WorldWideScience

Sample records for total social cost

  1. Social profile and cost analysis of deep infection following total hip replacement surgery

    Directory of Open Access Journals (Sweden)

    Vera Lucia Frazão

    Full Text Available ABSTRACT OBJECTIVE: To characterize the socio-economic and demographic profile of patients undergoing surgery for revision total hip arthroplasty regarding the diagnosis of deep prosthetic infection. METHODS: Twenty patients were retrospectively studied, admitted in the period between 2009 and 2010 by the Hip Surgery Group with the diagnosis of deep prosthetic infection, whose proposed treatment was surgical. This study was carried out in the presence of the patient by completing two forms applied by the social worker of the Group. RESULTS: In a 20-patient sample, 40% were male, 45% were working age, 50% of patients originated from the capital, 85% depended on benefits, 70% were retired, 60% of patients were from this hospital, and 40% were from other services. The average cost of patients to the public system was R$ 55,821.62 per patient and the total spent on treatment of patients in the study exceeded one million Brazilian reals, totalling R$ 1,116,432.40. CONCLUSION: Infection from total hip arthroplasty generates a major expense to the social security system and to the public healthcare system. Physicians must always be alert to the possible risk factors and perioperative care, striving to minimize this complication.

  2. Social costs of energy

    International Nuclear Information System (INIS)

    Jones, P.M.S.

    1990-01-01

    There have been many studies over the past 20 years which have looked at the environmental and other impacts of energy production, conversion and use. A number of these have attempted to put a monetary value to the external costs which are not reflected in the prices charged for energy. The topic has received increased attention recently as a direct result of the recognition of the potentially large social costs that might arise from the depletion of the ozone layer, the consequences of global warming and the continued releases of acid gases from fossil fuel combustion. The determination of external costs was attempted in the report for the European Economic Community, EUR11519, ''Social Costs of Energy Consumption'', by O Hohmeyer. Due to its official sponsorship, this report has been afforded greater respect than it deserves and is being used in some quarters to claim that the external costs of nuclear power are high relative to those of fossil fuels. The remainder of this note looks at some of the serious deficiencies of the document and why its conclusions offer no meaningful guidance to policy makers. So far as the present author is aware no serious criticism of the Hohmeyer study has previously appeared. (author)

  3. Total generating costs: coal and nuclear plants

    International Nuclear Information System (INIS)

    1979-02-01

    The study was confined to single and multi-unit coal- and nuclear-fueled electric-generating stations. The stations are composed of 1200-MWe PWRs; 1200-MWe BWRs; 800-and 1200-MWe High-Sulfur Coal units, and 800- and 1200-MWe Low-Sulfur Coal units. The total generating cost estimates were developed for commercial operation dates of 1985 and 1990; for 5 and 8% escalation rates, for 10 and 12% discount rates; and, for capacity factors of 50, 60, 70, and 80%. The report describes the methodology for obtaining annualized capital costs, levelized coal and nuclear fuel costs, levelized operation and maintenance costs, and the resulting total generating costs for each type of station. The costs are applicable to a hypothetical Middletwon site in the Northeastern United States. Plant descriptions with general design parameters are included. The report also reprints for convenience, summaries of capital cost by account type developed in the previous commercial electric-power cost studies. Appropriate references are given for additional detailed information. Sufficient detail is given to allow the reader to develop total generating costs for other cases or conditions

  4. Social costs of transition

    Directory of Open Access Journals (Sweden)

    Pavlović Dušan

    2006-01-01

    Full Text Available The risk of political and economic transformation in Central and East Europe after 1990 was based on the presumption that the reforms will collapse when the citizens realize that the cost they have to pay for them is too high. The classical claim was that democracy will be destroyed by democratic means-namely, that the losers in the transition will vote the way back to the authoritarian regime. The article offers an explanation as to the regress to the authoritarian regime will not be a consequence of the economic reforms. The article is divided in six section. Section 1 considers the general context of the start of the economic transformation in the light of the debate about the choice between the expert government and the significance of democratic procedures for economic reforms. Section 2 defines the context of Serbia within which economic transformation started out after 2000. Sections 4-5 consider economic policy of the two post-Milosevic government. The major finding is that it was the economic policy that was highly socially sensible that prevented social uprising and undermining democracy by democratic means. Section 6 concludes by applying the concept of equilibrium of partial reforms.

  5. Total Cost of Ownership and Cost-to-Serve

    DEFF Research Database (Denmark)

    Zachariassen, Frederik

    2007-01-01

    Artiklen reviewer den eksisterende litteratur vedrørende økonomistyringsværktøjerne Total Cost of Ownership (TCO) og Cost-to-Serve (CtS). Herefter kortlægges det, hvordan TCO og CtS bidrager til en identificering af direkte omkostninger såvel som indirekte omkostninger henholdsvis up-stream og down...

  6. Procedure for estimating permanent total enclosure costs

    Energy Technology Data Exchange (ETDEWEB)

    Lukey, M E; Prasad, C; Toothman, D A; Kaplan, N

    1999-07-01

    Industries that use add-on control devices must adequately capture emissions before delivering them to the control device. One way to capture emissions is to use permanent total enclosures (PTEs). By definition, an enclosure which meets the US Environmental Protection Agency's five-point criteria is a PTE and has a capture efficiency of 100%. Since costs play an important role in regulatory development, in selection of control equipment, and in control technology evaluations for permitting purposes, EPA has developed a Control Cost Manual for estimating costs of various items of control equipment. EPA's Manual does not contain any methodology for estimating PTE costs. In order to assist environmental regulators and potential users of PTEs, a methodology for estimating PTE costs was developed under contract with EPA, by Pacific Environmental Services, Inc. (PES) and is the subject of this paper. The methodology for estimating PTE costs follows the approach used for other control devices in the Manual. It includes procedures for sizing various components of a PTE and for estimating capital as well as annual costs. It contains verification procedures for demonstrating compliance with EPA's five-point criteria. In addition, procedures are included to determine compliance with Occupational Safety and Health Administration (OSHA) standards. Meeting these standards is an important factor in properly designing PTEs. The methodology is encoded in Microsoft Exel spreadsheets to facilitate cost estimation and PTE verification. Examples are given throughout the methodology development and in the spreadsheets to illustrate the PTE design, verification, and cost estimation procedures.

  7. Procedure for estimating permanent total enclosure costs

    Energy Technology Data Exchange (ETDEWEB)

    Lukey, M.E.; Prasad, C.; Toothman, D.A.; Kaplan, N.

    1999-07-01

    Industries that use add-on control devices must adequately capture emissions before delivering them to the control device. One way to capture emissions is to use permanent total enclosures (PTEs). By definition, an enclosure which meets the US Environmental Protection Agency's five-point criteria is a PTE and has a capture efficiency of 100%. Since costs play an important role in regulatory development, in selection of control equipment, and in control technology evaluations for permitting purposes, EPA has developed a Control Cost Manual for estimating costs of various items of control equipment. EPA's Manual does not contain any methodology for estimating PTE costs. In order to assist environmental regulators and potential users of PTEs, a methodology for estimating PTE costs was developed under contract with EPA, by Pacific Environmental Services, Inc. (PES) and is the subject of this paper. The methodology for estimating PTE costs follows the approach used for other control devices in the Manual. It includes procedures for sizing various components of a PTE and for estimating capital as well as annual costs. It contains verification procedures for demonstrating compliance with EPA's five-point criteria. In addition, procedures are included to determine compliance with Occupational Safety and Health Administration (OSHA) standards. Meeting these standards is an important factor in properly designing PTEs. The methodology is encoded in Microsoft Exel spreadsheets to facilitate cost estimation and PTE verification. Examples are given throughout the methodology development and in the spreadsheets to illustrate the PTE design, verification, and cost estimation procedures.

  8. Social cost in construction projects

    Energy Technology Data Exchange (ETDEWEB)

    Çelik, Tolga, E-mail: tolga.celik@emu.edu.tr [Department of Civil Engineering, Eastern Mediterranean University, Famagusta, T.R. North Cyprus, Via Mersin 10 (Turkey); Kamali, Saeed, E-mail: saeedkamali2002@gmail.com [Civil Engineering Department, Middle East Technical University, 06800 Ankara (Turkey); Arayici, Yusuf, E-mail: yusuf.arayici@hku.edu.tr [Department of Civil Engineering, Hasan Kalyoncu University, Gaziantep (Turkey)

    2017-05-15

    Despite the fact that completion of construction projects has a direct positive impact on the growth of national and local economies as well as humans' wellbeing, construction projects, especially in the urban areas, generate serious environmental nuisances for the adjacent residents and have unintentional adverse impacts on their surrounding environment. Construction causative adverse impacts on the neighbouring communities are known as the social costs. This study aims to present a state-of-the-art overview of social costs in construction industry in terms of definition, consideration, classification and quantification. Furthermore, it is aimed to bring the construction social cost phenomenon for the agenda of Environmental Impact Assessors.

  9. Social cost in construction projects

    International Nuclear Information System (INIS)

    Çelik, Tolga; Kamali, Saeed; Arayici, Yusuf

    2017-01-01

    Despite the fact that completion of construction projects has a direct positive impact on the growth of national and local economies as well as humans' wellbeing, construction projects, especially in the urban areas, generate serious environmental nuisances for the adjacent residents and have unintentional adverse impacts on their surrounding environment. Construction causative adverse impacts on the neighbouring communities are known as the social costs. This study aims to present a state-of-the-art overview of social costs in construction industry in terms of definition, consideration, classification and quantification. Furthermore, it is aimed to bring the construction social cost phenomenon for the agenda of Environmental Impact Assessors.

  10. Nuclear energy and social costs

    International Nuclear Information System (INIS)

    Ellens, S.H.

    1975-01-01

    The author introduces a new concept under the name 'social costs', defining it more or less as that which society is prepared to pay to solve the risks taken when a new technological system is introduced into that society. Social costs are the result of a complex of advantages and disadvantages inherent to a system. Applying this principle, a comparison is given of the health hazards involved in power generation by nuclear power plants and plants working on natural gas, oil or coal

  11. Social costs of energy consumption

    International Nuclear Information System (INIS)

    Hohmeyer, O.

    1988-01-01

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

  12. The total lifetime costs of smoking

    DEFF Research Database (Denmark)

    Rasmussen, S.R.; Prescott, E.; Sørensen, T.I.A.

    2004-01-01

    Net costs of smoking in a lifetime perspective and, hence, the economic interests in antismoking policies have been questioned. It has been proposed that the health-related costs of smoking are balanced by smaller expenditure due to shorter life expectancy.......Net costs of smoking in a lifetime perspective and, hence, the economic interests in antismoking policies have been questioned. It has been proposed that the health-related costs of smoking are balanced by smaller expenditure due to shorter life expectancy....

  13. Economic costs of social phobia: a population-based study.

    Science.gov (United States)

    Acarturk, C; Smit, Filip; de Graaf, R; van Straten, A; Ten Have, M; Cuijpers, P

    2009-06-01

    Information about the economic costs of social phobia is scant. In this study, we examine the economic costs of social phobia and subthreshold social phobia. Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) which is a population-based prospective study (n=4,789). Costs related to health service uptake, patients' out-of-pocket expenses, and costs arising from production losses were calculated for the reference year 2003. The costs for people with social phobia were compared with the costs for people with no mental disorder. The annual per capita total costs of social phobia were euro 11,952 (95% CI=7,891-16,013) which is significantly higher than the total costs for people with no mental disorder, euro 2957 (95% CI=2690-3224). When adjusting for mental and somatic co-morbidity, the costs decreased to euro 6,100 (95% CI=2681-9519), or 136 million euro per year per 1 million inhabitants, which was still significantly higher than the costs for people with no mental disorder. The costs of subthreshold social phobia were also significantly higher than the costs for people without any mental disorder, at euro 4,687 (95% CI=2557-6816). The costs presented here are conservative lower estimates because we only included costs related to mental health services. The economic costs associated with social phobia are substantial, and those of subthreshold social phobia approach those of the full-blown disorder.

  14. Social cost of pathological gambling.

    Science.gov (United States)

    Ladouceur, R; Boisvert, J M; Pépin, M; Loranger, M; Sylvain, C

    1994-12-01

    Pathological gambling creates enormous problems for the afflicted individuals, their families, employers, and society, and has numerous disastrous financial consequences. The present study evaluates the financial burdens of pathological gambling by questioning pathological gamblers in treatment in Gamblers Anonymous (n=60; 56 males, 4 females; mean age = 40 years old) about personal debts, loss of productivity at work, illegal activities, medical costs and the presence of other dependencies. Results show that important debts, loss of productivity at work and legal problems are associated with pathological gambling. Discussion is formulated in terms of the social cost of adopting a liberal attitude toward the legalization of various gambling activities.

  15. Social costs of road crashes : an international analysis.

    NARCIS (Netherlands)

    Wijnen, W. & Stipdonk, H.L.

    2016-01-01

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

  16. Direct cost comparison of totally endoscopic versus open ear surgery.

    Science.gov (United States)

    Patel, N; Mohammadi, A; Jufas, N

    2018-02-01

    Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

  17. The social cost of fuel cycles

    International Nuclear Information System (INIS)

    Pearce, D.; Bann, C.; Georgiou, S.

    1992-01-01

    This report was commissioned by the UK Department of Energy. Its purpose is to survey the available literature on the monetary estimation of the social costs of energy production and use. We focus on the social costs of electricity production. The report is not intended to convey original research. Nonetheless, the report does take various estimates of social cost and shows how they might be converted to monetary 'social cost surcharges' or externality adders in a UK context. It is also important to appreciate that the literature surveyed is on the monetary costs of fuel cycles. (author)

  18. Environmental protection using social costing

    International Nuclear Information System (INIS)

    Lee, R.

    1993-01-01

    Emissions and other residual wastes come from industrial production, commercial and household activities, and transportation. These wastes damage the environment, including human health. As economies grow, so does concern about balancing that growth with the desire for environmental protection. At issue is how much environmental protection we should have. We address this issue using the concept of social costing. The issue is discussed in the context of electric power generation. There is particular concern about the use of fossil fuels such as petroleum, the major fuel used in the Republic of China, and coal which is the most common fuel used in the U. S. Electric power generation is a major source of airborne pollutants such as SO 2 , NO x particulate matter, volatile organic compounds, CO, and CO 2 . It also results in liquid and solid wastes, and other effects such as changes in land use. To generate electric power, fuel (such as petroleum, coal or enriched uranium) or some other resource (e.g., wind or geothermal) is needed. A fuel cycle consists of a sequence of activities and processes involved in generating electric power. These activities include fuel extraction, treatment and processing; fuel conversion into electricity; transmission; waste disposal; and transportation of fuel and wastes between the different stages of the fuel cycle. Each stage results in emissions or other residuals. Several recent-studies have been about the environmental costs of electricity

  19. Total life cycle cost model for electric power stations

    International Nuclear Information System (INIS)

    Cardullo, M.W.

    1995-01-01

    The Total Life Cycle Cost (TLCC) model for electric power stations was developed to provide a technology screening model. The TLCC analysis involves normalizing cost estimates with respect to performance standards and financial assumptions and preparing a profile of all costs over the service life of the power station. These costs when levelized present a value in terms of a utility electricity rate. Comparison of cost and the pricing of the electricity for a utility shows if a valid project exists. Cost components include both internal and external costs. Internal costs are direct costs associated with the purchase, and operation of the power station and include initial capital costs, operating and maintenance costs. External costs result from societal and/or environmental impacts that are external to the marketplace and can include air quality impacts due to emissions, infrastructure costs, and other impacts. The cost stream is summed (current dollars) or discounted (constant dollars) to some base year to yield a overall TLCC of each power station technology on a common basis. While minimizing life cycle cost is an important consideration, it may not always be a preferred method for some utilities who may prefer minimizing capital costs. Such consideration does not always result in technology penetration in a marketplace such as the utility sector. Under various regulatory climates, the utility is likely to heavily weigh initial capital costs while giving limited consideration to other costs such as societal costs. Policy makers considering external costs, such as those resulting from environmental impacts, may reach significantly different conclusions about which technologies are most advantageous to society. The TLCC analysis model for power stations was developed to facilitate consideration of all perspectives

  20. Economics of human performance and systems total ownership cost.

    Science.gov (United States)

    Onkham, Wilawan; Karwowski, Waldemar; Ahram, Tareq Z

    2012-01-01

    Financial costs of investing in people is associated with training, acquisition, recruiting, and resolving human errors have a significant impact on increased total ownership costs. These costs can also affect the exaggerate budgets and delayed schedules. The study of human performance economical assessment in the system acquisition process enhances the visibility of hidden cost drivers which support program management informed decisions. This paper presents the literature review of human total ownership cost (HTOC) and cost impacts on overall system performance. Economic value assessment models such as cost benefit analysis, risk-cost tradeoff analysis, expected value of utility function analysis (EV), growth readiness matrix, multi-attribute utility technique, and multi-regressions model were introduced to reflect the HTOC and human performance-technology tradeoffs in terms of the dollar value. The human total ownership regression model introduces to address the influencing human performance cost component measurement. Results from this study will increase understanding of relevant cost drivers in the system acquisition process over the long term.

  1. evaluation of total annual costs of heat exchanger networks using

    African Journals Online (AJOL)

    user

    after solving the first problem using RPA based heat integration gave a minimum total annual cost (TAC) of $237, ... mathematical programming and non-RPA based Hint software. ... The concept of pinch analysis evolved over the years.

  2. A general approach to total repair cost limit replacement policies

    Directory of Open Access Journals (Sweden)

    F. Beichelt

    2014-01-01

    Full Text Available A common replacement policy for technical systems consists in replacing a system by a new one after its economic lifetime, i.e. at that moment when its long-run maintenance cost rate is minimal. However, the strict application of the economic lifetime does not take into account the individual deviations of maintenance cost rates of single systems from the average cost development. Hence, Beichet proposed the total repair cost limit replacement policy: the system is replaced by a new one as soon as its total repair cost reaches or exceeds a given level. He modelled the repair cost development by functions of the Wiener process with drift. Here the same policy is considered under the assumption that the one-dimensional probability distribution of the process describing the repair cost development is given. In the examples analysed, applying the total repair cost limit replacement policy instead of the economic life-time leads to cost savings of between 4% and 30%. Finally, it is illustrated how to include the reliability aspect into the policy.

  3. Draft Submission; Social Cost of Energy Generation

    Energy Technology Data Exchange (ETDEWEB)

    None

    1990-01-05

    This report is intended to provide a general understanding of the social costs associated with electric power generation. Based on a thorough review of recent literature on the subject, the report describes how these social costs can be most fully and accurately evaluated, and discusses important considerations in applying this information within the competitive bidding process. [DJE 2005

  4. Total cost of ownership: Getting past the 10% solution

    International Nuclear Information System (INIS)

    Anderson, R.F.

    1996-01-01

    As the refining industry strives to succeed in a more-competitive world, some fresh ideas are needed to counter the headlines of plant closings, layoffs, and corporate restructurings. Other industries facing the same pressures have discovered opportunities to reduce cost in a more human and effective manner by using some tools borrowed from the Total Quality process to enhance the procurement process. Experience suggests that the purchase cost is a small fraction of the actual cost of a commodity and is often dwarfed by hidden costs. Discovering and eliminating the hidden costs of variation, nonoptimal operations, and poorly aligned vendor relations is vital to economic survival. The purpose of this paper is to suggest some fresh approaches to vendor-customer relations that can dramatically reduce undesired costs

  5. Environmental benefits and social cost

    DEFF Research Database (Denmark)

    Henriksen, H.J.; Kjær, J.; Brüsh, W.

    2007-01-01

    There is a need for introducing interdisciplinary tools and approaches in water management for participatory integrated assessment of water protection costs and environmental benefits for different management scenarios. This is required for the Water Framework Directive. Bayesian belief networks...

  6. Social Cost of Substance Abuse in Russia.

    Science.gov (United States)

    Potapchik, Elena; Popovich, Larisa

    2014-09-01

    To summarize results of studies that estimate the social costs of alcohol, tobacco, and illicit drug abuse in Russia. The purpose of these studies was to inform policymakers about the real economic burden of risky behaviors and to provide conditions for evidence-based and well-informed decision making in this area. The cost-of-illness method was applied to estimate the social cost of substance abuse. The intangible cost was not included in estimation. A prevalence-based approach was applied to estimate the tangible cost. For the estimation of direct costs, a top-down method was used. Indirect costs were estimated using two methods: the human capital and the friction cost. In 2008, the social cost of substance abuse in Russia comprised 677.2 billion rubles if the friction cost method is applied and 1965.9 billion rubles if the human capital method is used. The social cost of substance abuse is defined to the greatest extent by alcohol consumption, comprising about 45% of the economic burden. Illicit drug use comprises about 30% of the economic burden and tobacco consumption 25%. The results of economic studies demonstrated that psychoactive substances impose a considerable economic burden on society. Analysis of the substance abuse social cost pattern shows that the main losses that society bears because of these behavioral risk factors fall outside the health care system and lay in other sectors of the economy such as social care, law enforcement, and productivity losses. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  7. [Total knee and hip prosthesis: variables associated with costs].

    Science.gov (United States)

    Herrera-Espiñeira, Carmen; Escobar, Antonio; Navarro-Espigares, José Luis; Castillo, Juan de Dios Lunadel; García-Pérez, Lidia; Godoy-Montijano, Amparo

    2013-01-01

    The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery. To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge. A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver. The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients. There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.

  8. The social costs of punishment

    NARCIS (Netherlands)

    van den Berg, Pieter; Molleman, Lucas; Weissing, Franz J.

    Lab experiments on punishment are of limited relevance for understanding cooperative behavior in the real world. In real interactions, punishment is not cheap, but the costs of punishment are of a different nature than in experiments. They do not correspond to direct payments or payoff deductions,

  9. evaluation of total annual costs of heat exchanger networks using

    African Journals Online (AJOL)

    This study presents pinch analysis of some heat exchanger networks (HENs) problems using Hint integration (HINT) software. Three examples reported to have been solved using different approaches by various researchers to obtain the least possible total annual cost (TAC) were solved using the Hint software. In this work ...

  10. Social opportunity cost of capital: empirical estimates

    Energy Technology Data Exchange (ETDEWEB)

    Townsend, S.

    1978-02-01

    This report develops estimates of the social-opportunity cost of public capital. The private and social costs of capital are found to diverge primarily because of the effects of corporate and personal income taxes. Following Harberger, the social-opportunity cost of capital is approximated by a weighted average of the returns to different classes of savers and investors where the weights are the flows of savings or investments in each class multiplied by the relevant elasticity. Estimates of these parameters are obtained and the social-opportunity cost of capital is determined to be in the range of 6.2 to 10.8%, depending upon the parameter values used. Uncertainty is found to affect the social-opportunity cost of capital in two ways. First, some allowance must be made for the chance of failure or at least of not realizing claims of a project's proponents. Second, a particular government project will change the expected variability of the returns to the government's entire portfolio of projects. In the absence of specific information about each project, the use of the economy-wide average default and risk adjustments is suggested. These are included in the empirical estimates reported. International capital markets make available private capital, the price of which is not distorted by the U.S. tax system. The inclusion of foreign sources slightly reduces the social-opportunity cost of capital. 21 references.

  11. Cost-identification analysis of total laryngectomy: an itemized approach to hospital costs.

    Science.gov (United States)

    Dedhia, Raj C; Smith, Kenneth J; Weissfeld, Joel L; Saul, Melissa I; Lee, Steve C; Myers, Eugene N; Johnson, Jonas T

    2011-02-01

    To understand the contribution of intraoperative and postoperative hospital costs to total hospital costs, examine the costs associated with specific hospital services in the postoperative period, and recognize the impact of patient factors on hospital costs. Case series with chart review. Large tertiary care teaching hospital system. Using the Pittsburgh Head and Neck Organ-Specific Database, 119 patients were identified as having total laryngectomy with bilateral selective neck dissection and primary closure from 1999 to 2009. Cost data were obtained for 112 patients. Costs include fixed and variable costs, adjusted to 2010 US dollars using the Consumer Price Index. Mean total hospital costs were $29,563 (range, $10,915 to $120,345). Operating room costs averaged 24% of total hospital costs, whereas room charges, respiratory therapy, laboratory, pharmacy, and radiology accounted for 38%, 14%, 8%, 7%, and 3%, respectively. Median length of stay was 9 days (range, 6-43), and median Charlson comorbidity index score was 8 (2-16). Patients with ≥1 day in the intensive care unit had significantly higher hospital costs ($46,831 vs $24,601, P cost differences with stratification based on previous radiation therapy ($27,598 vs $29,915 with no prior radiation, P = .62) or hospital readmission within 30 days ($29,483 vs $29,609 without readmission, P = .97). This is one of few studies in surgery and the first in otolaryngology to analyze hospital costs for a relatively standardized procedure. Further work will include cost analysis from multiple centers with investigation of global cost drivers.

  12. Social costing research: status and prospects

    International Nuclear Information System (INIS)

    Fri, R.W.

    1994-01-01

    Internalizing the costs of environmental and other externalities in electricity prices will, in principle, allocate resources to power generation more efficiently than command-and-control regulation. Recent research has made progress toward developing methods for calculating these full social costs. This research has already proved useful, especially in guiding state-level experiments in the use of social costing. Although difficult methodological issues remain, future research also promises to help policy makers use a variety of policy instruments more precisely and effectively. For this to happen, however, there must be a close link between policy and research communities in defining the research agenda. (author)

  13. Retail clinic utilization associated with lower total cost of care.

    Science.gov (United States)

    Sussman, Andrew; Dunham, Lisette; Snower, Kristen; Hu, Min; Matlin, Olga S; Shrank, William H; Choudhry, Niteesh K; Brennan, Troyen

    2013-04-01

    To better understand the impact of retail clinic use on a patient's annual total cost of care. A propensity score matched-pair, cohort design was used to analyze healthcare spending patterns among CVS Caremark employees in the year following a visit to a MinuteClinic, the retail clinics inside CVS pharmacies. De-identified medical and pharmacy claims for CVS Caremark employees and their dependents who received care at a retail clinic between June 1, 2009, and May 31, 2010, were matched to those of subjects who received care elsewhere. High-dimensional propensity score and greedy matching techniques were used to create a 1-to-1 matched cohort that was analyzed using generalized linear regression models. Individuals using a retail clinic had a lower total cost of care (-$262; 95% confidence interval, -$510 to -$31; P = .025) in the year following their clinic visit than individuals who received care in other settings. This savings was primarily due to lower medical expenses at physicians' offices ($77 savings, P = .008) and hospital inpatient care ($121 savings, P = .049). The 6022 retail clinic users also had 142 (12%) fewer emergency department visits (P = .01), though this was not related to significant cost savings. This study found that retail clinic use was associated with lower overall total cost of care compared with that at alternative sites. Savings may extend beyond the retail clinic visit itself to other types of medical utilization.

  14. Social costs and benefits of nuclear futures

    International Nuclear Information System (INIS)

    Pearce, D.

    1979-01-01

    The conceptual framework for evaluating which energy path is chosen is one of trading-off costs and benefits in a world of technological, economic and social uncertainty. The translation of this conceptual framework into an analytical format with empirical relevance is dealt with. Some salient features of cost benefit analysis are discussed. Actual costs and benefits of nuclear futures are then considered. Subjects discussed are: routine and non-routine radiation, waste management, proliferation, and civil liberties. A 'regret' matrix is presented showing the cost to any future generation if a decision on nuclear power is made now. (U.K.)

  15. Internal Logistics System Selection with Total Cost of Ownership Analysis

    Science.gov (United States)

    Araújo, Inês; Pimentel, Carina; Godina, Radu; Matias, João C. O.

    2017-06-01

    In this paper a methodology was followed in order to support the decision-making of one industrial unit regarding its internal logistics system. The addressed factory was facing issues with their internal logistics approach. Some alternatives were pointed out and a proper total cost of ownership (TCO) analysis was developed. This analysis was taken in order to demonstrate the more cost-effective solution for the internal logistics system. This tool is more and more valued by the companies, due to their willing to reduce the costs that are associated with the way of doing business. Despite the proposal of the best choice for the internal logistics system of the enterprise, this study also intends to present some conclusions about the match between the nature of the industrial unit and the logistics systems that best fit the requirements of those.

  16. En differentieret tilgang til total cost of ownership (TCO)

    DEFF Research Database (Denmark)

    Zachariassen, Frederik

    2010-01-01

    Økonomistyring er en nødvendig brik i forsøget på at kunne styre dele af eller hele forsyningskæden, og til dette bruges diverse økonomistyringsværktøjer. Denne artikel omhandler økonomistyringsværktøjet 'total cost of ownership', og hvordan dette kan bruges til at forbedre samarbejdet med...

  17. Excess costs of social anxiety disorder in Germany.

    Science.gov (United States)

    Dams, Judith; König, Hans-Helmut; Bleibler, Florian; Hoyer, Jürgen; Wiltink, Jörg; Beutel, Manfred E; Salzer, Simone; Herpertz, Stephan; Willutzki, Ulrike; Strauß, Bernhard; Leibing, Eric; Leichsenring, Falk; Konnopka, Alexander

    2017-04-15

    Social anxiety disorder is one of the most frequent mental disorders. It is often associated with mental comorbidities and causes a high economic burden. The aim of our analysis was to estimate the excess costs of patients with social anxiety disorder compared to persons without anxiety disorder in Germany. Excess costs of social anxiety disorder were determined by comparing two data sets. Patient data came from the SOPHO-NET study A1 (n=495), whereas data of persons without anxiety disorder originated from a representative phone survey (n=3213) of the general German population. Missing data were handled by "Multiple Imputation by Chained Equations". Both data sets were matched using "Entropy Balancing". Excess costs were calculated from a societal perspective for the year 2014 using general linear regression with a gamma distribution and log-link function. Analyses considered direct costs (in- and outpatient treatment, rehabilitation, and professional and informal care) and indirect costs due to absenteeism from work. Total six-month excess costs amounted to 451€ (95% CI: 199€-703€). Excess costs were mainly caused by indirect excess costs due to absenteeism from work of 317€ (95% CI: 172€-461€), whereas direct excess costs amounted to 134€ (95% CI: 110€-159€). Costs for medication, unemployment and disability pension was not evaluated. Social anxiety disorder was associated with statistically significant excess costs, in particular due to indirect costs. As patients in general are often unaware of their disorder or its severity, awareness should be strengthened. Prevention and early treatment might reduce long-term indirect costs. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Primary vs Conversion Total Hip Arthroplasty: A Cost Analysis

    Science.gov (United States)

    Chin, Garwin; Wright, David J.; Snir, Nimrod; Schwarzkopf, Ran

    2018-01-01

    Introduction Increasing hip fracture incidence in the United States is leading to higher occurrences of conversion total hip arthroplasty (THA) for failed surgical treatment of the hip. In spite of studies showing higher complication rates in conversion THA, the Centers for Medicare and Medicaid services currently bundles conversion and primary THA under the same diagnosis-related group. We examined the cost of treatment of conversion THA compared with primary THA. Our hypothesis is that conversion THA will have higher cost and resource use than primary THA. Methods Fifty-one consecutive conversion THA patients (Current Procedure Terminology code 27132) and 105 matched primary THA patients (Current Procedure Terminology code 27130) were included in this study. The natural log-transformed costs for conversion and primary THA were compared using regression analysis. Age, gender, body mass index, American Society of Anesthesiologist, Charlson comorbidity score, and smoker status were controlled in the analysis. Conversion THA subgroups formed based on etiology were compared using analysis of variance analysis. Results Conversion and primary THAs were determined to be significantly different (P conversion THA has significantly greater cost and resource use than primary THA. In order to prevent disincentives for treating these complex surgical patients, reclassification of conversion THA is needed, as they do not fit together with primary THA. PMID:26387923

  19. Cost-effectiveness of a ROPS social marketing campaign.

    Science.gov (United States)

    Sorensen, J A; Jenkins, P; Bayes, B; Clark, S; May, J J

    2010-01-01

    Tractor rollovers are the most frequent cause of death in the farm community. Rollover protection structures (ROPS) can prevent the injuries and fatalities associated with these events; however, almost half of U.S. farms lack these essential devices. One promising strategy for increasing ROPS use is social marketing. The purpose of this study was to assess the costs associated with the New York ROPS Social Marketing Campaign in relation to the cost of fatalities and injuries averted as a result of the campaign to determine whether cost savings could be demonstrated in the initial years of program implementation. A total of 524 farmers who had retrofitted a tractor through the program were mailed a survey to assess the number of rollovers or close calls that occurred since ROPS installation. Responses were obtained from 382 farmers, two of whom indicated that they had a potential fatality/injury scenario since retrofitting their tractor through the program. The cost savings associated with the intervention was estimated using a decision-tree analysis adapted from Myers and Pana-Cryan with appropriate consumer price index adjustments. The data were compared to the cost of the New York ROPS Social Marketing Campaign to arrive at an associated cost-savings estimate relative to the intervention. This study indicates that a net savings will likely be demonstrated within the third year of the New York ROPS Social Marketing initiative. These data may provide evidence for researchers hoping to generate support from state and private agencies for similar initiatives.

  20. Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study

    NARCIS (Netherlands)

    P.T.P.W. Burgers (Paul); M. Hoogendoorn (Martine); E.A.C. Van Woensel; R.W. Poolman (Rudolf); M. Bhandari (Mohit); P. Patka (Peter); E.M.M. van Lieshout (Esther)

    2016-01-01

    textabstractSummary: The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost

  1. Social costs of road crashes: An international analysis.

    Science.gov (United States)

    Wijnen, Wim; Stipdonk, Henk

    2016-09-01

    This paper provides an international overview of the most recent estimates of the social costs of road crashes: total costs, value per casualty and breakdown in cost components. The analysis is based on publications about the national costs of road crashes of 17 countries, of which ten high income countries (HICs) and seven low and middle income countries (LMICs). Costs are expressed as a proportion of the gross domestic product (GDP). Differences between countries are described and explained. These are partly a consequence of differences in the road safety level, but there are also methodological explanations. Countries may or may not correct for underreporting of road crashes, they may or may not use the internationally recommended willingness to pay (WTP)-method for estimating human costs, and there are methodological differences regarding the calculation of some other cost components. The analysis shows that the social costs of road crashes in HICs range from 0.5% to 6.0% of the GDP with an average of 2.7%. Excluding countries that do not use a WTP- method for estimating human costs and countries that do not correct for underreporting, results in average costs of 3.3% of GDP. For LMICs that do correct for underreporting the share in GDP ranges from 1.1% to 2.9%. However, none of the LMICs included has performed a WTP study of the human costs. A major part of the costs is related to injuries: an average share of 50% for both HICs and LMICs. The average share of fatalities in the costs is 23% and 30% respectively. Prevention of injuries is thus important to bring down the socio-economic burden of road crashes. The paper shows that there are methodological differences between countries regarding cost components that are taken into account and regarding the methods used to estimate specific cost components. In order to be able to make sound comparisons of the costs of road crashes across countries, (further) harmonization of cost studies is recommended. This can be

  2. Total Corporate social responsibility report 2004. Sharing our energy

    International Nuclear Information System (INIS)

    2005-05-01

    This document presents the social and environmental activities of the group Total for the year 2004. It provides information on the ethical aspects of the governance, the industrial security, the environmental policy, the public health and the occupational safety, the social liability and the economical and social impact of the group activities in the local development, the contribution to the climatic change fight and the development of other energy sources. (A.L.B.)

  3. Sharing cost in social community networks

    DEFF Research Database (Denmark)

    Pal, Ranjan; Elango, Divya; Wardana, Satya Ardhy

    2012-01-01

    their deployment in a residential locality. Our proposed mechanism accounts for heterogeneous user preferences towards different router features and comes up with the optimal (feature-set, user costs) router blueprint that satisfies each user in a locality, in turn motivating them to buy routers and thereby improve......Wireless social community networks (WSCNs) is an emerging technology that operate in the unlicensed spectrum and have been created as an alternative to cellular wireless networks for providing low-cost, high speed wireless data access in urban areas. WSCNs is an upcoming idea that is starting...... reflect their slow progress in capturing the WiFi router market. In this paper, we look at a router design and cost sharing problem in WSCNs to improve deployment. We devise a simple to implement, successful, budget-balanced, ex-post efficient, and individually rational auction-based mechanism...

  4. Cost effective campaigning in social networks

    Science.gov (United States)

    Kotnis, Bhushan; Kuri, Joy

    2016-05-01

    Campaigners are increasingly using online social networking platforms for promoting products, ideas and information. A popular method of promoting a product or even an idea is incentivizing individuals to evangelize the idea vigorously by providing them with referral rewards in the form of discounts, cash backs, or social recognition. Due to budget constraints on scarce resources such as money and manpower, it may not be possible to provide incentives for the entire population, and hence incentives need to be allocated judiciously to appropriate individuals for ensuring the highest possible outreach size. We aim to do the same by formulating and solving an optimization problem using percolation theory. In particular, we compute the set of individuals that are provided incentives for minimizing the expected cost while ensuring a given outreach size. We also solve the problem of computing the set of individuals to be incentivized for maximizing the outreach size for given cost budget. The optimization problem turns out to be non trivial; it involves quantities that need to be computed by numerically solving a fixed point equation. Our primary contribution is, that for a fairly general cost structure, we show that the optimization problems can be solved by solving a simple linear program. We believe that our approach of using percolation theory to formulate an optimization problem is the first of its kind.

  5. Social cost impact assessment of pipeline infrastructure projects

    International Nuclear Information System (INIS)

    Matthews, John C.; Allouche, Erez N.; Sterling, Raymond L.

    2015-01-01

    A key advantage of trenchless construction methods compared with traditional open-cut methods is their ability to install or rehabilitate underground utility systems with limited disruption to the surrounding built and natural environments. The equivalent monetary values of these disruptions are commonly called social costs. Social costs are often ignored by engineers or project managers during project planning and design phases, partially because they cannot be calculated using standard estimating methods. In recent years some approaches for estimating social costs were presented. Nevertheless, the cost data needed for validation of these estimating methods is lacking. Development of such social cost databases can be accomplished by compiling relevant information reported in various case histories. This paper identifies eight most important social cost categories, presents mathematical methods for calculating them, and summarizes the social cost impacts for two pipeline construction projects. The case histories are analyzed in order to identify trends for the various social cost categories. The effectiveness of the methods used to estimate these values is also discussed. These findings are valuable for pipeline infrastructure engineers making renewal technology selection decisions by providing a more accurate process for the assessment of social costs and impacts. - Highlights: • Identified the eight most important social cost factors for pipeline construction • Presented mathematical methods for calculating those social cost factors • Summarized social cost impacts for two pipeline construction projects • Analyzed those projects to identify trends for the social cost factors

  6. Social cost impact assessment of pipeline infrastructure projects

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, John C., E-mail: matthewsj@battelle.org [Battelle, 7231 Palmetto Dr, Baton Rouge, LA 70808 (United States); Allouche, Erez N., E-mail: allouche@latech.edu [Louisiana Tech University (United States); Sterling, Raymond L., E-mail: sterling@latech.edu [Louisiana Tech University (United States)

    2015-01-15

    A key advantage of trenchless construction methods compared with traditional open-cut methods is their ability to install or rehabilitate underground utility systems with limited disruption to the surrounding built and natural environments. The equivalent monetary values of these disruptions are commonly called social costs. Social costs are often ignored by engineers or project managers during project planning and design phases, partially because they cannot be calculated using standard estimating methods. In recent years some approaches for estimating social costs were presented. Nevertheless, the cost data needed for validation of these estimating methods is lacking. Development of such social cost databases can be accomplished by compiling relevant information reported in various case histories. This paper identifies eight most important social cost categories, presents mathematical methods for calculating them, and summarizes the social cost impacts for two pipeline construction projects. The case histories are analyzed in order to identify trends for the various social cost categories. The effectiveness of the methods used to estimate these values is also discussed. These findings are valuable for pipeline infrastructure engineers making renewal technology selection decisions by providing a more accurate process for the assessment of social costs and impacts. - Highlights: • Identified the eight most important social cost factors for pipeline construction • Presented mathematical methods for calculating those social cost factors • Summarized social cost impacts for two pipeline construction projects • Analyzed those projects to identify trends for the social cost factors.

  7. Cost Savings of Nuclear Power with Total Fuel Reprocessing

    International Nuclear Information System (INIS)

    Solbrig, Charles W.; Benedict, Robert W.

    2006-01-01

    The cost of fast reactor (FR) generated electricity with pyro-processing is estimated in this article. It compares favorably with other forms of energy and is shown to be less than that produced by light water reactors (LWR's). FR's use all the energy in natural uranium whereas LWR's utilize only 0.7% of it. Because of high radioactivity, pyro-processing is not open to weapon material diversion. This technology is ready now. Nuclear power has the same advantage as coal power in that it is not dependent upon a scarce foreign fuel and has the significant additional advantage of not contributing to global warming or air pollution. A jump start on new nuclear plants could rapidly allow electric furnaces to replace home heating oil furnaces and utilize high capacity batteries for hybrid automobiles: both would reduce US reliance on oil. If these were fast reactors fueled by reprocessed fuel, the spent fuel storage problem could also be solved. Costs are derived from assumptions on the LWR's and FR's five cost components: 1) Capital costs: LWR plants cost $106/MWe. FR's cost 25% more. Forty year amortization is used. 2) The annual O and M costs for both plants are 9% of the Capital Costs. 3) LWR fuel costs about 0.0035 $/kWh. Producing FR fuel from spent fuel by pyro-processing must be done in highly shielded hot cells which is costly. However, the five foot thick concrete walls have the advantage of prohibiting diversion. LWR spent fuel must be used as feedstock for the FR initial core load and first two reloads so this FR fuel costs more than LWR fuel. FR fuel costs much less for subsequent core reloads ( 6 /MWe. The annual cost for a 40 year licensed plant would be 2.5 % of this or less if interest is taken into account. All plants will eventually have to replace those components which become radiation damaged. FR's should be designed to replace parts rather than decommission. The LWR costs are estimated to be 2.65 cents/kWh. FR costs are 2.99 cents/kWh for the first

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

    Science.gov (United States)

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

    2017-12-16

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

  9. Reverse-total shoulder arthroplasty cost-effectiveness: A quality-adjusted life years comparison with total hip arthroplasty.

    Science.gov (United States)

    Bachman, Daniel; Nyland, John; Krupp, Ryan

    2016-02-18

    To compare reverse-total shoulder arthroplasty (RSA) cost-effectiveness with total hip arthroplasty cost-effectiveness. This study used a stochastic model and decision-making algorithm to compare the cost-effectiveness of RSA and total hip arthroplasty. Fifteen patients underwent pre-operative, and 3, 6, and 12 mo post-operative clinical examinations and Short Form-36 Health Survey completion. Short form-36 Health Survey subscale scores were converted to EuroQual Group Five Dimension Health Outcome scores and compared with historical data from age-matched patients who had undergone total hip arthroplasty. Quality-adjusted life year (QALY) improvements based on life expectancies were calculated. The cost/QALY was $3900 for total hip arthroplasty and $11100 for RSA. After adjusting the model to only include shoulder-specific physical function subscale items, the RSA QALY improved to 2.8 years, and its cost/QALY decreased to $8100. Based on industry accepted standards, cost/QALY estimates supported both RSA and total hip arthroplasty cost-effectiveness. Although total hip arthroplasty remains the quality of life improvement "gold standard" among arthroplasty procedures, cost/QALY estimates identified in this study support the growing use of RSA to improve patient quality of life.

  10. Effect of Body Mass Index and Psychosocial Traits on Total Knee Replacement Costs in Patients with Osteoarthritis.

    Science.gov (United States)

    Waimann, Christian A; Fernandez-Mazarambroz, Rodrigo J; Cantor, Scott B; Lopez-Olivo, Maria A; Barbo, Andrea G; Landon, Glenn C; Siff, Sherwin J; Lin, Heather; Suarez-Almazor, Maria E

    2016-08-01

    Clinical and psychosocial attributes are associated with clinical outcomes after total knee replacement (TKR) surgery in patients with osteoarthritis (OA), but their relationship with TKR-related costs is less clear. Our objective was to evaluate the effect of clinical and psychosocial attributes on TKR costs. We conducted a 6-month prospective cohort study of patients with knee OA who underwent TKR. We examined baseline demographic, clinical [body mass index (BMI) and comorbidities], and psychosocial attributes (social support, locus of control, coping, depression, anxiety, stress, and self-efficacy); baseline and 6-month OA clinical outcomes [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function]; and 6-month direct and indirect TKR-related costs. Multiple regression was performed to identify determinants of TKR-related costs. We included 212 patients; 66% were women, 71% were white, and the mean age was 65.2 years. The mean baseline WOMAC pain score was 55 (SD 19) and WOMAC function score was 54 (SD 20). Mean total TKR-related costs were US$30,831 (SD $9893). Multivariate regression analyses showed that increasing BMI and anxiety levels and decreasing levels of positive social interactions were associated with increased costs. A lower cost scenario with a lower range of normal BMI (19.5), highest positive social interaction, and no anxiety predicted TKR costs to be $22,247. Predicted costs in obese patients (BMI 36) with lowest positive social interaction and highest anxiety were $58,447. Increased baseline BMI, anxiety, and poor social support lead to higher TKR-related costs in patients with knee OA. Preoperative interventions targeting these factors may reduce TKR-related costs, and therefore be cost-effective.

  11. The Cost of Joint Replacement: Comparing Two Approaches to Evaluating Costs of Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Palsis, John A; Brehmer, Thomas S; Pellegrini, Vincent D; Drew, Jacob M; Sachs, Barton L

    2018-02-21

    In an era of mandatory bundled payments for total joint replacement, accurate analysis of the cost of procedures is essential for orthopaedic surgeons and their institutions to maintain viable practices. The purpose of this study was to compare traditional accounting and time-driven activity-based costing (TDABC) methods for estimating the total costs of total hip and knee arthroplasty care cycles. We calculated the overall costs of elective primary total hip and total knee replacement care cycles at our academic medical center using traditional and TDABC accounting methods. We compared the methods with respect to the overall costs of hip and knee replacement and the costs for each major cost category. The traditional accounting method resulted in higher cost estimates. The total cost per hip replacement was $22,076 (2014 USD) using traditional accounting and was $12,957 using TDABC. The total cost per knee replacement was $29,488 using traditional accounting and was $16,981 using TDABC. With respect to cost categories, estimates using traditional accounting were greater for hip and knee replacement, respectively, by $3,432 and $5,486 for personnel, by $3,398 and $3,664 for space and equipment, and by $2,289 and $3,357 for indirect costs. Implants and consumables were derived from the actual hospital purchase price; accordingly, both methods produced equivalent results. Substantial cost differences exist between accounting methods. The focus of TDABC only on resources used directly by the patient contrasts with the allocation of all operating costs, including all indirect costs and unused capacity, with traditional accounting. We expect that the true costs of hip and knee replacement care cycles are likely somewhere between estimates derived from traditional accounting methods and TDABC. TDABC offers patient-level granular cost information that better serves in the redesign of care pathways and may lead to more strategic resource-allocation decisions to optimize

  12. The social cost of congestion games by imposing variable delays

    Directory of Open Access Journals (Sweden)

    Josep Díaz

    2017-12-01

    Full Text Available In this study, we describe a new coordination mechanism for non-atomic congestion games that leads to a (selfish social cost which is arbitrarily close to the non-selfish optimal. This mechanism incurs no additional cost, in contrast to tolls that typically differ from the social cost as expressed in terms of delays.

  13. Economic costs of social phobia: a population-based study.

    NARCIS (Netherlands)

    Acarturk, C.; Smit, H.F.E.; de Graaf, R.; van Straten, A.; ten Have, M.; Cuijpers, P.

    2009-01-01

    Background: Information about the economic costs of social phobia is scant. In this study, we examine the economic costs of social phobia and subthreshold social phobia. Methods: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS) which is a population-based

  14. [Therapeutic education of total laryngectomy patients: Influence of social factors].

    Science.gov (United States)

    Woisard, V; Galtier, A; Baumann, L; Delpierre, C; Puech, M; Balaguer, M

    Current health policies promote patient education, parti­cu­lar­ly in oncology. Therapeutic education program must be tailo­red to the characteristics, needs and expectations of the population. In the ENT Department of Head and Neck Surgery, Larrey Hospital in Toulouse, a therapeutic education program for patient with total laryngectomy has been experienced since 2011. But its propagation remains difficult. The aim of this study is to determine if social factors are nfluencing the parti­cipation of the laryngectomized population in the program. The brochure explaining this program and a registration form coupled with a survey questionnaire were distributed to the regio­nal population of patient with total laryngectomy. After two months of investigation we collected 42 responses. It is clear from their analysis that social factors underlie partici­pa­tion, particularly educational level, available financial resources level and the socio-professional group.

  15. Impact Of Total Quality Management (TQM), Activity Based Costing ...

    African Journals Online (AJOL)

    Time (JIT), and Total Quality Management (TQM) as strategic initiatives lead to improved financial performance in the Turkish textile industry. Strong evidence emerged that there is a strong positive association between using ABC, JIT or TQM ...

  16. The costs of paying: Private and social costs of cash and card systems

    OpenAIRE

    Bergman, Mats; Guibourg, Gabriela; Segendorf, Björn

    2007-01-01

    Despite the central role of payments in theoretical and policy oriented economics, there is surprisingly little known about the costs of different payment instruments. We estimate social and private costs of cash, debit and credit card payments in Sweden in 2002. The combined social cost of providing these payment services is approximately 0.4 per cent of GDP. Debit and credit cards are socially less costly than cash for payments above EURO 8 and EURO 18, respectively. Corresponding threshold...

  17. Social Costs of Gambling in the Czech Republic 2012.

    Science.gov (United States)

    Winkler, Petr; Bejdová, Markéta; Csémy, Ladislav; Weissová, Aneta

    2017-12-01

    Evidence about social costs of gambling is scarce and the methodology for their calculation has been a subject to strong criticism. We aimed to estimate social costs of gambling in the Czech Republic 2012. This retrospective, prevalence based cost of illness study builds on the revised methodology of Australian Productivity Commission. Social costs of gambling were estimated by combining epidemiological and economic data. Prevalence data on negative consequences of gambling were taken from existing national epidemiological studies. Economic data were taken from various national and international sources. Consequences of problem and pathological gambling only were taken into account. In 2012, the social costs of gambling in the Czech Republic were estimated to range between 541,619 and 619,608 thousands EUR. While personal and family costs accounted for 63% of all social costs, direct medical costs were estimated to range from 0.25 to 0.28% of all social costs only. This is the first study which estimates social costs of gambling in any of the Central and East European countries. It builds upon the solid evidence about prevalence of gambling related problems in the Czech Republic and satisfactorily reliable economic data. However, there is a number of limitations stemming from assumptions that were made, which suggest that the methodology for the calculation of the social costs of gambling needs further development.

  18. HIGH ECCENTRICITY EOQ TOTAL COST FUNCTION YIELDS JIT RESULTs

    Directory of Open Access Journals (Sweden)

    Willian Roach

    2010-06-01

    Full Text Available No estoque de bens perecíveis, o custo de armazenamento H é muito maior do que o previsto na fórmula clássica do lote econômico do pedido (EOQ. Para bens perecíveis, a função custo total no EOQ é um pico e não uma reta horizontal. Esta forma pontiaguda leva o modelo EOQ a produzir entregas just in time (JIT - resultados semelhantes. O efeito pontiagudo (excentricidade da curva de custo total do lote econômico EOQ depende apenas do custo de armazenamento (H e não da demanda anual (D ou do custo do pedido (S. D e S determinam o nível (altura da curva de custo total do estoque (TC, mas não a forma.

  19. Risk aversion, time preference, and the social cost of carbon

    International Nuclear Information System (INIS)

    Anthoff, David; Tol, Richard S J; Yohe, Gary W

    2009-01-01

    The Stern Review reported a social cost of carbon of over $300/tC, calling for ambitious climate policy. We here conduct a systematic sensitivity analysis of this result on two crucial parameters: the rate of pure time preference, and the rate of risk aversion. We show that the social cost of carbon lies anywhere in between 0 and $120 000/tC. However, if we restrict these two parameters to matching observed behaviour, an expected social cost of carbon of $60/tC results. If we correct this estimate for income differences across the world, the social cost of carbon rises to over $200/tC.

  20. Total cost of performing analog-to-digital upgrades

    International Nuclear Information System (INIS)

    Albrigo, T.

    1993-01-01

    The financial well-being of nuclear power plants in the United States is dependent on reducing costs. Rapid advances in industrial technology have created a conundrum for utility executives and their engineering staffs. Digital technology is being touted as beneficial in many ways; however, a number of significant issues have been raised regarding the adequacy and financial viability of digital systems in nuclear power plants. Actual or perceived problems with digital system design, development, and installation have caused significant financial losses for nuclear utilities. This paper provides a list of problems that must be considered in performing an analog-to-digital conversion or for doing a large digital upgrade. It is desirable that the full financial risks associated with these types of upgrades are considered. Specific problems encountered at Palo Verde nuclear generating station are reviewed to emphasize some of the problem areas

  1. Epidemiology & social costs of haemophilia in India

    Directory of Open Access Journals (Sweden)

    Anita Kar

    2014-01-01

    Full Text Available India lacks a national policy on the prevention and control of genetic disorders. Although the haemoglobinopathies have received some attention, there are scarce data on the epidemiology of other genetic disorders in India. Haemophilia, an inherited single gene disorder with an incidence of 1 per 10,000 births, manifests as spontaneous or trauma-induced haemorrhagic episodes in patients, progressing to chronic disability and premature mortality in untreated patients or patients with sub-optimal treatment. Although the genetic basis of this disorder has been well studied in India, data on the number of patients, trends of the disorder in India, social costs of the condition and opportunities and competencies for offering genetic counselling through a public health programme have not been reported. This review article summarizes the available Indian data, which show that the country harbours the second highest number of global patients with haemophilia A. The reported number of patients with haemophilia A is 11,586 while the estimated prevalence could be around 50,000 patients. This review also identifies the need to immediately initiate a national programme for haemophilia, with components of prevention, care for patients, surveillance and education and support for families.

  2. Effects of the Length of Stay on the Cost of Total Knee and Total Hip Arthroplasty from 2002 to 2013.

    Science.gov (United States)

    Molloy, Ilda B; Martin, Brook I; Moschetti, Wayne E; Jevsevar, David S

    2017-03-01

    Utilization of total knee and hip arthroplasty has greatly increased in the past decade in the United States; these are among the most expensive procedures in patients with Medicare. Advances in surgical techniques, anesthesia, and care pathways decrease hospital length of stay. We examined how trends in hospital cost were altered by decreases in length of stay. Procedure, demographic, and economic data were collected on 6.4 million admissions for total knee arthroplasty and 2.8 million admissions for total hip arthroplasty from 2002 to 2013 using the National (Nationwide) Inpatient Sample, a component of the Healthcare Cost and Utilization Project. Trends in mean hospital costs and their association with length of stay were estimated using inflation-adjusted, survey-weighted generalized linear regression models, controlling for patient demographic characteristics and comorbidity. From 2002 to 2013, the length of stay decreased from a mean time of 4.06 to 2.97 days for total knee arthroplasty and from 4.06 to 2.75 days for total hip arthroplasty. During the same time period, the mean hospital cost for total knee arthroplasty increased from $14,988 (95% confidence interval [CI], $14,927 to $15,049) in 2002 to $22,837 (95% CI, $22,765 to $22,910) in 2013 (an overall increase of $7,849 or 52.4%). The mean hospital cost for total hip arthroplasty increased from $15,792 (95% CI, $15,706 to $15,878) in 2002 to $23,650 (95% CI, $23,544 to $23,755) in 2013 (an increase of $7,858 or 49.8%). If length of stay were set at the 2002 mean, the growth in cost for total knee arthroplasty would have been 70.8% instead of 52.4% as observed, and the growth in cost for total hip arthroplasty would have been 67.4% instead of 49.8% as observed. Hospital costs for joint replacement increased from 2002 to 2013, but were attenuated by reducing inpatient length of stay. With demographic characteristics showing an upward trend in the utilization of joint arthroplasty, including a shift

  3. Cost-effectiveness of positive contrast and nuclear arthrography in patients who underwent total hip arthroplasty

    International Nuclear Information System (INIS)

    Swan, J.S.; Braunstein, E.M.; Capello, W.; Wellman, H.

    1989-01-01

    The authors have compared the cost effectiveness of contrast arthrography (CA) and nuclear arthrography (NA), in which In-111 chloride is injected with the contrast material, of total hip arthroplasties. Their series included 48 cases of surgically proved loose femoral components. The cost per true-positive result was obtained by taking the total cost of the examinations in surgically proved cases and dividing by the number of true-position cases. The cost of CA was $297 and the cost of NA was $335. For CA, the cost per true positive was $1,018, and for the NA the cost per true positive was $946. In spite of higher initial cost, NA is more cost effective than CA on a cost per true-positive case basis. NA is cost effective in evaluating hip arthroplasties in which there is suspicion of a loose femoral component

  4. Electrochromic Windows: Process and Fabrication Improvements for Lower Total Costs

    Energy Technology Data Exchange (ETDEWEB)

    Mark Burdis; Neil Sbar

    2007-03-31

    The overall goal with respect to the U.S. Department of Energy (DOE) is to achieve significant national energy savings through maximized penetration of EC windows into existing markets so that the largest cumulative energy reduction can be realized. The speed with which EC windows can be introduced and replace current IGU's (and current glazings) is clearly a strong function of cost. Therefore, the aim of this project was to investigate possible improvements to the SageGlass{reg_sign} EC glazing products to facilitate both process and fabrication improvements resulting in lower overall costs. The project was split into four major areas dealing with improvements to the electrochromic layer, the capping layer, defect elimination and general product improvements. Significant advancements have been made in each of the four areas. These can be summarized as follows: (1) Plasma assisted deposition for the electrochromic layer was pursued, and several improvements made to the technology for producing a plasma beam were made. Functional EC devices were produced using the new technology, but there are still questions to be answered regarding the intrinsic properties of the electrochromic films produced by this method. (2) The capping layer work was successfully implemented into the existing SageGlass{reg_sign} product, thereby providing a higher level of transparency and somewhat lower reflectivity than the 'standard' product. (3) Defect elimination is an ongoing effort, but this project spurred some major defect reduction programs, which led to significant improvements in yield, with all the implicit benefits afforded. In particular, major advances were made in the development of a new bus bar application process aimed at reducing the numbers of 'shorts' developed in the finished product, as well as making dramatic improvements in the methods used for tempering the glass, which had previously been seen to produce a defect which appeared as a

  5. Cost of goods sold and total cost of delivery for oral and parenteral vaccine packaging formats.

    Science.gov (United States)

    Sedita, Jeff; Perrella, Stefanie; Morio, Matt; Berbari, Michael; Hsu, Jui-Shan; Saxon, Eugene; Jarrahian, Courtney; Rein-Weston, Annie; Zehrung, Darin

    2018-03-14

    Despite limitations of glass packaging for vaccines, the industry has been slow to implement alternative formats. Polymer containers may address many of these limitations, such as breakage and delamination. However, the ability of polymer containers to achieve cost of goods sold (COGS) and total cost of delivery (TCOD) competitive with that of glass containers is unclear, especially for cost-sensitive low- and lower-middle-income countries. COGS and TCOD models for oral and parenteral vaccine packaging formats were developed based on information from subject matter experts, published literature, and Kenya's comprehensive multiyear plan for immunization. Rotavirus and inactivated poliovirus vaccines (IPV) were used as representative examples of oral and parenteral vaccines, respectively. Packaging technologies evaluated included glass vials, blow-fill-seal (BFS) containers, preformed polymer containers, and compact prefilled auto-disable (CPAD) devices in both BFS and preformed formats. For oral vaccine packaging, BFS multi-monodose (MMD) ampoules were the least expensive format, with a COGS of $0.12 per dose. In comparison, oral single-dose glass vials had a COGS of $0.40. BFS MMD ampoules had the lowest TCOD of oral vaccine containers at $1.19 per dose delivered, and ten-dose glass vials had a TCOD of $1.61 per dose delivered. For parenteral vaccines, the lowest COGS was achieved with ten-dose glass vials at $0.22 per dose. In contrast, preformed CPAD devices had the highest COGS at $0.60 per dose. Ten-dose glass vials achieved the lowest TCOD of the parenteral vaccine formats at $1.56 per dose delivered. Of the polymer containers for parenteral vaccines, BFS MMD ampoules achieved the lowest TCOD at $1.89 per dose delivered, whereas preformed CPAD devices remained the most expensive format, at $2.25 per dose delivered. Given their potential to address the limitations of glass and reduce COGS and TCOD, polymer containers deserve further consideration as alternative

  6. The total lifetime health cost savings of smoking cessation to society

    DEFF Research Database (Denmark)

    Rasmussen, Gitte Susanne; Prescott, Eva; Sørensen, Thorkild I A

    2005-01-01

    Smoking cessation has major immediate and long-term health benefits. However, ex-smokers' total lifetime health costs and continuing smokers' costs remain uncompared, and hence the economic savings of smoking cessation to society have not been determined.......Smoking cessation has major immediate and long-term health benefits. However, ex-smokers' total lifetime health costs and continuing smokers' costs remain uncompared, and hence the economic savings of smoking cessation to society have not been determined....

