandular volume, serum TG< 40 ng/mL and normal TRAb values. We concluded that in spite of a careful protocol planned to increase compliance, more than 60% of patients with GD did not complete the therapeutic trial and were referred for radioiodine treatment. The solution for this low therapeutic success for GD should be the possible identification of factors that would indicate patients that are not inclined to follow a long period of clinical therapy.

  17. The Price per Prospective Consumer of Providing Therapist Training and Consultation in Seven Evidence-Based Treatments within a Large Public Behavioral Health System: An Example Cost-Analysis Metric

    Directory of Open Access Journals (Sweden)

    Kelsie H. Okamura

    2018-01-01

    Full Text Available ObjectivePublic-sector behavioral health systems seeking to implement evidence-based treatments (EBTs may face challenges selecting EBTs given their limited resources. This study describes and illustrates one method to calculate cost related to training and consultation to assist system-level decisions about which EBTs to select.MethodsTraining, consultation, and indirect labor costs were calculated for seven commonly implemented EBTs. Using extant literature, we then estimated the diagnoses and populations for which each EBT was indicated. Diagnostic and demographic information from Medicaid claims data were obtained from a large behavioral health payer organization and used to estimate the number of covered people with whom the EBT could be used and to calculate implementation-associated costs per consumer.ResultsFindings suggest substantial cost to therapists and service systems related to EBT training and consultation. Training and consultation costs varied by EBT, from Dialectical Behavior Therapy at $238.07 to Cognitive Behavioral Therapy at $0.18 per potential consumer served. Total cost did not correspond with the number of prospective consumers served by an EBT.ConclusionA cost-metric that accounts for the prospective recipients of a given EBT within a given population may provide insight into how systems should prioritize training efforts. Future policy should consider the financial burden of EBT implementation in relation to the context of the population being served and begin a dialog in creating incentives for EBT use.

  18. A cost analysis of a hospital-based palliative care outreach program: implications for expanding public sector palliative care in South Africa.

    Science.gov (United States)

    Hongoro, Charles; Dinat, Natalya

    2011-06-01

    Increasing access to palliative care services in low- and middle-income countries is often perceived as unaffordable despite the growing need for such services because of the increasing burden of chronic diseases including HIV and AIDS. The aim of the study was to establish the costs and cost drivers for a hospital outreach palliative care service in a low-resource setting, and to elucidate possible consequential quality-of-life improvements and potential cost savings. The study used a cost accounting procedure to cost the hospital outreach services--using a step-down costing method to measure unit (average) costs. The African Palliative Care Association Palliative Outcome Score (APCA POS) was applied at five intervals to a cohort of 72 consecutive and consenting patients, enrolled in a two-month period. The study found that of the 481 and 1902 patients registered for outreach and in-hospital visits, respectively, 4493 outreach hospital visits and 3412 in-hospital visits were done per year. The costs per hospital outreach visit and in-hospital visit were US$71 and US$80, respectively. The cost per outreach visit was 50% less than the average cost of a patient day equivalent for district hospitals of $142. Some of the POS of a subsample (n=72) showed statistically significant improvements. Hospital outreach services have the potential to avert hospital admissions in generally overcrowded services in low-resource settings and may improve the quality of life of patients in their home environments. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  19. Defense Management: Further Analysis Needed to Identify Guam’s Public Infrastructure Requirements and Costs for DOD’s Realignment Plan

    Science.gov (United States)

    2013-12-01

    47U.S. Department of the Interior Office of Inspector General, Tax Collection Activities Government of Guam: Revitalized Tax...A-11: Planning, Budgeting, and Acquisition of Capital Assets, app . 8 (ver. 3.0 (July 2013). 62GAO-09-3SP, pp. i and 182. DOD’s Cost Estimate to...Capital Assets, app . 8 (V 3.0 July 2013). According to our cost estimating guide, a reliable cost estimate is critical to successfully 64GAO-09-3SP

  20. Annual report on the cost and the quality of the wastes disposal utility; Rapport annuel sur le prix et la qualite du service public d'elimination des dechets

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-07-01

    In the framework of the Barnier law in favor of the environment protection, each EPCI (public enterprise of inter communal cooperation) has to present an annual report on the cost and the quality of the domestic waste disposal utility. This guideline aims to help this document redaction. The first and the second parts present respectively the technical and the financial indicators, illustrated by examples and opinions. (A.L.B.)

  1. Sociodemographic variations in the amount, duration and cost of potentially preventable hospitalisation for chronic conditions among Aboriginal and non-Aboriginal Australians: a period prevalence study of linked public hospital data

    OpenAIRE

    Banham, David; Chen, Tenglong; Karnon, Jonathan; Brown, Alex; Lynch, John

    2017-01-01

    Objectives To determine disparities in rates, length of stay (LOS) and hospital costs of potentially preventable hospitalisations (PPH) for selected chronic conditions among Aboriginal and non-Aboriginal South Australians (SA), then examine associations with area-level socioeconomic disadvantage and remoteness. Setting Period prevalence study using linked, administrative public hospital records. Participants Participants included all SA residents in 2005–2006 to 2010–2011. Analysis focused on...

  2. Cost-outcome analysis of joint replacement: evidence from a Spanish public hospital Análisis coste-resultado del remplazo de articulaciones: Evidencia de un hospital público español

    Directory of Open Access Journals (Sweden)

    José Luis Navarro Espigares

    2008-08-01

    Full Text Available Background and objectives: Efficiency-based healthcare decision-making has been widely accepted for some time, with cost per quality-adjusted life year (QALY as the main outcome measure. Nevertheless, for numerous medical procedures, little data are available on the cost per QALY gained. The aim of the present study was to calculate the cost per QALY gained with primary hip and knee replacement and to compare the result with the cost per QALY for other medical procedures, as well as with the maximum threshold cost considered acceptable in Spain. Methods: We performed a prospective cohort pre-test/post-test study of patients undergoing primary hip or knee arthroplasty. Age, sex, and clinical variables were recorded. Functional status and quality of life were measured by means of the WOMAC and EuroQol instruments, respectively, before the intervention and 6 months later. The direct costs of the intervention were calculated, with length of hospital stay and the prosthesis as the main cost drivers. Results: A total of 80 patients, 40 from each intervention, were included in this study. Both functional and perceived health status improved after the intervention. The number of QALYs gained in the knee cohort was 4.64, while that in the hip cohort was 0.86. The total cost of knee replacement was lower (6,865.52 € than that of hip replacement (7,891.21 €. The cost per QALY gained was 1,275.84 € and 7,936.12 € for knee and hip interventions, respectively. The calculations performed included a 6% discount rate for health outcomes, a 3% inflation rate for costs, and a success rate of 95% at 15 years. Conclusions: The costs of both knee and hip replacement were lower than the threshold of 30,000 € per QALY considered acceptable in Spain, and compared favorably with other medical and surgical procedures.Fundamento y objetivos: Está ampliamente aceptada la toma de decisiones sanitarias basada en la eficiencia, con el coste por año de vida ajustado

  3. Public synthesis of the reference costs study of the electric power production; Synthese publique de l'etude des couts de reference de la production electrique

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-07-01

    Every 3 or 5 years, the DGEC published the reference costs study of the electric power production which evaluates, in a theoretical framework, the total cost of an electrical MWh, from different production ways. These studies bring information for the definition of the energy policy and the elaboration of the investments program. because of the great competition of the market, it was decided not to publish the absolute value of the hypothesis and the results but under indexed form. (A.L.B.)

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

    Science.gov (United States)

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

    2014-09-16

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

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

    Science.gov (United States)

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

    2014-01-01

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

  6. Delivering Cost-Efficient Public Services in Health Care, Education and Housing in Chile. OECD Economics Department Working Papers, No. 606

    Science.gov (United States)

    Moccero, D.

    2008-01-01

    The Chilean authorities plan to raise budgetary allocations over the medium term for a variety of social programmes, including education, health care and housing. This incremental spending will need to be carried out in a cost-efficient manner to make sure that it yields commensurate improvements in social outcomes. Chile's health indicators show…

  7. Comparative Study on the Cost of Building Public House Construction Using Red Brick and Interlock Brick Building Material in the City of Banda Aceh

    Science.gov (United States)

    Malahayati, Nurul; Hayati, Yulia; Nursaniah, Cut; Firsa, T.; Fachrurrazi; Munandar, Aris

    2018-05-01

    Red brick and interlocking brick are the building materials that are often used for wall installation work on houses construction. In the development of building materials technology and cost savings, interlocking brick can be alternative to replace red bricks. In Aceh Province, the use of interlocking bricks is less popular compared to other big cities in Indonesia. Interlocking brick is made from a mixture of clay, concrete sand and compacted cement and one of the environmentally friendly materials because it does not burn the process like red brick material. It is named interlocking brick because the installation method is locked together and it serves as a structural and partition wall of residential buildings. The aims of this study are to compare the cost of building a house in Banda Aceh City using red brick and interlock brick building materials. The data were obtained from interviews and questionnaires distributed to respondents who had built houses in Banda Aceh City. The results concluded that the house construction cost using interlock brick offer lower construction cost at comparable quality rather than using red brick.

  8. Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: A modelling study

    NARCIS (Netherlands)

    A. Phillips (Andrew); V. Cambiano (Valentina); F. Nakagawa (Fumiyo); P. Revill (Paul); M.R. Jordan (Michael); T.B. Hallett (Timothy); M.C. Doherty (Meg); A. de Luca (Andrea); Lundgren, J.D. (Jens D.); Mhangara, M. (Mutsa); Apollo, T. (Tsitsi); J.W. Mellors (John W.); B.E. Nichols (Brooke); Parikh, U. (Urvi); D. Pillay (Deenan); T.F. Rinke de Wit (Tobias); K.C. Sigaloff (Kim); Havlir, D. (Diane); D.R. Kuritzkes (Daniel); A. Pozniak (Anton); D.A.M.C. van de Vijver (David); M. Vitoria (Marco); Wainberg, M.A. (Mark A.); E. Raizes (Elliot); S. Bertagnolio (Silvia)

    2017-01-01

    textabstractBackground: 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

  9. 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

  10. Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

    International Nuclear Information System (INIS)

    Ribeiro, Rodrigo Antonini; Duncan, Bruce Bartholow; Ziegelmann, Patricia Klarmann; Stella, Steffan Frosi; Vieira, Jose Luiz da Costa; Restelatto, Luciane Maria Fabian; Polanczyk, Carisi Anne

    2015-01-01

    Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil

  11. Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

    Directory of Open Access Journals (Sweden)

    Rodrigo Antonini Ribeiro

    2015-01-01

    Full Text Available Background: Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. Objective: To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS perspective. Methods: We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg, intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg, high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$. A willingness-to-pay (WTP threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770 was applied. Results: Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Conclusions: Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.

  12. Cost-Effectiveness of High, Moderate and Low-Dose Statins in the Prevention of Vascular Events in the Brazilian Public Health System

    Energy Technology Data Exchange (ETDEWEB)

    Ribeiro, Rodrigo Antonini, E-mail: rodrigo.ribeiro@htanalyze.com [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Duncan, Bruce Bartholow [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Ziegelmann, Patricia Klarmann [Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Departamento de Estatística da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Stella, Steffan Frosi [Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Vieira, Jose Luiz da Costa [Instituto de Cardiologia / Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil); Restelatto, Luciane Maria Fabian [Serviço de Medicina Interna do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS (Brazil); Polanczyk, Carisi Anne [Programa de Pós-Graduação em Epidemiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil); Instituto de Avaliação de Tecnologia em Saúde, Porto Alegre, RS (Brazil); Programa de Pós-Graduação em Cardiologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS (Brazil)

    2015-01-15

    Statins have proven efficacy in the reduction of cardiovascular events, but the financial impact of its widespread use can be substantial. To conduct a cost-effectiveness analysis of three statin dosing schemes in the Brazilian Unified National Health System (SUS) perspective. We developed a Markov model to evaluate the incremental cost-effectiveness ratios (ICERs) of low, intermediate and high intensity dose regimens in secondary and four primary scenarios (5%, 10%, 15% and 20% ten-year risk) of prevention of cardiovascular events. Regimens with expected low-density lipoprotein cholesterol reduction below 30% (e.g. simvastatin 10mg) were considered as low dose; between 30-40%, (atorvastatin 10mg, simvastatin 40mg), intermediate dose; and above 40% (atorvastatin 20-80mg, rosuvastatin 20mg), high-dose statins. Effectiveness data were obtained from a systematic review with 136,000 patients. National data were used to estimate utilities and costs (expressed as International Dollars - Int$). A willingness-to-pay (WTP) threshold equal to the Brazilian gross domestic product per capita (circa Int$11,770) was applied. Low dose was dominated by extension in the primary prevention scenarios. In the five scenarios, the ICER of intermediate dose was below Int$10,000 per QALY. The ICER of the high versus intermediate dose comparison was above Int$27,000 per QALY in all scenarios. In the cost-effectiveness acceptability curves, intermediate dose had a probability above 50% of being cost-effective with ICERs between Int$ 9,000-20,000 per QALY in all scenarios. Considering a reasonable WTP threshold, intermediate dose statin therapy is economically attractive, and should be a priority intervention in prevention of cardiovascular events in Brazil.

