WorldWideScience

Sample records for unnecessary spending act

  1. 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.

  2. [Unnecessary routine laboratory tests in patients referred for surgical services].

    Science.gov (United States)

    Mata-Miranda, María del Pilar; Cano-Matus, Norberto; Rodriguez-Murrieta, Margarita; Guarneros-Zapata, Idalia; Ortiz, Mario

    2016-01-01

    To question the usefulness of the lab analysis considered routine testing for the identification of abnormalities in the surgical care. To determine the percentage of unnecessary laboratory tests in the preoperative assessment as well as to estimate the unnecessary expenses. A descriptive, cross-sectional study of patients referred for surgical evaluation between January 1st and March 31st 2013. The database of laboratory testing and electronic files were reviewed. Reference criteria from surgical services were compared with the tests requested by the family doctor. In 65% of the patients (n=175) unnecessary examinations were requested, 25% (n=68) were not requested the tests that they required, and only 10% of the patients were requested laboratory tests in accordance with the reference criteria (n=27). The estimated cost in unnecessary examinations was $1,129,552 in a year. The results were similar to others related to this theme, however, they had not been revised from the perspective of the first level of attention regarding the importance of adherence to the reference criteria which could prevent major expenditures. It is a priority for leaders and operational consultants in medical units to establish strategies and lines of action that ensure compliance with institutional policies so as to contain spending on comprehensive services, and which in turn can improve the medical care. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  3. National Health Care Spending In 2016: Spending And Enrollment Growth Slow After Initial Coverage Expansions.

    Science.gov (United States)

    Hartman, Micah; Martin, Anne B; Espinosa, Nathan; Catlin, Aaron; The National Health Expenditure Accounts Team

    2018-01-01

    Total nominal US health care spending increased 4.3 percent and reached $3.3 trillion in 2016. Per capita spending on health care increased by $354, reaching $10,348. The share of gross domestic product devoted to health care spending was 17.9 percent in 2016, up from 17.7 percent in 2015. Health spending growth decelerated in 2016 following faster growth in 2014 and 2015 associated with coverage expansions under the Affordable Care Act (ACA) and strong retail prescription drug spending growth. In 2016 the slowdown was broadly based, as spending for the largest categories by payer and by service decelerated. Enrollment trends drove the slowdown in Medicaid and private health insurance spending growth in 2016, while slower per enrollee spending growth influenced Medicare spending. Furthermore, spending for retail prescription drugs slowed, partly as a result of lower spending for drugs used to treat hepatitis C, while slower use and intensity of services drove the slowdown in hospital care and physician and clinical services.

  4. 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.

  5. 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.

  6. 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

  7. Unnecessary work tasks and mental health

    DEFF Research Database (Denmark)

    Madsen, Ida E H; Tripathi, Manisha; Borritz, Marianne

    2014-01-01

    OBJECTIVES: According to the "stress-as-offense-to-self" perspective, work tasks that are considered unnecessary or unreasonable - so-called "illegitimate work tasks" - are likely to elicit stress-reactions. Previous studies, mostly cross-sectional, have shown that illegitimate tasks are associated...... with increased self-reported stress, cortisol, and counterproductive work behavior. In this article, we examine the prospective association between unnecessary work tasks, one type of illegitimate work tasks, and mental health among Danish human service workers. Further, we explore whether this association...... is modified by sex, age, occupational position, and baseline mental health status. METHODS: The data were obtained from self-administered questionnaires from 1351 Danish human service workers in three waves of data-collection during 1999-2005. We measured unnecessary work tasks by a single item, and assessed...

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. Retail Spending Potential

    Data.gov (United States)

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

  13. 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...

  14. 76 FR 18365 - Fair Credit Reporting Act and Bank Secrecy Act Compliance

    Science.gov (United States)

    2011-04-04

    ... Procedure Act (APA), an agency may, for good cause, find (and incorporate the finding and a brief statement... and comment procedures prescribed by the APA are unnecessary because the final rule makes technical... Asked Questions, and the FFIEC Bank Secrecy Act/Anti-Money Laundering Examination Manual. (iii...

  15. 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...

  16. 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...

  17. 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 ...

  18. 33 CFR 117.11 - Unnecessary opening of the draw.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Unnecessary opening of the draw. 117.11 Section 117.11 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS General Requirements § 117.11 Unnecessary opening of the draw. No...

  19. 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.

  20. [The unnecessary application of central venous catheterization in surgical patients].

    Science.gov (United States)

    Uemura, Keiko; Inoue, Satoki; Kawaguchi, Masahiko

    2018-04-06

    Perioperative physicians occasionally encounter situations where central venous catheters placed preoperatively turn out to be unnecessary. The purpose of this retrospective study is to identify the unnecessary application of central venous catheter placement and determine the factors associated with the unnecessary application of central venous catheter placement. Using data from institutional perioperative central venous catheter surveillance, we analysed data from 1,141 patients who underwent central venous catheter placement. We reviewed the central venous catheter registry and medical charts and allocated registered patients into those with the proper or with unnecessary application of central venous catheter according to standard indications. Multivariate analysis was used to identify factors associated with the unnecessary application of central venous catheter placement. In 107 patients, representing 9.38% of the overall population, we identified the unnecessary application of central venous catheter placement. Multivariate analysis identified emergencies at night or on holidays (odds ratio [OR] 2.109, 95% confidence interval [95% CI] 1.021-4.359), low surgical risk (OR=1.729, 95% CI 1.038-2.881), short duration of anesthesia (OR=0.961/10min increase, 95% CI 0.945-0.979), and postoperative care outside of the intensive care unit (OR=2.197, 95% CI 1.402-3.441) all to be independently associated with the unnecessary application of catheterization. Complications related to central venous catheter placement when the procedure consequently turned out to be unnecessary were frequently observed (9/107) compared with when the procedure was necessary (40/1034) (p=0.032, OR=2.282, 95% CI 1.076-4.842). However, the subsequent multivariate logistic model did not hold this significant difference (p=0.0536, OR=2.115, 95% CI 0.988-4.526). More careful consideration for the application of central venous catheter is required in cases of emergency surgery at night or on

  1. The Reaction of Private Spending and Market Interest Rates to the Changes in Public Spending

    Directory of Open Access Journals (Sweden)

    Przekota Grzegorz

    2016-01-01

    Full Text Available Expansionary fiscal policy is mired in controversy. Its proponents suggest that during recession, it stimulates investors’ activity and has a stabilizing effect on economic growth. However, its opponents point to the costs associated with the budget deficit and public debt handling. Increased public spending may result in an increase in the interest rates, which may, in turn, hinder private investment and weaken the multiplier effect of public spending. The following study examines how private spending and market interest rates reacted to changes in public spending in Poland. The study has shown that public spending stimulates private spending, which is consistent with the Keynesian model, but it also leads to an increase in market interest rates, which is consistent with the neoclassical model.

  2. 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.

  3. 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

  4. 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...

  5. 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...

  6. 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...

  7. 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...

  8. Inequalities in Parental Spending on Young Children

    Directory of Open Access Journals (Sweden)

    Sabino Kornrich

    2016-04-01

    Full Text Available This article investigates inequality in parental spending on young children over the period from 1972 to 2010. I find increased spending among parents at the top of the income distribution but little change among parents at the bottom of the income distribution. The gap in spending is equally attributable to increased spending on center-based care for preschool-age children and spending on enrichment goods and activities. The article examines potential causes of increased spending, including income, parental education, and wife’s work status, using decomposition analysis. Results indicate that higher incomes are the largest cause of the increased gap in spending but that increases in wife’s earnings, college completion, and wife’s work hours are also important for growth in spending.

  9. 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.

  10. Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion.

    Science.gov (United States)

    Sommers, Benjamin D; Gruber, Jonathan

    2017-05-01

    As states weigh whether to expand Medicaid under the Affordable Care Act (ACA) and Medicaid reform remains a priority for some federal lawmakers, fiscal considerations loom large. As part of the ACA's expansion of eligibility for Medicaid, the federal government paid for 100 percent of the costs for newly eligible Medicaid enrollees for the period 2014-16. In 2017 states will pay some of the costs for new enrollees, with each participating state's share rising to 10 percent by 2020. States continue to pay their traditional Medicaid share (roughly 25-50 percent, depending on the state) for previously eligible enrollees. We used data for fiscal years 2010-15 from the National Association of State Budget Officers and a difference-in-differences framework to assess the effects of the expansion's first two fiscal years. We found that the expansion led to an 11.7 percent increase in overall spending on Medicaid, which was accompanied by a 12.2 percent increase in spending from federal funds. There were no significant increases in spending from state funds as a result of the expansion, nor any significant reductions in spending on education or other programs. States' advance budget projections were also reasonably accurate in the aggregate, with no significant differences between the projected levels of federal, state, and Medicaid spending and the actual expenses as measured at the end of the fiscal year. Project HOPE—The People-to-People Health Foundation, Inc.

  11. Re-evaluating the relationships among filtering activity, unnecessary storage, and visual working memory capacity.

    Science.gov (United States)

    Emrich, Stephen M; Busseri, Michael A

    2015-09-01

    The amount of task-irrelevant information encoded in visual working memory (VWM), referred to as unnecessary storage, has been proposed as a potential mechanism underlying individual differences in VWM capacity. In addition, a number of studies have provided evidence for additional activity that initiates the filtering process originating in the frontal cortex and basal ganglia, and is therefore a crucial step in the link between unnecessary storage and VWM capacity. Here, we re-examine data from two prominent studies that identified unnecessary storage activity as a predictor of VWM capacity by directly testing the implied path model linking filtering-related activity, unnecessary storage, and VWM capacity. Across both studies, we found that unnecessary storage was not a significant predictor of individual differences in VWM capacity once activity associated with filtering was accounted for; instead, activity associated with filtering better explained variation in VWM capacity. These findings suggest that unnecessary storage is not a limiting factor in VWM performance, whereas neural activity associated with filtering may play a more central role in determining VWM performance that goes beyond preventing unnecessary storage.

  12. 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 ...

  13. 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...

  14. 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.

  15. 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.

  16. 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.

  17. Removing Unnecessary Variables from Horn Clause Verification Conditions

    Directory of Open Access Journals (Sweden)

    Emanuele De Angelis

    2016-07-01

    Full Text Available Verification conditions (VCs are logical formulas whose satisfiability guarantees program correctness. We consider VCs in the form of constrained Horn clauses (CHC which are automatically generated from the encoding of (an interpreter of the operational semantics of the programming language. VCs are derived through program specialization based on the unfold/fold transformation rules and, as it often happens when specializing interpreters, they contain unnecessary variables, that is, variables which are not required for the correctness proofs of the programs under verification. In this paper we adapt to the CHC setting some of the techniques that were developed for removing unnecessary variables from logic programs, and we show that, in some cases, the application of these techniques increases the effectiveness of Horn clause solvers when proving program correctness.

  18. 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.

  19. 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

  20. Understanding the recent growth in Medicaid spending, 2000-2003.

    Science.gov (United States)

    Holahan, John; Ghosh, Arunabh

    2005-01-01

    Growth in Medicaid spending averaged 10.2 percent per year between 2000 and 2003, resulting in a one-third increase in program spending. Spending growth was lower from 2002 to 2003 because of slower growth in enrollment and in spending per enrollee, particularly for acute care services, and declines in disproportionate-share hospital (DSH) payments and upper payment limit (UPL) programs. For the entire 2000-2003 period, Medicaid spending increases were largely driven by enrollment growth, much of which was attributable to the economic downturn. Increases in spending per enrollee over the period were faster than inflation but slower than increases in private insurance spending.

  1. How to save costs by reducing unnecessary testing: Lean thinking in clinical practice

    NARCIS (Netherlands)

    Vegting, I.L.; van Beneden, M.; Kramer, M.H.H.; Thijs, A.; Kostense, P.J.; Nanayakkara, P.W.B.

    2012-01-01

    Background: The burden of health care expenditure on national budgets has increased dramatically over the past decade. A pilot study in our hospital demonstrated that many unnecessary diagnostic tests were performed routinely. The aim of this study was to reduce the costs of unnecessary diagnostic

  2. 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...

  3. 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.

  4. 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.

  5. An Analysis of Fiscal Years 2014 to 2016 Navy Fourth Quarter Spending: Trends and Characteristics of Q4 O and M Contractual Awards

    Science.gov (United States)

    2017-09-01

    Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188...spending in the Navy Operations and Maintenance accounts between fiscal years 2014 and 2016 to help ensure the government is getting the best value for the...Competition. 14. SUBJECT TERMS Department of the Navy, appropriations, spending, contracts, operations and maintenance , fiscal, Anti-Deficiency Act

  6. 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.

  7. 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....

  8. Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    Directory of Open Access Journals (Sweden)

    MUHAMMAD AZAM ISHAQUE CHAUDHARY

    2017-07-01

    Full Text Available Focusing on health care systems can improve health outcomes now and in the future. Growing economies have serious concerns on the rising cost of health, whereas, in under developed countries like Pakistan, it is not emphasized yet at all. The research is conducted to improve a unique aspect of health care systems to provide effective, patient-centred, high-standard health care while maintaining the cost effectiveness. Research is being qualified in two paradigms qualitative and quantitative. In qualitative research, expert?s interviews have been taken to get the basic knowledge of radiology based testing and their prerequisites, in quantitative research ordered are being analysed to check the frequency and if they are unnecessary or qualified medical necessity guidelines as established in qualitative method. Analysis was made on the basis of the trinity relationship of diagnosis, symptoms and respected order to determine the necessity of the order to get its impact on cost of the overall health of those patients and point out more than 50% unnecessary orders are being performed in two government hospitals. The situation is alarming and policy makers should focus on unnecessary ordering to avoid out of pocket expenses and improve quality of care. The research helps in successful application of health care system modifications and policies pertaining to one aspect of health systems, i.e. cost-effectiveness of health care.

  9. 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

  10. 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.

  11. 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.

  12. 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

  13. 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...

  14. 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

  15. 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...

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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.

  2. 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).

  3. 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

  4. 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

  5. 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.

  6. 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....

  7. 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.

  8. "Unnecessary suffering": the cornerstone of animal protection legislation considered.

    Science.gov (United States)

    Radford, M

    1999-09-01

    Causing "unnecessary suffering" has been widely adopted in legislation to define criminal liability in respect of the treatment of animals. This article examines the way in which the term has been interpreted and applied by the courts, and considers its effectiveness in affording animals protection from abuse.

  9. Nongovernment Philanthropic Spending on Public Health in the United States.

    Science.gov (United States)

    Shaw-Taylor, Yoku

    2016-01-01

    The objective of this study was to estimate the dollar amount of nongovernment philanthropic spending on public health activities in the United States. Health expenditure data were derived from the US National Health Expenditures Accounts and the US Census Bureau. Results reveal that spending on public health is not disaggregated from health spending in general. The level of philanthropic spending is estimated as, on average, 7% of overall health spending, or about $150 billion annually according to National Health Expenditures Accounts data tables. When a point estimate of charity care provided by hospitals and office-based physicians is added, the value of nongovernment philanthropic expenditures reaches approximately $203 billion, or about 10% of all health spending annually.

  10. Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers.

    Science.gov (United States)

    Madsen, Ida E H; Tripathi, Manisha; Borritz, Marianne; Rugulies, Reiner

    2014-11-01

    According to the "stress-as-offense-to-self" perspective, work tasks that are considered unnecessary or unreasonable - so-called "illegitimate work tasks" - are likely to elicit stress-reactions. Previous studies, mostly cross-sectional, have shown that illegitimate tasks are associated with increased self-reported stress, cortisol, and counterproductive work behavior. In this article, we examine the prospective association between unnecessary work tasks, one type of illegitimate work tasks, and mental health among Danish human service workers. Further, we explore whether this association is modified by sex, age, occupational position, and baseline mental health status. The data were obtained from self-administered questionnaires from 1351 Danish human service workers in three waves of data-collection during 1999-2005. We measured unnecessary work tasks by a single item, and assessed mental health using the 5-item mental health inventory from the Short form 36 questionnaire. We analyzed data using multi-level modeling, adjusting for potential confounding by sex, age, cohabitation, occupational position, and baseline mental health. Unnecessary work tasks were prospectively associated with a decreased level of mental health. This association was stronger for employees with poor baseline mental health and tended to be more pronounced among older employees. Among participants with poor baseline mental health, the association was explained by neither psychological demands nor decision latitude. Our findings suggest that the prevention of unnecessary work tasks may benefit employee mental health, particularly among employees with pre-existing mental health problems.

  11. 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

  12. 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…

  13. [An initiative to reduce the use of unnecessary medication in infants with bronchiolitis in primary care].

    Science.gov (United States)

    Montejo Fernández, Marta; Benito Manrique, Iñaki; Montiel Eguía, Arantza; Benito Fernández, Javier

    2018-05-23

    Although evidence-based guidelines for acute bronchiolitis recommend primarily supportive care unnecessary treatments remain well documented. The objective of this study was to analyse a quality improvement initiative to reduce overuse of unnecessary treatments in infants with acute bronchiolitis in primary care settings. To determine the number of unnecessary treatments we reviewed the charts corresponding to infants aged initiative may be applied to the settings where the majority of infants with acute bronchiolitis are attended in western countries. Copyright © 2018. Publicado por Elsevier España, S.L.U.

  14. 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.

  15. 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 ...

  16. 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

  17. 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…

  18. 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.

  19. 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...

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. 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...

  5. Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report.

    Science.gov (United States)

    Huh, Jong-Ki; Shin, Su-Jung

    2013-08-01

    This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.

  6. 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.

  7. 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...

  8. [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.

