WorldWideScience

Sample records for unit spends increasing

  1. Does Increased Spending on Pharmaceutical Marketing Inhibit Pioneering Innovation?

    Science.gov (United States)

    Arnold, Denis G; Troyer, Jennifer L

    2016-04-01

    The pharmaceutical industry has been criticized for developing and aggressively marketing drugs that do not provide significant health benefits relative to existing drugs but retain the benefits of patent protection. Critics argue that drug marketing increases health care expenditures and provides a disincentive for pioneering drug innovation. However, evidence that marketing expenditures have any relationship to new drug approvals has been anecdotal. We hypothesized that, at publicly traded pharmaceutical firms, increased marketing expenditures will result in a reduced volume of pioneering new drugs in comparison to less innovative new drugs. We also hypothesized that additional research and development spending will result in an increased volume of pioneering new drugs in comparison to less innovative drugs. Results confirm our hypotheses. Specific policy recommendations for altering firms' incentives for the development of pioneering drugs are provided.

  2. Shopper marketing nutrition interventions: Social norms on grocery carts increase produce spending without increasing shopper budgets☆

    Science.gov (United States)

    Payne, Collin R.; Niculescu, Mihai; Just, David R.; Kelly, Michael P.

    2015-01-01

    Objectives We assessed the efficacy of an easy-to-implement shopper marketing nutrition intervention in a pilot and two additional studies to increase produce demand without decreasing store profitability or increasing shopper budgets. Methods We created grocery cart placards that detailed the number of produce items purchased (i.e., descriptive norm) at particular stores (i.e., provincial norm). The effect of these placards on produce spending was assessed across 971,706 individual person grocery store transactions aggregated by day. The pilot study designated a baseline period (in both control and intervention store) followed by installation of grocery cart placards (in the intervention store) for two weeks. The pilot study was conducted in Texas in 2012. In two additional stores, we designated baseline periods followed by 28 days of the same grocery cart placard intervention as in the pilot. Additional interventions were conducted in New Mexico in 2013. Results The pilot study resulted in a significant difference between average produce spending per day per person across treatment periods (i.e., intervention versus same time period in control) (16%) and the difference between average produce spending per day per person across stores in the control periods (4%); Furthermore, the same intervention in two additional stores resulted in significant produce spending increases of 12.4% and 7.5% per day per person respectively. In all stores, total spending did not change. Conclusions Descriptive and provincial social norm messages (i.e., on grocery cart placards) may be an overlooked tool to increase produce demand without decreasing store profitability and increasing shopper budgets. PMID:26844084

  3. Recession contributes to slowest annual rate of increase in health spending in five decades.

    Science.gov (United States)

    Martin, Anne; Lassman, David; Whittle, Lekha; Catlin, Aaron

    2011-01-01

    In 2009, US health care spending grew 4.0 percent--a historically low rate of annual increase--to $2.5 trillion, or $8,086 per person. Despite the slower growth, the share of the gross domestic product devoted to health spending increased to 17.6 percent in 2009 from 16.6 percent in 2008. The growth rate of health spending continued to outpace the growth of the overall economy, which experienced its largest drop since 1938. The recession contributed to slower growth in private health insurance spending and out-of-pocket spending by consumers, as well as a reduction in capital investments by health care providers. The recession also placed increased burdens on households, businesses, and governments, which meant that fewer financial resources were available to pay for health care. Declining federal revenues and strong growth in federal health spending increased the health spending share of total federal revenue from 37.6 percent in 2008 to 54.2 percent in 2009.

  4. Medicaid Fraud Control Units (MFCU) Annual Spending and Performance Statistics

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicaid Fraud Control Units (MFCU or Unit) investigate and prosecute Medicaid fraud as well as patient abuse and neglect in health care facilities. OIG certifies,...

  5. Thrown a curve. CMS' actuaries: healthcare spending will continue to increase, despite reform law promises.

    Science.gov (United States)

    Daly, Rich

    2011-08-01

    While CMS actuaries say the 2010 reform law will not slow the nation's healthcare spending in the coming decade, Mary Grealy, of the Healthcare Leadership Council, says the law "was basically a coverage bill. We just didn't get to the other half, which would be aimed at the cost-drivers in the system." She adds that the healthcare system will not control ongoing steep increases in spending until additional legislation reshapes the dominant public insurance plans.

  6. Retail Spending Potential

    Data.gov (United States)

    City and County of Durham, North Carolina — This map shows the average household spending potential for retail goods in the United States in 2012. Spending potential data measures household consumer spending...

  7. Assessing the Impact of Regeneration Spending: Lessons from the United Kingdom and the Wider World

    Science.gov (United States)

    Potts, David

    2008-01-01

    The government increased the funding for regional development agencies to 2.3 billion British Pounds in 2007/8, yet hard evidence on the effectiveness of the spending is difficult to find. Techniques for valuing benefits in difficult areas have existed for many years. They range from the hedonic methods and contingent valuation studies of…

  8. The Future of Utility Customer-Funded Energy Efficiency Programs in the United States: Projected Spending and Savings to 2025

    Energy Technology Data Exchange (ETDEWEB)

    Barbose, Galen [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Goldman, Charles [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hoffman, Ian [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Billingsley, Megan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2012-09-11

    We develop projections of future spending on, and savings from, energy efficiency programs funded by electric and gas utility customers in the United States, under three scenarios through 2025. Our analysis, which updates a previous LBNL study, relies on detailed bottom-up modeling of current state energy efficiency policies, regulatory decisions, and demand-side management and utility resource plans. The three scenarios are intended to represent a range of potential outcomes under the current policy environment (i.e., without considering possible major new policy developments). By 2025, spending on electric and gas efficiency programs (excluding load management programs) is projected to double from 2010 levels to $9.5 billion in the medium case, compared to $15.6 billion in the high case and $6.5 billion in the low case. Compliance with statewide legislative or regulatory savings or spending targets is the primary driver for the increase in electric program spending through 2025, though a significant share of the increase is also driven by utility DSM planning activity and integrated resource planning. Our analysis suggests that electric efficiency program spending may approach a more even geographic distribution over time in terms of absolute dollars spent, with the Northeastern and Western states declining from over 70% of total U.S. spending in 2010 to slightly more than 50% in 2025, with the South and Midwest splitting the remainder roughly evenly. Under our medium case scenario, annual incremental savings from customer-funded electric energy efficiency programs increase from 18.4 TWh in 2010 in the U.S. (which is about 0.5% of electric utility retail sales) to 28.8 TWh in 2025 (0.8% of retail sales). These savings would offset the majority of load growth in the Energy Information Administration’s most recent reference case forecast, given specific assumptions about the extent to which future energy efficiency program savings are captured in that forecast

  9. Status of Family Support Services and Spending in the United States.

    Science.gov (United States)

    Parish, Susan L.; Braddock, David; Hemp, Richard; Rizzolo, Mary C.

    2000-01-01

    Analysis of data on family support services and spending for individuals with developmental disabilities presents information on cash subsidy payments, respite care, and other family support. A graph shows U.S. spending for family support, 1986-1998. Additional tables break down subsidy spending for family support services by state in 1998 and…

  10. Shopper marketing nutrition interventions: Social norms on grocery carts increase produce spending without increasing shopper budgets

    Directory of Open Access Journals (Sweden)

    Collin R. Payne

    2015-01-01

    Conclusions: Descriptive and provincial social norm messages (i.e., on grocery cart placards may be an overlooked tool to increase produce demand without decreasing store profitability and increasing shopper budgets.

  11. County Spending

    Data.gov (United States)

    Montgomery County of Maryland — This dataset includes County spending data for Montgomery County government. It does not include agency spending. Data considered sensitive or confidential and will...

  12. Refining estimates of public health spending as measured in national health expenditures accounts: the United States experience.

    Science.gov (United States)

    Sensenig, Arthur L

    2007-01-01

    Providing for the delivery of public health services and understanding the funding mechanisms for these services are topics of great currency in the United States. In 2002, the Department of Homeland Security was created and the responsibility for providing public health services was realigned among federal agencies. State and local public health agencies are under increased financial pressures even as they shoulder more responsibilities as the vital first link in the provision of public health services. Recent events, such as hurricanes Katrina and Rita, served to highlight the need to accurately access the public health delivery system at all levels of government. The National Health Expenditure Accounts (NHEA), prepared by the National Health Statistics Group, measure expenditures on healthcare goods and services in the United States. Government public health activity constitutes an important service category in the NHEA. In the most recent set of estimates, Government Public Health Activity expenditures totaled $56.1 billion in 2004, or 3.0 percent of total US health spending. Accurately measuring expenditures for public health services in the United States presents many challenges. Among these challenges is the difficult task of defining what types of government activity constitute public health services. There is no clear-cut, universally accepted definition of government public health care services, and the definitions in the proposed International Classification for Health Accounts are difficult to apply to an individual country's unique delivery systems. Other challenges include the definitional issues associated with the boundaries of healthcare as well as the requirement that census and survey data collected from government(s) be compliant with the Classification of Functions of Government (COFOG), an internationally recognized classification system developed by the United Nations.

  13. Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending.

    Science.gov (United States)

    Wouters, Olivier J; Kanavos, Panos G; McKEE, Martin

    2017-09-01

    Policy Points: Our study indicates that there are opportunities for cost savings in generic drug markets in Europe and the United States. Regulators should make it easier for generic drugs to reach the market. Regulators and payers should apply measures to stimulate price competition among generic drugmakers and to increase generic drug use. To meaningfully evaluate policy options, it is important to analyze historical context and understand why similar initiatives failed previously. Rising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs. We compared generic drug prices and market shares in 13 European countries, using data from 2013, to assess the amount of variation that exists between countries. To place these results in context, we reviewed evidence from recent studies on the prices and use of generics in Europe and the United States. We also surveyed peer-reviewed studies, gray literature, and books published since 2000 to (1) outline existing generic drug policies in European countries and the United States; (2) identify ways to increase generic drug use and to promote price competition among generic drug companies; and (3) explore barriers to implementing reform of generic drug policies, using a historical example from the United States as a case study. The prices and market shares of generics vary widely across Europe. For example, prices charged by manufacturers in Switzerland are, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. The proportion of prescriptions filled with generics ranges from 17% in Switzerland to 83% in the United Kingdom. By comparison, the United States has historically had low generic drug prices and high rates of generic drug use (84% in 2013), but has in recent years experienced sharp price increases for some off-patent products. There are policy

  14. Alcohol Use Disorders and Community-Acquired Pneumococcal Pneumonia: Associated Mortality, Prolonged Hospital Stay and Increased Hospital Spending.

    Science.gov (United States)

    Gili-Miner, Miguel; López-Méndez, Julio; Béjar-Prado, Luis; Ramírez-Ramírez, Gloria; Vilches-Arenas, Ángel; Sala-Turrens, José

    2015-11-01

    The aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. Retrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008-2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. Among 16,202 non-elective admissions for CAPP in patients aged 18-74years, 2,685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI95%: 44.3-54.3%), prolonged length of stay (2.3days; CI95%: 2.0-2.7days) and increased costs (1,869.2€; CI95%: 1,498.6-2,239.8€). According to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  15. Impact of Attention-Deficit/Hyperactivity Disorder (ADHD on prescription dug spending for children and adolescents: increasing relevance of health economic evidence

    Directory of Open Access Journals (Sweden)

    Schlander Michael

    2007-11-01

    Full Text Available Abstract Background During the last decade, pharmaceutical spending for patients with attention-deficit-hyperactivity disorder (ADHD has been escalating internationally. Objectives First, to estimate future trends of ADHD-related drug expenditures from the perspectives of the statutory health insurance (SHI; Gesetzliche Krankenversicherung, GKV in Germany and the National Health Service (NHS in England, respectively, for children and adolescents age 6 to 18 years. Second, to evaluate the budgetary impact on individual prescribers (child and adolescent psychiatrists and pediatricians treating patients with ADHD in Germany. Methods A model was developed to predict plausible scenarios of future pharmaceutical expenditures for treatment of ADHD. Model inputs were derived from demographic and epidemiological data, a literature review of past spending trends, and an analysis of new pharmaceutical products in development for ADHD. Only products in clinical development phase III or later were considered. Uncertainty was addressed by way of scenario analysis. For each jurisdiction, five scenarios used different assumptions of future diagnosis prevalence, treatment prevalence, rates of adoption and unit costs of novel drugs, and treatment intensity. Results Annual ADHD pharmacotherapy expenditures for children and adolescents will further increase and may exceed €310 m (D; E: ₤78 m in 2012 (2002: ~€21.8 m; ~₤7.0 m. During this period, overall drug spending by individual physicians may increase 2.3- to 9.5-fold, resulting from the multiplicative effects of four variables: increased number of diagnosed cases, growing acceptance and intensity of pharmacotherapy, and higher unit costs of novel medications. Discussion Even for an extreme low case scenario, a more than six-fold increase of pharmaceutical spending for children and adolescents is predicted over the decade from 2002 to 2012, from the perspectives of both the NHS in England and the GKV in

  16. Marketplace Subsidies: Changing The 'Family Glitch' Reduces Family Health Spending But Increases Government Costs.

    Science.gov (United States)

    Buettgens, Matthew; Dubay, Lisa; Kenney, Genevieve M

    2016-07-01

    Under the Affordable Care Act, if one family member has an employer offer of single coverage deemed to be affordable-that is, costing less than 9.66 percent of family income in 2016-then all family members are ineligible for tax credits for Marketplace coverage, even if the cost of providing coverage to the whole family is greater than 9.66 percent of income. More than six million people live in such families and as a result are ineligible for premium tax credits. These families face premiums that can amount to 15.8 percent of income, or 12.0 percent after the tax advantages of employer-sponsored health coverage are factored in. We modeled the potential impact of changing the affordability test to take into account the cost of family coverage. Doing so would reduce spending on premiums from 12.0 percent to 6.3 percent of income, significantly alleviating financial burdens, but would generate little additional coverage. We estimated the additional costs to the federal government for premium tax credits and cost-sharing reductions to be between $3.7 billion and $6.5 billion in 2016.

  17. France, Germany, Greece and the United Kingdom: An Analysis and Comparison of Budget Deficits and Defense Spending

    Science.gov (United States)

    2011-09-01

    different from their budgeted expenditure. Differences in national tax regimes and the treatment of pension contributions can lead to significant...budget deficit and military spending. These findings might be justified by legislative inertia and contractural obligations. Results for a

  18. Sustaining Spending

    Institute of Scientific and Technical Information of China (English)

    Liu Xinlian

    2012-01-01

    Huang Mei,a migrant worker from Sichuan Province now living in Beijing,is satisfied with her income.She earns 3,000 yuan ($473) per month as a cleaner in a department and an additional 2,000 yuan ($316) from household cleaning."Although I have to work long hours,I am happy to earn 5,000 yuan ($790) a month.As far as I know my income was even higher than some university graduates," said Huang.Huang's husband also earns around 5,000yuan as a courier in Beijing.For many Chinese,the past year has been one of increases in wages,because of various government policies.Increased incomes will inevitably help boost consumption.According to the National Bureau of Statistics (NBS),retail sales of consumer goods totaled 16.35 trillion yuan ($2.58trillion) in the first 11 month of 2011,growing 17 percent year on year.It's foreseeable that the government is sure to continue its efforts to boost residential income.Fan Jianping,chief economist with the State Information Center,estimates that retail sales of consumer goods may grow by 13.2percent in 2012,and nominal growth in the indicator will likely be 17 percent.

  19. CMS Drug Spending

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS has released several information products that provide spending information for prescription drugs in the Medicare and Medicaid programs. The CMS Drug Spending...

  20. Increasing certification through unit-based education.

    Science.gov (United States)

    Fischer-Cartlidge, Erica; Mahon, Suzanne

    2014-04-01

    Certification has been identified by multiple organizations as an important component and means of elevating the level of nursing care provided to patients and demonstrating to the public that the nursing staff has subspecialty knowledge. Certification may lead to improved patient satisfaction and outcomes as well as increased nurse satisfaction and retention. Despite the known potential benefits associated with certification, institutions struggle to improve certification rates. One possible method to overcome system barriers to certification is the implementation of a unit-based study course to prepare nurses for the Certified Breast Care Nurse (CBCN) examination. Data collected by an author-developed tool as one institution created and executed a unit-based study course suggest that such an approach increased certification rates and improved disease-specific knowledge and confidence among the staff, despite no official data existing on the tool's reliability and validity. Implementation of similar programs may be successful in improving certification at other institutions seeking to raise certification rates.

  1. National trends in spending on and use of oral oncologics, first quarter 2006 through third quarter 2011.

    Science.gov (United States)

    Conti, Rena M; Fein, Adam J; Bhatta, Sumita S

    2014-10-01

    Oral prescription drugs are an increasingly important treatment option for cancer. Yet contemporaneous US trends in spending on anticancer drugs known as oral oncologics have not been described. Using nationally representative data, we describe trends in national spending on and use of forty-seven oral oncologics between the first quarter of 2006 and the third quarter of 2011. Average quarterly national spending on oral oncologics increased 37 percent, from $940.3 million to $1.4 billion in 2012 dollars, a significant change. Average quarterly use of oral oncologics in the same time period measured in extended units increased at a significant pace but more slowly than spending (10 percent). Within this broader trend, differences in spending among categories of oral oncologics were observed. High levels of and increases in both spending and use were concentrated among new brand-name and patent-protected oral oncologics, including second-generation tyrosine kinase inhibitors used to treat chronic myelogenous leukemia. Decreased spending but increased use was observed among oral oncologics that lost patent protection during the study period and were available in generic form, including hormonal therapies used to treat breast and prostate cancers. Spending on new and patent-protected oral oncologics and associated price increases are significant drivers of increased spending.

  2. Spending and Cutting are Two Different Worlds

    DEFF Research Database (Denmark)

    Houlberg, Kurt; Olsen, Asmus Leth; Holm Pedersen, Lene

    2016-01-01

    deserving receive the highest cuts. Ideology matters as left-wing councillors prefer more vague categories when cutting and prioritise childcare and unemployment policies when increasing spending. In contrast, right-wing councillors prefer to cut administration and increase spending on roads....

  3. Medicare Hospital Spending by Claim

    Data.gov (United States)

    U.S. Department of Health & Human Services — Also known as Medicare Spending per Beneficiary (MSPB) Spending Breakdowns by Claim Type file. The data displayed here show average spending levels during...

  4. To Spend, or Not to Spend

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    While it has become a stereotype that Chinese save their money and spend very little, millions of Chinese suffer from the opposite. Zhou Fugui, who migrated to Beijing several years ago from a destitute rural area, currently operates a vegetable stand and earns a little over 1,000 yuan every month. While this income is three times what he earned as a farmer in his hometown, he still finds it difficult to make ends meet and has had to borrow from people from his home

  5. Medical Spending in Denmark

    DEFF Research Database (Denmark)

    Christensen, Bent Jesper; Kallestrup-Lamb, Malene; Gørtz, Mette

    2016-01-01

    Using full population longitudinal data from merged administrative registers for Denmark, we document that medical spending is highly concentrated in the population, and persistent through time at the individual level. In addition, we provide overviews of institutional details of the Danish health...

  6. Geography of conservation spending, biodiversity, and culture.

    Science.gov (United States)

    McClanahan, T R; Rankin, P S

    2016-10-01

    We used linear and multivariate models to examine the associations between geography, biodiversity, per capita economic output, national spending on conservation, governance, and cultural traits in 55 countries. Cultural traits and social metrics of modernization correlated positively with national spending on conservation. The global distribution of this spending culture was poorly aligned with the distribution of biodiversity. Specifically, biodiversity was greater in the tropics where cultures tended to spend relatively less on conservation and tended to have higher collectivism, formalized and hierarchical leadership, and weaker governance. Consequently, nations lacking social traits frequently associated with modernization, environmentalism, and conservation spending have the largest component of Earth's biodiversity. This has significant implications for setting policies and priorities for resource management given that biological diversity is rapidly disappearing and cultural traits change slowly. Therefore, we suggest natural resource management adapt to and use characteristics of existing social organization rather than wait for or promote social values associated with conservation spending. Supporting biocultural traditions, engaging leaders to increase conservation commitments, cross-national efforts that complement attributes of cultures, and avoiding interference with nature may work best to conserve nature in collective and hierarchical societies. Spending in modernized nations may be a symbolic response to a symptom of economic development and environmental degradation, and here conservation actions need to ensure that biodiversity is not being lost. © 2016 Society for Conservation Biology.

  7. Trends in increasing gas-turbine units efficiency

    Science.gov (United States)

    Lebedev, A. S.; Kostennikov, S. V.

    2008-06-01

    A review of the latest models of gas-turbine units (GTUs) manufactured by leading firms of the world is given. With the example of units made by General Electric, Siemens, and Alstom, modern approaches to the problem of increasing the efficiency of gas-turbine units are dealt with. Basic principles of designing of moderate-size capacity gas turbine units are discussed, and comparison between characteristics of foreign-made GTUs belonging to this class and the advanced domestic GTE-65 unit is made.

  8. Lottery spending: a non-parametric analysis.

    Science.gov (United States)

    Garibaldi, Skip; Frisoli, Kayla; Ke, Li; Lim, Melody

    2015-01-01

    We analyze the spending of individuals in the United States on lottery tickets in an average month, as reported in surveys. We view these surveys as sampling from an unknown distribution, and we use non-parametric methods to compare properties of this distribution for various demographic groups, as well as claims that some properties of this distribution are constant across surveys. We find that the observed higher spending by Hispanic lottery players can be attributed to differences in education levels, and we dispute previous claims that the top 10% of lottery players consistently account for 50% of lottery sales.

  9. Lottery spending: a non-parametric analysis.

    Directory of Open Access Journals (Sweden)

    Skip Garibaldi

    Full Text Available We analyze the spending of individuals in the United States on lottery tickets in an average month, as reported in surveys. We view these surveys as sampling from an unknown distribution, and we use non-parametric methods to compare properties of this distribution for various demographic groups, as well as claims that some properties of this distribution are constant across surveys. We find that the observed higher spending by Hispanic lottery players can be attributed to differences in education levels, and we dispute previous claims that the top 10% of lottery players consistently account for 50% of lottery sales.

  10. Deficits, public debt dynamics, and tax and spending multipliers

    OpenAIRE

    Denes, Matthew; Eggertsson, Gauti B.; Gilbukh, Sophia

    2012-01-01

    Cutting government spending on goods and services increases the budget defi cit if the nominal interest rate is close to zero. This is the message of a simple but standard New Keynesian DSGE model calibrated with Bayesian methods. The cut in spending reduces output and thus - holding rates for labor and sales taxes constant - reduces revenues by even more than what is saved by the spending cut. Similarly, increasing sales taxes can increase the budget defi cit rather than reduce it. Both resu...

  11. Medical Spending in Denmark

    DEFF Research Database (Denmark)

    Christensen, Bent Jesper; Gørtz, Mette; Kallestrup-Lamb, Malene

    2016-01-01

    is responsible for more than twice as much spending on health as the richest, and this reverse social gradient is even stronger for long-term care and is stronger among men than among women, especially in hospital expenses. Expenditures in the year (over the three years) before death are nearly 12 times...... care system, aggregate trends in health care expenditures, and the relevant register data. Nearly two thirds of expenditures are on hospitals and one fifth on long-term care, with the remainder roughly equally split between primary care and prescription drugs. Health expenditures are higher for men...... than for women from age 61 to 78, and otherwise higher for women. Between ages 50 and 80, hospital expenditures more than triple for men while more than doubling for women, and total health expenditures quadruple for men while tripling for women. The top 1 per cent of all spenders account for nearly...

  12. Local Medicaid home- and community-based services spending and nursing home admissions of younger adults.

    Science.gov (United States)

    Thomas, Kali S; Keohane, Laura; Mor, Vincent

    2014-11-01

    We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states' efforts to expand HCBS for this population should continue.

  13. Federal mandatory spending caps vital for health care reform.

    Science.gov (United States)

    Domenici, P V

    1992-01-01

    Rising health spending creates an increasing burden on families, businesses, and government. Federal health spending--chiefly on Medicare and Medicaid--is a major contributor to a budget deficit that threatens to exceed $400 billion. In order to control that deficit, the President and the Congress must cap mandatory spending, excluding Social Security. In turn, policymakers should adopt health reforms to fit spending within the cap including enrolling more consumers in managed care plans, resolving medical liability disputes in arbitration instead of courts, and increasing assessment of research into cost-effective new technology.

  14. Public spending on rural tourism in Sweden

    Directory of Open Access Journals (Sweden)

    Åsa Almstedt

    2016-02-01

    Full Text Available Tourism is an important part of rural policies in European countries. An increased demand for rural amenities is seen as creating a more diversified labour market and contributing to the restructuring of the economy, from primary sectors and manufacturing to a more service-oriented economy, which has been termed a “new rural economy”. As a result, and as often presented in many policy documents, tourism is now seen as a universal tool for rural development. The purpose of this study is to investigate the distribution of public spending on tourism in rural areas in Sweden. It focuses on public spending on the main programme for rural development, the Swedish rural development programme, but also on the regional structural funds programmes, from 2000 to 2013. Another subject of interest is how policy makers understand rural tourism as presented in policy documents since these documents, to a great extent, direct programme spending in terms of projects and their content. This study is based on register data on programme spending, policy documents and programme evaluation reports. Results show that a relatively small amount of total public spending targets tourism – mainly going to accommodation, activities and marketing efforts – indicating that tourism is still not a prioritised area despite policy makers’ understanding of rural tourism as expressed in policy documents. Thus, although public efforts target adequate parts of the tourism industry, they cannot be expected to contribute significantly to the restructuring of the rural economy.

  15. Increasing fungal infections in the intensive care unit

    NARCIS (Netherlands)

    Pauw, B.E. de

    2006-01-01

    BACKGROUND: Yeasts and molds now rank among the most common pathogens in intensive care units. Whereas the incidence of Candida infections peaked in the late 1970s, aspergillosis is still increasing. METHOD: Review of the pertinent English-language literature. RESULTS: Most factors promoting an inva

  16. Hospital Quality And Intensity Of Spending: Is There An Association?

    OpenAIRE

    Yasaitis, Laura; Fisher, Elliott S.; Skinner, Jonathan S.; Chandra, Amitabh

    2009-01-01

    Numerous studies in the United States have examined the association between quality and spending at the regional level. In this paper we evaluate this relationship at the level of individual hospitals, which are a more natural unit of analysis for reporting on and improving accountability. For all of the quality indicators studied, the association with spending is either nil or negative. The absence of positive correlations suggests that some institutions achieve exemplary performance on qual...

  17. CMS releases data on drug spending

    OpenAIRE

    Robbins RA

    2016-01-01

    No abstract available. Article truncated at 150 words. Yesterday (11/14/16) the Centers for Medicare and Medicaid Services (CMS) released data on spending for drugs under Medicare and Medicaid (1,2). Medicare paid $137.4 billion on drugs covered by its prescription drug benefit in 2015. About $8.7 billion of that spending occurred on drugs that had "large" price hikes, defined as a more than 25 percent increase between 2014 and 2015. In 2015, Medicaid paid $57.3 billion about $5.1 billion of ...

  18. CMS releases data on drug spending

    OpenAIRE

    2016-01-01

    No abstract available. Article truncated at 150 words. Yesterday (11/14/16) the Centers for Medicare and Medicaid Services (CMS) released data on spending for drugs under Medicare and Medicaid (1,2). Medicare paid $137.4 billion on drugs covered by its prescription drug benefit in 2015. About $8.7 billion of that spending occurred on drugs that had "large" price hikes, defined as a more than 25 percent increase between 2014 and 2015. In 2015, Medicaid paid $57.3 billion about $5.1 billion of ...

  19. Government Spending and Legislative Organization

    DEFF Research Database (Denmark)

    Egger, Peter; Köthenbürger, Marko

    discontinuities in the legal rule that relates population size of a municipality to council size to identify a causal relationship between council size and public spending, and find a robust positive impact of council size on spending. Moreover, we show that municipalities primarily adjust current expenditure...

  20. Government spending and legislative organization

    DEFF Research Database (Denmark)

    Egger, Peter; Köthenbürger, Marko

    2010-01-01

    discontinuities in the legal rule that relate population size of a municipality in order to council size to identify a causal relationship between council size and public spending, and find a robust positive impact of council size on spending. Moreover, we show that municipalities primarily adjust current...

  1. Spending Reviews – a Tool to Support the Effcient Management of Public Funds

    Directory of Open Access Journals (Sweden)

    Marta Postuła

    2017-06-01

    Full Text Available Purpose: Respective European Union member states’ interest in using spending reviews varies as there are no international mandatory regulations. The EU legislation contains general indications as to maintaining a rational fscal policy, from the provisions of the TFUE, expanded in the Pact for Stability and Growth, and elaborated in 2011. Methodology: Adopting an interpretative research approach, this article elaborates a multiple explanatory case study design to discover how existing theories about public spending reviews are conceptualized by practitioners in their natural contexts. Findings: The deteriorated state of many countries’ public fnances, as a result of the global fnancial crisis, has increased the interest in advanced innovative consolidation and fscal stabilization methods. Spending reviews are among the most developed and advanced methods. Such reviews were conducted both by countries that had applied this instrument before (Netherlands, Denmark, Finland, United Kingdom, Australia, and by those that introduced them for the frst time (Ireland, Canada, France. However, reviews are applied in countries characterized by signifcant economic advancement and mature public management systems. Originality: This article analyses and draws conclusions from several selected countries’ experience to date in using spending reviews. The budget functions are compared using information from the implementation of the spending reviews. This article contributes to flling two main gaps identifed in the literature review.

  2. Increasing Vaccination Rates in a Pediatric Chronic Hemodialysis Unit.

    Science.gov (United States)

    Geer, Jessica J

    2016-01-01

    Children with chronic kidney disease (CKD) are at an increased risk for serious complications from vaccine-preventable childhood diseases. Despite this risk, vaccination rates remain low. The barriers to vaccination in the pediatric population on dialysis are multifactorial. The advanced practice registered nurse (APRN) is well poised to serve as a wellness champion for this chronic population. This article chronicles an APRN-led quality improvement project to increase vaccination rates to 100% in an outpatient pediatric population on hemodialysis. A quality improvement system was created to systematically review immunizations upon admission to the hemodialysis unit and annually thereafter. Over a two-year period, immunization rates improved significantly.

  3. Smart Shopping Carts: How Real-Time Feedback Influences Spending

    NARCIS (Netherlands)

    Ittersum, van K.; Wansink, B.; Pennings, J.M.E.; Sheehan, D.

    2013-01-01

    Although interest in smart shopping carts is increasing, both retailers and consumer groups have concerns about how real-time spending feedback will influence shopping behavior. Building on budgeting and spending theories, the authors conduct three lab and grocery store experiments that robustly sho

  4. Smart shopping carts : How real-time feedback influences spending

    NARCIS (Netherlands)

    van Ittersum, Koert; Wansink, B.; Pennings, J.M.E.; Sheehan, D.

    2013-01-01

    Although interest in smart shopping carts is increasing, both retailers and consumer groups have concerns about how real-time spending feedback will influence shopping behavior. Building on budgeting and spending theories, the authors conduct three lab and grocery store experiments that robustly sho

  5. Smart Shopping Carts: How Real-Time Feedback Influences Spending

    NARCIS (Netherlands)

    Ittersum, van K.; Wansink, B.; Pennings, J.M.E.; Sheehan, D.

    2013-01-01

    Although interest in smart shopping carts is increasing, both retailers and consumer groups have concerns about how real-time spending feedback will influence shopping behavior. Building on budgeting and spending theories, the authors conduct three lab and grocery store experiments that robustly sho

  6. Smart shopping carts : How real-time feedback influences spending

    NARCIS (Netherlands)

    van Ittersum, Koert; Wansink, B.; Pennings, J.M.E.; Sheehan, D.

    2013-01-01

    Although interest in smart shopping carts is increasing, both retailers and consumer groups have concerns about how real-time spending feedback will influence shopping behavior. Building on budgeting and spending theories, the authors conduct three lab and grocery store experiments that robustly sho

  7. Smart shopping carts : How real-time feedback influences spending

    NARCIS (Netherlands)

    van Ittersum, Koert; Wansink, B.; Pennings, J.M.E.; Sheehan, D.

    2013-01-01

    Although interest in smart shopping carts is increasing, both retailers and consumer groups have concerns about how real-time spending feedback will influence shopping behavior. Building on budgeting and spending theories, the authors conduct three lab and grocery store experiments that robustly

  8. Smart Shopping Carts: How Real-Time Feedback Influences Spending

    NARCIS (Netherlands)

    Ittersum, van K.; Wansink, B.; Pennings, J.M.E.; Sheehan, D.

    2013-01-01

    Although interest in smart shopping carts is increasing, both retailers and consumer groups have concerns about how real-time spending feedback will influence shopping behavior. Building on budgeting and spending theories, the authors conduct three lab and grocery store experiments that robustly

  9. Optimal savings and health spending over the life cycle.

    Science.gov (United States)

    Fioroni, Tamara

    2010-08-01

    This paper investigates the relationship between saving and health spending in a two-period overlapping generations economy. Individuals work in the first period of life and live in retirement in old age. Health spending is an activity that increases quality of life and longevity. Empirical evidence shows that both health spending and saving behave as luxury goods but their behaviour differs markedly according to the level of per capita GDP. The share of saving on GDP has a concave shape with respect to per capita GDP, whereas the share of health spending on GDP increases more than proportionally with respect to per capita GDP. The ratio of saving to spending is nonlinear with respect to income, i.e. first increasing and then decreasing. This ratio, in the proposed model, is equal to the ratio between the elasticity of the utility function with respect to saving and the elasticity of the utility function with respect to health.

  10. National health spending in 2013: growth slows, remains in step with the overall economy.

    Science.gov (United States)

    Hartman, Micah; Martin, Anne B; Lassman, David; Catlin, Aaron

    2015-01-01

    In 2013 US health care spending increased 3.6 percent to $2.9 trillion, or $9,255 per person. The share of gross domestic product devoted to health care spending has remained at 17.4 percent since 2009. Health care spending decelerated 0.5 percentage point in 2013, compared to 2012, as a result of slower growth in private health insurance and Medicare spending. Slower growth in spending for hospital care, investments in medical structures and equipment, and spending for physician and clinical care also contributed to the low overall increase. Project HOPE—The People-to-People Health Foundation, Inc.

  11. Medicare Hospital Spending Per Patient - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...

  12. Medicare Hospital Spending Per Patient - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...

  13. Medicare Hospital Spending Per Patient - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...

  14. Spending more money, saving more lives? The relationship between avoidable mortality and healthcare spending in 14 countries

    NARCIS (Netherlands)

    Heijink, R.; Koolman, X.; Westert, G.P.

    2013-01-01

    Healthcare expenditures rise as a share of GDP in most countries, raising questions regarding the value of further spending increases. Against this backdrop, we assessed the value of healthcare spending growth in 14 western countries between 1996 and 2006. We estimated macro-level health production

  15. Spending Disclosure - Fiscal Year 2012

    Data.gov (United States)

    Montgomery County of Maryland — The purpose of this Spending Disclosure Fiscal Year 12 dataset is to allow the public to search and view summary information on payments made to recipients (referred...

  16. [Patients requiring high healthcare spending].

    Science.gov (United States)

    Niehaus, F

    2008-03-01

    Data from private insurance companies make it possible to analyse how healthcare spending is distributed across individuals, how it depends on the age of the people and how it changes over time. Within age groups, healthcare spending is less concentrated if recipients are older. Over the analysed period of time, a considerable levelling of expenses takes place. These findings lead to the conclusion that the ageing population will result in a greater and more evenly spread utilisation of healthcare facilities.

  17. Increased variability of tornado occurrence in the United States.

    Science.gov (United States)

    Brooks, Harold E; Carbin, Gregory W; Marsh, Patrick T

    2014-10-17

    Whether or not climate change has had an impact on the occurrence of tornadoes in the United States has become a question of high public and scientific interest, but changes in how tornadoes are reported have made it difficult to answer it convincingly. We show that, excluding the weakest tornadoes, the mean annual number of tornadoes has remained relatively constant, but their variability of occurrence has increased since the 1970s. This is due to a decrease in the number of days per year with tornadoes combined with an increase in days with many tornadoes, leading to greater variability on annual and monthly time scales and changes in the timing of the start of the tornado season. Copyright © 2014, American Association for the Advancement of Science.

  18. Can Food Stamps Do More to Improve Food Choices? An Economic Perspective-Food Spending Patterns of Low-Income Households: Will Increasing Purchasing Power Result in Healthier Food Choices?

    OpenAIRE

    Frazao, Elizabeth; Andrews, Margaret S.; Smallwood, David M.; Prell, Mark A.

    2007-01-01

    The Food Stamp Program provides benefits that low-income households can use to purchase food in grocery stores. The rise in obesity has raised the question of whether food stamp participants would purchase more healthy foods, such as fruits and vegetables, if food stamp benefits were higher. This report examines household food spending patterns and how they differ across income levels to provide insight into how participants might change their food spending in response to additional income.

  19. Implications of Germany's declining defense spending

    OpenAIRE

    Merrath, Jurgen

    2000-01-01

    With its reunification on 3 October 1990, Germany regained its full sovereignty and stands now in a position of greater global responsibility. Faced with dramatically increased demands on and expectations for Germany's armed forces, it must answer the question of how much it is willing to invest for safety and stability in Europe and for protection of peace in the world. In determining the level of commitment behind Germany's foreign and security policy, defense spending is an important indic...

  20. National Health Expenditure Projections, 2015-25: Economy, Prices, And Aging Expected To Shape Spending And Enrollment.

    Science.gov (United States)

    Keehan, Sean P; Poisal, John A; Cuckler, Gigi A; Sisko, Andrea M; Smith, Sheila D; Madison, Andrew J; Stone, Devin A; Wolfe, Christian J; Lizonitz, Joseph M

    2016-08-01

    Health spending growth in the United States for 2015-25 is projected to average 5.8 percent-1.3 percentage points faster than growth in the gross domestic product-and to represent 20.1 percent of the total economy by 2025. As the initial impacts associated with the Affordable Care Act's coverage expansions fade, growth in health spending is expected to be influenced by changes in economic growth, faster growth in medical prices, and population aging. Projected national health spending growth, though faster than observed in the recent history, is slower than in the two decades before the recent Great Recession, in part because of trends such as increasing cost sharing in private health insurance plans and various Medicare payment update provisions. In addition, the share of total health expenditures paid for by federal, state, and local governments is projected to increase to 47 percent by 2025.

  1. CMS releases data on drug spending

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-11-01

    Full Text Available No abstract available. Article truncated at 150 words. Yesterday (11/14/16 the Centers for Medicare and Medicaid Services (CMS released data on spending for drugs under Medicare and Medicaid (1,2. Medicare paid $137.4 billion on drugs covered by its prescription drug benefit in 2015. About $8.7 billion of that spending occurred on drugs that had "large" price hikes, defined as a more than 25 percent increase between 2014 and 2015. In 2015, Medicaid paid $57.3 billion about $5.1 billion of which was spent on drugs that had large price increases. The Medicare spending database highlights 11 drugs that doubled in price. The Medicaid database identified 20 drugs that more than doubled in price with 9 of these being old, generic drugs. Medicare drugs were led by Glumetza, a Type 2 diabetes drug which saw its price soar 380 percent and hydroxychloroquine sulfate, a generic malaria drug, which went up 370 percent. Medicaid drugs were led by Ativan, an anti-anxiety ...

  2. Higher US branded drug prices and spending compared to other countries may stem partly from quick uptake of new drugs.

    Science.gov (United States)

    Kanavos, Panos; Ferrario, Alessandra; Vandoros, Sotiris; Anderson, Gerard F

    2013-04-01

    The United States spends considerably more per capita on prescription drugs than other countries in the Organization for Economic Cooperation and Development (OECD). Drawing on the Intercontinental Medical Statistics Midas database, we examined the variation in drug prices among selected OECD countries in 2005, 2007, and 2010 to determine which country paid the highest prices for brand-name drugs, what factors led to variation in per capita drug spending, and what factors contributed to the rate of increase in drug spending. We found that depending on how prices were weighted for volume across the countries, brand-name prescription drug prices were 5-198 percent higher in the United States than in the other countries in all three study years. (A limitation is that many negotiated price discounts obtained in the United States may not be fully reflected in the results of this study.) A contributor to higher US per capita drug spending is faster uptake of new and more expensive prescription drugs in the United States relative to other countries. In contrast, the other OECD countries employed mechanisms such as health technology assessment and restrictions on patients' eligibility for new prescription drugs, and they required strict evidence of the value of new drugs. Similarly, US health care decision makers could consider requiring pharmaceutical manufacturers to provide more evidence about the value of new drugs in relation to the cost and negotiating prices accordingly.

  3. A Golden Week to Spend

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    The weeklong National Day holiday sees a record spending blowout, displaying the huge potential of the Chinese consumption market Rong Xinchun, 38, works at a research institute in Beijing. Recently married,he chose to have his wedding during the National Day holiday because both his family and guests had enough time to enjoy the festivities.

  4. School Library Journal's Spending Survey

    Science.gov (United States)

    Farmer, Lesley; Shontz, Marilyn

    2009-01-01

    This year's "School Library Journal's" spending survey showed that, despite the recession, the vast majority of media centers around the country have retained their credentialed media specialists. For example, almost 85% of elementary schools and more than 95% of middle and high schools have a full-time certified librarian. In addition, salaries…

  5. Government Spending and Legislative Organization

    DEFF Research Database (Denmark)

    Egger, Peter; Köthenbürger, Marko

    This paper presents empirical evidence of a positive effect of council size on government spending using a data set of 2,056 municipalities in the German state of Bavaria over a period of 21 years. We apply a regression discontinuity design to avoid an endogeneity bias. In particular, we exploit...

  6. School Library Journal's Spending Survey

    Science.gov (United States)

    Farmer, Lesley; Shontz, Marilyn

    2009-01-01

    This year's "School Library Journal's" spending survey showed that, despite the recession, the vast majority of media centers around the country have retained their credentialed media specialists. For example, almost 85% of elementary schools and more than 95% of middle and high schools have a full-time certified librarian. In addition, salaries…

  7. Public health spending and population health: a systematic review.

    Science.gov (United States)

    Singh, Simone R

    2014-11-01

    This systematic review synthesizes what is known about the relationship between public health spending and population health outcomes, as well as the pathways that may explain how outcomes vary with spending. It also discusses the limitations of the existing literature and identifies areas in need of future research. Studies included in this review were retrieved through an iterative process, primarily through key word searches in two literature databases (PubMed and JSTOR) conducted in 2013. All retrieved studies underwent initial and secondary screening. Articles were included if they (1) examined the link between spending and outcomes or (2) explored pathways that mediate the relationship between spending and outcomes. Seventeen empirical studies and five literature reviews published between 1985 and 2012 were included in this review. Existing evidence suggests that increases in public health spending are associated with improved population health, at least for some outcomes. However, there is little evidence to suggest that increased spending contributes to meaningful reductions in health disparities. Moreover, the pathways through which greater spending translates into better outcomes are not well understood. Although the complexity of the public health delivery system makes it difficult to demonstrate definitive associations between spending and outcomes, financial investments in public health have the potential to improve community health. Additional research is needed to explore the pathways that mediate this relationship. This research would benefit public health practitioners who need evidence on how to best spend financial resources to achieve better health outcomes. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  8. Health care spending growth: can we avoid fiscal Armageddon?

    Science.gov (United States)

    Chernew, Michael

    Both private and public payers have experienced a persistent rise in health care spending that has exceeded income growth. The issue now transcends the health care system because health care spending growth threatens the fiscal health of the nation. This paper examines the causes and consequences of health care spending growth. It notes that the determinants of spending growth may differ from the determinants of high spending at a point in time. Specifically, the evidence overwhelmingly suggests that the primary driver ofinflation-adjusted, per capita spending growth over the past decades (and thus premium growth) has been the diffusion of new medical technology. The paper argues that while new technology has provided significant clinical benefit, we can no longer afford the persistent gap between health spending and income growth. In simple terms, if the economy is growing 2%, we cannot afford persistent health care spending growth of 4%. Growth in public spending is particularly important. If not abated, high public spending will require either substantially higher taxes or debt, both of which could lead to fiscal Armageddon. Growth in private spending also threatens economic well-being by forcing more resources toward health care and away from other sectors. For example, since the cost of employer-based coverage is always borne by employees (directly or indirectly), salary increases and health care cost increases cannot continue on together. To avoid economic disaster, payers will be forced to have a greater resolve in the future. Specifically, because neither public nor private payers will be able to finance growing health care spending, the coming decade will likely experience significant changes in health care financing. Consumers may be asked to pay more out of pocket when they seek care and both public and private payers will put increasing pressure on payment rates. Furthermore, payment rates to providers are likely to rise more slowly than in the past

  9. Spending more money, saving more lives? The relationship between avoidable mortality and healthcare spending in 14 countries.

    Science.gov (United States)

    Heijink, Richard; Koolman, Xander; Westert, Gert P

    2013-06-01

    Healthcare expenditures rise as a share of GDP in most countries, raising questions regarding the value of further spending increases. Against this backdrop, we assessed the value of healthcare spending growth in 14 western countries between 1996 and 2006. We estimated macro-level health production functions using avoidable mortality as outcome measure. Avoidable mortality comprises deaths from certain conditions "that should not occur in the presence of timely and effective healthcare". We investigated the relationship between total avoidable mortality and healthcare spending using descriptive analyses and multiple regression models, focussing on within-country variation and growth rates. We aimed to take into account the role of potential confounders and dynamic effects such as time lags. Additionally, we explored a method to estimate macro-level cost-effectiveness. We found an average yearly avoidable mortality decline of 2.6-5.3% across countries. Simultaneously, healthcare spending rose between 1.9 and 5.9% per year. Most countries with above-average spending growth demonstrated above-average reductions in avoidable mortality. The regression models showed a significant association between contemporaneous and lagged healthcare spending and avoidable mortality. The time-trend, representing an exogenous shift of the health production function, reduced the impact of healthcare spending. After controlling for this time-trend and other confounders, i.e. demographic and socioeconomic variables, a statistically significant relationship between healthcare spending and avoidable mortality remained. We tentatively conclude that macro-level healthcare spending increases provided value for money, at least for the disease groups, countries and years included in this study.

  10. Relationship between regional spending on vascular care and amputation rate

    Science.gov (United States)

    Goodney, Philip P.; Travis, Lori L.; Brooke, Benjamin S.; DeMartino, Randall R.; Goodman, David C.; Fisher, Elliott S.; Birkmeyer, John D.

    2014-01-01

    Importance While lower extremity revascularization is effective in preventing amputation, the relationship between spending on vascular care and regional amputation rates remains unclear. Objective To test the hypothesis that higher regional spending on vascular care is associated with lower amputation rates in patients with severe peripheral arterial disease (PAD). Design Retrospective cohort study. Setting United States Medicare patients, 2003-2010 Participants 18,463 patients who underwent major PAD-related amputation. Exposures Price-adjusted Medicare spending on revascularization procedures and related vascular care in the year before lower extremity amputation, across hospital referral regions. Main Outcome Measure(s) Correlation coefficient between regional spending on vascular care and regional rates of PAD-related amputation. Results Among patients ultimately subject to amputation, 64% were admitted to the hospital in the year prior to amputation for revascularization, wound-related care, or both; 36% were admitted only for their amputation. The mean cost of inpatient care in the year before amputation, including the amputation itself, was $22,405, but varied from $11,077 (Bismarck, North Dakota) to $42,613 (Salinas, California) (pamputation rates (R=0.10, p=0.06). Regions most aggressive in the use of endovascular interventions which most likely to have high spending (R=0.42, p=0.002) and high amputation rates (R=0.40, p=0.004). Conclusions Regions that spend the most on vascular care is highest perform the most procedures, especially endovascular interventions, in the year before amputation. However, there is little evidence that higher regional spending is associated with lower amputation rates. This suggests an opportunity to limit costs in vascular care without compromising quality. PMID:24258010

  11. Towards a comprehensive estimate of national spending on prevention

    Directory of Open Access Journals (Sweden)

    Polder Johan J

    2007-09-01

    Full Text Available Abstract Background Comprehensive information about national spending on prevention is crucial for health policy development and evaluation. This study provides a comprehensive overview of prevention spending in the Netherlands, including those activities beyond the national health accounts. Methods National spending on health-related primary and secondary preventive activities was examined by funding source with the use of national statistics, government reports, sector reports, and data from individual health associations and corporations, public services, occupational health services, and personal prevention. Costs were broken down by diseases, age groups and gender using population-attributable risks and other key variables. Results Total expenditures on prevention were €12.5 billion or €769 per capita in the Netherlands in 2003, of which 20% was included in the national health accounts. 82% was spent on health protection, 16% on disease prevention, and 2% on health promotion activities. Most of the spending was aimed at the prevention of infectious diseases (34% and acute physical injuries (29%. Per capita spending on prevention increased steeply by age. Conclusion Total expenditure on health-related prevention is much higher than normally reported due to the inclusion of health protection activities beyond the national health accounts. The allocative efficiency of prevention spending, particularly the high costs of health protection and the low costs of health promotion activities, should be addressed with information on their relative cost effectiveness.

  12. [Analysis of individual spending on smoking based on the Brazilian Family Budget Survey, 2002-2003].

    Science.gov (United States)

    Kroeff, Locimara Ramos; Mengue, Sotero Serrate

    2010-12-01

    In order to discuss new parameters for assessing personal spending on smoking in Brazil, this study aimed to describe the population's socio-demographic characteristics and the proportions of spending on smoking. The sample included individuals that spend money on smoking, according to the Brazilian Family Budget Survey for 2002-2003, conducted by the Brazilian Institute of Geography and Statistics. In the lowest income bracket, the proportion of spending on smoking for expenses greater than the median varied negatively by as much as 10% as compared to the proportion of spending on smoking for income greater than the median. For intermediate income brackets, the two proportions were similar, and in the higher income brackets there was a reversal, with a positive difference of up to 15%. The percentage of spending on smoking doubled for all the groups with low schooling. As income and schooling increased, there was a proportional reduction in spending on smoking.

  13. US health spending trends by age and gender: selected years 2002-10.

    Science.gov (United States)

    Lassman, David; Hartman, Micah; Washington, Benjamin; Andrews, Kimberly; Catlin, Aaron

    2014-05-01

    This article presents estimates of personal health care spending by age and gender in selected years during the period 2002-10 and an analysis of the variation in spending among children, working-age adults, and the elderly. Our research found that in this period, aggregate spending on children's health care increased at the slowest rate. However, per capita spending for children grew more rapidly than that for working-age adults and the elderly. Per capita spending for the elderly remained about five times higher than spending for children. Overall, females spent more per capita than males, but the gap had decreased by 2010. The implementation of Medicare Part D, the effects of the recent recession, and the aging of the baby boomers affected the spending trends and distributions during the period of this study.

  14. 50 CFR 86.73 - What if I do not spend all the money?

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false What if I do not spend all the money? 86.73 Section 86.73 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE... GRANT (BIG) PROGRAM How States Manage Grants § 86.73 What if I do not spend all the money? Funds...

  15. Bulk energy storage increases United States electricity system emissions.

    Science.gov (United States)

    Hittinger, Eric S; Azevedo, Inês M L

    2015-03-03

    Bulk energy storage is generally considered an important contributor for the transition toward a more flexible and sustainable electricity system. Although economically valuable, storage is not fundamentally a "green" technology, leading to reductions in emissions. We model the economic and emissions effects of bulk energy storage providing an energy arbitrage service. We calculate the profits under two scenarios (perfect and imperfect information about future electricity prices), and estimate the effect of bulk storage on net emissions of CO2, SO2, and NOx for 20 eGRID subregions in the United States. We find that net system CO2 emissions resulting from storage operation are nontrivial when compared to the emissions from electricity generation, ranging from 104 to 407 kg/MWh of delivered energy depending on location, storage operation mode, and assumptions regarding carbon intensity. Net NOx emissions range from -0.16 (i.e., producing net savings) to 0.49 kg/MWh, and are generally small when compared to average generation-related emissions. Net SO2 emissions from storage operation range from -0.01 to 1.7 kg/MWh, depending on location and storage operation mode.

  16. Money Buys Happiness When Spending Fits Our Personality.

    Science.gov (United States)

    Matz, Sandra C; Gladstone, Joe J; Stillwell, David

    2016-05-01

    In contrast to decades of research reporting surprisingly weak relationships between consumption and happiness, recent findings suggest that money can indeed increase happiness if it is spent the "right way" (e.g., on experiences or on other people). Drawing on the concept of psychological fit, we extend this research by arguing that individual differences play a central role in determining the "right" type of spending to increase well-being. In a field study using more than 76,000 bank-transaction records, we found that individuals spend more on products that match their personality, and that people whose purchases better match their personality report higher levels of life satisfaction. This effect of psychological fit on happiness was stronger than the effect of individuals' total income or the effect of their total spending. A follow-up study showed a causal effect: Personality-matched spending increased positive affect. In summary, when spending matches the buyer's personality, it appears that money can indeed buy happiness. © The Author(s) 2016.

  17. US Spending on Personal Health Care and Public Health, 1996-2013.

    Science.gov (United States)

    Dieleman, Joseph L; Baral, Ranju; Birger, Maxwell; Bui, Anthony L; Bulchis, Anne; Chapin, Abigail; Hamavid, Hannah; Horst, Cody; Johnson, Elizabeth K; Joseph, Jonathan; Lavado, Rouselle; Lomsadze, Liya; Reynolds, Alex; Squires, Ellen; Campbell, Madeline; DeCenso, Brendan; Dicker, Daniel; Flaxman, Abraham D; Gabert, Rose; Highfill, Tina; Naghavi, Mohsen; Nightingale, Noelle; Templin, Tara; Tobias, Martin I; Vos, Theo; Murray, Christopher J L

    2016-12-27

    US health care spending has continued to increase, and now accounts for more than 17% of the US economy. Despite the size and growth of this spending, little is known about how spending on each condition varies by age and across time. To systematically and comprehensively estimate US spending on personal health care and public health, according to condition, age and sex group, and type of care. Government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996 through 2013 were collected and combined. In total, 183 sources of data were used to estimate spending for 155 conditions (including cancer, which was disaggregated into 29 conditions). For each record, spending was extracted, along with the age and sex of the patient, and the type of care. Spending was adjusted to reflect the health condition treated, rather than the primary diagnosis. Encounter with US health care system. National spending estimates stratified by condition, age and sex group, and type of care. From 1996 through 2013, $30.1 trillion of personal health care spending was disaggregated by 155 conditions, age and sex group, and type of care. Among these 155 conditions, diabetes had the highest health care spending in 2013, with an estimated $101.4 billion (uncertainty interval [UI], $96.7 billion-$106.5 billion) in spending, including 57.6% (UI, 53.8%-62.1%) spent on pharmaceuticals and 23.5% (UI, 21.7%-25.7%) spent on ambulatory care. Ischemic heart disease accounted for the second-highest amount of health care spending in 2013, with estimated spending of $88.1 billion (UI, $82.7 billion-$92.9 billion), and low back and neck pain accounted for the third-highest amount, with estimated health care spending of $87.6 billion (UI, $67.5 billion-$94.1 billion). The conditions with the highest spending levels varied by age, sex, type of care, and year. Personal health care spending increased for 143 of the 155 conditions from 1996 through 2013. Spending on low

  18. Cities through the Prism of People's Spending Behavior

    CERN Document Server

    Sobolevsky, Stanislav; Combes, Remi Tachet des; Hawelka, Bartosz; Arias, Juan Murillo; Ratti, Carlo

    2015-01-01

    Scientific studies of society increasingly rely on digital traces produced by various aspects of human activity. In this paper, we use a relatively unexplored source of data, anonymized records of bank card transactions collected in Spain by a big European bank, in order to propose a new classification scheme of cities based on the economic behavior of their residents. First, we study how individual spending behavior is qualitatively and quantitatively affected by various factors such as customer's age, gender, and size of a home city. We show that, similar to other socioeconomic urban quantities, individual spending activity exhibits a statistically significant superlinear scaling with city size. With respect to the general trends, we quantify the distinctive signature of each city in terms of residents' spending behavior, independently from the effects of scale and demographic heterogeneity. Based on the comparison of city signatures, we build a novel classification of cities across Spain in three categorie...

