42 CFR 457.618 - Ten percent limit on certain Children's Health Insurance Program expenditures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Insurance Program expenditures. 457.618 Section 457.618 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS... Children's Health Insurance Program expenditures. (a) Expenditures. (1) Primary expenditures are...

Factors associated with expenditures for medicaid home and community based services (HCBS) and intermediate care facilities for persons with mental retardation (ICF/MR) services for persons with intellectual and developmental disabilities.

PubMed

Lakin, K Charlie; Doljanac, Robert; Byun, Soo-Yong; Stancliffe, Roger J; Taub, Sarah; Chiri, Giuseppina

2008-06-01

This article examines expenditures for a random sample of 1,421 adult Home and Community Based Services (HCBS) and Intermediate Care Facility/Mental Retardation (ICF/MR) recipients in 4 states. The article documents variations in expenditures for individuals with different characteristics and service needs and, controlling for individual characteristics, by residential setting type, Medicaid program (ICF/MR or HCBS), and state. Annual average per-person Medicaid expenditures for HCBS recipients were less than those of ICF/MR residents ($61,770 and $128,275, respectively). HCBS recipients had less severe disability (intellectual, physical, health service needs) than ICF/MR residents. Controlling these differences, and for congregate settings, HCBS were less costly than ICFs/MR, but this distinction accounted for only 3.3% of variation in expenditures. Persons living with families receiving HCBS ($25,072) and in host families (including foster, companion, or shared living arrangements; $44,112) had the lowest Medicaid expenditures.

The impact of changes in tobacco control funding on healthcare expenditures in California, 2012-2016.

PubMed

Max, Wendy; Sung, Hai-Yen; Lightwood, James

2013-05-01

This study presents estimates of the impact of changes in California tobacco control funding on healthcare expenditures for 2012-2016 under four funding scenarios. Smoking prevalence is projected using a cointegrated time series regression model. Smoking-attributable healthcare expenditures are estimated with econometric models that use a prevalence-based annual cost approach and an excess cost methodology. If tobacco control spending in California remains at the current level of 5 cents per pack (base case), smoking prevalence will increase from 12.2% in 2011 to 12.7% in 2016. If funding is cut in half, smoking prevalence will increase to 12.9% in 2016 and smoking-attributable healthcare expenditures will be $307 million higher over this time period than in the base case. If the tobacco tax is increased by $1.00 per pack with 20 cents per pack allocated to tobacco control, smoking prevalence will fall to 10.4% in 2016 and healthcare expenditures between 2012 and 2016 will be $3.3 billion less than in the base case. If funding is increased to the Centers for Disease Control and Prevention recommended level, smoking prevalence will fall to 10.6% in 2016 and there will be savings in healthcare expenditures of $4.7 billion compared to the base case due to the large reduction in heavy smoking prevalence. California's highly successful tobacco control program will become less effective over time because inflation is eroding the 5 cents per pack currently allocated to tobacco control activities. More aggressive action needs to be taken to reduce smoking prevalence and healthcare expenditures in the future.

Effects of the Medicare Alzheimer's Disease Demonstration on Medicare Expenditures

PubMed Central

Newcomer, Robert; Miller, Robert; Clay, Ted; Fox, Patrick

1999-01-01

Applicants were randomized either into a group with a limited Medicare community care service benefit and case management or into a control group receiving their regular medical care. Analyses assess whether or not community care management affected health care use. A tendency toward reduced expenditures was observed for the treatment group, combining all demonstration sites, and when observing each separately. These differences were or approached statistical significance in two sites for Medicare Part A and Parts A and B expenditures averaged over 3 years. Expenditure reductions approached budget neutrality with program costs in two sites. PMID:11482124

45 CFR 263.5 - When do expenditures in State-funded programs count?

Code of Federal Regulations, 2011 CFR

2011-10-01

... Care, or Transitional Child Care programs, then current fiscal year expenditures in this program count... recipients, At-Risk Child Care, or Transitional Child care programs, then countable expenditures are limited... 45 Public Welfare 2 2011-10-01 2011-10-01 false When do expenditures in State-funded programs...

45 CFR 263.5 - When do expenditures in State-funded programs count?

Code of Federal Regulations, 2014 CFR

2014-10-01

..., or Transitional Child Care programs, then current fiscal year expenditures in this program count in... recipients, At-Risk Child Care, or Transitional Child care programs, then countable expenditures are limited... 45 Public Welfare 2 2014-10-01 2012-10-01 true When do expenditures in State-funded programs count...

45 CFR 263.5 - When do expenditures in State-funded programs count?

Code of Federal Regulations, 2013 CFR

2013-10-01

..., or Transitional Child Care programs, then current fiscal year expenditures in this program count in... recipients, At-Risk Child Care, or Transitional Child care programs, then countable expenditures are limited... 45 Public Welfare 2 2013-10-01 2012-10-01 true When do expenditures in State-funded programs count...

45 CFR 263.5 - When do expenditures in State-funded programs count?

Code of Federal Regulations, 2012 CFR

2012-10-01

... Care, or Transitional Child Care programs, then current fiscal year expenditures in this program count... recipients, At-Risk Child Care, or Transitional Child care programs, then countable expenditures are limited... 45 Public Welfare 2 2012-10-01 2012-10-01 false When do expenditures in State-funded programs...

45 CFR 263.5 - When do expenditures in State-funded programs count?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Care, or Transitional Child Care programs, then current fiscal year expenditures in this program count... recipients, At-Risk Child Care, or Transitional Child care programs, then countable expenditures are limited... 45 Public Welfare 2 2010-10-01 2010-10-01 false When do expenditures in State-funded programs...

Enrollment, expenditures, and utilization after CHIP expansion: evidence from Alabama.

PubMed

Becker, David J; Blackburn, Justin; Morrisey, Michael A; Sen, Bisakha; Kilgore, Meredith L; Caldwell, Cathy; Sellers, Chris; Menachemi, Nir

2015-01-01

In October 2009, Alabama expanded eligibility in its Children's Health Insurance Program (CHIP), known as ALL Kids, from 200% to 300% of the federal poverty level (FPL). We examined the expenditures, utilization, and enrollment behavior of expansion enrollees relative to traditional enrollees (100-200% FPL) and assessed the impact of expansion on total program expenditures. We compared unadjusted mean person-month-level expenditures and utilization of expansion enrollees and various categories of existing enrollees and used a 2-part modeling strategy to examine differences after controlling for enrollee characteristics. We used probit models to examine adjusted differences in reenrollment behavior by eligibility category. Expansion enrollees had higher total monthly expenditures ($10.33, P < .05) than traditional ALL Kids enrollees, including higher outpatient ($5.35, P < .001) and dental ($0.85, P < .01) expenditures but lower emergency department (-$1.34, P < .001) expenditures. Expansion enrollees had marginally lower utilization of emergency department services for low-severity conditions and higher utilization of physician outpatient visits. Expansion enrollees were 4.47 percentage points (P < .001) more likely to reenroll before their contract expiration date than traditional ALL Kids enrollees. As of October 2012, expansion enrollees accounted for approximately 20% of ALL Kids enrollment and expenditures. The expansion population was characterized by moderately higher health expenditures and utilization, and more persistent enrollment relative to fee group enrollees who are subject to the same levels of cost sharing and annual premiums. Although states are prohibited from changing program eligibility until 2019, the costs associated with the expansion population will be important to future policy decisions. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

An Exercise Protocol Designed to control Energy Expenditure and to have a Positive Impact on Maximal Oxygen Consumption for Long-Term Space Missions

NASA Astrophysics Data System (ADS)

Matsuo, Tomoaki; Ohkawara, Kazunori; Seino, Satoshi; Shimojo, Nobutake; Yamada, Shin; Ohshima, Hiroshi; Tanaka, Kiyoji; Mukai, Chiaki

2013-02-01

Maximal oxygen consumption decreases during spaceflight, and astronauts also experience controversial weight loss. Future space missions require a more efficient exercise program to maintain work efficiency and to control increased energy expenditure (EE). We have been developing two types of original exercise training protocols which are better suited to astronauts’ daily routine exercise during long-term spaceflight: sprint interval training (SIT) and high-intensity interval aerobic training (HIAT). In this study, we compared the total EE, including excess post-exercise energy expenditure (EPEE), induced by our interval cycling protocols with the total EE of a traditional, continuous aerobic training (CAT). In the results, while the EPEEs after the SIT and HIAT were greater than after the CAT, the total EE for an entire exercise/rest session with the CAT was the greatest of our three exercise protocols. The SIT and HIAT would be potential protocols to control energy expenditure for long space missions.

A generic model for evaluating payor net cost savings from a disease management program.

PubMed

McKay, Niccie L

2006-01-01

Private and public payors increasingly are turning to disease management programs as a means of improving the quality of care provided and controlling expenditures for individuals with specific medical conditions. This article presents a generic model that can be adapted to evaluate payor net cost savings from a variety of types of disease management programs, with net cost savings taking into account both changes in expenditures resulting from the program and the costs of setting up and operating the program. The model specifies the required data, describes the data collection process, and shows how to calculate the net cost savings in a spreadsheet format. An accompanying hypothetical example illustrates how to use the model.

40 CFR 35.572 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Environmental Program Grants for Tribes Air Pollution Control (section 105) § 35.572 Definitions... of a continuing environmental program. All expenditures are considered recurrent unless justified by...

40 CFR 35.572 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Environmental Program Grants for Tribes Air Pollution Control (section 105) § 35.572 Definitions... of a continuing environmental program. All expenditures are considered recurrent unless justified by...

Urban-Rural Differences in the Effect of a Medicare Health Promotion and Disease Self-Management Program on Physical Function and Health Care Expenditures

ERIC Educational Resources Information Center

Meng, Hongdao; Wamsley, Brenda; Liebel, Diane; Dixon, Denise; Eggert, Gerald; Van Nostrand, Joan

2009-01-01

Purpose: To evaluate the impact of a multicomponent health promotion and disease self-management intervention on physical function and health care expenditures among Medicare beneficiaries. To determine if these outcomes vary by urban or rural residence. Design and Methods: We analyzed data from a 22-month randomized controlled trial of a health…

Energy Expenditure During Extravehicular Activity Through Apollo

NASA Technical Reports Server (NTRS)

Paul, Heather L.

2011-01-01

Monitoring crew health during manned space missions has always been an important factor to ensure that the astronauts can complete the missions successfully and within safe physiological limits. The necessity of real-time metabolic rate monitoring during extravehicular activities (EVAs) came into question during the Gemini missions, when the energy expenditure required to complete EVA tasks exceeded the life support capabilities for cooling and humidity control and crewmembers (CMs) ended the EVAs fatigued and overworked. This paper discusses the importance of real-time monitoring of metabolic rate during EVA, and provides a historical look at energy expenditure during EVA through the Apollo program.

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

An analysis of government immunization program expenditures in lower and lower middle income countries 2006-12.

PubMed

Nader, Alice Abou; de Quadros, Ciro; Politi, Claudio; McQuestion, Michael

2015-04-01

Financing is becoming increasingly important as the cost of immunizing the world's children continues to rise. By 2015, that cost will likely exceed US$60 per infant as new vaccines are introduced into national immunization programs. In 2006, 51 lower and lower middle income countries reported spending a mean US$12 per surviving infant on routine immunization. By 2012, the figure had risen to $20, a 67% increase. This study tests the hypothesis that lower and lower middle income countries will spend more on their routine immunization programs as their economies grow. A panel data regression approach is used. Expenditures reported by governments annually (2006-12) through the World Health Organization/UNICEF Joint Reporting Form are regressed on lagged annual per capita gross national income (GNI), controlling for prevailing mortality levels, immunization program performance, corruption control efforts, geographical region and correct reporting. Results show the expenditures increased with GNI. Expressed as an elasticity, the countries spent approximately $6.32 on immunization for every $100 in GNI increase from 2006 to 2012. Projecting forward and assuming continued annual GNI growth rates of 10.65%, countries could be spending $60 per infant by 2020 if national investment functions increase 4-fold. Given the political will, this result implies countries could fully finance their routine immunization programs without cutting funding for other programs. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Food expenditure share analysis of household: Case study of food reserved garden area program in Bone Bolango regency of Gorontalo province

NASA Astrophysics Data System (ADS)

Buri, N.; Mantau, Z.

2018-05-01

The share of food expenditure is one of food security indicator in communities. It also can be used as an indicator of the success of rural development. The aim of this research was to find the share of food expenditure of farm households before and after the program of Food Reserved Garden Area (KRPL/FRGA) in Suwawa and Tilongkabila districtat Bone Bolango Regency of Gorontalo Province. Analysis method used share of food expenditure method. The method measure the ratio of food expenditure and total expenditure of household for a month. Statistical test used a non-parametric method, especially The Wilcoxon Test (two paired samples test). The results found that KRPL program in Ulanta Village of Suwawa district did not significantly affect the share of food expenditure of farm household. While in the South Tunggulo village of Tilongkabila district, FRGA program significantly affected the share of food expenditure.

75 FR 69082 - Federal Financial Participation in State Assistance Expenditures; Federal Matching Shares for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-10

... Expenditures; Federal Matching Shares for Medicaid, the Children's Health Insurance Program, and Aid to Needy... assistance (Medicaid) and Children's Health Insurance Program (CHIP) expenditures, Temporary Assistance for... expenditures for most medical assistance and child health assistance, and assistance payments for certain...

24 CFR 905.120 - Penalties for slow obligation or expenditure of Capital Fund program assistance.

Code of Federal Regulations, 2011 CFR

2011-04-01

... expenditure of Capital Fund program assistance. 905.120 Section 905.120 Housing and Urban Development... INDIAN HOUSING, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT THE PUBLIC HOUSING CAPITAL FUND PROGRAM Capital Fund § 905.120 Penalties for slow obligation or expenditure of Capital Fund program assistance. In...

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

PubMed Central

Kane, Robert L; Wysocki, Andrea; Parashuram, Shriram; Shippee, Tetyana; Lum, Terry

2013-01-01

Background: Dual eligible Medicare and Medicaid beneficiaries consume disproportionate shares of both programs. Objectives: To compare Medicare and Medicaid expenditures of elderly dual eligible beneficiaries with non-dual eligible beneficiaries based on their long-term care (LTC) use. Research Design: Secondary analysis of linked MAX and Medicare data in seven states. Subjects: Dual eligible adults (65+) receiving LTC in institutions, in the community, or not at all; and Medicare non-dual eligibles. Measures: Medicaid acute medical and LTC expenditures per beneficiary year, Medicare expenditures. Results: Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs. Conclusions: Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures. PMID:24753971

The impact of health insurance programs on out-of-pocket expenditures in Indonesia: an increase or a decrease?

