Income Elasticity of Vaccines Spending versus General Healthcare Spending.

Science.gov (United States)

Alfonso, Y Natalia; Ding, Guiru; Bishai, David

2016-07-01

Using cross-country data on gross domestic product and national expenditure on vaccines, we estimate and compare the income elasticity of vaccine expenditure and general curative healthcare expenditure. This study provides the first evidence on the national income elasticity of vaccination spending. Both fixed and random effects models are applied to data from 84 countries from 2010 to 2011. The income elasticities for healthcare expenditure and vaccine expenditure are 0.844 and 0.336, respectively. Despite vaccines' high cost-effectiveness, the national propensity to spend income on vaccines as income increases lags behind general health care. The low income elasticity of vaccine spending means that relying on economic growth alone will provide an unacceptably slow trajectory to achieving high vaccine coverage levels. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

The U.S. employment effects of military and domestic spending priorities.

Science.gov (United States)

Pollin, Robert; Garrett-Peltier, Heidi

2009-01-01

This study focuses on the employment effects of military spending versus alternative domestic spending priorities. The authors begin by introducing the basic input-output modeling technique for considering issues such as these in a systematic way. They then present some simple alternative spending scenarios-namely, devoting $1 billion to the military versus the same amount of money spent for five alternatives: tax cuts that produce increased levels of personal consumption; health care; education; mass transit; and construction targeted at home weatherization and infrastructure repair. The first conclusion in assessing such relative employment effects is straightforward: $1 billion spent on personal consumption, health care, education, mass transit, and construction for home weatherization/infrastructure will all create more jobs in the U.S. economy than would the same $1 billion spent on the military. The authors then examine the pay level of jobs created through these alternative spending priorities and assess the overall welfare effects of the alternative employment outcomes. Combining these alternative domestic spending categories in an effective way can also generate a higher level of compensation for working people in the United States and a better average quality ofjobs.

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.

Understanding Trends in Medicare Spending, 2007-2014.

Science.gov (United States)

Keohane, Laura M; Gambrel, Robert J; Freed, Salama S; Stevenson, David; Buntin, Melinda B

2018-03-06

To analyze the sources of per-beneficiary Medicare spending growth between 2007 and 2014, including the role of demographic characteristics, attributes of Medicare coverage, and chronic conditions. Individual-level Medicare spending and enrollment data. Using an Oaxaca-Blinder decomposition model, we analyzed whether changes in price-standardized, per-beneficiary Medicare Part A and B spending reflected changes in the composition of the Medicare population or changes in relative spending levels per person. We identified a 5 percent sample of fee-for-service Medicare beneficiaries age 65 and above from years 2007 to 2014. Mean payment-adjusted Medicare per-beneficiary spending decreased by $180 between the 2007-2010 and 2011-2014 time periods. This decline was almost entirely attributable to lower spending levels for beneficiaries. Notably, declines in marginal spending levels for beneficiaries with chronic conditions were associated with a $175 reduction in per-beneficiary spending. The decline was partially offset by the increasing prevalence of certain chronic diseases. Still, we are unable to attribute a large share of the decline in spending levels to observable beneficiary characteristics or chronic conditions. Declines in spending levels for Medicare beneficiaries with chronic conditions suggest that changing patterns of care use may be moderating spending growth. © Health Research and Educational Trust.

Pocket Spending Guide

OpenAIRE

Poff, Karen

2015-01-01

Provides an example for how to set up a pocket spending guide. By filling out the guide and keeping it with you, you can easily see at any time how much money you have available to spend in each category. A pocket spending guide will help you adjust your spending plan to make your money go where you really want it to go.

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

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.

Interdependence between US and European Military Spending: A Panel Cointegration Analysis (1988-2013)

OpenAIRE

Caruso, Raul; Di Domizio, Marco

2015-01-01

The aim of this paper is to study the interdependence of military spending between US and a panel of European countries in the period 1988-2013. The empirical estimation is based on a: (i) a unit root tests and a cointegration analysis; (ii) FMOLS and DOLS estimations. General results highlight that military spending of European countries is: (1) positively associated with US military spending and (2) negatively associated with average military spending of other European countries.

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...

Future and potential spending on health 2015-40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries.

Science.gov (United States)

2017-05-20

The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. We estimated that global spending on health will increase from US$9·21 trillion in 2014 to $24·24 trillion (uncertainty interval [UI] 20·47-29·72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5·3% (UI 4·1-6·8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4·2% (3·8-4·9). High-income countries are expected to grow at 2·1% (UI 1·8-2·4) and low-income countries are expected to grow at 1·8% (1·0-2·8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending

How Much Do We Spend? Creating Historical Estimates of Public Health Expenditures in the United States at the Federal, State, and Local Levels.

Science.gov (United States)

Leider, Jonathon P; Resnick, Beth; Bishai, David; Scutchfield, F Douglas

2018-04-01

The United States has a complex governmental public health system. Agencies at the federal, state, and local levels all contribute to the protection and promotion of the population's health. Whether the modern public health system is well situated to deliver essential public health services, however, is an open question. In some part, its readiness relates to how agencies are funded and to what ends. A mix of Federalism, home rule, and happenstance has contributed to a siloed funding system in the United States, whereby health agencies are given particular dollars for particular tasks. Little discretionary funding remains. Furthermore, tracking how much is spent, by whom, and on what is notoriously challenging. This review both outlines the challenges associated with estimating public health spending and explains the known sources of funding that are used to estimate and demonstrate the value of public health spending.

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.

The Problem With Estimating Public Health Spending.

Science.gov (United States)

Leider, Jonathon P

2016-01-01

Accurate information on how much the United States spends on public health is critical. These estimates affect planning efforts; reflect the value society places on the public health enterprise; and allows for the demonstration of cost-effectiveness of programs, policies, and services aimed at increasing population health. Yet, at present, there are a limited number of sources of systematic public health finance data. Each of these sources is collected in different ways, for different reasons, and so yields strikingly different results. This article aims to compare and contrast all 4 current national public health finance data sets, including data compiled by Trust for America's Health, the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), and the Census, which underlie the oft-cited National Health Expenditure Account estimates of public health activity. In FY2008, ASTHO estimates that state health agencies spent $24 billion ($94 per capita on average, median $79), while the Census estimated all state governmental agencies including state health agencies spent $60 billion on public health ($200 per capita on average, median $166). Census public health data suggest that local governments spent an average of $87 per capita (median $57), whereas NACCHO estimates that reporting LHDs spent $64 per capita on average (median $36) in FY2008. We conclude that these estimates differ because the various organizations collect data using different means, data definitions, and inclusion/exclusion criteria--most notably around whether to include spending by all agencies versus a state/local health department, and whether behavioral health, disability, and some clinical care spending are included in estimates. Alongside deeper analysis of presently underutilized Census administrative data, we see harmonization efforts and the creation of a standardized expenditure reporting system as a way to

Retail prescription drug spending in the National Health Accounts.

Science.gov (United States)

Smith, Cynthia

2004-01-01

Recent rapid spending growth for retail drugs has largely arisen from increased use of new drugs, rather than from increasing prices of existing drugs. A sizable shift in the payment from consumers to third parties has also contributed to faster growth. Strategies such as negotiating for rebates and using tiered copayments have sought to slow spending growth but simultaneously have complicated the estimation of spending in the National Health Accounts (NHA). NHA estimates show that retail pharmaceuticals' share of health spending is not much different than it was in 1960, although its share of gross domestic product (GDP) has tripled.

Does spending on refugees make a difference? A cross-sectional study of the association between refugee program spending and health outcomes in 70 sites in 17 countries.

Science.gov (United States)

Tan, Timothy M; Spiegel, Paul; Haskew, Christopher; Greenough, P Gregg

2016-01-01

Numerous simultaneous complex humanitarian emergencies strain the ability of local governments and the international community to respond, underscoring the importance of cost-effective use of limited resources. At the end of 2011, 42.5 million people were forcibly displaced, including 10.4 million refugees under the mandate of the United Nations High Commissioner for Refugees (UNHCR). UNHCR spent US$1.65 billion on refugee programs in 2011. We analyze the impact of aggregate-level UNHCR spending on mortality of refugee populations. Using 2011 budget data, we calculated purchasing power parity adjusted spending, disaggregated by population planning groups (PPGs) and UNHCR Results Framework objectives. Monthly mortality reported to UNHCR's Health Information System from 2011 to 2012 was used to calculate crude (CMR) and under-5 (U5MR) mortality rates, and expressed as ratios to country of asylum mortality. Log-linear regressions were performed to assess correlation between spending and mortality. Mortality data for 70 refugee sites representing 1.6 million refugees in 17 countries were matched to 20 PPGs. Median 2011 spending was $623.27 per person (constant 2011 US$). Median CMR was 2.4 deaths per 1,000 persons per year; median U5MR was 18.1 under-5 deaths per 1,000 live births per year. CMR was negatively correlated with total spending ( p =  0.027), and spending for fair protection processes and documentation ( p =  0.005), external relations ( p =  0.034), logistics and operations support ( p =  0.007), and for healthcare ( p =  0.046). U5MR ratio was negatively correlated with total spending ( p =  0.015), and spending for favorable protection environment ( p =  0.024), fair protection processes and documentation ( p =  0.003), basic needs and essential services ( p =  0.027), and within basic needs, for healthcare services ( p =  0.007). Increased UNHCR spending on refugee populations is correlated with lower mortality

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...... effectiveness canexceed the welfare loss from introducing new distortions. Moreover, it is found that the investment subsidy is gradually phased out of the welfare maximizing policy, which may be a policy combining the two subsidies, when the level of government spending is increased.Keywords: welfare ranking......, indirect and direct policy instruments, restricted government spending JEL: E61, O21, O41...

Loyalty for Sale? Military Spending and Coups d'Etat

OpenAIRE

Leon, G.

2012-01-01

Coups d'etat continue to be common around the world, often leading to changes in leaders and institutions. We examine the relationship between military spending and coups and find that (i) successful coups increase military spending by more than failed attempts, and (ii) coups are more likely when military spending as a share of GDP is relatively low. Our identification strategy exploits the conditional independence between a coup's outcome and the change in military spending that follows it....

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.

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. Project HOPE—The People-to-People Health Foundation, Inc.

Medicare hospital spending per patient (Medicare Spending per Beneficiary) – Additional Decimal Places

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...

The economic impact of NASA R and D spending

Science.gov (United States)

Evans, M. K.

1976-01-01

The economic impact of R and D spending, particularly NASA R and D spending, on the U. S. economy was evaluated. The crux of the methodology and hence the results revolve around the fact that it was necessary to consider both the demand effects of increased spending and the supply effects of a higher rate of technological growth and a larger total productive capacity. The demand effects are primarily short-run in nature, while the supply effects do not begin to have a significant effect on aggregate economic activity until the fifth year after increased expenditures have taken place. The short-term economic impact of alternative levels of NASA expenditures for 1975 was first examined. The long-term economic impact of increased levels of NASA R and D spending over a sustained period was then evaluated.

Social protection spending and inequalities in depressive symptoms across Europe.

Science.gov (United States)

Niedzwiedz, Claire L; Mitchell, Richard J; Shortt, Niamh K; Pearce, Jamie R

2016-07-01

Common mental disorders are an increasing global public health concern. The least advantaged in society experience a greater burden of mental illness, but inequalities in mental health vary by social, political, and economic contexts. This study investigates whether spending on different types of social protection alters the extent of social inequality in depressive symptoms. Data were obtained from the 2006 and 2012 cross-sectional waves of the European Social Survey, which included 48,397 individuals from 18 European countries. Depressive symptoms were measured using the Centre for Epidemiologic Studies-Depression Scale (CES-D 8). Statistical interactions between country-level social protection spending and individuals' education level, employment and family status were explored using multilevel regression models. Higher spending on active labour market programmes was related to narrower inequality in depressive symptoms by education level. Compared to men with high education, the marginal effect of having low education was 1.67 (95 % CI, 1.46-1.87) among men in countries with lower spending and 0.85 (95 % CI, 0.66-1.03) in higher spending countries. Single parents exhibited fewer depressive symptoms, as spending on family policies increased. Little evidence was found for an overall association between spending on unemployment benefits and employment-related inequalities in depressive symptoms, but in 2012, unemployment spending appeared beneficial to mental health among the unemployed. Greater investment in social protection may act to reduce inequalities in depressive symptoms. Reductions in spending levels or increased conditionality may adversely affect the mental health of disadvantaged social groups.

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.

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

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.

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...

Worldwide Military Spending, 1990-1995

OpenAIRE

Jerald A Schiff; Benedict J. Clements; Sanjeev Gupta

1996-01-01

The decline in military spending that began in the mid-1980s continued through 1995, and this decline was widespread both geographically and by level of development. Cuts in military spending appear to have potentially important implications for nonmilitary spending and fiscal adjustment. In contrast to findings for previous periods, military spending has declined more than proportionately in those countries that have reduced total spending. Countries with Fund programs have reduced military ...

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 not...

Pro Bono Publico? Demand for Military Spending Between the World Wars

Directory of Open Access Journals (Sweden)

Jari Eloranta

2017-06-01

Full Text Available This article analyzes the demand for military spending in the 1920s and 1930s, based on variables arising from the international system and the selected countries. The main premise is that the military spending was an impure public good, implying that both public and private benefits drove the demand for this type of expenditure. Threats arising from the autocratic states in the 1930s increased these expenditures, and democracies overall tended to spend less. Moreover, the absence of clear international leadership by the USA or UK destabilized the international system and increased military spending, with alliances failing to produce a public good effect. Military spending resulted in joint products at the level of state and within state, and the level of economic development seemed to exert a downward pressure on the military spending of these states. There were some contradictory spillover effects felt by these states. On the whole, this article suggests that scholars should expand their explanatory models to include impure public good influences in military spending analysis.

Spending and cutting are two different worlds

DEFF Research Database (Denmark)

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

2016-01-01

This article investigates politicians’ preferences for cutting and spending. The research questions are where do politicians prefer to cut, where do they prefer to spend and how is this influenced by political ideology? These questions are investigated in a large-scale survey experiment fielded...... to Danish local councillors, who are randomly assigned to a decision-making situation, where the block grant provided to their municipality is either increased or reduced. The results show that the politicians’ preferences for cutting and spending are asymmetric, in the sense that the policy areas, which...... are assigned the least cuts when the grant is reduced, are rarely the ones which are assigned extra money when the grant is increased. Areas with well-organised interests and a target group which is perceived as deserving are granted more money, whereas policy areas where the target group is perceived as less...

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

Smart shopping carts : How real-time feedback influences spending

NARCIS (Netherlands)

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

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

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

Health Spending By State 1991-2014: Measuring Per Capita Spending By Payers And Programs.

Science.gov (United States)

Lassman, David; Sisko, Andrea M; Catlin, Aaron; Barron, Mary Carol; Benson, Joseph; Cuckler, Gigi A; Hartman, Micah; Martin, Anne B; Whittle, Lekha

2017-07-01

As the US health sector evolves and changes, it is informative to estimate and analyze health spending trends at the state level. These estimates, which provide information about consumption of health care by residents of a state, serve as a baseline for state and national-level policy discussions. This study examines per capita health spending by state of residence and per enrollee spending for the three largest payers (Medicare, Medicaid, and private health insurance) through 2014. Moreover, it discusses in detail the impacts of the Affordable Care Act implementation and the most recent economic recession and recovery on health spending at the state level. According to this analysis, these factors affected overall annual growth in state health spending and the payers and programs that paid for that care. They did not, however, substantially change state rankings based on per capita spending levels over the period. Project HOPE—The People-to-People Health Foundation, Inc.

Globalisation and social spending

OpenAIRE

De Grauwe, Paul; Polan, Magdalena

2003-01-01

We provide evidence indicating that countries with well-developed social security systems do not necessarily face a trade-off between social spending and competitiveness. On average, countries that spend a lot on social needs score well in the competitiveness league. We investigate the importance of a reverse causality from competitiveness to social spending, and find that this is weak. We also present some possible explanations for our empirical finding. Finally, we interpret our findings in...

The Multi-Billion Dollar Drug-Sensitive Spending Opportunity.

Science.gov (United States)

Easter, Jon C; Thorpe, Kenneth

2018-01-01

Chronic diseases increase utilization and avoidable drug-sensitive spending, but little is done to optimize medication use and drive value. Value-based approaches to health care financing should shift focus to drug-sensitive spending to balance patient access and quality improvement with cost containment. ©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995-2015.

Science.gov (United States)

2018-05-05

Comparable estimates of health spending are crucial for the assessment of health systems and to optimally deploy health resources. The methods used to track health spending continue to evolve, but little is known about the distribution of spending across diseases. We developed improved estimates of health spending by source, including development assistance for health, and, for the first time, estimated HIV/AIDS spending on prevention and treatment and by source of funding, for 188 countries. We collected published data on domestic health spending, from 1995 to 2015, from a diverse set of international agencies. We tracked development assistance for health from 1990 to 2017. We also extracted 5385 datapoints about HIV/AIDS spending, between 2000 and 2015, from online databases, country reports, and proposals submitted to multilateral organisations. We used spatiotemporal Gaussian process regression to generate complete and comparable estimates for health and HIV/AIDS spending. We report most estimates in 2017 purchasing-power parity-adjusted dollars and adjust all estimates for the effect of inflation. Between 1995 and 2015, global health spending per capita grew at an annualised rate of 3·1% (95% uncertainty interval [UI] 3·1 to 3·2), with growth being largest in upper-middle-income countries (5·4% per capita [UI 5·3-5·5]) and lower-middle-income countries (4·2% per capita [4·2-4·3]). In 2015, $9·7 trillion (9·7 trillion to 9·8 trillion) was spent on health worldwide. High-income countries spent $6·5 trillion (6·4 trillion to 6·5 trillion) or 66·3% (66·0 to 66·5) of the total in 2015, whereas low-income countries spent $70·3 billion (69·3 billion to 71·3 billion) or 0·7% (0·7 to 0·7). Between 1990 and 2017, development assistance for health increased by 394·7% ($29·9 billion), with an estimated $37·4 billion of development assistance being disbursed for health in 2017, of which $9·1 billion (24·2%) targeted HIV/AIDS. Between 2000 and

The economic impact of NASA R and D spending: Executive summary

Science.gov (United States)

Evans, M. K.

1976-01-01

An evaluation of the economic impact of NASA research and development programs is made. The methodology and the results revolve around the interrelationships existing between the demand and supply effects of increased research and development spending, in particular, NASA research and development spending. The INFORUM Inter-Industry Forecasing Model is used to measure the short-run economic impact of alternative levels of NASA expenditures for 1975. An aggregate production function approach is used to develop the data series necessary to measure the impact of NASA research and development spending, and other determinants of technological progress, on the rate of growth in productivity of the U. S. economy. The measured relationship between NASA research and development spending and technological progress is simulated in the Chase Macroeconometric Model to measure the immediate, intermediate, and long-run economic impact of increased NASA research and development spending over a sustained period.

U.S. industry to hold 1994 spending at the 1993 level

International Nuclear Information System (INIS)

Beck, R.J.

1994-01-01

A sharp cut in spending on pipelines will hold US petroleum industry budgets at about 1993 levels for domestic projects this year. Excluding pipeline outlays, industry spending for capital and exploration items will advance. Oil and Gas Journal's annual budget survey shows US companies plan to spend $31.3 billion on US projects in 1994, down only 0.7% from 1993. Spending last year was down by the same percentage from 1992's $31.7 billion. Total outlays, excluding pipelines, well be $28.9 billion, up 5.8% from 1993. In 1993 spending excluding pipelines was $27.3 billion, down 1.2% from 1992. Industry's total spending hit a high of $83 billion in 1981. It then fell to the recent low of $25.2 billion in 1987. Adjusted for inflation, spending in 1994 will be the lowest since 1987. A sharp drop in drilling lowered upstream outlays during the past several years. At the same time, spending for upgrades, renovation, environmental compliance, marketing, and transportation bolstered downstream budgets. E and P spending in 1994 will increase 6.2% from the 1993 level, moving up to $14.8 billion. Refining capital spending will inch up 0.9% to $5.4 billion for 1994

Understanding the size of the government spending multiplier: It's in the sign

OpenAIRE

Barnichon, Régis; Matthes, Christian

2016-01-01

Despite intense scrutiny, estimates of the government spending multiplier remain highly uncertain, with values ranging from 0.5 to 2. While an increase in government spending is generally assumed to have the same (mirror-image) effect as a decrease in government spending, we show that relaxing this assumption is important to understand the effects of fiscal policy. Regardless of whether we identify government spending shocks from (i) a narrative approach, or (ii) a timing restr...

Can corruption favour growth via the composition of government spending?

OpenAIRE

Sugata Ghosh; Andros Gregoriou

2010-01-01

In an endogenous growth model with two public goods, we analytically derive the optimal composition of government spending in the presence of corruption. Although corruption results in a loss of productivity per se, an increase in corruption in the category of public spending that is harmed relatively more by corruption could have a favourable effect on growth, as it would encourage a benevolent government to divert spending towards the public good that is more productive, net of corruption.

Inequalities in Parental Spending on Young Children: 1980-2010

Science.gov (United States)

Kornrich, Sabino

2016-01-01

Using 1972-2000 data from the Consumer Expenditure Survey (CES), a nationally representative survey of spending conducted by the Bureau of Labor Statistics, this paper investigates changes in the income-based gap in monetary investments in children under the age of six, when most children typically have entered school in the United States. The…

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...

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...

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...

Public hospital spending in England: Evidence from National Health Service administrative records

OpenAIRE

Kelly, Elaine; Stoye, George; Vera-Hernández, Marcos

2015-01-01

Health spending per capita in England has more than doubled since 1997, yet relatively little is known about how that spending is distributed across the population. This paper uses administrative National Health Service (NHS) hospital records to examine key features of public hospital spending in England. We describe how costs vary across the lifecycle, and the concentration of spending among people and over time. We find that costs per person start to increase after age 50 and escalate after...

Economic Recovery vs. Defense Spending.

Science.gov (United States)

De Grasse, Robert; Murphy, Paul

1981-01-01

Evaluates President Reagan's proposed military buildup in light of the cuts such expenditures would necessitate in approximately 300 domestic programs. Suggests that the dramatic proposed increase in military spending risks higher inflation and slower economic growth. Concludes with a plea for rethinking of Reagan's dramatic shift in national…

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.

Industry Evidence on the Effects of Government Spending

OpenAIRE

Christopher J. Nekarda; Valerie A. Ramey

2010-01-01

This paper investigates industry-level effects of government purchases in order to shed light on the transmission mechanism for government spending on the aggregate economy. We begin by highlighting the different theoretical predictions concerning the effects of government spending on industry labor market equilibrium. We then create a panel data set that matches output and labor variables to shifts in industry-specific government demand. The empirical results indicate that increases in gover...

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. © The Author 2016. Published by Oxford University Press

Effects of macroeconomic trends on social security spending due to sickness and disability.

Science.gov (United States)

Khan, Jahangir; Gerdtham, Ulf-G; Jansson, Bjarne

2004-11-01

We analyzed the relationship between macroeconomic conditions, measured as unemployment rate and social security spending, from 4 social security schemes and total spending due to sickness and disability. We obtained aggregated panel data from 13 Organization for Economic Cooperation and Development member countries for 1980-1996. We used regression analysis and fixed effect models to examine spending on sickness benefits, disability pensions, occupational-injury benefits, survivor's pensions, and total spending. A decline in unemployment increased sickness benefits spending and reduced disability pension spending. These effects reversed direction after 4 years of unemployment. Inclusion of mortality rate as an additional variable in the analysis did not affect the findings. Macroeconomic conditions influence some reimbursements from social security schemes but not total spending.

Tax-and-Spend or Spend-and-Tax? Empirical Evidence from Malaysia

OpenAIRE

Tan Juat Hong

2009-01-01

The paper investigates the causal relationships between government spending and revenue for Malaysia. The study uses annual data, a Johansen cointegration test and an error-correction model. A preliminary test shows that government revenue and expenditure are cointegrated. Empirical results support the spend-and-tax hypothesis. Furthermore, they underscore the fact that fiscal policy may not be effective enough to curb the rising budget deficits over the long term and may even reduce private ...

Trade Costs, Conflicts, and Defense Spending

OpenAIRE

Seitz, Michael; Tarasov, Alexander; Zakharenko, Roman

2013-01-01

This paper develops a quantitative model of trade, military conflicts, and defense spending. Trade liberalization between two countries reduces probability of an armed conflict between them, causing both to cut defense spending. This in turn causes a domino effect on defense spending by other countries. As a result, both countries and the rest of the world are better off. We estimate the model using data on trade, conflicts, and military spending. We find that, after reduction of costs of tra...

Saving Money or Spending Tomorrow's Money

Institute of Scientific and Technical Information of China (English)

罗芳梅

2017-01-01

Chinese are normally believed to be thrifty.However,economic development has had a tremendous impact upon Chinese society,uprooting the long-engraved ideas.With the emergence of the credit cards,spending tomorrow's money becomes a reality.In this way,people are in dilemma:saving money or spending tomorrow's money.Firstly,this paper focuses on the benefits of spending tomorrow's money.Secondly,it shows that spending tomorrow's money is confronted with many challenges.Finally,the paper comes up with some suggestions to solve these problems.

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

Health spending by state of residence, 1991-2009.

Science.gov (United States)

Cuckler, Gigi; Martin, Anne; Whittle, Lekha; Heffler, Stephen; Sisko, Andrea; Lassman, Dave; Benson, Joseph

2011-12-06

Provide a detailed discussion of baseline health spending by state of residence (per capita personal health care spending, per enrollee Medicare spending, and per enrollee Medicaid spending) in 2009, over the last decade (1998-2009), as well as the differential regional and state impacts of the recent recession. State Health Expenditures by State of Residence for 1991-2009, produced by the Centers for Medicare & Medicaid Services' Office of the Actuary. 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 spending was lowest ranged from 8 to 26 percent below the national average. States with the highest per capita spending tended to have older populations and the highest per capita incomes; states with the lowest per capita spending tended to have younger populations, lower per capita incomes, and higher rates of uninsured. Over the last decade, the New England and Mideast regions exhibited the highest per capita personal health care spending, while states in the Southwest and Rocky Mountain regions had the lowest per capita spending. Variation in per enrollee Medicaid spending, however, has consistently been greater than that of total per capita personal health care spending or per enrollee Medicare spending from 1998-2009. The Great Lakes, New England, and Far West regions experienced the largest slowdown in per person health spending growth during the recent recession, largely as a result of higher unemployment rates. Public Domain.

Pipeline, utilities to spend $127 million on scada systems

International Nuclear Information System (INIS)

Anon.

1993-01-01

Spending for new or upgraded supervisory control and data acquisition (scada) systems and for additional remote-terminal units (RTUs) by North American pipelines and utilities will exceed $165 million through February 1996. New and updated scada systems will total 122 at a cost of more than $127 million; 143 RTU add-on projects will cost more than $38 million. Pipelines and combined utilities/pipelines will spend $89.5 million for 58 scada-system projects and $30.2 million for RTU add-on projects. Scada systems are computerized hardware and software systems that perform monitoring and control functions. In gas utilities, these systems perform functions normally associated with gas transmission and distribution as well as production-plant process control. In gas and oil pipelines, the systems perform these functions as well as such specialized functions as batch tracking, leak detection, and gas load flow

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).

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.

Report on Spending Trends Highlights Inequities in Model for Financing Colleges

Science.gov (United States)

Blumenstyk, Goldie

2009-01-01

An analysis of spending trends that is designed to discourage policy makers' focus on finding new revenue rather than reining in spending suggests that the model for financing colleges has reinforced educational inequities and failed to increase the rate at which students graduate. According to the analysis, "serious fault lines" in the current…

Health care spending accounts: a flexible solution for Canadian employers.

Science.gov (United States)

Smithies, R; Steeves, L

1996-01-01

Flexible benefits plans have grown more slowly in Canada than in the United States, largely because of certain legal and regulatory considerations. Health care spending accounts (HCSAs) provide a cost-effective way for Canadian employers to address the health care benefit needs of a diverse workforce. A flexible health care spending account is a versatile and cost-effective instrument that can be used by Canadian employers that wish to provide a full range of health care benefits to employees. The health care alternatives available through an HCSA can provide employees with an opportunity to customize and optimize their benefits program. Regulatory requirements that an HCSA must meet in order to qualify for available tax advantages are discussed, as are the range of health care services that may be covered.

Crowd-out of defence and health spending: is Israel different from other industrialised nations?

Science.gov (United States)

Reeves, Aaron; Stuckler, David

2013-04-22

Does high defence spending limit the growth of public health investment? Using comparative data from 31 OECD countries between 1980 and 2010, we find little evidence that defence crowds out public health spending. Whether measured in terms of long-term levels or short-term changes, per capita defence and health spending positively and significantly correlate. To investigate the possibility that countries with high security needs such as Israel exhibit differing patterns, we also compare crowd-out among countries experiencing violent conflicts as well as current high military-spending countries. We observed a greater positive correlation between changes in health and defence spending among conflict-countries (r = 0.65, p military spending countries, Israel's politicians reduced defence spending while increasing health expenditure during its recent recession. These analyses reveal that while Israel's politicians have chronically underinvested in public health, there are modest steps being taken to rectify the country's unique and avoidable crowding out of public health from its high military spending.

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.

U.S., non-U.S. outlays to rise in '98, but oil price plunge clouds spending outlook

International Nuclear Information System (INIS)

Beck, R.J.

1998-01-01

Capital spending by oil and gas companies in and outside the US will rise in 1998, but that forecast may be jeopardized by the continuing plunge in oil prices. For operations in the US, oil and gas company capital spending is expected to move up in 1998 for the fourth year in a row. If the money is spent, it will be the highest industry investment level since 1985. Strong oil and gas prices and increased volumes have boosted company cash flow and profits the last few years, fueling increased spending. However, the near-term outlook has now been clouded by economic turmoil in a number of Asian countries and the recent collapse of oil prices. The paper discusses oil and gas prices, US upstream spending, US non-exploration and production spending, capital spending in Canada, and spending outside US and Canada

TRENDS IN SLOVAK REPUBLIC’S MILITARY SPENDING

Directory of Open Access Journals (Sweden)

Milota KUSTROVÁ

2012-01-01

Full Text Available The article focuses on the amount of military spending in the Slovak Republic. In the first part, the terms of defense expenditure and military spending are defined. The second part focuses on the evolution of military spending in the Slovak Republic so far and the future prospects, as well as on the structure of military spending. The final part covers the amount of defense expenditure in relation to the objectives and tasks of the Armed Forces of the Slovak Republic.

Re-spending rebound: A macro-level assessment for OECD countries and emerging economies

International Nuclear Information System (INIS)

Antal, Miklós; Bergh, Jeroen C.J.M. van den

2014-01-01

It is well-known that energy conservation can lead to rebound effects that partly offset the original energy savings. One particular rebound mechanism is re-spending of money savings associated with energy savings on energy intensive goods or services. We calculate the average magnitude of this “re-spending rebound” for different fuels and countries, and for both energy and carbon (CO 2 ) emissions. We find that emerging economies, neglected in past studies, typically have larger rebounds than OECD countries. Since such economies play an increasingly important role in the global economy the re-spending rebound is a growing concern. The re-spending effect is generally larger for gasoline than for natural gas and electricity. Paradoxically, stronger financial incentives to conserve energy tend to increase the rebound. This suggests that with climate regulation and peak oil the re-spending rebound may become more important. We discuss the policy implications of our findings. - highlights: • Energy and carbon rebound due to re-spending of money savings is analyzed. • The average magnitude of this rebound is calculated for several countries. • Emerging economies typically have substantially larger rebounds than OECD countries. • The effect is generally stronger for gasoline than for natural gas and electricity. • Policy conclusions are drawn

Trends in prescription drug utilization and spending for the Department of Defense, 2002-2007.

Science.gov (United States)

Devine, Joshua W; Trice, Shana; Spridgen, Stacia L; Bacon, Thomas A

2009-09-01

Examine trends in U.S. Department of Defense (DoD) outpatient drug spending and utilization between 2002 and 2007. We analyzed pharmacy claims data from the U.S. Military Health System (MHS), using a cross-sectional analysis at the prescription and patient-year level and measuring utilization in 30-day equivalent prescriptions and expenditures in dollars. Pharmaceutical spending more than doubled in DoD, from $3 billion in FY02 to $6.5 billion in FY07. The largest increase occurred in the DoD community pharmacy network, where utilization grew from 6 million 30-day equivalent prescriptions in the first quarter of FY02 to more than 16 million in the last quarter of FY07. The smallest increase in annual spending occurred in FY07 (5.5%), down from a high of 27.5% in FY03. The MHS has experienced rapid growth in pharmaceutical spending since FY02. However, there are signs that growth in pharmaceutical spending may be slowing.

Health Spending by State of Residence, 1991–2009

Science.gov (United States)

Cuckler, Gigi; Martin, Anne; Whittle, Lekha; Heffler, Stephen; Sisko, Andrea; Lassman, Dave; Benson, Joseph

2011-01-01

Objective Provide a detailed discussion of baseline health spending by state of residence (per capita personal health care spending, per enrollee Medicare spending, and per enrollee Medicaid spending) in 2009, over the last decade (1998–2009), as well as the differential regional and state impacts of the recent recession. Data Source State Health Expenditures by State of Residence for 1991–2009, produced by the Centers for Medicare & Medicaid Services' Office of the Actuary. Principal Findings 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 spending was lowest ranged from 8 to 26 percent below the national average. States with the highest per capita spending tended to have older populations and the highest per capita incomes; states with the lowest per capita spending tended to have younger populations, lower per capita incomes, and higher rates of uninsured. Over the last decade, the New England and Mideast regions exhibited the highest per capita personal health care spending, while states in the Southwest and Rocky Mountain regions had the lowest per capita spending. Variation in per enrollee Medicaid spending, however, has consistently been greater than that of total per capita personal health care spending or per enrollee Medicare spending from 1998–2009. The Great Lakes, New England, and Far West regions experienced the largest slowdown in per person health spending growth during the recent recession, largely as a result of higher unemployment rates. PMID:22340779

Higher fees paid to US physicians drive higher spending for physician services compared to other countries.

Science.gov (United States)

Laugesen, Miriam J; Glied, Sherry A

2011-09-01

Higher health care prices in the United States are a key reason that the nation's health spending is so much higher than that of other countries. Our study compared physicians' fees paid by public and private payers for primary care office visits and hip replacements in Australia, Canada, France, Germany, the United Kingdom, and the United States. We also compared physicians' incomes net of practice expenses, differences in financing the cost of medical education, and the relative contribution of payments per physician and of physician supply in the countries' national spending on physician services. Public and private payers paid somewhat higher fees to US primary care physicians for office visits (27 percent more for public, 70 percent more for private) and much higher fees to orthopedic physicians for hip replacements (70 percent more for public, 120 percent more for private) than public and private payers paid these physicians' counterparts in other countries. US primary care and orthopedic physicians also earned higher incomes ($186,582 and $442,450, respectively) than their foreign counterparts. We conclude that the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher US spending, particularly in orthopedics.

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.

Trends in Health Care Spending by the Private Sector

Science.gov (United States)

1997-04-01

private - sector spending for health insurance increases each year has raised many questions about the meaning of the trend and its implications for the future. According to the federal government’s national health accounts (NHA), the annual growth rate of private health insurance expenditures tumbled from around 14 percent in 1990 to less than 3 percent in 1994 and 1995. Understanding the factors that contribute to that reduction is of particular concern to policymakers who are seeking ways to slow the growth of Medicare spending. At the same time that fundamental

Corruption and government spending : The role of decentralization

OpenAIRE

Korneliussen, Kristine

2009-01-01

This thesis points to a possible weakness of the empirical literature on corruption and government spending. That corruption affects the composition of government spending, and in particular that it affects education and health spending adversely, seems to be empirically well established. However, there exist additional literature closely related to corruption and government spending, treating(i) a relationship between corruption and decentralization, and (ii) a relationship between decentral...

Private Debt Overhang and the Government Spending Multiplier: Evidence for the United States

OpenAIRE

Bernardini, Marco; Peersman, Gert

2015-01-01

Using state-dependent local projection methods and historical U.S. data, we find that government spending multipliers are considerably larger in periods of private debt overhang. In particular, we find significant crowding-out of personal consumption and investment in low-debt states, resulting in multipliers that are significantly below one. Conversely, in periods of private debt overhang, there is a strong crowding-in effect, while multipliers are much larger than one. In high-debt states, ...