  7. Total staff costs to implement a decision support system in nursing

    Directory of Open Access Journals (Sweden)

    Valéria Castilho

    2014-01-01

    Full Text Available OBJECTIVE: to identify the direct labor (DL costs to put in practice a decision support system (DSS in nursing at the University Hospital of the University of São Paulo (HU-USP. METHOD: the development of the DSS was mapped in four sub-processes: Conception, Elaboration, Construction and Transition. To calculate the DL, the baseline salary per professional category was added to the five-year additional remuneration, representation fees and social charges, and then divided by the number of hours contracted, resulting in the hour wage/professional, which was multiplied by the time spend on each activity in the sub-processes. RESULTS: the DL cost corresponded to R$ 752,618.56 (100%, R$ 26,000.00 (3.45% of which were funded by a funding agency, while R$ 726,618.56 (96,55% came from Hospital and University resources. CONCLUSION: considering the total DL cost, 72.1% related to staff wages for the informatics consulting company and 27.9% to the DL of professionals at the HU and the School of Nursing.

  8. Relational Benefits & Costs in Social Media Brand Pages

    OpenAIRE

    Tsimonis, Georgios; Dimitriadis, Sergios

    2014-01-01

    Attracted by the rapid penetration of social media into society, firms are increasingly using them to offer interactive services to their customers, and to create or enhance their relationships with them. As the number of consumers who join brand pages on social media platforms raises, it brings to the front a new question: What relational benefits and costs arise from customer interactions with brands in social media? Thus, this study is an attempt to identify what benefits and costs users p...

  9. 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.

  10. How do high cost-sharing policies for physician care affect total care costs among people with chronic disease?

    Science.gov (United States)

    Xin, Haichang; Harman, Jeffrey S; Yang, Zhou

    2014-01-01

    This study examines whether high cost-sharing in physician care is associated with a differential impact on total care costs by health status. Total care includes physician care, emergency room (ER) visits and inpatient care. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients. This study used the 2007 Medical Expenditure Panel Survey data with a cross-sectional study design. Difference in difference (DID), instrumental variable technique, two-part model, and bootstrap technique were employed to analyze cost data. Chronically ill individuals' probability of reducing any overall care costs was significantly less than healthier individuals (beta = 2.18, p = 0.04), while the integrated DID estimator from split results indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). This greater cost reduction in total care among sick people likely resulted from greater cost reduction in physician care, and may have come at the expense of jeopardizing health outcomes by depriving patients of needed care. Thus, these policies would be inappropriate in the short run, and unlikely in the long run to control health plans costs among chronically ill individuals. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees' health status.

  11. Controlling costs without compromising quality: paying hospitals for total knee replacement.

    Science.gov (United States)

    Pine, Michael; Fry, Donald E; Jones, Barbara L; Meimban, Roger J; Pine, Gregory J

    2010-10-01

    Unit costs of health services are substantially higher in the United States than in any other developed country in the world, without a correspondingly healthier population. An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs. The National Inpatient Sample of administrative claims data was used to measure risk-adjusted mortality, postoperative length-of-stay, costs of routine care, adverse outcome rates, and excess costs of adverse outcomes for total knee replacements performed between 2002 and 2005. Empirically identified inefficient and ineffective hospitals were then removed to create a reference group of high-performance hospitals. Predictive models for outcomes and costs were recalibrated to the reference hospitals and used to compute risk-adjusted outcomes and costs for all hospitals. Per case predicted costs were computed and compared with observed costs. Of the 688 hospitals with acceptable data, 62 failed to meet effectiveness criteria and 210 were identified as inefficient. The remaining 416 high-performance hospitals had 13.4% fewer risk-adjusted adverse outcomes (4.56%-3.95%; P costs ($12,773-$11,512; P costs. A payment system based on the demonstrated performance of effective, efficient hospitals can produce sizable cost savings without jeopardizing quality. In this study, 96% of total excess hospital costs resulted from higher routine costs at inefficient hospitals, whereas only 4% was associated with ineffective care.

  12. Supplier managed inventory in the OEM supply chain : the impact of relationship types on total costs and cost distribution

    NARCIS (Netherlands)

    Nyen, van P.L.M.; Bertrand, J.W.M.; Ooijen, van H.P.G.; Vandaele, N.J.

    2009-01-01

    We investigate the impact of four variants of supplier managed inventory on total costs and cost distribution in a capital goods supply chain consisting of a parts supplier who delivers parts to an original equipment manufacturer’s assembly plant. The four supplier managed inventory variants differ

  13. The adoption of total cost of ownership for sourcing decisions - a structural equations analysis

    NARCIS (Netherlands)

    Wouters, Marc; Anderson, James C.; Wynstra, Finn

    2005-01-01

    This study investigates the adoption of total cost of ownership (TCO) analysis to improve sourcing decisions. TCO can be seen as an application of activity based costing (ABC) that quantifies the costs that are involved in acquiring and using purchased goods or services. TCO supports purchasing

  14. Association of Hospital Costs With Complications Following Total Gastrectomy for Gastric Adenocarcinoma.

    Science.gov (United States)

    Selby, Luke V; Gennarelli, Renee L; Schnorr, Geoffrey C; Solomon, Stephen B; Schattner, Mark A; Elkin, Elena B; Bach, Peter B; Strong, Vivian E

    2017-10-01

    Postoperative complications are associated with increased hospital costs following major surgery, but the mechanism by which they increase cost and the categories of care that drive this increase are poorly described. To describe the association of postoperative complications with hospital costs following total gastrectomy for gastric adenocarcinoma. This retrospective analysis of a prospectively collected gastric cancer surgery database at a single National Cancer Institute-designated comprehensive cancer center included all patients undergoing curative-intent total gastrectomy for gastric adenocarcinoma between January 2009 and December 2012 and was conducted in 2015 and 2016. Ninety-day normalized postoperative costs. Hospital accounting system costs were normalized to reflect Medicare reimbursement levels using the ratio of hospital costs to Medicare reimbursement and categorized into major cost categories. Differences between costs in Medicare proportional dollars (MP $) can be interpreted as the amount that would be reimbursed to an average hospital by Medicare if it paid differentially based on types and extent of postoperative complications. In total, 120 patients underwent curative-intent total gastrectomy for stage I through III gastric adenocarcinoma between 2009 and 2012. Of these, 79 patients (65.8%) were men, and the median (interquartile range) age was 64 (52-70) years. The 51 patients (42.5%) who underwent an uncomplicated total gastrectomy had a mean (SD) normalized cost of MP $12 330 (MP $2500), predominantly owing to the cost of surgical care (mean [SD] cost, MP $6830 [MP $1600]). The 34 patients (28.3%) who had a major complication had a mean (SD) normalized cost of MP $37 700 (MP $28 090). Surgical care was more expensive in these patients (mean [SD] cost, MP $8970 [MP $2750]) but was a smaller contributor to total cost (24%) owing to increased costs from room and board (mean [SD] cost, MP $11 940 [MP $8820]), consultations (mean [SD

  15. Age and Social Support Seeking: Understanding the Role of Perceived Social Costs to Others.

    Science.gov (United States)

    Jiang, Li; Drolet, Aimee; Kim, Heejung S

    2018-07-01

    We examined age differences in the use of different types of social support and the reasons for these differences. We found that older adults (age 60+) seek explicit social support less compared with young adults (age 18-25), but there is no difference in implicit social support seeking. Concerns about the potential social costs of seeking explicit support mediate the age differences in explicit social support seeking. Whereas young adults view this strategy as conferring more benefits than costs, older adults have a more balanced view of the costs and benefits of explicit social support seeking. Older and young adults do not differ in perceptions of the relative costs versus benefits of implicit social support seeking. Finally, we found older adults benefit more from implicit (vs. explicit) social support emotionally than young adults, which further explains why age groups differ in their use of explicit versus implicit social support.

  16. Strategies for reducing implant costs in the revision total knee arthroplasty episode of care.

    Science.gov (United States)

    Elbuluk, Ameer M; Old, Andrew B; Bosco, Joseph A; Schwarzkopf, Ran; Iorio, Richard

    2017-12-01

    Implant price has been identified as a significant contributing factor to high costs associated with revision total knee arthroplasty (rTKA). The goal of this study is to analyze the cost of implants used in rTKAs and to compare this pricing with 2 alternative pricing models. Using our institutional database, we identified 52 patients from January 1, 2014 to December 31, 2014. Average cost of components for each case was calculated and compared to the total hospital cost for that admission. Costs for an all-component revision were then compared to a proposed "direct to hospital" (DTH) standardized pricing model and a fixed price revision option. Potential savings were calculated from these figures. On average, 28% of the total hospital cost was spent on implants for rTKA. The average cost for revision of all components was $13,640 and ranged from $3000 to $28,000. On average, this represented 32.7% of the total hospital cost. Direct to hospital implant pricing could potentially save approximately $7000 per rTKA, and the fixed pricing model could provide a further $1000 reduction per rTKA-potentially saving $8000 per case on implants alone. Alternative implant pricing models could help lower the total cost of rTKA, which would allow hospitals to achieve significant cost containment.

  17. A decision-making framework for total ownership cost management of complex systems: A Delphi study

    Science.gov (United States)

    King, Russel J.

    This qualitative study, using a modified Delphi method, was conducted to develop a decision-making framework for the total ownership cost management of complex systems in the aerospace industry. The primary focus of total ownership cost is to look beyond the purchase price when evaluating complex system life cycle alternatives. A thorough literature review and the opinions of a group of qualified experts resulted in a compilation of total ownership cost best practices, cost drivers, key performance factors, applicable assessment methods, practitioner credentials and potential barriers to effective implementation. The expert panel provided responses to the study questions using a 5-point Likert-type scale. Data were analyzed and provided to the panel members for review and discussion with the intent to achieve group consensus. As a result of the study, the experts agreed that a total ownership cost analysis should (a) be as simple as possible using historical data; (b) establish cost targets, metrics, and penalties early in the program; (c) monitor the targets throughout the product lifecycle and revise them as applicable historical data becomes available; and (d) directly link total ownership cost elements with other success factors during program development. The resultant study framework provides the business leader with incentives and methods to develop and implement strategies for controlling and reducing total ownership cost over the entire product life cycle when balancing cost, schedule, and performance decisions.

  18. The Social Cost Of Electricity. Scenarios and Policy Implications

    International Nuclear Information System (INIS)

    Markandya, A.; Bigano, A.; Porchia, R.

    2010-01-01

    This book reports and rationalizes the state-of-the-art concerning the social costs of electricity generation. Social costs are assessed by adding to the private generation costs, the external costs associated with damages to human health, the environment, crops, materials, and those related to the consequences of climate change. The authors consider the evolution of these costs up to 2030 for major electricity generating technologies and, using these estimates, evaluate policy options for external cost internalization, providing quantitative scenarios by country and primary fuel for 2010, 2020 and 2030. While mainly focusing on European countries, the book also examines the situation in key emerging economies such as China, India, Brazil and Turkey. With an analysis of the policies for external costs internalization, this book will appeal to energy policymakers, research institutions focusing on energy, environmental and energy NGOs and trade associations, as well as energy companies.

  19. Cost of the Cervical Cancer Screening Program at the Mexican Social Security Institute

    Directory of Open Access Journals (Sweden)

    Víctor Granados-García

    2014-09-01

    Full Text Available Objective. To estimate the annual cost of the National Cervical Cancer Screening Program (CCSP of the Mexican Institute of Social Security (IMSS. Materials and methods. This cost analysis examined regional coverage rates reported by IMSS. We estimated the number of cytology, colposcopy, biopsy and pathology evaluations, as well as the diagnostic test and treatment costs for cervical intraepithelial neoplasia grade II and III (CIN 2/3 and cervical cancer. Diagnostic test costs were estimated using a micro-costing technique. Sensitivity analyses were performed. Results. The cost to perform 2.7 million cytology tests was nearly 38 million dollars, which represents 26.1% of the total program cost (145.4 million. False negatives account for nearly 43% of the program costs. Conclusion. The low sensitivity of the cytology test generates high rates of false negatives, which results in high institutional costs from the treatment of undetected cervical cancer cases.

  20. The marginal social cost of headway for a scheduled service

    DEFF Research Database (Denmark)

    Fosgerau, Mogens

    2009-01-01

    waiting time costs as well as schedule delay costs measured relative to their desired time of arrival at the destination. They may either arrive at the station to choose just the next departure or they may plan for a specific departure in which case they incur also a planning cost. Then planning......This brief paper derives the marginal social cost of headway for a scheduled service, i.e. the cost for users of marginal increases to the time interval between departures. In brief we may call it the value of headway in analogy with the value of travel time and the value of reliability. Users have...... for a specific departure is costly but becomes more attractive at longer headways. Simple expressions for the user cost result. In particular, the marginal cost of headway is large at short headways and smaller at long headways. The difference in marginal costs is the value of time multiplied by half the headway....

  1. Animal board invited review: Dairy cow lameness expenditures, losses and total cost.

    Science.gov (United States)

    Dolecheck, K; Bewley, J

    2018-03-20

    Lameness is one of the most costly dairy cow diseases, yet adoption of lameness prevention strategies remains low. Low lameness prevention adoption might be attributable to a lack of understanding regarding total lameness costs. In this review, we evaluated the contribution of different expenditures and losses to total lameness costs. Evaluated expenditures included labor for treatment, therapeutic supplies, lameness detection and lameness control and prevention. Evaluated losses included non-saleable milk, reduced milk production, reduced reproductive performance, increased animal death, increased animal culling, disease interrelationships, lameness recurrence and reduced animal welfare. The previous literature on total lameness cost estimates was also summarized. The reviewed studies indicated that previous estimates of total lameness costs are variable and inconsistent in the expenditures and losses they include. Many of the identified expenditure and loss categories require further research to accurately include in total lameness cost estimates. Future research should focus on identifying costs associated with specific lameness conditions, differing lameness severity levels, and differing stages of lactation at onset of lameness to provide better total lameness cost estimates that can be useful for decision making at both the herd and individual cow level.

  2. Determining the Effect (the Social Costs) of Exclusion under the ...

    African Journals Online (AJOL)

    Determining the Effect (the Social Costs) of Exclusion under the South African Exclusionary Rule: Should Factual Guilt Tilt the Scales in Favour of the Admission of Unconstitutionally Obtained Evidence?

  3. [Preliminary analysis of total cost and life quality for elder patients with femoral neck fracture].

    Science.gov (United States)

    Liu, Haonan; He, Liang; Zhang, Guilin; Gong, Xiaofeng; Li, Ning

    2015-09-01

    To analyze the total cost and life quality of the femoral neck fracture patients who received different surgery and supplement comprehensive data of osteoporotic fracture. One hundred and five patients above 60-year old who were diagnosed femoral neck fracture and received operation in Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital were admitted into our study from August 2013 to December. According to the type of surgery there were 52 and 53 cases in internal fixation (IF) group and hemiarthroplasty (HA) group respectively. At first we collected the medical expense of the patients before and during hospitalization. And then the 1-year medical and non-medical expenses were collected by the cost diary ever 3 months after discharge. At the last follow-up we evaluated the life quality by the EuroQol-5 Dimensions (EQ-5D) and calculated the total cost. Outcome All the patients completed the operation successfully. No nonunion or delayed union cases in IF group, and no cases received revision surgery in both groups. The total average cost was 59 584.9 yuan including 79.1% medical cost and 20.9% non-medical cost. The primary treatment cost accounts for 84.1% of the medical cost. The cost for home care accounts for 90.7% of the non-medical care. The total and medical cost of IF group just account for 40.3% and 38.5% of the HA group and the non-medical showed no significant difference between the 2 groups (P>0.05). In addition the data of life quality and walking capability also showed no significant difference. The main cost for the femoral neck fracture is medical expense in 1-year follow-up. Both surgeries can provide satisfactory outcome, however IF may be more cost-effective compared to the HA because of the less total cost.

  4. Resource use and costs associated with opioid-induced constipation following total hip or total knee replacement surgery

    Directory of Open Access Journals (Sweden)

    Wittbrodt ET

    2018-05-01

    Full Text Available Eric T Wittbrodt,1 Tong J Gan,2 Catherine Datto,1 Charles McLeskey,1 Meenal Sinha3 1US Medical Affairs, AstraZeneca, Wilmington, DE, USA; 2Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY, USA; 3Premier Applied Sciences, Premier, Inc., Charlotte, NC, USA Purpose: Constipation is a well-known complication of surgery that can be exacerbated by opioid analgesics. This study evaluated resource utilization and costs associated with opioid-induced constipation (OIC. Patients and methods: This retrospective, observational, and propensity-matched cohort study utilized the Premier Healthcare Database. The study included adults ≥18 years of age undergoing total hip or total knee replacement as inpatients who received an opioid analgesic and were discharged between January 1, 2012, and June 30, 2015. Diagnosis codes identified patients with OIC who were then matched 1:1 to patients without OIC. Generalized linear and logistic regression models were used to compare inpatient resource utilization, total hospital costs, inpatient mortality, and 30-day all-cause readmissions and emergency department visits. Results: Of 788,448 eligible patients, 40,891 (5.2% had OIC. Covariates were well balanced between matched patients with and without OIC (n=40,890 each. In adjusted analyses, patients with OIC had longer hospital lengths of stay (3.6 versus 3.3 days; p<0.001, higher total hospital costs (US$17,479 versus US$16,265; p<0.001, greater risk of intensive care unit admission (odds ratio [OR]=1.12, 95% CI: 1.01–1.24, and increased likelihood of 30-day hospital readmissions (OR=1.16, 95% CI: 1.11–1.22 and emergency department visits (OR=1.38, 95% CI: 1.07–1.79 than patients without OIC. No statistically significant difference was found with inpatient mortality (OR=0.89, 95% CI: 0.59–1.35. Conclusion: OIC was associated with greater resource utilization and hospital costs for patients undergoing primarily elective total hip or total knee

  5. Analysis of economic and social costs of adverse events associated with blood transfusions in Spain.

    Science.gov (United States)

    Ribed-Sánchez, Borja; González-Gaya, Cristina; Varea-Díaz, Sara; Corbacho-Fabregat, Carlos; Bule-Farto, Isabel; Pérez de-Oteyza, Jaime

    2018-02-16

    To calculate, for the first time, the direct and social costs of transfusion-related adverse events in order to include them in the National Healthcare System's budget, calculation and studies. In Spain more than 1,500 patients yearly are diagnosed with such adverse events. Blood transfusion-related adverse events recorded yearly in Spanish haemovigilance reports were studied retrospectively (2010-2015). The adverse events were coded according to the classification of Diagnosis-Related Groups. The direct healthcare costs were obtained from public information sources. The productivity loss (social cost) associated with adverse events was calculated using the human capital and hedonic salary methodologies. In 2015, 1,588 patients had adverse events that resulted in direct health care costs (4,568,914€) and social costs due to hospitalization (200,724€). Three adverse reactions resulted in patient death (at a social cost of 1,364,805€). In total, the cost of blood transfusion-related adverse events was 6,134,443€ in Spain. For the period 2010-2015: the trends show a reduction in the total amount of transfusions (2 vs. 1.91M€; -4.4%). The number of adverse events increased (822 vs. 1,588; +93%), as well as their related direct healthcare cost (3.22 vs. 4.57M€; +42%) and the social cost of hospitalization (110 vs 200M€; +83%). Mortality costs decreased (2.65 vs. 1.36M€; -48%). This is the first time that the costs of post-transfusion adverse events have been calculated in Spain. These new figures and trends should be taken into consideration in any cost-effectiveness study or trial of new surgical techniques or sanitary policies that influence blood transfusion activities. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Using value-based total cost of ownership (TCO) measures to inform subsystem trade-offs

    Science.gov (United States)

    Radziwill, Nicole M.; DuPlain, Ronald F.

    2010-07-01

    Total Cost of Ownership (TCO) is a metric from management accounting that helps expose both the direct and indirect costs of a business decision. However, TCO can sometimes be too simplistic for "make vs. buy" decisions (or even choosing between competing design alternatives) when value and extensibility are more critical than total cost. A three-dimensional value-based TCO, which was developed to clarify product decisions for an observatory prior to Final Design Review (FDR), will be presented in this session. This value-based approach incorporates priority of requirements, satisfiability of requirements, and cost, and can be easily applied in any environment.

  7. Determining the total cost of reverse supply chain operations for original equipment manufacturers

    DEFF Research Database (Denmark)

    Larsen, Samuel Brüning; Jacobsen, Peter

    2014-01-01

    When original equipment manufacturers (OEM) examine whether or not to invest in a reverse supply chain (RSC), managers need insight into not only the cost savings and new revenue streams the RSC enables, but also the total cost of the RSC itself. Using case study research the study examines what...... cost parameters constitute the total cost (TC) of the RSC. The specific RSC that the study seeks the TC for consists of 1) end-product refurbishing, 2) component refurbishing, and 3) sales of used materials back to original suppliers or independent recyclers for materials recycling....

  8. Evaluation of the Total Cost of Ownership of Fuel Cell-Powered Material Handling Equipment

    Energy Technology Data Exchange (ETDEWEB)

    Ramsden, T.

    2013-04-01

    This report discusses an analysis of the total cost of ownership of fuel cell-powered and traditional battery-powered material handling equipment (MHE, or more typically 'forklifts'). A number of fuel cell MHE deployments have received funding support from the federal government. Using data from these government co-funded deployments, DOE's National Renewable Energy Laboratory (NREL) has been evaluating the performance of fuel cells in material handling applications. NREL has assessed the total cost of ownership of fuel cell MHE and compared it to the cost of ownership of traditional battery-powered MHE. As part of its cost of ownership assessment, NREL looked at a range of costs associated with MHE operation, including the capital costs of battery and fuel cell systems, the cost of supporting infrastructure, maintenance costs, warehouse space costs, and labor costs. Considering all these costs, NREL found that fuel cell MHE can have a lower overall cost of ownership than comparable battery-powered MHE.

  9. Variation in the cost of care for primary total knee arthroplasties.

    Science.gov (United States)

    Haas, Derek A; Kaplan, Robert S

    2017-03-01

    The study examined the cost variation across 29 high-volume US hospitals and their affiliated orthopaedic surgeons for delivering a primary total knee arthroplasty without major complicating conditions. The hospitals had similar patient demographics, and more than 80% of them had statistically-similar Medicare risk-adjusted readmission and complication rates. Hospital and physician personnel costs were calculated using time-driven activity-based costing. Consumable supply costs, such as the prosthetic implant, were calculated using purchase prices, and postacute care costs were measured using either internal costs or external claims as reported by each hospital. Despite having similar patient demographics and readmission and complication rates, the average cost of care for total knee arthroplasty across the hospitals varied by a factor of about 2 to 1. Even after adjusting for differences in internal labor cost rates, the hospital at the 90th percentile of cost spent about twice as much as the one at the 10th percentile of cost. The large variation in costs among sites suggests major and multiple opportunities to transfer knowledge about process and productivity improvements that lower costs while simultaneously maintaining or improving outcomes.

  10. Relationship between patient dependence and direct medical-, social-, indirect-, and informal-care costs in Spain

    Directory of Open Access Journals (Sweden)

    Darbà J

    2015-07-01

    over 6 months for direct medical-, social-, indirect-, and informal-care costs were estimated at €1,028.10 (€1,655.00, €843.80 (€2,684.80, €464.20 (€1,639.00, and €33,232.20 (€30,898.90, respectively. Dependence was independently and significantly associated with direct medical-, social-, informal-, and total-care costs. Conclusion: The costs of care for patients with AD in Spain are substantial, with informal care accounting for the greatest part. Interventions that reduce patient dependence on caregivers may be associated with important reduction in direct medical-, social-, informal-, and total-care costs. Keywords: Alzheimer, Dependence Scale, direct medical care costs, social care costs, indirect care costs, informal care costs.

  11. Total life-cycle cost analysis of conventional and alternative fueled vehicles

    International Nuclear Information System (INIS)

    Cardullo, M.W.

    1993-01-01

    Total Life-Cycle Cost (TLCC) Analysis can indicate whether paying higher capital costs for advanced technology with low operating and/or environmental costs is advantageous over paying lower capital costs for conventional technology with higher operating and/or environmental costs. While minimizing total life-cycle cost is an important consideration, the consumer often identifies non-cost-related benefits or drawbacks that make more expensive options appear more attractive. The consumer is also likely to heavily weigh initial capital costs while giving limited consideration to operating and/or societal costs, whereas policy-makers considering external costs, such as those resulting from environmental impacts, may reach significantly different conclusions about which technologies are most advantageous to society. This paper summarizes a TLCC model which was developed to facilitate consideration of the various factors involved in both individual and societal policy decision making. The model was developed as part of a US Department of Energy Contract and has been revised to reflect changes necessary to make the model more realistic. The model considers capital, operating, salvage, and environmental costs for cars, vans, and buses using conventional and alternative fuels. The model has been developed to operate on an IBM or compatible personal computer platform using the commercial spreadsheet program MicroSoft Excell reg-sign Version 4 for Windows reg-sign and can be easily kept current because its modular structure allows straightforward access to embedded data sets for review and update

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

    National Research Council Canada - National Science Library

    Reed, Danny

    2003-01-01

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

  13. Do illness rating systems predict discharge location, length of stay, and cost after total hip arthroplasty?

    Directory of Open Access Journals (Sweden)

    Sarah E. Rudasill, BA

    2018-06-01

    Conclusions: These findings suggest that although ASA classifications predict discharge location and SOI scores predict length of stay and total costs, other factors beyond illness rating systems remain stronger predictors of discharge for THA patients.

  14. Minimizing total costs of forest roads with computer-aided design ...

    Indian Academy of Sciences (India)

    imum total road costs, while conforming to design specifications, environmental ..... quality, and enhancing fish and wildlife habitat, an appropriate design ..... Soil, Water and Timber Management: Forest Engineering Solutions in Response to.

  15. Total Corporate social responsibility report 2004. Sharing our energy; TOTAL rapport societal and environnemental 2004. Notre energie en partage

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-05-15

    This document presents the social and environmental activities of the group Total for the year 2004. It provides information on the ethical aspects of the governance, the industrial security, the environmental policy, the public health and the occupational safety, the social liability and the economical and social impact of the group activities in the local development, the contribution to the climatic change fight and the development of other energy sources. (A.L.B.)

  16. Use of predefined biochemical admission profiles does not reduce the number of tests or total cost

    DEFF Research Database (Denmark)

    Pareek, Manan; Haidl, Felix; Folkestad, Lars

    2014-01-01

    The objective of this pilot study was to evaluate whether the use of predefined biochemical profiles as an alternative to individually ordered blood tests by the treating physicians resulted in fewer tests or a lower total cost.......The objective of this pilot study was to evaluate whether the use of predefined biochemical profiles as an alternative to individually ordered blood tests by the treating physicians resulted in fewer tests or a lower total cost....

  17. Comparative cost analyses: total flow vs other power conversion systems for the Salton Sea Geothermal Resource

    Energy Technology Data Exchange (ETDEWEB)

    Wright, G.W.

    1978-09-18

    Cost studies were done for Total Flow, double flash, and multistage flash binary systems for electric Energy production from the Salton Sea Geothermal Resource. The purpose was to provide the Department of energy's Division of Geothermal Energy with information by which to judge whether to continue development of the Total Flow system. Results indicate that the Total Flow and double flash systems have capital costs of $1,135 and $1,026 /kW with energy costs of 40.9 and 39.7 mills/kW h respectively. The Total Flow and double flash systems are not distinguishable on a cost basis alone; the multistage flash binary system, with capital cost of $1,343 /kW and energy cost of 46.9 mills/kW h, is significantly more expensive. If oil savings are considered in the total analysis, the Total Flow system could save 30% more oil than the double flash system, $3.5 billion at 1978 oil prices.

  18. Transaction costs and social networks in productivity measurement

    DEFF Research Database (Denmark)

    Henningsen, Geraldine; Henningsen, Arne; Henning, Christian H. C. A.

    2015-01-01

    and support. Hence, we use measures of a firm’s access to social networks as a proxy for the transaction costs the firm faces. We develop a microeconomic production model that takes into account transaction costs and networks. Using a data set of 384 Polish farms, we empirically estimate this model......We argue that in the presence of transaction costs, observed productivity measures may in many cases understate the true productivity, as production data seldom distinguish between resources entering the production process and resources of a similar type that are sacrificed for transaction costs....... Hence, both the absolute productivity measures and, more importantly, the productivity ranking will be distorted. A major driver of transaction costs is poor access to information and contract enforcement assistance. Social networks often catalyse information exchange as well as generate trust...

  19. The social cost of drugs in France in 2010.

    Science.gov (United States)

    Kopp, Pierre; Ogrodnik, Marysia

    2017-09-01

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

  20. Cost of Radiotherapy Versus NSAID Administration for Prevention of Heterotopic Ossification After Total Hip Arthroplasty

    International Nuclear Information System (INIS)

    Strauss, Jonathan B.; Chen, Sea S.; Shah, Anand P.; Coon, Alan B.; Dickler, Adam

    2008-01-01

    Purpose: Heterotopic ossification (HO), or abnormal bone formation, is a common sequela of total hip arthroplasty. This abnormal bone can impair joint function and must be surgically removed to restore mobility. HO can be prevented by postoperative nonsteroidal anti-inflammatory drug (NSAID) use or radiotherapy (RT). NSAIDs are associated with multiple toxicities, including gastrointestinal bleeding. Although RT has been shown to be more efficacious than NSAIDs at preventing HO, its cost-effectiveness has been questioned. Methods and Materials: We performed an analysis of the cost of postoperative RT to the hip compared with NSAID administration, taking into account the costs of surgery for HO formation, treatment-induced morbidity, and productivity loss from missed work. The costs of RT, surgical revision, and treatment of gastrointestinal bleeding were estimated using the 2007 Medicare Fee Schedule and inpatient diagnosis-related group codes. The cost of lost wages was estimated using the 2006 median salary data from the U.S. Census Bureau. Results: The cost of administering RT was estimated at $899 vs. $20 for NSAID use. After accounting for the additional costs associated with revision total hip arthroplasty and gastrointestinal bleeding, the corresponding estimated costs were $1,208 vs. $930. Conclusion: If the costs associated with treatment failure and treatment-induced morbidity are considered, the cost of NSAIDs approaches that of RT. Other NSAID morbidities and quality-of-life differences that are difficult to quantify add to the cost of NSAIDs. These considerations have led us to recommend RT as the preferred modality for use in prophylaxis against HO after total hip arthroplasty, even when the cost is considered

  1. Time-driven activity based costing of total knee replacement surgery at a London teaching hospital.

    Science.gov (United States)

    Chen, Alvin; Sabharwal, Sanjeeve; Akhtar, Kashif; Makaram, Navnit; Gupte, Chinmay M

    2015-12-01

    The aim of this study was to conduct a time-driven activity based costing (TDABC) analysis of the clinical pathway for total knee replacement (TKR) and to determine where the major cost drivers lay. The in-patient pathway was prospectively mapped utilising a TDABC model, following 20 TKRs. The mean age for these patients was 73.4 years. All patients were ASA grade I or II and their mean BMI was 30.4. The 14 varus knees had a mean deformity of 5.32° and the six valgus knee had a mean deformity of 10.83°. Timings were prospectively collected as each patient was followed through the TKR pathway. Pre-operative costs including pre-assessment and joint school were £ 163. Total staff costs for admission and the operating theatre were £ 658. Consumables cost for the operating theatre were £ 1862. The average length of stay was 5.25 days at a total cost of £ 910. Trust overheads contributed £ 1651. The overall institutional cost of a 'noncomplex' TKR in patients without substantial medical co-morbidities was estimated to be £ 5422, representing a profit of £ 1065 based on a best practice tariff of £ 6487. The major cost drivers in the TKR pathway were determined to be theatre consumables, corporate overheads, overall ward cost and operating theatre staffing costs. Appropriate discounting of implant costs, reduction in length of stay by adopting an enhanced recovery programme and control of corporate overheads through the use of elective orthopaedic treatment centres are proposed approaches for reducing the overall cost of treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. At What Cost? Examining the Cost Effectiveness of a Universal Social-Emotional Learning Program

    Science.gov (United States)

    Hunter, Leah J.; DiPerna, James C.; Hart, Susan Crandall; Crowley, Max

    2018-01-01

    Although implementation of universal social-emotional learning programs is becoming more common in schools, few studies have examined the cost-effectiveness of such programs. As such, the purpose of this article is two fold. First, we provide an overview of cost-effectiveness methods for school-based programs, and second, we share results of a…

  3. Social cost-benefit analysis and nuclear futures

    International Nuclear Information System (INIS)

    Pearce, D.W.

    1979-01-01

    The usefulness of cost-benefit analysis in making nuclear power investment decisions is considered. The essence of social cost-benefit analysis is outlined and shown to be unavoidably value-laden. As a case study six issues relevant to the decision to build on oxide fuel reprocessing plant (THORP) are examined. The potential practical value of using cost-benefit analysis as an aid to decision-making is considered for each of these issues. It is concluded that cost-benefit approach is of limited value in the nuclear power case because of its inapplicability to such issues as the liberty of the individual and nuclear weapons proliferation. (author)

  4. Social policy and costs of social protection and health

    OpenAIRE

    Koukoufilippou, Ioannis; Papavasileiou, Evanthia; Koinis, Aristotelis

    2016-01-01

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

  5. Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program

    International Nuclear Information System (INIS)

    1989-05-01

    The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's (DOE) Civilian Radioactive Waste Management Program is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 -- a fee levied on electricity generated in commercial nuclear power plants -- is sufficient to cover the cost of the program. This report provides cost estimates for the sixth annual evaluation of the adequacy of the fee and is consistent with the program strategy and plans contained in the DOE's Draft 1988 Mission Plan Amendment. The total-system cost for the system with a repository at Yucca Mountain, Nevada, a facility for monitored retrievable storage (MRS), and a transportation system is estimated at $24 billion (expressed in constant 1988 dollars). In the event that a second repository is required and is authorized by the Congress, the total-system cost is estimated at $31 to $33 billion, depending on the quantity of spent fuel to be disposed of. The $7 billion cost savings for the single-repository system in comparison with the two-repository system is due to the elimination of $3 billion for second-repository development and $7 billion for the second-repository facility. These savings are offset by $2 billion in additional costs at the first repository and $1 billion in combined higher costs for the MRS facility and transportation. 55 refs., 2 figs., 24 tabs

  6. Benefits and Costs of Social Media in Adolescence.

    Science.gov (United States)

    Uhls, Yalda T; Ellison, Nicole B; Subrahmanyam, Kaveri

    2017-11-01

    In 2015, American adolescents aged 13 to 18 years reported using social media 1 hour and 11 minutes a day, 7 days a week. Social media are used for a variety of activities, including sharing information, interacting with peers, and developing a coherent identity. In this review of the research, we examine how social media are intertwined with adolescent development and assess both the costs and benefits of adolescent social media use. We include suggestions for further research and recommendations for clinicians, policy makers, and educators. Copyright © 2017 by the American Academy of Pediatrics.

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

    Science.gov (United States)

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

    2017-03-01

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

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

    Science.gov (United States)

    Musgrove, P

    1995-01-01

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

  9. The Relationship between Cost Leadership Strategy, Total Quality Management Applications and Financial Performance

    Directory of Open Access Journals (Sweden)

    Ali KURT

    2016-03-01

    Full Text Available Firms need to implement some competition strategies and total quality management applications to overcome the fierce competition among others. The purpose of this study is to show the relationship between cost leadership strategy, total quality management applications and firms’ financial performance with literature review and empirical analysis. 449 questionnaires were conducted to the managers of 142 big firms. The data gathered was assessed with AMOS. As a result, the relationship between cost leadership strategy, total quality management applications and firms’ financial performance has been gathered. In addition, the relationship between TQM applications and financial performance has also been gathered.

  10. Clinical benefit and cost effectiveness of total knee arthroplasty in the older patient

    Directory of Open Access Journals (Sweden)

    Krummenauer F

    2009-02-01

    Full Text Available Abstract Purpose Total knee arthroplasty (TKA is an effective, but also cost-intensive health care procedure for the elderly. Furthermore, bearing demographic changes in Western Europe in mind, TKA-associated financial investment for health care insurers will increase notably and thereby catalyze discussions on ressource allocation to Orthopedic surgery. To derive a quantitative rationale for such discussions within Western Europe's health care systems, a prospective assessment of both the benefit of TKA from a patient's perspective as well as its cost effectiveness from a health care insurer's perspective was implemented. Methods A prospective cost effectiveness trial recruited a total of 65 patients (60% females, who underwent TKA in 2006; median age of patients was 66 years (interquartile range 61 - 74 years. Before and three months after surgery patients were interviewed by means of the EuroQol-5D and the WOMAC questionnaires to assess their individual benefit due to TKA and the subsequent inpatient rehabilitation. Both questionnaires' benefit estimates were transformed into the number of gained quality adjusted life years [QALYs]. Total direct cost estimates for the overall care were based on German DRG and rehabilitation cost rates [€]. The primary clinical endpoint of the investigation was the individual number of QALYs gained by TKA based on the WOMAC interview; the primary health economic endpoint was the marginal cost effectiveness ratio (MCER relating the costs to the associated gain in quality of life [€/QALY]. Results Total direct costs for the overall procedure were estimed 9549 € in median. The WOMAC based interview revealed an overall gain of 4.59 QALYs (interquartile range 2.39 - 6.21 QALYs, resulting in marginal costs of 1795 €/QALY (1488 - 3288 €/QALY. The corresponding EuroQol based estimates were 2.93 QALYs (1.75 - 5.59 QALYs and 3063 €/QALY (1613 - 5291 €/QALY. Logistic regression modelling identified the

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

    Science.gov (United States)

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

    2018-01-01

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

  12. Total costs and benefits of biomass in selected regions of the European Union - BioCosts

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, A de; Costa, F B [Coimbra Univ. (Portugal). Inst. de Sistemas e Robotica; Bauen, A [London Univ. (United Kingdom). Div. of Life Sciences; and others

    1998-11-01

    In the BioCosts project, representative biomass-to-electricity and biomass-to-transport-service fuel cycles located at different sites within the European Union have been evaluated concerning their environmental and economic performance. Each case study was compared to a fossil-fuel fired reference case. The case studies examined comprise: utilisation of forestry residues in the Naessjoe circulating fluidized bed combustion plant, Sweden, versus the use of Polish coal in the same plant; utilisation of forestry residues and short-rotation coppice for industrial combined heat and power production in Mangualde, Portugal, versus the use of fuel oil in an engine generating heat and power; production of biogas from manure slurry for municipal combined heat and power generation at Hashoej, Denmark, versus the use of Danish natural gas in the same engine; gasification of woody biomass for combined heat and power generation in Vaernamo, Sweden, and Eggborough, UK, versus the use of coal in the Naessjoe plant mentioned above and a UK power plant; production of cold-pressed rape-seed oil and its use in a cogeneration plant at Weissenburg, Germany, versus the use of diesel fuel in a similar engine; production of rape-seed oil methyl ester and its use for goods transport in Germany, versus the use of diesel fuel in the same fleet of trucks; production of ethyl tertiary butyl ether from sugar beets and sweet sorghum for transport applications in France, versus the use of methyl tertiary butyl ether from fossil sources for the same purpose 130 refs, 25 figs, 42 tabs. Research funded in part by the European Commission in the JOULE III programme

  13. In the balance. The social costs and benefits of PV

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, C. [ECN Solar Energy, Petten (Netherlands)

    2013-10-16

    For more than a decade, the growth in PV markets surpassed expectations. Then, in 2012, the European market declined for the first time compared with the previous year. As policymakers' support for PV hesitates over the costs to society of this technology, it is timely to take an overview of the social costs and benefits, also referred to as the 'external costs', of PV electricity. In this article, these costs are put into perspective vis-a-vis those associated with conventional electricity-generating technologies. The external costs of electricity can be broken down into: (1) the environmental and health costs; (2) the costs of subsidies and energy security; and (3) the costs for grid expansion and reliability. Included in these costs are the increased insurance, health, social and environmental costs associated with damages to health, infrastructure and environment, as well as tax payments that subsidize producers of electricity or fuels, their markets and the electricity infrastructure. A life cycle assessment (LCA) of the environmental impact is used in the quantification of the associated environmental and health costs. Because the environmental footprint of PV electricity is highly dependent on the electricity mix used in PV module fabrication, the environmental indicators are calculated for PV electricity manufactured using different electricity mixes, and compared with those for the European electricity mix (UCTE), and electricity generated by burning 100% coal or 100% natural gas. In 2012 USD, coal electricity requires 19-29 eurocent/kWh above the market price, compared with 1-1.6 eurocent/kWh for PV manufactured with 100% coal electricity. The sum of the subsidies, avoided fossil-fuel imports and energy security, and the economic stimulation associated with PV electricity deployment, amounts to net external benefits. Integrating high penetrations of renewables, with the same reliability as we have today, appears to be fully feasible and

  14. Transaction costs and social networks in productivity measurement

    DEFF Research Database (Denmark)

    Henningsen, Geraldine; Henningsen, Arne; Henning, Christian H. C. A.

    2015-01-01

    . Hence, both the absolute productivity measures and, more importantly, the productivity ranking will be distorted. A major driver of transaction costs is poor access to information and contract enforcement assistance. Social networks often catalyse information exchange as well as generate trust...... and support. Hence, we use measures of a firm’s access to social networks as a proxy for the transaction costs the firm faces. We develop a microeconomic production model that takes into account transaction costs and networks. Using a data set of 384 Polish farms, we empirically estimate this model...... and compare different parametric, semiparametric, and nonparametric model specifications. Our results generally support our hypothesis. Especially, large trading networks and dense household networks have a positive influence on a farm’s productivity. Furthermore, our results indicate that transaction costs...

  15. Bearing Procurement Analysis Method by Total Cost of Ownership Analysis and Reliability Prediction

    Science.gov (United States)

    Trusaji, Wildan; Akbar, Muhammad; Sukoyo; Irianto, Dradjad

    2018-03-01

    In making bearing procurement analysis, price and its reliability must be considered as decision criteria, since price determines the direct cost as acquisition cost and reliability of bearing determine the indirect cost such as maintenance cost. Despite the indirect cost is hard to identify and measured, it has high contribution to overall cost that will be incurred. So, the indirect cost of reliability must be considered when making bearing procurement analysis. This paper tries to explain bearing evaluation method with the total cost of ownership analysis to consider price and maintenance cost as decision criteria. Furthermore, since there is a lack of failure data when bearing evaluation phase is conducted, reliability prediction method is used to predict bearing reliability from its dynamic load rating parameter. With this method, bearing with a higher price but has higher reliability is preferable for long-term planning. But for short-term planning the cheaper one but has lower reliability is preferable. This contextuality can give rise to conflict between stakeholders. Thus, the planning horizon needs to be agreed by all stakeholder before making a procurement decision.

  16. Managing the total cost of risk exposures through risk mapping techniques

    International Nuclear Information System (INIS)

    Unione, A.J.; Rode, D.M.

    1998-01-01

    In a competitive power market, power producers are exposed to an increasingly broad spectrum of financial risks. The cumulative impact of these financial risks is known collectively as the Total of Cost of Risk. The concept of Total of Cost of Risk presents the business reality of a company's exposure to potentially devastating financial consequences in an integrated and useful way. In this way, a strategy of managing Total Cost of Risk in the most cost effective way can become a means of ensuring long term business health and security. This paper will examine the use of risk mapping as a tool for visually understanding Total Cost of Risk, thus creating an enhanced situational awareness and an integrated basis for risk management decision. The evaluation process, available through the use of risk maps allows the power producers to pro-actively implement prudent business decisions concerning the design, operation and maintenance of power plants. Risk mapping is thus a means for harmonizing operational objectives, such as improved plant reliability, with corporate strategies and goals in terms of an effective risk management program

  17. Time-based analysis of total cost of patient episodes: a case study of hip replacement.

    Science.gov (United States)

    Peltokorpi, Antti; Kujala, Jaakko

    2006-01-01

    Healthcare in the public and private sectors is facing increasing pressure to become more cost-effective. Time-based competition and work-in-progress have been used successfully to measure and improve the efficiency of industrial manufacturing. Seeks to address this issue. Presents a framework for time based management of the total cost of a patient episode and apply it to the six sigma DMAIC-process development approach. The framework is used to analyse hip replacement patient episodes in Päijät-Häme Hospital District in Finland, which has a catchment area of 210,000 inhabitants and performs an average of 230 hip replacements per year. The work-in-progress concept is applicable to healthcare--notably that the DMAIC-process development approach can be used to analyse the total cost of patient episodes. Concludes that a framework, which combines the patient-in-process and the DMAIC development approach, can be used not only to analyse the total cost of patient episode but also to improve patient process efficiency. Presents a framework that combines patient-in-process and DMAIC-process development approaches, which can be used to analyse the total cost of a patient episode in order to improve patient process efficiency.

  18. Hybrid Cloud Computing Architecture Optimization by Total Cost of Ownership Criterion

    Directory of Open Access Journals (Sweden)

    Elena Valeryevna Makarenko

    2014-12-01

    Full Text Available Achieving the goals of information security is a key factor in the decision to outsource information technology and, in particular, to decide on the migration of organizational data, applications, and other resources to the infrastructure, based on cloud computing. And the key issue in the selection of optimal architecture and the subsequent migration of business applications and data to the cloud organization information environment is the question of the total cost of ownership of IT infrastructure. This paper focuses on solving the problem of minimizing the total cost of ownership cloud.

  19. Total cost estimates for large-scale wind scenarios in UK

    International Nuclear Information System (INIS)

    Dale, Lewis; Milborrow, David; Slark, Richard; Strbac, Goran

    2004-01-01

    The recent UK Energy White Paper suggested that the Government should aim to secure 20% of electricity from renewable sources by 2020. A number of estimates of the extra cost of such a commitment have been made, but these have not necessarily included all the relevant cost components. This analysis sets out to identify these and to calculate the extra cost to the electricity consumer, assuming all the renewable electricity is sourced from wind energy. This enables one of the more controversial issues--the implications of wind intermittency--to be addressed. The basis of the assumptions associated with generating costs, extra balancing costs and distribution and transmission system reinforcement costs are all clearly identified and the total costs of a '20% wind' scenario are compared with a scenario where a similar amount of energy is generated by gas-fired plant. This enables the extra costs of the renewables scenario to be determined. The central estimate of the extra costs to electricity consumers is just over 0.3 p/kW h in current prices (around 5% extra on average domestic unit prices). Sensitivity analyses examine the implications of differing assumptions. The extra cost would rise if the capital costs of wind generation fall slower than anticipated, but would fall if gas prices rise more rapidly than has been assumed, or if wind plant are more productive. Even if it is assumed that wind has no capacity displacement value, the added cost to the electricity consumer rises by less than 0.1 p/kW h. It is concluded that there does not appear to be any technical reason why a substantial proportion of the country's electricity requirements could not be delivered by wind

  20. Confronting Perpetrators of Prejudice: The Inhibitory Effects of Social Costs

    Science.gov (United States)

    Shelton, J. Nicole; Stewart, Rebecca E.

    2004-01-01

    The purpose of this research is to investigate the extent to which social costs influence whether or not targets of prejudice confront individuals who behave in a prejudiced manner during interpersonal interactions. Consistent with our predictions, we found that although women believe they will confront perpetrators of prejudice regardless of the…

  1. Social costs enforce honesty of a dynamic signal of motivation

    Science.gov (United States)

    McGraw, Kevin J.

    2016-01-01

    Understanding the processes that promote signal reliability may provide important insights into the evolution of diverse signalling strategies among species. The signals that animals use to communicate must comprise mechanisms that prohibit or punish dishonesty, and social costs of dishonesty have been demonstrated for several fixed morphological signals (e.g. colour badges of birds and wasps). The costs maintaining the honesty of dynamic signals, which are more flexible and potentially cheatable, are unknown. Using an experimental manipulation of the dynamic visual signals used by male veiled chameleons (Chamaeleo calyptratus) during aggressive interactions, we tested the idea that the honesty of rapid colour change signals is maintained by social costs. Our results reveal that social costs are an important mechanism maintaining the honesty of these dynamic colour signals—‘dishonest’ chameleons whose experimentally manipulated coloration was incongruent with their contest behaviour received more physical aggression than ‘honest’ individuals. This is the first demonstration, to the best our knowledge, that the honesty of a dynamic signal of motivation—physiological colour change—can be maintained by the social costliness of dishonesty. Behavioural responses of signal receivers, irrespective of any specific detection mechanisms, therefore prevent chameleon cheaters from prospering. PMID:27798310

  2. Social costs enforce honesty of a dynamic signal of motivation.

    Science.gov (United States)

    Ligon, Russell A; McGraw, Kevin J

    2016-10-26

    Understanding the processes that promote signal reliability may provide important insights into the evolution of diverse signalling strategies among species. The signals that animals use to communicate must comprise mechanisms that prohibit or punish dishonesty, and social costs of dishonesty have been demonstrated for several fixed morphological signals (e.g. colour badges of birds and wasps). The costs maintaining the honesty of dynamic signals, which are more flexible and potentially cheatable, are unknown. Using an experimental manipulation of the dynamic visual signals used by male veiled chameleons (Chamaeleo calyptratus) during aggressive interactions, we tested the idea that the honesty of rapid colour change signals is maintained by social costs. Our results reveal that social costs are an important mechanism maintaining the honesty of these dynamic colour signals-'dishonest' chameleons whose experimentally manipulated coloration was incongruent with their contest behaviour received more physical aggression than 'honest' individuals. This is the first demonstration, to the best our knowledge, that the honesty of a dynamic signal of motivation-physiological colour change-can be maintained by the social costliness of dishonesty. Behavioural responses of signal receivers, irrespective of any specific detection mechanisms, therefore prevent chameleon cheaters from prospering. © 2016 The Author(s).

  3. The distribution over time of costs and social net benefits for pertussis immunization programs.

    Science.gov (United States)

    Girard, Dorota Zdanowska

    2010-03-01

    The cost of a six-dose pertussis immunization programs for children and adolescents is investigated in relation to estimators of the price of acellular vaccine, the value of a child's life, levels of vaccination rate and discount rates. We compare the cost of the program maintained over time at 90% with three alternative strategies, each involving a decrease in vaccination coverage. Data from England and Wales, 1966-2005, is used to formalize a delay in occurrence of pertussis cases as a result of a fall in coverage. We first apply the criterion of minimization of the total social cost of pertussis to identify the best cost saving immunization strategy. The results are also discussed in form of the discounted present value of the total social net benefits. We find that the discounted present value of the total social net benefit is maximized when a stable vaccination program at 90% is compared to a gradual decrease in vaccination coverage leading to the lowest vaccination rate. The benefits to society of providing sustained immunization strategy, vaccinating the highest proportion of children and adolescents, are systematically proved on the basis of the second optimisation criterion, independently of the level of estimators applied during economic evaluation for the cost variables.

  4. Total inpatient treatment costs in patients with severe burns: towards a more accurate reimbursement model.

    Science.gov (United States)

    Mehra, Tarun; Koljonen, Virve; Seifert, Burkhardt; Volbracht, Jörk; Giovanoli, Pietro; Plock, Jan; Moos, Rudolf Maria

    2015-01-01

    Reimbursement systems have difficulties depicting the actual cost of burn treatment, leaving care providers with a significant financial burden. Our aim was to establish a simple and accurate reimbursement model compatible with prospective payment systems. A total of 370 966 electronic medical records of patients discharged in 2012 to 2013 from Swiss university hospitals were reviewed. A total of 828 cases of burns including 109 cases of severe burns were retained. Costs, revenues and earnings for severe and nonsevere burns were analysed and a linear regression model predicting total inpatient treatment costs was established. The median total costs per case for severe burns was tenfold higher than for nonsevere burns (179 949 CHF [167 353 EUR] vs 11 312 CHF [10 520 EUR], interquartile ranges 96 782-328 618 CHF vs 4 874-27 783 CHF, p <0.001). The median of earnings per case for nonsevere burns was 588 CHF (547 EUR) (interquartile range -6 720 - 5 354 CHF) whereas severe burns incurred a large financial loss to care providers, with median earnings of -33 178 CHF (30 856 EUR) (interquartile range -95 533 - 23 662 CHF). Differences were highly significant (p <0.001). Our linear regression model predicting total costs per case with length of stay (LOS) as independent variable had an adjusted R2 of 0.67 (p <0.001 for LOS). Severe burns are systematically underfunded within the Swiss reimbursement system. Flat-rate DRG-based refunds poorly reflect the actual treatment costs. In conclusion, we suggest a reimbursement model based on a per diem rate for treatment of severe burns.

  5. The Relationship between Cost Leadership Strategy, Total Quality Management Applications and Financial Performance

    OpenAIRE

    Ali KURT; Cemal ZEHİR

    2016-01-01

    Firms need to implement some competition strategies and total quality management applications to overcome the fierce competition among others. The purpose of this study is to show the relationship between cost leadership strategy, total quality management applications and firms’ financial performance with literature review and empirical analysis. 449 questionnaires were conducted to the managers of 142 big firms. The data gathered was assessed with AMOS. As a result, the relationship between ...

  6. On the Social Cost of Distributed Selfish Content Replication

    DEFF Research Database (Denmark)

    Pollatos, Gerasimos G.; Telelis, Orestis A.; Zissimopoulos, Vassilis

    2008-01-01

    We study distributed content replication networks formed voluntarily by selfish autonomous users, seeking access to information objects that originate form distant servers. Each user caters to minimization of its individual access cost by replicating locally (up to constrained storage capacity......) a subset of objects, and accessing the rest form the nearest possible location. We show existence of stable networks by proving existence of pure strategy Nash equilibria for a game-theoretic formulation of this situation. Social (overall) cost of stable networks is measured by the average...... or by the maximum access cost experienced by any user. We study socially most and least expensive stable networks by means of tight bounds on the ratios of the Price of Anarchy and Stability respectively. Although in the worst case the ratios may coincide, we identify cases where they differ significantly. We...

  7. Discount rates, equity weights and the social cost of carbon

    International Nuclear Information System (INIS)

    Hope, Chris

    2008-01-01

    Equity weighting has been proposed as a way of allowing welfare equivalents to be included in the social cost of carbon since a dollar to a poor person is worth more than a dollar to a rich one. Here we use the PAGE2002 integrated assessment model to show that the social cost of carbon is higher without equity weights (an elasticity of marginal utility with respect to income of 0) than with them. This might seem counter-intuitive, but it comes about because of the logical link between equity weights and discount rates; as the elasticity goes from 0 to - 0.5 to - 1.0, the social rate of time preference rises, and the drop in present values that results far outweighs the small increase in impacts that equity weights bring. (author)

  8. Linking the spare parts management with the total costs of ownership: An agenda for future research

    International Nuclear Information System (INIS)

    Duran, O.; Roda, I.; Macchi, M.

    2016-01-01

    Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC). Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view). Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO). Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

  9. Linking the spare parts management with the total costs of ownership: An agenda for future research

    Energy Technology Data Exchange (ETDEWEB)

    Duran, O.; Roda, I.; Macchi, M.

    2016-07-01

    Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC). Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view). Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO). Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

  10. Linking the spare parts management with the total costs of ownership: An agenda for future research

    Directory of Open Access Journals (Sweden)

    Orlando Duran

    2016-12-01

    Full Text Available Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC. Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view. Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO. Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

  11. Total hip arthroplasty revision due to infection: a cost analysis approach.

    Science.gov (United States)

    Klouche, S; Sariali, E; Mamoudy, P

    2010-04-01

    The treatment of total hip arthroplasty (THA) infections is long and costly. However,the number of studies in the literature analysing the real cost of THA revision in relation to their etiology, including infection, is limited. The aim of this retrospective study was to determine the cost of revision of infected THA and to compare these costs to those of primary THA and revision of non-infected THA. We performed a retrospective cost analysis for the year 2006 using an identical analytic accounting system in each hospital department (according to internal criteria) based on allotment of direct costs and receipts for each department. From January to December 2006, 424 primary THA, 57 non-infected THA revisions and 40 THA revisions due to infection were performed. The different cost areas of the patient's treatment were identified.This included preoperative medical work-up, medicosurgical management during hospital stay,a second stay in an orthopedic rehabilitation hospital (ORH) and post-hospitalisation antibiotic therapy after revision due to infection, as well as home-based hospitalisation (HH) costs, if this was the selected alternative option. We used the national health insurance fee schedule found in the "Common classification of medical procedures" and the "General nomenclature of professional procedures" applicable in France since September 1, 2005. Hospital costs included direct costs (hospital overhead costs) and indirect costs, (medical, surgical, technical settings and net general service expenses). The calculation of HH costs and ORH costs were based on the average daily charge of these departments. The cost of primary THA was used as the reference.We then compared our surgical costs with those found for the corresponding comparable hospital stay groups (Groupes homogènes de séjour). The average hospital stay (AHS) was 7.5 +/- 1.8 days for primary THA, 8.9 +/- 2.2 days for non-infected revisions and 30.6 +/- 14.9 days for revisions due to infection

  12. A METHOD OF THE MINIMIZING OF THE TOTAL ACQUISITIONS COST WITH THE INCREASING VARIABLE DEMAND

    Directory of Open Access Journals (Sweden)

    ELEONORA IONELA FOCȘAN

    2015-12-01

    Full Text Available Over time, mankind has tried to find different ways of costs reduction. This subject which we are facing more often nowadays, has been detailed studied, without reaching a general model, and also efficient, regarding the costs reduction. Costs reduction entails a number of benefits over the entity, the most important being: increase revenue and default to the profit, increase productivity, a higher level of services / products offered to clients, and last but not least, the risk mitigation of the economic deficit. Therefore, each entity search different modes to obtain most benefits, for the company to succeed in a competitive market. This article supports the companies, trying to make known a new way of minimizing the total cost of acquisitions, by presenting some hypotheses about the increasing variable demand, proving them, and development of formulas for reducing the costs. The hypotheses presented in the model described below, can be maximally exploited to obtain new models of reducing the total cost, according to the modes of the purchase of entities which approach it.

  13. The social costs of alcohol misuse in Estonia.

    Science.gov (United States)

    Saar, Indrek

    2009-01-01

    The aim of this study was to estimate the social costs of alcohol misuse in Estonia in 2006. Using a prevalence-based cost-of-illness approach, both direct and indirect costs were considered, including tangible costs associated with health care, criminal justice, rescue services, damage to property, premature mortality, incarceration, incapability of working due to illnesses, and lower labor productivity. The results show that alcohol misuse cost Estonia more than EUR 200 million in 2006. The costs involved are estimated to represent 1.6% of the gross domestic product (GDP), which is relatively high in comparison with many other countries. In addition, the state receives less receipts from the alcohol excise tax than the costs that it incurs as a consequence of alcohol misuse, which points to the existence of economic inefficiency with respect to the alcohol market. The results of this study suggest that there is definitely a need for further cost-benefit analysis to reach a conclusion regarding the possible utility of government intervention. Copyright 2008 S. Karger AG, Basel.

  14. Total cost of ownership in the services sector: A case study

    NARCIS (Netherlands)

    K. Hurkens (Krisje); W. van der Valk (Wendy); J.Y.F. Wynstra (Finn)

    2006-01-01

    textabstractFew detailed studies exist of the trade-offs to be made when developing a comprehensive, strategically focused total cost of ownership (TCO) model. Moreover, most studies of TCO have been conducted in manufacturing firms, with little or no TCO research directed toward service

  15. Multi-Product Total Cost of Function for Higher Education: A Case of Bible Colleges.

    Science.gov (United States)

    Koshal, Rajindar K.; Koshal, Manjulika; Gupta, Ashok

    2001-01-01

    This study empirically estimates a multiproduct total cost function and output relationship for comprehensive U.S. universities. Statistical results for 184 Bible colleges suggest that there are both economies of scale and of scope in higher education. Additionally, product-specific economies of scope exist for all output levels and activities.…

  16. Counting the cost of social disadvantage in primary care: retrospective analysis of patient data.

    Science.gov (United States)

    Worrall, A; Rea, J N; Ben-Shlomo, Y

    1997-01-04

    To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current "deprivation" payments in relation to actual costings for patients living in qualifying areas. Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire. Inner city group practice with a socioeconomically diverse population. 382 male and female subjects of all ages, with a total of 1296 person years of observation. Primary care costs resulting from consultations with a general practitioner or a practice nurse and both new and repeat prescriptions. Morbidity, workload, and costs of drug treatment increased with decreasing socioeconomic status. The difference in cost for patients in social classes IV and V combined compared with those in I and II combined was about 150 Pounds per person year at risk (47 Pounds for workload and 103 Pounds for drugs). Deprivation payments met only half the extra workload cost for patients from qualifying wards. The greater workload caused by social disadvantage has been previously underestimated by simple consultation rates. The absolute difference in costs for socially disadvantaged patients increase as more detailed measures of workload and drug treatment are included. Current deprivation payments only partially offset the increased expenditure on workload. This shortfall will have to be addressed to attract general practitioners to, or retain them in, deprived areas.

  17. Permanent magnet design for magnetic heat pumps using total cost minimization

    Science.gov (United States)

    Teyber, R.; Trevizoli, P. V.; Christiaanse, T. V.; Govindappa, P.; Niknia, I.; Rowe, A.

    2017-11-01

    The active magnetic regenerator (AMR) is an attractive technology for efficient heat pumps and cooling systems. The costs associated with a permanent magnet for near room temperature applications are a central issue which must be solved for broad market implementation. To address this problem, we present a permanent magnet topology optimization to minimize the total cost of cooling using a thermoeconomic cost-rate balance coupled with an AMR model. A genetic algorithm identifies cost-minimizing magnet topologies. For a fixed temperature span of 15 K and 4.2 kg of gadolinium, the optimal magnet configuration provides 3.3 kW of cooling power with a second law efficiency (ηII) of 0.33 using 16.3 kg of permanent magnet material.