  9. Effective diagnostic DAQ systems to reduce unnecessary data in KSTAR

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Taegu, E-mail: glory@nfri.re.kr; Lee, Woongryol; Hong, Jaesic; Park, Kaprai

    2016-11-15

    Highlights: • When plasma shots do not successfully perform during the intended target time, the diagnostics systems continue to record these unusable data, contributing to increasing data size. • To overcome this problem, some KSTAR’s library were upgraded to monitor the plasma status in real-time. • With the real-time information of plasma status, some of the KSTAR diagnostic systems stop the acquisition process of unnecessary data. • We were able to reduce the refuse data of approximately 698 GByte in the KSTAR 7th campaign. • It was a very effective way to store useful data, and it was helpful to analysts after shot. - Abstract: The plasma status of Korea Superconducting Tokamak Advanced Research (KSTAR) is measured by various diagnostics systems. The measured data size has been increasing every year due to increasing plasma pulse lengths, higher diagnostics operating frequencies, the additions of new diagnostic systems, and an increasing number of diagnostics channels. At times, when plasma shots do not successfully perform during the intended target time, the diagnostics systems continue to record these unusable data, contributing to increasing data size. In addition, the analysis time was affected, as these data need to be separated from the relevant data set. To overcome this problem, KSTAR’s Standard Framework (SFW), Real Time Monitoring (RTMON), and Pulse Automation and Scheduling System (PASS) were upgraded to monitor the plasma status in real-time. When the plasma current is less than 200kA, RTMON sends the plasma status information every second to the SFW via EPICS Channel Access. With the real-time information on plasma status, some of the KSTAR diagnostic systems stop the acquisition process of unnecessary data. This paper describes a method for reducing the storage of unnecessary data and its results in the KSTAR 7th campaign.

  10. 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.

  11. 77 FR 29579 - Removing Unnecessary Office on Violence Against Women Regulations

    Science.gov (United States)

    2012-05-18

    ... now unnecessary STOP VAIW Program regulations. Higher Education Amendments of 1998 Violence against... Office on Violence Against Women Regulations AGENCY: Office on Violence Against Women, Justice. ACTION: Proposed rule. SUMMARY: This rule proposes to remove the regulations for the STOP Violence Against Indian...

  12. 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...

  13. 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

  14. 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

  15. 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

  16. 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...

  17. 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.

  18. 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...

  19. 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.

  20. 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...

  1. 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

  2. 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.

  3. 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...

  4. Re: Madsen et al. "Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers".

    Science.gov (United States)

    Durand-Moreau, Quentin; Loddé, Brice; Dewitte, Jean-Dominique

    2015-03-01

    Madsen et al (1) recently published a secondary analysis on data provided by the Project on Burnout, Motivation and Job Satisfaction (PUMA). The aim of their study, published in the Scandinavian Journal of Work, Environment & Health was to examine the associations between unnecessary work tasks and a decreased level of mental health. Though the topic was quite novel, reading this work proved disturbing and raised issues. Based on the results of this study, the authors stated that there is an association between unnecessary work tasks (assessed by a single question) and a decreased level of mental health, idem [assessed by the Mental Health Inventory (MHI-5)], in the specific population included in this PUMA survey. The authors point out a limitation of the study, namely that unnecessary work tasks were evaluated using one single question: "Do you sometimes have to do things in your job which appear to be unnecessary?". Semmer defines unnecessary work task as "tasks that should not be carried out at all because they do not make sense or because they could have been avoided, or could be carried out with less effort if things were organized more efficiently" (2). De facto, qualifying what an unnecessary task is requires stating or explaining whether the task makes sense. Making sense or not is not an objective notion. It is very difficult for either a manager or an employee to say if a task is necessary or not. Most important is that it makes sense from the worker's point of view. Making sense and being necessary are not synonyms. Some tasks do not make sense but are economically necessary (eg, when, as physicians, we are reporting our activity using ICD-10 on computers instead of being at patients' bedsides or reading this journal). Thus, there is a wide gap between Semmer's definition and the question used by the authors to evaluate his concept. A secondary analysis based on a single question is not adequate to evaluate unnecessary tasks. Nowadays, the general trend

  5. 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.

  6. 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...

  7. Thoracic splenosis. Know it-avoid unnecessary investigations, interventions, and thoracotomy

    International Nuclear Information System (INIS)

    Khan, A.M.; Manzoor, K.; Malik, Z.; Yasim, A.; Shim, C.

    2011-01-01

    Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. Most cases of TS are asymptomatic and are diagnosed during the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive workup and unnecessary invasive diagnostic procedures including thoracotomy. Multiple, asymptomatic, left-sided pleura-based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert one to suspect TS, which can then simply be confirmed with a 99m Tc-sulfa colloid radionuclide scan. If TS is suspected and radionuclide imaging studies are performed, further extensive investigations, such as bronchoscopy, biopsy, thoracoscopy, and thoracotomy, are not required as the radionuclide scan is definitive for diagnosis. Most cases are asymptomatic, so further treatment is rarely required; all cases are managed conservatively. We emphasize that all physicians, radiologists, pathologists, and interventionalists should recognize key features that suggest the diagnosis of TS, order appropriate imaging when it is suspected, and avoid unnecessary invasive diagnostic procedures including thoracotomy. (author)

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. Reducing unnecessary lab testing in the ICU with artificial intelligence.

    Science.gov (United States)

    Cismondi, F; Celi, L A; Fialho, A S; Vieira, S M; Reti, S R; Sousa, J M C; Finkelstein, S N

    2013-05-01

    To reduce unnecessary lab testing by predicting when a proposed future lab test is likely to contribute information gain and thereby influence clinical management in patients with gastrointestinal bleeding. Recent studies have demonstrated that frequent laboratory testing does not necessarily relate to better outcomes. Data preprocessing, feature selection, and classification were performed and an artificial intelligence tool, fuzzy modeling, was used to identify lab tests that do not contribute an information gain. There were 11 input variables in total. Ten of these were derived from bedside monitor trends heart rate, oxygen saturation, respiratory rate, temperature, blood pressure, and urine collections, as well as infusion products and transfusions. The final input variable was a previous value from one of the eight lab tests being predicted: calcium, PTT, hematocrit, fibrinogen, lactate, platelets, INR and hemoglobin. The outcome for each test was a binary framework defining whether a test result contributed information gain or not. Predictive modeling was applied to recognize unnecessary lab tests in a real world ICU database extract comprising 746 patients with gastrointestinal bleeding. Classification accuracy of necessary and unnecessary lab tests of greater than 80% was achieved for all eight lab tests. Sensitivity and specificity were satisfactory for all the outcomes. An average reduction of 50% of the lab tests was obtained. This is an improvement from previously reported similar studies with average performance 37% by [1-3]. Reducing frequent lab testing and the potential clinical and financial implications are an important issue in intensive care. In this work we present an artificial intelligence method to predict the benefit of proposed future laboratory tests. Using ICU data from 746 patients with gastrointestinal bleeding, and eleven measurements, we demonstrate high accuracy in predicting the likely information to be gained from proposed future

  14. Reducing unnecessary lab testing in the ICU with artificial intelligence

    Science.gov (United States)

    Cismondi, F.; Celi, L.A.; Fialho, A.S.; Vieira, S.M.; Reti, S.R.; Sousa, J.M.C.; Finkelstein, S.N.

    2017-01-01

    Objectives To reduce unnecessary lab testing by predicting when a proposed future lab test is likely to contribute information gain and thereby influence clinical management in patients with gastrointestinal bleeding. Recent studies have demonstrated that frequent laboratory testing does not necessarily relate to better outcomes. Design Data preprocessing, feature selection, and classification were performed and an artificial intelligence tool, fuzzy modeling, was used to identify lab tests that do not contribute an information gain. There were 11 input variables in total. Ten of these were derived from bedside monitor trends heart rate, oxygen saturation, respiratory rate, temperature, blood pressure, and urine collections, as well as infusion products and transfusions. The final input variable was a previous value from one of the eight lab tests being predicted: calcium, PTT, hematocrit, fibrinogen, lactate, platelets, INR and hemoglobin. The outcome for each test was a binary framework defining whether a test result contributed information gain or not. Patients Predictive modeling was applied to recognize unnecessary lab tests in a real world ICU database extract comprising 746 patients with gastrointestinal bleeding. Main results Classification accuracy of necessary and unnecessary lab tests of greater than 80% was achieved for all eight lab tests. Sensitivity and specificity were satisfactory for all the outcomes. An average reduction of 50% of the lab tests was obtained. This is an improvement from previously reported similar studies with average performance 37% by [1–3]. Conclusions Reducing frequent lab testing and the potential clinical and financial implications are an important issue in intensive care. In this work we present an artificial intelligence method to predict the benefit of proposed future laboratory tests. Using ICU data from 746 patients with gastrointestinal bleeding, and eleven measurements, we demonstrate high accuracy in predicting the

  15. 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...

  16. 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.

  17. 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...

  18. 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...

  19. 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.

  20. 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

  1. 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...

  2. 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

  3. 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...

  4. 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.

  5. 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.

  6. 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.

  7. 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…

  8. 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.

  9. 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 ...

  10. 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...

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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…

  17. Author response to letter. Ref: Madsen et al. "Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers".

    Science.gov (United States)

    Madsen, Ida Eh; Rugulies, Reiner

    2015-03-01

    We read with interest the letter from Drs Durand-Moreau, Loddé, and Dewitte (1) regarding our article on unnecessary work tasks and mental health (2). The authors argue that: (i) the article is flawed by an imprecise one-item exposure measurement, (ii) the results may be affected by reverse causality, and (iii) ultimately the elimination of unnecessary work tasks may increase "psychic suffering". We would like to take this opportunity to address their concerns. We acknowledge, as we did in the article itself, that measuring unnecessary work tasks using only one item is less than ideal and could have increased measurement error in our analyses. The item we used to measure unnecessary work tasks assesses the employee's overall evaluation regarding the extent to which they must conduct work tasks that they, for whatever reason, deem unnecessary. We are unconvinced by the claim by Drs Durand-Moreau, Loddé, and Dewitte that this phenomenon is somehow unrelated to Semmer's definition of unnecessary tasks (3, 4), regardless of the sense-making processes underlying an individual employee's evaluation of a particular work task as unnecessary. Regarding the issue of reverse causality, the analyses were longitudinal and the effect estimates were adjusted for the baseline mental health level of the participants. Consequently, we examined changes in mental health over time, and our results cannot be explained by poorer mental health making workers think "that what they're doing is useless" as claimed in the commentary. Although causal inference is always a delicate issue when applying observational research methods, the adjustment for baseline mental health should account for reverse causality at least. Drs Durand-Moreau, Loddé, and Dewitte question that our findings suggest that the elimination of unnecessary work tasks may be beneficial to employee mental health. Instead they propose that unnecessary work tasks may be conducive to mental health because "some tasks may seem

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

    Science.gov (United States)

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

    2011-01-01

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

  19. 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

  20. 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 ...

  1. 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.

  2. 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).

  3. 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

  4. 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.

  5. issn 1727-3781 the interpretation of the amended raf act 56 of 1996 ...

    African Journals Online (AJOL)

    user

    except for secondary emotional shock suffered due to the motor-vehicle accident. 4 ... the Amendment Act these claims are no longer limited or excluded and thus the potential ..... issue to a mystical Appeal Tribunal in his view would amount to an “unnecessary or .... The RAF should provide relevant, rational and substantial.

  6. Neonatal adrenal hemorrhage manifesting as acute scrotum: timely diagnosis prevents unnecessary surgery.

    Science.gov (United States)

    Avolio, Luigi; Fusillo, Mario; Ferrari, Giovanna; Chiara, Alberto; Bragheri, Romano

    2002-04-01

    Neonatal adrenal hemorrhage presenting as scrotal swelling has been reported in 17 cases, with unnecessary surgical exploration in 7. We report 2 new cases, emphasizing the knowledge of this clinical association and the role of ultrasonography in the differential diagnosis for this specific condition and in all cases of neonatal acute scrotum.

  7. 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.

  8. Hong Kong's health spending projections through 2033.

    Science.gov (United States)

    Leung, Gabriel M; Tin, Keith Y K; Chan, Wai-Sum

    2007-04-01

    To derive actuarial projection estimates of Hong Kong's total domestic health expenditure to the year 2033. Disaggregating health expenditure by age, sex, unit cost and utilisation level, we estimated future health spending by projecting utilisation (by public/private, inpatient/outpatient care) to reflect demographic changes and associated increase in demand (from higher expectations and greater intensity of care), and then multiplying such by the projected unit costs (incorporating the impact of key cost drivers such as public expectations, technological changes and potential productivity gains) to obtain total expenditure estimates. The model was most sensitive to the excess health care price inflation rate, i.e. the annual price/cost growth of medical goods and services over and above per capita GDP growth. Population ageing and growth per se, without taking into account related technologic innovation for chronic conditions that particularly afflict older adults, contribute relatively little to overall spending growth. Given the model assumptions, it is possible to limit total health spending to below 10% of GDP by 2033, where the public share would gradually decline from the current 57% to between 46% and 49%. Expenditure control through global budgeting, technology assessment and demand-side constraints should be considered although their effectiveness remains inconclusive.

  9. [For active dermatocosmetics and free of unnecessary animal experimentation].

    Science.gov (United States)

    Piérard, G E; Piérard-Franchimont, C

    1998-06-01

    At the dawn of this century, dermocosmetology is at cross-roads because new European regulations are changing its face. The proof of claims must be given and the entire composition of the product must be released. In addition, animal testing is about to be banned. Such new regulations incite to search for and validate predictive tests aiming at the objective evaluation of the activity and tolerance claimed by dermocosmetic products. Such tests must be an alternative to unnecessary animal experimentation. These aspects are scrutinized scientifically by the EEMCO experts in combination with the ECVAM and COLIPA organizations.

  10. 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.

  11. 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

  12. 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...

  13. 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.

  14. 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.

  15. 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...

  16. 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...

  17. 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...

  18. 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

  19. A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria

    OpenAIRE

    Irfan, Neal; Brooks, Annie; Mithoowani, Siraj; Celetti, Steve J.; Main, Cheryl; Mertz, Dominik

    2015-01-01

    Background Asymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice. Objective To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU. Design Quasi-experimental study with a control group. Setting Two tertiary teaching adult care hospitals. Participants Consec...

  20. 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

  1. 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…

  2. 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...

  3. [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.

  4. 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

  5. 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

  6. 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...

  7. 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.

  8. 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

  9. 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

  10. 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.

  11. 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.

  12. 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

  13. Opportunities in the American Recovery and Reinvestment Act for Supports and Services for Youth Transitioning from Foster Care

    Science.gov (United States)

    Flynn-Khan, Margaret; Langford, Barbara Hanson

    2009-01-01

    To address the economic crisis facing the country, the President signed the American Recovery and Reinvestment Act (ARRA) into law on February 17, 2009. This sweeping legislation provides $789 billion to jumpstart the economy and boost employment. This act includes $463 billion in new spending and $326 billion in tax relief directed at those…

  14. Influences of peer relations and locus of control on students ...

    African Journals Online (AJOL)

    Effort to checkmate extravagance and maximize gain is the focus of all organizations more in this period of global financial crisis. There is need therefore to checkmate unnecessary financial spending. This study examines the influence of the variables, peer relations and locus of control, on such spending among University ...

  15. Adjusting health spending for the presence of comorbidities: an application to United States national inpatient data.

    Science.gov (United States)

    Dieleman, Joseph L; Baral, Ranju; Johnson, Elizabeth; Bulchis, Anne; Birger, Maxwell; Bui, Anthony L; Campbell, Madeline; Chapin, Abigail; Gabert, Rose; Hamavid, Hannah; Horst, Cody; Joseph, Jonathan; Lomsadze, Liya; Squires, Ellen; Tobias, Martin

    2017-08-29

    One of the major challenges in estimating health care spending spent on each cause of illness is allocating spending for a health care event to a single cause of illness in the presence of comorbidities. Comorbidities, the secondary diagnoses, are common across many causes of illness and often correlate with worse health outcomes and more expensive health care. In this study, we propose a method for measuring the average spending for each cause of illness with and without comorbidities. Our strategy for measuring cause of illness-specific spending and adjusting for the presence of comorbidities uses a regression-based framework to estimate excess spending due to comorbidities. We consider multiple causes simultaneously, allowing causes of illness to appear as either a primary diagnosis or a comorbidity. Our adjustment method distributes excess spending away from primary diagnoses (outflows), exaggerated due to the presence of comorbidities, and allocates that spending towards causes of illness that appear as comorbidities (inflows). We apply this framework for spending adjustment to the National Inpatient Survey data in the United States for years 1996-2012 to generate comorbidity-adjusted health care spending estimates for 154 causes of illness by age and sex. The primary diagnoses with the greatest number of comorbidities in the NIS dataset were acute renal failure, septicemia, and endocarditis. Hypertension, diabetes, and ischemic heart disease were the most common comorbidities across all age groups. After adjusting for comorbidities, chronic kidney diseases, atrial fibrillation and flutter, and chronic obstructive pulmonary disease increased by 74.1%, 40.9%, and 21.0%, respectively, while pancreatitis, lower respiratory infections, and septicemia decreased by 21.3%, 17.2%, and 16.0%. For many diseases, comorbidity adjustments had varying effects on spending for different age groups. Our methodology takes a unified approach to account for excess spending caused

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. 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.

  1. 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.

  2. Does the addition of saline infusion sonohysterography to transvaginal ultrasonography prevent unnecessary hysteroscopy in premenopausal women with abnormal uterine bleeding?

    Science.gov (United States)

    Short, John; Sharp, Benjamin; Elliot, Nikki; McEwing, Rachael; McGeoch, Graham; Shand, Brett; Holland, Kieran

    2016-08-01

    This observational case series in 65 premenopausal women with abnormal uterine bleeding evaluated whether transvaginal ultrasound followed by saline infusion sonohysterography (SIS) prevented unnecessary hysteroscopy. Although SIS indicated that hysteroscopy was unnecessary in eight women, this benefit was offset by the invasive nature of the scan, the number of endometrial abnormalities falsely detected by SIS and the cost of the additional investigation. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  3. 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.

  4. 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.

  5. 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

  6. 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

  7. The criteria for the decision of transrectal US-guided prostate biopsy: Can we reduce the number of unnecessary biopsies?