PubMed

Aji, Budi; De Allegri, Manuela; Souares, Aurelia; Sauerborn, Rainer

2013-07-18

We used panel data from the Indonesian Family Life Survey to investigate the impact of health insurance programs on reducing out-of-pocket expenditures. We employed three linear panel data models, two of which accounted for endogeneity: pooled ordinary least squares (OLS), pooled two-stage least squares (2SLS) for instrumental variable (IV), and fixed effects (FE). The study revealed that two health insurance programs had a significantly negative impact on out-of-pocket expenditures by using IV estimates. In the IV model, Askeskin decreased out-of-pocket expenditures by 34% and Askes by 55% compared with non-Askeskin and non-Askes, respectively, while Jamsostek was found to bear a nonsignificant effect on out-of-pocket expenditures. In the FE model, only Askeskin had a significant negative effect with an 11% reduction on out-of-pocket expenditures. This study showed that two large existing health insurance programs in Indonesia, Askeskin and Askes, effectively reduced household out-of-pocket expenditures. The ability of programs to offer financial protection by reducing out-of-pocket expenditures is likely to be a direct function of their benefits package and co-payment policies.

The Impact of Health Insurance Programs on Out-of-Pocket Expenditures in Indonesia: An Increase or a Decrease?

PubMed Central

Aji, Budi; De Allegri, Manuela; Souares, Aurelia; Sauerborn, Rainer

2013-01-01

We used panel data from the Indonesian Family Life Survey to investigate the impact of health insurance programs on reducing out-of-pocket expenditures. We employed three linear panel data models, two of which accounted for endogeneity: pooled ordinary least squares (OLS), pooled two-stage least squares (2SLS) for instrumental variable (IV), and fixed effects (FE). The study revealed that two health insurance programs had a significantly negative impact on out-of-pocket expenditures by using IV estimates. In the IV model, Askeskin decreased out-of-pocket expenditures by 34% and Askes by 55% compared with non-Askeskin and non-Askes, respectively, while Jamsostek was found to bear a nonsignificant effect on out-of-pocket expenditures. In the FE model, only Askeskin had a significant negative effect with an 11% reduction on out-of-pocket expenditures. This study showed that two large existing health insurance programs in Indonesia, Askeskin and Askes, effectively reduced household out-of-pocket expenditures. The ability of programs to offer financial protection by reducing out-of-pocket expenditures is likely to be a direct function of their benefits package and co-payment policies. PMID:23873263

Unpredictable Variable Prenatal Stress Programs Expression of Genes Involved in Appetite Control and Energy Expenditure

NASA Technical Reports Server (NTRS)

Moyer, E. L.; Al-Shayeb, B.; Baer, L. A.; Ronca, A. E.

2016-01-01

Exposure to stress in the womb shapes neurobiological and physiological outcomes of offspring in later life, including body weight regulation and metabolic profiles. Our previous work utilizing a centrifugation-induced hyper-gravity demonstrated significantly increased (8-15%) body mass in male, but not female, rats exposed throughout gestation to chronic 2-g from conception to birth. We reported a similar outcome in adult offspring exposed throughout gestation to Unpredictable Variable Prenatal Stress (UVPS). Here we examine gene expression changes and the plasma of animals treated with our UVPS model to identify a potential role for prenatal stress in this hypergravity programming effect. Specifically we focused on appetite control and energy expenditure pathways in prenatally stressed adult (90-day-old) male Sprague-Dawley rats.

Energy Expenditure During Extravehicular Activity Through Apollo

NASA Technical Reports Server (NTRS)

Paul, Heather L.

2012-01-01

Monitoring crew health during manned space missions has always been an important factor to ensure that the astronauts can complete the missions successfully and within safe physiological limits. The necessity of real-time metabolic rate monitoring during extravehicular activities (EVAs) came into question during the Gemini missions, when the energy expenditure required to complete EVA tasks exceeded the life support capabilities for cooling and humidity control and, as a result, crew members ended the EVAs fatigued and overworked. This paper discusses the importance of real-time monitoring of metabolic rate during EVAs, and provides a historical look at energy expenditure during EVAs through the Apollo Program.

Brown Adipose YY1 Deficiency Activates Expression of Secreted Proteins Linked to Energy Expenditure and Prevents Diet-Induced Obesity

PubMed Central

Verdeguer, Francisco; Soustek, Meghan S.; Hatting, Maximilian; Blättler, Sharon M.; McDonald, Devin; Barrow, Joeva J.

2015-01-01

Mitochondrial oxidative and thermogenic functions in brown and beige adipose tissues modulate rates of energy expenditure. It is unclear, however, how beige or white adipose tissue contributes to brown fat thermogenic function or compensates for partial deficiencies in this tissue and protects against obesity. Here, we show that the transcription factor Yin Yang 1 (YY1) in brown adipose tissue activates the canonical thermogenic and uncoupling gene expression program. In contrast, YY1 represses a series of secreted proteins, including fibroblast growth factor 21 (FGF21), bone morphogenetic protein 8b (BMP8b), growth differentiation factor 15 (GDF15), angiopoietin-like 6 (Angptl6), neuromedin B, and nesfatin, linked to energy expenditure. Despite substantial decreases in mitochondrial thermogenic proteins in brown fat, mice lacking YY1 in this tissue are strongly protected against diet-induced obesity and exhibit increased energy expenditure and oxygen consumption in beige and white fat depots. The increased expression of secreted proteins correlates with elevation of energy expenditure and promotion of beige and white fat activation. These results indicate that YY1 in brown adipose tissue controls antagonistic gene expression programs associated with energy balance and maintenance of body weight. PMID:26503783

An explanatory model for state Medicaid per capita prescription drug expenditures.

PubMed

Roy, Sanjoy; Madhavan, S Suresh

2012-01-01

Rising prescription drug expenditure is a growing concern for publicly funded drug benefit programs like Medicaid. To be able to contain drug expenditures in Medicaid, it is important that cause(s) for such increases are identified. This study attempts to establish an explanatory model for Medicaid prescription drugs expenditure based on the impacts of key influencers/predictors identified using a comprehensive framework of drug utilization. A modified Andersen's behavior model of health services utilization is employed to identify potential determinants of pharmaceutical expenditures in state Medicaid programs. Level of federal matching funds, access to primary care, severity of diseases, unemployment, and education levels were found to be key influencers of Medicaid prescription drug expenditure. Increases in all, except education levels, were found to result in increases in drug expenditures. Findings from this study could better inform intervention policies and cost-containment strategies for state Medicaid drug benefit programs.

An innovative approach to reducing medical care utilization and expenditures.

PubMed

Orme-Johnson, D W; Herron, R E

1997-01-01

In a retrospective study, we assessed the impact on medical utilization and expenditures of a multicomponent prevention program, the Maharishi Vedic Approach to Health (MVAH). We compared archival data from Blue Cross/Blue Shield Iowa for MVAH (n = 693) with statewide norms for 1985 through 1995 (n = 600,000) and with a demographically matched control group (n = 4,148) for 1990, 1991, 1994, and 1995. We found that the 4-year total medical expenditures per person in the MVAH group were 59% and 57% lower than those in the norm and control groups, respectively; the 11-year mean was 63% lower than the norm. The MVAH group had lower utilization and expenditures across all age groups and for all disease categories. Hospital admission rates in the control group were 11.4 times higher than those in the MVAH group for cardiovascular disease, 3.3 times higher for cancer, and 6.7 times higher for mental health and substance abuse. The greatest savings were seen among MVAH patients older than age 45, who had 88% fewer total patients days compared with control patients. Our results confirm previous research supporting the effectiveness of MVAH for preventing disease. Our evaluation suggests that MVAH can be safely used as a cost-effective treatment regimen in the managed care setting.

7 CFR 1486.403 - What expenditures may CCC reimburse under the program?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 10 2013-01-01 2013-01-01 false What expenditures may CCC reimburse under the program... Contributions and Reimbursements § 1486.403 What expenditures may CCC reimburse under the program? (a) A... section, CCC will reimburse, in whole or in part, the cost of: (1) Salaries and benefits of the Recipient...

7 CFR 1486.403 - What expenditures may CCC reimburse under the program?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 10 2011-01-01 2011-01-01 false What expenditures may CCC reimburse under the program... MARKETS PROGRAM Contributions and Reimbursements § 1486.403 What expenditures may CCC reimburse under the... paragraph (a) of this section, CCC will reimburse, in whole or in part, the cost of: (1) Salaries and...

7 CFR 1486.403 - What expenditures may CCC reimburse under the program?

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false What expenditures may CCC reimburse under the program... Contributions and Reimbursements § 1486.403 What expenditures may CCC reimburse under the program? (a) A... section, CCC will reimburse, in whole or in part, the cost of: (1) Salaries and benefits of the Recipient...

Economic impact of a Medicaid population health management program.

PubMed

Rust, George; Strothers, Harry; Miller, William Johnson; McLaren, Susan; Moore, Barbara; Sambamoorthi, Usha

2011-10-01

A population health management program was implemented to assess growth in health care expenditures for the disabled segment of Georgia's Medicaid population before and during the first year of a population health outcomes management program, and to compare those expenditures with projected costs based on various cost inflation trend assumptions. A retrospective, nonexperimental approach was used to analyze claims data from Georgia Medicaid claims files for all program-eligible persons for each relevant time period (intent-to-treat basis). These included all non-Medicare, noninstitutionalized Medicaid aged-blind-disabled adults older than 18 years of age. Comparisons of health care expenditures and utilization were made between base year (2003-2004) and performance year one (2006-2007), and of the difference between actual expenditures incurred in the performance year vs. projected expenditures based on various cost inflation assumptions. Demographic characteristics and clinical complexity of the population (as measured by the Chronic Illness and Disability Payment System risk score) actually increased from baseline to implementation. Actual expenditures were less than projected expenditures using any relevant medical inflation assumption. Actual expenditures were less than projected expenditures by $9.82 million when using a conservative US general medical inflation rate, by $43.6 million using national Medicaid cost trends, and by $106 million using Georgia Medicaid's own cost projections for the non-dually eligible disabled segment of Medicaid enrollees. Quadratic growth curve modeling also demonstrated a lower rate of increase in total expenditures. The rate of increase in expenditures was lower over the first year of program implementation compared with baseline. Weighted utilization rates were also lower in high-cost categories, such as inpatient days, despite increases in the risk profile of the population. Varying levels of cost avoidance could be inferred from differences between actual and projected expenditures using each of the health-related inflation assumptions.

Economic Impact of a Medicaid Population Health Management Program

PubMed Central

Strothers, Harry; Miller, William Johnson; McLaren, Susan; Moore, Barbara; Sambamoorthi, Usha

2011-01-01

Abstract A population health management program was implemented to assess growth in health care expenditures for the disabled segment of Georgia's Medicaid population before and during the first year of a population health outcomes management program, and to compare those expenditures with projected costs based on various cost inflation trend assumptions. A retrospective, nonexperimental approach was used to analyze claims data from Georgia Medicaid claims files for all program-eligible persons for each relevant time period (intent-to-treat basis). These included all non-Medicare, noninstitutionalized Medicaid aged-blind-disabled adults older than 18 years of age. Comparisons of health care expenditures and utilization were made between base year (2003–2004) and performance year one (2006–2007), and of the difference between actual expenditures incurred in the performance year vs. projected expenditures based on various cost inflation assumptions. Demographic characteristics and clinical complexity of the population (as measured by the Chronic Illness and Disability Payment System risk score) actually increased from baseline to implementation. Actual expenditures were less than projected expenditures using any relevant medical inflation assumption. Actual expenditures were less than projected expenditures by $9.82 million when using a conservative US general medical inflation rate, by $43.6 million using national Medicaid cost trends, and by $106 million using Georgia Medicaid's own cost projections for the non-dually eligible disabled segment of Medicaid enrollees. Quadratic growth curve modeling also demonstrated a lower rate of increase in total expenditures. The rate of increase in expenditures was lower over the first year of program implementation compared with baseline. Weighted utilization rates were also lower in high-cost categories, such as inpatient days, despite increases in the risk profile of the population. Varying levels of cost avoidance could be inferred from differences between actual and projected expenditures using each of the health-related inflation assumptions. (Population Health Management 2011;14:215–222) PMID:21506728

7 CFR 1486.404 - What expenditures are not eligible for program funding?

Code of Federal Regulations, 2013 CFR

2013-01-01

... research or new product development; (11) Costs of developing technical assistance proposals submitted to... not reimburse expenditures made prior to approval of a Recipient's proposal, unreasonable expenditures... graduate programs at colleges and/or universities (salaries or fees for individual students who are...

7 CFR 1486.404 - What expenditures are not eligible for program funding?

Code of Federal Regulations, 2014 CFR

2014-01-01

... research or new product development; (11) Costs of developing technical assistance proposals submitted to... not reimburse expenditures made prior to approval of a Recipient's proposal, unreasonable expenditures... graduate programs at colleges and/or universities (salaries or fees for individual students who are...

7 CFR 1486.404 - What expenditures are not eligible for program funding?

Code of Federal Regulations, 2012 CFR

2012-01-01

... research or new product development; (11) Costs of developing technical assistance proposals submitted to... not reimburse expenditures made prior to approval of a Recipient's proposal, unreasonable expenditures... graduate programs at colleges and/or universities (salaries or fees for individual students who are...