  19. Senate panel boosts DOE spending, save Yucca account

    CERN Multimedia

    Behrens, L

    2002-01-01

    The Senate Appropriations Committee last week approved an energy and water spending bill with $21 billion for the Energy Department, $426 million more than the Bush administration requested, and $1.1 billion more than the agency received in the financial year 2000. The bill would provide increases above the Bush request and current spending across-the-board in DOE's renewable energy, nuclear energy, science, weapons complex cleanup, defense and nonproliferation programs. The only major program that would be funded below the president's request is nuclear waste disposal (1 page).

  20. State Variation in Medical Imaging: Despite Great Variation, the Medicare Spending Decline Continues.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Hughes, Danny R; Duszak, Richard

    2015-10-01

    The purpose of this study was to assess state-level trends in per beneficiary Medicare spending on medical imaging. Medicare part B 5% research identifiable files from 2004 through 2012 were used to compute national and state-by-state annual average per beneficiary spending on imaging. State-to-state geographic variation and temporal trends were analyzed. National average per beneficiary Medicare part B spending on imaging increased 7.8% annually between 2004 ($350.54) and its peak in 2006 ($405.41) then decreased 4.4% annually between 2006 and 2012 ($298.63). In 2012, annual per beneficiary spending was highest in Florida ($367.25) and New York ($355.67) and lowest in Ohio ($67.08) and Vermont ($72.78). Maximum state-to-state geographic variation increased over time, with the ratio of highest-spending state to lowest-spending state increasing from 4.0 in 2004 to 5.5 in 2012. Spending in nearly all states decreased since peaks in 2005 (six states) or 2006 (43 states). The average annual decrease among states was 5.1% ± 1.8% (range, 1.2-12.2%) The largest decrease was in Ohio. In only two states did per beneficiary spending increase (Maryland, 12.5% average annual increase since 2005; Oregon, 4.8% average annual increase since 2008). Medicare part B average per beneficiary spending on medical imaging declined in nearly every state since 2005 and 2006 peaks, abruptly reversing previously reported trends. Spending continued to increase, however, in Maryland and Oregon. Identification of state-level variation may facilitate future investigation of the potential effect of specific and regional changes in spending on patient access and outcomes.

  1. State Spending on Higher Education Capital Outlays

    Science.gov (United States)

    Delaney, Jennifer A.; Doyle, William R.

    2014-01-01

    This paper explores the role that state spending on higher education capital outlays plays in state budgets by considering the functional form of the relationship between state spending on higher education capital outlays and four types of state expenditures. Three possible functional forms are tested: a linear model, a quadratic model, and the…

  2. Government Spending Cycles: Ideological or Opportunistic?

    NARCIS (Netherlands)

    H.P. van Dalen (Hendrik); O.H. Swank (Otto)

    1996-01-01

    textabstractands. The time series analysis, covering the period 1953–1993, allows for different types of government spending. In general, spending is inspired by ideological and opportunistic motives: all government expenditure categories show an upward drift during election times and the partisan

  3. BEYOND GUNS AND BUTTER: Finnish Central Government Spending Patterns the in Twentieth Century

    Directory of Open Access Journals (Sweden)

    Jari Eloranta

    2008-01-01

    Full Text Available This paper explains the long-run demand for central government spending in Finland by analyzing quantitative and qualitative changes in the spending behavior, examining possible links between variables in a VAR-framework, and performing multivariate analysis of the demand factors. The results was shoved that a explained  by a lack of military versus social spending tradeoff effect. Even though certain other variables were found to be relevant in explaining this demand, this lack of a tradeoff increased the Finnish spending levels substantially during the twentieth centurt welfare state expansion.

  4. Health spending projections through 2017: the baby-boom generation is coming to Medicare.

    Science.gov (United States)

    Keehan, Sean; Sisko, Andrea; Truffer, Christopher; Smith, Sheila; Cowan, Cathy; Poisal, John; Clemens, M Kent

    2008-01-01

    The outlook for national health spending calls for continued steady growth. Spending growth is projected to be 6.7 percent in 2007, similar to its rate in 2006. Average annual growth over the projection period is expected to be 6.7 percent. Slower growth in private spending toward the end of the period is expected to be offset by stronger growth in public spending. The health share of gross domestic product (GDP) is expected to increase to 16.3 percent in 2007 and then rise throughout the projection period, reaching 19.5 percent of GDP by 2017.

  5. EU firms bump up R&D spend

    Science.gov (United States)

    Allen, Michael

    2017-01-01

    Companies in the European Union increased their spending on research and development (R&D) in the 2015/16 financial year at a higher rate than the global average, according to the latest EU Industrial R&D Investment Scoreboard.

  6. Analysis of capital spending and capital financing among large US nonprofit health systems.

    Science.gov (United States)

    Stewart, Louis J

    2012-01-01

    This article examines the recent trends (2006 to 2009) in capital spending among 25 of the largest nonprofit health systems in the United States and analyzes the financing sources that these large nonprofit health care systems used to fund their capital spending. Total capital spending for these 25 nonprofit health entities exceeded $41 billion for the four-year period of this study. Less than 3 percent of total capital spending resulted in mergers and acquisition activities. Total annual capital spending grew at an average annual rate of 17.6 percent during the first three year of this study's period of analysis. Annual capital spending for 2009 fell by more than 22 percent over prior year's level due to the impact of widespread disruption in US tax-exempt variable rate debt markets. While cash inflow from long-term debt issues was a significant source of capital financing, this study's primary finding was that operating cash flow was the predominant source of capital spending funding. Key words: nonprofit, mergers and acquisitions (M&A), capital spending, capital financing.

  7. Federal spending on behavioral health accelerated during recession as individuals lost employer insurance.

    Science.gov (United States)

    Levit, Katharine R; Mark, Tami L; Coffey, Rosanna M; Frankel, Sasha; Santora, Patricia; Vandivort-Warren, Rita; Malone, Kevin

    2013-05-01

    The 2007-09 recession had a dramatic effect on behavioral health spending, with the effect most prominent for private, state, and local payers. During the recession behavioral health spending increased at a 4.6 percent average annual rate, down from 6.1 percent in 2004-07. Average annual growth in private behavioral health spending during the recession slowed to 2.7 percent from 7.2 percent in 2004-07. State and local behavioral health spending showed negative average annual growth, -1.2 percent, during the recession, compared with 3.7 percent increases in 2004-07. In contrast, federal behavioral health spending growth accelerated to 11.1 percent during the recession, up from 7.2 percent in 2004-07. These behavioral health spending trends were driven largely by increased federal spending in Medicaid, declining private insurance enrollment, and severe state budget constraints. An increased federal Medicaid match reduced the state share of Medicaid spending, which prevented more drastic cuts in state-funded behavioral health programs during the recession. Federal Medicaid served as a critical safety net for people with behavioral health treatment needs during the recession.

  8. Accounting for health spending in developing countries.

    Science.gov (United States)

    Raciborska, Dorota A; Hernández, Patricia; Glassman, Amanda

    2008-01-01

    Data on health system financing and spending, together with information on the disease prevalence and cost-effectiveness of interventions, constitute essential input into health policy. It is particularly critical in developing countries, where resources are scarce and the marginal dollar has a major impact. Yet regular monitoring of health spending tends to be absent from those countries, and the results of international efforts to stimulate estimation activities have been mixed. This paper offers a history of health spending measurement, describes alternative sources of data, and recommends improving international collaboration and advocacy with the private sector for the way forward.

  9. Efficiency of Government Social Spending in Croatia

    Directory of Open Access Journals (Sweden)

    Etibar Jafarov

    2008-09-01

    Full Text Available This paper analyzes the relative efficiency of social spending and service delivery in Croatia by comparing social spending and key social (outcome indicators in Croatia to those of comparator countries. The analysis finds evidence of significant inefficiencies in Croatia’s social spending, mainly related to inadequate cost recovery for health and education services, weaknesses in the financing mechanisms and institutional arrangements, weak competition in the provision of social services, and weaknesses in targeting benefits. The paper also identifies areas for cost recovery and reform.

  10. The impact of unit cost reductions on gross profit: Increasing or decreasing returns?

    Directory of Open Access Journals (Sweden)

    Ely Dahan

    2011-09-01

    Full Text Available We suggest that marketers actively participate in reducing unit costs during new product development, consistent with the theme of integrated marketing and manufacturing. Most marketing managers misjudge the impact on gross profit of reducing variable unit manufacturing costs, mistakenly believing that such cost reductions yield decreasing or linear returns while they actually generate increasing returns.

  11. CDC Updates Spending Plans to Combat Zika

    Science.gov (United States)

    ... 161541.html CDC Updates Spending Plans to Combat Zika Some goals: prepare states for future outbreaks, and ... dollars to prepare states and cities for future Zika virus outbreaks, and to track the effects of ...

  12. 76 FR 70861 - Promoting Efficient Spending

    Science.gov (United States)

    2011-11-15

    ... developed by the OMB's Federal Strategic Sourcing Initiative to acquire printing and copying devices and.... However, to ensure efficient travel spending, agencies are encouraged to devise strategic alternatives to...

  13. How adolescents with substance use disorder spend research payments.

    Science.gov (United States)

    Thurstone, Christian; Salomensen-Sautel, Stacy; Riggs, Paula D

    2010-10-01

    There is concern that research reimbursements to adolescents may increase substance use. However, these concerns have not been examined empirically. Participants were 70 adolescents (13-19 years) with at least one non-nicotine substance use disorder (SUD) enrolled in a 12-week clinical trial of atomoxetine/placebo for attention/deficit-hyperactivity disorder (ADHD). Adolescent participants received cash reimbursement after each study visit (maximum possible = $425 over 12 weeks). Participants reported each week how they spent the previous reimbursement. Results were tallied, and correlates of spending a payment on substances were examined. Results showed that 26 of 70 subjects reported spending at least one research payment on alcohol or drugs, and 25 of 70 subjects reported spending at least one payment on tobacco. Comparing those who did and did not spend a research payment on alcohol/drugs, those who did had more frequent baseline alcohol/drug use but did not differ in demographics (age, gender) or other clinical characteristics (ADHD severity, diagnosis of conduct disorder, number of SUD diagnoses, number of treatment sessions attended, or pre/post-change in number of days used substances in the past 28 days). Comparing those who did and did not spend a payment on tobacco, those who did were slightly older and had more frequent baseline tobacco use. In conclusion, a significant proportion of subjects used at least a portion of one research payment to buy alcohol, drugs or tobacco. However, there was little indication that research payments increased substance use. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  14. Evidence for increasingly variable Palmer Drought Severity Index in the United States since 1895.

    Science.gov (United States)

    Rayne, Sierra; Forest, Kaya

    2016-02-15

    Annual and summertime trends towards increasingly variable values of the Palmer Drought Severity Index (PDSI) over a sub-decadal period (five years) were investigated within the contiguous United States between 1895 and the present. For the contiguous United States as a whole, there is a significant increasing trend in the five-year running minimum-maximum ranges for the annual PDSI (aPDSI5 yr(min|max, range)). During this time frame, the average aPDSI5 yr(min|max, range) has increased by about one full unit, indicating a substantial increase in drought variability over short time scales across the United States. The end members of the running aPDSI5 yr(min|max, range) highlight even more rapid changes in the drought index variability within the past 120 years. This increasing variability in the aPDSI5 yr(min|max, range) is driven primarily by changes taking place in the Pacific and Atlantic Ocean coastal climate regions, climate regions which collectively comprise one-third the area of the contiguous United States. Similar trends were found for the annual and summertime Palmer Hydrological Drought Index (PHDI), the Palmer Modified Drought Index (PMDI), and the Palmer Z Index (PZI). Overall, interannual drought patterns in the contiguous United States are becoming more extreme and difficult to predict, posing a challenge to agricultural and other water-resource related planning efforts.

  15. THE RELATIONSHIP BETWEEN ECONOMIC GROWTH AND GOVERNMENT SPENDING: A CASE STUDY OF OIC COUNTRIES

    Directory of Open Access Journals (Sweden)

    Heri Sudarsono

    2015-06-01

    Full Text Available This paper presents the results for testing for causal relationship between economic growth and goverment spending for OIC countries covering the time series data 1970~2006. There are usually two propositions regarding the relation between economic growth and government spending: Wagner’s Law states that as GDP grows, the public sector tends to grow; and the Keynesian framework postulates that public expenditure causes GDP to grow. The primary strength and originality of this paper is that we used aggregate data as well as disaggregate data for Granger causality test. By testing for causality between economic growth and government spending, we find that government spending does cause economic growth in Iran, Nigeria and Tunisia, which are compatible with Keynesian’s theory. However, the economic growth does cause the increase in goverment spending in Algeria, Burkina Faso, Benin, Indonesia, Libya Malaysia, Marocco, and Saudi, which are well-suited with Wagner’s law.

  16. The US healthcare workforce and the labor market effect on healthcare spending and health outcomes.

    Science.gov (United States)

    Pellegrini, Lawrence C; Rodriguez-Monguio, Rosa; Qian, Jing

    2014-06-01

    The healthcare sector was one of the few sectors of the US economy that created new positions in spite of the recent economic downturn. Economic contractions are associated with worsening morbidity and mortality, declining private health insurance coverage, and budgetary pressure on public health programs. This study examines the causes of healthcare employment growth and workforce composition in the US and evaluates the labor market's impact on healthcare spending and health outcomes. Data are collected for 50 states and the District of Columbia from 1999-2009. Labor market and healthcare workforce data are obtained from the Bureau of Labor Statistics. Mortality and health status data are collected from the Centers for Disease Control and Prevention's Vital Statistics program and Behavioral Risk Factor Surveillance System. Healthcare spending data are derived from the Centers for Medicare and Medicaid Services. Dynamic panel data regression models, with instrumental variables, are used to examine the effect of the labor market on healthcare spending, morbidity, and mortality. Regression analysis is also performed to model the effects of healthcare spending on the healthcare workforce composition. All statistical tests are based on a two-sided [Formula: see text] significance of [Formula: see text] .05. Analyses are performed with STATA and SAS. The labor force participation rate shows a more robust effect on healthcare spending, morbidity, and mortality than the unemployment rate. Study results also show that declining labor force participation negatively impacts overall health status ([Formula: see text] .01), and mortality for males ([Formula: see text] .05) and females ([Formula: see text] .001), aged 16-64. Further, the Medicaid and Medicare spending share increases as labor force participation declines ([Formula: see text] .001); whereas, the private healthcare spending share decreases ([Formula: see text] .001). Public and private healthcare spending also

  17. Machine-Learning Algorithms to Code Public Health Spending Accounts.

    Science.gov (United States)

    Brady, Eoghan S; Leider, Jonathon P; Resnick, Beth A; Alfonso, Y Natalia; Bishai, David

    Government public health expenditure data sets require time- and labor-intensive manipulation to summarize results that public health policy makers can use. Our objective was to compare the performances of machine-learning algorithms with manual classification of public health expenditures to determine if machines could provide a faster, cheaper alternative to manual classification. We used machine-learning algorithms to replicate the process of manually classifying state public health expenditures, using the standardized public health spending categories from the Foundational Public Health Services model and a large data set from the US Census Bureau. We obtained a data set of 1.9 million individual expenditure items from 2000 to 2013. We collapsed these data into 147 280 summary expenditure records, and we followed a standardized method of manually classifying each expenditure record as public health, maybe public health, or not public health. We then trained 9 machine-learning algorithms to replicate the manual process. We calculated recall, precision, and coverage rates to measure the performance of individual and ensembled algorithms. Compared with manual classification, the machine-learning random forests algorithm produced 84% recall and 91% precision. With algorithm ensembling, we achieved our target criterion of 90% recall by using a consensus ensemble of ≥6 algorithms while still retaining 93% coverage, leaving only 7% of the summary expenditure records unclassified. Machine learning can be a time- and cost-saving tool for estimating public health spending in the United States. It can be used with standardized public health spending categories based on the Foundational Public Health Services model to help parse public health expenditure information from other types of health-related spending, provide data that are more comparable across public health organizations, and evaluate the impact of evidence-based public health resource allocation.

  18. 76 FR 30035 - Fisheries of the Northeastern United States; Northeast Multispecies Fishery; Trip Limit Increase...

    Science.gov (United States)

    2011-05-24

    ... Northeastern United States; Northeast Multispecies Fishery; Trip Limit Increase for the Common Pool Fishery...), Commerce. ACTION: Temporary rule; inseason adjustment of trip limit. SUMMARY: NMFS increases the trip limit... Regional Administrator (RA) to adjust the trip limits for common pool vessels in order to optimize the...

  19. Are Australian men with psychosis spending more time homeless?

    Science.gov (United States)

    Holmes, Alex; Hodge, Mark; Bradley, Gail; Bluhm, Alan; Markulev, Natasha; North, Cameron; Innis, Andy

    2008-04-01

    The objective of this study was to determine if homeless men with psychosis using emergency accommodation services are spending more time homeless. A 12-month accommodation history was collected from all men with psychosis referred to mental health services using two emergency accommodation services in inner Melbourne over a 5-year period. Of the 241 men referred with psychosis, 200 (81%) were able to provide a full accommodation history. In 2001 the mean total days spent in crisis accommodation was 27.0 days and in 2005 the mean number of days was 60.9. Over the 5 years, increasing time was spent homeless in the 12 months prior to assessment, most commonly in emergency accommodations. Australian men with psychosis using emergency accommodation are spending an increasing amount of time homeless.

  20. Elderly Bias, New Social Risks, and Social Spending

    DEFF Research Database (Denmark)

    Tepe, Markus; Vanhuysse, Pieter

    2010-01-01

    : ENSS (elderly/non-elderly spending share) and NSRS (new social risks share). We find that population aging drives up pension spending, but not health spending or ENSS. Contemporaneous levels of new social risks conspicuously fail to affect either NSRS or individual program spending. But the timing...

  1. The Determinants of Arms Spending in South America

    OpenAIRE

    2013-01-01

    In recent years, South America has witnessed a large increase in arms purchases. Nonetheless, there are important intraregional differences in terms of the allocation of resources for weapons acquisitions. How can we account for these disparities? Mainstream literature suggests that levels of arms importation depend on either the size of the defense budget or the perception of threat. In contrast, this article contends that the level of spending on arms is mainly determined by: (a) the expans...

  2. The Financial Consequences of Too Many Men: Sex Ratio Effects on Saving, Borrowing, and Spending

    Science.gov (United States)

    Griskevicius, Vladas; Tybur, Joshua M.; Ackerman, Joshua M.; Delton, Andrew W.; Robertson, Theresa E.; White, Andrew E.

    2012-01-01

    The ratio of males to females in a population is an important factor in determining behavior in animals. We propose that sex ratio also has pervasive effects in humans, such as by influencing economic decisions. Using both historical data and experiments, we examined how sex ratio influences saving, borrowing, and spending in the United States. Findings show that male-biased sex ratios (an abundance of men) lead men to discount the future and desire immediate rewards. Male-biased sex ratios decreased men’s desire to save for the future and increased their willingness to incur debt for immediate expenditures. Sex ratio appears to influence behavior by increasing the intensity of same-sex competition for mates. Accordingly, a scarcity of women led people to expect men to spend more money during courtship, such as by paying more for engagement rings. These findings demonstrate experimentally that sex ratio influences human decision making in ways consistent with evolutionary biological theory. Implications for sex ratio effects across cultures are discussed. PMID:21767031

  3. The financial consequences of too many men: sex ratio effects on saving, borrowing, and spending.

    Science.gov (United States)

    Griskevicius, Vladas; Tybur, Joshua M; Ackerman, Joshua M; Delton, Andrew W; Robertson, Theresa E; White, Andrew E

    2012-01-01

    The ratio of males to females in a population is an important factor in determining behavior in animals. We propose that sex ratio also has pervasive effects in humans, such as by influencing economic decisions. Using both historical data and experiments, we examined how sex ratio influences saving, borrowing, and spending in the United States. Findings show that male-biased sex ratios (an abundance of men) lead men to discount the future and desire immediate rewards. Male-biased sex ratios decreased men's desire to save for the future and increased their willingness to incur debt for immediate expenditures. Sex ratio appears to influence behavior by increasing the intensity of same-sex competition for mates. Accordingly, a scarcity of women led people to expect men to spend more money during courtship, such as by paying more for engagement rings. These findings demonstrate experimentally that sex ratio influences human decision making in ways consistent with evolutionary biological theory. Implications for sex ratio effects across cultures are discussed.

  4. A study on environment public spending

    Directory of Open Access Journals (Sweden)

    Wellington Bueno

    2013-12-01

    Full Text Available This text deals with the importance of studying environment public spending. Initially, we discuss the concept of environment public spending and how it became a public accounting function. Later, an analysis of several studies on the theme was carried out to promote a discussion on the environment public funds allocated by governments. Next, a discussion on the relevance of the theme and the need for further studies is presented, since investments on environment management still need to be better allocated and duly dimensioned. Currently, transparence in public spending has promoted the realization of more studies, leading to a more careful observation of environmental issues by the society, showing that these issues still need more attention from the goverment.

  5. Anomalous Post-Newtonian terms and the secular increase of the Astronomical Unit

    CERN Document Server

    Acedo, L

    2014-01-01

    In the last decade a major debate has emerged on the astrophysics community concerning the anomalous behaviour of the astronomical unit, the fundamental scale of distances in the Solar system. Several independent studies have combined radar ranging and optical data from the last four decades to come to the conclusion that the astronomical unit is increasing by several meters per century. It is abundantly clear that General Relativity cannot account for this new effect, although an still undefined angular momentum transfer mechanism could provide the simpler and more conventional explanation. Here we investigate several anomalous post-newtonian terms containing only the product of the mass and angular momentum of the Sun as well as its Schwarzschild radius in order to determine if they could explain the secular increase of the astronomical unit and the recently reported increase of Lunar eccentricity. If these anomalies are confirmed, searching for a modification of General Relativity predicting these terms co...

  6. Does Advertising Spending Improve Sales Performance?

    DEFF Research Database (Denmark)

    Assaf, A. George; Josiassen, Alexander; Mattila, Anna S.

    2015-01-01

    Hotel managers and investors commonly analyze the impact of advertising spending on firm performance. This paper investigates such an impact using a comprehensive framework incorporating the moderating effects of hotel size and star ratings. We estimated sales performance via dynamic, stochastic...... frontier modelling. Using longitudinal data from a sample of Slovenian and Croatian hotels, we demonstrate that advertising spending has a positive impact on hotel sales performance, and that the relationship strengthens for larger hotels and hotels with higher star ratings. Theoretical and managerial...

  7. Projecting long term medical spending growth.

    Science.gov (United States)

    Borger, Christine; Rutherford, Thomas F; Won, Gregory Y

    2008-01-01

    We present a dynamic general equilibrium model of the U.S. economy and the medical sector in which the adoption of new medical treatments is endogenous and the demand for medical services is conditional on the state of technology. We use this model to prepare 75-year medical spending forecasts and a projection of the Medicare actuarial balance, and we compare our results to those obtained from a method that has been used by government actuaries. Our baseline forecast predicts slower health spending growth in the long run and a lower Medicare actuarial deficit relative to the previous projection methodology.

  8. China Leading in Clean Energy Spending

    Institute of Scientific and Technical Information of China (English)

    Wu Zhenjun

    2010-01-01

    @@ China has taken the lead in investments in clean energy,spending nearly double what the US did in 2009,as it ramps up projects in both renewable and traditional energy.China's investment and financing for clean energy rose to US$34.6 billion in 2009,out of US$162 billion invested globally,according to the report by the nonprofit Pew Charitable Trusts.US spending ranked second,at US$18.6 billion,with European nations also recording strong growth.

  9. Traditional Medicare Versus Private Insurance: How Spending, Volume, And Price Change At Age Sixty-Five.

    Science.gov (United States)

    Wallace, Jacob; Song, Zirui

    2016-05-01

    To slow the growth of Medicare spending, some policy makers have advocated raising the Medicare eligibility age from the current sixty-five years to sixty-seven years. For the majority of affected adults, this would delay entry into Medicare and increase the time they are covered by private insurance. Despite its policy importance, little is known about how such a change would affect national health care spending, which is the sum of health care spending for all consumers and payers-including governments. We examined how spending differed between Medicare and private insurance using longitudinal data on imaging and procedures for a national cohort of individuals who switched from private insurance to Medicare at age sixty-five. Using a regression discontinuity design, we found that spending fell by $38.56 per beneficiary per quarter-or 32.4 percent-upon entry into Medicare at age sixty-five. In contrast, we found no changes in the volume of services at age sixty-five. For the previously insured, entry into Medicare led to a large drop in spending driven by lower provider prices, which may reflect Medicare's purchasing power as a large insurer. These findings imply that increasing the Medicare eligibility age may raise national health care spending by replacing Medicare coverage with private insurance, which pays higher provider prices than Medicare does.

  10. Effects of state-level public spending on health on the mortality probability in India.

    Science.gov (United States)

    Farahani, Mansour; Subramanian, S V; Canning, David

    2010-11-01

    This study uses the second National Family Health Survey of India to estimate the effect of state-level public health spending on mortality across all age groups, controlling for individual, household, and state-level covariates. We use a state's gross fiscal deficit as an instrument for its health spending. Our study shows a 10% increase in public spending on health in India decreases the average probability of death by about 2%, with effects mainly on the young, the elderly, and women. Other major factors affecting mortality are rural residence, household poverty, and access to toilet facilities.

  11. Optimal Policy under Restricted Government Spending

    DEFF Research Database (Denmark)

    Sørensen, Anders

    2006-01-01

    Welfare ranking of policy instruments is addressed in a two-sector Ramsey model with monopoly pricing in one sector as the only distortion. When government spending is restricted, i.e. when a government is unable or unwilling to finance the required costs for implementing the optimum policy...

  12. Japan on target to double science spend...

    CERN Multimedia

    Saegusa, A

    1999-01-01

    A progress report from the Science and Technoloy Agency has concluded that Japan is likely to meet its goal of doubling its science spending by 2001, but still needs to improve the research environment at national laboratories and universities (1pg).

  13. Widespread increase of tree mortality rates in the western United States

    Science.gov (United States)

    Phillip J. van Mantgem; Nathan L. Stephenson; John C. Byrne; Lori D. Daniels; Jerry F. Franklin; Peter Z. Fule; Mark E. Harmon; Andrew J. Larson; Jeremy M. Smith; Alan H. Taylor; Thomas T. Veblen

    2009-01-01

    Persistent changes in tree mortality rates can alter forest structure, composition, and ecosystem services such as carbon sequestration. Our analyses of longitudinal data from unmanaged old forests in the western United States showed that background (noncatastrophic) mortality rates have increased rapidly in recent decades, with doubling periods ranging from 17 to 29...

  14. Increase in Clostridium difficile-related Mortality Rates, United States, 1999-2004

    Centers for Disease Control (CDC) Podcasts

    2008-01-08

    Deaths related to Clostridium difficile are on the rise in the United States. Matthew Redelings from the Los Angeles County Department of Health discusses the increase and what can be done to prevent this infection.  Created: 1/8/2008 by Emerging Infectious Diseases.   Date Released: 1/8/2008.

  15. Investing in children: changes in parental spending on children, 1972-2007.

    Science.gov (United States)

    Kornrich, Sabino; Furstenberg, Frank

    2013-02-01

    Parental spending on children is often presumed to be one of the main ways that parents invest in children and a main reason why children from wealthier households are advantaged. Yet, although research has tracked changes in the other main form of parental investment-namely, time-there is little research on spending. We use data from the Consumer Expenditure Survey to examine how spending changed from the early 1970s to the late 2000s, focusing particularly on inequality in parental investment in children. Parental spending increased, as did inequality of investment. We also investigate shifts in the composition of spending and linkages to children's characteristics. Investment in male and female children changed substantially: households with only female children spent significantly less than parents in households with only male children in the early 1970s; but by the 1990s, spending had equalized; and by the late 2000s, girls appeared to enjoy an advantage. Finally, the shape of parental investment over the course of children's lives changed. Prior to the 1990s, parents spent most on children in their teen years. After the 1990s, however, spending was greatest when children were under the age of 6 and in their mid-20s.

  16. Retiree out-of-pocket healthcare spending: a study of consumer expectations and policy implications.

    Science.gov (United States)

    Hoffman, Allison K; Jackson, Howell E

    2013-01-01

    Even though most American retirees benefit from Medicare coverage, a mounting body of research predicts that many will face large and increasing out-of-pocket expenditures for healthcare costs in retirement and that many already struggle to finance these costs. It is unclear, however, whether the general population understands the likely magnitude of these out-of-pocket expenditures well enough to plan for them effectively. This study is the first comprehensive examination of Americans' expectations regarding their out-of-pocket spending on healthcare in retirement. We surveyed over 1700 near retirees and retirees to assess their expectations regarding their own spending and then compared their responses to experts' estimates. Our main findings are twofold. First, overall expectations of out-of-pocket spending are mixed. While a significant proportion of respondents estimated out-of-pocket costs in retirement at or above expert estimates of what the typical retiree will spend, a disproportionate number estimated their future spending substantially below what experts view as likely. Estimates by members of some demographic subgroups, including women and younger respondents, deviated relatively further from the experts' estimates. Second, respondents consistently misjudged spending uncertainty. In particular, respondents significantly underestimated how much individual health experience and changes in government policy can affect individual out-of-pocket spending. We discuss possible policy responses, including efforts to improve financial planning and ways to reduce unanticipated financial risk through reform of health insurance regulation.

  17. Cities through the Prism of People’s Spending Behavior

    Science.gov (United States)

    Hawelka, Bartosz; Murillo Arias, Juan; Ratti, Carlo

    2016-01-01

    Scientific studies of society increasingly rely on digital traces produced by various aspects of human activity. In this paper, we exploit a relatively unexplored source of data–anonymized records of bank card transactions collected in Spain by a big European bank, and propose a new classification scheme of cities based on the economic behavior of their residents. First, we study how individual spending behavior is qualitatively and quantitatively affected by various factors such as customer’s age, gender, and size of his/her home city. We show that, similar to other socioeconomic urban quantities, individual spending activity exhibits a statistically significant superlinear scaling with city size. With respect to the general trends, we quantify the distinctive signature of each city in terms of residents’ spending behavior, independently from the effects of scale and demographic heterogeneity. Based on the comparison of city signatures, we build a novel classification of cities across Spain in three categories. That classification exhibits a substantial stability over different city definitions and connects with a meaningful socioeconomic interpretation. Furthermore, it corresponds with the ability of cities to attract foreign visitors, which is a particularly remarkable finding given that the classification was based exclusively on the behavioral patterns of city residents. This highlights the far-reaching applicability of the presented classification approach and its ability to discover patterns that go beyond the quantities directly involved in it. PMID:26849218

  18. Cities through the Prism of People's Spending Behavior.

    Directory of Open Access Journals (Sweden)

    Stanislav Sobolevsky

    Full Text Available Scientific studies of society increasingly rely on digital traces produced by various aspects of human activity. In this paper, we exploit a relatively unexplored source of data-anonymized records of bank card transactions collected in Spain by a big European bank, and propose a new classification scheme of cities based on the economic behavior of their residents. First, we study how individual spending behavior is qualitatively and quantitatively affected by various factors such as customer's age, gender, and size of his/her home city. We show that, similar to other socioeconomic urban quantities, individual spending activity exhibits a statistically significant superlinear scaling with city size. With respect to the general trends, we quantify the distinctive signature of each city in terms of residents' spending behavior, independently from the effects of scale and demographic heterogeneity. Based on the comparison of city signatures, we build a novel classification of cities across Spain in three categories. That classification exhibits a substantial stability over different city definitions and connects with a meaningful socioeconomic interpretation. Furthermore, it corresponds with the ability of cities to attract foreign visitors, which is a particularly remarkable finding given that the classification was based exclusively on the behavioral patterns of city residents. This highlights the far-reaching applicability of the presented classification approach and its ability to discover patterns that go beyond the quantities directly involved in it.

  19. Increased reliability through assessment of standard components with life cycle units

    Energy Technology Data Exchange (ETDEWEB)

    Buchholz, A.; Seliger, G. [Inst. fuer Werkzeugmaschinen und Fabrikbetrieb, Fachgebiet Montagetechnik und Fabrikbetrieb - PTZ 2, Berlin (Germany); Middendorf, A.; Reichl, H. [Research Center for Microperipheric Technologies of the TU-Berlin, Berlin (Germany); Ray, P.

    2004-07-01

    Products and their components underlie constant devaluation by their usage which sooner or later leads to a failure. As manufacturers of complex technical products are confronted with increasing demands regarding product availability and reliability, the assessment of the product's condition is desirable. Existing microelectronic technology enables a constant supervision of standard components in their usage to initiate timely adaptation processes like maintenance and repair. The Life Cycle Unit is presented as a modular microelectronic system for product supervision and assessment. Life Cycle Units have been prototypically implemented in various application examples using SMD technology and microsystem technology. (orig.)

  20. Nicotine reduction as an increase in the unit price of cigarettes: a behavioral economics approach.

    Science.gov (United States)

    Smith, Tracy T; Sved, Alan F; Hatsukami, Dorothy K; Donny, Eric C

    2014-11-01

    Urgent action is needed to reduce the harm caused by smoking. Product standards that reduce the addictiveness of cigarettes are now possible both in the U.S. and in countries party to the Framework Convention on Tobacco Control. Specifically, standards that required substantially reduced nicotine content in cigarettes could enable cessation in smokers and prevent future smoking among current non-smokers. Behavioral economics uses principles from the field of microeconomics to characterize how consumption of a reinforcer changes as a function of the unit price of that reinforcer (unit price=cost/reinforcer magnitude). A nicotine reduction policy might be considered an increase in the unit price of nicotine because smokers are paying more per unit of nicotine. This perspective allows principles from behavioral economics to be applied to nicotine reduction research questions, including how nicotine consumption, smoking behavior, use of other tobacco products, and use of other drugs of abuse are likely to be affected. This paper reviews the utility of this approach and evaluates the notion that a reduction in nicotine content is equivalent to a reduction in the reinforcement value of smoking-an assumption made by the unit price approach.

  1. Tidal mechanism as an impossible cause of the observed secular increase of the astronomical unit

    CERN Document Server

    Itoh, Yousuke

    2009-01-01

    Krasinsky and Brumberg (2004 Celest. Mech. Dyn. Astron., 90, 267) reported a secular increase of the astronomical unit (AU) of 15 meters per century. Recently, Miura et al. (2009, PASJ, 61) proposed that a possible angular momentum transfer from the rotation of the Sun to the orbital motion of the solar system planets may explain the observed increase of the AU. They assumed that the tidal effect between the planets and the Sun is the cause of this transfer. Here we claim that tidal effect cannot be a cause of this type of the transfer to explain the increase of the AU.

  2. Control Of Motor Unit Firing During Step-Like Increases In Voluntary Force

    Directory of Open Access Journals (Sweden)

    Xiaogang eHu

    2014-09-01

    Full Text Available In most skeletal muscles, force is generated by a combination of motor unit (MU recruitment and increases in the firing rate of previously active MUs. Two contrasting patterns of firing rate organization have been reported. In the first pattern, the earliest recruited MUs reach the highest firing rates as force is increased, and later recruited MUs fire at lower rates. When firing rate of multiple MUs are superimposed, these rate trajectories form a concentric layered profile termed ‘onion skin’. In the second pattern, called ‘reverse onion skin’, later recruited MUs reach higher firing rates, and crossing of firing rate trajectories for recorded MUs is common (although such trajectories are assembled routinely from different trials. Our present study examined the firing rate organization of concurrently active MUs of the first dorsal interosseous muscle during serial, step-like increases in isometric abduction forces. We used a surface sensor array coupled with MU discrimination algorithms to characterize MU firing patterns. Our objective was to determine whether ‘onion skin’ profiles are contingent upon the force trajectory of the motor task, examined here using step-like increases of force output, and also whether they are manifested at different force levels.Our results revealed that the overall ‘onion skin’ firing rate profile was retained as the force level increased with each force step up to 15% MVC. However, the distribution of firing rates across MUs was compressed with increasing force, and overlapping firing rate of units were observed. This rate compression was largely due to rate saturation of the relatively high frequency discharging MUs.Our results reflect flexible firing patterns across MUs at different levels of excitation drive. It is also evident that many units did not follow all the step increases consistently. This failure to track firing rate increases at higher forces could be due to an intrinsically

  3. Effects of the Affordable Care Act on Consumer Health Care Spending and Risk of Catastrophic Health Costs.

    Science.gov (United States)

    Nowak, Sarah A; Eibner, Christine; Adamson, David M; Saltzman, Evan

    2014-01-01

    This study examines the likely effects of the Affordable Care Act (ACA) on average annual consumer health care spending and the risk of catastrophic medical costs for the United States overall and in two large states that have decided not to expand their Medicaid programs (Texas and Florida). The ACA will have varied impacts on individuals' and families' spending on health care, depending on income level and on estimated 2016 insurance status without the ACA. The authors find that average out-of-pocket spending is expected to decrease for all groups considered in the analysis, although decreases in out-of-pocket spending will be largest for those who would otherwise be uninsured. People who would otherwise be uninsured who transition to the individual market under the ACA will have higher total health care spending on average after implementation of the ACA because they will now incur the cost of health insurance premiums. The authors also find that risk of catastrophic health care spending will decrease for individuals of all income levels for the insurance transitions considered; decreases will be greatest for those at the lowest income levels. Case studies found that in Texas and Florida, Medicaid expansion would substantially reduce out-of-pocket and total health care spending for those with incomes below 100 percent of the federal poverty level, compared with a scenario in which the ACA is implemented without Medicaid expansion. Expansion would reduce the risk of high medical spending for those covered under Medicaid who would remain uninsured without expansion.

  4. Regional Employment Growth and Defense Spending.

    Science.gov (United States)

    1987-12-01

    important part of regional growth. UI ACCA 9o1n For ’NDis i - Dljt s i-: . TABLE OF CONTENTS I. INTRODUCTION .. .. .. .... ..... .... .... .... ..... .. 7...proved. Bigger and better weapons requiring ever more advanced technology also mandated that a sector of our economy be dedicated toward the production...Mideast and Great Lakes, all show spending to taxation ratios of less than one on a per capita basis, yet the Southwest and Rocky Mountain states have

  5. Public Spending on Health as Political Instrument?

    DEFF Research Database (Denmark)

    Fielding, David; Freytag, Andreas; Münch, Angela

    2014-01-01

    The paper argues that the type of the political regime does not only drive public spending on health, but that dependent on the type of regime inequality in health status within its population is fostered by applying selective strategies. An empirical analysis is conducted for 132 low- and middle...... income states for the years 1995-2010. A simple political economic framework is implemented in order to analyse the rational of policy makers in implementing effective health care provision....

  6. Business spending markets and buying behavior

    Directory of Open Access Journals (Sweden)

    Stanković Čedomir

    2004-01-01

    Full Text Available Most buyers on the business spending markets use one or more of the following buying methods: description, inspection, sampling and negotiating. Products are usually standardized according to their characteristics (size, shape, weight or color. The buyer is able to buy only depending in the description or quantity or other characteristic. In some cases buyer may specify business brand or its equivalent when describing desired product.

  7. EMOTIONAL HEALTH, AND SPENDING TIME IN NATURE

    Directory of Open Access Journals (Sweden)

    Ileana-Loredana Vitalia

    2013-07-01

    Full Text Available For many people, nature represents a place to rest and recover from daily stress. Recent researches emphasized that living in neighbourhood with comparatively plentiful walkable green space was correlated with a better perceived general health, and a lower mortality risk (Maars et all, 2006; Van Dillen et all, 2011. Moreover, physical activity in nature is an important recovery aspect in psychological illness, such as anxiety or depression. This study proposed to investigate the relation between spending time in nature (as a preffered free time activity in the form of walking in the park, playing games in nature, trips etc. and emotional health (functional/dysfunctional emotions. We used Emotional Distress Profile to measure emotional health, and an open answer exercise ,,20 things I like to do``, to assess the spending time in nature variable. Statistical analyses were computed. Results showed that people who preffered to spend time in nature expressed a higher number of functional emotions compared to people who preffered other activities (in door activities.

  8. Towards a comprehensive estimate of national spending on prevention

    NARCIS (Netherlands)

    E.W. de Bekker-Grob (Esther); J.J. Polder (Johan); J.P. Mackenbach (Johan); W.J. Meerding (Willem Jan)

    2007-01-01

    textabstractBackground Comprehensive information about national spending on prevention is crucial for health policy development and evaluation. This study provides a comprehensive overview of prevention spending in the Netherlands, including those activities beyond the national health accounts. Met

  9. Who Benefits from Public Education Spending in Malawi? Results from the Recent Education Reform. World Bank Discussion Paper No. 350.

    Science.gov (United States)

    Castro-Leal, Florencia

    This study uses the Benefit Incidence Analysis to examine the distribution of public spending across different socioeconomic groups before and after the government of Malawi made great changes in educational policy in 1994. Primary education was made the top priority with increased spending on education and primary school fees abolished. The…

  10. The Impact on Growth of Higher Efficiency of Public Spending on Schools. OECD Economics Department Working Papers No. 547

    Science.gov (United States)

    Gonand, Frederic

    2007-01-01

    This paper assesses the impact on economic growth of increased efficiency of public spending in primary and lower-secondary education. Higher efficiency in public spending in schools can bolster growth through two main channels. On the one hand, it can allow a transfer of labour from the public sector to the business sector at unchanged…

  11. The Effect of Obesity and Chronic Conditions on Medicare Spending, 1987-2011.

    Science.gov (United States)

    Allen, Lindsay; Thorpe, Ken; Joski, Peter

    2015-07-01

    Slowing the growth in Medicare expenditure is a key policy goal. Rising chronic disease prevalence is responsible for much of this growth. The first goal of this study is to estimate the percentage of Medicare spending growth that is attributable to increasing disease prevalence rates of diabetes, hyperlipidaemia, hypertension and heart disease. Second, we estimate how much of this prevalence-related spending growth is attributable to rising obesity rates. We employ spending decomposition equations to estimate the percentage of Medicare spending growth that is attributable to rising chronic disease prevalence, and we use two-part models to estimate the portion of prevalence-related spending that is potentially due to obesity. For our four conditions of interest, growing disease prevalence accounted for between 13.6 % (in heart disease) and 58.9 % (in hyperlipidaemia) of Medicare expenditure growth. Up to 17.0 % (in diabetes) of the expenditure growth due to prevalence increases may be attributable to obesity and therefore may be modifiable. Rising obesity rates contribute to chronic disease prevalence, which, in turn, can lead to higher Medicare expenditures. To slow the growth in spending, policy makers should consider targeting obesity, using approaches such as improving pharmacotherapy coverage and providing intensive care coordination services to Medicare enrollees.

  12. Positional spending and status seeking in rural China

    NARCIS (Netherlands)

    Brown, P.; Bulte, E.H.; Zhang, X.

    2011-01-01

    Focusing on a remote area in rural China, we use a panel census of households in 26 villages to show that socially observable spending has risen sharply in recent years. We demonstrate that such spending by households is highly sensitive to social spending by other villagers. This suggests that soci

  13. Skewed, persistent and high before death : Medical spending in Germany

    NARCIS (Netherlands)

    Karlsson, Martin; Klein, Tobias; Ziebarth, Nicolas

    2016-01-01

    We use claims panel data from a big German private health insurer to provide detailed individual-level evidence on medical spending between 2005 and 2011. This includes evidence on the distribution of medical spending, the dependence of medical spending on age and other demographic characteristics,

  14. Has durable goods spending become less sensitive to interest rates?

    National Research Council Canada - National Science Library

    Van Zandweghe, Willem; Braxton, John Carter

    2013-01-01

    ... on this category of spending has weakened in the current recovery. Durable goods purchases, which include residential investment as well as spending on vehicles, recre- ational goods, and household goods, are a particularly interest-sensitive component of consumer spending. In the first four years of previous recoveries, a decline in interest rate...

  15. Modifying Endowment Spending Rules: Is it the Cure for Overspending?

    Science.gov (United States)

    Kaufman, Roger T.; Woglom, Geoffrey

    2005-01-01

    In this article we analyze the dynamics of endowment spending and real endowment values using rules that tie endowment spending to inflation. Numerical examples demonstrate that under a pure inflation rule, spending rates tend to drift away over time from the appropriate rate, leading to either rising or falling real endowment values. Under a…

  16. Increased trends in the use of treatment-limiting decisions in a regional neurosurgical unit.

    Science.gov (United States)

    Wilson, William T; McMillan, Tristan; Young, Adam M H; White, Mark A J

    2017-04-01

    Treatment-limiting decisions (TLDs) are employed to actively withhold treatment from patients whom clinicians feel would derive no benefit or suffer detrimental effects from further intervention. The use of such decisions has been heavily discussed in the media and clinicians in the past have been reluctant to institute them, even though it is in the best interests of the patients. Their use is influenced by several ethical, religious and social factors all of which have changed significantly over time. This study reports the trends in use of TLDs in a regional neurosurgical unit over 23 years. Patient archives were reviewed to identify the number of admissions and procedures performed at the Institute of Neurological Sciences, Glasgow, in the years 1988, 1997 and 2011. Death certificate records were used to identify mortality in the unit in the year 2011. Patient records were used to obtain details of diagnosis, time from admission to death, and the presence and timing of a TLD. The results show an increase in the use of TLDs, with decisions made for 89% of those who died in 2011, compared to 68% in 1997 and 51% in 1988. The number of admissions has increased substantially since 1988 as has the percentage of patients undergoing surgery (46, 67 and 72% in 1988, 1997 and 2011, respectively). There is a trending increase in the number of patients who have a TLD in our regional neurosurgical unit. This demonstrates an increased willingness of clinicians to recognise poor prognosis and to withdraw or withhold treatment in these cases. Continued appropriate use of the TLD is recommended but it is to only ever reflect the best interests of the patient.

  17. Financial protection from health spending in the Philippines: policies and progress.

    Science.gov (United States)

    Bredenkamp, Caryn; Buisman, Leander R

    2016-09-01

    The objective of this article is to assess the progress of the Philippines health sector in providing financial protection to the population, as measured by estimates of health insurance coverage, out-of-pocket spending, catastrophic payments and impoverishing health expenditures. Data are drawn from eight household surveys between 2000 and 2013, including two Demographic and Health Surveys, one Family Health Survey and five Family Income and Expenditure Surveys. We find that out-of-pocket spending increased by 150% (real) from 2000 to 2012, with the sharpest increases occurring in recent years. The main driver of health spending is medicines, accounting for almost two-thirds of total health spending, and as much as three-quarters among the poor. The incidence of catastrophic payments has tripled since 2000, from 2.5% to 7.7%. The percentage of people impoverished by health spending has also increased and, in 2012, out-of-pocket spending on health added 1.5 percentage points to the poverty rate, pushing more than 1.5 million people into poverty. In light of these findings, recent policies to enhance financial risk protection-such as the expansion of government-subsidized health insurance from the poor to the near-poor, a policy of zero copayments for the poor, a deepening of the benefit package and provider payment reform aimed at cost-containment-are to be commended. Indeed, between 2008 and 2013, self-reported health insurance coverage increased across all quintiles and its distribution became more pro-poor. To speed progress toward financial protection goals, quick wins could include issuing health insurance cards to the poor to increase awareness of coverage and limiting out-of-pocket spending by clearly defining a clear copayment structure for non-poor members. An in-depth analysis of the pharmaceutical sector would help to shed light on why medicines impose such a large financial burden on households.

  18. Increasing uptake of live attenuated influenza vaccine among children in the United States, 2008-2014.

    Science.gov (United States)

    Rodgers, Loren; Pabst, Laura J; Chaves, Sandra S

    2015-01-01

    The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for all persons in the United States aged ≥6 months. On June 25, 2014, ACIP preferentially recommended live attenuated influenza vaccine (LAIV) for healthy children aged 2-8 years. Little is known about national LAIV uptake. To determine uptake of LAIV relative to inactivated influenza vaccine, we analyzed vaccination records from six immunization information system sentinel sites (approximately 10% of US population). LAIV usage increased over time in all sites. Among children 2-8 years of age vaccinated for influenza, exclusive LAIV usage in the collective sentinel site area increased from 20.1% (2008-09 season) to 38.0% (2013-14). During 2013-14, at least half of vaccinated children received LAIV in Minnesota (50.0%) and North Dakota (55.5%). Increasing LAIV usage suggests formulation acceptability, and this preexisting trend offers a favorable context for implementation of ACIP's preferential recommendation.

  19. Benefits to the United States of Increasing Global Uptake of Clean Energy Technologies

    Energy Technology Data Exchange (ETDEWEB)

    Kline, D.

    2010-07-01

    A previous report describes an opportunity for the United States to take leadership in efforts to transform the global energy system toward clean energy technologies (CET). An accompanying analysis to that report provides estimates of the economic benefits to the United States of such a global transformation on the order of several hundred billion dollars per year by 2050. This report describes the methods and assumptions used in developing those benefit estimates. It begins with a summary of the results of the analysis based on an updated and refined model completed since the publication of the previous report. The framework described can be used to estimate the economic benefits to the U.S. of coordinated global action to increase the uptake of CETs worldwide. Together with a Monte Carlo simulation engine, the framework can be used to develop plausible ranges for benefits, taking into account the large uncertainty in the driving variables and economic parameters. The resulting estimates illustrate that larger global clean energy markets offer significant opportunities to the United States economy.

  20. It's the recipient that counts: spending money on strong social ties leads to greater happiness than spending on weak social ties.

    Directory of Open Access Journals (Sweden)

    Lara B Aknin

    Full Text Available Previous research has shown that spending money on others (prosocial spending increases happiness. But, do the happiness gains depend on who the money is spent on? Sociologists have distinguished between strong ties with close friends and family and weak ties--relationships characterized by less frequent contact, lower emotional intensity, and limited intimacy. We randomly assigned participants to reflect on a time when they spent money on either a strong social tie or a weak social tie. Participants reported higher levels of positive affect after recalling a time they spent on a strong tie versus a weak tie. The level of intimacy in the relationship was more important than the type of relationship; there was no significant difference in positive affect after recalling spending money on a family member instead of a friend. These results add to the growing literature examining the factors that moderate the link between prosocial behaviour and happiness.

  1. It's the recipient that counts: spending money on strong social ties leads to greater happiness than spending on weak social ties.

    Science.gov (United States)

    Aknin, Lara B; Sandstrom, Gillian M; Dunn, Elizabeth W; Norton, Michael I

    2011-02-10

    Previous research has shown that spending money on others (prosocial spending) increases happiness. But, do the happiness gains depend on who the money is spent on? Sociologists have distinguished between strong ties with close friends and family and weak ties--relationships characterized by less frequent contact, lower emotional intensity, and limited intimacy. We randomly assigned participants to reflect on a time when they spent money on either a strong social tie or a weak social tie. Participants reported higher levels of positive affect after recalling a time they spent on a strong tie versus a weak tie. The level of intimacy in the relationship was more important than the type of relationship; there was no significant difference in positive affect after recalling spending money on a family member instead of a friend. These results add to the growing literature examining the factors that moderate the link between prosocial behaviour and happiness.

  2. Vertical farming increases lettuce yield per unit area compared to conventional horizontal hydroponics.

    Science.gov (United States)

    Touliatos, Dionysios; Dodd, Ian C; McAinsh, Martin

    2016-08-01

    Vertical farming systems (VFS) have been proposed as an engineering solution to increase productivity per unit area of cultivated land by extending crop production into the vertical dimension. To test whether this approach presents a viable alternative to horizontal crop production systems, a VFS (where plants were grown in upright cylindrical columns) was compared against a conventional horizontal hydroponic system (HHS) using lettuce (Lactuca sativa L. cv. "Little Gem") as a model crop. Both systems had similar root zone volume and planting density. Half-strength Hoagland's solution was applied to plants grown in perlite in an indoor controlled environment room, with metal halide lamps providing artificial lighting. Light distribution (photosynthetic photon flux density, PPFD) and yield (shoot fresh weight) within each system were assessed. Although PPFD and shoot fresh weight decreased significantly in the VFS from top to base, the VFS produced more crop per unit of growing floor area when compared with the HHS. Our results clearly demonstrate that VFS presents an attractive alternative to horizontal hydroponic growth systems and suggest that further increases in yield could be achieved by incorporating artificial lighting in the VFS.

  3. An Increase in Estimation Accuracy Position Determination of Inertial Measurement Units

    Directory of Open Access Journals (Sweden)

    Beran Ladislav

    2016-01-01

    Full Text Available This paper deals with an increase in measurement accuracy of the Inertial Measurement Units (IMU. In the Inertial Navigation Systems (INS a fusion of gyroscopes, accelerometers and in some cases magnetometers are typically used. The typical problem of cheap IMU is non-stationary offset and high level of noise. The next problem of IMU is a problem with a bumpy floor. For this case it is necessary to a have high quality chassis to eliminate additional noise. Also, it is possible to eliminate this noise by using some algorithm, but results are still poor. These properties lead to the inaccurate position estimation in the integration process. Even a small offset error leads to a big mistake in position determination and grows quickly with a time. This research is focused on the elimination of these poor properties and increase of accuracy of position estimation using Kalman Filtration.

  4. Relevance of Defense Spending after the 1973-1975 Recession to Defense Spending Following the Great Recession of 2007-2009

    Science.gov (United States)

    2013-05-01

    Woods system. The 1944 United Nations Monetary and Financial Conference adopted the Bretton Woods system, named for the site of the conference, to...faced economic hardship due to higher spending and inflation growth. This divides the post-WWII period into pre- and post- Bretton Woods blocks. 6...foundation. The dissolution of the Bretton Woods agreement provides a solid line of demarcation when considering recessions after WWII. Domestically

  5. National spending on health by source for 184 countries between 2013 and 2040.

    Science.gov (United States)

    Dieleman, Joseph L; Templin, Tara; Sadat, Nafis; Reidy, Patrick; Chapin, Abigail; Foreman, Kyle; Haakenstad, Annie; Evans, Tim; Murray, Christopher J L; Kurowski, Christoph

    2016-06-18

    A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these changes vary substantially across countries, even at similar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected. We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks. Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42-22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9-3·4) in high-income countries, 3·4% (2·4-4·2) in upper-middle-income countries, 3·0% (2·3-3·6) in lower-middle-income countries, and 2·4% (1·6-3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low

  6. How do candidates spend their money? Objects of campaign spending and the effectiveness of diversification

    NARCIS (Netherlands)

    Sudulich, M.L.; Wall, M.

    2011-01-01

    We present a novel approach to the study of campaign effectiveness using disaggregated spending returns from the 2007 Irish general election. While previous studies have focused on overall levels of expenditure as a predictor of electoral success, we consider the types of activities on which candida

  7. The Public Benefits of Higher Education: Examining the Relationship Between State Spending on Higher Education and the Formation of Human Capital

    OpenAIRE

    Herndon, Matthew Craig

    2008-01-01

    This study contributes to the literature on the economic value of higher education by examining the extent to which a set of independent variables, including two measures of state spending on higher education predict the formation of human capital. The findings suggest that, in most states, increases in state spending per full-time equivalent enrollment in public higher education predict decreases in the formation of human capital, while increases in state spending per capita on public and pr...

  8. Boosting beauty in an economic decline: mating, spending, and the lipstick effect.

    Science.gov (United States)

    Hill, Sarah E; Rodeheffer, Christopher D; Griskevicius, Vladas; Durante, Kristina; White, Andrew Edward

    2012-08-01

    Although consumer spending typically declines in economic recessions, some observers have noted that recessions appear to increase women's spending on beauty products--the so-called lipstick effect. Using both historical spending data and rigorous experiments, the authors examine how and why economic recessions influence women's consumer behavior. Findings revealed that recessionary cues--whether naturally occurring or experimentally primed--decreased desire for most products (e.g., electronics, household items). However, these cues consistently increased women's desire for products that increase attractiveness to mates--the first experimental demonstration of the lipstick effect. Additional studies show that this effect is driven by women's desire to attract mates with resources and depends on the perceived mate attraction function served by these products. In addition to showing how and why economic recessions influence women's desire for beauty products, this research provides novel insights into women's mating psychology, consumer behavior, and the relationship between the two.