    International Nuclear Information System (INIS)

    Cho, Joon Hyung; Cho, Jae Ho; Ahn, Jay Hong; Chang, Jay Chun

    2001-01-01

    To establish the criteria which can safely reduce the number of unnecessary biopsies by comparing the transrectal ultrasonography (TRUS) findings, serum prostate-specific antigen (PSA), and prostate specific antigen density (PSAD) in the decision of criteria for the prostatic biopsy using TRUS. Two hundred and twenty patients underwent TRUS- guided prostate biopsy due to elevated PSA and/or focal nodule on TRUS were included. Sixty five (27.5%) patients were confirmed as prostate cancer, and remained 155 (70.5%) patients were reported as benign diseases including benign prostate hyperplasia. The sensitivity, specificity and accuracy of TRUS, PSA and PSAD were evaluated and the single criterion or the combination of the criteria which can safely reduce the unnecessary biopsies without missing prostatic cancer were investigated. The sensitivity, specificity and accuracy of TRUS, PSA (cut-off value, 4 ng/ml) and PSAD (cut-off level, 0.2 ng/ml/cm 3 ) were 78.5%/95.4%/95.4%/27.8%/51.6%/64/5%, 42.7%/64.5%/73.6%, respectively. PSAD cut-off level 0.2 ng/ml/cm 3 was the most excellent single criterion for the decision of prostatic biopsy and the number of unnecessary biopsies was 100 cases. But 3 cases of prostatic cancer which the PSAD level was below 0.2 ng/ml/cm 3 were included and in all these 3 cases, a focal nodule was detected on TRUS. Therefore, we applied these two criteria at once and the biopsies of 30 cases (13.6%) are unnecessary. With the single criterion, we could not obtain the satisfactory results but by the combinations of criteria (TRUS and PSAD), 30 (13.6%) cases are unnecessary biopsies without missing cancer. We think that the short term follow-up may be a substitute for the immediate when nodular lesion is suspicious on TRUS and serum PSAD level is below 0.2 ng/ml/cm 3 .

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. 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 ...

  13. 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

  14. 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

  15. 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.

  16. 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…

  17. 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

  18. 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.

  19. 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

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    Marta Postuła

    2017-06-01

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

  2. 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.

  3. 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

  4. Regional Employment Growth and Defense Spending.

    Science.gov (United States)

    1987-12-01

    important part of regional growth. UI ACCA 9o1n For ’NDis i - Dljt s i-: . TABLE OF CONTENTS I. INTRODUCTION .. .. .. .... ..... .... .... .... ..... .. 7...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

  5. 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....

  6. 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...

  7. 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

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. The Relationship Between the Status of Unnecessary Accommodations Being Made to Unconfirmed Food Allergy Students and the Presence or Absence of a Doctor’s Diagnosis

    Directory of Open Access Journals (Sweden)

    Yurika Ganaha

    2015-06-01

    Full Text Available The present study investigated the current state of unnecessary children food allergy accommodation and the medical efforts to confirm the existence of food allergies in school lunch service kitchens in Okinawa, Japan, including kitchens accommodating food allergy students by requiring medical documentation at the start and during provisions being made (Double Diagnosis, requiring medical documentation at the start only (Single Diagnosis, and with no medical documentation (Non-Diagnosis. Unnecessary accommodations are being made to unconfirmed food allergy students, wherein the more medical consultation was required, the lower the food allergy incident rate was and the more food allergens were diagnosed (Non-Diagnosis > Single Diagnosis > Double Diagnosis. This study suggests the possibility that unconfirmed food allergy students may be receiving unnecessary food allergy accommodations per school lunches, and the number of unnecessary food allergy provisions being made could be reduced by requiring medical documentation at the start and during these provisions.

  13. 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

  14. 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...

  15. 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.

  16. 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

  17. 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

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

    Directory of Open Access Journals (Sweden)

    Amico Peter

    2012-03-01

    Full Text Available Abstract Background AIDS continues to spread at an estimated 2.6 new million infections per year, making the prevention of HIV transmission a critical public health issue. The dramatic growth in global resources for AIDS has produced a steady scale-up in treatment and care that has not been equally matched by preventive services. This paper is a detailed analysis of how countries are choosing to spend these more limited prevention funds. Methods We analyzed prevention spending in 69 low- and middle-income countries with a variety of epidemic types, using data from national domestic spending reports. Spending information was from public and international sources and was analyzed based on the National AIDS Spending Assessment (NASA methods and classifications. Results Overall, prevention received 21% of HIV resources compared to 53% of funding allocated to treatment and care. Prevention relies primarily on international donors, who accounted for 65% of all prevention resources and 93% of funding in low-income countries. For the subset of 53 countries that provided detailed spending information, we found that 60% of prevention resources were spent in five areas: communication for social and behavioral change (16%, voluntary counselling and testing (14%, prevention of mother-to-child transmission (13%, blood safety (10% and condom programs (7%. Only 7% of funding was spent on most-at-risk populations and less than 1% on male circumcision. Spending patterns did not consistently reflect current evidence and the HIV specific transmission context of each country. Conclusions Despite recognition of its importance, countries are not allocating resources in ways that are likely to achieve the greatest impact on prevention across all epidemic types. Within prevention spending itself, a greater share of resources need to be matched with interventions that approximate the specific needs and drivers of each country's epidemic.

  19. 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.

  20. DOJ News Release: West Palm Beach Sellers of Unnecessary Septic Tank Products Plead Guilty to Wire Fraud

    Science.gov (United States)

    Moore, Nouerand and Lincoln, in concert with other employees of FBK Products, LLC., knowingly participated in a scheme to fraudulently market and sell an unnecessary and unneeded septic treatment product to residents of various states across the country.

  1. 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...

  2. 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...

  3. 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.

  4. 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.

  5. 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.

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

    Directory of Open Access Journals (Sweden)

    Helena Blažić

    2011-12-01

    Full Text Available The objective of this research is to analyze the relationship between government budget spending and the effect on the growth and structure of the GDP of Croatia during the past two decades. The starting working assumption (hypothesis is that the volume of total budget expenditure (including the foreign borrowing has not been realizing appropriate effect on GDP growth. In the analysis of these relationships we primarily use the method of vector autoregressions (VAR. The main result of the analysis showed that, in accordance with theoretical assumptions, the structure of expenditures is essential for the effects of budgetary spending on economic growth. We determine the positive effects of investment spending and purchases of goods and services and the negative effects of other categories of current spending. The reduction of capital expenditures during the recession presents a particularly adverse trend, which reduces the rate of growth of the economy in the long and short term. A fundamental conclusion of the research is that the budget expenditures have not adequately affected the GDP growth. Therefore, it is possible to affect the economic growth by changing the structure of budgetary spending, as well as directing public borrowing to investment financing.

  7. The HEART score is useful to predict cardiovascular risks and reduces unnecessary cardiac imaging in low-risk patients with acute chest pain.

    Science.gov (United States)

    Dai, Siping; Huang, Bo; Zou, Yunliang; Guo, Jianbin; Liu, Ziyong; Pi, Dangyu; Qiu, Yunhong; Xiao, Chun

    2018-06-01

    The present study was to investigate whether the HEART score can be used to evaluate cardiovascular risks and reduce unnecessary cardiac imaging in China.Acute coronary syndrome patients with the thrombosis in myocardial infarction risk score risk HEART score group and 2 patients (1.5%) in the high risk HEART score group had cardiovascular events. The sensitivity of HEART score to predict cardiovascular events was 100% and the specificity was 46.7%. The potential unnecessary cardiac testing was 46.3%. Cox proportional hazards regression analysis showed that per one category increase of the HEART score was associated with nearly 1.3-fold risk of cardiovascular events.In the low-risk acute chest pain patients, the HEART score is useful to physicians in evaluating the risk of cardiovascular events within the first 30 days. In addition, the HEART score is also useful in reducing the unnecessary cardiac imaging.

  8. 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

  9. 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.

  10. 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.

  11. Essays in economics: 1. Pre-committed government spending and partisan politics. 2. Investment in energy efficiency: Do the characteristics of firms matter? 3. Information processing and organizational structure

    Science.gov (United States)

    Watkins, William Edward, Jr.

    1. Spending commitments requiring future outlays are important for understanding partisan politics because they prevent a conservative government from scaling back spending programs. In a one-government-good model, a "stubborn liberal" policy maker can use precommitted spending to prevent a later conservative government from imposing spending cuts. In a model where parties differ about spending priorities, re-election uncertainty creates a bias towards higher government spending and higher taxes. 2. The literature on energy efficiency provides examples of profitable technologies that are not universally adopted. Theory indicates that firms should undertake all investments with a positive net present value, and that the discount rate for computing the present value of a project should be the return available on other projects in the same risk class, not on characteristics of the firm. This model is tested by examining whether firms' characteristics influence their decision to join the Environmental Protection Agency's Green Lights program. A discrete choice regression is estimated over a sample of participating and non-participating firms. Missing values in the data matrix are replaced with multiple imputations using the EM algorithm. The results show that: (1) substantial improvements in the power of hypothesis tests can be achieved through imputation of missing data, and (2) characteristics of firms do affect their decision to join Green Lights. 3. Standard theories of the firm stress profit maximization as the foundation for derivation of predictable behavior. Yet evidence continues to accumulate that firms do not act as required by the neoclassical framework. Instead of being represented by ever more elaborate maximization models, the firm can be modeled simply as a network of information-processing agents. The actions of the firm are then a function only of the network structure and the information-processing capabilities of the agents. This approach can be

  12. 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.

  13. 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

  14. 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

  15. [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.

  16. 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…

  17. 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…

  18. 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

  19. 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.

  20. 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.

  1. A New Conservative Cold Front? Democrat and Republican Responsiveness to the Passage of the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Stephen L. Morgan

    2015-09-01

    Full Text Available Through an analysis of the 2004 through 2014 General Social Survey (GSS, this article demonstrates that the 2010 passage of the Affordable Care Act (ACA decreased support for spending on health among Democrats, Independents, and Republicans, contrary to the conjecture that a rigid partisanship equilibrium has taken hold among voters in the United States. Instead, only a partisan deflection is present, with spending preferences declining more for Republicans than for Democrats, and with Independents in between. Through supplemental analysis of the GSS panel data, as well as comparative analysis of other GSS items on national spending preferences, government responsibility, and confidence in leaders, this article also undermines support for an alternative explanation that cannot be entirely eliminated from plausibility, which is that the identified period effect that emerged in 2010 and persisted through 2014 is a response to the Great Recession and resulting deficit spending by the federal government. Implications for public opinion research are discussed, lending support to current models of thermostat effects and policy-specific political mood from the political science literature, which are informed by an older literature on weather fronts in public opinion that originated in the sociology literature.

  2. 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…

  3. 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

  4. 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.

  5. Hospitalizations and economic analysis in psychotic patients with paliperidone palmitate long-acting injection.

    Science.gov (United States)

    Mesones-Peral, Jesús E; Gurillo-Muñoz, Pedro; Sánchez-Sicilia, Mari Paz; Miller, Adam; Griñant-Fernández, Alejandra

    Prevent hospitalizations in psychotic disorders is an important aim, so long-acting antipsychotic is a good option that can control better the correct adherence. Moreover, in the current economic context pharmacoeconomic studies are necessary. We estimate the effect in prevention of paliperidone palmitate long-acting injection (PP-LAI) and calculate the economic cost in the 12 months preceding the start of treatment with PP-LAI and 12 months later. Mirror image study of 71 outpatients diagnosed with psychotic disorders and treated with PP-LAI. In a first analysis, we measured along one year: number of hospitalizations/year, number of hospitalization in days, number of emergency assists/year and if there is antipsychotics associated to long-acting treatment. After this phase, we applied Fees Act of Valencia for economic analysis and estimate of the cost per hospitalization (€ 5,640.41) and hospital emergency (€ 187.61). After one year of treatment with PP-LAI (mean dose=130.65mg/month), we obtained greater numbers in assistance variables: total hospitalizations decrease, 78.8% (P=.009); shortening in hospitalization days, 89.4% (P=.009); abridgement of number of emergency assists, 79.1% (P=.002); decrease of rate of antipsychotics associated to long-acting treatment, 21% (P<.0001); increase in monotherapy, 53.8% (P<.0001). Therefore, after 12 months of treatment with PP-LAI we obtained a reduction in inpatient spending (savings of € 175,766.54) and increased spending on antipsychotics 32% (equivalent to € 151,126.92). PP-LAI can be an effective therapy for the treatment of patients with severe psychotic disorders: improves symptomatic stability and can prevent hospitalizations with cost-effective symptom control. Copyright © 2016 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. 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.

  7. 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...

  8. 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…

  9. 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…

  10. 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.

  11. Regulations implementing the Byrd Amendments to the Black Lung Benefits Act: determining coal miners' and survivors' entitlement to benefits. Final rule.

    Science.gov (United States)

    2013-09-25

    This final rule revises the Black Lung Benefits Act (BLBA or Act) regulations to implement amendments made by the Patient Protection and Affordable Care Act (ACA). The ACA amended the BLBA in two ways. First, it revived a rebuttable presumption of total disability or death due to pneumoconiosis for certain claims. Second, it reinstituted automatic entitlement to benefits for certain eligible survivors of coal miners whose lifetime benefit claims were awarded because they were totally disabled due to pneumoconiosis. These regulations clarify how the statutory presumption may be invoked and rebutted and the application and scope of the survivor-entitlement provision. The rule also eliminates several unnecessary or obsolete provisions.

  12. [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.

  13. 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.

  14. 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.

  15. 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…

  16. 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

  17. 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.

  18. 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.

  19. Contraceptive Coverage and the Affordable Care Act.

    Science.gov (United States)

    Tschann, Mary; Soon, Reni

    2015-12-01

    A major goal of the Patient Protection and Affordable Care Act is reducing healthcare spending by shifting the focus of healthcare toward preventive care. Preventive services, including all FDA-approved contraception, must be provided to patients without cost-sharing under the ACA. No-cost contraception has been shown to increase uptake of highly effective birth control methods and reduce unintended pregnancy and abortion; however, some institutions and corporations argue that providing contraceptive coverage infringes on their religious beliefs. The contraceptive coverage mandate is evolving due to legal challenges, but it has already demonstrated success in reducing costs and improving access to contraception. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. INTERCONNECTIONS BETWEEN THE ECONOMIC STRUCTURE OF LOCAL SPENDING AND ECONOMIC GROWTH IN ROMANIA

    Directory of Open Access Journals (Sweden)

    Bilan Irina

    2015-07-01

    Full Text Available The issue of the effects of government interventions, explicitly of the taxes and expenditures of local public authorities, has generated substantial debate over time, and still gives rise to numerous controversies in theory and practice. Following the Keynesian path of reasoning, it is, at least theoretically, admitted that it is possible to influence the socio-economic activities and support for economic growth by means of government spending, but different other factors act towards enhancing or, on the contrary, impeding the achievement of the desired effects. From this point of view, the delimitation of competences and public expenditure responsibilities between different levels of government raises the issue of some possible different effects of the central and local governments’ interventions. As the macroeconomic stabilization function is usually associated with central governments, and the contribution of local governments often is of lesser importance, less attention is paid to the effectiveness of local administrative actions. In such a context, the paper aims to empirically evaluate the effects of the economic structure of local public expenditures on the local (territorial economic growth in Romania, over the period 2007 to 2012. The analysis has been conducted at the level of the 42 Romanian counties and on annual data collected from both international and national sources (World Bank, INSSE, The Romanian Ministry of Regional Development and Public Administration.The general method of estimation is the fixed effects estimation technique for panel data models. Our empirical approach is of absolute novelty, especially for Romania, where previous empirical studies have been focusing on the assessment of the overall effects of general government spending. The main findings of our study are that local public expenditures have a negative impact on territorial economic growth, confirmed both for overall expenditures and for various

  1. 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 ...

  2. 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

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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,

  10. 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.

  11. Domestic Price, (Expected) Foreign Price, and Travel Spending by Canadians in the United States

    OpenAIRE

    Jan Vilasuso; Fredric C. Menz

    1998-01-01

    In this paper, the authors develop and test a model to explain travel expenditures in the United States by Canadians. The model examines a consumer's choice problem where income is allocated between domestic and foreign consumption. Consumers do not know the foreign price level and base their spending in part on expected foreign price. In addition to expected foreign price, domestic price, exchange rates, income, and foreign price uncertainty influence travel spending. Empirically, each deter...

  12. Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital.

    Science.gov (United States)

    Konger, Raymond L; Ndekwe, Paul; Jones, Genea; Schmidt, Ronald P; Trey, Marty; Baty, Eric J; Wilhite, Denise; Munshi, Imtiaz A; Sutter, Bradley M; Rao, Maddamsetti; Bashir, Chowdry M

    2016-03-01

    To implement an electronic laboratory utilization management system (laboratory expert system [LES]) to provide safe and effective reductions in unnecessary clinical laboratory testing. The LES is a set of frequency filter subroutines within the Veterans Affairs hospital and laboratory information system that was formulated by an interdisciplinary medical team. Since implementing the LES, total test volume has decreased by a mean of 11.18% per year compared with our pre-LES test volume. This change was not attributable to fluctuations in outpatient visits or inpatient days of care. Laboratory cost savings were estimated at $151,184 and $163,751 for 2012 and 2013, respectively. A significant portion of these cost savings was attributable to reductions in high-volume, large panel testing. No adverse effects on patient care were reported, and mean length of stay for patients remained unchanged. Electronic laboratory utilization systems can effectively reduce unnecessary laboratory testing without compromising patient care. Published by Oxford University Press on behalf of the American Society for Clinical Pathology, 2016. This work is written by US Government employees and is in the public domain in the US.

  13. 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.

  14. 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.

  15. 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…

  16. 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

  17. 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

    The goal of universal health coverage (UHC) requires that families who get needed health care do not suffer financial hardship as a result. This can be measured by instances of impoverishment, when a household's consumption including out-of-pocket spending on health is more than the poverty line but its consumption, excluding out-of-pocket spending, is less than the poverty line. This links UHC directly to the policy goal of reducing poverty. We measure the incidence and depth of impoverishment as the difference in the poverty head count and poverty gap with and without out-of-pocket spending included in household total consumption. We use three poverty lines: the US$1·90 per day and $3·10 per day international poverty lines and a relative poverty line of 50% of median consumption per capita. We estimate impoverishment in 122 countries using 516 surveys between 1984 and 2015. We estimate the global incidence of impoverishment due to out-of-pocket payments by aggregating up from each country, using a survey for the year in question when available, and interpolation and model-based estimates otherwise. We do not derive global estimates to measure the depth of impoverishment but focus on the median depth for the 122 countries in our sample, accounting for 90% of the world's population. We find impoverishment due to out-of-pocket spending even in countries where the entire population is officially covered by a health insurance scheme or by national or subnational health services. Incidence is negatively correlated with the share of total health spending channelled through social security funds and other government agencies. Across countries, the population-weighted median annual rate of change of impoverishment is negative at the $1·90 per day poverty line but positive at the $3·10 per day and relative poverty lines. We estimate that at the $1·90 per day poverty line, the worldwide incidence of impoverishment decreased between 2000 and 2010, from 131 million

  18. 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.

  19. 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.

  20. 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

  1. 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

  2. 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

  3. 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

  4. 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.

  5. 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...

  6. 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...

