WorldWideScience

Sample records for transmission service cost

  1. Probabilistic costing of transmission services

    International Nuclear Information System (INIS)

    Wijayatunga, P.D.C.

    1992-01-01

    Costing of transmission services of electrical utilities is required for transactions involving the transport of energy over a power network. The calculation of these costs based on Short Run Marginal Costing (SRMC) is preferred over other methods proposed in the literature due to its economic efficiency. In the research work discussed here, the concept of probabilistic costing of use-of-system based on SRMC which emerges as a consequence of the uncertainties in a power system is introduced using two different approaches. The first approach, based on the Monte Carlo method, generates a large number of possible system states by simulating random variables in the system using pseudo random number generators. A second approach to probabilistic use-of-system costing is proposed based on numerical convolution and multi-area representation of the transmission network. (UK)

  2. Transmission service charges: cost allocation and rate design

    International Nuclear Information System (INIS)

    Poray, A. T.

    2000-01-01

    The application of the Ontario Hydro Networks Company (OHNC) to the Ontario Energy Board to seek approval for cost allocation and rate design methodology to recover revenue requirements for the provision of transmission services in Ontario are summarized. Insights that led to the arguments made in support of the application are also described. The paper contains an overview of plans for the operation of the transmission system, the agreement between Ontario Hydro Services Company (OHSC) and the Independent Market Operator (IMO), the stakeholder consultation process by OHNC to develop the transmission cost allocation and rate design methodology, a discussion of the major rate design issues, a summary of stakeholder opinions and a summary of OHNC's final proposal for transmission pricing. Public hearings on the OHNC application were held between February 16 and March 20, 2000. Final decision by the OEB is expected sometime in May 2000

  3. Marginal pricing of transmission services: An analysis of cost recovery

    International Nuclear Information System (INIS)

    Perez-Arriaga, I.J.; Rubio, F.J.; Puerta, J.F.; Arceluz, J.; Marin, J.

    1995-01-01

    This paper presents an in-depth analysis of network revenues computed with marginal pricing, and in particular it investigates the reasons why marginal prices fail to recover the total incurred network costs in actual power systems. The basic theoretical results are presented and the major causes of the mismatch between network costs and marginal revenues are identified and illustrated with numerical examples, some tutorial and others of realistic size. The regulatory implications of marginal network pricing in the context of competitive electricity markets are analyzed, and suggestions are provided for the meaningful allocation of the costs of the network among its users

  4. Marginal pricing of transmission services: An analysis of cost recovery

    Energy Technology Data Exchange (ETDEWEB)

    Perez-Arriaga, I.J.; Rubio, F.J. [Univ. Pontificia Comillas, Madrid (Spain); Puerta, J.F.; Arceluz, J.; Marin, J. [IBERDROLA, Bilbao (Spain). Unidad de Planificacion Estrategica

    1995-02-01

    This paper presents an in-depth analysis of network revenues computed with marginal pricing, and in particular it investigates the reasons why marginal prices fail to recover the total incurred network costs in actual power systems. The basic theoretical results are presented and the major causes of the mismatch between network costs and marginal revenues are identified and illustrated with numerical examples, some tutorial and others of realistic size. The regulatory implications of marginal network pricing in the context of competitive electricity markets are analyzed, and suggestions are provided for the meaningful allocation of the costs of the network among its users.

  5. Marginal pricing of transmission services. An analysis of cost recovery

    Energy Technology Data Exchange (ETDEWEB)

    Perez-Arriaga, I.J.., Rubio, F.J. [Instituto de Investigacion Technologica, Universidad Pontificia Comillas, Madrid (Spain); Puerta, J.F.; Arceluz, J.; Marin, J. [Unidad de Planificacion Estrategica, Iberdrola, Madrid (Spain)

    1996-12-31

    The authors present an in-depth analysis of network revenues that are computed with marginal pricing, and investigate the reasons why marginal prices in actual power systems fail to recover total incurred network costs. The major causes of the failure are identified and illustrated with numerical examples. The paper analyzes the regulatory implications of marginal network pricing in the context of competitive electricity markets and provides suggestions for the meaningful allocation of network costs among users. 5 figs., 9 tabs., 8 refs.

  6. Marginal pricing of transmission services. An analysis of cost recovery

    International Nuclear Information System (INIS)

    Perez-Arriaga, I.J.., Rubio, F.J.; Puerta, J.F.; Arceluz, J.; Marin, J.

    1996-01-01

    The authors present an in-depth analysis of network revenues that are computed with marginal pricing, and investigate the reasons why marginal prices in actual power systems fail to recover total incurred network costs. The major causes of the failure are identified and illustrated with numerical examples. The paper analyzes the regulatory implications of marginal network pricing in the context of competitive electricity markets and provides suggestions for the meaningful allocation of network costs among users. 5 figs., 9 tabs., 8 refs

  7. Selection of methods for evaluating the cost of transmission wheeling services

    International Nuclear Information System (INIS)

    Happ, H.H.

    1995-01-01

    Wheeling has been defined as the use of a utility's transmission facilities to transmit power for other buyers and sellers. On October 26, 1994, the Federal Energy Regulatory Commission (FERC) announced a POLICY STATEMENT, concerning the Commission's Pricing transmission services. It follows a Pricing inquiry conducted by FERC in 1993, and an analysis of the 165 responses FERC had received to that inquiry including one from the Department with which this author is associated. The single most important new element introduced in FERC's Policy Statement of October 26, is flexibility in methodologies which are allowed for determining costs and, thus, prices for transmission services. FERC stated that the respondents to the Pricing Inquiry of 1993 almost unanimously requested that the Commission allow such flexibility. The Policy Statement may lead to experimentation on the part of users of transmission systems, to determine the magnitude of costs predicted by various cost of wheeling methodologies. It is the objective of this paper to outline the steps which New York State has taken and started over five years ago, in executing an investigation of wheeling costs which are generated by a number of cost of wheeling methodologies; documents which are available will be indicated, which should help other investigators in the execution of a similar study. A summary of FERC's Policy Statement dated October 26, 1994 appears in the Appendix

  8. Transmission line capital costs

    International Nuclear Information System (INIS)

    Hughes, K.R.; Brown, D.R.

    1995-05-01

    The displacement or deferral of conventional AC transmission line installation is a key benefit associated with several technologies being developed with the support of the U.S. Department of Energy's Office of Energy Management (OEM). Previous benefits assessments conducted within OEM have been based on significantly different assumptions for the average cost per mile of AC transmission line. In response to this uncertainty, an investigation of transmission line capital cost data was initiated. The objective of this study was to develop a database for preparing preliminary estimates of transmission line costs. An extensive search of potential data sources identified databases maintained by the Bonneville Power Administration (BPA) and the Western Area Power Administration (WAPA) as superior sources of transmission line cost data. The BPA and WAPA data were adjusted to a common basis and combined together. The composite database covers voltage levels from 13.8 to 765 W, with cost estimates for a given voltage level varying depending on conductor size, tower material type, tower frame type, and number of circuits. Reported transmission line costs vary significantly, even for a given voltage level. This can usually be explained by variation in the design factors noted above and variation in environmental and land (right-of-way) costs, which are extremely site-specific. Cost estimates prepared from the composite database were compared to cost data collected by the Federal Energy Regulatory Commission (FERC) for investor-owned utilities from across the United States. The comparison was hampered because the only design specifications included with the FERC data were voltage level and line length. Working within this limitation, the FERC data were not found to differ significantly from the composite database. Therefore, the composite database was judged to be a reasonable proxy for estimating national average costs

  9. Costs along the service cascades for HIV testing and counselling and prevention of mother-to-child transmission

    Science.gov (United States)

    Bautista-Arredondo, Sergio; Sosa-Rubí, Sandra G.; Opuni, Marjorie; Contreras-Loya, David; Kwan, Ada; Chaumont, Claire; Chompolola, Abson; Condo, Jeanine; Galárraga, Omar; Martinson, Neil; Masiye, Felix; Nsanzimana, Sabin; Ochoa-Moreno, Ivan; Wamai, Richard; Wang’ombe, Joseph

    2016-01-01

    Objective: We estimate facility-level average annual costs per client along the HIV testing and counselling (HTC) and prevention of mother-to-child transmission (PMTCT) service cascades. Design: Data collected covered the period 2011–2012 in 230 HTC and 212 PMTCT facilities in Kenya, Rwanda, South Africa, and Zambia. Methods: Input quantities and unit prices were collected, as were output data. Annual economic costs were estimated from the service providers’ perspective using micro-costing. Average annual costs per client in 2013 United States dollars (US$) were estimated along the service cascades. Results: For HTC, average cost per client tested ranged from US$5 (SD US$7) in Rwanda to US$31 (SD US$24) in South Africa, whereas average cost per client diagnosed as HIV-positive ranged from US$122 (SD US$119) in Zambia to US$1367 (SD US$2093) in Rwanda. For PMTCT, average cost per client tested ranged from US$18 (SD US$20) in Rwanda to US$89 (SD US$56) in South Africa; average cost per client diagnosed as HIV-positive ranged from US$567 (SD US$417) in Zambia to US$2021 (SD US$3210) in Rwanda; average cost per client on antiretroviral prophylaxis ranged from US$704 (SD US$610) in South Africa to US$2314 (SD US$3204) in Rwanda; and average cost per infant on nevirapine ranged from US$888 (SD US$884) in South Africa to US$2359 (SD US$3257) in Rwanda. Conclusion: We found important differences in unit costs along the HTC and PMTCT service cascades within and between countries suggesting that more efficient delivery of these services is possible. PMID:27753679

  10. A framework for cost-based pricing of transmission and ancillary services in competitive electric power markets

    International Nuclear Information System (INIS)

    Zobian, A.; Ilic, M.D.

    1995-01-01

    In this paper the authors propose a framework for accurate cost determination and pricing of transmission and ancillary services in competitive electric power markets. The proposed framework is based on their anticipation of the evolving environment and industry structure. They envision the future as a competitive energy market with a centralized control entity that coordinates system activities, prices transmission and ancillary services and controls various system resources. This control entity has control over a certain (pre-defined) geographical area. It is proposed that the system operation and control be kept as they are currently done in control centers, no major change in these functions is required for the proposed pricing strategy. The pricing strategy is divided into two main classes based on time scale separation and firmness, short and long term, firm and interruptible contracts. The approach is based on superposition of different transaction on the network, and a three-part tariff design. The charges are directly related to the impact of each transaction on the system

  11. Survey of Transmission Cost Allocation Methodologies for Regional Transmission Organizations

    Energy Technology Data Exchange (ETDEWEB)

    Fink, S.; Porter, K.; Mudd, C.; Rogers, J.

    2011-02-01

    The report presents transmission cost allocation methodologies for reliability transmission projects, generation interconnection, and economic transmission projects for all Regional Transmission Organizations.

  12. Cost characteristics of transmission

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    FERC regulation of transmission is predicated, at least in part, on a belief that, in the absence of regulation, some utilities would be able to exercise monopoly power and the ability to extract monopoly profits. This monopoly power follows from the view that transmission facilities inevitably are a natural monopoly for both economic and social/regulatory reasons. In the first part of this section the authors present the argument that transmission is a natural monopoly. They then consider the impact of this on regulation and the problems that that view creates

  13. Integrated approach to transmission services pricing

    International Nuclear Information System (INIS)

    Yu, C.W.; David, A.K.

    1999-01-01

    The paper presents an intuitively logical split between: (a) embedded, (b) operating, and (c) expansion cost based pricing and methodologies for implementation, for transmission services. A conceptually straightforward mechanism for the equitable allocation of transmission network embedded cost recovery based on capacity-use and reliability benefit is proposed, expansion cost is charged on a long-run marginal cost basis and finally, operating cost recovery is based on short-run marginal pricing. This is followed by co-ordinating these alternatives and integrating the pricing mechanisms to achieve appropriate price signals for bulk power users of transmission systems. (author)

  14. Economic Costs of Patients Attending the Prevention of Mother-to- Child Transmission of HIV/AIDS (PMTCT Services in Ethiopia: Urban-Rural Settings

    Directory of Open Access Journals (Sweden)

    Elias Asfaw Zegeye

    2016-08-01

    Full Text Available Economic analyses of patients’ costs are pertinent to improve effective healthcare services including the prevention of mother-to-child HIV/AIDS transmission (PMTCT. This study assessed the direct and non-direct medical costs borne by pregnant women attending PMTCT services in urban (high-HIV prevalence and rural (low-HIV prevalence settings, in Ethiopia. Patient-level direct medical costs and direct non-medical data were collected from HIV-positive pregnant women in six regions. The cost estimation was classified as direct medical (service fee, drugs and laboratory and direct non-medical (food, transportation and accommodation. The mean direct medical expense per patient per year was Ethiopian birr (ETB 746 (US$ 38 in the urban settings, as compared to ETB 368 (US$ 19 in the rural settings. On average, a pregnant woman from urban and rural catchments incurred direct non-medical costs of ETB 6,435 (US$ 327 and ETB 2,154 (US$ 110 per year, respectively. On average, non-medical costs of friend/relative/guardian were ETB 2,595 (US$ 132 and ETB 2,919 (US$ 148.39 in the urban and rural settings, respectively. Although the PMTCT service is provided free of charge, HIV-positive pregnant women and infant pairs still face a substantial amount of out-of-pocket spending due to direct medical and non-medical costs.

  15. Allocation of the transmission service cost with base in marginal costs of the transmission network expansion; Asignacion del costo del servicio de transmision con base en costos marginales de expansion de la red de transmision

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz Casillas, Manuel E.; Nieva Gomez, Rolando [Instituto de Investigaciones Electricas, Temixco, Morelos (Mexico)

    2001-07-01

    The transmission charges to the users must be completely defined in those systems where the restructuring has broken up the traditional functions of the companies; in order to introduce competition in the generation and commercialization segments of the electrical energy. The fundamentals of a method used are explained to assure the transmission service cases between their users. The method is based on the marginal expansion costs of the transmission network. Their more known applications have been in competitive markets of energy, in particular, where the energy price is the same one in all the localities. Nevertheless, it can be used under other forms of organization of the electrical industry. In order to illustrate results, the obtained ones from their application to the most important part of the transmission network of the Mexican system that operates interconnected, are presented. [Spanish] Los cargos de transmision a los usuarios deben estar completamente definidos en aquellos sistemas donde la reestructuracion ha desagregado las funciones tradicionales de las empresas; para introducir competencia en los segmentos de generacion y comercializacion de la energia electrica. Se explican los fundamentos de un metodo utilizado para asegurar los casos del servicio de transmision entre sus usuarios. El metodo se basa en los costos marginales de expansion de la red de transmision. Sus aplicaciones mas conocidas han sido en mercados competitivos de energia, en particular, donde el precio de la energia es el mismo en todas las localidades. Sin embargo, puede utilizarse bajo otras formas de organizacion de la industria electrica. Con el proposito de ilustrar resultados, se muestran los obtenidos de su aplicacion a la parte mas importante de la red de transmision del sistema mexicano que opera interconectada.

  16. Pricing transmission services

    International Nuclear Information System (INIS)

    Haaden, E.

    1995-01-01

    The price structure for transmission of electric power through the main lines in Sweden is analyzed. After deregulation of the electricity market, the main transmission lines are owned by a separate national company, with no interests from the power producers. Comparisons are made to ideal marginal price structures. 6 refs

  17. Transmission usage cost allocation schemes

    International Nuclear Information System (INIS)

    Abou El Ela, A.A.; El-Sehiemy, R.A.

    2009-01-01

    This paper presents different suggested transmission usage cost allocation (TCA) schemes to the system individuals. Different independent system operator (ISO) visions are presented using the proportional rata and flow-based TCA methods. There are two proposed flow-based TCA schemes (FTCA). The first FTCA scheme generalizes the equivalent bilateral exchanges (EBE) concepts for lossy networks through two-stage procedure. The second FTCA scheme is based on the modified sensitivity factors (MSF). These factors are developed from the actual measurements of power flows in transmission lines and the power injections at different buses. The proposed schemes exhibit desirable apportioning properties and are easy to implement and understand. Case studies for different loading conditions are carried out to show the capability of the proposed schemes for solving the TCA problem. (author)

  18. Some fundamental technical concepts about cost based transmission pricing

    International Nuclear Information System (INIS)

    Shirmohammadi, D.; Filho, X.V.; Gorenstin, B.; Pereira, M.V.P.

    1996-01-01

    In this paper the authors describe the basic technical concepts involved in developing cost based transmission prices. They introduce the concepts of transmission pricing paradigms and methodologies to better illustrate how transmission costs are transformed into transmission prices. The authors also briefly discuss the role of these paradigms and methodologies in promoting ''economic efficiency'' which is narrowly defined in this paper. They conclude the paper with an example of the application of some of these paradigms and methodologies for pricing transmission services in Brazil

  19. Uptake, outcomes, and costs of antenatal, well-baby, and prevention of mother-to-child transmission of HIV services under routine care conditions in Zambia.

    Directory of Open Access Journals (Sweden)

    Callie A Scott

    Full Text Available BACKGROUND: Zambia adopted Option A for prevention of mother-to-child transmission of HIV (PMTCT in 2010 and announced a move to Option B+ in 2013. We evaluated the uptake, outcomes, and costs of antenatal, well-baby, and PMTCT services under routine care conditions in Zambia after the adoption of Option A. METHODS: We enrolled 99 HIV-infected/HIV-exposed (index mother/baby pairs with a first antenatal visit in April-September 2011 at four study sites and 99 HIV-uninfected/HIV-unexposed (comparison mother/baby pairs matched on site, gestational age, and calendar month at first visit. Data on patient outcomes and resources utilized from the first antenatal visit through six months postpartum were extracted from site registers. Costs in 2011 USD were estimated from the provider's perspective. RESULTS: Index mothers presented for antenatal care at a mean 23.6 weeks gestation; 55% were considered to have initiated triple-drug antiretroviral therapy (ART based on information recorded in site registers. Six months postpartum, 62% of index and 30% of comparison mother/baby pairs were retained in care; 67% of index babies retained had an unknown HIV status. Comparison and index mother/baby pairs utilized fewer resources than under fully guideline-concordant care; index babies utilized more well-baby resources than comparison babies. The average cost per comparison pair retained in care six months postpartum was $52 for antenatal and well-baby services. The average cost per index pair retained was $88 for antenatal, well-baby, and PMTCT services and increased to $185 when costs of triple-drug ART services were included. CONCLUSIONS: HIV-infected mothers present to care late in pregnancy and many are lost to follow up by six months postpartum. HIV-exposed babies are more likely to remain in care and receive non-HIV, well-baby care than HIV-unexposed babies. Improving retention in care, guideline concordance, and moving to Option B+ will result in

  20. Transmission embedded cost allocation methodology with consideration of system reliability

    International Nuclear Information System (INIS)

    Hur, D.; Park, J.-K.; Yoo, C.-I.; Kim, B.H.

    2004-01-01

    In a vertically integrated utility industry, the cost of reliability, as a separate service, has not received much rigorous analysis. However, as a cornerstone of restructuring the industry, the transmission service pricing must change to be consistent with, and supportive of, competitive wholesale electricity markets. This paper focuses on the equitable allocation of transmission network embedded costs including the transmission reliability cost based on the contributions of each generator to branch flows under normal conditions as well as the line outage impact factor under a variety of load levels. A numerical example on a six-bus system is given to illustrate the applications of the proposed methodology. (author)

  1. Trends in coordination and transmission service

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    Investor-owned utilities increasingly are taking significant advantage of the benefits available from coordination transactions and transmission service. This chapter describes Edison Electric Institute (EEI's) estimate as to the growth in sales-for-resale (including coordination service) over the past two decades. With respect to transmission service, this chapter describes the significant growth in both the level of transmission service and the number of transmission agreements

  2. New transmission interconnection reduces consumer costs

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    2008-09-15

    The Central American electric interconnection system (SIEPAC) project will involve the construction of a 1830 km 230 kV transmission system that will link Guatemala, El Salvador, Honduras, Costa Rica, Nicaragua, and Panama. The system is expected to alleviate the region's power shortages and reduce electricity costs for consumers. Costs for the SIEPAC project have been estimated at $370 million. The system will serve approximately 37 million customers, and will include 15 substations. The contract for building the electrical equipment has been awarded to Schweitzer Engineering Laboratories (SEL) who plan to manufacture components at a plant in Mexico. The equipment will include high speed line protection, automation, and control systems. Line current differential systems and satellite-synchronized clocks will also be used. The new transmission system is expected to be fully operational by 2009. 1 fig.

  3. A transaction assessment method for allocation of transmission services

    Science.gov (United States)

    Banunarayanan, Venkatasubramaniam

    The purpose of this research is to develop transaction assessment methods for allocating transmission services that are provided by an area/utility to power transactions. Transmission services are the services needed to deliver, or provide the capacity to deliver, real and reactive power from one or more supply points to one or more delivery points. As the number of transactions increase rapidly in the emerging deregulated environment, accurate quantification of the transmission services an area/utility provides to accommodate a transaction is becoming important, because then appropriate pricing schemes can be developed to compensate for the parties that provide these services. The Allocation methods developed are based on the "Fair Resource Allocation Principle" and they determine for each transaction the following: the flowpath of the transaction (both real and reactive power components), generator reactive power support from each area/utility, real power loss support from each area/utility. Further, allocation methods for distributing the cost of relieving congestion on transmission lines caused by transactions are also developed. The main feature of the proposed methods is representation of actual usage of the transmission services by the transactions. The proposed method is tested extensively on a variety of systems. The allocation methods developed in this thesis for allocation of transmission services to transactions is not only useful in studying the impact of transactions on a transmission system in a multi-transaction case, but they are indeed necessary to meet the criteria set forth by FERC with regard to pricing based on actual usage. The "consistency" of the proposed allocation methods has also been investigated and tested.

  4. Electricity transmission pricing. How contracts must reflect costs

    International Nuclear Information System (INIS)

    Shuttleworth, G.

    1996-01-01

    Two basic structures of transmission systems are distinguished: transmission channels offered through an integrated electric utility and open access offered over an independent network. The first structure allows the application of 'top-down pricing', where transmission prices are derived from customer tariffs less avoidable generation costs. Transmission prices in the second structure must be derived from a 'bottom-up' analysis of transmission costs, including building capacity, marginal losses, and congestion. 5 refs

  5. Unbundling generation and transmission services for competitive electricity markets

    International Nuclear Information System (INIS)

    Hirst, E.; Kirby, B.

    1998-01-01

    Ancillary services are those functions performed by the equipment and people that generate, control, and transmit electricity in support of the basic services of generating capacity, energy supply, and power delivery. The Federal Energy Regulatory Commission (FERC) defined such services as those 'necessary to support the transmission of electric power from seller to purchaser given the obligations of control areas and transmitting utilities within those control areas to maintain reliable operations of the interconnected transmission system.' The nationwide cost of ancillary services is about $12 billion a year, roughly 10% of the cost of the energy commodity. More important than the cost, however, is the necessity of these services for bulk-power reliability and for the support of commercial transactions. FERC's landmark Order 888 included a pro forma tariff with provision for six key ancillary services. The Interconnected Operations Services Working Group identified another six services that it felt were essential to the operation of bulk-power systems. Several groups throughput the United States have created or are forming independent system operators, which will be responsible for reliability and commerce. To date, the electricity industry (including traditional vertically integrated utilities, distribution utilities, power markets and brokers, customers, and state and federal regulators) has paid insufficient attention to these services. Although the industry had made substantial progress in identifying and defining the key services, much remains to be doe to specify methods to measure the production, delivery, and consumption of these services; to identify the costs and cost-allocation factors for these services; and to develop market and operating rules for their provision and pricing. Developing metrics, determining costs, and setting pricing rules are important because most of these ancillary services are produced by the same pieces of equipment that

  6. Optimal pricing of transmission and distribution services in electricity supply

    International Nuclear Information System (INIS)

    Farmer, E.D.; Cory, B.J.; Perera, B.L.P.P.

    1995-01-01

    A new strategy for the separate pricing of transmission and distribution services in electricity supply is formulated and evaluated. The proposed methodology is a multivariate transmission generalisation of the method of peak load pricing previously applied to the optimal time-of-use pricing of generation on a power system with diverse generation technologies and with elastic demand. The method allocates both capacity and operational costs on a time-of-use basis, in an optimal manner, that avoids cross-subsidisation both between differing supply system participants and differing times of usage. The method is shown to promote the optimal development of the transmission, distribution or interconnecting systems, rewarding justified investments in transmission capacity and discouraging overinvestment. It also leads to appropriate returns on invested capital without significant 'revenue reconciliation'. This contrasts with SRMC pricing as is shown by a comparative revenue evaluation. It is concluded that the method has wide potential application in electricity supply. (author)

  7. Electricity transmission congestion costs: A review of recent reports

    Energy Technology Data Exchange (ETDEWEB)

    Lesieutre, Bernard C.; Eto, Joseph H.

    2003-10-01

    Recently, independent system operators (ISOs) and others have published reports on the costs of transmission congestion. The magnitude of congestion costs cited in these reports has contributed to the national discussion on the current state of U.S. electricity transmission system and whether it provides an adequate platform for competition in wholesale electricity markets. This report reviews reports of congestion costs and begins to assess their implications for the current national discussion on the importance of the U.S. electricity transmission system for enabling competitive wholesale electricity markets. As a guiding principle, we posit that a more robust electricity system could reduce congestion costs; and thereby, (1) facilitate more vibrant and fair competition in wholesale electricity markets, and (2) enable consumers to seek out the lowest prices for electricity. Yet, examining the details suggests that, sometimes, there will be trade-offs between these goals. Therefore, it is essential to understand who pays, how much, and how do they benefit in evaluating options (both transmission and non-transmission alternatives) to address transmission congestion. To describe the differences among published estimates of congestion costs, we develop and motivate three ways by which transmission congestion costs are calculated in restructured markets. The assessment demonstrates that published transmission congestion costs are not directly comparable because they have been developed to serve different purposes. More importantly, critical information needed to make them more comparable, for example in order to evaluate the impacts of options to relieve congestion, is sometimes not available.

  8. Assessment of Long-Run Marginal Costing of Transmission and ...

    African Journals Online (AJOL)

    The Long-Run Marginal Costing (LRMC) technique is used as a cost-reflecting pricing method and finds useful application in the recovery of the total investment cost for the use of a transmission or distribution network. This paper reviews recent applications of this technique based on some examples from United Kingdom, ...

  9. Transmission pricing and stranded costs in the electric power industry

    International Nuclear Information System (INIS)

    Baumol, W.J.; Sidak, J.G.

    1995-09-01

    Stranded costs are those costs that electric utilities are currently permitted to recover through their rates but whose recovery may be impeded or prevented by the advent of competition in the industry. Estimates of these costs run from the tens to the hundreds of billions of dollars. Should regulators permit utilities to recover stranded costs while they take steps to promote competition in the electric power industry. William Baumol and J. Gregory Sidak argue that answer to that question should be yes.The authors show that a transmission price, the price for sending electricity over the transmission grid, can be determined in a manner that is compatible with economic efficiency and clearly neutral in its effects upon all competitors in electricity generation. A correctly constructed regime of transmission pricing may in fact achieve the efficiency and equity goals that justify the recovery of stranded costs

  10. Inflation Dynamics and the Cost Channel of Monetary Transmission

    NARCIS (Netherlands)

    Chowdhury, I.; Hoffmann, M.; Schabert, A.

    2006-01-01

    Evidence from vector autoregressions indicates that the impact of interest rate shocks on macroeconomic aggregates can substantially be affected by the so-called cost channel of monetary transmission. In this paper, we apply a structural approach to examine the relevance of the cost channel for

  11. The Cost of Transmission for Wind Energy: A Review of Transmission Planning Studies

    Energy Technology Data Exchange (ETDEWEB)

    Mills, Andrew D.; Wiser, Ryan; Porter, Kevin

    2009-02-02

    The rapid development of wind power that the United States has experienced over the last several years has been coupled with a growing concern that wind development will require substantial additions to the nation's transmission infrastructure. Transmission is particularly important for wind power due to the locational dependence of wind resources, the relatively low capacity factor of wind plants, and the mismatch between the short lead time to build a new wind project and the longer lead time often needed to plan, permit, and construct transmission. It is clear that institutional issues related to transmission planning, siting, and cost allocation will pose major obstacles to accelerated wind power deployment, but also of concern is the potential cost of this infrastructure build out. Simply put, how much extra cost will society bear to deliver wind power to load centers? Without an answer to this question, there can be no consensus on whether or not the cost of developing transmission for wind will be a major barrier to further wind deployment, or whether the institutional barriers to transmission expansion are likely to be of more immediate concern. In this report, we review a sample of 40 detailed transmission studies that have included wind power. These studies cover a broad geographic area, and were completed from 2001-2008. Our primary goal in reviewing these studies is to develop a better understanding of the transmission costs needed to access growing quantities of wind generation. A secondary goal is to gain a better appreciation of the differences in transmission planning approaches in order to identify those methodologies that seem most able to estimate the incremental transmission costs associated with wind development. Finally, we hope that the resulting dataset and discussion might be used to inform the assumptions, methods, and results of higher-level assessment models that are sometimes used to estimate the cost of wind deployment (e.g. NEMS

  12. Integrated Cost Allocation of Transmission Usage under Electricity Markets

    Directory of Open Access Journals (Sweden)

    Hermagasantos Zein

    2012-08-01

    Full Text Available Cost allocation of transmission usage on the power networks is an important issue especially in the modern electricity market mechanism. In this context, all costs that have been embedded in the transmission, embedded cost, should be covered by the transmission users. This paper follows general methods, where generators are fullyresponsible to cover the embedded cost. It proposes a method to determine the cost allocation of transmission usage based on decomposition through the superposition techinique to determine power flow contributions from an integrated base case of the results of the power flow calculations of all transactions, bilateral and nonbilateral contracts. Mathematically, the applied formulations are illustrated clearly in this paper. The proposed method has been tested with 5-bus system and the results are much different compared to a few of the published methods. This is shown by the test results on the 5 bus system. The published methods produce total power flow contributions in each line is greater than the actual. And they earn total revenues approximately 11.6% greater than the embedded cost. While on the proposed method, the power flow contribu tions are equal to the actual and the revenues are equal to the embedded cost. It shows also that the proposed method gives results as expected.

  13. 18 CFR 37.7 - Auditing Transmission Service Information.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Auditing Transmission Service Information. 37.7 Section 37.7 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... SYSTEMS § 37.7 Auditing Transmission Service Information. (a) All OASIS database transactions, except...

  14. An integrated framework for transmission cost allocation retaining efficiency concepts

    Energy Technology Data Exchange (ETDEWEB)

    Lima, J.W. Marangon [Escola Federal de Engenharia de Itajuba, MG (Brazil); Gorenstin, B G; Vieira Filho, X [Centro de Pesquisas de Energia Eletrica (CEPEL), Rio de Janeiro, RJ (Brazil); Chipp, H J; Alvarenga Filho, S [ELETROBRAS, Rio de Janeiro, RJ (Brazil); Hirota, M [Companhia Energetica de Sao Paulo (CESP), SP (Brazil); Pereira, M V.F. [Power System Research, Inc., Rio de Janeiro, RJ (Brazil)

    1994-12-31

    This paper describes a methodology for allocating transmission costs among utilities and wheeling agents. The proposed approach is based on the extension of marginal cost theory to take into account discrete component sizes and economy of scale, while retaining desirable economic properties such as revenue reconciliation and incentives for all participants to remain in the pool. The methodology is illustrated in case studies with the Brazilian system. (author) 21 refs., 1 fig., 3 tabs.

  15. Cost estimation of HVDC transmission system of Bangka's NPP candidates

    Science.gov (United States)

    Liun, Edwaren; Suparman

    2014-09-01

    Regarding nuclear power plant development in Bangka Island, it can be estimated that produced power will be oversupply for the Bangka Island and needs to transmit to Sumatra or Java Island. The distance between the regions or islands causing considerable loss of power in transmission by alternating current, and a wide range of technical and economical issues. The objective of this paper addresses to economics analysis of direct current transmission system to overcome those technical problem. Direct current transmission has a stable characteristic, so that the power delivery from Bangka to Sumatra or Java in a large scale efficiently and reliably can be done. HVDC system costs depend on the power capacity applied to the system and length of the transmission line in addition to other variables that may be different.

  16. Managing Food Service Costs and Satisfying Customers.

    Science.gov (United States)

    Reuther, Anne; Otto, Ione

    1987-01-01

    Milwaukee Area Technical College, Wisconsin, has four campuses, each with its own food service operation that, combined, serve nearly 3,000 people daily. Several food service-related programs are part of the curriculum. Cost containment and customer satisfaction are the two overriding goals of the food service programs. (MLF)

  17. Universal access, cost recovery, and payment services

    OpenAIRE

    Sujit Chakravorti; Jeffery W. Gunther; Robert R. Moore

    2005-01-01

    We suggest a subtle, yet far- reaching, tension in the objectives specified by the Monetary Control Act of 1980 (MCA) for the Federal Reserve’s role in providing retail payment services, such as check processing. Specifically, we argue that the requirement of an overall cost-revenue match, coupled with the goal of ensuring equitable access on a universal basis, partially shifted the burden of cost recovery from high-cost to low-cost service points during the MCA’s early years, thereby allowin...

  18. Operating cost model for local service airlines

    Science.gov (United States)

    Anderson, J. L.; Andrastek, D. A.

    1976-01-01

    Several mathematical models now exist which determine the operating economics for a United States trunk airline. These models are valuable in assessing the impact of new aircraft into an airline's fleet. The use of a trunk airline cost model for the local service airline does not result in representative operating costs. A new model is presented which is representative of the operating conditions and resultant costs for the local service airline. The calculated annual direct and indirect operating costs for two multiequipment airlines are compared with their actual operating experience.

  19. Cost management of service composition

    NARCIS (Netherlands)

    Albuquerque de Medeiros, Robson Wagner

    2017-01-01

    Many organisations across the world have adopted Service-Oriented Architecture (SOA) to interconnect their computing infrastructures (Business-to- Business) and offer interfaces to their customers (Business-to-Customer). SOA can help these organisations access the market more quickly, respond to

  20. Liner Shipping Service Scheduling with Workshift Costs

    DEFF Research Database (Denmark)

    Reinhardt, Line Blander

    while ensuring that given transit time limits for the carried cargo is satisfied, and considering the layover time for containers transshipping between services. Workshift times and cost are included ensuring that changing the port visit time will not introduce an addition cost for the port operations...

  1. Cost Allocation of Transmission Losses in Electric Market Mechanism

    Directory of Open Access Journals (Sweden)

    Erwin Dermawan

    2012-06-01

    Full Text Available This paper proposes a new method to calculate cost allocation of transmission losses (losses, based on a certain price of energy (i.e. a marginal price of system. Here is developed a mathematic model through manipulating of the network equation to separate losses. This model uses complex power injection and, does not use approximations and assumptions in determining the cost allocation of losses. Its calculation begins from the results of load flow calculation and then is continued to calculate power distribution from a generator to every load and every line. Finally, to be calculated separating of losses and cost allocation of losses. The proposed method is easy to be understood and applied. An illustration results on IEEE 14-bus system show that the method is always consistent with expectancies and somewhat different with a few reference methods.

  2. Cost containment in laundry and linen service.

    Science.gov (United States)

    Ellis, B

    1978-03-16

    One major problem looms among all others in the area of laundry and linen service, whether a hospital has an in-house operation, is part of a shared or central laundry, or uses a commercial service. That is the costly problem of controling linen consumption and replacement. A recent seminar offers some insight into reasons for the problem and some possible solutions.

  3. Home Health Care: Services and Cost

    Science.gov (United States)

    Widmer, Geraldine; And Others

    1978-01-01

    Findings from a study of home care services in one New York district document the value and relatively modest costs of home health care for the chronically ill and dependent elderly. Professional nurses coordinated the care, but most of the direct services were provided by home health aides and housekeepers. (MF)

  4. Cost Calculation Model for Logistics Service Providers

    Directory of Open Access Journals (Sweden)

    Zoltán Bokor

    2012-11-01

    Full Text Available The exact calculation of logistics costs has become a real challenge in logistics and supply chain management. It is essential to gain reliable and accurate costing information to attain efficient resource allocation within the logistics service provider companies. Traditional costing approaches, however, may not be sufficient to reach this aim in case of complex and heterogeneous logistics service structures. So this paper intends to explore the ways of improving the cost calculation regimes of logistics service providers and show how to adopt the multi-level full cost allocation technique in logistics practice. After determining the methodological framework, a sample cost calculation scheme is developed and tested by using estimated input data. Based on the theoretical findings and the experiences of the pilot project it can be concluded that the improved costing model contributes to making logistics costing more accurate and transparent. Moreover, the relations between costs and performances also become more visible, which enhances the effectiveness of logistics planning and controlling significantly

  5. Delivery Unit Costs for Antiretroviral Treatment and Prevention of Mother-to-Child-Transmission of HIV

    Science.gov (United States)

    Galárraga, Omar; Wirtz, Veronika J.; Figueroa-Lara, Alejandro; Santa-Ana-Tellez, Yared; Coulibaly, Ibrahima; Viisainen, Kirsi; Medina-Lara, Antonieta; Korenromp, Eline L.

    2013-01-01

    Background As antiretroviral treatment (ART) for HIV/AIDS is scaled-up globally, information on per-person costs is critical to improve efficiency in service delivery and maximize coverage and health impact. Objective To review studies on delivery unit costs for adult and pediatric ART provision per-patient-year, and prevention of mother-to-child transmission (PMTCT) interventions per mother-infant pair screened or treated, in low- and middle-income countries. Methods Systematic review of English, French and Spanish publications from 2001 to 2009, reporting empirical costing that accounted for at least antiretroviral (ARV) medicines, laboratory testing and personnel. Expenditures were analyzed by country income level and cost component. All costs were standardized to 2009 US dollars. Results Analyses covered 29 eligible, comprehensive costing studies. In the base case, in low-income countries (LIC), median, ART cost per patient-year was $792 (mean: $839, range: $682-$1089); for lower-middle-income countries (LMIC), the median was $932 (mean: $1246, range: $156-$3904); and for upper-middle-income countries (UMIC) the median was $1454 (mean: $2783, range: $1230-$5667). ARV drugs were largest component of overall ART cost in all settings (62%, 50% and 47% in LIC, LMIC and UMIC respectively). Out of 26 ART studies, 14 report which drug regimes were used, and only one study explicitly reported second line treatment costs. The second cost driver was laboratory cost in LIC and LMIC (14% and 19.5%) whereas it was personnel costs in UMIC (26%). Two studies specified the types of laboratory tests costed, and three studies specifically included above-facility-level personnel costs. Three studies reported detailed PMTCT costs, and two studies reported on pediatric ART. Conclusions There is a paucity of data on the full ART and PMTCT delivery unit costs, in particular for low-and middle-income countries. Heterogeneity in activities costed and insufficient detail regarding

  6. Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services.

    Science.gov (United States)

    Shade, Starley B; Kevany, Sebastian; Onono, Maricianah; Ochieng, George; Steinfeld, Rachel L; Grossman, Daniel; Newmann, Sara J; Blat, Cinthia; Bukusi, Elizabeth A; Cohen, Craig R

    2013-10-01

    To evaluate costs, cost-efficiency and cost-effectiveness of integration of family planning into HIV services. Integration of family planning services into HIV care and treatment clinics. A cluster-randomized trial. Twelve health facilities in Nyanza, Kenya were randomized to integrate family planning into HIV care and treatment; six health facilities were randomized to (nonintegrated) standard-of-care with separately delivered family planning and HIV services. We assessed costs, cost-efficiency (cost per additional use of more effective family planning), and cost-effectiveness (cost per pregnancy averted) associated with the first year of integration of family planning into HIV care. More effective family planning methods included oral and injectable contraceptives, subdermal implants, intrauterine device, and female and male sterilization. We collected cost data through interviews with study staff and review of financial records to determine costs of service integration. Integration of services was associated with an average marginal cost of $841 per site and $48 per female patient. Average overall and marginal costs of integration were associated with personnel costs [initial ($1003 vs. $872) and refresher ($498 vs. $330) training, mentoring ($1175 vs. $902) and supervision ($1694 vs. $1636)], with fewer resources required for other fixed ($18 vs. $0) and recurring expenses ($471 vs. $287). Integration was associated with a marginal cost of $65 for each additional use of more effective family planning and $1368 for each pregnancy averted. Integration of family planning and HIV services is feasible, inexpensive to implement, and cost-efficient in the Kenyan setting, and thus supports current Kenyan integration policy.

  7. 76 FR 49841 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

    Science.gov (United States)

    2011-08-11

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

  8. Quality of Security Service Costing Demonstration for the MSHN Project

    National Research Council Canada - National Science Library

    Spyropoulou, Evdoxia

    2000-01-01

    .... Each service has two costs: an initialization cost and a run-time cost. The demonstration illustrates the costs incurred as network modes and security levels are changed. High level and detailed specifications are provided.

  9. A proposal for transmission pricing methodology in Thailand based on electricity tracing and long-run average incremental cost

    International Nuclear Information System (INIS)

    Limpasuwan, T.; Bialek, J.W.; Ongsakul, W.; Limmeechokchai, B.

    2004-01-01

    Although there is no universally accepted methodology for restructuring of electricity supply industry, the transformations often involve separation of generation and transmission. Such separation results in a need for a transmission service charge to be levied on the system users. The National Energy Policy Office (NEPO) of Thailand has commissioned PricewaterhouseCooper (PwC) to propose a transmission service charge that is to be used during the market reform for the transmission business unit of the Electricity Generating Authority of Thailand (EGAT). Although the PwCs transmission use of system charge (TUOS) based on the long-run average incremental cost (LRAIC) and average transmission loss can satisfy the financial requirements, the charge allocations are not economically efficient since they do not provide any locational signal which could reflect costs imposed on the system by locating a system user in a particular geographical location. This paper describes the TUOS methodology suggested by PwC and makes a comparison with a transmission pricing method based on combination of the electricity tracing and LRAIC. The results indicate that, with electricity tracing, the charge allocations are improved in terms of fairness, as the charge reflects the geographical location and system conditions

  10. Cost function for the natural gas transmission, industry: further considerations

    International Nuclear Information System (INIS)

    Massol, Olivier

    2009-01-01

    This article studies the cost function for the natural gas transmission industry. 60 years ago, Hollis B. Chenery published an important contribution that demonstrated how, in that particular industry, the production function of micro-economic theory can be rewritten with engineering variables (Chenery, 1949). In 2008, an article published in The Engineering Economist (Yepez, 2008) provided a refreshing revival on Chenery's seminal thoughts. In addition to a tribute to the late H.B. Chenery, this document offers some further comments and extensions on Yepez (2008). It provides a statistically estimated characterisation of the long-run scale economies and a discussion on the short-run economics of the duplication of existing equipments. As a first extension, we study the optimal design for infrastructure that is planned to transport a seasonally-varying flow of natural gas. The second extension analyzes the optimal degree of excess capacity to be built into a new infrastructure by a firm that expects a random rise in its output during the infrastructure's lifetime. (author)

  11. 77 FR 64890 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

    Science.gov (United States)

    2012-10-24

    ... regional transmission organizations (RTOs) are required to follow regarding the availability of long-term.... P 649. \\51\\ Id. P 746. \\52\\ As Transmission Access Policy Study Group also recognizes, not all RTOs...

  12. 76 FR 58517 - Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV...

    Science.gov (United States)

    2011-09-21

    ...-2011-0011] Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus... public comment on the draft Public Health Service Guideline for Reducing Transmission of Human..., Attn: Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV...

  13. Cutting costs in your own backyard: opportunities in financial services.

    Science.gov (United States)

    van Londen, Jan; Zimmerman, Paul

    2012-03-01

    Hospitals looking to reduce cost and improve performance in financial services should focus on these areas: Treasury banking services costs and fees. The possibility of a revenue-generating vendor payment solution. The accounts payable process.

  14. Optimizing quality, service, and cost through innovation.

    Science.gov (United States)

    Walker, Kathleen; Allen, Jennifer; Andrews, Richard

    2011-01-01

    With dramatic increases in health care costs and growing concerns about the quality of health care services, nurse executives are seeking ways to transform their organizations to improve operational and financial performance while enhancing quality care and patient safety. Nurse leaders are challenged to meet new cost, quality and service imperatives, and change cannot be achieved by traditional approaches, it must occur through innovation. Imagine an organization that can mitigate a $56 million loss in revenue and claim the following successes: Increase admissions by a 8 day and a $5.5 million annualized increase by repurposing existing space. Decrease emergency department holding hours by an average of 174 hours a day, with a labor savings of $502,000 annually. Reduce overall inpatient length of stay by 0.5 day with total compensation running $4.2 million less than the budget for first quarter of 2010. Grow emergency department volume 272 visits greater than budgeted for first quarter of 2010. Complete admission assessments and diagnostics in 90 minutes. This article will address how these outcomes were achieved by transforming care delivery, creating a patient transition center, enhancing outreach referrals, and revising admission processes through collaboration and innovation.

  15. Marginal cost calculation of energy production in hydro thermoelectric systems considering the transmission system

    International Nuclear Information System (INIS)

    Pereira, M.V.F.; Gorenstin, B.G.; Alvarenga Filho, S.

    1989-01-01

    The alternatives for calculation of energy marginal cost in hydroelectric systems, considering the transmission one, was analysed, including fundamental concepts; generation/transmission systems, represented by linear power flow model; production marginal costs in hydrothermal systems and computation aspects. (C.G.C.). 11 refs, 5 figs

  16. Transmission cost allocation based on power flow tracing considering reliability benefit

    International Nuclear Information System (INIS)

    Leepreechanon, N.; Singharerg, S.; Padungwech, W.; Nakawiro, W.; Eua-Arporn, B.; David, A.K.

    2007-01-01

    Power transmission networks must be able to accommodate the continuously growing demand for reliable and economical electricity. This paper presented a method to allocate transmission use and reliability cost to both generators and end-consumers. Although transmission cost allocation methods change depending on the local context of the electric power industry, there is a common principle that transmission line capacity should be properly allocated to accommodate actual power delivery with an adequate reliability margin. The method proposed in this paper allocates transmission embedded cost to both generators and loads in an equitable manner, incorporating probability indices to allocate transmission reliability margin among users in both supply and demand sides. The application of the proposed method was illustrated using Bialek's tracing method on a multiple-circuit, six-bus transmission system. Probabilistic indices known as the transmission internal reliability margin (TIRM) and transmission external reliability margin (TERM) decomposed from the transmission reliability margin (TRM) were introduced, making true cost of using overall transmission facilities. 6 refs., 11 tabs., 5 figs

  17. 75 FR 37883 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

    Science.gov (United States)

    2010-06-30

    ... transmission providers, including Commission-approved regional transmission organizations (RTOs) and... granted extensions. 12. As a result of these compliance filings, RTOs and ISOs have enhanced their... outside of RTOs and ISOs have relied on to comply with certain requirements of Order No. 890 are the North...

  18. Value management: optimizing quality, service, and cost.

    Science.gov (United States)

    Makadon, Harvey J; Bharucha, Farzan; Gavin, Michael; Oliveira, Jason; Wietecha, Mark

    2010-01-01

    Hospitals have wrestled with balancing quality, service, and cost for years--and the visibility and urgency around measuring and communicating real metrics has grown exponentially in the last decade. However, even today, most hospital leaders cannot articulate or demonstrate the "value" they provide to patients and payers. Instead of developing a strategic direction that is based around a core value proposition, they focus their strategic efforts on tactical decisions like physician recruitment, facility expansion, and physician alignment. In the healthcare paradigm of the next decade, alignment of various tactical initiatives will require a more coherent understanding of the hospital's core value positioning. The authors draw on their experience in a variety of healthcare settings to suggest that for most hospitals, quality (i.e., clinical outcomes and patient safety) will become the most visible indicator of value, and introduce a framework to help healthcare providers influence their value positioning based on this variable.

  19. FRAMEWORK: ACTIVITY-BASED COSTING IN SERVICES

    Directory of Open Access Journals (Sweden)

    Nara Medianeira Stefano

    2014-07-01

    Full Text Available Organizations have a constant need to be prepared to continue competing, which shows the search for alternatives for their stay in the market. It has become a common goal in today's business environment, to improve efficiency and restructure organization, turning it effective. In this context, information about costs has become increasingly important to support and justify the process of decision-making. This article is aimed at structuring a bibliography portfolio to treat the application of the ABC method in service and contribute to discussions within the scientific community. The methodology followed a three-stage procedure: Planning, execution and Synthesis. International databases were used to collect information (ISI Web of Knowledge and Scopus. As a result, we obtained a bibliography portfolio of 21 articles (with scientific recognition dealing with the proposed theme.

  20. Cost and Benefit Analysis of VSC-HVDC Schemes for Offshore Wind Power Transmission

    Institute of Scientific and Technical Information of China (English)

    Sheng WANG; Chunmei FENG; An WEN; Jun LIANG

    2013-01-01

    Due to low load factors of wind power generation,it is possible to reduce transmission capacity to minimize the cost of transmission system construction.Two VSC-HVDC schemes for offshore wind farm,called the point to point (PTP) and DC mesh connections are compared in terms of the utilization of transmission system and its cost.A Weibull distribution is used for estimating offshore wind power generation,besides,the cross correlation between wind farms is considered.The wind energy curtailment is analyzed using the capacity output possibility table (COPT).The system power losses,costs of transmission investment and wind energy curtailment are also computed.A statistic model for the wind generation and transmission is built and simulated in MATLAB to validate the study.It is concluded that a DC mesh transmission can reduce the energy curtailment and power losses.Further benefit is achievable as the wind cross correlation between wind farms decreases.

  1. Transmission expansion cost allocation based on cooperative game theory for congestion relief

    Energy Technology Data Exchange (ETDEWEB)

    Erli, Ge; Takahasi, Kazuhiro; Kurihara, Ikuo [Central Research Inst. of Electric Power Industry, Tokyo (Japan); Luonan Chen [Osaka Sangyo Univ., Osaka (Japan)

    2005-01-01

    In conventional power systems, upstream and downstream of power were distinct. However, due to the competition, power injection and sink can appear at unexpected locations, and cost sharing for such a new power system configuration must be considered. This paper proposes a scheme for transmission expansion cost allocation among electric market participants by using Core and Nucleolus concepts of game theory, which are developed particularly for the transmission users. A solution of the n-person cooperative game is adopted to distribute the line transmission expansion cost among the players. Congestion is assumed to be the transmission constraint, and expansion of transmission line is expected to relieve transmission congestion. A case study is illustrated to demonstrate the proposed method. (Author)

  2. Least cost energy services for Australia: Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-07-01

    The Australian electricity industry is in the process of major structural reforms, the most significant of its 100 year history. The industry is being separated into generation, transmission, distribution and retail supply businesses. Competition will be introduced to the wholesale (generation) and retail supply markets. The remaining monopoly elements of the industry, the networks and retail franchise businesses, will be regulated. This report considers a range of mechanisms to incorporate integrated resource planning (IRP) and demand management (DM) into the proposed competitive electricity markets in Australia. The mechanisms are analysed in terms of international experience and their application in the reformed Australian energy sector. The advantages and disadvantages of a range of mechanisms are discussed in relation to achieving a least cost energy services outcome, pricing reforms, regulation of utilities, and other DM activities outside the utilities. The paper concludes with recommendations for a national approach to DM and IRP in the electricity sector. (author). 22 tabs.

  3. Gas Transport Services. West European Gas Transmission Tariff Comparisons

    International Nuclear Information System (INIS)

    2006-07-01

    Since 1999, the Dutch gas transmission company, Gastransport Services (GTS), has commissioned an independent consultant to prepare reports comparing gas transportation tariffs across Western Europe on an annual basis. This report describes the tariffs in force at 1 February 2006. The previous report was published in May 2005, and reported on the tariffs which were in force at 1 January 2005. Since then several companies have published revised carriage arrangements, or have adjusted their tariffs (e.g. to reflect inflation, or for other reasons). In this report we compare the GTS tariff with the transportation tariffs in eleven other countries: Austria, Belgium, Denmark, France, Germany, Ireland, Italy, Luxembourg, Spain, Sweden, and the United Kingdom. This means that all West European countries with Third Party Access to gas transmission systems (except Finland) are covered in this report. In this main part of the report, we concentrate on showing charts which illustrate the comparisons of tariffs, at various distances, volumes and load factors. This gives an overall picture of the tariffs offered by each company, rather than concentrating on particular cases. The detailed calculations for each of the 45 cases are shown in the Appendix to this report, and the conclusions from the cases are shown in a colour-coded chart in the Summary and Conclusions.

  4. Virtual Reference, Real Money: Modeling Costs in Virtual Reference Services

    Science.gov (United States)

    Eakin, Lori; Pomerantz, Jeffrey

    2009-01-01

    Libraries nationwide are in yet another phase of belt tightening. Without an understanding of the economic factors that influence library operations, however, controlling costs and performing cost-benefit analyses on services is difficult. This paper describes a project to develop a cost model for collaborative virtual reference services. This…

  5. 48 CFR 46.305 - Cost-reimbursement service contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Cost-reimbursement service... CONTRACT MANAGEMENT QUALITY ASSURANCE Contract Clauses 46.305 Cost-reimbursement service contracts. The contracting officer shall insert the clause at 52.246-5, Inspection of Services—Cost Reimbursement, in...

  6. Bi-directional Multi Dimension CAP Transmission for Smart Grid Communication Services

    DEFF Research Database (Denmark)

    Zhang, Xu; Binti Othman, Maisara; Pang, Xiaodan

    2012-01-01

    We experimentally demonstrate bi-directional multi dimension carrierless amplitude and phase (CAP) transmission for smart grid communication services based on optical fiber networks. The proposed system is able to support multi-Gb/s transmission with high spectral efficiency.......We experimentally demonstrate bi-directional multi dimension carrierless amplitude and phase (CAP) transmission for smart grid communication services based on optical fiber networks. The proposed system is able to support multi-Gb/s transmission with high spectral efficiency....

  7. Cost Accounting: Production and Equipment Services.

    Science.gov (United States)

    Schmid, William T.

    Cost accounting for audiovisual productions should include direct costs, and, in some cases, the media administrator may have to calculate a per-hour surcharge for general operating overhead as well. Such procedures enable the administrator to determine cost effectiveness, to control cost overruns, and to generate more staff efficiency. Cost…

  8. 75 FR 62023 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

    Science.gov (United States)

    2010-10-07

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

  9. Cross Service Fixed-Wing Cost Estimation

    Science.gov (United States)

    2016-05-17

    costing aircraft , such as cost per system or cost per Air Force unit. There are differing opinions on how costs should be determined for aircraft . A 2010...large confidence interval , but this is most likely because of the addition of the B-2 Bomber, 15 Figure 8. CPFH Trends of Various Aircraft a very... Maintenance O&S Operating and Support OSD Office of the Secretary of Defense PAI Primary Aircraft Inventory POL Petroleum, Lubricants, and Oil SME

  10. Network cost in transmission and distribution of electric power

    International Nuclear Information System (INIS)

    Lindahl, A.; Naeslund, B.; Oettinger-Biberg, C.; Olander, H.; Wuolikainen, T.; Fritz, P.

    1994-01-01

    This report is divided in two parts, where part 1 treats the charges on the regional nets with special emphasis on the net owners tariffs on a deregulated market. Part 2 describes the development of the network costs in electric power distribution for the period 1991-1993. 11 figs, 33 tabs

  11. A low cost data logging system with satellite transmission capabilities

    Digital Repository Service at National Institute of Oceanography (India)

    Desa, E.S.; DeSa, E.J.; Desai, R.G.P.

    data collected at sea can be received on a shore computer at 2400 baud with a negligible error rate. Furthermore, this development shows that in-house construction of essential hardware/software components based on specific user needs reduces cost...

  12. Allocation of fixed transmission cost to wheeling transactions by cooperative game theory

    International Nuclear Information System (INIS)

    Tsukamoto, Yukitoki; Iyoda, Isao

    1996-01-01

    This paper describes a methodology to allocate the cost of transmission network facilities to wheeling transactions in decentralized power systems. The authors propose that the responsibility placed on transmission facilities involved in each transaction be according to the transmission usage pattern. Their proposal incorporates MW-mile method and considers economies of scale of transmission network facilities. The authors also incorporate a nucleolus scheme in the cooperative game theory to deal with matters of conflict. The applicability of their method is demonstrated in a numerical example

  13. In-service crosstalk monitoring for dense space division multiplexed multi-core fiber transmission systems

    DEFF Research Database (Denmark)

    Mizuno, T.; Isoda, A.; Shibahara, K.