  9. Climate change. Projected increase in lightning strikes in the United States due to global warming.

    Science.gov (United States)

    Romps, David M; Seeley, Jacob T; Vollaro, David; Molinari, John

    2014-11-14

    Lightning plays an important role in atmospheric chemistry and in the initiation of wildfires, but the impact of global warming on lightning rates is poorly constrained. Here we propose that the lightning flash rate is proportional to the convective available potential energy (CAPE) times the precipitation rate. Using observations, the product of CAPE and precipitation explains 77% of the variance in the time series of total cloud-to-ground lightning flashes over the contiguous United States (CONUS). Storms convert CAPE times precipitated water mass to discharged lightning energy with an efficiency of 1%. When this proxy is applied to 11 climate models, CONUS lightning strikes are predicted to increase 12 ± 5% per degree Celsius of global warming and about 50% over this century.

  10. Empirical explanation of the anomalous increases of the astronomical unit and of the lunar eccentricity

    CERN Document Server

    Iorio, Lorenzo

    2011-01-01

    Both the recently reported anomalous secular increase of the astronomical unit, of the order of a few cm yr^-1, and of the eccentricity of the lunar orbit e_ = (9+/-3) 10^-12 yr^-1 can be phenomenologically explained by postulating that the acceleration of a test particle orbiting a central body, in addition to usual Newtonian component, contains a small additional radial term proportional to the radial projection vr of the velocity of the particle's orbital motion. Indeed, it induces secular variations of both the semi-major axis a and the eccentricity e of the test particle's orbit. In the case of the Earth and the Moon, they numerically agree rather well with the measured anomalies if one takes the numerical value of the coefficient of proportionality of the extra-acceleration approximately equal to that of the Hubble parameter H0 = 7.3 10^-11 yr^-1.

  11. Price cuts and drug spending in South Korea: the case of antihyperlipidemic agents.

    Science.gov (United States)

    Kwon, Hye-Young; Hong, Ji-Min; Godman, Brian; Yang, Bong-Min

    2013-10-01

    To identify the effect of price control policies on drug expenditure in South Korea. We retrospectively examined the effects of price-reduction policies on drug expenditures, in particular regarding anti-hyperlipidemic drugs. The National Health Insurance claims data for a 60-month period between 2006 and 2010 were analysed. A segmented regression analysis was conducted with three intervention variables: July 2008, April 2009, and January 2010. Despite three rounds of price cuts, monthly drug expenditures increased by KRW 599.67 million (USD 523,726) after the third intervention (p=0.0781). The trend in volume increased consistently, but not significantly. The unit prices showed a steady downward trend over time, but rebounded after the third price cut. The number of patients with hyperlipidemia more than doubled to 3729 (p=0.0801) per month after the entry of generics for atorvastatin in July 2008. Extensive price controls did not effectively suppress the growth of pharmaceutical expenditures. The increased number of patients, attributable to the newly launched generic drug atorvastatin, and the increased use of expensive drugs were major factors affecting the increase in drug spending. Policies that regulate both drug prices and utilisation, and that reduce financial burdens via enhanced use of generics need to be introduced. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. Forest responses to increasing aridity and warmth in the southwestern United States

    Science.gov (United States)

    Williams, A.P.; Allen, C.D.; Millar, C.I.; Swetnam, T.W.; Michaelsen, J.; Still, C.J.; Leavitt, Steven W.

    2010-01-01

    In recent decades, intense droughts, insect outbreaks, and wildfires have led to decreasing tree growth and increasingmortality inmany temperate forests. We compared annual tree-ring width data from 1,097 populations in the coterminous United States to climate data and evaluated site-specific tree responses to climate variations throughout the 20th century. For each population, we developed a climate-driven growth equation by using climate records to predict annual ring widths. Forests within the southwestern United States appear particularly sensitive to drought and warmth.We input 21st century climate projections to the equations to predict growth responses. Our results suggest that if temperature and aridity rise as they are projected to, southwestern trees will experience substantially reduced growth during this century. As tree growth declines, mortality rates may increase at many sites. Increases in wildfires and bark-beetle outbreaks in the most recent decade are likely related to extreme drought and high temperatures during this period. Using satellite imagery and aerial survey data, we conservatively calculate that ???2.7% of southwestern forest and woodland area experienced substantialmortality due to wildfires from1984 to 2006, and???7. 6%experiencedmortality associated with bark beetles from 1997 to 2008. We estimate that up to ???18% of southwestern forest area (excluding woodlands) experienced mortality due to bark beetles or wildfire during this period. Expected climatic changes will alter future forest productivity, disturbance regimes, and species ranges throughout the Southwest. Emerging knowledge of these impending transitions informs efforts to adaptively manage southwestern forests.

  13. Increasing cervical cancer screening in the United States-Mexico border region.

    Science.gov (United States)

    Thompson, Beti; Vilchis, Hugo; Moran, Crystal; Copeland, Wade; Holte, Sarah; Duggan, Catherine

    2014-01-01

    Hispanic women living on the United States-México border experience health disparities, are less likely to access cervical cancer screening services, and have a higher rate of cervical cancer incidence compared to women living in nonborder areas. Here we investigate the effects of an intervention delivered by community health workers (CHWs, known as lay health educators or Promotores de Salud in Spanish) on rates of cervical cancer screening in Hispanic women who were out of compliance with recommended screening guidelines. Hispanic women out of compliance with screening guidelines, attending clinics in southern New Mexico, were identified using medical record review. All eligible women were offered the intervention. The study was conducted between 2009 and 2011, and data were analyzed in 2012. Setting/participants--162 Hispanic women, resident in New Mexico border counties, aged 29-80 years, who had not had a Pap test within the past 3 years. Intervention--a CHW-led, culturally appropriate, computerized education intervention. Main outcome measures--the percentage of women who underwent cervical cancer screening within 12 months of receiving the intervention. Change in knowledge of, and attitudes toward cervical cancer and screening as assessed by a baseline and follow-up questionnaire. 76.5% of women had a Pap test after the intervention. Women displayed increased knowledge about cervical cancer screening and about HPV. A culturally appropriate promotora-led intervention is successful in increasing cervical cancer screening in at-risk Hispanic women on the United States-México border. © 2013 National Rural Health Association.

  14. What Factors Control the Trend of Increasing AAOD Over the United States in the Last Decade?

    Science.gov (United States)

    Zhang, Li; Henze, Daven K.; Grell, Georg A.; Torres, Omar; Jethva, Hiren; Lamsal, Lok N.

    2017-01-01

    We examine the spatial and temporal trends of absorbing aerosol optical depth (AAOD) in the last decade over the United States (U.S.) observed by the Ozone Monitoring Instrument (OMI). Monthly average OMI AAOD has increased over broad areas of the central U.S. from 2005 to 2015, by up to a factor of 4 in some grid cells (60 km resolution). The AAOD increases in all seasons, although the percentage increases are larger in summer (June-July-August) than in winter (December-January-February) by a factor of 3. Despite enhancements in AAOD, OMI AOD exhibits insignificant trend over most of the U.S. except parts of the central and western U.S., the latter which may partly be due to decreases in precipitation. Trends in AAOD contrast with declining trends in surface concentrations of black carbon (BC) aerosol. Interannual variability of local biomass burning emissions of BC may contribute to the positive trend in AAOD over the western U.S. Changes in both dust aerosol measured at the surface (in terms of concentration and size) and dust AAOD indicate distinct enhancements, especially over the central U.S. by 50-100%, which appears to be one of the major factors that impacts positive trends in AAOD.

  15. What Factors Control the Trend of Increasing AAOD Over the United States in the Last Decade?

    Science.gov (United States)

    Zhang, Li; Henze, Daven K.; Grell, Georg A.; Torres, Omar; Jethva, Hiren; Lamsal, Lok N.

    2017-01-01

    We examine the spatial and temporal trends of absorbing aerosol optical depth (AAOD) in the last decade over the United States (U.S.) observed by the Ozone Monitoring Instrument (OMI). Monthly average OMI AAOD has increased over broad areas of the central U.S. from 2005 to 2015, by up to a factor of 4 in some grid cells (60 km resolution). The AAOD increases in all seasons, although the percentage increases are larger in summer (June-July-August) than in winter (December-January-February) by a factor of 3. Despite enhancements in AAOD, OMI AOD exhibits insignificant trend over most of the U.S. except parts of the central and western U.S., the latter which may partly be due to decreases in precipitation. Trends in AAOD contrast with declining trends in surface concentrations of black carbon (BC) aerosol. Interannual variability of local biomass burning emissions of BC may contribute to the positive trend in AAOD over the western U.S. Changes in both dust aerosol measured at the surface (in terms of concentration and size) and dust AAOD indicate distinct enhancements, especially over the central U.S. by 50-100%, which appears to be one of the major factors that impacts positive trends in AAOD.

  16. What factors control the trend of increasing AAOD over the United States in the last decade?

    Science.gov (United States)

    Zhang, Li; Henze, Daven K.; Grell, Georg A.; Torres, Omar; Jethva, Hiren; Lamsal, Lok N.

    2017-02-01

    We examine the spatial and temporal trends of absorbing aerosol optical depth (AAOD) in the last decade over the United States (U.S.) observed by the Ozone Monitoring Instrument (OMI). Monthly average OMI AAOD has increased over broad areas of the central U.S. from 2005 to 2015, by up to a factor of 4 in some grid cells ( 60 km resolution). The AAOD increases in all seasons, although the percentage increases are larger in summer (June-July-August) than in winter (December-January-February) by a factor of 3. Despite enhancements in AAOD, OMI AOD exhibits insignificant trend over most of the U.S. except parts of the central and western U.S., the latter which may partly be due to decreases in precipitation. Trends in AAOD contrast with declining trends in surface concentrations of black carbon (BC) aerosol. Interannual variability of local biomass burning emissions of BC may contribute to the positive trend in AAOD over the western U.S. Changes in both dust aerosol measured at the surface (in terms of concentration and size) and dust AAOD indicate distinct enhancements, especially over the central U.S. by 50-100%, which appears to be one of the major factors that impacts positive trends in AAOD.

  17. Increasing importance of deposition of reduced nitrogen in the United States.

    Science.gov (United States)

    Li, Yi; Schichtel, Bret A; Walker, John T; Schwede, Donna B; Chen, Xi; Lehmann, Christopher M B; Puchalski, Melissa A; Gay, David A; Collett, Jeffrey L

    2016-05-24

    Rapid development of agriculture and fossil fuel combustion greatly increased US reactive nitrogen emissions to the atmosphere in the second half of the 20th century, resulting in excess nitrogen deposition to natural ecosystems. Recent efforts to lower nitrogen oxides emissions have substantially decreased nitrate wet deposition. Levels of wet ammonium deposition, by contrast, have increased in many regions. Together these changes have altered the balance between oxidized and reduced nitrogen deposition. Across most of the United States, wet deposition has transitioned from being nitrate-dominated in the 1980s to ammonium-dominated in recent years. Ammonia has historically not been routinely measured because there are no specific regulatory requirements for its measurement. Recent expansion in ammonia observations, however, along with ongoing measurements of nitric acid and fine particle ammonium and nitrate, permit new insight into the balance of oxidized and reduced nitrogen in the total (wet + dry) US nitrogen deposition budget. Observations from 37 sites reveal that reduced nitrogen contributes, on average, ∼65% of the total inorganic nitrogen deposition budget. Dry deposition of ammonia plays an especially key role in nitrogen deposition, contributing from 19% to 65% in different regions. Future progress toward reducing US nitrogen deposition will be increasingly difficult without a reduction in ammonia emissions.

  18. Projected increase in total knee arthroplasty in the United States - an alternative projection model.

    Science.gov (United States)

    Inacio, M C S; Paxton, E W; Graves, S E; Namba, R S; Nemes, S

    2017-08-08

    The purpose of our study was to estimate the future incidence rate (IR) and volume of primary total knee arthroplasty (TKA) in the United States from 2015 to 2050 using a conservative projection model that assumes a maximum IR of procedures. Furthermore, our study compared these projections to a model assuming exponential growth, as done in previous studies, for illustrative purposes. A population based epidemiological study was conducted using data from US National Inpatient Sample (NIS) and Census Bureau. Primary TKA procedures performed between 1993 and 2012 were identified. The IR, 95% confidence intervals (CI), or prediction intervals (PI) of TKA per 100,000 US citizens over the age of 40 years were calculated. The estimated IR was used as the outcome of a regression modelling with a logistic regression (i.e., conservative model) and Poisson regression equation (i.e., exponential growth model). Logistic regression modelling suggests the IR of TKA is expected to increase 69% by 2050 compared to 2012, from 429 (95%CI 374-453) procedures/100,000 in 2012 to 725 (95%PI 121-1041) in 2050. This translates into a 143% projected increase in TKA volume. Using the Poisson model, the IR in 2050 was projected to increase 565%, to 2854 (95%CI 2278-4004) procedures/100,000 IR, which is an 855% projected increase in volume compared to 2012. Even after using a conservative projection approach, the number of TKAs in the US, which already has the highest IR of knee arthroplasty in the world, is expected to increase 143% by 2050. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  19. Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending

    Science.gov (United States)

    Song, Zirui; Chernew, Michael E.; Landon, Bruce E.; McNeil, Barbara J.; Safran, Dana G.; Schuster, Mark A.

    2014-01-01

    OBJECTIVE: To examine the 2-year effect of Blue Cross Blue Shield of Massachusetts’ global budget arrangement, the Alternative Quality Contract (AQC), on pediatric quality and spending for children with special health care needs (CSHCN) and non-CSHCN. METHODS: Using a difference-in-differences approach, we compared quality and spending trends for 126 975 unique 0- to 21-year-olds receiving care from AQC groups with 415 331 propensity-matched patients receiving care from non-AQC groups; 23% of enrollees were CSHCN. We compared quality and spending pre (2006–2008) and post (2009–2010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends. Pediatric outcome measures included 4 preventive and 2 acute care measures tied to pay-for-performance (P4P), 3 asthma and 2 attention-deficit/hyperactivity disorder quality measures not tied to P4P, and average total annual medical spending. RESULTS: During the first 2 years of the AQC, pediatric care quality tied to P4P increased by +1.8% for CSHCN (P < .001) and +1.2% for non-CSHCN (P < .001) for AQC versus non-AQC groups; quality measures not tied to P4P showed no significant changes. Average total annual medical spending was ∼5 times greater for CSHCN than non-CSHCN; there was no significant impact of the AQC on spending trends for children. CONCLUSIONS: During the first 2 years of the contract, the AQC had a small but significant positive effect on pediatric preventive care quality tied to P4P; this effect was greater for CSHCN than non-CSHCN. However, it did not significantly influence (positively or negatively) CSHCN measures not tied to P4P or affect per capita spending for either group. PMID:24366988

  20. Nursing home spending, staffing, and turnover.

    Science.gov (United States)

    Kash, Bita A; Castle, Nicholas G; Phillips, Charles D

    2007-01-01

    Recent work on nursing home staffing and turnover has stressed the importance of ownership and resources. However, few studies have examined spending behaviors, which might also influence staffing levels and staff turnover rates. This study investigates whether spending behaviors measured by financial ratios are associated with staffing levels and staff turnover in nursing homes. We analyzed cross-sectional data from 1,014 Texas homes. Data were from the 2002 Texas Nursing Facility Medicaid Cost Report and the 2003 Area Resource File. First, we examined differences in financial ratios by ownership type. Next, the effect of 10 financial ratios on staffing levels and turnover rates for registered nurses, licensed vocational nurses, and certified nursing assistants was examined using robust regression models. Descriptive data indicated that expense ratios related to resident care activities and staff development were significantly higher among not-for-profit than for-profit homes. Higher profits were associated with lower staffing levels, but not higher turnover rates. Administrative expenses (a measure of management capacity) had a negative impact both on staffing levels and staff turnover for licensed vocational nurses and certified nursing assistants, but they did not affect registered nurse staffing. Employee benefit expenses exhibited a positive impact on registered nurse and licensed vocational nurse staffing levels. The addition of information on financial ratios to models predicting staffing indicators reduced the effect of ownership on these indicators. Solutions to the staffing and turnover problem should focus on more effective management practices. Certain levels of administrative and staff benefit expenses may be necessary to improve professional staff recruitment and reduce both staffing and turnover costs. Differences in these financial ratios may partially explain the role played by ownership in determining staffing levels and turnover.

  1. State Education Spending: Current Pressures and Future Trends

    OpenAIRE

    Sheila E. Murray; Rueben, Kim; Rosenberg, Carol

    2007-01-01

    Education expenditures are one of the largest spending areas for state and local governments, and per–pupil expenditures have been growing over time. We examine trends in state aid for education and overall education spending and decompose the existing drivers behind growing state costs. We then explore how predicted future demographic trends will affect education spending levels, as the percent of the population that is of school age falls. We conclude that there will continue to be a large ...

  2. Life Science’s Average Publishable Unit (APU) Has Increased over the Past Two Decades

    Science.gov (United States)

    Cordero, Radames J. B.; de León-Rodriguez, Carlos M.; Alvarado-Torres, John K.; Rodriguez, Ana R.; Casadevall, Arturo

    2016-01-01

    Quantitative analysis of the scientific literature is important for evaluating the evolution and state of science. To study how the density of biological literature has changed over the past two decades we visually inspected 1464 research articles related only to the biological sciences from ten scholarly journals (with average Impact Factors, IF, ranging from 3.8 to 32.1). By scoring the number of data items (tables and figures), density of composite figures (labeled panels per figure or PPF), as well as the number of authors, pages and references per research publication we calculated an Average Publishable Unit or APU for 1993, 2003, and 2013. The data show an overall increase in the average ± SD number of data items from 1993 to 2013 of approximately 7±3 to 14±11 and PPF ratio of 2±1 to 4±2 per article, suggesting that the APU has doubled in size over the past two decades. As expected, the increase in data items per article is mainly in the form of supplemental material, constituting 0 to 80% of the data items per publication in 2013, depending on the journal. The changes in the average number of pages (approx. 8±3 to 10±3), references (approx. 44±18 to 56±24) and authors (approx. 5±3 to 8±9) per article are also presented and discussed. The average number of data items, figure density and authors per publication are correlated with the journal’s average IF. The increasing APU size over time is important when considering the value of research articles for life scientists and publishers, as well as, the implications of these increasing trends in the mechanisms and economics of scientific communication. PMID:27310929

  3. Life Science's Average Publishable Unit (APU Has Increased over the Past Two Decades.

    Directory of Open Access Journals (Sweden)

    Radames J B Cordero

    Full Text Available Quantitative analysis of the scientific literature is important for evaluating the evolution and state of science. To study how the density of biological literature has changed over the past two decades we visually inspected 1464 research articles related only to the biological sciences from ten scholarly journals (with average Impact Factors, IF, ranging from 3.8 to 32.1. By scoring the number of data items (tables and figures, density of composite figures (labeled panels per figure or PPF, as well as the number of authors, pages and references per research publication we calculated an Average Publishable Unit or APU for 1993, 2003, and 2013. The data show an overall increase in the average ± SD number of data items from 1993 to 2013 of approximately 7±3 to 14±11 and PPF ratio of 2±1 to 4±2 per article, suggesting that the APU has doubled in size over the past two decades. As expected, the increase in data items per article is mainly in the form of supplemental material, constituting 0 to 80% of the data items per publication in 2013, depending on the journal. The changes in the average number of pages (approx. 8±3 to 10±3, references (approx. 44±18 to 56±24 and authors (approx. 5±3 to 8±9 per article are also presented and discussed. The average number of data items, figure density and authors per publication are correlated with the journal's average IF. The increasing APU size over time is important when considering the value of research articles for life scientists and publishers, as well as, the implications of these increasing trends in the mechanisms and economics of scientific communication.

  4. Life Science's Average Publishable Unit (APU) Has Increased over the Past Two Decades.

    Science.gov (United States)

    Cordero, Radames J B; de León-Rodriguez, Carlos M; Alvarado-Torres, John K; Rodriguez, Ana R; Casadevall, Arturo

    2016-01-01

    Quantitative analysis of the scientific literature is important for evaluating the evolution and state of science. To study how the density of biological literature has changed over the past two decades we visually inspected 1464 research articles related only to the biological sciences from ten scholarly journals (with average Impact Factors, IF, ranging from 3.8 to 32.1). By scoring the number of data items (tables and figures), density of composite figures (labeled panels per figure or PPF), as well as the number of authors, pages and references per research publication we calculated an Average Publishable Unit or APU for 1993, 2003, and 2013. The data show an overall increase in the average ± SD number of data items from 1993 to 2013 of approximately 7±3 to 14±11 and PPF ratio of 2±1 to 4±2 per article, suggesting that the APU has doubled in size over the past two decades. As expected, the increase in data items per article is mainly in the form of supplemental material, constituting 0 to 80% of the data items per publication in 2013, depending on the journal. The changes in the average number of pages (approx. 8±3 to 10±3), references (approx. 44±18 to 56±24) and authors (approx. 5±3 to 8±9) per article are also presented and discussed. The average number of data items, figure density and authors per publication are correlated with the journal's average IF. The increasing APU size over time is important when considering the value of research articles for life scientists and publishers, as well as, the implications of these increasing trends in the mechanisms and economics of scientific communication.

  5. 77 FR 45379 - Increasing the Supply of Forensic Pathologists in the United States: A Report and Recommendations

    Science.gov (United States)

    2012-07-31

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF JUSTICE Office of Justice Programs Increasing the Supply of Forensic Pathologists in the United States: A Report... Forensic Pathologists in the United States: A Report and Recommendations.'' The opportunity to provide...

  6. Who pays for health care in the United States? Implications for health system reform.

    Science.gov (United States)

    Holahan, J; Zedlewski, S

    1992-01-01

    This paper examines the distribution of health care spending and financing in the United States. We analyze the distribution of employer and employee contributions to health insurance, private nongroup health insurance purchases, out-of-pocket expenses, Medicaid benefits, uncompensated care, tax benefits due to the exemption of employer-paid health benefits, and taxes paid to finance Medicare, Medicaid, and the health benefit tax exclusion. All spending and financing burdens are distributed across the U.S. population using the Urban Institute's TRIM2 microsimulation model. We then examine the distributional effects of the U.S. health care system across income levels, family types, and regions of the country. The results show that health care spending increases with income. Spending for persons in the highest income deciles is about 60% above that of persons in the lowest decile. Nonetheless, the distribution of health care financing is regressive. When direct spending, employer contributions, tax benefits, and tax spending are all considered, the persons in the lowest income deciles devote nearly 20% of cash income to finance health care, compared with about 8% for persons in the highest income decile. We discuss how alternative health system reform approaches are likely to change the distribution of health spending and financing burdens.

  7. Increasing Utilization Of Pediatric Epilepsy Surgery In The United States Between 1997 and 2009

    Science.gov (United States)

    Pestana Knight, Elia M.; Schiltz, Nicholas K.; Bakaki, Paul M.; Koroukian, Siran M.; Lhatoo, Samden D.; Kaiboriboon, Kitti

    2014-01-01

    SUMMARY OBJECTIVE To examine national trends of pediatric epilepsy surgery usage in the United States between 1997 and 2009. METHODS We performed a serial cross-sectional study of pediatric epilepsy surgery using triennial data from the Kids’ Inpatient Database from 1997 to 2009. The rates of epilepsy surgery for lobectomies, partial lobectomies, and hemispherectomies in each study year were calculated based on the number of prevalent epilepsy cases in the corresponding year. The age-race-sex adjusted rates of surgeries were also estimated. Mann-Kendall trend test was used to test for changes in the rates of surgeries over time. Multivariable regression analysis was also performed to estimate the effect of time, age, race, and sex on the annual incidence of epilepsy surgery. RESULTS The rates of pediatric epilepsy surgery significantly increased from 0.85 epilepsy surgeries per 1,000 children with epilepsy in 1997 to 1.44 epilepsy surgeries per 1,000 children with epilepsy in 2009. An increment in the rates of epilepsy surgeries was noted across all age groups, in boys and girls, all races, and all payer types. The rate of increase was lowest in blacks and in children with public insurance. The overall number of surgical cases for each study year was lower than 35% of children who were expected to have surgery, based on the estimates from the Connecticut Study of Epilepsy. SIGNIFICANCE In contrast to adults, pediatric epilepsy surgery numbers have increased significantly in the past decade. However, epilepsy surgery remains an underutilized treatment for children with epilepsy. In addition, black children and those with public insurance continue to face disparities in the receipt of epilepsy surgery. PMID:25630252

  8. MILITARY COMPETITION BETWEEN FRIENDS? HEGEMONIC DEVELOPMENT AND MILITARY SPENDING AMONG EIGHT WESTERN DEMOCRACIES, 1920-1938

    Directory of Open Access Journals (Sweden)

    Jari Eloranta

    2001-01-01

    Full Text Available This article explores the complicated phenomenon of military spending among a sample of eight Western democracies in the interwar period by analyzing especially the possibility of economic and/or military competition between the Western Great Powers and the ensuing impacts on the smaller states included here. The hegemonic paradigm suggested by e.g. Paul Kennedy predicts that the economic leader in a system will increasingly invest on maintaining security; thus eventually bringing economic growth to a halt. The military spending patterns respective of economic growth at first seem to suggest that not only the totalitarian states, as is the traditional view, but also the UK and France stepped in to fill the void created by the lack of American leadership. However, the military expenditures of these nations were too low to warrant the conclusion that they had any impact on their respective economic performance. This result is also verified here by employing Granger non-causality tests between the military spending and economic growth variables. Moreover, regression analysis on the military spending variables for the UK and France points towards competition on the level. The smaller states, respectively, seemed to follow the UK and France fairly closely in their military spending decisions.

  9. An analysis of the slowdown in growth of spending for psychiatric drugs, 1986-2008.

    Science.gov (United States)

    Mark, Tami L; Kassed, Cheryl; Levit, Katharine; Vandivort-Warren, Rita

    2012-01-01

    This study analyzed recent trends in spending on psychiatric prescription drugs and underlying factors that served as drivers of these changes. Data were collected from the MarketScan Commercial Claims and Encounters Database (1997-2008), Substance Abuse and Mental Health Services Administration spending estimates (1986-2005), and the Medical Expenditure Panel Survey (1997-2007). The trends in medication spending derived from the data were decomposed into three categories: percentage of enrollees who used psychiatric medications, days supplied per user, and cost per day supplied. The average annual rate of growth in expenditures per enrollee slowed from 18.5% in 1997-2001 to 6.3% in 2001-2008. A decline in the growth rate of cost per day supplied, from 8% to 2%, accounted for 49% of the overall decline in spending growth, and a decline in the growth of the percentage of enrollees who used medication, from 7% to 2%, contributed 41% to the overall decline. There was a smaller change in days supplied per user, from 3% to 2%, that contributed 10% to the overall decline. The increased entry of generic medications, which constituted 70% of all psychiatric prescriptions by 2008, particularly generic antidepressants, was a key contributor to the slower growth in costs. Past high growth in psychiatric drug spending arising from growth in utilization of branded medications has declined significantly, which may have implications for access and new product investment.

  10. Identification with the retail organization and customer-perceived employee similarity: effects on customer spending.

    Science.gov (United States)

    Netemeyer, Richard G; Heilman, Carrie M; Maxham, James G

    2012-09-01

    Two constructs important to academicians and managers are the degree to which employees and customers identify with an organization, employee organizational identification (employee OI) and customer-company identification (customer identification), respectively. This research examines the effects of these identification constructs and the related construct of customer perceived similarity to employees on customer spending. Via a 1-year multilevel study of 12,047 customers and 1,464 store employees (sales associates) covering 212 stores of a specialty apparel retailer, our study contributes to the literature in 2 critical ways. First, we expand the theoretical network of employee OI and customer identification by examining the related construct of a customer's perceived similarity to store employees. We examine the incremental (not fully mediated) main and interaction effects of customer-perceived similarity to employees and employee OI on customer spending. Second, we examine the effect of customer identification on customer spending relative to the effect of customer satisfaction on customer spending. Thus, our study also contributes by demonstrating a potential complementary route to achieve customer spending (customer identification), a route that may be more readily affected by management than the efforts required for a sustained increase in customer satisfaction. Implications for academics and managers are offered.

  11. Increasing communication in the intensive care unit: is blogging the answer?

    Science.gov (United States)

    Curry, Kimberly

    2012-01-01

    Effective communication is a key factor to success in intensive care nursing. At Allegheny General Hospital in Pittsburgh, Pennsylvania, a cardiac intensive care unit (ICU) incorporated blogging as one of its primary means of communication. In the health care clinical environment, blogging can help to promote 2-way communication among nursing staff and leadership. Blogging can serve as a valuable method of relaying important updates, changes in practice, and educational resources. Incorporating a blog into the ICU environment involves a cultural shift and some potential barriers. Lack of a technological understanding of social media, outdated software systems, and limited hospital policies may pose issues when incorporating a blog into the health care setting. The benefits though are impressive. Blogging is a form of rapid, real-time communication for which any person may post or comment on an important thought or message. Blogging can help to increase compliance with quality measures, update staff on need to know information such as changes in policies and procedures, and provide up-to-date educational resources at any time, from anywhere.

  12. Assessing the level of public health partner spending using the funding formula analysis tool.

    Science.gov (United States)

    Bernet, Patrick M

    2012-01-01

    Public health services are delivered through a variety of organizations. Traditional accounting of public health expenditures typically captures only spending by government agencies. New Hampshire collected information from public health partners, such as community centers that host smoking cessation classes or health education done by Girls, Inc. This study compares the new data to spending by government agencies, focusing on breakdowns by fund source and service categories. Expanded funds secured by these partners account for a 42% of all local public health spending, and they spent 4 times more than government agencies on promoting healthy behavior. The funding formula analysis tool revealed that these partners spent in ways that would be politically difficult to achieve. In an era of declining budgets, an understanding of public health's partners is increasingly vital.

  13. Explaining the Growth in US Health Care Spending Using State-Level Variation in Income, Insurance, and Provider Market Dynamics.

    Science.gov (United States)

    Herring, Bradley; Trish, Erin

    2015-01-01

    The slowed growth in national health care spending over the past decade has led analysts to question the extent to which this recent slowdown can be explained by predictable factors such as the Great Recession or must be driven by some unpredictable structural change in the health care sector. To help address this question, we first estimate a regression model for state personal health care spending for 1991-2009, with an emphasis on the explanatory power of income, insurance, and provider market characteristics. We then use the results from this simple predictive model to produce state-level projections of health care spending for 2010-2013 to subsequently compare those average projected state values with actual national spending for 2010-2013, finding that at least 70% of the recent slowdown in health care spending can likely be explained by long-standing patterns. We also use the results from this predictive model to both examine the Great Recession's likely reduction in health care spending and project the Affordable Care Act's insurance expansion's likely increase in health care spending.

  14. 75 FR 62184 - Notification of United States Mint Silver Eagle Bullion Coin Premium Increase

    Science.gov (United States)

    2010-10-07

    ... Sales and Marketing; United States Mint; 801 9th Street, NW., Washington, DC 20220; or call 202-354-7500. Authority: 31 U.S.C. 5112(e)-(f) & 9701. Dated: October 4, 2010. Andrew D. Brunhart, Deputy Director, United States Mint. BILLING CODE 4810-02-P...

  15. Unit GDP Energy Consumption in 2006:Moving from Increase to Decline

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ On July 12, Xie Fuzhan, Commissioner of National Bureau of Statistics of China attended the press conference held by State Council Information Office, and delivered the report on China's national unit GDP energy consumption in 2006, presenting with major indicators of unit GDP energy consumption both at national and regional levels in the year 2006.

  16. Consumer Spending and Customer Satisfaction: Untying the Knot

    Directory of Open Access Journals (Sweden)

    Peter Sephton

    2012-01-01

    Full Text Available The recession of 2007–2009 has led to renewed interest in forecasting discretionary consumer spending and whether marketing variables contain predictive content. Using the ACSI customer satisfaction index and both linear and nonlinear methods, this note suggests the index fails to enhance our understanding of the temporal evolution of discretionary spending.

  17. Child poverty: what can social spending explain in Europe?

    NARCIS (Netherlands)

    Diris, R.; Vandenbroucke, F.; Verbist, G.

    2014-01-01

    This study assesses the role of social spending in relation to child poverty in European welfare states. Using macro-level panel data from EU SILC 2005-2012, we analyze the effect of the size of social spending and the effect of how those benefits are targeted. We separately estimate the effect of p

  18. Consumer Spending and Customer Satisfaction: Untying the Knot

    OpenAIRE

    Peter Sephton

    2012-01-01

    The recession of 2007–2009 has led to renewed interest in forecasting discretionary consumer spending and whether marketing variables contain predictive content. Using the ACSI customer satisfaction index and both linear and nonlinear methods, this note suggests the index fails to enhance our understanding of the temporal evolution of discretionary spending.

  19. Defense Spending and the Economy - An Econometric View

    Science.gov (United States)

    1994-01-01

    spend the peace dividend. Most people expect that dividend to be generated by improvements in the economy fueled by reductions in defense expenditure...There have been a myriad of articles written regarding the effects defense spending has on the economy . Many of the authors of these articles disagree

  20. New Rule on Spending by States Lacks Teeth

    Science.gov (United States)

    Kelderman, Eric

    2009-01-01

    A new federal requirement that states provide consistent spending for higher education may not yet have much effect. As state budgets sour and colleges brace for cuts, only one state seems likely to have run afoul of the new rules this year, according to a "Chronicle" analysis of available data on state higher-education spending. Under the rule,…

  1. Reviewing prescription spending and accessory usage.

    Science.gov (United States)

    Oxenham, Julie

    This article aims to explore the role of the stoma nurse specialist in the community and how recent initiatives within the NHS have impacted on the roles in stoma care to react to the rising prescription costs in the specialty. The article will explore how the stoma care nurse conducted her prescription reviews within her own clinical commissioning group (CCG). The findings of the reviews will be highlighted by a small case history and a mini audit that reveals that some stoma patients may be using their stoma care accessories inappropriately, which may contribute to the rise in stoma prescription spending. To prevent the incorrect use of stoma appliances it may necessitate an annual review of ostomates (individuals who have a stoma), as the author's reviews revealed that inappropriate usage was particularly commonplace when a patient may have not been reviewed by a stoma care specialist for some considerable amount of time. Initial education of the ostomate and ongoing education of how stoma products work is essential to prevent the misuse of stoma appliances, particularly accessories, as the reviews revealed that often patients were not always aware of how their products worked in practice.

  2. Financial Incentives, Workplace Wellness Program Participation, and Utilization of Health Care Services and Spending.

    Science.gov (United States)

    Fronstin, Paul; Roebuck, M Christopher

    2015-08-01

    This paper analyzes data from a large employer that enhanced financial incentives to encourage participation in its workplace wellness programs. It examines, first, the effect of financial incentives on wellness program participation, and second, it estimates the impact of wellness program participation on utilization of health care services and spending. The Patient Protection and Affordable Care Act of 2010 (PPACA) allows employers to provide financial incentives of as much as 30 percent of the total cost of coverage when tied to participation in a wellness program. Participation in health risk assessments (HRAs) increased by 50 percentage points among members of unions that bargained in the incentive, and increased 22 percentage points among non-union employees. Participation in the biometric screening program increased 55 percentage points when financial incentives were provided. Biometric screenings led to an average increase of 0.31 annual prescription drug fills, with related spending higher by $56 per member per year. Otherwise, no significant effects of participation in HRAs or biometric screenings on utilization of health care services and spending were found. The largest increase in medication utilization as a result of biometric screening was for statins, which are widely used to treat high cholesterol. This therapeutic class accounted for one-sixth of the overall increase in prescription drug utilization. Second were antidepressants, followed by ACE inhibitors (for hypertension), and thyroid hormones (for hypothyroidism). Biometric screening also led to significantly higher utilization of biologic response modifiers and immunosuppressants. These specialty medications are used to treat autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, and are relatively expensive compared with non-specialty medications. The added spending associated with the combined increase in fills of 0.02 was $27 per member per year--about one-half of the

  3. Proton Pump Inhibitors Do Not Increase Risk for Clostridium difficile Infection in the Intensive Care Unit.

    Science.gov (United States)

    Faleck, David M; Salmasian, Hojjat; Furuya, E Yoko; Larson, Elaine L; Abrams, Julian A; Freedberg, Daniel E

    2016-11-01

    Patients in the intensive care unit (ICU) frequently receive proton pump inhibitors (PPIs) and have high rates of Clostridium difficile infection (CDI). PPIs have been associated with CDI in hospitalized patients, but ICU patients differ fundamentally from non-ICU patients and few studies have focused on PPI use exclusively in the critical care setting. We performed a retrospective cohort study to determine the associations between PPIs and health-care facility-onset CDI in the ICU. We analyzed data from all adult ICU patients at three affiliated hospitals (14 ICUs) between 2010 and 2013. Patients were excluded if they had recent CDI or an ICU stay of exposures, focusing on PPIs and other potentially modifiable exposures that occurred during ICU stays. Health-care facility-onset CDI in the ICU was defined as a newly positive PCR for the C. difficile toxin B gene from an unformed stool, with subsequent receipt of anti-CDI therapy. We analyzed PPIs and other exposures as time-varying covariates and used Cox proportional hazards models to adjust for demographics, comorbidities, and other clinical factors. Of 18,134 patients who met the criteria for inclusion, 271 (1.5%) developed health-care facility-onset CDI in the ICU. Receipt of antibiotics was the strongest risk factor for CDI (adjusted HR (aHR) 2.79; 95% confidence interval (CI), 1.50-5.19). There was no significant increase in risk for CDI associated with PPIs in those who did not receive antibiotics (aHR 1.56; 95% CI, 0.72-3.35), and PPIs were actually associated with a decreased risk for CDI in those who received antibiotics (aHR 0.64; 95% CI, 0.48-0.83). There was also no evidence of increased risk for CDI in those who received higher doses of PPIs. Exposure to antibiotics was the most important risk factor for health-care facility-onset CDI in the ICU. PPIs did not increase risk for CDI in the ICU regardless of use of antibiotics.

  4. Increased rates of intensive care unit admission in patients with Mycoplasma pneumoniae: a retrospective study.

    Science.gov (United States)

    Khoury, T; Sviri, S; Rmeileh, A A; Nubani, A; Abutbul, A; Hoss, S; van Heerden, P V; Bayya, A E; Hidalgo-Grass, C; Moses, A E; Nir-Paz, R

    2016-08-01

    Mycoplasma pneumoniae is a leading cause of respiratory disease. In the Intensive Care Unit (ICU) setting M. pneumoniae is not considered a common pathogen. In 2010-13 an epidemic of M. pneumoniae-associated infections was reported and we observed an increase of M. pneumoniae patients admitted to ICU. We analysed the cohort of all M. pneumoniae-positive patients' admissions during 2007 to 2012 at the Hadassah-Hebrew University Medical Centre (a 1100-bed tertiary medical centre). Mycoplasma pneumoniae diagnosis was made routinely using PCR on throat swabs and other respiratory samples. Clinical parameters were retrospectively extracted. We identified 416 M. pneumoniae-infected patients; of which 68 (16.3%) were admitted to ICU. Of these, 48% (173/416) were paediatric patients with ICU admission rate of 4.6% (8/173). In the 19- to 65-year age group ICU admission rate rose to 18% (32/171), and to 38.8% (28/72) for patients older than 65 years. The mean APACHE II score on ICU admission was 20, with a median ICU stay of 7 days, and median hospital stay of 11.5 days. Of the ICU-admitted patients, 54.4% (37/68) were mechanically ventilated upon ICU admission. In 38.2% (26/68), additional pathogens were identified mostly later as secondary pathogens. A concomitant cardiac manifestation occurred in up to 36.8% (25/68) of patients. The in-hospital mortality was 29.4% (20/68) and correlated with APACHE II score. Contrary to previous reports, a substantial proportion (16.3%) of our M. pneumoniae-infected patients required ICU admission, especially in the adult population, with significant morbidity and mortality.

  5. Stability of omeprazole in SyrSpend SF Alka (reconstituted).

    Science.gov (United States)

    Whaley, Paul A; Voudrie, Mark A; Sorenson, Bridget

    2012-01-01

    Omeprazole is used in the treatment of dyspepsia, peptic ulcer disease, gastroesophageal reflux disease, laryngopharyngeal reflux, and Zollinger-Ellison syndrome. Omeprazole is marketed by AstraZeneca under a number of names, most notably Prilosec and Losec, as well as being available from a number of generic manufacturers. Omeprazole is available in both tablet and capsule form, with varying strengths of each. The need for other administration options for those patients who cannot take tablets or capsules has led compounding pharmacies to seek other alternatives. One possible alternative is the use of a suspending agent to create an oral solution or suspension. In the past, this has been accomplished using a sodium bicarbonate solution as the vehicle. However, sodium bicarbonate/omeprazole combination imparts a bitter and unpleasant taste. SyrSpend SF Alka (reconstituted) is a vehicle for making a suspension which has a pleasant taste, thus increasing palpability and compliance. The objective of this study was to determine the stability of omeprazole in SyrSpend SF Alka (for reconstitution). The studied sample was compounded into a 2-mg/mL suspension and stored in a low-actinic plastic prescription bottle at temperatures between 2 degrees C and 8 degrees C. Six samples were assayed at each time point out to 92 days by a stability-indicating high-performance liquid chromatography method. The method was validated for its specificity through forced degradation studies. The shelf life of this product is at least 92 days, based on data collected when refrigerated and protected from light.

  6. Hong Kong's domestic health spending--financial years 1989/90 through 2004/05.

    Science.gov (United States)

    Leung, G M; Tin, K Y K; Yeung, G M K; Leung, E S K; Tsui, E L H; Lam, D W S; Tsang, C S H; Fung, A Y K; Lo, S V

    2008-04-01

    This report presents the latest estimates of Hong Kong's domestic health spending between fiscal years 1989/90 and 2004/05, cross-stratified and categorised by financing source, provider and function on an annual basis. Total expenditure on health was HK$67,807 million in fiscal year 2004/05. In real terms, total expenditure on health showed positive growth averaging 7% per annum throughout the period covered in this report while gross domestic product grew at 4% per annum on average, indicating a growing percentage of health spending relative to gross domestic product, from 3.5% in 1989/90 to 5.2% in 2004/05. This increase was largely driven by the rise in public spending, which rose 9% per annum on average in real terms over the period, compared with 5% for private spending. This represents a growing share of public spending from 40% to 55% of total expenditure on health during the period. While public spending was the dominant source of health financing in 2004/05, private household out-of-pocket expenditure accounted for the second largest share of total health spending (32%). The remaining sources of health finance were employer-provided group medical benefits (8%), privately purchased insurance (5%), and other private sources (1%). Of the $67,807 million total health expenditure in 2004/05, current expenditure comprised $65,429 million (96%) while $2378 million (4%) were capital expenses (ie investment in medical facilities). Services of curative care accounted for the largest share of total health spending (67%) which were made up of ambulatory services (35%), in-patient curative care (28%), day patient hospital services (3%), and home care (1%). The next largest share of total health expenditure was spent on medical goods outside the patient care setting (10%). Analysed by health care provider, hospitals accounted for the largest share (46%) and providers of ambulatory health care the second largest share (30%) of total health spending in 2004/05. We

  7. Carbon Mitigation Impacts of Increased Softwood Lumber and Structural Panel Use for Nonresidential Construction in the United States

    Science.gov (United States)

    Prakash Nepal; Kenneth E. Skog; David B. McKeever; Richard D. Bergman; Karen L. Abt; Robert C. Abt

    2016-01-01

    More wood use in the United States to construct low-rise nonresidential (NR) buildings would increase consumption and production of softwood (SW) lumber, engineered wood products, and structural and nonstructural wood panels. Using a consequential life-cycle analysis, we estimated the change in net CO2 emissions thatwould be caused by increased...

  8. Social Spending and Aggregate Welfare in Developing and Transition Economies

    DEFF Research Database (Denmark)

    Gebregziabher, Fiseha Haile; Niño-Zarazúa, Miguel

    Notwithstanding the unprecedented attention devoted to reducing poverty and fostering human development via scaling up social sector spending, there is surprisingly little rigorous empirical work on the question of whether social spending is effective in achieving these goals. This paper examines...... the impact of government spending on the social sectors (health, education, and social protection) on two major indicators of aggregate welfare (the inequality-adjusted Human Development Index and child mortality), using a panel dataset comprising 55 developing and transition countries from 1990 to 2009. We...

  9. Using State Student Unit Record Data to Increase Community College Student Success

    Science.gov (United States)

    Ewell, Peter; Jenkins, Davis

    2008-01-01

    This chapter examines lessons learned by states that are using student unit record (SUR) data to improve outcomes for community college students and recommends steps states can take to strengthen their use of SUR databases to benefit students and communities. (Contains 1 exhibit.)

  10. Increase in fall-related hospitalizations in the United States, 2001-2008

    NARCIS (Netherlands)

    K.A. Hartholt (Klaas); J.A. Stevens (Judy); S. Polinder (Suzanne); T.J.M. van der Cammen (Tischa); P. Patka (Peter)

    2011-01-01

    textabstractBACKGROUND: The objective was to determine secular trends in unintentional fall-related hospitalizations in people aged 65 years and older in the United States. MATERIALS: Data were obtained from a nationally representative sample of emergency department visits from January 1, 2001, to D

  11. The expansion of Medicaid coverage under the ACA: implications for health care access, use, and spending for vulnerable low-income adults.

    Science.gov (United States)

    Clemans-Cope, Lisa; Long, Sharon K; Coughlin, Teresa A; Yemane, Alshadye; Resnick, Dean

    2013-05-01

    The expansion of Medicaid coverage under the Affordable Care Act offers the potential for significant increases in health care access, use, and spending for vulnerable nonelderly adults who are uninsured. Using pooled data from the Medical Expenditure Panel Survey, this study estimates the potential effects of Medicaid, controlling for individual and local community characteristics. Our findings project significant gains in health care access and use for uninsured adults who enroll in Medicaid coverage and have chronic health conditions and mental health conditions. With that increased use, annual per capita health care spending for those newly insured individuals (excluding out-of-pocket spending) is projected to grow from $2,677 to $6,370 in 2013 dollars, while their out-of-pocket spending would drop by $921. It is expected that these increases in spending would be offset at least in part by reductions in uncompensated care and charity care.

  12. Informing policy makers about future health spending: a comparative analysis of forecasting methods in OECD countries.

    Science.gov (United States)

    Astolfi, Roberto; Lorenzoni, Luca; Oderkirk, Jillian

    2012-09-01

    Concerns about health care expenditure growth and its long-term sustainability have risen to the top of the policy agenda in many OECD countries. As continued growth in spending places pressure on government budgets, health services provision and patients' personal finances, policy makers have launched forecasting projects to support policy planning. This comparative analysis reviewed 25 models that were developed for policy analysis in OECD countries by governments, research agencies, academics and international organisations. We observed that the policy questions that need to be addressed drive the choice of forecasting model and the model's specification. By considering both the level of aggregation of the units analysed and the level of detail of health expenditure to be projected, we identified three classes of models: micro, component-based, and macro. Virtually all models account for demographic shifts in the population, while two important influences on health expenditure growth that are the least understood include technological innovation and health-seeking behaviour. The landscape for health forecasting models is dynamic and evolving. Advances in computing technology and increases in data granularity are opening up new possibilities for the generation of system of models which become an on-going decision support tool capable of adapting to new questions as they arise. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  13. United We Stand, Divided We Fall: Increasing Response Capability in Kentucky through Regionalization and Leadership

    Science.gov (United States)

    2011-03-01

    made. This research will help national leaders to recognize the gap between the theory and practice. 13 II. LITERATURE REVIEW The following...throughout a region” (United States House of Representatives, 2004, p. 15). 1. Adaptive Leadership In “Complexity Leadership Theory : An Interactive...significant role in the ice storm response. Public health nurses worked in shelters; environmentalists were called upon to ensure that restaurants with

  14. The push to increase the use of EHR technology by hospitals and physicians in the United States through the HITECH Act and the Medicare incentive program.

    Science.gov (United States)

    Pipersburgh, Jessica

    2011-01-01

    This article reviews key health care spending and electronic health records (EHR) statistics in the United States (Section II); highlights positive and negative aspects of EHR technology (Sections III and IV); briefly reviews the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) (Section V); discusses the rule passed by the Office of the National Coordinator for Health Information Technology (ONCHIT) and to implement the goals of HITECH (Section VI); discusses the rule passed by the Centers for Medicare & Medicaid Services (CMS) to implement the goals of HITECH and focuses on significant requirements of the Medicare incentive program rule as it applies to hospitals and physicians (Section VII); and finally, concludes by highlighting certain issues that have been raised regarding the goals of HITECH (Section VIII).

  15. Hedging Medical Spending Growth: An Adaptive Expectations Approach.

    Science.gov (United States)

    Lieberthal, Robert D

    2016-08-01

    Long-term health insurance provides consumers with protection against persistent, negative health shocks. While the stochastic rise in medical spending growth may make some health risks harder to insure, financial assets could act as a hedge for medical spending growth risk. The purpose of this research was to determine whether such hedges exist. The results of this study were two-fold. First, the asset classes with the strongest statistical evidence as hedges were bonds, not stocks. Second, any strategy to hedge medical spending growth involved shorting assets i.e. betting against the bond or stock market. Health insurers writing long-term contracts should combine the use of hedges in the bond market with of portfolio diversification, and may benefit from health policies to moderate the uncertainty of medical spending growth.

  16. Healthcare spending and health outcomes: evidence from selected ...

    African Journals Online (AJOL)

    Healthcare spending and health outcomes: evidence from selected East ... rates, life expectancy at birth and other health outcome indicators have improved. ... Conclusion: The results of this study have important policy and management ...

  17. Health Spending by State of Residence, 1991 - 2009

    Data.gov (United States)

    U.S. Department of Health & Human Services — In 2009, the 10 states where per capita spending was highest ranged from 13 to 36 percent higher than the national average, and the 10 states where per capita...

  18. R&D figures 'distorted' by defence spending

    CERN Multimedia

    Coghlan, A

    1990-01-01

    A report published by the House of Lords Select Committee on Science and Technology, claims that government figures for R&D spending are misleading. They apparently include military projects that are more concerned with product development than original research.

  19. Dollars to Results: Linking Spending to Outputs and Outcomes

    Data.gov (United States)

    US Agency for International Development — Dollars to Results shows spending in a fiscal year alongside results reported for that same year. Data are illustrative and do not reflect the entirety of impact...

  20. Spending Natural Resource Revenues in an Altruistic Growth Model

    DEFF Research Database (Denmark)

    Frederiksen, Elisabeth Hermann

    This paper examines how revenues from a natural resource interact with growth and welfare in an overlapping generations model with altruism. The revenues are allocated between public productive services and direct transfers to members of society by spending policies. We analyze how these policies...... and in spending policies may be part of the reason why natural resources seem to affect economic performance across nations differently...

  1. The Willingness to Spend on Healthcare: Evidence from Singapore

    OpenAIRE

    Lydia L. Gan; Frederick, James R.

    2010-01-01

    For the past few decades, the household healthcare expenditures have experienced a phenomenal growth in Singapore. This paper seeks to identify the underlying socio-economic factors that contribute towards this phenomenon by employing time series data to examine the household willingness to spend on healthcare from 1970 to 2006. The results from our log-linear regression show that the willingness to spend on healthcare is positively related to the proportion of Singapore's population who are ...

  2. Misery is not miserly: sad and self-focused individuals spend more.

    Science.gov (United States)

    Cryder, Cynthia E; Lerner, Jennifer S; Gross, James J; Dahl, Ronald E

    2008-06-01

    Misery is not miserly: Sadness increases the amount of money that decision makers give up to acquire a commodity. The present research investigated when and why the misery-is-not-miserly effect occurs. Drawing on William James's concept of the material self, we tested a model specifying relationships among sadness, self-focus, and the amount of money that decision makers spend. Consistent with our Jamesian hypothesis, results demonstrated that the misery-is-not-miserly effect occurs only when self-focus is high. That is, self-focus moderates the effect of sadness on spending. Moreover, mediational analyses revealed that, at sufficiently high levels, self-focus mediates (explains) the relationship between sadness and spending. Because the study used real commodities and real money, the results hold implications for everyday decisions, as well as implications for the development of theory. For example, economic theories of spending may benefit from incorporating psychological theories -- specifically, theories of emotion and the self -- into their models.

  3. Health Care Spending and Quality in Year 1 of the Alternative Quality Contract

    Science.gov (United States)

    Song, Zirui; Safran, Dana Gelb; Landon, Bruce E.; He, Yulei; Ellis, Randall P.; Mechanic, Robert E.; Day, Matthew P.; Chernew, Michael E.

    2012-01-01

    Background In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality. Methods Seven provider organizations began 5-year contracts as part of the AQC system in 2009. We analyzed 2006–2009 claims for 380,142 enrollees whose primary care physicians (PCPs) were in the AQC system (intervention group) and for 1,351,446 enrollees whose PCPs were not in the system (control group). We used a propensity-weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the AQC in comparisons of spending and quality between the intervention group and the control group. Results Average spending increased for enrollees in both the intervention and control groups in 2009, but the increase was smaller for enrollees in the intervention group — $15.51 (1.9%) less per quarter (P = 0.007). Savings derived largely from shifts in outpatient care toward facilities with lower fees; from lower expenditures for procedures, imaging, and testing; and from a reduction in spending for enrollees with the highest expected spending. The AQC system was associated with an improvement in performance on measures of the quality of the management of chronic conditions in adults (P<0.001) and of pediatric care (P = 0.001), but not of adult preventive care. All AQC groups met 2009 budget targets and earned surpluses. Total BCBS payments to AQC groups, including bonuses for quality, are likely to have exceeded the estimated savings in year 1. Conclusions The AQC system was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in

  4. Increasing Unit Effectiveness in a Dynamic Environment by Implementing a Leadership Mathematical Model

    Science.gov (United States)

    2011-06-10

    Samurais and British units in the scene of ―Final battle‖ of the movie ―The Last Samurai ‖ (YouTube n. d., 12:52) when the British used machine-guns...opposite Japanese swords. In spite of high unity, spirit, commitment to their culture and traditions, the Samurais lost the battle because they did...2011). ———. The last Samurai -final battle. Windows Media Player video file. http://www.youtube.com/watch?v=zHkxUiE1Vxo&feature=related (accessed

  5. Brief Report: Increasing Acceptance of Homosexuality in the United States Across Racial and Ethnic Subgroups.

    Science.gov (United States)

    Glick, Sara Nelson; Cleary, Sean D; Golden, Matthew R

    2015-11-01

    After recent civil rights expansions for sexual minorities in the United States, we updated previous findings on population-level attitudes toward homosexuality measured in the General Social Survey. In 2014, 40.1% of respondents reported that homosexuality was "always wrong" compared with 54.8% in 2008 (P homosexuality than white respondents throughout 2008 to 2014, the percentage declined among all racial/ethnic groups. Among MSM, more positive attitudes were associated with HIV testing. Research shows a potential association between homophobia and HIV risk; thus, these population-level changes may promote better health among MSM.

  6. Air Quality Impacts of Increased Use of Ethanol under the United States' Energy Independence and Security Act

    Science.gov (United States)

    Increased use of ethanol in the United States fuel supply will impact emissions and ambient concentrations of greenhouse gases, “criteria” pollutants for which the U. S. EPA sets ambient air quality standards, and a variety of air toxic compounds. This paper focuses on impacts of...

  7. Functional unit and product functionality—addressing increase in consumption and demand for functionality in sustainability assessment with LCA

    DEFF Research Database (Denmark)

    Kim, Seung Jin; Kara, Sami; Hauschild, Michael Zwicky

    2016-01-01

    Purpose: The static functional unit definition in the current LCA framework has limitations in addressing the changing product functionality and associated environmental impact of constantly evolving product technologies. As a result, it overlooks the changes in consumer behaviour of increased co...... cycle design that helps keep the total environmental impact of the company’s product portfolio within absolute boundaries....