Cumulative Expenditures under the DI, SSI, Medicare, and Medicaid Programs for a Cohort of Disabled Working-Age Adults

PubMed Central

Riley, Gerald F; Rupp, Kalman

2015-01-01

Objective To estimate cumulative DI, SSI, Medicare, and Medicaid expenditures from initial disability benefit award to death or age 65. Data Sources Administrative records for a cohort of new CY2000 DI and SSI awardees aged 18–64. Study Design Actual expenditures were obtained for 2000–2006/7. Subsequent expenditures were simulated using a regression-adjusted Markov process to assign individuals to annual disability benefit coverage states. Program expenditures were simulated conditional on assigned benefit coverage status. Estimates reflect present value of expenditures at initial award in 2000 and are expressed in constant 2012 dollars. Expenditure estimates were also updated to reflect benefit levels and characteristics of new awardees in 2012. Data Collection We matched records for a 10 percent nationally representative sample. Principal Findings Overall average cumulative expenditures are $292,401 through death or age 65, with 51.4 percent for cash benefits and 48.6 percent for health care. Expenditures are about twice the average for individuals first awarded benefits at age 18–30. Overall average expenditures increased by 10 percent when updated for a simulated 2012 cohort. Conclusions Data on cumulative expenditures, especially combined across programs, are useful for evaluating the long-term payoff of investments designed to modify entry to and exit from the disability rolls. PMID:25109322

Criterion 6, indicator 34 : value of capital investment and annual expenditure in forest management, wood and non-wood product industries, forest-based environmental services, recreation, and tourism

Treesearch

Ken Skog; John Bergstrom; Elizabeth Hill; Ken Cordell

2010-01-01

USDA Forest Service capital investment in management infrastructure was $501 and $390 million (2005$) for 2005 and 2007, respectively. National forest programs expenditures decreased from $3.0 to $2.7 billion between 2004 and 2007 and wildfire management expenditures increased from $1.7 to $2.1 billion (2005$). State forestry program expenditures for 1998, 2002, and...

Policy Shifts and Their Impact on Health Care for Elderly Persons

PubMed Central

Estes, Carroll L.; Lee, Philip R.

1981-01-01

Three major shifts in federal policy have been initiated recently that will directly affect the medical care of the elderly: (1) A significant reduction in federal expenditures for domestic social programs; (2) decentralization of program authority and responsibility to states, particularly through block grants; (3) deregulation and greater emphasis on market forces and competition to address the problem of continuing increase in the costs of medical care. The federal policy shifts come at a time when many state and local governments are experiencing fiscal strain or fiscal crisis due, in part, to the rapid rise in expenditures for medical care for the poor and the imposition of limitations on, and even reductions in, tax revenues. In the short term, changes at the state level, particularly limitations on Medicaid expenditures, are likely to have the most profound effect on medical care for the elderly. These changes will most likely include reductions in Medicaid eligibility and in scope of benefits as well as tight controls on hospital, nursing home and physician reimbursement. PMID:7336717

Policy shifts and their impact on health care for elderly persons.

PubMed

Estes, C L; Lee, P R

1981-12-01

THREE MAJOR SHIFTS IN FEDERAL POLICY HAVE BEEN INITIATED RECENTLY THAT WILL DIRECTLY AFFECT THE MEDICAL CARE OF THE ELDERLY: (1) A significant reduction in federal expenditures for domestic social programs; (2) decentralization of program authority and responsibility to states, particularly through block grants; (3) deregulation and greater emphasis on market forces and competition to address the problem of continuing increase in the costs of medical care. The federal policy shifts come at a time when many state and local governments are experiencing fiscal strain or fiscal crisis due, in part, to the rapid rise in expenditures for medical care for the poor and the imposition of limitations on, and even reductions in, tax revenues. In the short term, changes at the state level, particularly limitations on Medicaid expenditures, are likely to have the most profound effect on medical care for the elderly. These changes will most likely include reductions in Medicaid eligibility and in scope of benefits as well as tight controls on hospital, nursing home and physician reimbursement.

24 CFR 982.157 - Budget and expenditure.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Budget and expenditure. 982.157... and PHA Administration of Program § 982.157 Budget and expenditure. (a) Budget submission. Each PHA fiscal year, the PHA must submit its proposed budget for the program to HUD for approval at such time and...

Trends in prescription drug expenditures by Medicaid enrollees.

PubMed

Banthin, Jessica S; Miller, G Edward

2006-05-01

As prescription drug expenditures consume an increasingly larger portion of Medicaid budgets, states are anxious to control drug costs without endangering enrollees' health. In this report, we analyzed recent trends in Medicaid prescription drug expenditures by therapeutic classes and subclasses. Identifying the fastest growing categories of drugs, where drugs are grouped into clinically relevant classes and subclasses, can help policymakers decide where to focus their cost containment efforts. We used data from the Medical Expenditure Panel Survey linked to a prescription drug therapeutic classification system, to examine trends between 1996/1997 and 2001/2002 in utilization and expenditures for the noninstitutionalized Medicaid population. We separated aggregate trends into changes in population with use and changes in expenditures per user, and percent generic. We also highlighted differences within the Medicaid population, including children, adults, disabled, and elderly. We found rapid growth in expenditures for antidepressants, antipsychotics, antihyperlipidemics, antidiabetic agents, antihistamines, COX-2 inhibitors, and proton pump inhibitors and found evidence supporting the rapid take-up of new drugs. In some cases these increases are the result of increased expenditures per user and in other cases the overall growth also comes from an increase in the population with use. Medicaid programs may want to reassess their cost-containment policies in light of the rapid take-up of new drugs. Our analysis also identifies areas in which more information is needed on the comparative effectiveness of new versus existing treatments.

The influence of training characteristics on the effect of aerobic exercise training in patients with chronic heart failure: A meta-regression analysis.

PubMed

Vromen, T; Kraal, J J; Kuiper, J; Spee, R F; Peek, N; Kemps, H M

2016-04-01

Although aerobic exercise training has shown to be an effective treatment for chronic heart failure patients, there has been a debate about the design of training programs and which training characteristics are the strongest determinants of improvement in exercise capacity. Therefore, we performed a meta-regression analysis to determine a ranking of the individual effect of the training characteristics on the improvement in exercise capacity of an aerobic exercise training program in chronic heart failure patients. We focused on four training characteristics; session frequency, session duration, training intensity and program length, and their product; total energy expenditure. A systematic literature search was performed for randomized controlled trials comparing continuous aerobic exercise training with usual care. Seventeen unique articles were included in our analysis. Total energy expenditure appeared the only training characteristic with a significant effect on improvement in exercise capacity. However, the results were strongly dominated by one trial (HF-action trial), accounting for 90% of the total patient population and showing controversial results compared to other studies. A repeated analysis excluding the HF-action trial confirmed that the increase in exercise capacity is primarily determined by total energy expenditure, followed by session frequency, session duration and session intensity. These results suggest that the design of a training program requires high total energy expenditure as a main goal. Increases in training frequency and session duration appear to yield the largest improvement in exercise capacity. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Impact of Family Policy Expenditure on Fertility in Western Europe

PubMed Central

KALWIJ, ADRIAAN

2010-01-01

This article analyzes the impact on fertility of changes in national expenditure for family allowances, maternity- and parental-leave benefits, and childcare subsidies. To do so, I estimate a model for the timing of births using individual-level data from 16 western European countries, supplemented with data on national social expenditure for different family policy programs. The latter allow approximation of the subsidies that households with children receive from such programs. The results show that increased expenditure on family policy programs that help women to combine family and employment— and thus reduce the opportunity cost of children—generates positive fertility responses. PMID:20608108

Results of the Medicare Health Support disease-management pilot program.

PubMed

McCall, Nancy; Cromwell, Jerry

2011-11-03

In the Medicare Modernization Act of 2003, Congress required the Centers for Medicare and Medicaid Services to test the commercial disease-management model in the Medicare fee-for-service program. The Medicare Health Support Pilot Program was a large, randomized study of eight commercial programs for disease management that used nurse-based call centers. We randomly assigned patients with heart failure, diabetes, or both to the intervention or to usual care (control) and compared them with the use of a difference-in-differences method to evaluate the effects of the commercial programs on the quality of clinical care, acute care utilization, and Medicare expenditures for Medicare fee-for-service beneficiaries. The study included 242,417 patients (163,107 in the intervention group and 79,310 in the control group). The eight commercial disease-management programs did not reduce hospital admissions or emergency room visits, as compared with usual care. We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures. In this large study, commercial disease-management programs using nurse-based call centers achieved only modest improvements in quality-of-care measures, with no demonstrable reduction in the utilization of acute care or the costs of care.

Discontinuity of Coverage for Medicaid and S-CHIP Children at a Transitional Birthday

PubMed Central

Ketsche, Patricia; Adams, E Kathleen; Snyder, Angela; Zhou, Mei; Minyard, Karen; Kellenberg, Rebecca

2007-01-01

Research Objective To investigate disenrollment from public insurance at the 6-year transitional birthday when eligibility for many children moves from Medicaid to State Children's Health Insurance Program (S-CHIP). Data Sources Data from Georgia's S-CHIP (PeachCare) and Medicaid programs from 2000 to 2002. Study Design The likelihood of dropping public coverage after the reference birthday is modeled for children turning age 6 compared with a control cohort of children turning age 9 controlling for demographic and geographic differences between enrollees. Principal Findings Over 17 percent of 6-year-olds versus only 7 percent of the control cohort dropped coverage. After controlling for other factors (e.g., race/ethnicity, prior enrollment, and geographic region) having lower historical expenditures is predictive of dropping coverage among all children, although the unadjusted effect is stronger among children enrolled in PeachCare before their sixth birthday. Only 1 percent of Medicaid children who remained covered transitioned to PeachCare. Conclusions Turnover at transitional birthdays identifies a common pathway for children into the ranks of the uninsured. Facilitating continuous enrollment would retain in the programs children with lower than average expenditures. This may be one of the more cost effective ways of reducing the number of uninsured children in Georgia. PMID:17995550

Financial burden of raising CSHCN: association with state policy choices.

PubMed

Parish, Susan L; Shattuck, Paul T; Rose, Roderick A

2009-12-01

We examined the association between state Medicaid and State Children's Health Insurance Program (SCHIP) income eligibility and the financial burden reported by low-income families raising children with special health care needs (CSHCN). Data on low-income CSHCN and their families were from the National Survey of Children With Special Health Care Needs (N = 17039), with a representative sample from each state. State Medicaid and SCHIP income-eligibility thresholds were from publicly available sources. The 3 outcomes included whether families had any out-of-pocket health care expenditures during the previous 12 months for their CSHCN, amount of expenditure, and expenditures as a percentage of family income. We used multilevel logistic regression to model the association between Medicaid and SCHIP characteristics and families' financial burden, controlling state median income and child- and family-level characteristics. Overall, 61% of low-income families reported expenditures of >$0. Among these families, 30% had expenses between $250 and $500, and 34% had expenses of more than $500. Twenty-seven percent of the families reporting any expenses had expenditures that exceeded 3% of their total household income. The percentage of low-income families with out-of-pocket expenses that exceeded 3% of their income varied considerably according to state and ranged from 5.6% to 25.8%. Families living in states with higher Medicaid and SCHIP income-eligibility guidelines were less likely to have high absolute burden and high relative burden. Beyond child and family characteristics, there is considerable state-level variability in low-income families' out-of-pocket expenditures for their CSHCN. A portion of this variability is associated with states' Medicaid and SCHIP income-eligibility thresholds. Families living in states with more generous programs report less absolute and relative financial burden than families living in states with less generous benefits.

Effect of neuromuscular electrical muscle stimulation on energy expenditure in healthy adults.

PubMed

Hsu, Miao-Ju; Wei, Shun-Hwa; Chang, Ya-Ju

2011-01-01

Weight loss/weight control is a major concern in prevention of cardiovascular disease and the realm of health promotion. The primary aim of this study was to investigate the effect of neuromuscular electrical stimulation (NMES) at different intensities on energy expenditure (oxygen and calories) in healthy adults. The secondary aim was to develop a generalized linear regression (GEE) model to predict the increase of energy expenditure facilitated by NMES and identify factors (NMES stimulation intensity level, age, body mass index, weight, body fat percentage, waist/hip ratio, and gender) associated with this NMES-induced increase of energy expenditure. Forty sedentary healthy adults (18 males and 22 females) participated. NMES was given at the following stimulation intensities for 10 minutes each: sensory level (E1), motor threshold (E2), and maximal intensity comfortably tolerated (E3). Cardiopulmonary gas exchange was evaluated during rest, NMES, and recovery stage. The results revealed that NMES at E2 and E3 significantly increased energy expenditure and the energy expenditure at recovery stage was still significantly higher than baseline. The GEE model demonstrated that a linear dose-response relationship existed between the stimulation intensity and the increase of energy expenditure. No subject's demographic or anthropometric characteristics tested were significantly associated with the increase of energy expenditure. This study suggested NMES may be used to serve as an additional intervention for weight loss programs. Future studies to develop electrical stimulators or stimulation electrodes to maximize the comfort of NMES are recommended.

7 CFR 246.25 - Records and reports.

Code of Federal Regulations, 2013 CFR

2013-01-01

... year of food and NSA funds available for expenditure; and, (E) NSA expenditures and unliquidated... information as is necessary for the efficient management of food and NSA funds expenditures. (2) Annual... agencies must submit itemized NSA expenditure reports annually as an addendum to their WIC Program closeout...

The effectiveness of a health promotion program after 3 years: evidence from the University of Minnesota.

PubMed

Nyman, John A; Abraham, Jean M; Jeffery, Molly Moore; Barleen, Nathan A

2012-09-01

Health promotion programs for the workplace are often sold to employers with the promise that they will pay for themselves with lowered health care expenditures and reduced absenteeism. In a recent review of the literature, it was noted that analysts often caution not to expect a positive return on investment until the third year of operation. This study investigates whether a positive return on investment was generated in the third year for the health promotion program used by the University of Minnesota. It further investigates what it is about the third year that would explain such a phenomenon. The study uses health care expenditure data and absenteeism data from 2004 to 2008 to investigate the effect of the University's lifestyle and disease management programs. It also investigates the effectiveness of participation in Minnesota's 10,000 Steps walking program and Miavita self-help programs. A differences-in-differences equations approach is used to address potential selection bias. Possible regression to the mean is dealt with by using only those who were eligible to participate as control observations. Propensity score weighting was used to balance the sample on observable characteristics and reduce bias due to omitted variables. The study finds that a 1.76 return on investment occurs in the third year of operation that is generated solely by the effect of disease management program participation in reducing health care expenditures. However, neither of the explanations for a third-year effect we tested seemed to be able to explain this phenomenon.

The economic burden of diabetes to French national health insurance: a new cost-of-illness method based on a combined medicalized and incremental approach.