    2017-01-01

    We present in-service inter-core crosstalk monitoring for MCF transmission systems. We transmit 54-WDM PDM-16QAM signals over 111.6-km 32-core DSDM transmission line incorporating cladding-pumped 32-core MC-EYDFA, and demonstrate -30 dB crosstalk monitoring without affecting transmission...

  14. Cost associated with stroke: outpatient rehabilitative services and medication.

    Science.gov (United States)

    Godwin, Kyler M; Wasserman, Joan; Ostwald, Sharon K

    2011-10-01

    This study aimed to capture direct costs of outpatient rehabilitative stroke care and medications for a 1-year period after discharge from inpatient rehabilitation. Outpatient rehabilitative services and medication costs for 1 year, during the time period of 2001 to 2005, were calculated for 54 first-time stroke survivors. Costs for services were based on Medicare reimbursement rates. Medicaid reimbursement rates and average wholesale price were used to estimate medication costs. Of the 54 stroke survivors, 40 (74.1%) were categorized as independent, 12 (22.2%) had modified dependence, and 2 (3.7%) were dependent at the time of discharge from inpatient rehabilitation. Average cost for outpatient stroke rehabilitation services and medications the first year post inpatient rehabilitation discharge was $17,081. The corresponding average yearly cost of medication was $5,392, while the average cost of yearly rehabilitation service utilization was $11,689. Cost attributed to medication remained relatively constant throughout the groups. Outpatient rehabilitation service utilization constituted a large portion of cost within each group: 69.7% (dependent), 72.5% (modified dependence), and 66.7% (independent). Stroke survivors continue to incur significant costs associated with their stroke for the first 12 months following discharge from an inpatient rehabilitation setting. Changing public policies affect the cost and availability of care. This study provides a snapshot of outpatient medication and therapy costs prior to the enactment of major changes in federal legislation and serves as a baseline for future studies.

  15. Health Services Cost Analyzing in Tabriz Health Centers 2008

    Directory of Open Access Journals (Sweden)

    Massumeh gholizadeh

    2015-08-01

    Full Text Available Background and objectives : Health Services cost analyzing is an important management tool for evidence-based decision making in health system. This study was conducted with the purpose of cost analyzing and identifying the proportion of different factors on total cost of health services that are provided in urban health centers in Tabriz. Material and Methods : This study was a descriptive and analytic study. Activity Based Costing method (ABC was used for cost analyzing. This cross–sectional survey analyzed and identified the proportion of different factors on total cost of health services that are provided in Tabriz urban health centers. The statistical population of this study was comprised of urban community health centers in Tabriz. In this study, a multi-stage sampling method was used to collect data. Excel software was used for data analyzing. The results were described with tables and graphs. Results : The study results showed the portion of different factors in various health services. Human factors by 58%, physical space 8%, medical equipment 1.3% were allocated with high portion of expenditures and costs of health services in Tabriz urban health centers. Conclusion : Based on study results, since the human factors included the highest portion of health services costs and expenditures in Tabriz urban health centers, balancing workload with staff number, institutionalizing performance-based management and using multidisciplinary staffs may lead to reduced costs of services. ​

  16. Multiarea Transmission Cost Allocation in Large Power Systems Using the Nodal Pricing Control Approach

    Directory of Open Access Journals (Sweden)

    M. Ghayeni

    2010-12-01

    Full Text Available This paper proposes an algorithm for transmission cost allocation (TCA in a large power system based on nodal pricing approach using the multi-area scheme. The nodal pricing approach is introduced to allocate the transmission costs by the control of nodal prices in a single area network. As the number of equations is dependent on the number of buses and generators, this method will be very time consuming for large power systems. To solve this problem, the present paper proposes a new algorithm based on multi-area approach for regulating the nodal prices, so that the simulation time is greatly reduced and therefore the TCA problem with nodal pricing approach will be applicable for large power systems. In addition, in this method the transmission costs are allocated to users more equitable. Since the higher transmission costs in an area having a higher reliability are paid only by users of that area in contrast with the single area method, in which these costs are allocated to all users regardless of their locations. The proposed method is implemented on the IEEE 118 bus test system which comprises three areas. Results show that with application of multi-area approach, the simulation time is greatly reduced and the transmission costs are also allocated to users with less variation in new nodal prices with respect to the single area approach.

  17. 47 CFR 25.211 - Analog video transmissions in the Fixed-Satellite Services.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Analog video transmissions in the Fixed-Satellite Services. 25.211 Section 25.211 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS Technical Standards § 25.211 Analog video transmissions...

  18. 76 FR 44323 - National Grid Transmission Services Corporation; Bangor Hydro Electric Company; Notice of...

    Science.gov (United States)

    2011-07-25

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. EL11-49-000] National Grid Transmission Services Corporation; Bangor Hydro Electric Company; Notice of Petition for Declaratory Order Take..., 18 CFR 385.207, National Grid Transmission Services Corporation and Bangor Hydro Electric Company...

  19. Transmission cost allocation for an efficient tariff action of electricity in a liberalised market

    International Nuclear Information System (INIS)

    Bassi, C.; Caldon, R.; Lorenzoni, A.

    1999-01-01

    The work is focused on the evaluation of the costs of an electricity transmission system operator and on their allocation among the users of the grid in liberalized market. After a recall of the goals of an efficient tariff for transmission, an original method for the cost allocation is proposed called ZI. Based on the marginal cost approach, this method could be the base for setting an efficient transmission tariff that at the same time covers costs and stimulates efficient behaviours. The performances of such an approach have been tested on a real 47 bus grid and ZI tariffs have been compared to the traditional postage stamp ones, highlighting the strong differences between them [it

  20. Transmission cost minimization strategies for wind-electric generating facilities

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, R. [Northern States Power Company, Minneapolis, MN (United States)

    1997-12-31

    Integrating wind-electric generation facilities into existing power systems presents opportunities not encountered in conventional energy projects. Minimizing outlet cost requires probabilistic value-based analyses appropriately reflecting the wind facility`s operational characteristics. The wind resource`s intermittent nature permits relaxation of deterministic criteria addressing outlet configuration and capacity required relative to facility rating. Equivalent capacity ratings of wind generation facilities being a fraction of installed nameplate rating, outlet design studies contingency analyses can concentrate on this fractional value. Further, given its non-dispatchable, low capacity factor nature, a lower level of redundancy in outlet facilities is appropriate considering the trifling contribution to output unreliability. Further cost reduction opportunities arise from {open_quotes}wind speed/generator power output{close_quotes} and {open_quotes}wind speed/overhead conductor rating{close_quotes} functions` correlation. Proper analysis permits the correlation`s exploitation to safely increase line ratings. Lastly, poor correlation between output and utility load may permit use of smaller conductors, whose higher (mostly off-peak) losses are economically justifiable.

  1. Wheeling and transmission system service policy in North America

    International Nuclear Information System (INIS)

    Casazza, J.A.; Schultz, A.J.; Limmer, H.D.

    1991-01-01

    This paper provides a review and discussion of the status of wheeling in the USA and Canada; the pros and cons of the new policies that are evolving and under consideration for wheeling and transmission access; specific case examples of some of the difficulties that have arisen; and the potential for new transmission technology. (author)

  2. Cost effectiveness and efficiency in assistive technology service delivery.

    Science.gov (United States)

    Warren, C G

    1993-01-01

    In order to develop and maintain a viable service delivery program, the realities of cost effectiveness and cost efficiency in providing assistive technology must be addressed. Cost effectiveness relates to value of the outcome compared to the expenditures. Cost efficiency analyzes how a provider uses available resources to supply goods and services. This paper describes how basic business principles of benefit/cost analysis can be used to determine cost effectiveness. In addition, basic accounting principles are used to illustrate methods of evaluating a program's cost efficiency. Service providers are encouraged to measure their own program's effectiveness and efficiency (and potential viability) in light of current trends. This paper is meant to serve as a catalyst for continued dialogue on this topic.

  3. Service Time Analysis for Secondary Packet Transmission with Adaptive Modulation

    KAUST Repository

    Wang, Wen-Jing; Usman, Muneer; Yang, Hong-Chuan; Alouini, Mohamed-Slim

    2017-01-01

    Cognitive radio communications can opportunistically access underutilized spectrum for emerging wireless applications. With interweave cognitive implementation, secondary user transmits only if primary user does not occupy the channel and waits for transmission otherwise. Therefore, secondary packet transmission involves both transmission time and waiting time. The resulting extended delivery time (EDT) is critical to the throughput analysis of secondary system. In this paper, we study the EDT of secondary packet transmission with adaptive modulation under interweave implementation to facilitate the delay and throughput analysis of such cognitive radio system. In particular, we propose an analytical framework to derive the probability density functions of EDT considering random-length transmission and waiting slots. We also present selected numerical results to illustrate the mathematical formulations and to verify our analytical approach.

  4. Service Time Analysis for Secondary Packet Transmission with Adaptive Modulation

    KAUST Repository

    Wang, Wen-Jing

    2017-05-12

    Cognitive radio communications can opportunistically access underutilized spectrum for emerging wireless applications. With interweave cognitive implementation, secondary user transmits only if primary user does not occupy the channel and waits for transmission otherwise. Therefore, secondary packet transmission involves both transmission time and waiting time. The resulting extended delivery time (EDT) is critical to the throughput analysis of secondary system. In this paper, we study the EDT of secondary packet transmission with adaptive modulation under interweave implementation to facilitate the delay and throughput analysis of such cognitive radio system. In particular, we propose an analytical framework to derive the probability density functions of EDT considering random-length transmission and waiting slots. We also present selected numerical results to illustrate the mathematical formulations and to verify our analytical approach.

  5. Load control services in the management of power system security costs

    International Nuclear Information System (INIS)

    Jayantilal, A.; Strbac, G.

    1999-01-01

    The new climate of deregulation in the electricity industry is creating a need for a more transparent cost structure and within this framework the cost of system security has been a subject of considerable interest. Traditionally power system security has been supplied by out-of-merit generation, in the short term, and transmission reinforcement, in the long term. This paper presents a method of analysing the role of load-demand in the management of power system security costs by utilising load control services (LCS). It also proposes a competitive market to enable bidding from various participants within the electricity industry to supply system security. (author)

  6. A survey of cost accounting in service-oriented computing

    NARCIS (Netherlands)

    de Medeiros, Robson W.A.; Rosa, Nelson S.; Campos, Glaucia M.M.; Ferreira Pires, Luis

    Nowadays, companies are increasingly offering their business services through computational services on the Internet in order to attract more customers and increase their revenues. However, these services have financial costs that need to be managed in order to maximize profit. Several models and

  7. What Do Information Technology Support Services Really Cost?

    Science.gov (United States)

    Leach, Karen; Smallen, David

    1998-01-01

    A study examined the cost of information-technology support services in higher education institutions. The report describes the project's origins and work to date and reports initial results in three areas: network services, desktop repair services, and administrative information systems, looking in each case at economies of scale, outsourcing…

  8. Applying Activity Based Costing (ABC) Method to Calculate Cost Price in Hospital and Remedy Services.

    Science.gov (United States)

    Rajabi, A; Dabiri, A

    2012-01-01

    Activity Based Costing (ABC) is one of the new methods began appearing as a costing methodology in the 1990's. It calculates cost price by determining the usage of resources. In this study, ABC method was used for calculating cost price of remedial services in hospitals. To apply ABC method, Shahid Faghihi Hospital was selected. First, hospital units were divided into three main departments: administrative, diagnostic, and hospitalized. Second, activity centers were defined by the activity analysis method. Third, costs of administrative activity centers were allocated into diagnostic and operational departments based on the cost driver. Finally, with regard to the usage of cost objectives from services of activity centers, the cost price of medical services was calculated. The cost price from ABC method significantly differs from tariff method. In addition, high amount of indirect costs in the hospital indicates that capacities of resources are not used properly. Cost price of remedial services with tariff method is not properly calculated when compared with ABC method. ABC calculates cost price by applying suitable mechanisms but tariff method is based on the fixed price. In addition, ABC represents useful information about the amount and combination of cost price services.

  9. Consumer-Operated Service Programs: monetary and donated costs and cost-effectiveness.

    Science.gov (United States)

    Yates, Brian T; Mannix, Danyelle; Freed, Michael C; Campbell, Jean; Johnsen, Matthew; Jones, Kristine; Blyler, Crystal R

    2011-01-01

    Examine cost differences between Consumer Operated Service Programs (COSPs) as possibly determined by a) size of program, b) use of volunteers and other donated resources, c) cost-of-living differences between program locales, d) COSP model applied, and e) delivery system used to implement the COSP model. As part of a larger evaluation of COSP, data on operating costs, enrollments, and mobilization of donated resources were collected for eight programs representing three COSP models (drop-in centers, mutual support, and education/advocacy training). Because the 8 programs were operated in geographically diverse areas of the US, costs were examined with and without adjustment for differences in local cost of living. Because some COSPs use volunteers and other donated resources, costs were measured with and without these resources being monetized. Scale of operation also was considered as a mediating variable for differences in program costs. Cost per visit, cost per consumer per quarter, and total program cost were calculated separately for funds spent and for resources donated for each COSP. Differences between COSPs in cost per consumer and cost per visit seem better explained by economies of scale and delivery system used than by cost-of-living differences between program locations or COSP model. Given others' findings that different COSP models produce little variation in service effectiveness, minimize service costs by maximizing scale of operation while using a delivery system that allows staff and facilities resources to be increased or decreased quickly to match number of consumers seeking services.

  10. Unit cost of medical services at different hospitals in India.

    Directory of Open Access Journals (Sweden)

    Susmita Chatterjee

    Full Text Available Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010-11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital to Rs. 2,213 (private hospital (USD 1 = INR 52. The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country's hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising

  11. Unit Cost of Medical Services at Different Hospitals in India

    Science.gov (United States)

    Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

    2013-01-01

    Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

  12. Transmission avoided cost: a new parameter to evaluate the economic competitiveness of generations plants projects

    Energy Technology Data Exchange (ETDEWEB)

    Ramos, D S [Companhia Energetica de Sao Paulo, SP (Brazil); Albuquerque, J C.R.; Rosenblat, J [ELETROBRAS, Rio de Janeiro, RJ (Brazil)

    1994-12-31

    The paper presents a new formulation that makes feasible a composition of long run production marginal costs with the long run transmission marginal costs, including the costs related to the interconnection EHV networks and that related to the voltage levels below. The goal top be attained is to have available a more adequate parameter in order to compare production cost related to a plant, that will be connected to a certain voltage level network, to the cost related supplying the sam,e amount of energy from the bulk power system which will be represented by the marginal costs up to the voltage level under consideration. This procedure brings to light the Transmission Avoided Costs concepts, that are stressed throughout the text. The proposed methodology is now being used, in the brazilian Power Sector, as a rule of thumb in order to guide planning decisions about the schedule of new plants that have installed capacity below 30 MW. For plants with higher capacity, the transmission avoided costs are evaluated for each specific case, simulating the system behavior without the quoted hydroelectric plant. This paper focuses, an an application example, the case of the Canoas Hydroelectric Project, recently included in the Generation Expansion Reference Plan after a detailed analysis supported by the methodology described here. (author) 7 refs., 3 tabs.

  13. A cost benefit analysis of outsourced laboratory services.

    Science.gov (United States)

    Bowers, J A

    1995-11-01

    As healthcare moves toward increased capitation, hospital administrators must be aware of all costs associated with patient services. This article describes the cost benefit analysis process used by northern Indiana hospital consumers during 1994-1995 to evaluate a local laboratory service outsource provider, South Bend Medical Foundation (SBMF). In an effort to meet the best interests of the community at large, three competing hospitals, medical leadership, and the local outsource provider joined forces to ensure that cost effective quality services would be provided. Laboratory utilization patterns for common DRGs were also analyzed. The team created a reconfiguration analysis to help develop benchmark figures for consideration in future contract negotiations.

  14. Obesity, hospital services use and costs

    DEFF Research Database (Denmark)

    Folmann, Nana Bro; Bossen, Kristine Skovgaard; Willaing, Ingrid

    2007-01-01

    To quantify the association between obesity and somatic hospital costs and number of overall somatic hospital contacts--number of inpatient admissions, number of outpatient visits, and number of emergency department visits--based on anthropometric measurements of waist circumference (WC) and info......) and information from The National Patient Registry and The Danish Case-Mix System (DRG)....

  15. Service time analysis of secondary packet transmission with opportunistic channel access

    KAUST Repository

    Usman, Muneer; Yang, Hongchuan; Alouini, Mohamed-Slim

    2014-01-01

    Cognitive radio transceiver can opportunistically access the underutilized channels of primary systems for new wireless services. The secondary transmission may be interrupted by the primary user's transmission. To facilitate the delay analysis of such secondary packet transmission, we study the resulting extended delivery time for a fixed-size secondary packet that includes both transmission time and waiting time. In particular we derive the exact distribution functions of extended delivery time of secondary transmission for both continuous sensing and periodic sensing cases. Selected numerical results are presented for illustrating the mathematical formulation.

  16. Service time analysis of secondary packet transmission with opportunistic channel access

    KAUST Repository

    Usman, Muneer

    2014-09-01

    Cognitive radio transceiver can opportunistically access the underutilized channels of primary systems for new wireless services. The secondary transmission may be interrupted by the primary user\\'s transmission. To facilitate the delay analysis of such secondary packet transmission, we study the resulting extended delivery time for a fixed-size secondary packet that includes both transmission time and waiting time. In particular we derive the exact distribution functions of extended delivery time of secondary transmission for both continuous sensing and periodic sensing cases. Selected numerical results are presented for illustrating the mathematical formulation.

  17. Canby Area Service Project substation and associated transmission line

    International Nuclear Information System (INIS)

    1992-02-01

    Bonneville Power Administration (BPA) provides power to Surprise Valley Electrification Corporation (SVEC) in Modoc County, California. BPA uses PacificCorp's substation and transmission facilities between Alturas and Canby, California to transfer power to SVEC's Canby Substation. In the next year, SVEC expects increased industrial, agricultural, and residential electric loads on their 69-kV transmission system south of Canby. SVEC's substation can accommodate only about 10 percent of the expected additional electric load. BPA's proposed action is intended to meet SVEC's increasing electric load. BPA proposes to meet SVEC's increasing energy load by tapping into BPA's existing BPA Malin-Warner 230-kV transmission line, and building an 7.9-mile transmission line to a new BPA substation. BPA proposes to build the new substation next to the west side of SVEC's Canby Substation (Figure 1). This new substation will allow SVEC to move the additional power over their existing transmission or distribution lines. This report is the environmental assessment of the potential impact of the proposed project. The assessment determined that no ''environmental impact statement'' is not required

  18. 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....

  19. Cost-benefit study of school nursing services.

    Science.gov (United States)

    Wang, Li Yan; Vernon-Smiley, Mary; Gapinski, Mary Ann; Desisto, Marie; Maughan, Erin; Sheetz, Anne

    2014-07-01

    In recent years, across the United States, many school districts have cut on-site delivery of health services by eliminating or reducing services provided by qualified school nurses. Providing cost-benefit information will help policy makers and decision makers better understand the value of school nursing services. To conduct a case study of the Massachusetts Essential School Health Services (ESHS) program to demonstrate the cost-benefit of school health services delivered by full-time registered nurses. Standard cost-benefit analysis methods were used to estimate the costs and benefits of the ESHS program compared with a scenario involving no school nursing service. Data from the ESHS program report and other published studies were used. A total of 477 163 students in 933 Massachusetts ESHS schools in 78 school districts received school health services during the 2009-2010 school year. School health services provided by full-time registered nurses. Costs of nurse staffing and medical supplies incurred by 78 ESHS districts during the 2009-2010 school year were measured as program costs. Program benefits were measured as savings in medical procedure costs, teachers' productivity loss costs associated with addressing student health issues, and parents' productivity loss costs associated with student early dismissal and medication administration. Net benefits and benefit-cost ratio were calculated. All costs and benefits were in 2009 US dollars. During the 2009-2010 school year, at a cost of $79.0 million, the ESHS program prevented an estimated $20.0 million in medical care costs, $28.1 million in parents' productivity loss, and $129.1 million in teachers' productivity loss. As a result, the program generated a net benefit of $98.2 million to society. For every dollar invested in the program, society would gain $2.20. Eighty-nine percent of simulation trials resulted in a net benefit. The results of this study demonstrated that school nursing services provided in

  20. Marginal ambulatory teaching cost under varying levels of service utilization.

    Science.gov (United States)

    Panton, D M; Mushlin, A I; Gavett, J W

    1980-06-01

    The ambulatory component of residency training jointly produces two products, namely, training and patient services. In costing educational programs of this type, two approaches are frequently taken. The first considers the total costs of the educational program, including training and patient services. These costs are usually constructed from historical accounting records. The second approach attempts to cost the joint products separately, based upon estimates of future changes in program costs, if the product in question is added to or removed from the program. The second approach relates to typical decisions facing the managers of medical centers and practices used for teaching purposes. This article reports such a study of costs in a primary-care residency training program in a hospital outpatient setting. The costs of the product, i.e., on-the-job training, are evaluated using a replacement-cost concept under different levels of patient services. The results show that the cost of the product, training, is small at full clinical utilization and is sensitive to changes in the volume of services provided.

  1. Mental health services costs within the Alberta criminal justice system.

    Science.gov (United States)

    Jacobs, Philip; Moffatt, Jessica; Dewa, Carolyn S; Nguyen, Thanh; Zhang, Ting; Lesage, Alain

    2016-01-01

    Mental illness has been widely cited as a driver of costs in the criminal justice system. The objective of this paper is to estimate the additional mental health service costs incurred within the criminal justice system that are incurred because of people with mental illnesses who go through the system. Our focus is on costs in Alberta. We set up a model of the flow of all persons through the criminal justice system, including police, court, and corrections components, and for mental health diversion, review, and forensic services. We estimate the transitional probabilities and costs that accrue as persons who have been charged move through the system. Costs are estimated for the Alberta criminal justice system as a whole, and for the mental illness component. Public expenditures for each person diverted or charged in Alberta in the criminal justice system, including mental health costs, were $16,138. The 95% range of this estimate was from $14,530 to $19,580. Of these costs, 87% were for criminal justice services and 13% were for mental illness-related services. Hospitalization for people with mental illness who were reviewed represented the greatest additional cost associated with mental illnesses. Treatment costs stemming from mental illnesses directly add about 13% onto those in the criminal justice system. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Trends in transmission, distribution, and administration costs for U.S. investor-owned electric utilities

    International Nuclear Information System (INIS)

    Fares, Robert L.; King, Carey W.

    2017-01-01

    This paper analyzes the cost of transmission, distribution, and administration for U.S. investor-owned electric utilities. We analyze data reported to the Federal Energy Regulatory Commission (FERC) from 1994 to 2014 using linear regression to understand how the number of customers in a utility's territory, annual peak demand, and annual energy sales affect annual TD&A spending. Then, we use Edison Electric Institute data for 1960 to 1992 to show trends in TD&A spending between 1960 and 2014. We find that the number of customers in a utility's territory is the single best predictor for annual TD&A costs. Between 1994 and 2014, the average cost per customer was $119/Customer-Year for transmission, $291/Customer-Year for distribution, and $333/Customer-Year for utility administration. Total TD&A costs per customer have been approximately $700–$800/Customer-Year since 1960, but the cost per kWh of energy sold was significantly higher in the 1960s because the average customer used less than half as much energy annually versus 2014. Thus, TD&A costs per kWh are likely to increase if kWh energy sales decline in the future unless cost recovery is transitioned to a mechanism not based solely on kWh sales. - Highlights: • U.S. investor-owned electric utility delivery costs from 1960? 2014 are investigated. • Transmission, distribution, and utility administrative costs are analyzed separately. • The number of utility customers is the best predictor for annual delivery costs. • Delivery costs per kWh are likely to increase if kWh sales decrease in the future.

  3. Cost-benefit analysis of the ATM automatic deposit service

    Directory of Open Access Journals (Sweden)

    Ivica Županović

    2015-03-01

    Full Text Available Bankers and other financial experts have analyzed the value of automated teller machines (ATM in terms of growing consumer demand, rising costs of technology development, decreasing profitability and market share. This paper presents a step-by-step cost-benefit analysis of the ATM automatic deposit service. The first step is to determine user attitudes towards using ATM automatic deposit service by using the Technology Acceptance Model (TAM. The second step is to determine location priorities for ATMs that provide automatic deposit services using the Analytic Hierarchy Process (AHP model. The results of the previous steps enable a highly efficient application of cost-benefit analysis for evaluating costs and benefits of automatic deposit services. To understand fully the proposed procedure outside of theoretical terms, a real-world application of a case study is conducted.

  4. Defense Finance and Accounting Service Administration of Unit Costs

    National Research Council Canada - National Science Library

    Lay, F

    1996-01-01

    ...) of products or outputs produced. Audit Objectives. We conducted this part of our audit to find out whether unit costs for goods and services provided by DFAS were determined in accordance with DoD policies and based on actual costs incurred...

  5. Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique

    International Nuclear Information System (INIS)

    Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

    2015-01-01

    Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system

  6. Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique.

    Science.gov (United States)

    Bayati, Mohsen; Mahboub Ahari, Alireza; Badakhshan, Abbas; Gholipour, Mahin; Joulaei, Hassan

    2015-10-01

    Considerable development of MRI technology in diagnostic imaging, high cost of MRI technology and controversial issues concerning official charges (tariffs) have been the main motivations to define and implement this study. The present study aimed to calculate the unit-cost of MRI services using activity-based costing (ABC) as a modern cost accounting system and to fairly compare calculated unit-costs with official charges (tariffs). We included both direct and indirect costs of MRI services delivered in fiscal year 2011 in Shiraz Shahid Faghihi hospital. Direct allocation method was used for distribution of overhead costs. We used micro-costing approach to calculate unit-cost of all different MRI services. Clinical cost data were retrieved from the hospital registering system. Straight-line method was used for depreciation cost estimation. To cope with uncertainty and to increase the robustness of study results, unit costs of 33 MRI services was calculated in terms of two scenarios. Total annual cost of MRI activity center (AC) was calculated at USD 400,746 and USD 532,104 based on first and second scenarios, respectively. Ten percent of the total cost was allocated from supportive departments. The annual variable costs of MRI center were calculated at USD 295,904. Capital costs measured at USD 104,842 and USD 236, 200 resulted from the first and second scenario, respectively. Existing tariffs for more than half of MRI services were above the calculated costs. As a public hospital, there are considerable limitations in both financial and administrative databases of Shahid Faghihi hospital. Labor cost has the greatest share of total annual cost of Shahid Faghihi hospital. The gap between unit costs and tariffs implies that the claim for extra budget from health providers may not be relevant for all services delivered by the studied MRI center. With some adjustments, ABC could be implemented in MRI centers. With the settlement of a reliable cost accounting system

  7. Rate of transmission: a major determinant of the cost of clinical mastitis.

    Science.gov (United States)

    Down, P M; Green, M J; Hudson, C D

    2013-10-01

    The aim of this research was to use probabilistic sensitivity analysis to evaluate the relative importance of different components of a model designed to estimate the cost of clinical mastitis (CM). A particular focus was placed on the importance of pathogen transmission relative to other factors, such as milk price or treatment costs. A stochastic Monte Carlo model was developed to simulate a case of CM at the cow level and to calculate the associated costs for 5 defined treatment protocols. The 5 treatment protocols modeled were 3 d of antibiotic intramammary treatment, 5 d of antibiotic intramammary treatment, 3 d of intramammary and systemic antibiotic treatment, 3d of intramammary and systemic antibiotic treatment plus 1 d of nonsteroidal antiinflammatory drug treatment, and 5 d of intramammary and systemic antibiotic treatment. Uniform distributions were used throughout the model to enable investigation of the cost of CM over a spectrum of clinically realistic scenarios without specifying which scenario was more or less likely. A risk of transmission parameter distribution, based on literature values, was included to model the effect of pathogen transmission to uninfected cows, from cows that remained subclinically infected after treatment for CM. Spearman rank correlation coefficients were used to evaluate the relationships between model input values and the estimated cost of CM. Linear regression models were used to explore the effect that changes to specific independent variables had on the cost of CM. Risk of transmission was found to have the strongest association with the cost of CM, followed by bacteriological cure rate, cost of culling, and yield loss. Other factors such as milk price, cost of labor, and cost of medicines were of minimal influence in comparison. The cost of CM was similar for all 5 treatment protocols. The results from this study suggest that, when seeking to minimize the economic impact of CM in dairy herds, great emphasis should be

  8. A Transmission-Cost-Based Model to Estimate the Amount of Market-Integrable Wind Resources

    DEFF Research Database (Denmark)

    Morales González, Juan Miguel; Pinson, Pierre; Madsen, Henrik

    2012-01-01

    are made to share the expenses in transmission derived from their integration, they may see the doors of electricity markets closed for not being competitive enough. This paper presents a model to decide the amount of wind resources that are economically exploitable at a given location from a transmission......In the pursuit of the large-scale integration of wind power production, it is imperative to evaluate plausible frictions among the stochastic nature of wind generation, electricity markets, and the investments in transmission required to accommodate larger amounts of wind. If wind producers......-cost perspective. This model accounts for the uncertain character of wind by using a modeling framework based on stochastic optimization, simulates market barriers by means of a bi-level structure, and considers the financial risk of investments in transmission through the conditional value-at-risk. The major...

  9. Cost estimation of HVDC transmission system of Bangka’s NPP candidates

    Energy Technology Data Exchange (ETDEWEB)

    Liun, Edwaren, E-mail: edwaren@batan.go.id; Suparman, E-mail: edwaren@batan.go.id [Centre for Nuclear Energy Development, National Nuclear Energy Agency of Indonesia (Indonesia)

    2014-09-30

    Regarding nuclear power plant development in Bangka Island, it can be estimated that produced power will be oversupply for the Bangka Island and needs to transmit to Sumatra or Java Island. The distance between the regions or islands causing considerable loss of power in transmission by alternating current, and a wide range of technical and economical issues. The objective of this paper addresses to economics analysis of direct current transmission system to overcome those technical problem. Direct current transmission has a stable characteristic, so that the power delivery from Bangka to Sumatra or Java in a large scale efficiently and reliably can be done. HVDC system costs depend on the power capacity applied to the system and length of the transmission line in addition to other variables that may be different.

  10. Cost estimation of HVDC transmission system of Bangka’s NPP candidates

    International Nuclear Information System (INIS)

    Liun, Edwaren; Suparman

    2014-01-01

    Regarding nuclear power plant development in Bangka Island, it can be estimated that produced power will be oversupply for the Bangka Island and needs to transmit to Sumatra or Java Island. The distance between the regions or islands causing considerable loss of power in transmission by alternating current, and a wide range of technical and economical issues. The objective of this paper addresses to economics analysis of direct current transmission system to overcome those technical problem. Direct current transmission has a stable characteristic, so that the power delivery from Bangka to Sumatra or Java in a large scale efficiently and reliably can be done. HVDC system costs depend on the power capacity applied to the system and length of the transmission line in addition to other variables that may be different

  11. In-Service Aircraft Transmission Life Modeling for Improved Flight Safety, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — It is proposed to develop an accurate, in-service transmission life-estimation system for the prediction of remaining component and system life for a helicopter...

  12. In-Service Aircraft Transmission Life Modeling for Improved Flight Safety, Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — It is proposed to develop an accurate, in-service transmission life-use estimation system for the prediction of remaining component and system life for a helicopter...

  13. Activity-Based Costing in the After Press Services Industry

    Science.gov (United States)

    Shevasuthisilp, Suntichai; Punsathitwong, Kosum

    2009-10-01

    This research was conducted to apply activity-based costing (ABC) in an after press service company in Chiang Mai province, Thailand. The company produces all of its products by one-stop service (such as coating, stitching, binding, die cutting, and gluing). All products are made to order, and have different sizes and patterns. A strategy of low price is used to compete in the marketplace. After cost analysis, the study found that the company has high overhead (36.5% of total cost). The company's problem is its use of traditional cost accounting, which has low accuracy in assigning overhead costs. If management uses this information when pricing customer orders, losses may occur because real production costs may be higher than the selling price. Therefore, the application of ABC in cost analysis can help executives receive accurate cost information; establish a sound pricing strategy; and improve the manufacturing process by determining work activities which have excessively high production costs. According to this research, 6 out of 56 items had a production cost higher than the selling price, leading to losses of 123,923 baht per year. Methods used to solve this problem were: reducing production costs; establishing suitable prices; and creating a sales promotion with lower prices for customers whose orders include processes involving unused capacity. These actions will increase overall sales of the company, and allow more efficient use of its machinery.

  14. Developing a costing framework for palliative care services.

    Science.gov (United States)

    Mosoiu, Daniela; Dumitrescu, Malina; Connor, Stephen R

    2014-10-01

    Palliative care services have been reported to be a less expensive alternative to traditional treatment; however, little is known about how to measure the cost of delivering quality palliative care. The purpose of this project was to develop a standardized method for measuring the cost of palliative care delivery that could potentially be replicated in multiple settings. The project was implemented in three stages. First, an interdisciplinary group of palliative care experts identified standards of quality palliative care delivery in the inpatient and home care services. Surveys were conducted of government agencies and palliative care providers to identify payment practices and budgets for palliative care services. In the second phase, unit costs were defined and a costing framework was designed to measure inpatient and home-based palliative care unit costs. The final phase was advocacy for inclusion of calculated costs into the national funding system. In this project, a reliable framework for determining the cost of inpatient and home-based palliative care services was developed. Inpatient palliative care cost in Romania was calculated at $96.58 per day. Home-based palliative care was calculated at $30.37 per visit, $723.60 per month, and $1367.71 per episode of care, which averaged 45 visits. A standardized methodology and framework for costing palliative care are presented. The framework allows a country or provider of care to substitute their own local costs to generate cost information relevant to the health-care system. In Romania, this allowed the palliative care provider community to advocate for a consistent payment system. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  15. Costs of publicly provided maternity services in Rosario, Argentina

    Directory of Open Access Journals (Sweden)

    Borghi Josephine

    2003-01-01

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

  16. Parametric study of variable renewable energy integration in Europe: Advantages and costs of transmission grid extensions

    International Nuclear Information System (INIS)

    Schaber, Katrin; Steinke, Florian; Mühlich, Pascal; Hamacher, Thomas

    2012-01-01

    Wind and solar energy will play an important role in the decarbonization of the European electricity generation. However, high shares of these variable renewable energies (VREs) challenge the power system considerably due to their temporal fluctuations and geographical dispersion. In this paper, we systematically analyze transmission grid extensions as an integration measure for VREs in Europe. We show the effects of grid extensions for fundamental properties of the power system as a function of the penetration and mix of wind and solar energy. Backup capacity requirements and overproduction are reduced with a powerful overlay transmission grid. We determine the costs of the grid extensions in dependence of the VRE penetration and mix and find that the grid integration costs remain below 25% of the VRE investment costs for all conceivable VRE configurations. Furthermore, robust design features of future power systems in terms of grid geometry and flexibility requirements for backup technologies are identified. We apply a spatially and temporally highly resolved techno-economic model of the European power system for our analysis. - Highlights: ► Quantification of the advantages and costs of a European overlay transmission grid. ► Grid integration costs for VREs in Europe remain below 6€/MWh. ► Application of a detailed power system model to a wide parameter space.

  17. Optimal decoding and information transmission in Hodgkin-Huxley neurons under metabolic cost constraints.

    Science.gov (United States)

    Kostal, Lubomir; Kobayashi, Ryota

    2015-10-01

    Information theory quantifies the ultimate limits on reliable information transfer by means of the channel capacity. However, the channel capacity is known to be an asymptotic quantity, assuming unlimited metabolic cost and computational power. We investigate a single-compartment Hodgkin-Huxley type neuronal model under the spike-rate coding scheme and address how the metabolic cost and the decoding complexity affects the optimal information transmission. We find that the sub-threshold stimulation regime, although attaining the smallest capacity, allows for the most efficient balance between the information transmission and the metabolic cost. Furthermore, we determine post-synaptic firing rate histograms that are optimal from the information-theoretic point of view, which enables the comparison of our results with experimental data. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. HTGR molten salt sensible energy transmission and storage system design and costs

    International Nuclear Information System (INIS)

    1981-09-01

    This report, which was prepared for Gas-Cooled Reactor Associates by United Engineers and Constructors under Contract No. GCRA/UE and C 81-203, presents the design and cost for a molten salt Sensible Energy Transmission and Storage (SETS) System. Although the reference system for this study is sized to be compatible with an 1170 MW(t) HTGR Nuclear Heat Source, the results and conclusions should be generally applicable to most large scale molten salt energy transmission system applications. A preliminary conceptual design is presented and alternative configurations are discussed. The sensitivity of system costs to variations in important system parameters are also presented. Costs for a reference case conceptual design are reported in constant 1980 dollars and inflated 1995 dollars

  19. Establishment of reference costs for occupational health services and implementation of cost management in Japanese manufacturing companies.

    Science.gov (United States)

    Nagata, Tomohisa; Mori, Koji; Aratake, Yutaka; Ide, Hiroshi; Nobori, Junichiro; Kojima, Reiko; Odagami, Kiminori; Kato, Anna; Hiraoka, Mika; Shiota, Naoki; Kobayashi, Yuichi; Ito, Masato; Tsutsumi, Akizumi; Matsuda, Shinya

    2016-07-22

    We developed a standardized cost estimation method for occupational health (OH) services. The purpose of this study was to set reference OH services costs and to conduct OH services cost management assessments in two workplaces by comparing actual OH services costs with the reference costs. Data were obtained from retrospective analyses of OH services costs regarding 15 OH activities over a 1-year period in three manufacturing workplaces. We set the reference OH services costs in one of the three locations and compared OH services costs of each of the two other workplaces with the reference costs. The total reference OH services cost was 176,654 Japanese yen (JPY) per employee. The personnel cost for OH staff to conduct OH services was JPY 47,993, and the personnel cost for non-OH staff was JPY 38,699. The personnel cost for receipt of OH services-opportunity cost-was JPY 19,747, expense was JPY 25,512, depreciation expense was 34,849, and outsourcing cost was JPY 9,854. We compared actual OH services costs from two workplaces (the total OH services costs were JPY 182,151 and JPY 238,023) with the reference costs according to OH activity. The actual costs were different from the reference costs, especially in the case of personnel cost for non-OH staff, expense, and depreciation expense. Using our cost estimation tool, it is helpful to compare actual OH services cost data with reference cost data. The outcomes help employers make informed decisions regarding investment in OH services.

  20. The cost of providing combined prevention and treatment services, including ART, to female sex workers in Burkina Faso.

    Directory of Open Access Journals (Sweden)

    Fiona Cianci

    Full Text Available BACKGROUND: Female Sex workers (FSW are important in driving HIV transmission in West Africa. The Yerelon clinic in Burkina Faso has provided combined preventative and therapeutic services, including anti-retroviral therapy (ART, for FSWs since 1998, with evidence suggesting it has decreased HIV prevalence and incidence in this group. No data exists on the costs of such a combined prevention and treatment intervention for FSW. This study aims to determine the mean cost of service provision per patient year for FSWs attending the Yerelon clinic, and identifies differences in costs between patient groups. METHODS: Field-based retrospective cost analyses were undertaken using top-down and bottom-up costing approaches for 2010. Expenditure and service utilisation data was collated from primary sources. Patients were divided into groups according to full-time or occasional sex-work, HIV status and ART duration. Patient specific service use data was extracted. Costs were converted to 2012 US$. Sensitivity analyses considered removal of all research costs, different discount rates and use of different ART treatment regimens and follow-up schedules. RESULTS: Using the top-down costing approach, the mean annual cost of service provision for FSWs on or off ART was US$1098 and US$882, respectively. The cost for FSWs on ART reduced by 29%, to US$781, if all research-related costs were removed and national ART monitoring guidelines were followed. The bottom-up patient-level costing showed the cost of the service varied greatly across patient groups (US$505-US$1117, primarily due to large differences in the costs of different ART regimens. HIV-negative women had the lowest annual cost at US$505. CONCLUSION: Whilst FSWs may require specialised services to optimise their care and hence, the public health benefits, our study shows that the cost of ART provision within a combined prevention and treatment intervention setting is comparable to providing ART to

  1. Compressor-less Hydrogen Transmission Pipelines Deliver Large-scale Stranded Renewable Energy at Competitive Cost

    International Nuclear Information System (INIS)

    W Leighty; J Holloway; R Merer; B Somerday; C San Marchi; G Keith; D White

    2006-01-01

    We assume a transmission-constrained world, where large new wind plants and other renewable energies must pay all transmission costs for delivering their energy to distant markets. We modeled a 1,000 MW (1 GW) (name plate) wind plant in the large wind resource of the North America Great Plains, delivering exclusively hydrogen fuel, via a new gaseous hydrogen (GH2) pipeline, to an urban market at least 300 km distant. All renewable electric energy output would be converted, at the source, to hydrogen, via 100 bar output electrolyzers, directly feeding the GH2 transmission pipeline without costly compressor stations at inlet or at midline. The new GH2 pipeline is an alternative to new electric transmission lines. We investigate whether the pipeline would provide valuable energy storage. We present a simple model by which we estimate the cost of wind-source hydrogen fuel delivered to the distant city gate in year 2010, at GW scale. Ammonia, synthetic hydrocarbons, and other substances may also be attractive renewable-source energy carriers, storage media, and fuels; they are not considered in this paper. (authors)

  2. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    Directory of Open Access Journals (Sweden)

    Koopmanschap Marc A

    2003-02-01

    Full Text Available Abstract Background Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses patient costs after stroke and compares costs between regular and stroke service care. Methods Costs were calculated within the framework of the evaluation of three experiments with stroke services in the Netherlands. Cost calculations are base on medical consumption data and actual costs. Results 598 patients were consecutively admitted to hospital after stroke. The average total costs of care per patient for the 6 month follow-up are estimated at €16,000. Costs are dominated by institutional and accommodation costs. Patients who die after stroke incur less costs. For patients that survive the acute phase, the most important determinants of costs are disability status and having a partner – as they influence patients' stroke careers. These determinants also interact. The most efficient stroke service experiment was most successful in co-ordinating patient flow from hospital to (nursing home, through capacity planning and efficient discharge procedures. In this region the costs of stroke service care are the same as for regular stroke care. The other experiments suffered from waiting lists for nursing homes and home care, leading to "blocked beds" in hospitals and nursing homes and higher costs of care. Costs of co-ordination are estimated at about 3% of total costs of care. Conclusion This paper demonstrates that by organising care for stroke patients in a stroke service, better health effects can be achieved with the same budget. In addition, it provides insight in need, predisposing and enabling factors that determine costs of care after stroke.

  3. Low-cost sensor integrators for measuring the transmissivity of complex canopies to photosynthetically active radiation

    International Nuclear Information System (INIS)

    Newman, S.M.

    1985-01-01

    A system has been designed, tested and evaluated for measuring the transmissivities of complex canopies to photosynthetically active radiation (PAR). The system consists of filtered silicon photocells in cosine corrected mounts with outputs integrated by the use of chemical coulometers. The reading accumulated by the coulometers was taken electronically by the use of microcomputers. The low-cost sensor integrators, which do not require batteries, performed as expected and proved ideal for the study of agroforestry systems in remote areas. Information on the PAR transmissivity of a temperate agroforestry system in the form of an intercropped orchard is also presented. (author)

  4. Strategic cost management, contingent factors and performance in services

    Directory of Open Access Journals (Sweden)

    Odysseas Pavlatos

    2018-06-01

    Full Text Available The purpose of this paper is to investigate the relationship between contextual factors identified from contingency-based research, the extent of the use of strategic cost management (SCM techniques and business performance in services. An empirical survey was conducted on a sample of 88 services in Greece. The analysis of the survey data indicates that the use of strategic cost management techniques in services can be considered quite satisfactory. By drawing on the grounds of contingency theory, five factors were identified as potentially exhibiting an emergent relationship with strategic cost management. The five factors are; (1 Perceived environmental uncertainty, (2 Structure, (3 Organizational life cycle stage, (4 Strategy and (5 Size. The survey revealed that SCM usage is positively affected by these five contingent factors, while SCM usage, in turn, positively affects performance. A significant mediating effect of SCM usage on performance is evident.

  5. Cost and outcome analysis of two alcohol detoxification services.

    Science.gov (United States)

    Parrott, Steve; Godfrey, Christine; Heather, Nick; Clark, Jenny; Ryan, Tony

    2006-01-01

    To examine the relationship between service use and outcomes (individual and wider consequences) using an economic analysis of a direct-access alcohol detoxification service in Manchester (the Smithfield Centre) and an NHS partial hospitalization programme in Newcastle upon Tyne (Newcastle and North Tyneside Drug and Alcohol Service, Plummer Court). A total of 145 direct-access admissions to the Smithfield Centre and 77 admissions to Plummer Court completed a battery of questionnaires shortly after intake and were followed up 6 months after discharge. Full economic data at follow-up were available for 54 Smithfield admissions and 49 Plummer Court admissions. Mean total cost of treatment per patient was pound1113 at the Smithfield Centre and pound1054 at Plummer Court in 2003-04 prices. Comparing the 6 months before treatment with the 6 months before follow-up, social costs fell by pound331 on average for each patient at Plummer Court but rose by pound1047 for each patient at the Smithfield Centre. When treatment costs and wider social costs were combined, the total cost to society at Smithfield was on average pound2159 per patient whilst at Plummer Court it was pound723 per patient. Combining the cost of treatment with drinking outcomes yielded a net cost per unit reduction in alcohol consumption of pound1.79 at Smithfield and pound1.68 at Plummer Court. Both services delivered a flexible needs-based service to very disadvantaged population at a reasonable cost and were associated with statistically significant reductions in drinking. For some patients, there was evidence of public sector resource savings but for others these detoxification services allowed those not previously in contact with services to meet health and social care needs. These patterns of cost through time are more complex than in previous evaluations of less severely dependent patients and difficult to predict from drinking patterns or patient characteristics. More research is required to judge

  6. Integration of prevention of mother-to-child HIV transmission into maternal health services in Senegal.

    Science.gov (United States)

    Cisse, C

    2017-06-01

    The objective of this study was to assess the level of integration of prevention of mother-to-child HIV transmission (PMTCT) in facilities providing services for maternal, newborn, and child health (MNCH) and reproductive health (RH) in Senegal. The survey, conducted from August through November, 2014, comprised five parts : a literature review to assess the place of this integration in the health policies, standards, and protocols in effect in Senegal; an analysis by direct observation of attitudes and practices of 25 healthcare providers at 5 randomly-selected obstetrics and gynecology departments representative of different levels of the health pyramid; a questionnaire evaluating knowledge and attitudes of 10 providers about the integration of PMTCT services into MNCH/RH facilities; interviews to collect the opinions of 70 clients, including 16 HIV-positive, about the quality of PMTCT services they received; and a questionnaire evaluating knowledge and opinions of 14 policy-makers/managers of health programs focusing on mothers and children about this integration. The literature review revealed several constraints impeding this integration : the policy documents, standards, and protocols of each of the programs involved do not clearly indicate the modalities of this integration; the programs are housed in two different divisions while the national Program against the Human Immunodeficiency Virus reports directly to the Prime Minister; program operations remains generally vertical; the resources for the different programs are not sufficiently shared; there is no integrated training module covering integrated management of pregnancy and delivery; and supervision for each of the different programs is organized separately.The observation of the providers supporting women during pregnancy, during childbirth, and in the postpartum period, showed an effort to integrate PMTCT into the MNCH/RH services delivered daily to clients. But this desire is hampered by many

  7. Specialty and full-service hospitals: a comparative cost analysis.

    Science.gov (United States)

    Carey, Kathleen; Burgess, James F; Young, Gary J

    2008-10-01

    To compare the costs of physician-owned cardiac, orthopedic, and surgical single specialty hospitals with those of full-service hospital competitors. The primary data sources are the Medicare Cost Reports for 1998-2004 and hospital inpatient discharge data for three of the states where single specialty hospitals are most prevalent, Texas, California, and Arizona. The latter were obtained from the Texas Department of State Health Services, the California Office of Statewide Health Planning and Development, and the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. Additional data comes from the American Hospital Association Annual Survey Database. We identified all physician-owned cardiac, orthopedic, and surgical specialty hospitals in these three states as well as all full-service acute care hospitals serving the same market areas, defined using Dartmouth Hospital Referral Regions. We estimated a hospital cost function using stochastic frontier regression analysis, and generated hospital specific inefficiency measures. Application of t-tests of significance compared the inefficiency measures of specialty hospitals with those of full-service hospitals to make general comparisons between these classes of hospitals. Results do not provide evidence that specialty hospitals are more efficient than the full-service hospitals with whom they compete. In particular, orthopedic and surgical specialty hospitals appear to have significantly higher levels of cost inefficiency. Cardiac hospitals, however, do not appear to be different from competitors in this respect. Policymakers should not embrace the assumption that physician-owned specialty hospitals produce patient care more efficiently than their full-service hospital competitors.

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

    Science.gov (United States)

    Cartwright, William S

    2008-03-01

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

  9. Strategies to Prevent MRSA Transmission in Community-Based Nursing Homes: A Cost Analysis.

    Science.gov (United States)

    Roghmann, Mary-Claire; Lydecker, Alison; Mody, Lona; Mullins, C Daniel; Onukwugha, Eberechukwu

    2016-08-01

    OBJECTIVE To estimate the costs of 3 MRSA transmission prevention scenarios compared with standard precautions in community-based nursing homes. DESIGN Cost analysis of data collected from a prospective, observational study. SETTING AND PARTICIPANTS Care activity data from 401 residents from 13 nursing homes in 2 states. METHODS Cost components included the quantities of gowns and gloves, time to don and doff gown and gloves, and unit costs. Unit costs were combined with information regarding the type and frequency of care provided over a 28-day observation period. For each scenario, the estimated costs associated with each type of care were summed across all residents to calculate an average cost and standard deviation for the full sample and for subgroups. RESULTS The average cost for standard precautions was $100 (standard deviation [SD], $77) per resident over a 28-day period. If gown and glove use for high-risk care was restricted to those with MRSA colonization or chronic skin breakdown, average costs increased to $137 (SD, $120) and $125 (SD, $109), respectively. If gowns and gloves were used for high-risk care for all residents in addition to standard precautions, the average cost per resident increased substantially to $223 (SD, $127). CONCLUSIONS The use of gowns and gloves for high-risk activities with all residents increased the estimated cost by 123% compared with standard precautions. This increase was ameliorated if specific subsets (eg, those with MRSA colonization or chronic skin breakdown) were targeted for gown and glove use for high-risk activities. Infect Control Hosp Epidemiol 2016;37:962-966.

  10. Cost-efficient evaluation of ambulance services for community ...

    African Journals Online (AJOL)

    A total of 12,674 victims were transported to different tares of hospital and referrals ... The mean cost-efficiency (technical) of Machakos ambulance transport services was 90.6% (C.I 82.7% - 98.2%). ... EMAIL FULL TEXT EMAIL FULL TEXT

  11. Selecting cost-effective areas for restoration of ecosystem services.

    Science.gov (United States)

    Adame, M F; Hermoso, V; Perhans, K; Lovelock, C E; Herrera-Silveira, J A

    2015-04-01

    Selection of areas for restoration should be based on cost-effectiveness analysis to attain the maximum benefit with a limited budget and overcome the traditional ad hoc allocation of funds for restoration projects. Restoration projects need to be planned on the basis of ecological knowledge and economic and social constraints. We devised a novel approach for selecting cost-effective areas for restoration on the basis of biodiversity and potential provision of 3 ecosystem services: carbon storage, water depuration, and coastal protection. We used Marxan, a spatial prioritization tool, to balance the provision of ecosystem services against the cost of restoration. We tested this approach in a mangrove ecosystem in the Caribbean. Our approach efficiently selected restoration areas that at low cost were compatible with biodiversity targets and that maximized the provision of one or more ecosystem services. Choosing areas for restoration of mangroves on the basis carbon storage potential, largely guaranteed the restoration of biodiversity and other ecosystem services. © 2014 Society for Conservation Biology.

  12. Comparative Cost Analysis of Four Interventions to Prevent HIV Transmission in Bandung, Indonesia

    Directory of Open Access Journals (Sweden)

    Eveline J.M. Verstraaten

    2017-11-01

    Full Text Available Background: the costs of HIV/AIDS interventions in Indonesia are largely unknown. Knowing these costs is an important input for policy makers in the decision-making of setting priorities among HIV/AIDS interventions. The aim of this analysis is to determine the costs of four HIV/AIDS interventions in Bandung, Indonesia in 2015, to inform the local AIDS commission. Methods: data on utilization and costs of the different interventions were collected in a sexual transmitted infections (STI-clinic and the KPA, the local HIV/AIDS commission, for the period of January 2015-December 2015. The costs were estimated from a societal perspective, using a micro-costing approach. Results: the total annualized costs for condom distribution, mobile voluntary counselling and testing (VCT, religious based information, communication, and education (IEC and STI services equalled US$56,926, US$2,985, US$1,963 and US$5,865, respectively. Conclusion: this analysis has provided cost estimates of four different HIV/AIDS interventions in Bandung, Indonesia. Additionally, it has estimated the costs of scaling up these interventions. Together, this provides important information for policy makers vis-à-vis the implementation of these interventions. However, an evaluation of the effectiveness of these interventions is needed to estimate the cost-effectiveness.

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

    Science.gov (United States)

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

    2017-12-28

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

  14. IMPLEMENTATION OF THE ABC COSTING IN A SERVICES PROVIDER COMPANY

    Directory of Open Access Journals (Sweden)

    Luiz Ricardo Aguena Jacintho Gil de Castro

    2012-12-01

    Full Text Available This paper describes the implementation of the Activity-Based Cost (ABC method in a company of taxes and accounting services and outlines the positive and negative aspects encountered during implementation. It should be taken into account that this work has been developed in the fiscal area of cost verification. Bibliographical references, internal company documents and interviews with industry officials and the administrator responsible for the company were used. In the evolving of operations, the costs of the fiscal area and their main activities have been described monthly and through this information, drivers have been developed and the ABC (Activity-Based Costing method has been adopted. With the implementation it became clear that the system provides better visualization for the decision making process, it also provided learning for the company, so that the method should be used for an undetermined period of time.

  15. Transmission Algorithm with QoS Considerations for a Sustainable MPEG Streaming Service

    Directory of Open Access Journals (Sweden)

    Sang-Hyong Kim

    2017-03-01

    Full Text Available With the proliferation of heterogeneous networks, there is a need to provide multimedia stream services in a sustainable manner. It is especially critical to maintain the Quality of Service (QoS standards. Existing multimedia streaming services have been studied to guarantee QoS on the receiving side. QoS has not been ensured due to the fact that the loss of streaming data to be transmitted has not been considered in network conditions. With an algorithm that considers the QoS and can reduce the overhead of the network, it will be possible to reduce the transmission error and wastage of communication network resources. In this paper, we propose a scheme that improves the reliability of multimedia transmissions by using an adaptive algorithm that switches between UDP (User Datagram Protocol and TCP (Transmission Control Protocol based on the size of the data. In addition, we present a method that retransmits essential portions of the multimedia data, thus improving transmission efficiency. We simulate an MPEG (Moving Picture Experts Group stream service and evaluate the performance of the proposed adaptive MPEG stream service.

  16. Association of antipsychotic polypharmacy with health service cost: a register-based cost analysis

    DEFF Research Database (Denmark)

    Baandrup, Lone; Sørensen, Jan; Lublin, Henrik Kai Francis

    2012-01-01

    at the two cross-sectional dates was recorded and used as proxy of polypharmacy exposure during the preceding year. A multivariate generalised linear model was fitted with total costs of primary and secondary health service use as dependent variable, and antipsychotic polypharmacy, diagnosis, age, gender......, disease duration, psychiatric inpatient admissions, and treatment site as covariates. RESULTS: The sample consisted of 736 outpatients with a diagnosis in the schizophrenia spectrum. Antipsychotic polypharmacy was associated with significantly higher total health service costs compared with monotherapy...

  17. Costing and pricing electric power reserve services. Final report

    International Nuclear Information System (INIS)

    Kirsch, L.D.; Rajaraman, R.; Clark, C.