  13. Diretrizes e modelo conceitual de custos para o setor público a partir da experiência no governo federal do Brasil Guidelines and conceptual model of costs for the public sector based on the Brazilian federal government's experience

    Directory of Open Access Journals (Sweden)

    Nelson Machado

    2010-08-01

    Full Text Available Este artigo apresenta o Sistema de Informação de Custos do Governo Federal, descrevendo o modelo e suas principais características, desde o conceito até a finalidade e os grupos de usuários, explorando a correspondência entre os conceitos de contabilidade governamental e de custos. O artigo demonstra o relacionamento entre as políticas públicas, recursos, atividades e objetos de custo. Para tanto, remete aos conceitos de sistema de acumulação e método de custeio de custos no setor público, correlacionando-os aos sistemas de informação governamentais. O artigo também apresenta o modelo téorico-conceitual, as diretrizes que sustentaram a sua concepção e a descrição do seu processo de implantação que ainda está em curso. O artigo finalmente olha para o futuro, depois de vencida a etapa de implantação do sistema, e exorta os leitores a se inserirem no debate sobre mensuração de custos. A importância do SIC é enfatizada como elemento de melhoria da qualidade do gasto no setor públicoThis article presents the Cost Information System (CIS of the Brazilian federal government. It describes the taxonomic model and its main features, from its concepts to its purposes and user groups, and explores the correlation between the concepts of governmental accounting and cost accounting. It demonstrates the relationship between public policies, fund management, activities and cost objects. To this end, it uses the concepts of accumulation system, costing method and costs in the public sector, as well as government information systems. The article also presents the theoretic conceptual model and the guidelines of the design, and describes the implementation process, which is still ongoing. It finally looks into the future after the development stage of the CIS, and urges its readers to dive into the debate about measuring costs. The importance of CIS to improve the quality of spending in the public sector is highlighted

  14. Successful and cost neutral strategies to increase organic food used in public kitchens: results from the Danish Organic Action Plan 2020

    DEFF Research Database (Denmark)

    Thorsen, Anne Vibeke; Brorson, B.; Lassen, Anne Dahl

    of practical strategies being effective in increasing the organic food used in the public kitchens.MethodsStudy design included baseline data collection, training sessions for all kitchens employees, goal setting, strategy development and implementation for each kitchen, and end point data collection...... baseline to end point were 29 percentage points (Pemployees were trained in the principles of organic food production. The organic price premium was covered within...... existing budget by optimizing the budget and menu planning, minimizing food waste, increase production of homemade food, focusing on seasonal food, and optimizing meat and fish consumption.ConclusionsThis study demonstrates a large potential for public kitchens to increase the level of organic food...

  15. Disaggregating the Truth: A Re-Analysis of the Costs and Benefits of Michigan's Public Universities. Professional File. Number 125, Summer 2012

    Science.gov (United States)

    Daun-Barnett, Nathan J.

    2012-01-01

    For more than 50 years, human capital theory has been the cornerstone for understanding the value of investing in individuals' productive capacities in terms of both personal social and economic gain and the collective benefits that accrue to society. Vedder and Denhart (2007) challenge the hypothesis that public investment in higher education…

  16. Does the Common Core Further Democracy? A Response to "The Common Core and Democratic Education: Examining Potential Costs and Benefits to Public and Private Autonomy"

    Science.gov (United States)

    Neem, Johann N.

    2018-01-01

    The Common Core does not advance democratic education. Far from it, the opening section of the language standards argues that the goal of public K-12 education is "college and career readiness." Only at the end of their introductory section do the Common Core's authors suggest that K-12 education has any goals beyond the economic:…

  17. Panorama 2017 - What public policies are required to stimulate European electric vehicle sales up to 2030? At what cost, and with what level of social equality?

    International Nuclear Information System (INIS)

    Hache, Emmanuel; Tchung-Ming, Stephane; Cheze, Benoit; Gastineau, Pascal

    2016-06-01

    The growth of electric vehicle sales is extremely reliant on the public policy tools used to promote the adoption of these vehicles. The results are extremely heterogeneous depending on whether we use policies designed to support their purchase (scrapping premiums, subsidies) or taxation policies (fuel tax, carbon tax) aimed at encouraging substitution

  18. Using Disability-Adjusted Life Years and Cost-Effectiveness Analysis to define Priorities for the Public Health Care Sector in Zimbabwe

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz

    by estimates from epidemiological studies from other settings if no Zimbabwean sources were available. Disease and public health experts were consulted about the identification of the best possible sources of information, the quality of these sources and the data adjustments made. Epidemiological information...

  19. What should be given a priority - costly medications for relatively few people or inexpensive ones for many? The Health Parliament public consultation initiative in Israel.

    Science.gov (United States)

    Guttman, Nurit; Shalev, Carmel; Kaplan, Giora; Abulafia, Ahuva; Bin-Nun, Gabi; Goffer, Ronen; Ben-Moshe, Roei; Tal, Orna; Shani, Mordechai; Lev, Boaz

    2008-06-01

    In the past two decades, government and civic organizations have been implementing a wide range of deliberative public consultations on health care-related policy. Drawing on these experiences, a public consultation initiative in Israel called the Health Parliament was established. To implement a public consultation initiative that will engage members of the public in the discussion of four healthcare policy questions associated with equity in health services and on priorities for determining which medications and treatments should be included in the basket of national health services. One hundred thirty-two participants from the general population recruited through a random sample were provided with background materials and met over several months in six regional sites. Dilemma activities were used and consultants were available for questions and clarifications. Participants presented their recommendations in a national assembly to the Minister of Health. Across the regional groups the recommendations were mostly compatible, in particular regarding considering the healthcare system's monetary state, even at the expense of equity, but for each policy question minority views were also expressed. A strong emphasis in the recommendations was pragmatism. Participants felt the experience was worthwhile; though the actual impact of their recommendations on policy making was indirect, they were willing to participate in future consultations. However, despite enthusiasm the initiative was not continued. Issues raised are whether consultation initiatives must have a direct impact on healthcare policy decisions or can be mainly a venue to involve citizens in the deliberation of healthcare policy issues.

  20. For our own security and for the sake of the Afghans. How the Danish public was persuaded to support an unprecedented costly military endeavor in Afghanistan

    DEFF Research Database (Denmark)

    Jakobsen, Peter Viggo; Ringsmose, Jens

    2015-01-01

    conditions for success from these literatures that governments must be able to meet in order to mobilize and sustain public support for military operations and demonstrate empirically that these conditions apply in the Danish case. The secret Danish recipe for maintaining support for the Afghan war thus came...

  1. Vaccines for tick-borne diseases and cost-effectiveness of vaccination : a public health challenge to reduce the diseases’ burden

    NARCIS (Netherlands)

    Smit, Renata; Postma, Maarten J

    Tick-borne encephalitis (TBE) and Lyme borreliosis (LB) are tick-borne diseases (TBDs), and both present an increasing burden worldwide. Vaccination as public health intervention could be the most effective way to reduce this burden. TBE vaccines are available, but vaccines against LB are still in

  2. Cost Analysis of a Transition to Green Vehicle Technology for Light Duty Fleet Vehicles in Public Works Department Naval Support Activity Monterey (PWD Monterey)

    Science.gov (United States)

    2015-12-01

    price of the hybrid vehicle. Many consumers will view the idea of paying more initially to save on gasoline costs down the road as not worthwhile...braking and electricity generation from an ICE. Similar to the HEV, upon purchase of a PHEV, the consumer may take advantage of the green vehicle tax ... electric cards and Hybrids? (2015, November 3). Retrieved from Plug’n Drive website: https://www.plugndrive.ca/whats- the-difference-between- electric - cars

  3. Effectiveness and cost-effectiveness of fining non-attendance at public hospitals: a randomised controlled trial from Danish outpatient clinics.

    Science.gov (United States)

    Blæhr, Emely Ek; Væggemose, Ulla; Søgaard, Rikke

    2018-04-13

    Fines have been proposed as means for reducing non-attendance in healthcare. The empirical evidence of the effect of fines is however limited. The objective of this study is to investigate the effectiveness and cost-effectiveness of fining non-attendance at outpatient clinics. 1:1 randomised controlled trial of appointments for an outpatient clinic, posted to Danish addresses, between 1 May 2015 and 30 November 2015. Only first appointment for users was included. Healthcare professionals and investigators were masked. A fine of DKK250 (€34) was issued for non-attendance. Users were informed about the fine in case of non-attendance by the appointment letter, and were able to reschedule or cancel until the appointment. A central administration office administered the fine system. The main outcome measures were non-attendance of non-cancelled appointments, fine policy administration costs, net of productivity consequences and probability of fining non-attendance being cost-effective over no fining for a range of hypothetical values of reduced non-attendance. All of the 6746 appointments included were analysed. Of the 3333 appointments randomised to the fine policy, 130 (5%) of non-cancelled appointments were unattended, and of the 3413 appointments randomised to no-fine policy, 131 (5%) were unattended. The cost per appointment of non-attendance was estimated at DKK 56 (SE 5) in the fine group and DKK47 (SE 4) in the no-fine group, leading to a non-statistically significant difference of DKK10 (95% CI -9 to 22) per appointment attributable to the fine policy. The probability of cost-effectiveness remained around 50%, irrespective of increased values of reduced non-attendance or various alternative assumptions used for sensitivity analyses. At a baseline level of around 5%, fining non-attendance does not seem to further reduce non-attendance. Future studies should focus on other means for reduction of non-attendance such as nudging or negative reinforcement. ISRCTN

  4. What should be given a priority – costly medications for relatively few people or inexpensive ones for many? The Health Parliament public consultation initiative in Israel

    Science.gov (United States)

    Guttman, Nurit; Shalev, Carmel; Kaplan, Giora; Abulafia, Ahuva; Bin‐Nun, Gabi; Goffer, Ronen; Ben‐Moshe, Roei; Tal, Orna; Shani, Mordechai; Lev, Boaz

    2008-01-01

    Abstract Background  In the past two decades, government and civic organizations have been implementing a wide range of deliberative public consultations on health care‐related policy. Drawing on these experiences, a public consultation initiative in Israel called the Health Parliament was established. Goals  To implement a public consultation initiative that will engage members of the public in the discussion of four healthcare policy questions associated with equity in health services and on priorities for determining which medications and treatments should be included in the basket of national health services. Method  One hundred thirty‐two participants from the general population recruited through a random sample were provided with background materials and met over several months in six regional sites. Dilemma activities were used and consultants were available for questions and clarifications. Participants presented their recommendations in a national assembly to the Minister of Health. Outcomes  Across the regional groups the recommendations were mostly compatible, in particular regarding considering the healthcare system’s monetary state, even at the expense of equity, but for each policy question minority views were also expressed. A strong emphasis in the recommendations was pragmatism. Conclusion  Participants felt the experience was worthwhile; though the actual impact of their recommendations on policy making was indirect, they were willing to participate in future consultations. However, despite enthusiasm the initiative was not continued. Issues raised are whether consultation initiatives must have a direct impact on healthcare policy decisions or can be mainly a venue to involve citizens in the deliberation of healthcare policy issues. PMID:18429997

  5. Resources and Costs Associated with the Treatment of Advanced and Metastatic Gastric Cancer in the Mexican Public Sector: A Patient Chart Review.

    Science.gov (United States)

    Quintana, Miguel; Toriz, José A; Novick, Diego; Jones, Kyla; Botello, Brenda S; Silva, Juan Alejandro

    2017-07-31

    Little evidence is available on the management and cost of treating patients with advanced or metastatic gastric cancer (GC). This study evaluates patient characteristics, treatment patterns, and resource utilization for these patients in Mexico. Data were collected from three centers of investigation (tertiary level). Patients were ≥18 years of age, diagnosed between 1 January 2009 and 1 January 2015, had advanced or metastatic GC, received first-line fluoropyrimidine/platinum, and had ≥3 months follow-up after discontinuing first-line treatment. Data were summarized using descriptive statistics. The study sample totaled 180. Patients' mean age was 57.2 years (±12.4) and 57.0% were male; 151 (83.9%) patients received second-line chemotherapy. A total of 16 and 19 regimens were identified in first- and second-line therapy. Of the sample, 51 (28.3%) received third-line therapy, and <10% received more than three lines of active chemotherapy. Supportive care received in first- and second-line chemotherapy, included pain interventions (12.2 and 7.9%), nutritional support (3.3 and 1.3%), radiotherapy (6.1 and 16.6%), and transfusions (13.3 and 10.6%), respectively. Using Mexican Institute of Social Security (IMSS) tariffs, the average total cost per patient-month in first- and second-line therapy was US$1230 [95% confidence interval (CI) 1034-1425] and US$1192 (95% CI 913-1471), respectively. Administration and acquisition of chemotherapy comprised the majority of costs. This study shows considerable variation in first- and second-line chemotherapy regimens of patients with advanced or metastatic GC. Understanding GC treatment patterns in Mexico will help address unmet needs.