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Semiconductor materials and their properties

    NARCIS (Netherlands)

    Reinders, Angelina H.M.E.; Verlinden, Pierre; van Sark, Wilfried; Freundlich, Alexandre; Reinders, Angele; Verlinden, Pierre; van Sark, Wilfried; Freundlich, Alexandre

    2017-01-01

    Semiconductor materials are the basic materials which are used in photovoltaic (PV) devices. This chapter introduces solid-state physics and semiconductor properties that are relevant to photovoltaics without spending too much time on unnecessary information. Usually atoms in the group of

  9. 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.

  10. COMPARING THE TREND BETWEEN SOUTH AFRICAN GOVERNMENT SPENDING AND THE INCREASE IN TAX REVENUE FOR THE COUNTRY’S TAXPAYERS

    OpenAIRE

    Jacobs, Lerike; Moolman, Anneke Maré

    2017-01-01

    Adam Smith provides guidance through the four Canons of Taxation to assist government to design a good tax system based on a set of principles. These principles are being applied throughout the world, as well as in South Africa. However, the South African government has been challenged to reduce income inequality and promote growth. This has led to an increase in government spending. Although literature provides information about governmental spending, spending patterns have not been in...

  11. Medical innovation laws: an unnecessary innovation.

    Science.gov (United States)

    Richards, Bernadette

    2016-06-01

    Objective This paper aims to demonstrate that any suggestion that there is a need for specific innovation laws is flawed. Innovation is central to good medical practice and is adequately supported by current law. Methods The paper reviews the nature of medical innovation and outlines recent attempts in the UK to introduce specific laws aimed at 'encouraging' and 'supporting' innovation. The current legal framework is outlined and the role of the law in relation to medical innovation explored. Results The analysis demonstrates the cyclic relationship between medical advancement and the law and concludes that there is no requirement for specific innovation laws. Conclusions The law not only supports innovation and development in medical treatment but encourages it as central to a functioning medical system. There is no need to introduce specific laws aimed at medical innovation; to do so represents an unnecessary legal innovation and serves to complicate matters. What is known about the topic? Over recent months, there has been a great deal of discussion surrounding the law in the context of medical innovation. This was driven by the attempts in the UK to introduce specific laws in the Medical Innovation Bill. The general subject matter - negligence and the expected standard of care in the provision of treatment - is very well understood, but not in cases where the treatment can be described as innovative. The general rhetoric in both the UK and Australia around the Medical Innovation Bill demonstrates a lack of understanding of the position of the law with regards to innovative treatment. What does this paper add? This paper adds clarity to the debate. It presents the law and explains the manner in which the law can operate around innovative treatment. The paper asserts that medical innovation is both supported and encouraged by existing legal principles. What are the implications for practitioners? The paper presents an argument that can guide the policy position

  12. Unnecessary antiretroviral treatment switches and accumulation of HIV resistance mutations; two arguments for viral load monitoring in Africa.

    Science.gov (United States)

    Sigaloff, Kim C E; Hamers, Raph L; Wallis, Carole L; Kityo, Cissy; Siwale, Margaret; Ive, Prudence; Botes, Mariette E; Mandaliya, Kishor; Wellington, Maureen; Osibogun, Akin; Stevens, Wendy S; van Vugt, Michèle; de Wit, Tobias F Rinke

    2011-09-01

    This study aimed to investigate the consequences of using clinicoimmunological criteria to detect antiretroviral treatment (ART) failure and guide regimen switches in HIV-infected adults in sub-Saharan Africa. Frequencies of unnecessary switches, patterns of HIV drug resistance, and risk factors for the accumulation of nucleoside reverse transcriptase inhibitor (NRTI)-associated mutations were evaluated. Cross-sectional analysis of adults switching ART regimens at 13 clinical sites in 6 African countries was performed. Two types of failure identification were compared: diagnosis of clinicoimmunological failure without viral load testing (CIF only) or CIF with local targeted viral load testing (targeted VL). After study enrollment, reference HIV RNA and genotype were determined retrospectively. Logistic regression assessed factors associated with multiple thymidine analogue mutations (TAMs) and NRTI cross-resistance (≥2 TAMs or Q151M or K65R/K70E). Of 250 patients with CIF switching to second-line ART, targeted VL was performed in 186. Unnecessary switch at reference HIV RNA <1000 copies per milliliter occurred in 46.9% of CIF only patients versus 12.4% of patients with targeted VL (P < 0.001). NRTI cross-resistance was observed in 48.0% of 183 specimens available for genotypic analysis, comprising ≥2 TAMs (37.7%), K65R (7.1%), K70E (3.3%), or Q151M (3.3%). The presence of NRTI cross-resistance was associated with the duration of ART exposure and zidovudine use. Clinicoimmunological monitoring without viral load testing resulted in frequent unnecessary regimen switches. Prolonged treatment failure was indicated by extensive NRTI cross-resistance. Access to virological monitoring should be expanded to prevent inappropriate switches, enable early failure detection and preserve second-line treatment options in Africa.

  13. 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...

  14. 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

  15. 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.

  16. 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.

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

    Science.gov (United States)

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

    2015-01-01

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

  18. 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.

  19. 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.

  20. 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

  1. 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

  2. The National Historic Preservation Act is Not Your Problem, But How You are Addressing it for Your CERCLA Project May Be - 12344

    Energy Technology Data Exchange (ETDEWEB)

    Cusick, Lesley T. [Restoration Services, Inc. (RSI), Oak Ridge, Tennessee (United States)

    2012-07-01

    The 1995 Environmental Protection Agency (EPA) and U.S. Department of Energy (DOE) joint 'Policy on Decommissioning of Department of Energy Facilities Under CERCLA was developed so that decommissioning could occur in a manner that ensures protection of worker and public health and the environment, that is consistent with Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), that provides for stakeholder involvement, and that achieves risk reduction without unnecessary delay'. The source of the 'unnecessary delays' the joint policy intended to avert could be attributed to numerous factors such as obtaining permits, conducting administrative activities, or implementing regulatory processes that could yield, among other things, differing preferred alternatives. Why, you might ask, more than fifteen years later, does DOE continue to struggle through CERCLA projects with unnecessary delays? From problem identification, to determination of nature and extent, to alternative analysis and ultimately remedy selection and implementation, reaching a compliant and effective clean-up end-point can be a process that seems to mimic geologic timescales. The source of these delays is often the failure to use all of the tools the CERCLA process offers. As one example, renewed commitment to follow the CERCLA process to address the regulatory reviews pursuant to the National Historic Preservation Act (NHPA) is called for. Project managers implementing CERCLA actions in any agency, not only DOE, do not need to be apprehensive about using the CERCLA process for NHPA review but should welcome it. It is critical that methods are used that address substantive NHPA requirements clearly and consistently, and that they are shared and communicated as frequently as needed to interested and questioning stakeholders. (author)

  3. 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 ...

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

    Directory of Open Access Journals (Sweden)

    Soyoung Kim

    2008-06-01

    Full Text Available This paper examines the effects of government spending shocks on the current account and the real exchange rate for 20 OECD countries using panel VAR model, in order to provide empirical stylized facts. The countries were grouped based on openness and size, and the influence of openness and size on the effects of government spending shocks. The main findings are as follows. First, in the analysis of all 20 countries, in response to government spending shocks, the worsening of the current account is significant, but real exchange rate appreciation is not significant. Second, real exchange rate appreciation is more significant and worsening of the current account is more temporary in the group of countries with higher openness than in those with low openness. Third, the worsening of the current account is more significant in the group of large countries than in the group of small countries. Although real exchange rate depreciation under fiscal expansion is not consistent with traditional theories, the results are broadly consistent with the existing theories that incorporate openness and the size of the country.

  5. 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…

  6. 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…

  7. 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 ...

  8. Are unnecessary follow-up procedures induced by computer-aided diagnosis (CAD) in mammography? Comparison of mammographic diagnosis with and without use of CAD

    International Nuclear Information System (INIS)

    Marx, Christiane; Malich, Ansgar; Facius, Mirjam; Grebenstein, Uta; Sauner, Dieter; Pfleiderer, Stefan O.R.; Kaiser, Werner A.

    2004-01-01

    Objective: To evaluate the rate of unnecessary follow-up procedures recommended by radiologists using a CAD-system. Materials and methods: 185 patients (740 images) were consecutively selected from three groups (36 histologically proven cancers=group 1; 49 histologically proven benign lesions=group 2 and 100 screening cases (4 years-follow up=group 3). Mammograms were evaluated by a CAD system (Second Look [reg] , CADx, Canada). Five blinded radiologists assessed the images without/with CAD outputs. Diagnostic decisions were ranked from surely benign to surely malignant according to BIRADS classification, follow-up procedures were recommended for each observed lesion (a, screening; b, short interval follow-up examination in 6 months; c, pathologic clarification). Results: CAD-system detected 32/36 cancers (88.9%) (FP-rate: 1.04 massmarks and 0.27 calcmarks/image). The following values were reached by all observers without/with CAD in the mean: Sensitivity 80.6/80.0%, specificity 83.2/86.4%, PPV 53.1/58.1%, and NPV 94.6/94.7%. Observers described a similar number of additional lesions without/with the use of CAD (325/326). Whereas the number of unnecessary short-time follow up recommendations increased in all case-subgroups with CAD: 40.8/42.9% (group 1), 35.6/38.1% (group 2), 44.7/46.8% (group 3), respectively, the number of recommended biopsies decreased in all subgroups: group 1: 34.7/27.1%; group 2: 47.4/41.5%, group 3: 33.3/22.0%, respectively. Conclusion: In this rather small population additional usage of CAD led to a lower rate of unnecessary biopsies. The observed decrease of recommended unnecessary biopsies due to the usage of CAD in the screening group suggests a potential financial benefit by using CAD as diagnostic aid

  9. 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.

  10. 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...

  11. 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

  12. 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…

  13. [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.

  14. 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

  15. 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...

  16. 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

  17. 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.

  18. 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.

  19. Reducing Young Adults' Health Care Spending through the ACA Expansion of Dependent Coverage.

    Science.gov (United States)

    Chen, Jie; Vargas-Bustamante, Arturo; Novak, Priscilla

    2017-10-01

    To estimate health care expenditure trends among young adults ages 19-25 before and after the 2010 implementation of the Affordable Care Act (ACA) provision that extended eligibility for dependent private health insurance coverage. Nationally representative Medical Expenditure Panel Survey data from 2008 to 2012. We conducted repeated cross-sectional analyses and employed a difference-in-differences quantile regression model to estimate health care expenditure trends among young adults ages 19-25 (the treatment group) and ages 27-29 (the control group). Our results show that the treatment group had 14 percent lower overall health care expenditures and 21 percent lower out-of-pocket payments compared with the control group in 2011-2012. The overall reduction in health care expenditures among young adults ages 19-25 in years 2011-2012 was more significant at the higher end of the health care expenditure distribution. Young adults ages 19-25 had significantly higher emergency department costs at the 10th percentile in 2011-2012. Differences in the trends of costs of private health insurance and doctor visits are not statistically significant. Increased health insurance enrollment as a consequence of the ACA provision for dependent coverage has successfully reduced spending and catastrophic expenditures, providing financial protections for young adults. © Health Research and Educational Trust.

  20. 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.

  1. 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

  2. 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.

  3. Childhood masturbation simulating epileptic seizures: A report of ...

    African Journals Online (AJOL)

    owner

    2013-03-01

    Mar 1, 2013 ... Childhood masturbation is re- garded as one of the paroxysmal, non-epileptic disorders in children, which incorporate several potential diagno- ses. Therefore, if not recognized, it could pose diagnos- tic difficulties, unnecessary investigative spending and considerable parental anxiety.3. There is paucity of ...

  4. 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...

  5. Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Lahaye, M.J.; Lambregts, D.M.J.; Mutsaers, E.; Beets-Tan, R.G.H. [Maastricht University Medical Centre, Department of Radiology, Maastricht (Netherlands); Essers, B.A.B. [Maastricht University Medical Centre, Department of Epidemiology and Medical Technology, Maastricht (Netherlands); Breukink, S.; Beets, G.L. [Maastricht University Medical Centre, Department of Surgery, Maastricht (Netherlands); Cappendijk, V.C. [Jeroen Bosch Hospital, Department of Radiology, ' s Hertogenbosch (Netherlands)

    2015-05-01

    To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 EUR from 2,482 to 1,888 EUR (CL:-1081; -143). Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. (orig.)

  6. 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

  7. 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…

  8. 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.

  9. 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.

  10. 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.

  11. 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)

  12. 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)

  13. France, Germany, Greece and the United Kingdom an analysis and comparison of budget deficits and defense spending

    OpenAIRE

    Schoettelndreyer, Friedrich.

    2011-01-01

    Approved for public release; distribution is unlimited. This thesis documents findings on the relationship of government budget deficits and defense spending for France, Germany, Greece, and the United Kingdom in detail and for NATO and OECD country collectives. The thesis topic is relevant, as many European countries are justifying their recent cuts in defense spending with high government budget deficits. The author looked at different data sources and metrics to graphically analyze the ...

  14. 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.

  15. 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

  16. The value of a poison control center in preventing unnecessary ED visits and hospital charges: A multi-year analysis.

    Science.gov (United States)

    Tak, Casey R; Malheiro, Marty C; Bennett, Heather K W; Crouch, Barbara I

    2017-03-01

    The purpose of this study is to determine the economic value of the Utah Poison Control Center (UPCC) by examining its contribution to the reduction of unnecessary emergency department (ED) visits and associated charges across multiple years. A multi-year (2009-2014) analysis of cross-sectional data was performed. Callers were asked what they would do for a poison emergency if the UPCC was not available. Healthcare charges for ED visits averted were calculated according to insurance status using charges obtained from a statewide database. Of the 10,656 survey attempts, 5018 were completed. Over 30,000 cases were managed on-site each year. Using the proportion of callers who noted they would call 911, visit an ED, or call a physician's office, between 20.0 and 24.2 thousand ED visits were potentially prevented each year of the survey. Between $16.6 and $24.4 million dollars in unnecessary healthcare charges were potentially averted annually. Compared to the cost of operation, the service UPCC provides demonstrates economic value by reducing ED visits and associated charges. As the majority of patients have private insurance, the largest benefit falls to private payers. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Tax Expert Offers Ideas for Monitoring Big Spending on College Sports

    Science.gov (United States)

    Sander, Libby

    2009-01-01

    The federal government could take a cue from its regulation of charitable organizations in monitoring the freewheeling fiscal habits of big-time college athletics, a leading tax lawyer says. The author reports on the ideas offered by John D. Colombo, a professor at the University of Illinois College of Law, for monitoring big spending on college…

  18. 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…

  19. Reply to: Mounting evidence indicates that escalating doses of allopurinol are unnecessary for cardiovascular protection.

    Science.gov (United States)

    Coburn, Brian W; Michaud, Kaleb; Bergman, Debra A; Mikuls, Ted R

    2018-05-08

    We thank Dr. Bredemeier for his comments regarding our manuscript on allopurinol dose escalation and mortality. He raises important evidence to consider in support of an interesting hypothesis that dose escalation may be unnecessary for allopurinol's cardiovascular (CV) protection and may actually be related to adverse CV outcomes. While we agree that evidence exists suggesting that low doses of allopurinol may be sufficient for CV protection, we believe that the studies cited highlight a number of areas where knowledge gaps remain which preclude any definitive conclusions about the effect of dose escalation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  20. 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

  1. 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

  2. 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.

  3. A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria.

    Science.gov (United States)

    Irfan, Neal; Brooks, Annie; Mithoowani, Siraj; Celetti, Steve J; Main, Cheryl; Mertz, Dominik

    2015-01-01

    Asymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice. To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU. Quasi-experimental study with a control group. Two tertiary teaching adult care hospitals. Consecutive patients with positive urine cultures between January 30th and April 17th, 2012 (baseline) and January 30th and April 30th, 2013 (intervention). In January 2013, a multifaceted educational intervention based on risk factors identified during the baseline period was provided to medical residents (monthly) on one clinical teaching unit (CTU) at one hospital site, with the CTU of the other hospital serving as the control. During the baseline period, 160/341 (46.9%) positive urine cultures were obtained from asymptomatic patients at the two hospitals, and 94/160 (58.8%) were inappropriately treated with antibiotics. Risk factors for inappropriate use included: female gender (OR 2.1, 95% CI 1.1-4.3), absence of a catheter (OR 2.5, 1.2-5), bacteriuria versus candiduria (OR 10.6, 3.8-29.4), pyuria (OR 2.0, 1.1-3.8), and positive nitrites (OR 2.2, 1.1-4.5). In 2013, only 2/24 (8%) of ABU patients were inappropriately treated on the intervention CTU as compared to 14/29 (52%) on the control CTU (OR 0.10; 95% CI 0.02-0.49). A reduction was also observed as compared to baseline on the intervention CTU (OR 0.1, 0.02-0.7) with no significant change noted on the control CTU (OR 0.47, 0.13-1.7). A multifaceted educational intervention geared towards medical residents with a focus on identified risk factors for inappropriate management of ABU was effective in reducing unnecessary antibiotic use.

  4. A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria.

    Directory of Open Access Journals (Sweden)

    Neal Irfan

    Full Text Available Asymptomatic bacteriuria (ABU should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice.To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU.Quasi-experimental study with a control group.Two tertiary teaching adult care hospitals.Consecutive patients with positive urine cultures between January 30th and April 17th, 2012 (baseline and January 30th and April 30th, 2013 (intervention.In January 2013, a multifaceted educational intervention based on risk factors identified during the baseline period was provided to medical residents (monthly on one clinical teaching unit (CTU at one hospital site, with the CTU of the other hospital serving as the control.During the baseline period, 160/341 (46.9% positive urine cultures were obtained from asymptomatic patients at the two hospitals, and 94/160 (58.8% were inappropriately treated with antibiotics. Risk factors for inappropriate use included: female gender (OR 2.1, 95% CI 1.1-4.3, absence of a catheter (OR 2.5, 1.2-5, bacteriuria versus candiduria (OR 10.6, 3.8-29.4, pyuria (OR 2.0, 1.1-3.8, and positive nitrites (OR 2.2, 1.1-4.5. In 2013, only 2/24 (8% of ABU patients were inappropriately treated on the intervention CTU as compared to 14/29 (52% on the control CTU (OR 0.10; 95% CI 0.02-0.49. A reduction was also observed as compared to baseline on the intervention CTU (OR 0.1, 0.02-0.7 with no significant change noted on the control CTU (OR 0.47, 0.13-1.7.A multifaceted educational intervention geared towards medical residents with a focus on identified risk factors for inappropriate management of ABU was effective in reducing unnecessary antibiotic use.

