Science.gov

Sample records for cost containment policies

  1. Policy options to contain healthcare costs: a review and classification.

    PubMed

    Stadhouders, Niek; Koolman, Xander; Tanke, Marit; Maarse, Hans; Jeurissen, Patrick

    2016-05-01

    Containing health care costs has been a challenge for most OECD member states. We classify 2250 cost containment policies in forty-one groups of policy options. This conceptual framework might act as a toolkit for policymakers that seek to develop strategies for cost control; and for researchers that seek to evaluate them. We found that certain important cost drivers such as wages and capital are being sparsely covered. We distinguish four primary targets to contain costs: volume controls, price controls, budgeting and market oriented policies. Price controls and budgeting, both seen as relatively effective, appear substantially less often in literature than volume controls and market oriented policies. The relative use of each option hardly changed over time, although the health system type did matter. Market oriented policies were more likely to be suggested for countries with public provision of health care, as well as for the US system. In contrast, budgeting policy proposals were more likely to be suggested for countries with market provision systems, such as Canada, Germany and France. Implementation of cost containment policies could lead to convergence of health care systems, except for the US system, if policies are implemented based on the literature. PMID:27066728

  2. Multiple drug cost containment policies in Michigan's Medicaid program saved money overall, although some increased costs.

    PubMed

    Kibicho, Jennifer; Pinkerton, Steven D

    2012-04-01

    Michigan's Medicaid program implemented four cost containment policies--preferred drug lists, joint and multistate purchasing arrangements, and maximum allowable cost--during 2002-04. The goal was to control growth of drug spending for beneficiaries who were enrolled in both Medicaid and Medicare and taking antihypertensive or antihyperlipidemic prescription drugs. We analyzed the impact of each policy while holding the effect of all other policies constant. Preferred drug lists increased both preferred and generic drugs' market share and reduced daily cost--the cost per day for each prescription provided to a beneficiary. In contrast, the maximum allowable cost policy increased daily cost and was the only policy that did not generate cost savings. The joint and multistate arrangements did not affect daily cost. Despite these policy trade-offs, the cumulative effect was a 10 percent decrease in daily cost and a total cost savings of $46,195 per year. Our findings suggest that policy makers need to evaluate the impact of multiple policies aimed at restraining drug spending, and further evaluate the policy trade-offs, to ensure that scarce public dollars achieve the greatest return for money spent. PMID:22492899

  3. Cracking the Books: Policy Measures to Contain Textbook Costs. Policy Matters: A Higher Education Policy Brief

    ERIC Educational Resources Information Center

    McBain, Lesley

    2009-01-01

    As parents and students struggle with increasing college costs, one issue receiving considerable attention over the past several years has been the rising price of textbooks. The question of whether a relationship exists between textbook pricing and the overall cost of college has attracted notice from consumer interest groups and, subsequently,…

  4. The attitudes of physicians toward health care cost-containment policies.

    PubMed Central

    Ku, L; Fisher, D

    1990-01-01

    This study analyzed physician attitudes toward a variety of health care cost-containment policies, based on a national survey of 500 practicing doctors in 1984. Reactions to 23 policies were simplified to nine common themes using factor analysis. Although there was great diversity in views, physicians generally favored policies that increased responsibilities or costs for patients and disfavored policies that decreased physicians' autonomy of practice. For most policies, practice characteristics (specialty; type of practice, e.g., solo or group, salaried or self-employed; membership in medical societies; or percent of time in direct patient care) were not significant determinants of attitudes. Physicians who were more "conservative" with respect to the health care system tended to favor policies that shifted cost to patients, while more "liberal" doctors were more supportive of using prepaid health care, reducing the intensity of care, or selecting efficient providers. Overall, this study indicates that physicians still place a high value on their professional autonomy. PMID:2329048

  5. Doctors commitment and long-term effectiveness for cost containment policies: lesson learned from biosimilar drugs

    PubMed Central

    Menditto, Enrica; Orlando, Valentina; Coretti, Silvia; Putignano, Daria; Fiorentino, Denise; Ruggeri, Matteo

    2015-01-01

    Background Agency is a pervasive feature of the health care market, with doctors acting as agents for both patients and the health care system. In a context of scarce resources, doctors are required to take opportunity cost into account when prescribing treatments, while cost containment policies cannot overlook their active role in determining health care resource allocation. This paper addresses this issue, investigating the effects of cost containment measures in the market of biosimilar drugs that represent a viable and cost-saving strategy for the reduction of health care expenditure. The analysis focuses on a particular region in Italy, where several timely policies to incentivize biosimilar prescribing were launched. Methods Drugs were identified by the anatomical therapeutic chemical classification system. Information about biosimilar drugs and their originator biological products was extracted from the IMS Health regional database. Drug consumption was expressed in terms of counting units, while expenditure was evaluated in Euro (€). The market penetration of biosimilars was analyzed by year and quarterly. Results In the Campania region of Italy, the effects of cost containment policies, launched between 2009 and 2013, showed the prescription of biosimilars strongly increasing in 2010 until prescribing levels reached and exceeded the market share of the reference biological products in 2012. After a slight reduction, a plateau was observed at the beginning of 2013. At the same time, the use of the originator products had been decreasing until the first quarter of 2011. However, after a 1-year plateau, this trend was reversed, with a new increase in the consumption of the originators observed. Conclusion Results show that the cost containment policies, applied to cut health expenditure “to cure and not to care”, did not produce the cultural change necessary to make these policies effective in the long run. Therefore, top-down policies for cost

  6. Cost Containment in Europe

    PubMed Central

    Culyer, A. J.

    1989-01-01

    Health care cost containment is not in itself a sensible policy objective, because any assessment of the appropriateness of health care expenditure in aggregate, as of that on specific programs, requires a balancing of costs and benefits at the margin. International data on expenditures can, however, provide indications of the likely impact on costs and expenditures of structural features of health care systems. Data from the Organization for Economic Cooperation and Development for both European countries and a wider set are reviewed, and some current policies in Europe that are directed at controlling health care costs are outlined. PMID:10313433

  7. Cost Containment for Higher Education: Strategies for Public Policy and Institutional Administration.

    ERIC Educational Resources Information Center

    Simpson, William Brand

    This book discusses long term strategies for cost containment for higher education that are currently in use or could be employed. Some of the strategies discussed are applicable at various levels of government, some relate to interinstitutional arrangements and some are options of the individual institutions. The chapters are as follows: (1)…

  8. Cost containment in the concentrated care center: a study of nursing, bed and patient assignment policies.

    PubMed

    Landau, T P; Thiagarajan, T R; Ledley, R S

    1983-01-01

    In an effort to deliver the best possible care to seriously ill patients in the most cost-effective manner, Georgetown University has developed the Concentrated Care Center (CCC) as an essential component of the medical center complex. The design of the CCC, together with the application of controlled variable staffing procedures, permits considerable flexibility in the assignment of nurses (as well as patients) to individual units. This report outlines certain research hypotheses regarding policies designed to increase the cost-effectiveness of patient care in the CCC environment. Statistical techniques based on the theory of stochastic processes are developed to test these hypotheses and a FORTRAN IV computer program is developed to analyze one year of operational data from the CCC. PMID:6413127

  9. Expenditure limits and cost containment.

    PubMed

    Ginsburg, P B

    1993-01-01

    The Clinton administration's proposal for health care reform would tie limits on premiums and, indirectly, provider payment rates to a national health care budget. An expenditure limit (or global budget) is a mechanism to calibrate the parameters of underlying cost containment policies. This article analyzes provider rate setting and managed competition and discusses how they can be guided by expenditure limits. Particular attention is paid to health systems that include elements of both traditional fee-for-service insurance and organized systems of care. Success in containing costs also will require additional policies that can supplement rate setting and managed competition to achieve specific goals to slow spending growth. PMID:8288402

  10. Cost containment: Europe. Italy.

    PubMed

    Apolone, G; Melotti, R; Repetto, F; Iapichino, G

    1994-08-01

    Through prepaid compulsory insurance managed by the central government, Italy's National Health Service (NHS) provides full coverage, free accessibility, and no or limited copayment by individuals when receiving health services. Although Italy spends less than other countries on health care (< 8% of the country's gross national product), the present NHS faces considerable difficulties, and its performance regarding quality, outcome, and spending has come under question. ICUs account for < 2% of total hospital beds, and the proportion of ICU patients is < 2.5% of all hospital patients (2.5% of all Italian hospital patients receive ICU care at some time during their hospital stay). Information from administrative databases and epidemiologic studies gives an interesting national picture of the situation in Italy regarding admission criteria case mix, and outcomes when compared with data from other countries. Important changes in the financial and institutional framework of the NHS are underway, yielding an unpredictable scenario for the future. Innovations focus mostly on cost containment and quality initiatives. These innovations will likely produce a new health service in which regions will have a more important role than in the past. Actions planned in a large Italian region by the local government are used as an example to explain the potential impact of this new trend on critical care medicine. PMID:8087596

  11. Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries?

    PubMed Central

    Carrin, Guy; Hanvoravongchai, Piya

    2003-01-01

    In this paper, we focus on those policy instruments with monetary incentives that are used to contain public health expenditure in high-income countries. First, a schematic view of the main cost-containment methods and the variables in the health system they intend to influence is presented. Two types of instruments to control the level and growth of public health expenditure are considered: (i) provider payment methods that influence the price and quantity of health care, and (ii) cost-containment measures that influence the behaviour of patients. Belonging to the first type of instruments, we have: fee-for-service, per diem payment, case payment, capitation, salaries and budgets. The second type of instruments consists of patient charges and reference price systems for pharmaceuticals. Secondly, we provide an overview of experience in high-income countries that use or have used these particular instruments. Finally, the paper assesses the overall potential of these instruments in cost-containment policies. PMID:12914661

  12. Containing Health Care Costs

    PubMed Central

    Derzon, Robert A.

    1980-01-01

    As the federal government shifted from its traditional roles in health to the payment for personal health care, the relationship between public and private sectors has deteriorated. Today federal and state revenue funds and trusts are the largest purchasers of services from a predominantly private health system. This financing or “gap-filling” role is essential; so too is the purchaser's concern for the costs and prices it must meet. The cost per person for personal health care in 1980 is expected to average $950, triple for the aged. Hospital costs vary considerably and inexplicably among states; California residents, for example, spend 50 percent more per year for hospital care than do state of Washington residents. The failure of each sector to understand the other is potentially damaging to the parties and to patients. First, and most important, differences can and must be moderated through definite changes in the attitudes of the protagonists. PMID:6770551

  13. Cost containment: the Pacific. Japan.

    PubMed

    Tajimi, K; Shimada, Y; Nishimura, S; Sirio, C A

    1994-08-01

    The Japanese healthcare system is structured to provide universal healthcare access to the entire Japanese population via a constitutional guarantee. Increasing costs within the Japanese healthcare system are largely attributable to the country's rapidly aging population. Intensive care services are provided primarily in large tertiary care hospitals by a relatively small cadre of dedicated critical care physicians. Triage pressure is high in many Japanese hospitals due to a relatively small proportion of ICU beds. As a result, few patients are admitted to the ICU at low risk of adverse outcome or monitoring. Costs associated with providing critical care are poorly understood because of current hospital cost accounting systems. Critical care costs have only recently become an area of concern. Nevertheless, critical care physicians are taking steps to more fully understand severity of illness, clinical outcome, and utilization of resources in order to effectively guide healthcare policy and resource allocation decisions impacting Japanese critical care. PMID:8087603

  14. Cost containment and child health.

    PubMed

    Fox, V L

    1987-08-01

    Children, as consumers of health resources, have special developmental, psychological, and medical needs different from those of adults. Thus, cost containment efforts can affect children differently. Data related to insurance benefits changes, intensified market forces, and reductions in federal funding are cited. Their analysis focuses on the importance of accountability in applying cost constraints to services that can have a significant effect upon the health and well-being of one quarter of the next generation. PMID:2980911

  15. Health care cost containment in the Federal Republic of Germany

    PubMed Central

    Schneider, Markus

    1991-01-01

    Since 1977, cost containment has been an integral part of health policy in the Federal Republic of Germany. The common goal of the cost-containment acts was to bring the growth of health care expenditures in line with growth of wages and salaries of sickness fund members. The Health Care Reform Act of 1989 is the most recent manifestation of this policy. The main features of the numerous cost-containment acts are described in this article, and the effects of cost containment on supply and demand are analyzed. PMID:10113614

  16. Innovative Feed-In Tariff Designs that Limit Policy Costs

    SciTech Connect

    Kreycik, Claire; Couture, Toby D.; Cory, Karlynn S.

    2011-06-01

    Feed-in tariffs (FITs) are the most prevalent policy used globally to reduce development risks, cut financing costs, and grow the renewable energy industry. However, concerns over escalating costs in jurisdictions with FIT policies have led to increased attention on cost control. Using case studies and market-focused analysis, this report from the National Renewable Energy Laboratory (NREL) examines strengths and weaknesses of three cost-containment tools: (1) caps, (2) payment level adjustment mechanisms, and (3) auction-based designs. The report provides useful insights on containing costs for policymakers and regulators in the United States and other areas where FIT policies are in development.

  17. Laboratory cost and utilization containment.

    PubMed

    Steiner, J W; Root, J M; White, D C

    1991-01-01

    The authors analyzed laboratory costs and utilization in 3,771 cases of Medicare inpatients admitted to a New England academic medical center ("the Hospital") from October 1, 1989 to September 30, 1990. The data were derived from the Hospital's Decision Resource System comprehensive data base. The authors established a historical reference point for laboratory costs as a percentage of total inpatient costs using 1981-82 Medicare claims data and cost report information. Inpatient laboratory costs were estimated at 9.5% of total inpatient costs for pre-Diagnostic Related Groups (DRGs) Medicare discharges. Using this reference point and adjusting for the Hospital's 1990 case mix, the "expected" laboratory cost was 9.3% of total cost. In fact, the cost averaged 11.5% (i.e., 24% above the expected cost level), and costs represented an even greater percentage of DRG reimbursement at 12.9%. If we regard the reimbursement as a total cost target (to eliminate losses from Medicare), then that 12.9% is 39% above the "expected" laboratory proportion of 9.3%. The Hospital lost an average of $1,091 on each DRG inpatient. The laboratory contributed 29% to this loss per case. Compared to other large hospitals, the Hospital was slightly (3%) above the mean direct cost per on-site test and significantly (58%) above the mean number of inpatient tests per inpatient day compared to large teaching hospitals. The findings suggest that careful laboratory cost analyses will become increasingly important as the proportion of patients reimbursed in a fixed manner grows. The future may hold a prospective zero-based laboratory budgeting process based on predictable patterns of DRG admissions or other fixed-reimbursement admission and laboratory utilization patterns. PMID:10113716

  18. Innovative Feed-In Tariff Designs that Limit Policy Costs

    SciTech Connect

    Kreycik, C.; Couture, T. D.; Cory, K. S.

    2011-06-01

    Feed-in tariffs (FITs) are the most prevalent renewable energy policy used globally to date, and there are many benefits to the certainty offered in the marketplace to reduce development risks and associated financing costs and to grow the renewable energy industry. However, concerns over escalating costs in jurisdictions with FIT policies have led to increased attention on cost control in renewable energy policy design. In recent years, policy mechanisms for containing FIT costs have become more refined, allowing policymakers to exert greater control on policy outcomes and on the resulting costs to ratepayers. As policymakers and regulators in the United States begin to explore the use of FITs, careful consideration must be given to the ways in which policy design can be used to balance the policies' advantages while bounding its costs. This report explores mechanisms that policymakers have implemented to limit FIT policy costs. If designed clearly and transparently, such mechanisms can align policymaker and market expectations for project deployment. Three different policy tools are evaluated: (1) caps, (2) payment level adjustment mechanisms, and (3) auction-based designs. The report employs case studies to explore the strengths and weaknesses of these three cost containment tools. These tools are then evaluated with a set of criteria including predictability for policymakers and the marketplace and the potential for unintended consequences.

  19. Lessons for Teaching Cost Containment.

    ERIC Educational Resources Information Center

    McPhee, Stephen J.; And Others

    1984-01-01

    An educational program for medical and surgical house staffs and for medical students designed to reduce unneeded orders for low cost, high volume ancillary and nursing services is discussed. The program components include lectures, medical record audits and reviews, and group feedback in the form of cost summaries. (Author/MLW)

  20. ''Measuring the Costs of Climate Change Policies''

    SciTech Connect

    Montgomery, W. D.; Smith, A. E.; Biggar, S. L.; Bernstein, P.M.

    2003-05-09

    Studies of the costs of climate change policies have utilized a variety of measures or metrics for summarizing costs. The leading economic models have utilized GNP, GDP, the ''area under a marginal cost curve,'' the discounted present value of consumption, and a welfare measure taken directly from the utility function of the model's representative agent (the ''Equivalent Variation''). Even when calculated using a single model, these metrics do not necessarily give similar magnitudes of costs or even rank policies consistently. This paper discusses in non-technical terms the economic concepts lying behind each concept, the theoretical basis for expecting each measure to provide a consistent ranking of policies, and the reasons why different measures provide different rankings. It identifies a method of calculating the ''Equivalent Variation'' as theoretically superior to the other cost metrics in ranking policies. When regulators put forward new economic or regulatory policies, there is a need to compare the costs and benefits of these new policies to existing policies and other alternatives to determine which policy is most cost-effective. For command and control policies, it is quite difficult to compute costs, but for more market-based policies, economists have had a great deal of success employing general equilibrium models to assess a policy's costs. Not all cost measures, however, arrive at the same ranking. Furthermore, cost measures can produce contradictory results for a specific policy. These problems make it difficult for a policy-maker to determine the best policy. For a cost measures to be of value, one would like to be confident of two things. First one wants to be sure whether the policy is a winner or loser. Second, one wants to be confident that a measure produces the correct policy ranking. That is, one wants to have confidence in a policy measure's ability to correctly rank policies from most beneficial to most harmful. This paper analyzes

  1. College Cost Containment Project. Final Report.

    ERIC Educational Resources Information Center

    Lemke, Darrell

    In response to serious concerns about the dramatic increases in college and university costs, the Department of Education solicited proposals in May 1987 for innovative projects to explore means of cost reduction or containment which promise significant cost savings, whether accrued in the short- or long-term. The solicitation for cost containment…

  2. Valuation effects of health cost containment measures.

    PubMed

    Strange, M L; Ezzell, J R

    2000-01-01

    This study reports the findings of research into the valuation effects of health cost containment activities by publicly traded corporations. The motivation for this study was employers' increasing cost of providing health care insurance to their employees and employers' efforts to contain those costs. A 1990 survey of corporate health benefits indicated that these costs represented 25 percent of employers' net earnings and this would rise by the year 2000 if no actions were taken to reduce cost. Health cost containment programs that are implemented by firms should be seen by shareholders as a wealth maximizing effort. As such, this should be reflected in share price. This study employed standard event study methodology where the event is a media announcement or report regarding an attempt by a firm to contain the costs of providing health insurance and other health related benefits to employees. It examined abnormal returns on a number of event days and for a number of event intervals. Of the daily and interval returns that are least significant at the 10 percent level, virtually all are negative. Cross-sectional analysis shows that the abnormal returns are related negatively to a unionization variable. PMID:10961833

  3. Cost containment and KSC Shuttle facilities or cost containment and aerospace construction

    NASA Technical Reports Server (NTRS)

    Brown, J. A.

    1985-01-01

    This presentation has the objective to show examples of Cost Containment of Aerospace Construction at Kennedy Space Center (KSC), taking into account four major levels of Project Development of the Space Shuttle Facilities. The levels are related to conceptual criteria and site selection, the design of construction and ground support equipment, the construction of facilities and ground support equipment (GSE), and operation and maintenance. Examples of cost containment are discussed. The continued reduction of processing time from landing to launching represents a demonstration of the success of the cost containment methods. Attention is given to the factors which led to the selection of KSC, the use of Cost Engineering, the employment of the Construction Management Concept, and the use of Computer Aided Design/Drafting.

  4. Cost containment: the Pacific. New Zealand.

    PubMed

    Streat, S; Judson, J A

    1994-08-01

    New Zealand is a small nation with an extensive state-funded system of health, education, and welfare that is currently under "reform." The healthcare system remains largely government-funded and is free to all New Zealand residents. Healthcare spending accounts for approximately 7.4% of the country's gross domestic product and has not changed in the last 5 yrs. Ninety-three percent of New Zealand's ICUs are in public hospitals, where ICU beds constitute 0.9% of the total number of beds. In all, there are 43 ICU beds/1 million inhabitants. Between 1989 and 1992, the number of public hospital beds decreased by 19% and the number of ICU beds decreased by 5%. ICU Resources have been limited for many years, and clinicians have responded by attempting to prevent disease and limit its severity, by vetting (and declining) requests for ICU admission, by reducing length of ICU stay of both survivors and nonsurvivors, and by reducing marginal costs. Both limiting and actively withdrawing therapy are well established practices in New Zealand ICUs. The country's physicians are conservative in their use of new technology but demand excellence and value in equipment. ICU technology and knowledge diffuse easily throughout New Zealand because of the country's geography and population distribution, in addition to the activities of the Australian and New Zealand Intensive Care Society (ANZICS) and the defined specialty training pathways for intensive care. Hospital care is relatively cheap and nurse extenders, respiratory therapists, and ward pharmacists are not used. Flow charts in the ICU are custom-designed and not computerized, but computers are increasingly being used for clinical databases and ICU policy development. PMID:8087602

  5. Health Care Cost Containment. A Seminar on Health Cost Containment, March 14-15, 1985, Washington, D.C.

    ERIC Educational Resources Information Center

    Council of State Governments, Lexington, KY.

    This document presents the texts of speeches from a conference on health care cost containment. Topics presented include Medicare solvency, capitated programs, diagnostic related groups (DRGs), Medicaid restructuring, long term care financing, private sector cost containment strategies, British health cost containment, health maintenance…

  6. Space Planning: A Basis for Cost Containment.

    ERIC Educational Resources Information Center

    Snyder, Fred A.; And Others

    Decreasing budgets and enrollments, the reluctance of state legislatures to provide funds for higher education facilities, and the rising costs of energy necessitate the development of space ownership management. Three patterns of space planning problems have developed at different colleges: (1) costly, underutilized facilities due to optimistic…

  7. 39 CFR 551.8 - Cost offset policy.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...., manufacturing process, gum type), thereby establishing a baseline for cost comparison purposes. The... 39 Postal Service 1 2010-07-01 2010-07-01 false Cost offset policy. 551.8 Section 551.8 Postal Service UNITED STATES POSTAL SERVICE POSTAGE PROGRAMS SEMIPOSTAL STAMP PROGRAM § 551.8 Cost offset...

  8. 39 CFR 551.8 - Cost offset policy.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...., manufacturing process, gum type), thereby establishing a baseline for cost comparison purposes. The... 39 Postal Service 1 2011-07-01 2011-07-01 false Cost offset policy. 551.8 Section 551.8 Postal Service UNITED STATES POSTAL SERVICE POSTAGE PROGRAMS SEMIPOSTAL STAMP PROGRAM § 551.8 Cost offset...

  9. Cost analysis of post-polio certification immunization policies.

    PubMed Central

    Sangrujee, Nalinee; Cáceres, Victor M.; Cochi, Stephen L.

    2004-01-01

    OBJECTIVE: An analysis was conducted to estimate the costs of different potential post-polio certification immunization policies currently under consideration, with the objective of providing this information to policy-makers. METHODS: We analyzed three global policy options: continued use of oral poliovirus vaccine (OPV); OPV cessation with optional inactivated poliovirus vaccine (IPV); and OPV cessation with universal IPV. Assumptions were made on future immunization policy decisions taken by low-, middle-, and high-income countries. We estimated the financial costs of each immunization policy, the number of vaccine-associated paralytic poliomyelitis (VAPP) cases, and the global costs of maintaining an outbreak response capacity. The financial costs of each immunization policy were based on estimates of the cost of polio vaccine, its administration, and coverage projections. The costs of maintaining outbreak response capacity include those associated with developing and maintaining a vaccine stockpile in addition to laboratory and epidemiological surveillance. We used the period 2005-20 as the time frame for the analysis. FINDINGS: OPV cessation with optional IPV, at an estimated cost of US$ 20,412 million, was the least costly option. The global cost of outbreak response capacity was estimated to be US$ 1320 million during 2005-20. The policy option continued use of OPV resulted in the highest number of VAPP cases. OPV cessation with universal IPV had the highest financial costs, but it also had the least number of VAPP cases. Sensitivity analyses showed that global costs were sensitive to assumptions on the cost of the vaccine. Analysis also showed that if the price per dose of IPV was reduced to US$ 0.50 for low-income countries, the cost of OPV cessation with universal IPV would be the same as the costs of continued use of OPV. CONCLUSION: Projections on the vaccine price per dose and future coverage rates were major drivers of the global costs of post

  10. Costs of Juvenile Violence: Policy Implications.

    ERIC Educational Resources Information Center

    Miller, Ted; Fisher, Deborah A.; Cohen, Mark A.

    2001-01-01

    Investigated the magnitude of juvenile violence in Pennsylvania in terms of victimization and perpetration. Used archival data on violent crimes in Pennsylvania during 1993 to develop cost estimates reflecting the costs incurred by society for both victims and perpetrators. Overall, violence against children and adolescents proved to be a much…

  11. Indirect Cost Recovery as an Issue of Science Policy.

    ERIC Educational Resources Information Center

    Rosenzweig, Robert M.

    1987-01-01

    The history of the debate over federal efforts to reduce indirect cost recovery in federal research grants to universities is outlined and discussed by a former university administrator involved in the policy's formation. (MSE)

  12. The ethics of cost containment from the anesthesiologist's perspective.

    PubMed

    Vogel, W A; Manecke, G R; Poppers, P J

    1999-02-01

    Cost containment, as an essential part of current effort to manage health care, has been examined thoroughly from the perspectives of finance and patient care. In this article, the ethics of cost containment are discussed from the vantage point of the health care provider. Cost-cutting initiatives, however necessary and sound, nevertheless may place anesthesiologists in situations of ethical conflict and ultimately interfere with their rights as workers and professionals. The anesthesiology community is encouraged to investigate the effect of cost-cutting measures on patients and physicians alike. PMID:10396723

  13. Effective Prototype Costing Policies in Research Universities: Are They Possible?

    ERIC Educational Resources Information Center

    McClure, Maureen W.; Abu-Duhou, Ibtisam

    Policy problems of prototype costing at research universities are discussed, based on a case study of a clinical treatment prototype program at a research university hospital. Prototypes programs generate reproducible knowledge with useful applications and are primarily developed in professional schools. The potential of using costing prototypes…

  14. Honoring the Trust: Quality and Cost Containment in Higher Education.

    ERIC Educational Resources Information Center

    Massy, William F.

    This book asserts that improvements in quality and cost containment are required not only for the well-being of individual institutions of higher education, but also to honor the trust placed in academe by society. The book outlines a practical program for improvement. The chapters of part 1, "The Case for Change," are: (1) "The Erosion of Trust";…

  15. 7 CFR 246.16a - Infant formula cost containment.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 4 2011-01-01 2011-01-01 false Infant formula cost containment. 246.16a Section 246.16a Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions...

  16. 7 CFR 246.16a - Infant formula cost containment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Infant formula cost containment. 246.16a Section 246.16a Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions...