  6. 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.

  7. 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...

  8. 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...

  9. 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. ...

  10. Who deserves health care? The effects of causal attributions and group cues on public attitudes about responsibility for health care costs.

    Science.gov (United States)

    Gollust, Sarah E; Lynch, Julia

    2011-12-01

    This research investigates the impact of cues about ascriptive group characteristics (race, class, gender) and the causes of ill health (health behaviors, inborn biological traits, social systemic factors) on beliefs about who deserves society's help in paying for the costs of medical treatment. Drawing on data from three original vignette experiments embedded in a nationally representative survey of American adults, we find that respondents are reluctant to blame or deny societal support in response to explicit cues about racial attributes--but equally explicit cues about the causal impact of individual behaviors on health have large effects on expressed attitudes. Across all three experiments, a focus on individual behavioral causes of illness is associated with increased support for individual responsibility for health care costs and lower support for government-financed health insurance. Beliefs about social groups and causal attributions are, however, tightly intertwined. We find that when groups suffering ill health are defined in racial, class, or gender terms, Americans differ in their attribution of health disparities to individual behaviors versus biological or systemic factors. Because causal attributions also affect health policy opinions, varying patterns of causal attribution may reinforce group stereotypes and undermine support for universal access to health care.

  11. Publicity and public relations

    Science.gov (United States)

    Fosha, Charles E.

    1990-01-01

    This paper addresses approaches to using publicity and public relations to meet the goals of the NASA Space Grant College. Methods universities and colleges can use to publicize space activities are presented.

  12. Task-sharing or public finance for the expansion of surgical access in rural Ethiopia: an extended cost-effectiveness analysis.

    Science.gov (United States)

    Shrime, Mark G; Verguet, Stéphane; Johansson, Kjell Arne; Desalegn, Dawit; Jamison, Dean T; Kruk, Margaret E

    2016-07-01

    Despite a high burden of surgical disease, access to surgical services in low- and middle-income countries is often limited. In line with the World Health Organization's current focus on universal health coverage and equitable access to care, we examined how policies to expand access to surgery in rural Ethiopia would impact health, impoverishment and equity. An extended cost-effectiveness analysis was performed. Deterministic and stochastic models of surgery in rural Ethiopia were constructed, utilizing pooled estimates of costs and probabilities from national surveys and published literature. Model calibration and validation were performed against published estimates, with sensitivity analyses on model assumptions to check for robustness. Outcomes of interest were the number of deaths averted, the number of cases of poverty averted and the number of cases of catastrophic expenditure averted for each policy, divided across wealth quintiles. Health benefits, financial risk protection and equity appear to be in tension in the expansion of access to surgical care in rural Ethiopia. Health benefits from each of the examined policies accrued primarily to the poor. However, without travel vouchers, many policies also induced impoverishment in the poor while providing financial risk protection to the rich, calling into question the equitable distribution of benefits by these policies. Adding travel vouchers removed the impoverishing effects of a policy but decreased the health benefit that could be bought per dollar spent. These results were robust to sensitivity analyses. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  13. A systematic review of the clinical, public health and cost-effectiveness of rapid diagnostic tests for the detection and identification of bacterial intestinal pathogens in faeces and food.

    Science.gov (United States)

    Abubakar, I; Irvine, L; Aldus, C F; Wyatt, G M; Fordham, R; Schelenz, S; Shepstone, L; Howe, A; Peck, M; Hunter, P R

    2007-09-01

    To determine the diagnostic accuracy of tests for the rapid diagnosis of bacterial food poisoning in clinical and public health practice and to estimate the cost-effectiveness of these assays in a hypothetical population in order to inform policy on the use of these tests. Studies evaluating diagnostic accuracy of rapid tests were retrieved using electronic databases and handsearching reference lists and key journals. Hospital laboratories and test manufacturers were contacted for cost data, and clinicians involved in the care of patients with food poisoning were invited to discuss the conclusions of this review using the nominal group technique. A systematic review of the current medical literature on assays used for the rapid diagnosis of bacterial food poisoning was carried out. Specific organisms under review were Salmonella, Campylobacter, Escherichia coli O157, Staphylococcus aureus, Clostridium perfringens and Bacillus cereus. Data extraction was undertaken using standardised data extraction forms. Where a sufficient number of studies evaluating comparable tests were identified, meta-analysis was performed. A decision analytic model was developed, using effectiveness data from the review and cost data from hospitals and manufacturers, which contributed to an assessment of the cost-effectiveness of rapid tests in a hypothetical UK population. Finally, diagnostic accuracy and cost-effectiveness results were presented to a focus group of GPs, microbiologists and consultants in communicable disease control, to assess professional opinion on the use of rapid tests in the diagnosis of food poisoning. Good test performance levels were observed with rapid test methods, especially for polymerase chain reaction (PCR) assays. The estimated levels of diagnostic accuracy using the area under the curve of the summary receiver operating characteristic curve was very high. Indeed, although traditional culture is the natural reference test to use for comparative statistical

  14. Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes.

    Science.gov (United States)

    Tracy, Sally K; Welsh, Alec; Hall, Bev; Hartz, Donna; Lainchbury, Anne; Bisits, Andrew; White, Jan; Tracy, Mark B

    2014-01-24

    In many countries midwives act as the main providers of care for women throughout pregnancy, labour and birth. In our large public teaching hospital in Australia we restructured the way midwifery care is offered and introduced caseload midwifery for one third of women booked at the hospital. We then compared the costs and birth outcomes associated with caseload midwifery compared to the two existing models of care, standard hospital care and private obstetric care. We undertook a cross sectional study examining the risk profile, birth outcomes and cost of care for women booked into one of the three available models of care in a tertiary teaching hospital in Australia between July 1st 2009 December 31st 2010. To control for differences in population or case mix we described the outcomes for a cohort of low risk first time mothers known as the 'standard primipara'. Amongst the 1,379 women defined as 'standard primipara' there were significant differences in birth outcome. These first time 'low risk' mothers who received caseload care were more likely to have a spontaneous onset of labour and an unassisted vaginal birth 58.5% in MGP compared to 48.2% for Standard hospital care and 30.8% with Private obstetric care (p 1590.91 less than Standard hospital care per woman (p women in the study who received caseload care. Cost reduction appears to be achieved through reorganising the way care is delivered in the public hospital system with the introduction of Midwifery Group Practice or caseload care. The study also highlights the unexplained clinical variation that exists between the three models of care in Australia.

  15. 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.

  16. Aquisição de medicamentos no setor público: o binômio qualidade - custo Pharmaceutical procurement by the public sector: the quality/cost relationship

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Luiza

    1999-10-01

    Full Text Available No presente trabalho, os autores abordam, dentro do âmbito da administração de materiais, a aquisição e o aprovisionamento de medicamentos no setor público de saúde, discutindo as duas principais vertentes da questão: qualidade e custo. São relatados os fatores que devem ser considerados pelo comprador quando se avalia o quesito qualidade de medicamentos, em especial a questão dos genéricos, a bioequivalência e a estabilidade das formulações. Por outro lado, o item custo é examinado, assim como as implicações que uma demanda diferenciada e voltada para as inovações tecnológicas tem sobre ele. Por fim, discutem-se alternativas, já empregadas em algumas instituições, apresentando-se sugestões cuja finalidade implica na possibilidade de compra de produtos de qualidade aliada à contenção de custos.The authors discuss procurement and provision of pharmaceutical products from the perspective of supply management in the public health sector, focusing on two main aspects: quality and cost. The article analyzes issues to be considered by buyers when evaluating drug quality, especially formulation stability, bioequivalence, and the role of generics. Also discussed are factors involving costs and cost management in relation to technological innovations and consumer demands. New alternatives and suggestions are examined and presented for procurement of high-quality, cost-effective drug products.

  17. Sociodemographic variations in the amount, duration and cost of potentially preventable hospitalisation for chronic conditions among Aboriginal and non-Aboriginal Australians: a period prevalence study of linked public hospital data.

    Science.gov (United States)

    Banham, David; Chen, Tenglong; Karnon, Jonathan; Brown, Alex; Lynch, John

    2017-10-15

    To determine disparities in rates, length of stay (LOS) and hospital costs of potentially preventable hospitalisations (PPH) for selected chronic conditions among Aboriginal and non-Aboriginal South Australians (SA), then examine associations with area-level socioeconomic disadvantage and remoteness. Period prevalence study using linked, administrative public hospital records. Participants included all SA residents in 2005-2006 to 2010-2011. Analysis focused on those individuals experiencing chronic PPH as defined by the Australian Institute of Health and Welfare. Number and rates (unadjusted, then adjusted for sex and age) of chronic PPH, total LOS and direct hospital costs by Aboriginality. Aboriginal SAs experienced higher risk of index chronic PPH compared with non-Aboriginals (11.5 and 6.2 per 1000 persons per year, respectively) and at younger ages (median age 48 vs 70 years). Once hospitalised, Aboriginal people experienced more chronic PPH events, longer total LOS with higher costs than non-Aboriginal people (2.6 vs 1.9 PPH per person; 11.7 vs 9.0 days LOS; at $A17 928 vs $A11 515, respectively). Compared with population average LOS, the standardised rate ratio of LOS among Aboriginal people increased by 0.03 (95% CI 0.00 to 0.07) as disadvantage rank increased and 1.04 (95% CI 0.63 to 1.44) as remoteness increased. Non-Aboriginal LOS also increased as disadvantage increased but at a lower rate (0.01 (95% CI 0.01 to 0.01)). Costs of Aboriginal chronic PPH increased by 0.02 (95% CI 0.00 to 0.06) for each increase in disadvantage and 1.18 (95% CI 0.80 to 1.55) for increased remoteness. Non-Aboriginal costs also increased as disadvantage increased but at lower rates (0.01 (95% CI 0.01 to 0.01)). Aboriginal people's heightened risk of chronic PPH resulted in more time in hospital and greater cost. Systematic disparities in chronic PPH by Aboriginality, area disadvantage and remoteness highlight the need for improved uptake of effective primary care. Routine

  18. 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

  19. 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...

  20. Costo-efectividad de prácticas en salud pública: revisión bibliográfica de las intervenciones de la Iniciativa Mesoamericana de Salud Cost-effectiveness of public health practices: A literature review of public health interventions from the Mesoamerican Health Initiative

    Directory of Open Access Journals (Sweden)

    Atanacio Valencia-Mendoza

    2011-01-01

    Full Text Available OBJETIVO: Presentar y analizar información de costo-efectividad de intervenciones propuestas por la Iniciativa Mesoamericana de Salud (IMS en las áreas de nutrición infantil, inmunizaciones, paludismo, dengue y salud materno-infantil y reproductiva. MATERIAL Y MÉTODOS: Se llevó a cabo una revisión sistemática de la literatura de evaluaciones económicas publicadas entre el año 2000 y agosto 2009 sobre intervenciones en las áreas de la salud mencionadas, en los idiomas inglés y español. RESULTADOS: Las intervenciones en nutrición y de salud materno-infantil mostraron ser altamente costo-efectivas (con rangos menores a US$200 por año de vida ajustado por discapacidad [AVAD] evitado para nutrición y US$100 para materno-infantil. En dengue sólo se encontró información sobre la aplicación de larvicidas, cuya razón de costo efectividad estimada fue de US$40.79 a US$345.06 por AVAD evitado. Respecto al paludismo, las intervenciones estudiadas resultaron costo-efectivas (OBJECTIVE: Present and analyze cost-effectiveness information of public health interventions proposed by the Mesoamerican Health Initiative in child nutrition, vaccination, malaria, dengue, and maternal, neonatal, and reproductive health. MATERIAL AND METHODS: A systematic literature review was conducted on cost-effectiveness studies published between January 2000 and August 2009 on interventions related to the health areas previously mentioned. Studies were included if they measured effectiveness in terms of Disability-Adjusted Life Year (DALY or death averted. RESULTS: Child nutrition and maternal and neonatal health interventions were found to be highly cost-effective (most of them below US$200 per DALY averted for nutritional interventions and US$100 for maternal and neonatal health. For dengue, information on cost-effectiveness was found just for application of larvicides, which resulted in a cost per DALY averted ranking from US$40.79 to US$345.06. Malarial

  1. Publications about Asthma

    Science.gov (United States)

    EPA provides the general public, partners, media outlets and health care professionals with a wide variety of asthma resources at no-cost. EPA develops resources to share information about asthma, its triggers, and comprehensive asthma management.