Future and potential spending on health 2015-40

NARCIS (Netherlands)

Dieleman, Joseph L.; Campbell, Madeline; Chapin, Abigail; Eldrenkamp, Erika; Fan, Victoria Y.; Haakenstad, Annie; Kates, Jennifer; Li, Zhiyin; Matyasz, Taylor; Micah, Angela; Reynolds, Alex; Sadat, Nafis; Schneider, Matthew T.; Sorensen, Reed; Abbas, Kaja M.; Abera, Semaw Ferede; Ahmad Kiadaliri, Aliasghar; Ahmed, Muktar Beshir; Alam, Khurshid; Alizadeh-Navaei, Reza; Alkerwi, A.; Amini, Erfan; Ammar, Walid; Antonio, Carl Abelardo T.; Atey, Tesfay Mehari; Avila-Burgos, Leticia; Awasthi, Ashish; Barac, Aleksandra; Berheto, Tezera Moshago; Beyene, Addisu Shunu; Beyene, Tariku Jibat; Birungi, Charles; Bizuayehu, Habtamu Mellie; Breitborde, Nicholas J.K.; Cahuana-Hurtado, Lucero; Castro, Ruben Estanislao; Catalá-López, Ferran; Dalal, Koustuv; Dandona, Lalit; Dharmaratne, Rakhi Dandona Samath D.; Dubey, Manisha; Faro, Andé; Feigl, Andrea B.; Fischer, Florian; Anderson Fitchett, Joseph R.; Foigt, Nataliya; Giref, Ababi Zergaw; Gupta, Rahul; Hamidi, Samer; Harb, Hilda L.; Hay, Simon I.; Hendrie, Delia; Horino, Masako; Jürisson, Mikk; Jakovljevic, Mihajlo B.; Javanbakht, Mehdi; John, Denny; Jonas, Jost B.; Karimi, Seyed M.; Khang, Young Ho; Khubchandani, Jagdish; Kim, Yun Jin; Kinge, Jonas M.; Krohn, Kristopher J.; Kumar, G.A.; Leung, Ricky; Magdy Abd El Razek, Hassan; Magdy Abd El Razek, Mohammed; Majeed, Azeem; Malekzadeh, Reza; Malta, Deborah Carvalho; Meretoja, Atte; Miller, Ted R.; Mirrakhimov, Erkin M.; Mohammed, Shafiu; Molla, Gedefaw; Nangia, Vinay; Olgiati, Stefano; Owolabi, Mayowa O.; Patel, Tejas; Paternina Caicedo, Angel J.; Pereira, David M.; Perelman, Julian; Polinder, Suzanne; Rafay, Anwar; Rahimi-Movaghar, Vafa; Rai, Rajesh Kumar; Ram, Usha; Ranabhat, Chhabi Lal; Roba, Hirbo Shore; Savic, Miloje; Sepanlou, Sadaf G.; Ao, Te Braden J.; Tesema, Azeb Gebresilassie; Thomson, Alan J.; Tobe-Gai, Ruoyan; Topor-Madry, Roman; Undurraga, Eduardo A.; Vargas, Veronica; Vasankari, Tommi; Violante, Francesco S.; Wijeratne, Tissa; Xu, Gelin; Yonemoto, Naohiro; Younis, Mustafa Z.; Yu, Chuanhua; Zaidi, Zoubida; Sayed Zaki, El Maysaa; Murray, Christopher J.L.

2017-01-01

Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future

Public preferences for government spending in Canada

Directory of Open Access Journals (Sweden)

Ramji Sabrina

2012-10-01

Full Text Available Abstract This study considers three questions: 1. What are the Canadian public’s prioritization preferences for new government spending on a range of public health-related goods outside the scope of the country’s national system of health insurance? 2. How homogenous or heterogeneous is the Canadian public in terms of these preferences? 3. What factors are predictive of the Canadian public’s preferences for new government spending? Data were collected in 2008 from a national random sample of Canadian adults through a telephone interview survey (n =1,005. Respondents were asked to rank five spending priorities in terms of their preference for new government spending. Bivariate and multivariable logistic regression analyses were conducted. As a first priority, Canadian adults prefer spending on child care (26.2%, followed by pharmacare (23.1%, dental care (20.8%, home care (17.2%, and vision care (12.7%. Sociodemographic characteristics predict spending preferences, based on the social position and needs of respondents. Policy leaders need to give fair consideration to public preferences in priority setting approaches in order to ensure that public health-related goods are distributed in a manner that best suits population needs.

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.

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

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...... (respectively nine times) higher than average, but nevertheless are only 11 per cent (respectively a quarter) of lifetime spending. Out-of-pocket expenses on prescription drugs only amount to 3 per cent of total health expenditures and are less concentrated than these....

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

Increasing Public Expenditure

Directory of Open Access Journals (Sweden)

Ammar Ben Zaed

2017-04-01

Full Text Available 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 in the short and long term where you see the Wagner hypothesis that causal heading of GDP to government spending while there is a causal relationship analysis positive trending of government spending to GDP according to the Keynesian hypothesis in this study will be used descriptive analytical method to validate these hypotheses. Results in the short and long term made it clear that there is a difference in the outcome of Applied Studies where we find that each supports a relationship Wagner in the sense that the causal trending of real GDP to government spending and more precisely to increase the economic growth lead to increased aggregate demand which leads in turn increasing the need to increase government spending and to increase the resources available to the government sector to finance the increase in spending by the additional resources resulting from the economic growth while others opines opposes the existence of the relationship.

Mental health and substance use disorder spending in the Department of Veterans Affairs, fiscal years 2000-2007.

Science.gov (United States)

Wagner, Todd H; Sinnott, Patricia; Siroka, Andrew M

2011-04-01

This study analyzed spending for treatment of mental health and substance use disorders in the Department of Veterans Affairs (VA) in fiscal years (FYs) 2000 through 2007. VA spending as reported in the VA Decision Support System was linked to patient utilization data as reported in the Patient Treatment Files, the National Patient Care Database, and the VA Fee Basis files. All care and costs from FY 2000 to FY 2007 were analyzed. Over the study period the number of veterans treated at the VA increased from 3.7 million to over 5.1 million (an average increase of 4.9% per year), and costs increased .7% per person per year. For mental health and substance use disorder treatment, the volume of inpatient care decreased markedly, residential care increased, and spending decreased on average 2% per year (from $668 in FY 2000 to $578 per person in FY 2007). FY 2007 saw large increases in mental health spending, bucking the trend from FY 2000 through FY 2006. VA's continued emphasis on outpatient and residential care was evident through 2007. This trend in spending might be unimpressive if VA were enrolling healthier Veterans, but the opposite seems to be true: over this time period the prevalence of most chronic conditions, including depression and posttraumatic stress disorder, increased. VA spending on mental health care grew rapidly in 2007, and given current military activities, this trend is likely to increase.

Income distribution determinants and public spending efficiency

OpenAIRE

Afonso, António; Schuknecht, Ludger; Tanzi, Vito

2008-01-01

In this paper we examine the impact of public spending, education, and institutions on income distribution in advanced economies. We also assess the efficiency of public spending in redistributing income by using a DEA (Data Envelopment Analysis) nonparametric approach. We find that public policies significantly affect income distribution, notably via social spending, and indirectly via high quality education/human capital and via sound economic institutions. Moreover, for our set of OECD cou...

Trends in Health Care Spending by the Private Sector

National Research Council Canada - National Science Library

1997-01-01

A recent dramatic slowdown in the rate at which private-sector spending for health insurance increases each year has raised many questions about the meaning of the trend and its implications for the future...

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

Reductions in global biodiversity loss predicted from conservation spending

Science.gov (United States)

Waldron, Anthony; Miller, Daniel C.; Redding, Dave; Mooers, Arne; Kuhn, Tyler S.; Nibbelink, Nate; Roberts, J. Timmons; Tobias, Joseph A.; Gittleman, John L.

2017-11-01

Halting global biodiversity loss is central to the Convention on Biological Diversity and United Nations Sustainable Development Goals, but success to date has been very limited. A critical determinant of success in achieving these goals is the financing that is committed to maintaining biodiversity; however, financing decisions are hindered by considerable uncertainty over the likely impact of any conservation investment. For greater effectiveness, we need an evidence-based model that shows how conservation spending quantitatively reduces the rate of biodiversity loss. Here we demonstrate such a model, and empirically quantify how conservation investment between 1996 and 2008 reduced biodiversity loss in 109 countries (signatories to the Convention on Biological Diversity and Sustainable Development Goals), by a median average of 29% per country. We also show that biodiversity changes in signatory countries can be predicted with high accuracy, using a dual model that balances the effects of conservation investment against those of economic, agricultural and population growth (human development pressures). Decision-makers can use this model to forecast the improvement that any proposed biodiversity budget would achieve under various scenarios of human development pressure, and then compare these forecasts to any chosen policy target. We find that the impact of spending decreases as human development pressures grow, which implies that funding may need to increase over time. The model offers a flexible tool for balancing the Sustainable Development Goals of human development and maintaining biodiversity, by predicting the dynamic changes in conservation finance that will be needed as human development proceeds.

Reductions in global biodiversity loss predicted from conservation spending.

Science.gov (United States)

Waldron, Anthony; Miller, Daniel C; Redding, Dave; Mooers, Arne; Kuhn, Tyler S; Nibbelink, Nate; Roberts, J Timmons; Tobias, Joseph A; Gittleman, John L

2017-11-16

Halting global biodiversity loss is central to the Convention on Biological Diversity and United Nations Sustainable Development Goals, but success to date has been very limited. A critical determinant of success in achieving these goals is the financing that is committed to maintaining biodiversity; however, financing decisions are hindered by considerable uncertainty over the likely impact of any conservation investment. For greater effectiveness, we need an evidence-based model that shows how conservation spending quantitatively reduces the rate of biodiversity loss. Here we demonstrate such a model, and empirically quantify how conservation investment reduced biodiversity loss in 109 countries (signatories to the Convention on Biological Diversity and Sustainable Development Goals), by a median average of 29% per country between 1996 and 2008. We also show that biodiversity changes in signatory countries can be predicted with high accuracy, using a dual model that balances the effects of conservation investment against those of economic, agricultural and population growth (human development pressures). Decision-makers can use this model to forecast the improvement that any proposed biodiversity budget would achieve under various scenarios of human development pressure, and then compare these forecasts to any chosen policy target. We find that the impact of spending decreases as human development pressures grow, which implies that funding may need to increase over time. The model offers a flexible tool for balancing the Sustainable Development Goals of human development and maintaining biodiversity, by predicting the dynamic changes in conservation finance that will be needed as human development proceeds.

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

MULTI PERIOD SHOCKS ROLES ON GOVERNMENT SPENDING IN INDONESIA

Directory of Open Access Journals (Sweden)

Jaka Sriyana

2011-09-01

Full Text Available This paper proposes an alternative dynamic model of government spending in Indonesia. The model is based on short term disequilibrium assumption, in which multi period of shocks variables may play an important role. This research applies a loss function approach and uses optimum shock variables as the determinant for government spending during 1970-2010. The result shows that real GDP, population, and multi period shock of government spending are statistically significant. It provides evidence of the impact of multi period shocks to the realization of government spending. It implies that government faces a serious disequilibrium in determining their spending both in short and long terms.Keywords: Fiscal, government spending, deficit budget, shockJEL classification numbers: H53, H62, C22

Geographic Variation in Household and Catastrophic Health Spending in India: Assessing the Relative Importance of Villages, Districts, and States, 2011-2012.

Science.gov (United States)

Mohanty, Sanjay K; Kim, Rockli; Khan, Pijush Kanti; Subramanian, S V

2018-03-01

Policy Points: Per-capita household health spending was higher in economically developed states and was associated with ability to pay, but catastrophic health spending (CHS) was equally high in both poorer and more developed states in India. Based on multilevel modeling, we found that the largest geographic variation in health spending and CHS was at the state and village levels, reflecting wide inequality in the accessibility to and cost of health care at these levels. Contextual factors at macro and micro political units are important to reduce health spending and CHS in India. In India, health care is a local good, and households are the major source of financing it. Earlier studies have examined diverse determinants of health care spending, but no attempt has been made to understand the geographical variation in household and catastrophic health spending. We used multilevel modeling to assess the relative importance of villages, districts, and states to health spending in India. We used data on the health expenditures of 101,576 households collected in the consumption expenditure schedule (68th round) carried out by the National Sample Survey in 2011-2012. We examined 4 dependent variables: per-capita health spending (PHS), per-capita institutional health spending (PIHS), per-capita noninstitutional health spending (PNHS), and catastrophic health spending (CHS). CHS was defined as household health spending exceeding 40% of its capacity to pay. We used multilevel linear regression and logistic models to decompose the variation in each outcome by state, region, district, village, and household levels. The average PHS was 1,331 Indian rupees (INR), which varied by state-level economic development. About one-fourth of Indian households incurred CHS, which was equally high in both the economically developed and poorer states. After controlling for household level factors, 77.1% of the total variation in PHS was attributable to households, 10.1% to states, 9.5% to

Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities.

Science.gov (United States)

Mays, Glen P; Mamaril, Cezar B

2017-12-01

To examine whether local expenditures for public health activities influence area-level medical spending for Medicare beneficiaries. Six census surveys of the nation's 2,900 local public health agencies were conducted between 1993 and 2013, linked with contemporaneous information on population demographics, socioeconomic characteristics, and area-level Medicare spending estimates from the Dartmouth Atlas of Health Care. Measures derive from agency survey data and aggregated Medicare claims. A longitudinal cohort design follows the geographic areas served by local public health agencies. Multivariate, fixed-effects, and instrumental-variables regression models estimate how area-level Medicare spending changes in response to shifts in local public health spending, controlling for observed and unmeasured confounders. A 10 percent increase in local public health spending per capita was associated with 0.8 percent reduction in adjusted Medicare expenditures per person after 1 year (p health insurance coverage, and health professional shortages. Expanded financing for public health activities may provide an effective way of constraining Medicare spending, particularly in low-resource communities. © Health Research and Educational Trust.

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

Relationship between government spending and economic growth in the Czech Republic

Directory of Open Access Journals (Sweden)

Irena Szarowská

2011-01-01

Full Text Available This article aims to provide direct empirical evidence on business cycle relations between government spending and economic growth in the Czech Republic. Government spending plays an important role in a fiscal policy as a possible automatic stabilizer. We analyzed annual data on government spending in compliance with the COFOG international standard. We use cross-correlation on cyclically filtered adjusted time series over the period 1995–2008. The cyclical properties of GDP and government spending function were, in average, found as weakly correlated. However, we report considerable differences in correlations across the spending functions. The lowest correlation coefficient (0.06 was found for recreation, culture and religion and the highest average was reported for economic affairs (−0.51. As regards to using government spending as the stabilizer, total government spending, general public services, defense, economic affairs and education spending were negative correlated and it confirms countercyclical relation between these spending functions and GDP. It is in line with theory suggestion. On the other hand, the highest spending function (social protection correlated weak positive and it expresses procyclical development.The results of Johansen cointegration test proved the existence of long-run relationship between GDP and total government spending, GDP and public order and safety spending and GDP and economic affairs spending.

Is spending money on others good for your heart?

Science.gov (United States)

Whillans, Ashley V; Dunn, Elizabeth W; Sandstrom, Gillian M; Dickerson, Sally S; Madden, Kenneth M

2016-06-01

Does spending money on others (prosocial spending) improve the cardiovascular health of community-dwelling older adults diagnosed with high blood pressure? In Study 1, 186 older adults diagnosed with high blood pressure participating in the Midlife in the U.S. Study (MIDUS) were examined. In Study 2, 73 older adults diagnosed with high blood pressure were assigned to spend money on others or to spend money on themselves. In Study 1, the more money people spent on others, the lower their blood pressure was 2 years later. In Study 2, participants who were assigned to spend money on others for 3 consecutive weeks subsequently exhibited lower systolic and diastolic blood pressure compared to participants assigned to spend money on themselves. The magnitude of these effects was comparable to the effects of interventions such as antihypertensive medication or exercise. Together, these findings suggest that spending money on others shapes cardiovascular health, thereby providing a pathway by which prosocial behavior improves physical health among at-risk older adults. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Vertical integration: hospital ownership of physician practices is associated with higher prices and spending.

Science.gov (United States)

Baker, Laurence C; Bundorf, M Kate; Kessler, Daniel P

2014-05-01

We examined the consequences of contractual or ownership relationships between hospitals and physician practices, often described as vertical integration. Such integration can reduce health spending and increase the quality of care by improving communication across care settings, but it can also increase providers' market power and facilitate the payment of what are effectively kickbacks for inappropriate referrals. We investigated the impact of vertical integration on hospital prices, volumes (admissions), and spending for privately insured patients. Using hospital claims from Truven Analytics MarketScan for the nonelderly privately insured in the period 2001-07, we constructed county-level indices of prices, volumes, and spending and adjusted them for enrollees' age and sex. We measured hospital-physician integration using information from the American Hospital Association on the types of relationships hospitals have with physicians. We found that an increase in the market share of hospitals with the tightest vertically integrated relationship with physicians--ownership of physician practices--was associated with higher hospital prices and spending. We found that an increase in contractual integration reduced the frequency of hospital admissions, but this effect was relatively small. Taken together, our results provide a mixed, although somewhat negative, picture of vertical integration from the perspective of the privately insured.

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

Canadian capital spending to slip 4.7% in 1993

International Nuclear Information System (INIS)

Anon.

1993-01-01

Total capital and exploration spending by the Canadian petroleum industry is estimated at $6.579 billion in 1993, a drop of 4.7% from estimated 1992 outlays. Last year Canadian capital spending of $6.9 billion represented a drop of 8.9% from 1991 outlays, according to an Oil and Gas Journal survey. All survey related spending estimates in this paper are in U.S. dollars. All individual company spending estimates are in Canadian dollars

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.

Association of Reference Pricing with Drug Selection and Spending.

Science.gov (United States)

Robinson, James C; Whaley, Christopher M; Brown, Timothy T

2017-08-17

Background In the United States, prices for therapeutically similar drugs vary widely, which has prompted efforts by public and private insurers to steer patients toward the lower-priced options. Under reference pricing, the insurer or employer establishes a maximum contribution it will make toward the price of a drug or procedure, and the patient pays the remainder. Methods We used difference-in-differences multivariable regression methods to analyze changes in prescriptions and pricing for 1302 drugs in 78 therapeutic classes in the United States, before and after implementation of reference pricing by an alliance of private employers. We assessed trends for the study group relative to those for an employee group that was not subject to reference pricing. The study included 1,122,741 prescriptions that were reimbursed during the period from 2010 through 2014. Results Implementation of reference pricing was associated with a higher percentage of prescriptions that were filled for the lowest-priced reference drug within its therapeutic class (difference in probability, 7.0 percentage points; 95% confidence interval [CI], 4.0 to 9.9), a lower average price paid per prescription (-13.9%; 95% CI, -23.8 to -2.7), and a higher rate of copayment by patients (5.2%; 95% CI, 0.2 to 10.4) than in the comparison group. During the first 18 months after implementation, spending for employers was $1.34 million lower and the amount of copayments for employees was $0.12 million higher than in the comparison group. Conclusions Implementation of reference pricing was associated with significant changes in drug selection and spending for a population of patients covered by employment-based insurance in the United States. (Funded by the Agency for Healthcare Research and Quality and the Genentech Foundation.).

Establishing a Baseline: Community Benefit Spending by Not-for-Profit Hospitals Prior to Implementation of the Affordable Care Act.

Science.gov (United States)

Leider, Jonathon P; Tung, Greg J; Lindrooth, Richard C; Johnson, Emily K; Hardy, Rose; Castrucci, Brian C

Community Benefit spending by not-for-profit hospitals has served as a critical, formalized part of the nation's safety net for almost 50 years. This has occurred mostly through charity care. This article examines how not-for-profit hospitals spent Community Benefit dollars prior to full implementation of the Affordable Care Act (ACA). Using data from 2009 to 2012 hospital tax and other governmental filings, we constructed national, hospital-referral-region, and facility-level estimates of Community Benefit spending. Data were collected in 2015 and analyzed in 2015 and 2016. Data were matched at the facility level for a non-profit hospital's IRS tax filings (Form 990, Schedule H) and CMS Hospital Cost Report Information System and Provider of Service data sets. During 2009, hospitals spent about 8% of total operating expenses on Community Benefit. This increased to between 8.3% and 8.5% in 2012. The majority of spending (>80%) went toward charity care, unreimbursed Medicaid, and subsidized health services, with approximately 6% going toward both community health improvement and health professionals' education. By 2012, national spending on Community Benefit likely exceeded $60 billion. The largest hospital systems spent the vast majority of the nation's Community Benefit; the top 25% of systems spent more than 80 cents of every Community Benefit dollar. Community Benefit spending has remained relatively steady as a proportion of total operating expenses and so has increased over time-although charity care remains the major focus of Community Benefit spending overall. More than $60 billion was spent on Community Benefit prior to implementation of the ACA. New reporting and spending requirements from the IRS, alongside changes by the ACA, are changing incentives for hospitals in how they spend Community Benefit dollars. In the short term, and especially the long term, hospital systems would do well to partner with public health, other social services, and even

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.

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.

HEALTH CARE SPENDING GROWTH AND THE FUTURE OF U.S. TAX RATES

Science.gov (United States)

Baicker, Katherine; Skinner, Jonathan S.

2011-01-01

The fraction of GDP devoted to health care in the United States is the highest in the world and rising rapidly. Recent economic studies have highlighted the growing value of health improvements, but less attention has been paid to the efficiency costs of tax-financed spending to pay for such improvements. This paper uses a life cycle model of labor supply, saving, and longevity improvement to measure the balanced-budget impact of continued growth in the Medicare and Medicaid programs. The model predicts that top marginal tax rates could rise to 70 percent by 2060, depending on the progressivity of future tax changes. The deadweight loss of the tax system is greater when the financing is more progressive. If the share of taxes paid by high-income taxpayers remains the same, the efficiency cost of raising the revenue needed to finance the additional health spending is $1.48 per dollar of revenue collected, and GDP declines (relative to trend) by 11 percent. A proportional payroll tax has a lower efficiency cost (41 cents per dollar of revenue averaged over all tax hikes, a 5 percent drop in GDP) but more than doubles the share of the tax burden borne by lower income taxpayers. Empirical support for the model comes from analysis of OECD country data showing that countries facing higher tax burdens in 1979 experienced slower health care spending growth in subsequent decades. The rising burden imposed by the public financing of health care expenditures may therefore serve as a brake on health care spending growth. PMID:21608156

Charter School Spending and Saving in California

Science.gov (United States)

Reed, Sherrie; Rose, Heather

2015-01-01

Examining resource allocation practices, including savings, of charter schools is critical to understanding their financial viability and sustainability. Using 9 years of finance data from California, we find charter schools spend less on instruction and pupil support services than traditional public schools. The lower spending on instruction and…

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

Hong Kong domestic health spending: financial years 1989/90 to 2008/09.

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

2012-08-01

This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2008/09, cross-stratified and categorised by financing source, provider and function. Total expenditure on health (TEH) was HK$84,391 million in financial year 2008/09, which represents an increase of HK$5030 million or 6.3% over the preceding year. Amid the financial tsunami in late 2008, TEH grew faster relative to gross domestic product (GDP) leading to a marked increase as a percentage of GDP from 4.8% in 2007/08 to 5.1% in 2008/09. During the period 1989/90 to 2008/09, TEH per capita (at constant 2009 prices) grew at an average annual rate of 4.9%, which was faster than that of per capita GDP by 2.0 percentage points. 6.4% when compared with 2007/08, reaching HK$41 257 million and HK$43 134 million, respectively. Consequently, public and private shares of total health expenditure remained the same in the 2 years at 48.9% and 51.1%, respectively. Regarding private spending, the most important source of health financing was out-of-pocket payments by households (35.4% of TEH), followed by employer-provided group medical benefits (7.5%) and private insurance (6.4%). During the period, a growing number of households (mostly in middle to high-income groups) subscribed to pre-payment plans for financing health care. As such, private insurance has taken on an increasingly important role for financing private spending. Of the HK$84 391 million total health expenditure in 2008/09, current expenditure comprised HK$81 186 million (96.2%), whereas HK$3206 million (3.8%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share of total health spending (66.1%), which was made up of ambulatory services (32.8%), in-patient curative care (28.8%), day patient hospital services (3.9%) and home care (0.5%). Notwithstanding the small share of total spending for day patient

Primary Healthcare Spending: Striving for Equity under Fiscal ...

International Development Research Centre (IDRC) Digital Library (Canada)

2010-04-01

Apr 1, 2010 ... Book cover Primary Healthcare Spending: Striving for Equity under Fiscal Federalism ... Primary Healthcare Spending is an important reference for ... field of health policy and health economics, agencies involved in providing ...

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…

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.

Changes in Healthcare Spending After Diagnosis of Comorbidities Among Endometriosis Patients: A Difference-in-Differences Analysis.

Science.gov (United States)

Epstein, Andrew J; Soliman, Ahmed M; Davis, Matthew; Johnson, Scott J; Snabes, Michael C; Surrey, Eric S

2017-11-01

We sought to characterize changes in healthcare spending associated with the onset of 22 endometriosis-related comorbidities. Women aged 18-49 years with endometriosis (N = 180,278) were extracted from 2006-2015 de-identified Clinformatics ® DataMart claims data. For 22 comorbidities, comorbidity patients were identified on the basis of having a first comorbidity diagnosis after their initial endometriosis diagnosis. Controls were identified on the basis of having no comorbidity diagnosis and were matched 1:1 to comorbidity patients on demographics and baseline spending. Total medical and pharmacy spending was measured during 12 months before and after each patient's index date (first comorbidity diagnosis for comorbidity patients, and equal number of days after earliest endometriosis claim for controls). Pre-post spending differences were compared using difference-in-differences linear regression. Total and comorbidity-related cumulative spending per patient for all endometriosis patients were calculated annually for the 5 years following endometriosis diagnosis. The number of endometriosis patients with each comorbidity varied between 121 for endometrial cancer and 16,177 for fatigue. Healthcare spending increased significantly with the onset of eight comorbidities: breast cancer, ovarian cancer, pregnancy complications, systemic lupus erythematosus/rheumatoid arthritis/Sjogren's/multiple sclerosis, infertility, uterine fibroids, ovarian cyst, and headache [p endometriosis patient, of which between 11% and 23% was attributable to comorbidity-related medical claims. For all but one of the 22 comorbidities associated with endometriosis, comorbidity onset was associated with a relative increase in total healthcare spending. AbbVie Inc.

Specialty Drug Spending Trends Among Medicare And Medicare Advantage Enrollees, 2007–11

OpenAIRE

Trish, Erin; Joyce, Geoffrey; Goldman, Dana P.

2014-01-01

Specialty pharmaceuticals include most injectable and biologic agents used to treat complex conditions such as rheumatoid arthritis, multiple sclerosis, and cancer. We analyzed trends in specialty drug spending among Medicare beneficiaries ages sixty-five and older using 2007–11 pharmacy claims data from a 20 percent sample of Medicare beneficiaries. Annual specialty drug spending per beneficiary who used specialty drugs increased considerably during the study period, from $2,641 to $8,976. H...

[Municipal public health spending in the state of Pernambuco, Brazil, from 2000 to 2007].

Science.gov (United States)

Espírito Santo, Antônio Carlos Gomes do; Fernando, Virgínia Conceição Nascimento; Bezerra, Adriana Falangola Benjamin

2012-04-01

In order to assess the impact of macro-political measures implemented in the latter half of the 1990s on the increase in public spending on health and the possible reduction in allocation inequity, a descriptive, quantitative, cross-sectional study was carried out involving 184 municipalities in the state of Pernambuco, Brazil. Data from the Public Health Budget Information System was used, with the selected indicator being spending on health per inhabitant under the responsibility of the municipality. The correlations of this variable with the municipal Human Development Index, population size and value of the municipal budget per capita were analyzed. It was seen that, although the mean increase in municipal spending on health is 190.76%, the value per capita has remained relatively low - at around R$183.79 - which is below the national and macro-regional averages. Both spending on health per capita and growth percentages are distributed irregularly among health regions as well as among municipalities within a single region. In conclusion, there is marked allocation inequity among municipalities with regard to the distribution of public resources for health, despite the macro-political measures adopted to reduce this inequity.

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.

Changes in government spending on healthcare and population mortality in the European union, 1995-2010: a cross-sectional ecological study.

Science.gov (United States)

Budhdeo, Sanjay; Watkins, Johnathan; Atun, Rifat; Williams, Callum; Zeltner, Thomas; Maruthappu, Mahiben

2015-12-01

Economic measures such as unemployment and gross domestic product are correlated with changes in health outcomes. We aimed to examine the effects of changes in government healthcare spending, an increasingly important measure given constrained government budgets in several European Union countries. Multivariate regression analysis was used to assess the effect of changes in healthcare spending as a proportion of total government expenditure, government healthcare spending as a proportion of gross domestic product and government healthcare spending measured in purchasing power parity per capita, on five mortality indicators. Additional variables were controlled for to ensure robustness of data. One to five year lag analyses were conducted. European Union countries 1995-2010. Neonatal mortality, postneonatal mortality, one to five years of age mortality, under five years of age mortality, adult male mortality, adult female mortality. A 1% decrease in government healthcare spending was associated with significant increase in all mortality metrics: neonatal mortality (coefficient -0.1217, p = 0.0001), postneonatal mortality (coefficient -0.0499, p = 0.0018), one to five years of age mortality (coefficient -0.0185, p = 0.0002), under five years of age mortality (coefficient -0.1897, p = 0.0003), adult male mortality (coefficient -2.5398, p = 0.0000) and adult female mortality (coefficient -1.4492, p = 0.0000). One per cent decrease in healthcare spending, measured as a proportion of gross domestic product and in purchasing power parity, was both associated with significant increases (p < 0.05) in all metrics. Five years after the 1% decrease in healthcare spending, significant increases (p < 0.05) continued to be observed in all mortality metrics. Decreased government healthcare spending is associated with increased population mortality in the short and long term. Policy interventions implemented in response to the financial crisis may be associated with worsening

Cities through the Prism of People's Spending Behavior.

Science.gov (United States)

Sobolevsky, Stanislav; Sitko, Izabela; Tachet des Combes, Remi; 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.

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.

THE RELATIONSHIP BETWEEN DEFENSE SPENDING AND MACROECONOMIC VARIABLES

Directory of Open Access Journals (Sweden)

Onur OZSOY

2010-01-01

Full Text Available In this study, the rate of Defense Spendings in the GDP, and the growth rate of GDP, and the portion of current accounts in GDP and Annual Inflation Rate are examined with getting the annual data between the 1980-2006 years, and using VAR model for Egypt, Israel, Jordan, and Turkey. In course of this examination, the results of Granger Casuality and Impulse-Response Functions and Variance Decomposition were used. The focus point of our study is for the reason of defense spendings are effective on macroeconomic variables that while Egypt and Israel has uni-directional Granger causality from the defense spendings to inflation, for other countries there couldn`t be found any Granger causality. On the other hand when we look at the impulse response functions, in case of a shock of defense spending as a percentage of GNP, while the rate of Israel`s inflation and Current account as a percentage of GNP are affected by the pozitive direction , Turkey`s growth rate is affected negatively. For Egypt and Jordan, the significiant effects on defense spendings according to macroeconomic variables couldn`t be found any significiant effects.

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

[The application of National AIDS spending assessment in a county of Dehong prefecture, Yunnan province, China].

Science.gov (United States)

Shan, Duo; Sun, Jiang-ping; Yakusik, Anna; Chen, Zhong-dan; Yuan, Jian-hua; Li, Tao; Duan, Song; Yang, Xing; Wei, Mei; Michael, Sante; Ye, Run-hua; Xiang, Li-fen; Yang, Yue-cheng; Ren, Da

2012-11-01

To calculate the actual expenditures in a county of Dehong prefecture, Yunnan province, China by using the method of National AIDS Spending Assessment (NASA) in 2010. Data were collected through NASA data collection form based on adapted NASA classification in the county of Dehong prefecture from October to December, 2011, and complemented by semi-structured interview with 16 well trained programmatic and financial representatives in 8 spending units. Data were entered in Resource Tracking Software (RTS) V 2009.3.0, and SPSS 13.0 was used for data processing and analysis. The NASA estimations showed that the county spent a total of ¥16 235 954 on HIV/AIDS in 2010. Public funds constituted 96.3% of the total expenditure (¥15 630 937), followed by Global Fund which accounted for 3.0% (¥484 585) and private sources which accounted for 0.7% (¥120 432). Findings based on NASA categories showed that AIDS spendings were mainly on 4 areas, and expenditure on Care & Treatment was ¥12 401 382 (76.4% of total expenditure), followed by Prevention which accounted for 14.3% (¥2 325 707), Program Management & Administration which accounted for 7.8% (¥1 268 523) and human resources which accounted for 1.5% (¥240 342). The most beneficial population group was People Living with HIV (PLHIV), accounting for 84.7% of total expenditure. (¥13 753 428), followed by 4.8% for high risk population, including female sex workers and their partners (¥297 333), injection drug users and their partners (¥293 143), men having sex with men and their partners (¥185 136) and 1.5% (¥241 429) for the general population. The local funds for HIV/AIDS in this county was insufficient. The local government should increase corresponding funds based on central government funding. Care and treatment was the first spending priority in the county and the investment of prevention services needs to be increased. Prevention and treatment and care should be combined to ensure the effectiveness of

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...

Patient risk taking and spending habits correlate with willingness to pay for novel total joint arthroplasty implants

Directory of Open Access Journals (Sweden)

Ran Schwarzkopf, MD, MSc

2015-03-01

Full Text Available In this study, we compare patients' risk-taking and spending behaviors to their willingness to pay (WTP for novel implants in a joint arthroplasty. 210 patients were surveyed regarding risk-taking and spending behavior, and WTP for novel implants with either increased-longevity, increased-longevity with higher risk of complications, or decreased risk of complications compared to a standard implant. Patients with increased recreational risk-taking behavior were more WTP for increased-longevity. Patients who “rarely“ take health-risks were more WTP for decreased risk of complications. Patients with higher combined risk scores were more WTP for all novel implants. Patients who paid more than $50,000 for their current car were more WTP for decreased complications. This study shows that patients' risk taking and spending behavior influences their WTP for novel implants.

Primary Healthcare Spending : Striving for Equity under Fiscal ...

International Development Research Centre (IDRC) Digital Library (Canada)

Primary Healthcare Spending : Striving for Equity under Fiscal Federalism. Couverture du livre Primary Healthcare Spending: Striving for Equity under Fiscal Federalism. Auteur(s) : Okore Apia Okorafor. Maison(s) d'édition : UCT Press, CRDI. 1 avril 2010. ISBN : 9781919895215. 200 pages. e-ISBN : 9781552504895.

The role of market orientation in advertising spending during economic collapse : The case of Turkey in 2001

NARCIS (Netherlands)

Ozturan, P.; Oszomer, A.; Pieters, R.

The authors investigate the role of market orientation in advertising spending during economic contraction. They use the 2001 economic collapse in Turkey as the empirical context in which to test hypotheses regarding why some firms increase their advertising spending in a contraction period while

The Role of Market Orientation in Advertising Spending during Economic Collapse: The Case of Turkey in 2001

NARCIS (Netherlands)

Ozturan, P.; Ozsomer, A.; Pieters, F.G.M.

2014-01-01

The authors investigate the role of market orientation in advertising spending during economic contraction. They use the 2001 economic collapse in Turkey as the empirical context in which to test hypotheses regarding why some firms increase their advertising spending in a contraction period while

Multidimensional poverty and catastrophic health spending in the mountainous regions of Myanmar, Nepal and India.

Science.gov (United States)

Mohanty, Sanjay K; Agrawal, Nand Kishor; Mahapatra, Bidhubhusan; Choudhury, Dhrupad; Tuladhar, Sabarnee; Holmgren, E Valdemar

2017-01-18

Economic burden to households due to out-of-pocket expenditure (OOPE) is large in many Asian countries. Though studies suggest increasing household poverty due to high OOPE in developing countries, studies on association of multidimensional poverty and household health spending is limited. This paper tests the hypothesis that the multidimensionally poor are more likely to incur catastrophic health spending cutting across countries. Data from the Poverty and Vulnerability Assessment (PVA) Survey carried out by the International Center for Integrated Mountain Development (ICIMOD) has been used in the analyses. The PVA survey was a comprehensive household survey that covered the mountainous regions of India, Nepal and Myanmar. A total of 2647 households from India, 2310 households in Nepal and 4290 households in Myanmar covered under the PVA survey. Poverty is measured in a multidimensional framework by including the dimensions of education, income and energy, water and sanitation using the Alkire and Foster method. Health shock is measured using the frequency of illness, family sickness and death of any family member in a reference period of one year. Catastrophic health expenditure is defined as 40% above the household's capacity to pay. Results suggest that about three-fifths of the population in Myanmar, two-fifths of the population in Nepal and one-third of the population in India are multidimensionally poor. About 47% of the multidimensionally poor in India had incurred catastrophic health spending compared to 35% of the multidimensionally non-poor and the pattern was similar in both Nepal and Myanmar. The odds of incurring catastrophic health spending was 56% more among the multidimensionally poor than among the multidimensionally non-poor [95% CI: 1.35-1.76]. While health shocks to households are consistently significant predictors of catastrophic health spending cutting across country of residence, the educational attainment of the head of the household is

Association between quality domains and health care spending across physician networks

Science.gov (United States)

Rahman, Farah; Guan, Jun; Glazier, Richard H.; Brown, Adalsteinn; Bierman, Arlene S.; Croxford, Ruth; Stukel, Therese A.

