Intergenerational enrollment and expenditure changes in Medicaid: trends from 1991 to 2005

Directory of Open Access Journals (Sweden)

Patrick Stephen W

2012-09-01

Full Text Available Abstract Background From its inception, Medicaid was aimed at providing insurance coverage for low income children, elderly, and disabled. Since this time, children have become a smaller proportion of the US population and Medicaid has expanded to additional eligibility groups. We sought to evaluate relative growth in spending in the Medicaid program between children and adults from 1991-2005. We hypothesize that this shifting demographic will result in fewer resources being allocated to children in the Medicaid program. Methods We utilized retrospective enrollment and expenditure data for children, adults and the elderly from 1991 to 2005 for both Medicaid and Children’s Health Insurance Program Medicaid expansion programs. Data were obtained from the Centers for Medicare and Medicaid Services using their Medicaid Statistical Information System. Results From 1991 to 2005, the number of enrollees increased by 83% to 58.7 million. This includes increases of 33% for children, 100% for adults and 50% for the elderly. Concurrently, total expenditures nationwide rose 150% to $273 billion. Expenditures for children increased from $23.4 to $65.7 billion, adults from $46.2 to $123.6 billion, and elderly from $39.2 to $71.3 billion. From 1999 to 2005, Medicaid spending on long-term care increased by 31% to $84.3 billion. Expenditures on the disabled grew by 61% to $119 billion. In total, the disabled account for 43% and long-term care 31%, of the total Medicaid budget. Conclusion Our study did not find an absolute decrease in the overall resources being directed toward children. However, increased spending on adults on a per-capita and absolute basis, particularly disabled adults, is responsible for much of the growth in spending over the past 15 years. Medicaid expenditures have grown faster than inflation and overall national health expenditures. A national strategy is needed to ensure adequate coverage for Medicaid recipients while dealing with the

Medicaid Financial Management Data – National Totals

Data.gov (United States)

U.S. Department of Health & Human Services — This dataset reports summary state-by-state total expenditures by program for the Medicaid Program, Medicaid Administration and CHIP programs. These state...

Projecting future drug expenditures--2009.

Science.gov (United States)

Hoffman, James M; Shah, Nilay D; Vermeulen, Lee C; Doloresco, Fred; Martin, Patrick K; Blake, Sharon; Matusiak, Linda; Hunkler, Robert J; Schumock, Glen T

2009-02-01

Drug expenditure trends in 2007 and 2008, projected drug expenditures for 2009, and factors likely to influence drug expenditures are discussed. Various factors are likely to influence drug expenditures in 2009, including drugs in development, the diffusion of new drugs, drug safety concerns, generic drugs, Medicare Part D, and changes in the drug supply chain. The increasing availability of important generic drugs and drug safety concerns continue to moderate growth in drug expenditures. The drug supply chain remains dynamic and may influence drug expenditures, particularly in specialized therapeutic areas. Initial data suggest that the Medicare Part D benefit has influenced drug expenditures, but the ultimate impact of the benefit on drug expenditures remains unclear. From 2006 to 2007, total U.S. drug expenditures increased by 4.0%, with total spending rising from $276 billion to $287 billion. Drug expenditures in clinics continue to grow more rapidly than in other settings, with a 9.9% increase from 2006 to 2007. Hospital drug expenditures increased at a moderate rate of only 1.6% from 2006 to 2007; through the first nine months of 2008, hospital drug expenditures increased by only 2.8% compared with the same period in 2007. In 2009, we project a 0-2% increase in drug expenditures in outpatient settings, a 1-3% increase in expenditures for clinic-administered drugs, and a 1-3% increase in hospital drug expenditures.

Do health care workforce, population, and service provision significantly contribute to the total health expenditure? An econometric analysis of Serbia.

Science.gov (United States)

Santric-Milicevic, M; Vasic, V; Terzic-Supic, Z

2016-08-15

In times of austerity, the availability of econometric health knowledge assists policy-makers in understanding and balancing health expenditure with health care plans within fiscal constraints. The objective of this study is to explore whether the health workforce supply of the public health care sector, population number, and utilization of inpatient care significantly contribute to total health expenditure. The dependent variable is the total health expenditure (THE) in Serbia from the years 2003 to 2011. The independent variables are the number of health workers employed in the public health care sector, population number, and inpatient care discharges per 100 population. The statistical analyses include the quadratic interpolation method, natural logarithm and differentiation, and multiple linear regression analyses. The level of significance is set at P Total health expenditure increased by 1.21 standard deviations, with an increase in health workforce growth rate by 1 standard deviation. Furthermore, this rate decreased by 1.12 standard deviations, with an increase in (negative) population growth rate by 1 standard deviation. Finally, the growth rate increased by 0.38 standard deviation, with an increase of the growth rate of inpatient care discharges per 100 population by 1 standard deviation (P < 0.001). Study results demonstrate that the government has been making an effort to control strongly health budget growth. Exploring causality relationships between health expenditure and health workforce is important for countries that are trying to consolidate their public health finances and achieve universal health coverage at the same time.

Oil sands tax expenditures

International Nuclear Information System (INIS)

Ketchum, K; Lavigne, R.; Plummer, R.

2001-01-01

The oil sands are a strategic Canadian resource for which federal and provincial governments provide financial incentives to develop and exploit. This report describes the Oil Sands Tax Expenditure Model (OSTEM) developed to estimate the size of the federal income tax expenditure attributed to the oil sands industry. Tax expenditures are tax concessions which are used as alternatives to direct government spending for achieving government policy objectives. The OSTEM was developed within the business Income Tax Division of Canada's Department of Finance. Data inputs for the model were obtained from oil sands developers and Natural Resources Canada. OSTEM calculates annual revenues, royalties and federal taxes at project levels using project-level projections of capital investment, operating expenses and production. OSTEM calculates tax expenditures by comparing taxes paid under different tax regimes. The model also estimates the foregone revenue as a percentage of capital investment. Total tax expenditures associated with investment in the oil sands are projected to total $820 million for the period from 1986 to 2030, representing 4.6 per cent of the total investment. 10 refs., 2 tabs., 7 figs

45 CFR 260.33 - When are expenditures on State or local tax credits allowable expenditures for TANF-related...

Science.gov (United States)

2010-10-01

... State or local tax credits allowable expenditures for TANF-related purposes? (a) To be an allowable expenditure for TANF-related purposes, any tax credit program must be reasonably calculated to accomplish one... credit to be an allowable expenditure. (2) Under a State Earned Income Tax Credit (EITC) program, the...

78 FR 22361 - 60-Day Notice of Proposed Information Collection: PEPFAR Program Expenditures

Science.gov (United States)

2013-04-15

.... Summaries of these data provide key information about program costs under PEPFAR on a global level. Applying...-0208 Type of Request: Revision of a Currently Approved Collection Originating Office: Office of the U.S... Economics Work Group supporting PEPFAR has added reporting of expenditures by program area to the current...

Determinants of malaria program expenditures during elimination: case study evidence from select provinces in the Philippines.

Directory of Open Access Journals (Sweden)

Jenny X Liu

Full Text Available ...Even though eliminating malaria from the endemic margins is a part of the Global Malaria Action Plan, little guidance exists on what resources are needed to transition from controlling malaria to eliminating it. Using Philippines as an example, this study aimed to (1 estimate the financial resources used by sub-national malaria programs in different phases during elimination and (2 understand how different environmental and organizational factors may influence expenditure levels and spending proportions. The Philippines provides an opportunity to study variations in sub-national programs because its epidemiological and ecological diversity, devolved health system, and progressive elimination strategy all allow greater flexibility for lower-level governments to direct activities, but also create challenges for coordination and resource mobilization. Through key informant interviews and archival record retrieval in four selected provinces chosen based on eco-epidemiological variation, expenditures associated with provincial malaria programs were collected for selected years (mid-1990s to 2010. Results show that expenditures per person at risk per year decrease as programs progress from a state of controlled low-endemic malaria to elimination to prevention of reintroduction regardless of whether elimination was deliberately planned. However, wide variation across provinces were found: expenditures were generally higher if mainly financed with donor grants, but were moderated by the level of economic development, the level of malaria transmission and receptivity, and the capacity of program staff. Across all provinces, strong leadership appears to be a necessary condition for maintaining progress and is vital in controlling outbreaks. While sampled provinces and years may not be representative of other sub-national malaria programs, these findings suggest that the marginal yearly cost declines with each phase during elimination.

Determinants of malaria program expenditures during elimination: case study evidence from select provinces in the Philippines.

Science.gov (United States)

Liu, Jenny X; Newby, Gretchen; Brackery, Aprielle; Smith Gueye, Cara; Candari, Christine J; Escubil, Luz R; Vestergaard, Lasse S; Baquilod, Mario

2013-01-01

...Even though eliminating malaria from the endemic margins is a part of the Global Malaria Action Plan, little guidance exists on what resources are needed to transition from controlling malaria to eliminating it. Using Philippines as an example, this study aimed to (1) estimate the financial resources used by sub-national malaria programs in different phases during elimination and (2) understand how different environmental and organizational factors may influence expenditure levels and spending proportions. The Philippines provides an opportunity to study variations in sub-national programs because its epidemiological and ecological diversity, devolved health system, and progressive elimination strategy all allow greater flexibility for lower-level governments to direct activities, but also create challenges for coordination and resource mobilization. Through key informant interviews and archival record retrieval in four selected provinces chosen based on eco-epidemiological variation, expenditures associated with provincial malaria programs were collected for selected years (mid-1990s to 2010). Results show that expenditures per person at risk per year decrease as programs progress from a state of controlled low-endemic malaria to elimination to prevention of reintroduction regardless of whether elimination was deliberately planned. However, wide variation across provinces were found: expenditures were generally higher if mainly financed with donor grants, but were moderated by the level of economic development, the level of malaria transmission and receptivity, and the capacity of program staff. Across all provinces, strong leadership appears to be a necessary condition for maintaining progress and is vital in controlling outbreaks. While sampled provinces and years may not be representative of other sub-national malaria programs, these findings suggest that the marginal yearly cost declines with each phase during elimination.

Trends in health care expenditure among US adults with heart failure: The Medical Expenditure Panel Survey 2002-2011.

Science.gov (United States)

Echouffo-Tcheugui, Justin B; Bishu, Kinfe G; Fonarow, Gregg C; Egede, Leonard E

2017-04-01

Population-based national data on the trends in expenditures related to heart failure (HF) are scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition. Using 10-year data (2002-2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194US adults aged ≥18years) and a 2-part model (adjusting for demographics, comorbidities, and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency department, inpatient hospital, pharmacy, home health care, and other medical expenditures). Compared with expenditures for individuals without HF ($5511 [95% CI 5405-5617]), individuals with HF had a 4-fold higher mean expenditures of ($23,854 [95% CI 21,733-25,975]). Individuals with HF had $3446 (95% CI 2592-4299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95% CI 18,359-24,272) in 2002/2003 to $27,152 (95% CI 20,066-34,237) in 2010/2011, and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/y and the adjusted total incremental expenditure was $5.8 billion/y. Heart failure is costly and over a recent 10-year period, and direct expenditure related to HF increased markedly, mainly driven by inpatient costs. Copyright © 2017 Elsevier Inc. All rights reserved.

Managing the Effects of Tax Expenditures on National Budgets

OpenAIRE

Swift, Zhicheng Li

2006-01-01

Tax expenditures, in the form of tax provisions, are government expenditures. They are conceptually and functionally distinct from those tax provisions whose purpose is to raise revenue. Tax expenditure programs are comparable to entitlement programs. Therefore, tax expenditures must be analyzed in spending terms and integrated into the budgetary process to ensure fiscal accountability. In addition, tax expenditures must be audited for performance and the information must be published (with c...

Skipping meals and alcohol consumption. The regulation of energy intake and expenditure among weight loss participants.

Science.gov (United States)

Carels, Robert A; Young, Kathleen M; Coit, Carissa; Clayton, Anna Marie; Spencer, Alexis; Wagner, Marissa

2008-11-01

Research suggests that specific eating patterns (e.g., eating breakfast) may be related to favorable weight status. This investigation examined the relationship between eating patterns (i.e., skipping meals; consuming alcohol) and weight loss treatment outcomes (weight loss, energy intake, energy expenditure, and duration of exercise). Fifty-four overweight or obese adults (BMI> or =27 kg/m(2)) participated in a self-help or therapist-assisted weight loss program. Daily energy intake from breakfast, lunch, dinner, and alcoholic beverages, total daily energy intake, total daily energy expenditure, physical activity, and weekly weight loss were assessed. On days that breakfast or dinner was skipped, or alcoholic beverages were not consumed, less total daily energy was consumed compared to days that breakfast, dinner, or alcoholic beverages were consumed. On days that breakfast or alcohol was consumed, daily energy expenditure (breakfast only) and duration of exercise were higher compared to days that breakfast or alcohol was not consumed. Individuals who skipped dinner or lunch more often had lower energy expenditure and exercise duration than individuals who skipped dinner or lunch less often. Individuals who consumed alcohol more often had high daily energy expenditure than individuals who consumed alcohol less often. Skipping meals or consuming alcoholic beverages was not associated with weekly weight loss. In this investigation, weight loss program participants may have compensated for excess energy intake from alcoholic beverages and meals with greater daily energy expenditure and longer exercise duration.

Predictors of regional Medicare expenditures for otolaryngology physician services.

Science.gov (United States)

Smith, Alden; Handorf, Elizabeth; Arjmand, Ellis; Lango, Miriam N

2017-06-01

To describe geographic variation in spending and evaluate regional Medicare expenditures for otolaryngologist services with population- and beneficiary-related factors, physician supply, and hospital system factors. Cross-sectional study. The average regional expenditures for otolaryngology physician services were defined as the total work relative value units (wRVUs) collected by otolaryngologists in a hospital referral region (HRR) per thousand Medicare beneficiaries in the HRR. A multivariable linear regression model tested associations with regional sociodemographics (age, sex, race, income, education), the physician and hospital bed supply, and the presence of an otolaryngology residency program. In 2012, the mean Medicare expenditure for otolaryngology provider services across HRRs was 224 wRVUs per thousand Medicare beneficiaries (standard deviation [SD] 104), ranging from 31 to 604 wRVUs per thousand Medicare beneficiaries. In 2013, the average Medicare expenditures for each HRR was highly correlated with expenditures collected in 2012 (Pearson correlation coefficient .997, P = .0001). Regional Medicare expenditures were independently and positively associated with otolaryngology, medical specialist, and hospital bed supply in the region, and were negatively associated with the supply of primary care physicians and presence of an otolaryngology residency program after adjusting for other factors. The magnitude of associations with physician supply and hospital factors was stronger than any population or Medicare beneficiary factor. Wide variations in regional Medicare expenditures for otolaryngology physician services, highly stable over 2 years, were strongly associated with regional health system factors. Changes in health policy for otolaryngology care may require coordination with other physician specialties and integrated hospital systems. NA. Laryngoscope, 127:1312-1317, 2017. © 2016 The American Laryngological, Rhinological and Otological Society

Trends in Health Care Expenditure among U.S. Adults with Heart Failure - The Medical Expenditure Panel Survey 2002–2011

Science.gov (United States)

Echouffo-Tcheugui, Justin B.; Bishu, Kinfe G.; Fonarow, Gregg C; Egede, Leonard E.

2017-01-01

Background Population-based national data on the trends in expenditures related to heart failure (HF) is scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition. Methods Using 10-year data (2002–2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194 U.S adults aged ≥18 years) and a two-part model (adjusting for demographics, comorbidities and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures). Results Compared to expenditures for individuals without HF ($5,511 [95% confidence interval (CI): 5,405–5,617]), individuals with HF had a four-fold higher mean expenditures of ($23,854 [95%CI: 21,733–25,975]). Individuals with HF had $3,446 (95%CI: 2,592–4,299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95%CI: 18,359–24,272) in 2002/2003 to $27,152 (95%CI: 20,066–34,237) in 2010/2011; and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/year and the adjusted total incremental expenditure $5.8 billion/year. Conclusions Heart failure is costly and over a recent 10-year period, direct expenditure related to HF increased markedly, mainly driven by inpatient costs. PMID:28454834

Chronic condition combinations and health care expenditures and out-of-pocket spending burden among adults, Medical Expenditure Panel Survey, 2009 and 2011.

Science.gov (United States)

Meraya, Abdulkarim M; Raval, Amit D; Sambamoorthi, Usha

2015-01-29

Little is known about how combinations of chronic conditions in adults affect total health care expenditures. Our objective was to estimate the annual average total expenditures and out-of-pocket spending burden among US adults by combinations of conditions. We conducted a cross-sectional study using 2009 and 2011 data from the Medical Expenditure Panel Survey. The sample consisted of 9,296 adults aged 21 years or older with at least 2 of the following 4 highly prevalent chronic conditions: arthritis, diabetes mellitus, heart disease, and hypertension. Unadjusted and adjusted regression techniques were used to examine the association between chronic condition combinations and log-transformed total expenditures. Logistic regressions were used to analyze the relationship between chronic condition combinations and high out-of-pocket spending burden. Among adults with chronic conditions, adults with all 4 conditions had the highest average total expenditures ($20,016), whereas adults with diabetes/hypertension had the lowest annual total expenditures ($7,116). In adjusted models, adults with diabetes/hypertension and hypertension/arthritis had lower health care expenditures than adults with diabetes/heart disease (P expenditures compared with those with diabetes and heart disease. However, the difference was only marginally significant (P = .04). Among adults with arthritis, diabetes, heart disease, and hypertension, total health care expenditures differed by type of chronic condition combinations. For individuals with multiple chronic conditions, such as heart disease and diabetes, new models of care management are needed to reduce the cost burden on the payers.

Household Consumption of Food-Away-From-Home: Total Expenditure and by Type of Food Facility

OpenAIRE

Vicki A. McCracken; Jon A. Brandt

1987-01-01

Consistent with prior expectations based on household production theory, household income, time value, size and composition, and the environment in which production and consumption occurred were all important determinants of total household expenditures on food-away-from-home. However, the importance of these factors varied by type of food facility: conventional restaurants, fast-food facilities, and other commercial establishments. Decomposition of the tobit elasticities indicated the differ...

Managing the effects of tax expenditures on the national budget

OpenAIRE

Swift, Zhicheng Li

2006-01-01

Tax expenditures, in the form of tax provisions, are government expenditures. They are conceptually and functionally distinct from those tax provisions whose purpose is to raise revenue. Tax expenditure programs are comparable to entitlement programs. Therefore, tax expenditures must be analyzed in spending terms and integrated into the budgetary process to ensure fiscal accountability. In addition, tax expenditures must be audited for performance and the information must be published (with c...

Intensive care unit drug costs in the context of total hospital drug expenditures with suggestions for targeted cost containment efforts.

Science.gov (United States)

Altawalbeh, Shoroq M; Saul, Melissa I; Seybert, Amy L; Thorpe, Joshua M; Kane-Gill, Sandra L

2018-04-01

To assess costs of intensive care unit (ICU) related pharmacotherapy relative to hospital drug expenditures, and to identify potential targets for cost-effectiveness investigations. We offer the unique advantage of comparing ICU drug costs with previously published data a decade earlier to describe changes over time. Financial transactions for all ICU patients during fiscal years (FY) 2009-2012 were retrieved from the hospital's data repository. ICU drug costs were evaluated for each FY. ICU departments' charges were also retrieved and calculated as percentages of total ICU charges. Albumin, prismasate (dialysate), voriconazole, factor VII and alteplase denoted the highest percentages of ICU drug costs. ICU drug costs contributed to an average of 31% (SD 1.0%) of the hospital's total drug costs. ICU drug costs per patient day increased by 5.8% yearly versus 7.8% yearly for non-ICU drugs. This rate was higher for ICU drugs costs at 12% a decade previous. Pharmacy charges contributed to 17.7% of the total ICU charges. Growth rates of costs per year have declined but still drug expenditures in the ICU are consistently a significant driver in this resource intensive environment with a high impact on hospital drug expenditures. Copyright © 2017 Elsevier Inc. All rights reserved.

77 FR 27266 - 60-Day Notice of Proposed Information Collection: Form DS-4213, PEPFAR Program Expenditures; OMB...

Science.gov (United States)

2012-05-09

... information about program costs under PEPFAR on a global level. Applying expenditure results will improve... the global response to HIV/AIDS. In order to improve program monitoring, the Finance and Economics... partners in countries with PEPFAR programs using a standard tool (DS-4213) via an electronic interface...

Energy expenditure in caving.

Directory of Open Access Journals (Sweden)

Giorgia Antoni

Full Text Available The aim of this study was to determine the energy expenditure of a group of cavers of both genders and different ages and experience during a 10 hour subterranean exploration, using portable metabolimeters. The impact of caving activity on body composition and hydration were also assessed through bioelectrical impedance, and nutritional habits of cavers surveyed. During cave activity, measured total energy expenditure (TEE was in the range 225-287 kcal/h for women-men (MET = 4.1, respectively; subjects had an energy intake from food in the range 1000-1200 kcal, thus inadequate to restore lost calories. Bayesian statistical analysis estimated the effect of predictive variables on TEE, revealing that experienced subjects had a 5% lower TEE than the less skilled ones and that women required a comparatively larger energy expenditure than men to perform the same task. BIVA (bioelectrical impedance vector analysis showed that subjects were within the range of normal hydration before and after cave activity, but bioelectrical changes indicated a reduction of extracellular water in men, which might result in hypo-osmolal dehydration in the case of prolonged underground exercise. All these facts should be considered when planning cave explorations, preparing training programs for subjects practising caving, and optimizing a diet for cavers. Further, information gathered through this study could be of value to reduce accidents in caves related to increase in fatigue.

The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee.

Science.gov (United States)

Anderson, D R; Whitmer, R W; Goetzel, R Z; Ozminkowski, R J; Dunn, R L; Wasserman, J; Serxner, S

2000-01-01

To assess the relationship between modifiable health risks and total health care expenditures for a large employee group. Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period. The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers. Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures. Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures. Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.

24 CFR 982.157 - Budget and expenditure.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Budget and expenditure. 982.157... and PHA Administration of Program § 982.157 Budget and expenditure. (a) Budget submission. Each PHA fiscal year, the PHA must submit its proposed budget for the program to HUD for approval at such time and...

44 CFR 361.8 - Ineligible expenditures.

Science.gov (United States)

2010-10-01

... OF HOMELAND SECURITY PREPAREDNESS NATIONAL EARTHQUAKE HAZARDS REDUCTION ASSISTANCE TO STATE AND LOCAL GOVERNMENTS Earthquake Hazards Reduction Assistance Program § 361.8 Ineligible expenditures. (a) Expenditures... for the purchase or rental of any equipment such as radio/telephone communications equipment, warning...

Analysis of temperature difference on the total of energy expenditure during static bicycle exercise

Science.gov (United States)

Sugiono

2016-04-01

How to manage energy expenditure for cyclist is very crucial part to achieve a good performance. As the tropical situation, the differences of temperature level might be contributed in energy expenditure and durability. The aim of the paper is to estimate and to analysis the configuration of energy expenditure for static cycling activity based on heart rate value in room with air conditioning (AC)/no AC treatment. The research is started with study literatures of climate factors, temperature impact on human body, and definition of energy expenditure. The next step is design the experiment for 5 participants in 2 difference models for 26.80C - 74% relative humidity (room no AC) and 23,80C - 54.8% relative humidity (room with AC). The participants’ heart rate and blood pressure are measured in rest condition and in cycling condition to know the impact of difference temperature in energy expenditure profile. According to the experiment results, the reducing of the temperature has significantly impact on the decreasing of energy expenditure at average 0.3 Kcal/minute for all 5 performers. Finally, the research shows that climate condition (temperature and relative humidity) are very important factors to manage and to reach a higher performance of cycling sport.

The relationship of post-acute home care use to Medicaid utilization and expenditures.

Science.gov (United States)

Payne, Susan M C; DiGiuseppe, David L; Tilahun, Negussie

2002-06-01

lower-cost settings. Controlling for patients' need for services, PAHC utilization was not associated with lower utilization rates or lower total Medicaid expenditures. Medicaid programs are advised to proceed cautiously before expanding PAHC utilization and to monitor its use carefully. Further study, incorporating non-economic outcomes and additional factors influencing PAHC use, is warranted.

Changes in initial expenditures for benign prostatic hyperplasia evaluation in the Medicare population: a comparison to overall Medicare inflation.

Science.gov (United States)

Bellinger, Adam S; Elliott, Sean P; Yang, Liu; Wei, John T; Saigal, Christopher S; Smith, Alexandria; Wilt, Timothy J; Strope, Seth A

2012-05-01

Benign prostatic hyperplasia creates significant expenses for the Medicare program. We determined expenditure trends for benign prostatic hyperplasia evaluative testing after urologist consultation and placed these trends in the context of overall Medicare expenditures. Using a 5% national sample of Medicare beneficiaries from 2000 to 2007 we developed a cohort of 40,253 with claims for new visits to urologists for diagnoses consistent with symptomatic benign prostatic hyperplasia. We assessed trends in initial inflation and geography adjusted expenditures within 12 months of diagnosis by evaluative test categories derived from the 2003 American Urological Association guideline on the management of benign prostatic hyperplasia. Using governmental reports on Medicare expenditure trends for benign prostatic hyperplasia we compared expenditures to overall and imaging specific Medicare expenditures. Comparisons were assessed by the Z-test and regression analysis for linear trends, as appropriate. Between 2000 and 2007 inflation adjusted total Medicare expenditures per patient for the initial evaluation of patients with benign prostatic hyperplasia seen by urologists increased from $255.44 to $343.98 (p inflation adjusted expenditures increased for benign prostatic hyperplasia related evaluations. This growth was slower than the overall growth in Medicare expenditures. The increase in BPH related imaging expenditures was restrained compared to that of the Medicare program as a whole. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

ACE Inhibitor and ARB utilization and expenditures in the Medicaid fee-for-service program from 1991 to 2008.

Science.gov (United States)

Bian, Boyang; Kelton, Christina M L; Guo, Jeff J; Wigle, Patricia R

2010-01-01

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are widely prescribed for the treatment of hypertension and heart failure, as well as for kidney disease prevention in patients with diabetes mellitus and the management of patients after myocardial infarction. To (a) describe ACE inhibitor and ARB utilization and spending in the Medicaid fee-for-service program from 1991 through 2008, and (b) estimate the potential cost savings for the collective Medicaid programs from a higher ratio of generic ACE inhibitor utilization. A retrospective, descriptive analysis was performed using the National Summary Files from the Medicaid State Drug Utilization Data, which are composed of pharmacy claims that are subject to federally mandated rebates from pharmaceutical manufacturers. For the years 1991-2008, quarterly claim counts and expenditures were calculated by summing data for individual ACE inhibitors and ARBs. Quarterly per-claim expenditure as a proxy for drug price was computed for all brand and generic drugs. Market shares were calculated based on the number of pharmacy claims and Medicaid expenditures. In the Medicaid fee-for-service program, ACE inhibitors accounted for 100% of the claims in the combined market for ACE inhibitors and ARBs in 1991, 80.6% in 2000, and 64.7% in 2008. The Medicaid expenditure per ACE inhibitor claim dropped from $37.24 in 1991 to $24.03 in 2008 when generics accounted for 92.5% of ACE inhibitor claims; after adjusting for inflation for the period from 1991 to 2008, the real price drop was 59.2%. Brand ACE inhibitors accounted for only 7.5% of the claims in 2008 for all ACE inhibitors but 32.1% of spending; excluding the effects of manufacturer rebates, Medicaid spending would have been reduced by $28.7 million (9%) in 2008 if all ACE inhibitor claims were generic. The average price per ACE inhibitor claim in 2008 was $24.03 ($17.64 per generic claim vs. $103.45 per brand claim) versus $81.98 per ARB

Twelve weeks of moderate aerobic exercise without dietary intervention or weight loss does not affect 24-h energy expenditure in lean and obese adolescents

NARCIS (Netherlands)

van der Heijden, Gert-Jan; Sauer, Pieter J. J.; Sunehag, Agneta L.

Background: Exercise might have a persistent effect on energy expenditure and fat oxidation, resulting in increased fat loss. However, even without weight loss, exercise results in positive metabolic effects. The effect of an aerobic exercise program on 24-h total energy expenditure (TEE) and its

Adult mental health needs and expenditure in Australia.

Science.gov (United States)

Burgess, Philip; Pirkis, Jane; Buckingham, Bill; Burns, Jane; Eagar, Kathy; Eckstein, Gary

2004-06-01

Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.

Estimates of state-level health-care expenditures associated with disability.

Science.gov (United States)

Anderson, Wayne L; Armour, Brian S; Finkelstein, Eric A; Wiener, Joshua M

2010-01-01

We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002-2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. The DAHE for all U.S. adults totaled $397.8 billion in 2006, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total, the DAHE were $118.9 billion for the Medicare population, $161.1 billion for Medicaid recipients, and $117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.

Exceptional circumstance drug dispensing: history and expenditures of the Brazilian Ministry of Health.

Science.gov (United States)

Carias, Claudia Mezleveckas; Vieira, Fabíola Sulpino; Giordano, Carlos V; Zucchi, Paola

2011-04-01

To describe the technical aspects of the Exceptional Circumstance Drug Dispensing Program of the Brazilian Ministry of Health, especially with respect to the cost of dispensed medication. Technical information was obtained from the ordinances that regulate the Program. Expenditure from 2000 to 2007 was obtained from the Sistema Único de Saúde's (Unified Healthcare System) Outpatient Information System. All drugs dispensed between 1993 and 2009 and the amount and cost of each procedure were evaluated, based on information from the high-complexity procedure authorization of each of the country's states. The Program changed with the increase in the number of pharmacological agents and presentations distributed by, and the number of diseases contemplated in the program. In 1993, the program distributed 15 pharmacological agents in 31 distinct presentations. This number increased to 109 agents in 243 presentations in 2009. Total Ministry of Health expenditure with medications was R$1,410,181,600.74 in 2007, almost twice the amount spent in 2000, R$684,975,404.43. Diseases whose expenditure increased in the period included chronic renal insufficiency, transplantation, and hepatitis C. The Exceptional Circumstance Drug Dispensing Program is in constant transformation, aimed at building instruments and strategies that can ensure and expand access to medication among the population. Alternatives should be sought to decrease the financial impact of the Program to a level that does not impact other sectors of the health care system, given the high cost associated with novel interventions.

Socioeconomic inequality in catastrophic health expenditure in Brazil.

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Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Barros, Aluísio Jardim Dornellas de; Posenato, Leila Garcia; Peres, Karen Glazer

2014-08-01

To analyze the evolution of catastrophic health expenditure and the inequalities in such expenses, according to the socioeconomic characteristics of Brazilian families. Data from the National Household Budget 2002-2003 (48,470 households) and 2008-2009 (55,970 households) were analyzed. Catastrophic health expenditure was defined as excess expenditure, considering different methods of calculation: 10.0% and 20.0% of total consumption and 40.0% of the family's capacity to pay. The National Economic Indicator and schooling were considered as socioeconomic characteristics. Inequality measures utilized were the relative difference between rates, the rates ratio, and concentration index. The catastrophic health expenditure varied between 0.7% and 21.0%, depending on the calculation method. The lowest prevalences were noted in relation to the capacity to pay, while the highest, in relation to total consumption. The prevalence of catastrophic health expenditure increased by 25.0% from 2002-2003 to 2008-2009 when the cutoff point of 20.0% relating to the total consumption was considered and by 100% when 40.0% or more of the capacity to pay was applied as the cut-off point. Socioeconomic inequalities in the catastrophic health expenditure in Brazil between 2002-2003 and 2008-2009 increased significantly, becoming 5.20 times higher among the poorest and 4.17 times higher among the least educated. There was an increase in catastrophic health expenditure among Brazilian families, principally among the poorest and those headed by the least-educated individuals, contributing to an increase in social inequality.

Determinants of catastrophic health expenditure in iran.

Science.gov (United States)

Abolhallaje, M; Hasani, Sa; Bastani, P; Ramezanian, M; Kazemian, M

2013-01-01

This study will provide detailed specification of those variables and determinants of unpredictable health expenditure in Iran, and the requirements to reduce extensive effects of the factors affecting households' payments for health and other goods and services inappropriately. This study aims to identify measures of fair financing of health services and determinants of fair financing contribution, regarding the required share of households that prevents their catastrophic payments. In this regard, analysis of shares of households' expenditures on main groups of goods and services in urban and rural areas and in groups of deciles in the statistics from households' expenditure surveys was applied. The growth of spending in nominal values within the years 2002-2008 was considerably high and the rate for out-of-pocket payments is nearly the same or greater than the rate for total health expenditure. In 2008, urban and rural households in average pay 6.4% and 6.35% of their total expenditure on health services. Finally three categories of determinants of unfair and catastrophic payments by households were recognized in terms of households' socio-economic status, equality/inequality conditions of the distribution of risk of financing, and economic aspects of health expenditure distribution. While extending the total share of government and prepayment sources of financing health services are considered as the simplest policy for limiting out-of-pocket payments, indicators and policies introduced in this study could also be considered important and useful for the development of health sector and easing access to health services, irrespective of health financing fairness.

Hand-held indirect calorimeter offers advantages compared with prediction equations, in a group of overweight women, to determine resting energy expenditures and estimated total energy expenditures during research screening.

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Spears, Karen E; Kim, Hyunsook; Behall, Kay M; Conway, Joan M

2009-05-01

To compare standardized prediction equations to a hand-held indirect calorimeter in estimating resting energy and total energy requirements in overweight women. Resting energy expenditure (REE) was measured by hand-held indirect calorimeter and calculated by prediction equations Harris-Benedict, Mifflin-St Jeor, World Health Organization/Food and Agriculture Organization/United Nations University (WHO), and Dietary Reference Intakes (DRI). Physical activity level, assessed by questionnaire, was used to estimate total energy expenditure (TEE). Subjects (n=39) were female nonsmokers older than 25 years of age with body mass index more than 25. Repeated measures analysis of variance, Bland-Altman plot, and fitted regression line of difference. A difference within +/-10% of two methods indicated agreement. Significant proportional bias was present between hand-held indirect calorimeter and prediction equations for REE and TEE (Pvalues and underestimated at higher values. Mean differences (+/-standard error) for REE and TEE between hand-held indirect calorimeter and Harris-Benedict were -5.98+/-46.7 kcal/day (P=0.90) and 21.40+/-75.7 kcal/day (P=0.78); between hand-held indirect calorimeter and Mifflin-St Jeor were 69.93+/-46.7 kcal/day (P=0.14) and 116.44+/-75.9 kcal/day (P=0.13); between hand-held indirect calorimeter and WHO were -22.03+/-48.4 kcal/day (P=0.65) and -15.8+/-77.9 kcal/day (P=0.84); and between hand-held indirect calorimeter and DRI were 39.65+/-47.4 kcal/day (P=0.41) and 56.36+/-85.5 kcal/day (P=0.51). Less than 50% of predictive equation values were within +/-10% of hand-held indirect calorimeter values, indicating poor agreement. A significant discrepancy between predicted and measured energy expenditure was observed. Further evaluation of hand-held indirect calorimeter research screening is needed.

Expenditure Analysis of HIV Testing and Counseling Services Using the Cascade Framework in Vietnam.

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Van Thu Nguyen

Full Text Available Currently, HIV testing and counseling (HTC services in Vietnam are primarily funded by international sources. However, international funders are now planning to withdraw their support and the Government of Vietnam (GVN is seeking to identify domestic funding and generate client fees to continue services. A clear understanding of the cost to sustain current HTC services is becoming increasingly important to facilitate planning that can lead to making HTC and other HIV services more affordable and sustainable in Vietnam. The objectives of this analysis were to provide a snapshot of current program costs to achieve key program outcomes including 1 testing and identifying PLHIV unaware of their HIV status and 2 successfully enrolling HIV (+ clients in care.We reviewed expenditure data reported by 34 HTC sites in nine Vietnamese provinces over a one-year period from October 2012 to September 2013. Data on program outcomes were extracted from the HTC database of 42,390 client records. Analysis was carried out from the service providers' perspective.The mean expenditure for a single client provided HTC services (testing, receiving results and referral for care/treatment was US $7.6. The unit expenditure per PLHIV identified through these services varied widely from US $22.8 to $741.5 (median: $131.8. Excluding repeat tests, the range for expenditure to newly diagnose a PLHIV was even wider (from US $30.8 to $1483.0. The mean expenditure for one successfully referred HIV client to care services was US $466.6. Personnel costs contributed most to the total cost.Our analysis found a wide range of expenditures by site for achieving the same outcomes. Re-designing systems to provide services at the lowest feasible cost is essential to making HIV services more affordable and treatment for prevention programs feasible in Vietnam. The analysis also found that understanding the determinants and reasons for variance in service costs by site is an important

Association between uncoupling protein 2, adiponectin and resting energy expenditure in obese women with normal and low resting energy expenditure.

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Taghadomi Masoumi, Zahra; Eshraghian, Mohammad Reza; Hedayati, Mahdi; Pishva, Hamideh

2018-02-01

Obesity is recognized as the most prevalent metabolic disease worldwide. Decreases in energy expenditure may increase risk of obesity. One of the key regulators of energy balance is uncoupling protein2 (UCP2), a transporter protein presents in mitochondrial inner membrane. Moreover, adiponectin is the most abundant adipocytokine, it may play a role in energy metabolism and gene expression of UCP2. The aim of this study was to investigate potential associations between the level of uncoupling protein 2 and adiponectin and their relationship with REE (Resting Energy Expenditure) in obese women with normal and low resting energy expenditure. A total of 49 subjects (women, 25-50 years old), were included in current study, 16 subjects with BMI > 30 and low resting energy expenditure, 17 subjects with BMI > 30 and normal resting energy expenditure and 16 non-obese subjects as a control group. Anthropometric, body composition parameters and resting energy expenditure were measured. Plasma adiponectin, UCP2 protein and total protein in PBMC were determined. Measured resting energy expenditure in obese subjects with low REE was significantly lower than other groups. Plasma adiponectin in the obese subjects with low REE was significantly lower compared to normal weight group. There was a significant relationship between 'UCP2 protein/Total protein' ratio and plasma adiponectin in obese group with low REE and in three groups when we pooled. There was a significant association between REE and plasma adiponectin in three groups when we pooled. There was a significant association between plasma adiponectin and REE. Moreover, there was a significant relationship between UCP2 and REE.

Household Expenditures on Private Tutoring: Emerging Evidence from Malaysia

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Kenayathulla, Husaina Banu

2013-01-01

Private tutoring has been a burgeoning phenomenon in Malaysia for decades. This study examines the determinants of private tutoring expenditures in Malaysia using the 2004/2005 Household Expenditures Survey and applies hurdle regression models to the data. The results indicate that total household expenditures, household head's level of education,…

An analysis of Malaysia's corporate income tax expenditures and negative income tax expenditures using accounting standards as the benchmark tax base

OpenAIRE

Yussof, Salwa Hana

2017-01-01

Tax expenditures are government indirect spending, hidden in the tax system, often used to support government’s social and economic objectives. Instead of directly allocating money for a particular objective, the government forgoes tax revenues from those who undertake activities that could achieve the objective. Therefore, tax expenditures should be analysed as government spending programs. Tax expenditure reporting and analysis has been a regular practice among many countries in the worl...

Use of econometric models to estimate expenditure shares.

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Trogdon, Justin G; Finkelstein, Eric A; Hoerger, Thomas J

2008-08-01

To investigate the use of regression models to calculate disease-specific shares of medical expenditures. Medical Expenditure Panel Survey (MEPS), 2000-2003. Theoretical investigation and secondary data analysis. Condition files used to define the presence of 10 medical conditions. Incremental effects of conditions on expenditures, expressed as a fraction of total expenditures, cannot generally be interpreted as shares. When the presence of one condition increases treatment costs for another condition, summing condition-specific shares leads to double-counting of expenditures. Condition-specific shares generated from multiplicative models should not be summed. We provide an algorithm that allows estimates based on these models to be interpreted as shares and summed across conditions.

Food Insecurity and Health Care Expenditures in the United States, 2011-2013.

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Berkowitz, Seth A; Basu, Sanjay; Meigs, James B; Seligman, Hilary K

2018-06-01

To determine whether food insecurity, limited or uncertain food access owing to cost, is associated with greater health care expenditures. Nationally representative sample of the civilian noninstitutionalized population of the United States (2011 National Health Interview Survey [NHIS] linked to 2012-2013 Medication Expenditure Panel Survey [MEPS]). Longitudinal retrospective cohort. A total of 16,663 individuals underwent assessment of food insecurity, using the 10-item adult 30-day food security module, in the 2011 NHIS. Their total health care expenditures in 2012 and 2013 were recorded in MEPS. Expenditure data were analyzed using zero-inflated negative binomial regression and adjusted for age, gender, race/ethnicity, education, income, insurance, and residence area. Fourteen percent of individuals reported food insecurity, representing 41,616,255 Americans. Mean annualized total expenditures were $4,113 (standard error $115); 9.2 percent of all individuals had no health care expenditures. In multivariable analyses, those with food insecurity had significantly greater estimated mean annualized health care expenditures ($6,072 vs. $4,208, p insecurity was associated with greater subsequent health care expenditures. Future studies should determine whether food insecurity interventions can improve health and reduce health care costs. © Health Research and Educational Trust.

An analysis of government immunization program expenditures in lower and lower middle income countries 2006-12.

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Nader, Alice Abou; de Quadros, Ciro; Politi, Claudio; McQuestion, Michael

2015-04-01

Financing is becoming increasingly important as the cost of immunizing the world's children continues to rise. By 2015, that cost will likely exceed US$60 per infant as new vaccines are introduced into national immunization programs. In 2006, 51 lower and lower middle income countries reported spending a mean US$12 per surviving infant on routine immunization. By 2012, the figure had risen to $20, a 67% increase. This study tests the hypothesis that lower and lower middle income countries will spend more on their routine immunization programs as their economies grow. A panel data regression approach is used. Expenditures reported by governments annually (2006-12) through the World Health Organization/UNICEF Joint Reporting Form are regressed on lagged annual per capita gross national income (GNI), controlling for prevailing mortality levels, immunization program performance, corruption control efforts, geographical region and correct reporting. Results show the expenditures increased with GNI. Expressed as an elasticity, the countries spent approximately $6.32 on immunization for every $100 in GNI increase from 2006 to 2012. Projecting forward and assuming continued annual GNI growth rates of 10.65%, countries could be spending $60 per infant by 2020 if national investment functions increase 4-fold. Given the political will, this result implies countries could fully finance their routine immunization programs without cutting funding for other programs. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

State-level Medicaid expenditures attributable to smoking.

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Armour, Brian S; Finkelstein, Eric A; Fiebelkorn, Ian C

2009-07-01

Medicaid recipients are disproportionately affected by tobacco-related disease because their smoking prevalence is approximately 53% greater than that of the overall US adult population. This study estimates state-level smoking-attributable Medicaid expenditures. We used state-level and national data and a 4-part econometric model to estimate the fraction of each state's Medicaid expenditures attributable to smoking. These fractions were multiplied by state-level Medicaid expenditure estimates obtained from the Centers for Medicare and Medicaid Services to estimate smoking-attributable expenditures. The smoking-attributable fraction for all states was 11.0% (95% confidence interval, 0.4%-17.0%). Medicaid smoking-attributable expenditures ranged from $40 million (Wyoming) to $3.3 billion (New York) in 2004 and totaled $22 billion nationwide. Cigarette smoking accounts for a sizeable share of annual state Medicaid expenditures. To reduce smoking prevalence among recipients and the growth rate in smoking-attributable Medicaid expenditures, state health departments and state health plans such as Medicaid are encouraged to provide free or low-cost access to smoking cessation counseling and medication.

Medical Expenditures and Earnings Losses Among US Adults With Arthritis in 2013.

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Murphy, Louise B; Cisternas, Miriam G; Pasta, David J; Helmick, Charles G; Yelin, Edward H

2018-06-01

We estimated the economic impact of arthritis using 2013 US Medical Expenditure Panel Survey (MEPS) data. We calculated arthritis-attributable and all-cause medical expenditures for adults age ≥18 years and arthritis-attributable earnings losses among those ages 18-64 years who had ever worked. We calculated arthritis-attributable costs using multistage regression-based methods, and conducted sensitivity analyses to estimate costs for 2 other arthritis definitions in MEPS. In 2013, estimated total national arthritis-attributable medical expenditures were $139.8 billion (range $135.9-$157.5 billion). Across expenditure categories, ambulatory care expenditures accounted for nearly half of arthritis-attributable expenditures. All-cause expenditures among adults with arthritis represented 50% of the $1.2 trillion national medical expenditures among all US adults in MEPS. Estimated total national arthritis-attributable earning losses were $163.7 billion (range $163.7-$170.0 billion). The percentage with arthritis who worked in the past year was 7.2 percentage points lower than those without arthritis (76.8% [95% confidence interval (95% CI)] 75.0-78.6 and 84.0% [95% CI 82.5-85.5], respectively, adjusted for sociodemographics and chronic conditions). Total arthritis-attributable medical expenditures and earnings losses were $303.5 billion (range $303.5-$326.9 billion). Total national arthritis-attributable medical care expenditures and earnings losses among adults with arthritis were $303.5 billion in 2013. High arthritis-attributable medical expenditures might be reduced by greater efforts to reduce pain and improve function. The high earnings losses were largely attributable to the substantially lower prevalence of working among those with arthritis compared to those without, signaling the need for interventions that keep people with arthritis in the workforce. © 2017, American College of Rheumatology.

Public health and the economy could be served by reallocating medical expenditures to social programs

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Linda Diem Tran

2017-12-01

Full Text Available As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate.

Public health and the economy could be served by reallocating medical expenditures to social programs.

Science.gov (United States)

Tran, Linda Diem; Zimmerman, Frederick J; Fielding, Jonathan E

2017-12-01

As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate.

Infrastructure expenditures and costs. Practical guidelines to calculate total infrastructure costs for five modes of transport. Final report

International Nuclear Information System (INIS)

2005-11-01

Transport infrastructures in general, and the Trans European Transport Network (TEN-T) in particular, play an important role in achieving the medium and long-term objectives of the European Union. In view of this, the Commission has recently adopted a revision of the guidelines for the TEN-T. The main consequences of this revision are the need for a better understanding of the investments made by the member states in the TEN-T and the need for ensuring optimal consistency in the reporting by the Members States of such investments. With Regulation number 1108/70 the Council of the European Communities introduced an accounting system for expenditure on infrastructure in respect of transport by rail, road and inland waterways. The purpose of this regulation is to introduce a standard and permanent accounting system for infrastructure expenditures. However maritime and aviation infrastructure were not included. Further, the need for an effective and easy to apply classification for infrastructure investments concerning all five transport modes was still pending. Therefore, DG TREN has commissioned ECORYS Transport and CE Delft to study the expenditures and costs of infrastructure, to propose an adequate classification of expenditures, and to propose a method for translating data on expenditures into data on costs. The objectives of the present study are threefold: To set out a classification of infrastructure expenditures, in order to increase knowledge of expenditures related to transport infrastructures. This classification should support a better understanding of fixed and variable infrastructure costs; To detail the various components of such expenditures for five modes of transportation, which would enable the monitoring of infrastructure expenditures and costs; and to set up a methodology to move from annual series of expenditures to costs, including fixed and variable elements.

THE IMPACT OF EDUCATIONAL EXPENDITURES OF GOVERNMENT ON ECONOMIC GROWTH OF IRAN

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FOZIEH JEYHOON TABAR

Full Text Available ABSTRACT Using the annual data of Iran’s economy from 1981-2012, this study examines Wagner’s law and the Keynesian hypothesis about the relationship between the real government expenditure and the real GDP. In this regard, this paper investigated the relationship between the total government expenditure, the GDP and the relationship between government educational expenditure and GDP using bivariate and multivariate models. The multivariate model is used to reduce the specified error issues that has not been considered in many studies. The co-integration was examined using the auto regressive distributive lag method (ARDL of both long-term and short-term relationships. In making the estimations of the Wagner’s view, the variables: real GDP, capital stock and labor force stock respectively, had a positive, a negative, and a positive impact on total government expenditure and the long-term relationship is true in this regard. Additionally, in the estimation of Keynesian model, the educational expenditures, unlike real expenditures of government, had a long-term relationship. In addition, the variable, capital, in both models had a similar effect on the real GDP, and the labor force coefficient in the presence of the total expenditures and educational expenditures were negative and positive respectively.

Análisis del gasto en salud reproductiva en México, 2003 Analysis of reproductive health expenditures in Mexico, 2003

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Lucero Cahuana-Hurtado

2006-11-01

estimate reproductive health expenditures in Mexico during 2003; analyze how costs were distributed across the main programs, funding entities, and providers of health goods and services; and evaluate the relationship between reproductive health expenditures and economic indicators in different states, using health accounts methods. METHODS: We estimated reproductive health expenditures between January and December 2003, at the national and state level. We used health accounts methods adjusted for the particular characteristics of Mexico on the basis of information from public and private sources. Expenditures were calculated for the four main reproductive health programs (maternal-perinatal health, family planning, cervical and uterine cancer, and breast cancer according to different funding entities, goods and services providers, and functions of health care, in both the public and private sector. We estimated public expenditures by state per beneficiary, and analyzed how these costs were related with pubic health care expenditures and annual per capita gross domestic product (GDP for each state. RESULTS: The reproductive health expenditures in Mexico during the year 2003 were US$ 2.912 6 billion, a figure that represented 0.5% of the national GDP in 2003 and slightly more than 8% of the total health care expenditures. Costs were higher for public entities (53.5% than for private entities (46.5%. The maternal-perinatal health program accounted for the highest costs, mainly from deliveries and complications; direct payments from households accounted for nearly 50% of the total figure. Costs for family planning were accrued mainly in the public sector, and represented 5.9% of the total expenditure. Of the total spending on reproductive health, 7.9% was devoted to cervical and uterine cancer and breast cancer programs. Mean public expenditures on reproductive health per beneficiary were US$ 680.03, and differences between states were associated with differences in public

Impact of Provider Participation in ACO Programs on Preventive Care Services, Patient Experiences, and Health Care Expenditures in US Adults Aged 18-64.

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Hong, Young-Rock; Sonawane, Kalyani; Larson, Samantha; Mainous, Arch G; Marlow, Nicole M

2018-05-15

Little is known about the impact of accountable care organization (ACO) on US adults aged 18-64. To examine whether having a usual source of care (USC) provider participating in an ACO affects receipt of preventive care services, patient experiences, and health care expenditures among nonelderly Americans. A cross-sectional analysis of the 2015 Medical Organizations Survey linked with the Medical Expenditure Panel Survey. Survey respondents aged 18-64 with an identified USC and continuous health insurance coverage during 2015. Preventative care services (routine checkup, flu vaccination, and cancer screening), patient experiences with health care (access to care, interaction quality with providers, and global satisfaction), and health care expenditures (total and out-of-pocket expenditures) for respondents with USC by ACO and non-ACO provider groups. Among 1563, nonelderly Americans having a USC, we found that nearly 62.7% [95% confidence interval (CI), 58.6%-66.7%; representing 15,722,208 Americans] were cared for by ACO providers. Our analysis showed no significant differences in preventive care services or patient experiences between ACO and non-ACO groups. Adjusted mean total health expenditures were slightly higher for the ACO than non-ACO group [$7016 (95% CI, $4949-$9914) vs. $6796 (95% CI, $4724-$9892)]; however, this difference was not statistically significant (P=0.250). Our findings suggest that having a USC provider participating in an ACO is not associated with preventive care services use, patient experiences, or health care expenditures among a nonelderly population.

Physical activity, sleep pattern and energy expenditure in double-handed offshore sailing.

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Galvani, C; Ardigò, L P; Alberti, M; Daniele, F; Capelli, C

2015-12-01

The aim of the present study was to quantify total energy expenditure, activity energy expenditure and time spent at three levels of physical activity (low, moderate, high intensity) in four two-person crews during a 500-mile double-handed sailing regatta. Physical activity intensity and energy expenditure were assessed during a 500-nautical-mile double-handed offshore competition in eight male sailors (46.3±3.4 years; 180±13 cm; 85.4±12.5 kg). During the whole regatta, they wore an activity monitor that estimated energy expenditure and minutes spent at each level of intensity (sedentary, 6.0 METs). The sailors spent longer periods (Penergy expenditure was 14.26±1.89 MJ/day and the activity energy expenditure was 5.06±1.42 MJ/day. Activity energy expenditure was significantly correlated with total sleep time, boat speed, and distance covered each day (Penergy expenditure was more likely a consequence of the short and rare periods of sleep during the competition rather than of the bouts of moderate and vigorous physical activities.

Executive function, episodic memory, and Medicare expenditures.

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Bender, Alex C; Austin, Andrea M; Grodstein, Francine; Bynum, Julie P W

2017-07-01

We examined the relationship between health care expenditures and cognition, focusing on differences across cognitive systems defined by global cognition, executive function, or episodic memory. We used linear regression models to compare annual health expenditures by cognitive status in 8125 Nurses' Health Study participants who completed a cognitive battery and were enrolled in Medicare parts A and B. Adjusting for demographics and comorbidity, executive impairment was associated with higher total annual expenditures of $1488 per person (P episodic memory impairment was found. Expenditures exhibited a linear relationship with executive function, but not episodic memory ($584 higher for every 1 standard deviation decrement in executive function; P < .01). Impairment in executive function is specifically and linearly associated with higher health care expenditures. Focusing on management strategies that address early losses in executive function may be effective in reducing costly services. Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Does the pharmacy expenditure of patients always correspond with their morbidity burden? Exploring new approaches in the interpretation of pharmacy expenditure

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Abad-Díez José

2010-05-01

Full Text Available Abstract Background The computerisation of primary health care (PHC records offers the opportunity to focus on pharmacy expenditure from the perspective of the morbidity of individuals. The objective of the present study was to analyse the behaviour of pharmacy expenditure within different morbidity groups. We paid special attention to the identification of individuals who had higher values of pharmacy expenditure than their morbidity would otherwise suggest (i.e. outliers. Methods Observational study consisting of 75,574 patients seen at PHC centres in Zaragoza, Spain, at least once in 2005. Demographic and disease variables were analysed (ACG® 8.1, together with a response variable that we termed 'total pharmacy expenditure per patient'. Outlier patients were identified based on boxplot methods, adjusted boxplot for asymmetric distributions, and by analysing standardised residuals of tobit regression models. Results The pharmacy expenditure of up to 7% of attendees in the studied PHC centres during one year exceeded expectations given their morbidity burden. This group of patients was responsible for up to 24% of the total annual pharmacy expenditure. There was a significantly higher number of outlier patients within the low-morbidity band which matched up with the higher variation coefficient observed in this group (3.2 vs. 2.0 and 1.3 in the moderate- and high-morbidity bands, respectively. Conclusions With appropriate validation, the methodologies of the present study could be incorporated in the routine monitoring of the prescribing profile of general practitioners. This could not only enable evaluation of their performance, but also target groups of outlier patients and foster analyses of the causes of unusually high pharmacy expenditures among them. This interpretation of pharmacy expenditure gives new clues for the efficiency in utilisation of healthcare resources, and could be complementary to management interventions focused on

Modeling Health Care Expenditures and Use.