  17. Priorities of health policy: cost shifting or population health

    PubMed Central

    Richardson, Jeff RJ

    2005-01-01

    Background This paper is an edited version of an invited paper submitted to the Australian Health Care Summit on 17–19 August 2003. It comments upon the policies which have dominated recent debate and contrasts their importance with the importance of five issues which have received relatively little attention. Methods Policy is usually a response to identified problems and the paper examines the nature and size of the problems which heave led to recent policy initiatives. These are contrasted with the magnitude and potential cost effectiveness policies to address the problems in five areas of comparative neglect. Results It is argued that recent and proposed changes to the financing and delivery of health services in Australia have focused upon issues of relatively minor significance while failing to address adequately major inequities and system deficiencies. Conclusion There is a need for an independent review of the health system with the terms of reference focusing attention upon large system-wide failures. PMID:15679895

  18. Toward strategies for cost containment in surgical patients.

    PubMed

    Drucker, W R; Gavett, J W; Kirshner, R; Messick, W J; Ingersoll, G

    1983-09-01

    The University of Rochester, Department of Surgery, in response to an experimental community-wide limit on hospital budgets, studied high-cost general surgical patients as a potential source of leverage for containment of hospital costs. It was found that a small number of patients impact significantly on hospital costs. In 1980, 3935 patients at Strong Memorial Hospital (SMH) had at least one contact with a general surgical patient care or intensive care unit; 261 patients (6.6%) had total 1980 charges of more than $20,000 each. They contributed 32% of the total of both general surgical charges and patient days. A subset of 2021 patients was selected to represent more precisely the general surgical patient. The 85 high-cost patients (4.2%) of this subset were chosen for intensive study. These patients generated a significant and disproportionate per cent of total (2021) general surgical charges (26.8%) and hospital days (27.6%). Average total charges were more than 8 times those of the complementary general surgical subset (1936). Nineteen of the 85 patients (22.3%) died in the hospital and 42 patients (49.4%) were dead within 2 1/2 years. Forty patients (of the 85) were then further identified as "complex", based on multiple, usually unrelated, illnesses and multiple annual admissions. Tending to be elderly with poor prognoses, 60% of them had died by April 1983. The major criterion of complexity was the lack of a well-focused medical problem; the cure for one problem simply relinquished primacy to another. A parallel study of hospital ancillary procedures disclosed a similar high-cost pattern. Of approximately 4000 ancillary procedures, 100 (2.5%) had annual charges of $100,000 or over, accounting for two-thirds of total 1980 ancillary charges. Roughly 20% of a single patient's ordered procedures accounted for 80% of the patient's ancillary charges, thus allowing concentrated study of a relatively small number of charges. Means for cost containment may be

  19. Toward strategies for cost containment in surgical patients.

    PubMed Central

    Drucker, W R; Gavett, J W; Kirshner, R; Messick, W J; Ingersoll, G

    1983-01-01

    The University of Rochester, Department of Surgery, in response to an experimental community-wide limit on hospital budgets, studied high-cost general surgical patients as a potential source of leverage for containment of hospital costs. It was found that a small number of patients impact significantly on hospital costs. In 1980, 3935 patients at Strong Memorial Hospital (SMH) had at least one contact with a general surgical patient care or intensive care unit; 261 patients (6.6%) had total 1980 charges of more than $20,000 each. They contributed 32% of the total of both general surgical charges and patient days. A subset of 2021 patients was selected to represent more precisely the general surgical patient. The 85 high-cost patients (4.2%) of this subset were chosen for intensive study. These patients generated a significant and disproportionate per cent of total (2021) general surgical charges (26.8%) and hospital days (27.6%). Average total charges were more than 8 times those of the complementary general surgical subset (1936). Nineteen of the 85 patients (22.3%) died in the hospital and 42 patients (49.4%) were dead within 2 1/2 years. Forty patients (of the 85) were then further identified as "complex", based on multiple, usually unrelated, illnesses and multiple annual admissions. Tending to be elderly with poor prognoses, 60% of them had died by April 1983. The major criterion of complexity was the lack of a well-focused medical problem; the cure for one problem simply relinquished primacy to another. A parallel study of hospital ancillary procedures disclosed a similar high-cost pattern. Of approximately 4000 ancillary procedures, 100 (2.5%) had annual charges of $100,000 or over, accounting for two-thirds of total 1980 ancillary charges. Roughly 20% of a single patient's ordered procedures accounted for 80% of the patient's ancillary charges, thus allowing concentrated study of a relatively small number of charges. Means for cost containment may be

  20. Environmental policy, adjustment costs, and behavior of the firm

    SciTech Connect

    Xepapadeas, A.P. )

    1992-11-01

    The effects of environmental policy, in the form of emission charges or emission limits, on the firm's optimal choices of productive and abatement inputs are analyzed. Short-run and long-run impacts on inputs, and the properties of static emission function, are determined through comparative static analysis. Comparative dynamics reveal the properties of the cumulative emission function and the cumulative shadow-cost-of-emission-limits function. 10 refs.

  1. National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis with Policy Implications

    PubMed Central

    Harris, Catherine R.; Osterberg, E. Charles; Sanford, Thomas; Alwaal, Amjad; Gaither, Thomas W.; McAninch, Jack W.; McCulloch, Charles E.; Breyer, Benjamin N.

    2016-01-01

    Objective To determine which factors are associated with higher urethroplasty procedural costs and whether they have been increasing or decreasing over time. Identification of determinants of extreme costs may help reduce cost while maintaining quality. Materials and Methods We conducted a retrospective analysis using the 2001–2010 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS). The HCUP-NIS captures hospital charges which we converted to cost using the HCUP Cost-to-Charge Ratio. Log cost linear regression with sensitivity analysis was used to determine variables associated with increased costs. Extreme cost was defined as the top 20th percentile of expenditure, analyzed with logistic regression and expressed as Odds Ratios (OR). Results A total of 2298 urethroplasties were recorded in NIS over the study period. The median (interquartile range) calculated costs was $7321 ($5677–$10000). Patients with multiple comorbid conditions were associated with extreme costs (OR 1.56 95% CI 1.19–2.04, p=0.02) compared to patients with no comorbid disease. Inpatient complications raised the odds of extreme costs OR 3.2 CI 2.14–4.75, p<0.001). Graft urethroplasties were associated with extreme costs (OR 1.78 95% CI 1.2–2.64, p=0.005). Variation in patient age, race, hospital region, bed size, teaching status, payer type, and volume of urethroplasty cases were not associated with extremes of cost. Conclusion Cost variation for perioperative inpatient urethroplasty procedures is dependent on preoperative patient comorbidities, postoperative complications and surgical complexity related to graft usage. Procedural cost and cost variation are critical for understanding which aspects of care have the greatest impact on cost. PMID:27107626

  2. Chapter 15: Public health policy and cost-effectiveness analysis.

    PubMed

    Goldie, Sue J

    2003-01-01

    Recent scientific advances are providing an opportunity to revisit strategies for cervical cancer prevention. How to invest health resources wisely, such that public health benefits are maximized-and opportunity costs are minimized-is a critical question in the setting of enhanced cytologic screening methods, human papillomavirus DNA testing, and vaccine development. Developing sound clinical guidelines and public health policy will require careful consideration of the incremental benefits, harms, and costs associated with new interventions compared with existing interventions, at both an individual and a population level. In addition to an intervention's effectiveness, public health decision making requires the consideration of its feasibility, sustainability, and affordability. No clinical trial or single cohort study will be able to simultaneously consider all of these components. Cost-effectiveness analysis and disease-simulation modeling, capitalizing on data from multiple sources, can serve as a valuable tool to extend the time horizon of clinical trials, to evaluate more strategies than possible in a single clinical trial, and to assess the relative costs and benefits of alternative policies to reduce mortality from cervical cancer. PMID:12807953

  3. Are renewables portfolio standards cost-effective emission abatement policy?

    SciTech Connect

    Katerina Dobesova; Jay Apt; Lester B. Lave

    2005-11-15

    Renewables portfolio standards (RPS) could be an important policy instrument for 3P and 4P control. The authors examine the costs of renewable power, accounting for the federal production tax credit, the market value of a renewable credit, and the value of producing electricity without emissions of SO{sub 2}, NOx, mercury, and CO{sub 2}. The focus is on Texas, which has a large RPS and is the largest U.S. electricity producer and one of the largest emitters of pollutants and CO{sub 2}. The private and social costs of wind generation in an RPS is compared with the current cost of fossil generation, accounting for the pollution and CO{sub 2} emissions. It was found that society paid about 5.7 cents/kWh more for wind power, counting the additional generation, transmission, intermittency, and other costs. The higher cost includes credits amounting to 1.1 cents/kWh in reduced SO{sub 2}, NOx, and Hg emissions. These pollution reductions and lower CO{sub 2} emissions could be attained at about the same cost using pulverized coal (PC) or natural gas combined cycle (NGCC) plants with carbon capture and sequestration (CCS); the reductions could be obtained more cheaply with an integrated coal gasification combined cycle (IGCC) plant with CCS. 35 refs., 7 tabs.

  4. Comparison of the hospital cost of primary and revision total hip arthroplasty after cost containment.

    PubMed

    Iorio, R; Healy, W L; Richards, J A

    1999-02-01

    This study compared the hospital cost of primary and revision total hip arthroplasty (THA) after the introduction of cost-containment programs (clinical pathway, hip implant standardization, and competitive bid purchasing of hip implants). Hospital financial records for 290 primary and 85 revision THAs performed from October 1993 through September 1995 were analyzed. A cost-accounting system provided actual hospital cost data for each procedure. Accurate calculation of hospital income or loss was determined. Average hospital length of stay was 4.9 days for primary THA and 5.9 days for revision THA. Average hospital cost was $11,104 for primary THA and $14,935 for revision THA. Average net income (hospital revenue hospital expense) for primary THA was $2486. Average loss from revision THA was $401. The payer mix included commercial insurance, Blue Cross/Blue Shield, managed care, Medicare, Medicaid, and workmen's compensation. For primary THA, all payers were profitable except Medicaid and selected managed care contracts. For revision THA, profit was achieved with payment from commercial insurance only. Despite the introduction of cost-containment programs, revision THA did not achieve profitability at our institution. PMID:10037332

  5. A dynamic model for costing disaster mitigation policies.

    PubMed

    Altay, Nezih; Prasad, Sameer; Tata, Jasmine

    2013-07-01

    The optimal level of investment in mitigation strategies is usually difficult to ascertain in the context of disaster planning. This research develops a model to provide such direction by relying on cost of quality literature. This paper begins by introducing a static approach inspired by Joseph M. Juran's cost of quality management model (Juran, 1951) to demonstrate the non-linear trade-offs in disaster management expenditure. Next it presents a dynamic model that includes the impact of dynamic interactions of the changing level of risk, the cost of living, and the learning/investments that may alter over time. It illustrates that there is an optimal point that minimises the total cost of disaster management, and that this optimal point moves as governments learn from experience or as states get richer. It is hoped that the propositions contained herein will help policymakers to plan, evaluate, and justify voluntary disaster mitigation expenditures. PMID:23601023

  6. Cost-effective design of economic instruments in nutrition policy.

    PubMed

    Jensen, Jørgen D; Smed, Sinne

    2007-01-01

    This paper addresses the potential for using economic regulation, e.g. taxes or subsidies, as instruments to combat the increasing problems of inappropriate diets, leading to health problems such as obesity, diabetes 2, cardiovascular diseases etc. in most countries. Such policy measures may be considered as alternatives or supplements to other regulation instruments, including information campaigns, bans or enhancement of technological solutions to the problems of obesity or related diseases. 7 different food tax and subsidy instruments or combinations of instruments are analysed quantitatively. The analyses demonstrate that the average cost-effectiveness with regard to changing the intake of selected nutritional variables can be improved by 10-30 per cent if taxes/subsidies are targeted against these nutrients, compared with targeting selected food categories. Finally, the paper raises a range of issues, which need to be investigated further, before firm conclusions about the suitability of economic instruments in nutrition policy can be drawn. PMID:17408494

  7. Managing the cost of emissions for durable, carbon-containing products

    SciTech Connect

    Shirley, Kevin; Marland, Eric; Cantrell, Jenna; Marland, Gregg

    2011-03-01

    We recognize that carbon-containing products do not decay and release CO2 to the atmosphere instantaneously, but release that carbon over extended periods of time. For an initial production of a stock of carbon-containing product, we can treat the release as a probability distribution covering the time over which that release occurs. The probability distribution that models the carbon release predicts the amount of carbon that is released as a function of time. The use of a probability distribution in accounting for the release of carbon to the atmosphere realizes a fundamental shift from the idea that all carbon-containing products contribute to a single pool that decays in proportion to the size of the stock. Viewing the release of carbon as a continuous probabilistic process introduces some theoretical opportunities not available in the former paradigm by taking advantage of other fields where the use of probability distributions has been prevalent for many decades. In particular, theories developed in the life insurance industry can guide the development of pricing and payment structures for dealing with the costs associated with the oxidation and release of carbon. These costs can arise from a number of proposed policies (cap and trade, carbon tax, social cost of carbon, etc), but in the end they all result in there being a cost to releasing carbon to the atmosphere. If there is a cost to the emitter for CO2 emissions, payment for that cost will depend on both when the emissions actually occur and how payment is made. Here we outline some of the pricing and payment structures that are possible which result from analogous theories in the life insurance industry. This development not only provides useful constructs for valuing sequestered carbon, but highlights additional motivations for employing a probability distribution approach to unify accounting methodologies for stocks of carbon containing products.

  8. Detecting nuclear materials smuggling: performance evaluation of container inspection policies.

    PubMed

    Gaukler, Gary M; Li, Chenhua; Ding, Yu; Chirayath, Sunil S

    2012-03-01

    In recent years, the United States, along with many other countries, has significantly increased its detection and defense mechanisms against terrorist attacks. A potential attack with a nuclear weapon, using nuclear materials smuggled into the country, has been identified as a particularly grave threat. The system for detecting illicit nuclear materials that is currently in place at U.S. ports of entry relies heavily on passive radiation detectors and a risk-scoring approach using the automated targeting system (ATS). In this article we analyze this existing inspection system and demonstrate its performance for several smuggling scenarios. We provide evidence that the current inspection system is inherently incapable of reliably detecting sophisticated smuggling attempts that use small quantities of well-shielded nuclear material. To counter the weaknesses of the current ATS-based inspection system, we propose two new inspection systems: the hardness control system (HCS) and the hybrid inspection system (HYB). The HCS uses radiography information to classify incoming containers based on their cargo content into "hard" or "soft" containers, which then go through different inspection treatment. The HYB combines the radiography information with the intelligence information from the ATS. We compare and contrast the relative performance of these two new inspection systems with the existing ATS-based system. Our studies indicate that the HCS and HYB policies outperform the ATS-based policy for a wide range of realistic smuggling scenarios. We also examine the impact of changes in adversary behavior on the new inspection systems and find that they effectively preclude strategic gaming behavior of the adversary. PMID:22043828

  9. Evaluation of the Arizona health care cost-containment system

    PubMed Central

    McCall, Nelda; Henton, Douglas; Crane, Michael; Haber, Susan; Freund, Deborah; Wrightson, William

    1985-01-01

    This article evaluates Arizona's alternative to the acute portion of Medicaid, the Arizona Health Care Cost-Containment System (AHCCCS), during its first 18 months of operation from October 1982 through March 1984. It focuses on the program's implementation and describes and evaluates the program's innovative features. The features of the program outlined in the original AHCCCS legislation included: Competitive bidding, prepaid capitation of providers, capitation of the State by the Health Care Financing Administration, assignment of gatekeepers, beneficiary copayment, private administration, inclusion of private and public employees and county financed long-term care. An assessment of implementation during the second 18 months of the program reporting on more recent developments and is now being prepared by SRI International. PMID:10311438

  10. Cost containment and quality of care in Japan: is there a trade-off?

    PubMed

    Hashimoto, Hideki; Ikegami, Naoki; Shibuya, Kenji; Izumida, Nobuyuki; Noguchi, Haruko; Yasunaga, Hideo; Miyata, Hiroaki; Acuin, Jose M; Reich, Michael R

    2011-09-24

    Japan's health indices such as life expectancy at birth are among the best in the world. However, at 8·5% the proportion of gross domestic product spent on health is 20th among Organisation for Economic Co-operation and Development countries in 2008 and half as much as that in the USA. Costs have been contained by the nationally uniform fee schedule, in which the global revision rate is set first and item-by-item revisions are then made. Although the structural and process dimensions of quality seem to be poor, the characteristics of the health-care system are primarily attributable to how physicians and hospitals have developed in the country, and not to the cost-containment policy. However, outcomes such as postsurgical mortality rates are as good as those reported for other developed countries. Japan's basic policy has been a combination of tight control of the conditions of payment, but a laissez-faire approach to how services are delivered; this combination has led to a scarcity of professional governance and accountability. In view of the structural problems facing the health-care system, the balance should be shifted towards increased freedom of payment conditions by simplification of reimbursement rules, but tightened control of service delivery by strengthening of regional health planning, both of which should be supported through public monitoring of providers' performance. Japan's experience of good health and low cost suggests that the priority in health policy should initially be improvement of access and prevention of impoverishment from health care, after which efficiency and quality of services should then be pursued. PMID:21885098

  11. The effect of owning private long-term care insurance policies on out-of-pocket costs.

    PubMed Central

    Rice, T; Thomas, K; Weissert, W

    1991-01-01

    This article examines the effect of owning long-term care insurance policies on the amount of out-of-pocket costs incurred by the elderly during their nursing home stays, and the importance of different policy features and restrictions. Data were drawn from the 1985 National Nursing Home Survey, and from copies of long-term care insurance policies collected from 11 leading companies during the spring and summer of 1988. The study results show a great deal of uncertainty concerning amounts the policies are likely to pay toward nursing home stays. This implies that the policies collected did not adequately fulfill one of the primary purposes of insurance: a reduction in risk and uncertainty. To examine whether rapid policy changes in recent years have made a difference, we assessed each of seven policy features and found that the two most important restrictions in long-term care insurance policies are prior hospitalization and level-of-care requirements. Recently, the National Association of Insurance Commissioners (NAIC) recommended that states prohibit the sale of policies containing these restrictions. Our findings confirm the wisdom of this recommendation. We did find, however, that two other policy restrictions--policy maximums and lack of inflation adjustment--are problematic. We recommend that the NAIC expand its model regulations to require that policy maximums be a minimum of four years, and that some form of inflation protection be incorporated into policy benefit structures. PMID:1899410

  12. Container-based sanitation: assessing costs and effectiveness of excreta management in Cap Haitien, Haiti

    PubMed Central

    Tilmans, Sebastien; Russel, Kory; Sklar, Rachel; Page, Leah; Kramer, Sasha

    2015-01-01

    Container-based sanitation (CBS) – in which wastes are captured in sealable containers that are then transported to treatment facilities – is an alternative sanitation option in urban areas where on-site sanitation and sewerage are infeasible. This paper presents the results of a pilot household CBS service in Cap Haitien, Haiti. We quantify the excreta generated weekly in a dense urban slum,(1) the proportion safely removed via container-based public and household toilets, and the costs associated with these systems. The CBS service yielded an approximately 3.5-fold decrease in the unmanaged share of faeces produced, and nearly eliminated the reported use of open defecation and “flying toilets” among service recipients. The costs of this pilot small-scale service were higher than those of large-scale waterborne sewerage, but economies of scale have the potential to reduce CBS costs over time. The paper concludes with a discussion of planning and policy implications of incorporating CBS into the menu of sanitation options for rapidly growing cities. PMID:26097288

  13. Ship Compliance in Emission Control Areas: Technology Costs and Policy Instruments.

    PubMed

    Carr, Edward W; Corbett, James J

    2015-08-18

    This paper explores whether a Panama Canal Authority pollution tax could be an effective economic instrument to achieve Emission Control Area (ECA)-like reductions in emissions from ships transiting the Panama Canal. This tariff-based policy action, whereby vessels in compliance with International Maritime Organisation (IMO) ECA standards pay a lower transit tariff than noncompliant vessels, could be a feasible alternative to petitioning for a Panamanian ECA through the IMO. A $4.06/container fuel tax could incentivize ECA-compliant emissions reductions for nearly two-thirds of Panama Canal container vessels, mainly through fuel switching; if the vessel(s) also operate in IMO-defined ECAs, exhaust-gas treatment technologies may be cost-effective. The RATES model presented here compares current abatement technologies based on hours of operation within an ECA, computing costs for a container vessel to comply with ECA standards in addition to computing the Canal tax that would reduce emissions in Panama. Retrofitted open-loop scrubbers are cost-effective only for vessels operating within an ECA for more than 4500 h annually. Fuel switching is the least-cost option to industry for vessels that operate mostly outside of ECA regions, whereas vessels operating entirely within an ECA region could reduce compliance cost with exhaust-gas treatment technology (scrubbers). PMID:26258438

  14. Cost Sharing in Higher Education in Kenya: Examining the Undesired Policy Outcomes

    ERIC Educational Resources Information Center

    Ngolovoi, Mary S.

    2010-01-01

    Cost sharing in higher education is a policy that comes from the United States. The policy advocates that costs of higher education should be shared between the government, parents, students and/or donor organizations. Proponents of the policy (such as the World Bank) have over the years been advocating for its implementation in African countries.…

  15. Costs and benefits of children: implications for population policy.

    PubMed

    Robey, B

    1989-03-01

    Family size preferences are strongly affected by parents' perceptions of the value, economic contributions, and costs of children. Better understanding of these factors can help policy-makers to improve the effectiveness of population IEC campaigns, design strategies to persuade couples to have smaller families, assess the relationship between economic development and family size preferences, and devise national population policies and family planning programs that reflect individual choices. Parents in high-fertility countries are more likely to perceive children as productive investments than those in low-fertility countries. Parents in the former countries maintain children are an economic advantage or provide practical assistance in the household; they are less likely to emphasize the psychological advantages of children. As economic development occurs, and parents no longer value children for their economic contributions, psychological and social reasons become more important. Changing fertility preferences is more complex than providing couples with family planning services. Similarly, efforts to persuade families that large families are a burden are successful only when families are already interested in reducing their family size. Efforts to persuade couples to have smaller families are likely to be more successful if there are alternative sources of old-age support available, for example, from increased household savings, public or private pensions, or greater contributions from 1st and 2nd children. Investments in education and training, especially for women and children, would also support these goals. PMID:12315609

  16. Containing U.S. health care costs: What bullet to bite?

    PubMed Central

    Jencks, Stephen F.; Schieber, George J.

    1992-01-01

    In this article, the authors provide an overview of the problem of health care cost containment. Both the growth of health care spending and its underlying causes are discussed. Further, the authors define cost containment, provide a framework for describing cost-containment strategies, and describe the major cost-containment strategies. Finally, the role of research in choosing such a strategy for the United States is examined. PMID:25372928

  17. Health Cost Containment, Wellness, and the 1990s.

    ERIC Educational Resources Information Center

    Stasica, Edward R.

    Virtually every employer has it in their power to reduce their employee health care costs by 10-20 percent or more. The solution to the rising health care costs problem is a total health care system. Most cost savings potential will be centered in three areas: control of wasteful and often harmful use of the health care system; provider price…

  18. 75 FR 26270 - Environmental Planning and Historic Preservation Compliance Costs Policy; Environmental Planning...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-11

    ... SECURITY Federal Emergency Management Agency Environmental Planning and Historic Preservation Compliance Costs Policy; Environmental Planning and Historic Preservation Mitigation Policy AGENCY: Federal... Emergency Management Agency (FEMA) is accepting comments on a draft Environmental Planning and...

  19. Optimal management of a stochastically varying population when policy adjustment is costly.

    PubMed

    Boettiger, Carl; Bode, Michael; Sanchirico, James N; Lariviere, Jacob; Hastings, Alan; Armsworth, Paul R

    2016-04-01

    Ecological systems are dynamic and policies to manage them need to respond to that variation. However, policy adjustments will sometimes be costly, which means that fine-tuning a policy to track variability in the environment very tightly will only sometimes be worthwhile. We use a classic fisheries management problem, how to manage a stochastically varying population using annually varying quotas in order to maximize profit, to examine how costs of policy adjustment change optimal management recommendations. Costs of policy adjustment (changes in fishing quotas through time) could take different forms. For example, these costs may respond to the size of the change being implemented, or there could be a fixed cost any time a quota change is made. We show how different forms of policy costs have contrasting implications for optimal policies. Though it is frequently assumed that costs to adjusting policies will dampen variation in the policy, we show that certain cost structures can actually increase variation through time. We further show that failing to account for adjustment costs has a consistently worse economic impact than would assuming these costs are present when they are not. PMID:27411252

  20. Cost-containment and the use of reference laboratories.

    PubMed

    Shaw, S T; Miller, J M

    1985-12-01

    Hospital laboratories and hospital-independent reference laboratories will need to change in order to provide comprehensive, medically appropriate, and reasonably priced laboratory services in the cost-containment age we are entering. The change must be economically and technologically innovative and relevant to society's next generation of health care needs. Hospital laboratories and commercial laboratories may become weaker or stronger relative to one another, but our guess is that they will ultimately become more like one another or even may join forces to provide optimal patient care in the future. Until that time comes, hospital laboratories must decide whether to employ reference laboratory services more or less, enter a joint venture with a reference laboratory, or become a reference laboratory. Some of the items that could be considered in arriving at this decision are listed in Table 2. Some items favor hospital laboratories; some favor reference laboratories; some are a toss-up; and some suggest there are advantages in a team approach. For the present, we believe there are many arguments favoring a continuation and possibly even an expansion of hospital laboratory services, but this will likely be most feasible in financially sound and progressive hospitals having forward-looking administrators and imaginative but fiscally minded laboratory directors and managers. If decisions are made to send more tests to reference laboratories, each hospital or user laboratory must seek the best and most cost-effective services available. Various financial, technical, and medical considerations are described that should aid in the evaluation of where to have tests performed. We have provided suggestions on how agreements with reference laboratories can be established in either a formal (contractual) or an informal (verbal) way. Additionally, we have described methods for evaluating (or monitoring) the quality and quantity of services received from a reference

  1. European hospital reforms in times of crisis: aligning cost containment needs with plans for structural redesign?

    PubMed

    Clemens, Timo; Michelsen, Kai; Commers, Matt; Garel, Pascal; Dowdeswell, Barrie; Brand, Helmut

    2014-07-01

    Hospitals have become a focal point for health care reform strategies in many European countries during the current financial crisis. It has been called for both, short-term reforms to reduce costs and long-term changes to improve the performance in the long run. On the basis of a literature and document analysis this study analyses how EU member states align short-term and long-term pressures for hospital reforms in times of the financial crisis and assesses the EU's influence on the national reform agenda. The results reveal that there has been an emphasis on cost containment measures rather than embarking on structural redesign of the hospital sector and its position within the broader health care system. The EU influences hospital reform efforts through its enhanced economic framework governance which determines key aspects of the financial context for hospitals in some countries. In addition, the EU health policy agenda which increasingly addresses health system questions stimulates the process of structural hospital reforms by knowledge generation, policy advice and financial incentives. We conclude that successful reforms in such a period would arguably need to address both the organisational and financing sides to hospital care. Moreover, critical to structural reform is a widely held acknowledgement of shortfalls in the current system and belief that new models of hospital care can deliver solutions to overcome these deficits. Advancing the structural redesign of the hospital sector while pressured to contain cost in the short-term is not an easy task and only slowly emerging in Europe. PMID:24703855

  2. 39 CFR 551.8 - Cost offset policy.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... to package comparable stamps; (2) Printing costs of flyers and special receipts; (3) Costs of changes... (including market research); (2) Costs of stamp production and printing; (3) Costs of stamp shipping and...) may be used for specific cost comparisons. (d) Except as specified, all costs associated...

  3. Japan's universal long-term care system reform of 2005: containing costs and realizing a vision.

    PubMed

    Tsutsui, Takako; Muramatsu, Naoko

    2007-09-01

    Japan implemented a mandatory social long-term care insurance (LTCI) system in 2000, making long-term care services a universal entitlement for every senior. Although this system has grown rapidly, reflecting its popularity among seniors and their families, it faces several challenges, including skyrocketing costs. This article describes the recent reform initiated by the Japanese government to simultaneously contain costs and realize a long-term vision of creating a community-based, prevention-oriented long-term care system. The reform involves introduction of two major elements: "hotel" and meal charges for nursing home residents and new preventive benefits. They were intended to reduce economic incentives for institutionalization, dampen provider-induced demand, and prevent seniors from being dependent by intervening while their need levels are still low. The ongoing LTCI reform should be critically evaluated against the government's policy intentions as well as its effect on seniors, their families, and society. The story of this reform is instructive for other countries striving to develop coherent, politically acceptable long-term care policies. PMID:17767690

  4. An analysis of structural incentives in the Arizona Health Care Cost-Containment System

    PubMed Central

    Vogel, Ronald J.

    1984-01-01

    This article analyzes the financial structures of the prevailing public and private health insurance mechanisms. Based on this analysis, it was concluded that the financial structures of health insurance mechanisms are deficient in that they neither produce efficiency in the consumption of health services, nor generate efficiency in the production of health services. On the other hand, closed-end systems of finance, such as the health maintenance organization (HMO) or the new Arizona Health Care Cost-Containment System (AHCCCS), give more promise of achieving such efficiencies. The AHCCCS represents an important innovation in the public financing of health care, and, for policy purposes, should be considered a viable national alternative for the reform of Medicare and Medicaid. PMID:10310943

  5. Analysis of a corporation's health care experience: implications for cost containment and disease prevention.

    PubMed

    Bernacki, E J; Tsai, S P; Reedy, S M

    1986-07-01

    This article presents the health care experience of 14,162 employees and their families, covered under a private third-party insurance plan of a large multinational corporation for the 1984 policy year. A total of $29.5 million was charged by health care providers to deliver medical care for the studied employees and their families. This amounted to $2,083 per employee and his/her family. Approximately 51% of the employees submitted claims, with females having greater utilization than males. The highest expenditures were for diseases of the circulatory system among adults (3.2 million or 23% for employees, $1.5 million or 14% for spouses). Among employees, neoplasms accounted for $1.4 million or 10% of costs, and musculoskeletal system $1.2 million or 9% of costs. Among spouses, pregnancy and diseases of the female reproductive system accounted for $1.2 million (12%) and $1.1 million (10%), respectively. Among dependents, the top three cost categories were mental disorders ($1.2 million or 24%), accident-related illnesses ($0.7 million or 14%), and diseases of the respiratory system ($0.6 million or 12%). Hospital care expenditures, including room and board, ancillary, and physician services, accounted for approximately 60% of total health care spending. The percentage of health care costs paid for by this insurance plan was 75% for active employees, 34% for retirees, 60% for female spouses, 38% for male spouses, and 64% for dependents. The analyses and parameters measured can be viewed as the first step toward the development of a health care cost containment and disease prevention strategy. PMID:3734919

  6. 42 CFR 100.2 - Average cost of a health insurance policy.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Average cost of a health insurance policy. 100.2 Section 100.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of...

  7. 42 CFR 100.2 - Average cost of a health insurance policy.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Average cost of a health insurance policy. 100.2 Section 100.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of...

  8. 42 CFR 100.2 - Average cost of a health insurance policy.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Average cost of a health insurance policy. 100.2 Section 100.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of...

  9. 42 CFR 100.2 - Average cost of a health insurance policy.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Average cost of a health insurance policy. 100.2 Section 100.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of...

  10. 42 CFR 100.2 - Average cost of a health insurance policy.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Average cost of a health insurance policy. 100.2 Section 100.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES VACCINES VACCINE INJURY COMPENSATION § 100.2 Average cost of a health insurance policy. For purposes of...