PubMed

de Lagasnerie, Grégoire; Aguadé, Anne-Sophie; Denis, Pierre; Fagot-Campagna, Anne; Gastaldi-Menager, Christelle

2018-03-01

A better understanding of the economic burden of diabetes constitutes a major public health challenge in order to design new ways to curb diabetes health care expenditure. The aim of this study was to develop a new cost-of-illness method in order to assess the specific and nonspecific costs of diabetes from a public payer perspective. Using medical and administrative data from the major French national health insurance system covering about 59 million individuals in 2012, we identified people with diabetes and then estimated the economic burden of diabetes. Various methods were used: (a) global cost of patients with diabetes, (b) cost of treatment directly related to diabetes (i.e., 'medicalized approach'), (c) incremental regression-based approach, (d) incremental matched-control approach, and (e) a novel combination of the 'medicalized approach' and the 'incremental matched-control' approach. We identified 3 million individuals with diabetes (5% of the population). The total expenditure of this population amounted to €19 billion, representing 15% of total expenditure reimbursed to the entire population. Of the total expenditure, €10 billion (52%) was considered to be attributable to diabetes care: €2.3 billion (23% of €10 billion) was directly attributable, and €7.7 billion was attributable to additional reimbursed expenditure indirectly related to diabetes (77%). Inpatient care represented the major part of the expenditure attributable to diabetes care (22%) together with drugs (20%) and medical auxiliaries (15%). Antidiabetic drugs represented an expenditure of about €1.1 billion, accounting for 49% of all diabetes-specific expenditure. This study shows the economic impact of the assumption concerning definition of costs on evaluation of the economic burden of diabetes. The proposed new cost-of-illness method provides specific insight for policy-makers to enhance diabetes management and assess the opportunity costs of diabetes complications' management programs.

Double Up Food Bucks program effects on SNAP recipients' fruit and vegetable purchases.

PubMed

Steele-Adjognon, Marie; Weatherspoon, Dave

2017-12-12

To encourage the consumption of more fresh fruits and vegetables, the 2014 United Sates Farm Bill allocated funds to the Double Up Food Bucks Program. This program provided Supplemental Nutrition Assistance Program beneficiaries who spent $10 on fresh fruits and vegetables, in one transaction, with a $10 gift card exclusively for Michigan grown fresh fruits and vegetables. This study analyzes how fruit and vegetable expenditures, expenditure shares, variety and purchase decisions were affected by the initiation and conclusion, as well as any persistent effects of the program. Changes in fruit and vegetable purchase behaviors due to Double Up Food Bucks in a supermarket serving a low-income, predominantly Hispanic community in Detroit, Michigan were evaluated using a difference in difference fixed effects estimation strategy. We find that the Double Up Food Bucks program increased vegetable expenditures, fruit and vegetable expenditure shares, and variety of fruits and vegetables purchased but the effects were modest and not sustainable without the financial incentive. Fruit expenditures and the fruit and vegetable purchase decision were unaffected by the program. This study provides valuable insight on how a nutrition program influences a low-income, urban, Hispanic community's fruit and vegetable purchase behavior. Policy recommendations include either removing or lowering the purchase hurdle for incentive eligibility and dropping the Michigan grown requirement to better align with the customers' preferences for fresh fruits and vegetables.

Hyperlipidemia and Medical Expenditures by Cardiovascular Disease Status in US Adults.

PubMed

Zhang, Donglan; Wang, Guijing; Fang, Jing; Mercado, Carla

2017-01-01

Hyperlipidemia is a major risk factor for cardiovascular disease (CVD), affecting 73.5 million American adults. Information about health care expenditures associated with hyperlipidemia by CVD status is needed to evaluate the economic benefit of primary and secondary prevention programs for CVD. The study sample includes 48,050 men and nonpregnant women ≥18 from 2010 to 2012 Medical Expenditure Panel Survey. A 2-part econometric model was used to estimate annual hyperlipidemia-associated medical expenditures by CVD status. The estimation results from the 2-part model were used to calculate per-capita and national medical expenditures associated with hyperlipidemia. We adjusted the medical expenditures into 2012 dollars. Among those with CVD, per person hyperlipidemia-associated expenditures were $1105 [95% confidence interval (CI), $877-$1661] per year, leading to an annual national expenditure of $15.47 billion (95% CI, $5.23-$27.75 billion). Among people without CVD, per person hyperlipidemia-associated expenditures were $856 (95% CI, $596-$1211) per year, resulting in an annual national expenditure of $23.11 billion (95% CI, $16.09-$32.71 billion). Hyperlipidemia-associated expenditures were attributable mostly to the costs of prescription medication (59%-90%). Among people without CVD, medication expenditures associated with hyperlipidemia were $13.72 billion (95% CI, $10.55-$15.74 billion), higher in men than in women. Hyperlipidemia significantly increased medical expenditures and the increase was higher in people with CVD than without. The information on estimated expenditures could be used to evaluate and develop effective programs for CVD prevention.

Direct medical expenditure associated with rheumatoid arthritis in a nationally representative sample from the medical expenditure panel survey.

PubMed

Kawatkar, Aniket A; Jacobsen, Steven J; Levy, Gerald D; Medhekar, Swati S; Venkatasubramaniam, Kumarapuram V; Herrinton, Lisa J

2012-11-01

To quantify the incremental direct medical expenditure associated with rheumatoid arthritis (RA) in the US population from a payer's perspective. A probability-weighted sample of adult respondents from the Medical Expenditure Panel Survey (2008) was used to identify a cohort of patients with RA and compared to a control cohort without RA. Annual expenditure outcomes, including total expenditure and subgroups related to pharmacy, office-based visits, emergency department visits, hospital inpatient stays, and residual expenditures were estimated. Differences between the RA and control cohort were adjusted for sociodemographic factors, employment status, insurance coverage, health behavior, and health status using a generalized linear model with log link and gamma distribution. Statistical inferences on difference in expenditures between RA and non-RA controls were based on nonparametric cluster bootstrapping using percentiles. The adjusted average annual total expenditure of the RA cohort in 2008 US dollars (USD) was $13,012 (95% confidence interval [95% CI] $1,737-$47,081), while that of the control cohort was $4,950 (95% CI $567-$17,425). The incremental total expenditure of the RA patients as compared to non-RA controls was $2,085 (95% CI $250-$7,822). RA patients also had a significantly higher pharmacy expenditure of $5,825 (95% CI $446-$30,998) that was on average $1,380 (95% CI $94-$7,492) higher as compared to the controls. The summated total incremental expenditure of all RA patients in the US was $22.3 billion (2008 USD). RA exerts considerable incremental economic burden on US health care, which is primarily driven by the incremental pharmacy expenditure. Copyright © 2012 by the American College of Rheumatology.

Federal, state, and local transportation financial statistics : fiscal years 1982-1994

DOT National Transportation Integrated Search

1997-09-01

This report identifies financial trends of federal, state, and local government transportation-related program revenues and expenditures. Revenues and budget expenditures are displayed for all government transportation-related programs, including pro...

Treadmill training improves overground walking economy in Parkinson's disease: a randomized, controlled pilot study.

PubMed

Fernández-Del-Olmo, Miguel Angel; Sanchez, Jose Andres; Bello, Olalla; Lopez-Alonso, Virginia; Márquez, Gonzalo; Morenilla, Luis; Castro, Xabier; Giraldez, Manolo; Santos-García, Diego

2014-01-01

Gait disturbances are one of the principal and most incapacitating symptoms of Parkinson's disease (PD). In addition, walking economy is impaired in PD patients and could contribute to excess fatigue in this population. An important number of studies have shown that treadmill training can improve kinematic parameters in PD patients. However, the effects of treadmill and overground walking on the walking economy remain unknown. The goal of this study was to explore the walking economy changes in response to a treadmill and an overground training program, as well as the differences in the walking economy during treadmill and overground walking. Twenty-two mild PD patients were randomly assigned to a treadmill or overground training group. The training program consisted of 5 weeks (3 sessions/week). We evaluated the energy expenditure of overground walking, before and after each of the training programs. The energy expenditure of treadmill walking (before the program) was also evaluated. The treadmill, but not the overground training program, lead to an improvement in the walking economy (the rate of oxygen consumed per distance during overground walking at a preferred speed) in PD patients. In addition, walking on a treadmill required more energy expenditure compared with overground walking at the same speed. This study provides evidence that in mild PD patients, treadmill training is more beneficial compared with that of walking overground, leading to a greater improvement in the walking economy. This finding is of clinical importance for the therapeutic administration of exercise in PD.

Do Differences in Programmatic Resource Investments Result in Different 3-Year Pass Rates on the U.S. National Physical Therapy Examination?

PubMed

Covington, Kyle; McCallum, Christine; Engelhard, Chalee; Landry, Michel D; Cook, Chad

2016-01-01

The rising cost of health professions education is well documented and a growing concern among educators; however, little is known about the implications of resource investment on student success. The objective of this study was to determine whether programs with higher National Physical Therapist Exam (NPTE) pass rates invested significantly more on programmatic resources. This observational study used data from the Commission on Accreditation in Physical Therapy Education's (CAPTE) Annual Accreditation Report including all accredited physical therapist programs from the United States who graduated physical therapist students in 2011. Resource expenditures were recorded as both raw and as an index variable (resources per student). Descriptive statistics and comparisons (using chi-square and t-tests) among programs with <100% and 100% pass rates were analyzed from 2009-2011. An ANCOVA was used to determine differences in raw resource expenditures and resource expenditures per student. There were no differences in raw resource expenditures between programs with <100% and 100% pass rates. Programs with 100% pass rates were provided more resource expenditures per student for personnel, overall budget, and core faculty. The results of this study suggest programs with 100% pass rates invested significantly more per student for selected resources.

Economic impacts of Medicaid in North Carolina.

PubMed

Dumas, Christopher; Hall, William; Garrett, Patricia

2008-01-01

The purpose of this study is to provide estimates of the economic impacts of Medicaid program expenditures in North Carolina in state fiscal year (SFY) 2003. The study uses input-output analysis to estimate the economic impacts of Medicaid expenditures. The study uses North Carolina Medicaid program expenditure data for SFY 2003 as submitted by the North Carolina Division of Medical Assistance to the federal Centers for Medicare and Medicaid Services (CMS). Industry structure data from 2002 that are part of the IMPLAN input-output modeling software database are also used in the analysis. In SFY 2003 $6.307 billion in Medicaid program expenditures occurred within the state of North Carolina-$3.941 billion federal dollars, $2.014 billion state dollars, and $351 million in local government funds. Each dollar of state and local government expenditures brought $1.67 in federal Medicaid cost-share to the state. The economic impacts within North Carolina of the 2003 Medicaid expenditures included the following: 182,000 jobs supported (including both full-time and some part-time jobs); $6.1 billion in labor income (wages, salaries, sole proprietorship/partnership profits); and $1.9 billion in capital income (rents, interest payments, corporate dividend payments). If the Medicaid program were shut down and the funds returned to taxpayers who saved/spent the funds according to typical consumer expenditure patterns, employment in North Carolina would fall by an estimated 67,400 jobs, and labor income would fall by $2.83 billion, due to the labor-intensive nature of Medicaid expenditures. Medicaid expenditure and economic impact results do not capture the economic value of the improved health and well-being of Medicaid recipients. Furthermore, the results do not capture the savings to society from increased preventive care and reduced uncompensated care resulting from Medicaid. State and local government expenditures do not fully capture the economic consequences of Medicaid in North Carolina. This study finds that Medicaid makes a large contribution to state and local economic activity by creating jobs, income, and profit in North Carolina. Any changes to the Medicaid program should be made with caution. The rising costs of health care and the appropriate role of government health insurance programs are the object of current policy debates. Informed discussion of these issues requires good information on the economic and health consequences of alternative policy choices. This is the first systematic study of the broader economic impacts of Medicaid expenditures in North Carolina.

The effectiveness of state-level tobacco control interventions: a review of program implementation and behavioral outcomes.

PubMed

Siegel, Michael

2002-01-01

In 2001, nearly one billion dollars will be spent on statewide tobacco control programs, including those in California, Massachusetts, Arizona, and Oregon, funded by cigarette tax revenues, and the program in Florida, funded by the state's settlement with the tobacco industry. With such large expenditures, it is imperative to find out whether these programs are working. This paper reviews the effectiveness of the statewide tobacco control programs in California, Massachusetts, Arizona, Oregon, and Florida. It focuses on two aspects of process evaluation--the funding and implementation of the programs and the tobacco industry's response, and four elements of outcome evaluation--the programs' effects on cigarette consumption, adult and youth smoking prevalence, and protection of the public from secondhand smoke. The paper formulates general lessons learned from these existing programs and generates recommendations to improve and inform the development and implementation of these and future programs.

45 CFR 2551.121 - What legal limitations apply to the operation of the Senior Companion Program and to the...

Code of Federal Regulations, 2010 CFR

2010-10-01

... the Senior Companion Program and to the expenditure of grant funds? 2551.121 Section 2551.121 Public... SENIOR COMPANION PROGRAM Restrictions and Legal Representation § 2551.121 What legal limitations apply to the operation of the Senior Companion Program and to the expenditure of grant funds? (a) Political...

45 CFR 263.3 - When do child care expenditures count?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 2 2013-10-01 2012-10-01 true When do child care expenditures count? 263.3... do child care expenditures count? (a) State funds expended to meet the requirements of the CCDF... amounts), or any other Federal child care program, may also count as basic MOE expenditures. The limit...

45 CFR 263.3 - When do child care expenditures count?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false When do child care expenditures count? 263.3... do child care expenditures count? (a) State funds expended to meet the requirements of the CCDF... amounts), or any other Federal child care program, may also count as basic MOE expenditures. The limit...

45 CFR 263.3 - When do child care expenditures count?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 2 2011-10-01 2011-10-01 false When do child care expenditures count? 263.3... do child care expenditures count? (a) State funds expended to meet the requirements of the CCDF... amounts), or any other Federal child care program, may also count as basic MOE expenditures. The limit...

45 CFR 263.3 - When do child care expenditures count?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 2 2014-10-01 2012-10-01 true When do child care expenditures count? 263.3... do child care expenditures count? (a) State funds expended to meet the requirements of the CCDF... amounts), or any other Federal child care program, may also count as basic MOE expenditures. The limit...

45 CFR 263.3 - When do child care expenditures count?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 2 2012-10-01 2012-10-01 false When do child care expenditures count? 263.3... do child care expenditures count? (a) State funds expended to meet the requirements of the CCDF... amounts), or any other Federal child care program, may also count as basic MOE expenditures. The limit...

Changes in Initial Expenditures for Benign Prostatic Hyperplasia Evaluation in the Medicare Population: A Comparison to Overall Medicare Inflation

PubMed Central

Bellinger, Adam S.; Elliott, Sean P.; Yang, Liu; Wei, John T.; Saigal, Christopher S.; Smith, Alexandria; Wilt, Timothy J.; Strope, Seth A.