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Deb, Partha; Norton, Edward C

2018-04-01

Health care expenditures and use are challenging to model because these dependent variables typically have distributions that are skewed with a large mass at zero. In this article, we describe estimation and interpretation of the effects of a natural experiment using two classes of nonlinear statistical models: one for health care expenditures and the other for counts of health care use. We extend prior analyses to test the effect of the ACA's young adult expansion on three different outcomes: total health care expenditures, office-based visits, and emergency department visits. Modeling the outcomes with a two-part or hurdle model, instead of a single-equation model, reveals that the ACA policy increased the number of office-based visits but decreased emergency department visits and overall spending.

The impact of population ageing on future Danish drug expenditure

DEFF Research Database (Denmark)

Kildemoes, Helle Wallach

expenditure among the elderly partly is due the high "costs of dying". Aims The aim of this study was to estimate the impact of the ageing Danish population on future total expenditures on out-of-hospital prescription drugs and to describe the association between age and drug expenditure among survivors......Background Population ageing is likely to place an increasing burden on future health care budgets. Several studies have demonstrated that the impact of ageing on future hospital expenditures will be overestimated when not accounting for proximity to death. This is because greater health care...... compared to that of decedents. Methods Taking expenditure during the last year of life and the changes in mortality rates into account, future drug expenditure was projected by multiplying estimated mean annual drug expenditure according to age, gender and survival status by the predicted future number...

Trends in the distribution of South African health care expenditure

African Journals Online (AJOL)

1990-08-04

Aug 4, 1990 ... This paper considers the distribution of health expenditure between the public ... An understanding of past health care expenditure patterns is a prerequisite to any .... of this total and local government for 8% in the same year.

Vigorous exercise is associated with superior metabolic profiles in polycystic ovary syndrome independent of total exercise expenditure.

Science.gov (United States)

Greenwood, Eleni A; Noel, Martha W; Kao, Chia-Ning; Shinkai, Kanade; Pasch, Lauri A; Cedars, Marcelle I; Huddleston, Heather G

2016-02-01

To characterize metabolic features of women with polycystic ovary syndrome (PCOS) by exercise behavior and determine relative health benefits of different exercise intensities. Cross-sectional study. Tertiary academic institution. Three hundred and twenty-six women aged 14-52 years-old with PCOS by Rotterdam criteria examined between 2006 and 2013. International Physical Activity Questionnaire (IPAQ) administered to classify patients into three groups based on Department of Health and Human Services (DHHS) Guidelines of vigorous, moderate, and inactive, along with physical examination and serum testing. Blood pressure, body mass index (BMI), waist circumference, fasting lipids, fasting glucose and insulin, 2-hour 75-gram oral glucose tolerance, homeostatic model assessment of insulin resistance (HOMA-IR). The DHHS guidelines for adequate physical activity were met by 182 (56%) women. Compared with moderate exercisers and inactive women, the vigorous exercisers had lower BMI and lower HOMA-IR; higher levels of high-density lipoprotein cholesterol and sex hormone-binding globulin; and a reduced prevalence of the metabolic syndrome. In a multivariate logistic regression analysis controlling for age, BMI, and total energy expenditure, every hour of vigorous exercise reduced a patient's odds of metabolic syndrome by 22% (odds ratio 0.78; 95% confidence interval, 0.62, 0.99). Women with PCOS who met DHHS guidelines for exercise demonstrated superior metabolic health parameters. Vigorous but not moderate activity is associated with reduced odds of the metabolic syndrome, independent of age, BMI, and total energy expenditure. PCOS patients should be encouraged to meet activity guidelines via vigorous physical activity. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or chronic obstructive pulmonary disease: a systematic review of the literature.

Science.gov (United States)

de Bruin, Simone R; Heijink, Richard; Lemmens, Lidwien C; Struijs, Jeroen N; Baan, Caroline A

2011-07-01

Evaluating the impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or COPD. Systematic Pubmed search for studies reporting the impact of disease management programs on healthcare expenditures. Included were studies that contained two or more components of Wagner's chronic care model and were published between January 2007 and December 2009. Thirty-one papers were selected, describing disease management programs for patients with diabetes (n=14), depression (n=4), heart failure (n=8), and COPD (n=5). Twenty-one studies reported incremental healthcare costs per patient per year, of which 13 showed cost-savings. Incremental costs ranged between -$16,996 and $3305 per patient per year. Substantial variation was found between studies in terms of study design, number and combination of components of disease management programs, interventions within components, and characteristics of economic evaluations. Although it is widely believed that disease management programs reduce healthcare expenditures, the present study shows that evidence for this claim is still inconclusive. Nevertheless disease management programs are increasingly implemented in healthcare systems worldwide. To support well-considered decision-making in this field, well-designed economic evaluations should be stimulated. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Socio-economic expenditure impacts report

International Nuclear Information System (INIS)

2004-01-01

The direct and indirect employment and employment income that can result from lifting the moratorium on British Columbia's west coast were estimated. Jobs and income are the two socio-economic benefits that generate the most concern at the local, provincial and national levels. The estimates are based on the development scenarios of one natural gas project in the Hecate Strait, and one oil project in the Queen Charlotte Sound. It was noted that a significant component of the potential socio-economic benefits from offshore development in British Columbia will result from project investment expenditures. Statistics Canada's Input-Output Model was used to assess the total expenditure impacts at the national and provincial levels. The indirect impacts are relatively more important to the local economy because they deal mainly with accommodation, food, beverage, and transportation. The total impacts can be measured in terms of total revenues, gross domestic product, and wages and salaries. The nature of supplier services that may be required were also identified. It was estimated that with the combined impacts of construction and operations, the total Canadian gross domestic product will increase by $3.0 billion, most of which will accrue to British Columbia. refs., tabs., figs

Testing the stability of travel expenditures in Nigeria

International Nuclear Information System (INIS)

Osula, D.O.A.; Adebisi, O.

2001-01-01

A report is presented on a study carried out to develop a functional form for travel money expenditure in a Nigerian setting, and test its stability against energy policy change, specifically the fuel price increase of October 1994. The Box-Cox transformation regression approach was adopted in the modelling exercise in order to evolve a data-defined functional form and ensure a more rational basis for the stability test. The results of the modelling exercise show that while statistically significant functional forms were estimated for the 'before' and 'after' fuel price increase periods, the functional forms estimated are not stable across the periods. Thus 'travel budget' is as yet not usable as a term for travel expenditures in Nigeria. The implication of this for travel demand modelling in Nigeria is that, at least till other evidences prove otherwise, there is as yet no basis for using the 'Universal Mechanism of Travel' model developed by Zahavi (The UMOT Project. Report No. DOT-RSPA-DPB-20-79-3; The UMOT Travel Model II Report No. DOT-RSPA-DPB-50-82-11). Of disposable income and total expenditure, the former has proved to be more appropriate for use as 'available money' for the estimation of travel expenditures in Nigeria in the 'before' energy policy change period, while total expenditure proved appropriate in the 'after' period. (author)

Validating self-reported food expenditures against food store and eating-out receipts.

Science.gov (United States)

Tang, W; Aggarwal, A; Liu, Z; Acheson, M; Rehm, C D; Moudon, A V; Drewnowski, A

2016-03-01

To compare objective food store and eating-out receipts with self-reported household food expenditures. The Seattle Obesity Study II was based on a representative sample of King County adults, Washington, USA. Self-reported household food expenditures were modeled on the Flexible Consumer Behavior Survey (FCBS) Module from 2007 to 2009 National Health and Nutrition Examination Survey (NHANES). Objective food expenditure data were collected using receipts. Self-reported food expenditures for 447 participants were compared with receipts using paired t-tests, Bland-Altman plots and κ-statistics. Bias by sociodemographics was also examined. Self-reported expenditures closely matched with objective receipt data. Paired t-tests showed no significant differences between receipts and self-reported data on total food expenditures, expenditures at food stores or eating out. However, the highest-income strata showed weaker agreement. Bland-Altman plots confirmed no significant bias across both methods-mean difference: 6.4; agreement limits: -123.5 to 143.4 for total food expenditures, mean difference 5.7 for food stores and mean difference 1.7 for eating out. The κ-statistics showed good agreement for each (κ 0.51, 0.41 and 0.49 respectively. Households with higher education and income had significantly more number of receipts and higher food expenditures. Self-reported food expenditures using NHANES questions, both for food stores and eating out, serve as a decent proxy for objective household food expenditures from receipts. This method should be used with caution among high-income populations, or with high food expenditures. This is the first validation of the FCBS food expenditures question using food store and eating-out receipts.

Households across all income quintiles, especially the poorest, increased animal source food expenditures substantially during recent Peruvian economic growth.

Science.gov (United States)

Humphries, Debbie L; Behrman, Jere R; Crookston, Benjamin T; Dearden, Kirk A; Schott, Whitney; Penny, Mary E

2014-01-01

Relative to plant-based foods, animal source foods (ASFs) are richer in accessible protein, iron, zinc, calcium, vitamin B-12 and other nutrients. Because of their nutritional value, particularly for childhood growth and nutrition, it is important to identify factors influencing ASF consumption, especially for poorer households that generally consume less ASFs. To estimate differential responsiveness of ASF consumption to changes in total household expenditures for households with different expenditures in a middle-income country with substantial recent income increases. The Peruvian Young Lives household panel (n = 1750) from 2002, 2006 and 2009 was used to characterize patterns of ASF expenditures. Multivariate models with controls for unobserved household fixed effects and common secular trends were used to examine nonlinear relationships between changes in household expenditures and in ASF expenditures. Households with lower total expenditures dedicated greater percentages of expenditures to food (58.4% vs.17.9% in 2002 and 24.2% vs. 21.5% in 2009 for lowest and highest quintiles respectively) and lower percentages of food expenditures to ASF (22.8% vs. 33.9% in 2002 and 30.3% vs. 37.6% in 2009 for lowest and highest quintiles respectively). Average percentages of overall expenditures spent on food dropped from 47% to 23.2% between 2002 and 2009. Households in the lowest quintiles of expenditures showed greater increases in ASF expenditures relative to total consumption than households in the highest quintiles. Among ASF components, meat and poultry expenditures increased more than proportionately for households in the lowest quintiles, and eggs and fish expenditures increased less than proportionately for all households. Increases in household expenditures were associated with substantial increases in consumption of ASFs for households, particularly households with lower total expenditures. Increases in ASF expenditures for all but the top quintile of

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh.

Science.gov (United States)

Mahumud, Rashidul Alam; Sarker, Abdur Razzaque; Sultana, Marufa; Islam, Ziaul; Khan, Jahangir; Morton, Alec

2017-03-01

As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

Families at financial risk due to high ratio of out-of-pocket health care expenditures to total income.

Science.gov (United States)

Bennett, Kevin J; Dismuke, Clara E

2010-05-01

High out-of-pocket expenditures for health care can put individuals and families at financial risk. Several groups, including racial/ethnic minority groups, the uninsured, rural residents, and those in poorer health are at risk for this increased burden. The analysis utilized 2004-2005 MEPS data. The dependent variables were the out-of-pocket health care spending to total income ratios for total spending, office-based visits, and prescription drugs. Multivariate analyses with instrumental variables controlled for respondent characteristics. Gender, age, rurality, insurance coverage, health status, and health care utilization were all associated with higher out-of-pocket to income ratios. Certain groups, such as women, the elderly, those in poor health, and rural residents, are at a greater financial risk due to their higher out-of-pocket to total income spending ratios. Policymakers must be aware of these increased risks in order to provide adequate resources and targeted interventions to alleviate some of this burden.

Faculty Employment and R&D Expenditures at Research Universities

Science.gov (United States)

Zhang, Liang; Ehrenberg, Ronald G.

2010-01-01

This study uses panel data to examine the relationship between faculty employment and external R&D expenditures at Research and Doctoral institutions over a 15-year period of time. On average, a 1% increase in the number of full-time faculty is associated with about 0.2% increase in total R&D expenditure. Further, a one percentage point increase…

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh

Directory of Open Access Journals (Sweden)

Rashidul Alam Mahumud

2017-03-01

Full Text Available Objectives As in many low-income and middle-income countries, out-of-pocket (OOP payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results The mean total OOP healthcare expenditures was US dollar (USD 27.66; while, the cost of medicines (USD 16.98 was the highest cost driver (61% of total OOP healthcare expenditure. In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

Testing the stability of travel expenditures in Nigeria

Energy Technology Data Exchange (ETDEWEB)

Osula, D.O.A.; Adebisi, O. [Ahmadu Bello University, Zaria (Nigeria). Department of Civil Engineering

2001-07-01

A report is presented on a study carried out to develop a functional form for travel money expenditure in a Nigerian setting, and test its stability against energy policy change, specifically the fuel price increase of October 1994. The Box-Cox transformation regression approach was adopted in the modelling exercise in order to evolve a data-defined functional form and ensure a more rational basis for the stability test. The results of the modelling exercise show that while statistically significant functional forms were estimated for the 'before' and 'after' fuel price increase periods, the functional forms estimated are not stable across the periods. Thus 'travel budget' is as yet not usable as a term for travel expenditures in Nigeria. The implication of this for travel demand modelling in Nigeria is that, at least till other evidences prove otherwise, there is as yet no basis for using the 'Universal Mechanism of Travel' model developed by Zahavi (The UMOT Project. Report No. DOT-RSPA-DPB-20-79-3; The UMOT Travel Model II Report No. DOT-RSPA-DPB-50-82-11). Of disposable income and total expenditure, the former has proved to be more appropriate for use as 'available money' for the estimation of travel expenditures in Nigeria in the 'before' energy policy change period, while total expenditure proved appropriate in the 'after' period. (author)

Activity limitations predict health care expenditures in the general population in Belgium.

Science.gov (United States)

Van der Heyden, Johan; Van Oyen, Herman; Berger, Nicolas; De Bacquer, Dirk; Van Herck, Koen

2015-03-19

Disability and chronic conditions both have an impact on health expenditures and although they are conceptually related, they present different dimensions of ill-health. Recent concepts of disability combine a biological understanding of impairment with the social dimension of activity limitation and resulted in the development of the Global Activity Limitation Indicator (GALI). This paper reports on the predictive value of the GALI on health care expenditures in relation to the presence of chronic conditions. Data from the Belgian Health Interview Survey 2008 were linked with data from the compulsory national health insurance (n = 7,286). The effect of activity limitation on health care expenditures was assessed via cost ratios from multivariate linear regression models. To study the factors contributing to the difference in health expenditure between persons with and without activity limitations, the Blinder-Oaxaca decomposition method was used. Activity limitations are a strong determinant of health care expenditures. People with severe activity limitations (5.1%) accounted for 16.9% of the total health expenditure, whereas those without activity limitations (79.0%), were responsible for 51.5% of the total health expenditure. These observed differences in health care expenditures can to some extent be explained by chronic conditions, but activity limitations also contribute substantially to higher health care expenditures in the absence of chronic conditions (cost ratio 2.46; 95% CI 1.74-3.48 for moderate and 4.45; 95% CI 2.47-8.02 for severe activity limitations). The association between activity limitation and health care expenditures is stronger for reimbursed health care costs than for out-of-pocket payments. In the absence of chronic conditions, activity limitations appear to be an important determinant of health care expenditures. To make projections on health care expenditures, routine data on activity limitations are essential and complementary to data

Health Expenditure Growth under Single-Payer Systems: Comparing South Korea and Taiwan.

Science.gov (United States)

Cheng, Shou-Hsia; Jin, Hyun-Hyo; Yang, Bong-Min; Blank, Robert H

2018-05-03

Achieving universal health coverage has been an important goal for many countries worldwide. However, the rapid growth of health expenditures has challenged all nations, both those with and without such universal coverage. Single-payer systems are considered more efficient for administrative affairs and may be more effective for containing costs than multipayer systems. However, South Korea, which has a typical single-payer scheme, has almost the highest growth rate in health expenditures among industrialized countries. The aim of the present study is to explicate this situation by comparing South Korea with Taiwan. This study analyzed statistical reports published by government departments in South Korea and Taiwan from 2001 to 2015, including population and economic statistics, health statistics, health expenditures, and social health insurance reports. Between 2001 and 2015, the per capita national health expenditure (NHE) in South Korea grew 292%, whereas the corresponding growth of per capita NHE in Taiwan was only 83%. We find that the national health insurance (NHI) global budget cap in Taiwan may have restricted the growth of health expenditures. Less comprehensive benefit coverage for essential diagnosis/treatment services under the South Korean NHI program may have contributed to the growth of out-of-pocket payments. The expansion of insurance coverage for vulnerable individuals may also contribute to higher growth in NHE in South Korea. Explicit regulation of health care resource distribution may also lead to more limited provisioning and utilization of health services in Taiwan. Under analogous single-payer systems, South Korea had a much higher growth in health spending than Taiwan. The annual budget cap for total reimbursement, more comprehensive coverage for essential diagnosis and treatment services, and the regulation of health care resource distribution are important factors associated with the growth of health expenditures. Copyright © 2018

Household food insecurity and food expenditure in Bolivia, Burkina Faso, And the Philippines.

Science.gov (United States)

Melgar-Quinonez, Hugo R; Zubieta, Ana C; MkNelly, Barbara; Nteziyaremye, Anastase; Gerardo, Maria Filipinas D; Dunford, Christopher

2006-05-01

This study examined the association between food insecurity, determined by a modified version of the U.S. Household Food Security Survey Module (US HFSSM), and total daily per capita (DPC) consumption (measured as household expenditures) in Bolivia, Burkina Faso, and the Philippines. Household food insecurity was determined by an adapted 9-item US HFSSM version. A short version of the World Bank's Living Standards Measurement Study (LSMS) consumption module measured household expenditures. Focus groups were used to adapt the survey instrument to each local context. The sample (n approximately 330 per country) includes residents of urban and rural areas. A 12-month food expenditure aggregate was generated as part of the total household expenditures calculation. DPC food expenditure, which represented over 60% of the total household consumption, as well as expenditures on specific food groups correlated with food insecurity both as a continuous Food Insecurity Score (FinSS) and a tricategorical food insecurity status variable. ANOVA and regression analysis were executed adjusting for social and demographic covariates. Food-secure households have significantly higher (P insecure households. The results offer evidence that the US HFSSM is able to discriminate between households at different levels of food insecurity status in diverse developing world settings.

Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program

Science.gov (United States)

Howell, Doris M.; Abernathy, Tom; Cockerill, Rhonda; Brazil, Kevin; Wagner, Frank; Librach, Larry

2011-01-01

Purpose: Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services. Methods: Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot. Results: Subjects with gastrointestinal symptoms (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; phome care expenditures. Conclusions: Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies. Relevance: Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources. PMID:22294993

Catastrophic Health Expenditure and Household Impoverishment: a case of NCDs prevalence in Kenya

Directory of Open Access Journals (Sweden)

Daniel Mwai

2016-03-01

Full Text Available Introduction and problem: Non-Communicable Diseases (NCDs have become one of the leading causes of morbidity and mortality in Kenya. Their claim on financial and time resources adversely affects household welfare. Health care cost for NCDs in Kenya is predominantly paid by households as OOP. Health expenditure on NCD stands at 6.2% of Total Health Expenditure which is 0.4 % of the total gross domestic product of the country. This expenditure scenario could have implications on household welfare through catastrophic expenditure in Kenya. Most studies done on catastrophic expenditure in Kenya have not looked at the effect of NCD on poverty. Methodology: The paper has investigated the determinants of catastrophic health spending in a household with special focus on the NCDs. It has also investigated the effect of catastrophic expenditure on household welfare.A National household level survey data on expenditure and utilization is used. Controlling for endogeneity, the results revealed that NCDs and communicable diseases contribute significantly to the likelihood of a household incurring catastrophic expenditure. Results: Although all types of sicknesses have negative effects on household welfare, NCDs have more severe impacts on impoverishment. Policy wise, government and development partners should put in place a health financing plan entailing health insurance and resource pooling as a mean towards social protection. Key words:  Non-Communicable Diseases (NCD, Catastrophic Health Expenditure, endogeneity Impoverishment

Travel purpose and expenditure patterns in city tourism : evidence from the Amsterdam Metropolitan Area

NARCIS (Netherlands)

van Loon, Ruben; Rouwendal, Jan

2017-01-01

This study examines the expenditure patterns of urban tourists with different trip purposes including visiting cultural heritage. Expenditure categories include museums and theatres. We use a two-step approach, in which we first analyse the total daily amount of expenditure and then the budget

MARKETING EXPENDITURES IN THE INDONESIAN CONSTRUCTION INDUSTRY

OpenAIRE

Krishna Mochtar

2004-01-01

In the 1960s, a ânewâ marketing concept known as "four Ps marketing mix" appeared and shifted the focus from the product to the customer. The objective of the new concept was not only profit, and the means of achieving the objective expanded to include the entire âmarketing mixâ: product, price, promotion, and place (channels and distribution). Expenditures of marketing in a company should be explored from these mixes, because each mix would have an impact on the total marketing expenditures....

Obesity and people with disabilities: the implications for health care expenditures.

Science.gov (United States)

Anderson, Wayne L; Wiener, Joshua M; Khatutsky, Galina; Armour, Brian S

2013-12-01

This study estimates additional average health care expenditures for overweight and obesity for adults with disabilities vs. without. Descriptive and multivariate methods were used to estimate additional health expenditures by service type, age group, and payer using 2004-2007 Medical Expenditure Panel Survey data. In 2007, 37% of community-dwelling Americans with disabilities were obese vs. 27% of the total population. People with disabilities had almost three times ($2,459) the additional average obesity cost of people without disabilities ($889). Prescription drug expenditures for obese people with disabilities were three times as high and outpatient expenditures were 74% higher. People with disabilities in the 45- to 64-year age group had the highest obesity expenditures. Medicare had the highest additional average obesity expenditures among payers. Among people with prescription drug expenditures, obese people with disabilities had nine times the prevalence of diabetes as normal weight people with disabilities. Overweight people with and without disabilities had lower expenditures than normal-weight people with and without disabilities. Obesity results in substantial additional health care expenditures for people with disabilities. These additional expenditures pose a serious current and future problem, given the potential for higher obesity prevalence in the coming decade. Copyright © 2013 The Obesity Society.

National Trends in Nonstatin Use and Expenditures Among the US Adult Population From 2002 to 2013: Insights From Medical Expenditure Panel Survey.

Science.gov (United States)

Salami, Joseph A; Warraich, Haider J; Valero-Elizondo, Javier; Spatz, Erica S; Desai, Nihar R; Rana, Jamal S; Virani, Salim S; Blankstein, Ron; Khera, Amit; Blaha, Michael J; Blumenthal, Roger S; Katzen, Barry T; Lloyd-Jones, Donald; Krumholz, Harlan M; Nasir, Khurram

2018-01-22

Evidence supporting nonstatin lipid-lowering therapy in atherosclerotic cardiovascular disease risk reduction is variable. We aim to examine nonstatin utilization and expenditures in the United States between 2002 and 2013. We used the Medical Expenditure Panel Survey database to estimate national trends in nonstatin use and cost (total and out-of-pocket, adjusted to 2013 US dollars using a gross domestic product deflator) among adults 40 years or older. Nonstatin users increased from 3 million (2.5%) in 2002-2003 (20.1 million prescriptions) to 8 million (5.6%) in 2012-2013 (45.8 million prescriptions). Among adults with atherosclerotic cardiovascular disease, nonstatin use increased from 7.5% in 2002-2003 to 13.9% in 2012-2013 after peaking at 20.3% in 2006-2007. In 2012-2013, 15.9% of high-intensity statin users also used nonstatins, versus 9.7% of low/moderate-intensity users and 3.6% of statin nonusers. Nonstatin use was significantly lower among women (odds ratio 0.80; 95% confidence interval 0.75-0.86), racial/ethnic minorities (odds ratio 0.41; 95% confidence interval 0.36-0.47), and the uninsured (odds ratio 0.47; 95% confidence interval 0.40-0.56). Total nonstatin expenditures increased from $1.7 billion (out-of-pocket cost, $0.7 billion) in 2002-2003 to $7.9 billion (out-of-pocket cost $1.6 billion) in 2012-2013, as per-user nonstatin expenditure increased from $550 to $992. Nonstatin expenditure as a proportion of all lipid-lowering therapy expenditure increased 4-fold from 8% to 32%. Between 2002 and 2013, nonstatin use increased by 124%, resulting in a 364% increase in nonstatin-associated expenditures. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Total Energy Expenditure (TEE) measured with the doubly labeled water technique in women from 60 to 70 years of age from Havana City, Cuba

International Nuclear Information System (INIS)

Hernandez-Triana, M.H.; Porrata, C.; Estrada, G.; Diaz, M.E.; Martin, I.; Bayley, H.; McCormack, B.A.; Jones, P.J.H.

2002-01-01

Aim: With the purpose to measure the Total Energy Expenditure (TEE) and to validate the Cuban Dietary Energy Allowance for elderly subjects, energy expenditure was assessed by the doubly labeled water technique in 11 women aged 65.9 ± 2.8 y with a mean BMI of 21.4 ± 4.2 kg/m2 during 14 days under free-living conditions in their own environment in Havana City. Materials and Methods: After taking a basal urine sample, the women received an oral dose of 2.5 g H218O (10%) and 0.12 g 2H2O (99.8%) body weight and samples of saliva and urine were collected 14 days after. Resting Metabolic Rate (RMR) was estimated by the Schofield equations proposed by the 1985 FAO/WHO/UNU Expert Committee Report and energy intake was measured by trained dietitians using the 3-day weighed dietary record. A mean value of the food quotient of 0.85 was used for the calculations of the CO2 production by the isotopic method. Results: In spite of the expected variability, the differences between TEE measured by the isotopic method (7.57 MJ/d) and estimated according to FAO/WHO/UNU, 1985 (7.24 MJ/d) were not significant (0.625). The recommended dietary allowance for energy valid for Cuban elderly subjects (7.66 MJ/d) was only slight over the value of the measured TEE. The value of energy expenditure measured in free-living elderly women from Havana City was in the range of acceptable values (6-8 MJ/d) for this group of age. Conclusions: The total energy expenditure of elderly women from Havana City was lower than reported values for women living in developed countries but coincident with those of women of the developing world. The differences between dietary energy intake and TEE measured by the isotopic method were around 27% and coincident with previous reports in elderly people. The Cuban allowance for dietary energy for elderly women was enough for covering their energy requirements

Assessing the Energy Expenditure of Elite Female Soccer Players: A Preliminary Study.

Science.gov (United States)

Mara, Jocelyn K; Thompson, Kevin G; Pumpa, Kate L

2015-10-01

The aim of this study was to assess the total and exercise energy expenditure of elite female soccer players during a training week. Eight elite female soccer players wore SenseWear Mini Armbands (SWAs) for 7 consecutive days during the preseason phase of a national league competition. In addition, players wore 15-Hz GPSports tracking devices during 4 training sessions and a friendly game. Total energy expenditure, exercise energy expenditure, and training and game demands were collected from the SWA and GPSports devices. Mean daily energy expenditure for the game day, training days, and rest days were 12,242 kJ (SD = 603 kJ), 11,692 (SD = 274 kJ), and 9,516 (SD = 369 kJ), respectively, with significant differences shown between activities (p soccer players. Nutritional intake should be adjusted accordingly to avoid energy imbalances for optimal performance and recovery.

PUBLIC EXPENDITURE ON HEALTH IN LOCAL BUDGETS

Directory of Open Access Journals (Sweden)

Cristinel ICHIM

2017-06-01

Full Text Available This paper entitled "Public expenditure on health in local budgets" aims analysing and deepening major spending categories that public authorities finance at local level, namely health expenditure. In the first part of the article we have specified the content and role of this category of expenditure in local budgets and also made some feedback on decentralization in health. In the second part of the work, based on data available in Statistical Yearbook of Romania, we have carried out an analysis of the dynamics of health spending from local budgets to emphasize their place and role in the health care expenses. The research carried out follows that the evolution and structure of health expenditure financed from local budgets is determined, along with the legislative framework in the field, by several variables that differ from one territorial administrative unit to another: the existence of sanitary units, their type, the involving of local public authorities in their development and modernization, the number and the social structure of the population. The research shows that over the period 1993-2015, the dynamics of the share of health spending in total expenditures of local budgets is sinusoidal, with a minimum threshold in 2000 of only 0.3%.

A smooth mixture of Tobits model for healthcare expenditure.

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Keane, Michael; Stavrunova, Olena

2011-09-01

This paper develops a smooth mixture of Tobits (SMTobit) model for healthcare expenditure. The model is a generalization of the smoothly mixing regressions framework of Geweke and Keane (J Econometrics 2007; 138: 257-290) to the case of a Tobit-type limited dependent variable. A Markov chain Monte Carlo algorithm with data augmentation is developed to obtain the posterior distribution of model parameters. The model is applied to the US Medicare Current Beneficiary Survey data on total medical expenditure. The results suggest that the model can capture the overall shape of the expenditure distribution very well, and also provide a good fit to a number of characteristics of the conditional (on covariates) distribution of expenditure, such as the conditional mean, variance and probability of extreme outcomes, as well as the 50th, 90th, and 95th, percentiles. We find that healthier individuals face an expenditure distribution with lower mean, variance and probability of extreme outcomes, compared with their counterparts in a worse state of health. Males have an expenditure distribution with higher mean, variance and probability of an extreme outcome, compared with their female counterparts. The results also suggest that heart and cardiovascular diseases affect the expenditure of males more than that of females. Copyright © 2011 John Wiley & Sons, Ltd.

Intraspecies variation in BMR does not affect estimates of early hominin total daily energy expenditure.

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Froehle, Andrew W; Schoeninger, Margaret J

2006-12-01

We conducted a meta-analysis of 45 studies reporting basal metabolic rate (BMR) data for Homo sapiens and Pan troglodytes to determine the effects of sex, age, and latitude (a proxy for climate, in humans only). BMR was normalized for body size using fat-free mass in humans and body mass in chimpanzees. We found no effect of sex in either species and no age effect in chimpanzees. In humans, juveniles differed significantly from adults (ANCOVA: P BMR and body size, and used them to predict total daily energy expenditure (TEE) in four early hominin species. Our predictions concur with previous TEE estimates (i.e. Leonard and Robertson: Am J Phys Anthropol 102 (1997) 265-281), and support the conclusion that TEE increased greatly with H. erectus. Our results show that intraspecific variation in BMR does not affect TEE estimates for interspecific comparisons. Comparisons of more closely related groups such as humans and Neandertals, however, may benefit from consideration of this variation. 2006 Wiley-Liss, Inc.

The impact of public expenditure on undernourishment distribution in Mexico.

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Moreno-Macías, Lidia; Palma-Solís, Marco; Zapata-Vázquez, Rita E

2013-09-01

The status of undernourishment in children under the age of five in Mexico is open to debate. Linked to poverty, underweight and stunting, the rates of undernourishment are reported to be diminishing, although poverty remains an incessant problem. This study was done to determine whether there is an association between public expenditure and underweight and stunting distribution in Mexico based on data from the 2006 health and population census and from macroeconomic, social, and demographic variables. We used principal component analysis to reduce the number of variables and analyze their behavior. Multiple regressions showed that underweight and stunting are significantly associated with the marginalization index, support from the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) supplies and breakfast program, the gross domestic product per capita, and expenditure from the Opportunities program. Further, public expenditure aimed to combat undernourishment is inadequately oriented to address the needs of the poor.

Using an ounce of prevention: does it reduce health care expenditures and reap pounds of profits? A study of the financial impact of wellness and health risk screening programs.

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Phillips, Janet F

2009-01-01

As we are all well aware, health care expenditures in the United States are out of control and growing at epic proportions. Since private industry shoulders a significant burden of paying these rising health care costs, the huge and ever increasing sum paid by these corporations continues to impact the US economy translating into higher prices of services and manufactured goods and reduced job opportunities when companies outsource jobs or locate manufacturing facilities to avoid paying health care benefits for workers. As a result, health care expenditures have become a centerpiece of an enormous public policy debate as Congress is currently working on several versions of a bill to completely revise health care from the ground up. This research project was accomplished to examine the effectiveness of one approach to control rising health care costs and contain corporate financial responsibility--the establishment of wellness and health risk screening programs to improve the health of employees. Total health care cost per insured individual was gathered through an online survey directly from health care benefit administrators. The survey also asked information about wellness and health risk screening programs and the related responses were used to determine if there were a relationship between health care costs and health prevention programs. While statistical analysis was hampered in the current study because of the small sample size, some valid conclusions were reached. The study was successful in identifying a benchmark of Average Total Health Care Cost per Individual from $5,100 to $5,800 for 2005 through 2007. This is especially interesting in light of the fact that an average of $7,026 was spent on health care per person in 2006 in the United States. The study was also able to contribute an estimate of the increase realized in these expenditures of 6 percent in 2007 over 2006, and 4 percent in 2006 over 2005, which were in fact similar to the national average

Establishing a total information management program

International Nuclear Information System (INIS)

Hegstrom, K.L.; Fisher, J.

1982-01-01

A total information management program manages documents for easy access and identifies data elements commonly found in all documents. The program thus links disparate documents by identifying information they share in common

Effect of chewing speed on energy expenditure in healthy subjects.

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Paphangkorakit, Jarin; Leelayuwat, Naruemon; Boonyawat, Nattawat; Parniangtong, Auddamar; Sripratoom, Jindamanee

2014-08-01

The aim of the study was to investigate the effect of rate of chewing on energy expenditure in human subjects. Fourteen healthy subjects (aged 18-24 years) within the normal range of BMI participated in a cross-over experiment consisting of two 6-min sessions of gum chewing, slow (∼60 cycles/min) and fast (∼120 cycles/min) chewing. The resting energy expenditure (REE) and during gum chewing was measured using a ventilated hood connected to a gas analyzer system. The normality of data was explored using the Shapiro-Wilk test. The energy expenditure rate during chewing and the energy expenditure per chewing cycle were compared between the two chewing speeds using Wilcoxon signed ranks tests. The energy expenditure per chewing cycle during slow chewing (median 1.4, range 5.2 cal; mean 2.1±1.6 cal) was significantly higher than that during fast chewing (median 0.9, range 2.2 cal; mean 1.0±0.7 cal) (p chewing speeds (p > 0.05). The results of this study suggest that chewing at a slower speed could increase the energy expenditure per cycle and might affect the total daily energy expenditure.

Association Between Modifiable Risk Factors and Pharmaceutical Expenditures Among Adults With Atherosclerotic Cardiovascular Disease in the United States: 2012-2013 Medical Expenditures Panel Survey.

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Salami, Joseph A; Valero-Elizondo, Javier; Ogunmoroti, Oluseye; Spatz, Erica S; Rana, Jamal S; Virani, Salim S; Blankstein, Ron; Younus, Adnan; Arrieta, Alejandro; Blaha, Michael J; Veledar, Emir; Nasir, Khurram

2017-06-09

Atherosclerotic cardiovascular disease (ASCVD) causes most deaths in the United States and accounts for the highest healthcare spending. The association between the modifiable risk factors (MRFs) of ASCVD and pharmaceutical expenditures are largely unknown. We examined the association between MRFs and pharmaceutical expenditures among adults with ASCVD using the 2012 and 2013 Medical Expenditure Panel Survey. A 2-part model was used while accounting for the survey's complex design to obtain nationally representative results. All costs were adjusted to 2013 US dollars using the gross domestic product deflator. The annual total pharmaceutical expenditure among those with ASCVD was $71.6 billion, 33% of which was for medications for cardiovascular disease and 14% medications for diabetes mellitus. The adjusted relationship between MRFs and pharmaceutical expenditures showed significant marginal increase in average annual pharmaceutical expenditure associated with inadequate physical activity ($519 [95% confidence interval (CI), $12-918; P =0.011]), dyslipidemia ($631 [95% CI, $168-1094; P =0.008]), hypertension: ($1078 [95% CI, $697-1460; P expenditures among patients with established ASCVD regardless of non-ASCVD comorbidity. In-depth studies of the roles played by other factors in this association can help reduce medication-related expenditures among ASCVD patients. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Forecasting drug utilization and expenditure in a metropolitan health region

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Korkmaz Seher

2010-05-01

Full Text Available Abstract Background New pharmacological therapies are challenging the healthcare systems, and there is an increasing need to assess their therapeutic value in relation to existing alternatives as well as their potential budget impact. Consequently, new models to introduce drugs in healthcare are urgently needed. In the metropolitan health region of Stockholm, Sweden, a model has been developed including early warning (horizon scanning, forecasting of drug utilization and expenditure, critical drug evaluation as well as structured programs for the introduction and follow-up of new drugs. The aim of this paper is to present the forecasting model and the predicted growth in all therapeutic areas in 2010 and 2011. Methods Linear regression analysis was applied to aggregate sales data on hospital sales and dispensed drugs in ambulatory care, including both reimbursed expenditure and patient co-payment. The linear regression was applied on each pharmacological group based on four observations 2006-2009, and the crude predictions estimated for the coming two years 2010-2011. The crude predictions were then adjusted for factors likely to increase or decrease future utilization and expenditure, such as patent expiries, new drugs to be launched or new guidelines from national bodies or the regional Drug and Therapeutics Committee. The assessment included a close collaboration with clinical, clinical pharmacological and pharmaceutical experts from the regional Drug and Therapeutics Committee. Results The annual increase in total expenditure for prescription and hospital drugs was predicted to be 2.0% in 2010 and 4.0% in 2011. Expenditures will increase in most therapeutic areas, but most predominantly for antineoplastic and immune modulating agents as well as drugs for the nervous system, infectious diseases, and blood and blood-forming organs. Conclusions The utilisation and expenditure of drugs is difficult to forecast due to uncertainties about the rate

The private sector economic and employment benefits to the nation and to each state of proposed FY 1990 NASA procurement expenditures

Science.gov (United States)

1989-01-01

The private sector economic and employment benefits (disaggregated among 80 industries and 475 occupations) of the proposed FY 1990 NASA procurement expenditures to the nation and to each state are estimated. Nationwide, it is found that FY 1990 NASA procurement expenditures of $11.3 billion will have an economic multiplier of 2.1 and will create, directly and indirectly, 237,000 jobs, $23.2 billion in total industry sales, $2.4 billion in corporate profits, and $7.4 billion in Federal, state, and local government tax revenues. These benefits are widely dispersed throughout the United States and are significant in many states not normally considered to be major beneficiaries of NASA spending. The indirect economic benefits are identified for each state resulting from the second-, third-, and fourth rounds of industry purchases generated by NASA procurement expenditures. Each state is ranked on the basis of several criteria, including the total benefits, indirect benefits, and per capita benefits received from NASA spending. The estimates developed are important for maintaining a viable U.S. Space Program through the remainder of this century.

Determinants and Equity Evaluation for Health Expenditure Among Patients with Rare Diseases in China.

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Xin, Xiao-Xiong; Zhao, Liang; Guan, Xiao-Dong; Shi, Lu-Wen

2016-06-20

China has not established social security system for rare diseases. Rare diseases could easily impoverish patients and their families. Little research has studied the equity and accessibility of health services for patients with rare diseases in China. This study aimed to explore the factors that influence health expenditure of rare diseases and evaluate its equity. Questionnaire survey about living conditions and cost burden of patients with rare diseases was conducted. Individual and family information, health expenditure and reimbursement in 2014 of 982 patients were collected. The impact of medical insurance, individual sociodemographic characteristics, family characteristics, and healthcare need on total and out-of-pocket (OOP) health expenditures was analyzed through the generalized linear model. Equity of health expenditure was evaluated by both concentration index and Lorenz curve. Of all the surveyed patients, 11.41% had no medical insurance and 92.10% spent money to seek medical treatment in 2014. It was suggested female (P = 0.048), over 50 years of age (P = 0.062), high-income group (P = 0.021), hospitalization (P = 0.000), and reimbursement ratio (RR) (P = 0.000) were positively correlated with total health expenditure. Diseases not needing long-term treatment (P = 0.000) was negatively correlated with total health expenditure. Over 50 years of age (P = 0.065), high-income group (P = 0.018), hospitalization (P = 0.000) and having Urban Employee Basic Medical Insurance (UEBMI) (P = 0.022) were positively correlated with OOP health expenditure. Patient or the head of the household having received higher education (P = 0.044 and P = 0.081) and reimbursement ratio (P = 0.078) were negatively correlated with OOP health expenditure. The equity evaluation found concentration indexes of health expenditure before and after reimbursement were 0.0550 and 0.0539, respectively. OOP health expenditure of patients with UEBMI was significantly more than that of

THE ECONOMIC CRISIS IMPACT ON PUBLIC EXPENDITURES IN EU NEW MEMBER STATES

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Sabau-Popa Diana Claudia

2012-07-01

Full Text Available This article analyzes the main trends of public expenditures in the New Member States 12 in the last decade. We develop a synthetic analysis of the total public expenditures and also an analytical inquiry of major categories of public expenditures according to COFOG. Based on data provided by Eurostat from 2000 to 2010 we try to capture the impact of global financial crisis on the major trends of the public expenditures for new member states. Our purpose is to reveal a global view of the state of public expenditures in this group of EU countries and also we try to make a comparison between Romania and these countries considering that the stance of public finance is quite similar to the new member states. The major findings of this study are the high increase of the public expenditures for all the countries especially in 2009, due to a huge increase of the social protection expenditures. In this context we underline some correlations between the public expenditures evolution and economic growth.

Restaurants and hotels expenditure in Polish households of the elderly

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Piekut Marlena

2016-03-01

Full Text Available The age of household members is an important factor for expenditures. The aim of the study is to investigate the level of expenditure on restaurants and hotels incurred in Polish households of the elderly in 2004-2013 and to identify the factors affecting such expenditures. The source of information used in the study was the household budget survey of the Central Statistical Office of Poland. The main methods used in this study were variance analysis and regression analysis. Restaurants and hotels expenditure increases every year together with their share in total household expenditure. The most important factors affecting the restaurants and hotels spending in Polish households of the elderly are: income per capita and the level of education of the head of the family. The study on consumption determinants at different groups leads to better understanding of consumer behavior circumstances and thereby ensuring a good quality of life for the people of the elderly.

ADMINISTRATIVE EXPENDITURES OF SOCIAL SECURITY FUNDS IN UKRAINE

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Nataliia Ivanchuk

2017-12-01

Full Text Available Along with the expenditures for social protection, social security funds finance administrative direction, which should correspond to the amount of functions performed by a particular fund. The purpose of the paper is to determine ways to reduce administrative expenditures of state social security funds in the conditions of reforming Ukrainian economy. For this purpose, the authors investigate distribution of the expenditures between social security funds, analyse dynamics and structure of assignments for fund administration, and suggest possible ways to rationalize maintenance cost for these institutions. Methodology. Administrative expenditures are an integral part of the cost of social security funds and include particular items of expenses in the budget of these institutions. Applying a systematic approach to calculating the administrative costs of social security funds of Ukraine the authors have taken into account the expenditures related to funding management, support for information systems, and organization of work with insured people. Results of the survey showed that in 2007–2016 Pension Fund of Ukraine incurred the largest part of social expenditures (more than 90% compared with other social insurance funds (less than 10%. At the same time, the administrative expenses were divided approximately into two halves between Pension Fund and other social security funds. In 2015, the government launched a reform of social insurance funds that aimed to reduce funds to three institutions but a decrease in the total amount of administrative expenditures has not been achieved yet. In addition, Pension Fund of Ukraine was least burdened with administrative expenses, while other social security funds with a relatively small share of social expenditures were burdened with administrative expenditures much more. Practical implications. Research showed that nowadays the existence of several social security funds in Ukraine is economically

Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility.

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Newcomer, Robert J; Ko, Michelle; Kang, Taewoon; Harrington, Charlene; Hulett, Denis; Bindman, Andrew B

2016-03-01

Individuals who receive long-term services and supports (LTSS) are among the most costly participants in the Medicare and Medicaid programs. To compare health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care. Retrospective cohort analysis of California dually eligible adult Medicaid and Medicare beneficiaries who initiated Medicaid LTSS, identified as HCBS or extended nursing facility care, in 2006 or 2007. Propensity score matching for demographic, health, and functional characteristics resulted in a subsample of 34,660 users who initiated Medicaid HCBS versus extended nursing facility use. Those with developmental disabilities or in managed care plans were excluded. Average monthly adjusted acute, postacute, long-term, and total Medicare and Medicaid expenditures for the 12 months following initiation of either HCBS or extended nursing facility care. Those initiating extended nursing facility care had, on average, $2919 higher adjusted total health care expenditures per month compared with those who initiated HCBS. The difference was primarily attributable to spending on LTSS $2855. On average, the monthly LTSS expenditures were higher for Medicare $1501 and for Medicaid $1344 when LTSS was provided in a nursing facility rather than in the community. The higher cost of delivering LTSS in a nursing facility rather than in the community was not offset by lower acute and postacute spending. Medicare and Medicaid contribute similar amounts to the LTSS cost difference and both could benefit financially by redirecting care from institutions to the community.

Local health departments and specific maternal and child health expenditures: relationships between spending and need.

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Bekemeier, Betty; Dunbar, Matthew; Bryan, Matthew; Morris, Michael E

2012-11-01

As a part of the Public Health Activities and Service Tracking study and in collaboration with partners in 2 Public Health Practice-Based Research Network states, we examined relationships between local health department (LHD) maternal and child health (MCH) expenditures and local needs. We used a multivariate pooled time-series design to estimate ecologic associations between expenditures in 3 MCH-specific service areas and related measures of need from 2005 to 2010 while controlling for other factors. Retrospective expenditure data from LHDs and for 3 MCH services represented annual investments in (1) Special Supplemental Nutrition for Women, Infants, and Children (WIC), (2) family planning, and (3) a composite of Maternal, Infant, Child, and Adolescent (MICA) service. Expenditure data from all LHDs in Florida and Washington were then combined with "need" and control variables. Our sample consisted of the 102 LHDs in Florida and Washington and the county (or multicounty) jurisdictions they serve. Expenditures for WIC and for our composite of MICA services were strongly associated with need among LHDs in the sample states. For WIC, this association was positive, and for MICA services, this association was negative. Family planning expenditures were weakly associated, in a positive direction. Findings demonstrate wide variations across programs and LHDs in relation to need and may underscore differences in how programs are funded. Programs with financial disbursements based on guidelines that factor in local needs may be better able to provide service as local needs grow than programs with less needs-based funding allocations.

[Changes in processed food expenditure in the population of Metropolitan Santiago in the last twenty years].

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Crovetto, Mirta; Uauy, Ricardo

2012-03-01

During recent decades household incomes have increased steadily, leading to changes in dietary habits and food expenditure. To report changes in household food expenditure focusing on trends in processed food across income quintiles in Metropolitan Santiago. Information obtained from the Fourth (1986-1987), Fifth (1996-1997) and Sixth National Institute of Statistics (INE) Surveys (2006-2007) were used. Food expenditure data over the study periods was extracted from household expenditure surveys (HES) after verifying and adjusting food prices registered by the INE to current 2007 prices. Absolute food expenditure over the study period increased for all groups; the largest increase was found in lowest income quintiles; however, the proportion of total family budget spent on food decreased in all groups. The largest increases in food expenditure corresponded to sweetened beverages, processed fruit juices, alcoholic drinks, ready meals and "eating out". Expenditure on fish rose slightly whereas the absolute spending on legumes, eggs and oils decreased. Expenditure in processed food as percentage of total food expenditure increased from 42% to 57% of total for mean household. For the 2nd quintile it rose from 31% to 48% and for the lowest quintile increased from 53% to 68% over the three decades (1987-2007). Changes were greatest in energy rich processed foods such as bread, pastries, confectioneries and granulated sugar. These particular foods are of high energy density and contain high amounts of saturated fat, sodium and added sugars. These results confirm that food consumption patterns over the past decades have progressively departed from the recommended dietary guidelines given by national and international health organizations.

Simultaneous measurement of milk intake and total energy expenditure in mixed-fed infants: Methodological approach and prediction of total body water

International Nuclear Information System (INIS)

Wells, J.C.K.; Davies, P.S.W.; Coward, W.A.

2000-01-01

Evaluation of the energy metabolism that underlies the new WHO breast-fed growth reference requires simultaneous measurements of milk volume intake (MVI) and total energy expenditure (TEE) by stable isotope methodologies. In young infants, such data is collected without difficulty using the dose-to-the-infant method. In older infants, where breast-milk is supplemented with non-milk foods, MVI must be measured by dosing the mother instead of the infant. This procedure would interfere with a simple measurement of infant TEE using the standard dose-to-the-infant method. Theoretically, this difficulty can be resolved by dosing the mother with deuterium and the infant with 18-oxygen, and using curve-peeling methods to calculate the infant deuterium kinetics. We propose to ascertain whether such an approach is viable in practice, such that MVI, TEE and body composition could all be measured simultaneously in mixed-fed infants. Where MVI in older infants is measured on its own, there is a need to predict infant body water in order to estimate the deuterium dilution space. Using a database of 234 infants aged 1.5 to 12 months, we provide new predictive equations by which such values may be obtained. (author)

Pharmaceutical expenditure on drugs for rare diseases in Canada: a historical (2007-13) and prospective (2014-18) MIDAS sales data analysis.

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Divino, Victoria; DeKoven, Mitch; Kleinrock, Michael; Wade, Rolin L; Kim, Tony; Kaura, Satyin

2016-05-21

Health Canada has defined rare diseases as life-threatening, seriously debilitating, or serious chronic conditions affecting a very small number of patients (~1 in 2,000 persons). An estimated 9 % of Canadians suffer from a rare disease. Drugs treating rare diseases (DRDs) are also known as orphan drugs. While Canada is currently developing an orphan drug framework, in the United States (US), the Orphan Drug Act (ODA) of 1983 established incentives for the development of orphan drugs. This study measured total annual expenditure of orphan drugs in Canada (2007-13) and estimated future (2014-18) orphan drug expenditure. Orphan drugs approved by the US Food and Drug Administration (FDA) in the US were used as a proxy for the orphan drug landscape in Canada. Branded, orphan drugs approved by the FDA between 1983 through 2013 were identified (N = 356 unique products). Only US orphan drugs with the same orphan indication(s) approved in Canada were included in the analysis. Adjustment via an indication factoring was applied to products with both orphan and non-orphan indications using available data sources to isolate orphan-indication sales. The IMS Health MIDAS database of audited biopharmaceutical sales was utilized to measure total orphan drug expenditure, calculated annually from 2007-2013 and evaluated as a proportion of total annual pharmaceutical drug expenditure (adjusted to 2014 CAD). Between 2007 and 2013, expenditure was measured for a final N = 147 orphan drugs. Orphan drug expenditure totaled $610.2 million (M) in 2007 and $1,100.0 M in 2013, representing 3.3- 5.6 % of total Canadian pharmaceutical drug expenditure in 2007-2013, respectively. Future trend analysis suggests orphan drug expenditure will remain under 6 % of total expenditure in 2014-18. While the number of available orphan drugs and associated expenditure increased over time, access remains an issue, and from the perspectives of society and equity, overall spending on orphan drugs

Catastrophic household expenditure on health in Nepal: a cross-sectional survey.

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Saito, Eiko; Gilmour, Stuart; Rahman, Md Mizanur; Gautam, Ghan Shyam; Shrestha, Pradeep Krishna; Shibuya, Kenji

2014-10-01

To determine the incidence of - and illnesses commonly associated with - catastrophic household expenditure on health in Nepal. We did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household surveyed, out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household's total expenditure over the same period was considered to be catastrophic. We estimated the incidence and intensity of catastrophic health expenditure. We identified the illnesses most commonly associated with such expenditure using a Poisson regression model and assessed the distribution of expenditure by economic quintile of households using the concentration index. Overall, 284 of the 1997 households studied in Kathmandu, i.e. 13.8% after adjustment by sampling weight, reported catastrophic health expenditure in the 30 days before the survey. After adjusting for confounders, this expenditure was found to be associated with injuries, particularly those resulting from road traffic accidents. Catastrophic expenditure by households in the poorest quintile were associated with at least one episode of diabetes, asthma or heart disease. In an urban area of Nepal, catastrophic household expenditure on health was mostly associated with injuries and noncommunicable diseases such as diabetes and asthma. Throughout Nepal, interventions for the control and management of noncommunicable diseases and the prevention of road traffic accidents should be promoted. A phased introduction of health insurance should also reduce the incidence of catastrophic household expenditure.

Health care expenditure in the Islamic Republic of Iran versus other high spending countries.

Science.gov (United States)

Khosravi, Bahman; Soltani, Shahin; Javan-Noughabi, Javad; Faramarzi, Ahmad

2017-01-01

Background: In all countries, health expenditures are a main part of government expenditure, and governments try to find policies and strategies to reduce this expenditure. Overall expenditure index has been raised 30 times during the past 20 years in Iran, while in the health sector, the growth in health expenditures index has been 71 times. The present study aimed at examining health care expenditure in the Islamic Republic of Iran versus other high spending countries. Methods: A comparative panel study was conducted in selected countries with the high mean of health expenditure per capita. Data were collected from the WORLD BANK. Out- of- pocket (OOP), health expenditure per capita, public and private health expenditure, and total health expenditure were compared among the selected counties. Results: Iran has the lowest health expenditure per capita compared to other countries and the USA has the highest health expenditures per capita. In Iran, out- of- pocket expenditure, with more than 50%, was the most cost, while in Luxembourg it was the least cost during 2004 to 2014, with less than 12%. Conclusion: Our findings revealed that politicians and health care executives should find a stable source to finance the health system. Stable sources of financing lead to having a steady trend in health expenditure.