  8. The Effect of Increasing Meeting Time on the Physiological Indices of Patients Admitted to the Intensive Care Unit

    OpenAIRE

    2016-01-01

    Background Most hospitals have restricted visitation time in intensive care units (ICUs) for various reasons. Given the advantages of family presence and positive effect of emotional touching, talking and smiling on nervous system stimulation and vital signs of the patients. Objectives The present study aimed to determine the effect of increased visitation time on physiological indices of the patients hospitalized in ICUs. ...

  9. Trends in Spending by the Department of Defense for Operation and Maintenance

    Science.gov (United States)

    2017-01-01

    to in this report are federal fi September 30 and are designated by the calendar year in which they end. Numbers in the text and exhibits may not add...component and reserves ) has also increased in the past several years; O&M funding in defensewide organizations has increased at an even faster pace...military personnel and their families, see Congressional Budget Office, Approaches to Reducing Federal Spending on Military Health Care (January

  10. Increasing the resilience and security of the United States' power infrastructure

    Energy Technology Data Exchange (ETDEWEB)

    Happenny, Sean F. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-08-01

    The United States' power infrastructure is aging, underfunded, and vulnerable to cyber attack. Emerging smart grid technologies may take some of the burden off of existing systems and make the grid as a whole more efficient, reliable, and secure. The Pacific Northwest National Laboratory (PNNL) is funding research into several aspects of smart grid technology and grid security, creating a software simulation tool that will allow researchers to test power infrastructure control and distribution paradigms by utilizing different smart grid technologies to determine how the grid and these technologies react under different circumstances. Understanding how these systems behave in real-world conditions will lead to new ways to make our power infrastructure more resilient and secure. Demonstrating security in embedded systems is another research area PNNL is tackling. Many of the systems controlling the U.S. critical infrastructure, such as the power grid, lack integrated security and the aging networks protecting them are becoming easier to attack.

  11. Hong Kong domestic health spending: financial years 1989/90 to 2005/06.

    Science.gov (United States)

    Tin, K Y K; Tsoi, P K O; Leung, E S K; Tsui, E L H; Lam, D W S; Tsang, C S H; Lo, S V

    2010-02-01

    This report presents the latest estimates of Hong Kong domestic health spending between fiscal years 1989/90 and 2005/06, cross-stratified and categorised by financing source, provider, and function on an annual basis. In fiscal year 2005/06, total health expenditure was HK$71 557 million. In real terms, it grew 6.5% per annum on average throughout the study period, whereas gross domestic product grew 4.1%, indicating a growing percentage of health spending relative to gross domestic product, from 3.5% in 1989/90 to 5.1% in 2005/06. This increase was largely funded by public spending, which rose 8.2% per annum on average in real terms, compared with 5.1% for private spending. This represents a growing share of public spending from 40.2% to 51.6% of total health expenditure during the period. Public spending was the dominant source of health financing in 2005/06, whereas private household out-of-pocket expenditure accounted for the second largest share (34.5%), followed by employer-provided group medical benefits (7.5%), privately purchased insurance (5.1%), and other private sources (1.3%). Of the HK$71 557 million total health expenditure in 2005/06, HK$68 810 million (96.2%) was on current expenditure and HK$2746 million (3.8%) on capital expenses (ie investment in medical facilities). Services of curative care accounted for the largest share (67.3%) and were made up of ambulatory services (35.7%), in-patient services (27.7%), day patient hospital services (3.4%), and home care (0.6%). The second largest share was spending on medical goods outside the patient care setting (10.8%). In terms of health care providers, hospitals (44.0%) accounted for the largest share of total health expenditure in 2005/06, followed by providers of ambulatory health care (31.4%). We observed a system-wide trend towards service consolidation at institutions (as opposed to free-standing ambulatory clinics, most of which are staffed by solo practitioners). Not taking capital expenses

  12. Increasing incidence of testicular cancer in the United States and Europe between 1992 and 2009.

    Science.gov (United States)

    Nigam, Manas; Aschebrook-Kilfoy, Briseis; Shikanov, Sergey; Eggener, Scott

    2015-05-01

    Increasing in incidence, testicular cancer is the most commonly diagnosed cancer in young men in the USA and in Europe. We sought to determine contemporary trends in testicular cancer incidence in the USA and Europe. Testicular cancer incidence data covering the USA and Europe were extracted from the SEER-13 (SEER*Stat 8.0.1) and the EUREG databases, respectively. Trends were determined using JoinPoint 3.5.3. Testicular germ cell tumor (TGCT) incidence among US males >15 years increased from 1992 (5.7/100,000) to 2009 (6.8/100,000) with a significant annual percentage change (APC: 1.1%, p testicular cancer increased in 15 of 19 (79%) European countries analyzed (p testicular cancer incidence in the USA and Europe continued to increase, most notably in US Hispanic, Northern European, Spanish, and younger and older populations.

  13. Increasing Public Expenditure

    National Research Council Canada - National Science Library

    Ammar Ben Zaed

    2015-01-01

    This article aims to analyze and interpret the phenomenon of increased public expenditures and test explanatory theories as well as to analyze Abstract the relationship between public spending and GDP...

  14. Train-the-trainer intervention to increase nursing teamwork and decrease missed nursing care in acute care patient units.

    Science.gov (United States)

    Kalisch, Beatrice J; Xie, Boqin; Ronis, David L

    2013-01-01

    Teamwork is essential for patient safety and results in less missed nursing care. The aim of this study was to test the impact of a train-the-trainer intervention on the level of satisfaction with nursing teamwork and the amount of missed nursing care. This study used a quasiexperimental design with repeated measures taken at pretest, posttest, and 2 months after completion of the intervention. The sample for this study was the nursing staff on three medical-surgical units in three separate acute care hospitals (one unit in each hospital). Three nurses from each unit underwent a training program and then taught the skills and knowledge they acquired to the staff members on their units in three-hour-long sessions. The training involved staff role-playing scenarios based on teamwork problems that occur regularly on inpatient units in acute care hospitals followed by debriefing, which focused on teamwork behaviors (e.g., leadership, team orientation, backup, performance monitoring) and missed nursing care. Four measures were used to test the efficacy of this intervention: The Nursing Teamwork Survey, the MISSCARE Survey, and questions about the knowledge of and satisfaction with teamwork. Return rates for the surveys ranged from 73% to 84%. Follow-up tests individually comparing pretest, posttest, and delayed posttest were conducted within the mixed model and used the Bonferroni correction for multiple comparisons. Teamwork increased (F = 6.91, df = 259.01, p = .001) and missed care decreased (F = 3.59, df = 251.29, p = .03) over time. Nursing staff also reported a higher level of satisfaction with teamwork and an increase of teamwork knowledge after the intervention. The intervention tested in this study shows promise of being an effective and efficient approach to increase nursing teamwork and decrease missed nursing care.

  15. Trust in intimate relationships : The increased importance of embeddedness for marriage in the United States

    NARCIS (Netherlands)

    Rijt, Arnout van de; Buskens, Vincent

    2006-01-01

    Due to the rise of a market for casual relationships, investing in a serious relationship now requires more trust than it did four decades ago. We develop a theory of trust and embeddedness in intimate relationships. One implication of the theory is that given the increased importance of trust, the

  16. Insurer market structure and variation in commercial health care spending.

    Science.gov (United States)

    McKellar, Michael R; Naimer, Sivia; Landrum, Mary B; Gibson, Teresa B; Chandra, Amitabh; Chernew, Michael

    2014-06-01

    To examine the relationship between insurance market structure and health care prices, utilization, and spending. Claims for 37.6 million privately insured employees and their dependents from the Truven Health Market Scan Database in 2009. Measures of insurer market structure derived from Health Leaders Inter study data. Regression models are used to estimate the association between insurance market concentration and health care spending, utilization, and price, adjusting for differences in patient characteristics and other market-level traits. Insurance market concentration is inversely related to prices and spending, but positively related to utilization. Our results imply that, after adjusting for input price differences, a market with two equal size insurers is associated with 3.9 percent lower medical care spending per capita (p = .002) and 5.0 percent lower prices for health care services relative to one with three equal size insurers (p market might lead to higher prices and higher spending for care, suggesting some of the gains from insurer competition may be absorbed by higher prices for health care. Greater attention to prices and utilization in the provider market may need to accompany procompetitive insurance market strategies. © Health Research and Educational Trust.

  17. The Impact of Public Spending on Regional Economic Dynamics

    Directory of Open Access Journals (Sweden)

    Henry Antonio Mendoza Tolosa

    2014-01-01

    Full Text Available The impact that public spending and investment have upon economic growth in the departments of Colombia is examined using the results of national accounts for the years 2000-2011. Figures for departmental production by activity, along with change over the period and information for the gross public capital are brought together to create a statistical model to assess effects. A data panel model is chosen to relate the existing differences between departments and compare the impact of spending and investment between departments using the available information. Results indicate that public spending and investment play an important role in departmental economic dynamic and that its effect is greater in larger and wealthier departments.

  18. Gallstone Disease is Associated with Increased Mortality in the United States

    Science.gov (United States)

    Ruhl, Constance E.; Everhart, James E.

    2010-01-01

    Background & Aims Gallstones are common and contribute to morbidity and health-care costs, but their effects on mortality are unclear. We examined whether gallstone disease was associated with overall and cause-specific mortalities in a prospective national population-based sample. Methods We analyzed data from 14,228 participants in the third U.S. National Health and Nutrition Examination Survey (20–74 years old) who underwent gallbladder ultrasonography from 1988 to 1994. Gallstone disease was defined as ultrasound-documented gallstones or evidence of cholecystectomy. The underlying cause of death was identified from death certificates collected through 2006 (mean follow up=14.3 years). Mortality hazard ratios (HR) were calculated using Cox proportional hazards regression analysis, to adjust for multiple demographic and cardiovascular-disease risk factors. Results The prevalence of gallstones was 7.1% and of cholecystectomy was 5.3%. During a follow-up period of 18 years or more, the cumulative mortality was 16.5% from all causes (2,389 deaths), 6.7% from cardiovascular disease (886 deaths), and 4.9% from cancer (651 deaths). Participants with gallstone disease had higher all-cause mortality in age-adjusted (HR, 1.3; 95% confidence interval [CI], 1.2–1.5) and multivariate-adjusted analysis (HR, 1.3; 95% CI, 1.1–1.5). A similar increase was observed for cardiovascular disease mortality (multivariate-adjusted HR, 1.4; 95% CI, 1.2–1.7) and cancer mortality (multivariate-adjusted HR, 1.3; 95% CI, 0.98–1.8). Individuals with gallstones had a similar increase in risk of death as those with cholecystectomy (multivariate-adjusted HR, 1.1; 95% CI, 0.92–1.4). Conclusions In the U.S. population, persons with gallstone disease have increased mortality, overall, and mortalities from cardiovascular disease and cancer. This relationship was found for both ultrasound-diagnosed gallstones and cholecystectomy. PMID:21075109

  19. Increasing Vulnerability to Drought and Climate Change on the Navajo Nation, southwestern United States

    Science.gov (United States)

    Hiza, M. M.; Kelley, K. B.; Francis, H.

    2011-12-01

    The Navajo Nation of Arizona, New Mexico, and Utah, is an ecologically sensitive semi-arid to arid area where rapid growth of one of the largest population of Native Americans is outstripping the capacity of the land to sustain them. Recent drought conditions, combined with increasing temperatures, are significantly altering the habitability of a region already characterized by harsh living conditions. In addition to altered landscape conditions due to climatic change, drought, and varying land use practices over the last 200 years, the Navajo people have been affected by land use policies and harsh economic conditions that weaken their cultural fabric. Increasing aridity combined with drought threaten the very existence of Navajo culture and the survival of traditional Navajo communities. People presently living on these Native lands are unique in American society as their traditional lifestyle requires intimate knowledge of the ecosystem, knowledge that has been passed on for generations through oral traditions. We present data from the lifelong observations of 73 Native American elders that provide a record of the changes in plants and animals, water availability, weather, and sand or dust storms. This information is used to complement the scant long-term meteorological records and historical documentation for the region to further refine our understanding of the historical trends and local impacts of climate change and drought. Among the most cited changes is a long-term decrease in the amount of annual snowfall over the past century, a transition from wet conditions to dry conditions in the 1940s, and a decline in surface water features. The lack of available water, in addition to changing socioeconomic conditions, was mentioned as a leading cause for the decline in the ability to grow corn and other crops. Other noted changes include the disappearance of springs, and of plant and animal populations (particularly medicinal plants, cottonwood trees, beavers

  20. Proactive patient rounding to increase customer service and satisfaction on an orthopaedic unit.

    Science.gov (United States)

    Tea, Christine; Ellison, Michael; Feghali, Fadia

    2008-01-01

    Customer service and patient satisfaction have become increasingly important in the healthcare industry. Given limited resources and a myriad of choices, on which facets of patient satisfaction should healthcare providers focus? An analysis of 40,000 observations across 4 hospitals found 1 important intervention: timely staff responsiveness. Using the Plan-Do-Check-Act (PDCA) quality methodology, the goal was set to improve staff responsiveness to orthopaedic patient needs and requests, thus improving patient satisfaction. A model to improve staff responsiveness was systematically developed and implemented. The I Care Rounding model places the emphasis on proactively meeting patient needs through hourly rounding, rather than caregivers providing care in a reactionary mode. After full implementation, positive improvement was demonstrated.

  1. Photovoltaic cost reduction powered by nuclear spending

    Science.gov (United States)

    Smith, Timothy; Deinert, Mark

    2013-04-01

    Between 1975 to 2010, Japan has spent an average of 2700 Million per year on nuclear R&D and 74 Million per year on solar energy R&D (2010 dollars). While the cost of photovoltaics dropped by a factor of 30 during that time, the overnight cost to build a nuclear power plant has doubled between 2003 and 2009. The price of commercially available photovoltaics has been shown to follow a power law reduction with the number of units produced. This begs the question as to what the current price of these systems would be had some of the available funds used for nuclear R&D been spent on the acquisition of photovoltaics. Here we show the reduction in price for single crystal photovoltaic panels if the Japanese government spent some of their nuclear R&D funds on the installation of these systems. We use historical cost and cumulative production for the world and Japan to build a learning curve model for PV. If the government had spent only 0.07% of its nuclear R&D budget toward PV technology since 1975, photovoltaics would now have reached 1/Watt, the point at which they are cost competitive with conventional resources.

  2. Financial Audit and Spending of Appropriations

    Directory of Open Access Journals (Sweden)

    Ivo Mijoč

    2013-07-01

    Full Text Available Local and district (regional governments receive various forms of revenue. The entitlement to and purpose of this income is determined by law. Likewise for companies owned by local government there are revenues with allocated use, which are also associated with the budget of the local unit. The importance of proper recording of the revenue collected, as well as claims for different types of income is significant because it affects the proper presentation of the financial statements. The presented data are the basis for making decisions, which result in opportunities to meet the needs of local communities. When it comes to the disposal of revenue collected, misconduct or even illegal activities might occur. It is crucial to spot them early on, and here the internal control system and the accounting system have a key role, as they examine the financial and other information for management purposes. The aim of the paper was to investigate irregularities in the use of local funds by examining the data obtained by Financial Audits and to show the movement of appropriations (allocated funds at the county level.

  3. Social Spending and Aggregate Welfare in Developing and Transition Economies

    DEFF Research Database (Denmark)

    Gebregziabher, Fiseha Haile; Niño-Zarazúa, Miguel

    the impact of government spending on the social sectors (health, education, and social protection) on two major indicators of aggregate welfare (the inequality-adjusted Human Development Index and child mortality), using a panel dataset comprising 55 developing and transition countries from 1990 to 2009. We...... find that government social spending has a significantly positive causal effect on the inequality-adjusted Human Development Index, while government expenditure on health has a significant negative impact on child mortality rate. These results are fairly robust to the method of estimation, the use...

  4. Relationship Among Reserve Ratio, Government Spending and Economic Growth

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yan; ZHOU Sheng-Wu

    2005-01-01

    The relationship among reserve ration, government spending and economic growth was analyzed. A monetary endogenous growth model is well developed by taking into account the growth-enhancing effects of reserve-augmenting seigniorage. If the government spends all the seigniorage revenue on the provision of a public input which has positive externality on the private sector's production, some results to be utterly different from Bronx's have been obtained: the economy has a unique saddle-balanced growth path, but it has nothing to do with reserve ratio. However, the higher reserve ratio, the faster speed of economic convergence.

  5. DECENTRALIZATION, FISCAL CAPABILITY AND PUBLIC SPENDING EFFICIENCY

    Directory of Open Access Journals (Sweden)

    Abdul Hakim

    2012-01-01

    Full Text Available Assigning autonomy to regency governments in Indonesia has failed to increase regency’s economies.While it increases regency government role in planning and initiating policies, its impact oneconomic development has been insignificant. This stems from the lack of institution’s capacity inorganizing the bulk funds transfer from the central government which leads to inefficiency in resourceallocation. This paper maps these regencies based on their fiscal dependency. This paperalso applies Data Envelopment Analysis to identify the efficient and non efficient regencies in sucha way that the non efficient regencies might use the efficient ones as the benchmark to increase theirefficiency.Keywords: Autonomy, regency government, efficiencyJEL classification numbers: H21, H53, H71, H72

  6. National health spending in 2006: a year of change for prescription drugs.

    Science.gov (United States)

    Catlin, Aaron; Cowan, Cathy; Hartman, Micah; Heffler, Stephen

    2008-01-01

    In 2006, U.S. health care spending increased 6.7 percent to $2.1 trillion, or $7,026 per person. The health care portion of gross domestic product (GDP) was 16.0 percent, slightly higher than in 2005. Prescription drug spending growth accelerated in 2006 to 8.5 percent, partly as a result of Medicare Part D's impact. Most of the other major health care services and public payers experienced slower growth in 2006 than in prior years. The implementation of Medicare Part D caused a major shift in the distribution of payers for prescription drugs, as Medicare played a larger role in drug purchases than it had before.

  7. Assessment of the relative socioeconomic effects of increased coal development in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Stenehjem, E.J.; Santini, D.J.

    1979-12-01

    This report contains a description of the Social and Economic Assessment Model, which is used to analyze the social and economic effects of energy development at the regional and county levels. Using the SEAM, the effects of coal mines and coal-fired utilities projected for over 340 US counties are examined. The study utilizes a clustering algorithm to determine the assimilative capacity of a county, that is, the county's ability to sustain the effects of an influx of population and thus an increased demand on its resources. The results of the clustering algorithm are used, together with county demographic data, as well as data on projected facility location, size, timing, and type, to estimate socioeconomic effects in terms of public costs that will be imposed on the affected populations. These results are aggregated to the regional level to give a rough estimate of the relative regional effects of coal development. The results indicate that 93% of the entire long-term, adverse impact from coal will be borne by states and counties of the Rocky Mountain area, whereas only 14% of the short-term impacts will be borne by this region. About 42% of the short-term costs will occur in the Southern region and 33% in the North Central region, but only 5% of the long-term costs are estimated for these two regions. Of the four major Census regions (Northeast, South, North Central, and West) only the Northeast is expected to be relatively free of community growth problems caused by coal development.

  8. Early transfer of mated females into the maternity unit reduces stress and increases maternal care in farm mink

    DEFF Research Database (Denmark)

    Malmkvist, Jens; Palme, Rupert

    2015-01-01

    sized groups (n = 60): (i) ‘EARLY’, transfer to maternity unit immediately after the end of the mating period, March 23; (ii) ‘INTERMEDIATE’, transfer in the middle of the period, April 10; (iii) ‘LATE’, transfer late in the pregnancy period, April 25. Data collection included weekly determination...... to an environment with free access to nest building material. During the weeks before delivery, INTERMEDIATE females had 50% higher FCM concentrations than the other two groups (P = 0.002), indicative of stress. After delivery, late moved females had, in average, 2.7 °C colder nests compared to early moved females...... vitality from early moved females. In conclusion, transfer into the maternity unit early after mating, rather than later during the pregnancy period, reduces stress and increases maternal care in farm mink....

  9. Spatial-temporal Variation Characteristics of Grain Yield per Unit Area and its Balanced Increasing Potential in China

    Directory of Open Access Journals (Sweden)

    Liu Yu

    2015-03-01

    Full Text Available The aim of this study is to provide assistance decision for grain yield in China, which can provide basis for reasonable layout of grain production project. Based on the statistical data of 2301 counties in China, using spatial autocorrelation analysis method, spatial changes of grain yield per unit area at county level in China during 1990-2010 were discussed and then the increase potential of grain yield per hectare and total yield at regional scale were calculated. The results showed that: (1 Grain yield per unit area at county level showed the evident pattern “High in the northern while low in the southern” and “High in the eastern and western while low in the middle”; The average grain yield per hectare increased by 1040.74 kg/hm2 during 1990-2010 and the increment of grain yield per unit area descended from North to South at county level. (2 Grain yield per unit area at county level in China had a strong spatial autocorrelation. The counties with "High-High" and "Low-Low" correlation were the majority. Counties with significant "High-High" correlation in 2010 were mostly located in plain area, while counties with significant "Low-Low" correlation were mainly distributed in Hengduan Mountainous Area, Inner Mongolia steppe Area, etc. (3 Two thousand three hundred and one counties were divided into 41 first-grade regions and 115 sec-grade regions according to the coupled conditions of cultivation system regionalization and LISA cluster map. The total potential output of China was 1.77×108 tons.

  10. The ‘Alternative Quality Contract’ in Massachusetts, Based on Global Budgets, Lowered Medical Spending and Improved Quality

    Science.gov (United States)

    Song, Zirui; Safran, Dana Gelb; Landon, Bruce E.; Landrum, Mary Beth; He, Yulei; Mechanic, Robert E.; Day, Matthew P.; Chernew, Michael E.

    2012-01-01

    Seven provider organizations in Massachusetts entered the Blue Cross Blue Shield Alternative Quality Contract in 2009, followed by four more organizations in 2010. This contract, based on a global budget and pay-for-performance for achieving certain quality benchmarks, places providers at risk for excessive spending and rewards them for quality, similar to the new Pioneer Accountable Care Organizations in Medicare. We analyzed changes in spending and quality associated with the Alternative Quality Contract and found that the rate of increase in spending slowed compared to control groups. Overall, participation in the contract over two years led to a savings of 3.3% (1.9% in year-1, 3.3% in year-2) compared to spending in groups not participating in the contract. The savings were even higher for groups whose previous experience had been only in fee-for-service contracting. Such groups’ quarterly savings over two years averaged 8.2% (6.3% in year-1, 9.9% in year-2). Quality of care also improved within organizations participating in the Alternative Quality Contract compared to control organizations in both years. Chronic care management, adult preventive care, and pediatric care improved from year 1 to year 2 within the contracting groups. These results suggest that global budgets coupled with pay-for-performance can begin to slow the underlying growth in medical spending while improving quality. PMID:22786651

  11. How the ACA's Health Insurance Expansions Have Affected Out-of-Pocket Cost-Sharing and Spending on Premiums.

    Science.gov (United States)

    Glied, Sherry; Solís-Román, Claudia; Parikh, Shivani

    2016-09-01

    One important benefit gained by the millions of Americans with health insurance through the Affordable Care Act (ACA) is protection from high out-of-pocket health spending. While Medicaid unambiguously reduces out-of-pocket premium and medical costs for low-income people, it is less certain that marketplace coverage and other types of insurance purchased to comply with the law's individual mandate also protect from high health spending. Goal: To compare out-of-pocket spending in 2014 to spending in 2013; assess how this spending changed in states where many people enrolled in the marketplaces relative to states where few people enrolled; and project the decline in the percentage of people paying high amounts out-of-pocket. Methods: Linear regression models were used to estimate whether people under age 65 spent above certain thresholds. Key findings and conclusions: The probability of incurring high out-of-pocket costs and premium expenses declined as marketplace enrollment increased. The percentage reductions were greatest among those with incomes between 250 percent and 399 percent of poverty, those who were eligible for premium subsidies, and those who previously were uninsured or had very limited nongroup coverage. These effects appear largely attributable to marketplace enrollment rather than to other ACA provisions or to economic trends.

  12. Hong Kong domestic health spending: financial years 1989/90 to 2009/10.

    Science.gov (United States)

    Tin, K Y K; Tsoi, P K O; Lee, Y H; Tsui, E L H; Lam, D W S; Chui, A W M; Lo, S V

    2013-04-01

    This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2009/10, cross-stratified and categorised by financing source, provider and function. Total expenditure on health (TEH) was HK$88,721 million in financial year 2009/10, which represents an increase of HK$5031 million or 6.0% over the preceding year. As a result of a slow revival in the economy from the financial tsunami in 2008, TEH grew faster relative to gross domestic product (GDP) leading to a marked increase in TEH as a percentage of GDP from 5.0% in 2008/09 to 5.2% in 2009/10. During the period 1989/90 to 2009/10, total health spending per capita (at constant 2010 prices) grew at an average annual rate of 4.9%, which was faster than the average annual growth rate of per capita GDP by 2.0 percentage points. In 2009/10, public and private expenditure on health increased by 6.2% and 5.8% when compared with 2008/09, reaching HK$43,823 million and HK$44,898 million, respectively. Consequently, public and private shares of total health expenditure stayed at similar levels (49% and 51% respectively) in the 2 years. With respect to private spending, the most important source of health financing was out-of-pocket payments by households (34.9% of TEH), followed by employer-provided group medical benefits (7.4%) and private insurance (6.8%). During the period, a growing number of households (mostly in middle to high income groups) have taken out pre-payment plans to finance health care. As such, private insurance has taken on an increasingly important role in financing private spending. Of the HK$88,721 million total health expenditure in 2009/10, current expenditure comprised HK$84,874 million (95.7%), whereas HK$3847 million (4.3%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share (66.2%), which was made up of ambulatory services (33.5%), in

  13. [Excessive spending by misuse of clinical laboratory].

    Science.gov (United States)

    Benítez-Arvizu, Gamaliel; Novelo-Garza, Bárbara; Mendoza-Valdez, Antonia Lorena; Galván-Cervantes, Jorge; Morales-Rojas, Alejandro

    2016-01-01

    Seventy five percent or more of a diagnosis comes from a proper medical history along with an excellent physical examination. This leaves to the clinical laboratory the function of supporting the findings, determining prognosis, classifying the diseases, monitoring the diseases and, in the minimum of cases, establishing the diagnosis. In recent years there has been a global phenomenon in which the allocation of resources to health care has grown in an excessive way; the Instituto Mexicano del Seguro Social is not an exception with an increase of 29 % from 2009 to 2011; therefore, it is necessary to set containment and reduction without compromising the quality of patient care.

  14. Government spending in a New Keynesian Endogenous Growth Model

    NARCIS (Netherlands)

    Kuehn, S.; Veen, van A.P. (Tom); Muysken, J.

    2009-01-01

    Standard New Keynesian models cannot generate the widely observed result that private consumption is crowded in by government spending. We use a New Keynesian endogenous growth model with endogenous labour supply to analyse this phenomenon. The presence of small direct productivity effects of govern

  15. Spending Behavior of the Teaching Personnel in an Asian University

    Directory of Open Access Journals (Sweden)

    Niño Philip L. Perculeza

    2016-02-01

    Full Text Available Money, through the years, has been a commodity for everyone. As it is termed in international trade parlance, it is considered to be “sine qua non” or without which, nothing could be done. This study aimed to determine the current status of the spending practices of the teaching personnel in Lyceum of the Philippines University – Batangas; specifically, their profile, spending behavior and their encountered problems related to the forgoing matter. This study is descriptive in nature. It was participated by 161 teaching personnel of LPU-Batangas computed and selected through the G* power series with an effective size of 40 percent and power size of 95 percent. It made use of an adopted and modified questionnaire as its primary data gathering instrument which has three parts. The needed data were encoded, tallied and interpreted using different statistical tools such as frequency distribution, ranking, weighted mean and F-Test; and were further analyzed and interpreted through PASW version 19 using 0.05 alpha levels. From the results, it was concluded that the respondents had an often type of spending on the Basic Necessity. Moreover, overspending is the problem that was most encountered by the respondents. Various recommendations were posted by the researchers including a proposed plan of action that could help improve the spending behavior of the faculty members of LPU Batangas.

  16. Online ATM Helps Youth Smarten Up about Spending

    Science.gov (United States)

    Hibbert, Kathy; Coulson, Elizabeth

    2009-01-01

    While many high school students confess a desire to develop personal money management skills, statistics tracking the average Canadian's personal debt underscore the need to ensure the youth have the tools they need for financial success. What would it take to motivate teens to learn more about how they spend and manage their money? The authors…

  17. Florida's Opinion on K-12 Public Education Spending

    Science.gov (United States)

    Forster, Greg

    2006-01-01

    This scientifically representative poll of 1,200 Floridians finds that public opinion about K-12 public education spending is seriously misinformed. Floridians think public schools need more money, but the main reason is that they are badly mistaken about how much money the public schools actually get. Key findings of the study include: (1) Half…

  18. Broad and narrow bracketing in gift certificate spending

    NARCIS (Netherlands)

    Felsö, F.Á.; Soetevent, A.R.

    2014-01-01

    We survey 1050 consumers who have just redeemed one or more open loop gift certificates to learn whether they view gift certificate income, cash gifts and non-gift income as substitutes. We find that the majority (83%) of recipients spend the certificates in the same way as cash. The other

  19. Broad and narrow bracketing in gift certificate spending

    NARCIS (Netherlands)

    Felso, Flora A.; Soetevent, Adriaan R.

    We survey 1050 consumers who have just redeemed one or more open loop gift certificates to learn whether they view gift certificate income, cash gifts and non-gift income as substitutes. We find that the majority (83%) of recipients spend the certificates in the same way as cash. The other

  20. An Empirical Approach to Determining Advertising Spending Level.

    Science.gov (United States)

    Sunoo, D. H.; Lin, Lynn Y. S.

    To assess the relationship between advertising and consumer promotion and to determine the optimal short-term advertising spending level for a product, a research project was undertaken by a major food manufacturer. One thousand homes subscribing to a dual-system cable television service received either no advertising exposure to the product or…

  1. No money printing machine. The market for cogeneration units with a Stirling engine begins to increase; Keine Gelddruckmaschinen. Markt fuer Stirling-KWK-Geraete kommt in Bewegung

    Energy Technology Data Exchange (ETDEWEB)

    Schmid, Wolfgang

    2012-10-15

    The serial production of micro combined heat and power units with a Stirling engine is started. However, it is becoming apparent, that from economic reasons units of the 1-kW{sub el.}-class designed for single-family houses and two-family houses are increasingly used as a base load unit in multi-family houses and small trades.

  2. Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures.

    Science.gov (United States)

    Greenspon, Arnold J; Patel, Jasmine D; Lau, Edmund; Ochoa, Jorge A; Frisch, Daniel R; Ho, Reginald T; Pavri, Behzad B; Kurtz, Steven M

    2012-10-16

    This study sought to define contemporary trends in permanent pacemaker use by analyzing a large national database. The Medicare National Coverage Determination for permanent pacemaker, which emphasized single-chamber pacing, has not changed significantly since 1985. We sought to define contemporary trends in permanent pacemaker use by analyzing a large national database. We queried the Nationwide Inpatient Sample to identify permanent pacemaker implants between 1993 and 2009 using the International Classification of Diseases-Ninth Revision-Clinical Modification procedure codes for dual-chamber (DDD), single-ventricular (VVI), single-atrial (AAI), or biventricular (BiV) devices. Annual permanent pacemaker implantation rates and patient demographics were analyzed. Between 1993 and 2009, 2.9 million patients received permanent pacemakers in the United States. Overall use increased by 55.6%. By 2009, DDD use increased from 62% to 82% (p pacemaker use fell from 36% to 14% (p = 0.01). Use of DDD devices was higher in urban, nonteaching hospitals (79%) compared with urban teaching hospitals (76%) and rural hospitals (72%). Patients with private insurance (83%) more commonly received DDD devices than Medicaid (79%) or Medicare (75%) recipients (p pacemakers in the United States. Although DDD device use is increasing, whereas single-chamber ventricular pacemaker use is decreasing. Patients are becoming older and have more medical comorbidities. These trends have important health care policy implications. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  3. Hong Kong domestic health spending: financial years 1989/90 to 2011/12.

    Science.gov (United States)

    Tin, K Y K; Tsoi, P K O; Lee, Y H; Chong, D S Y; Lam, D W S; Yeung, A Y T; Ma, E S K; Maw, C K C

    2015-06-01

    This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2011/12, cross-stratified and categorized by financing source, provider, and function. Total expenditure on health (TEH) was HK$101 985 million in financial year 2011/12, which represents an increase of HK$8580 million or 9.2% over the preceding year. TEH grew faster relative to gross domestic product (GDP) leading to a rise in TEH as a percentage of GDP from 5.1% in 2010/11 to 5.2% in 2011/12. During the period 1989/90 to 2011/12, total health spending per capita (at constant 2012 prices) grew at an average annual rate of 4.8%, which was faster than the average annual growth rate of per capita GDP by 1.8 percentage points. In 2011/12, public and private expenditure on health increased by 8.3% and 10.0% when compared with 2010/11, reaching HK$49,262 million and HK$52,723 million respectively. Consequently, public share of total health expenditure dropped slightly from 48.7% to 48.3% over the year. Of private spending, the most important source of health financing was out-of-pocket payments by households (34.9% of TEH), followed by employer-provided group medical benefits (7.5%) and private insurance (7.4%). It is worth noting that private insurance will likely take over employers as the second largest private payer if the insurance market continues to expand at the current rate. Of the HK$101,985 million total health expenditure in 2011/12, current expenditure comprised HK$96,572 million (94.7%), whereas HK$5413 million (5.3%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services of curative care accounted for the largest share of total health spending (65.2%), which was made up of ambulatory services (33.6%), in-patient curative care (26.9%), day patient hospital services (4.1%), and home care (0.5%). Notwithstanding its small share, the total spending for day patient hospital services shows an

  4. Has The Era Of Slow Growth For Prescription Drug Spending Ended?

    Science.gov (United States)

    Aitken, Murray; Berndt, Ernst R; Cutler, David; Kleinrock, Michael; Maini, Luca

    2016-09-01

    In the period 2005-13 the US prescription drug market grew at an average annual pace of only 1.8 percent in real terms on an invoice price basis (that is, in constant dollars and before manufacturers' rebates and discounts). But the growth rate increased dramatically in 2014, when the market expanded by 11.5 percent-which raised questions about future trends. We determined the impact of manufacturers' rebates and discounts on prices and identified the underlying factors likely to influence prescription spending over the next decade. These include a strengthening of the innovation pipeline; consolidation among buyers such as wholesalers, pharmacy benefit managers, and health insurers; and reduced incidence of patent expirations, which means that fewer less costly generic drug substitutes will enter the market than in the recent past. While various forecasts indicate that pharmaceutical spending growth will moderate from its 2014 level, the business tension between buyers and sellers could play out in many different ways. This suggests that future spending trends remain highly uncertain.

  5. Medicare Advantage Members’ Expected Out-Of-Pocket Spending For Inpatient And Skilled Nursing Facility Services

    Science.gov (United States)

    Keohane, Laura M.; Grebla, Regina C.; Mor, Vincent; Trivedi, Amal N.

    2015-01-01

    Inpatient and skilled nursing facility (SNF) cost sharing in Medicare Advantage (MA) plans may reduce unnecessary use of these services. However, large out-of-pocket expenses potentially limit access to care and encourage beneficiaries at high risk of needing inpatient and postacute care to avoid or leave MA plans. In 2011 new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in MA plans. After these regulations, MA members in plans with low premiums averaged $1,758 in expected out-of-pocket spending for an episode of seven hospital days and twenty skilled nursing facility days. Among members with the same low-premium plan in 2010 and 2011, 36 percent of members belonged to plans that added an out-of-pocket spending limit in 2011. However, these members also had a $293 increase in average cost sharing for an inpatient and skilled nursing facility episode, possibly to offset plans’ expenses in financing out-of-pocket limits. Some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing. PMID:26056208

  6. Lower- Versus Higher-Income Populations In The Alternative Quality Contract: Improved Quality And Similar Spending.

    Science.gov (United States)

    Song, Zirui; Rose, Sherri; Chernew, Michael E; Safran, Dana Gelb

    2017-01-01

    As population-based payment models become increasingly common, it is crucial to understand how such payment models affect health disparities. We evaluated health care quality and spending among enrollees in areas with lower versus higher socioeconomic status in Massachusetts before and after providers entered into the Alternative Quality Contract, a two-sided population-based payment model with substantial incentives tied to quality. We compared changes in process measures, outcome measures, and spending between enrollees in areas with lower and higher socioeconomic status from 2006 to 2012 (outcome measures were measured after the intervention only). Quality improved for all enrollees in the Alternative Quality Contract after their provider organizations entered the contract. Process measures improved 1.2 percentage points per year more among enrollees in areas with lower socioeconomic status than among those in areas with higher socioeconomic status. Outcome measure improvement was no different between the subgroups; neither were changes in spending. Larger or comparable improvements in quality among enrollees in areas with lower socioeconomic status suggest a potential narrowing of disparities. Strong pay-for-performance incentives within a population-based payment model could encourage providers to focus on improving quality for more disadvantaged populations.

  7. Medicare Advantage Members' Expected Out-Of-Pocket Spending For Inpatient And Skilled Nursing Facility Services.

    Science.gov (United States)

    Keohane, Laura M; Grebla, Regina C; Mor, Vincent; Trivedi, Amal N

    2015-06-01

    Inpatient and skilled nursing facility (SNF) cost sharing in Medicare Advantage (MA) plans may reduce unnecessary use of these services. However, large out-of-pocket expenses potentially limit access to care and encourage beneficiaries at high risk of needing inpatient and postacute care to avoid or leave MA plans. In 2011 new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in MA plans. After these regulations, MA members in plans with low premiums averaged $1,758 in expected out-of-pocket spending for an episode of seven hospital days and twenty skilled nursing facility days. Among members with the same low-premium plan in 2010 and 2011, 36 percent of members belonged to plans that added an out-of-pocket spending limit in 2011. However, these members also had a $293 increase in average cost sharing for an inpatient and skilled nursing facility episode, possibly to offset plans' expenses in financing out-of-pocket limits. Some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing.

  8. Slesers says spend, spend, spend

    Index Scriptorium Estoniae

    2011-01-01

    5. augustil kinnitas Läti Esimene Partei/Läti Tee parlamendivalimiste valimisplatvormi, mille peamine mõte seisneb selles, et raha tuleb teenida, mitte säästa. Zatlersi Reformierakond on samuti oma valimisplatvormi kinnitanud

  9. The Nexus between Military Spending and Economic Growth in Newly Industrialized Countries: Panel Evidence from CrossSectional Dependency

    OpenAIRE

    Mehmet Akif DESTEK

    2016-01-01

    In this study, the long term relationship between military spending and economic growth in newly industrialized countries is analyzed with panel data methods for the years of 1988-2013. The study, where panel unit root, panel co-integration, panel co-integration estimator and panel causality tests that allow cross-sectional dependence are used, shows that the feedback hypothesis is valid in newly industrialized countries. And when these countries are analyzed separately, it is ...

  10. Mitigating an increase of specific power consumption in a cryogenic air separation unit at reduced oxygen production

    Science.gov (United States)

    Singla, Rohit; Chowdhury, Kanchan

    2017-02-01

    Specific power consumed in a Linde double column air separation unit (ASU) increases as the quantity of oxygen produced at a given purity is decreased due to the changes of system requirement or market demand. As the plant operates in part load condition, the specific power consumption (SPC) increases as the total power consumption remains the same. In order to mitigate the increase of SPC at lower oxygen production, the operating pressure of high pressure column (HPC) can be lowered by extending the low pressure column (LPC) by a few trays and adding a second reboiler. As the duty of second reboiler in LPC is increased, the recovery of oxygen decreases with a lowering of the HPC pressure. This results in mitigation of the increase of SPC of the plant. A Medium pressure ASU with dual reboiler that produces pressurised gaseous and liquid products of oxygen and nitrogen is simulated in Aspen Hysys 8.6®, a commercial process simulator to determine SPC at varying oxygen production. The effects of reduced pressure of air feed into the cold box on the size of heat exchangers (HX) are analysed. Operation strategy to obtain various oxygen production rates at varying demand is also proposed.

  11. Rethinking the Relation between Government Spending and Economic Growth: A Composition Approach to Fiscal Policy Instruction for Principles Students

    Science.gov (United States)

    Goldsmith, Arthur H.

    2008-01-01

    Standard introductory textbook authors assert that an increase in government spending expands aggregate demand in the short run but also raises the interest rate and, thus, crowds out private investment in the long run. Because the decrease in investment results in a smaller capital stock, potential output or production capacity decreases. The…

  12. How Do Cohabiting Couples with Children Spend Their Money?

    Science.gov (United States)

    Deleire, Thomas; Kalil, Ariel

    2005-01-01

    Increasing rates of cohabitation in the United States raise important questions about how cohabitation fits in with the definition of family. Answers to this question depend in part upon the extent to which cohabitors behavior differs from that of other family types. Using data from the Consumer Expenditure Survey, we compare the expenditure…

  13. Using search query surveillance to monitor tax avoidance and smoking cessation following the United States' 2009 "SCHIP" cigarette tax increase.

    Science.gov (United States)

    Ayers, John W; Ribisl, Kurt; Brownstein, John S

    2011-03-16

    Smokers can use the web to continue or quit their habit. Online vendors sell reduced or tax-free cigarettes lowering smoking costs, while health advocates use the web to promote cessation. We examined how smokers' tax avoidance and smoking cessation Internet search queries were motivated by the United States' (US) 2009 State Children's Health Insurance Program (SCHIP) federal cigarette excise tax increase and two other state specific tax increases. Google keyword searches among residents in a taxed geography (US or US state) were compared to an untaxed geography (Canada) for two years around each tax increase. Search data were normalized to a relative search volume (RSV) scale, where the highest search proportion was labeled 100 with lesser proportions scaled by how they relatively compared to the highest proportion. Changes in RSV were estimated by comparing means during and after the tax increase to means before the tax increase, across taxed and untaxed geographies. The SCHIP tax was associated with an 11.8% (95% confidence interval [95%CI], 5.7 to 17.9; ptax levels in Canada during the months after the tax. Tax avoidance searches increased 27.9% (95%CI, 15.9 to 39.9; ptax compared to Canada, respectively, suggesting avoidance is the more pronounced and durable response. Trends were similar for state-specific tax increases but suggest strong interactive processes across taxes. When the SCHIP tax followed Florida's tax, versus not, it promoted more cessation and avoidance searches. Efforts to combat tax avoidance and increase cessation may be enhanced by using interventions targeted and tailored to smokers' searches. Search query surveillance is a valuable real-time, free and public method, that may be generalized to other behavioral, biological, informational or psychological outcomes manifested online.

  14. Health spending, macroeconomics and fiscal space in countries of the World Health Organization South-East Asia Region.

    Science.gov (United States)

    Gupta, Indrani; Mondal, Swadhin

    2014-01-01

    The paper examines the issues around mobilization of resources for the 11 countries of the South-East Asia Region of the World Health Organization (WHO), by analysing their macroeconomic situation, health spending, fiscal space and other determinants of health. With the exception of a few, most of these countries have made fair progress on their own Millennium Development Goal (MDG) targets of maternal mortality ratio and mortality rate in children aged under 5 years. However, the achieved targets have been very modest - with the exception of Thailand and Sri Lanka - indicating the continued need for additional efforts to improve these indicators. The paper discusses the need for investment, by looking at evidence on economic growth, the availability of fiscal space, and improvements in "macroeconomic-plus" factors like poverty, female literacy, governance and efficiency of the health sector. The analysis indicates that, overall, the countries of the WHO South-East Asia Region are collectively in a position to make the transition from low public spending to moderate or even high health spending, which is required, in turn, for transition from lowcoverage-high out-of-pocket spending (OOPS) to highcoverage-low OOPS. However, explicit prioritization for health within the overall government budget for low spenders would require political will and champions who can argue the case of the health sector. Additional innovative avenues of raising resources, such as earmarked taxes or a health levy can be considered in countries with good macroeconomic fundamentals. With the exception of Thailand, this is applicable for all the countries of the region. However, countries with adverse macroeconomic-plus factors, as well as inefficient health systems, need to be alert to the possibility of overinvesting - and thereby wasting - resources for modest health gains, making the challenge of increasing health sector spending alongside competing demands for spending on other areas of

  15. Three essays on the causes and consequences of government spending and regulatory programs

    Science.gov (United States)

    Bee, C. Adam

    Chapter 1 assesses the impact of household car ownership on individual labor supply. Various economic theories suggest one reason for low rates of employment among low-skill, inner-city residents is that their residences are spatially separated from suburban jobs. To measure this, I exploit changes in state insurance rate regulation which has been shown to suppress auto insurance prices, thereby decreasing the cost of owning a car. I find that rate regulation increases multi-car ownership among married couples with children. I find that the additional car in the household consequently encourages married mothers to decrease their labor supply while their husbands increase their labor supply. One possible explanation of this result is that second cars are stronger complements to time spent in home production (and especially childrearing) than they are to time spent in the labor market. Chapter 2 (with Shawn Moulton) tests for political budget cycles among US municipalities. According to the political budget cycle hypothesis, in election years government officials engage in opportunistic fiscal policy manipulation for electoral gains. This chapter tests that hypothesis using data on taxes and spending for a panel of 268 US cities over the period 1970-2004. While our estimates provide no evidence of altered total expenditures or taxes in election years, we do find a 0.7 percent increase in total municipal employment, including increases in police, education, and sanitation employment. Chapter 3 (with Andrew Deines, David Lodge, and Richard Jensen) assesses trade-offs between fisheries and hydropower production in a tropical floodplain fishery. We compile catch per unit effort, total harvest, and monthly-mean hydrographs from the Kafue River in Zambia for the years 1955-1996 and develop population growth models to test for effects of density, total fisheries harvest, and water regime. We find that alteration of the flood regime has reduced fish density but enhanced

  16. Early transfer of mated females into the maternity unit reduces stress and increases maternal care in farm mink

    DEFF Research Database (Denmark)

    Malmkvist, Jens; Palme, Rupert

    2015-01-01

    Mated mammals on farms are typically transferred to another housing environment prior to delivery. We investigated whether the timing of this transfer – EARLY (Day −36), INTERMEDIATE (Day −18), or LATE (Day −3) relative to the expected day of birth (Day 0) – affects maternal stress, maternal care...... vitality from early moved females. In conclusion, transfer into the maternity unit early after mating, rather than later during the pregnancy period, reduces stress and increases maternal care in farm mink.......Mated mammals on farms are typically transferred to another housing environment prior to delivery. We investigated whether the timing of this transfer – EARLY (Day −36), INTERMEDIATE (Day −18), or LATE (Day −3) relative to the expected day of birth (Day 0) – affects maternal stress, maternal care...... sized groups (n = 60): (i) ‘EARLY’, transfer to maternity unit immediately after the end of the mating period, March 23; (ii) ‘INTERMEDIATE’, transfer in the middle of the period, April 10; (iii) ‘LATE’, transfer late in the pregnancy period, April 25. Data collection included weekly determination...

  17. Interest Groups and Political Economy of Public Education Spending

    Directory of Open Access Journals (Sweden)

    Ece H. Guleryuz

    2015-09-01

    Full Text Available This paper examines the relationship between the lobbying power of different interest groups and public education spending in a panel data estimationduring the period 1996-2009 for 132 countries. The resource rents, manufacture exports, and agriculture value added are used as proxy variables for the lobbying power of the natural resource owners, manufacturers, and landowners, respectively, in order to substantiate the definition of the lobbying power of the interest groups more with economic fundamentals. As lobbying power is mediated through political institutions, different governance indicators are used individually and in interaction terms with the proxy variables in the estimations. It is found that when the country is more politically stable and the more the rule of law applies, the negative (positive effect of the lobbying power of natural resource owners (manufacturers on public education spending intensifies. The negative effect of landowners’ lobbying power diminishes as institutional quality as measured by governance indicators improves.

  18. Interest Groups and Political Economy of Public Education Spending

    Directory of Open Access Journals (Sweden)

    Ece H. Guleryuz

    2015-12-01

    Full Text Available This paper examines the relationship between the lobbying power of different interest groups and public education spending in a panel data estimation during the period 1996-2009 for 132 countries. The resource rents, manufacture exports, and agriculture value added are used as proxy variables for the lobbying power of the natural resource owners, manufacturers, and landowners, respectively, in order to substantiate the definition of the lobbying power of the interest groups more with economic fundamentals. As lobbying power is mediated through political institutions, different governance indicators are used individually and in interaction terms with the proxy variables in the estimations. It is found that when the country is more politically stable and the more the rule of law applies, the negative (positive effect of the lobbying power of natural resource owners (manufacturers on public education spending intensifies. The negative effect of landowners’ lobbying power diminishes as institutional quality as measured by governance indicators improves.

  19. Does Population Aging Drive Up Pro-Elderly Social Spending?

    DEFF Research Database (Denmark)

    Vanhuysse, Pieter

    This essay reviews recent evidence on the pro-elderly social spending bias of OECD welfare states. It shows that the cross-national variance in this variable is remarkably large, with Southern Europe and countries such as Germany, Austria, Japan, the USA, and Switzerland being most heavily pro......-elderly biased. It then points out that population ageing actually cannot explain very much of this pro-elderly bias variance. For instance, countries such as Denmark, Finland and Sweden are demographically old societies, yet they boast among the lowest pro-elderly spending biases in the OECD world, due...... to their greater commitment to family-friendly policies, active labour market policies and similar pro-young policies. The essay reviews a series of similarly counter-intuitive findings about generational politics and policies as published in Ageing Populations in Post-Industrial Democracies (Vanhuysse and Goerres...

  20. Ways of spending free time by alcohol addicts during periods of drinking and rehabilitation

    Directory of Open Access Journals (Sweden)

    Dragišić-Labaš Slađana

    2012-01-01

    Full Text Available In the introduction we discuss free time in the context of consequences of alcoholism on social, psychological, and especially family life, then, the changing use of free time as a significant symptom of alcoholism, and finally, the new organization of free time as an important goal of social reintegration of alcoholics’ families. In the next section, we examine ways in which members of Skela Club at the “Dr Laza Lazarević” Psychiatric Hospital spend their free time during periods of drinking, and during rehabilitation and social integration. The sample consisted of 30 subjects (25 men and 5 women, aged between 25 and 65, living in Belgrade or nearby, regularly attending Club meetings and actively participating in its work. A questionnaire with 35 questions, 32 closed and 3 open, was used. The first part referred to socio-demographic variables, the second to ways of spending free time during the period of addiction, and the third part to free time at present, in the stage of abstinence and rehabilitation. During the period of drinking, subjects were mostly spending their free time in the company of other addicts, in 80% of cases. Their leisure was not very interesting, as it consisted of very few activities: sitting in a bar (76.6%, watching TV (53.3%, reading newspapers (50%, sleeping (40%. In the period of drinking a large number of subjects, regardless of gender, felt lonely - 83%. During the period of abstinence, on the contrary, leisure is better organized, the number of activities increases, and their model changes to socializing with friends (76.6%, communication with family members (66.6%, going for walks (60%, reading books (50%, listening to music (46.6%, and sport activities (36.6%. The conclusion is that alcohol addicts spent their free time during the period of drinking significantly differently than at present, when they are undergoing treatment and rehabilitation. The difference in the quality and organization of free time

  1. Effects of Prescription Coinsurance and Income-Based Deductibles on Net Health Plan Spending for Older Users of Inhaled Medications

    Science.gov (United States)

    Dormuth, Colin R.; Neumann, Peter; Maclure, Malcolm; Glynn, Robert J.; Schneeweiss, Sebastian

    2010-01-01

    Background Health plans that increase prescription cost-sharing for their patients may increase overall plan costs. We analyzed the impact on health plan spending of a switch in public drug insurance from full coverage to a prescription copayment (copay), and then to income-based deductibles plus coinsurance (IBD). Methods We studied British Columbia residents 65 years of age or older who were dispensed inhaled steroids, β2 agonists or anticholinergics on or after January 1996. Multivariable linear regression was used to estimate health plan costs for the population using inhalers by the Ministry of Health (MOH) during the copay and IBD policies. We estimated costs for excess physician visits and emergency hospitalizations based on data from a previously published cohort study and cost data from the MOH. We estimated the net change in MOH spending as the sum of changes in spending for inhalers, physician visits, hospitalizations, and policy administration costs. Results Net health plan spending increased by C$1.98 million per year during the copay policy [95% confidence interval (CI): 0.10–4.34], and C$5.76 million per year during the first 10 months of the IBD policy (95% CI: 1.75–10.58). Out-of-pocket spending by older patients increased 30% during the copay policy (95% CI: 24–36) and 59% during the IBD policy (95% CI: 56–63). Conclusions British Columbia’s experience indicates that cost containment focused on cost-shifting to patients may increase net expenditures for the treatment of some diseases. Health plans should consult experts to anticipate the potential cross-program impacts of policy changes. PMID:19365295

  2. Business, households, and government: health care spending, 1995.

    Science.gov (United States)

    Cowan, C A; Braden, B R

    1997-01-01

    For the period 1990-95, we will present data on health care spending by business, households, and government. In addition, we will measure the relative impact of these expenditures on each sector's ability to pay. In 1994 and 1995, health care costs experienced the slowest growth in 3 decades. Combined with healthy revenue growth, slow cost growth helped ease or stabilize the financing burden faced by business, households and government.

  3. Political Institutions and Government Spending Behavior in Iran

    OpenAIRE

    Dizaji, Sajjad Faraji; Farzanegan, Mohammad Reza

    2014-01-01

    This study examines how quality of political institutions affects the distribution of government budget and how development of government spending in major sections shapes the political institutions in Iran. This question has become especially important due to recent international sanctions, aiming to change the political behavior of Iran. We use the impulse response functions (IRF) and variance decomposition analysis (VDC) on the basis of Vector Autoregressive (VAR) model with annual data fr...

  4. TREASURY EXECUTION OF LOCAL SPENDING BUDGETS: PROBLEMS AND SOLUTIONS

    OpenAIRE

    Dema, Dmitry; Feshchenko, Natalya

    2014-01-01

    The theoretical and practical aspects of using a treasury management system for servicing of local budgets are considered; the role of treasury bodies in routine management of local finances is defined. Current problems of treasury-based execution of local spending budgets are investigated and main deregulating factors affecting the procedure of cash execution of budgets are arranged in a system.Ways to improve budget funds management at the local level are proposed including: improvement of ...

  5. Understanding the timing and magnitude of advertising spending patterns.

    OpenAIRE

    Gijsenberg, Maarten; van Heerde, Harald J.; Dekimpe, Marnik; Jan-Benedict E M Steenkamp; Nijs, Vincent R.

    2009-01-01

    Notwithstanding the fact that advertising is one of the most used marketing tools, little is known about what is driving (i) the timing and (ii) the magnitude of advertising actions. Building on normative theory, the authors develop a parsimonious model that captures this dual investment process. They explain advertising spending patterns as observed in the market, and investigate the impact of company, competitive, and category-related factors on these decisions, thereby introducing the nove...

  6. The impact of weight loss among seniors on Medicare spending

    OpenAIRE

    Thorpe, Kenneth E.; Yang, Zhou; Long, Kathleen M.; Garvey, W. Timothy

    2013-01-01

    Objective: To examine the impact of temporary and permanent weight loss of 10% and 15% on 10-year and lifetime Medicare spending among adults with overweight and obesity aged 65 years and older. Weight loss of this magnitude is consistent with next generation anti-obesity medications recently approved by the Food and Drug Administration. Methods: We follow the approach of a longitudinal dynamic aging process model developed by our research team. This model considers the dynamic relationships ...