    1997-12-01

    In the competitive electric power markets of the imminent future, reserves will be the second largest generation service in terms of their revenues and profits. Because reserves will be more widely traded than at present, they will be provided by the cheapest available sources regardless of the ownership of those sources. Price will determine the willingness of generators and consumers to provide reserve services; and it may also determine the willingness of reserve users to purchase reserve services. This report presents a methodology by which generation firms and merchant firms can profitably cost and price the reserve services that they offer. The methodology is generally applicable to a wide range of market structures that such firms might face

  18. Investigating the Effects of Consumer Innovativeness, Service Quality and Service Switching Costs on Service Loyalty in the Mobile Phone Service Context

    Directory of Open Access Journals (Sweden)

    Farzana Quoquab

    2016-02-01

    Full Text Available The objective of this study is to examine the effects of consumer innovativeness, service quality, service switching costs and service satisfaction on service loyalty among mobile phone service users. A cross sectional survey was employed which yielded 535 responses. Structural equation modelling using the AMOS version 2.0 was utilized to test study the hypotheses. Test results reveal that service satisfaction, service switching costs and service quality are the three antecedents that directly influence service loyalty. However, consumer innovativeness does not have any direct effect on service loyalty. Moreover, service satisfaction is found to be a partial mediator between ‘service quality’ and ‘service loyalty’. Findings from this study will develop insights to enable policy-makers, managers and marketers to better strategize and effectively implement loyalty programs and prevent their customers from switching. This will enhance value creation for both their users and for the industry.

  19. A novel beamforming based model of coverage and transmission costing in IEEE 802.11 WLAN networks

    Directory of Open Access Journals (Sweden)

    Mehdi Guessous

    2017-09-01

    Full Text Available IEEE 802.11 WLAN indoor networks face major inherent and environmental issues such as interference, noise, and obstacles. At the same time, they must provide a maximal service performance in highly changing radio environments and conformance to various applications’ requirements. For this purpose, they require a solid design approach that considers both inputs from the radio interface and the upper-layer services at every design step. The modelization of radio area coverage is a key component in this process and must build on feasible work hypotheses. It should be able also to interpret highly varying characteristics of dense indoor environments, technology advances, service design best practices, end-to-end integration with other network parts: Local Area Network (LAN, Wide Area Network (WAN or Data Center Network (DCN. This work focuses on Radio Resource Management (RRM as a key tool to achieve a solid design in WLAN indoor environments by planning frequency channel assignment, transmit directions and corresponding power levels. Its scope is limited to tackle co-channel interference but can be easily extended to address cross-channel ones. In this paper, we consider beamforming and costing techniques to augment conventional RRM’s Transmit Power Control (TPC procedures that market-leading vendors has implemented and related research has worked on. We present a novel approach of radio coverage modelization and prove its additions to the cited related-work’s models. Our solution model runs three algorithms to evaluate transmission opportunities of Wireless Devices (WD under the coverage area. It builds on realistic hypotheses and a thorough system operation’s understanding to evaluate such an opportunity to transmit, overcomes limitations from compared related-work’s models, and integrates a hierarchical costing system to match Service Level Agreement (SLA expectations. The term “opportunity” in this context relates also to the new

  20. 18 CFR 2.22 - Pricing policy for transmission services provided under the Federal Power Act.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Pricing policy for... INTERPRETATIONS Statements of General Policy and Interpretations Under the Federal Power Act § 2.22 Pricing policy... Policy Statement on its pricing policy for transmission services provided under the Federal Power Act...

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

    Science.gov (United States)

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

    2010-02-01

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

  2. Pharmaceutical services cost analysis using time-driven activity-based costing: A contribution to improve community pharmacies' management.

    Science.gov (United States)

    Gregório, João; Russo, Giuliano; Lapão, Luís Velez

    2016-01-01

    The current financial crisis is pressing health systems to reduce costs while looking to improve service standards. In this context, the necessity to optimize health care systems management has become an imperative. However, little research has been conducted on health care and pharmaceutical services cost management. Pharmaceutical services optimization requires a comprehensive understanding of resources usage and its costs. This study explores the development of a time-driven activity-based costing (TDABC) model, with the objective of calculating the cost of pharmaceutical services to help inform policy-making. Pharmaceutical services supply patterns were studied in three pharmacies during a weekday through an observational study. Details of each activity's execution were recorded, including time spent per activity performed by pharmacists. Data on pharmacy costs was obtained through pharmacies' accounting records. The calculated cost of a dispensing service in these pharmacies ranged from €3.16 to €4.29. The cost of a counseling service when no medicine was supplied ranged from €1.24 to €1.46. The cost of health screening services ranged from €2.86 to €4.55. The presented TDABC model gives us new insights on management and costs of community pharmacies. This study shows the importance of cost analysis for health care services, specifically on pharmaceutical services, in order to better inform pharmacies' management and the elaboration of pharmaceutical policies. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Hidden Costs in Paediatric Psychiatry Consultation Liaison Services

    LENUS (Irish Health Repository)

    Kehoe, C

    2018-03-01

    It is recognised that children attending paediatric services have an increased rate of mental health (MH) problems1. Hospital based Mental Health services, interchangeably termed Psychiatric Consultation Liaison Services (PCLS), or Psychological Medicine, exist in the large hospitals, and collaborate with their paediatric colleagues, offering assessment and intervention as required. However, PCLS may also have a role in providing Emergency MH assessments for young people presenting to the Emergency Department (ED), a role independent of their paediatric colleagues. In some cases, these children will need to be admitted to an acute paediatric bed for the management of their mental health illness or psychological distress, awaiting transfer to a child psychiatry specialised bed, or discharge to community services. The profile and costs of these cases are inadequately captured by both HSE CAMHS Annual Reporting System3,4 and the Healthcare Pricing Office (HIPE)2 as they often inadequately record MH referrals. This study explores the costs associated with a cohort of patients presenting to a large paediatric hospital ED, and managed by PCLS, in a one-year period.

  4. Conceptual framework of Tenaga Nasional Berhad (TNB) cost of service (COS) model

    Science.gov (United States)

    Zainudin, WNRA; Ishak, WWM; Sulaiman, NA

    2017-09-01

    One of Malaysia Electricity Supply Industry (MESI) objectives is to ensure Tenaga Nasional Berhad (TNB) economic viability based on a fair economic electricity pricing. In meeting such objective, a framework that investigates the effect of cost of service (COS) on revenue is in great need. This paper attempts to present a conceptual framework that illustrate the distribution of the COS among TNB’s various cost centres which are subsequently redistributed in varying quantities among all of its customer categories. A deep understanding on the concepts will ensure optimal allocation of COS elements between different sub activities of energy production processes can be achieved. However, this optimal allocation needs to be achieved with respect to the imposed TNB revenue constraint. Therefore, the methodology used for this conceptual approach is being modelled into four steps. Firstly, TNB revenue requirement is being examined to ensure the conceptual framework addressed the requirement properly. Secondly, the revenue requirement is unbundled between three major cost centres or business units consist of generation, transmission and distribution and the cost is classified based on demand, energy and customers related charges. Finally, the classified costs are being allocated to different customer categories i.e. Household, Commercial, and Industrial. In summary, this paper proposed a conceptual framework on the cost of specific services that TNB currently charging its customers and served as potential input into the process of developing revised electricity tariff rates. On that purpose, the finding of this COS study finds cost to serve customer varies with the voltage level that customer connected to, the timing and the magnitude of customer demand on the system. This COS conceptual framework could potentially be integrated into a particular tariff structure and serve as a useful tool for TNB.

  5. Treatment Cost Analysis Tool (TCAT) for estimating costs of outpatient treatment services.

    Science.gov (United States)

    Flynn, Patrick M; Broome, Kirk M; Beaston-Blaakman, Aaron; Knight, Danica K; Horgan, Constance M; Shepard, Donald S

    2009-02-01

    A Microsoft Excel-based workbook designed for research analysts to use in a national study was retooled for treatment program directors and financial officers to allocate, analyze, and estimate outpatient treatment costs in the U.S. This instrument can also be used as a planning and management tool to optimize resources and forecast the impact of future changes in staffing, client flow, program design, and other resources. The Treatment Cost Analysis Tool (TCAT) automatically provides feedback and generates summaries and charts using comparative data from a national sample of non-methadone outpatient providers. TCAT is being used by program staff to capture and allocate both economic and accounting costs, and outpatient service costs are reported for a sample of 70 programs. Costs for an episode of treatment in regular, intensive, and mixed types of outpatient treatment were $882, $1310, and $1381 respectively (based on 20% trimmed means and 2006 dollars). An hour of counseling cost $64 in regular, $85 intensive, and $86 mixed. Group counseling hourly costs per client were $8, $11, and $10 respectively for regular, intensive, and mixed. Future directions include use of a web-based interview version, much like some of the commercially available tax preparation software tools, and extensions for use in other modalities of treatment.

  6. 18 CFR 2.20 - Good faith requests for transmission services and good faith responses by transmitting utilities.

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Good faith requests for transmission services and good faith responses by transmitting utilities. 2.20 Section 2.20 Conservation of... Power Act § 2.20 Good faith requests for transmission services and good faith responses by transmitting...

  7. 78 FR 17652 - Tri-State Generation and Transmission Association, Inc. v. Public Service Company of New Mexico...

    Science.gov (United States)

    2013-03-22

    ... Generation and Transmission Association, Inc. v. Public Service Company of New Mexico; Notice of Complaint... CFR 385.206 and 18 CFR 385.212, Tri-State Generation and Transmission Association, Inc. (Complainant), filed a complaint against the Public Service Company of New Mexico (Respondent or PNM) alleging that...

  8. Are Free Maternity Services Completely Free of Costs?

    Science.gov (United States)

    Acharya, Jeevan

    2016-02-01

    The Government of Nepal revised free maternity health services, "Aama Surakshya Karyakram", beginning at the start of Fiscal Year 2012/13, which specifies the services to be funded, the tariffs for reimbursement, and the system for claiming and reporting on free deliveries each month. This study was designed to investigate the amount of monetary expenditure incurred by families using apparently free maternity services. Between August 2014 and December 2014, a hospital-based cross-sectional study was conducted at Manipal Teaching Hospital and Western Regional Hospital. Nepalese women were not involved with family finances and had very little knowledge of income or expenditures. Therefore, face-to-face interviews with 384 postpartum mothers with their husbands or the head of the family household were conducted at the time of discharge by using a pre-tested semi-structural questionnaire. The average monthly family income was 19,272.4 NRs (189.01 US$), the median duration of hospital stay was 4 days (range, 2-19 days), and the median patient expenditure was equivalent to 13% of annual family income. The average total visible cost was 3,887.07 NRs (38.1 US$). When the average total hidden cost of 27,288.5 NRs (267.6 US$) was added, then the average total maternity care expenditure was 31,175.6 NRs (305.76 US$), with an average cost per day of 7,167.5 NRs (70.29 US$). The mean patient expenditure on food and drink, clothes, transport, and medicine was equivalent to 53.07%, 9.8%. 7.3%, and 5.6% of the mean total maternity care expenditure, respectively. The earnings lost by respondent women, husbands, and heads of household were 5,963.7 NRs (58.4 US$), 7,429.3 NRs (72.9 US$), and 6,175.9 NRs (60.6 US$), respectively. The free maternity service in Nepal has high out-of-pocket expenditures, and did not represent a system completely free of costs. Therefore, arrangements should be made by hospitals free of cost to provide medicine that is not included as essential during

  9. The costs and benefits of Option B+ for the prevention of mother-to-child transmission of HIV.

    Science.gov (United States)

    Gopalappa, Chaitra; Stover, John; Shaffer, Nathan; Mahy, Mary

    2014-01-01

    Most countries follow WHO 2010 guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV using either Option A or B for women not yet eligible for antiretroviral therapy (ART). Both of these approaches involve the use of antiretrovirals during pregnancy and breastfeeding. Some countries have adopted a new strategy, Option B+, in which HIV-positive pregnant women are started immediately on ART and continued for life. Option B+ is more costly than Options A or B, but provides additional health benefits. In this article, we estimate the additional costs and effectiveness of Option B+. We developed a deterministic model to simulate births, breastfeeding, and HIV infection in women in four countries, Kenya, Zambia, South Africa, and Vietnam that differ in fertility rate, birth interval, age at first birth, and breastfeeding patterns, but have similar age at HIV infection. We estimated the total PMTCT costs and new child infections under Options A, B, and B+, and measured cost-effectiveness as the incremental PMTCT-related costs per child infection averted. We included adult sexual transmissions averted from ART, the corresponding costs saved, and estimated the total incremental cost per transmission (child and adult) averted. When considering PMTCT-related costs and child infections, Option B+ was the most cost-effective strategy costing between $6000 and $23 000 per infection averted compared with Option A. Option B+ averted more child infections compared with Option B in all four countries and cost less than Option B in Kenya and Zambia. When including adult sexual transmissions averted, Option B+ cost less and averted more infections than Options A and B.

  10. On the relation between cost and service models for general inventory systems

    NARCIS (Netherlands)

    Houtum, van G.J.J.A.N.; Zijm, W.H.M.

    2000-01-01

    In this paper, we present a systematic overview of possible relations between cost and service models for fairly general single- and multi-stage inventory systems. In particular, we relate various types of penalty costs in pure cost models to equivalent types of service measures in service models.

  11. 48 CFR 5152.245-9001 - Government property for installation support services (cost-reimbursement contracts).

    Science.gov (United States)

    2010-10-01

    ... installation support services (cost-reimbursement contracts). 5152.245-9001 Section 5152.245-9001 Federal... CONTRACT CLAUSES 5152.245-9001 Government property for installation support services (cost-reimbursement... Installation Support Services (Cost-Reimbursement Contracts) (OCT 1989) (DEV) (a) Government-furnished property...

  12. 7 CFR 62.300 - Fees and other costs for service.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Fees and other costs for service. 62.300 Section 62...) Quality Systems Verification Programs Definitions Charges for Service § 62.300 Fees and other costs for service. Fees and other charges will be levied based on the following provisions: (a) Fees for service...

  13. 22 CFR 92.68 - Foreign Service fees and incidental costs in the taking of evidence.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Foreign Service fees and incidental costs in... SERVICES NOTARIAL AND RELATED SERVICES Depositions and Letters Rogatory § 92.68 Foreign Service fees and incidental costs in the taking of evidence. The fees for the taking of evidence by officers of the Foreign...

  14. The determinants of hospital cost: a cost-volume-profit analysis of health services in the occupied territories: Palestine.

    Science.gov (United States)

    Younis, Mustafa Z; Jaber, Samer; Smith, Pamela C; Hartmann, Michael; Bongyu, Moye

    2010-06-01

    The purpose of this study is to examine the unit costs of a multi-service hospital in Palestine for the period 2005-2007. We investigate the cost structure of the Rafidya Hospital located in Nablus city, for both inpatient and outpatient departments. This study uses cost-volume-profit (CVP) analysis, also known as breakeven analysis. CVP analysis requires examining total costs, along with fixed and variable costs. CVP analysis illuminates how changes in assumptions about cost behaviour and the relevant range in which those assumptions are valid affect the relationships among revenues, variable costs and fixed costs at various production levels. For the hospital of interest, we find that fixed costs account for 70% of total costs, and variable costs were 30% of total costs. Inpatient departments accounted for 86% of total costs, and outpatient departments were 14% of total costs. Results of the breakeven analysis illustrate that several departments charge sufficient fees to cover all unit costs. Results provide useful information about unit cost based on four categories: (1) unit cost per admission of each department, (2) unit cost per patient day of each department, (3) unit cost per admission with annual capital cost of each department and (4) unit cost per patient day with annual capital cost. Our results provide hospital cost information that can be used by decision-makers to provide and expand healthcare services, in an effort to increase sustainability and profitability. The use of cost analysis by administrators and regulators will improve the quality of financial information, as well as enhance the efficient use of scarce resources.

  15. Cost Analysis of Operation Theatre Services at an Apex Tertiary Care Trauma Centre of India.

    Science.gov (United States)

    Siddharth, Vijaydeep; Kumar, Subodh; Vij, Aarti; Gupta, Shakti Kumar

    2015-12-01

    Operating room services are one of the major cost and revenue-generating centres of a hospital. The cost associated with the provisioning of operating department services depends on the resources consumed and the unit costs of those resources. The objective of this study was to calculate the cost of operation theatre services at Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi. The study was carried out at the operation theatre department of Jai Prakash Narayan Apex Trauma Centre (JPNATC), AIIMS from April 2010 to March 2011 after obtaining approval from concerned authorities. This study was observational and descriptive in nature. Traditional (average or gross) costing methodology was used to arrive at the cost for the provisioning of operation theatre (OT) services. Cost was calculated under two heads; as capital and operating cost. Annualised cost of capital assets was calculated according to the methodology prescribed by the World Health Organization and operating costs were taken on actual basis; thereafter, per day cost of OT services was obtained. The average number of surgeries performed in the trauma centre per day is 13. The annual cost of providing operating room services at JPNATC, New Delhi was calculated to be 197,298,704 Indian rupees (INR) (US$ 3,653,679), while the per hour cost was calculated to be INR 22,626.92 (US$ 419). Majority of the expenditures were for human resource (33.63 %) followed by OT capital cost (31.90 %), consumables (29.97 %), engineering maintenance cost (2.55 %), support services operating cost (1.22 %) and support services capital cost (0.73 %). Of the total cost towards the provisioning of OT services, 32.63 % was capital cost while 67.37 % is operating cost. The results of this costing study will help in the future planning of resource allocation within the financial constraints (US$ 1 = INR 54).

  16. Cost-effective practices in the blood service sector.

    Science.gov (United States)

    Katsaliaki, Korina

    2008-05-01

    The objective of this study is to recommend alternative policies, which are tested on a computer simulation model, towards a more cost-effective management of the blood supply chain in the UK. With the use of primary and secondary data from the National Blood Service (NBS) and the supplied hospitals, statistical analysis is conducted and a detailed discrete event simulation model of a vertical part of the UK supply chain of blood products is developed to test and identify good ordering, inventory and distribution practices. Fewer outdates, group substitutions, shortages and deliveries could be achieved by blood banks: holding stock of rare blood groups of red blood cells (RBC), having a second routine delivery per weekday, exercising a more insensitive ordering point for RBC, reducing the total crossmatch release period to less than 1.5 days, increasing the transfusion-to-crossmatch ratio to 70%, adhering to an age-based issuing of orders, holding RBC stock of a weighted average of approximately 4 days. The blood supply simulation model can offer useful pieces of advice to the stakeholders of the examined system which leads to cost reductions and increased safety. Moreover, it provides a great range of experimental capabilities in a risk-free environment.

  17. Some factors affecting the cost of irradiation services in thailand

    International Nuclear Information System (INIS)

    Kasemsanta, S.

    1985-01-01

    The future of food irradiation in developing countries depends to a large extent on cost considerations. Although food irradiation technology itself is widely known and appears to offer many advantages, concrete evidence on the economic viability of a multi-product irradiation plant is presently not readily available to the private sector in developing countries. It is doubtful whether such evidence exists in a form which is comprehensible to industrialists outside the radiation technology circle. With respect to the economic aspects of food irradiation, information available from the literature appears to be based largely on a summing-up of studies of single products on a case-by-case basis. In an agricultural country, the main inputs to an irradiation service facility are likely to be agricultural produce which vary in kind and quantity with cropping seasons. Moreover, in most developing countries, uncontrollable factors play an important role in the production of annual crops and their transportation. Thus, it is hardly possible to make a credible long term forecast on the throughput required for the multi-product service plant, let alone determine with confidence the return on investment. Accordingly, as far as the private sector is concerned, investment decisions regarding the establishment of a commercial food irradiation service plant have to be considered as 'decision making under risk'. This paper attempts to raise questions to which the author cannot yet find clear and practical answers from the available literature. It is intended to stimulate a more thorough and objective discussion on the subject of economic viability of a multi-product food irradiation plant under the prevailing environment in ASEAN

  18. The Cost of Health Services Delivery in Health Houses of Alborz: A Case Study

    Directory of Open Access Journals (Sweden)

    Javad Ghoddousinejad

    2015-07-01

    Full Text Available Background and Objectives : Health houses play an active role to improve health status of rural population.Furthermore, it is important to know the costs of provided services. This research was designed to determine the costs of healthcare delivery in health houses of ALBORZ district. Material and Methods : In this cross-sectional descriptive study, Activity Based Costing (ABC was used to analyze the costs of services. Results : The average Direct Costs (DC of healthcare delivery in health houses was estimated 37033365 Rials. Direct and Indirect Costs (IC of service delivery in health houses were 65.91% and 34.09% of Total Costs (TC respectively. Conclusion : Since human resources play the most important role in determining the costs of health services delivery in healthcare, reforming payment mechanisms would be a suitable solution to reduce extra costs. Moreover, in order to decrease extra costs, it is essential to modify activities and eliminate parallel tasks.

  19. Optimal combinations of control strategies and cost-effective analysis for visceral leishmaniasis disease transmission.

    Directory of Open Access Journals (Sweden)

    Santanu Biswas

    Full Text Available Visceral leishmaniasis (VL is a deadly neglected tropical disease that poses a serious problem in various countries all over the world. Implementation of various intervention strategies fail in controlling the spread of this disease due to issues of parasite drug resistance and resistance of sandfly vectors to insecticide sprays. Due to this, policy makers need to develop novel strategies or resort to a combination of multiple intervention strategies to control the spread of the disease. To address this issue, we propose an extensive SIR-type model for anthroponotic visceral leishmaniasis transmission with seasonal fluctuations modeled in the form of periodic sandfly biting rate. Fitting the model for real data reported in South Sudan, we estimate the model parameters and compare the model predictions with known VL cases. Using optimal control theory, we study the effects of popular control strategies namely, drug-based treatment of symptomatic and PKDL-infected individuals, insecticide treated bednets and spray of insecticides on the dynamics of infected human and vector populations. We propose that the strategies remain ineffective in curbing the disease individually, as opposed to the use of optimal combinations of the mentioned strategies. Testing the model for different optimal combinations while considering periodic seasonal fluctuations, we find that the optimal combination of treatment of individuals and insecticide sprays perform well in controlling the disease for the time period of intervention introduced. Performing a cost-effective analysis we identify that the same strategy also proves to be efficacious and cost-effective. Finally, we suggest that our model would be helpful for policy makers to predict the best intervention strategies for specific time periods and their appropriate implementation for elimination of visceral leishmaniasis.

  20. Identification of Conflicts between Transmission and Distribution System Operators when Acquiring Ancillary Services from Electric Vehicles

    DEFF Research Database (Denmark)

    Zecchino, Antonio; Knezovic, Katarina; Marinelli, Mattia

    2017-01-01

    ancillary services from flexible units. The investigation is carried out considering a 3-area power system which allows to take into account local constraints as well as system-wide needs. As outcome, this paper identifies the conflicts from both a theoretical and a practical point of view, by means...... products according to requests coming from both distribution and transmission system operators. The goal of this paper is to provide an identification procedure that is able to detect, identify and catalogue possible conflicts among the involved stakeholders that take place when requesting and/or acquiring...

  1. A cost function for the natural gas transmission industry: further considerations

    International Nuclear Information System (INIS)

    Massol, O.

    2009-09-01

    This article studies the cost function for the natural gas transmission industry. 60 years ago, Hollis B. Chenery published an important contribution that demonstrated how, in that particular industry, the production function of micro-economic theory can be rewritten with engineering variables (Chenery, 1949). In 2008, an article published in The Engineering Economist (Yepez, 2008) provided a refreshing revival on Chenery's seminal thoughts. In addition to a tribute to the late H.B. Chenery, this document offers some further comments and extensions on Yepez (2008). It provides a statistically estimated characterisation of the long-run scale economies and a discussion on the short-run economics of the duplication of existing equipments. As a first extension, we study the optimal design for infrastructure that is planned to transport a seasonally-varying flow of natural gas. The second extension analyzes the optimal degree of excess capacity to be built into a new infrastructure by a firm that expects a random rise in its output during the infrastructure's lifetime. (author)

  2. Least cost pathways to a low carbon electricity system for Australia: impacts of transmission augmentation and extension

    Science.gov (United States)

    Dargaville, R. J.

    2016-12-01

    Designing the pathway to a low carbon energy system is complex, requiring consideration of the variable nature of renewables at the hourly timescale, emission intensity and ramp rate constraints of dispatchable technologies (both fossil and renewable) and transmission and distribution network limitations. In this work, an optimization framework taking into account these considerations has been applied to find the lowest cost ways to reduce carbon emissions by either 80% or 100% in 2050 while keeping the system operating reliably along the way. Technologies included are existing and advanced coal and gas technologies (with and without carbon capture and storage), rooftop PV, utility scale PV, concentrating solar thermal, hydro with and without pumped storage, bioenergy, and nuclear. In this study we also also the optimisation to increase transmission capacity along existing lines, and to extend key trunk lines into currently unserved areas. These augementations and extensions come at a cost. The otpimisation chooses these options when the benefits of accessing high quality renewable energy resources outweights the costs. Results show that for the 80% emission reduction case, there is limited need for transmission capacity increase, and that the existing grid copes well with the increased flows due to conversion to distrubuted renewable energy resources. However, in the 100% case the increased reliance on renewables means that signficant transmission augmentation is beneficial to the overall cost. This strongly suggests that it is important to understand the long term emission target early so that infrastructure investments can be optimised.

  3. Low cost Polymer Optical Fibre based transmission system for feeding integrated broadband wireless in-house LANs

    NARCIS (Netherlands)

    Ng'Oma, A.; Koonen, A.M.J.; Tafur Monroy, I.; Boom, van den H.P.A.; Smulders, P.F.M.; Khoe, G.D.; Visser, D. Taco; Lenstra, Daan; Schouten, F. Hugo

    2002-01-01

    A bi-directional transmission system using low cost Polymer Optical Fibre (POF) to feed the required large number of radio access points in next-generation integrated broadband wireless in-house LANs is proposed. Results from simulations and experiments show that, by tuning system parameters, a

  4. Big Comsats for big jobs at low user cost. [considering wrist telephony, electronic mail transmission and educational television applications

    Science.gov (United States)

    Bekey, I.

    1979-01-01

    Three examples are used to illustrate what is possible with large space systems: (1) personal communications using wrist telephones, (2) electronic transmission of mail, and (3) wide dissemination of educational TV. Design concepts and costs are explored and compared to alternative ground-based concepts.

  5. Cost analysis for the implementation of a medication review with follow-up service in Spain.

    Science.gov (United States)

    Noain, Aranzazu; Garcia-Cardenas, Victoria; Gastelurrutia, Miguel Angel; Malet-Larrea, Amaia; Martinez-Martinez, Fernando; Sabater-Hernandez, Daniel; Benrimoj, Shalom I

    2017-08-01

    Background Medication review with follow-up (MRF) is a professional pharmacy service proven to be cost-effective. Its broader implementation is limited, mainly due to the lack of evidence-based implementation programs that include economic and financial analysis. Objective To analyse the costs and estimate the price of providing and implementing MRF. Setting Community pharmacy in Spain. Method Elderly patients using poly-pharmacy received a community pharmacist-led MRF for 6 months. The cost analysis was based on the time-driven activity based costing model and included the provider costs, initial investment costs and maintenance expenses. The service price was estimated using the labour costs, costs associated with service provision, potential number of patients receiving the service and mark-up. Main outcome measures Costs and potential price of MRF. Results A mean time of 404.4 (SD 232.2) was spent on service provision and was extrapolated to annual costs. Service provider cost per patient ranged from €196 (SD 90.5) to €310 (SD 164.4). The mean initial investment per pharmacy was €4594 and the mean annual maintenance costs €3,068. Largest items contributing to cost were initial staff training, continuing education and renting of the patient counselling area. The potential service price ranged from €237 to €628 per patient a year. Conclusion Time spent by the service provider accounted for 75-95% of the final cost, followed by initial investment costs and maintenance costs. Remuneration for professional pharmacy services provision must cover service costs and appropriate profit, allowing for their long-term sustainability.

  6. 24 CFR 208.112 - Cost.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Cost. 208.112 Section 208.112... MULTIFAMILY SUBSIDIZED PROJECTS § 208.112 Cost. (a) The costs of the electronic transmission of the correctly... cost of contracting for those services, or the cost of centralizing the electronic transmission...

  7. 17 CFR 256.01-5 - Determination of service cost accounting.

    Science.gov (United States)

    2010-04-01

    ... accounting. Service at cost and fair allocation of costs require, first of all, an accurate accounting for... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Determination of service cost accounting. 256.01-5 Section 256.01-5 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION...

  8. Customer satisfaction : Cost driver or value driver? Empirical evidence from the financial services industry

    NARCIS (Netherlands)

    Terpstra, Maarten; Verbeeten, Frank H M

    2014-01-01

    We investigate the relation between customer satisfaction, customer servicing costs, and customer value in a financial services firm. We find that customer satisfaction is positively associated with future customer servicing costs, as well as with customer value. The relation between customer

  9. Customer satisfaction: Cost driver or value driver? Empirical evidence from the financial services industry

    NARCIS (Netherlands)

    Terpstra, M.; Verbeeten, F.H.M.

    2014-01-01

    We investigate the relation between customer satisfaction, customer servicing costs, and customer value in a financial services firm. We find that customer satisfaction is positively associated with future customer servicing costs, as well as with customer value. The relation between customer

  10. Cost analysis, cost recovery, marketing and fee-based services a guide for the health sciences librarian

    CERN Document Server

    Wood, M Sandra

    2013-01-01

    This outstanding volume won the 1986 Ida and George Eliot Prize--awarded by the Medical Library Association for the work judged most effective in furthering medical librarianship. Library professionals review the controversy behind fee-for-service programs and provide a rationale for incorporating them into contemporary library philosophies of service. Some fee-based services are necessary for survival in a society that treats information as a marketable commodity; this comprehensive book gives practical advice on cost analysis, cost recovery and marketing of reference services, and presents i

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

    Science.gov (United States)

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

    2016-02-01

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

  12. Long term warranty and after sales service concept, policies and cost models

    CERN Document Server

    Rahman, Anisur

    2015-01-01

    This volume presents concepts, policies and cost models for various long-term warranty and maintenance contracts. It offers several numerical examples for estimating costs to both the manufacturer and consumer. Long-term warranties and maintenance contracts are becoming increasingly popular, as these types of aftersales services provide assurance to consumers that they can enjoy long, reliable service, and protect them from defects and the potentially high costs of repairs. Studying long-term warranty and service contracts is important to manufacturers and consumers alike, as offering long-term warranty and maintenance contracts produce additional costs for manufacturers / service providers over the product’s service life. These costs must be factored into the price, or the manufacturer / dealer will incur losses instead of making a profit. On the other hand, the buyer / consumer needs to weigh the cost of maintaining it over its service life and to decide whether or not these policies are worth purchasing....

  13. Advertising sexual health services that provide sexually transmissible infection screening for rural young people - what works and what doesn't.

    Science.gov (United States)

    Gamage, Deepa G; Fuller, Candice A; Cummings, Rosey; Tomnay, Jane E; Chung, Mark; Chen, Marcus; Garrett, Cameryn C; Hocking, Jane S; Bradshaw, Catriona S; Fairley, Christopher K

    2011-09-01

    'TESTme' is a sexually transmissible infection (STI) screening service for Victorian young people living in rural areas. We evaluated the effectiveness of advertising for this service over an 11-month pilot period. The advertising that was used included websites, a Facebook page, posters, flyers, business cards, wrist bands and professional development sessions for health nurses that occurred throughout the pilot period. We also used once-off methods including advertisements in newspapers, student diaries and short messages to mobile phones. Twenty-eight clients had a consultation through TESTme. Twenty found the service through health professionals, six through the Melbourne Sexual Health Centre (MSHC) web page, one through the Facebook page and one through the student diary. The total direct costs incurred by the centre for advertising were $20850. The advertising cost per client reached for each advertising method was $26 for health professionals, $80 for the MSHC web advertisement, $1408 for Facebook and $790 for the student diary. Other advertising methods cost $12248 and did not attract any clients. Advertising STI health services for rural young people would be best to focus on referrals from other health services or health care websites.

  14. Differential Game Analyses of Logistics Service Supply Chain Coordination by Cost Sharing Contract

    Directory of Open Access Journals (Sweden)

    Haifeng Zhao

    2014-01-01

    Full Text Available Cooperation of all the members in a supply chain plays an important role in logistics service. The service integrator can encourage cooperation from service suppliers by sharing their cost during the service, which we assume can increase the sales by accumulating the reputation of the supply chain. A differential game model is established with the logistics service supply chain that consists of one service integrator and one supplier. And we derive the optimal solutions of the Nash equilibrium without cost sharing contract and the Stackelberg equilibrium with the integrator as the leader who partially shares the cost of the efforts of the supplier. The results make the benefits of the cost sharing contract in increasing the profits of both players as well as the whole supply chain explicit, which means that the cost sharing contract is an effective coordination mechanism in the long-term relationship of the members in a logistics service supply chain.

  15. Comparing methodologies for the allocation of overhead and capital costs to hospital services.

    Science.gov (United States)

    Tan, Siok Swan; van Ineveld, Bastianus Martinus; Redekop, William Ken; Hakkaart-van Roijen, Leona

    2009-06-01

    Typically, little consideration is given to the allocation of indirect costs (overheads and capital) to hospital services, compared to the allocation of direct costs. Weighted service allocation is believed to provide the most accurate indirect cost estimation, but the method is time consuming. To determine whether hourly rate, inpatient day, and marginal mark-up allocation are reliable alternatives for weighted service allocation. The cost approaches were compared independently for appendectomy, hip replacement, cataract, and stroke in representative general hospitals in The Netherlands for 2005. Hourly rate allocation and inpatient day allocation produce estimates that are not significantly different from weighted service allocation. Hourly rate allocation may be a strong alternative to weighted service allocation for hospital services with a relatively short inpatient stay. The use of inpatient day allocation would likely most closely reflect the indirect cost estimates obtained by the weighted service method.

  16. 48 CFR 52.246-5 - Inspection of Services-Cost-Reimbursement.

    Science.gov (United States)

    2010-10-01

    ...-Cost-Reimbursement. 52.246-5 Section 52.246-5 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.246-5 Inspection of Services—Cost-Reimbursement. As prescribed in 46.305, insert... furnishing of services, when a cost-reimbursement contract is contemplated: Inspection of Services—Cost...

  17. A DDC Bibliography on Cost/Benefits of Technical Information Services and Technology Transfer.

    Science.gov (United States)

    Defense Documentation Center, Alexandria, VA.

    This bibliography is a compilation of literature existing in both the government and public sectors and concerning Cost/Benefits of Technical information Services and Technology Transfer. Not only was the cost-benefit to the user reflected, but consideration was given to the initial cost of information collections, the cost of processing the…

  18. The impact of switching costs on closing of service branches

    OpenAIRE

    Baron, Mira G.

    2002-01-01

    The paper deals with the optimal location of service branches. Consumers can receive service from different firms and branches offering substitute services. The consumer chooses the firm and the branch. Examples are banking services (which firm and branch?), healthcare providers, insurance companies and their agents, brokerage firms and their branches. With the change in the accessibility of the internet, the service industry witnesses the impact of the change in technology. More customers pr...

  19. What Do Products/Services Cost? How Do We Know?

    Science.gov (United States)

    Weingand, Darlene E.

    1995-01-01

    Price (cost) analysis provides the library manager with valuable data for decision making and developing marketing strategies. This article examines program budget, cost-finding methodologies that influence demand, the impact of technology, and budget presentation. (Author/AEF)

  20. Pricing in M/M/1 queues when cost of waiting in queue differs from cost of waiting in service

    Directory of Open Access Journals (Sweden)

    Görkem Sarıyer

    2016-11-01

    Full Text Available Service providers can adjust the entrance price to the state of the demand in real life service systems where the customers' decision to receive the service, is based on this price, state of demand and other system parameters. We analyzed service provider's short and long term pricing problems in unobservable M/M/1 queues having the rational customers, where, for customers, the unit cost of waiting in the queue is higher than unit cost of waiting in the service. We showed that waiting in the queue has a clear negative effect on customers’ utilities, hence the service provider's price values. We also showed that, in the short term, monopolistic pricing is optimal for congested systems with high server utilization levels, whereas in the long term, market capturing pricing is more profitable.

  1. Health services utilization and costs of the insured and uninsured ...

    African Journals Online (AJOL)

    Background: Health insurance is a social security system that aims to facilitate fair financing of health costs through pooling and judicious utilization of financial resources, in order to provide financial risk protections and cost burden sharing for people against high cost of healthcare through various prepayment methods ...

  2. Cost-effectiveness of antiviral therapy during late pregnancy to prevent perinatal transmission of hepatitis B virus

    Directory of Open Access Journals (Sweden)

    Wenjun Wang

    2016-03-01

    Full Text Available Background. Hepatitis B virus (HBV infections are perinatally transmitted from chronically infected mothers. Supplemental antiviral therapy during late pregnancy with lamivudine (LAM, telbivudine (LdT, or tenofovir (TDF can substantially reduce perinatal HBV transmission compared to postnatal immunoprophylaxis (IP alone. However, the cost-effectiveness of these measures is not clear. Aim. This study evaluated the cost-effectiveness from a societal perspective of supplemental antiviral agents for preventing perinatal HBV transmission in mothers with high viral load (>6 log10 copies/mL. Methods. A systematic review and network meta-analysis were performed for the risk of perinatal HBV transmission with antiviral therapies. A decision analysis was conducted to evaluate the clinical and economic outcomes in China of four competing strategies: postnatal IP alone (strategy IP, or in combination with perinatal LAM (strategy LAM + IP, LdT (strategy LdT + IP, or TDF (strategy TDF + IP. Antiviral treatments were administered from week 28 of gestation to 4 weeks after birth. Outcomes included treatment-related costs, number of infections, and quality-adjusted life years (QALYs. One- and two-way sensitivity analyses were performed to identify influential clinical and cost-related variables. Probabilistic sensitivity analyses were used to estimate the probabilities of being cost-effective for each strategy. Results. LdT + IP and TDF + IP averted the most infections and HBV-related deaths, and gained the most QALYs. IP and TDF + IP were dominated as they resulted in less or equal QALYs with higher associated costs. LdT + IP had an incremental $2,891 per QALY gained (95% CI [$932–$20,372] compared to LAM + IP (GDP per capita for China in 2013 was $6,800. One-way sensitivity analyses showed that the cost-effectiveness of LdT + IP was only sensitive to the relative risk of HBV transmission comparing LdT + IP with LAM + IP. Probabilistic sensitivity analyses

  3. ABC estimation of unit costs for emergency department services.

    Science.gov (United States)

    Holmes, R L; Schroeder, R E

    1996-04-01

    Rapid evolution of the health care industry forces managers to make cost-effective decisions. Typical hospital cost accounting systems do not provide emergency department managers with the information needed, but emergency department settings are so complex and dynamic as to make the more accurate activity-based costing (ABC) system prohibitively expensive. Through judicious use of the available traditional cost accounting information and simple computer spreadsheets. managers may approximate the decision-guiding information that would result from the much more costly and time-consuming implementation of ABC.

  4. Steam sterilization costs: a guide for the central service manager.

    Science.gov (United States)

    O'Shaughnessy, K L

    1993-07-01

    The Nassau County Medical Center CS department, East Meadow, New York, was faced with a staff layoff and an increased workload. With some hard thinking and strong staff support, new processes/systems were designed to save time and money. These included outsourcing the sterilization of "easy" trays, instituting a case cart program and developing custom packs. In order to determine where savings could be had, it was first important to examine current costs. By breaking the costs of sterilization processing down into an average cost per load, a formula was developed that helped determine many additional cost comparisons for the department. For example, the cost analysis formula could be used by CS departments to determine the cost-effectiveness of off-site sterilization, to compare using disposable vs. reusable items and to determine costs for EtO sterilization and aeration.

  5. The calculation of costs of postal network and universal postal service based on standard and average cost principles

    Directory of Open Access Journals (Sweden)

    Blagojević Mladenka Z.

    2017-01-01

    Full Text Available The provision of universal postal service involves high costs for operator, especially in rural areas. The aim of this paper is to propose and test tool for managing the cost of providing universal postal service and maintaining the postal network in order to facilitate understanding of the problem in the sector. The proposed approach use standard prices and standard quantities (the redefined number of postal units, the number of employees, etc. as well as average costs for calculation of the costs of the universal postal service and postal network. The methodology provides the efficiency analysis, benchmarking and identification of causes of poor performance of management and resource allocation. It can be used for postal operators that do not have modern accounting systems.

  6. Cost Effectiveness and Demand for Medical Services among Rural ...

    African Journals Online (AJOL)

    With daily improvement in science and technology, the demand for modern medical services is becoming increasing. This is because modern medical services provide answers to some medical problems which could not be handled by traditional or other forms of medicine. Regrettably, these medical services receive low ...

  7. The European Power System. Decarbonization and Cost Reduction: Lost in Transmissions?

    International Nuclear Information System (INIS)

    Jaureguy-Naudin, Maite

    2012-01-01

    Europe's energy policy is commonly defined by three axes of equal importance: security of supplies, competitiveness and sustainable development. The European Commission is mandated to develop the policy tools that allow the implementation of this common policy. Early on, challenges arose from the trade-offs to be made not only between these three pillars but also between a common European policy and national approaches. The European Commission has always had to struggle in attempting to keep a balanced line. Over the past twenty years, the EU has been engaged in the liberalization of the electricity and gas sector. For a long time, liberalization was the main objective of European energy policy. Liberalization of the electricity sector was supposed to bring many benefits. Foremost, these included the more efficient allocation of generation and transmission capacities, and the enhancement of the competitiveness of the European economy as a whole, through lower energy costs. The trading of electricity output between countries was part of this strategy. Interconnections are vital to facilitating electricity trade between Member States. It is in this context that interest in cross-border interconnections has increased. However, new constraints have emerged and have put climate change at the top of European agenda. In December 2008, as part of the fight against climate change, the European Union adopted its Energy and Climate package endorsing three objectives for 2020: i) a 20% increase in energy efficiency, ii) a 20% reduction in GHG emissions (compared to 1990), and iii) a 20% share of renewable energy sources in final energy consumption. A direct consequence of the later objective is that renewable energy sources (RES) in electricity generation are expected to expand from 20.3% of electricity output in 2010, to around 33%, in order to meet the objective set by the European Commission. Hydroelectric power has limited additional potential due to geographical

  8. Capital cost models for geothermal power plants and fluid transmission systems. [GEOCOST

    Energy Technology Data Exchange (ETDEWEB)

    Schulte, S.C.

    1977-09-01

    The GEOCOST computer program is a simulation model for evaluating the economics of developing geothermal resources. The model was found to be both an accurate predictor of geothermal power production facility costs and a valid designer of such facilities. GEOCOST first designs a facility using thermodynamic optimization routines and then estimates costs for the selected design using cost models. Costs generated in this manner appear to correspond closely with detailed cost estimates made by industry planning groups. Through the use of this model, geothermal power production costs can be rapidly and accurately estimated for many alternative sites making the evaluation process much simpler yet more meaningful.

  9. Stakeholders’ perceptions on factors influencing male involvement in prevention of mother to child transmission of HIV services in Blantyre, Malawi

    OpenAIRE

    Nyondo, Alinane Linda; Chimwaza, Angela Faith; Muula, Adamson Sinjani

    2014-01-01

    Background Male Involvement (MI) in the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) services is essential in a patriarchal society where men are decision makers of the household. Male partners have a role in the woman’s risk of acquiring HIV, uptake of HIV testing and participation in Mother to Child Transmission (MTCT) prevention programmes. Although MI is important for uptake of PMTCT interventions, it remains low in Africa. The purpose of this s...

  10. A cost-consequences analysis of a primary care librarian question and answering service.

    Directory of Open Access Journals (Sweden)

    Jessie McGowan

    Full Text Available BACKGROUND: Cost consequences analysis was completed from randomized controlled trial (RCT data for the Just-in-time (JIT librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs and Family Health Groups (FHGs. METHODS: We conducted a cost consequences analysis based on data from the JIT project. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system. RESULTS: The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55. CONCLUSIONS: The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.

  11. The costs and potential savings of a novel telepaediatric service in Queensland

    Directory of Open Access Journals (Sweden)

    Scuffham Paul

    2007-03-01

    Full Text Available Abstract Background There are few cost-minimisation studies in telemedicine. We have compared the actual costs of providing a telepaediatric service to the potential costs if patients had travelled to see the specialist in person. Methods In November 2000, we established a novel telepaediatric service for selected regional hospitals in Queensland. Instead of transferring patients to Brisbane, the majority of referrals to specialists in Brisbane were dealt with via videoconference. Since the service began, 1499 consultations have been conducted for a broad range of paediatric sub-specialities including burns, cardiology, child development, dermatology, diabetes, endocrinology, gastroenterology, nephrology, neurology, oncology, orthopaedics, paediatric surgery and psychiatry. Results During a five year period, the total cost of providing 1499 consultations through the telepaediatric service was A$955,996. The estimated potential cost of providing an outpatient service to the same number of patients at the Royal Children's Hospital in Brisbane was A$1,553,264; thus, telepaediatric services resulted in a net saving of approximately A$600,000 to the health service provider. Conclusion Telepaediatrics was a cheaper method for the delivery of outpatient services when the workload exceeded 774 consultations. A sensitivity analysis showed that the threshold point was most sensitive to changes related to patient travel costs, coordinator salaries and videoconference equipment costs. The study showed substantial savings for the health department, mainly due to reduced costs associated with patient travel.

  12. Activity-Based Costing in User Services of an Academic Library.

    Science.gov (United States)

    Ellis-Newman, Jennifer

    2003-01-01

    The rationale for using Activity-Based Costing (ABC) in a library is to allocate indirect costs to products and services based on the factors that most influence them. This paper discusses the benefits of ABC to library managers and explains the steps involved in implementing ABC in the user services area of an Australian academic library.…

  13. Costs and outcomes of VCT delivery models in the context of scaling up services in Indonesia

    NARCIS (Netherlands)

    Siregar, A.Y.M.; Komarudin, D.; Wisaksana, R.; Crevel, R. van; Baltussen, R.M.P.M.

    2011-01-01

    OBJECTIVE: To evaluate costs and outcomes of voluntary counselling and testing (VCT) service delivery models in urban Indonesia. METHODS: We collected primary data on utilization, costs and outcomes of VCT services in a hospital clinic (568 clients), HIV community clinic (28 clients), sexually

  14. Long-term effects of penicillin resistance and fitness cost on pneumococcal transmission dynamics in a developed setting

    Directory of Open Access Journals (Sweden)

    Diana Tilevik

    2016-05-01

    Full Text Available Background: The increasing prevalence of penicillin non-susceptible pneumococci (PNSP throughout the world threatens successful treatment of infections caused by this important bacterial pathogen. The rate at which PNSP clones spread in the community is thought to mainly be determined by two key determinants; the volume of penicillin use and the magnitude of the fitness cost in the absence of treatment. The aim of the study was to determine the impacts of penicillin consumption and fitness cost on pneumococcal transmission dynamics in a developed country setting. Methods: An individual-based network model based on real-life demographic data was constructed and applied in a developed country setting (Sweden. A population structure with transmission of carriage taking place within relevant mixing groups, i.e. families, day care groups, school classes, and other close contacts, was considered to properly assess the transmission dynamics for susceptible and PNSP clones. Several scenarios were simulated and model outcomes were statistically analysed. Results: Model simulations predicted that with an outpatient penicillin use corresponding to the sales in Sweden 2010 (118 recipes per 1,000 inhabitants per year, the magnitude of a fitness cost for resistance must be at least 5% to offset the advantage of penicillin resistance. Moreover, even if there is a fitness cost associated with penicillin resistance, a considerable reduction of penicillin usage appears to be required to significantly decrease the incidence of PNSP in a community. Conclusion: The frequency of PNSP clones is hard to reverse by simply reducing the penicillin consumption even if there is a biological cost associated with resistance. However, because penicillin usage does promote further spread of PNSP clones, it is important to keep down penicillin consumption considering future resistance problems.

  15. Cost Analysis of an Intervention to Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA Transmission.

    Directory of Open Access Journals (Sweden)

    Michal Chowers

    Full Text Available Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia.We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel.An average of 20,000 patients were screened yearly. The cost of prevention was $208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was $14,500, and the net cost attributable to nosocomial bacteremia was $9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of $199,600.A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country.

  16. Cost Analysis of an Intervention to Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) Transmission.

    Science.gov (United States)

    Chowers, Michal; Carmeli, Yehuda; Shitrit, Pnina; Elhayany, Asher; Geffen, Keren

    2015-01-01

    Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia. We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel. An average of 20,000 patients were screened yearly. The cost of prevention was $208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was $14,500, and the net cost attributable to nosocomial bacteremia was $9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of $199,600. A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country.

  17. Fracture liaison service in a non-regional orthopaedic clinic--a cost-effective service.

    LENUS (Irish Health Repository)

    Ahmed, M

    2012-01-01

    Fracture liaison services (FLS) aim to provide cost-effective targeting of secondary fracture prevention. It is proposed that a dedicated FLS be available in any hospital to which a patient presents with a fracture. An existing orthopaedic clinic nurse was retrained to deliver a FLS. Proformas were used so that different nurses could assume the fracture liaison nurse (FLN) role, as required. Screening consisted of fracture risk estimation, phlebotomy and DXA scanning. 124 (11%) of all patients attending the orthopaedic fracture clinic were reviewed in the FLS. Upper limb fractures accounted for the majority of fragility fractures screened n=69 (55.6%). Two-thirds of patients (n=69) had reduced bone mineral density (BMD). An evidence based approach to both non-pharmacological and pharmacotherapy was used and most patients (76.6%) receiving pharmacotherapy received an oral bisphosphonate (n=46). The FLS has proven to be an effective way of delivering secondary prevention for osteoporotic fracture in a non-regional fracture clinic, without increasing staff costs.

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

    Science.gov (United States)

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

    2016-01-01

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

  19. Can home care services achieve cost savings in long-term care for older people?

    Science.gov (United States)

    Greene, V L; Ondrich, J; Laditka, S

    1998-07-01

    To determine whether efficient allocation of home care services can produce net long-term care cost savings. Hazard function analysis and nonlinear mathematical programming. Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

  20. 78 FR 27307 - Establishment of Class A TV Service and Cable Television Rate Regulation; Cost of Service Rules...

    Science.gov (United States)

    2013-05-10

    ... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Parts 73 and 76 [MM Docket No. 00-10; FCC 01-123 and MM Docket No. 93-215; FCC 95-502] Establishment of Class A TV Service and Cable Television Rate Regulation; Cost of Service Rules--Clarification Regarding Information Collection Requirements; Correction AGENCY...

  1. Business aspects and cost advantages of partnering for fossil engineering services

    International Nuclear Information System (INIS)

    Featham, M.D.; Sensenig, R.G.

    1995-01-01

    In today's environment where utility companies are attempting to reduce costs, alternative cost competitive approaches are being adopted to traditional fossil power plant engineering. One approach is to utilize Partnering of multiple organizations to provide cost competitive and quality engineering services. An approach to Partnering that involves Florida Power Corporation Partnering with multiple architect/engineers to provide the fossil plant engineering services is described in this paper

  2. Cutting Costs and Improving Outcomes for Janitorial Services

    Science.gov (United States)

    Campbell, Jeffery L.

    2011-01-01

    Recent research reveals that janitorial services account for nearly 30 percent of facility budgets, which translates into billions of dollars annually. With janitorial services consuming such a large share of budgets, other industry findings are alarming. Most cleaning systems: 1) have no quantifiable standards; 2) are based solely on appearance;…

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

    Science.gov (United States)

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

    2013-05-10

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

  4. 7 CFR 160.204 - Fees for extra cost and hourly rate service.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Fees for extra cost and hourly rate service. 160.204... STORES REGULATIONS AND STANDARDS FOR NAVAL STORES Specific Fees Payable for Services Rendered § 160.204 Fees for extra cost and hourly rate service. The fees specified in §§ 160.201 and 160.202 apply to the...

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

    OpenAIRE

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

    2008-01-01

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

  6. An Invocation Cost Optimization Method for Web Services in Cloud Environment

    OpenAIRE

    Qi, Lianyong; Yu, Jiguo; Zhou, Zhili

    2017-01-01

    The advent of cloud computing technology has enabled users to invoke various web services in a “pay-as-you-go” manner. However, due to the flexible pricing model of web services in cloud environment, a cloud user’ service invocation cost may be influenced by many factors (e.g., service invocation time), which brings a great challenge for cloud users’ cost-effective web service invocation. In view of this challenge, in this paper, we first investigate the multiple factors that influence the in...

  7. Overcoming Language Barriers in Health Care: Costs and Benefits of Interpreter Services

    Science.gov (United States)

    Jacobs, Elizabeth A.; Shepard, Donald S.; Suaya, Jose A.; Stone, Esta-Lee

    2004-01-01

    Objectives. We assessed the impact of interpreter services on the cost and the utilization of health care services among patients with limited English proficiency. Methods. We measured the change in delivery and cost of care provided to patients enrolled in a health maintenance organization before and after interpreter services were implemented. Results. Compared with English-speaking patients, patients who used the interpreter services received significantly more recommended preventive services, made more office visits, and had more prescriptions written and filled. The estimated cost of providing interpreter services was $279 per person per year. Conclusions. Providing interpreter services is a financially viable method for enhancing delivery of health care to patients with limited English proficiency. PMID:15117713

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

    Science.gov (United States)

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

    2013-04-01

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

  9. 34 CFR 361.54 - Participation of individuals in cost of services based on financial need.

    Science.gov (United States)

    2010-07-01

    ... types of vocational rehabilitation services for which the unit has established a financial needs test... service. (3) The designated State unit may not apply a financial needs test, or require the financial... 34 Education 2 2010-07-01 2010-07-01 false Participation of individuals in cost of services based...

  10. The cost minimization analysis of an outreach dental service: a pilot ...

    African Journals Online (AJOL)

    For people with limited or no access to oral health care services, outreach dental services may be used to reduce oral health inequality. There is however paucity of information on the economic analysis of outreach dental services in sub Saharan Africa. Objective: To report a cost minimization analysis of an outreach dental ...

  11. Health services utilization and costs of the insured and uninsured ...

    African Journals Online (AJOL)

    2013-07-05

    Jul 5, 2013 ... Background: Health insurance is a social security system that aims to ... civil servants have no appreciable advantage in terms of access to and cost of health .... self‑medication, pharmaceutical shops, traditional healers,.

  12. Comparative cost-effectiveness of Option B+ for prevention of mother-to-child transmission of HIV in Malawi.

    Science.gov (United States)

    Tweya, Hannock; Keiser, Olivia; Haas, Andreas D; Tenthani, Lyson; Phiri, Sam; Egger, Matthias; Estill, Janne

    2016-03-27

    To estimate the cost-effectiveness of prevention of mother-to-child transmission (MTCT) of HIV with lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women ('Option B+') compared with ART during pregnancy or breastfeeding only unless clinically indicated ('Option B'). Mathematical modelling study of first and second pregnancy, informed by data from the Malawi Option B+ programme. Individual-based simulation model. We simulated cohorts of 10 000 women and their infants during two subsequent pregnancies, including the breastfeeding period, with either Option B+ or B. We parameterized the model with data from the literature and by analysing programmatic data. We compared total costs of antenatal and postnatal care, and lifetime costs and disability-adjusted life-years of the infected infants between Option B+ and Option B. During the first pregnancy, 15% of the infants born to HIV-infected mothers acquired the infection. With Option B+, 39% of the women were on ART at the beginning of the second pregnancy, compared with 18% with Option B. For second pregnancies, the rates MTCT were 11.3% with Option B+ and 12.3% with Option B. The incremental cost-effectiveness ratio comparing the two options ranged between about US$ 500 and US$ 1300 per DALY averted. Option B+ prevents more vertical transmissions of HIV than Option B, mainly because more women are already on ART at the beginning of the next pregnancy. Option B+ is a cost-effective strategy for PMTCT if the total future costs and lost lifetime of the infected infants are taken into account.

  13. Potential cost-effectiveness of schistosomiasis treatment for reducing HIV transmission in Africa--the case of Zimbabwean women.