Uranium exploration expenditures in 1980 and plans for 1981-1982

International Nuclear Information System (INIS)

Sanders, L.R. Jr.

1981-05-01

The Grand Junction Office of the US Department of Energy has conducted annual surveys of actual and planned uranium exploration activities since 1971. This report summarizes the aggregated proprietary information which has been furnished by the industry on a confidential basis. This work is part of an overall program to evaluate future supplies of nuclear fuel. The annual surveys have covered: (1) land acquired for exploration and cost of acquisition (since 1966); (2) surface drilling footage and cost (since 1966); (3) all other exploration expenditures (since 1966); (4) estimates of exploration activities and costs for the next 2 years (since 1971), this year's survey covered estimates for 1981 to 1982; (5) year-end total of lands held for uranium exploration (since 1972); (6) exploration for nonsandstone deposits (since 1974); (7) exploration in nonestablished areas (since 1974); (8) foreign uranium exploration expenditures by US companies (since 1966); (9) foreign participation in exploration activities in the United States (since 1975); (10) aerial radiometric exploration activities (since 1977); and (11) solution mining production drilling (since 1976). This report presents a compilation of data from the replies of 147 companies

Validation of doubly labeled water for measuring energy expenditure during parenteral nutrition

International Nuclear Information System (INIS)

Schoeller, D.A.; Kushner, R.F.; Jones, P.J.

1986-01-01

The doubly labeled water method was compared with intake-balance for measuring energy expenditure in five patients receiving total parenteral nutrition (TPN). Because parenteral solutions were isotopically different from local water, patients had to be placed on TPN at least 10 days before the metabolic period. Approximately 0.1 g 2H2O and 0.25 g H2(18)O per kg total body water were given orally. We collected saliva before, 3 h, and 4 h after the dose for measurement of total body water and urine before, 1 day, and 14 days after the dose for measurement of isotope eliminations. On day 14, total body weight was remeasured and change in body energy stores was calculated, assuming constant hydration. Intake was assessed from weights of TPN fluids plus dietary record for any oral intake. Energy expenditure from doubly labeled water (+/- SD) averaged 3 +/- 6% greater than intake-balance. Doubly labeled water method is a noninvasive, nonrestrictive method for measuring energy expenditure in patients receiving TPN

Comparison of resting energy equations and total energy expenditure in haemodialysis patients and body composition measured by multi-frequency bioimpedance.

Science.gov (United States)

Oliveira, Ben; Sridharan, Sivakumar; Farrington, Ken; Davenport, Andrew

2017-07-13

Waste products of metabolism are retained in haemodialysis (HD) patients. Cellular metabolism generates energy, and patients with greater energy expenditure may therefore require more dialysis. To determine the amount of dialysis required, equations estimating resting and total energy expenditure (REE,TEE) are required. We compared estimates of REE in HD patients using established equations with a novel equation recently validated in HD patients (HD equation). TEE was derived from REE (HD equation) and estimates of physical activity obtained by questionnaire. REE and TEE relationships with bioimpedance measured body composition were then determined. We studied 317 HD patients; 195 males (61.5%), 123 diabetic (38.9%), mean age 65.0 ± 15.3 and weight 73.1 ± 16.8 kg. REE from HD Equation was 1509 ± 241 kcal/day, which was greater than for Mifflin St Joer 1384 ± 259, Harris-Benedict 1437 ± 244, Katch-McArdle 1345 ± 232 (all p employment (β 406.5, p appearance (β 2.7, p = 0.015), and negatively with age (β -7.9, p appearance, lower co-morbidity, age, and dialysis vintage, and the employed. More metabolically active patients may require greater dialytic clearances. This article is protected by copyright. All rights reserved.

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach.

Science.gov (United States)

Agarwal, Parul; Sambamoorthi, Usha

2015-12-01

Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.

Measurements of Daily Energy Intake and Total Energy Expenditure in People with Dementia in Care Homes: The Use of Wearable Technology.

Science.gov (United States)

Murphy, J; Holmes, J; Brooks, C

2017-01-01

To estimate daily total energy expenditure (TEE) using a physical activity monitor, combined with dietary assessment of energy intake to assess the relationship between daily energy expenditure and patterns of activity with energy intake in people with dementia living in care homes. A cross-sectional study in care homes in the UK. Twenty residents with confirmed dementia diagnosis were recruited from two care homes that specialised in dementia care. A physical activity monitor (SensewearTM Armband, Body Media, Pittsburgh, PA) was employed to objectively determine total energy expenditure, sleep duration and physical activity. The armband was placed around the left upper triceps for up to 7 days. Energy intake was determined by weighing all food and drink items over 4 days (3 weekdays and 1 weekend day) including measurements of food wastage. The mean age was 78.7 (SD ± 11.8) years, Body Mass Index (BMI) 23.0 (SD ± 4.2) kg/m2; 50% were women. Energy intake (mean 7.4; SD ± 2.6) MJ/d) was correlated with TEE (mean 7.6; SD ± 1.8 MJ/d; r=0.49, p<0.05). Duration of sleeping ranged from 0.4-12.5 (mean 6.1) hrs/d and time spent lying down was 1.3-16.0 (8.3) hrs/d. On average residents spent 17.9 (6.3-23.4) hrs/d undertaking sedentary activity. TEE was correlated with BMI (r=0.52, p<0.05) and body weight (r=0.81, p<0.001) but inversely related to sleep duration (r=-0.59, p<0.01) and time lying down (r=-0.62, p<0.01). Multiple linear regression analysis revealed that after taking BMI, sleep duration and time spent lying down into account, TEE was no longer correlated with energy intake. The results show the extent to which body mass, variable activity and sleep patterns may be contributing to TEE and together with reduced energy intake, energy requirements were not satisfied. Thus wearable technology has the potential to offer real-time monitoring to provide appropriate nutrition management that is more person-centred to prevent weight loss in dementia.

2016 Writing Contest Undergraduate Winner: The Relationship Between Medication Adherence and Total Healthcare Expenditures by Race/Ethnicity in Patients with Diabetes in Hawai'i.

Science.gov (United States)

Sutton, Cori X; Carpenter, Dee-Ann; Sumida, Wesley; Taira, Deborah

2017-07-01

Diabetes is a costly, chronic disease that is becoming increasingly prevalent worldwide. Studies show that Native Hawaiians suffer from higher rates of diabetes and lower rates of medication adherence compared to Caucasians and Japanese. This study compared total annual healthcare expenditures of patients with diabetes in Hawai'i by race and ethnicity and determined whether any existing differences persisted after controlling for medication adherence and demographic factors. The study population consisted of 30,445 individuals, using administrative claims data from a large health plan in Hawai'i. Filipinos, Native Hawaiians, and Other Pacific Islanders had significantly lower medication adherence rates compared to other groups. These ethnic groups also had the lowest median healthcare costs. In contrast, Caucasians had one of the highest medication adherence rates coupled with the highest median annual healthcare expenditures at $5,132. Generalized linear regression models showed that after controlling for demographic factors and medication adherence, Japanese (RR=0.86, 95%CI [0.78, 0.94]), Chinese (RR=0.83, 95%CI [0.73, 0.95]), Filipinos (RR=0.74, 95%CI [0.67, 0.82]), and Native Hawaiians (RR=0.74, 95%CI [0.67, 0.82]) had significantly lower total healthcare costs compared to Caucasians. Costs for Other Pacific Islanders were not significantly different from those of Caucasians. This study provides evidence that total health-related cost is associated with a multitude of factors that further research may reveal.

Assessment of physical activity and energy expenditure: an overview of objective measures

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Andrew P Hills

2014-06-01

Full Text Available The ability to assess energy expenditure and estimate physical activity in free-living individuals is extremely important in the global context of non-communicable diseases including malnutrition, overnutrition (obesity and diabetes. It is also important to appreciate that physical activity and energy expenditure are different constructs with physical activity defined as any bodily movement that results in energy expenditure and accordingly, energy is expended as a result of physical activity. However, total energy expenditure, best assessed using the criterion doubly labelled water technique, includes components in addition to physical activity energy expenditure, namely resting energy expenditure and the thermic effect of food. Given the large number of assessment techniques currently used to estimate physical activity in humans, it is imperative to understand the relative merits of each. The goal of this review is to provide information on the utility and limitations of a range of objective measures of physical activity and their relationship with energy expenditure. The measures discussed include those based on energy expenditure or oxygen uptake including doubly labelled water, activity energy expenditure, physical activity level, and metabolic equivalent; those based on heart rate monitoring and motion sensors; and because of their widespread use, selected subjective measures.

Government programs for climate change mitigation in Japan. An analysis based on public budget documents and Government Project Review Sheets

International Nuclear Information System (INIS)

Kimura, Osamu

2016-01-01

The Japanese government has been spending huge public budgets for various programs to mitigate climate change, such as subsidy programs for energy efficient and renewable technologies, and R and D programs to develop innovative low carbon technologies. This report makes a comprehensive review of government projects and expenditure related to climate change mitigation in order to grasp their total expenditure and to analyze portfolio of supported technology and activity types, outcome, and the cost-effectiveness. It is estimated that the total expenditure for climate change mitigation excluding nuclear energy and forest sink projects amounts to 4.8 trillion JPY (approximately 40 billion USD) in the period of 2008 to 2014. 40% of the total expenditure went to only three largest programs, namely the Eco Car Subsidy, the Eco Point Programs for Appliances and Houses, all of which have gone through virtually no or only poor evaluations by the implementing ministries. While some programs had decent cost-effectiveness of reducing carbon dioxide emission at below 10,000 JPY/t-CO 2 (approximately 90 USD), there are also programs with very low cost-effectiveness at more than 100,000 JPY/t-CO 2 . Moreover, all of the evaluation was based on 'gross' reduction, not on 'net' of freeriders, rebound and other factors, which may lead to overestimation of performances. The result shows the need for a much larger resource for evaluation activities by the government. (author)

Health care expenditure associated with overweight/obesity: a study among urban married women in Delhi, India.

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Agrawal, Praween; Agrawal, Sutapa

2015-08-01

Obesity is a multifaceted problem with wide-reaching medical, social and economic consequences. While health consequences are much known, but due to paucity of data, economic consequences are less known in India. The prevalence for excessive weight particularly among women population has been increasing dramatically in India in the last decades. We examined the economic burden on individual and households due to overweight and obesity among women in the national capital territory of India, Delhi. We particularly examined the health expenditure pattern in absolute amount as well as a proportion to their household expenditure among women according to their level of body mass index (BMI). A population based follow-up survey of 325 ever-married women aged 20-54 years residing in the national capital territory of Delhi in India, systematically selected from the second round of National Family Health Survey (NFHS-2, 1998-99) samples who were re-interviewed after four years in 2003. Women's expenditure on health has been seen as a gross and as a ratio of total household expenditure. Anthropometric measurements were obtained from women to compute their current body mass index. Multiple logistic regression analysis was used to estimate the odds ratios adjusting for various socio demographic confounders. A significantly (peconomic burden which accounts for more than 5% of their total household expenditure on their health compared to only 10% normal weight women. Significantly, obese and morbidly obese women were more than two times more likely to spend higher amount on their health (OR 2.29 95% CI: 1.07-4.90; p=0.033) than normal weight women. Also overweight women were significantly two times more likely to spend high proportion on their health with respect to total household expenditure (OR 2.11; 95% CI: 1.03-4.35; p=0.042) than normal weight women. There is substantial economic burden of obesity for individuals as well as for the households which calls for urgent

Tourism Expenditures and Environment in Thailand

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Malliga Sompholkrang

2014-09-01

Full Text Available Tourism activities affect the environment of different destinations, which is influenced by different tourists’ consumption. The objective of this study is to examine the relationship between inbound tourist expenditures and three main environmental dimensions, which are carbon dioxide emission from transport, energy demand, and water usage, in Thailand. This paper employs Vector Autoregressive (VAR models to determine the relationship of variables. Data from Ministry of Energy, Bank of Thailand, Metropolitan Electricity Authority, Provincial Waterworks Authority, National Statistical Office, Department of Tourism, and Tourism Authority of Thailand between 1988 and 2012 have been applied in the model. Note that, energy demand is represented by total electricity consumption of hotel and accommodation sector in Thailand, while water usage is represented by the total water consumption of tourists. This study found the relationships among tourists’ expenditures, carbon dioxide emission from transport, energy demand, and water usage. Therefore, the policies recommendations may be essential to prepare the optimal schemes and budgets for encountering the environmental impacts from tourism business expansion.

Energy Expenditure in Infants in Health and Disease

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Ross Shepherd

1997-01-01

Full Text Available Measurement of energy balance represents a basic theoretical concept in the determination of nutritional and fluid requirements in humans in health and disease. Infants have special nutrient requirements, more limited reserves and relative immaturity of organ function. Energy requirements of infants have been based either retrospectively on intakes required to achieve normal growth or on equations derived from energy expenditure studies performed early this century. Recently, improved techniques for studying resting energy expenditure (REE, total energy expenditure (TEE and metabolically active body compartments in infants have facilitated more accurate estimates of energy requirements. Such studies indicated that current reference values for energy requirements are overestimates, and that compared with measured values, predicted values vary markedly between the various predictive equations with wide co-efficients of variation. In disease states with altered body composition, such as cystic fibrosis and end-stage liver disease, predictive equations markedly underestimate both energy and fluid requirements. In cystic fibrosis, both TEE and REE are 25% higher than values in healthy infants. In extrahepatic biliary atresia, energy expenditure per unit body cell mass is markedly elevated, suggesting that this is a catabolic condition in infants. Current estimates of energy and fluid requirements in both health and disease in infants need reappraisal. Bedside and free living energy expenditure methodology should be used to define accurately components of energy requirement in individual infants.

Health Care Expenditure of Rural Households in Pondicherry, India

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Poornima Varadarajan

2013-11-01

Full Text Available Background: Shortcomings in healthcare delivery has led people to spend a substantial proportion of their incomes on medical treatment. World Health Organization (2005 estimates reveal that every year 25 million households are forced into poverty by illness and the struggle to pay for healthcare. Thus we planned to calculate the health care expenditure of rural households and to assess the households incurring catastrophic health expenditure. Methods: A cross-sectional study was conducted in the service area of Sri Manakula Vinayagar Medical College and Hospital from May to August 2011. A total of 100 households from the 4 adjoining villages of our Institute were selected for operational and logistic feasibility. The household’s capacity to pay, out of pocket expenditure and catastrophic health expenditure were calculated. Data collection was done using a pretested questionnaire by the principal investigator and the analysis was done using SPSS (version 16. Results: The average income in the highest income quintile was Rs 51,885 but the quintile ratio was 14.98. The median subsistence expenditure was Rs 4,520. About 18% of households got impoverished paying for health care. About 81% of households were incurring out of pocket expenditure and 66% were facing catastrophic health expenses of 40%.Conclusion There was very high out of pocket spending and a high prevalence of catastrophic expenditure noted. Providing quality care at affordable cost and appropriate risk pooling mechanism are warranted to protect households from such economic threats.

Determinants of outpatient expenditure within primary care in the Brazilian National Health System

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Bruna Camilo Turi

2017-04-01

Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: One of the big challenges facing governments worldwide is the financing of healthcare systems. Thus, it is necessary to understand the factors and key components associated with healthcare expenditure. The aim here was to identify demographic, socioeconomic, lifestyle and clinical factors associated with direct healthcare expenditure within primary care, among adults attended through the Brazilian National Health System in the city of Bauru. DESIGN AND SETTING: Cross-sectional study conducted in five primary care units in Bauru (SP, Brazil. METHODS: Healthcare expenditure over the last 12 months was assessed through medical records of adults aged 50 years or more. Annual healthcare expenditure was assessed in terms of medication, laboratory tests, medical consultations and the total. Body mass index, waist circumference, hypertension, age, sex, physical activity and smoking were assessed through face-to-face interviews. RESULTS: The total healthcare expenditure for 963 participants of this survey was US$ 112,849.74 (46.9% consultations, 35.2% medication and 17.9% laboratory tests. Expenditure on medication was associated with overweight (odds ratio, OR = 1.80; 95% confidence interval, CI: 1.07-3.01, hypertension (OR = 3.04; 95% CI: 1.91-4.82 and moderate physical activity (OR = 0.56; 95% CI: 0.38-0.81. Expenditure on consultations was associated with hypertension (OR = 1.67; 95% CI: 1.12-2.47 and female sex (OR = 1.70; 95% CI: 1.14-2.55. CONCLUSIONS: Our results showed that overweight, lower levels of physical activity and hypertension were independent risk factors associated with higher healthcare expenditure within primary care.

[Reimbursed health expenditures during the last year of life, in France, in the year 2008].

Science.gov (United States)

Ricci, P; Mezzarobba, M; Blotière, P O; Polton, D

2013-02-01

To measure the reimbursed health expenditures in the last year of life and the proportion it represents in total reimbursement costs in 2008, to analyse the structure of such expenditures and to identify costs by cause of death. Data were obtained from the French national insurance information system (SNIIRAM). Data from the national hospital discharge database were linked to the outpatient reimbursement database for patients covered by the general health insurance scheme (n=49 million persons). The cost of the last year of life was calculated for the exhaustive population (361,328 deaths in 2008). The supposed cause of death was mainly derived from the primary diagnosis of the last hospital stay during which the patient died. The average reimbursed expenses during the last year of life were estimated at 22,000 € per person in 2008, with 12,500 € accounting for public hospital costs. Reimbursed health expenditures varied according to different medical causes of death: 52,300 € for HIV disease and about 40,000 € for tumors. A negative effect of age on the expenditure during the last year of life was observed. Health care spending increased with shorter time before death, the last month of life corresponding to 28% of reimbursed expenditures during the last year of life. Health care use in the last year of life represented 10.5% of the total health expenditures in 2008. This study found results similar to those observed in the past or in other countries. Our results show in particular that the weight of health expenditures during the last year of life on total health expenditures remains stable over the years. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Alcohol consumption and household expenditure on alcohol in a rural district in Vietnam

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Peter Allebeck

2013-01-01

Full Text Available Introduction: Alcohol use and alcohol-related problems are on the rise in low- and middle-income countries. Expenditure on alcohol is an important problem for families and communities and needs to be assessed. Aim: This study examines level of alcohol consumption and expenditure on alcohol in a district in Vietnam. Methods: A cross-sectional survey was conducted in a rural district in northern Vietnam. Multi-stage sampling was employed to randomly select participants from 20 communities and a town in the same district. One thousand five hundred and sixty-four adults (765 males and 799 females aged 18–60 years were interviewed. Information about alcohol use as well as expenditure on alcohol consumption four weeks prior to the interview was gathered. Non-parametric tests and log-linear regression were employed to compare expenditure on alcohol consumption across socioeconomic groups. Results: The prevalence of alcohol use one month prior to interview was 35% (66% among men and 5% among women. The median alcohol consumption among those who reported use of alcohol in the week prior to the interview was 7.9 standard drinks. Excessive drinking (more than 14 standard drinks per week for men and more than seven standard drinks per week for women occurred among 35% of those who used alcohol. Median expenditure for alcohol consumption during one month by those who drank alcohol was USD 3.5, accounting for 4.6% of household food expenditure, 2.7% of total household expenditure, and 1.8% of household income. The differences in alcohol consumption and expenditure between sexes and between socioeconomic groups are also presented. Conclusion: Our study confirms that alcohol consumption and alcohol-related problems are common among men in Vietnam. The share of alcohol expenditure in total household expenditure is substantial, especially among poor households. This should be considered an important public health issue, which needs to be taken into account in

Alcohol consumption and household expenditure on alcohol in a rural district in Vietnam.

Science.gov (United States)

Giang, Kim Bao; Van Minh, Hoang; Allebeck, Peter

2013-01-28

Alcohol use and alcohol-related problems are on the rise in low- and middle-income countries. Expenditure on alcohol is an important problem for families and communities and needs to be assessed. This study examines level of alcohol consumption and expenditure on alcohol in a district in Vietnam. A cross-sectional survey was conducted in a rural district in northern Vietnam. Multi-stage sampling was employed to randomly select participants from 20 communities and a town in the same district. One thousand five hundred and sixty-four adults (765 males and 799 females) aged 18-60 years were interviewed. Information about alcohol use as well as expenditure on alcohol consumption four weeks prior to the interview was gathered. Non-parametric tests and log-linear regression were employed to compare expenditure on alcohol consumption across socioeconomic groups. The prevalence of alcohol use one month prior to interview was 35% (66% among men and 5% among women). The median alcohol consumption among those who reported use of alcohol in the week prior to the interview was 7.9 standard drinks. Excessive drinking (more than 14 standard drinks per week for men and more than seven standard drinks per week for women) occurred among 35% of those who used alcohol. Median expenditure for alcohol consumption during one month by those who drank alcohol was USD 3.5, accounting for 4.6% of household food expenditure, 2.7% of total household expenditure, and 1.8% of household income. The differences in alcohol consumption and expenditure between sexes and between socioeconomic groups are also presented. Our study confirms that alcohol consumption and alcohol-related problems are common among men in Vietnam. The share of alcohol expenditure in total household expenditure is substantial, especially among poor households. This should be considered an important public health issue, which needs to be taken into account in the alcohol policy debate.

7 CFR 1486.404 - What expenditures are not eligible for program funding?

Science.gov (United States)

2010-01-01

...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS EMERGING..., unreasonable expenditures, or any cost of: (1) Branded product promotions—in-store, restaurant advertising...

Basal Metabolic Rate and Energy Expenditure of Rural Farmers in ...

African Journals Online (AJOL)

Measurement of basal metabolic rate (BMR) provides an important baseline for the determination of an individual's total energy requirement. The study sought to establish human energy expenditure of rural farmers in Magubike village in Tanzania, through determination of BMR, physical activity level (PAL) and total energy ...

Effect of Workplace Weight Management on Health Care Expenditures and Quality of Life.

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Michaud, Tzeyu L; Nyman, John A; Jutkowitz, Eric; Su, Dejun; Dowd, Bryan; Abraham, Jean M

2016-11-01

We examined the effectiveness of the weight management program used by the University of Minnesota in reducing health care expenditures and improving quality of life of its employees, and also in reducing their absenteeism during a 3-year intervention. A differences-in-differences regression approach was used to estimate the effect of weight management participation. We further applied ordinary least squares regression models with fixed effects to estimate the effect in an alternative analysis. Participation in the weight management program significantly reduced health care expenditures by $69 per month for employees, spouses, and dependents, and by $73 for employees only. Quality-of-life weights were 0.0045 points higher for participating employees than for nonparticipating ones. No significant effect was found for absenteeism. The workplace weight management used by the University of Minnesota reduced health care expenditures and improved quality of life.

Russia - Public Expenditure Review

OpenAIRE

World Bank

2011-01-01

The primary objective of the Public Expenditure Review (PER) is to assist the Ministry of Finance (MOF) in identifying opportunities for efficiency gains in some key categories of government expenditure. In this context, policy makers face two related fiscal dilemmas. First, how can expenditure efficiency are increased to provide public services with fewer resources? Second, how can the fi...

Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India.

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Garg, Charu C; Karan, Anup K

2009-03-01

Out-of-pocket (OOP) expenditure on health care has significant implications for poverty in many developing countries. This paper aims to assess the differential impact of OOP expenditure and its components, such as expenditure on inpatient care, outpatient care and on drugs, across different income quintiles, between developed and less developed regions in India. It also attempts to measure poverty at disaggregated rural-urban and state levels. Based on Consumer Expenditure Survey (CES) data from the National Sample Survey (NSS), conducted in 1999-2000, the share of households' expenditure on health services and drugs was calculated. The number of individuals below the state-specific rural and urban poverty line in 17 major states, with and without netting out OOP expenditure, was determined. This also enabled the calculation of the poverty gap or poverty deepening in each region. Estimates show that OOP expenditure is about 5% of total household expenditure (ranging from about 2% in Assam to almost 7% in Kerala) with a higher proportion being recorded in rural areas and affluent states. Purchase of drugs constitutes 70% of the total OOP expenditure. Approximately 32.5 million persons fell below the poverty line in 1999-2000 through OOP payments, implying that the overall poverty increase after accounting for OOP expenditure is 3.2% (as against a rise of 2.2% shown in earlier literature). Also, the poverty headcount increase and poverty deepening is much higher in poorer states and rural areas compared with affluent states and urban areas, except in the case of Maharashtra. High OOP payment share in total health expenditures did not always imply a high poverty headcount; state-specific economic and social factors played a role. The paper argues for better methods of capturing drugs expenditure in household surveys and recommends that special attention be paid to expenditures on drugs, in particular for the poor. Targeted policies in just five poor states to reduce

Estimation of nuclear power-related expenditures in fiscal 1982

International Nuclear Information System (INIS)

1981-01-01

In fiscal 1982 (April to March, 1983), the research and development on nuclear power should be promoted actively and extensively by taking the appropriate measures. In view of the importance, the budgetary expenditures are to be estimated duly for the purpose, considering also the stringent financial situation. The budgetary expenditures for nuclear power estimated for the fiscal year 1982 are about 292,800 Million in total and the obligation act limit is about 139,900 Million. The following matters are described: nuclear power-related measures for securing nuclear power safety, promotion of nuclear power generation, establishment of the nuclear fuel cycle, development of power reactors, research on nuclear fusion, strengthening of the foundation in nuclear power research, development and utilization, promotion of international cooperation, etc.; estimated budgetary expenditures; tables of budgetary demands in various categories. (J.P.N.)

Unpredictable Variable Prenatal Stress Programs Expression of Genes Involved in Appetite Control and Energy Expenditure

Science.gov (United States)

Moyer, E. L.; Al-Shayeb, B.; Baer, L. A.; Ronca, A. E.

2016-01-01

Exposure to stress in the womb shapes neurobiological and physiological outcomes of offspring in later life, including body weight regulation and metabolic profiles. Our previous work utilizing a centrifugation-induced hyper-gravity demonstrated significantly increased (8-15%) body mass in male, but not female, rats exposed throughout gestation to chronic 2-g from conception to birth. We reported a similar outcome in adult offspring exposed throughout gestation to Unpredictable Variable Prenatal Stress (UVPS). Here we examine gene expression changes and the plasma of animals treated with our UVPS model to identify a potential role for prenatal stress in this hypergravity programming effect. Specifically we focused on appetite control and energy expenditure pathways in prenatally stressed adult (90-day-old) male Sprague-Dawley rats.

Reconciling medical expenditure estimates from the MEPS and NHEA, 2007.

Science.gov (United States)

Bernard, Didem; Cowan, Cathy; Selden, Thomas; Cai, Liming; Catlin, Aaron; Heffler, Stephen

2012-01-01

Provide a comparison of health care expenditure estimates for 2007 from the Medical Expenditure Panel Survey (MEPS) and the National Health Expenditure Accounts (NHEA). Reconciling these estimates serves two important purposes. First, it is an important quality assurance exercise for improving and ensuring the integrity of each source's estimates. Second, the reconciliation provides a consistent baseline of health expenditure data for policy simulations. Our results assist researchers to adjust MEPS to be consistent with the NHEA so that the projected costs as well as budgetary and tax implications of any policy change are consistent with national health spending estimates. The Medical Expenditure Panel Survey produced by the Agency for Healthcare Research and Quality, and the National Health Center for Health Statistics and the National Health Expenditures produced by the Centers for Medicare & Medicaid Service's Office of the Actuary. In this study, we focus on the personal health care (PHC) sector, which includes the goods and services rendered to treat or prevent a specific disease or condition in an individual. The official 2007 NHEA estimate for PHC spending is $1,915 billion and the MEPS estimate is $1,126 billion. Adjusting the NHEA estimates for differences in underlying populations, covered services, and other measurement concepts reduces the NHEA estimate for 2007 to $1,366 billion. As a result, MEPS is $240 billion, or 17.6 percent, less than the adjusted NHEA total.

The Research of Economic Growth and Optimal Public Financial Expenditure%经济增长与最优财政支出规模研究

Institute of Scientific and Technical Information of China (English)

马树才; 孙长清

2005-01-01

The size of fiscal expenditure reflect the degree that government intervene in market, if government intervene in market too much, the action of government will lower economic growth. In order to choose optimal size of fiscal expenditure, the paper developed a endogenous growth model including government, and estimated the optimal size of fiscal expenditure in china from experience, the period is from 1978 to 2000. The conclusion is the optimal internal budget size of fiscal expenditure is 21.2% (fiscal expenditure relative to GDP), the total optimal size of fiscal expenditure is 24% (the total fiscal expenditure relative to GDP).

Recent trends in workload, input costs, and expenditures in the Air Force Medical Service Direct Care System.

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Robbins, Anthony S; Moilanen, Dale A; Fonseca, Vincent P; Chao, Susan Y

2002-04-01

A study was conducted to examine the relationship between two types of trends in the Air Force Medical Service Direct Care System (AFMS/DCS): trends in expenditures, total and by categories; and trends in medical workload, defined as the sum of inpatient admissions and outpatient clinic visits. Expenditure and medical workload data were extracted from the Medical Expense and Performance Reporting System Executive Query System. Medical inflation data were obtained from the Bureau of Labor Statistics Producer Price Index series. Between fiscal years 1995 and 1999, the AFMS/DCS experienced a 21.2% decrease in medical workload, but total (nominal) expenditures declined only 3.6%. Of all expenditure categories, only inpatient medical care, outpatient medical care, and military-funded private sector care for active duty personnel (supplemental care) have any direct relationship with AFMS/DCS medical workload. Real expenditures for the three categories above decreased by 20.3% during the 5-year period. Accounting for inflation and considering only expenditures related to medical workload, these results suggest that the AFMS/DCS is spending approximately 20% less money to do approximately 20% less work.

Revenues and Expenditures for Public Elementary and Secondary Education: School Year 2013-14 (Fiscal Year 2014). First Look. NCES 2016-301

Science.gov (United States)

Cornman, Stephen Q.; Zhou, Lei

2016-01-01

This "First Look" contains national and state totals of revenues and expenditures for public elementary and secondary education for school year 2013-14. This "First Look" includes revenues by source and expenditures by function and object, including current expenditures per pupil and instructional expenditures per pupil. This…

Robust analysis of the determinants of healthcare expenditure growth: evidence from panel data for low-, middle- and high-income countries.

Science.gov (United States)

Younsi, Moheddine; Chakroun, Mohamed; Nafla, Amine

2016-10-01

This paper examines the determinants of healthcare expenditure for low-, middle- and high-income countries, and it quantifies their influences in order to assess policies for achieving universal health coverage. We elaborate two models, a fixed-effect model and the dynamic panel model, to estimate the factors associated with the total health expenditure growth as well as its major components for 167 countries over the period of 1993-2013. The panel data on total health expenditure per capita and its components were taken from the World Development Indicators. Overall, our results showed that total health expenditure per capita is rising in all countries over time as a result of rising incomes. However, our estimates showed that the income elasticity of health expenditure ranged from 0.75 to 0.96 in the fixed-effect static panel model, while in the dynamic panel model, it was smaller and ranged from 0.16 to 0.47. Our empirical findings indicate that development assistance for health reduced government domestic spending on health but increased total government health spending. Our results also indicate that the trend in health expenditure growth is significantly depending with the country's economic development. In addition, out-of-pocket expenditure is powerfully influenced by a country's capacity to increase general government revenues and social insurance contributions. Knowledge of factors associated to health expenditure might help policy makers to make wise judgments, plan health reforms and allocate resources efficiently. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Total Energy Expenditure in Obese Kuwaiti Primary School Children Assessed by the Doubly-Labeled Water Technique

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Lena Davidsson

2016-10-01

Full Text Available The aim of this pilot study was to assess body composition and total energy expenditure (TEE in 35 obese 7–9 years old Kuwaiti children (18 girls and 17 boys. Total body water (TBW and TEE were assessed by doubly-labeled water technique. TBW was derived from the intercept of the elimination rate of deuterium and TEE from the difference in elimination rates of 18O and deuterium. TBW was used to estimate fat-free mass (FFM, using hydration factors for different ages and gender. Fat mass (FM was calculated as the difference between body weight and FFM. Body weight was not statistically different but TBW was significantly higher (p = 0.018 in boys (44.9% ± 3.3% than girls (42.4% ± 3.0%, while girls had significantly higher estimated FM (45.2 ± 3.9 weight % versus 41.6% ± 4.3%; p = 0.014. TEE was significantly higher in boys (2395 ± 349 kcal/day compared with girls (1978 ± 169 kcal/day; p = 0.001. Estimated physical activity level (PAL was significantly higher in boys; 1.61 ± 0.167 versus 1.51 ± 0.870; p = 0.034. Our results provide the first dataset of TEE in 7–9 years old obese Kuwaiti children and highlight important gender differences to be considered during the development of school based interventions targeted to combat childhood obesity.

Determinants of health expenditure in Nigeria | Agbatogun | Journal ...

African Journals Online (AJOL)

The paper examined the significance of the determinants of total government health expenditure in Nigeria. The various literature show that improvement of health sector is sine-qua-non to sustainable economic growth and development. Using regression analysis on macroeconomic data gathered, the results showed that ...

Misreporting of energy intake in the elderly using doubly labeled water to measure total energy expenditure and weight change.

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Shahar, Danit R; Yu, Binbing; Houston, Denise K; Kritchevsky, Stephen B; Newman, Anne B; Sellmeyer, Deborah E; Tylavsky, Frances A; Lee, Jung Sun; Harris, Tamara B

2010-02-01

One of the major problems in dietary assessment is inaccuracy in reporting diet. To examine the association between self-reported energy intake (EI) by food frequency questionnaire (FFQ) and energy expenditure (EE), measured by doubly labeled water (DLW), among older persons. EE was assessed in 298 high-functioning, community-dwelling older adults (70-79 years of age) over a 2-week period using DLW. Dietary intake was assessed using a Block FFQ. The ratio between reported EI and total energy expenditure (TEE) was calculated. Misreporting was defined as follows: participants with an EI/TEE ratio of reporters, while participants with an EI/TEE ratio >1.28 were categorized as high energy reporters. Participants with an EI/TEE ratio of 0.77-1.28 were categorized as "true" energy reporters. One-year percent weight change prior to EE visit was used as another validation indicator. Participants who were low energy reporters but lost >2% of their body weight were categorized as undereaters. Two hundred ninety-six participants provided both FFQ and DLW measurements. Forty-three percent of participants were low energy reporters; among them, almost 30% lost weight and, therefore, were categorized as undereaters. The undereaters consumed significantly fewer calories. No difference in the frequency of low energy reporting was detected between genders or racial groups. Underreporters had significantly higher body weight than "true" or high reporters. Undereaters tended to have higher body mass index than the underreporters. Undereating is prevalent in the elderly and may be falsely perceived as underreporting. It should be further addressed and characterized in future studies.

Higher Education Research Expenditure in South Africa: A Review of the New Funding Framework

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Odhiambo, Nicholas M.; Ntenga, Lydia

2015-01-01

The trends and the trajectory of higher education research expenditure in South Africa since the introduction of the New Funding Formula in 2004 have been analysed. The paper also compares the level of South Africa's total gross expenditure on research and development with those of other selected economies. The findings show that following…

Relation between holiday weight gain and total energy expenditure among 40- to 69-y-old men and women (OPEN study).

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Cook, Chad M; Subar, Amy F; Troiano, Richard P; Schoeller, Dale A

2012-03-01

A significant proportion of the average annual body weight (BW) gain in US adults (~0.5-1 kg/y) may result from modest episodes of positive energy balance during the winter holiday season. We tested whether holiday BW gain was reduced in participants with high baseline total energy expenditure (TEE) or whether it varied by BMI (in kg/m(2)). In a secondary analysis of previously published data, ΔBW normalized over 90 d from mid-September/mid-October 1999 to mid-January/early March 2000 was analyzed by sex, age, and BMI in 443 men and women (40-69 y of age). TEE was measured by doubly labeled water. High or low energy expenditure was assessed as residual TEE after linear adjustment for age, height, and BW. No correlations between ΔBW and TEE or TEE residuals were found. Sixty-five percent of men and 58% of women gained ≥0.5 kg BW, with ~50% of both groups gaining ≥1% of preholiday BW. Obese men (BMI ≥30) gained more BW than did obese women. A high preholiday absolute TEE or residual TEE did not protect against BW gain during the winter holiday quarter. It is not known whether higher than these typical TEE levels would protect against weight gain or if the observed gain may be attributed to increased food consumption and/or reduced physical activity during the holiday quarter.

National Health Expenditure Data

Data.gov (United States)

U.S. Department of Health & Human Services — National Health Expenditure Accounts are comprised of the following, National Health Expenditures - Historical and Projected, Age Estimates, State Health...

[The effect of Seguro Popular de Salud on catastrophic and impoverishing expenditures in Mexico, 2004-2012].

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Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Wong, Rebeca; Lugo-Palacios, David G; Méndez-Carniado, Oscar

2018-01-01

To determine the impact of Seguro Popular (SPS) on catastrophic and impoverishing household expenditures and on the financial protection of the Mexican health system. The propensity score matching (PSM) method was applied to the population affiliated to SPS to determine the program's attributable effect on health expenditure. This analysis uses the National Household Income and Expenditure Survey (ENIGH) during 2004-2012, conducted by Mexico's National Institute of Statistics andGeography (INEGI). It was found that SPS has a significant effect on reducing the likelihood that households will incur impoverishing expenditures. A negative effect on catastrophic expenditures was also found, but it was not statistically significant. This paper shows the effect that SPS, in particular health insurance, has as an instrument of financial protection. Future studies using longer periods of ENIGH data should analyze the persistence of high out-of-pocket expenditure.

HOUSEHOLD EXPENDITURE IN RESPONSE TO NATURAL DISASTERS

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Eny Sulistyaningrum

2015-09-01

Full Text Available Natural disasters have increased in their frequency, and the intensity of their destruction over the last ten years in Indonesia. Households usually respond to these difficulties by cutting their consump-tion, especially for non-essential goods. Arguably natural disasters are exogenous events, so this paper uses the exogenous variation from natural disasters as a natural experiment design to estimate the effect of disasters on household expenditure. When a certain group is exposed to the causal variable of interest, such as a disaster, and other groups are not, the Difference In Difference model (DID can be used for estimation. Using a micro level survey data set from the Indonesian Family Life Survey (IFLS which covers approximately 83 percent of the Indonesian population within the survey area, this paper examines the effects of natural disasters on household expenditure. This paper also examines whether there are any different impacts from different types of disasters. The finding is there are no significant effects of disasters on total household expenditure for households living in disaster regions, whether they are affected directly or not by the disaster.

Medical resource use and expenditure in patients with chronic heart failure: a population-based analysis of 88 195 patients.

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Farré, Nuria; Vela, Emili; Clèries, Montse; Bustins, Montse; Cainzos-Achirica, Miguel; Enjuanes, Cristina; Moliner, Pedro; Ruiz, Sonia; Verdú-Rotellar, Jose Maria; Comín-Colet, Josep

2016-09-01

Heart failure (HF) is one of the diseases with greater healthcare expenditure. However, little is known about the cost of HF at a population level. Hence, our aim was to study the population-level distribution and predictors of healthcare expenditure in patients with HF. This was a population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on 31 December 2012 (n = 88 195). We evaluated 1-year healthcare resource use and expenditure using the Health Department (CatSalut) surveillance system that collects detailed information on healthcare usage for the entire population. Mean age was 77.4 (12) years; 55% were women. One-year mortality rate was 14%. All-cause emergency department visits and unplanned hospitalizations were required at least once in 53.4% and 30.8% of patients, respectively. During 2013, a total of €536.2 million were spent in the care of HF patients (7.1% of the total healthcare budget). The main source of expenditure was hospitalization (39% of the total) whereas outpatient care represented 20% of the total expenditure. In the general population, outpatient care and hospitalization were the main expenses. In multivariate analysis, younger age, higher presence of co-morbidities, and a recent HF or all-cause hospitalization were independently associated with higher healthcare expenditure. In Catalonia, a large portion of the annual healthcare budget is devoted to HF patients. Unplanned hospitalization represents the main source of healthcare-related expenditure. The knowledge of how expenditure is distributed in a non-selected HF population might allow health providers to plan the distribution of resources in patients with HF. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

Changes in health expenditures in China in 2000s: has the health system reform improved affordability.

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Long, Qian; Xu, Ling; Bekedam, Henk; Tang, Shenglan

2013-06-13

China's health system reform launched in early 2000s has achieved better coverage of health insurance and significantly increased the use of healthcare for vast majority of Chinese population. This study was to examine changes in the structure of total health expenditures in China in 2000-2011, and to investigate the financial burden of healthcare placed on its population, particularly between urban and rural areas and across different socio-economic development regions. Health expenditures data came from the China National Health Accounts study in 1990-2011, and other data used to calculate the financial burden of healthcare were from China Statistical Yearbook and China Population Statistical Yearbook. Total health expenditures were divided into government and social expenditure, and out-of-pocket payment. The financial burden of healthcare was estimated as out-of-pocket payment per capita as a percentage of annual household living consumption expenditure per capita. Between 2000 and 2011, total health expenditures in China increased from Chinese yuan 319 to 1888 (United States dollars 51 to 305), with average annual increase of 17.4%. Government and social health expenditure increased rapidly being 22.9% and 18.8% of average annual growth rate, respectively. The share of out-of-pocket payment in total health expenditure for the urban population declined from 53% in 2005 to 36% in 2011, but had only a slight decrease for the rural population from 53% to 50%. Out-of-pocket payment, as a percentage of annual household living consumption, has continued to rise, particularly in the rural population from the less developed region (6.1% in 2000 to 8.8% in 2011). The rapid increase of public funding to subsidize health insurance in China, as part of the reform strategy, did not mitigate the out-of-pocket payment for healthcare over the past decade. Financial burden of healthcare on the rural population increased. Affordability among the rural households with sick

Tax Expenditures in Croatia

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Vjekoslav Bratić

2006-06-01

Full Text Available The tax system of the Republic of Croatia contains a large number of very diverse kinds of tax expenditures whose the declared aim is to achieve certain social and economic objectives. This paper considers all the items that constitute tax expenditures in Croatia, within the systems of the personal income tax, corporate income tax, and real estate transfer tax and value added tax. The objective of the article is to determine the real level of tax expenditures per form of tax in the 2001-2004 period. We hypothesised that the tax expenditures in the analysed forms of tax are both high and growing, which was ultimately borne out, for almost all the analysed items in the tax forms considered are growing.

European healthcare policies for controlling drug expenditure.

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Ess, Silvia M; Schneeweiss, Sebastian; Szucs, Thomas D

2003-01-01

In the last 20 years, expenditures on pharmaceuticals - as well as total health expenditures - have grown faster than the gross national product in all European countries. The aim of this paper was to review policies that European governments apply to reduce or at least slow down public expenditure on pharmaceutical products. Such policies can target the industry, the wholesalers and retailers, prescribers, and patients. The objectives of pharmaceutical policies are multidimensional and must take into account issues relating to public health, public expenditure and industrial incentives. Both price levels and consumption patterns determine the level of total drug expenditure in a particular country, and both factors vary greatly across countries. Licensing and pricing policies intend to influence the supply side. Three types of pricing policies can be recognised: product price control, reference pricing and profit control. Profit control is mainly used in the UK. Reference pricing systems were first used in Germany and The Netherlands and are being considered in other countries. Product price control is still the most common method for establishing the price of drugs. For the aim of fiscal consolidation, price-freeze and price-cut measures have been frequently used in the 1980s and 1990s. They have affected all types of schemes. For drug wholesalers and retailers, most governments have defined profit margins. The differences in price levels as well as the introduction of a Single European Pharmaceutical Market has led to the phenomenon of parallel imports among member countries of the European Union. This may be facilitated by larger and more powerful wholesalers and the vertical integration between wholesalers and retailers. To control costs, the use of generic drugs is encouraged in most countries, but only few countries allow pharmacists to substitute generic drugs for proprietary brands. Various interventions are used to reduce the patients' demand for drugs by

Medical Care Expenditure in Suicides From Non-illness-related Causes

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Jungwoo Sohn

2014-11-01

Full Text Available Objectives: Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated. Methods: Suicides motivated by non-illness-related factors were identified using the investigator’s note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status. Results: Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women. Conclusions: Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.

DOES THE RELATIONSHIP BETWEEN GOVERNMENT EXPENDITURE AND ECONOMIC GROWTH FOLLOW WAGNER’S LAW IN NIGERIA?

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CLEMENT A.U. IGHODARO

2010-01-01

Full Text Available While previous studies to test Wagner’s hypothesis for Nigeria usedtotal government expenditure, this paper in addition to total government expenditure used adisaggregated government expenditure data from 1961 - 2007, specifically; expenditure ongeneral administration and that of community and social services to determine the specificgovernment expenditure that economic growth may have significant impact on. Economicconditions and policies change implying that it is not only economic growth that can affectgovernment expenditure hence the inclusion of other fiscal policy variable and politicalfreedom to augment the functional form of Wagner’s law. All the variables used were found tobe I(1 and long run relationship exist between the dependent and the independent variablesexcept in the case where only GDP was used as the independent variable. Wagner’s hypothesisdoes not hold in all the estimations rather Keynesian hypothesis was validated in all theestimation. Elasticity estimates and Granger causality results are in agreement.

Characteristics, treatment, and health care expenditures of Medicare supplemental-insured patients with painful diabetic peripheral neuropathy, post-herpetic neuralgia, or fibromyalgia.

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Johnston, Stephen S; Udall, Margarita; Alvir, Jose; McMorrow, Donna; Fowler, Robert; Mullins, Daniel

2014-04-01

To describe the characteristics, treatment, and health care expenditures of Medicare Supplemental-insured patients with painful diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), or fibromyalgia. Retrospective cohort study. United States clinical practice, as reflected within a database comprising administrative claims from 2.3 million older adults participating in Medicare supplemental insurance programs. Selected patients were aged ≥65 years, continuously enrolled in medical and prescription benefits throughout years 2008 and 2009, and had ≥1 medical claim with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for DPN, PHN, or fibromyalgia, followed within 60 days by a medication or pain intervention procedure used in treating pDPN, PHN, or fibromyalgia during 2008-2009. Utilization of, and expenditures on, pain-related and all-cause pharmacotherapy and medical interventions in 2009. The study included 25,716 patients with pDPN (mean age 75.2 years, 51.2% female), 4,712 patients with PHN (mean age 77.7 years, 63.9% female), and 25,246 patients with fibromyalgia (mean age 74.4 years, 73.0% female). Patients typically had numerous comorbidities, and many were treated with polypharmacy. Mean annual expenditures on total pain-related health care and total all-cause health care, respectively, (in 2010 USD) were: $1,632, $24,740 for pDPN; $1,403, $16,579 for PHN; and $1,635, $18,320 for fibromyalgia. In age-stratified analyses, pain-related health care expenditures decreased as age increased. The numerous comorbidities, polypharmacy, and magnitude of expenditures in this sample of Medicare supplemental-insured patients with pDPN, PHN, or fibromyalgia underscore the complexity and importance of appropriate management of these chronic pain patients. Wiley Periodicals, Inc.

Evaluation of Expenditure Alternates

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Poehlein, Gary W.; And Others

1973-01-01

Illustrates a system of calculating dollar expenditures over periods of time in terms of present value. The system enables planners, school boards, and administrators to compare expenditure alternatives as a decisionmaking factor. (Author)

Health expenditure comparison of extended-release metoprolol succinate and immediate-release metoprolol tartarate

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Vaidya V

2012-02-01

Full Text Available Varun Vaidya, Pranav PatelCollege of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USABackground: Metoprolol, a selective beta-1 blocker, is available in two different salt forms in the market – metoprolol succinate (MS and metoprolol tartarate (MT. Both the formulations are Food and Drug Administration approved for the treatment of hypertension. Several studies have shown similar efficacies between the two salts; however, they differ in their pharmacokinetic properties and are therefore priced differently. The primary objective of this study was to compare the overall health care expenditures of hypertensive patients on MT and MS to see if the price difference in the two preparations is offset by savings in overall expenditure.Methods: Two cohorts of patients using MT and MS were selected from the 2008 Medical Expenditure Panel Survey. Propensity score matching technique was used to balance the cohorts on various parameters such as demographic information, insurance status, and comorbidity score. Patients using MT were matched to patients using MS on the logit of propensity score using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity score. Multiple regression analysis was carried out to examine the association between health expenditure and type of metoprolol salt, adjusting for other covariates.Results: A total of 742 patients were found to use metoprolol (MT-388, MS-354. After propensity score matching, a total of 582 patients were left in the sample for final analysis (291 patients in each cohort. The average annual health care expenditure was slightly higher in the MT cohort; however, after adjusting for covariates in a multivariate analysis, the difference was found to be statistically insignificant (P = 0.23.Conclusion: Both the products of metoprolol were found to have similar average annual total health care expenditure; however, MS once a day has higher out

Effect of neuromuscular electrical muscle stimulation on energy expenditure in healthy adults.

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Hsu, Miao-Ju; Wei, Shun-Hwa; Chang, Ya-Ju

2011-01-01

Weight loss/weight control is a major concern in prevention of cardiovascular disease and the realm of health promotion. The primary aim of this study was to investigate the effect of neuromuscular electrical stimulation (NMES) at different intensities on energy expenditure (oxygen and calories) in healthy adults. The secondary aim was to develop a generalized linear regression (GEE) model to predict the increase of energy expenditure facilitated by NMES and identify factors (NMES stimulation intensity level, age, body mass index, weight, body fat percentage, waist/hip ratio, and gender) associated with this NMES-induced increase of energy expenditure. Forty sedentary healthy adults (18 males and 22 females) participated. NMES was given at the following stimulation intensities for 10 minutes each: sensory level (E1), motor threshold (E2), and maximal intensity comfortably tolerated (E3). Cardiopulmonary gas exchange was evaluated during rest, NMES, and recovery stage. The results revealed that NMES at E2 and E3 significantly increased energy expenditure and the energy expenditure at recovery stage was still significantly higher than baseline. The GEE model demonstrated that a linear dose-response relationship existed between the stimulation intensity and the increase of energy expenditure. No subject's demographic or anthropometric characteristics tested were significantly associated with the increase of energy expenditure. This study suggested NMES may be used to serve as an additional intervention for weight loss programs. Future studies to develop electrical stimulators or stimulation electrodes to maximize the comfort of NMES are recommended.

National expenditure on health research in South Africa: What is the ...

African Journals Online (AJOL)

research should be raised to at least 2% of total public sector health ... of a detailed information system, renders interpretation of these ... We found that total expenditure on health research in SA, aggregated across the public and private sectors, .... and technology development, with health research receiving 10% of this ...

45 CFR 96.135 - Restrictions on expenditure of grant.

Science.gov (United States)

2010-10-01

... needle exchange program would be effective in reducing drug abuse and the risk that the public will become infected with the etiologic agent for AIDS. (b) The State shall limit expenditures on the... support paragraph (d)(1) of this section, such as local needs assessments, waiting lists, survey data and...

The influence of health expenditures on household impoverishment in Brazil

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Alexandra Crispim Boing

2014-10-01

Full Text Available OBJECTIVE To analyze the variation in the proportion of households living below the poverty line in Brazil and the factors associated with their impoverishment. METHODS Income and expenditure data from the Household Budget Survey, which was conducted in Brazil between 2002-2003 (n = 48,470 households and 2008-2009 (n = 55,970 households with a national sample, were analyzed. Two cutoff points were used to define poverty. The first cutoff is a per capita monthly income below R$100.00 in 2002-2003 and R$140.00 in 2008-2009, as recommended by the Bolsa Família Program. The second, which is proposed by the World Bank and is adjusted for purchasing power parity, defines poverty as per capita income below US$2.34 and US$3.54 per day in 2002-2003 and 2008-2009, respectively. Logistic regression was used to identify the sociodemographic factors associated with the impoverishment of households. RESULTS After subtracting health expenditures, there was an increase in households living below the poverty line in Brazil. Using the World Bank poverty line, the increase in 2002-2003 and 2008-2009 was 2.6 percentage points (6.8% and 2.3 percentage points (11.6%, respectively. Using the Bolsa Família Program poverty line, the increase was 1.6 (11.9% and 1.3 (17.3% percentage points, respectively. Expenditure on prescription drugs primarily contributed to the increase in poor households. According to the World Bank poverty line, the factors associated with impoverishment include a worse-off financial situation, a household headed by an individual with low education, the presence of children, and the absence of older adults. Using the Bolsa Família Program poverty line, the factors associated with impoverishment include a worse-off financial situation and the presence of children. CONCLUSIONS Health expenditures play an important role in the impoverishment of segments of the Brazilian population, especially among the most disadvantaged.

The influence of health expenditures on household impoverishment in Brazil.

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Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Posenato, Leila Garcia; Peres, Karen Glazer

2014-10-01

To analyze the variation in the proportion of households living below the poverty line in Brazil and the factors associated with their impoverishment. Income and expenditure data from the Household Budget Survey, which was conducted in Brazil between 2002-2003 (n = 48,470 households) and 2008-2009 (n = 55,970 households) with a national sample, were analyzed. Two cutoff points were used to define poverty. The first cutoff is a per capita monthly income below R$100.00 in 2002-2003 and R$140.00 in 2008-2009, as recommended by the Bolsa Família Program. The second, which is proposed by the World Bank and is adjusted for purchasing power parity, defines poverty as per capita income below US$2.34 and US$3.54 per day in 2002-2003 and 2008-2009, respectively. Logistic regression was used to identify the sociodemographic factors associated with the impoverishment of households. After subtracting health expenditures, there was an increase in households living below the poverty line in Brazil. Using the World Bank poverty line, the increase in 2002-2003 and 2008-2009 was 2.6 percentage points (6.8%) and 2.3 percentage points (11.6%), respectively. Using the Bolsa Família Program poverty line, the increase was 1.6 (11.9%) and 1.3 (17.3%) percentage points, respectively. Expenditure on prescription drugs primarily contributed to the increase in poor households. According to the World Bank poverty line, the factors associated with impoverishment include a worse-off financial situation, a household headed by an individual with low education, the presence of children, and the absence of older adults. Using the Bolsa Família Program poverty line, the factors associated with impoverishment include a worse-off financial situation and the presence of children. Health expenditures play an important role in the impoverishment of segments of the Brazilian population, especially among the most disadvantaged.