  7. Fiscal Competition and the Pattern of Public Spending

    OpenAIRE

    1996-01-01

    Much attention has been given to the impact of fiscal competition on the level of public expenditure, but relatively little to the impact on its composition. Using a broadly familiar and reasonably rich model of fiscal competition in the presence of mobile capital, this paper establishes a systematic bias in public spending patterns: starting from the non-cooperative equilibrium, and holding tax rates constant, welfare would be improved by a coordinated reduction in the provision of local pub...

  8. Diabetes Takes Biggest Bite Out of U.S. Health Care Spending

    Science.gov (United States)

    ... Health Metrics and Evaluation. "That's really a remarkable growth rate, notably faster than the economy is growing or health care spending as a whole," he said. The annual rate of growth in health care spending between 1996 and 2013 ...

  9. Public spending efficiency and political and economic factors: Evidence from selected East Asian countries

    Directory of Open Access Journals (Sweden)

    Chan Sok-Gee

    2012-01-01

    Full Text Available This paper analyses public spending efficiency and the effect of political and economic factors on public spending efficiency in East Asian countries for the period 2000-2007. In the first stage, the non-parametric Data Envelopment Analysis (DEA approach is used to estimate public spending efficiency scores. In the second stage, the Tobit regression model is then used to determine the effect of political and economic factors on public spending efficiency. Results of the study show that China is relatively efficient in public spending on education, health, and maintaining economic performance and stability, Japan on infrastructure, and Singapore on promoting public services. In addition, countries in East Asia are relatively less efficient in public spending for promoting equal income distribution. The results also indicate that political stability and financial freedom have a positive effect on public spending efficiency. However, voice, accountability, and civil liberties have a negative effect on public spending efficiency.

  10. Linking Consumer Debt and Consumer Expenditures: Do Borrowers Spend Money Differently?

    Science.gov (United States)

    Fan, Jessie X.

    2000-01-01

    Data from 5,174 households were analyzed to investigate differences in spending patterns between households who borrow money and those who do not. Findings indicate that borrowers spend less money on necessities and more on luxury commodities. (JOW)

  11. United Kingdom (Wales): Health system review.

    Science.gov (United States)

    Longley, Marcus; Riley, Neil; Davies, Paul; Hernandez-Quevedo, Cristina

    2012-01-01

    Wales is situated to the west of England, with a population of approximately 3 million (5% of the total for the United Kingdom), and a land mass of just over 20 000 km2. For several decades, Wales had a health system largely administered through the United Kingdom Governments Welsh Office, but responsibility for most aspects of health policy was devolved to Wales in a process beginning in 1999. Since then, differences between the policy approach and framework in England and Wales have widened. The internal market introduced in the United Kingdom National Health Service (NHS) has been abandoned in Wales, and seven local health boards (LHBs; supported by three specialist NHS trusts) now plan and provide all health services for their resident populations. Wales currently has more than 120 hospitals as part of an overall estate valued at 2.3 billion pounds. Total spending on health services increased in the first decade of the 21st century, but Wales now faces a period of financial retrenchment greater than in other parts of the United Kingdom as a result of the Welsh Governments decision not to afford the same degree of protection to health spending as that granted elsewhere. The health system in Wales continues to face some structural weaknesses that have proved resistant to reform for some time. However, there has been substantial improvement in service quality and outcomes since the end of the 1990s, in large part facilitated by substantial real growth in health spending. Life expectancy has continued to increase, but health inequalities have proved stubbornly resistant to improvement.

  12. 21st century increases in the likelihood of extreme hydrologic conditions for the mountainous basins of the Southwestern United States

    Science.gov (United States)

    Stewart, Iris T.; Ficklin, Darren L.; Carrillo, Carlos A.; McIntosh, Russell

    2015-10-01

    Extreme hydrologic conditions, such as floods, droughts, and elevated stream temperatures, significantly impact the societal fabric and ecosystems, and there is rising concern about increases in the frequency of extreme conditions with projected climate changes. Here we ask what changes in the occurrence of extreme hydrologic conditions can be expected by the end of the century for the important water-generating, mountainous basins of the Southwestern United States, namely the Sierra Nevada and Upper Colorado River Basins. The extreme conditions considered are very high flows, low flows, and elevated stream temperature as derived from historic and future simulations using the Soil and Water Assessment Tool (SWAT) hydrologic model and downscaled output from a General Circulation Model ensemble. Results indicate noteworthy differences in the frequency changes of extremes based on geographic region, season, elevation, and stream size. We found wide-spread increases in the occurrence of stream flows exceeding 150% of historic monthly averages for winter by the end of the century, and extensive increases in the occurrence of both extreme low flows (representing 3 °C of monthly averages) during the summer months, with some basins expecting extreme conditions 90-100% of the time by the end of the century. Understanding the differences in the changes of extreme conditions can identify climate-sensitive regions and assist in targeted planning for climate change adaptation and mitigation.

  13. Using search query surveillance to monitor tax avoidance and smoking cessation following the United States' 2009 "SCHIP" cigarette tax increase.

    Directory of Open Access Journals (Sweden)

    John W Ayers

    Full Text Available Smokers can use the web to continue or quit their habit. Online vendors sell reduced or tax-free cigarettes lowering smoking costs, while health advocates use the web to promote cessation. We examined how smokers' tax avoidance and smoking cessation Internet search queries were motivated by the United States' (US 2009 State Children's Health Insurance Program (SCHIP federal cigarette excise tax increase and two other state specific tax increases. Google keyword searches among residents in a taxed geography (US or US state were compared to an untaxed geography (Canada for two years around each tax increase. Search data were normalized to a relative search volume (RSV scale, where the highest search proportion was labeled 100 with lesser proportions scaled by how they relatively compared to the highest proportion. Changes in RSV were estimated by comparing means during and after the tax increase to means before the tax increase, across taxed and untaxed geographies. The SCHIP tax was associated with an 11.8% (95% confidence interval [95%CI], 5.7 to 17.9; p<.001 immediate increase in cessation searches; however, searches quickly abated and approximated differences from pre-tax levels in Canada during the months after the tax. Tax avoidance searches increased 27.9% (95%CI, 15.9 to 39.9; p<.001 and 5.3% (95%CI, 3.6 to 7.1; p<.001 during and in the months after the tax compared to Canada, respectively, suggesting avoidance is the more pronounced and durable response. Trends were similar for state-specific tax increases but suggest strong interactive processes across taxes. When the SCHIP tax followed Florida's tax, versus not, it promoted more cessation and avoidance searches. Efforts to combat tax avoidance and increase cessation may be enhanced by using interventions targeted and tailored to smokers' searches. Search query surveillance is a valuable real-time, free and public method, that may be generalized to other behavioral, biological

  14. Consumption patterns and levels among households with HIV positive members and economic impoverishment due to medical spending in Pune city, India.

    Science.gov (United States)

    Sharma, Varun; Krishnaswamy, Divya; Mulay, Sanjeevanee

    2015-01-01

    HIV infection poses a serious threat to the economy of a household. Out of pocket (OOP) health spending can be prohibitive and can drag households below poverty level. Based on the data collected from a cross-sectional survey of 401 households with HIV+ members in Pune city, India, this paper examines the consumption levels and patterns among households, and comments on the economic impoverishment resulting from OOP medical spending. Analysis reveals that households with HIV members spend a major portion of their monthly consumption expenditure on food items. Medical expenditure constitutes a large portion of their total consumption spending. Expenditure on children's education constitutes a minor proportion of total monthly spending. A high proportion of medical expenditure has a bearing on the economic condition of households with HIV members. Poverty increases by 20% among the studied HIV households when OOP health spending is adjusted. It increases 18% among male-headed households and 26% among female-headed households. The results reiterate the need of greater support from the government in terms of accessibility and affordability of health care to save households with HIV members from economic catastrophe.

  15. The impact of weight loss among seniors on Medicare spending.

    Science.gov (United States)

    Thorpe, Kenneth E; Yang, Zhou; Long, Kathleen M; Garvey, W Timothy

    2013-03-20

    To examine the impact of temporary and permanent weight loss of 10% and 15% on 10-year and lifetime Medicare spending among adults with overweight and obesity aged 65 years and older. Weight loss of this magnitude is consistent with next generation anti-obesity medications recently approved by the Food and Drug Administration. We follow the approach of a longitudinal dynamic aging process model developed by our research team. This model considers the dynamic relationships between weight, chronic disease, acute medical events, functional status, mortality, health care utilization and spending among Medicare beneficiaries from age 65 until death. Using this model, we estimate baseline Medicare spending over the next decade and then over the lifetime of seniors with a body mass index (BMI) ≥ 27 with at least one weight-related comorbidity (overweight), and seniors with obesity having a BMI ≥ 30 and ≥ 35. We then estimate Medicare spending for this population between ages 65 and 70 over the course of a year, assuming 10% and 15% weight loss under alternative scenarios: with and without weight regain. (Weight regain is assumed to be 90% over a 10-year period.) The difference in spending between baseline (no weight-loss intervention) and the alternative scenarios represent potential gross savings to the Medicare program. Permanent weight loss of 10 to 15% will yield $9,445 to $15,987 in gross per capita savings throughout their lifetime, and $8,070 to $13,474 over ten years. Similarly, initial weight loss of 10 to 15% followed by 90% weight regain will result in gross per capita savings of $7,556 to $11,109 over their lifetime, and $6,456 to $8,911 over ten years. Targeting weight loss medications to adults with obesity (BMI ≥ 30) produces greater savings to the Medicare program. Medicare can realize significant cost savings through anti-obesity medications that produce substantial weight loss, and as a result, reduce the progression to type 2 diabetes, and

  16. Classification of Region’s Municipalities by Structure and Level of Incomes and Consumer Spending

    Directory of Open Access Journals (Sweden)

    Vladislav Yakovlevich Fokin

    2015-11-01

    Full Text Available The paper presents a classification of region’s municipalities that differ according to two criteria – the structure and level of incomes, and the level of consumer spending. The author investigated the combination of income sources (wages, pensions and unemployment benefits that form in the aggregate the amount of disposable money income of the people who live in the administrative-territorial units of Perm Krai. The author also analyzed the influence of people’s incomes on retail trade turnover in the region’s municipalities. The data were collected, grouped and analyzed; they show that the level of people’s income in large and medium cities, which are industrial centers, exceeds considerably the values of these indicators registered in rural municipalities, single-industry settlements and depressed areas. The reason for this lies in low wages of working population, a large proportion of retirees and the unemployed in the rural areas, single-industry settlements and depressed areas. The article defines nine types of territorial entities in the region that differ in level and structure of income and consumer spending in the municipalities. The author concludes that the territorial differentiation of municipal formations influences the formation of stratified population groups distinguished by the level of income and consumption. The solution to this problem requires joint efforts by the regional administration and municipal authorities to develop management actions with regard to specific features of each municipality

  17. Selected Trends in Public Spending for MR/DD Services and the State Economies.

    Science.gov (United States)

    Hemp, Richard; Rizzolo, Mary Catherine; Braddock, David

    2002-01-01

    This article summarizes mental retardation/developmental disabilities (MR/DD) spending since 1977, with emphasis on spending from 1995-2000. The change in state economic conditions, from strong growth in recent years to fiscal constraints in 2002, is addressed. Tables provide data trends in MR spending by type of placement and state and changes in…

  18. 78 FR 24206 - Agency Information Collection Activities; Information Collection; USA Spending

    Science.gov (United States)

    2013-04-24

    ... ADMINISTRATION Agency Information Collection Activities; Information Collection; USA Spending AGENCY: Interagency... requirement regarding USA Spending. DATES: Submit comments on or before June 24, 2013. ADDRESSES: Submit comments identified by Information Collection 3090- 00xx, USA Spending, by any of the following...

  19. US Spending On Complementary And Alternative Medicine During 2002–08 Plateaued, Suggesting Role In Reformed Health System

    Science.gov (United States)

    Davis, Matthew A.; Martin, Brook I.; Coulter, Ian D.; Weeks, William B.

    2013-01-01

    Complementary and alternative medicine services in the United States are an approximately $9 billion market each year, equal to 3 percent of national ambulatory health care expenditures. Unlike conventional allopathic health care, complementary and alternative medicine is primarily paid for out of pocket, although some services are covered by most health insurance. Examining trends in demand for complementary and alternative medicine services in the United States reported in the Medical Expenditure Panel Survey during 2002–08, we found that use of and spending on these services, previously on the rise, have largely plateaued. The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth. Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best. Should some forms of complementary and alternative medicine—for example, chiropractic care for back pain—be proven more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow growth in national health care spending. PMID:23297270

  20. US spending on complementary and alternative medicine during 2002-08 plateaued, suggesting role in reformed health system.

    Science.gov (United States)

    Davis, Matthew A; Martin, Brook I; Coulter, Ian D; Weeks, William B

    2013-01-01

    Complementary and alternative medicine services in the United States are an approximately $9 billion market each year, equal to 3 percent of national ambulatory health care expenditures. Unlike conventional allopathic health care, complementary and alternative medicine is primarily paid for out of pocket, although some services are covered by most health insurance. Examining trends in demand for complementary and alternative medicine services in the United States reported in the Medical Expenditure Panel Survey during 2002-08, we found that use of and spending on these services, previously on the rise, have largely plateaued. The higher proportion of out-of-pocket responsibility for payment for services may explain the lack of growth. Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best. Should some forms of complementary and alternative medicine-for example, chiropractic care for back pain-be proven more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow growth in national health care spending.

  1. Healthcare reform in the United States and China: pharmaceutical market implications.

    Science.gov (United States)

    Daemmrich, Arthur; Mohanty, Ansuman

    2014-01-01

    The United States and China are broadening health insurance coverage and increasing spending on pharmaceuticals, in contrast to other major economies that are reducing health spending and implementing a variety of drug price controls. This article analyzes the implications of health system reforms in the United States and China for national pharmaceutical markets. It follows a historical institutionalist approach that identifies path dependency in the design and operation of national health systems. On that basis, we estimate prescription sales for 2015 and 2020, analyze the sustainability of free-market pricing for drugs in the two countries, and assess future competitive dynamics in the pharmaceutical sector. The institutional trajectories of health system reform and insurance coverage were studied for the United States and China. Next, data were collected from government, industry, and analyst reports on total healthcare spending and prescription drug expenditure by insurance status (in the United States) and by site of care (in China). Simple quantitative models were developed to estimate future drug spending based on insurance coverage, treatment locations, and health spending as a percentage of GDP. Both countries will see rising total pharmaceutical spending and will be the two largest country markets for prescription drugs through at least 2020. In dollar terms, the U.S. pharmaceutical market will be over $440 billion in 2015 and $700 billion in 2020; China's prescription market will be over $155 billion in 2015 and grow further to $260 billion in 2020. In both countries, generics will increase their share of all prescriptions, but economic and structural incentives for new drug invention and brand-name prescribing by physicians will keep the share of patented drug sales high compared to countries with more direct government control over the pharmaceutical market. Expanding private insurance contributes to spending on branded drugs, since insurers compete

  2. The impact of the increase in user fees on the demand for primary health care in the Parque Family Health Unit

    OpenAIRE

    Ramos, António; Rúbio, Catarina; Rodrigues, Diogo; Nunes, Gonçalo; Bettencourt, Joana; Ângelo, Samuel; Coelho, Sónia; Maria, Vasco

    2013-01-01

    Objectives: To assess the impact of the increase in user fees on the demand for primary health care in the Parque Family Health Unit, to compare consultation rates in the Parque FHU between January 1and May 31, 2011, and the same period in 2012, and to identify factors associated with patient demand for care in this unit. Design: Retrospective longitudinal, observational and analytical. Setting: Parque Family Health Unit, North Lisbon Health Centres Group (ACES Lisboa Norte) Population: Pa...

  3. Postoperative delirium is associated with increased intensive care unit and hospital length of stays after liver transplantation.

    Science.gov (United States)

    Bhattacharya, Bishwajit; Maung, Adrian; Barre, Kimberly; Maerz, Linda; Rodriguez-Davalos, Manuel I; Schilsky, Michael; Mulligan, David C; Davis, Kimberly A

    2017-01-01

    Delirium is increasingly recognized as a common and important postoperative complication that significantly hinders surgical recovery. However, there is a paucity of data examining the incidence and impact of delirium after liver transplantation. Retrospective case series in a tertiary care center examining all (n = 144) adult patients who underwent liver transplantation during a 6-y period. Delirium occurred in 25% of the patients with an average duration of 4.56 d. Patients who developed delirium were older (P = 0.007), had higher preoperative model for end-stage liver disease score (P = 0.019) and longer pretransplant hospital length of stay (LOS; P = 0.003). Patients with delirium were also more likely to have alcohol ingestion as an etiology of the liver failure (P = 0.033). Delirious patients had a trend toward increased ventilator days (P = 0.235) and significantly longer postoperative hospital (P = 0.001) and intensive care unit LOS (P = 0.001). Delirium was also associated with an increased frequency of hospital acquired infections including urinary tract infections (P = 0.005) and pneumonias (P = 0.001). Delirium is a common occurrence among liver transplant patients associated with increased complications and LOSs. Further prospective studies are needed to determine the specific risk factors in this complex population and to determine if delirium has an impact on long-term outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. 21st century United States emissions mitigation could increase water stress more than the climate change it is mitigating.

    Science.gov (United States)

    Hejazi, Mohamad I; Voisin, Nathalie; Liu, Lu; Bramer, Lisa M; Fortin, Daniel C; Hathaway, John E; Huang, Maoyi; Kyle, Page; Leung, L Ruby; Li, Hong-Yi; Liu, Ying; Patel, Pralit L; Pulsipher, Trenton C; Rice, Jennie S; Tesfa, Teklu K; Vernon, Chris R; Zhou, Yuyu

    2015-08-25

    There is evidence that warming leads to greater evapotranspiration and surface drying, thus contributing to increasing intensity and duration of drought and implying that mitigation would reduce water stresses. However, understanding the overall impact of climate change mitigation on water resources requires accounting for the second part of the equation, i.e., the impact of mitigation-induced changes in water demands from human activities. By using integrated, high-resolution models of human and natural system processes to understand potential synergies and/or constraints within the climate-energy-water nexus, we show that in the United States, over the course of the 21st century and under one set of consistent socioeconomics, the reductions in water stress from slower rates of climate change resulting from emission mitigation are overwhelmed by the increased water stress from the emissions mitigation itself. The finding that the human dimension outpaces the benefits from mitigating climate change is contradictory to the general perception that climate change mitigation improves water conditions. This research shows the potential for unintended and negative consequences of climate change mitigation.

  5. Effect of household and village characteristics on financial catastrophe and impoverishment due to health care spending in Western and Central Rural China: A multilevel analysis

    Directory of Open Access Journals (Sweden)

    Zhang Hong

    2011-04-01

    Full Text Available Abstract Objective The study aimed to examine the effect of household and community characteristics on financial catastrophe and impoverishment due to health payment in Western and Central Rural China. Methods A household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Independent variables included village characteristics, household income, chronic illness status, health care use and health spending. A composite contextual variable, named village deprivation, was derived from socio-economic status and availability of health care facilities in each village using factor analysis. Dependent variables were whether household health payment was more than 40% of household's capacity to pay (catastrophic health payment and whether household per capita income was put under Chinese national poverty line (1067 Yuan income per year after health spending (impoverishment. Mixed effects logistic regression was used to assess the effect of the independent variables on the two outcomes. Results Households with low per capita income, having elderly, hospitalized or chronically ill members, and whose head was unemployed were more likely to incur financial catastrophe and impoverishment due to health expenditure. Both catastrophic and impoverishing health payments increased with increased village deprivation. However, the presence of a village health clinic had no effect on the two outcomes, nor did household enrollment in the New Rural Cooperative Medical Scheme (national health insurance. Conclusions Village deprivation independently increases the risk for financial hardship due to health payment after adjusting for known household-level factors. This suggests that policy makers need to view the individual, household and village as separate units for policy targeting.

  6. Health Care Use And Spending Patterns Vary By Wage Level In Employer-Sponsored Plans.

    Science.gov (United States)

    Sherman, Bruce W; Gibson, Teresa B; Lynch, Wendy D; Addy, Carol

    2017-02-01

    Employees face an increasing financial burden for health services as health care costs increase relative to earnings. Yet little is known about health care utilization patterns relative to employee wages. To better understand this association and the resulting implications, we examined patterns of health care use and spending by wage category during 2014 among 42,936 employees of four self-insured employers enrolled in a private health insurance exchange. When demographics and other characteristics were controlled for, employees in the lowest-wage group had half the usage of preventive care (19 percent versus 38 percent), nearly twice the hospital admission rate (31 individuals per 1,000 versus 17 per 1,000), more than four times the rate of avoidable admissions (4.3 individuals per 1,000 versus 0.9 per 1,000), and more than three times the rate of emergency department visits (370 individuals per 1,000 versus 120 per 1,000) relative to top-wage-group earners. Annual total health care spending per patient was highest in both the lowest-wage ($4,835) and highest-wage ($5,074) categories relative to the middle two wage groups ($3,952 and $3,987, respectively). These findings provide new insights about wage-associated variations in health care use and spending in employer-sponsored plans. For policy makers, these findings can inform employer benefit design strategies and research priorities, to encourage effective use of health care services.

  7. Levels of spending and resource allocation to HIV programs and services in Latin America and the Caribbean.

    Directory of Open Access Journals (Sweden)

    Daniel Arán-Matero

    Full Text Available BACKGROUND: An estimated 1.86 million people are living with HIV in Latin America and the Caribbean (LAC. The region is comprised of mainly middle-income countries with steady economic growth while simultaneously there are enormous social inequalities and several concentrated AIDS epidemics. This paper describes HIV spending patterns in LAC countries including analysis of the levels and patterns of domestic HIV spending from both public and international sources. METHODS AND FINDINGS: We conducted an extensive analysis of the most recently available data from LAC countries using the National AIDS Spending Assessment tool. The LAC countries spent a total of US$ 1.59 billion on HIV programs and services during the latest reported year. Countries providing detailed information on spending showed that high percentages are allocated to treatment and care (75.1% and prevention (15.0%. Domestic sources accounted for 93.6 percent of overall spending and 79 percent of domestic funds were directed to treatment and care. International funds represented 5.4 percent of total HIV funding in the region, but they supplied the majority of the effort to reach most-at-risk-populations (MARPs. However, prevalence rates among men who have sex with men (MSM still reached over 25 percent in some countries. CONCLUSIONS: Although countries in the region have increasingly sustained their response from domestic sources, still there are future challenges: 1 The growing number of new HIV infections and more people-living-with-HIV (PLWH eligible to receive antiretroviral treatment (ART; 2 Increasing ART coverage along with high prices of antiretroviral drugs; and 3 The funding for prevention activities among MARPs rely almost exclusively on external donors. These threats call for strengthened actions by civil society and governments to protect and advance gains against HIV in LAC.

  8. Mitigating the “Life-Sucking” Power of the Electronic Health Record (Editorial/News Medical Image of the Week: Bronchial Clot Removal via Cryotherapy Substitution of Assistants for Nurses Increases Mortality, Decreases Quality (News Corticosteroids and Influenza A associated Acute Respiratory Distress  Syndrome November 2016 Arizona Thoracic Society Notes Medical Image of the Week: Extrapleural Pneumolysis for Tuberculosis CMS Releases Data on Drug Spending (News Trump Proposes Initial Healthcare Agenda (News Tucson Critical Care Journal Club: Albumin Use in the Critical Care Unit Has the VA Become a White Elephant? (Editorial Inhaler Device Preferences in Older Adults with Chronic Lung Disease Election Results of Southwest Ballot Measures Affecting Healthcare (News Medical Image of the Week: Intraventricular Hemorrhage Casting Southwest Ballot Measures Affecting Healthcare (News ACGME Proposes Dropping the 16 Hour Resident Shift Limit (News November 2016 Imaging Case of the Month Non-Small Cell Lung Cancer: RT Out, Pembrolizumab In, and Vaccine Hope or Hype (News Medical Image of the Week: Lynch Syndrome November 2016 Critical Care Case of the Month November 2016 Pulmonary Case of the Month

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2016-11-01

    Full Text Available No abstract available. Article truncated at 150 words. An article in PulmCCM discussed “life-sucking” electronic health care records (EHR (1. It is in turn based on an article in the Annals of Internal Medicine on the work time spent by physicians (2. The latter, funded by the American Medical Association, observed 57 physicians in internal medicine, family medicine, cardiology, and orthopedics over hundreds of hours. The study revealed that physicians spend almost two hours working on their electronic health record for every one hour of face-to-face patient time. Interestingly, physicians who used a documentation assistant or dictation spent more time with patients (31 and 44% compared to those with no documentation support (23%. The PulmCCM goes on to list some of the reasons that the EHR requires so much time: ●The best and brightest minds in software design don't go to work for Epic, Cerner, Allscripts, and whoever the other ones are. ●There's a high barrier …

  9. Wind Energy in the United Kingdom: Modelling the Effect of Increases in Installed Capacity on Generation Efficiency

    CERN Document Server

    Stephens, Anthony D

    2016-01-01

    The decision by the United Kingdom (UK) government in 2007 that the country should build a 33GW wind fleet, capable of generating 25 percent of the UK electricity requirement, was controversial. Proponents argued that it was the most attractive means of lowering the UK greenhouse gas emissions, whereas opponents noted that it would result in an unnecessary and burdensome additional expense to industry and households. Subsequently there have been calls for the wind fleet target to be further increased to perhaps 50 percent of demand. Although the National Grid has had little difficulty in accommodating the current output of about 10 percent of the total demand on the grid, this will not be the case for a substantially larger wind fleet. When the wind blows strongly, turbines shed wind which is surplus to demand, leading to significant reductions in generating efficiency. The purpose of the research described in this paper has been to develop a method for investigating the likely performance of future large win...

  10. Fiscal space for health spending in Southeast Asia.

    Science.gov (United States)

    Gupta, Indrani; Mondal, Swadhin

    2013-01-01

    This article examines the availability of fiscal space in the context of health spending and the challenges and constraints in raising additional resources for health given the macroeconomic situations, in the ten countries of the South-East Asia region (SEAR) of the World Health Organization (WHO). Using a variety of secondary data, the analysis indicates that there are differences among the SEAR countries with respect to the various indicators of fiscal space. While the aid situation is under control, there are concerns regarding public debt, fiscal deficit, and revenues. Based on the findings, this article proposes ways forward for each of the countries in the coming years.

  11. Spending Natural Resource Revenues in an Altruistic Growth Model

    DEFF Research Database (Denmark)

    Frederiksen, Elisabeth Hermann

    This paper examines how revenues from a natural resource interact with growth and welfare in an overlapping generations model with altruism. The revenues are allocated between public productive services and direct transfers to members of society by spending policies. We analyze how these policies...... influence the dynamics, and how the dynamics are influenced by the abundance of the revenue. Abundant revenues may harm growth, but growth and welfare can be oppositely affected. We also provide the socially optimal policy. Overall, the analysis suggests that variation in the strength of altruism...

  12. HOW DO IMMIGRANTS SPEND THEIR TIME?: THE PROCESS OF ASSIMILATION.

    Science.gov (United States)

    Hamermesh, Daniel S; Trejo, Stephen J

    2013-04-01

    Sharp differences in time use by nativity emerge when activities are distinguished by incidence and intensity in recent U.S. data. A model with daily fixed costs for assimilating activities predicts immigrants are less likely than natives to undertake such activities on a given day; but those who do will spend relatively more time on them. Activities such as purchasing, education, and market work conform to the model. Other results suggest that fixed costs for assimilating activities are higher for immigrants with poor English proficiency or who originate in less developed countries. An analysis of comparable Australian data yields similar results.

  13. The Impact of Global Budgets on Pharmaceutical Spending and Utilization

    Directory of Open Access Journals (Sweden)

    Christopher C. Afendulis PhD

    2014-12-01

    Full Text Available In 2009, Blue Cross Blue Shield of Massachusetts implemented a global budget-based payment system, the Alternative Quality Contract (AQC, in which provider groups assumed accountability for spending. We investigate the impact of global budgets on the utilization of prescription drugs and related expenditures. Our analyses indicate no statistically significant evidence that the AQC reduced the use of drugs. Although the impact may change over time, early evidence suggests that it is premature to conclude that global budget systems may reduce access to medications.

  14. How to Spend the Two-day Weekend

    Institute of Scientific and Technical Information of China (English)

    吴士玉

    2000-01-01

    Perhaps you are a freshman and at a loss how to make the best use of theweekend. After all, the weekend on campus is very different from that in highschool. To tell the truth, I met with the same trouble as you when I entereduniversity. However, little by little, I learned how to spend the weekend. HereI'd like to give you some advice.1. Have a good rest. We can't always put ourselves under heavy pressure,for example, studying day and night. Remember: we are not machines. Afterfive days' hard work, we are v...

  15. Does widowhood explain gender differences in out-of-pocket medical spending among the elderly?

    Science.gov (United States)

    Goda, Gopi Shah; Shoven, John B; Slavov, Sita Nataraj

    2013-05-01

    Despite the presence of Medicare, out-of-pocket medical spending is a large expenditure risk facing the elderly. While women live longer than men, elderly women incur higher out-of-pocket medical spending than men at each age. In this paper, we examine whether differences in marital status and living arrangements can explain this difference. We find that out-of-pocket medical spending is approximately 24 percent higher when an individual becomes widowed, a large portion of which is spending on nursing homes. Our results suggest a substantial role of living arrangements in out-of-pocket medical spending. Our estimates combined with differences in rates of widowhood across gender suggest that marital status can explain about one third of the gender difference in total out-of-pocket medical spending, leaving a large portion unexplained. On the other hand, gender differences in widowhood more than explain the observed gender difference in out-of-pocket spending on nursing homes.

  16. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada.

    Directory of Open Access Journals (Sweden)

    Hasina Samji

    Full Text Available Combination antiretroviral therapy (ART has significantly increased survival among HIV-positive adults in the United States (U.S. and Canada, but gains in life expectancy for this region have not been well characterized. We aim to estimate temporal changes in life expectancy among HIV-positive adults on ART from 2000-2007 in the U.S. and Canada.Participants were from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD, aged ≥20 years and on ART. Mortality rates were calculated using participants' person-time from January 1, 2000 or ART initiation until death, loss to follow-up, or administrative censoring December 31, 2007. Life expectancy at age 20, defined as the average number of additional years that a person of a specific age will live, provided the current age-specific mortality rates remain constant, was estimated using abridged life tables.The crude mortality rate was 19.8/1,000 person-years, among 22,937 individuals contributing 82,022 person-years and 1,622 deaths. Life expectancy increased from 36.1 [standard error (SE 0.5] to 51.4 [SE 0.5] years from 2000-2002 to 2006-2007. Men and women had comparable life expectancies in all periods except the last (2006-2007. Life expectancy was lower for individuals with a history of injection drug use, non-whites, and in patients with baseline CD4 counts <350 cells/mm(3.A 20-year-old HIV-positive adult on ART in the U.S. or Canada is expected to live into their early 70 s, a life expectancy approaching that of the general population. Differences by sex, race, HIV transmission risk group, and CD4 count remain.

  17. Analysis of temperature increase in swine gingiva after exposure to a Polywave(®) LED light curing unit.

    Science.gov (United States)

    Maucoski, Cristiane; Zarpellon, Driellen Christine; Dos Santos, Fabio Andre; Lipinski, Leandro Cavalcante; Campagnoli, Eduardo Bauml; Rueggeberg, Frederick Allen; Arrais, Cesar Augusto Galvão

    2017-08-18

    This study evaluated the temperature increase in swine gingival temperature after exposure to light emitted by a Polywave(®) LED light curing unit (LCU, Bluephase 20i, Ivoclar Vivadent). After local Ethics Committee approval (protocol 711/2015), 40 pigs were subjected to general anesthesia and the LCU tip was placed 5mm from the buccal gingival tissue (GT) close to lower lateral incisors. A thermocouple probe (Thermes WFI, Physitemp) was inserted into the gingival sulcus before and immediately after exposure to light. Real-time temperature (°C) was measured after the following exposure modes were applied: High Power (20s-H, 40s-H, and 60s-H) or Turbo mode (5s-T), either with or without the presence of rubber dam (RD) interposed between the LCU tip and GT (n=10). The presence of gingival lesions after the exposures was also evaluated. Peak temperature (°C) and the temperature increase during exposure over that of the pre-exposure baseline value (ΔT) data were analyzed using 2-way ANOVA followed by Bonferroni's post-hoc test (α=5%). A binary logistic regression analysis determined the risk of gingival lesion development. Without RD, no significant difference in ΔT was observed among 20s-H, 40s-H, and 60s-H groups, which showed the highest temperature values, while the 5s-T exposure showed the lowest ΔT, regardless of RD. RD reduced ΔT only for the 20s-H group (p=0.004). Gingival lesions were predominantly observed using 40s-H, with RD, and 60s-H, with and without RD. Exposure to a LCU light might be harmful to swine gingiva only when high radiant exposure values are delivered, regardless of the use of RD. Copyright © 2017 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  18. Resource flows and levels of spending for the response to HIV and AIDS in Belarus

    Directory of Open Access Journals (Sweden)

    Amico Peter

    2011-07-01

    Full Text Available Abstract Background Belarus has a focused HIV epidemic concentrated among injecting drug users, female sex workers and men who have sex with men. However, until 2008, Belarus had no way of evaluating HIV spending priorities. In 2008, Belarus committed to undertaking a comprehensive National AIDS Spending Assessment (NASA in order to analyze HIV spending priorities. NASA was used to 'follow the money' from the funding sources to agents and providers, and eventually to beneficiary populations. Findings Belarus spent the majority of its funding on prevention, diagnosis and treatment of sexually transmitted infections and on securing the blood supply. International donors and NGOs working within Belarus spent the majority of their funding on preventative activities for high risk groups while Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM solely funded antiretroviral treatment. Conclusions The data and experience obtained through conducting NASA will help build capacity for future resource tracking activities for HIV and other health priorities. This experience established the foundation for enhanced and future consistent quality-reporting of National Health Accounts. Monitoring the flow of resources for Belarus' HIV response provides valuable strategic information that can improve operations and planning as well as mobilize greater resources. NASA offers Belarusian policy makers an overview of HIV activities that merit their priority attention. In addition, the findings from Belarus are particularly relevant for the rest of the Commonwealth of Independent States due to their similar epidemiological profiles and centrally planned systems. The Belarusian government faces future challenges, especially in increasing public investments in HIV prevention for female sex workers and their clients, men who have sex with men, and among intravenous drug users.

  19. Can we spend our way out of the AIDS epidemic? A world halting AIDS model

    Science.gov (United States)

    2009-01-01

    Background There has been a sudden increase in the amount of money donors are willing to spend on the worldwide HIV/AIDS epidemic. Present plans are to hold most of the money in reserve and spend it slowly. However, rapid spending may be the best strategy for halting this disease. Methods We develop a mathematical model that predicts eradication or persistence of HIV/AIDS on a world scale. Dividing the world into regions (continents, countries etc), we develop a linear differential equation model of infectives which has the same eradication properties as more complex models. Results We show that, even if HIV/AIDS can be eradicated in each region independently, travel/immigration of infectives could still sustain the epidemic. We use a continent-level example to demonstrate that eradication is possible if preventive intervention methods (such as condoms or education) reduced the infection rate to two fifths of what it is currently. We show that, for HIV/AIDS to be eradicated within five years, the total cost would be ≈ $63 billion, which is within the existing $60 billion (plus interest) amount raised by the donor community. However, if this action is spread over a twenty year period, as currently planned, then eradication is no longer possible, due to population growth, and the costs would exceed $90 billion. Conclusion Eradication of AIDS is feasible, using the tools that we have currently to hand, but action needs to occur immediately. If not, then HIV/AIDS will race beyond our ability to afford it. PMID:19922685

  20. Evidence of High Out of Pocket Spending for HIV Care Leading to Catastrophic Expenditure for Affected Patients in Lao People's Democratic Republic.

    Directory of Open Access Journals (Sweden)

    Hubert Barennes

    Full Text Available The scaling up of antiviral treatment (ART coverage in the past decade has increased access to care for numerous people living with HIV/AIDS (PLWHA in low-resource settings. Out-of-pocket payments (OOPs represent a barrier for healthcare access, adherence and ART effectiveness, and can be economically catastrophic for PLWHA and their family. We evaluated OOPs of PLWHA attending outpatient and inpatient care units and estimated the financial burden for their households in the Lao People's Democratic Republic. We assumed that such OOPs may result in catastrophic health expenses in this context with fragile economical balance and low health insurance coverage.We conducted a cross-sectional survey of a randomized sample of routine outpatients and a prospective survey of consecutive new inpatients at two referral hospitals (Setthathirat in the capital city, Savannaket in the province. After obtaining informed consent, PLWHA were interviewed using a standardized 82-item questionnaire including information on socio-economic characteristics, disease history and coping strategies. All OOPs occurring during a routine visit or a hospital stay were recorded. Household capacity-to-pay (overall income minus essential expenses, direct and indirect OOPs, OOPs per outpatient visit and per inpatient stay as well as catastrophic spending (greater than or equal to 40% of the capacity-to-pay were calculated. A multivariate analysis of factors associated with catastrophic spending was conducted.A total of 320 PLWHA [280 inpatients and 40 outpatients; 132 (41.2% defined as poor, and 269 (84.1% on ART] were enrolled. Monthly median household income, essential expenses and capacity-to-pay were US$147.0 (IQR: 86-242, $126 (IQR: 82-192 and $14 (IQR: 19-80, respectively. At the provincial hospital OOPs were higher during routine visits, but three fold lower during hospitalization than in the central hospital ($21.0 versus $18.5 and $110.8 versus $329.8 respectively (p<0

  1. Evidence of High Out of Pocket Spending for HIV Care Leading to Catastrophic Expenditure for Affected Patients in Lao People's Democratic Republic.

    Science.gov (United States)

    Barennes, Hubert; Frichittavong, Amphonexay; Gripenberg, Marissa; Koffi, Paulin

    2015-01-01

    The scaling up of antiviral treatment (ART) coverage in the past decade has increased access to care for numerous people living with HIV/AIDS (PLWHA) in low-resource settings. Out-of-pocket payments (OOPs) represent a barrier for healthcare access, adherence and ART effectiveness, and can be economically catastrophic for PLWHA and their family. We evaluated OOPs of PLWHA attending outpatient and inpatient care units and estimated the financial burden for their households in the Lao People's Democratic Republic. We assumed that such OOPs may result in catastrophic health expenses in this context with fragile economical balance and low health insurance coverage. We conducted a cross-sectional survey of a randomized sample of routine outpatients and a prospective survey of consecutive new inpatients at two referral hospitals (Setthathirat in the capital city, Savannaket in the province). After obtaining informed consent, PLWHA were interviewed using a standardized 82-item questionnaire including information on socio-economic characteristics, disease history and coping strategies. All OOPs occurring during a routine visit or a hospital stay were recorded. Household capacity-to-pay (overall income minus essential expenses), direct and indirect OOPs, OOPs per outpatient visit and per inpatient stay as well as catastrophic spending (greater than or equal to 40% of the capacity-to-pay) were calculated. A multivariate analysis of factors associated with catastrophic spending was conducted. A total of 320 PLWHA [280 inpatients and 40 outpatients; 132 (41.2%) defined as poor, and 269 (84.1%) on ART] were enrolled. Monthly median household income, essential expenses and capacity-to-pay were US$147.0 (IQR: 86-242), $126 (IQR: 82-192) and $14 (IQR: 19-80), respectively. At the provincial hospital OOPs were higher during routine visits, but three fold lower during hospitalization than in the central hospital ($21.0 versus $18.5 and $110.8 versus $329.8 respectively (pexpenses; 36

  2. How Taxes and Spending on Education Influence Economic Growth in Poland

    Directory of Open Access Journals (Sweden)

    Michał Konopczyński

    2014-09-01

    Full Text Available This paper investigates the relationship between economic growth in Poland and four types of taxes and human capital investment. We primarily rely on an exogenous growth model that merges the Mankiw-Romer-Weil model, augmented with learning-by-doing and spillover-effects, with selected elements from the literature on optimal taxation. We demonstrate that in the period 2000-2011, economic growth in Poland was primarily due to a rapid increase in the human capital stock (at a rate of 5% per annum and only secondarily due to the accumulation of productive capital (2.7% annually. Simulations of tax cuts suggest that income taxes and consumption taxes restrict economic growth equally heavily. Simultaneously reducing all tax rates by 5 percentage points (pp in Poland should increase annual GDP growth by approximately 0.4 pp. Increasing spending on education by 1 pp of GDP would increase the growth rate by approximately 0.3 pp.

  3. The Effect of Increasing Meeting Time on the Physiological Indices of Patients Admitted to the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mahmoudi

    2016-04-01

    Full Text Available Background Most hospitals have restricted visitation time in intensive care units (ICUs for various reasons. Given the advantages of family presence and positive effect of emotional touching, talking and smiling on nervous system stimulation and vital signs of the patients. Objectives The present study aimed to determine the effect of increased visitation time on physiological indices of the patients hospitalized in ICUs. Materials and Methods This clinical trial study was conducted in the ICUs of Vail-e-Asr hospital in Arak city, Iran. A total of 60 subjects were randomly assigned to the intervention and control groups with visitation time for 10 minutes 3 times a day and 10 minutes once a day, respectively. Then, the patients’ physiological indices were measured before, during, and 10 and 30 minutes after the hospital visiting hours. Data were analyzed using SPSS version 20. Results Findings showed no statistically significant differences among mean values of all physiological indices in measurement stages before, during, and 10 and 30 minutes after the visitation times in the control group (P > 0.05. While, in the intervention group, systolic blood pressure (SBP measurements at 9 (previous mean: 126.9, 30 minutes later: 111.9, 12:00 PM (previous mean: 126.9, 30 minutes later: 114.9, and 3:00 PM (previous mean: 125.2, 30 minutes later: 105.8, diastolic blood pressure (DBP measurements at 9:00 AM (previous mean: 87.4, 30 minutes later: 83.2, 12:00 PM (previous mean: 86.6, 30 minutes later: 81.7, and 3:00 PM (previous mean: 87.1, 30 minutes later: 85.0, heart rate (HR measurements at 9:00 AM (previous mean: 90, 30 minutes later: 78.4, 12:00 PM (previous mean: 89.8, 30 minutes later: 78.6, and 3:00 PM (previous mean: 89.3, 30 minutes later: 78.3, repertory rate (RR measurements at 9:00 AM (previous mean: 20.9, 30 minutes later: 15.0, 12:00 PM (previous mean: 20.6, 30 minutes later: 15.4, and 3:00 PM (previous mean: 21.0, 30 minutes later: 15

  4. Financial impact of the GFC: health care spending across the OECD.

    Science.gov (United States)

    Morgan, David; Astolfi, Roberto

    2015-01-01

    Since the onset of the global financial crisis (GFC), health spending has slowed markedly or fallen in many OECD countries after years of continuous growth. However, health spending patterns across the 34 countries of the OECD have been affected to varying degrees. This article examines in more detail the observed downturn in health expenditure growth, analysing which countries and which sectors of health spending have been most affected. In addition, using more recent preliminary data for a subset of countries, this article tries to shed light on the prospects for health spending trends. Given that public sources account for around three-quarters of total spending on health on average across the OECD, and, in an overall context of managing public deficits, the article focuses on the specific areas of public spending that have been most affected. This study also tries to link the observed trends with some of the main policy measures and instruments put in place by countries. The investigation finds that while nearly all OECD countries have seen health spending growth decrease since 2009, there is wide variation as to the extent of the slowdown, with some countries outside of Europe continuing to see significant growth in health spending. While all sectors of spending appear to have been affected, initial analysis appears to show the greatest decreases has been experienced in pharmaceutical spending and in areas of public health and prevention.

  5. Local health and social services expenditures: An empirical typology of local government spending.

    Science.gov (United States)

    McCullough, J Mac

    2017-09-04

    The conceptual importance of social services to health outcomes is well known and recent empirical evidence has linked social services spending to better population health outcomes. Yet little research has been devoted to what social services spending actually entails as it relates to population health and whether broadly similar spending patterns may exist across communities. The purpose of this study was to identify empirical patterns in spending, and explore health status and outcome correlates with social services spending. Spending data come from the 2012 U.S. Census Bureau's Census of Governments, which includes spending data for 14 social services within 3129 U.S. counties. Additional 2012 demographic, socioeconomic, and population health data were obtained and analyzed at the county-level in 2017. Hierarchical cluster analysis revealed 5 clusters of counties according to local government spending. One group had significantly lower income, social services spending, health indicators, and health outcomes than other counties. Two other groups had relatively high income, high social services spending, and strong health outcomes and indicators. Yet these latter two groups invested differently, with one spreading spending across a larger number of social services and the other concentrating spending in a smaller number of services such as education. Determining the extent to which spending approaches contribute to population health may offer communities guidance for maximizing population health. While it cannot establish causality, this study adds to the literature regarding the ways in which communities invest in both health care and social services to prevent disease and promote population health. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Heterogeneity in the smoking response to health shocks by out-of-pocket spending risk.

    Science.gov (United States)

    Richards, Michael R; Marti, Joachim

    2014-10-01

    An existing literature demonstrates that adverse changes to health can lead to improvements in health behaviors. Although the exact explanations for these empirical findings are debated, some posit that individuals learn about their true health risks through health shocks. Updated health risk information can then induce changes in health behaviors. While we follow a learning framework, we argue that past work has neglected the role of health insurance and medically related financial risk within this decision making context. Using longitudinal data from 11 European countries, we investigate the impact of a new cardiovascular (CV) health shock on smoking decisions among older adults and examine whether personal exposure to medical spending risk influences the smoking response. We then explore two potential mechanisms for this link: larger updates to health risk beliefs and higher medical expenditures to incentivize behavior change. We find that CV shocks impact the propensity to smoke, with relatively more impact among individuals with high financial risk exposure to medical spending. We also see larger increases in out-of-pocket expenditures following a shock for this group--consistent with the latter mechanism for behavior change.

  7. Increasing the repeating units of ethylene glycol-based dimethacrylates directed toward reduced oxidative stress and co-stimulatory factors expression in human monocytic cells.

    Science.gov (United States)

    Tamura, Atsushi; Fukumoto, Izumi; Yui, Nobuhiko; Matsumura, Mitsuaki; Miura, Hiroyuki

    2015-03-01

    The ethylene glycol-based dimethacrylates are commonly used in biomaterials and dental restorative materials as a cross-linking agent. In this study, toxic effect of triethylene glycol dimethacrylate (TEGDMA) and poly(ethylene glycol) dimethacrylates (PEG-DMAs) with various ethylene glycol repeating units was investigated in terms of cytotoxicity, oxidative stress, and the expression of co-stimulatory factors in human leukemia cell line (THP-1 cells) to verify the effect of ethylene glycol repeating units. Note that the 1-octanol/water partition coefficient of PEG-based dimethacrylates decreased with increasing the ethylene glycol repeating units, indicating that the hydrophilicity of PEG-DMAs increased with ethylene glycol repeating units. The toxic effect of PEG-DMAs such as cytotoxicity, oxidative stress, and the expression of CD86 in treated THP-1 cells are reduced with increasing the ethylene glycol repeating units in PEG-DMAs. However, the expression of CD54 in treated THP-1 cells was not influenced with the ethylene glycol repeating units and the maximal expression level of CD54 was observed at the concentration range of 2-4 mM for all samples. Accordingly, hydrophilic character of PEG-DMAs with long ethylene glycol chains definitely alleviates the some toxic aspect of PEG-based DMAs. This finding would provide important insight into the design of new biomaterials and dental materials with superior biocompatibility. © 2014 Wiley Periodicals, Inc.

  8. Integrity, transparency and education as determinants of optimal public spending

    Directory of Open Access Journals (Sweden)

    Ewa Lotko

    2016-12-01

    Full Text Available The difficulties in the effective implementation of the performance budgeting in Poland has become the starting point for the research presented in this paper. Despite over twenty years of experience in this field, it is difficult to say that public spending are effective, efficient and economical. We consider that this objective could be achieved by applying the optimal model of the functioning of public sector in practice. The model where, apart legal provisions, the moral attitudes and values, education and transparency play the crucial role. Thus the paper presents the results of the online survey, which enabled the identification of learning disabilities in citizens’ control of public expenditure presented in conclusions.

  9. Consumer Markets Big Spending in the Rust Belt

    Institute of Scientific and Technical Information of China (English)

    JING CHENG

    2006-01-01

    @@ Better known as the blue-collar industrial heartland of China, the Northeast is leading the way when it comes to the consumption of luxury goods Many a Chinese city can boast its own auto show, but that of Harbin in northeastern Heilongjiang Province managed to stand out from the crowd this year. During its 9th annual show in mid July, Harbin persuaded Daimler-Chrysler to introduce its high-end Maybach 62 in the province for the first time, while Ferrari displayed its F430. Local buyers purchased both cars on the spot, with the German auto selling for 10 million yuan (US$2.5 million). For an up-and-coming auto show in a provincial location, these deals show that when it comes to luxury products, the northeast has a market that is ready to spend.

  10. Credit card spending limit and personal finance: system dynamics approach

    Directory of Open Access Journals (Sweden)

    Mirjana Pejić Bach

    2014-03-01

    Full Text Available Credit cards have become one of the major ways for conducting cashless transactions. However, they have a long term impact on the well being of their owner through the debt generated by credit card usage. Credit card issuers approve high credit limits to credit card owners, thereby influencing their credit burden. A system dynamics model has been used to model behavior of a credit card owner in different scenarios according to the size of a credit limit. Experiments with the model demonstrated that a higher credit limit approved on the credit card decreases the budget available for spending in the long run. This is a contribution toward the evaluation of action for credit limit control based on their consequences.

  11. The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Specialty Behavioral Health Care Utilization and Spending Among Carve-In Enrollees.

    Science.gov (United States)

    Harwood, Jessica M; Azocar, Francisca; Thalmayer, Amber; Xu, Haiyong; Ong, Michael K; Tseng, Chi-Hong; Wells, Kenneth B; Friedman, Sarah; Ettner, Susan L

    2017-02-01

    The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA's impact on BH expenditures and utilization among "carve-in" enrollees. We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008-2009), during (2010), and after (2011-2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits, medication management, individual and family psychotherapy); intermediate care utilization (structured outpatient, day treatment, residential); and inpatient utilization. MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits [respective immediate increases of: $1.05 (P=0.02); $0.88 (P=0.04); 0.00045 visits (P=0.00)], and individual psychotherapy visits [immediate increase of 0.00578 visits (P=0.00) and additional increases of 0.00017 visits/mo (P=0.03)]. MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; for example, in July 2012 predicted per-enrollee plan spending was $4.92 without MHPAEA and $6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act's inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets.

  12. Not out of control: analysis of the federal disaster spending trend

    OpenAIRE

    2016-01-01

    Approved for public release; distribution is unlimited The purpose of this study of 20-year trends in federal disaster spending was to determine whether and to what extent spending has been on the rise, and to examine contributing factors. A grounded theory analysis was conducted on 1,156 major declared disasters from fiscal years 1995 through 2014. Numerical data graphically illustrate budgeting, spending, and declaration trends, and policy and inertia influences are described. This study...

  13. Prosocial Spending and Happiness: Using Money to Benefit Others Pays Off

    OpenAIRE

    Dunn, Elizabeth W.; Aknin, Lara B.; Norton, Michael Irwin

    2013-01-01

    While a great deal of research has shown that people with more money are somewhat happier than people with less money, our research demonstrates that how people spend their money also matters for their happiness. In particular, both correlational and experimental studies show that people who spend money on others report greater happiness. The benefits of such prosocial spending emerge among adults around the world, and the warm glow of giving can be detected even in toddlers. These benefits a...

  14. Business Development in Emerging Markets: The Impact on spending behaviour of elderly caregivers of family members with HIV/AIDS in SA

    Directory of Open Access Journals (Sweden)

    Christo Boshoff

    2010-12-01

    Full Text Available Business development in emerging markets, known as the “base of the pyramid”, is not without financial risk and a key concern in South African communities are the costs associated with HIV/AIDS. Due to the enormous demand for healthcare, many governments have opted for home-based care systems. Caregivers are mainly older women and their financial survival is critically important. We found that as the patient’s illness progressed: 1 the cultural norm ubuntu led the caregiver to increase spending on the patient and a decreased spending on themselves and 2 the social pressure of stigma led to a very dramatic drop in direct interpersonal assistance to the patient and an increase in spending on themselves. Their resulting coping strategies and implications for economic development are discussed. Keywords - Emerging Markets, Cultural, Health Services

  15. A systematic review of reference pricing: implications for US prescription drug spending.

    Science.gov (United States)

    Lee, Joy Li-Yueh; Fischer, Micahel A; Shrank, William H; Polinski, Jennifer M; Choudhry, Niteesh K

    2012-11-01

    Given rising pharmaceutical expenditures and the widespread use of reference pricing as a costcontainment instrument abroad, we systematically reviewed the evidence evaluating reference pricing policies. We performed a structured electronic search of peer-reviewed journals for studies published before that reported on the effects of reference pricing policies on medication use, payer and patient spending, and resource consumption. Our search yielded 16 studies describing 9 reference-pricing policies from 6 countries. Reference-pricing policies led to decreases in drug prices and increases in utilization of targeted medications, while also reducing payer and patient expenditures. In addition, these policies did not lead to increased use of medical services, such as physician office visits and hospitalization. These results suggest that reference pricing may be an attractive policy strategy for the US healthcare system.

  16. The slowdown in health care spending in 2009-11 reflected factors other than the weak economy and thus may persist.

    Science.gov (United States)

    Ryu, Alexander J; Gibson, Teresa B; McKellar, M Richard; Chernew, Michael E

    2013-05-01

    During and immediately after the recent recession, national health expenditures grew exceptionally slowly. During 2009-11 per capita national health spending grew about 3 percent annually, compared to an average of 5.9 percent annually during the previous ten years. Policy experts disagree about whether the slower health spending growth was temporary or represented a long-term shift. This study examined two factors that might account for the slowdown: job loss and benefit changes that shifted more costs to insured people. Based on an examination of data covering more than ten million enrollees with health care coverage from large firms in 2007-11, we found that these enrollees' out-of-pocket costs increased as the benefit design of their employer-provided coverage became less generous in this period. We conclude that such benefit design changes accounted for about one-fifth of the observed decrease in the rate of growth. However, we also observed a slowdown in spending growth even when we held benefit generosity constant, which suggests that other factors, such as a reduction in the rate of introduction of new technology, were also at work. Our findings suggest cautious optimism that the slowdown in the growth of health spending may persist--a change that, if borne out, could have a major impact on US health spending projections and fiscal challenges facing the country.

  17. Unemployment, government healthcare spending, and cerebrovascular mortality, worldwide 1981-2009: an ecological study.

    Science.gov (United States)

    Maruthappu, Mahiben; Shalhoub, Joseph; Tariq, Zoon; Williams, Callum; Atun, Rifat; Davies, Alun H; Zeltner, Thomas

    2015-04-01

    The global economic downturn has been associated with unemployment rises, reduced health spending, and worsened population health. This has raised the question of how economic variations affect health outcomes. We sought to determine the effect of changes in unemployment and government healthcare expenditure on cerebrovascular mortality globally. Data were obtained from the World Bank and World Health Organization. Multivariate regression analysis was used to assess the effect of changes in unemployment and government healthcare expenditure on cerebrovascular mortality. Country-specific differences in infrastructure and demographics were controlled for. One- to five-year lag analyses and robustness checks were conducted. Across 99 countries worldwide, between 1981 and 2009, every 1% increase in unemployment was associated with a significant increase in cerebrovascular mortality (coefficient 187, CI: 86.6-288, P = 0.0003). Every 1% rise in government healthcare expenditure, across both genders, was associated with significant decreases in cerebrovascular deaths (coefficient 869, CI: 383-1354, P = 0.0005). The association between unemployment and cerebrovascular mortality remained statistically significant for at least five years subsequent to the 1% unemployment rise, while the association between government healthcare expenditure and cerebrovascular mortality remained significant for two years. These relationships were both shown to be independent of changes in gross domestic product per capita, inflation, interest rates, urbanization, nutrition, education, and out-of-pocket spending. Rises in unemployment and reductions in government healthcare expenditure are associated with significant increases in cerebrovascular mortality globally. Clinicians may also need to consider unemployment as a possible risk factor for cerebrovascular disease mortality. © 2015 World Stroke Organization.