2012-01-01

Introduction Benign prostatic hyperplasia (BPH) creates significant expenses for the Medicare program. We sought to determine trends in expenditures for BPH evaluative testing after urologist consultation, and place these trends in the context of overall Medicare expenditures. Methods Using a 5% national sample of Medicare beneficiaries from 2000 to 2007, we developed a cohort of men with claims for new visits to urologists for diagnoses consistent with symptomatic BPH (n=40,253). We assessed trends in initial expenditures (within 12 months of diagnosis; inflation and geography adjusted) by categories of evaluative tests derived from the 2003 AUA Guideline on the Management of BPH. Using governmental reports on Medicare expenditures, trends in BPH expenditures were compared to overall and imaging-specific Medicare expenditures. Comparisons were assessed by Z-tests and regression analysis for linear trends as appropriate. Results Between 2000 and 2007 inflation adjusted total Medicare expenditure per patient for the initial evaluation of BPH patients seen by urologists increased from $255.44 to $343.98 (p<0.0001). Increases in BPH related imaging (55%), were significantly less than increases in overall Medicare expenditures on imaging (104%; p<0.001). The 35% increase in per patient expenditures for BPH was significantly lower than the increase in overall Medicare expenditure per enrollee (45%; p=0.0.0015). Conclusion From 2000 to 2007, inflation adjusted expenditures on BPH related evaluations increased. This growth was slower than overall growth in Medicare expenditures, and increases in imaging expenditures related to BPH were restrained compared to the Medicare program as a whole. PMID:22425128

20 CFR 602.41 - Proper expenditure of Quality Control granted funds.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Proper expenditure of Quality Control granted... LABOR QUALITY CONTROL IN THE FEDERAL-STATE UNEMPLOYMENT INSURANCE SYSTEM Quality Control Grants to States § 602.41 Proper expenditure of Quality Control granted funds. The Secretary may, after reasonable...

20 CFR 602.41 - Proper expenditure of Quality Control granted funds.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Proper expenditure of Quality Control granted... LABOR QUALITY CONTROL IN THE FEDERAL-STATE UNEMPLOYMENT INSURANCE SYSTEM Quality Control Grants to States § 602.41 Proper expenditure of Quality Control granted funds. The Secretary may, after reasonable...

Prescription drug coverage and effects on drug expenditures among elderly Medicare beneficiaries.

PubMed

Huh, Soonim; Rice, Thomas; Ettner, Susan L

2008-06-01

To identify determinants of drug coverage among elderly Medicare beneficiaries and to investigate the impact of drug coverage on drug expenditures with and without taking selection bias into account. The primary data were from the 2000 Medicare Current Beneficiary Survey (MCBS) Cost and Use file, linked to other data sources at the county or state-level that provided instrumental variables. Community-dwelling elderly Medicare beneficiaries who completed the survey were included in the study (N=7,525). A probit regression to predict the probability of having drug coverage and the effects of drug coverage on drug expenditures was estimated by a two-part model, assuming no correlation across equations. In addition, the discrete factor model estimated choice of drug coverage and expenditures for prescription drugs simultaneously to control for self-selection into drug coverage, allowing for correlation of error terms across equations. Findings indicated that unobservable characteristics leading elderly Medicare beneficiaries to purchase drug coverage also lead them to have higher drug expenditures on conditional use (i.e., adverse selection), while the same unobservable factors do not influence their decisions whether to use any drugs. After controlling for potential selection bias, the probability of any drug use among persons with drug coverage use was 4.5 percent higher than among those without, and drug coverage led to an increase in drug expenditures of $308 among those who used prescription drugs. Given significant adverse selection into drug coverage before the implementation of the Medicare Prescription Drug Improvement and Modernization Act, it is essential that selection effects be monitored as beneficiaries choose whether or not to enroll in this voluntary program.

Multinational Corporate Penetration, Industrialism, Region, and Social Security Expenditures: A Cross-National Analysis.

ERIC Educational Resources Information Center

Clark, Roger; Filinson, Rachel

1991-01-01

Examined determinants of spending on social security programs, using data from 75 nations representative of core, semiperipheral, and peripheral nations. Industrialization variables had strong effects in models involving all nations, as did multinational corporate penetration in extraction, particularly when region was controlled; such penetration…

76 FR 584 - Glen Canyon Dam Adaptive Management Program Work Group (AMWG)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-05

... 2010 expenditures, (2) updates on High Flow Experimental Protocol and the Non-native Fish Control... Group (AMWG) AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of public meeting. SUMMARY: The... committee, the Adaptive Management Work Group (AMWG), a technical work group (TWG), a Grand Canyon...

The Effect of Pharmaceutical Patent Term Length on Research and Development and Drug Expenditures in Canada

PubMed Central

Grootendorst, Paul; Matteo, Livio Di

2007-01-01

While pharmaceutical patent terms have increased in Canada, increases in patented drug spending have been mitigated by price controls and retrenchment of public prescription drug subsidy programs. We estimate the net effects of these offsetting policies on domestic pharmaceutical R&D expenditures and also provide an upper-bound estimate on the effects of these policies on Canadian pharmaceutical spending over the period 1988–2002. We estimate that R&D spending increased by $4.4 billion (1997 dollars). Drug spending increased by $3.9 billion at most and, quite likely, by much less. Cutbacks to public drug subsidies and the introduction of price controls likely mitigated drug spending growth. In cost–benefit terms, we suspect that the patent extension policies have been beneficial to Canada. PMID:19305720

Medicaid Managed Care and Cost Containment in the Adult Disabled Population

PubMed Central

Burns, Marguerite E.

2010-01-01

Background Despite the increasing enrollment of adult disabled beneficiaries into Medicaid managed care organizations (MCOs) there is little evidence of its (hoped for) effectiveness at reducing Medicaid expenditures. Objective To evaluate the impact of Medicaid MCOs on health care expenditures for adults with disabilities. Research Design I employ a repeated observations design comparing individual monthly Medicaid expenditures across beneficiaries who reside in counties with mandatory, voluntary, and no MCOs. County-level Medicaid MCO program status for adults with disabilities was merged with the Medical Expenditure Panel Survey and the Area Resource File for 1996–2004. Two-part regression models are used to estimate the probability and level of Medicaid expenditure. Subjects Working age Medicaid beneficiaries who receive Supplement Security Income for disability comprise the sample of 1,613 individuals. Measures Outcome measures include total and service-specific Medicaid expenditures. Results On average, total monthly Medicaid expenditures per beneficiary do not differ between FFS and MCO counties although some service-specific spending differs. Relative to FFS counties, average monthly Medicaid spending per beneficiary is higher for prescription medications in voluntary ($24) and mandatory ($25) MCO counties. Average Medicaid monthly spending for other medical care and dental care is $4 – $11 higher per beneficiary in MCO relative to FFS counties. Conclusions Medicaid MCO programs as implemented are not associated with lower Medicaid spending; thus, state Medicaid programs should consider additional policy tools to contain health care expenditures in this population. PMID:19820613

Changes in initial expenditures for benign prostatic hyperplasia evaluation in the Medicare population: a comparison to overall Medicare inflation.

PubMed

Bellinger, Adam S; Elliott, Sean P; Yang, Liu; Wei, John T; Saigal, Christopher S; Smith, Alexandria; Wilt, Timothy J; Strope, Seth A

2012-05-01

Benign prostatic hyperplasia creates significant expenses for the Medicare program. We determined expenditure trends for benign prostatic hyperplasia evaluative testing after urologist consultation and placed these trends in the context of overall Medicare expenditures. Using a 5% national sample of Medicare beneficiaries from 2000 to 2007 we developed a cohort of 40,253 with claims for new visits to urologists for diagnoses consistent with symptomatic benign prostatic hyperplasia. We assessed trends in initial inflation and geography adjusted expenditures within 12 months of diagnosis by evaluative test categories derived from the 2003 American Urological Association guideline on the management of benign prostatic hyperplasia. Using governmental reports on Medicare expenditure trends for benign prostatic hyperplasia we compared expenditures to overall and imaging specific Medicare expenditures. Comparisons were assessed by the Z-test and regression analysis for linear trends, as appropriate. Between 2000 and 2007 inflation adjusted total Medicare expenditures per patient for the initial evaluation of patients with benign prostatic hyperplasia seen by urologists increased from $255.44 to $343.98 (p <0.0001). Benign prostatic hyperplasia related imaging increases were significantly less than overall Medicare imaging expenditure increases (55% vs 104%, p <0.001). The increase in per patient expenditures for benign prostatic hyperplasia was significantly lower than the increase in overall Medicare expenditures per enrollee (35% vs 45%, p = 0.0015). From 2000 to 2007 inflation adjusted expenditures increased for benign prostatic hyperplasia related evaluations. This growth was slower than the overall growth in Medicare expenditures. The increase in BPH related imaging expenditures was restrained compared to that of the Medicare program as a whole. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Impact of the Bolsa Família program on food availability of low-income Brazilian families: a quasi experimental study.

PubMed

Martins, Ana Paula Bortoletto; Monteiro, Carlos Augusto

2016-08-19

The Bolsa Família Program was created in Brazil in 2003, by the joint of different social programs aimed at poor or very poor families with focus on income transfer to promote immediate poverty relief, conditionalities and complementary programs. Given the contributions of conditional cash transfer programs to poverty alleviation and their potential effects on nutrition and health, the objective of this study was to assess the impact of the Bolsa Família Program on food purchases of low-income households in Brazil. Representative data from the Household Budget Survey conducted in 2008-2009 were studied, with probabilistic sample of 55,970 households. 11,282 households were eligible for this study and 48.5 % were beneficiaries of the BFP. Food availability indicators were compared among paired blocks of households (n = 100), beneficiaries or non-beneficiaries of the Bolsa Família Program, with monthly per capita income up to R$ 210.00. Blocks of households were created based on the propensity score of each household to have beneficiaries and were homogeneous regarding potential confounding variables. The food availability indicators were weekly per capita expenditure and daily energy consumption, both calculated considering all food items and four food groups based on the extent and purpose of the industrial food processing. The comparisons between the beneficiaries and non-beneficiaries blocks of households were conducted through paired 't' tests. Compared to non-beneficiaries, the beneficiaries households had 6 % higher food expenditure (p = 0.015) and 9.4 % higher total energy availability (p = 0.010). It was found a 7.3 % higher expenditure on in natura or minimally processed foods and 10.4 % higher expenditure on culinary ingredients among the Bolsa Família Program families. No statistically significant differences were found regarding the expenditure and the availability of processed and ultra-processed food and drink products. In the in natura or minimally processed foods group, the expenditure and the availability of meat, tubers and vegetables were higher among the Bolsa Família Program beneficiaries. The Bolsa Família Program impact on food availability among low-income families was higher food expenditure, higher availability of fresh foods and culinary ingredients, including those foods that increase diet's quality and diversity.

Telecommunication and Technology Infrastructure Program (TTIP) Certification for Expenditures, Fiscal Year 2000-2001.

ERIC Educational Resources Information Center

Williams, Lindy

This document presents the guidelines for the California Community College 2000-2001 State-Funded Telecommunication and Technology Infrastructure Program (TTIP) Program. The 2000-2001 State Budget Act contains $44.3 million for expenditures on the TTIP. The Act provides that $31,600,000 be allocated to colleges for the following purposes: (1) data…

76 FR 17419 - Agency Information Collection Activities; Proposed Collection; Comment Request; Extension of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-29

... Title III and Minor Revisions to the Certification of Long-Term Care Ombudsman Program Expenditures... Certification of Long-Term Care Ombudsman Program Expenditures provides statutorily required information... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration on Aging Agency Information Collection...

45 CFR 86.41 - Athletics.

Code of Federal Regulations, 2011 CFR

2011-10-01

... EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 86.41 Athletics. (a) General. No person shall, on... expenditures for members of each sex or unequal expenditures for male and female teams if a recipient operates...

45 CFR 618.450 - Athletics.

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 618.450 Athletics. (a) General. No... aggregate expenditures for members of each sex or unequal expenditures for male and female teams if a...

45 CFR 86.41 - Athletics.

Code of Federal Regulations, 2013 CFR

2013-10-01

... EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 86.41 Athletics. (a) General. No person shall, on... expenditures for members of each sex or unequal expenditures for male and female teams if a recipient operates...

45 CFR 618.450 - Athletics.

Code of Federal Regulations, 2012 CFR

2012-10-01

... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 618.450 Athletics. (a) General. No... aggregate expenditures for members of each sex or unequal expenditures for male and female teams if a...

45 CFR 86.41 - Athletics.

Code of Federal Regulations, 2014 CFR

2014-10-01

... EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 86.41 Athletics. (a) General. No person shall, on... expenditures for members of each sex or unequal expenditures for male and female teams if a recipient operates...

45 CFR 618.450 - Athletics.

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 618.450 Athletics. (a) General. No... aggregate expenditures for members of each sex or unequal expenditures for male and female teams if a...

45 CFR 618.450 - Athletics.

Code of Federal Regulations, 2013 CFR

2013-10-01

... OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities Prohibited § 618.450 Athletics. (a) General. No... aggregate expenditures for members of each sex or unequal expenditures for male and female teams if a...

Effective policy initiatives to constrain lipid-lowering drug expenditure growth in South Korea.

PubMed

Bae, Green; Park, Chanmi; Lee, Hyejin; Han, Euna; Kim, Dong-Sook; Jang, Sunmee

2014-03-03

The rapid growth of prescription drug expenditures is a major problem in South Korea. Accordingly, the South Korean government introduced a positive listing system in 2006. They also adopted various price reduction policies. Nevertheless, the total expenditure for lipid-lowering drugs have steadily increased throughout South Korea. The present study explores the factors that have influenced the increased expenditures of lipid-lowering drugs with a particular focus on the effects of statins in this process. This paper investigates the National Health Insurance claims data for prescribed lipid-lowering drugs collected between January 1, 2005 and December 31, 2009. We specifically focused on statins and assessed the yearly variation of statin expenditure by calculating the increased rate of paired pharmaceutical expenditures over a 2 year period. Our study classified statins into three categories: new entrants, core medicines and exiting medicines. For core medicines, we further examined influencing factors such as price, amount of drugs consumed by volume, and prescription changes (substitutes for other drug). Statin expenditure showed an average annual increase of 25.7% between 2005 and 2009. Among the different statins, the expenditure of atorvastatin showed a 36.6% annual increase rate, which was the most dramatic among all statins. Also we divided expenditure for core medicines by the price factor, volume factor, and prescription change. The result showed that annual weighted average prices of individual drug decreased each year, which clearly showed that price influenced statin expenditure in a negative direction. The use of generic drugs containing the same active ingredient as name-brand drugs increased and negatively affected statin expenditure (Generic Mix effect). However, the use of relatively expensive ingredients within statin increase, Ingredient Mix effect contributed to increased statin expenditure (Ingredient Mix effect). In particular, the volume effect was found to be critical for increasing statin expenditure as the amount of statin consumed increased steadily throughout the study period. The recent rapid increase in statin expenditure can largely be attributed to an increase in consumption volume. In order to check drug expenditures effectively in our current situation, in which chronic diseases remain steadily on the rise, it is necessary to not only have supply-side initiatives such as price reduction, but also demand-side initiatives that could control drug consumption volume, for example: educational programs for rational prescription, generic drug promotional policies, and policies providing prescription targets.

Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates

PubMed Central

Lightwood, James; Glantz, Stanton A.

2016-01-01

Background Reductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states. Methods and Findings State per capita healthcare expenditure is modeled as a function of current smoking prevalence, mean cigarette consumption per smoker, other demographic and economic factors, and cross-sectional time trends using a fixed effects panel data regression on annual time series data for each the 50 states and the District of Columbia for the years 1992 through 2009. We found that 1% relative reductions in current smoking prevalence and mean packs smoked per current smoker are associated with 0.118% (standard error [SE] 0.0259%, p < 0.001) and 0.108% (SE 0.0253%, p < 0.001) reductions in per capita healthcare expenditure (elasticities). The results of this study are subject to the limitations of analysis of aggregate observational data, particularly that a study of this nature that uses aggregate data and a relatively small sample size cannot, by itself, establish a causal connection between smoking behavior and healthcare costs. Historical regional variations in smoking behavior (including those due to the effects of state tobacco control programs, smoking restrictions, and differences in taxation) are associated with substantial differences in per capita healthcare expenditures across the United States. Those regions (and the states in them) that have lower smoking have substantially lower medical costs. Likewise, those that have higher smoking have higher medical costs. Sensitivity analysis confirmed that these results are robust. Conclusions Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. State and national policies that reduce smoking should be part of short term healthcare cost containment. PMID:27163933

Estimating annual medical and out-of-pocket expenditures associated with traumatic injuries in the United States.

PubMed

Alghnam, Suliman; Vanness, David J; Gaskin, Darrell J; Thorpe, Roland J; Castillo, Renan

2016-02-01

Every year, as many as 31 million Americans sustain traumatic injuries, leaving survivors with risks of disabilities and health settings with staggering medical costs. Little is known on the societal burden of injuries in terms of medical and out-of-pocket expenditures. Therefore, we used a nationally representative sample to evaluate the association between injuries and health expenditures among a nationally representative US sample. This study used years 2006 to 2010 (Panels 11-14; n = 53,065) of the Medical Expenditure Panel Survey. Each panel was followed up for 2 years. Total expenditures included insurance payments and out-of-pocket costs. Two-part models were constructed to examine differences in annual medical expenditures between injured and noninjured populations controlling for confounding effects. A total of 4,210 individuals (7.9%) reported injuries representing 21.5 million individuals. Injured individuals were more likely to be males, to be white, and to report higher medical expenditures in the second year than the reference population (p < 0.01). Adjusted analyses showed that reporting any injury was associated with $2,577 (95% confidence interval [CI], $2,049-$3,103) and $186 (95% CI, $142-$230) increase in total and out-of-pocket costs, respectively. While a moderate or severe injury was associated with $4,779 (95% CI, $3,947-$5,610) increase in the average of medical expenditures and $256 (95% CI, $190-$322) increase in out-of-pocket costs adjusting for covariates. Our adjusted national medical cost of injuries was estimated at $56 billion and out-of-pocket cost to be approximately $4 billion. Injuries pose a substantial burden on medical expenditures in the United States. Investment in injury prevention can facilitate reducing medical expenditures and save resources. Prevention programs may use the out-of-pocket findings to highlight injury burden on individual's prosperity and thus facilitate engagement of the public in prevention. Economic and evaluation study, level III.

The effect of a telephone-based health coaching disease management program on Medicaid members with chronic conditions.

PubMed

Lin, Wen-Chieh; Chien, Hung-Lun; Willis, Georgianna; O'Connell, Elizabeth; Rennie, Kate Staunton; Bottella, Heather M; Ferris, Timothy G

2012-01-01

Despite the growing popularity of disease management programs for chronic conditions, evidence regarding the effect of these programs has been mixed. In addition, few peer-reviewed studies have examined the effect of these programs on publicly insured populations. To examine the effect of a telephone-based health coaching disease management program on healthcare utilization and expenditures in Medicaid members with chronic conditions. Using a difference-in-differences analysis, we examined changes in hospitalizations, emergency department (ED) visits, ambulatory care visits, and Medicaid expenditures among program members for 1 year before and 2 years after their enrollment compared with a matched comparison group. Medicaid members aged 18 to 64 with a diagnosis of qualifying chronic conditions and 2 acute health service events of hospitalizations and/or ED visits within a 12-month period. Changes in acute hospitalizations, ambulatory care visits, and Medicaid expenditures before and after program enrollment were similar between the 2 study groups. However, during the second year after enrollment, program members had a significantly smaller decrease in ED visits than the comparisons (8% in program members and 23% in comparisons, P value=0.03). Compared with a matched comparison group, the telephone-based health coaching disease management program did not demonstrate significant effects on healthcare utilization and expenditures in Medicaid members with chronic conditions.

Expenditures and use of wraparound health insurance for employed people with disabilities.

PubMed

Gettens, John; Hoffman, Denise; Henry, Alexis D

2016-04-01

The Affordable Care Act (ACA) provides health insurance to many working-age adults with disabilities, but we do not expect the new coverage or existing insurance options to fully meet their employment-related health care needs. Wraparound services have the potential to foster employment among people with disabilities. We use Massachusetts, which implemented health care reform in 2006, as a case study to estimate the wraparound health care expenditures and use for workers with disabilities. We identified a group of employed, working-age people with disabilities whose primary health insurance is Medicare or private insurance and who use the Medicaid Buy-In Program for wraparound coverage. We analyzed claims to estimate expenditures and use. Wraparound expenditures averaged $427 per member per month. Community-based services for both mental and non-mental health, which are generally not covered by Medicare or private insurance, accounted for 63% of all expenditures. The number who used community-based services was low, but the expenditures were high. The majority of the remaining expenditures were for services usually covered by primary insurance including: inpatient and outpatient, pharmacy and professional services. Expenditures were higher for people with Medicare compared to private insurance. This case study suggests that, from a total program cost perspective, wraparound demand is greatest for community-based services. From a member utilization perspective, the demand is greatest for coverage that alleviates out-of-pocket costs for services provided by primary insurance. Additional analysis is needed to further assess the design options for wraparound programs and their feasibility. Copyright © 2016 Elsevier Inc. All rights reserved.

Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities.

PubMed

Snowden, Lonnie R; Wallace, Neal; Cordell, Kate; Graaf, Genevieve

2017-09-01

Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services. We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites. Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs. Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities. EPSDT expanded funding increased proportional expenditures for Whites absent cultural and language-sensitive treatment programs. The programs moderate, but do not overcome, entrenched expenditure disparities. These findings use investment in mental health services for Latino populations to indicate treatment access and utilization, but do not explicitly reflect penetration rates or intensity of services for consumers. New funding, along with an expectation that Latino children's well documented mental health treatment disparities will be addressed, holds potential for improved mental health access and reducing utilization inequities for this population, especially when specialized, culturally and linguistically sensitive mental health treatment programs are present to serve as recipients of funding. To further expand knowledge of how federal or state funding for community based mental health services for low income populations can drive down the longstanding and considerable Latino-White mental health treatment disparities, we must develop and test questions targeting policy drivers which can channel funding to programs and organizations aimed at delivering linguistically and culturally sensitive services to Latino children and their families.

A cash-back rebate program for healthy food purchases in South Africa: results from scanner data.

PubMed

Sturm, Roland; An, Ruopeng; Segal, Darren; Patel, Deepak

2013-06-01

Improving diet quality is a key health promotion strategy. There is much interest in the role of prices and financial incentives to encourage healthy diet, but no data from large population interventions. This study examines the effect of a price reduction for healthy food items on household grocery shopping behavior among members of South Africa's largest health plan. The HealthyFood program provides a cash-back rebate of up to 25% for healthy food purchases in over 400 designated supermarkets across all provinces in South Africa. Monthly household supermarket food purchase scanner data between 2009 and 2012 are linked to 170,000 households (60% eligible for the rebate) with Visa credit cards. Two approaches were used to control for selective participation using these panel data: a household fixed-effect model and a case-control differences-in-differences model. Rebates of 10% and 25% for healthy foods are associated with an increase in the ratio of healthy to total food expenditure by 6.0% (95% CI=5.3, 6.8) and 9.3% (95% CI=8.5, 10.0); an increase in the ratio of fruit and vegetables to total food expenditure by 5.7% (95% CI=4.5, 6.9) and 8.5% (95% CI=7.3, 9.7); and a decrease in the ratio of less desirable to total food expenditure by 5.6% (95% CI=4.7, 6.5) and 7.2% (95% CI=6.3, 8.1). Participation in a rebate program for healthy foods led to increases in purchases of healthy foods and to decreases in purchases of less-desirable foods, with magnitudes similar to estimates from U.S. time-series data. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Medicaid care management: description of high-cost addictions treatment clients.

PubMed

Neighbors, Charles J; Sun, Yi; Yerneni, Rajeev; Tesiny, Ed; Burke, Constance; Bardsley, Leland; McDonald, Rebecca; Morgenstern, Jon

2013-09-01

High utilizers of alcohol and other drug treatment (AODTx) services are a priority for healthcare cost control. We examine characteristics of Medicaid-funded AODTx clients, comparing three groups: individuals <90th percentile of AODTx expenditures (n=41,054); high-cost clients in the top decile of AODTx expenditures (HC; n=5,718); and 1760 enrollees in a chronic care management (CM) program for HC clients implemented in 22 counties in New York State. Medicaid and state AODTx registry databases were combined to draw demographic, clinical, social needs and treatment history data. HC clients accounted for 49% of AODTx costs funded by Medicaid. As expected, HC clients had significant social welfare needs, comorbid medical and psychiatric conditions, and use of inpatient services. The CM program was successful in enrolling some high-needs, high-cost clients but faced barriers to reaching the most costly and disengaged individuals. Copyright © 2013 Elsevier Inc. All rights reserved.

26 CFR 53.4945-6 - Expenditures for noncharitable purposes.

Code of Federal Regulations, 2010 CFR

2010-04-01

... a direct charitable act or the making of a program-related investment, or (ii) Through compliance... be treated as taxable expenditures under section 4945(d)(5): (i) Expenditures to acquire investments... in section 170(c)(2)(B), (ii) Reasonable expenses with respect to investments described in...

10 CFR 420.38 - Special projects expenditure prohibitions and limitations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 3 2010-01-01 2010-01-01 false Special projects expenditure prohibitions and limitations. 420.38 Section 420.38 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION STATE ENERGY PROGRAM Implementation of Special Projects Financial Assistance § 420.38 Special projects expenditure prohibitions and...

10 CFR 420.38 - Special projects expenditure prohibitions and limitations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 3 2011-01-01 2011-01-01 false Special projects expenditure prohibitions and limitations. 420.38 Section 420.38 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION STATE ENERGY PROGRAM Implementation of Special Projects Financial Assistance § 420.38 Special projects expenditure prohibitions and...

10 CFR 420.38 - Special projects expenditure prohibitions and limitations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 3 2012-01-01 2012-01-01 false Special projects expenditure prohibitions and limitations. 420.38 Section 420.38 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION STATE ENERGY PROGRAM Implementation of Special Projects Financial Assistance § 420.38 Special projects expenditure prohibitions and...

10 CFR 420.38 - Special projects expenditure prohibitions and limitations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 3 2013-01-01 2013-01-01 false Special projects expenditure prohibitions and limitations. 420.38 Section 420.38 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION STATE ENERGY PROGRAM Implementation of Special Projects Financial Assistance § 420.38 Special projects expenditure prohibitions and...

10 CFR 420.38 - Special projects expenditure prohibitions and limitations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 3 2014-01-01 2014-01-01 false Special projects expenditure prohibitions and limitations. 420.38 Section 420.38 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION STATE ENERGY PROGRAM Implementation of Special Projects Financial Assistance § 420.38 Special projects expenditure prohibitions and...

Higher pharmaceutical public expenditure after direct price control: improved access or induced demand? The Colombian case.

PubMed

Prada, Sergio I; Soto, Victoria E; Andia, Tatiana S; Vaca, Claudia P; Morales, Álvaro A; Márquez, Sergio R; Gaviria, Alejandro

2018-01-01

High pharmaceutical expenditure is one of the main concerns for policymakers worldwide. In Colombia, a middle-income country, outpatient prescription represents over 10% of total health expenditure in the mandatory benefits package (POS), and close to 90% in the complementary government fund (No POS). In order to control expenditure, since 2011, the Ministry of Health introduced price caps on inpatient drugs reimbursements by active ingredient. By 2013, more than 400 different products, covering 80% of public pharmaceutical expenditure were controlled. This paper investigates the effects of the Colombian policy efforts to control expenditure by controlling prices. Using SISMED data, the official database for prices and quantities sold in the domestic market, we estimate a Laspeyres price index for 90 relevant markets in the period 2011-2015, and, then, we estimate real pharmaceutical expenditure. Results show that, after direct price controls were enacted, price inflation decreased almost - 43%, but real pharmaceutical expenditure almost doubled due mainly to an increase in units sold. Such disproportionate increase in units sold maybe attributable to better access to drugs due to lower prices, and/or to an increase in marketing efforts by the pharmaceutical industry to maintain profits. We conclude that pricing interventions should be implemented along with a strong market monitoring to prevent market distortions such as inappropriate and unnecessary drug use.

Impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or chronic obstructive pulmonary disease: a systematic review of the literature.