  2. 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...

  3. 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....

  4. O financiamento da educação pública municipal de Teresina: o custo-aluno/ano Financiación de la educación pública municipal de Teresina: el coste alumno/año The public education financing in Teresina: the student per year cost

    Directory of Open Access Journals (Sweden)

    Luís Carlos Sales

    2009-12-01

    of Municipal Public School financing of Teresina city - Piauí", which aimed to define the municipal educational cost , specially those related to the direct operational cost of seventeen institutions. This dissertation intended to answer three questions: a what the student per year cost of public school in the basic education in Teresina city in 2006 is; b what is the category or what are the categories of items which present a higher participation in the composition of direct cost of the municipal schools and what factors intervene in this cost?, and finally, c what is the participation of Fundef in the composition of the student per year cost in the public education of Teresina city in 2006? In order to examine deeply the result of the last question, it was intended to disaggregate the expense per each student undertaken by the municipality of Teresina in 17 municipal public schools,intentionally chosen and giving special attention to some features, in order to identify Fundef's participation in relation to the school expenses in the different stages of the Basic education in each zone covered by it (rural and urban. It was searched in Schultz's (1973, Verhine's (1998, 2003, Castro's (1973, 1976 and Davies's (1999, 2004, 2005 studies and also in the current educational legislation, the necessary epistemology basis to dialogue with the collected data. It was concluded that the student per year cost of the schools remained pretty above of the student per year amount nationally defined for Fundef, which reinforces some criticism stood out in the literature about the lack of accomplishment by the Federal Government established by the 1st from the 6th article from the Law 9.424/96 which deals with the calculus methodology to define the national minimum amount.

  5. Cost Behavior

    DEFF Research Database (Denmark)

    Hoffmann, Kira

    The objective of this dissertation is to investigate determinants and consequences of asymmetric cost behavior. Asymmetric cost behavior arises if the change in costs is different for increases in activity compared to equivalent decreases in activity. In this case, costs are termed “sticky......” if the change is less when activity falls than when activity rises, whereas costs are termed “anti-sticky” if the change is more when activity falls than when activity rises. Understanding such cost behavior is especially relevant for decision-makers and financial analysts that rely on accurate cost information...... to facilitate resource planning and earnings forecasting. As such, this dissertation relates to the topic of firm profitability and the interpretation of cost variability. The dissertation consists of three parts that are written in the form of separate academic papers. The following section briefly summarizes...

  6. Informações de custos e qualidade do gasto público: lições da experiência internacional Government cost information and the quality of public expenditure: lessons from the international experience

    Directory of Open Access Journals (Sweden)

    Fernando Rezende

    2010-08-01

    Full Text Available O conhecimento dos custos do governo é de suma importância para a adoção de mudanças nos procedimentos que regem as decisões sobre o uso dos recursos públicos, bem como sobre os métodos aplicados à gestão das políticas e dos programas governamentais, de modo a aumentar o valor dos recursos aplicados pelo governo e ampliar o benefício social da tributação. Sob a ótica dos especialistas em orçamento, a questão está em escolher a melhor maneira de usar as informações geradas pela contabilidade de competência para aumentar a eficiência e melhorar a qualidade do gasto. Uns defendem que tais informações devem ser vistas como mais uma ferramenta importante para a melhoria das decisões sobre o uso dos recursos públicos. Outros, que elas poderiam revolucionar o processo orçamentário levando à posterior adoção do orçamento de competência. Este artigo explora essa questão, com base na análise de experiências internacionais, apontando para aspectos relevantes que devem ser observados na sequência dos debates sobre esse tema no BrasilAllocation and management of public funds can be significantly improved when good information on costs of producing and delivering public goods and services is regularly available, so that tax payers' money can bring better social benefits. Pundits diverge on which is the best way to use the information on government costs extracted from the adoption of accrual accounting in the public sector. Some argue in favor of using such information as an important tool for improving decision making during the regular budgetary process. Others support the idea of revolutionizing the whole budget by adopting the so-called accrual budgeting. This article explores this question on the basis of evidences provided by international experiences and points to important elements that should be taken into account in the ongoing debate in Brazil

  7. 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....

  8. 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...

  9. 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

  10. Teacher Costs

    OpenAIRE

    DINIS MOTA DA COSTA PATRICIA; DE SOUSA LOBO BORGES DE ARAUJO LUISA

    2015-01-01

    The purpose of this technical brief is to assess current methodologies for the collection and calculation of teacher costs in European Union (EU) Member States in view of improving data series and indicators related to teacher salaries and teacher costs. To this end, CRELL compares the Eurydice collection on teacher salaries with the similar Organisation for Economic Co-operation and Development (OECD) data collection and calculates teacher costs based on the methodology established by Statis...

  11. 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...

  12. 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...

  13. Rehabilitation costs

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Arthur S [BDM Corp., VA (United States); [Bikini Atoll Rehabilitation Committee, Berkeley, CA (United States)

    1986-07-01

    The costs of radioactivity contamination control and other matters relating to the resettlement of Bikin atoll were reviewed for Bikini Atoll Rehabilitation Committee by a panel of engineers which met in Berkeley, California on January 22-24, 1986. This Appendix presents the cost estimates.

  14. Rehabilitation costs

    International Nuclear Information System (INIS)

    Kubo, Arthur S.

    1986-01-01

    The costs of radioactivity contamination control and other matters relating to the resettlement of Bikin atoll were reviewed for Bikini Atoll Rehabilitation Committee by a panel of engineers which met in Berkeley, California on January 22-24, 1986. This Appendix presents the cost estimates

  15. Cost considerations

    NARCIS (Netherlands)

    Michiel Ras; Debbie Verbeek-Oudijk; Evelien Eggink

    2013-01-01

    Original title: Lasten onder de loep The Dutch government spends almost 7 billion euros  each year on care for people with intellectual disabilities, and these costs are rising steadily. This report analyses what underlies the increase in costs that occurred between 2007 and 2011. Was

  16. 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

  17. Troubleshooting Costs

    Science.gov (United States)

    Kornacki, Jeffrey L.

    Seventy-six million cases of foodborne disease occur each year in the United States alone. Medical and lost productivity costs of the most common pathogens are estimated to be 5.6-9.4 billion. Product recalls, whether from foodborne illness or spoilage, result in added costs to manufacturers in a variety of ways. These may include expenses associated with lawsuits from real or allegedly stricken individuals and lawsuits from shorted customers. Other costs include those associated with efforts involved in finding the source of the contamination and eliminating it and include time when lines are shut down and therefore non-productive, additional non-routine testing, consultant fees, time and personnel required to overhaul the entire food safety system, lost market share to competitors, and the cost associated with redesign of the factory and redesign or acquisition of more hygienic equipment. The cost associated with an effective quality assurance plan is well worth the effort to prevent the situations described.

  18. Cost comparisons

    CERN Multimedia

    CERN Bulletin

    2010-01-01

    How much does the LHC cost? And how much does this represent in other currencies? Below we present a table showing some comparisons with the cost of other projects. Looking at the figures, you will see that the cost of the LHC can be likened to that of three skyscrapers, or two seasons of Formula 1 racing! One year's budget of a single large F1 team is comparable to the entire materials cost of the ATLAS or CMS experiments.   Please note that all the figures are rounded for ease of reading.    CHF € $   LHC 4.6 billions 3 billions  4 billions   Space Shuttle Endeavour (NASA) 1.9 billion 1.3 billion 1.7 billion   Hubble Space Telescope (cost at launch – NASA/...

  19. 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.)…

  20. Enzo Croatto, Vocabolario ampezzano, Cortina d'Ampezzo, 1986; XXX + 426 pagine.Enzo Croatto, Vocabolario ampezzano, Cortina d'Ampezzo, 1986; XXX + 426 pagine

    Directory of Open Access Journals (Sweden)

    Mitja Skubic

    1997-12-01

    Full Text Available Il  prof. Enzo Croatto si dichiara solo coordinatore di questo vocabolario, ma i  suoi meriti non sono pochi. E' vero che ha raccolto oltre alle inchieste dirette anche fonti già pubblicate, soprattutto il vocabolario di Angelo Majoni, pubblicato nel lontano 1929, che ottenne delle lodi da parte del grande conoscitore del lessico e della vita nelle Dolomiti che fu Carlo Battisti; però ha arricchito il vocabolario aggiungendo le inchieste dirette e anche i materiali dell'AIS e del (mai pubblicato ALI, nonché il materiale che contiene il Vocabolario provvisorio della parlata ampezzana, pubblicato nei fascicoli tra il 1974 e il 1977. Il vocabolario fornisce anche informazioni grammaticali, ad es. sulla formazione del plurale dei nomi o sulle forme verbali le quali, per i così detti verbi irregolari, appaiono per intero

  1. Public Values

    DEFF Research Database (Denmark)

    Beck Jørgensen, Torben; Rutgers, Mark R.

    2015-01-01

    administration is approached in terms of processes guided or restricted by public values and as public value creating: public management and public policy-making are both concerned with establishing, following and realizing public values. To study public values a broad perspective is needed. The article suggest......This article provides the introduction to a symposium on contemporary public values research. It is argued that the contribution to this symposium represent a Public Values Perspective, distinct from other specific lines of research that also use public value as a core concept. Public...... a research agenda for this encompasing kind of public values research. Finally the contributions to the symposium are introduced....

  2. 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.

  3. Fitness cost

    DEFF Research Database (Denmark)

    Nielsen, Karen L.; Pedersen, Thomas M.; Udekwu, Klas I.

    2012-01-01

    phage types, predominantly only penicillin resistant. We investigated whether isolates of this epidemic were associated with a fitness cost, and we employed a mathematical model to ask whether these fitness costs could have led to the observed reduction in frequency. Bacteraemia isolates of S. aureus...... from Denmark have been stored since 1957. We chose 40 S. aureus isolates belonging to phage complex 83A, clonal complex 8 based on spa type, ranging in time of isolation from 1957 to 1980 and with varyous antibiograms, including both methicillin-resistant and -susceptible isolates. The relative fitness...... of each isolate was determined in a growth competition assay with a reference isolate. Significant fitness costs of 215 were determined for the MRSA isolates studied. There was a significant negative correlation between number of antibiotic resistances and relative fitness. Multiple regression analysis...

  4. (Super Variable Costing-Throughput Costing)

    OpenAIRE

    Çakıcı, Cemal

    2006-01-01

    (Super Variable Costing-Throughput Costing) The aim of this study is to explain the super-variable costing method which is a new subject in cost and management accounting and to show it’s working practicly.Shortly, super-variable costing can be defined as a costing method which is use only direct material costs in calculate of product costs and treats all costs except these (direct labor and overhead) as periad costs or operating costs.By using super-variable costing method, product costs ar...

  5. 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

  6. 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...

  7. Evaluation of public transport

    DEFF Research Database (Denmark)

    Flyvbjerg, Bent; Kahr, Kjeld; Petersen, Peter Bo

    1986-01-01

    by a given supply of transport. In contrast with conventional methods, this method operates with real measures, i.e. real location (instead of traffic zones), real time (instead of average travel time), and real costs (instead of proxy-costs). The purpose is to produce relevant and easily understandable......This paper discusses a method to evaluate sceduled, fixed-route public transport. One major evaluation criterion in the method is total travel time, subdivided into walking time, waiting time, time on vehicle, transfer time, and concealed waiting time. The other major criterion is cost incurred...

  8. 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...

  9. Public lighting.

    NARCIS (Netherlands)

    Schreuder, D.A.

    1986-01-01

    The function of public lighting and the relationship between public lighting and accidents are considered briefly as aspects of effective countermeasures. Research needs and recent developments in installation and operational described. Public lighting is an efficient accident countermeasure, but

  10. 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...

  11. 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?

  12. Cost restructuring

    International Nuclear Information System (INIS)

    Schmidt, J.A.

    1991-01-01

    This paper reports on the cost restructuring of the petroleum industry. This current decade is likely to be one of the most challenging for the petroleum industry. Though petroleum remains among the world's biggest businesses, news of consolidations, restructuring, and layoffs permeates the oil patch from the Gulf of Mexico to the Arctic Isles. The recessionary economy has accelerated these changes, particularly in the upstream sector. Today, even the best-managed companies are transforming their cost structures, and companies that fail to do likewise probably won't survive as independent companies. Indeed, significant consolidation took place during the 1980s. More consolidations can be expected in this decade for companies that do not adapt to the economic realities of the mature business

  13. Small public private partnerships

    DEFF Research Database (Denmark)

    Koch, Christian; Jensen, Jesper Ole

    2009-01-01

    Public Private Partnerships (PPP) are frequently mobilized as a purchasing form suitable for large infrastructure projects. And it is commonly assumed that transaction costs linked to the establishment of PPP make them prohibitive in small sizes. In a Danish context this has been safeguarded by t...