    Directory of Open Access Journals (Sweden)

    Martial L Ndeffo Mbah

    Full Text Available Epidemiological data from Zimbabwe suggests that genital infection with Schistosoma haematobium may increase the risk of HIV infection in young women. Therefore, the treatment of Schistosoma haematobium with praziquantel could be a potential strategy for reducing HIV infection. Here we assess the potential cost-effectiveness of praziquantel as a novel intervention strategy against HIV infection.We developed a mathematical model of female genital schistosomiasis (FGS and HIV infections in Zimbabwe that we fitted to cross-sectional data of FGS and HIV prevalence of 1999. We validated our epidemic projections using antenatal clinic data on HIV prevalence. We simulated annual praziquantel administration to school-age children. We then used these model predictions to perform a cost-effectiveness analysis of annual administration of praziquantel as a potential measure to reduce the burden of HIV in sub-Saharan Africa.We showed that for a variation of efficacy between 30-70% of mass praziquantel administration for reducing the enhanced risk of HIV transmission per sexual act due to FGS, annual administration of praziquantel to school-age children in Zimbabwe could result in net savings of US$16-101 million compared with no mass treatment of schistosomiasis over a ten-year period. For a variation in efficacy between 30-70% of mass praziquantel administration for reducing the acquisition of FGS, annual administration of praziquantel to school-age children could result in net savings of US$36-92 million over a ten-year period.In addition to reducing schistosomiasis burden, mass praziquantel administration may be a highly cost-effective way of reducing HIV infections in sub-Saharan Africa. Program costs per case of HIV averted are similar to, and under some conditions much better than, other interventions that are currently implemented in Africa to reduce HIV transmission. As a cost-saving strategy, mass praziquantel administration should be prioritized

  14. Cost-effectiveness of strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit.

    Science.gov (United States)

    Gidengil, Courtney A; Gay, Charlene; Huang, Susan S; Platt, Richard; Yokoe, Deborah; Lee, Grace M

    2015-01-01

    OBJECTIVE To create a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. DESIGN Cost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection. PATIENTS AND SETTING Hypothetical cohort of 10,000 adult patients admitted to a US intensive care unit. METHODS We compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures; (2) active surveillance cultures plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate baths; (5) universal decolonization; (6) UCP + chlorhexidine gluconate baths; and (7) UCP+decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted. RESULTS A total of 1989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared with all strategies except UCP+decolonization and UCP+chlorhexidine gluconate. UCP+decolonization was more effective than universal decolonization but would cost $2469 per colonization averted and $9007 per infection averted. If MRSA colonization prevalence decreases from 12% to 5%, active surveillance cultures plus selective decolonization becomes the least expensive strategy. CONCLUSIONS Universal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission.

  15. A computational model for determining the minimal cost expansion alternatives in transmission systems planning

    International Nuclear Information System (INIS)

    Pinto, L.M.V.G.; Pereira, M.V.F.; Nunes, A.

    1989-01-01

    A computational model for determining an economical transmission expansion plan, based in the decomposition techniques is presented. The algorithm was used in the Brazilian South System and was able to find an optimal solution, with a low computational resource. Some expansions of this methodology are been investigated: the probabilistic one and the expansion with financier restriction. (C.G.C.). 4 refs, 7 figs

  16. The cost of chronic pain: an analysis of a regional pain management service in Ireland.

    Science.gov (United States)

    Gannon, Brenda; Finn, David P; O'Gorman, David; Ruane, Nancy; McGuire, Brian E

    2013-10-01

    The objective of the study was to collect data on the direct and indirect economic cost of chronic pain among patients attending a pain management clinic in Ireland. A tertiary pain management clinic serving a mixed urban and rural area in the West of Ireland. Data were collected from 100 patients using the Client Services Receipt Inventory and focused on direct and indirect costs of chronic pain. Patients were questioned about health service utilization, payment methods, and relevant sociodemographics. Unit costs were multiplied by resource use data to obtain full costs. Cost drivers were then estimated. Our study showed a cost per patient of US$24,043 over a 12-month period. Over half of this was attributable to wage replacement costs and lost productivity in those unable to work because of pain. Hospital stays and outpatient hospital services were the main drivers for health care utilization costs, together accounting for 63% of the direct medical costs per study participant attending the pain clinic. The cost of chronic pain among intensive service users is significant, and when extrapolated to a population level, these costs represent a very substantial economic burden. Wiley Periodicals, Inc.

  17. The cost and utilisation patterns of a pilot sign language interpreter service for primary health care services in South Africa.

    Directory of Open Access Journals (Sweden)

    Tryphine Zulu

    Full Text Available The World Health Organisation estimates disabling hearing loss to be around 5.3%, while a study of hearing impairment and auditory pathology in Limpopo, South Africa found a prevalence of nearly 9%. Although Sign Language Interpreters (SLIs improve the communication challenges in health care, they are unaffordable for many signing Deaf people and people with disabling hearing loss. On the other hand, there are no legal provisions in place to ensure the provision of SLIs in the health sector in most countries including South Africa. To advocate for funding of such initiatives, reliable cost estimates are essential and such data is scarce. To bridge this gap, this study estimated the costs of providing such a service within a South African District health service based on estimates obtained from a pilot-project that initiated the first South African Sign Language Interpreter (SASLI service in health-care.The ingredients method was used to calculate the unit cost per SASLI-assisted visit from a provider perspective. The unit costs per SASLI-assisted visit were then used in estimating the costs of scaling up this service to the District Health Services. The average annual SASLI utilisation rate per person was calculated on Stata v.12 using the projects' registry from 2008-2013. Sensitivity analyses were carried out to determine the effect of changing the discount rate and personnel costs.Average Sign Language Interpreter services' utilisation rates increased from 1.66 to 3.58 per person per year, with a median of 2 visits, from 2008-2013. The cost per visit was US$189.38 in 2013 whilst the estimated costs of scaling up this service ranged from US$14.2million to US$76.5million in the Cape Metropole District. These cost estimates represented 2.3%-12.2% of the budget for the Western Cape District Health Services for 2013.In the presence of Sign Language Interpreters, Deaf Sign language users utilise health care service to a similar extent as the

  18. The cost and utilisation patterns of a pilot sign language interpreter service for primary health care services in South Africa.

    Science.gov (United States)

    Zulu, Tryphine; Heap, Marion; Sinanovic, Edina

    2017-01-01

    The World Health Organisation estimates disabling hearing loss to be around 5.3%, while a study of hearing impairment and auditory pathology in Limpopo, South Africa found a prevalence of nearly 9%. Although Sign Language Interpreters (SLIs) improve the communication challenges in health care, they are unaffordable for many signing Deaf people and people with disabling hearing loss. On the other hand, there are no legal provisions in place to ensure the provision of SLIs in the health sector in most countries including South Africa. To advocate for funding of such initiatives, reliable cost estimates are essential and such data is scarce. To bridge this gap, this study estimated the costs of providing such a service within a South African District health service based on estimates obtained from a pilot-project that initiated the first South African Sign Language Interpreter (SASLI) service in health-care. The ingredients method was used to calculate the unit cost per SASLI-assisted visit from a provider perspective. The unit costs per SASLI-assisted visit were then used in estimating the costs of scaling up this service to the District Health Services. The average annual SASLI utilisation rate per person was calculated on Stata v.12 using the projects' registry from 2008-2013. Sensitivity analyses were carried out to determine the effect of changing the discount rate and personnel costs. Average Sign Language Interpreter services' utilisation rates increased from 1.66 to 3.58 per person per year, with a median of 2 visits, from 2008-2013. The cost per visit was US$189.38 in 2013 whilst the estimated costs of scaling up this service ranged from US$14.2million to US$76.5million in the Cape Metropole District. These cost estimates represented 2.3%-12.2% of the budget for the Western Cape District Health Services for 2013. In the presence of Sign Language Interpreters, Deaf Sign language users utilise health care service to a similar extent as the hearing population

  19. Preterm birth-associated cost of early intervention services: an analysis by gestational age.

    Science.gov (United States)

    Clements, Karen M; Barfield, Wanda D; Ayadi, M Femi; Wilber, Nancy

    2007-04-01

    Characterizing the cost of preterm birth is important in assessing the impact of increasing prematurity rates and evaluating the cost-effectiveness of therapies to prevent preterm delivery. To assess early intervention costs that are associated with preterm births, we estimated the program cost of early intervention services for children who were born in Massachusetts, by gestational age at birth. Using the Pregnancy to Early Life Longitudinal Data Set, birth certificates for infants who were born in Massachusetts between July 1999 and June 2000 were linked to early intervention claims through 2003. We determined total program costs, in 2003 dollars, of early intervention and mean cost per surviving infant by gestational age. Costs by plurality, eligibility criteria, provider discipline, and annual costs for children's first 3 years also were examined. Overall, 14,033 of 76,901 surviving infants received early intervention services. Program costs totaled almost $66 million, with mean cost per surviving infant of $857. Mean cost per infant was highest for children who were 24 to 31 weeks' gestational age ($5393) and higher for infants who were 32 to 36 weeks' gestational age ($1578) compared with those who were born at term ($725). Cost per surviving infant generally decreased with increasing gestational age. Among children in early intervention, mean cost per child was higher for preterm infants than for term infants. At each gestational age, mean cost per surviving infant was higher for multiples than for singletons, and annual early intervention costs were higher for toddlers than for infants. Compared with their term counterparts, preterm infants incurred higher early intervention costs. This information along with data on birth trends will inform budget forecasting for early intervention programs. Costs that are associated with early childhood developmental services must be included when considering the long-term costs of prematurity.

  20. On the relationship between perceived service quality, service loyalty and switching costs

    NARCIS (Netherlands)

    Ruyter, de J.C.; Wetzels, M.G.M.; Bloemer, J.M.M.

    1998-01-01

    In the services marketing literature it has been argued that the concept of service loyalty needs further conceptual and empirical investigation. In this paper a theoretical framework for service loyalty consisting of three dimensions: preference loyalty; price indifference loyalty; and

  1. Quality Dimensions, Value, Service Cost and Recommendation Behaviour: Evidence from the Nigerian Cellular Industry

    Directory of Open Access Journals (Sweden)

    Abolaji Joachim Abiodun

    2014-09-01

    Full Text Available The present study proposed and test a model that connects both affective and cognitive factors in cellular service to customers’ recommendation behavior. Results of the analysis of data collected through questionnaire from 293 respondents with cellular phones and active account in the Nigerian cellular industry indicate that core cellular service dimensions, service cost (price and hedonic values are significant determinants of customers’ recommendation behavior. In addition, the study found that customer service and utilitarian value exert negative effect on recommendation behavior. It seems that strengthening the performance of service providers on core service attributes, service cost (price and the entertainment and emotion evoking aspects of cellular service is of more value in partnering with customer to enlarge customer base through recommendation

  2. [Cost-effectiveness and affordability of strategy for preventing mother-to-child transmission of hepatitis B in China].

    Science.gov (United States)

    Lin, Y; Zhang, S X; Yang, P C; Cai, Y L; Zou, Y H

    2017-07-10

    Objective: To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B, and estimate the willing to pay and budget impacts on the PMTCT. Methods: The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention. The parameters in the model were obtained from literatures of national surveys or Meta-analysis. The costs, cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives, respectively. The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization. One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results. In addition, cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy. Results: The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier, which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention. Due to the strategy, a total of 24.516 1 QALYs per person would be gained, which was higher than that in those receiving no intervention. From societal perspective, the ICER was -59 136.6 yuan (RMB) per additional QALYs gained, indicating that the PMTCT is cost effective. The results were reliable indicated by one-way, multi-way and probability sensitivity analyses. By the CEAC, the willing to pay was much lower than the cost-effectiveness threshold. From the affordability curve of the PMTCT strategy, the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB), which was lower than the financial ability. Based on the results of cost-effectiveness affordability curves, the higher annual budget was determined

  3. An Invocation Cost Optimization Method for Web Services in Cloud Environment

    Directory of Open Access Journals (Sweden)

    Lianyong Qi

    2017-01-01

    Full Text Available The advent of cloud computing technology has enabled users to invoke various web services in a “pay-as-you-go” manner. However, due to the flexible pricing model of web services in cloud environment, a cloud user’ service invocation cost may be influenced by many factors (e.g., service invocation time, which brings a great challenge for cloud users’ cost-effective web service invocation. In view of this challenge, in this paper, we first investigate the multiple factors that influence the invocation cost of a cloud service, for example, user’s job size, service invocation time, and service quality level; and afterwards, a novel Cloud Service Cost Optimization Method named CS-COM is put forward, by considering the above multiple impact factors. Finally, a set of experiments are designed, deployed, and tested to validate the feasibility of our proposal in terms of cost optimization. The experiment results show that our proposed CS-COM method outperforms other related methods.

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

    Directory of Open Access Journals (Sweden)

    Arezoo Chouhdari

    2015-03-01

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

  5. Cost-effectiveness of World Health Organization 2010 Guidelines for Prevention of Mother-to-Child HIV Transmission in Zimbabwe

    Science.gov (United States)

    Ciaranello, Andrea L.; Perez, Freddy; Engelsmann, Barbara; Walensky, Rochelle P.; Mushavi, Angela; Rusibamayila, Asinath; Keatinge, Jo; Park, Ji-Eun; Maruva, Matthews; Cerda, Rodrigo; Wood, Robin; Dabis, Francois; Freedberg, Kenneth A.

    2013-01-01

    Background. In 2010, the World Health Organization (WHO) released revised guidelines for prevention of mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). We projected clinical impacts, costs, and cost-effectiveness of WHO-recommended PMTCT strategies in Zimbabwe. Methods. We used Zimbabwean data in a validated computer model to simulate a cohort of pregnant, HIV-infected women (mean age, 24 years; mean CD4 count, 451 cells/µL; subsequent 18 months of breastfeeding). We simulated guideline-concordant care for 4 PMTCT regimens: single-dose nevirapine (sdNVP); WHO-recommended Option A, WHO-recommended Option B, and Option B+ (lifelong maternal 3-drug antiretroviral therapy regardless of CD4). Outcomes included maternal and infant life expectancy (LE) and lifetime healthcare costs (2008 US dollars [USD]). Incremental cost-effectiveness ratios (ICERs, in USD per year of life saved [YLS]) were calculated from combined (maternal + infant) discounted costs and LE. Results. Replacing sdNVP with Option A increased combined maternal and infant LE from 36.97 to 37.89 years and would reduce lifetime costs from $5760 to $5710 per mother–infant pair. Compared with Option A, Option B further improved LE (38.32 years), and saved money within 4 years after delivery ($5630 per mother–infant pair). Option B+ (LE, 39.04 years; lifetime cost, $6620 per mother–infant pair) improved maternal and infant health, with an ICER of $1370 per YLS compared with Option B. Conclusions. Replacing sdNVP with Option A or Option B will improve maternal and infant outcomes and save money; Option B increases health benefits and decreases costs compared with Option A. Option B+ further improves maternal outcomes, with an ICER (compared with Option B) similar to many current HIV-related healthcare interventions. PMID:23204035

  6. The cost effectiveness of NHS physiotherapy support for occupational health (OH) services.

    Science.gov (United States)

    Phillips, Ceri J; Phillips Nee Buck, Rhiannon; Main, Chris J; Watson, Paul J; Davies, Shân; Farr, Angela; Harper, Christie; Noble, Gareth; Aylward, Mansel; Packman, Julie; Downton, Matt; Hale, Janine

    2012-02-23

    Musculoskeletal pain is detrimental to quality of life (QOL) and disruptive to activities of daily living. It also places a major economic burden on healthcare systems and wider society. In 2006, the Welsh Assembly Government (WAG) established a three tiered self-referral Occupational Health Physiotherapy Pilot Project (OHPPP) comprising: 1.) telephone advice and triage, 2.) face-to-face physiotherapy assessment and treatment if required, and 3.) workplace assessment and a return-to-work facilitation package as appropriate. This study aimed to evaluate the feasibility and cost-effectiveness of the pilot service. A pragmatic cohort study was undertaken, with all OHPPP service users between September 2008 and February 2009 being invited to participate. Participants were assessed on clinical status, yellow flags, sickness absence and work performance at baseline, after treatment and at 3 month follow up. Cost-effectiveness was evaluated from both top-down and bottom-up perspectives and cost per Quality Adjusted Life Year (cost/QALY) was calculated. The cost-effectiveness analysis assessed the increase in service cost that would be necessary before the cost-effectiveness of the service was compromised. A total of 515 patients completed questionnaires at baseline. Of these, 486 were referred for face to face assessment with a physiotherapist and were included in the analysis for the current study. 264 (54.3%) and 199 (40.9%) were retained at end of treatment and 3 month follow up respectively. An improvement was observed at follow up in all the clinical outcomes assessed, as well as a reduction in healthcare resource usage and sickness absence, and improvement in self-reported work performance. Multivariate regression indicated that baseline and current physical health were associated with work-related outcomes at follow up. The costs of the service were £194-£360 per service user depending on the method used, and the health gains contributed to a cost/QALY of £1386

  7. 47 CFR 76.924 - Allocation to service cost categories.

    Science.gov (United States)

    2010-10-01

    ... franchise, system, regional, and/or company level(s) in a manner consistent with the accounting practices of the operator on April 3, 1993. However, in all events, cable operators shall identify at the franchise level their costs of franchise requirements, franchise fees, local taxes and local programming. (d...

  8. Cost-Effectiveness Analysis of Family Planning Services Offered by ...

    African Journals Online (AJOL)

    USER

    Keywords: Mobile clinics; Staic clinic; Family planning; Cost-effectiveness. Résumé. Des analyses ... d'offrir plus de méthodes de longue durée d'action peut influer sur une décision politique entre ces options. Cliniques ... nurse and a driver9.

  9. Cost Minimization Model of Gas Transmission Line for Indonesian SIJ Pipeline Network

    Directory of Open Access Journals (Sweden)

    Septoratno Siregar

    2003-05-01

    Full Text Available Optimization of Indonesian SIJ gas pipeline network is being discussed here. Optimum pipe diameters together with the corresponding pressure distribution are obtained from minimization of total cost function consisting of investment and operating costs and subjects to some physical (Panhandle A and Panhandle B equations constraints. Iteration technique based on Generalized Steepest-Descent and fourth order Runge-Kutta method are used here. The resulting diameters from this continuous optimization are then rounded to the closest available discrete sizes. We have also calculated toll fee along each segment and safety factor of the network by determining the pipe wall thickness, using ANSI B31.8 standard. Sensitivity analysis of toll fee for variation of flow rates is shown here. The result will gives the diameter and compressor size and compressor location that feasible to use for the SIJ pipeline project. The Result also indicates that the east route cost relatively less expensive than the west cost.

  10. A cost-constrained model of strategic service quality emphasis in nursing homes.

    Science.gov (United States)

    Davis, M A; Provan, K G

    1996-02-01

    This study employed structural equation modeling to test the relationship between three aspects of the environmental context of nursing homes; Medicaid dependence, ownership status, and market demand, and two basic strategic orientations: low cost and differentiation based on service quality emphasis. Hypotheses were proposed and tested against data collected from a sample of nursing homes operating in a single state. Because of the overwhelming importance of cost control in the nursing home industry, a cost constrained strategy perspective was supported. Specifically, while the three contextual variables had no direct effect on service quality emphasis, the entire model was supported when cost control orientation was introduced as a mediating variable.

  11. A Novel Short-Term Maintenance Strategy for Power Transmission and Transformation Equipment Based on Risk-Cost-Analysis

    Directory of Open Access Journals (Sweden)

    Hang Yang

    2017-11-01

    Full Text Available Current studies on preventive condition-based maintenance of power transmission and transformation equipment mainly focus on mid-term or long-term maintenance, and cannot meet the requirements of short-term especially temporary maintenance. In order to solve the defects of the present preventive maintenance strategies, according to the engineering application and based on risk-cost analysis, a short-term maintenance strategy is proposed in this manuscript. For the equipment working in bad health condition, its active maintenance costs and operation risk costs are evaluated, respectively. Then the latest maintenance time is calculated in accordance with the principle that its operation risk costs are no higher than active maintenance costs. Utilizing the latest maintenance time, the best maintenance time is calculated by setting the maximum relative earnings of postponing maintenance as the target, which provides the operation staffs with comprehensive maintenance-decision support. In the end, different cases on the IEEE 24-bus system are simulated. The effectiveness and advantages of the proposed strategy are demonstrated by the simulation results.

  12. Cost-effective up to 40 Gbit/s transmission performance of 1310 nm directly modulated lasers for short to medium range distances

    NARCIS (Netherlands)

    Huiszoon, B.; Jonker, R.J.W.; Bennekom, van P.K.; Khoe, G.D.; Waardt, de H.

    2005-01-01

    This paper presents successful 20 and 40 Gb/s potentially low-cost transmission experiments using 1310 nm directly modulated distributed feedback lasers (DMLs) in the very-short- to medium-range distances. This paper will recommend operating conditions for error-free transmission at these bit rates

  13. Helicopter Emergency Medical Services: effects, costs and benefits

    NARCIS (Netherlands)

    A.N. Ringburg (Akkie)

    2009-01-01

    textabstractAdvanced prehospital medical care with air transport was introduced in the Netherlands in May 1995. The fi rst helicopter Mobile Medical Team, also called Helicopter Emergency Medical Service (HEMS) was a joint venture initiative of the VU Medical Center in Amsterdam and the Algemene

  14. Counting the cost of language services in psychiatry

    African Journals Online (AJOL)

    Conclusions. PsychiatricaJly educated staff are clearly preferred as interpreters. A significant proportion of patients are being assessed through the use of family members, cleaners and other inappropriate people. The financial burden to the hospitals of not proViding an interpreter service is small, but the impact on working.

  15. Counting the cost of language services in psychiatry | Drennan ...

    African Journals Online (AJOL)

    Conclusions. PsychiatricaJly educated staff are clearly preferred as interpreters. A significant proportion of patients are being assessed through the use of family members, cleaners and other inappropriate people. The financial burden to the hospitals of not providing an interpreter service is small, but the impact on working ...

  16. The distribution of communication cost for a mobile service scenario

    DEFF Research Database (Denmark)

    Møller, Jesper; Yiu, Man Lung

    We consider the following mathematical model for a mobile service scenario. Consider a planar stationary Poisson process, with its points radially ordered with respect to the origin (the anchor); these points may correspond to locations of e.g. restaurants. A user, with a location different from...

  17. A Method for Estimating Costs and Benefits of Space Assembly and Servicing By Astronauts and Robots

    Science.gov (United States)

    Purves, Lloyd R.; Benfield, Mark (Technical Monitor)

    2002-01-01

    One aspect of designing future space missions is to determine whether Space Assembly and Servicing (SAS) is useful and, if so, what combination of robots and astronauts provides the most effective means of accomplishing it. Certain aspects of these choices, such as the societal value of developing the means for humans to live in space, do not lend themselves to quantification. However, other SAS costs and benefits can be quantified in a manner that can help select the most cost-effective SAS approach. Any space facility, whether it is assembled and serviced or not, entails an eventual replacement cost due to wear and obsolescence. Servicing can reduce this cost by limiting replacement to only failed or obsolete components. However, servicing systems, such as space robots, have their own logistics cost, and astronauts can have even greater logistics requirements. On the other hand, humans can be more capable than robots at performing dexterous and unstructured tasks, which can reduce logistics costs by allowing a reduction in mass of replacement components. Overall, the cost-effectiveness of astronaut SAS depends on its efficiency; and, if astronauts have to be wholly justified by their servicing usefulness, then the serviced space facility has to be large enough to fully occupy them.

  18. Costs of a school-based dental mobile service in South Africa.

    Science.gov (United States)

    Molete, M P; Chola, L; Hofman, K J

    2016-10-19

    The burden of untreated tooth decay remains high and oral healthcare utilisation is low for the majority of children in South Africa. There is need for alternative methods of improving access to low cost oral healthcare. The mobile dental unit of the University of the Witwatersrand (Wits) has been operational for over 25 years, providing alternative oral healthcare to children and adults who otherwise would not have access. The aim of this study was to conduct a cost-analysis of a school based oral healthcare program in the Wits mobile dental unit. The objectives were to estimate the general costs of the school based program, costs of oral healthcare per patient and the economic implications of providing services at scale. In 2012, the Wits mobile dental unit embarked on a 5 month project to provide oral healthcare in four schools located around Johannesburg. Cost and service use data were retrospectively collected from the program records for the cost analysis, which was undertaken from a provider perspective. The costs considered included both financial and economic costs. Capital costs were annualised and discounted at 6 %. One way sensitivity tests were conducted for uncertain parameters. The total economic costs were R813.701 (US$76,048). The cost of screening and treatment per patient were R331 (US$31) and R743 (US$69) respectively. Furthermore, fissure sealants cost the least out of the treatments provided. The sensitivity analysis indicated that the Wits mobile dental unit was cost efficient at 25 % allocation of staff time and that a Dental Therapy led service could save costs by 9.1 %. Expanding the services to a wider population of children and utilising Dental Therapists as key personnel could improve the efficiency of mobile dental healthcare provision.

  19. Cost of Services Provided by the National Breast and Cervical Cancer Early Detection Program

    Science.gov (United States)

    Ekwueme, Donatus U.; Subramanian, Sujha; Trogdon, Justin G.; Miller, Jacqueline W.; Royalty, Janet E.; Li, Chunyu; Guy, Gery P.; Crouse, Wesley; Thompson, Hope; Gardner, James G.

    2015-01-01

    BACKGROUND The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is the largest cancer screening program for low-income women in the United States. This study updates previous estimates of the costs of delivering preventive cancer screening services in the NBCCEDP. METHODS We developed a standardized web-based cost-assessment tool to collect annual activity-based cost data on screening for breast and cervical cancer in the NBCCEDP. Data were collected from 63 of the 66 programs that received funding from the Centers for Disease Control and Prevention during the 2006/2007 fiscal year. We used these data to calculate costs of delivering preventive public health services in the program. RESULTS We estimated the total cost of all NBCCEDP services to be $296 (standard deviation [SD], $123) per woman served (including the estimated value of in-kind donations, which constituted approximately 15% of this total estimated cost). The estimated cost of screening and diagnostic services was $145 (SD, $38) per women served, which represented 57.7% of the total cost excluding the value of in-kind donations. Including the value of in-kind donations, the weighted mean cost of screening a woman for breast cancer was $110 with an office visit and $88 without, the weighted mean cost of a diagnostic procedure was $401, and the weighted mean cost per breast cancer detected was $35,480. For cervical cancer, the corresponding cost estimates were $61, $21, $415, and $18,995, respectively. CONCLUSIONS These NBCCEDP cost estimates may help policy makers in planning and implementing future costs for various potential changes to the program. PMID:25099904

  20. Cost, Emissions, and Customer Service Trade-Off Analysis In Pickup and Delivery Systems.

    Science.gov (United States)

    2011-05-01

    This research offers a novel formulation for including emissions into fleet assignment and vehicle routing, and for the : trade-offs faced by fleet operators between cost, emissions, and service quality. This approach enables evaluation of : the impa...

  1. Cost-Benefit Analysis of Radiation Therapy Services at Tripler Army Medical Center

    National Research Council Canada - National Science Library

    Diehl, Diane S

    2004-01-01

    The purpose of this analysis was to examine the costs and benefits associated with continuance of "in-house" radiation therapy services to eligible beneficiaries at Tripler Army Medical Center (TAMC...

  2. Measuring Changes in Service Costs to Meet the Requirements of the 2002 National Defense Authorization Act

    National Research Council Canada - National Science Library

    Shirley, Chad; Ausink, John; Baldwin, Laura H

    2004-01-01

    The National Defense Authorization Act for Fiscal Year 2002 sets forth a series of goals for the Department of Defense to reduce the cost of the services it buys over a ten-year period through changes...

  3. The hidden costs of self-management services in the accounting activity of a company

    Directory of Open Access Journals (Sweden)

    Dan Ioan TOPOR

    2017-05-01

    Full Text Available This article addresses relevant aspects regarding the hidden costs of self-management services in the accounting area, within the accounting department of a company. With this aim, the authors conducted a study using a questionnaire, whose results were analyzed and interpreted. The hidden costs of the self-management of business accounting services observed in the accounting department of the company have been assessed and the causes of their generating sources were identified and analyzed. The debate of these hidden costs involved the treating of notions that exist in the accounting language, but are still not sufficiently explored by the specialists in the area. We also presented and analyzed the causes of the hidden costs of self-management in the accounting activity, as well as a reporting document for failures, arising from the case study. The article ends with the authors' conclusions regarding the hidden costs of self-management services in the accounting area.

  4. Demonstration of DFT-spread 256QAM-OFDM signal transmission with cost-effective directly modulated laser.

    Science.gov (United States)

    Li, Fan; Yu, Jianjun; Fang, Yuan; Dong, Ze; Li, Xinying; Chen, Lin

    2014-04-07

    We experimentally demonstrated a 256-ary quadrature amplitude modulation (256QAM) direct-detection optical orthogonal frequency division multiplexing (DDO-OFDM) transmission system utilizing a cost-effective directly modulated laser (DML). Intra-symbol frequency-domain averaging (ISFA) is applied to suppress in-band noise while the channel response estimation and Discrete Fourier Transform-spread (DFT-spread) is used to reduce the peak-to-average power ratio (PAPR) of the transmitted OFDM signal. The bit-error ratio (BER) of 15-Gbit/s 256QAM-OFDM signal has been measured after 20-km SSMF transmission that is less than 7% forward-error-correction (FEC) threshold of 3.8 × 10(-3) as the launch power into fiber is set at 6dBm. For 11.85-Gbit/s 256QAM-OFDM signal, with the aid of ISFA-based channel estimation and PAPR reduction enabled by DFT-spread, the BER after 20-km SSMF transmission can be improved from 6.4 × 10(-3) to 6.8 × 10(-4) when the received optical power is -6dBm.

  5. COST-EFFECTIVENESS ANALYSIS OF OUTSOURCING SERVICES IN REGARD TO Foreign ECONOMIC ACTIVITY OF ENTERPRISES

    Directory of Open Access Journals (Sweden)

    Evgenia Sergeevna Gracheva

    2017-06-01

    Full Text Available Despite enterprises, which render outsourcing services, appeared on the Russian services market with the beginning of market relations, there are not many researches that deal with competition and cost-effectiveness analyses of outsourcing services in regard to foreign economic activity. Economic integration of Russian business into international economic relations leads to complication of all national foreign economic complex and to the necessity of international economic infrastructure development. One of its most important parts are both services which deal with execution of support international economic operations (interpreting and translation services, transport services, customs services etc. and conducting foreign economic activity for client-enterprise (complex outsourcing FEA. Welcoming environment is formed nowadays for outsourcing business development in regard to foreign economic activity. It dictates the need for more thorough study of this type of business activity and development of indicators system for cost-effectiveness analysis of outsourcing in regard to foreign economic activity. Purpose – to define the complex outsourcing FEA, to develop the indicators system for cost-effectiveness analysis of outsourcing services in regard to foreign economic activity. Methodology: in article following scientific methods are used: functional method and statistical method. Results: is given authorial definition of complex outsourcing FEA, is developed the indicators system for cost-effectiveness analysis of outsourcing. Practical implications: the results of this research may be used by the businesses, which render outsourcing and intermediary services in regard to foreign economic activity.

  6. 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

  7. Understanding the cost of capital of logistics service providers: an empirical investigation of multiple contingency variables

    OpenAIRE

    Lampe, Kerstin; Hofmann, Erik

    2014-01-01

    The article analyzes the influence of company-, industry- and market-related variables on the cost of capital of logistics service providers, as well as on their systematic risk. Financial information has become more and more important in strategic decision making (especially in the international context); in addition of being a measure of performance, the cost of capital is an important variable for logistics service providers in decisions about investing capital and developing the appropria...

  8. Guide to resource conservation and cost savings opportunities in the food service sector

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-03-01

    Opportunities for conserving energy and water, as well as reducing waste, within the 24,000 establishment-strong food service sector in Ontario are identified. Operators are encouraged to take advantage of these opportunities to lower their costs while conserving valuable resources at the same time. In preparing this guide, site visits were carried out at six food service facilities in Ontario. Information about how much money is generally spent on energy, water and waste management by food service operators is provided. The amount and type of waste generated by these facilities is also described. The volatility of the commercial food service market place was identified as one of the major impediments to energy conservation. It was found that most owners of the food service facilities make business decisions based on the lowest first costs, irrespective of longer-term energy efficiency and operating costs. 31 refs., 13 tabs., 9 figs., 4 appendices.

  9. Who should carry the cost of ecosystem service provision? A pan-European citizens’ view

    DEFF Research Database (Denmark)

    Prokofieva, Irina; Mavsar, Robert; Bartczak, Anna

    2014-01-01

    accepted concept in theory, the legitimacy of which nevertheless has not yet been challenged in practice. In our study, we conducted an extensive survey in five European countries – Finland, Denmark, Poland, Italy and Spain – with the aim to explore citizens’ opinions of who should carry the costs...... of ecosystem services provision. The ecosystem services in question were biodiversity, recreation, carbon sequestration, water quality, and scenic beauty. Our results show that the majority of respondents in all studied countries generally think that the costs of enhanced provision of ecosystem services shall......The underlying notion of payments for environmental services is that beneficiaries of environmental services (directly or indirectly) financially support their provision by covering at least part of the costs landowners incur to generate them. This so-called “beneficiary-pay principle” is a widely...

  10. Network cost in transmission and distribution of electric power; Naetkostnader i oeverfoering och distribution av el

    Energy Technology Data Exchange (ETDEWEB)

    Lindahl, A; Naeslund, B; Oettinger-Biberg, C; Olander, H; Wuolikainen, T; Fritz, P

    1994-12-31

    This report is divided in two parts, where part 1 treats the charges on the regional nets with special emphasis on the net owners tariffs on a deregulated market. Part 2 describes the development of the network costs in electric power distribution for the period 1991-1993. 11 figs, 33 tabs

  11. Contracting for health services in New Zealand: a transaction cost analysis.

    Science.gov (United States)

    Ashton, T

    1998-02-01

    The splitting of the functions of purchaser and provider in the New Zealand health system in 1993 necessitated the use of explicit contracts between the two parties. This paper examines contracting experiences during the first two years of operation. The study focuses on four services: rest homes, primary care clinics, surgical services, and acute mental health services. The insights of transaction cost economics form the theoretical framework. The objective of this study was to examine whether the transaction costs associated with contracting vary across the four different services, and whether different types of contracts and contractual relationships are emerging as transactors attempt to reduce these costs. Information was collected in a series of 53 interviews with purchasers and providers, together with any relevant documentation. The results suggest that the costs of contracting are indeed greater for some services than for others. Other variables such as the style of negotiations, the type and specificity of contracts and the degree of monitoring also differ across the four services. At this early stage of the reform process, there was little evidence that purchasers and providers were attempting to reduce transaction costs by negotiating more flexible, longer-term, relational contracts. The main benefit from contracting to date has been improved accountability of service providers.

  12. Activity-based costing in services: literature bibliometric review.

    Science.gov (United States)

    Stefano, Nara Medianeira; Filho, Nelson Casarotto

    2013-12-01

    This article is aimed at structuring a bibliography portfolio to treat the application of the ABC method in service and contribute to discussions within the scientific community. The methodology followed a three-stage procedure: Planning, execution and Synthesis. Also, the process ProKnow-C (Knowledge Process Development - Constructivist) was used in the execution stage. International databases were used to collect information (ISI Web of Knowledge and Scopus). As a result, we obtained a bibliography portfolio of 21 articles (with scientific recognition) dealing with the proposed theme.

  13. Multi-standard transmission of converged wired and wireless services over 100m plastic optical fibre

    NARCIS (Netherlands)

    Yang, H.; Visani, D.; Okonkwo, C.M.; Shi, Y.; Tartarini, G.; Tangdiongga, E.; Koonen, A.M.J.

    2010-01-01

    The first multi-standard transmission consisting of 6 Gbit/s DMT baseband and 200 Mbit/s MB-OFDM UWB radio signals over 100m perfluorinated graded-index plastic optical fibre is demonstrated. Transmission performance indicates BER <10-5 and EVM <-22dB respectively.

  14. [Cost-effectiveness and cost-benefit analysis on strategy for preventing mother-to-child transmission of hepatitis B virus].

    Science.gov (United States)

    Cai, Y L; Zhang, S X; Yang, P C; Lin, Y

    2016-06-01

    Through cost-benefit analysis (CBA), cost-effectiveness analysis (CEA) and quantitative optimization analysis to understand the economic benefit and outcomes of strategy regarding preventing mother-to-child transmission (PMTCT) on hepatitis B virus. Based on the principle of Hepatitis B immunization decision analytic-Markov model, strategies on PMTCT and universal vaccination were compared. Related parameters of Shenzhen were introduced to the model, a birth cohort was set up as the study population in 2013. The net present value (NPV), benefit-cost ratio (BCR), incremental cost-effectiveness ratio (ICER) were calculated and the differences between CBA and CEA were compared. A decision tree was built as the decision analysis model for hepatitis B immunization. Three kinds of Markov models were used to simulate the outcomes after the implementation of vaccination program. The PMTCT strategy of Shenzhen showed a net-gain as 38 097.51 Yuan/per person in 2013, with BCR as 14.37. The universal vaccination strategy showed a net-gain as 37 083.03 Yuan/per person, with BCR as 12.07. Data showed that the PMTCT strategy was better than the universal vaccination one and would end with gaining more economic benefit. When comparing with the universal vaccination program, the PMTCT strategy would save 85 100.00 Yuan more on QALY gains for every person. The PMTCT strategy seemed more cost-effective compared with the one under universal vaccination program. In the CBA and CEA hepatitis B immunization programs, the immunization coverage rate and costs of hepatitis B related diseases were the most important influencing factors. Outcomes of joint-changes of all the parameters in CEA showed that PMTCT strategy was a more cost-effective. The PMTCT strategy gained more economic benefit and effects on health. However, the cost of PMTCT strategy was more than the universal vaccination program, thus it is important to pay attention to the process of PMTCT strategy and the universal

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2017-09-01

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

  17. 42 CFR 413.106 - Reasonable cost of physical and other therapy services furnished under arrangements.

    Science.gov (United States)

    2010-10-01

    ... of therapy, to therapists working full time in an employment relationship. (2) Fringe benefit and... geographical area in which the services are furnished and a standard travel allowance. (3) If therapy services... 42 Public Health 2 2010-10-01 2010-10-01 false Reasonable cost of physical and other therapy...

  18. Capabilities and costs for ancillary services provision by wind power plants. Deliverable D 3.1

    DEFF Research Database (Denmark)

    Faiella, Mariano; Hennig, Tobias; Cutululis, Nicolaos Antonio

    This report is the deliverable of the third work package of the REserviceS project and describes the technical options and related costs for the provision of ancillary services specifically from wind energy technologies. It is focused on the set of ancillary services defined in the previous work...

  19. 42 CFR 412.405 - Preadmission services as inpatient operating costs under the inpatient psychiatric facility...

    Science.gov (United States)

    2010-10-01

    ... under the inpatient psychiatric facility prospective payment system. 412.405 Section 412.405 Public... Services of Inpatient Psychiatric Facilities § 412.405 Preadmission services as inpatient operating costs under the inpatient psychiatric facility prospective payment system. The prospective payment system...

  20. Comparison of two dose and three dose human papillomavirus vaccine schedules: cost effectiveness analysis based on transmission model.

    Science.gov (United States)

    Jit, Mark; Brisson, Marc; Laprise, Jean-François; Choi, Yoon Hong

    2015-01-06

    To investigate the incremental cost effectiveness of two dose human papillomavirus vaccination and of additionally giving a third dose. Cost effectiveness study based on a transmission dynamic model of human papillomavirus vaccination. Two dose schedules for bivalent or quadrivalent human papillomavirus vaccines were assumed to provide 10, 20, or 30 years' vaccine type protection and cross protection or lifelong vaccine type protection without cross protection. Three dose schedules were assumed to give lifelong vaccine type and cross protection. United Kingdom. Males and females aged 12-74 years. No, two, or three doses of human papillomavirus vaccine given routinely to 12 year old girls, with an initial catch-up campaign to 18 years. Costs (from the healthcare provider's perspective), health related utilities, and incremental cost effectiveness ratios. Giving at least two doses of vaccine seems to be highly cost effective across the entire range of scenarios considered at the quadrivalent vaccine list price of £86.50 (€109.23; $136.00) per dose. If two doses give only 10 years' protection but adding a third dose extends this to lifetime protection, then the third dose also seems to be cost effective at £86.50 per dose (median incremental cost effectiveness ratio £17,000, interquartile range £11,700-£25,800). If two doses protect for more than 20 years, then the third dose will have to be priced substantially lower (median threshold price £31, interquartile range £28-£35) to be cost effective. Results are similar for a bivalent vaccine priced at £80.50 per dose and when the same scenarios are explored by parameterising a Canadian model (HPV-ADVISE) with economic data from the United Kingdom. Two dose human papillomavirus vaccine schedules are likely to be the most cost effective option provided protection lasts for at least 20 years. As the precise duration of two dose schedules may not be known for decades, cohorts given two doses should be closely

  1. COST-EFFECTIVENESS ANALYSIS OF OUTSOURCING SERVICES IN REGARD TO Foreign ECONOMIC ACTIVITY OF ENTERPRISES

    OpenAIRE

    Evgenia Sergeevna Gracheva; Evgeniya Alexandrovna Ermakova

    2017-01-01

    Despite enterprises, which render outsourcing services, appeared on the Russian services market with the beginning of market relations, there are not many researches that deal with competition and cost-effectiveness analyses of outsourcing services in regard to foreign economic activity. Economic integration of Russian business into international economic relations leads to complication of all national foreign economic complex and to the necessity of international economic infrastructure ...

  2. The influence of costs and benefits' analysis on service strategy formulation: Learnings from the shipping industry

    DEFF Research Database (Denmark)

    Pagoropoulos, Aris; Kjær, Louise Laumann; Andersen, Jakob Axel Bejbro

    2017-01-01

    . This paper assesses how the analysis of costs and benefits of Product-Service Systems (PSS) as servitized offerings influences the formulation of service strategies in the shipping industry. The study examines both the manufacturer and customer perspectives using two case studies from the shipping sector....... Life Cycle Costing (LCC) was used as a tool to assess the associated costs and benefits of two proposed PSS. Based on the results of the LCC, the drivers and barriers of the actual transformation processes were explored through workshops and interviews served to map the perspectives of both...

  3. Analysis of health services cost at the dental clinic of the San Marcos University.

    OpenAIRE

    Madrid Chumacero, Marco Tulio; Echeandía Arellano, Juana V.

    2014-01-01

    The objectives of this study were: To establish the unitary services cost in Dentistry, To describe simplest way to determine the costs structure approximated for each dental service offered at the clinic. They it was compared with the welfare rates at the dental clinic of the UNMSM, the results were the following ones: 1. Diagnosis: in the four cost activities is higher compared with the official rates, demonstrating "minimum utilities" that goes up from 0,21 to s. 15.96. 2. Radiology: in th...

  4. An Analysis of the Cost Accounting System for the Depot Maintenance Service, Air Force Industrial Fund.

    Science.gov (United States)

    1987-09-01

    AN A NALYSIS OF THE COST ACCOUNTING SYSTEM FOR THE DEPOT 1/1 MRINTENANCE SERVI..(U) MIR FORCE INST OF TECH IIGHT-PTTERSON RFB OH SCHOOL OF SYST.. 0 L...I "VV h S~ ~~i FiLE COV, THSI CIO ~OF AN ANALYSIS OF THE COST ACCOUNTING SYSTEM FOR THE DEPOT MAINTENANCE SERVICE, AIR FORCE INDUSTRIAL FUND...Patterson Air Force Base, Ohio ~ p~UOW~~ ’ I ~ 1 12 02 0 AFIT/GLM/LSY/87S-83 AN ANALYSIS OF THE COST ACCOUNTING SYSTEM FOR THE DEPOT MAINTENANCE SERVICE, AIR

  5. 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

  6. Variation in the costs of delivering routine immunization services in Peru.

    Science.gov (United States)

    Walker, D; Mosqueira, N R; Penny, M E; Lanata, C F; Clark, A D; Sanderson, C F B; Fox-Rushby, J A

    2004-09-01

    Estimates of vaccination costs usually provide only point estimates at national level with no information on cost variation. In practice, however, such information is necessary for programme managers. This paper presents information on the variations in costs of delivering routine immunization services in three diverse districts of Peru: Ayacucho (a mountainous area), San Martin (a jungle area) and Lima (a coastal area). We consider the impact of variability on predictions of cost and reflect on the likely impact on expected cost-effectiveness ratios, policy decisions and future research practice. All costs are in 2002 prices in US dollars and include the costs of providing vaccination services incurred by 19 government health facilities during the January-December 2002 financial year. Vaccine wastage rates have been estimated using stock records. The cost per fully vaccinated child ranged from 16.63-24.52 U.S. Dollars in Ayacucho, 21.79-36.69 U.S. Dollars in San Martin and 9.58-20.31 U.S. Dollars in Lima. The volume of vaccines administered and wastage rates are determinants of the variation in costs of delivering routine immunization services. This study shows there is considerable variation in the costs of providing vaccines across geographical regions and different types of facilities. Information on how costs vary can be used as a basis from which to generalize to other settings and provide more accurate estimates for decision-makers who do not have disaggregated data on local costs. Future studies should include sufficiently large sample sizes and ensure that regions are carefully selected in order to maximize the interpretation of cost variation.

  7. Evaluating the cost-effectiveness of combination antiretroviral therapy for the prevention of mother-to-child transmission of HIV in Uganda

    NARCIS (Netherlands)

    Kuznik, Andreas; Lamorde, Mohammed; Hermans, Sabine; Castelnuovo, Barbara; Auerbach, Brandon; Semeere, Aggrey; Sempa, Joseph; Ssennono, Mark; Ssewankambo, Fred; Manabe, Yukari C.

    2012-01-01

    Objective To model the cost-effectiveness in Uganda of combination antiretroviral therapy (ART) to prevent mother-to-child transmission of human immunodeficiency virus (HIV). Methods The cost-effectiveness of ART was evaluated on the assumption that ART reduces the risk of an HIV-positive pregnant

  8. The Cost of Library Services: Activity-Based Costing in an Australian Academic Library.

    Science.gov (United States)

    Robinson, Peter; Ellis-Newman, Jennifer

    1998-01-01

    Explains activity-based costing (ABC), discusses the benefits of ABC to library managers, and describes the steps involved in implementing ABC in an Australian academic library. Discusses the budgeting process in universities, and considers benefits to the library. (Author/LRW)

  9. DEVELOPMENT AND EVALUATION OF MEASURES TO REDUCE COSTS OF REGIONAL LOANS SERVICING

    Directory of Open Access Journals (Sweden)

    Pavel Arkadyevitch Galanskiy

    2014-10-01

    Full Text Available The paper discusses major problems of current concern connected with controlling direct obligations of Russian regions (the model of debt servicing cost parameter optimization has been worked out, and their key solutions. The methods offered to analyze debts and manage them are applicable to any Russian Federation regions characterized by budget deficit and forced to cover it using borrowed funds. The important leverage found and their impacts on sub-federal debt servicing cost are also treated in the article.Objective: to identify the direction and impact degree of various parameters on the cost of sub-federal loans.Methodology: there were used general scientific methods: analysis and synthesis, comparison, generalization, systematic approach.Results: main parameters that influence the cost of sub-federal loans servicing and allow its most effective reduction have been identified.

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  11. Using a Time-Driven Activity-Based Costing Model To Determine the Actual Cost of Services Provided by a Transgenic Core.

    Science.gov (United States)

    Gerwin, Philip M; Norinsky, Rada M; Tolwani, Ravi J

    2018-03-01

    Laboratory animal programs and core laboratories often set service rates based on cost estimates. However, actual costs may be unknown, and service rates may not reflect the actual cost of services. Accurately evaluating the actual costs of services can be challenging and time-consuming. We used a time-driven activity-based costing (ABC) model to determine the cost of services provided by a resource laboratory at our institution. The time-driven approach is a more efficient approach to calculating costs than using a traditional ABC model. We calculated only 2 parameters: the time required to perform an activity and the unit cost of the activity based on employee cost. This method allowed us to rapidly and accurately calculate the actual cost of services provided, including microinjection of a DNA construct, microinjection of embryonic stem cells, embryo transfer, and in vitro fertilization. We successfully implemented a time-driven ABC model to evaluate the cost of these services and the capacity of labor used to deliver them. We determined how actual costs compared with current service rates. In addition, we determined that the labor supplied to conduct all services (10,645 min/wk) exceeded the practical labor capacity (8400 min/wk), indicating that the laboratory team was highly efficient and that additional labor capacity was needed to prevent overloading of the current team. Importantly, this time-driven ABC approach allowed us to establish a baseline model that can easily be updated to reflect operational changes or changes in labor costs. We demonstrated that a time-driven ABC model is a powerful management tool that can be applied to other core facilities as well as to entire animal programs, providing valuable information that can be used to set rates based on the actual cost of services and to improve operating efficiency.

  12. Costs of providing tuberculosis diagnosis and treatment services in Viet Nam.

    Science.gov (United States)

    Minh, H V; Mai, V Q; Nhung, N V; Hoi, L V; Giang, K B; Chung, L H; Kien, V D; Duyen, N T; Ngoc, N B; Anh, T T; Phuong, T B; Ngan, T T; Khanh, P H

    2017-09-01

    To estimate the cost of providing tuberculosis (TB) diagnosis and treatment packages at different levels of health facilities in Viet Nam. This was a retrospective costing study from the providers' perspective using a standard costing approach. We included typical services for TB diagnosis and treatment based on standard protocols. The least expensive TB service was the 6-month isoniazid preventive therapy regimen for latent tuberculous infection provided by district health centres (US$7.20-14.30, accounting for 0.3-0.7% of Viet Nam's per capita gross domestic product [GDP] of US$2052.30 in 2014). The cost of diagnosing and treating a patient with drug-susceptible TB (the most common type of TB) ranged between US$51.20 and US$180.70, and represented 2.5-8.8% of Viet Nam's per capita GDP in 2014. The most expensive TB service was the diagnosis and treatment of a multidrug-resistant TB case (US$1568.20-2391.20), accounting for 76.4-116.5% of Viet Nam's per capita GDP in 2014). The cost of TB diagnosis and treatment services in Viet Nam varied according to level of health facility, type of TB, different costing options, and different staff cost scenarios.

  13. Study protocol for the Integra Initiative to assess the benefits and costs of integrating sexual and reproductive health and HIV services in Kenya and Swaziland

    Directory of Open Access Journals (Sweden)

    Warren Charlotte E

    2012-11-01

    Full Text Available Abstract Background In sub-Saharan Africa (SSA there are strong arguments for the provision of integrated sexual and reproductive health (SRH and HIV services. Most HIV transmissions are sexually transmitted or associated with pregnancy, childbirth, and breastfeeding. Many of the behaviours that prevent HIV transmission also prevent sexually transmitted infections and unintended pregnancies. There is potential for integration to increase the coverage of HIV services, as individuals who use SRH services can benefit from HIV services and vice-versa, as well as increase cost-savings. However, there is a dearth of empirical evidence on effective models for integrating HIV/SRH services. The need for robust evidence led a consortium of three organizations – International Planned Parenthood Federation, Population Council and the London School of Hygiene & Tropical Medicine – to design/implement the Integra Initiative. Integra seeks to generate rigorous evidence on the feasibility, effectiveness, cost and impact of different models for delivering integrated HIV/SRH services in high and medium HIV prevalence settings in SSA. Methods/design A quasi-experimental study will be conducted in government clinics in Kenya and Swaziland – assigned into intervention/comparison groups. Two models of service delivery are investigated: integrating HIV care/treatment into 1 family planning and 2 postnatal care. A full economic-costing will be used to assess the costs of different components of service provision, and the determinants of variations in unit costs across facilities/service models. Health facility assessments will be conducted at four time-periods to track changes in quality of care and utilization over time. A two-year cohort study of family planning/postnatal clients will assess the effect of integration on individual outcomes, including use of SRH services, HIV status (known/unknown and pregnancy (planned/unintended. Household surveys within some

  14. The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review

    Directory of Open Access Journals (Sweden)

    Johri Mira

    2011-02-01

    Full Text Available Abstract Background Although highly effective prevention interventions exist, the epidemic of paediatric HIV continues to challenge control efforts in resource-limited settings. We reviewed the cost-effectiveness of interventions to prevent mother-to-child transmission (MTCT of HIV in low- and middle-income countries (LMICs. This article presents syntheses of evidence on the costs, effects and cost-effectiveness of HIV MTCT strategies for LMICs from the published literature and evaluates their implications for policy and future research. Methods Candidate studies were identified through a comprehensive database search including PubMed, Embase, Cochrane Library, and EconLit restricted by language (English or French, date (January 1st, 1994 to January 17th, 2011 and article type (original research. Articles reporting full economic evaluations of interventions to prevent or reduce HIV MTCT were eligible for inclusion. We searched article bibliographies to identify additional studies. Two authors independently assessed eligibility and extracted data from studies retained for review. Study quality was appraised using a modified BMJ checklist for economic evaluations. Data were synthesised in narrative form. Results We identified 19 articles published in 9 journals from 1996 to 2010, 16 concerning sub-Saharan Africa. Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings as measured against accepted international benchmarks. In concentrated epidemics where HIV prevalence in the general population is very low, MTCT strategies based on universal testing of pregnant women may not compare well against cost-effectiveness benchmarks, or may satisfy formal criteria for cost-effectiveness but offer a low relative value as compared to competing interventions to improve population health. Conclusions and Recommendations Interventions to prevent HIV MTCT are compelling on economic

  15. 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

  16. Cost of delivering health care services at primary health facilities in Ghana

    Directory of Open Access Journals (Sweden)

    Maxwell Ayindenaba Dalaba

    2017-11-01

    Full Text Available Abstract Background There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs and Community-based Health Planning and Services (CHPS in Ghana. Methods The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD attendance were estimated. Results The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC. The cost per OPD attendance was higher at CHPS (US$8.79 than at HCs (US$5.16. The average Internally Generated Funds (IGF recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS reimbursement was the main source of revenue accounting for over 90% total IGF. Conclusions The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar

  17. Can the real opportunity cost stand up: displaced services, the straw man outside the room.

    Science.gov (United States)

    Eckermann, Simon; Pekarsky, Brita

    2014-04-01

    In current literature, displaced services have been suggested to provide a basis for determining a threshold value for the effects of a new technology as part of a reimbursement process when budgets are fixed. We critically examine the conditions under which displaced services would represent an economically meaningful threshold value. We first show that if we assume that the least cost-effective services are displaced to finance a new technology, then the incremental cost-effectiveness ratio (ICER) of the displaced services (d) only coincides with that related to the opportunity cost of adopting that new technology, the ICER of the most cost-effective service in expansion (n), under highly restrictive conditions-namely, complete allocative efficiency in existing provision of health care interventions. More generally, reimbursement of new technology with a fixed budget comprises two actions; adoption and financing through displacement and the effect of reimbursement is the net effect of these two actions. In order for the reimbursement process to be a pathway to allocative efficiency within a fixed budget, the net effect of the strategy of reimbursement is compared with the most cost-effective alternative strategy for reimbursement: optimal reallocation, the health gain maximizing expansion of existing services financed by the health loss minimizing contraction. The shadow price of the health effects of a new technology, βc = (1/n + 1/d - 1/m)(-1), accounts for both imperfect displacement (the ICER of the displaced service, d < m, the ICER of the least cost-effective of the existing services in contraction) and the allocative inefficiency (n < m) characteristic of health systems.

  18. 77 FR 10489 - Xcel Energy Services Inc., Northern States Power Company v. American Transmission Company, LLC...

    Science.gov (United States)

    2012-02-22

    ... ATC has not compiled with express terms and conditions of the Transmission Owners Agreement and the Midwest ISO Tariff and (2) direct ATC to enter into negotiations with XES and NSPW to develop final terms...

  19. Delivery of antiretroviral treatment services in India: Estimated costs incurred under the National AIDS Control Programme.

    Science.gov (United States)

    Agarwal, Reshu; Rewari, Bharat Bhushan; Shastri, Suresh; Nagaraja, Sharath Burugina; Rathore, Abhilakh Singh

    2017-04-01

    Competing domestic health priorities and shrinking financial support from external agencies necessitates that India's National AIDS Control Programme (NACP) brings in cost efficiencies to sustain the programme. In addition, current plans to expand the criteria for eligibility for antiretroviral therapy (ART) in India will have significant financial implications in the near future. ART centres in India provide comprehensive services to people living with HIV (PLHIV): those fulfilling national eligibility criteria and receiving ART and those on pre-ART care, i.e. not on ART. ART centres are financially supported (i) directly by the NACP; and (ii) indirectly by general health systems. This study was conducted to determine (i) the cost incurred per patient per year of pre-ART and ART services at ART centres; and (ii) the proportion of this cost incurred by the NACP and by general health systems. The study used national data from April 2013 to March 2014, on ART costs and non-ART costs (human resources, laboratory tests, training, prophylaxis and management of opportunistic infections, hospitalization, operational, and programme management). Data were extracted from procurement records and reports, statements of expenditure at national and state level, records and reports from ART centres, databases of the National AIDS Control Organisation, and reports on use of antiretroviral drugs. The analysis estimates the cost for ART services as US$ 133.89 (?8032) per patient per year, of which 66% (US$ 88.66, ?5320) is for antiretroviral drugs and 34% (US$ 45.23, ?2712) is for non-ART recurrent expenditure, while the cost for pre-ART care is US$ 33.05 (?1983) per patient per year. The low costs incurred for patients in ART and pre-ART care services can be attributed mainly to the low costs of generic drugs. However, further integration with general health systems may facilitate additional cost saving, such as in human resources.