  11. Estimating the Cost of National Class Size Reductions under Different Policy Alternatives.

    ERIC Educational Resources Information Center

    Brewer, Dominic J.; Krop, Cathy; Gill, Brian P.; Reichardt, Robert

    1999-01-01

    Estimates the operational costs of nationwide class-size-reduction programs under various policy alternatives, including the specified class size, flexibility in implementation, and whether the policy is targeted toward at-risk students. Depending on the options, estimated costs range from about $2 billion per year to over $11 billion per year.…

  12. Using the Kaldor-Hicks Tableau Format for Cost-Benefit Analysis and Policy Evaluation

    ERIC Educational Resources Information Center

    Krutilla, Kerry

    2005-01-01

    This note describes the Kaldor-Hicks (KH) tableau format as a framework for distributional accounting in cost-benefit analysis and policy evaluation. The KH tableau format can serve as a heuristic aid for teaching microeconomics-based policy analysis, and offer insight to policy analysts and decisionmakers beyond conventional efficiency analysis.

  13. Understanding the cost bases of Space Shuttle pricing policies for commercial and foreign customers

    NASA Technical Reports Server (NTRS)

    Stone, Barbara A.

    1984-01-01

    The principles and underlying cost bases of the 1977 and 1982 Space Shuttle Reimbursement Policies are compared and contrasted. Out-of-pocket cost recovery has been chosen as the base of the price for the 1986-1988 time period. With this cost base, it is NASA's intent to recover the total cost of consumables and the launch and flight operations costs added by commercial and foreign customers over the 1986-1988 time period. Beyond 1988, NASA intends to return to its policy of full cost recovery.

  14. Reliability and cost evaluation of small isolated power systems containing photovoltaic and wind energy

    NASA Astrophysics Data System (ADS)

    Karki, Rajesh

    risk, well-being and energy based indices to provide realistic cost/reliability measures of utilizing renewable energy. The concepts presented and the examples illustrated in this thesis will help system planners to decide on appropriate installation sites, the types and mix of different energy generating sources, the optimum operating policies, and the optimum generation expansion plans required to meet increasing load demands in small isolated power systems containing photovoltaic and wind energy sources.

  15. The ABCs of Activity-Based Costing: A Cost Containment and Reallocation Tool.

    ERIC Educational Resources Information Center

    Turk, Frederick J.

    1992-01-01

    This article describes activity-based costing (ABC) and how this tool may help management understand the costs of major activities and identify possible alternatives. Also discussed are the traditional costing systems used by higher education and ways of applying ABC to higher education. (GLR)

  16. The High Cost of Teacher Turnover. Policy Brief

    ERIC Educational Resources Information Center

    National Commission on Teaching and America's Future, 2007

    2007-01-01

    In 2007, the National Commission on Teaching and America's Future (NCTAF) completed an 18-month study of the costs of teacher turnover in five school districts. The selected districts varied in size, location, and demographics enabling exploration of how these variations affected costs. Costs of recruiting, hiring, processing, and training…

  17. An Industrial Engineering Approach to Cost Containment of Pharmacy Education.

    PubMed

    Duncan, Wendy; Bottenberg, Michelle; Chase, Marilea; Chesnut, Renae; Clarke, Cheryl; Schott, Kathryn; Torry, Ronald; Welty, Tim

    2015-11-25

    A 2-semester project explored employing teams of fourth-year industrial engineering students to optimize some of our academic management processes. Results included significant cost savings and increases in efficiency, effectiveness, and student and faculty satisfaction. While we did not adopt all of the students' recommendations, we did learn some important lessons. For example, an initial investment of time in developing a mutually clear understanding of the problems, constraints, and goals maximizes the value of industrial engineering analysis and recommendations. Overall, industrial engineering was a valuable tool for optimizing certain academic management processes. PMID:26839421

  18. An Industrial Engineering Approach to Cost Containment of Pharmacy Education

    PubMed Central

    Bottenberg, Michelle; Chase, Marilea; Chesnut, Renae; Clarke, Cheryl; Schott, Kathryn; Torry, Ronald; Welty, Tim

    2015-01-01

    A 2-semester project explored employing teams of fourth-year industrial engineering students to optimize some of our academic management processes. Results included significant cost savings and increases in efficiency, effectiveness, and student and faculty satisfaction. While we did not adopt all of the students’ recommendations, we did learn some important lessons. For example, an initial investment of time in developing a mutually clear understanding of the problems, constraints, and goals maximizes the value of industrial engineering analysis and recommendations. Overall, industrial engineering was a valuable tool for optimizing certain academic management processes. PMID:26839421

  19. Policies of containment: immigration in the era of AIDS.

    PubMed Central

    Fairchild, A L; Tynan, E A

    1994-01-01

    The US Public Health Service began the medical examination of immigrants at US ports in 1891. By 1924, national origin had become a means to justify broad-based exclusion of immigrants after Congress passed legislation restricting immigration from southern and eastern European countries. This legislation was passed based on the alleged genetic inferiority of southern and eastern Europeans. Since 1987, the United States has prohibited the entrance of immigrants infected with the human immunodeficiency virus (HIV). On the surface, a policy of excluding individuals with an inevitably fatal "communicable disease of public health significance" rests solidly in the tradition of protecting public health. But excluding immigrants with HIV is also a policy that, in practice, resembles the 1924 tradition of selective racial restriction of immigrants from "dangerous nations." Since the early 1980s, the United States has erected barriers against immigrants from particular Caribbean and African nations, whose citizens were thought to pose a threat of infecting the US blood supply with HIV. Images p2012-a p2014-a PMID:7998650

  20. Containing the cost of third-molar extractions: a dilemma for health insurance.

    PubMed Central

    Friedman, J W

    1983-01-01

    No known scientific studies support the extraction of third molars (wisdom teeth) to prevent future disease. Yet, third-molar surgery for this purpose has become so common that in at least one major U.S. health insurance plan, the cumulative cost exceeds that for every other kind of major surgery. Many third molars that are developing normally in adolescents are classified as impacted and removed before they erupt, a practice that results in large expenditures for unnecessary surgery. In addition, the difficulty of the extractions is frequently exaggerated, so that patients and insurance plans are overcharged. Third molar surgery is not without risk of iatrogenic injury. Fracture of the jaw, permanent numbness of the lip (paresthesia), and injury to other teeth may occur. This paper presents a mechanism for containing the cost of third-molar surgery by elimination of payment for nonessential extractions and of the related overcharges. Adoption of this policy by administrators of dental insurance plans would save millions of dollars each year, money that could be better used in providing care for more people with real dental disease. PMID:6611824

  1. Tobacco litter costs and public policy: a framework and methodology for considering the use of fees to offset abatement costs

    PubMed Central

    Peterson, N Andrew; Kiss, Noemi; Ebeid, Omar; Doyle, Alexis S

    2011-01-01

    Objectives Growing concern over the costs, environmental impact and safety of tobacco product litter (TPL) has prompted states and cities to undertake a variety of policy initiatives, of which litter abatement fees are part. The present work describes a framework and methodology for calculating TPL costs and abatement fees. Methods Abatement is associated with four categories of costs: (1) mechanical and manual abatement from streets, sidewalks and public places, (2) mechanical and manual abatement from storm water and sewer treatment systems, (3) the costs associated with harm to the ecosystem and harm to industries dependent on clean and healthy ecosystems, and (4) the costs associated with direct harm to human health. The experiences of the City of San Francisco's recently proposed tobacco litter abatement fee serve as a case study. Results City and municipal TPL costs are incurred through manual and mechanical clean-up of surfaces and catchment areas. According to some studies, public litter abatement costs to US cities range from US$3 million to US$16 million. TPL typically comprises between 22% and 36% of all visible litter, implying that total public TPL direct abatement costs range from about US$0.5 million to US$6 million for a city the size of San Francisco. The costs of mitigating the negative externalities of TPL in a city the size of San Francisco can be offset by implementing a fee of approximately US$0.20 per pack. Conclusions Tobacco litter abatement costs to cities can be substantial, even when the costs of potential environmental pollution and tourism effects are excluded. One public policy option to address tobacco litter is levying of fees on cigarettes sold. The methodology described here for calculating TPL costs and abatement fees may be useful to state and local authorities who are considering adoption of this policy initiative. PMID:21504923

  2. 24 CFR 891.670 - Cost containment and modest design standards.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Cost containment and modest design... Handicapped Families and Individuals-Section 162 Assistance § 891.670 Cost containment and modest design standards. (a) Restrictions on amenities. Projects must be modest in design. Except as provided in...

  3. College Costs: Recent Trends, Likely Future. Policy Brief.

    ERIC Educational Resources Information Center

    Henderson, Cathy

    Recent trends in college costs and reasons why college costs have been increasing are considered. Comparative data are presented on recent rates of growth among average college charges, faculty salaries, the Higher Education Price Index (HEPI), and the Consumer Price Index (CPI). It is shown that from 1977 through 1982, average total tuition,…

  4. New Center Applies Cost-Benefit Analysis to Education Policies

    ERIC Educational Resources Information Center

    Viadero, Debra

    2008-01-01

    This article describes the Center for Benefit-Cost Studies of Education, at Teachers College, Columbia University. Launched last year by a pair of economists, the center specializes in calculating and comparing the long- and short-term costs--and probable payoffs--of different educational strategies that promise to improve students' lives. Studies…

  5. Cost Benefit Analysis of Two Policy Options for Cannabis: Status Quo and Legalisation

    PubMed Central

    Shanahan, Marian; Ritter, Alison

    2014-01-01

    Aims To date there has been limited analysis of the economic costs and benefits associated with cannabis legalisation. This study redresses this gap. A cost benefit analysis of two cannabis policy options the status quo (where cannabis use is illegal) and a legalised–regulated option was conducted. Method A cost benefit analysis was used to value the costs and benefits of the two policies in monetary terms. Costs and benefits of each policy option were classified into five categories (direct intervention costs, costs or cost savings to other agencies, benefits or lost benefits to the individual or the family, other impacts on third parties, and adverse or spill over events). The results are expressed as a net social benefit (NSB). Findings The mean NSB per annum from Monte Carlo simulations (with the 5 and 95 percentiles) for the status quo was $294.6 million AUD ($201.1 to $392.7 million) not substantially different from the $234.2 million AUD ($136.4 to $331.1 million) for the legalised–regulated model which excludes government revenue as a benefit. When government revenue is included, the NSB for legalised–regulated is higher than for status quo. Sensitivity analyses demonstrate the significant impact of educational attainment and wellbeing as drivers for the NSB result. Conclusion Examining the percentiles around the two policy options, there appears to be no difference between the NSB for these two policy options. Economic analyses are essential for good public policy, providing information about the extent to which one policy is substantially economically favourable over another. In cannabis policy, for these two options this does not appear to be the case. PMID:24755942

  6. Final Technical Report Power through Policy: "Best Practices" for Cost-Effective Distributed Wind

    SciTech Connect

    Rhoads-Weaver, Heather; Gagne, Matthew; Sahl, Kurt; Orrell, Alice; Banks, Jennifer

    2012-02-28

    Power through Policy: 'Best Practices' for Cost-Effective Distributed Wind is a U.S. Department of Energy (DOE)-funded project to identify distributed wind technology policy best practices and to help policymakers, utilities, advocates, and consumers examine their effectiveness using a pro forma model. Incorporating a customized feed from the Database of State Incentives for Renewables and Efficiency (DSIRE), the Web-based Distributed Wind Policy Comparison Tool (Policy Tool) is designed to assist state, local, and utility officials in understanding the financial impacts of different policy options to help reduce the cost of distributed wind technologies. The project's final products include the Distributed Wind Policy Comparison Tool, found at www.windpolicytool.org, and its accompanying documentation: Distributed Wind Policy Comparison Tool Guidebook: User Instructions, Assumptions, and Case Studies. With only two initial user inputs required, the Policy Tool allows users to adjust and test a wide range of policy-related variables through a user-friendly dashboard interface with slider bars. The Policy Tool is populated with a variety of financial variables, including turbine costs, electricity rates, policies, and financial incentives; economic variables including discount and escalation rates; as well as technical variables that impact electricity production, such as turbine power curves and wind speed. The Policy Tool allows users to change many of the variables, including the policies, to gauge the expected impacts that various policy combinations could have on the cost of energy (COE), net present value (NPV), internal rate of return (IRR), and the simple payback of distributed wind projects ranging in size from 2.4 kilowatts (kW) to 100 kW. The project conducted case studies to demonstrate how the Policy Tool can provide insights into 'what if' scenarios and also allow the current status of incentives to be examined or defended when necessary. The ranking

  7. 76 FR 60357 - Federal Regulations; OMB Circulars, OFPP Policy Letters, and CASB Cost Accounting Standards...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-29

    ... implementing Executive Order No. 12866 (October 4, 1993, 58 FR 51735). OMB policy guidelines are issued under... / Thursday, September 29, 2011 / Rules and Regulations#0;#0; ] OFFICE OF MANAGEMENT AND BUDGET 5 CFR Ch. III and 48 CFR Ch. 1 Federal Regulations; OMB Circulars, OFPP Policy Letters, and CASB Cost...

  8. 75 FR 49508 - Recovery Policy, RP9525.7, Labor Costs-Emergency Work

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-13

    ... SECURITY Federal Emergency Management Agency Recovery Policy, RP9525.7, Labor Costs--Emergency Work AGENCY...--Emergency Work. This is an existing policy that is scheduled for review to ensure that Recovery Directorate..., temporary, and contract employees who perform emergency work (Categories A and B). DATES: Comments must...

  9. Cost justification of filmless PACS and national policy

    NASA Astrophysics Data System (ADS)

    Lim, Jae H.

    2002-05-01

    The expense of installing PACS is high so most Korean hospitals cannot afford to purchase the system easily. We can justify the cost of PACS by considering the visible and invisible benefits. As a visible benefit we can save the cost of films and equipments for film processing. Invisible benefits of PACS is the cost of film handling. Generally, doctors spend some 25 minutes in handling X-ray films everyday and they spend 10 days (84 hours) throughout a year. Radiology technicians, nurses, orderlies and clerks also handle films and the total salary for handling films by doctors and paramedics will be considerable. Considering the visible and invisible benefits, cost of PACS is justified and PACS can be installed in every hospital, whatever their size. The Korean Society of PACS tried to make reimbursement of the cost of PACS and persuaded the government officers and eventually the Ministry of Health and Welfare decided to reimburse the use of PACS in hospitals. Based on the money reimbursed, general hospitals or university hospitals will earn enough money to purchase a PACS in 3 - 5 years. After the Korean government started to reimburse the cost of PACS, many hospitals wanted to install PACS and the number of hospitals installing PACS is soaring.

  10. Optimal production policy for a remanufacturing system with virtual inventory cost

    NASA Astrophysics Data System (ADS)

    Nakashima, Kenichi; Gupta, Surendra M.

    2005-11-01

    This paper deals with a cost management problem of a remanufacturing system with stochastic demand. We model the system with consideration for two types of inventories. One is the actual product inventory in the factory. The other is the virtual inventory that is being used by the customer. For this virtual inventory, it should be required to consider an operational cost that we need in order to observe and check the quantity of the inventory. We call this the virtual inventory cost and model the system by including it. We define the state of the remanufacturing system by the two inventory levels. It is assumed that the cost function is composed of various cost factors such as holding, backlog and manufacturing costs. We obtain the optimal policy that minimizes the expected average cost per period. Numerical results reveal the effects of the factors on the optimal policy.

  11. Extended Cost-Effectiveness Analysis for Health Policy Assessment: A Tutorial.

    PubMed

    Verguet, Stéphane; Kim, Jane J; Jamison, Dean T

    2016-09-01

    Health policy instruments such as the public financing of health technologies (e.g., new drugs, vaccines) entail consequences in multiple domains. Fundamentally, public health policies aim at increasing the uptake of effective and efficient interventions and at subsequently leading to better health benefits (e.g., premature mortality and morbidity averted). In addition, public health policies can provide non-health benefits in addition to the sole well-being of populations and beyond the health sector. For instance, public policies such as social and health insurance programs can prevent illness-related impoverishment and procure financial risk protection. Furthermore, public policies can improve the distribution of health in the population and promote the equalization of health among individuals. Extended cost-effectiveness analysis was developed to address health policy assessment, specifically to evaluate the health and financial consequences of public policies in four domains: (1) the health gains; (2) the financial risk protection benefits; (3) the total costs to the policy makers; and (4) the distributional benefits. Here, we present a tutorial that describes both the intent of extended cost-effectiveness analysis and its keys to allow easy implementation for health policy assessment. PMID:27374172

  12. School Transportation Costs, Policies and Practices: A Review of Issues in New York and Selected States.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Educational Research Services Unit.

    To draw comparisons for assessing transportation costs and developing recommendations for legislative action in New York, this study compares school transportation policies and practices that may be related to differences in transportation costs in eight states having the largest public school enrollments for 1980. Data were obtained from existing…

  13. Policies with Varying Costs and Benefits: A Land Conservation Classroom Game

    ERIC Educational Resources Information Center

    Dissanayake, Sahan T. M.; Jacobson, Sarah A.

    2016-01-01

    Some policies try to maximize net benefits by targeting different individuals to participate. This is difficult when costs and benefits of participation vary independently, such as in land conservation. The authors share a classroom game that explores cases in which minimizing costs may not maximize benefits and vice versa. The game is a…

  14. Strengthening Cost-Effectiveness Analysis for Public Health Policy.

    PubMed

    Russell, Louise B; Sinha, Anushua

    2016-05-01

    Although the U.S. spends more on medical care than any country in the world, Americans live shorter lives than the citizens of other high-income countries. Many important opportunities to improve this record lie outside the health sector and involve improving the conditions in which Americans live and work: safe design and maintenance of roads, bridges, train tracks, and airports; control of environmental pollutants; occupational safety; healthy buildings; a safe and healthy food supply; safe manufacture of consumer products; a healthy social environment; and others. Faced with the overwhelming array of possibilities, U.S. decision makers need help identifying those that can contribute the most to health. Cost-effectiveness analysis is designed to serve that purpose, but has mainly been used to assess interventions within the health sector. This paper briefly reviews the objective of cost-effectiveness analysis and its methodologic evolution and discusses the issues that arise when it is used to evaluate interventions that fall outside the health sector under three headings: structuring the analysis, quantifying/measuring benefits and costs, and valuing benefits and costs. PMID:27102861

  15. A Pollution Control Strategy Game: Costs of Control Policies.

    ERIC Educational Resources Information Center

    Bierma, Thomas J.; Walbert, Mark S.

    1987-01-01

    Describes an interactive classroom game designed to enhance student understanding of air pollution control strategies. Discusses the game's focus on the differences in compliance costs that can occur between the three principal control approaches of emission limits, emission permits, and emission taxes. (TW)

  16. Status of costing hospital nursing work within Australian casemix activity-based funding policy.

    PubMed

    Heslop, Liza

    2012-02-01

    Australia has a long history of patient level costing initiated when casemix funding was implemented in several states in the early 1990s. Australia includes, to some extent, hospital payment based on nursing intensity adopted within casemix funding policy and the Diagnostic Related Group system. Costing of hospital nursing services in Australia has not changed significantly in the last few decades despite widespread introduction of casemix funding policy at the state level. Recent Commonwealth of Australia National Health Reform presents change to the management of the delivery of health care including health-care costing. There is agreement for all Australian jurisdictions to progress to casemix-based activity funding. Within this context, nurse costing infrastructure presents contemporary issues and challenges. An assessment is made of the progress of costing nursing services within casemix funding models in Australian hospitals. Valid and reliable Australian-refined nursing service weights might overcome present cost deficiencies and limitations. PMID:22257324

  17. Improving air pollution control policy in China--A perspective based on cost-benefit analysis.

    PubMed

    Gao, Jinglei; Yuan, Zengwei; Liu, Xuewei; Xia, Xiaoming; Huang, Xianjin; Dong, Zhanfeng

    2016-02-01

    To mitigate serious air pollution, the State Council of China promulgated the Air Pollution Prevention and Control Action Plan in 2013. To verify the feasibility and validity of industrial energy-saving and emission-reduction policies in the action plan, we conducted a cost-benefit analysis of implementing these policies in 31 provinces for the period of 2013 to 2017. We also completed a scenario analysis in this study to assess the cost-effectiveness of different measures within the energy-saving and the emission-reduction policies individually. The data were derived from field surveys, statistical yearbooks, government documents, and published literatures. The results show that total cost and total benefit are 118.39 and 748.15 billion Yuan, respectively, and the estimated benefit-cost ratio is 6.32 in the S3 scenario. For all the scenarios, these policies are cost-effective and the eastern region has higher satisfactory values. Furthermore, the end-of-pipe scenario has greater emission reduction potential than energy-saving scenario. We also found that gross domestic product and population are significantly correlated with the benefit-cost ratio value through the regression analysis of selected possible influencing factors. The sensitivity analysis demonstrates that benefit-cost ratio value is more sensitive to unit emission-reduction cost, unit subsidy, growth rate of gross domestic product, and discount rate among all the parameters. Compared with other provinces, the benefit-cost ratios of Beijing and Tianjin are more sensitive to changes of unit subsidy than unit emission-reduction cost. These findings may have significant implications for improving China's air pollution prevention policy. PMID:26595398

  18. Risk informed resource allocation policy: safety can save costs.

    PubMed

    Pasman, H J

    2000-01-01

    During economic doldrums, decision making on investments for safety is even more difficult than it already is when funds are abundant. This paper attempts to offer some guidance. After stating the present challenge to prevention of losses in the process industries, the systematic approach of quantified risk assessment is briefly reviewed and improvements in the methodology are mentioned. In addition, attention is given to the use of a risk matrix to survey a plant and to derive a plan of action. Subsequently, the reduction of risk is reviewed. Measures for prevention, protection, and mitigation are discussed. The organization of safety has become at least as important as technical safety of equipment and standards. It is reflected in the introduction of a safety management system. Furthermore, the design process in a pro-active approach is described and the concept of inherent safety is briefly addressed. The concept of Layer of Protection Analysis is explained and also the reason why it is relevant to provide a cost-benefit analysis. Finally, after comments regarding the cost of accidents, the basics of costing and profitability are summarized and a way is suggested to apply this approach to risk-reducing measures. An example is provided on how a selection can be made from a number of alternatives. PMID:10677670

  19. Initiatives for Containing the Cost of Higher Education. Stretching the Higher Education Dollar. Special Report 1

    ERIC Educational Resources Information Center

    Massy, William F.

    2013-01-01

    In this article, the author offers a comprehensive reform agenda for policymakers interested in cost containment. Massy lays out a series of initiatives that, working in tandem, can promote the larger goal of compelling colleges to spend money wisely. Among the individual reforms Massy proposes are creating a national database of cost-containment…

  20. Potential unintended pregnancies averted and cost savings associated with a revised Medicaid sterilization policy

    PubMed Central

    Borrero, Sonya; Zite, Nikki; Potter, Joseph E.; Trussell, James; Smith, Kenneth

    2013-01-01

    Objective Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly-funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers. Study design We constructed a cost effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a post-partum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively. Results With the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and $215 million saved. Conclusion A revised Medicaid sterilization policy could potentially honor women's reproductive decisions, reduce the number of unintended pregnancies, and save a significant amount of public funds. Implication Compared to the current federal Medicaid sterilization policy, a hypothetical, revised policy that reduces logistical barriers for women who desire publicly-funded, post-partum sterilization could potentially avert over 29,000 unintended pregnancies annually and therefore lead to a cost savings of $215 million each year. PMID:24028751

  1. Cost-sensitive Bayesian control policy in human active sensing

    PubMed Central

    Ahmad, Sheeraz; Huang, He; Yu, Angela J.

    2014-01-01

    An important but poorly understood aspect of sensory processing is the role of active sensing, the use of self-motion such as eye or head movements to focus sensing resources on the most rewarding or informative aspects of the sensory environment. Here, we present behavioral data from a visual search experiment, as well as a Bayesian model of within-trial dynamics of sensory processing and eye movements. Within this Bayes-optimal inference and control framework, which we call C-DAC (Context-Dependent Active Controller), various types of behavioral costs, such as temporal delay, response error, and sensor repositioning cost, are explicitly minimized. This contrasts with previously proposed algorithms that optimize abstract statistical objectives such as anticipated information gain (Infomax) (Butko and Movellan, 2010) and expected posterior maximum (greedy MAP) (Najemnik and Geisler, 2005). We find that C-DAC captures human visual search dynamics better than previous models, in particular a certain form of “confirmation bias” apparent in the way human subjects utilize prior knowledge about the spatial distribution of the search target to improve search speed and accuracy. We also examine several computationally efficient approximations to C-DAC that may present biologically more plausible accounts of the neural computations underlying active sensing, as well as practical tools for solving active sensing problems in engineering applications. To summarize, this paper makes the following key contributions: human visual search behavioral data, a context-sensitive Bayesian active sensing model, a comparative study between different models of human active sensing, and a family of efficient approximations to the optimal model. PMID:25520640

  2. Cost-sensitive Bayesian control policy in human active sensing.

    PubMed

    Ahmad, Sheeraz; Huang, He; Yu, Angela J

    2014-01-01

    An important but poorly understood aspect of sensory processing is the role of active sensing, the use of self-motion such as eye or head movements to focus sensing resources on the most rewarding or informative aspects of the sensory environment. Here, we present behavioral data from a visual search experiment, as well as a Bayesian model of within-trial dynamics of sensory processing and eye movements. Within this Bayes-optimal inference and control framework, which we call C-DAC (Context-Dependent Active Controller), various types of behavioral costs, such as temporal delay, response error, and sensor repositioning cost, are explicitly minimized. This contrasts with previously proposed algorithms that optimize abstract statistical objectives such as anticipated information gain (Infomax) (Butko and Movellan, 2010) and expected posterior maximum (greedy MAP) (Najemnik and Geisler, 2005). We find that C-DAC captures human visual search dynamics better than previous models, in particular a certain form of "confirmation bias" apparent in the way human subjects utilize prior knowledge about the spatial distribution of the search target to improve search speed and accuracy. We also examine several computationally efficient approximations to C-DAC that may present biologically more plausible accounts of the neural computations underlying active sensing, as well as practical tools for solving active sensing problems in engineering applications. To summarize, this paper makes the following key contributions: human visual search behavioral data, a context-sensitive Bayesian active sensing model, a comparative study between different models of human active sensing, and a family of efficient approximations to the optimal model. PMID:25520640

  3. Environmental cost-effectiveness analysis in intertemporal natural resource policy: evaluation of selective fishing gear.

    PubMed

    Kronbak, Lone Grønbæk; Vestergaard, Niels

    2013-12-15

    In most decision-making involving natural resources, the achievements of a given policy (e.g., improved ecosystem or biodiversity) are rather difficult to measure in monetary units. To address this problem, the current paper develops an environmental cost-effectiveness analysis (ECEA) to include intangible benefits in intertemporal natural resource problems. This approach can assist managers in prioritizing management actions as least cost solutions to achieve quantitative policy targets. The ECEA framework is applied to a selective gear policy case in Danish mixed trawl fisheries in Kattegat and Skagerrak. The empirical analysis demonstrates how a policy with large negative net benefits might be justified if the intangible benefits are included. PMID:24184529

  4. National vaccine injury compensation program: calculation of average cost of a health insurance policy. Final rule.

    PubMed

    2007-07-01

    Subtitle 2 of Title XXI of the Public Health Service Act, as enacted by the National Childhood Vaccine Injury Act of 1986, as amended (the Act), governs the National Vaccine Injury Compensation Program (VICP). The VICP, administered by the Secretary of Health and Human Services (the Secretary), provides that a proceeding for compensation for a vaccine-related injury or death shall be initiated by service upon the Secretary, and the filing of a petition with the United States Court of Federal Claims (the Court). In some cases, the injured individual may receive compensation for future lost earnings, less appropriate taxes and the "average cost of a health insurance policy, as determined by the Secretary." The final rule establishes the new method of calculating the average cost of a health insurance policy and determines the amount of the average cost of a health insurance policy to be deducted from the compensation award. PMID:17674490

  5. COST MINIMIZATION MODEL OF OCEANGOING CARRIERS ON A LARGE-SCALE INTERNATIONAL MARITIME CONTAINER SHIPPING NETWORK CONSIDERING CHARACTERISTICS OF PORTS

    NASA Astrophysics Data System (ADS)

    Shibasaki, Ryuichi; Watanabe, Tomihiro; Ieda, Hitoshi

    This paper deals with a cost minimization problem of oceangoing carriers on a large-scale network of international maritime container shipping industry, in order to measure impact of port policies for each country including Japan. Concretely, the authors develop a model to decide ports to call and size of containership in each route by ocean-going carrier group, with consideration of construction of deeper berths to deal with enlargement of containership, decrease of various port charges per cargo by attracting cargos into one port, and congestion by exceeding aggregation. The developed model is applied to the actual large-scale international maritime container shipping network in Eastern Asia. The performance of the model developed is validated. Also, the sensitivity of the model output is confirmed from the viewpoints of economy and diseconomy of scale included in the model.

  6. Decreasing spine implant costs and inter-physician cost variation: the impact of programme of cost containment on implant expenditure in spinal surgery.