  18. Time-driven Activity-based Cost of Fast-Track Total Hip and Knee Arthroplasty

    DEFF Research Database (Denmark)

    Andreasen, Signe E; Holm, Henriette B; Jørgensen, Mira

    2017-01-01

    this between 2 departments with different logistical set-ups. METHODS: Prospective data collection was analyzed using the time-driven activity-based costing method (TDABC) on time consumed by different staff members involved in patient treatment in the perioperative period of fast-track THA and TKA in 2 Danish...... orthopedic departments with standardized fast-track settings, but different logistical set-ups. RESULTS: Length of stay was median 2 days in both departments. TDABC revealed minor differences in the perioperative settings between departments, but the total cost excluding the prosthesis was similar at USD......-track methodology, the result could be a more cost-effective pathway altogether. As THA and TKA are potentially costly procedures and the numbers are increasing in an economical limited environment, the aim of this study is to present baseline detailed economical calculations of fast-track THA and TKA and compare...

  19. Pengaruh Pengungkapan Corporate Social Responsibility terhadap Cost Of Equity Perusahaan

    Directory of Open Access Journals (Sweden)

    Mitta Ariyani

    2016-06-01

    The purpose of this study is to investigate the effect of Corporate Social Responsibility (CSR Disclosure on Cost of Equity Capital. CSR disclosure index is measured based on Global Reporting Initiative standards, while Cost of Equity Capital is measured by Capital Asset Pricing Model (CAPM. This study uses manufacturing companies which is listed on Indonesia Stock Exchange (IDX in 2010. By purposive sampling, this research obtained 72 companies as a samples. The control variables used are financial leverage and firm size. Multiple regression analysis by SPSS 16 was run for testing the hypothesis. The result show that CSR disclosure and financial leverage have no effect to Cost of Equity. Then, firm size have positive effect to Cost of Equity.

  20. Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Improvement Initiative.

    Science.gov (United States)

    Clair, Andrew J; Evangelista, Perry J; Lajam, Claudette M; Slover, James D; Bosco, Joseph A; Iorio, Richard

    2016-09-01

    The Bundled Payment for Care Improvement (BPCI) Initiative is a Centers for Medicare and Medicaid Services program designed to promote coordinated and efficient care. This study seeks to report costs of readmissions within a 90-day episode of care for BPCI Initiative patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA). From January 2013 through December 2013, 1 urban, tertiary, academic orthopedic hospital admitted 664 patients undergoing either primary TKA or THA through the BPCI Initiative. All patients readmitted to our hospital or an outside hospital within 90-days from the index episode were identified. The diagnosis and cost for each readmission were analyzed. Eighty readmissions in 69 of 664 patients (10%) were identified within 90-days. There were 53 readmissions (45 patients) after THA and 27 readmissions (24 patients) after TKA. Surgical complications accounted for 54% of THA readmissions and 44% of TKA readmissions. These complications had an average cost of $36,038 (range, $6375-$60,137) for THA and $38,953 (range, $4790-$104,794) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $27,979. Medical complications of THA and TKA had an average cost of $22,775 (range, $5678-$82,940) for THA and $24,183 (range, $3306-$186,069) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $11,682. Hospital readmissions after THA and TKA are common and costly. Identifying the causes for readmission and assessing the cost will guide quality improvement efforts. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2017-03-01

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

  2. Using Electromagnetic Algorithm for Total Costs of Sub-contractor Optimization in the Cellular Manufacturing Problem

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Shahriari

    2016-12-01

    Full Text Available In this paper, we present a non-linear binary programing for optimizing a specific cost in cellular manufacturing system in a controlled production condition. The system parameters are determined by the continuous distribution functions. The aim of the presented model is to optimize the total cost of imposed sub-contractors to the manufacturing system by determining how to allocate the machines and parts to each seller. In this system, DM could control the occupation level of each machine in the system. For solving the presented model, we used the electromagnetic meta-heuristic algorithm and Taguchi method for determining the optimal algorithm parameters.

  3. Cost-Effective Mobile-Based Healthcare System for Managing Total Joint Arthroplasty Follow-Up.

    Science.gov (United States)

    Bitsaki, Marina; Koutras, George; Heep, Hansjoerg; Koutras, Christos

    2017-01-01

    Long-term follow-up care after total joint arthroplasty is essential to evaluate hip and knee arthroplasty outcomes, to provide information to physicians and improve arthroplasty performance, and to improve patients' health condition. In this paper, we aim to improve the communication between arthroplasty patients and physicians and to reduce the cost of follow-up controls based on mobile application technologies and cloud computing. We propose a mobile-based healthcare system that provides cost-effective follow-up controls for primary arthroplasty patients through questions about symptoms in the replaced joint, questionnaires (WOMAC and SF-36v2) and the radiological examination of knee or hip joint. We also perform a cost analysis for a set of 423 patients that were treated in the University Clinic for Orthopedics in Essen-Werden. The estimation of healthcare costs shows significant cost savings (a reduction of 63.67% for readmission rate 5%) in both the University Clinic for Orthopedics in Essen-Werden and the state of North Rhine-Westphalia when the mobile-based healthcare system is applied. We propose a mHealth system to reduce the cost of follow-up assessments of arthroplasty patients through evaluation of diagnosis, self-monitoring, and regular review of their health status.

  4. Social costs of energy. Present status and future trends. Proceedings

    International Nuclear Information System (INIS)

    Hohmeyer, O.; Ottinger, R.L.

    1994-01-01

    The social or external costs of energy have received a high degree of internatinal attention since the publication of the first empirical results in 1988. Possible global climate change and the call for a sustainable future of mankind have put the question of social costs onto the agenda of many national and international converences like the 'Earth Summit' in Rio 1992. A scientific discussion has been sparked off, searching for the best methodoligical approaches and reliable empirical data. An overview of this discussion was given by the report on the 1st international workshop published in 1991. This book reports on the 2nd international workshop on the subject and gives a broad overview of the discussion in the 25 papers presented. It is the most comprehensive picture of this subject matter avvailable. (orig.)

  5. Analysis of economic and social costs of adverse events associated with blood transfusions in Spain

    Directory of Open Access Journals (Sweden)

    Borja Ribed-Sánchez

    2018-05-01

    Full Text Available Objective: To calculate, for the first time, the direct and social costs of transfusion-related adverse events in order to include them in the National Healthcare System's budget, calculation and studies. In Spain more than 1,500 patients yearly are diagnosed with such adverse events. Method: Blood transfusion-related adverse events recorded yearly in Spanish haemovigilance reports were studied retrospectively (2010-2015. The adverse events were coded according to the classification of Diagnosis-Related Groups. The direct healthcare costs were obtained from public information sources. The productivity loss (social cost associated with adverse events was calculated using the human capital and hedonic salary methodologies. Results: In 2015, 1,588 patients had adverse events that resulted in direct health care costs (4,568,914€ and social costs due to hospitalization (200,724€. Three adverse reactions resulted in patient death (at a social cost of 1,364,805€. In total, the cost of blood transfusion-related adverse events was 6,134,443€ in Spain. For the period 2010-2015: the trends show a reduction in the total amount of transfusions (2 vs. 1.91 M€; -4.4%. The number of adverse events increased (822 vs. 1,588; +93%, as well as their related direct healthcare cost (3.22 vs. 4.57M€; +42% and the social cost of hospitalization (110 vs 200M€; +83%. Mortality costs decreased (2.65 vs. 1.36M€; -48%. Discussion: This is the first time that the costs of post-transfusion adverse events have been calculated in Spain. These new figures and trends should be taken into consideration in any cost-effectiveness study or trial of new surgical techniques or sanitary policies that influence blood transfusion activities. Resumen: Objetivo: Calcular por primera vez los costes económicos y sociales relacionados con las reacciones adversas postransfusionales para actualizar estudios e incluirlos en los presupuestos del Sistema Nacional de Salud. En Espa

  6. Cost per case or total cost? The potential of prevention of hand injuries in young children – Retrospective and prospective studies

    Directory of Open Access Journals (Sweden)

    Carlsson Katarina

    2008-07-01

    Full Text Available Abstract Background Health-care costs for hand and forearm injuries in young children are poorly documented. We examined costs in 533 children injured years 1996–2003. Methods Health-care costs and costs for lost productivity were retrospectively calculated in children from three catchment areas in Sweden. Seven case categories corresponding to alternative prevention strategies were constructed. Results Over time, diminishing number of ward days reduced the health-care cost per case. Among children, the cost of lost productivity due to parental leave was 14 percent of total cost. Fingertip injuries had low median costs but high total costs due to their frequency. Complex injuries by machine or rifle had high costs per case, and despite a low number of cases, total cost was high. Type of injury, surgery and physiotherapy sessions were associated with variations in health-care cost. Low age and ethnic background had a significant effect on number of ward days. Conclusion The costs per hand injury for children were lower compared to adults due to both lower health-care costs and to the fact that parents had comparatively short periods of absence from work. Frequent simple fingertip injuries and rare complex injuries induce high costs for society. Such costs should be related to costs for prevention of these injuries.

  7. Taxing Electricity Sector Carbon Emissions at Social Cost

    OpenAIRE

    Paul, Anthony; Beasley, Blair; Palmer, Karen

    2013-01-01

    Concerns about budget deficits, tax reform, and climate change are fueling discussions about taxing carbon emissions to generate revenue and reduce greenhouse gas emissions. Imposing a carbon tax on electricity production based on the social cost of carbon (SCC) could generate between $21 and $82 billion in revenues in 2020 and would have important effects on electricity markets. The sources of emissions reductions in the sector depend on the level of the tax. A carbon tax based on lower SCC ...

  8. Costes sociales de siniestralidad laboral (2000-2007

    Directory of Open Access Journals (Sweden)

    María Nieves Remo Díez

    2013-03-01

    Full Text Available En el presente trabajo se realiza, en primer lugar, un análisis descriptivo de la siniestralidad laboral en España durante los años 2000 a 2007, considerando su evolución en función de distintasvariables. Para posteriormente y, dada la importante repercusión económica que los accidentes de trabajo y enfermedades profesionales suponen para la sociedad y para las empresas, cuantificar el coste social derivado de la siniestralidad laboral y desarrollar un modelo capaz de explicar las variables que influyen en el mismo y que ayude a la definición de medidas preventivas. Los resultados muestran que a pesar de los esfuerzos legislativos en materia de prevención deriesgos laborales en los últimos años, los costes sociales derivados de los accidentes de trabajo y las enfermedades profesionales alcanzaron en 2007 el 2% del PIB.In the present paper, it is being carried out a descriptive analysis of industrial accidents in Spain during the years 2000 to 2007, considering its evolution in terms of different variables. Moreover,and given the significant economic impact of occupational accidents and diseases mean to society and business, it is being quantified the social costs of workplace accidents in order to develop a model able to explain this variables and its influences. Furthermore, this model will help to define preventive measures. Finally and despite the legislative efforts in the prevention of occupational hazards in recent years, the results show that social costs of occupational accidents and occupational diseases in 2007 has reached 2% of GDP.

  9. 12 CFR Appendix K to Part 226 - Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions

    Science.gov (United States)

    2010-01-01

    ... Appendix K to Part 226—Total Annual Loan Cost Rate Computations for Reverse Mortgage Transactions (a... loan cost rate for various transactions, as well as instructions, explanations, and examples for.... (2) Term of the transaction. For purposes of total annual loan cost disclosures, the term of a...

  10. Social capital and transaction costs in millet markets.

    Science.gov (United States)

    Jacques, Damien Christophe; Marinho, Eduardo; d'Andrimont, Raphaël; Waldner, François; Radoux, Julien; Gaspart, Frédéric; Defourny, Pierre

    2018-01-01

    In sub-Saharan Africa, transaction costs are believed to be the most significant barrier that prevents smallholders and farmers from gaining access to markets and productive assets. In this study, we explore the impact of social capital on millet prices for three contrasted years in Senegal. Social capital is approximated using a unique data set on mobile phone communications between 9 million people allowing to simulate the business network between economic agents. Our approach is a spatial equilibrium model that integrates a diversified set of data. Local supply and demand were respectively derived from remotely sensed imagery and population density maps. The road network was used to establish market catchment areas, and transportation costs were derived from distances between markets. Results demonstrate that accounting for the social capital in the transaction costs explained 1-9% of the price variance depending on the year. The year-specific effect remains challenging to assess but could be related to a strengthening of risk aversion following a poor harvest.

  11. Social capital and transaction costs in millet markets

    Directory of Open Access Journals (Sweden)

    Damien Christophe Jacques

    2018-01-01

    Full Text Available In sub-Saharan Africa, transaction costs are believed to be the most significant barrier that prevents smallholders and farmers from gaining access to markets and productive assets. In this study, we explore the impact of social capital on millet prices for three contrasted years in Senegal. Social capital is approximated using a unique data set on mobile phone communications between 9 million people allowing to simulate the business network between economic agents. Our approach is a spatial equilibrium model that integrates a diversified set of data. Local supply and demand were respectively derived from remotely sensed imagery and population density maps. The road network was used to establish market catchment areas, and transportation costs were derived from distances between markets. Results demonstrate that accounting for the social capital in the transaction costs explained 1–9% of the price variance depending on the year. The year-specific effect remains challenging to assess but could be related to a strengthening of risk aversion following a poor harvest.

  12. Micronutrient deficiencies and gender: social and economic costs.

    Science.gov (United States)

    Darnton-Hill, Ian; Webb, Patrick; Harvey, Philip W J; Hunt, Joseph M; Dalmiya, Nita; Chopra, Mickey; Ball, Madeleine J; Bloem, Martin W; de Benoist, Bruno

    2005-05-01

    Vitamin and mineral deficiencies adversely affect a third of the world's people. Consequently, a series of global goals and a serious amount of donor and national resources have been directed at such micronutrient deficiencies. Drawing on the extensive experience of the authors in a variety of institutional settings, the article used a computer search of the published scientific literature of the topic, supplemented by reports and published and unpublished work from the various agencies. In examining the effect of sex on the economic and social costs of micronutrient deficiencies, the paper found that: (1) micronutrient deficiencies affect global health outcomes; (2) micronutrient deficiencies incur substantial economic costs; (3) health and nutrition outcomes are affected by sex; (4) micronutrient deficiencies are affected by sex, but this is often culturally specific; and finally, (5) the social and economic costs of micronutrient deficiencies, with particular reference to women and female adolescents and children, are likely to be considerable but are not well quantified. Given the potential impact on reducing infant and child mortality, reducing maternal mortality, and enhancing neuro-intellectual development and growth, the right of women and children to adequate food and nutrition should more explicitly reflect their special requirements in terms of micronutrients. The positive impact of alleviating micronutrient malnutrition on physical activity, education and productivity, and hence on national economies suggests that there is also an urgent need for increased effort to demonstrate the cost of these deficiencies, as well as the benefits of addressing them, especially compared with other health and nutrition interventions.

  13. Incorporating a total cost perspective intothe purchasing strategy : A case study of amedium sized retail compan

    OpenAIRE

    EKSTRÖM, MARCUS; FAHNEHJELM, CAROLINA

    2016-01-01

    The retail industry is today characterized by downward price pressure, and the increasedcompetition in the industry has led to pressure on profit margins. Purchasing and supply chainmanagement have become areas of increased strategic importance and play a crucial role inthe business performance. This study aims to extend previous literature in these fields byproviding the existing research with an empirical study on how the purchasing strategy canincorporate a total cost perspective of the su...

  14. Clinical and cost effectiveness-related aspects of retransfusion in total hip and knee arthroplasty.

    Science.gov (United States)

    Dobosz, Bartłomiej; Dutka, Julian; Dutka, Lukasz; Maleta, Paweł

    2012-01-01

    An increasing demand for blood products forces the rationalisation of management and conservation of blood. The aim of the study is to evaluate the possibility of retransfusion of blood conservation and the cost-effectiveness of this procedure when employed in Total Hip Replacement and Total Knee Arthroplasty. This prospective cohort study involved two groups of patients. Group I comprised 50 patients who underwent blood retransfusion and in several cases had supplementary allogeneic transfusion. Group II, a control group, consisted of 50 patients who did not receive retransfusion. The retransfusion in Group I enabled the recovery of a mean amount of 364.5 ml (± 52.7) of blood in THR patients and 403.8 ml (± 110.7) in TKA patients. Demand for allogeneic blood transfusions in Group I versus Group II was 46% lower in THR patients and 42% lower in TKA patients. The blood recovered for retransfusion is biologically valuable with regard to cellular elements and plasma chemistries. In the costs evaluation, the total savings in Group I were 5,000 PLN. Retransfusion of recuperated blood from postoperative drainage tubing is a simple and safe method that provides clinical and cost-effectiveness advantages.

  15. Climate-based policies may increase life-cycle social costs of vehicle fleet operation

    International Nuclear Information System (INIS)

    Emery, Isaac; Mbonimpa, Eric; Thal, Alfred E.

    2017-01-01

    Sustainability guidelines and regulations in the United States often focus exclusively on carbon or petroleum reductions. Though some of these policies have resulted in substantial progress toward their goals, the effects of these efforts on other social and environmental externalities are often ignored. In this study, we examine the life-cycle air pollutant emissions for alternative fuel and vehicle purchase scenarios at a military installation near a typical urban area in the United States (U.S.). We find that scenarios which minimize petroleum use or greenhouse gas emissions do not concomitantly minimize criteria air pollutant emissions. We also employ social cost methodologies to quantify economic externalities due to climate change and health-related air pollutant impacts. Accounting for the social costs of climate change and air pollution from vehicle use reveals that criteria air pollutants may have a greater total impact than greenhouse gas emissions in locations similar to the urban area examined in this study. Use of first-generation biofuels, particularly corn grain ethanol, may reduce net petroleum use at the cost of increased total health impacts. More comprehensive policies may be needed to ensure that sustainability policies result in a net benefit to society. - Highlights: • U.S. energy and transportation policies focus on petroleum use and greenhouse gases. • Use of corn ethanol at a military base in Ohio, U.S. increases total social costs vs. gasoline. • Renewable electricity provides cost-effective climate and health protection. • DOD strategy to improve energy security may damage Americans' health. • More inclusive policies needed to protect health and climate.

  16. The social cost of methane: theory and applications.

    Science.gov (United States)

    Shindell, D T; Fuglestvedt, J S; Collins, W J

    2017-08-24

    Methane emissions contribute to global warming, damage public health and reduce the yield of agricultural and forest ecosystems. Quantifying these damages to the planetary commons by calculating the social cost of methane (SCM) facilitates more comprehensive cost-benefit analyses of methane emissions control measures and is the first step to potentially incorporating them into the marketplace. Use of a broad measure of social welfare is also an attractive alternative or supplement to emission metrics focused on a temperature target in a given year as it incentivizes action to provide benefits over a broader range of impacts and timescales. Calculating the SCM using consistent temporal treatment of physical and economic processes and incorporating climate- and air quality-related impacts, we find large SCM values, e.g. ∼$2400 per ton and ∼$3600 per ton with 5% and 3% discount rates respectively. These values are ∼100 and 50 times greater than corresponding social costs for carbon dioxide. Our results suggest that ∼110 of 140 Mt of identified methane abatement via scaling up existing technology and policy options provide societal benefits that outweigh implementation costs. Within the energy sector, renewables compare far better against use of natural gas in electricity generation when incorporating these social costs for methane. In the agricultural sector, changes in livestock management practices, promoting healthy diets including reduced beef and dairy consumption, and reductions in food waste have been promoted as ways to mitigate emissions, and these are shown here to indeed have the potential to provide large societal benefits (∼$50-150 billion per year). Examining recent trends in methane and carbon dioxide, we find that increases in methane emissions may have offset much of the societal benefits from a slowdown in the growth rate of carbon dioxide emissions. The results indicate that efforts to reduce methane emissions via policies spanning a wide

  17. [Direct service costs of diabetes mellitus hospitalisations in the Mexican Institute of Social Security].

    Science.gov (United States)

    Salas-Zapata, Leonardo; Palacio-Mejía, Lina Sofía; Aracena-Genao, Belkis; Hernández-Ávila, Juan Eugenio; Nieto-López, Emmanuel Salvador

    To estimate the direct costs related to hospitalizations for diabetes mellitus and its complications in the Mexican Institute of Social Security METHODS: The hospital care costs of patients with diabetes mellitus using diagnosis-related groups in the IMSS (Mexican Institute of Social Security) and the hospital discharges from the corresponding E10-E14 codes for diabetes mellitus were estimated between 2008-2013. Costs were grouped according to demographic characteristics and main condition, and were estimated in US dollars in 2013. 411,302 diabetes mellitus discharges were recorded, representing a cost of $1,563 million. 52.44% of hospital discharges were men and 77.26% were for type 2 diabetes mellitus. The biggest cost was attributed to peripheral circulatory complications (34.84%) and people from 45-64 years of age (47.1%). Discharges decreased by 3.84% and total costs by 1.75% in the period analysed. The complications that caused the biggest cost variations were ketoacidosis (50.7%), ophthalmic (22.6%) and circulatory (18.81%). Hospital care for diabetes mellitus represents an important financial challenge for the IMSS. The increase in the frequency of hospitalisations in the productive age group, which affects society as a whole, is an even bigger challenge, and suggests the need to strengthen monitoring of diabetics in order to prevent complications that require hospital care. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Changes in Energy Cost and Total External Work of Muscles in Elite Race Walkers Walking at Different Speeds

    Directory of Open Access Journals (Sweden)

    Chwała Wiesław

    2014-12-01

    Full Text Available The aim of the study was to assess energy cost and total external work (total energy depending on the speed of race walking. Another objective was to determine the contribution of external work to total energy cost of walking at technical, threshold and racing speed in elite competitive race walkers.

  19. Social costs of illegal drugs, alcohol and tobacco in the European Union: A systematic review.

    Science.gov (United States)

    Barrio, Pablo; Reynolds, Jillian; García-Altés, Anna; Gual, Antoni; Anderson, Peter

    2017-09-01

    Drug use accounts for one of the main disease groups in Europe, with relevant consequences to society. There is an increasing need to evaluate the economic consequences of drug use in order to develop appropriate policies. Here, we review the social costs of illegal drugs, alcohol and tobacco in the European Union. A systematic search of relevant databases was conducted. Grey literature and previous systematic reviews were also searched. Studies reporting on social costs of illegal drugs, alcohol and tobacco were included. Methodology, cost components as well as costs were assessed from individual studies. To compare across studies, final costs were transformed to 2014 Euros. Forty-five studies reported in 43 papers met the inclusion criteria (11 for illegal drugs, 26 for alcohol and 8 for tobacco). While there was a constant inclusion of direct costs related to treatment of substance use and comorbidities, there was a high variability for the rest of cost components. Total costs showed also a great variability. Price per capita for the year 2014 ranged from €0.38 to €78 for illegal drugs, from €26 to €1500 for alcohol and from €10.55 to €391 for tobacco. Drug use imposes a heavy economic burden to Europe. However, given the high existing heterogeneity in methodologies, and in order to better assess the burden and thus to develop adequate policies, standardised methodological guidance is needed. [Barrio P, Reynolds J, García-Altés A, Gual A, Anderson P. Social costs of illegal drugs, alcohol and tobacco in the European Union: A systematic review. Drug Alcohol Rev 2017;00:000-000]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

  20. The social costs to the US of monopolization of the world oil market, 1972--1991

    International Nuclear Information System (INIS)

    Greene, D.L.; Leiby, P.N.

    1993-03-01

    The partial monopolization of the world oil market by the OPEC cartel has produced significant economic costs to the economies of the world. This paper reports estimates of the costs of monopolization of oil to the US over the period 1972--1991. Two fundamental assumptions of the analysis are, (1) that OPEC has acted as a monopoly, albeit with limited control, knowledge, and ability to act and, (2) that the US and other consuming nations could, through collective (social) action affect the cartel's ability to act as a monopoly. We measure total costs by comparing actual costs for the 1972--1991 period to a hypothetical ''more competitive'' world oil market scenario. By measuring past costs we avoid the enormous uncertainties about the future course of the world oil market and leave to the reader's judgment the issue of how much the future will be like the past. We note that total cost numbers cannot be used to determine the value of reducing US oil use by one barrel. They are useful for describing the overall size of the petroleum problem and are one important factor in deciding how much effort should be devoted to solving it. Monopoly pricing of oil transfers wealth from US oil consumers to foreign oil producers and, by increasing theeconomic scarcity of oil, reduces the economy's potential to produce. The actions of the OPEC cartel have also produced oil price shocks, both upward and downward, that generate additional costs because of the economy's inherent inability to adjust quickly to a large change in energy prices. Estimated total costs to the United States from these three sources for the 1972--1991 period are put at $4.1 trillion in 1990$($1.2 T wealth transfer, $0.8 T macroeconomic adjustment costs, $2.1 T potential GNP losses). The cost of the US's primary oil supply contingency program is small ($10 B) by comparison

  1. Episode of Care Payments in Total Joint Arthroplasty and Cost Minimization Strategies.

    Science.gov (United States)

    Nwachukwu, Benedict U; O'Donnell, Evan; McLawhorn, Alexander S; Cross, Michael B

    2016-02-01

    Total joint arthroplasty (TJA) is receiving significant attention in the US health care system for cost containment strategies. Specifically, payer organizations have embraced and are implementing bundled payment schemes in TJA. Consequently, hospitals and providers involved in the TJA care cycle have sought to adapt to the new financial pressures imposed by episode of care payment models by analyzing what components of the total "event" of a TJA are most essential to achieve a good outcome after TJA. As part of this review, we analyze and discuss a health economic study by Snow et al. As part of their study, the authors aimed to understand the association between preoperative physical therapy (PT) and post-acute care resource utilization, and its effect on the total cost of care during total joint arthroplasty. The purpose of this current review therefore is to (1) describe and analyze the findings presented by Snow et al. and (2) provide a framework for analyzing and critiquing economic analyses in orthopedic surgery. The study under review, while having important strengths, has several notable limitations that are important to keep in mind when making policy and coverage decisions. We support cautious interpretation and application of study results, and we encourage maintained attention to economic analysis in orthopedics as well as continued care path redesign to maximize value for patients and health care providers.

  2. Quantifying the social costs of nuclear energy: Perceived risk of accident at nuclear power plants

    International Nuclear Information System (INIS)

    Huhtala, Anni; Remes, Piia

    2017-01-01

    The preferences expressed in voting on nuclear reactor licenses and the risk perceptions of citizens provide insights into social costs of nuclear power and decision making in energy policy. We show analytically that these costs consist of disutility caused by unnecessary anxiety - due to misperceived risks relating to existing reactors - and where licenses for new nuclear reactors are not granted, delayed or totally lost energy production. Empirical evidence is derived from Finnish surveys eliciting explicitly the importance of risk perceptions on preferences regarding nuclear power and its environmental and economic impacts. We show that the estimated marginal impact of a high perceived risk of nuclear accident is statistically significant and that such a perception considerably decreases the probability of a person supporting nuclear power. This result holds across a number of robustness checks including an instrumental variable estimation and a model validation by observed voting behavior of the members of Parliament. The public's risk perceptions translate into a significant social cost, and are likely to affect the revenues, costs and financing conditions in the nuclear power sector in the future. - Highlights: • Survey on preferences regarding nuclear power and its environmental and economic impacts utilized. • A high perceived risk of nuclear accident decreases support for nuclear power. • The public's risk perceptions translate into a significant social cost.

  3. Methodology of Evaluation of the Impact of Picking Area Location on the Total Costs of Warehouse

    Directory of Open Access Journals (Sweden)

    Apsalons Raitis

    2017-12-01

    Full Text Available The picking system and the layout of the picking area are the key drivers for the evaluation of a warehouse picking cost. There are five variants for organizing the picking process of orders in a warehouse. The choice of a specific variant depends on the total cost of picking. The picking cost is evaluated within an uninterrupted picking process. It means that no stock out occurs in the time period of the picking process. The storing area and the picking area are created as two separate zones for picking quantities of the customer’s orders; the principle of division of orders is observed strictly. Referring to the locations of stock keeping units (SKU, two approaches of the layout of SKU in the picking area can be estimated. The first one is the single picking location for each single SKU, where replenishment is realized in the picking process. The second one - various picking locations for each single SKU, and the replenishment here is realized just only prior to a picking process or after it. The main benefits of the economy of the picking cost as far as these two approaches are concerned are the shortest picking route in the first case and one common replenishment option in the second case.

  4. Cost-effectivness analysis of total thyroidectomy vs radioiodine for Graves disease

    Directory of Open Access Journals (Sweden)

    Prokić Anđelka

    2013-01-01

    Full Text Available Among the patients suffering from hyperthyroidism 60-80% have Graves' disease. The initial therapy of Graves's disease are antithyroid drugs. If the remission is not achieved after 12-18 months, the patients should be directed to surgical treatment or to the therapy with radioactive iodine. The aim of this study was to compare cost/effectiveness ratios for radioactive iodine and total thyroidectomy. The analysis was made using Markov model, from the perspective of Republic Fund for Health Insurance in Serbia. Duration of one cycle in the model is six months, and the time horizon is 30 years. Monte Carlo simulation was performed for 1000 virtual patients as well as the analysis of sensitivity with the variation of parameters ± 50%. For total thyroidectomy the insurance should provide 138.389,72 RSD / 57, 83 QALY i.e. 2.393,04 dinars for one quality-adjusted life year, and for radioactive iodine the insurance should provide 110.043,64 RSD / 57,82 QALY i.e. 1.903,37 dinars for one quality-adjusted life year. This economic analysis showed that radioactive iodine has better ratio of costs to clinical effectiveness as opposed to total thyroidectomy.

  5. Social Cost Benefit Analysis for Environmental Policy-Making

    International Nuclear Information System (INIS)

    De Zeeuw, A.; In t Veld, R.; Van Soest, D.; Meuleman, L.; Hoogewoning, P.

    2008-01-01

    Review of the theoretical literature and the current debate on the valuation of environmental goods and services, on the discounting of future benefits and costs, and on how social cost benefit analysis (SCBAs) can be integrated in the policy and decision making process. It is concluded that SCBA can be a good decision support method in environmental policy-making if it is transparent and if all impacts are taken into account. Furthermore, the SCBA process should be participative, and politicians must be prepared to take responsibility for the assumptions behind the SCBA, including the assumptions on valuation and on the discount rate. Such a political role makes each SCBA a unique product of a politically responsible actor, and makes it possible for other stakeholders to have calculated an alternative SCBA based on their own assumptions. This Background Study also contains the proceedings of the international SCBA conference organised by RMNO on 16-17 January 2008

  6. Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Mustafa Gökhan Bilgili

    2014-06-01

    Full Text Available Background: Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Aims: Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Study Design: Retrospective comparative study. Methods: Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. Results: No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05 and cost was higher in Group 1 (p<0.05. Conclusion: Cell saver systems do not decrease the amount of allogenic blood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index.

  7. Social cost benefit analysis of sustainable industrial areas

    International Nuclear Information System (INIS)

    Blom, M.J.; Schroten, A.

    2010-05-01

    In restructuring a industrial park many different interests are involved, such as space, business climate, environmental quality or landscape. The social cost-benefit analysis (SCBA) is a tool for mapping all current and future pros and cons (expressed in Euros) of a restructuring project for society as a whole as objective as possible. The SCBA manual for sustainable industrial parks describes how an SCBA can be performed and how the results could accommodate decisions made. SCBA pilots have been carried out for restructuring projects in four Dutch municipalities: Katwijk, Rijnwoude, Hardinxveld-Giessendam and Westland. [nl

  8. Conflict translates environmental and social risk into business costs.

    Science.gov (United States)

    Franks, Daniel M; Davis, Rachel; Bebbington, Anthony J; Ali, Saleem H; Kemp, Deanna; Scurrah, Martin

    2014-05-27

    Sustainability science has grown as a field of inquiry, but has said little about the role of large-scale private sector actors in socio-ecological systems change. However, the shaping of global trends and transitions depends greatly on the private sector and its development impact. Market-based and command-and-control policy instruments have, along with corporate citizenship, been the predominant means for bringing sustainable development priorities into private sector decision-making. This research identifies conflict as a further means through which environmental and social risks are translated into business costs and decision making. Through in-depth interviews with finance, legal, and sustainability professionals in the extractive industries, and empirical case analysis of 50 projects worldwide, this research reports on the financial value at stake when conflict erupts with local communities. Over the past decade, high commodity prices have fueled the expansion of mining and hydrocarbon extraction. These developments profoundly transform environments, communities, and economies, and frequently generate social conflict. Our analysis shows that mining and hydrocarbon companies fail to factor in the full scale of the costs of conflict. For example, as a result of conflict, a major, world-class mining project with capital expenditure of between US$3 and US$5 billion was reported to suffer roughly US$20 million per week of delayed production in net present value terms. Clear analysis of the costs of conflict provides sustainability professionals with a strengthened basis to influence corporate decision making, particularly when linked to corporate values. Perverse outcomes of overemphasizing a cost analysis are also discussed.

  9. Patterns of pharmacotherapy and health care utilization and costs prior to total hip or total knee replacement in patients with osteoarthritis.

    Science.gov (United States)

    Berger, Ariel; Bozic, Kevin; Stacey, Brett; Edelsberg, John; Sadosky, Alesia; Oster, Gerry

    2011-08-01

    To examine patterns of pharmacotherapy and health care utilization and costs prior to total knee replacement (TKR) or total hip replacement (THR) in patients with osteoarthritis (OA). Using a large US health insurance claims database, we identified all patients with OA who were ages ≥40 years and had undergone TKR or THR between January 1, 2006 and December 31, 2007. Patients with care utilization and costs over the 2-year period preceding surgery. A total of 16,527 patients met all study entry criteria. Their mean ± SD age was 56.6 ± 6.1 years, and 56% of them were women. In the 2 years preceding surgery, 55% of patients received prescription nonsteroidal antiinflammatory drugs, 58% received opioids, and 50% received injections of corticosteroids. The numbers of patients receiving these drugs increased steadily during the presurgery period. The mean ± SD total health care costs in the 2 years preceding surgery were $19,466 ± 29,869, of which outpatient care, inpatient care, and pharmacotherapy represented 45%, 20%, and 20%, respectively. Costs increased from $2,094 in the eighth calendar quarter prior to surgery to $3,100 in the final quarter. Patients with OA who undergo THR or TKR have relatively high levels of use of pain-related pharmacotherapy and high total health care costs in the 2-year period preceding surgery. Levels of utilization and cost increase as the date of surgery approaches. Copyright © 2011 by the American College of Rheumatology.

  10. Blood Transfusion During Total Ankle Arthroplasty Is Associated With Increased In-Hospital Complications and Costs.

    Science.gov (United States)

    Ewing, Michael A; Huntley, Samuel R; Baker, Dustin K; Smith, Kenneth S; Hudson, Parke W; McGwin, Gerald; Ponce, Brent A; Johnson, Michael D

    2018-04-01

    Total ankle arthroplasty (TAA) is an increasingly used, effective treatment for end-stage ankle arthritis. Although numerous studies have associated blood transfusion with complications following hip and knee arthroplasty, its effects following TAA are largely unknown. This study uses data from a large, nationally representative database to estimate the association between blood transfusion and inpatient complications and hospital costs following TAA. Using the Nationwide Inpatient Sample (NIS) database from 2004 to 2014, 25 412 patients who underwent TAA were identified, with 286 (1.1%) receiving a blood transfusion. Univariate analysis assessed patient and hospital factors associated with blood transfusion following TAA. Patients requiring blood transfusion were more likely to be female, African American, Medicare recipients, and treated in nonteaching hospitals. Average length of stay for patients following transfusion was 3.0 days longer, while average inpatient cost was increased by approximately 50%. Patients who received blood transfusion were significantly more likely to suffer from congestive heart failure, peripheral vascular disease, hypothyroidism, coagulation disorder, or anemia. Acute renal failure was significantly more common among patients receiving blood transfusion ( P < .001). Blood transfusions following TAA are infrequent and are associated with multiple medical comorbidities, increased complications, longer hospital stays, and increased overall cost. Level III: Retrospective, comparative study.

  11. Social cost of leptospirosis cases attributed to the 2011 disaster striking Nova Friburgo, Brazil.

    Science.gov (United States)

    Pereira, Carlos; Barata, Martha; Trigo, Aline

    2014-04-15

    The aim of this study was to estimate the social cost of the leptospirosis cases that were attributed to the natural disaster of January 2011 in Nova Friburgo (State of Rio de Janeiro, Brazil) through a partial economic assessment. This study utilized secondary data supplied by the Municipal Health Foundation of Nova Friburgo. Income scenarios based on the national and state minimum wages and on average income of the local population were employed. The total social cost of leptospirosis cases attributed to the 2011 disaster may range between US$21,500 and US$66,000 for the lower income scenario and between US$23,900 and US$100,800 for that of higher income. Empirical therapy represented a total avoided cost of US$14,800, in addition to a reduction in lethality. An estimated 31 deaths were avoided among confirmed cases of the disease, and no deaths resulted from the leptospirosis cases attributed to the natural disaster. There has been a significant post-disaster rise in leptospirosis incidence in the municipality, which illustrates the potential for increased cases--and hence costs--of this illness following natural disasters, which justifies the adoption of preventive measures in environmental health.

  12. Efficiency and cost analysis of cell saver auto transfusion system in total knee arthroplasty.

    Science.gov (United States)

    Bilgili, Mustafa Gökhan; Erçin, Ersin; Peker, Gökhan; Kural, Cemal; Başaran, Serdar Hakan; Duramaz, Altuğ; Avkan, Cevdet

    2014-06-01

    Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Retrospective comparative study. Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (pblood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index.

  13. [A totally implantable venous access device. Implantation in general or local anaesthesia? A retrospective cost analysis].

    Science.gov (United States)

    Schuld, J; Richter, S; Moussavian, M R; Kollmar, O; Schilling, M K

    2009-08-01

    Implantation of venous access port systems can be performed in local or general anesthesia. In spite of the increasing rate of interventionally implanted systems, the surgical cut-down represents a safe alternative. Thus, the question arises whether--in context to the increasing health-economic pressure--open implantation in general anesthesia is still a feasible alternative to implantation in local anesthesia regarding OR efficiency and costs. In a retrospective analysis, 993 patients receiving a totally implantable venous access device between 2001 and 2007 were evaluated regarding OR utilization, turnover times, intraoperative data and costs. Implantations in local (LA) and general anesthesia (GA) were compared. GA was performed in 762 cases (76.6 %), LA was performed in 231 patients (23.3 %). Mean operation time was similar in both groups (LA 47.27 +/- 1.40 min vs. GA 45.41 +/- 0.75 min, p = 0.244). Patients receiving local anesthesia had a significantly shorter stay in the OR unit (LA 95.9 +/- 1.78 min vs. GA 105.92 +/- 0.92 min; p cut (LA 39.57 +/- 0.69 min vs. GA 50.46 +/- 0.52 min; p material costs were significantly lower in the LA group compared with the GA group (LA: 400.72 +/- 8.25 euro vs. GA: 482.86 +/- 6.23 euro; p systems in local anesthesia is superior in comparison to the implantation under general anesthesia regarding procedural times in the OR unit and costs. With the same operation duration, but less personnel and material expenditure, implantation in local anesthesia offers a potential economic advantage by permitting faster changing times. Implantation in GA only should be performed at a special request by the patient or in difficult venous conditions. Georg Thieme Verlag Stuttgart.New York.

  14. SEIR Model of Rumor Spreading in Online Social Network with Varying Total Population Size

    International Nuclear Information System (INIS)

    Dong Suyalatu; Deng Yan-Bin; Huang Yong-Chang

    2017-01-01

    Based on the infectious disease model with disease latency, this paper proposes a new model for the rumor spreading process in online social network. In this paper what we establish an SEIR rumor spreading model to describe the online social network with varying total number of users and user deactivation rate. We calculate the exact equilibrium points and reproduction number for this model. Furthermore, we perform the rumor spreading process in the online social network with increasing population size based on the original real world Facebook network. The simulation results indicate that the SEIR model of rumor spreading in online social network with changing total number of users can accurately reveal the inherent characteristics of rumor spreading process in online social network . (paper)

  15. SEIR Model of Rumor Spreading in Online Social Network with Varying Total Population Size

    Science.gov (United States)

    Dong, Suyalatu; Deng, Yan-Bin; Huang, Yong-Chang

    2017-10-01

    Based on the infectious disease model with disease latency, this paper proposes a new model for the rumor spreading process in online social network. In this paper what we establish an SEIR rumor spreading model to describe the online social network with varying total number of users and user deactivation rate. We calculate the exact equilibrium points and reproduction number for this model. Furthermore, we perform the rumor spreading process in the online social network with increasing population size based on the original real world Facebook network. The simulation results indicate that the SEIR model of rumor spreading in online social network with changing total number of users can accurately reveal the inherent characteristics of rumor spreading process in online social network. Supported by National Natural Science Foundation of China under Grant Nos. 11275017 and 11173028

  16. The economics of tobacco in Lebanon: an estimation of the social costs of tobacco consumption.

    Science.gov (United States)

    Salti, Nisreen; Chaaban, Jad; Naamani, Nadia

    2014-05-01

    Assess the socioeconomic costs of smoking in Lebanon and understand the tobacco market and identify the winners and losers from the Lebanese tobacco trade. We take a close look at the market for tobacco and related markets to identify the main stakeholders and estimate the direct costs and benefits of tobacco. We also estimate lower bounds for the costs of tobacco, in terms of lost productivity, the cost of medical treatment, lost production due to premature death, and environmental damage. The paucity of data means our cost estimates are conservative lower bounds and we explicitly list the effects that we are unable to include. We identify the main actors in the tobacco trade: the Régie (the state-owned monopoly which regulates the tobacco trade), tobacco farmers, international tobacco companies, local distributors, retailers, consumers, and advertising firms. We identify as proximate actors the Ministries of Finance and Health, employers, and patients of smoking-related illnesses. In 2008, tobacco trade in Lebanon led to a total social cost of $326.7 million (1.1% of GDP). Low price tags on imported cigarettes not only increase smoking prevalence, but they also result in a net economic loss. Lebanese policymakers should consider the overall deficit from tobacco trade and implement the guidelines presented in the Framework Convention on Tobacco Control to at once increase government revenue and reduce government outlays, and save the labor market and the environment substantial costs.

  17. Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program: executive summary

    International Nuclear Information System (INIS)

    1985-04-01

    The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's Civilian Radioactive Waste Management Progrram is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 is sufficient to cover the cost of the program. This report is an input into the third evaluation of the adequacy of the fee. The total-system cost for the reference waste-management program in this analysis is estimated to be 24 to 30 billion (1984) dollars. For the sensitivity cases studied in this report, the costs could be as high as 35 billion dollars and as low as 21 billion dollars. Because factors like repository location, the quantity of waste generated, transportation-cask technology, and repository startup dates exert substantial impacts on total-system costs, there are several tradeoffs between these factors, and these tradeoffs can greatly influence the total cost of the program. The total-system cost for the reference program described in this report is higher by 3 to 5 billion dollars, or 15 to 20%, than the cost for the reference program of the TSLCC analysis of April 1984. More than two-thirds of this increase is in the cost of repository construction and operation. These repository costs have increased because of changing design concepts, different assumptions about the effort required to perform the necessary activities, and a change in the source data on which the earlier analysis was based. Development and evaluation costs have similarly increased because of a net addition to the work content. Transportation costs have increased because of different assumptions about repository locations and several characteristics of the transportation system. It is expected that the estimates of total-system costs will continue to change in response to both an evolving program strategy and better definition of the work required to achieve the program objectives

  18. Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program: Volume 2, Supporting information

    International Nuclear Information System (INIS)

    1987-06-01

    This report provides cost estimates for the fifth evaluation of the adequacy of the fee and is consistent with the program strategy and plans. The total-system cost for the reference cases in the improved-performance system is estimated at $32.1 to $38.2 billion (expressed in constant 1986 collars) over the entire life of the system, or $1.5 to $1.6 billion more than that of the authorized system (i.e., the system without an MRS facility). The current estimate of the total-system cost for the reference cases in the improved-performance system is $3.8 to $5.4 billion higher than the estimate for the same system in the 1986 TSLCC analysis. In the case with the maximum increase, nearly all of the higher cost is due to a $5.2-billion increase in the costs of development and evaluation (D and E); all other system costs are essentially unchanged. The cost difference between the improved-performance system and the authorized system is smaller than the difference estimated in last year's TSLCC analysis. Volume 2 presents the detailed results for the 1987 analysis of the total-system life cycle cost (TSLCC). It consists of four sections: Section A presents the yearly flows of waste between waste-management facilities for the 12 aggregate logistics cases that were studied; Section B presents the annual total-system costs for each of the 30 TSLCC cases by major cost category; Section C presents the annual costs for the disposal of 16,000 canisters of defense high-level waste (DHLW) by major cost category for each of the 30 TSLCC cases; and Section D presents a summary of the cost-allocation factors that were calculated to determine the defense waste share of the total-system costs

  19. Value of social media in reaching and engaging employers in Total Worker Health.

    Science.gov (United States)

    Hudson, Heidi; Hall, Jennifer

    2013-12-01

    To describe the initial use of social media by the National Institute for Occupational Safety and Health (NIOSH) Total Worker Health™ (TWH) Program and the University of Iowa Healthier Workforce Center for Excellence (HWCE) Outreach Program. Social media analytics tools and process evaluation methods were used to derive initial insights on the social media strategies used by the NIOSH and the HWCE. The on-line community size for the NIOSH TWH Program indicated 100% growth in 6 months; however, social media platforms have been slow to gain participation among employers. The NIOSH TWH Program and the HWCE Outreach Program have found social media tools as an effective way to expand reach, foster engagement, and gain understanding of audience interests around TWH concepts. More needs to be known about how to best use social media to reach and engage target audiences on issues relevant to TWH.

  20. Distributed Flexibility Management Targeting Energy Cost and Total Power Limitations in Electricity Distribution Grids

    DEFF Research Database (Denmark)

    Bessler, Sanford; Kemal, Mohammed Seifu; Silva, Nuno

    2018-01-01

    Demand Management uses the interaction and information exchange between multiple control functions in order to achieve goals that can vary in different application contexts. Since there are several stakeholders involved, these may have diverse objectives and even use different architectures...... to actively manage power demand. This paper utilizes an existing distributed demand management architecture in order to provide the following contributions: (1) It develops and evaluates a set of algorithms that combine the optimization of energy costs in scenarios of variable day-ahead prices with the goal...... to improve distribution grid operation reliability, here implemented by a total Power limit. (2) It evaluates the proposed scheme as a distributed system where flexibility information is exchanged with the existing industry standard OpenADR. A Hardware-in-the-Loop testbed realization demonstrates...

  1. Noninvasive Hemoglobin Monitoring: A Rapid, Reliable, and Cost-Effective Method Following Total Joint Replacement.

    Science.gov (United States)

    Martin, J Ryan; Camp, Christopher L; Stitz, Amber; Young, Ernest Y; Abdel, Matthew P; Taunton, Michael J; Trousdale, Robert T

    2016-03-02

    Noninvasive hemoglobin (nHgb) monitoring was initially introduced in the intensive care setting as a means of rapidly assessing Hgb values without performing a blood draw. We conducted a prospective analysis to compare reliability, cost, and patient preference between nHgb monitoring and invasive Hgb (iHgb) monitoring performed via a traditional blood draw. We enrolled 100 consecutive patients undergoing primary or revision total hip or total knee arthroplasty. On postoperative day 1, nHgb and iHgb values were obtained within thirty minutes of one another. iHgb and nHgb values, cost, patient satisfaction, and the duration of time required to obtain each reading were recorded. The concordance correlation coefficient (CCC) was utilized to evaluate the agreement of the two Hgb measurement methods. Paired t tests and Wilcoxon signed-rank tests were utilized to compare mean Hgb values, time, and pain for all readings. The mean Hgb values did not differ significantly between the two measurement methods: the mean iHgb value (and standard deviation) was 11.3 ± 1.4 g/dL (range, 8.2 to 14.3 g/dL), and the mean nHgb value was 11.5 ± 1.8 g/dL (range, 7.0 to 16.0 g/dL) (p = 0.11). The CCC between the two Hgb methods was 0.69. One hundred percent of the patients with an nHgb value of ≥ 10.5 g/dL had an iHgb value of >8.0 g/dL. The mean time to obtain an Hgb value was 0.9 minute for the nHgb method and 51.1 minutes for the iHgb method (p measurement, resulting in a savings of $26 per Hgb assessment when the noninvasive method is used. Noninvasive Hgb monitoring was found to be more efficient, less expensive, and preferred by patients compared with iHgb monitoring. Providers could consider screening total joint arthroplasty patients with nHgb monitoring and only order iHgb measurement if the nHgb value is protocol had been applied to the first blood draw in our 100 patients, approximately $2000 would have been saved. Extrapolated to the U.S. total joint arthroplasty practice

  2. Clinical Outcomes and 90-Day Costs Following Hemiarthroplasty or Total Hip Arthroplasty for Hip Fracture.

    Science.gov (United States)

    Nichols, Christine I; Vose, Joshua G; Nunley, Ryan M

    2017-09-01

    In the era of bundled payments, many hospitals are responsible for costs from admission through 90 days postdischarge. Although bundled episodes for hip fracture will have a separate target price for the bundle, little is known about the 90-day resource use burden for this patient population. Using Medicare 100% Standard Analytic Files (2010-2014), we identified patients undergoing hemiarthroplasty or total hip arthroplasty (THA). Patients were aged 65 and older with admitting diagnosis of closed hip fracture, no concurrent fractures of the lower limb, and no history of hip surgery in the prior 12 months baseline. Continuous Medicare-only enrollment was required. Complications, resource use, and mortality from admission through 90 days following discharge (follow-up) were summarized. Four cohorts met selection criteria for analysis: (1) hemiarthroplasty diagnosis-related group (DRG) 469 (N = 19,634), (2) hemiarthroplasty DRG 470 (N = 77,744), (3) THA DRG 469 (N = 1686), and (4) THA DRG 470 (N = 9314). All-cause mortality during the study period was 51.6%, 29.5%, 48.1%, and 24.9% with mean 90-day costs of $28,952, $19,243, $29,763, and $18,561, respectively. Most of the patients waited 1 day from admission to surgery (41%-51%). Incidence of an all-cause complication was approximately 70% in each DRG 469 cohort and 14%-16% in each DRG 470 cohort. This study confirms patients with hip fracture are a costly subpopulation. Tailored care pathways to minimize post-acute care resource use are warranted for these patients. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  3. Factors Influencing the Total Inpatient Pharmacy Cost at a Tertiary Hospital in Malaysia: A Retrospective Study

    Science.gov (United States)

    Ali Jadoo, Saad Ahmed

    2018-01-01

    The steady growth of pharmaceutical expenditures is a major concern for health policy makers and health care managers in Malaysia. Our study examined the factors affecting the total inpatient pharmacy cost (TINPC) at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). In this retrospective study, we used 2011 administration electronic prescriptions records and casemix databases at UKMMC to examine the impact of sociodemographic, diagnostic, and drug variables on the TINPC. Bivariate and multivariate analyses of the factors associated with TINPC were conducted. The mean inpatient pharmacy cost per patient was USD 102.07 (SD = 24.76). In the multivariate analysis, length of stay (LOS; B = 0.349, P < .0005) and severity level III (B = 0.253, P < .0005) were the primary factors affecting the TINPC. For each day increase in the LOS and each increase of a case of severity level III, there was an increase of approximately USD 11.97 and USD 171.53 in the TINPC per year, respectively. Moreover, the number of prescribed items of drugs and supplies was positively associated with the TINPC (B = 0.081, P < .0005). Gender appears to have affected the TINPC; male patients seem to be associated with a higher TINPC than females (mean = 139.55, 95% confidence interval [CI]: 112.97-166.13, P < .001). Surgical procedures were associated with higher cost than medical cases (mean = 87.93, 95% CI: 61.00-114.85, P < .001). Malay (MYR 242.02, SD = 65.37) and Chinese (MYR 214.66, SD = 27.99) ethnicities contributed to a lower TINPC compared with Indian (MYR 613.93, SD = 98.41) and other ethnicities (MYR 578.47, SD = 144.51). A longer hospitalization period accompanied by major complications and comorbidities had the greatest influence on the TINPC. PMID:29436248

  4. Discount rates for social cost benefit analysis of nuclear energy

    International Nuclear Information System (INIS)

    Owen, P.A.

    1978-01-01

    The question that this paper addresses is how decisions affecting many citizens should be made when there are uncertain outcomes in the distant future. By distant is meant beyond the lifetimes of individuals alive now. Thus the proposed methodology would apply to many decisions in nuclear energy from the investment in new energy sources such as fusion, to the long-term storage of wastes. Decisions of this type have usually been analyzed using cost benefit analysis. In this case, future outcomes are discounted at the so-called social discount rate. By comparison, the proposed methodology uses information on individual citizen's preferences and willingness to pay to make a future generation better off. The connection between the proposed approach and more traditional discounting techniques is examined using the government decision about storing helium for the future as an example

  5. How much electricity really costs. Comparison of the state subsidisation and overall social costs of conventional and renewable energy resources

    International Nuclear Information System (INIS)

    Kuechler, Swantje; Meyer, Bettina

    2012-01-01

    This study explains how the costs of electricity are an aggregate of different components. The electricity price paid by the end consumer contains not only the actual costs of energy production, which make up only about a third of the actual price in an average household, but also different surcharges such as network charges, electricity tax, value added tax and the concession levy. It furthermore contains the allocation charge stipulated by the Renewable Energy Law (EEG reallocation charge) as a means of allocating the costs of the subsidisation of electricity from renewable resources to the consumers. On the other hand conventional energy resources such as nuclear energy, hard coal and brown coal have substantially benefited over many decades from state subsidies in the form of financial aids, tax rebates and other promotive measures. The main difference between this and the subsidisation of renewable energy is that the costs of conventional energy resources are largely charged to the state budget rather than being made transparent in the electricity price. Based on an evaluation of the literature, data, interviews and the authors' own methodological deliberations this study makes a systematic comparison of the direct as well as indirect state subsidisation of renewable and conventional energy resources during the period from 1970 until 2012. The annual totals obtained for each energy resources are then set in relation to the share of that resource in overall electricity production, yielding specific subsidisation rates in terms of cents per kWh for each resource. This does not yet take into account the high consequential costs in the form of environmental damage and climate-related damage caused by fossil and nuclear fuels as well as the risks associated with the latter (collectively referred to as ''external costs''), all of which are charged to the polluters only at a small fraction of the true amount. The two cost categories of state

  6. Social Cost Benefit Analysis of HL-LHC

    CERN Document Server

    Bastianin, Andrea

    2018-01-01

    We present a Social Cost–Benefit Analysis (CBA) of the High Luminosity upgrade of the Large Hadron Collider (HL-LHC), assessing its economic costs and benefits up to 2038. The Net Present Value (NPV) of the HL-LHC project is positive at the end of the observation period. The ratio between incremental benefits and incremental costs of the HL-LHC with respect to continue operating the LHC under normal consolidation (i.e. without high-luminosity upgrade) is slightly over 1.7, meaning that each Swiss Franc invested in the HL-LHC upgrade project pays back approximately 1.7 CHF in societal benefits. Simulations based on 50000 Monte Carlo rounds show that there is a 94% chance to observe a positive NPV (i.e. a quantifiable economic benefit for the society). The attractiveness of CERN for Early Stage Researchers (ESR) is key for a positive CBA result. Given that benefits to ESRs are the single most important societal benefit, CERN should invest more in activities facilitating the transition to the international job...

  7. Modeling social norms increasingly influences costly sharing in middle childhood.

    Science.gov (United States)

    House, Bailey R; Tomasello, Michael

    2018-07-01

    Prosocial and normative behavior emerges in early childhood, but substantial changes in prosocial behavior in middle childhood may be due to it becoming integrated with children's understanding of what is normative. Here we show that information about what is normative begins influencing children's costly sharing in middle childhood in a sample of 6- to 11-year-old German children. Information about what is normative was most influential when indicating what was "right" (i.e., "The right thing is to choose this"). It was less influential when indicating what was prescribed by a rule (i.e., "There is a rule that says to choose this") or when it indicated what the majority of people do (i.e., "Most people choose this"). These findings support the idea that middle childhood is when social norms begin to shape children's costly sharing and provide insight into the psychological foundations of the relationship between norms and prosocial behavior. Copyright © 2018 Elsevier Inc. All rights reserved.

  8. Social Cost of Leptospirosis Cases Attributed to the 2011 Disaster Striking Nova Friburgo, Brazil

    Directory of Open Access Journals (Sweden)

    Carlos Pereira

    2014-04-01

    Full Text Available The aim of this study was to estimate the social cost of the leptospirosis cases that were attributed to the natural disaster of January 2011 in Nova Friburgo (State of Rio de Janeiro, Brazil through a partial economic assessment. This study utilized secondary data supplied by the Municipal Health Foundation of Nova Friburgo. Income scenarios based on the national and state minimum wages and on average income of the local population were employed. The total social cost of leptospirosis cases attributed to the 2011 disaster may range between US$21,500 and US$66,000 for the lower income scenario and between US$23,900 and US$100,800 for that of higher income. Empirical therapy represented a total avoided cost of US$14,800, in addition to a reduction in lethality. An estimated 31 deaths were avoided among confirmed cases of the disease, and no deaths resulted from the leptospirosis cases attributed to the natural disaster. There has been a significant post-disaster rise in leptospirosis incidence in the municipality, which illustrates the potential for increased cases—and hence costs—of this illness following natural disasters, which justifies the adoption of preventive measures in environmental health.

  9. Discounting and the social cost of carbon: A closer look at uncertainty

    NARCIS (Netherlands)

    Guo, J.K.; Hepburn, C.; Tol, R.S.J.; Anthoff, D.

    2006-01-01

    Recently, in the economics literature, several papers have put forward arguments for using a declining discount rate in social-cost benefit analysis. This paper examines the impact of employing a declining discount rate on the social cost of carbon-the marginal social damage from a ton of emitted

  10. Social network diversity and risks of ischemic heart disease and total mortality

    DEFF Research Database (Denmark)

    Barefoot, John C; Grønbaek, Morten; Jensen, Gorm

    2005-01-01

    Measures of various types of social contacts were used as predictors of ischemic heart disease events and total mortality in an age-stratified random sample of 9,573 adults enrolled in the Copenhagen City Heart Study (Copenhagen, Denmark). Baseline examinations were conducted in 1991-1994, and pa......Measures of various types of social contacts were used as predictors of ischemic heart disease events and total mortality in an age-stratified random sample of 9,573 adults enrolled in the Copenhagen City Heart Study (Copenhagen, Denmark). Baseline examinations were conducted in 1991...

  11. Economic consequences of legal and illegal drugs: The case of social costs in Belgium.

    Science.gov (United States)

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

    2017-06-01

    Legal and illegal drugs impose a considerable burden to the individual and to society. The misuse of addictive substances results in healthcare and law enforcement costs, loss of productivity and reduced quality of life. A social cost study was conducted to estimate the substance-attributable costs of alcohol, tobacco, illegal drugs and psychoactive medication to Belgian society in 2012. The cost-of-illness framework with prevalence-based and human capital approach was applied. Three cost components were considered: direct, indirect and intangible costs related to substance misuse. The direct and indirect cost of addictive substances was estimated at 4.6 billion euros in Belgium (419 euros per capita or 1.19% of the GDP) and more than 515,000 healthy years are lost due to substance misuse. The Belgian social cost study reaffirms that alcohol and tobacco impose the highest cost to society compared to illegal drugs. Health problems are the main driver of the social cost of legal drugs. Law enforcement expenditure exceed the healthcare costs but only in the case of illegal drugs. Estimating social costs of addictive substances is complex because it is difficult to determine to what extent the societal harm is caused by substances. It can be argued that social cost studies take only a 'snapshot' of the monetary consequences of substance misuse. Nevertheless, the current study offers the most comprehensive analysis thus far of the social costs of substance misuse in Belgium. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Social/economic costs and health-related quality of life in patients with spinal muscular atrophy (SMA) in Spain.

    Science.gov (United States)

    López-Bastida, Julio; Peña-Longobardo, Luz María; Aranda-Reneo, Isaac; Tizzano, Eduardo; Sefton, Mark; Oliva-Moreno, Juan

    2017-08-18

    The aim of this study was to determine the economic burden and health-related quality of life (HRQOL) of patients with Spinal Muscular Atrophy (SMA) and their caregivers in Spain. This was a cross-sectional and retrospective study of patients diagnosed with SMA in Spain. We adopted a bottom up, prevalence approach design to study patients with SMA. The patient's caregivers completed an anonymous questionnaire regarding their socio-demographic characteristics, use of healthcare services and non-healthcare services. Costs were estimated from a societal perspective (including healthcare costs and non-healthcare costs), and health-related quality of life (HRQOL) was assessed using the EQ-5D questionnaire. The main caregivers also answered a questionnaire on their characteristics and on their HRQOL. A total of 81 caregivers of patients with different subtypes of SMA completed the questionnaire. Based on the reference unitary prices for 2014, the average annual costs per patient were € 33,721. Direct healthcare costs were € 10,882 (representing around 32.3% of the total cost) and the direct non-healthcare costs were € 22,839 (67.7% of the total cost). The mean EQ-5D social tariff score for patients was 0.16, and the mean score of the EQ-5D visual analogue scale was 54. The mean EQ-5D social tariff score for caregivers was 0.49 and their mean score on the EQ-5D visual analogue scale was 69. The results highlight the burden that SMA has in terms of costs and decreased HRQOL, not only for patients but also for their caregivers. In particular, the substantial social/economic burden is mostly attributable to the high direct non-healthcare costs.