  20. Policy Framework for Covering Preventive Services Without Cost Sharing: Saving Lives and Saving Money?

    Science.gov (United States)

    Chen, Stephanie C; Pearson, Steven D

    2016-08-01

    The US Affordable Care Act mandates that private insurers cover a list of preventive services without cost sharing. The list is determined by 4 expert committees that evaluate the overall health effect of preventive services. We analyzed the process by which the expert committees develop their recommendations. Each committee uses different criteria to evaluate preventive services and none of the committees consider cost systematically. We propose that the existing committees adopt consistent evidence review methodologies and expand the scope of preventive services reviewed and that a separate advisory committee be established to integrate economic considerations into the final selection of free preventive services. The comprehensive framework and associated criteria are intended to help policy makers in the future develop a more evidence-based, consistent, and ethically sound approach.

  1. A Low-Cost Time-Hopping Impulse Radio System for High Data Rate Transmission

    Directory of Open Access Journals (Sweden)

    Jinyun Zhang

    2005-03-01

    Full Text Available We present an efficient, low-cost implementation of time-hopping impulse radio that fulfills the spectral mask mandated by the FCC and is suitable for high-data-rate, short-range communications. Key features are (i all-baseband implementation that obviates the need for passband components, (ii symbol-rate (not chip rate sampling, A/D conversion, and digital signal processing, (iii fast acquisition due to novel search algorithms, and (iv spectral shaping that can be adapted to accommodate different spectrum regulations and interference environments. Computer simulations show that this system can provide 110 Mbps at 7–10 m distance, as well as higher data rates at shorter distances under FCC emissions limits. Due to the spreading concept of time-hopping impulse radio, the system can sustain multiple simultaneous users, and can suppress narrowband interference effectively.

  2. Time, costs and farmers’ perceptions: The case of livestock service delivery in tamilnadu

    Directory of Open Access Journals (Sweden)

    G kathiravan

    2011-10-01

    Full Text Available A study was undertaken in southern peninsular State of India, the Tamil Nadu State, (i to ascertain the time costs of animal health care and bovine breeding services, and (ii to comprehend the perceptions of farmers on the livestock services rendered by different service providers. The districts of the state were categorized as 'Livestock Developed' (LD and 'Livestock Under Developed' (LUD based on initial base line developed. Travel, waiting and service time were among the primary non-price factors that affected service quality. Average travel time was highest for visiting the public veterinary centre in both LUD (23.05 min. and LD (21.32 min. districts. Waiting time with regard to veterinarians providing home services in LUD districts was highest (23.01 min., followed by public veterinary centre services at LUD districts (22.35 min., home services by para-veterinarians (22.01 min. and public veterinary centre services at LD districts (20.10 min.. Both travel and waiting time were much higher in case of breeding services compared to curative services, which could be due to the fact that the farmers preferred Artificial Insemination (AI over its close substitute, the natural service. However, the service time was relatively less in case of insemination services vis-à-vis curative services both in LUD and LD districts. The quality perceptions of farmers on livestock services revealed that the home services rendered by veterinarians as the best one (0.83, followed by private veterinary clinics (0.75, home services by para-veterinarians (0.74, public veterinary centres (0.64 and co-operative veterinary centres (0.48. [Vet. World 2011; 4(5.000: 209-212

  3. Optimal pricing policies for services with consideration of facility maintenance costs

    Science.gov (United States)

    Yeh, Ruey Huei; Lin, Yi-Fang

    2012-06-01

    For survival and success, pricing is an essential issue for service firms. This article deals with the pricing strategies for services with substantial facility maintenance costs. For this purpose, a mathematical framework that incorporates service demand and facility deterioration is proposed to address the problem. The facility and customers constitute a service system driven by Poisson arrivals and exponential service times. A service demand with increasing price elasticity and a facility lifetime with strictly increasing failure rate are also adopted in modelling. By examining the bidirectional relationship between customer demand and facility deterioration in the profit model, the pricing policies of the service are investigated. Then analytical conditions of customer demand and facility lifetime are derived to achieve a unique optimal pricing policy. The comparative statics properties of the optimal policy are also explored. Finally, numerical examples are presented to illustrate the effects of parameter variations on the optimal pricing policy.

  4. The economics of planning electricity transmission to accommodate renewables: Using two-stage optimisation to evaluate flexibility and the cost of disregarding uncertainty

    International Nuclear Information System (INIS)

    Weijde, Adriaan Hendrik van der; Hobbs, Benjamin F.

    2012-01-01

    Aggressive development of renewable electricity sources will require significant expansions in transmission infrastructure. We present a stochastic two-stage optimisation model that captures the multistage nature of transmission planning under uncertainty and use it to evaluate interregional grid reinforcements in Great Britain (GB). In our model, a proactive transmission planner makes investment decisions in two time periods, each time followed by a market response. Uncertainty is represented by economic, technology, and regulatory scenarios, and first-stage investments must be made before it is known which scenario will occur. The model allows us to identify expected cost-minimising first-stage investments, as well as estimate the value of information, the cost of ignoring uncertainty, and the value of flexibility. Our results show that ignoring risk in planning transmission for renewables has quantifiable economic consequences, and that considering uncertainty can yield decisions that have lower expected costs than traditional deterministic planning methods. In the GB case, the value of information and cost of disregarding uncertainty in transmission planning were of the same order of magnitude (approximately £100 M, in present worth terms). Further, the best plan under a risk-neutral decision criterion can differ from the best under risk-aversion. Finally, a traditional sensitivity analysis-based robustness analysis also yields different results than the stochastic model, although the former's expected cost is not much higher.

  5. Transmission issues in Alberta

    International Nuclear Information System (INIS)

    Levson, D.

    2002-01-01

    This paper outlined the major issues and concerns facing users of the transmission system in Alberta. They include congestion management issues that make investors uncertain about power generation. It is necessary to know the difference between which transmission price signals will be faced by low cost cogeneration at Fort McMurray and Cold Lake coal-fired generation near Edmonton compared to combined cycle gas generation near Calgary. Import and export policy tariffs are another concern. Most new generation opportunities in Alberta require access to export markets, but transmission facilities for export need policy support and appropriate tariffs. It was noted that the past actions of Alberta's Transmission Administrator and balancing pool may be distorting market signals for ancillary service markets, and that loss studies and calculations need upgrading

  6. Ecosystem services and opportunity costs shift spatial priorities for conserving forest biodiversity.

    Directory of Open Access Journals (Sweden)

    Matthias Schröter

    Full Text Available Inclusion of spatially explicit information on ecosystem services in conservation planning is a fairly new practice. This study analyses how the incorporation of ecosystem services as conservation features can affect conservation of forest biodiversity and how different opportunity cost constraints can change spatial priorities for conservation. We created spatially explicit cost-effective conservation scenarios for 59 forest biodiversity features and five ecosystem services in the county of Telemark (Norway with the help of the heuristic optimisation planning software, Marxan with Zones. We combined a mix of conservation instruments where forestry is either completely (non-use zone or partially restricted (partial use zone. Opportunity costs were measured in terms of foregone timber harvest, an important provisioning service in Telemark. Including a number of ecosystem services shifted priority conservation sites compared to a case where only biodiversity was considered, and increased the area of both the partial (+36.2% and the non-use zone (+3.2%. Furthermore, opportunity costs increased (+6.6%, which suggests that ecosystem services may not be a side-benefit of biodiversity conservation in this area. Opportunity cost levels were systematically changed to analyse their effect on spatial conservation priorities. Conservation of biodiversity and ecosystem services trades off against timber harvest. Currently designated nature reserves and landscape protection areas achieve a very low proportion (9.1% of the conservation targets we set in our scenario, which illustrates the high importance given to timber production at present. A trade-off curve indicated that large marginal increases in conservation target achievement are possible when the budget for conservation is increased. Forty percent of the maximum hypothetical opportunity costs would yield an average conservation target achievement of 79%.

  7. Ecosystem Services and Opportunity Costs Shift Spatial Priorities for Conserving Forest Biodiversity

    Science.gov (United States)

    Schröter, Matthias; Rusch, Graciela M.; Barton, David N.; Blumentrath, Stefan; Nordén, Björn

    2014-01-01

    Inclusion of spatially explicit information on ecosystem services in conservation planning is a fairly new practice. This study analyses how the incorporation of ecosystem services as conservation features can affect conservation of forest biodiversity and how different opportunity cost constraints can change spatial priorities for conservation. We created spatially explicit cost-effective conservation scenarios for 59 forest biodiversity features and five ecosystem services in the county of Telemark (Norway) with the help of the heuristic optimisation planning software, Marxan with Zones. We combined a mix of conservation instruments where forestry is either completely (non-use zone) or partially restricted (partial use zone). Opportunity costs were measured in terms of foregone timber harvest, an important provisioning service in Telemark. Including a number of ecosystem services shifted priority conservation sites compared to a case where only biodiversity was considered, and increased the area of both the partial (+36.2%) and the non-use zone (+3.2%). Furthermore, opportunity costs increased (+6.6%), which suggests that ecosystem services may not be a side-benefit of biodiversity conservation in this area. Opportunity cost levels were systematically changed to analyse their effect on spatial conservation priorities. Conservation of biodiversity and ecosystem services trades off against timber harvest. Currently designated nature reserves and landscape protection areas achieve a very low proportion (9.1%) of the conservation targets we set in our scenario, which illustrates the high importance given to timber production at present. A trade-off curve indicated that large marginal increases in conservation target achievement are possible when the budget for conservation is increased. Forty percent of the maximum hypothetical opportunity costs would yield an average conservation target achievement of 79%. PMID:25393951

  8. Providing all global energy with wind, water, and solar power, Part II: Reliability, system and transmission costs, and policies

    International Nuclear Information System (INIS)

    Delucchi, Mark A.; Jacobson, Mark Z.

    2011-01-01

    This is Part II of two papers evaluating the feasibility of providing all energy for all purposes (electric power, transportation, and heating/cooling), everywhere in the world, from wind, water, and the sun (WWS). In Part I, we described the prominent renewable energy plans that have been proposed and discussed the characteristics of WWS energy systems, the global demand for and availability of WWS energy, quantities and areas required for WWS infrastructure, and supplies of critical materials. Here, we discuss methods of addressing the variability of WWS energy to ensure that power supply reliably matches demand (including interconnecting geographically dispersed resources, using hydroelectricity, using demand-response management, storing electric power on site, over-sizing peak generation capacity and producing hydrogen with the excess, storing electric power in vehicle batteries, and forecasting weather to project energy supplies), the economics of WWS generation and transmission, the economics of WWS use in transportation, and policy measures needed to enhance the viability of a WWS system. We find that the cost of energy in a 100% WWS will be similar to the cost today. We conclude that barriers to a 100% conversion to WWS power worldwide are primarily social and political, not technological or even economic. - Research highlights: → We evaluate the feasibility of global energy supply from wind, water, and solar energy. → WWS energy can be supplied reliably and economically to all energy-use sectors. → The social cost of WWS energy generally is less than the cost of fossil-fuel energy. → Barriers to 100% WWS power worldwide are socio-political, not techno-economic.

  9. Recommendations and final report on the Alberta transmission administrator function

    International Nuclear Information System (INIS)

    Billinton, R.; Wallace, R.B.

    1997-01-01

    In May 1995, the Electric Utilities Act (EUA) was passed formalizing the Alberta government's policy of electric industry restructuring. The Act established two new important market entities: a power pool and a transmission administrator (TA). Combined, these two entities create the open access required to enable competition in generation. Functionally, the TA acts as a single transmission service agent for all transmission wire owners. The TA leases the wires from owners then provides a province-wide tariff schedule for transmission services to recover the required revenue. Customers can only purchase transmission service from the TA. Both the lease wire cost and the TA tariff schedule must be approved by the regulator

  10. Cost-volume-profit analysis and expected benefit of health services: a study of cardiac catheterization services.

    Science.gov (United States)

    Younis, Mustafa Z; Jabr, Samer; Smith, Pamela C; Al-Hajeri, Maha; Hartmann, Michael

    2011-01-01

    Academic research investigating health care costs in the Palestinian region is limited. Therefore, this study examines the costs of the cardiac catheterization unit of one of the largest hospitals in Palestine. We focus on costs of a cardiac catheterization unit and the increasing number of deaths over the past decade in the region due to cardiovascular diseases (CVDs). We employ cost-volume-profit (CVP) analysis to determine the unit's break-even point (BEP), and investigate expected benefits (EBs) of Palestinian government subsidies to the unit. Findings indicate variable costs represent 56 percent of the hospital's total costs. Based on the three functions of the cardiac catheterization unit, results also indicate that the number of patients receiving services exceed the break-even point in each function, despite the unit receiving a government subsidy. Our findings, although based on one hospital, will permit hospital management to realize the importance of unit costs in order to make informed financial decisions. The use of break-even analysis will allow area managers to plan minimum production capacity for the organization. The economic benefits for patients and the government from the unit may encourage government officials to focus efforts on increasing future subsidies to the hospital.

  11. Canby Area Service Project substation and associated transmission line. Environmental Assessment

    Energy Technology Data Exchange (ETDEWEB)

    1992-02-01

    Bonneville Power Administration (BPA) provides power to Surprise Valley Electrification Corporation (SVEC) in Modoc County, California. BPA uses PacificCorp`s substation and transmission facilities between Alturas and Canby, California to transfer power to SVEC`s Canby Substation. In the next year, SVEC expects increased industrial, agricultural, and residential electric loads on their 69-kV transmission system south of Canby. SVEC`s substation can accommodate only about 10 percent of the expected additional electric load. BPA`s proposed action is intended to meet SVEC`s increasing electric load. BPA proposes to meet SVEC`s increasing energy load by tapping into BPA`s existing BPA Malin-Warner 230-kV transmission line, and building an 7.9-mile transmission line to a new BPA substation. BPA proposes to build the new substation next to the west side of SVEC`s Canby Substation (Figure 1). This new substation will allow SVEC to move the additional power over their existing transmission or distribution lines. This report is the environmental assessment of the potential impact of the proposed project. The assessment determined that no ``environmental impact statement`` is not required.

  12. Canby Area Service Project : Substation and Associated Transmission Line : Environmental Assessment.

    Energy Technology Data Exchange (ETDEWEB)

    United States. Bonneville Power Administration.

    1992-02-01

    Bonneville Power Administration (BPA) provides power to Surprise Valley Electrification Corporation (SVEC) in Modoc County, California. BPA uses PacificCorp's substation and transmission facilities between Alturas and Canby, California to transfer power to SVEC's Canby Substation. In the next year, SVEC expects increased industrial, agricultural, and residential electric loads on their 69-kV transmission system south of Canby. SVEC's substation can accommodate only about 10 percent of the expected additional electric load. BPA's proposed action is intended to meet SVEC's increasing electric load. BPA proposes to meet SVEC's increasing energy load by tapping into BPA's existing BPA Malin-Warner 230-kV transmission line, and building an 7.9-mile transmission line to a new BPA substation. BPA proposes to build the new substation next to the west side of SVEC's Canby Substation (Figure 1). This new substation will allow SVEC to move the additional power over their existing transmission or distribution lines. This report is the environmental assessment of the potential impact of the proposed project. The assessment determined that no environmental impact statement'' is not required.

  13. The cost effectiveness of NHS physiotherapy support for occupational health (OH services

    Directory of Open Access Journals (Sweden)

    Phillips Ceri J

    2012-02-01

    Full Text Available Abstract Background Musculoskeletal pain is detrimental to quality of life (QOL and disruptive to activities of daily living. It also places a major economic burden on healthcare systems and wider society. In 2006, the Welsh Assembly Government (WAG established a three tiered self-referral Occupational Health Physiotherapy Pilot Project (OHPPP comprising: 1. telephone advice and triage, 2. face-to-face physiotherapy assessment and treatment if required, and 3. workplace assessment and a return-to-work facilitation package as appropriate. This study aimed to evaluate the feasibility and cost-effectiveness of the pilot service. Methods A pragmatic cohort study was undertaken, with all OHPPP service users between September 2008 and February 2009 being invited to participate. Participants were assessed on clinical status, yellow flags, sickness absence and work performance at baseline, after treatment and at 3 month follow up. Cost-effectiveness was evaluated from both top-down and bottom-up perspectives and cost per Quality Adjusted Life Year (cost/QALY was calculated. The cost-effectiveness analysis assessed the increase in service cost that would be necessary before the cost-effectiveness of the service was compromised. Results A total of 515 patients completed questionnaires at baseline. Of these, 486 were referred for face to face assessment with a physiotherapist and were included in the analysis for the current study. 264 (54.3% and 199 (40.9% were retained at end of treatment and 3 month follow up respectively. An improvement was observed at follow up in all the clinical outcomes assessed, as well as a reduction in healthcare resource usage and sickness absence, and improvement in self-reported work performance. Multivariate regression indicated that baseline and current physical health were associated with work-related outcomes at follow up. The costs of the service were £194-£360 per service user depending on the method used, and the

  14. Cost-effectiveness of alternative changes to a national blood collection service.

    Science.gov (United States)

    Willis, S; De Corte, K; Cairns, J A; Zia Sadique, M; Hawkins, N; Pennington, M; Cho, G; Roberts, D J; Miflin, G; Grieve, R

    2018-05-16

    To evaluate the cost-effectiveness of changing opening times, introducing a donor health report and reducing the minimum inter-donation interval for donors attending static centres. Evidence is required about the effect of changes to the blood collection service on costs and the frequency of donation. This study estimated the effect of changes to the blood collection service in England on the annual number of whole-blood donations by current donors. We used donors' responses to a stated preference survey, donor registry data on donation frequency and deferral rates from the INTERVAL trial. Costs measured were those anticipated to differ between strategies. We reported the cost per additional unit of blood collected for each strategy versus current practice. Strategies with a cost per additional unit of whole blood less than £30 (an estimate of the current cost of collection) were judged likely to be cost-effective. In static donor centres, extending opening times to evenings and weekends provided an additional unit of whole blood at a cost of £23 and £29, respectively. Introducing a health report cost £130 per additional unit of blood collected. Although the strategy of reducing the minimum inter-donation interval had the lowest cost per additional unit of blood collected (£10), this increased the rate of deferrals due to low haemoglobin (Hb). The introduction of a donor health report is unlikely to provide a sufficient increase in donation frequency to justify the additional costs. A more cost-effective change is to extend opening hours for blood collection at static centres. © 2018 The Authors. Transfusion Medicine published by John Wiley & Sons Ltd on behalf of British Blood Transfusion Society.

  15. Low-cost, digital lock-in module with external reference for coating glass transmission/reflection spectrophotometer

    Science.gov (United States)

    Alonso, R.; Villuendas, F.; Borja, J.; Barragán, L. A.; Salinas, I.

    2003-05-01

    A versatile, low-cost, digital signal processor (DSP) based lock-in module with external reference is described. This module is used to implement an industrial spectrophotometer for measuring spectral transmission and reflection of automotive and architectonic coating glasses over the ultraviolet, visible and near-infrared wavelength range. The light beams are modulated with an optical chopper. A digital phase-locked loop (DPLL) is used to lock the lock-in to the chop frequency. The lock-in rejects the ambient radiation and permits the spectrophotometer to work in the presence of ambient light. The algorithm that implements the dual lock-in and the DPLL in the DSP56002 evaluation module from Motorola is described. The use of a DSP allows implementation of the lock-in and DPLL by software, which gives flexibility and programmability to the system. Lock-in module cost, under 300 euro, is an important parameter taking into account that two modules are used in the system. Besides, the algorithms implemented in this DSP can be directly implemented in the latest DSP generations. The DPLL performance and the spectrophotometer are characterized. Capture and lock DPLL ranges have been measured and checked to be greater than the chop frequency drifts. The lock-in measured frequency response shows that the lock-in performs as theoretically predicted.

  16. The cost-effectiveness of three interventions for providing preventive services to low-income children.

    Science.gov (United States)

    Johnson, Ben; Serban, Nicoleta; Griffin, Paul M; Tomar, Scott L

    2017-12-01

    We evaluated the impact of loan repayment programmes, revising Medicaid fee-for-service rates, and changing dental hygienist supervision requirements on access to preventive dental care for children in Georgia. We estimated cost savings from the three interventions of preventive care for young children after netting out the intervention cost. We used a regression model to evaluate the impact of changing the Medicaid reimbursement rates. The impact of supervision was evaluated by comparing general and direct supervision in school-based dental sealant programmes. Federal loan repayments to dentists and school-based sealant programmes (SBSPs) had lower intervention costs (with higher potential cost savings) than raising the Medicaid reimbursement rate. General supervision had costs 56% lower than direct supervision of dental hygienists for implementing a SBSP. Raising the Medicaid reimbursement rate by 10 percentage points would improve utilization by Loan repayment could serve almost 13 000 children for a cost of $400 000 and a potential cost saving of $176 000. The three interventions all improved met need for preventive dental care. Raising the reimbursement rate alone would marginally affect utilization of Medicaid services but would not substantially increase acceptance of Medicaid by providers. Both loan repayment programmes and amending supervision requirements are potentially cost-saving interventions. Loan repayment programmes provide complete care to targeted areas, while amending supervision requirements of dental hygienists could provide preventive care across the state. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Surgical wound dehiscence in an Australian community nursing service: time and cost to healing.

    Science.gov (United States)

    Sandy-Hodgetts, K; Leslie, G D; Lewin, G; Hendrie, D; Carville, K

    2016-07-02

    Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on patient wellbeing and health-care costs. Globally, the health-care costs associated with SWD are poorly reported and those reported are frequently associated with surgical site infection (SSI), rather than dehiscence of non-microbial cause. This retrospective study describes and reports on the costs and time to healing associated with a number of surgical patients who were referred to a community nursing service for treatment of an SWD following discharge from a metropolitan hospital, in Perth, Western Australia. Descriptive statistical analysis was carried out to describe the patient, wound and treatment characteristics. A costing analysis was conducted to investigate the cost of healing these wounds. Among the 70 patients referred with a SWD, 55% were treated for an infected wound dehiscence which was a significant factor (p=0.001). Overall, the cost of treating the 70 patients with a SWD in a community nursing service was in excess of $56,000 Australian dollars (AUD) (£28,705) and did not include organisational overheads or travel costs for nurse visits. The management of infection contributed to 67% of the overall cost. SWD remains an unquantified aspect of wound care from a prevalence and fiscal point of view. Further work needs to be done in the identification of SWD and which patients may be 'at risk'. The authors declare they have no competing interests.

  18. Ancillary reactive power service allocation cost in deregulated markets: a methodology

    International Nuclear Information System (INIS)

    Hernandez, J. Horacio Tovar; Jimenez-Guzman, Miguel; Gutierrez-Alcaraz, Guillermo

    2005-01-01

    This paper presents a methodology to allocate reactive power costs in deregulated markets. Reactive power supply service is decomposed into voltage regulation and reactive power spinning reserve. The proposed methodology is based on sensitivities and the postage-stamp method in order to allocate the total costs service among all participants. With the purpose of achieving this goal, the system operator identifies voltage support and/or reactive power requirements, and looks out for suitable providers. One case study is presented here to illustrate the methodology over a simplified southeastern Mexican grid. (Author)

  19. Cost-effectiveness of dryland forest restoration evaluated by spatial analysis of ecosystem services

    Science.gov (United States)

    Birch, Jennifer C.; Newton, Adrian C.; Aquino, Claudia Alvarez; Cantarello, Elena; Echeverría, Cristian; Kitzberger, Thomas; Schiappacasse, Ignacio; Garavito, Natalia Tejedor

    2010-01-01

    Although ecological restoration is widely used to combat environmental degradation, very few studies have evaluated the cost-effectiveness of this approach. We examine the potential impact of forest restoration on the value of multiple ecosystem services across four dryland areas in Latin America, by estimating the net value of ecosystem service benefits under different reforestation scenarios. The values of selected ecosystem services were mapped under each scenario, supported by the use of a spatially explicit model of forest dynamics. We explored the economic potential of a change in land use from livestock grazing to restored native forest using different discount rates and performed a cost–benefit analysis of three restoration scenarios. Results show that passive restoration is cost-effective for all study areas on the basis of the services analyzed, whereas the benefits from active restoration are generally outweighed by the relatively high costs involved. These findings were found to be relatively insensitive to discount rate but were sensitive to the market value of carbon. Substantial variation in values was recorded between study areas, demonstrating that ecosystem service values are strongly context specific. However, spatial analysis enabled localized areas of net benefits to be identified, indicating the value of this approach for identifying the relative costs and benefits of restoration interventions across a landscape. PMID:21106761

  20. Keeping and transmission of the memory. The memory duty for the human and the environment service

    International Nuclear Information System (INIS)

    2003-05-01

    Applied to the long-dated survey mission devoted to the ANDRA, the memory duty is a regulation necessity. They must realize the conservation and the transmission of the long-dated memory of stored radioactive wastes and their behavior in the future. A presentation of the interveners and their point of view during the conference are presented. (A.L.B.)

  1. Cost Effectiveness of Field Trauma Triage among Injured Adults Served by Emergency Medical Services

    Science.gov (United States)

    Newgard, Craig D; Yang, Zhuo; Nishijima, Daniel; McConnell, K John; Trent, Stacy; Holmes, James F; Daya, Mohamud; Mann, N Clay; Hsia, Renee Y; Rea, Tom; Wang, N Ewen; Staudenmayer, Kristan; Delgado, M Kit

    2016-01-01

    Background The American College of Surgeons Committee on Trauma sets national targets for the accuracy of field trauma triage at ≥ 95% sensitivity and ≥ 65% specificity, yet the cost-effectiveness of realizing these goals is unknown. We evaluated the cost-effectiveness of current field trauma triage practices compared to triage strategies consistent with the national targets. Study Design This was a cost-effectiveness analysis using data from 79,937 injured adults transported by 48 emergency medical services (EMS) agencies to 105 trauma and non-trauma hospitals in 6 regions of the Western U.S. from 2006 through 2008. Incremental differences in survival, quality adjusted life years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER; costs per QALY gained) were estimated for each triage strategy over a 1-year and lifetime horizon using a decision analytic Markov model. We considered an ICER threshold of less than $100,000 to be cost-effective. Results For these 6 regions, a high sensitivity triage strategy consistent with national trauma policy (sensitivity 98.6%, specificity 17.1%) would cost $1,317,333 per QALY gained, while current triage practices (sensitivity 87.2%, specificity 64.0%) cost $88,000 per QALY gained compared to a moderate sensitivity strategy (sensitivity 71.2%, specificity 66.5%). Refining EMS transport patterns by triage status improved cost-effectiveness. At the trauma system level, a high-sensitivity triage strategy would save 3.7 additional lives per year at a 1-year cost of $8.78 million, while a moderate sensitivity approach would cost 5.2 additional lives and save $781,616 each year. Conclusions A high-sensitivity approach to field triage consistent with national trauma policy is not cost effective. The most cost effective approach to field triage appears closely tied to triage specificity and adherence to triage-based EMS transport practices. PMID:27178369

  2. Effects of Housing Costs and Home Sales on Local Government Revenues and Services

    OpenAIRE

    Allee, David J.

    1991-01-01

    The subtitle of this paper should be " How recession and federal devolution have caused local governments to cut services and raise property taxes --now, what should be done in response to the resulting clamor for local government consolidation?" Housing drives local government services. Home sales represent opportunities for more income and more costs. Intergovernmental competition for tax base and the role of state and federal aid to provide equity between jurisdictions are central to the q...

  3. Non-Dam Alternatives for Delivering Water Services at Least Cost and Risk

    Directory of Open Access Journals (Sweden)

    Michael P. Totten

    2010-06-01

    We present evidence that a value-adding and risk-minimising water planning process can be achieved by shifting from the conventional focus on supply expansion to one that concentrates on efficiently delivering services at and near the point of use. The State of California has two decades of experience with this approach, demonstrating that market-based policy and regulatory innovations can unleash efficiency gains resulting in more utility water services and energy services delivered with less supply expansion at lower costs, while minimising climate-change risk, pollution and the social cost that accompany large infrastructural projects. Efficiency in delivered water services could be accomplished with investments in the range of US$10-25 billion annually, while obviating the need for spending hundreds of billions of dollars on more expensive hydropower and related infrastructural expansion projects. The shift to a regulatory system that encompasses cost-effective end-use efficiency improvements in delivering water and energy services could eliminate the need for an estimated half of all proposed dams globally, thus allowing for the maintenance of other ecosystem service benefits and offer the best hopes of meeting basic human needs for water at a more achievable level of investment.

  4. The relationship between staff skill mix, costs and outcomes in intermediate care services

    Directory of Open Access Journals (Sweden)

    Martin Graham P

    2010-07-01

    Full Text Available Abstract Background The purpose of this study was to assess the relationship between skill mix, patient outcomes, length of stay and service costs in older peoples' intermediate care services in England. Methods We undertook multivariate analysis of data collected as part of the National Evaluation of Intermediate Care Services. Data were analysed on between 337 and 403 older people admitted to 14 different intermediate care teams. Independent variables were the numbers of different types of staff within a team and the ratio of support staff to professionally qualified staff within teams. Outcome measures include the Barthel index, EQ-5D, length of service provision and costs of care. Results Increased skill mix (raising the number of different types of staff by one is associated with a 17% reduction in service costs (p = 0.011. There is weak evidence (p = 0.090 that a higher ratio of support staff to qualified staff leads to greater improvements in EQ-5D scores of patients. Conclusions This study provides limited evidence on the relationship between multidisciplinary skill mix and outcomes in intermediate care services.

  5. Stigma as experienced by women accessing prevention of parent to child transmission of HIV services in Karnataka, India

    Science.gov (United States)

    Rahangdale, Lisa; Banandur, Pradeep; Sreenivas, Amita; Turan, Janet; Washington, Reynold; Cohen, Craig R.

    2010-01-01

    In Karnataka, India only one-third of HIV-infected pregnant women received antiretroviral prophylaxis at delivery in 2007 through the state government’s prevention of parent-to-child HIV transmission (PPTCT) program. The current qualitative study explored the role of HIV-associated stigma as a barrier to accessing PPTCT services in the rural northern Karnataka district of Bagalkot using in depth interviews and focus group discussions with HIV-infected women who had participated in the PPTCT program, male and female family members, and HIV service providers. Participants discussed personal experiences, community perceptions of HIV, and decision-making related to accessing PPTCT services. They described stigma towards HIV-infected individuals from multiple sources: healthcare workers, community members, family and self. Stigma-related behaviors were based on fears of HIV transmission through personal contact and moral judgment. Experience and/or fears of discrimination led pregnant women to avoid using PPTCT interventions. Government, cultural and historical factors are described as the roots of much the stigma-related behavior in this setting. Based on these formative data, PPTCT program planners should consider further research and interventions aimed at diminishing institutional and interpersonal HIV-associated stigma experienced by pregnant women. PMID:20635247

  6. Cost accounting models used for price-setting of health services: an international review.

    Science.gov (United States)

    Raulinajtys-Grzybek, Monika

    2014-12-01

    The aim of the article was to present and compare cost accounting models which are used in the area of healthcare for pricing purposes in different countries. Cost information generated by hospitals is further used by regulatory bodies for setting or updating prices of public health services. The article presents a set of examples from different countries of the European Union, Australia and the United States and concentrates on DRG-based payment systems as they primarily use cost information for pricing. Differences between countries concern the methodology used, as well as the data collection process and the scope of the regulations on cost accounting. The article indicates that the accuracy of the calculation is only one of the factors that determine the choice of the cost accounting methodology. Important aspects are also the selection of the reference hospitals, precise and detailed regulations and the existence of complex healthcare information systems in hospitals. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. 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...

  8. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    N.J.A. van Exel (Job); M.A. Koopmanschap (Marc); J.D.H. van Wijngaarden (Jeroen); W.J.M. Scholte op Reimer (Wilma)

    2003-01-01

    textabstractBackground. Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients. This paper discusses

  9. Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

    NARCIS (Netherlands)

    M.A. Koopmanschap (Marc); W.J.M. Scholte op Reimer (Wilma); J.D.H. van Wijngaarden (Jeroen); N.J.A. van Exel (Job)

    2003-01-01

    textabstractBACKGROUND: Stroke is a major cause of death and long-term disability in Western societies and constitutes a major claim on health care budgets. Organising stroke care in a stroke service has recently been demonstrated to result in better health effects for patients.

  10. Women's experiences and views about costs of seeking malaria chemoprevention and other antenatal services

    DEFF Research Database (Denmark)

    Mubyazi, Godfrey M.; Bloch, Paul; Magnussen, Pascal

    2010-01-01

    and indirect costs, travel distances and waiting time. Strengthening of user-fee exemption practices and bringing services closer to the users, for example by promoting community-directed control of selected public health services, including IPTp, are urgently needed measures for increasing equity in health...... seeking behaviour of pregnant women because it seriously affected their domestic responsibilities. CONCLUSION: A variety of resource-related factors were shown to affect the health seeking behaviour of pregnant women in rural Tanzania. Thus, accessibility to ANC services was hampered by direct...

  11. Costs associated with wheeling

    International Nuclear Information System (INIS)

    Anon.

    1991-01-01

    Wheeling costs are incurred by all companies that experience a change in power flows over their transmission lines during a specific transaction, whether or not the lines of that company are part of the contract path. The costs of providing wheeling service differ from one system to another and from one kind of wheeling transaction to another. While most transactions may be completed using existing capacity, others may require an increase in line. Depending on the situation, some cost components may be high, low, negative, or not incurred at all. This article discusses two general categories of costs; transactional and capital. The former are all operation, maintenance and opportunity costs incurred in completing a specific transaction assuming the existence of adequate capacity. Capital costs are the costs of major new equipment purchases and lines necessary to provide any increased level of transmission services

  12. Maternal health service disparities across incomes and implications on prevention of mother-to-child transmission service coverage: current context in Sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Nibretie Gobezie Workneh

    2016-12-01

    Full Text Available About 69% of people living with HIV globally and over 90% of the children who acquired HIV infection are in Sub-Saharan Africa. Despite this, promising results have been observed, especially over the last decade – for example, a 25% decline in new HIV infections as compared to 2001 and a 38% decline in the number of children newly infected by HIV in 2012 as compared to 2009. However, the Global Plan and the Global Fast-Track Commitments of eliminating new HIV infections among children require addressing impediments to service expansion. In this regard, this paper attempts to draw attention to the extent to which disparities across income in using antenatal care (ANC services may constrain the prevention of mother-to-child transmission (PMTCT service expansion in Sub-Saharan Africa. The analysis is based on ANC service coverage data from Demographic and Health Surveys conducted between 2008 and 2015 in 31 Sub-Saharan African countries; and PMTCT coverage data from UNAIDS datasets released in 2016. Our analysis found that women in the highest wealth quintile are about three times more likely to frequently use ANC services (at least four visits as compared to those in the lowest wealth quintile (95%CI: 1.7-5.7, P<0.0001. A regression analysis shows that one-quarter of the PMTCT service coverage can be explained by the disparity in ANC use associated with income; and the higher the disparity in ANC use, the lower the PMTCT service (P<0.05. The findings suggest that achieving the ambitious plan of zero new HIV infections among children while keeping their mothers alive will require on-going PMTCT/ANC service integration and ensuring that programs reach women who are most in need; specifically those in the poorest income categories.

  13. 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

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

    Science.gov (United States)

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

    2018-01-01

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

  15. A comparative study of transaction costs of payments for forest ecosystem services in Vietnam

    NARCIS (Netherlands)

    Phan, Thu Ha Dang; Brouwer, Roy; Davidson, Marc David; Hoang, Long Phi

    2017-01-01

    Two payments for forest ecosystem services (PFES) schemes under one common legal-institutional coordination mechanism but different historical-institutional background and organizational design are analyzed to measure and explain their transaction costs (TC). Data on TC related to payment

  16. Using Excel's Solver Function to Facilitate Reciprocal Service Department Cost Allocations

    Science.gov (United States)

    Leese, Wallace R.

    2013-01-01

    The reciprocal method of service department cost allocation requires linear equations to be solved simultaneously. These computations are often so complex as to cause the abandonment of the reciprocal method in favor of the less sophisticated and theoretically incorrect direct or step-down methods. This article illustrates how Excel's Solver…

  17. Artificial intelligence guides system's best practices, cutting costs and improving services.

    Science.gov (United States)

    1999-06-01

    One for the history books. Clinical care improvement initiatives guided by a sophisticated artificial intelligence program have helped a major Virginia integrated health system make dramatic improvements in the cost and quality of its health care services. Find out how the technological innovation has earned Sentara Health System a place in the permanent collection of the Smithsonian's National Museum of American History.

  18. Model-based predictive control scheme for cost optimization and balancing services for supermarket refrigeration Systems

    NARCIS (Netherlands)

    Weerts, H.H.M.; Shafiei, S.E.; Stoustrup, J.; Izadi-Zamanabadi, R.; Boje, E.; Xia, X.

    2014-01-01

    A new formulation of model predictive control for supermarket refrigeration systems is proposed to facilitate the regulatory power services as well as energy cost optimization of such systems in the smart grid. Nonlinear dynamics existed in large-scale refrigeration plants challenges the predictive

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

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    2017-01-01

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

  20. Effects of Health-Care Services and Commodities Cost on the ...

    African Journals Online (AJOL)

    2017-09-14

    Sep 14, 2017 ... services and commodities cost on the patients at the primary health facilities in Zaria .... This is a social security system that guarantees the provision of needed ..... tourism to India, Dubai, London, America, and even to some other ..... Mudyarabikwa O. An examination of public sector subsidies to the private ...

  1. Cost-effectiveness of quantitative hepatitis B virus surface antigen testing in pregnancy in predicting vertical transmission risk.

    Science.gov (United States)

    Samadi Kochaksaraei, Golasa; Congly, Stephen E; Matwiy, Trudy; Castillo, Eliana; Martin, Steven R; Charlton, Carmen L; Coffin, Carla S

    2016-11-01

    Vertical transmission of hepatitis B virus (HBV) can occur despite immunoprophylaxis in mothers with high HBV DNA levels (>5-7 log 10 IU/ml). Quantitative hepatitis B surface antigen (qHBsAg) testing could be used as a surrogate marker to identify high viral load carriers, but there is limited data in pregnancy. We conducted a prospective observational study to determine the cost-effectiveness and utility of qHBsAg as a valid surrogate marker of HBV DNA. Pregnant patients with chronic hepatitis B were recruited from a tertiary referral centre. HBV DNA levels and qHBsAg were assessed in the second to third trimester. Statistical analysis was performed by Spearman's rank correlation and student's t-test. The cost-effectiveness of qHBsAg as compared to HBV DNA testing was calculated. Ninety nine women with 103 pregnancies, median age 32 years, 65% Asian, 23% African and 12% other [Hispanic, Caucasian] were enrolled. Overall, 23% (23/99) were HBV e Ag (HBeAg)-positive. A significant correlation between qHBsAg and HBV DNA levels was noted in HBeAg-positive patients (r = 0.79, P < 0.05) but not in HBeAg-negative patients (r = 0.17, P = 0.06). In receiver operating characteristic analysis, the optimal qHBsAg cut-off values for predicting maternal viraemia associated with immunoprophylaxis failure (i.e., HBV DNA ≥7 log 10 IU/ml) was 4.3 log 10 IU/ml (accuracy 98.7%, sensitivity 94.7%, specificity 94.4%) (95% CI, 97-100%, P < 0.05). Use of HBV DNA as compared to qHBsAg costs approximately $20 000 more per infection prevented. In resource poor regions, qHBsAg could be used as a more cost-effective marker for high maternal viraemia, and indicate when anti-HBV nucleos/tide analogue therapy should be used to prevent HBV immunoprophylaxis failure. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

    Science.gov (United States)

    Cid P, Camilo; Bastías S, Gabriel

    2014-02-01

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

  3. Cost and impact of a quality improvement programme in mental health services.

    Science.gov (United States)

    Beecham, Jennifer; Ramsay, Angus; Gordon, Kate; Maltby, Sophie; Walshe, Kieran; Shaw, Ian; Worrall, Adrian; King, Sarah

    2010-04-01

    To estimate the cost and impact of a centrally-driven quality improvement initiative in four UK mental health communities. Total costs in year 1 were identified using documentation, a staff survey, semi-structured interviews and discussion groups. Few outcome data were collected within the programme so thematic analysis was used to identify the programme's impact within its five broad underlying principles. The survey had a 40% response. Total costs ranged between pound164,000 and pound458,000 per site, plus staff time spent on workstreams. There was a very hazy view of the resources absorbed and poor recording of expenditure and activity. The initiative generated little demonstrable improvements in service quality but some participants reported changes in attitudes. Given the difficult contexts, short time-scales and capacity constraints, the programme's lack of impact is not surprising. It may, however, represent a worthwhile investment in cultural change which might facilitate improvements in how services are delivered.

  4. Cost of Treatment of Hospitalized Patients with Diabetes in Prenda Hospital Medicine Service, Angola

    Directory of Open Access Journals (Sweden)

    António Zangulo

    2017-07-01

    Full Text Available Introduction: Diabetes has a major impact on morbidity and mortality today. It is estimated that by 2040, about 642 million people are affected worldwide, of which, 34.2 million are from sub-Saharan countries. The direct annual cost of diabetes health care worldwide is estimated at about 153 billion dollars. These patients represent 30% to 40% of all admissions to emergency services, leading to high values of hospital expenditure. We aim to evaluate the cost of treatment of patients with diabetes admitted to Prenda Hospital Medicine Service in 2012. Methods: Retrospective analytical observational study, with data collected from the clinical processes of medical service (age and gender, length of hospitalization, resources consumed, cost of treatment per patient and discharge. Results: Out of 121 patients, the majority was female (n = 70, 57.9%. The age group of 36 to 45 years old was the most frequent among these patients (n = 26, 21.5%. November was the month that recorded the largest number of admissions (n = 17, 14%. About 45.5% were hospitalized during five to eight days, on average for nine days. The majority (76.9% was discharged due to health condition improvement. The price of materials used for treatment of the disease had high variation, and 31 550.15 kwanzas was spent to acquire them. The direct cost per patient per day was 4170.11 kwanzas and the estimated annual cost of care of diabetic patients admitted to Prenda Hospital was 45 525 490.9 kwanzas in 2012. Discussion and Conclusion: These results are in accordance with other studies, indicating a relevant cost of treatment of diabetic patients admitted to Prenda Hospital Medicine Service in 2012.

  5. The delivery of low-cost, low-carbon rural energy services

    Energy Technology Data Exchange (ETDEWEB)

    Casillas, Christian E., E-mail: cecasillas@berkeley.edu [Energy and Resources Group, University of California, Berkeley (United States); Kammen, Daniel M. [Energy and Resources Group, University of California, Berkeley (United States); Goldman School of Public Policy, University of California, Berkeley, CA 94720 (United States); The World Bank, Washington, DC 20433 (United States)

    2011-08-15

    The provision of both electrical and mechanical energy services can play a critical role in poverty alleviation for the almost two billion rural users who currently lack access to electricity. Distributed generation using diesel generators remains a common means of electricity provision for rural communities throughout the world. Due to rising fuel costs, the need to address poverty, and consequences of global warming, it is necessary to develop cost efficient means of reducing fossil fuel consumption in isolated diesel microgrids. Based on a case study in Nicaragua, a set of demand and supply side measures are ordered by their annualized costs in order to approximate an energy supply curve. The curve highlights significant opportunities for reducing the costs of delivering energy services while also transitioning to a carbon-free electrical system. In particular, the study demonstrates the significant cost savings resulting from the implementation of conventional metering, efficient residential lighting, and electricity generation using renewable energy sources. - Highlights: > We present a case study of conservation measures implemented in a diesel microgrid. > An energy conservation and supply curve is constructed using additional measures. > Energy efficiency and renewable energy result in cost savings and carbon abatement. > We discuss weaknesses of energy supply and carbon abatement curve calculations

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

    OpenAIRE

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

    2015-01-01

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

  7. A systematic review of the unit costs of allied health and community services used by older people in Australia

    Directory of Open Access Journals (Sweden)

    Farag Inez

    2013-02-01

    Full Text Available Abstract Background An economic evaluation of interventions for older people requires accurate assessment of costing and consideration of both acute and long-term services. Accurate information on the unit cost of allied health and community services is not readily available in Australia however. This systematic review therefore aims to synthesise information available in the literature on the unit costs of allied health and community services that may be utilised by an older person living in Australia. Method A comprehensive search of Medline, Embase, CINAHL, Google Scholar and Google was undertaken. Specialised economic databases were also reviewed. In addition Australian Government Department websites were inspected. The search identified the cost of specified allied health services including: physiotherapy, occupational therapy, dietetics, podiatry, counselling and home nursing. The range of community services included: personal care, meals on wheels, transport costs and domestic services. Where the information was not available, direct contact with service providers was made. Results The number of eligible studies included in the qualitative synthesis was fourty-nine. Calculated hourly rates for Australian allied health services were adjusted to be in equivalent currency and were as follows as follows: physiotherapy $157.75, occupational therapy $150.77, dietetics $163.11, psychological services $165.77, community nursing $105.76 and podiatry $129.72. Conclusions Utilisation of the Medicare Benefits Scheduled fee as a broad indicator of the costs of services, may lead to underestimation of the real costs of services and therefore to inaccuracies in economic evaluation.

  8. Cost evaluation of reproductive and primary health care mobile service delivery for women in two rural districts in South Africa.

    Directory of Open Access Journals (Sweden)

    Kathryn Schnippel

    Full Text Available Cervical cancer screening is a critical health service that is often unavailable to women in under-resourced settings. In order to expand access to this and other reproductive and primary health care services, a South African non-governmental organization established a van-based mobile clinic in two rural districts in South Africa. To inform policy and budgeting, we conducted a cost evaluation of this service delivery model.The evaluation was retrospective (October 2012-September 2013 for one district and April-September 2013 for the second district and conducted from a provider cost perspective. Services evaluated included cervical cancer screening, HIV counselling and testing, syndromic management of sexually transmitted infections (STIs, breast exams, provision of condoms, contraceptives, and general health education. Fixed costs, including vehicle purchase and conversion, equipment, operating costs and mobile clinic staffing, were collected from program records and public sector pricing information. The number of women accessing different services was multiplied by ingredients-based variable costs, reflecting the consumables required. All costs are reported in 2013 USD.Fixed costs accounted for most of the total annual costs of the mobile clinics (85% and 94% for the two districts; the largest contributor to annual fixed costs was staff salaries. Average costs per patient were driven by the total number of patients seen, at $46.09 and $76.03 for the two districts. Variable costs for Pap smears were higher than for other services provided, and some services, such as breast exams and STI and tuberculosis symptoms screening, had no marginal cost.Staffing costs are the largest component of providing mobile health services to rural communities. Yet, in remote areas where patient volumes do not exceed nursing staff capacity, incorporating multiple services within a cervical cancer screening program is an approach to potentially expand access to

  9. Dynamic quality of service model for improving performance of multimedia real-time transmission in industrial networks.

    Science.gov (United States)

    Gopalakrishnan, Ravichandran C; Karunakaran, Manivannan

    2014-01-01

    Nowadays, quality of service (QoS) is very popular in various research areas like distributed systems, multimedia real-time applications and networking. The requirements of these systems are to satisfy reliability, uptime, security constraints and throughput as well as application specific requirements. The real-time multimedia applications are commonly distributed over the network and meet various time constraints across networks without creating any intervention over control flows. In particular, video compressors make variable bit-rate streams that mismatch the constant-bit-rate channels typically provided by classical real-time protocols, severely reducing the efficiency of network utilization. Thus, it is necessary to enlarge the communication bandwidth to transfer the compressed multimedia streams using Flexible Time Triggered- Enhanced Switched Ethernet (FTT-ESE) protocol. FTT-ESE provides automation to calculate the compression level and change the bandwidth of the stream. This paper focuses on low-latency multimedia transmission over Ethernet with dynamic quality-of-service (QoS) management. This proposed framework deals with a dynamic QoS for multimedia transmission over Ethernet with FTT-ESE protocol. This paper also presents distinct QoS metrics based both on the image quality and network features. Some experiments with recorded and live video streams show the advantages of the proposed framework. To validate the solution we have designed and implemented a simulator based on the Matlab/Simulink, which is a tool to evaluate different network architecture using Simulink blocks.

  10. Transmission pricing: paradigms and methodologies

    Energy Technology Data Exchange (ETDEWEB)

    Shirmohammadi, Dariush [Pacific Gas and Electric Co., San Francisco, CA (United States); Vieira Filho, Xisto; Gorenstin, Boris [Centro de Pesquisas de Energia Eletrica (CEPEL), Rio de Janeiro, RJ (Brazil); Pereira, Mario V.P. [Power System Research, Rio de Janeiro, RJ (Brazil)

    1994-12-31

    In this paper we describe the principles of several paradigms and methodologies for pricing transmission services. The paper outlines some of the main characteristics of these paradigms and methodologies such as where they may be used for best results. Due to their popularity, power flow based MW-mile and short run marginal cost pricing methodologies will be covered in some detail. We conclude the paper with examples of the application of these two pricing methodologies for pricing transmission services in Brazil. (author) 25 refs., 2 tabs.

  11. Prehospital ECG transmission: comparison of advanced mobile phone and facsimile devices in an urban Emergency Medical Service System.

    Science.gov (United States)

    Väisänen, Olli; Mäkijärvi, Markku; Silfvast, Tom

    2003-05-01

    To compare the speed and reliability of electrocardiogram (ECG) transmissions from the prehospital setting to a conventional table facsimile device and to an advanced mobile phone in a Helicopter Emergency Medical Service System (HEMS). Eighteen authentic ECGs stored in the memory module of a monitor defibrillator were used. The ECGs were (1) sent directly from the monitor defibrillator to a table fax and an advanced mobile phone at the HEMS base; (2) printed out and sent from a mobile fax connected to an ordinary mobile phone to the table fax and the advanced mobile phone at the HEMS base; (3) printed out and sent from an ordinary table fax as well as from a table fax connected to a satellite phone system to the receiving devices at the HEMS base. When the ECGs were sent from the table fax via satellite, the transmission times were longer to the advanced mobile phone than to the table fax at the HEMS base (1 min 54 s+/-0 min 21 s vs. 1 min 37 s+/-0 min 20 s, (mean+/-SD), (Ptransmission from the other fax devices, there were no differences in transmission times between the two receiving devices. The fastest way to transmit ECGs to the advanced mobile phone was to send it from conventional table fax (1 min 22 s+/-0 min 18 s) and the longest transmission times were with mobile fax connected to mobile phone (5 min 23 s+/-3 min 5 s). In all ECGs transmitted except one the cardiac rhythm and ST-changes could be recognised. An advanced mobile phone is as fast and reliable as a conventional table fax in receiving ECGs. A mobile phone with advanced features is a practical tool for HEMS physicians who need to evaluate ECGs in the prehospital setting.

  12. A cost-effective and serviceable ATLAST 9.2m telescope architecture

    Science.gov (United States)

    Feinberg, Lee D.; Jones, Andrew; Mosier, Gary; Rioux, Norman; Redding, Dave; Kienlen, Mike

    2014-08-01

    The ATLAST 9.2m architecture has evolved to be more cost effective while also meeting a more thorough understanding of the driving science requirements. The new approach can fit in an existing Delta IV Heavy rocket and makes extensive use of heritage and selective use of technology in order to minimize development time and cost. We have performed a more thorough look at how to meet the stability requirements for both thermal and dynamics and have an approach consistent with an initial error budget. In addition, we have developed concepts to support robotic or human servicing in a cost effective manner through a modular approach that relies on simple, external access and metrology. These refinements to the architecture enable a cost-effective, long-lifecycle, and relatively low risk approach to development.

  13. Cost and price auditing: effectiveness in the procurement of defense services in Spain

    Directory of Open Access Journals (Sweden)

    José Aguado Romero

    Full Text Available Abstract Contract auditing, or cost and price auditing, has been applied in Spain as a means of determining prices in non-competitive defense contracts since 1989. Factors such as Spain's participation in international defense organizations, the characteristics of the defense market and the contractual legal framework for the procurement of defense goods and services help underscore the need for the Spanish Ministry of Defense to implement cost and price auditing. With the evolution of cost and price auditing in Spain in mind, this paper analyses the entire process, describes the audit procedures that are most commonly used today and assesses the main results achieved, in terms of financial savings. The results obtained show that cost and price auditing does indeed contribute to a more efficient use of public resources.

  14. Cost characteristics of tilt-rotor, conventional air and high speed rail short-haul intercity passenger service

    Science.gov (United States)

    Schoendorfer, David L.; Morlok, Edward K.

    1985-01-01

    The cost analysis done to support an assessment of the potential for a small tilt-rotor aircraft to operate in short-haul intercity passenger service is described in detail. Anticipated costs of tilt-rotor air service were compared to the costs of two alternatives: conventional air and high speed rail (HSR). Costs were developed for corridor service, varying key market characteristics including distance, passenger volumes, and minimum frequency standards. The resulting cost vs output information can then be used to compare modal costs for essentially identical service quality and passenger volume or for different service levels and volumes for each mode, as appropriate. Extensive sensitivity analyses are performed. The cost-output features of these technologies are compared. Tilt-rotor is very attractive compared to HSR in terms of costs over the entire range of volume. It also has costs not dramatically different from conventional air, but tilt-rotor costs are generally higher. Thus some of its other advantages, such as the VTOL capability, must offset the cost disadvantage for it to be a preferred or competitive mode in any given market. These issues are addressed in the companion report which considers strategies for tilt-rotor development in commercial air service.

  15. Benefits, costs, and livelihood implications of a regional payment for ecosystem service program.

    Science.gov (United States)

    Zheng, Hua; Robinson, Brian E; Liang, Yi-Cheng; Polasky, Stephen; Ma, Dong-Chun; Wang, Feng-Chun; Ruckelshaus, Mary; Ouyang, Zhi-Yun; Daily, Gretchen C

    2013-10-08

    Despite broad interest in using payment for ecosystem services to promote changes in the use of natural capital, there are few expost assessments of impacts of payment for ecosystem services programs on ecosystem service provision, program cost, and changes in livelihoods resulting from program participation. In this paper, we evaluate the Paddy Land-to-Dry Land (PLDL) program in Beijing, China, and associated changes in service providers' livelihood activities. The PLDL is a land use conversion program that aims to protect water quality and quantity for the only surface water reservoir that serves Beijing, China's capital city with nearly 20 million residents. Our analysis integrates hydrologic data with household survey data and shows that the PLDL generates benefits of improved water quantity and quality that exceed the costs of reduced agricultural output. The PLDL has an overall benefit-cost ratio of 1.5, and both downstream beneficiaries and upstream providers gain from the program. Household data show that changes in livelihood activities may offset some of the desired effects of the program through increased expenditures on agricultural fertilizers. Overall, however, reductions in fertilizer leaching from land use change dominate so that the program still has a positive net impact on water quality. This program is a successful example of water users paying upstream landholders to improve water quantity and quality through land use change. Program evaluation also highlights the importance of considering behavioral changes by program participants.

  16. Costs and benefits of implementing child survival services at a private mining company in Peru.

    Science.gov (United States)

    Foreit, K G; Haustein, D; Winterhalter, M; La Mata, E

    1991-08-01

    Costs and savings of child health services were studied in a private mining company in Peru. Despite considerable outlays for medical services, few children under age 5 were vaccinated, and half of their illnesses went untreated. Children who were attended at the company clinic usually received unnecessary medication. As a result of the study, the company hired additional staff to provide integrated maternal-child preventive health care and family planning and contracted for intensive training and periodic on-site supervision. In less than 2 years, vaccination coverage reached 75%, and virtually all children under age 1 were enrolled in growth monitoring. Prescriptions were reduced by 24%, including a 67% drop in antimicrobials. The cost of the new services was $13,200 for the first 2 years. Approximately $6800 has been saved in pharmaceuticals prescribed for respiratory infection and diarrhea. Recently, two more mines adopted maternal and child health and family planning services. It is hoped that cost-benefit arguments will encourage other companies to incorporate aggressive child survival measures into their health plans.

  17. Benefits, costs, and livelihood implications of a regional payment for ecosystem service program

    Science.gov (United States)

    Zheng, Hua; Robinson, Brian E.; Liang, Yi-Cheng; Polasky, Stephen; Ma, Dong-Chun; Wang, Feng-Chun; Ruckelshaus, Mary; Ouyang, Zhi-Yun; Daily, Gretchen C.