PubMed

de Bruin, Simone R; Heijink, Richard; Lemmens, Lidwien C; Struijs, Jeroen N; Baan, Caroline A

2011-07-01

Evaluating the impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or COPD. Systematic Pubmed search for studies reporting the impact of disease management programs on healthcare expenditures. Included were studies that contained two or more components of Wagner's chronic care model and were published between January 2007 and December 2009. Thirty-one papers were selected, describing disease management programs for patients with diabetes (n=14), depression (n=4), heart failure (n=8), and COPD (n=5). Twenty-one studies reported incremental healthcare costs per patient per year, of which 13 showed cost-savings. Incremental costs ranged between -$16,996 and $3305 per patient per year. Substantial variation was found between studies in terms of study design, number and combination of components of disease management programs, interventions within components, and characteristics of economic evaluations. Although it is widely believed that disease management programs reduce healthcare expenditures, the present study shows that evidence for this claim is still inconclusive. Nevertheless disease management programs are increasingly implemented in healthcare systems worldwide. To support well-considered decision-making in this field, well-designed economic evaluations should be stimulated. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

20 CFR 626.5 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... apply as appropriate to programs under titles I, II, and III of the Act: Accrued expenditures means charges made to the JTPA program. Expenditures are the sum of actual cash disbursements, the amount of indirect expense incurred, and the net increase (or decrease) in the amounts owed by the recipient for the...

20 CFR 626.5 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... apply as appropriate to programs under titles I, II, and III of the Act: Accrued expenditures means charges made to the JTPA program. Expenditures are the sum of actual cash disbursements, the amount of indirect expense incurred, and the net increase (or decrease) in the amounts owed by the recipient for the...

20 CFR 626.5 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... apply as appropriate to programs under titles I, II, and III of the Act: Accrued expenditures means charges made to the JTPA program. Expenditures are the sum of actual cash disbursements, the amount of indirect expense incurred, and the net increase (or decrease) in the amounts owed by the recipient for the...

Notification: Review of the Pace of State Expenditures in the Drinking Water State Revolving Fund Program

EPA Pesticide Factsheets

Project #OA-FY13-0214, July 16, 2013. The U.S. Environmental Protection Agency Office of Inspector General plans to begin the fieldwork phase of our audit on the pace of state expenditures in the Drinking Water State Revolving Fund program.

78 FR 72972 - Information Collection Activities

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-04

... expenditures by a recipient for the last five (5) fiscal years. The program is a discretionary grant program... the amount of, and purpose for, each expenditure. In the past, PHMSA has not collected this... response teams. Questions to HMEP Grantees Following the close of this 60-Day Notice and receipt of...

Assessing the relation of USDA conservation expenditures to suspended sediment reductions in an Iowa watershed.

PubMed

Villarini, Gabriele; Schilling, Keith E; Jones, Christopher S

2016-09-15

From 1936 to 2010, U.S. Department of Agriculture (USDA) agencies spent $293.7 billion (value adjusted for inflation at the 2009 level) on conservation programs. Of these expenditures, $75.2 billion (26%) were allocated for technical assistance (TA; it is related to costs associated with USDA field staff providing their expert advice to farmers) and $218.5 billion (74%) for financial assistance (FA; monetary incentives for farmers to adopt conservation programs). A major environmental goal of these programs was to reduce soil erosion and sediment leaving the land. In this study, we correlate expenditures on FA and TA programs to a unique long (1937-2009) record of total suspended solids (TSS) and sediment load (SL) for the Raccoon River at Van Meter, Iowa. Study results suggest that three predictors (rainfall, TA and FA) are important in explaining the temporal changes in annual TSS and SL and provide evidence that USDA expenditures helped reduce TSS and SL in the Raccoon River. TA was more effective than FA in reducing TSS levels in the watershed. Our empirical model represents an initial, broad-scale attempt to correlate conservation expenditures to a specific water quality outcome, although more work is needed to disentangle the impacts associated with other unexplored factors. Copyright © 2016 Elsevier Ltd. All rights reserved.

Energy Expenditure of Sport Stacking

ERIC Educational Resources Information Center

Murray, Steven R.; Udermann, Brian E.; Reineke, David M.; Battista, Rebecca A.

2009-01-01

Sport stacking is an activity taught in many physical education programs. The activity, although very popular, has been studied minimally, and the energy expenditure for sport stacking is unknown. Therefore, the purposes of this study were to determine the energy expenditure of sport stacking in elementary school children and to compare that value…

An exercise protocol designed to control energy expenditure for long-term space missions.

PubMed

Matsuo, Tomoaki; Ohkawara, Kazunori; Seino, Satoshi; Shimojo, Nobutake; Yamada, Shin; Ohshima, Hiroshi; Tanaka, Kiyoji; Mukai, Chiaki

2012-08-01

Astronauts experience weight loss during spaceflight. Future space missions require a more efficient exercise program not only to maintain work efficiency, but also to control increased energy expenditure (EE). When discussing issues concerning EE incurred through exercise, excess post-exercise energy expenditure (EPEE) must also be considered. The aim of this study was to compare the total EE, including EPEE, induced by two types of interval cycling protocols with the total EE of a traditional, continuous cycling protocol. There were 10 healthy men, ages 20 to 31 yr, who completed 3 exercise sessions: sprint interval training (SIT) consisting of 7 sets of 30-s cycling at 120% VO2max with a 15-s rest between each bout; high-intensity interval aerobic training (HIAT) consisting of 3 sets of 3-min cycling at 80-90% VO2max with a 2-min active rest at 50% VO2max; and continuous aerobic training (CAT) consisting of 40 min of cycling at 60-65% VO2max. During each session, resting metabolic rate, exercise EE, and a 180-min post-exercise EE were measured. The EPEEs during the SIT, HIAT, and CAT averaged 32 +/- 19, 21 +/- 16, and 13 +/- 13 kcal, and the total EE for an entire exercise/ rest session averaged 109 +/- 20, 182 +/- 17, and 363 +/- 45 kcal, respectively. While the EPEE after the CAT was significantly less than after the SIT, the total EE with the CAT was the greatest of the three. The SIT and HIAT would be potential protocols to control energy expenditure for long space missions.

A close examination of healthcare expenditures related to fractures.

PubMed

Kilgore, Meredith L; Curtis, Jeffrey R; Delzell, Elizabeth; Becker, David J; Arora, Tarun; Saag, Kenneth G; Morrisey, Michael A

2013-04-01

This study evaluated reasons for healthcare expenditures both before and after the occurrence of fractures among Medicare beneficiaries. In a previous study we examined healthcare expenditures in the 6 months before and after fractures. The difference-"incremental" expenditures-provides one estimate of the potentially avoidable costs associated with fractures. We constructed a second estimate of the cost burden-"attributable" expenditures-using only those costs recorded in claims with fracture diagnosis codes. Attributable expenditures accounted for only 24% to 60% of incremental expenditures, depending on the fracture site. We examined health care expenditures between 1999 and 2005 among Medicare beneficiaries who experienced fractures (cases) and among beneficiaries who did not experience fractures (controls), matched to cases on age, race, and sex. We also examined healthcare expenditures for cases and controls for 24 months prior to the fracture index date. When expenditures associated with diagnoses for aftercare, joint pain, and osteoporosis, other musculoskeletal diagnoses, pneumonia, and pressure ulcers were included, the proportion of incremental costs directly attributable to fracture care rose to 72% to 88%. Expenditures prior to fracture were higher for cases than controls, and the rate of increase accelerated over the 12 months prior to the hip fracture. Our findings confirm that the original incremental cost analysis constituted a satisfactory method for estimating avoidable costs associated with fractures. We also conclude that those with fractures had much higher and growing healthcare expenditures in the 12 months prior to the event, compared with age-, race-, and sex-matched controls. This suggests that patterns of healthcare services utilization may provide a means to improve fracture prediction rules. Copyright © 2013 American Society for Bone and Mineral Research.

Evidence of effectiveness of preventive dental care in reducing dental treatment use and related expenditures.

PubMed

Pourat, Nadereh; Choi, Moonkyung Kate; Chen, Xiao

2018-02-06

Preventive dental health services are intended to reduce the likelihood of development of tooth decay and the need for more intensive treatment overtime. The evidence on the effectiveness of preventive dental care in reducing treatment services and expenditures is lagging for adults, particularly those with lower incomes and chronic conditions. We assessed the impact of preventive dental services on dental treatment service use and expenditures overall and by category of service. We calculated the annual numbers of preventive (periodic diagnostic and prophylactic procedures) and treatment (restorative, surgery, prosthodontic, endodontic, and periodontic) services per beneficiary using Medicaid enrollment and claims data for beneficiaries with three categories of conditions (diabetes, heart disease, and respiratory disease) from 10 largest California counties. We used Cragg hurdle exponential regression models controlling for past service use, demographics, length of enrollment, and county. We found that using preventive services in 2005-2007 was associated with higher likelihood and number of treatment dental services used, but associated with lower treatment expenditures in 2008. The reduction in expenditures was noted only in restorative, prosthodontics, and periodontic services. The findings provide much needed evidence of the contribution of preventive dental care in maintaining oral health of low-income adults with chronic conditions and potential for savings to the Medicaid program. Providing lower cost preventive dental care to the individuals with chronic conditions would achieve better oral health and lower treatment expenditures. © 2018 American Association of Public Health Dentistry.

Foreign Military Sales between Thailand and U.S.

DTIC Science & Technology

1982-06-01

level of the material acquisition process, and are organized to manage, the following functional activities. - Financial Accounting Control - Contract... Accounting Center (SAAC) . NAVILCO is also involved with the financial control of FMS programs, since it records all obligational/expenditure authorities from...CATEGORIES OF STANDARD FMS CASES 6 6 1. Blanket Order 66 2. Defined Order 70 VI. FINANCIAL 74 A. FLOW OF FUNDS FOR FMS 74 1. Demand for Funds 74 2

A 3-week multimodal intervention involving high-intensity interval training in female cancer survivors: a randomized controlled trial.

PubMed

Schmitt, Joachim; Lindner, Nathalie; Reuss-Borst, Monika; Holmberg, Hans-Christer; Sperlich, Billy

2016-02-01

To compare the effects of a 3-week multimodal rehabilitation involving supervised high-intensity interval training (HIIT) on female breast cancer survivors with respect to key variables of aerobic fitness, body composition, energy expenditure, cancer-related fatigue, and quality of life to those of a standard multimodal rehabilitation program. A randomized controlled trial design was administered. Twenty-eight women, who had been treated for cancer were randomly assigned to either a group performing exercise of low-to-moderate intensity (LMIE; n = 14) or a group performing high-intensity interval training (HIIT; n = 14) as part of a 3-week multimodal rehabilitation program. No adverse events related to the exercise were reported. Work economy improved following both HIIT and LMIE, with improved peak oxygen uptake following LMIE. HIIT reduced mean total body fat mass with no change in body mass, muscle or fat-free mass (best P < 0.06). LMIE increased muscle and total fat-free body mass. Total energy expenditure (P = 0.45) did not change between the groups, whereas both improved quality of life to a similar high extent and lessened cancer-related fatigue. This randomized controlled study demonstrates that HIIT can be performed by female cancer survivors without adverse health effects. Here, HIIT and LMIE both improved work economy, quality of life and cancer-related fatigue, body composition or energy expenditure. Since the outcomes were similar, but HIIT takes less time, this may be a time-efficient strategy for improving certain aspects of the health of female cancer survivors. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

Measuring disparities across the distribution of mental health care expenditures.

PubMed

Le Cook, Benjamin; Manning, Willard; Alegria, Margarita

2013-03-01

Previous mental health care disparities studies predominantly compare mean mental health care use across racial/ethnic groups, leaving policymakers with little information on disparities among those with a higher level of expenditures. To identify racial/ethnic disparities among individuals at varying quantiles of mental health care expenditures. To assess whether disparities in the upper quantiles of expenditure differ by insurance status, income and education. Data were analyzed from a nationally representative sample of white, black and Latino adults 18 years and older (n=83,878). Our dependent variable was total mental health care expenditure. We measured disparities in any mental health care expenditures, disparities in mental health care expenditure at the 95th, 97.5 th, and 99 th expenditure quantiles of the full population using quantile regression, and at the 50 th, 75 th, and 95 th quantiles for positive users. In the full population, we tested interaction coefficients between race/ethnicity and income, insurance, and education levels to determine whether racial/ethnic disparities in the upper quantiles differed by income, insurance and education. Significant Black-white and Latino-white disparities were identified in any mental health care expenditures. In the full population, moving up the quantiles of mental health care expenditures, Black-White and Latino-White disparities were reduced but remained statistically significant. No statistically significant disparities were found in analyses of positive users only. The magnitude of black-white disparities was smaller among those enrolled in public insurance programs compared to the privately insured and uninsured in the 97.5 th and 99 th quantiles. Disparities persist in the upper quantiles among those in higher income categories and after excluding psychiatric inpatient and emergency department (ED) visits. Disparities exist in any mental health care and among those that use the most mental health care resources, but much of disparities seem to be driven by lack of access. The data do not allow us to disentangle whether disparities were related to white respondent's overuse or underuse as compared to minority groups. The cross-sectional data allow us to make only associational claims about the role of insurance, income, and education in disparities. With these limitations in mind, we identified a persistence of disparities in overall expenditures even among those in the highest income categories, after controlling for mental health status and observable sociodemographic characteristics. Interventions are needed to equalize resource allocation to racial/ethnic minority patients regardless of their income, with emphasis on outreach interventions to address the disparities in access that are responsible for the no/low expenditures for even Latinos at higher levels of illness severity. Increased policy efforts are needed to reduce the gap in health insurance for Latinos and improve outreach programs to enroll those in need into mental health care services. Future studies that conclusively disentangle overuse and appropriate use in these populations are warranted.

Medical Expenditures Associated With Diabetes Among Youth With Medicaid Coverage.

PubMed

Shrestha, Sundar S; Zhang, Ping; Thompson, Theodore J; Gregg, Edward W; Albright, Ann; Imperatore, Giuseppina

2017-07-01

Information on diabetes-related excess medical expenditures for youth is important to understand the magnitude of financial burden and to plan the health care resources needed for managing diabetes. However, diabetes-related excess medical expenditures for youth covered by Medicaid program have not been investigated recently. To estimate excess diabetes-related medical expenditures among youth aged below 20 years enrolled in Medicaid programs in the United States. We analyzed data from 2008 to 2012 MarketScan multistate Medicaid database for 6502 youths with diagnosed diabetes and 6502 propensity score matched youths without diabetes, enrolled in fee-for-service payment plans. We stratified analysis by Medicaid eligibility criteria (poverty or disability). We used 2-part regression models to estimate diabetes-related excess medical expenditures, adjusted for age, sex, race/ethnicity, year of claims, depression status, asthma status, and interaction terms. For poverty-based Medicaid enrollees, estimated annual diabetes-related total medical expenditure was $9046 per person [$3681 (no diabetes) vs. $12,727 (diabetes); P<0001], of which 41.7%, 34.0%, and 24.3% were accounted for by prescription drugs, outpatient, and inpatient care, respectively. For disability-based Medicaid enrollees, the estimated annual diabetes-related total medical expenditure was $9944 per person ($14,149 vs. $24,093; P<0001), of which 41.5% was accounted for by prescription drugs, 31.3% by inpatient, and 27.3% by outpatient care. The per capita annual diabetes-related medical expenditures in youth covered by publicly financed Medicaid programs are substantial, which is larger among those with disabilities than without disabilities. Identifying cost-effective ways of managing diabetes in this vulnerable segment of the youth population is needed.