  5. Sutekina kurashi - Rückbesinnung auf Heim und Familie

    DEFF Research Database (Denmark)

    Platz, Anemone

    2009-01-01

    is the recent developments of the phenomenon of sugomori kazoku (homing family) that at first sight seems to be a direct consequence of the economic recession, obligating many people to spend more time at home than in times of economic stability in order to avoid unnecessary expenses. However, a second look...

  6. 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.

  7. 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.

  8. Taiwan experience suggests that RhD typing for blood transfusion is unnecessary in southeast Asian populations.

    Science.gov (United States)

    Lin, Marie

    2006-01-01

    The high frequency of RhD (D) antigen among Taiwanese persons (99.67%) often imposes unnecessary risks of under-transfusion on D- patients awaiting D- blood. Also because of the rare occurrence of anti-D among Taiwanese persons, routine pretransfusion D typing has been discontinued in the Mackay Memorial Hospital since 1988. This report is the retrospective evaluation of the outcome of abolishing RhD typing for Taiwanese. More than 10 years of alloantibody data at Mackay Memorial Hospital Blood Bank were reviewed. The cases with anti-D were further used to analyze the potency of D antigen and to observe whether there were differences in the incidence of anti-D before and after discontinuation of routine D typing among Taiwanese individuals. The incidence of anti-D before and after discontinuation of routine pretransfusion D typing has remained unchanged. The immunogenicity of D and "Mi(a)" in Taiwanese persons is found to be similar. In terms of opportunity for immunization, however, the "Mi(a)" antigen (phenotype frequency 7.3% in Taiwanese persons) has become the most important blood group antigen in Taiwan. The results strongly support the exclusion of D typing from routine compatibility testing for individuals of Taiwanese origin. Because the low incidence of D- and relatively high incidence of "Mi(a)"+ phenotypes are common findings throughout southeast Asia, and because a population genetic study revealed that the Taiwanese people are genetically related to southern Asian populations, it is suggested that RhD typing for blood transfusion is unnecessary among southeast Asian populations.

  9. A Consultation Phone Service for Patients With Total Joint Arthroplasty May Reduce Unnecessary Emergency Department Visits.

    Science.gov (United States)

    Hällfors, Eerik; Saku, Sami A; Mäkinen, Tatu J; Madanat, Rami

    2018-03-01

    Different measures for reducing costs after total joint arthroplasty (TJA) have gained attention lately. At our institution, a free-of-charge consultation phone service was initiated that targeted patients with TJA. This service aimed at reducing unnecessary emergency department (ED) visits and, thus, potentially improving the cost-effectiveness of TJAs. To our knowledge, a similar consultation service had not been described previously. We aimed at examining the rates and reasons for early postdischarge phone calls and evaluating the efficacy of this consultation service. During a 2-month period, we gathered information on every call received by the consultation phone service from patients with TJAs within 90 days of the index TJA procedure. Patients were followed for 2 weeks after making a call to detect major complications and self-initiated ED visits. Data were collected from electronic medical charts regarding age, gender, type of surgery, date of discharge, and length of hospital stay. We analyzed 288 phone calls. Calls were mostly related to medication (41%), wound complications (17%), and mobilization issues (15%). Most calls were resolved in the phone consultation. Few patients (13%) required further evaluation in the ED. The consultation service failed to detect the need for an ED visit in 2 cases (0.7%) that required further care. The consultation phone service clearly benefitted patients with TJAs. The service reduced the number of unnecessary ED visits and functioned well in detecting patients who required further care. Most postoperative concerns were related to prescribed medications, wound complications, and mobilization issues. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. 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

  11. Trial Manufacture and Evaluation of a Hologram with an unnecessary development process at 1.55 μm

    OpenAIRE

    大島, 茂

    2016-01-01

    A holographic optical element (HOE) for optical fiber coupling has been investigated. The hologram with an unnecessary development process has been manufactured at wavelength of 1.55μm. Diimonium organic dye was used for photosensitive material. Because diimonium organic dye did not stick to a plate glass, acrylic resin was used for binder resin. The thin film of the organic dye was exposed by improved equipment for high power light irradiation at wavelength of 1.55μm. The thin film became th...

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. 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)

  17. The role of parental health care utilization in children's unnecessary utilization in China: evidence from Shaanxi province.

    Science.gov (United States)

    Zhang, Yi; Zhou, Zhongliang; Si, Yafei

    2017-03-09

    China has a large population of children under 18 years of age, whose health is of great concern to the Chinese health care system. However, few studies have been conducted to analyze the factors associated with children's unnecessary health care utilization in China. The objective of this study is to provide some empirical evidence on this issue by investigating the role of parental health care utilization in children's unnecessary health care use. The data were obtained from the fifth Health Service Survey of Shaanxi province in 2013. We employed three dependent variables to measure children's health care utilization: the number of children's outpatient visits during the past 2 weeks, whether or not infusion was used if the child had any outpatient visits during the past 2 weeks, and the number of children's inpatient visits during last year. Based on specific characteristics of these outcome variables, negative binomial models were used for the non-negative numbers of outpatient and inpatient visits, while a probit model was used for the zero-one indicator variable showing whether infusion was used during outpatient visits. Based on a sample of 11,024 children, our results of multivariate analysis showed that children whose parents used outpatient care were estimated to have a larger number of outpatient visits than those whose parents did not have outpatient visits in the past 2 weeks (with a difference of 0.0393 visits). Among children having outpatient visits in the last 2 weeks, the probability of obtaining infusion was 57.01 percentage points higher for children whose parents used infusion in the past 2 weeks than the probability for those whose parents did not use infusion. The predicted number of inpatient visits was higher for children whose parents used inpatient services in the last year, compared with the group whose parents did not use (with a difference of 0.0567 visits). Moreover, we noted that the positive association between parental and

  18. 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

  19. 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...

  20. 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)

  1. 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...

  2. "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...

  3. 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.

  4. Health Care Spending in the United States and Other High-Income Countries.

    Science.gov (United States)

    Papanicolas, Irene; Woskie, Liana R; Jha, Ashish K

    2018-03-13

    Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs. To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) to gain insight into what the United States can learn from these nations. Analysis of data primarily from 2013-2016 from key international organizations including the Organisation for Economic Co-operation and Development (OECD), comparing underlying differences in structural features, types of health care and social spending, and performance between the United States and 10 high-income countries. When data were not available for a given country or more accurate country-level estimates were available from sources other than the OECD, country-specific data sources were used. In 2016, the US spent 17.8% of its gross domestic product on health care, and spending in the other countries ranged from 9.6% (Australia) to 12.4% (Switzerland). The proportion of the population with health insurance was 90% in the US, lower than the other countries (range, 99%-100%), and the US had the highest proportion of private health insurance (55.3%). For some determinants of health such as smoking, the US ranked second lowest of the countries (11.4% of the US population ≥15 years smokes daily; mean of all 11 countries, 16.6%), but the US had the highest percentage of adults who were overweight or obese at 70.1% (range for other countries, 23.8%-63.4%; mean of all 11 countries, 55.6%). Life expectancy in the US was the lowest of the 11 countries at 78.8 years (range for other countries, 80.7-83.9 years; mean of all 11 countries, 81.7 years), and infant

  5. 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.

  6. 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…

  7. 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."

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

    Science.gov (United States)

    Maslin, M. A.; Georgeson, L.

    2015-12-01

    Urban areas are increasingly at risk from climate change with negative impacts predicted for human health, the economy and ecosystems. These risks require responses from cities, to improve the resilience of their infrastructure, economy and environment to climate change. Policymakers need to understand what is already being spent on adaptation so that they can make more effective and comprehensive adaptation plans. Through the measurement of spend in the newly defined 'Adaptation Economy' we analysis the current efforts of 10 global megacities in adapting to climate change. These cities were chosen based on their size, geographical location and their developmental status. The cities are London, Paris, New York, Mexico City, Sao Paulo, Beijing, Mumbai, Jakarta, Lagos and Addis Ababa. It is important to study a range of cities in different regions of the world, with different climates and at different states of socio-economic development. While in economic terms, disaster losses from weather, climate and geophysical events are greater in developed countries, fatalities and economic losses as a proportion of GDP are higher in developing countries. In all cities examined the Adaptation Economy is still a small part of the overall economy accounting for a maximum of 0.3% of the Cities total GDP (GDPc). The differences in total spend are significant between cities in developed and rapidly emerging countries, compared to those in developing countries with a spend ranging from £16 million to £1,500 million. Comparing key sub sectors, we demonstrate that there are distinctive adaptation profiles with developing cities having a higher relative spend on health, while developed cities have a higher spend on disaster preparedness, ICT and professional services. Comparing spend per capita and as a percentage of GDPc demonstrates even more clearly disparities between the cities in the study; developing country cities spend half as much as a proportion of GPCc in some cases, and

  9. 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

  10. Promoting High-Value Practice by Reducing Unnecessary Transfusions With a Patient Blood Management Program.

    Science.gov (United States)

    Sadana, Divyajot; Pratzer, Ariella; Scher, Lauren J; Saag, Harry S; Adler, Nicole; Volpicelli, Frank M; Auron, Moises; Frank, Steven M

    2018-01-01

    Although blood transfusion is a lifesaving therapy for some patients, transfusion has been named 1 of the top 5 overused procedures in US hospitals. As unnecessary transfusions only increase risk and cost without providing benefit, improving transfusion practice is an effective way of promoting high-value care. Most high-quality clinical trials supporting a restrictive transfusion strategy have been published in the past 5 to 10 years, so the value of a successful patient blood management program has only recently been recognized. We review the most recent transfusion practice guidelines and the evidence supporting these guidelines. We also discuss several medical societies' Choosing Wisely campaigns to reduce or eliminate overuse of transfusions. A blueprint is presented for developing a patient blood management program, which includes discussion of specific methods for optimizing transfusion practice.

  11. 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

  12. 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.

  13. 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.

  14. Program spending to increase adherence: South African cervical cancer screening.

    Directory of Open Access Journals (Sweden)

    Jeremy D Goldhaber-Fiebert

    2009-05-01

    Full Text Available Adherence is crucial for public health program effectiveness, though the benefits of increasing adherence must ultimately be weighed against the associated costs. We sought to determine the relationship between investment in community health worker (CHW home visits and increased attendance at cervical cancer screening appointments in Cape Town, South Africa.We conducted an observational study of 5,258 CHW home visits made in 2003-4 as part of a community-based screening program. We estimated the functional relationship between spending on these visits and increased appointment attendance (adherence. Increased adherence was noted after each subsequent CHW visit. The costs of making the CHW visits was based on resource use including both personnel time and vehicle-related expenses valued in 2004 Rand. The CHW program cost R194,018, with 1,576 additional appointments attended. Adherence increased from 74% to 90%; 55% to 87%; 48% to 77%; and 56% to 80% for 6-, 12-, 24-, and 36-month appointments. Average per-woman costs increased by R14-R47. The majority of this increase occurred with the first 2 CHW visits (90%, 83%, 74%, and 77%; additional cost: R12-R26.We found that study data can be used for program planning, identifying spending levels that achieve adherence targets given budgetary constraints. The results, derived from a single disease program, are retrospective, and should be prospectively replicated.

  15. "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...

  16. 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.

  17. Implications of the 2017 Tax Cuts and Jobs Act for Public Health.

    Science.gov (United States)

    Glied, Sherry

    2018-03-22

    The recently passed Tax Cuts and Jobs Act will reduce total federal revenues by about 4% between 2018 and 2027. The law makes multiple changes to the taxation of individuals and corporations. It also repeals the Affordable Care Act's (ACA's) individual mandate penalties, which will erase some of the gains in insurance coverage achieved since implementation of the ACA's coverage expansions. The resulting increases in rates of uninsurance will likely lead to increased uncompensated care and deflect hospitals and health departments from addressing other prevention and public health needs. In addition, the law is expected to lead to substantial increases in the federal debt and, consequently, to calls for reductions in spending on entitlement programs, particularly Medicare, and on discretionary programs, including public health. Many other provisions of the law could also have second-order effects on public health. (Am J Public Health. Published online ahead of print March 22, 2018: e1-e3. doi:10.2105/AJPH.2018.304388).

  18. The Partnership Bill 2003: unnecessary tinkering or much-needed reform?

    OpenAIRE

    Berry, E

    2005-01-01

    Purpose - To examine the nature and merits of the proposed changes to partnership law contained in the draft Partnership Bill published in the Law Commission's Partnership Law Report (2003). Design/methodology/approach - Sets out how the proposed Bill differs from the current law of partnership (contained in the Partnership Act 1890 and the Limited Partnerships Act 1907), looking at the definition of 'partnership', the introduction of separate legal personality, the provisions governing partn...

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. The Goldwater Nichols Act of 1986: 30 Years of Acquisition Reform

    Science.gov (United States)

    2016-12-01

    helicopters failed to arrive at Desert One, the mission was aborted . While one helicopter was repositioning to a refuel point, it crashed into a C-130...unnecessary requirements and certifications,” another section 800 panel review to identify unnecessary acquisition legal requirements, and a study into the

  6. Psychology of Economics in the Analysis of Consumer Behavior

    Directory of Open Access Journals (Sweden)

    José Jonas Alves Correia

    2017-06-01

    Full Text Available Psychology of Economics addresses issues far beyond market research. Thus, studies in this area also observe variables such as work, unemployment, decisions about purchases and savings, investments, financing, responses to advertising, among others. The present research was carried out with the objective of analyzing, through the fundamentals of consumer behavior, its relation to the propensity for compulsive or superfluous consumption. This quantitative study relates, using as means of phenomena and variables a description of the consumers behavior through the statistical tool Propensity Score Matching of Stata software. A semi-structured questionnaire was used to collect the data, which was applied online from April to August in 2016. Data analysis was performed by the Ordinary Least Squares (OLS regression with controlled dummy variables (dependent variable, whether or not it belongs to the consumer group Compulsive by the set of explanatory (independent variables. The results showed that the average monthly spending of compulsive consumers increases, and the higher the income of individuals, the greater the spending on unnecessary or superfluous consumption. Considering the gender variable, male individuals have higher levels of unnecessary spending and are prone to superfluous consumption. Thus, consumption is composed of influences for purchase and that the consumer determines consumption, according to economic position (income factor and cultural factors (customs, needs, impulsivities within the society.

  7. 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

  8. Implementation of the 2011 Reimbursement Act in Poland: Desired and undesired effects of the changes in reimbursement policy.

    Science.gov (United States)

    Kawalec, Paweł; Sagan, Anna; Stawowczyk, Ewa; Kowalska-Bobko, Iwona; Mokrzycka, Anna

    2016-04-01

    The Act of 12 May 2011 on the Reimbursement of Medicines, Foodstuffs Intended for Particular Nutritional Uses and Medical Devices constitutes a major change of the reimbursement policy in Poland. The main aims of this Act were to rationalize the reimbursement policy and to reduce spending on reimbursed drugs. The Act seems to have met these goals: reimbursement policy (including pricing of reimbursed drugs) was overhauled and the expenditure of the National Health Fund on reimbursed drugs saw a significant decrease in the year following the Act's introduction. The annual savings achieved since then (mainly due to the introduction of risk sharing schemes), have made it possible to include new drugs into the reimbursement list and improve access to innovative drugs. However, at the same time, the decrease in prices of reimbursed drugs, that the Act brought about, led to an uncontrolled outflow of some of these drugs abroad and shortages in Poland. This paper analyses the main changes introduced by the Reimbursement Act and their implications. Since the Act came into force relatively recently, its full impact on the reimbursement policy is not yet possible to assess. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  9. 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.

  10. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

    International Nuclear Information System (INIS)

    Golding, Lauren P.; Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn; Gyr, Bettina M.; Gardner, Alison

    2015-01-01

    Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

  11. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

    Energy Technology Data Exchange (ETDEWEB)

    Golding, Lauren P. [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Triad Radiology Associates, Winston-Salem, NC (United States); Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Gyr, Bettina M. [Wake Forest University Baptist Health, Department of Orthopedic Surgery, Winston-Salem, NC (United States); Gardner, Alison [Wake Forest University Baptist Health, Department of Pediatric Emergency Medicine, Winston-Salem, NC (United States)

    2015-08-15

    Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

  12. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-09-11

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

  14. Treatment for Common Running/Walking Foot Injuries

    Science.gov (United States)

    McDaniel, Larry W.; Haar, Calin; Ihlers, Matt; Jackson, Allen; Gaudet, Laura

    2009-01-01

    Whether you are a weekend warrior or a serious athlete, most runners fear the possibility of being injured. For those who are physically active or stand on their feet all day, healthy feet are important Highly conditioned runners spend many hours performing foot maintenance to prevent unnecessary injuries. Some of the common foot injuries are:…

  15. Double-blind placebo-controlled food challenges in children with alleged cow's milk allergy: prevention of unnecessary elimination diets and determination of eliciting doses.

    Science.gov (United States)

    Dambacher, Wendy M; de Kort, Ellen H M; Blom, W Marty; Houben, Geert F; de Vries, Esther

    2013-02-08

    Children with cow's milk allergy (CMA) need a cow's milk protein (CMP) free diet to prevent allergic reactions. For this, reliable allergy-information on the label of food products is essential to avoid products containing the allergen. On the other hand, both overzealous labeling and misdiagnosis that result in unnecessary elimination diets, can lead to potentially hazardous health situations. Our objective was to evaluate if excluding CMA by double-blind placebo-controlled food challenge (DBPCFC) prevents unnecessary elimination diets in the long term. Secondly, to determine the minimum eliciting dose (MED) for an acute allergic reaction to CMP in DBPCFC positive children. All children with suspected CMA under our care (Oct'05-Jun'09) were prospectively enrolled in a DBPCFC. Placebo and verum feedings were administered on two randomly assigned separate days. The MED was determined by noting the 'lowest observed adverse effect level' (LOAEL) in DBPCFC-positive children. Based on the outcomes of the DBPCFC a dietary advice was given. Parents were contacted by phone several months later about the diet of their child. 116 children were available for analysis. In 76 children CMA was rejected. In 60 of them CMP was successfully reintroduced, in 2 the parents refused introduction, in another 3 the parents stopped reintroduction. In 9 children CMA symptoms reappeared. In 40 children CMA was confirmed. Infants aged ≤ 12 months in our study group have a higher cumulative distribution of MED than older children. Excluding CMA by DBPCFC successfully stopped unnecessary elimination diets in the long term in most children. The MEDs form potential useful information for offering dietary advice to patients and their caretakers.