    2013-01-01

    Despite broad interest in using payment for ecosystem services to promote changes in the use of natural capital, there are few expost assessments of impacts of payment for ecosystem services programs on ecosystem service provision, program cost, and changes in livelihoods resulting from program participation. In this paper, we evaluate the Paddy Land-to-Dry Land (PLDL) program in Beijing, China, and associated changes in service providers’ livelihood activities. The PLDL is a land use conversion program that aims to protect water quality and quantity for the only surface water reservoir that serves Beijing, China’s capital city with nearly 20 million residents. Our analysis integrates hydrologic data with household survey data and shows that the PLDL generates benefits of improved water quantity and quality that exceed the costs of reduced agricultural output. The PLDL has an overall benefit–cost ratio of 1.5, and both downstream beneficiaries and upstream providers gain from the program. Household data show that changes in livelihood activities may offset some of the desired effects of the program through increased expenditures on agricultural fertilizers. Overall, however, reductions in fertilizer leaching from land use change dominate so that the program still has a positive net impact on water quality. This program is a successful example of water users paying upstream landholders to improve water quantity and quality through land use change. Program evaluation also highlights the importance of considering behavioral changes by program participants. PMID:24003160

  18. Negotiated settlements with a cost of service backstop: The consequences for depreciation

    International Nuclear Information System (INIS)

    Fellows, G. Kent

    2011-01-01

    The movement from traditional regulatory hearings to negotiated settlements represents both a departure from cost of service regulation and a relaxation of regulatory oversight. Under negotiation parties are able to renegotiate inclusions in their cost of service while simultaneously creating a profit margin for the regulated firm where none existed under the cost of service outcome of a traditional hearing. This paper constructs a model to illustrate the existence of positive gains to pipeline and shipper from the re-allocation of expenses through time in the regulated pipeline services market in Canada. Behaviour consistent with the model is observable in anecdotal and econometric evidence gathered from the library of the National Energy Board of Canada, responsible for pipeline toll regulation in Canada. Empirical investigation by into settlement procedures in the Florida electricity market reveals similar findings; however, this analysis represents the first attempt to model the behaviour formally. The econometric analysis uses new data collected and compiled specifically for this exercise. - Research highlights: → Regulated firms' preference for negotiated settlements over litigation is examined. → A mathematical framework for the impact of settlements on profits is established. → Deferred depreciation is identified as a likely outcome of negotiated settlements. → The hypothesis of deferred depreciation is tested using Canadian Pipeline Data.

  19. e-Calibrations: using the Internet to deliver calibration services in real time at lower cost

    International Nuclear Information System (INIS)

    Desrosiers, Marc; Nagy, Vitaly; Puhl, James; Glenn, Robert; Densock, Robert; Stieren, David; Lang, Brian; Kamlowski, Andreas; Maier, Diether; Heiss, Arthur

    2002-01-01

    The National Institute of Standards and Technology (NIST) is expanding into a new frontier in the delivery of measurement services. The Internet will be employed to provide industry with electronic traceability to national standards. This is a radical departure from the traditional modes of traceability and presents many new challenges. The traditional mail-based calibration service relies on sending artifacts to the user, who then mails them back to NIST for evaluation. The new service will deliver calibration results to the industry customer on-demand, in real-time, at a lower cost. The calibration results can be incorporated rapidly into the production process to ensure the highest quality manufacturing. The service would provide the US radiation processing industry with a direct link to the NIST calibration facilities and its expertise, and provide an interactive feedback process between industrial processing and the national measurement standard. Moreover, an Internet calibration system should contribute to the removal of measurement-related trade barriers

  20. Effect of reducing cost sharing for outpatient care on children's inpatient services in Japan.

    Science.gov (United States)

    Kato, Hirotaka; Goto, Rei

    2017-08-15

    Assessing the impact of cost sharing on healthcare utilization is a critical issue in health economics and health policy. It may affect the utilization of different services, but is yet to be well understood. This paper investigates the effects of reducing cost sharing for outpatient services on hospital admissions by exploring a subsidy policy for children's outpatient services in Japan. Data were extracted from the Japanese Diagnosis Procedure Combination database for 2012 and 2013. A total of 366,566 inpatients from 1390 municipalities were identified. The impact of expanding outpatient care subsidy on the volume of inpatient care for 1390 Japanese municipalities was investigated using the generalized linear model with fixed effects. A decrease in cost sharing for outpatient care has no significant effect on overall hospital admissions, although this effect varies by region. The subsidy reduces the number of overall admissions in low-income areas, but increases it in high-income areas. In addition, the results for admissions by type show that admissions for diagnosis increase particularly in high-income areas, but emergency admissions and ambulatory-care-sensitive-condition admissions decrease in low-income areas. These results suggest that outpatient and inpatient services are substitutes in low-income areas but complements in high-income ones. Although the subsidy for children's healthcare would increase medical costs, it would not improve the health status in high-income areas. Nevertheless, it could lead to some health improvements in low-income areas and, to some extent, offset costs by reducing admissions in these regions.

  1. Preventing Obesity in the USA: Impact on Health Service Utilization and Costs.

    Science.gov (United States)

    Cecchini, Michele; Sassi, Franco

    2015-07-01

    With more than two-thirds of the US population overweight or obese, the obesity epidemic is a major threat for population health and the financial sustainability of the healthcare service. Whether, and to what extent, effective prevention interventions may offer the opportunity to 'bend the curve' of rising healthcare costs is still an object of debate. This study evaluates the potential economic impact of a set of prevention programmes, including education, counselling, long-term drug treatment, regulation (e.g. of advertising or labelling) and fiscal measures, on national healthcare expenditure and use of healthcare services in the USA. The study was carried out as a retrospective evaluation of alternative scenarios compared with a 'business as usual' scenario. An advanced econometric approach involving the use of logistic regression and generalized linear models was used to calculate the number of contacts with key healthcare services (inpatient, outpatient, drug prescriptions) and the associated cost. Analyses were carried out on the Medical Expenditure Panel Survey (1997-2010). In 2010, prevention interventions had the potential to decrease total healthcare expenditure by up to $US2 billion. This estimate does not include the implementation costs. The largest share of savings is produced by reduced use and costs of inpatient care, followed by reduced use of drugs. Reduction in expenditure for outpatient care would be more limited. Private insurance schemes benefit from the largest savings in absolute terms; however, public insurance schemes benefit from the largest cost reduction per patient. People in the lowest income groups show the largest economic benefits. Prevention interventions aimed at tackling obesity and associated risk factors may produce a significant decrease in the use of healthcare services and expenditure. Savings become substantial when a long-term perspective is taken.

  2. Analysis of the Prevention of Mother-to-Child Transmission (PMTCT Service utilization in Ethiopia: 2006-2010

    Directory of Open Access Journals (Sweden)

    Woldegebriel Yoseph

    2011-04-01

    Full Text Available Abstract Introduction Although progressive improvements have been made in the coverage and quality of prevention of HIV/AIDS mother-to-child transmission (PMTCT services in Ethiopia, the national coverage remained persistently low. Analysis of the cascaded PMTCT services can reveal the advancements made and the biggest hurdles faced during implementation. Objective To examine the progresses and unaddressed needs in access and utilization of PMTCT services in Ethiopia from 2006 to 2010 thereby developing best-fit regression models to predict the values of key PMTCT indicators at critical future points. Methods Five-year national level PMTCT data were analyzed in a cascaded manner. Five levels of analysis were used for ten major PMTCT indicators. These included description of progress made, assessment of unaddressed needs, developing best-fit models, prediction for future points and estimation using constant prevalence. Findings were presented using numerical and graphic summaries. Results Based on the current trend, Ethiopia could achieve universal ANC coverage by 2015. The prevalence of HIV at PMTCT sites has shown a four-fold decrease during the five-year period. This study has found that only 53% of known HIV-positive mothers and 48% of known HIV-exposed infants have received ARV prophylaxis. Based on assumption of constant HIV prevalence, the estimated ARV coverage was found to be 11.6% for HIV positive mothers and 8.4% for their babies. Conclusion There has been a remarkable improvement in the potential coverage of PMTCT services due to rapid increase in the number of PMTCT service outlets. However, the actual coverage remained low. Integration of PMTCT services with grassroots level health systems could unravel the problem.

  3. The cost-effectiveness of alternative vaccination strategies for polyvalent meningococcal vaccines in Burkina Faso: A transmission dynamic modeling study.

    Science.gov (United States)

    Yaesoubi, Reza; Trotter, Caroline; Colijn, Caroline; Yaesoubi, Maziar; Colombini, Anaïs; Resch, Stephen; Kristiansen, Paul A; LaForce, F Marc; Cohen, Ted

    2018-01-01

    The introduction of a conjugate vaccine for serogroup A Neisseria meningitidis has dramatically reduced disease in the African meningitis belt. In this context, important questions remain about the performance of different vaccine policies that target remaining serogroups. Here, we estimate the health impact and cost associated with several alternative vaccination policies in Burkina Faso. We developed and calibrated a mathematical model of meningococcal transmission to project the disability-adjusted life years (DALYs) averted and costs associated with the current Base policy (serogroup A conjugate vaccination at 9 months, as part of the Expanded Program on Immunization [EPI], plus district-specific reactive vaccination campaigns using polyvalent meningococcal polysaccharide [PMP] vaccine in response to outbreaks) and three alternative policies: (1) Base Prime: novel polyvalent meningococcal conjugate (PMC) vaccine replaces the serogroup A conjugate in EPI and is also used in reactive campaigns; (2) Prevention 1: PMC used in EPI and in a nationwide catch-up campaign for 1-18-year-olds; and (3) Prevention 2: Prevention 1, except the nationwide campaign includes individuals up to 29 years old. Over a 30-year simulation period, Prevention 2 would avert 78% of the meningococcal cases (95% prediction interval: 63%-90%) expected under the Base policy if serogroup A is not replaced by remaining serogroups after elimination, and would avert 87% (77%-93%) of meningococcal cases if complete strain replacement occurs. Compared to the Base policy and at the PMC vaccine price of US$4 per dose, strategies that use PMC vaccine (i.e., Base Prime and Preventions 1 and 2) are expected to be cost saving if strain replacement occurs, and would cost US$51 (-US$236, US$490), US$188 (-US$97, US$626), and US$246 (-US$53, US$703) per DALY averted, respectively, if strain replacement does not occur. An important potential limitation of our study is the simplifying assumption that all

  4. The Health Costs and Diseases in Medical Services Insurance Organization, Tehran Province, 1386 (2008

    Directory of Open Access Journals (Sweden)

    Ali Shojaei

    2012-01-01

    Full Text Available Objectives: The current research in addition to study of the diseases in the elders, surveys the health costs of these diseases. Methods & Materials: Study of the cost information and related diseases in (MSIO- Medical Services Insurance Organization, Tehran province, surveys costs and Medical Services of this group on 183093 hospitalized files. Results: 31% of hospital`s referrals and 37% of inpatient costs related to elders and display the expensive Services of this group of the Insured. The mean costs of every hospitalization in elderly groups were 4634384 rials, which was more than total mean costs, from all groups. Diagnostic code I27 (other cardio-vascular diseases, I20 (Angina pectoris, H25 (cataract, I25 (chronic IHD, I50 (heart failure, devote first to fifth grade of the prevalent Diagnosis cods (ICD in the aged group older than 60 and displays the most prevalence of the cardio-vascular system diseases in the elders. The most common surgical Code (California code in elderly (above 60 yrs. was related to Coronary Angioplasty, with its mean cost of 9116371 rials. And then was Cataract. 15% of the Global files are related to the elders which is equal to 23% of the charges of these files in this group of the elders. Extraction of Lens (Intra-capsular and extra-capsular Lens Insertion (57 code One-lateral Inguinal Hernia with or without excision of Hydrocele or Spermatocele except Incarcerated Inguinal Hernia (Global code 28, cholecystectomy with or without cholangiography or exploration of Biliary ducts (Global code 27 from first to third grade of the prevalent Global surgeries of the elders. Statistical test displays the Pierson coherent between the age and residence period and paid costs, There is a little positive coherent between the age and residence period in hospital and paid costs. Conclusion: These reviews show the results of the current study (the prevalent in-patient causes are adapted to the performed studies in this field and

  5. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services.

    Science.gov (United States)

    Chersich, Matthew F; Luchters, Stanley; Ntaganira, Innocent; Gerbase, Antonio; Lo, Ying-Ru; Scorgie, Fiona; Steen, Richard

    2013-03-04

    Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes. We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs) and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers' access to care and antiretroviral treatment (ART), but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers' control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services - including peer interventions, condom promotion and STI screening - would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are required to enhance access to HIV testing and ART for

  6. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services

    Science.gov (United States)

    Chersich, Matthew F; Luchters, Stanley; Ntaganira, Innocent; Gerbase, Antonio; Lo, Ying-Ru; Scorgie, Fiona; Steen, Richard

    2013-01-01

    Introduction Virtually no African country provides HIV prevention services in sex work settings with an adequate scale and intensity. Uncertainty remains about the optimal set of interventions and mode of delivery. Methods We systematically reviewed studies reporting interventions for reducing HIV transmission among female sex workers in sub-Saharan Africa between January 2000 and July 2011. Medline (PubMed) and non-indexed journals were searched for studies with quantitative study outcomes. Results We located 26 studies, including seven randomized trials. Evidence supports implementation of the following interventions to reduce unprotected sex among female sex workers: peer-mediated condom promotion, risk-reduction counselling and skills-building for safer sex. One study found that interventions to counter hazardous alcohol-use lowered unprotected sex. Data also show effectiveness of screening for sexually transmitted infections (STIs) and syndromic STI treatment, but experience with periodic presumptive treatment is limited. HIV testing and counselling is essential for facilitating sex workers’ access to care and antiretroviral treatment (ART), but testing models for sex workers and indeed for ART access are little studied, as are structural interventions, which create conditions conducive for risk reduction. With the exception of Senegal, persistent criminalization of sex work across Africa reduces sex workers’ control over working conditions and impedes their access to health services. It also obstructs health-service provision and legal protection. Conclusions There is sufficient evidence of effectiveness of targeted interventions with female sex workers in Africa to inform delivery of services for this population. With improved planning and political will, services – including peer interventions, condom promotion and STI screening – would act at multiple levels to reduce HIV exposure and transmission efficiency among sex workers. Initiatives are

  7. Room Service Improves Nutritional Intake and Increases Patient Satisfaction While Decreasing Food Waste and Cost.

    Science.gov (United States)

    McCray, Sally; Maunder, Kirsty; Krikowa, Renee; MacKenzie-Shalders, Kristen

    2018-02-01

    Room service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs. The aim of this study was to comprehensively evaluate the nutritional intake, plate waste, patient satisfaction, and patient meal costs of room service compared to a traditional foodservice model. A retrospective analysis of quality-assurance data audits was undertaken to assess patient nutritional intake between a facility utilizing a traditional foodservice model and a facility utilizing room service and in a pre-post study design to assess plate waste, patient satisfaction, and patient meal costs before and after the room service implementation. Audit data were collected for eligible adult inpatients in Mater Private Hospital Brisbane and Mater Hospital Brisbane, Australia, between July 2012 and May 2015. The primary outcome measures were nutritional intake, plate waste, patient satisfaction, and patient meal costs. Independent samples t-tests and χ 2 analyses were conducted between pre and post data for continuous data and categorical data, respectively. Pearson χ 2 analysis of count data for sex and reasons for plate waste for data with counts more than five was used to determine asymptotic (two-sided) significance and n-1 χ 2 used for the plate waste analysis. Significance was assessed at P<0.05. This study reported an increased nutritional intake, improved patient satisfaction, and reduced plate waste and patient meal costs with room service compared to a traditional foodservice model. Comparison of nutritional intake between a traditional foodservice model (n=85) and room service (n=63) showed statistically significant increases with room service in both energy (1,306 kcal/day vs 1,588 kcal/day; P=0

  8. Effects of Expanded Coverage for Chiropractic Services on Medicare Costs in a CMS Demonstration.

    Science.gov (United States)

    Stason, William B; Ritter, Grant A; Martin, Timothy; Prottas, Jeffrey; Tompkins, Christopher; Shepard, Donald S

    2016-01-01

    Moderately convincing evidence supports the benefits of chiropractic manipulations for low back pain. Its effectiveness in other applications is less well documented, and its cost-effectiveness is not known. These questions led the Centers for Medicaid and Medicare Services (CMS) to conduct a two-year demonstration of expanded Medicare coverage for chiropractic services in the treatment of beneficiaries with neuromusculoskeletal (NMS) conditions affecting the back, limbs, neck, or head. The demonstration was conducted in 2005-2007 in selected counties of Illinois, Iowa, and Virginia and the entire states of Maine and New Mexico. Medicare claims were compiled for the preceding year and two demonstration years for the demonstration areas and matched comparison areas. The impact of the demonstration was analyzed through multivariate regression analysis with a difference-in-difference framework. Expanded coverage increased Medicare expenditures by $50 million or 28.5% in users of chiropractic services and by $114 million or 10.4% in all patients treated for NMS conditions in demonstration areas during the two-year period. Results varied widely among demonstration areas ranging from increased costs per user of $485 in Northern Illinois and Chicago counties to decreases in costs per user of $59 in New Mexico and $178 in Scott County, Iowa. The demonstration did not assess possible decreases in costs to other insurers, out-of-pocket payments by patients, the need for and costs of pain medications, or longer term clinical benefits such as avoidance of orthopedic surgical procedures beyond the two-year period of the demonstration. It is possible that other payers or beneficiaries saved money during the demonstration while costs to Medicare were increased.

  9. Effects of Expanded Coverage for Chiropractic Services on Medicare Costs in a CMS Demonstration.

    Directory of Open Access Journals (Sweden)

    William B Stason

    Full Text Available Moderately convincing evidence supports the benefits of chiropractic manipulations for low back pain. Its effectiveness in other applications is less well documented, and its cost-effectiveness is not known. These questions led the Centers for Medicaid and Medicare Services (CMS to conduct a two-year demonstration of expanded Medicare coverage for chiropractic services in the treatment of beneficiaries with neuromusculoskeletal (NMS conditions affecting the back, limbs, neck, or head.The demonstration was conducted in 2005-2007 in selected counties of Illinois, Iowa, and Virginia and the entire states of Maine and New Mexico. Medicare claims were compiled for the preceding year and two demonstration years for the demonstration areas and matched comparison areas. The impact of the demonstration was analyzed through multivariate regression analysis with a difference-in-difference framework.Expanded coverage increased Medicare expenditures by $50 million or 28.5% in users of chiropractic services and by $114 million or 10.4% in all patients treated for NMS conditions in demonstration areas during the two-year period. Results varied widely among demonstration areas ranging from increased costs per user of $485 in Northern Illinois and Chicago counties to decreases in costs per user of $59 in New Mexico and $178 in Scott County, Iowa.The demonstration did not assess possible decreases in costs to other insurers, out-of-pocket payments by patients, the need for and costs of pain medications, or longer term clinical benefits such as avoidance of orthopedic surgical procedures beyond the two-year period of the demonstration. It is possible that other payers or beneficiaries saved money during the demonstration while costs to Medicare were increased.

  10. Effects of Expanded Coverage for Chiropractic Services on Medicare Costs in a CMS Demonstration

    Science.gov (United States)

    Stason, William B.; Ritter, Grant A; Prottas, Jeffrey; Tompkins, Christopher; Shepard, Donald S.

    2016-01-01

    Background Moderately convincing evidence supports the benefits of chiropractic manipulations for low back pain. Its effectiveness in other applications is less well documented, and its cost-effectiveness is not known. These questions led the Centers for Medicaid and Medicare Services (CMS) to conduct a two-year demonstration of expanded Medicare coverage for chiropractic services in the treatment of beneficiaries with neuromusculoskeletal (NMS) conditions affecting the back, limbs, neck, or head. Methods The demonstration was conducted in 2005–2007 in selected counties of Illinois, Iowa, and Virginia and the entire states of Maine and New Mexico. Medicare claims were compiled for the preceding year and two demonstration years for the demonstration areas and matched comparison areas. The impact of the demonstration was analyzed through multivariate regression analysis with a difference-in-difference framework. Results Expanded coverage increased Medicare expenditures by $50 million or 28.5% in users of chiropractic services and by $114 million or 10.4% in all patients treated for NMS conditions in demonstration areas during the two-year period. Results varied widely among demonstration areas ranging from increased costs per user of $485 in Northern Illinois and Chicago counties to decreases in costs per user of $59 in New Mexico and $178 in Scott County, Iowa. Conclusion The demonstration did not assess possible decreases in costs to other insurers, out-of-pocket payments by patients, the need for and costs of pain medications, or longer term clinical benefits such as avoidance of orthopedic surgical procedures beyond the two-year period of the demonstration. It is possible that other payers or beneficiaries saved money during the demonstration while costs to Medicare were increased. PMID:26928221

  11. Cost-benefit analysis of establishing and operating radiation oncology services in Fiji.

    Science.gov (United States)

    Kim, Eunkyoung; Cho, Yoon-Min; Kwon, Soonman; Park, Kunhee

    2017-10-01

    Rising demand for services of cancer patients has been recognised by the Government of Fiji as a national health priority. Increasing attention has been paid to the lack of service of radiation therapy or radiotherapy in Fiji. This study aims to estimate and compare the costs and benefits of introducing radiation oncology services in Fiji from the societal perspective. Time horizon for cost-benefit analysis (CBA) was 15 years from 2021 to 2035. The benefits and costs were converted to the present values of 2016. Estimates for the CBA model were taken from previous studies and expert opinions and data obtained from field visits to Fiji in January 2016. Sensitivity analyses with changing assumptions were undertaken. The estimated net benefit, applying the national minimum wage (NMW) to measure monetary value for life-year gained, was -31,624,421 FJD with 0.69 of benefit-cost (B/C) ratio. If gross national income (GNI) per capita was used for the value of life years, net benefit was 3,975,684 FJD (B/C ratio: 1.04). With a pessimistic scenario, establishing the center appeared to be not cost-beneficial, and the net benefit was -53,634,682 FJD (B/C ratio: 0.46); net benefit with an optimistic scenario was estimated 23,178,189 FJD (B/C ratio: 1.20). Based on the CBA results from using GNI per capita instead of the NMW, this project would be cost-beneficial. Introducing a radiation oncology center in Fiji would have potential impacts on financial sustainability, financial protection, and accessibility and equity of the health system. Copyright © 2017 World Health Organization. Published by Elsevier Ltd.. All rights reserved.

  12. The impact of scale, complexity, and service quality on the administrative costs of pension funds: A cross-country comparison

    OpenAIRE

    J.A. Bikker; O.W. Steenbeek; F. Torracchi

    2010-01-01

    Administrative costs per participant appear to vary widely across pension funds in different countries. These costs are important because they reduce the rate of return on the investments of pension funds, and consequently raise the cost of retirement security. Using unique data on 90 pension funds over the period 2004-2008, this paper examines the impact of scale, the complexity of pension plans, and service quality on the administrative costs of pension funds, and compares those costs acros...

  13. Service and multimedia data transmission in IoT networks using hybrid communication devices

    Directory of Open Access Journals (Sweden)

    Saveliev Anton

    2017-01-01

    Full Text Available Employment of various protocols and technologies in IoT networks leads to the lack of module unification and increase in incompatible technical solutions. Modern IoT networks are not designed for streaming audio/video data, so their application field is limited. Also, modern IoT networks should have connection areas for devices transferring data to the Internet, and consider hardware and software specific characteristics of these devices. We offer one-size-fits-all solution for organization of IoT network, using hybrid modules. These devices provide flexibility, scalability, energy efficiency and multi-use of network for the transfer of various types of data. This approach takes into account software and hardware features of the devices used for data transmission in IoT networks, which helps to automate connecting the modules chosen by user.

  14. Near-toll quality digital speech transmission in the mobile satellite service

    Science.gov (United States)

    Townes, S. A.; Divsalar, D.

    1986-01-01

    This paper discusses system considerations for near-toll quality digital speech transmission in a 5 kHz mobile satellite system channel. Tradeoffs are shown for power performance versus delay for a 4800 bps speech compression system in conjunction with a 16 state rate 2/3 trellis coded 8PSK modulation system. The suggested system has an additional 150 ms of delay beyond the propagation delay and requires an E(b)/N(0) of about 7 dB for a Ricean channel assumption with line-of-sight to diffuse component ratio of 10 assuming ideal synchronization. An additional loss of 2 to 3 dB is expected for synchronization in fading environment.

  15. Opportunity costs and local health service spending decisions: a qualitative study from Wales.

    Science.gov (United States)

    Karlsberg Schaffer, Sarah; Sussex, Jon; Hughes, Dyfrig; Devlin, Nancy

    2016-03-25

    All health care systems face the need to find the resources to meet new demands such as a new, cost-increasing health technology. In England and Wales, when a health technology is recommended by the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS) is mandated to provide the funding to accommodate it within three months of publication of the recommendation. Identifying what, in practice, is foregone when new cost-increasing technologies are introduced is important for understanding the effects of health technology assessment (HTA) decisions on the NHS or any other health care system. Our objective was to investigate how in practice local NHS commissioners in Wales accommodated financial "shocks" arising from technology appraisals (TAs) issued by NICE and from other cost pressures. Semi-structured interviews were conducted with Finance Directors and Medical Directors from all seven Local Health Boards (LHBs) in NHS Wales. These interviews covered prioritisation processes, as well as methods of financing NICE TAs and other financial shocks at each LHB. We then undertook a systematic identification of themes and topics from the information recorded. The study relates to the period October 2010 to March 2013. The financial impact of NICE TAs is generally anticipated and planned for in advance and the majority of LHBs have contingency funds available to cope with these and other financial shocks within-period. Efficiency savings (defined as reductions in costs with no assumed reductions in quality) were a source of funds for cost pressures of all kinds. Service displacements were not linkable to particular NICE TAs and there appears to be a general lack of explicit prioritisation activities. The Welsh Government has, on occasion, explicitly or implicitly acted as the funder of last resort. Services may be displaced as part of a response to the cumulative impact of all types of cost pressures, including cost-increasing health

  16. Adaptive social learning strategies in temporally and spatially varying environments : how temporal vs. spatial variation, number of cultural traits, and costs of learning influence the evolution of conformist-biased transmission, payoff-biased transmission, and individual learning.

    Science.gov (United States)

    Nakahashi, Wataru; Wakano, Joe Yuichiro; Henrich, Joseph

    2012-12-01

    Long before the origins of agriculture human ancestors had expanded across the globe into an immense variety of environments, from Australian deserts to Siberian tundra. Survival in these environments did not principally depend on genetic adaptations, but instead on evolved learning strategies that permitted the assembly of locally adaptive behavioral repertoires. To develop hypotheses about these learning strategies, we have modeled the evolution of learning strategies to assess what conditions and constraints favor which kinds of strategies. To build on prior work, we focus on clarifying how spatial variability, temporal variability, and the number of cultural traits influence the evolution of four types of strategies: (1) individual learning, (2) unbiased social learning, (3) payoff-biased social learning, and (4) conformist transmission. Using a combination of analytic and simulation methods, we show that spatial-but not temporal-variation strongly favors the emergence of conformist transmission. This effect intensifies when migration rates are relatively high and individual learning is costly. We also show that increasing the number of cultural traits above two favors the evolution of conformist transmission, which suggests that the assumption of only two traits in many models has been conservative. We close by discussing how (1) spatial variability represents only one way of introducing the low-level, nonadaptive phenotypic trait variation that so favors conformist transmission, the other obvious way being learning errors, and (2) our findings apply to the evolution of conformist transmission in social interactions. Throughout we emphasize how our models generate empirical predictions suitable for laboratory testing.

  17. Modelling the Intention to Adopt Cloud Computing Services: A Transaction Cost Theory Perspective

    Directory of Open Access Journals (Sweden)

    Ogan Yigitbasioglu

    2014-11-01

    Full Text Available This paper uses transaction cost theory to study cloud computing adoption. A model is developed and tested with data from an Australian survey. According to the results, perceived vendor opportunism and perceived legislative uncertainty around cloud computing were significantly associated with perceived cloud computing security risk. There was also a significant negative relationship between perceived cloud computing security risk and the intention to adopt cloud services. This study also reports on adoption rates of cloud computing in terms of applications, as well as the types of services used.

  18. The AskIT Service Desk: A Model for Improving Productivity and Reducing Costs

    Energy Technology Data Exchange (ETDEWEB)

    Ashcraft, Phillip Lynn [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Fogle, Blythe G. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Cummings, Susan M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Lopez, Leon [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-07-29

    This was prepared for the business process improvement presentation to the Department of Energy. Los Alamos National Laboratory provides a single point of contact, the AskIT Service Desk, to address issues that impact customer productivity. At the most basic level, what customers want is for their calls to be received, to get a response from a knowledgeable analyst, and to have their issues resolved and their requests fulfilled. Providing a centralized, single point of contact service desk makes initiating technical or business support simple for the customer and improves the odds of immediately resolving the issue or correctly escalating the request to the next support level when necessary. Fulfilling customer requests through automated workflow also improves customer productivity and reduces costs. Finally, customers should be provided the option to solve their own problems through easy access to self-help resources such as frequently asked questions (FAQs) and how-to guides. To accomplish this, everyone who provides and supports services must understand how these processes and functions work together. Service providers and those who support services must “speak the same language” and share common objectives. The Associate Directorate for Business Innovation (ADBI) began the journey to improve services by selecting a known service delivery framework (Information Technology Infrastructure Library, or ITIL). From this framework, components that contribute significant business value were selected.

  19. Accounting for Inventories as Service Producing Cost in Hospitals In According To Turkish Accounting Standard-2

    Directory of Open Access Journals (Sweden)

    Seyhan Çil Koçyiğit

    2011-03-01

    Full Text Available As known, service is an intangible concept. This prevents services to be stored and makes them impossible to be used in another time in the future. Thus, it is a matter of discussion to suppose the services (which occur in the hospitals as an intangible concept as inventory. There are some differences between Turkish uniform accounting system and Turkish accounting standards in stockpiling the service producing costs in hospitals. In this study, especially Turkish Accounting Standard-2 Inventories is considered regarding service inventories in order to emphasise the differences and guiding to apply this standard towards hospitals is aimed. Furthermore, a sample is issued in booking the service inventories in hospitals by using financials of Acıbadem Health Services CO. as the unique hospital written in İstanbul Stock Exchange. At the end of the study, more truthful results has been inspected by applying Turkish Accounting Standard-2 instead of current application by compliying with the matching principle as well.

  20. 76 FR 72003 - Calendar Year 2011 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Science.gov (United States)

    2011-11-21

    ... Cosmetic Surgery Services Furnished by Department of Defense Medical Treatment Facilities; Certain Rates... recovery from tortiously liable third persons for the cost of outpatient medical, dental, and cosmetic... of the full cost of all services provided. The outpatient medical, dental, and cosmetic surgery...

  1. 78 FR 62709 - Calendar Year 2013 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Science.gov (United States)

    2013-10-22

    ... Cosmetic Surgery Services Furnished by Department of Defense Medical Treatment Facilities; Certain Rates... recovery from tortiously liable third persons for the cost of outpatient medical, dental and cosmetic... of the full cost of all services provided. The CY13 Outpatient Medical, Dental, and Cosmetic Surgery...

  2. Stakeholders' perceptions on factors influencing male involvement in prevention of mother to child transmission of HIV services in Blantyre, Malawi.

    Science.gov (United States)

    Nyondo, Alinane Linda; Chimwaza, Angela Faith; Muula, Adamson Sinjani

    2014-07-07

    Male Involvement (MI) in the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) services is essential in a patriarchal society where men are decision makers of the household. Male partners have a role in the woman's risk of acquiring HIV, uptake of HIV testing and participation in Mother to Child Transmission (MTCT) prevention programmes. Although MI is important for uptake of PMTCT interventions, it remains low in Africa. The purpose of this study was to identify factors that promote and hinder MI in PMTCT services in antenatal care (ANC) services in Blantyre, Malawi. Understanding of the factors that influence MI will assist in developing strategies that will involve men more in the programme thereby improving the uptake of PMTCT and HIV testing and counselling services by women and men respectively. An exploratory qualitative study was conducted from December 2012 to January 2013 at South Lunzu Health Centre (SLHC) in Blantyre, Malawi. It consisted of six face to face Key Informant Interviews (KIIs) with health care workers and four Focus Group discussions (FGDs) with 18 men and 17 pregnant women attending antenatal care at the clinic. The FGDs were divided according to sex and age. All FGDs and KIIs were digitally recorded and simultaneously transcribed and translated verbatim into English. Data were analysed using thematic content analysis. Participants in both FGDs and KIIs identified the following barriers: lack of knowledge of MI in PMTCT, socioeconomic factors, relationship issues, timidity to be seen in a woman's domain, unplanned and or extramarital pregnancies, fear of knowing one's HIV status, unwillingness to be associated with the service, health facility based factors, peer influence and cultural factors. The factors that would potentially promote male involvement were categorized into community, health facility and personal or family level factors. The factors that may hinder or promote MI arise from different

  3. Stakeholders’ perceptions on factors influencing male involvement in prevention of mother to child transmission of HIV services in Blantyre, Malawi

    Science.gov (United States)

    2014-01-01

    Background Male Involvement (MI) in the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) services is essential in a patriarchal society where men are decision makers of the household. Male partners have a role in the woman’s risk of acquiring HIV, uptake of HIV testing and participation in Mother to Child Transmission (MTCT) prevention programmes. Although MI is important for uptake of PMTCT interventions, it remains low in Africa. The purpose of this study was to identify factors that promote and hinder MI in PMTCT services in antenatal care (ANC) services in Blantyre, Malawi. Understanding of the factors that influence MI will assist in developing strategies that will involve men more in the programme thereby improving the uptake of PMTCT and HIV testing and counselling services by women and men respectively. Methods An exploratory qualitative study was conducted from December 2012 to January 2013 at South Lunzu Health Centre (SLHC) in Blantyre, Malawi. It consisted of six face to face Key Informant Interviews (KIIs) with health care workers and four Focus Group discussions (FGDs) with 18 men and 17 pregnant women attending antenatal care at the clinic. The FGDs were divided according to sex and age. All FGDs and KIIs were digitally recorded and simultaneously transcribed and translated verbatim into English. Data were analysed using thematic content analysis. Results Participants in both FGDs and KIIs identified the following barriers: lack of knowledge of MI in PMTCT, socioeconomic factors, relationship issues, timidity to be seen in a woman’s domain, unplanned and or extramarital pregnancies, fear of knowing one's HIV status, unwillingness to be associated with the service, health facility based factors, peer influence and cultural factors. The factors that would potentially promote male involvement were categorized into community, health facility and personal or family level factors. Conclusions The factors that may

  4. Model-Based Predictive Control Scheme for Cost Optimization and Balancing Services for Supermarket Refrigeration Systems

    DEFF Research Database (Denmark)

    Weerts, Hermanus H. M.; Shafiei, Seyed Ehsan; Stoustrup, Jakob

    2014-01-01

    A new formulation of model predictive control for supermarket refrigeration systems is proposed to facilitate the regulatory power services as well as energy cost optimization of such systems in the smart grid. Nonlinear dynamics existed in large-scale refrigeration plants challenges the predictive...... control design. It is however shown that taking into account the knowledge of different time scales in the dynamical subsystems makes possible a linear formulation of a centralized predictive controller. A realistic scenario of regulatory power services in the smart grid is considered and formulated...... in the same objective as of cost optimization one. A simulation benchmark validated against real data and including significant dynamics of the system are employed to show the effectiveness of the proposed control scheme....

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

    Science.gov (United States)

    Kempers, Jari; Ketting, Evert; Lesco, Galina

    2014-07-21

    Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result suggest that, together the three SRH

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

    Science.gov (United States)

    2014-01-01

    Background Youth-friendly sexual and reproductive health services (YFHS) have high priority in many countries. Yet, little is known about the cost and cost-effectiveness of good quality YFHS in resource limited settings. This paper analyses retrospectively costs and potential cost-effectiveness of four well performing youth-friendly health centres (YFHC) in Moldova. This study assesses: (1) what were the costs of YFHSs at centre level, (2) how much would scaling-up to a national good quality YFHS programme cost, and (3) was the programme potentially cost-effective? Methods Four well performing YFHCs were selected for the study. YFHS costs were analysed per centre, funding source, service and person reached. The costing results were extrapolated to estimate cost of a good quality national YFHS programme in Moldova. A threshold analysis was carried out to estimate the required impact level for the YFHSs to break-even (become cost saving). Results Average annual cost of a well performing YFHC was USD 26,000 in 2011. 58% was financed by the National Health Insurance Company and the rest by external donors (42%). Personnel salaries were the largest expense category (47%). The annual implementation costs of a good quality YFHSs in all 38 YFHCs of Moldova were estimated to be USD 1.0 million. The results of the threshold analysis indicate that the annual break-even impact points in a YFHC for: 1) STI services would be >364 averted STIs, 2) early pregnancy and contraceptive services >178 averted unwanted pregnancies, and 3) HIV services only >0.65 averted new HIV infections. Conclusions The costing results highlight the following: 1) significant additional resources would be required for implementation of a good quality national YFHS programme, 2) the four well performing YFHCs rely heavily on external funding (42%), 3) which raises questions about financial sustainability of the programme. At the same time results of the threshold analysis are encouraging. The result

  7. The longitudinal study of turnover and the cost of turnover in emergency medical services.

    Science.gov (United States)

    Patterson, P Daniel; Jones, Cheryl B; Hubble, Michael W; Carr, Matthew; Weaver, Matthew D; Engberg, John; Castle, Nicholas

    2010-01-01

    Few studies have examined employee turnover and associated costs in emergency medical services (EMS). To quantify the mean annual rate of turnover, total median cost of turnover, and median cost per termination in a diverse sample of EMS agencies. A convenience sample of 40 EMS agencies was followed over a six-month period. Internet, telephone, and on-site data-collection methods were used to document terminations, new hires, open positions, and costs associated with turnover. The cost associated with turnover was calculated based on a modified version of the Nursing Turnover Cost Calculation Methodology (NTCCM). The NTCCM identified direct and indirect costs through a series of questions that agency administrators answered monthly during the study period. A previously tested measure of turnover to calculate the mean annual rate of turnover was used. All calculations were weighted by the size of the EMS agency roster. The mean annual rate of turnover, total median cost of turnover, and median cost per termination were determined for three categories of agency staff mix: all-paid staff, mix of paid and volunteer (mixed) staff, and all-volunteer staff. The overall weighted mean annual rate of turnover was 10.7%. This rate varied slightly across agency staffing mix (all-paid = 10.2%, mixed = 12.3%, all-volunteer = 12.4%). Among agencies that experienced turnover (n = 25), the weighted median cost of turnover was $71,613.75, which varied across agency staffing mix (all-paid = $86,452.05, mixed = $9,766.65, and all-volunteer = $0). The weighted median cost per termination was $6,871.51 and varied across agency staffing mix (all-paid = $7,161.38, mixed = $1,409.64, and all-volunteer = $0). Annual rates of turnover and costs associated with turnover vary widely across types of EMS agencies. The study's mean annual rate of turnover was lower than expected based on information appearing in the news media and EMS trade magazines. Findings provide estimates of two key

  8. A Cost-Effective Strategy for Storing Scientific Datasets with Multiple Service Providers in the Cloud

    OpenAIRE

    Yuan, Dong; Cui, Lizhen; Liu, Xiao; Fu, Erjiang; Yang, Yun

    2016-01-01

    Cloud computing provides scientists a platform that can deploy computation and data intensive applications without infrastructure investment. With excessive cloud resources and a decision support system, large generated data sets can be flexibly 1 stored locally in the current cloud, 2 deleted and regenerated whenever reused or 3 transferred to cheaper cloud service for storage. However, due to the pay for use model, the total application cost largely depends on the usage of computation, stor...

  9. Podoconiosis patients’ willingness to pay for treatment services in Northwest Ethiopia: potential for cost recovery

    Science.gov (United States)

    2014-01-01

    Background Podoconiosis is non-filarial elephantiasis of the lower legs. It is more commonly found in tropical Africa, Central and South America, and northwest India. In Ethiopia, a few non-governmental organizations provide free treatment to podoconiosis patients, but sustainability of free treatment and scale-up of services to reach the huge unmet need is challenged by resource limitations. We aimed to determine podoconiosis patient’s willingness to pay (WTP) for a treatment package (composed of deep cleaning of limbs with diluted antiseptic solution, soap, and water, bandaging, application of emollient on the skin, and provision of shoes), and factors associated with WTP in northwestern Ethiopia. Methods A cross-sectional study was conducted among randomly selected untreated podoconiosis patients (n = 393) in Baso Liben woreda, northwestern Ethiopia. The contingent valuation method was used with a pre-tested interviewer-administered questionnaire. Results The majority of podoconiosis patients (72.8%) were willing to pay for treatment services. The median WTP amount was 64 Birr (US$ 3.28) per person per year. More than one-third of patients (36.7%) were willing to pay at least half of the full treatment cost and 76.2% were willing to pay at least half of the cost of shoes. A multivariate analysis showed that having a higher monthly income, being a woman, older age, being aware of the role of shoes to prevent podoconiosis, and possession of a functional radio were significantly associated with higher odds of WTP. Conclusions The considerable WTP estimates showed that podoconiosis treatment could improve sustainability and service utilization. A subsidized cost recovery scheme could reduce treatment costs and more feasibility integrate podoconiosis treatment service with other NTDs and the government’s primary health care system. PMID:24642085

  10. ENHANCING VOLUNTARY COMPLIANCE BY REDUCING COMPLIANCE COSTS: A TAXPAYER SERVICE APPROACH

    OpenAIRE

    Glenn Jenkins; EDWIN FORLEMU

    1993-01-01

    In this paper an overview is made of the determinants of voluntary tax compliance. Unlike previous treatments of this subject, the cost of taxpayer compliance is considered as an important determinant of overall level of voluntary compliance in a country. A number of ways that tax authorities reduce compliance are discussed, and the most common uses of information technology in providing taxpayer service is described. Finally, the paper considers some of the ways that such activities might be...

  11. Comparing service use and costs among adolescents with autism spectrum disorders, special needs and typical development.

    Science.gov (United States)

    Barrett, Barbara; Mosweu, Iris; Jones, Catherine Rg; Charman, Tony; Baird, Gillian; Simonoff, Emily; Pickles, Andrew; Happé, Francesca; Byford, Sarah

    2015-07-01

    Autism spectrum disorder is a complex condition that requires specialised care. Knowledge of the costs of autism spectrum disorder, especially in comparison with other conditions, may be useful to galvanise policymakers and leverage investment in education and intervention to mitigate aspects of autism spectrum disorder that negatively impact individuals with the disorder and their families. This article describes the services and associated costs for four groups of individuals: adolescents with autistic disorder, adolescents with other autism spectrum disorders, adolescents with other special educational needs and typically developing adolescents using data from a large, well-characterised cohort assessed as part of the UK Special Needs and Autism Project at the age of 12 years. Average total costs per participant over 6 months were highest in the autistic disorder group (£11,029), followed by the special educational needs group (£9268), the broader autism spectrum disorder group (£8968) and the typically developing group (£2954). Specialised day or residential schooling accounted for the vast majority of costs. In regression analysis, lower age and lower adaptive functioning were associated with higher costs in the groups with an autism spectrum disorder. Sex, ethnicity, number of International Classification of Diseases (10th revision) symptoms, autism spectrum disorder symptom scores and levels of mental health difficulties were not associated with cost. © The Author(s) 2014.

  12. Implementation of an acute care emergency surgical service: a cost analysis from the surgeon's perspective.

    Science.gov (United States)

    Anantha, Ram Venkatesh; Parry, Neil; Vogt, Kelly; Jain, Vipan; Crawford, Silvie; Leslie, Ken

    2014-04-01

    Acute care surgical services provide comprehensive emergency general surgical care while potentially using health care resources more efficiently. We assessed the volume and distribution of emergency general surgery (EGS) procedures before and after the implementation of the Acute Care and Emergency Surgery Service (ACCESS) at a Canadian tertiary care hospital and its effect on surgeon billings. This single-centre retrospective case-control study compared adult patients who underwent EGS procedures between July and December 2009 (pre-ACCESS), to those who had surgery between July and December 2010 (post-ACCESS). Case distribution was compared between day (7 am to 3 pm), evening (3 pm to 11 pm) and night (11 pm to 7 am). Frequencies were compared using the χ(2) test. Pre-ACCESS, 366 EGS procedures were performed: 24% during the day, 55% in the evening and 21% at night. Post-ACCESS, 463 operations were performed: 55% during the day, 36% in the evening and 9% at night. Reductions in night-time and evening EGS were 57% and 36% respectively (p cost-modelling analysis, post-ACCESS surgeon billing for appendectomies, segmental colectomies, laparotomies and cholecystectomies all declined by $67 190, $125 215, $66 362, and $84 913, respectively (p Cost-modelling analysis demonstrates that these services have cost-savings potential for the health care system without reducing overall surgeon billing.

  13. Costs of denied health care services and of the lawsuits filed to obtain them in Medellín, 2009

    Directory of Open Access Journals (Sweden)

    Emmanuel Nieto L

    2011-07-01

    Full Text Available Objective: to retrace the legal route of writs for the protection of constitutional rights involving health care services and to determine the cost of such processes and those of the health care services invoked in a sample of such writs taken in Medellín city. Methods: a descriptive study with a qualitative focus for retracing the legal route of the writs, and a quantitative approach for the purpose of cost estimation. The 2009 SOAT (Mandatory Car Insurance fees were used for assessing the cost of the health care services. As for the assessment of the legal costs, we used the micro-costing approach together with the activity-based costing methodology. Results: for each $100 corresponding to the cost of the services denied by the health care services provider, the Medellín judicial system spent around $48 on each legal process. In more than half of the cases, the cost of the legal action was higher than the services’ cost. Discussion: the cost of the legal process involving the writs for the protection of constitutional rights regarding health care services that were filed in the country between 1999 and 2009 could represent 2% of the budget circulating throughout the entire health system. This cost is just a part of the transaction costs generated by the health care services providers’ breach of the social contract established by the Colombian Constitution. Furthermore, in most cases there is also a breach of the private contract between these service providers and the health system users.

  14. Time-Driven Activity-Based Costing for Inter-Library Services: A Case Study in a University

    Science.gov (United States)

    Pernot, Eli; Roodhooft, Filip; Van den Abbeele, Alexandra

    2007-01-01

    Although the true costs of inter-library loans (ILL) are unknown, universities increasingly rely on them to provide better library services at lower costs. Through a case study, we show how to perform a time-driven activity-based costing analysis of ILL and provide evidence of the benefits of such an analysis.

  15. Health service cost associated with percutaneous vertebroplasty in patients with spinal metastases.

    Science.gov (United States)

    Chew, C; O'Dwyer, P J; Edwards, R

    2013-08-01

    To ascertain prospectively the health service cost of vertebroplasty in a cohort of consecutive patients with spinal metastases. Percutaneous vertebroplasty was performed under conscious sedation and local anaesthetic in the Interventional Suite with fluoroscopic guidance. Data were collected prospectively on standard forms. Quality of life questionnaires (EQ-5D) were filled out pre-, 6 weeks, and at 6 months post-vertebroplasty. The majority of the procedures were performed on an outpatient basis (8/11). The median duration of the procedure was 60 min (range 40-80 min) with a further 60 min spent in the recovery room (range 10-230 min). Personnel involved included a consultant radiologist, a radiology registrar, four nurses, and two radiographers. The average cost of vertebroplasty per patient, including consumables, capital equipment, hotel/clinic costs, and staffing, was £2213.25 (95% CI £729.95). The mean EQ-5D utility scores increased from 0.421 pre-treatment to 0.5979 post-treatment (p = 0.047). The visual analogue scale (VAS) of perceived health improved from a mean of 41.88 to 63.75 (p = 0.00537). Health service costs for percutaneous vertebroplasty in patients with spinal metastases is significantly lower than previously estimated and is in keeping with that of other palliative radiological procedures. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  16. Health service cost associated with percutaneous vertebroplasty in patients with spinal metastases

    International Nuclear Information System (INIS)

    Chew, C.; O'Dwyer, P.J.; Edwards, R.

    2013-01-01

    Aims: To ascertain prospectively the health service cost of vertebroplasty in a cohort of consecutive patients with spinal metastases. Materials and methods: Percutaneous vertebroplasty was performed under conscious sedation and local anaesthetic in the Interventional Suite with fluoroscopic guidance. Data were collected prospectively on standard forms. Quality of life questionnaires (EQ-5D) were filled out pre-, 6 weeks, and at 6 months post-vertebroplasty. Results: The majority of the procedures were performed on an outpatient basis (8/11). The median duration of the procedure was 60 min (range 40–80 min) with a further 60 min spent in the recovery room (range 10–230 min). Personnel involved included a consultant radiologist, a radiology registrar, four nurses, and two radiographers. The average cost of vertebroplasty per patient, including consumables, capital equipment, hotel/clinic costs, and staffing, was £2213.25 (95% CI £729.95). The mean EQ-5D utility scores increased from 0.421 pre-treatment to 0.5979 post-treatment (p = 0.047). The visual analogue scale (VAS) of perceived health improved from a mean of 41.88 to 63.75 (p = 0.00537). Conclusion: Health service costs for percutaneous vertebroplasty in patients with spinal metastases is significantly lower than previously estimated and is in keeping with that of other palliative radiological procedures

  17. Marginal cost calculation of energy production in hydro thermoelectric systems considering the transmission system; Calculo do custo marginal de producao de energia em sistemas hidrotermoeletricos levando em consideracao a rede de transmissao

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, M V.F. [Pontificia Univ. Catolica do Rio de Janeiro, RJ (Brazil); Gorenstin, B G [Centro de Pesquisas de Energia Eletrica, Rio de Janeiro, RJ (Brazil); Alvarenga Filho, S [ELETROBRAS, Rio de Janeiro, RJ (Brazil)

    1990-12-31

    The alternatives for calculation of energy marginal cost in hydroelectric systems, considering the transmission one, was analysed, including fundamental concepts; generation/transmission systems, represented by linear power flow model; production marginal costs in hydrothermal systems and computation aspects. (C.G.C.). 11 refs, 5 figs.

  18. Cost-price estimation of clinical laboratory services based on activity-based costing: A case study from a developing country.

    Science.gov (United States)

    Mouseli, Ali; Barouni, Mohsen; Amiresmaili, Mohammadreza; Samiee, Siamak Mirab; Vali, Leila

    2017-04-01

    It is believed that laboratory tariffs in Iran don't reflect the real costs. This might expose private laboratories at financial hardship. Activity Based Costing is widely used as a cost measurement instrument to more closely approximate the true cost of operations. This study aimed to determine the real price of different clinical tests of a selected private clinical laboratory. This study was a cross sectional study carried out in 2015. The study setting was the private laboratories in the city of Kerman, Iran. Of 629 tests in the tariff book of the laboratory (relative value), 188 tests were conducted in the laboratory that used Activity Based Costing (ABC) methodology to estimate cost-price. Analyzing and cost-price estimating of laboratory services were performed by MY ABCM software Version 5.0. In 2015, the total costs were $641,645. Direct and indirect costs were 78.3% and 21.7% respectively. Laboratory consumable costs by 37% and personnel costs by 36.3% had the largest share of the costing. Also, group of hormone tests cost the most $147,741 (23.03%), and other tests group cost the least $3,611 (0.56%). Also after calculating the cost of laboratory services, a comparison was made between the calculated price and the private sector's tariffs in 2015. This study showed that there was a difference between costs and tariffs in the private laboratory. One way to overcome this problem is to increase the number of laboratory tests with regard to capacity of the laboratories.

  19. Variability in the Initial Costs of Care and One-Year Outcomes of Observation Services

    Directory of Open Access Journals (Sweden)

    Abbass, Ibrahim

    2015-05-01

    Full Text Available Introduction: The use of observation units (OUs following emergency departments (ED visits as a model of care has increased exponentially in the last decade. About one-third of U.S. hospitals now have OUs within their facilities. While their use is associated with lower costs and comparable level of care compared to inpatient units, there is a wide variation in OUs characteristics and operational procedures. The objective of this research was to explore the variability in the initial costs of care of placing patients with non-specific chest pain in observation units (OUs and the one-year outcomes. Methods: The author retrospectively investigated medical insurance claims of 22,962 privately insured patients (2009-2011 admitted to 41 OUs. Outcomes included the one-year chest pain/cardiovascular related costs and primary and secondary outcomes. Primary outcomes included myocardial infarction, congestive heart failure, stroke or cardiac arrest, while secondary outcomes included revascularization procedures, ED revisits for angina pectoris or chest pain and hospitalization due to cardiovascular diseases. The author aggregated the adjusted costs and prevalence rates of outcomes for patients over OUs, and computed the weighted coefficients of variation (WCV to compare variations across OUs. Results: There was minimal variability in the initial costs of care (WCV=2.2%, while the author noticed greater variability in the outcomes. Greater variability were associated with the adjusted cardiovascular-related costs of medical services (WCV=17.6% followed by the adjusted prevalence odds ratio of patients experiencing primary outcomes (WCV=16.3% and secondary outcomes (WCV=10%. Conclusion: Higher variability in the outcomes suggests the need for more standardization of the observation services for chest pain patients. [West J Emerg Med. 2015;16(3:395–400.

  20. Estimating the Size and Cost of the STD Prevention Services Safety Net.

    Science.gov (United States)

    Gift, Thomas L; Haderxhanaj, Laura T; Torrone, Elizabeth A; Behl, Ajay S; Romaguera, Raul A; Leichliter, Jami S

    2015-01-01

    The Patient Protection and Affordable Care Act is expected to reduce the number of uninsured people in the United States during the next eight years, but more than 10% are expected to remain uninsured. Uninsured people are one of the main populations using publicly funded safety net sexually transmitted disease (STD) prevention services. Estimating the proportion of the uninsured population expected to need STD services could help identify the potential demand for safety net STD services and improve program planning. In 2013, an estimated 8.27 million people met the criteria for being in need of STD services. In 2023, 4.70 million uninsured people are expected to meet the criteria for being in need of STD services. As an example, the cost in 2014 U.S. dollars of providing chlamydia screening to these people was an estimated $271.1 million in 2013 and is estimated to be $153.8 million in 2023. A substantial need will continue to exist for safety net STD prevention services in coming years.

  1. Cost-benefit of the telecardiology service in the state of Minas Gerais: Minas Telecardio Project.

    Science.gov (United States)

    Andrade, Mônica Viegas; Maia, Ana Carolina; Cardoso, Clareci Silva; Alkmim, Maria Beatriz; Ribeiro, Antônio Luiz Pinho

    2011-10-01

    Telecardiology is a tool that can aid in cardiovascular care, mainly in towns located in remote areas. However, economic assessments on this subject are scarce and have yielded controversial results. To evaluate the cost-benefit of implementing a Telecardiology service in remote, small towns in the state of Minas Gerais, Brazil. The study used the database from the Minas Telecardio (MTC) Project, developed from June 2006 to November 2008, in 82 towns in the countryside of the state. Each municipality received a microcomputer with a digital electrocardiograph, with the possibility of transmitting ECG tracings and communicating with the on-duty cardiologist at the University hospital. The cost-benefit analysis was carried out by comparing the cost of performing an ECG in the project versus the cost of performing it by patient referral to another city. The average cost of an ECG in the MTC project was R$ 28.92, decomposed into R$ 8.08 for the cost of implementation and R$ 20.84 for maintenance. The cost simulation of the ECG with referral ranged from R$ 30.91 to R$ 54.58, with the cost-benefit ratio being always favorable to the MTC program, regardless of the type of calculation used for referral distance. The simulations considered the financial sponsor's and society's points-of-view. The sensitivity analysis with variation of calibration parameters confirmed these results. The implementation of a Telecardiology system as support to primary care in small Brazilian towns is feasible and economically beneficial, and can be used as a regular program within the Brazilian public health system.

  2. The impact of NHS based primary care complementary therapy services on health outcomes and NHS costs: a review of service audits and evaluations

    Directory of Open Access Journals (Sweden)

    Wye Lesley

    2009-03-01

    Full Text Available Abstract Background The aim of this study was to review evaluations and audits of primary care complementary therapy services to determine the impact of these services on improving health outcomes and reducing NHS costs. Our intention is to help service users, service providers, clinicians and NHS commissioners make informed decisions about the potential of NHS based complementary therapy services. Methods We searched for published and unpublished studies of NHS based primary care complementary therapy services located in England and Wales from November 2003 to April 2008. We identified the type of information included in each document and extracted comparable data on health outcomes and NHS costs (e.g. prescriptions and GP consultations. Results Twenty-one documents for 14 services met our inclusion criteria. Overall, the quality of the studies was poor, so few conclusions can be made. One controlled and eleven uncontrolled studies using SF36 or MYMOP indicated that primary care complementary therapy services had moderate to strong impact on health status scores. Data on the impact of primary care complementary therapy services on NHS costs were scarcer and inconclusive. One controlled study of a medical osteopathy service found that service users did not decrease their use of NHS resources. Conclusion To improve the quality of evaluations, we urge those evaluating complementary therapy services to use standardised health outcome tools, calculate confidence intervals and collect NHS cost data from GP medical records. Further discussion is needed on ways to standardise the collection and reporting of NHS cost data in primary care complementary therapy services evaluations.