  13. The Cost-Effectiveness of Dual Mobility Implants for Primary Total Hip Arthroplasty: A Computer-Based Cost-Utility Model.

    Science.gov (United States)

    Barlow, Brian T; McLawhorn, Alexander S; Westrich, Geoffrey H

    2017-05-03

    Dislocation remains a clinically important problem following primary total hip arthroplasty, and it is a common reason for revision total hip arthroplasty. Dual mobility (DM) implants decrease the risk of dislocation but can be more expensive than conventional implants and have idiosyncratic failure mechanisms. The purpose of this study was to investigate the cost-effectiveness of DM implants compared with conventional bearings for primary total hip arthroplasty. Markov model analysis was conducted from the societal perspective with use of direct and indirect costs. Costs, expressed in 2013 U.S. dollars, were derived from the literature, the National Inpatient Sample, and the Centers for Medicare & Medicaid Services. Effectiveness was expressed in quality-adjusted life years (QALYs). The model was populated with health state utilities and state transition probabilities derived from previously published literature. The analysis was performed for a patient's lifetime, and costs and effectiveness were discounted at 3% annually. The principal outcome was the incremental cost-effectiveness ratio (ICER), with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to explore relevant uncertainty. In the base case, DM total hip arthroplasty showed absolute dominance over conventional total hip arthroplasty, with lower accrued costs ($39,008 versus $40,031 U.S. dollars) and higher accrued utility (13.18 versus 13.13 QALYs) indicating cost-savings. DM total hip arthroplasty ceased being cost-saving when its implant costs exceeded those of conventional total hip arthroplasty by $1,023, and the cost-effectiveness threshold for DM implants was $5,287 greater than that for conventional implants. DM was not cost-effective when the annualized incremental probability of revision from any unforeseen failure mechanism or mechanisms exceeded 0.29%. The probability of intraprosthetic dislocation exerted the most influence on model results. This model

  14. Force Structure: Restructuring and Rebuilding the Army Will Cost Billions of Dollars for Equipment but the Total Cost Is Uncertain

    National Research Council Canada - National Science Library

    St. Laurent, Janet A

    2008-01-01

    .... Several factors are contributing to the uncertainties about future costs. First, the Army's $43.6 funding plan for equipping modular units was based on preliminary modular unit designs and did not fully consider the needs of National Guard units...

  15. Analysing uncertainty around costs of innovative medical technologies: the case of fibrin sealant (QUIXIL) for total knee replacement.

    NARCIS (Netherlands)

    Steuten, Lotte Maria Gertruda; Vallejo-Torres, Laura; Bastide, Philippe; Buxton, Martin J.

    2009-01-01

    This paper presents a relatively simple cost model comparing the costs of using a commercial fibrin sealant (QUIXIL®) in addition to conventional haemostatic treatment vs. conventional treatment alone in total knee replacement (TKR) surgery, and demonstrates and discusses how one- and two-way

  16. The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs.

    Science.gov (United States)

    Landeiro, F; Leal, J; Gray, A M

    2016-02-01

    Delayed discharges represent an inefficient use of acute hospital beds. Social isolation and referral to a public-funded rehabilitation unit were significant predictors of delayed discharges while admission from an institution was a protective factor for older hip fracture patients. Preventing delays could save between 11.2 and 30.7 % of total hospital costs for this patient group. Delayed discharges of older patients from acute care hospitals are a major challenge for administrative, humanitarian, and economic reasons. At the same time, older people are particularly vulnerable to social isolation which has a detrimental effect on their health and well-being with cost implications for health and social care services. The purpose of the present study was to determine the impact and costs of social isolation on delayed hospital discharge. A prospective study of 278 consecutive patients aged 75 or older with hip fracture admitted, as an emergency, to the Orthopaedics Department of Hospital Universitário de Santa Maria, Portugal, was conducted. A logistic regression model was used to examine the impact of relevant covariates on delayed discharges, and a negative binomial regression model was used to examine the main drivers of days of delayed discharges. Costs of delayed discharges were estimated using unit costs from national databases. Mean age at admission was 85.5 years and mean length of stay was 13.1 days per patient. Sixty-two (22.3 %) patients had delayed discharges, resulting in 419 bed days lost (11.5 % of the total length of stay). Being isolated or at a high risk of social isolation, measured with the Lubben social network scale, was significantly associated with delayed discharges (odds ratio (OR) 3.5) as was being referred to a public-funded rehabilitation unit (OR 7.6). These two variables also increased the number of days of delayed discharges (2.6 and 4.9 extra days, respectively, holding all else constant). Patients who were admitted from an

  17. Variation in the cost of care for primary total knee arthroplasties

    Directory of Open Access Journals (Sweden)

    Derek A. Haas, MBA

    2017-03-01

    Conclusions: The large variation in costs among sites suggests major and multiple opportunities to transfer knowledge about process and productivity improvements that lower costs while simultaneously maintaining or improving outcomes.

  18. Integrating a Social Behavior Intervention during Small Group Academic Instruction Using a Total Group Criterion Intervention

    Science.gov (United States)

    Rodriguez, Billie Jo; Anderson, Cynthia M.

    2014-01-01

    Total group contingencies, a variation of interdependent group contingencies, provide educators with an efficient and effective mechanism to improve social behavior and increase academic skills. Their utility has not been examined in small educational groups. This is unfortunate as supplemental instruction frequently is delivered in small group…

  19. The evolution of honest communication: integrating social and physiological costs of ornamentation.

    Science.gov (United States)

    Tibbetts, Elizabeth A

    2014-10-01

    Much research on animal communication has addressed how costs such as social costs or physiological costs favor the accuracy of signals. Previous work has largely considered these costs separately, but we may be missing essential connections by studying costs in isolation. After all, social interactions produce rapid changes in hormone titers which can then affect individual behavior and physiology. As a result, social costs are likely to have widespread physiological consequences. Here, I present a new perspective on the factors that maintain honest signals by describing how the interplay between social costs and physiological costs may maintain an accurate link between an animal's abilities and ornament elaboration. I outline three specific mechanisms by which the interaction between social behavior and hormones could favor honest signals and present specific predictions for each of the three models. Then, I review how ornaments alter agonistic behavior, agonistic behavior influences hormones, and how these hormonal effects influence fitness. I also describe the few previous studies that have directly tested how ornaments influence hormones. Finally, opportunities for future work are discussed. Considering the interaction between social behavior and physiology may address some challenges associated with both social and physiological models of costs. Understanding the dynamic feedbacks between physiology and social costs has potential to transform our understanding of the stability of animals' communication systems. © The Author 2014. Published by Oxford University Press on behalf of the Society for Integrative and Comparative Biology. All rights reserved. For permissions please email: journals.permissions@oup.com.

  20. Efforts to Support Consumer Enrollment Decisions Using Total Cost Estimators: Lessons from the Affordable Care Act’s Marketplaces.

    Science.gov (United States)

    Giovannelli, Justin; Curran, Emily

    2017-02-01

    Issue: Policymakers have sought to improve the shopping experience on the Affordable Care Act’s marketplaces by offering decision support tools that help consumers better understand and compare their health plan options. Cost estimators are one such tool. They are designed to provide consumers a personalized estimate of the total cost--premium, minus subsidy, plus cost-sharing--of their coverage options. Cost estimators were available in most states by the start of the fourth open enrollment period. Goal: To understand the experiences of marketplaces that offer a total cost estimator and the interests and concerns of policymakers from states that are not using them. Methods: Structured interviews with marketplace officials, consumer enrollment assisters, technology vendors, and subject matter experts; analysis of the total cost estimators available on the marketplaces as of October 2016. Key findings and conclusions: Informants strongly supported marketplace adoption of a total cost estimator. Marketplaces that offer an estimator faced a range of design choices and varied significantly in their approaches to resolving them. Interviews suggested a clear need for additional consumer testing and data analysis of tool usage and for sustained outreach to enrollment assisters to encourage greater use of the estimators.

  1. Climate system properties determining the social cost of carbon

    International Nuclear Information System (INIS)

    Otto, Alexander; Allen, Myles R; Todd, Benjamin J; Bowerman, Niel; Frame, David J

    2013-01-01

    The choice of an appropriate scientific target to guide global mitigation efforts is complicated by uncertainties in the temperature response to greenhouse gas emissions. Much climate policy discourse has been based on the equilibrium global mean temperature increase following a concentration stabilization scenario. This is determined by the equilibrium climate sensitivity (ECS) which, in many studies, shows persistent, fat-tailed uncertainty. However, for many purposes, the equilibrium response is less relevant than the transient response. Here, we show that one prominent policy variable, the social cost of carbon (SCC), is generally better constrained by the transient climate response (TCR) than by the ECS. Simple analytic expressions show the SCC to be directly proportional to the TCR under idealized assumptions when the rate at which we discount future damage equals 2.8%. Using ensemble simulations of a simple climate model we find that knowing the true value of the TCR can reduce the relative uncertainty in the SCC substantially more, up to a factor of 3, than knowing the ECS under typical discounting assumptions. We conclude that the TCR, which is better constrained by observations, less subject to fat-tailed uncertainty and more directly related to the SCC, is generally preferable to the ECS as a single proxy for the climate response in SCC calculations. (letter)

  2. Climate system properties determining the social cost of carbon

    Science.gov (United States)

    Otto, Alexander; Todd, Benjamin J.; Bowerman, Niel; Frame, David J.; Allen, Myles R.

    2013-06-01

    The choice of an appropriate scientific target to guide global mitigation efforts is complicated by uncertainties in the temperature response to greenhouse gas emissions. Much climate policy discourse has been based on the equilibrium global mean temperature increase following a concentration stabilization scenario. This is determined by the equilibrium climate sensitivity (ECS) which, in many studies, shows persistent, fat-tailed uncertainty. However, for many purposes, the equilibrium response is less relevant than the transient response. Here, we show that one prominent policy variable, the social cost of carbon (SCC), is generally better constrained by the transient climate response (TCR) than by the ECS. Simple analytic expressions show the SCC to be directly proportional to the TCR under idealized assumptions when the rate at which we discount future damage equals 2.8%. Using ensemble simulations of a simple climate model we find that knowing the true value of the TCR can reduce the relative uncertainty in the SCC substantially more, up to a factor of 3, than knowing the ECS under typical discounting assumptions. We conclude that the TCR, which is better constrained by observations, less subject to fat-tailed uncertainty and more directly related to the SCC, is generally preferable to the ECS as a single proxy for the climate response in SCC calculations.

  3. 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.

  4. Risk and Cost of 90-Day Complications in Morbidly and Superobese Patients After Total Knee Arthroplasty.

    Science.gov (United States)

    Meller, Menachem M; Toossi, Nader; Johanson, Norman A; Gonzalez, Mark H; Son, Min-Sun; Lau, Edmund C

    2016-10-01

    This study investigated the risk and cost of postoperative complications associated with morbid and super obesity after total knee arthroplasty (TKA). A retrospective cohort study was conducted of patients who underwent TKA using Medicare hospital claims data. The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code V85.4x was used to identify morbidly obese patients (body mass index [BMI] ≥40 kg/m(2)) and superobese patients (BMI ≥50 kg/m(2)) in 2011-2013. Patients without any BMI-related diagnosis codes were used as controls. Twelve complications occurred in the 90-day period after TKA were analyzed using multivariate Cox models, adjusting for patient demographic, morbidity, and institutional factors. In addition, hospital charges and payments were compared from primary surgery through subsequent 90 days. Morbidly obese patients showed a significantly elevated risk in most complications examined, with a 2-fold or higher risk in dislocation and wound dehiscence. In addition, death, periprosthetic joint infection, acute renal failure, and knee revision had significant hazard ratios between 1.5 and 2.0. However, risk of deep vein thrombosis and acute myocardial infarction did not increase for the morbidly obese patients. Superobese patients had significant increase in risk of infection, wound dehiscence, acute renal failures, revisions, death, and readmission compared with patients with BMI 40-49 kg/m(2). Significant dose-response trend was found between the level of BMI and risk for death, dislocation, implant failure, infection, readmission, revision, wound dehiscence, and acute renal failure. Controlling for patient and institutional factors, each TKA had an average total hospital charges of $75,884 among superobese patients, compared to $65,118 for the control group, a difference of $10,767. Medicare payment for the superobese patients was also higher, but only by $2703. Morbidly obese patients pose a significantly

  5. Assessing the Total cost of ownership of ERP systems : Case study analysis on the factors behind customer costs in recent minor implementations

    OpenAIRE

    Rydgård, Göran; Palmberg, Nils

    2010-01-01

    This master’s thesis presents a model for calculating the total cost of ownership (TCO) of relatively small ERP implementations, including two years of running the system. The main factors affecting the cost items in the model are also analyzed, based in part on four case projects that the consultancy company Acando has carried out recently and in part on literature. The case projects were investigated through interviews with key actors in the projects from Acando and the customer, and throug...

  6. The Social Costs of Electricity Generation—Categorising Different Types of Costs and Evaluating Their Respective Relevance

    Directory of Open Access Journals (Sweden)

    Sascha Samadi

    2017-03-01

    Full Text Available Various electricity generation technologies using different primary energy sources are available. Many published studies compare the costs of these technologies. However, most of those studies only consider plant-level costs and do not fully take into account additional costs that societies may face in using these technologies. This article reviews the literature on the costs of electricity generation technologies, aiming to determine which types of costs are relevant from a societal point of view when comparing generation technologies. The paper categorises the relevant types of costs, differentiating between plant-level, system and external costs as the main categories. It discusses the relevance of each type of cost for each generation technology. The findings suggest that several low-carbon electricity generation technologies exhibit lower social costs per kWh than the currently dominant technologies using fossil fuels. More generally, the findings emphasise the importance of taking not only plant-level costs, but also system and external costs, into account when comparing electricity generation technologies from a societal point of view. The article intends to inform both policymakers and energy system modellers, the latter who may strive to include all relevant types of costs in their models.

  7. The Social Cost of Stochastic and Irreversible Climate Change

    Science.gov (United States)

    Cai, Y.; Judd, K. L.; Lontzek, T.

    2013-12-01

    Many scientists are worried about climate change triggering abrupt and irreversible events leading to significant and long-lasting damages. For example, a rapid release of methane from permafrost may lead to amplified global warming, and global warming may increase the frequency and severity of heavy rainfall or typhoon, destroying large cities and killing numerous people. Some elements of the climate system which might exhibit such a triggering effect are called tipping elements. There is great uncertainty about the impact of anthropogenic carbon and tipping elements on future economic wellbeing. Any rational policy choice must consider the great uncertainty about the magnitude and timing of global warming's impact on economic productivity. While the likelihood of tipping points may be a function of contemporaneous temperature, their effects are long lasting and might be independent of future temperatures. It is assumed that some of these tipping points might occur even in this century, but also that their duration and post-tipping impact are uncertain. A faithful representation of the possibility of tipping points for the calculation of social cost of carbon would require a fully stochastic formulation of irreversibility, and accounting for the deep layer of uncertainties regarding the duration of the tipping process and also its economic impact. We use DSICE, a DSGE extension of the DICE2007 model of William Nordhaus, which incorporates beliefs about the uncertain economic impact of possible climate tipping events and uses empirically plausible parameterizations of Epstein-Zin preferences to represent attitudes towards risk. We find that the uncertainty associated with anthropogenic climate change imply carbon taxes much higher than implied by deterministic models. This analysis indicates that the absence of uncertainty in DICE2007 and similar IAM models may result in substantial understatement of the potential benefits of policies to reduce GHG emissions.

  8. The true costs of participatory sanitation: Evidence from community-led total sanitation studies in Ghana and Ethiopia.

    Science.gov (United States)

    Crocker, Jonny; Saywell, Darren; Shields, Katherine F; Kolsky, Pete; Bartram, Jamie

    2017-12-01

    Evidence on sanitation and hygiene program costs is used for many purposes. The few studies that report costs use top-down costing methods that are inaccurate and inappropriate. Community-led total sanitation (CLTS) is a participatory behavior-change approach that presents difficulties for cost analysis. We used implementation tracking and bottom-up, activity-based costing to assess the process, program costs, and local investments for four CLTS interventions in Ghana and Ethiopia. Data collection included implementation checklists, surveys, and financial records review. Financial costs and value-of-time spent on CLTS by different actors were assessed. Results are disaggregated by intervention, cost category, actor, geographic area, and project month. The average household size was 4.0 people in Ghana, and 5.8 people in Ethiopia. The program cost of CLTS was $30.34-$81.56 per household targeted in Ghana, and $14.15-$19.21 in Ethiopia. Most program costs were from training for three of four interventions. Local investments ranged from $7.93-$22.36 per household targeted in Ghana, and $2.35-$3.41 in Ethiopia. This is the first study to present comprehensive, disaggregated costs of a sanitation and hygiene behavior-change intervention. The findings can be used to inform policy and finance decisions, plan program scale-up, perform cost-effectiveness and benefit studies, and compare different interventions. The costing method is applicable to other public health behavior-change programs. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  9. Preliminary estimates of the total-system cost for the restructured program: An addendum to the May 1989 analysis of the total-system life cycle cost for the Civilian Radioactive Waste Management Program

    International Nuclear Information System (INIS)

    1990-12-01

    The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's (DOE) Civilian Radioactive Waste Management Program is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 - a fee levied on electricity generated and sold by commercial nuclear power plants - is sufficient to cover the cost of the program. This report provides cost estimates for the sixth annual evaluation of the adequacy of the fee. The costs contained in this report represent a preliminary analysis of the cost impacts associated with the Secretary of Energy's Report to Congress on Reassessment of the Civilian Radioactive Waste Management Program issued in November 1989. The major elements of the restructured program announced in this report which pertain to the program's life-cycle costs are: a prioritization of the scientific investigations program at the Yucca Mountain candidate site to focus on identification of potentially adverse conditions, a delay in the start of repository operations until 2010, the start of limited waste acceptance at the monitored retrievable storage (MRS) facility in 1998, and the start of waste acceptance at the full-capability MRS facility in 2,000. Based on the restructured program, the total-system cost for the system with a repository at the candidate site at Yucca Mountain in Nevada, a facility for monitored retrievable storage (MRS), and a transportation system is estimated at $26 billion (expressed in constant 1988 dollars). In the event that a second repository is required and is authorized by the Congress, the total-system cost is estimated at $34 to $35 billion, depending on the quantity of spent fuel and high-level waste (HLW) requiring disposal. 17 figs., 17 tabs

  10. Is total pancreatectomy as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy? A single center, prospective, observational study.

    Science.gov (United States)

    Casadei, Riccardo; Ricci, Claudio; Taffurelli, Giovanni; Guariniello, Anna; Di Gioia, Anthony; Di Marco, Mariacristina; Pagano, Nico; Serra, Carla; Calculli, Lucia; Santini, Donatella; Minni, Francesco

    2016-09-01

    Total pancreatectomy is actually considered a viable option in selected patients even if large comparative studies between partial versus total pancreatectomy are not currently available. Our aim was to evaluate whether total pancreatectomy can be considered as feasible, safe, efficacious, and cost-effective as pancreaticoduodenectomy. A single center, prospective, observational trial, regarding postoperative outcomes, long-term results, and cost-effectiveness, in a tertiary referral center was conducted, comparing consecutive patients who underwent elective total pancreatectomy and/or pancreaticoduodenectomy. Seventy-three consecutive elective total pancreatectomies and 184 pancreaticoduodenectomies were compared. There were no significant differences regarding postoperative outcomes and overall survival. The quality of life, evaluated in 119 patients according to the EQ-5D-5L questionnaire, showed that there were no significant differences regarding the five items considered. The mean EQ-5D-5L score was similar in the two procedures (total pancreatectomy = 0.872, range 0.345-1.000; pancreaticoduodenectomy = 0.832, range 0.393-1.000; P = 0.320). The impact of diabetes according to the Problem Areas in Diabetes (PAID) questionnaire did not show any significant differences except for question 13 (total pancreatectomy = 0.60; pancreaticoduodenectomy = 0.19; P = 0.022). The cost-effectiveness analysis suggested that the quality-adjusted life year was not significantly different between the two procedures (total pancreatectomy = 0.910, range 0.345-1.000; pancreaticoduodenectomy = 0.910, range -0.393-1.000; P = 0.320). From this study, it seems reasonable to suggest that total pancreatectomy can be considered as safe, feasible, and efficacious as PD and acceptable in terms of cost-effectiveness.

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

    Science.gov (United States)

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

    2017-12-01

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

  12. The effect of alcohol treatment on social costs of alcohol dependence: results from the COMBINE study.

    Science.gov (United States)

    Zarkin, Gary A; Bray, Jeremy W; Aldridge, Arnie; Mills, Michael; Cisler, Ron A; Couper, David; McKay, James R; O'Malley, Stephanie

    2010-05-01

    The COMBINE (combined pharmacotherapies and behavioral intervention) clinical trial recently evaluated the efficacy of pharmacotherapies, behavioral therapies, and their combinations for the treatment of alcohol dependence. Previously, the cost and cost-effectiveness of COMBINE have been studied. Policy makers, patients, and nonalcohol-dependent individuals may be concerned not only with alcohol treatment costs but also with the effect of alcohol interventions on broader social costs and outcomes. To estimate the sum of treatment costs plus the costs of health care utilization, arrests, and motor vehicle accidents for the 9 treatments in COMBINE 3 years postrandomization. A cost study based on a randomized controlled clinical trial. : The study involved 786 participants 3 years postrandomization. Multivariate results show no significant differences in mean costs between any of the treatment arms as compared with medical management (MM) + placebo for the 3-year postrandomization sample. The median costs of MM + acamprosate, MM + naltrexone, MM + acamprosate + naltrexone, and MM + acamprosate + combined behavioral intervention were significantly lower than the median cost for MM + placebo. The results show that social cost savings are generated relative to MM + placebo by 3 years postrandomization, and the magnitude of these cost savings is greater than the costs of the COMBINE treatment received 3 years prior. Our study suggests that several alcohol treatments may indeed lead to reduced median social costs associated with health care, arrests, and motor vehicle accidents.

  13. Federal Regulations: Efforts to Estimate Total Costs and Benefits of Rules

    Science.gov (United States)

    2004-04-07

    the Chamber of Commerce , academicians, the media, and others, and is sometimes cited with a high degree of certainty ." For example, some articles...House of Representatives, Feb . 25,2004; and testimony of William P . Kovacs, Vice President, U .S. Chamber of Commerce , before the Subcommittee on Energy...estimated the annual cost to employers of the Family and Medical Leave Act at $825 million, but that the Chamber of Commerce estimated the cost at between $3

  14. Determining the Cost-Savings Threshold and Alignment Accuracy of Patient-Specific Instrumentation in Total Ankle Replacements.

    Science.gov (United States)

    Hamid, Kamran S; Matson, Andrew P; Nwachukwu, Benedict U; Scott, Daniel J; Mather, Richard C; DeOrio, James K

    2017-01-01

    Traditional intraoperative referencing for total ankle replacements (TARs) involves multiple steps and fluoroscopic guidance to determine mechanical alignment. Recent adoption of patient-specific instrumentation (PSI) allows for referencing to be determined preoperatively, resulting in less steps and potentially decreased operative time. We hypothesized that usage of PSI would result in decreased operating room time that would offset the additional cost of PSI compared with standard referencing (SR). In addition, we aimed to compare postoperative radiographic alignment between PSI and SR. Between August 2014 and September 2015, 87 patients undergoing TAR were enrolled in a prospectively collected TAR database. Patients were divided into cohorts based on PSI vs SR, and operative times were reviewed. Radiographic alignment parameters were retrospectively measured at 6 weeks postoperatively. Time-driven activity-based costing (TDABC) was used to derive direct costs. Cost vs operative time-savings were examined via 2-way sensitivity analysis to determine cost-saving thresholds for PSI applicable to a range of institution types. Cost-saving thresholds defined the price of PSI below which PSI would be cost-saving. A total of 35 PSI and 52 SR cases were evaluated with no significant differences identified in patient characteristics. Operative time from incision to completion of casting in cases without adjunct procedures was 127 minutes with PSI and 161 minutes with SR ( P cost-savings threshold range at our institution of $863 below which PSI pricing would provide net cost-savings. Two-way sensitivity analysis generated a globally applicable cost-savings threshold model based on institution-specific costs and surgeon-specific time-savings. This study demonstrated equivalent postoperative TAR alignment with PSI and SR referencing systems but with a significant decrease in operative time with PSI. Based on TDABC and associated sensitivity analysis, a cost-savings threshold

  15. Universitarios y redes sociales informativas: Escépticos totales, moderados duales o pro-digitales

    Directory of Open Access Journals (Sweden)

    2017-10-01

    Full Text Available El objetivo del presente trabajo es analizar el uso de las redes sociales informativas como herramienta de empoderamiento social por los universitarios españoles, y su percepción de la universidad como institución que contribuye a la formación de una ciudadanía crítica y activa, al tiempo que les proporciona las pertinentes competencias digitales. La revisión bibliográfica evidencia posibles discrepancias respecto al efecto que tienen las nuevas formas de comunicación digital en el empoderamiento de los jóvenes y en particular de los universitarios, así como la existencia de numerosas cuestiones por aclarar en este escenario digital. A continuación se presenta un análisis tipológico de la percepción de los estudiantes universitarios respecto a las redes sociales informativas, empoderamiento social y el papel de la universidad. A partir de los datos recogidos mediante un cuestionario estructurado de una muestra de 236 estudiantes de Grados de Ciencias Sociales, se realiza un análisis de tipologías con el algoritmo K Medias. Se identifican tres tipos –etiquetados como «escépticos totales», «moderados duales» y «pro-digitales»– significativamente diferentes. Se explica su prevalencia, y su caracterización: perfiles de creencias y conducta relacionadas con dichas creencias. El trabajo concluye con diversas recomendaciones para futuras investigaciones en cuanto a la percepción del universitario sobre el uso de las redes sociales como herramienta de transformación social y el papel de la universidad.

  16. Monetary valuation of the social cost of CO2 emissions : A critical survey

    NARCIS (Netherlands)

    van den Bergh, J. C J M; Botzen, W. J W|info:eu-repo/dai/nl/297620584

    2015-01-01

    An expanding branch of research has estimated the potential costs of climate change, which are often expressed as the "Social Cost of Carbon" (SCC) or the costs of an additional ton of CO2 emissions. Estimates of the SCC can be used by policy makers to evaluate climate change policies and greenhouse

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

    Science.gov (United States)

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

    2016-04-01

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

  18. Is Social Work Advocacy Worth the Cost? Issues and Barriers to an Economic Analysis of Social Work Political Practice

    Science.gov (United States)

    McNutt, John

    2011-01-01

    Advocacy is central to the social work profession's commitment to social betterment and justice, yet much of what we know about it is based on conventional wisdom. We have little evidence on the effectiveness of interventions and even less on the costs and benefits of advocacy campaigns. This article discusses some of the conceptual and…

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

    Science.gov (United States)

    Ross, Abigail M.; Wachman, Madeline K.

    2017-01-01

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

  20. Disclosure Regulation in Duopoly Markets: Proprietary Costs and Social Welfare

    NARCIS (Netherlands)

    Suijs, J.P.M.; Wielhouwer, J.L.

    2014-01-01

    The argument of proprietary costs is commonly used by firms to object against proposed disclosure regulations. The goal of this paper is to improve our understanding of the welfare consequences of disclosure in duopoly markets and to identify market settings where proprietary costs are a viable

  1. Disclosure regulation in duopoly markets : Proprietary costs and social welfare

    NARCIS (Netherlands)

    Suijs, J.P.M.; Wielhouwer, J.L.

    2014-01-01

    The argument of proprietary costs is commonly used by firms to object against proposed disclosure regulations. The goal of this paper is to improve our understanding of the welfare consequences of disclosure in duopoly markets and to identify market settings where proprietary costs are a viable

  2. Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study

    Science.gov (United States)

    Hill, Anne-Marie; Ross-Adjie, Gail; McPhail, Steven M; Monterosso, Leanne; Bulsara, Max; Etherton-Beer, Christopher; Powell, Sarah-Jayne; Hardisty, Gerard

    2016-01-01

    Introduction The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. Methods and analyses A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. Ethics and dissemination The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. Trial registration number ACTRN12615000653561; Pre-results. PMID:27412102

  3. Quantifying the total cost of infrastructure to enable environmentally preferable decisions: the case of urban roadway design

    International Nuclear Information System (INIS)

    Gosse, Conrad A; Clarens, Andres F

    2013-01-01

    Efforts to reduce the environmental impacts of transportation infrastructure have generally overlooked many of the efficiencies that can be obtained by considering the relevant engineering and economic aspects as a system. Here, we present a framework for quantifying the burdens of ground transportation in urban settings that incorporates travel time, vehicle fuel and pavement maintenance costs. A Pareto set of bi-directional lane configurations for two-lane roadways yields non-dominated combinations of lane width, bicycle lanes and curb parking. Probabilistic analysis and microsimulation both show dramatic mobility reductions on road segments of insufficient width for heavy vehicles to pass bicycles without encroaching on oncoming traffic. This delay is positively correlated with uphill grades and increasing traffic volumes and inversely proportional to total pavement width. The response is nonlinear with grade and yields mixed uphill/downhill optimal lane configurations. Increasing bicycle mode share is negatively correlated with total costs and emissions for lane configurations allowing motor vehicles to safely pass bicycles, while the opposite is true for configurations that fail to facilitate passing. Spatial impacts on mobility also dictate that curb parking exhibits significant spatial opportunity costs related to the total cost Pareto curve. The proposed framework provides a means to evaluate relatively inexpensive lane reconfiguration options in response to changing modal share and priorities. These results provide quantitative evidence that efforts to reallocate limited pavement space to bicycles, like those being adopted in several US cities, could appreciably reduce costs for all users. (letter)

  4. Quantifying the total cost of infrastructure to enable environmentally preferable decisions: the case of urban roadway design

    Science.gov (United States)

    Gosse, Conrad A.; Clarens, Andres F.

    2013-03-01

    Efforts to reduce the environmental impacts of transportation infrastructure have generally overlooked many of the efficiencies that can be obtained by considering the relevant engineering and economic aspects as a system. Here, we present a framework for quantifying the burdens of ground transportation in urban settings that incorporates travel time, vehicle fuel and pavement maintenance costs. A Pareto set of bi-directional lane configurations for two-lane roadways yields non-dominated combinations of lane width, bicycle lanes and curb parking. Probabilistic analysis and microsimulation both show dramatic mobility reductions on road segments of insufficient width for heavy vehicles to pass bicycles without encroaching on oncoming traffic. This delay is positively correlated with uphill grades and increasing traffic volumes and inversely proportional to total pavement width. The response is nonlinear with grade and yields mixed uphill/downhill optimal lane configurations. Increasing bicycle mode share is negatively correlated with total costs and emissions for lane configurations allowing motor vehicles to safely pass bicycles, while the opposite is true for configurations that fail to facilitate passing. Spatial impacts on mobility also dictate that curb parking exhibits significant spatial opportunity costs related to the total cost Pareto curve. The proposed framework provides a means to evaluate relatively inexpensive lane reconfiguration options in response to changing modal share and priorities. These results provide quantitative evidence that efforts to reallocate limited pavement space to bicycles, like those being adopted in several US cities, could appreciably reduce costs for all users.

  5. Evaluation of the Influence of the Logistic Operations Reliability on the Total Costs of a Supply Chain

    Directory of Open Access Journals (Sweden)

    Lukinskiy Valery

    2016-12-01

    Full Text Available Nowadays in logistics integral processes between the material and related flows in supply chains are getting developed more and more. However, in spite of increasing volume of statistical data which reflect the integral processes, the influence evaluation issues of the logistic operations reliability indexes on the total logistics costs remain open and require the corresponding researches implementation.

  6. Cost-effectiveness of a health-social partnership transitional program for post-discharge medical patients

    Directory of Open Access Journals (Sweden)

    Wong Frances Kam Yuet

    2012-12-01

    Full Text Available Abstract Background Readmissions are costly and have implications for quality of care. Studies have been reported to support effects of transitional care programs in reducing hospital readmissions and enhancing clinical outcomes. However, there is a paucity of studies executing full economic evaluation to assess the cost-effectiveness of these transitional care programs. This study is therefore launched to fill this knowledge gap. Methods Cost-effectiveness analysis was conducted alongside a randomized controlled trial that examined the effects of a Health-Social Transitional Care Management Program (HSTCMP for medical patients discharged from an acute regional hospital in Hong Kong. The cost and health outcomes were compared between the patients receiving the HSTCMP and usual care. The total costs comprised the pre-program, program, and healthcare utilization costs. Quality of life was measured with SF-36 and transformed to utility values between 0 and 1. Results The readmission rates within 28 (control 10.2%, study 4.0% and 84 days (control 19.4%, study 8.1% were significantly higher in the control group. Utility values showed no difference between the control and study groups at baseline (p = 0.308. Utility values for the study group were significantly higher than in the control group at 28 (p  Conclusions Previous studies on transitional care focused mainly on clinical outcomes and not too many included cost as an outcome measure. Studies examining the cost-effectiveness of the post-discharge support services are scanty. This study is the first to examine the cost-effectiveness of a transitional care program that used nurse-led services participated by volunteers. Results have shown that a health-social partnership transitional care program is cost-effective in reducing healthcare costs and attaining QALY gains. Economic evaluation helps to inform funders and guide decisions for the effective use of competing healthcare resources.

  7. Reducing Customers’ Total Cost of Ownership Within a Software Supply Network

    NARCIS (Netherlands)

    Slinger, S.R.L.; Rijsemus, W.

    2006-01-01

    This paper describes how the company Cordys avoids the ERP problems from the last 15 years by improving the software release, delivery, deployment, and maintenance processes. These ERP problems, such as costly ERP migrations and highly complex maintenance procedures, are circumvented by the

  8. RANKED SET SAMPLING FOR ECOLOGICAL RESEARCH: ACCOUNTING FOR THE TOTAL COSTS OF SAMPLING

    Science.gov (United States)

    Researchers aim to design environmental studies that optimize precision and allow for generalization of results, while keeping the costs of associated field and laboratory work at a reasonable level. Ranked set sampling is one method to potentially increase precision and reduce ...

  9. Total and Marginal Cost Analysis for a High School Based Bystander Intervention

    Science.gov (United States)

    Bush, Joshua L.; Bush, Heather M.; Coker, Ann L.; Brancato, Candace J.; Clear, Emily R.; Recktenwald, Eileen A.

    2018-01-01

    Costs of providing the Green Dot bystander-based intervention, shown to be effective in the reduction of sexual violence among Kentucky high school students, were estimated based on data from a large cluster-randomized clinical trial. Rape Crisis Center Educators were trained to provide Green Dot curriculum to students. Implementing Green Dot in…

  10. Functional and oncologic outcomes after excision of the total femur in primary bone tumors: Results with a low cost total femur prosthesis

    Directory of Open Access Journals (Sweden)

    Ajay Puri

    2012-01-01

    Full Text Available Background: The extent of tumor may necessitate resection of the complete femur rarely to achieve adequate oncologic clearance in bone sarcomas. We present our experience with reconstruction in such cases using an indigenously manufactured, low-cost, total femoral prosthesis (TFP. We assessed the complications of the procedure, the oncologic and functional outcomes, and implant survival. Materials and Methods: Eight patients (four males and four females with a mean age of 32 years, operated between December 2003 and June 2009, had a TFP implanted. The diagnosis included osteogenic sarcoma (5, Ewing′s sarcoma (1, and chondrosarcoma (2. Mean followup was 33 months (9-72 months for all and 40 months (24-72 months in survivors. They were evaluated by Musculoskeletal Tumor Society score, implant survival as well as patient survival. Results: There was one local recurrence and five of seven patients are currently alive at the time of last followup. The Musculoskeletal Tumor Society score for patients ranged from 21 to 25 with a mean of 24 (80%. The implant survival was 88% at 5 years with only one TFP needing removal because of infection. Conclusions: A TFP in appropriately indicated patients with malignant bone tumors is oncologically safe. A locally manufactured, cost-effective implant provided consistent and predictable results after excision of the total femur with good functional outcomes.

  11. Social Media and Total Joint Arthroplasty: An Analysis of Patient Utilization on Instagram.

    Science.gov (United States)

    Ramkumar, Prem N; Navarro, Sergio M; Haeberle, Heather S; Chughtai, Morad; Flynn, Megan E; Mont, Michael A

    2017-09-01

    The purpose of this study was to analyze the nature of shared content of total joint arthroplasty patients on Instagram. Specifically, we evaluated social media posts for: (1) perspective and timing; (2) tone; (3) focus (activities of daily living [ADLs], rehabilitation, return-to-work); and (4) the comparison between hip and knee arthroplasties. A search of the public Instagram domain was performed over a 6-month period. Total hip and knee arthroplasties (THA and TKA) were selected for the analysis using the following terms: "#totalhipreplacement," "#totalkneereplacement," and associated terms. 1287 individual public posts of human subjects were shared during the period. A categorical scoring system was utilized for media format (photo or video), time (preoperative, perioperative, or postoperative) period, tone (positive or negative), return-to-work, ADLs, rehabilitation, surgical site, radiograph image, satisfaction, and dissatisfaction. Ninety-one percent of the posts were shared during the postoperative period. Ninety-three percent of posts had a positive tone. Thirty-four percent of posts focused on both ADLs and 33.8% on rehabilitation. TKA patients shared more about their surgical site (14.5% vs 3.3%, P Instagram, arthroplasty patients did so with a positive tone, starting a week after surgery. TKA posts focused more on rehabilitation and wound healing than THA patients, whereas THA patients shared more posts on ADLs. The analysis of social media posts provides insight into what matters to patients after total joint arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients.

    Science.gov (United States)

    Saxena, S K; Ng, T P; Yong, D; Fong, N P; Gerald, K

    2006-11-01

    Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98). Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed.

  13. Cost of post-operative intravenous iron therapy in total lower limb arthroplasty: a retrospective, matched cohort study

    Science.gov (United States)

    Muñoz, Manuel; Gómez-Ramírez, Susana; Martín-Montañez, Elisa; Naveira, Enrique; Seara, Javier; Pavía, José

    2014-01-01

    Background Requirements for allogeneic red cell transfusion after total lower limb arthroplasty are still high (20–50%), and post-operative intravenous iron has been shown to reduce transfusion requirements for this surgery. We performed a cost analysis to ascertain whether this alternative is also likely to be cost-effective. Materials and methods Data from 182 matched-pairs of total lower limb arthroplasty patients, managed with a restrictive transfusion protocol and without (control group) or with post-operative intravenous iron (iron group), were retrospectively reviewed. Acquisition and administration costs of iron (iron sucrose or ferric carboxymaltose) and allogeneic red cell concentrates, haemoglobin measurements, and prolonged stay in hospital were used for blood management cost analysis. Results Patients in the iron group received 600 mg intravenous iron, without clinically relevant incidents, and had a lower allogeneic transfusion rate (11.5% vs 26.4% for the iron and control groups, respectively; p=0.001). The reduction in transfusion rate was more pronounced in anaemic patients (17% vs 40%; p=0.015) than in non-anaemic ones (9.6% vs 21.2%; p=0.011). There were no differences with respect to post-operative infection rate. Patients receiving allogeneic transfusion stayed in hospital longer (+1.9 days [95% CI: 1.2–2.6]). As intravenous iron reduces the allogeneic transfusion rate, both iron formulations were cost-neutral in the different cost scenarios (−25.5 to 62.1 €/patient for iron sucrose, and −51.1 to 64.4 €/patient for ferric carboxymaltose). Discussion In patients presenting with or without pre-operative anaemia, post-operative intravenous iron after total lower limb arthroplasty seems to be safe and is associated with reduced transfusion rates, without incremental costs. For anaemic patients, its efficacy could be increased by associating some other blood-saving method. PMID:24120595

  14. Deep water tie-back economics capex vs opex and the total costs

    Energy Technology Data Exchange (ETDEWEB)

    Tarlton, Oran D. [Oil States Industries Inc., Arlington, TX (United States)

    2005-07-01

    This paper explores the real cost and time benefits associated with the current, past, and future contracting strategies associated with subsea developments. It looks at the real cost associated with out sourcing engineering development and the impact of engineering, procurement, installation, and construction (EPIC) contracts. Development costs are first and foremost in the minds of operators as a field is analyzed for development potential. The cycle starts with an analysis of the geological information to estimate the potential value in the field. It proceeds to conceptual design where the first development methodology and cost estimates are prepared. If the project is initially viable it will proceed from conceptual design to Front End Engineering and Design (FEED) where a complete development plan is prepared with possible options and recommendations. Engineering companies may as a part of the FEED prepare a Request for Quotation (RFQ) which is sent to potential suppliers. As part of a FEED contract, an engineering company may also review responses to the RFQ and provide recommendations for selected suppliers. Typically large subsea projects are divided into several major categories such as: topsides; subsea production systems; wells; subsea umbilical risers and glow lines (SURF), and commissioning in order to simplify management and procurement. Many times these contracts are awarded as EPIC contracts to further simplify management and internal procurement efforts. A case study is presented which challenges current contracting strategies and presents an option for a lower cost and a better way forward with respect to the short term and a focus on the long term. (author)

  15. Total cost of ownership of CHP SOFC systems: Effect of installation context

    International Nuclear Information System (INIS)

    Arduino, Francesco; Santarelli, Massimo

    2016-01-01

    Solid oxide fuel cells (SOFC) are one of the most interesting between the emerging technologies for energy production. Although some information about the production cost of these devices are already known, their operational cost has not been studied yet with sufficient accuracy. This paper presents a life cycle cost (LCC) analysis of CHP (combined heat and power) SOFC systems performed in hospitals located in various cities of the US and one in Italy. In this study the strong effects of the installation context will be analyzed using a customized use phase model for each location. The cost effectiveness of these devices has been proved without credits in Mondovi (IT), New York (NY) and Minneapolis (MN) where the payback time goes from 10 to 7 years. Considering the credits, it is possible to obtain economic feasibility also in Chicago (IL) and reduce the payback for other cities to values from 4 to 6 years. In other cities like Phoenix (AZ) and Houston (TX) the payback can’t be reached in any case. The life cycle impact assessment analysis has shown how, even in the cities with cleaner electricity grid, there is a reduction in the emissions of both greenhouse gases and pollutants. - Highlights: •Life cycle cost analysis has been performed for CHP SOFC systems. •The strong effects of the installation context have been analyzed. •Economic feasibility has been proven in new york, Minneapolis and Mondovi. •Economic feasibility can’t be reached in phoenix and Houston. •SOFC always provide a reduction in the emissions of greenhouse gases and pollutant.

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

    Science.gov (United States)

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

    2014-07-28

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

  17. Total cost of ownership of electric vehicles compared to conventional vehicles: A probabilistic analysis and projection across market segments

    International Nuclear Information System (INIS)

    Wu, Geng; Inderbitzin, Alessandro; Bening, Catharina

    2015-01-01

    While electric vehicles (EV) can perform better than conventional vehicles from an environmental standpoint, consumers perceive them to be more expensive due to their higher capital cost. Recent studies calculated the total cost of ownership (TCO) to evaluate the complete cost for the consumer, focusing on individual vehicle classes, powertrain technologies, or use cases. To provide a comprehensive overview, we built a probabilistic simulation model broad enough to capture most of a national market. Our findings indicate that the comparative cost efficiency of EV increases with the consumer's driving distance and is higher for small than for large vehicles. However, our sensitivity analysis shows that the exact TCO is subject to the development of vehicle and operating costs and thus uncertain. Although the TCO of electric vehicles may become close to or even lower than that of conventional vehicles by 2025, our findings add evidence to past studies showing that the TCO does not reflect how consumers make their purchase decision today. Based on these findings, we discuss policy measures that educate consumers about the TCO of different vehicle types based on their individual preferences. In addition, measures improving the charging infrastructure and further decreasing battery cost are discussed. - Highlights: • Calculates the total cost of ownership across competing vehicle technologies. • Uses Monte Carlo simulation to analyse distributions and probabilities of outcomes. • Contains a comprehensive assessment across the main vehicle classes and use cases. • Indicates that cost efficiency of technology depends on vehicle class and use case. • Derives specific policy measures to facilitate electric vehicle diffusion

  18. Corporate social responsible costs in the environmental area

    Directory of Open Access Journals (Sweden)

    Sefa Boria-Reverter

    2013-09-01

    Full Text Available Purpose: To know how the application of environmental politicies facilitates the identification of unknown costs and their next reaction. Moreover we try to determine, if these costs have a connection with the different environmental strategies, which are used. Design/methodology/approach: An empiric study was done through a telephonic survey all over Spain in 2012. The idea was to obtain a representative sample. From 943 companies, the survey was answered by 141 of them. Findings and Originality/value: It is shown the relationship between the costs behavior, knowledge of the unknown and hidden costs with the environmental strategies. Research limitations/implications: To dispose a bigger sample, this allowed us to obtain results in relationship with sectors type and to verify the result for regions. Practical implications: The organizations can be aware of costs reaction, depending on their action in the environmental area. Originality/value: Environmental politicies in the CSR field facilitate unknown or hidden costs detection and they allow their evaluation and the decisions about them. The obtained improvements can revert to the society due to the development of environmental politicies and they offer a competitive advantage for the company.

  19. Ranking periodic ordering models on the basis of minimizing total inventory cost

    Directory of Open Access Journals (Sweden)

    Mohammadali Keramati

    2015-06-01

    Full Text Available This paper aims to provide proper policies for inventory under uncertain conditions by comparing different inventory policies. To review the efficiency of these algorithms it is necessary to specify the area in which each of them is applied. Therefore, each of the models has been reviewed under different forms of retailing and they are ranked in terms of their expenses. According to the high values of inventories and their impacts on the costs of the companies, the ranking of various models using the simulation annealing algorithm are presented, which indicates that the proposed model of this paper could perform better than other alternative ones. The results also indicate that the suggested algorithm could save from 4 to 29 percent on costs of inventories.

  20. Implementation of Distance Support (DS) to Reduce Total Ownership Cost (R-TOC)

    Science.gov (United States)

    2012-02-01

    Policy of 22 Mar 2007, states that DS combines people, processes and technology into a collaborative infrastructure regardless of geographic location...Tech Assist Data for Submarine Enterprise 120 FTA Events Performed 164 MH Via On-Si te Support Average Cost Per Event (Based on $60.00 Per Hour...CFFC/Command Policy) 16% Success Rate Overa l l On Al l FTA Events 37% Success Rate On Out-Of-Area Events Average MHs Per Event 19 MH Via DS

  1. Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty

    OpenAIRE

    Mustafa Gökhan Bilgili; Ersin Erçin; Cemal Kural; Altuğ Duramaz; Cevdet Avkan; Gökhan Peker; Serdar Hakan Başaran

    2014-01-01

    Background: Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Aims: Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system ...

  2. Cost-utility analysis comparing radioactive iodine, anti-thyroid drugs and total thyroidectomy for primary treatment of Graves' disease.

    Science.gov (United States)

    Donovan, Peter J; McLeod, Donald S A; Little, Richard; Gordon, Louisa

    2016-12-01

    Little data is in existence about the most cost-effective primary treatment for Graves' disease. We performed a cost-utility analysis comparing radioactive iodine (RAI), anti-thyroid drugs (ATD) and total thyroidectomy (TT) as first-line therapy for Graves' disease in England and Australia. We used a Markov model to compare lifetime costs and benefits (quality-adjusted life-years (QALYs)). The model included efficacy, rates of relapse and major complications associated with each treatment, and alternative second-line therapies. Model parameters were obtained from published literature. One-way sensitivity analyses were conducted. Costs were presented in 2015£ or Australian Dollars (AUD). RAI was the least expensive therapy in both England (£5425; QALYs 34.73) and Australia (AUD5601; 30.97 QALYs). In base case results, in both countries, ATD was a cost-effective alternative to RAI (£16 866; 35.17 QALYs; incremental cost-effectiveness ratio (ICER) £26 279 per QALY gained England; AUD8924; 31.37 QALYs; ICER AUD9687 per QALY gained Australia), while RAI dominated TT (£7115; QALYs 33.93 England; AUD15 668; 30.25 QALYs Australia). In sensitivity analysis, base case results were stable to changes in most cost, transition probabilities and health-relative quality-of-life (HRQoL) weights; however, in England, the results were sensitive to changes in the HRQoL weights of hypothyroidism and euthyroidism on ATD. In this analysis, RAI is the least expensive choice for first-line treatment strategy for Graves' disease. In England and Australia, ATD is likely to be a cost-effective alternative, while TT is unlikely to be cost-effective. Further research into HRQoL in Graves' disease could improve the quality of future studies. © 2016 European Society of Endocrinology.

  3. Social Motivation: Costs and Benefits of Selfishness and Otherishness.

    Science.gov (United States)

    Crocker, Jennifer; Canevello, Amy; Brown, Ashley A

    2017-01-03

    We examine recent evidence on the consequences of selfishness and otherishness for psychological well-being, physical health, and relationships. In the first sections, we consider recent evidence regarding the costs and benefits of giving time, money, and support to others and the costs and benefits of taking or receiving those things from others. Then, because the behaviors of giving and taking can be motivated either by selfish or otherish concerns, we next consider the costs and benefits of the motivation underlying giving and taking. We also examine why and for whom selfishness and otherishness have consequences for psychological well-being, physical health, and relationships. We focus on mechanisms identified in research, including intrapsychic mechanisms such as positive and negative affect, self-esteem and self-efficacy, a sense of meaning and purpose in life, and a sense of connectedness to or isolation from others, as well as interpersonal processes such as reciprocation of support and responsiveness.

  4. A Validation of the Health and Social Costs of Asthma Using Questionnaire Data

    Directory of Open Access Journals (Sweden)

    Alison Brookman

    2017-04-01

    Societal cost factors are not adequately captured within existing tools, our findings will inform the development of a new RUM which will be piloted and validated according to best practice guidelines. Capturing the societal costs of asthma will allow more accurate estimates of the total costs of asthma in the UK.

  5. Social costs of innovative electricity generation technologies in the present and in 2030

    Energy Technology Data Exchange (ETDEWEB)

    Preiss, Philipp; Friedrich, Rainer; Blesl, Markus; Wissel, Steffen; Mayer-Spohn, Oliver; Klotz, Volker [Stuttgart Univ. (DE). Inst. fuer Energiewirtschaft und Rationelle Energieanwendung (IER)

    2008-07-01

    Social costs (costs seen from the perspective of the society) differ from private costs and thus influence the ranking of electricity generating technologies. The resulting social costs data provide a basis for the recommendation to use the potential of nuclear, wind and hydropower as far as possible, however the potential of these technologies is limited. The analysis shows, that the remaining electricity demand in the future still should be met by using lignite and coal. Depending on the stringency of the climate change aims these plants would be equipped with CCS (carbon capture and storage) or not. Only with ambitious climate change aims and if CCS turns out to be less economically or technically feasible, than the import of electricity generated by a solar through systems in Mediterranean countries would become an option. The environmental advantages of PV are too small to compensate the very high investment costs in Germany. The detailed analysis of different contributions to the social costs per kWh shows that the costs of natural gas technologies are dominated by private costs of fuel supply. If we assume 50% higher prices than in the basic assumption this increases social costs up to 30%. (orig.)

  6. Social benefits of luxury brands as costly signals of wealth and status

    NARCIS (Netherlands)

    Nelissen, R.M.A.; Meijers, M.H.C.

    2011-01-01

    Drawing from costly signaling theory, we predicted that luxury consumption enhances status and produces benefits in social interactions. Across seven experiments, displays of luxury — manipulated through brand labels on clothes — elicited different kinds of preferential treatment, which even

  7. Gender Differences in the Social Cost of Affective Deviance.

    Science.gov (United States)

    Brown, Christina M; Olkhov, Yevgeniy M; Bailey, Veronika S; Daniels, Emily R

    2015-01-01

    The current study tested whether men and women receive different degrees of social punishment for violating norms of emotional expression. Participants watched videos of male and female targets (whose reactions were pre-tested to be equivalent in expressivity and valence) viewing either a positive or negative slideshow, with their emotional reaction to the slideshow manipulated to be affectively congruent, affectively incongruent, or flat. Participants then rated the target on a number of social evaluation measures. Displaying an incongruent emotional expression, relative to a congruent one, harmed judgments of women more than men. Women are expected to be more emotionally expressive than men, making an incongruent expression more deviant for women. These results highlight the importance of social norms in construing another person's emotion displays, which can subsequently determine acceptance or rejection of that person.

  8. Cost-Effectiveness Analysis of Total Hip Arthroplasty Performed by a Canadian Short-Stay Surgical Team in Ecuador.

    Science.gov (United States)

    Schlegelmilch, Michael; Rashiq, Saifee; Moreau, Barbara; Jarrín, Patricia; Tran, Bach; Chuck, Anderson

    2017-01-01

    Few charitable overseas surgical missions produce cost-effectiveness analyses of their work. We compared the pre- and postoperative health status for 157 total hip arthroplasty (THA) patients operated on from 2007 to 2011 attended by an annual Canadian orthopedic mission to Ecuador to determine the quality-adjusted life years (QALYs) gained. The costs of each mission are known. The cost per surgery was divided by the average lifetime QALYs gained to estimate an incremental cost-effectiveness ratio (ICER) in Canadian dollars per QALY. The average lifetime QALYs (95% CI) gained were 1.46 (1.4-1.5), 2.5 (2.4-2.6), and 2.9 (2.7-3.1) for unilateral, bilateral, and staged (two THAs in different years) operations, respectively. The ICERs were $4,442 for unilateral, $2,939 for bilateral, and $4392 for staged procedures. Seventy percent of the mission budget was spent on the transport and accommodation of volunteers. THA by a Canadian short-stay surgical team was highly cost-effective, according to criteria from the National Institute for Health and Care Excellence and the World Health Organization. We encourage other international missions to provide similar cost-effectiveness data to enable better comparison between mission types and between mission and nonmission care.

  9. Using cost-benefit analysis and social return on investment to evaluate the impact of social enterprise: Promises, implementation, and limitations.

    Science.gov (United States)

    Cordes, Joseph J

    2017-10-01

    Since the early 2000's there has been growing interest in using the Social Return on Investment (SROI) as a measure for assessing the performance of social enterprises. By analogy with its business counterpart, the Return on Investment (ROI), the SROI is a metric that compares the monetized social costs of a program with the monetized social benefits of achieving an outcome (or set of outcomes). For example, calculating the SROI of a nonprofit half-way house for drug addicts might involve estimating the reduced social costs attributable to successful rehabilitation of addicts, and comparing this to the social costs of operating the half-way house. Alternatively, the total return of a for-profit social enterprise providing affordable housing might consist both of the traditional private return on investment along with the economic value of meeting the housing needs of lower income households. Early descriptions of the methodology for calculating the SROI suggest that the approach initially evolved from standard methodologies found in the business finance literature for evaluating investments, with the important twist that nonprofit sector returns/payoffs are defined in broader social terms (Thornley, Anderson, & Dixon, 2016). Yet, someone who is familiar with the economic literature on cost benefit analysis (CBA) as it is applied to the evaluation of public programs cannot help but be struck by the similarity between the outcomes that CBA is intended to measure, and those that are the object of efforts to calculate the SROI. One implication is that the literature on the theory and practice of cost benefit analysis offers useful lessons about how to measure the social return on investment, as well as about potential caveats and limitations that need to be confronted when attempting to undertake an analysis of the SROI. The paper discusses the potential uses and limitations of CBA and SROI as tools that governments, private donor/investors, and foundations can use to

  10. 45 CFR 201.6 - Withholding of payment; reduction of Federal financial participation in the costs of social...

    Science.gov (United States)

    2010-10-01

    ... financial participation in the costs of social services and training. 201.6 Section 201.6 Public Welfare... Federal financial participation in the costs of social services and training. (a) When withheld. Further... (AABD) of the Act, Federal financial participation in the costs of social services and training approved...

  11. Feasibility studies to improve plant availability and reduce total installed cost in IGCC plants

    Energy Technology Data Exchange (ETDEWEB)

    Sullivan, Kevin [General Electric Company, Houston, TX (United States); Anasti, William [General Electric Company, Houston, TX (United States); Fang, Yichuan [General Electric Company, Houston, TX (United States); Subramanyan, Karthik [General Electric Company, Houston, TX (United States); Leininger, Tom [General Electric Company, Houston, TX (United States); Zemsky, Christine [General Electric Company, Houston, TX (United States)

    2015-03-30

    The main purpose of this project is to look at technologies and philosophies that would help reduce the costs of an Integrated Gasification Combined Cycle (IGCC) plant, increase its availability or do both. GE’s approach to this problem is to consider options in three different areas: 1) technology evaluations and development; 2) constructability approaches; and 3) design and operation methodologies. Five separate tasks were identified that fall under the three areas: Task 2 – Integrated Operations Philosophy; Task 3 – Slip Forming of IGCC Components; Task 4 – Modularization of IGCC Components; Task 5 – Fouling Removal; and Task 6 – Improved Slag Handling. Overall, this project produced results on many fronts. Some of the ideas could be utilized immediately by those seeking to build an IGCC plant in the near future. These include the considerations from the Integrated Operations Philosophy task and the different construction techniques of Slip Forming and Modularization (especially if the proposed site is in a remote location or has a lack of a skilled workforce). Other results include ideas for promising technologies that require further development and testing to realize their full potential and be available for commercial operation. In both areas GE considers this project to be a success in identifying areas outside the core IGCC plant systems that are ripe for cost reduction and ity improvement opportunities.

  12. Calculating the Social Costs of Carbon without knowing preferences : Comment on “A rapid assessment model for understanding the social cost of carbon”

    NARCIS (Netherlands)

    Gerlagh, R.

    The Social Costs of Carbon (SCC) equals the marginal welfare loss associated with one unit of emitted CO2, divided by the marginal welfare gain associated with one unit of consumption. In stochastic assessments, both the nominator and denominator can depend on uncertain parameters; specifically they

  13. Cost-effectiveness analysis of HPV vaccination: comparing the general population with socially vulnerable individuals.

    Science.gov (United States)

    Han, Kyu-Tae; Kim, Sun Jung; Lee, Seo Yoon; Park, Eun-Cheol

    2014-01-01

    After the WHO recommended HPV vaccination of the general population in 2009, government support of HPV vaccination programs was increased in many countries. However, this policy was not implemented in Korea due to perceived low cost-effectiveness. Thus, the aim of this study was to analyze the cost-utility of HPV vaccination programs targeted to high risk populations as compared to vaccination programs for the general population. Each study population was set to 100,000 people in a simulation study to determine the incremental cost-utility ratio (ICUR), then standard prevalence rates, cost, vaccination rates, vaccine efficacy, and the Quality-Adjusted Life-Years (QALYs) were applied to the analysis. In addition, sensitivity analysis was performed by assuming discounted vaccination cost. In the socially vulnerable population, QALYs gained through HPV vaccination were higher than that of the general population (General population: 1,019, Socially vulnerable population: 5,582). The results of ICUR showed that the cost of HPV vaccination was higher for the general population than the socially vulnerable population. (General population: 52,279,255 KRW, Socially vulnerable population: 9,547,347 KRW). Compared with 24 million KRW/QALYs as the social threshold, vaccination of the general population was not cost-effective. In contrast, vaccination of the socially vulnerable population was strongly cost-effective. The results suggest the importance and necessity of government support of HPV vaccination programs targeted to socially vulnerable populations because a targeted approach is much more cost-effective. The implementation of government support for such vaccination programs is a critical strategy for decreasing the burden of HPV infection in Korea.

  14. Resilience and social costs: centralised towns vs. distributed settlements?

    DEFF Research Database (Denmark)

    Hendriksen, Kåre

    In government reports and political debates in Greenland it is often stated, that the divided settlement in general and especially the settlements are too costly, and that the outlying districts in general do not contribute sufficiently to the national economy. This presumption is used as an argu...

  15. External effects and social costs of road transport

    NARCIS (Netherlands)

    Verhoef, E.T.