Public Expenditures, Budgetary Sustainability and the Assessment of Management of Public Expenditures in Kosovo

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Behxhet Brajshori

2009-05-01

Full Text Available Public expenditures are public outlays which competent state organs realize for the purpose of fulfilling obligations of general public interest. They are manifested in different forms and in different social, economic and political areas. Public expenditures produce direct and indirect effects in production and influence consumption and prices. Economic structure and conjectural courses of one country have an impact on the highness of the public expenditures. Economic and social subsidies present the main instruments for achieving economic and social effects through the policy of public expenditures, whilst in conjectural economies; the effect of public expenditures is large and is realized through the mechanism of multiplicators which are used when the economy is in the state of economic stagnation and recession. After the war, Kosovo built a new fiscal system according to the best international practices. The tax system consists of some taxes, it has a wide spread of tax charges and applies relatively low tax rates. Both budgetary revenues and budgetary consumption have marked certain variations in relation to GDP. Currently, The Kosovo Consolidated Budget (KCB is completely fulfilled by domestic revenues. It is considered that, even if the budgetary consumption increases up to 30-34% of GDP, this raise will not endanger budgetary sustainability of the country. According to the World Bank assessment (PEFA document- 2006 on the Effectiveness of Management of Public Expenditures in Kosovo, based on the performance of main indicators of management of public finances, the effectiveness of management of public expenditures in Kosovo is relatively satisfactory. According to the draft-document of the World Bank and the Government of Kosovo (PEFA-2008, the quality of management of public expenditures in 2008 has been profoundly improved.

Modification of a whole room indirect calorimeter for measurement of rapid changes in energy expenditure.

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Sun, M; Reed, G W; Hill, J O

1994-06-01

Whole room indirect calorimeters are among the most accurate devices for measurement of human energy expenditure and have provided useful data about determinants of total daily energy expenditure. However, a limitation of whole room indirect calorimeters has been the inability to detect acute (usually calorimeter (respiratory chamber) to allow accurate measurement of energy expenditure over time periods as short as 1 min. The modifications involve changes in the system design and use of signal processing techniques. With these modifications, we can measure energy expenditure in 1-min intervals throughout the day. This allows accurate study of the acute effects of food, exercise, or drugs on energy expenditure in subjects moving freely inside the respiratory chamber. The ability to use respiratory chambers for these types of studies should improve our understanding of how body weight is regulated.

Bucking the trend? Health care expenditures in low-income countries 1990-1995.

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Jowett, M

1999-01-01

Health care expenditures in low-income countries are analysed for the years 1990 and 1995 using four key indicators. Key findings include a substantial reduction in public spending per capita across low-income countries between 1990-95; a significant shift towards private expenditures, which appears increasingly to be substituting rather than supplementing public expenditures; a fall in total and public health spending in many countries despite growth in national income, contradicting the relationship found in other studies. Two possible explanations are put forward. First that the patterns found are a direct result of the structural adjustment policies adopted by many low-income countries, which aim to control and often cut public financing, whilst promoting private health expenditures. Secondly, that following the wave of privatization of state industries, many governments are finding problems adapting to their new role as a tax collector, and are thus not benefiting from economic growth to the extent that might be expected.

Economic impact of chikungunya epidemic: out-of-pocket health expenditures during the 2007 outbreak in Kerala, India.

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Vijayakumar, K; George, B; Anish, T S; Rajasi, R S; Teena, M J; Sujina, C M

2013-01-01

The southern state of Kerala, India was seriously affected by a chikungunya epidemic in 2007. As this outbreak was the first of its kind, the morbidity incurred by the epidemic was a challenge to the state's public health system. A cross sectional survey was conducted in five districts of Kerala that were seriously affected by the epidemic, using a two-stage cluster sampling technique to select households, and the patients were identified using a syndromic case definition. We calculated the direct health expenditure of families and checked whether it exceed the margins of catastrophic health expenditure (CHE). The median (IQR) total out-of-pocket (OOP) health expenditure in the study population was USD7.4 (16.7). The OOP health expenditure did not show any significant association with increasing per-capita monthly income.The major share (47.4%) of the costs was utilized for buying medicines, but costs for transportation (17.2%), consultations (16.6%), and diagnoses (9.9%) also contributed significantly to the total OOP health expenditure. The OOP health expenditure was high in private sector facilities, especially in tertiary care hospitals. For more than 15% of the respondents, the OOP was more than double their average monthly family income. The chikungunya outbreak of 2007 had significantly contributed to the OOP expenditure of the affected community in Kerala.The OOP health expenditure incurred was high, irrespective of the level of income. Governments should attempt to ensure comprehensive financial protection by covering the costs of care, along with loss of productivity.

Abdominal fat sub-depots and energy expenditure: Magnetic resonance imaging study.

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Serfaty, Dana; Rein, Michal; Schwarzfuchs, Dan; Shelef, Ilan; Gepner, Yftach; Bril, Nitzan; Cohen, Noa; Shemesh, Elad; Sarusi, Benjamin; Kovsan, Julia; Kenigsbuch, Shira; Chassidim, Yoash; Golan, Rachel; Witkow, Shula; Henkin, Yaakov; Stampfer, Meir J; Rudich, Assaf; Shai, Iris

2017-06-01

We aimed to assess the association between the distinct abdominal sub-depots and resting energy expenditure (REE). We performed magnetic resonance imaging (MRI) to quantify abdominal visceral-adipose-tissue (VAT), deep-subcutaneous-adipose-tissue (deep-SAT), and superficial-subcutaneous-adipose-tissue (superficial-SAT). We measured REE by indirect-calorimetry. Non-exercise activity thermogenesis (NEAT) [1-3 metabolic equivalents (METs)] and exercise thermogenesis (activities of 4+MET S ) were estimated based on 6-days of accelerometry to assess total physical activity energy expenditure (PAEE). We studied 282 participants: 249 men [mean age = 47.4 years, body-mass-index (BMI) = 31 kg/m 2 , mean VAT proportion from total abdominal fat = 34.5%, mean superficial-SAT proportion from total abdominal fat = 24.3%] and 33 women (mean age = 51.2 years, BMI = 30.1 kg/m 2 , mean VAT proportion from total abdominal fat = 22.8%, mean superficial-SAT proportion from total abdominal fat = 37.8%). As expected, women had lower REE [by 32.4% (1488 ± 234 kcal/day vs. 1971 ± 257 kcal/day; p abdominal VAT was the dominant proportional depot, had higher REE (1964 ± 297 kcal/day vs. 1654 ± 352 kcal/day; p Abdominal fat distribution patterns are associated with varying levels of resting energy expenditure, potentially reflecting different metabolic rates of adipose sub-depots and providing an anatomic/anthropometric link to physiological obese sub-phenotypes. Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities.

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Snowden, Lonnie R; Wallace, Neal; Cordell, Kate; Graaf, Genevieve

2017-09-01

Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services. We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites. Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs. Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities. EPSDT expanded funding increased proportional

Health Care Expenditure among People with Disabilities: Potential Role of Workplace Health Promotion and Implications for Rehabilitation Counseling

Science.gov (United States)

Karpur, Arun; Bruyere, Susanne M.

2012-01-01

Workplace health-promotion programs have the potential to reduce health care expenditures, especially among people with disabilities. Utilizing nationally representative survey data, the authors provide estimates for health care expenditures related to secondary conditions, obesity, and health behaviors among working-age people with disabilities.…

Effect of Neuromuscular Electrical Muscle Stimulation on Energy Expenditure in Healthy Adults

Directory of Open Access Journals (Sweden)

Ya-Ju Chang

2011-02-01

Full Text Available Weight loss/weight control is a major concern in prevention of cardiovascular disease and the realm of health promotion. The primary aim of this study was to investigate the effect of neuromuscular electrical stimulation (NMES at different intensities on energy expenditure (oxygen and calories in healthy adults. The secondary aim was to develop a generalized linear regression (GEE model to predict the increase of energy expenditure facilitated by NMES and identify factors (NMES stimulation intensity level, age, body mass index, weight, body fat percentage, waist/hip ratio, and gender associated with this NMES-induced increase of energy expenditure. Forty sedentary healthy adults (18 males and 22 females participated. NMES was given at the following stimulation intensities for 10 minutes each: sensory level (E1, motor threshold (E2, and maximal intensity comfortably tolerated (E3. Cardiopulmonary gas exchange was evaluated during rest, NMES, and recovery stage. The results revealed that NMES at E2 and E3 significantly increased energy expenditure and the energy expenditure at recovery stage was still significantly higher than baseline. The GEE model demonstrated that a linear dose-response relationship existed between the stimulation intensity and the increase of energy expenditure. No subject’s demographic or anthropometric characteristics tested were significantly associated with the increase of energy expenditure. This study suggested NMES may be used to serve as an additional intervention for weight loss programs. Future studies to develop electrical stimulators or stimulation electrodes to maximize the comfort of NMES are recommended.

76 FR 50887 - Elections Regarding Start-Up Expenditures, Corporation Organizational Expenditures, and...

Science.gov (United States)

2011-08-17

... begins an active trade or business, an amount equal to the lesser of (1) the amount of the start-up... begins. All start-up expenditures that relate to the active trade or business are considered in... active trade or business to which the expenditures relate begins. The election either to amortize start...

Energy expenditure and sex differences of golf playing.

Science.gov (United States)

Zunzer, Stefan C; von Duvillard, Serge P; Tschakert, Gerhard; Mangus, Brent; Hofmann, Peter

2013-01-01

The purpose of the study was to assess the average physical intensity and energy expenditure during a single round of golf on hilly and flat courses in a heterogeneous group of healthy men and women of varying age and golf handicap. Forty-two males and 24 females completed an incremental cycle-ergometer exercise test to determine exercise performance markers. The heart rate (HR), duration, distance, walking speed, ascent and descent were measured via a global positioning system (GPS)/HR monitor during the game and energy expenditure was calculated. Playing 9 or 18-holes of golf, independent of the golf course design, the average HR was not significantly different between sexes or the subgroups. The intensities were light with respect to the percentage of maximal HR and metabolic equivalents of task (METs). Total energy expenditure of all participants was not significantly different for hilly (834 ± 344 kcal) vs. flat courses (833 ± 295 kcal) whereas male players expended significantly greater energy than female players (926 ± 292 vs. 556 ± 180 kcal), but did not have significantly greater relative energy expenditure (2.8 ± 0.8 vs. 2.2 ± 0.7 METs). As a high volume physical activity, playing golf is suggested to yield health benefits. Since the intensity was well below recommended limits, golf may have health related benefits unrelated to the intensity level of the activity.

Criterion 6, indicator 34 : value of capital investment and annual expenditure in forest management, wood and non-wood product industries, forest-based environmental services, recreation, and tourism

Science.gov (United States)

Ken Skog; John Bergstrom; Elizabeth Hill; Ken Cordell

2010-01-01

USDA Forest Service capital investment in management infrastructure was $501 and $390 million (2005$) for 2005 and 2007, respectively. National forest programs expenditures decreased from $3.0 to $2.7 billion between 2004 and 2007 and wildfire management expenditures increased from $1.7 to $2.1 billion (2005$). State forestry program expenditures for 1998, 2002, and...

Burden of out-of-pocket expenditure for road traffic injuries in urban India

Directory of Open Access Journals (Sweden)

Kumar G

2012-08-01

Full Text Available Abstract Background Road traffic injuries (RTI are an increasing public health problem in India where out-of-pocket (OOP expenditures on health are among the highest in the world. We estimated the OOP expenses for RTI in a large city in India. Methods Information on medical and non-medical expenditure was documented for RTI cases of all ages that reported alive or dead to the emergency departments of two public hospitals and a large private hospital in Hyderabad. Differential risk of catastrophic OOP total expenditure (COPE-T and medical expenditure (COPE-M, and distress financing was assessed for 723 RTI cases that arrived alive at the study hospitals with multiple logistic regression. Catastrophic expenditure was defined as expenditure > 25% of the RTI patient’s annual household income. Variation in intensity of COPE-M in RTI was assessed using multiple classification analysis (MCA. Results The median OOP medical and non-medical expenditure was USD 169 and USD 163, respectively. The prevalence of COPE-M and COPE-T was 21.9% (95% CI 18.8-24.9 and 46% (95% CI 42–49.3, respectively. Only 22% had access to medical insurance. Being admitted to a private hospital (OR 5.2, 95% CI 2.7–9.9 and not having access to insurance (OR 3.8, 95% CI 1.9–7.6 were significantly associated with risk of having COPE – M. Similar results were seen for COPE - T. MCA analysis showed that the burden of OOP medical expenditure was mainly associated with in-patient days in hospital (Eta =0.191. Prevalence of distress financing was 69% (95% CI 65.5-72.3 with it being significantly higher for those reporting to the public hospitals (OR 2.8, 95% CI 1.7-4.6, those belonging to the lowest per capita annual household income quartile (OR 7.0, 95% CI 3.7-13.3, and for those without insurance access (OR 3.4, 95% CI 2.0-5.7. Conclusions This paper has outlined the high burden of out-of-pocket medical and total expenditure associated with RTI in India. These data

Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003-2014.

Science.gov (United States)

Kirkland, Elizabeth B; Heincelman, Marc; Bishu, Kinfe G; Schumann, Samuel O; Schreiner, Andrew; Axon, R Neal; Mauldin, Patrick D; Moran, William P

2018-05-30

One in 3 US adults has high blood pressure, or hypertension. As prior projections suggest hypertension is the costliest of all cardiovascular diseases, it is important to define the current state of healthcare expenditures related to hypertension. We used a nationally representative database, the Medical Expenditure Panel Survey, to calculate the estimated annual healthcare expenditure for patients with hypertension and to measure trends in expenditure longitudinally over a 12-year period. A 2-part model was used to estimate adjusted incremental expenditures for individuals with hypertension versus those without hypertension. Sex, race/ethnicity, education, insurance status, census region, income, marital status, Charlson Comorbidity Index, and year category were included as covariates. The 2003-2014 pooled data include a total sample of 224 920 adults, of whom 36.9% had hypertension. Unadjusted mean annual medical expenditure attributable to patients with hypertension was $9089. Relative to individuals without hypertension, individuals with hypertension had $1920 higher annual adjusted incremental expenditure, 2.5 times the inpatient cost, almost double the outpatient cost, and nearly triple the prescription medication expenditure. Based on the prevalence of hypertension in the United States, the estimated adjusted annual incremental cost is $131 billion per year higher for the hypertensive adult population compared with the nonhypertensive population. Individuals with hypertension are estimated to face nearly $2000 higher annual healthcare expenditure compared with their nonhypertensive peers. This trend has been relatively stable over 12 years. Healthcare costs associated with hypertension account for about $131 billion. This warrants intense effort toward hypertension prevention and management. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

42 CFR 403.754 - Monitoring expenditure level.

Science.gov (United States)

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Monitoring expenditure level. 403.754 Section 403..., Conditions of Participation, and Payment § 403.754 Monitoring expenditure level. (a) Tracking expenditures... between the trigger level and Medicare expenditures for a FFY results in a carry forward that either...

Total quality management program planning

Energy Technology Data Exchange (ETDEWEB)

Thornton, P.T.; Spence, K.

1994-05-01

As government funding grows scarce, competition between the national laboratories is increasing dramatically. In this era of tougher competition, there is no for resistance to change. There must instead be a uniform commitment to improving the overall quality of our products (research and technology) and an increased focus on our customers` needs. There has been an ongoing effort to bring the principles of total quality management (TQM) to all Energy Systems employees to help them better prepare for future changes while responding to the pressures on federal budgets. The need exists for instituting a vigorous program of education and training to an understanding of the techniques needed to improve and initiate a change in organizational culture. The TQM facilitator is responsible for educating the work force on the benefits of self-managed work teams, designing a program of instruction for implementation, and thus getting TQM off the ground at the worker and first-line supervisory levels so that the benefits can flow back up. This program plan presents a conceptual model for TQM in the form of a hot air balloon. In this model, there are numerous factors which can individually and collectively impede the progress of TQM within the division and the Laboratory. When these factors are addressed and corrected, the benefits of TQM become more visible. As this occurs, it is hoped that workers and management alike will grasp the ``total quality`` concept as an acceptable agent for change and continual improvement. TQM can then rise to the occasion and take its rightful place as an integral and valid step in the Laboratory`s formula for survival.

Revenues and Expenditures for Public Elementary and Secondary Education: School Year 2011-12 (Fiscal Year 2012). First Look. NCES 2014-301

Science.gov (United States)

Cornman, Stephen Q.

2015-01-01

This First Look report introduces new data for national and state-level public elementary and secondary revenues and expenditures for fiscal year (FY) 2012. Specifically, this report includes findings from the following types of school finance data: (1) Revenue and expenditure totals; (2) Revenues by source; (3) Expenditures by function and…

Revenues and Expenditures for Public Elementary and Secondary Education: School Year 2014-15 (Fiscal Year 2015). First Look. NCES 2018-301

Science.gov (United States)

Cornman, Stephen Q.; Zhou, Lei; Howell, Malia R.; Young, Jumaane

2018-01-01

This First Look report introduces new data for national and state-level public elementary and secondary revenues and expenditures for fiscal year (FY) 2015. Specifically, this report includes the following school finance data: (1) revenue and expenditure totals; (2) revenues by source; (3) expenditures by function and object; (4) current…

Determinants of residential space heating expenditures in Great Britain

Energy Technology Data Exchange (ETDEWEB)

Meier, Helena [Department of Economics, University of Hamburg, Von Melle Park 5, 20146 Hamburg (Germany); Rehdanz, Katrin [Department of Economics, University of Kiel, Olshausenstrasse 40, 24118 Kiel (Germany)

2010-09-15

In Great Britain, several policy measures have been implemented in order to increase energy efficiency and reduce carbon emissions. In the domestic sector, this could, for example, be achieved by improving space heating efficiency and thus decreasing heating expenditure. However, in order to efficiently design and implement such policy measures, a better understanding of the determinants affecting heating expenditure is needed. In this paper we examine the following determinants: socio-economic factors, building characteristics, heating technologies and weather conditions. In contrast to most other studies we use panel data to investigate household demand for heating in Great Britain. Our data sample is the result of an annual set of interviews with more than 5000 households, starting in 1991 and ending in 2005. The sample represents a total of 64,000 observations over the fifteen-year period. Our aim is to derive price and income elasticities both for Britain as a whole and for different types of household. Our results suggest that differences exist between owner-occupied and renter households. These households react differently to changes in income and prices. Our results also imply that a number of socio-economic criteria have a significant influence on heating expenditure, independently of the fuel used for heating. Understanding the impacts of different factors on heating expenditure and impact differences between types of household is helpful in designing target-oriented policy measures. (author)

Environment-related expenditures in 2013

International Nuclear Information System (INIS)

Diel, Olivier

2015-12-01

In 2013, households, private corporations and general government spent Euro 47.2 billion for environmental protection, an increase of 1.8% over 2012. For the 2000-2013 period on the whole, this expenditure has been rising faster than the gross domestic product (GDP): +4% on an annual average for the environmental protection expenditure compared with +2.8% for the GDP. In connection with the growing environmental concerns of society, public policy contributed to this steady increase through economic incentives ('bonus/malus' system, for instance) and regulation. In particular, the latter led to a technical improvement of processes (selective collection of waste, bringing up to standard of water treatment plants) which participated in the growth of expenditure. Wastewater and waste managements are the two main environmental protection expenditure domains. Furthermore, they are connected with topics related to resource management: drinking water supply and materials recovery. However, the expenditure for the materials recovery sector is decreasing in 2013, due to declines in raw materials prices. Expenditure for renewable energies - another topic related to environment - is considerably growing in 2013. Electricity production notably from water power is rising sharply, as a result of a particularly rainy spring. Nevertheless, the growth of environmental expenditures does not impact the corresponding employment in a systematic way. Thus, even if value added of the environmental goods and services sector (EGSS) increased by 1.8% in 2013, employment decreased by 0.3%. And the labor market in the green economy has been in decay since 2011, at a practically similar rate as for the economy as a whole

The Relationship of Government Revenue and Government Expenditure: A case study of Malaysia

OpenAIRE

Ullah, Nazim

2016-01-01

Malaysia is a developing Islamic state that faced budget deficit since 1998. But it is not accepted by all and hopes that state should be in a position of either balance budget or surplus budget. The optimum level of Government budget is the state where government expenditure is totally offset by source of government revenue and that can be achieved through increasing tax revenue or decreasing expenditure. The aim of this study to find out the theoretical relationship betwee...

Sales drive advertising expenditures: Evidence for consumer packaged and durable goods in Germany

OpenAIRE

Lischka, Juliane A; Kienzler, Stephanie; Mellmann, Ulrike

2014-01-01

The relation between sales and advertising is both complex and diverse. Whether advertising activities drive or follow sales is still unclear. We uncover this relation distinguishing between consumer packaged goods (CPG) and durable consumer goods (DCG) industries. We fit vector autoregressive models to sales and advertising expenditures of four CPG and three DCG industries in Germany from 1991 q1 to 2009 q4. Findings reveal that advertising expenditures do not increase total sales of industr...

Revenues and Expenditures for Public Elementary and Secondary Education: School Year 2012-13 (Fiscal Year 2013). First Look. NCES 2015-301

Science.gov (United States)

Cornman, Stephen Q.

2016-01-01

This First Look report introduces new data for national and state-level public elementary and secondary revenues and expenditures for fiscal year 2013 (FY 13). Specifically, this report includes findings from the following types of school finance data: (1) revenue and expenditure totals; (2) revenues by source; (3) expenditures by function and…

Tax Expenditures: A Theoretical Review

Directory of Open Access Journals (Sweden)

Vjekoslav Bratić

2006-06-01

Full Text Available Tax expenditures are an instrument frequently used when a government wishes to achieve certain economic and social effects. But because of the increasing number and scope of tax expenditures, their proper use, quality of administration and record-keeping have become a major challenge for the tax authorities and the whole of the government. The article considers and explains very diverse forms of tax expenditure such as reliefs, tax deductions, tax allowances, tax exceptions and special rates of taxation and the ways in which they are defined and calculated. The key problems in the analysis are the absence of a single definition and of methodology for the calculations; these ultimately make it impossible to compare tax expenditures between or among countries.

On the examination of out-of-pocket health expenditures in India, Pakistan, Sri Lanka, Maldives, Bhutan, Bangladesh and Nepal

Directory of Open Access Journals (Sweden)

Imlak Shaikh

2017-05-01

Full Text Available The aim of this study is to analyze the healthcare expenditures in seven South Asian countries namely, India, Pakistan, Sri Lanka, Maldives, Bhutan, Bangladesh and Nepal. The longitudinal data has been taken for 19 years from 1995 to 2013. We specifically examine the out-of-pocket healthcare expenditure in these countries. The per-capita health expenditure differences have been compared. We also develop panel data pooled OLS model for out-of-pocket expenditure with the factors affecting it, i.e. per capita health expenditure, household final consumption expenditure and public health expenditure. The work is in line with the earlier studies of determinants of out-of-pocket health expenditures. The results suggest that Maldives has the highest per capita health expenditure while out-of-pocket health expenditure as a percentage of total expenditure on health is highest for the India. The fixed and random effect is evidenced on health expenses across the years and cross section based on various determinants. The novel aspect of the work is that, this is an attempt to explain healthcare financing in the developing economies. The key determinant of out-of-pocket expenditure is the final household expenditures as the percentage of gross domestic product.

Doubly labelled water assessment of energy expenditure: principle, practice, and promise.

Science.gov (United States)

Westerterp, Klaas R

2017-07-01

The doubly labelled water method for the assessment of energy expenditure was first published in 1955, application in humans started in 1982, and it has become the gold standard for human energy requirement under daily living conditions. The method involves enriching the body water of a subject with heavy hydrogen ( 2 H) and heavy oxygen ( 18 O), and then determining the difference in washout kinetics between both isotopes, being a function of carbon dioxide production. In practice, subjects get a measured amount of doubly labelled water ( 2 H 2 18 O) to increase background enrichment of body water for 18 O of 2000 ppm with at least 180 ppm and background enrichment of body water for 2 H of 150 ppm with 120 ppm. Subsequently, the difference between the apparent turnover rates of the hydrogen and oxygen of body water is assessed from blood-, saliva-, or urine samples, collected at the start and end of the observation interval of 1-3 weeks. Samples are analyzed for 18 O and 2 H with isotope ratio mass spectrometry. The doubly labelled water method is the indicated method to measure energy expenditure in any environment, especially with regard to activity energy expenditure, without interference with the behavior of the subjects. Applications include the assessment of energy requirement from total energy expenditure, validation of dietary assessment methods and validation of physical activity assessment methods with doubly labelled water measured energy expenditure as reference, and studies on body mass regulation with energy expenditure as a determinant of energy balance.

Advertising Expenditure and Consumer Prices

OpenAIRE

Ferdinand Rauch

2011-01-01

This paper studies the effect of a change in the marginal costs of advertising on advertising expenditures of firms and consumer prices across industries. It makes use of a unique policy change that caused a decrease of the taxation on advertising expenditures in parts of Austria and a simultaneous increase in other parts. Advertising expenditures move immediately in the opposite direction to the marginal costs of advertising. Simultaneously the price reaction to advertising is negative in so...

Nonresidential buildings energy consumption survey: 1979 consumption and expenditures. Part 2. Steam, fuel oil, LPG, and all fuels

Energy Technology Data Exchange (ETDEWEB)

Patinkin, L.

1983-12-01

This report presents data on square footage and on total energy consumption and expenditures for commercial buildings in the contiguous United States. Also included are detailed consumption and expenditures tables for fuel oil or kerosene, liquid petroleum gas (LPG), and purchased steam. Commercial buildings include all nonresidential buildings with the exception of those where industrial activities occupy more of the total square footage than any other type of activity. 7 figures, 23 tables.

The Cost of Getting Into Orthopedic Residency: Analysis of Applicant Demographics, Expenditures, and the Value of Away Rotations.

Science.gov (United States)

Camp, Christopher L; Sousa, Paul L; Hanssen, Arlen D; Karam, Matthew D; Haidukewych, George J; Oakes, Daniel A; Turner, Norman S

2016-01-01

Little is known about the demographics and expenditures of applicants attempting to match into the competitive field of orthopedic surgery. In attempt to better inform potential applicants, the purposes of this work are to (1) better understand the demographics of successfully matched applicants, (2) determine the monetary cost of applying, and (3) assess the value of away rotations for improving chances of a successful match. Prospective comparative survey. Mayo Clinic Department of Orthopedic Surgery, Rochester, MN. A week following the 2015 Orthopedic Surgery Residency Match, a survey was sent to 1,091. The survey focused on applicant demographics, number of programs applied to, cost of applying, and the value of away rotations. A total of 408 applicants completed the survey (response rate = 37%). Of these, 312 (76%) matched and 96 (24%) did not match into a US Orthopedic Surgery Residency. Of the matched applicants, 300 (96%) were from US allopathic medical schools, 9 (3%) US Osteopathic Schools, and 3 (1%) were international graduates. Males comprised 84% of these applicants whereas 16% were female. The mean number of programs applied to was 71 (range: 20-140). On average, applicants were offered 16 interviews (range: 1-53) and they attended 11 (range: 0-12). Completing a rotation at a program increased an applicant׳s chances of matching into that program by a factor of 1.5 (60% vs 40%). Of the applicants who matched, most applicants matched to an orthopedic residency in the same region where the applicant attended medical school (58%). The average cost of the application was $1,664 (range: $100-$5,000) whereas the cost of interviews (travel, food, etc.) was $3,656 (range: $15-$20,000). Total expenditures ranged from $450 to $25,000 (mean = $5,415). Over 8% of matched applicants spent >$10,000. Gaining acceptance into orthopedic surgery residency remains a very competitive process. Away rotations appear to correlate strongly with match status; however, the

26 CFR 1.501(h)-1 - Application of the expenditure test to expenditures to influence legislation; introduction.

Science.gov (United States)

2010-04-01

... expenditures to influence legislation; introduction. 1.501(h)-1 Section 1.501(h)-1 Internal Revenue INTERNAL...) Exempt Organizations § 1.501(h)-1 Application of the expenditure test to expenditures to influence... attempting to influence legislation, (except as otherwise provided in subsection (h)).” This requirement is...

Predictors of high out-of-pocket healthcare expenditure: an analysis using Bangladesh household income and expenditure survey, 2010.

Science.gov (United States)

Molla, Azaher Ali; Chi, Chunhuei; Mondaca, Alicia Lorena Núñez

2017-01-31

Predictors of high out-of-pocket household healthcare expenditure are essential for creating effective health system finance policy. In Bangladesh, 63.3% of health expenditure is out-of-pocket and born by households. It is imperative to know what determines household health expenditure. This study aims to investigate the predicting factors of high out-of-pocket household healthcare expenditure targeting to put forward policy recommendations on equity in financial burden. Bangladesh household income and expenditure survey 2010 provides data for this study. Predictors of high out-of-pocket household healthcare expenditure were analyzed using multiple linear regressions. We have modeled non-linear relationship using logarithmic form of linear regression. Heteroscedasticity and multicollinearity were checked using Breusch-Pagan/Cook-Weishberg and VIF tests. Normality of the residuals was checked using Kernel density curve. We applied required adjustment for survey data, so that standard errors and parameters estimation are valid. Presence of chronic disease and household income were found to be the most influential and statistically significant (p financing in Bangladesh to minimize the burden of high OOP healthcare expenditure.

State energy price and expenditure report 1989

International Nuclear Information System (INIS)

1991-01-01

The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates for the 50 States, the District of Columbia, and the United States. The estimates are provided by energy source (e.g., petroleum, natural gas, coal, and electricity) and by major consuming or economic sector. This report is an update of the State Energy Price and Expenditure Report 1988 published in September 1990. Changes from the last report are summarized in a section of the documentation. Energy price and expenditure estimates are published for the years 1970, 1975, 1980, and 1985 through 1989. Documentation follows the tables and describes how the price estimates are developed, including sources of data, methods of estimation, and conversion factors applied. Consumption estimates used to calculate expenditures, and the documentation for those estimates, are from the State Energy Data Report, Consumption Estimates, 1960--1989 (SEDR), published in May 1991. Expenditures are calculated by multiplying the price estimates by the consumption estimates, adjusted to remove process fuel and intermediate product consumption. All expenditures are consumer expenditures, that is, they represent estimates of money directly spent by consumers to purchase energy, generally including taxes. 11 figs., 43 tabs

State energy price and expenditure report 1989

Energy Technology Data Exchange (ETDEWEB)

1991-09-30

The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates for the 50 States, the District of Columbia, and the United States. The estimates are provided by energy source (e.g., petroleum, natural gas, coal, and electricity) and by major consuming or economic sector. This report is an update of the State Energy Price and Expenditure Report 1988 published in September 1990. Changes from the last report are summarized in a section of the documentation. Energy price and expenditure estimates are published for the years 1970, 1975, 1980, and 1985 through 1989. Documentation follows the tables and describes how the price estimates are developed, including sources of data, methods of estimation, and conversion factors applied. Consumption estimates used to calculate expenditures, and the documentation for those estimates, are from the State Energy Data Report, Consumption Estimates, 1960--1989 (SEDR), published in May 1991. Expenditures are calculated by multiplying the price estimates by the consumption estimates, adjusted to remove process fuel and intermediate product consumption. All expenditures are consumer expenditures, that is, they represent estimates of money directly spent by consumers to purchase energy, generally including taxes. 11 figs., 43 tabs.

Variations in resting energy expenditure: impact on gestational weight gain.

Science.gov (United States)

Berggren, E K; O'Tierney-Ginn, P; Lewis, S; Presley, L; De-Mouzon, S Hauguel; Catalano, P M

2017-10-01

There are significant variations in gestational weight gain, with many women gaining in excess of the Institute of Medicine guidelines. Unfortunately, efforts to improve appropriate gestational weight gain have had only limited success. To date, interventions have focused primarily on decreasing energy intake and/or increasing physical activity. Maternal resting energy expenditure, which comprises ∼60% of total energy expenditure compared with the ∼20% that comes from physical activity, may be an important consideration in understanding variations in gestational weight gain. Our objective was to quantify the changes in resting energy expenditure during pregnancy and their relationship to gestational weight gain and body composition changes among healthy women. We hypothesized that greater gestational weight gain, and fat mass accrual in particular, are inversely related to variations in resting energy expenditure. We conducted a secondary analysis of a prospective cohort studied before conception and late pregnancy (34-36 weeks). Body composition (estimated using hydrodensitometry) and resting energy expenditure (estimated using indirect calorimetry) were measured. The relationship between the changes in resting energy expenditure and gestational weight gain and the change in fat mass and fat-free mass were quantified. Resting energy expenditure was expressed as kilocalories per kilogram of fat-free mass per day (kilocalories per kilogram of fat-free mass -1 /day -1 ) and kilocalories per day. Correlations are reported as r. Among 51 women, preconception body mass index was 23.0 (4.7) kg/m 2 ; gestational weight gain was 12.8 (4.7) kg. Preconception and late pregnancy resting energy expenditure (kilocalories per day) correlated positively with the change in fat-free mass (r = 0.37, P = .008; r = 0.51, P = .001). Late-pregnancy resting energy expenditure (kilocalories per kilogram of fat-free mass -1 /day -1 ) was inversely associated with the change in fat

Medicaid Expenditures for Fee-for-Service Enrollees with Behavioral Diagnoses: Findings from a 50 State Claims Analysis.

Science.gov (United States)

Ward, Martha C; Lally, Cathy; Druss, Benjamin G

2017-01-01

Medicaid is an important funder of care for individuals with behavioral (psychiatric and/or substance use) diagnoses, and expenditures will likely increase with expansion of services under the Affordable Care Act. This study provides national estimates of Medicaid expenditures using a comprehensive sample of fee-for-service Medicaid enrollees with behavioral diagnoses. Data for analysis came from 2003 to 2004 Medicaid Analytic eXtract (MAX) files for 50 states and the District of Columbia. Individuals with behavioral diagnoses had high rates of chronic medical comorbidities, and expenditures for medical (non-behavioral) diagnoses accounted for 74 % of their health care expenditures. Total Medicaid expenditure was approximately 15 billion dollars (equivalent to 18.91 billion in 2016 dollars) for individuals with any behavioral diagnosis. Medicaid fee-for-service beneficiaries with behavioral diagnoses have a high treated prevalence of individual medical comorbid conditions, and the majority of health care expenditures in these individuals are for medical, rather than behavioral health, services.

Sensitivity analysis and comparison of two methods of using heart rate to represent energy expenditure during walking.

Science.gov (United States)

Karimi, Mohammad Taghi

2015-01-01

Heart rate is an accurate and easy to use method to represent the energy expenditure during walking, based on physiological cost index (PCI). However, in some conditions the heart rate during walking does not reach to a steady state. Therefore, it is not possible to determine the energy expenditure by use of the PCI index. The total heart beat index (THBI) is a new method to solve the aforementioned problem. The aim of this research project was to find the sensitivity of both the physiological cost index (PCI) and total heart beat index (THBI). Fifteen normal subjects and ten patients with flatfoot disorder and two subjects with spinal cord injury were recruited in this research project. The PCI and THBI indexes were determined by use of heart beats with respect to walking speed and total distance walked, respectively. The sensitivity of PCI was more than that of THBI index in the three groups of subjects. Although the PCI and THBI indexes are easy to use and reliable parameters to represent the energy expenditure during walking, their sensitivity is not high to detect the influence of some orthotic interventions, such as use of insoles or using shoes on energy expenditure during walking.

Catastrophic health expenditure and its determinants in Kenya slum communities.

Science.gov (United States)

Buigut, Steven; Ettarh, Remare; Amendah, Djesika D

2015-05-14

In Kenya, where 60 to 80% of the urban residents live in informal settlements (frequently referred to as slums), out-of-pocket (OOP) payments account for more than a third of national health expenditures. However, little is known on the extent to which these OOP payments are associated with personal or household financial catastrophe in the slums. This paper seeks to examine the incidence and determinants of catastrophic health expenditure among urban slum communities in Kenya. We use a unique dataset on informal settlement residents in Kenya and various approaches that relate households OOP payments for healthcare to total expenditures adjusted for subsistence, or income. We classified households whose OOP was in excess of a predefined threshold as facing catastrophic health expenditures (CHE), and identified the determinants of CHE using multivariate logistic regression analysis. The results indicate that the proportion of households facing CHE varies widely between 1.52% and 28.38% depending on the method and the threshold used. A core set of variables were found to be key determinants of CHE. The number of working adults in a household and membership in a social safety net appear to reduce the risk of catastrophic expenditure. Conversely, seeking care in a public or private hospital increases the risk of CHE. This study suggests that a substantial proportion of residents of informal settlements in Kenya face CHE and would likely forgo health care they need but cannot afford. Mechanisms that pool risk and cost (insurance) are needed to protect slum residents from CHE and improve equity in health care access and payment.

Household food group expenditure patterns are associated with child anthropometry at ages 5, 8 and 12 years in Ethiopia, India, Peru and Vietnam.

Science.gov (United States)

Humphries, Debbie L; Dearden, Kirk A; Crookston, Benjamin T; Woldehanna, Tassew; Penny, Mary E; Behrman, Jere R

2017-08-01

Population-level analysis of dietary influences on nutritional status is challenging in part due to limitations in dietary intake data. Household expenditure surveys, covering recent household expenditures and including key food groups, are routinely conducted in low- and middle-income countries. These data may help identify patterns of food expenditure that relate to child growth. We investigated the relationship between household food expenditures and child growth using factor analysis. We used data on 6993 children from Ethiopia, India, Peru and Vietnam at ages 5, 8 and 12y from the Young Lives cohort. We compared associations between household food expenditures and child growth (height-for-age z scores, HAZ; body mass index-for-age z scores, BMI-Z) using total household food expenditures and the "household food group expenditure index" (HFGEI) extracted from household expenditures with factor analysis on the seven food groups in the child dietary diversity scale, controlling for total food expenditures, child dietary diversity, data collection round, rural/urban residence and child sex. We used the HFGEI to capture households' allocations of their finances across food groups in the context of local food pricing, availability and pReferences RESULTS: The HFGEI was associated with significant increases in child HAZ in Ethiopia (0.07), India (0.14), and Vietnam (0.07) after adjusting for all control variables. Total food expenditures remained significantly associated with increases in BMI-Z for India (0.15), Peru (0.11) and Vietnam (0.06) after adjusting for study round, HFGEI, dietary diversity, rural residence, and whether the child was female. Dietary diversity was inversely associated with BMI-Z in India and Peru. Mean dietary diversity increased from age 5y to 8y and decreased from age 8y to 12y in all countries. Household food expenditure data provide insights into household food purchasing patterns that significantly predict HAZ and BMI-Z. Including food

Allowing Spouses to Be Paid Personal Care Providers: Spouse Availability and Effects on Medicaid-Funded Service Use and Expenditures

Science.gov (United States)

Newcomer, Robert J.; Kang, Taewoon; Doty, Pamela

2012-01-01

Purpose of the Study: Medicaid service use and expenditure and quality of care outcomes in California's personal care program known as In-Home Supportive Service (IHSS) are described. Analyses investigated Medicaid expenditures, hospital use, and nursing home stays, comparing recipients who have paid spouse caregivers with those having other…

Hypocretin/orexin and energy expenditure.

Science.gov (United States)

Teske, J A; Billington, C J; Kotz, C M

2010-03-01

The hypocretins or orexins are endogenous neuropeptides synthesized in discrete lateral, perifornical and dorsal hypothalamic neurones. These multi-functional neuropeptides modulate energy homeostasis, arousal, stress, reward, reproduction and cardiovascular function. This review summarizes the role of hypocretins in modulating non-sleep-related energy expenditure with specific focus on the augmentation of whole body energy expenditure as well as hypocretin-induced physical activity and sympathetic outflow. We compare the efficacy of hypocretin-1 and 2 on energy expenditure and evaluate whether the literature implicates hypocretin signalling though the hypocretin-1 and -2 receptor as having shared and or functionally specific physiological effects. Thus far data suggest that hypocretin-1 has a more robust stimulatory effect relative to hypocretin-2. Furthermore, hypocretin-1 receptor predominantly mediates behaviours known to influence energy expenditure. Further studies on the hypocretin-2 receptor are needed.

Uranium exploration expenditures in 1976 and plans for 1977--78

International Nuclear Information System (INIS)

1977-05-01

A survey of actual and planned uranium exploration activities was made by the Grand Junction Office of the U.S. Energy Research and Development Administration as part of an overall program to evaluate future supplies of nuclear fuel. The survey covered: land acquired in 1976 for exploration and cost of acquisition; 1976 surface drilling footage and cost; all other exploration expenditures in 1976; estimates of 1977-78 exploration activities and costs; exploration for non-sandstone deposits; exploration in non-established areas; foreign uranium exploration expenditures by U.S. companies; foreign participation in exploration activities in the United States; aerial radiometric exploration activities in the United States, 1972-76; and solution-mining production drilling during 1976. Data from the replies of 108 companies are compiled

Energy expenditure of acutely ill hospitalised patients

Directory of Open Access Journals (Sweden)

Gariballa Salah

2006-03-01

Full Text Available Abstract Objective To measure energy expenditure of acutely ill elderly patients in hospital and following discharge in the community. Design Sixty-three consecutive hospitalised acutely ill elderly patients were recruited. Eight patients were studied to assess the reliability of the Delta Tract Machine as a measure of energy expenditure; 35 patients had their energy expenditure studied in hospital on two occasions and 20 patients had their energy expenditure measured in hospital and at 6 weeks in the community Results Men had higher basal energy expenditure (BMR values compared to women however the difference was not statistically significant [Men, mean (SD 1405 (321 Kcal, women 1238 (322 kcal; mean difference (95% CI 166 kcal (-17 to 531, p = 0.075]. After adjusting for age, gender and body mass index both medication and C-reactive protein (CRP, concentrations showed significant correlation with measured energy expenditure in hospital, (r = -0.36, "p Conclusion Tissue inflammation and medications were associated with change in measured energy expenditure in acutely ill patients.

Impacts of informal caregiver availability on long-term care expenditures in OECD countries.

Science.gov (United States)

Yoo, Byung-Kwang; Bhattacharya, Jay; McDonald, Kathryn M; Garber, Alan M

2004-12-01

To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries. Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000. Secondary data analysis, applying fixed- and random-effects models to time-series cross-sectional data. Outcome variables are inpatient or home heath LTC expenditures. Key explanatory variables are measures of the availability of informal caregivers, generosity in public funding for formal LTC, and the proportion of the elderly population in the total population. Aggregated macro data were obtained from OECD Health Data, United Nations Demographic Yearbooks, and U.S. Census Bureau International Data Base. Most of the 15 OECD countries experienced growth in LTC expenditures over the study period. The availability of a spouse caregiver, measured by male-to-female ratio among the elderly, is associated with a $28,840 (1995 U.S. dollars) annual reduction in formal LTC expenditure per additional elderly male. Availability of an adult child caregiver, measured by female labor force participation and full-time/part-time status shift, is associated with a reduction of $310 to $3,830 in LTC expenditures. These impacts on LTC expenditure vary across countries and across time within a country. The availability of an informal caregiver, particularly a spouse caregiver, is among the most important factors explaining variation in LTC expenditure growth. Long-term care policies should take into account behavioral responses: decreased public funding in LTC may lead working women to leave the labor force to provide more informal care.

Household income and expenditure surveys: a tool for accelerating the development of evidence-based fortification programs.

Science.gov (United States)

Fiedler, John L; Smitz, Marc-Francois; Dupriez, Olivier; Friedman, Jed

2008-12-01

One-third of the world's population suffers from micronutrient deficiencies due primarily to inadequate dietary intake. Food fortification is often touted as the most promising short- to medium-term strategy for combating these deficiencies. Despite its appealing characteristics, progress in fortification has been slow. To assess the potential of household food-purchase data to fill the food-consumption information gap, which has been an important factor contributing to the slow growth of fortification programs. Household income and expenditure survey (HIES) data about: (a) a population's distribution of apparent household consumption, which are essential to setting safe fortification levels, (b) the proportion of households purchasing "fortifiable" food, and (c) the quantity of food being purchased were used to proxy food-consumption data and develop suggested fortification levels. The usefulness of the approach in addressing several common fortification program design issues is demonstrated. HIES-based suggested fortification levels are juxtaposed with ones developed using the most common current approach, which relies upon Food and Agriculture Organization (FAO) Food Balance Sheets. Despite its limitations, the use of HIES data constitutes a generally unexploited opportunity to address the food-consumption information gap by using survey data that nearly every country of the world is already routinely collecting. HIES data enable the design of fortification programs to become more based on country-specific data and less on general rules of thumb. The more routine use of HIES data constitutes a first step in improving the precision of fortification feasibility analyses and improving estimates of the coverage, costs, and impact of fortification programs.

Effects of a popular exercise and weight loss program on weight loss, body composition, energy expenditure and health in obese women

Directory of Open Access Journals (Sweden)

Magrans-Courtney Teresa

2009-05-01

Full Text Available Abstract Objective To determine the safety and efficacy of altering the ratio of carbohydrate and protein in low-energy diets in conjunction with a popular exercise program in obese women. Design Matched, prospective clinical intervention study to assess efficacy of varying ratios of carbohydrate and protein intake in conjunction with a regular exercise program. Participants One-hundred sixty one sedentary, obese, pre-menopausal women (38.5 ± 8.5 yrs, 164.2 ± 6.7 cm, 94.2 ± 18.8 kg, 34.9 ± 6.4 kg·m-2, 43.8 ± 4.2% participated in this study. Participants were weight stable and not participating in additional weight loss programs. Methods Participants were assigned to either a no exercise + no diet control (CON, a no diet + exercise group (ND, or one of four diet + exercise groups (presented as kcals; % carbohydrate: protein: fat: 1 a high energy, high carbohydrate, low protein diet (HED [2,600; 55:15:30%], 2 a very low carbohydrate, high protein diet (VLCHP [1,200 kcals; 63:7:30%], 3 a low carbohydrate, moderate protein diet (LCMP [1,200 kcals; 50:20:30%] and 4 a high carbohydrate, low protein diet (HCLP [1,200 kcals; 55:15:30%]. Participants in exercise groups (all but CON performed a pneumatic resistance-based, circuit training program under supervision three times per week. Measurements Anthropometric, body composition, resting energy expenditure (REE, fasting blood samples and muscular fitness assessments were examined at baseline and weeks 2, 10 and 14. Results All groups except CON experienced significant reductions (P P P P P Conclusion Exercise alone (ND appears to have minimal impact on measured outcomes with positive outcomes apparent when exercise is combined with a hypoenergetic diet. Greater improvements in waist circumference and body composition occurred when carbohydrate is replaced in the diet with protein. Weight loss in all diet groups (VLCHP, LCMP and HCLP was primarily fat and stimulated improvements in markers of

Dietary intake, physical activity and energy expenditure of Malaysian adolescents.

Science.gov (United States)

Zalilah, M S; Khor, G L; Mirnalini, K; Norimah, A K; Ang, M

2006-06-01

Paediatric obesity is a public health concern worldwide as it can track into adulthood and increase the risk of adult morbidity and mortality. While the aetiology of obesity is multi-factorial, the roles of diet and physical activity are controversial. Thus, the purpose of this study was to report on the differences in energy intake, diet composition, time spent doing physical activity and energy expenditure among underweight (UW), normal weight (NW) and at-risk of overweight (OW) Malaysian adolescents (317 females and 301 males) aged 11-15 years. This was a cross-sectional study with 6,555 adolescents measured for weights and heights for body mass index (BMI) categorisation. A total of 618 subjects were randomly selected from each BMI category according to gender. The subjects' dietary intake and physical activity were assessed using self-reported three-day food and activity records, respectively. Dietary intake components included total energy and macronutrient intakes. Energy expenditure was calculated as a sum of energy expended for basal metabolic rate and physical activity. Time spent (in minutes) in low, medium and high intensity activities was also calculated. The OW adolescents had the highest crude energy intake and energy expenditure. However, after adjusting for body weight, the OW subjects had the lowest energy intake and energy expenditure (p-value is less than 0.001). The study groups did not differ significantly in time spent for low, medium and high intensity activities. Macronutrient intakes differed significantly only among the girls where the OW group had the highest intakes compared to UW and NW groups (p-value is less than 0.05). All study groups had greater than 30 percent and less than 55 percent of energy intake from fat and carbohydrate, respectively. The data suggested that a combination of low energy expenditure adjusted for body weight and high dietary fat intake may be associated with overweight and obesity among adolescents. To

Energy expenditure in frontotemporal dementia: a behavioural and imaging study

Science.gov (United States)

Ahmed, Rebekah M; Landin-Romero, Ramon; Collet, Tinh-Hai; van der Klaauw, Agatha A; Devenney, Emma; Henning, Elana; Kiernan, Matthew C; Piguet, Olivier; Farooqi, I Sadaf; Hodges, John R

2017-01-01

Abstract See Finger (doi:10.1093/aww312) for a scientific commentary on this article. Abnormal eating behaviour and metabolic parameters including insulin resistance, dyslipidaemia and body mass index are increasingly recognized as important components of neurodegenerative disease and may contribute to survival. It has previously been established that behavioural variant frontotemporal dementia is associated with abnormal eating behaviour characterized by increased sweet preference. In this study, it was hypothesized that behavioural variant frontotemporal dementia might also be associated with altered energy expenditure. A cohort of 19 patients with behavioural variant frontotemporal dementia, 13 with Alzheimer’s disease and 16 (age- and sex-matched) healthy control subjects were studied using Actiheart devices (CamNtech) to assess resting and stressed heart rate. Actiheart devices were fitted for 7 days to measure sleeping heart rate, activity levels, and resting, active and total energy expenditure. Using high resolution structural magnetic resonance imaging the neural correlates of increased resting heart rate were investigated including cortical thickness and region of interest analyses. In behavioural variant frontotemporal dementia, resting (P = 0.001), stressed (P = 0.037) and sleeping heart rate (P = 0.038) were increased compared to control subjects, and resting heart rate (P = 0.020) compared to Alzheimer disease patients. Behavioural variant frontotemporal dementia was associated with decreased activity levels compared to controls (P = 0.002) and increased resting energy expenditure (P = 0.045) and total energy expenditure (P = 0.035). Increased resting heart rate correlated with behavioural (Cambridge Behavioural Inventory) and cognitive measures (Addenbrooke’s Cognitive Examination). Increased resting heart rate in behavioural variant frontotemporal dementia correlated with atrophy involving the mesial temporal cortex, insula, and amygdala

State energy price and expenditure report 1994

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-06-01

The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 States and the District of Columbia and in aggregate for the United States. The price and expenditure estimates developed in the State Energy Price and Expenditure Data System (SEPEDS) are provided by energy source and economic sector and are published for the years 1970 through 1994. Consumption estimates used to calculate expenditures and the documentation for those estimates are taken from the State Energy Data Report 1994, Consumption Estimates (SEDR), published in October 1996. Expenditures are calculated by multiplying the price estimates by the consumption estimates, which are adjusted to remove process fuel; intermediate petroleum products; and other consumption that has no direct fuel costs, i.e., hydroelectric, geothermal, wind, solar, and photovoltaic energy sources. Documentation is included describing the development of price estimates, data sources, and calculation methods. 316 tabs.

State energy price and expenditure report 1994

International Nuclear Information System (INIS)

1997-06-01

The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 States and the District of Columbia and in aggregate for the United States. The price and expenditure estimates developed in the State Energy Price and Expenditure Data System (SEPEDS) are provided by energy source and economic sector and are published for the years 1970 through 1994. Consumption estimates used to calculate expenditures and the documentation for those estimates are taken from the State Energy Data Report 1994, Consumption Estimates (SEDR), published in October 1996. Expenditures are calculated by multiplying the price estimates by the consumption estimates, which are adjusted to remove process fuel; intermediate petroleum products; and other consumption that has no direct fuel costs, i.e., hydroelectric, geothermal, wind, solar, and photovoltaic energy sources. Documentation is included describing the development of price estimates, data sources, and calculation methods. 316 tabs

Free does not mean affordable: maternity patient expenditures in a public hospital in Bangladesh

Directory of Open Access Journals (Sweden)

Khan Suhaila H

2005-01-01

Full Text Available Abstract Objective This study investigated a the amount and types of out-of-pocket expenditures by patients for nominally free services in a large public hospital in Bangladesh, b the factors influencing these expenses, and c the impact of these expenses on household income. Methods Eighty-one maternity patients were interviewed during their hospitalization in the Dhaka Medical College Hospital. Patients were selected by quota sample to match the distribution of maternity patient categories in the hospital. Patients were interviewed with a semi-structured, in-depth questionnaire. Results All interviewees incurred substantial out-of-pocket expenditures for travel, hospital admission fees, medicine, tests, food, and tips. Only two of the expenditures, travel expenses and admission fees, were not supposed to be provided free of charge by the hospital. The median total per-patient expenditure was $65 (range $2–$350, equivalent to 7% (range 0.04%–225% of annual household income. Half of all patients reported that their families had to borrow to pay for care at interest rates of 5%–30% per month. A third of these families reported selling jewelry, land or household items to moneylenders. The rural patients reported more difficulty in paying for care than the urban patients. Factors increasing the expenditures were duration of hospitalization, rural residence, and necessary (e.g. C-section, hysterectomy and unnecessary (e.g. episiotomy medical procedures. Conclusion Free maternity services in Bangladesh impose large out-of-pocket expenditures on patients. Authorities could reduce the burden by reducing the duration of hospital stays, limiting use of medical procedures, eliminating tips, and moving routine services closer to potential users. Fee for service could reduce unofficial expenditures if the fee were lower than and replaced typical unofficial expenditures, otherwise adding service fees without reform of current hospital practices would

Medicaid expenditures for children living with smokers

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Levy Douglas E

2011-05-01

Full Text Available Abstract Background Children's exposure to secondhand smoke is associated with increased morbidity. We estimated Medicaid expenditures for children living with smokers compared to those living with no smokers in the United States. Methods Data were overall and service-specific (i.e., inpatient, ambulatory, emergency department, prescription drug, and dental annual Medicaid expenditures for children 0-11 years old from the 2000-2007 Medical Expenditures Panel Surveys. Smokers' presence in households was determined by adult respondents' self reports. There were 25,835 person-years of observation. We used multivariate analyses to adjust for child, parent, and geographic characteristics. Results Children with Medicaid expenditures were nearly twice as likely to live with a smoker as other children in the U.S. population. Adjusted analyses revealed no detectable differences in children's overall Medicaid expenditures by presence of smokers in the household. Medicaid children who lived with smokers on average had $10 (95% CI $3, $18 higher emergency department expenditures per year than those living with no smokers. Conclusions Living with at least one smoker (a proxy for secondhand smoke exposure is unrelated to children's overall short-term Medicaid expenditures, but has a modest impact on emergency department expenditures. Additional research is necessary to understand the relationship between secondhand smoke exposure and long-term health and economic outcomes.