  14. Advanced public transportation systems benefits

    Science.gov (United States)

    1996-03-01

    Benefits and cost savings for various Advanced Public Transportation Systems are outlined here. Operational efficiencies are given for Transit Management Systems in different locales, as well as compliant resolution and safety. Electronic Fare Paymen...

  15. The costs of providing antiretroviral therapy services to HIV-infected individuals presenting with advanced HIV disease at public health centres in Dar es Salaam, Tanzania: Findings from a randomised trial evaluating different health care strategies.

    Science.gov (United States)

    Kimaro, Godfather Dickson; Mfinanga, Sayoki; Simms, Victoria; Kivuyo, Sokoine; Bottomley, Christian; Hawkins, Neil; Harrison, Thomas S; Jaffar, Shabbar; Guinness, Lorna

    2017-01-01

    Understanding the costs associated with health care delivery strategies is essential for planning. There are few data on health service resources used by patients and their associated costs within antiretroviral (ART) programmes in Africa. The study was nested within a large trial, which evaluated screening for cryptococcal meningitis and tuberculosis and a short initial period of home-based adherence support for patients initiating ART with advanced HIV disease in Tanzania and Zambia. The economic evaluation was done in Tanzania alone. We estimated costs of providing routine ART services from the health service provider's perspective using a micro-costing approach. Incremental costs for the different novel components of service delivery were also estimated. All costs were converted into US dollars (US$) and based on 2012 prices. Of 870 individuals enrolled in Tanzania, 434 were enrolled in the intervention arm and 436 in the standard care/control arm. Overall, the median (IQR) age and CD4 cell count at enrolment were 38 [31, 44] years and 52 [20, 89] cells/mm3, respectively. The mean per patient costs over the first three months and over a one year period of follow up following ART initiation in the standard care arm were US$ 107 (95%CI 101-112) and US$ 265 (95%CI 254-275) respectively. ART drugs, clinic visits and hospital admission constituted 50%, 19%, and 19% of the total cost per patient year, while diagnostic tests and non-ART drugs (co-trimoxazole) accounted for 10% and 2% of total per patient year costs. The incremental costs of the intervention to the health service over the first three months was US$ 59 (p<0.001; 95%CI 52-67) and over a one year period was US$ 67(p<0.001; 95%CI 50-83). This is equivalent to an increase of 55% (95%CI 51%-59%) in the mean cost of care over the first three months, and 25% (95%CI 20%-30%) increase over one year of follow up.

  16. The real cost of energy

    International Nuclear Information System (INIS)

    Hubbard, H.M.

    1991-01-01

    Gas prices only seem high. When you say fillerup, you pay but a fraction of the actual cost. Not included are the tens of billions (close to $50 for each barrel of oil) the military spends annually to protect oil fields in the Persian Gulf. Then tack on the hidden costs of environmental degradation, health effects, lost employment, government subsidies and more. Sooner or later, the public pays the entire price. Bringing market prices in line with energy's hidden burdens will be one of the great challenges of the coming decades. The author describes these hidden costs and makes estimates of them

  17. 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...

  18. A utilização das informações de custos na gestão da saúde pública: um estudo preliminar em secretarias municipais de saúde do estado de Santa Catarina The use of costs information in public health: a preliminary study in local health departments in the state of Santa Catarina

    Directory of Open Access Journals (Sweden)

    André Graf de Almeida

    2009-06-01

    Full Text Available Este artigo analisa o uso das informações de custos pelos gestores de 20 grandes secretarias municipais da saúde do estado de Santa Catarina. Para isso, foi avaliado o perfil dos gestores entrevistados; foi verificada a existência ou não de sistemas de custos implantados nessas secretarias; foi feita uma avaliação da percepção desses gestores sobre a utilização das informações de custos no processo de tomada de decisão e foram identificadas quais informações de custos são utilizadas atualmente na gestão desses órgãos. Os entrevistados foram os ocupantes de cargos administrativos nas secretarias municipais da saúde pesquisadas. Conseguiu-se avaliar o uso das informações de custos na gestão de 18 secretarias municipais da saúde do estado de Santa Catarina. Os resultados indicam que apenas duas secretarias municipais da saúde possuem esse processo um pouco mais avançado; nas demais, o que se verifica é que existem algumas tentativas de se obter informações mais detalhadas sobre custos. Entretanto, na opinião dos entrevistados, as informações de custos são bastante importantes na gestão das secretarias.This article analyzes the use of costs information in decision-making by managers of the 20 local health departments in the state of Santa Catarina, Brazil. Public managers profiles were assessed so as to verify whether they had the schooling and experience needed to produce ethical information on certain issues. The existence of costs systems in such departments was assessed through the managers' perceptions of the use of costs information in the decision-making process, and which information is actually used. The methodology used was guided interviews, and the subjects were public employees withholding managing positions in local health departments. The goals of the study were reached as 18 local health departments in the state of Santa Catarina were assessed on their use of costs information. Results show that in

  19. Design to Cost and Life Cycle Cost.

    Science.gov (United States)

    1980-07-01

    MANAGEMENT TASK ORIENTATED COST STRUCTURE 5. COSTS OF CONSTRUCTION INIFRA 2. COSTS DURING DEVELOPMENT -6. COSTS OF TRAINING 3. COSTS DURING TESi ...de r~duction des coats, ii faut disponer de ?!vyenr. performants d’eetimation des coats en main-d’oeuvre et en applrvininrinesent. Cam moyenm doivent

  20. Public Schools

    Data.gov (United States)

    Department of Homeland Security — This Public Schools feature dataset is composed of all Public elementary and secondary education in the United States as defined by the Common Core of Data, National...

  1. Endogenous and costly institutional deterrence

    Science.gov (United States)

    David C. Kingsley; Thomas C. Brown

    2014-01-01

    Modern economies rely on central-authority institutions to regulate individual behaviour. Despite the importance of such institutions little is known about their formation within groups. In a public good experiment, groups selected the level of deterrence implemented by the institution, knowing that the administrative costs of the institution rose with the level of...

  2. 17 CFR 230.403 - Requirements as to paper, printing, language and pagination.

    Science.gov (United States)

    2010-04-01

    ....40, or 239.41 of this chapter), that contains text in both French and English if the issuer included the French text to comply with the requirements of the Canadian securities administrator or other Canadian authority and, for an electronic filing, if the filing is an HTML document, as defined in...

  3. Dolci pagine: la pasticceria napoletana nell´opera di Matilde Serao

    Directory of Open Access Journals (Sweden)

    Fabiano Dalla Bona

    2004-12-01

    Full Text Available L´identità di un popolo può essere verificata anche tramite le sue pratiche culinarie e la letteratura serve come un grande documento. Nell´ópera di Matilde Serao, scritrice e giornalista napoletana, Napoli viene descritta in maniera completa e la cucina è un elemento che serve a distinguere la sua popolazione dalle altre colletività italiane, soprattutto per quanto riguarda la pasticceria.

  4. Dolci pagine: la pasticceria napoletana nell´opera di Matilde Serao

    Directory of Open Access Journals (Sweden)

    Fabiano Dalla Bona

    2004-12-01

    Full Text Available A identidade de um povo pode ser verificada também por meio de suas práticas culinárias e a literatura serve como um grande documento. Na obra de Matilde Serao, escritora e jornalista napolitana, a cidade de Nápoles é descrita de maneira completa e a cozinha é um elemento que serve para distinguir sua população das outras coletividades italianas, especialmente no tocante à confeitaria.

  5. Dalle pagine della Fackel agli Ultimi giorni dell’umanità. Karl Kraus e la guerra

    Directory of Open Access Journals (Sweden)

    Riccardo Morello

    2014-06-01

    Full Text Available From Fackel’s pages to The Last Days of Mankind. Karl Kraus and the War. Between 1915 and the end of the war, Karl Kraus, an Austrian intellectual who had made political satire and criticism of journalistic language, engages in a fierce battle against the inhumanity and cruelty of war. On the pages of Fackel, a magazine published by him for over thirty years, from 1899 to 1936, he gathers many texts that then come together in the tragedy of the Last Days of Mankind, a great work, dripping horror, which seeks to represent the unrepresentable.

  6. Dissoluzioni, parodie o mutamenti? Considerazioni sulla storia nelle pagine di Wikipedia

    Directory of Open Access Journals (Sweden)

    Mateus H. F. Pereira

    2017-03-01

    Full Text Available What kind of relationship do the historical sciences have with Wikipedia? How should a reader approach Wikipedia articles dealing with history? What role will the upcoming “free encyclopedia” play in the study and teaching of history? Starting from an analysis on some Wikipedia’s article performed by the “Nicoletta Bourbaki” working group, six authors animate a panel discussion on the relationship between the free encyclopedia and history.

  7. Public acceptability

    International Nuclear Information System (INIS)

    Bolter, H.E.

    1989-01-01

    An urgent need to rebuild public confidence after an incident attracting widespread adverse publicity led to the development by British Nuclear Fuels plc of a completely new approach to public relations. The Company's experience suggests that impressions count more than sheer information, provided the impressions have a firm base in reality. (author)

  8. 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

  9. Power plant removal costs

    International Nuclear Information System (INIS)

    Ferguson, J.S.

    1998-01-01

    The financial, regulatory and political significance of the estimated high removal costs of nuclear power plants has generated considerable interest in recent years, and the political significance has resulted in the Nuclear Regulatory Commission (NRC) eliminating the use of conventional depreciation accounting for the decontamination portion of the removal (decommissioning). While nuclear plant licensees are not precluded from utilizing conventional depreciation accounting for the demolition of non-radioactive structures and site restoration, state and federal utility regulators have not been favorably inclined to requests for this distinction. The realization that steam-generating units will be more expensive to remove, relative to their original cost, predates the realization that nuclear units will be expensive. However, the nuclear issues have overshadowed this realization, but are unlikely to continue to do so. Numerous utilities have prepared cost estimates for steam generating units, and this presentation discusses the implications of a number of such estimates that are a matter of public record. The estimates cover nearly 400 gas, oil, coal and lignite generating units. The earliest estimate was made in 1978, and for analysis purposes the author has segregated them between gas and oil units, and coal and lignite units

  10. Creative ways to manage paratransit costs.

    Science.gov (United States)

    2008-07-01

    As communities continue to move toward providing a wide range of public transportation : services often referred to as the family of services one common concern is the rising : costs of providing services, specifically those falling und...

  11. Life cycle costs for Alaska bridges.

    Science.gov (United States)

    2014-08-01

    A study was implemented to assist the Alaska Department of Transportation and Public Facilities (ADOT&PF) with life cycle costs for : the Alaska Highway Bridge Inventory. The study consisted of two parts. Part 1 involved working with regional offices...

  12. Cost Effectiveness of Premium Versus Regular Gasoline in MCPS Buses.

    Science.gov (United States)

    Baacke, Clifford M.; Frankel, Steven M.

    The primary question posed in this study is whether premium or regular gasoline is more cost effective for the Montgomery County Public School (MCPS) bus fleet, as a whole, when miles-per-gallon, cost-per-gallon, and repair costs associated with mileage are considered. On average, both miles-per-gallon, and repair costs-per-mile favor premium…

  13. 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...

  14. 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

  15. 77 FR 17121 - Quarterly Rail Cost Adjustment Factor

    Science.gov (United States)

    2012-03-23

    ... decision may be purchased by contacting the Office of Public Assistance, Governmental Affairs, and...)] Quarterly Rail Cost Adjustment Factor AGENCY: Surface Transportation Board, Department of Transportation. ACTION: Approval of rail cost adjustment factor. [[Page 17122

  16. 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.

  17. 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

  18. 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....

  19. 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)

  20. Social costs of energy consumption

    International Nuclear Information System (INIS)

    Hohmeyer, O.

    1988-01-01

    This study systematically compares the external costs and benefits of different electricity generating technologies. It covers environmental and employment effects, the depletion of natural resources, and public subsidies. Electricity production based on fossil fuels and nuclear energy compared with electricity production based on wind energy and photovoltaic systems. The study shows that wind and photovoltaic solar energy induce far less social costs than conventionally generated electricity. The impact of excluding social costs on the competitive position of the different energy technologies is analyzed. It is shown that the allocation process is seriously distorted resulting in sub-optimal investment decisions concerning competing energy technologies. This exclusion of social costs can delay the introduction of renewable energy sources by more than ten years and results in considerable losses to society. (orig./HSCH) With 17 figs., 24 tabs

  1. Labour cost of radiation dose

    International Nuclear Information System (INIS)

    Cook, A.; Lockett, L.E.