  18. Future funding for mental health and substance abuse: increasing burdens for the public sector.

    Science.gov (United States)

    Levit, Katharine R; Kassed, Cheryl A; Coffey, Rosanna M; Mark, Tami L; Stranges, Elizabeth M; Buck, Jeffrey A; Vandivort-Warren, Rita

    2008-01-01

    Spending on mental health (MH) and substance abuse (SA) treatment is expected to double between 2003 and 2014, to $239 billion, and is anticipated to continue falling as a share of all health spending. By 2014, our projections of SA spending show increasing responsibility for state and local governments (45 percent); deteriorating shares financed by private insurance (7 percent); and 42 percent of SA spending going to specialty SA centers. For MH, Medicaid is forecasted to fund an increasingly larger share of treatment costs (27 percent), and prescription medications are expected to capture 30 percent of MH spending by 2014.

  19. Increase of propylene production and recovery in a PETROBRAS FCC units; Aumento da producao e recuperacao de propeno em uma Unidade de FCC da PETROBRAS

    Energy Technology Data Exchange (ETDEWEB)

    Penna, Elisangela Melo; Pinho, Andrea de Rezende; Wolff, Marcelo Straubel [Petroleo Brasileiro S.A (PETROBRAS), Rio de Janeiro, RJ (Brazil)

    2012-07-01

    Propylene is one of the major petrochemical raw materials and its demand has been growing rapidly in recent years. Projections for future years indicate that the growth in propylene production via pyrolysis tends to be lower than the growth in the demand for ethylene, creating a supply deficit of this product. The FCC units are in a unique position to meet this increase in propylene demand due to its operational flexibility. Although their primary function in recent decades has been the gasoline production, FCC units are often operated for maximizing other products, such as LPG or distillates. At the FCC conversion section, the increase of propylene yield requires some increase in reaction severity, which can be obtained by increasing reactor riser temperature, and the use of catalyst additives based on ZSM-5. However, besides maximizing the propylene production in the reactor, a second objective should be pursued: the propylene recovery increase in the gas recovery section. In this section, the yield is affected by the gas compressor performance, the equipment design and process scheme. Eventually, new equipment may be installed, such as chillers, aimed at improving the absorption system. Predicting a real increase in propylene demand in the Brazilian market, this study aims to evaluate the adequacy of the gas recovery section of a PETROBRAS FCC unit, analyzing the impacts that a new products yields profile, which bend the propylene production compared to a conventional operation, would cause on this unit. In this paper, the main limitations and modifications that would be needed for an operation were identified, aiming at maximizing the propylene production, as well as proposed changes in the hardware of the unit. (author)

  20. The effect of altruism on the spending behavior of elderly caregivers of family members with HIV/AIDS in South African townships.

    Science.gov (United States)

    Klemz, Bruce R; Boshoff, Christo; Mazibuko, Noxolo-Eileen; Asquith, Jo Ann

    2015-01-01

    HIV/AIDS has led to an enormous demand for health care in the developing world and many governments have opted to capitalize on altruistic home-based caregivers. These caregivers are mainly poor older women and their financial survival is critically important to themselves and their families. We found that as the patient's illness progressed: (a) the altruistic cultural norm "ubuntu" led the caregiver to increase spending and (b) the social pressure (sanction) of stigma led to a very dramatic drop in direct interpersonal assistance. The impact on their spending, health care, and the related public policies are discussed.

  1. A Research on The Effects of Marketing Spending on Firm Value

    Directory of Open Access Journals (Sweden)

    Mesut Doğan

    2015-06-01

    Full Text Available The purpose of this study is to investigate the influence of “Marketing Expenses”on firm value. The study uses data belonging to 120 firms, which are traded in Borsa Istanbul (BIST in the period of 2009-2012. The independent variables used in the study consist of “Return on Assets” (ROA and “Return on Equity”(ROE, which are accounting based performance indicators. The other is "Tobin's q" ratio which is market-based ratio. The regression and correlation analysis have been employed in empirical analyzes. The result of the conducted analysis showed that the increase in marketing expenses influences value of the firms in a positive way. As a result, organizations should accept the marketing expenses not only as a spending but also an investment as a value added to business

  2. Health-care expenditure and health policy in the USA versus other high-spending OECD countries.

    Science.gov (United States)

    Lorenzoni, Luca; Belloni, Annalisa; Sassi, Franco

    2014-07-05

    The USA has exceptional levels of health-care expenditure, but growth has slowed dramatically in recent years, amidst major efforts to close the coverage gap with other countries of the Organisation for Economic Co-operation and Development (OECD). We reviewed expenditure trends and key policies since 2000 in the USA and five other high-spending OECD countries. Higher health-sector prices explain much of the difference between the USA and other high-spending countries, and price dynamics are largely responsible for the slowdown in expenditure growth. Other high-spending countries did not face the same coverage challenges, and could draw from a broader set of policies to keep expenditure under control, but expenditure growth was similar to the USA. Tightening Medicare and Medicaid price controls on plans and providers, and leveraging the scale of the public programmes to increase efficiency in financing and care delivery, might prevent a future economic recovery from offsetting the slowdown in health sector prices and expenditure growth. Copyright © 2014 Elsevier Ltd. All rights reserved.

  3. Marginal benefit incidence of public health spending: evidence from Indonesian sub-national data

    NARCIS (Netherlands)

    R.A. Sparrow (Robert); M.P. Pradhan (Menno); I. Kruse (Ioana)

    2009-01-01

    textabstractWe examine the marginal effects of decentralized public health spending by incorporating estimates of behavioural responses to changes in public health spending through benefit incidence analysis. The analysis is based on a panel dataset of 207 Indonesian districts over a 4-year period f

  4. Trends in Dutch hospital spending by age and disease 1994-2010

    NARCIS (Netherlands)

    Wubulihasimu, P.; Gheorghe, M.; Slobbe, L.C.J.; Polder, J.J.; van Baal, P.H.

    2015-01-01

    Understanding the age pattern of medical spending and changes therein – the purpose of this paper – is essential in an ageing society. We started by combining several data sources to create a comprehensive time-based data series of hospital spending by age group, gender and disease category for The

  5. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking.

    Science.gov (United States)

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael

    2016-03-01

    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients.

  6. 45 CFR 2520.45 - How much time may an AmeriCorps member spend fundraising?

    Science.gov (United States)

    2010-10-01

    ... fundraising? 2520.45 Section 2520.45 Public Welfare Regulations Relating to Public Welfare (Continued... How much time may an AmeriCorps member spend fundraising? An AmeriCorps member may spend no more than... enrollment in the National Service Trust, performing fundraising activities, as described in § 2520.40....

  7. Preliminary Examination of Adolescent Spending in a Contingency Management-Based Smoking-Cessation Program

    Science.gov (United States)

    Cavallo, Dana A.; Nich, Charla; Schepis, Ty S.; Smith, Anne E.; Liss, Thomas B.; McFetridge, Amanda K.; Krishnan-Sarin, Suchitra

    2010-01-01

    Contingency management (CM) utilizing monetary incentives is efficacious in enhancing abstinence in an adolescent smoking-cessation program, but how adolescents spend their money has not been examined. We assessed spending habits of 38 adolescent smokers in a CM-based smoking-cessation project prior to quitting and during treatment using a…

  8. Performance Information, Blame Avoidance, and Politicians’ Attitudes to Spending and Reform: Evidence From an Experiment

    DEFF Research Database (Denmark)

    Nielsen, Poul Aaes; Bækgaard, Martin

    2015-01-01

    information on politicians’ attitudes to spending and reform. To isolate the causal effect of performance information, we conducted a randomized survey experiment among 844 Danish city councilors. Information treatments showing high and low performance had a positive effect on attitudes to spending, whereas...

  9. 40 CFR 35.4070 - How can my group spend TAG money?

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false How can my group spend TAG money? 35.4070 Section 35.4070 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL... my group spend TAG money? (a) Your group must use all or most of your funds to procure a...

  10. State Education Trends: Academic Performance and Spending over the Past 40 Years. Policy Analysis No. 746

    Science.gov (United States)

    Coulson, Andrew J.

    2014-01-01

    Long-term trends in academic performance and spending are valuable tools for evaluating past education policies and informing current ones. But such data have been scarce at the state level, where the most important education policy decisions are made. State spending data exist reaching back to the 1960s, but the figures have been scattered across…

  11. Monopoly Money: The Effect of Payment Coupling and Form on Spending Behavior

    Science.gov (United States)

    Raghubir, Priya; Srivastava, Joydeep

    2008-01-01

    This article examines consumer spending as a function of payment mode both when the modes differ in terms of payment coupling (association between purchase decision and actual parting of money) and physical form as well as when the modes differ only in terms of form. Study 1 demonstrates that consumers are willing to spend more when a credit card…

  12. 2014 National Park visitor spending effects: economic contributions to local communities, states, and the nation

    Science.gov (United States)

    Cullinane Thomas, Catherine; Huber, Christopher; Koontz, Lynne

    2015-01-01

    The National Park System covers more than 84 million acres and is comprised of more than 401 sites across the Nation. These lands managed by the National Park Service (NPS) serve as recreational destinations for visitors from across the Nation and around the world. On vacations or on day trips, NPS visitors spend time and money in the gateway communities surrounding NPS sites. Spending by NPS visitors generates and supports a considerable amount of economic activity within park gateway economies. The NPS has been measuring and reporting visitor spending and economic effects for the past 25 years. The 2012 analysis marked a major revision to the NPS visitor spending effects analyses, with the development of the Visitor Spending Effects model (VSE model) which replaced the previous Money Generation Model (see Cullinane Thomas et al. (2014) for a description of how the VSE model differs from the previous model). This report provides updated VSE estimates associated with 2014 NPS visitation.

  13. Impact of Increased Academic Intensity on Transfer Rates: An Application of Matching Estimators to Student-Unit Record Data

    Science.gov (United States)

    Doyle, William R.

    2009-01-01

    The impact of increased academic intensity on transfer rates from community colleges to 4-year institutions has been estimated only from observational data, with the possibility of selection bias. This study uses matching estimators to overcome possible selection bias and estimate the causal impact of increased academic intensity on transfer…

  14. National Security Implications of Long-Term Deficit Spending

    Science.gov (United States)

    2010-02-01

    play out, the relationship with China in the near-term is a codependent one. The United States needs China to continue buying debt securities and...synergistic relationship to one where China would in fact act In the current environment, it is unlikely China would begin a sell-off of its position...benefits both parties. 17 against United States financial interests. Certainly nobody knows exactly what type of relationship the United States and

  15. Production Increasing and Consumption Reducing for Low Pressure Alcoholization and Alkylation Unit%低压醇烃化系统提产降耗优化措施

    Institute of Scientific and Technical Information of China (English)

    赵阳

    2013-01-01

    The problems affect normal operation and high consumption of the unit during trial production , w hich include low methanol production , the alcoholization and alkylation unit not being able to maintain autothermal equilibrium and the high content trace organic impurities to cause the ammonia plant operation fluctuation etc . After analyzing the reasons and taking optimization measures , the production is increased and consumption is reduced in the alcoholization and alkylation unit .%基于试生产过程中出现的甲醇产量低、醇烃化系统不能维持自热平衡、出口微量高导致合成氨系统波动大等影响系统正常运行且消耗高的问题,分析其原因,制定优化措施,从而降低了能耗,提高了产量。

  16. Learning from 25 years of experience with the United States clean air act

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, R.H. [Trinity Consultants Incorporated, Dallas, TX (United States)

    1995-12-31

    Twenty-five years ago, the United States embarked on a quest to attain clean air. President Nixon, in signing the Clean Air Act of 1970, defined clean air as the objective for the `70s. Although enormous progress has been made, much remains to be done. Newly constructed industry is quite clean, but many older facilities continue to operate with antiquated controls. Significant advances have been made in cleaning up the emissions from new automobiles, but two factors have impaired progress. First, cars last longer than they did in 1970, so the average age of the fleet has increased. Second, travel has increased as people have moved to the suburbs. Thus, the emission decreases from clean cars have not been as great as expected. This presentation will address some of the lessons learned from the efforts in the United States to implement clean air programs. In a large number of countries, excessively elaborate studies have been substituted for action programs. Since much is now known about air quality, fairly brief studies can define programs that should be undertaken. What may take longer is developing public support and enthusiasm for improved air quality. In most cases, it is desirable to reduce spending on studies and increase spending on devising and implementing plans, as well as effectively communicating the necessary changes to the public. Balanced spending on studies- and action programs is essential to a sound air quality control program. (author)

  17. The questionable effectiveness of science spending by international conservation organizations in the tropics.

    Science.gov (United States)

    Cleary, David

    2006-06-01

    The general context of conservation in the tropics--in the Amazon basin and elsewhere--is stagnant or declining funding and rapidly growing threat levels. For conservation programs this makes strategic deployment of limited conservation resources all the more important. International conservation organizations active in the tropics increasingly define themselves as science driven and expend considerable resources on science-based activities such as ecoregional analysis, field research, and monitoring of ecological variables. l argue that an overemphasis on science has generated a series of unintended but serious problems for conservation in the tropics. Spending on monitoring and ecoregional analysis has effectively starved protection and threat analysis of resources. A decoupling of biology from serious cost-benefit analysis has led to the privileging of small-scale and local analyses, rather than the systemic analyses essential for the strategic allocation of scarce conservation resources. Successful conservation in the tropics depends on the crossing of biogeography with sophisticated threat analysis to identify priority geographies for protection. This should be combined with much more systematic engagement with the principal drivers of tropical deforestation, especially agribusiness. Caution and a sense of proportion are required when balancing the financial demands of science and those of protection. I suggest that conservation organizations should cooperate far more in assembling and analyzing information on conservation spending and on threat levels and biogeography at the continental, national, and regional levels. Site selection should follow rather than precede this kind of strategic analysis, and sites should be considered elements of a network rather than stand-alone projects. More attention should be paid to market-driven conservation through techniques such as certification and responsible supply-chain management.

  18. Big increase in Spanish reseach funding

    CERN Multimedia

    Bosch, X

    1998-01-01

    The Spanish government plans to increase spending on civilian science research and development by between 8 and 10 per cent. The exact figure is unclear since it has been included in the budget along with military research projects (1 page).

  19. Investigating how high school deaf students spend their leisure time

    Directory of Open Access Journals (Sweden)

    Allahyar Arabmomeni

    2012-09-01

    Full Text Available This paper presents an investigation on deaf students' interests in spending their leisure times. We design a questionnaire and distribute among all deaf students who are enrolled in high schools in two provinces of Iran. The questionnaire consists of three parts, in the first part, we ask female and male deaf students about their interests in various entertainment activities in Likert scale. In terms of gender, we find out that walking inside or outside house is number one favorite exercise for female students while male students mostly prefer to walk on the streets. Although male students prefer to go biking or running activities, female students prefer to go for picnic or similar activities. This could be due to limitations on female for running or biking inside cities. While going to picnic with members of family or friends is the third popular activity for male students, stretching exercises is third most popular activity among female students. Breathing exercise is the fourth most popular activity among both male and female students. The second part of the survey is associated with the barriers for having no exercise among deaf students. According to our survey, while lack of good attention from public and ordinary people on exercising deaf students is believed to be number one barrier among male students, female students blame lack of transportation facilities as the most important barrier. However, both female and male students believe these two items are the most important factors preventing them to exercise. Lack of awareness for exercising deaf students and lack of good recreational facilities are the third most important barriers among male and female students. The last part of the survey attempted to detect important entertainment activities. Watching TV, entertaining with mobile devices, chatting with friends and watching DVD or movies were the most important items influencing deaf students' free times.DOI: 10.5267/j.msl.2012

  20. Spending on pharmaceuticals in Italy: macro constraints with local autonomy.

    Science.gov (United States)

    Mapelli, Vittorio; Lucioni, Carlo

    2003-01-01

    Italy has a national health service (SSN) that is moving toward decentralization and empowerment of local health enterprises (LHEs)-the arms of the regions for delivering health services. Drug policy and spending decisions are both influenced by central government and local authorities. At the "macro" level, the government holds the power to decide the amount of drug expenditure, currently at 13% of total SSN expenditure; the pricing policy, price negotiation, reference price, and price cuts; criteria for reimbursement, inclusion in the positive list, and restrictive notes; and the copayments and exemptions. So far, the government concern has been predominantly on cost containment, and its approach in selecting drugs for reimbursement has been cost minimization. Italy has no centralized office for health technology assessment and this hinders the search for an efficient use of drugs. At the "micro" level, however, the LHEs are showing a great vitality in fostering a better use of drugs by general practitioners. One of the tools employed is local voluntary agreements between LHEs and general practitioners (GPs) that may be supported by economic incentives, in cash or in kind. In 2000 there were 61 agreements in place, 31% of total LHEs, which concerned the respect of drug expenditure ceilings and the local development and implementation of clinical guidelines (47% of LHEs). A traditional and widespread tool for controlling drug expenditure is providing GPs with regular reports on their drug prescriptions (59% of LHEs). Monitoring, moral suasion, and clinical guidelines are the main incentives for efficiency at local level, but focus on health outcomes is limited. The cost-containment mentality still prevails and the use of drug budget for purchasing better health is at its very early stage.

  1. Monitoring what governments "give for" and "spend on" vaccine procurement: Vaccine Procurement Assistance and Vaccine Procurement Baseline.

    Directory of Open Access Journals (Sweden)

    E A S Nelson

    Full Text Available BACKGROUND: The Global Vaccine Action Plan will require, inter alia, the mobilization of financial resources from donors and national governments - both rich and poor. Vaccine Procurement Assistance (VPA and Vaccine Procurement Baseline (VPB are two metrics that could measure government performance and track resources in this arena. VPA is proposed as a new subcategory of Official Development Assistance (ODA given for the procurement of vaccines and VPB is a previously suggested measure of the share of Gross Domestic Product (GDP that governments spend on their own vaccine procurement. OBJECTIVE: To determine realistic targets for VPA and VPB. METHODS: Organization for Economic Co-Operation and Development (OECD and World Bank data for 2009 were analyzed to determine the proportions of bilateral ODA from the 23 Development Assistance Committee (DAC countries disbursed (as % of GDP in current US$ for infectious disease control. DAC country contributions to the GAVI Alliance for 2009 were assessed as a measure of multilateral donor support for vaccines and immunization programs. FINDINGS: In 2009, total DAC bilateral ODA was 0.16% of global GDP and 0.25% of DAC GDP. As a percentage of GDP, Norway (0.013% and United Kingdom (0.0085% disbursed the greatest proportion of bilateral ODA for infectious disease control, and Norway (0.024% and Canada (0.008% made the greatest contributions to the GAVI Alliance. In 2009 0.02% of DAC GDP was US$7.61 billion and 0.02% of the GDP of the poorest 117 countries was US$2.88 billion. CONCLUSIONS: Adopting 0.02% GDP as minimum targets for both VPA and VPB is based on realistic estimates of what both developed and developing countries should spend, and can afford to spend, to jointly ensure procurement of vaccines recommended by national and global bodies. New OECD purpose codes are needed to specifically track ODA disbursed for a vaccine procurement; and b immunization programs.

  2. Spending Analysis of Government Purchase Card Buys for United States Navy Destroyers

    Science.gov (United States)

    2009-12-01

    Among the diagnostic reviews of the GPC program are examinations of purchase history by the TYCOM APC through use of the Citibank Program Audit Tools...Guide Diagnostic Control Systems TYCOM APC monitoring ATG quarterly reviews Citibank PAT Standardized Documents and Procedures Monthly Summary

  3. An analysis of Mexican consumers’ purchases in the United States based on household spending

    Directory of Open Access Journals (Sweden)

    Eliseo Díaz González

    2015-12-01

    Full Text Available Using microdata, consumer choice models, and fiscal competition, this study analyzes the reasons for cross–border shopping by Mexicans in the U.S. market by examining whether the incentive for consumers to cross the border is an inverse function of the distance from the border. Assuming rational consumers and given the differences in prices and consumption taxes between the two countries, this study finds that the location of consumers in border states and migratory traditions are the main determinants of cross–border shopping.

  4. The Impact of Decreased Department of Defense Spending on Employment in the United States

    Science.gov (United States)

    1991-11-01

    Rolling and Drawing 2.4 10.607 Nonferrous Rolling and Drawing, nec 2.3 11.170 New Military Facilities 1.6 00.000 Wood and Radio Cabinets 1.5 16.891...1989.49. Hagstrom. Jerry, and Robert Guskind. "Lobbying the Pentagon." National Jour- nal, 31 May 1986, 1316-21. Henderson, Yolanda K. "Defense

  5. Increased Suicides in the United States Army: Improving the Effectiveness of the US Army’s Suicide Prevention Program

    Science.gov (United States)

    2013-06-14

    a major cause of suicide, as expressed by an individual who suffered from it to the extent that he made a compulsive decision that almost cost him...Has the US Army Suicide Prevention Program changed the rate (either increased or decreased) of suicide in terms of more “ buy in” from senior leadership

  6. Increased Extreme Hydrological Events and Decreased Water Supply Availability for the Southwestern United States Projected by Mid-Century

    Science.gov (United States)

    Pagan, B. R.; Ashfaq, M.; Rastogi, D.; Naz, B. S.; Kao, S. C.; Mei, R.; Kendall, D. R.; Pal, J. S.

    2015-12-01

    Semi-arid Southern California relies primarily on imported water originating mostly from snowpack in basins outside of the region including the San-Joaquin River, Tulare Lake, Sacramento River, Owens Valley, Mono Lake, and Colorado River basins. This study provides an integrated ensemble approach to assessing climate change impacts on the hydrologic cycle and hydrologic extremes for all water supplies to Southern California. Output from 10 global climate models is used to force a regional climate model and hydrological model resulting in high-resolution 4.17-km output for the region. Greenhouse gas concentrations are prescribed according to historical values for the present-day (1965-2005) and the IPCC Representative Concentration Pathway 8.5 for the near to mid term future (2010-2050). On the annual timescale, temperature, precipitation and evaporation increase throughout the majority of the study area. With increased temperatures, precipitation is less likely to fall as snow, decreasing snowpack and natural storage and shifting peak flows to earlier in the year. Daily annual maximum runoff and precipitation events are projected to significantly increase in intensity and frequency by mid-century. The 50-year event, for example, becomes approximately five times more likely in the Colorado River basin and twice as likely in the other basins. In densely populated coastal Southern Californian cities, extreme flood events become three to five times as likely substantially increasing the risk of overburdening flood control systems and potential widespread flooding. The escalating likelihood of the combined effects of runoff occurring earlier in the year and in significantly higher amounts poses a substantial flood control risk requiring adaptation measures such as water release from reservoirs. Significant snowpack reductions and increased flood risk will likely necessitate additional multiyear storage solutions for urban and agricultural regions in the Southwestern US.

  7. Utilization and spending trends for antiretroviral medications in the U.S. Medicaid program from 1991 to 2005

    Directory of Open Access Journals (Sweden)

    Li Xing

    2007-10-01

    Full Text Available Abstract Background HIV/AIDS incidence and mortality rates have decreased in the U.S. since 1996. Accompanying the longer life spans of those diagnosed with the disease, however, is a tremendous rise in expenditures on medication. The objective of this study is to describe the trends in utilization of, spending on, and market shares of antiretroviral medications in the U.S. Medicaid Program. Antiretroviral drugs include nucleoside reverse transcriptase inhibitors (NRTIs, protease inhibitors (PIs, nonnucleoside reverse transcriptase inhibitors (NNRTIs, and fusion inhibitors (FIs. Methods Utilization and payment data from 1991 to 2005 are provided by the Centers for Medicare & Medicaid Services. Descriptive summary analyses were used to assess quarterly prescription numbers and amounts of payment. Results The total number of prescriptions for antiretrovirals increased from 168,914 in 1991 to 2.0 million in 1998, and 3.0 million in 2005, a 16.7-fold increase over 15 years. The number of prescriptions for NRTIs reached 1.6 million in 2005. Prescriptions for PIs increased from 114 in 1995 to 932,176 in 2005, while the number of prescriptions for NNRTIs increased from 1,339 in 1996 to 401,272 in 2005. The total payment for antiretroviral drugs in the U.S. Medicaid Program increased from US$ 30.6 million in 1991 to US$ 1.6 billion in 2005, a 49.8-fold increase. In 2005, NRTIs as a class had the highest payment market share. These drugs alone accounted for US$ 787.9 million in Medicaid spending (50.8 percent of spending on antiretrovirals. Payment per prescription for each drug, with the exception of Agenerase®, increased, at least somewhat, over time. The relatively expensive drugs in 2005 included Trizivir® ($1040 and Combivir® ($640, as well as Reyataz® ($750, Lexiva® ($700, Sustiva® ($420, Viramune® ($370, and Fuzeon® ($1914. Conclusion The tremendous growth in antiretroviral spending is due primarily to rising utilization, secondarily to

  8. Increased Prevalence of Celiac Disease in Patients with Unexplained Infertility in the United States: A Prospective Study

    Science.gov (United States)

    Lebwohl, Benjamin; Wang, Jeffrey; Lee, Susie K.; Murray, Joseph A.; Sauer, Mark V.; Green, Peter H. R.

    2011-01-01

    Celiac disease is an autoimmune disorder which can present with a variety of non-gastrointestinal manifestations. In women, it may manifest with an assortment of gynecologic or obstetric disorders. Some reports have linked female infertility with undiagnosed celiac disease. Though there are a number of studies from Europe and the Middle East, only two prior American studies have examined the prevalence of “silent” celiac disease in a female infertility population. We prospectively performed serologic screening for celiac disease in 188 infertile women (ages 25–39). While we did not demonstrate an increased prevalence of celiac disease in our overall infertile female population, we were able to detect a significantly increased prevalence (5.9%) of undiagnosed celiac disease among women presenting with unexplained infertility (n=51). Our findings suggest the importance of screening infertile female patients, particularly those with unexplained infertility, for celiac disease. PMID:21682114

  9. Increase in Annual Number of Pancreatic Head Resections Does not Affect Mortality of Pancreatic Cancer in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Efthymios Ypsilantis

    2009-07-01

    Full Text Available Dear Sir, Lee and Saif urged for new effective methods for early diagnosis of pancreatic head adenocarcinoma, emphasizing that at the time of initial presentation, the majority of patients have non-resectable tumours [1]. Also, Li and Saif, in their thorough overview of current advancements in the management of the disease, summarized that pancreatic cancer requires a multidisciplinary therapeutic approach that should aim to increase the chances of surgical resection [2].

  10. House Calls: California Program For Homebound Patients Reduces Monthly Spending, Delivers Meaningful Care.

    Science.gov (United States)

    Melnick, Glenn A; Green, Lois; Rich, Jeremy

    2016-01-01

    In 2009 HealthCare Partners Affiliates Medical Group, based in Southern California, launched House Calls, an in-home program that provides, coordinates, and manages care primarily for recently discharged high-risk, frail, and psychosocially compromised patients. Its purpose is to reduce preventable emergency department visits and hospital readmissions. We present data over time from this well-established program to provide an example for other new programs that are being established across the United States to serve this population with complex needs. The findings show that the initial House Calls structure, staffing patterns, and processes differed across the geographic areas that it served, and that they also evolved over time in different ways. In the same time period, all areas experienced a reduction in operating costs per patient and showed substantial reductions in monthly per patient health care spending and hospital utilization after enrollment in the House Calls program, compared to the period before enrollment. Despite more than five years of experience, the program structure continues to evolve and adjust staffing and other features to accommodate the dynamic nature of this complex patient population.

  11. A comparison of cancer burden and research spending reveals discrepancies in the distribution of research funding

    Directory of Open Access Journals (Sweden)

    Carter Ashley JR

    2012-07-01

    Full Text Available Abstract Background Ideally, the distribution of research funding for different types of cancer should be equitable with respect to the societal burden each type of cancer imposes. These burdens can be estimated in a variety of ways; “Years of Life Lost” (YLL measures the severity of death in regard to the age it occurs, "Disability-Adjusted Life-Years" (DALY estimates the effects of non-lethal disabilities incurred by disease and economic metrics focus on the losses to tax revenue, productivity or direct medical expenses. We compared research funding from the National Cancer Institute (NCI to a variety of burden metrics for the most common types of cancer to identify mismatches between spending and societal burden. Methods Research funding levels were obtained from the NCI website and information for societal health and economic burdens were collected from government databases and published reports. We calculated the funding levels per unit burden for a wide range of different cancers and burden metrics and compared these values to identify discrepancies. Results Our analysis reveals a considerable mismatch between funding levels and burden. Some cancers are funded at levels far higher than their relative burden suggests (breast cancer, prostate cancer, and leukemia while other cancers appear underfunded (bladder, esophageal, liver, oral, pancreatic, stomach, and uterine cancers. Conclusions These discrepancies indicate that an improved method of health care research funding allocation should be investigated to better match funding levels to societal burden.

  12. 合成系统提前升温的可行性分析%Feasibility Analysis of Ammonia Synthesis Unit Temperature Increasing in Advance

    Institute of Scientific and Technical Information of China (English)

    田红; 曹超; 董金国

    2014-01-01

    根据该厂氨合成系统工艺流程、系统资源情况,介绍氨合成系统两种可能的提前升温方案,并分析两种提前升温方案各自的利弊。%Based on the ammonia synthesis system process and resources ,describe two programs of increasing ammonia synthesis unit temperature in advance ,and analyze advantages and disadvantages .

  13. Thimerosal exposure and increased risk for diagnosed tic disorder in the United States: a case-control study

    Directory of Open Access Journals (Sweden)

    Geier David A.

    2015-06-01

    Full Text Available A hypothesis testing, case-control study evaluated automated medical records for exposure to organic-Hg from Thimerosal-containing hepatitis B vaccines (TM-HepB administered at specific intervals in the first six-months-of-life among cases diagnosed with a tic disorder (TD or cerebral degeneration (CD (an outcome not biologically plausibly linked to TM exposure in comparison to controls; both cases and controls were continuously enrolled from birth (born from 1991–2000 within the Vaccine Safety Datalink (VSD database. TD cases were significantly more likely than controls to have received increased organic-Hg from TM-HepB administered within the first month-of-life (odds ratio (OR=1.59, p<0.00001, first two-months-of-life (OR=1.59, p<0.00001, and first six-months-of-life (OR=2.97, p<0.00001. Male TD cases were significantly more likely than male controls to have received increased organic-Hg from TM-HepB administered within the first month-of-life (OR =1.65, p<0.0001, first two-months-of-life (OR=1.64, p<0.0001, and first six months-of-life (OR=2.47, p<0.05, where as female TD were significantly more likely than female controls to have received increased organic-Hg from TM-HepB administered within the first six-months-of-life (OR=4.97, p<0.05. By contrast, CD cases were no more likely than controls to have received increased organic-Hg exposure from TM-HepB administered at any period studied within the first six-months-of-life. Although routine childhood vaccination is considered an important public health tool to combat infectious diseases, the present study associates increasing organic-Hg exposure from TM-HepB and the subsequent risk of a TD diagnosis.

  14. Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries

    Science.gov (United States)

    McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.

    2013-01-01

    Background The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5,000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (−$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending

  15. Unemployment, public-sector healthcare spending and stomach cancer mortality in the European Union, 1981-2009.

    Science.gov (United States)

    Maruthappu, Mahiben; Painter, Annabelle; Watkins, Johnathan; Williams, Callum; Ali, Raghib; Zeltner, Thomas; Faiz, Omar; Sheth, Hemant

    2014-11-01

    We sought to determine the association between changes in unemployment, healthcare spending and stomach cancer mortality. Multivariate regression analysis was used to assess how changes in unemployment and public-sector expenditure on healthcare (PSEH) varied with stomach cancer mortality in 25 member states of the European Union from 1981 to 2009. Country-specific differences in healthcare infrastructure and demographics were controlled for 1- to 5-year time-lag analyses and robustness checks were carried out. A 1% increase in unemployment was associated with a significant increase in stomach cancer mortality in both men and women [men: coefficient (R)=0.1080, 95% confidence interval (CI)=0.0470-0.1690, P=0.0006; women: R=0.0488, 95% CI=0.0168-0.0809, P=0.0029]. A 1% increase in PSEH was associated with a significant decrease in stomach cancer mortality (men: R=-0.0009, 95% CI=-0.0013 to -0.005, Punemployment or PSEH. Increases in unemployment are associated with a significant increase in stomach cancer mortality. Stomach cancer mortality is also affected by public-sector healthcare spending. Initiatives that bolster employment and maintain public-sector healthcare expenditure may help to minimize increases in stomach cancer mortality during economic downturns.

  16. A Three-Lesson Teaching Unit Significantly Increases High School Students’ Knowledge about Epilepsy and Positively Influences Their Attitude towards This Disease

    Science.gov (United States)

    Simon, Uwe K.; Gesslbauer, Lisa; Fink, Andreas

    2016-01-01

    Epilepsy is not a regular topic in many countries’ schools. Thus many people harbor misconceptions about people suffering from this disease. It was our aim to a) examine what grade ten students know and believe about epilepsy, and b) to develop and test a teaching unit to improve their knowledge and attitude. The test group comprised eight grade ten classes from six different Austrian high schools (54 girls and 51 boys aged 14–17), the control group (no intervention) five grade ten classes from the same schools (26 girls and 37 boys aged 14–17). The teaching unit consisted of three 45-min lessons using different methods and material. Changes in knowledge about and attitude towards epilepsy as a result of the intervention were psychometrically assessed in a pre-test intervention post-test design (along with a follow-up assessment two months after the intervention) by means of a questionnaire capturing different facets of epilepsy-related knowledge and attitude. Across all knowledge/attitude domains, students of the test group had a significantly improved knowledge about and a more positive attitude towards epilepsy and people suffering from it after the teaching unit. However, starting levels were different between the five knowledge/attitude domains tested. Medical background knowledge was lowest and consequently associated with the highest increase after the intervention. This study shows that epilepsy-related knowledge of many grade ten high school students is fragmentary and that some harbor beliefs and attitudes which require improvement. Our comprehensive but concise teaching unit significantly increased knowledge about epilepsy and positively influenced attitude towards individuals with epilepsy. Thus we recommend implementing this unit into regular school curricula. PMID:26919557

  17. A Three-Lesson Teaching Unit Significantly Increases High School Students' Knowledge about Epilepsy and Positively Influences Their Attitude towards This Disease.

    Science.gov (United States)

    Simon, Uwe K; Gesslbauer, Lisa; Fink, Andreas

    2016-01-01

    Epilepsy is not a regular topic in many countries' schools. Thus many people harbor misconceptions about people suffering from this disease. It was our aim to a) examine what grade ten students know and believe about epilepsy, and b) to develop and test a teaching unit to improve their knowledge and attitude. The test group comprised eight grade ten classes from six different Austrian high schools (54 girls and 51 boys aged 14-17), the control group (no intervention) five grade ten classes from the same schools (26 girls and 37 boys aged 14-17). The teaching unit consisted of three 45-min lessons using different methods and material. Changes in knowledge about and attitude towards epilepsy as a result of the intervention were psychometrically assessed in a pre-test intervention post-test design (along with a follow-up assessment two months after the intervention) by means of a questionnaire capturing different facets of epilepsy-related knowledge and attitude. Across all knowledge/attitude domains, students of the test group had a significantly improved knowledge about and a more positive attitude towards epilepsy and people suffering from it after the teaching unit. However, starting levels were different between the five knowledge/attitude domains tested. Medical background knowledge was lowest and consequently associated with the highest increase after the intervention. This study shows that epilepsy-related knowledge of many grade ten high school students is fragmentary and that some harbor beliefs and attitudes which require improvement. Our comprehensive but concise teaching unit significantly increased knowledge about epilepsy and positively influenced attitude towards individuals with epilepsy. Thus we recommend implementing this unit into regular school curricula.

  18. The Time Is Now: Attention Increases to Transgender Health in the United States but Scientific Knowledge Gaps Remain.

    Science.gov (United States)

    MacCarthy, Sarah; Reisner, Sari L; Nunn, Amy; Perez-Brumer, Amaya; Operario, Don

    2015-12-01

    Attention to transgender health has dramatically increased in the U.S. Scientific knowledge gaps in empirical research, however, remain and act as barriers to achieving transgender-related health equity. We conducted a search using PubMed and PsycINFO to identify gaps in empirical, peer-reviewed publications related to adult transgender health in the U.S. between 1981 and 2013. We synthesized these findings and commented on opportunities for improving health research. Reducing health disparities and advancing transgender-related health equity requires greater investment in research that addresses current gaps to more comprehensively respond to the diverse health needs of transgender people.

  19. Defense Spending and the Trade Performance of U.S. Industries

    Science.gov (United States)

    1992-01-01

    certain countries such as Japan have an overly important influ- ence on the results. 13Smith (1980). 6 EFFECTS OF DEFENSE SPENDING ON TRADE...AD-A261 026 Defense Spending and the Trade Performance of U.S. Industries Ai Loren Yager, C. R. Neu FEB 2 3 1993 Appwvovd for pukAie r.10a", 93-02799...the Joint Staff, Contract No. MDA903-90-C-0004. Library of Congress Cataloging in Publication Data Yager, Loren, 1954- Defense spending and the trade

  20. Addressing the United States Debt and Deficit

    Science.gov (United States)

    2010-03-01

    current government approach to the economy , then examining the current projections for United States’ spending from 2009 through 2019 and examining...manner and thereby strengthen the economy of the United States, this paper concludes with three examples that are predicated on the synergistic benefits associated with small reforms.

  1. The relationship between visitor spending and repeat visits: An analysis of spectators at the Old Mutual Two Oceans Marathon

    Directory of Open Access Journals (Sweden)

    M. Kruger

    2012-12-01

    Full Text Available Purpose: The purpose of this research is to determine the relationship between visitor spending patterns, and previous and planned return visits as well as demographic and trip characteristics of supporters to the Old Mutual Two Oceans Marathon held annually in Cape Town. Problem investigated: Spectator sport is a significant segment of the tourism industry which also has a considerable economic impact on host communities. For this reason, communities and destinations have recognised and attempt to capitalise on hosting large sporting events. In this regard visitor spending is crucial since information concerning the latter can provide sport event organisers to focus their marketing efforts to attract optimal economic benefits. In addition, the relationship of previous visits to a sport event and intended re-visits to visitor spending has received increasing attention since it is believed that repeat visitation is associated with higher levels of expenditure. However limited attention is currently being paid to the relationship between spectator spending patterns and previous and planned return visits in a South African sport spectator context even though the latter has a direct impact on the future sustainability of an event. Methodology: A supporter survey was done for the first time in 2010 (30 March - 2 April 2010 at the event and 430 questionnaires were completed. Factor analysis and regression analysis are used to analyse the data and to identify the relationship between repeat visits and visitor spending patterns. Findings: Results from this study shows that it is predominantly socio-demographic variables that influence travel behaviour. The significant socio-demographic determinants that influence spending per person are gender, language and province of origin while the only behavioural determinant was group size. The results also revealed that there is no significant relationship between spectator spending, repeat attendance and

  2. In the United States, "Opt-Out" States Show No Increase in Access to Anesthesia Services for Medicare Beneficiaries Compared with Non-"Opt-Out" States.

    Science.gov (United States)

    Sun, Eric C; Miller, Thomas R; Halzack, Nicholas M

    2016-05-01

    In the United States, anesthesia care can be provided by anesthesiologists or nurse anesthetists. Since 2001, 17 states have exercised their right to "opt-out" of the federal requirement that a physician supervise the administration of anesthesia by a nurse anesthetist, with the majority citing increased access to anesthesia care as the rationale for their decision. By using Medicare data, we found that most (4 of 5) cohorts of "opt-out" states likely experienced smaller growth in anesthesia utilization rates compared with non-"opt-out" states, suggesting that opt-out was not associated with an increase in access to anesthesia care.

  3. Brief Report: Gonorrhea and Chlamydia Testing Increasing but Still Lagging in HIV Clinics in the United States.

    Science.gov (United States)

    Berry, Stephen A; Ghanem, Khalil G; Mathews, William Christopher; Korthuis, Philip Todd; Yehia, Baligh R; Agwu, Allison L; Lehmann, Christoph U; Moore, Richard D; Allen, Sara L; Gebo, Kelly A

    2015-11-01

    Screening persons living with HIV for gonorrhea and chlamydia has been recommended since 2003. We compared annual gonorrhea/chlamydia testing to syphilis and lipid testing among 19,368 adults (41% men who have sex with men, 30% heterosexual men, and 29% women) engaged in HIV care. In 2004, 22%, 62%, and 70% of all patients were tested for gonorrhea/chlamydia, syphilis, and lipid levels, respectively. Despite increasing steadily [odds ratio per year (95% confidence interval): 1.14 (1.13 to 1.15)], gonorrhea/chlamydia testing in 2010 remained lower than syphilis and lipid testing (39%, 77%, 76%, respectively). Interventions to improve gonorrhea/chlamydia screening are needed. A more targeted screening approach may be warranted.

  4. Spend Now or Spend Later: The Role of a Business Education and Critical Thinking Skills in Increasing Retirement Plan Saving Rates for New, Young Enrollees

    Science.gov (United States)

    Arling, Priscilla A.; Kirby, Jill; Saajasto, Kegan

    2015-01-01

    For college graduates entering the workforce, contributing to an employer-sponsored 401(k) retirement plan can be an important way of saving for the future. However, contribution rates for young people in these plans are far below recommended percentages, leading to concerns about future financial stability for these individuals. Prior work has…

  5. AST/ASTS workshop on increasing organ donation in the United States: creating an "arc of change" from removing disincentives to testing incentives.

    Science.gov (United States)

    Salomon, D R; Langnas, A N; Reed, A I; Bloom, R D; Magee, J C; Gaston, R S

    2015-05-01

    The American Society of Transplantation (AST) and American Society of Transplant Surgeons (ASTS) convened a workshop on June 2-3, 2014, to explore increasing both living and deceased organ donation in the United States. Recent articles in the lay press on illegal organ sales and transplant tourism highlight the impact of the current black market in kidneys that accompanies the growing global organ shortage. We believe it important not to conflate the illegal market for organs, which we reject in the strongest possible terms, with the potential in the United States for concerted action to remove all remaining financial disincentives for donors and critically consider testing the impact and acceptability of incentives to increase organ availability in the United States. However, we do not support any trials of direct payments or valuable considerations to donors or families based on a process of market-assigned values of organs. This White Paper represents a summary by the authors of the deliberations of the Incentives Workshop Group and has been approved by both AST and ASTS Boards. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  6. Trends in the utilization of, spending on, and prices for outpatient antifungal agents in US Medicaid programs: 1991-2009.

    Science.gov (United States)

    Desai, Vibha C A; Cavanaugh, Teresa M; Kelton, Christina M L; Guo, Jeff J; Heaton, Pamela C

    2012-10-01

    The incidence of invasive fungal infections (IFIs) has increased substantially in the recent past. Advances in medical technology, including broad-spectrum antibiotics, may increase the risk for fungal infections. Moreover, immunocompromised patients with cancer, HIV/AIDS, and/or transplants are susceptible to IFIs. Meanwhile, superficial fungal infections (SFIs) are common and can be difficult to cure. To provide a historical perspective on a dynamic market with expensive medications, this study describes trends in the utilization of, spending on, and average per-prescription spending on outpatient antifungal medications individually, in classes (for IFIs or SFIs), and overall, by the US Medicaid programs from 1991 to 2009. The publicly available Medicaid State Drug Utilization Data, maintained by the Centers for Medicare & Medicaid Services, were used. Annual prescription counts and reimbursement amounts were calculated for each of the antifungals reimbursed by Medicaid. Average per-prescription spending as a proxy for drug price was calculated by dividing reimbursement by the number of prescriptions. Overall utilization for Medicaid beneficiaries remained steady, with 4.56 million prescriptions in 1991 and 4.51 million in 2009. Expenditures rose from $93.87 million to $143.76 million (in current-year US$) over the same time period. The drop in the utilization of first-generation azoles over the last 5 years of the study period can be explained in part by the movement of dual-eligibles from Medicaid to Medicare Part D and in part to a rise in fungal infections better treated with second-generation azoles or echinocandins. Whereas the average per-prescription price for generic (oral) fluconazole was $8 in 2009, the price per prescription of branded (intravenous) voriconazole was $2178. Overall spending by Medicaid on outpatient antifungal medications increased more slowly than did the growth of the Medicaid programs from 1991 to 2009. However, the utilization of

  7. Intra-Household Gender-Bias in Child Educational Spending in ...

    African Journals Online (AJOL)

    Andinet

    and it is an essential part of personal welfare (Behrman, 1997). Since the .... country's Education and Training policy aims at providing education on equal basis ..... household consumption budget, conditional on positive spending. As can be ...

  8. Investment Spending in the Netherlands : The Impact of Liquidity and Corporate Governance

    NARCIS (Netherlands)

    Degryse, H.A.; de Jong, A.

    2000-01-01

    This paper examines the relation between cash flow, corporate governance and fixed-investment spending. In perfect capital markets we expect no systematic relationship. However, Myers and Majluf's (1984) asymmetric information hypothesis and Jensen's (1986) managerial discretion hypothesis present

  9. Investment Spending in the Netherlands : The Impact of Liquidity and Corporate Governance

    NARCIS (Netherlands)

    Degryse, H.A.; de Jong, A.

    2000-01-01

    This paper examines the relation between cash flow, corporate governance and fixed-investment spending. In perfect capital markets we expect no systematic relationship. However, Myers and Majluf's (1984) asymmetric information hypothesis and Jensen's (1986) managerial discretion hypothesis present i

  10. Microeconomics. Harnessing naturally occurring data to measure the response of spending to income.

    Science.gov (United States)

    Gelman, Michael; Kariv, Shachar; Shapiro, Matthew D; Silverman, Dan; Tadelis, Steven

    2014-07-11

    This paper presents a new data infrastructure for measuring economic activity. The infrastructure records transactions and account balances, yielding measurements with scope and accuracy that have little precedent in economics. The data are drawn from a diverse population that overrepresents males and younger adults but contains large numbers of underrepresented groups. The data infrastructure permits evaluation of a benchmark theory in economics that predicts that individuals should use a combination of cash management, saving, and borrowing to make the timing of income irrelevant for the timing of spending. As in previous studies and in contrast to the predictions of the theory, there is a response of spending to the arrival of anticipated income. The data also show, however, that this apparent excess sensitivity of spending results largely from the coincident timing of regular income and regular spending. The remaining excess sensitivity is concentrated among individuals with less liquidity.

  11. The Long-Term Impact of Educational and Health Spending on Unemployment Rates

    Directory of Open Access Journals (Sweden)

    Zafer PIRIM

    2014-05-01

    Full Text Available This study used panel data regression analysis to evaluate the long-term effects of several measures of U.S. education expenditure on unemployment rates in 50 states and Washington D.C. over 25 years. The data included state-level statistics for fiscal effort, graduation rates, education spending per pupil, gross state product per capita, welfare spending, health spending, political party affiliation, union versus nonunion states, and unemployment rates. Results find that the best way to effectively reduce unemployment is investment in improving the quality of human capital through funding education. Findings specifically conclude that over the long term, investment in human capital through education as defined by per-pupil spending and health services could play a significant role in reducing unemployment rates.

  12. The Long-Term Impact of Educational and Health Spending on Unemployment Rates

    Directory of Open Access Journals (Sweden)

    Zafer Pirim

    2016-02-01

    Full Text Available This study used panel data regression analysis to evaluate the long-term effects of several measures of U.S. education expenditure on unemployment rates in 50 states and Washington D.C. over 25 years. The data included state-level statistics for fiscal effort, graduation rates, education spending per pupil, gross state product per capita, welfare spending, health spending, political party affiliation, union versus nonunion states, and unemployment rates. Results find that the best way to effectively reduce unemployment is investment in improving the quality of human capital through funding education. Findings specifically conclude that over the long term, investment in human capital through education as defined by per-pupil spending and health services could play a significant role in reducing unemployment rates.

  13. Evaluating the Effectiveness of Possible Introduction of Fiscal Spending Regulation in Ukraine in Retrospective

    Directory of Open Access Journals (Sweden)

    Laktionova Olexandra A.

    2016-02-01

    Full Text Available A possible impact of introducing fiscal regulation of spending into the budgetary mechanism, if used before the financial crisis of 2008—2009 or afterwards, has been studied. Accumulation of public finance imbalances in the form of government deficit and debt was taken as an introduction effect. Two approaches are considered as a variant of the spending regulation — limitation of spending depending on the state revenue growth and depending on the nominal GDP growth as well. According to the dynamics, the model defined by the GDP dynamics has more tight restrictions but it is more correlated with the business activity dynamics and is more procyclical. Provided the application of the spending regulation at the beginning of the financial crisis, its level in the GDP would have amounted to 9—21%, the reserve of fiscal space according to this indicator would have amounted to 1—16 percentage points.

  14. 2013 National Park visitor spending effects: economic contributions to local communities, states, and the nation

    Science.gov (United States)

    Cullinane Thomas, Catherine M.; Huber, Christopher C.; Koontz, Lynne

    2014-01-01

    The National Park Service (NPS) manages the nation's most iconic destinations that attract millions of visitors form across the nation and around the world. Trip-related spending by NPS visitors generates and supports a considerable amount of economic activity within park gateway communities. This economic effects analysis measures how NPS visitor spending cycles through local economies, generating business sales and supporting jobs and income.

  15. Political Institutions and Government Spending Behavior: Theory and Evidence from Iran

    OpenAIRE

    Dizaji, Sajjad Faraji; Farzanegan, Mohammad Reza; Naghavi, Alireza

    2015-01-01

    This study examines how the quality of political institutions affects the distribution of the government budget in Iran. We first introduce a mechanism through which democracy can shift government expenditure from national defense (military) to productivity-enhancing public spending (e.g., education). Using impulse response functions (IRF) and a variance decomposition analysis (VDC) on the basis of a vector autoregressive (VAR) model, our results imply that the response of military spending t...

  16. Changes in Health Care Spending and Quality 4 Years into Global Payment

    Science.gov (United States)

    Song, Zirui; Rose, Sherri; Safran, Dana G.; Landon, Bruce E.; Day, Matthew P.; Chernew, Michael E.

    2014-01-01

    BACKGROUND Spending and quality under global budgets remain unknown beyond 2 years. We evaluated spending and quality measures during the first 4 years of the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC). METHODS We compared spending and quality among enrollees whose physician organizations entered the AQC from 2009 through 2012 with those among persons in control states. We studied spending changes according to year, category of service, site of care, experience managing risk contracts, and price versus utilization. We evaluated process and outcome quality. RESULTS In the 2009 AQC cohort, medical spending on claims grew an average of $62.21 per enrollee per quarter less than it did in the control cohort over the 4-year period (P<0.001). This amount is equivalent to a 6.8% savings when calculated as a proportion of the average post-AQC spending level in the 2009 AQC cohort. Analogously, the 2010, 2011, and 2012 cohorts had average savings of 8.8% (P<0.001), 9.1% (P<0.001), and 5.8% (P = 0.04), respectively, by the end of 2012. Claims savings were concentrated in the outpatient-facility setting and in procedures, imaging, and tests, explained by both reduced prices and reduced utilization. Claims savings were exceeded by incentive payments to providers during the period from 2009 through 2011 but exceeded incentive payments in 2012, generating net savings. Improvements in quality among AQC cohorts generally exceeded those seen elsewhere in New England and nationally. CONCLUSIONS As compared with similar populations in other states, Massachusetts AQC enrollees had lower spending growth and generally greater quality improvements after 4 years. Although other factors in Massachusetts may have contributed, particularly in the later part of the study period, global budget contracts with quality incentives may encourage changes in practice patterns that help reduce spending and improve quality. (Funded by the Commonwealth Fund and others

  17. The impact of airport shopping environments and dwell time on consumer spending

    OpenAIRE

    Bohl, Patrick

    2014-01-01

    This article provides new insight into how the ambience and design of shopping environments impact onspending behaviour. Environmental cues in a retail area influence emotional states of by-passers, which in turn influence spending levels. Past research suggested that this effect only applies to shops with moderate arousal level. Also, several studies failed to confirm a relationship between emotions and spending levels. This is surprising, since high arousal environments (e.g., a...

  18. 2012 National Park visitor spending effects: economic contributions to local communities, states, and the nation

    Science.gov (United States)

    Cullinane Thomas, Catherine; Huber, Christopher C.; Koontz, Lynne

    2014-01-01

    The National Park Service (NPS) manages the nation's most iconic destinations that attract millions of visitors from across the nation and around the world. Trip-related spending by NPS visitors generates and supports a considerable amount of economic activity within park gateway communities. This economic effects analysis measures how NPS visitor spending cycles through local economies, generating business sales and supporting jobs and income.

  19. SpEnD: Linked Data SPARQL Endpoints Discovery Using Search Engines

    OpenAIRE

    Yumusak, Semih; Dogdu, Erdogan; KODAZ, Halife; Kamilaris, Andreas

    2016-01-01

    In this study, a novel metacrawling method is proposed for discovering and monitoring linked data sources on the Web. We implemented the method in a prototype system, named SPARQL Endpoints Discovery (SpEnD). SpEnD starts with a "search keyword" discovery process for finding relevant keywords for the linked data domain and specifically SPARQL endpoints. Then, these search keywords are utilized to find linked data sources via popular search engines (Google, Bing, Yahoo, Yandex). By using this ...

  20. Quality of governance, public spending on health and health status in Sub Saharan Africa: a panel data regression analysis.

    Science.gov (United States)

    Makuta, Innocent; O'Hare, Bernadette

    2015-09-21

    corresponding semi elasticities with respect to life expectancy are about 6 in countries with higher QoG and about 3 in countries with lower QoG. Public spending on health improves health outcomes. Its impact is mediated by quality of governance, having the higher impact on health outcomes in countries with higher quality of governance and lower impact in countries with lower quality of governance. This may be due to increased efficiency in the use of available resources and better allocation of the same as QoG improves. Improving QoG would improve health outcomes in SSA. The same increase in PSH is twice as effective in reducing U5M and increasing LE in countries with good QoG when compared with countries with poor QoG.

  1. Changing the Game: Athletics Spending in an Academic Context

    Science.gov (United States)

    Kirwan, William E.; Turner, R. Gerald

    2010-01-01

    At many of the nation's most prominent institutions of higher education, sports are far more than just extracurricular activities or even campus spectacles. Contests in football, basketball, and often other sports unite colleges and universities with their students, fans, friends, and alumni, both in person and across the globe. Big-time college…

  2. Monopoly money: the effect of payment coupling and form on spending behavior.

    Science.gov (United States)

    Raghubir, Priya; Srivastava, Joydeep

    2008-09-01

    This article examines consumer spending as a function of payment mode both when the modes differ in terms of payment coupling (association between purchase decision and actual parting of money) and physical form as well as when the modes differ only in terms of form. Study 1 demonstrates that consumers are willing to spend more when a credit card logo is present versus absent. Study 2 shows that the credit card effect can be attenuated when people estimate their expenses using a decomposition strategy (vs. a holistic one). Noting that credit card and cash payments differ in terms of payment coupling and form, Studies 3 and 4 examine consumer spending when the payment mode differs only in physical form. Study 3 demonstrates that consumers spend more when they are spending scrip (a form of stored value certificate) versus cash of the same face value. Study 4 shows that the difference in spending across payment modes (cash and gift certificates) is attenuated by altering the salience of parting with money through contextual manipulations of the differences between cash and gift certificates.

  3. Cre/loxP-mediated excision of a neomycin resistance expression unit from an integrated retroviral vector increases long terminal repeat-driven transcription in human hematopoietic cells.