  16. Government observations on the 7. report from the Committee (Session 1989-90) on the Department of Energy's spending plans, 1990-91

    International Nuclear Information System (INIS)

    1990-01-01

    The House of Commons Energy Committee recently reported in the Department of Energy's spending plans for 1990-91. This Memorandum represents the Government's response to their recommendations. A review of the structure and size of research and development expenditure is anticipated. Research should focus on pollution reduced coal-based electricity generation and wave energy provided prospects prove sufficiently promising. The reasons for the closure of the Winfrith Reactor are outlined. Fusion power is seen as expensive, too long term and unlikely to be economically viable, but the Joint European Torus (JET) programme will be supported until 1996. Cost of decommissioning JET are a cause for concern. Nuclear Electric is deemed to be acting too slowly in setting proper financial targets. No change is envisaged in the Government's arrangements to fund overseas atomic energy programmes in collaboration with the International Atomic Energy Authority. The costs of publicity promoting civilian nuclear programmes is seen as too high. (author)

  17. 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.

  18. 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.

  19. 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.

  20. Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.

    Science.gov (United States)

    Jacobs, Jac J W M; Jacobs, Jan P A M; van Sonderen, Eric; van der Molen, Thys; Sanderman, Robbert

    2015-05-06

    Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands. In a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital. A total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77. Since the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital.

  1. 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.

  2. 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.

  3. 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

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

    Science.gov (United States)

    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.

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. Wearing the crown of Solomon? Chief Justice Roberts and the Affordable Care Act "tax".

    Science.gov (United States)

    Muise, Robert J; Yerushalmi, David

    2013-04-01

    Attempting to play the role of King Solomon in his PPACA decision, Chief Justice John Roberts split the baby perversely by ruling it was not a tax under the Anti-Injunction Act, which would have likely deprived the Court of jurisdiction to hear this pre-enforcement challenge to the individual mandate, but it was a tax for taxing and spending purposes even though Congress said it was a "penalty" and not a tax. And the Chief Justice had to twist further his "wisdom" to hold that it was not an unconstitutional direct tax, even though that is exactly what it is, if it is a tax in the first instance.

  11. 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...

  12. 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.).

  13. 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.

  14. 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....

  15. A simple classification system (the Tree flowchart) for breast MRI can reduce the number of unnecessary biopsies in MRI-only lesions

    Energy Technology Data Exchange (ETDEWEB)

    Woitek, Ramona; Spick, Claudio; Schernthaner, Melanie; Kapetas, Panagiotis; Bernathova, Maria; Furtner, Julia; Pinker, Katja; Helbich, Thomas H.; Baltzer, Pascal A.T. [Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Rudas, Margaretha [Medical University of Vienna, Clinical Institute of Pathology, Vienna (Austria)

    2017-09-15

    To assess whether using the Tree flowchart obviates unnecessary magnetic resonance imaging (MRI)-guided biopsies in breast lesions only visible on MRI. This retrospective IRB-approved study evaluated consecutive suspicious (BI-RADS 4) breast lesions only visible on MRI that were referred to our institution for MRI-guided biopsy. All lesions were evaluated according to the Tree flowchart for breast MRI by experienced readers. The Tree flowchart is a decision rule that assigns levels of suspicion to specific combinations of diagnostic criteria. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. To assess reproducibility by kappa statistics, a second reader rated a subset of 82 patients. There were 454 patients with 469 histopathologically verified lesions included (98 malignant, 371 benign lesions). The area under the curve (AUC) of the Tree flowchart was 0.873 (95% CI: 0.839-0.901). The inter-reader agreement was almost perfect (kappa: 0.944; 95% CI 0.889-0.998). ROC analysis revealed exclusively benign lesions if the Tree node was ≤2, potentially avoiding unnecessary biopsies in 103 cases (27.8%). Using the Tree flowchart in breast lesions only visible on MRI, more than 25% of biopsies could be avoided without missing any breast cancer. (orig.)

  16. 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.

  17. 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.

  18. 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

  19. 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.

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

    Science.gov (United States)

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

    2013-01-01

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

  1. 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...

  2. 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

  3. 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…

  4. 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...

  5. 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.

  6. 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...

  7. Pre-procedural scout radiographs are unnecessary for routine pediatric fluoroscopic examinations

    Energy Technology Data Exchange (ETDEWEB)

    Creeden, Sean G.; Rao, Anil G.; Eklund, Meryle J.; Hill, Jeanne G.; Thacker, Paul G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2017-03-15

    Although practice patterns vary, scout radiographs are often routinely performed with pediatric fluoroscopic studies. However few studies have evaluated their utility in routine pediatric fluoroscopy. To evaluate the value of scout abdomen radiographs in routine barium or water-soluble enema, upper gastrointestinal (GI) series, and voiding cystourethrogram pediatric fluoroscopic procedures. We retrospectively evaluated 723 barium or water-soluble enema, upper GI series, and voiding cystourethrogram fluoroscopic procedures performed at our institution. We assessed patient history and demographics, clinical indication for the examination, prior imaging findings and impressions, scout radiograph findings, additional findings provided by the scout radiograph that were previously unknown, and whether the scout radiograph contributed any findings that significantly changed management. We retrospectively evaluated 723 fluoroscopic studies (368 males and 355 females) in pediatric patients. Of these, 700 (96.8%) had a preliminary scout radiograph. Twenty-three (3.2%) had a same-day radiograph substituted as a scout radiograph. Preliminary scout abdomen radiographs/same-day radiographs showed no new significant findings in 719 (99.4%) studies. New but clinically insignificant findings were seen in 4 (0.6%) studies and included umbilical hernia, inguinal hernia and hip dysplasia. No findings were found on the scout radiographs that would either alter the examination performed or change management with regard to the exam. Pre-procedural scout abdomen radiographs are unnecessary in routine barium and water-soluble enema, upper GI series, and voiding cystourethrogram pediatric fluoroscopic procedures and can be substituted with a spot fluoroscopic last-image hold. (orig.)

  8. Tracking unnecessary negative urinalyses to reduce healthcare costs: a transversal study.

    Science.gov (United States)

    Malmartel, A; Dutron, M; Ghasarossian, C

    2017-09-01

    About 7 million urinalyses are reimbursed yearly by the French public healthcare system, but the results of most of these tests are normal. The aim of this study was to estimate the prevalence of negative urinalyses in ambulatory care, identify the associated factors and assess the relevance of prescriptions by general practitioners (GPs) according to French guidelines. A cross-sectional study was conducted in patients over 18 coming for urinalyses in two French ambulatory laboratories. Patients received a questionnaire on their symptoms, the reason for performing urinalysis and the use of urinary dipsticks. GP who prescribed urinalyses received a questionnaire assessing their practice. A total of 510 patients were included, and 71% of urinalyses were negative. Urinalyses were prescribed to 283 patients by GPs. Compared to those of specialists, GP prescriptions were associated with fewer negative urinalyses (59 vs 86%; p GPs, the reasons of prescription were as follows: suspected urinary tract infection (UTI) (42.7%), control of bacteriological cure after UTI (24%), fever or abdominal pain (13%) and routine test (7%). About 35% of urinalyses were not indicated according to guidelines. Only 12% of patients used dipsticks before performing urinalysis although 87% of GPs were favourable to their use if they were provided by healthcare services. The annual cost of non-indicated urinalyses is estimated at 13 million euro. A systematic use of dipsticks provided by healthcare services could help to reduce health costs and the unnecessary use of antibiotics.

  9. 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

  10. 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.

  11. Deciphering the Sunshine Act: Transparency Regulation and Financial Conflicts in Health Care.

    Science.gov (United States)

    Saver, Richard S

    2017-11-01

    industry spending directed at individual physicians and their prescribing and referral decisions. Moreover, savvy counsel are recognizing that Sunshine Act information provides explosive evidence in private civil litigation and this Article explores the first wave of cases.

  12. Granger Causality and National Procurement Spending: Applications to the CC130 Hercules Fleet Performance

    Science.gov (United States)

    2011-09-01

    intentionally left blank. ii DRDC CORA TM 2011-154 Dr aft Co py Executive summary Granger Causality and National Procurement Spending David W...à croire que la chaîne d’approvisionnement sous jacente est optimale - la résistance aux chocs de dépenses peut simplement s’expliquer par des stocks...i Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii Sommaire

  13. 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.

  14. 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

  15. [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

  16. The VA mission act: Funding to fail?

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2018-06-01

    Full Text Available No abstract available. Article truncated after 150 words. Yesterday on D-Day, the 74th anniversary of the invasion of Normandy, President Trump signed the VA Mission Act. The law directs the VA to combine a number of existing private-care programs, including the so-called Choice program, which was created in 2014 after veterans died waiting for appointments at the Phoenix VA (1. During the signing Trump touted the new law saying “there has never been anything like this in the history of the VA” and saying that veterans “can go right outside [the VA] to a private doctor”-but can they? Although the bill authorizes private care, it appropriates no money to pay for it. Although a bipartisan plan to fund the expansion is proposed in the House, the White House has been lobbying Republicans to vote the plan down (2. Instead Trump has been asking Congress to pay for veteran’s programs by cutting spending elsewhere (2. We in Arizona are …

  17. Inappropriately Timed Pediatric Orthopaedic Referrals From the Emergency Department Result in Unnecessary Appointments and Financial Burden for Patients.

    Science.gov (United States)

    Jackson, Taylor J; Blumberg, Todd J; Shah, Apurva S; Sankar, Wudbhav N

    2018-03-01

    Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system. We performed a retrospective review of pediatric patients with acute musculoskeletal injuries referred from our ED (without a formal orthopaedic consult) to our outpatient clinic. Patients were retrospectively reviewed in a consecutive fashion. The appropriateness of the recommended follow-up time interval was determined for each patient, and the direct and indirect cost of the inappropriate services were calculated utilizing a combination of traditional cost accounting techniques and time-driven activity-based costing. The characteristics of patients with appropriate and untimely follow-up referrals were compared. Two hundred consecutive referrals from the ED were reviewed. Overall, 96.5% of the follow-up visits recommended by the ED were premature, which led 106 (53%) patients to require a second visit to complete their clinical care. Patients who required a second visit were significantly younger (P=0.005), more likely to be male (P=0.042), more likely to have a fracture (Pcost of $342.93 per patient. Untimely referrals for follow-up of acute pediatric musculoskeletal conditions are very common and represent a significant financial burden to patients, families, and the health care system. Over 40% of unnecessary visits resulted from just 3 diagnoses. Improved orthopaedic follow-up guidelines, particularly for these readily recognizable conditions, and feedback to referring providers may reduce poorly timed clinic visits and decrease costs in

  18. The affordable care act and long-term care: comprehensive reform or just tinkering around the edges?

    Science.gov (United States)

    Miller, Edward Alan

    2012-01-01

    The Patient Protection and Affordable Care Act (ACA) includes several provisions that aim to improve prevailing deficiencies in the nation's long-term care system. But just how effective is the ACA likely to be in addressing these challenges? Will it result in meaningful or marginal reform? This special issue of Journal of Aging & Social Policy seeks to answer these questions. The most prominent long-term care provision is the now-suspended Community Living Assistance Services and Supports Act. Others include incentives and options for expanding home- and community-based care, a number of research and demonstration projects in the areas of chronic care coordination and the dually eligible, and nursing home quality reforms. There are also elements that seek to improve workforce recruitment and retention, in addition to benefit improvements and spending reductions under Medicare. This article reviews the basic problems plaguing the long-term care sector and the provisions within the ACA meant to address them. It also includes a brief overview of issue content.

  19. New Mexican taxes to transform Pemex capital spending strategy

    International Nuclear Information System (INIS)

    Anon.

    1994-01-01

    Mexico's government this year will introduce petroleum tax reforms that will transform how its state owned petroleum company approaches capital spending. Effective Jan. 1, 1994, the Mexican government began to implement a revamped tax regime designed to accompany the breakup of Petroleos Mexicanos into four new operating subsidiaries. Each of the four new companies -- Pemex Exploration and Production, Pemex Refining, Pemex Natural Gas and Basic Petrochemicals, and Pemex Secondary Petrochemicals -- will be responsible for paying a new income tax. Levies on E and P will be tied to a ring-fence mechanism tailored after the scheme employed by the U.K. and Norwegian governments in the North Sea. The paper discusses the affected investment rationale, the North Sea ring-fence model, other tax changes, and shifting the burden

  20. A time series analysis of macroeconomic determinants of household spending in the era of cross-cultural dynamics: Czech Republic as a case study

    OpenAIRE

    Verter, Nahanga; Osakwe, Christian Nedu

    2014-01-01

    The paper investigates selected macroeconomic variables where are seemingly influencing household spending in the Republic in the present era of evolving cross-cultural interactions from 1993-2012. Based on the estimated regression model, it plausible to state that net disposable income, cross-cultural dynamics, inflation rate, and saving rate as a proportion of household income impact significantly on household spending. Moreover, the Granger causality analysis provides evidence of feedback ...

  1. 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

    The population in Sub Saharan Africa (SSA) suffers poor health as manifested in high mortality rates and low life expectancy. Economic growth has consistently been shown to be a major determinant of health outcomes. However, even with good economic growth rates, it is not possible to achieve desired improvements in health outcomes. Public spending on health (PSH) has long been viewed as a potential complement to economic growth in improving health. However, the relationship between PSH and health outcomes is inconclusive and this inconclusiveness may, in part, be explained by governance-related factors which mediate the impact of the former on the latter. Little empirical work has been done in this regard on SSA. This paper investigates whether or not the quality of governance (QoG) has a modifying effect on the impact of public health spending on health outcomes, measured by under-five mortality (U5M) and life expectancy at birth (LE), in SSA. Using two staged least squares regression technique on panel data from 43 countries in SSA over the period 1996-2011, we estimated the effect of public spending on health and quality of governance U5M and LE, controlling for GDP per capita and other socio-economic factors. We also interacted PSH and QoG to find out if the latter has a modifying effect on the former's impact on U5M and LE. Public spending on health has a statistically significant impact in improving health outcomes. Its direct elasticity with respect to under-five mortality is between -0.09 and -0.11 while its semi-elasticity with respect to life expectancy is between 0.35 and 0.60. Allowing for indirect effect of PSH spending via interaction with quality of governance, we find that an improvement in QoG enhances the overall impact of PSH. In countries with higher quality of governance, the overall elasticity of PSH with respect to under-five mortality is between -0.17 and -0.19 while in countries with lower quality of governance, it is about -0.09. The

  2. 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, ...

  3. Segmenting consumers based on how they spend a tax rebate: An analysis of the Australian stimulus payment

    NARCIS (Netherlands)

    Oppewal, H.; Paas, L.J.; Crouch, G.I.; Huybers, T.

    2010-01-01

    Tax rebates are instruments for stimulating consumer spending during recessions. Previous research assessed whether consumers use tax rebates for saving or, alternatively, purchasing goods and services. These studies concentrated on aggregate estimations. Based on the saving motive hierarchy

  4. 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

  5. Type I error probability spending for post-market drug and vaccine safety surveillance with binomial data.

    Science.gov (United States)

    Silva, Ivair R

    2018-01-15

    Type I error probability spending functions are commonly used for designing sequential analysis of binomial data in clinical trials, but it is also quickly emerging for near-continuous sequential analysis of post-market drug and vaccine safety surveillance. It is well known that, for clinical trials, when the null hypothesis is not rejected, it is still important to minimize the sample size. Unlike in post-market drug and vaccine safety surveillance, that is not important. In post-market safety surveillance, specially when the surveillance involves identification of potential signals, the meaningful statistical performance measure to be minimized is the expected sample size when the null hypothesis is rejected. The present paper shows that, instead of the convex Type I error spending shape conventionally used in clinical trials, a concave shape is more indicated for post-market drug and vaccine safety surveillance. This is shown for both, continuous and group sequential analysis. Copyright © 2017 John Wiley & Sons, Ltd.

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

    Science.gov (United States)

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

    2016-10-06

    Chinese consumers' spending has been expanding rapidly in the past decade, and along with it household and credit card debt. The present research collected evidence to triangulate the contention that materialism is positively related with Chinese's problem spending tendency (PST), and that present-time-perspective (PTP) and future-time perspectives (FTP) interact systematically with materialism to affect PST. A survey of the general population in Macao, China (Study 1; N = 239) confirmed that materialism was positively correlated with PST. An interaction between materialism and PTP intensified the relationship, whereas an interaction with FTP weakened the relationship. Another survey with a sample of university students (Study 2; N = 223) again found positive relationships among PST, materialism, and PTP, as measured by temporal discount rate. But further exploration showed that PST was only related with temporal discounting among high materialists, but not among low materialists. Study 3 experimentally examined the causal effects of materialism and FTP on PST. When being primed of an orientation towards materialism (n = 33), the participants' planned consumption doubled that of the control group (n = 31). A FTP prime interacted with materialism prime and put a "damper" on participants' planned spending (n = 29), compared to their counterparts who were not primed of such a time perspective. © 2016 International Union of Psychological Science.

  7. Routine preoperative blood group and save testing is unnecessary for elective laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Tandon, A.; Shahzad, K.; Nunes, Q.; Shrotri, M.; Lunevicius, R.

    2017-01-01

    Background: Although the practice of preoperative testing of ABO group and Rh (D) type for elective cholecystectomy has deep historical roots, it is not evidence-based. We aimed to assess the preoperative blood group and save testing practice for a cohort of patients subjected to elective laparoscopic cholecystectomy for symptomatic cholecystolithiasis between January 2010 and October 2014. Methods: National Health Service (NHS) hospital based, surgical procedure-specific, retrospective study was conducted. A final group consisted of 2,079 adult patients. We estimated the incidence of perioperative blood transfusion attributable to laparoscopic cholecystectomy. The results of eight other studies are presented. Results: A preoperative blood group and save test was performed in 907 patients (43.6%), whereas cross-matching was documented in 28 patients (3.1%). None required an intraoperative blood transfusion. Twelve patients (0.58%) underwent blood transfusion postoperatively following laparoscopic cholecystectomy, of which ten were transfused due to severe intra-abdominal bleeding (0.48%). There were no deaths. Conclusions: The likelihood of blood transfusion attributable to elective laparoscopic cholecystectomy is 1:200. A routine preoperative blood group and save testing is unnecessary. It neither alters the management of severe hypovolemia, secondary to perioperative bleeding, nor does it lead to better outcomes. (author)

  8. The danger of engagement: Behavioral observations of online community activity and service spending in the online gaming

    NARCIS (Netherlands)

    Kaptein, M.C.; Parvinen, P.; Pöyri, E.