PUBLIC EXPENDITURE POLICY IN THE CONTEXT OF ECONOMIC CRISIS - CHALLENGES AND IMPLICATIONS

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Petrisor Mihai - Bogdan

2011-07-01

Full Text Available Public spending is a key component for both public finances and government financial policy. In this situation, government expenditures are made in direct relation with the results of governance with economic and financial crises and global social welfare of the nation. From this perspective, our article aims to highlight the correlation between public expenditure and budgetary financial and economic crisis and, also, state government responses, anticipating their impact on medium and long term. Also, in the context of the crisis and the concomitent lack of public revenue, we identify the pillars on which to base the budget reduction in public expenditure. The implications of the economic crisis in Romania are analyzed along with proposed measures to be followed by the Government through budgetary fiscal strategy. In relation to the purpose and objectives of the research, documentation was made both in terms of bibliographic resources and the plan of legislative documents and quantitative reporting. We believe that the issue of increasing allocative efficiency of resources is vital to counter the current crisis, but also to maximize the positive effects of public interventions in general and from another state, we consider that state and, consequently, public expenditure budget which should be used to replace the market, can not be regarded as some suggest to be founded and we suggest a line for developed countries. This work was supported by the grant “Post-doctoral studies in Economics: program for continuous forming of elite researchers – SPODE”, contract POSDRU/89/1.5/S/61755, project financed by the European Social Fund, by the Operational Sectorial Program Development of Human Resources 2007-2013.

Relationship between Energy Expenditure Related Factors and Oxidative Stress in Follicular Fluid

OpenAIRE

Kazemi, Ashraf; Ramezanzadeh, Fatemeh; Nasr Esfahani, Mohammad Hosein; Saboor-Yaraghi, Ali Akbar; Nejat, Saharnaz Nejat; Rahimi-Foroshani, Abbas

2014-01-01

Background This study evaluated the impact of body mass index (BMI), total calorie intake and physical activity (PA) as energy expenditure related factors on oxidative stress (OS) in follicular fluid (FF). Materials and Methods This prospective study conducted on 219 infertile women. We evaluated patients’ BMI, total calorie intake and PA in their assisted reproduction treatment cycles. Malondialdehyde (MDA) and total antioxidant capacity (TAC) in pooled FF at oocyte retrieval were additional...

7 CFR 1484.55 - What expenditures may not be reimbursed under the Cooperator program?

Science.gov (United States)

2010-01-01

... (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS... sales expenditures; (5) The purchase, construction, or lease of space for permanent displays, i.e... discounts; (8) Refundable deposits or advances; (9) Giveaways, awards, prizes, gifts, and other similar...

The impacts of China’s household consumption expenditure patterns on energy demand and carbon emissions towards 2050

International Nuclear Information System (INIS)

Dai, Hancheng; Masui, Toshihiko; Matsuoka, Yuzuru; Fujimori, Shinichiro

2012-01-01

This paper explores how China’s household consumption patterns over the period 2005–2050 influence the total energy demand and carbon dioxide (CO 2 ) emissions in two baseline scenarios, and how it influences carbon prices as well as the economic cost in the corresponding carbon mitigation scenarios. To this end we first put forward two possible household consumption expenditure patterns up to 2050 using the Working–Leser model, taking into account total expenditure increase and urbanization. For comparison, both expenditure patterns are then incorporated in a hybrid recursive dynamic computable general equilibrium model. The results reveal that as income level increases in the coming decades, the direct and indirect household energy requirements and CO 2 emissions would rise drastically. When household expenditure shifts from material products and transport to service-oriented goods, around 21,000 mtce of primary energy and 45 billion tons of CO 2 emissions would be saved over the 45-year period from 2005 to 2050. Moreover, carbon prices in the dematerialized mitigation scenario would fall by 13% in 2050, thus reducing the economic cost. - Highlights: ► Propose two household expenditure patterns considering income rise and urbanization. ► Much energy and CO 2 emissions would be saved in low-carbon consumption scenario. ► Carbon prices would reduce a lot in low-carbon consumption scenario.

Health Care Expenditures for Children with Autism Spectrum Disorders in Medicaid

Science.gov (United States)

Wang, Li; Leslie, Douglas L.

2010-01-01

Objective: To study trends in health care expenditures associated with autism spectrum disorders (ASDs) in state Medicaid programs. Method: Using Medicaid data from 42 states from 2000 to 2003, patients aged 17 years and under who were continuously enrolled in fee-for-service Medicaid were studied. Patients with claims related to autistic disorder…

Sustainability of recurrent expenditure on public social welfare programmes: expenditure analysis of the free maternal care programme of the Ghana National Health Insurance Scheme.

Science.gov (United States)

Ankrah Odame, Emmanuel; Akweongo, Patricia; Yankah, Ben; Asenso-Boadi, Francis; Agyepong, Irene

2014-05-01

Sustainability of public social welfare programmes has long been of concern in development circles. An important aspect of sustainability is the ability to sustain the recurrent financial costs of programmes. A free maternal care programme (FMCP) was launched under the Ghana National Health Insurance Scheme (NHIS) in 2008 with a start-up grant from the British Government. This article examines claims expenditure under the programme and the implications for the financial sustainability of the programme, and the lessons for donor and public financing of social welfare programmes. Records of reimbursement claims for services and medicines by women benefitting from the policy in participating facilities in one sub-metropolis in Ghana were analysed to gain an understanding of the expenditure on this programme at facility level. National level financial inflow and outflow (expenditure) data of the NHIS, related to implementation of this policy for 2008 and 2009, were reviewed to put the facility-based data in the national perspective. A total of US$936 450.94 was spent in 2009 by the scheme on FMCP in the sub-metropolis. The NHIS expenditure on the programme for the entire country in 2009 was US$49.25 million, exceeding the British grant of US$10.00 million given for that year. Subsequently, the programme has been entirely financed by the National Health Insurance Fund. The rapidly increasing, recurrent demands on this fund from the maternal delivery exemption programme-without a commensurate growth on the amounts generated annually-is an increasing threat to the sustainability of the fund. Provision of donor start-up funding for programmes with high recurrent expenditures, under the expectation that government will take over and sustain the programme, must be accompanied by clear long-term analysis and planning as to how government will sustain the programme.

Medical expenditure for liver cancer in urban China: A 10-year multicenter retrospective survey (2002-2011).

Science.gov (United States)

Qiu, Wu-Qi; Shi, Ju-Fang; Guo, Lan-Wei; Mao, A-Yan; Huang, Hui-Yao; Hu, Guang-Yu; Dong, Pei; Bai, Fang-Zhou; Yan, Xiao-Ling; Liao, Xian-Zhen; Liu, Guo-Xiang; Bai, Ya-Na; Ren, Jian-Song; Sun, Xiao-Jie; Zhu, Xin-Yu; Zhou, Jin-Yi; Gong, Ji-Yong; Zhu, Lin; Mai, Ling; Du, Ling-Bing; Zhou, Qi; Xing, Xiao-Jing; Song, Bing-Bing; Liu, Yu-Qin; Lou, Pei-An; Sun, Xiao-Hua; Wu, Shou-Ling; Cao, Rong; Qi, Xiao; Lan, Li; Ren, Ying; Zhang, Kai; He, Jie; Qu, Chunfeng; Dai, Min

2018-01-01

This study aims to understand the medical expenditure for liver cancer during 2002-2011 in urban areas of China. This is a retrospective study. Based on a stratified cluster sampling method, a medical expenditure survey collected basic personal information from related medical records. Two-tailed independent sample t-test, variance analysis, and Student-Newman-Keuls Tests were used in cost analysis for the corresponding data types. A total of 12,342 liver cancer patients were included in the analysis. Overall average medical expenditure per case for liver cancer diagnosis and treatment in China has increased from ¥21, 950 to ¥40, 386 over the study period. For each liver cancer patient diagnosed between 2009 and 2011, the average expenditures were 29,332 CNY for stage I, 35,754 CNY for stage II, 34,288 CNY for stage III, and 30,275 CNY for stage IV diseases (P medical expenditure and it rose from 48.01% to 52.96% during these ten years, and the share of nursing fee expenses was the lowest (around 1%). Over the entire 10-year data period, the per capita expenditure of the east region (32,983 CNY) was higher than that of the west region (26,219 CNY) and slightly higher than the central region (31,018 CNY, P medical expenditure is heavy for families. Early diagnosis and treatment for liver cancer will save medical expenditure. The economic burden of liver cancer is high in China and related medical expenditure has increased.

Using time-series intervention analysis to understand U.S. Medicaid expenditures on antidepressant agents.

Science.gov (United States)

Ferrand, Yann; Kelton, Christina M L; Guo, Jeff J; Levy, Martin S; Yu, Yan

2011-03-01

Medicaid programs' spending on antidepressants increased from $159 million in 1991 to $2 billion in 2005. The National Institute for Health Care Management attributed this expenditure growth to increases in drug utilization, entry of newer higher-priced antidepressants, and greater prescription drug insurance coverage. Rising enrollment in Medicaid has also contributed to this expenditure growth. This research examines the impact of specific events, including branded-drug and generic entry, a black box warning, direct-to-consumer advertising (DTCA), and new indication approval, on Medicaid spending on antidepressants. Using quarterly expenditure data for 1991-2005 from the national Medicaid pharmacy claims database maintained by the Centers for Medicare and Medicaid Services, a time-series autoregressive integrated moving average (ARIMA) intervention analysis was performed on 6 specific antidepressant drugs and on overall antidepressant spending. Twenty-nine potentially relevant interventions and their dates of occurrence were identified from the literature. Each was tested for an impact on the time series. Forecasts from the models were compared with a holdout sample of actual expenditure data. Interventions with significant impacts on Medicaid expenditures included the patent expiration of Prozac® (P0.05), implying that the expanding market for antidepressants overwhelmed the effect of generic competition. Copyright © 2011 Elsevier Inc. All rights reserved.

Evaluating direct medical expenditures estimation methods of adults using the medical expenditure panel survey: an example focusing on head and neck cancer.

Science.gov (United States)

Coughlan, Diarmuid; Yeh, Susan T; O'Neill, Ciaran; Frick, Kevin D

2014-01-01

To inform policymakers of the importance of evaluating various methods for estimating the direct medical expenditures for a low-incidence condition, head and neck cancer (HNC). Four methods of estimation have been identified: 1) summing all health care expenditures, 2) estimating disease-specific expenditures consistent with an attribution approach, 3) estimating disease-specific expenditures by matching, and 4) estimating disease-specific expenditures by using a regression-based approach. A literature review of studies (2005-2012) that used the Medical Expenditure Panel Survey (MEPS) was undertaken to establish the most popular expenditure estimation methods. These methods were then applied to a sample of 120 respondents with HNC, derived from pooled data (2003-2008). The literature review shows that varying expenditure estimation methods have been used with MEPS but no study compared and contrasted all four methods. Our estimates are reflective of the national treated prevalence of HNC. The upper-bound estimate of annual direct medical expenditures of adult respondents with HNC between 2003 and 2008 was $3.18 billion (in 2008 dollars). Comparable estimates arising from methods focusing on disease-specific and incremental expenditures were all lower in magnitude. Attribution yielded annual expenditures of $1.41 billion, matching method of $1.56 billion, and regression method of $1.09 billion. This research demonstrates that variation exists across and within expenditure estimation methods applied to MEPS data. Despite concerns regarding aspects of reliability and consistency, reporting a combination of the four methods offers a degree of transparency and validity to estimating the likely range of annual direct medical expenditures of a condition. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Published by International Society for Pharmacoeconomics and Outcomes Research (ISPOR) All rights reserved.

Total Energy Expenditure by the doubly labelled water method in rural pre-school children in Cuba

International Nuclear Information System (INIS)

Hernandez-Triana, M.H.; Gonzalez-Calderin, S.; Sanchez, V.; Basabe-Tuero, B.; Salazar, G.; Diaz, E.

2002-01-01

Aim: Total Energy Expenditure (TEE) was measured by the doubly labelled water method in nineteen 5 y old children of a rural mountain community in Cuba. Materials and Methods. Ten males and nine females (18.4 and 18.5 kg average weight) with mean BMI values of 16.3 and 16.1 kg/m2 were included in the study. RMR was previously measured in year 2000 by indirect calorimetry in a sample of 11 children and values correlated properly with the estimations using the proposed equations of Henry and Rees. This estimate was used then for the whole group. Energy intake measured by 3-day weighed dietary record was 3.73 MJ/day. Tee was measured by the doubly labelled water method. Results: TEE values of well nourished children were 7.15 and 5.77 MJ/d for boys and girls, respectively. These findings imply that well nourished boys and girls are having a moderate to heavy physical activity requiring 93 and 75 kcal/kg per day. Physical activity of normal Cuban boys and girls living in rural areas was 1.88 and 1.59 METS, which is much higher than those values reported for children from developed countries using DLW. Energy intake was 1639 ± 381 in boys and 1230 ± 355 kcal/d in girls. Conclusions: TEE and physical activity level of rural Cuban children was higher than reported values of children living in developed countries

Expenditures for Resources in School Library Media Centers, FY 1991-92.

Science.gov (United States)

Miller, Marilyn L.; Shontz, Marilyn

1993-01-01

The sixth in a series of "School Library Journal" reports on trends in school library expenditures for program development shows that commitment to the teaching and motivating of reading is in conflict with fascination with technology and that access to books is being seriously curtailed by the deteriorating state of school library collections.…

Optimizing capital and time expenditures for drilling service operations

Energy Technology Data Exchange (ETDEWEB)

Zazovskiy, F Ya; Soltysyak, T I

1980-01-01

The operational efficiency of drilling services operations management are examined. The structure of time expenditure is analyzed for repair operations according to equipment type employed by the Ivano-Frankovsk Drilling Management under the Ukrneft' enterprise during 1977. The results of this analysis are weighed against a series of service operations carried out at industrial enterprises and connected with technical disruptions. Some of the cases examined include service competion operations outside of the industrial units when technical processes are disrupted only for the change of equipment which has outlived its usefulness and is no longer in series production. First of all, time expended for repair work can be reduced to zero during the drilling of shallow wells which do not require extensive drilling time. The actual savings, both in time and money, as far as repair work is concerned, hinges on the actual time factor for total oil depetion. An equation is provided for optimal time expenditure necessary for repair work and equipment replacement. An actual example is given from the Dolinsk UBR (Drillin Management) under the Ukrneft' enterprise where time spent on actual service operations has appeared to be less than the optimal figure cited in the above material. This is possible because of increased capital expenditures.

Expenditures on health research in sub-Saharan African countries: results of a questionnaire-based survey.

Science.gov (United States)

Kebede, Derege; Zielinski, Chris; Mbondji, Peter Ebongue; Sanou, Issa; Kouvividila, Wenceslas; Lusamba-Dikassa, Paul-Samson

2014-05-01

To estimate the sources of funds for health research (revenue) and the uses of these funds (expenditure). A structured questionnaire was used to solicit financial information from health research institutions. Forty-two sub-Saharan African countries. Key informants in 847 health research institutions in the 42 sub-Saharan African countries. Expenditure on health research by institutions, funders and subject areas. An estimated total of US$ 302 million was spent on health research by institutions that responded to the survey in the World Health Organization (WHO) African Region for the biennium 2005-2006. The most notable funders for health research activities were external funding, ministries of health, other government ministries, own funds and non-profit institutions. Most types of health research performers spent significant portions of their resources on in-house research, with medical schools spending 82% and government agencies 62%. Hospitals spent 38% of their resources on management, and other institutions (universities, firms, etc.) spent 87% of their resources on capital investment. Research on human immunodeficiency virus/tuberculosis and malaria accounted for 30% of funds, followed by research on other communicable diseases and maternal, perinatal and nutritional conditions (23%). Research on major health problems of the Region, such as communicable diseases, accounts for most of the research expenditures. However, the total expenditure is very low compared with other WHO regions. © The Royal Society of Medicine.

Health care expenditure for hospital-based delivery care in Lao PDR

Directory of Open Access Journals (Sweden)

Douangvichit Daovieng

2012-01-01

Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family

State energy price and expenditure report 1990

International Nuclear Information System (INIS)

1992-01-01

The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 States and the District of Columbia and in aggregate for the United States. The estimates are provided by energy source and economic sector. This report is an update of the State Energy Price and Expenditure Report 1989 published in September 1991. Energy price and expenditure estimates are published for the years 1970, 1975, 1980, and 1985 through 1990. Documentation follows the tables and describes how the price estimates are developed, including sources of data, methods of estimation, and conversion factors applied

Household expenditure on leprosy outpatient services in the Indian health system: A comparative study.

Directory of Open Access Journals (Sweden)

Anuj Tiwari

2018-01-01

Full Text Available Leprosy is a major public health problem in many low and middle income countries, especially in India, and contributes considerably to the global burden of the disease. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. However, evidence on patient's expenditure is scarce. In this study, we estimate the expenditure in primary care (outpatient by leprosy households in two different public health settings.We performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators. The mean direct expenditure was USD 6.5 (95% CI: 2.4-17.9 in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8-7.9 per visit in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2-10.6 in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0-21.9 in Umbergaon. The age of the leprosy patients and type of health facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, the higher the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients.An enhanced public health system reduces the patient's expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy.

Household expenditure on leprosy outpatient services in the Indian health system: A comparative study.

Science.gov (United States)

Tiwari, Anuj; Suryawanshi, Pramilesh; Raikwar, Akash; Arif, Mohammad; Richardus, Jan Hendrik

2018-01-01

Leprosy is a major public health problem in many low and middle income countries, especially in India, and contributes considerably to the global burden of the disease. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. However, evidence on patient's expenditure is scarce. In this study, we estimate the expenditure in primary care (outpatient) by leprosy households in two different public health settings. We performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH) survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators. The mean direct expenditure was USD 6.5 (95% CI: 2.4-17.9) in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8-7.9) per visit in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2-10.6) in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0-21.9) in Umbergaon. The age of the leprosy patients and type of health facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, the higher the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients. An enhanced public health system reduces the patient's expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy.

State energy price and expenditure report, 1995

Energy Technology Data Exchange (ETDEWEB)

NONE

1998-08-01

The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 States and the District of Columbia and in aggregate for the US. The estimates developed in the State Energy Price and Expenditure Data System (SEPEDS) are provided by energy source and economic sector and are published for the years 1970 through 1995. Data for all years are available on a CD-ROM and via Internet. Consumption estimates used to calculate expenditures and the documentation for those estimates are taken from the State Energy Data Report 1995, Consumption Estimates (SEDR), published in December 1997. Expenditures are calculated by multiplying the price estimates by the consumption estimates, which are adjusted to remove process fuel; intermediate petroleum products; and other consumption that has no direct fuel costs, i.e., hydroelectric, geothermal, wind, solar, and photovoltaic energy sources.

[Quantitative analysis of drug expenditures variability in dermatology units].

Science.gov (United States)

Moreno-Ramírez, David; Ferrándiz, Lara; Ramírez-Soto, Gabriel; Muñoyerro, M Dolores

2013-01-01

Variability in adjusted drug expenditures among clinical departments raises the possibility of difficult access to certain therapies at the time that avoidable expenditures may also exist. Nevertheless, drug expenditures are not usually applied to clinical practice variability analysis. To identify and quantify variability in drug expenditures in comparable dermatology department of the Servicio Andaluz de Salud. Comparative economic analysis regarding the drug expenditures adjusted to population and health care production in 18 dermatology departments of the Servicio Andaluz de Salud. The 2012 cost and production data (homogeneous production units -HPU-)were provided by Inforcoan, the cost accounting information system of the Servicio Andaluz de Salud. The observed drug expenditure ratio ranged from 0.97?/inh to 8.90?/inh and from 208.45?/HPU to 1,471.95?/ HPU. The Pearson correlation between drug expenditure and population was 0.25 and 0.35 for the correlation between expenditure and homogeneous production (p=0.32 and p=0,15, respectively), both Pearson coefficients confirming the lack of correlation and arelevant degree of variability in drug expenditures. The quantitative analysis of variability performed through Pearson correlation has confirmed the existence of drug expenditure variability among comparable dermatology departments. Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.

Fuel taxes and road expenditures: making the link

International Nuclear Information System (INIS)

Derkson, W.W.; Shurvell, S.J.

1999-11-01

This document reports on a study undertaken at the request of the United Grain Growers regarding government fuel tax revenue and the relationship to expenditures on roads. The account of fuel tax revenues was compiled from data collected from several different sources, as was the case for the road expenditures at the federal, provincial, local and modal levels. The emphasis was placed on the effects of fuel taxes on grain handling and transportation in the Prairie provinces. The authors presented fuel tax revenues broken down by mode of transportation and by province. The document was divided as follows: the first part was the introduction with the second part dealing with fuel tax rates and policies. In the third part, the topic of fuel tax and road related revenues was examined. Part four discussed road expenditures. The authors concluded that Transport Canada has traditionally represented the most important federal link to provincial highway infrastructure. It was noted that 4.2 billion dollars in road fuel taxes were collected by the federal government in 1998/1999, and of that amount, 198 million dollars, or 4.7 per cent, was reinvested in the National Highway System in programs managed by Transport Canada. Nearly one dollar on roads is spent by provincial governments on a Prairie-wide basis for every dollar collected in road fuel taxes, with Alberta spending the most and Saskatchewan spending the least. 15 tabs

Energy expenditure in patients with chronic renal failure.

Science.gov (United States)

Monteon, F J; Laidlaw, S A; Shaib, J K; Kopple, J D

1986-11-01

Although nondialyzed, chronically uremic patients and patients undergoing maintenance hemodialysis often show evidence for wasting and calorie malnutrition and have low dietary energy intakes, their energy expenditure has never been systematically evaluated. It is possible that low energy intakes are an adaptive response to reduced energy needs; alternatively, energy expenditure could be normal or high and the low energy intakes would be inappropriate. Energy expenditure was therefore measured by indirect calorimetry in 12 normal individuals, 10 nondialyzed patients with chronic renal failure, and 16 patients undergoing maintenance hemodialysis. Energy expenditure was measured in the resting state, during quiet sitting, during controlled exercise on an exercise bicycle, and for four hours after ingestion of a test meal. Resting energy expenditure (kcal/min/1.73 m2) in the normal subjects, chronically uremic patients and hemodialysis patients was, respectively, 0.94 +/- 0.24 (SD), 0.91 +/- 0.20, and 0.97 +/- 0.10. There was also no difference among the three groups in energy expenditure during sitting, exercise, or the postprandial state. Within each group, energy expenditure during resting and sitting was directly correlated. During bicycling, energy expenditure was directly correlated with work performed, and the regression equation for this relationship was similar in each of the three groups. These findings suggest that for a given physical activity, energy expenditure in nondialyzed, chronically uremic patients and maintenance hemodialysis patients is not different from normal. The low energy intakes of many of these patients may be inadequate for their needs.

Economic growth and inflation rate: implications for municipal revenue and health expenditure of the municipalities of Pernambuco, Brazil.

Science.gov (United States)

Feliciano, Marciana; Bezerra, Adriana Falangola Benjamin; Santo, Antônio Carlos Gomes do Espírito

2017-06-01

This paper analyzes the implications of municipal budget revenue growth and the monetary policy's inflation rates goals in the availability of public health resources of municipalities. This is a descriptive, exploratory, quantitative, retrospective and longitudinal cross-sectional study covering the period 2002-2011. We analyzed health financing and expenditure variables in the municipalities of the state of Pernambuco, Brazil, describing the trend and the relationship between them. Data showed the growth of the variables and trend towards homogeneity. The exception was for the participation of Intergovernmental Transfers in the Total Health Expenditure of the Municipality. We found a significant correlation between Budget Revenue per capita and Health Expenditure per capita and a strong significant negative correlation between Inflation Rate, Budget Revenue per capita and Health Expenditure per capita. We concluded that increased health expenditure is due more to higher municipal tax revenue than to increased transfers that, in relative terms, did not increase. The strong inverse relationship between inflation rate and the Financing and Expenditure variables show that the monetary policy's inflation goals have restricted health financing to municipalities.

[Influence of income on food expenditures away from home among Brazilian families, 2002-2003].

Science.gov (United States)

Claro, Rafael Moreira; Levy, Renata Bertazzi; Bandoni, Daniel Henrique

2009-11-01

This study describes and evaluates the influence of income on the percentage of food expenditures away from home for Brazilian families. Food acquisition data from the National Household Budget Survey conducted from 2002 to 2003 (POF 2002/2003) by the Brazilian Institute of Geography and Statistics (IBGE) or National Census Bureau was used in the analysis. Information on food-and-drink expenditures away from home was analyzed. The influence of income on the share of food purchased away from home in the household budget, adjusted for socio-demographic variables, was analyzed through elasticity coefficients estimated in multiple linear regression. Food purchased away from home accounted for 21% of total food expenditures by Brazilian households. A 10% increase in income increased the share of food purchased away from home by 3%. Income elasticity was high, especially for the lowest income families. The results demonstrate an important influence of income on food expenditures away from home, and higher income is associated with a greater share of food purchased away from home.

Combined Effects of Chewing Ability and Dietary Diversity on Medical Service Use and Expenditures.

Science.gov (United States)

Lo, Yuan-Ting C; Wahlqvist, Mark L; Chang, Yu-Hung; Lee, Meei-Shyuan

2016-06-01

To examine whether chewing ability affects healthcare use and expenditure and whether improving dietary quality alleviates any such effects. Prospective cohort. The Elderly Nutrition and Health Survey in Taiwan (1999-2000), a nationwide community-based survey of people aged 65 and older. Individuals aged 65 and older (N = 1,793; 903 men, 890 women). Chewing ability (satisfactory or unsatisfactory) was assessed using a questionnaire, and dietary quality was assessed using a 24-hour dietary recall as a dietary diversity score. Data on annual medical use and expenditures from the interview date until December 31, 2006, were collected from National Health Insurance claims. Generalized linear models were used to assess the associations between chewing ability, dietary quality, and annual medical usage or expenditure. After 8 years of follow-up, older adults with unsatisfactory chewing ability had considerably higher emergency, hospitalization, and total medical expenditures. Older adults with unsatisfactory chewing ability and a poor diet used fewer annual preventive care and dental services than those with satisfactory chewing ability but had longer hospital stays and higher expenditures. After adjusting for covariates, unsatisfactory chewing ability resulted in significantly longer hospital stays in participants with a poor diet (β = 2.34, 95% confidence interval = 2.02-2.71, P chewing ability and a less-diverse diet together are associated with longer hospital stays and higher medical expenditures. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Ocoee Junior High School's Total School Reading Program on a Shoestring.

Science.gov (United States)

Hinson, Bess; Williams, Robert W.

The total school reading program described in this booklet includes a program for remedial, developmental, and special education students. Faculty members and students not participating in this program spend one half hour a day in a silent reading program. The booklet outlines each facet of the program, lists the equipment and materials used,…

Genotype by energy expenditure interaction with metabolic syndrome traits: the Portuguese healthy family study.

Science.gov (United States)

Santos, Daniel M V; Katzmarzyk, Peter T; Diego, Vincent P; Souza, Michele C; Chaves, Raquel N; Blangero, John; Maia, José A R

2013-01-01

Moderate-to-high levels of physical activity are established as preventive factors in metabolic syndrome development. However, there is variability in the phenotypic expression of metabolic syndrome under distinct physical activity conditions. In the present study we applied a Genotype X Environment interaction method to examine the presence of GxEE interaction in the phenotypic expression of metabolic syndrome. A total of 958 subjects, from 294 families of The Portuguese Healthy Family study, were included in the analysis. Total daily energy expenditure was assessed using a 3 day physical activity diary. Six metabolic syndrome related traits, including waist circumference, systolic blood pressure, glucose, HDL cholesterol, total cholesterol and triglycerides, were measured and adjusted for age and sex. GxEE examination was performed on SOLAR 4.3.1. All metabolic syndrome indicators were significantly heritable. The GxEE interaction model fitted the data better than the polygenic model (pmetabolic syndrome traits expression is significantly influenced by the interaction established between total daily energy expenditure and genotypes. Physical activity may be considered an environmental variable that promotes metabolic differences between individuals that are distinctively active.

Household energy consumption and expenditures, 1990

International Nuclear Information System (INIS)

1993-01-01

This report, Household Energy Consumption and Expenditures 1990, is based upon data from the 1990 Residential Energy Consumption Survey (RECS). Focusing on energy end-use consumption and expenditures of households, the 1990 RECS is the eighth in a series conducted since 1978 by the Energy Information Administration (EIA). Over 5,000 households were surveyed, providing information on their housing units, housing characteristics, energy consumption and expenditures, stock of energy-consuming appliances, and energy-related behavior. The information provided represents the characteristics and energy consumption of 94 million households nationwide

Estimating the Relationship between Economic Growth and Health Expenditures in ECO Countries Using Panel Cointegration Approach

Directory of Open Access Journals (Sweden)

Nahid Hatam

2016-03-01

Full Text Available Increasing knowledge of people about health leads to raising the share of health expenditures in government budget continuously; although governors do not like this rise because of budget limitations. This study aimed to find the association between health expenditures and economic growth in ECO countries. We added health capital in Solow model and used the panel cointegration approach to show the importance of health expenditures in economic growth. For estimating the model, first we used Pesaran cross-sectional dependency test, after that we used Pesaran CADF unit root test, and then we used Westerlund panel cointegration test to show if there is a long-term association between variables or not. After that, we used chaw test, Breusch-Pagan test and Hausman test to find the form of the model. Finally, we used OLS estimator for panel data. Findings showed that there is a positive, strong association between health expenditures and economic growth in ECO countries. If governments increase investing in health, the total production of the country will be increased, so health expenditures are considered as an investing good. The effects of health expenditures in developing countries must be higher than those in developed countries. Such studies can help policy makers to make long-term decisions.

Estimating the Relationship between Economic Growth and Health Expenditures in ECO Countries Using Panel Cointegration Approach.

Science.gov (United States)

Hatam, Nahid; Tourani, Sogand; Homaie Rad, Enayatollah; Bastani, Peivand

2016-02-01

Increasing knowledge of people about health leads to raising the share of health expenditures in government budget continuously; although governors do not like this rise because of budget limitations. This study aimed to find the association between health expenditures and economic growth in ECO countries. We added health capital in Solow model and used the panel cointegration approach to show the importance of health expenditures in economic growth. For estimating the model, first we used Pesaran cross-sectional dependency test, after that we used Pesaran CADF unit root test, and then we used Westerlund panel cointegration test to show if there is a long-term association between variables or not. After that, we used chaw test, Breusch-Pagan test and Hausman test to find the form of the model. Finally, we used OLS estimator for panel data. Findings showed that there is a positive, strong association between health expenditures and economic growth in ECO countries. If governments increase investing in health, the total production of the country will be increased, so health expenditures are considered as an investing good. The effects of health expenditures in developing countries must be higher than those in developed countries. Such studies can help policy makers to make long-term decisions.

Heterogeneous effects of health insurance on out-of-pocket expenditure on medicines in Mexico.

Science.gov (United States)

Wirtz, Veronika J; Santa-Ana-Tellez, Yared; Servan-Mori, Edson; Avila-Burgos, Leticia

2012-01-01

Given the importance of health insurance for financing medicines and recent policy changes designed to reduce health-related out-of-pocket expenditure (OOPE) in Mexico, our study examined and analyzed the effect of health insurance on the probability and amount of OOPE for medicines and the proportion spent from household available expenditure (AE) funds. We conducted a cross-sectional analysis by using the Mexican National Household Survey of Income and Expenditures for 2008. Households were grouped according to household medical insurance type (Social Security, Seguro Popular, mixed, or no affiliation). OOPE for medicines and health costs, and the probability of occurrence, were estimated with linear regression models; subsequently, the proportion of health expenditures from AE was calculated. The Heckman selection procedure was used to correct for self-selection of health expenditure; a propensity score matching procedure and an alternative procedure using instrumental variables were used to correct for heterogeneity between households with and without Seguro Popular. OOPE in medicines account for 66% of the total health expenditures and 5% of the AE. Households with health insurance had a lower probability of OOPE for medicines than their comparison groups. There was heterogeneity in the health insurance effect on the proportion of OOPE for medicines out of the AE, with a reduction of 1.7% for households with Social Security, 1.4% for mixed affiliation, but no difference between Seguro Popular and matched households without insurance. Medicines were the most prevalent component of health expenditures in Mexico. We recommend improving access to health services and strengthening access to medicines to reduce high OOPE. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Estimation of the fiscal year 1985 expenditures in nuclear energy relation

International Nuclear Information System (INIS)

1985-01-01

In Japan, the electric power by nuclear energy accounts for about 20 % of the total power at present. Then, radiation is utilized extensively in such fields as industries, agriculture and medicine. The expenditures (budgets) estimated for the fiscal year 1985 are about 343.8 billion yen plus contract authorization limitation about 146.7 billion yen. In connection with the expenditures estimation (of which a breakdown is given in tables), the research and development plans for nuclear energy relation for fiscal year 1985 are presented: strengthening in nuclear energy safety, promotion of nuclear power generation, establishment of the nuclear fuel cycle, development of advanced power reactors, research on nuclear fusion, promotion of radiation utilizations, strengthening in the research and development infrastructure, promotion of international cooperation, etc. (Mori, K.)

How has alcohol advertising in traditional and online media in Australia changed? Trends in advertising expenditure 1997-2011.

Science.gov (United States)

White, Victoria; Faulkner, Agatha; Coomber, Kerri; Azar, Denise; Room, Robin; Livingston, Michael; Chikritzhs, Tanya; Wakefield, Melanie

2015-06-19

The aim of this study was to determine changes in advertising expenditures across eight media channels for the four main alcohol beverage types and alcohol retailers in Australia. Yearly advertising expenditures between January 1997 and December 2011 obtained from a leading media-monitoring company. Media channels assessed were: free-to-air television, newspapers, magazines, radio, outdoors (billboards), cinema, direct mail (from 2005) and online (from 2008). Data were categorised into alcohol retailers (e.g. supermarkets, off-licences) or four alcoholic beverage types (beer, wine, spirits, premixed spirits/cider). Regression analyses examined associations between year and expenditure. Total alcohol advertising expenditure peaked in 2007, then declined to 2011 (P = 0.02). Television advertising expenditure declined between 2000 and 2011 (P advertising expenditure increased between 1997 and 2007. Alcohol retailers' advertising expenditure increased over time (P advertising expenditure declined over time (beer: P advertising expenditure increased (beer: P advertised beer (P advertising alcohol. As our study excluded non-traditional advertising media (e.g. sponsorships, in-store) we cannot determine whether declines in television advertising have been offset by increases in advertising in newer media channels. However, our findings that media channels used for alcohol advertising have changed over time highlights the need for adequate controls on alcohol advertising in all media channels. [White V, Faulkner A, Coomber K, Azar D, Room R, Livingston M, Chikritzhs T, Wakefield M. How has alcohol advertising in traditional and online media in Australia changed? Trends in advertising expenditure 1997-2011. Drug Alcohol Rev 2015]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Local health department food safety and sanitation expenditures and reductions in enteric disease, 2000-2010.

Science.gov (United States)

Bekemeier, Betty; Yip, Michelle Pui-Yan; Dunbar, Matthew D; Whitman, Greg; Kwan-Gett, Tao

2015-04-01

In collaboration with Public Health Practice-Based Research Networks, we investigated relationships between local health department (LHD) food safety and sanitation expenditures and reported enteric disease rates. We combined annual infection rates for the common notifiable enteric diseases with uniquely detailed, LHD-level food safety and sanitation annual expenditure data obtained from Washington and New York state health departments. We used a multivariate panel time-series design to examine ecologic relationships between 2000-2010 local food safety and sanitation expenditures and enteric diseases. Our study population consisted of 72 LHDs (mostly serving county-level jurisdictions) in Washington and New York. While controlling for other factors, we found significant associations between higher LHD food and sanitation spending and a lower incidence of salmonellosis in Washington and a lower incidence of cryptosporidiosis in New York. Local public health expenditures on food and sanitation services are important because of their association with certain health indicators. Our study supports the need for program-specific LHD service-related data to measure the cost, performance, and outcomes of prevention efforts to inform practice and policymaking.

Propensity Analysis on Consumption Expenditure of Rural Residents in Hebei Province, China

OpenAIRE

Liu, Meng; Wang, Guirong; Wang, Huijun

2009-01-01

Consumption expenditure of rural residents can be divided into eight types of indices, such as food consumption expenditure, clothing consumption expenditure, household equipment and service consumption expenditure, health care consumption expenditure, transportation and communication consumption expenditure, cultural and educational entertainment and service consumption expenditure, housing consumption expenditure, and other goods and services consumption expenditure. Changes in structures o...

Government expenditure and energy intensity in China

International Nuclear Information System (INIS)

Yuxiang, Karl; Chen, Zhongchang

2010-01-01

The recent economic stimulus package of China has raised growing concern about its potential impact on energy demand and efficiency. To what extent does such expansion of government expenditure influence energy intensity? This question has not been well answered by the previous research. Using provincial panel data, this paper provides some evidence of a link between government expenditure and energy intensity in China. The empirical results demonstrate that the expansion of government expenditure since Asian financial crisis has exerted a significant influence on energy intensity. An increase in government expenditure in China leads to an increase in energy intensity. Further analysis compares such relationships in different economic situations. The comparison shows that such positive effect of government expenditure remains significant after the alteration in economic situation. Therefore, the results suggest introducing some measures to consolidate China's existing gains in energy efficiency. The analysis also explains why the downward trend in energy intensity is reversed in China since 2002. (author)

Military Expenditure and Socio-Economic Development.

Science.gov (United States)

Ball, Nicole

1983-01-01

The relationship between military expenditure and the stimulation of aggregate demand, inflation, investment, trade balance, foreign exchange, the improvement of taxation, and employment creation and industrialization in the Third World is analyzed. To some extent military expenditure does promote economic growth, but it does not automatically…

Labelled drug-related public expenditure in relation to gross domestic product (GDP) in Europe: a luxury good?

LENUS (Irish Health Repository)

Prieto, Luis

2010-01-01

"Labelled drug-related public expenditure" is the direct expenditure explicitly labelled as related to illicit drugs by the general government of the state. As part of the reporting exercise corresponding to 2005, the European Monitoring Centre for Drugs and Drug Addiction\\'s network of national focal points set up in the 27 European Union (EU) Member States, Norway, and the candidates countries to the EU, were requested to identify labelled drug-related public expenditure, at the country level. This was reported by 10 countries categorised according to the functions of government, amounting to a total of EUR 2.17 billion. Overall, the highest proportion of this total came within the government functions of Health (66%), and Public Order and Safety (POS) (20%). By country, the average share of GDP was 0.023% for Health, and 0.013% for POS. However, these shares varied considerably across countries, ranging from 0.00033% in Slovakia, up to 0.053% of GDP in Ireland in the case of Health, and from 0.003% in Portugal, to 0.02% in the UK, in the case of POS; almost a 161-fold difference between the highest and the lowest countries for Health, and a 6-fold difference for POS. Why do Ireland and the UK spend so much in Health and POS, or Slovakia and Portugal so little, in GDP terms? To respond to this question and to make a comprehensive assessment of drug-related public expenditure across countries, this study compared Health and POS spending and GDP in the 10 reporting countries. Results found suggest GDP to be a major determinant of the Health and POS drug-related public expenditures of a country. Labelled drug-related public expenditure showed a positive association with the GDP across the countries considered: r = 0.81 in the case of Health, and r = 0.91 for POS. The percentage change in Health and POS expenditures due to a one percent increase in GDP (the income elasticity of demand) was estimated to be 1.78% and 1.23% respectively. Being highly income elastic

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

Science.gov (United States)

Phillips, Charles D.

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges.

Science.gov (United States)

Phillips, Charles D

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

The Pediatric Home Care/Expenditure Classification Model (P/ECM: A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

Directory of Open Access Journals (Sweden)

Charles D. Phillips

2015-01-01

Full Text Available Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

Accuracy of a novel multi-sensor board for measuring physical activity and energy expenditure.

Science.gov (United States)

Duncan, Glen E; Lester, Jonathan; Migotsky, Sean; Goh, Jorming; Higgins, Lisa; Borriello, Gaetano

2011-09-01

The ability to relate physical activity to health depends on accurate measurement. Yet, none of the available methods are fully satisfactory due to several factors. This study examined the accuracy of a multi-sensor board (MSB) that infers activity types (sitting, standing, walking, stair climbing, and running) and estimates energy expenditure in 57 adults (32 females) 39.2 ± 13.5 years. In the laboratory, subjects walked and ran on a treadmill over a select range of speeds and grades for 3 min each (six stages in random order) while connected to a stationary calorimeter, preceded and followed by brief sitting and standing. On a different day, subjects completed scripted activities in the field connected to a portable calorimeter. The MSB was attached to a strap at the right hip. Subjects repeated one condition (randomly selected) on the third day. Accuracy of inferred activities compared with recorded activities (correctly identified activities/total activities × 100) was 97 and 84% in the laboratory and field, respectively. Absolute accuracy of energy expenditure [100 - absolute value (kilocalories MSB - kilocalories calorimeter/kilocalories calorimeter) × 100] was 89 and 76% in the laboratory and field, the later being different (P calorimeter. Test-retest reliability for energy expenditure was significant in both settings (P type in laboratory and field settings and energy expenditure during treadmill walking and running although the device underestimates energy expenditure in the field.

MARKETING EXPENDITURES IN THE INDONESIAN CONSTRUCTION INDUSTRY

Directory of Open Access Journals (Sweden)

Krishna Mochtar

2004-01-01

Full Text Available In the 1960s, a “new” marketing concept known as "four Ps marketing mix" appeared and shifted the focus from the product to the customer. The objective of the new concept was not only profit, and the means of achieving the objective expanded to include the entire “marketing mix”: product, price, promotion, and place (channels and distribution. Expenditures of marketing in a company should be explored from these mixes, because each mix would have an impact on the total marketing expenditures. These four mixes are the main aspects of marketing and thus, should represent almost all expenditures in marketing in a company. From this research it is discovered that the responding contractors have only average efforts to improve or innovate their service, mostly using the latest construction methods and management approach. Correlated to their policy in the fourth mix (Place, they are still national oriented and not international oriented in marketing their services, this may lead to the big question of their survival; their motivation to innovate is only average while their target market is only national market. Their attitude to use more intensive “fees” policy rather than both product innovation and promotion is also interesting. Big percentage of the responding contractors assumes these “fees” are regular marketing practices. This attitude may better be stopped to make the construction industry practices healthier. Attitude to use more product innovation and true promotion approach in marketing in construction must be encouraged systematically in the future, to improve competitiveness in the long term.

Out-of-pocket expenditure on maternity care for hospital births in Uttar Pradesh, India.

Science.gov (United States)

Goli, Srinivas; Rammohan, Anu; Moradhvaj

2018-02-27

The studies measured Out-of-Pocket Expenditure (OOPE) for hospital births previously suffer from serious data limitations. To overcome such limitations, we designed a hospital-based study for measuring the levels and factors of OOPE on maternity care for hospital births by its detailed components. Data were collected from women for non-complicated deliveries 24-h before the survey and complicated deliveries 48-h prior to the survey at the hospital settings in Uttar Pradesh, India during 2014. The simple random sampling design was used in the selection of respondents. Bivariate analyses were used to estimate mean expenditure on Antenatal care services (ANCs), Delivery care and Total Maternity Expenditure (TME). Multivariate linear regression was employed to examine the factor associated with the absolute and relative share of expenditure in couple's annual income on ANCs, delivery care, and TME. The findings show that average expenditure on maternal health care is high ($155) in the study population. Findings suggest that factors such as income, place, and number of ANCs, type, and place of institutional delivery are significantly associated with both absolute and relative expenditure on maternity care. The likelihood of incidence of catastrophic expenditure on maternity care is significantly higher for women delivered in private hospitals (β = 2.427, p maternity care for hospital births reported in this study is much higher as it was collected with a better methodology, although with smaller sample size. Therefore, ongoing maternity benefit scheme in India in general and Uttar Pradesh in particular need to consider the levels of OOPE on maternity care and demand-side and supply-side factors determining it for a more effective policy to reduce the catastrophic burden on households and help women to achieve better maternity health outcomes in poor regional settings like Uttar Pradesh in India.

Increased Body Weight Reduces Voluntary Movement to Maintain Energy Expenditure of Rats Exposed to Increases in Gravity

Science.gov (United States)

Wade, C. E.; Moran, M. M.; Stein, T. P.; Sin, Sidney (Technical Monitor)

2001-01-01

With the increase in obesity related diseases there is heightened interest in mechanisms regulating body weight. To assess the influence of increases in body weight on energy expenditure and intake in rats we employed variable levels of gravity. Our approach afforded the means to measure interactions of energy expenditure and intake in response to increases in body weight (body mass x gravity level). We found a dose relationship between rapid elevation of body weight and reduction of voluntary movement, such that the energy requirements for activity are unchanged, and total energy expenditure and intake maintained. Reduction of movement appears to be a response to increased body weight, rather than a contributing factor, suggesting a new regulatory pathway.

Household energy and consumption and expenditures, 1990

International Nuclear Information System (INIS)

1993-01-01

The purpose of this supplement to the Household Energy Consumption and Expenditures 1990 report is to provide information on the use of energy in residential housing units, specifically at the four Census regions and nine Census division levels. This report includes household energy consumption, expenditures, and prices for natural gas, electricity, fuel oil, liquefied petroleum gas (LPG), and kerosene as well as household wood consumption. For national-level data, see the main report, Household Energy Consumption and Expenditures 1990

The association between different types of exercise and energy expenditure in young nonoverweight and overweight adults

Science.gov (United States)

Drenowatz, Clemens; Hand, Gregory A.; Shook, Robin P.; Jakicic, John M.; Hebert, James R.; Burgess, Stephanie; Blair, Steven N.

2015-01-01

With decades of trends for decreasing activity during work and travel, exercise becomes an important contributor to total physical activity (PA) and energy expenditure. The purpose of this study was to examine the contribution of different types of exercise to the variability in energy expenditure and time spent at different PA intensities in young adults. Four hundred and seventeen adults (49.9% male; 46.2 overweight/obese) between 21 and 36 years of age provided valid objective PA and energy expenditure data, assessed via the SenseWear Armband (BodyMedia Inc.). Frequency and duration of participation in various exercise types was self-reported. Weight status was based on body mass index (BMI) (kg/m2) with body weight and height being measured according to standard procedures. Eighty-four percent of the participants reported regular exercise engagement with no difference in participation rate by sex or BMI category. Exercise time along with sex and ethnicity explained roughly 60% of the variability in total daily energy expenditure (TDEE) while the association between exercise and time spent in moderate to vigorous PA or being sedentary was low or nonsignificant. Engagement in endurance exercise and sports contributed predominantly to the variability in energy expenditure and PA in nonoverweight participants. In overweight/obese participants engagement in resistance exercise and swimming contributed significantly to variability in TDEE. Current exercise recommendations focus primarily on aerobic exercise, but results of the present study suggest that nonweight-bearing exercises, such as resistance exercise and swimming, contribute significantly to the variability in TDEE in overweight/obese adults, which would make these types of activities viable options for exercise interventions. PMID:25647557

Energy expenditure and intake during Special Operations Forces field training in a jungle and glacial environment.

Science.gov (United States)

Johnson, Caleb D; Simonson, Andrew J; Darnell, Matthew E; DeLany, James P; Wohleber, Meleesa F; Connaboy, Christopher

2018-04-01

The purpose of this study was to identify and compare energy requirements specific to Special Operations Forces in field training, in both cool and hot environments. Three separate training sessions were evaluated, 2 in a hot environment (n = 21) and 1 in a cool environment (n = 8). Total energy expenditure was calculated using doubly labeled water. Dietary intake was assessed via self-report at the end of each training mission day, and macronutrient intakes were calculated. Across the 3 missions, mean energy expenditure (4618 ± 1350 kcal/day) exceeded mean energy intake (2429 ± 838 kcal/day) by an average of 2200 kcal/day. Macronutrient intakes (carbohydrates (g/(kg·day body weight (bw)) -1 ) = 3.2 ± 1.2; protein (g/(kg·day bw) -1 ) = 1.3 ± 0.7; fat (g/(kg·day bw) -1 ) = 1.2 ± 0.7) showed inadequate carbohydrate and possibly protein intake across the study period, compared with common recommendations. Total energy expenditures were found to be similar between hot (4664 ± 1399 kcal/day) and cool (4549 ± 1221 kcal/day) environments. However, energy intake was found to be higher in the cool (3001 ± 900 kcal/day) compared with hot (2200 ± 711 kcal/day) environments. Based on the identified energy deficit, high variation in energy expenditures, and poor macronutrient intake, a greater attention to feeding practices during similar training scenarios for Special Operations Forces is needed to help maintain performance and health. The differences in environmental heat stress between the 2 climates/environments had no observed effect on energy expenditures, but may have influenced intakes.

Medicaid CMS-64 New Adult Group Expenditures

Data.gov (United States)

U.S. Department of Health & Human Services — This dataset reports summary level expenditure data associated with the new adult group established under the Affordable Care Act. These state expenditures are...

Adjusting Health Expenditures for Inflation: A Review of Measures for Health Services Research in the United States.

Science.gov (United States)

Dunn, Abe; Grosse, Scott D; Zuvekas, Samuel H

2018-02-01

To provide guidance on selecting the most appropriate price index for adjusting health expenditures or costs for inflation. Major price index series produced by federal statistical agencies. We compare the key characteristics of each index and develop suggestions on specific indexes to use in many common situations and general guidance in others. Price series and methodological documentation were downloaded from federal websites and supplemented with literature scans. The gross domestic product implicit price deflator or the overall Personal Consumption Expenditures (PCE) index is preferable to the Consumer Price Index (CPI-U) to adjust for general inflation, in most cases. The Personal Health Care (PHC) index or the PCE health-by-function index is generally preferred to adjust total medical expenditures for inflation. The CPI medical care index is preferred for the adjustment of consumer out-of-pocket expenditures for inflation. A new, experimental disease-specific Medical Care Expenditure Index is now available to adjust payments for disease treatment episodes. There is no single gold standard for adjusting health expenditures for inflation. Our discussion of best practices can help researchers select the index best suited to their study. © Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty.

Science.gov (United States)

Flores, Gabriela; Krishnakumar, Jaya; O'Donnell, Owen; van Doorslaer, Eddy

2008-12-01

In the absence of formal health insurance, we argue that the strategies households adopt to finance health care have important implications for the measurement and interpretation of how health payments impact on consumption and poverty. Given data on source of finance, we propose to (a) approximate the relative impact of health payments on current consumption with a 'coping'-adjusted health expenditure ratio, (b) uncover poverty that is 'hidden' because total household expenditure is inflated by financial coping strategies and (c) identify poverty that is 'transient' because necessary consumption is temporarily sacrificed to pay for health care. Measures that ignore coping strategies not only overstate the risk to current consumption and exaggerate the scale of catastrophic payments but also overlook the long-run burden of health payments. Nationally representative data from India reveal that coping strategies finance as much as three-quarters of the cost of inpatient care. Payments for inpatient care exceed 10% of total household expenditure for around 30% of hospitalized households but less than 4% sacrifice more than 10% of current consumption to accommodate this spending.Ignoring health payments leads to underestimate poverty by 7-8% points among hospitalized households; 80% of this adjustment is hidden poverty due to coping.

Political determinants of social expenditures in Greece: an empirical analysis

OpenAIRE

Canikalp, Ebru; Unlukaplan, Ilter

2017-01-01

A view prominently expounded is that the interaction between the composition and the volume of public expenditures is directly affected by political, institutional, psephological and ideological indicators. A crucial component of public expenditures, social expenditures play an important role in the economy as they directly and indirectly affect the distribution of income and wealth. Social expenditures aim at reallocating income and wealth unequal distribution. These expenditures comprise ca...

Out-of-pocket expenditure on chronic non-communicable diseases in sub-Saharan Africa: the case of rural Malawi.

Directory of Open Access Journals (Sweden)

Qun Wang

Full Text Available In Sub-Saharan Africa (SSA the disease burden of chronic non-communicable diseases (CNCDs is rising considerably. Given weaknesses in existing financial arrangements across SSA, expenditure on CNCDs is often borne directly by patients through out-of-pocket (OOP payments. This study explored patterns and determinants of OOP expenditure on CNCDs in Malawi. We used data from the first round of a longitudinal household health survey conducted in 2012 on a sample of 1199 households in three rural districts in Malawi. We used a two-part model to analyze determinants of OOP expenditure on CNCDs. 475 respondents reported at least one CNCD. More than 60% of the 298 individuals who reported seeking care incurred OOP expenditure. The amount of OOP expenditure on CNCDs comprised 22% of their monthly per capita household expenditure. The poorer the household, the higher proportion of their monthly per capita household expenditure was spent on CNCDs. Higher severity of disease was significantly associated with an increased likelihood of incurring OOP expenditure. Use of formal care was negatively associated with the possibility of incurring OOP expenditure. The following factors were positively associated with the amount of OOP expenditure: being female, Alomwe and household head, longer duration of disease, CNCDs targeted through active screening programs, higher socio-economic status, household head being literate, using formal care, and fewer household members living with a CNCD within a household. Our study showed that, in spite of a context where care for CNCDs should in principle be available free of charge at point of use, OOP payments impose a considerable financial burden on rural households, especially among the poorest. This suggests the existence of important gaps in financial protection in the current coverage policy.

Out-of-pocket expenditure on chronic non-communicable diseases in sub-Saharan Africa: the case of rural Malawi.