    Science.gov (United States)

    Fernex, C; Dubreuil, P; Mannoni, P; Bagnis, C

    1997-01-01

    Recombinant retroviruses are currently the most attractive vehicles for gene transfer into hematopoietic cells. Retroviral vectors often contain an easily selectable marker gene in addition to the gene of interest. However, the presence and selection for expression of the selectable gene often result in a significant reduction of the expression of the gene of interest in the transduced cells. In order to circumvent this problem, we have developed a Cre/loxP recombination system for specific excision of the selectable expression unit from integrated retroviruses. A retroviral vector, containing both a neomycin resistance expression unit flanked by loxP sites and granulocyte-macrophage colony-stimulating factor cDNA, was used to transduce the human hematopoietic K-562 cell line. Four transduced cell clones were then superinfected with a retrovirus containing a Cre recombinase expression unit. Molecular analyses of 30 doubly transduced subclones showed a strict correlation between cre expression and loxP-flanked selectable cassette excision, thus implying that Cre recombinase activity is very efficient in a retroviral context. Moreover, the excision of the selectable cassette results in a significant increase of granulocyte-macrophage colony-stimulating factor transcription driven by the retroviral promoter. PMID:9311833

  4. Out-of-Pocket Spending for Ambulatory Physical Therapy Services From 2008 to 2012: National Panel Survey.

    Science.gov (United States)

    Chevan, Julia; Riddle, Daniel L; Reed, Shelby D

    2015-12-01

    Out-of-pocket (OOP) expenditures are incurred as insurers and employers shift some of the burden of health care costs onto consumers. As cost-sharing increases, OOP expenditures could be a barrier to physical therapy care. The purposes of this study were: (1) to identify factors associated with any OOP physical therapy spending and (2) to identify factors associated with higher spending among individuals incurring OOP costs. The study was a retrospective analysis using the 4 most recently available panels of data from the Medical Expenditure Panel Survey (MEPS) encompassing 2008-2012. A data file containing episodes of physical therapy care for 2,189 people was created. Logistic regression was used to identify factors related to having an OOP expenditure. A multivariable generalized linear model was used to identify factors related to mean OOP expenditures. On average, an episode of care encompassed 9.9 visits, with mean total expenditures of $1,708 (median: $792). Fifty-four percent of episodes of care had an OOP expenditure. For individuals with OOP expenditures, the mean OOP expenditure for an episode of care was $351 (median: $144). Being female or non-Hispanic and having a higher income were associated with higher odds of incurring an OOP expenditure, whereas being in worse general health, >65 years of age, or nonwhite and having public funding were associated with lower odds of incurring an OOP expenditure. Amounts of OOP spending were higher in urban areas and in all census geographic regions relative to the Northeast region. Estimates are based on household-reported survey data, limited to ambulatory care, and do not include institutionalized individuals. At 54%, the proportion of individuals with OOP expenditures for physical therapy is lower than for general medical care. Several predictors were found of having OOP expenditures and of the magnitude of those expenditures. © 2015 American Physical Therapy Association.

  5. Revising Social Contracts: Social Spending in Latin America, East Asia, and the Former Socialist Countries, 1980-2000

    Directory of Open Access Journals (Sweden)

    Stephan Haggard

    2004-01-01

    Full Text Available This paper examines the determinants of social spending in Latin America, Eastern Europe, and East Asia during the 1980s and 1990s. We hypothesize that pronounced and enduring differences in welfare legacies and fiscal constraints affected the way countries of the three regions responded to more contemporary challenges of economic crisis, integration into global markets, and transitions from autocracy to democratic rule. Latin American countries, which inherited the most severe fiscal constraints, were least able to protect social spending during economic downturns. East Asian countries and, to a lesser extent, those of Eastern Europe, were less likely to reduce social spending in the face of downturns and somewhat more likely to increase during democratic transitionsEste trabajo examina los determinantes del gasto social en América Latina, Europa Oriental y el Este Asiático durante los años 80 y los 90. Presumimos que las diferencias duraderas y significativas en las herencias del estado de bienestar y las restricciones fiscales afectaron la manera en la cual los países en las tres regiones respondieron a los desafíos de las crisis económicas más contemporáneos, la integración en los mercados globales y las transiciones a la democracia. Los países latinoamericanos, que heredaron las restricciones fiscales más severas, fueron los que menos pudieron proteger el gasto social durante momentos de apremio económico. Los países del Este Asiático, y en un grado menor, los de Europa Oriental, fueron menos proclives a reducir el gasto social en vistas a los apremios económicos e inclusive se vieron más inclinados a aumentarlo durante las transiciones democráticas

  6. Global Megacities Differing Adaptation Responses to Climate Change: an Analysis of Annual Spend of Ten Major cities on the adaptation economy

    Science.gov (United States)

    Maslin, M. A.; Georgeson, L.

    2015-12-01

    Urban areas are increasingly at risk from climate change with negative impacts predicted for human health, the economy and ecosystems. These risks require responses from cities, to improve the resilience of their infrastructure, economy and environment to climate change. Policymakers need to understand what is already being spent on adaptation so that they can make more effective and comprehensive adaptation plans. Through the measurement of spend in the newly defined 'Adaptation Economy' we analysis the current efforts of 10 global megacities in adapting to climate change. These cities were chosen based on their size, geographical location and their developmental status. The cities are London, Paris, New York, Mexico City, Sao Paulo, Beijing, Mumbai, Jakarta, Lagos and Addis Ababa. It is important to study a range of cities in different regions of the world, with different climates and at different states of socio-economic development. While in economic terms, disaster losses from weather, climate and geophysical events are greater in developed countries, fatalities and economic losses as a proportion of GDP are higher in developing countries. In all cities examined the Adaptation Economy is still a small part of the overall economy accounting for a maximum of 0.3% of the Cities total GDP (GDPc). The differences in total spend are significant between cities in developed and rapidly emerging countries, compared to those in developing countries with a spend ranging from £16 million to £1,500 million. Comparing key sub sectors, we demonstrate that there are distinctive adaptation profiles with developing cities having a higher relative spend on health, while developed cities have a higher spend on disaster preparedness, ICT and professional services. Comparing spend per capita and as a percentage of GDPc demonstrates even more clearly disparities between the cities in the study; developing country cities spend half as much as a proportion of GPCc in some cases, and

  7. Increased Incidence Rate of Trauma- and Stressor-Related Disorders in Denmark After the September 11, 2001, Terrorist Attacks in the United States.

    Science.gov (United States)

    Hansen, Bertel T; Østergaard, Søren D; Sønderskov, Kim M; Dinesen, Peter T

    2016-10-01

    The terrorist attacks that occurred on September 11, 2001 (hereafter referred to as 9/11) in the United States had a profound impact on the physical and mental health of Americans, but the effects beyond the United States are largely unknown. To understand the wider aftermath, we examined the consequences of the 9/11 attacks on mental disorders in the Kingdom of Denmark. Utilizing population data from the Danish Psychiatric Central Research Register from 1995 to 2012, we used a time-series intervention approach to estimate the change in the incidence rate of mental disorders after the 9/11 attacks. Based on analyses of 1,448,250 contacts with psychiatric services, we found that the attacks were followed by an immediate 16% increase in the incidence rate of trauma- and stressor-related disorders. This surge dissipated approximately a year after 9/11. In contrast, no similar increases were found for other disorders. This is consistent with the prominent role of external stressors in the etiology of trauma- and stressor-related disorders. The results indicate that the effects of 9/11 on mental disorders extended across the Atlantic Ocean to Denmark. Thus, the impact of terrorist attacks on mental health is likely not limited to inhabitants of the country under attack; it also extends to people far away and without immediate relation to it.

  8. Using Search Query Surveillance to Monitor Tax Avoidance and Smoking Cessation following the United States' 2009 “SCHIP” Cigarette Tax Increase

    Science.gov (United States)

    Ayers, John W.; Ribisl, Kurt; Brownstein, John S.

    2011-01-01

    Smokers can use the web to continue or quit their habit. Online vendors sell reduced or tax-free cigarettes lowering smoking costs, while health advocates use the web to promote cessation. We examined how smokers' tax avoidance and smoking cessation Internet search queries were motivated by the United States' (US) 2009 State Children's Health Insurance Program (SCHIP) federal cigarette excise tax increase and two other state specific tax increases. Google keyword searches among residents in a taxed geography (US or US state) were compared to an untaxed geography (Canada) for two years around each tax increase. Search data were normalized to a relative search volume (RSV) scale, where the highest search proportion was labeled 100 with lesser proportions scaled by how they relatively compared to the highest proportion. Changes in RSV were estimated by comparing means during and after the tax increase to means before the tax increase, across taxed and untaxed geographies. The SCHIP tax was associated with an 11.8% (95% confidence interval [95%CI], 5.7 to 17.9; ptax levels in Canada during the months after the tax. Tax avoidance searches increased 27.9% (95%CI, 15.9 to 39.9; ptax compared to Canada, respectively, suggesting avoidance is the more pronounced and durable response. Trends were similar for state-specific tax increases but suggest strong interactive processes across taxes. When the SCHIP tax followed Florida's tax, versus not, it promoted more cessation and avoidance searches. Efforts to combat tax avoidance and increase cessation may be enhanced by using interventions targeted and tailored to smokers' searches. Search query surveillance is a valuable real-time, free and public method, that may be generalized to other behavioral, biological, informational or psychological outcomes manifested online. PMID:21436883

  9. Government Spending and Real Exchange Rate Case of Albania

    Directory of Open Access Journals (Sweden)

    Edmira Cakrani

    2013-04-01

    Full Text Available Various studies have found that governmentspending can lead to overestimation orunderestimation of the real exchange rate, depending on the composition of theseexpenditures. The purpose of this paper is toassess the impact of government spendingon real exchange rate in Albania. In this paper is used a log liner model with quarterlydata. Other explanatory variables in this model are: foreign direct investment, remittances,real GDP per capita, openness. Variables are tested for unit root and cointegration. Theresults indicate that government spendingis associated with overvaluation of realexchange rate in Albania.JEL Classification: E62; F31Various studies have found that governmentspending can lead to overestimation orunderestimation of the real exchange rate, depending on the composition of theseexpenditures. The purpose of this paper is toassess the impact of government spendingon real exchange rate in Albania. In this paper is used a log liner model with quarterlydata. Other explanatory variables in this model are: foreign direct investment, remittances,real GDP per capita, openness. Variables are tested for unit root and cointegration. Theresults indicate that government spendingis associated with overvaluation of realexchange rate in Albania.JEL Classification: E62; F31

  10. Government Spending and Real Exchange Rate Case of Albania

    Directory of Open Access Journals (Sweden)

    Edmira Cakrani

    2013-04-01

    Full Text Available Various studies have found that governmentspending can lead to overestimation orunderestimation of the real exchange rate, depending on the composition of theseexpenditures. The purpose of this paper is toassess the impact of government spendingon real exchange rate in Albania. In this paper is used a log liner model with quarterlydata. Other explanatory variables in this model are: foreign direct investment, remittances,real GDP per capita, openness. Variables are tested for unit root and cointegration. Theresults indicate that government spendingis associated with overvaluation of realexchange rate in Albania.JEL Classification: E62; F31Various studies have found that governmentspending can lead to overestimation orunderestimation of the real exchange rate, depending on the composition of theseexpenditures. The purpose of this paper is toassess the impact of government spendingon real exchange rate in Albania. In this paper is used a log liner model with quarterlydata. Other explanatory variables in this model are: foreign direct investment, remittances,real GDP per capita, openness. Variables are tested for unit root and cointegration. Theresults indicate that government spendingis associated with overvaluation of realexchange rate in Albania.

  11. Public health spending in 2008: on the challenge of integrating PHSSR data sets and the need for harmonization.

    Science.gov (United States)

    Leider, Jonathon P; Sellers, Katie; Shah, Gulzar; Pearsol, Jim; Jarris, Paul E

    2012-01-01

    In recent years, state and local public health department budgets have been cut, sometimes drastically. However, there is no systematic tracking of governmental public health spending that would allow researchers to assess these cuts in comparison with governmental public health spending as a whole. Furthermore, attempts to quantify the impact of public health spending are limited by the lack of good data on public health spending on state and local public health services combined. The objective of this article is to integrate self-reported state and local health department (LHD) survey data from 2 major national organizations to create state-level estimates of governmental public health spending. To create integrated estimates, we selected 1388 LHDs and 46 states that had reported requisite financial information. To account for the nonrespondent LHDs, estimates of the spending were developed by using appropriate statistical weights. Finally, funds from federal pass-through and state sources were estimated for LHDs and subtracted from the total spending by the state health agency to avoid counting these dollars in both state and local figures. On average, states spend $106 per capita on traditional public health at the state and local level, with an average of 42% of spending occurring at the local level. Considerable variation exists in state and local public health funding. The results of this analysis show a relatively low level of public health funding compared with state Medicaid spending and health care more broadly.

  12. 2016 National Park visitor spending effects: Economic contributions to local communities, states, and the Nation

    Science.gov (United States)

    Cullinane Thomas, Catherine; Koontz, Lynne

    2017-01-01

    The National Park Service (NPS) manages the Nation’s most iconic destinations that attract millions of visitors from across the Nation and around the world. Trip-related spending by NPS visitors generates and supports a considerable amount of economic activity within park gateway communities. This economic effects analysis measures how NPS visitor spending cycles through local economies, generating business sales and supporting jobs and income. In 2016, the National Park System received an estimated 330,971,689 recreation visits. Visitors to National Parks spent an estimated $18.4 billion in local gateway regions (defined as communities within 60 miles of a park). The contribution of this spending to the national economy was 318 thousand jobs, $12.0 billion in labor income, $19.9 billion in value added, and $34.9 billion in economic output. The lodging sector saw the highest direct contributions with $5.7 billion in economic output directly contributed to local gateway economies nationally. The sector with the next greatest direct contributions was the restaurants and bars sector, with $3.7 billion in economic output directly contributed to local gateway economies nationally. Results from the Visitor Spending Effects report series are available online via an interactive tool. Users can view year-by-year trend data and explore current year visitor spending, jobs, labor income, value added, and economic output effects by sector for national, state, and local economies. This interactive tool is available at https://www.nps.gov/subjects/socialscience/vse.htm.

  13. Budget spending and economic growth in Croatia - Dynamics and relathionships over the past two decades

    Directory of Open Access Journals (Sweden)

    Helena Blažić

    2011-12-01

    Full Text Available The objective of this research is to analyze the relationship between government budget spending and the effect on the growth and structure of the GDP of Croatia during the past two decades. The starting working assumption (hypothesis is that the volume of total budget expenditure (including the foreign borrowing has not been realizing appropriate effect on GDP growth. In the analysis of these relationships we primarily use the method of vector autoregressions (VAR. The main result of the analysis showed that, in accordance with theoretical assumptions, the structure of expenditures is essential for the effects of budgetary spending on economic growth. We determine the positive effects of investment spending and purchases of goods and services and the negative effects of other categories of current spending. The reduction of capital expenditures during the recession presents a particularly adverse trend, which reduces the rate of growth of the economy in the long and short term. A fundamental conclusion of the research is that the budget expenditures have not adequately affected the GDP growth. Therefore, it is possible to affect the economic growth by changing the structure of budgetary spending, as well as directing public borrowing to investment financing.

  14. Adding A Spending Metric To Medicare's Value-Based Purchasing Program Rewarded Low-Quality Hospitals.

    Science.gov (United States)

    Das, Anup; Norton, Edward C; Miller, David C; Ryan, Andrew M; Birkmeyer, John D; Chen, Lena M

    2016-05-01

    In fiscal year 2015 the Centers for Medicare and Medicaid Services expanded its Hospital Value-Based Purchasing program by rewarding or penalizing hospitals for their performance on both spending and quality. This represented a sharp departure from the program's original efforts to incentivize hospitals for quality alone. How this change redistributed hospital bonuses and penalties was unknown. Using data from 2,679 US hospitals that participated in the program in fiscal years 2014 and 2015, we found that the new emphasis on spending rewarded not only low-spending hospitals but some low-quality hospitals as well. Thirty-eight percent of low-spending hospitals received bonuses in fiscal year 2014, compared to 100 percent in fiscal year 2015. However, low-quality hospitals also began to receive bonuses (0 percent in fiscal year 2014 compared to 17 percent in 2015). All high-quality hospitals received bonuses in both years. The Centers for Medicare and Medicaid Services should consider incorporating a minimum quality threshold into the Hospital Value-Based Purchasing program to avoid rewarding low-quality, low-spending hospitals.

  15. Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: A before-and-after study.

    Science.gov (United States)

    Silver, Lynn D; Ng, Shu Wen; Ryan-Ibarra, Suzanne; Taillie, Lindsey Smith; Induni, Marta; Miles, Donna R; Poti, Jennifer M; Popkin, Barry M

    2017-04-01

    Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being adopted, yet evaluation is scarce. This study examines the association of the first penny per ounce SSB excise tax in the United States, in Berkeley, California, with beverage prices, sales, store revenue/consumer spending, and usual beverage intake. Methods included comparison of pre-taxation (before 1 January 2015) and first-year post-taxation (1 March 2015-29 February 2016) measures of (1) beverage prices at 26 Berkeley stores; (2) point-of-sale scanner data on 15.5 million checkouts for beverage prices, sales, and store revenue for two supermarket chains covering three Berkeley and six control non-Berkeley large supermarkets in adjacent cities; and (3) a representative telephone survey (17.4% cooperation rate) of 957 adult Berkeley residents. Key hypotheses were that (1) the tax would be passed through to the prices of taxed beverages among the chain stores in which Berkeley implemented the tax in 2015; (2) sales of taxed beverages would decline, and sales of untaxed beverages would rise, in Berkeley stores more than in comparison non-Berkeley stores; (3) consumer spending per transaction (checkout episode) would not increase in Berkeley stores; and (4) self-reported consumption of taxed beverages would decline. Main outcomes and measures included changes in inflation-adjusted prices (cents/ounce), beverage sales (ounces), consumers' spending measured as store revenue (inflation-adjusted dollars per transaction) in two large chains, and usual beverage intake (grams/day and kilocalories/day). Tax pass-through (changes in the price after imposition of the tax) for SSBs varied in degree and timing by store type and beverage type. Pass-through was complete in large chain supermarkets (+1.07¢/oz, p = 0.001) and small chain supermarkets and chain gas stations (1.31¢/oz, p = 0.004), partial in pharmacies (+0.45¢/oz, p = 0.03), and negative in independent corner stores and

  16. The role of energy efficiency spending in Maryland's implementation of the Regional Greenhouse Gas Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Paul, Anthony; Palmer, Karen; Myers, Erica [Resources for the Future, Washington, DC (United States); Ruth, Matthias [Center for Integrative Environmental Research, University of Maryland (United States); Engineering and Public Policy Program, University of Maryland (United States); Environmental Policy Program, School of Public Policy, University of Maryland (United States); Hobbs, Benjamin F. [Department of Geography and Environmental Engineering, Whiting School of Engineering, The Johns Hopkins University (United States); Irani, Daraius [Regional Economic Studies Institute, Towson University, Towson, MD (United States); Michael, Jeffrey [Business Forecasting Center, Eberhardt School of Business, University of the Pacific (United States); Chen, Yihsu [School of Engineering, Social Sciences, Humanities and Arts, University of California, Merced, CA (United States); Ross, Kimberly [Center for Integrative Environmental Research, University of Maryland (United States)

    2010-11-15

    What are the economic consequences of increased state spending on electricity consumption efficiency? The State of Maryland faces this question in deciding how much of its CO{sub 2} allowances auction proceeds (under the Regional Greenhouse Gas Initiative) to devote to such programs. Starting at a base of 25% of the proceeds, we consider the energy savings, emissions reductions, employment, and other impacts of increasing that percentage to 50% and 100%. A series of models - Haiku, JHU-OUTEC, and IMPLAN - are used for the analysis. We conclude that increasing the state's expenditures on energy efficiency programs would result in a decline in electricity consumption in the state and a corresponding decline in expenditures on electricity. Program implementation would lead to net positive growth in statewide economic activity and include growth in both jobs and wages. (author)

  17. Why do some countries spend more for health? An assessment of sociopolitical determinants and international aid for government health expenditures.

    Science.gov (United States)

    Liang, Li-Lin; Mirelman, Andrew J

    2014-08-01

    A consensus exists that rising income levels and technological development are among key drivers of total health spending. Determinants of public sector health expenditure, by contrast, are less well understood. This study examines a complex relationship across government health expenditure (GHE), sociopolitical risks, and international aid, while taking into account the impacts of national income, debt and tax financing and aging populations on health spending. We apply a fixed-effects two-stage least squares regression method to a panel dataset comprising 120 countries for the years 1995 through 2010. Our results show that democratic accountability has a diminishing positive correlation with GHE, and that levels of GHE are higher when government is more stable. Corruption is associated with less GHE in developing countries, but with higher GHE in developed countries. We also find that development assistance for health (DAH) is fungible with domestically financed government health expenditure (DGHE). For an average country, a 1% increase in DAH to government is associated with a 0.03-0.04% decrease in DGHE. Furthermore, the degree of fungibility of DAH to government is higher in countries where corruption or ethnic tensions are widespread. However, DAH to non-governmental organizations is not fungible with DGHE.

  18. Theory Z as a framework for the application of a professional practice model in increasing nursing staff retention on oncology units.

    Science.gov (United States)

    Boyd, M; Collins, L; Pipitone, J; Balk, E; Kapustay, P

    1990-10-01

    Recruitment and retention of nurses is the most significant issue facing nursing administrators, educators, researchers and clinicians in the ongoing nursing shortage in the United States today. It has been cited in the literature that American nurses feel that job satisfaction is a major issue in retaining qualified nurses in hospitals. Satisfaction occurs when nurse expectations are matched with the hospital's vision and values. It is for this purpose that the authors have chosen theory Z as a hospital management model to coincide with the institution of the Marker Professional Practice Model to increase job satisfaction (autonomy) in hospital-based nurses. There are four 'hidden' challenges in health care today. They are: (a) fundamental changes occurring within the profession and practice of nursing; (b) the expanded role of women in management; (c) ethical dilemmas related to advances in medical technologies; and (d) the difficulty for health care managers in the United States to make changes related to the above three challenges. The authors feel that it is inherent to the nursing profession to combine existing theories and models to enhance the retention of nurses to the profession.

  19. Effect of Inhomogeneity of the Universe on a Gravitationally Bound Local System: A No-Go Result for Explaining the Secular Increase in the Astronomical Unit

    Indian Academy of Sciences (India)

    Hideyoshi Arakida

    2012-06-01

    We will investigate the influence of the inhomogeneity of the Universe, especially that of the Lemaître–Tolman–Bondi (LTB) model, on a gravitationally bound local system such as the solar system.We concentrate on the dynamical perturbation to the planetary motion and derive the leading order effect generated from the LTB model. It will be shown that there appear not only a well-known cosmological effect arisen from the homogeneous and isotropic model, such as the Robertson–Walker (RW) model, but also the additional terms due to the radial inhomogeneity of the LTB model. We will also apply the obtained results to the problem of secular increase in the astronomical unit, reported by Krasinsky and Brumberg (2004), and imply that the inhomogeneity of the Universe cannot have a significant effect for explaining the observed dAU/d = 15 ± 4 [m/century].

  20. Leisure time spending assessment forms of the physical education and sport teachers (Sakarya city example

    Directory of Open Access Journals (Sweden)

    Nuran Kandaz Gelen

    2007-05-01

    Full Text Available The purpose of this study was to exhibit forms of the spending the leisure time of the physical education and sport teachers in National Education Ministry schools in Sakarya. A questinnoaire was distrubuted to the physical education and sport teachers in elemantary school (50, in high school (50, frequency and percentage methods were used in evaluating the data. As a result, the physical education and sport teachers could not attend sufficient leisure time activities because of not to have enough time and money and they spent their leisure time at home with their spouses by reading, visiting and making sports. They claimed that they spend their time inefficiently, and if they have sufficient time they  defined that they will spend their time by reading, visiting and exercising.

  1. Leisure time spending assessment forms of the physical education and sport teachers (Sakarya city example

    Directory of Open Access Journals (Sweden)

    Nuran Kandaz Gelen

    2007-05-01

    Full Text Available The purpose of this study was to exhibit forms of the spending the leisure time of the physical education and sport teachers in National Education Ministry schools in Sakarya. A questinnoaire was distrubuted to the physical education and sport teachers in elemantary school (50, in high school (50, frequency and percentage methods were used in evaluating the data. As a result, the physical education and sport teachers could not attend sufficient leisure time activities because of not to have enough time and money and they spent their leisure time at home with their spouses by reading, visiting and making sports. They claimed that they spend their time inefficiently, and if they have sufficient time they defined that they will spend their time by reading, visiting and exercising.

  2. Comparative analysis of Medicare spending for medical imaging: sustained dramatic slowdown compared with other services.

    Science.gov (United States)

    Lee, David W; Duszak, Richard; Hughes, Danny R

    2013-12-01

    The purpose of this study was to assess trends in Medicare spending growth for medical imaging relative to other services and the Deficit Reduction Act (DRA). We calculated per-beneficiary Part B Medicare medical imaging expenditures for three-digit Berenson-Eggers Type of Service (BETOS) categories using Physician Supplier Procedure Summary Master Files for 32 million beneficiaries from 2000 to 2011. We adjusted BETOS categories to address changes in coding and payment policy and excluded categories with 2011 aggregate spending less than $500 million. We computed and ranked compound annual growth rates over three periods: pre-DRA (2000-2005), DRA transition period (2005-2007), and post-DRA (2007-2011). Forty-four modified BETOS categories fulfilled the inclusion criteria. Between 2000 and 2006, Medicare outlays for nonimaging services grew by 6.8% versus 12.0% for imaging services. In the ensuing 5 years, annual growth in spending for nonimaging continued at 3.6% versus a decline of 3.5% for imaging. Spending growth for all services during the pre-DRA, DRA, and post-DRA periods were 7.8%, 3.8%, and 2.9 compared with 15.0%, -3.4%, and -2.2% for advanced imaging services. Advanced imaging was among the fastest growing categories of Medicare services in the early 2000s but was in the bottom 2% of spending categories in 2011. Between 2007 and 2011, the fastest growing service categories were evaluation and management services with other specialists (29.1%), nursing home visits (11.2%), anesthesia (9.1%), and other ambulatory procedures (9.0%). Slowing volume growth and massive Medicare payment cuts have left medical imaging near the bottom of all service categories contributing to growth in Medicare spending.

  3. Replacing the Transfusion of 1–2 Units of Blood with Plasma Expanders that Increase Oxygen Delivery Capacity: Evidence from Experimental Studies

    Directory of Open Access Journals (Sweden)

    Amy G. Tsai

    2014-10-01

    Full Text Available At least a third of the blood supply in the world is used to transfuse 1–2 units of packed red blood cells for each intervention and most clinical trials of blood substitutes have been carried out at this level of oxygen carrying capacity (OCC restoration. However, the increase of oxygenation achieved is marginal or none at all for molecular hemoglobin (Hb products, due to their lingering vasoactivity. This has provided the impetus for the development of “oxygen therapeutics” using Hb-based molecules that have high oxygen affinity and target delivery of oxygen to anoxic areas. However it is still unclear how these oxygen carriers counteract or mitigate the functional effects of anemia due to obstruction, vasoconstriction and under-perfusion. Indeed, they are administered as a low dosage/low volume therapeutic Hb (subsequently further diluted in the circulatory pool and hence induce extremely small OCC changes. Hyperviscous plasma expanders provide an alternative to oxygen therapeutics by increasing the oxygen delivery capacity (ODC; in anemia they induce supra-perfusion and increase tissue perfusion (flow by as much as 50%. Polyethylene glycol conjugate albumin (PEG-Alb accomplishes this by enhancing the shear thinning behavior of diluted blood, which increases microvascular endothelial shear stress, causes vasodilation and lowering peripheral vascular resistance thus facilitating cardiac function. Induction of supra-perfusion takes advantage of the fact that ODC is the product of OCC and blood flow and hence can be maintained by increasing either or both. Animal studies suggest that this approach may save a considerable fraction of the blood supply. It has an additional benefit of enhancing tissue clearance of toxic metabolites.

  4. A 15-year overview of increasing tramadol utilisation and associated mortality and the impact of tramadol classification in the United Kingdom.

    Science.gov (United States)

    Chen, Teng-Chou; Chen, Li-Chia; Knaggs, Roger David

    2017-09-24

    This study aimed to develop hypotheses to explain the increasing tramadol utilisation, evaluate the impact of tramadol classification, and explore the trend between tramadol utilisation and related deaths in the United Kingdom. This cross-sectional study used individual patient data, the Clinical Practice Research Datalink from 1993 to 2015, to calculate monthly defined daily dose (DDD)/1000 registrants, monthly prevalence and incidence of tramadol users, annual supply days, and mean daily dose of tramadol. Aggregated-level national statistics and reimbursement data from 2004 to 2015 were also used to quantify annual and monthly tramadol DDD/1000 inhabitants and rate of tramadol-related deaths in England and Wales. Interrupted time-series analysis was used to evaluate the impact of tramadol classification in June 2014. Prevalence of tramadol users increased from 23 to 97.6/10 000 registrants from 2000 to 2015. Both annual dose and annual supply days of existing tramadol users were higher than new users. Level and trend of monthly utilisation (β2 : -12.9, β3 : -1.6) and prevalence of tramadol users (β2 : -6.4, β3 : -0.37) significantly reduced after classification. Both annual tramadol utilisation and rate of tramadol-related deaths increased before tramadol classification and decreased thereafter. Increasing tramadol utilisation was influenced by the increase in prevalence and incidence of tramadol users, mean daily dose, and day of supply. Prevalence of tramadol users, tramadol utilisation, and reported deaths declined after tramadol classification. Future studies need to evaluate the influencing factors to ensure the safety of long-term tramadol use. Copyright © 2017 John Wiley & Sons, Ltd.

  5. Fiscal competition in health spending among local governments in the Philippines.

    Science.gov (United States)

    Kelekar, Uma

    2013-01-01

    The Philippines is one of several Asian countries that has decentralized the provision of health care to its local governments in recent decades. In the context of decentralization, a few studies have previously examined the issue of fiscal competition among local governments in the developing world. This report presents a summary of a published study that examined the existence of inter-jurisdictional competition in health-care spending in the Philippines. The results indicate the presence of positive fiscal "spillovers" in health spending, consistent with municipalities/cities competing to outspend their neighbours. Several potential explanations forthis finding are discussed.

  6. Utilizing Online Connectivity to Combat Reduced Federal Spending

    Science.gov (United States)

    Mayall, T.

    2013-12-01

    With a diminishing grant pool and increasing competition for federal funding, utilizing free online resources to collaborate with other scientists, share information and insights, and promote your research is critical to success. As budgets tighten, efficient use of both time and money is becoming more and more important. Tools such as Mendeley, ResearchGate, and Science Exchange enable scientists to promote their own work while gaining valuable connections and collaborations. Additionally, scientists can build their online presence to increase visibility for potential funding. Through intelligent use of these online tools, scientists can increase their chances of funding and minimize wasted time and resources. For this session, I will examine how to adapt to the changing landscape of federal funding through the effective use of social media and online tools.

  7. Department of Defense Fuel Spending, Supply, Acquisition, and Policy

    Science.gov (United States)

    2009-03-20

    Figure 5). The range of crude oils assays are summarized in Table 5. In the past, when U.S. crude oil production was higher than today, refineries...declining worldwide crude oil production . In 2006, due to increasing fuel costs, the Bush Administration’s war on terrorism, and military operations in

  8. Proposition 76: State Spending and School Funding Limits. Voter Guide

    Science.gov (United States)

    EdSource, 2005

    2005-01-01

    On Nov. 8, 2005, California voters will decide whether to pass Proposition 76, known as the "Live Within Our Means Act." Sponsored by Gov. Arnold Schwarzenegger, the measure seeks to address state budget problems that have been particularly severe in California since 2002 due to cuts in state taxes and increases in state expenditures.…

  9. Influence of cavity preparation, light-curing units, and composite filling on intrapulpal temperature increase in an in vitro tooth model.

    Science.gov (United States)

    Choi, S H; Roulet, J F; Heintze, S D; Park, S H

    2014-01-01

    This study examined the effect of both the tooth substance and restorative filling materials on the increase in pulp chamber temperature when using light-curing units with different power densities. The tip of a temperature sensor was positioned on the pulpal dentinal wall of the buccal side of a maxillary premolar. Metal tubes were inserted in the palatal and buccal root of the tooth, one for water inflow and the other for water outflow. Polyethylene tubes were connected from the metal tubes to a pump to control the flow rate. For the unprepared tooth group (group 1), the tooth was light-cured from the buccal side using two light-curing units (three curing modes): the VIP Junior (QTH, BISCO, Schaumburg, IL, USA) and the Bluephase LED light-curing units (two modes: LEDlow and LEDhigh; Ivoclar Vivadent, Schaan, Liechtenstein). The power densities of each light-curing unit for the LEDlow, QTH, and LEDhigh modes were 785 mW/cm(2), 891 mW/cm(2), and 1447 mW/cm(2), respectively. All light-curing units were activated for 60 seconds. For the prepared tooth group (group 2), a Class V cavity, 4.0 mm in width by 4.0 mm in height by 1.8 mm in depth in size, was prepared on the buccal surface of the same tooth for the temperature measurement. The light-curing and temperature measurements were performed using the same methods used in group 1. The cavity prepared in group 2 was filled with a resin composite (Tetric N Ceram A3 shade, Ivoclar Vivadent) (group 3) or a flowable composite (Tetric N Flow with A3 shade, Ivoclar Vivadent) (group 4). The light-curing and temperature measurements were performed for these groups using the same methods used for the other groups. The highest intrapulpal temperature (TMAX) was measured, and a comparison was conducted between the groups using two-way analysis of variance with a post hoc Tukey test at the 95% confidence level. The TMAX values were as follows: 38.4°C (group 1), 39.0°C (group 2), 39.8°C (group 3), and 40.3°C (group 4) for the

  10. Increasing Area Deprivation and Socioeconomic Inequalities in Heart Disease, Stroke, and Cardiovascular Disease Mortality Among Working Age Populations, United States, 1969-2011

    Directory of Open Access Journals (Sweden)

    Gopal K. Singh, PhD

    2015-04-01

    Full Text Available Objectives: We examined the extent to which area- and individual-level socioeconomic inequalities in cardiovascular-disease (CVD, heart disease, and stroke mortality among United States men and women aged 25-64 years changed between 1969 and 2011. Methods: National vital statistics data and the National Longitudinal Mortality Study were used to estimate area- and individual-level socioeconomic gradients in mortality over time. Rate ratios and log-linear and Cox regression were used to model mortality trends and differentials. Results: Area socioeconomic gradients in mortality from CVD, heart disease, and stroke increased substantially during the study period. Compared to those in the most affluent group, individuals in the most deprived area group had, respectively 35%, 29%, and 73% higher CVD, heart disease, and stroke mortality in 1969, but 120-121% higher mortality in 2007-2011. Gradients were steeper for women than for men. Education, income, and occupation were inversely associated with CVD, heart disease, and stroke mortality, with individual-level socioeconomic gradients being steeper during 1990-2002 than in 1979-1989. Individuals with low education and incomes had 2.7 to 3.7 times higher CVD, heart disease, and stroke mortality risks than their counterparts with high education and income levels. Conclusions and Global Health Implications: Although mortality declined for all US groups during 1969-2011, socioeconomic disparities in mortality from CVD, heart disease and stroke remained marked and increased over time because of faster declines in mortality among higher socioeconomic groups. Widening disparities in mortality may reflect increasing temporal areal inequalities in living conditions, behavioral risk factors such as smoking, obesity and physical inactivity, and access to and use of health services. With social inequalities and prevalence of smoking, obesity, and physical inactivity on the rise, most segments of the working

  11. Alternative Fuel Vehicle Adoption Increases Fleet Gasoline Consumption and Greenhouse Gas Emissions under United States Corporate Average Fuel Economy Policy and Greenhouse Gas Emissions Standards.

    Science.gov (United States)

    Jenn, Alan; Azevedo, Inês M L; Michalek, Jeremy J

    2016-03-01

    The United States Corporate Average Fuel Economy (CAFE) standards and Greenhouse Gas (GHG) Emission standards are designed to reduce petroleum consumption and GHG emissions from light-duty passenger vehicles. They do so by requiring automakers to meet aggregate criteria for fleet fuel efficiency and carbon dioxide (CO2) emission rates. Several incentives for manufacturers to sell alternative fuel vehicles (AFVs) have been introduced in recent updates of CAFE/GHG policy for vehicles sold from 2012 through 2025 to help encourage a fleet technology transition. These incentives allow automakers that sell AFVs to meet less-stringent fleet efficiency targets, resulting in increased fleet-wide gasoline consumption and emissions. We derive a closed-form expression to quantify these effects. We find that each time an AFV is sold in place of a conventional vehicle, fleet emissions increase by 0 to 60 t of CO2 and gasoline consumption increases by 0 to 7000 gallons (26,000 L), depending on the AFV and year of sale. Using projections for vehicles sold from 2012 to 2025 from the Energy Information Administration, we estimate that the CAFE/GHG AFV incentives lead to a cumulative increase of 30 to 70 million metric tons of CO2 and 3 to 8 billion gallons (11 to 30 billion liters) of gasoline consumed over the vehicles' lifetimes - the largest share of which is due to legacy GHG flex-fuel vehicle credits that expire in 2016. These effects may be 30-40% larger in practice than we estimate here due to optimistic laboratory vehicle efficiency tests used in policy compliance calculations.

  12. Factors Associated With the Increasing Rates of Discharges Directly Home From Intensive Care Units-A Direct From ICU Sent Home Study.

    Science.gov (United States)

    Lau, Vincent I; Priestap, Fran A; Lam, Joyce N H; Ball, Ian M

    2016-09-20

    To evaluate the relationship between rates of discharge directly to home (DDH) from the intensive care unit (ICU) and bed availability (ward and ICU). Also to identify patient characteristics that make them candidates for safe DDH and describe transfer delay impact on length of stay (LOS). Retrospective cohort study of all adult patients who survived their stay in our medical-surgical-trauma ICU between April 2003 and March 2015. Median age was 49 years (interquartile range [IQR]: 33.5-60.4), and the majority of the patients were males (54.8%). Median number of preexisting comorbidities was 5 (IQR: 2-7) diagnoses. Discharge directly to home increased from 28 (3.1% of all survivors) patients in 2003 to 120 (12.5%) patients in 2014. The mean annual rate of DDH was between 11% and 12% over the last 6 years. Approximately 62% (n = 397) of patients waited longer than 4 hours for a ward bed, with a median delay of 2.0 days (IQR: 0.5-4.7) before being DDH. There was an inverse correlation between ICU occupancy and DDH rates (r P = -.55, P occupancy and DDH rates (r s = -.055, P = .64, 95% CI = -0.25 to 0.21). The DDH rates have been increasing over time at our institution and were inversely correlated with ICU bed occupancy but were not associated with ward occupancy. The DDH patients are young, have few comorbidities on admission, and few discharge diagnoses, which are usually reversible single system problems with low disease burden. Transfers to the ward are delayed in a majority of cases, leading to increased ICU LOS and likely increased overall hospital LOS as well. © The Author(s) 2016.

  13. Biomedical innovation in the era of health care spending constraints.

    Science.gov (United States)

    Robinson, James C

    2015-02-01

    Insurers, hospitals, physicians, and consumers are increasingly weighing price against performance in their decisions to purchase and use new drugs, devices, and other medical technologies. This approach will tend to affect biomedical innovation adversely by reducing the revenues available for research and development. However, a more constrained funding environment may also have positive impacts. The passing era of largely cost-unconscious demand fostered the development of incremental innovations priced at premium levels. The new constrained-funding era will require medical technology firms to design their products with the features most valued by payers and patients, price them at levels justified by clinical performance, and manage distribution through organizations rather than to individual physicians. The emerging era has the potential to increase the social value of innovation by focusing industry on design, pricing, and distribution principles that are more closely aligned with the preferences-and pocketbooks-of its customers. Project HOPE—The People-to-People Health Foundation, Inc.

  14. Military spending and economic growth: the case of Iran

    OpenAIRE

    Farzanegan, Mohammad Reza

    2011-01-01

    Iranian government budget on military over the last decade has been higher than the average of the world. The current increasing international sanctions aim to reduce the military capabilities and capacities of the Iranian government. In this study, we analyze the response of the Iranian economy to shocks in its military budget from 1959-2007, using Impulse Response Functions (IRF) and Variance Decomposition Analysis (VDA) techniques. The Granger causality results show that there is unidirect...

  15. Money Buys Happiness When Spending Fits Our Personality

    OpenAIRE

    Matz, Sandra; Gladstone, Joe; Stillwell, David

    2016-01-01

    This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by SAGE. In contrast to decades of research reporting surprisingly weak relationships between con-sumption and happiness, recent studies suggest that money can indeed increase happiness if it is spent the “right way” (e.g. on experiences or on others). Drawing on the concept of psy-chological fit, we extend this research by arguing that individual differences play a central role in deter...

  16. Does Proximity to Wetland Shrubland Increase the Habitat Value for Shrubland Birds of Small Patches of Upland Shrubland in the Northeastern United States?

    Directory of Open Access Journals (Sweden)

    Bill Buffum

    2014-01-01

    Full Text Available The loss of shrubland habitat is linked to population declines for many wildlife species, including several bird species of conservation concern. Conservation agencies in the northeastern United States encourage private landowners to clearcut patches of forest to create shrubland habitat. Many private landowners are only willing to create small clearcuts; therefore, it is important to understand how to maximize the impact of small clearcuts on bird habitat use. In this study we examined whether proximity to wetland shrubland increases the habitat value of small patches of upland shrubland. We conducted point counts at 22 sites containing small patches of upland shrubland ranging in size from 0.1 to 7 ha. Shrubland bird species richness was significantly positively correlated with the proportion of wetland shrubland habitat within 100 m of a site, and with the extent of all shrubland habitat within 100 m, but not with the proportion of upland shrubland. Occupancy modeling indicated that the size of adjacent wetland shrub patches increased occupancy at the sites for five of eight species observed with sufficient rates of detection. Our results suggest that creating clearcuts adjacent to existing areas of wetland shrubland may enhance the habitat value of the patches for shrubland birds.

  17. [Real per capita health spending by age and sex in Spain (1998-2008): changes and effects on public healthcare expenditure projections].

    Science.gov (United States)

    Blanco Moreno, Ángela; Urbanos Garrido, Rosa; Thuissard Vasallo, Israel John

    2013-01-01

    To analyze changes in real per capita spending by age and sex from 1998 to 2008 in Spain, and to assess their effects on public healthcare expenditure projections. Age- and sex-related expenditure profiles in constant terms were estimated for the Spanish population for 3 distinct years (1998, 2003 and 2008) by using data from hospital records and several National Health Surveys. These profiles were used to compare actual healthcare expenditure for 2003 and 2008 with the projections obtained by considering 1998 as the base year and by applying the methodology used by the Working Group on Aging of the European Union. The average annual growth rate of real per capita spending per person from 1998 to 2008 was 2.79%, which was higher than the GDP per capita growth rate (1.90%), basically due to its high rate of increase in the second half of the decade. From 1998 to 2008, per capita healthcare expenditure increased in most age groups, particularly in the groups aged 45-49 years, 60-64 years and 75 years and older. Projections of per capita expenditure in constant terms covered the real value observed for 2003, but were below the real value for 2008. Changes in the quantity and quality of healthcare services consumed by each person are an important factor in changes in healthcare expenditure and must be included in spending projections. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

  18. The United States does a poor job of evaluating Medicare hospitals: perhaps Australia can help.

    Science.gov (United States)

    Bogart, G

    1992-01-01

    The United States spends more money per person on healthcare than does any other country in the world, and this rate of spending is increasing. Healthcare expenses currently absorb more than 12 percent of the American gross national product, and recent projections indicate that such expenses will exceed 16 percent by the year 2000. By the year 2005, the U.S. Medicare program is expected to absorb more of the national budget than either Social Security or defense. One justification for the high rate of spending has been that, for those who receive it, U.S. healthcare is the best in the world. There is, however, no way to validate this view because no national or international agreed-upon set of criteria for measuring quality of care exists. Proponents of the American system seem to assume that if it costs more, it must be better. If this is true, it is certainly not reflected in American consumer satisfaction: a recent poll of citizens of ten developed countries indicated that Americans were by far the least satisfied with their healthcare system. This article focuses on the American oversight of Medicare hospitals to determine it, in this narrow area, dissatisfied American consumers are justified.

  19. Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: A before-and-after study

    Science.gov (United States)

    Ryan-Ibarra, Suzanne; Taillie, Lindsey Smith; Induni, Marta

    2017-01-01

    Background Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being adopted, yet evaluation is scarce. This study examines the association of the first penny per ounce SSB excise tax in the United States, in Berkeley, California, with beverage prices, sales, store revenue/consumer spending, and usual beverage intake. Methods and findings Methods included comparison of pre-taxation (before 1 January 2015) and first-year post-taxation (1 March 2015–29 February 2016) measures of (1) beverage prices at 26 Berkeley stores; (2) point-of-sale scanner data on 15.5 million checkouts for beverage prices, sales, and store revenue for two supermarket chains covering three Berkeley and six control non-Berkeley large supermarkets in adjacent cities; and (3) a representative telephone survey (17.4% cooperation rate) of 957 adult Berkeley residents. Key hypotheses were that (1) the tax would be passed through to the prices of taxed beverages among the chain stores in which Berkeley implemented the tax in 2015; (2) sales of taxed beverages would decline, and sales of untaxed beverages would rise, in Berkeley stores more than in comparison non-Berkeley stores; (3) consumer spending per transaction (checkout episode) would not increase in Berkeley stores; and (4) self-reported consumption of taxed beverages would decline. Main outcomes and measures included changes in inflation-adjusted prices (cents/ounce), beverage sales (ounces), consumers’ spending measured as store revenue (inflation-adjusted dollars per transaction) in two large chains, and usual beverage intake (grams/day and kilocalories/day). Tax pass-through (changes in the price after imposition of the tax) for SSBs varied in degree and timing by store type and beverage type. Pass-through was complete in large chain supermarkets (+1.07¢/oz, p = 0.001) and small chain supermarkets and chain gas stations (1.31¢/oz, p = 0.004), partial in pharmacies (+0.45¢/oz, p = 0.03), and

  20. How to use our talents based on Information Theory - or spending time wisely

    CERN Document Server

    Chiani, Marco

    2010-01-01

    We discuss the allocation of finite resources in the presence of a logarithmic diminishing return law, in analogy to some results from Information Theory. To exemplify the problem we assume that the proposed logarithmic law is applied to the problem of how to spend our time.

  1. The Growth Effects of R&D Spending in the EU

    DEFF Research Database (Denmark)

    Kokko, Ari; Tingvall, Patrik Gustavsson; Videnord, Josefin

    2015-01-01

    In this paper we conduct a meta-analysis to examine the link between R&D spending and economic growth in the EU and other regions. The results suggest that the growth-enhancing effect of R&D in the EU15 countries does not differ from that in other countries in general, but it is less significant ...

  2. Priority setting of public spending in developing countries: do not try to do everything for everybody.

    NARCIS (Netherlands)

    Baltussen, R.M.P.M.

    2006-01-01

    BACKGROUND: Public spending on health care in many developing countries falls short to provide a comprehensive set of essential health services, which indicates the need to target and prioritize resources. However, governments often attempt to provide free services to the whole population, and often

  3. 13 CFR 123.303 - How can my business spend my economic injury disaster loan?

    Science.gov (United States)

    2010-01-01

    ... economic injury disaster loan? 123.303 Section 123.303 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION DISASTER LOAN PROGRAM Economic Injury Disaster Loans § 123.303 How can my business spend my economic injury disaster loan? (a) You can only use the loan proceeds for working capital necessary...

  4. Not Out of Control: Analysis of the Federal Disaster Spending Trend

    Science.gov (United States)

    2016-03-01

    businesses to out-of- jurisdiction real estate owners and lenders. In the case of FEMA’s PA program, adjustments for TTR in setting the threshold for a... financial , fund, incentive, insurance, major disaster declaration, mitigation, per capita damage indicator, risk management, spending, supplemental, total...RESOURCES .......................................................................89 D. SHIFTING PROPERTY INSURANCE MORAL HAZARD TO THE PRIVATE SECTOR

  5. Prosocial spending and well-being: cross-cultural evidence for a psychological universal.

    Science.gov (United States)

    Aknin, Lara B; Barrington-Leigh, Christopher P; Dunn, Elizabeth W; Helliwell, John F; Burns, Justine; Biswas-Diener, Robert; Kemeza, Imelda; Nyende, Paul; Ashton-James, Claire E; Norton, Michael I

    2013-04-01

    This research provides the first support for a possible psychological universal: Human beings around the world derive emotional benefits from using their financial resources to help others (prosocial spending). In Study 1, survey data from 136 countries were examined and showed that prosocial spending is associated with greater happiness around the world, in poor and rich countries alike. To test for causality, in Studies 2a and 2b, we used experimental methodology, demonstrating that recalling a past instance of prosocial spending has a causal impact on happiness across countries that differ greatly in terms of wealth (Canada, Uganda, and India). Finally, in Study 3, participants in Canada and South Africa randomly assigned to buy items for charity reported higher levels of positive affect than participants assigned to buy the same items for themselves, even when this prosocial spending did not provide an opportunity to build or strengthen social ties. Our findings suggest that the reward experienced from helping others may be deeply ingrained in human nature, emerging in diverse cultural and economic contexts.

  6. Farmers as Consumers of Agricultural Education Services: Willingness to Pay and Spend Time

    Science.gov (United States)

    Charatsari, Chrysanthi; Papadaki-Klavdianou, Afroditi; Michailidis, Anastasios

    2011-01-01

    This study assessed farmers' willingness to pay for and spend time attending an Agricultural Educational Program (AEP). Primary data on the demographic and socio-economic variables of farmers were collected from 355 farmers selected randomly from Northern Greece. Descriptive statistics and multivariate analysis methods were used in order to meet…

  7. Disneyland Dads, Disneyland Moms? How Nonresident Parents Spend Time with Absent Children.

    Science.gov (United States)

    Stewart, Susan D.

    1999-01-01

    Examines gender differences in how nonresident parents spend time with their absent children. Results suggest that nonresident mothers and fathers exhibit a similar pattern of participation in activities with their absent children. Most nonresident parents either engage in only leisure activities with their children or have no contact. (Author/MKA)

  8. The "Negative" Credit Card Effect: Credit Cards as Spending-Limiting Stimuli in New Zealand

    Science.gov (United States)

    Lie, Celia; Hunt, Maree; Peters, Heather L.; Veliu, Bahrie; Harper, David

    2010-01-01

    The "credit card effect" describes a finding where greater value is given to consumer items if credit card logos are present. One explanation for the effect is that credit cards elicit spending behavior through associative learning. If this is true, social, economic and historical contexts should alter this effect. In Experiment 1, Year…

  9. Structural adjustment and public spending on health: evidence from IMF programs in low-income countries.

    Science.gov (United States)

    Kentikelenis, Alexander E; Stubbs, Thomas H; King, Lawrence P

    2015-02-01

    The relationship between health policy in low-income countries (LICs) and structural adjustment programs devised by the International Monetary Fund (IMF) has been the subject of intense controversy over past decades. While the influence of the IMF on health policy can operate through various pathways, one main link is via public spending on health. The IMF has claimed that its programs enhance government spending for health, and that a number of innovations have been introduced to enable borrowing countries to protect health spending from broader austerity measures. Critics have pointed to adverse effects of Fund programs on health spending or to systematic underfunding that does not allow LICs to address health needs. We examine the effects of Fund programs on government expenditures on health in low-income countries using data for the period 1985-2009. We find that Fund programs are associated with higher health expenditures only in Sub-Saharan African LICs, which historically spent less than any other region. This relationship turns negative in LICs in other regions. We outline the implications of these findings for health policy in a development context. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. National forest visitor spending averages and the influence of trip-type and recreation activity.

    Science.gov (United States)

    Eric M. White; Daniel I. Stynes

    2008-01-01

    Estimates of national forest recreation visitor spending serve us inputs to regional economic analyses and help to identify the economic linkages between national forest recreation use and local forest communities. When completing recreation-related analyses, managers, planners, and researchers frequently think of visitors in terms of recreation activity. When...

  11. Unveiling the relationship between the transaction timing, spending and dropout behavior of customers

    NARCIS (Netherlands)

    Glady, N.; Lemmens, A.; Croux, C.

    2015-01-01

    The customer lifetime value combines into one construct the transaction timing, spending and dropout processes that characterize the purchase behavior of customers. Recently, the potential relationship between these processes, either at the individual customer level (i.e. intra-customer correlation)

  12. Spending on Health Care in the Netherlands: Not Going so Dutch

    NARCIS (Netherlands)

    P.L.H. Bakx (Pieter); O.A. O'Donnell (Owen); E.K.A. van Doorslaer (Eddy)

    2016-01-01

    textabstractThe Netherlands is among the top spenders on health in the OECD. We document the life-cycle profile, concentration and persistence of this expenditure using claims data covering both curative and long-term care expenses for the full Dutch population. Spending on health care is strongly c

  13. Spending on Health Care in the Netherlands: Not Going So Dutch

    NARCIS (Netherlands)

    P. Bakx (Pieter); O.A. O'Donnell (Owen); E.K.A. van Doorslaer (Eddy)

    2016-01-01

    textabstractThe Netherlands is among the top spenders on health in the OECD. We document the life-cycle profile, concentration and persistence of this expenditure using claims data covering both curative and long-term care expenses for the full Dutch population. Spending on health care is strongly c

  14. Prosocial Spending and Well-Being : Cross-Cultural Evidence for a Psychological Universal

    NARCIS (Netherlands)

    Aknin, Lara B.; Barrington-Leigh, Christopher P.; Dunn, Elizabeth W.; Helliwell, John F.; Burns, Justine; Biswas-Diener, Robert; Kemeza, Imelda; Nyende, Paul; Ashton-James, Claire E.; Norton, Michael I.

    This research provides the first support for a possible psychological universal: Human beings around the world derive emotional benefits from using their financial resources to help others (prosocial spending). In Study 1, survey data from 136 countries were examined and showed that prosocial

  15. Trying Harder and Doing Worse: How Grocery Shoppers Track In-Store Spending

    NARCIS (Netherlands)

    Ittersum, van K.; Pennings, J.M.E.; Wansink, B.

    2010-01-01

    Although almost one in three U.S. households shops on a budget, it remains unclear whether and how shoppers track their in-store spending to stay within those budgets. A field study and two laboratory studies offer four key generalizations about budget shoppers in grocery stores: (1) They predominan

  16. Trying Harder and Doing Worse : How Grocery Shoppers Track In-Store Spending

    NARCIS (Netherlands)

    van Ittersum, Koert; Pennings, Joost M. E.; Wansink, Brian

    2010-01-01

    Although almost one in three U.S. households shops on a budget, it remains unclear whether and how shoppers track their in-store spending to stay within those budgets. A field study and two laboratory studies offer four key generalizations about budget shoppers in grocery stores: (1) They predominan

  17. Tax Expert Offers Ideas for Monitoring Big Spending on College Sports

    Science.gov (United States)

    Sander, Libby

    2009-01-01

    The federal government could take a cue from its regulation of charitable organizations in monitoring the freewheeling fiscal habits of big-time college athletics, a leading tax lawyer says. The author reports on the ideas offered by John D. Colombo, a professor at the University of Illinois College of Law, for monitoring big spending on college…

  18. Effects of a consumer driven health plan on pharmaceutical spending and utilization.

    Science.gov (United States)

    Parente, Stephen T; Feldman, Roger; Chen, Song

    2008-10-01

    To compare pharmaceutical spending and utilization in a consumer driven health plan (CDHP) with a three-tier pharmacy benefit design, and to examine whether the CDHP creates incentives to reduce pharmaceutical spending and utilization for chronically ill patients, generic or brand name drugs, and mail-order drugs. Retrospective insurance claims analysis from a large employer that introduced a CDHP in 2001 in addition to a point of service (POS) plan and a preferred provider organization (PPO), both of which used a three-tier pharmacy benefit. Difference-in-differences regression models were estimated for drug spending and utilization. Control variables included the employee's income, age, and gender, number of covered lives per contract, election of flexible spending account, health status, concurrent health shock, cohort, and time trend. Results. CDHP pharmaceutical expenditures were lower than those in the POS cohort in 1 year without differences in the use of brand name drugs. We find limited evidence of less drug consumption by CDHP enrollees with chronic illnesses, and some evidence of less generic drug use and more mail-order drug use among CDHP members. The CDHP is cost-neutral or cost-saving to both the employer and the employee compared with three-tier benefits with no differences in brand name drug use. © Health Research and Educational Trust.