    2015-01-01

    Research indicates that customer engagement in online communities has positive effects on related businesses, and that, on an aggregated level, community activity and service spending are positively related. Therefore, marketing efforts tend to focus on promoting the community activity of customers.

  9. Intelligence Spending: Public Disclosure Issues

    Science.gov (United States)

    2007-02-15

    Intelligence Act, 50 U.S.C. § 403g (1976).57 The plaintiff argued that application of these statutes under the FOIA exemption was violative of the...expenses incurred by the Committee in sending out its “ agents ”.61 When the Committee received information from Arthur Lee, one of its agents , regarding

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

    Science.gov (United States)

    Arnold, Denis G; Troyer, Jennifer L

    2016-04-01

    The pharmaceutical industry has been criticized for developing and aggressively marketing drugs that do not provide significant health benefits relative to existing drugs but retain the benefits of patent protection. Critics argue that drug marketing increases health care expenditures and provides a disincentive for pioneering drug innovation. However, evidence that marketing expenditures have any relationship to new drug approvals has been anecdotal. We hypothesized that, at publicly traded pharmaceutical firms, increased marketing expenditures will result in a reduced volume of pioneering new drugs in comparison to less innovative new drugs. We also hypothesized that additional research and development spending will result in an increased volume of pioneering new drugs in comparison to less innovative drugs. Results confirm our hypotheses. Specific policy recommendations for altering firms' incentives for the development of pioneering drugs are provided. Copyright © 2016 by Duke University Press.

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

    Directory of Open Access Journals (Sweden)

    Vidhi Thakkar

    2017-11-01

    Full Text Available Health services and policy research (HSPR represent a multidisciplinary field which integrates knowledge from health economics, health policy, health technology assessment, epidemiology, political science among other fields, to evaluate decisions in health service delivery. Health service decisions are informed by evidence at the clinical, organizational, and policy level, levels with distinct, managerial drivers. HSPR has an evolving discourse spanning knowledge translation, linkage and exchange between research and decision-maker partners and more recently, implementation science and learning health systems. Local context is important for HSPR and is important in advancing health reform practice. The amounts and configuration of national investment in this field remain important considerations which reflect priority investment areas. The priorities set within this field or research may have greater or lesser effects and promise with respect to modernizing health services in pursuit of better value and better population outcomes. Within Canada an asset map for HSPR was published by the national HSPR research institute. Having estimated publiclyfunded research spending in Canada, we sought identify best available comparable estimates from the United States and the United Kingdom. Investments from industry and charitable organizations were not included in these numbers. This commentary explores spending by the United States, Canada, and the United Kingdom on HSPR as a fraction of total public spending on health and the importance of these respective investments in advancing health service performance. Proposals are offered on the merits of common nomenclature and accounting for areas of investigation in pursuit of some comparable way of assessing priority HSPR investments and suggestions for earmarking such investments to total investment in health services spending.

  12. Measuring transparency in public spending: Case of Czech public e-procurement information system

    OpenAIRE

    Chvalkovská, Jana; Skuhrovec, Jiří

    2010-01-01

    The objective of this paper is to analyze the potential of e-Government tools to enable the general public to oversee spending of public institutions. The paper illustrates the “watchdog” potential of reducing corruption by means of providing information to the public on the example of the Czech Public e-Procurement Information System (further called System). The System is an Internet portal, where public authorities announce their intention to purchase goods and services. Such announcements ...

  13. Scaling cost-sharing to wages: how employers can reduce health spending and provide greater economic security.

    Science.gov (United States)

    Robertson, Christopher T

    2014-01-01

    In the employer-sponsored insurance market that covers most Americans; many workers are "underinsured." The evidence shows onerous out-of-pocket payments causing them to forgo needed care, miss work, and fall into bankruptcies and foreclosures. Nonetheless, many higher-paid workers are "overinsured": the evidence shows that in this domain, surplus insurance stimulates spending and price inflation without improving health. Employers can solve these problems together by scaling cost-sharing to wages. This reform would make insurance better protect against risk and guarantee access to care, while maintaining or even reducing insurance premiums. Yet, there are legal obstacles to scaled cost-sharing. The group-based nature of employer health insurance, reinforced by federal law, makes it difficult for scaling to be achieved through individual choices. The Affordable Care Act's (ACA) "essential coverage" mandate also caps cost-sharing even for wealthy workers that need no such cap. Additionally, there is a tax distortion in favor of highly paid workers purchasing healthcare through insurance rather than out-of-pocket. These problems are all surmountable. In particular, the ACA has expanded the applicability of an unenforced employee-benefits rule that prohibits "discrimination" in favor of highly compensated workers. A novel analysis shows that this statute gives the Internal Revenue Service the authority to require scaling and to thereby eliminate the current inequities and inefficiencies caused by the tax distortion. The promise is smarter insurance for over 150 million Americans.

  14. The Growth Effects of R&D Spending in the EU

    DEFF Research Database (Denmark)

    Kokko, Ari; Tingvall, Patrik Gustavsson; Videnord, Josefin

    private sector investment in R&D and stronger public-private sector linkages than in the EU. Hence, to reduce the “innovation gap” vis-à-vis the US, it may not be enough for the EU to raise the share of R&D expenditures in GDP: continuous improvements in the European innovation system will also be needed......, with focus on areas like private sector R&D and public-private sector linkages.......In this paper we conduct a meta-analysis to examine the link between R&D spending and economic growth in the EU and other regions. The results suggest that the growth-enhancing effect of R&D in the EU15 countries does not differ from that in other countries in general, but it is less significant...

  15. The Growth Effects of R&D Spending in the EU

    DEFF Research Database (Denmark)

    Kokko, Ari; Tingvall, Patrik Gustavsson; Videnord, Josefin

    2015-01-01

    private sector investment in R&D and stronger public-private sector linkages than in the EU. Hence, to reduce the “innovation gap” vis-à-vis the US, it may not be enough for the EU to raise the share of R&D expenditures in GDP: continuous improvements in the European innovation system will also be needed......, with focus on areas like private sector R&D and public-private sector linkages.......In this paper we conduct a meta-analysis to examine the link between R&D spending and economic growth in the EU and other regions. The results suggest that the growth-enhancing effect of R&D in the EU15 countries does not differ from that in other countries in general, but it is less significant...

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

    Directory of Open Access Journals (Sweden)

    Mirjana Pejić Bach

    2014-03-01

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

  17. Better Patient Care At High-Quality Hospitals May Save Medicare Money And Bolster Episode-Based Payment Models.

    Science.gov (United States)

    Tsai, Thomas C; Greaves, Felix; Zheng, Jie; Orav, E John; Zinner, Michael J; Jha, Ashish K

    2016-09-01

    US policy makers are making efforts to simultaneously improve the quality of and reduce spending on health care through alternative payment models such as bundled payment. Bundled payment models are predicated on the theory that aligning financial incentives for all providers across an episode of care will lower health care spending while improving quality. Whether this is true remains unknown. Using national Medicare fee-for-service claims for the period 2011-12 and data on hospital quality, we evaluated how thirty- and ninety-day episode-based spending were related to two validated measures of surgical quality-patient satisfaction and surgical mortality. We found that patients who had major surgery at high-quality hospitals cost Medicare less than those who had surgery at low-quality institutions, for both thirty- and ninety-day periods. The difference in Medicare spending between low- and high-quality hospitals was driven primarily by postacute care, which accounted for 59.5 percent of the difference in thirty-day episode spending, and readmissions, which accounted for 19.9 percent. These findings suggest that efforts to achieve value through bundled payment should focus on improving care at low-quality hospitals and reducing unnecessary use of postacute care. Project HOPE—The People-to-People Health Foundation, Inc.

  18. 3 CFR - Ensuring Responsible Spending of Recovery Act Funds

    Science.gov (United States)

    2010-01-01

    ... long-term public benefits by, for example, investing in technological advances in science and health to... protection, and other infrastructure that will provide long-term economic benefits; fostering energy..., aquarium, zoo, golf course, or swimming pool.” (b) In exercising their available discretion to commit...

  19. 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.

  20. France acts on electronic cigarettes.

    Science.gov (United States)

    Cahn, Zachary

    2013-11-01

    France is deciding how to regulate electronic cigarettes. I first consider the French approach and how it contrasts with other attempts at electronic cigarette regulation globally. Next, I critique the individual elements of the French proposal. The overall approach taken by France is a positive development, but banning indoor use appears unnecessary and banning advertising may be counterproductive.

  1. A comparison of laws preventing unnecessary canine cosmetic surgery in Italy and in the Czech Republic

    Directory of Open Access Journals (Sweden)

    Valeria Quartarone

    2012-01-01

    Full Text Available Many invasive procedures, including surgery (ear cropping, tail docking, and debarking in the dog, are performed on dogs for purely cosmetic reasons or convenience. These procedures, also known as “cosmetic surgery”, fall into a variety of categories from the questionably unethical to the undoubtedly criminal, because they are mostly carried out solely to alter a dog’s physical appearance. Although in several European countries these procedures are banned, except when performed by a veterinarian for medical reasons, veterinarians are often requested to perform them for various reasons. Though controversial, canine cosmetic surgery continues to be performed, reaching epidemic proportions. The authors summarize legislation, individual positions and veterinary attitudes regarding cosmetic surgery in Italy and the Czech Republic. Additionally, they explain the ways in which the law is being used in the two countries to prevent these unnecessary procedures, and how current and future anti-cruelty laws can stop unethical use of cosmetic surgery.

  2. Cash transfers for HIV prevention: what do young women spend it on? Mixed methods findings from HPTN 068

    Directory of Open Access Journals (Sweden)

    Catherine MacPhail

    2017-07-01

    Full Text Available Abstract Background Social grants have been found to have an impact on health and wellbeing in multiple settings. Who receives the grant, however, has been the subject of discussion with regards to how the money is spent and who benefits from the grant. Methods Using survey data from 1214 young women who were in the intervention arm and completed at least one annual visit in the HPTN 068 trial, and qualitative interview data from a subset of 38 participants, we examined spending of a cash transfer provided to young women conditioned on school attendance. Results We found that spending was largely determined and controlled by young women themselves and that the cash transfer was predominately spent on toiletries, clothing and school supplies. In interview data, young women discussed the significant role of cash transfers for adolescent identity, specifically with regard to independence from family and status within the peer network. There were almost no negative consequences from receiving the cash transfer. Conclusions We established that providing adolescents access to cash was not reported to be associated with social harms or negative consequences. Rather, spending of the cash facilitated appropriate adolescent developmental behaviours. The findings are encouraging at a time in which there is global interest in addressing the structural drivers of HIV risk, such as poverty, for young women. Trial registration Clinicaltrials.gov NCT01233531 (1 Nov 2010. First participant enrolled 5 March 2011.

  3. Antibiotics may not decrease prostate-specific antigen levels or prevent unnecessary prostate biopsy in patients with moderately increased prostate-specific antigen levels: A meta-analysis.

    Science.gov (United States)

    Yang, Lu; Zhu, Yuchun; Tang, Zhuang; Chen, Yongji; Gao, Liang; Liu, Liangren; Han, Ping; Li, Xiang; Wei, Qiang

    2015-05-01

    To evaluate the effect of empiric antibiotics on decreasing prostate-specific antigen (PSA) levels and the possibility of avoiding unnecessary prostate biopsies (PBs). A systematic search of PubMed, Embase, and the Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared effects of empiric antibiotics with no treatment or placebo on lowering PSA levels and minimizing unnecessary PBs in patients with moderately increased PSA levels. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis. The inclusion criteria for the study were met by 6 RCTs (1 placebo controlled and 5 no treatment controlled) involving 656 patients. The synthesized data from these RCTs indicated that there were no significant differences between the antibiotic and control groups in the PSA levels after treatment (mean difference [MD] = 0.15, 95% CI:-0.50 to 0.81, P = 0.65], number of patients with decreased PSA levels after treatment (relative risk [RR] = 1.22, 95% CI: 0.90-1.65, P = 0.20], prostate-specific antigen density levels after treatment (MD =-0.04, 95% CI:-0.15 to 0.07, P = 0.47), f/t% PSA after treatment (MD =-1.47, 95% CI:-4.65 to 1.71, P = 0.37), number of patients with responsive PSA (RR = 1.02, 95% CI: 0.58-1.81, P = 0.94), and individual Pca-positiverate in these patients (RR = 1.07, 95% CI: 0.53-2.16, P = 0.86), and Pca-positiverates (RR = 0.85, 95% CI: 0.48-1.50, P = 0.57). However, the antibiotic group had a significant change in the net PSA decrease after treatment compared with the control group (MD = 1.44, 95% CI: 0.70-2.17, P = 0.0001). The use of empiric antibiotics may not significantly decrease PSA levels or avoid unnecessary PBs. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. 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 ...

  5. 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.

  6. LEADERSHIP AND TIME MANAGEMENT

    OpenAIRE

    NIKEZIC Srdan; BATAVELJIC Dragan; NIKEZIC Stefan; BATAVELJIC Branka

    2014-01-01

    When it comes to resources, it is primarily referred to material and financial and rarely human. It is assumed that human resources are used in the right way that their involvement, measured in time and intensity, is properly set to goals and tasks. Practice, unfortunately disproves this assumption. Employees spend too much time for unnecessary and low-priority activities, not realizing that the implementation of certain, key activities the requirement for achieving the ...

  7. The derivation and application of a risk related value of the spend for saving a statistical life

    International Nuclear Information System (INIS)

    Jackson, D; Stone, D; Butler, G G; McGlynn, G

    2004-01-01

    The concept of a risk related value of the spend for saving a statistical life (VSSSL) is advanced for use in cost-benefit studies across the power generation sector, and the nuclear industry in particular. For illustrative purposes, a best estimate VSSSL is set based on HSE guidance at Pounds 2 M. Above a risk of 10 -3 y -1 it is assumed that the VSSSL may approach this maximum sustainable value. As the risk reduces so does the VSSSL. At a risk level of 10 -6 y -1 a VSSSL of Pounds 0.5 M is applied. For risks below 10 -9 y -1 the value of further risk reduction approaches zero, although a nominal VSSSL of Pounds 10 k is applied as a pragmatic way forward in this study. The implications of adopting this concept as an aid to decision making in determining the spend on radiological dose reduction measures are illustrated through a worked example with a banded approach to estimating collective dose

  8. High Out-of-Pocket Health Spending in Countries With a Mediterranean Connection

    Directory of Open Access Journals (Sweden)

    Simon Grima

    2018-05-01

    Full Text Available In this study, we analyzed healthcare provision and health expenditure across six Mediterranean countries that adopt the National Health System (Beveridge model and that form part of the European Union (EU with the main aim being that of analyzing and comparing out-of-pocket health spending in countries with a European Mediterranean connection. To this end, we considered various economic indicators and statistics to derive commonalities and differences across these countries and also compared trends in these indicators to those observed across the rest of the EU. We then analyzed these findings in light of other data related to the quality of healthcare delivery and the infrastructure of the health system and discussed recent developments in healthcare within each country and the main challenges faced by the respective health systems. The results show that on average, Mediterranean countries spend less on total healthcare expenditure (THE than the EU average, both as a proportion of GDP, as well as in per capita terms. This is primarily driven by lower-than-EU-average public funding of healthcare. The 2008/2009 macro-economic and financial crisis had a significant impact on the countries under review, and explains the persistent reductions in public health spending as part of the austerity measures put in force across sectors. On the flipside, Mediterranean countries have a higher presence of private health providers in total funding, thereby explaining the higher Out-of-Pocket (OOPs health expenditures in these countries relative to the EU-average. With regard to the overall health infrastructure in these countries, we observed that although the supply of physicians is largely in line with the rest of the EU, there is under-supply when it comes to hospital beds. This may be symptomatic of lower government funding. Nonetheless, all countries score highly in the evaluation of the quality of health services, as recorded by international rankings

  9. The danger of engagement : Behavioral observations of online community activity and service spending in the online gaming context

    NARCIS (Netherlands)

    Kaptein, M.C.; Parvinen, Petri; Poyry, Essi

    2016-01-01

    Research indicates that customer engagement in online communities has positive effects on related businesses, and that, on an aggregated level, community activity and service spending are positively related. Therefore, marketing efforts tend to focus on promoting the community activity of customers.

  10. The Tab: How Connecticut Can Fix Its Dysfunctional Education Spending System to Reward Success, Incentivize Choice and Boost Student Achievement. A ConnCAN/Public Impact Research Report

    Science.gov (United States)

    Hassel, Bryan C.; Doyle, Daniela

    2009-01-01

    Thirty years ago, the Connecticut Supreme Court forced our state to take stock of its system for funding schools. Our poorest towns had thousands of dollars less per child to spend. Today, our poorest districts spend roughly the same as our richest, but Connecticut's poor children still score far below their wealthy peers. Our school finance…

  11. 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…

  12. Maternal Medical Complexity: Impact on Prenatal Health Care Spending among Women at Low Risk for Cesarean Section.

    Science.gov (United States)

    Cunningham, Shayna D; Herrera, Carolina; Udo, Ifeyinwa E; Kozhimannil, Katy B; Barrette, Eric; Magriples, Urania; Ickovics, Jeannette R

    Obstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured. The objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending during the prenatal period among a national sample of 95,663 commercially-insured women at low risk for cesarean delivery. We conducted secondary analyses of 2010-2011 inpatient, outpatient, and professional claims for health care services from the Health Care Cost Institute. Allowed charges were summed for the prenatal and childbirth periods. Ordinary least squares regressions tested associations between maternal health conditions and health care expenditures during pregnancy. Thirty-four percent of pregnant women had one or more comorbidities; 8% had two or more. Pregnant women with one or more comorbidities had significantly higher allowed charges than those without comorbidities (p prenatal period was nearly three times higher for women with preexisting diabetes compared with women with no comorbid conditions. Average levels of prenatal period spending associated with maternal comorbidities were similar for women who had vaginal and cesarean deliveries. Patient characteristics accounted for 30% of the variance in prenatal period expenditures. The impact of maternal comorbidities, and in particular preexisting diabetes, on prenatal care expenditures should be taken into account as provider payment reforms, such as pay-for performance incentives and bundled payments for episodes of care, extend to maternal and child health-related services. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  13. Poverty, heterogeneous elite, and allocation of public spending: Panel evidence from the Indian States

    OpenAIRE

    Pal, S; Ghosh, S

    2010-01-01

    In this paper, we explore how in the world’s largest democracy, India, the presence of different elite groups – the dominant landed and capitalist elite and the minority elite (who are the elected representatives of the marginalised women and low caste population) – could affect the nature and extent of public spending on various accounts, especially education. Our results suggest that the dominant landed elite tends to be unresponsive to the underlying poverty rate while the capitalist e...