2018-01-01

One of the more fundamental health policy questions is the relationship between health care quality and spending. A better understanding of these relationships is needed to inform health systems interventions aimed at increasing quality and efficiency of care. We measured 65 validated quality indicators (QI) across Ontario physician networks. QIs were aggregated into domains representing six dimensions of care: screening and prevention, evidence-based medications, hospital-community transitions (7-day post-discharge visit with a primary care physician; 30-day post-discharge visit with a primary care physician and specialist), potentially avoidable hospitalizations and emergency department (ED) visits, potentially avoidable readmissions and unplanned returns to the ED, and poor cancer end of life care. Each domain rate was computed as a weighted average of QI rates, weighting by network population at risk. We also measured overall and sector-specific per capita healthcare network spending. We evaluated the associations between domain rates, and between domain rates and spending using weighted correlations, weighting by network population at risk, using an ecological design. All indicators were measured using Ontario health administrative databases. Large variations were seen in timely hospital-community transitions and potentially avoidable hospitalizations. Networks with timely hospital-community transitions had lower rates of avoidable admissions and readmissions (r = -0.89, -0.58, respectively). Higher physician spending, especially outpatient primary care spending, was associated with lower rates of avoidable hospitalizations (r = -0.83) and higher rates of timely hospital-community transitions (r = 0.81) and moderately associated with lower readmission rates (r = -0.46). Investment in effective primary care services may help reduce burden on the acute care sector and associated expenditures. PMID:29614131

Cost and Cost-Effectiveness of a Demand Creation Intervention to Increase Uptake of Voluntary Medical Male Circumcision in Tanzania: Spending More to Spend Less.

Science.gov (United States)

Torres-Rueda, Sergio; Wambura, Mwita; Weiss, Helen A; Plotkin, Marya; Kripke, Katharine; Chilongani, Joseph; Mahler, Hally; Kuringe, Evodius; Makokha, Maende; Hellar, Augustino; Schutte, Carl; Kazaura, Kokuhumbya J; Simbeye, Daimon; Mshana, Gerry; Larke, Natasha; Lija, Gissenge; Changalucha, John; Vassall, Anna; Hayes, Richard; Grund, Jonathan M; Terris-Prestholt, Fern

2018-03-19

Although voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition, demand for services is lower among men in most at-risk age groups (ages 20-34 years). A randomised controlled trial was conducted to assess the effectiveness of locally-tailored demand creation activities (including mass media, community mobilisation and targeted service delivery) in increasing uptake of campaign-delivered VMMC among men aged 20-34 years. We conducted an economic evaluation to understand the intervention's cost and cost-effectiveness. Tanzania (Njombe and Tabora regions). Cost data were collected on surgery, demand creation activities and monitoring and supervision related to VMMC implementation across clusters in both trial arms, as well as start-up activities for the intervention arm. The Decision Makers' Program Planning Tool was used to estimate the number of HIV infections averted and related cost savings given total VMMCs per cluster. Disability-adjusted life years were calculated and used to estimate incremental cost-effectiveness ratios. Client load was higher in the intervention arms than in the control arms: 4394 v. 2901, respectively, in Tabora and 1797 v. 1025 in Njombe. Despite additional costs of tailored demand creation, demand increased more than proportionally: mean costs per VMMC in the intervention arms were $62 in Tabora and $130 in Njombe, and in the control arms $70 and $191, respectively. More infections were averted in the intervention arm than in the control arm in Tabora (123 v. 67, respectively) and in Njombe (164 v. 102, respectively). The intervention dominated the control as it was both less costly and more effective. Cost-savings were observed in both regions stemming from the antiretroviral treatment costs averted as a result of the VMMCs performed. Spending more to address local preferences as a way to increase uptake of VMMC can be cost-saving.This is an open access article distributed under the terms of the Creative Commons

Single European currency and Monetary Union. Macroeconomic implications for pharmaceutical spending.

Science.gov (United States)

Kanavos, P

1998-01-01

This article examines the potential implications of introducing a single currency among the Member States of the European Union for national pharmaceutical prices and spending. In doing so, it provides a brief account of the direct effects of introducing a single currency on pharmaceutical business. These are static in nature and include the elimination of exchange rate volatility and transaction costs, increased price transparency and limited potential for parallel trade. It subsequently analyses the potential medium and long term macroeconomic policy choices facing the Member States and their impact on pharmaceutical spending following the introduction of a single currency. These include policy directions in order to meet the Maastricht convergence criteria in the run-up to forming an Economic and Monetary Union (EMU) and the implications of EMU on national macroeconomic policy thereafter. This article argues that the necessity for tight fiscal policies across the EU and, in particular, in those Member States facing high budget deficits and overall debt levels, will continue to exert considerable downward pressure on pharmaceutical spending.

Consumer Spending and Customer Satisfaction: Untying the Knot

OpenAIRE

Sephton, Peter

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.

The demand for military spending in Egypt

OpenAIRE

Abu-Qarn, A. S.; Dunne, J. P.; Abdelfattah, Y.; Zaher, S.

2013-01-01

Egypt plays a pivotal role in the security of the Middle East as the doorway to Europe and its military expenditure reflects its involvement in the machinations of such an unstable region, showing considerable variation over the last forty years. These characteristics make it a particularly interesting case study of the determinants of military spending. This paper specifies and estimates an econometric model of the Egyptian demand for military spending, taking into account important strategi...

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.

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.

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...

[Colombian Health spending 1993-2003: its composition and trends].

Science.gov (United States)

Barón-Leguizamón, Gilberto

2007-01-01

Analysing the magnitude, composition, evolution and trends in Colombian national spending on health, forming a proposal and making an important contribution towards knowledge re the reality of social health security. The results obtained respond to an ongoing effort to systematise and standardise the adopted methodology and update calculations and estimates for the eleven-year period during which Law 100/1993 was being reformed. Analysing the above led to identifying changes in the flow of resources and establishing objective comparisons according to current/available international standards. The project began in the Colombian Planning Department (lasting 5 years) and was then passed to the Ministry of Social Protection's Health Reform Support Programme where new institutional scope has been applied during the last four years. Perhaps the work's most important contribution consists of producing annual estimates of total public and private spending on health as a time-series, for a relatively significant period. The results confirm fulfilment of the reform's suppositions in terms of the significant amount of resources channelled to the sector, the important substitution of financing private spending for spending on health insurance, greater dynamism and the importance of public funds in financing total spending and the managing of an important segment of such resources by some of the new agents created by the reform. This contrasts with the little importance paid to spending on promotion and prevention and on public health and basic attention programmes.

Time Investment and Time Management: An Analysis of Time Students Spend Working at Home for School

Science.gov (United States)

Wagner, Petra; Schober, Barbara; Spiel, Christiane

2008-01-01

This paper deals with the time students spend working at home for school. In Study 1, we investigated amount and regulation of time. Study 2 serves to validate the results of Study 1 and, in addition, investigates the duration of the time units students used and their relation to scholastic success. In Study 1, the participants were 332 students…

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

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

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,...

Health spending, illicit financial flows and tax incentives in Malawi.

Science.gov (United States)

O'Hare, B; Curtis, M

2014-12-01

This analysis examines the gaps in health care financing in Malawi and how foregone taxes could fill these gaps. It begins with an assessment of the disease burden and government health expenditure. Then it analyses the tax revenues foregone by the government of Malawi by two main routes: Illicit financial flows (IFF) from the country, Tax incentives. We find that there are significant financing gaps in the health sector; for example, government expenditure is United States Dollars (USD) 177 million for 2013/2014 while projected donor contribution in 2013/2014 is USD 207 million and the total cost for the minimal health package is USD 535 million. Thus the funding gap between the government budget for health and the required spending to provide the minimal package for 2013/2014 is USD 358 million. On the other hand we estimate that almost USD 400 million is lost through IFF and corporate utilization of tax incentives each year. The revenues foregone plus the current government health spending would be sufficient to cover the minimal public health package for all Malawians and would help tackle Malawi's disease burden. Every effort must be made, including improving transparency and revising laws, to curtail IFF and moderate tax incentives.

Fiscal Policy Puzzles and Intratemporal Substitution among Private Consumption, Government Spending and Leisure.

OpenAIRE

Masataka Eguchi; Yuhki Hosoya

2009-01-01

This paper investigates how does the response of private consumption to government spending be changed by intratemporal substitution among private consumption, government spending and leisure. We show that the response of private consumption to government spending can be positive even if private consumption and government spending are not complements and private consumption and leisure are not substitutes. In this case, substitution between leisure and government spending plays important role...

Infrastructure Quality, Local Government Spending and Corruption

OpenAIRE

Ig. Sigit Murwito; Boedi Rheza; Sri Mulyati; Elizabeth Karlinda; Ratnawati Muyanto

2012-01-01

We study on how a larger local government budget on infrastructure does not reflect into good quality of road in forty-one district/city across Indonesia given the fact of low infrastructure quality and low government spending on infrastructure. This study excels its preceded studies done by Tanzi and Davoodi (1997) at country level. The methodology used is a combination of quantitative and qualitative approach since our main research query is to seek facts on why a larger government spending...

Government Spending in Indonesia 2005-2013 from Islamic Economic Perspective

OpenAIRE

Andriansyah, Yuli; Anto, M. Bekti Hendrie

2016-01-01

This research is aimed to analyse government spending in Indonesia based on its types and functions according to Islamic economic perspective. Data used in this research are government spending classified based on type and function which were secondary one collected from financial note of government and national budget and spending or Anggaran Pendapatan dan Belanja Negara in Bahasa of Republic of Indonesia, 2005-2013. Theoretical framework used in this research includes modern approach to go...

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.

Follow the Money: School Spending from Title I to Adult Earnings

Directory of Open Access Journals (Sweden)

Rucker C. Johnson

2015-12-01

Full Text Available Title I funding has been the largest federal program of K–12 education for the past fifty years, the objective being to eliminate the educational disadvantage associated with poverty. I provide new evidence on the long-term effects of school spending from Title I on children's educational and adult economic outcomes. To study effects of Title I, I link school district spending and administrative data on Title I funding to nationally representative data on children born between 1950 and 1977 and followed through 2011. Models include controls for birth cohort and school district fixed effects, childhood family–neighborhood characteristics, and other policies. I find that increases in Title I funding are significantly related to increases in educational attainment, high school graduation rates, higher earnings and work hours, reductions in grade repetition, school suspension or expulsion, incarceration, and reductions in the annual incidence of poverty in adulthood; effects on educational outcomes are more pronounced for poor children.

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.

The 'Alternative Quality Contract,' based on a global budget, 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

2012-08-01

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, more so in the second year than in the first. Overall, participation in the contract over two years led to savings of 2.8 percent (1.9 percent in year 1 and 3.3 percent in year 2) compared to spending in nonparticipating groups. Savings were accounted for by lower prices achieved through shifting procedures, imaging, and tests to facilities with lower fees, as well as reduced utilization among some groups. Quality of care also improved compared to control organizations, with chronic care management, adult preventive care, and pediatric care within the contracting groups improving more in year 2 than in year 1. These results suggest that global budgets with pay-for-performance can begin to slow underlying growth in medical spending while improving quality of care.

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.

The Alternative Quality Contract: Impact on Service Use and Spending for Children With ADHD.

Science.gov (United States)

Joyce, Nina R; Huskamp, Haiden A; Hadland, Scott E; Donohue, Julie M; Greenfield, Shelly F; Stuart, Elizabeth A; Barry, Colleen L

2017-12-01

In 2009, Blue Cross-Blue Shield of Massachusetts (BCBSMA) implemented the alternative quality contract (AQC), which pays provider organizations a global payment for all services used by enrollees. BCBSMA claims for 2006-2011 were used to compare youths enrolled in provider organizations participating in the AQC (7,407 person-years [PYs]) with those not participating (45,398 PYs). Difference-in-differences models estimated changes in mental health and substance abuse treatment service utilization and spending attributable to the AQC. The AQC was associated with small increases in the probability of any outpatient visits and in the probability and number of medication management visits among children with attention-deficit hyperactivity disorder (ADHD). Spending did not change, and there was no evidence of reductions in service utilization or spending for children with ADHD in the first three years of AQC implementation.

Drivers of Greek and Turkish Defense Spending

Directory of Open Access Journals (Sweden)

Waszkiewicz Grzegorz

2016-09-01

Full Text Available This paper evaluates the factors responsible for maintaining substantial military expenditures in Greece and Turkey. The presented research encompasses theoretical and empirical aspects. First, defense spending by both countries was analyzed based on statistical data from international sources. Next, the theoretical determinants of budgetary spending are reviewed, which consider political, economic and military factors behind high expenditures on the army in Greece and in Turkey. Finally, Granger causality tests is applied to determine whether a causal relation between variables exists in the case of these two countries.

Market-based Lobbying: Evidence from Advertising Spending in Italy

OpenAIRE

Stefano DellaVigna; Ruben Durante; Brian Knight; Eliana La Ferrara

2013-01-01

An extensive literature has studied lobbying by special interest groups. We analyze a novel lobbying channel: lobbying businessmen-politicians through business proxies. When a politician controls a business, firms attempting to curry favors shift their spending towards the politician's business. The politician benefits from increased revenues, and the firms hope for favorable regulation in return. We investigate this channel in Italy where government members, including the prime minister, are...

Federal Spending for Means Tested Programs, 2007 to 2027

Science.gov (United States)

2017-02-01

child tax credits (which are refundable), the Supplemental Nutrition Assistance Program (SNAP), and Supplemental Security Income. The largest non...child tax credits, and SNAP—have been or will be significantly affected by program changes that unfold over time: B Medicaid spending rose by 35...total outlays in the Part D program). Increases in the number of beneficiaries account for about one- third of that growth; the introduction of new

The impact of healthcare spending on health outcomes: A meta-regression analysis.

Science.gov (United States)

Gallet, Craig A; Doucouliagos, Hristos

2017-04-01

While numerous studies assess the impact of healthcare spending on health outcomes, typically reporting multiple estimates of the elasticity of health outcomes (most often measured by a mortality rate or life expectancy) with respect to healthcare spending, the extent to which study attributes influence these elasticity estimates is unclear. Accordingly, we utilize a meta-data set (consisting of 65 studies completed over the 1969-2014 period) to examine these elasticity estimates using meta-regression analysis (MRA). Correcting for a number of issues, including publication selection bias, healthcare spending is found to have the greatest impact on the mortality rate compared to life expectancy. Indeed, conditional on several features of the literature, the spending elasticity for mortality is near -0.13, whereas it is near to +0.04 for life expectancy. MRA results reveal that the spending elasticity for the mortality rate is particularly sensitive to data aggregation, the specification of the health production function, and the nature of healthcare spending. The spending elasticity for life expectancy is particularly sensitive to the age at which life expectancy is measured, as well as the decision to control for the endogeneity of spending in the health production function. With such results in hand, we have a better understanding of how modeling choices influence results reported in this literature. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

Two-year impact of the alternative quality contract on pediatric health care quality and spending.

Science.gov (United States)

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

2014-01-01

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. 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. 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. 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.

Evolution and patterns of global health financing 1995-2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries.

Science.gov (United States)

2017-05-20

An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP

Advertising Spending, Firm Performance, and the Moderating Impact of CSR

DEFF Research Database (Denmark)

Assaf, A. George; Josiassen, Alexander; Ahn, Jin Sun

2017-01-01

This article investigates the potential of corporate social responsibility (CSR) to influence the link between advertising spending and firm performance. Drawing upon the literature of CSR, we hypothesize that CSR positively moderates the relationship between advertising spending and firm perform...

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...

National Health Expenditure Projections, 2017-26: Despite Uncertainty, Fundamentals Primarily Drive Spending Growth.

Science.gov (United States)

Cuckler, Gigi A; Sisko, Andrea M; Poisal, John A; Keehan, Sean P; Smith, Sheila D; Madison, Andrew J; Wolfe, Christian J; Hardesty, James C

2018-03-01

Under current law, national health spending is projected to grow 5.5 percent annually on average in 2017-26 and to represent 19.7 percent of the economy in 2026. Projected national health spending and enrollment growth over the next decade is largely driven by fundamental economic and demographic factors: changes in projected income growth, increases in prices for medical goods and services, and enrollment shifts from private health insurance to Medicare that are related to the aging of the population. The recent enactment of tax legislation that eliminated the individual mandate is expected to result in only a small reduction to insurance coverage trends.

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

Military spending and economic growth in China: a regime-switching analysis

OpenAIRE

Menla Ali, F; Dimitraki, O

2014-01-01

This article has been made available through the Brunel Open Access Publishing Fund. This article investigates the impact of military spending changes on economic growth in China over the period 1953 to 2010. Using two-state Markov-switching specifications, the results suggest that the relationship between military spending changes and economic growth is state dependent. Specifically, the results show that military spending changes affect the economic growth negatively during a slower grow...

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)

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)

1996-12-31

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)

Mental Health Spending and Intensity of Service Use Among Individuals With Diagnoses of Eating Disorders Following Federal Parity.

Science.gov (United States)

Huskamp, Haiden A; Samples, Hillary; Hadland, Scott E; McGinty, Emma E; Gibson, Teresa B; Goldman, Howard H; Busch, Susan H; Stuart, Elizabeth A; Barry, Colleen L

2018-02-01

The Mental Health Parity and Addiction Equity Act (MHPAEA) was intended to eliminate differences in insurance coverage for mental health and substance use disorder services and medical-surgical care. No studies have examined mental health service use after federal parity implementation among individuals with diagnoses of eating disorders, for whom financial access to care has often been limited. This study examined whether MHPAEA implementation was associated with changes in use of mental health services and spending in this population. Using Truven Health MarketScan data from 2007 to 2012, this study examined trends in mental health spending and intensity of use of specific mental health services (inpatient days, total outpatient visits, psychotherapy visits, and medication management visits) among individuals ages 13-64 with a diagnosis of an eating disorder (N=27,594). MHPAEA implementation was associated with a small increase in total mental health spending ($1,271.92; p<.001) and no change in out-of-pocket spending ($112.99; p=.234) in the first year after enforcement of the parity law. The law's implementation was associated with an increased number of outpatient mental health visits among users, corresponding to an additional 5.8 visits on average during the first year (p<.001). This overall increase was driven by an increase in psychotherapy use of 2.9 additional visits annually among users (p<.001). MHPAEA implementation was associated with increased intensity of outpatient mental health service use among individuals with diagnoses of eating disorders but no increase in out-of-pocket expenditures, suggesting improvements in financial protection.

Linking Quality and Spending to Measure Value for People with Serious Illness

Science.gov (United States)

Rodgers, Phillip E.

2018-01-01

Abstract Background: Healthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges. Objective: To evaluate the state of current efforts to measure and reward value for the care of seriously ill patients. Design: We performed a PubMed search of articles related to (1) measures of spending for people with serious illness and (2) linking spending and quality measures and rewarding performance for the care of people with serious illness. We limited our search to U.S.-based studies published in English between January 1, 1960, and March 31, 2017. We supplemented this search by identifying public programs and other known initiatives that linked quality and spending for the seriously ill and extracted key program elements. Results: Our search related to linking spending and quality measures and rewarding performance for the care of people with serious illness yielded 277 articles. We identified three current public programs that currently link measures of quality and spending—or are likely to within the next few years—the Oncology Care Model; the Comprehensive End-Stage Renal Disease Model; and Home Health Value-Based Purchasing. Models that link quality and spending consist of four core components: (1) measuring quality, (2) measuring spending, (3) the payment adjustment model, and (4) the linking/incentive model. We found that current efforts to reward value for seriously ill patients are targeted for specific patient populations, do not broadly encourage the use of palliative care, and have not closely aligned quality and spending measures related to palliative care. Conclusions: We develop recommendations for policymakers and stakeholders about how measures of spending and quality can be balanced in value-based payment programs. PMID:29091529

The Impact of Perceived Advertising Spending and Price Promotion on Brand Equity:A Case of ABC Brand

OpenAIRE

Nurcahya, Kevin Edward

2014-01-01

Intense competition in Indonesian beverage industry lead many corporations to spend trillion rupiah on marketing communication, such as advertising and price promotion with the hope of increasing brand equity. However, the question is whether promotional activities in this industry amplify or attenuate the brand equity of a product. Therefore, this paper aims to model the impact of perceived advertising spending and price promotion on brand equity, measured through consumer perceptions, spec...

Comparing the Income Elasticity of Health Spending in Middle-Income and High-Income Countries: The Role of Financial Protection

Science.gov (United States)

Vargas Bustamante, Arturo; Shimoga, Sandhya V.

2018-01-01

Background: As middle-income countries become more affluent, economically sophisticated and productive, health expenditure patterns are likely to change. Other socio-demographic and political changes that accompany rapid economic growth are also likely to influence health spending and financial protection. Methods: This study investigates the relationship between growth on per-capita healthcare expenditure and gross domestic product (GDP) in a group of 27 large middle-income economies and compares findings with those of 24 high-income economies from the Organization for Economic Cooperation and Development (OECD) group. This comparison uses national accounts data from 1995-2014. We hypothesize that the aggregated income elasticity of health expenditure in middle-income countries would be less than one (meaning healthcare is a normal good). An initial exploratory analysis tests between fixed-effects and random-effects model specifications. A fixed-effects model with time-fixed effects is implemented to assess the relationship between the two measures. Unit root, Hausman and serial correlation tests are conducted to determine model fit. Additional explanatory variables are introduced in different model specifications to test the robustness of our regression results. We include the out-of-pocket (OOP) share of health spending in each model to study the potential role of financial protection in our sample of high- and middle-income countries. The first-difference of study variables is implemented to address non-stationarity and cointegration properties. Results: The elasticity of per-capita health expenditure and GDP growth is positive and statistically significant among sampled middle-income countries (51 per unit-growth in GDP) and high-income countries (50 per unit-growth in GDP). In contrast with previous research that has found that income elasticity of health spending in middle-income countries is larger than in high-income countries, our findings show that

Geographic Variation in Medicare Spending Dashboard

Data.gov (United States)

U.S. Department of Health & Human Services — The Geographic Variation Dashboards present Medicare fee-for-service per-capita spending at the state and county level in an interactive format. We calculated the...

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.

FRANKLIN ROOSEVELT, FEDERAL SPENDING, AND THE POSTWAR SOUTHERN ECONOMIC REBOUND

Directory of Open Access Journals (Sweden)

Fred Bateman

2002-01-01

Full Text Available Franklin Roosevelt publicly stated his devotion to the American South and pledged to help reform the region’s laggard economy. However, Southern states received significantly fewer federal expenditures per capita, both during the New Deal of the 1930s and the military emergency of the 1940s. This article investigates economic, political, and strategic reasons for this result. Additionally, we apply a public goods perspective to New Deal and World War II spending and propose that lower levels of per capita spending in the South do not necessarily translate into a smaller impact of that spending.

Healthcare Utilization and Spending for Constipation in Children With Versus Without Complex Chronic Conditions.

Science.gov (United States)

Stephens, John R; Steiner, Michael J; DeJong, Neal; Rodean, Jonathan; Hall, Matt; Richardson, Troy; Berry, Jay G

2017-01-01

The aim of the study was to examine the prevalence of diagnosis and treatment for constipation among children receiving Medicaid and to compare healthcare utilization and spending for constipation among children based on number of complex chronic conditions (CCCs). Retrospective cohort study of 4.9 million children ages 1 to 17 years enrolled in Medicaid from 2009 to 2011 in 10 states in the Truven Marketscan Database. Constipation was identified using International Classification of Disease, 9th revision codes for constipation (564.0x), intestinal impaction (560.3x), or encopresis (307.7). Outpatient and inpatient utilization and spending for constipation were assessed. CCC status was identified using validated methodology. A total of 267,188 children (5.4%) were diagnosed with constipation. Total constipation spending was $79.5 million. Outpatient constipation spending was $66.8 million (84.1%) during 406,814 visits, mean spending $120/visit. Among children with constipation, 1363 (0.5%) received inpatient treatment, accounting for $12.2 million (15.4%) of constipation spending, mean spending $7815/hospitalization. Of children hospitalized for constipation, 552 (40.5%) did not have an outpatient visit for constipation before admission. Approximately 6.8% of children in the study had ≥1 CCC; these children accounted for 33.5% of total constipation spending, 70.3% of inpatient constipation spending, and 19.8% of emergency department constipation spending. Constipation prevalence was 11.0% for children with 1 CCC, 16.6% with 2 CCCs, and 27.1% with ≥3 CCCs. Although the majority of pediatric constipation treatment occurs in the outpatient setting, inpatient care accounts for a sizable percentage of spending. Children with CCCs have a higher prevalence of constipation and account for a disproportionate amount of constipation healthcare utilization and spending.

Hong Kong domestic health spending: financial years 1989/90 to 2010/11.

Science.gov (United States)

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

2013-12-01

This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2010/11, cross-stratified and categorised by financing source, provider, and function.Total expenditure on health (TEH) was HK$93 433 million in financial year 2010/11, which represents an increase of HK$5364 million or 6.1% over the preceding year. As a result of a gradual recovery from the financial tsunami in 2008, gross domestic product (GDP) grew faster relative to TEH leading to a drop in TEH as a percentage of GDP from 5.2% in 2009/10 to 5.1% in 2010/11.During the period 1989/90 to 2010/11, TEH per capita (at constant 2011 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.Compared to 2009/10, in 2010/11 public and private expenditure on health increased by 3.7% and 8.5% and reached HK$45 491 million and HK$47 943 million, respectively. Consequently, the public share of TEH dropped slightly from 49.8% to 48.7% over the year. Regarding private spending, the most important source was out-of-pocket payments by households (35.0% of TEH),followed by employer-provided group medical benefits (7.4%), and private insurance (7.2%). It is worth noting that private insurance will likely overtake employer benefits as the second largest private payer if the insurance market continues to expand at the current rate.Of the HK$93 433 million TEH in 2010/11, HK$88 987 million (95.2%) was current expenditure and HK$4446 million (4.8%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share of TEH (65.8%), which was made up of ambulatory services (34.0%), in-patient curative care (27.0%), day patient hospital services (4.2%), and home care (0.5%). Notwithstanding its small share,the total spending for day patient hospital services shows an increasing trend over the period 1989

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 ...

Government spending and legislative organization

DEFF Research Database (Denmark)

Egger, Peter; Köthenbürger, Marko

2010-01-01

This paper presents empirical evidence of a positive effect of council size on government spending using a dataset 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 d...

The Foundational Public Health Services as a Framework for Estimating Spending.

Science.gov (United States)

Resnick, Beth A; Fisher, Jessica S; Colrick, Ian P; Leider, Jonathon P

2017-11-01

In support of the nation's effort to address rising healthcare costs and improve healthcare outcomes, the National Academy of Medicine called for a minimum package of public health services available in every community to protect and improve population health and identification of the resources needed to make these services universally available. In response, the Foundational Public Health Services (FPHS) framework was developed to outline a basic set of public health programs and capabilities. Although the FPHS is considered a useful public health practice tool, cost estimation for providing the FPHS is in its infancy. This is in part due to inability to estimate total costs of individual public health services and programs. This research begins to address this knowledge gap. FPHS formed the basis of a coding framework used in 2013-2016 to code 1.9 million U.S. Census Bureau State Finance non-hospital expenditure records from 49 states from 2000 to 2013. Results were used to develop estimates of state governmental FPHS spending. FPHS spending constituted 36% of total state governmental non-hospital health spending from 2008 to 2013. The largest proportion of FPHS spending was on maternal/child health and the smallest proportion of spending was on access and linkage to clinical care. This research is an important step in response to the National Academy of Medicine's call for estimating the resources needed to provide the FPHS. Such estimates allow for spending comparisons across states and may inform future research to assess and evaluate FPHS spending impacts. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Perceived Need Versus Current Spending: Gaps in Providing Foundational Public Health Services in Communities.

Science.gov (United States)

Bekemeier, Betty; Marlowe, Justin; Squires, Linda Sharee; Tebaldi, Jennifer; Park, Seungeun

Our objective was to estimate the gap between the costs for local health jurisdictions (LHJs) to provide foundational public health services (FPHS) and actual spending on FPHS and to examine factors associated with that gap. We employed resource-based cost estimation methods for this observational study and conducted multivariate analyses with measures derived from secondary administrative data. We used primary data collected from LHJ leaders that depicted 2014 spending and perceived need. We also included secondary administrative data depicting annual 2000-2013 expenditures organized into categories containing key elements of FPHS areas. We included primary data from a representative sample of 10 LHJs in Washington State and secondary data for all 35 LHJs in Washington. Participants were public health practice leaders from each sample LHJ. Our main outcome of interest was the gap identified between current spending and the perceived spending needed to provide FPHS in a jurisdiction. Actual FPHS spending was approximately 65% of spending needed to provide overall FPHS for our sample LHJs, but the size of the gap varied substantially by program. Some gaps also varied widely by LHJ, with spending gaps widest among rural and high poverty communities. Percent poverty and the metropolitan nature of a jurisdiction were factors significantly related to FPHS spending in our multivariate analyses. Actual spending lags far behind local officials' estimates of spending needed to provide FPHS and is likely influenced by local conditions. Major apparent gaps between spending and need, particularly in areas such as costly Business Competencies, underscore the need for cross-cutting capabilities to support public health system responsiveness and for attention to be paid to local conditions.

Italian refiners' environmental spending to soar in 1990s

International Nuclear Information System (INIS)

Anon.

1993-01-01

Industry estimates are that Italian refiners' capital outlays will total almost 12 trillion lire ($7.2 billion), in 1990 currencies, in the 1990's. Most spending will be earmarked to develop cleaner fuels and plant-specific environmental mitigation measures related to new European Community regulations. Italian refiners generally have lagged some of their counterparts in Europe and North America on environmental spending. That's because they have faced a continuing margin squeeze as a result of product prices remaining under tight government controls. Last year, the government began to implement price deregulation in line with EC directives. At the same time, the government is enforcing stiffer emissions rules to improve air quality in urban areas. The paper describes spending plans; demand for oxygenates; demand for low sulfur fuel oil for power plants; and price regulations

The 2011-2015 physical and monetary balance for electricity: spending of over euro 50 billion in 2015

International Nuclear Information System (INIS)

Guggemos, Fabien; Meilhac, Christophe; Riedinger, Nicolas; Martial, Elodie; Mombel, David; Moreau, Sylvain; Bottin, Anne; Lavail, Jennyfer

2017-09-01

Electricity consumers (excluding the electricity sector itself) spent euro 52 billion in 2015 to consume 446 TWh. Taxes accounted for 27% of that expenditure (of which around one-half contributed to financing renewable sources of electricity and to geographical price adjustments), the cost of transmission 27%, and that of supply (including production and sales) 46%. Trade with other countries showed a positive balance of euro 2.3 billion. The residential sector was the main consuming sector, accounting for 35% of physical deliveries. Given the transmission and sales costs, higher on average for households than for businesses, the residential sector accounted for a greater proportion of the spending (48%). Conversely, industry accounted for 24% of physical consumption but only 15% of spending. The share of the services sector was around one-third, in both physical-unit and monetary terms

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…

Design of governmental policies for oil production rates and oil income spending. A long-term perspective. [Norway

Energy Technology Data Exchange (ETDEWEB)

Moxnes, E

1982-09-01

In 1980, oil production in Norway amounted to 1 million barrels per day. Taxes and royalties to the government from this production provides 9 per cent of the GNP. With current estimates of recoverable reserves, the 1980 production rate would last for 100 years. Decisions about oil production rates and oil income spending have tremendous impact on society. Attemps to design an appropriate oil policy are complicated by uncertainty about total reserves, future oil prices and complex economic responses to production and income. This report provides and integrating framework to aid government officials in their evaluation of policy options. A system dynamics model of the Norwegian national economy is developed for the analysis. The model determines endogenously the spending of oil income, GNP, consumption and investments, imports and exports, unemployment and labor migration from exporting industries to service industries; all variables result from exogenous decisions about oil production. Though the model is based on behavioral theory of economic decision making at the microeconomic level, it reproduces well major behavior modes of macroeconomic indicators from the 1970s. The most attractive oil policy has been found to be a dynamic and firm ceiling on spending. Dynamic means that growth in spending should be limited, spending should not increase unless the economy is appropriately buffered against oil price drops by foreign savings and spending should never exceed a maximum ceiling set to ensure a desirabel distribution of benefits and problems over time. Firm means that the ceiling cannot be changed by Parliament within an election period. If a firm ceiling on spending is politically infeasible, oil production should be kept lower than otherwise.

Comparison of historical medical spending patterns among the BRICS and G7.

Science.gov (United States)

Jakovljevic, Mihajlo Michael

2016-01-01

The past few decades have been marked by a bold increase in national health spending across the globe. Rather successful health reforms in leading emerging markets such as BRICS reveal a reshaping of their medical care-related expenditures. There is a scarcity of evidence explaining differences in long-term medical spending patterns between top ranked G7 traditional welfare economies and the BRICS nations. A retrospective observational study was conducted on a longitudinal WHO Global Health Expenditure data-set based on the National Health Accounts (NHA) system. Data were presented in a simple descriptive manner, pointing out health expenditure dynamics and differences between the two country groups (BRICS and G7) and individual nations in a 1995-2013 time horizon. Average total per capita health spending still remains substantially higher among G7 (4747 Purchase Power Parity (PPP) $PPP in 2013) compared to the BRICS (1004 $PPP in 2013) nations. The percentage point share of G7 in global health expenditure (million current PPP international $US) has been falling constantly since 1995 (from 65% in 1995 to 53.2% in 2013), while in BRICS nations it grew (from 10.7% in 1995 to 20.2% in 2013). Chinese national level medical spending exceeded significantly that of all G7 members except the US in terms of current $PPP in 2013. Within a limited time horizon of only 19 years it appears that the share of global medical spending by the leading emerging markets has been growing steadily. Simultaneously, the world's richest countries' global share has been falling constantly, although it continues to dominate the landscape. If the contemporary global economic mainstream continues, the BRICS per capita will most likely reach or exceed the OECD average in future decades. Rising out-of-pocket expenses threatening affordability of medical care to poor citizens among the BRICS nations and a too low percentage of GDP in India remain the most notable setbacks of these developments.

High Spending on Maternity Care in India: What Are the Factors Explaining It?

Science.gov (United States)

Goli, Srinivas; Moradhvaj; Rammohan, Anu; Shruti; Pradhan, Jalandhar

2016-01-01

High maternity-related health care spending is often cited as an important barrier in utilizing quality health care during pregnancy and childbirth. This study has two objectives: (i) to measure the levels of expenditure on total maternity care in disaggregated components such as ANCs, PNCs, and Natal care expenditure; (ii) to quantify the extent of catastrophic maternity expenditure (CME) incurred by households and identify the factors responsible for it. Data from the 71st round of the National Sample Survey (2014) was used to estimate maternity expenditure and its predictors. CME was measured as a share of consumption expenditure by different cut-offs. The two-part model was used to identify the factors associated with maternity spending and CME. The findings show that household spending on maternity care (US$ 149 in constant price) is much higher than previous estimates (US$ 50 in constant price). A significant proportion of households in India (51%) are incurring CME. Along with economic and educational status, type of health care and place of residence emerged as significant factors in explaining CME. Findings from this study assume importance in the context of an emerging demand for higher maternity entitlements and government spending on public health care in India. To reduce CME, India needs to improve the availability and accessibility of better-quality public health services and increase maternity entitlements in line with maternity expenditure identified in this study.

Budgeting and spending habits of university students in South Africa ...

African Journals Online (AJOL)

The aim of this study was to investigate the budgeting and spending habits of university students at a South African university. In addition, the study examined if there is a significant gender difference in the budgeting and spending habits of university students. The study adopted a quantitative research approach with a ...

Public Health's Falling Share of US Health Spending.

Science.gov (United States)

Himmelstein, David U; Woolhandler, Steffie

2016-01-01

We examined trends in US public health expenditures by analyzing historical and projected National Health Expenditure Accounts data. Per-capita public health spending (inflation-adjusted) rose from $39 in 1960 to $281 in 2008, and has fallen by 9.3% since then. Public health's share of total health expenditures rose from 1.36% in 1960 to 3.18% in 2002, then fell to 2.65% in 2014; it is projected to fall to 2.40% in 2023. Public health spending has declined, potentially undermining prevention and weakening responses to health inequalities and new health threats.

COHORT CHANGE, DIFFUSION, AND SUPPORT FOR ENVIRONMENTAL SPENDING IN THE UNITED STATES.