Science.gov (United States)

Wang, Qun; Fu, Alex Z; Brenner, Stephan; Kalmus, Olivier; Banda, Hastings Thomas; De Allegri, Manuela

2015-01-01

In Sub-Saharan Africa (SSA) the disease burden of chronic non-communicable diseases (CNCDs) is rising considerably. Given weaknesses in existing financial arrangements across SSA, expenditure on CNCDs is often borne directly by patients through out-of-pocket (OOP) payments. This study explored patterns and determinants of OOP expenditure on CNCDs in Malawi. We used data from the first round of a longitudinal household health survey conducted in 2012 on a sample of 1199 households in three rural districts in Malawi. We used a two-part model to analyze determinants of OOP expenditure on CNCDs. 475 respondents reported at least one CNCD. More than 60% of the 298 individuals who reported seeking care incurred OOP expenditure. The amount of OOP expenditure on CNCDs comprised 22% of their monthly per capita household expenditure. The poorer the household, the higher proportion of their monthly per capita household expenditure was spent on CNCDs. Higher severity of disease was significantly associated with an increased likelihood of incurring OOP expenditure. Use of formal care was negatively associated with the possibility of incurring OOP expenditure. The following factors were positively associated with the amount of OOP expenditure: being female, Alomwe and household head, longer duration of disease, CNCDs targeted through active screening programs, higher socio-economic status, household head being literate, using formal care, and fewer household members living with a CNCD within a household. Our study showed that, in spite of a context where care for CNCDs should in principle be available free of charge at point of use, OOP payments impose a considerable financial burden on rural households, especially among the poorest. This suggests the existence of important gaps in financial protection in the current coverage policy.

Gross domestic product and health expenditure associated with incidence, 30-day fatality, and age at stroke onset: a systematic review.

Science.gov (United States)

Sposato, Luciano A; Saposnik, Gustavo

2012-01-01

Differences in definitions of socioeconomic status and between study designs hinder their comparability across countries. We aimed to analyze the correlation between 3 widely used macrosocioeconomic status indicators and clinical outcomes. We selected population-based studies reporting incident stroke risk and/or 30-day case-fatality according to prespecified criteria. We used 3 macrosocioeconomic status indicators that are consistently defined by international agencies: per capita gross domestic product adjusted for purchasing power parity, total health expenditures per capita at purchasing power parity, and unemployment rate. We examined the correlation of each macrosocioeconomic status indicator with incident risk of stroke, 30-day case-fatality, proportion of hemorrhagic strokes, and age at stroke onset. Twenty-three articles comprising 30 population-based studies fulfilled the eligibility criteria. Age-adjusted incident risk of stroke using the standardized World Health Organization World population was associated to lower per capita gross domestic product adjusted for purchasing power parity (ρ=-0.661, P=0.027, R(2)=0.32) and total health expenditures per capita at purchasing power parity (ρ=-0.623, P=0.040, R(2)=0.26). Thirty-day case-fatality rates and proportion of hemorrhagic strokes were also related to lower per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity. Moreover, stroke occurred at a younger age in populations with low per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity. There was no correlation between unemployment rates and outcome measures. Lower per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity were associated with higher incident risk of stroke, higher case-fatality, a greater

Obesity and health expenditures: evidence from Australia.

Science.gov (United States)

Buchmueller, Thomas C; Johar, Meliyanni

2015-04-01

Rising rates of obesity are a public health concern in every industrialized country. This study investigates the relationship between obesity and health care expenditure in Australia, where the rate of obesity has tripled in the last three decades. Now one in four Australians is considered obese, defined as having a body mass index (BMI, kg/m(2)) of 30 or over. The analysis is based on a random sample survey of over 240,000 adults aged 45 and over that is linked at the individual-level to comprehensive administrative health care claims for the period 2006-2009. This sub-population group has an obesity rate that is nearly 30% and is a major consumer of health services. Relative to the average annual health expenditures of those with normal weight, we find that the health expenditures of those with a BMI between 30 and 35 (obese type I) are 19% higher and expenditures of those with BMI greater than 35 (obese type II/III) are 51% higher. We find large and significant differences in all types of care: inpatient, emergency department, outpatient and prescription drugs. The obesity-related health expenditures are higher for obese type I women than men, but in the obese type II/III state, obesity-related expenditures are higher for men. When we stratify further by age groups, we find that obesity has the largest impact among men over age 75 and women aged 60-74 years old. In addition, we find that obesity impacts health expenditures not only through its link to chronic diseases, but also because it increases the cost of recovery from acute health shocks. Copyright © 2015 Elsevier B.V. All rights reserved.

Low levels of energy expenditure in childhood cancer survivors: Implications for obesity prevention

Science.gov (United States)

Childhood cancer survivors are at an increased risk of obesity but causes for this elevated risk are uncertain. We evaluated total energy expenditure in childhood cancer survivors using the doubly labeled water method in a cross-sectional study of 17 survivors of pediatric leukemia or lymphoma (medi...

Impact of the Bolsa Família program on food availability of low-income Brazilian families: a quasi experimental study.

Science.gov (United States)

Martins, Ana Paula Bortoletto; Monteiro, Carlos Augusto

2016-08-19

The Bolsa Família Program was created in Brazil in 2003, by the joint of different social programs aimed at poor or very poor families with focus on income transfer to promote immediate poverty relief, conditionalities and complementary programs. Given the contributions of conditional cash transfer programs to poverty alleviation and their potential effects on nutrition and health, the objective of this study was to assess the impact of the Bolsa Família Program on food purchases of low-income households in Brazil. Representative data from the Household Budget Survey conducted in 2008-2009 were studied, with probabilistic sample of 55,970 households. 11,282 households were eligible for this study and 48.5 % were beneficiaries of the BFP. Food availability indicators were compared among paired blocks of households (n = 100), beneficiaries or non-beneficiaries of the Bolsa Família Program, with monthly per capita income up to R$ 210.00. Blocks of households were created based on the propensity score of each household to have beneficiaries and were homogeneous regarding potential confounding variables. The food availability indicators were weekly per capita expenditure and daily energy consumption, both calculated considering all food items and four food groups based on the extent and purpose of the industrial food processing. The comparisons between the beneficiaries and non-beneficiaries blocks of households were conducted through paired 't' tests. Compared to non-beneficiaries, the beneficiaries households had 6 % higher food expenditure (p = 0.015) and 9.4 % higher total energy availability (p = 0.010). It was found a 7.3 % higher expenditure on in natura or minimally processed foods and 10.4 % higher expenditure on culinary ingredients among the Bolsa Família Program families. No statistically significant differences were found regarding the expenditure and the availability of processed and ultra-processed food and drink products. In the in

Incremental impact of body mass status with modifiable unhealthy lifestyle behaviors on pharmaceutical expenditure.

Science.gov (United States)

Kim, Tae Hyun; Lee, Eui-Kyung; Han, Euna

Overweight/obesity is a growing health risk in Korea. The impact of overweight/obesity on pharmaceutical expenditure can be larger if individuals have multiple risk factors and multiple comorbidities. The current study estimated the combined effects of overweight/obesity and other unhealthy behaviors on pharmaceutical expenditure. An instrumental variable quantile regression model was estimated using Korea Health Panel Study data. The current study extracted data from 3 waves (2009, 2010, and 2011). The final sample included 7148 person-year observations for adults aged 20 years or older. Overweight/obese individuals had higher pharmaceutical expenditure than their non-obese counterparts only at the upper quantiles of the conditional distribution of pharmaceutical expenditure (by 119% at the 90th quantile and 115% at the 95th). The current study found a stronger association at the upper quantiles among men (152%, 144%, and 150% at the 75th, 90th, and 95th quantiles, respectively) than among women (152%, 150%, and 148% at the 75th, 90th, and 95th quantiles, respectively). The association at the upper quantiles was stronger when combined with moderate to heavy drinking and no regular physical check-up, particularly among males. The current study confirms that the association of overweight/obesity with modifiable unhealthy behaviors on pharmaceutical expenditure is larger than with overweight/obesity alone. Assessing the effect of overweight/obesity with lifestyle risk factors can help target groups for public health intervention programs. Copyright © 2015 Elsevier Inc. All rights reserved.

32 CFR 37.560 - Must I be able to estimate project expenditures precisely in order to justify use of a fixed...

Science.gov (United States)

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Must I be able to estimate project expenditures... I be able to estimate project expenditures precisely in order to justify use of a fixed-support TIA... purposes of this illustration, let that minimum recipient cost sharing be 40% of the total project costs...

Medical Care Expenditures for Individuals with Prediabetes: The Potential Cost Savings in Reducing the Risk of Developing Diabetes.

Science.gov (United States)

Khan, Tamkeen; Tsipas, Stavros; Wozniak, Gregory

2017-10-01

The United States has 86 million adults with prediabetes. Individuals with prediabetes can prevent or delay the development of type 2 diabetes through lifestyle modifications such as participation in the National Diabetes Prevention Program (DPP), thereby mitigating the medical and economic burdens associated with diabetes. A cohort analysis of a commercially insured population was conducted using individual-level claims data from Truven Health MarketScan ® Lab Database to identify adults with prediabetes, track whether they develop diabetes, and compare medical expenditures for those who are newly diagnosed with diabetes to those who are not. This study then illustrates how reducing the risk of developing diabetes by participation in an evidence-based lifestyle change program could yield both positive net savings on medical care expenditures and return on investment (ROI). Annual expenditures are found to be nearly one third higher for those who develop diabetes in subsequent years relative to those who do not transition from prediabetes to diabetes, with an average difference of $2671 per year. At that cost differential, the 3-year ROI for a National DPP is estimated to be as high as 42%. The results show the importance and economic benefits of participation in lifestyle intervention programs to prevent or delay the onset of type 2 diabetes.

An Empirical Analysis of Rural-Urban Differences in Out-Of-Pocket Health Expenditures in a Low-Income Society of China.

Directory of Open Access Journals (Sweden)

Lidan Wang

Full Text Available The paper examines whether out-of-pocket health care expenditure also has regional discrepancies, comparing to the equity between urban and rural areas, and across households.Sampled data were derived from Urban Household Survey and Rural Household Survey data for 2011/2012 for Anhui Province, and 11049 households were included in this study. The study compared differences in out-of-pocket expenditure on health care between regions (urban vs. rural areas and years (2011 vs. 2012 using two-sample t-test, and also investigated the degree of inequality using Lorenz and concentration curves.Approximately 5% and 8% of total household consumption expenditure was spent on health care for urban and rural populations, respectively. In 2012, the wealthiest 20% of urban and rural population contributed 49.7% and 55.8% of urban and rural total health expenditure respectively, while the poorest 20% took only 4.7% and 4.4%. The concentration curve for out-of-pocket expenditure in 2012 fell below the corresponding concentration curve for 2011 for both urban and rural areas, and the difference between curves for rural areas was greater than that for urban areas.A substantial and increasing gap in health care expenditures existed between urban and rural areas in Anhui. The health care financing inequality merits ample attention, with need for policymaking to focus on improving the accessibility to essential health care services, particularly for rural and poor residents. This study may provide useful information on low income areas of China.

Cost of living in free-ranging degus (Octodon degus) : seasonal dynamics of energy expenditure

NARCIS (Netherlands)

Bozinovic, F; Bacigalupe, LD; Vasquez, RA; Visser, GH; Veloso, C; Kenagy, GJ

Animals process and allocate energy at different seasons at variable rates, depending on their breeding season and changes in environmental conditions and resulting physiological demands. Overall total energy expenditure, in turn, should either increase in some seasons due to special added demands

Military Expenditure, Threats, and Growth

OpenAIRE

Aizenman, Joshua; Glick, Reuven

2003-01-01

This paper clarifies one of the puzzling results of the economic growth literature: the impact of military expenditure is frequently found to be non-significant or negative, yet most countries spend a large fraction of their GDP on defense and the military. We start by empirical evaluation of the non- linear interactions between military expenditure, external threats, corruption, and other relevant controls. While growth falls with higher levels of military spending, given the values of the o...

Impact of morbid obesity on medical expenditures in adults.

Science.gov (United States)

Arterburn, D E; Maciejewski, M L; Tsevat, J

2005-03-01

Morbid obesity (body mass index (BMI) > or =40 kg/m2) is associated with substantially increased morbidity and mortality from chronic health conditions and with poorer health-related quality of life; however, less is known about the impact of morbid obesity on healthcare expenditures. To examine the impact of morbid obesity on healthcare expenditures using a nationally representative sample of US adults. We performed a cross-sectional analysis of 16 262 adults from the 2000 Medical Expenditure Panel Survey, a nationally representative survey of the noninstitutionalized civilian population of the United States. Per capita healthcare expenditures were calculated for National Institutes of Health BMI categories, based on self-reported height and weight, using a two-part, multivariable model adjusted for age, gender, race, income, education level, type of health insurance, marital status, and smoking status. Odds of incurring any healthcare expenditure and per capita healthcare expenditures associated with morbid obesity in 2000. When compared with normal-weight adults, the odds of incurring any healthcare expenditure in 2000 were two-fold greater among adults with morbid obesity. Per capita healthcare expenditures for morbidly obese adults were 81% (95% confidence interval (CI): 48-121%) greater than normal-weight adults, 65% (95% CI: 37-110%) greater than overweight adults, and 47% (95% CI: 11-96%) greater than adults with class I obesity. Excess costs among morbidly obese adults resulted from greater expenditures for office-based visits, outpatient hospital care, in-patient care, and prescription drugs. Aggregate US healthcare expenditures associated with excess body weight among morbidly obese US adults exceeded $11 billion in 2000. The economic burden of morbid obesity among US adults is substantial. Further research is needed to identify interventions to reduce the incidence and prevalence of morbid obesity and improve the health and economic outcomes of morbidly

The expenditure for the protection of the environment in 2012

International Nuclear Information System (INIS)

Diel, Olivier

2014-11-01

Illustrated by several graphs, this publication comments the evolution of public expenditure for the protection of the environment, compares the current expenditure and the capital expenditure. It comments the share of waste management and wastewater sanitation with respect to the global expenditure (it represents 62 pc of it) and the evolutions of the expenditures for each domain of the environment (protection of the environment and ecosystems, waste management and struggle against noise pollution, research and development, public actions for regulation and administration). It comments the increase of prices of sanitation services and the decrease of consumed volumes of water, the increase of R and D expenditure, the influence of the legal context on the increase of industry investments for air protection. The expenditures for the protection of the environment in the European countries are indicated and compared

26 CFR 53.4955-1 - Tax on political expenditures.

Science.gov (United States)

2010-04-01

... turnout, or voter education constitute other expenses, treated as political expenditures by reason of... 26 Internal Revenue 17 2010-04-01 2010-04-01 false Tax on political expenditures. 53.4955-1... Tax on political expenditures. (a) Relationship between section 4955 excise taxes and substantive...

The Incidence of Local Water Pollution Abatement Expenditures: A Case Study of the Merrimack River Basin (1974)

Science.gov (United States)

Part I is an analysis of the determinants of local government expenditures on water pollution abatement facilities. Part II is an investigation of the incidence of costs and benefits of public environmental programs.

Economic growth and military expenditure linkages: a panel data analysis

Directory of Open Access Journals (Sweden)

Ahmed Shahid

2015-12-01

Full Text Available This paper has made an attempt to examine relationship between military expenditure and economic growth using 56 country panel data spanning over 1995—2011. Panel fixed effect model has been estimated for all 56 countries and sub-groups classified on the basis of World Bank income criteria. The results of this study indicate a positive effect of military expenditure on economic growth but this positive effect is negligible compared to the alternative uses of scare resources on non-military expenditure. Thus, the effect of military expenditure on economic growth is very low compared to the effect of expenditure on capital formation, hence military expenditure as a sub-optimal means of increasing economic growth compared to alternative uses of government spending on formation of fixed capital. This study raises an important argument of huge opportunity cost of military expenditure. The present study concludes that the boosting of economic growth through higher military expenditure is neither effective nor efficient way of achieving higher growth in the economy.

Political determinants of social expenditures in Greece: an empirical analysis

Directory of Open Access Journals (Sweden)

Ebru Canikalp

2017-09-01

Full Text Available A view prominently expounded is that the interaction between the composition and the volume of public expenditures is directly affected by political, institutional, psephological and ideological indicators. A crucial component of public expenditures, social expenditures play an important role in the economy as they directly and indirectly affect the distribution of income and wealth. Social expenditures aim at reallocating income and wealth unequal distribution. These expenditures comprise cash benefits, direct in-kind provision of goods and services, and tax breaks with social purposes.The aim of this study is to determine the relationship between political structure, i.e. government fragmentation, ideological composition, elections and so on, and the social expenditures in Greece. Employing data from the Comparative Political Dataset (CPDS and the OECD Social Expenditure Database (SOCX, a time series analysis was conducted for Greece for the 1980-2014 period. The findings of the study indicate that voter turnout, spending on the elderly population and the number of government changes have positive and statistically significant effects on social expenditures in Greece while debt stock and cabinet composition have negative effects.

Private dental insurance expenditure in Brazil

Science.gov (United States)

Cascaes, Andreia Morales; de Camargo, Maria Beatriz Junqueira; de Castilhos, Eduardo Dickie; Silva, lexandre Emídio Ribeiro; Barros, Aluísio J D

2018-01-01

ABSTRACT OBJECTIVE To quantify the household expenditure per capita and to estimate the percentage of Brazilian households that have spent with dental insurance. METHODS We analyzed data from 55,970 households that participated in the research Pesquisa de Orçamentos Familiares in 2008–2009. We have analyzed the annual household expenditure per capita with dental insurance (business and private) according to the Brazilian states and the socioeconomic and demographic characteristics of the households (sex, age, race, and educational level of the head of the household, family income, and presence of an older adult in the household). RESULTS Only 2.5% of Brazilian households have reported spending on dental insurance. The amount spent per capita amounted to R$5.10 on average, most of which consisted of private dental insurance (R$4.70). Among the characteristics of the household, higher educational level and income were associated with higher spending. São Paulo was the state with the highest household expenditure per capita (R$10.90) and with the highest prevalence of households with expenditures (4.6%), while Amazonas and Tocantins had the lowest values, in which both spent less than R$1.00 and had a prevalence of less than 0.1% of households, respectively. CONCLUSIONS Only a small portion of the Brazilian households has dental insurance expenditure. The market for supplementary dentistry in oral health care covers a restricted portion of the Brazilian population. PMID:29489995

Measuring body composition and energy expenditure in children with severe neurologic impairment and intellectual disability

NARCIS (Netherlands)

Rieken, Rob; van Goudoever, Johannes B.; Schierbeek, Henk; Willemsen, Sten P.; Calis, Elsbeth A. C.; Tibboel, Dick; Evenhuis, Heleen M.; Penning, Corine

2011-01-01

Accurate prediction equations for estimating body composition and total energy expenditure (TEE) in children with severe neurologic impairment and intellectual disability are currently lacking. The objective was to develop group-specific equations to predict body composition by using

Wealth, Health Expenditure, and Cancer: A National Perspective.

Science.gov (United States)

Chahoud, Jad; Semaan, Adele; Rieber, Alyssa

2016-08-01

The US health care system is characterized by high health expenditures with penultimate outcomes. This ecological study evaluates the associations between wealth, health expenditure, and cancer outcomes at the state level. We extracted gross domestic product (GDP) and health expenditure per capita from the 2009 Bureau of Economic Analysis and the Centers for Medicare & Medicaid Services, respectively. Using data from the NCI, we retrieved colorectal cancer (CRC), breast cancer, and all-cancer age-adjusted rates and computed mortality/incidence (M/I) ratios. We used the Spearman's rank correlation to determine the association between the financial indicators and cancer outcomes, and we constructed geographic distribution maps to describe these associations. GDP per capita significantly correlated with lower M/I ratios for all cancers, breast cancer, and CRC. As for health expenditure per capita, preliminary analysis highlighted a rift between the Northeastern and Southern states, which translated into worse breast and all-cancer outcomes in Southern states. Further analysis showed that higher health expenditure significantly correlated with decreased breast cancer M/I ratio. However, CRC outcomes were not significantly affected by health expenditure, nor were all-cancer outcomes. All cancers, breast cancer, and CRC outcomes significantly correlated with wealth, whereas only breast cancer correlated with higher health expenditure. Future research is needed to evaluate the potential role of policies in optimizing resource allocation in the states' efforts against CRC and minimizing disparities in interstate cancer outcomes. Copyright © 2016 by the National Comprehensive Cancer Network.

Financial burden of household out-of pocket health expenditure in Viet Nam: findings from the National Living Standard Survey 2002-2010.

Science.gov (United States)

Van Minh, Hoang; Kim Phuong, Nguyen Thi; Saksena, Priyanka; James, Chris D; Xu, Ke

2013-11-01

In Viet Nam, household direct out-of-pocket (OOP) health expenditure as a share of the total health expenditure has been always high, ranging from 50% to 70%. The high share of OOP expenditure has been linked to different inequity problems such as catastrophic health expenditure (households must reduce their expenditure on other necessities) and impoverishment. This paper aims to examine catastrophic and poverty impacts of household out-of-pocket health expenditure in Viet Nam over time and identify socio-economic indicators associated with them. Data used in this research were obtained from a nationally representative household survey, Viet Nam Living Standard Survey 2002, 2004, 2006, 2008 and 2010. The findings revealed that there were problems in health care financing in Viet Nam - many households encountered catastrophic health expenditure and/or were pushed into poverty due to health care payments. The issues were pervasive over time. Catastrophic expenditure and impoverishment problems were more common among the households who had more elderly people and those located in rural areas. Importantly, the financial protection aspect of the national health insurance schemes was still modest. Given these findings, more attention is needed on developing methods of financial protection in Viet Nam. Copyright © 2012 Elsevier Ltd. All rights reserved.

The Impact of an Epidemic Outbreak on Consumer Expenditures:An Empirical Assessment for MERS Korea

Directory of Open Access Journals (Sweden)

Hojin Jung

2016-05-01

Full Text Available In this paper, we investigate the effect of an epidemic outbreak on consumer expenditures. In light of scanner panel data on consumers’ debit and credit card transactions, we present empirical evidence that outbreaks cause considerable disruption in total consumer expenditures with significant heterogeneity across categories. Our findings strongly imply that customers alter their behaviors to reduce the risk of infection. The estimated effect of an epidemic outbreak is qualitatively different from that of other macroeconomic factors. The implications of this research provide important guidance for policy interventions and marketing decisions aimed at sustaining economic growth.

Washington state foster care: dental utilization and expenditures.

Science.gov (United States)

Melbye, Molly L R; Chi, Donald L; Milgrom, Peter; Huebner, Colleen E; Grembowski, David

2014-01-01

To identify factors associated with dental utilization and expenditures for children enrolled in Washington State (WA) foster care (FC). This cross-sectional study used 2008 Medicaid enrollment and claims files for children ages WA FC program for ≥11 months (N = 10,177). Regression models were used to examine associations between utilization and expenditures and sex, race, age group, Supplemental Security Income (SSI) (i.e., disability), substance abuse, behavior problems, placement setting (Foster Home Care, Kinship Care, Group Care, Other), and urbanicity. Only 43 percent of the children utilized any dental care; the adjusted mean expenditure was $198.35 [95% confidence interval (CI) $181.35, $215.36]. Fewer utilized diagnostic (41 percent), preventive (39 percent), restorative (11 percent), or complex (5 percent) services. Associated with utilization (P ≤ 0.01) were: female [ARR = 1.05, 95% CI(1.01, 1.10)]; 0-2 years [ARR = 0.18, 95% CI(0.15, 0.21)], [3-5 years ARR = 0.78, 95% CI(0.74, 0.83)]; Native American [ARR = 0.85, 95% CI(0.80, 0.91)]; SSI [ARR = 1.10, 95% CI(1.04, 1.17)]; Kinship Care [ARR = 0.94, 95% CI(0.90, 0.98)]; Group Care [ARR = 1.25 95% CI(1.15, 1.37)]; and urban/rural urbanicity with population WA FC for ≥11 months during 2008 did not receive dental care. Research is needed to determine the level of unmet need among children in FC and interventions to improve access to oral health of the children. Enforcement of existing federal legislation is needed. © 2013 American Association of Public Health Dentistry.

Food Expenditures away from Home by Elderly Households

OpenAIRE

Yen, Steven T.; Kasteridis, Panagiotis P.; Riley, John B.

2012-01-01

This study investigates the differentiated effects of economic and socio-demographic variables on food away from home (FAFH) expenditures by type of facility among elderly households in the United States. Using data from the 2008–2010 Consumer Expenditure Surveys, the systems of expenditures on full-service, fast food, and other restaurants are estimated with a multivariate sample selection estimator which also accommodates heteroscedasticity in the error distribution. Statistical significanc...

How to improve the equity of health financial sources? - Simulation and analysis of total health expenditure of one Chinese province on system dynamics.

Science.gov (United States)

Wang, Xin; Sun, Yuanling; Mu, Xin; Guan, Li; Li, Jingjie

2015-08-27

We simulate and analyze Total Health Expenditure (THE) in financial sources and other economic indicators (such as THE per capita, GDP, etc.) in a province of China from 2002 to 2012 on System Dynamics. Based on actual data and certain mathematical methods, we use system dynamic software to construct a logic model for THE and changing proportions, and thus simulate the actual conditions of development and changes in THE. According to the simulation results, the government possess the largest investment in the average annual growth rate of THE, which was 25.16% in 2012. Social investment comprises the majority of the possession ratio, which was up to 41.20%. The personal investment growth rate decreased by almost 21%, but the total amount of personal investment increased by 28075 million yuan, which is far higher than the increase in government investment. Individuals are still the main carriers of health care expenses. The equity of health financial sources is still poor. The System Dynamics method used in this paper identifies a dynamic measurement process, provides a scientific basis for simulation and analysis of the changes in THE and its key constraining factors, as well as put forward suggestions for the improvement of equity of health financial sources.

Revenues and Expenditures for Public Elementary and Secondary School Districts: School Year 2011-12 (Fiscal Year 2012). First Look. NCES 2014-303

Science.gov (United States)

Cornman, Stephen Q.

2015-01-01

This First Look report presents data on public elementary and secondary education revenues and expenditures at the local education agency (LEA) or school district level for fiscal year (FY) 2012.1. Specifically, this report includes findings from the following types of school finance data: (1) Revenue and expenditure totals by state and the 100…

Revenues and Expenditures for Public Elementary and Secondary School Districts: School Year 2012-13 (Fiscal Year 2013). First Look. NCES 2015-303

Science.gov (United States)

Cornman, Stephen Q.

2016-01-01

This First Look report presents data on public elementary and secondary education revenues and expenditures at the local education agency (LEA) or school district level for fiscal year (FY) 2013. Specifically, this report includes findings from the following types of school finance data: (1) revenue and expenditure totals by state and the 100…

Household energy consumption and expenditures 1993

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-10-05

This presents information about household end-use consumption of energy and expenditures for that energy. These data were collected in the 1993 Residential Energy Consumption Survey; more than 7,000 households were surveyed for information on their housing units, energy consumption and expenditures, stock of energy-consuming appliances, and energy-related behavior. The information represents all households nationwide (97 million). Key findings: National residential energy consumption was 10.0 quadrillion Btu in 1993, a 9% increase over 1990. Weather has a significant effect on energy consumption. Consumption of electricity for appliances is increasing. Houses that use electricity for space heating have lower overall energy expenditures than households that heat with other fuels. RECS collected data for the 4 most populous states: CA, FL, NY, TX.

Energy expenditure of genuine laughter

Science.gov (United States)

Buchowski, MS; Majchrzak, KM; Blomquist, K; Chen, KY; Byrne, DW; Bachorowski, J-A

2012-01-01

Objective To measure energy expenditure (EE) and heart rate (HR) during genuine laughter. Design Experimental trial of viewing film clips in four cycles either intended to evoke laughter (humorous −10 min) or unlikely to elicit laughter (not humorous −5 min) under strictly controlled conditions of a whole-room indirect calorimeter equipped with audio recording system. Participants Forty five adult friend dyads in either same-sex male (n=7), same-sex female (n=21) and mix-sex male-female (n=17); age 18–34 years; body mass index 24.7±4.9 (range 17.9–41.1). Measurements Energy expenditure in a whole-room indirect calorimeter, HR using Polar HR monitor. Laugh rate, duration and type from digitized audio data using a computerized system and synchronized with HR and EE results. Results Laughter EE was 0.79±1.30 kJ/min (0.19±0.31 kcal/min) higher than resting EE (Plaughter segments increased above resting by 2.1±3.8 beats/min, ranging from −7.6 to 26.8 beats/min. Laughter EE was correlated with HR (rs=0.250, Plaughter EE and HR were positively correlated with laughter duration (rs=0.282 and 0.337, both Plaughter causes a 10–20% increase in EE and HR above resting values, which means that 10–15 min of laughter per day could increase total EE by 40–170 kJ (10–40 kcal). PMID:16652129

Exercise, energy expenditure and energy balance, as measured with doubly labelled water.

Science.gov (United States)

Westerterp, Klaas R

2018-02-01

The doubly labelled water method for the measurement of total daily energy expenditure (TDEE) over 1-3 weeks under daily living conditions is the indicated method to study effects of exercise and extreme environments on energy balance. Subjects consume a measured amount of doubly labelled water (2H2 18O) to increase background enrichment of body water for 18O and 2H, and the subsequent difference in elimination rate between 18O and 2H, as measured in urine, saliva or blood samples, is a measure for carbon dioxide production and thus allows calculation of TDEE. The present review describes research showing that physical activity level (PAL), calculated as TDEE (assessed with doubly labelled water) divided by resting energy expenditure (REE, PAL = TDEE/REE), reaches a maximum value of 2·00-2·40 in subjects with a vigorously active lifestyle. Higher PAL values, while maintaining energy balance, are observed in professional athletes consuming additional energy dense foods to compete at top level. Exercise training can increase TDEE/REE in young adults to a value of 2·00-2·40, when energy intake is unrestricted. Furthermore, the review shows an exercise induced increase in activity energy expenditure can be compensated by a reduction in REE and by a reduction in non-exercise physical activity, especially at a negative energy balance. Additionally, in untrained subjects, an exercise-induced increase in activity energy expenditure is compensated by a training-induced increase in exercise efficiency.

Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021.

Science.gov (United States)

Kurtz, Steven M; Ong, Kevin L; Lau, Edmund; Bozic, Kevin J

2014-04-16

Few studies have explored the role of the National Health Expenditure and macroeconomics on the utilization of total joint replacement. The economic downturn has raised questions about the sustainability of growth for total joint replacement in the future. Previous projections of total joint replacement demand in the United States were based on data up to 2003 using a statistical methodology that neglected macroeconomic factors, such as the National Health Expenditure. Data from the Nationwide Inpatient Sample (1993 to 2010) were used with United States Census and National Health Expenditure data to quantify historical trends in total joint replacement rates, including the two economic downturns in the 2000s. Primary and revision hip and knee arthroplasty were identified using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Projections in total joint replacement were estimated using a regression model incorporating the growth in population and rate of arthroplasties from 1993 to 2010 as a function of age, sex, race, and census region using the National Health Expenditure as the independent variable. The regression model was used in conjunction with government projections of National Health Expenditure from 2011 to 2021 to estimate future arthroplasty rates in subpopulations of the United States and to derive national estimates. The growth trend for the incidence of joint arthroplasty, for the overall United States population as well as for the United States workforce, was insensitive to economic downturns. From 2009 to 2010, the total number of procedures increased by 6.0% for primary total hip arthroplasty, 6.1% for primary total knee arthroplasty, 10.8% for revision total hip arthroplasty, and 13.5% for revision total knee arthroplasty. The National Health Expenditure model projections for primary hip replacement in 2020 were higher than a previously projected model, whereas the current model estimates for total

Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads.

Science.gov (United States)

Philpot, Lindsey M; Stockbridge, Erica L; Padrón, Norma A; Pagán, José A

2016-06-01

Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211).

Automatic energy expenditure measurement for health science

NARCIS (Netherlands)

Catal, Cagatay; Akbulut, Akhan

2018-01-01

Background and objective: It is crucial to predict the human energy expenditure in any sports activity and health science application accurately to investigate the impact of the activity. However, measurement of the real energy expenditure is not a trivial task and involves complex steps. The

Evidence of effectiveness of preventive dental care in reducing dental treatment use and related expenditures.

Science.gov (United States)

Pourat, Nadereh; Choi, Moonkyung Kate; Chen, Xiao

2018-02-06

Preventive dental health services are intended to reduce the likelihood of development of tooth decay and the need for more intensive treatment overtime. The evidence on the effectiveness of preventive dental care in reducing treatment services and expenditures is lagging for adults, particularly those with lower incomes and chronic conditions. We assessed the impact of preventive dental services on dental treatment service use and expenditures overall and by category of service. We calculated the annual numbers of preventive (periodic diagnostic and prophylactic procedures) and treatment (restorative, surgery, prosthodontic, endodontic, and periodontic) services per beneficiary using Medicaid enrollment and claims data for beneficiaries with three categories of conditions (diabetes, heart disease, and respiratory disease) from 10 largest California counties. We used Cragg hurdle exponential regression models controlling for past service use, demographics, length of enrollment, and county. We found that using preventive services in 2005-2007 was associated with higher likelihood and number of treatment dental services used, but associated with lower treatment expenditures in 2008. The reduction in expenditures was noted only in restorative, prosthodontics, and periodontic services. The findings provide much needed evidence of the contribution of preventive dental care in maintaining oral health of low-income adults with chronic conditions and potential for savings to the Medicaid program. Providing lower cost preventive dental care to the individuals with chronic conditions would achieve better oral health and lower treatment expenditures. © 2018 American Association of Public Health Dentistry.

Children as consumers: investigating child diary expenditure data

OpenAIRE

Lisa Farrell; Michael A. Shields

2007-01-01

We investigate expenditure behaviour of school-aged children using child diary information contained in the British Family Expenditure Survey. The estimates from an Almost Ideal Demand System (AIDS) for child expenditure suggest that drinks, sweets, books, and toys are `normal' goods for children, but clothes, travel, leisure and vice products are `luxury' items with income elasticities greater than one. Being a lone-parent child and having a working mother are important factors in determinin...

Does drug price-regulation affect healthcare expenditures?

Science.gov (United States)

Ben-Aharon, Omer; Shavit, Oren; Magnezi, Racheli

2017-09-01

Increasing health costs in developed countries are a major concern for decision makers. A variety of cost containment tools are used to control this trend, including maximum price regulation and reimbursement methods for health technologies. Information regarding expenditure-related outcomes of these tools is not available. To evaluate the association between different cost-regulating mechanisms and national health expenditures in selected countries. Price-regulating and reimbursement mechanisms for prescription drugs among OECD countries were reviewed. National health expenditure indices for 2008-2012 were extracted from OECD statistical sources. Possible associations between characteristics of different systems for regulation of drug prices and reimbursement and health expenditures were examined. In most countries, reimbursement mechanisms are part of publicly financed plans. Maximum price regulation is composed of reference-pricing, either of the same drug in other countries, or of therapeutic alternatives within the country, as well as value-based pricing (VBP). No association was found between price regulation or reimbursement mechanisms and healthcare costs. However, VBP may present a more effective mechanism, leading to reduced costs in the long term. Maximum price and reimbursement mechanism regulations were not found to be associated with cost containment of national health expenditures. VBP may have the potential to do so over the long term.

National Income Elasticities of Educational and Non-Educational Government Expenditures Among Selected Nations.

Science.gov (United States)

Choi, Jae W.

The main purposes of this study are to investigate through national income elasticities the amounts of governmental expenditure in 30 countries on total governmental service and on selected services of education, defense, health, and social welfare over the period from 1950 to 1967. Analysis of data available from various statistical sources, such…

Energy expenditure during sexual activity in young healthy couples.

Directory of Open Access Journals (Sweden)

Julie Frappier

Full Text Available OBJECTIVE: To determine energy expenditure in kilocalories (kcal during sexual activity in young healthy couples in their natural environment and compare it to a session of endurance exercise. METHODS: The study population consisted of twenty one heterosexual couples (age: 22.6 ± 2.8 years old from the Montreal region. Free living energy expenditure during sexual activity and the endurance exercise was measured using the portable mini SenseWear armband. Perceived energy expenditure, perception of effort, fatigue and pleasure were also assessed after sexual activity. All participants completed a 30 min endurance exercise session on a treadmill at a moderate intensity. RESULTS: Mean energy expenditure during sexual activity was 101 kCal or 4.2 kCal/min in men and 69.1 kCal or 3.1 kCal/min in women. In addition, mean intensity was 6.0 METS in men and 5.6 METS in women, which represents a moderate intensity. Moreover, the energy expenditure and intensity during the 30 min exercise session in men was 276 kCal or 9.2 kCal/min and 8.5 METS, respectively and in women 213 kCal or 7.1 kCal/min and 8.4 METS, respectively. Interestingly, the highest range value achieved by men for absolute energy expenditure can potentially be higher than that of the mean energy expenditure of the 30 min exercise session (i.e. 306.1 vs. 276 kCal, respectively whereas this was not observed in women. Finally, perceived energy expenditure during sexual activity was similar in men (100 kCal and in women (76.2 kCal when compared to measured energy expenditure. CONCLUSION: The present study indicates that energy expenditure during sexual activity appears to be approximately 85 kCal or 3.6 kCal/min and seems to be performed at a moderate intensity (5.8 METS in young healthy men and women. These results suggest that sexual activity may potentially be considered, at times, as a significant exercise.

An overview of federal government financial involvement in the Canadian nuclear program

International Nuclear Information System (INIS)

Wallace, T.W.

1981-01-01

The government of Canada has had a financial involvement with the nuclear industry in four areas: nuclear power development, including expenditures for research and development, prototype reactors, and regulation; uranium industry support, including the operations of Eldorado Nuclear Ltd. and the uranium stockpiling program; the financing of nuclear reactors, activities in which the federal government has acted as a banker for the sale of reactors; and heavy water production. Up to 1978-79 total federal expenditures of around $3.4 billion in current collars had been invested. Of this amount, about 56 percent was associated with nuclear power development, 2 percent with uranium industry support, 22 percent with heavy water, and 22 percent with financing reactor sales

Relationship Between Education Expenditure And Economic Growth ...

African Journals Online (AJOL)

The empirical part of the result shows that there is unidirectional relationship between education and economic growth with causality running from education expenditure to economic growth. The result therefore suggests that policy makers should boost expenditure on education as it will further improve economic growth in ...

Local Health Department Food Safety and Sanitation Expenditures and Reductions in Enteric Disease, 2000–2010

Science.gov (United States)

Yip, Michelle Pui-Yan; Dunbar, Matthew D.; Whitman, Greg; Kwan-Gett, Tao

2015-01-01

Objectives. In collaboration with Public Health Practice–Based Research Networks, we investigated relationships between local health department (LHD) food safety and sanitation expenditures and reported enteric disease rates. Methods. We combined annual infection rates for the common notifiable enteric diseases with uniquely detailed, LHD-level food safety and sanitation annual expenditure data obtained from Washington and New York state health departments. We used a multivariate panel time-series design to examine ecologic relationships between 2000–2010 local food safety and sanitation expenditures and enteric diseases. Our study population consisted of 72 LHDs (mostly serving county-level jurisdictions) in Washington and New York. Results. While controlling for other factors, we found significant associations between higher LHD food and sanitation spending and a lower incidence of salmonellosis in Washington and a lower incidence of cryptosporidiosis in New York. Conclusions. Local public health expenditures on food and sanitation services are important because of their association with certain health indicators. Our study supports the need for program-specific LHD service-related data to measure the cost, performance, and outcomes of prevention efforts to inform practice and policymaking. PMID:25689186

Energy Expenditure in Vinyasa Yoga Versus Walking.

Science.gov (United States)

Sherman, Sally A; Rogers, Renee J; Davis, Kelliann K; Minster, Ryan L; Creasy, Seth A; Mullarkey, Nicole C; O'Dell, Matthew; Donahue, Patrick; Jakicic, John M

2017-08-01

Whether the energy cost of vinyasa yoga meets the criteria for moderate-to-vigorous physical activity has not been established. To compare energy expenditure during acute bouts of vinyasa yoga and 2 walking protocols. Participants (20 males, 18 females) performed 60-minute sessions of vinyasa yoga (YOGA), treadmill walking at a self-selected brisk pace (SELF), and treadmill walking at a pace that matched the heart rate of the YOGA session (HR-Match). Energy expenditure was assessed via indirect calorimetry. Energy expenditure was significantly lower in YOGA compared with HR-Match (difference = 79.5 ± 44.3 kcal; P YOGA = 3.6 ± 0.6; P YOGA, showed energy expenditure was significantly lower in YOGA compared with HR-Match (difference = 68.0 ± 40.1 kcal; P YOGA meets the criteria for moderate-intensity physical activity. Thus, YOGA may be a viable form of physical activity to achieve public health guidelines and to elicit health benefits.

Integration of body temperature into the analysis of energy expenditure in the mouse.

Science.gov (United States)

Abreu-Vieira, Gustavo; Xiao, Cuiying; Gavrilova, Oksana; Reitman, Marc L

2015-06-01

We quantified the effect of environmental temperature on mouse energy homeostasis and body temperature. The effect of environmental temperature (4-33 °C) on body temperature, energy expenditure, physical activity, and food intake in various mice (chow diet, high-fat diet, Brs3 (-/y) , lipodystrophic) was measured using continuous monitoring. Body temperature depended most on circadian phase and physical activity, but also on environmental temperature. The amounts of energy expenditure due to basal metabolic rate (calculated via a novel method), thermic effect of food, physical activity, and cold-induced thermogenesis were determined as a function of environmental temperature. The measured resting defended body temperature matched that calculated from the energy expenditure using Fourier's law of heat conduction. Mice defended a higher body temperature during physical activity. The cost of the warmer body temperature during the active phase is 4-16% of total daily energy expenditure. Parameters measured in diet-induced obese and Brs3 (-/y) mice were similar to controls. The high post-mortem heat conductance demonstrates that most insulation in mice is via physiological mechanisms. At 22 °C, cold-induced thermogenesis is ∼120% of basal metabolic rate. The higher body temperature during physical activity is due to a higher set point, not simply increased heat generation during exercise. Most insulation in mice is via physiological mechanisms, with little from fur or fat. Our analysis suggests that the definition of the upper limit of the thermoneutral zone should be re-considered. Measuring body temperature informs interpretation of energy expenditure data and improves the predictiveness and utility of the mouse to model human energy homeostasis.

Improving military expenditure decisionmaking in sub-Saharan Africa

OpenAIRE

Geoff Harris

2010-01-01

This article begins by emphasizing that the number and intensity of armed conflict has fallen substantially but that military expenditure levels in sub-Saharan Africa have nonetheless increased, largely as a result of South African expenditure. The article attempts to answer two questions. First, how can the budget of the security sector be allocated so as to result in effective and efficient security outcomes? Second, how can an appropriate level of military expenditure for a country be dete...

Forecasting military expenditure

Directory of Open Access Journals (Sweden)

Tobias Böhmelt

2014-05-01

Full Text Available To what extent do frequently cited determinants of military spending allow us to predict and forecast future levels of expenditure? The authors draw on the data and specifications of a recent model on military expenditure and assess the predictive power of its variables using in-sample predictions, out-of-sample forecasts and Bayesian model averaging. To this end, this paper provides guidelines for prediction exercises in general using these three techniques. More substantially, however, the findings emphasize that previous levels of military spending as well as a country’s institutional and economic characteristics particularly improve our ability to predict future levels of investment in the military. Variables pertaining to the international security environment also matter, but seem less important. In addition, the results highlight that the updated model, which drops weak predictors, is not only more parsimonious, but also slightly more accurate than the original specification.

Playing active video games increases energy expenditure in children.

Science.gov (United States)

Graf, Diana L; Pratt, Lauren V; Hester, Casey N; Short, Kevin R

2009-08-01

To compare energy expenditure rates in children playing the physically active video games, Dance Dance Revolution (DDR) and Nintendo's Wii Sports in relation to treadmill walking. Energy expenditure, heart rate, step rate, and perceived exertion were measured in 14 boys and 9 girls (ages 10-13 years; BMI at 3-98th percentile for age and gender) while watching television at rest, playing DDR at 2 skill levels, playing Wii bowling and boxing, and walking at 2.6, 4.2, and 5.7 km/h. Arterial elasticity was measured at rest and immediately after gaming. Compared with watching television, energy expenditure while gaming or walking increased 2- to 3-fold. Similarly, high rates of energy expenditure, heart rate, and perceived exertion were elicited from playing Wii boxing, DDR level 2, or walking at 5.7 km/h. This occurred despite variations in step rate among activities, reflecting greater use of upper body during Wii play (lowest step rate) than during walking (highest step rate) or DDR play. Wii bowling and beginner level DDR elicited a 2-fold increase in energy expenditure compared to television watching. Large-artery elasticity declined immediately after both DDR and Wii. The change was inversely related to the increment in energy expenditure above rest achieved during the activity. Energy expenditure during active video game play is comparable to moderate-intensity walking. Thus, for children who spend considerable time playing electronic screen games for entertainment, physically active games seem to be a safe, fun, and valuable means of promoting energy expenditure.

Are the Chinese Saving for Old Age?: The Relationship between Future Pension Benefits of 45-60 Years Old Chinese and Current Household Expenditures.

Science.gov (United States)

van Dullemen, C E; Nagel, I; de Bruijn, J M G

2017-01-01

Worldwide, older people's support used to be the adult children's responsibility. In China, two generations after introducing the one-child policy in the late 70-ies, this becomes an increasingly demanding obligation. The Chinese government took the responsibility to mitigating old- age poverty risks and realized unprecedented progress in pension coverage. At the same time, the household savings increased to about 30 % of disposable income. Built on previous research on the politics of ageing, this study analyses households responses to the established governmental and firm pension programs as well as to the New Rural Pension Scheme (NRPS), introduced in 2009. The central question is: will participation in the established and new pension programs lead to higher current Chinese household expenditures and therefore to lower savings? The China Health and Retirement Longitudinal Study (CHARLS) dataset of 2011 offered the opportunity to study the influence of the recently introduced NRPS. We find that Chinese households with members between 45 and 60 years who expect future benefits of NRPS do not have higher expenditures than those not covered by NRPS. For the participants in the established, mostly urban pension programs a correlation was found with higher current expenditures (28 % more spending on basic needs, 80 % more on luxury) However, further analysis shows that this correlation cannot be interpreted as a causal relationship. This implies that coverage by pensions, be it in urban or rural programs, does not determine higher current expenditures and lower savings.

Effect of Diet Composition on Energy Expenditure during Weight Loss: The POUNDS LOST Study

Science.gov (United States)

Bray, George A.; Smith, Steven R.; DeJonge, Lilian; de Souza, Russell; Rood, Jennifer; Champagne, Catherine M.; Laranjo, Nancy; Carey, Vincent; Obarzanek, Eva; Loria, Catherine M.; Anton, Stephen D.; Ryan, Donna H.; Greenway, Frank L.; Williamson, Donald; Sacks, Frank M.

2011-01-01

Background Weight loss reduces energy expenditure, but the contribution of different macronutrients to this change is unclear. Hypothesis We tested the hypothesis that macronutrient composition of the diet might affect the partitioning of energy expenditure during weight loss. Design A sub-study of 99 participants from the POUNDS LOST trial had total energy expenditure (TEE) measured by doubly labeled water and resting energy expenditure (REE) measured by indirect calorimetry at baseline and repeated at 6 months in 89 participants. Participants were randomly assigned to one of 4 diets with either 15% or 25% protein and 20% or 40% fat. Results TEE and REE were positively correlated with each other and with fat free mass and body fat, at baseline and 6 months. The average weight loss of 8.1±0.65 kg (LSmean±SE) reduced TEE by 120±56 kcal/d and REE by 136±18 kcal/d. A greater weight loss at 6 months was associated with a greater decrease in TEE and REE. Participants eating the high fat diet lost significantly more fat free mass (1.52±0.55 kg) than the low fat diet group (p<0.05). Participants eating the low fat diet had significantly higher measures of physical activity than the high fat group. Conclusion A greater weight loss was associated with a larger decrease in both TEE and REE. The low fat diet was associated with significant changes in fat free body mass and energy expenditure from physical activity compared to the high fat diet. PMID:21946707

High-Expenditure Pharmaceutical Use Among Children in Medicaid.

Science.gov (United States)

Cohen, Eyal; Hall, Matt; Lopert, Ruth; Bruen, Brian; Chamberlain, Lisa J; Bardach, Naomi; Gedney, Jennifer; Zima, Bonnie T; Berry, Jay G

2017-09-01

Medication use may be a target for quality improvement, cost containment, and research. We aimed to identify medication classes associated with the highest expenditures among pediatric Medicaid enrollees and to characterize the demographic, clinical, and health service use of children prescribed these medications. Retrospective, cross-sectional study of 3 271 081 Medicaid-enrolled children. Outpatient medication spending among high-expenditure medication classes, defined as the 10 most expensive among 261 mutually exclusive medication classes, was determined by using transaction prices paid to pharmacies by Medicaid agencies and managed care plans among prescriptions filled and dispensed in 2013. Outpatient medications accounted for 16.6% of all Medicaid expenditures. The 10 most expensive medication classes accounted for 63.9% of all medication expenditures. Stimulants (amphetamine-type) accounted for both the highest proportion of expenditures (20.6%) and days of medication use (14.0%) among medication classes. Users of medications in the 10 highest-expenditure classes were more likely to have a chronic condition of any complexity (77.9% vs 41.6%), a mental health condition (35.7% vs 11.9%), or a complex chronic condition (9.8% vs 4.3%) than other Medicaid enrollees (all P costs may benefit from better delineation of the appropriate prescription of these medications. Copyright © 2017 by the American Academy of Pediatrics.

Novel methodology for pharmaceutical expenditure forecast

OpenAIRE

Vataire, Anne-Lise; Cetinsoy, Laurent; Aball?a, Samuel; R?muzat, C?cile; Urbinati, Duccio; Kornfeld, ?sa; Mzoughi, Olfa; Toumi, Mondher

2014-01-01

Background and objective: The value appreciation of new drugs across countries today features a disruption that is making the historical data that are used for forecasting pharmaceutical expenditure poorly reliable. Forecasting methods rarely addressed uncertainty. The objective of this project was to propose a methodology to perform pharmaceutical expenditure forecasting that integrates expected policy changes and uncertainty (developed for the European Commission as the ‘EU Pharmaceutical e...

Development and changes in consumption expenditures of the population

Directory of Open Access Journals (Sweden)

Zuzana Toufarová

2008-01-01

Full Text Available The paper deals with development and changes in consumption expenditures of population. It uses secondary data to analyze consumption expenditures of EU-25 and the Czech Republic and concetrates on changes in the expenditure groups over the period of past years. Other part of this paper is devoted to primary data analysis. Primary data were obtained in a questionnaire survey. Primary data analysis is based on statistical methods and it investigates changes in the structure of consumption expenditures of households in relation to changes in household income. By using dependency analysis the paper verifies dependency of surveyed groups of consumption expenditures and groups of households sorted by identification characteristics. Additionally, also based on the primary research, the paper tries to find out the way households allocate money surplus remaining after covering all the adequate expenses.

Aspects of marginal expenditures in energy sector

International Nuclear Information System (INIS)

Stojchev, D.; Kynev, K.

1994-01-01

Technical and economical problems of marginal analysis methodology, its application procedure in energy sector and marginal expenditures determination are outlined. A comparative characteristics of the application is made for different periods of time. The differences in calculation of the marginal expenditures and prices are discussed. The operational costs, investments and inflation are analyzed. The mechanism of application of this approach in different planing horizon is outlined. The role of the change in the costs in time, the time unit, volume, the scope of application, etc. are determined. The areas of transition from one to other form of marginal expenditures are shown. 4 refs. (orig.)

Atomic Energy Control Board 1991-92 estimates part III expenditure plan

Energy Technology Data Exchange (ETDEWEB)

NONE

1992-12-31

This Expenditure Plan is designed to be used as a reference document. As such, it contains several levels of detail to respond to the various needs of its audience. This Plan is divided into two sections. Section 1 presents an overview of the Program including a description, information on its background, objectives and planning perspective as well as performance information that forms the basis for the resources requested. Section 2 provides further information on costs and resources as well as special analyses that the reader may require to understand the Program more fully. Section 1 is preceded by details of Spending Authorities from Part 2 of the Estimates and Volume 2 of the Public Accounts. This is to provide continuity with other Estimates documents and to help in assessing the Program`s financial performance over the past year. 22 figs.

Atomic Energy Control Board 1992-93 estimates part III expenditure plan

Energy Technology Data Exchange (ETDEWEB)

NONE

1993-12-31

This Expenditure Plan is designed to be used as a reference document. As such, it contains several levels of detail to respond to the various needs of its audience. This Plan is divided into two sections. Section 1 presents an overview of the Program including a description, information on its background, objectives and planning perspective as well as performance information that forms the basis for the resources requested. Section 2 provides further information on costs and resources as well as special analyses that the reader may require to understand the Program more fully. Section 1 is preceded by details of Spending Authorities from Part 2 of the Estimates and Volume 2 of the Public Accounts. This is to provide continuity with other Estimates documents and to help in assessing the Program`s financial performance over the past year. 7 refs., 21 figs.

Energy expenditure during a single-handed transatlantic yacht race.

Science.gov (United States)

Myers, S D; Leamon, S M; Nevola, V R; Llewellyn, M G L

2008-04-01

The popularity of sports that expose people to consecutive days of high-intensity physical activity continues to increase. The ability to adequately nourish the human body to sustain the required level of competitive performance may be a key contributor to success in such events. The energy expenditure of a male competitor in a single-handed, transatlantic race (Transat 2004) was assessed using the doubly-labelled water technique. Mean total daily energy expenditure (TDEE) during the race (13 days) was 14.5 MJ/day with a peak expenditure of 18.6 MJ during the most physically demanding 24-hour period. This mean TDEE was approximately 25% lower than that reported in a previous study (14.5 vs. 19.3 MJ/day) for a 13-day leg of a fully crewed offshore race. The difference in results was probably due to the fact that in the previous study, the crew operated in "watches" (work shifts), affording each crew member greater opportunity to eat, rest and sleep. Effective planning and efficient management of resources is essential to the success of the solo sailor. However, the extent to which maintenance of energy balance underpins competitive success remains to be established. To maintain energy balance during the race, a mean daily energy intake of 14.5 MJ/day was necessary for the subject in this study. However, this mean value for energy intake would have been inadequate to match the peak energy expended during the most physically demanding 24 hours of the race.

Genotype by energy expenditure interaction with metabolic syndrome traits: the Portuguese healthy family study.