    1978-01-01

    In order to optimise capital expenditure on measures to protect workers against radiation it would be useful to have a means to measure radiation dose in money terms. Because labour has to be employed to perform radiation work there must be some relationship between the wages paid and the doses received. Where the next increment of radiation dose requires additional labour to be recruited the cost will at least equal the cost of the extra labour employed. This paper examines some of the factors which affect the variability of the labour cost of radiation dose and notes that for 'in-plant' exposures the current cost per rem appears to be significantly higher than values quoted in ICRP Publication 22. An example is given showing how this concept may be used to determine the capital it is worth spending on installed plant to prevent regular increments of radiation dose to workers. (author)

  2. [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.

  3. 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...

  4. Guilt and voting in public good games

    NARCIS (Netherlands)

    Rothenhäusler, Dominik; Schweizer, Nikolaus; Szech, Nora

    This paper analyzes how moral costs affect individual support of morally difficult group decisions. We study a threshold public good game with moral costs. Motivated by recent empirical findings, we assume that these costs are heterogeneous and consist of three parts. The first one is a standard

  5. Academic Publications

    OpenAIRE

    Francisco H C Felix

    2017-01-01

    Alternative modes of academic publication. What it is: Page for the dissemination of academic papers in alternative formats. Aimed at the diffusion of the idea of open publication, or open access publication, a branch of open science, a multidisciplinary movement that seeks to modify the paradigm of knowledge production that centralizes it and prevents its spreading. Historically, Western tradition has become firmly rooted in the free dissemination of knowledge among peers. However, the c...

  6. Public transport

    OpenAIRE

    Lethbridge, Jane

    2008-01-01

    Public transport plays an essential role in enabling people from low income and other disadvantaged groups to access employment and services. It also contributes to the development of social networks and social capital, by helping people to visit friends and relatives and take part in community and other social activities. Public policy makers have begun to recognise that adequate public transport provision can play an important role in reducing social exclusion. [Taken from introductory para...

  7. New plant construction cost and schedule

    International Nuclear Information System (INIS)

    Akins, M. J.

    2009-01-01

    The presentation covers the following topics: cost structure; capital costs; variation of capital costs; trends in power plant construction; studies of costs completion; periods and risks. Nuclear plant costs have recently risen so rapidly that vendors are not willing to publicly commit to cost estimates: ∼ $2000/Kw overnight costs in 2006 in the US market > $4000/Kw and in 2008 in the US market > $6000/Kw in 2008 in emerging markets. There is vendors pricing uncertainty. Current contract models may not apply. Current construction projects have problems: Olkiluoto-3 is reported to be 50% over budget and two years behind schedule, increasing perceptions that nuclear costs will continue to increase rapidly; Price of materials is a big volatile unknown, which may decrease Labor could become more available due to limited number of new projects; Lack of debt/credit to finance new project may decrease demand of new construction

  8. 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)

  9. Costs Associated with Endangered Species Act Compliance

    Science.gov (United States)

    2013-08-01

    August 2013 2 on economic costs or values related to endangered species costs or values, focuses primarily on Contingent Valuation Method studies...of species preservation (Lew, Layton, and Rowe 2010; Wallmo 2006). Most studies consider public valuation of species preservation, and not costs of...2012, NMFS 2006, U.S. Army Engineer, Mississippi Valley Division 2012, Kozlowski 1993, PFMC 2002) and through development of expenditure categories

  10. QUANTIFYING BENEFITS FOR COST-BENEFIT ANALYSIS

    OpenAIRE

    Attila GYORGY; Nicoleta VINTILA; Florian GAMAN

    2014-01-01

    Cost Benefit Analysis is one of the most widely used financial tools to select future investment projects in public and private sector. This method is based on comparing costs and benefits in terms of constant prices. While costs are easier to predict and monetize, the benefits should be identified not only in direct relation with the investment, but also widening the sphere of analysis to indirect benefits experienced by the community from the neighbourhood or the whole society. During finan...

  11. Road crash costs.

    NARCIS (Netherlands)

    2010-01-01

    Road crashes result in all kinds of social costs, such as medical costs, production loss, human losses, property damage, settlement costs and costs due to congestion. Studies into road crash costs and their trends are carried out quite regularly. In 2009, the costs amounted to € 12.5 billion, or

  12. Public Transparency

    OpenAIRE

    UNCTAD; World Bank

    2018-01-01

    This note provides guidance on the type of information about agricultural investments that investors and governments can make publicly available. Transparency about certain aspects of investments can improve relations between investors and communities, enable external stakeholders to hold investors to commitments, and improve investors’ public image. Although some information should be kep...

  13. Public relations

    International Nuclear Information System (INIS)

    1998-01-01

    Public relations activities continued in a well-proved form of organizing plant visits and Information Centre off - site activities. Bohunice NPPs were visited by the number of 7294 visitors in 1997. A brief account of activities in public relations carried out by the Nuclear power plants Jaslovske Bohunice in 1997 is presented

  14. An Assessment of Cost Improvements in the NASA COTS - CRS Program and Implications for Future NASA Missions

    Science.gov (United States)

    Zapata, Edgar

    2017-01-01

    This review brings rigorous life cycle cost (LCC) analysis into discussions about COTS program costs. We gather publicly available cost data, review the data for credibility, check for consistency among sources, and rigorously define and analyze specific cost metrics.

  15. COST MEASUREMENT AND COST MANAGEMENT IN TARGET COSTING

    Directory of Open Access Journals (Sweden)

    Moisello Anna Maria

    2012-07-01

    Full Text Available Firms are coping with a competitive scenario characterized by quick changes produced by internationalization, concentration, restructuring, technological innovation processes and financial market crisis. On the one hand market enlargement have increased the number and the segmentation of customers and have raised the number of competitors, on the other hand technological innovation has reduced product life cycle. So firms have to adjust their management models to this scenario, pursuing customer satisfaction and respecting cost constraints. In a context where price is a variable fixed by the market, firms have to switch from the cost measurement logic to the cost management one, adopting target costing methodology. The target costing process is a price driven, customer oriented profit planning and cost management system. It works, in a cross functional way, from the design stage throughout all the product life cycle and it involves the entire value chain. The process implementation needs a costing methodology consistent with the cost management logic. The aim of the paper is to focus on Activity Based Costing (ABC application to target costing process. So: -it analyzes target costing logic and phases, basing on a literary review, in order to highlight the costing needs related to this process; -it shows, through a numerical example, how to structure a flexible ABC model – characterized by the separation between variable, fixed in the short and fixed costs - that effectively supports target costing process in the cost measurement phase (drifting cost determination and in the target cost alignment; -it points out the effectiveness of the Activity Based Costing as a model of cost measurement applicable to the supplier choice and as a support for supply cost management which have an important role in target costing process. The activity based information allows a firm to optimize the supplier choice by following the method of minimizing the

  16. Costing in Radiotherapy. Chapter 18

    International Nuclear Information System (INIS)

    Zubizarreta, E.; Lievens, Y.; Levin, V.C.; Van Der Merwe, D.

    2017-01-01

    The available literature on the cost of radiotherapy yields a large variation in data related to the specifics of the methodology used (the viewpoint of the analysis, time frame, health care system, etc.) and to the cost components and radiotherapy activities included. To overcome this difficulty, the reimbursement paid by medical insurance is commonly used as a proxy for the actual radiotherapy costs. Costs, however, generally bear little or no resemblance to charges, as the latter also include allowances for non-capacity use and profit margins. Accurate resource cost data are therefore more valid and should ideally be used in the context of economic evaluations and public health provisions. In addition to the theoretical problems related to obtaining accurate costs, it is difficult to interpret cost data across country borders because of differences in economics. If this is already the case for high income countries, using these cost data for low and middle income countries (LMICs) is even more problematic. Thus, there clearly is a need for calculations performed from the viewpoint of LMICs to prevent misapprehensions based on conclusions derived from data from their high income counterparts. The IAEA endeavours to assist Member States in accumulating appropriate and sufficient cost data for the initiation or expansion of radiation oncology services. Although relatively simple and easy to understand, the IAEA has found that in many countries where it has been involved in the establishment of new radiotherapy departments, the basic principles of cost calculation for radiotherapy facilities were not followed by the local planners. Radiotherapy needs careful planning, organization and a strong quality assurance (QA) programme in order to deliver safe treatments, due to the complexity of the planning and treatment process and the possibility of systematic errors. Administrators should be aware that the cost of building a radiotherapy facility and buying machines

  17. Leveraging community health worker system to map a mountainous rural district in low resource setting: a low-cost approach to expand use of geographic information systems for public health.

    Science.gov (United States)

    Munyaneza, Fabien; Hirschhorn, Lisa R; Amoroso, Cheryl L; Nyirazinyoye, Laetitia; Birru, Ermyas; Mugunga, Jean Claude; Murekatete, Rachel M; Ntaganira, Joseph

    2014-12-06

    Geographic Information Systems (GIS) have become an important tool in monitoring and improving health services, particularly at local levels. However, GIS data are often unavailable in rural settings and village-level mapping is resource-intensive. This study describes the use of community health workers' (CHW) supervisors to map villages in a mountainous rural district of Northern Rwanda and subsequent use of these data to map village-level variability in safe water availability. We developed a low literacy and skills-focused training in the local language (Kinyarwanda) to train 86 CHW Supervisors and 25 nurses in charge of community health at the health center (HC) and health post (HP) levels to collect the geographic coordinates of the villages using Global Positioning Systems (GPS). Data were validated through meetings with key stakeholders at the sub-district and district levels and joined using ArcMap 10 Geo-processing tools. Costs were calculated using program budgets and activities' records, and compared with the estimated costs of mapping using a separate, trained GIS team. To demonstrate the usefulness of this work, we mapped drinking water sources (DWS) from data collected by CHW supervisors from the chief of the village. DWSs were categorized as safe versus unsafe using World Health Organization definitions. Following training, each CHW Supervisor spent five days collecting data on the villages in their coverage area. Over 12 months, the CHW supervisors mapped the district's 573 villages using 12 shared GPS devices. Sector maps were produced and distributed to local officials. The cost of mapping using CHW supervisors was $29,692, about two times less than the estimated cost of mapping using a trained and dedicated GIS team ($60,112). The availability of local mapping was able to rapidly identify village-level disparities in DWS, with lower access in populations living near to lakes and wetlands (p villages even in mountainous rural areas. These data

  18. The unit cost factors and calculation methods for decommissioning - Cost estimation of nuclear research facilities

    International Nuclear Information System (INIS)

    Kwan-Seong Jeong; Dong-Gyu Lee; Chong-Hun Jung; Kune-Woo Lee

    2007-01-01

    Available in abstract form only. Full text of publication follows: The uncertainties of decommissioning costs increase high due to several conditions. Decommissioning cost estimation depends on the complexity of nuclear installations, its site-specific physical and radiological inventories. Therefore, the decommissioning costs of nuclear research facilities must be estimated in accordance with the detailed sub-tasks and resources by the tasks of decommissioning activities. By selecting the classified activities and resources, costs are calculated by the items and then the total costs of all decommissioning activities are reshuffled to match with its usage and objectives. And the decommissioning cost of nuclear research facilities is calculated by applying a unit cost factor method on which classification of decommissioning works fitted with the features and specifications of decommissioning objects and establishment of composition factors are based. Decommissioning costs of nuclear research facilities are composed of labor cost, equipment and materials cost. Of these three categorical costs, the calculation of labor costs are very important because decommissioning activities mainly depend on labor force. Labor costs in decommissioning activities are calculated on the basis of working time consumed in decommissioning objects and works. The working times are figured out of unit cost factors and work difficulty factors. Finally, labor costs are figured out by using these factors as parameters of calculation. The accuracy of decommissioning cost estimation results is much higher compared to the real decommissioning works. (authors)

  19. Hydropower Baseline Cost Modeling

    Energy Technology Data Exchange (ETDEWEB)

    O' Connor, Patrick W. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Zhang, Qin Fen [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); DeNeale, Scott T. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Chalise, Dol Raj [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Centurion, Emma E. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-01-01

    Recent resource assessments conducted by the United States Department of Energy have identified significant opportunities for expanding hydropower generation through the addition of power to non-powered dams and on undeveloped stream-reaches. Additional interest exists in the powering of existing water resource infrastructure such as conduits and canals, upgrading and expanding existing hydropower facilities, and the construction new pumped storage hydropower. Understanding the potential future role of these hydropower resources in the nation’s energy system requires an assessment of the environmental and techno-economic issues associated with expanding hydropower generation. To facilitate these assessments, this report seeks to fill the current gaps in publically available hydropower cost-estimating tools that can support the national-scale evaluation of hydropower resources.