  3. Assessing missed opportunities for the prevention of mother-to-child HIV transmission in an Eastern Cape local service area.

    Science.gov (United States)

    Rispel, L C; Peltzer, K; Phaswana-Mafuya, N; Metcalf, C A; Treger, L

    2009-03-01

    Prevention of new HIV infections is a critical imperative for South Africa; the prevention of mother-to-child transmission (PMTCT) is one of the most efficacious HIV prevention interventions. Assessment of a PMTCT programme to determine missed opportunities. The Kouga local service area (LSA), bordering Nelson Mandela Bay Municipality (Port Elizabeth) in the Eastern Cape. An assessment was conducted in 2007 before implementing technical support for strengthening the PMTCT programme, including: interviews with 20 PMTCT managers, 4 maternity staff and 27 other health workers on service provision, management, infrastructure, human resources and the health information system; 296 antenatal clinic users on their service perceptions; 70 HIV-positive women on HIV knowledge, infant feeding, coping, support and service perceptions; 8 representatives from community organisations and 101 traditional health practitioners (THPs). Observations were conducted during site visits to health facilities, and the District Health Information System (DHIS) data were reviewed. Staff had high levels of awareness of HIV policies and most had received some relevant training. Nevirapine uptake varied by clinic, with an average of 56%. There were many missed opportunities for PMTCT, with 67% of pregnant women tested for HIV and only 43% of antenatal care attendees tested during a previous pregnancy. Only 6% of HIV-positive women reported support group participation. Reducing missed opportunities for PMTCT requires strengthening of the formal health sector, intersectoral liaison, and greater community support. Priority areas that require strengthening in the formal health sector include HIV counselling and testing; family planning and nutrition counselling; infant follow-up; human resources; and monitoring and evaluation.

  4. Cost-Effectiveness Analysis of a Mobile Ear Screening and Surveillance Service versus an Outreach Screening, Surveillance and Surgical Service for Indigenous Children in Australia.

    Directory of Open Access Journals (Sweden)

    Kim-Huong Nguyen

    Full Text Available Indigenous Australians experience a high rate of ear disease and hearing loss, yet they have a lower rate of service access and utilisation compared to their non-Indigenous counterparts. Screening, surveillance and timely access to specialist ear, nose and throat (ENT services are key components in detecting and preventing the recurrence of ear diseases. To address the low access and utilisation rate by Indigenous Australians, a collaborative, community-based mobile telemedicine-enabled screening and surveillance (MTESS service was trialled in Cherbourg, the third largest Indigenous community in Queensland, Australia. This paper aims to evaluate the cost-effectiveness of the MTESS service using a lifetime Markov model that compares two options: (i the Deadly Ears Program alone (current practice involving an outreach ENT surgical service and screening program, and (ii the Deadly Ears Program supplemented with the MTESS service. Data were obtained from the Deadly Ears Program, a feasibility study of the MTESS service and the literature. Incremental cost-utility ratios were calculated from a societal perspective with both costs (in 2013-14 Australian dollars and quality-adjusted life years (QALYs discounted at 5% annually. The model showed that compared with the Deadly Ears Program, the probability of an acceptable cost-utility ratio at a willingness-to-pay threshold of $50,000/QALY was 98% for the MTESS service. This cost effectiveness arises from preventing hearing loss in the Indigenous population and the subsequent reduction in associated costs. Deterministic and probability sensitivity analyses indicated that the model was robust to parameter changes. We concluded that the MTESS service is a cost-effective strategy. It presents an opportunity to resolve major issues confronting Australia's health system such as the inequitable provision and access to quality healthcare for rural and remotes communities, and for Indigenous Australians

  5. Cost-Effectiveness Analysis of a Mobile Ear Screening and Surveillance Service versus an Outreach Screening, Surveillance and Surgical Service for Indigenous Children in Australia.

    Science.gov (United States)

    Nguyen, Kim-Huong; Smith, Anthony C; Armfield, Nigel R; Bensink, Mark; Scuffham, Paul A

    2015-01-01

    Indigenous Australians experience a high rate of ear disease and hearing loss, yet they have a lower rate of service access and utilisation compared to their non-Indigenous counterparts. Screening, surveillance and timely access to specialist ear, nose and throat (ENT) services are key components in detecting and preventing the recurrence of ear diseases. To address the low access and utilisation rate by Indigenous Australians, a collaborative, community-based mobile telemedicine-enabled screening and surveillance (MTESS) service was trialled in Cherbourg, the third largest Indigenous community in Queensland, Australia. This paper aims to evaluate the cost-effectiveness of the MTESS service using a lifetime Markov model that compares two options: (i) the Deadly Ears Program alone (current practice involving an outreach ENT surgical service and screening program), and (ii) the Deadly Ears Program supplemented with the MTESS service. Data were obtained from the Deadly Ears Program, a feasibility study of the MTESS service and the literature. Incremental cost-utility ratios were calculated from a societal perspective with both costs (in 2013-14 Australian dollars) and quality-adjusted life years (QALYs) discounted at 5% annually. The model showed that compared with the Deadly Ears Program, the probability of an acceptable cost-utility ratio at a willingness-to-pay threshold of $50,000/QALY was 98% for the MTESS service. This cost effectiveness arises from preventing hearing loss in the Indigenous population and the subsequent reduction in associated costs. Deterministic and probability sensitivity analyses indicated that the model was robust to parameter changes. We concluded that the MTESS service is a cost-effective strategy. It presents an opportunity to resolve major issues confronting Australia's health system such as the inequitable provision and access to quality healthcare for rural and remotes communities, and for Indigenous Australians. Additionally, it may

  6. A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention.

    Science.gov (United States)

    Ambia, Julie; Mandala, Justin

    2016-01-01

    The success of prevention of mother-to-child transmission of HIV (PMTCT) is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps. Selected databases were searched for studies published in English (up to September 2015). Outcomes of interest included antiretroviral (ARV) drugs or antiretroviral therapy (ART) initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID) of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis. Interventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs), mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized) that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I(2)=83%) in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I(2)=0%) in four studies (one randomized). Four studies (three randomized) that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I(2)=69%) in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I(2)=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings. Our findings indicate that mobile phone-based reminders may increase the uptake

  7. Cost Analysis and Performance Assessment of Partner Services for Human Immunodeficiency Virus and Sexually Transmitted Diseases, New York State, 2014.

    Science.gov (United States)

    Johnson, Britney L; Tesoriero, James; Feng, Wenhui; Qian, Feng; Martin, Erika G

    2017-12-01

    To estimate the programmatic costs of partner services for HIV, syphilis, gonorrhea, and chlamydial infection. New York State and local health departments conducting partner services activities in 2014. A cost analysis estimated, from the state perspective, total program costs and cost per case assignment, patient interview, partner notification, and disease-specific key performance indicator. Data came from contracts, a time study of staff effort, and statewide surveillance systems. Disease-specific costs per case assignment (mean: $580; range: $502-$1,111), patient interview ($703; $608-$1,609), partner notification ($1,169; $950-$1,936), and key performance indicator ($2,697; $1,666-$20,255) varied across diseases. Most costs (79 percent) were devoted to gonorrhea and chlamydial infection investigations. Cost analysis complements cost-effectiveness analysis in evaluating program performance and guiding improvements. © Health Research and Educational Trust.

  8. Cost calculator methods for estimating casework time in child welfare services: A promising approach for use in implementation of evidence-based practices and other service innovations.

    Science.gov (United States)

    Holmes, Lisa; Landsverk, John; Ward, Harriet; Rolls-Reutz, Jennifer; Saldana, Lisa; Wulczyn, Fred; Chamberlain, Patricia

    2014-04-01

    Estimating costs in child welfare services is critical as new service models are incorporated into routine practice. This paper describes a unit costing estimation system developed in England (cost calculator) together with a pilot test of its utility in the United States where unit costs are routinely available for health services but not for child welfare services. The cost calculator approach uses a unified conceptual model that focuses on eight core child welfare processes. Comparison of these core processes in England and in four counties in the United States suggests that the underlying child welfare processes generated from England were perceived as very similar by child welfare staff in California county systems with some exceptions in the review and legal processes. Overall, the adaptation of the cost calculator for use in the United States child welfare systems appears promising. The paper also compares the cost calculator approach to the workload approach widely used in the United States and concludes that there are distinct differences between the two approaches with some possible advantages to the use of the cost calculator approach, especially in the use of this method for estimating child welfare costs in relation to the incorporation of evidence-based interventions into routine practice.

  9. Effects of tunnel and station size on the costs and service of subway transit systems

    Science.gov (United States)

    Dayman, B., Jr.

    1979-01-01

    The feasibility of less spacious, less costly underground rail mass transit system designs is studied. The major cost saving expected from alternative tunnel designs results from using precast concrete segment liners in place of steel. The saying expected for a two-foot decrease in the diameter of twin, single track tunnels is about two million dollars per route mile from 13 million dollars for precast concrete segment liners (a saving of about 16%). The cost per route-mile of a double track tunnel appears to be 15 to 25% higher than for the twin, single track tunnels. The effective cost saving expected from stations with four-car train capability instead of the usual eight-car trains is nearly 25% or seven million dollars per route mile. The saving in station costs can be obtained while improving service to the user (lower transit time and less waiting for trains) up to a capacity of 36,000 riders per hour in each direction.

  10. Cost-effectiveness of midwifery services vs. medical services in Quebec. LEquipe dEvaluation des Projets-Pilotes Sages-Femmes.

    Science.gov (United States)

    Reinharz, D; Blais, R; Fraser, W D; Contandriopoulos, A P

    2000-01-01

    This study compared the cost-effectiveness of midwife services provided in birth centres operating as pilot projects with current hospital-based medical services in the province of Quebec. One thousand midwives' clients were matched with 1,000 physicians' clients on the basis of socio-demographic characteristics and obstetrical risk. Direct costs for the prenatal, intrapartum and postpartum periods were estimated. Effectiveness was assessed on the basis of three clinical indicators and four indices related to the individualization of care as assessed by women. Results show that the costs of midwife services were barely lower than or equal to those of physician services, but cost-effectiveness ratios were to the advantage of the midwife group, except for one clinical indicator (neonatal ventilation). Overall, this study provides rational support for the process of legalizing midwifery in the province.

  11. Bridging the gap between theory and practice of transmission pricing

    International Nuclear Information System (INIS)

    Hughes, W.R.; Felak, R.

    1996-01-01

    The authors describe some strategies for pricing transmission service. Traditionally, wheeling prices have been postage stamp rates based on the level of megawatt demand; a related approach would assign grid costs to customers based on their respective shares of overall megawatt-miles. Innovative regulators have recently approved transmission rates based on opportunity cost of foregone capacity and the incremental costs of additional capacity needed to enable delivery. Others determined prices designed to reflect short-run congestion costs on the grid. The authors assess these pricing approaches and their effects on the distribution of wealth and economic efficiency for both firm and interruptible services. 3 refs

  12. Effects of Caps on Cost Sharing for Skilled Nursing Facility Services in Medicare Advantage Plans.

    Science.gov (United States)

    Keohane, Laura M; Rahman, Momotazur; Thomas, Kali S; Trivedi, Amal N

    2018-03-12

    To evaluate a federal regulation effective in 2011 that limited how much that Medicare Advantage (MA) plans could charge for the first 20 days of care in a skilled nursing facility (SNF). Difference-in-differences retrospective analysis comparing SNF utilization trends from 2008-2012. Select MA plans. Members of 27 plans with mandatory cost sharing reductions (n=132,000) and members of 21 plans without such reductions (n=138,846). Mean monthly number of SNF admissions and days per 1,000 members; annual proportion of MA enrollees exiting the plan. In plans with mandated cost sharing reductions, cost sharing for the first 20 days of SNF care decreased from an average of $2,039 in 2010 to $992 in 2011. In adjusted analyses, plans with mandated cost-sharing reductions averaged 158.1 SNF days (95% confidence interval (CI)=153.2-163.1 days) per 1,000 members per month before the cost sharing cap. This measure increased by 14.3 days (95% CI=3.8-24.8 days, p=0.009) in the 2 years after cap implementation. However, increases in SNF utilization did not significantly differ between plans with and without mandated cost-sharing reductions (adjusted between-group difference: 7.1 days per 1,000 members, 95% CI=-6.5-20.8, p=.30). Disenrollment patterns did not change after the cap took effect. When a federal regulation designed to protect MA members from high out-of-pocket costs for postacute care took effect, the use of SNF services did not change. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

  13. Service alliances : new oilfield partnership techniques cut costs, put expertise to better use

    International Nuclear Information System (INIS)

    Curran, R.

    1997-01-01

    The co-operative relationship that is needed between service providers and oil companies was discussed. Oil exploration and oil production companies rely on members of the Petroleum Services Association of Canada (PSAC) for a wide range of specialties such as production testing, cementing and well stimulation, wireline data recording and perforating, drilling and completions, specialized trucking, pipe coating and inspection, blowout prevention, coring and tong services. For example, the Dowell division of Schlumberger Canada Ltd. has had long-term alliances with PanCanadian Petroleum Ltd., Chevron Canada Resources, Amoco Canada Petroleum Co., Suncor Energy Inc., Talisman Energy Inc., and Petro-Canada. Both the service providers and the oil companies work collaboratively to determine which processes should be used to achieve cost-cutting efficiency. The exchange of technological ideas is a definite advantage. In much the same manner, the Dominion Supply Co., (DOSCO) provides a wide variety of equipment and supplies to exploration and production firms, drilling contractors, and service contractors in the petroleum industry. 3 figs

  14. Using the simplified case mix tool (sCMT) to identify cost in special care dental services to support commissioning.

    Science.gov (United States)

    Duane, B G; Freeman, R; Richards, D; Crosbie, S; Patel, P; White, S; Humphris, G

    2017-03-01

    To commission dental services for vulnerable (special care) patient groups effectively, consistently and fairly an evidence base is needed of the costs involved. The simplified Case Mixed Tool (sCMT) can assess treatment mode complexity for these patient groups. To determine if the sCMT can be used to identify costs of service provision. Patients (n=495) attending the Sussex Community NHS Trust Special Care Dental Service for care were assessed using the sCMT. sCMT score and costs (staffing, laboratory fees, etc.) besides patient age, whether a new patient and use of general anaesthetic/intravenous sedation. Statistical analysis (adjusted linear regression modelling) compared sCMT score and costs then sensitivity analyses of the costings to age, being a new patient and sedation use were undertaken. Regression tables were produced to present estimates of service costs. Costs increased with sCMT total scale and single item values in a predictable manner in all analyses except for 'cooperation'. Costs increased with the use of IV sedation; with each rising level of the sCMT, and with complexity in every sCMT category, except cooperation. Costs increased with increase in complexity of treatment mode as measured by sCMT scores. Measures such as the sCMT can provide predictions of the resource allocations required when commissioning special care dental services. Copyright© 2017 Dennis Barber Ltd.

  15. Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF) services.

    Science.gov (United States)

    Yildiz, M Said; Khan, M Mahmud

    2016-08-12

    The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and large comparative cost advantage. This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF) in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Package price offered by the dominant IVF-service provider to international patients in Turkey was used as a measure of cost for Turkey while IVF-specific service prices were used to estimate the cost for USA. To compare quality and effectiveness of IVF services, a number of general clinical quality indicators and IVF success rate were used. Indicators of quality, cost and success rate in the Turkish hospital were found to be better than the corresponding indicators in US hospitals. The cost difference of IVF services between USA and Turkey is so significant that the overall cost of obtaining the service from Turkey remains lower even with additional expenses for travel and accommodation. Cost-effectiveness ratio of IVF treatment per successful clinical pregnancy was much lower in Turkey than in the USA. It appears that cost and quality are the two most important factors affecting demand for health care services by international patients in Turkey. Like other important players in the medical tourism market, Turkey should be able to take advantage of its success in IVF, a highly specialized niche market, to transform its health system into an important exporter of general health services.

  16. Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF services

    Directory of Open Access Journals (Sweden)

    M. Said Yildiz

    2016-08-01

    Full Text Available Abstract Background The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and large comparative cost advantage. Methods This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Package price offered by the dominant IVF-service provider to international patients in Turkey was used as a measure of cost for Turkey while IVF-specific service prices were used to estimate the cost for USA. To compare quality and effectiveness of IVF services, a number of general clinical quality indicators and IVF success rate were used. Results Indicators of quality, cost and success rate in the Turkish hospital were found to be better than the corresponding indicators in US hospitals. The cost difference of IVF services between USA and Turkey is so significant that the overall cost of obtaining the service from Turkey remains lower even with additional expenses for travel and accommodation. Conclusions Cost-effectiveness ratio of IVF treatment per successful clinical pregnancy was much lower in Turkey than in the USA. It appears that cost and quality are the two most important factors affecting demand for health care services by international patients in Turkey. Like other important players in the medical tourism market, Turkey should be able to take advantage of its success in IVF, a highly specialized niche market, to transform its health system into an important exporter of general health services.

  17. Maui Smart Grid Demonstration Project Managing Distribution System Resources for Improved Service Quality and Reliability, Transmission Congestion Relief, and Grid Support Functions

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2014-09-30

    The Maui Smart Grid Project (MSGP) is under the leadership of the Hawaii Natural Energy Institute (HNEI) of the University of Hawaii at Manoa. The project team includes Maui Electric Company, Ltd. (MECO), Hawaiian Electric Company, Inc. (HECO), Sentech (a division of SRA International, Inc.), Silver Spring Networks (SSN), Alstom Grid, Maui Economic Development Board (MEDB), University of Hawaii-Maui College (UHMC), and the County of Maui. MSGP was supported by the U.S. Department of Energy (DOE) under Cooperative Agreement Number DE-FC26-08NT02871, with approximately 50% co-funding supplied by MECO. The project was designed to develop and demonstrate an integrated monitoring, communications, database, applications, and decision support solution that aggregates renewable energy (RE), other distributed generation (DG), energy storage, and demand response technologies in a distribution system to achieve both distribution and transmission-level benefits. The application of these new technologies and procedures will increase MECO’s visibility into system conditions, with the expected benefits of enabling more renewable energy resources to be integrated into the grid, improving service quality, increasing overall reliability of the power system, and ultimately reducing costs to both MECO and its customers.

  18. Running Neuroimaging Applications on Amazon Web Services: How, When, and at What Cost?

    Directory of Open Access Journals (Sweden)

    Tara M. Madhyastha

    2017-11-01

    Full Text Available The contribution of this paper is to identify and describe current best practices for using Amazon Web Services (AWS to execute neuroimaging workflows “in the cloud.” Neuroimaging offers a vast set of techniques by which to interrogate the structure and function of the living brain. However, many of the scientists for whom neuroimaging is an extremely important tool have limited training in parallel computation. At the same time, the field is experiencing a surge in computational demands, driven by a combination of data-sharing efforts, improvements in scanner technology that allow acquisition of images with higher image resolution, and by the desire to use statistical techniques that stress processing requirements. Most neuroimaging workflows can be executed as independent parallel jobs and are therefore excellent candidates for running on AWS, but the overhead of learning to do so and determining whether it is worth the cost can be prohibitive. In this paper we describe how to identify neuroimaging workloads that are appropriate for running on AWS, how to benchmark execution time, and how to estimate cost of running on AWS. By benchmarking common neuroimaging applications, we show that cloud computing can be a viable alternative to on-premises hardware. We present guidelines that neuroimaging labs can use to provide a cluster-on-demand type of service that should be familiar to users, and scripts to estimate cost and create such a cluster.

  19. Pursuing cost-effectiveness in mental health service delivery for youth with complex needs.

    Science.gov (United States)

    Grimes, Katherine E; Schulz, Margaret F; Cohen, Steven A; Mullin, Brian O; Lehar, Sophie E; Tien, Shelly

    2011-06-01

    Mental health advocates seek to expand children's services, noting widespread failure to meet the needs of public sector youth suffering from serious emotional disturbance (SED). However, state and national budgets face deepening cuts, with rising health care costs taking the blame. As the gap between needs and finances widens, identification of cost-effective treatments that will benefit children with SED and their families is of increasing importance. Community-based interventions for this population, such as the wraparound approach and systems-of-care, are being disseminated but literature is scant regarding effects on expense. The Mental Health Services Program for Youth (MHSPY) model is aligned philosophically with wraparound and systems-of-care but unique in blending public agency dollars to deliver integrated medical, mental health and social services. MHSPY's linked clinical and expense data is useful to study community-based treatment cost-effectiveness. To examine the cost-effectiveness of an intensively integrated, family and community-based clinical intervention for youth with mental health needs in comparison to "usual care.'' Study and reference populations were matched on age, gender, community, psychiatric diagnosis, morbidity and insurance type. Claims analyses included patterns of service utilization and medical expense for both groups. Using propensity score matching, results for study youth are compared with results for the population receiving "usual care.'' Clinical functioning was measured for the intervention group at baseline and 12 months. The intervention group used lower intensity services and had substantially lower claims expense (e.g. 32% lower for emergency room, 74% lower for inpatient psychiatry) than their matched counterparts in the "usual care'' group. Intervention youth were consistently maintained in least restrictive settings, with over 88% of days spent at home and showed improved clinical functioning on standard measures

  20. Inequity in costs of seeking sexual and reproductive health services in India and Kenya.

    Science.gov (United States)

    Haghparast-Bidgoli, Hassan; Pulkki-Brännström, Anni-Maria; Lafort, Yves; Beksinska, Mags; Rambally, Letitia; Roy, Anuradha; Reza-Paul, Sushena; Ombidi, Wilkister; Gichangi, Peter; Skordis-Worrall, Jolene

    2015-09-15

    This study aims to assess inequity in expenditure on sexual and reproductive health (SRH) services in India and Kenya. In addition, this analysis aims to measure the extent to which payments are catastrophic and to explore coping mechanisms used to finance health spending. Data for this study were collected as a part of the situational analysis for the "Diagonal Interventions to Fast Forward Enhanced Reproductive Health" (DIFFER) project, a multi-country project with fieldwork sites in three African sites; Mombasa (Kenya), Durban (South Africa) and Tete (Mozambique), and Mysore in India. Information on access to SRH services, the direct costs of seeking care and a range of socio-economic variables were obtained through structured exit interviews with female SRH service users in Mysore (India) and Mombasa (Kenya) (n = 250). The costs of seeking care were analysed by household income quintile (as a measure of socio-economic status). The Kakwani index and quintile ratios are used as measures of inequitable spending. Catastrophic spending on SRH services was calculated using the threshold of 10% of total household income. The results showed that spending on SRH services was highly regressive in both sites, with lower income households spending a higher percentage of their income on seeking care, compared to households with a higher income. Spending on SRH as a percentage of household income ranged from 0.02 to 6.2% and 0.03-7.5% in India and Kenya, respectively. There was a statistically significant difference in the proportion of spending on SRH services across income quintiles in both settings. In India, the poorest households spent two times, and in Kenya ten times, more on seeking care than the least poor households. The most common coping mechanisms in India and Kenya were "receiving [money] from partner or household members" (69%) and "using own savings or regular income" (44%), respectively. Highly regressive spending on SRH services highlights the heavier

  1. Design of a Multiobjective Reverse Logistics Network Considering the Cost and Service Level

    Directory of Open Access Journals (Sweden)

    Shuang Li

    2012-01-01

    Full Text Available Reverse logistics, which is induced by various forms of used products and materials, has received growing attention throughout this decade. In a highly competitive environment, the service level is an important criterion for reverse logistics network design. However, most previous studies about product returns only focused on the total cost of the reverse logistics and neglected the service level. To help a manufacturer of electronic products provide quality postsale repair service for their consumer, this paper proposes a multiobjective reverse logistics network optimisation model that considers the objectives of the cost, the total tardiness of the cycle time, and the coverage of customer zones. The Nondominated Sorting Genetic Algorithm II (NSGA-II is employed for solving this multiobjective optimisation model. To evaluate the performance of NSGA-II, a genetic algorithm based on weighted sum approach and Multiobjective Simulated Annealing (MOSA are also applied. The performance of these three heuristic algorithms is compared using numerical examples. The computational results show that NSGA-II outperforms MOSA and the genetic algorithm based on weighted sum approach. Furthermore, the key parameters of the model are tested, and some conclusions are drawn.

  2. Women's decision-making and uptake of services to prevent mother-to-child HIV transmission in Zambia.

    Science.gov (United States)

    Ford, Catherine; Chibwesha, Carla J; Winston, Jennifer; Jacobs, Choolwe; Lubeya, Mwansa Ketty; Musonda, Patrick; Stringer, Jeffrey S A; Chi, Benjamin H

    2018-04-01

    Women's empowerment is associated with engagement in some areas of healthcare, but its role in prevention of mother-to-child HIV transmission (PMTCT) services has not been previously considered. In this secondary analysis, we investigated the association of women's decision-making and uptake of health services for PMTCT. Using data from population-based household surveys, we included women who reported delivery in the 2-year period prior to the survey and were HIV-infected. We measured a woman's self-reported role in decision-making in her own healthcare, making of large purchases, schooling of children, and healthcare for children. For each domain, respondents were categorized as having an "active" or "no active" role. We investigated associations between decision-making and specific steps along the PMTCT cascade: uptake of maternal antiretroviral drugs, uptake of infant HIV prophylaxis, and infant HIV testing. We calculated unadjusted and adjusted odds ratios via logistic regression. From March to December 2011, 344 HIV-infected mothers were surveyed and 276 completed the relevant survey questions. Of these, 190 (69%) took antiretroviral drugs during pregnancy; 175 (64%) of their HIV-exposed infants received antiretroviral prophylaxis; and 160 (58%) had their infant tested for HIV. There was no association between decision-making and maternal or infant antiretroviral drug use. We observed a significant association between decision-making and infant HIV testing in univariate analyses (OR 1.56-1.85; p women who reported an active role in decision-making trended toward a higher likelihood of uptake of infant testing in the PMTCT cascade. Larger studies are needed to evaluate the impact of empowerment initiatives on the PMTCT service utilization overall and infant testing in particular.

  3. A mathematical model of Clostridium difficile transmission in medical wards and a cost-effectiveness analysis comparing different strategies for laboratory diagnosis and patient isolation.

    Directory of Open Access Journals (Sweden)

    Vered Schechner

    Full Text Available Clostridium difficile infection (CDI is a common and potentially fatal healthcare-associated infection. Improving diagnostic tests and infection control measures may prevent transmission. We aimed to determine, in resource-limited settings, whether it is more effective and cost-effective to allocate resources to isolation or to diagnostics.We constructed a mathematical model of CDI transmission based on hospital data (9 medical wards, 350 beds between March 2010 and February 2013. The model consisted of three compartments: susceptible patients, asymptomatic carriers and CDI patients. We used our model results to perform a cost-effectiveness analysis, comparing four strategies that were different combinations of 2 test methods (the two-step test and uniform PCR and 2 infection control measures (contact isolation in multiple-bed rooms or single-bed rooms/cohorting. For each strategy, we calculated the annual cost (of CDI diagnosis and isolation for a decrease of 1 in the average daily number of CDI patients; the strategy of the two-step test and contact isolation in multiple-bed rooms was the reference strategy.Our model showed that the average number of CDI patients increased exponentially as the transmission rate increased. Improving diagnosis by adopting uniform PCR assay reduced the average number of CDI cases per day per 350 beds from 9.4 to 8.5, while improving isolation by using single-bed rooms reduced the number to about 1; the latter was cost saving.CDI can be decreased by better isolation and more sensitive laboratory methods. From the hospital perspective, improving isolation is more cost-effective than improving diagnostics.

  4. A mathematical model of Clostridium difficile transmission in medical wards and a cost-effectiveness analysis comparing different strategies for laboratory diagnosis and patient isolation.

    Science.gov (United States)

    Schechner, Vered; Carmeli, Yehuda; Leshno, Moshe

    2017-01-01

    Clostridium difficile infection (CDI) is a common and potentially fatal healthcare-associated infection. Improving diagnostic tests and infection control measures may prevent transmission. We aimed to determine, in resource-limited settings, whether it is more effective and cost-effective to allocate resources to isolation or to diagnostics. We constructed a mathematical model of CDI transmission based on hospital data (9 medical wards, 350 beds) between March 2010 and February 2013. The model consisted of three compartments: susceptible patients, asymptomatic carriers and CDI patients. We used our model results to perform a cost-effectiveness analysis, comparing four strategies that were different combinations of 2 test methods (the two-step test and uniform PCR) and 2 infection control measures (contact isolation in multiple-bed rooms or single-bed rooms/cohorting). For each strategy, we calculated the annual cost (of CDI diagnosis and isolation) for a decrease of 1 in the average daily number of CDI patients; the strategy of the two-step test and contact isolation in multiple-bed rooms was the reference strategy. Our model showed that the average number of CDI patients increased exponentially as the transmission rate increased. Improving diagnosis by adopting uniform PCR assay reduced the average number of CDI cases per day per 350 beds from 9.4 to 8.5, while improving isolation by using single-bed rooms reduced the number to about 1; the latter was cost saving. CDI can be decreased by better isolation and more sensitive laboratory methods. From the hospital perspective, improving isolation is more cost-effective than improving diagnostics.

  5. Case-mix tool, costs and effectiveness in improving primary care mental health and substance abuse services.

    Science.gov (United States)

    Riihimäki, Kirsi; Heiska-Johansson, Ainomaija; Ketola, Eeva

    2018-02-01

    Despite its importance in improving care and developing services, high-quality data evaluating cost-effectiveness and services in different case-mix populations is scarce in primary care. The objective was to investigate the service use of those mental health and substance abuse patients, who use lots of services. Primary health care diagnosis-related groups (pDRG) is a tool to evaluate service provider system and improve efficiency, productivity and quality. We viewed all pDRG results available from the year 2015 concerning municipal mental health and substance abuse services. In primary care mental health and substance abuse services, the most common ICD-10-codes were depression and substance abuse. One-fifth of patients produced 57% of costs. Their medium of appointments was 16 per year versus 6 per year of all patients. Only 54% of their diagnoses were recorded in the electronic health records versus 75% of all patients. They made 5.7 different pDRG episodes, including 1.8 episodes of depression, per patient. The average episode cost for this patient group was 301€. pDRG makes health care production transparent also in mental health and substance abuse services. It is easy to identify patients, who use a lot of services and thus induce the majority of costs, and focus on their needs in managing and developing services.

  6. Regional Transmission Projects: Finding Solutions

    Energy Technology Data Exchange (ETDEWEB)

    The Keystone Center

    2005-06-15

    The Keystone Center convened and facilitated a year-long Dialogue on "Regional Transmission Projects: Finding Solutions" to develop recommendations that will help address the difficult and contentious issues related to expansions of regional electric transmission systems that are needed for reliable and economic transmission of power within and across regions. This effort brought together a cross-section of affected stakeholders and thought leaders to address the problem with the collective wisdom of their experience and interests. Transmission owners sat at the table with consumer advocates and environmental organizations. Representatives from regional transmission organizations exchanged ideas with state and federal regulators. Generation developers explored common interests with public power suppliers. Together, the Dialogue participants developed consensus solutions about how to begin unraveling some of the more intractable issues surrounding identification of need, allocation of costs, and reaching consensus on siting issues that can frustrate the development of regional transmission infrastructure. The recommendations fall into three broad categories: 1. Recommendations on appropriate institutional arrangements and processes for achieving regional consensus on the need for new or expanded transmission infrastructure 2. Recommendations on the process for siting of transmission lines 3. Recommendations on the tools needed to support regional planning, cost allocation, and siting efforts. List of Dialogue participants: List of Dialogue Participants: American Electric Power American Transmission Company American Wind Energy Association California ISO Calpine Corporation Cinergy Edison Electric Institute Environmental Defense Federal Energy Regulatory Commission Great River Energy International Transmission Company ISO-New England Iowa Public Utility Board Kanner & Associates Midwest ISO National Association of Regulatory Utility Commissioners National Association

  7. Study of the full-service and low-cost carriers network configuration

    Directory of Open Access Journals (Sweden)

    Oriol Lordan

    2014-10-01

    Full Text Available Purpose: The network strategies used by airline carriers have been a recurring subject in air transport research. The aim of this paper is to investigate the relationship between the different operational characteristics of the airline and its route network configuration. Design/methodology/approach: The two main airline carrier typologies - Full-Service and Low-Cost carriers – are analysed using empirical models developed on complex network research relating them to the business model of the airlines. Findings and Originality/value: Just in Europe, one can differentiate between Full-Service and Low-Cost Carriers by complex network analyses. In this process, it has been also found that new concept Low-Cost Carriers, such as Vueling, have network properties closer to Full-Service Carriers. Research limitations/implications: This paper has a limited sample, as includes 26 airline case studies from Europe, United States and Asia. Practical implications: The analysis carried out in this research can help to the assessment of the evolution of the strategies of airline carriers, and has also operational implications, since the configuration of an airline route network can determine its resilience to attacks and errors. Social implications: A better understanding of the properties of airline route networks can benefit airlines, passengers and another stakeholders of the air transport industry. Originality/value: Current research on air transport networks has only considered the global or regional level, but few studies have addressed the study of airline transport networks, and its relationship with their business model.

  8. An estimated cost of lost climate regulation services caused by thawing of the Arctic cryosphere.

    Science.gov (United States)

    Euskirchen, Eugénie S; Goodstein, Eban S; Huntington, Henry P

    2013-12-01

    Recent and expected changes in Arctic sea ice cover, snow cover, and methane emissions from permafrost thaw are likely to result in large positive feedbacks to climate warming. There is little recognition of the significant loss in economic value that the disappearance of Arctic sea ice, snow, and permafrost will impose on humans. Here, we examine how sea ice and snow cover, as well as methane emissions due to changes in permafrost, may potentially change in the future, to year 2100, and how these changes may feed back to influence the climate. Between 2010 and 2100, the annual costs from the extra warming due to a decline in albedo related to losses of sea ice and snow, plus each year's methane emissions, cumulate to a present value cost to society ranging from US$7.5 trillion to US$91.3 trillion. The estimated range reflects uncertainty associated with (1) the extent of warming-driven positive climate feedbacks from the thawing cryosphere and (2) the expected economic damages per metric ton of CO2 equivalents that will be imposed by added warming, which depend, especially, on the choice of discount rate. The economic uncertainty is much larger than the uncertainty in possible future feedback effects. Nonetheless, the frozen Arctic provides immense services to all nations by cooling the earth's temperature: the cryosphere is an air conditioner for the planet. As the Arctic thaws, this critical, climate-stabilizing ecosystem service is being lost. This paper provides a first attempt to monetize the cost of some of those lost services.

  9. Extended benefit cost analysis as an instrument of economic valuated in Petungkriyono forest ecosystem services

    Science.gov (United States)

    Damayanti, Irma; Nur Bambang, Azis; Retnaningsih Soeprobowati, Tri

    2018-05-01

    Petungkriyono is the last tropical forest in Java and provides biodiversity including rare flora and fauna that must be maintained, managed and utilized in order to give meaning for humanity and sustainability. Services of Forest Ecosystem in Petungkriyono are included such as goods supply, soil-water conservation, climate regulation, purification environment and flora fauna habitats. The approach of this study is the literature review from various studies before perceiving the influenced of economic valuation in determining the measurement conservation strategies of Petungkriyono Natural Forest Ecosystem in Pekalongan Regency. The aims of this study are to analyzing an extended benefit cost of natural forest ecosystems and internalizing them in decision making. The method of quantification and valuation of forest ecosystem is Cost and Benefit Analysis (CBA) which is a standard economic appraisal tools government in development economics. CBA offers the possibility capturing impact of the project. By using productivity subtitution value and extended benefit cost analysis any comodity such as Backwoods,Pine Woods, Puspa woods and Pine Gum. Water value, preventive buildings of landslide and carbon sequestration have total economic value of IDR.163.065.858.080, and the value of Extended Benefit Cost Ratio in Petungkriyono is 281.35 %. However, from the result is expected the local government of Pekalongan to have high motivation in preserve the existence of Petungkriyono forest.

  10. Access, equity and costs of induced abortion services in Australia: a cross-sectional study.

    Science.gov (United States)

    Shankar, Mridula; Black, Kirsten I; Goldstone, Philip; Hussainy, Safeera; Mazza, Danielle; Petersen, Kerry; Lucke, Jayne; Taft, Angela

    2017-06-01

    To examine access and equity to induced abortion services in Australia, including factors associated with presenting beyond nine weeks gestation. Cross-sectional survey of 2,326 women aged 16+ years attending for an abortion at 14 Dr Marie clinics. Associations with later presentation assessed using multivariate logistic regression. Over a third of eligible women opted for a medical abortion. More than one in 10 (11.2%) stayed overnight. The median Medicare rebated upfront cost of a medical abortion was $560, compared to $470 for a surgical abortion at ≤9 weeks. Beyond 12 weeks, costs rose considerably. More than two-thirds (68.1%) received financial assistance from one or more sources. Women who travelled ≥4 hours (AdjOR: 3.0, 95%CI 1.2-7.3), had no prior knowledge of the medical option (AdjOR: 2.1, 95%CI 1.4-3.1), had difficulty paying (AdjOR: 1.5, 95%CI 1.2-1.9) and identified as Aboriginal and/or Torres Strait Islander (AdjOR: 2.1, 95%CI 1.2-3.4) were more likely to present ≥9 weeks. Abortion costs are substantial, increase at later gestations, and are a financial strain for many women. Poor knowledge, geographical and financial barriers restrict method choice. Implications for public health: Policy reform should focus on reducing costs and enhancing early access. © 2017 The Authors.

  11. Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana.

    Science.gov (United States)

    VanDeusen, Adam; Paintsil, Elijah; Agyarko-Poku, Thomas; Long, Elisa F

    2015-03-18

    Achieving the goal of eliminating mother-to-child HIV transmission (MTCT) necessitates increased access to antiretroviral therapy (ART) for HIV-infected pregnant women. Option B provides ART through pregnancy and breastfeeding, whereas Option B+ recommends continuous ART regardless of CD4 count, thus potentially reducing MTCT during future pregnancies. Our objective was to compare maternal and pediatric health outcomes and cost-effectiveness of Option B+ versus Option B in Ghana. A decision-analytic model was developed to simulate HIV progression in mothers and transmission (in utero, during birth, or through breastfeeding) to current and all future children. Clinical parameters, including antenatal care access and fertility rates, were estimated from a retrospective review of 817 medical records at two hospitals in Ghana. Additional parameters were obtained from published literature. Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios. HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3). Projected maternal life expectancy under Option B+ is 16.1 years, versus 16.0 years with Option B, yielding a gain of 0.1 maternal QALYs and 3.2 additional QALYs per child. Despite higher initial ART costs, Option B+ costs $785/QALY gained, a value considered very cost-effective by World Health Organization benchmarks. Widespread implementation of Option B+ in Ghana could theoretically prevent up to 668 HIV infections among children annually. Cost-effectiveness estimates remained favorable over robust sensitivity analyses. Although more expensive than Option B, Option B+ substantially reduces MTCT in future pregnancies, increases both maternal and pediatric QALYs, and is a cost-effective use of limited resources in Ghana.

  12. Delivering an effective outpatient service in gynaecology. A randomised controlled trial analysing the cost of outpatient versus daycase hysteroscopy.

    Science.gov (United States)

    Marsh, Fiona; Kremer, Christian; Duffy, Sean

    2004-03-01

    To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer. Randomised controlled trial. The gynaecology clinic of a large teaching hospital. Ninety-seven women with abnormal uterine bleeding requiring investigation. Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy. Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses. The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P Service approximately pound 53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service. Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.

  13. A Low-Cost Remote Lab for Internet Services Distance Education

    Directory of Open Access Journals (Sweden)

    James Sissom

    2006-08-01

    Full Text Available Academic departments seeking to reach students via distance education course offerings find that some on-line curricula require a traditional hands-on lab model for student evaluation and assessment. The authors solve the problem of providing distance education curriculum and supporting instruction lab components by using a low-cost remote lab. The remote lab is used to evaluate student performance in managing web services and website development, solving security problems, patch management, scripting and web server management. In addition, the authors discuss assessment and evaluation techniques that will be used to determine instructional quality and student performance. Discussed are the remote lab architecture, use of disk images and utilization of Windows 2003 Internet Information Service, and Linux Red Hat 9.0 platforms.

  14. Quantifying Queensland patients with cancer health service usage and costs: study protocol.

    Science.gov (United States)

    Callander, Emily; Topp, Stephanie M; Larkins, Sarah; Sabesan, Sabe; Bates, Nicole

    2017-01-24

    The overall mortality rate for cancer has declined in Australia. However, socioeconomic inequalities exist and the out-of-pocket costs incurred by patients in Australia are high compared with some European countries. There is currently no readily available data set to provide a systematic means of measuring the out-of-pocket costs incurred by patients with cancer within Australia. The primary aim of the project is to quantify the direct out-of-pocket healthcare expenditure of individuals in the state of Queensland, who are diagnosed with cancer. This project will build Australia's first model (called CancerCostMod) of out-of-pocket healthcare expenditure of patients with cancer using administrative data from Queensland Cancer Registry, for all individuals diagnosed with any cancer in Queensland between 1 July 2011 and 30 June 2012, linked to their Admitted Patient Data Collection, Emergency Department Information System, Medicare Benefits Schedule and Pharmaceutical Benefits Scheme records from 1 July 2011 to 30 June 2015. No identifiable information will be provided to the authors. The project will use a combination of linear and logistic regression modelling, Cox proportional hazards modelling and machine learning to identify differences in survival, total health system expenditure, total out-of-pocket expenditure and high out-of-pocket cost patients, adjusting for demographic and clinical confounders, and income group, Indigenous status and geographic location. Results will be analysed separately for different types of cancer. Human Research Ethics approval has been obtained from the Townsville Hospital and Health Service Human Research Ethics Committee (HREC/16/QTHS/110) and James Cook University Human Research Ethics Committee (H6678). Permission to waive consent has been sought from Queensland Health under the Public Health Act 2005. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  15. Business Service Outsourcing: An Evolution of Concentration on Core Business Concepts and Transaction Cost Economies

    Directory of Open Access Journals (Sweden)

    Ahmad H. Juma'h

    2000-08-01

    Full Text Available Present and evaluate the literature with respect to business service outsourcing (BSO, with a particular concentration on a common form of BSO, information technology (IT. The review defines the issues with respect to BSO in terms of drivers and motivations, as well as internal and external implications for BSO companies and their contractors. BSO is an evolution of transaction cost theory and concentration on core business concepts. Although, there are several attempts to explain when a company should outsource, these theoretical frameworks are difficult to apply in practice since satisfaction is a function of expectation and the identification of activities are core commodity is not straightforward.

  16. Using community partners to deliver low-cost and effective emergency management and business continuity services.

    Science.gov (United States)

    Thomas, Joan; Roggiero, Jean Paul; Silva, Brian

    2010-11-01

    Small to medium-sized organisations enhance their business mission as well as their communities by continuing to offer services in extreme circumstances. Developing emergency preparedness and business continuity plans that are cost-effective, comprehensive and operational for small to medium-sized organisations with limited resources requires a consistent, supportive, hands-on approach over time with professionals to create appropriate and sustainable strategies. Using a unique, multi-layered and applied approach to emergency preparedness training, organisations have successfully created plans that are effective and sustainable.

  17. The Costs of Container Transport Flow Between Far East and Serbia Using Different Liner Shipping Services

    Directory of Open Access Journals (Sweden)

    Rajkovic Radoslav

    2015-11-01

    Full Text Available Liner shipping is the most efficient mode of transport for goods. International liner shipping is a sophisticated network of regularly scheduled services that transports goods from anywhere in the world to anywhere in the world at low cost and with greater energy efficiency than any other form of international transportation. Liner shipping connects countries, markets, businesses and people, allowing them to buy and sell goods on a scale not previously possible. Today, the liner shipping industry transports goods representing approximately one-third of the total value of global trade. Ocean shipping contributes significantly to international stability and security. Considering the large and constant struggle in the market in terms of competitive pricing of products, a very important and indispensable role represents the container transport with a clear task to define the final price of the product. This paper analyzes the costs of container transport flow between Far East and Serbia, using different liner shipping services, observing the six world’s largest container operators (Maersk Line, Mediterranean Shipping Company, CMA CGM, Evergreen Line, China Ocean Shipping Company and Hapag-Lloyd and inland (truck-rail-river transport corridors. These corridors include distance between selected Mediterranean ports (Koper, Rijeka, Bar, Thessaloniki, Constanta and Serbia. As a result, in this paper is considered a mathematical model that provides a comparative analysis of transportation costs on the different routes. It is observed already existing transport routes and it is also given hypothetical review to the development of new transport routes. The main goal of this research is to provide an optimal route with lowest transportation cost during container transport. Selection of the best route in the intermodal network is a very difficult and complex task. The costs in all modes of transport and the quality of their services are not constant

  18. 76 FR 49762 - FirstEnergy Service Co. v. Midwest Independent Transmission System Operator, Inc.; Notice of...

    Science.gov (United States)

    2011-08-11

    ... declaratory order asking that the Commission declare that Multi-Value Project (MVP) transmission usage charges... unreasonable to apply MVP transmission usage charges to FirstEnergy or its customers migrated from the Midwest...

  19. The cost determinants of routine infant immunization services: a meta-regression analysis of six country studies.

    Science.gov (United States)

    Menzies, Nicolas A; Suharlim, Christian; Geng, Fangli; Ward, Zachary J; Brenzel, Logan; Resch, Stephen C

    2017-10-06

    Evidence on immunization costs is a critical input for cost-effectiveness analysis and budgeting, and can describe variation in site-level efficiency. The Expanded Program on Immunization Costing and Financing (EPIC) Project represents the largest investigation of immunization delivery costs, collecting empirical data on routine infant immunization in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. We developed a pooled dataset from individual EPIC country studies (316 sites). We regressed log total costs against explanatory variables describing service volume, quality, access, other site characteristics, and income level. We used Bayesian hierarchical regression models to combine data from different countries and account for the multi-stage sample design. We calculated output elasticity as the percentage increase in outputs (service volume) for a 1% increase in inputs (total costs), averaged across the sample in each country, and reported first differences to describe the impact of other predictors. We estimated average and total cost curves for each country as a function of service volume. Across countries, average costs per dose ranged from $2.75 to $13.63. Average costs per child receiving diphtheria, tetanus, and pertussis ranged from $27 to $139. Within countries costs per dose varied widely-on average, sites in the highest quintile were 440% more expensive than those in the lowest quintile. In each country, higher service volume was strongly associated with lower average costs. A doubling of service volume was associated with a 19% (95% interval, 4.0-32) reduction in costs per dose delivered, (range 13% to 32% across countries), and the largest 20% of sites in each country realized costs per dose that were on average 61% lower than those for the smallest 20% of sites, controlling for other factors. Other factors associated with higher costs included hospital status, provision of outreach services, share of effort to management, level of staff training

  20. Tricks and Clicks: How Low-Cost Carriers Ply Their Trade Through Self-Service Websites

    Science.gov (United States)

    Barry, Chris; Torres, Ann M.

    Ethics on the Internet has been a widely debated topic in recent years covering issues that range from privacy to security to fraud. Little, however, has been written on more subtle ethical questions, such as the exploitation of web technologies to inhibit or avoid customer service. Increasingly some firms are using websites to create distance between them and their customer base in specific areas of their operations, while simultaneously developing excellence in sales transaction committal via self-service. This chapter takes a magnifying glass with an ethical lens to one sector - the low-cost, web-based, self-service airline industry, specifically in Ireland. It is noted that the teaching of information systems development (ISD) and, for the most part its practice, assumes ethicality. Similarly, marketing courses focus on satisfying customer needs more effectively and efficiently within the confines of an acceptable ethos. This chapter observes that while these business disciplines are central to the success of self-service websites, there is a disconnect between the normative view and the actuality of practice.

  1. From Polluter Pays to Provider Gets: Distribution of Rights and Costs under Payments for Ecosystem Services

    Directory of Open Access Journals (Sweden)

    Volker Mauerhofer

    2013-12-01

    Full Text Available Should society have the right to freely available clean air and water, or should people be required to pay for these as commodities just as they do for many other goods or services that they consume? With this question and further questions on environmental governance in mind, we reviewed the paradigm shift in natural resource management from the polluter pays principle (PPP, which focuses on polluters and enforcement of thresholds, to the principle of payments for ecosystem services (PES, which emphasizes provider-based economic approaches. Given that there are conflicts of interest over natural resources and ecosystem services (ESs, these conflicts could be resolved through rights and/or cost assignments via third-party intervention, i.e., by the "state," or through private compensation beyond initial regulation and state-initiated assignments of cost. Our analysis includes an in-depth literature review and a description of existing policies on ESs. We also examine the so-called Coase theorem based on a "neutral" situation where no rights or costs are distributed in advance. This theorem provides room for the PPP approaches and the provider-gets approaches. Both of these approaches should ensure, given certain assumptions, an economically efficient allocation of resources; however, they still ignore two indispensable issues, namely, the ecologically sustainable scale and inherent qualities of ecosystems and the distributional effects. With regard to the relationship between these two sets of approaches and their respective relationship to the legal framework, PES programs can evolve instead of PPP where no regulations are in place, existing regulations are deemed to be insufficiently formulated, or regulations are not enforced at all. We also further address some critical issues that can arise when PES programs evolve instead of PPP in practice, such as the general necessity of PES to coexist with basic rights and legal obligations

  2. Estimating the costs of the vaccine supply chain and service delivery for selected districts in Kenya and Tanzania.

    Science.gov (United States)

    Mvundura, Mercy; Lorenson, Kristina; Chweya, Amos; Kigadye, Rosemary; Bartholomew, Kathryn; Makame, Mohammed; Lennon, T Patrick; Mwangi, Steven; Kirika, Lydia; Kamau, Peter; Otieno, Abner; Murunga, Peninah; Omurwa, Tom; Dafrossa, Lyimo; Kristensen, Debra

    2015-05-28

    Having data on the costs of the immunization system can provide decision-makers with information to benchmark the costs when evaluating the impact of new technologies or programmatic innovations. This paper estimated the supply chain and immunization service delivery costs and cost per dose in selected districts in Kenya and Tanzania. We also present operational data describing the supply chain and service delivery points (SDPs). To estimate the supply chain costs, we collected resource-use data for the cold chain, distribution system, and health worker time and per diems paid. We also estimated the service delivery costs, which included the time cost of health workers to provide immunization services, and per diems and transport costs for outreach sessions. Data on the annual quantities of vaccines distributed to each facility, and the occurrence and duration of stockouts were collected from stock registers. These data were collected from the national store, 2 regional and 4 district stores, and 12 SDPs in each country for 2012. Cost per dose for the supply chain and immunization service delivery were estimated. The average annual costs per dose at the SDPs were $0.34 (standard deviation (s.d.) $0.18) for Kenya when including only the vaccine supply chain costs, and $1.33 (s.d. $0.82) when including immunization service delivery costs. In Tanzania, these costs were $0.67 (s.d. $0.35) and $2.82 (s.d. $1.64), respectively. Both countries experienced vaccine stockouts in 2012, bacillus Calmette-Guérin vaccine being more likely to be stocked out in Kenya, and oral poliovirus vaccine in Tanzania. When stockouts happened, they usually lasted for at least one month. Tanzania made investments in 2011 in preparation for planned vaccine introductions, and their supply chain cost per dose is expected to decline with the new vaccine introductions. Immunization service delivery costs are a significant portion of the total costs at the SDPs. Copyright © 2015 Elsevier Ltd. All

  3. The Potential Cost Effectiveness of Different Dengue Vaccination Programmes in Malaysia: A Value-Based Pricing Assessment Using Dynamic Transmission Mathematical Modelling.

    Science.gov (United States)

    Shafie, Asrul Akmal; Yeo, Hui Yee; Coudeville, Laurent; Steinberg, Lucas; Gill, Balvinder Singh; Jahis, Rohani; Amar-Singh Hss

    2017-05-01

    Dengue disease poses a great economic burden in Malaysia. This study evaluated the cost effectiveness and impact of dengue vaccination in Malaysia from both provider and societal perspectives using a dynamic transmission mathematical model. The model incorporated sensitivity analyses, Malaysia-specific data, evidence from recent phase III studies and pooled efficacy and long-term safety data to refine the estimates from previous published studies. Unit costs were valued in $US, year 2013 values. Six vaccination programmes employing a three-dose schedule were identified as the most likely programmes to be implemented. In all programmes, vaccination produced positive benefits expressed as reductions in dengue cases, dengue-related deaths, life-years lost, disability-adjusted life-years and dengue treatment costs. Instead of incremental cost-effectiveness ratios (ICERs), we evaluated the cost effectiveness of the programmes by calculating the threshold prices for a highly cost-effective strategy [ICER price of $US32.39 for programme 6 (highly cost effective up to $US14.15) and up to a price of $US100.59 for programme 1 (highly cost effective up to $US47.96) from the provider perspective. The cost-effectiveness analysis is sensitive to under-reporting, vaccine protection duration and model time horizon. Routine vaccination for a population aged 13 years with a catch-up cohort aged 14-30 years in targeted hotspot areas appears to be the best-value strategy among those investigated. Dengue vaccination is a potentially good investment if the purchaser can negotiate a price at or below the cost-effective threshold price.

  4. Literature review of the passenger airline business models : Full service carrier, low-cost carrier and charter airlines

    NARCIS (Netherlands)

    Carmona Benitez, R.B.; Lodewijks, G.

    2008-01-01

    The deregulation and liberalization of the air transportation industry have developed three main passenger business models: full service carriers, low-cost carriers, and charter airlines. Deregulation removed regulated fares and routes increasing competition and yields. Airlines business models main

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

    Science.gov (United States)

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

    2016-01-01

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

  6. Understanding Consumer Preference Between Low Cost Airlines and Full Service Carriers : A Study on Consumer Choice and Decisions

    OpenAIRE

    Lee, Alex Hoong Onn

    2008-01-01

    The emergence of low cost or no frills airlines in last decade or so have posed considerable threat to the businesses of traditional full service airlines. The competition between the different type of airlines have changed the landscape of the airline industry tremendously and have provided air travelers with options which are unprecedented. The aim of this study is to understand consumer preference between low cost and full service airlines and to determine what are the motivations or facto...

  7. Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF) services

    OpenAIRE

    Yildiz, M. Said; Khan, M. Mahmud

    2016-01-01

    Abstract Background The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and large comparative cost advantage. Methods This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF) in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Packa...

  8. 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.

  9. 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)

  10. 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.

  11. Benchmarking the cost efficiency of community care in Australian child and adolescent mental health services: implications for future benchmarking.

    Science.gov (United States)

    Furber, Gareth; Brann, Peter; Skene, Clive; Allison, Stephen

    2011-06-01

    The purpose of this study was to benchmark the cost efficiency of community care across six child and adolescent mental health services (CAMHS) drawn from different Australian states. Organizational, contact and outcome data from the National Mental Health Benchmarking Project (NMHBP) data-sets were used to calculate cost per "treatment hour" and cost per episode for the six participating organizations. We also explored the relationship between intake severity as measured by the Health of the Nations Outcome Scales for Children and Adolescents (HoNOSCA) and cost per episode. The average cost per treatment hour was $223, with cost differences across the six services ranging from a mean of $156 to $273 per treatment hour. The average cost per episode was $3349 (median $1577) and there were significant differences in the CAMHS organizational medians ranging from $388 to $7076 per episode. HoNOSCA scores explained at best 6% of the cost variance per episode. These large cost differences indicate that community CAMHS have the potential to make substantial gains in cost efficiency through collaborative benchmarking. Benchmarking forums need considerable financial and business expertise for detailed comparison of business models for service provision.

  12. Environmental costs os service sector and new economy; Los costes ambientales del sector servicios y la nueva economia: entre la desmaterializacion y efecto rebote

    Energy Technology Data Exchange (ETDEWEB)

    Carpintero, O.