Directory of Open Access Journals (Sweden)

Daniel M V Santos

Full Text Available Moderate-to-high levels of physical activity are established as preventive factors in metabolic syndrome development. However, there is variability in the phenotypic expression of metabolic syndrome under distinct physical activity conditions. In the present study we applied a Genotype X Environment interaction method to examine the presence of GxEE interaction in the phenotypic expression of metabolic syndrome. A total of 958 subjects, from 294 families of The Portuguese Healthy Family study, were included in the analysis. Total daily energy expenditure was assessed using a 3 day physical activity diary. Six metabolic syndrome related traits, including waist circumference, systolic blood pressure, glucose, HDL cholesterol, total cholesterol and triglycerides, were measured and adjusted for age and sex. GxEE examination was performed on SOLAR 4.3.1. All metabolic syndrome indicators were significantly heritable. The GxEE interaction model fitted the data better than the polygenic model (p<0.001 for waist circumference, systolic blood pressure, glucose, total cholesterol and triglycerides. For waist circumference, glucose, total cholesterol and triglycerides, the significant GxEE interaction was due to rejection of the variance homogeneity hypothesis. For waist circumference and glucose, GxEE was also significant by the rejection of the genetic correlation hypothesis. The results showed that metabolic syndrome traits expression is significantly influenced by the interaction established between total daily energy expenditure and genotypes. Physical activity may be considered an environmental variable that promotes metabolic differences between individuals that are distinctively active.

Energy intake and expenditure in obese older adults with and without type 2 diabetes

NARCIS (Netherlands)

Memelink, R.G.; Verreijen, A.M.; de Vogel-van den Bosch, J.; Weijs, P.J.; Deutz, N.E.P.; Mays, J.A.; Roeske, S.C.

2017-01-01

Rationale: Obesity is a risk factor for type 2 diabetes (DM2), however not all obese people develop DM2. We explored differences in energy intake and expenditure between obese older adults with and without DM2. Methods: Baseline data from 2 lifestyle interventions with a total of 202 obese older

Pharmaceutical expenditure changes in Serbia and Greece during the global economic recession

Directory of Open Access Journals (Sweden)

Mihajlo Jakovljevic

2016-04-01

Full Text Available Aim: Clarity on health expenditures is essential for the timely identification of risks that jeopardize the democratic provision of health services and the credibility of health insurance systems. Furthermore, observing health outcomes with geographical scope is essential for making multilateral associations. This study aimed at conveying information on the variability of important economic parameters of the health sector of Serbia and Greece from 2007 to 2012, when the most serious financial crisis in the post-war economic history hit the global economy. Methods: Exchange rates, purchase-power-parities (PPP and price indices were used for the bilateral review of health and pharmaceutical expenditure dynamics during 2007-2012. Prescription and dispensing changes were also studied taking into account the anatomical therapeutic chemical (ATC structure of drugs consumed. Results: Greece was forced to cut down its total health care and pharmaceutical expenditure and mainly its out-of-pocket payments were more seriously affected by the recession. Surprisingly, emerging market of Serbia, although severely damaged by global recession, succeeded to maintain 19% growth of its per capita health expenditure and even 25% increase of its per capita spending on pharmaceuticals. Innovative pharmaceuticals showed an upward trend in both countries. Conclusions: These two countries might serve as an example of two distinct pathways of mature and emerging health care markets during financial constraints caused by global recession. Our findings show that producing disease-based feedback, in the long run, may empower the assessment of the return on investment on medical technology and healthcare systems’ cost-effectiveness.

Long-term care cost drivers and expenditure projection to 2036 in Hong Kong

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Chan Wai

2009-09-01

Full Text Available Abstract Background Hong Kong's rapidly ageing population, characterised by one of the longest life expectancies and the lowest fertility rate in the world, is likely to drive long-term care (LTC expenditure higher. This study aims to identify key cost drivers and derive quantitative estimates of Hong Kong's LTC expenditure to 2036. Methods We parameterised a macro actuarial simulation with data from official demographic projections, Thematic Household Survey 2004, Hong Kong's Domestic Health Accounts and other routine data from relevant government departments, Hospital Authority and other LTC service providers. Base case results were tested against a wide range of sensitivity assumptions. Results Total projected LTC expenditure as a proportion of GDP reflected secular trends in the elderly dependency ratio, showing a shallow dip between 2004 and 2011, but thereafter yielding a monotonic rise to reach 3.0% by 2036. Demographic changes would have a larger impact than changes in unit costs on overall spending. Different sensitivity scenarios resulted in a wide range of spending estimates from 2.2% to 4.9% of GDP. The availability of informal care and the setting of formal care as well as associated unit costs were important drivers of expenditure. Conclusion The "demographic window" between the present and 2011 is critical in developing policies to cope with the anticipated burgeoning LTC burden, in concert with the related issues of health care financing and retirement planning.

ACCOUNTING CONTROVERSY ON THE RECOGNITION AND EVALUATION OF DEVELOPMENT EXPENDITURE

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TULVINSCHI MIHAELA

2017-12-01

Full Text Available The development of technology in recent decades has forced the transition from the industrialized society, where the main role was occupied by tangible assets, to an information society, where the essential place is played by intangible assets. These are assets that can not be touched or felt, but are very important to produce wealth and to maintain competitiveness. Within these, development expenditure occupies an important place because it influences the analysis of an entity and its future. The accounting practices applicable to development expenditure are based on theoretical fundamentals and ambiguous typologies. The purpose of the article is to present the controversies about recognizing and evaluating development expenditure. Although development expenditure involves large initial investments, it generates, on medium and long term, significant savings. Depending on the purpose for which it is carried out, research and development expenditure can in time generate identifiable intangible assets but also intangible unidentifiable assets. An optimistic attitude regarding the chances of success of a development project will lead to the capitalization of development expenditure. Capitalizing development expenditures, the usefulness of financial statements is increased, which is generally measured in the ability to explain stock prices through earnings and accounting values.

Circadian rhythm of energy expenditure and oxygen consumption.

Science.gov (United States)

Leuck, Marlene; Levandovski, Rosa; Harb, Ana; Quiles, Caroline; Hidalgo, Maria Paz

2014-02-01

This study aimed to evaluate the effect of continuous and intermittent methods of enteral nutrition (EN) administration on circadian rhythm. Thirty-four individuals, aged between 52 and 80 years, were fed through a nasoenteric tube. Fifteen individuals received a continuous infusion for 24 hours/d, and 19 received an intermittent infusion in comparable quantities, every 4 hours from 8:00 to 20:00. In each patient, 4 indirect calorimetric measurements were carried out over 24 hours (A: 7:30, B: 10:30, C: 14:30, and D: 21:30) for 3 days. Energy expenditure and oxygen consumption were significantly higher in the intermittent group than in the continuous group (1782 ± 862 vs 1478 ± 817 kcal/24 hours, P = .05; 257 125 vs 212 117 ml/min, P = .048, respectively). The intermittent group had higher levels of energy expenditure and oxygen consumption at all the measured time points compared with the continuous group. energy expenditure and oxygen consumption in both groups were significantly different throughout the day for 3 days. There is circadian rhythm variation of energy expenditure and oxygen consumption with continuous and intermittent infusion for EN. This suggests that only one indirect daily calorimetric measurement is not able to show the patient's true needs. Energy expenditure is higher at night with both food administration methods. Moreover, energy expenditure and oxygen consumption are higher with the intermittent administration method at all times.

Energy expenditure in children with cerebral palsy and moderate / severe malnutrition during nutritional recovery.

Science.gov (United States)

García-Contreras, Andrea A; Vásquez-Garibay, Edgar M; Romero-Velarde, Enrique; Ibarra-Gutierrez, Ana I; Troyo-Sanroman, Rogelio

2015-05-01

To analyze the total energy expenditure (TEE) and resting energy expenditure (REE) in children with cerebral palsy (CP) and moderate or severe malnutrition during nutritional recovery. In an intervention study, thirteen subjects with CP (10 females and 3 males with a mean age of 9y11m ± 2y3m), level V of the Gross Motor Function Classification System and moderate or severe malnutrition were included. Eight were fed by nasogastric tube and five by gastrostomy. They were compared with 57 healthy participants (31 females and 26 males with mean age of 8y7m ± 10m). Anthropometric measurements, body composition and energy expenditure by bioelectrical impedance analysis (BIA) and indirect calorimetry (IC) were performed in both groups. TEE and REE were higher in healthy children than in children with CP in kcal/d and kcal/cm/d but were lower in kcal/kg/d (p children with CP produced a significant increase in energy expenditure. TEE and REE, in children with CP, are lower than in healthy children. Estimating the REE in children with CP and malnutrition is better performed in kcal/kg/d than in kcal/cm/d. Fat-free mass (FFM) is a good predictor of the REE in healthy children and children with CP. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

CHARACTERISTICS OF INDONESIAN HOUSEHOLD’S LIVING EXPENDITURE

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Duddy Roesmara Donna

2014-09-01

Full Text Available The aim of this study is to estimate and analize the characteristics of Indonesian household expenditure on goods and services, for example food, clothes, household utensils, housing, medical care, education, oil and transportation, gas, electricity and communication. Linear Expenditure System (LES model and seemingly uncorrelated regression (SUR estimation method were applied. This study has some conclusions. First, if ones have more incomes, they will proportionally allocate them for housing, oil and transportation, education, food, and medical care. Second, medical care, education and communication are categorized as superior or deluxe commodities. Third, the approximation of minimum living expenditure to survive is Rp 147.236 for a household per week.  

10 CFR 603.310 - Use of an expenditure-based TIA.

Science.gov (United States)

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Use of an expenditure-based TIA. 603.310 Section 603.310 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS... expenditure-based TIA. In general, the contracting officer must use an expenditure-based TIA under conditions...

Romanian Public Expenditures Policy during the Economic Crisis

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Anca-Ştefania SAVA

2011-03-01

Full Text Available The aim of this paper is to discuss the Romanian public expenditures policy promoted in the context of the economic and financial crisis. Firstly, we present a brief introduction on the effects of public expenditures policy to economic growth and the role of automatic stabilizers in times of economic recessions. Secondly, the paper analyzes the evolution of current and capital public expenditures before and during the economic and financial crisis, according to which unproductive spending prevailed, in detriment of productive investments which can stimulate the economic recovery.

Postprandial energy expenditure in whole-food and processed-food meals: implications for daily energy expenditure.

Science.gov (United States)

Barr, Sadie B; Wright, Jonathan C

2010-07-02

Empirical evidence has shown that rising obesity rates closely parallel the increased consumption of processed foods (PF) consumption in USA. Differences in postprandial thermogenic responses to a whole-food (WF) meal vs. a PF meal may be a key factor in explaining obesity trends, but currently there is limited research exploring this potential link. The goal was to determine if a particular PF meal has a greater thermodynamic efficiency than a comparable WF meal, thereby conferring a greater net-energy intake. Subjective satiation scores and postprandial energy expenditure were measured for 5-6 h after isoenergetic meals were ingested. The meals were either 'whole' or 'processed' cheese sandwiches; multi-grain bread and cheddar cheese were deemed whole, while white bread and processed cheese product were considered processed. Meals were comparable in terms of protein (15-20%), carbohydrate (40-50%), and fat (33-39%) composition. Subjects were healthy women (n=12) and men (n=5) studied in a crossover design. There were no significant differences in satiety ratings after the two meals. Average energy expenditure for the WF meal (137+/-14.1 kcal, 19.9% of meal energy) was significantly larger than for the PF meal (73.1+/-10.2 kcal, 10.7% of meal energy). Ingestion of the particular PF meal tested in this study decreases postprandial energy expenditure by nearly 50% compared with the isoenergetic WF meal. This reduction in daily energy expenditure has potential implications for diets comprised heavily of PFs and their associations with obesity.

Aerobic Capacity, Activity Levels and Daily Energy Expenditure in Male and Female Adolescents of the Kenyan Nandi Sub-Group.

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Alexander R Gibson

Full Text Available The relative importance of genetic and socio-cultural influences contributing to the success of east Africans in endurance athletics remains unknown in part because the pre-training phenotype of this population remains incompletely assessed. Here cardiopulmonary fitness, physical activity levels, distance travelled to school and daily energy expenditure in 15 habitually active male (13.9±1.6 years and 15 habitually active female (13.9±1.2 adolescents from a rural Nandi primary school are assessed. Aerobic capacity ([Formula: see text] was evaluated during two maximal discontinuous incremental exercise tests; physical activity using accelerometry combined with a global positioning system; and energy expenditure using the doubly labelled water method. The [Formula: see text] of the male and female adolescents were 73.9±5.7 ml(. kg(-1. min(-1 and 61.5±6.3 ml(. kg(-1. min(-1, respectively. Total time spent in sedentary, light, moderate and vigorous physical activities per day was 406±63 min (50% of total monitored time, 244±56 min (30%, 75±18 min (9% and 82±30 min (10%. Average total daily distance travelled to and from school was 7.5±3.0 km (0.8-13.4 km. Mean daily energy expenditure, activity-induced energy expenditure and physical activity level was 12.2±3.4 MJ(. day(-1, 5.4±3.0 MJ(. day(-1 and 2.2±0.6. 70.6% of the variation in [Formula: see text] was explained by sex (partial R(2 = 54.7% and body mass index (partial R(2 = 15.9%. Energy expenditure and physical activity variables did not predict variation in [Formula: see text] once sex had been accounted for. The highly active and energy-demanding lifestyle of rural Kenyan adolescents may account for their exceptional aerobic fitness and collectively prime them for later training and athletic success.

National Energy Board 1992-93 estimates part III expenditure plan

Energy Technology Data Exchange (ETDEWEB)

NONE

1993-12-31

This Expenditure Plan is designed to be used as a reference document. As such, it contains several levels of detail to respond to the various needs of its audience. This Plan is divided into two sections. Section 1 presents an overview of the Program including a description, information on its background, objectives and planning perspective as well as performance information that forms the basis for the resources requested. Section 2 provides further information on costs and resources as well as special analyses that the reader may require to understand the Program more fully. Section 1 is preceded by details of Spending Authorities from Part 2 of the Estimates and Volume 2 of the Public Accounts. This is to provide continuity with other Estimates documents and to help in assessing the Program`s financial performance over the past year. The format and organization of the document should be regarded as transitional. For the most part the document is organized to be consistent with the program structure approved for the National Energy Board. 16 figs.

Energy expenditure evaluation in humans and non-human primates by SenseWear Armband. Validation of energy expenditure evaluation by SenseWear Armband by direct comparison with indirect calorimetry.

Science.gov (United States)

Casiraghi, Francesca; Lertwattanarak, Raweewan; Luzi, Livio; Chavez, Alberto O; Davalli, Alberto M; Naegelin, Terry; Comuzzie, Anthony G; Frost, Patricia; Musi, Nicolas; Folli, Franco

2013-01-01

The purpose of this study was to compare and validate the use of SenseWear Armband (SWA) placed on the arm (SWA ARM) and on the back (SWA BACK) in healthy humans during resting and a cycle-ergometer exercise and to evaluate the SWA to estimate Resting Energy Expenditure (REE) and Total Energy Expenditure (TEE) in healthy baboons. We studied 26 (15F/11M) human subjects wearing SWA in two different anatomical sites (arm and back) during resting and a cycle-ergometer test and directly compared these results with indirect calorimetry evaluation (IC), performed at the same time. We then inserted the SWA in a metabolic jacket for baboons and evaluated the TEE and REE in free living condition for 6 days in 21 (8F/13M) non-human primates. In humans we found a good correlation between SWA place on the ARM and on the BACK with IC during the resting experiment (1.1±0.3 SWAs, 1±0.2 IC kcal/min) and a slight underestimation in the SWAs data compared with IC during the cycle-ergometer exercise (5±1.9 SWA ARM, 4.5±1.5 SWA BACK and 5.4±2.1 IC kcal/min). In the non-human primate (baboons) experiment SWA estimated a TEE of 0.54±0.009 kcal/min during free living and a REE of 0.82±0.06 kcal/min. SWA, an extremely simple and inexpensive apparatus, provides quite accurate measurements of energy expenditure in humans and in baboons. Energy expenditure data obtained with SWA are highly correlated with the data obtained with "gold standard", IC, in humans.

Productive Government Expenditure in Monetary Business Cycle Models

NARCIS (Netherlands)

Linnemann, L.; Schabert, A.

2006-01-01

This paper assesses the transmission of fiscal policy shocks in a New Keynesian framework where government expenditures contribute to aggregate production. It is shown that even if the impact of government expenditures on production is small, this assumption helps to reconcile the models'

Productivity and Energy Expenditure by Sawyers When Using ...

African Journals Online (AJOL)

Therefore, based on overall results it is concluded that, the PLSP is technically more appropriate technology or method for reducing energy expenditure and for increasing productivity during timber harvesting in agroforestry farms. Keywords: Productivity, Energy expenditure, Pitsawing and Portable log sawing. Rwanda ...

Government expenditure, efficiency and economic growth: a panel ...

African Journals Online (AJOL)

Finally Generalized Methods of Moments (GMM) is applied to answer the two research questions. The results demonstrate that increasing government expenditure accelerates economic growth of low income countries in Sub Saharan Africa. However, when government expenditure is interacted with government efficiency ...

Summary of expenditures of rebates from the low-level radioactive waste surcharge escrow account for calendar year 1991

International Nuclear Information System (INIS)

1992-06-01

This is the sixth report submitted to Congress under section 5(d)(2)(E)(ii)(II) of the Low-Level Radioactive Waste Policy Act of 1985 (the Act). This section of the Act directs the Department of Energy (DOE) to summarize the annual expenditures of funds disbursed from the DOE surcharge escrow account and to assess compliance of these expenditures with the limitations specified in the Act. In addition to placing limitations on the use of these funds, the Act also requires the nonsited compact regions and nonmember States to provide DOE with an itemized report of their expenditures on December 31 of each year in which funds are expended. Within 6 months after receiving the individual reports, the Act requires the Secretary to furnish Congress with a summary of the reported expenditures and an assessment of compliance with the specified usage limitations. This report fulfills that requirement. DOE disbursed funds totaling $15,037,778.91 to the States and compact regions following the July 1, 1986, January 1, 1988, and January 1, 1990, milestones specified in the Act. Of this amount, $3,517,020.56 was expended during calendar year 1991 and $6,602,546.24 was expended during the prior 5 years. At the end of December 1991, $4,918,212.11 was unexpended. DOE has reviewed each of the reported expenditures and concluded that all reported expenditures comply with the spending limitations stated in section 5(d)(2)(E)(i) of the Act

Incentives of Health Care Expenditure

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Eero Siljander

2012-12-01

Full Text Available The incentives of health care expenditure (HCE have been a topic of discussion in the USA (Obama reforms and in Europe (adjustment to debt crisis. There are competing views of institutional versus GDP (unit income elasticity and productivity related factors of growth of expenditure. However ageing of populations, technology change and economic incentives related to institutions are also key drivers of growth according to the OECD and EU’s AWG committee. Simulation models have been developed to forecast the growth of social expenditure (including HCEs to 2050. In this article we take a historical perspective to look at the institutional structures and their relationship to HCE growth. When controlling for age structure, price developments, doctor density and in-patient and public shares of expenditures, we find that fee-for-service in primary care, is according to the results, in at least 20 percent more costly than capitation or salary remuneration. Capitation and salary (or wage remuneration are at same cost levels in primary care. However we did not find the cost lowering effect for gatekeeping which could have been expected based on previous literature. Global budgeting 30 (partly DRG based percent less costly in specialized care than other reimbursement schemes like open contracting or volume based reimbursement. However the public integration of purchaser and provider cost seems to result to about 20 higher than public reimbursement or public contracting. Increasing the number of doctors or public financing share results in increased HCEs. Therefore expanding public reimbursement share of health services seems to lead to higher HCE. On the contrary, the in-patient share reduced expenditures. Compared to the previous literature, the finding on institutional dummies is in line with similar modeling papers. However the results for public expansion of services is a contrary one to previous works on the subject. The median lag length of

Quality-quantity decomposition of income elasticity of U.S. hospital care expenditure using state-level panel data.

Science.gov (United States)

Chen, Weiwei; Okunade, Albert; Lubiani, Gregory G

2014-11-01

Economic theory suggests that income growth could lead to changes in consumption quantity and quality as the spending on a commodity changes. Similarly, the volume and quality of healthcare consumption could rise with incomes because of demographic changes, usage of innovative medical technologies, and other factors. Hospital healthcare spending is the largest component of aggregate US healthcare expenditures. The novel contribution of our paper is estimating and decomposing the income elasticity of hospital care expenditures (HOCEXP) into its quantity and quality components. By using a 1999-2008 panel dataset of the 50 US states, results from the seemingly unrelated regressions model estimation reveal the income elasticity of HOCEXP to be 0.427 (std. error=0.044), with about 0.391 (calculated std. error=0.044) arising from care quality improvements and 0.035 (std. error=0.050) emanating from the rise in usage volume. Our novel research findings suggest the following: (i) the quantity part of hospital expenditure is inelastic to income change; (ii) almost the entire income-induced rise in hospital expenditure comes from care quality changes; and (iii) the 0.427 income elasticity of HOCEXP, the largest component of total US healthcare expenditure, makes hospital care a normal commodity and a much stronger technical necessity than aggregate healthcare. Policy implications are discussed. Copyright © 2013 John Wiley & Sons, Ltd.

Does intra-abdominal fluid increase the resting energy expenditure?

Science.gov (United States)

Zarling, E J; Grande, A; Hano, J

1997-10-01

In patients with intra-abdominal fluid collection, caloric needs are based on an estimated dry weight. This is done because intra-abdominal fluid has been assumed to be metabolically inactive. One recent study of patients with slowly resolving ascites suggested otherwise. In our study, the effect of intra-abdominal fluid on the resting energy expenditure (REE) and apparent lean body mass was determined in 10 stable patients requiring peritoneal dialysis. For each subject, in both the empty and full state, we measured REE by indirect calorimetry, and body composition by the bioelectric impedance method. In the full state, the VCO2 was significantly increased (210 +/- 11 versus 197 +/- 9 mL/min, P empty state. This caused an increase in the calculated resting energy expenditure (1531 +/- 88 kcal/d empty versus 1593 +/- 94 kcal/d full, P calories derived from glucose absorbed out of the dialysate. Estimates of body fat, lean body mass, and total water also were not affected by the intra-abdominal fluid. We conclude that intra-abdominal fluid will not affect the measured REE and hence may be considered to be metabolically inactive.

Energy Expenditure in Rock/Pop Drumming

OpenAIRE

De La Rue, S; Draper, Stephen B; Potter, Christopher R; Smith, M.

2013-01-01

Despite the vigorous nature of rock/pop drumming, there are no precise data on the energy expenditure of this activity. The aim of this study was to quantify the energy cost of rock/pop drumming. Fourteen male drummers (mean +/- SD; age 27 +/- 8 yrs.) completed an incremental drumming test to establish the relationship between energy expenditure and heart rate for this activity and a ramped cycle ergometer test to exhaustion as a criterion measure for peak values (oxygen uptake and heart rate...

The effects of government expenditure on economic growth: the case of Malaysia

OpenAIRE

Hasnul, Al Gifari

2015-01-01

The relationship between government expenditure and economic growth has been debated for decades and has not clearly stated yet. This paper gives a further evidence on the relationship between government expenditure and economic growth in the case of Malaysia. In this study, the government expenditure has been disaggregated in to the government operating and development expenditure. We also classified the government expenditure based on the sector of which it expensed. We used OLS technique t...

Determinants of cruise passengers’ expenditures in the port of call

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Maršenka Marksel

2016-12-01

Full Text Available Cruise tourism generates different types of cruise consumption and related indirect, direct and induced expenditure effects, in homeports as well as in ports of call. Cruise passengers’ expenditures produce positive economic effects for destinations, from increasing the incomes and employment, to tax incomes, duties, etc. Therefore, it is no doubt that cruise stakeholders and local economies can benefit from increased cruise passenger consumption. To stimulate higher consumption and passengers’ satisfaction, it is necessary to design the supportive policy framework and build appropriate quality of products and services. Identifying influential variables of cruise passengers’ expenditures in this sense enables the design of appropriate policies and measures. In the current research, based on a survey of 357 cruise passengers, several variables included in a new theoretical model of the expenditures determinants, such as gender, nationality, frequency of cruising and frequency of visits, were found to be statistically significantly associated with cruise passengers’ expenditures. Several conclusions and suggestions to stimulate cruise passenger expenditures based on research findings are provided.

Double Up Food Bucks program effects on SNAP recipients' fruit and vegetable purchases.

Science.gov (United States)

Steele-Adjognon, Marie; Weatherspoon, Dave

2017-12-12

To encourage the consumption of more fresh fruits and vegetables, the 2014 United Sates Farm Bill allocated funds to the Double Up Food Bucks Program. This program provided Supplemental Nutrition Assistance Program beneficiaries who spent $10 on fresh fruits and vegetables, in one transaction, with a $10 gift card exclusively for Michigan grown fresh fruits and vegetables. This study analyzes how fruit and vegetable expenditures, expenditure shares, variety and purchase decisions were affected by the initiation and conclusion, as well as any persistent effects of the program. Changes in fruit and vegetable purchase behaviors due to Double Up Food Bucks in a supermarket serving a low-income, predominantly Hispanic community in Detroit, Michigan were evaluated using a difference in difference fixed effects estimation strategy. We find that the Double Up Food Bucks program increased vegetable expenditures, fruit and vegetable expenditure shares, and variety of fruits and vegetables purchased but the effects were modest and not sustainable without the financial incentive. Fruit expenditures and the fruit and vegetable purchase decision were unaffected by the program. This study provides valuable insight on how a nutrition program influences a low-income, urban, Hispanic community's fruit and vegetable purchase behavior. Policy recommendations include either removing or lowering the purchase hurdle for incentive eligibility and dropping the Michigan grown requirement to better align with the customers' preferences for fresh fruits and vegetables.

Gender disparities in medical expenditures attributable to hypertension in the United States.

Science.gov (United States)

Basu, Rituparna; Franzini, Luisa; Krueger, Patrick M; Lairson, David R

2010-01-01

We sought to examine and attempt to explain gender disparities in hypertension-attributable expenditure among noninstitutionalized individuals in the United States. Using the 2001-2004 Medical Expenditure Panel Survey and the Aday and Andersen health care use model, we estimated hypertension-attributable health care expenditures for inpatient stay, outpatient visits, prescription drugs, office visits, and emergency room (ER) visits among men and women by applying the method of recycled prediction. Hypertensive individuals were identified using International Classification of Diseases, 9th edition, codes or self-report of a diagnosis of hypertension. The adjusted mean hypertension-attributable expenditure per individual was significantly higher for women than for men for prescription drugs, inpatient stays, office visits, outpatient visits and ER visits expenditures. However, as age increased, the gender difference in adjusted mean expenditures became smaller and eventually reversed. This reversal occurred at different ages for different expenditures. For prescription drugs, office visits and outpatient expenditures, the reversal in expenditures occurred around age 50 to 59. The maximum difference was observed in outpatient expenditures, where women's average expenditure was $102 more than men's below age 45 but $103 less than men's above age 75. These differences remained significant even after controlling for predisposing, enabling, and need predictors of health care use. Our findings imply that there are gender disparities in hypertension-related expenditures, but that this disparity depends on age. These findings support recent findings on gender disparities in heart diseases and raise the question of physicians' bias in their diagnostic or prognostic approaches to hypertension in men and women. Copyright 2010 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Out-of-pocket expenditures for childbirth in the context of the Janani Suraksha Yojana (JSY) cash transfer program to promote facility births: who pays and how much? Studies from Madhya Pradesh, India.

Science.gov (United States)

Sidney, Kristi; Salazar, Mariano; Marrone, Gaetano; Diwan, Vishal; DeCosta, Ayesha; Lindholm, Lars

2016-05-03

High out-of-pocket expenditures (OOPE) make delivery care difficult to access for a large proportion of India's population. Given that home deliveries increase the risk of maternal mortality, in 2005 the Indian Government implemented the Janani Suraksha Yojana (JSY) program to incentivize poor women to deliver in public health facilities by providing a cash transfer upon discharge. We study the OOPE among JSY beneficiaries and women who deliver at home, and predictors of OOPE in two districts of Madhya Pradesh. September 2013 to April 2015 a cross-sectional community-based survey was performed. All recently delivered women were interviewed to elicit delivery costs, socio-demographic characteristics and delivery related information. Most women (n = 1995, 84 %) delivered in JSY public health facility, the remaining 16 % (n = 386) delivered at home. Women who delivered under JSY program had a higher median, IQR OOPE ($8, 3-18) compared to home ($6, 2-13). Among JSY beneficiaries, poorest women had twice net gain ($20) versus wealthiest ($10) post cash transfer. Informal payments (64 %) and food/baby items (77 %) were the two most common sources of OOPE. OOPE made among JSY beneficiaries was pro-poor: poorer women made proportionally less expenditures compared to wealthier women. In an adjusted model, delivering in a JSY public facility increased odds of incurring expenditures (OR: 1.58, 95 % CI: 1.11-2.25) but at the same time to a 16 % (95 % CI: 0.73-0.96) decrease in the amount paid compared to home deliveries. OOPE is prevalent among JSY beneficiaries as well in home deliveries. In JSY, OOPE varies by income quintile: wealthier quintiles pay more OOPE. However the cash incentive is adequate enough to provide a net gain for all quintiles. OOPE was largely due to indirect costs and not direct medical payments. The program seems to be effective in providing financial protection for the most vulnerable groups.

Gambling Participation, Expenditure and Risk of Harm in Australia, 1997-1998 and 2010-2011.

Science.gov (United States)

Armstrong, Andrew Richard; Thomas, Anna; Abbott, Max

2018-03-01

Gambling-related harm results primarily from financial losses. Internationally Australia continues to rank as the largest spending nation per capita on gambling products. This would suggest that Australian gamblers are at disproportionately high risk of harm despite almost two decades of industry scrutiny and regulation, and investment in research, treatment and education programs. However, declines in participation rates, per capita expenditure, household expenditure, national disposable income spent on gambling and problem gambling rates have been cited as evidence that fewer people are gambling, that gamblers are spending less, and that gambling safety in Australia has improved. The current study investigated these propositions using national population and accounts data, and statistics from Australia's two population-representative gambling surveys conducted in 1997-1998 and 2010-2011. Despite a falling participation rate the study found no real change in the number of people gambling overall, and increasing numbers consuming casino table games, race wagering and sports betting. Further found were increases rather than decreases in average gambler expenditure, overall, and across most products, particularly electronic gaming machines (EGMs). Potentially risky levels of average expenditure were observed in both periods, overall and for race wagering, casino table gaming, and EGMs. Changes in the proportion of income spent on gambling suggest risks declined overall and for race wagering and casino table gaming, but increased for EGMs. Finally, while problem gambling statistics were not comparable between periods, the study found double the number of moderate risk gamblers previously estimated for 2010-2011 amongst the 2 million Australians found to have experienced one or more gambling-related problems. The findings have implications for public health policy and resourcing, and the way in which prevalence and expenditure statistics have been interpreted by

Convergence and determinants of health expenditures in OECD countries.

Science.gov (United States)

Nghiem, Son Hong; Connelly, Luke Brian

2017-08-17

This study examines the trend and determinants of health expenditures in OECD countries over the 1975-2004 period. Based on recent developments in the economic growth literature we propose and test the hypothesis that health care expenditures in countries of similar economic development level may converge. We hypothesise that the main drivers for growth in health care costs include: aging population, technological progress and health insurance. The results reveal no evidence that health expenditures among OECD countries converge. Nevertheless, there is evidence of convergence among three sub-groups of countries. We found that the main driver of health expenditure is technological progress. Our results also suggest that health care is a (national) necessity, not a luxury good as some other studies in this field have found.

Postprandial energy expenditure in whole-food and processed-food meals: implications for daily energy expenditure

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Sadie B. Barr

2010-07-01

Full Text Available Background: Empirical evidence has shown that rising obesity rates closely parallel the increased consumption of processed foods (PF consumption in USA. Differences in postprandial thermogenic responses to a whole-food (WF meal vs. a PF meal may be a key factor in explaining obesity trends, but currently there is limited research exploring this potential link. Objective: The goal was to determine if a particular PF meal has a greater thermodynamic efficiency than a comparable WF meal, thereby conferring a greater net-energy intake. Design: Subjective satiation scores and postprandial energy expenditure were measured for 5–6 h after isoenergetic meals were ingested. The meals were either ‘whole’ or ‘processed’ cheese sandwiches; multi-grain bread and cheddar cheese were deemed whole, while white bread and processed cheese product were considered processed. Meals were comparable in terms of protein (15–20%, carbohydrate (40–50%, and fat (33–39% composition. Subjects were healthy women (n=12 and men (n=5 studied in a crossover design. Results: There were no significant differences in satiety ratings after the two meals. Average energy expenditure for the WF meal (137±14.1 kcal, 19.9% of meal energy was significantly larger than for the PF meal (73.1±10.2 kcal, 10.7% of meal energy. Conclusion: Ingestion of the particular PF meal tested in this study decreases postprandial energy expenditure by nearly 50% compared with the isoenergetic WF meal. This reduction in daily energy expenditure has potential implications for diets comprised heavily of PFs and their associations with obesity.

Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran

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Bakhtiar Piroozi

2016-07-01

Full Text Available Background: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE after the implementation of HSEP and the factors that determine CHE. Methods: A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. Results: The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. Conclusion: The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of

E-cigarette advertising expenditures in the U.S., 2011-2012.

Science.gov (United States)

Kim, Annice E; Arnold, Kristin Y; Makarenko, Olga

2014-04-01

Electronic cigarettes (e-cigarettes) are growing in popularity, but little is known about the extent to which these products are advertised to consumers. To estimate expenditures for e-cigarette advertising in magazines, TV, the Internet, newspapers, and radio in the U.S. from 2011 to 2012. E-cigarette advertising data were obtained from leading media intelligence companies, Kantar Media and Nielsen. Estimated e-cigarette advertising expenditures were summarized across media channels for 2011 and 2012. Additional information on brands advertised and market-level buys (i.e., local versus national) also was examined. Overall, e-cigarette advertising expenditures across media channels tripled from $6.4 million in 2011 to $18.3 million in 2012. Expenditures were highest in magazines and TV and lowest in newspapers and on the Internet. More than 80 unique brands were advertised, but blu eCigs dominated ad spending, comprising 76.7% of all e-cigarette advertising expenditures in 2012. National markets were increasingly targeted from 54.9% of ad buys in 2011 to 87.0% of ad buys in 2012. E-cigarette advertising expenditures are increasing, with a greater focus on national markets and TV ads, which will likely increase consumer awareness and use of e-cigarettes in the future. Federal-level efforts are needed to mandate that e-cigarette companies report their advertising expenditures. Future studies should examine how e-cigarette advertising expenditures and message content influence consumer awareness of, interest in, and use of e-cigarettes. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.

LOCAL PUBLIC 0 EXPENDITURE AUTONOMY – MEASURING APPROACH

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Irina BILAN

2013-06-01

Full Text Available The decentralization process was continuous in Romania starting with 1990, generating the implication of local authorities in local public finance, as a result of exclusives, shared and delegate competences and, so, the necessity of ensuring a good management of resources and expenditures. Therefore, the decentralization of competences / responsibilities from State to local governments was a major Romanian political theme and a first rank component of management of local public finance, as main driving instrument for local development. Specific legal framework of local responsibilities is established both to European and national level. Researchers based on regulation and practice have tried to quantify the responsibilities developing different models to measure local revenue and expenditures autonomy. The paper aims is to identify some models for measuring local expenditure autonomy and to apply for Romania. The study is oriented to measure local expenditure autonomy in Romania using Bell, Ebel, Kaiser and Rojchaichainthorn's model.

Price elasticity of expenditure across health care services.

Science.gov (United States)

Duarte, Fabian

2012-12-01

Policymakers in countries around the world are faced with rising health care costs and are debating ways to reform health care to reduce expenditures. Estimates of price elasticity of expenditure are a key component for predicting expenditures under alternative policies. Using unique individual-level data compiled from administrative records from the Chilean private health insurance market, I estimate the price elasticity of expenditures across a variety of health care services. I find elasticities that range between zero for the most acute service (appendectomy) and -2.08 for the most elective (psychologist visit). Moreover, the results show that at least one third of the elasticity is explained by the number of visits; the rest is explained by the intensity of each visit. Finally, I find that high-income individuals are five times more price sensitive than low-income individuals and that older individuals are less price-sensitive than young individuals. Copyright © 2012 Elsevier B.V. All rights reserved.

Multiple Sclerosis and Catastrophic Health Expenditure in Iran.

Science.gov (United States)

Juyani, Yaser; Hamedi, Dorsa; Hosseini Jebeli, Seyede Sedighe; Qasham, Maryam

2016-09-01

There are many disabling medical conditions which can result in catastrophic health expenditure. Multiple Sclerosis is one of the most costly medical conditions through the world which encounter families to the catastrophic health expenditures. This study aims to investigate on what extent Multiple sclerosis patients face catastrophic costs. This study was carried out in Ahvaz, Iran (2014). The study population included households that at least one of their members suffers from MS. To analyze data, Logit regression model was employed by using the default software STATA12. 3.37% of families were encountered with catastrophic costs. Important variables including brand of drug, housing, income and health insurance were significantly correlated with catastrophic expenditure. This study suggests that although a small proportion of MS patients met the catastrophic health expenditure, mechanisms that pool risk and cost (e.g. health insurance) are required to protect them and improve financial and access equity in health care.

Highway Expenditures and Associated Customer Satisfaction: A Case Study

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Alexander Paz

2016-01-01

Full Text Available This study analyzes the satisfaction of the Nevadans with respect to their highway transportation system and the corresponding expenditures of Nevada Department of Transportation (NDOT. A survey questionnaire was designed to capture the opinions of the Nevadans (customers about a number of characteristics of their transportation system. Data from the financial data warehouse of the NDOT was used to evaluate expenditures. Multinomial probit models were estimated to study the correlations between customers’ opinion and the government expenditures in transportation. The results indicate the customer satisfaction is decreasing with respect to traffic safety throughout Northwestern and Southern Nevada highways. In addition, users of Northwestern highways are more likely to be satisfied, compared to their counterparts, with increasing construction spending to reduce the time taken to complete construction projects. In Southern Nevada highways, customers’ satisfaction increases with the expenditures associated with reduction of congestion. These insights are examples of the conclusions that were obtained as a consequence of simultaneously considering customer satisfaction and the corresponding expenditures in transportation.

Out-Of-Pocket Expenditure on Institutional Delivery in Rural Lucknow

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Mukesh Shukla

2015-06-01

Full Text Available   Introduction: Promotion of reproductive health through institutional delivery has been adopted by government as a strategy for reducing maternal mortality rate but still about half of the deliveries have been conducted at home. Cost barrier is one of the major cause for preferring home delivery instead of institutional delivery. Not only the direct costs responsible for low institutional delivery but also indirect costs too accountable for less number of institutional births in the country. Aims & Objectives: To estimate the out of pocket expenditure incurred by households during delivery and its determinants. Materials and methods: A community based cross sectional study was conducted during which a total 272 households having women who had recently delivered in government institutions were interviewed. Result: The mean out of pocket expenditure was found to be Rs. 1406.04 ± 103.27 including spending’s on drugs, travel, pathological tests and unofficial payments. Low socioeconomic class, residence outside the catchment area of delivery point, tertiary and secondary health care facilities as place of delivery and low literacy status of head of the family below high school  were found to be significantly associated with out of pocket expenditure bivariate analysis (p<0.05. On multivariate analysis low socioeconomic (OR 22.40; 95% CI 9.44-53.15; p = 0.01   and residence (OR 13.07; 95% CI (1.58-116.55; p = 0.03  outside the catchment area of delivery point were found to be independent predictors of catastrophic out of pocket expenditure during delivery. Conclusions: Although government has been running lot of schemes for availing free of cost health services but still one has to pay from their pocket as medical expenses. In order to bear these expenses, they have to borrow money, sell their assets and securities due to which households suffer a lot. In the present study, unofficial payment was found prevalent in public institutions

Out-Of-Pocket Expenditure on Institutional Delivery in Rural Lucknow

Directory of Open Access Journals (Sweden)

Mukesh Shukla

2015-06-01

Full Text Available AbstractIntroduction: Promotion of reproductive health through institutional delivery has been adopted by government as a strategy for reducing maternal mortality rate but still about half of the deliveries have been conducted at home. Cost barrier is one of the major cause for preferring home delivery instead of institutional delivery. Not only the direct costs responsible for low institutional delivery but also indirect costs too accountable for less number of institutional births in the country. Aims & Objectives: To estimate the out of pocket expenditure incurred by households during delivery and its determinants. Materials and methods: A community based cross sectional study was conducted during which a total 272 households having women who had recently delivered in government institutions were interviewed. Result: The mean out of pocket expenditure was found to be Rs. 1406.04 ± 103.27 including spending’s on drugs, travel, pathological tests and unofficial payments. Low socioeconomic class, residence outside the catchment area of delivery point, tertiary and secondary health care facilities as place of delivery and low literacy status of head of the family below high school  were found to be significantly associated with out of pocket expenditure bivariate analysis (p<0.05. On multivariate analysis low socioeconomic (OR 22.40; 95% CI 9.44-53.15; p = 0.01   and residence (OR 13.07; 95% CI (1.58-116.55; p = 0.03  outside the catchment area of delivery point were found to be independent predictors of catastrophic out of pocket expenditure during delivery. Conclusions: Although government has been running lot of schemes for availing free of cost health services but still one has to pay from their pocket as medical expenses. In order to bear these expenses, they have to borrow money, sell their assets and securities due to which households suffer a lot. In the present study, unofficial payment was found prevalent in public institutions

Green Pricing Program Marketing Expenditures: Finding the Right Balance

Energy Technology Data Exchange (ETDEWEB)

Friedman, B.; Miller, M.

2009-09-01

In practice, it is difficult to determine the optimal amount to spend on marketing and administering a green pricing program. Budgets for marketing and administration of green pricing programs are a function of several factors: the region of the country; the size of the utility service area; the customer base and media markets encompassed within that service area; the point or stage in the lifespan of the program; and certainly, not least, the utility's commitment to and goals for the program. All of these factors vary significantly among programs. This report presents data on programs that have funded both marketing and program administration. The National Renewable Energy Laboratory (NREL) gathers the data annually from utility green pricing program managers. Programs reporting data to NREL spent a median of 18.8% of program revenues on marketing their programs in 2008 and 16.6% in 2007. The smallest utilities (those with less than 25,000 in their eligible customer base) spent 49% of revenues on marketing, significantly more than the overall median. This report addresses the role of renewable energy credit (REC) marketers and start-up costs--and the role of marketing, generally, in achieving program objectives, including expansion of renewable energy.

Is Wagner’s theory relevant in explaining health expenditure dynamics in Botswana?

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Kunofiwa Tsaurai

2014-11-01

Full Text Available This study tests the relevance of the Wagner’s theory in explaining the health expenditure in Botswana. There is no consensus yet when it comes to the causality relationship between health expenditure and economy. At the moment, there are four dominant schools of thought explaining the causality relationship between health expenditure and economy. The first school of thought is that health expenditure spurs the economy whilst the second school of thought says that the economy drives health expenditure. The third school of thought maintains that there is a feedback effect between health expenditure and the economy whilst the fourth mentions that there is no causality at all between the two variables. However, this study found out that there is no causality relationship between health expenditure and GDP in Botswana thereby dismissing the relevance of the Wagner’s theory.

[Analysis of several containment measures of pharmaceutical expenditure in an Ambulatory Surgery Centre].

Science.gov (United States)

Esteban, J L; León, A; Porras, I

2013-11-01

In the context of the current crisis, sustainability of National Health Service must be considered a priority issue. To compare several cost saving measures in drug expenditure due to outpatient drug treatment after surgery in an Ambulatory Surgical Centre. Pharmaco-economic analysis of cost minimization of ambulatory pharmaceutical services during the year 2011. A total of 3,346 patients were operated on and discharged on the same day, were included. Treatments were collected from the discharge report of each patient. We compared changes in real outpatient drug spending after separately applying each of the following measures: 1) increasing the co-payment; 2) improving the quality of prescribing; 3) dispensing by units of drugs through pharmacies, and 4) dispensing through the hospital pharmacy service. The real outpatient pharmaceutical expenditure was 29,454.21€. Increasing the co-payment mean a transfer of 2,091.82€ from the funding institutions to users. Improving the quality of prescriptions, dispensing through units of drugs in the pharmacy, and dispensing through the hospital pharmacy service led to a pharmaceutical expenditure of 24,215.14€, 21,766.24€ and 7,827.71€, respectively. Only considering co-payment to contain pharmaceutical expenditure arising from prescribing in an Ambulatory Surgical Centre is the least effective measure. The most effective measure, for this purpose, is the supply of drugs through the hospital pharmacy service. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Atomic Energy Control Board 1991-92 estimates part III expenditure plan

International Nuclear Information System (INIS)

1991-01-01

This Expenditure Plan is designed to be used as a reference document. As such, it contains several levels of detail to respond to the various needs of its audience. This Plan is divided into two sections. Section 1 presents an overview of the Program including a description, information on its background, objectives and planning perspective as well as performance information that forms the basis for the resources requested. Section 2 provides further information on costs and resources as well as special analyses that the reader may require to understand the Program more fully. Section 1 is preceded by details of Spending Authorities from Part 2 of the Estimates and Volume 2 of the Public Accounts. This is to provide continuity with other Estimates documents and to help in assessing the Program's financial performance over the past year. 22 figs

Atomic Energy Control Board 1992-93 estimates part III expenditure plan

International Nuclear Information System (INIS)

1992-01-01

This Expenditure Plan is designed to be used as a reference document. As such, it contains several levels of detail to respond to the various needs of its audience. This Plan is divided into two sections. Section 1 presents an overview of the Program including a description, information on its background, objectives and planning perspective as well as performance information that forms the basis for the resources requested. Section 2 provides further information on costs and resources as well as special analyses that the reader may require to understand the Program more fully. Section 1 is preceded by details of Spending Authorities from Part 2 of the Estimates and Volume 2 of the Public Accounts. This is to provide continuity with other Estimates documents and to help in assessing the Program's financial performance over the past year. 7 refs., 21 figs

Trends in Australian government health expenditure by age: a fiscal incidence analysis.

Science.gov (United States)

Tapper, Alan; Phillimore, John

2014-11-01

Australian government health expenditure per capita has grown steadily across the past few decades, but little is known about trends in the age distribution of health expenditure. In this paper, the Australian Bureau of Statistics (ABS) fiscal incidence studies, which track expenditure at the household level between 1984 and 2010, are used to shed light on this topic. The main finding was that spending has shifted focus from the younger half to the older half of the population. This shift is evident in three areas: (1) acute care (hospitals); (2) community health services (doctors); and (3) pharmaceuticals. Together, these areas account for approximately 88% of expenditure. The trend is independent of demographic aging. It is unlikely to reflect changes in population health. Its explanation is open to debate. Growth in expenditure per household has been more than threefold faster for elderly than young households. Across this period, expenditure per household per week has increased by 51% for the young, by 79% for the middle aged and by 179% for the elderly. This age-related growth is most prominent in expenditure on acute care, community health services and pharmaceuticals. WHAT IS KNOWN ABOUT THE TOPIC?: The Productivity Commission has published figures that relate age and Australian heath expenditure. However, there has been no published study of age-related trends in Australian health expenditure. WHAT DOES THIS PAPER ADD?: In addition to tracking age-related trends across 26 years, this paper adds a breakdown of those trends into four categories of expenditure, namely acute care, community health services, pharmaceutical benefits, and other. This breakdown shows that the trends vary by expenditure type. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: The paper shows that forward projections in health expenditure need to take into account age-related trends as well as demographic trends.

Advertising expenditures in the nursing home sector: evaluating the need for and purpose of advertising.

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Kash, Bita A; Boyer, Gregory J

2008-01-01

Marketing and advertising activities in the nursing home sector have increased in recent years, following the example of hospitals and health systems. The reasons for this trend may be related to the growth in competition but are not clearly identified yet. Theoretically, advertising becomes necessary to gain an advantage over the competition. The purpose of this study was to identify the reasons for the variation in advertising expenditures among nursing homes in Texas. For this study, we merged 2003 data from the Texas Medicaid Nursing Facility Cost Report, the Texas Nursing Home Quality Reporting System, and the Area Resource File for Texas. Using the Herfindahl-Hirschman Index, we then examined the correlations between advertising expenses and the level of market concentration. We evaluated the association between advertising expenditures and market competition using two logistic and four linear regression models. Total advertising expenses in Texas nursing homes ranged from $0 to $165,000 per year. Higher advertising expenditures were associated with larger facilities, higher occupancy, and high Medicare census. Market competition, however, was not a significant predictor of such expenses. Advertising seems to be more resource-driven than market-driven. Therefore, some advertising expenditures may be unnecessary, may lack impact, and may even be wasteful. Reducing unnecessary advertising costs could free up resources, which may be allocated to necessary resident care activities.

Physical activity recommendations: an alternative approach using energy expenditure.

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Mudd, Lanay M; Rafferty, Ann P; Reeves, Mathew J; Pivarnik, James M

2008-10-01

Most adults do not meet the American College of Sports Medicine and Centers for Disease Control and Prevention (ACSM/CDC) physical activity recommendations. Even fewer meet the more extreme Institute of Medicine (IOM) physical activity recommendations. Compliance with either recommendation has been conventionally assessed by combining frequencies and durations of self-reported activities. Leisure-time energy expenditure is a cumulative measure of activity that offers an alternative method of defining compliance. To calculate the leisure-time energy expenditure of adults complying with the ACSM/CDC or the IOM physical activity recommendations determined by conventional measures and to reexamine compliance with the IOM recommendation using energy expenditure criteria. National, cross-sectional data from the 2000 Behavioral Risk Factor Surveillance System determined the mode, frequency, and duration of up to two leisure-time activities performed by adults. Four mutually exclusive activity groups (Non-, Low-, ACSM/CDC-, and IOM-Active) were defined on the basis of frequencies and durations of reported activities. Leisure-time energy expenditure (kcal x kg(-1) x wk(-1)) was calculated per respondent. The energy expenditure threshold for meeting the IOM recommendation was calculated as 21 kcal x kg(-1) x wk(-1). Of the 162,669 respondents included in the analyses, 29.9% were Nonactive, whereas 42.3%, 23.3%, and 4.5% were Low-, ACSM/CDC-, and IOM-Active, respectively. Median leisure-time energy expenditure values were 9.0, 27.4, and 63.0 kcal x kg(-1) x wk(-1) for Low-, ACSM/CDC-, and IOM-Active groups, respectively. When using energy expenditure criteria, compliance with the IOM recommendation rose to 27.7% of respondents. Compliance with the IOM physical activity recommendation dramatically increased when assessed by energy expenditure compared with conventional criteria, thereby highlighting the potential bias of conventional methods. A significant proportion of adults

Maternal and neonatal health expenditure in mumbai slums (India: A cross sectional study

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Joshi Wasundhara

2011-03-01

Full Text Available Abstract Background The cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. We analyzed spending on maternity care in urban slum communities in Mumbai to better understand the equity of spending and the impact of spending on household poverty. Methods We used expenditure data for maternal and neonatal care, collected during post-partum interviews. Interviews were conducted in 2005-2006, with a sample of 1200 slum residents in Mumbai (India. We analysed expenditure by socio-economic status (SES, calculating a Kakwani Index for a range of spending categories. We also calculated catastrophic health spending both with and without adjustment for coping strategies. This identified the level of catastrophic payments incurred by a household and the prevalence of catastrophic payments in this population. The analysis also gave an understanding of the protection from medical poverty afforded by coping strategies (for example saving and borrowing. Results A high proportion of respondents spent catastrophically on care. Lower SES was associated with a higher proportion of informal payments. Indirect health expenditure was found to be (weakly regressive as the poorest were more likely to use wage income to meet health expenses, while the less poor were more likely to use savings. Overall, the incidence of catastrophic maternity expenditure was 41%, or 15% when controlling for coping strategies. We found no significant difference in the incidence of catastrophic spending across wealth quintiles, nor could we conclude that total expenditure is regressive. Conclusions High expenditure as a proportion of household resources should alert policymakers to the burden of maternal spending in this context. Differences in informal payments, significantly regressive indirect spending and the use of savings versus wages to finance spending, all highlight the heavier burden borne by the most poor. If a policy objective

Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement.

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Whitcomb, Winthrop F; Lagu, Tara; Krushell, Robert J; Lehman, Andrew P; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K

2015-09-01

Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls-patients treated before bundle implementation-45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p=.24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p=.43), and lower median posthospital payments ($704 versus $1,121, p=.002), and were more likely to receive guideline-consistent care (99% versus 95%, p=.05). The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams.

Impact of recent reforms in Austria on utilization and expenditure of PPIs and lipid-lowering drugs: implications for the future.

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Godman, Brian; Burkhardt, Thomas; Bucsics, Anna; Wettermark, Björn; Wieninger, Peter

2009-10-01

To assess the impact of a plethora of reforms and initiatives introduced in Austria since 2002 on the actual utilization and expenditure of proton pump inhibitors and statins. Utilization of dispensed prescriptions in ambulatory care was captured from 2001 to 2007 using defined daily doses (DDD) as well as DDDs/1000 inhabitants/day for patients covered by the social health insurance system. The data were provided by the internal data warehouse of Hauptverband der Osterreichischen Sozialversicherungsträger. Total costs in Euros were used for the analysis from the payer's perspective. The reduction in the expenditure per DDD for both generic PPIs and statins was generally in line with expectations at over 60% of originator prices before multiple sources became available. There was also increased utilization of generics following the range of demand-side initiatives. This was 89.5% for generic omeprazole versus total omeprazole and 95.1% for generic simvastatin versus total simvastatin by the end of 2007. The utilization of atorvastatin fell substantially from 36.5% of all statins in 2002 to 10.7% by the end of 2007 following restrictions on its prescribing to patients not achieving target lipid levels with, for instance, generic simvastatin. The combined initiatives reduced expenditure per DDD for the PPIs and the statins by 41 and 60%, respectively, in 2007 versus 2001 levels. This reduction translated into lower expenditure for the statins in 2007 versus 2001 despite substantially increased utilization. The results provide examples to other European countries, especially the restrictions on atorvastatin utilization. Nevertheless, further initiatives will be needed to conserve resources as utilization rates grow in chronic disease areas. This includes potential lessons from other European countries.