    PubMed

    Oren, J; Hutzler, L H; Hunter, T; Errico, T; Zuckerman, J; Bosco, J

    2015-08-01

    The demand for spinal surgery and its costs have both risen over the past decade. In 2008 the aggregate hospital bill for surgical care of all spinal procedures was reported to be $33.9 billion. One key driver of rising costs is spinal implants. In 2011 our institution implemented a cost containment programme for spinal implants which was designed to reduce the prices of individual spinal implants and to reduce the inter-surgeon variation in implant costs. Between February 2012 and January 2013, our spinal surgeons performed 1493 spinal procedures using implants from eight different vendors. By applying market analysis and implant cost data from the previous year, we established references prices for each individual type of spinal implant, regardless of vendor, who were required to meet these unit prices. We found that despite the complexity of spinal surgery and the initial reluctance of vendors to reduce prices, significant savings were made to the medical centre. PMID:26224828

  7. How to Calculate the Costs or Savings of Tax Credit Voucher Policies. NEPC Policy Memo

    ERIC Educational Resources Information Center

    Welner, Kevin

    2011-01-01

    In this NEPC Policy Memo, Professor Welner explains that the most honest and conscientious approach to reporting the fiscal impact of tax credit vouchers is to provide a range of outcomes and let the readers--not the legislative analysts themselves--speculate on which is most likely. If a bottom line is demanded, it should be couched in as many…

  8. Consumer cost effectiveness of CO2 mitigation policies in restructured electricity markets

    NASA Astrophysics Data System (ADS)

    Moore, Jared; Apt, Jay

    2014-10-01

    We examine the cost of carbon dioxide mitigation to consumers in restructured USA markets under two policy instruments, a carbon price and a renewable portfolio standard (RPS). To estimate the effect of policies on market clearing prices, we constructed hourly economic dispatch models of the generators in PJM and in ERCOT. We find that the cost effectiveness of policies for consumers is strongly dependent on the price of natural gas and on the characteristics of the generators in the dispatch stack. If gas prices are low (˜4/MMBTU), a technology-agnostic, rational consumer seeking to minimize costs would prefer a carbon price over an RPS in both regions. Expensive gas (˜7/MMBTU) requires a high carbon price to induce fuel switching and this leads to wealth transfers from consumers to low carbon producers. The RPS may be more cost effective for consumers because the added energy supply lowers market clearing prices and reduces CO2 emissions. We find that both policies have consequences in capacity markets and that the RPS can be more cost effective than a carbon price under certain circumstances: continued excess supply of capacity, retention of nuclear generators, and high natural gas prices.

  9. Economically and environmentally informed policy for road resurfacing: tradeoffs between costs and greenhouse gas emissions

    NASA Astrophysics Data System (ADS)

    Reger, Darren; Madanat, Samer; Horvath, Arpad

    2014-10-01

    As road conditions worsen, users experience an increase in fuel consumption and vehicle wear and tear. This increases the costs incurred by the drivers, and also increases the amount of greenhouse gases (GHGs) that vehicles emit. Pavement condition can be improved through rehabilitation activities (resurfacing) to reduce the effects on users, but these activities also have significant cost and GHG emission impacts. The objective of pavement management is to minimize total societal (user and agency) costs. However, the environmental impacts associated with the cost-minimizing policy are not currently accounted for. We show that there exists a range of potentially optimal decisions, known as the Pareto frontier, in which it is not possible to decrease total emissions without increasing total costs and vice versa. This research explores these tradeoffs for a system of pavement segments. For a case study, a network was created from a subset of California’s highways using available traffic data. It was shown that the current resurfacing strategy used by the state’s transportation agency, Caltrans, does not fall on the Pareto frontier, meaning that significant savings in both total costs and total emissions can be achieved by switching to one of the optimal policies. The methods presented in this paper also allow the decision maker to evaluate the impact of other policies, such as reduced vehicle kilometers traveled or better construction standards.

  10. Cost-effectiveness analysis and policy choices: investing in health systems.

    PubMed Central

    Murray, C. J.; Kreuser, J.; Whang, W.

    1994-01-01

    The role of health systems infrastructure in studies of cost-effectiveness analysis and health resource allocation is discussed, and previous health sector cost-effectiveness analyses are cited. Two substantial difficulties concerning the nature of health system costs and the policy choices are presented. First, the issue of health system infrastructure can be addressed by use of computer models such as the Health Resource Allocation Model (HRAM) developed at Harvard, which integrates cost-effectiveness and burden of disease data. It was found that a model which allows for expansion in health infrastructure yields nearly 40% more total DALYs for a hypothetical sub-Saharan African country than a model which neglects infrastructure expansion. Widespread use of cost-effectiveness databases for resource allocations in the health sector will require the cost-effectiveness analyses shift from reporting costs to reporting production functions. Second, three distinct policy questions can be treated using these tools, each necessitating its own inputs and constraints: allocations when given a fixed budget and health infrastructure, or when given resources for marginal expansion, or when given a politically constrained situation of expanding resources. Confusion concerning which question is being addressed must be avoided through development of a consistent and rigorous approach to using cost-effectiveness data for informing resource allocations. PMID:7923545

  11. Cost estimate of high-level radioactive waste containers for the Yucca Mountain Site Characterization Project

    SciTech Connect

    Russell, E.W.; Clarke, W.; Domian, H.A.; Madson, A.A.

    1991-08-01

    This report summarizes the bottoms-up cost estimates for fabrication of high-level radioactive waste disposal containers based on the Site Characterization Plan Conceptual Design (SCP-CD). These estimates were acquired by Babcock and Wilcox (B&S) under sub-contract to Lawrence Livermore National Laboratory (LLNL) for the Yucca Mountain Site Characterization Project (YMP). The estimates were obtained for two leading container candidate materials (Alloy 825 and CDA 715), and from other three vendors who were selected from a list of twenty solicited. Three types of container designs were analyzed that represent containers for spent fuel, and for vitrified high-level waste (HLW). The container internal structures were assumed to be AISI-304 stainless steel in all cases, with an annual production rate of 750 containers. Subjective techniques were used for estimating QA/QC costs based on vendor experience and the specifications derived for the LLNL-YMP Quality Assurance program. In addition, an independent QA/QC analysis is reported which was prepared by Kasier Engineering. Based on the cost estimates developed, LLNL recommends that values of $825K and $62K be used for the 1991 TSLCC for the spent fuel and HLW containers, respectively. These numbers represent the most conservative among the three vendors, and are for the high-nickel anstenitic steel (Alloy 825). 6 refs., 7 figs.

  12. Human Papillomavirus (HPV) Vaccine Availability, Recommendations, Cost, and Policies Among Health Departments in Seven Appalachian States

    PubMed Central

    Katz, Mira L.; Reiter, Paul L.; Kluhsman, Brenda C.; Kennedy, Stephenie; Dwyer, Sharon; Schoenberg, Nancy; Johnson, Andy; Ely, Gretchen; Roberto, Karen A.; Lengerich, Eugene J.; Brown, Pamela; Paskett, Electra D.; Dignan, Mark

    2009-01-01

    Telephone interviews of health department personnel in six states and review of an immunization database from one state were conducted to assess human papillomavirus (HPV) vaccine availability, recommendations, cost, policies, and educational materials in health departments in seven Appalachian states. Most (99.1%) health departments (n=234) reported receiving patient requests for the HPV vaccine, and only two (1%) health departments reported that they did not provide the vaccine for patients. HPV vaccine supply was reported to not meet demand in 10.5% (24/228) of health departments due to high costs. Level (state, region, county) at which policy about the HPV vaccine was determined, vaccine recommendations, costs, and available educational materials varied among states. This study documented variation in vaccine availability, recommendations, cost, policies, and educational materials in Appalachian health departments that could significantly affect vaccine distribution. Findings highlight the need for more comprehensive and consistent policies that maximize accessibility of the HPV vaccine to women, especially those in underserved areas. PMID:19446191

  13. 76 FR 70037 - Federal Regulations; OMB Circulars, OFPP Policy Letters, and CASB Cost Accounting Standards...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-10

    .... SUPPLEMENTARY INFORMATION: In a document published in the Federal Register of September 29, 2011 (77 FR 60357... / Thursday, November 10, 2011 / Rules and Regulations#0;#0; ] OFFICE OF MANAGEMENT AND BUDGET 5 CFR Chapter III 48 CFR Chapter 1 Federal Regulations; OMB Circulars, OFPP Policy Letters, and CASB Cost...

  14. Environmental tipping points significantly affect the cost-benefit assessment of climate policies.

    PubMed

    Cai, Yongyang; Judd, Kenneth L; Lenton, Timothy M; Lontzek, Thomas S; Narita, Daiju

    2015-04-14

    Most current cost-benefit analyses of climate change policies suggest an optimal global climate policy that is significantly less stringent than the level required to meet the internationally agreed 2 °C target. This is partly because the sum of estimated economic damage of climate change across various sectors, such as energy use and changes in agricultural production, results in only a small economic loss or even a small economic gain in the gross world product under predicted levels of climate change. However, those cost-benefit analyses rarely take account of environmental tipping points leading to abrupt and irreversible impacts on market and nonmarket goods and services, including those provided by the climate and by ecosystems. Here we show that including environmental tipping point impacts in a stochastic dynamic integrated assessment model profoundly alters cost-benefit assessment of global climate policy. The risk of a tipping point, even if it only has nonmarket impacts, could substantially increase the present optimal carbon tax. For example, a risk of only 5% loss in nonmarket goods that occurs with a 5% annual probability at 4 °C increase of the global surface temperature causes an immediate two-thirds increase in optimal carbon tax. If the tipping point also has a 5% impact on market goods, the optimal carbon tax increases by more than a factor of 3. Hence existing cost-benefit assessments of global climate policy may be significantly underestimating the needs for controlling climate change. PMID:25825719

  15. 30 CFR 1218.704 - What is ONRR's policy on interest and administrative costs?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 3 2014-07-01 2014-07-01 false What is ONRR's policy on interest and administrative costs? 1218.704 Section 1218.704 Mineral Resources OFFICE OF NATURAL RESOURCES REVENUE, DEPARTMENT OF THE INTERIOR NATURAL RESOURCES REVENUE COLLECTION OF ROYALTIES, RENTALS, BONUSES, AND OTHER MONIES DUE THE FEDERAL GOVERNMENT Debt...

  16. Financing Higher Education in Ethiopia: Analysis of Cost-Sharing Policy and its Implementation

    ERIC Educational Resources Information Center

    Ayalew, Sewale Abate

    2013-01-01

    Cost-sharing as a policy in Ethiopian higher education institutions (HEIs) has been adopted since 2003 to achieve a set of objectives such as supplementing revenue as an alternative non-governmental source, maintaining and enhancing access to higher education, addressing equity in terms of opportunity in higher education and making students…

  17. Policy-driven development of cost-effective, risk-based surveillance strategies.

    PubMed

    Reist, M; Jemmi, T; Stärk, K D C

    2012-07-01

    Animal health and residue surveillance verifies the good health status of the animal population, thereby supporting international free trade of animals and animal products. However, active surveillance is costly and time-consuming. The development of cost-effective tools for animal health and food hazard surveillance is therefore a priority for decision-makers in the field of veterinary public health. The assumption of this paper is that outcome-based formulation of standards, legislation leaving room for risk-based approaches and close collaboration and a mutual understanding and exchange between scientists and policy makers are essential for cost-effective surveillance. We illustrate this using the following examples: (i) a risk-based sample size calculation for surveys to substantiate freedom from diseases/infection, (ii) a cost-effective national surveillance system for Bluetongue using scenario tree modelling and (iii) a framework for risk-based residue monitoring. Surveys to substantiate freedom from infectious bovine rhinotracheitis and enzootic bovine leucosis between 2002 and 2009 saved over 6 million € by applying a risk-based sample size calculation approach, and by taking into account prior information from repeated surveys. An open, progressive policy making process stimulates research and science to develop risk-based and cost-efficient survey methodologies. Early involvement of policy makers in scientific developments facilitates implementation of new findings and full exploitation of benefits for producers and consumers. PMID:22265642

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

    NASA Astrophysics Data System (ADS)

    Yeh, Ruey Huei; Lin, Yi-Fang

    2012-06-01

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

  19. 7 CFR 246.16a - Infant formula and authorized foods cost containment.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 4 2013-01-01 2013-01-01 false Infant formula and authorized foods cost containment. 246.16a Section 246.16a Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN...

  20. Building Housing for the Low-Income Elderly: Cost Containment in the Section 202 Program.

    ERIC Educational Resources Information Center

    Turner, Margery Austin

    1985-01-01

    Assessed cost containment and modest design requirements for the Section 202 Direct Loan Program using projects in five Housing and Urban Development (HUD) field offices. Concluded that project design changes and amenities may be undermining Section 202 as a housing production program. (NRB)

  1. 24 CFR 891.670 - Cost containment and modest design standards.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Cost containment and modest design standards. 891.670 Section 891.670 Housing and Urban Development REGULATIONS RELATING TO HOUSING AND URBAN DEVELOPMENT (CONTINUED) OFFICE OF THE ASSISTANT SECRETARY FOR HOUSING-FEDERAL HOUSING COMMISSIONER, DEPARTMENT OF HOUSING AND URBAN...

  2. 7 CFR 246.16a - Infant formula and authorized foods cost containment.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 4 2014-01-01 2014-01-01 false Infant formula and authorized foods cost containment. 246.16a Section 246.16a Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN...

  3. Practice patterns, case mix, Medicare payment policy, and dialysis facility costs.

    PubMed Central

    Hirth, R A; Held, P J; Orzol, S M; Dor, A

    1999-01-01

    OBJECTIVE: To evaluate the effects of case mix, practice patterns, features of the payment system, and facility characteristics on the cost of dialysis. DATA SOURCES/STUDY SETTING: The nationally representative sample of dialysis units in the 1991 U.S. Renal Data System's Case Mix Adequacy (CMA) Study. The CMA data were merged with data from Medicare Cost Reports, HCFA facility surveys, and HCFA's end-stage renal disease patient registry. STUDY DESIGN: We estimated a statistical cost function to examine the determinants of costs at the dialysis unit level. PRINCIPAL FINDINGS: The relationship between case mix and costs was generally weak. However, dialysis practices (type of dialysis membrane, membrane reuse policy, and treatment duration) did have a significant effect on costs. Further, facilities whose payment was constrained by HCFA's ceiling on the adjustment for area wage rates incurred higher costs than unconstrained facilities. The costs of hospital-based units were considerably higher than those of freestanding units. Among chain units, only members of one of the largest national chains exhibited significant cost savings relative to independent facilities. CONCLUSIONS: Little evidence showed that adjusting dialysis payment to account for differences in case mix across facilities would be necessary to ensure access to care for high-cost patients or to reimburse facilities equitably for their costs. However, current efforts to increase dose of dialysis may require higher payments. Longer treatments appear to be the most economical method of increasing the dose of dialysis. Switching to more expensive types of dialysis membranes was a more costly means of increasing dose and hence must be justified by benefits beyond those of higher dose. Reusing membranes saved money, but the savings were insufficient to offset the costs associated with using more expensive membranes. Most, but not all, of the higher costs observed in hospital-based units appear to reflect

  4. Alleviating inequality in climate policy costs: an integrated perspective on mitigation, damage and adaptation

    NASA Astrophysics Data System (ADS)

    De Cian, E.; Hof, A. F.; Marangoni, G.; Tavoni, M.; van Vuuren, D. P.

    2016-07-01

    Equity considerations play an important role in international climate negotiations. While policy analysis has often focused on equity as it relates to mitigation costs, there are large regional differences in adaptation costs and the level of residual damage. This paper illustrates the relevance of including adaptation and residual damage in equity considerations by determining how the allocation of emission allowances would change to counteract regional differences in total climate costs, defined as the costs of mitigation, adaptation, and residual damage. We compare emission levels resulting from a global carbon tax with two allocations of emission allowances under a global cap-and-trade system: one equating mitigation costs and one equating total climate costs as share of GDP. To account for uncertainties in both mitigation and adaptation, we use a model-comparison approach employing two alternative modeling frameworks with different damage, adaptation cost, and mitigation cost estimates, and look at two different climate goals. Despite the identified model uncertainties, we derive unambiguous results on the change in emission allowance allocation that could lessen the unequal distribution of adaptation costs and residual damages through the financial transfers associated with emission trading.

  5. Health cost containment: what it will mean for workers and local economies.

    PubMed Central

    Bishop, C E

    1998-01-01

    After decades of rapid growth, the rate of increase in health services spending appears to be moderating. Although a slowdown in health expenditure growth would release resources for other uses in the economy, concerns have been raised about the effects of a spending slowdown on health workers and regional economies. Based on projections carried out by the Bureau of Labor Statistics during the health reform debate and on state health sector employment data, the author concludes that health workers may experience costly dislocation as health spending growth slows, and some regions may be more affected than others. However, the appropriate response is a general economic policy supporting economic growth and full employment policy with regard to health expenditure growth cannot be held hostage to concerns about employment effects. Images p205-a p212-a PMID:9633864

  6. The low cost of geological assessment for underground CO2 storage: Policy and economic implication

    SciTech Connect

    Friedmann, S. J.; Dooley, James J.; Held, Herman; Ottmar, Edenhofer

    2006-08-31

    The costs for carbon dioxide (CO2) capture and storage (CCS) in geologic formations is estimated to be $6–75/t CO2. In the absence of a mandate to reduce greenhouse gas emissions or some other significant incentive for CCS deployment, this cost effectively limits CCS technology deployment to small niche markets and stymies the potential for further technological development through learning by doing until these disincentives for the free venting of CO2 are in place. By far, the largest current fraction of these costs is capture (including compression and dehydration), commonly estimated at $25–60/t CO2 for power plant applications, followed byCO2 transport and storage, estimated at $0–15/tCO2.Of the storage costs, only a small fraction of the cost will go to accurate geological characterization. These one time costs are probably on the order of $0.1/t CO2 or less as these costs are spread out over the many millions of tons likely to be injected into a field over many decades. Geologic assessments include information central to capacity prediction, risk estimation for the target intervals and development facilities engineering. Since assessment costs are roughly two orders of magnitude smaller than capture costs, and assessment products carry other tangible societal benefits, such as improved accuracy in fossil fuel and ground water reserves estimates, government or joint private–public funding of major assessment initiatives should underpin early policy choices regarding CO2 storage deployment and should serve as a point of entry for policy makers and regulators. Early assessment is also likely to improve the knowledge base upon which the first commercial CCS deployments will rest.

  7. The low cost of geological assessment for underground CO2 storage: Policy and economic implications

    SciTech Connect

    Friedmann, S J; Dooley, J; Held, H; Edenhofer, O

    2005-01-31

    The costs for carbon dioxide (CO{sub 2}) capture and storage (CCS) in geologic formations is estimated to be $6-75/t CO{sub 2}. In the absence of a mandate to reduce greenhouse gas emissions or some other significant incentive for CCS deployment, this cost effectively limits CCS technology deployment to small niche markets and stymies the potential for further technological development through learning-by-doing until these disincentives for the free venting of CO{sub 2} are in place. By far, the largest current fraction of these costs is capture (including compression and dehydration), commonly estimated at $25-60/t CO{sub 2} for power plant applications followed by CO{sub 2} transport and storage, estimated at $0-15/t CO{sub 2}. Of the storage costs, only a small fraction of the cost will go to accurate geological characterization. These one-time costs are probably on the order of $0.1/t CO{sub 2} or less as these costs are spread out over the many millions of tons likely to be injected into a field over many decades. Geologic assessments include information central to capacity prediction, risk estimation for the target intervals, and development facilities engineering. Since assessment costs are roughly 2 orders of magnitude smaller than capture costs, and assessment products carry other tangible societal benefits such as improved accuracy in fossil fuel and ground water reserves estimates, government or joint private/public funding of major assessment initiatives should underpin early policy choices regarding CO{sub 2} storage deployment and should serve as a point of entry for policy makers and regulators. Early assessment is also likely to improve the knowledge base upon which the first commercial CCS deployments will rest.d

  8. Cost-Benefit Analysis of Confidentiality Policies for Advanced Knowledge Management Systems

    SciTech Connect

    May, D

    2003-03-01

    Knowledge Discovery (KD) processes can create new information within a Knowledge Management (KM) system. In many domains, including government, this new information must be secured against unauthorized disclosure. Applying an appropriate confidentiality policy achieves this. However, it is not evident which confidentiality policy to apply, especially when the goals of sharing and disseminating knowledge have to be balanced with the requirements to secure knowledge. This work proposes to solve this problem by developing a cost-benefit analysis technique for examining the tradeoffs between securing and sharing discovered knowledge.

  9. A cost-benefit analysis of a deposit-refund program for beverage containers in Israel

    SciTech Connect

    Lavee, Doron

    2010-02-15

    The paper presents a full cost-benefit analysis of a deposit-refund program for beverage containers in Israel. We examine all cost elements of the program - storage, collection, and treatment costs of empty containers, and all potential benefits - savings in alternative treatment costs (waste collection and landfill disposal), cleaner public spaces, reduction of landfill volumes, energy-savings externalities associated with use of recycled materials, and creation of new workplaces. A wide variety of data resources is employed, and some of the critical issues are examined via several approaches. The main finding of the paper is that the deposit-refund program is clearly economically worthwhile. The paper contributes to the growing body of literature on deposit-refund programs by its complete and detailed analysis of all relevant factors of such a program, and also specifically in its analysis of the savings in alternative waste management costs. This analysis reveals greater savings than are usually assumed, and thus shows the deposit-refund program to be highly efficient.

  10. Policy considerations based on a cost analysis of alternative test formats in large scale science assessments

    NASA Astrophysics Data System (ADS)

    Lawrenz, Frances; Huffman, Douglas; Welch, Wayne

    2000-08-01

    This article compares the costs of four assessment formats: multiple choice, open ended, laboratory station, and full investigation. The amount of time spent preparing the devices, developing scoring consistency for the devices, and scoring the devices was tracked as the devices were developed. These times are presented by individual item and by complete device. Times are also compared as if 1,000 students completed each assessment. Finally, the times are converted into cost estimates by assuming a potential hourly wage. The data show that a multiple choice item costs the least, and that it is approximately 80 times as much for an open ended item, 300 times as much for a content station, and 500 times as much for a full investigation item. The very large discrepancies in costs are used as a basis to raise several policy issues related to the inclusion of alternative assessment formats in large scale science achievement testing.

  11. Cost savings associated with 10 years of road safety policies in Catalonia, Spain

    PubMed Central

    Suelves, Josep M; Barbería, Eneko

    2013-01-01

    Abstract Objective To determine whether the road safety policies introduced between 2000 and 2010 in Catalonia, Spain, which aimed primarily to reduce deaths from road traffic collisions by 50% by 2010, were associated with economic benefits to society. Methods A cost analysis was performed from a societal perspective with a 10-year time horizon. It considered the costs of: hospital admissions; ambulance transport; autopsies; specialized health care; police, firefighter and roadside assistance; adapting to disability; and productivity lost due to institutionalization, death or sick leave of the injured or their caregivers; as well as material and administrative costs. Data were obtained from a Catalan hospital registry, the Catalan Traffic Service information system, insurance companies and other sources. All costs were calculated in euros (€) at 2011 values. Findings A substantial reduction in deaths from road traffic collisions was observed between 2000 and 2010. Between 2001 and 2010, with the implementation of new road safety policies, there were 26 063 fewer road traffic collisions with victims than expected, 2909 fewer deaths (57%) and 25 444 fewer hospitalizations. The estimated total cost savings were around €18 000 million. Of these, around 97% resulted from reductions in lost productivity. Of the remaining cost savings, 63% were associated with specialized health care, 15% with adapting to disability and 8.1% with hospital care. Conclusion The road safety policies implemented in Catalonia in recent years were associated with a reduction in the number of deaths and injuries from traffic collisions and with substantial economic benefits to society. PMID:23397348

  12. Sustainability of least cost policies for meeting Mexico City's future water demand

    NASA Astrophysics Data System (ADS)

    Downs, Timothy J.; Mazari-Hiriart, Marisa; DomíNguez-Mora, Ramón; Suffet, I. H.

    2000-08-01

    Meeting future water demand without degrading ecosystems is one important indicator of sustainable development. Using simulations, we showed that compared to existing policy, more sustainable water supply options are similar or cheaper in cost. We probabilistically forecasted the Mexico City metropolitan zone population for the year 2015 to be 23.5 million and total required water supply to be 106 m3 s-1. We optimized existing and potential supply sources from aquifers, surface water, treatment/reuse, and efficiency/demand management by cost to meet future supply needs; the applied source supply limits determined the degree of sustainability. In two scenarios to supply 106 m3 s-1, the business-as-usual scenario (zero sustainability) had an average relative unit cost of 1.133; while for the most sustainable scenario (it includes reducing potential supply basins' exploitation limits by 50%), the value was 1.121. One extreme scenario to supply the forecast's 95% confidence value (124 m3 s-1) showed little unit cost change (1.106). The simulation shows sustainable policies can be cost-effective.

  13. Learning Near-Optimal Cost-Sensitive Decision Policy for Object Detection.

    PubMed

    Wu, Tianfu; Zhu, Song-Chun

    2015-05-01

    Many popular object detectors, such as AdaBoost, SVM and deformable part-based models (DPM), compute additive scoring functions at a large number of windows in an image pyramid, thus computational efficiency is an important consideration in real time applications besides accuracy. In this paper, a decision policy refers to a sequence of two-sided thresholds to execute early reject and early accept based on the cumulative scores at each step. We formulate an empirical risk function as the weighted sum of the cost of computation and the loss of false alarm and missing detection. Then a policy is said to be cost-sensitive and optimal if it minimizes the risk function. While the risk function is complex due to high-order correlations among the two-sided thresholds, we find that its upper bound can be optimized by dynamic programming efficiently. We show that the upper bound is very tight empirically and thus the resulting policy is said to be near-optimal. In experiments, we show that the decision policy outperforms state-of-the-art cascade methods significantly, in several popular detection tasks and benchmarks, in terms of computational efficiency with similar accuracy of detection. PMID:26353325

  14. Memphis Business Group on Health: a model for health care reform and cost containment.

    PubMed

    Miller, D

    1994-01-01

    A market-driven, community-based, competitive health care model has effectively assisted Memphis employers to achieve their cost containment and health care reform objectives. Members of the Memphis Business Group on Health joined forces and successfully implemented a variety of programs and services that resulted in dramatic cost savings and reform of health care delivery systems. Programs included development of a purchasing alliance for negotiating contracts for hospital, medical, workers' compensation, psychiatric, and substance abuse care and other service and product options. Utilization management programs focused on appropriate consumption of resources and intensive management of critical cases. While increases in per employee costs averaged 14.7 percent per year for five years nationally, members of the Memphis Business Group on Health held their increases to an average of 6 percent per year. PMID:10132786

  15. Deposits on single use containers--a social cost-benefit analysis of the Danish deposit system for single use drink containers.

    PubMed

    Vigsø, Dorte

    2004-12-01

    This study compares the social costs and environmental benefits of collecting single use drink containers through the Danish deposit system with the social costs and benefits of treating the containers as part of the municipal waste-disposal system. It focuses on single use polyethylene terphthalate and glass bottles, and steel and aluminium cans. The social costs of handling these containers in the deposit system includes the costs of collection, sorting, and transportation, adjusted against the profit from selling the collected material for recycling. The social cost of incinerating these containers as municipal waste consists of the expenses for the collection, incineration of the containers and disposal of ashes. If there is any income from energy generation accompanying incineration, this is adjusted against costs. The main environmental effects related to both strategies are quantified, valuated and included in the assessment. The results of the analysis show that there are significant social costs compared to the benefits connected with the new deposit system. This is true for all four types of single use drink containers examined. All in all, Denmark bears a net social cost of 6.7 to 8.1 million Euros per year compared to a baseline of incineration with energy recovery. PMID:15666450

  16. The Cost of Crime to Society: New Crime-Specific Estimates for Policy and Program Evaluation

    PubMed Central

    French, Michael T.; Fang, Hai

    2010-01-01

    Estimating the cost to society of individual crimes is essential to the economic evaluation of many social programs, such as substance abuse treatment and community policing. A review of the crime-costing literature reveals multiple sources, including published articles and government reports, which collectively represent the alternative approaches for estimating the economic losses associated with criminal activity. Many of these sources are based upon data that are more than ten years old, indicating a need for updated figures. This study presents a comprehensive methodology for calculating the cost of society of various criminal acts. Tangible and intangible losses are estimated using the most current data available. The selected approach, which incorporates both the cost-of-illness and the jury compensation methods, yields cost estimates for more than a dozen major crime categories, including several categories not found in previous studies. Updated crime cost estimates can help government agencies and other organizations execute more prudent policy evaluations, particularly benefit-cost analyses of substance abuse treatment or other interventions that reduce crime. PMID:20071107

  17. Financing Higher Standards in Public Education: The Importance of Accounting for Educational Costs. Policy Brief, No. 10.

    ERIC Educational Resources Information Center

    Duncombe, William; Yinger, John

    This policy brief explains why performance focus and educational cost indexes must go hand in hand, discusses alternative methods for estimating educational cost indexes, and shows how these costs indexes can be incorporated into a performance-based state aid program. A shift to educational performance standards, whether these standards are…

  18. Modelling geographic variation in the cost-effectiveness of control policies for infectious vector diseases: the example of Chagas disease.