    2003-07-01

    The growing size of the service sector in developed countries and the recent emergence of the new economy have contributed to extend a controversial message: the service sector and the Information and Communications Technologies (ICTs) are less intensive in energy and materials use than industrial and agricultural activities. then, it is possible to maintain the current pattern of economic growth without taking into account its environmental costs. This paper explores the truthfulness, of those arguments, paying particular attention to some empirical evidences. These facts invite to caution when it comes to evaluating the green influence of ICTs in the reduction of the environmental costs of industrial economies. (Author)

  13. Comparative cost-effectiveness of Option B+ for prevention of mother to child transmission of HIV in Malawi: Mathematical modelling study

    Science.gov (United States)

    Tweya, Hannock; Keiser, Olivia; Haas, Andreas D.; Tenthani, Lyson; Phiri, Sam; Egger, Matthias; Estill, Janne

    2016-01-01

    Objective To estimate the cost-effectiveness of prevention of mother to child transmission (MTCT) of HIV with lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (‘Option B+’) compared to ART during pregnancy or breastfeeding only unless clinically indicated (‘Option B’). Design Mathematical modelling study of first and second pregnancy, informed by data from the Malawi Option B+ programme. Methods Individual-based simulation model. We simulated cohorts of 10,000 women and their infants during two subsequent pregnancies, including the breastfeeding period, with either Option B+ or B. We parameterised the model with data from the literature and by analysing programmatic data. We compared total costs of ante-natal and post-natal care, and lifetime costs and disability-adjusted life-years (DALYs) of the infected infants between Option B+ and Option B. Results During the first pregnancy, 15% of the infants born to HIV-infected mothers acquired the infection. With Option B+, 39% of the women were on ART at the beginning of the second pregnancy, compared to 18% with Option B. For second pregnancies, the rates MTCT were 11.3% with Option B+ and 12.3% with Option B. The incremental cost-effectiveness ratio comparing the two options ranged between about US$ 500 and US$ 1300 per DALY averted. Conclusion Option B+ prevents more vertical transmissions of HIV than Option B, mainly because more women are already on ART at the beginning of the next pregnancy. Option B+ is a cost-effective strategy for PMTCT if the total future costs and lost lifetime of the infected infants are taken into account. PMID:26691682

  14. Less wireless costs : optimizing firms aim to cut wireless service bills

    International Nuclear Information System (INIS)

    Mahony, J.

    2006-01-01

    The Calgary-based firm Alliance is offering optimized billing to oil companies, many of which spend more than $100,000 a month on wireless services for devices such as cellular telephones, pagers and Blackberries. In particular, Alliance is focusing on cutting the cost of wireless for corporate clients by analyzing client-usage patterns and choosing the most cost-efficient rate plans offered by the telecoms. Alliance suggests that do-it-yourself optimization is too complex for the average user, given the very large choice of rate plans. Using algorithms, Alliance software goes through all the wireless service contract options from the telecoms to choose the best plan for a company's needs. Optimizers claim their clients will see significant savings on wireless, in the order to 20 to 50 per cent. This article presented a brief case history of a successful optimization plan for Nabors Canada LP. Alliance allows its clients to view their billing information on their web-based server. Call records can be viewed by device or company division. 1 ref., 1 fig

  15. Service utilisation and costs of language impairment in children: The early language in Victoria Australian population-based study.

    Science.gov (United States)

    Le, Ha N D; Gold, Lisa; Mensah, Fiona; Eadie, Patricia; Bavin, Edith L; Bretherton, Lesley; Reilly, Sheena

    2017-08-01

    To examine (1) the patterns of service use and costs associated with language impairment in a community cohort of children from ages 4-9 years and (2) the relationship between language impairment and health service utilisation. Participants were children and caregivers of six local government areas in Melbourne participating in the community-based Early Language in Victoria Study (ELVS). Health service use was reported by parents. Costs were valued in Australian dollars in 2014, from the government and family perspectives. Depending on age, the Australian adapted Clinical Evaluation of Language Fundamentals - Pre-school, 2nd Edition (CELF-P2) or the CELF, 4th Edition (CELF4) was used to assess expressive and receptive language. At 5, 7 and 9 years respectively 21%, 11% and 8% of families reported using services for speech and/or language concerns. The annual costs associated with using services averaged A$612 (A$255 to government, A$357 to family) at 5 years and A$992 (A$317 to government, A$675 to family) at 7 years. Children with persistent language impairment had significantly higher service costs than those with typical language. Language impairment in 4-9-year-old children is associated with higher use of services and costs to both families and government compared to typical language.

  16. From Doctor to Nurse Triage in the Danish Out-of-Hours Primary Care Service: Simulated Effects on Costs

    NARCIS (Netherlands)

    Moth, G.; Huibers, L.; Vedsted, P.

    2013-01-01

    Introduction. General practitioners (GP) answer calls to the Danish out-of-hours primary care service (OOH) in Denmark, and this is a subject of discussions about quality and cost-effectiveness. The aim of this study was to estimate changes in fee costs if nurses substituted the GPs. Methods. We

  17. 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...

  18. 76 FR 15349 - Fiscal Year 2010 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by...

    Science.gov (United States)

    2011-03-21

    ... OFFICE OF MANAGEMENT AND BUDGET Fiscal Year 2010 Cost of Outpatient Medical, Dental, and Cosmetic Surgery Services Furnished by Department of Defense Medical Treatment Facilities; Certain Rates Regarding... recovery from tortiously liable third persons for the cost of outpatient medical, dental and cosmetic...

  19. From costs to prices: economic analysis of photovoltaic energy and services

    International Nuclear Information System (INIS)

    Chabot, Bernard

    1998-01-01

    A global economic analysis methodology is proposed in order to simplify the cost and the profitability assessment of energy and services delivered by photovoltaic (PV) systems. As examples, equations and graphic tools derived from this methodology give directly the overall discounted costs (ODC) of electricity delivered by grid-connected PV power plants and the ODC of water delivered by a stand-alone PV pumping system. The main criteria used for profitability analysis of PV projects are reviewed: net present value, internal rate of return and profitability index (PI). A simple method with associated equations and graphic tools is presented in order to assess the profitability of PV projects from their PI. Examples of profitability analysis of present and future grid-connected PV power plants built and operated by an independent power producers are presented and discussed, together with examples of stand-alone PV water pumping systems operated by the local community in developing countries. In both cases, equations and specific graphic tools are presented. Specific graphs can be used with different monetary units, different sizes and different investment costs of PV projects. (Author)

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

    Science.gov (United States)

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

    2017-07-01

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

  1. Making the Organization Fly Organizational Identification and Citizenship in Full-Service and Low-Cost Airlines

    NARCIS (Netherlands)

    Peters, K.; Tevichapong, Passagorn; Haslam, S. Alexander; Postmes, Tom

    2010-01-01

    Recently, the service industry has seen a low-cost sector emerge alongside the traditional full-service sector. We explored whether these business models have different implications for employee cooperation, one factor that plays an important role in organizational functioning. Drawing on the social

  2. Alberta's transmission development policy : review and recommendations

    International Nuclear Information System (INIS)

    Stubbings, R.V.

    2004-01-01

    Alberta's Department of Energy (ADOE) released a policy paper in November 2003 regarding power transmission development for the province. The transmission development policy (TDP) is intended to promote economic growth in Alberta while ensuring consumers with reliable, reasonably priced electricity. This presentation reviewed the main features of the policy and then focused on the allocation of costs to generation customers. The author argued that the proposed changes would result in a sub-optimal development of generation and higher total electricity bills for consumers. He argued that the policy will spare generation customers of any obligation to pay wire-related costs other than local interconnection costs. This would weaken a long-standing ADOE policy which requires generators to pay costs that depend on their location on the transmission system. With the new proposal, generators would not be responsible for ancillary service costs even when they provide direct benefits, and they would pay for system losses on a zonal basis. The author recommended that location charges should be large enough to influence the siting decisions of generators. He also recommended that generators should pay their fare share of transmission use-of-system charges, including ancillary services that provide benefits to generators in the form of a stable, reliable transmission system. 2 tabs., 2 figs

  3. What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation

    Science.gov (United States)

    Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

    2016-01-01

    Objective This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Design Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Setting Champlain health region in Eastern Ontario, Canada. Population Primary care providers and specialists registered to use the eConsult service. Main outcome measures Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. Results A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Conclusions Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. PMID:27338880

  4. Does integrated care lead to both improved service quality and lower care cost

    Science.gov (United States)

    Waldeyer, Regina; Siegel, Achim; Daul, Gisela; Gaiser, Karin; Hildebrandt, Helmut; Köster, Ingrid; Schubert, Ingrid; Stunder, Brigitte; Stützle, Yvonne

    2010-01-01

    Purpose and context ‘Gesundes Kinzigtal’ is one of the few population-based integrated care approaches in Germany, organising care across all health service sectors and indications. The management company and its contracting partners (the physicians’ network in the region and two statutory health insurers) strive to reach a higher quality of care at a lower overall cost as compared with the German standard. During its first two years of operation (2006–2007), the Kinzigtal project achieved surprisingly positive financial results compared with its reference value. To gain independent evidence on the quality aspects of the system, the management company and its partners provided a remarkable budget for its evaluation by independent scientific institutions. Case description and data sources We will present interim results of a population-based controlled cohort study. In this study, quality of care is checked by relying on health and service quality indicators that have been constructed from health insurers’ administrative data (claims data). Interim results are presented for the intervention region (Kinzigtal area) and the control region (the rest of Baden-Württemberg, i.e., Southwest Germany). Preliminary conclusions and discussion The evaluation of ‘Gesundes Kinzigtal’ is in full progress. Until now, there is no evidence that the surprisingly positive financial results of the Kinzigtal system have been achieved at the expense of care quality. Rather, Gesundes Kinzigtal Integrated Care seems to be about to increasingly realize comparative advantages regarding health service quality (in comparison to the control region).

  5. Electrical transmission

    Energy Technology Data Exchange (ETDEWEB)

    Sayers, D P

    1960-05-01

    After briefly tracing the history of electricity transmission, trends in high voltage transmission and experiments being conducted on 650 kV are discussed. 5000 miles of the U.K. grid are operated at 132 kV and 1000 at 275 kV, ultimately to provide a super grid at 380 kV. Problems are insulation, radio interference and the cost of underground lines (16 times that of overhead lines). Also considered are the economics of the grid as a means of transporting energy and as a means of spreading the peak load over the power stations in the most efficient manner. Finally, the question of amenities is discussed.

  6. Randomized evaluation and cost-effectiveness of HIV and sexual and reproductive health service referral and linkage models in Zambia

    Directory of Open Access Journals (Sweden)

    Paul C. Hewett

    2016-08-01

    Full Text Available Abstract Background Provision of HIV prevention and sexual and reproductive health services in Zambia is largely characterized by discrete service provision with weak client referral and linkage. The literature reveals gaps in the continuity of care for HIV and sexual and reproductive health. This study assessed whether improved service delivery models increased the uptake and cost-effectiveness of HIV and sexual and reproductive health services. Methods Adult clients 18+ years of age accessing family planning (females, HIV testing and counseling (females and males, and male circumcision services (males were recruited, enrolled and individually randomized to one of three study arms: 1 the standard model of service provision at the entry point (N = 1319; 2 an enhanced counseling and referral to add-on service with follow-up (N = 1323; and 3 the components of study arm two, with the additional offer of an escort (N = 1321. Interviews were conducted with the same clients at baseline, six weeks and six months. Uptake of services for HIV, family planning, male circumcision, and cervical cancer screening at six weeks and six months were the primary endpoints. Pairwise chi-square and multivariable logistic regression statistical tests assessed differences across study arms, which were also assessed for incremental cost-efficiency and cost-effectiveness. Results A total of 3963 clients, 1920 males and 2043 females, were enrolled; 82 % of participants at six weeks were tracked and 81 % at six months; follow-up rates did not vary significantly by study arm. The odds of clients accessing HIV testing and counseling, cervical cancer screening services among females, and circumcision services among males varied significantly by study arm at six weeks and six months; less consistent findings were observed for HIV care and treatment. Client uptake of family planning services did not vary significantly by study arm. Integrated services were found

  7. Transmission Challenges and Best Practices for Cost-Effective Renewable Energy Delivery across State and Provincial Boundaries

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Shengru [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Hurlbut, David J. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Bird, Lori A. [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Wang, Qin [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-08-22

    A strategically planned transmission network is an important source of flexibility for the integration of large-scale renewable energy (RE). Such a network can offer access to a broad geographic diversity of resources, which can reduce flexibility needs and facilitate sharing between neighboring balancing areas. This report builds on two previous NREL technical reports - Advancing System Flexibility for High Penetration Renewable Integration (Milligan et al. 2015) and 'Renewables-Friendly' Grid Development Strategies (Hurlbut et al. 2015) - which discuss various flexibility options and provide an overview of U.S. market models and grid planning. This report focuses on addressing issues with cross-regional/provincial transmission in China with the aim of integrating renewable resources that are concentrated in remote areas and require inter-regional/provincial power exchange.

  8. Transmission Challenges and Best Practices for Cost-Effective Renewable Energy Delivery across State and Provincial Boundaries

    Energy Technology Data Exchange (ETDEWEB)

    Hurlbut, David [National Renewable Energy Lab. (NREL), Golden, CO (United States); Zhou, Ella [National Renewable Energy Lab. (NREL), Golden, CO (United States); Bird, Lori [National Renewable Energy Lab. (NREL), Golden, CO (United States); Wang, Qin [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2017-03-21

    A strategically planned transmission network is an important source of flexibility for the integration of large-scale renewable energy (RE). Such a network can offer access to a broad geographic diversity of resources, which can reduce flexibility needs and facilitate sharing between neighboring balancing areas. This report builds on two previous NREL technical reports - Advancing System Flexibility for High Penetration Renewable Integration (Milligan et al. 2015) and 'Renewables-Friendly' Grid Development Strategies (Hurlbut et al. 2015) - which discuss various flexibility options and provide an overview of U.S. market models and grid planning. This report focuses on addressing issues with cross-regional/provincial transmission in China with the aim of integrating renewable resources that are concentrated in remote areas and require inter-regional/provincial power exchange.

  9. Optimal Medical Equipment Maintenance Service Proposal Decision Support System combining Activity Based Costing (ABC) and the Analytic Hierarchy Process (AHP).

    Science.gov (United States)

    da Rocha, Leticia; Sloane, Elliot; M Bassani, Jose

    2005-01-01

    This study describes a framework to support the choice of the maintenance service (in-house or third party contract) for each category of medical equipment based on: a) the real medical equipment maintenance management system currently used by the biomedical engineering group of the public health system of the Universidade Estadual de Campinas located in Brazil to control the medical equipment maintenance service, b) the Activity Based Costing (ABC) method, and c) the Analytic Hierarchy Process (AHP) method. Results show the cost and performance related to each type of maintenance service. Decision-makers can use these results to evaluate possible strategies for the categories of equipment.

  10. Potential impacts of the Alberta fetal alcohol spectrum disorder service networks on secondary disabilities: a cost-benefit analysis.

    Science.gov (United States)

    Thanh, Nguyen Xuan; Moffatt, Jessica; Jacobs, Philip; Chuck, Anderson W; Jonsson, Egon

    2013-01-01

    To estimate the break-even effectiveness of the Alberta Fetal Alcohol Spectrum Disorder (FASD) Service Networks in reducing occurrences of secondary disabilities associated with FASD. The secondary disabilities addressed within this study include crime, homelessness, mental health problems, and school disruption (for children) or unemployment (for adults). We used a cost-benefit analysis approach where benefits of the service networks were the cost difference between the two approaches: having the 12 service networks and having no service network in place, across Alberta. We used a threshold analysis to estimate the break-even effectiveness (i.e. the effectiveness level at which the service networks became cost-saving). If no network was in place throughout the province, the secondary disabilities would cost $22.85 million (including $8.62 million for adults and $14.24 million for children) per year. Given the cost of network was $6.12 million per year, the break-even effectiveness was estimated at 28% (range: 25% to 32%). Although not all benefits associated with the service networks are included, such as the exclusion of the primary benefit to those experiencing FASD, the benefits to FASD caregivers, and the preventative benefits, the economic and social burden associated with secondary disabilities will "pay-off" if the effectiveness of the program in reducing secondary disabilities is 28%.

  11. Cost-effectiveness Analysis of an Aftercare Service vs Treatment-As-Usual for Patients with Severe Mental Disorders.

    Science.gov (United States)

    Barfar, Eshagh; Sharifi, Vandad; Amini, Homayoun; Mottaghipour, Yasaman; Yunesian, Masud; Tehranidoost, Mehdi; Sobhebidari, Payam; Rashidian, Arash

    2017-09-01

    There have been claims that community mental health principles leads to the maintenance of better health and functioning in patients and can be more economical for patients with severe and chronic mental disorders. Economic evaluation studies have been used to assess the cost-effectiveness of national health programs, or to propose efficient strategies for health care delivery. The current study is intended to test the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran. This study was a parallel group randomized controlled trial. A total of 160 post-discharge eligible patients were randomized into two equal patient groups, Aftercare Service (that includes either Home Visiting Care, or Telephone Follow-up for outpatient treatment) vs Treatment-As-Usual, using stratified balanced block randomization method. All patients were followed for 12 months after discharge. The perspective of the present study was the societal perspective. The outcome measures were the rate of readmission at the hospitals after discharge, psychotic symptoms, manic symptoms, depressive symptoms, illness severity, global functioning, quality of life, and patients' satisfaction with the services. The costs included the intervention costs and the patient and family costs in the evaluation period. There was no significant difference in effectiveness measures between the two groups. The Aftercare Service arm was about 66,000 US$ cheaper than Treatment-As-Usual arm. The average total cost per patient in the Treatment-As-Usual group was about 4651 USD, while it was reduced to 3823 US$ in the Aftercare Service group; equivalent to a cost reduction of about 800 USD per patient per year. Given that there was no significant difference in effectiveness measures between the two groups (slightly in favor of the intervention), the Aftercare Service was cost-effective. The most important limitation of the study was the relatively

  12. The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model.

    Science.gov (United States)

    Chesson, Harrell W; Markowitz, Lauri E; Hariri, Susan; Ekwueme, Donatus U; Saraiya, Mona

    2016-06-02

    The objective of this study was to assess the incremental costs and benefits of the 9-valent HPV vaccine (9vHPV) compared with the quadrivalent HPV vaccine (4vHPV). Like 4vHPV, 9vHPV protects against HPV types 6, 11, 16, and 18. 9vHPV also protects against 5 additional HPV types 31, 33, 45, 52, and 58. We adapted a previously published model of the impact and cost-effectiveness of 4vHPV to include the 5 additional HPV types in 9vHPV. The vaccine strategies we examined were (1) 4vHPV for males and females; (2) 9vHPV for females and 4vHPV for males; and (3) 9vHPV for males and females. In the base case, 9vHPV cost $13 more per dose than 4vHPV, based on available vaccine price information. Providing 9vHPV to females compared with 4vHPV for females (assuming 4vHPV for males in both scenarios) was cost-saving regardless of whether or not cross-protection for 4vHPV was assumed. The cost per quality-adjusted life year (QALY) gained by 9vHPV for both sexes (compared with 4vHPV for both sexes) was < $0 (cost-saving) when assuming no cross-protection for 4vHPV and $8,600 when assuming cross-protection for 4vHPV. Compared with a vaccination program of 4vHPV for both sexes, a vaccination program of 9vHPV for both sexes can improve health outcomes and can be cost-saving.

  13. Prevention of mother-to-child transmission of HIV: cost-effectiveness of antiretroviral regimens and feeding options in Rwanda.

    Directory of Open Access Journals (Sweden)

    Agnes Binagwaho

    Full Text Available Rwanda's National PMTCT program aims to achieve elimination of new HIV infections in children by 2015. In November 2010, Rwanda adopted the WHO 2010 ARV guidelines for PMTCT recommending Option B (HAART for all HIV-positive pregnant women extended throughout breastfeeding and discontinued (short course-HAART only for those not eligible for life treatment. The current study aims to assess the cost-effectiveness of this policy choice.Based on a cohort of HIV-infected pregnant women in Rwanda, we modelled the cost-effectiveness of six regimens: dual ARV prophylaxis with either 12 months breastfeeding or replacement feeding; short course HAART (Sc-HAART prophylaxis with either 6 months breastfeeding, 12 months breastfeeding, or 18 months breastfeeding; and Sc-HAART prophylaxis with replacement feeding. Direct costs were modelled based on all inputs in each scenario and related unit costs. Effectiveness was evaluated by measuring HIV-free survival at 18 months. Savings correspond to the lifetime costs of HIV treatment and care avoided as a result of all vertical HIV infections averted.All PMTCT scenarios considered are cost saving compared to "no intervention." Sc-HAART with 12 months breastfeeding or 6 months breastfeeding dominate all other scenarios. Sc-HAART with 12 months breastfeeding allows for more children to be alive and HIV-uninfected by 18 months than Sc-HAART with 6 months breastfeeding for an incremental cost per child alive and uninfected of 11,882 USD. This conclusion is sensitive to changes in the relative risk of mortality by 18 months for exposed HIV-uninfected children on replacement feeding from birth and those who were breastfed for only 6 months compared to those breastfeeding for 12 months or more.Our findings support the earlier decision by Rwanda to adopt WHO Option B and could inform alternatives for breastfeeding duration. Local contexts and existing care delivery models should be part of national policy decisions.

  14. Least cost planning within the service concept of power supply companies

    International Nuclear Information System (INIS)

    Lueschen, H.; Sonntag, J.; Werner, R.

    1995-01-01

    In discussing the implementation of energy service concepts, German power supply companies are gradually adopting categories originating from the USA, namely integrated resources planning (IRP), least cost planning (LCP), and demand-side management (DSM). While the activities of German power supply companies are more encompassing than those of their US counterparts in the traditional features of DSM such as load management, information, and consulting, further-going measures such as direct investment and financial incentive programmes for exploiting energy-saving potentials play a less important role and are controversial in the energy-political debate. The article presents the concept of power supply companies for implementing IRP/LCP and makes a concrete assessment of the worth and efficiency of consulting compared with the newer type of financial incentive programmes. (orig.) [de

  15. Catalysing low cost green technologies for sustainable water service delivery in Kenya: Feasibility Study Report

    DEFF Research Database (Denmark)

    Ndirangu, Wangai; Schaer, Caroline

    2017-01-01

    Since 1974, the government of Kenya has recognised water supplies as critical for poverty reduction and development. Kenya’s economic and social development Vision 2030 emphasises the need for adequate and sustainable provision of water supply and sanitation services, with a target to achieve...... universal access by 2030. However, thus far most water development targets have not been achieved. Improvement has been much slower in rural and low income urban areas, and the current funding level is inadequate to achieve universal access by 2030. Over the years, official effort have been complemented...... to planning, standards and operations and maintenance, including source and cost of energy in rural and peri-urban water supplies is a key challenge to functionality and sustainability....

  16. Low cost, scalable proteomics data analysis using Amazon's cloud computing services and open source search algorithms.

    Science.gov (United States)

    Halligan, Brian D; Geiger, Joey F; Vallejos, Andrew K; Greene, Andrew S; Twigger, Simon N

    2009-06-01

    One of the major difficulties for many laboratories setting up proteomics programs has been obtaining and maintaining the computational infrastructure required for the analysis of the large flow of proteomics data. We describe a system that combines distributed cloud computing and open source software to allow laboratories to set up scalable virtual proteomics analysis clusters without the investment in computational hardware or software licensing fees. Additionally, the pricing structure of distributed computing providers, such as Amazon Web Services, allows laboratories or even individuals to have large-scale computational resources at their disposal at a very low cost per run. We provide detailed step-by-step instructions on how to implement the virtual proteomics analysis clusters as well as a list of current available preconfigured Amazon machine images containing the OMSSA and X!Tandem search algorithms and sequence databases on the Medical College of Wisconsin Proteomics Center Web site ( http://proteomics.mcw.edu/vipdac ).

  17. Integrating tuberculosis and HIV services for people living with HIV: Costs of the Zambian ProTEST Initiative

    Directory of Open Access Journals (Sweden)

    Kayawe Ignatius

    2008-01-01

    Full Text Available Abstract Background In the face of the dual TB/HIV epidemic, the ProTEST Initiative was one of the first to demonstrate the feasibility of providing collaborative TB/HIV care for people living with HIV (PLWH in poor settings. The ProTEST Initiative facilitated collaboration between service providers. Voluntary counselling and testing (VCT acted as the entry point for services including TB screening and preventive therapy, clinical treatment for HIV-related disease, and home-based care (HBC, and a hospice. This paper estimates the costs of the ProTEST Initiative in two sites in urban Zambia, prior to the introduction of anti-retroviral therapy. Methods Annual financial and economic providers costs and output measures were collected in 2000–2001. Estimates are made of total costs for each component and average costs per: person reached by ProTEST; VCT pre-test counselled, tested and completed; isoniazid preventive therapy started and completed; clinic visit; HBC patient; and hospice admission and bednight. Results Annual core ProTEST costs were (in 2007 US dollars $84,213 in Chawama and $31,053 in Matero. The cost of coordination was 4%–5% of total site costs ($1–$6 per person reached. The largest cost component in Chawama was voluntary counselling and testing (56% and the clinic in Matero (50%, where VCT clients had higher HIV-prevalences and more advanced HIV. Average costs were lower for all components in the larger site. The cost per HBC patient was $149, and per hospice bednight was $24. Conclusion This study shows that coordinating an integrated and comprehensive package of services for PLWH is relatively inexpensive. The lessons learnt in this study are still applicable today in the era of ART, as these services must still be provided as part of the continuum of care for people living with HIV.

  18. CUSTOMER COST - SECOND IMPORTANT FACTOR FOR IMAGE GAP ANALYSIS OF LIFE INSURANCE SERVICES - BASED ON THE DATA COLLECTION FROM GUWAHATI

    OpenAIRE

    Pankaj Bihani; Prof. Amalesh Bhowal

    2017-01-01

    The concept of Customer Cost was developed by Lauterborn (1990) while developing the customer oriented Marketing Mix- the 4C concept. 4C model replaces the earlier 4Ps of Marketing Mix, here the focus is on customer and the current chapter is all about the second C of this model i.e. Customer Cost or Price in earlier 4P model. The Customer Cost concept is based on the fact that customers are more concerned with the total cost of acquiring a solution of their problem (Product or Service) rathe...

  19. Healthcare tariffs for specialist inpatient neurorehabilitation services: rationale and development of a UK casemix and costing methodology.

    Science.gov (United States)

    Turner-Stokes, Lynne; Sutch, Stephen; Dredge, Robert

    2012-03-01

    To describe the rationale and development of a casemix model and costing methodology for tariff development for specialist neurorehabilitation services in the UK. Patients with complex needs incur higher treatment costs. Fair payment should be weighted in proportion to costs of providing treatment, and should allow for variation over time CASEMIX MODEL AND BAND-WEIGHTING: Case complexity is measured by the Rehabilitation Complexity Scale (RCS). Cases are divided into five bands of complexity, based on the total RCS score. The principal determinant of costs in rehabilitation is staff time. Total staff hours/week (estimated from the Northwick Park Nursing and Therapy Dependency Scales) are analysed within each complexity band, through cross-sectional analysis of parallel ratings. A 'band-weighting' factor is derived from the relative proportions of staff time within each of the five bands. Total unit treatment costs are obtained from retrospective analysis of provider hospitals' budget and accounting statements. Mean bed-day costs (total unit cost/occupied bed days) are divided broadly into 'variable' and 'non-variable' components. In the weighted costing model, the band-weighting factor is applied to the variable portion of the bed-day cost to derive a banded cost, and thence a set of cost-multipliers. Preliminary data from one unit are presented to illustrate how this weighted costing model will be applied to derive a multilevel banded payment model, based on serial complexity ratings, to allow for change over time.

  20. A Comparative Study on Evaluating the Service Quality Attributes based on Kano Model: A Case of Low-cost Carrier and Full-service Carrier

    Directory of Open Access Journals (Sweden)

    Byun Hyojeong

    2014-01-01

    Full Text Available The emergence and development of low-cost carriers(LCC with competitive price is heating up the competition in the aviation market more, especially between low-cost carriers(LCC and full-service carriers(FSC. Therefore, it became more important than ever to implement service differentiation strategies of each airline for securing customers and competitiveness. In this sense, the purpose of this study is to compare and assess the different expectations of the customers for airline service attributes pursued by FSCs and LCCs. Three main dimensions of airline service quality attributes (physical, human, and system service, were selected and this study clarified the service quality attributes of each airline carrier using Kano Model. Data were collected from Korean passengers who experienced both LCCs and FSCs for international or domestic flights. As results, this study demonstrated several differences in airline service quality attributes between FSCs and LCCs, which imply that each airline needs to adopt differential strategies to be more competitive. In particular, most physical-related attributes for FSCs were a ‘must-be’ dimension while the majority of attributes for LCCs was clarified ‘one-dimensional’ attribute. The current study also presented implications to be helpful in developing the quality of service and establishing marketing strategies for improvement in customer satisfaction.

  1. Cost-effectiveness of national mandatory screening of all admissions to English National Health Service hospitals for meticillin-resistant Staphylococcus aureus: a mathematical modelling study.

    Science.gov (United States)

    Robotham, Julie V; Deeny, Sarah R; Fuller, Chris; Hopkins, Susan; Cookson, Barry; Stone, Sheldon

    2016-03-01

    In December, 2010, National Health Service (NHS) England introduced national mandatory screening of all admissions for meticillin-resistant Staphylococcus aureus (MRSA). We aimed to assess the effectiveness and cost-effectiveness of this policy, from a regional or national health-care decision makers' perspective, compared with alternative screening strategies. We used an individual-based dynamic transmission model parameterised with national MRSA audit data to assess the effectiveness and cost-effectiveness of admission screening of patients in English NHS hospitals compared with five alternative strategies (including no screening, checklist-activated screening, and high-risk specialty-based screening), accompanied by patient isolation and decolonisation, over a 5 year time horizon. We evaluated strategies for different NHS hospital types (acute, teaching, and specialist), MRSA prevalence, and transmission potentials using probabilistic sensitivity analyses. Compared with no screening, mean cost per quality-adjusted life-year (QALY) of screening all admissions was £89,000-148,000 (range £68,000-222,000), and this strategy was consistently more costly and less effective than alternatives for all hospital types. At a £30,000/QALY willingness-to-pay threshold and current prevalence, only the no-screening strategy was cost effective. The next best strategies were, in acute and teaching hospitals, targeting of high-risk specialty admissions (30-40% chance of cost-effectiveness; mean incremental cost-effectiveness ratios [ICERs] £45,200 [range £35,300-61,400] and £48,000/QALY [£34,600-74,800], respectively) and, in specialist hospitals, screening these patients plus risk-factor-based screening of low-risk specialties (a roughly 20% chance of cost-effectiveness; mean ICER £62,600/QALY [£48,000-89,400]). As prevalence and transmission increased, targeting of high-risk specialties became the optimum strategy at the NHS willingness-to-pay threshold (£30,000/QALY

  2. What are the cost savings associated with providing access to specialist care through the Champlain BASE eConsult service? A costing evaluation.

    Science.gov (United States)

    Liddy, Clare; Drosinis, Paul; Deri Armstrong, Catherine; McKellips, Fanny; Afkham, Amir; Keely, Erin

    2016-06-23

    This study estimates the costs and potential savings associated with all eConsult cases completed between 1 April 2014 and 31 March 2015. Costing evaluation from the societal perspective estimating the costs and potential savings associated with all eConsults completed during the study period. Champlain health region in Eastern Ontario, Canada. Primary care providers and specialists registered to use the eConsult service. Costs included (1) delivery costs; (2) specialist remuneration; (3) costs associated with traditional (face-to-face) referrals initiated as a result of eConsult. Potential savings included (1) costs of traditional referrals avoided; (2) indirect patient savings through avoided travel and lost wages/productivity. Net potential societal cost savings were estimated by subtracting total costs from total potential savings. A total of 3487 eConsults were completed during the study period. In 40% of eConsults, a face-to-face specialist visit was originally contemplated but avoided as result of eConsult. In 3% of eConsults, a face-to-face specialist visit was not originally contemplated but was prompted as a result of the eConsult. From the societal perspective, total costs were estimated at $207 787 and total potential savings were $246 516. eConsult led to a net societal saving of $38 729 or $11 per eConsult. Our findings demonstrate potential cost savings from the societal perspective, as patients avoided the travel costs and lost wages/productivity associated with face-to-face specialist visits. Greater savings are expected once we account for other costs such as avoided tests and visits and potential improved health outcomes associated with shorter wait times. Our findings are valuable for healthcare delivery decision-makers as they seek solutions to improve care in a patient-centred and efficient manner. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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

    Science.gov (United States)

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

    2011-07-01

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

  4. The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

    OpenAIRE

    Chesson, Harrell W.; Markowitz, Lauri E.; Hariri, Susan; Ekwueme, Donatus U.; Saraiya, Mona

    2016-01-01

    Introduction: The objective of this study was to assess the incremental costs and benefits of the 9-valent HPV vaccine (9vHPV) compared with the quadrivalent HPV vaccine (4vHPV). Like 4vHPV, 9vHPV protects against HPV types 6, 11, 16, and 18. 9vHPV also protects against 5 additional HPV types 31, 33, 45, 52, and 58. Methods: We adapted a previously published model of the impact and cost-effectiveness of 4vHPV to include the 5 additional HPV types in 9vHPV. The vaccine strategies we examined w...

  5. Cost-effective clinical pharmacy services in a veterans administration drop-in clinic.

    Science.gov (United States)

    Scrivens, J J; Magalian, P; Crozier, G A

    1983-11-01

    Services provided by a clinical pharmacist in a Veterans Administration outpatient clinic are described. Patients who come to the drop-in clinic for prescription refill authorization or medication-related problems are seen by a pharmacist rather than by a physician. The pharmacist interviews the patient, reviews the medical records and prescription and nonprescription drug profile, assesses appropriateness of current drug use, and records findings in the progress notes. The pharmacist may recommend presciption refill, change of medication or dosage, discontinuation, referral to a physician or nurse practitioner, follow-up appointments, or laboratory tests. The physician must countersign the pharmacist's prescriptions, referrals, and requests for laboratory tests. The clinical pharmacist's services reduced demand for physicians' time, allowed patients direct access to the health-care provider suited to deal with medication-related problems, and provided improved continuity of care. Potential benefits are cost savings from discontinuation of inappropriate drug therapy and from use of a pharmacist instead of a physician. The number of hospital admissions related to adverse drug reactions also may be reduced.

  6. Energy consumption, costs and environmental impacts for urban water cycle services: Case study of Oslo (Norway)

    International Nuclear Information System (INIS)

    Venkatesh, G.; Brattebo, Helge

    2011-01-01

    Energy consumption in the operation and maintenance phase of the urban water and wastewater network is directly related to both the quantity and the desired quality of the supplied water/treated wastewater - in other words, to the level of service provided to consumers. The level of service is dependent on not just the quantity and quality of the water but also the state of the infrastructure. Maintaining the infrastructure so as to be able to provide the required high level of service also demands energy. Apart from being a significant operational cost component, energy use also contributes to life-cycle environmental impacts. This paper studies the direct energy consumption in the operation and maintenance phase of the water and wastewater system in Oslo; and presents a break-up among the different components of the network, of quantities, costs and environmental impacts. Owing to the diversity in the periods of time for which comprehensive data for the whole system are available, the study period is restricted to years 2000-2006. The per-capita annual consumption of energy in the operational phase of the system varied between 220 and 260 kWh; and per-capita annual expenses on energy in inflation-adjusted year-2006-Euros ranged between 6.5 and 11 Euros. The energy consumed on the upstream, per unit volume water supplied was around 0.4 kWh on average, while the corresponding value for the downstream was 0.8 kWh per cubic metre wastewater treated. The upstream Greenhouse gas (GHG) emissions ranged between 70 and 80 g per cubic metre of water supplied, about 22% greater on average than the corresponding specific GHG emissions on the downstream. -- Research highlights: → Annual per-capita energy consumption in the Operation and Maintenance (O and M) phase of the system varied between 220 and 260 kWh. → Annual per-capita annual expenses on energy in inflation-adjusted year-2006-Euros ranged between 6.5 and 11 Euros. → Upstream O and M energy consumption per

  7. Accounting for costs, QALYs, and capacity constraints: using discrete-event simulation to evaluate alternative service delivery and organizational scenarios for hospital-based glaucoma services.

    Science.gov (United States)

    Crane, Glenis J; Kymes, Steven M; Hiller, Janet E; Casson, Robert; Martin, Adam; Karnon, Jonathan D

    2013-11-01

    Decision-analytic models are routinely used as a framework for cost-effectiveness analyses of health care services and technologies; however, these models mostly ignore resource constraints. In this study, we use a discrete-event simulation model to inform a cost-effectiveness analysis of alternative options for the organization and delivery of clinical services in the ophthalmology department of a public hospital. The model is novel, given that it represents both disease outcomes and resource constraints in a routine clinical setting. A 5-year discrete-event simulation model representing glaucoma patient services at the Royal Adelaide Hospital (RAH) was implemented and calibrated to patient-level data. The data were sourced from routinely collected waiting and appointment lists, patient record data, and the published literature. Patient-level costs and quality-adjusted life years were estimated for a range of alternative scenarios, including combinations of alternate follow-up times, booking cycles, and treatment pathways. The model shows that a) extending booking cycle length from 4 to 6 months, b) extending follow-up visit times by 2 to 3 months, and c) using laser in preference to medication are more cost-effective than current practice at the RAH eye clinic. The current simulation model provides a useful tool for informing improvements in the organization and delivery of glaucoma services at a local level (e.g., within a hospital), on the basis of expected effects on costs and health outcomes while accounting for current capacity constraints. Our model may be adapted to represent glaucoma services at other hospitals, whereas the general modeling approach could be applied to many other clinical service areas.

  8. The incremental cost of switching from Option B to Option B+ for the prevention of mother-to-child transmission of HIV.

    Science.gov (United States)

    O'Brien, Lisa; Shaffer, Nathan; Sangrujee, Nalinee; Abimbola, Taiwo O

    2014-03-01

    To estimate the incremental cost over 5 years of a policy switch from the Option B to the Option B+ protocol for the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV). Data from cost studies and other published sources were used to determine the cost, per woman and per cohort (1000 breastfeeding and 1000 non-breastfeeding women), of switching from Option B (maternal triple antiretroviral [ARV] regimen during pregnancy and breastfeeding plus daily nevirapine for the infant for 6 weeks) to Option B+ (maternal triple ARV regimen initiated during pregnancy and continued for life). The variables used to model the different scenarios were maternal CD4+ T lymphocyte (CD4+ cell) count (350-500 versus > 500 cells/µl), rate of decline in CD4+ cells (average, rapid, slow), breastfeeding status (yes, no) and breastfeeding duration (12, 18 or 24 months). For women with CD4+ cell counts of 350-500 cells/µl, the incremental cost per 1000 women was 157,345 United States dollars (US$) for breastfeeding women and US$ 92,813 for non-breastfeeding women. For women with CD4+ cell counts > 500 cells/µl, the incremental cost per 1000 women ranged from US$ 363,443 to US$ 484,591 for breastfeeding women and was US$ 605,739 for non-breastfeeding women. From a cost perspective, a policy switch from Option B to Option B+ is feasible in PMTCT programme settings where resources are currently being allocated to Option B.

  9. The incremental cost of switching from Option B to Option B+ for the prevention of mother-to-child transmission of HIV

    Science.gov (United States)

    Shaffer, Nathan; Sangrujee, Nalinee; Abimbola, Taiwo O

    2014-01-01

    Abstract Objective To estimate the incremental cost over 5 years of a policy switch from the Option B to the Option B+ protocol for the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV). Methods Data from cost studies and other published sources were used to determine the cost, per woman and per cohort (1000 breastfeeding and 1000 non-breastfeeding women), of switching from Option B (maternal triple antiretroviral [ARV] regimen during pregnancy and breastfeeding plus daily nevirapine for the infant for 6 weeks) to Option B+ (maternal triple ARV regimen initiated during pregnancy and continued for life). The variables used to model the different scenarios were maternal CD4+ T lymphocyte (CD4+ cell) count (350–500 versus > 500 cells/µl), rate of decline in CD4+ cells (average, rapid, slow), breastfeeding status (yes, no) and breastfeeding duration (12, 18 or 24 months). Findings For women with CD4+ cell counts of 350–500 cells/µl, the incremental cost per 1000 women was 157 345 United States dollars (US$) for breastfeeding women and US$ 92 813 for non-breastfeeding women. For women with CD4+ cell counts > 500 cells/µl, the incremental cost per 1000 women ranged from US$ 363 443 to US$ 484 591 for breastfeeding women and was US$ 605 739 for non-breastfeeding women. Conclusion From a cost perspective, a policy switch from Option B to Option B+ is feasible in PMTCT programme settings where resources are currently being allocated to Option B. PMID:24700975

  10. 78 FR 5268 - Allocation of Capacity on New Merchant Transmission Projects and New Cost-Based, Participant...

    Science.gov (United States)

    2013-01-25

    ... construction and/or in-service dates [ssquf] Type of line--for example, AC, DC, bi-directional [ssquf... solicitation, selection and negotiation process criteria set forth herein. The Commission is making these..., and (2) demonstrate to the Commission that the developer has satisfied the solicitation, selection and...

  11. Women's Initiative for Nonsmoking-VII: evaluation of health service utilization and costs among women smokers with cardiovascular disease.

    Science.gov (United States)

    Froelicher, Erika Sivarajan; Sohn, Min; Max, Wendy; Bacchetti, Peter

    2004-01-01

    The Women's Initiative for Nonsmoking (WINS), a randomized clinical trial of a smoking cessation intervention for women with cardiovascular disease, permitted an assessment of the types and costs of health services women used during the 30 months after their hospitalization with cardiovascular disease. A prospective design nested within WINS was used for this study. A structured telephone interview guide included questions about medical services and 15 categories of prevention services, including cardiac rehabilitation at 6, 12, 24, and 30 months. Costs were estimated from state and national databases. The 277 women studied had a mean age of 60.7 +/- 10 years. They had smoked approximately 40 +/- 11.4 years. More than 50% of the women had one or more risk factors for cardiovascular disease. During the first 6 months after the index hospitalization, 94% had a physician visit, 39% had an emergency-room visit, and 36% had a hospital admission. Prevention services used were home healthcare by nurse or home health aide (26%), a cardiac rehabilitation program, including Multifit and Heart Smart (19%), and physical therapy (14%). Usage decreased over the 30 months. For the women who used any service, the mean total monthly cost per woman was 913 dollars +/- 1204 dollars. This is the first report on health service use by women smokers with cardiovascular disease. Data collection using a telephone interview guide proved feasible for evaluating health service use. The greatest costs resulted from hospital admissions and physician and emergency-room visits. Considering the high prevalence of risk factors in this cohort, secondary prevention services were severely underutilized. By increasing referrals to such services, physicians and nurses might influence women to reduce their risk for subsequent cardiovascular disease.

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

    Science.gov (United States)

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

    2015-06-06

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

  13. The revenue generated from clinical chemistry and hematology laboratory services as determined using activity-based costing (ABC) model.

    Science.gov (United States)

    Adane, Kasaw; Abiy, Zenegnaw; Desta, Kassu

    2015-01-01

    The rapid and continuous growth of health care cost aggravates the frequently low priority and less attention given in financing laboratory services. The poorest countries have the highest out-of-pocket spending as a percentage of income. Higher charges might provide a greater potential for revenue. If fees raise quality sufficiently, it can enhance usage. Therefore, estimating the revenue generated from laboratory services could help in capacity building and improved quality service provision. Panel study design was used to determine revenue generated from clinical chemistry and hematology services at Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia. Activity-Based Costing (ABC) model was used to determine the true cost of tests performed from October 2011 to December 2011 in the hospital. The principle of Activity-based Costing is that activities consume resources and activities consumed by services which incur the costs and hence service takes the cost of resources. All resources with costs are aggregated with the established casual relationships. The process maps designed was restructured in consultation with the senior staffs working and/or supervising the laboratory and pretested checklists were used for observation. Moreover, office documents, receipts and service bills were used while collecting data. The amount of revenue collected from services was compared with the cost of each subsequent test and the profitability or return on investment (ROI) of services was calculated. Data were collected, entered, cleaned, and analyzed using Microsoft Excel 2007 software program and Statistical Software Package for Social Sciences version 19 (SPSS). Paired sample t test was used to compare the price and cost of each test. P-value less than 0.05 were considered as statistically significant. A total of 25,654 specimens were analyzed during 3 months of regular working hours. The total numbers of clinical chemistry and hematology tests performed during

  14. Two-tier charging in Maputo Central Hospital: costs, revenues and effects on equity of access to hospital services.

    Science.gov (United States)

    McPake, Barbara; Hongoro, Charles; Russo, Giuliano

    2011-06-02

    Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations. A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures. The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital. While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total), where capital and drug costs were surprisingly low (2 and 4% respectively). We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a) the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b) because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic operations, rather than the other way around. We conclude that the

  15. A low cost, high precision extreme/harsh cold environment, autonomous sensor data gathering and transmission platform.

    Science.gov (United States)

    Chetty, S.; Field, L. A.

    2014-12-01

    SWIMS III, is a low cost, autonomous sensor data gathering platform developed specifically for extreme/harsh cold environments. Arctic ocean's continuing decrease of summer-time ice is related to rapidly diminishing multi-year ice due to the effects of climate change. Ice911 Research aims to develop environmentally inert materials that when deployed will increase the albedo, enabling the formation and/preservation of multi-year ice. SWIMS III's sophisticated autonomous sensors are designed to measure the albedo, weather, water temperature and other environmental parameters. This platform uses low cost, high accuracy/precision sensors, extreme environment command and data handling computer system using satellite and terrestrial wireless solution. The system also incorporates tilt sensors and sonar based ice thickness sensors. The system is light weight and can be deployed by hand by a single person. This presentation covers the technical, and design challenges in developing and deploying these platforms.

  16. Econometric estimation of WHO-CHOICE country-specific costs for inpatient and outpatient health service delivery.

    Science.gov (United States)

    Stenberg, Karin; Lauer, Jeremy A; Gkountouras, Georgios; Fitzpatrick, Christopher; Stanciole, Anderson

    2018-01-01

    Policy makers require information on costs related to inpatient and outpatient health services to inform resource allocation decisions. Country data sets were gathered in 2008-2010 through literature reviews, website searches and a public call for cost data. Multivariate regression analysis was used to explore the determinants of variability in unit costs using data from 30 countries. Two models were designed, with the inpatient and outpatient models drawing upon 3407 and 9028 observations respectively. Cost estimates are produced at country and regional level, with 95% confidence intervals. Inpatient costs across 30 countries are significantly associated with the type of hospital, ownership, as well as bed occupancy rate, average length of stay, and total number of inpatient admissions. Changes in outpatient costs are significantly associated with location, facility ownership and the level of care, as well as to the number of outpatient visits and visits per provider per day. These updated WHO-CHOICE service delivery unit costs are statistically robust and may be used by analysts as inputs for economic analysis. The models can predict country-specific unit costs at different capacity levels and in different settings.

  17. Transmission : roadway to a competitive electricity market

    Energy Technology Data Exchange (ETDEWEB)

    Thon, S. [AltaLink L.P., AB (Canada)

    2002-07-01

    Having a variety of suppliers, marketers and retailers is the key to developing a successful electricity market which is more competitive on pricing, with less price volatility, more innovative customer products and higher levels of customer services. Some areas of Alberta are developing their own power markets with limited capacity to interact. These include Pincher Creek, Empress, Calgary, Edmonton, and Fort McMurray. It was noted that increasing transmission capacity is the key to ensuring a bigger and more competitive electricity market. Transmission constraints only encourage a small number of suppliers to control the market. The current cost of transmission capacity accounts for less than 5 per cent of an average residential customer's bill, but it plays a major role in providing more choice to competitive electricity suppliers. Developing more transmission capacity will create an even more competitive market that benefits both consumers and suppliers. Prices in Alberta have been very volatile in the past couple of years because of supply and demand issues, and there is a need to increase market liquidity. Alberta's Transmission Administrator is looking to expand the transmission network to alleviate constraints and to lower the cost of power generation, regardless of location. These expansions are not expected to affect customers' bills by more than 2 to 3 per cent. Such transmission concerns are being felt all over North America. The Federal Energy Regulatory Commission (FERC) in the United States also recognizes the link between transmission and creating a competitive electricity market.

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

    Science.gov (United States)

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

    2017-09-19

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

  19. The MyHealthService approach for chronic disease management based on free open source software and low cost components.

    Science.gov (United States)

    Vognild, Lars K; Burkow, Tatjana M; Luque, Luis Fernandez

    2009-01-01

    In this paper we present an approach to building personal health services, supporting following-up, physical exercising, health education, and psychosocial support for the chronically ill, based on free open source software and low-cost computers, mobile devices, and consumer health and fitness devices. We argue that this will lower the cost of the systems, which is important given the increasing number of people with chronicle diseases and limited healthcare budgets.

  20. 77 FR 48453 - Connect America Fund; High-Cost Universal Service Support; Universal Service Reform-Mobility Fund

    Science.gov (United States)

    2012-08-14

    ... constitutes corporate welfare, as the average annual net income of such carriers purportedly demonstrates that... preferences here. Blooston cites the Universal Service principle of competitive neutrality, which it...

  1. Accurate costs of blood transfusion: a microcosting of administering blood products in the United Kingdom National Health Service.

    Science.gov (United States)

    Stokes, Elizabeth A; Wordsworth, Sarah; Staves, Julie; Mundy, Nicola; Skelly, Jane; Radford, Kelly; Stanworth, Simon J

    2018-04-01

    In an environment of limited health care resources, it is crucial for health care systems which provide blood transfusion to have accurate and comprehensive information on the costs of transfusion, incorporating not only the costs of blood products, but also their administration. Unfortunately, in many countries accurate costs for administering blood are not available. Our study aimed to generate comprehensive estimates of the costs of administering transfusions for the UK National Health Service. A detailed microcosting study was used to cost two key inputs into transfusion: transfusion laboratory and nursing inputs. For each input, data collection forms were developed to capture staff time, equipment, and consumables associated with each step in the transfusion process. Costing results were combined with costs of blood product wastage to calculate the cost per unit transfused, separately for different blood products. Data were collected in 2014/15 British pounds and converted to US dollars. A total of 438 data collection forms were completed by 74 staff. The cost of administering blood was $71 (£49) per unit for red blood cells, $84 (£58) for platelets, $55 (£38) for fresh-frozen plasma, and $72 (£49) for cryoprecipitate. Blood administration costs add substantially to the costs of the blood products themselves. These are frequently incurred costs; applying estimates to the blood components supplied to UK hospitals in 2015, the annual cost of blood administration, excluding blood products, exceeds $175 (£120) million. These results provide more accurate estimates of the total costs of transfusion than those previously available. © 2018 AABB.

  2. Towards Scalable Cost-Effective Service and Survivability Provisioning in Ultra High Speed Networks

    Energy Technology Data Exchange (ETDEWEB)

    Bin Wang

    2006-12-01

    Optical transport networks based on wavelength division multiplexing (WDM) are considered to be the most appropriate choice for future Internet backbone. On the other hand, future DOE networks are expected to have the ability to dynamically provision on-demand survivable services to suit the needs of various high performance scientific applications and remote collaboration. Since a failure in aWDMnetwork such as a cable cut may result in a tremendous amount of data loss, efficient protection of data transport in WDM networks is therefore essential. As the backbone network is moving towards GMPLS/WDM optical networks, the unique requirement to support DOE’s science mission results in challenging issues that are not directly addressed by existing networking techniques and methodologies. The objectives of this project were to develop cost effective protection and restoration mechanisms based on dedicated path, shared path, preconfigured cycle (p-cycle), and so on, to deal with single failure, dual failure, and shared risk link group (SRLG) failure, under different traffic and resource requirement models; to devise efficient service provisioning algorithms that deal with application specific network resource requirements for both unicast and multicast; to study various aspects of traffic grooming in WDM ring and mesh networks to derive cost effective solutions while meeting application resource and QoS requirements; to design various diverse routing and multi-constrained routing algorithms, considering different traffic models and failure models, for protection and restoration, as well as for service provisioning; to propose and study new optical burst switched architectures and mechanisms for effectively supporting dynamic services; and to integrate research with graduate and undergraduate education. All objectives have been successfully met. This report summarizes the major accomplishments of this project. The impact of the project manifests in many aspects: First

  3. 78 FR 12967 - Establishment of Class A TV Service and Cable Television Rate Regulation; Cost of Service Rules...

    Science.gov (United States)

    2013-02-26

    ... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Parts 73 and 76 [MM Docket No. 00-10; FCC 01-123 and MM Docket No. 93-215; FCC 95-502] Establishment of Class A TV Service and Cable Television Rate Regulation... Federal Communications Commission published requirements related to Establishment of Class A TV Service...

  4. Comparative cost study of the processes for producing niobium--tin (Nb3Sn) superconducting tapes for their application to power transmission lines. Final report

    International Nuclear Information System (INIS)

    1976-10-01

    This report considers the manufacture of superconducting Nb 3 Sn tapes for ac superconducting transmission cables. The 14 product examples studied are produced by processes involving solid-state diffusion of Sn and Nb and/or physical vapor deposition. Production of 80,000 km per year is assumed, sufficient for 100 km of 3 phase ac line. Results are summarized in a table entitled ''Variants of 6 mm wide Nb 3 Sn Superconducting Tapes with Economics of Manufacture.'' The table identifies the 14 product examples by method of manufacture; by the composition of the layers integrated into the tape; and by the final thickness of Nb used in 12 of the product examples. The estimated fixed capital for plant is listed for each product example together with the estimated costs of manufacture in cents per meter of tape. The total manufacturing cost given is the sum of the costs of raw materials, operating labor, depreciation and other overhead. The depreciation is calculated on a 10 year straight line basis. Stainless steel strip (304L) is used in 6 of the product examples. The final line in the table shows the ''selling price'' which will earn the equivalent of 20 percent p.a. on the total capital, fixed and working, employed at any time during an eleven-year plant life where depreciation is sum of year digits for a 10 year period, investment credit is 10 percent, and income tax is 48 percent. 13 tables, 21 figures

  5. A review of the incidence and transmission of Listeria monocytogenes in ready-to-eat products in retail and food service environments.

    Science.gov (United States)

    Lianou, Alexandra; Sofos, John N

    2007-09-01

    Contamination of ready-to-eat products with Listeria monocytogenes may occur at several stages before consumption. Accessibility to the public and relatively limited control interventions at retail and food service establishments (compared with the processing sector of the food industry) and the lack of a specific regulatory framework increase the likelihood of introduction of this pathogen into some foods in these establishments. This review is a compilation of available information on the incidence and transmission of L. monocytogenes through ready-to-eat products at the retail and food service level. The potential transmission of L. monocytogenes within retail and food service operations has been indicated in epidemiological investigations and by survey data. Potential sources of the organism in these operations include the environment, food handlers, and incoming raw ingredients or processed products that have become contaminated after the lethality treatment at the manufacturing facility. L. monocytogenes may be present at retail and food service establishments in various ready-to-eat products, both prepackaged and those packaged in the store, and occasionally at high concentrations. This issue dictates the need for development and application of effective control measures, and potential control approaches are discussed here. Good manufacturing practices, appropriate cleaning, sanitation and hygiene programs, and temperature control required for prevention or inhibition of growth of the pathogen to high levels are critical for control of L. monocytogenes in the retail and food service sector. A comprehensive food safety system designed to be functional in retail and food service operations and based on the philosophy of hazard analysis and critical control point systems and a series of sound prerequisite programs can provide effective control of L. monocytogenes in these environments. However, competent delivery of food safety education and training to retail

  6. Increase plant safety and reduce cost by implementing risk-informed in-service inspection programs

    International Nuclear Information System (INIS)

    Billington, A.; Monette, P.

    2001-01-01

    The idea behind the program is that it is possible to 'inspect less, but inspect better'. In other words, the risk-informed In-Service Inspection (ISI) process is used to improve the effectiveness of examination of piping components, i.e. concentrate inspection resources and enhance inspection strategies on high safety significant locations, and reduce inspection requirements on others. The Westinghouse Owners Group (WOG) risk-informed ISI process has already been applied for full scope (Millstone 3, Surry 1) and limited scope (Beznau, Ringhals 4, Asco, Turkey Point 3). By examining the high safety significant piping segments for the different fluid piping systems, the total piping core damage frequency is reduced. In addition, more than 80% of the risk associated with potential pressure boundary failures is addressed with the WOG risk-informed ISI process, while typically less that 50% of this same risk is addressed by the current inspection programs. The risk-informed ISI processes are used to improve the effectiveness of inspecting safety-significant piping components, to reduce inspection requirements on other piping components, to evaluate improvements to plant availability and enhanced safety measures, including reduction of personnel radiation exposure, and to reduce overall Operation and Maintenance (O and M) costs while maintaining regulatory compliance. A description of the process as well as benefits from past projects is presented, since the methodology is applicable for WWER plant design. (author)

  7. Increase plant safety and reduce cost by implementing risk-informed In-Service Inspection programs

    International Nuclear Information System (INIS)

    Billington, A.; Monette, P.; Doumont, C.

    2000-01-01

    The idea behind the program is that it is possible to 'inspect less, but inspect better'. In other words, the risk-informed In-Service Inspection (ISI) process is used to improve the effectiveness of examination of piping components, i.e