Factors Affecting Tourist Expenditure Coming To Mugla Region

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Fehime Korkmaz Bingöl

2012-12-01

Full Text Available Increasing tourist expenditure is a means to increase tourism income, which is extremely important for local economies. The purpose of this study is to understand the expending pattern of tourists coming to Mugla Region and provide empirical background for the policies to increase per tourist expenditure. The survey conducted at Dalaman International Airport and the data has been analyzed using OLS method. Nationality, age, accommodation type, pension type, credit card usage, availability of shopping facilities, standard of night life and entertainment, quality of food and beverage, length of holiday and group size has been found as significant factors affecting tourist expenditure

11 CFR 110.20 - Prohibition on contributions, donations, expenditures, independent expenditures, and...

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2010-01-01

... participate in the decision-making process of any person, such as a corporation, labor organization, political... activities, such as decisions concerning the making of contributions, donations, expenditures, or... party for the purchase or construction of an office building. See 11 CFR 300.10 and 300.35. (e...

Dental Use and Expenditures for Older Uninsured Americans: The Simulated Impact of Expanded Coverage

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Manski, Richard J; Moeller, John F; Chen, Haiyan; Schimmel, Jody; Pepper, John V; St Clair, Patricia A

2015-01-01

Objective To determine if providing dental insurance to older Americans would close the current gaps in dental use and expenditure between insured and uninsured older Americans. Data Sources/Study Setting We used data from the 2008 Health and Retirement Survey (HRS) supplemented by data from the 2006 Medical Expenditure Panel Survey (MEPS). Study Design We compared the simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured. Data Collection/Extraction Methods The HRS is a nationally representative survey administered by the Institute for Social Research (ISR). The MEPS is a nationally representative household survey sponsored by the Agency for Healthcare Research and Quality (AHRQ). Principal Findings We found that expanding dental coverage to older uninsured Americans would close previous gaps in dental use and expense between uninsured and insured noninstitutionalized Americans 55 years and older. Conclusions Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users. PMID:25040355

Environmental protection expenditure in 2010 - Report from the environment public accounts and economics commission - 2012 edition

International Nuclear Information System (INIS)

Balmand, Samuel; Bouagal, Farid; Gicquiaux, Cyril; Margontier, Sophie; Randriambololona, Celine; Boitard, Corinne; Dron, Dominique

2012-07-01

The expenditure related to the activities of environmental protection reached nearly 46 billion euros in 2010, up 3.1%, despite a fall in investment (1.5%). The expenditure, which had slowed down in 2009, resumed its rate of progression in 2010 this latter was still lower than between the years 2000 and 2008, when annual increase exceeded 5.3%. The dynamics of environmental protection expenditure is connected with the one of the gross domestic product at current prices, whose growth was interrupted in 2009 and resumed in 2010 (2.7%). The trend reversal observed previously for investments in the environmental protection domains continued and the downturn begun in 2009 went on (down 1.5% in 2010). Except for wastewater management and noise abatement, expenditures in the various fields of environmental protection increase, in particular those for waste management. The share of the financial effort between agents did not change much, the private enterprises still were bearing the largest relative share of total expenditure (36.4%). There was a significant increase (10.9%) for those of followed expenditures in natural resource use and management area (recovery/recycling, intake and distribution of water), very sensitive to price changes in the recovery sector. In 2010, the production of eco-activities reached almost 70 billion euros, up 8.5%. The environmental employment rose significantly (4.5%), and amounted to 452 600 full-time equivalent jobs in 2010. The environmental job market was less dynamic in 2011 than it had been in the past years, the number of applications increased slightly (0.7%) and the one of situations vacant rose a little more (2.1 %), while the increases for all types jobs were more marked. (authors)

18 CFR 367.1880 - Account 188, Research, development, or demonstration expenditures.

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2010-04-01

... 188, Research, development, or demonstration expenditures. (a) This account must be charged with the cost of all expenditures coming within the meaning of research, development and demonstration (RD&D) of..., development, and demonstration expenditures that are nonrecurring and that would distort the annual research...

Energy Expenditure Evaluation in Humans and Non-Human Primates by SenseWear Armband. Validation of Energy Expenditure Evaluation by SenseWear Armband by Direct Comparison with Indirect Calorimetry

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Casiraghi, Francesca; Chavez, Alberto O.; Davalli, Alberto M.; Naegelin, Terry; Comuzzie, Anthony G.; Frost, Patricia; Musi, Nicolas; Folli, Franco

2013-01-01

Introduction The purpose of this study was to compare and validate the use of SenseWear Armband (SWA) placed on the arm (SWA ARM) and on the back (SWA BACK) in healthy humans during resting and a cycle-ergometer exercise and to evaluate the SWA to estimate Resting Energy Expenditure (REE) and Total Energy Expenditure (TEE) in healthy baboons. Methods We studied 26 (15F/11M) human subjects wearing SWA in two different anatomical sites (arm and back) during resting and a cycle-ergometer test and directly compared these results with indirect calorimetry evaluation (IC), performed at the same time. We then inserted the SWA in a metabolic jacket for baboons and evaluated the TEE and REE in free living condition for 6 days in 21 (8F/13M) non-human primates. Results In humans we found a good correlation between SWA place on the ARM and on the BACK with IC during the resting experiment (1.1±0.3 SWAs, 1±0.2 IC kcal/min) and a slight underestimation in the SWAs data compared with IC during the cycle-ergometer exercise (5±1.9 SWA ARM, 4.5±1.5 SWA BACK and 5.4±2.1 IC kcal/min). In the non-human primate (baboons) experiment SWA estimated a TEE of 0.54±0.009 kcal/min during free living and a REE of 0.82±0.06 kcal/min. Conclusion SWA, an extremely simple and inexpensive apparatus, provides quite accurate measurements of energy expenditure in humans and in baboons. Energy expenditure data obtained with SWA are highly correlated with the data obtained with “gold standard”, IC, in humans. PMID:24069218

Novel methodology for pharmaceutical expenditure forecast.

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Vataire, Anne-Lise; Cetinsoy, Laurent; Aballéa, Samuel; Rémuzat, Cécile; Urbinati, Duccio; Kornfeld, Åsa; Mzoughi, Olfa; Toumi, Mondher

2014-01-01

The value appreciation of new drugs across countries today features a disruption that is making the historical data that are used for forecasting pharmaceutical expenditure poorly reliable. Forecasting methods rarely addressed uncertainty. The objective of this project was to propose a methodology to perform pharmaceutical expenditure forecasting that integrates expected policy changes and uncertainty (developed for the European Commission as the 'EU Pharmaceutical expenditure forecast'; see http://ec.europa.eu/health/healthcare/key_documents/index_en.htm). 1) Identification of all pharmaceuticals going off-patent and new branded medicinal products over a 5-year forecasting period in seven European Union (EU) Member States. 2) Development of a model to estimate direct and indirect impacts (based on health policies and clinical experts) on savings of generics and biosimilars. Inputs were originator sales value, patent expiry date, time to launch after marketing authorization, price discount, penetration rate, time to peak sales, and impact on brand price. 3) Development of a model for new drugs, which estimated sales progression in a competitive environment. Clinical expected benefits as well as commercial potential were assessed for each product by clinical experts. Inputs were development phase, marketing authorization dates, orphan condition, market size, and competitors. 4) Separate analysis of the budget impact of products going off-patent and new drugs according to several perspectives, distribution chains, and outcomes. 5) Addressing uncertainty surrounding estimations via deterministic and probabilistic sensitivity analysis. This methodology has proven to be effective by 1) identifying the main parameters impacting the variations in pharmaceutical expenditure forecasting across countries: generics discounts and penetration, brand price after patent loss, reimbursement rate, the penetration of biosimilars and discount price, distribution chains, and the time

National Energy Board 1992-93 estimates part III expenditure plan

International Nuclear Information System (INIS)

1992-01-01

This Expenditure Plan is designed to be used as a reference document. As such, it contains several levels of detail to respond to the various needs of its audience. This Plan is divided into two sections. Section 1 presents an overview of the Program including a description, information on its background, objectives and planning perspective as well as performance information that forms the basis for the resources requested. Section 2 provides further information on costs and resources as well as special analyses that the reader may require to understand the Program more fully. Section 1 is preceded by details of Spending Authorities from Part 2 of the Estimates and Volume 2 of the Public Accounts. This is to provide continuity with other Estimates documents and to help in assessing the Program's financial performance over the past year. The format and organization of the document should be regarded as transitional. For the most part the document is organized to be consistent with the program structure approved for the National Energy Board. 16 figs

11 CFR 9035.1 - Campaign expenditure limitation; compliance and fundraising exemptions.

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2010-01-01

... 11 Federal Elections 1 2010-01-01 2010-01-01 false Campaign expenditure limitation; compliance and... ELECTION CAMPAIGN FUND: PRESIDENTIAL PRIMARY MATCHING FUND EXPENDITURE LIMITATIONS § 9035.1 Campaign... campaign for nomination, which expenditures, in the aggregate, exceed $10,000,000 (as adjusted under 2 U.S...

ENERGY EXPENDITURE AND INTAKE COMPARISONS IN CHILEAN CHILDREN 4-5 YEARS ATTENDING DAY-CARE CENTRES.

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Salazar, Gabriela; Vásquez, Fabián; Rodríguez, Maria P; Andrade, Ana M; Anziani, Maria A; Vio, Fernando; Coward, Williams

2015-09-01

the doubly labelled water (DLW) method has an accuracy of 1% and within-subject precision of 5-8%, depending on subject's age and environments issues. Energy intake assessment is prone to errors (>15- 20%) depending in the method utilized. to quantify DLW methodology errors in four to five year olds that could affect the comparison with energy intake. energy expenditure (TEE, by DLW), was assessed during 14 days in 18 preschool children, who attended eight hours daily to day-care centres. Energy intake was determined by a combined method: food weighing during weekdays and recall after leaving the Centre (17h to sleep time) plus 24 h recall, during the weekend. Several assumptions affecting DLW total error were assessed to determine their influence in the comparison to energy intake (i.e. background variability, space ratio, proportion of water subject to fractionation, food quotient value). the individual mean energy expenditure was 1 373 ± 177 kcal and the energy intake (1 409 ± 161 kcal). The overall difference between intake and expenditure was 42.9 kcal/day (limits of agreement + 259.1 to -112.3 kcal/day). TEE measurement error only explained a minor quantity (2.4%), between both measurements, and the observed mean isotope dilution space was 1.030 ± 0.010 confirming the value utilized in adults studies. energy expenditure data is similar to other studies in preschool children. The small difference found between energy intake and expenditure may be attributed to the applied energy intake methodology, the homogeneous diet at care centres during the week-days and the lower DLW methodology error. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Automatic energy expenditure measurement for health science.

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Catal, Cagatay; Akbulut, Akhan

2018-04-01

It is crucial to predict the human energy expenditure in any sports activity and health science application accurately to investigate the impact of the activity. However, measurement of the real energy expenditure is not a trivial task and involves complex steps. The objective of this work is to improve the performance of existing estimation models of energy expenditure by using machine learning algorithms and several data from different sensors and provide this estimation service in a cloud-based platform. In this study, we used input data such as breathe rate, and hearth rate from three sensors. Inputs are received from a web form and sent to the web service which applies a regression model on Azure cloud platform. During the experiments, we assessed several machine learning models based on regression methods. Our experimental results showed that our novel model which applies Boosted Decision Tree Regression in conjunction with the median aggregation technique provides the best result among other five regression algorithms. This cloud-based energy expenditure system which uses a web service showed that cloud computing technology is a great opportunity to develop estimation systems and the new model which applies Boosted Decision Tree Regression with the median aggregation provides remarkable results. Copyright © 2018 Elsevier B.V. All rights reserved.

Self-Directed Weight Loss Strategies: Energy Expenditure Due to Physical Activity Is Not Increased to Achieve Intended Weight Loss.

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Elbelt, Ulf; Schuetz, Tatjana; Knoll, Nina; Burkert, Silke

2015-07-16

Reduced physical activity and almost unlimited availability of food are major contributors to the development of obesity. With the decline of strenuous work, energy expenditure due to spontaneous physical activity has attracted increasing attention. Our aim was to assess changes in energy expenditure, physical activity patterns and nutritional habits in obese subjects aiming at self-directed weight loss. Energy expenditure and physical activity patterns were measured with a portable armband device. Nutritional habits were assessed with a food frequency questionnaire. Data on weight development, energy expenditure, physical activity patterns and nutritional habits were obtained for 105 patients over a six-month period from an initial cohort of 160 outpatients aiming at weight loss. Mean weight loss was -1.5 ± 7.0 kg (p = 0.028). Patients with weight maintenance (n = 75), with substantial weight loss (>5% body weight, n = 20) and with substantial weight gain (>5% body weight, n = 10) did not differ in regard to changes of body weight adjusted energy expenditure components (total energy expenditure: -0.2 kcal/kg/day; non-exercise activity thermogenesis: -0.3 kcal/kg/day; exercise-related activity thermogenesis (EAT): -0.2 kcal/kg/day) or patterns of physical activity (duration of EAT: -2 min/day; steps/day: -156; metabolic equivalent unchanged) measured objectively with a portable armband device. Self-reported consumption frequency of unfavorable food decreased significantly (p = 0.019) over the six-month period. An increase in energy expenditure or changes of physical activity patterns (objectively assessed with a portable armband device) are not employed by obese subjects to achieve self-directed weight loss. However, modified nutritional habits could be detected with the use of a food frequency questionnaire.

Initiation of a Transanal Total Mesorectal Excision Program at an Academic Training Program: Evaluating Patient Safety and Quality Outcomes.

Science.gov (United States)

Maykel, Justin A; Phatak, Uma R; Suwanabol, Pasithorn A; Schlussel, Andrew T; Davids, Jennifer S; Sturrock, Paul R; Alavi, Karim

2017-12-01

Short-term results have shown that transanal total mesorectal excision is safe and effective for patients with mid to low rectal cancers. Transanal total mesorectal excision is considered technically challenging; thus, adoption has been limited to a few academic centers in the United States. The aim of this study is to describe outcomes after the initiation of a transanal total mesorectal excision program in the setting of an academic colorectal training program. This is a single-center retrospective review of consecutive patients who underwent transanal total mesorectal excision from December 2014 to August 2016. This study was conducted at an academic center with a colorectal residency program. Patients with benign and malignant diseases were selected. All transanal total mesorectal excisions were performed with abdominal and perineal teams working simultaneously. The primary outcomes measured were pathologic quality, length of hospital stay, 30-day morbidity, and 30-day mortality. There were 40 patients (24 male). The median age was 55 years (interquartile range, 46.7-63.4) with a median BMI of 29 kg/m (interquartile range, 24.6-32.4). The primary indication was cancer (n = 30), and tumor height from the anal verge ranged from 0.5 to 15 cm. Eighty percent (n = 24) of the patients who had rectal cancer received preoperative chemoradiation. The most common procedures were low anterior resection (67.5%), total proctocolectomy (15%), and abdominoperineal resection (12.5%). Median operative time was 380 minutes (interquartile range, 306-454.4), with no change over time. For patients with malignancy, the mesorectum was complete or nearly complete in 100% of the specimens. A median of 14 lymph nodes (interquartile range, 12-17) were harvested, and 100% of the rectal cancer specimens achieved R0 status. Median length of stay was 4.5 days (interquartile range, 4-7), and there were 6 readmissions (15%). There were no deaths or intraoperative complications. This study

The Effect of Corruption on Government Expenditure Allocation in OECD Countries

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Ondřej Jajkowicz

2015-01-01

Full Text Available This paper empirically examines the effect of corruption on the allocation of government expenditures by function. Equations using pooled panel dataset for 21 OECD countries between 1998 and 2011 were tested, and the findings show that government expenditure on defense and general public services increase, while government expenditures on education, health, recreation, culture and religion decline with higher levels of corruption. This paper presents new results and new evidence on the link between corruption and allocation of government expenditures in OECD countries.

Variability of resting energy expenditure in infants and young children with intestinal failure-associated liver disease.

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Duro, Debora; Mitchell, Paul D; Mehta, Nilesh M; Bechard, Lori J; Yu, Yong-Ming; Jaksic, Tom; Duggan, Christopher

2014-05-01

The aim of the study was to determine, in a cohort of young children with intestinal failure (IF), whether the estimates of basal metabolic rate (BMR) by standard equations can approximate measured resting energy expenditure (REE) by indirect calorimetry (IC). IC was performed using the dilutional canopy technique. REE measurements were compared with standard, age-based estimation equations (World Health Organization) for BMR. Subjects were classified as hypermetabolic (REE > 110% BMR), hypometabolic (REE BMR), or normal (REE = 90%-110% BMR). Twenty-eight IF patients (11 girls, 17 boys) had an underlying diagnosis of necrotizing enterocolitis (n = 10) or a congenital gastrointestinal defect (n = 18). Median age was 5.3 months. Median interquartile range (IQR) REE was 46 (42-58) kcal · kg · day. Median (IQR) total energy intake provided 209% (172%-257%) of REE, with parenteral nutrition providing 76% (23%) of total energy intake. REE was variable, with 39% (n = 11) of measurements hypermetabolic, 39% (n = 11) hypometabolic, and the remaining 21% (n = 6) normal. Although REE was well correlated with estimated BMR (r = 0.82, P BMR was not consistently an adequate predictor of REE. BMR over- or underestimated REE by >10 kcal · kg · day in 15 of 28 (54%) patients. REE was not significantly correlated with severity of liver disease, nutritional status, total energy intake, or gestational age. Energy expenditure is variable among children with IF and IF-associated liver disease, with approximately 80% of our cohort exhibiting either hypo- or hypermetabolism. Standard estimation equations frequently do not correctly predict individual REE. Longitudinal studies of energy expenditure and body composition may be needed to guide provision of nutrition regimens.

Food Marketing Expenditures Aimed at Youth Putting the Numbers in Context

Science.gov (United States)

Powell, Lisa M.; Harris, Jennifer L.; Fox, Tracy

2013-01-01

In response to concerns about childhood obesity, the Federal Trade Commission (FTC) released two reports documenting food and beverage marketing expenditures to children and adolescents. The recently released 2012 report found an inflation-adjusted 19.5% reduction in marketing expenditures targeted to youth from $2.1 billion in 2006 to $1.8 billion in 2009. The current article highlights features of the FTC’s analysis, examines how expenditures relate to youth exposure to food marketing, and assesses changes in the nutritional content of marketed products. Of the $304.0 million decline in expenditures, $117.8 million (38.7%) was from a decline in premium (i.e., restaurant children’s meal toys) expenditures rather than direct marketing. Although inflation-adjusted TV expenditures fell by 19.4%, children and teens still see 12–16 TV advertisements (ads)/day for products generally high in saturated fat, sugar or sodium. In addition, newer digital forms of unhealthy food and beverage marketing to youths are increasing; the FTC reported an inflation-adjusted 50.7% increase in new media marketing expenditures. The self-regulatory Children’s Food and Beverage Advertising Initiative (CFBAI) is limited in scope and effectiveness: expenditures increased for many noncovered marketing techniques (i.e., product placement, movie/video, cross-promotion licenses, athletic sponsorship, celebrity fees, events, philanthropy, and other); only two restaurants are members of CFBAI, and nonpremium restaurant marketing expenditures were up by $86.0 million (22.5% inflation-adjusted increase); industry pledges do not protect children aged >11 years, and some marketing appears to have shifted to older children; and, nutritional content remains poor. Continued monitoring of and improvements to food marketing to youth are needed. PMID:24050422

Food marketing expenditures aimed at youth: putting the numbers in context.

Science.gov (United States)

Powell, Lisa M; Harris, Jennifer L; Fox, Tracy

2013-10-01

In response to concerns about childhood obesity, the Federal Trade Commission (FTC) released two reports documenting food and beverage marketing expenditures to children and adolescents. The recently released 2012 report found an inflation-adjusted 19.5% reduction in marketing expenditures targeted to youth from $2.1 billion in 2006 to $1.8 billion in 2009. The current article highlights features of the FTC's analysis, examines how expenditures relate to youth exposure to food marketing, and assesses changes in the nutritional content of marketed products. Of the $304.0 million decline in expenditures, $117.8 million (38.7%) was from a decline in premium (i.e., restaurant children's meal toys) expenditures rather than direct marketing. Although inflation-adjusted TV expenditures fell by 19.4%, children and teens still see 12-16 TV advertisements (ads)/day for products generally high in saturated fat, sugar, or sodium. In addition, newer digital forms of unhealthy food and beverage marketing to youths are increasing; the FTC reported an inflation-adjusted 50.7% increase in new media marketing expenditures. The self-regulatory Children's Food and Beverage Advertising Initiative (CFBAI) is limited in scope and effectiveness: expenditures increased for many noncovered marketing techniques (i.e., product placement, movie/video, cross-promotion licenses, athletic sponsorship, celebrity fees, events, philanthropy, and other); only two restaurants are members of CFBAI, and nonpremium restaurant marketing expenditures were up by $86.0 million (22.5% inflation-adjusted increase); industry pledges do not protect children aged >11 years, and some marketing appears to have shifted to older children; and, nutritional content remains poor. Continued monitoring of and improvements to food marketing to youth are needed. © 2013 American Journal of Preventive Medicine.

Expenditures on Children by Families: 1997 Annual Report.

Science.gov (United States)

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 1997 dollars using the Consumer Price Index. Data and…

Expenditures on Children by Families: 1999 Annual Report.

Science.gov (United States)

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 1999 dollars using the Consumer Price Index. Data and…

Expenditures on Children by Families: 1998 Annual Report.

Science.gov (United States)

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 1998 dollars using the Consumer Price Index. Data and…

Expenditures on Children by Families: 2000 Annual Report.

Science.gov (United States)

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 2000 dollars using the Consumer Price Index. Data and…

Expenditures on Children by Families: 2001 Annual Report.

Science.gov (United States)

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 2001 dollars using the Consumer Price Index. Data and…

Expenditures on Children by Families: 2002 Annual Report.

Science.gov (United States)

Lino, Mark

Since 1960, the U.S. Department of Agriculture has provided estimates of expenditures on children from birth through age 17. This technical report presents the most recent estimates for husband-wife and single-parent families, using data from the 1990-92 Consumer Expenditure Survey, updated to 2002 dollars using the Consumer Price Index. Data and…

Public environmental expenditure in the province of Buenos Aires, Argentina (1997-2012

Directory of Open Access Journals (Sweden)

Verónica L. Cáceres

2014-11-01

Full Text Available The article contributes to the discussion on public environmental issues in the province of Buenos Aires; in particular, it focuses on the analysis of public environmental expenditure during 1997-2012. It considers the estimation of expenditure, identifying the actors who execute and implement programs that allow you to have a reference to the relevance of the issue tacked by the provincial agenda. The work was done from the budgetary information produced by the General accounting of BAP, which is dependant of the Ministry of Finance, through classifiers used by the province. Firstly it presents the estimation and evolution of environmental expense according to the provincial classification, then it widens with the Classification of Environmental Protection Activities (CEPA 2000. Secondly it characterizes state actors that implement environmental expense and the financed program types. Finally it is presented some preliminary conclusions. The central input refers that environmental public expenses, later in one decade of increase after politic, social and economic crisis in 2001, does not achieve the convertibility participation levels. Also it emphasizes in the water and sanitation engineering; it has a strong component of participation of centralized agencies in detriment of those that agglutinates the main environmental functions; it is not observed instances of civil society participation in execution; and it adjudge a low relevance to the promotion and education activities in environmental matters.

24 CFR 570.504 - Program income.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Program income. 570.504 Section 570... income. (a) Recording program income. The receipt and expenditure of program income as defined in § 570... of program income received by recipients. (1) Program income received before grant closeout may be...

Estimating energy expenditure during front crawl swimming using accelerometers

DEFF Research Database (Denmark)

Nordsborg, Nikolai Baastrup; Espinosa, Hugo G.; Van Thiel, David H

2014-01-01

The determination of energy expenditure is of major interest in training load and performance assessment. Small, wireless accelerometer units have the potential to characterise energy expenditure during swimming. The correlation between absorbed oxygen versus flume swimming speed and absorbed oxy...

78 FR 73753 - Partnerships; Start-Up Expenditures; Organization and Syndication Fees

Science.gov (United States)

2013-12-09

... deduct start-up expenditures in the taxable year in which the active trade or business begins. The amount... begins. All start-up expenditures that relate to the active trade or business are considered in...(b) to amortize start-up expenditures for the taxable year in which the active trade or business to...

EFFECT OF FISCAL DECENTRALIZATION ON CAPITAL EXPENDITURE, GROWTH, AND WELFARE

OpenAIRE

Badrudin, Rudy

2013-01-01

This research analyzes the influence of fiscal decentralization on capital expenditure, economic growth, and social welfare of 29 regencies and 6 cities in Central Java Province based on the data of year 2004 to 2008. The method used to analyze the hypotheses is the Partial Least Square. The results showes that fiscal decentralization has no significant effect on capital expenditure; fiscal decentralization has significant effect on economic growth and social welfare; capital expenditure has ...

The Behaviour of Disaggregated Public Expenditures and Income in Malaysia

OpenAIRE

Tang, Chor-Foon; Lau, Evan

2011-01-01

The present study attempts to re-investigate the behaviour of disaggregated public expenditures data and national income for Malaysia. This study covers the sample period of annual data from 1960 to 2007. The Bartlett-corrected trace tests proposed by Johansen (2002) were used to ascertain the presence of long run equilibrium relationship between public expenditures and national income. The results show one cointegrating vector for each specification of public expenditures. The relatively new...

Measuring Government Expenditure Efficiencies Towards Peace and Human Development

Directory of Open Access Journals (Sweden)

Ahmad Danu Prasetyo

2014-02-01

Full Text Available In this paper, we investigate the efficiency level of government expenditure in 82 countries towards the human development and peace index of the respective countries by using Data Envelopment Analysis (DEA approach during 2007-2011. We found that only few countries that always being positioned in the efficient frontier during the sample period, namely: Japan, Nigeria, and Norway.  By using Malmquist index approach, we also found that Cyprus has the largest government expenditure efficiency improvement.Keywords: Government Expenditure Efficiencies, Human Development Index, Global Peace Indexdoi:10.12695/ajtm.2013.6.2.3 How to cite this article:Prasetyo, A.D., and Pudjono, A.N.S. (2013. Measuring Government Expenditure Efficiencies Towards Peace and Human Development. The Asian Journal of Technology Management 6 (2: 82-91. Print ISSN: 1978-6956; Online ISSN: 2089-791X. doi:10.12695/ajtm.2013.6.2.3

Disability Compensation and Patient Expenditures: FY2000 to FY2013

Data.gov (United States)

Department of Veterans Affairs — This report contains FY2000 through FY2013 data on disability compensation expenditures and recipients and on VA healthcare system patients and patient expenditures.

[Evaluation of Direct and Indirect Expenditures for Management of Patients With Stable Ischemic Heart Disease After Stenting of Coronary Arteries].

Science.gov (United States)

Sveshnikova, N D; Paleev, F N

2016-03-01

Assessment of cost of management of patients during 1 year after stenting of coronary arteries has shown that priority should be given to active introduction into practical health care of technologies increasing duration of life and lowering probability of invalidization. We stress the need for evaluation of indirect expenditures on patients care because of their substantial share in the total cost. We also consider essential to elaborate measures of state regulation of medication supply irrespective of type of treatment for shifting expenditures from hospital to ambulatory sector and improvement of effectiveness of pharmacotherapy.

Health system costs by sex, age and proximity to death, and implications for estimation of future expenditure.

Science.gov (United States)

Blakely, Tony; Atkinson, June; Kvizhinadze, Giorgi; Nghiem, Nhung; McLeod, Heather; Wilson, Nick

2014-05-02

Health expenditure increases with age, but some of this increase is due to costs proximal to death. We used linked health datasets (HealthTracker) to determine health expenditure by proximity to death. We then determined the impact on future health expenditure projections of accounting for proximity to death in costs. 2007 to 2009 national health event data were linked for hospitalisations, inpatient procedures, outpatient events, pharmaceuticals, laboratory tests, and primary care consultations. Each event was assigned a cost. Health expenditure by sex, age and whether in last 6 or 12 months of life or not were calculated. Future health expenditure trends were then estimated for the Statistics New Zealand median projection population counts, with 2010-12 mortality rates reducing by 2% per annum into the future. A total of $8.1, $8.8 and $9.2 billion dollars (inflation-adjusted to 2011 NZ$) was allocated to individual health events in HealthTracker in 2007, 2008 and 2009, respectively. Citizen costs for people not within 6 months of death ranged from $498 per person-year (10-14 year old females) to $6900 per person-year (90-94 year old males). Per person-year costs in the last 6 months of life were 10-fold higher on average, being maximal at $30,000 or more among infants and the older elderly (80+ years). Similar patterns were apparent for costs within 12 months of death. For people hypothetically exposed to these 2007-09 health system costs over their full life, the cumulative costs for a person dying at age 70 years was $113,000, and doubled to $223,000 for a person dying at age 90. The proportion of cumulative health expenditure in the last year of life declined with increasing age of death: e.g. 24%, 13% and 10% for someone aged 40, 70 and 90 respectively. Projections of future health system expenditure were overestimated by 2.3% to 3.5% in 2041 when not accounting for proximity to death in costs. New Zealand is fortunate to have access to rich data on health

[Sedentary lifestyle: physical activity duration versus percentage of energy expenditure].

Science.gov (United States)

Cabrera de León, Antonio; Rodríguez-Pérez, María del C; Rodríguez-Benjumeda, Luis M; Anía-Lafuente, Basilio; Brito-Díaz, Buenaventura; Muros de Fuentes, Mercedes; Almeida-González, Delia; Batista-Medina, Marta; Aguirre-Jaime, Armando

2007-03-01

To compare different definitions of a sedentary lifestyle and to determine which is the most appropriate for demonstrating its relationship with the metabolic syndrome and other cardiovascular risk factors. A cross-sectional study of 5814 individuals was carried out. Comparisons were made between two definitions of a sedentary lifestyle: one based on active energy expenditure being less than 10% of total energy expenditure, and the other, on performing less than 25-30 minutes of physical activity per day. Reported levels of physical activity, anthropometric measurements, and biochemical markers of cardiovascular risk were recorded. The associations between a sedentary lifestyle and metabolic syndrome and other risk factors were adjusted for gender, age and tobacco use. The prevalence of a sedentary lifestyle was higher in women (70%) than in men (45-60%, according to the definition used). The definitions based on physical activity duration and on energy expenditure were equally useful: there were direct associations between a sedentary lifestyle and metabolic syndrome, body mass index, abdominal and pelvic circumferences, systolic blood pressure, heart rate, apolipoprotein B, and triglycerides, and inverse associations with high-density lipoprotein cholesterol and paraoxonase activity, which demonstrated the greatest percentage difference between sedentary and active individuals. An incidental finding was that both definitions of a sedentary lifestyle were more strongly associated with the metabolic syndrome as defined by International Diabetes Federation criteria than by Adult Treatment Panel III criteria. Given that it is relatively easy to determine whether a patient performs less than 25 minutes of physical activity per day, use of this definition of a sedentary lifestyle is recommended for clinical practice. The serum paraoxonase activity level could provide a useful marker for studying sedentary lifestyles.

Energy expenditure estimation in beta-blocker-medicated cardiac patients by combining heart rate and body movement data.

Science.gov (United States)

Kraal, Jos J; Sartor, Francesco; Papini, Gabriele; Stut, Wim; Peek, Niels; Kemps, Hareld Mc; Bonomi, Alberto G

2016-11-01

Accurate assessment of energy expenditure provides an opportunity to monitor physical activity during cardiac rehabilitation. However, the available assessment methods, based on the combination of heart rate (HR) and body movement data, are not applicable for patients using beta-blocker medication. Therefore, we developed an energy expenditure prediction model for beta-blocker-medicated cardiac rehabilitation patients. Sixteen male cardiac rehabilitation patients (age: 55.8 ± 7.3 years, weight: 93.1 ± 11.8 kg) underwent a physical activity protocol with 11 low- to moderate-intensity common daily life activities. Energy expenditure was assessed using a portable indirect calorimeter. HR and body movement data were recorded during the protocol using unobtrusive wearable devices. In addition, patients underwent a symptom-limited exercise test and resting metabolic rate assessment. Energy expenditure estimation models were developed using multivariate regression analyses based on HR and body movement data and/or patient characteristics. In addition, a HR-flex model was developed. The model combining HR and body movement data and patient characteristics showed the highest correlation and lowest error (r 2  = 0.84, root mean squared error = 0.834 kcal/minute) with total energy expenditure. The method based on individual calibration data (HR-flex) showed lower accuracy (i 2  = 0.83, root mean squared error = 0.992 kcal/minute). Our results show that combining HR and body movement data improves the accuracy of energy expenditure prediction models in cardiac patients, similar to methods that have been developed for healthy subjects. The proposed methodology does not require individual calibration and is based on the data that are available in clinical practice. © The European Society of Cardiology 2016.

Daily energy expenditure, physical activity, and weight loss in Parkinson's disease patients

Science.gov (United States)

Patients with Parkinson's disease (PD) commonly exhibit weight loss (WL) which investigators attribute to various factors, including elevated energy expenditure. We tested the hypothesis that daily energy expenditure (DEE) and its components, resting energy expenditure (REE) and physical activity (P...

Self-Directed Weight Loss Strategies: Energy Expenditure Due to Physical Activity Is Not Increased to Achieve Intended Weight Loss

Directory of Open Access Journals (Sweden)

Ulf Elbelt

2015-07-01

Full Text Available Reduced physical activity and almost unlimited availability of food are major contributors to the development of obesity. With the decline of strenuous work, energy expenditure due to spontaneous physical activity has attracted increasing attention. Our aim was to assess changes in energy expenditure, physical activity patterns and nutritional habits in obese subjects aiming at self-directed weight loss. Methods: Energy expenditure and physical activity patterns were measured with a portable armband device. Nutritional habits were assessed with a food frequency questionnaire. Results: Data on weight development, energy expenditure, physical activity patterns and nutritional habits were obtained for 105 patients over a six-month period from an initial cohort of 160 outpatients aiming at weight loss. Mean weight loss was −1.5 ± 7.0 kg (p = 0.028. Patients with weight maintenance (n = 75, with substantial weight loss (>5% body weight, n = 20 and with substantial weight gain (>5% body weight, n = 10 did not differ in regard to changes of body weight adjusted energy expenditure components (total energy expenditure: −0.2 kcal/kg/day; non-exercise activity thermogenesis: −0.3 kcal/kg/day; exercise-related activity thermogenesis (EAT: −0.2 kcal/kg/day or patterns of physical activity (duration of EAT: −2 min/day; steps/day: −156; metabolic equivalent unchanged measured objectively with a portable armband device. Self-reported consumption frequency of unfavorable food decreased significantly (p = 0.019 over the six-month period. Conclusions: An increase in energy expenditure or changes of physical activity patterns (objectively assessed with a portable armband device are not employed by obese subjects to achieve self-directed weight loss. However, modified nutritional habits could be detected with the use of a food frequency questionnaire.

Food Consumption, Prices, and Expenditures, 1960-81

OpenAIRE

Anonymous

1982-01-01

This bulletin presents 1960-81 data on per capita food consumption, prices, nutrient availability, food expenditures and marketing costs, and U.S. income and population. Retail food prices rose 7.9 percent, aggregate food consumption fell 1.0 percent, and personal consumption expenditures for food rose 9.7 percent. Per capita meat consumption was down 2.5 pounds in 1981, hut poultry usage rose 1.8 pounds. Dairy consumption per person was lower. Fresh fruit consumption rose 1.6 pounds per pers...

Food Consumption, Prices, and Expenditures, 1962-82

OpenAIRE

Anonymous

1983-01-01

This bulletin ,presents 1962-82 data on per capita food consumption, prices, nutrient availability,food expenditures and marketing costs, and U.S. income and population. Retail food prices in 1982 rose 4.0 percent, aggregate food consumption fell 0.4 percent, and personal food, consumption expenditures rose 6.3 percent from 1981. Per, capita red meat consumption was down 5.8 pounds, but poultry use rose 1.3 pounds. Dairy product consumption per person decreased. Fresh fruit consumption fell 3...

Elm Street School:A Case Study of Professional Development Expenditures

Directory of Open Access Journals (Sweden)

H. Alix Gallagher

2002-05-01

Full Text Available This article addresses the question of how much is spent on teachers' professional development.  A review of the literature finds two problems that have frequently led to inaccurate estimates of professional development spending: 1 the accounting codes that are used in many studies provide little description of spending, and 2 studies generally focus on district or state expenditures for professional development, but do not collect data on school-level spending.  These problems are compounded by the fact that studies define professional development spending differently, and thus it is difficult to compare findings across studies.  In an effort to begin to address this problem, this study utilizes a detailed cost structure to analyze both district and school site expenditures on professional development across cost categories.  The study found that school-level expenditures were a significant source of professional development for teachers.  This has implications for the methodologies used to estimate current professional development expenditures and what level of expenditures would be necessary to generate dramatic improvements in student achievement.

25 CFR 214.13 - Diligence; annual expenditures; mining records.

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Diligence; annual expenditures; mining records. 214.13... OSAGE RESERVATION LANDS, OKLAHOMA, FOR MINING, EXCEPT OIL AND GAS § 214.13 Diligence; annual expenditures; mining records. (a) Lessees shall exercise diligence in the conduct of prospecting and mining...

26 CFR 1.617-3 - Recapture of exploration expenditures.

Science.gov (United States)

2010-04-01

... property which is neither a capital asset nor property described in section 1231. (iii) If a taxpayer pays...) Allocation of certain expenditures. A project area consists of that territory which the taxpayer has... available) can be explored advantageously as a single integrated operation. If exploration expenditures are...

Validation of five minimally obstructive methods to estimate physical activity energy expenditure in young adults in semi-standardized settings

DEFF Research Database (Denmark)

Schneller, Mikkel Bo; Pedersen, Mogens Theisen; Gupta, Nidhi

2015-01-01

We compared the accuracy of five objective methods, including two newly developed methods combining accelerometry and activity type recognition (Acti4), against indirect calorimetry, to estimate total energy expenditure (EE) of different activities in semi-standardized settings. Fourteen particip...

Slovenian income taxes and analysis of their tax expenditure in 2006-2010

Directory of Open Access Journals (Sweden)

Maja Klun

2012-09-01

Full Text Available Tax expenditure analyses have been an important element in the supervision of reform processes linked to implementing different kinds of tax incentive and the management of a correct tax policy. The paper provides an evaluation of tax expenditure in Slovenia relating to personal income tax and corporate income tax. Four consecutive tax years were selected for the calculation of the tax expenditure on personal income tax (2006-09, while three consecutive years were selected for the corporate income tax calculation (2008-10. The tax expenditure calculated for personal income tax was highest in 2006 and reached 5.2% of GDP. After several changes in personal income tax, expenditures decreased to around 3% of GDP in the following three years. The tax expenditure calculated for corporate income tax was much lower as compared to GDP than for personal income tax, reaching around 0.2% of GDP.

Reduction of pharmaceutical expenditure by a drug appropriateness intervention in polymedicated elderly subjects in Catalonia (Spain).

Science.gov (United States)

Campins, Lluís; Serra-Prat, Mateu; Palomera, Elisabet; Bolibar, Ignasi; Martínez, Miquel Àngel; Gallo, Pedro

2017-11-18

To assess the monetary savings resulting from a pharmacist intervention on the appropriateness of prescribed drugs in community-dwelling polymedicated (≥8 drugs) elderly people (≥70 years). An evaluation of pharmaceutical expenditure reduction was performed within a randomised, multicentre clinical trial. The study intervention consisted of a pharmacist evaluation of all drugs prescribed to each patient using the "Good Palliative-Geriatric Practice" algorithm and the "Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment" criteria (STOPP/START). The control group followed the routine standard of care. A time horizon of one year was considered and cost elements included human resources and drug expenditure. 490 patients (245 in each group) were analysed. Both groups experienced a decrease in drug expenditure 12 months after the study started, but this decrease was significantly higher in the intervention group than in the control group (-14.3% vs.-7.7%; p=0.041). Total annual drug expenditure decreased 233.75 €/patient (95% confidence interval [95%CI]: 169.83-297.67) in the intervention group and 169.40 €/patient (95%CI: 103.37-235.43) in the control group over a one-year period, indicating that 64.30 € would be the drug expenditure savings per patient a year attributable to the study intervention. The estimated return per Euro invested in the programme would be 2.38 € per patient a year on average. The study intervention is a cost-effective alternative to standard care that could generate a positive return of investment. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

23 CFR 420.107 - What is the minimum required expenditure of State planning and research funds for research...

Science.gov (United States)

2010-04-01

... RESEARCH PROGRAM ADMINISTRATION Administration of FHWA Planning and Research Funds § 420.107 What is the... 23 Highways 1 2010-04-01 2010-04-01 false What is the minimum required expenditure of State planning and research funds for research development and technology transfer? 420.107 Section 420.107...

Equity in Health Care Expenditure in Nigeria

Directory of Open Access Journals (Sweden)

Olanrewaju Olaniyan

2013-07-01

Full Text Available Equity isone of the basic principles of health systems and features explicitly in theNigerian health financing policy. Despite acclaimed commitment to theimplementation of this policy through various pro-poor health programmes andinterventions, the level of inequity in health status and access to basichealth care interventions remain high. This paper examines the equity of healthcare expenditure by individuals in Nigeria. The paper evaluated equity in out-of-pocketspending( OOP for the country and separately for the six geopolitical zones ofthe country.The methodological framework rests onKakwani Progressivity Indices (KPIs, ReynoldSmolensky indices andconcentration indices (CIs using data from the 2004 Nigerian National LivingStandard Survey( NLSS collected by the National Bureau of Statistics. .The results reveal that health financing isregressive with the incidence disproportionately rest on poor households withabout 70% of the total expenditure on health is through out-of-pocket paymentsby households. Poor households are prone to bear most of the expenses in theevent of any health shock. The catastrophic consequences thus push some intopoverty, and aggravate the poverty of others.The paper therefore suggests that thecountry’s health financingsystems must be designed not only to allow people to access services when theyare needed, but must also protect household, from financial catastrophe, byreducing OOP spending through risk pooling and prepayment schemes within thehealth system.Keywords:                            Equity, Health careexpenditure, Kakwani progressivity index, Nigeria.

Households' incidence on malaria and expenditures to treat malaria ...

African Journals Online (AJOL)

CONCLUSION: The relationship between expenditure and use of different vector control depends on the geographic location of respondents. People living in the rural areas spend more to have access to malaria control tools. Location of respondent has a positive effect on expenditures and use of malaria control tools.

Expiry of patent protection on statins: effects on pharmaceutical expenditure in Australia.

Science.gov (United States)

Clarke, Philip M; Fitzgerald, Edmund M

2010-06-07

To compare changes in the costs of statins following patent expiry in Australia and England, and to estimate projected savings for Australia based on the government and consumers paying prices equivalent to those in England and increased use of generics. Review of administrative data and predictive models based on recent trends. Administrative price and quantity data for the Pharmaceutical Benefits Scheme between January 2002 and October 2009, and comparable information from England. Total government and consumer expenditure on statins whose patent has expired, and projected expenditure on all statins from January 2009 to December 2019 under various scenarios regarding pricing and prescribing trends. From January 2005 to October 2009, the cumulative loss to the Australian community from paying more than the English price for generic statins was more than $900 million. Expenditure could have been reduced by a further $1087 million if Australia had increased the proportion of generic medications prescribed to match trends in England. Future savings depend on the proportion of statin prescriptions that are subject to lower generic pricing. From January 2009 to December 2019, potential savings from paying English prices could be as high as $3.21 billion, and savings of up to $9.31 billion could be made by paying English prices and using generic statins only. The current arrangement for pricing statins places a considerable burden on the Australian community. Alternative pricing arrangements that provide incentives to lower statin prices and increase the proportion of generic prescriptions could be highly advantageous.

Main drivers of health expenditure growth in China: a decomposition analysis.

Science.gov (United States)

Zhai, Tiemin; Goss, John; Li, Jinjing

2017-03-09

In past two decades, health expenditure in China grew at a rate of 11.6% per year, which is much faster than the growth of the country's economy (9.9% per year). As cost containment is a key aspect of China's new health system reform agenda, this study aims to identify the main drivers of past growth so that cost containment policies are focussed in the right areas. The analysis covered the period 1993-2012. To understand the drivers of past growth during this period, Das Gupta's decomposition method was used to decompose the changes in health expenditure by disease into five main components that include population growth, population ageing, disease prevalence rate, expenditure per case of disease, and excess health price inflation. Demographic data on population size and age-composition were obtained from the Department of Economic and Social Affairs of the United Nations. Age- and disease- specific expenditure and prevalence rates by age and disease were extracted from China's National Health Accounts studies and Global Burden of Disease 2013 studies of the Institute for Health Metrics and Evaluation, respectively. Growth in health expenditure in China was mainly driven by a rapid increase in real expenditure per prevalent case, which contributed 8.4 percentage points of the 11.6% annual average growth. Excess health price inflation and population growth contributed 1.3 and 1.3% respectively. The effect of population ageing was relatively small, contributing 0.8% per year. However, reductions in disease prevalence rates reduced the growth rate by 0.3 percentage points. Future policy in optimising growth in health expenditure in China should address growth in expenditure per prevalent case. This is especially so for neoplasms, and for circulatory and respiratory disease. And a focus on effective interventions to reduce the prevalence of disease in the country will ensure that changing disease rates do not lead to a higher growth in future health expenditure

The complexity of changes in the domain of managing public expenditures

Directory of Open Access Journals (Sweden)

Dimitrijević Marina

2016-01-01

Full Text Available Public expenditures are a huge problem in contemporary states. In the conditions of a global economic crisis and the circumstances involving high level of citizen dissatisfaction related to the former methods of funding and managing the public sector (reflected in ruining the funding sources, irrational spending of public expenditure funds, increase in the budget deficit and the level of public debt, the changes in the domain of managing public expenditures have become a priority. By their nature, these changes are complex and long-lasting, and they should bring significant improvements in the field of public expenditure; they have to provide for lawful and purposeful spending of public funds. It is expected to lower the needed public incomes for financing public expenditure, to improve production and competition in the market economy, and to increase personal consumption, living standard and the quality of life of the population. Regardless of the social, economic, legal or political environment in each of state, the topical issue of reforming the management of public expenditures seems to imply a return to a somewhat neglected need for the public sector to function within its own financial possibilities. The state modernisation processes and advancement in the process of managing public expenditures call for a realistic evaluation of the existing condition and circumstances in which these processes occur, as well as the assessment of potential and actual risks that may hinder their effectiveness. Otherwise, it seems that the establishment of a significant level of responsibility in spending the budget funds and a greater transparency of public expenditure may be far-fetched goals.

Gender quotas in development programming

NARCIS (Netherlands)

Windt, van der Peter; Humphreys, Macartan; Sanchez de la Sierra, Raul

2018-01-01

We examine whether gender quotas introduced by development agencies empower women. As part of a development program, an international organization created community management committees in 661 villages to oversee village level program expenditures. In a randomly selected half of these villages the

Simultaneous measurement of free-living energy expenditure by the doubly labeled water method and heart-rate monitoring

International Nuclear Information System (INIS)

Livingstone, M.B.; Prentice, A.M.; Coward, W.A.; Ceesay, S.M.; Strain, J.J.; McKenna, P.G.; Nevin, G.B.; Barker, M.E.; Hickey, R.J.

1990-01-01

Total energy expenditure (TEE) was measured simultaneously in 14 free-living adults over 15 d by the doubly labeled water (DLW) method and for 2-4 separate days by heart-rate (HR) monitoring. Individual curves for HR vs oxygen consumption (VO2) were obtained and an HR (FLEX HR: 97 +/- 8 beats/min, range 84-113 beats/min) that discriminated between rest and activity was identified. Calibration curves were used to assign an energy value to daytime HR above FLEX HR. Below FLEX HR energy expenditure was taken as resting metabolism. Sleeping energy expenditure was assumed to be equal to basal metabolic rate. Average HR TEE (12.99 +/- 3.83 MJ/d) and average DLW TEE (12.89 +/- 3.80 MJ/d) were similar. HR TEE discrepancies ranged from -22.2% to +52.1%, with nine values lying within +/- 10% of DLW TEE estimates. The FLEX HR method provides a close estimation of the TEE of population groups. However, an increased number of sampling days may improve the precision of individual estimates of TEE

Prediction equation for estimating total daily energy requirements of special operations personnel.

Science.gov (United States)

Barringer, N D; Pasiakos, S M; McClung, H L; Crombie, A P; Margolis, L M

2018-01-01

Special Operations Forces (SOF) engage in a variety of military tasks with many producing high energy expenditures, leading to undesired energy deficits and loss of body mass. Therefore, the ability to accurately estimate daily energy requirements would be useful for accurate logistical planning. Generate a predictive equation estimating energy requirements of SOF. Retrospective analysis of data collected from SOF personnel engaged in 12 different SOF training scenarios. Energy expenditure and total body water were determined using the doubly-labeled water technique. Physical activity level was determined as daily energy expenditure divided by resting metabolic rate. Physical activity level was broken into quartiles (0 = mission prep, 1 = common warrior tasks, 2 = battle drills, 3 = specialized intense activity) to generate a physical activity factor (PAF). Regression analysis was used to construct two predictive equations (Model A; body mass and PAF, Model B; fat-free mass and PAF) estimating daily energy expenditures. Average measured energy expenditure during SOF training was 4468 (range: 3700 to 6300) Kcal·d- 1 . Regression analysis revealed that physical activity level ( r  = 0.91; P  plan appropriate feeding regimens to meet SOF nutritional requirements across their mission profile.

The contribution of body composition, substrates and hormones to the variability in energy expenditure and substrate utilization in premenopausal women

DEFF Research Database (Denmark)

Astrup, A.; Buemann, Benjamin; Christensen, N.J.

1992-01-01

Twenty-four-hour energy expenditure and substrate use were measured by indirect calorimetry in respiration chambers on a fixed physical program and related to body composition and plasma concentrations of various substrates and thermogenic hormones. Fifty premenopausal women with a wide range of ...

Energy expenditure and activity among Hadza hunter-gatherers.

Science.gov (United States)

Pontzer, Herman; Raichlen, David A; Wood, Brian M; Emery Thompson, Melissa; Racette, Susan B; Mabulla, Audax Z P; Marlowe, Frank W

2015-01-01

Studies of total energy expenditure, (TEE; kcal/day) among traditional populations have challenged current models relating habitual physical activity to daily energy requirements. Here, we examine the relationship between physical activity and TEE among traditional Hadza hunter-gatherers living in northern Tanzania. Hadza adults were studied at two camps, with minimal intervention so as to monitor energy expenditure and activity during normal daily life. We measured daily walking distance and walking speed using wearable GPS units for 41 adults. For a subset of 30 adults, we measured TEE using doubly labeled water, three indices of work load (foraging return rate, maternal status, and number of dependent children), and urinary biomarkers of metabolic activity and stress (8-hydroxydeoxyguanosine, cortisol, and testosterone). Fat-free mass was the single strongest predictor of TEE among Hadza adults (r(2)  = 0.66, P < 0.001). Hadza men used greater daily walking distances and faster walking speeds compared with that of Hadza women, but neither sex nor any measure of physical activity or work load were correlated with TEE in analyses controlling for fat-free mass. Compared with developed, industrial populations, Hadza adults had similar TEE but elevated levels of metabolic stress as measured by 8-hydroxydeoxyguanosine. Our results indicate that daily physical activity may not predict TEE within traditional hunter-gatherer populations like the Hadza. Instead, adults with high levels of habitual physical activity may adapt by reducing energy allocation to other physiological activity. © 2015 Wiley Periodicals, Inc.

Effect of calorie restriction on energy expenditure in overweight and obese adult women.

Science.gov (United States)

Jiménez Jaime, Teresa; Leiva Balich, Laura; Barrera Acevedo, Gladys; de la Maza Cave, María Pía; Hirsch Birn, Sandra; Henríquez Parada, Sandra; Rodríguez Silva, Juan; Bunout Barnett, Daniel

2015-06-01

Energy expenditure (EE) may decrease in subjects on hypocaloric diets, in amounts that exceed body mass loss, favoring weight regain. To verify if a short-term caloric restriction lowers Resting Energy Expenditure (REE) and Total Energy Expenditure (TEE) more than predicted by changes in body composition, and if this reduction of EE is related with compliance to the diet. Twenty-two women aged 23-44 years with a body mass index (BMI) of 25-32 kg/m2, underwent a three-month calorie restriction treatment (20 kcal/kg initial weight) and were encouraged to increase their physical activity. At the beginning and end of the intervention, body composition (DEXA), REE, Physical Activity Energy Expenditure (PAEE) and TEE were assessed, through a combination of indirect calorimetry and actigraphy. Participants, who lost more or equal than 5% of their initial weight were considered compliant with the diet. In the compliant group, REE decreased, when expressed in absolute numbers or when adjusted by fat free mass (FFM) [-164 ± 168 kcal/day (10,6%) and -4,3 ± 4,6 kcal/kg FFM (10,5%)]. This decline was significantly greater than that observed in the non-compliant group [-6,2 ± 1.42 Kcal/day (0.16%) and -0,5 ± 3,4/Kg FFM (0.96%)]. FFM did not change in any of the two groups. At baseline, there was a significant correlation between FFM and REE (r = 0, 56 p women showed a significant reduction in both absolute and adjusted REE, which together with the loss of correlation between REE and FFM at the end of the intervention suggests a metabolic adaptation. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Relating the environmental impact of consumption to household expenditures. An input-output analysis

International Nuclear Information System (INIS)

Kerkhof, Annemarie C.; Nonhebel, Sanderine; Moll, Henri C.

2009-01-01

In this paper we evaluate the relationships between household expenditures and the environmental impact categories climate change, acidification, eutrophication and smog formation, by combining household expenditures with environmentally extended input-output analysis. Expenditure elasticities are examined with regression analysis, and are compared and interpreted on the basis of insight at the product level. With data from the Netherlands in the year 2000, we find that environmental impact increases with increasing household expenditures, although the degree to which the environmental impact increases differs per impact category. Climate change and eutrophication increase less than proportionally with increasing expenditures. Acidification increases nearly proportionally with increasing expenditures, whereas smog formation increases more than proportionally. It appears that the mix of necessities and luxuries to which an environmental impact is related is essential in explaining the relationship. (author)