  14. Leisure, Means Of Spending Free Time At Agrotourist Farm

    Directory of Open Access Journals (Sweden)

    Ioan Petroman

    2017-11-01

    Full Text Available Leisure at agrotourist farm includes all recreational and entertainment activities, offered to its visitors willing of uniqueness and beyond, having as purpose the insurance of a good mood, pleasure and relaxation, along with printing some positive impressions and of a pleasant memory about the visited location. In case of agrotourist farm product, leisure has a very diverse content, depending on the profile of the rural area, of the farm, of the motivation, of the visitation season and of the customer segments. Animation from agrotourist farm should contribute to meeting the requirements of active recreation and meeting physical and mental demands of tourists and generate the necessary frame to pleasantly spend a pleasant and instructive leisure. Leisure services can be organized by the staff from agrotourist farm, by specialized personnel or third parties, in order to meet the functions of relaxation and physical comfort, entertainment and improvingits capabilities, satisfying the needs of consumers of such niche tourism.

  15. 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

  16. Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico.

    Science.gov (United States)

    Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Méndez-Carniado, Oscar; Bryson-Cahn, Chloe; Barofsky, Jeremy; Maguire, Rachel; Miranda, Martha; Sesma, Sergio

    2006-11-18

    Absence of financial protection in health is a recently diagnosed "disease" of health systems. The most obvious symptom is that families face economic ruin and poverty as a consequence of financing their health care. Mexico was one of the first countries to diagnose the problem, attribute it to lack of financial protection, and propose systemic therapy through health reform. In this article we assess how Mexico turned evidence on catastrophic and impoverishing health spending into a catalyst for institutional renovation through the reform that created Seguro Popular (Popular Health Insurance). We present 15-year trends on the evolution of catastrophic and impoverishing health spending, including evidence on how the situation is improving. The results of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.

  17. [Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico].

    Science.gov (United States)

    Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Méndez-Carniado, Oscar; Bryson-Cahn, Chloe; Barofsky, Jeremy; Maguire, Rachel; Miranda, Martha; Sesma, Sergio

    2007-01-01

    Absence of financial protection in health is a recently diagnosed "disease" of health systems. The most obvious symptom is that families face economic ruin and poverty as a consequence of financing their health care. Mexico was one of the first countries to diagnose the problem, attribute it to lack of financial protection, and propose systemic therapy through health reform. In this article we assess how Mexico turned evidence on catastrophic and impoverishing health spending into a catalyst for institutional renovation through the reform that created Seguro Popular de Salud (Popular Health Insurance). We present 15-year trends on the evolution of catastrophic and impoverishing health spending, including evidence on how the situation is improving. The results of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.

  18. The Determinants of State Spending on Higher Education: How Capital Project Funding Differs from General Fund Appropriations

    Science.gov (United States)

    Ness, Erik C.; Tandberg, David A.

    2013-01-01

    Our fixed-effects panel data analysis of state spending on higher education fills a near void of studies examining capital expenditures on higher education. In our study, we found that political characteristics (e.g., interest group activity, organizational structure, and formal powers) largely account for differences between general fund and…

  19. Parental Control of the Time Preadolescents Spend on Social Media: Links with Preadolescents' Social Media Appearance Comparisons and Mental Health.

    Science.gov (United States)

    Fardouly, Jasmine; Magson, Natasha R; Johnco, Carly J; Oar, Ella L; Rapee, Ronald M

    2018-07-01

    Time spent on social media and making online comparisons with others may influence users' mental health. This study examined links between parental control over the time their child spends on social media, preadolescents' time spent browsing social media, preadolescents' appearance comparisons on social media, and preadolescents' appearance satisfaction, depressive symptoms, and life satisfaction. Preadolescent social media users (N = 284, 49.1% female; aged 10-12) and one of their parents completed online surveys. Preadolescents, whose parents reported greater control over their child's time on social media, reported better mental health. This relationship was mediated by preadolescents spending less time browsing and making fewer appearance comparisons on social media. Parental control over time spent on social media may be associated with benefits for mental health among preadolescents.

  20. A case of autoimmune cholangitis misdiagnosed for cholangiocarcinoma: How to avoid unnecessary surgical intervention?

    Directory of Open Access Journals (Sweden)

    Ignjatović Igor I.

    2015-01-01

    Full Text Available Introduction. Autoimmune cholangitis or immunoglobulin G4-associated cholangitis (IAC has been recently regarded as a new clinical and histopathological entity and is a part of a complex autoimmune disorder - IgG4-related systemic disease (ISD. ISD is an autoimmune disease with multi-organic involvement, characterized with IgG4-positive plasmocytic infiltration of various tissues and organs with a consequent sclerosis, which responds well to steroid therapy. Most commonly affected organs are the pancreas (autoimmune pancreatitis, [AIP] and the common bile duct (IAC. IAC and cholangiocarcinoma (CCA share many clinical, laboratory and imaging findings. Case Outline. We present a case of a 60-year-old male with a biliary stricture of a common bile duct, which was clinically considered as a bile duct carcinoma and treated surgically. Definite histopathological findings and immunohistochemistry revealed profound chronic inflammation, showing lymphoplasmacytic IgG-positive infiltration of a resected part of a common bile duct, highly suggestive for the diagnosis of IAC. In addition, postoperative IgG4 serum levels were also increased. Conclusion. It is of primary clinical importance to make a difference between IAC and CCA, in order to avoid unnecessary surgical intervention. Therefore, IAC should be considered in differential diagnosis in similar cases.

  1. 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.

  2. Reduction of the unnecessary dose from the over-range area with a spiral dynamic z-collimator: comparison of beam pitch and detector coverage with 128-detector row CT.

    Science.gov (United States)

    Shirasaka, Takashi; Funama, Yoshinori; Hayashi, Mutsukazu; Awamoto, Shinichi; Kondo, Masatoshi; Nakamura, Yasuhiko; Hatakenaka, Masamitsu; Honda, Hiroshi

    2012-01-01

    Our purpose in this study was to assess the radiation dose reduction and the actual exposed scan length of over-range areas using a spiral dynamic z-collimator at different beam pitches and detector coverage. Using glass rod dosimeters, we measured the unilateral over-range scan dose between the beginning of the planned scan range and the beginning of the actual exposed scan range. Scanning was performed at detector coverage of 80.0 and 40.0 mm, with and without the spiral dynamic z-collimator. The dose-saving ratio was calculated as the ratio of the unnecessary over-range dose, with and without the spiral dynamic z-collimator. In 80.0 mm detector coverage without the spiral dynamic z-collimator, the actual exposed scan length for the over-range area was 108, 120, and 126 mm, corresponding to a beam pitch of 0.60, 0.80, and 0.99, respectively. With the spiral dynamic z-collimator, the actual exposed scan length for the over-range area was 48, 66, and 84 mm with a beam pitch of 0.60, 0.80, and 0.99, respectively. The dose-saving ratios with and without the spiral dynamic z-collimator for a beam pitch of 0.60, 0.80, and 0.99 were 35.07, 24.76, and 13.51%, respectively. With 40.0 mm detector coverage, the dose-saving ratios with and without the spiral dynamic z-collimator had the highest value of 27.23% with a low beam pitch of 0.60. The spiral dynamic z-collimator is important for a reduction in the unnecessary over-range dose and makes it possible to reduce the unnecessary dose by means of a lower beam pitch.

  3. Impact of GDP, spending on R&D, number of universities and scientific journals on research publications in pharmacological sciences in Middle East.

    Science.gov (United States)

    Meo, S A; Usmani, A M; Vohra, M S; Bukhari, I A

    2013-10-01

    Research in pharmacological science is vital to support the health needs of human beings. Measuring the research output provides information that forms the basis of strategic decisions. This study aimed to investigate the impact of Gross Domestic Product (GDP), spending on Research and Development (R&D), number of universities and scientific journals on research documents (papers), citable documents, citations per document and H-index in pharmacological science among Middle East countries. All the 16 Middle East countries were included in the study. The information regarding GDP, spending on R&D, total number of universities and indexed scientific journals were collected. We recorded the total number of research documents, citable documents, citations per document and H-index in pharmacological science during the period 1996-2011. The main sources for information were World Bank, Web of Science, Journal Citation Reports (Thomson Reuters) and SCI-mago/Scopus. The mean per capita GDP of all the Middle East countries is 18125.49±5386.28 US$, spending on R&D 0.63±0.28% of GDP in US$, number of universities 36.56±11.33 and mean ISI indexed journal are 8.25±3.93. The number of research documents published in pharmacological science among the Middle East countries during the period 1996-2011 is 1344.44±499.34; citable documents 1286.37±476.34; citations per document 7.62± 0.84; and H-index is 30.68±6.32. There was a positive correlation between spending on R&D and citations per documents (r = 0.56, p = 0.02), H-Index (r = 0.56, p = 0.02); number of universities and research documents (r = 0.72, p = 0.002), citable documents (r = 0.72, p = 0.001); ISI indexed journals and research documents (r = 0.88, p = 0.0001), citable documents (r = 0.88, p = 0.0001), H-Index (r = 0.67, p = 0.004). However, there was no correlation between the GDP per capita and research outcome in pharmacological science. There is a positive association between spending on R&D, number of

  4. 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.

  5. 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.

  6. 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.

  7. Decision analysis for the cost effectiveness of Sestamibi Scintimammography in minimizing unnecessary biopsies

    International Nuclear Information System (INIS)

    Allen, M.W.; Hendi, P.; Schwimmer, J.; Gambhir, S.S.; Bassett, L.

    2000-01-01

    The purpose of this study was to assess if breast cancer screening using sestamibi scintimammography (SSMM) in conjunction with mammography (MM) is cost effective in avoiding biopsies in healthy patients. Quantitative decision tree sensitivity analysis was used to compare the conventional MM alone strategy (strategy A) with two decision strategies for screening with SSMM; SSMM after an indeterminate mammogram (strategy B) or SSMM after both a positive and an indeterminate mammogram (strategy C). Cost effectiveness was measured by calculating the expected cost per patient and the average life expectancy per patient for baseline values as well as over a range of values for all of the variables of each strategy. Based on Medicare reimbursement values, strategies B and C showed a cost savings of $9 and $20 per patient respectively as compared to strategy A. This translates into respective savings of $189 and $420 million per year assuming 21 million females undergo screening each year. Strategies B and C did however have a loss of mean life expectancy of 0.000178 and 0.000222 years respectively as compared to strategy A due to interval progression of breast cancer in a small number of women. Strategies B and C significantly lowered the number of biopsies performed on healthy patients in the screening population by 750,063 and 1,557,915 biopsies respectively as compared to strategy A. These results quantitatively verify the potential utility of using SSMM in avoiding unnecessary biopsies

  8. 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.

  9. 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

  10. 77 FR 31019 - Agency Information Collection Activities; Submission for Office of Management and Budget Review...

    Science.gov (United States)

    2012-05-24

    ... Competition and Innovation Act of 2009 (BPCI Act) which amends the Public Health Service Act (PHS Act) and... Services (the Secretary) may determine that any of these elements is unnecessary. The biological product... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2012-N-1029...

  11. Money for Music Education: A District Analysis of the How, What, and Where of Spending for Music Education

    Science.gov (United States)

    Fermanich, Mark L.

    2011-01-01

    Evidence suggests that accountability and financial pressures are causing schools across the country to reduce investments in subject areas that are not assessed for accountability purposes. However, due to the design of financial reporting systems in most states, inadequate data are available to analyze spending levels and patterns for specific…

  12. Benefit Incidence Analysis of Government Spending on Public-Private Partnership Schooling under Universal Secondary Education Policy in Uganda

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    Wokadala, J.; Barungi, M.

    2015-01-01

    The study establishes whether government spending on private universal secondary education (USE) schools is equitable across quintiles disaggregated by gender and by region in Uganda. The study employs benefit incidence analysis tool on the Uganda National Panel Survey (UNPS 2009/10) data to establish the welfare impact of public subsidy on…

  13. 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

  14. 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

  15. Effect of exercise training on sports enjoyment and leisure-time spending in adolescents with complex congenital heart disease: the moderating effect of health behavior and disease knowledge.

    Science.gov (United States)

    Dulfer, Karolijn; Duppen, Nienke; Blom, Nico A; van Dijk, Arie P J; Helbing, Wim A; Verhulst, Frank C; Utens, Elisabeth M W J

    2014-01-01

    The aim of this study was to evaluate the effects of a standardized exercise program on sports enjoyment and leisure-time spending in adolescents with congenital heart disease and to know what the moderating impact of their baseline health behavior and disease knowledge is. Included were 93 patients, aged 10 to 25, with surgical repair for tetralogy of Fallot or with a Fontan circulation for single-ventricle physiology, of 5 participating centers of pediatric cardiology in The Netherlands. They were randomly allocated, stratified for age, gender, and type of congenital heart disease to a 12-week period with either: (1) three times per week standardized exercise training or (2) care as usual (randomization ratio 2:1). At baseline and after 12 weeks, participants completed Web-based questionnaires and were interviewed by phone. Primary analyses tested changes from baseline to follow-up in sports enjoyment and leisure-time spending in the exercise group vs. control group. Secondary analyses concerned the moderating influence of baseline health behavior and disease knowledge on changes from baseline to follow-up, and comparison with normative data. At follow-up, the exercise group reported a decrease in passive leisure-time spending (watching television and computer usage) compared with controls. Exercise training had no effect on sports enjoyment and active leisure-time spending. Disease knowledge had a moderating effect on improvement in sports enjoyment, whereas health behavior did not. Compared with normative data, patients obtained similar leisure time scores and lower frequencies as to drinking alcohol and smoking. Exercise training decreased passive, but not active, leisure-time spending. It did not influence sports enjoyment. © 2013 Wiley Periodicals, Inc.

  16. 25 CFR 700.33 - Act (The Act).

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Act (The Act). 700.33 Section 700.33 Indians THE OFFICE OF NAVAJO AND HOPI INDIAN RELOCATION COMMISSION OPERATIONS AND RELOCATION PROCEDURES General Policies and Instructions Definitions § 700.33 Act (The Act). (a) The Act. The Act is Pub. L. 93-531, (88 Stat...

  17. The cost of virtual wins: An examination of gambling-related risks in youth who spend money on social casino games.

    Science.gov (United States)

    King, Daniel L; Russell, Alex; Gainsbury, Sally; Delfabbro, Paul H; Hing, Nerilee

    2016-09-01

    Background and aims Social casino games (SCGs) are not technically considered a form of gambling but they do enable players to spend money in a game that is gambling themed or structurally approximate to gambling. It has been theorized that SCGs could be a gateway to gambling activities or otherwise normalize the experience of gambling for young people, particularly when money becomes involved. The aim of this study was to investigate whether adolescents' financial expenditure in SCGs was associated with broader gambling activity, including level of participation, expenditure, and problem gambling symptoms. Methods An online survey was administered to 555 adolescents, including 130 SCG players (78 non-paying and 52 paying users). Results Paying SCG users tended to be employed males who play more frequently and engage in more SCG activities, who report more symptoms of problem gambling and higher psychological distress than non-paying SCG users. Paying SCG users reported more frequent engagement and spending in monetary gambling activities, and two-thirds of SCG payers recalled that their SCG use had preceded involvement in financial gambling. Discussion and conclusions Spending in simulated gambling activities by adolescents may be a risk factor for problem gambling. Although SCGs may currently defy classification as a form of gambling, these activities will likely continue to be scrutinized by regulators for the use of dubious or exploitative payment features offered in a gambling-themed format that is available to persons of all ages.

  18. A Continuous Act...

    Directory of Open Access Journals (Sweden)

    Nico Jenkins

    2013-05-01

    Full Text Available Traditionally, a wayzgoose was a celebration at the end of a printer’s year, a night off in the late fall before the work began of printing by candlelight. According to the OED, the Master Printer would make for the journeymen “a good Feast, and not only entertains them at his own House, but besides, gives them Money to spend at the Ale-house or Tavern at Night.”

  19. Store manager performance and satisfaction: effects on store employee performance and satisfaction, store customer satisfaction, and store customer spending growth.

    Science.gov (United States)

    Netemeyer, Richard G; Maxham, James G; Lichtenstein, Donald R

    2010-05-01

    Based on emotional contagion theory and the value-profit chain literatures, the present study posits a number of hypotheses that show how managers in the small store, small number of employees retail context may affect store employees, customers, and potentially store performance. With data from 306 store managers, 1,615 store customer-contact employees, and 57,656 customers of a single retail chain, the authors examined relationships among store manager job satisfaction and job performance, store customer-contact employee job satisfaction and job performance, customer satisfaction with the retailer, and a customer-spending-based store performance metric (customer spending growth over a 2-year period). Via path analysis, several hypothesized direct and interaction relations among these constructs are supported. The results suggest implications for academic researchers and retail managers. PsycINFO Database Record (c) 2010 APA, all rights reserved.

  20. AN EMPIRICAL ANALYSIS OF EFFECTS OF MILITARY SPENDING ON ECONOMIC GROWTH IN NIGERIA: A BOUND TESTING APPROACH TO COINTEGRATION 1989 - 2013

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    Olumuyiwa Tolulope APANISILE

    2014-12-01

    Full Text Available The study examines the effect of military expenditure on output in Nigeria both in the short-run and in the long-run period. In addition, it verified whether military expenditure is an economically non-contributive activity using ARDL bounds testing approach to co-integration. Results showed that military spending has negative and significant effect on output in the short-run but positive and significant effect in the long-run. Labour and capital have positive and significant effects both in the long-run and short-run. In addition, labour has the highest coefficient (3.0709 in the long-run.The study concludes that government should reduce its expenditure on defense and concentrate more on human capital development, since military spending contributes nothing to output in the short-run.