    1994-01-01

    The article contains a welfare economic analysis of road transport's external effects. First, we discuss the definition of external effects. Applying this definition, it is concluded that road transport activities give rise to a wide range of external costs. However, there are no external benefits

  16. Leveraging Real-World Evidence in Disease-Management Decision-Making with a Total Cost of Care Estimator.

    Science.gov (United States)

    Nguyen, Thanh-Nghia; Trocio, Jeffrey; Kowal, Stacey; Ferrufino, Cheryl P; Munakata, Julie; South, Dell

    2016-12-01

    Health management is becoming increasingly complex, given a range of care options and the need to balance costs and quality. The ability to measure and understand drivers of costs is critical for healthcare organizations to effectively manage their patient populations. Healthcare decision makers can leverage real-world evidence to explore the value of disease-management interventions in shifting total cost trends. To develop a real-world, evidence-based estimator that examines the impact of disease-management interventions on the total cost of care (TCoC) for a patient population with nonvalvular atrial fibrillation (NVAF). Data were collected from a patient-level real-world evidence data set that uses the IMS PharMetrics Health Plan Claims Database. Pharmacy and medical claims for patients meeting the inclusion or exclusion criteria were combined in longitudinal cohorts with a 180-day preindex and 360-day follow-up period. Descriptive statistics, such as mean and median patient costs and event rates, were derived from a real-world evidence analysis and were used to populate the base-case estimates within the TCoC estimator, an exploratory economic model that was designed to estimate the potential impact of several disease-management activities on the TCoC for a patient population with NVAF. Using Microsoft Excel, the estimator is designed to compare current direct costs of medical care to projected costs by varying assumptions on the impact of disease-management activities and applying the associated changes in cost trends to the affected populations. Disease-management levers are derived from literature-based concepts affecting costs along the NVAF disease continuum. The use of the estimator supports analyses across 4 US geographic regions, age, cost types, and care settings during 1 year. All patients included in the study were continuously enrolled in their health plan (within the IMS PharMetrics Health Plan Claims Database) between July 1, 2010, and June 30

  17. Assessing the Social and Environmental Costs of Institution Nitrogen Footprints.

    Science.gov (United States)

    Compton, Jana E; Leach, Allison M; Castner, Elizabeth A; Galloway, James N

    2017-04-01

    This article estimates the damage costs associated with the institutional nitrogen (N) footprint and explores how this information could be used to create more sustainable institutions. Potential damages associated with the release of nitrogen oxides (NOx), ammonia (NH 3 ), and nitrous oxide (N 2 O) to air and release of nitrogen to water were estimated using existing values and a cost per unit of nitrogen approach. These damage cost values were then applied to two universities. Annual potential damage costs to human health, agriculture, and natural ecosystems associated with the N footprint of institutions were $11.0 million (2014) at the University of Virginia (UVA) and $3.04 million at the University of New Hampshire (UNH). Costs associated with the release of nitrogen oxides to human health, in particular the use of coal-derived energy, were the largest component of damage at UVA. At UNH the energy N footprint is much lower because of a landfill cogeneration source, and thus the majority of damages were associated with food production. Annual damages associated with release of nitrogen from food production were very similar at the two universities ($1.80 million vs. $1.66 million at UVA and UNH, respectively). These damages also have implications for the extent and scale at which the damages are felt. For example, impacts to human health from energy and transportation are generally larger near the power plants and roads, while impacts from food production can be distant from the campus. Making this information available to institutions and communities can improve their understanding of the damages associated with the different nitrogen forms and sources, and inform decisions about nitrogen reduction strategies.

  18. The opportunity cost of negative screening in socially responsible investing

    NARCIS (Netherlands)

    Trinks, Pieter Jan; Scholtens, Bert

    2017-01-01

    This paper investigates the impact of negative screening on the investment universe as well as on financial performance. We come up with a novel identification process and as such depart from mainstream Socially Responsible Investing (SRI) literature by concentrating on individual firms’ conduct and

  19. Add Interest to Your Social Studies Curriculum without Cost.

    Science.gov (United States)

    Bloom, Marion G.; And Others

    1992-01-01

    Lists a sampling of free materials and their sources for use by social studies teachers. Includes videos, maps, pamphlets, booklets, games, posters, and travel brochures from Norway, Saudi Arabia, Germany, and Korea among others. Provides source addresses, turnaround times, and descriptions of the materials. (DK)

  20. Developmentally Sensitive Interaction Effects of Genes and the Social Environment on Total and Subcortical Brain Volumes.

    Science.gov (United States)

    Richards, Jennifer S; Arias Vásquez, Alejandro; Franke, Barbara; Hoekstra, Pieter J; Heslenfeld, Dirk J; Oosterlaan, Jaap; Faraone, Stephen V; Buitelaar, Jan K; Hartman, Catharina A

    2016-01-01

    Smaller total brain and subcortical volumes have been linked to psychopathology including attention-deficit/hyperactivity disorder (ADHD). Identifying mechanisms underlying these alterations, therefore, is of great importance. We investigated the role of gene-environment interactions (GxE) in interindividual variability of total gray matter (GM), caudate, and putamen volumes. Brain volumes were derived from structural magnetic resonance imaging scans in participants with (N = 312) and without ADHD (N = 437) from N = 402 families (age M = 17.00, SD = 3.60). GxE effects between DAT1, 5-HTT, and DRD4 and social environments (maternal expressed warmth and criticism; positive and deviant peer affiliation) as well as the possible moderating effect of age were examined using linear mixed modeling. We also tested whether findings depended on ADHD severity. Deviant peer affiliation was associated with lower caudate volume. Participants with low deviant peer affiliations had larger total GM volumes with increasing age. Likewise, developmentally sensitive GxE effects were found on total GM and putamen volume. For total GM, differential age effects were found for DAT1 9-repeat and HTTLPR L/L genotypes, depending on the amount of positive peer affiliation. For putamen volume, DRD4 7-repeat carriers and DAT1 10/10 homozygotes showed opposite age relations depending on positive peer affiliation and maternal criticism, respectively. All results were independent of ADHD severity. The presence of differential age-dependent GxE effects might explain the diverse and sometimes opposing results of environmental and genetic effects on brain volumes observed so far.

  1. Developmentally Sensitive Interaction Effects of Genes and the Social Environment on Total and Subcortical Brain Volumes.

    Directory of Open Access Journals (Sweden)

    Jennifer S Richards

    Full Text Available Smaller total brain and subcortical volumes have been linked to psychopathology including attention-deficit/hyperactivity disorder (ADHD. Identifying mechanisms underlying these alterations, therefore, is of great importance. We investigated the role of gene-environment interactions (GxE in interindividual variability of total gray matter (GM, caudate, and putamen volumes. Brain volumes were derived from structural magnetic resonance imaging scans in participants with (N = 312 and without ADHD (N = 437 from N = 402 families (age M = 17.00, SD = 3.60. GxE effects between DAT1, 5-HTT, and DRD4 and social environments (maternal expressed warmth and criticism; positive and deviant peer affiliation as well as the possible moderating effect of age were examined using linear mixed modeling. We also tested whether findings depended on ADHD severity. Deviant peer affiliation was associated with lower caudate volume. Participants with low deviant peer affiliations had larger total GM volumes with increasing age. Likewise, developmentally sensitive GxE effects were found on total GM and putamen volume. For total GM, differential age effects were found for DAT1 9-repeat and HTTLPR L/L genotypes, depending on the amount of positive peer affiliation. For putamen volume, DRD4 7-repeat carriers and DAT1 10/10 homozygotes showed opposite age relations depending on positive peer affiliation and maternal criticism, respectively. All results were independent of ADHD severity. The presence of differential age-dependent GxE effects might explain the diverse and sometimes opposing results of environmental and genetic effects on brain volumes observed so far.

  2. Costs and benefits of railway urban logistics: a prospective social cost benefit analysis

    OpenAIRE

    Gonzalez-Feliu, Jesus

    2014-01-01

    This paper presents a general framework to assess urban rail logistics suitability via a socio-economic cost benefit analysis. Firstly, we propose an overview on the basic notions of CBA and SCBA. Secondly, we identify and present the main types of costs and benefits or railway urban logistics services and the related final delivery services using low emission road vehicles to serve customers where the rail systems cannot. Thirdly, as an example of application, we propose to assess a scenario...

  3. Comparing the social costs of biofuels and fossil fuels: A case study of Vietnam

    NARCIS (Netherlands)

    Thanh, le L.; Ierland, van E.C.; Zhu, X.; Wesseler, J.H.H.; Ngo, G.

    2013-01-01

    Biofuel substitution for fossil fuels has been recommended in the literature and promoted in many countries; however, there are concerns about its economic viability. In this paper we focus on the cost-effectiveness of fuels, i.e., we compare the social costs of biofuels and fossil fuels for a

  4. Process Improvement Project Using Tranexamic Acid Is Cost-Effective in Reducing Blood Loss and Transfusions After Total Hip and Total Knee Arthroplasty.

    Science.gov (United States)

    Demos, Harry A; Lin, Zilan X; Barfield, William R; Wilson, Sylvia H; Robertson, Dawn C; Pellegrini, Vincent D

    2017-08-01

    Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA. After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation. TXA administration increased with project implementation (group A = 3.57%, group B = 86.01%) and was associated with reductions in perioperative hemoglobin decrement (20.2%), patients transfused (45%), and number of units transfused per patient (61.9%). Cost savings were notable per patient ($128) and annually program wide ($55,884) with the primary THA subgroup contributing the most to the savings. No increase in adverse effects was observed. Standardized administration of TXA is an effective and economically favorable blood-reduction strategy for patients undergoing elective THA or TKA. Although reduction in transfusions with TXA may be greater after TKA, the economic and clinical impact of transfusion reduction is more substantial in THA patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Touching the Void - Introducing CoST: Corpus of Social Touch

    NARCIS (Netherlands)

    Jung, Merel M.; Poppe, Ronald; Poel, Mannes; Heylen, Dirk K. J.

    2014-01-01

    Touch behavior is of great importance during social interaction. To transfer the tactile modality from interpersonal interaction to other areas such as Human-Robot Interaction (HRI) and remote communication automatic recognition of social touch is necessary. This paper introduces CoST: Corpus of

  6. Technical support to the social cost study of Ignalina NPP decommissioning

    International Nuclear Information System (INIS)

    Vitkiene, E.

    2001-01-01

    Description of Phare project on assessment of social cost related with decommissioning of unit 1 of Ignalina NPP is presented. This is the first project of social guarantees in Visaginas financed by European Commission Project will develop pilot studies aimed at encouraging small and medium size business in Visaginas, creating new jobs, employment of young people. The project will also consult about the activities of the said projects, inform the community about the things being done to mitigate social impact

  7. What is the Best Strategy to Minimize After-Care Costs for Total Joint Arthroplasty in a Bundled Payment Environment?

    Science.gov (United States)

    Slover, James D; Mullaly, Kathleen A; Payne, Ashley; Iorio, Richard; Bosco, Joseph

    2016-12-01

    The post-acute care strategies after lower extremity total joint arthroplasty including the use of post-acute rehabilitation centers and home therapy services are associated with different costs. Providers in bundled payment programs are incentivized to use the most cost-effective strategies. We used decision analysis to examine the impact of extending the inpatient hospital stay to avoid discharge of patients to a post-acute rehabilitation facility. The results of this decision analysis show that extended acute hospital care for up to 5.2 extra days to allow for home discharge, rather than discharge to a post-acute inpatient facility can be financially preferable, provided quality is not negatively impacted. The data demonstrate that because the cost of additional acute care hospital days is relatively small and because the cost of an extended post-acute inpatient rehabilitation facility is high, keeping patients in the acute facility for a few extra days and then discharging them directly to home may result in an overall lower cost than discharge after a shorter hospital stay to an expensive post-acute facility. However, this approach will have challenges, and future studies are needed to evaluate this change in strategy. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Power plant allocation in East Kalimantan considering total cost and emissions

    Science.gov (United States)

    Muslimin; Utomo, D. S.

    2018-04-01

    The fulfillment of electricity need in East Kalimantan is the responsibility of State Electricity Company/Perusahaan Listrik Negara (PLN). But PLN faces constraints in the lack of generating capacity it has. So the allocation of power loads in East Kalimantan has its own challenges. Additional power supplies from other parties are required. In this study, there are four scenarios tested to meet the electricity needs in East Kalimantan with the goal of minimizing costs and emissions. The first scenario is only by using PLN power plant. The second scenario is by combining PLN + Independent Power Producer (IPP) power plants. The third scenario is by using PLN + Rented power plants. The fourth scenario is by using PLN + Excess capacity generation. Numerical experiment using nonlinear programming is conducted with the help of the solver. The result shows that in the peak load condition, the best combination is scenario 2 (PLN + IPP). While at the lowest load condition, the cheapest scenario is PLN + IPP while the lowest emission is PLN + Rent.

  9. Social/economic costs and health-related quality of life in patients with Duchenne muscular dystrophy in Europe.

    Science.gov (United States)

    Cavazza, Marianna; Kodra, Yllka; Armeni, Patrizio; De Santis, Marta; López-Bastida, Julio; Linertová, Renata; Oliva-Moreno, Juan; Serrano-Aguilar, Pedro; Posada-de-la-Paz, Manuel; Taruscio, Domenica; Schieppati, Arrigo; Iskrov, Georgi; Péntek, Márta; von der Schulenburg, Johann Matthias Graf; Kanavos, Panos; Chevreul, Karine; Persson, Ulf; Fattore, Giovanni

    2016-04-01

    The aim of this study was to determine the economic burden from a societal perspective and the health-related quality of life (HRQOL) of patients with Duchenne muscular dystrophy (DMD) in Europe. We conducted a cross-sectional study of patients with DMD from Bulgaria, France, Germany, Hungary, Italy, Spain, Sweden, and the UK. Data on demographic characteristics, healthcare resource utilization, informal care, labor productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D) questionnaire. Costs have been estimated from a societal perspective adopting a bottom-up approach. A total of 422 questionnaires were included in the study; 268 of which were collected from patients with DMD and 154 from caregivers. The average annual cost per person in 2012 ranged from €7657 in Hungary to €58,704 in France. Direct non-healthcare costs are the main component of whole costs and informal care is the main driver of non-healthcare costs. Costs are also shown to differ between children and adults. With regard to HRQOL of adult patients, the EQ-5D VAS score and EQ-5D index scores were 50.5 and 0.24, respectively. The corresponding EQ-5D VAS and EQ-5D index scores for caregivers were 74.7 and 0.71, respectively. We have estimated the average annual cost per patient with DMD in eight European countries adopting a social perspective, and to our knowledge this is the first study with such a wide perspective. The results on costs show a considerable gap between Eastern and Western European countries. Non-healthcare costs range from 64 to 89 % of overall costs and informal care is to a great extent the main driver of this cost category. The HRQOL of people with DMD is much lower than that of the general population.

  10. Individual social security accounts: issues in assessing administrative feasibility and costs.

    Science.gov (United States)

    Olsen, K A; Salisbury, D L

    1998-11-01

    Whether to add individual accounts (IAs) to the Social Security system is a highly political issue. But almost lost in the debate so far have been any practical considerations about how to administer such accounts. Any discussion of whether to create individual accounts must also address the basic but critical questions of how they would work: Who would run them? What would they cost? Logistically, are they even possible? This EBRI Issue Brief provides an overview of the most salient administrative issues facing the current Social Security reform debate--issues that challenge proponents to carefully think through how their proposals could be implemented so as to achieve their policy goals. The options and difficulties in administering IAs raise concerns that cut across ideology. The object of this report is neither to dissuade the advocates nor support the critics of individual accounts. Rather, it is to bring practical considerations to a political debate that has largely ignored the pragmatic challenges of whether IAs would be too complex for participants to understand or too difficult for record keepers to administer. The major findings in this analysis include: Adding individual accounts to Social Security could be the largest undertaking in the history of the U.S. financial market, and no system to date has the capacity to administer such a system. The number of workers currently covered by Social Security--the largest single entitlement program in the nation--is at least four times higher than the combined number of all tax-favored employment-based retirement accounts in the United States, which are administered by hundreds of entities. Direct comparisons between employment-based retirement savings plans and Social Security reform are tenuous at best. Social Security covers workers and businesses that are disproportionately excluded from employment-based plans. Because of these differences, a system of individual Social Security accounts would be more

  11. Social cost pricing of fossil fuels used in the production of electricity: implications to biomass feasibility

    International Nuclear Information System (INIS)

    Dillivan, K.D.; English, B.C.

    1997-01-01

    The primary objective of this study is to investigate full social pricing for fossil fuels and the subsequent effect on biomass quantities in the state of Tennessee. The first step is to estimate the full social costs and then to estimate the effects of their internalization. Other objectives are (1) investigate whether or not market imperfections exist, (2) if they exist, how should full social cost pricing be estimated, (3) what other barriers help fossil fuels stay economically attractive and prevent biomass from competing, (4) estimating the demand for biomass, and (5) given this demand for biomass, what are the implications for farmers and producers in Tennessee. (author)

  12. Exploring the costs and benefits of social information use: an appraisal of current experimental evidence.

    Science.gov (United States)

    Rieucau, Guillaume; Giraldeau, Luc-Alain

    2011-04-12

    Research on social learning has focused traditionally on whether animals possess the cognitive ability to learn novel motor patterns from tutors. More recently, social learning has included the use of others as sources of inadvertent social information. This type of social learning seems more taxonomically widespread and its use can more readily be approached as an economic decision. Social sampling information, however, can be tricky to use and calls for a more lucid appraisal of its costs. In this four-part review, we address these costs. Firstly, we address the possibility that only a fraction of group members are actually providing social information at any one time. Secondly, we review experimental research which shows that animals are circumspect about social information use. Thirdly, we consider the cases where social information can lead to incorrect decisions and finally, we review studies investigating the effect of social information quality. We address the possibility that using social information or not is not a binary decision and present results of a study showing that nutmeg mannikins combine both sources of information, a condition that can lead to the establishment of informational cascades. We discuss the importance of empirically investigating the economics of social information use.

  13. A total cost perspective on use of polymeric materials in solar collectors – Importance of environmental performance on suitability

    International Nuclear Information System (INIS)

    Carlsson, Bo; Persson, Helena; Meir, Michaela; Rekstad, John

    2014-01-01

    Highlights: • A polymeric solar collector system was compared with two traditional ones. • It was found the best in terms of climatic performance per solar heat collected. • The differences in climatic cost between the systems compared however are small. • The low climatic cost makes solar heating better compared to natural gas heating. • Use of Ecoindicator 99 for environmental cost makes solar heating even better. - Abstract: To assess the suitability of solar collector systems in which polymeric materials are used versus those in which more traditional materials are used, a case study was undertaken. In this case study a solar heating system with polymeric solar collectors was compared with two equivalent but more traditional solar heating systems: one with flat plate solar collectors and one with evacuated tube solar collectors. To make the comparison, a total cost accounting approach was adopted. The life cycle assessment (LCA) results clearly indicated that the polymeric solar collector system is the best as regards climatic and environmental performance when they are expressed in terms of the IPPC 100 a indicator and the Ecoindicator 99, H/A indicator, respectively. In terms of climatic and environmental costs per amount of solar heat collected, the differences between the three kinds of collector systems were small when compared with existing energy prices. With the present tax rates, it seems unlikely that the differences in environmental and climatic costs will have any significant influence on which system is the most favoured, from a total cost point of view. In the choice between a renewable heat source and a heat source based on the use of a fossil fuel, the conclusion was that for climatic performance to be an important economic factor, the tax or trade rate of carbon dioxide emissions must be increased significantly, given the initial EU carbon dioxide emission trade rate. The rate would need to be at least of the same order of magnitude

  14. Cost of providing injectable contraceptives through a community-based social marketing program in Tigray, Ethiopia.

    Science.gov (United States)

    Prata, Ndola; Downing, Janelle; Bell, Suzanne; Weidert, Karen; Godefay, Hagos; Gessessew, Amanuel

    2016-06-01

    To provide a cost analysis of an injectable contraceptive program combining community-based distribution and social marketing in Tigray, Ethiopia. We conducted a cost analysis, modeling the costs and programmatic outcomes of the program's initial implementation in 3 districts of Tigray, Ethiopia. Costs were estimated from a review of program expense records, invoices, and interviews with health workers. Programmatic outcomes include number of injections and couple-year of protection (CYP) provided. We performed a sensitivity analysis on the average number of injections provided per month by community health workers (CHWs), the cost of the commodity, and the number of CHWs trained. The average programmatic CYP was US $17.91 for all districts with a substantial range from US $15.48-38.09 per CYP across districts. Direct service cost was estimated at US $2.96 per CYP. The cost per CYP was slightly sensitive to the commodity cost of the injectable contraceptives and the number of CHWs. The capacity of each CHW, measured by the number of injections sold, was a key input that drove the cost per CYP of this model. With a direct service cost of US $2.96 per CYP, this study demonstrates the potential cost of community-based social marketing programs of injectable contraceptives. The findings suggest that the cost of social marketing of contraceptives in rural communities is comparable to other delivery mechanisms with regards to CYP, but further research is needed to determine the full impact and cost-effectiveness for women and communities beyond what is measured in CYP. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Methodology of social and environmental external costs estimation in the Ukraine’s energy sector

    Directory of Open Access Journals (Sweden)

    Karaieva Nataliia Veniaminivna

    2016-09-01

    Full Text Available Paper objective is analysis of the external costs assessment model for the eco-social damage, and/or human capital losses caused by environmental pollution from the energy enterprises in Ukraine. Using the given method, necessary initial socio-economic parameters were defined and used for calculating the social costs of capital health losses in Ukraine due to deterioration of the environment, and due to the negative impact of energy sector on the air quality for the period 2002-2013. On the proposed technique determines the range value of social losses due to the negative impact of energy on air quality in Ukraine excluding future external costs for years 2002 – 2013 ranges from 1.6 – 4.5% of GDP, and the range of values of taking into account future costs is 2.0 – 6.2% of GDP.

  16. Social living mitigates the costs of a chronic illness in a cooperative carnivore

    Science.gov (United States)

    Almberg, Emily S.; Cross, Paul C.; Dobson, Andrew P.; Smith, Douglas W.; Metz, Matthew C; Stahler, Daniel R.; Hudson, Peter J.

    2015-01-01

    Infection risk is assumed to increase with social group size, and thus be a cost of group living. We assess infection risk and costs with respect to group size using data from an epidemic of sarcoptic mange (Sarcoptes scabiei) among grey wolves (Canis lupus). We demonstrate that group size does not predict infection risk and that individual costs of infection, in terms of reduced survival, can be entirely offset by having sufficient numbers of pack-mates. Infected individuals experience increased mortality hazards with increasing proportions of infected pack-mates, but healthy individuals remain unaffected. The social support of group hunting and territory defence are two possible mechanisms mediating infection costs. This is likely a common phenomenon among other social species and chronic infections, but difficult to detect in systems where infection status cannot be measured continuously over time.

  17. Using a Total Environment Framework (Built, Natural, Social Environments) to Assess Life-long Health Effects of Chemical Exposures

    Science.gov (United States)

    EPAseeks applications for research on how pollution affects human health in the context of the total environment – built, natural, and social environments interacting together with inherent characteristics and interactions.

  18. Direct hospital costs of total laparoscopic hysterectomy compared with fast-track open hysterectomy at a tertiary hospital: a retrospective case-controlled study.

    Science.gov (United States)

    Rhou, Yoon J J; Pather, Selvan; Loadsman, John A; Campbell, Neil; Philp, Shannon; Carter, Jonathan

    2015-12-01

    To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy. A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost. Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P funding model in our hospital is inaccurate when compared to directly calculated hospital costs. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  20. Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: results from a randomized controlled trial.

    Science.gov (United States)

    Hedman, Erik; Andersson, Erik; Ljótsson, Brjánn; Andersson, Gerhard; Rück, Christian; Lindefors, Nils

    2011-11-01

    Social anxiety disorder (SAD) is highly prevalent and associated with a substantial societal economic burden, primarily due to high costs of productivity loss. Cognitive behavior group therapy (CBGT) is an effective treatment for SAD and the most established in clinical practice. Internet-based cognitive behavior therapy (ICBT) has demonstrated efficacy in several trials in recent years. No study has however investigated the cost-effectiveness of ICBT compared to CBGT from a societal perspective, i.e. an analysis where both direct and indirect costs are included. The aim of the present study was to investigate the cost-effectiveness of ICBT compared to CBGT from a societal perspective using a prospective design. We conducted a randomized controlled trial where participants with SAD were randomized to ICBT (n=64) or CBGT (n=62). Economic data were assessed at pre-treatment, immediately following treatment and six months after treatment. Results showed that the gross total costs were significantly reduced at six-month follow-up, compared to pre-treatment in both treatment conditions. As both treatments were equivalent in reducing social anxiety and gross total costs, ICBT was more cost-effective due to lower intervention costs. We conclude that ICBT can be more cost-effective than CBGT in the treatment of SAD and that both treatments reduce societal costs for SAD. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Incorporating social justice and stigma in cost-effectiveness analysis: drug-resistant tuberculosis treatment.

    Science.gov (United States)

    Zwerling, A; Dowdy, D; von Delft, A; Taylor, H; Merritt, M W

    2017-11-01

    Novel therapies for multidrug-resistant tuberculosis (MDR-TB) are likely to be expensive. The cost of novel drugs (e.g., bedaquiline, delamanid) may be so prohibitively high that a traditional cost-effectiveness analysis (CEA) would rate regimens containing these drugs as not cost-effective. Traditional CEA may not appropriately account for considerations of social justice, and may put the most disadvantaged populations at greater risk. Using the example of novel drug regimens for MDR-TB, we propose a novel methodology, 'justice-enhanced CEA', and demonstrate how such an approach can simultaneously assess social justice impacts alongside traditional cost-effectiveness ratios. Justice-enhanced CEA, as we envision it, is performed in three steps: 1) systematic data collection about patients' lived experiences, 2) use of empirical findings to inform social justice assessments, and 3) incorporation of data-informed social justice assessments into a decision analytic framework that includes traditional CEA. These components are organized around a core framework of social justice developed by Bailey et al. to compare impacts on disadvantage not otherwise captured by CEA. Formal social justice assessments can produce three composite levels: 'expected not to worsen…', 'may worsen…', and 'expected to worsen clustering of disadvantage'. Levels of social justice impact would be assessed for each major type of outcome under each policy scenario compared. Social justice assessments are then overlaid side-by-side with cost-effectiveness assessments corresponding to each branch pathway on the decision tree. In conclusion, we present a 'justice-enhanced' framework that enables the incorporation of social justice concerns into traditional CEA for the evaluation of new regimens for MDR-TB.

  2. Benefits of using customized instrumentation in total knee arthroplasty: results from an activity-based costing model.

    Science.gov (United States)

    Tibesku, Carsten O; Hofer, Pamela; Portegies, Wesley; Ruys, C J M; Fennema, Peter

    2013-03-01

    The growing demand for total knee arthroplasty (TKA) associated with the efforts to contain healthcare expenditure by advanced economies necessitates the use of economically effective technologies in TKA. The present analysis based on activity-based costing (ABC) model was carried out to estimate the economic value of patient-matched instrumentation (PMI) compared to standard surgical instrumentation in TKA. The costs of the two approaches, PMI and standard instrumentation in TKA, were determined by the use of ABC which measures the cost of a particular procedure by determining the activities involved and adding the cost of each activity. Improvement in productivity due to increased operating room (OR) turn-around times was determined and potential additional revenue to the hospital by the efficient utilization of gained OR time was estimated. Increased efficiency in the usage of OR and utilization of surgical trays were noted with patient-specific approach. Potential revenues to the hospital were estimated with the use of PMI by efficient utilization of time saved in OR. Additional revenues of 78,240 per year were estimated considering utilization of gained OR time to perform surgeries other than TKA. The analysis suggests that use of PMI in TKA is economically effective when compared to standard instrumentation.

  3. Social costs of loss in productivity-related absenteeism in Poland

    Directory of Open Access Journals (Sweden)

    Agnieszka Genowska

    2017-10-01

    Full Text Available Objectives: The aim of this study was to estimate indirect costs associated with losses in productivity due to sickness absence among registered workers in Poland. Material and Methods: Data on sick leave durations in 2013 was obtained from the Social Insurance Institution (SII (Zakład Ubezpieczeń Społecznych – ZUS. Based on the number of assumptions, this data was used for calculating absence durations. The costs of lost productivity were estimated on the basis of the measure of gross value added. Results: Estimated losses in productivity due to absenteeism in 2013 together accounted for 4.33% of gross domestic product (GDP (17.09 billion euro. In the female population, the total value of losses amounted to 9.66 billion euro, but excluding the costs of pregnancy, childbirth, and puerperium (2.96 billion euro, it was 6.7 billion euro. In the male population, the loss amounted to 7.43 billion euro. The highest overall costs of sickness absence based on age were found in the age group of 30–39 years (5.14 billion euro, including pregnancy, childbirth, and puerperium – 1.474 billion euro; respiratory diseases – 0.632 billion euro, injuries and poisonings – 0.62 billion euro. In the group of people aged > 40 years, the highest cost was generated by bone-muscular diseases (1.553 billion euro and injuries and poisoning (1.251 billion euro. Higher losses in the productivity of women in addition to pregnancy, childbirth, and puerperium were due to mental and behavioral disorders (0.71 billion euro, diseases of the genitourinary system (0.38 billion euro, and neoplasms (0.35 billion euro. At the same time, in men, compared to women, we observed higher losses due to injuries and poisoning (1.65 billion euro, and diseases of musculoskeletal (1.26 billion euro, nervous (0.79 billion euro, circulatory (0.65 billion euro, and digestive (0.41 billion euro systems. Conclusions: Improvement and further development of effective strategies for

  4. Social costs of loss in productivity-related absenteeism in Poland.

    Science.gov (United States)

    Genowska, Agnieszka; Fryc, Justyna; Pinkas, Jarosław; Jamiołkowski, Jacek; Szafraniec, Krystyna; Szpak, Andrzej; Bojar, Iwona

    2017-10-06

    The aim of this study was to estimate indirect costs associated with losses in productivity due to sickness absence among registered workers in Poland. Data on sick leave durations in 2013 was obtained from the Social Insurance Institution (SII) (Zakład Ubezpieczeń Społecznych - ZUS). Based on the number of assumptions, this data was used for calculating absence durations. The costs of lost productivity were estimated on the basis of the measure of gross value added. Estimated losses in productivity due to absenteeism in 2013 together accounted for 4.33% of gross domestic product (GDP) (17.09 billion euro). In the female population, the total value of losses amounted to 9.66 billion euro, but excluding the costs of pregnancy, childbirth, and puerperium (2.96 billion euro), it was 6.7 billion euro. In the male population, the loss amounted to 7.43 billion euro. The highest overall costs of sickness absence based on age were found in the age group of 30-39 years (5.14 billion euro, including pregnancy, childbirth, and puerperium - 1.474 billion euro; respiratory diseases - 0.632 billion euro, injuries and poisonings - 0.62 billion euro). In the group of people aged > 40 years, the highest cost was generated by bone-muscular diseases (1.553 billion euro) and injuries and poisoning (1.251 billion euro). Higher losses in the productivity of women in addition to pregnancy, childbirth, and puerperium were due to mental and behavioral disorders (0.71 billion euro), diseases of the genitourinary system (0.38 billion euro), and neoplasms (0.35 billion euro). At the same time, in men, compared to women, we observed higher losses due to injuries and poisoning (1.65 billion euro), and diseases of musculoskeletal (1.26 billion euro), nervous (0.79 billion euro), circulatory (0.65 billion euro), and digestive (0.41 billion euro) systems. Improvement and further development of effective strategies for prevention of complications of pregnancy and chronic diseases in the

  5. [Unit cost variation in a social security company in Querétaro, México].

    Science.gov (United States)

    Villarreal-Ríos, Enrique; Campos-Esparza, Maribel; Garza-Elizondo, María E; Martínez-González, Lidia; Núñez-Rocha, Georgina M; Romero-Islas, Nestor R

    2006-01-01

    Comparing unit cost variation between departments and reasons for consultation in outpatient health services provided by a social security company from Querétaro, Mexico. A study of costs (in US dollars) was carried out in outpatient health service units during 2004. Fixed unit costs were estimated per department and adjusted for one year's productivity. Material, physical and consumer resources were included. Weighting was assigned to resources invested in each department. Unit cost was estimated by using the micro cost technique; medicaments, materials used during treatment and reagents were considered to be consumer items. Unit cost resulted from adding fixed unit cost to the variable unit cost corresponding to the reason for consulting. Units costs were then compared between the medical units. Unit cost per month for diabetic treatment varied from 34.8 US dollars, 32,2 US dollars to US 34 US dollars, pap smear screening test costs were 7,2 US dollars, 8,7 US dollars and 7,3 US dollars and dental treatment 27 US dollars, 33 US dollars, 6 and 28,7 US dollars. Unit cost variation was more important in the emergency room and the dental service.

  6. Template-Directed Instrumentation Reduces Cost and Improves Efficiency for Total Knee Arthroplasty: An Economic Decision Analysis and Pilot Study.

    Science.gov (United States)

    McLawhorn, Alexander S; Carroll, Kaitlin M; Blevins, Jason L; DeNegre, Scott T; Mayman, David J; Jerabek, Seth A

    2015-10-01

    Template-directed instrumentation (TDI) for total knee arthroplasty (TKA) may streamline operating room (OR) workflow and reduce costs by preselecting implants and minimizing instrument tray burden. A decision model simulated the economics of TDI. Sensitivity analyses determined thresholds for model variables to ensure TDI success. A clinical pilot was reviewed. The accuracy of preoperative templates was validated, and 20 consecutive primary TKAs were performed using TDI. The model determined that preoperative component size estimation should be accurate to ±1 implant size for 50% of TKAs to implement TDI. The pilot showed that preoperative template accuracy exceeded 97%. There were statistically significant improvements in OR turnover time and in-room time for TDI compared to an historical cohort of TKAs. TDI reduces costs and improves OR efficiency. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Integrated batch production and maintenance scheduling for multiple items processed on a deteriorating machine to minimize total production and maintenance costs with due date constraint

    Directory of Open Access Journals (Sweden)

    Zahedi Zahedi

    2016-04-01

    Full Text Available This paper discusses an integrated model of batch production and maintenance scheduling on a deteriorating machine producing multiple items to be delivered at a common due date. The model describes the trade-off between total inventory cost and maintenance cost as the increase of production run length. The production run length is a time bucket between two consecutive preventive maintenance activities. The objective function of the model is to minimize total cost consisting of in process and completed part inventory costs, setup cost, preventive and corrective maintenance costs and rework cost. The problem is to determine the optimal production run length and to schedule the batches obtained from determining the production run length in order to minimize total cost.

  8. Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement.

    Science.gov (United States)

    Snow, Richard; Granata, Jaymes; Ruhil, Anirudh V S; Vogel, Karen; McShane, Michael; Wasielewski, Ray

    2014-10-01

    Health-care costs following acute hospital care have been identified as a major contributor to regional variation in Medicare spending. This study investigated the associations of preoperative physical therapy and post-acute care resource use and its effect on the total cost of care during primary hip or knee arthroplasty. Historical claims data were analyzed using the Centers for Medicare & Medicaid Services Limited Data Set files for Diagnosis Related Group 470. Analysis included descriptive statistics of patient demographic characteristics, comorbidities, procedures, and post-acute care utilization patterns, which included skilled nursing facility, home health agency, or inpatient rehabilitation facility, during the ninety-day period after a surgical hospitalization. To evaluate the associations, we used bivariate and multivariate techniques focused on post-acute care use and total episode-of-care costs. The Limited Data Set provided 4733 index hip or knee replacement cases for analysis within the thirty-nine-county Medicare hospital referral cluster. Post-acute care utilization was a significant variable in the total cost of care for the ninety-day episode. Overall, 77.0% of patients used post-acute care services after surgery. Post-acute care utilization decreased if preoperative physical therapy was used, with only 54.2% of the preoperative physical therapy cohort using post-acute care services. However, 79.7% of the non-preoperative physical therapy cohort used post-acute care services. After adjusting for demographic characteristics and comorbidities, the use of preoperative physical therapy was associated with a significant 29% reduction in post-acute care use, including an $871 reduction of episode payment driven largely by a reduction in payments for skilled nursing facility ($1093), home health agency ($527), and inpatient rehabilitation ($172). The use of preoperative physical therapy was associated with a 29% decrease in the use of any post-acute care

  9. The social cost of alcohol, tobacco and illicit drugs in France, 1997.

    Science.gov (United States)

    Fenoglio, Philippe; Parel, Véronique; Kopp, Pierre

    2003-01-01

    AIM, DESIGN AND SETTING: The economic costs of alcohol, tobacco and illicit drugs to French society are estimated using a cost of illness framework. For the cause of disease or death (using ICD-9 categories), pooled relative risk estimates from meta-analyses were combined with prevalence data by age and gender to derive the proportion attributable to alcohol, tobacco and/or illicit drugs. The resulting estimates of attributable deaths and hospitalizations were used to calculate the associated health care, law enforcement, productivity and other costs. The results were compared with those of other studies, and sensitivity analyses were conducted by alternative ways of measuring risk attribution and costs. The use of alcohol, tobacco and illicit drugs cost more than 200 billion francs (FF) in France in 1997, representing 3714 FF per capita or 2.7% of the gross domestic product (GDP). Alcohol is the drug that gives rise to the greatest cost in France, i.e. 115420.91 million FF (1.42% of GDP) or an expenditure per capita of 1966 FF in 1997. Alcohol takes more than half of the social cost of drugs to society. The greatest share of the social cost of alcohol comes from the loss of productivity (57555.66 million FF), due to premature death (53168.60 million FF), morbidity (3884.0 million FF) and imprisonment (503.06 million FF). Tobacco leads to a social cost of 89256.90 million FF, that is an expenditure per capita of 1520.56 FF or 1.1% of GDP. Productivity losses amount to 50446.70 million FF, with losses of 42765.80 million FF as a result of premature death and 7680.90 million FF linked to morbidity. Health care costs for tobacco occupy second place at 26973.70 million FF. Illicit drugs generate a social cost of 13350.28 million FF, that is an expenditure per capita of 227.43 FF or 0.16% of GDP. Productivity losses reach 6099.19 million FF, with 5246.92 million FF linked to imprisonment and 852.27 million FF to premature death. The cost of enforcing the law for illicit

  10. Cost-effectiveness of cervical total disc replacement vs fusion for the treatment of 2-level symptomatic degenerative disc disease.

    Science.gov (United States)

    Ament, Jared D; Yang, Zhuo; Nunley, Pierce; Stone, Marcus B; Kim, Kee D

    2014-12-01

    Cervical total disc replacement (CTDR) was developed to treat cervical spondylosis, while preserving motion. While anterior cervical discectomy and fusion (ACDF) has been the standard of care for 2-level disease, a randomized clinical trial (RCT) suggested similar outcomes. Cost-effectiveness of this intervention has never been elucidated. To determine the cost-effectiveness of CTDR compared with ACDF. Data were derived from an RCT that followed up 330 patients over 24 months. The original RCT consisted of multi-institutional data including private and academic institutions. Using linear regression for the current study, health states were constructed based on the stratification of the Neck Disability Index and a visual analog scale. Data from the 12-item Short-Form Health Survey questionnaires were transformed into utilities values using the SF-6D mapping algorithm. Costs were calculated by extracting Diagnosis-Related Group codes from institutional billing data and then applying 2012 Medicare reimbursement rates. The costs of complications and return-to-work data were also calculated. A Markov model was built to evaluate quality-adjusted life-years (QALYs) for both treatment groups. The model adopted a third-party payer perspective and applied a 3% annual discount rate. Patients included in the original RCT had to be diagnosed as having radiculopathy or myeloradiculopathy at 2 contiguous levels from C3-C7 that was unresponsive to conservative treatment for at least 6 weeks or demonstrated progressive symptoms. Incremental cost-effectiveness ratio of CTDR compared with ACDF. A strong correlation (R2 = 0.6864; P sensitivity analysis, the incremental cost-effectiveness ratio value stays below the threshold of $50,000 per QALY in most scenarios (range, -$58,194 to $147,862 per QALY). The incremental cost-effectiveness ratio of CTDR compared with traditional ACDF is lower than the commonly accepted threshold of $50,000 per QALY. This remains true with varying input

  11. A Flexible Job Shop Scheduling Problem with Controllable Processing Times to Optimize Total Cost of Delay and Processing

    Directory of Open Access Journals (Sweden)

    Hadi Mokhtari

    2015-11-01

    Full Text Available In this paper, the flexible job shop scheduling problem with machine flexibility and controllable process times is studied. The main idea is that the processing times of operations may be controlled by consumptions of additional resources. The purpose of this paper to find the best trade-off between processing cost and delay cost in order to minimize the total costs. The proposed model, flexible job shop scheduling with controllable processing times (FJCPT, is formulated as an integer non-linear programming (INLP model and then it is converted into an integer linear programming (ILP model. Due to NP-hardness of FJCPT, conventional analytic optimization methods are not efficient. Hence, in order to solve the problem, a Scatter Search (SS, as an efficient metaheuristic method, is developed. To show the effectiveness of the proposed method, numerical experiments are conducted. The efficiency of the proposed algorithm is compared with that of a genetic algorithm (GA available in the literature for solving FJSP problem. The results showed that the proposed SS provide better solutions than the existing GA.

  12. Social Workers' Observations of the Needs of the Total Military Community

    Science.gov (United States)

    Frey, Jodi J.; Collins, Kathryn S.; Pastoor, Jennifer; Linde, Linnea

    2014-01-01

    Researchers surveyed licensed social workers from 5 Mid-Atlantic states to explore their perspectives on the current state of mental health and service delivery for military service workers, families, and contractors. Social workers identified needs in the following areas: mental health, physical health and wellness, social and environmental,…

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

    DEFF Research Database (Denmark)

    Hostenkamp, Gisela; Stolpe, Michael

    2012-01-01

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

  14. Supply risk management from a transaction cost and social exchange theory perspective

    OpenAIRE

    Hoffmann, Petra; Schiele, Holger; Song, Michael; Krabbendam, Johannes Jacobus

    2012-01-01

    Supply risk management gained prominence over the last decade, both in the academic discourse and in practical application. This research examines the influence of Transaction Cost characteristics -behavioral uncertainty, environmental uncertainty and asset specificity on supply risk management performance. We also identify two antecedents of the transaction cost constructs based on social exchange theory: dependency and preferred customer status. We used survey data to discover a positive in...

  15. Economics of climate change : sensitivity analysis of social cost of carbon

    OpenAIRE

    Torniainen, Sami

    2016-01-01

    Social cost of carbon (SCC) is the key concept in the economics of climate change. It measures the economic cost of climate impacts. SCC has influence on how beneficial it is to prevent climate change: if the value of SCC increases, investments to low-carbon technology become more attractive and profitable. This paper examines the sensitivity of two important assumptions that affect to SCC: the choice of a discount rate and time horizon. Using the integrated assessment model, ...

  16. Flexicurity as a measuring leakage protection of workers: between "social pollution" and "total security".

    Directory of Open Access Journals (Sweden)

    Calogero Massimo Cammalleri

    2012-01-01

    Full Text Available Was not the labour problem the same everywhere? The paper at­tempts to answer this question by proposing a re-interpretation of flexicurity through the comparison with the economic concepts of externalities and distortion of competition. After a methodological and epistemological premise, based on a multidisciplinary literature, the paper - crit­ically addresses the origins of flexicurity and argues that it lacks an archetypical definition, especially in the formulation of the EU Commission. Hence, the paper considers flexicurity as any balance between flexibility and security and, therefore, pro­poses ordering any set of contracts, providing the same balance and with the same regulatory framework, in “communities”. It is assumed, therefore, that communities can differ either in terms of a “protective” trade­-off, where the differential is not a surrogate measure of security, or in terms of an economic trade-off, where it is met by the provision of social insurance or security. One of these sets is called community 0 and it corresponds to undeclared work, not only illegal, but also completely devoid of security and fully flexible. After identifying from ILO, EU and constitutional sources the foundation of the “incompressibility” of rights which guarantee decent work, the paper likens decent work to a public good of general interest, in the same way as laws generally recognize the natural environment. On the basis of this comparative axiom, the paper proposes considering the dispersion of security produced by undeclared work as “un-decent” work and, therefore, as a form of “pollution”. The paper proposes, conversely, to define as a “total secure” environment one where there is no loss of se­curity and, therefore, a non-polluted environment. Because an environment can be little or very polluted, the paper proposes considering as social pollution any form, even legal, of security leakage - such as that induced by the

  17. A Study on the Cost of Issuing Social Healthcare Corporation Bonds.

    Science.gov (United States)

    Fukunaga, Hajime; Yamauchi, Kazunobu

    2015-07-01

    The "Social Healthcare Corporation" system was established on 1 April 2007 as a result of the revised Japanese Medical Care Law. As of 1 October 2014, 234 corporations are certified Social Healthcare Corporations. These corporations are allowed to issue public bonds. However, to this day (1 December 2014), no bonds have been issued. In this paper, we focus on cost analysis with respect to issuing public bonds.

  18. Social cost considerations and legal constraints in implementing modular integrated utility systems

    Science.gov (United States)

    Lede, N. W.; Dixon, H. W.; King, O.; Hill, D. K.

    1974-01-01

    Social costs associated with the design, demonstration, and implementation of the Modular Integrated Utility System are considered including the social climate of communities, leadership patterns, conflicts and cleavages, specific developmental values, MIUS utility goal assessment, and the suitability of certian alternative options for use in a program of implementation. General considerations are discussed in the field of socio-technological planning. These include guidelines for understanding the conflict and diversity; some relevant goal choices and ideas useful to planners of the MIUS facility.

  19. A protocol for sustained reduction of Total Parenteral Nutrition and cost savings by improvement of nutritional care in hospitals.

    Science.gov (United States)

    van Schaik, Rian; Van den Abeele, Kurt; Melsens, Glenn; Schepens, Peter; Lanssens, Truus; Vlaemynck, Bernadette; Devisch, Maria; Niewold, Theo A

    2016-10-01

    Malnutrition and the use of Total Parenteral Nutrition (TPN) contribute considerably to hospital costs. Recently, we reported on the introduction of malnutrition screening and monitoring of TPN use in our hospital, which resulted in a large (40%) reduction in TPN and improved quality of nutritional care in two years (2011/12). Here, we aimed to assure continuation of improved care by developing a detailed malnutrition screening and TPN use protocol involving instruction tools for hospital staff, while monitoring the results in the following two years (2013/14). A TPN decision tree for follow up of TPN in patients and a TP-EN instruction card for caregivers was introduced, showing TPN/EN introduction schedules based on the energy needs of patients according to EB guidelines, also addressing the risk of refeeding syndrome. TPN patients were monitored by dietitians and TPN usage and costs were presented to the (medical) staff. Screening and treatment of malnourished patients by dietitians is simultaneously ongoing. In 2014 48% of patients, hospitalized for at least 48 h, were screened on malnutrition, 17% of them were diagnosed at risk, 7.9% malnourished and treated by dietitians. TPN usage dropped by 53% and cost savings of 51% were obtained due to 50% decrease of TPN users in 2014 versus 2010. TPN over EN ratio dropped from 2.4 in 2010 to 1.2 in 2014. Sustained improvement of nutritional care and reduction of TPN usage and costs is possible by introduction of procedures embedded in the existing structures. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  20. Factors associated with the utilization and costs of health and social services in frail elderly patients

    Directory of Open Access Journals (Sweden)

    Kehusmaa Sari

    2012-07-01

    Full Text Available Abstract Background Universal access is one of the major aims in public health and social care. Services should be provided on the basis of individual needs. However, municipal autonomy and the fragmentation of services may jeopardize universal access and lead to variation between municipalities in the delivery of services. This paper aims to identify patient-level characteristics and municipality-level service patterns that may have an influence on the use and costs of health and social services of frail elderly patients. Methods Hierarchical analysis was applied to estimate the effects of patient and municipality-level variables on services utilization. Results The variation in the use of health care services was entirely due to patient-related variables, whereas in the social services, 9% of the variation was explained by the municipality-level and 91% by the patient-level characteristics. Health-related quality of life explained a major part of variation in the costs of health care services. Those who had reported improvement in their health status during the preceding year were more frequent users of social care services. Low informal support, poor functional status and poor instrumental activities of daily living, living at a residential home, and living alone were associated with higher social services expenditure. Conclusions The results of this study showed municipality-level variation in the utilization of social services, whereas health care services provided for frail elderly people seem to be highly equitable across municipalities. Another important finding was that the utilization of social and health services were connected. Those who reported improvement in their health status during the preceding year were more frequently also using social services. This result suggests that if municipalities continue to limit the provision of support services only for those who are in the highest need, this saving in the social sector may, in

  1. Social cost of heavy drinking and alcohol dependence in high-income countries.

    Science.gov (United States)

    Mohapatra, Satya; Patra, Jayadeep; Popova, Svetlana; Duhig, Amy; Rehm, Jürgen

    2010-06-01

    A comprehensive review of cost drivers associated with alcohol abuse, heavy drinking, and alcohol dependence for high-income countries was conducted. The data from 14 identified cost studies were tabulated according to the potential direct and indirect cost drivers. The costs associated with alcohol abuse, alcohol dependence, and heavy drinking were calculated. The weighted average of the total societal cost due to alcohol abuse as percent gross domestic product (GDP)--purchasing power parity (PPP)--was 1.58%. The cost due to heavy drinking and/or alcohol dependence as percent GDP (PPP) was estimated to be 0.96%. On average, the alcohol-attributable indirect cost due to loss of productivity is more than the alcohol-attributable direct cost. Most of the countries seem to incur 1% or more of their GDP (PPP) as alcohol-attributable costs, which is a high toll for a single factor and an enormous burden on public health. The majority of alcohol-attributable costs incurred as a consequence of heavy drinking and/or alcohol dependence. Effective prevention and treatment measures should be implemented to reduce these costs.

  2. [Costs and sick leave due to chikungunya in the Instituto Mexicano del Seguro Social in Guerrero, Mexico].

    Science.gov (United States)

    Vázquez-Cruz, Irene; Juanico-Morales, Guillermina; Sánchez-Ramos, Apolinar; Morales-Sánchez, Ofelia de Jesúis

    2018-01-01

    Chikungunya fever (CHIK) generally causes temporary sick leave, affecting groups of productive age, which represents a significant economic impact from the labor point of view. The objective was to estimate costs of disability due to chikungunya in the Instituto Mexicano del Seguro Social (IMSS) in Guerrero, Mexico. Cost assessment of working population from IMSS in Guerrero who met the definition of case for CHIK and took sick leave, which was registered in the Original Disability Certificates (OCI, according to its initials in Spanish) processed from January to April, 2015. Paid sick days were multiplied by the current minimum wage of the municipality of Acapulco (geographical area A, general = $ 70.10: seventy pesos with 10 cents per day]). Of all the OCIs, 31.5% (38 271/12 062) met the criteria for CHIK with a total of 41 197 prescribed days and 14 941 paid sick days with an estimated cost of 2 397 393.40 pesos (two million, three hundred and ninety seven thousand, three hundred and ninety three dollars and forty cents). Sick leaves increase the costs in health systems. These costs increase as increases the number of days granted. The average number of days granted is consistent with the information published in different articles.

  3. Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program: Volume 1, The analysis and its results

    International Nuclear Information System (INIS)

    1987-06-01

    This report provides cost estimates for the fifth evaluation of the adequacy of the fee and is consistent with the program strategy and plans. The total-system cost for the reference cases in the improved-performance system is estimated at $32.1 to $38.2 billion (expressed in constant 1986 dollars) over the entire life of the system...or $1.5 to $1.6 billion more than that of the authorized system (i.e., the system without an MRS facility). The current estimate of the total-system cost for the reference cases in the improved-performance system is $3.8 to $5.4 billion higher than the estimate for the same system in the 1986 TSLCC analysis. In the case with the maximum increase, nearly all of the higher cost is due to a $5.2-billion increase in the costs of development and evaluation (D and E); all other system costs are essentially unchanged. The cost difference between the improved-performance system and the authorized system is smaller than the difference estimated in last year's TSLCC analysis. Volume 2 presents the detailed results for the 1987 analysis of the total-system life cycle cost (TSLCC). It consists of four sections: Section A presents the yearly flows of waste between waste-management facilities for the 12 aggregate logistics cases that were studied; Section B presents the annual total-system costs for each of the 30 TSLCC cases by major cost category; Section C presents the annual costs for the disposal of 16,000 canisters of defense high-level waste (DHLW) by major cost category for each of the 30 TSLCC cases; and Section D presents a summary of the cost-allocation factors that were calculated to determine the defense waste share of the total-system costs

  4. Complex cooperative breeders: Using infant care costs to explain variability in callitrichine social and reproductive behavior.

    Science.gov (United States)

    Díaz-Muñoz, Samuel L

    2016-03-01

    The influence of ecology on social behavior and mating strategies is one of the central questions in behavioral ecology and primatology. Callitrichines are New World primates that exhibit high behavioral variability, which is widely acknowledged, but not always systematically researched. Here, I examine the hypothesis that differences in the cost of infant care among genera help explain variation in reproductive traits. I present an integrative approach to generate and evaluate predictions from this hypothesis. I first identify callitrichine traits that vary minimally and traits that are more flexible (e.g., have greater variance or norm of reaction), including the number of males that mate with a breeding female, mechanisms of male reproductive competition, number of natal young retained, and the extent of female reproductive suppression. I outline how these more labile traits should vary along a continuum of infant care costs according to individual reproductive strategies. At one end of the spectrum, I predict that groups with higher infant care costs will show multiple adult males mating and providing infant care, high subordinate female reproductive suppression, few natal individuals delaying dispersal, and increased reproductive output by the dominant female -with opposite predictions under low infant costs. I derive an estimate of the differences in ecological and physiological infant care costs that suggest an order of ascending costs in the wild: Cebuella, Callithrix, Mico, Callimico, Saguinus, and Leontopithecus. I examine the literature on each genus for the most variable traits and evaluate a) where they fall along the continuum of infant care costs according to their reproductive strategies, and b) whether these costs correspond to the ecophysiological estimates of infant care costs. I conclude that infant care costs can provide a unifying explanation for the most variable reproductive traits among callitrichine genera. The approach presented can be

  5. BUSINESS ADMINISTRATION VS. SOCIAL POLITICS: AN ASSESSMENT WITH REGARD TO TOTAL QUALITY MANAGEMENT AND SOCIAL RESPONSIBILITY APPLICATIONS

    Directory of Open Access Journals (Sweden)

    A.N.Sozer

    2007-03-01

    Full Text Available The discipline of business administration has close relations with the disciplines of economics, law, behavioral sciences, statistics and mathematics. The manager of an enterprise should not only manage the sources of capital securing the maximum profit, but also he/she should have knowledge on how to manage the people working for the enterprise (workers and other personnel. Social politics is the discipline which analyses the human relations arising from economic affairs. Thus the main concern of this discipline is the influence of economics on human beings and society as well as the social problems arising from economic affairs. The aim is the general harmony between all the segments of the society, i.e. creation and maintenance of social balance. Globalization has shown its effects also on the existing disciplines. For instance business administration has adopted the concept of social responsibility enlarging its field of interest. As a result of this enlargement, social politics and social responsibility have largely corresponded to each other in terms of scope. However this correspondence is valid only for partners, but not for actors and instruments involved.

  6. Individuals with fear of blushing explicitly and automatically associate blushing with social costs

    NARCIS (Netherlands)

    Glashouwer, K.A.; de Jong, P.J.; Dijk, C.; Buwalda, F.M.

    2011-01-01

    To explain fear of blushing, it has been proposed that individuals with fear of blushing overestimate the social costs of their blushing. Current information-processing models emphasize the relevance of differentiating between more automatic and more explicit cognitions, as both types of cognitions

  7. Individuals with Fear of Blushing Explicitly and Automatically Associate Blushing with Social Costs

    NARCIS (Netherlands)

    Glashouwer, Klaske A.; de Jong, Peter J.; Dijk, Corine; Buwalda, Femke M.

    2011-01-01

    To explain fear of blushing, it has been proposed that individuals with fear of blushing overestimate the social costs of their blushing. Current information-processing models emphasize the relevance of differentiating between more automatic and more explicit cognitions, as both types of cognitions

  8. "The Bewitching Tyranny of Custom": The Social Costs of Indian Drinking in Colonial America.

    Science.gov (United States)

    Mancall, Peter C.

    1993-01-01

    Colonial accounts depict how the alcohol trade destabilized Indian communities in colonial British America during the seventeenth and eighteenth centuries. Despite the social costs of alcohol use within Indian communities, liquor remained a staple of Indian-colonist trade, perhaps because it facilitated the conquest of eastern North America. (LP)

  9. Computed tomography for preoperative planning in minimal-invasive total hip arthroplasty: Radiation exposure and cost analysis

    Energy Technology Data Exchange (ETDEWEB)

    Huppertz, Alexander, E-mail: Alexander.Huppertz@charite.de [Imaging Science Institute Charite Berlin, Robert-Koch-Platz 7, D-10115 Berlin (Germany); Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Radmer, Sebastian, E-mail: s.radmer@immanuel.de [Department of Orthopedic Surgery and Rheumatology, Immanuel-Krankenhaus, Koenigstr. 63, D-14109, Berlin (Germany); Asbach, Patrick, E-mail: Patrick.Asbach@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Juran, Ralf, E-mail: ralf.juran@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Schwenke, Carsten, E-mail: carsten.schwenke@scossis.de [Biostatistician, Scossis Statistical Consulting, Zeltinger Str. 58G, D-13465 Berlin (Germany); Diederichs, Gerd, E-mail: gerd.diederichs@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Hamm, Bernd, E-mail: Bernd.Hamm@charite.de [Department of Radiology, Medical Physics, Charite-University Hospitals of Berlin, Chariteplatz 1, D-10117 Berlin (Germany); Sparmann, Martin, E-mail: m.sparmann@immanuel.de [Department of Orthopedic Surgery and Rheumatology, Immanuel-Krankenhaus, Koenigstr. 63, D-14109, Berlin (Germany)

    2011-06-15

    Computed tomography (CT) was used for preoperative planning of minimal-invasive total hip arthroplasty (THA). 92 patients (50 males, 42 females, mean age 59.5 years) with a mean body-mass-index (BMI) of 26.5 kg/m{sup 2} underwent 64-slice CT to depict the pelvis, the knee and the ankle in three independent acquisitions using combined x-, y-, and z-axis tube current modulation. Arthroplasty planning was performed using 3D-Hip Plan (Symbios, Switzerland) and patient radiation dose exposure was determined. The effects of BMI, gender, and contralateral THA on the effective dose were evaluated by an analysis-of-variance. A process-cost-analysis from the hospital perspective was done. All CT examinations were of sufficient image quality for 3D-THA planning. A mean effective dose of 4.0 mSv (SD 0.9 mSv) modeled by the BMI (p < 0.0001) was calculated. The presence of a contralateral THA (9/92 patients; p = 0.15) and the difference between males and females were not significant (p = 0.08). Personnel involved were the radiologist (4 min), the surgeon (16 min), the radiographer (12 min), and administrative personnel (4 min). A CT operation time of 11 min and direct per-patient costs of 52.80 Euro were recorded. Preoperative CT for THA was associated with a slight and justifiable increase of radiation exposure in comparison to conventional radiographs and low per-patient costs.

  10. Extending total parenteral nutrition hang time in the neonatal intensive care unit: is it safe and cost effective?

    Science.gov (United States)

    Balegar V, Kiran Kumar; Azeem, Mohammad Irfan; Spence, Kaye; Badawi, Nadia

    2013-01-01

    To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload. A before-after observational study comparing the practice of hanging TPN bags for 48 h (6 February 2009-5 February 2010) versus 24 h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload. One hundred thirty-six infants received 24-h TPN bags and 124 received 48-h TPN bags. Median (inter-quartile range) gestation (37 weeks (33,39) vs. 36 weeks (33,39)), mean (±standard deviation) admission weight of 2442 g (±101) versus 2476 g (±104) and TPN duration (9.7 days (±12.7) vs. 9.9 days (±13.4)) were similar (P > 0.05) between the 24- and 48-h TPN groups. There was no increase in CLABSI with longer hang time (0.8 vs. 0.4 per 1000 line days in the 24-h vs. 48-h group; P < 0.05). Annual cost saving using 48-h TPN was AUD 97,603.00. By using 48-h TPN, 68.3% of nurses indicated that their workload decreased and 80.5% indicated that time spent changing TPN reduced. Extending TPN hang time from 24 to 48 h did not alter CLABSI rate and was associated with a reduced TPN-related cost and perceived nursing workload. Larger randomised controlled trials are needed to more clearly delineate these effects. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

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

    Science.gov (United States)

    Burtless, Gary; Milusheva, Sveta

    2013-01-01

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

  12. Self-centered social exchange: differential use of costs versus benefits in prosocial reciprocity.

    Science.gov (United States)

    Zhang, Yan; Epley, Nicholas

    2009-11-01

    Maintaining equitable social relations often requires reciprocating "in kind" for others' prosocial favors. Such in-kind reciprocity requires assessing the value of a prosocial action, an assessment that can lead to egocentric biases in perceived value between favor givers versus favor receivers. In any prosocial exchange, 1 person (the giver) incurs a cost to provide a benefit for another person (the receiver). Six experiments suggest that givers may attend more to the costs they incur in performing a prosocial act than do receivers, who tend to focus relatively more on the benefits they receive. Givers may therefore expect to be reciprocated on the basis of the costs they incur, whereas receivers actually reciprocate primarily on the basis of the benefit they receive. This research identifies 1 challenge to maintaining a sense of equity in social relations and predicts when people are likely to feel fairly versus unfairly valued in their relationships.

  13. Residential Mobility and Turnout: The Relevance of Social Costs, Timing and Education

    DEFF Research Database (Denmark)

    Hansen, Jonas Hedegaard

    2016-01-01

    Residential mobility has substantial negative effects on voter turnout. However, existing studies have been unable to disentangle whether this is due to social costs, informational costs or convenience costs that are related to re-registration. This article analyzes the relevance of the different...... moved from the old neighborhood and it does not matter if citizens change municipality. Thus, the disruption of social ties is the main explanation for the negative effect of moving on turnout. Furthermore, the timing of residential mobility is important as the effect on turnout declines quickly after...... settling down. This illustrates that large events in citizens’ everyday life close to Election Day can distract them from going to the polling station. Finally, residential mobility mostly affects the turnout of less educated citizens. Consequentially, residential mobility increases inequalities in voter...

  14. Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Palle, Connie; Møller, Ann M.

    2016-01-01

    INTRODUCTION: The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost. MATERIAL...... AND METHODS: This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare...... professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference...