Science.gov (United States)

Pampel, Fred C; Hunter, Lori M

2012-09-01

The long-standing and sometimes heated debates over the direction and size of the effect of socioeconomic status (SES) on environmental concern contrast post-materialist and affluence arguments, suggesting a positive relationship in high-income nations, with counter arguments for a negative or near zero relationship. A diffusion-of-innovations approach adapts parts of both arguments by predicting that high SES groups first adopt pro-environmental views, which produces a positive relationship. Like other innovations, however, environmentalism diffuses over time to other SES groups, which subsequently weakens the association. We test this argument using the General Social Survey from 1973 to 2008 to compare support for environmental spending across 83 cohorts born from around 1900 to 1982. In developing attitudes before, during, and after the emergence of environmentalism, varying cohorts provide the contrast needed to identify long-term changes in environmental concern. Multilevel age, period, and cohort models support diffusion arguments by demonstrating the effects, across cohorts, of three common indicators of SES - education, income and occupational prestige - first strengthen and then weaken. This finding suggests that diffusion of environmental concern first produces positive relationships consistent with postmaterialism arguments and later produces null or negative relationships consistent with global environmentalism arguments.

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.

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. Project HOPE—The People-to-People Health Foundation, Inc.

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

Science.gov (United States)

2017-01-01

funding across DoD has occurred at the ime that the number of military personnel er stayed relatively flat or fallen. As a result, spending for each... military personnel and their families, see Congressional Budget Office, Approaches to Reducing Federal Spending on Military Health Care (January...MAINTENANCE BETWEEN 1980 AND 2015 TRENDS IN SPENDING BY ibit 1. D’s Base Budget by Type of Appropriation, 1980 to 2015 ions of 2015 Dollars Military Personnela

Prosocial Spending and Well-Being: Cross-Cultural Evidence for a Psychological Universal

OpenAIRE

Lara B. Aknin; Christopher P. Barrington-Leigh; Elizabeth W. Dunn; John F. Helliwell; Robert Biswas-Diener; Imelda Kemeza; Paul Nyende; Claire E. Ashton-James; Michael I. Norton

2010-01-01

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). Analyzing survey data from 136 countries, we show that prosocial spending is consistently associated with greater happiness. To test for causality, we conduct experiments within two very different countries (Canada and Uganda) and show that spending money on others has a consistent, ca...

The effects of mental health parity on spending and utilization for bipolar, major depression, and adjustment disorders.

Science.gov (United States)

Busch, Alisa B; Yoon, Frank; Barry, Colleen L; Azzone, Vanessa; Normand, Sharon-Lise T; Goldman, Howard H; Huskamp, Haiden A

2013-02-01

The Mental Health Parity and Addiction Equity Act requires insurance parity for mental health/substance use disorder and general medical services. Previous research found that parity did not increase mental health/substance use disorder spending and lowered out-of-pocket spending. Whether parity's effects differ by diagnosis is unknown. The authors examined this question in the context of parity implementation in the Federal Employees Health Benefits (FEHB) Program. The authors compared mental health/substance use disorder treatment use and spending before and after parity (2000 and 2002, respectively) for two groups: FEHB enrollees diagnosed in 1999 with bipolar disorder, major depression, or adjustment disorder (N=19,094) and privately insured enrollees unaffected by the policy in a comparison national sample (N=10,521). Separate models were fitted for each diagnostic group. A difference-in-difference design was used to control for secular time trends and to better reflect the specific impact of parity on spending and utilization. Total spending was unchanged among enrollees with bipolar disorder and major depression but decreased for those with adjustment disorder (-$62, 99.2% CI=-$133, -$11). Out-of-pocket spending decreased for all three groups (bipolar disorder: -$148, 99.2% CI=-$217, -$85; major depression: -$100, 99.2% CI=-$123, -$77; adjustment disorder: -$68, 99.2% CI=-$84, -$54). Total annual utilization (e.g., medication management visits, psychotropic prescriptions, and mental health/substance use disorder hospitalization bed days) remained unchanged across all diagnoses. Annual psychotherapy visits decreased significantly only for individuals with adjustment disorders (-12%, 99.2% CI=-19%, -4%). Parity implemented under managed care improved financial protection and differentially affected spending and psychotherapy utilization across groups. There was some evidence that resources were preferentially preserved for diagnoses that are typically more

Tax-Exempt Hospitals' Investments in Community Health and Local Public Health Spending: Patterns and Relationships.

Science.gov (United States)

Singh, Simone R; Young, Gary J

2017-12-01

To investigate whether tax-exempt hospitals' investments in community health are associated with patterns of governmental public health spending focusing specifically on the relationship between hospitals' community benefit expenditures and the spending patterns of local health departments (LHDs). We combined data on tax-exempt hospitals' community benefit spending with data on spending by the corresponding LHD that served the county in which a hospital was located. Data were available for 2 years, 2009 and 2013. Generalized linear regressions were estimated with indicators of hospital community benefit spending as the dependent variable and LHD spending as the key independent variable. Hospital community benefit spending was unrelated to how much local public health agencies spent, per capita, on public health in their communities. Patterns of local public health spending do not appear to impact the investments of tax-exempt hospitals in community health activities. Opportunities may, however, exist for a more active engagement between the public and private sector to ensure that the expenditures of all stakeholders involved in community health improvement efforts complement one another. © Health Research and Educational Trust.

The Long-Term Impact of Educational and Health Spending on Unemployment Rates

Directory of Open Access Journals (Sweden)

ZAFER PIRIM

2017-12-01

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.

Public Hospital Spending in England: Evidence from National Health Service Administrative Records

OpenAIRE

Kelly, E.; Stoye, G.; Vera-Hernández, M.

2016-01-01

© 2016 The Authors. Fiscal Studies published by John Wiley & Sons Ltd. on behalf of Institute for Fiscal StudiesHealth spending per capita in England has almost doubled since 1997, yet relatively little is known about how that spending is distributed across the population. This paper uses administrative National Health Service (NHS) hospital records to examine key features of public hospital spending in England. We describe how costs vary across the life cycle, and the concentration of spendi...

The Relationship Between Federal Government Revenue and Spending: Empirical Evidence From Asean-5 Countries

OpenAIRE

Mohd.Yusoff, Zetty Zahureen; Antoni, Antoni; Abdullah, Azrina Al-Hadi; Asri, Norain Mod; Karim, Zulkefly Abdul

2006-01-01

The main objectives of this paper is to examine the long run relationship between total expenditure, revenue (tax and nontax) and economic growth in ASEAN-5 countries namely by Malaysia, Indonesia, Thailand, Singapore and Philippines. According to the prior studies, there are several hypotheses to explain the relationship between revenue and spend-ing such as (1) spend-revenue hypotheses, (2) revenue-spend hypotheses and (3)bi-directional causality hypotheses. To test the validity of these hy...

The Relationship Between Federal Government Revenue and Spending: Empirical Evidence from Asean-5 Countries

OpenAIRE

Karim, Zulkefly Abdul; Asri, Norain Mod; Abdullah, Azrina Al-Hadi; Antoni, Antoni; Mohd.Yusoff, Zetty Zahureen

2009-01-01

The main objectives of this paper is to examine the long run relationship between total expenditure, revenue (tax and nontax) and economic growth in ASEAN-5 countries namely by Malaysia, Indonesia, Thailand, Singapore and Philippines. According to the prior studies, there are several hypotheses to explain the relationship between revenue and spend-ing such as (1) spend-revenue hypotheses, (2) revenue-spend hypotheses and (3)bi-directional causality hypotheses. To test the validity of these hy...

Progress on impoverishing health spending in 122 countries: a retrospective observational study.

Science.gov (United States)

Wagstaff, Adam; Flores, Gabriela; Smitz, Marc-François; Hsu, Justine; Chepynoga, Kateryna; Eozenou, Patrick

2018-02-01

people (2·1% of the world's population) to 97 million people (1·4%). The population-weighted median of the poverty gap increase attributable to out-of-pocket health expenditures among the 122 countries in our sample are ¢1·22 per capita at the $1·90 per day poverty line and ¢3·74 per capita at the $3·10 per day poverty line. In all countries, out-of-pocket spending can be both catastrophic and impoverishing at all income levels, but this partly depends on the choice of the poverty line. Out-of-pocket spending on health can add to the poverty head count and the depth of poverty by diverting household spending from non-health budget items. The scale of such impoverishment varies between countries and depends on the poverty line but might in some low-income countries account for as much as four percentage points of the poverty head count. Increasing the share of total health expenditure that is prepaid, especially through taxes and mandatory contributions, can help reduce impoverishment. Rockefeller Foundation, Ministry of Health of Japan, and UK Department for International Development. © 2017 The World Bank and World Health Organization. Published by Elsevier. This is an Open Access Article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this Article, there should be no suggestion that The World Bank or WHO endorse any specific organisation, products, or services. The use of The World Bank or the WHO logo is not permitted. This notice should be preserved along with the Article's original URL.

Introducing a checking technician allows pharmacists to spend more time on patient-focused activities.

Science.gov (United States)

Napier, Patti; Norris, Pauline; Braund, Rhiannon

2018-04-01

Internationally there is an increasing focus on the clinical and cognitive services that pharmacists can provide. Lack of time has been identified as a barrier to pharmacists increasing their clinical activities. Within the pharmacy workplace there are many tasks that can only be performed by a pharmacist. The final accuracy check of a dispensed prescription is currently the sole responsibility of pharmacists in New Zealand. This takes up a significant amount of time during a pharmacist's work day. The introduction of a checking technician role has been suggested to allow pharmacists more time to do more patient focused work. To investigate the amount of time pharmacy staff spend on specific activities and to establish whether the introduction of a checking technician into twelve pilot sites increased the amount of time that the pharmacists could spend on patient focused activities. This study utilised a self-reported work sampling technique in twelve pilot sites, selected from both the hospital and community settings. Work sampling using an electronic device was conducted at two time-points (before the implementation of a Pharmacy Accuracy Checking Technician (PACT) role and when the PACT was in place). Data was collected at 10 min intervals for the period of five days, a working week. Tasks were grouped into patient focused, dispensing and personal activities. The introduction of the PACT into the pilot sites saw a mean increase of 19% in pharmacists' patient focused activities and a mean 20% decrease in dispensing activities. The introduction of a checking technician role into New Zealand pharmacies demonstrated the potential to provide pharmacists with more time to spend on patient focused activities. Copyright © 2017 Elsevier Inc. All rights reserved.

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

The future of utility customer-funded energy efficiency programs in the USA. Projected spending and savings to 2025

Energy Technology Data Exchange (ETDEWEB)

Barbose, G.L.; Goldman, C.A.; Hoffman, I.M.; Billingsley, M. [Ernest Orlando Lawrence Berkeley National Laboratory, One Cyclotron Road, MS 90R4000, Berkeley, CA 94720-8136 (United States)

2013-08-15

We develop projections of future spending on, and savings from, energy efficiency programs funded by electric and gas utility customers in the USA, 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). Key findings from the analysis are as follows: (1) By 2025, spending on electric and gas efficiency programs (excluding load management programs) is projected to double from 2010 levels to USD 9.5 billion in the medium case, compared to USD 15.6 billion in the high case and USD 6.5 billion in the low case; (2) 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; (3) 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 USA spending in 2010 to slightly more than 50 % in 2025, and the South and Midwest splitting the remainder roughly evenly; (4) Under our medium case scenario, annual incremental savings from customer-funded electric energy efficiency programs increase from 18.4 TWh in 2010 in the USA (which is about 0.5 % of electric utility retail sales) to 28.8 TWh in 2025 (0.8 % of retail sales); (5) 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

Proposal to increase the drug adherence in a brazilian health unit

Directory of Open Access Journals (Sweden)

Ariane Garrocho de Faria

2016-12-01

Full Text Available http://dx.doi.org/10.5007/1807-0221.2016v13n24p174 The aim of this work was to use a Strategic Planning tool to check for problems and propose strategic activities that increases the drug treatment adherence in a UBS of Minas Gerais. This study was developed from May to October 2015 using Strategic Planning divided in four stages: explanatory, normative, strategic and tactical situational. Resulting actions were defined in order to increase the drug treatment adherence and reduce unnecessary spending. Thus, the importance of the method was perceived, been able to meet the views of participants need and direct discussions to achieve the proposed goals. In conclusion, the method evidenced the awareness of the participants and the shared responsibility for patients as well as the planning official. It is expected following the implementation of the proposed actions, achieving success in relation to the drug treatment adherence.

Parenting and Time Adolescents Spend in Criminogenic Settings : A Between- and Within-person Analysis

NARCIS (Netherlands)

Janssen, Heleen J.; Dekovic, Maja; Bruinsma, Gerben J. N.

Although there has been increasing interest in explaining adolescents' crime involvement by the time adolescents spend in criminogenic settings, little is known about its determinants. We examine the extent to which (change in) parenting is related to (change in) time spent in criminogenic settings.

Save or (over-)spend? : The impact of hard-discounter shopping on consumers' grocery outlay

NARCIS (Netherlands)

Gijsbrechts, Els; Campo, K.; Vroegrijk, M.J.J.

An increasing number of consumers have come to patronize a hard discounter (HD) to save on their grocery budget. Given the HDs' rock-bottom prices, a complete switch from the traditional supermarket (TS) to the HD format would, indeed, substantially reduce grocery spending. However, consumers

Not Out of Control: Analysis of the Federal Disaster Spending Trend

Science.gov (United States)

2016-03-01

continue to benefit politically from large emergency supplemental spending bills for their constituents after a disaster, no incentive to change the...not need to compete for emergency funds as they must do in the regular appropriations process.69 They explain the political benefits of this...reflect true market prices, and was in essence, a subsidy to homeowners living in hazard areas.245 Resulting rate hikes and increased premiums were not

Pharmaceutical company spending on research and development and promotion in Canada, 2013-2016: a cohort analysis.

Science.gov (United States)

Lexchin, Joel

2018-01-01

Competing claims are made about the amount of money that pharmaceutical companies spend on research and development (R&D) versus promotion. This study investigates this question in the Canadian context. Two methods for determining industry-wide figures for spending on promotion were employed. First, total industry spending on detailing and journal advertising for 2013-2016 was abstracted from reports from QuintilesIMS. Second, the mean total promotion spending for the years 2002-2005 was used to estimate total spending for 2013-2016. Total industry spending on R&D came from the Patented Medicine Prices Review Board (PMPRB). R&D to promotion spending using each method of determining the amount spent on promotion was compared for 2013-2016 inclusive. Data on the 50 top promoted drugs, the amounts spent, the companies marketing these products and their overall sales were abstracted from the QuintilesIMS reports. Spending on R&D and promotion as a percent of sales was compared for these companies. Industry wide, the ratio of R&D to promotion spending went from 1.43 to 2.18 when promotion was defined as the amount spent on detailing and journal advertising for the 50 most promoted drugs. Calculating total promotion spending from the mean of the 2002-2005 figures the ratio was 0.88 to 1.32 for the 50 most promoted drugs. For individual companies marketing one or more of the 50 most promoted drugs, mean R&D spending ranged from 3.7% of sales to 4.1% compared to mean promotion spending that went from 1.7 to 1.9%. The ratio of spending on R&D to promotion varied from 2.11 to 2.32. Eight to 10 companies per year spent more on promotion than on R&D. Depending on the method used to determine promotion spending, industry-wide the ratio of R&D spending to promotion ranges from 1.45 to 2.18 (sales representatives and journal advertising only) or from 0.88 to 1.32 (total promotion spending estimated based 2003-2005 data.) For the individual companies promoting one or more of the

Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016-40.

Science.gov (United States)

2018-05-05

Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040. We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios. In the reference scenario, global health spending was projected to increase from US$10 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $20 trillion (18 trillion to 22 trillion) in 2040. Per capita health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4-5·1) per year, followed by lower-middle-income countries (4·0%, 3·6-4·5) and low-income countries (2·2%, 1·7-2·8). Despite global growth, per capita health spending was projected to range from only $40 (24-65) to $413 (263-668) in 2040 in low-income countries, and from $140 (90-200) to $1699 (711-3423) in lower-middle-income countries. Globally, the share of health spending

How Medicaid Expansion Affected Out-of-Pocket Health Care Spending for Low-Income Families.

Science.gov (United States)

Glied, Sherry; Chakraborty, Ougni; Russo, Therese

2017-08-01

ISSUE. Prior research shows that low-income residents of states that expanded Medicaid under the Affordable Care Act are less likely to experience financial barriers to health care access, but the impact on out-of-pocket spending has not yet been measured. GOAL. Assess how the Medicaid expansion affected out-of-pocket health care spending for low-income families compared to those in states that did not expand and consider whether effects differed in states that expanded under conventional Medicaid rules vs. waiver programs. METHODS. Analysis of the Consumer Expenditure Survey 2010–2015. KEY FINDINGS AND CONCLUSIONS. Compared to families in nonexpansion states, low-income families in states that did expand Medicaid saved an average of $382 in annual spending on health care. In these states, low-income families were less like to report any out-of-pocket spending on insurance premiums or medical care than were similar families in nonexpansion states. For families that did have some out-of-pocket spending, spending levels were lower in states that expanded Medicaid. Low-income families in Medicaid expansion states were also much less likely to have catastrophically high spending levels. The form of coverage expansion — conventional Medicaid or waiver rules — did not have a statistically significant effect on these outcomes.

Allocating Spending Between Advertising and Information Technology in Electronic Retailing

OpenAIRE

Yong Tan; Vijay S. Mookerjee

2005-01-01

This study examines coordination issues that occur in allocating spending between advertising and information technology (IT) in electronic retailing. Electronic retailers run the risk of overspending on advertising to attract customers but underspending on IT, thus resulting in inadequate processing capacity at the firm's website. In this paper, we present a centralized, joint marketing-IT model to optimally allocate spending between advertising and IT, and we discuss an uncoordinated case w...

[Central purchasing bodies and spending review in health sector].

Science.gov (United States)

Spampinato, Luigi

2017-01-01

The aim of this paper is to analyze the new model of centralization of purchases in Italy after the approval of the 2016 Stability Law, with particular reference to the health sector. In fact, the spending review process in Italy in the health sector has had a strong evolution with the 2016 Stability Law, which has introduced the obligation for the institutions of the National Health Service to obtain supplies, exclusively, from aggregators subjects, for certain product categories of the health sector. The legislature, over the years, was mainly characterized by measures to reduce the spending limits for purchases of goods and services or by resetting the fees, including the provision of an obligation for the renegotiation of health goods and services contracts, in order to ensure the effective implementation of the expenditure rationalization by aggregation of goods and services. From 2016, the legislature has provided an innovative model of centralization of purchases based on a new network governance model on several levels, national and regional, which should ensure an efficiency of procurement processes. The proper functioning of the governance model adopted can be an important driver of economic policy in order to understand that it is important not only to spend less, but to spend better. This can be realized in the public administration with a strong innovation process in this administration and also with a strong investment in skills, in order to ensure the same service quality throughout the national territory to the health sector.

Approaches based on behavioral economics could help nudge patients and providers toward lower health spending growth.

Science.gov (United States)

King, Dominic; Greaves, Felix; Vlaev, Ivo; Darzi, Ara

2013-04-01

Policies that change the environment or context in which decisions are made and "nudge" people toward particular choices have been relatively ignored in health care. This article examines the role that approaches based on behavioral economics could play in "nudging" providers and patients in ways that could slow health care spending growth. The basic insight of behavioral economics is that behavior is guided by the very fallible human brain and greatly influenced by the environment or context in which choices are made. In policy arenas such as pensions and personal savings, approaches based on behavioral economics have provided notable results. In health care, such approaches have been used successfully but in limited ways, as in the use of surgical checklists that have increased patient safety and reduced costs. With health care spending climbing at unsustainable rates, we review the role that approaches based on behavioral economics could play in offering policy makers a potential set of new tools to slow spending growth.

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 technical...

Out-of-Pocket and Health Care Spending Changes for Patients Using Orally Administered Anticancer Therapy After Adoption of State Parity Laws.

Science.gov (United States)

Dusetzina, Stacie B; Huskamp, Haiden A; Winn, Aaron N; Basch, Ethan; Keating, Nancy L

2017-11-09

Oral anticancer medications are increasingly important but costly treatment options for patients with cancer. By early 2017, 43 states and Washington, DC, had passed laws to ensure patients with private insurance enrolled in fully insured health plans pay no more for anticancer medications administered by mouth than anticancer medications administered by infusion. Federal legislation regarding this issue is currently pending. Despite their rapid acceptance, the changes associated with state adoption of oral chemotherapy parity laws have not been described. To estimate changes in oral anticancer medication use, out-of-pocket spending, and health plan spending associated with oral chemotherapy parity law adoption. Analysis of administrative health plan claims data from 2008-2012 for 3 large nationwide insurers aggregated by the Health Care Cost Institute. Data analysis was first completed in 2015 and updated in 2017. The study population included 63 780 adults living in 1 of 16 states that passed parity laws during the study period and who received anticancer drug treatment for which orally administered treatment options were available. Study analysis used a difference-in-differences approach. Time period before and after adoption of state parity laws, controlling for whether the patient was enrolled in a plan subject to parity (fully insured) or not (self-funded, exempt via the Employee Retirement Income Security Act). Oral anticancer medication use, out-of-pocket spending, and total health care spending. Of the 63 780 adults aged 18 through 64 years, 51.4% participated in fully insured plans and 48.6% in self-funded plans (57.2% were women; 76.8% were aged 45 to 64 years). The use of oral anticancer medication treatment as a proportion of all anticancer treatment increased from 18% to 22% (adjusted difference-in-differences risk ratio [aDDRR], 1.04; 95% CI, 0.96-1.13; P = .34) comparing months before vs after parity. In plans subject to parity laws, the

Russia's defense spending and the economic decline

Directory of Open Access Journals (Sweden)

Susanne Oxenstierna

2016-01-01

Full Text Available The purpose of this article is to explore the development of Russian military spending in light of weak and negative growth of the Russian economy and to look at the reasons for the economic decline that has developed after the economic crisis in 2009 and is due to long-term internal structural factors that have existed since the mid-2000s. The confidence crisis resulting from Russia's aggression against Ukraine 2014, Western sanctions and falling oil prices has further aggravated these tendencies and the economy is now contracting. The main conclusions are that the share of the defense budget in GDP has risen substantially, but there is still a trade-off between defense and other public spending in the budget. Political reform would be necessary to implement market institutions and revive the economy.

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

The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation.

Science.gov (United States)

Vargas Bustamante, Arturo; Chen, Jie

2014-12-01

We study the association between the timing of the Great Recession (GR) and health spending among uninsured adults distinguishing by citizenship/nativity status and time of U.S. residence. Uninsured U.S. citizens and noncitizens from the 2005-2006 and 2008-2009 Medical Expenditure Panel Survey. The probability of reporting any health spending and the natural logarithm of health spending are our main dependent variables. We compare health spending across population categories before/during the GR. Subsequently, we implement two-part regression analyses of total and specific health-spending measures. We predict average health spending before/during the GR with a smearing estimation. The probability of reporting any spending diminished for recent immigrants compared to citizens during the GR. For those with any spending, recent immigrants reported higher spending during the GR (27 percent). Average reductions in total spending were driven by the decline in the share of the population reporting any spending among citizens and noncitizens. Our study findings suggest that recent immigrants could be forgoing essential care, which later translates into higher spending. It portrays the vulnerability of a population that would remain exposed to income shocks, even after the Affordable Care Act (ACA) implementation. © Health Research and Educational Trust.

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.

Reducing the Deficit: Spending and Revenue Options

Science.gov (United States)

1994-03-01

357 B SPENDING OPTIONS BY BUDGET FUNCION ...... 363 TABLES 1. Baseline Deficit Projections, Fiscal Years 1993-2004...direct control of the Congress. abled beneficiaries and beneficiaries with end-stage renal disease. Nonhealth changes enacted in The total that is

Vertical Integration of Hospitals and Physicians: Economic Theory and Empirical Evidence on Spending and Quality.

Science.gov (United States)

Post, Brady; Buchmueller, Tom; Ryan, Andrew M

2017-08-01

Hospital-physician vertical integration is on the rise. While increased efficiencies may be possible, emerging research raises concerns about anticompetitive behavior, spending increases, and uncertain effects on quality. In this review, we bring together several of the key theories of vertical integration that exist in the neoclassical and institutional economics literatures and apply these theories to the hospital-physician relationship. We also conduct a literature review of the effects of vertical integration on prices, spending, and quality in the growing body of evidence ( n = 15) to evaluate which of these frameworks have the strongest empirical support. We find some support for vertical foreclosure as a framework for explaining the observed results. We suggest a conceptual model and identify directions for future research. Based on our analysis, we conclude that vertical integration poses a threat to the affordability of health services and merits special attention from policymakers and antitrust authorities.

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

Changes in health care spending and quality for Medicare beneficiaries associated with a commercial ACO contract.

Science.gov (United States)

McWilliams, J Michael; Landon, Bruce E; Chernew, Michael E

2013-08-28

In a multipayer system, new payment incentives implemented by one insurer for an accountable care organization (ACO) may also affect spending and quality of care for another insurer's enrollees served by the ACO. Such spillover effects reflect the extent of organizational efforts to reform care delivery and can contribute to the net impact of ACOs. We examined whether the Blue Cross Blue Shield (BCBS) of Massachusetts' Alternative Quality Contract (AQC), an early commercial ACO initiative associated with reduced spending and improved quality for BCBS enrollees, was also associated with changes in spending and quality for Medicare beneficiaries, who were not covered by the AQC. Quasi-experimental comparisons from 2007-2010 of elderly fee-for-service Medicare beneficiaries in Massachusetts (1,761,325 person-years) served by 11 provider organizations entering the AQC in 2009 or 2010 (intervention group) vs beneficiaries served by other providers (control group). Using a difference-in-differences approach, we estimated changes in spending and quality for the intervention group in the first and second years of exposure to the AQC relative to concurrent changes for the control group. Regression and propensity score methods were used to adjust for differences in sociodemographic and clinical characteristics. The primary outcome was total quarterly medical spending per beneficiary. Secondary outcomes included spending by setting and type of service, 5 process measures of quality, potentially avoidable hospitalizations, and 30-day readmissions. Before entering the AQC, total quarterly spending per beneficiary for the intervention group was $150 (95% CI, $25-$274) higher than for the control group and increased at a similar rate. In year 2 of the intervention group's exposure to the AQC, this difference was reduced to $51 (95% CI, -$109 to $210; P = .53), constituting a significant differential change of -$99 (95% CI, -$183 to -$16; P = .02) or a 3.4% savings

Systems GMM estimates of the health care spending and GDP relationship: a note.

Science.gov (United States)

Kumar, Saten

2013-06-01

This paper utilizes the systems generalized method of moments (GMM) [Arellano and Bover (1995) J Econometrics 68:29-51; Blundell and Bond (1998) J Econometrics 87:115-143], and panel Granger causality [Hurlin and Venet (2001) Granger Causality tests in panel data models with fixed coefficients. Mime'o, University Paris IX], to investigate the health care spending and gross domestic product (GDP) relationship for organisation for economic co-operation and development countries over the period 1960-2007. The system GMM estimates confirm that the contribution of real GDP to health spending is significant and positive. The panel Granger causality tests imply that a bi-directional causality exists between health spending and GDP. To this end, policies aimed at raising health spending will eventually improve the well-being of the population in the long run.

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.

Comparing the Income Elasticity of Health Spending in Middle-Income and High-Income Countries: The Role of Financial Protection.

Science.gov (United States)

Vargas Bustamante, Arturo; V Shimoga, Sandhya

2017-07-19

As middle-income countries become more affluent, economically sophisticated and productive, health expenditure patterns are likely to change. Other socio-demographic and political changes that accompany rapid economic growth are also likely to influence health spending and financial protection. This study investigates the relationship between growth on per-capita healthcare expenditure and gross domestic product (GDP) in a group of 27 large middle-income economies and compares findings with those of 24 high-income economies from the Organization for Economic Cooperation and Development (OECD) group. This comparison uses national accounts data from 1995-2014. We hypothesize that the aggregated income elasticity of health expenditure in middle-income countries would be less than one (meaning healthcare is a normal good). An initial exploratory analysis tests between fixed-effects and random-effects model specifications. A fixed-effects model with time-fixed effects is implemented to assess the relationship between the two measures. Unit root, Hausman and serial correlation tests are conducted to determine model fit. Additional explanatory variables are introduced in different model specifications to test the robustness of our regression results. We include the out-of-pocket (OOP) share of health spending in each model to study the potential role of financial protection in our sample of high- and middle-income countries. The first-difference of study variables is implemented to address non-stationarity and cointegration properties. The elasticity of per-capita health expenditure and GDP growth is positive and statistically significant among sampled middle-income countries (51 per unit-growth in GDP) and high-income countries (50 per unit-growth in GDP). In contrast with previous research that has found that income elasticity of health spending in middle-income countries is larger than in high-income countries, our findings show that elasticity estimates can change if

Associations Between Medicare Part D and Out-of-Pocket Spending, HIV Viral Load, Adherence, and ADAP Use in Dual Eligibles With HIV.

Science.gov (United States)

Belenky, Nadya; Pence, Brian W; Cole, Stephen R; Dusetzina, Stacie B; Edmonds, Andrew; Oberlander, Jonathan; Plankey, Michael W; Adedimeji, Adebola; Wilson, Tracey E; Cohen, Jennifer; Cohen, Mardge H; Milam, Joel E; Golub, Elizabeth T; Adimora, Adaora A

2018-01-01

The implementation of Medicare part D on January 1, 2006 required all adults who were dually enrolled in Medicaid and Medicare (dual eligibles) to transition prescription drug coverage from Medicaid to Medicare part D. Changes in payment systems and utilization management along with the loss of Medicaid protections had the potential to disrupt medication access, with uncertain consequences for dual eligibles with human immunodeficiency virus (HIV) who rely on consistent prescription coverage to suppress their HIV viral load (VL). To estimate the effect of Medicare part D on self-reported out-of-pocket prescription drug spending, AIDS Drug Assistance Program (ADAP) use, antiretroviral adherence, and HIV VL suppression among dual eligibles with HIV. Using 2003-2008 data from the Women's Interagency HIV Study, we created a propensity score-matched cohort and used a difference-in-differences approach to compare dual eligibles' outcomes pre-Medicare and post-Medicare part D to those enrolled in Medicaid alone. Transition to Medicare part D was associated with a sharp increase in the proportion of dual eligibles with self-reported out-of-pocket prescription drug costs, followed by an increase in ADAP use. Despite the increase in out-of-pocket costs, both adherence and HIV VL suppression remained stable. Medicare part D was associated with increased out-of-pocket spending, although the increased spending did not seem to compromise antiretroviral therapy adherence or HIV VL suppression. It is possible that increased ADAP use mitigated the increase in out-of-pocket spending, suggesting successful coordination between Medicare part D and ADAP as well as the vital role of ADAP during insurance transitions.

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. Project HOPE—The People-to-People Health Foundation, Inc.

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

Anesthesia Service Use During Outpatient Gastroenterology Procedures Continued to Increase From 2010 to 2013 and Potentially Discretionary Spending Remained High.

Science.gov (United States)

Predmore, Zachary; Nie, Xiaoyu; Main, Regan; Mattke, Soeren; Liu, Hangsheng

2017-02-01

Previous studies have identified an increasing number of gastroenterology (GI) procedures using anesthesia services to provide sedation, with a majority of these services delivered to low-risk patients. The aim of this study was to update these trends with the most recent years of data. We used Medicare and commercial claims data from 2010 to 2013 to identify GI procedures and anesthesia services based on CPT codes, which were linked together using patient identifiers and dates of service. We defined low-risk patients as those who were classified as ASA (American Society of Anesthesiologists) physical status class I or II. For those patients without an ASA class listed on the claim, we used a prediction algorithm to impute an ASA physical status. Over 6.6 million patients in our sample had a GI procedure between 2010 and 2013. GI procedures involving anesthesia service accounted for 33.7% in 2010 and 47.6% in 2013 in Medicare patients, and 38.3% in 2010 and 53.0% in 2013 in commercially insured patients. Overall, as more patients used anesthesia services, total anesthesia service use in low-risk patients increased 14%, from 27,191 to 33,181 per million Medicare enrollees. Similarly, we observed a nearly identical uptick in commercially insured patients from 15,871 to 22,247 per million, an increase of almost 15%. During 2010-2013, spending associated with anesthesia services in low-risk patients increased from US$3.14 million to US$3.45 million per million Medicare enrollees and from US$7.69 million to US$10.66 million per million commercially insured patients. During 2010 to 2013, anesthesia service use in GI procedures continued to increase and the proportion of these services rendered for low-risk patients remained high.

One sector models, indeterminacy, and productive public spending

Czech Academy of Sciences Publication Activity Database

Slobodyan, Sergey

-, č. 293 (2006), s. 1-24 ISSN 1211-3298 Institutional research plan: CEZ:MSM0021620846 Keywords : indeterminacy * absolute instability * productive public spending Subject RIV: AH - Economics http://www.cerge-ei.cz/pdf/wp/Wp293.pdf

A Bayesian sequential design using alpha spending function to control type I error.

Science.gov (United States)

Zhu, Han; Yu, Qingzhao

2017-10-01

We propose in this article a Bayesian sequential design using alpha spending functions to control the overall type I error in phase III clinical trials. We provide algorithms to calculate critical values, power, and sample sizes for the proposed design. Sensitivity analysis is implemented to check the effects from different prior distributions, and conservative priors are recommended. We compare the power and actual sample sizes of the proposed Bayesian sequential design with different alpha spending functions through simulations. We also compare the power of the proposed method with frequentist sequential design using the same alpha spending function. Simulations show that, at the same sample size, the proposed method provides larger power than the corresponding frequentist sequential design. It also has larger power than traditional Bayesian sequential design which sets equal critical values for all interim analyses. When compared with other alpha spending functions, O'Brien-Fleming alpha spending function has the largest power and is the most conservative in terms that at the same sample size, the null hypothesis is the least likely to be rejected at early stage of clinical trials. And finally, we show that adding a step of stop for futility in the Bayesian sequential design can reduce the overall type I error and reduce the actual sample sizes.

Associations Between County Wealth, Health and Social Services Spending, and Health Outcomes.

Science.gov (United States)

McCullough, J Mac; Leider, Jonathon P

2017-11-01

Each year, the County Health Rankings rate the health outcomes of each county in the U.S. A common refrain is that poor counties perform worse than wealthier ones. This article examines that assumption and specifically analyzes characteristics of counties that have performed better in terms of health outcomes than their wealth alone would suggest. Data from the 2013 County Health Rankings were used, as were 2012 financial and demographic information collected by the U.S. Census Bureau. A logistic model was constructed to examine the odds of a county "overperforming" in the rankings relative to community wealth. Analyses were performed in 2016. Communities that were wealthier performed better on the rankings. However, more than 800 of 3,141 counties overperformed by ranking in a better health outcomes quartile than their county's wealth alone would suggest. Regression analyses found that for each additional percentage point of total public spending that was allocated toward community health care and public health, the odds of being an overperformer increased by 3.7%. Community wealth correlates with health, but not always. Population health outcomes in hundreds of counties overperform what would be expected given community wealth alone. These counties tend to invest more in community health care and public health spending and other social services. Although the level of a community's wealth is outside the control of practitioners, shifting the proportion of spending to certain social services may positively impact population health. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Evaluating the Effects of Pioneer Accountable Care Organizations on Medicare Part D Drug Spending and Utilization.

Science.gov (United States)

Zhang, Yuting; Caines, Kadin J; Powers, Christopher A

2017-05-01

The improvement of medication use is a critical mechanism that accountable care organization (ACO) could use to save overall costs. Currently pharmaceutical spending is not part of the calculation for ACO-shared savings and risks. Thus, ACO providers may have strong incentives to prescribe more medications hoping to avoid expensive downstream medical costs. We designed a quasinatural experiment study to evaluate the effects of Pioneer ACOs on Medicare Part D spending and utilization. Medicare fee-for-service beneficiaries with Part D drug coverage who were aligned to a Pioneer ACO were compared with a random 5% sample of non-ACO beneficiaries. Outcomes included changes in Part D spending, number of prescription fills, percent of brand medications, and total Part A and B medical spending. We utilized a generalized linear model with a difference-in-differences approach to estimate 2011-2012 changes in these outcomes among beneficiaries aligned with Pioneer ACOs, adjusting for all beneficiary-level demographics, income and insurance status, clinical characteristics, and regional fixed effects. Being in an ACO did not significantly affect Part D spending (-$23.52; P=0.19), total prescriptions filled (-0.12; P=0.27), and the percent of claims for brand-name drugs (0.06%; P=0.23). The ACO group was associated with savings in Parts A and B spending of $345 (PPioneer ACOs were not associated with changes in pharmaceutical spending and use, but were associated with savings in Parts A and B spending in 2012.

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. Copyright © 2014, American Association for the Advancement of Science.

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 ...

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.

How College Students Spend Their Time Communicating

Science.gov (United States)

Emanuel, Richard; Adams, Jim; Baker, Kim; Daufin, E. K.; Ellington, Coke; Fitts, Elizabeth; Himsel, Jonathan; Holladay, Linda; Okeowo, David

2008-01-01

This study sought to assess how college students spend their time communicating and what impact, if any, communications devices may be having on how that time is spent. Undergraduates (N = 696) at four southeastern colleges were surveyed. Results revealed that listening comprises 55.4% of the total average communication day followed by reading…

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.