  19. Impact on the Federal Budget of Freezing Non-Security Discretionary Spending

    Science.gov (United States)

    2011-03-22

    Discretionary Spending Mindy R. Levit Analyst in Public Finance March 22, 2011 Congressional Research Service 7-5700 www.crs.gov R41174 Report...future years as well. Author Contact Information Mindy R. Levit Analyst in Public Finance mlevit@crs.loc.gov, 7-7792

  20. How Newspaper Advertising Sales Managers Spend Their Time: A Pilot Study.

    Science.gov (United States)

    Hudson, Jerry C.; Saathoff, Roger C.

    A pilot study examined how newspaper advertising sales managers in five southwestern states spend their time during a typical work day. Of the 360 questionnaires mailed, 176 responses were received. The largest number of responses (93) came from retail sales managers of newspapers in markets with less than 50,000 population. The questionnaire…

  1. Unveiling the relationship between the transaction timing, spending and dropout behavior of customers

    NARCIS (Netherlands)

    Glady, N.; Lemmens, A.; Croux, C.

    The customer lifetime value combines into one construct the transaction timing, spending and dropout processes that characterize the purchase behavior of customers. Recently, the potential relationship between these processes, either at the individual customer level (i.e. intra-customer correlation)

  2. CRIMINAL AND LEGAL CHARACTERISTIC OF NON-TARGETED SPENDING OF BUDGETARY FUNDS

    Directory of Open Access Journals (Sweden)

    Shishchenko E. A.

    2016-01-01

    Full Text Available The article analyses the criminal and budgetary legislation in the field of non-targeted spending of budgetary funds. Research of the official statistics provided by the General Prosecutor’s Office of the Russian Federation from 2003 to 2014 showed a decrease in the facts of nontargeted spending of budgetary funds, that, according to the authors, is a sign of high level of latency, because law enforcement and financial control authorities are facing difficulties at a stage of identification of this crime and proof of data obtained during the investigative measures. The authors of the article paid special attention to the analysis of the elements of the non-targeted spending of budgetary funds. The different points of view of the object of this crime are considered. At disclosure of objective features, the authors point to the terminological differences between the Criminal code of the Russian Federation and the Budgetary code of the Russian Federation that, undoubtedly, in practice disturb the correct qualification of the actions. By consideration the subject of non-targeted spending of budgetary funds, materials of criminal cases have been studied which allowed to reveal obvious gaps of the criminal law in this sphere. The authors formulated the proposals for improving the legislation by inclusion of the qualifying features and addition the third part of article that, certainly, has to be reflected in differentiation of criminal responsibility

  3. 45 CFR 400.103 - Coverage of refugees who spend down to State financial eligibility standards.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Coverage of refugees who spend down to State... Welfare OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Refugee Medical Assistance Conditions of Eligibility...

  4. Does Spending More on Education Improve Academic Achievement? Backgrounder. No. 2179

    Science.gov (United States)

    Lips, Dan; Watkins, Shanea J.; Fleming, John

    2008-01-01

    Debates about how to improve public education in America often focus on whether government should spend more on education. Federal and state policymakers proposing new education programs often base their arguments on the need to provide more resources to schools to improve opportunities for students. Many Americans seem to share this view. While…

  5. The Spending Review: What It Really Means for FE and Skills

    Science.gov (United States)

    Buttle, David

    2010-01-01

    The FE (further education) and and Skills sector will be transformed by the announcements of the Spending Review. The impact will be far more wide-reaching than a simple reduction in the amount of central funding the sector will receive from government. The decisions taken will directly affect issues as diverse as uptake, retention, curricula,…

  6. Spending on vegetable and fruit consumption could reduce all-cause mortality among older adults

    Directory of Open Access Journals (Sweden)

    Lo Yuan-Ting

    2012-12-01

    Full Text Available Abstract Background Few studies have evaluated the linkage between food cost and mortality among older adults. This study considers the hypothesis that greater food expenditure in general, and particularly on more nutritious plant and animal-derived foods, decreases mortality in older adults. Methods This study uses the 1999–2000 Elderly Nutrition and Health Survey in Taiwan and follows the cohort until 2008, collecting 24-hr dietary recall data for 1781 participants (874 men and 907 women aged 65 y or older. Using monthly mean national food prices and 24-hr recall, this study presents an estimate of daily expenditures for vegetable, fruit, animal-derived, and grain food categories. Participants were linked to the national death registry. Results Of the 1781 original participants, 625 died during the 10-y follow-up period. Among the 4 food categories, the fourth and fifth expenditure quintiles for vegetables and for fruits had the highest survival rates. After adjusting for co-variates, higher (Q4 vegetable and higher fruit (Q4 food expenditures referent to Q1 were significantly predictive of reduced mortality (HR = 0.55, 95% CI: 0.39-0.78 and HR = 0.64, 95% CI: 0.42–0.99, respectively and the risk decreased by 12% and 10% for every NT$15 (US$0.50 increase in their daily expenditures. Animal-derived and grain food spending was not predictive of mortality. Conclusion Greater and more achievable vegetable and fruit affordability may improve food security and longevity for older adults.

  7. Web-Based STAR E-Learning Course Increases Empathy and Understanding in Dementia Caregivers: Results from a Randomized Controlled Trial in the Netherlands and the United Kingdom

    Science.gov (United States)

    Meiland, Franka; van der Roest, Henriëtte; Kevern, Peter; Abiuso, Francesca; Bengtsson, Johan; Giuliano, Angele; Duca, Annalise; Sanders, Jennifer; Basnett, Fern; Nugent, Chris; Kingston, Paul; Dröes, Rose-Marie

    2015-01-01

    Background The doubling of the number of people with dementia in the coming decades coupled with the rapid decline in the working population in our graying society is expected to result in a large decrease in the number of professionals available to provide care to people with dementia. As a result, care will be supplied increasingly by untrained informal caregivers and volunteers. To promote effective care and avoid overburdening of untrained and trained caregivers, they must become properly skilled. To this end, the European Skills Training and Reskilling (STAR) project, which comprised experts from the domains of education, technology, and dementia care from 6 countries (the Netherlands, Sweden, Italy, Malta, Romania, and the United Kingdom), worked together to create and evaluate a multilingual e-learning tool. The STAR training portal provides dementia care training both for informal and formal caregivers. Objective The objective of the current study was to evaluate the user friendliness, usefulness, and impact of STAR with informal caregivers, volunteers, and professional caregivers. Methods For 2 to 4 months, the experimental group had access to the STAR training portal, a Web-based portal consisting of 8 modules, 2 of which had a basic level and 6 additional modules at intermediate and advanced levels. The experimental group also had access to online peer and expert communities for support and information exchange. The control group received free access to STAR after the research had ended. The STAR training portal was evaluated in a randomized controlled trial among informal caregivers and volunteers in addition to professional caregivers (N=142) in the Netherlands and the United Kingdom. Assessments were performed with self-assessed, online, standardized questionnaires at baseline and after 2 to 4 months. Primary outcome measures were user friendliness, usefulness, and impact of STAR on knowledge, attitudes, and approaches of caregivers regarding dementia

  8. Master Settlement Agreement (MSA) spending and tobacco control efforts.

    Science.gov (United States)

    Jayawardhana, Jayani; Bradford, W David; Jones, Walter; Nietert, Paul J; Silvestri, Gerard

    2014-01-01

    We investigate whether the distributions to the states from the Tobacco Master Settlement Agreement (MSA) in 1998 is associated with stronger tobacco control efforts. We use state level data from 50 states and the District of Columbia from four time periods post MSA (1999, 2002, 2004, and 2006) for the analysis. Using fixed effect regression models, we estimate the relationship between MSA disbursements and a new aggregate measure of strength of state tobacco control known as the Strength of Tobacco Control (SoTC) Index. Results show an increase of $1 in the annual per capita MSA disbursement to a state is associated with a decrease of -0.316 in the SoTC mean value, indicating higher MSA payments were associated with weaker tobacco control measures within states. In order to achieve the initial objectives of the MSA payments, policy makers should focus on utilizing MSA payments strictly on tobacco control activities across states.

  9. 'Government Patent Use': A Legal Approach To Reducing Drug Spending.

    Science.gov (United States)

    Kapczynski, Amy; Kesselheim, Aaron S

    2016-05-01

    The high cost of patent-protected brand-name drugs can strain budgets and curb the widespread use of new medicines. An example is the case of direct-acting antiviral drugs for the treatment of hepatitis C. While prices for these drugs have come down in recent months, they still create barriers to treatment. Additionally, prescribing restrictions imposed by insurers put patients at increased risk of medical complications and contribute to transmission of the hepatitis C virus. We propose that the federal government invoke its power under an existing "government patent use" law to reduce excessive prices for important patent-protected medicines. Using this law would permit the government to procure generic versions of patented drugs and in exchange pay the patent-holding companies reasonable royalties to compensate them for research and development. This would allow patients in federal programs, and perhaps beyond, to be treated with inexpensive generic medicines according to clinical need-meaning that many more patients could be reached for no more, and perhaps far less, money than is currently spent. Another benefit would be a reduction in the opportunity for companies to extract monopoly profits that far exceed their risk-adjusted costs of research and development.

  10. Can Voter Identification Laws Increase Electoral Participation in the United States? Probably Not—A Simple Model of the Voting Market

    Directory of Open Access Journals (Sweden)

    Russell Weaver

    2015-04-01

    Full Text Available Proponents of voter photographic identification (ID laws in the United States have argued that such measures can increase overall voter turnout. The implications of this proposition contradict classic models of voting behavior, which state that voting costs and electoral participation are inversely related. The present article/research note explores this tension in the context of some fundamental economic concepts. Namely, after identifying characteristics of a voting “market” that might facilitate the outcome in question, a simple model of that market is developed and used to simulate changes in turnout due to changes in voter ID rules for a hypothetical polity. Counter to proponents’ claims, the findings suggest that voter ID laws tend to decrease turnout, even when most voters place positive value on stricter (i.e., fraud preventing voting regulations. That being said, the model is intentionally simplistic, and it is put forward primarily as a tool for thinking critically about the relationship between voter ID laws and electoral participation. Because data that are suited to empirical analyses of this relationship are lacking, complementary techniques, such as modeling and simulation, are useful for testing unverified hypotheses about voter ID rules from the political discourse. The simple exercises in this research note begin to fill this gap, though they function most readily as points of departure for future research.

  11. Cell-free DNA increase over first 48 hours in emergency intensive care unit predicts fatal outcome in patients with shock.

    Science.gov (United States)

    Xia, Dun Ling; Zhang, Hong; Luo, Qing Li; Zhang, A Fang; Zhu, Li Xin

    2016-10-01

    Objective To investigate whether circulating cell-free (cf)-DNA levels are a useful biomarker for survival in patients with shock in the emergency intensive care unit (EICU). Methods This prospective observational study enrolled patients admitted to the EICU diagnosed with shock. Blood cf-DNA levels were analysed on admission, and after 24 and 48 h. As a measure of circulating cf-DNA, copy number of the β-globin gene in plasma was assessed using quantitative real-time polymerase chain reaction. Results Circulating cf-DNA levels were higher at hospital admission and after 24 h in EICU patients with shock who died than in those who recovered. Change in cf-DNA levels over the first 48 h in critical care was independently associated with 28-day mortality. The critical cut-off value for cf-DNA change over 48 h in predicting 28-day mortality was +16.12% (sensitivity 68.9%, specificity 89.7%). Conclusions Increased circulating cf-DNA levels in EICU patients with shock are associated with risk of death and measuring cf-DNA change over 48 h improves risk prediction. The present study suggests that cf-DNA may serve as a viable plasma biomarker of mortality risk in EICU patients with shock.

  12. In-house or outsourced public services? A social and economic analysis of the impact of spending policy on the private wage share in OECD countries

    Science.gov (United States)

    Pensiero, Nicola

    2017-01-01

    This article analyses the relationship between government spending and the distribution of private income between capital and labour. While most previous research assumes that government spending redistributes in favour of the less wealthy, I distinguish between types of expenditures that enhance the bargaining position of labour – that is, unemployment benefits, public sector employment and investment in new capital – and labour-saving and pro-business types of expenditures – that is, outsourcing to private firms. The results are derived from various panel regression techniques on a panel of 19 Organisation for Economic Co-operation and Development (OECD) countries in the period 1985–2010 and show that expenditures on public sector employment and, to a lesser extent, on new capital prevented the private wage share from declining further, even after controlling for labour market institutions, globalisation and technological change. Conversely, expenditures on outsourcing substantially contributed to reducing the private wage share. Unemployment benefits had a non-significant and negative effect on the private wage share because their increase was the consequence of higher levels of unemployment rather than policy. Implications for theory and policy are drawn, including the support for a public employment-led spending policy. PMID:28919641

  13. Atrial Fibrillation on Intensive Care Unit Admission Independently Increases the Risk of Weaning Failure in Nonheart Failure Mechanically Ventilated Patients in a Medical Intensive Care Unit: A Retrospective Case-Control Study.

    Science.gov (United States)

    Tseng, Yen-Han; Ko, Hsin-Kuo; Tseng, Yen-Chiang; Lin, Yi-Hsuan; Kou, Yu Ru

    2016-05-01

    Atrial fibrillation (AF) is one of the most frequent arrhythmias in clinical practice. Previous studies have reported the influence of AF on patients with heart failure (HF). The effect of AF on the non-HF critically ill patients in a medical intensive care unit (ICU) remains largely unclear. The study aimed to investigate the impact of AF presenting on ICU admission on the weaning outcome of non-HF mechanically ventilated patients in a medical ICU.A retrospective observational case-control study was conducted over a 1-year period in a medical ICU at Taipei Veterans General Hospital, a tertiary medical center in north Taiwan. Non-HF mechanically ventilated patients who were successful in their spontaneous breathing trial and underwent ventilator discontinuation were enrolled. The primary outcome measure was the ventilator status after the first episode of ventilator discontinuation.A total of 285 non-HF patients enrolled were divided into AF (n = 62) and non-AF (n = 223) groups. Compared with the non-AF patients, the AF patients were significantly associated with old age (P = 0.002), a higher rate of acute respiratory distress syndrome causing respiratory failure (P = 0.015), a higher percentage of sepsis before liberation from mechanical ventilation (MV) (P = 0.004), and a higher serum level of blood urea nitrogen on the day of liberation from MV (P = 0.003). Multivariate logistic regression analysis demonstrated that AF independently increased the risk of weaning failure [adjusted odds ratio (AOR), 3.268; 95% confidence interval (CI), 1.254-8.517; P = 0.015]. Furthermore, the AF patients were found to be independently associated with a high rate of ventilator dependence (log rank test, P = 0.026), prolonged total ventilator use (AOR, 1.979; 95% CI, 1.032-3.794; P = 0.040), increased length of ICU stay (AOR, 2.256; 95% CI, 1.049-4.849; P = 0.037), increased length of hospital stay (AOR, 2.921; 95% CI, 1.363-6.260; P = 0

  14. Differences in Spending in School Districts across Geographic Locales in Minnesota. Summary. Issues & Answers. REL 2012-No. 124

    Science.gov (United States)

    Wan, Yinmei; Norbury, Heather; Molefe, Ayrin C.; Gerdeman, R. Dean; Meyers, Coby V.; Burke, Matthew

    2012-01-01

    This study examines differences in spending in school districts across geographic locales in Minnesota and factors that might contribute to these differences. The study finds that district spending per student in 2008/09 varied across locale types in Minnesota. These differences are largely accounted for by differences in regional characteristics…

  15. Military Spending and Economic Well-Being in the American States: The Post-Vietnam War Era

    Science.gov (United States)

    Borch, Casey; Wallace, Michael

    2010-01-01

    Using growth curve modeling techniques, this research investigates whether military spending improved or worsened the economic well-being of citizens within the American states during the post-Vietnam War period. We empirically test the military Keynesianism claim that military spending improves the economic conditions of citizens through its use…

  16. Proposed Social Spending Innovation Research (SSIR) Program: Harnessing American Entrepreneurial Talent to Solve Major U.S. Social Problems

    Science.gov (United States)

    Coalition for Evidence-Based Policy, 2015

    2015-01-01

    The Social Spending Innovation Research (SSIR) proposal seeks to replicate, in social spending, the great success of the Small Business Innovation Research (SBIR) program in technology development. The SBIR program funds technology development by entrepreneurial small companies. The program has spawned breakthrough technologies in diverse areas…

  17. Workforce Investment Act: States' Spending Is on Track, But Better Guidance Would Improve Financial Reporting. Report to Congressional Requesters.

    Science.gov (United States)

    General Accounting Office, Washington, DC.

    The U.S. Congress asked the Government Accounting Office (GAO) to determine the following: (1) to what extent states were spending their Workforce Investment Act (WIA) funds and whether the Department of Labor's (Labor's) data accurately reflected available funds; (2) what Labor did to assess how states were managing their WIA spending; and (3)…

  18. Increased Incidence Rate of Trauma- and Stressor-Related Disorders in Denmark After the September 11, 2001, Terrorist Attacks in the United States

    DEFF Research Database (Denmark)

    Hansen, Bertel T; Østergaard, Søren D; Sønderskov, Kim M

    2016-01-01

    The terrorist attacks that occurred on September 11, 2001 (hereafter referred to as 9/11) in the United States had a profound impact on the physical and mental health of Americans, but the effects beyond the United States are largely unknown. To understand the wider aftermath, we examined...

  19. Immigration to the United States: 1996 Update. Executive Summary.

    Science.gov (United States)

    Keuffel, Eric; Pemberton, Alissa

    Immigration, both legal and illegal, has a profound impact on the United States. The public policy implications of immigration include the impact on population growth, employment, wages, taxes, and social spending. In 1994, a net total of between 900,000 and 1.1 million immigrants were added to the foreign-born population of the United States.…

  20. Longitudinal Patterns of Spending Enhance the Ability to Predict Costly Patients: A Novel Approach to Identify Patients for Cost Containment.

    Science.gov (United States)

    Lauffenburger, Julie C; Franklin, Jessica M; Krumme, Alexis A; Shrank, William H; Brennan, Troyen A; Matlin, Olga S; Spettell, Claire M; Brill, Gregory; Choudhry, Niteesh K

    2017-01-01

    With rising health spending, predicting costs is essential to identify patients for interventions. Many of the existing approaches have moderate predictive ability, which may result, in part, from not considering potentially meaningful changes in spending over time. Group-based trajectory modeling could be used to classify patients into dynamic long-term spending patterns. To classify patients by their spending patterns over a 1-year period and to assess the ability of models to predict patients in the highest spending trajectory and the top 5% of annual spending using prior-year predictors. We identified all fully insured adult members enrolled in a large US nationwide insurer and used medical and prescription data from 2009 to 2011. Group-based trajectory modeling was used to classify patients by their spending patterns over a 1-year period. We assessed the predictive ability of models that categorized patients in the top fifth percentile of annual spending and in the highest spending trajectory, using logistic regression and split-sample validation. Models were estimated using investigator-specified variables and a proprietary risk-adjustment method. Among 998,651 patients, in the best-performing model, prediction was strong for patients in the highest trajectory group (C-statistic: 0.86; R: 0.47). The C-statistic of being in the top fifth percentile of spending in the best-performing model was 0.82 (R: 0.26). Approaches using nonproprietary investigator-specified methods performed almost as well as other risk-adjustment methods (C-statistic: 0.81 vs. 0.82). Trajectory modeling may be a useful way to predict costly patients that could be implementable by payers to improve cost-containment efforts.

  1. Spending Smart

    Science.gov (United States)

    Grush, Mary

    2009-01-01

    There is no doubt that eProcurement technology has turned cumbersome paper-based processes into highly connected online systems. The most basic parameters of eProcurement range from shopping for or sourcing goods, to creating purchase requisitions and getting them approved, to placing orders with suppliers, to receiving invoices--all…

  2. Spending Spree

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Chinese enterprises are casting their eyes globally in search of new investment china’s economic expansion is sizzling with its outward investment continuing to reach new highs.Chen Jian,Vice Minister of Commerce revealed at the Fourth East Asia Investment Forum that the first quarter of 2008

  3. Spending Smart

    Science.gov (United States)

    Grush, Mary

    2009-01-01

    There is no doubt that eProcurement technology has turned cumbersome paper-based processes into highly connected online systems. The most basic parameters of eProcurement range from shopping for or sourcing goods, to creating purchase requisitions and getting them approved, to placing orders with suppliers, to receiving invoices--all…

  4. Deletion of intragenic tandem repeats in unit C of FLO1 of Saccharomyces cerevisiae increases the conformational stability of flocculin under acidic and alkaline conditions.

    Directory of Open Access Journals (Sweden)

    Ee Li

    Full Text Available Flocculation is an attractive property for Saccaromyces cerevisiae, which plays important roles in fermentation industry and environmental remediation. The process of flocculation is mediated by a family of cell surface flocculins. As one member of flocculins, Flo1 is characterized by four families of repeats (designated as repeat units A, B, C and D in the central domain. It is generally accepted that variation of repeat unit A in length in Flo1 influences the degree of flocculation or specificity for sugar recognization. However, no reports were observed for other repeat units. Here, we compared the flocculation ability and its sensitivity to environmental factors between yeast strain YSF1 carrying the intact FLO1 gene and yeast strains carrying the derived forms of FLO1 with partial or complete deletion of repeats in unit C. No obvious differences in flocculation ability and specificity of carbohydrate recognition were observed among these yeast strains, which indicates the truncated flocculins can stride across the cell wall and cluster the N-terminal domain on the surface of yeast cells as the intact Flo1 thereby improving intercellular binding. However, yeast strains with the truncated flocculins required more mannose to inhibit completely the flocculation, displayed broad tolerance of flocculation to pH fluctuation, and the fewer the repeats in unit C, the stronger adaptability of flocculation to pH change, which was not relevant to the position of deletion. This suggests that more stable active conformation is obtained for flocculin by deletion the repeat unit C in the central domain of Flo1, which was validated further by the higher hydrophobicity on the surface of cells of YSF1c with complete deletion of unit C under neutral and alkaline conditions and the stabilization of GFP conformation by fusion with flocculin with complete deletion of unit C in the central domain.

  5. The Increasing Challenge of Multidrug-Resistant Gram-Negative Bacilli: Results of a 5-Year Active Surveillance Program in a Neonatal Intensive Care Unit.

    Science.gov (United States)

    Giuffrè, Mario; Geraci, Daniela M; Bonura, Celestino; Saporito, Laura; Graziano, Giorgio; Insinga, Vincenzo; Aleo, Aurora; Vecchio, Davide; Mammina, Caterina

    2016-03-01

    Colonization and infection by multidrug-resistant gram-negative bacilli (MDR GNB) in neonatal intensive care units (NICUs) are increasingly reported.We conducted a 5-year prospective cohort surveillance study in a tertiary NICU of the hospital "Paolo Giaccone," Palermo, Italy. Our objectives were to describe incidence and trends of MDR GNB colonization and the characteristics of the most prevalent organisms and to identify the risk factors for colonization. Demographic, clinical, and microbiological data were prospectively collected. Active surveillance cultures (ASCs) were obtained weekly. Clusters of colonization by extended spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae were analyzed by conventional and molecular epidemiological tools.During the study period, 1152 infants were enrolled in the study. Prevalences of colonization by MDR GNB, ESBL-producing GNB and multiple species/genera averaged, respectively, 28.8%, 11.7%, and 3.7%. Prevalence and incidence density of colonization by MDR GNB and ESBL-producing GNB showed an upward trend through the surveillance period. Rates of ESBL-producing E coli and K pneumoniae colonization showed wide fluctuations peaking over the last 2 years. The only independent variables associated with colonization by MDR GNB and ESBL-producing organisms and multiple colonization were, respectively, the days of NICU stay (odds ratio [OR] 1.041), the days of exposure to ampicillin-sulbactam (OR 1.040), and the days of formula feeding (OR 1.031). Most clusters of E coli and K pneumoniae colonization were associated with different lineages. Ten out of 12 clusters had an outborn infant as their index case.Our study confirms that MDR GNB are an increasing challenge to NICUs. The universal once-a-week approach allowed us to understand the epidemiology of MDR GNB, to timely detect new clones and institute contact precautions, and to assess risk factors. Collection of these data can be an important tool to

  6. Parental Involvement and Work Schedules: Time with Children in the United States, Germany, Norway, and the United Kingdom.

    Science.gov (United States)

    Hook, Jennifer L; Wolfe, Christina M

    2013-06-01

    We examine variation in parents' time with children by work schedule in two-parent families, utilizing time use surveys from the United States (2003), Germany (2001), Norway (2000), and the United Kingdom (2000) (N = 6,835). We find that American fathers working the evening shift spend more time alone with children regardless of mothers' employment status, whereas this association is conditional on mothers' employment in the United Kingdom and Germany. We find no evidence that Norwegian fathers working the evening shift spend more time alone with children. We conclude that a consequence of evening work often viewed as positive for children - fathers spending more time with children - is sensitive to both household employment arrangements and country context.

  7. Examination of the effects of public spending and trade policy on real exchange rate in Cameroon

    Directory of Open Access Journals (Sweden)

    Victalice Ngimanang ACHAMOH

    2015-11-01

    Full Text Available The study adopts the inter-temporal model of Rodríguez (1989 and Edward (1989 extended in Elbadawi and Soto (1997 to empirically examine the effect of public expenditure and trade openness on the real exchange rate using Cameroon data from 1977 to 2010. After exploring some issues on exchange rate and reviewing the relevant literature, the study employs residual based-cointegration technique. All the variables were stationary at level form or first differences. Public spending significantly appreciates the real exchange likewise the trade openness variable in the longrun. The results of the study suggests that appreciation of real exchange rate could be prevented by contracting public spending or adopting restrictive trade measures especially in the long run.

  8. Distinguishing Event Spectator Spending Profiles: Projected Impacts of the 2009 U.S. Open Golf Championship

    Directory of Open Access Journals (Sweden)

    Amy K.S. Scott

    2009-01-01

    Full Text Available Spectators at mega-sport events are an aggregation of market segments with distinct consumer behaviours. Relatively few economic impact studies have distinguished spectator market segments or the event tourists crowding out other visitors, resulting in inaccurate results. Despite a plethora of prior studies, there remains a need for a refined and agile model to predict a sporting event’s economic impact. The purpose of this study is to describe the ex ante model, ACE: Assessing Consumers of Events, developed to estimate spending impacts by spectators. ACE is then applied to the 2009 U.S. Women’s Open Golf Championship to illustrate its data requirements and results. U.S. Open spectators are projected to spend $7.5 million in the host economy and induce a slight crowding out effect. Future applications of the ACE model are discussed.

  9. Refining estimates of public health spending as measured in national health expenditure accounts: the Canadian experience.

    Science.gov (United States)

    Ballinger, Geoff

    2007-01-01

    The recent focus on public health stemming from, among other things, severe acute respiratory syndrome and avian flu has created an imperative to refine health-spending estimates in the Canadian Health Accounts. This article presents the Canadian experience in attempting to address the challenges associated with developing the needed taxonomies for systematically capturing, measuring, and analyzing the national investment in the Canadian public health system. The first phase of this process was completed in 2005, which was a 2-year project to estimate public health spending based on a more classic definition by removing the administration component of the previously combined public health and administration category. Comparing the refined public health estimate with recent data from the Organization for Economic Cooperation and Development still positions Canada with the highest share of total health expenditure devoted to public health than any other country reporting. The article also provides an analysis of the comparability of public health estimates across jurisdictions within Canada as well as a discussion of the recommendations for ongoing improvement of public health spending estimates. The Canadian Institute for Health Information is an independent, not-for-profit organization that provides Canadians with essential statistics and analysis on the performance of the Canadian health system, the delivery of healthcare, and the health status of Canadians. The Canadian Institute for Health Information administers more than 20 databases and registries, including Canada's Health Accounts, which tracks historically 40 categories of health spending by 5 sources of finance for 13 provincial and territorial jurisdictions. Until 2005, expenditure on public health services in the Canadian Health Accounts included measures to prevent the spread of communicable disease, food and drug safety, health inspections, health promotion, community mental health programs, public

  10. The Role of Central Bank Operating Procedures in an Economy with Productive Government Spending

    OpenAIRE

    Caballé, Jordi; Hromcova, Jana

    2001-01-01

    The choice of either the rate of monetary growth or the nominal interest rate as the instrument controlled by monetary authorities has both positive and normative implications for economic performance. We reexamine some of the issues related to the choice of the monetary policy instrument in a dynamic general equilibrium model exhibiting endogenous growth in which a fraction of productive government spending is financed by means of issuing currency. When we evaluate the performance of the two...

  11. Rural-Urban Differences in Parental Spending on Children’s Primary Education in Malawi

    OpenAIRE

    Mussa, Richard

    2010-01-01

    The paper investigates two issues regarding household expenditure on primary education of own children using the Second Malawi Integrated Household Survey(IHS2) data. Firstly, we look at factors which infuence a household's decision to spend or not (the participation decision), and by how much (the expenditure decision). This is done for urban and rural households. We �find that there are differences in the factors which influence both decision levels for the two groups of households. Secondl...

  12. FY2017 Defense Spending Under an Interim Continuing Resolution (CR): In Brief

    Science.gov (United States)

    2016-11-07

    anomalies could affect both the amount and purposes of defense spending in the CR. For instance, specific language could be included to allow...DOD may also encounter significant color of money issues. Many defense acquisition programs may face problems if they were going through a...transitional period in the acquisition process amid a CR. For example, a program ramping down development activities and transitioning into production

  13. In health care spending, Americans who make the least contribute the greatest share of income.

    Science.gov (United States)

    Collado, Megan

    2012-10-01

    Key findings. (1) Health care spending, both public and private, accounted for more than 20 percent of family income for families in the lowest-income quintile, but no more than 16 percent for families in any other income quintile. (2) The Affordable Care Act should reduce, but is unlikely to completely eliminate, some of this inequity through its heavy reliance on federal funding for the Medicaid expansion and income-related subsidies for private insurance.

  14. However you spend it, money isn’t the key to happiness

    OpenAIRE

    Boyce, Christopher J.

    2014-01-01

    The question as to whether more money brings greater happiness comes up time and time again and will no doubt continue to do so. Studies have shown that money matters much less than people assume and some conclude this is because we aren’t spending it right. Christopher Boyce accepts this argument may have some value, but emphasises money is unimportant compared to other factors at raising individual wellbeing.

  15. The Crowding Out-In Effect of Economic Openning on Government’s Social Spending%对外开放对我国社会性支出的挤出挤入效应研究

    Institute of Scientific and Technical Information of China (English)

    刘苓玲; 张璐

    2014-01-01

    文章基于动态面板模型研究了对外开放度对我国民生建设中社会性支出的挤出挤入效应。实证研究结果表明,在全国范围及沿海地区,贸易开放对社会性支出存在挤出效应,而金融开放对内陆地区存在挤入效应。社会性支出主要由教育支出、医疗支出和社会保障支出三项构成,分项研究表明,对外开放对三者的作用也存在差异。为了加快我国民生建设,需要有计划地增加财政社会性支出资金,在提高社会性支出资金利用效率的同时提高内陆地区的开放水平,以增强经济基础。%Social spending is consists of education ,medical health and social security spending .Using the dynamic panel data model ,this paper investigates the crowing in-out effect of economic openning on gov-ernment’s social spending in China .The result shows that there exists crowd-out effect in the coastal area , and a significant crowd-in effect in inland area .Apart from these ,it has a greater impact on medical spend-ing than the other two .Since social spending has a close relationship with our livelihood and it is insuffi-cient in China ,we should take measures to promote the development of economic openning ,increasing the financial support of social spending ,and improving the efficiency of social spending funding to improve people’s livelihood .

  16. Unemployment, public-sector health-care spending and breast cancer mortality in the European Union: 1990-2009.

    Science.gov (United States)

    Maruthappu, Mahiben; Watkins, Johnathan A; Waqar, Mueez; Williams, Callum; Ali, Raghib; Atun, Rifat; Faiz, Omar; Zeltner, Thomas

    2015-04-01

    The global economic crisis has been associated with increased unemployment, reduced health-care spending and adverse health outcomes. Insights into the impact of economic variations on cancer mortality, however, remain limited. We used multivariate regression analysis to assess how changes in unemployment and public-sector expenditure on health care (PSEH) varied with female breast cancer mortality in the 27 European Union member states from 1990 to 2009. We then determined how the association with unemployment was modified by PSEH. Country-specific differences in infrastructure and demographic structure were controlled for, and 1-, 3-, 5- and 10-year lag analyses were conducted. Several robustness checks were also implemented. Unemployment was associated with an increase in breast cancer mortality [P unemployment rises (P unemployment and breast cancer mortality remained in all robustness checks. Rises in unemployment are associated with significant short- and long-term increases in breast cancer mortality, while increases in PSEH are associated with reductions in breast cancer mortality. Initiatives that bolster employment and maintain total health-care expenditure may help minimize increases in breast cancer mortality during economic crises. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  17. Government Spending Shocks, the Current Account and the Real Exchange Rate in OECD Countries

    Directory of Open Access Journals (Sweden)

    Soyoung Kim

    2008-06-01

    Full Text Available This paper examines the effects of government spending shocks on the current account and the real exchange rate for 20 OECD countries using panel VAR model, in order to provide empirical stylized facts. The countries were grouped based on openness and size, and the influence of openness and size on the effects of government spending shocks. The main findings are as follows. First, in the analysis of all 20 countries, in response to government spending shocks, the worsening of the current account is significant, but real exchange rate appreciation is not significant. Second, real exchange rate appreciation is more significant and worsening of the current account is more temporary in the group of countries with higher openness than in those with low openness. Third, the worsening of the current account is more significant in the group of large countries than in the group of small countries. Although real exchange rate depreciation under fiscal expansion is not consistent with traditional theories, the results are broadly consistent with the existing theories that incorporate openness and the size of the country.

  18. Racial Prejudice and Spending on Drug Rehabilitation: The Role of Attitudes Toward Blacks and Latinos.

    Science.gov (United States)

    Nielsen, Amie L; Bonn, Scott; Wilson, George

    2010-12-01

    We enhance understanding of the prejudice-induced "color coding" phenomenon among whites by determining whether racial and ethnic prejudices are associated with a previously unexplored policy outcome, spending on drug rehabilitation. We examine attitudes toward both blacks and Latinos; the latter is a group largely ignored in previous research. We assess the impact of several types of racial/ethnic views, including those that manifest modern/indirect prejudice (e.g., stereotypes about violence, individualistic causal attributions) and those that reflect social-distance-based traditional prejudice (opposition to residential proximity and to interracial marriage). These relationships are examined using data from the General Social Survey. Bivariate results support the linkage between both traditional and modern prejudice and rehabilitation spending. Logistic regression analyses also indicate that support for rehabilitation is racialized: Attributing race differences in socioeconomic outcomes to "structural" factors, namely discrimination and lack of chance for education, is associated with believing rehabilitation spending is inadequate, controlling for the effects of other racial/ethnic attitudes and background factors. The relationship between this measure of modern prejudice and the outcome is consistent with color coding. The implications of the findings are discussed, and suggestions for future research that further examine the scope of color coding are offered.

  19. Linkage of Credit on BI Rate, Funds Rate, Inflation and Government Spending on Capital

    Directory of Open Access Journals (Sweden)

    Mangasa Augustinus Sipahutar

    2017-03-01

    Full Text Available Linkage of credit on BI rate, funds rate, inflation, and government spending on capital provides evidence from Indonesia.  This paper found advance explanation about banks credit as monetary transmission channel and its role on Indonesian economy.  We used credit depth as a ratio of banks credit to GDP nominal, to explain the role of credit in Indonesian economy.  We developed a VAR model to measure the response of credit to BI rate, funds rate and inflation rate, and OLS method to find out how banks credit response to government spending on capital. This paper revealed bi-direction causality between credit and BI rate, credit and funds rate, and credit and inflation.  There is trade-off between credit and BI rate, credit and funds rate, and credit and inflation, but government spending on capital promotes credit depth.  We found that Indonesian banking is bank view, allocated their credit based on their performance, not merely on the monetary policy determined by central bank.  For bank view perspectives, we analyzed the link between LDR as an indicator of credit channel mechanism to NPLs and CAR.  We found that there is no significant effect of CAR to LDR, but has a strong negatively relationship between NPLs to LDR.  This evidence indicates that commercial banks in Indonesia allocated their credit do not related to their capital but merely to the quality of their credit portfolio.

  20. Spending to save? State health expenditure and infant mortality in India.

    Science.gov (United States)

    Bhalotra, Sonia

    2007-09-01

    There are severe inequalities in health in the world, poor health being concentrated amongst poor people in poor countries. Poor countries spend a much smaller share of national income on health expenditure than do richer countries. What potential lies in political or growth processes that raise this share? This depends upon how effective government health spending in developing countries is. Existing research presents little evidence of an impact on childhood mortality. Using specifications similar to those in the existing literature, this paper finds a similar result for India, which is that state health spending saves no lives. However, upon allowing lagged effects, controlling in a flexible way for trended unobservables and restricting the sample to rural households, a significant effect of health expenditure on infant mortality emerges, the long run elasticity being about -0.24. There are striking differences in the impact by social group. Slicing the data by gender, birth order, religion, maternal and paternal education and maternal age at birth, I find the weakest effects in the most vulnerable groups (with the exception of a large effect for scheduled tribes).

  1. Franchising Education: Challenges and Opportunities for Coping with the Economic Recession and the Provision of Higher Education in the United Kingdom

    Science.gov (United States)

    Miller, Paul; Shotte, Gertrude

    2010-01-01

    When the global economic recession hit the world some 18 months ago, very few could predict the impact this would have on government spending on higher education. Higher education institutions in the United Kingdom face spending cuts. Notwithstanding, they are expected to deliver quality education with fewer resources. This article discusses…

  2. Financial burden of medical out-of-pocket spending by state and the implications of the 2014 Medicaid expansions.

    Science.gov (United States)

    Caswell, Kyle J; Waidmann, Timothy; Blumberg, Linda J

    2013-08-01

    This study is the first to offer a detailed look at the burden of medical out-of-pocket spending, defined as total family medical out-of-pocket spending as a proportion of income, for each state. It further investigates which states have greater shares of individuals with high burden levels and no Medicaid coverage but would be Medicaid eligible under the 2014 rules of the Affordable Care Act should their state choose to participate in the expansion. This work suggests which states have the largest populations likely to benefit, in terms of lowering medical spending burden, from participating in the 2014 adult Medicaid expansions.

  3. Trends in spending on eating away from home in Brazil, 2002-2003 to 2008-2009.

    Science.gov (United States)

    Claro, Rafael Moreira; Baraldi, Larissa Galastri; Martins, Ana Paula Bortoletto; Bandoni, Daniel Henrique; Levy, Renata Bertazzi

    2014-07-01

    The study aims to describe trends in food consumption away from home in Brazil from 2002-2003 to 2008-2009 and to analyze the influence of income on this behavior. The authors used data collected by the Household Budget Surveys conducted by the Brazilian Institute of Geography and Statistics (IBGE) in 2002-2003 and 2008-2009. The information analyzed in this study involves records of food and beverage purchases for consumption away from home. Trends in eating away from home were estimated for the total population and according to demographic and economic strata. The association between the share of food consumed away from home and income was studied using regression models to estimate income elasticity coefficients. The share of eating away from home increased 25% during the period, reaching 28% of total spending on food. Each 10% increase in mean per capita income leads to a 3.5% increase in the share of food consumed away from home. This suggests that income growth will result in future increases in the share of eating away from home.

  4. Trends in spending on eating away from home in Brazil, 2002-2003 to 2008-2009

    Directory of Open Access Journals (Sweden)

    Rafael Moreira Claro

    2014-07-01

    Full Text Available The study aims to describe trends in food consumption away from home in Brazil from 2002-2003 to 2008-2009 and to analyze the influence of income on this behavior. The authors used data collected by the Household Budget Surveys conducted by the Brazilian Institute of Geography and Statistics (IBGE in 2002-2003 and 2008-2009. The information analyzed in this study involves records of food and beverage purchases for consumption away from home. Trends in eating away from home were estimated for the total population and according to demographic and economic strata. The association between the share of food consumed away from home and income was studied using regression models to estimate income elasticity coefficients. The share of eating away from home increased 25% during the period, reaching 28% of total spending on food. Each 10% increase in mean per capita income leads to a 3.5% increase in the share of food consumed away from home. This suggests that income growth will result in future increases in the share of eating away from home.

  5. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial

    DEFF Research Database (Denmark)

    Jensen, Jens U; Hein, Lars; Lundgren, Bettina;

    2011-01-01

    For patients in intensive care units, sepsis is a common and potentially deadly complication and prompt initiation of appropriate antimicrobial therapy improves prognosis. The objective of this trial was to determine whether a strategy of antimicrobial spectrum escalation, guided by daily...

  6. Increasing nutrient use efficiency through improved feeding and manure manegement in urban and peri-urban livestock units of a West African city: A scenario analysis

    NARCIS (Netherlands)

    Diogo, V.; Schlecht, E.; Buerkert, A.; Rufino, M.C.; Wijk, van M.T.

    2013-01-01

    In many African cities urban and peri-urban agriculture (UPA) plays a major role in creating jobs and contributing to food security. However, many small-scale UPA systems are characterised by excessive nutrient inputs to the livestock unit and poor handling of manure. To assess the impact of improve

  7. California Community Colleges: Poor Oversight by the Chancellor's Office Allows Districts to Incorrectly Report Their Level of Spending on Instructor Salaries.

    Science.gov (United States)

    California State Office of the Auditor General, Sacramento.

    This report by the California State Auditor reports that six of 10 California community college districts audited are incorrectly reporting their levels of spending on teacher salaries. State law requires that districts spend 50% of their current educational expenses on instructor salaries each year. By mandating this spending level, the…

  8. Performance audit as a tool oriented at the accountability of public finance spending in Poland against the background of UK practices 

    Directory of Open Access Journals (Sweden)

    Anna Bartoszewicz

    2015-11-01

    Full Text Available In recent years, public finance spending in Poland has been subject to citizens’ critical assessment. It forces public finance sector units to introduce tools that will enable the effectiveness of actions within this area to be scrutinized. The performance audit, a new idea of auditing oriented at performance, provides such a tool. At the same time, a chance to introduce accountability to Polish public finance sector entities appeared. The aim of the article is to determine the role and usefulness of performance audits for the effective management of public finances by public finance sector units in Poland with reference to British practice in this area. In the article, the author attempted to answer the question about what the perspective of performance audit development is in Poland in the next couple of years. To achieve the goal, the author used an analysis of the Polish and foreign literature on the subject, an analysis of legal instruments of internal audit, the comparative analysis method, and benchmarking (modelled on the British practice, the author indicating the implications connected with implementing performance audits in public finance sector units in Poland as well as mentioning legal-economic loopholes that should be closed in order to raise the effectiveness of performance audit in public finance sector in Poland. The author’s conclusions are based on deduction. Considering the experience of Great Britain, one may think that the role of the performance audit in Poland will grow along with the development of managerial control within public institutions, causing the rationalization of public finance spending. The aspects that should be complemented in the scope of the performance audit include: cyclical, not short-term, control of the use of public finances by government institutions, and acknowledging this tool as an obligatory element of management.

  9. Performance audit as a tool oriented at the accountability of public finance spending in Poland against the background of UK practices

    Directory of Open Access Journals (Sweden)

    Anna Bartoszewicz

    2015-09-01

    Full Text Available In recent years, public finance spending in Poland has been subject to citizens’ critical assessment. It forces public finance sector units to introduce tools that will enable the effectiveness of actions within this area to be scrutinized. The performance audit, a new idea of auditing oriented at performance, providessuch a tool. At the same time, a chance to introduce accountability to Polish public finance sector entitiesappeared. The aim of the article is to determine the role and usefulness of performance audits for the effective management of public finances by public finance sector units in Poland with reference to British practice in this area. In the article, the author attempted to answer the question about what the perspective of performance audit development is in Poland in the next couple of years. To achieve the goal, the author used an analysis of the Polish and foreign literature on the subject, an analysis of legal instruments of internal audit, the comparative analysis method, and benchmarking (modelled on the British practice, the author indicating the implications connected with implementing performance audits in public finance sector units in Poland as well as mentioning legal-economic loopholes that should be closed in order to raise the effectiveness of performance audit in public finance sector in Poland. The author’s conclusions are based on deduction. Considering the experience of Great Britain, one may think that the role of the performance audit in Poland will grow along with the development of managerial control within public institutions, causing the rationalization of public finance spending. The aspects that should be complemented in the scope of the performance audit include: cyclical, not short-term, control of the use of public finances by government institutions, and acknowledging this tool as an obligatory element of management.

  10. Examining the link between cash flow, market value, and research and development investment spending in the medical device industry.

    Science.gov (United States)

    Schmutz, Bryan P; Santerre, Rexford E

    2013-02-01

    Unlike the pharmaceutical industry, no empirical research has focused on the factors influencing research and development (R&D) spending in the medical device industry. To fill that gap, this study examines how R&D spending is influenced by prior year cash flow and corporate market value using multiple regression analysis and a panel data set of medical device companies over the period 1962-2008. The empirical findings suggest that the elasticities of R&D spending with respect to cash flow and corporate market value equal 0.58 and 0.31, respectively. Moreover, based upon these estimates, simulations show that the recently enacted excise tax on medical devices, taken alone, will reduce R&D spending by approximately $4 billion and thereby lead to a minimum loss of $20 billion worth of human life years over the first 10 years of its enactment.

  11. Growth in US health spending remained slow in 2010; health share of gross domestic product was unchanged from 2009.

    Science.gov (United States)

    Martin, Anne B; Lassman, David; Washington, Benjamin; Catlin, Aaron

    2012-01-01

    Medical goods and services are generally viewed as necessities. Even so, the latest recession had a dramatic effect on their utilization. US health spending grew more slowly in 2009 and 2010-at rates of 3.8 percent and 3.9 percent, respectively-than in any other years during the fifty-one-year history of the National Health Expenditure Accounts. In 2010 extraordinarily slow growth in the use and intensity of services led to slower growth in spending for personal health care. The rates of growth in overall US gross domestic product (GDP) and in health spending began to converge in 2010. As a result, the health spending share of GDP stabilized at 17.9 percent.

  12. United States v. Caronia: The increasing strength of commercial free speech and potential new emphasis on classifying off-label promotion as "false and misleading".

    Science.gov (United States)

    Scheineson, Marc J; Cuevas, Guillermo

    2013-01-01

    The authority of the United States Food and Drug Administration (FDA) to prohibit off-label promotion of drug products suffered another serious setback in United States v. Caronia. Viewing a legal system where physicians can prescribe prescription pharmaceuticals for unapproved uses legally in their practice of medicine, the Federal appeals court affirmed the commercial free speech rights of manufacturers to use truthful, non-misleading speech about lawfully marketed products. As a result of this case, and others upon which the decision is based, FDA is likely to challenge manufacturer promotion more carefully, and only if it can demonstrate that claims are not truthful, but are false or misleading, or otherwise deprive the prescriber of adequate directions for use.

  13. Optimal Financing by Money and Taxes of Productive and Unproductive Government Spending: Effects on Economic Growth, Inflation, and Welfare

    OpenAIRE

    David Alan Aschauer

    1998-01-01

    This paper contains an investigation of the effects of different means of financing government spending on economic growth, inflation, and welfare. In this setting, two different types of government spending are considered: productive expenditures which provide services to the private sector in its production activities; and unproductive expenditures which have no direct influence on the private economy. In turn, two different forms of finance are considered: proportional income taxation; and...

  14. Assessment of Gasoline Prices and its Predictive Power on U.S. Consumers' Retail Spending and Savings

    Science.gov (United States)

    Alvarado-Bonilla, Joel

    The rising costs of fuels and specifically gasoline pose an economic challenge to U.S. consumers. Thus, the specific problem considered in this study was a rise in gasoline prices can reduce consumer spending, disposable income, food service traffic, and spending on healthy food, medicines, or visits to the doctor. Aligned with the problem, the purpose of this quantitative multiple correlation study was to examine the economic aspects for a rise in gasoline prices to reduce the six elements in the problem. This study consisted of a correlational design based on a retrospective longitudinal analysis (RLA) to examine gasoline prices versus the economic indexes of: (a) Retail Spending and (b) personal savings (PS). The RLA consisted on historic archival public data from 1978 to 2015. This RLA involved two separate linear multiple regression analyses to measure gasoline price's predictive power (PP) on two indexes while controlling for Unemployment Rate (UR). In summary, regression Formula 1 revealed Gasoline Price had a significant 61.1% PP on Retail Spending. In contrast, Formula 2 had Gasoline Price not having a significant PP on PS. Formula 2 yielded UR with 38.8% PP on PS. Results were significant at pGasoline Price's PP on Retail Spending means a spending link to retail items such as: food service traffic, healthy food, medicines, and consumer spending. The UR predictive power on PS was unexpected, but logical from an economic view. Also unexpected was Gasoline Price's non-predictive power on PS, which suggests Americans may not save money when gasoline prices drop. These results shed light on the link of gasoline and UR on U.S. consumer's economy through savings and spending, which can be useful for policy design on gasoline and fuels taxing and pricing. The results serve as a basis for future study on gasoline and economics.

  15. Pattern and levels of spending allocated to HIV prevention programs in low- and middle-income countries

    Directory of Open Access Journals (Sweden)

    Amico Peter

    2012-03-01

    Full Text Available Abstract Background AIDS continues to spread at an estimated 2.6 new million infections per year, making the prevention of HIV transmission a critical public health issue. The dramatic growth in global resources for AIDS has produced a steady scale-up in treatment and care that has not been equally matched by preventive services. This paper is a detailed analysis of how countries are choosing to spend these more limited prevention funds. Methods We analyzed prevention spending in 69 low- and middle-income countries with a variety of epidemic types, using data from national domestic spending reports. Spending information was from public and international sources and was analyzed based on the National AIDS Spending Assessment (NASA methods and classifications. Results Overall, prevention received 21% of HIV resources compared to 53% of funding allocated to treatment and care. Prevention relies primarily on international donors, who accounted for 65% of all prevention resources and 93% of funding in low-income countries. For the subset of 53 countries that provided detailed spending information, we found that 60% of prevention resources were spent in five areas: communication for social and behavioral change (16%, voluntary counselling and testing (14%, prevention of mother-to-child transmission (13%, blood safety (10% and condom programs (7%. Only 7% of funding was spent on most-at-risk populations and less than 1% on male circumcision. Spending patterns did not consistently reflect current evidence and the HIV specific transmission context of each country. Conclusions Despite recognition of its importance, countries are not allocating resources in ways that are likely to achieve the greatest impact on prevention across all epidemic types. Within prevention spending itself, a greater share of resources need to be matched with interventions that approximate the specific needs and drivers of each country's epidemic.

  16. Rational Planning and Politicians' Preferences for Spending and Reform: Replication and Extension of a Survey Experiment

    DEFF Research Database (Denmark)

    George, Bert; Deschmidt, Sebastian; Bækgaard, Martin;

    2016-01-01

    on the relation between performance information and politicians' preferences for spending and reform and extends this experiment by investigating the role of strategic goals. Based on a randomized survey experiment (1.484 Flemish city councilors) and an analysis of 225 strategic plans, we found that information......The rational planning cycle of formulating strategic goals and using performance information to assess goal implementation is assumed to assist decision-making by politicians. Empirical evidence supporting this assumption is scarce. Our study replicates Nielsen and Baekgaard's (2015) experiment...

  17. Propensity to spending of an average consumer over a brief period

    Science.gov (United States)

    De Luca, Roberto; Di Mauro, Marco; Falzarano, Angelo; Naddeo, Adele

    2016-08-01

    Understanding consumption dynamics and its impact on the whole economy and welfare within the present economic crisis is not an easy task. Indeed the level of consumer demand for different goods varies with the prices, consumer incomes and demographic factors. Furthermore crisis may trigger different behaviors which result in distortions and amplification effects. In the present work we propose a simple model to quantitatively describe the time evolution over a brief period of the amount of money an average consumer decides to spend, depending on his/her available budget. A simple hydrodynamical analog of the model is discussed. Finally, perspectives of this work are briefly outlined.

  18. THE TIME-(INVARIANT INTERPLAY OF GOVERNMENT SPENDING AND PRIVATE CONSUMPTION IN BRAZIL

    Directory of Open Access Journals (Sweden)

    Diego Ferreira

    2015-09-01

    Full Text Available AbstractThis paper analyzes the relationship between government spending and private consumption in Brazil through an application of a VAR with time-varying parameters and stochastic volatility, estimated with Bayesian simulation over the 1996:Q1–2014:Q2 period. The findings reveal that fiscal policy is indeed effective in stimulating GDP and private consumption, which characterizes the presence of positive Keynesian multipliers. However, these positive effects are only sustained on the shortrun. Also, stochastic volatility seems to have decreased from 2000 onwards, suggesting that Brazil has steadily improved its macroeconomic stability after the adoption of the inflation-targeting framework and the Fiscal Responsibility Law.

  19. Economic impacts of illness in older workers: quantifying the impact of illness on income, tax revenue and government spending

    Directory of Open Access Journals (Sweden)

    Passey Megan E

    2011-06-01

    Full Text Available Abstract Background Long term illness has far reaching impacts on individuals, and also places a large burden upon government. This paper quantifies the indirect economic impacts of illness related early retirement on individuals and government in Australia in 2009. Methods The output data from a microsimulation model, Health&WealthMOD, was analysed. Health&WealthMOD is representative of the 45 to 64 year old Australian population in 2009. The average weekly total income, total government support payments, and total taxation revenue paid, for individuals who are employment full-time, employed part-time and not in the labour force due to ill health was quantified. Results It was found that persons out of the labour force due to illness had significantly lower incomes ($218 per week as opposed to $1167 per week for those employed full-time, received significantly higher transfer payments, and paid significantly less tax than those employed full-time or part-time. This results in an annual national loss of income of over $17 billion, an annual national increase of $1.5 billion in spending on government support payments, and an annual loss of $2.1 billion in taxation revenue. Conclusions Illness related early retirement has significant economic impacts on both the individual and on governments as a result of lost income, lost taxation revenue and increased government support payments. This paper has quantified the extent of these impacts for Australia.

  20. [Financial and economic sustainability of public spending on health care by local governments: an analysis of data from municipalities in Mato Grosso State, Brazil].

    Science.gov (United States)

    Scatena, João Henrique Gurtler; Viana, Ana Luiza d'Avila; Tanaka, Oswaldo Yoshimi

    2009-11-01

    Brazil's Unified National Health System is financed according to a model known as fiscal federalism, the fund-sharing rules of the Social Security Budget, Ministry of Health norms, and Constitutional Amendment 29 (EC-29), which links Federal, State, and municipal resources to health. This article discusses the sustainability of public spending on health at the municipal level. Twenty-one municipalities were studied, using municipal budget data. From 1996 to 2006, total current per capita revenues increased by 280% above the accumulated inflation and Gross Domestic Product, varying by size of municipality, which also defined the composition of the municipal budgets. Meanwhile, the budget comprising the basis for EC-29 increased less (178%), thus placing limits on the municipal share of health spending. The results observed in these municipalities are believed to reflect the reality in thousands of other Brazilian municipalities, thus jeopardizing the capacity for municipal investment in health, especially beginning in 2008. The situation may become even worse, considering the repeal of the so-called Bank Transaction Tax (CPMF), Bills of Law 306/08 and 233/08 (currently under review in the National Congress), and the world recession stemming from the U.S. financial crisis.