  15. [Fuel Rod Consolidation Project]: The estimated total life cycle cost for the 30-year operation of prototypical consolidation demonstration equipment: Volume 4, Phase 2

    International Nuclear Information System (INIS)

    1987-01-01

    The Total Life Cycle Costs have been developed for the construction, operation and decommissioning of a single line of hot-cell-enclosed production consolidation equipment operating on spent fuel at the rate of 750 MTU/year for 30 years. The cost estimate is for a single production line that is part of an overall facility at either a Monitored Retrievable Storage or a Repository facility. This overall facility would include other capabilities and possibly other consolidation lines. However, no costs were included in the cost estimate for other portions of the plant, except that staff costs include an overhead charge that reflects the overhead support services in an overall facility

  16. Priority for the worse-off and the social cost of carbon

    Science.gov (United States)

    Adler, Matthew; Anthoff, David; Bosetti, Valentina; Garner, Greg; Keller, Klaus; Treich, Nicolas

    2017-06-01

    The social cost of carbon (SCC) is a key tool in climate policy. The SCC expresses in monetary terms the social impact of the emission of a ton of CO2 in a given year. The SCC is calculated using a `social welfare function’ (SWF): a method for assessing social welfare. The dominant SWF in climate policy is the discounted-utilitarian SWF. Individuals’ well-being numbers (utilities) are summed, and the values for later generations are reduced (`discounted’). This SWF has been criticized for ignoring the distribution of well-being and including an arbitrary time preference. Here, we use a `prioritarian’ SWF, with no time discount, to calculate the SCC. This SWF gives extra weight (`priority’) to worse-off individuals. Prioritarianism is a well-developed concept in ethics and welfare economics, but has been rarely used in climate scholarship. We find substantial differences between the discounted-utilitarian and non-discounted prioritarian SCCs.

  17. SOCIAL COSTS OF THE EUROPEAN UNION IN THE CONTEXT OF THE ECONOMIC-FINANCIAL CRISIS

    Directory of Open Access Journals (Sweden)

    Andreea Gradinaru

    2013-12-01

    Full Text Available The start of the financial crisis in mid-2007 at a global scale had a major impact on the European Union’s economy. All member states have been economically affected, but the social effects were mainly of large amplitude. This paper focuses precisely on analysing the social costs which the economic-financial crisis has generated in the European Union. After finishing the study we have noticed that numerous social consequences of the recession have manifested intensely since the beginning of the crisis and continue to do so even today. These consist in the increase of poverty and social exclusion, rise in unemployment, decrease in birth rate, changes regarding the migration process, reduction in income, excessive indebtedness, the disparities between countries contributing to the augmentation of all these.

  18. Survival benefits select for group living in a social spider despite reproductive costs

    DEFF Research Database (Denmark)

    Bilde, T.; Coates, K.S.; Birkhofer, K.

    2007-01-01

    The evolution of cooperation requires benefits of group living to exceed costs. Hence, some components of fitness are expected to increase with increasing group size, whereas others may decrease because of competition among group members. The social spiders provide an excellent system to investig......The evolution of cooperation requires benefits of group living to exceed costs. Hence, some components of fitness are expected to increase with increasing group size, whereas others may decrease because of competition among group members. The social spiders provide an excellent system...... to investigate the costs and benefits of group living: they occur in groups of various sizes and individuals are relatively short-lived, therefore life history traits and Lifetime Reproductive Success (LRS) can be estimated as a function of group size. Sociality in spiders has originated repeatedly...... and survival in the social spider Stegodyphus dumicola in two populations in Namibia. In both populations, the major benefit of group living was improved survival of colonies and late-instar juveniles with increasing colony size. By contrast, female fecundity, female body size and early juvenile survival...

  19. The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar

    OpenAIRE

    Bishai, David; LeFevre, Amnesty; Theuss, Marc; Boxshall, Matt; Hetherington, John D; Zaw, Min; Montagu, Dominic

    2013-01-01

    Abstract Introduction This paper examines the cost of quality improvements in Population Services International (PSI) Myanmar’s social franchise operations from 2007 to 2009. Methods The social franchise commodities studied were products for reproductive health, malaria, STIs, pneumonia, and diarrhea. This project applied ingredients based costing for labor, supplies, transport, and overhead. Data were g...

  20. The Perceived Social Costs and Importance of Seeking Emotional Support in the Workplace: Gender Differences and Similarities.

    Science.gov (United States)

    Cahill, Daniel J.; Sias, Patricia M.

    1997-01-01

    Investigates gender differences and similarities in the perceived social costs and importance of seeking emotional support regarding work-related problems. Finds women perceived such support to be more important than did men. Finds no gender differences regarding perceived social costs associated with seeking support from coworkers. Finds women…

  1. Comparing the social costs of biofuels and fossil fuels: A case study of Vietnam

    International Nuclear Information System (INIS)

    Le, Loan T.; Ierland, Ekko C. van; Zhu, Xueqin; Wesseler, Justus; Ngo, Giang

    2013-01-01

    Biofuel substitution for fossil fuels has been recommended in the literature and promoted in many countries; however, there are concerns about its economic viability. In this paper we focus on the cost-effectiveness of fuels, i.e., we compare the social costs of biofuels and fossil fuels for a functional unit defined as 1 km of vehicle transportation. We base our empirical results on a case study in Vietnam and compare two biofuels and their alternative fossil fuels: ethanol and gasoline, and biodiesel and diesel with a focus on the blends of E5 and E10 for ethanol, and B5 and B10 for biodiesel. At the discount rate of 4%, ethanol substitution for gasoline in form of E5 or E10 saves 33% of the social cost of gasoline if the fuel consumption of E5 and E10 is the same as gasoline. The ethanol substitution will be cost-effective if the fuel consumption of E5 and E10, in terms of L km −1 , is not exceeding the consumption of gasoline by more than 1.7% and 3.5% for E5 and E10 respectively. The biodiesel substitution would be cost-effective if the fuel consumption of B5 and B10, in terms of L km −1 compared to diesel, would decrease by more than 1.4% and 2.8% for B5 and B10 respectively at the discount rate of 4%. -- Highlights: •We examine cost-effectiveness of biofuels under efficiency levels of blends. •Cassava-based ethanol used as E5 saves 33% of social cost compared to gasoline. •Ethanol is cost-effective if E5 consumption per km is less than 1.017 times gasoline consumption. •Jatropha-based biodiesel used as B5 or B10 is currently not cost-effective in comparison to diesel. •Biodiesel would be cost-effective if B5 consumption per km would be less than 0.986 times diesel consumption

  2. Analysis of the total system life cycle cost for the Civilian Radioactive Waste Management Program. Volume 1. The analysis and its results

    International Nuclear Information System (INIS)

    1986-04-01

    The total-system life-cycle cost (TSLCC) analysis for the Department of Energy's (DOE) Civilian Radioactive Waste Management Program is an ongoing activity that helps determine whether the revenue-producing mechanism established by the Nuclear Waste Policy Act of 1982 is sufficient to cover the cost of the program. This report provides cost estimates for the fourth evaluation of the adequacy of the fee. The total-system cost for the reference authorized-system program is estimated to be 24 to 32 billion (1985) dollars. The total-system cost for the reference improved-performance system is estimated to be 26 to 34 billion dollars. A number of sensitivity cases were analyzed. For the authorized system, the costs for the sensitivity cases studied range from 21 to 39 billion dollars. For the improved-performance system, which includes a facility for monitored retrievable storage, the total-system cost in the sensitivity cases is estimated to be as high as 41 billion dollars. The factors that affect costs more than any other single factor for both the authorized and the improved-performance systems are delays in repository startup. A preliminary analysis of the impact of extending the burnup of nuclear fuel in the reactor was also performed; its results indicate that the impact is insignificant: the total-system cost is essentially unchanged from the comparable constant-burnup cases. The current estimate of the the total-system cost for the reference authorized system is zero to 3 billion dollars (9%) higher than the estimate for the reference system in the January 1985 TSLCC analysis

  3. Autologous Stem Cell Transplantation in Patients With Multiple Myeloma: An Activity-based Costing Analysis, Comparing a Total Inpatient Model Versus an Early Discharge Model.

    Science.gov (United States)

    Martino, Massimo; Console, Giuseppe; Russo, Letteria; Meliado', Antonella; Meliambro, Nicola; Moscato, Tiziana; Irrera, Giuseppe; Messina, Giuseppe; Pontari, Antonella; Morabito, Fortunato

    2017-08-01

    Activity-based costing (ABC) was developed and advocated as a means of overcoming the systematic distortions of traditional cost accounting. We calculated the cost of high-dose chemotherapy and autologous stem cell transplantation (ASCT) in patients with multiple myeloma using the ABC method, through 2 different care models: the total inpatient model (TIM) and the early-discharge outpatient model (EDOM) and compared this with the approved diagnosis related-groups (DRG) Italian tariffs. The TIM and EDOM models involved a total cost of €28,615.15 and €16,499.43, respectively. In the TIM model, the phase with the greatest economic impact was the posttransplant (recovery and hematologic engraftment) with 36.4% of the total cost, whereas in the EDOM model, the phase with the greatest economic impact was the pretransplant (chemo-mobilization, apheresis procedure, cryopreservation, and storage) phase, with 60.4% of total expenses. In an analysis of each episode, the TIM model comprised a higher absorption than the EDOM. In particular, the posttransplant represented 36.4% of the total costs in the TIM and 17.7% in EDOM model, respectively. The estimated reduction in cost per patient using an EDOM model was over €12,115.72. The repayment of the DRG in Calabrian Region for the ASCT procedure is €59,806. Given the real cost of the transplant, the estimated cost saving per patient is €31,190.85 in the TIM model and €43,306.57 in the EDOM model. In conclusion, the actual repayment of the DRG does not correspond to the real cost of the ASCT procedure in Italy. Moreover, using the EDOM, the cost of ASCT is approximately the half of the TIM model. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Investing in health: is social housing value for money? A cost-utility analysis.

    Science.gov (United States)

    Lawson, K D; Kearns, A; Petticrew, M; Fenwick, E A L

    2013-10-01

    There is a healthy public policy agenda investigating the health impacts of improving living conditions. However, there are few economic evaluations, to date, assessing value for money. We conducted the first cost-effectiveness analysis of a nationwide intervention transferring social and private tenants to new-build social housing, in Scotland. A quasi-experimental prospective study was undertaken involving 205 intervention households and 246 comparison households, over 2 years. A cost-utility analysis assessed the average cost per change in health utility (a single score summarising overall health-related quality of life), generated via the SF-6D algorithm. Construction costs for new builds were included. Analysis was conducted for all households, and by family, adult and elderly households; with estimates adjusted for baseline confounders. Outcomes were annuitised and discounted at 3.5%. The average discounted cost was £18, 708 per household, at a national programme cost of £ 28.4 million. The average change in health utility scores in the intervention group attributable to the intervention were +0.001 for all households, +0.001 for family households, -0.04 for adult households and -0.03 for elderly households. All estimates were statistically insignificant. At face value, the interventions were not value for money in health terms. However, because the policy rationale was the amenity provision of housing for disadvantaged groups, impacts extend beyond health and may be fully realised over the long term. Before making general value-for-money inferences, economic evaluation should attempt to estimate the full social value of interventions, model long-term impacts and explicitly incorporate equity considerations.

  5. The effect of fiscal incentives on market penetration of electric vehicles: A pairwise comparison of total cost of ownership

    International Nuclear Information System (INIS)

    Lévay, Petra Zsuzsa; Drossinos, Yannis; Thiel, Christian

    2017-01-01

    An important barrier to electric vehicle (EV) sales is their high purchase price compared to internal combustion engine (ICE) vehicles. We conducted total cost of ownership (TCO) calculations to study how costs and sales of EVs relate to each other and to examine the role of fiscal incentives in reducing TCO and increasing EV sales. We composed EV-ICE vehicle pairs that allowed cross-segment and cross-country comparison in eight European countries. Actual car prices were used to calculate the incentives for each model in each country. We found a negative TCO-sales relationship that differs across car segments. Compared to their ICE vehicle pair, big EVs have lower TCO, higher sales, and seem to be less price responsive than small EVs. Three country groups can be distinguished according to the level of fiscal incentives and their impact on TCO and EV sales. In Norway, incentives led to the lowest TCO for the EVs. In the Netherlands, France, and UK the TCO of EVs is close to the TCO of the ICE pairs. In the other countries the TCO of EVs exceeds that of the ICE vehicles. We found that exemptions from flat taxes favour big EVs, while lump-sum subsidies favour small EVs. - Highlights: • Pairwise comparison of EV and ICE vehicle TCO and sales in eight European countries. • In NO, EV TCO is lower than ICE TCO; in NL, FR, and UK, EV TCO is slightly higher. • Compared to ICE vehicles, big EVs have lower TCO and higher sales than small EVs. • Exemptions from flat taxes favour big EVs, lump-sum subsidies favour small EVs. • Most popular EV models: Tesla Model S, Nissan Leaf, Mitsubishi Outlander PHEV.

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

    Science.gov (United States)

    Jiang, Yu; Dinar, Ariel; Hellegers, Petra

    2018-04-01

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

  7. A Cost-based Explanation of Gradual, Regional Internationalization of Multinationals on Social Networking Sites

    DEFF Research Database (Denmark)

    Pogrebnyakov, Nicolai

    2017-01-01

    This paper examines firm internationalization on social networking sites (SNS). It systematically examines costs faced by an internationalizing firm and how firms react to these costs according to “distance-dependent” (gradual and regional) and “distance-invariant” (born-global) explanations...... of internationalization. Data on 5827 country pages of 240 multinational firms on Facebook, the most popular SNS today, is used. Creating a foreign country-specific Facebook page is considered the SNS equivalent of opening a physical subsidiary in that country. The data show that multinationals exhibit...

  8. Philosophical origins of the social rate of discount in cost-benefit analysis.

    Science.gov (United States)

    Robinson, J C

    1990-01-01

    The social rate of discount--that is, the way decision makers today evaluate future consequences of collective activity--raises difficult issues of intergenerational justice. When benefits are discounted at the present rate the United States government requires, serious efforts to promote public health over the long term will fail cost-benefit tests. No consensus exists among theorists to establish fair rates; philosophers support discounting with economic arguments that economists reject, while economists no less paradoxically support the concept using philosophical arguments that philosophers disavow. A new emphasis on the role of consumers' and citizens' time preferences, however, will keep open rather than close debates on the social discount rate.

  9. Alain Supiot, L’Esprit de Philadelphie. La justice sociale face au marché total

    Directory of Open Access Journals (Sweden)

    Jean-Luc Metzger

    2013-03-01

    Full Text Available Les transformations contemporaines qu’ont connues la plupart des pays depuis le début des années 1980 ont donné lieu à des analyses convergentes, pointant le rôle moteur de l’idéologie néolibérale et tout particulièrement de la financiarisation des économies. Complétant ce diagnostic, Alain Supiot propose, dans L’Esprit de Philadelphie, une perspective et des pistes originales pour une conception alternative de la mondialisation, centrée sur la justice sociale et le Droit social. C’est dans c...

  10. Joint estimation of vertical total electron content (VTEC) and satellite differential code biases (SDCBs) using low-cost receivers

    Science.gov (United States)

    Zhang, Baocheng; Teunissen, Peter J. G.; Yuan, Yunbin; Zhang, Hongxing; Li, Min

    2018-04-01

    Vertical total electron content (VTEC) parameters estimated using global navigation satellite system (GNSS) data are of great interest for ionosphere sensing. Satellite differential code biases (SDCBs) account for one source of error which, if left uncorrected, can deteriorate performance of positioning, timing and other applications. The customary approach to estimate VTEC along with SDCBs from dual-frequency GNSS data, hereinafter referred to as DF approach, consists of two sequential steps. The first step seeks to retrieve ionospheric observables through the carrier-to-code leveling technique. This observable, related to the slant total electron content (STEC) along the satellite-receiver line-of-sight, is biased also by the SDCBs and the receiver differential code biases (RDCBs). By means of thin-layer ionospheric model, in the second step one is able to isolate the VTEC, the SDCBs and the RDCBs from the ionospheric observables. In this work, we present a single-frequency (SF) approach, enabling the joint estimation of VTEC and SDCBs using low-cost receivers; this approach is also based on two steps and it differs from the DF approach only in the first step, where we turn to the precise point positioning technique to retrieve from the single-frequency GNSS data the ionospheric observables, interpreted as the combination of the STEC, the SDCBs and the biased receiver clocks at the pivot epoch. Our numerical analyses clarify how SF approach performs when being applied to GPS L1 data collected by a single receiver under both calm and disturbed ionospheric conditions. The daily time series of zenith VTEC estimates has an accuracy ranging from a few tenths of a TEC unit (TECU) to approximately 2 TECU. For 73-96% of GPS satellites in view, the daily estimates of SDCBs do not deviate, in absolute value, more than 1 ns from their ground truth values published by the Centre for Orbit Determination in Europe.

  11. Social cost of land mines in four countries: Afghanistan, Bosnia, Cambodia, and Mozambique.

    Science.gov (United States)

    Andersson, N; da Sousa, C P; Paredes, S

    1995-09-16

    To document the effects of land mines on the health and social conditions of communities in four affected countries. A cross design of cluster survey and rapid appraisal methods including a household questionnaire and qualitative data from key informants, institutional reviews, and focus groups of survivors of land mines from the same communities. 206 communities, 37 in Afghanistan, 66 in Bosnia, 38 in Cambodia, and 65 in Mozambique. 174,489 people living in 32,904 households in the selected communities. Effects of land mines on food security, residence, livestock, and land use; risk factors: extent of individual land mine injuries; physical, psychological, social, and economic costs of injuries during medical care and rehabilitation. Between 25% and 87% of households had daily activities affected by land mines. Based on expected production without the mines, agricultural production could increase by 88-200% in different regions of Afghanistan, 11% in Bosnia, 135% in Cambodia, and 3.6% in Mozambique. A total of 54,554 animals was lost because of land mines, with a minimum cash value of $6.5m, or nearly $200 per household. Overall, 6% of households (1964) reported a land mine victim; a third of victims died in the blast. One in 10 of the victims was a child. The most frequent activities associated with land mine incidents were agricultural or pastoral, except in Bosnia where more than half resulted from military activities, usually during patrols. Incidences have more than doubled between 1980-3 and 1990-3, excluding the incidents in Bosnia. Some 22% of victims (455/2100) were from households reporting attempts to remove land mines; in these households there was a greatly increased risk of injury (odds ratio 4.2 and risk difference 19% across the four countries). Lethality of the mines varied; in Bosnia each blast killed an average of 0.54 people and injured 1.4, whereas in Mozambique each blast killed 1.45 people and wounded 1.27. Households with a land mine victim

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

    Directory of Open Access Journals (Sweden)

    Le HH

    2014-07-01

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

  13. Total Work, Gender and Social Norms in EU and US Time Use

    OpenAIRE

    Burda , Michael C; Hamermesh , Daniel S; Weil , Philippe

    2008-01-01

    Using time-diary data from 27 countries, we demonstrate a negative relationship between real GDP per capita and the female-male difference in total work time--the sum of work for pay and work at home. We also show that in rich non-Catholic countries on four continents men and women do the same amount of total work on average. Our survey results demonstrate that labor economists, macroeconomists, sociologists and the general public consistently believe that women perform more total work. The f...

  14. Economic analysis of two-stage septic revision after total hip arthroplasty: What are the relevant costs for the hospital's orthopedic department?

    Science.gov (United States)

    Kasch, R; Assmann, G; Merk, S; Barz, T; Melloh, M; Hofer, A; Merk, H; Flessa, S

    2016-03-01

    The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department's point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.

  15. A pilot study to evaluate the cost-effectiveness of ondansetron and granisetron in fractionated total body irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Gibbs, S.J.; Cassoni, A.M. [Middlesex Hospital, London (United Kingdom)

    1996-11-01

    The duration of the antiemetic effect of granisetron was examined in a pilot study of patients (n = 26) undergoing a standard emetogenic stimulus in the form of total body irradiation fractionated over 3-4 days, in a randomized comparison with twice-daily ondansetron. A single intravenous dose of granisetron at the onset of therapy was effective over the entire follow-up period in 50% (6/12) of patients, compared with 77% (10/13) prescribed twice-daily oral ondansetron for 3 or 4 days. The response rate within the first 24 hours from the start of irradiation was 67% (8/12) for granisetron and 77% (10/13) for ondansetron. Granisetron and ondansetron was therefore of similar efficacy within the first 24-hour period, but granisetron was less efficaceous more than 24 hours after the onset of therapy. Patients who required a second dose of granisetron did so at intervals of 12, 42, 47 and 48 hours following the first fraction of radiotherapy. The cost per patient in this study was 48 for granisetron and {sub 1}54 for ondanestron, but the dose scheduling we used cannot be recommended in view of the lower effectiveness of granisetron. (author).

  16. A pilot study to evaluate the cost-effectiveness of ondansetron and granisetron in fractionated total body irradiation

    International Nuclear Information System (INIS)

    Gibbs, S.J.; Cassoni, A.M.

    1996-01-01

    The duration of the antiemetic effect of granisetron was examined in a pilot study of patients (n = 26) undergoing a standard emetogenic stimulus in the form of total body irradiation fractionated over 3-4 days, in a randomized comparison with twice-daily ondansetron. A single intravenous dose of granisetron at the onset of therapy was effective over the entire follow-up period in 50% (6/12) of patients, compared with 77% (10/13) prescribed twice-daily oral ondansetron for 3 or 4 days. The response rate within the first 24 hours from the start of irradiation was 67% (8/12) for granisetron and 77% (10/13) for ondansetron. Granisetron and ondansetron was therefore of similar efficacy within the first 24-hour period, but granisetron was less efficaceous more than 24 hours after the onset of therapy. Patients who required a second dose of granisetron did so at intervals of 12, 42, 47 and 48 hours following the first fraction of radiotherapy. The cost per patient in this study was 48 for granisetron and 1 54 for ondanestron, but the dose scheduling we used cannot be recommended in view of the lower effectiveness of granisetron. (author)

  17. Rising Use Of Observation Care Among The Commercially Insured May Lead to Total And Out-Of-Pocket Cost Savings.

    Science.gov (United States)

    Adrion, Emily R; Kocher, Keith E; Nallamothu, Brahmajee K; Ryan, Andrew M

    2017-12-01

    Proponents of hospital-based observation care argue that it has the potential to reduce health care spending and lengths-of-stay, compared to short-stay inpatient hospitalizations. However, critics have raised concerns about the out-of-pocket spending associated with observation care. Recent reports of high out-of-pocket spending among Medicare beneficiaries have received considerable media attention and have prompted direct policy changes. Despite the potential for changed policies to indirectly affect non-Medicare patients, little is known about the use of, and spending associated with, observation care among commercially insured populations. Using multipayer commercial claims for the period 2009-13, we evaluated utilization and spending among patients admitted for six conditions that are commonly managed with either observation care or short-stay hospitalizations. In our study period, the use of observation care increased relative to that of short-stay hospitalizations. Total and out-of-pocket spending were substantially lower for observation care, though both grew rapidly-and at rates much higher than spending in the inpatient setting-over the study period. Despite this growth, spending on observation care is unlikely to exceed spending for short-stay hospitalizations. As observation care attracts greater attention, policy makers should be aware that Medicare policies that disincentivize observation may have unintended financial impacts on non-Medicare populations, where observation care may be cost saving.

  18. Total cost of care lower among Medicare fee-for-service beneficiaries receiving care from patient-centered medical homes.

    Science.gov (United States)

    van Hasselt, Martijn; McCall, Nancy; Keyes, Vince; Wensky, Suzanne G; Smith, Kevin W

    2015-02-01

    To compare health care utilization and payments between NCQA-recognized patient-centered medical home (PCMH) practices and practices without such recognition. Medicare Part A and B claims files from July 1, 2007 to June 30, 2010, 2009 Census, 2007 Health Resources and Services Administration and CMS Utilization file, Medicare's Enrollment Data Base, and the 2005 American Medical Association Physician Workforce file. This study used a longitudinal, nonexperimental design. Three annual observations (July 1, 2008-June 30, 2010) were available for each practice. We compared selected outcomes between practices with and those without NCQA PCMH recognition. Individual Medicare fee-for-service (FFS) beneficiaries and their claims and utilization data were assigned to PCMH or comparison practices based on where they received the plurality of evaluation and management services between July 1, 2007 and June 30, 2008. Relative to the comparison group, total Medicare payments, acute care payments, and the number of emergency room visits declined after practices received NCQA PCMH recognition. The decline was larger for practices with sicker than average patients, primary care practices, and solo practices. This study provides additional evidence about the potential of the PCMH model for reducing health care utilization and the cost of care. © Health Research and Educational Trust.

  19. Multi-objective ACO algorithms to minimise the makespan and the total rejection cost on BPMs with arbitrary job weights

    Science.gov (United States)

    Jia, Zhao-hong; Pei, Ming-li; Leung, Joseph Y.-T.

    2017-12-01

    In this paper, we investigate the batch-scheduling problem with rejection on parallel machines with non-identical job sizes and arbitrary job-rejected weights. If a job is rejected, the corresponding penalty has to be paid. Our objective is to minimise the makespan of the processed jobs and the total rejection cost of the rejected jobs. Based on the selected multi-objective optimisation approaches, two problems, P1 and P2, are considered. In P1, the two objectives are linearly combined into one single objective. In P2, the two objectives are simultaneously minimised and the Pareto non-dominated solution set is to be found. Based on the ant colony optimisation (ACO), two algorithms, called LACO and PACO, are proposed to address the two problems, respectively. Two different objective-oriented pheromone matrices and heuristic information are designed. Additionally, a local optimisation algorithm is adopted to improve the solution quality. Finally, simulated experiments are conducted, and the comparative results verify the effectiveness and efficiency of the proposed algorithms, especially on large-scale instances.

  20. The Social-Cost Calculator (SCC): Documentation of Methods and Data, and Case Study of Sacramento

    OpenAIRE

    Delucchi, Mark

    2005-01-01

    Planning agencies, analysts, non-profit organizations, regulatory and legislative bodies, and other organizations develop long-range local, state, regional, and national transportation plans. These plans typically comprise two or more alternatives, or scenarios. These alternatives have different financial costs and different impacts on travel, air quality, noise, safety, and so on. To evaluate and compare these alternatives with their different impacts, planners and analysts often use social ...

  1. Effect of Entry into Socially Responsible Investment Index on Cost of Equity and Firm Value

    Directory of Open Access Journals (Sweden)

    Kijung Eom

    2017-04-01

    Full Text Available The purpose of this study was to identify the effect of a company’s incorporation into the Socially Responsible Investment (SRI index on its cost of equity (COE and corporate value. The study collected and analyzed data about the four-year long changes of the component stocks of the Korea Exchange (KRX SRI index from September 2010 to September 2013 to verify the correlation between the incorporation of the SRI index and the cost of equity or corporate value by using the Price-Earnings Growth (PEG, Modified PEG (MPEG and Gode and Mohanram (GM models for estimation of the implied costs of equity capital, as well as Tobin’s Q ratio. The analysis results failed to show any significant relation between the incorporation of the SRI index and the cost of equity capital. Also, no statistically significant correlation between the incorporation of the SRI index and corporate value was observed. However, at an early phase of introduction of the SRI index, the included companies revealed a negative correlation with the cost of equity. However, after changing the listed stocks, they showed a positive correlation with the cost of equity capital. All in all, this can be ascribed to a mixed presence of optimistic and pessimistic investors about CSR activities, or there is a possibility that the KRX SRI index might not correctly reflect the CSR activities of companies.

  2. Are Luxury Brand Labels and "Green" Labels Costly Signals of Social Status? An Extended Replication.

    Science.gov (United States)

    Berger, Joël

    2017-01-01

    Costly signaling theory provides an explanation for why humans are willing to a pay a premium for conspicuous products such as luxury brand-labeled clothing or conspicuous environmentally friendly cars. According to the theory, the extra cost of such products is a signal of social status and wealth and leads to advantages in social interactions for the signaler. A previous study found positive evidence for the case of luxury brand labels. However, an issue of this study was that some of the experiments were not conducted in a perfectly double-blind manner. I resolved this by replicating variations of the original design in a double-blind procedure. Additionally, besides the luxury label condition, I introduced a "green" label condition. Thus, the hypothesis that signaling theory is able to explain pro-environmental behavior was tested for the first time in a natural field setting. Further, I conducted experiments in both average and below-average socioeconomic neighborhoods, where, according to signaling theory, the effects of luxury signals should be even stronger. In contrast to the original study, I did not find positive effects of the luxury brand label in any of the five experiments. Nor did I find evidence for a green-signaling effect. Moreover, in poor neighborhoods a negative tendency of the luxury label actually became evident. This suggests that a signaling theory explanation of costly labels must take into account the characteristics of the observers, e.g. their social status.

  3. Are Luxury Brand Labels and "Green" Labels Costly Signals of Social Status? An Extended Replication.

    Directory of Open Access Journals (Sweden)

    Joël Berger

    Full Text Available Costly signaling theory provides an explanation for why humans are willing to a pay a premium for conspicuous products such as luxury brand-labeled clothing or conspicuous environmentally friendly cars. According to the theory, the extra cost of such products is a signal of social status and wealth and leads to advantages in social interactions for the signaler. A previous study found positive evidence for the case of luxury brand labels. However, an issue of this study was that some of the experiments were not conducted in a perfectly double-blind manner. I resolved this by replicating variations of the original design in a double-blind procedure. Additionally, besides the luxury label condition, I introduced a "green" label condition. Thus, the hypothesis that signaling theory is able to explain pro-environmental behavior was tested for the first time in a natural field setting. Further, I conducted experiments in both average and below-average socioeconomic neighborhoods, where, according to signaling theory, the effects of luxury signals should be even stronger. In contrast to the original study, I did not find positive effects of the luxury brand label in any of the five experiments. Nor did I find evidence for a green-signaling effect. Moreover, in poor neighborhoods a negative tendency of the luxury label actually became evident. This suggests that a signaling theory explanation of costly labels must take into account the characteristics of the observers, e.g. their social status.

  4. Study on measuring social cost of water pollution: concentrated on Han River water system

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kwang Im; Min, Dong Gee; Chung, Hoe Seong; Lim, Hyun Jeong; Kim, Mee Sook [Korea Environment Institute, Seoul (Korea)

    1999-12-01

    Following the economic development and the progress of urbanization, the damage on water pollution has been more serious but a social cost caused by water pollution cannot be measured. Although the need of water quality preservation is emphasized, a base material for public investment on enhancing water quality preservation is not equipped yet due to the absence of economic values of water resource. Therefore it measured a cost generated by leaving pollution not treated water quality in this study. To measure the usable value of water resource or the cost of water pollution all over the country should include a national water system, but this study is limited on the mainstream of Han River water system from North Han River through Paldang to Chamsil sluice gates. Further study on Nakdong River and Keum River water systems should be done. 74 refs., 4 figs., 51 tabs.

  5. Determining the True Cost to Deliver Total Hip and Knee Arthroplasty Over the Full Cycle of Care: Preparing for Bundling and Reference-Based Pricing.

    Science.gov (United States)

    DiGioia, Anthony M; Greenhouse, Pamela K; Giarrusso, Michelle L; Kress, Justina M

    2016-01-01

    The Affordable Care Act accelerates health care providers' need to prepare for new care delivery platforms and payment models such as bundling and reference-based pricing (RBP). Thriving in this environment will be difficult without knowing the true cost of care delivery at the level of the clinical condition over the full cycle of care. We describe a project in which we identified true costs for both total hip and total knee arthroplasty. With the same tool, we identified cost drivers in each segment of care delivery and collected patient experience information. Combining cost and experience information with outcomes data we already collect allows us to drive costs down while protecting outcomes and experiences, and compete successfully in bundling and RBP programs. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. The advanced launch system: Application of total quality management principles to low-cost space transportation system development

    Science.gov (United States)

    Wolfe, M. G.; Rothwell, T. G.; Rosenberg, D. A.; Oliver, M. B.

    Recognizing that a major inhibitor of man's rapid expansion of the use of space is the high cost (direct and induced) of space transportation, the U.S. has embarked on a major national program to radically reduce the cost of placing payloads into orbit while, at the same time, making equally radical improvements inlaunch system operability. The program is entitled "The Advanced Launch System" (ALS) and is a joint Department of Defense/National Aeronautics and Space Administration (DoD/NASA) program which will provide launch capability in the post 2000 timeframe. It is currently in Phase II (System Definition), which began in January 1989, and will serve as a major source of U.S. launch system technology over the next several years. The ALS is characterized by a new approach to space system design, development, and operation. The practices that are being implemented by the ALS are expected to affect the management and technical operation of all future launch systems. In this regard, the two most significant initiatives being implemented on the ALS program are the practices of Total Quality Management (TQM) and the Unified Information System (Unis). TQM is a DoD initiative to improve the quality of the DoD acquisition system, contractor management systems, and the technical disciplines associated with the design, development, and operation of major systems. TQM has been mandated for all new programs and affects the way every group within the system currently does business. In order to implement the practices of TQM, new methods are needed. A program on the scale of the ALS generates vast amounts of information which must be used effectively to make sound decisions. Unis is an information network that will connect all ALS participants throughout all phases of the ALS development. Unis is providing support for project management and system design, and in following phases will provide decision support for launch operations, computer integrated manufacturing, automated

  7. Different but Equal: Total Work, Gender and Social Norms in EU and US Time Use

    OpenAIRE

    Daniel S Hamermesh; Michael C Burda; Philippe Weil

    2008-01-01

    Using time-diary data from 27 countries, we demonstrate a negative relationship between real GDP per capita and the female-male difference in total work time—the sum of work for pay and work at home. We also show that in rich non-Catholic countries on four continents men and women do the same amount of total work on average. Our survey results demonstrate that labor economists, macroeconomists, sociologists and the general public consistently believe that women perform more tot...

  8. Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study.

    Science.gov (United States)

    Copanitsanou, Panagiota; Valkeapää, Kirsi; Cabrera, Esther; Katajisto, Jouko; Leino-Kilpi, Helena; Sigurdardottir, Arun K; Unosson, Mitra; Zabalegui, Adelaida; Lemonidou, Chryssoula

    2017-04-01

    Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs. Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs. There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs. There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research. © 2016 Wiley Periodicals, Inc.

  9. Energy management for cost reduction in the production. TEEM - Total Energy Efficiency Management; Energiemanagement zur Kostensenkung in der Produktion. TEEM - Total Energy Efficiency Management

    Energy Technology Data Exchange (ETDEWEB)

    Westkaemper, Engelbert; Verl, Alexander (eds.)

    2009-07-01

    Within the workshop of the Fraunhofer Institute for Manufacturing Engineering and Automation IPA (Stuttgart, Federal Republic of Germany) at 6th October, 2009, in Stuttgart the following lectures were held: (1) Presentation of Fraunhofer Institute for Manufacturing Engineering and Automation IPA (Engelbert Westkaemper); (2) TEEM - Total Energy Efficiency Management - ''With energy management to an energy efficient production'' (Alexander Schloske); (3) DIN EN 16001 Introduction of an energy management system - utilization and advantages for companies (Sylvia Wahren); (4) Analysis of the energy efficiency with power flow - Support and implementation at factory planning and optimization of production (Klaus Erlach); (5) Total Energy Efficiency Management - Approaches at the company Kaercher in injection moulding for example (Axel Leschtar); (6) Modelling the embodied product energy (Shahin Rahimifard); (7) Acquisition of energy data in the production - Technologies and possibilities (Joachim Neher); (8) Active energy management by means of an ''energy control centre'' - Analysis of the real situation and upgrading measures in the production using coating plants as an example (Wolfgang Klein); (9) Visualisation and simulation of energy values in the digital factory (Carmen Constantinescu, Axel Bruns).

  10. The importance of creating a social business to produce low-cost hearing aids.

    Science.gov (United States)

    Caccamo, Samantha; Voloshchenko, Anastasia; Dankyi, Nana Yaa

    2014-09-01

    The World Health Organization (WHO) estimates that about 280 million people worldwide have a bilateral hearing loss, mostly living in poor countries. Hearing loss causes heavy social burdens on individuals, families, communities and countries. However, due to the lack of accessibility and affordability, the vast majority of people in the world who need hearing aids do not have access to them. Low-income countries are thus pulled into a disability/poverty spiral. From this standpoint, the production of available, accessible and affordable hearing aids for the poorest populations of our planet should be one of the main issues in global hearing healthcare. Designing and producing a brand new low-cost hearing aid is the most effective option. Involving a large producer of hearing aids in the creation of a social business to solve the problem of access to affordable hearing aids is an essential step to reduce hearing disability on a large scale globally. Today's technology allows for the creation of a "minimal design" product that does not exceed $100-$150, that can be further lowered when purchased in large quantities and dispensed with alternative models. It is conceivable that by making a sustainable social business, the low cost product could be sold with a cross-subsidy model in order to recover the overhead costs. Social business is an economic model that has the potential to produce and distribute affordable hearing aids in low- and middle-income countries. Rehabilitation of hearing impaired children will be carried out in partnership with Sahic (Society of Assistance to Hearing Impaired Children) in Dhaka, Bangladesh and the ENT Department of Ospedale Burlo di Trieste, Dr. Eva Orzan.

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

    Science.gov (United States)

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

    2017-10-27

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

  12. Use of Quantile Regression to Determine the Impact on Total Health Care Costs of Surgical Site Infections Following Common Ambulatory Procedures.

    Science.gov (United States)

    Olsen, Margaret A; Tian, Fang; Wallace, Anna E; Nickel, Katelin B; Warren, David K; Fraser, Victoria J; Selvam, Nandini; Hamilton, Barton H

    2017-02-01

    To determine the impact of surgical site infections (SSIs) on health care costs following common ambulatory surgical procedures throughout the cost distribution. Data on costs of SSIs following ambulatory surgery are sparse, particularly variation beyond just mean costs. We performed a retrospective cohort study of persons undergoing cholecystectomy, breast-conserving surgery, anterior cruciate ligament reconstruction, and hernia repair from December 31, 2004 to December 31, 2010 using commercial insurer claims data. SSIs within 90 days post-procedure were identified; infections during a hospitalization or requiring surgery were considered serious. We used quantile regression, controlling for patient, operative, and postoperative factors to examine the impact of SSIs on 180-day health care costs throughout the cost distribution. The incidence of serious and nonserious SSIs was 0.8% and 0.2%, respectively, after 21,062 anterior cruciate ligament reconstruction, 0.5% and 0.3% after 57,750 cholecystectomy, 0.6% and 0.5% after 60,681 hernia, and 0.8% and 0.8% after 42,489 breast-conserving surgery procedures. Serious SSIs were associated with significantly higher costs than nonserious SSIs for all 4 procedures throughout the cost distribution. The attributable cost of serious SSIs increased for both cholecystectomy and hernia repair as the quantile of total costs increased ($38,410 for cholecystectomy with serious SSI vs no SSI at the 70th percentile of costs, up to $89,371 at the 90th percentile). SSIs, particularly serious infections resulting in hospitalization or surgical treatment, were associated with significantly increased health care costs after 4 common surgical procedures. Quantile regression illustrated the differential effect of serious SSIs on health care costs at the upper end of the cost distribution.

  13. Estimating Total Program Cost of a Long-Term, High-Technology, High-Risk Project with Task Durations and Costs That May Increase Over Time

    National Research Council Canada - National Science Library

    Brown, Gerald G; Grose, Roger T; Koyak, Robert A

    2006-01-01

    .... Each task suffers some risk of delay and changed cost. Ignoring budget constraints, we use Monte Carlo simulation of the duration of each task in the project to infer the probability distribution of the project completion time...

  14. Estimation of incidence and social cost of colon cancer due to nitrate in drinking water in the EU: a tentative cost-benefit assessment.

    Science.gov (United States)

    van Grinsven, Hans J M; Rabl, Ari; de Kok, Theo M

    2010-10-06

    Presently, health costs associated with nitrate in drinking water are uncertain and not quantified. This limits proper evaluation of current policies and measures for solving or preventing nitrate pollution of drinking water resources. The cost for society associated with nitrate is also relevant for integrated assessment of EU nitrogen policies taking a perspective of welfare optimization. The overarching question is at which nitrogen mitigation level the social cost of measures, including their consequence for availability of food and energy, matches the social benefit of these measures for human health and biodiversity. Epidemiological studies suggest colon cancer to be possibly associated with nitrate in drinking water. In this study risk increase for colon cancer is based on a case-control study for Iowa, which is extrapolated to assess the social cost for 11 EU member states by using data on cancer incidence, nitrogen leaching and drinking water supply in the EU. Health costs are provisionally compared with nitrate mitigation costs and social benefits of fertilizer use. For above median meat consumption the risk of colon cancer doubles when exposed to drinking water exceeding 25 mg/L of nitrate (NO3) for more than ten years. We estimate the associated increase of incidence of colon cancer from nitrate contamination of groundwater based drinking water in EU11 at 3%. This corresponds to a population-averaged health loss of 2.9 euro per capita or 0.7 euro per kg of nitrate-N leaching from fertilizer. Our cost estimates indicate that current measures to prevent exceedance of 50 mg/L NO3 are probably beneficial for society and that a stricter nitrate limit and additional measures may be justified. The present assessment of social cost is uncertain because it considers only one type of cancer, it is based on one epidemiological study in Iowa, and involves various assumptions regarding exposure. Our results highlight the need for improved epidemiological studies.

  15. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland

    NARCIS (Netherlands)

    Retèl, Valesca P.; van den Boer, Cindy; Steuten, Lotte M. G.; Okła, Sławomir; Hilgers, Frans J.; van den Brekel, Michiel W.

    2015-01-01

    The beneficial physical and psychosocial effects of heat and moisture exchangers (HMEs) for pulmonary rehabilitation of laryngectomy patients are well evidenced. However, cost-effectiveness in terms of costs per additional quality-adjusted life years (QALYs) has not yet been investigated. Therefore,

  16. Predictors for total hospital and cardiology cost claims among patients with atrial fibrillation initiating dabigatran or acenocoumarol in the Netherlands

    NARCIS (Netherlands)

    Jacobs, M S; van Leent, M W J; Tieleman, R G; Jansman, F G A; Cao, Q; Postma, M J; van Hulst, M

    2017-01-01

    Aims: The prevalence of atrial fibrillation (AF) has increased over the past years due to aging of the population, and healthcare costs associated with AF reflect a significant financial burden. The aim of this study was to explore predictors for the real-world AF-related in-hospital costs in

  17. Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff Tears.

    Science.gov (United States)

    Makhni, Eric C; Swart, Eric; Steinhaus, Michael E; Mather, Richard C; Levine, William N; Bach, Bernard R; Romeo, Anthony A; Verma, Nikhil N

    2016-09-01

    To compare the cost-effectiveness within the United States health care system of arthroscopic rotator cuff repair versus reverse total shoulder arthroplasty in patients with symptomatic large and massive rotator cuff tears without cuff-tear arthropathy. An expected-value decision analysis was constructed comparing the costs and outcomes of patients undergoing arthroscopic rotator cuff repair and reverse total shoulder arthroplasty for large and massive rotator cuff tears (and excluding cases of cuff-tear arthropathy). Comprehensive literature search provided input data to extrapolate costs and health utility states for these outcomes. The primary outcome assessed was that of incremental cost-effectiveness ratio (ICER) of reverse total shoulder arthroplasty versus rotator cuff repair. For the base case, both arthroscopic rotator cuff repair and reverse total shoulder were superior to nonoperative care, with an ICER of $15,500/quality-adjusted life year (QALY) and $37,400/QALY, respectively. Arthroscopic rotator cuff repair was dominant over primary reverse total shoulder arthroplasty, with lower costs and slightly improved clinical outcomes. Arthroscopic rotator cuff repair was the preferred strategy as long as the lifetime progression rate from retear to end-stage cuff-tear arthropathy was less than 89%. However, when the model was modified to account for worse outcomes when reverse shoulder arthroplasty was performed after a failed attempted rotator cuff repair, primary reverse total shoulder had superior outcomes with an ICER of $90,000/QALY. Arthroscopic rotator cuff repair-despite high rates of tendon retearing-for patients with large and massive rotator cuff tears may be a more cost-effective initial treatment strategy when compared with primary reverse total shoulder arthroplasty and when assuming no detrimental impact of previous surgery on outcomes after arthroplasty. Clinical judgment should still be prioritized when formulating treatment plans for these

  18. Deep uncertainty and broad heterogeneity in country-level social cost of carbon

    Science.gov (United States)

    Ricke, K.; Drouet, L.; Caldeira, K.; Tavoni, M.

    2017-12-01

    The social cost of carbon (SCC) is a commonly employed metric of the expected economic damages expected from carbon dioxide (CO2) emissions. Recent estimates of SCC range from approximately 10/tonne of CO2 to as much as 1000/tCO2, but these have been computed at the global level. While useful in an optimal policy context, a world-level approach obscures the heterogeneous geography of climate damages and vast differences in country-level contributions to global SCC, as well as climate and socio-economic uncertainties, which are much larger at the regional level. For the first time, we estimate country-level contributions to SCC using recent climate and carbon-cycle model projections, empirical climate-driven economic damage estimations, and information from the Shared Socio-economic Pathways. Central specifications show high global SCC values (median: 417 /tCO2, 66% confidence intervals: 168 - 793 /tCO2) with country-level contributions ranging from -11 (-8 - -14) /tCO2 to 86 (50 - 158) /tCO2. We quantify climate-, scenario- and economic damage- driven uncertainties associated with the calculated values of SCC. We find that while the magnitude of country-level social cost of carbon is highly uncertain, the relative positioning among countries is consistent. Countries incurring large fractions of the global cost include India, China, and the United States. The share of SCC distributed among countries is robust, indicating climate change winners and losers from a geopolitical perspective.

  19. Olanzapine versus typical neuroleptics for schizophrenia: evaluation of social and economic costs

    Directory of Open Access Journals (Sweden)

    Giorgio Mariani

    2006-06-01

    Full Text Available An important number of publications is reporting results from health outcomes studies comparing atypical antipsychotics (AA with typical neuroleptics (TN over 1 year of observation. Our study has prolonged the period observation of the economical and social outcomes to 4 years: 31 patients with schizophrenia were observed retrospectively during two years of TN treatment and then followed during 2 more years of olanzapine treatment after naturalistic switch. The results show a general reduction of health care interventions (territory and hospital during the olanzapine treatment period. Global costs during olanzapine treatment were lower than during TN treatment (10506 euros with TN vs 6193 euros with olanzapine over 2 years. The social outcome, measured through the registration of the number of working days in the two periods of the study (retrospective with TN and prospective with olanzapine, was better during olanzapine treatment, probably due to increased patient compliance to the rehabilitative activities offered by the Department of Mental Health. In our experience, olanzapine appeared to dominate TN treatment, as its higher acquisition costs were offset by the reduction of territorial and nosocomial health care interventions over two years of observation, and associated with higher involvement in rehabilitative and social activities.

  20. The Cost Effectiveness of Psychological and Pharmacological Interventions for Social Anxiety Disorder: A Model-Based Economic Analysis.

    Directory of Open Access Journals (Sweden)

    Ifigeneia Mavranezouli

    Full Text Available Social anxiety disorder is one of the most persistent and common anxiety disorders. Individually delivered psychological therapies are the most effective treatment options for adults with social anxiety disorder, but they are associated with high intervention costs. Therefore, the objective of this study was to assess the relative cost effectiveness of a variety of psychological and pharmacological interventions for adults with social anxiety disorder.A decision-analytic model was constructed to compare costs and quality adjusted life years (QALYs of 28 interventions for social anxiety disorder from the perspective of the British National Health Service and personal social services. Efficacy data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published literature and national sources, supplemented by expert opinion.Individual cognitive therapy was the most cost-effective intervention for adults with social anxiety disorder, followed by generic individual cognitive behavioural therapy (CBT, phenelzine and book-based self-help without support. Other drugs, group-based psychological interventions and other individually delivered psychological interventions were less cost-effective. Results were influenced by limited evidence suggesting superiority of psychological interventions over drugs in retaining long-term effects. The analysis did not take into account side effects of drugs.Various forms of individually delivered CBT appear to be the most cost-effective options for the treatment of adults with social anxiety disorder. Consideration of side effects of drugs would only strengthen this conclusion, as it would improve even further the cost effectiveness of individually delivered CBT relative to phenelzine, which was the next most cost-effective option, due to the serious side effects associated with phenelzine. Further research needs to determine more accurately the long

  1. Skilled Nursing Facility Partnerships May Decrease 90-Day Costs in a Total Joint Arthroplasty Episode Under the Bundled Payments for Care Improvement Initiative.

    Science.gov (United States)

    Behery, Omar A; Kouk, Shalen; Chen, Kevin K; Mullaly, Kathleen A; Bosco, Joseph A; Slover, James D; Iorio, Richard; Schwarzkopf, Ran

    2018-03-01

    The Bundled Payments for Care Improvement initiative was developed to reduce costs associated with total joint arthroplasty through a single payment for all patient care from index admission through a 90-day post-discharge period, including care at skilled nursing facilities (SNFs). The aim of this study is to investigate whether forming partnerships between hospitals and SNFs could lower the post-discharge costs. We hypothesize that institutionally aligned SNFs have lower post-discharge costs than non-aligned SNFs. A cohort of 615 elective, primary total hip and knee arthroplasty subjects discharged to an SNF under the Bundled Payments for Care Improvement from 2014 to 2016 were included in our analysis. Patients were grouped into one of the 3 categories of SNF alignment: group 1: non-partners; group 2: agreement-based partners; group 3: institution-owned partners. Demographics, comorbidities, length of stay (LOS) at SNF, and associated costs during the 90-day post-operative period were compared between the 3 groups. Mean index hospital LOS was statistically shortest in group 3 (mean 2.7 days vs 3.5 for groups 1 and 2, P = .001). SNF LOS was also shortest in group 3 (mean 11 days vs 19 and 21 days in groups 2 and 1 respectively, P Total SNF costs and total 90-day costs were both significantly lower in group 3 compared with groups 1 and 2 (P total 90-day costs, without increased risk of readmissions, compared with other SNFs. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Cost-Effectiveness Analysis of a Navigation Program for Colorectal Cancer Screening to Reduce Social Health Inequalities: A French Cluster Randomized Controlled Trial.

    Science.gov (United States)

    De Mil, Rémy; Guillaume, Elodie; Guittet, Lydia; Dejardin, Olivier; Bouvier, Véronique; Pornet, Carole; Christophe, Véronique; Notari, Annick; Delattre-Massy, Hélène; De Seze, Chantal; Peng, Jérôme; Launoy, Guy; Berchi, Célia

    2018-06-01

    Patient navigation programs to increase colorectal cancer (CRC) screening adherence have become widespread in recent years, especially among deprived populations. To evaluate the cost-effectiveness of the first patient navigation program in France. A total of 16,250 participants were randomized to either the usual screening group (n = 8145) or the navigation group (n = 8105). Navigation consisted of personalized support provided by social workers. A cost-effectiveness analysis of navigation versus usual screening was conducted from the payer perspective in the Picardy region of northern France. We considered nonmedical direct costs in the analysis. Navigation was associated with a significant increase of 3.3% (24.4% vs. 21.1%; P = 0.003) in participation. The increase in participation was higher among affluent participants (+4.1%; P = 0.01) than among deprived ones (+2.6%; P = 0.07). The cost per additional individual screened by navigation compared with usual screening (incremental cost-effectiveness ratio) was €1212 globally and €1527 among deprived participants. Results were sensitive to navigator wages and to the intervention effectiveness whose variations had the greatest impact on the incremental cost-effectiveness ratio. Patient navigation aiming at increasing CRC screening participation is more efficient among affluent individuals. Nevertheless, when the intervention is implemented for the entire population, social inequalities in CRC screening adherence increase. To reduce social inequalities, patient navigation should therefore be restricted to deprived populations, despite not being the most cost-effective strategy, and accepted to bear a higher extra cost per additional individual screened. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. The Effect of Corporate Social Responsibility Disclosure on the Cost of Equity of Firms and the Moderating Role of Ownership

    NARCIS (Netherlands)

    Kabir, Rezaul; Thái Minh, H¿nh

    2017-01-01

    The empirical relationship between corporate social responsibility (CSR) disclosure and the cost of equity is conflicting. Various corporate governance mechanisms may moderate this relationship. However, the moderating effect of foreign ownership - a key corporate governance mechanism in many

  4. On the Trade-off Between Real-time Pricing and the Social Acceptability Costs of Demand Response

    DEFF Research Database (Denmark)

    da Silva, Hendrigo Batista; Santiago, Leonardo

    2018-01-01

    on the social acceptability costs of implementing demand response programs, and we discuss the key features of implementing a real-time price to energy. Although the literature acknowledges the existence of a social acceptability cost, it does not propose an explicit approach to dealing with this issue. A model...... for investigating the implications of the social acceptability cost is thus introduced and through it, we discuss thoroughly the joint impact of the elasticity and externality parameters on the tariff design of a demand response program. We explore how the increases in elasticity and in externality effects...... influence price changes in such programs and how the social acceptability cost could be reduced as a function of pricing policies. We conclude by discussing the policy design mechanisms in line with demand elasticity and their role in decreasing price variations to cope with the minimum volatility principle...

  5. Social network diversity and risks of ischemic heart disease and total mortality: findings from the Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Barefoot, JC; Grønbæk, M; Jensen, Gorm Boje

    2005-01-01

    Measures of various types of social contacts were used as predictors of ischemic heart disease events and total mortality in an age-stratified random sample of 9,573 adults enrolled in the Copenhagen City Heart Study (Copenhagen, Denmark). Baseline examinations were conducted in 1991-1994, and pa......Measures of various types of social contacts were used as predictors of ischemic heart disease events and total mortality in an age-stratified random sample of 9,573 adults enrolled in the Copenhagen City Heart Study (Copenhagen, Denmark). Baseline examinations were conducted in 1991......-1994, and participants were followed until the end of 1997. Contacts with parents, children, family members, and friends were associated with better health. The presence of a spouse or partner was protective for men. Contacts with neighbors showed a trend toward a reversed pattern, and the effects of contacts with work...... colleagues and children differed by gender. Most types of contacts that occurred at least monthly were just as protective as those occurring more frequently. An index of intimate social contact diversity with family and friends had graded relations with both outcomes. Comparisons of persons reporting three...

  6. Social Costs of Iron Deficiency Anemia in 6-59-Month-Old Children in India.

    Science.gov (United States)

    Plessow, Rafael; Arora, Narendra Kumar; Brunner, Beatrice; Tzogiou, Christina; Eichler, Klaus; Brügger, Urs; Wieser, Simon

    2015-01-01

    Inadequate nutrition has a severe impact on health in India. According to the WHO, iron deficiency is the single most important nutritional risk factor in India, accounting for more than 3% of all disability-adjusted life years (DALYs) lost. We estimate the social costs of iron deficiency anemia (IDA) in 6-59-month-old children in India in terms of intangible costs and production losses. We build a health economic model estimating the life-time costs of a birth cohort suffering from IDA between the ages of 6 and 59 months. The model is stratified by 2 age groups (6-23 and 24-59-months), 2 geographical areas (urban and rural), 10 socio-economic strata and 3 degrees of severity of IDA (mild, moderate and severe). Prevalence of anemia is calculated with the last available National Family Health Survey. Information on the health consequences of IDA is extracted from the literature. IDA prevalence is 49.5% in 6-23-month-old and 39.9% in 24-58-month-old children. Children living in poor households in rural areas are particularly affected but prevalence is high even in wealthy urban households. The estimated yearly costs of IDA in 6-59-month-old children amount to intangible costs of 8.3 m DALYs and production losses of 24,001 m USD, equal to 1.3% of gross domestic product. Previous calculations have considerably underestimated the intangible costs of IDA as the improved WHO methodology leads to a threefold increase of DALYs due to IDA. Despite years of iron supplementation programs and substantial economic growth, IDA remains a crucial public health issue in India and an obstacle to the economic advancement of the poor. Young children are especially vulnerable due to the irreversible effects of IDA on cognitive development. Our research may contribute to the design of new effective interventions aiming to reduce IDA in early childhood.

  7. Social incidence and economic costs of carbon limits; A computable general equilibrium analysis for Switzerland

    Energy Technology Data Exchange (ETDEWEB)

    Stephan, G.; Van Nieuwkoop, R.; Wiedmer, T. (Institute for Applied Microeconomics, Univ. of Bern (Switzerland))

    1992-01-01

    Both distributional and allocational effects of limiting carbon dioxide emissions in a small and open economy are discussed. It starts from the assumption that Switzerland attempts to stabilize its greenhouse gas emissions over the next 25 years, and evaluates costs and benefits of the respective reduction programme. From a methodological viewpoint, it is illustrated how a computable general equilibrium approach can be adopted for identifying economic effects of cutting greenhouse gas emissions on the national level. From a political economy point of view it considers the social incidence of a greenhouse policy. It shows in particular that public acceptance can be increased and economic costs of greenhouse policies can be reduced, if carbon taxes are accompanied by revenue redistribution. 8 tabs., 1 app., 17 refs.

  8. Sustainable Technologies and Social Costs for Eliminating Contamination of an Aquifer

    Directory of Open Access Journals (Sweden)

    Mario Schirmer

    2010-07-01

    Full Text Available This case study deals with long-term contamination of the Leuna aquifer, which is intended to be restored using sustainable technologies financed by the state. The contamination can only be solved using active rather than passive intervention, because the aquifer has an extraordinarily low natural attenuation capacity for the specific pollutants. Due to the longevity of the contamination source, the groundwater treatment technology that was chosen for the site must operate for a minimum of 20 years but probably much longer. Since the polluter-pay principle cannot be applied, the estimated dynamic primary remediation costs must be accepted as a political or social cost, which must be paid by current and future generations.

  9. Construction Costs Assessment of Structural Systems for Low-Rise and Social Welfare Housing

    Directory of Open Access Journals (Sweden)

    Carrillo Julián

    2015-09-01

    Full Text Available A comparative analysis of the costs related to the construction of low-rise, low-cost and social welfare housing was carried out. The study included three of the most commonly used structural systems for low-rise housing in Latin America, such as the traditional system of confined masonry walls, concrete walls conventionally reinforced with welded-wire meshes and concrete walls reinforced with steel fiber. The cost comparison was carried out by budgets analysis, which were performed based on construction quantities, unit prices and particular items for each structural system. It was found in the study that, from an economic point of view, the systems of concrete walls reinforced with welded-wire meshes or steel fibers are more advantageous than confined masonry systems. In addition, the integral comparison of the three structural systems demonstrates that the industrialized system of steel fiber reinforced concrete walls allows obtaining greater advantages of cleaning and sustainability, faster construction, lower cost and a more attractive scenario for builders investing in such projects.

  10. A cost-benefit analysis of the Mexican Social Security Administration's family planning program.

    Science.gov (United States)

    Nortman, D L; Halvas, J; Rabago, A

    1986-01-01

    A cost-benefit analysis of the family planning program of the Mexican Social Security System (IMSS) was undertaken to test the hypothesis that IMSS's family planning services yield a net savings to IMSS by reducing the load on its maternal and infant care service. The cost data are believed to be of exceptionally high quality because they were empirically ascertained by a retrospective and prospective survey of unit time and personnel costs per specified detailed type of service in 37 IMSS hospitals and 16 clinics in 13 of Mexico's 32 states. Based on the average cost per case, the analysis disclosed that for every peso (constant 1983 currency) that IMSS spent on family planning services to its urban population during 1972-1984 inclusive, the agency saved nine pesos. The article concludes by raising the speculative question as to the proportion of the births averted by the IMSS family planning program that would have been averted in the absence of IMSS's family planning services.

  11. Applying Bayesian decision theory to assess reprocessing economic and social cost-benefits

    International Nuclear Information System (INIS)

    Heising, C.D.

    1978-01-01

    Bayesian decision theory, combined with conventional systems analysis techniques into the discipline called decision analysis, has been applied in this work to assess economic and social cost-benefits associated with reprocessing nuclear fuel. Particular attention in this paper is given to the models which have been developed to place numerical estimates in dollar terms on the three categories of social risks that have been identified with reprocessing. These categories include: (1) health, environment, and safety, (2) diversion of fissile material, including sabotage, terrorist acts, and subnational diversion, and (3) nuclear proliferation, defined to be a diversion at the national level to obtain weapons capability. The emphasis is placed on the third category, as proliferation risk has not been treated elsewhere in a quantitative fashion; most arguments have in the main been qualitative conjectures put forth by political scientists

  12. A strategic decision-making model considering the social costs of carbon dioxide emissions for sustainable supply chain management.

    Science.gov (United States)

    Tseng, Shih-Chang; Hung, Shiu-Wan

    2014-01-15

    Incorporating sustainability into supply chain management has become a critical issue driven by pressures from governments, customers, and various stakeholder groups over the past decade. This study proposes a strategic decision-making model considering both the operational costs and social costs caused by the carbon dioxide emissions from operating such a supply chain network for sustainable supply chain management. This model was used to evaluate carbon dioxide emissions and operational costs under different scenarios in an apparel manufacturing supply chain network. The results showed that the higher the social cost rate of carbon dioxide emissions, the lower the amount of the emission of carbon dioxide. The results also suggested that a legislation that forces the enterprises to bear the social costs of carbon dioxide emissions resulting from their economic activities is an effective approach to reducing carbon dioxide emissions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Accounting for social impacts and costs in the forest industry, British Columbia

    International Nuclear Information System (INIS)

    Gale, Robert; Gale, Fred

    2006-01-01

    Business reviews of the forest industry in British Colombia, Canada, typically portray an unequivocally positive picture of its financial and economic health. In doing so, they fail to consider the following six categories of social impacts and costs: (1) direct and indirect subsidies; (2) government support through investment; (3) community dependence; (4) the maintenance of public order; (5) aboriginal title; and (6) the overestimation of employment. Our findings show that conventional economic and financial accounting methods inflate the industry's net contribution to the economy. We make a number of recommendations to address this shortcoming to improve future accounting and reporting procedures

  14. Integrating Estimates of the Social and Individual Costs of Caregiving into Dementia Treatment Trials

    Directory of Open Access Journals (Sweden)

    Charles D. Phillips

    2016-01-01

    Full Text Available A variety of new treatments for dementia are awaiting or undergoing randomized clinical trails. These trials focus on outcomes such as changes in cognitive function, physical function, or amyloid plaques. What is quite important and is too often missing from these trials are estimates of the impact of these treatments on the social and individual costs of providing care for those facing dementia. Until outcomes such as family caregiver time and caregiver burden are included in trails of dementia treatments, the picture of how well these treatments work will be distressingly incomplete.