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.

Defense Spending, Growth And Inequality, 1970-2008: An Econometric Analysis

Directory of Open Access Journals (Sweden)

Seyhan TAŞ

2013-12-01

Full Text Available This paper examines the relationship between defense expentures, income inequality and growth in Turkey for the period of 1970-2008. In the study, the problem of lack of time series data has been overcome by using manufacturing pay inequality index constructed by Theil T Statistic. Although there are numerous studies that examine the different aspects of military spending in Turkey, there are few studies that analyse the impact of military spending on income distribution in Turkey. Considering this lack in the literature, the study, utilizing basic cointegration and VAR model, aims to contribute to the literaure

Inventory information approval system certification and flexible spending account purchases.

Science.gov (United States)

Shuey, Brandon; Williams, La Vonn A

2010-01-01

There is no question that 2009 was a year of change within the pharmacy industry. Several new requirements were implemented, including the need for an Inventory Information Approval System for accepting flexible spending or health reimbursement account cords. Some pharmacies relied on the 90% exemption rule, which is discussed within this article, or an alternative method to avoid the expense of a point of sale. However, with flexible spending or health reimbursement account card participation expected to reach 85% in 2010, now bay be the time for compounding pharmacists to weigh the pros and cons of Inventory Information Approval System certification.

The governance of federal debt in the United States of America

Directory of Open Access Journals (Sweden)

Gisele Mah

2017-02-01

Full Text Available The United State of America has been experiencing high debt to GDP ratio of more than 100% and these Public debts are detrimental. The main purpose of this study was to examine the shocks of the variables on others in the USA economy by using quarterly data. The variance decomposition and the Generalised Impulse Response Function techniques were employed to analyse the data. The result revealed that high variation of shocks in real federal debt is explained by their own innovations in the short run, by CPI followed by real federal debt its self. In the long run, this leads to CPI and real government spending. The GIRF reveals that in the short run, real federal debt responds negatively to shocks from CPI, real federal interest payment and real federal government tax receipts and positively to real federal debt and real government spending. In medium term, only real federal government tax receipts are negative while the others are positive. In the long run, the response are all positive to shock from the independent variables. The results lead to the recommendation that the US government should focus on real federal debt in the short run. In the medium term, US government should focus on increasing real government spending and reducing only real federal government tax receipts. In the long run the target should real be federal debt, CPI, real federal interest payment, real government spending and real federal government tax receipts

Offering A Price Transparency Tool Did Not Reduce Overall Spending Among California Public Employees And Retirees.

Science.gov (United States)

Desai, Sunita; Hatfield, Laura A; Hicks, Andrew L; Sinaiko, Anna D; Chernew, Michael E; Cowling, David; Gautam, Santosh; Wu, Sze-Jung; Mehrotra, Ateev

2017-08-01

Insurers, employers, and states increasingly encourage price transparency so that patients can compare health care prices across providers. However, the evidence on whether price transparency tools encourage patients to receive lower-cost care and reduce overall spending remains limited and mixed. We examined the experience of a large insured population that was offered a price transparency tool, focusing on a set of "shoppable" services (lab tests, office visits, and advanced imaging services). Overall, offering the tool was not associated with lower shoppable services spending. Only 12 percent of employees who were offered the tool used it in the first fifteen months after it was introduced, and use of the tool was not associated with lower prices for lab tests or office visits. The average price paid for imaging services preceded by a price search was 14 percent lower than that paid for imaging services not preceded by a price search. However, only 1 percent of those who received advanced imaging conducted a price search. Simply offering a price transparency tool is not sufficient to meaningfully decrease health care prices or spending. Project HOPE—The People-to-People Health Foundation, Inc.

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. Project HOPE—The People-to-People Health Foundation, Inc.

Variation In Health Outcomes: The Role Of Spending On Social Services, Public Health, And Health Care, 2000-09.

Science.gov (United States)

Bradley, Elizabeth H; Canavan, Maureen; Rogan, Erika; Talbert-Slagle, Kristina; Ndumele, Chima; Taylor, Lauren; Curry, Leslie A

2016-05-01

Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000-09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health-not only in health care but also in social services and public health-is warranted. Project HOPE—The People-to-People Health Foundation, Inc.

Revealed preference for taxation and spending

OpenAIRE

McDowell, Moore

1993-01-01

This paper analyses some of the results of a survey of public opinion carried out in Ireland in the early Autumn of 1989. The survey itself was an innovation in the political economy of taxation and public spending in Ireland in that it was the first time a fully articulated exercise was mounted to establish the actual preferences of the population over specified areas of the economics of the public sector.[extract

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...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...because businesses look beyond the obvious nominal rate and locate according to effective rates of taxation , ie. actual tax liability. In addition, tax

End-of-Life Medical Spending In Last Twelve Months of Life is Lower than Previously Reported

DEFF Research Database (Denmark)

French, Eric; Aragon, Maria; Mccauley, Jeremy

2017-01-01

Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiw...... but to spending on people with chronic conditions, which are associated with shorter life expectancies....

United States home births increase 20 percent from 2004 to 2008.

Science.gov (United States)

MacDorman, Marian F; Declercq, Eugene; Mathews, T J

2011-09-01

After a gradual decline from 1990 to 2004, the percentage of births occurring at home increased from 2004 to 2008 in the United States. The objective of this report was to examine the recent increase in home births and the factors associated with this increase from 2004 to 2008. United States birth certificate data on home births were analyzed by maternal demographic and medical characteristics. In 2008, there were 28,357 home births in the United States. From 2004 to 2008, the percentage of births occurring at home increased by 20 percent from 0.56 percent to 0.67 percent of United States births. This rise was largely driven by a 28 percent increase in the percentage of home births for non-Hispanic white women, for whom more than 1 percent of births occur at home. At the same time, the risk profile for home births has been lowered, with substantial drops in the percentage of home births of infants who are born preterm or at low birthweight, and declines in the percentage of home births that occur to teen and unmarried mothers. Twenty-seven states had statistically significant increases in the percentage of home births from 2004 to 2008; only four states had declines. The 20 percent increase in United States home births from 2004 to 2008 is a notable development that will be of interest to practitioners and policymakers. (BIRTH 38:3 September 2011). © 2011, Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc.

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.

Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO.

Science.gov (United States)

Hsu, John; Price, Mary; Vogeli, Christine; Brand, Richard; Chernew, Michael E; Chaguturu, Sreekanth K; Weil, Eric; Ferris, Timothy G

2017-05-01

Accountable care organizations (ACOs) appear to lower medical spending, but there is little information on how they do so. We examined the impact of patient participation in a Pioneer ACO and its care management program on rates of emergency department (ED) visits and hospitalizations and on Medicare spending. We used data for the period 2009-14, exploiting naturally staggered program entry to create concurrent controls to help isolate the program effects. The care management program (the ACO's primary intervention) targeted beneficiaries with elevated but modifiable risks for future spending. ACO participation had a modest effect on spending, in line with previous estimates. Participation in the care management program was associated with substantial reductions in rates for hospitalizations and both all and nonemergency ED visits, as well as Medicare spending, when compared to preparticipation levels and to rates and spending for a concurrent sample of beneficiaries who were eligible for but had not yet started the program. Rates of ED visits and hospitalizations were reduced by 6 percent and 8 percent, respectively, and Medicare spending was reduced by 6 percent. Targeting beneficiaries with modifiable high risks and shifting care away from the ED represent viable mechanisms for altering spending within ACOs. Project HOPE—The People-to-People Health Foundation, Inc.

The Advertising Strategies of Early E-cigarette Brand Leaders in the United States.

Science.gov (United States)

Haardörfer, Regine; Cahn, Zachary; Lewis, Michael; Kothari, Shreya; Sarmah, Raina; Getachew, Betelihem; Berg, Carla J

2017-04-01

We examined differential advertising strategies used by 4 major United States e-cigarette companies with differential affiliations with the traditional tobacco industry (ie, Njoy - independent, Blu - acquired, Vuse and MarkTen - launched by cigarette companies) over time. We conducted a mixed-methods study regarding e-cigarette adspend, adspend per media channel (eg, TV, print), and advertising messaging strategies among these 4 top e-cigarette brands from January 2013 through December 2015. E-cigarette adspend increased from $59 million in 2013 to $91 million in 2014, followed by a sharp decline to $37 million in 2015. These companies showed distinct spending trajectories overall and across media channels, with Njoy and Vuse spending a higher proportion of their dollars on TV and Blu and MarkTen spending more on print. Marketing messages were also different by company. Key themes included switching from cigarettes (particularly by Njoy and Blu), circumventing smoke-free policies (particularly by Blu), and technological advancement (particularly by Vuse and MarkTen). These e-cigarette brands have shifted their adspend, use of media channels, and advertising messaging strategies over time. Some differing strategies may reflect the different affiliations of each brand to the traditional cigarette industry.

Targets for Marine Corps Purchasing and Supply Management Initiatives: Spend Analysis Findings

Science.gov (United States)

2011-01-01

Corps Purchasing and Supply Management Initiatives: Spend Analysis Findings source contracts with providers in them. We also examine contract “ churn ...repair, and rebuilding of equipment; general purpose ADP equipment; ADP and telecommunication ser- vices—are also shown in the previous chart for top...to $469 million in FY 2004. The spend for other ADP and telecommunication services, $264 million in FY 2004, was not even in the top ten in FY 2003

Transmission of government spending shocks in the Euro area: time variation and driving forces

NARCIS (Netherlands)

Kirchner, M.; Cimadomo, J.; Hauptmeier, S.

2010-01-01

This paper provides new evidence on the effects of government spending shocks and the fiscal transmission mechanism in the euro area for the period 1980-2008. Our contribution is two-fold. First, we investigate changes in the macroeconomic impact of government spending shocks using time-varying

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.

Reprioritizing government spending on health: pushing an elephant up the stairs?

Science.gov (United States)

Tandon, Ajay; Fleisher, Lisa; Li, Rong; Yap, Wei Aun

2014-01-01

Countries vary widely with respect to the share of government spending on health, a metric that can serve as a proxy for the extent to which health is prioritized by governments. World Health Organization (WHO) data estimate that, in 2011, health's share of aggregate government expenditure averaged 12% in the 170 countries for which data were available. However, country differences were striking: ranging from a low of 1% in Myanmar to a high of 28% in Costa Rica. Some of the observed differences in health's share of government spending across countries are unsurprisingly related to differences in national income. However, significant variations exist in health's share of government spending even after controlling for national income. This paper provides a global overview of health's share of government spending and summarizes some of the key theoretical and empirical perspectives on allocation of public resources to health vis-à-vis other sectors from the perspective of reprioritization, one of the modalities for realizing fiscal space for health. The paper argues that theory and cross-country empirical analyses do not provide clear-cut explanations for the observed variations in government prioritization of health. Standard economic theory arguments that are often used to justify public financing for health are equally applicable to many other sectors including defence, education and infrastructure. To date, empirical work on prioritization has been sparse: available cross-country econometric analyses suggest that factors such as democratization, lower levels of corruption, ethnolinguistic homogeneity and more women in public office are correlated with higher shares of public spending on health; however, these findings are not robust and are sensitive to model specification. Evidence from case studies suggests that country-specific political economy considerations are key, and that results-focused reform efforts - in particular efforts to explicitly expand the

Spending on social and public health services and its association with homicide in the USA: an ecological study.

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Sipsma, Heather L; Canavan, Maureen E; Rogan, Erika; Taylor, Lauren A; Talbert-Slagle, Kristina M; Bradley, Elizabeth H

2017-10-12

To examine whether state-level spending on social and public health services is associated with lower rates of homicide in the USA. Ecological study. USA. All states in the USA and the District of Columbia for which data were available (n=42). Homicide rates for each state were abstracted from the US Department of Justice Federal Bureau of Investigation's Uniform Crime Reporting. After adjusting for potential confounding variables, we found that every $10 000 increase in spending per person living in poverty was associated with 0.87 fewer homicides per 100 000 population or approximately a 16% decrease in the average homicide rate (estimate=-0.87, SE=0.15, phomicide rates at the state level. Although we cannot infer causality from this research, such spending may provide promising avenues for homicide reduction in the USA, particularly among states with lower levels of poverty. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Spending on Hospital Care and Pediatric Psychology Service Use Among Adolescents and Young Adults With Cancer.

Science.gov (United States)

McGrady, Meghan E; Peugh, James L; Brown, Gabriella A; Pai, Ahna L H

2017-10-01

To examine the relationship between need-based pediatric psychology service use and spending on hospital care among adolescents and young adults (AYAs) with cancer. Billing data were obtained from 48 AYAs with cancer receiving need-based pediatric psychology services and a comparison cohort of 48 AYAs with cancer not receiving services. A factorial analysis of covariance examined group differences in spending for hospital care. Pending significant findings, a multivariate analysis of covariance was planned to examine the relationship between need-based pediatric psychology service use and spending for inpatient admissions, emergency department (ED) visits, and outpatient visits. Spending for hospital care was higher among AYAs receiving need-based pediatric psychology services than in the comparison cohort (p psychology services. The behavioral and psychosocial difficulties warranting need-based pediatric psychology services may predict higher health care spending. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Pattern and levels of spending allocated to HIV prevention programs in low- and middle-income countries

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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.

The economic downturn and its lingering effects reduced medicare spending growth by $4 billion in 2009-12.

Science.gov (United States)

Dranove, David; Garthwaite, Craig; Ody, Christopher

2015-08-01

Previous work has found a strong connection between the most recent economic recession and reductions in private health spending. However, the effect of economic downturns on Medicare spending is less clear. In contrast to studies involving earlier time periods, our study found that when the macroeconomy slowed during the Great Recession of 2007-09, so did Medicare spending growth. A small (14 percent) but significant share of the decline in Medicare spending growth from 2009 to 2012 relative to growth from 2004 to 2009 can be attributed to lingering effects of the recession. Absent the economic downturn, Medicare spending would have been $4 billion higher in 2009-12. A major reason for the relatively small impact of the macroeconomy is the relative lack of labor-force participation among people ages sixty-five and older. We estimate that if they had been working at the same rate as the nonelderly before the recession, the effect of the downturn on Medicare spending growth would have been twice as large. Project HOPE—The People-to-People Health Foundation, Inc.

Elderly Bias, New Social Risks, and Social Spending

DEFF Research Database (Denmark)

Tepe, Markus; Vanhuysse, Pieter

2010-01-01

of the large-scale arrival of such risks 'on the ground' does play a key role. Countries that entered the postindustrial society comparatively late record lower NSRS values, as they spend less on programs such as education and family allowances. Institutional differences as captured by welfare regime type...

Is happiness choosing to give or to take money? : An experimental study of prosocial spending, active and passive choices and nudging

OpenAIRE

Moche, Hajdi

2016-01-01

Research within positive psychology has shown that spending money on other people (prosocial spending) makes you happier than spending it on yourself (proself spending). The present study tested and extended this idea. Also, how an active or a passive choice in spending affect happiness has been tested. Lastly, this study is the first one to test the effect of nudging on happiness by examining the role of choice, defaults in spending. Three measures of subjective well-being (SWB) was used bef...

Poor markets, lack of incentives cause drastic drop in capital spending. [1977

Energy Technology Data Exchange (ETDEWEB)

Fish, R

1977-10-01

Canadian Mining Journal's 1977 Capital Expenditure Survey shows a drop of 52% in announced spending intentions compared with the 1976 survey total. Coal is particularly hard hit with announced spending for 1977 at 1,250,000 dollars as compared to 700,770,000 in 1976. This total 1977 amount is reported by Kaiser Resources for installing a Honeywell Model 66/05 large scale computer system to be used for accounting, inventory control, engineering and material procurement applications at Sparwood.

Budget spending and economic growth in Croatia - Dynamics and relathionships over the past two decades

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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.

The quality of governance and education spending in Africa

African Journals Online (AJOL)

public budget allocation to education by using data for a panel of ... social sector spending categories, education accounts for the highest share of GDP. (5.3%), which ..... that politically stable countries will devote more resources to education.

The quality of governance and education spending in Africa ...

African Journals Online (AJOL)

The quality of governance and education spending in Africa. ... and democracy, on the public budget allocation to education by using data for a panel of 28 African countries over the period 1995–2004. ... AJOL African Journals Online.

Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries.

Science.gov (United States)

Gross, D J; Alecxih, L; Gibson, M J; Corea, J; Caplan, C; Brangan, N

1999-04-01

To estimate out-of-pocket health care spending by lower-income Medicare beneficiaries, and to examine spending variations between those who receive Medicaid assistance and those who do not receive such aid. DATA SOURCES AND COLLECTION: 1993 Medicare Current Beneficiary Survey (MCBS) Cost and Use files, supplemented with data from the Bureau of the Census (Current Population Survey); the Congressional Budget Office; the Health Care Financing Administration, Office of the Actuary (National Health Accounts); and the Social Security Administration. We analyzed out-of-pocket spending through a Medicare Benefits Simulation model, which projects out-of-pocket health care spending from the 1993 MCBS to 1997. Out-of-pocket health care spending is defined to include Medicare deductibles and coinsurance; premiums for private insurance, Medicare Part B, and Medicare HMOs; payments for non-covered goods and services; and balance billing by physicians. It excludes the costs of home care and nursing facility services, as well as indirect tax payments toward health care financing. Almost 60 percent of beneficiaries with incomes below the poverty level did not receive Medicaid assistance in 1997. We estimate that these beneficiaries spent, on average, about half their income out-of-pocket for health care, whether they were enrolled in a Medicare HMO or in the traditional fee-for-service program. The 75 percent of beneficiaries with incomes between 100 and 125 percent of the poverty level who were not enrolled in Medicaid spent an estimated 30 percent of their income out-of-pocket on health care if they were in the traditional program and about 23 percent of their income if they were enrolled in a Medicare HMO. Average out-of-pocket spending among fee-for-service beneficiaries varied depending on whether beneficiaries had Medigap policies, employer-provided supplemental insurance, or no supplemental coverage. Those without supplemental coverage spent more on health care goods and

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

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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

Global Megacities Differing Adaptation Responses to Climate Change: an Analysis of Annual Spend of Ten Major cities on the adaptation economy

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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

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.

Science.gov (United States)

Friedman, Sarah; Xu, Haiyong; Harwood, Jessica M; Azocar, Francisca; Hurley, Brian; Ettner, Susan L

2017-09-01

The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between behavioral health and medical health insurance benefits among the commercially insured. This study determines whether MHPAEA was associated with increased BH expenditures and utilization among a population with substance use disorder (SUD) diagnoses. Claims and eligibility data from 5,987,776 enrollees, 2008-2013, were obtained from a national, commercial, managed behavioral health organization. An interrupted time series study design with segmented regression analysis estimated time trends of per-member-per-month (PMPM) spending and use before (2008-2009), during (2010), and after (2011-2013) MHPAEA compliance. The study sample contained individuals with drug or alcohol use disorder diagnosis during study period (N=2,716,473 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits; medication management; individual, group and family psychotherapy, and structured outpatient care); intermediate care utilization (day treatment; recovery home and residential); and inpatient utilization. Starting at the beginning of the post-parity period, MHPAEA was associated with increased levels of PMPM total and plan spending ($25.80 [p=0.01]; $28.33 [p=0.00], respectively), as well as the number of PMPM assessment/evaluation, individual psychotherapy, and group psychotherapy visits, and inpatient days (0.01 visits [p=0.01]; 0.02 visits [p=0.01]; 0.01 visits [p=0.03]; 0.01days [p=0.01], respectively). Following these initial level changes, MHPAEA was also associated with monthly increases in PMPM total, plan, and patent out-of-pocket spending ($2.56/month [p=0.00]; $2.25/month [p=0.00]; $0.27 [p=0.03], respectively), as well as structured outpatient visits and inpatient days (0.0012 visits/month [p=0.01]; 0.0012days/month [p=0.00]). MHPAEA was associated with modest

[Public spending on health and population health in Algeria: an econometric analysis].

Science.gov (United States)

Messaili, Moussa; Kaïd Tlilane, Nouara

2017-07-10

Objective: The objective of this study was to estimate the impact of public spending on health, among other determinants of health, on the health of the population in Algeria, using life expectancy (men and women) and infant mortality rates as indicators of health status. Methods: We conducted a longitudinal study over the period from 1974 to 2010 using the ARDL (Autoregressive Distributed Lags) approach to co-integration to estimate the short-term and long-term relationship. Results: Public spending on health has a positive, but not statistically significant impact, in the long and short term, on life expectancy (men and women). However, public spending significantly reduces the infant mortality rate. The long-term impact of the number of hospital beds is significant for the life expectancy of men, but not for women and infant mortality, but is significant for all indicators in the short-term relationship. The most important variables in improving the health of the population are real GDP per capita and fertility rate.

Communicating Spending Cuts: Lessons for Australian University Leaders

Science.gov (United States)

Sharrock, Geoff

2014-01-01

In 2011 and 2012, two Australian university vice chancellors flagged spending cuts at their institutions to overcome financial problems. In both cases, union and staff opposition led to public protests, intense media scrutiny, delays and retreats. This article compares the two cases to see what lessons may be drawn for university leaders faced…

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…

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.

The financial burden of out-of-pocket expenses in the United States and Canada: How different is the United States?

Directory of Open Access Journals (Sweden)

Katherine E Baird

2016-01-01

Full Text Available Background: This article compares the burden that medical cost-sharing requirements place on households in the United States and Canada. It estimates the probability that individuals with similar demographic features in the two countries have large medical expenses relative to income. Method: The study uses 2010 nationally representative household survey data harmonized for cross-national comparisons to identify individuals with high medical expenses relative to income. Using logistic regression, it estimates the probability of high expenses occurring among 10 different demographic groups in the two countries. Results: The results show the risk of large medical expenses in the United States is 1.5–4 times higher than it is in Canada, depending on the demographic group and spending threshold used. The United States compares least favorably when evaluating poorer citizens and when using a higher spending threshold. Conclusion: Recent health care reforms can be expected to reduce Americans’ catastrophic health expenses, but it will take very large reductions in out-of-pocket expenditures—larger than can be expected—if poorer and middle-class families are to have the financial protection from high health care costs that their counterparts in Canada have.

Accountable and Responsible Disclosure of Financial Open Government Data : Open Spending Initiatives enhancing Civic Engagement

NARCIS (Netherlands)

A.W. (Bert) Mulder; M.W. (Martijn) Hartog

2017-01-01

This research focuses an optimal arrangement of open spending as added instrumental value to the accountability incommunicating financial information towards citizens within The Netherlands. Open Spending is more and more of relevance in the Netherlands and is addressed as one of the key action

Compulsive consumption and commercial media : changing attitudes to spending and saving among Maltese youth

OpenAIRE

Grixti, Joe;

2005-01-01

This paper explores changing patterns in young Maltese people’s attitudes to spending and saving, and how they see their lives and opportunities as being different from those of their parents’ generation. The paper suggests that many of these perceptions have been inflected by the increasingly global and commercialised orientations of the media environments inhabited by today’s youth. It is because these influences are so often unexamined or miscinstructed that more systematic and widespread ...

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…

How Taxes and Spending on Education Influence Economic Growth in Poland

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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.

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). Copyright (c) 2007 John Wiley & Sons, Ltd.

Stability of regularly prescribed oral liquids formulated with SyrSpend® SF.

Science.gov (United States)

Uriel, M; Gómez-Rincón, C; Marro, D

2018-04-02

The purpose of this research was to evaluate the stability of 12 oral liquid formulations frequently compounded in hospital and community settings formulated in a specific vehicle: SyrSpend® SF. The stability of melatonin, glycopyrrolate, ciclosporin, chloral hydrate, flecainide acetate, tiagabine HCl, labetalol HCl, ciprofloxacin HCl, spironolactone/hydrochlorothiazide, hydrocortisone, itraconazole and celecoxib in SyrSpend SF PH4 (liquid) was investigated at 0, 30, 60 and 90 days and stored at both controlled room temperature and refrigerated. Itraconazole samples were also investigated at 15 and 45 days. No change in odor, color or appearance was observed in the formulations during the test period. Based on the results, a beyond-use date of 30 days can be assigned to tiagabine HCl 1.0 mg/ml in SyrSpend SF when stored at controlled room temperature, and 90 days under refrigeration, improving stability data previously published using other vehicles. A beyond-use date of 60 days can be assigned to chloral hydrate 100.0 mg/ml. In this case, stability is not enhanced by refrigeration. With the rest of the formulations, less than 10% API loss occurred over 90 days at either controlled room temperature or under refrigeration. Including for example itraconazole 20.0 mg/ml, thus providing extended stability compared to simple syrup and other oral liquid vehicles. The findings of this study show that SyrSpend SF is an appropriate suspending vehicle to be used for personalized formulations of the APIs studied here.

Prioritization of the essentials in the spending patterns of Canadian households experiencing food insecurity.

Science.gov (United States)

Fafard St-Germain, Andrée-Anne; Tarasuk, Valerie

2018-03-21

Food insecurity is a potent determinant of health and indicator of material deprivation in many affluent countries. Food insecurity is associated with compromises in food and housing expenditures, but how it relates to other expenditures is unknown. The present study described households' resource allocation over a 12-month period by food insecurity status. Expenditure data from the 2010 Survey of Household Spending were aggregated into four categories (basic needs, other necessities, discretionary, investments/assets) and ten sub-categories (food, clothing, housing, transportation, household/personal care, health/education, leisure, miscellaneous, personal insurance/pension, durables/assets). A four-level food insecurity status was created using the adult-specific items of the Household Food Security Survey Module. Mean dollars spent and budget share by food insecurity status were estimated with generalized linear models adjusted first for household size and composition, and subsequently for after-tax income quartiles. Canada. Population-based sample of households from the ten provinces (n 9050). Food-secure households had higher mean total expenditures than marginally, moderately and severely food-insecure households (P-trend insecurity increased, households spent less on all categories and sub-categories, except transportation, but they allocated a larger budget share to basic needs and smaller shares to discretionary spending and investments/assets. The downward trends for dollars spent on basic needs and other necessities became non-significant after accounting for income, but the upward trend in the budget shares for basic needs persisted. The spending patterns of food-insecure households suggest that they prioritized essential needs above all else.

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.

Medicaid spending on contraceptive coverage and pregnancy-related care

Science.gov (United States)

2014-01-01

Objective Up to 50% of pregnancies are unintended in the United States, and the healthcare costs associated with pregnancy are the most expensive among hospitalized conditions. The current study aims to assess Medicaid spending on various methods of contraception and on pregnancy care including unintended pregnancies. Methods We analyzed Medicaid health claims data from 2004 to 2010. Women 14–49 years of age initiating contraceptive methods and pregnant women were included as separate cohorts. Medicaid spending was summarized using mean all-cause and contraceptive healthcare payments per patient per month (PPPM) over a follow-up period of up to 12 months. Medicaid payments were also estimated in 2008 per female member of childbearing age per month (PFCPM) and per member per month (PMPM). Medicaid payments on unintended pregnancies were also evaluated PFCPM and PMPM in 2008. Results For short-acting reversible contraception (SARC) users, all-cause payments and contraceptive payments PPPM were respectively $365 and $18.3 for oral contraceptive (OC) users, $308 and $19.9 for transdermal users, $215 and $21.6 for vaginal ring users, and $410 and $8.8 for injectable users. For long-acting reversible contraception (LARC) users (follow-up of 9–10 months), corresponding payments were $194 and $36.8 for IUD users, and $237 and $29.9 for implant users. Pregnancy cohort all-cause mean healthcare payments PPPM were $610. Payments PFCPM and PMPM for contraceptives were $1.44 and $0.54, while corresponding costs of pregnancies were estimated at $39.91 and $14.81, respectively. Payments PFCPM and PMPM for contraceptives represented a small fraction at 6.56% ($1.44/$21.95) and 6.63% ($0.54/$8.15), respectively of the estimated payments for unintended pregnancy. Conclusions This study of a large sample of Medicaid beneficiaries demonstrated that, over a follow-up period of 12 months, Medicaid payments for pregnancy were considerably higher than payments for either SARC or

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…

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.

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

Science.gov (United States)

Nelson, E A S; Bloom, David E; Mahoney, Richard T

2014-01-01

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. To determine realistic targets for VPA and VPB. 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. 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. 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.

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…

Impact of out-of-pocket spending caps on financial burden of those with group health insurance.

Science.gov (United States)

Riggs, Kevin R; Buttorff, Christine; Alexander, G Caleb

2015-05-01

The Affordable Care Act (ACA) mandates that all private health insurance include out-of-pocket spending caps. Insurance purchased through the ACA's Health Insurance Marketplace may qualify for income-based caps, whereas group insurance will not have income-based caps. Little is known about how out-of-pocket caps impact individuals' health care financial burden. We aimed to estimate what proportion of non-elderly individuals with group insurance will benefit from out-of-pocket caps, and the effect that various cap levels would have on their financial burden. We applied the expected uniform spending caps, hypothetical reduced uniform spending caps (reduced by one-third), and hypothetical income-based spending caps (similar to the caps on Health Insurance Marketplace plans) to nationally representative data from the Medical Expenditure Panel Survey (MEPS). Participants were non-elderly individuals (aged health insurance in the 2011 and 2012 MEPS surveys (n =26,666). (1) The percentage of individuals with reduced family out-of-pocket spending as a result of the various caps; and (2) the percentage of individuals experiencing health care services financial burden (family out-of-pocket spending on health care, not including premiums, greater than 10% of total family income) under each scenario. With the uniform caps, 1.2% of individuals had lower out-of-pocket spending, compared with 3.8% with reduced uniform caps and 2.1% with income-based caps. Uniform caps led to a small reduction in percentage of individuals experiencing financial burden (from 3.3% to 3.1%), with a modestly larger reduction as a result of reduced uniform caps (2.9%) and income-based caps (2.8%). Mandated uniform out-of-pocket caps for those with group insurance will benefit very few individuals, and will not result in substantial reductions in financial burden.

Place of death among older Americans: does state spending on home- and community-based services promote home death?

Science.gov (United States)

Muramatsu, Naoko; Hoyem, Ruby L; Yin, Hongjun; Campbell, Richard T

2008-08-01

The majority of Americans die in institutions although most prefer to die at home. States vary greatly in their proportion of home deaths. Although individuals' circumstances largely determine where they die, health policies may affect the range of options available to them. To examine whether states' spending on home- and community-based services (HCBS) affects place of death, taking into consideration county health care resources and individuals' family, sociodemographic, and health factors. Using exit interview data from respondents in the Health and Retirement Study born in 1923 or earlier who died between 1993 and 2002 (N = 3362), we conducted discrete-time survival analysis of the risk of end-of-life nursing home relocation to examine whether states' HCBS spending would delay or prevent end-of-life nursing home admission. Then we ran logistic regression analysis to investigate the HCBS effects on place of death separately for those who relocated to a nursing home and those who remained in the community. Living in a state with higher HCBS spending was associated with lower risk of end-of-life nursing home relocation, especially among people who had Medicaid. However, state HCBS support was not directly associated with place of death. States' generosity for HCBS increases the chance of dying at home via lowering the risk of end-of-life nursing home relocation. State-to-state variation in HCBS spending may partly explain variation in home deaths. Our findings add to the emerging encouraging evidence for continued efforts to enhance support for HCBS.

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…

DEMAND FOR TURKEY MEAT: PRICE EFFECT OR SPENDING EFFECT

Directory of Open Access Journals (Sweden)

Miguel Angel Martinez Damian

2016-08-01

Full Text Available Turkey meat is a white meat demand in Mexico, however, its consumption is still low. In order to explore the convenience of expanding the market and foresee if the industry should compete in price or expenditure, the aim of this work is to study the demand for turkey meat as part of a protein basket; that consists of beef, chicken, pork and egg. Methodologically an almost ideal demand model was used, in an economic sense, this model allows an optimal assignment representation through budget share equations as a function of prices and real expenditure within the bundle. With statistical information from secondary sources, the results showed that the demand for turkey meat responds inelastically to price, and that the response on spending is almost one. With the estimates of price and expenditure growth rates, in terms of an expansion policy in the turkey market, results conclude that spending is the most relevant factor in demand, followed to a lesser extent by price.

Time Students Spend Working at Home for School

Science.gov (United States)

Wagner, Petra; Schober, Barbara; Spiel, Christiane

2008-01-01

The paper presents three studies which deal with the time students spend working at home for school. In addition, the paper focuses on the distribution of time investment over the course of a week and on the relationship between academic achievement and time spent working at home for school. In sum, 824 students with an average age of 15 years…

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.

Medicare Spending for Breast, Prostate, Lung, and Colorectal Cancer Patients in the Year of Diagnosis and Year of Death.

Science.gov (United States)

Chen, Christopher T; Li, Ling; Brooks, Gabriel; Hassett, Michael; Schrag, Deborah

2017-07-26

To characterize spending patterns for Medicare patients with incident breast, prostate, lung, and colorectal cancer. 2007-2012 data from the Surveillance, Epidemiology, and End Results Program linked with Medicare fee-for-service claims. We calculate per-patient monthly and yearly mean and median expenditures, by cancer type, stage at diagnosis, and spending category, over the years of diagnosis and death. Over the year of diagnosis, mean spending was $35,849, $26,295, $55,597, and $63,063 for breast, prostate, lung, and colorectal cancer, respectively. Over the year of death, spending was similar across different cancer types and stage at diagnosis. Characterization of Medicare spending according to clinically meaningful categories may assist development of oncology alternative payment models and cost-effectiveness models. © Health Research and Educational Trust.

Sources of Cross-national Heterogeneity in E-retail Spending: Evidence from Country-Level Data

OpenAIRE

Nir Kshetri; Ralf Bebenroth; Nicholas C. Williamson

2010-01-01

The global e-retail industry is growing rapidly. Economies worldwide, however, differ greatly in the development of the e-retail industry. Using data from forty-seven economies, this paper empirically examines how technological, economic, and institutional factors explain international heterogeneity in e-retail spending. The results indicated that broadband penetration was the strongest predictor of e-retail spending. We found that externalities mechanisms generated by the development of the ...

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

Directory of Open Access Journals (Sweden)

Mehmet Akif DESTEK

2016-05-01

Full Text Available 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 seen that the growth hypothesis is valid for India, Malaysia, Mexico and South Africa; the neutrality hypothesis is valid for China, Indonesia, Philippines, Thailand and Turkey and the growth detriment hypothesis is valid for Brazil.

The roles and functions of occupational health nurses in Brazil and in the United States.

Science.gov (United States)

Marziale, Maria Helena Palucci; Hong, Oi Saeng; Morris, Judy A; Rocha, Fernanda Ludmilla Rossi

2010-01-01

Cross-sectional exploratory research developed to outline the roles and functions of occupational health nurses (OHNs) in Brazil and compare them with those in the United States. The sample consisted of 154 Brazilian occupational health nurses. First, the instrument Job Analysis Survey of Occupational Health Nursing Practice was translated into Portuguese, followed by data collection and data analysis, comparing the results of the proposed study in Brazil with the findings of a job delineation study conducted in the United States. It was found that most were women, white, between 41 and 50 years of age and working primarily at hospitals or medical centers as clinicians and managers/administrators. Besides, it was found that most Brazilian OHNs spend more time in managerial roles, followed by consultant and educator responsibilities while, in the United States, OHNs spend significantly more time in education/advisory roles.

2017 National Park visitor spending effects : Economic contributions to local communities, states, and the Nation

Science.gov (United States)

Cullinane Thomas, Catherine M.; Koontz, Lynne; Cornachione, Egan

2018-01-01

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 2017, the National Park System received an estimated 331 million recreation visits. Visitors to National Parks spent an estimated \\$18.2 billion in local gateway regions (defined as communities within 60 miles of a park). The contribution of this spending to the national economy was 306 thousand jobs, \\$11.9 billion in labor income, \\$20.3 billion in value added, and \\$35.8 billion in economic output. The lodging sector saw the highest direct contributions with \\$5.5 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.

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.

2015 National Park visitor spending effects: Economic contributions to local communities, states, and the nation

Science.gov (United States)

Cullinane Thomas, Catherine M.; Koontz, Lynne

2016-01-01

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 2015, the National Park System received over 307.2 million recreation visits. NPS visitors spent \\$16.9 billion in local gateway regions (defined as communities within 60 miles of a park). The contribution of this spending to the national economy was 295 thousand jobs, \\$11.1 billion in labor income, \\$18.4 billion in value added, and \\$32.0 billion in economic output. The lodging sector saw the highest direct contributions with \\$5.2 billion in economic output directly contributed to local gateway economies nationally. The sector with the next greatest direct contributions was the restaurants and bar sector, with \\$3.4 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 http://go.nps.gov/vse.

The global impact of non-communicable diseases on healthcare spending and national income: a systematic review.