  20. Publications, 1978

    International Nuclear Information System (INIS)

    Hilborn, H.S.

    1979-03-01

    This is a compilation of documents that communicate the results of scientific and technical work done at Savannah River. The compilation includes those documents that have been published (research and development reports, journal articles, book chapters, etc.), documents that have been announced in Energy Research Abstracts, and papers that have been presented at technical meetings but have not yet been published or announced. The information was compiled by machine methods to produce bibliographic, subject, and author listings. This report updates the information included in DP-929, Rev. 2, Publications, 1951 through 1971 DP-929-1, Publications, 1972 through 1976, and DP-929-1, Supplement 1, Publications, 1977

  1. 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.

  2. 77 FR 69441 - Federal Acquisition Regulation; Information Collection; Cost Accounting Standards Administration

    Science.gov (United States)

    2012-11-19

    ...; Information Collection; Cost Accounting Standards Administration AGENCY: Department of Defense (DOD), General... collection requirement concerning cost accounting standards administration. Public comments are particularly... Information Collection 9000- 0129, Cost Accounting Standards Administration by any of the following methods...

  3. COSTS CALCULATION OF TARGET COSTING METHOD

    Directory of Open Access Journals (Sweden)

    Sebastian UNGUREANU

    2014-06-01

    Full Text Available Cost information system plays an important role in every organization in the decision making process. An important task of management is ensuring control of the operations, processes, sectors, and not ultimately on costs. Although in achieving the objectives of an organization compete more control systems (production control, quality control, etc., the cost information system is important because monitors results of the other. Detailed analysis of costs, production cost calculation, quantification of losses, estimate the work efficiency provides a solid basis for financial control. Knowledge of the costs is a decisive factor in taking decisions and planning future activities. Managers are concerned about the costs that will appear in the future, their level underpinning the supply and production decisions as well as price policy. An important factor is the efficiency of cost information system in such a way that the information provided by it may be useful for decisions and planning of the work.

  4. Guideline to Estimate Decommissioning Costs

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Taesik; Kim, Younggook; Oh, Jaeyoung [KHNP CRI, Daejeon (Korea, Republic of)

    2016-10-15

    The primary objective of this work is to provide guidelines to estimate the decommissioning cost as well as the stakeholders with plausible information to understand the decommissioning activities in a reasonable manner, which eventually contribute to acquiring the public acceptance for the nuclear power industry. Although several cases of the decommissioning cost estimate have been made for a few commercial nuclear power plants, the different technical, site-specific and economic assumptions used make it difficult to interpret those cost estimates and compare them with that of a relevant plant. Trustworthy cost estimates are crucial to plan a safe and economic decommissioning project. The typical approach is to break down the decommissioning project into a series of discrete and measurable work activities. Although plant specific differences derived from the economic and technical assumptions make a licensee difficult to estimate reliable decommissioning costs, estimating decommissioning costs is the most crucial processes since it encompasses all the spectrum of activities from the planning to the final evaluation on whether a decommissioning project has successfully been preceded from the perspective of safety and economic points. Hence, it is clear that tenacious efforts should be needed to successfully perform the decommissioning project.

  5. Proprietary hospitals in cost containment.

    Science.gov (United States)

    Jones, D A

    1985-08-23

    Any effort to control the rise in health care costs must start with analyzing the causes, which are really quite simple. Most cost control efforts fail because they do not address the causes. The causes are large subsidies in several forms that send a false message that health care is free and should be used abundantly, and expansive reimbursement programs that reward inefficient providers with higher payments. This combination of demand stimulation and cost-plus reimbursement produced the world's most expensive health care delivery system and strident calls for reform. A long overdue change in public policy took effect October 1, 1983, when Medicare payments moved from cost-plus reimbursement to fixed, prospectively determined prices. Because it addressed one of the causes of medical inflation, this change has been effective in slowing the rise in Medicare expenditures. Sponsorship of a hospital is not a determinant of its cost-effectiveness. There are examples of efficient and inefficient hospitals in both the voluntary and the investor-owned or taxpaying hospitals. The determining factor is the will of management to keep costs under control.

  6. State cost sharing of training

    International Nuclear Information System (INIS)

    Montgomery, J.M.; Flater, D.A.; Hughes, D.R. Sr.; Lubenau, J.O.; Merges, P.J.; Mobley, M.H.; Raglin, K.A.

    1989-08-01

    In March 1988, The Office of Governmental and Public Affairs (GPA) completed a report (NUREG-1311) entitled, ''Funding the NRC Training Program for States.'' This report responded to a Commission's request for study of NRC's long-standing practice of paying the travel and per diem of state personnel who attend NRC sponsored training. In May 1988, the Chairman endorsed the report in most respects but asked for further study of a cost sharing of travel and per diem costs. As a result, the Director of GPA's State, Local and Indian Tribe Programs (SLITP) established a Task Force comprised of representatives from the Conference of Radiation Control Program Directors, Inc., the Agreement States and the NRC to look at ways that the states can share the costs of NRC training, particularly travel and per diem. At the request of the Director, GPA, the Task Force also looked at related cost and quantity issues associated with the NRC training program for state personnel. This report includes a discussion of NRC and state perspectives on the issue of sharing travel and per diem costs, a discussion of options, and recommendations for likely cost savings and quality of training improvement. 1 ref., 3 figs., 2 tabs

  7. Public Airports

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This data set is a vector point digital data structure that contains the locations of General Public Use Airports in the State of New Mexico. It only contains those...

  8. Public Sociology

    DEFF Research Database (Denmark)

    by the media? Does the choice of public sociology mean the relinquishment of scientific integrity and critical conviction? These questions will also be addressed in this book - together with a host of others related to the topic of public sociology.   The chapters included in this book are all manuscripts......What is the role of sociology in society? How can - and should - sociology contribute with insights relevant and useful to the outside world? Is sociology attuned to accommodate the demands of the wider public and of surrounding society? Who benefits from the knowledge produced and provided...... by sociology? What are the social implications and cultural effects of the knowledge sociology provides and creates? All of these questions, and many others, concern and centre on sociology's relationship to the surrounding society, in short to the ‘public'. All of these questions - and many others...

  9. Public meetings

    CERN Multimedia

    Staff Association

    2017-01-01

    Do you have questions about the elections to the Staff Council, 2017 MERIT exercise, EVE and School, LD to IC exercise, CHIS, the Pension Fund… Come get informed and ask your questions at our public meetings. These public meetings are also an opportunity to get the more information on current issues. Benefit from this occasion to get the latest news and to discuss with the representatives of the statutory body that is the Staff Association!

  10. Life cycle cost analysis rehabilitation costs.

    Science.gov (United States)

    2015-07-01

    This study evaluates data from CDOTs Cost Data books and Pavement Management Program. Cost : indices were used to normalize project data to year 2014. Data analyzed in the study was obtained from : the CDOTs Cost Data books and the Pavement Man...

  11. Process-based costing.

    Science.gov (United States)

    Lee, Robert H; Bott, Marjorie J; Forbes, Sarah; Redford, Linda; Swagerty, Daniel L; Taunton, Roma Lee

    2003-01-01

    Understanding how quality improvement affects costs is important. Unfortunately, low-cost, reliable ways of measuring direct costs are scarce. This article builds on the principles of process improvement to develop a costing strategy that meets both criteria. Process-based costing has 4 steps: developing a flowchart, estimating resource use, valuing resources, and calculating direct costs. To illustrate the technique, this article uses it to cost the care planning process in 3 long-term care facilities. We conclude that process-based costing is easy to implement; generates reliable, valid data; and allows nursing managers to assess the costs of new or modified processes.

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

    Science.gov (United States)

    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

  13. 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...

  14. The cost of nuclear accidents

    International Nuclear Information System (INIS)

    2015-01-01

    Proposed by a technical section of the SFEN, and based on a meeting with representatives of different organisations (OECD-NEA, IRSN, EDF, and European Nuclear Energy Forum), this publication addresses the economic consequences of a severe accident (level 6 or 7) within an electricity producing nuclear power plant. Such an assessment essentially relies on three pillars: release of radio-elements outside the reactor, the scenario of induced consequences, and the method of economic quantification. After a recall and a comment of safety arrangements, and of the generally admitted probability of such an accident, this document notices that several actors are concerned by nuclear energy and are trying to assess accident costs. The issue of how to assess a cost (or costs) of a nuclear accident is discussed: there are in fact several types of costs and consequences. Thus, some costs can be rather precisely quantified when some others can be difficult to assess or with uncertainty. The relevance of some cost categories appears to be a matter of discussion and one must not forget that consequences can occur on a long term. The need for methodological advances is outlined and three categories of technical objectives are identified for the assessment (efficiency of safety measures to be put forward to mitigate the risk via a better accident management, compensation of victims and nuclear civil responsibility, and comparison of electricity production sectors and assessment of externalisation to guide public choices). It is outlined that the impact of accidents depend on several factors, that the most efficient mean to limit consequences of accidents is of course to limit radioactive emissions

  15. 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...

  16. 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...

  17. 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,…

  18. Photovoltaic energy cost limit

    International Nuclear Information System (INIS)

    Coiante, D.

    1992-01-01

    Referring to a photovoltaic system for grid connected applications, a parametric expression of kWh cost is derived. The limit of kWh cost is carried out extrapolating the values of cost components to their lowest figure. The reliability of the forecast is checked by disaggregating kWh cost in direct and indirect costs and by discussing the possible cost reduction of each component

  19. 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.

  20. Going public

    DEFF Research Database (Denmark)

    Meyer, Gitte; Sandøe, Peter

    2012-01-01

    conduct, contains a tacit maxim of openness which may naturally be extended to cover the public relations of science. Discussing openness as access, accountability, transparency and receptiveness, the argumentation concentrates on the possible prevention of misconduct with respect to, on the one hand......The paper addresses issues of scientific conduct regarding relations between science and the media, relations between scientists and journalists, and attitudes towards the public at large. In the large and increasing body of literature on scientific conduct and misconduct, these issues seem...... deal with ethical public relations issues, guided by a norm or maxim of openness. Drawing on and rethinking the CUDOS codification of the scientific ethos, as it was worked out by Robert K. Merton in 1942, we propose that this, which is echoed in current codifications of norms for good scientific...

  1. Public Sphere

    DEFF Research Database (Denmark)

    Trenz, Hans-Jörg

    2015-01-01

    In modern societies, the public sphere represents the intermediary realm that supports the communication of opinions, the discovery of problems that need to be dealt with collectively, the channeling of these problems through the filter of the media and political institutions, and the realization...... of the collective will of the people in the act of democratic self-government. The concept of the public sphere is used across the fields of media and communication research, cultural studies and the humanities, the history of ideas, legal and constitutional studies as well as democracy studies. Historically......, public spheres have undergone structural transformations that were closely connected to the emergence of different mass media. More recently, they are subject to trends of transnationalization and digitalization in politics and society....

  2. 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...

  3. public spaces

    Directory of Open Access Journals (Sweden)

    Elena Grigoryeva

    2013-01-01

    Full Text Available The topic of this issue is PUBLIC SPACES. It is familiar and clear to every citizen. The streets and courtyards as childhood experiences remain with us forever. And these are the places where we come with our parents at weekends, where we meet friends, where we have dates and where we already come for a walk with our children.The history of public spaces is long and captivating. It was the main city squares where the most important events took place in history. The Agoras of Ancient Greece and the Roman Forums, the squares of Vatican, Paris and London, Moscow and Saint Petersburg… Greve, Trafalgar, Senate, Palace, Red, Bolotnaya – behind every name there is life of capitals, countries and nations.Public spaces, their shapes, image and development greatly influence the perception of the city as a whole. Both visitors and inhabitants can see in public spaces not only the visage but the heart, the soul and the mind of the city.Unfortunately, sometimes we have to prove the value of public spaces and defend them from those who consider them nothing but a blank space, nobody’s land destined for barbarous development.What should happen to make citizens perceive public spaces as their own and to make authorities consider development and maintenance of squares and parks their priority task against the  background of increasing competition between cities and the fight for human capital? Lately they more often say about “a high-quality human capital”. And now, when they say “the city should be liveable” they add “for all groups of citizens, including the creative class”.

  4. Public Performance

    Science.gov (United States)

    Krupp, E. C.