  15. Social Costs of the Inefficient Management of the EU Funds for Bulgaria

    OpenAIRE

    Nozharov, Shteryo

    2016-01-01

    The study identifies and defines the social costs of the inefficient management of EU funds for Bulgaria. It is analyzed the last due programme period (2007-2015) and its prolongation. As methodology of the research the V4 BM model of Al-Debei and Avison (2010) which has not been used for analysis of EU funds management for cohesion policy in the public sector, is applied. In this way its potential for application in this field is tested. The concept of the study could be successfully used fo...

  16. Liquefied Natural Gas as an alternative fuel: a regional-level social cost-benefit appraisal

    OpenAIRE

    Moreira, Paulo Pires; Caetano, Fernando J. P.

    2017-01-01

    The impact from traditional marine fuels has the potential of causing health and non-health damages and contributes to climate change. Here, the introduction of Liquefied Natural Gas (LNG) as an energy end-use fuel for marine purposes is analysed. The aim of this study is to verify LNG’s policy implementation feasibility as a step-change for a low carbon perspective for shipping by means of developing a social cost-benefit analysis on a regional basis. Emissions from the Portuguese merchant f...

  17. Cost-effectiveness of total hip and knee replacements for the Australian population with osteoarthritis: discrete-event simulation model.

    Directory of Open Access Journals (Sweden)

    Hideki Higashi

    Full Text Available BACKGROUND: Osteoarthritis constitutes a major musculoskeletal burden for the aged Australians. Hip and knee replacement surgeries are effective interventions once all conservative therapies to manage the symptoms have been exhausted. This study aims to evaluate the cost-effectiveness of hip and knee replacements in Australia. To our best knowledge, the study is the first attempt to account for the dual nature of hip and knee osteoarthritis in modelling the severities of right and left joints separately. METHODOLOGY/PRINCIPAL FINDINGS: We developed a discrete-event simulation model that follows up the individuals with osteoarthritis over their lifetimes. The model defines separate attributes for right and left joints and accounts for several repeat replacements. The Australian population with osteoarthritis who were 40 years of age or older in 2003 were followed up until extinct. Intervention effects were modelled by means of disability-adjusted life-years (DALYs averted. Both hip and knee replacements are highly cost effective (AUD 5,000 per DALY and AUD 12,000 per DALY respectively under an AUD 50,000/DALY threshold level. The exclusion of cost offsets, and inclusion of future unrelated health care costs in extended years of life, did not change the findings that the interventions are cost-effective (AUD 17,000 per DALY and AUD 26,000 per DALY respectively. However, there was a substantial difference between hip and knee replacements where surgeries administered for hips were more cost-effective than for knees. CONCLUSIONS/SIGNIFICANCE: Both hip and knee replacements are cost-effective interventions to improve the quality of life of people with osteoarthritis. It was also shown that the dual nature of hip and knee OA should be taken into account to provide more accurate estimation on the cost-effectiveness of hip and knee replacements.

  18. The cost of being a man: social and health consequences of Igbo masculinity.

    Science.gov (United States)

    Odimegwu, Clifford; Pallikadavath, Saseendran; Adedini, Sunday

    2013-01-01

    In the bid to explain reproductive health outcomes in most developing countries, men have often been seen as the cause of the problem. However, no systematic attempt has been made to examine men's perception of their own social and health needs, including how ideologies of masculinity impact men's social and physical health. This study examines the Igbo context and shows how men understand and interpret masculinity and the consequences of this for social and health behaviours. Data from adolescent and adult Igbo men aged 15-75 were collected using both quantitative survey interviews (n = 1372) and qualitative techniques such as focus-group discussion (n = 20), in-depth interviews (n = 10) and key informant interviews (n = 10) in selected areas of south-eastern Nigeria. We collected data on gender role ideologies and sexuality issues and practices. Our analysis shows that there are social and health costs associated with adherence to masculine ideologies and a strong association between masculine ideologies and men's health, risk-taking and health-seeking behaviours in the study population. We conclude that all sexual and reproductive health programmes should include services that address the specific needs of men and those negative aspects of masculinity that tend to expose men to adverse health outcomes.

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

    OpenAIRE

    Bretschger, Lukas; Pattakou, Aimilia

    2017-01-01

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

  20. Predictors for total medical costs for acute hemorrhagic stroke patients transferred to the rehabilitation ward at a regional hospital in Taiwan.

    Science.gov (United States)

    Chen, Chien-Min; Ke, Yen-Liang

    2016-02-01

    One-third of the acute stroke patients in Taiwan receive rehabilitation. It is imperative for clinicians who care for acute stroke patients undergoing inpatient rehabilitation to identify which medical factors could be the predictors of the total medical costs. The aim of this study was to identify the most important predictors of the total medical costs for first-time hemorrhagic stroke patients transferred to inpatient rehabilitation using a retrospective design. All data were retrospectively collected from July 2002 to June 2012 from a regional hospital in Taiwan. A stepwise multivariate linear regression analysis was used to identify the most important predictors for the total medical costs. The medical records of 237 patients (137 males and 100 females) were reviewed. The mean total medical cost per patient was United States dollar (USD) 5939.5 ± 3578.5.The following were the significant predictors for the total medical costs: impaired consciousness [coefficient (B), 1075.7; 95% confidence interval (CI) = 138.5-2012.9], dysphagia [coefficient (B), 1025.8; 95% CI = 193.9-1857.8], number of surgeries [coefficient (B), 796.4; 95% CI = 316.0-1276.7], pneumonia in the neurosurgery ward [coefficient (B), 2330.1; 95% CI = 1339.5-3320.7], symptomatic urinary tract infection (UTI) in the rehabilitation ward [coefficient (B), 1138.7; 95% CI = 221.6-2055.7], and rehabilitation ward stay [coefficient (B), 64.9; 95% CI = 31.2-98.7] (R(2) = 0.387). Our findings could help clinicians to understand that cost reduction may be achieved by minimizing complications (pneumonia and UTI) in these patients.

  1. Social life factors affecting the mortality, longevity, and birth rate of total Japanese population: effects of rapid industrialization and urbanization.

    Science.gov (United States)

    Araki, S; Uchida, E; Murata, K

    1990-12-01

    To expand upon the findings that lower mortality was found in Japanese urban areas in contrast to the Western model where in the US and Britain the risk of death was higher in metropolitan areas and conurbations, 22 social life indicators are examined among 46 prefectures in Japan in terms of their effect on age specific mortality, life expectancy, and age adjusted marriage, divorce, and birth rates. The effects of these factors on age adjusted mortality for 8 major working and nonworking male populations, where also analyzed. The 22 social life factors were selected from among 227 indicators in the system of Statistical Indicators on Life. Factor analysis was used to classify the indicators into 8 groups of factors for 1970 and 7 for 1975. Factors 1-3 for both years were rural or urban residence, low income and unemployment, and prefectural age distribution. The 4th for 1970 was home help for the elderly and for 1975, social mobility. The social life indicators were classified form 1 to 8 as rural residence in 1970 and 1975, urban residence, low income, high employment, old age, young age, social mobility, and home help for the elderly which moved from 8th place in 1970 to 1st in 1975. Between 1960-75, rapid urbanization took place with the proportion of farmers, fishermen, and workers declining from 43% in 1960 to 19% in 1975. The results of stepwise regression analysis indicate a positive relationship of urban residence with mortality of men and women except school-aged and middle-aged women, and the working populations, as well as life expectancy at birth for males and females and ages 20 and 40 years for males. Rural residence was positively associated with the male marriage rate, whereas the marriage rate for females was affected by industrialization and urbanization. High employment and social mobility were positively related to the female marriage rate. Low income was positively related to the divorce rate for males and females. Rural residence and high

  2. The Cost-Effectiveness and Return-On-Investment of a Combined Social and Physical Environmental Intervention in Office Employees

    Science.gov (United States)

    van Dongen, J. M.; Coffeng, J. K.; van Wier, M. F.; Boot, C. R. L.; Hendriksen, I. J. M.; van Mechelen, W.; Bongers, P. M.; van der Beek, A. J.; Bosmans, J. E.; van Tulder, M. W.

    2017-01-01

    This study explored the cost-effectiveness and return-on-investment of a combined social and physical environmental worksite health promotion program compared with usual practice, and of both intervention conditions separately. Participants were randomized to the combined intervention (n = 92), social environmental intervention (n = 118), physical…

  3. A Case Report: Cornerstone Health Care Reduced the Total Cost of Care Through Population Segmentation and Care Model Redesign.

    Science.gov (United States)

    Green, Dale E; Hamory, Bruce H; Terrell, Grace E; O'Connell, Jasmine

    2017-08-01

    Over the course of a single year, Cornerstone Health Care, a multispecialty group practice in North Carolina, redesigned the underlying care models for 5 of its highest-risk populations-late-stage congestive heart failure, oncology, Medicare-Medicaid dual eligibles, those with 5 or more chronic conditions, and the most complex patients with multiple late-stage chronic conditions. At the 1-year mark, the results of the program were analyzed. Overall costs for the patients studied were reduced by 12.7% compared to the year before enrollment. All fully implemented programs delivered between 10% and 16% cost savings. The key area for savings factor was hospitalization, which was reduced by 30% across all programs. The greatest area of cost increase was "other," a category that consisted in large part of hospice services. Full implementation was key; 2 primary care sites that reverted to more traditional models failed to show the same pattern of savings.

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

    International Nuclear Information System (INIS)

    Cohen, D.R.; Patel, N.

    2010-01-01

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

  5. Investigating attitudes to hydrogen refuelling facilities and the social cost to local residents

    International Nuclear Information System (INIS)

    O'Garra, Tanya; Mourato, Susana; Pearson, Peter

    2008-01-01

    Vehicles fuelled by hydrogen (H 2 ) have attracted increasing attention because of their potentially enhanced environmental profiles. Their penetration into the vehicle stock will be influenced by the spread of refuelling facilities. This study investigates local attitudes towards the proposed installation of H 2 storage facilities at existing refuelling stations throughout London. Using multinomial logit analysis, we identify the determinants of attitudes. Results suggest that residents living very close to a proposed H 2 facility are less likely to be opposed than residents living 200-500 m away. Opposition appears to be determined by a lack of trust in safety regulations, non-environmental attitudes, and concerns about the existing local refuelling station. The social cost to local residents of a local H 2 storage facility was estimated using a method developed by Atkinson et al. [2004. 'Amenity' or 'eyesore'? Negative willingness to pay for options to replace electricity transmission towers. Applied Economics Letters 11(4), 203-208], which elicits the amount of time respondents are willing to commit to oppose a new facility development. Using the leisure rate of time, the social cost is estimated at just under Pounds 14 per local opposed resident. Add to this the WTP to support opposition efforts by a local group, and the value comes to just under Pounds 25 per opposed resident

  6. A Supply Chain Coordination Mechanism with Cost Sharing of Corporate Social Responsibility

    Directory of Open Access Journals (Sweden)

    Yong Liu

    2018-04-01

    Full Text Available The competition of modern enterprises has shifted from brand competition among enterprises of the past to that of supply chains; and considering corporate social responsibility (CSR within supply chain management has become an inevitable requirement for improving the competitiveness of enterprises and conforms to the trend of standardization of social responsibility guidelines. This paper deals with channel coordination and decision-making in a CSR supply chain that is comprised of a dominant retailer and n homogeneous suppliers. The Stackelberg game is employed to analyze the optimal decision-making of this supply chain under either decentralized or centralized decision-making processes. After that, the thought and method of super conflict equilibrium are used to design the coordination decision-making mechanism of this supply chain based on the cost sharing of CSR to solve channel conflict and to optimize the decision. The results show that the proposed mechanism based on the cost sharing of CSR is better than those with only either the retailer or the suppliers being CSR; and it can well describe the relationship between the retailer and the suppliers, and increase the eagerness of the retailer and suppliers to carry out their CSR under various circumstances without having the profits adversely affected. As a matter of fact, this mechanism maximizes the profits of the entire supply chain system and also enhances the competitiveness of the chain.

  7. Explicit instructions increase cognitive costs of deception in predictable social context

    Directory of Open Access Journals (Sweden)

    Marcel eFalkiewicz

    2015-12-01

    Full Text Available Convincing participants to deceive remains one of the biggest and most important challenges of laboratory-based deception research. The simplest and most prevalent method involves explicitly instructing participants to lie or tell the truth before presenting each task item. The usual finding of such experiments is increased cognitive load associated with deceptive responses, explained by necessity to inhibit default and automatic honest responses. However, explicit instructions are usually coupled with the absence of social context in the experimental task. Context plays a key role in social cognition by activating prior knowledge, which facilitates behaviors consistent with the latter. We hypothesized that in the presence of social context, both honest and deceptive responses can be produced on the basis of prior knowledge, without reliance on truth and without additional cognitive load during deceptive responses. In order to test the hypothesis, we have developed Speed-Dating Task (SDT, which is based on a real-life social event. In SDT, participants respond both honestly and deceptively to questions in order to appear similar to each of the dates. The dates are predictable and represent well-known categories (i.e. atheist or conservative. In one condition participants rely on explicit instructions preceding each question (external cue. In the second condition no explicit instructions are present, so the participants need to adapt based on prior knowledge about the category the dates belong to (internal cue. With internal cues, reaction times are similar for both honest and deceptive responses. However, in the presence of external cues, reaction times are longer for deceptive than honest responses, suggesting that deceptive responses are associated with increased cognitive load. Compared to internal cues, deception costs were higher when external cues were present. However, the effect was limited to the first part of the experiment, only

  8. It Is a Brave New World: Alternative Payment Models and Value Creation in Total Joint Arthroplasty: Creating Value for TJR, Quality and Cost-Effectiveness Programs.

    Science.gov (United States)

    Chen, Kevin K; Harty, Jonathan H; Bosco, Joseph A

    2017-06-01

    The increasing cost of our country's healthcare is not sustainable. To address this crisis, the federal government is transiting healthcare reimbursement from the traditional volume-based system to a value-based system. As such, increasing healthcare value has become an essential point of discussion for all healthcare stakeholders. The purpose of this study is to discuss the importance of healthcare value as a means to achieve this goal of value-based medicine and 3 methods to create value in total joint arthroplasty. These methods are to: (1) improve outcomes greater than the increased costs to achieve this improvement, (2) decrease costs without affecting outcomes, and (3) decrease costs while simultaneously improving outcomes. Following these guidelines will help practitioners thrive in a bundled care environment. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Prevention of low back pain in the military cluster randomized trial: effects of brief psychosocial education on total and low back pain-related health care costs.

    Science.gov (United States)

    Childs, John D; Wu, Samuel S; Teyhen, Deydre S; Robinson, Michael E; George, Steven Z

    2014-04-01

    Effective strategies for preventing low back pain (LBP) have remained elusive, despite annual direct health care costs exceeding $85 billion dollars annually. In our recently completed Prevention of Low Back Pain in the Military (POLM) trial, a brief psychosocial education program (PSEP) that reduced fear and threat of LBP reduced the incidence of health care-seeking for LBP. The purpose of this cost analysis was to determine if soldiers who received psychosocial education experienced lower health care costs compared with soldiers who did not receive psychosocial education. The POLM trial was a cluster randomized trial with four intervention arms and a 2-year follow-up. Consecutive subjects (n=4,295) entering a 16-week training program at Fort Sam Houston, TX, to become a combat medic in the U.S. Army were considered for participation. In addition to an assigned exercise program, soldiers were cluster randomized to receive or not receive a brief psychosocial education program delivered in a group setting. The Military Health System Management Analysis and Reporting Tool was used to extract total and LBP-related health care costs associated with LBP incidence over a 2-year follow-up period. After adjusting for postrandomization differences between the groups, the median total LBP-related health care costs for soldiers who received PSEP and incurred LBP-related costs during the 2-year follow-up period were $26 per soldier lower than for those who did not receive PSEP ($60 vs. $86, respectively, p=.034). The adjusted median total health care costs for soldiers who received PSEP and incurred at least some health care costs during the 2-year follow-up period were estimated at $2 per soldier lower than for those who did not receive PSEP ($2,439 vs. $2,441, respectively, p=.242). The results from this analysis demonstrate that a brief psychosocial education program was only marginally effective in reducing LBP-related health care costs and was not effective in reducing

  10. Social cost of carbon pricing of power sector CO2: accounting for leakage and other social implications from subnational policies

    Science.gov (United States)

    Bistline, John E.; Rose, Steven K.

    2018-01-01

    In environments where climate policy has partial coverage or unequal participation, carbon dioxide (CO2) emissions or economic activity may shift to locations and sectors where emissions are unregulated. This is referred to as leakage. Leakage can offset or augment emissions reductions associated with a policy, which has important environmental and economic implications. Although leakage has been studied at national levels, analysis of leakage for subnational policies is limited. This is despite greater market integration and many existing state and regional environmental regulations in the US. This study explores leakage potential, net emissions changes, and other social implications in the US energy system with regionally differentiated pricing of power sector CO2 emissions. We undertake an economic analysis using EPRI’s US-REGEN model, where power sector CO2 emissions are priced in individual US regions with a range of social cost of carbon (SCC) values. SCC estimates are being considered by policy-makers for valuing potential societal damages from CO2 emissions. In this study, we evaluate the emissions implications within the SCC pricing region, within the power sector outside the SCC region, and outside the power sector (i.e. in the rest of the energy system). Results indicate that CO2 leakage is possible within and outside the electric sector, ranging from negative 70% to over 80% in our scenarios, with primarily positive leakage outcomes. Typically ignored in policy analysis, leakage would affect CO2 reduction benefits. We also observe other potential societal effects within and across regions, such as higher electricity prices, changes in power sector investments, and overall consumption losses. Efforts to reduce leakage, such as constraining power imports into the SCC pricing region likely reduce leakage, but could also result in lower net emissions reductions, as well as larger price increases. Thus, it is important to look beyond leakage and consider a

  11. A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly.

    Science.gov (United States)

    Osterhoff, Georg; O'Hara, Nathan N; D'Cruz, Jennifer; Sprague, Sheila A; Bansback, Nick; Evaniew, Nathan; Slobogean, Gerard P

    2017-03-01

    There is ongoing debate regarding the optimal surgical treatment of complex proximal humeral fractures in elderly patients. To evaluate the cost-effectiveness of reverse total shoulder arthroplasty (RTSA) compared with hemiarthroplasty (HA) in the management of complex proximal humeral fractures, using a cost-utility analysis. On the basis of data from published literature, a cost-utility analysis was conducted using decision tree and Markov modeling. A single-payer perspective, with a willingness-to-pay (WTP) threshold of Can$50,000 (Canadian dollars), and a lifetime time horizon were used. The incremental cost-effectiveness ratio (ICER) was used as the study's primary outcome measure. In comparison with HA, the incremental cost per quality-adjusted life-year gained for RTSA was Can$13,679. One-way sensitivity analysis revealed the model to be sensitive to the RTSA implant cost and the RTSA procedural cost. The ICER of Can$13,679 is well below the WTP threshold of Can$50,000, and probabilistic sensitivity analysis demonstrated that 92.6% of model simulations favored RTSA. Our economic analysis found that RTSA for the treatment of complex proximal humeral fractures in the elderly is the preferred economic strategy when compared with HA. The ICER of RTSA is well below standard WTP thresholds, and its estimate of cost-effectiveness is similar to other highly successful orthopedic strategies such as total hip arthroplasty for the treatment of hip arthritis. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  12. Reducing Length of Stay, Direct Cost, and Readmissions in Total Joint Arthroplasty Patients With an Outcomes Manager-Led Interprofessional Team.

    Science.gov (United States)

    Arana, Melissa; Harper, Licia; Qin, Huanying; Mabrey, Jay

    The purpose of this quality improvement project was to determine whether an outcomes manager-led interprofessional team could reduce length of stay and direct cost without increasing 30-day readmission rates in the total joint arthroplasty patient population. The goal was to promote interprofessional relationships combined with collaborative practice to promote coordinated care with improved outcomes. Results from this project showed that length of stay (total hip arthroplasty [THA] reduced by 0.4 days and total knee arthroplasty [TKA] reduced by 0.6 days) and direct cost (THA reduced by $1,020 per case and TKA reduced by $539 per case) were significantly decreased whereas 30-day readmission rates of both populations were not significantly increased.

  13. Social Security cost-of-living adjustments and the Consumer Price Index.

    Science.gov (United States)

    Burdick, Clark; Fisher, Lynn

    2007-01-01

    OASDI benefits are indexed for inflation to protect beneficiaries from the loss of purchasing power implied by inflation. In the absence of such indexing, the purchasing power of Social Security benefits would be eroded as rising prices raise the cost of living. By statute, cost-of-living adjustments (COLAs) for Social Security benefits are calculated using the Bureau of Labor Statistics (BLS) Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). Some argue that this index does not accurately reflect the inflation experienced by the elderly population and should be changed to an elderly-specific price index such as the Experimental Consumer Price Index for Americans 62 Years of Age and Older, often referred to as the Consumer Price Index for the Elderly (CPI-E). Others argue that the measure of inflation underlying the COLA is technically biased, causing it to overestimate changes in the cost of living. This argument implies that current COLAs tend to increase, rather than merely maintain, the purchasing power of benefits over time. Potential bias in the CPI as a cost-of-living index arises from a number of sources, including incomplete accounting for the ability of consumers to substitute goods or change purchasing outlets in response to relative price changes. The BLS has constructed a new index called the Chained Consumer Price Index for All Urban Consumers (C-CPI-U) that better accounts for those consumer adjustments. Price indexes are not true cost-of-living indexes, but approximations of cost-of-living indexes (COLI). The Bureau of Labor Statistics (2006a) explains the difference between the two: As it pertains to the CPI, the COLI for the current month is based on the answer to the following question: "What is the cost, at this month ' market prices, of achieving the standard of living actually attained in the base period?" This cost is a hypothetical expenditure-the lowest expenditure level necessary at this month's prices to achieve the

  14. Social Costs of Iron Deficiency Anemia in 6–59-Month-Old Children in India

    Science.gov (United States)

    Plessow, Rafael; Arora, Narendra Kumar; Brunner, Beatrice; Tzogiou, Christina; Eichler, Klaus; Brügger, Urs; Wieser, Simon

    2015-01-01

    Introduction Inadequate nutrition has a severe impact on health in India. According to the WHO, iron deficiency is the single most important nutritional risk factor in India, accounting for more than 3% of all disability-adjusted life years (DALYs) lost. We estimate the social costs of iron deficiency anemia (IDA) in 6–59-month-old children in India in terms of intangible costs and production losses. Materials and Methods We build a health economic model estimating the life-time costs of a birth cohort suffering from IDA between the ages of 6 and 59 months. The model is stratified by 2 age groups (6–23 and 24–59-months), 2 geographical areas (urban and rural), 10 socio-economic strata and 3 degrees of severity of IDA (mild, moderate and severe). Prevalence of anemia is calculated with the last available National Family Health Survey. Information on the health consequences of IDA is extracted from the literature. Results IDA prevalence is 49.5% in 6–23-month-old and 39.9% in 24–58-month-old children. Children living in poor households in rural areas are particularly affected but prevalence is high even in wealthy urban households. The estimated yearly costs of IDA in 6–59-month-old children amount to intangible costs of 8.3 m DALYs and production losses of 24,001 m USD, equal to 1.3% of gross domestic product. Previous calculations have considerably underestimated the intangible costs of IDA as the improved WHO methodology leads to a threefold increase of DALYs due to IDA. Conclusion Despite years of iron supplementation programs and substantial economic growth, IDA remains a crucial public health issue in India and an obstacle to the economic advancement of the poor. Young children are especially vulnerable due to the irreversible effects of IDA on cognitive development. Our research may contribute to the design of new effective interventions aiming to reduce IDA in early childhood. PMID:26313356

  15. Social Costs of Iron Deficiency Anemia in 6-59-Month-Old Children in India.

    Directory of Open Access Journals (Sweden)

    Rafael Plessow

    Full Text Available Inadequate nutrition has a severe impact on health in India. According to the WHO, iron deficiency is the single most important nutritional risk factor in India, accounting for more than 3% of all disability-adjusted life years (DALYs lost. We estimate the social costs of iron deficiency anemia (IDA in 6-59-month-old children in India in terms of intangible costs and production losses.We build a health economic model estimating the life-time costs of a birth cohort suffering from IDA between the ages of 6 and 59 months. The model is stratified by 2 age groups (6-23 and 24-59-months, 2 geographical areas (urban and rural, 10 socio-economic strata and 3 degrees of severity of IDA (mild, moderate and severe. Prevalence of anemia is calculated with the last available National Family Health Survey. Information on the health consequences of IDA is extracted from the literature.IDA prevalence is 49.5% in 6-23-month-old and 39.9% in 24-58-month-old children. Children living in poor households in rural areas are particularly affected but prevalence is high even in wealthy urban households. The estimated yearly costs of IDA in 6-59-month-old children amount to intangible costs of 8.3 m DALYs and production losses of 24,001 m USD, equal to 1.3% of gross domestic product. Previous calculations have considerably underestimated the intangible costs of IDA as the improved WHO methodology leads to a threefold increase of DALYs due to IDA.Despite years of iron supplementation programs and substantial economic growth, IDA remains a crucial public health issue in India and an obstacle to the economic advancement of the poor. Young children are especially vulnerable due to the irreversible effects of IDA on cognitive development. Our research may contribute to the design of new effective interventions aiming to reduce IDA in early childhood.

  16. Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness.

    Science.gov (United States)

    van der Woude, J A D; Nair, S C; Custers, R J H; van Laar, J M; Kuchuck, N O; Lafeber, F P J G; Welsing, P M J

    2016-01-01

    In end-stage knee osteoarthritis the treatment of choice is total knee arthroplasty (TKA). An alternative treatment is knee joint distraction (KJD), suggested to postpone TKA. Several studies reported significant and prolonged clinical improvement of KJD. To make an appropriate decision regarding the position of this treatment, a cost-effectiveness and cost-utility analysis from healthcare perspective for different age and gender categories was performed. A treatment strategy starting with TKA and a strategy starting with KJD for patients of different age and gender was simulated. To extrapolate outcomes to long-term health and economic outcomes a Markov (Health state) model was used. The number of surgeries, QALYs, and treatment costs per strategy were calculated. Costs-effectiveness is expressed using the cost-effectiveness plane and cost-effectiveness acceptability curves. Starting with KJD the number of knee replacing procedures could be reduced, most clearly in the younger age categories; especially revision surgery. This resulted in the KJD strategy being dominant (more effective with cost-savings) in about 80% of simulations (with only inferiority in about 1%) in these age categories when compared to TKA. At a willingness to pay of 20.000 Euro per QALY gained, the probability of starting with KJD to be cost-effective compared to starting with a TKA was already found to be over 75% for all age categories and over 90-95% for the younger age categories. A treatment strategy starting with knee joint distraction for knee osteoarthritis has a large potential for being a cost-effective intervention, especially for the relatively young patient.

  17. Early assessment of the likely cost-effectiveness of a new technology: A Markov model with probabilistic sensitivity analysis of computer-assisted total knee replacement.

    Science.gov (United States)

    Dong, Hengjin; Buxton, Martin

    2006-01-01

    The objective of this study is to apply a Markov model to compare cost-effectiveness of total knee replacement (TKR) using computer-assisted surgery (CAS) with that of TKR using a conventional manual method in the absence of formal clinical trial evidence. A structured search was carried out to identify evidence relating to the clinical outcome, cost, and effectiveness of TKR. Nine Markov states were identified based on the progress of the disease after TKR. Effectiveness was expressed by quality-adjusted life years (QALYs). The simulation was carried out initially for 120 cycles of a month each, starting with 1,000 TKRs. A discount rate of 3.5 percent was used for both cost and effectiveness in the incremental cost-effectiveness analysis. Then, a probabilistic sensitivity analysis was carried out using a Monte Carlo approach with 10,000 iterations. Computer-assisted TKR was a long-term cost-effective technology, but the QALYs gained were small. After the first 2 years, the incremental cost per QALY of computer-assisted TKR was dominant because of cheaper and more QALYs. The incremental cost-effectiveness ratio (ICER) was sensitive to the "effect of CAS," to the CAS extra cost, and to the utility of the state "Normal health after primary TKR," but it was not sensitive to utilities of other Markov states. Both probabilistic and deterministic analyses produced similar cumulative serious or minor complication rates and complex or simple revision rates. They also produced similar ICERs. Compared with conventional TKR, computer-assisted TKR is a cost-saving technology in the long-term and may offer small additional QALYs. The "effect of CAS" is to reduce revision rates and complications through more accurate and precise alignment, and although the conclusions from the model, even when allowing for a full probabilistic analysis of uncertainty, are clear, the "effect of CAS" on the rate of revisions awaits long-term clinical evidence.

  18. Indirect costs of absenteeism due to rheumatoid arthritis, psoriasis, multiple sclerosis, insulin-dependent diabetes mellitus, and ulcerative colitis in 2012: a study based on real-life data from the Social Insurance Institution in Poland.

    Science.gov (United States)

    Malinowski, Krzysztof Piotr; Kawalec, Paweł Piotr; Moćko, Paweł

    2016-01-01

    The aim of this study is to assess the indirect costs of six major autoimmune diseases including seropositive rheumatoid arthritis, other types of rheumatoid arthritis, psoriasis, multiple sclerosis, Type 1 diabetes, and ulcerative colitis. Relevant data for 2012 on sick leave and short- and long-term work disabilities were obtained from the Social Insurance Institution in Poland. Indirect costs were estimated using the human capital approach based on gross domestic product per capita, gross value added per worker, and gross income per worker in Poland in 2012 and expressed in euro. We recorded data on the total number of 45,500 patients. The total indirect costs were EUR 146,862,569; 353,683,508; and 108,154,271, calculated using gross domestic product, gross value added, and gross income, respectively. Considering only data on absenteeism collected by the Social Insurance Institution in Poland, we can conclude that the selected autoimmune diseases are associated with great indirect costs.

  19. Corporate Social Responsibility Reporting and Earnings Management: The Role of Political Costs

    Directory of Open Access Journals (Sweden)

    Erica Yip

    2011-09-01

    Full Text Available Recently, Francis, Nanda and Olsson (2008 proposed that earnings quality influence firms’ disclosure decisions. We examine whether Corporate Social Responsibility (CSR disclosure is related to earnings management and if the relationship is mitigated by political cost considerations or by the firm’s ethical predisposition. We argue that the relationship between CSR reporting and earnings management is context-specific and we consider one particular context, the political environment. We test our hypotheses by regressing earnings management on CSR disclosure while controlling for other factors that may affect the level of earnings management. We find a significant relationship between CSR reporting and earnings management, and more specifically, we find evidence of a negative (complementary relationship in the oil and gas industry while we find evidence of a positive (substitutive relationship in the food industry. The evidence supports the view that the relationship between CSR reporting and earnings management is affected by the political environment and not by ethical considerations.

  20. Environmentally Related Diseases and the Possibility of Valuation of Their Social Costs

    Directory of Open Access Journals (Sweden)

    Ilona Hajok

    2014-01-01

    Full Text Available The risks of the morbidity of the asbestos-related lung cancer was estimated in the general population of Poles as the result of increased exposure to asbestos fibers during the removal of asbestos-cement products and the possibility of the valuation of the social costs related to this risk. The prediction of the new incidences was made using linear regression model. The forecast shows that to the end of 2030 about 3,500 new cases of lung cancer can be expected as a result of occupational exposure to asbestos in the past which makes together with paraoccupational exposure about 14.000 new cases. The forecast shows the increasing number of asbestos-related lung cancer in Poland and indicates the priority areas where preventive action should be implemented.

  1. Seven-year cost-effectiveness of ProDisc-C total disc replacement: results from investigational device exemption and post-approval studies.

    Science.gov (United States)

    Radcliff, Kris; Lerner, Jason; Yang, Chao; Bernard, Thierry; Zigler, Jack E

    2016-05-01

    OBJECTIVE The purpose of this study was to evaluate the 7-year cost-effectiveness of cervical total disc replacement (CTDR) versus anterior cervical discectomy and fusion (ACDF) for the treatment of patients with single-level symptomatic degenerative disc disease. A change in the spending trajectory for spine care is to be achieved, in part, through the selection of interventions that have been proven effective yet cost less than other options. This analysis complements and builds upon findings from other cost-effectiveness evaluations of CTDR through the use of long-term, patient-level data from a randomized study. METHODS This was a 7-year health economic evaluation comparing CTDR versus ACDF from the US commercial payer perspective. Prospectively collected health care resource utilization and treatment effects (quality-adjusted life years [QALYs]) were obtained from individual patient-level adverse event reports and SF-36 data, respectively, from the randomized, multicenter ProDisc-C total disc replacement investigational device exemption (IDE) study and post-approval study. Statistical distributions for unit costs were derived from a commercial claims database and applied using Monte Carlo simulation. Patient-level costs and effects were modeled via multivariate probabilistic analysis. Confidence intervals for 7-year costs, effects, and net monetary benefit (NMB) were obtained using the nonparametric percentile method from results of 10,000 bootstrap simulations. The robustness of results was assessed through scenario analysis and within a parametric regression model controlling for baseline variables. RESULTS Seven-year follow-up data were available for more than 70% of the 209 randomized patients. In the base-case analysis, CTDR resulted in mean per-patient cost savings of $12,789 (95% CI $5362-$20,856) and per-patient QALY gains of 0.16 (95% CI -0.073 to 0.39) compared with ACDF over 7 years. CTDR was more effective and less costly in 90.8% of probabilistic

  2. Cost-Effectiveness of Five Commonly Used Prosthesis Brands for Total Knee Replacement in the UK: A Study Using the NJR Dataset.

    Directory of Open Access Journals (Sweden)

    Mark Pennington

    Full Text Available There is a lack of evidence on the effectiveness or cost-effectiveness of alternative brands of prosthesis for total knee replacement (TKR. We compared patient-reported outcomes, revision rates, and costs, and estimated the relative cost-effectiveness of five frequently used cemented brands of unconstrained prostheses with fixed bearings (PFC Sigma, AGC Biomet, Nexgen, Genesis 2, and Triathlon.We used data from three national databases for patients who had a TKR between 2003 and 2012, to estimate the effect of prosthesis brand on post-operative quality of life (QOL (EQ-5D-3L in 53 126 patients at six months. We compared TKR revision rates by brand over 10 years for 239 945 patients. We used a fully probabilistic Markov model to estimate lifetime costs and quality-adjusted life years (QALYs, incremental cost effectiveness ratios (ICERs, and the probability that each prosthesis brand is the most cost effective at alternative thresholds of willingness-to-pay for a QALY gain.Revision rates were lowest with the Nexgen and PFC Sigma (2.5% after 10 years in 70-year-old women. Average lifetime costs were lowest with the AGC Biomet (£9 538; mean post-operative QOL was highest with the Nexgen, which was the most cost-effective brand across all patient subgroups. For example, for 70-year-old men and women, the ICERs for the Nexgen compared to the AGC Biomet were £2 300 per QALY. At realistic cost per QALY thresholds (£10 000 to £30 000, the probabilities that the Nexgen is the most cost-effective brand are about 98%. These results were robust to alternative modelling assumptions.AGC Biomet prostheses are the least costly cemented unconstrained fixed brand for TKR but Nexgen prostheses lead to improved patient outcomes, at low additional cost. These results suggest that Nexgen should be considered as a first choice prosthesis for patients with osteoarthritis who require a TKR.

  3. A Total Cost of Ownership Model for Low Temperature PEM Fuel Cells in Combined Heat and Power and Backup Power Applications

    Energy Technology Data Exchange (ETDEWEB)

    University of California, Berkeley; Wei, Max; Lipman, Timothy; Mayyas, Ahmad; Chien, Joshua; Chan, Shuk Han; Gosselin, David; Breunig, Hanna; Stadler, Michael; McKone, Thomas; Beattie, Paul; Chong, Patricia; Colella, Whitney; James, Brian

    2014-06-23

    A total cost of ownership model is described for low temperature proton exchange membrane stationary fuel cell systems for combined heat and power (CHP) applications from 1-250kW and backup power applications from 1-50kW. System designs and functional specifications for these two applications were developed across the range of system power levels. Bottom-up cost estimates were made for balance of plant costs, and detailed direct cost estimates for key fuel cell stack components were derived using design-for-manufacturing-and-assembly techniques. The development of high throughput, automated processes achieving high yield are projected to reduce the cost for fuel cell stacks to the $300/kW level at an annual production volume of 100 MW. Several promising combinations of building types and geographical location in the U.S. were identified for installation of fuel cell CHP systems based on the LBNL modelling tool DER CAM. Life-cycle modelling and externality assessment were done for hotels and hospitals. Reduced electricity demand charges, heating credits and carbon credits can reduce the effective cost of electricity ($/kWhe) by 26-44percent in locations such as Minneapolis, where high carbon intensity electricity from the grid is displaces by a fuel cell system operating on reformate fuel. This project extends the scope of existing cost studies to include externalities and ancillary financial benefits and thus provides a more comprehensive picture of fuel cell system benefits, consistent with a policy and incentive environment that increasingly values these ancillary benefits. The project provides a critical, new modelling capacity and should aid a broad range of policy makers in assessing the integrated costs and benefits of fuel cell systems versus other distributed generation technologies.

  4. Control Analysis Of Tobacco Raw Material Supplies Using Eoq Method Economic Order Quantity To Reach Efficiency Total Costs Of Raw Material In Pr. Sukun

    Directory of Open Access Journals (Sweden)

    Wiwik Sudarwati

    2017-07-01

    Full Text Available The raw material inventory control system determines and guarantees the availability of raw material stock in the right quantity quality and timing. The problem in this research is the procurement of raw materials of tobacco. PR. Sukun still often experiences the excess. This is related to the frequency of raw material purchases and the quantity of raw material purchases which can lead to waste of working capital embedded in raw material inventory raw material ordering costs and raw material storage costs. The purpose of this research is to know how to make an efficiency level in procurement of raw material inventory between EOQ method compared with policy of PR. Sukun. The type of research used is analytic descriptive type. Data analysis begins by analyzing raw material quantity comparison total raw material inventory cost and raw material cost between PR Sukun policy with EOQ method. Based on the results of research known that by using EOQ method can be much more efficient compared to policy of PR. Sukun. The quantity and frequency of purchasing raw materials is less but still take into account the safety stock and reorder point so the production process is not disturbed. In addition the cost of purchasing ordering costs and raw materials storage costs less so as to create efficiencies on the cost of raw materials inventory. PR. Sukun in the procurement of raw material inventory should use EOQ method to be more efficient and take into account the safety stock and reorder point to avoid the inventory excess of raw materials.

  5. Costly hide and seek pays: unexpected consequences of deceit in a social dilemma

    International Nuclear Information System (INIS)

    Szolnoki, Attila; Perc, Matjaž

    2014-01-01

    Deliberate deceptiveness intended to gain an advantage is commonplace in human and animal societies. In a social dilemma, an individual may only pretend to be a cooperator to elicit cooperation from others, while in reality he is a defector. With this as motivation, we study a simple variant of the evolutionary prisoner's dilemma game entailing deceitful defectors and conditional cooperators that lifts the veil on the impact of such two-faced behavior. Defectors are able to hide their true intentions at a personal cost, while conditional cooperators are probabilistically successful at identifying defectors and act accordingly. By focusing on the evolutionary outcomes in structured populations, we observe a number of unexpected and counterintuitive phenomena. We show that deceitful behavior may fare better if it is costly, and that a higher success rate of identifying defectors does not necessarily favor cooperative behavior. These results are rooted in the spontaneous emergence of cycling dominance and spatial patterns that give rise to fascinating phase transitions, which in turn reveal the hidden complexity behind the evolution of deception. (paper)

  6. SCBA (social cost-benefit analysis) Wind energy Flevoland, Netherlands; MKBA Windenergie Flevoland

    Energy Technology Data Exchange (ETDEWEB)

    Warringa, G.E.A.; Blom, M.J.; Bles, M.

    2012-02-15

    The Dutch province of Flevoland aims to recover its open landscape by reducing the number of wind turbines , while also generating more wind energy. To this end, an integrated spatial and social exploration was carried out and different policy scenarios were developed. These scenarios have different financial but also social effects, such as stimulating the regional economy, impact on the landscape, etc. It is not clear in advance which of the scenarios scores most favorably from a social perspective. To obtain more insight in the social impact, a social cost-benefit analysis (SCBA) was conducted. The main conclusion is that the net welfare effect can be both positive and negative, depending on the scenario. As with any financial calculation and SCBA, the results depend on the assumptions. Factors such as the price of electricity, the investment, the amount of SDE subsidy (subsidy for production of renewable energy), the time of reorganizing, the discount rate applied, etc., all affect the results and may change over time. Therefore, in parallel with this report, a calculation model was developed which makes it easy to adjust these variables. This way results can easily be adjusted based on modified starting points [Dutch] De provincie Flevoland heeft als oorspronkelijke doelstelling haar open landschap te herstellen door het aantal windmolens te verminderen, en tegelijkertijd meer windenergie op te wekken. Hiertoe is een integrale ruimtelijke en maatschappelijke verkenning uitgevoerd en zijn verschillende beleidsscenario's ontwikkeld. Deze scenario's hebben verschillende financiële maar ook maatschappelijke effecten tot gevolg, zoals stimulering van de regionale economie, effect op het landschap, etc. Het is vooraf niet duidelijk welk van de scenario's vanuit maatschappelijk perspectief het meest gunstig scoort. Om meer inzicht te verkrijgen in het maatschappelijke effect, is daarom een maatschappelijke kosten-batenanalyse (MKBA) uitgevoerd

  7. Telepressure and College Student Employment: The Costs of Staying Connected Across Social Contexts.

    Science.gov (United States)

    Barber, Larissa K; Santuzzi, Alecia M

    2017-02-01

    Telepressure is a psychological state consisting of the preoccupation and urge to respond quickly to message-based communications from others. Telepressure has been linked with negative stress and health outcomes, but the existing measure focuses on experiences specific to the workplace. The current study explores whether an adapted version of the workplace telepressure measure is relevant to general social interactions that rely on information and communication technologies. We validated a general telepressure measure in a sample of college students and found psychometric properties similar to the original workplace measure. Also, general telepressure was related to, but distinct from, the fear of missing out, self-control and technology use. Using a predictive validity design, we also found that telepressure at the beginning of the semester was related to student reports of burnout, perceived stress and poor sleep hygiene 1 month later (but not work-life balance or general life satisfaction). Moreover, telepressure was more strongly related to more negative outcomes (burnout, stress and poor sleep hygiene) and less positive outcomes (work-life balance and life satisfaction) among employed compared with non-employed students. Thus, the costs of staying connected to one's social network may be more detrimental to college students with additional employment obligations. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  8. COSTE DE UNA PROPUESTA DE NIVEL BASICO DE PREVISION SOCIAL EN ESPAÑA

    Directory of Open Access Journals (Sweden)

    Joseba Iñaki de la Peña Esteban

    2014-05-01

    Full Text Available En el año 2005 el Banco Mundial propuso diseñar una asignación económica para cada ciudadano en función de su propia situación, que fuera sufragada anualmente teniendo en cuenta tanto la situación demográfica como económica del país. Sus orígenes más cercanos pueden derivar de la concepción de la Renta Básica (Van Parijs, P., 1994; Raventós, D., 2005. Este nuevo pilar de previsión, también llamado pilar cero, implica un rediseño de las prestaciones básicas que se otorgan dentro del país. Igualmente, también implica rediseñar todo el sistema de prestaciones contributivas, pues parte de ellas se abonarían a través de un nivel básico de cobertura. El objeto principal de la presente contribución es determinar el coste de establecer un nivel básico de previsión que aúne las prestaciones sociales mínimas en una única, que redistribuya las existentes (jubilación, invalidez, fallecimiento en una única prestación propia, así como que dirija los ingresos suficientes como para financiarla, sin menoscabar el equilibrio técnico del sistema. Ello implica modificar los niveles de cobertura de la Seguridad Social propuestos por la Organización Internacional del Trabajo en 1998, para adecuarlos a una prestación de carácter universal. In the year 2005 the World Bank proposed to design an economic benefit for all citizens depending on their own situation. This kind of benefit has to be supported in an annual financial base, taking into account the demographic and economic situation of the country. Its origin could be the Basic Income (Van Parijs, P., 1994; Raventós, D. 2005. This new level of social protection implies a redesign of the basic and compulsory level of protection that every country has. Even more, it implies re-designing the whole system of benefits, because part of them would be included as basic coverage. The aim of this paper is to determine the cost of a social protection level for Spain. This benefit has to

  9. Review of Least Cost Analysis of Social Landscapes. Archaeological Case Studies [Book

    Directory of Open Access Journals (Sweden)

    Irmela Herzog

    2013-07-01

    Full Text Available The application of least cost analysis by archaeologists in Northern America and Europe has increased considerably during the last decade, and the readily available tools for this purpose have led to a much wider interest in the application of this set of techniques for research. The volume under review mainly presents the papers held at the symposium "Tracing trails and modeling movement: Understanding past cultural landscapes and social networks through least cost analysis". This symposium was organised by the editors of the volume at the 74th Annual Meeting of the Society for American Archaeologists in Atlanta in April 2009. As the book, which contains 14 chapters by 18 - all US-based - contributors, took three years to appear, inevitably some references to more recent publications on the subject of least cost analysis (LCA were not included. The volume starts with an introduction and fairly basic applications of LCA, i.e. a methodology to reconstruct patterns of human movement in space; this is followed by two parts, each consisting of three papers with new ideas for LCA applications or more advanced methods for calculating LCA. The final part presents three papers discussing different aspects of LCA raised in the first parts of the volume and general issues of methodology. In the introductory chapter the editors describe the intention of the book. It is designed "to be a guidebook for archaeologists interested in using LCA to answer behavioral questions". They explain that LCA is based on the assumption that humans tend to economise many aspects of their behaviour. They emphasise that LCA is not an end in itself but a tool which should be used properly. This ambitious goal is however not necessarily matched by the contributions to the volume, in this reviewer's eyes. Some examples are presented here to show that LCA requires a clear understanding of its methodology and that outcomes need to be validated.

  10. Associations between preoperative Oxford hip and knee scores and costs and quality of life of patients undergoing primary total joint replacement in the NHS England: an observational study.

    Science.gov (United States)

    Eibich, Peter; Dakin, Helen A; Price, Andrew James; Beard, David; Arden, Nigel K; Gray, Alastair M

    2018-04-10

    To assess how costs and quality of life (measured by EuroQoL-5 Dimensions (EQ-5D)) before and after total hip replacement (THR) and total knee replacement (TKR) vary with age, gender and preoperative Oxford hip score (OHS) and Oxford knee score (OKS). Regression analyses using prospectively collected data from clinical trials, cohort studies and administrative data bases. UK secondary care. Men and women undergoing primary THR or TKR. The Hospital Episode Statistics data linked to patient-reported outcome measures included 602 176 patients undergoing hip or knee replacement who were followed up for up to 6 years. The Knee Arthroplasty Trial included 2217 patients undergoing TKR who were followed up for 12 years. The Clinical Outcomes in Arthroplasty Study cohort included 806 patients undergoing THR and 484 patients undergoing TKR who were observed for 1 year. EQ-5D-3L quality of life before and after surgery, costs of primary arthroplasty, costs of revision arthroplasty and the costs of hospital readmissions and ambulatory costs in the year before and up to 12 years after joint replacement. Average postoperative utility for patients at the 5th percentile of the OHS/OKS distribution was 0.61/0.5 for THR/TKR and 0.89/0.85 for patients at the 95th percentile. The difference between postoperative and preoperative EQ-5D utility was highest for patients with preoperative OHS/OKS lower than 10. However, postoperative EQ-5D utility was higher than preoperative utility for all patients with OHS≤46 and those with OKS≤44. In contrast, costs were generally higher for patients with low preoperative OHS/OKS than those with high OHS/OKS. For example, costs of hospital readmissions within 12 months after primary THR/TKR were £740/£888 for patients at the 5th percentile compared with £314/£404 at the 95th percentile of the OHS/OKS distribution. Our findings suggest that costs and quality of life associated with total joint replacement vary systematically with

  11. The cost of post-operative shed blood salvage after total knee arthroplasty: an analysis of 1,093 consecutive procedures

    Science.gov (United States)

    Muñoz, Manuel; Ariza, Daniel; Campos, Arturo; Martín-Montañez, Elisa; Pavía, José

    2013-01-01

    Background Requirements for allogeneic red cell transfusion after total knee arthroplasty are still high (20–50%), and salvage and reinfusion of unwashed, filtered post-operative shed blood is an established method for reducing transfusion requirements following this operation. We performed a cost analysis to ascertain whether this alternative is likely to be cost-effective. Materials and methods Data from 1,093 consecutive primary total knee arthroplasties, managed with (reinfusion group, n=763) or without reinfusion of unwashed salvaged blood (control group, n=330), were retrospectively reviewed. The costs of low-vacuum drains, shed blood collection canisters (Bellovac ABT®, Wellspect HealthCare and ConstaVac CBC II®, Stryker), shed blood reinfusion, acquisition and transfusion of allogeneic red cell concentrate, haemoglobin measurements, and prolonged length of hospital stay were used for the blood management cost analysis. Results Patients in the reinfusion group received 152±64 mL of red blood cells from postoperatively salvaged blood, without clinically relevant incidents, and showed a lower allogeneic transfusion rate (24.5% vs 8.5%, for the control and reinfusion groups, respectively; p =0.001). There were no differences in post-operative infection rates. Patients receiving allogeneic transfusions stayed in hospital longer (+1.9 days [95% CI: 1.2 to 2.6]). As reinfusion of unwashed salvaged blood reduced the allogeneic transfusion rate, both reinfusion systems may provide net savings in different cost scenarios (€ 4.6 to € 106/patient for Bellovac ABT, and € −51.9 to € 49.9/patient for ConstaVac CBCII). Discussion Return of unwashed salvaged blood after total knee arthroplasty seems to save costs in patients with pre-operative haemoglobin between 12 and 15 g/dL. It is not cost-saving in patients with a pre-operative haemoglobin >15 g/dL, whereas in those with a pre-operative haemoglobin cost-saving, its efficacy could be increased by

  12. Social costs of illicit financial flows in low- and middle-income countries: the case of infant vaccination coverage.

    Science.gov (United States)

    Ortega, Bienvenido; Sanjuán, Jesús; Casquero, Antonio

    2018-03-01

    The liberalization of capital flows is generally associated with prospects of higher growth. However, in developing countries, opening the capital account may also facilitate the flow of capital out of the country through illicit financial flows (IFFs). Given that IFFs drain the scarce public resources available to finance the provision of public goods and services, the extent of illicit capital flows from developing countries is serious cause for concern. In this context, as a first step in analysing the social costs of IFFs in developing countries, this article studied the relationship between IFFs and infant immunization coverage rates. Data for 56 low- and middle-income countries for the period 2002-13 were used in the empirical analysis. The main result was that the relative level of IFFs to total trade negatively impacted vaccination coverage but only in the case of countries with very high levels of perceived corruption. In this case, the total effect of an annual 1 p.p. increase in the ratio of IFFs to total trade was to reduce the level of vaccination coverage rates over the coming years by 0.19 p.p. Given that there was an annual average of 18 million infants in this cluster of 25 countries, this result suggests that at least 34 000 children may not receive this basic health care intervention in the future as a consequence of this increase in IFFs in any particular year. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Increased Severe Trauma Patient Volume is Associated With Survival Benefit and Reduced Total Health Care Costs: A Retrospective Observational Study Using a Japanese Nationwide Administrative Database.

    Science.gov (United States)

    Endo, Akira; Shiraishi, Atsushi; Fushimi, Kiyohide; Murata, Kiyoshi; Otomo, Yasuhiro

    2017-06-07

    The aim of this study was to evaluate the associations of severe trauma patient volume with survival benefit and health care costs. The effect of trauma patient volume on survival benefit is inconclusive, and reports on its effects on health care costs are scarce. We conducted a retrospective observational study, including trauma patients who were transferred to government-approved tertiary emergency hospitals, or hospitals with an intensive care unit that provided an equivalent quality of care, using a Japanese nationwide administrative database. We categorized hospitals according to their annual severe trauma patient volumes [1 to 50 (reference), 51 to 100, 101 to 150, 151 to 200, and ≥201]. We evaluated the associations of volume categories with in-hospital survival and total cost per admission using a mixed-effects model adjusting for patient severity and hospital characteristics. A total of 116,329 patients from 559 hospitals were analyzed. Significantly increased in-hospital survival rates were observed in the second, third, fourth, and highest volume categories compared with the reference category [94.2% in the highest volume category vs 88.8% in the reference category, adjusted odds ratio (95% confidence interval, 95% CI) = 1.75 (1.49-2.07)]. Furthermore, significantly lower costs (in US dollars) were observed in the second and fourth categories [mean (standard deviation) for fourth vs reference = $17,800 ($17,378) vs $20,540 ($32,412), adjusted difference (95% CI) = -$2559 (-$3896 to -$1221)]. Hospitals with high volumes of severe trauma patients were significantly associated with a survival benefit and lower total cost per admission.

  14. The total cost of logistics in supplier selection, under conditions of multiple sourcing, multiple criteria and capacity constraint

    Directory of Open Access Journals (Sweden)

    Elnaz Bani

    2016-06-01

    Full Text Available This paper presents a mathematical model to solve a multi-objective decision making supplier selection problem. The proposed problem considers three objective functions: the first objective function minimizes the cost of purchasing the products while the second objective function minimizes the due dates and finally the third objective function maximizes the customer satisfaction. The resulted problem is formulated as mixed integer programming and, therefore, we use invasive weed optimization technique to solve the resulted problem. The performance of the proposed model is compared with NSGA II based on different criteria such as mean ideal distance and quality matrix. The preliminary results indicate that the proposed model performs relatively well compared with alternative method.

  15. The social costs and benefits of Smart Grids; Maatschappelijke kosten en baten van Intelligente Netten

    Energy Technology Data Exchange (ETDEWEB)

    Blom, M.J.; Bles, M.; Leguijt, C.; Rooijers, F.J. [CE Delft, Delft (Netherlands); Van Gerwen, R.; Van Hameren, D.; Verheij, F. [KEMA, Arnhem (Netherlands)

    2012-01-15

    Although a reliable social cost-benefit analysis (SCBA) of large-scale introduction of Smart Grids is currently lacking, the rough-and-ready estimates available give the impression that the results of such an exercise would be positive. In the latter half of 2011 and in early 2012 a number of large-scale trials to explore Smart Grids were initiated in the Netherlands: the so-called 'Pilots Smart Grids'. To identify and quantify the social costs and benefits associated with Smart Grids and to assess whether large-scale introduction is indeed desirable, an SCBA needed to be conducted. An additional question concerned the issue to be considered when rolling out large-scale trials aimed at improving the economic impact of Smart Grids in the Netherlands. The key question posed by the commissioning party, the Dutch Ministry of Economic Affairs, Agriculture and Innovation, was to identify and quantify the costs and benefits, both direct and indirect, of a national roll-out of Smart Grids. The present report deals with Phase 1 of the SCBA. [Dutch] De aanleg van intelligente elektriciteitsnetten - ook wel smart grids genoemd - levert een positieve bijdrage aan de toekomstige energievoorziening. Het leidt tot lagere prijzen voor consumenten en bedrijfsleven. Dit wordt geconcludeerd uit een maatschappelijke kosten-batenanalyse (MKBA) die door CE Delft en KEMA is verricht in opdracht van het ministerie van Economische Zaken, Landbouw en Innovatie. In de analyse zijn verschillende energiescenario's tot 2050 doorgerekend. In vrijwel elk toekomstscenario leveren smart grids een positieve bijdrage; of het nu gaat om wel of geen klimaatbeleid, een groot of klein aandeel decentrale energieproductie en andere variaties. Dat komt vooral door de te verwachten gedragsverandering van gebruikers als gevolg van variabele energietarieven en kostenbesparing in de netaanleg en elektriciteitsproductie. Uit de recent gestarte proeftuinen voor Intelligente Netten zal duidelijk

  16. A multi-perspective cost-effectiveness analysis comparing rivaroxaban with enoxaparin sodium for thromboprophylaxis after total hip and knee replacement in the German healthcare setting

    Directory of Open Access Journals (Sweden)

    Zindel Sonja

    2012-07-01

    Full Text Available Abstract Background Patients undergoing major orthopaedic surgery (MOS, such as total hip (THR or total knee replacement (TKR, are at high risk of developing venous thromboembolism (VTE. For thromboembolism prophylaxis, the oral anticoagulant rivaroxaban has recently been included in the German diagnosis related group (DRG system. However, the cost-effectiveness of rivaroxaban is still unclear from both the German statutory health insurance (SHI and the German hospital perspective. Objectives To assess the cost-effectiveness of rivaroxaban from the German statutory health insurance (SHI perspective and to analyse financial incentives from the German hospital perspective. Methods Based on data from the RECORD trials and German cost data, a decision tree was built. The model was run for two settings (THR and TKR and two perspectives (SHI and hospital per setting. Results Prophylaxis with rivaroxaban reduces VTE events (0.02 events per person treated after TKR; 0.007 after THR compared with enoxaparin. From the SHI perspective, prophylaxis with rivaroxaban after TKR is cost saving (€27.3 saving per patient treated. However, the cost-effectiveness after THR (€17.8 cost per person remains unclear because of stochastic uncertainty. From the hospital perspective, for given DRGs, the hospital profit will decrease through the use of rivaroxaban by €20.6 (TKR and €31.8 (THR per case respectively. Conclusions Based on our findings, including rivaroxaban for reimbursement in the German DRG system seems reasonable. Yet, adequate incentives for German hospitals to use rivaroxaban are still lacking.

  17. The Thrift Industry and the Community Reinvestment Act: Assessing the Cost of Social Responsibility

    OpenAIRE

    Donald F. Vitaliano; Gregory Stella

    2003-01-01

    A stochastic frontier cost function indicates that the annual cost of complying with the anti-redlining Community Reinvestment Act (CRA) is $171,000 per thrift institution, roughly 2.3 percent of variable costs. But compliance cost is significantly less than the estimated 21 percent cost inefficiency. Based on published estimates of the incremental number of mortgage loans induced by CRA, the marginal cost is $38,000 per loan. The regulations whose compliance cost is estimated apply to about ...

  18. Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

    Directory of Open Access Journals (Sweden)

    Umer Chaudhry Muhammad

    2011-05-01

    Full Text Available Abstract Background & Purpose Allogenic blood transfusion in elective orthopaedic surgery is best avoided owing to its associated risks. Total knee replacement often requires blood transfusion, more so when bilateral surgery is performed. Many strategies are currently being employed to reduce the amount of peri-operative allogenic transfusions. Anti-fibrinolytic compounds such as aminocaproic acid and tranexamic acid have been used systemically in perioperative settings with promising results. This study aimed to evaluate the effectiveness of tranexamic acid in reducing allogenic blood transfusion in total knee replacement surgery. Methodology This was a retrospective cohort study conducted on patients undergoing total knee replacement during the time period November 2005 to November 2008. Study population was 99 patients, of which 70 underwent unilateral and 29 bilateral knee replacement. Forty-seven patients with 62 (49.5% knees (group-I had received tranexamic acid (by surgeon preference while the remaining fifty-two patients with 66 (51.5% knees (group-II had did not received any tranexamic acid either pre- or post-operatively. Results The mean drop in the post-operative haemoglobin concentration in Group-II for unilateral and bilateral cases was 1.79 gm/dl and 2.21 gm/dl, with a mean post-operative drainage of 1828 ml (unilateral and 2695 ml (bilateral. In comparison, the mean drop in the post-op haemoglobin in Group-I was 1.49 gm/dl (unilateral and 1.94 gm/dl (bilateral, with a mean drainage of 826 ml (unilateral and 1288 ml (bilateral (p-value Interpretation Tranexamic acid is effective in reducing post-operative drainage and requirement of blood transfusion after knee replacement.