Science.gov (United States)

Muka, Taulant; Imo, David; Jaspers, Loes; Colpani, Veronica; Chaker, Layal; van der Lee, Sven J; Mendis, Shanthi; Chowdhury, Rajiv; Bramer, Wichor M; Falla, Abby; Pazoki, Raha; Franco, Oscar H

2015-04-01

The impact of non-communicable diseases (NCDs) in populations extends beyond ill-health and mortality with large financial consequences. To systematically review and meta-analyze studies evaluating the impact of NCDs (including coronary heart disease, stroke, type 2 diabetes mellitus, cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease and chronic kidney disease) at the macro-economic level: healthcare spending and national income. Medical databases (Medline, Embase and Google Scholar) up to November 6th 2014. For further identification of suitable studies, we searched reference lists of included studies and contacted experts in the field. We included randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults assessing the economic consequences of NCDs on healthcare spending and national income without language restrictions. All abstracts and full text selection was done by two independent reviewers. Any disagreements were resolved through consensus or consultation of a third reviewer. Data were extracted by two independent reviewers using a pre-designed data collection form. Studies evaluating the impact of at least one of the selected NCDs on at least one of the following outcome measures: healthcare expenditure, national income, hospital spending, gross domestic product (GDP), gross national product, net national income, adjusted national income, total costs, direct costs, indirect costs, inpatient costs, outpatient costs, per capita healthcare spending, aggregate economic outcome, capital loss in production levels in a country, economic growth, GDP per capita (per capita income), percentage change in GDP, intensive growth, extensive growth, employment, direct governmental expenditure and non-governmental expenditure. From 4,364 references, 153 studies met our inclusion criteria. Most of the studies were focused on healthcare related costs of NCDs

End-of-life medical spending in last twelve months of life is lower than previously reported

NARCIS (Netherlands)

French, E.; Klein, Tobias; a., e.

Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan,

Monitoring health spending increases: incremental budget analyses reveal challenging tradeoffs.

Science.gov (United States)

Hartman, Micah; Smith, Cynthia; Heffler, Stephen; Freeland, Mark

2006-01-01

With each passing decade, health care has consumed a larger share of gross domestic product (GDP) and Federal budgets. By the 2000-2004 period, society was willing to devote over 20 percent of the cumulative increase in GDP and the cumulative increase in Federal outlays towards health care. The financing challenges are expected to become more acute for private payers as well as Federal, State, and local budgets. With the implementation of Part D in 2006, the U.S. Office of Management and Budget projects that Federal budget pressures will heighten, bringing increased attention to Medicare's long-term fiscal outlook.

SpEnD: Linked Data SPARQL Endpoints Discovery Using Search Engines

Science.gov (United States)

Yumusak, Semih; Dogdu, Erdogan; Kodaz, Halife; Kamilaris, Andreas; Vandenbussche, Pierre-Yves

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 method, most of the currently listed SPARQL endpoints in existing endpoint repositories, as well as a significant number of new SPARQL endpoints, have been discovered. Finally, we have developed a new SPARQL endpoint crawler (SpEC) for crawling and link analysis.

Are Alcohol Taxation and Pricing Policies Regressive? Product-Level Effects of a Specific Tax and a Minimum Unit Price for Alcohol.

Science.gov (United States)

Vandenberg, Brian; Sharma, Anurag

2016-07-01

To compare estimated effects of two policy alternatives, (i) a minimum unit price (MUP) for alcohol and (ii) specific (per-unit) taxation, upon current product prices, per capita spending (A$), and per capita consumption by income quintile, consumption quintile and product type. Estimation of baseline spending and consumption, and modelling policy-to-price and price-to-consumption effects of policy changes using scanner data from a panel of demographically representative Australian households that includes product-level details of their off-trade alcohol spending (n = 885; total observations = 12,505). Robustness checks include alternative price elasticities, tax rates, minimum price thresholds and tax pass-through rates. Current alcohol taxes and alternative taxation and pricing policies are not highly regressive. Any regressive effects are small and concentrated among heavy consumers. The lowest-income consumers currently spend a larger proportion of income (2.3%) on alcohol taxes than the highest-income consumers (0.3%), but the mean amount is small in magnitude [A$5.50 per week (95%CI: 5.18-5.88)]. Both a MUP and specific taxation will have some regressive effects, but the effects are limited, as they are greatest for the heaviest consumers, irrespective of income. Among the policy alternatives, a MUP is more effective in reducing consumption than specific taxation, especially for consumers in the lowest-income quintile: an estimated mean per capita reduction of 11.9 standard drinks per week (95%CI: 11.3-12.6). Policies that increase the cost of the cheapest alcohol can be effective in reducing alcohol consumption, without having highly regressive effects. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

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.

Increased Use of Productivity Management Can Help Control Government Costs.

Science.gov (United States)

1983-11-10

estimated that 34 percent of agency spend- ing reductions made to balance the budget in fiscal year 1984 can be attributed to the productivity program. The...result in the services 5. [] use of employee incentives (9) of some employees no longer being required in the unit in which they 6. [) quality of worklife

An Update on Asset Management Plans in the United Kingdom.

Science.gov (United States)

Patel, Mukund

1999-01-01

Describes a current project in the United Kingdom designed to improve school buildings. The use of Asset Management Plans (AMPs) in providing the means through which likely future needs are assessed, criteria for prioritization are set, and informed decisions on local spending are made are examined. (GR)

Family socio-economic profile and private spending on educational goods and services in Poland

Directory of Open Access Journals (Sweden)

Magdalena Rokicka

2014-01-01

Full Text Available According to theory, educational goods and services have an important impact on a child’s human capital. Although the majority of educational services in Poland are delivered within a public education system, various educational costs are borne by parents. This paper looks at the socio-economic determinants of private spending on education, including fees, private tutoring and courses, educational goods and materials, and the internet. The analysis was performed using the Polish Household Budget Survey for 2009 and 2010. Results from a logit regression suggest that disposable household income per capita and parental level of education, especially mother’s level of education have the greatest impact on spending on educational goods and services. This was true for all analysed categories of expenditure. Regional disparities and community size were an important factor especially with regards to spending on private tutoring and additional courses.

Characteristics and spending on out-of-home eating in Brazil.

Science.gov (United States)

Bezerra, Ilana Nogueira; Sichieri, Rosely

2010-04-01

To analyze the characteristics of out-of-home eating and spending on such consumption. A complex sample of 48,470 Brazilian households, selected from the 2002-2003 Household Budget Survey (HBS) was analyzed. Out-of-home eating was defined as the purchase of at least one type of food for consumption out of the home during seven days. Frequencies of out-of-home eating were estimated according to age, sex, level of education, monthly per capita household income, number of residents per household, Brazilian regions, situation of household (urban/rural) and capital/other city. A total of nine groups of foods were studied: alcoholic beverages, soft drinks, cookies, fruits, sweets, milk and dairy products, fast foods, sit-down meals and deep-fried snacks. Frequency of out-of-home eating was 35%, being higher in the Southeast region (38.8%) and lower in the North region (28.1%) of Brazil. Frequency was higher in individuals aged between 20 and 40 years (42%), males (39% vs. 31%), with higher income (52%) and educational levels (61%). Foods most frequently consumed out of the home were as follows: soft drinks (12%), sit-down meals (11.5%), sweets (9.5%), deep-fried snacks (9.2%) and fast foods (7.2%). Consumption of food groups increased linearly with income, except for fruits and cookies. Values of weekly mean spending were lower for cookies (R$ 1.79 or US$ 0.54) and sweets (R$ 2.02 or US$ 0.67) and higher for sit-down meals (R$ 21.56 or US$ 6.53). Out-of-home eating is frequent in all Brazilian regions. Public policies must incorporate this dimension when proposing healthy eating strategies.

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.

Impact of minimally invasive surgery on medical spending and employee absenteeism.

Science.gov (United States)

Epstein, Andrew J; Groeneveld, Peter W; Harhay, Michael O; Yang, Feifei; Polsky, Daniel

2013-07-01

As many surgical procedures have undergone a transition from a standard, open surgical approach to a minimally invasive one in the past 2 decades, the diffusion of minimally invasive surgery may have had sizeable but overlooked effects on medical expenditures and worker productivity. To examine the impact of standard vs minimally invasive surgery on health plan spending and workplace absenteeism for 6 types of surgery. Cross-sectional regression analysis. National health insurance claims data and matched workplace absenteeism data from January 1, 2000, to December 31, 2009. A convenience sample of adults with employer-sponsored health insurance who underwent either standard or minimally invasive surgery for coronary revascularization, uterine fibroid resection, prostatectomy, peripheral revascularization, carotid revascularization, or aortic aneurysm repair. Health plan spending and workplace absenteeism from 14 days before through 352 days after the index surgery. There were 321,956 patients who underwent surgery; 23,814 were employees with workplace absenteeism data. After multivariable adjustment, mean health plan spending was lower for minimally invasive surgery for coronary revascularization (-$30,850; 95% CI, -$31,629 to -$30,091), uterine fibroid resection (-$1509; 95% CI, -$1754 to -$1280), and peripheral revascularization (-$12,031; 95% CI, -$15,552 to -$8717) and higher for prostatectomy ($1350; 95% CI, $611 to $2212) and carotid revascularization ($4900; 95% CI, $1772 to $8370). Undergoing minimally invasive surgery was associated with missing significantly fewer days of work for coronary revascularization (mean difference, -37.7 days; 95% CI, -41.1 to -34.3), uterine fibroid resection (mean difference, -11.7 days; 95% CI, -14.0 to -9.4), prostatectomy (mean difference, -9.0 days; 95% CI, -14.2 to -3.7), and peripheral revascularization (mean difference, -16.6 days; 95% CI, -28.0 to -5.2). For 3 of 6 types of surgery studied, minimally invasive

Working Mothers and the State: Under Which Conditions do governments spend much on maternal employment supporting policies?

NARCIS (Netherlands)

Koole, K.; Vis, B.

2012-01-01

Over the last years, the level of spending on maternal employment supporting policies has risen in most countries. Still, the variation across governments in this level is substantial. Under which conditions do governments spend relatively much? Drawing on the critical mass literature, we argue that

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…

The increase performance BMF-14 calcination unit

International Nuclear Information System (INIS)

Triyono

2013-01-01

The heating element of performance increase BMF-14 calcination unit has been installed. The activity includes: installation and function test heating element step by step. The main component includes: kanthal heating element type with size long 58,2 cm diameter 0,9 cm slot total 28, flexible cable resists heat 30 Amperes, band cable heat resists and flexible clamp. The heating elements installation includes from 3 groups and every groups have 4 heating elements to connectly series. Every group connecting to every phase RST and neutral for getting electric voltage 380 Volts follow contact relay 3 phases to controlling by digital temperature control. The resulting installation of heating element in the BMF-14 calcination unit showed that: BMF-14 calcination unit can be again of the setting temperature step by step. In the step I get optimal temperature 560 °C test time 1068 minutes with rate velocity heat 0 to 18,0 °C/minutes with current between 5,8 to 6,4 Amperes voltage 103 to 123 Volts (phase R and T). In the step II gets optimal temperature 600 °C test time 265 minutes getting rate velocity heat 0 to 40,3 °C/minutes with current 3,8 to 8,5 Amperes voltage 76 to 142 Volts (phase RST). In the step III gets optimal temperature 1000 °C test time 107 minutes getting rate velocity heat 0 to 53,5 °C/minutes with current 9,7 to 12,5 Amperes voltage 215 to 225 Volts (phase RST). (author)

Estimating DoD Transportation Spending: Analyses of Contract and Payment Transactions

National Research Council Canada - National Science Library

Moore, Nancy Y; Chenoweth, Mary E; Reardon, Elaine; Grammich, Clifford A; Bullock, Arthur M; Mele, Judith D; Kofner, Aaron; Unger, Eric J

2007-01-01

.... This analysis of combined individual contracting action report (DD350) and PowerTrack (PT) data indicates that DoD has additional opportunities to leverage transportation spending, particularly where it uses tenders to purchase transportation services...

Accountable and Responsible Disclosure of Financial Open Government Data: Open Spending Initiatives enhancing Civic Engagement

OpenAIRE

Mulder, A.W. (Bert); Hartog, M.W. (Martijn)

2017-01-01

This research focuses an optimal arrangement of open spending as added instrumental value to the accountability incommunicating financial information towards citizens within The Netherlands. Open Spending is more and more of relevance in the Netherlands and is addressed as one of the key action points in the Open Government Partnership Action plan of The Netherlands. In order to adequately communicate financial information towards citizens, 5 arrangement variables of accountability (transpare...

Growth in Spending on and Use of Services for Mental and Substance Use Disorders After the Great Recession Among Individuals With Private Insurance.

Science.gov (United States)

Mark, Tami L; Hodgkin, Dominic; Levit, Katharine R; Thomas, Cindy Parks

2016-05-01

Recessions are associated with increased prevalence of mental and substance use disorders, but their effect on use of behavioral health services is less clear. This study examined changes in spending per enrollee for behavioral health services compared with general medical services among individuals with private insurance following the Great Recession that began in 2007. The National Survey on Drug Use and Health was used to examine the prevalence of behavioral health conditions among persons with private insurance from 2004 to 2013. Truven Health MarketScan Commercial Claims and Encounters data (2004-2012) were used to calculate use of and spending on treatment of behavioral and general medical conditions before and after the recession among individuals with employer-sponsored private health insurance. There was a statistically significant increase in serious psychological distress and episodes of major depression between 2007 and 2010. Between 2004-2009 and 2009-2012, the growth in average annual spending per individual slowed for general medical care (from 6.6% to 3.7%) but accelerated for behavioral health care (from 4.8% to 6.6%). From 2009 to 2012, the percentage of individuals receiving inpatient treatment, outpatient treatment, and prescription drugs for behavioral conditions increased, whereas use of these services for general medical care decreased or remained flat. Out-of-pocket costs increased more slowly for behavioral conditions than for other medical conditions. The recession was associated with increased need for and use of behavioral health services among individuals with private insurance. The Mental Health Parity and Addiction Equity Act may have also played a role in facilitating increasing use of behavioral health services after 2008.

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.

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.

The role of government spending on economic growth in a developing country

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M.F. Oladele

2017-05-01

Full Text Available The issue of whether government expenditure helps or hinders economic growth is still debatable. This study examines the contribution of government spending towards economic growth in South Africa using annual data from 1980 – 2014. The cointegration approach and Vector Error Correction Model were used to analyse the data. The cointegration test results indicate that there is long run relationship between government expenditure and economic growth in South Africa. The VECM outcome indicates a positive and significant link between economic growth and expenditure on the long run. There is a positive and significant relationship between exchange rate and economic growth and a significant and negative relationship between economic growth and private consumption. Based on these findings, the correlation between government expenditure and economic growth showed that there is positive relationship on the long run in South Africa, while there is a negative and significant relationship between government spending and economic growth on the short run. More spending should therefore be directed towards important sectors such as infrastructural development and industrial development in order to accelerate economic growth. There is also a need for fiscal policy to be used as an instrument to regulate the amount of money in the economy.

Making Research Matter Comment on "Public Spending on Health Service and Policy Research in Canada, the United Kingdom, and the United States: A Modest Proposal".

Science.gov (United States)

Hunter, David J; Frank, John

2017-08-13

We offer a UK-based commentary on the recent "Perspective" published in IJHPM by Thakkar and Sullivan. We are sympathetic to the authors' call for increased funding for health service and policy research (HSPR). However, we point out that increasing that investment - in any of the three countries they compare: Canada, the United States and the United Kingdom- will ipso facto not necessarily lead to any better use of research by health system decision-makers in these settings. We cite previous authors' descriptions of the many factors that tend to make the worlds of researchers and decision-makers into "two solitudes." And we call for changes in the structure and funding of HSPR, particularly the incentives now in place for purely academic publishing, to tackle a widespread reality: most published research in HSPR, as in other applied fields of science, is never read or used by the vast majority of decision-makers, working out in the "real world. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Financial effects of pharmaceutical price regulation on R&D spending by EU versus US firms.

Science.gov (United States)

Golec, Joseph; Vernon, John A

2010-01-01

EU countries closely regulate pharmaceutical prices, whereas the US does not. This paper shows how price constraints affect the profitability, stock returns and R&D spending of EU and US firms. Compared with EU firms, US firms are more profitable, earn higher stock returns and spend more on R&D. We tested the relationship between price regulation and R&D spending, and estimated the costs of tight EU price regulation. Although results show that EU consumers enjoyed much lower pharmaceutical price inflation, we estimated that price controls cost EU firms 46 fewer new medicines and 1680 fewer research jobs during our 19-year sample period. Had the US used controls similar to those used in the EU, we estimate it would have led to 117 fewer new medicines and 4368 fewer research jobs in the US.

Working at the Weekend: Fathers' Time with Family in the United Kingdom.

Science.gov (United States)

Hook, Jennifer L

2012-08-01

Whereas most resident fathers are able to spend more time with their children on weekends than on weekdays, many fathers work on the weekends spending less time with their children on these days. There are conflicting findings about whether fathers are able to make up for lost weekend time on weekdays. Using unique features of the United Kingdom's National Survey of Time Use 2000 (UKTUS) I examine the impact of fathers' weekend work on the time fathers spend with their children, family, and partners (N = 595 fathers). I find that weekend work is common among fathers and is associated with less time with children, families, and partners. Fathers do not recover lost time with children on weekdays, largely because weekend work is a symptom of overwork. Findings also reveal that even if fathers had compensatory time, they are unlikely to recover lost time spent as a family or couple.

Growth Convergence and Spending Efficiency among Filipino Households

OpenAIRE

Erniel B. Barrios

2007-01-01

A growth model is used in the context of Sala-i-Martin’s definition of conditional convergence to assess the household income dynamics in segmented groups at the provincial level in the Philippines. There is a direct relationship between spending efficiency and income growth convergence across income groups. The lower income convergence rate among low income households can be attributed to their relatively less efficient access to the factors of production. The study provides tools in identif...

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. Copyright © 2015 Elsevier B.V. All rights reserved.

Consumption of food away from home in Bangladesh: Do rich households spend more?

Science.gov (United States)

Mottaleb, Khondoker A; Rahut, Dil Bahadur; Mishra, Ashok K

2017-12-01

While consumption of food away from home (FAFH) is an established phenomenon among households in the developed countries, FAFH is a growing phenomenon in many middle-income and rapidly growing developing countries. Although, studies are available on the factors affecting consumption of FAFH in developed countries, there is a paucity of such studies in developing countries. This study examines households' choice of and expenditures on FAFH. We used information from Bangladeshi households and applied a double-hurdle regression model estimation procedure. Findings show that, in general, rich households are spending proportionately less on FAFH and, over time, the trend is continuing. Although households with female members who work in the non-farm sector are more likely to consume FAFH, educated household heads and spouses, and particularly urban households are less likely to consume and spend on FAFH. As the problem of food adulteration by dishonest sellers is rampant in Bangladesh, perhaps it discourages rich, urban and households headed by educated heads and spouses to consume and spend more on FAFH. Based on the findings, some points of interventions are also prescribed in this study. Copyright © 2017 Elsevier Ltd. All rights reserved.

Robust Machine Learning Variable Importance Analyses of Medical Conditions for Health Care Spending.

Science.gov (United States)

Rose, Sherri

2018-03-11

To propose nonparametric double robust machine learning in variable importance analyses of medical conditions for health spending. 2011-2012 Truven MarketScan database. I evaluate how much more, on average, commercially insured enrollees with each of 26 of the most prevalent medical conditions cost per year after controlling for demographics and other medical conditions. This is accomplished within the nonparametric targeted learning framework, which incorporates ensemble machine learning. Previous literature studying the impact of medical conditions on health care spending has almost exclusively focused on parametric risk adjustment; thus, I compare my approach to parametric regression. My results demonstrate that multiple sclerosis, congestive heart failure, severe cancers, major depression and bipolar disorders, and chronic hepatitis are the most costly medical conditions on average per individual. These findings differed from those obtained using parametric regression. The literature may be underestimating the spending contributions of several medical conditions, which is a potentially critical oversight. If current methods are not capturing the true incremental effect of medical conditions, undesirable incentives related to care may remain. Further work is needed to directly study these issues in the context of federal formulas. © Health Research and Educational Trust.

An unhealthy public-private tension: pharmacy ownership, prescribing, and spending in the Philippines.

Science.gov (United States)

James, Chris D; Peabody, John; Solon, Orville; Quimbo, Stella; Hanson, Kara

2009-01-01

Physicians' links with pharmacies may create perverse financial incentives to overprescribe, prescribe products with higher profit margins, and direct patients to their pharmacy. Interviews with pharmacy customers in the Philippines show that those who use pharmacies linked to public-sector physicians had 5.4 greater odds of having a prescription from such physicians and spent 49.3 percent more than customers using other pharmacies. For customers purchasing brand-name medicines, switching to generics would reduce drug spending by 58 percent. Controlling out-of-pocket spending on drugs requires policies to control financial links between doctors and pharmacies, as well as tighter regulation of nongeneric prescribing.

How much do we spend on prescription medicines? Out-of-pocket costs for patients in Australia and other OECD countries.

Science.gov (United States)

Kemp, Anna; Preen, David B; Glover, John; Semmens, James; Roughead, Elizabeth E

2011-08-01

To determine changes in out-of-pocket expenditure on prescription medicines for Australian patients, and how patient expenditure compares with other Organisation for Economic Co-operation and Development (OECD) countries. We examined out-of-pocket expenditure on prescription medicines by patients in Australia between 1970 and 2007, and between Australia and 15 other OECD countries (Canada, Czech Republic, Denmark, Finland, France, Germany, Japan, Republic of Korea (South Korea), Luxembourg, Poland, Slovak Republic, Spain, Sweden, Switzerland and the United States) in 2005. Spending on publicly subsidised medicines by Australian patients increased from $16 per person in 1971 to $62 in 2007. Patient expenditure on all prescription medicines had risen to $134 per person in 2007. Out-of-pocket expenditure for Australian patients ranked 4th of 14 OCED countries with universal pharmaceutical subsidies. Australian patients pay 28% of national pharmaceutical expenditure; more than patients in South Korea (27%), Slovak Republic (26%), Sweden (22%), France, Luxembourg, Japan and Switzerland (17%), Germany (15%), Czech Republic (11%) and Spain (6%), but less than patients in Finland (36%), Denmark (33%) and Poland (34%). Compared to other OECD countries, Australian out-of-pocket costs are now in the mid to upper range. Further increases have the potential to significantly affect access to care.

The effect of public health spending on under-five mortality rate in ...

African Journals Online (AJOL)

The effect of public health spending on under-five mortality rate in Uganda. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... rate, Neonatal mortality rate, Public health expenditure, Sustainable Development Goals and Health status ...

Government Spending Shocks, the Current Account and the Real Exchange Rate in OECD Countries

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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.

Increased use of lethal methods and annual increase of suicide rates in Korean adolescents: comparison with adolescents in the United States.

Science.gov (United States)

Park, Subin; Cho, Soo-Churl; Kim, Bung-Nyun; Kim, Jae-Won; Yoo, Hee Jeong; Hong, Jin Pyo

2014-03-01

The lethality of the suicide method is a strong risk factor for completed suicide. We examined whether the annual change in the pattern of suicide methods was related to the annual change in suicide rates among adolescents in South Korea and the United States. We analyzed annual data for the 2000-2009 period for South Korea and the 2000-2008 period for the United States to examine time trends in the suicide rates and suicide methods of adolescents aged 10-19 years in two countries. Data on suicide methods were obtained from the World Health Organization (WHO) mortality database. Suicide rates among adolescents in the United States have remained relatively steady since 2000, whereas the suicide among Korean adolescents has increased. Between 2000 and 2009, the most common suicide method among Korean adolescents was jumping for boys and girls, whereas it was hanging for girls and firearms for boys in the United States. Along with the annual increase in suicide rates in South Korea, the incidences of jumping among males and hanging (and recently jumping) among females have increased steadily, whereas suicide by self-poisoning steadily decreased. In the United States, between 2000 and 2008, the proportion of suicides committed by hanging increased, whereas those committed using firearms steadily decreased, particularly among adolescent females. These findings suggest that the increased use of lethal suicide methods is reflected in the increase in suicide rates in Korean adolescents. The most fruitful approach to addressing the rises in jumping suicides among Korean adolescents and hanging suicides among adolescents in the United States may be through population-based initiatives to reduce the physical availability (e.g., limiting access to or fencing off tall structures) and the social acceptability (e.g., effective and responsible regulations for reporting suicide) of these methods. © 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association

A Research on The Effects of Marketing Spending on Firm Value

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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

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…

Review of "Spend Smart: Fix Our Broken School Funding System"

Science.gov (United States)

Baker, Bruce

2011-01-01

ConnCAN's Spend Smart: "Fix Our Broken School Funding System" was released concurrently with a bill introduced in the Connecticut legislature, based on the principles outlined in the report. However, the report is of negligible value to the policy debate over Connecticut school finance because it provides little or no support for any of…

Health spending, illicit financial flows and tax incentives in Malawi ...

African Journals Online (AJOL)

Health spending, illicit financial flows and tax incentives in Malawi. B O'Hare, M Curtis. Abstract. This analysis examines the gaps in health care financing in Malawi and how foregone taxes could fill these gaps. It begins with an assessment of the disease burden and government health expenditure. Then it analyses the tax ...

Finite Element in Angle Unit Sphere Meshing for Charged Particle Transport.

Energy Technology Data Exchange (ETDEWEB)

Ortega, Mario Ivan [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Drumm, Clifton R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2017-10-01

Finite element in angle formulations of the charged particle transport equation require the discretization of the unit sphere. In Sceptre, a three-dimensional surface mesh of a sphere is transformed into a two-dimensional mesh. Projection of a sphere onto a two-dimensional surface is well studied with map makers spending the last few centuries attempting to create maps that preserve proportion and area. Using these techniques, various meshing schemes for the unit sphere were investigated.

ERP correlates of source memory: unitized source information increases familiarity-based retrieval.

Science.gov (United States)

Diana, Rachel A; Van den Boom, Wijnand; Yonelinas, Andrew P; Ranganath, Charan

2011-01-07

Source memory tests typically require subjects to make decisions about the context in which an item was encoded and are thought to depend on recollection of details from the study episode. Although it is generally believed that familiarity does not contribute to source memory, recent behavioral studies have suggested that familiarity may also support source recognition when item and source information are integrated, or "unitized," during study (Diana, Yonelinas, and Ranganath, 2008). However, an alternative explanation of these behavioral findings is that unitization affects the manner in which recollection contributes to performance, rather than increasing familiarity-based source memory. To discriminate between these possibilities, we conducted an event-related potential (ERP) study testing the hypothesis that unitization increases the contribution of familiarity to source recognition. Participants studied associations between words and background colors using tasks that either encouraged or discouraged unitization. ERPs were recorded during a source memory test for background color. The results revealed two distinct neural correlates of source recognition: a frontally distributed positivity that was associated with familiarity-based source memory in the high-unitization condition only and a parietally distributed positivity that was associated with recollection-based source memory in both the high- and low-unitization conditions. The ERP and behavioral findings provide converging evidence for the idea that familiarity can contribute to source recognition, particularly when source information is encoded as an item detail. Copyright © 2010 Elsevier B.V. All rights reserved.

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

Judging Money: When Courts Decide How to Spend Taxpayer Dollars

Science.gov (United States)

Dunn, Josh; Derthick, Martha

2007-01-01

Since the 1970s, proponents of greater spending in disadvantaged school districts have pursued their goal through litigation in state courts. They have brought suits in 45 of the 50 states. These suits began with claims of equity, which sought to redistribute revenues from rich to poor districts. Disappointed with the results, within a decade the…

[Comparison of physical activity and favourite ways of spending free time in preschool girls and boys from the Mazowsze region].

Science.gov (United States)

Merkiel, Sylwia; Chalcarz, Wojciech; Deptuła, Monika

2011-01-01

The aim of this study was to compare physical activity of preschool girls and boys from the Mazowsze region and their favourite ways of spending free time. The studied population included 131 children aged 3 to 7 years. Parents filled in questionnaires about their children's physical activity and favourite ways of spending free time, as well as about general information on the children and their families. Gender had statistically significant influence on the children's birth weight, attending karate outside the preschool and on riding a bicycle, playing with a ball and playing with a dog as favourite ways of spending free time during sunny weather as well as playing on a computer and playing with dolls as favourite ways of spending free time during rainy weather. Gender had little influence on the studied preschoolers' physical activity. However favourite ways of spending free time turned out to be significantly different according to gender. Physical activity level in both girls and boys was low, similarly to their peers from the previous studies.

What Contributes Most to High Health Care Costs? Health Care Spending in High Resource Patients.

Science.gov (United States)

Pritchard, Daryl; Petrilla, Allison; Hallinan, Shawn; Taylor, Donald H; Schabert, Vernon F; Dubois, Robert W

2016-02-01

U.S. health care spending nearly doubled in the decade from 2000-2010. Although the pace of increase has moderated recently, the rate of growth of health care costs is expected to be higher than the growth in the economy for the near future. Previous studies have estimated that 5% of patients account for half of all health care costs, while the top 1% of spenders account for over 27% of costs. The distribution of health care expenditures by type of service and the prevalence of particular health conditions for these patients is not clear, and is likely to differ from the overall population. To examine health care spending patterns and what contributes to costs for the top 5% of managed health care users based on total expenditures. This retrospective observational study employed a large administrative claims database analysis of health care claims of managed care enrollees across the full age and care spectrum. Direct health care expenditures were compared during calendar year 2011 by place of service (outpatient, inpatient, and pharmacy), payer type (commercially insured, Medicare Advantage, and Medicaid managed care), and therapy area between the full population and high resource patients (HRP). The mean total expenditure per HRP during calendar year 2011 was $43,104 versus $3,955 per patient for the full population. Treatment of back disorders and osteoarthritis contributed the largest share of expenditures in both HRP and the full study population, while chronic renal failure, heart disease, and some oncology treatments accounted for disproportionately higher expenditures in HRP. The share of overall expenditures attributed to inpatient services was significantly higher for HRP (40.0%) compared with the full population (24.6%), while the share of expenditures attributed to pharmacy (HRP = 18.1%, full = 21.4%) and outpatient services (HRP = 41.9%, full = 54.1%) was reduced. This pattern was observed across payer type. While the use of physician

Increasing personal exemption of fixed income earners: A cost-benefit analysis on government revenues

Directory of Open Access Journals (Sweden)

Rebecca Maquiling

2016-12-01

Full Text Available Personal exemption (PE was one of the remedies of the government to offset the burden of taxation imposed to its sovereignty. In the Philippines, a motion to increase the PE has already been made by lawmakers, and this prompted the researchers to conduct a study on the effect of this disposable income of fixed income earners on their spending pattern on identified goods and services to VAT and other taxes collected by the government. The study made use of descriptive-survey method given to 100 random respondents earning fixed income in the City of Davao, Philippines. The study determined that the respondents’ age, civil status, sex, and number of qualified dependents affects her/his spending pattern. Married people spend more on basic commodities than single people, male spends more alcohol and tobacco than the female, zero dependents spends more on recreation than more dependents and there is a decrease of spending in recreation as people aged. Moreover, the survey revealed that implementing additional PE will decrease direct income tax of the government. However, forty percent of this will return in the form of indirect taxes since respondents have lower marginal propensity to save than their marginal propensity to consume, it results in a positive impact in the economy as a whole. This is done through the use of the concept of the Tax Cut Multiplier (m[tax]= -MPC/MPS effect. Given the prospective increase in PE, consumers spend their additional disposable income on basic commodities, additional clothing, recreation and excises taxed products, among others.

26 CFR 1.148-7 - Spending exceptions to the rebate requirement.

Science.gov (United States)

2010-04-01

... issue to be a refunding issue. (4) De minimis rule. Any failure to satisfy the final spending... to land, such as buildings or other inherently permanent structures, including interests in real.... Except as otherwise provided, construction expenditures means capital expenditures (as defined in § 1.150...

Impact of defense spending on unemployment in five countries from Asia

Directory of Open Access Journals (Sweden)

Abdul Qayyum Khan

2015-11-01

Full Text Available The objective of this study is to examine empirically the impact of defense spending on unemployment along with a number of control variables for a set of five selected countries from Asia which include Cambodia, China, Malaysia, Pakistan, and the Philippines. For empirical investigation annual data over the period of 1992 to 2013 are used. While, prior to regression analysis, the data were sensibly checked using sundry of relevant tests. The empirical results reveal that defense spending is not a better option to overcome unemployment problem in most of the sample countries. Thus, the findings suggest that lower defense budget allocation will provide more resources for other sectors which are relatively more productive and can help to improve economic and social welfare of these selected countries from Asia. Besides decreased military expenditures, encouraging domestic investment and discouraging population growth can help reduce unemployment. Remittance appears to have a positive relation with unemployment, the implications of which need to be addressed by policymakers

Compulsive buying and depressive symptoms among female citizens of the United Arab Emirates.

Science.gov (United States)

Thomas, Justin; Al-Menhali, Salwa; Humeidan, Majeda

2016-03-30

Compulsive buying is particularly relevant in nations with high levels of consumer spending. Most previous studies have focused on European and North America populations. This study explores compulsive buying amongst citizens of the United Arab Emirates, an Arab nation with high retail outlet density, and high levels of consumer spending. Female college students (N=100) completed an English/Arabic version of the compulsive buying scale along with a measure of depression. Rates of compulsive buying were higher than those reported in any previously published study. Furthermore, in line with previous findings from other nations, compulsive buying was associated with elevated depressive symptomatology. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

An Explanation of Nakamoto's Analysis of Double-spend Attacks

OpenAIRE

Ozisik, A. Pinar; Levine, Brian Neil

2017-01-01

The fundamental attack against blockchain systems is the double-spend attack. In this tutorial, we provide a very detailed explanation of just one section of Satoshi Nakamoto's original paper where the attack's probability of success is stated. We show the derivation of the mathematics relied upon by Nakamoto to create a model of the attack. We also validate the model with a Monte Carlo simulation, and we determine which model component is not perfect.

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

Centers for Disease Control (CDC) Podcasts

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.

China-United States Productivity Catch-Up

DEFF Research Database (Denmark)

Deng, Paul Duo; Jefferson, Gary H.

China’s gap in industrial labor productivity with the United States has been steadily shrinking over recent decades. In this paper we examine the main sources of gap reduction and the potential for further catch-up. Using Chinese above-scale firm-level data during 1998-2007 period and BEA industry...... -level data in the US, we first document the respective rates of growth of labor productivity, gap reduction, and contributions to overall catch-up of China’s manufacturing sector during 1998-2007. We then aggregate the firm-level data to the 3-digit industry level to estimate a productivity gap...... reduction function and find that the key drivers for the productivity convergence are the initial technology gap, increased R&D spending, firm’s ownership restructuring, and industry level entry-exit ratio, a measure of competitive dynamism. A key finding is that the catch-up dynamic entails the break out...

Mapping at-risk-of-poverty rates, household employment, and social spending

NARCIS (Netherlands)

Vandenbroucke, F.; Diris, R.; Cantillon, B.; Vandenbroucke, F.

2014-01-01

As a first step stylized facts are presented concerning at-risk-of-poverty rates for the non-elderly population, household employment (a concept introduced in this chapter) and social spending in European welfare states. The chapter provides a first exploration of a central theme of the book, which

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.

Burning a hole in the budget: tobacco spending and its crowd-out of other goods.

Science.gov (United States)

Busch, Susan H; Jofre-Bonet, Mireia; Falba, Tracy A; Sindelar, Jody L

2004-01-01

Smoking is an expensive habit. Smoking households spend, on average, more than $US1000 annually on cigarettes. When a family member quits, in addition to the former smoker's improved long-term health, families benefit because savings from reduced cigarette expenditures can be allocated to other goods. For households in which some members continue to smoke, smoking expenditures crowd-out other purchases, which may affect other household members, as well as the smoker. We empirically analyse how expenditures on tobacco crowd-out consumption of other goods, estimating the patterns of substitution and complementarity between tobacco products and other categories of household expenditure. We use the Consumer Expenditure Survey data for the years 1995-2001, which we complement with regional price data and state cigarette prices. We estimate a consumer demand system that includes several main expenditure categories (cigarettes, food, alcohol, housing, apparel, transportation, medical care) and controls for socioeconomic variables and other sources of observable heterogeneity. Descriptive data indicate that, comparing smokers to nonsmokers, smokers spend less on housing. Results from the demand system indicate that as the price of cigarettes rises, households increase the quantity of food purchased, and, in some samples, reduce the quantity of apparel and housing purchased.

Big increase in Spanish reseach funding

CERN Document Server

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).

Defensive spending on tap water substitutes: the value of reducing perceived health risks.

Science.gov (United States)

Dupont, Diane P; Jahan, Nowshin

2012-03-01

We examine factors that explain consumer spending on tap water substitutes using information from a national survey undertaken with a representative set of Canadian respondents. We develop a model to predict the percentage of households that undertake such spending for the purpose of reducing perceived health risks from tap water consumption. Using results from the model we estimate the magnitude of defensive expenditures to be over half a billion dollars (2010 US$) per year for Canada, as a whole. This is equivalent to approximately $48 per household per year or about $19 per person per year. Residents of Ontario, the province in which an Escherichia coli incident took place in 2000, have the highest willingness-to-pay of approximately $60 per household per year.