    2013-01-01

    America’s first planetaria all opened in the 1930s, and each was the distinctive product of local circumstances. In Los Angeles, the populist sensibilities of Griffith J. Griffith prompted him to value the transformative power of a personal encounter with a telescope, and he quickly embraced the idea of a public observatory with free access to all. Griffith Observatory and its planetarium emerged from that intent. Authenticity, intelligibility, and theatricality were fundamental principles in Griffith’s thinking, and they were transformed into solid and enduring scientific and astronomical values by those who actually guided the Observatory’s design, construction, and programming. That said, the public profile of Griffith Observatory was most defined by its inspired hilltop location, its distinctive, commanding architecture, and its felicitous proximity to Hollywood. The Observatory is theatric in placement and in appearance, and before the Observatory even opened, it was used as a motion picture set. That continuing vocation turned Griffith Observatory into a Hollywood star. Because entertainment industry objectives and resources were part of the Los Angeles landscape, they influenced Observatory programming throughout the Observatory’s history. Public astronomy in Los Angeles has largely been framed by the Observatory’s fundamental nature. It has exhibits, but it is not a museum. It has a planetarium, but it is essentially an observatory. As a public observatory, it is filled with instruments that transform visitors into observers. This role emphasized the importance of personal experience and established the perception of Griffith Observatory as a place for public gathering and shared contact with the cosmos. The Observatory’s close and continuous link with amateur astronomers made amateurs influential partners in the public enterprise. In full accord with Griffith J. Griffith’s original intent, Griffith Observatory has all been about putting

  5. Custos de Transação e Estrutura de Governança no Setor PúblicoTransaction Costs and Governance Structures in the Public SectorCustos de Transacción y Estructuras de Gobernanza en el Sector Público

    Directory of Open Access Journals (Sweden)

    PERES, Ursula Dias

    2007-05-01

    Full Text Available RESUMOEste artigo se dedica na apresentação de uma abordagem da economia dos custos de transação aplicada ao setor público. Em um primeiro momento, são trabalhados alguns conceitos básicos utilizados pela Nova Economia Institucional; a saber: custos de transação e estruturas de governança. A segunda parte deste artigo está focada na adaptação dessa teoria para o setor público, com especial ênfase na análise de seus atores, custos de transação e de outras particularidades relevantes que afetam a definição de sua estrutura de governança. Como forma de equacionar parte dos custos de transação presente no setor público, especialmente a presença de oportunismo político, a terceira seção descreve duas possibilidades de aperfeiçoamento da gestão pública. Por fim, em suas conclusões, este artigo enfatiza a necessidade de se estabelecer mecanismos externos de incentivo e supervisão para a boa gestão pública e da ampliação dos estudos a respeito da eficiência e eficácia dos instrumentos descritos na terceira seção.ABSTRACTThe present paper presents an approach of the transaction costs theory applied in the public sector. In a first moment, some basic concepts used by the New Institutional Economy are presented, namely, transaction cost and governance structure. The second part of the paper focuses on the adaptation of this theory to the public sector, with special emphasis in the analysis of its actors, their transaction costs and other relevant peculiarities that affect the definition of the governance structure. As a way to equate part of the transaction costs present in the public sector, particularly the presence of political opportunism, the third part describes two possibilities of improving public management. Finally, in the conclusions, the paper emphasizes the need of establishing external incentive mechanisms and supervision towards a good public management, besides enhancing the studies on the efficiency

  6. 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…

  7. Public acceptance

    International Nuclear Information System (INIS)

    Bucaille, A.

    2006-01-01

    Full text of publication follows: A great deal of determination and professionalism are required when communicating to the public on nuclear energy. Challenging the advantages and adopting an educational tone are, of course, essential. But we have to do much more if we truly want to set people thinking and give nuclear energy its rightful position among the possible energy solutions. This is particularly important in Europe where dissension between countries is on the increase, whereas the US and China, shortly to be joined by India, have clearly decided to invest in nuclear energy. (author)

  8. 20 CFR 404.276 - Publication of notice of increase.

    Science.gov (United States)

    2010-04-01

    ... DISABILITY INSURANCE (1950- ) Computing Primary Insurance Amounts Cost-Of-Living Increases § 404.276 Publication of notice of increase. When we determine that an automatic cost-of-living increase is due, we...

  9. Public information plan. Version 2

    International Nuclear Information System (INIS)

    1993-01-01

    The Public Information Plan is intended to be used in conjunction with the U.S. Department of Energy (DOE) Uranium Mill Tailings Remedial Action (UMTRA) Project Public Participation Plan. The Public Participation Pion describes the DOE procedure for involving the public in the decision-making process related to the UMTRA Project during the stages at which public participation is required and solicited. This Public Information Plan describes the department's procedure for communicating with the public about project policies, plans, and activities. Together, these complementary plans describe the DOE public affairs program for the UMTRA Project. This project was authorized by Congress in the Uranium Mill Tailings Radiation Control Act (UMTRCA) of 1978, (Public Law (PL) 95-6041), as amended. The Act provides for a cooperative effort with affected states and Indian tribes for the cleanup of designated abandoned or inactive uranium mill tailings sites, which are located in 10 states, 9 of them west of the Mississippi River. The public has a right to know about proposed government actions and to be heard in the planning of activities that influence their lives. The UMTRA Project is unclassified and the DOE provides accurate information about policy and project activities to interested stakeholders, including the news media, in a timely way. The DOE encourages states and local governments, as well as individuals, to join actively in the decision-making process. This is intended to ensure that the resulting decisions are made with full knowledge of the public's views and that these decisions address the public's concerns to the extent possible within the law. The DOE, through the implementation of the Public Information Plan, keeps the public informed on matters such as health concerns, environmental issues, remedial action construction plans, project costs, and specific site activities

  10. Public health

    NARCIS (Netherlands)

    Berg, van den A.E.

    2007-01-01

    Agnes van den Berg wrote an essay about human health and nature, establishing that subject as an important policy argument in developing (urban) nature in the Netherlands. She studied the public balance of fear and fascination for nature, summarising benefits on human health. In this chapter, she

  11. Publication Design.

    Science.gov (United States)

    Nelson, Roy Paul

    This book is designed to solve the problem of coordinating art and typography with content in publications. Through text and illustrations, this book suggests ways to make pages and spreads in magazines, newspapers, and books attractive and readable. As a book of techniques, it is directed at potential and practicing art directors, designers, and…

  12. 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...

  13. 42 CFR 50.504 - Allowable cost of drugs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Allowable cost of drugs. 50.504 Section 50.504... APPLICABILITY Maximum Allowable Cost for Drugs § 50.504 Allowable cost of drugs. (a) The maximum amount which may be expended from program funds for the acquisition of any drug shall be the lowest of (1) The...

  14. 77 FR 67366 - Federal Acquisition Regulation; Information Collection; Travel Costs

    Science.gov (United States)

    2012-11-09

    ...; Information Collection; Travel Costs AGENCY: Department of Defense (DOD), General Services Administration (GSA... requirement concerning Travel Costs. Public comments are particularly invited on: Whether this collection of...- 0088, Travel Costs by any of the following methods: Regulations.gov : http://www.regulations.gov...

  15. 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...

  16. 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...

  17. 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

  18. 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...

  19. 45 CFR 74.45 - Cost and price analysis.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Cost and price analysis. 74.45 Section 74.45... ORGANIZATIONS, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Procurement Standards § 74.45 Cost and price analysis. Some form of cost or price analysis shall be made and documented in the procurement files in...

  20. 45 CFR 2543.45 - Cost and price analysis.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Cost and price analysis. 2543.45 Section 2543.45... ORGANIZATIONS Post-Award Requirements Property Standards § 2543.45 Cost and price analysis. Some form of cost or price analysis shall be made and documented in the procurement files in connection with every...

  1. 43 CFR 12.945 - Cost and price analysis.

    Science.gov (United States)

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Cost and price analysis. 12.945 Section 12... Requirements § 12.945 Cost and price analysis. Some form of cost or price analysis shall be made and documented in the procurement files in connection with every procurement action. Price analysis may be...

  2. 41 CFR 105-72.505 - Cost and price analysis.

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Cost and price analysis... § 105-72.505 Cost and price analysis. Some form of cost or price analysis shall be made and documented in the procurement files in connection with every procurement action. Price analysis may be...

  3. 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...

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 42 CFR 412.302 - Introduction to capital costs.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Introduction to capital costs. 412.302 Section 412... Inpatient Hospital Capital Costs General Provisions § 412.302 Introduction to capital costs. (a) New capital... revision of the debt instrument. (iii) If short-term financing was used to acquire old capital assets and...

  13. 42 CFR 417.930 - Initial costs of operation.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Initial costs of operation. 417.930 Section 417.930... PREPAYMENT PLANS Administration of Outstanding Loans and Loan Guarantees § 417.930 Initial costs of operation. Under section 1305 of the PHS, loans and loan guarantees were awarded for initial costs of operation of...

  14. 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...

  15. 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...

  16. Spatial and temporal distribution of long term public policy costs under uncertainty, the case of climate change; Distribution spatiale et temporelle des couts de politiques publiques sous incertitudes: theorie et pratique dans le cas de l'effet de serre

    Energy Technology Data Exchange (ETDEWEB)

    Lecocq, F

    2000-07-15

    Because of the inertia of the climate system, policy makers cannot avoid making early decisions regarding climate change in a sea of uncertainties. In this context, the very legitimacy of economic analysis to tackle such questions, and in particular the underlying equity issues (who pays for climate mitigation? when?) faces widespread skepticism. This thesis aims at demonstrating how public economy still remains a powerful tool to try and put some rationale into the debate, by checking the internal consistency of the different discourses, and by providing robust insights, if not definitive answers, into climate decisions. We use a set of compact integrated climate policy optimization models to progressively introduce, articulate, and assess numerically the prominent issues at stake. We obtain three main results. We first demonstrate that the so-called timing debate between short term and long term action cannot be reduced to a mere dispute over discount rate. Given the high uncertainties surrounding climate change indeed, the margins of freedom we pass on to future generations, and in particular the technical and institutional systems we transmit, become more important than the discount rate value. Secondly, we apply the various emission quota allocation rules proposed in the literature for the enlargement of annex B to developing economies. We show that the distributive outcome of these rules depends critically on ex ante assumptions about future economic and emission growth. Therefrom, we conclude that a careful design of the institutions surrounding the tradable permits market is a necessary condition to enhance the systems robustness. Last, on a broader perspective, this thesis illustrates the complementarity between ethics and economics: though the economist does not have per se a superior word about what is fair, his toolbox is powerful enough to show how some intuitively appealing ideas, such as a zero discount rate to take care of both present and future

  17. Nursing Home Cost Studies and Reimbursement Issues

    Science.gov (United States)

    Bishop, Christine E.

    1980-01-01

    This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care. PMID:10309223

  18. Nursing home cost studies and reimbursement issues.

    Science.gov (United States)

    Bishop, C E

    1980-01-01

    This review of nursing home cost function research shows that certain provider and service characteristics are systematically associated with differences in the average cost of care. This information can be used to group providers for reasonable cost related rate-setting or to adjust their rates or rate ceilings. However, relationships between average cost and such service characteristics as patient mix, service intensity, and quality of care have not been fully delineated. Therefore, econometric cost functions cannot yet provide rate-setters with predictions about the cost of the efficient provision of nursing home care appropriate to patient needs. In any case, the design of reimbursement systems must be founded not only on technical information but also on public policy goals for long-term care.

  19. Utah Public Library Trustee Handbook.

    Science.gov (United States)

    Utah State Library, Salt Lake City.

    Designed to answer basic questions and to assist the Utah public library trustee in the performance of his duties, this handbook's brief, informative sections cover efficiency guidelines, policies and procedures, standards, money, personnel services, travel costs, operations, capital outlay, trustee checklist, job description for librarian,…

  20. Costing the Australian National Hand Hygiene Initiative.

    Science.gov (United States)

    Page, K; Barnett, A G; Campbell, M; Brain, D; Martin, E; Fulop, N; Graves, N

    2014-11-01

    The Australian National Hand Hygiene Initiative (NHHI) is a major patient safety programme co-ordinated by Hand Hygiene Australia (HHA) and funded by the Australian Commission for Safety and Quality in Health Care. The annual costs of running this programme need to be understood to know the cost-effectiveness of a decision to sustain it as part of health services. To estimate the annual health services cost of running the NHHI; the set-up costs are excluded. A health services perspective was adopted for the costing and collected data from the 50 largest public hospitals in Australia that implemented the initiative, covering all states and territories. The costs of HHA, the costs to the state-level infection-prevention groups, the costs incurred by each acute hospital, and the costs for additional alcohol-based hand rub are all included. The programme cost AU$5.56 million each year (US$5.76, £3.63 million). Most of the cost is incurred at the hospital level (65%) and arose from the extra time taken for auditing hand hygiene compliance and doing education and training. On average, each infection control practitioner spent 5h per week on the NHHI, and the running cost per annum to their hospital was approximately AU$120,000 in 2012 (US$124,000, £78,000). Good estimates of the total costs of this programme are fundamental to understanding the cost-effectiveness of implementing the NHHI. This paper reports transparent costing methods, and the results include their uncertainty. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.