  19. Small distributed generation versus centralised supply: a social cost-benefit analysis in the residential and service sectors

    International Nuclear Information System (INIS)

    Gulli, Francesco

    2006-01-01

    This paper aims at measuring the social benefits of small CHP distributed generation (DG) in the residential and service sectors. We do this by comparing the social costs of decentralised and centralised supplies, simulating 'ideal' situations in which any source of allocative inefficiencies is eliminated. This comparison focuses on assessing internal and external costs. The internal costs are calculated by simulating the optimal prices of the electricity and gas inputs. The external costs are estimated by using and elaborating the results of the dissemination process of the ExternE project, one of the most recent and accurate methodologies in this field. The analysis takes into account the main sources of uncertainty about the parameter values, including uncertainty about external cost estimations. Despite these sources of uncertainty, the paper concludes that centralised supply is still preferable to small DG. In fact, the overall range of DG social competitiveness is restricted, even considering further remarkable improvements in DG electrical efficiency and investment costs. The results are particularly unfavourable for the residential sector, whereas, in the service sector, the performance of DG technologies is slightly better

  20. Stroke in Switzerland: social determinants of treatment access and cost of illness.

    Science.gov (United States)

    Snozzi, Philippe; Blank, Patricia R; Szucs, Thomas D

    2014-01-01

    Few useful empirical data on stroke are available for Switzerland. The aim of this study was to collect data on the use of medical resources and associated costs among stroke patients. Special attention was paid to possible correlations between epidemiologic indicators, sociodemographic variables, resource use, and costs. We carried out a representative population survey of 19,123 households in the German- and French-speaking parts of Switzerland with computer-assisted telephone interviews in 2005. Detailed sociodemographic data and information on the use of resources were collected from 509 individuals aged 15-75 years who had cared for a stroke patient in the past 1-2 years. In the last 1-2 years, a total of 7.8% of households were affected by stroke in the German-speaking part of Switzerland, whereas only 4.3% of households were affected in the French-speaking part of Switzerland (odds ratio [OR] = 1.89, P Switzerland. Patients with supplementary insurance were treated more frequently as inpatients than patients with statutory insurance (OR: 2.14, P = .014), and patients with a low household income were referred less frequently to an inpatient rehabilitation facility than those with medium or high household income (OR = .58, P Switzerland. Patients without supplementary insurance or with low household income were less likely to receive inpatient treatment. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Cost-effectiveness of antibiotic prophylaxis for dental patients with prosthetic joints: Comparisons of antibiotic regimens for patients with total hip arthroplasty.

    Science.gov (United States)

    Skaar, Daniel D; Park, Taehwan; Swiontkowski, Marc F; Kuntz, Karen M

    2015-11-01

    Clinician uncertainty concerning the need for antibiotic prophylaxis to prevent prosthetic joint infection (PJI) after undergoing dental procedures persists. Improved understanding of the potential clinical and economic risks and benefits of antibiotic prophylaxis will help inform the debate and facilitate the continuing evolution of clinical management guidelines for dental patients with prosthetic joints. The authors developed a Markov decision model to compare the lifetime cost-effectiveness of alternative antibiotic prophylaxis strategies for dental patients aged 65 years who had undergone total hip arthroplasty (THA). On the basis of the authors' interpretation of previous recommendations from the American Dental Association and American Academy of Orthopaedic Surgeons, they compared the following strategies: no prophylaxis, prophylaxis for the first 2 years after arthroplasty, and lifetime prophylaxis. A strategy of foregoing antibiotic prophylaxis before dental visits was cost-effective and resulted in lower lifetime accumulated costs ($11,909) and higher accumulated quality-adjusted life years (QALYs) (12.375) when compared with alternative prophylaxis strategies. The results of Markov decision modeling indicated that a no-antibiotic prophylaxis strategy was cost-effective for dental patients who had undergone THA. These results support the findings of case-control studies and the conclusions of an American Dental Association Council on Scientific Affairs report that questioned general recommendations for antibiotic prophylaxis before dental procedures. The results of cost-effectiveness decision modeling support the contention that routine antibiotic prophylaxis for dental patients with total joint arthroplasty should be reconsidered. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

  2. Sharing the cost of river basin adaptation portfolios to climate change: Insights from social justice and cooperative game theory

    Science.gov (United States)

    Girard, Corentin; Rinaudo, Jean-Daniel; Pulido-Velazquez, Manuel

    2016-10-01

    The adaptation of water resource systems to the potential impacts of climate change requires mixed portfolios of supply and demand adaptation measures. The issue is not only to select efficient, robust, and flexible adaptation portfolios but also to find equitable strategies of cost allocation among the stakeholders. Our work addresses such cost allocation problems by applying two different theoretical approaches: social justice and cooperative game theory in a real case study. First of all, a cost-effective portfolio of adaptation measures at the basin scale is selected using a least-cost optimization model. Cost allocation solutions are then defined based on economic rationality concepts from cooperative game theory (the Core). Second, interviews are conducted to characterize stakeholders' perceptions of social justice principles associated with the definition of alternatives cost allocation rules. The comparison of the cost allocation scenarios leads to contrasted insights in order to inform the decision-making process at the river basin scale and potentially reap the efficiency gains from cooperation in the design of river basin adaptation portfolios.

  3. Individual quality and age but not environmental or social conditions modulate costs of reproduction in a capital breeder.

    Science.gov (United States)

    Debeffe, Lucie; Poissant, Jocelyn; McLoughlin, Philip D

    2017-08-01

    Costs associated with reproduction are widely known to play a role in the evolution of reproductive tactics with consequences to population and eco-evolutionary dynamics. Evaluating these costs as they pertain to species in the wild remains an important goal of evolutionary ecology. Individual heterogeneity, including differences in individual quality (i.e., among-individual differences in traits associated with survival and reproduction) or state, and variation in environmental and social conditions can modulate the costs of reproduction; however, few studies have considered effects of these factors simultaneously. Taking advantage of a detailed, long-term dataset for a population of feral horses (Sable Island, Nova Scotia, Canada), we address the question of how intrinsic (quality, age), environmental (winter severity, location), and social conditions (group size, composition, sex ratio, density) influence the costs of reproduction on subsequent reproduction. Individual quality was measured using a multivariate analysis on a combination of four static and dynamic traits expected to depict heterogeneity in individual performance. Female quality and age interacted with reproductive status of the previous year to determine current reproductive effort, while no effect of social or environmental covariates was found. High-quality females showed higher probabilities of giving birth and weaning their foal regardless of their reproductive status the previous year, while those of lower quality showed lower probabilities of producing foals in successive years. Middle-aged (prime) females had the highest probability of giving birth when they had not reproduced the year before, but no such relationship with age was found among females that had reproduced the previous year, indicating that prime-aged females bear higher costs of reproduction. We show that individual quality and age were key factors modulating the costs of reproduction in a capital breeder but that

  4. The roles of social bonds, personality, and perceived costs: an empirical investigation into Hirschi's "new" control theory.

    Science.gov (United States)

    Intravia, Jonathan; Jones, Shayne; Piquero, Alex R

    2012-12-01

    Hirschi's reconceptualized control theory suggests that social bonds serve as the primary inhibitors to delinquency and that personality-based self-control (PBSC) is not relevant. He also indicates that the number of inhibitors, multiplied by their salience, influences the perceived costs of delinquency. These claims have not been widely tested. Using a large, school-based sample of adolescents, the authors test Hirschi's reconceptualization and find that certain inhibitors (e.g., parental monitoring) are more important than others (e.g., maternal attachment). There are also unique types of costs (e.g., parental costs, peer costs) with differential impacts. Salience exerts a main effect, but there was little evidence to suggest it interacts with costs. Finally, PBSC has the strongest effect. These findings not only offer support for some of Hirschi's claims but also provide directions to better formulate a more comprehensive and empirically supported control theory.

  5. Pengaruh Biaya Corporate Social Responsibility Terhadap Kinerja Keuangan dan Nilai Perusahaan [Influence of Cost against Corporate Social Responsibility, Financial Performance, and Value

    Directory of Open Access Journals (Sweden)

    Aditya Satya Yudharma

    2016-10-01

    Full Text Available Corporate social responsibility is becoming increasingly important in Indonesia and many companies get into trouble when they do not care about environmental and social issues. The purpose of this research is to analyze the influence of corporate social responsibility expenditure on the financial performance and value of a firm. The samples used in this study were 56 companies listed in the Indonesia Stock Exchange 2012 and 2013. The samples were chosen using the purposive sampling method based on certain designated criterias. Corporate social responsibility expenditure is measured by employee welfare cost and social expenditure for the community. The financial performance is measured by return on assets (ROA and the firm value is measured by Tobin’s Q ratio. For testing hypothesis, this study used multiple regression analysis. The result of this study showed that the employee welfare cost had a positive effect toward financial performance (ROA and no effect toward firm value (Tobin's Q while social expenditure for community had no effect toward financial performance (ROA and firm value (Tobin’s Q.

  6. The Costly Consequences of not Being Socially and Behaviorally Ready to Learn by Kindergarten in Baltimore City.

    Science.gov (United States)

    Bettencourt, Amie F; Gross, Deborah; Ho, Grace; Perrin, Nancy

    2018-02-01

    Social, emotional, and behavioral skills are foundational to learning and long-term success. However, poverty and exposure to adverse childhood experiences reduce the chances of children entering kindergarten socially-behaviorally ready to learn. This study examined the unique impact of 5-year-old children (N = 11,412) entering kindergarten not socially-behaviorally ready on three costly school outcomes by fourth grade in Baltimore City Public Schools: being retained in grade, receiving services and supports through an IEP or 504 plan, and being suspended/expelled. Controlling for all other types of school readiness, students not identified as socially-behaviorally ready for kindergarten were more likely to experience all three school outcomes. Findings underscore the importance of early prevention and intervention strategies targeting parents and social-behavioral readiness skills during the first 5 years of life.

  7. Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients.

    Science.gov (United States)

    Sills, E Scott; Collins, Gary S; Salem, Shala A; Jones, Christopher A; Peck, Alison C; Salem, Rifaat D

    2012-08-30

    During in vitro fertilization (IVF), fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF. Data were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied. Completed questionnaires (n = 71) revealed a mean +/- SD patient age of 34 +/- 4.1 yrs. Most (83.1%) had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s). When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/- 11.75 and $654.55 +/- 106.34, respectively (p cost difference increased. This investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist) was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs reach a critical level.

  8. Accounting for risk aversion, income distribution, and social welfare in cost-benefit analysis for flood risk management

    NARCIS (Netherlands)

    Kind, Jarl; Botzen, W.J.W.|info:eu-repo/dai/nl/297620584; Aerts, Jeroen

    2017-01-01

    Most cost-benefit analysis (CBA) textbooks and guidelines recognize the objective of CBAs to improve social welfare—a function of well-being of all individuals, conceptualized by utility. However, today's common practice to value flood risk management benefits as the reduction of the expected annual

  9. The cost-effectiveness and return-on-investment of a combined social and physical environmental intervention in office employees

    NARCIS (Netherlands)

    van Dongen, J M; Coffeng, J K; van Wier, M F; Boot, Cecile R. L.; Hendriksen, I.J.M.; van Mechelen, W.; Bongers, Paulien M.; Van Der Beek, Allard J.; Bosmans, J E; van Tulder, M W

    2017-01-01

    This study explored the cost-effectiveness and return-on-investment of a combined social and physical environmental worksite health promotion program compared with usual practice, and of both intervention conditions separately. Participants were randomized to the combined intervention (n = 92),

  10. The Social Costs of Ubiquitous Information: Consuming Information on Mobile Phones Is Associated with Lower Trust.

    Science.gov (United States)

    Kushlev, Kostadin; Proulx, Jason D E

    2016-01-01

    In an age already saturated with information, the ongoing revolution in mobile computing has expanded the realm of immediate information access far beyond our homes and offices. In addition to changing where people can access information, mobile computing has changed what information people access-from finding specific directions to a restaurant to exploring nearby businesses when on the go. Does this ability to instantly gratify our information needs anytime and anywhere have any bearing on how much we trust those around us-from neighbors to strangers? Using data from a large nationally representative survey (World Values Survey: Wave 6), we found that the more people relied on their mobile phones for information, the less they trusted strangers, neighbors and people from other religions and nationalities. In contrast, obtaining information through any other method-including TV, radio, newspapers, and even the Internet more broadly-predicted higher trust in those groups. Mobile information had no bearing on how much people trusted close others, such as their family. Although causality cannot be inferred, these findings provide an intriguing first glimpse into the possible unforeseen costs of convenient information access for the social lubricant of society-our sense of trust in one another.

  11. The Social Costs of Ubiquitous Information: Consuming Information on Mobile Phones Is Associated with Lower Trust.

    Directory of Open Access Journals (Sweden)

    Kostadin Kushlev

    Full Text Available In an age already saturated with information, the ongoing revolution in mobile computing has expanded the realm of immediate information access far beyond our homes and offices. In addition to changing where people can access information, mobile computing has changed what information people access-from finding specific directions to a restaurant to exploring nearby businesses when on the go. Does this ability to instantly gratify our information needs anytime and anywhere have any bearing on how much we trust those around us-from neighbors to strangers? Using data from a large nationally representative survey (World Values Survey: Wave 6, we found that the more people relied on their mobile phones for information, the less they trusted strangers, neighbors and people from other religions and nationalities. In contrast, obtaining information through any other method-including TV, radio, newspapers, and even the Internet more broadly-predicted higher trust in those groups. Mobile information had no bearing on how much people trusted close others, such as their family. Although causality cannot be inferred, these findings provide an intriguing first glimpse into the possible unforeseen costs of convenient information access for the social lubricant of society-our sense of trust in one another.

  12. Cost-effectiveness as a method of evaluating social objectives among countries

    Energy Technology Data Exchange (ETDEWEB)

    Rittenoure, R L [Univ. of Tulsa, OK; Pluta, J E

    1979-01-01

    This article suggests a methodology for measuring the achievement of an educational system in terms of a relevant set of social objectives. It is designed to encourage intercountry comparisons of the effectiveness and/or efficiency in educational systems and to provide an analytical foundation for further empirical efforts. Using data from a sample of seven Latin American countries, this paper builds on past attempts to analyze public education expenditures, extend the interdisciplinary dimensions of public policy analysis, and specifies data needs through the identification of measures useful for evaluation and comparison. Background research for the article involved comparing historical data for inputs to educational systems such as number of teachers, educational institutions, students enrolled, and student/teacher ratios with data on the outputs, such as literacy rates and demand for reading material as is evidenced by per capita newsprint consumption, daily newspaper circulation, and the number of books published and translated. Where data are relatively satisfactory and consistent we compared the measures of output with costs of public education programmes. Our results suggest that input and output measures yield quite different interpretations of the performance of educational systems - often diametrically opposed. We find this result disturbing in light of the extended use of input measures in both academic circles and by policy makers within individual countries to judge the effectiveness of educational efforts.

  13. Social cost-efficient service quality-Integrating customer valuation in incentive regulation: Evidence from the case of Norway

    International Nuclear Information System (INIS)

    Growitsch, Christian; Jamasb, Tooraj; Mueller, Christine; Wissner, Matthias

    2010-01-01

    In order to overcome the perverse incentives of excessive maintenance reductions and insufficient network investments arising with incentive regulation of electricity distribution companies, regulators throughout Europe have started regulating service quality. In this paper, we explore the impact of incorporating customers' willingness-to-pay for service quality in benchmarking models on cost efficiency of distribution networks. Therefore, we examine the case of Norway, which features this approach to service quality regulation. We use the data envelopment analysis technique to analyse the effectiveness of such regulatory instruments. Moreover, we discuss the extent to which this indirect regulatory instrument motivates a socially desired service quality level. The results indicate that internalising external or social cost of service quality does not seem to have played an important role in improving cost efficiency in Norwegian distribution utilities.

  14. Social cost-efficient service quality. Integrating customer valuation in incentive regulation. Evidence from the case of Norway

    Energy Technology Data Exchange (ETDEWEB)

    Growitsch, Christian; Mueller, Christine; Wissner, Matthias [WIK, Department Energy Markets and Energy Regulation, Rhoendorfer Str. 68, 53604 Bad Honnef (Germany); Jamasb, Tooraj [University of Cambridge, Faculty of Economics (United Kingdom)

    2010-05-15

    In order to overcome the perverse incentives of excessive maintenance reductions and insufficient network investments arising with incentive regulation of electricity distribution companies, regulators throughout Europe have started regulating service quality. In this paper, we explore the impact of incorporating customers' willingness-to-pay for service quality in benchmarking models on cost efficiency of distribution networks. Therefore, we examine the case of Norway, which features this approach to service quality regulation. We use the data envelopment analysis technique to analyse the effectiveness of such regulatory instruments. Moreover, we discuss the extent to which this indirect regulatory instrument motivates a socially desired service quality level. The results indicate that internalising external or social cost of service quality does not seem to have played an important role in improving cost efficiency in Norwegian distribution utilities. (author)

  15. Social cost-efficient service quality-Integrating customer valuation in incentive regulation: Evidence from the case of Norway

    Energy Technology Data Exchange (ETDEWEB)

    Growitsch, Christian, E-mail: c.growitsch@wik.or [WIK, Department Energy Markets and Energy Regulation, Rhoendorfer Str. 68, 53604 Bad Honnef (Germany); Jamasb, Tooraj [University of Cambridge, Faculty of Economics (United Kingdom); Mueller, Christine; Wissner, Matthias [WIK, Department Energy Markets and Energy Regulation, Rhoendorfer Str. 68, 53604 Bad Honnef (Germany)

    2010-05-15

    In order to overcome the perverse incentives of excessive maintenance reductions and insufficient network investments arising with incentive regulation of electricity distribution companies, regulators throughout Europe have started regulating service quality. In this paper, we explore the impact of incorporating customers' willingness-to-pay for service quality in benchmarking models on cost efficiency of distribution networks. Therefore, we examine the case of Norway, which features this approach to service quality regulation. We use the data envelopment analysis technique to analyse the effectiveness of such regulatory instruments. Moreover, we discuss the extent to which this indirect regulatory instrument motivates a socially desired service quality level. The results indicate that internalising external or social cost of service quality does not seem to have played an important role in improving cost efficiency in Norwegian distribution utilities.

  16. A benefit-cost analysis of a long-term intervention on social and emotional learning in compulsory school

    Directory of Open Access Journals (Sweden)

    Alli Klapp

    2017-04-01

    Full Text Available There is growing evidence that social and emotional skills can be taught to students in school and teaching these skills can have a positive effect on later outcomes, such as better mental health and less drug use. This paper presents a benefit-cost analysis of a longitudinal social and emotional learning intervention in Sweden, using data for 663 students participating in the evaluation. Intervention costs are compared against treatment impact on self-reported drug use. Pre-test and post-test data are available. Since follow-up data for the participants´ drug use as adults is not available, informed projections have been made. Net present monetary values are calculated for the general public and society. The results show that students in the treatment group report decreasing use of drugs over the five year long intervention, the value of which easily outweighs the intervention costs.

  17. Costs and outcomes of improving population health through better social housing: a cohort study and economic analysis.

    Science.gov (United States)

    Bray, Nathan; Burns, Paul; Jones, Alice; Winrow, Eira; Edwards, Rhiannon Tudor

    2017-12-01

    We sought to determine the impact of warmth-related housing improvements on the health, well-being, and quality of life of families living in social housing. An historical cohort study design was used. Households were recruited by Gentoo, a social housing contractor in North East England. Recruited households were asked to complete a quality of life, well-being, and health service use questionnaire before receiving housing improvements (new energy-efficient boiler and double-glazing) and again 12 months afterwards. Data were collected from 228 households. The average intervention cost was £3725. At 12-month post-intervention, a 16% reduction (-£94.79) in household 6-month health service use was found. Statistically significant positive improvements were observed in main tenant and household health status (p cost-effective means of improving the health of social housing tenants and reducing health service expenditure, particularly in older populations.

  18. Association between muscle atrophy/weakness and health care costs and utilization among patients receiving total knee replacement surgery: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Chen SY

    2013-08-01

    Full Text Available Shih-Yin Chen,1 Ning Wu,1 Yuan-Chi Lee,1 Yang Zhao21Health Economics and Epidemiology, Evidera, Lexington, Massachusetts, 2Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USAPurpose: The aim of the study reported here was to examine health care resource utilization, costs, and risk of rehospitalization for total knee replacement (TKR patients with and without muscle atrophy/weakness (MAW.Patients and methods: Individuals aged 50–64 years with commercial insurance or 65+ years with Medicare Supplemental Insurance (Medicare who had a hospitalization for TKR between January 1, 2006 and September 30, 2009 were identified from a large US claims database. First hospitalization for TKR was defined as the index stay. All patients were classified into three cohorts according to when MAW was diagnosed relative to TKR: pre-MAW, post-MAW, and no MAW. The association between MAW and health care costs over the 12-month post-index period and the probability of rehospitalization were assessed via multivariate regressions.Results: The study sample included 53,696 Medicare and 46,058 commercial insurance TKR patients. Controlling for cross-cohort differences, both the pre- and post-MAW cohorts had significantly higher total health care costs (Medicare US$4,201 and US$9,404 higher, commercial insurance US$2,737 and US$6,640 higher, respectively than the no MAW cohort (all P < 0.05. The post-MAW cohort in both populations was also more likely to have any all-cause or replacement-related rehospitalization compared with the no MAW cohort.Conclusion: Among US patients undergoing TKR, those with MAW had higher health care utilization and costs than patients without MAW.Keywords: rehospitalization, resource utilization, Medicare, health insurance, USA

  19. Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients

    Directory of Open Access Journals (Sweden)

    Sills E

    2012-08-01

    Full Text Available Abstract Background During in vitro fertilization (IVF, fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF. Methods Data were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied. Results Completed questionnaires (n = 71 revealed a mean +/− SD patient age of 34 +/− 4.1 yrs. Most (83.1% had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s. When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/− 11.75 and $654.55 +/− 106.34, respectively (p  Conclusions This investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs

  20. a Circleless "2D/3D Total STATION": a Low Cost Instrument for Surveying, Recording Point Clouds, Documentation, Image Acquisition and Visualisation

    Science.gov (United States)

    Scherer, M.

    2013-07-01

    Hardware and software of the universally applicable instrument - referred to as a 2D/3D total station - are described here, as well as its practical use. At its core it consists of a 3D camera - often also called a ToF camera, a pmd camera or a RIM-camera - combined with a common industrial 2D camera. The cameras are rigidly coupled with their optical axes in parallel. A new type of instrument was created mounting this 2D/3D system on a tripod in a specific way. Because of it sharing certain characteristics with a total station and a tacheometer, respectively, the new device was called a 2D/3D total station. It may effectively replace a common total station or a laser scanner in some respects. After a brief overview of the prototype's features this paper then focuses on the methodological characteristics for practical application. Its usability as a universally applicable stand-alone instrument is demonstrated for surveying, recording RGB-coloured point clouds as well as delivering images for documentation and visualisation. Because of its limited range (10m without reflector and 150 m to reflector prisms) and low range accuracy (ca. 2 cm to 3 cm) compared to present-day total stations and laser scanners, the practical usage of the 2D/3D total station is currently limited to acquisition of accidents, forensic purpuses, speleology or facility management, as well as architectural recordings with low requirements regarding accuracy. However, the author is convinced that in the near future advancements in 3D camera technology will allow this type of comparatively low cost instrument to replace the total station as well as the laser scanner in an increasing number of areas.

  1. Plerixafor mobilization leads to a lower ratio of CD34+ cells to total nucleated cells which results in greater storage costs.

    Science.gov (United States)

    Tanhehco, Yvette C; Adamski, Jill; Sell, Mary; Cunningham, Kathleen; Eisenmann, Christa; Magee, Deborah; Stadtmauer, Edward A; O'Doherty, Una

    2010-01-01

    Plerixafor (Mozobil, AMD3100) with granulocyte-colony stimulating factor (G-CSF) mobilizes more CD34+ cells/kg compared to G-CSF alone. Given that plerixafor enhances mobilization of multiple white blood cell lineages, we determined if more storage space is required for products collected from patients mobilized with plerixafor. A review of the medical records of 15 patients mobilized with chemotherapy and G-CSF (control) and 14 patients mobilized with plerixafor plus G-CSF (plerixafor) was performed. Data on demographics, baseline characteristics, CD34+ cells/kg, total nucleated cells, total mononuclear cells, total apheresis sessions, and total bags for storage were collected. Mean values were determined and compared using Student's t-test. We found that the proportion of CD34+ cells among total nucleated cells was less in the plerixafor group compared to the control group (P = 0.0427). More nucleated cells (10.7 x 10(10) vs. 7.1 x 10(10), P =0.0452) and mononuclear cells (9.7 x 10(10) vs. 5.9 x 10(10), P = 0.0059) were mobilized with plerixafor plus G-CSF. However, there was no significant difference in CD34+ cells/kg, total CD34+ cells or the proportion of mononuclear cells among total nucleated cells between the two groups. More storage bags were required for the plerixafor group compared to the control group (15 vs. 9, P = 0.0299). Mobilization with plerixafor plus G-CSF resulted in a smaller proportion of CD34+ cells collected and a greater number of storage bags. An increase in the number of bags required for stem cell storage may be logistically problematic and will also lead to increased costs for storage of stem cells.

  2. Cost minimization analysis at the Hospital Mexico in the Caja Costarricense de Seguro Social for the accommodation of patients with radiotherapy with linear accelerator: shelter vs transfers

    International Nuclear Information System (INIS)

    Cespedes Quiros, Yehudi; Pereira Barrantes, Edgar

    2010-01-01

    Patients with oncological pathology have attended daily in sessions for several weeks in the linear accelerator radiation therapy. Persons subject to this intervention have moved to the Hospital Mexico of the social security of Costa Rica, place that centralizes this treatment. The Caja Costarricense de Seguro Social (CCSS) has considered two options depending on the place of origin of users: bear the costs of commuting from the area of habitual residence, or place them temporarily in a shelter provided by the institution; the CCSS has chosen the first alternative. This research has consisted of a cost-minimization analysis between these two alternatives. The study population are patients with oncological pathology attending sessions of radiotherapy with linear accelerator at the Hospital Mexico in the first half of 2009 using ambulances of Cruz Roja Costarricense. The size of the study population is 107 persons, the total number of transferred recorded in the Fondo Rotatorio de Operaciones of Hospital Mexico is 998. Patients came from five regions and twenty areas of health according to the geographical division of the CCSS. The variables included have been: cost per day by way of transfer, which involves the distance to the radiotherapy center of Hospital Mexico and the cost of the rate at Cruz Roja ambulance per Km (326.86 colons, according to the agreement CCSS-Cruz Roja in June 2009) estimated daily cost of lodging in a shelter, and the reason daily cost of relocation / daily cost of shelter. The cost of shelter includes food and were used data from the company International Medical Suppliers S. A. as a basis for estimating the daily cost, the price fixed by the company was 65 dollars a day, and the conversion into colons exchange rate as established by the Banco Central de Costa Rica; dated April 30, 2010, the amount has been 33.542.60 colons. The reason for each area of health was given by the ratio of the average daily cost in colons by way of ambulance of

  3. Latest results of the international discussion on the social costs of energy - how does wind compare today?

    International Nuclear Information System (INIS)

    Hohmeyer, O.H.

    1990-01-01

    A first analysis of the social costs of competing technologies for electric power generation published in 1988 has induced a rather controversial scientific discussion about the magnitude of and the possible ways to incorporate cost elements not included in energy prices into decisions on energy systems. Different research projects following up a number of controversial or unanswered questions in the field of social costs have been started in the Federal Republic of Germany (FRG), in Europe and overseas. A first ''counter-study'' has been published in the FRG in 1989. The paper summarizes the latest results of international scientific discussion and research and sketches possible future trends in this field and the practical and political implementation of its results. A first estimate of the consideration of global warming effects due to conventional electricity generation is included in addition to recalculated results on topics addressed by the author in 1988. It concludes that the figures calculated in 1988 have been underestimating the magnitude of the costs not included in the energy prices and that new calculations including further results on CO 2 lead to significantly higher figures. The difference of the costs not included in the price of conventional electricity and wind energy rises from 8.4 to 14 Pf/kWh on average with an estimated range of 4.7 to 25.4 Pf/kWh (1 DM = 100 pf = 0.5 ECU). Considering the full costs of electricity generation it can be concluded that wind energy is one of the most economical ways to produce electricity today. Political considerations on how to take social costs of electricity generation into account have reached some definite conclusions in some states of the USA. The paper gives a short sketch of these activities. (Author)

  4. Assessing energy projects from the viewpoint of individual economic branches and total economy. The role of economic efficiency analysis, cost-benefit analysis and multicriteria methods

    International Nuclear Information System (INIS)

    Sell, A.

    1992-01-01

    Energy is an extremely important good and means of production not only for the individual branches of economy but, due to its essential meaning to the development of a region or a national economy and its external effects connected with production and consumption, also of great interest to all economic branches. This article deals with the relation of analyses in individual economical branches and those in total economy and with the question of what the importance of cost-benefit analyses and other methods is in the analysis in total economy. The author also mentions the planning as in the special literature the planning and evaluation phases are not analytically separated which is seen especially in the discussion about the multi-criteria methods. (orig.) [de

  5. Life-Cycle Cost-Benefit (LCCB) Analysis of Bridges from a User and Social Point of View

    DEFF Research Database (Denmark)

    Thoft-Christensen, Palle

    2009-01-01

    is to present and discuss some of these problems from a user and social point of view. A brief presentation of a preliminary study of the importance of including benefits in life-cycle cost-benefit analysis in management systems for bridges is shown. Benefits may be positive as well as negative from the user...... point of view. In the paper, negative benefits (user costs) are discussed in relation to the maintenance of concrete bridges. A limited number of excerpts from published reports that are related to the importance of estimating user costs when repairs of bridges are planned, and when optimized strategies......During the last two decades, important progress has been made in the life-cycle cost-benefit (LCCB) analysis of structures, especially offshore platforms, bridges and nuclear installations. Due to the large uncertainties related to the deterioration, maintenance, and benefits of such structures...

  6. Social/economic costs and health-related quality of life in patients with cystic fibrosis in Europe.

    Science.gov (United States)

    Chevreul, Karine; Michel, Morgane; Brigham, Karen Berg; López-Bastida, Julio; Linertová, Renata; Oliva-Moreno, Juan; Serrano-Aguilar, Pedro; Posada-de-la-Paz, Manuel; Taruscio, Domenica; Schieppati, Arrigo; Iskrov, Georgi; Péntek, Márta; von der Schulenburg, Johann Matthias Graf; Kanavos, Panos; Persson, Ulf; Fattore, Giovani

    2016-04-01

    Our goal was to provide data on the economic burden and health-related quality of life (HRQOL) of patients with cystic fibrosis (CF) and their caregivers in Europe. A cross-sectional study was carried out on adults and children with CF in eight European countries. Patients completed an anonymous questionnaire regarding their socio-demographic characteristics, use of healthcare services and presence of a caregiver. Costs were calculated with a bottom-up approach using unit costs from each participating country, and HRQOL was assessed using EQ-5D. The principal caregiver also answered a questionnaire on their characteristics, HRQOL and burden. A total of 905 patients with CF was included (399 adults and 506 children). The total average annual cost per patient varied from €21,144 in Bulgaria to €53,256 in Germany. Adults had higher direct healthcare costs than children, but children had much higher informal care costs (P costs increased with patients' level of dependence. In adults, mean utility fell between 0.640 and 0.870, and the visual analogue scale ranged from 46.0 to 69.7. There was no difference in caregiver HRQOL regardless of whether they cared for an adult or a child. However, caregivers who looked after a child had a significantly higher burden (P = 0.0013). Our study highlights the burden of CF in terms of costs and decreased HRQOL for both patients and their caregivers throughout Europe.

  7. Total Environment of Change: Impacts of Climate Change and Social Transitions on Subsistence Fisheries in Northwest Alaska

    Directory of Open Access Journals (Sweden)

    Katie J. Moerlein

    2012-03-01

    Full Text Available Arctic ecosystems are undergoing rapid changes as a result of global climate change, with significant implications for the livelihoods of Arctic peoples. In this paper, based on ethnographic research conducted with the Iñupiaq communities of Noatak and Selawik in northwestern Alaska, we detail prominent environmental changes observed over the past twenty to thirty years and their impacts on subsistence-based lifestyles. However, we suggest that it is ultimately insufficient to try to understand how Arctic communities are experiencing and responding to climate change in isolation from other stressors. During interviews and participant observation documenting local observations of climatic and related environmental shifts and impacts to subsistence fishing practices, we find the inseparability of environmental, social, economic, cultural, and political realms for community residents. Many of our informants, who live in a mixed economy based on various forms of income and widespread subsistence harvesting of fish and game, perceive and experience climate change as embedded among numerous other factors affecting subsistence patterns and practices. Changing lifestyles, decreasing interest by younger generations in pursuing subsistence livelihoods, and economic challenges are greatly affecting contemporary subsistence patterns and practices in rural Alaska. Observations of climate change are perceived, experienced, and articulated to researchers through a broader lens of these linked lifestyle and cultural shifts. Therefore, we argue that to properly assess and understand the impacts of climate change on the subsistence practices in Arctic communities, we must also consider the total environment of change that is dramatically shaping the relationship between people, communities, and their surrounding environments.

  8. Occupational and behavioural factors in the explanation of social inequalities in premature and total mortality: a 12.5-year follow-up in the Lorhandicap study

    OpenAIRE

    Niedhammer, Isabelle; Bourgkard, Eve; Chau, Nearkasen

    2010-01-01

    Abstract The respective contribution of occupational and behavioural factors to social disparities in all-cause mortality has been studied very seldom. The objective of this study was to evaluate the role of occupational and behavioural factors in explaining social inequalities in premature and total mortality in the French working population. The study population consisted of a sample of 2,189 and 1,929 French working men and women, who responded to a self-administered questionnai...

  9. The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar

    Science.gov (United States)

    2013-01-01

    Introduction This paper examines the cost of quality improvements in Population Services International (PSI) Myanmar’s social franchise operations from 2007 to 2009. Methods The social franchise commodities studied were products for reproductive health, malaria, STIs, pneumonia, and diarrhea. This project applied ingredients based costing for labor, supplies, transport, and overhead. Data were gathered seven during key informant interviews with staff in the central Yangon office, examination of 3 years of payroll data, examination of a time motion study conducted by PSI, and spreadsheets recording the costs of acquiring and transporting supplies. Results In 2009 PSI Myanmar’s social franchise devoted $2.02 million towards a 94% reduction in commodity prices offered to its network of over 1700 primary care providers. These providers retained 1/3 of the subsidy as revenue and passed along the other 2/3 to their patients in the course of offering subsidized care for 1.5 million health episodes. In addition, PSI Myanmar devoted $2.09 million to support a team of franchise officers who conducted quality assurance for the private providers overseeing service quality and to distributing medical commodities. Conclusion In Myanmar, the social franchise operated by PSI spends roughly $1.00 in quality management and retailing for every $1.00 spent subsidizing medical commodities. Some services are free, but patients also pay fees for other lines of service. Overall patients contribute 1/6 as much as PSI does. Unlike other NGO’s, health services in social franchises like PSI are not all free to the patients, nor are the discounts uniformly applied. Discounts and subsidies evolve in response to public health concerns, market demand, providers’ cost structures as well as strategic objectives in maintaining the network and its portfolio of services. PMID:23826743

  10. The cost of service quality improvements: tracking the flow of funds in social franchise networks in Myanmar.

    Science.gov (United States)

    Bishai, David; LeFevre, Amnesty; Theuss, Marc; Boxshall, Matt; Hetherington, John D; Zaw, Min; Montagu, Dominic

    2013-01-01

    This paper examines the cost of quality improvements in Population Services International (PSI) Myanmar's social franchise operations from 2007 to 2009. The social franchise commodities studied were products for reproductive health, malaria, STIs, pneumonia, and diarrhea. This project applied ingredients based costing for labor, supplies, transport, and overhead. Data were gathered seven during key informant interviews with staff in the central Yangon office, examination of 3 years of payroll data, examination of a time motion study conducted by PSI, and spreadsheets recording the costs of acquiring and transporting supplies. In 2009 PSI Myanmar's social franchise devoted $2.02 million towards a 94% reduction in commodity prices offered to its network of over 1700 primary care providers. These providers retained 1/3 of the subsidy as revenue and passed along the other 2/3 to their patients in the course of offering subsidized care for 1.5 million health episodes. In addition, PSI Myanmar devoted $2.09 million to support a team of franchise officers who conducted quality assurance for the private providers overseeing service quality and to distributing medical commodities. In Myanmar, the social franchise operated by PSI spends roughly $1.00 in quality management and retailing for every $1.00 spent subsidizing medical commodities. Some services are free, but patients also pay fees for other lines of service. Overall patients contribute 1/6 as much as PSI does. Unlike other NGO's, health services in social franchises like PSI are not all free to the patients, nor are the discounts uniformly applied. Discounts and subsidies evolve in response to public health concerns, market demand, providers' cost structures as well as strategic objectives in maintaining the network and its portfolio of services.

  11. Trends in primary total hip arthroplasty in Spain from 2001 to 2008: Evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality

    Directory of Open Access Journals (Sweden)

    Jimenez-Trujillo Isabel

    2011-02-01

    Full Text Available Abstract Background Hip arthroplasties is one of the most frequent surgical procedures in Spain and are conducted mainly in elderly subjects. We aim to analyze changes in incidence, co-morbidity profile, length of hospital stay (LOHS, costs and in-hospital mortality (IHM of patients undergoing primary total hip arthroplasty (THA over an 8-year study period in Spain. Methods We selected all surgical admissions in individuals aged ≥40 years who had received a primary THA (ICD-9-CM procedure code 81.51 between 2001 and 2008 from the National Hospital Discharge Database. Age- and sex-specific incidence rates, LOHS, costs and IHM were estimated for each year. Co-morbidity was assessed using the Charlson comorbidity index. Multivariate analysis of time trends was conducted using Poisson regression. Logistic regression models were conducted to analyze IHM. Results We identified a total of 161,791 discharges of patients having undergone THA from 2001 to 2008. Overall crude incidence had increased from 99 to 105 THA per 100.000 inhabitants from 2001 to 2008 (p 2 and in 2008, the prevalence of 1-2 or >2 had increased to 20.4% and 1.1% respectively (p Conclusions The current study provides clear and valid data indicating increased incidence of primary THA in Spain from 2001 to 2008 with concomitant reductions in LOHS, slight reduction IHM, but a significant increase in cost per patient. The health profile of the patient undergoing a THA seems to be worsening in Spain.

  12. Commentary on community-led total sanitation and human rights: should the right to community-wide health be won at the cost of individual rights?

    Science.gov (United States)

    Bartram, Jamie; Charles, Katrina; Evans, Barbara; O'Hanlon, Lucinda; Pedley, Steve

    2012-12-01

    The Millennium Development Goals (MDGs) set out to halve the proportion of the population without access to basic sanitation between 1990 and 2015. The slow pace of progress has lead to a search for innovative responses, including social motivation approaches. One example of this type of approach is 'Community-led Total Sanitation' (CLTS). CLTS represents a major shift for sanitation projects and programmes in recognising the value of stopping open-defecation across the whole community, even when the individual toilets built are not necessarily wholly hygienic. However, recent publications on CLTS document a number of examples of practices which fail to meet basic ethical criteria and infringe human rights. There is a general theme in the CLTS literature encouraging the use of 'shame' or 'social stigma' as a tool for promoting behaviours. There are reported cases where monetary benefits to which individuals are otherwise entitled or the means to practice a livelihood are withheld to create pressures to conform. At the very extreme end of the scale, the investigation and punishment of violence has reportedly been denied if the crime occurred while defecating in the open, violating rights to a remedy and related access to justice. While social mobilisation in general, and CLTS in particular, have drastically and positively changed the way we think about sanitation, they neither need nor benefit from an association with any infringements of human rights.

  13. Effects of primary care team social networks on quality of care and costs for patients with cardiovascular disease.

    Science.gov (United States)

    Mundt, Marlon P; Gilchrist, Valerie J; Fleming, Michael F; Zakletskaia, Larissa I; Tuan, Wen-Jan; Beasley, John W

    2015-03-01

    Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Primary care teams can be best suited to improve quality of care and lower costs for patients with cardiovascular disease. This study evaluates the associations between primary care team communication, interaction, and coordination (ie, social networks); quality of care; and costs for patients with cardiovascular disease. Using a sociometric survey, 155 health professionals from 31 teams at 6 primary care clinics identified with whom they interact daily about patient care. Social network analysis calculated variables of density and centralization representing team interaction structures. Three-level hierarchical modeling evaluated the link between team network density, centralization, and number of patients with a diagnosis of cardiovascular disease for controlled blood pressure and cholesterol, counts of urgent care visits, emergency department visits, hospital days, and medical care costs in the previous 12 months. Teams with dense interactions among all team members were associated with fewer hospital days (rate ratio [RR] = 0.62; 95% CI, 0.50-0.77) and lower medical care costs (-$556; 95% CI, -$781 to -$331) for patients with cardiovascular disease. Conversely, teams with interactions revolving around a few central individuals were associated with increased hospital days (RR = 1.45; 95% CI, 1.09-1.94) and greater costs ($506; 95% CI, $202-$810). Team-shared vision about goals and expectations mediated the relationship between social network structures and patient quality of care outcomes. Primary care teams that are more interconnected and less centralized and that have a shared team vision are better positioned to deliver high-quality cardiovascular disease care at a lower cost. © 2015 Annals of Family Medicine, Inc.

  14. Social Costs of Poverty; Leisure Time Socializing and the Subjective Experience of Social Isolation among 13-16-Year-Old Norwegians

    Science.gov (United States)

    Sletten, Mira Aaboen

    2010-01-01

    The article examines leisure time socializing and the subjective experience of social isolation among Norwegian 13-16-year-olds in poor families. The empirical analyses use data from a representative survey in Norway in 2002 and show the likelihood of participation in leisure time socializing with peers to be lower among 13-16-year-olds in poor…

  15. Comparison of turnaround time and total cost of HIV testing before and after implementation of the 2014 CDC/APHL Laboratory Testing Algorithm for diagnosis of HIV infection.

    Science.gov (United States)

    Chen, Derrick J; Yao, Joseph D

    2017-06-01

    Updated recommendations for HIV diagnostic laboratory testing published by the Centers for Disease Control and Prevention and the Association of Public Health Laboratories incorporate 4th generation HIV immunoassays, which are capable of identifying HIV infection prior to seroconversion. The purpose of this study was to compare turnaround time and cost between 3rd and 4th generation HIV immunoassay-based testing algorithms for initially reactive results. The clinical microbiology laboratory database at Mayo Clinic, Rochester, MN was queried for 3rd generation (from November 2012 to May 2014) and 4th generation (from May 2014 to November 2015) HIV immunoassay results. All results from downstream supplemental testing were recorded. Turnaround time (defined as the time of initial sample receipt in the laboratory to the time the final supplemental test in the algorithm was resulted) and cost (based on 2016 Medicare reimbursement rates) were assessed. A total of 76,454 and 78,998 initial tests were performed during the study period using the 3rd generation and 4th generation HIV immunoassays, respectively. There were 516 (0.7%) and 581 (0.7%) total initially reactive results, respectively. Of these, 304 (58.9%) and 457 (78.7%) were positive by supplemental testing. There were 10 (0.01%) cases of acute HIV infection identified with the 4th generation algorithm. The most frequent tests performed to confirm an HIV-positive case using the 3rd generation algorithm, which were reactive initial immunoassay and positive HIV-1 Western blot, took a median time of 1.1 days to complete at a cost of $45.00. In contrast, the most frequent tests performed to confirm an HIV-positive case using the 4th generation algorithm, which included a reactive initial immunoassay and positive HIV-1/-2 antibody differentiation immunoassay for HIV-1, took a median time of 0.4 days and cost $63.25. Overall median turnaround time was 2.2 and 1.5 days, and overall median cost was $63.90 and $72.50 for

  16. [Prevention of Occupational Injuries Related to Hands: Calculation of Subsequent Injury Costs for the Austrian Social Occupational Insurance Institution (AUVA)].

    Science.gov (United States)

    Rauner, M S; Mayer, B; Schaffhauser-Linzatti, M M

    2015-08-01

    Occupational injuries cause short-term, direct costs as well as long-term follow-up costs over the lifetime of the casualties. Due to shrinking budgets accident insurance companies focus on cost reduction programmes and prevention measures. For this reason, a decision support system for consequential cost calculation of occupational injuries was developed for the main Austrian social occupational insurance institution (AUVA) during three projects. This so-called cost calculation tool combines the traditional instruments of accounting with quantitative methods such as micro-simulation. The cost data are derived from AUVA-internal as well as external economic data sources. Based on direct and indirect costs, the subsequent occupational accident costs from the time of an accident and, if applicable, beyond the death of the individual casualty are predicted for the AUVA, the companies in which the casualties are working, and the other economic sectors. By using this cost calculation tool, the AUVA classifies risk groups and derives related prevention campaigns. In the past, the AUVA concentrated on falling, accidents at construction sites and in agriculture/forestry, as well as commuting accidents. Currently, among others, a focus on hand injuries is given and first prevention programmes have been initiated. Hand injuries represent about 38% of all casualties with average costs of about 7,851 Euro/case. Main causes of these accidents are cutting injuries in production, agriculture, and forestry. Beside a low, but costly, number of amputations with average costs of more than 100,000 Euro/case, bone fractures and strains burden the AUVA-budget with about 17,500 and 10,500 € per case, respectively. Decision support systems such as this cost calculation tool represent necessary instruments to identify risk groups and their injured body parts, causes of accidents, and economic activities, which highly burden the budget of an injury company, and help derive

  17. How much electricity really costs. Comparison of the state subsidisation and overall social costs of conventional and renewable energy resources; Was Strom wirklich kostet. Vergleich der staatlichen Foerderungen und gesamtgesellschaftlichen Kosten konventioneller und erneuerbarer Energien

    Energy Technology Data Exchange (ETDEWEB)

    Kuechler, Swantje; Meyer, Bettina

    2012-07-01

    This study explains how the costs of electricity are an aggregate of different components. The electricity price paid by the end consumer contains not only the actual costs of energy production, which make up only about a third of the actual price in an average household, but also different surcharges such as network charges, electricity tax, value added tax and the concession levy. It furthermore contains the allocation charge stipulated by the Renewable Energy Law (EEG reallocation charge) as a means of allocating the costs of the subsidisation of electricity from renewable resources to the consumers. On the other hand conventional energy resources such as nuclear energy, hard coal and brown coal have substantially benefited over many decades from state subsidies in the form of financial aids, tax rebates and other promotive measures. The main difference between this and the subsidisation of renewable energy is that the costs of conventional energy resources are largely charged to the state budget rather than being made transparent in the electricity price. Based on an evaluation of the literature, data, interviews and the authors' own methodological deliberations this study makes a systematic comparison of the direct as well as indirect state subsidisation of renewable and conventional energy resources during the period from 1970 until 2012. The annual totals obtained for each energy resources are then set in relation to the share of that resource in overall electricity production, yielding specific subsidisation rates in terms of cents per kWh for each resource. This does not yet take into account the high consequential costs in the form of environmental damage and climate-related damage caused by fossil and nuclear fuels as well as the risks associated with the latter (collectively referred to as ''external costs''), all of which are charged to the polluters only at a small fraction of the true amount. The two cost categories of state

  18. The Generalized Roy Model and the Cost-Benefit Analysis of Social Programs*

    Science.gov (United States)

    Eisenhauer, Philipp; Heckman, James J.; Vytlacil, Edward

    2015-01-01

    The literature on treatment effects focuses on gross benefits from program participation. We extend this literature by developing conditions under which it is possible to identify parameters measuring the cost and net surplus from program participation. Using the generalized Roy model, we nonparametrically identify the cost, benefit, and net surplus of selection into treatment without requiring the analyst to have direct information on the cost. We apply our methodology to estimate the gross benefit and net surplus of attending college. PMID:26709315

  19. The Generalized Roy Model and the Cost-Benefit Analysis of Social Programs.

    Science.gov (United States)

    Eisenhauer, Philipp; Heckman, James J; Vytlacil, Edward

    2015-04-01

    The literature on treatment effects focuses on gross benefits from program participation. We extend this literature by developing conditions under which it is possible to identify parameters measuring the cost and net surplus from program participation. Using the generalized Roy model, we nonparametrically identify the cost, benefit, and net surplus of selection into treatment without requiring the analyst to have direct information on the cost. We apply our methodology to estimate the gross benefit and net surplus of attending college.

  20. The social costs of production and the structure of technology in the Brazilian ethanol industry: A cost-benefit analysis and an infant industry evaluation, 1978-1987

    International Nuclear Information System (INIS)

    Rask, K.N.

    1991-01-01

    Only one country, Brazil, has developed an economy-wide liquid fuel industry which directly substitutes for gasoline. The experience of sugar-cane-based ethanol production in Brazil provides an important case study in the economic efficiency of this petroleum substitute. Partial equilibrium cost-benefit analysis is used to evaluate the net social benefits of ethanol production over the decade beginning in 1978. Ethanol production from the southern region of Brazil is found to be an economically efficient substitute for petroleum when world oil prices are over $20 per barrel. Ethanol production in the northern Brazil has never been economic and will not be until oil prices rise above $40 per barrel. The second half of this thesis uses applied production analysis to determine the source of the ethanol unit cost reductions. For sugar-cane production, a modified symmetric generalized McFadden cost function which includes fixed factors of production is estimated. There is little evidence of technical progress and no evidence of increasing returns to scale in sugar-cane production

  1. Changes in social isolation and loneliness following total hip and knee arthroplasty: longitudinal analysis of the English Longitudinal Study of Ageing (ELSA) cohort.

    Science.gov (United States)

    Smith, T O; Dainty, J R; MacGregor, A J

    2017-09-01

    To determine the prevalence and change in social isolation and loneliness in people before and after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in England. The English Longitudinal Study of Ageing (ELSA) dataset, a prospective study of community-dwelling older adults, was used to identify people who had undergone primary THA or TKA because of osteoarthritis. Social isolation was assessed using the ELSA Social Isolation Index. Loneliness was evaluated using the Revised University of California, Los Angeles (UCLA) Loneliness Scale. The prevalence of social isolation and loneliness were calculated and multilevel modelling was performed to assess the potential change of these measures before arthroplasty, within a two-year operative-recovery phase and a following two-year follow-up. The sample consisted of 393 people following THA and TKA. The prevalence of social isolation and loneliness changed from 16.9% to 18.8% pre-operative to 21.8% and 18.9% at the final post-operative follow-up respectively. This was not a statistically significant change for either measure (P = 0.15; P = 0.74). There was a significant difference in social isolation at the recovery phase compared to the pre-operative phase (P = 0.01), where people following arthroplasty reported an increase in social isolation (16.9-21.4%). There was no significant difference between the assessment phases in respect to UCLA Loneliness Scale score (P ≥ 0.74). Given the negative physical and psychological consequences which social isolation and loneliness can have on individuals following THA or TKA, clinicians should be mindful of this health challenge for this population. The reported prevalence of social isolation and loneliness suggests this is an important issue. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  2. Are Luxury Brand Labels and “Green” Labels Costly Signals of Social Status? An Extended Replication

    Science.gov (United States)

    2017-01-01

    Costly signaling theory provides an explanation for why humans are willing to a pay a premium for conspicuous products such as luxury brand-labeled clothing or conspicuous environmentally friendly cars. According to the theory, the extra cost of such products is a signal of social status and wealth and leads to advantages in social interactions for the signaler. A previous study found positive evidence for the case of luxury brand labels. However, an issue of this study was that some of the experiments were not conducted in a perfectly double-blind manner. I resolved this by replicating variations of the original design in a double-blind procedure. Additionally, besides the luxury label condition, I introduced a “green” label condition. Thus, the hypothesis that signaling theory is able to explain pro-environmental behavior was tested for the first time in a natural field setting. Further, I conducted experiments in both average and below-average socioeconomic neighborhoods, where, according to signaling theory, the effects of luxury signals should be even stronger. In contrast to the original study, I did not find positive effects of the luxury brand label in any of the five experiments. Nor did I find evidence for a green-signaling effect. Moreover, in poor neighborhoods a negative tendency of the luxury label actually became evident. This suggests that a signaling theory explanation of costly labels must take into account the characteristics of the observers, e.g. their social status. PMID:28170399

  3. Don't grin when you win: the social costs of positive emotion expression in performance situations.

    Science.gov (United States)

    Kalokerinos, Elise K; Greenaway, Katharine H; Pedder, David J; Margetts, Elise A

    2014-02-01

    People who express positive emotion usually have better social outcomes than people who do not, and suppressing the expression of emotions can have interpersonal costs. Nevertheless, social convention suggests that there are situations in which people should suppress the expression of positive emotions, such as when trying to appear humble in victory. The present research tested whether there are interpersonal costs to expressing positive emotions when winning. In Experiment 1, inexpressive winners were evaluated more positively and rated as lower in hubristic-but not authentic-pride compared with expressive winners. Experiment 2 confirmed that inexpressive winners were perceived as using expressive suppression to downregulate their positive emotion expression. Experiment 3 replicated the findings of Experiment 1, and also found that people were more interested in forming a friendship with inexpressive winners than expressive winners. The effects were mediated by the perception that the inexpressive winner tried to protect the loser's feelings. This research is the first to identify social costs of expressing positive emotion, and highlights the importance of understanding the situational context when determining optimal emotion regulation strategies. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  4. Social capital and transaction cost on co-creating IT value towards inter-organizational EMR exchange.

    Science.gov (United States)

    Chang, Hsin Hsin; Hung, Chung-Jye; Huang, Ching Ying; Wong, Kit Hong; Tsai, Yi Ju

    2017-01-01

    This study adopts social capital theory and transaction cost theory to explore the feasibility of an inter-organizational cross-hospital electronic medical records (EMR) exchange system, and the factors that affect its adoption. The concept of value co-creation is also used to assess such a system, and its influence on the performance of participating medical institutes. This research collected 330 valid paper-based questionnaires from the medical staff of various institutes. The results showed that social interaction ties and shared vision positively affected medical institutes' willingness to adopt the EMR exchange system, while asset specificity and uncertainty increased the related transaction costs. With a greater willingness to invest in relation-specific assets and to meet the related transaction costs, this behavior lead to an increase in medical IT value, as well as better results for the related medical institutes, medical staff, and patients. Therefore, this study suggests that such institutes encourage their medical staff to participate in seminars or reunions in order to develop their professional and social networks, and set up clear schedules and desire for expected effects when introducing the cross-hospital EMR exchange system. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study.

    NARCIS (Netherlands)

    Brembo, E.A.; Kapstad, H.; Dulmen, S. van; Eide, H.

    2017-01-01

    Background: Despite the overall success of total hip replacement (THR) in patients with symptomatic osteoarthritis (OA), up to one-quarter of patients report suboptimal recovery. The aim of this study was to determine whether social support and general self-efficacy predict variability in short-term

  6. An integer batch scheduling model considering learning, forgetting, and deterioration effects for a single machine to minimize total inventory holding cost

    Science.gov (United States)

    Yusriski, R.; Sukoyo; Samadhi, T. M. A. A.; Halim, A. H.

    2018-03-01

    This research deals with a single machine batch scheduling model considering the influenced of learning, forgetting, and machine deterioration effects. The objective of the model is to minimize total inventory holding cost, and the decision variables are the number of batches (N), batch sizes (Q[i], i = 1, 2, .., N) and the sequence of processing the resulting batches. The parts to be processed are received at the right time and the right quantities, and all completed parts must be delivered at a common due date. We propose a heuristic procedure based on the Lagrange method to solve the problem. The effectiveness of the procedure is evaluated by comparing the resulting solution to the optimal solution obtained from the enumeration procedure using the integer composition technique and shows that the average effectiveness is 94%.

  7. Hemophilia A Pseudoaneurysm in a Patient with High Responding Inhibitors Complicating Total Knee Arthroplasty: Embolization: A Cost-Reducing Alternative to Medical Therapy

    International Nuclear Information System (INIS)

    Kickuth, Ralph; Anderson, Suzanne; Peter-Salonen, Kristiina; Laemmle, Bernhard; Eggli, Stefan; Triller, Juergen

    2006-01-01

    Joint hemorrhages are very common in patients with severe hemophilia. Inhibitors in patients with hemophilia are allo-antibodies that neutralize the activity of the clotting factor. After total knee replacement, rare intra-articular bleeding complications might occur that do not respond to clotting factor replacement. We report a 40-year-old male with severe hemophilia A and high responding inhibitors presenting with recurrent knee joint hemorrhage after bilateral knee prosthetic surgery despite adequate clotting factor treatment. There were two episodes of marked postoperative hemarthrosis requiring extensive use of subsititution therapy. Eleven days postoperatively, there was further hemorrhage into the right knee. Digital subtraction angiography diagnosed a complicating pseudoaneurysm of the inferior lateral geniculate artery and embolization was successfully performed. Because clotting factor replacement therapy has proved to be excessively expensive and prolonged, especially in patients with inhibitors, we recommend the use of cost-effective early angiographic embolization

  8. Cost-effectiveness and evidence-based policy : Steering on social Impact

    NARCIS (Netherlands)

    van Yperen, Tom

    2016-01-01

    Introduction - The cost-effectiveness of many services is unknown. Because the demand for services is growing, whereas budgets are cut, the issue how to enhance the cost-effectiveness of Child and Youth Care is urgent in day to day politics and practice. The NJi developed a working model that helps

  9. Children's reasoning about the refusal to help : The role of need, costs, and social perspective taking

    NARCIS (Netherlands)

    Sierksma, Jellie|info:eu-repo/dai/nl/357399609; Thijs, Jochem|info:eu-repo/dai/nl/187457344; Verkuijten, Maykel|info:eu-repo/dai/nl/073378542; Komter, Aafke|info:eu-repo/dai/nl/070789282

    2014-01-01

    Children (n = 133, aged 8-13) were interviewed about helping situations that systematically varied in recipient's need for help and the costs for the helper. In situations where helping a peer involved low costs, children perceived a moral obligation to help that was independent of peer norms,

  10. Children's Reasoning About the Refusal to Help: The Role of Need, Costs, and Social Perspective Taking

    NARCIS (Netherlands)

    Sierksma, J.; Thijs, J.T.; Verkuyten, M.J.A.M.; Komter, A.E.

    2014-01-01

    Children (n=133, aged 8-13) were interviewed about helping situations that systematically varied in recipient's need for help and the costs for the helper. In situations where helping a peer involved low costs, children perceived a moral obligation to help that was independent of peer norms,

  11. Social welfare and the Affordable Care Act: is it ever optimal to set aside comparative cost?

    Science.gov (United States)

    Mortimer, Duncan; Peacock, Stuart

    2012-10-01

    The creation of the Patient-Centered Outcomes Research Institute (PCORI) under the Affordable Care Act has set comparative effectiveness research (CER) at centre stage of US health care reform. Comparative cost analysis has remained marginalised and it now appears unlikely that the PCORI will require comparative cost data to be collected as an essential component of CER. In this paper, we review the literature to identify ethical and distributional objectives that might motivate calls to set priorities without regard to comparative cost. We then present argument and evidence to consider whether there is any plausible set of objectives and constraints against which priorities can be set without reference to comparative cost. We conclude that - to set aside comparative cost even after accounting for ethical and distributional constraints - would be truly to act as if money is no object. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. The social costs and benefits of anger as a function of gender and relationship context

    NARCIS (Netherlands)

    Fischer, A.H.; Evers, C.

    2011-01-01

    On the basis of Social Role Theory and a social functional view of emotions, we argue that gender differences in anger experiences and expression are related to men’s and women’s relationship context. We hypothesized that women in traditional relationship contexts would express their anger less

  13. Have Dutch Municipalities Become More Efficient in Managing the Costs of Social Assistance Dependency?

    NARCIS (Netherlands)

    Broersma, Lourens; Edzes, Arjen; van Dijk, Jouke

    2010-01-01

    Many welfare reforms undertaken in OECD-countries are directed towards enhancing efficiency in the administration and implementation of social security and social benefits. In this perspective the governance reforms in The Netherlands are an example of decentralisation through budgeting of means to

  14. Pyrrhic Victories: The Need for Social Status Drives Costly Competitive Behavior.

    Directory of Open Access Journals (Sweden)

    Wouter eVan Den Bos

    2013-10-01

    Full Text Available Competitive behavior is commonly defined as the decision to maximize one’s payoffs relative to others. We argue instead that competitive drive derives from a desire for social status. We make use of a multi-player auction task in which subjects knowingly incur financial losses for the sake of winning auctions. First, we show that overbidding is increased when the task includes members of a rival out-group, suggesting that social identity is an important mediator of competitiveness. In addition, we show that the extent that individuals are willing to incur losses is related to affective responses to social comparisons but not to monetary outcomes. Second, we show that basal levels of testosterone predict overbidding, and that this effect of testosterone is mediated by affective responses to social comparisons. Based on these findings, we argue that competitive behavior should be conceptualized in terms of social motivations as opposed to just relative monetary payoffs.

  15. The design of a Social Cost-Benefit Analysis of preventive interventions for toxoplasmosis: An example of the One Health approach.

    Science.gov (United States)

    Suijkerbuijk, A W M; van Gils, P F; Bonačić Marinović, A A; Feenstra, T L; Kortbeek, L M; Mangen, M-J J; Opsteegh, M; de Wit, G A; van der Giessen, J W B

    2018-02-01

    Toxoplasma gondii infections cause a large disease burden in the Netherlands, with an estimated health loss of 1,900 Disability Adjusted Life Years and a cost-of-illness estimated at €44 million annually. Infections in humans occur via exposure to oocysts in the environment and after eating undercooked meat containing tissue cysts, leading to asymptomatic or mild symptoms, but potentially leading to the development of ocular toxoplasmosis. Infection in pregnant women can lead to stillbirth and disorders in newborns. At present, prevention is only targeted at pregnant women. Cat vaccination, freezing of meat destined for undercooked consumption and enhancing biosecurity in pig husbandries are possible interventions to prevent toxoplasmosis. As these interventions bear costs for sectors in society that differ from those profiting from the benefits, we perform a social cost-benefit analysis (SCBA). In an SCBA, costs and benefits of societal domains affected by the interventions are identified, making explicit which stakeholder pays and who benefits. Using an epidemiological model, we consider transmission of T. gondii after vaccination of all owned cats or cats at livestock farms. To identify relevant high-risk meat products that will be eaten undercooked, a quantitative microbial risk assessment model developed to attribute predicted T. gondii infections to specific meat products will be used. In addition, we evaluate se