    PubMed

    Castillo-Riquelme, Marianela; Chalabi, Zaid; Lord, Joanne; Guhl, Felipe; Campbell-Lendrum, Diarmid; Davies, Clive; Fox-Rushby, Julia

    2008-03-01

    Few cost-effectiveness analysis (CEA) models have accounted for geographic variation in input parameters. This paper describes a deterministic discrete-time multi-state model to estimate the cost-effectiveness of vector control policies for Chagas disease, where implementation varies according to village characteristics. The model outputs include the total number of new infections, disability adjusted life years (DALYs) incurred, costs of associated healthcare, and total costs of the Ministry of Health's control policy for house surveillance and spraying. Incremental net benefits were estimated to determine Colombian villages in which it is cost-effective to implement the control policy. The robustness of these conclusions was evaluated by deterministic sensitivity analyses. The model should help provide a decision-support system to compare control policies and to allocate resources geographically. PMID:18222556

  19. A Cost Effectiveness Analysis of Salt Reduction Policies to Reduce Coronary Heart Disease in Four Eastern Mediterranean Countries

    PubMed Central

    Mason, Helen; Shoaibi, Azza; Ghandour, Rula; O'Flaherty, Martin; Capewell, Simon; Khatib, Rana; Jabr, Samer; Unal, Belgin; Sözmen, Kaan; Arfa, Chokri; Aissi, Wafa; Romdhane, Habiba Ben; Fouad, Fouad; Al-Ali, Radwan; Husseini, Abdullatif

    2014-01-01

    Background Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. Methods and Findings Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia; $39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and $1,3000,000,000 and 378439 LYG in Turkey. Conclusion Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives. PMID:24409297

  20. Costs of genetic testing: Supporting Brazilian Public Policies for the incorporating of molecular diagnostic technologies

    PubMed Central

    Schlatter, Rosane Paixão; Matte, Ursula; Polanczyk, Carisi Anne; Koehler-Santos, Patrícia; Ashton-Prolla, Patricia

    2015-01-01

    This study identifies and describes the operating costs associated with the molecular diagnosis of diseases, such as hereditary cancer. To approximate the costs associated with these tests, data informed by Standard Operating Procedures for various techniques was collected from hospital software and a survey of market prices. Costs were established for four scenarios of capacity utilization to represent the possibility of suboptimal use in research laboratories. Cost description was based on a single site. The results show that only one technique was not impacted by rising costs due to underutilized capacity. Several common techniques were considerably more expensive at 30% capacity, including polymerase chain reaction (180%), microsatellite instability analysis (181%), gene rearrangement analysis by multiplex ligation probe amplification (412%), non-labeled sequencing (173%), and quantitation of nucleic acids (169%). These findings should be relevant for the definition of public policies and suggest that investment of public funds in the establishment of centralized diagnostic research centers would reduce costs to the Public Health System. PMID:26500437

  1. Tritium accident containment within a large fusion enclosure: cost, benefit, and risk considerations

    SciTech Connect

    Sherwood, A.E.

    1983-01-01

    Containment of a tritium accident within a large fusion device building will be difficult and costly. Complete containment is impossible, and with this fact in mind, the global dispersion and health effects of tritium are reviewed. Atmospheric tritium emissions lead to an estimated population dose to the Northern Hemisphere of 5.6 x 10/sup -3/ man-rem/Ci, which may also be interpreted as 1 cancer fatality per MCi. Updating the NRC $1000 per man-rem criterion to 1982 costs gives 9.5 $/y per Ci/y as the unit annual health benefit rate from averting tritium release at a continuous rate. Present worth considerations lead to an estimate of $100 per Ci/y for the maximum capital investment justified per expected curie per year of tritium release averted. A simplified enclosure model is used to explore the trade-off between processing capacity and recycle time with the health cost of residual tritium release included in the analysis.

  2. Cost-comparison of different management policies for tuberculosis patients in Italy. AIPO TB Study Group.

    PubMed Central

    Migliori, G. B.; Ambrosetti, M.; Besozzi, G.; Farris, B.; Nutini, S.; Saini, L.; Casali, L.; Nardini, S.; Bugiani, M.; Neri, M.; Raviglione, M. C.

    1999-01-01

    Although in developing countries the treatment of tuberculosis (TB) cases is among the most cost-effective health interventions, few studies have evaluated the cost-effectiveness of TB control in low-prevalence countries. The aim of the present study was to carry out an economic analysis in Italy that takes into account both the perspective of the resource-allocating authority (i.e. the Ministry of Health) and the broader social perspective, including a cost description based on current outcomes applied to a representative sample of TB patients nationwide (admission and directly observed treatment (DOT) during the initial intensive phase of treatment); a cost-comparison analysis of two alternative programmes: current policy based on available data (scenario 1) and an hypothetical policy oriented more towards outpatient care (scenario 2) (both scenarios included the option of including or not including DOT outside hospital admission, and incentives) were compared in terms of cost per case treated successfully. Indirect costs (such as loss of productivity) were included in considerations of the broader social perspective. The study was designed as a prospective monitoring activity based on the supervised collection of forms from a representative sample of Italian TB units. Individual data were collected and analysed to obtain a complete economic profile of the patients enrolled and to evaluate the effectiveness of the intervention. A separate analysis was done for each scenario to determine the end-point at different levels of cure rate (50-90%). The mean length of treatment was 6.6 months (i.e. patients hospitalized during the intensive phase; length of stay was significantly higher in smear-positive patients and in human immunodeficiency virus (HIV) seropositive patients). Roughly six direct smear and culture examinations were performed during hospital admission and three during ambulatory treatment. The cost of a single bed day was US$186.90, whereas that of a

  3. 32 CFR 643.22 - Policy-Public safety: Requirement for early identification of lands containing dangerous materials.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Policy-Public safety: Requirement for early... Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE Policy § 643.22 Policy—Public safety: Requirement for early identification of lands containing dangerous materials. (a) DA...

  4. Diabetes in Mexico: cost and management of diabetes and its complications and challenges for health policy

    PubMed Central

    2013-01-01

    Background Mexico has been experiencing some of the most rapid shifts ever recorded in dietary and physical activity patterns leading to obesity. Diabetes mellitus has played a crucial role causing nearly 14% of all deaths. We wanted to make a comprehensive study of the role of diabetes in terms of burden of disease, prevalence, cost of diabetes, cost of complications and health policy. Method We review the quantitative data that provides evidence of the extent to which the Mexican health economy is affected by the disease and its complications. We then discuss the current situation of diabetes in Mexico with experts in the field. Results There was a significant increase in the prevalence of diabetes from 1994 to 2006 with rising direct costs (2006: outpatient USD$ 717,764,787, inpatient USD$ 223,581,099) and indirect costs (2005: USD$ 177,220,390), and rising costs of complications (2010: Retinopathy USD$ 10,323,421; Cardiovascular disease USD$ 12,843,134; Nephropathy USD$ 81,814,501; Neuropathy USD$ 2,760,271; Peripheral vascular disease USD$ 2,042,601). The health policy focused on screening and the creation of self-support groups across the country. Conclusions The increasing diabetes mortality and lack of control among diagnosed patients make quality of treatment a major concern in Mexico. The growing prevalence of childhood and adult obesity and the metabolic syndrome suggest that the situation could be even worse in the coming years. The government has reacted strongly with national actions to address the growing burden posed by diabetes. However our research suggests that the prevalence and mortality of diabetes will continue to rise in the future. PMID:23374611

  5. Costs and Benefits of Eyewitness Identification Reform: Psychological Science and Public Policy.

    PubMed

    Clark, Steven E

    2012-05-01

    Psychological science has come to play an increasingly important role in the legal system by informing the court through expert testimony and by shaping public policy. In recent years, psychological research has driven a movement to reform the procedures that police use to obtain eyewitness identification evidence. This reform movement has been based in part on an argument suggesting that recommended procedures reduce the risk of false identifications with little or no reduction in the rate of correct identifications. A review of the empirical literature, however, challenges this no-cost view. With only one exception, changes in eyewitness identification procedures that reduce the risk of false identification of the innocent also reduce the likelihood of correct identification of the guilty. The implication that criminals may escape prosecution as a result of procedures implemented to protect the innocent makes policy decisions far more complicated than they would otherwise be under the no-cost view. These costs (correct identifications lost) and benefits (false identifications avoided) are discussed in terms of probative value and expected utility. PMID:26168461

  6. A Cost-Effectiveness Tool for Informing Policies on Zika Virus Control

    PubMed Central

    Tamagnan, Jules A.; Medlock, Jan; Ndeffo-Mbah, Martial L.; Fish, Durland; Ávila-Agüero, María L.; Marín, Rodrigo; Ko, Albert I.; Galvani, Alison P.

    2016-01-01

    Background As Zika virus continues to spread, decisions regarding resource allocations to control the outbreak underscore the need for a tool to weigh policies according to their cost and the health burden they could avert. For example, to combat the current Zika outbreak the US President requested the allocation of $1.8 billion from Congress in February 2016. Methodology/Principal Findings Illustrated through an interactive tool, we evaluated how the number of Zika cases averted, the period during pregnancy in which Zika infection poses a risk of microcephaly, and probabilities of microcephaly and Guillain-Barré Syndrome (GBS) impact the cost at which an intervention is cost-effective. From Northeast Brazilian microcephaly incidence data, we estimated the probability of microcephaly in infants born to Zika-infected women (0.49% to 2.10%). We also estimated the probability of GBS arising from Zika infections in Brazil (0.02% to 0.06%) and Colombia (0.08%). We calculated that each microcephaly and GBS case incurs the loss of 29.95 DALYs and 1.25 DALYs per case, as well as direct medical costs for Latin America and the Caribbean of $91,102 and $28,818, respectively. We demonstrated the utility of our cost-effectiveness tool with examples evaluating funding commitments by Costa Rica and Brazil, the US presidential proposal, and the novel approach of genetically modified mosquitoes. Our analyses indicate that the commitments and the proposal are likely to be cost-effective, whereas the cost-effectiveness of genetically modified mosquitoes depends on the country of implementation. Conclusions/Significance Current estimates from our tool suggest that the health burden from microcephaly and GBS warrants substantial expenditures focused on Zika virus control. Our results justify the funding committed in Costa Rica and Brazil and many aspects of the budget outlined in the US president’s proposal. As data continue to be collected, new parameter estimates can be customized

  7. 2 CFR 200.411 - Adjustment of previously negotiated indirect (F&A) cost rates containing unallowable costs.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... by the cognizant agency for indirect costs. The choice of method must be at the discretion of the cognizant agency for indirect costs, based on its judgment as to which method would be most practical. (e... Cost Principles Basic Considerations § 200.411 Adjustment of previously negotiated indirect (F&A)...

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

    PubMed

    Chen, Stephanie C; Pearson, Steven D

    2016-08-01

    The US Affordable Care Act mandates that private insurers cover a list of preventive services without cost sharing. The list is determined by 4 expert committees that evaluate the overall health effect of preventive services. We analyzed the process by which the expert committees develop their recommendations. Each committee uses different criteria to evaluate preventive services and none of the committees consider cost systematically. We propose that the existing committees adopt consistent evidence review methodologies and expand the scope of preventive services reviewed and that a separate advisory committee be established to integrate economic considerations into the final selection of free preventive services. The comprehensive framework and associated criteria are intended to help policy makers in the future develop a more evidence-based, consistent, and ethically sound approach. PMID:27366833

  9. The moral psychology of rationing among physicians: the role of harm and fairness intuitions in physician objections to cost-effectiveness and cost-containment

    PubMed Central

    2013-01-01

    Introduction Physicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called “moral foundations.” The objective of this study was to determine if “harm” and “fairness” intuitions can explain physicians’ judgments about cost-containment in U.S. health care and using cost-effectiveness data in practice, as well as the relative importance of those intuitions compared to “purity”, “authority” and “ingroup” in cost-related judgments. Methods We mailed an 8-page survey to a random sample of 2000 practicing U.S. physicians. The survey included the MFQ30 and items assessing agreement/disagreement with cost-containment and degree of objection to using cost-effectiveness data to guide care. We used t-tests for pairwise subscale mean comparisons and logistic regression to assess associations with agreement with cost-containment and objection to using cost-effectiveness analysis to guide care. Results 1032 of 1895 physicians (54%) responded. Most (67%) supported cost-containment, while 54% expressed a strong or moderate objection to the use of cost-effectiveness data in clinical decisions. Physicians who strongly objected to the use of cost-effectiveness data had similar scores in all five of the foundations (all p-values > 0.05). Agreement with cost-containment was associated with higher mean “harm” (3.6) and “fairness” (3.5) intuitions compared to “in-group” (2.8), “authority” (3.0), and “purity” (2.4) (p < 0.05). In multivariate models adjusted for age, sex, region, and specialty, both “harm” and “fairness” were significantly associated with judgments about cost-containment (OR = 1.2 [1.0-1.5]; OR = 1.7 [1.4-2.1], respectively) but were not associated with degree of objection to cost-effectiveness (OR = 1.2 [1.0-1.4]; OR = 0.9 [0.7-1.0]). Conclusions Moral intuitions shed light on variation in physician judgments

  10. Cardiovascular disease and impoverishment averted due to a salt reduction policy in South Africa: an extended cost-effectiveness analysis.

    PubMed

    Watkins, David A; Olson, Zachary D; Verguet, Stéphane; Nugent, Rachel A; Jamison, Dean T

    2016-02-01

    The South African Government recently set targets to reduce cardiovascular disease (CVD) by lowering salt consumption. We conducted an extended cost-effectiveness analysis (ECEA) to model the potential health and economic impacts of this salt policy. We used surveys and epidemiologic studies to estimate reductions in CVD resulting from lower salt intake. We calculated the average out-of-pocket (OOP) cost of CVD care, using facility fee schedules and drug prices. We estimated the reduction in OOP expenditures and government subsidies due to the policy. We estimated public and private sector costs of policy implementation. We estimated financial risk protection (FRP) from the policy as (1) cases of catastrophic health expenditure (CHE) averted or (2) cases of poverty averted. We also performed a sensitivity analysis. We found that the salt policy could reduce CVD deaths by 11%, with similar health gains across income quintiles. The policy could save households US$ 4.06 million (2012) in OOP expenditures (US$ 0.29 per capita) and save the government US$ 51.25 million in healthcare subsidies (US$ 2.52 per capita) each year. The cost to the government would be only US$ 0.01 per capita; hence, the policy would be cost saving. If the private sector food reformulation costs were passed on to consumers, food expenditures would increase by <0.2% across all income quintiles. Preventing CVD could avert 2400 cases of CHE or 2000 cases of poverty yearly. Our results were sensitive to baseline CVD mortality rates and the cost of treatment. We conclude that, in addition to health gains, population salt reduction can have positive economic impacts-substantially reducing OOP expenditures and providing FRP, particularly for the middle class. The policy could also provide large government savings on health care. PMID:25841771

  11. Applying cost analyses to drive policy that protects children. Mercury as a case study

    SciTech Connect

    Leonardo Trasande; Clyde Schechter; Karla A. Haynes; Philip J. Landrigan

    2006-09-15

    Exposure in prenatal life to methylmercury (MeHg) has become the topic of intense debate in the United States after the Environmental Protection Agency (EPA) announced a proposal in 2004 to reverse strict controls on emissions of mercury from coal-fired power plants that had been in effect for the preceding 15 years. This proposal failed to incorporate any consideration of the health impacts on children that would result from increased mercury emissions. We assessed the impact on children's health of industrial mercury emissions and found that between 316,588 and 637,233 babies are born with mercury-related losses of cognitive function ranging from 0.2 to 5.13 points. We calculated that decreased economic productivity resulting from diminished intelligence over a lifetime results in an aggregate economic cost in each annual birth cohort of $8.7 billion annually. $1.3 billion of this cost is attributable to mercury emitted from American coal-fired power plants. Downward shifts in intellectual quotient (IQ) are also associated with 1566 excess cases of mental retardation annually. This number accounts for 3.2% of MR cases in the United States. If the lifetime excess cost of a case of MR is $1,248,648 in 2000 dollars, then the cost of these excess cases of MR is $2.0 billion annually. Preliminary data suggest that more stringent mercury policy options would prevent thousands of cases of MR and billions of dollars over the next 25 years.

  12. Modeling spatial segregation and travel cost influences on utilitarian walking: Towards policy intervention

    PubMed Central

    Yang, Yong; Auchincloss, Amy H.; Rodriguez, Daniel A.; Brown, Daniel G.; Riolo, Rick; Diez-Roux, Ana V.

    2015-01-01

    We develop an agent-based model of utilitarian walking and use the model to explore spatial and socioeconomic factors affecting adult utilitarian walking and how travel costs as well as various educational interventions aimed at changing attitudes can alter the prevalence of walking and income differentials in walking. The model is validated against US national data. We contrast realistic and extreme parameter values in our model and test effects of changing these parameters across various segregation and pricing scenarios while allowing for interactions between travel choice and place and for behavioral feedbacks. Results suggest that in addition to income differences in the perceived cost of time, the concentration of mixed land use (differential density of residences and businesses) are important determinants of income differences in walking (high income walk less), whereas safety from crime and income segregation on their own do not have large influences on income differences in walking. We also show the difficulty in altering walking behaviors for higher income groups who are insensitive to price and how adding to the cost of driving could increase the income differential in walking particularly in the context of segregation by income and land use. We show that strategies to decrease positive attitudes towards driving can interact synergistically with shifting cost structures to favor walking in increasing the percent of walking trips. Agent-based models, with their ability to capture dynamic processes and incorporate empirical data, are powerful tools to explore the influence on health behavior from multiple factors and test policy interventions. PMID:25733776

  13. Cost-benefit analysis of the Swiss national policy on reducing micropollutants in treated wastewater.

    PubMed

    Logar, Ivana; Brouwer, Roy; Maurer, Max; Ort, Christoph

    2014-11-01

    Contamination of freshwater with micropollutants (MPs) is a growing concern worldwide. Even at very low concentrations, MPs can have adverse effects on aquatic ecosystems and possibly also on human health. Switzerland is one of the first countries to start implementing a national policy to reduce MPs in the effluents of municipal sewage treatment plants (STPs). This paper estimates the benefits of upgrading STPs based on public's stated preferences. To assess public demand for the reduction of the environmental and health risks of MPs, we conducted a choice experiment in a national online survey. The results indicate that the average willingness to pay per household is CHF 100 (US$ 73) annually for reducing the potential environmental risk of MPs to a low level. These benefits, aggregated over households in the catchment of the STPs to be upgraded, generate a total annual economic value of CHF 155 million (US$ 113 million). This compares with estimated annual costs for upgrading 123 STPs of CHF 133 million (US$ 97 million) or CHF 86 (US$ 63) per household connected to these STPs. Hence, a cost-benefit analysis justifies the investment decision from an economic point of view and supports the implementation of the national policy in the ongoing political discussion. PMID:25251946

  14. Effect of changes in DOE pricing policies for enrichment and reprocessing on research reactor fuel cycle costs

    SciTech Connect

    Matos, J.E.; Freese, K.E.

    1986-11-03

    Fuel cycle costs with HEU and LEU fuels for the IAEA generic 10 MW reactor are updated to reflect the change in DOE pricing policy for enrichment services as of October 1985 and the published charges for LEU reprocessing services as of February 1986. The net effects are essentially no change in HEU fuel cycle costs and a reduction of about 8 to 10% in the fuel cycle costs for LEU silicide fuel.

  15. Supply chain management with cost-containment & financial-sustainability in a tertiary care hospital.

    PubMed

    Chandra, Hem; Rinkoo, Arvind Vashishta; Verma, Jitendra Kumar; Verma, Shuchita; Kapoor, Rakesh; Sharma, R K

    2013-01-01

    Financial crunch in the present recession results in the non-availability of the right materials at the right time in large hospitals. However due to insufficient impetus towards systems development, situation remains dismal even when funds are galore. Cost incurred on materials account for approximately one-third of the total recurring expenditures in hospitals. Systems development for effective and efficient materials management is thus tantamount to cost-containment and sustainability. This scientific paper describes an innovative model, Hospital Revolving Fund (HRF), developed at a tertiary care research institute in Asia. The main idea behind inception of HRF was to ensure availability of all supplies in the hospital so that the quality of healthcare delivery was not affected. The model was conceptualized in the background of non-availability of consumables in the hospital leading to patient as well as staff dissatisfaction. Hospital supplies have been divided into two parts, approximately 3250 unit items and 1750 miscellaneous items. This division is based on cost, relative-utility and case-specific utilization. 0.1 Million USD, separated from non-planned budget, was initially used as seed money in 1998. HRF procures supplies from reputed firms on concessional rates (8-25%) and make them available to patients at much lesser rates vis-à-vis market rates, levying minimal maintenance charges. In 2009-10, total annual purchases of 14 Million USD were made. The balance sheet reflected 1.4 Million USD as fixed deposit investment. The minimal maintenance charges levied on the patients along with the interest income were sufficient to pay for all recurring expenses related to HRF. Even after these expenses, HRF boosted of 0.2 Million USD as cash-in-hand in financial year 2009-10. In-depth analysis of 'balance sheet' and 'Income and Expenditure' statement of the fund for last five financial years affirms that HRF is a self-sustainable and viable supply chain

  16. Effect of antibiotic order form guiding rational use of expensive drugs on cost containment.

    PubMed

    Sirinavin, S; Suvanakoot, P; Sathapatayavongs, B; Malatham, K

    1998-09-01

    New injectable antimicrobial agents are generally costly and broad-spectrum. Overusage results in unnecessary economic loss and multi-drug resistant organisms. Effective strategies for decreasing costs without compromising patient care are required. This study aimed to evaluate the economic impact of a system using an antimicrobial order form to assist rational usage of expensive antimicrobial agents. The study was performed during 1988-1996 at a 900-bed, tertiary-care, medical school hospital in Bangkok. The target drugs were 3 costly, broad-spectrum antibacterial drugs, namely imipenem, vancomycin, and injectable ciprofloxacin. The restriction of these 3 drugs was started in 1992 and was extended to netilmicin and ceftazidime in 1995. A filled antimicrobial order form (AOF) was required by pharmacists before dispensing the drugs. The AOF guided the physicians to give explicit information about anatomic diagnosis, etiologic diagnosis, and suspected antimicrobial resistance patterns of the organisms. It also contained information about indications of the restricted drugs. The filled forms were audited daily during working days by the chairman of The Hospital Antibiotic Committee. Feedback was given to the prescribers by infectious disease specialists at least twice a week. The strategy was endorsed by the executive committee of the hospital. Impact of AOF without endorsement, audit and feedback, was evaluated in 1996. The expenditures of the drugs were adjusted to the average admitted patient-days per fiscal year of the study period. The system with endorsement was well accepted and could be maintained for 4 years. The adjusted expenditures per year of the 3 restricted antibiotics were 1.41-1.87 million baht less (22-29%) in 1992-1994 than the pre-intervention year 1991. The cost reduction of imipenem and injectable ciprofloxacin could also be maintained for 1995 but not vancomycin for which use increased. The costs of these 3 restricted drugs increased very

  17. A low-cost technique to manufacture a container to process meiofauna for scanning electron microscopy.

    PubMed

    Abolafia, J

    2015-09-01

    An easy and low-cost method to elaborate a container to dehydrate nematodes and other meiofauna in order to process them for scanning electron microscopy (SEM) is presented. Illustrations of its elaboration, step by step, are included. In addition, a brief methodology to process meiofauna, especially nematodes and kinorhynchs, and illustrations are provided. With this methodology it is possible to easily introduce the specimens, to lock them in a closed chamber allowing the infiltration of fluids and gases (ethanol, acetone, carbon dioxide) but avoiding losing the specimens. After using this meiofauna basket for SEM the results are efficient. Examples of nematode and kinorhynch SEM pictures obtained using this methodology are also included. PMID:26178782

  18. Containing Ontario's hospital costs under universal insurance in the 1980s: what was the record?

    PubMed

    Detsky, A S; O'Rourke, K; Naylor, C D; Stacey, S R; Kitchens, J M

    1990-03-15

    In recent years the Ontario government has been concerned that the proportion of public expenditures devoted to health care is at an all-time high. In addition, the media have devoted considerable attention to specific incidents that may represent inadequate funding of hospital services. To shed light on the debate on health care expenditures we analysed the trend in expenditures of Ontario's hospital sector in the 1980s in terms of the amount of inputs (e.g., labour) used to produce hospital services (e.g., a patient-day or admission) and after adjustment for general inflation. As in the 1970s the number of inputs grew relatively slowly during the 1980s. Inputs per patient-day grew at an annual rate of 0.46% and inputs per admission at an annual rate of 2.4%. Cost increases were largely accounted for by hospital wage increases; this could have been due to Ontario's rapidly expanding economy. These findings indicate that Ontario has continued to be successful in containing the number of inputs used in the hospital sector. However, after two decades of substantial success with publicly acceptable cost control, the government faces increased scrutiny as the media and the public focus attention on several areas of perceived inadequate funding in health care services. PMID:2107020

  19. Weighing the Costs and Benefits of Renewables Portfolio Standards:A Comparative Analysis of State-Level Policy Impact Projections

    SciTech Connect

    Chen, Cliff; Wiser, Ryan; Bolinger, Mark

    2007-01-16

    State renewables portfolio standards (RPS) have emerged as one of the most important policy drivers of renewable energy capacity expansion in the U.S. Collectively, these policies now apply to roughly 40% of U.S. electricity load, and may have substantial impacts on electricity markets, ratepayers, and local economies. As RPS policies have been proposed or adopted in an increasing number of states, a growing number of studies have attempted to quantify the potential impacts of these policies, focusing primarily on projecting cost impacts, but sometimes also estimating macroeconomic and environmental effects. This report synthesizes and analyzes the results and methodologies of 28 distinct state or utility-level RPS cost impact analyses completed since 1998. Together, these studies model proposed or adopted RPS policies in 18 different states. We highlight the key findings of these studies on the costs and benefits of RPS policies, examine the sensitivity of projected costs to model assumptions, assess the attributes of different modeling approaches, and suggest possible areas of improvement for future RPS analysis.

  20. Lung cancer deaths from indoor radon and the cost effectiveness and potential of policies to reduce them

    PubMed Central

    Read, Simon; McGale, Paul; Darby, Sarah

    2009-01-01

    Objective To determine the number of deaths from lung cancer related to radon in the home and to explore the cost effectiveness of alternative policies to control indoor radon and their potential to reduce lung cancer mortality. Design Cost effectiveness analysis. Setting United Kingdom. Data sources Epidemiological data on risks from indoor radon and from smoking, vital statistics on deaths from lung cancer, survey information on effectiveness and costs of radon prevention and remediation. Main outcome measures Estimated number of deaths from lung cancer related to indoor radon, lifetime risks of death from lung cancer before and after various potential interventions to control radon, the cost per quality adjusted life year (QALY) gained from different policies for control of radon, and the potential of those policies to reduce lung cancer mortality. Results The mean radon concentration in UK homes is 21 becquerels per cubic metre (Bq/m3). Each year around 1100 deaths from lung cancer (3.3% of all deaths from lung cancer) are related to radon in the home. Over 85% of these arise from radon concentrations below 100 Bq/m3 and most are caused jointly by radon and active smoking. Current policy requiring basic measures to prevent radon in new homes in selected areas is highly cost effective, and such measures would remain cost effective if extended to the entire UK, with a cost per QALY gained of £11 400 ( €12 200; $16 913). Current policy identifying and remediating existing homes with high radon levels is, however, neither cost effective (cost per QALY gained £36 800) nor effective in reducing lung cancer mortality. Conclusions Policies requiring basic preventive measures against radon in all new homes throughout the UK would be cost effective and could complement existing policies to reduce smoking. Policies involving remedial work on existing homes with high radon levels cannot prevent most radon related deaths, as these are caused by moderate exposure

  1. Applying cost analyses to drive policy that protects children: mercury as a case study.

    PubMed

    Trasande, Leonardo; Schechter, Clyde; Haynes, Karla A; Landrigan, Philip J

    2006-09-01

    Exposure in prenatal life to methylmercury (MeHg) has become the topic of intense debate in the United States after the Environmental Protection Agency (EPA) announced a proposal in 2004 to reverse strict controls on emissions of mercury from coal-fired power plants that had been in effect for the preceding 15 years. This proposal failed to incorporate any consideration of the health impacts on children that would result from increased mercury emissions. We assessed the impact on children's health of industrial mercury emissions and found that between 316,588 and 637,233 babies are born with mercury-related losses of cognitive function ranging from 0.2 to 5.13 points. We calculated that decreased economic productivity resulting from diminished intelligence over a lifetime results in an aggregate economic cost in each annual birth cohort of $8.7 billion annually (range: $0.7-$13.9 billion, 2000 dollars). $1.3 billion (range: $51 million-$2.0 billion) of this cost is attributable to mercury emitted from American coal-fired power plants. Downward shifts in intellectual quotient (IQ) are also associated with 1566 (range: 115-2675) excess cases of mental retardation (MR defined as IQ < 70) annually. This number accounts for 3.2% (range: 0.2-5.4%) of MR cases in the United States. If the lifetime excess cost of a case of MR (excluding individual productivity losses) is $1,248,648 in 2000 dollars, then the cost of these excess cases of MR is $2.0 billion annually (range: $143 million-$3.3 billion). Preliminary data suggest that more stringent mercury policy options would prevent thousands of cases of MR and billions of dollars over the next 25 years. PMID:17119266

  2. Between Too Little and Too Late: Political Opportunity Costs in Climate Policy Analysis

    NASA Astrophysics Data System (ADS)

    Gilligan, J. M.; Vandenbergh, M. P.