Monitoring What Governments “Give for” and “Spend on” Vaccine Procurement: Vaccine Procurement Assistance and Vaccine Procurement Baseline

Science.gov (United States)

Nelson, E. A. S.; Bloom, David E.; Mahoney, Richard T.

2014-01-01

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. PMID:24586899

Does state budget pressure matter for uncompensated care spending in hospitals? Findings from Texas and California.

Science.gov (United States)

Chang, Jongwha; Patel, Isha; Suh, Won S; Lin, Hsien-Chang; Kim, Sunjung; Balkrishnan, Rajesh

2012-01-01

This study examined the impact of state budget cuts on uncompensated care at general acute care hospital organizations. This study capitalized on the variations in the states of Texas and California to form a natural experiment testing the joint impact of budget cut status on uncompensated care costs, as well as specific charity care costs and bad debt expenses from indigent patients. Budget cuts in the state of Texas occurred in the year 2004. Information was obtained from the Texas Department of Health and the California Department of Health Services regarding financial characteristics of hospitals and from the American Hospital Directory annual survey regarding organizational characteristics of hospitals. We created three dependent variables: R(UC) (the ratio of total uncompensated care costs to gross patient revenue), R(CC) (the ratio of charity care to total patient revenue) and R(BD) (the ratio of bad debt expenses to gross patient revenue). Using a two-period panel data set and individual hospital fixed effects, we captured hospital uncompensated care spending that could also have influenced budget cut status. Additionally, the impact of the state budget cut status on hospitals' uncompensated care spending, charity care spending and bad debt expenses was also estimated using the similar methodology. In this study, we included 416 (in Texas) and 352 (in California) public, not-for-profit (NFP) and for-profit (FP) hospitals that completed the annual survey during the study period 2002-2005. For the state of Texas, results from the fixed effect model confirmed that the year 2005 was directly related to increased R(UC) and R(CC) . The coefficients of 2005 were significantly and positively associated with R(UC) (0.43, p budget cut pressure on uncompensated care provided in Texas general acute care hospitals. Copyright © 2012 John Wiley & Sons, Ltd.

Ways of spending leisure time by the third year-students of the Faculty of Pharmacy, Medical University of Lublin.

Science.gov (United States)

Czabak-Garbacz, Róza; Skibniewska, Agnieszka; Mazurkiewicz, Piotr; Gdula, Agnieszka

2002-01-01

The aim of the study was the assessment of leisure time among third-year students from the Faculty of Pharmacy of the Medical University of Lublin. It analysed quantity of time devoted to school activity and ways of spending free time. The study involved 114 students (82 women and 32 men). The study revealed that women had less free time than men, who, most probably did not attend some lectures. The most popular activities among the questioned students were: sleeping (average 6.8 hours a day), studying (average 3.6 hours a day), listening to the radio (average 2.9 hours a day), talking with friends (average 1.9 hours a day), personal hygiene (average 1.1 hours a day), watching TV (average 1.1 hours a day), housework. Students devoted the least of their free time on active rest, for example walking (women did it more often than men) or practising sport (more popular among men). Cultural life of the students consisted only of meetings with friends and going to the cinema (women did it more often). The least popular way of spending free time was going to the theatre, opera, concerts and exhibitions. Few students spent their time working. Their number increased significantly during holidays. The way of spending free time by third-year students from the Faculty of Pharmacy (both men and women) during the day was similar, differences related only to the amount of time devoted to each activity.

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

Increasing prevalence of diagnosed diabetes--United States and Puerto Rico, 1995-2010.

Science.gov (United States)

2012-11-16

In 2010, an estimated 18.8 million persons in the United States had diagnosed diabetes mellitus and another 7.0 million had undiagnosed diabetes. Since 1990, the prevalence of diagnosed diabetes in the United States has risen sharply among all age groups, both sexes, and all racial/ethnic groups for which data are available. To learn whether the increase has been greater in some regions of the United States than in others, data on self-reported diabetes in adults collected during 1995-2010 by the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. The analysis showed that the age-adjusted prevalence of diagnosed diabetes increased during the interval in every state, the District of Columbia (DC), and Puerto Rico. In 1995, age-adjusted prevalence was ≥6% in only three states, DC, and Puerto Rico, but by 2010 it was ≥6% in every state, DC, and Puerto Rico, and ≥10.0% in six states and Puerto Rico. Strategies to prevent diabetes and its preventable risk factors are needed, especially for those at highest risk for diabetes, to slow the rise in diabetes prevalence across the United States. Continued surveillance of diabetes prevalence and incidence, its risk factors, and prevention efforts is important to measure progress of prevention efforts.

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…

Socio-demographic and behavioural determinants of visitor spending at the Kruger National Park in South Africa

Directory of Open Access Journals (Sweden)

Andrea Saayman

2011-04-01

Full Text Available The Kruger National Park is one of the most visited national parks in the world and one of South Africa’s prime tourism destinations.  It attracts more than 1 million visitors per year and, as such, plays an important role in the regional and national economy.   The article aims to assess the extent to which socio-demographic and behavioural indicators influence the spending of tourists to the Park.  From 2001-2007 surveys have been conducted amongst tourists to the Park including a number of socio-demographic, behavioural and motivational questions, totalling 2 904 questionnaires used in the analysis.  The methodology includes both cross-sectional regression analysis and pseudo-panel data analysis to identify and compare possible influences on spending.  Findings indicate that, even though a combination of socio-demographic, behavioural and motivational factors influence spending at National Parks, behavioural indicators seem to be the most important and consistent influencer.

The Structure of Professional Profiles for Tourism in the United Kingdom.

Science.gov (United States)

Cooper, Chris; And Others

The tourism and leisure industries are among the fastest growing in the United Kingdom, generating jobs and spending and stimulating economic development. The hotel and catering sector is by far the best documented of the tourism industry and is the major employer. It is also an underqualified sector, despite a range of courses from craft to…

Increasing the flexibility of base-load generating units in operation on fossil fuel

Energy Technology Data Exchange (ETDEWEB)

Girshfel' d, V Ya; Khanaev, V A; Volkova, E D; Gorelov, V A; Gershenkroi, M L

1979-01-01

Increasing the flexibility of base-load generating units operating on fossil fuel by modifying them is a necessary measure. The highest economic effect is attained with modification of gas- and oil-fired generating units in the Western United Power Systems of the European part of the SPSS. On the basis of available experience, 150- and 200-MW units can be extensively used to regulate the power in the European part of the SPSS through putting them into reserve for the hours of the load dip at night. The change under favorable conditions of 150- and 200-MW units operating on coal to a district-heating operating mode does not reduce the possibilities for flexible operation of these units because it is possible greatly to unload the turbines while the minimum load level of the pulverized fuel fired boiler is retained through transferring a part of the heat load to the desuperheater. It is necessary to accumulate and analyze experience with operation of generating units (especially of supercritical units) with regular shutdowns and starts of groups of units and to solve the problems of modification of generating units, with differentiation with respect to types of fuel and to the united power supply system.

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 (pspending

Cohabitation and children's living arrangements: New estimates from the United States

Directory of Open Access Journals (Sweden)

Larry Bumpass

2008-09-01

Full Text Available This paper uses the 1995 and 2002 waves of the National Survey of Family Growth to examine recent trends in cohabitation in the United States. We find increases in both the prevalence and duration of unmarried cohabitation. Cohabitation continues to transform children's family lives, as children are increasingly likely to be born to a cohabiting mother (18Å  during 1997-2001 or to experience their mother's entry into a cohabiting union. Consequently, we estimate that two-fifths of all children spend some time in a cohabiting family by age 12. Because of substantial missing data in the 2002 NSFG, we are unable to produce new estimates of divorce and children's time in single-parent families. Nonetheless, our results point to the steady growth of cohabitation and to the evolving role of cohabitation in U.S. family life.

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

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.

COMPARINGTHE TREND BETWEEN SOUTH AFRICAN GOVERNMENT SPENDINGAND THE INCREASE INTAX REVENUE FOR THECOUNTRY’S TAXPAYERS

Directory of Open Access Journals (Sweden)

Lerike Jacobs

2017-01-01

Full Text Available Adam Smithprovidesguidance through the four Canons of Taxation to assistgovernmenttodesign a good tax system based on a set of principles. These principles are being appliedthroughout the world, as well as in South Africa. However, the South Africangovernmenthasbeen challenged to reduce income inequality and promote growth. This has led to an increase ingovernmentspending.Although literature provides information about governmental spending, spending patterns have notbeen investigated. Therefore, this study followed a partially mixed sequential dominant statusdesign by investigating actual versus budgeted governmental tax revenue and spending, as well asthe relationship between governmental tax revenue, spending and the inflation rate. This was donefor the periodof2000 to 2007, seven years before the global financial crisisand 2008 to 2017,seven years after the global financial crisis. Qualitative data were collected by means of a literaturestudy to identify the main themes. The main themes were used in the investigation of the budgetsand compared to the budget reviews. Quantitative data were analysed to determine the correlationbetween governmental tax revenue, spending and the inflation rate. The findings suggest a strongcorrelation between governmental tax revenue and spending but a weak correlation between thegovernmental tax revenue, spending and the inflation rate.This study will enable South African stakeholders, including the country’s residents and potentialforeign investors, to determine the trend between governmental tax revenue, spending andinflation.

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…

Spending Time: The Impact of Hours Worked on Work-Family Conflict

Science.gov (United States)

Adkins, Cheryl L.; Premeaux, Sonya F.

2012-01-01

Scholars have long assumed that as workers spend more time at work fewer hours are available for their non-work lives leading to negative effects in both domains, and most studies examining the impact of work hours on work and life domains have supported this viewpoint. However, the majority of these studies have used one-dimensional measures of…

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.

PROVIDING MORALE, WELFARE, AND RECREATION FUNDS AS INCENTIVES TO SAVE - ENDING THE END OF YEAR SPENDING FRENZY

Science.gov (United States)

2015-10-25

budget law as it applies to the Air Force. The issue of wasteful year end spending is rooted in the very laws originally passed to reduce abuses of...statutes, each layered upon the prior one… [t]his incremental growth has created something of a legal nettle .”21 7 One-year Incremental Budget...attitudes toward spending versus saving. 29 CONCLUSION In order to reach its conclusion, this research paper began by examining the roots of the

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

Consumer-Centered Extension Education Website Increases Usage

Science.gov (United States)

Franics, Sarah L.; Martin, Peggy; Taylor, Kristin

2012-01-01

Concern about young families' ability to cope with rising food prices resulted in creating Spend Smart. Eat Smart (SSES), a website focused on budget-friendly nutrition information for limited resource audiences (LRA). SSES was redesigned using LRAs needs and preferences to increase use by LRAs. SSES usage increased after it was revised to…

Images of illness: how causal claims and racial associations influence public preferences toward diabetes research spending.

Science.gov (United States)

Gollust, Sarah E; Lantz, Paula M; Ubel, Peter A

2010-12-01

Despite the salience of health disparities in media and policy discourse, little previous research has investigated if imagery associating an illness with a certain racial group influences public perceptions. This study evaluated the influence of the media's presentation of the causes of type 2 diabetes and its implicit racial associations on attitudes toward people with diabetes and preferences toward research spending. Survey participants who viewed an article on genetic causation or social determinants of diabetes were more likely to support increased government spending on research than those viewing an article with no causal language, while participants viewing an article on behavioral choices were more likely to attribute negative stereotypes to people with diabetes. Participants who viewed a photo of a black woman accompanying the article were less likely to endorse negative stereotypes than those viewing a photo of a white woman, but those who viewed a photo of a glucose-testing device expressed the lowest negative stereotypes. The effect of social determinants language was significantly different for blacks and whites, lowering stereotypes only among blacks. Emphasizing the behavioral causes of diabetes, as is common in media coverage, may perpetuate negative stereotypes. While drawing attention to the social determinants that shape these behaviors could mitigate stereotypes, this strategy is unlikely to influence the public uniformly.

Income inequities in end-of-life health care spending in British Columbia, Canada: A cross-sectional analysis, 2004-2006

Directory of Open Access Journals (Sweden)

Hanley Gillian E

2011-03-01

Full Text Available Abstract Background This study aimed to measure the income-related inequalities and inequities - the inequalities that remain after accounting for differences in health need - in expenditure on fully publicly covered (hospital and ambulatory and partially publicly covered (prescription drugs services for those in their last year of life in the province of British Columbia (B.C., Canada. We focused on a decedent population for three reasons: to minimize unmeasured need differences among our cohort and therefore isolate income effects; to explore inequities for a high-spending window of health care use; and, because previous studies have found conflicting relationships between income and decedent health care spending, to further quantify this relationship. Methods We used linked administrative databases to describe spending on health services by income for all 58,820 deaths of B.C. residents 65 and older from 2004 to 2006. Regression analyses examined the association between income and health care spending, adjusting for age, sex, health status, cause of death, and other relevant factors. We then used concentration indexes to measure both inequalities and inequities separately for three key types of services. Analyses were also run separately for men and women. Results On average, per capita expenditure on acute health care in the last year of life was $20,705 (CDN2006. In need-adjusted regression analyses, we found decedents in the highest income quintile had 11% lower hospital expenditures, 15% higher specialist expenditures and 23% higher prescription drug expenditures than decedents in the lowest income quintile. Concentration index analysis suggested that spending for all types of care was concentrated among those with higher income before adjusting for need. Need-adjusted equity results mirrored regression findings and suggested patterns of inequities that were more pronounced among male decedents than females. Conclusions Despite the

Widespread increase of tree mortality rates in the Western United States

Science.gov (United States)

van Mantgem, P.J.; Stephenson, N.L.; Byrne, J.C.; Daniels, L.D.; Franklin, J.F.; Fule, P.Z.; Harmon, M.E.; Larson, A.J.; Smith, Joseph M.; Taylor, A.H.; Veblen, T.T.

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 years among regions. Increases were also pervasive across elevations, tree sizes, dominant genera, and past fire histories. Forest density and basal area declined slightly, which suggests that increasing mortality was not caused by endogenous increases in competition. Because mortality increased in small trees, the overall increase in mortality rates cannot be attributed solely to aging of large trees. Regional warming and consequent increases in water deficits are likely contributors to the increases in tree mortality rates.

Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates

Directory of Open Access Journals (Sweden)

Hamidi S

2015-02-01

Full Text Available Samer Hamidi School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates Introduction: A national health account (NHA provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Dubai with schemes in Qatar and selected member countries of the Organization for Economic Cooperation and Development (OECD. Methods: The author analyzed secondary data published in NHAs of Dubai and Qatar and data collected by the OECD countries and publicly available from Eurostat (Statistical Office of the European Union of 25 OECD countries for comparative analysis. All health financing indicators used were as defined in the international System of Health Accounts (SHA. Results: In Dubai, spending on inpatient care was the highest-costing component, with 30% of current health expenditures (CHE. Spending on outpatient care was the second highest-costing component and accounted for about 23% of the CHE. Household spending accounted for about 22% of CHE (equivalent to US$187 per capita, compared to an average of 20% of CHE of OECD countries. Dubai spent 0.02% of CHE on long-term care, compared to an average of 11% of CHE of OECD countries. Dubai spent about 6% of CHE on prevention and public health services, compared to an average of 3.2% of CHE of OECD countries. Conclusion: The findings point to potential opportunities for growth and improvement in several health policy issues in Dubai, including increasing focus and funding of preventive services; shifting from inpatient care to day surgery, outpatient, and home-based services and strengthening long-term care; and introducing cost-containment measures for pharmaceuticals. More investment in the translation of

Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care.

Science.gov (United States)

Lemak, Christy Harris; Nahra, Tammie A; Cohen, Genna R; Erb, Natalie D; Paustian, Michael L; Share, David; Hirth, Richard A

2015-04-01

As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs. Project HOPE—The People-to-People Health Foundation, Inc.

Economic stagnation in the United States: underlying causes and global consequences

Directory of Open Access Journals (Sweden)

Robert A. Blecker

2014-12-01

Full Text Available This paper analyzes the causes of the slow recovery of the US economy since the financial crisis and Great Recession of 2008-9. Fallen house values and excessive household debts continue to depress consumer spending, while corporations are failing to invest in spite of record profits. The increasingly unequal distribution of income limits demand, while long-term structural transformations continue to erode employment creation. An expansionary monetary policy has been incapable of sparking a more robust recovery and fiscal policy has been shifted to an austerity stance. In this context, Brazil and other emerging market nations cannot count on the United States to continue to be the leading source of global demand as it was in previous decades.

Economic Growth and Defense Spending in Greece, Turkey and Cyprus: Evidence from Cointegrated Panel Analysis

Directory of Open Access Journals (Sweden)

Stylianou Tasos

2012-06-01

Full Text Available This paper investigates the nexus between economic growth and defense spending for three adjacent countries, namely Greece, Turkey and Cyprus. Greece and Cyprus, members-countries of European Union spend much more money than other member countries of EU relatively to their GDP. Turkey is in accession negotiations with EU and is among the top 15 countries with the highest military expenditure. These three countries are particularly interesting case studies because of their high military burdens and the bad relations between them (Greece and Cyprus opposite Turkey. The empirical analysis is based on panel data analysis of data over the period 1960 – 2006.

Budgetary and Economic Outcomes Under Paths for Federal Revenues and Noninterest Spending Specified by Chairman Price, March 2016

Science.gov (United States)

2016-03-01

Budgetary and Economic Outcomes Under Paths for Federal Revenues and Noninterest Spending Specified by Chairman Price , March 2016 March 2016CONGRESS... Price and His Staff 1 The Extended Baseline and Three Illustrative Paths 1 How CBO Analyzed the Effects of the Budgetary Paths 3 What Would Outcomes...Be Under Current Law? 4 What Paths for Federal Revenues and Noninterest Spending Did Chairman Price Specify? 6 What Would Budgetary and Economic

Trying Harder and Doing Worse : How Grocery Shoppers Track In-Store Spending

NARCIS (Netherlands)

van Ittersum, Koert; Pennings, Joost M. E.; Wansink, Brian

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

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

Vital signs : spending hit new high as industry stepped on the gas to reap strong prices

International Nuclear Information System (INIS)

Lunan, D.

2001-01-01

This paper presented a review of Canadian oil industry expenditures plus oil and gas revenues for Alberta, Saskatchewan, British Columbia and Manitoba since 1991. In the year 2000, the oil and gas industry boosted expenditures by 33 per cent and drilled a record number of wells in an effort to cash in on record natural gas prices and near-record crude oil prices which were a result of soaring demand and low supply. Total expenditures by Canadian oil and gas companies reached $33.98 billion in 2000 from $25.5 billion in 1999. A total of 16,507 wells were completed. Canada-wide development drilling expenditures increased to $5.7 billion in 2000 from $4.2 billion in 1999. In addition, exploration dollars and land expenditures also rose, as did investments in production facilities and production costs. Most of the new spending was concentrated in Alberta where most of the development drilling took place. Exploration efforts were held back to boost deliverability from known reserves. As a result, exploration spending in Alberta rose only slightly to $2.6 billion from $2.3 billion in 1999. Total crude and equivalent production for the Canadian oil patch in year 2000 rose only about 5 per cent, with most of the increase being associated with higher output from offshore development. Total sales of Canadian gas rose a modest 3 per cent, but measured by financial growth, these results are very positive. Most companies are reporting record revenues, cash flow and earnings for year 2000. 2 tabs., 1 fig

The refugee crisis in Lebanon and Jordan: the need for economic development spending

Directory of Open Access Journals (Sweden)

Omar Dahi

2014-09-01

Full Text Available The most effective way to tackle the Syrian refugee crisis is for neighbouring states to assume a leading role in development spending, infrastructure upgrading and job creation, particularly in the most underdeveloped regions of those countries.

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)

THE EFFECT OF TAX PREFERENCES ON HEALTH SPENDING

Science.gov (United States)

Cogan, John F.; Hubbard, R. Glenn; Kessler, Daniel P.

2011-01-01

In this paper, we estimate the effect of the tax preference for health insurance on health care spending using data from the Medical Expenditure Panel Surveys from 1996–2005. We use the fact that Social Security taxes are only levied on earnings below a statutory threshold to identify the impact of the tax preference. Because employer-sponsored health insurance premiums are excluded from Social Security payroll taxes, workers who earn just below the Social Security tax threshold receive a larger tax preference for health insurance than workers who earn just above it. We find a significant effect of the tax preference, consistent with previous research. PMID:22500056

Defense Spending Databases for Countries in the Asia-Pacific Region: An Analysis and Comparison

National Research Council Canada - National Science Library

Reuning, Charles

2001-01-01

The purpose of this research was to identify and analyze a select number of unclassified databases that cover defense spending and other defense related criteria for countries in the Asia-Pacific region...

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)

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...

"We want the world and we want it now": Materialism, time perspectives and problem spending tendency of Chinese

OpenAIRE

Ku, L.; Wu, Anise M. S.; Lao, Angie K. P.; Lam, Kerwin I. N.

2016-01-01

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. Chinese consumers' spending has been expanding rapidly in the past decade, and along with it household and credit card debt. The present research collected evidenced to triangulate the contention that materialism is positively related with Chinese's problem spending tendency (PST), and that present- and future-time perspectives interact systema...

Looking for a road to get out of poverty. Is the current allocation of public spending on education in Colombia helping?

Directory of Open Access Journals (Sweden)

Blanca Cecilia Zuluaga Díaz

2004-01-01

Full Text Available This paper presents a methodology to explore the impact on poverty of the public spending on education. The methodology consists of two approaches: Benefit Incidence Analysis (BIA and behavioral approach. BIA considers the cost and use of the educational service, and the distribution of the benefits among groups of income. Regarding the behavioral approach, we use a Probit model of schooling attendance, in order to determine the influence of public spending on the probability for the poor to attend the school. As a complement, a measurement of targeting errors in the allocation of public spending is included in the methodology.

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...

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.

Visitor spending effects: assessing and showcasing America's investment in national parks

Science.gov (United States)

Koontz, Lynne; Cullinane Thomas, Catherine; Ziesler, Pamela; Olson, Jeffrey; Meldrum, Bret

2017-01-01

This paper provides an overview of the evolution, future, and global applicability of the U.S. National Park Service's (NPS) visitor spending effects framework and discusses the methods used to effectively communicate the economic return on investment in America's national parks. The 417 parks represent many of America's most iconic destinations: in 2016, they received a record 331 million visits. Competing federal budgetary demands necessitate that, in addition to meeting their mission to preserve unimpaired natural and cultural resources for the enjoyment of the people, parks also assess and showcase their contributions to the economic vitality of their regions and the nation. Key approaches explained include the original Money Generation Model (MGM) from 1990, MGM2 used from 2001, and the visitor spending effects model which replaced MGM2 in 2012. Detailed discussion explains the NPS's visitor use statistics system, the formal program for collecting, compiling, and reporting visitor use data. The NPS is now establishing a formal socioeconomic monitoring (SEM) program to provide a standard visitor survey instrument and a long-term, systematic sampling design for in-park visitor surveys. The pilot SEM survey is discussed, along with the need for international standardization of research methods.

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

2017-08-01

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.

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

State Medicaid Spending and Financial Burden of Families Raising Children with Autism

Science.gov (United States)

Parish, Susan L.; Thomas, Kathleen C.; Rose, Roderick; Kilany, Mona; Shattuck, Paul T.

2012-01-01

We examined the association between state Medicaid spending for children with disabilities and the financial burden reported by families of children with autism. Child and family data were from the 2005-2006 National Survey of Children with Special Health Care Needs (n = 2,011 insured children with autism). State characteristics were from public…

Health needs, budget cuts & military spending.

Science.gov (United States)

1991-01-01

A healthy, well-fed, educated populace is synonymous with a prospering economy. Yet, when planning their budgets, governments tend to emphasize infrastructural/industrial projects and defence rather than investing in health, education and other social programmes to eliminate the widespread poverty and high mortality of its population, which would assure a more promising future in the long-term. As citizens, nurses are responsible for initiating and supporting action to meet the health and social needs of the public. And in keeping with ICN's 1989 resolution on nuclear war, INR presents some facts on social and defence spending to show how health needs are often being deprived by emphasis on others sectors, particularly defence. The aim is "to encourage nurses to critically appraise expenditure on health and welfare at a national and global level in relation to that spent on conventional and nuclear arms and to assist nurses to develop strategies of action to contribute to international peace."

Evaluation of leakage in cobalt-60 unit in National Cancer Institute (NCI) Wad Medani

International Nuclear Information System (INIS)

Fadlellah, R. A.

2013-08-01

This study has been conducted primarily to evaluate the leakages radiation in cobalt-60 unit in National Cancer Institute Wad Medani, which represent the basic risky factor in this unit for the radio therapists who spend much time during patient set up, also they need to stand near the head of the machine to fix some accessories. The measurements which done using survey meter give normal level of occupational exposure compared with IAEA references except one situation that the radio therapist to be close contact to the head of unit for long time which may increase the received dose, in this situation. The radio therapist either not well trained, or there is insufficient accessories to reduce the time inside the room. Radiotherapy department need a special considerations from the beginning of construction till starting of treatment. It is important to contain separate rooms, for planning to determine treatment area, another one for molding to shape lead blocks to protect normal parts and an optimum designed room for treatment to enable workers to apply basic radiation protection principles. (Author)

Establishment and assessment of cataract surgery in Day-care Unit at northwest of China

Directory of Open Access Journals (Sweden)

Xiu-Li Zhang

2018-04-01

Full Text Available AIM: To describe the protocol and economic cost of the Day-care Unit cataract surgery procedure in northwest of China.METHODS: Patients who received phacoemulcification and intraocular lens implantation in both Day-care Unit and regular Unit were recruited from January 2016 to December 2016. The baseline data and average cost were recorded and analyzed. Furthermore, satisfaction questionnaire of patients were collected.RESULTS: Patients with Day-care Unit showed shorter registration duration, less cost including housing and nursing charge as well as higher rate of patient satisfaction. Meanwhile, Day-care Unit shorten the time the doctors and nurses spending on filling the medical charts.CONCLUSION:Day-care Unit cataract surgery procedure could benefit both patients and medical staffs and is worthy to generalize.

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

Racial Prejudice and Spending on Drug Rehabilitation: The Role of Attitudes Toward Blacks and Latinos

Science.gov (United States)

Bonn, Scott; Wilson, George

2011-01-01

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. PMID:21532926

Who children spend time with after school: associations with objectively recorded indoor and outdoor physical activity

Science.gov (United States)

2014-01-01

Background Understanding how the determinants of behaviour vary by context may support the design of interventions aiming to increase physical activity. Such factors include independent mobility, time outdoors and the availability of other children. At present little is known about who children spend their time with after school, how this relates to time spent indoors or outdoors and activity in these locations. This study aimed to quantify who children spend their time with when indoors or outdoors and associations with moderate to vigorous physical activity (MVPA). Methods Participants were 427 children aged 10–11 from Bristol, UK. Physical activity was recorded using an accelerometer (Actigraph GT1M) and matched to Global Positioning System receiver (Garmin Foretrex 201) data to differentiate indoor and outdoor location. Children self-reported who they spent time with after school until bed-time using a diary. Each 10 second epoch was coded as indoors or outdoors and for ‘who with’ (alone, friend, brother/sister, mum/dad, other grown-up) creating 10 possible physical activity contexts. Time spent and MVPA were summarised for each context. Associations between time spent in the different contexts and MVPA were examined using multiple linear regression adjusting for daylight, age, deprivation and standardised body mass index. Results During the after school period, children were most often with their mum/dad or alone, especially when indoors. When outdoors more time was spent with friends (girls: 32.1%; boys: 28.6%) than other people or alone. Regression analyses suggested hours outdoors with friends were positively associated with minutes of MVPA for girls (beta-coefficient [95% CI]: 17.4 [4.47, 30.24]) and boys (17.53 [2.76, 32.31]). Being outdoors with brother/sister was associated with MVPA for girls (21.2 [14.17, 28.25]) but not boys. Weaker associations were observed for time indoors with friends (girls: 4.61 [1.37, 7.85]; boys: (7.42 [2.99, 11

The Impacts of Perceived Advertising Spending and Price Promotions on Brand Equity: a Case of an Indonesian Instant Noodle Brand

OpenAIRE

Tamara, Steven

2014-01-01

One of Indonesia's largest producers of instant noodle has the long term vision to make its brand Indonesia's number one instant noodles brand. Heavy advertising and intense price promotions are part of its strategy to increase the brand equity. The researcher, therefore, wishes to examine whether advertising and price promotions that the company conducts contribute to the instant noodle brand equity. To test the impacts of perceived advertising spending and price promotions on brand equity...

Role of location in the attendance and spending of Festinos

Directory of Open Access Journals (Sweden)

Veronique Labuschagne

2014-01-01

Full Text Available The purpose of this research was to identify the determinants of spending by the visitors at Innibos, Vryfees en Kierieklapper arts festivals with special focus on the different locations, using the same questionnaire and methodology. The survey measured the attendance and spending of different arts festivals in different locations in order to determine whether any differences exist and if so what these differences are. The research was conducted by means of a visitor survey at the three arts festivals during the same year with questionnaires administered at Innibos (428, Vryfees (336 and Kierieklapper (202, respectively. A factor analysis, Tukey d test and chi-square test were performed. The results indicate that the location and size of the town is not an important factor regarding the impact an event has on the town and the region. Findings that were meaningful included that small, medium type arts festivals differ from each other and also from larger arts festivals in a number of ways. The travel motives revealed four factors, namely: Family and arts; Meet new people; Productions and uniqueness and Escape. The latter was the most significant travel motive and this information can be used in future marketing exercises of arts festivals in different locations – to escape one’s own province and immediate surroundings.

The Effect of Tuition Increases on Business Student Decisions

Science.gov (United States)

Godek, John; Murray, Kyle B.; Karns, Gary

2015-01-01

Tuition increases have become all too common as states have cut spending to public institutions and private schools face declining enrollments. As such, understanding the effects of various methods of framing tuition increases is an important, but infrequently researched topic. The authors examine different ways to frame tuition increases…

"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...

The Effects of Socioeconomic Vulnerability, Psychosocial Services, and Social Service Spending on Family Reunification: A Multilevel Longitudinal Analysis.

Science.gov (United States)

Esposito, Tonino; Delaye, Ashleigh; Chabot, Martin; Trocmé, Nico; Rothwell, David; Hélie, Sonia; Robichaud, Marie-Joelle

2017-09-09

Socio-environmental factors such as poverty, psychosocial services, and social services spending all could influence the challenges faced by vulnerable families. This paper examines the extent to which socioeconomic vulnerability, psychosocial service consultations, and preventative social services spending impacts the reunification for children placed in out-of-home care. This study uses a multilevel longitudinal research design that draws data from three sources: (1) longitudinal administrative data from Quebec's child protection agencies; (2) 2006 and 2011 Canadian Census data; and, (3) intra-province health and social services data. The final data set included all children ( N = 39,882) placed in out-of-home care for the first time between 1 April 2002 and 31 March 2013, and followed from their initial out-of-home placement. Multilevel hazard results indicate that socioeconomic vulnerability, controlling for psychosocial services and social services spending, contributes to the decreased likelihood of reunification. Specifically, socioeconomic vulnerability, psychosocial services, and social services spending account for 24.0% of the variation in jurisdictional reunification for younger children less than 5 years of age, 12.5% for children age 5 to 11 years and 21.4% for older children age 12 to 17 years. These findings have implications for decision makers, funding agencies, and child protection agencies to improve jurisdictional resources to reduce the socioeconomic vulnerabilities of reunifying families.

Recruitment of single human low-threshold motor units with increasing loads at different muscle lengths.

Science.gov (United States)

McNulty, P A; Cresswell, A G

2004-06-01

We investigated the recruitment behaviour of low threshold motor units in flexor digitorum superficialis by altering two biomechanical constraints: the load against which the muscle worked and the initial muscle length. The load was increased using isotonic (low load), loaded dynamic (intermediate load) and isometric (high load) contractions in two studies. The initial muscle position reflected resting muscle length in series A, and a longer length with digit III fully extended in series B. Intramuscular EMG was recorded from 48 single motor units in 10 experiments on five healthy subjects, 21 units in series A and 27 in series B, while subjects performed ramp up, hold and ramp down contractions. Increasing the load on the muscle decreased the force, displacement and firing rate of single motor units at recruitment at shorter muscle lengths (Precruitment pattern was observed between loaded dynamic and isotonic contractions, but not between isometric and loaded dynamic contractions. Thus, the recruitment properties of single motor units in human flexor digitorum superficialis are sensitive to changes in both imposed external loads and the initial length of the muscle.

The Challenges of International Education: Developing a Public Relations Unit for the Asian Region

Science.gov (United States)

Fitch, Kate; Surma, Anne

2006-01-01

Murdoch University's public relations program attracts a significant number of international students. Up to 60% of students in some units come from Singapore and Malaysia. While many spend at least one year in Australia as part of the three year degree, students in both countries may complete the entire degree offshore from 2007. The authors…

The United States of America and scientific research.

Science.gov (United States)

Hather, Gregory J; Haynes, Winston; Higdon, Roger; Kolker, Natali; Stewart, Elizabeth A; Arzberger, Peter; Chain, Patrick; Field, Dawn; Franza, B Robert; Lin, Biaoyang; Meyer, Folker; Ozdemir, Vural; Smith, Charles V; van Belle, Gerald; Wooley, John; Kolker, Eugene

2010-08-16

To gauge the current commitment to scientific research in the United States of America (US), we compared federal research funding (FRF) with the US gross domestic product (GDP) and industry research spending during the past six decades. In order to address the recent globalization of scientific research, we also focused on four key indicators of research activities: research and development (R&D) funding, total science and engineering doctoral degrees, patents, and scientific publications. We compared these indicators across three major population and economic regions: the US, the European Union (EU) and the People's Republic of China (China) over the past decade. We discovered a number of interesting trends with direct relevance for science policy. The level of US FRF has varied between 0.2% and 0.6% of the GDP during the last six decades. Since the 1960s, the US FRF contribution has fallen from twice that of industrial research funding to roughly equal. Also, in the last two decades, the portion of the US government R&D spending devoted to research has increased. Although well below the US and the EU in overall funding, the current growth rate for R&D funding in China greatly exceeds that of both. Finally, the EU currently produces more science and engineering doctoral graduates and scientific publications than the US in absolute terms, but not per capita. This study's aim is to facilitate a serious discussion of key questions by the research community and federal policy makers. In particular, our results raise two questions with respect to: a) the increasing globalization of science: "What role is the US playing now, and what role will it play in the future of international science?"; and b) the ability to produce beneficial innovations for society: "How will the US continue to foster its strengths?"

The United States of America and scientific research.

Directory of Open Access Journals (Sweden)

Gregory J Hather

2010-08-01

Full Text Available To gauge the current commitment to scientific research in the United States of America (US, we compared federal research funding (FRF with the US gross domestic product (GDP and industry research spending during the past six decades. In order to address the recent globalization of scientific research, we also focused on four key indicators of research activities: research and development (R&D funding, total science and engineering doctoral degrees, patents, and scientific publications. We compared these indicators across three major population and economic regions: the US, the European Union (EU and the People's Republic of China (China over the past decade. We discovered a number of interesting trends with direct relevance for science policy. The level of US FRF has varied between 0.2% and 0.6% of the GDP during the last six decades. Since the 1960s, the US FRF contribution has fallen from twice that of industrial research funding to roughly equal. Also, in the last two decades, the portion of the US government R&D spending devoted to research has increased. Although well below the US and the EU in overall funding, the current growth rate for R&D funding in China greatly exceeds that of both. Finally, the EU currently produces more science and engineering doctoral graduates and scientific publications than the US in absolute terms, but not per capita. This study's aim is to facilitate a serious discussion of key questions by the research community and federal policy makers. In particular, our results raise two questions with respect to: a the increasing globalization of science: "What role is the US playing now, and what role will it play in the future of international science?"; and b the ability to produce beneficial innovations for society: "How will the US continue to foster its strengths?"

On the value relevance of retailer advertising spending and same-store sales growth

NARCIS (Netherlands)

Tuli, K.; Mukherjee, A.; Dekimpe, M.G.

2012-01-01

In response to recent calls to study factors that determine a retailer's stock price, this study draws on signaling theory to examine the impact of two key marketing metrics that are widely disclosed by retailers to investors, advertising spending and growth in same-store sales (COMPS), and

COMPARINGTHE TREND BETWEEN SOUTH AFRICAN GOVERNMENT SPENDINGAND THE INCREASE INTAX REVENUE FOR THECOUNTRY’S TAXPAYERS

OpenAIRE

Lerike Jacobs; Anneke Maré Moolman

2017-01-01

Adam Smithprovidesguidance through the four Canons of Taxation to assistgovernmenttodesign a good tax system based on a set of principles. These principles are being appliedthroughout the world, as well as in South Africa. However, the South Africangovernmenthasbeen challenged to reduce income inequality and promote growth. This has led to an increase ingovernmentspending.Although literature provides information about governmental spending, spending pattern...