    2014-12-01

    Discussion of climate policy has focused almost exclusively on comprehensive regulatory instruments to price emissions with tradeable permits or emissions taxes. More recently, a number of proposals have been advanced to abandon comprehensive emissions pricing in favor of focusing exclusively on clean-energy innovation. Neither approach adequately accounts for the combination of timing and scale. Advocates of emissions pricing are persuasive that this is the most likely way to reduce emissions sufficiently to stabilize greenhouse gas (GHG) concentrations at desirable levels. However, as innovation advocates point out, the political climate is inhospitable to such sweeping regulations and it is unlikely that comprehensive carbon pricing can be enacted and implemented in the next decade. However, clean-energy innovation by itself is a high-stakes gamble that may fail to reduce emissions sufficiently to stabilize GHG concentrations, and may reduce support for the kind of comprehensive pricing measures that could stabilize GHG concentrations.We propose that analysis of climate policies take account of the opportunity costs associated with the process of enacting a proposed policy: If one measure is much more controversial than another, how does the difference in time necessary to persuade the public and legislators to adopt them affect their ultimate impact? As General Patton is reputed to have said, "A good solution applied with vigor now is better than a perfect solution applied ten minutes later." Similarly, it is important to consider whether adopting one measure would build or erode support for complementary ones. As an example, we consider the largely neglected role of nonregulatory measures, such as private governance and household-level behavior change, as examples of actions that could buy time by producing rapid, although modest, impacts without eroding support for more comprehensive measures later on.

  3. Policy.

    ERIC Educational Resources Information Center

    Evans, Judith L.; And Others

    1995-01-01

    This theme issue is devoted to discussions of early childhood policy issues. "Creating a Shared Vision: How Policy Affects Early Childhood Care and Development" (Judith L. Evans) defines policy, discusses the motivation for changing or creating national policy and the process for changing such policies, and provides a sample design for an early…

  4. Diabetes in Argentina: cost and management of diabetes and its complications and challenges for health policy

    PubMed Central

    2013-01-01

    Background Diabetes is an expensive disease in Argentina as well as worldwide, and its prevalence is continuously rising affecting the quality of life of people with the disease and their life expectancy. It also imposes a heavy burden to the national health care budget and on the economy in the form of productivity losses. Aims To review and discuss a) the reported evidence on diabetes prevalence, the degree of control, the cost of care and outcomes, b) available strategies to decrease the health and economic disease burden, and c) how the disease fits in the Argentinian health care system and policy. Finally, to propose evidence-based policy options to reduce the burden of diabetes, both from an epidemiological as well as an economic perspective, on the Argentinian society. The evidence presented is expected to help the local authorities to develop and implement effective diabetes care programmes. Methodology A comprehensive literature review was performed using databases such as MEDLINE, EMBASE and LILACS (Latin American and Caribbean Health Sciences). Literature published from 1980 to 2011 was included. This information was complemented with grey literature, including data from national and provincial official sources, personal communications and contacts with health authorities and diabetes experts in Argentina. Results Overall diabetes prevalence increased from 8.4% in 2005 to 9.6% 2009 at national level. In 2009, diabetes was the seventh leading cause of death with a mortality rate of 19.2 per 100,000 inhabitants, and it accounted for 1,328,802 DALYs lost in the adult population, mainly affecting women aged over fifty. The per capita hospitalisation cost for people with diabetes was significantly higher than for people without the disease, US$ 1,628 vs. US$ 833 in 2004. Evidence shows that implementation of combined educative interventions improved quality of care and outcomes, decreased treatment costs and optimised the use of economic resources

  5. Determining the Cost Effectiveness of Training (A Self-Contained Instructional Module).

    ERIC Educational Resources Information Center

    Decker, Carol A.; Campbell, Clifton P.

    This instructional module is designed to teach training managers how to calculate training costs, measure the effectiveness of training, and determine the cost effectiveness of training. It is organized in three parts. Part 1 points out why some training managers are reluctant to determine the cost effectiveness of training. It discusses the need…

  6. Cost Containment in Higher Education: Issues and Recommendations. ASHE-ERIC Higher Education Report, Volume 28, Number 5. Jossey-Bass Higher and Adult Education Series.

    ERIC Educational Resources Information Center

    Brown, Walter A.; Gamber, Cayo

    This book provides an overview of strategies colleges and universities can use to help contain costs. It also describes a range of strategies that have been used to contain costs and refine budgeting systems in an era of low returns on investment and greater competition. The volume synthesizes research on internal cost containment strategies…

  7. A Review of Recent RTO Benefit-Cost Studies: Toward MoreComprehensive Assessments of FERC Electricity RestructuringPolicies

    SciTech Connect

    Eto, Joseph H.; Lesieutre, Bernard C.

    2005-12-01

    During the past three years, government and private organizations have issued more than a dozen studies of the benefits and costs of Regional Transmission Organizations (RTOs). Most of these studies have focused on benefits that can be readily estimated using traditional production-cost simulation techniques, which compare the cost of centralized dispatch under an RTO to dispatch in the absence of an RTO, and on costs associated with RTO start-up and operation. Taken as a whole, it is difficult to draw definitive conclusions from these studies because they have not examined potentially much larger benefits (and costs) resulting from the impacts of RTOs on reliability management, generation and transmission investment and operation, and wholesale electricity market operation. This report: (1) Describes the history of benefit-cost analysis of FERC electricity restructuring policies; (2)Reviews current practice by analyzing 11 RTO benefit-cost studies that were published between 2002 and 2004 and makes recommendations to improve the documentation of data and methods and the presentation of findings in future studies that focus primarily on estimating short-run economic impacts; and (3) Reviews important impacts of FERC policies that have been overlooked or incompletely treated by recent RTO benefit-cost studies and the challenges to crafting more comprehensive assessments of these impacts based on actual performance, including impacts on reliability management, generation and transmission investment and operation, and wholesale electricity market operation.

  8. Partnerships for Policy Development: A Case Study From Uganda's Costed Implementation Plan for Family Planning.

    PubMed

    Lipsky, Alyson B; Gribble, James N; Cahaelen, Linda; Sharma, Suneeta

    2016-06-20

    In global health, partnerships between practitioners and policy makers facilitate stakeholders in jointly addressing those issues that require multiple perspectives for developing, implementing, and evaluating plans, strategies, and programs. For family planning, costed implementation plans (CIPs) are developed through a strategic government-led consultative process that results in a detailed plan for program activities and an estimate of the funding required to achieve an established set of goals. Since 2009, many countries have developed CIPs. Conventionally, the CIP approach has not been defined with partnerships as a focal point; nevertheless, cooperation between key stakeholders is vital to CIP development and execution. Uganda launched a CIP in November 2014, thus providing an opportunity to examine the process through a partnership lens. This article describes Uganda's CIP development process in detail, grounded in a framework for assessing partnerships, and provides the findings from 22 key informant interviews. Findings reveal strengths in Uganda's CIP development process, such as willingness to adapt and strong senior management support. However, the evaluation also highlighted challenges, including district health officers (DHOs), who are a key group of implementers, feeling excluded from the development process. There was also a lack of planning around long-term partnership practices that could help address anticipated execution challenges. The authors recommend that future CIP development efforts use a long-term partnership strategy that fosters accountability by encompassing both the short-term goal of developing the CIP and the longer-term goal of achieving the CIP objectives. Although this study focused on Uganda's CIP for family planning, its lessons have implications for any policy or strategy development efforts that require multiple stakeholders to ensure successful execution. PMID:27353621

  9. The financial implications of endovascular aneurysm repair in the cost containment era

    PubMed Central

    Stone, David H.; Horvath, Alexander J.; Goodney, Philip P.; Rzucidlo, Eva M.; Nolan, Brian W.; Walsh, Daniel B.; Zwolak, Robert M.; Powell, Richard J.

    2014-01-01

    Objective Endovascular aneurysm repair (EVAR) is associated with significant direct device costs. Such costs place EVAR at odds with efforts to constrain healthcare expenditures. This study examines the procedure-associated costs and operating margins associated with EVAR at a tertiary care academic medical center. Methods All infrarenal EVARs performed from April 2011 to March 2012 were identified (n = 127). Among this cohort, 49 patients met standard commercial instruction for use guidelines, were treated using a single manufacturer device, and billed to Medicare diagnosis-related group (DRG) 238. Of these 49 patients, net technical operating margins (technical revenue minus technical cost) were calculated in conjunction with the hospital finance department. EVAR implant costs were determined for each procedure. DRG 238-associated costs and length of stay were benchmarked against other academic medical centers using University Health System Consortium 2012 data. Results Among the studied EVAR cohort (age 75, 82% male, mean length of stay, 1.7 days), mean technical costs totaled $31,672. Graft implants accounted for 52% of the allocated technical costs. Institutional overhead was 17% ($5495) of total technical costs. Net mean total technical EVAR-associated operating margins were —$4015 per procedure. Our institutional costs and length of stay, when benchmarked against comparable centers, remained in the lowest quartile nationally using University Health System Consortium costs for DRG 238. Stent graft price did not correlate with total EVAR. market share. Conclusions EVAR is currently associated with significant negative operating margins among Medicare beneficiaries. Currently, device costs account for over 50% of EVAR-associated technical costs and did not impact EVAR market share, reflecting an unawareness of cost differential among surgeons. These data indicate that EVAR must undergo dramatic care delivery redesign for this practice to remain sustainable

  10. Cost Analysis and its Use in Simulation of Policy Options: The Papua New Guinea Education Finance Model.

    ERIC Educational Resources Information Center

    Webster, Thomas

    1997-01-01

    Describes the structure and operations of a computer simulation model used in Papua New Guinea, developed with technical assistance from UNESCO. Notes that model establishes baseline data on student enrollments, teacher posts, and costs of education, and can be used to simulate policies under consideration and provide output on student flows,…

  11. Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease (COPD) Using an Ontario Policy Model

    PubMed Central

    Chandra, K; Blackhouse, G; McCurdy, BR; Bornstein, M; Campbell, K; Costa, V; Franek, J; Kaulback, K; Levin, L; Sehatzadeh, S; Sikich, N; Thabane, M; Goeree, R

    2012-01-01

    Pulmonary Disease (COPD): An Evidence-Based Analysis Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Long-Term Oxygen Therapy for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Acute Respiratory Failure Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Noninvasive Positive Pressure Ventilation for Chronic Respiratory Failure Patients With Stable Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Hospital-at-Home Programs for Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Cost-Effectiveness of Interventions for Chronic Obstructive Pulmonary Disease Using an Ontario Policy Model Experiences of Living and Dying With COPD: A Systematic Review and Synthesis of the Qualitative Empirical Literature For more information on the qualitative review, please contact Mita Giacomini at: http://fhs.mcmaster.ca/ceb/faculty_member_giacomini.htm. For more information on the economic analysis, please visit the PATH website: http://www.path-hta.ca/About-Us/Contact-Us.aspx. The Toronto Health Economics and Technology Assessment (THETA) collaborative has produced an associated report on patient preference for mechanical ventilation. For more information, please visit the THETA website: http://theta.utoronto.ca/static/contact. Background Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation throughout the airways, parenchyma, and pulmonary vasculature. The inflammation causes repeated cycles of injury and repair in the airway wall— inflammatory cells release a variety of chemicals and lead to cellular damage. The inflammation process also contributes to the loss of elastic recoil pressure

  12. Policy recommendations and cost implications for a more sustainable framework for European human biomonitoring surveys.

    PubMed

    Joas, Anke; Knudsen, Lisbeth E; Kolossa-Gehring, Marike; Sepai, Ovnair; Casteleyn, Ludwine; Schoeters, Greet; Angerer, Jürgen; Castaño, Argelia; Aerts, Dominique; Biot, Pierre; Horvat, Milena; Bloemen, Louis; Reis, M Fátima; Lupsa, Ioana-Rodica; Katsonouri, Andromachi; Cerna, Milena; Berglund, Marika; Crettaz, Pierre; Rudnai, Peter; Halzlova, Katarina; Mulcahy, Maurice; Gutleb, Arno C; Fischer, Marc E; Becher, Georg; Fréry, Nadine; Jensen, Genon; Van Vliet, Lisette; Koch, Holger M; Den Hond, Elly; Fiddicke, Ulrike; Esteban, Marta; Exley, Karen; Schwedler, Gerda; Seiwert, Margarete; Ligocka, Danuta; Hohenblum, Philipp; Kyrtopoulos, Soterios; Botsivali, Maria; DeFelip, Elena; Guillou, Claude; Reniero, Fabiano; Grazuleviciene, Regina; Veidebaum, Toomas; Mørck, Thit A; Nielsen, Jeanette K S; Jensen, Janne F; Rivas, Teresa C; Sanchez, Jinny; Koppen, Gudrun; Smolders, Roel; Kozepesy, Szilvia; Hadjipanayis, Adamos; Krskova, Andrea; Mannion, Rory; Jakubowski, Marek; Fucic, J Aleksandra; Pereira-Miguel, Jose; Gurzau, Anca E; Jajcaj, Michal; Mazej, Darja; Tratnik, Janja Snoj; Lehmann, Andrea; Larsson, Kristin; Dumez, Birgit; Joas, Reinhard

    2015-08-01

    The potential of Human Biomonitoring (HBM) in exposure characterisation and risk assessment is well established in the scientific HBM community and regulatory arena by many publications. The European Environment and Health Strategy as well as the Environment and Health Action Plan 2004-2010 of the European Commission recognised the value of HBM and the relevance and importance of coordination of HBM programmes in Europe. Based on existing and planned HBM projects and programmes of work and capabilities in Europe the Seventh Framework Programme (FP 7) funded COPHES (COnsortium to Perform Human Biomonitoring on a European Scale) to advance and improve comparability of HBM data across Europe. The pilot study protocol was tested in 17 European countries in the DEMOCOPHES feasibility study (DEMOnstration of a study to COordinate and Perform Human biomonitoring on a European Scale) cofunded (50%) under the LIFE+ programme of the European Commission. The potential of HBM in supporting and evaluating policy making (including e.g. REACH) and in awareness raising on environmental health, should significantly advance the process towards a fully operational, continuous, sustainable and scientifically based EU HBM programme. From a number of stakeholder activities during the past 10 years and the national engagement, a framework for sustainable HBM structure in Europe is recommended involving national institutions within environment, health and food as well as European institutions such as ECHA, EEA, and EFSA. An economic frame with shared cost implications for national and European institutions is suggested benefitting from the capacity building set up by COPHES/DEMOCOPHES. PMID:25526891

  13. Costs and Benefits Associated with the MRSA Search and Destroy Policy in a Hospital in the Region Kennemerland, The Netherlands

    PubMed Central

    Souverein, Dennis; Houtman, Patricia; Euser, Sjoerd M.; Herpers, Bjorn L.; Kluytmans, Jan; Den Boer, Jeroen W.

    2016-01-01

    Objective The objective of this study was to analyze the costs and benefits of the MRSA Search and Destroy (S&D) policy between 2008 and 2013 in the Kennemer Gasthuis, a 400 bed teaching hospital in the region Kennemerland, the Netherlands. Methods A patient registration database was used to retrospectively calculate costs, including screening, isolation, follow-up, contact tracing, cleaning, treatment, deployment of extra healthcare workers, salary for an infection control practitioner (ICP) and service of isolation rooms. The estimated benefits (costs and lives when no MRSA S&D was applied) were based on a varying MRSA prevalence rate (up to 50%). Results When no MRSA S&D policy was applied, the additional costs and deaths due to MRSA bacteraemia were estimated to be € 1,388,907 and 33 respectively (at a MRSA prevalence rate of 50%). Currently, the total costs were estimated to be € 290,672 (€ 48,445 annually) and a MRSA prevalence rate of 17.3% was considered as break-even point. Between 2008 and 2013, a total of 576 high risk patients were screened for MRSA carriage, of whom 19 (3.3%) were found to be MRSA positive. Forty-nine patients (72.1%) were found unexpectedly. Conclusions Application of the MRSA S&D policy saves lives and money, although the high rate of unexpected MRSA cases is alarming. PMID:26849655

  14. Geothermal power, policy, and design: Using levelized cost of energy and sensitivity analysis to target improved policy incentives for the U.S. geothermal market

    NASA Astrophysics Data System (ADS)

    Richard, Christopher L.

    At the core of the geothermal industry is a need to identify how policy incentives can better be applied for optimal return. Literature from Bloomquist (1999), Doris et al. (2009), and McIlveen (2011) suggest that a more tailored approach to crafting geothermal policy is warranted. In this research the guiding theory is based on those suggestions and is structured to represent a policy analysis approach using analytical methods. The methods being used are focus on qualitative and quantitative results. To address the qualitative sections of this research an extensive review of contemporary literature is used to identify the frequency of use for specific barriers, and is followed upon with an industry survey to determine existing gaps. As a result there is support for certain barriers and justification for expanding those barriers found within the literature. This method of inquiry is an initial point for structuring modeling tools to further quantify the research results as part of the theoretical framework. Analytical modeling utilizes the levelized cost of energy as a foundation for comparative assessment of policy incentives. Model parameters use assumptions to draw conclusions from literature and survey results to reflect unique attributes held by geothermal power technologies. Further testing by policy option provides an opportunity to assess the sensitivity of each variable with respect to applied policy. Master limited partnerships, feed in tariffs, RD&D, and categorical exclusions all result as viable options for mitigating specific barriers associated to developing geothermal power. The results show reductions of levelized cost based upon the model's exclusive parameters. These results are also compared to contemporary policy options highlighting the need for tailored policy, as discussed by Bloomquist (1999), Doris et al. (2009), and McIlveen (2011). It is the intent of this research to provide the reader with a descriptive understanding of the role of

  15. Cost and Price Increases in Higher Education: Evidence of a Cost Disease on Higher Education Costs and Tuition Prices and the Implications for Higher Education Policy

    ERIC Educational Resources Information Center

    Trombella, Jerry

    2011-01-01

    As concern over rapidly rising college costs and tuition sticker prices have increased, a variety of research has been conducted to determine potential causes. Most of this research has focused on factors unique to higher education. In contrast, cost disease theory attempts to create a comparative context to explain cost increases in higher…

  16. The Societal Costs and Benefits of Commuter Bicycling: Simulating the Effects of Specific Policies Using System Dynamics Modeling

    PubMed Central

    Connor, Jennie; Witten, Karen; Kearns, Robin; Rees, David; Woodward, Alistair

    2014-01-01

    Background: Shifting to active modes of transport in the trip to work can achieve substantial co-benefits for health, social equity, and climate change mitigation. Previous integrated modeling of transport scenarios has assumed active transport mode share and has been unable to incorporate acknowledged system feedbacks. Objectives: We compared the effects of policies to increase bicycle commuting in a car-dominated city and explored the role of participatory modeling to support transport planning in the face of complexity. Methods: We used system dynamics modeling (SDM) to compare realistic policies, incorporating feedback effects, nonlinear relationships, and time delays between variables. We developed a system dynamics model of commuter bicycling through interviews and workshops with policy, community, and academic stakeholders. We incorporated best available evidence to simulate five policy scenarios over the next 40 years in Auckland, New Zealand. Injury, physical activity, fuel costs, air pollution, and carbon emissions outcomes were simulated. Results: Using the simulation model, we demonstrated the kinds of policies that would likely be needed to change a historical pattern of decline in cycling into a pattern of growth that would meet policy goals. Our model projections suggest that transforming urban roads over the next 40 years, using best practice physical separation on main roads and bicycle-friendly speed reduction on local streets, would yield benefits 10–25 times greater than costs. Conclusions: To our knowledge, this is the first integrated simulation model of future specific bicycling policies. Our projections provide practical evidence that may be used by health and transport policy makers to optimize the benefits of transport bicycling while minimizing negative consequences in a cost-effective manner. The modeling process enhanced understanding by a range of stakeholders of cycling as a complex system. Participatory SDM can be a helpful method

  17. 78 FR 17300 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-21

    ... Cooperative Agreements; Cost Principles and Administrative Requirements (Including Single Audit Act) AGENCY...; Cost Principles and Administrative Requirements (Including Single Audit Act) published February 1,...

  18. Multifunctional polymer composites containing inorganic nanoparticles and novel low-cost carbonaceous fillers

    NASA Astrophysics Data System (ADS)

    Wu, Hongchao

    Advanced polymer nanocomposites/composites containing inorganic nanoparticles and novel carbonaceous fillers were processed and evaluated for the multifunctional purposes. To prepare the high performance conformal coating materials for microelectronic industries, epoxy resin was incorporated with zirconium tungstate (ZrW 2O8) nanoparticles synthesized from hydrothermal reaction to alleviate the significant thermal expansion behavior. Three types of ZrW 2O8 at different loading levels were selected to study their effect of physical (morphology, particle size, surface area, etc.) and thermal (thermal expansivity) properties on the rheological, thermo-mechanical, dynamic-mechanical, and dielectric properties of epoxy resin. Epoxy resin incorporated by Type-1 ZrW2O8 exhibited the overall excellent performance. Hexagonal boron nitride (h-BN) nanoplatelets were non-covalently encapsulated by a versatile and mussel-adhesive protein polydopamine through the strong pi-pi* interaction. The high-temperature thermoset bisphenol E cyanate ester (BECy) reinforced with homogenously dispersed h-BN at different volume fractions and functionalities were processed to investigate their effect on thermo-mechanical, dynamic-mechanical, dielectric properties and thermal conductivity. Different theoretical and empirical models were also successfully applied for the prediction of CTE, thermal conductivity and dielectric constant of h-BN/BECy nanocomposites. On the basis of the improvement in dimensional stability, the enhancement in storage modulus in both glassy and rubbery regions, associated with the increment in thermal conductivity without deterioration of thermal stability, glassy transition temperature and dielectric properties, pristine h-BN/BECy nanocomposites exhibited the prospective application in microelectronic packaging industry. Polydopamine functionalized h-BN significantly increased the dielectric constant of cyanate ester at lower frequency region. Asphaltene, a

  19. Benefits, cost requirements and cost-effectiveness of the HPV16,18 vaccine for cervical cancer prevention in developing countries: policy implications.

    PubMed

    Goldie, Sue J; O'Shea, Meredith; Diaz, Mireia; Kim, Sun-Young

    2008-11-01

    Approximately 70% of cases of cervical cancer worldwide are caused by genotypes 16 and 18 of human papillomavirus (HPV), which is sexually transmitted. With the availability of an effective vaccine against these HPV types, there is real hope for reducing the global burden of cervical cancer in developing countries. Stakeholders faced with decisions about where to invest money to improve health must consider the burden of disease caused by cervical cancer relative to other priorities and the comparative benefits of different interventions. We conducted a series of analyses to obtain information for agencies drafting immunisation policy recommendations, financing coordination mechanisms, and country decision-makers on the benefits, cost requirements and cost-effectiveness of the HPV16,18 vaccine. We found that making an HPV16,18 vaccine accessible to 70% of young adolescent girls in 72 of the poorest countries, China, Thailand, and all of Latin America and the Caribbean, could prevent the future deaths of more than four million women vaccinated over the next decade. Provided the cost per vaccinated girl is less than $10-$25, adolescent HPV16,18 vaccination would be cost-effective even in relatively poor countries. Concerns about financial costs and affordability highlight the need for lowering vaccine prices, cost-efficient mechanisms for delivery of vaccinations to adolescents, and creative sources of financing. PMID:19027626

  20. Hospital cost-containment strategies that earn the respect of rating agencies.

    PubMed

    Dopoulos, Jason

    2016-01-01

    To confirm that hospitals have the necessary structures and strategies in place to reduce costs and secure future market share, credit rating agencies analyze a variety of quantitative and qualitative criteria, including: Salaries and benefits, bad debt, age of plant and depreciation, and other line items that may point to inefficiencies in a hospital's expense structure. Cost-benefit analyses, strategic plans, and leadership qualities that show the long-term value of expense cuts, capital investments, and mergers and acquisitions. Cost-effective and clinically appropriate shifts in a hospital's outpatient-to-inpatient ratio. Liquidity and market share. PMID:26863833

  1. 75 FR 34448 - Proposed CERCLA Administrative Cost Recovery Settlement; Great Lakes Container Corporation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-17

    ... costs (Section XV of the proposed settlement). The Agency will consider all comments received and may..., Environmental Protection Agency--Region I, 5 Post Office Square--Suite 100 (ORA18-1), Boston, MA 02109-3912....

  2. Revisiting sub-Saharan African countries' drug problems: health, social, economic costs, and drug control policy.

    PubMed

    Affinnih, Yahya H

    2002-02-01

    This article takes an international perspective on the drug problem in sub-Saharan Africa. This analysis borrows ideas from physical and economic geography as a heuristic device to conceptualize the global narcoscapes in which drug trafficking occurs. Both the legitimate and the illegal drug trade operate within the same global capitalist system and draw on the same technological innovations and business processes. Central to the paper's argument is evidence that sub-Saharan African countries are now integrated into the political economy of drug consumption due to the spill-over effect. These countries are now minor markets for "hard drugs" as the result of the activities of organizations and individual traffickers that use Africa as a staging point in their trade with Europe and the United States. As a result, sub-Saharan African countries have drug consumption problems that were essentially absent prior to 1980, along with associated health, social, and economic costs. The emerging drug problem has forced African countries to develop their own drug control policy. The sub-Saharan African countries mentioned below vary to some extent in the level of drug use and misuse problems: Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mauritius, Mozambique, Reunion, Rwanda, Seychelles, Somalia, Tanzania, Uganda, Zambia, Angola, Cameroon, Central African Republic, Chad, Congo, Congo (Zaire), Equatorial Guinea, Gabon, Sao Tome and Principe, Botswana, Lesotho, Namibia, South Africa, Swaziland, Benin, Burkina Faso, Cape Verde, Cote d'Ivoire, Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, and Togo. As part of this effort, African countries are assessing the health, social, and economic costs of drug-use-related problems to pinpoint methods which are both effective and inexpensive, since their budgets for social programs are severely constrained. Many have progressed to the point of adopting anti

  3. Policy change to improve pathology turnaround time and reduce costs – possible to do both?

    PubMed Central

    Dimeski, Goce; Silvester, Breeann; Ungerer, Jacobus; Johnson, Leslie; Martin, Jennifer H.

    2013-01-01

    Background: Overcrowding and prolonged length of stay in emergency departments (ED) are increasing problems in hospitals. Rapid availability of all laboratory results has an impact on clinical decision-making, admissions or discharge decisions and resource utilisation. Increasing number of our urinary drugs of abuse (DOA) screens had a turnaround time (TAT) of up to 33 days after the discharge of the patient. Materials and methods: Following an audit and a consultation period with clinicians using the service, a policy change was implemented to reduce the use of gas chromatography mass spectroscopy (GCMS): all requests would have a standard immunoassay (IA) test panel undertaken unless specifically they requested GCMS (including medico-legal) analysis. Results: Almost all of the clinicians interviewed had no understanding of the DOA screening or the difference in the information generated between a confirmatory GCMS urine toxicology screen and IA DOA panel. It appeared none of the patients surveyed in the audit would have had a different clinical decision made if a GCMS had not been undertaken. Post change audit showed only 4.3% of drug requests for IA also received a confirmatory GCMS testing. The estimated saving post change implementation was $127,000 (AU $) in test costs alone over a two year period. The TAT of GCMS results was reduced to 3–4 days. Conclusion: A laboratory-led behavioural change in test requesting is possible and sustainable provided the reason is clinically sound and accompanied by consultation and availability of advice by phone when requested on test requesting or interpretation. PMID:24266298

  4. The cost-effectiveness of policies for the safe and appropriate use of injection in healthcare settings.

    PubMed Central

    Dziekan, Gerald; Chisholm, Daniel; Johns, Benjamin; Rovira, Juan; Hutin, Yvan J. F.

    2003-01-01

    OBJECTIVE: Poor injection practices transmit potentially life-threatening pathogens. We modelled the cost-effectiveness of policies for the safe and appropriate use of injections in ten epidemiological subregions of the world in terms of cost per disability-adjusted life year (DALY) averted. METHODS: The incidence of injection-associated hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections was modelled for a year 2000 cohort over a 30-year time horizon. The consequences of a "do nothing" scenario were compared with a set of hypothetical scenarios that incorporated the health gains of effective interventions. Resources needed to implement effective interventions were costed for each subregion and expressed in international dollars (I dollars). FINDINGS: Worldwide, the reuse of injection equipment in the year 2000 accounted for 32%, 40%, and 5% of new HBV, HCV and HIV infections, respectively, leading to a burden of 9.18 million DALYs between 2000 and 2030. Interventions implemented in the year 2000 for the safe (provision of single-use syringes, assumed effectiveness 95%) and appropriate (patients-providers interactional group discussions, assumed effectiveness 30%) use of injections could reduce the burden of injection-associated infections by as much as 96.5% (8.86 million DALYs) for an average yearly cost of 905 million I dollars (average cost per DALY averted, 102; range by region, 14-2293). Attributable fractions and the number of syringes and needles required represented the key sources of uncertainty. CONCLUSION: In all subregions studied, each DALY averted through policies for the safe and appropriate use of injections costs considerably less than one year of average per capita income, which makes such policies a sound investment for health care. PMID:12764494

  5. Cost and schedule control systems criteria for contract performance measurement. Implementation guide. [Contains glossary

    SciTech Connect

    Not Available

    1980-05-01

    This document provides uniform guidance for implementation of the DOE Order 2250.1, Cost and Schedule Control Systems Criteria (CSCSC) for Contract Performance Measurement. Its purpose is to assist both DOE and contractor representatives in fulfilling their responsibilities for meeting CSCSC requirements. Compliance with the contractual requirements for work definition, cost and schedule control, and performance reporting should provide increased assurance that a contractor's progress is sufficiently visible to indicate status reliably and to provide the basis for timely and meaningful management decisions. 8 figures. (RWR)

  6. Impacts of the Universal Primary Education Policy on Educational Attainment and Private Costs in Rural Uganda

    ERIC Educational Resources Information Center

    Nishimura, Mikiko; Yamano, Takashi; Sasaoka, Yuichi

    2008-01-01

    While some governments in Sub-Saharan Africa have abolished tuition to achieve universal primary education (UPE), few studies have examined the impacts of the UPE policy beyond school enrolment. This study estimates the impact of the UPE policy in Uganda on overall primary education attainments by using data including 940 rural households. We find…

  7. Labor Market Policy: A Comparative View on the Costs and Benefits of Labor Market Flexibility

    ERIC Educational Resources Information Center

    Kahn, Lawrence M.

    2012-01-01

    I review theories and evidence on wage-setting institutions and labor market policies in an international comparative context. These include collective bargaining, minimum wages, employment protection laws, unemployment insurance (UI), mandated parental leave, and active labor market policies (ALMPs). Since it is unlikely that an unregulated…

  8. The new era of payment reform, spending targets, and cost containment in Massachusetts: early lessons for the nation.

    PubMed

    Mechanic, Robert E; Altman, Stuart H; McDonough, John E

    2012-10-01

    As its 2012 session drew to a close, the Massachusetts legislature passed a much-anticipated cost control bill. The bill sets annual state spending targets, encourages the formation of accountable care organizations, and establishes an independent commission to oversee health care system performance. It is Massachusetts's third law to address health spending since the state's landmark health insurance coverage reforms in 2006. The 2012 legislation is a notable step beyond other recent cost control efforts. Although it lacks strong mechanisms to enforce the new spending goals, it creates a framework for increased regulation if spending trends fail to moderate. Massachusetts's experience provides several lessons for state and federal policy makers. First, implementing near-universal coverage, as is planned under the Affordable Care Act for 2014, will increase pressure on government to begin controlling overall health care spending. Second, introduction of cost control measures takes time: Massachusetts enacted a series of incremental but increasingly strong laws over the past six years that have gradually increased its ability to influence health spending. Finally, the effectiveness of new cost control laws will depend on changes in providers' and insurers' behavior; in Massachusetts, private market activity has had a complementary impact on the pace of health system change. PMID:22993207

  9. Safety Is 99 Percent Attitude: Strategies to Contain Workers' Compensation Costs.

    ERIC Educational Resources Information Center

    Parnell, Janet

    1993-01-01

    The University of Denver (Colorado) reduced workers' compensation losses 97 percent in 1990-91 by developing a master safety plan, sponsoring safety training, managing medical costs, providing modified duty for injured employees, screening applicants, orienting new employees, investigating claims thoroughly, performing life-safety audits, and…

  10. Effectiveness of Strategies To Contain Costs of the Post-Retirement Health Benefit Program.

    ERIC Educational Resources Information Center

    Wan, Thomas T. H.; And Others

    The management of the cost of post-retirement health benefits (PRHBs) for retirees is a major concern to American corporations because of a declining commitment to the Medicare program by the federal government, new proposed accounting rules that will change the financial treatment of PRHBs, and a growing retiree population. This study was…

  11. A systematic review to assess the policy-making relevance of dementia cost-of-illness studies in the US and Canada.

    PubMed

    Oremus, Mark; Aguilar, S Carolina

    2011-02-01

    A systematic review of dementia cost-of-illness (COI) studies in the US and Canada was conducted to explore the policy-making relevance of these studies. MEDLINE, CINAHL, EconLit, AMED and the Cochrane Library were searched from inception to March 2010 for English-language COI articles. Content analysis was used to extract common themes about dementia cost from the conclusions of articles that passed title, abstract and full-text screening. These themes informed our exploration of the policy-making relevance of COI studies in dementia. The literature search retrieved 961 articles and data were extracted from 46 articles. All except three articles reported data from the US; 27 articles included Alzheimer's dementia only. Common themes pertained to general observations about dementia cost, cost drivers in dementia, caregiver cost, items that may lower dementia cost, social service cost, Medicare and Medicaid cost, and cost comparisons with other diseases. The common themes suggest policy-oriented research for the future. However, the extracted COI studies were typically not conducted for policy-making purposes and they did not commonly provide prescriptive policy options. Researchers and policy makers need to consider whether the optimal research focus in dementia should be on programme evaluations instead of more COI studies. PMID:21090840

  12. Costs and benefits of an enhanced reduction policy of particulate matter exhaust emissions from road traffic in Flanders

    NASA Astrophysics Data System (ADS)

    Schrooten, Liesbeth; De Vlieger, Ina; Lefebre, Filip; Torfs, Rudi

    We demonstrate that accelerated policies beyond the steady improvement of technologies and the fleet turnover are not always justified by assumptions about health benefits. Between the years 2000 and 2010, particulate matter (PM) exhaust emissions from traffic in Flanders, a region of Belgium, will be reduced by about 44% without taking any extra reduction measures (baseline scenario). The PM emissions from road traffic were calculated using the MIMOSA model. Furthermore, we explored a range of options to increase attempts to reduce PM exhaust emission from traffic in 2010. When installing particle filters on heavy-duty trucks and buses, introducing biodiesel and diesel/hybrid cars, as well as slowing down the increase of private diesel cars, only an extra reduction of about 8% PM can be achieved in Flanders. The costs to achieve this small reduction are very high. To justify these costs, benefits for public health have been calculated and expressed in external costs. We demonstrate that only an enhanced effort to retrofit trucks and buses with particle filters has a net benefit. We have used Monte Carlo techniques to test the validity of this conclusion. It is concluded that a local or national policy that goes beyond European policies is not always beneficial and that additional measures should be assessed carefully.

  13. High performance, low cost, self-contained, multipurpose PC based ground systems

    NASA Technical Reports Server (NTRS)

    Forman, Michael; Nickum, William; Troendly, Gregory

    1993-01-01

    The use of embedded processors greatly enhances the capabilities of personal computers when used for telemetry processing and command control center functions. Parallel architectures based on the use of transputers are shown to be very versatile and reusable, and the synergism between the PC and the embedded processor with transputers results in single unit, low cost workstations of 20 less than MIPS less than or equal to 1000.

  14. Low-cost, fly-ash-containing aluminum-matrix composites

    NASA Astrophysics Data System (ADS)

    Rohatgi, Pradeep K.

    1994-11-01

    In recent years there has been considerable activity in the development of metal-matrix composites, especially for aerospace, ground transportation, and the leisure industry. Short-fiber-reinforced pistons and cylinder blocks have been marketed by Japanese companies for several years. It is likely that in the near future cast particulate composites like aluminum-graphite, aluminum-silicon carbide, and aluminum-alumina will find widespread applications as brake rotors, drive shafts, cylinder liners, connecting rods, and wrist pins. The cost of metal-matrix composites has been one of the major barriers toward their widespread application. This paper describes the development of cast aluminum-fly ash particle composites (ash alloy). Incorporation of fly-ash particles, which are a waste by-product of coal-based power generation, reduces the cost of aluminum castings by acting as a filler; decreases their density, and increases their hardness, abrasion resistance, and stiffness. Several prototype castings have been made from aluminum-fly ash composites to demonstrate their castability. With sustained research and the support of manufacturing organizations, these alloys can find widespread applications as low-cost aluminum composite components.

  15. Water supply development and tariffs in Tanzania: From free water policy towards cost recovery

    NASA Astrophysics Data System (ADS)

    Mashauri, Damas A.; Katko, Tapio S.

    1993-01-01

    The article describes the historical development of water tariff policy in Tanzania from the colonial times to present. After gaining independence, the country introduced “free” water policy in its rural areas. Criticism against this policy was expressed already in the 1970s, but it was not until the late 1980s that change became unavoidable. All the while urban water tariffs continued to decline in real terms. In rural and periurban areas of Tanzania consumers often have to pay substantial amounts of money for water to resellers and vendors since the public utilities are unable to provide operative service. Besides, only a part of the water bills are actually collected. Now that the free water supply policy has been officially abandoned, the development of water tariffs and the institutions in general are a great challenge for the country.

  16. Natural Iraqi palygorskite clay as low cost adsorbent for the treatment of dye containing industrial wastewater.

    PubMed

    Nassir Taha, Dakhil; Sadi Samaka, Isra'a

    2012-01-01

    In this study, natural Iraqi low- cost locally available clay (palygorskite) was studied for its potential use as an adsorbent for removal Congo red from aqueous solutions. Batch type experiments were conducted to study the effect of contact time, initial pH of the dye solution, initial dye concentration, adsorbent dosage, and particle size of adsorbent on adsorption capacity of Congo red. The adsorption occurred very fast initially and attains equilibrium within 60 min. When the effect of pH of solution dye on the yield adsorption has been carried in a range of 2-10, the adsorption obtained was nearly the same with very slightly effect of pH and it was reported that above 49.07 mg/g of Cong red by palygorskite clay occurred in the pH range 2 to 10. It was observed that the removal of Congo red increase with increasing initial dye concentration and adsorbent dose, but, adsorption capacity decrease with increasing adsorbent dose. The adsorption capacity increase with decreasing particle size of adsorbent. The equilibrium adsorption data were interpreted using Langmuir and Freundlich isotherm models. The obtained results revealed that the equilibrium data closely followed both models, but the Langmuir isotherm fitted the data better. The maximum adsorption capacity was found to be 99 mg/g at ambient temperature. Results indicate that Iraqi palygorskite clay could be employed as a low cost alternative to commercial activated carbon in wastewater treatment for the removal of colour and dyes. PMID:23196874

  17. Survey of consumer attitudes and awareness of the metric conversion of distilled spirits containers: A policy and planning evaluation

    NASA Astrophysics Data System (ADS)

    Simpson, J. A.; Barsby, S. L.

    1981-12-01

    The survey was conducted as part of a policy and planning evaluation study. The overall study was an examination of a completed private sector conversion to the metric system, in the light of the US Metric Board's planning guidelines and procedures. The conversion of distilled spirits containers took place prior to the establishment of the USMB. The study's objective was to use the completed version to determine if the guidelines and related procedures were adequate to help the conversion process. If they were not, the study was designed to provide suggestions for improvement.

  18. Benefit-Cost Analysis of the Perry Preschool Program and Its Policy Implications.

    ERIC Educational Resources Information Center

    Barnett, W. Steven

    1985-01-01

    Benefit-cost analysis is applied to the Perry Preschool Program and its long-term follow-up in order to examine preschool education as a social investment. The net present value of benefits and costs is positive, indicating that the program was a profitable social investment. (Author/LMO)

  19. Price-Cost Ratios in Higher Education: Subsidy Structure and Policy Implications

    ERIC Educational Resources Information Center

    Xie, Yan

    2010-01-01

    The diversity of US institutions of higher education is manifested in many ways. This study looks at that diversity from the economic perspective by studying the subsidy structure through the distribution of institutional price-cost ratio (PCR), defined as the sum of net tuition price divided by total supplier cost and equals to one minus…

  20. 77 FR 17360 - Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles And...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-26

    ... Federal Register on February 28, 2012, at 77 FR 11178. The original comment period was scheduled to end on... Cooperative Agreements; Cost Principles And Administrative Requirements (Including Single Audit Act) AGENCY... Grants and Cooperative Agreements; cost principles and administrative requirements (including...

  1. Suicide and Suicidal Attempts in the United States: Costs and Policy Implications.

    PubMed

    Shepard, Donald S; Gurewich, Deborah; Lwin, Aung K; Reed, Gerald A; Silverman, Morton M

    2016-06-01

    The national cost of suicides and suicide attempts in the United States in 2013 was $58.4 billion based on reported numbers alone. Lost productivity (termed indirect costs) represents most (97.1%) of this cost. Adjustment for under-reporting increased the total cost to $93.5 billion or $298 per capita, 2.1-2.8 times that of previous studies. Previous research suggests that improved continuity of care would likely reduce the number of subsequent suicidal attempts following a previous nonfatal attempt. We estimate a highly favorable benefit-cost ratio of 6 to 1 for investments in additional medical, counseling, and linkage services for such patients. PMID:26511788

  2. Quality assurance and medical outcomes in the era of cost containment.

    PubMed

    Campion, F X; Rosenblatt, M S

    1996-02-01

    Market forces are driving health care organizations to "prove" quality while diminishing costs. Payers for health care, led by large employers and insurance companies, are demanding clinical, financial, and satisfaction outcomes from providers. To meet the challenge, traditional quality assurance based on inspection and rooting out "bad apples" is rapidly being replaced by the industrial engineering principles of continuous quality improvement. A philosophical shift is occurring from a focus on episodes of care delivered by physicians to the delivery of processes of care by teams of health care personnel. We are seeing a shift in emphasis from a fascination with intensive care delivered to sick patients to cost-effective preventive services delivered to populations of well patients. The locus of care delivery is moving from inpatient hospitals to ambulatory clinics and home care. The need for this information is leading to innovation in computer systems and health care organizations. New partnerships are emerging between physicians, nurses, and hospitals. Traditional oversight bodies including the JCAHO and the HCFA-sponsored PROs are restructuring to meet these new demands. New organizations such as the National Committee on Quality Assurance and state governmental agencies are being established to fill the perceived void. Individual surgeons have begun to receive performance data on their individual and group practices. Professional societies have collaborated in the development of clinical guidelines and outcomes data bases. This massive reorganization will take several more years to play out. With careful development it has the potential to dramatically improve patient care through the efficient application of new scientific knowledge and the sustained flow of information back to physicians and patients. PMID:8629197

  3. A study of metric conversion of distilled spirits containers: A policy and planning evaluation on findings and lessons learned

    NASA Astrophysics Data System (ADS)

    Simpson, J. A.; Barsby, S. L.

    1981-10-01

    This report is the Task 4 report and final product for "A Study of Metric Conversion of Distilled Spirits Containers: A Policy and Planning Evaluation,' performed by Applied Concepts Corporation for the United States Metric Board (USMB). This report summarizes the results for the entire project, which entailed: conducting a detailed case study of the distilled spirits conversion; developing and analyzing a set of hypothetical scenarios regarding the circumstances of the conversion and USMB's possible role in it; assessing the completeness and clarity of USMB's planning guidelines; conducting a survey of consumer awareness of and attitudes toward the conversion; and analyzing the implications of the findings from all the above for USMB policy. The report presents a brief overview of the major findings from the case study, regarding the actual events, issues, and impacts of the distilled spirits conversion. It traces the impacts of possible USMB intervention strategies under several alternative scenarios, in the context of the distilled spirits conversion. The study assesses the planning guidelines and analyzes the implications for USMB policy and presents a concise summary of findings and "lessons learned' over the course of this project. Consumer survey results are attached in an Appendix.

  4. Cost savings associated with landfilling wastes containing very low levels of uranium

    SciTech Connect

    Boggs, C.J.; Shaddoan, W.T.

    1996-03-01

    The Paducah Gaseous Diffusion Plant (PGDP) has operated captive landfills (both residential and construction/demolition debris) in accordance with the Commonwealth of Kentucky regulations since the early 1980s. Typical waste streams allowed in these landfills include nonhazardous industrial and municipal solid waste (such as paper, plastic, cardboard, cafeteria waste, clothing, wood, asbestos, fly ash, metals, and construction debris). In July 1992, the U.S. Environmental Protection Agency issued new requirements for the disposal of sanitary wastes in a {open_quotes}contained landfill.{close_quotes} These requirements were promulgated in the 401 Kentucky Administrative Record Chapters 47 and 48 that became effective 30 June 1995. The requirements for a new contained landfill include a synthetic liner made of high-density polyethylene in addition to the traditional 1-meter (3-foot) clay liner and a leachate collection system. A new landfill at Paducah would accept waste streams similar to those that have been accepted in the past. The permit for the previously existing landfills did not include radioactivity limits; instead, these levels were administratively controlled. Typically, if radioactivity was detected above background levels, the waste was classified as low-level waste (LLW), which would be sent off-site for disposal.

  5. Utility planning using least-cost principles and the role of externalities - staff report on a Keystone policy dialogue

    SciTech Connect

    1996-05-01

    For over two years, The Keystone Center facilitated a two-phase dialogue on Utility Planning Using Least-Cost Principles and, in the second phase, on the role of Externalities. The intent of this report is to assist policy-makers faced with decisions about changes to traditional utility regulation and planning. This report is not a consensus document, rather it is staff written summary of two years of discussion on the issues. As a concept, least-cost planning has been discussed since the 1970`s and many states have implemented such programs since the mid-1980`s. Yet, the actual goals and objectives of least-cost planning remain a source of controversy between affected interest groups. Some industry observers believe that least-cost planning can help reconcile the often conflicting demands between increased capacity requirements and concerns about the external costs of power production. In traditional utility regulation practices, capital investments are rewarded and revenue is a direct function of sales. However, a number state public utility commissions have altered their practices to allow for returns on investments in more efficient end-use equipment (also known as ratebasing conservation) and adjusting revenues to account for sales lost due to utility conservation programs. Other states are planning these types of changes. Still others are observing the impacts of the changes before they commit.

  6. Monitoring Conformance and Containment for Geological Carbon Storage: Can Technology Meet Policy and Public Requirements?

    NASA Astrophysics Data System (ADS)

    Lawton, D. C.; Osadetz, K.

    2014-12-01

    The Province of Alberta, Canada identified carbon capture and storage (CCS) as a key element of its 2008 Climate Change strategy. The target is a reduction in CO2 emissions of 139 Mt/year by 2050. To encourage uptake of CCS by industry, the province has provided partial funding to two demonstration scale projects, namely the Quest Project by Shell and partners (CCS), and the Alberta Carbon Trunk Line Project (pipeline and CO2-EOR). Important to commercial scale implementation of CCS will be the requirement to prove conformance and containment of the CO2 plume injected during the lifetime of the CCS project. This will be a challenge for monitoring programs. The Containment and Monitoring Institute (CaMI) is developing a Field Research Station (FRS) to calibrate various monitoring technologies for CO2 detection thresholds at relatively shallow depths. The objective being assessed with the FRS is sensitivity for early detection of loss of containment from a deeper CO2 storage project. In this project, two injection wells will be drilled to sandstone reservoir targets at depths of 300 m and 700 m. Up to four observation wells will be drilled with monitoring instruments installed. Time-lapse surface and borehole monitoring surveys will be undertaken to evaluate the movement and fate of the CO2 plume. These will include seismic, microseismic, cross well, electrical resistivity, electromagnetic, gravity, geodetic and geomechanical surveys. Initial baseline seismic data from the FRS will presented.

  7. Bearing the Cost: An Examination of the Gendered Impacts of Water Policy Reform in Malawi

    ERIC Educational Resources Information Center

    Marra, Simona

    2008-01-01

    Water insecurity is one of the most pressing issues currently faced by Malawi. The consequences of these issues are borne significantly by women, who are most directly involved with water provision and use, particularly at the household level. Since the mid-1990s, Malawi has undertaken a process of water policy reform. Reflective of international…

  8. Financing Policies for High Cost University of Minnesota Health Professions Programs.

    ERIC Educational Resources Information Center

    Minnesota Higher Education Coordinating Board, St. Paul.

    Issues and related data are examined concerning financial aid to students in the health professions at the University of Minnesota, with a focus on targeted grant programs for dentistry, pharmacy, veterinary medicine, and medicine. Following a discussion of policy implications in general and an overview of each of the fields involved, eight policy…

  9. Keeping Teachers on the Job Costs Less than Advertised. Policy Memorandum #168

    ERIC Educational Resources Information Center

    Bivens, Josh

    2010-01-01

    A misplaced obsession with the size of federal budget deficits remains the single biggest obstacle to enacting new measures to create jobs on a scale commensurate with the crisis in the American labor market. Even assuming that budget scoring rules can't be changed, at the very least policy makers should be aware of the true impact a given piece…

  10. Development and evaluation of die and container materials. Low cost silicon solar array project

    NASA Technical Reports Server (NTRS)

    Wills, R. R.; Niesx, D. E.

    1979-01-01

    Specific compositions of high purity silicon aluminum oxynitride (Sialon) and silicon beryllium oxynitride (Sibeon) solid solutions were shown to be promising refractory materials for handling and manipulating solar grade silicon into silicon ribbon. Evaulation of the interaction of these materials in contact with molten silicon indicated that solid solutions based upon beta-Si3N4 were more stable than those based on Si2N2O. Sibeon was more resistant to molten silicon attack than Sialon. Both materials should preferably be used in an inert atmosphere rather than under vacuum conditions because removal of oxygen from the silicon melt occurs as SiO enhances the dissolution of aluminum and beryllium. The wetting angles of these materials were low enough for these materials to be considered as both die and container materials.

  11. Use of Generics—A Critical Cost Containment Measure for All Healthcare Professionals in Europe?

    PubMed Central

    Godman, Brian; Shrank, William; Wettermark, Bjorn; Andersen, Morten; Bishop, Iain; Burkhardt, Thomas; Garuolienè, Kristina; Kalaba, Marija; Laius, Ott; Joppi, Roberta; Sermet, Catherine; Schwabe, Ulrich; Teixeira, Inês; Tulunay, F. Cankat; Wendykowska, Kamila; Zara, Corinne; Gustafsson, Lars L.

    2010-01-01

    resource pressures grow. Policies regarding generics and their subsequent impact on reimbursement and utilization of single sourced products will continue to play a key role to release valuable resources. However, there must continue to be strategies to address concerns with generics when they exist.

  12. A study of metric conversion of distilled spirits containers: A policy and planning evaluation

    NASA Astrophysics Data System (ADS)

    Simpson, J. A.

    1981-08-01

    The report establishes the historical baseline regarding events that occurred, the reasons for the events, their impacts, and the lessons learned from the conversion. The report consists of eight chapters and an appendix: (1) an overview of the distilled spirits industry, (2) an analysis of the motivation phase of the conversion, (3) an analysis of the planning phase, (4) a description and analysis of the events of the implementation phase, (5) an analysis of the costs and savings resulting from the conversion, (6) an analysis of the impact of the conversion on prices of distilled spirits, (7) an analysis of the impacts on consumption, profitability, industry structure, and size, product and brand preferences, (8) a summary of the findings and conclusions from the assessment of the process, and (9) (the appendix) a detailed chronology of events.

  13. The Costs and Valuation of Health Impacts of Measles and Rubella Risk Management Policies.

    PubMed

    Thompson, Kimberly M; Odahowski, Cassie L

    2016-07-01

    National and global health policymakers require good information about the costs and benefits of their investments in measles and rubella immunization programs. Building on our review of the existing measles and rubella health economics literature, we develop inputs for use in regional and global models of the expected future benefits and costs of vaccination, treatment, surveillance, and other global coordination activities. Given diversity in the world and limited data, we characterize the costs for countries according to the 2013 World Bank income levels using 2013 U.S. dollars (2013$US). We estimate that routine immunization and supplemental immunization activities will cost governments and donors over 2013$US 2.3 billion per year for the foreseeable future, with high-income countries accounting for 55% of the costs, to vaccinate global birth cohorts of approximately 134 million surviving infants and to protect the global population of over 7 billion people. We find significantly higher costs and health consequences of measles or rubella disease than with vaccine use, with the expected disability-adjusted life year (DALY) loss for case of disease generally at least 100 times the loss per vaccine dose. To support estimates of the economic benefits of investments in measles and/or rubella elimination or control, we characterize the probabilities of various sequelae of measles and rubella infections and vaccine adverse events, the DALY inputs for health outcomes, and the associated treatment costs. Managing measles and rubella to achieve the existing and future regional measles and rubella goals and the objectives of the Global Vaccine Action Plan will require an ongoing commitment of financial resources that will prevent adverse health outcomes and save the associated treatment costs. PMID:26249331

  14. Modelling Common Agricultural Policy-Water Framework Directive interactions and cost-effectiveness of measures to reduce nitrogen pollution.

    PubMed

    Mouratiadou, Ioanna; Russell, Graham; Topp, Cairistiona; Louhichi, Kamel; Moran, Dominic

    2010-01-01

    Selecting cost-effective measures to regulate agricultural water pollution to conform to the Water Framework Directive presents multiple challenges. A bio-economic modelling approach is presented that has been used to explore the water quality and economic effects of the 2003 Common Agricultural Policy Reform and to assess the cost-effectiveness of input quotas and emission standards against nitrate leaching, in a representative case study catchment in Scotland. The approach combines a biophysical model (NDICEA) with a mathematical programming model (FSSIM-MP). The results indicate only small changes due to the Reform, with the main changes in farmers' decision making and the associated economic and water quality indicators depending on crop price changes, and suggest the use of target fertilisation in relation to crop and soil requirements, as opposed to measures targeting farm total or average nitrogen use. PMID:20453343

  15. Wasteful waste-reducing policies? The impact of waste reduction policy instruments on collection and processing costs of municipal solid waste.

    PubMed

    De Jaeger, Simon; Eyckmans, Johan; Rogge, Nicky; Van Puyenbroeck, Tom

    2011-07-01

    We study the impact of some local policies aimed at municipal solid waste (MSW) reduction on the cost efficiency of MSW collection and disposal. We explicitly account for differences between municipalities in background conditions by using a bootstrapped version of the Data Envelopment Analysis methodology in combination with a matching technique. Using data on 299 municipalities in Flanders, Belgium, for the year 2003, our results indicate that municipalities that are member of a waste collection joint venture, or that subscribe to a voluntary agreement to reduce MSW at the highest ambition level, collect and process MSW more efficiently than other municipalities. Weekly instead of two-weekly waste collection, or using a weight-based pricing system appears to have no impact on efficiency. Our results show that aiming at MSW reduction does not lead to lower efficiency of public service provision, even on the contrary. PMID:21429732

  16. What School Administrators Should Know about Inclusion and Its Costs.

    ERIC Educational Resources Information Center

    Pruslow, John T.

    2003-01-01

    Examines cost-effectiveness of school inclusion for special-needs students. Includes cost analysis of instructional personnel, impact on general education spending, transportation, and school space. Draws policy implications. (Contains 34 references.) (PKP)

  17. Policies to clean up toxic industrial contaminated sites of Gela and Priolo: a cost-benefit analysis

    PubMed Central

    2011-01-01

    Background Cost-benefit analysis is a transparent tool to inform policy makers about the potential effect of regulatory interventions, nevertheless its use to evaluate clean-up interventions in polluted industrial sites is limited. The two industrial areas of Gela and Priolo in Italy were declared "at high risk of environmental crisis" in 1990. Since then little has been done to clean the polluted sites and reduce the health outcomes attributable to pollution exposure. This study, aims to quantify the monetary benefits resulting from clean-up interventions in the contaminated sites of Gela and Priolo. Methods A damage function approach was used to estimate the number of health outcomes attributable to industrial pollution exposure. Extensive one way analyses and probabilistic analyses were conducted to investigate the sensitivity of results to different model assumptions. Results It has been estimated that, on average, 47 cases of premature death, 281 cases of cancer and 2,702 cases of non-cancer hospital admission could be avoided each year by removing environmental exposure in these two areas. Assuming a 20 year cessation lag and a 4% discount rate we calculate that the potential monetary benefit of removing industrial pollution is €3,592 million in Priolo and €6,639 million in Gela. Conclusions Given the annual number of health outcomes attributable to pollution exposure the effective clean-up of Gela and Priolo should be prioritised. This study suggests that clean-up policies costing up to €6,639 million in Gela and €3,592 million in Priolo would be cost beneficial. These two amounts are notably higher than the funds allocated thus far to clean up the two sites, €127.4 million in Gela and €774.5 million in Priolo, implying that further economic investments - even considerable ones - could still prove cost beneficial. PMID:21797993

  18. R&D policy, agency costs and innovation in personalized medicine.

    PubMed

    Yin, Wesley

    2009-09-01

    The Orphan Drug Act (ODA) was designed to spur the development of drugs for rare diseases. In principle, its design also incentivizes pharmaceutical firms to develop drugs for "rare" subdivisions of more prevalent diseases. I find that in response to this incentive, firms develop drugs for ODA-qualifying subdivisions of non-rare diseases. The impact in these tailored drug markets represents half of the total R&D response to the ODA. I also find that 10-percent of the innovation in subdivided disease drugs induced by the ODA would have been conducted without the policy. While modest in size, this inefficiency suggests that agency problems should be considered when designing innovation policy. PMID:19671480

  19. Environmental policy making: liability for externalities in the presence of transaction costs

    SciTech Connect

    Bird, P.J.W.N.

    1980-07-01

    Environmental law that favors the victim of pollution against the polluter has some theoretical justification. For depletable externalities, this originates from the important asymmetries between free riding and holding out and from the physical nature of several externality problems. For a large class of pollution examples, however, where the externality is undepletable, no market can achieve a Pareto optimal allocation. Market solutions are useless in these cases if efficiency is the criterion for the allocation of liability. In a real-world context, very high transaction costs remove the justification for any rule, and the possibility of asymmetry in pollution costs could be used to support laws that favor the polluter. The efforts of policymakers should be directed towards more careful assessment of the likely costs and benefits of polluting activities and of the distributional and ethical dimensions. 13 references, 3 figures.

  20. Early adoption of cyclosporine and recombinant human erythropoietin: clinical, economic, and policy issues with emergence of high-cost drugs.