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.

Explaining the increase in family financial pressures from medical bills between 2003 and 2007: do affordability thresholds change over time?

Science.gov (United States)

Cunningham, Peter J

2011-06-01

This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills--defined as the percent with problems paying medical bills--increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that "affordability thresholds" for medical care as defined by individuals and families are not stable over time, especially for lower-income persons, which has implications for setting affordability standards in health reform.

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.

Natural resources: A curse on education spending?

International Nuclear Information System (INIS)

Cockx, Lara; Francken, Nathalie

2016-01-01

In line with the rising interest in harnessing natural resource revenues for economic and human development through productive government investments, this paper aims to address an important blind spot in our understanding of the “resource curse” by contributing innovative insights on how natural resource wealth impacts government priorities and expenditure practices. Using a large panel dataset of 140 countries covering the period from 1995 to 2009, we find an adverse effect of resource dependence on public education expenditures relative to GDP that is robust to controlling for a range of additional covariates. Furthermore, our findings indicate that this resource curse effect on the government prioritization of education mainly stems from point-source natural resources. These results are of particular importance for the sustainable management of natural resource wealth in developing countries, as they could achieve especially high returns by investing resource revenues in public goods such as education. While this paper underlines the importance of institutions and government accountability, our findings also raise questions on the role of the private sector as a partner in development, as the extractives industry could consider increasing funding for education through Corporate Social Responsibility (CSR) initiatives. - Highlights: •We use a panel dataset of 140 countries covering the period from 1995 to 2009. •We find an inverse relationship between resource dependence and education spending. •The effect of resource dependence is robust to controlling for several covariates. •Indirect effects through a decline in accountability and the service industry. •This curse mainly stems from point-source resource dependence.

Impacts of generic competition and benefit management practices on spending for prescription drugs: evidence from Medicare's Part D benefit.

Science.gov (United States)

Sheingold, Steven; Nguyen, Nguyen Xuan

2014-01-01

This study estimates the effects of generic competition, increased cost-sharing, and benefit practices on utilization and spending for prescription drugs. We examined changes in Medicare price and utilization from 2007 to 2009 of all drugs in 28 therapeutic classes. The classes accounted for 80% of Medicare Part D spending in 2009 and included the 6 protected classes and 6 classes with practically no generic competition. All variables were constructed to measure each drug relative to its class at a specific plan sponsor. We estimated that the shift toward generic utilization had cut in half the rate of increase in the price of a prescription during 2007-2009. Specifically, the results showed that (1) rapid generic penetration had significantly held down costs per prescription, (2) copayment and other benefit practices shifted utilization to generics and favored brands, and (3) price increases were generally greater in less competitive classes of drugs. In many ways, Part D was implemented at a fortuitous time; since 2006, there have been relatively few new blockbuster drugs introduced, and many existing high-volume drugs used by beneficiaries were in therapeutic classes with multiple brands and generic alternatives. Under these conditions, our paper showed that plan sponsors have been able to contain costs by encouraging use of generics or drugs offering greater value within therapeutic classes. It is less clear what will happen to future Part D costs if a number of new and effective drugs for beneficiaries enter the market with no real competitors.

The adverse effects of government spending on private consumption in New Keynesian Models

NARCIS (Netherlands)

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

2009-01-01

Empirical evidence shows that government spending crowds in private consumption, a Keynesian phenomenon. The current state of the art, New Keynesian models based on optimising households and firms, is not able to predict such a result. We show with a graphical framework as well as a formal model why

Medicaid prospective payment: Case-mix increase

Science.gov (United States)

Baker, Samuel L.; Kronenfeld, Jennie J.

1990-01-01

South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced. PMID:10113463

Shadow Education in Malaysia: Identifying the Determinants of Spending and Amount of Time Attending Private Supplementary Tutoring of Upper Secondary School Students

Directory of Open Access Journals (Sweden)

Chang Da Wan

2017-10-01

Full Text Available This paper examines the determinants of spending and the amount of time attending private supplementary tutoring, or commonly known as private tuition, in Malaysia. Based on 343 self-reported questionnaires with upper secondary students across three states in Malaysia and using multiple regression analysis, we identified ethnicity, father’s level of education and past academic performance as significant determinants of spending and amount of time attending private tuition. However, interestingly, we found that while geographical location and participation in internal tuition in schools were also determinants of spending, these two were not significant in determining the amount of time attending private supplementary tutoring. The identification of determinants of spending and amount of time, and in addition, the differences between these two illustrates the economic and educational dimensions of shadow education. More importantly, the insight also contributes to the formulation of possible interventions that can improve quality and reduce inequality in the mainstream education system.

Managing Your Energy; An Energy Star Guide for Identifying Energy Savings in Manufacturing Plants

NARCIS (Netherlands)

Worrell, E.; Angelini, T.; Masanet, E.

2010-01-01

In the United States, industry spends over $100 billion annually to power its manufacturing plants. Companies also spend on maintenance, capital outlay, and energy services. Improving energy efficiency is vital to reduce these costs and increase earnings. Many cost-effective opportunities to reduce

A New Type of Great Power Relationship Between the United States and China: The Military Dimension

Science.gov (United States)

2014-09-01

multipolar world system and a pro- spective security and economic partner of the United States. This stands midway between the panda -hug- ging and dragon...spending, on the other hand, are more difficult to calculate and may prove significantly less easy to bear . 79. Eberhard Sandschneider, “Is China’s

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

A Supermarket Double-Dollar Incentive Program Increases Purchases of Fresh Fruits and Vegetables Among Low-Income Families With Children: The Healthy Double Study.

Science.gov (United States)

Polacsek, Michele; Moran, Alyssa; Thorndike, Anne N; Boulos, Rebecca; Franckle, Rebecca L; Greene, Julie C; Blue, Dan J; Block, Jason P; Rimm, Eric B

2018-03-01

To carry out a pilot study to determine whether a supermarket double-dollar fruit and vegetable (F&V) incentive increases F&V purchases among low-income families. Randomized controlled design. Purchases were tracked using a loyalty card that provided participants with a 5% discount on all purchases during a 3-month baseline period followed by the 4-month intervention. A supermarket in a low-income rural Maine community. A total of 401 low-income and Supplemental Nutrition Assistance Program (SNAP) supermarket customers. Same-day coupon at checkout for half-off eligible fresh, frozen, or canned F&V over 4 months. Weekly spending in dollars on eligible F&V. A linear model with random intercepts accounted for repeated transactions by individuals to estimate change in F&V spending per week from baseline to intervention. Secondary analyses examined changes among SNAP-eligible participants. Coupons were redeemed among 53% of eligible baskets. Total weekly F&V spending increased in the intervention arm compared with control ($1.83; 95% confidence interval [CI], $0.29 to $3.88). The largest increase was for fresh F&V ($1.97; 95% CI, $0.49 to $3.44). Secondary analyses revealed greater increases in F&V spending among SNAP-eligible participants who redeemed coupons ($5.14; 95% CI, $1.93 to $8.34) than among non-SNAP eligible participants who redeemed coupons ($3.88; 95% CI, $1.67 to $6.08). A double-dollar pricing incentive increased F&V spending in a low-income community despite the moderate uptake of the coupon redemption. Customers who were eligible for SNAP saw the greatest F&V spending increases. Financial incentives for F&V are an effective strategy for food assistance programs to increase healthy purchases and improve dietary intake in low-income families. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Employee choice of flexible spending account participation and health plan.

Science.gov (United States)

Hamilton, Barton H; Marton, James

2008-07-01

Despite the fact that flexible spending accounts (FSAs) are becoming an increasingly popular employer-provided health benefit, there has been very little empirical study of FSA use among employees at the individual level. This study contributes to the literature on FSAs using a unique data set that provides three years of employee-level-matched benefits data. Motivated by the theoretical model of FSA choice presented in Cardon and Showalter (J. Health Econ. 2001; 20(6):935-954), we examine the determinants of FSA participation and contribution levels using cross-sectional and random-effect two-part models. FSA participation and health plan choice are also modeled jointly in each year using conditional logit models. We find that, even after controlling for a number of other demographic characteristics, non-whites are less likely to participate in the FSA program, have lower contributions conditional on participation, and have a lower probability of switching to new lower cost share, higher premium plans when they were introduced. We also find evidence that choosing health plans with more expected out-of-pocket expenses is correlated with participation in the FSA program. Copyright (c) 2007 John Wiley & Sons, Ltd.

Adjusting health expenditure for military spending and interest payment: Israel and the OECD countries.

Science.gov (United States)

Shmueli, Amir; Israeli, Avi

2013-02-20

Compared to OECD countries, Israel has a remarkably low percentage of GDP and of government expenditure spent on health, which are not reflected in worse national outcomes. Israel is also characterized by a relatively high share of GDP spent on security expenses and payment of public debt. To determine to what extent differences between Israel and the OECD countries in security expenses and payment of the public debt might account for the gaps in the percentage of GDP and of government expenditures spent on health. We compare the percentages of GDP and of government expenditures spent on health in the OECD countries with the respective percentages when using primary civilian GDP and government expenditures (i.e., when security expenses and interest payment are deducted). We compared Israel with the OECD average and examined the ranking of the OECD countries under the two measures over time. While as a percentage of GDP, the national expenditure on health in Israel was well below the average of the OECD countries, as a percentage of primary civilian GDP it was above the average until 2003 and below the average thereafter. When the OECD countries were ranked according to decreasing percent of GDP and of government expenditure spent on health, adjusting for security and debt payment expenditures changed the Israeli rank from 23rd to 17th and from 27th to 25th, respectively. Adjusting for security expenditures and interest payment, Israel's low spending on health as a percentage of GDP and as a percentage of government's spending increases and is closer to the OECD average. Further analysis should explore the effect of additional population and macroeconomic differences on the remaining gaps.

Stability of rifampin in SyrSpend SF.

Science.gov (United States)

Sorenson, Bridget; Whaley, Paul

2013-01-01

Rifampin is a bactericidal antibiotic drug of the rifamycin group. It is a semisynthetic drug produced from the bacterium Streptomyces mediterranei. Rifampin is commonly manufactured in capsule, tablet, and syrup dosage solutions containing alcohol or sorbitol. The objective of this study was to determine the stability of rifampin in SyrSpend SF. The studied samples were compounded into 25-mg/mL suspensions and stored in low-actinic bottles at room temperature and refrigerated conditions. Samples were assayed at each time point out to 60 days by a stability-indicating high-performance liquid chromatography method. The method was validated for its specificity through forced-degradation studies. The sample remained within 90% to 110% of the initial concentration throughout the course of the study. Based on data collected, the beyond-use date of the preparation is at least 60 days when refrigerated or stored at room temperature and protected from light.

Microbial respiration per unit microbial biomass increases with carbon-to-nutrient ratios in soils

Science.gov (United States)

Spohn, Marie; Chodak, Marcin

2015-04-01

The ratio of carbon-to-nutrient in forest floors is usually much higher than the ratio of carbon-to-nutrient that soil microorganisms require for their nutrition. In order to understand how this mismatch affects carbon cycling, the respiration rate per unit soil microbial biomass carbon - the metabolic quotient (qCO2) - was studied. This was done in a field study (Spohn and Chodak, 2015) and in a meta-analysis of published data (Spohn, 2014). Cores of beech, spruce, and mixed spruce-beech forest soils were cut into slices of 1 cm from the top of the litter layer down to 5 cm in the mineral soil, and the relationship between the qCO2 and the soil carbon-to-nitrogen (C:N) and the soil carbon-to-phosphorus (C:P) ratio was analyzed. We found that the qCO2 was positively correlated with soil C:N ratio in spruce soils (R = 0.72), and with the soil C:P ratio in beech (R = 0.93), spruce (R = 0.80) and mixed forest soils (R = 0.96). We also observed a close correlation between the qCO2 and the soil C concentration in all three forest types. Yet, the qCO2 decreased less with depth than the C concentration in all three forest types, suggesting that the change in qCO2 is not only controlled by the soil C concentration. We conclude that microorganisms increase their respiration rate per unit biomass with increasing soil C:P ratio and C concentration, which adjusts the substrate to their nutritional demands in terms of stoichiometry. In an analysis of literature data, I tested the effect of the C:N ratio of soil litter layers on microbial respiration in absolute terms and per unit microbial biomass C. For this purpose, a global dataset on the microbial respiration rate per unit microbial biomass C - termed the metabolic quotient (qCO2) - was compiled form literature data. It was found that the qCO2 in the soil litter layers was positively correlated with the litter C:N ratio and negatively related with the litter nitrogen (N) concentration. The positive relation between the qCO2

How do disabled individuals spend their leisure time?

Science.gov (United States)

Pagán-Rodríguez, Ricardo

2014-04-01

Despite the important role that leisure time plays in individuals' health, wellness and quality of life, the disability studies addressing leisure remain extremely limited. Examine how people with disabilities allocate their time to leisure activities as compared to their non-disabled counterparts. Using data at an individual level from the Time Use Survey for Spain in 2002-2003 and the social model of disability as a framework, we estimate the determinants of time (minutes per day) spent on three aggregate categories (active, passive and social activities) for non-disabled, non-limited disabled and limited disabled individuals. Individuals who are limited in their daily activities are more likely to allocate their time to passive leisure (e.g., reading, television, video, and radio) and less likely to spend their time in social entertainment (e.g., theater, culture, and social events) as compared to non-disabled individuals. In addition, we find significant differences in minutes per day spent on leisure activities by gender, age, marital status and number of children. Accessible facilities and leisure installations as well as actions aimed at combating barriers and discrimination practices are needed to encourage participation in physical activity and social entertainment of people with disabilities. It is necessary to define, adapt and implement specific leisure activities that allow people with disabilities to fully participate in these activities and increase their levels of social integration and life satisfaction. Copyright © 2014 Elsevier Inc. All rights reserved.

Women Saw Large Decrease In Out-Of-Pocket Spending For Contraceptives After ACA Mandate Removed Cost Sharing.

Science.gov (United States)

Becker, Nora V; Polsky, Daniel

2015-07-01

The Affordable Care Act mandates that private health insurance plans cover prescription contraceptives with no consumer cost sharing. The positive financial impact of this new provision on consumers who purchase contraceptives could be substantial, but it has not yet been estimated. Using a large administrative claims data set from a national insurer, we estimated out-of-pocket spending before and after the mandate. We found that mean and median per prescription out-of-pocket expenses have decreased for almost all reversible contraceptive methods on the market. The average percentages of out-of-pocket spending for oral contraceptive pill prescriptions and intrauterine device insertions by women using those methods both dropped by 20 percentage points after implementation of the ACA mandate. We estimated average out-of-pocket savings per contraceptive user to be $248 for the intrauterine device and $255 annually for the oral contraceptive pill. Our results suggest that the mandate has led to large reductions in total out-of-pocket spending on contraceptives and that these price changes are likely to be salient for women with private health insurance. Project HOPE—The People-to-People Health Foundation, Inc.

Increased mechanical cost of walking in children with diplegia: the role of the passenger unit cannot be neglected.

Science.gov (United States)

Van de Walle, P; Hallemans, A; Truijen, S; Gosselink, R; Heyrman, L; Molenaers, G; Desloovere, K

2012-01-01

Gait efficiency in children with cerebral palsy is decreased. To date, most research did not include the upper body as a separate functional unit when exploring these changes in gait efficiency. Since children with spastic diplegia often experience problems with trunk control, they could benefit from separate evaluation of the so-called 'passenger unit'. Therefore, the aim of the current study was to improve insights in the role of the passenger unit in decreased gait efficiency in children with diplegia. Mechanical cost of walking was investigated by calculating work by the integrated joint power approach in 18 children with diplegia and 25 age-related typical developing controls. The total mechanical work in children with diplegia was 1.5 times higher than in typical children. In children with diplegia work at the lower limbs was increased by 37% compared to typical children. Substantially higher increases, up to 222%, were noted at the passenger unit. Trunk and head were the main contributors to the increased work of the passenger unit, but the role of the arms cannot be neglected. Due to these disproportional increases in locomotor and passenger unit, the demands of the passenger unit in pathological gait can no longer be considered minor, as in typical gait. Therefore, the role of the passenger unit must be recognized in the decrease of gait efficiency in children with spastic diplegia and should be part of the evaluation of gait efficiency in clinical practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

Transmission of government spending shocks in the Euro area: time variation and driving forces

NARCIS (Netherlands)

Kirchner, M.; Cimadomo, J.; Hauptmeier, S.

This paper applies structural vector autoregressions with time-varying parameters in order to investigate changes in the effects of government spending shocks in the euro area, and the driving forces of those changes. Our contribution is two-fold. First, we present evidence that the short-run impact

The Treadmill of Destruction in Comparative Perspective: A Panel Study of Military Spending and Carbon Emissions, 1960-2014

Directory of Open Access Journals (Sweden)

John Hamilton Bradford

2017-08-01

Full Text Available This article analyzes a unique panel data set to assess the effect of militarism on per capita carbon dioxide emissions.   We extend previous research examining the effects of military expenditures on carbon emissions by including in our analyses over 30 years of additional data.  In addition, we compare our preliminary results to those obtained from other estimation procedures.  Specifically, we report and visually illustrate the results of 54 cross-sectional models (one for each year and 36 unique panel regression models on both balanced and unbalanced panels.  We assess how this relationship has changed over time by testing for interactions between military spending and time and by systematically re-analyzing our data across 180 panel regressions with varying time frames.  A strong and enduring association between military spending and per capita carbon emissions is indicated in cross-sectional comparisons.  Our panel analyses reveal a much weaker and varying relationship that has become stronger in recent decades. Moreover, we find that the effect of military spending on per capita carbon emissions is moderated by countries’ level of economic development, with military spending of more wealthy countries having relatively larger net effects on carbon emissions.  We partially confirm previous findings on the temporal stability of the environmental impacts of militarism.  Our analyses show, however, that this temporal stability has emerged relatively recently, and that the relationship between military expenditures and carbon emissions is weaker prior to the 1990s.

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.

ASPECTS REGARDING VACATION SPENDING IN THE ROMANIAN TOURISM

Directory of Open Access Journals (Sweden)

Cristina ŞOŞEA

2011-12-01

Full Text Available For most of the time, tourism has been the privilege of rich people however, during the last century; it became a mass phenomenon, as its genetic (economic, social and demographic factors have changed considerably. Unlike the developed countries which account for the main international tourist flows, Romania is a state with a much lower number of potential tourists as a result of the lower income of the population, but which witness a revival of the tourist phenomenon at the beginning of the 21st century. Based on statistical data, the present paper focuses on the factors that influence the choice of holiday destinations for the Europeans and for Romanians as well, some aspects regarding vacation spending, types of destinations that Romanians choose and their expenses for holiday trips.

[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.

An Analysis of Year-End Spending and the Feasibility of a Carryover Incentive for Federal Agencies

National Research Council Canada - National Science Library

McPherson, Michael F

2007-01-01

This project investigates the year-end rush to spend and the origins. A secondary examination considers the feasibility of using carryover incentives to extend the obligation period by up to twelve months...

Does long time spending on the electronic devices affect the reading abilities? A cross-sectional study among Chinese school-aged children.

Science.gov (United States)

He, Zhen; Shao, Shanshan; Zhou, Jie; Ke, Juntao; Kong, Rui; Guo, Shengnan; Zhang, Jiajia; Song, Ranran

2014-12-01

Home literacy environment (HLE) is one of most important modifiable risk factors to dyslexia. With the development in technology, we include the electronic devices usage at home, such as computers and televisions, to the definition of HLE and investigate its impact on dyslexia based on the on-going project of Tongji's Reading Environment and Dyslexia Study. The data include 5063 children, primary school students (grade 3-grade 6), from a middle-sized city in China. We apply the principal component analysis (PCA) to reduce the large dimension of variables in HLE, and find the first three components, denoted as PC1, PC2 and PC3, can explain 95.45% of HLE information. PC1 and PC2 demonstrate strong positive association with 'total time spending on electronic devices' and 'literacy-related activity', respectively. PC3 demonstrates strong negative association with 'restrictions on using electronic devices'. From the generalized linear model, we find that PC1 significantly increases the risk of dyslexia (OR = 1.043, 95% CI: 1.018-1.070), while PC2 significantly decreases the risk of dyslexia (OR = 0.839, 95% CI: 0.795-0.886). Therefore, reducing the total time spending on electronic devices and increasing the literacy-related activity would be the potential protective factors for dyslexic children in China. Copyright © 2014 Elsevier Ltd. All rights reserved.

Whistleblowing in the pharmaceutical industry in the United States, England, Canada, and Australia.

Science.gov (United States)

Boumil, Sylvester James; Nariani, Ashiyana; Boumil, Marcia M; Berman, Harris A

2010-04-01

Fraud and abuse in the spending of public monies plague governments around the world. In the United States the False Claims Act encourages whistleblowing by private individuals to expose evidence of fraud. They are rewarded for their efforts with monetary compensation and protection from retaliation. Such is not the case in Canada, England, and Australia. Although some recent legislation has increased the protections afforded to whistleblowers, they are still likely to be viewed more as disloyal employees than courageous public servants, and there is little incentive to risk their jobs and reputation. Qui tam laws provide a police force of thousands in the effort to reduce rampant fraud, waste, and abuse, and would be an asset in any health-care system where pubic health policy requires conservation of resources.

Price and utilization: why we must target both to curb health care costs.

Science.gov (United States)

Spiro, Topher; Lee, Emily Oshima; Emanuel, Ezekiel J

2012-10-16

The United States spends nearly $8000 per person on health care annually. Even for a wealthy country, this amount is substantially more than would be expected and 2.5 times the average spent by other Organization for Economic Cooperation and Development (OECD) countries. The growth rate of health care spending in the United States has also far outpaced that in all other high-income OECD countries since 1970, even accounting for population growth. This increase in health spending threatens to squeeze out critical investments in education and infrastructure. To successfully develop and implement policies that effectively address both the level and growth of U.S. health care costs, it is critical to first understand cost drivers. Many health policy and economics scholars have contributed to an ongoing debate on whether to blame high prices or high utilization of services for escalating health care spending in the United States. This paper argues that price and volume both contribute to high and increasing health care costs, along with high administrative costs, supply issues, and the fee-for-service payment system. Initial strategies to contain costs might include implementation and expansion of bundled payment systems and competitive bidding.

Does Population Aging Drive Up Pro-Elderly Social Spending?

DEFF Research Database (Denmark)

Vanhuysse, Pieter

-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......, 2012) and makes a plea for institutionally and historically richly informed explanations of the political consequences and the policy feedback effects arising from population ageing....

Impact of GDP, spending on R&D, number of universities and scientific journals on research publications among Asian countries.

Directory of Open Access Journals (Sweden)

Sultan Ayoub Meo

Full Text Available OBJECTIVES: This study aimed to compare the impact of Gross Domestic Product (GDP per capita, spending on Research and Development (R&D, number of universities, and Indexed Scientific Journals on total number of research documents (papers, citations per document and Hirsch index (H-index in various science and social science subjects among Asian countries. MATERIALS AND METHODS: In this study, 40 Asian countries were included. The information regarding Asian countries, their GDP per capita, spending on R&D, total number of universities and indexed scientific journals were collected. We recorded the bibliometric indicators, including total number of research documents, citations per document and H-index in various science and social sciences subjects during the period 1996-2011. The main sources for information were World Bank, SCI-mago/Scopus and Web of Science; Thomson Reuters. RESULTS: The mean per capita GDP for all the Asian countries is 14448.31±2854.40 US$, yearly per capita spending on R&D 0.64±0.16 US$, number of universities 72.37±18.32 and mean number of ISI indexed journal per country is 17.97±7.35. The mean of research documents published in various science and social science subjects among all the Asian countries during the period 1996-2011 is 158086.92±69204.09; citations per document 8.67±0.48; and H-index 122.8±19.21. Spending on R&D, number of universities and indexed journals have a positive correlation with number of published documents, citations per document and H-index in various science and social science subjects. However, there was no association between the per capita GDP and research outcomes. CONCLUSION: The Asian countries who spend more on R&D have a large number of universities and scientific indexed journals produced more in research outcomes including total number of research publication, citations per documents and H-index in various science and social science subjects.

Impact of GDP, spending on R&D, number of universities and scientific journals on research publications among Asian countries.

Science.gov (United States)

Meo, Sultan Ayoub; Al Masri, Abeer A; Usmani, Adnan Mahmood; Memon, Almas Naeem; Zaidi, Syed Ziauddin

2013-01-01

This study aimed to compare the impact of Gross Domestic Product (GDP) per capita, spending on Research and Development (R&D), number of universities, and Indexed Scientific Journals on total number of research documents (papers), citations per document and Hirsch index (H-index) in various science and social science subjects among Asian countries. In this study, 40 Asian countries were included. The information regarding Asian countries, their GDP per capita, spending on R&D, total number of universities and indexed scientific journals were collected. We recorded the bibliometric indicators, including total number of research documents, citations per document and H-index in various science and social sciences subjects during the period 1996-2011. The main sources for information were World Bank, SCI-mago/Scopus and Web of Science; Thomson Reuters. The mean per capita GDP for all the Asian countries is 14448.31±2854.40 US$, yearly per capita spending on R&D 0.64±0.16 US$, number of universities 72.37±18.32 and mean number of ISI indexed journal per country is 17.97±7.35. The mean of research documents published in various science and social science subjects among all the Asian countries during the period 1996-2011 is 158086.92±69204.09; citations per document 8.67±0.48; and H-index 122.8±19.21. Spending on R&D, number of universities and indexed journals have a positive correlation with number of published documents, citations per document and H-index in various science and social science subjects. However, there was no association between the per capita GDP and research outcomes. The Asian countries who spend more on R&D have a large number of universities and scientific indexed journals produced more in research outcomes including total number of research publication, citations per documents and H-index in various science and social science subjects.

Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates

Science.gov (United States)

Hamidi, Samer

2015-01-01

Introduction A national health account (NHA) provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Dubai with schemes in Qatar and selected member countries of the Organization for Economic Cooperation and Development (OECD). Methods The author analyzed secondary data published in NHAs of Dubai and Qatar and data collected by the OECD countries and publicly available from Eurostat (Statistical Office of the European Union) of 25 OECD countries for comparative analysis. All health financing indicators used were as defined in the international System of Health Accounts (SHA). Results In Dubai, spending on inpatient care was the highest-costing component, with 30% of current health expenditures (CHE). Spending on outpatient care was the second highest-costing component and accounted for about 23% of the CHE. Household spending accounted for about 22% of CHE (equivalent to US$187 per capita), compared to an average of 20% of CHE of OECD countries. Dubai spent 0.02% of CHE on long-term care, compared to an average of 11% of CHE of OECD countries. Dubai spent about 6% of CHE on prevention and public health services, compared to an average of 3.2% of CHE of OECD countries. Conclusion The findings point to potential opportunities for growth and improvement in several health policy issues in Dubai, including increasing focus and funding of preventive services; shifting from inpatient care to day surgery, outpatient, and home-based services and strengthening long-term care; and introducing cost-containment measures for pharmaceuticals. More investment in the translation of NHA data into policy is suggested for future researchers. PMID:25750545

Health services financing and delivery: analysis of policy options for Dubai, United Arab Emirates.

Science.gov (United States)

Hamidi, Samer

2015-01-01

A national health account (NHA) provides a systematic approach to mapping the flow of health sector funds within a specified health system over a defined time period. This article attempts to present a profile of health system financing in Dubai, United Arab Emirates using data from NHAs, and to compare the functional structures of financing schemes in Dubai with schemes in Qatar and selected member countries of the Organization for Economic Cooperation and Development (OECD). The author analyzed secondary data published in NHAs of Dubai and Qatar and data collected by the OECD countries and publicly available from Eurostat (Statistical Office of the European Union) of 25 OECD countries for comparative analysis. All health financing indicators used were as defined in the international System of Health Accounts (SHA). In Dubai, spending on inpatient care was the highest-costing component, with 30% of current health expenditures (CHE). Spending on outpatient care was the second highest-costing component and accounted for about 23% of the CHE. Household spending accounted for about 22% of CHE (equivalent to US$187 per capita), compared to an average of 20% of CHE of OECD countries. Dubai spent 0.02% of CHE on long-term care, compared to an average of 11% of CHE of OECD countries. Dubai spent about 6% of CHE on prevention and public health services, compared to an average of 3.2% of CHE of OECD countries. The findings point to potential opportunities for growth and improvement in several health policy issues in Dubai, including increasing focus and funding of preventive services; shifting from inpatient care to day surgery, outpatient, and home-based services and strengthening long-term care; and introducing cost-containment measures for pharmaceuticals. More investment in the translation of NHA data into policy is suggested for future researchers.

Adjusting health expenditure for military spending and interest payment: Israel and the OECD countries

Directory of Open Access Journals (Sweden)

Shmueli Amir

2013-02-01

Full Text Available Abstract Background Compared to OECD countries, Israel has a remarkably low percentage of GDP and of government expenditure spent on health, which are not reflected in worse national outcomes. Israel is also characterized by a relatively high share of GDP spent on security expenses and payment of public debt. Objectives To determine to what extent differences between Israel and the OECD countries in security expenses and payment of the public debt might account for the gaps in the percentage of GDP and of government expenditures spent on health. Methods We compare the percentages of GDP and of government expenditures spent on health in the OECD countries with the respective percentages when using primary civilian GDP and government expenditures (i.e., when security expenses and interest payment are deducted. We compared Israel with the OECD average and examined the ranking of the OECD countries under the two measures over time. Results While as a percentage of GDP, the national expenditure on health in Israel was well below the average of the OECD countries, as a percentage of primary civilian GDP it was above the average until 2003 and below the average thereafter. When the OECD countries were ranked according to decreasing percent of GDP and of government expenditure spent on health, adjusting for security and debt payment expenditures changed the Israeli rank from 23rd to 17th and from 27th to 25th, respectively. Conclusions Adjusting for security expenditures and interest payment, Israel's low spending on health as a percentage of GDP and as a percentage of government's spending increases and is closer to the OECD average. Further analysis should explore the effect of additional population and macroeconomic differences on the remaining gaps.

Vulnerability of United States Bridges to Potential Increases in Flooding from Climate Change

Science.gov (United States)

This study assesses the potential impacts of increased river flooding from climate change on bridges in the continental United States. Daily precipitation statistics from four climate models and three greenhouse gas (GHG) emissions scenarios (A2, A1B, and B1) are used to capture ...

Can online benchmarking increase rates of thrombolysis? Data from the Austrian stroke unit registry.

Science.gov (United States)

Ferrari, Julia; Seyfang, Leonhard; Lang, Wilfried

2013-09-01

Despite its widespread availability and known safety and efficacy, a therapy with intravenous thrombolysis is still undergiven. We aimed to identify whether nationwide quality projects--like the stroke registry in Austria--as well as online benchmarking and predefined target values can increase rates of thrombolysis. Therefore, we assessed 6,394 out of 48,462 patients with ischemic stroke from the Austrian stroke registry (study period from March 2003 to December 2011) who had undergone thrombolysis treatment. We defined lower level and target values as quality parameters and evaluated whether or not these parameters could be achieved in the past years. We were able to show that rates of thrombolysis in Austria increased from 4.9% in 2003 to 18.3% in 2011. In a multivariate regression model, the main impact seen was the increase over the years [the OR ranges from 0.47 (95% CI 0.32-0.68) in 2003 to 2.51 (95% CI 2.20-2.87) in 2011). The predefined lower and target levels of thrombolysis were achieved at the majority of participating centers: in 2011 the lower value of 5% was achieved at all stroke units, and the target value of 15% was observed at 21 of 34 stroke units. We conclude that online benchmarking and the concept of defining target values as a tool for nationwide acute stroke care appeared to result in an increase in the rate of thrombolysis over the last few years while the variability between the stroke units has not yet been reduced.

The Effect of Advertising Spending on Brand Loyalty Mediated by Store Image, Perceived Quality and Customer Satisfaction: A Case of Hypermarkets

OpenAIRE

Farhina Hameed

2013-01-01

First, the study aims to investigate the effect of advertising spending on brand loyalty. Second, to test the mediating role of store image, perceived quality and customer satisfaction in above mentioned relationship. A quantitative approach was employed, using 15-item, 5-point Likert scale questionnaire administered to 360 participants. Data from the departmental stores are used to examine the direct and indirect impact of advertising spending on brand loyalty. Confirmatory Factor Analysis a...

Increasing plant density in eastern United States broccoli production systems to maximize marketable head yields

Science.gov (United States)

Increased demand for fresh market broccoli (Brassica oleracea L. var. italica) has led to increased production along the eastern seaboard of the United States. Maximizing broccoli yields is a primary concern for quickly expanding eastern commercial markets. Thus, a plant density study was carried ...

Funding AIDS programmes in the era of shared responsibility: an analysis of domestic spending in 12 low-income and middle-income countries.

Science.gov (United States)

Resch, Stephen; Ryckman, Theresa; Hecht, Robert

2015-01-01

As the incomes of many AIDS-burdened countries grow and donors' budgets for helping to fight the disease tighten, national governments and external funding partners increasingly face the following question: what is the capacity of countries that are highly affected by AIDS to finance their responses from domestic sources, and how might this affect the level of donor support? In this study, we attempt to answer this question. We propose metrics to estimate domestic AIDS financing, using methods related to national prioritisation of health spending, disease burden, and economic growth. We apply these metrics to 12 countries in sub-Saharan Africa with a high prevalence of HIV/AIDS, generating scenarios of possible future domestic expenditure. We compare the results with total AIDS financing requirements to calculate the size of the resulting funding gaps and implications for donors. Nearly all 12 countries studied fall short of the proposed expenditure benchmarks. If they met these benchmarks fully, domestic spending on AIDS would increase by 2·5 times, from US$2·1 billion to $5·1 billion annually, covering 64% of estimated future funding requirements and leaving a gap of around a third of the total $7·9 billion needed. Although upper-middle-income countries, such as Botswana, Namibia, and South Africa, would become financially self-reliant, lower-income countries, such as Mozambique and Ethiopia, would remain heavily dependent on donor funds. The proposed metrics could be useful to stimulate further analysis and discussion around domestic spending on AIDS and corresponding donor contributions, and to structure financial agreements between recipient country governments and donors. Coupled with improved resource tracking, such metrics could enhance transparency and accountability for efficient use of money and maximise the effect of available funding to prevent HIV infections and save lives. US Centers for Disease Control and Prevention. Copyright © 2015 Hecht et

Money in the bank : Feeling powerful increases saving

NARCIS (Netherlands)

Garbinsky, E.; Klesse, A.K.; Aaker, J.

2014-01-01

Across five studies, this research reveals that feeling powerful increases saving. This effect is driven by the desire to maintain one’s current state. When the purpose of saving is no longer to accumulate money but to spend it on a status-related product, the basic effect is reversed, and those who

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…

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 for...

China’s Increasing Influence in Oceania: Implications for the United States

Science.gov (United States)

2013-03-01

protection, and the promotion of women’s development and gender equity issues. Each of these areas also provide scope for the United States and China ...development, increasing healthcare capacity, fisheries conservation and management, marine protection, and promoting women’s development and gender equity ...institutions, promotion of dynamic civil society organizations, and promoting women’s development and gender equity are all areas applicable to Oceania

Shadow Education in Malaysia: Identifying the Determinants of Spending and Amount of Time Attending Private Supplementary Tutoring of Upper Secondary School Students

OpenAIRE

Chang Da Wan; Benedict Weerasena

2017-01-01

This paper examines the determinants of spending and the amount of time attending private supplementary tutoring, or commonly known as private tuition, in Malaysia. Based on 343 self-reported questionnaires with upper secondary students across three states in Malaysia and using multiple regression analysis, we identified ethnicity, father’s level of education and past academic performance as significant determinants of spending and amount of time attending private tuition. However, interestin...

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.

Energetic audit at the Hotel Punta Leona and solutions to reduce the spend in electricity

International Nuclear Information System (INIS)

Hernandez Madrigal, Tattiana; Gamboa Iglesias, Francisco Javier; Saenz Roldan, Esteban

2013-01-01

An energy audit is realized at the Hotel Punta Leona to determine the solutions in the reducing of the spend in electricity. The energy conservation opportunities are pointed in the rooms of Selvamar, Torremar, Arenas and Chalets. A system that stores, warms and distributes is identified in a optimal area to take advantage the solar energy. A storage system and food refrigeration are designed in the Restaurante Carabelas. Electricity consumption in different areas of the hotel and spend of potency of the household appliances of the rooms selected were measured with high technology equipment. Thermals leakages are analyzed by an infrared camera. The solar incidence taken advantage in the hotel facilities is determined. Topics such as energy audit, heat transfer, the sun and refrigeration systems are developed. Recommendations to reduce the electricity consumption in the areas studied are mentioned. An economic analysis is developed to justify the replacement of some equipment and the project profitability [es