    PubMed

    Powe, N R; Eggers, P W; Johnson, C B

    1994-07-01

    The discovery of new drugs and their introduction into US markets will become an intense area of focus should health care reform result in Medicare insurance coverage for prescription drugs. Particular attention will be focused on high-cost drugs. Two high-cost drugs, cyclosporine and recombinant human erythropoietin (rHuEPO), introduced into the clinical management of patients with kidney disease during the past decade, provide some experience concerning the forces affecting the use of expensive drugs in a cost-conscious health care system. The decision to prescribe a drug will depend on provider's judgements of the drug's clinical benefits and costs compared with those of other possible therapies. It may also depend on payment policy. Both cyclosporine and rHuEPO were adopted rapidly and extensively by providers of end-stage renal disease care following US Food and Drug Administration approval, despite their high costs. Both drugs were remarkably effective, relatively safe, and able to be administered without great difficulty compared with the therapies they have replaced. There was no additional payment to hospitals for the initial use of cyclosporine, which was introduced in 1983 at the time when Medicare's prospective payment was established, since choice of immunosuppressive agent did not affect the fixed, per-admission payment determined by the diagnosis-related group for kidney transplantation. Medicare coverage for continuing outpatient use of cyclosporine was not initially provided, in contrast to rHuEPO, which was introduced in 1989 with Medicare outpatient coverage and payment of 80% of the allowed charge. Despite their high costs and different methods of insurance payment both drugs achieved a rather quick and high penetration rate into their respective populations.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8023822

  1. Importance of cost-effectiveness and value in cancer care and healthcare policy.

    PubMed

    Kang, Ravinder; Goodney, Philip P; Wong, Sandra L

    2016-09-01

    The cost of cancer care has increased by five fold over the last three decades. As our healthcare system shifts from volume to value, greater scrutiny of interventions with clinical equipoise is required. Traditionally, QALYs and ICER have served as surrogate markers for value. However, this approach fails to incorporate all stakeholders' viewpoints. Prostate cancer, low risk DCIS, and thyroid cancer are used as a framework to discuss value and cost-effectiveness. J. Surg. Oncol. 2016;114:275-280. © 2016 Wiley Periodicals, Inc. PMID:27334052

  2. Vaccination benefits and cost-sharing policy for non-institutionalized adult Medicaid enrollees in the United States

    PubMed Central

    Stewart, Alexandra M.; Lindley, Megan C.; Chang, Kristen H.M.; Cox, Marisa A.

    2015-01-01

    Medicaid is the largest funding source of health services for the poorest people in the United States. Medicaid enrollees have greater health care, needs, and higher health risks than other individuals in the country and, experience disproportionately low rates of preventive care. Without, Medicaid coverage, poor uninsured adults may not be vaccinated or would, rely on publicly-funded programs that provide vaccinations. We examined each programs’ policies related to benefit coverage and, copayments for adult enrollees. Our study was completed between October 2011 and September 2012 using a document review and a survey of Medicaid administrators that assessed coverage and cost-sharing policy for fee-for-service programs. Results were compared to a similar review, conducted in 2003. Over the past 10 years, Medicaid programs have typically maintained or expanded vaccination coverage benefits for adults and nearly half have explicitly prohibited copayments. The 17 programs that cover all recommended vaccines while prohibiting, copayments demonstrate a commitment to providing increased access to vaccinations for adult enrollees. When developing responses to fiscal and political challenges, the programs that do not cover all ACIP recommended adult vaccines or those that permit copayments for vaccinations, should consider all strategies to increase vaccinations and reduce costs to enrollees. PMID:24291539

  3. A retrospective investigation of energy efficiency standards: policies may have accelerated long term declines in appliance costs

    NASA Astrophysics Data System (ADS)

    Van Buskirk, R. D.; Kantner, C. L. S.; Gerke, B. F.; Chu, S.

    2014-11-01

    We perform a retrospective investigation of multi-decade trends in price and life-cycle cost (LCC) for home appliances in periods with and without energy efficiency (EE) standards and labeling polices. In contrast to the classical picture of the impact of efficiency standards, the introduction and updating of appliance standards is not associated with a long-term increase in purchase price; rather, quality-adjusted prices undergo a continued or accelerated long-term decline. In addition, long term trends in appliance LCCs—which include operating costs—consistently show an accelerated long term decline with EE policies. We also show that the incremental price of efficiency improvements has declined faster than the baseline product price for selected products. These observations are inconsistent with a view of EE standards that supposes a perfectly competitive market with static supply costs. These results suggest that EE policies may be associated with other forces at play, such as innovation and learning-by-doing in appliance production and design, that can affect long term trends in quality-adjusted prices and LCCs.

  4. [Drug utilization and pharmaceutical cost-containment in germany-perspectives 1 year after enactment of the GMG].

    PubMed

    Schlander, Michael

    2005-06-15

    After 3 decades of health care cost containment in Germany, enactment of the most recent reform (Health Insurance Modernization Act, GMG) marks a watershed insofar as, apparently, the potential has been largely exhausted for further savings in pharmaceutical spending. Yet the new drugs segment maintains its role as a growth driver, owing to the continuing shift from older to new, and frequently more expensive, products. This observation holds true even after introducing phase 2 reference pricing, covering so-called me too products. Health economic analyses would be required to better differentiate pharmaceutical products based on their incremental cost-effectiveness ratio. However, the opportunity was missed with the GMG to introduce formal health-economic evaluations and thus overcome the counterproductive silo mentality associated with traditional German component management. International experience from Australia, Canada, and the United Kingdom suggests that economic evaluations, while informing rational reimbursement decisions, may in fact contribute to increasing pharmaceutical expenditures. Further tightening of pharmaceutical component management in Germany may result in increasing inefficiencies due to underuse of effective products; furthermore, it appears conceivable that ("second order") dynamic inefficiencies and, hence, social costs might be the consequence of reduced pharmaceutical research and development expenditures. PMID:15968483

  5. An integrated assessment of two decades of air pollution policy making in Spain: Impacts, costs and improvements.

    PubMed

    Vedrenne, Michel; Borge, Rafael; Lumbreras, Julio; Conlan, Beth; Rodríguez, María Encarnación; de Andrés, Juan Manuel; de la Paz, David; Pérez, Javier; Narros, Adolfo

    2015-09-15

    This paper analyses the effects of policy making for air pollution abatement in Spain between 2000 and 2020 under an integrated assessment approach with the AERIS model for number of pollutants (NOx/NO2, PM10/PM2.5, O3, SO2, NH3 and VOC). The analysis of the effects of air pollution focused on different aspects: compliance with the European limit values of Directive 2008/50/EC for NO2 and PM10 for the Spanish air quality management areas; the evaluation of impacts caused by the deposition of atmospheric sulphur and nitrogen on ecosystems; the exceedance of critical levels of NO2 and SO2 in forest areas; the analysis of O3-induced crop damage for grapes, maize, potato, rice, tobacco, tomato, watermelon and wheat; health impacts caused by human exposure to O3 and PM2.5; and costs on society due to crop losses (O3), disability-related absence of work staff and damage to buildings and public property due to soot-related soiling (PM2.5). In general, air quality policy making has delivered improvements in air quality levels throughout Spain and has mitigated the severity of the impacts on ecosystems, health and vegetation in 2020 as target year. The findings of this work constitute an appropriate diagnosis for identifying improvement potentials for further mitigation for policy makers and stakeholders in Spain. PMID:25965050

  6. Comparing the cost-effectiveness of water conservation policies in a depleting aquifer:A dynamic analysis of the Kansas High Plains

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This research analyzes two groundwater conservation policies in the Kansas High Plains located within the Ogallala aquifer: 1) cost-share assistance to increase irrigation efficiency; and 2) incentive payments to convert irrigated crop production to dryland crop production. To compare the cost-effec...

  7. Measuring (and Managing) the Invisible Costs of Postsecondary Attrition. Policy Brief

    ERIC Educational Resources Information Center

    Wellman, Jane; Johnson, Nate; Steele, Patricia

    2012-01-01

    The collision between funding realities and the paramount goal of increasing educational attainment has brought new attention to ways to reduce postsecondary attrition and get more students who enroll in college to complete a degree or credential. Reductions in attrition are both educationally effective and cost effective. Students reach…

  8. The Cost Structure of Higher Education: Implications for Governmental Policy in Steady State.

    ERIC Educational Resources Information Center

    Lyell, Edward H.

    The historical pattern of resource allocation in American higher education as exemplified by public colleges in Colorado was examined. The reliance upon average cost information in making resource allocation decisions was critiqued for the special problems that arise from student enrollment decline or steady state. A model of resource allocation…

  9. Wrestling Rising Costs with Innovation. Policy Matters. Volume 4, Number 1, January 2007

    ERIC Educational Resources Information Center

    Markowitz, Melissa

    2007-01-01

    While tuition costs are likely the most talked about topic in higher education, focusing on the institutional finance is equally important. The growing expenses associated with educating students is often a catalyst for rising tuition and fees, and they play a large role as educators plan for the future of their institutions. Although higher…

  10. The Evidence on Universal Preschool: Are Benefits Worth the Cost? Policy Analysis. Number 760

    ERIC Educational Resources Information Center

    Armor, David J.

    2014-01-01

    Calls for universal preschool programs have become commonplace, reinforced by President Obama's call for "high-quality preschool for all" in 2013. Any program that could cost state and federal taxpayers $50 billion per year warrants a closer look at the evidence on its effectiveness. This report reviews the major evaluations of preschool…

  11. Costs and Policy Options for Federal Student Loan Programs. A CBO Study

    ERIC Educational Resources Information Center

    Lucas, Deborah; Moore, Damien

    2010-01-01

    The Department of Education oversees various programs to help students pay for the costs of postsecondary education. This Congressional Budget Office (CBO) study focuses on the two largest student loan programs created under the authority of the Higher Education Act of 1965 (as amended): (1) The Federal Family Education Loan (FFEL) program, which…

  12. Increasing Fuel Costs Hit Hard: Districts Change Policies to Offset Rising Prices

    ERIC Educational Resources Information Center

    Ash, Katie

    2008-01-01

    This article reports that with fuel prices soaring nationwide, reaching more than $4 for each gallon of gas or diesel, school districts are struggling to supplement transportation-budget shortfalls and find ways to offset the increasing costs as a new school year approaches. Now districts--most of whose buses run on diesel fuel--are scrambling to…

  13. Adjusting Teacher Salaries for the Cost of Living: The Effect on Salary Comparisons and Policy Conclusions

    ERIC Educational Resources Information Center

    Stoddard, C.

    2005-01-01

    Teaching salaries are commonly adjusted for the cost of living, but this incorrectly accounts for welfare differences across states. Adjusting for area amenities and opportunities, however, produces more accurate salary comparisons. Amenities and opportunities can be measured by the wage premium other workers in a state face. The two methods…

  14. The Cost and Management of Program Adequacy: An Emerging Issue in Educational Policy and Finance.

    ERIC Educational Resources Information Center

    Clune, William H.

    1994-01-01

    Introduces a special issue on educational program adequacy--the cost of raising poor children's outcomes to functional levels through improved systems of finance, governance, organization, implementation, and educational practice. Essays raise numerous problems, including a weak knowledge base, low educational productivity, political resistance,…

  15. Weighing the Costs and Benefits of State Renewables Portfolio Standards in the United States: A Comparative Analysis of State-Level Policy Impact Projections

    SciTech Connect

    Chen, Cliff; Wiser, Ryan; Mills, Andrew; Bolinger, Mark

    2008-01-07

    State renewables portfolio standards (RPS) have emerged as one of the most important policy drivers of renewable energy capacity expansion in the U.S. As RPS policies have been proposed or adopted in an increasing number of states, a growing number of studies have attempted to quantify the potential impacts of these policies, focusing primarily on cost impacts, but sometimes also estimating macroeconomic, risk reduction, and environmental effects. This article synthesizes and analyzes the results and methodologies of 31 distinct state or utility-level RPS cost-impact analyses completed since 1998. Together, these studies model proposed or adopted RPS policies in 20 different states. We highlight the key findings of these studies on the projected costs of state RPS policies, examine the sensitivity of projected costs to model assumptions, evaluate the reasonableness of key input assumptions, and suggest possible areas of improvement for future RPS analyses. We conclude that while there is considerable uncertainty in the study results, the majority of the studies project modest cost impacts. Seventy percent of the state RPS cost studies project retail electricity rate increases of no greater than one percent. Nonetheless, there is considerable room for improving the analytic methods, and therefore accuracy, of these estimates.

  16. The French nuclear power plant reactor building containment contributions of prestressing and concrete performances in reliability improvements and cost savings

    SciTech Connect

    Rouelle, P.; Roy, F.

    1998-12-31

    The Electricite de France`s N4 CHOOZ B nuclear power plant, two units of the world`s largest PWR model (1450 Mwe each), has earned the Electric Power International`s 1997 Powerplant Award. This lead NPP for EDF`s N4 series has been improved notably in terms of civil works. The presentation will focus on the Reactor Building`s inner containment wall which is one of the main civil structures on a technical and safety point of view. In order to take into account the necessary evolution of the concrete technical specification such as compressive strength low creep and shrinkage, the HSC/HPC has been used on the last N4 Civaux 2 NPP. As a result of the use of this type of professional concrete, the containment withstands an higher internal pressure related to severe accident and ensures higher level of leak-tightness, thus improving the overall safety of the NPP. On that occasion, a new type of prestressing has been tested locally through 55 C 15 S tendons using a new C 1500 FE Jack. These updated civil works techniques shall allow EDF to ensure a Reactor Containment lifespan for more than 50 years. The gains in terms of reliability and cost saving of these improved techniques will be developed hereafter.

  17. The Hidden Costs of a Free Caesarean Section Policy in West Africa (Kayes Region, Mali).

    PubMed

    Ravit, Marion; Philibert, Aline; Tourigny, Caroline; Traore, Mamadou; Coulibaly, Aliou; Dumont, Alexandre; Fournier, Pierre

    2015-08-01

    The fee exemption policy for EmONC in Mali aims to lower the financial barrier to care. The objective of the study was to evaluate the direct and indirect expenses associated with caesarean interventions performed in EmONC and the factors associated with these expenses. Data sampling followed the case control approach used in the large project (deceased and near-miss women). Our sample consisted of a total of 190 women who underwent caesarean interventions. Data were collected from the health workers and with a social approach by administering questionnaires to the persons who accompanied the woman. Household socioeconomic status was assessed using a wealth index constructed with a principal component analysis. The factors significantly associated with expenses were determined using multivariate linear regression analyses. Women in the Kayes region spent on average 77,017 FCFA (163 USD) for a caesarean episode in EmONC, of which 70 % was for treatment. Despite the caesarean fee exemption, 91 % of the women still paid for their treatment. The largest treatment-related direct expenses were for prescriptions, transfusion, antibiotics, and antihypertensive medication. Near-misses, women who presented a hemorrhage or an infection, and/or women living in rural areas spent significantly more than the others. Although abolishing fees of EmONC in Mali plays an important role in reducing maternal death by increasing access to caesarean sections, this paper shows that the fee policy did not benefit to all women. There are still barriers to EmONC access for women of the lowest socio-economic group. These included direct expenses for drugs prescription, treatment and indirect expenses for transport and food. PMID:25874875

  18. Chemical gel barriers as low-cost alternative to containment and in situ cleanup of hazardous wastes to protect groundwater

    SciTech Connect

    1997-01-01

    Chemical gel barriers are being considered as a low-cost alternative for containment and in situ cleanup of hazardous wastes to protect groundwater. Most of the available gels in petroleum application are non-reactive and relative impermeable, providing a physical barriers for all fluids and contaminants. However, other potential systems can be envisioned. These systems could include gels that are chemically reactive and impermeable such that most phase are captured by the barriers but the contaminants could diffuse through the barriers. Another system that is chemically reactive and permeable could have potential applications in selectivity capturing contaminants while allowing water to pass through the barriers. This study focused on chemically reactive and permeable gel barriers. The gels used in experiment are DuPont LUDOX SM colloidal silica gel and Pfizer FLOPAAM 1330S hydrolyzed polyacrylamide (HPAM) gel.

  19. Cost, Price and Public Policy: Peering into the Higher Education Black Box. New Agenda Series[TM], Volume 1, Number 3.

    ERIC Educational Resources Information Center

    Stringer, William L.; Cunningham, Alisa F.

    This report contains a conceptual framework for analyzing costs and prices by evaluating the higher education production function and the determinants of both prices and costs. The framework can be used to strengthen understanding of costs and prices within individual institutions and to inform macro level investments at state and national levels.…

  20. Cost Containment Through Risk-Sharing by Primary Care Physicians: A History of the Development of United Healthcare

    PubMed Central

    Moore, Stephen H.; Martin, Diane P.; Richardson, William C.; Riedel, Donald C.

    1980-01-01

    A new type of Independent practice association has been organized to encourage primary care physicians in private practice to become coordinators and financial managers for their patients' medical care. Each patient chooses one internist, family or general physician, or pediatrician and must be referred by that physician for all specialized care. The primary care physician authorizes payment from his/her own account for hospital and referral care provided to patients. He or she shares any deficit or surplus remaining at the end of the year. This is a background paper detailing the history of development and specific features contained in this new concept of putting the physician in charge and “at risk” for the costs of medical care to his/her patients. The plan has been operating in northern California, Washington, and Utah and has 40,000 members and 750 participating physicians. This historical background paper is part of a large project—State Employees' Insurance Benefits Utilization Study (SEIBUS) being done by the University of Washington School of Public Health to evaluate use and costs of medical care under this innovative plan. PMID:10309220

  1. Collaboration across private and public sector primary health care services: benefits, costs and policy implications.

    PubMed

    McDonald, Julie; Powell Davies, Gawaine; Jayasuriya, Rohan; Fort Harris, Mark

    2011-07-01

    Ongoing care for chronic conditions is best provided by interprofessional teams. There are challenges in achieving this where teams cross organisational boundaries. This article explores the influence of organisational factors on collaboration between private and public sector primary and community health services involved in diabetes care. It involved a case study using qualitative methods. Forty-five participants from 20 organisations were purposively recruited. Data were collected through semi-structured interviews and from content analysis of documents. Thematic analysis was used employing a two-level coding system and cross case comparisons. The patterns of collaborative patient care were influenced by a combination of factors relating to the benefits and costs of collaboration and the influence of support mechanisms. Benefits lay in achieving common or complementary health or organisational goals. Costs were incurred in bridging differences in organisational size, structure, complexity and culture. Collaboration was easier between private sector organisations than between private and public sectors. Financial incentives were not sufficient to overcome organisational barriers. To achieve more coordinated primary and community health care structural changes are also needed to better align funding mechanisms, priorities and accountabilities of the different organisations. PMID:21554068

  2. The Impact of Proposed Changes in Liver Allocation Policy on Cold Ischemia Times and Organ Transportation Costs

    PubMed Central

    DuBay, D. A.; MacLennan, P. A.; Reed, R. D.; Fouad, M.; Martin, M.; Meeks, C. B.; Taylor, G.; Kilgore, M. L.; Tankersley, M.; Gray, S. H.; White, J. A.; Eckhoff, D. E.; Locke, J. E.

    2015-01-01

    Changes to the liver allocation system have been proposed to decrease regional variation in access to liver transplant. It is unclear what impact these changes will have on cold ischemia times (CITs) and donor transportation costs. Therefore, we performed a retrospective single center study (2008–2012) measuring liver procurement CIT and transportation costs. Four groups were defined: Local-within driving distance (Local-D, n = 262), Local-flight (Local-F, n = 105), Regional-flight <3 h (Regional <3h, n = 61) and Regional-Flight >3 h (Regional >3h, n = 53). The median travel distance increased in each group, varying from zero miles (Local-D), 196 miles (Local-F), 384 miles (Regional <3 h), to 1647 miles (Regional >3 h). Increasing travel distances did not significantly increase CIT until the flight time was >3 h. The average CIT ranged from 5.0 to 6.0 h for Local-D, Local-F and Regional <3h, but increased to 10 h for Regional >3h (p < 0.0001). Transportation costs increased with greater distance traveled: Local-D $101, Local-F $1993, Regional <3h $8324 and Regional >3 h $27 810 (p < 0.0001). With proposed redistricting, local financial modeling suggests that the average liver donor procurement transportation variable direct costs will increase from $2415 to $7547/liver donor, an increase of 313%. These findings suggest that further discussion among transplant centers and insurance providers is needed prior to policy implementation. PMID:25612501

  3. How state and federal policies as well as advances in genome science contribute to the high cost of cancer drugs.

    PubMed

    Ramsey, Scott D

    2015-04-01

    During a time when cancer drug prices are increasing at an unprecedented rate, a debate has emerged as to whether these drugs continue to provide good value. In this article I argue that this debate is irrelevant because under today's highly distorted market, prices will not be set with value considerations in mind. As an alternative, I suggest considering the "value" of three policy changes—Medicare's "average sales price plus 6 percent" payment program, laws that require insurance coverage of all new cancer drugs, and the Affordable Care Act—that are fueling manufacturers' willingness to set higher prices. More important than these issues, however, is the revolution that is occurring in molecular biology and its impact on scientists' ability to detect changes in the cancer genome. The lowered cost of discovery is driving more competitors into the market, which under distorted pricing paradoxically encourages drug makers to charge ever higher prices for their products. PMID:25847638

  4. Risk-cost-benefit analysis of atrazine in drinking water from agricultural activities and policy implications

    NASA Astrophysics Data System (ADS)

    Tesfamichael, Aklilu A.; Caplan, Arthur J.; Kaluarachchi, Jagath J.

    2005-05-01

    This study provides an improved methodology for investigating the trade-offs between the health risks and economic benefits of using atrazine in the agricultural sector by incorporating public attitude to pesticide management in the analysis. Regression models are developed to predict finished water atrazine concentration in high-risk community water supplies in the United States. The predicted finished water atrazine concentrations are then used in a health risk assessment. The computed health risks are compared with the total economic surplus in the U.S. corn market for different atrazine application rates using estimated demand and supply functions developed in this work. Analysis of different scenarios with consumer price premiums for chemical-free and reduced-chemical corn indicate that if the society is willing to pay a price premium, risks can be reduced without a large reduction in the total economic surplus and net benefits may be higher. The results also show that this methodology provides an improved scientific framework for future decision making and policy evaluation in pesticide management.

  5. Thermophysical properties and corrosion characterization of low cost lithium containing nitrate salts produced in northern Chile for thermal energy storage

    NASA Astrophysics Data System (ADS)

    Fernández, Ángel G.; Gomez, Judith C.; Galleguillos, Hector; Fuentealba, Edward

    2016-05-01

    In recent years, lithium containing salts have been studied for thermal energy storage (TES) systems applications, because of their optimal thermophysical properties. In solar power plants, lithium is seen as a way to improve the properties of molten salts used today. Lithium nitrate is a good candidate for sensible heat storage, due to its ability to increase the salt mixture's working temperature range. In the present research, thermophysical properties characterization of lithium nitrate containing salts, produced in Chile, have been carried out. Corrosion evaluations of carbon and low chromium steels were performed at 390°C for 1000 hours. Thermophysical properties of the salt mixtures, such as thermal stability and heat capacity, were measured before and after corrosion tests. Chemical composition of the salts was also determined and an estimation of Chilean production costs is reported. Results showed that purity, thermal stability and heat capacity of the salts were reduced, caused by partial thermal decomposition and incorporation of corrosion products from the steel.

  6. Potential of trans fats policies to reduce socioeconomic inequalities in mortality from coronary heart disease in England: cost effectiveness modelling study

    PubMed Central

    Pearson-Stuttard, Jonathan; Hooton, William; Diggle, Peter; Capewell, Simon; O’Flaherty, Martin

    2015-01-01

    Objectives To determine health and equity benefits and cost effectiveness of policies to reduce or eliminate trans fatty acids from processed foods, compared with consumption remaining at most recent levels in England. Design Epidemiological modelling study. Setting Data from National Diet and Nutrition Survey, Low Income Diet and Nutrition Survey, Office of National Statistics, and health economic data from other published studies Participants Adults aged ≥25, stratified by fifths of socioeconomic circumstance. Interventions Total ban on trans fatty acids in processed foods; improved labelling of trans fatty acids; bans on trans fatty acids in restaurants and takeaways. Main outcome measures Deaths from coronary heart disease prevented or postponed; life years gained; quality adjusted life years gained. Policy costs to government and industry; policy savings from reductions in direct healthcare, informal care, and productivity loss. Results A total ban on trans fatty acids in processed foods might prevent or postpone about 7200 deaths (2.6%) from coronary heart disease from 2015-20 and reduce inequality in mortality from coronary heart disease by about 3000 deaths (15%). Policies to improve labelling or simply remove trans fatty acids from restaurants/fast food could save between 1800 (0.7%) and 3500 (1.3%) deaths from coronary heart disease and reduce inequalities by 600 (3%) to 1500 (7%) deaths, thus making them at best half as effective. A total ban would have the greatest net cost savings of about £265m (€361m, $415m) excluding reformulation costs, or £64m if substantial reformulation costs are incurred outside the normal cycle. Conclusions A regulatory policy to eliminate trans fatty acids from processed foods in England would be the most effective and equitable policy option. Intermediate policies would also be beneficial. Simply continuing to rely on industry to voluntary reformulate products, however, could have negative health and economic outcomes

  7. The financial impact of a state adopting a personal/philosophical belief exemption policy: modeling the cost of pertussis disease in infants, children and adolescents.

    PubMed

    Wells, Katelyn B; Omer, Saad B

    2012-09-01

    State school immunization exemption policies help reduce the risk of individual and community disease. Assessing the costs of vaccine preventable disease associated with a state adding a philosophical/personal belief school exemption policy is useful for making future policy decisions. Two formulas were developed to estimate the infant, child and adolescent hospitalization and non-medical costs of pertussis disease that are associated with adding a philosophical/personal belief school exemption policy. The parameter estimates were obtained from peer reviewed literature and the Centers for Disease Control and Prevention. The state of Iowa was used as an example in order to demonstrate how the formulas can be applied. The annual projected impact of pertussis disease in Iowa is $273,365 without a philosophical/personal belief exemption policy and an average of $410,047 (range of $281,566-$582,267) with adding a personal belief exemption policy. We project that adding a philosophical/personal belief exemption will cost 50% more dollars annually. PMID:22863661

  8. Health Care Cost Containment: Are America's Aged Protected? Hearing before the Select Committee on Aging. House of Representatives, Ninety-Ninth Congress, First Session.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. House Select Committee on Aging.

    This document contains testimony and prepared statements from the Congressional hearing examining the impact on the elderly of the federal health care cost containment measure. Correspondence between the Select Committee on Aging and the Department of Health and Human Services, concerning the government restrictions' harmful effects on the…

  9. Partnerships for Policy Development: A Case Study From Uganda’s Costed Implementation Plan for Family Planning

    PubMed Central

    Lipsky, Alyson B; Gribble, James N; Cahaelen, Linda; Sharma, Suneeta

    2016-01-01

    ABSTRACT In global health, partnerships between practitioners and policy makers facilitate stakeholders in jointly addressing those issues that require multiple perspectives for developing, implementing, and evaluating plans, strategies, and programs. For family planning, costed implementation plans (CIPs) are developed through a strategic government-led consultative process that results in a detailed plan for program activities and an estimate of the funding required to achieve an established set of goals. Since 2009, many countries have developed CIPs. Conventionally, the CIP approach has not been defined with partnerships as a focal point; nevertheless, cooperation between key stakeholders is vital to CIP development and execution. Uganda launched a CIP in November 2014, thus providing an opportunity to examine the process through a partnership lens. This article describes Uganda’s CIP development process in detail, grounded in a framework for assessing partnerships, and provides the findings from 22 key informant interviews. Findings reveal strengths in Uganda’s CIP development process, such as willingness to adapt and strong senior management support. However, the evaluation also highlighted challenges, including district health officers (DHOs), who are a key group of implementers, feeling excluded from the development process. There was also a lack of planning around long-term partnership practices that could help address anticipated execution challenges. The authors recommend that future CIP development efforts use a long-term partnership strategy that fosters accountability by encompassing both the short-term goal of developing the CIP and the longer-term goal of achieving the CIP objectives. Although this study focused on Uganda’s CIP for family planning, its lessons have implications for any policy or strategy development efforts that require multiple stakeholders to ensure successful execution. PMID:27353621

  10. Comparative Cost-Effectiveness of Conservative or Intensive Blood Pressure Treatment Guidelines in Adults Aged 35-74 Years: The Cardiovascular Disease Policy Model.

    PubMed

    Moise, Nathalie; Huang, Chen; Rodgers, Anthony; Kohli-Lynch, Ciaran N; Tzong, Keane Y; Coxson, Pamela G; Bibbins-Domingo, Kirsten; Goldman, Lee; Moran, Andrew E

    2016-07-01

    The population health effect and cost-effectiveness of implementing intensive blood pressure goals in high-cardiovascular disease (CVD) risk adults have not been described. Using the CVD Policy Model, CVD events, treatment costs, quality-adjusted life years, and drug and monitoring costs were simulated over 2016 to 2026 for hypertensive patients aged 35 to 74 years. We projected the effectiveness and costs of hypertension treatment according to the 2003 Joint National Committee (JNC)-7 or 2014 JNC8 guidelines, and then for adults aged ≥50 years, we assessed the cost-effectiveness of adding an intensive goal of systolic blood pressure <120 mm Hg for patients with CVD, chronic kidney disease, or 10-year CVD risk ≥15%. Incremental cost-effectiveness ratios <$50 000 per quality-adjusted life years gained were considered cost-effective. JNC7 strategies treat more patients and are more costly to implement compared with JNC8 strategies. Adding intensive systolic blood pressure goals for high-risk patients prevents an estimated 43 000 and 35 000 annual CVD events incremental to JNC8 and JNC7, respectively. Intensive strategies save costs in men and are cost-effective in women compared with JNC8 alone. At a willingness-to-pay threshold of $50 000 per quality-adjusted life years gained, JNC8+intensive had the highest probability of cost-effectiveness in women (82%) and JNC7+intensive the highest probability of cost-effectiveness in men (100%). Assuming higher drug and monitoring costs, adding intensive goals for high-risk patients remained consistently cost-effective in men, but not always in women. Among patients aged 35 to 74 years, adding intensive blood pressure goals for high-risk groups to current national hypertension treatment guidelines prevents additional CVD deaths while saving costs provided that medication costs are controlled. PMID:27181996