Resting energy expenditure and carbohydrate oxidation are higher in elderly patients with COPD: a case control study

PubMed Central

2012-01-01

Background Elderly patients with chronic obstructive pulmonary disease (COPD) usually have a compromised nutritional status which is an independent predictor of morbidity and mortality. To know the Resting Energy Expenditure (REE) and the substrate oxidation measurement is essential to prevent these complications. This study aimed to compare the REE, respiratory quotient (RQ) and body composition between patients with and without COPD. Methods This case–control study assessed 20 patients with chronic obstructive pulmonary disease attending a pulmonary rehabilitation program. The group of subjects without COPD (control group) consisted of 20 elderly patients attending a university gym, patients of a private service and a public healthy care. Consumption of oxygen (O2) and carbon dioxide (CO2) was determined by indirect calorimetry and used for calculating the resting energy expenditure and respiratory quotient. Body mass index (BMI) and waist circumference (WC) were also measured. Percentage of body fat (%BF), lean mass (kg) and muscle mass (kg) were determined by bioimpedance. The fat free mass index (FFMI) and muscle mass index (MMI) were then calculated. Results The COPD group had lower BMI than control (p = 0.02). However, WC, % BF, FFMI and MM-I did not differ between the groups. The COPD group had greater RQ (p = 0.01), REE (p = 0.009) and carbohydrate oxidation (p = 0.002). Conclusions Elderly patients with COPD had higher REE, RQ and carbohydrate oxidation than controls. PMID:22672689

Using Comparative Expenditure Data for Institutional Planning. SAIR Conference Paper.

ERIC Educational Resources Information Center

Sanford, Timothy R.; Sadler, James C.

The use of Higher Education General Information Survey (HEGIS) data and a software program to compare public university expenditures is discussed. Financial expenditures at the University of North Carolina, Chapel Hill, (UNC) and other public universities were compared using 1981-1982 and 1982-1983 HEGIS data for public university members of the…

Health Care Expenditure among People with Disabilities: Potential Role of Workplace Health Promotion and Implications for Rehabilitation Counseling

ERIC Educational Resources Information Center

Karpur, Arun; Bruyere, Susanne M.

2012-01-01

Workplace health-promotion programs have the potential to reduce health care expenditures, especially among people with disabilities. Utilizing nationally representative survey data, the authors provide estimates for health care expenditures related to secondary conditions, obesity, and health behaviors among working-age people with disabilities.…

75 FR 21314 - Medicaid Program; Final FY 2008, Revised Preliminary FY 2009, and Preliminary FY 2010...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-23

... Federal share) IMD and other mental health facility DSH expenditures applicable to the State's FY 1995 DSH... State's total computable DSH expenditures attributable to the FY 1995 DSH allotment for mental health... DSH expenditures (mental health facility plus inpatient hospital) applicable to the FY 1995 DSH...

42 CFR 52d.7 - Expenditure of grant funds.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Expenditure of grant funds. 52d.7 Section 52d.7 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS NATIONAL CANCER INSTITUTE CLINICAL CANCER EDUCATION PROGRAM § 52d.7 Expenditure of grant funds. (a) Any funds granted...

42 CFR 52d.7 - Expenditure of grant funds.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Expenditure of grant funds. 52d.7 Section 52d.7 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS NATIONAL CANCER INSTITUTE CLINICAL CANCER EDUCATION PROGRAM § 52d.7 Expenditure of grant funds. (a) Any funds granted...

42 CFR 52d.7 - Expenditure of grant funds.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Expenditure of grant funds. 52d.7 Section 52d.7 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS NATIONAL CANCER INSTITUTE CLINICAL CANCER EDUCATION PROGRAM § 52d.7 Expenditure of grant funds. (a) Any funds granted...

42 CFR 52d.7 - Expenditure of grant funds.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Expenditure of grant funds. 52d.7 Section 52d.7 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS NATIONAL CANCER INSTITUTE CLINICAL CANCER EDUCATION PROGRAM § 52d.7 Expenditure of grant funds. (a) Any funds granted...

42 CFR 52d.7 - Expenditure of grant funds.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Expenditure of grant funds. 52d.7 Section 52d.7 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS NATIONAL CANCER INSTITUTE CLINICAL CANCER EDUCATION PROGRAM § 52d.7 Expenditure of grant funds. (a) Any funds granted...

Estimating risk reduction required to break even in a health promotion program.

PubMed

Ozminkowski, Ronald J; Goetzel, Ron Z; Santoro, Jan; Saenz, Betty-Jo; Eley, Christine; Gorsky, Bob

2004-01-01

To illustrate a formula to estimate the amount of risk reduction required to break even on a corporate health promotion program. A case study design was implemented. Base year (2001) health risk and medical expenditure data from the company, along with published information on the relationships between employee demographics, health risks, and medical expenditures, were used to forecast demographics, risks, and expenditures for 2002 through 2011 and estimate the required amount of risk reduction. Motorola. 52,124 domestic employees. Demographics included age, gender, race, and job type. Health risks for 2001 were measured via health risk appraisal. Risks were noted as either high or low and related to exercise/eating habits, body weight, blood pressure, blood sugar levels, cholesterol levels, depression, stress, smoking/drinking habits, and seat belt use. Medical claims for 2001 were used to calculate medical expenditures per employee. Assuming a dollar 282 per employee program cost, Motorola employees would need to reduce their lifestyle-related health risks by 1.08% to 1.42% per year to break even on health promotion programming, depending upon the discount rate. Higher or lower program investments would change the risk reduction percentages. Employers can use information from published studies, along with their own data, to estimate the amount of risk reduction required to break even on their health promotion programs.

Energy Expenditure in Obese Children with Pseudohypoparathyroidism Type 1a

PubMed Central

Shoemaker, Ashley H.; Lomenick, Jefferson P.; Saville, Benjamin R.; Wang, Wenli; Buchowski, Maciej S.; Cone, Roger D.

2012-01-01

Context Patients with pseudohypoparathyroidism type 1a (PHP-1a) develop early-onset obesity. The abnormality in energy expenditure and/or energy intake responsible for this weight gain is unknown. Objective The aim of this study was to evaluate energy expenditure in children with PHP-1a compared with obese controls. Patients We studied 6 obese females with PHP-1a and 17 obese female controls. Patients were recruited from a single academic center. Measurements Resting energy expenditure and thermogenic effect of a high fat meal were measured using whole room indirect calorimetry. Body composition was assessed using whole body dual energy x-ray absorptiometry. Fasting glucose, insulin and hemoglobin A1C were measured. Results Children with PHP-1a had decreased resting energy expenditure compared with obese controls (P <0.01). After adjustment for fat free mass, the PHP-1a group’s resting energy expenditure was 346.4 kcals/day less than obese controls (95% CI [−585.5 to −106.9], P <0.01). The thermogenic effect of food, expressed as percent increase in postprandial energy expenditure over resting energy expenditure, was lower in PHP-1a patients than obese controls but did not reach statistical significance (absolute reduction of 5.9%, 95% CI [−12.2% to 0.3%], P = 0.06). Conclusions Our data indicate that children with PHP-1a have decreased resting energy expenditure compared with obese controls and that may contribute to the development of obesity in these children. These patients may also have abnormal diet-induced thermogenesis in response to a high fat meal. Understanding the causes of obesity in PHP-1a may allow for targeted nutritional or pharmacologic treatments in the future. PMID:23229731

Motivating effects of cooperative exergame play for overweight and obese adolescents.

PubMed

Staiano, Amanda E; Abraham, Anisha A; Calvert, Sandra L

2012-07-01

Exergames (i.e., video games that require gross motor activity) may provide intrinsically motivating experiences that engage youth in sustained physical activity. Thirty-one low-income 15- to 19-year-old overweight and obese African American adolescents were randomly assigned to a competitive exergame (n = 17) or a cooperative exergame (n = 14) condition. Participants played a preassigned Wii Active exergame routine that took between 30 and 60 min each school day, and sessions occurred during lunch time or an after-school program over a 6 month period. Participation was voluntary, so students decided whether to come or not on a given day. Cooperative exergame players worked together with a peer to expend calories and earn points, while competitive exergame players competed individually against a peer to expend calories and earn points. Motivation was measured through surveys and interviews at the end of the intervention, and energy expenditure was measured by accelerometry during game play. Compared with the competitive group, the cooperative players were significantly more intrinsically motivated to play (p = .034, partial eta-squared = 0.366) and more psychologically attracted to the design of the exergame (p = .034, partial eta-squared = 0.320). Intrinsic motivation was significantly positively correlated with energy expenditure during game play: individuals who were motivated by control/choice had higher energy expenditure (p = .026), and those who were more goal motivated (p = .004) and more immersed in game play (p = .024) had lower energy expenditure during game play. Cooperative exergame play produced higher intrinsic motivation to play the exergame than competitive exergame play did. Intrinsic motivation that came from a desire for control/choice was related to higher energy expenditure during game play. Cooperative exergame play holds promise as a method for engaging overweight and obese youth in physical activity. © 2012 Diabetes Technology Society.

Motivating Effects of Cooperative Exergame Play for Overweight and Obese Adolescents

PubMed Central

Staiano, Amanda E.; Abraham, Anisha A.; Calvert, Sandra L.

2012-01-01

Background Exergames (i.e., video games that require gross motor activity) may provide intrinsically motivating experiences that engage youth in sustained physical activity. Method Thirty-one low-income 15- to 19-year-old overweight and obese African American adolescents were randomly assigned to a competitive exergame (n = 17) or a cooperative exergame (n = 14) condition. Participants played a preassigned Wii Active exergame routine that took between 30 and 60 min each school day, and sessions occurred during lunch time or an after-school program over a 6 month period. Participation was voluntary, so students decided whether to come or not on a given day. Cooperative exergame players worked together with a peer to expend calories and earn points, while competitive exergame players competed individually against a peer to expend calories and earn points. Motivation was measured through surveys and interviews at the end of the intervention, and energy expenditure was measured by accelerometry during game play. Results Compared with the competitive group, the cooperative players were significantly more intrinsically motivated to play (p = .034, partial eta-squared = 0.366) and more psychologically attracted to the design of the exergame (p = .034, partial eta-squared = 0.320). Intrinsic motivation was significantly positively correlated with energy expenditure during game play: individuals who were motivated by control/choice had higher energy expenditure (p = .026), and those who were more goal motivated (p = .004) and more immersed in game play (p = .024) had lower energy expenditure during game play. Conclusions Cooperative exergame play produced higher intrinsic motivation to play the exergame than competitive exergame play did. Intrinsic motivation that came from a desire for control/choice was related to higher energy expenditure during game play. Cooperative exergame play holds promise as a method for engaging overweight and obese youth in physical activity. PMID:22920807

Animal health surveillance: navigation amidst the flotsam of human frailty and fiscal inertia.

PubMed

Kellar, J A

2012-07-01

National veterinary services monitor endemic, emerging and exotic disease situations. They intervene when epidemic tendencies demand. They unravel complex disease situations. They do so as monopolies, in environments of political influence and budgetary restraint. When human, animal health and trade protection dictate, they design import or domestic disease control programs. As much as 80% of program expenditures are on surveillance. Their initiatives are scrutinized by treasuries from which they seek funding, industries from which they seek collaboration and trading partners from whom they seek recognition. In democracies, surveillance and control programs are often the products of a complicated consultative process. It involves individuals who have both a commitment to improving an existing animal health situation and access to the required resources. The generations that designed traditionally risk-averse national surveillance and control programs have given way to a new one which is more epidemiologically informed. Their successors design programs bearing epidemiologically based improvements. The transition, however, has not been overwhelmingly welcomed. Expenditures on surveillance are tolerated out of fear during outbreaks of foreign or re-emergence of indigenous disease. Between epidemics, they decline at the hands of producers' unwillingness and budgetary restraint. Human nature responds to the high cost of surveillance in forms ranging from naïveté through to conspiracy. While legislation cannot subdue such human frailty, several other opportunities exist. Education can remove the majority of problems caused by ignorance, leaving the minority that arise intentionally. Technology decreases the high cost of testing which tempts individuals to cut corners. International standards assist National Veterinary Services to overcome domestic resistance. Copyright © 2012 Elsevier B.V. All rights reserved.

Effective policy initiatives to constrain lipid-lowering drug expenditure growth in South Korea

PubMed Central

2014-01-01

Background The rapid growth of prescription drug expenditures is a major problem in South Korea. Accordingly, the South Korean government introduced a positive listing system in 2006. They also adopted various price reduction policies. Nevertheless, the total expenditure for lipid-lowering drugs have steadily increased throughout South Korea. The present study explores the factors that have influenced the increased expenditures of lipid-lowering drugs with a particular focus on the effects of statins in this process. Methods This paper investigates the National Health Insurance claims data for prescribed lipid-lowering drugs collected between January 1, 2005 and December 31, 2009. We specifically focused on statins and assessed the yearly variation of statin expenditure by calculating the increased rate of paired pharmaceutical expenditures over a 2 year period. Our study classified statins into three categories: new entrants, core medicines and exiting medicines. For core medicines, we further examined influencing factors such as price, amount of drugs consumed by volume, and prescription changes (substitutes for other drug). Results Statin expenditure showed an average annual increase of 25.7% between 2005 and 2009. Among the different statins, the expenditure of atorvastatin showed a 36.6% annual increase rate, which was the most dramatic among all statins. Also we divided expenditure for core medicines by the price factor, volume factor, and prescription change. The result showed that annual weighted average prices of individual drug decreased each year, which clearly showed that price influenced statin expenditure in a negative direction. The use of generic drugs containing the same active ingredient as name-brand drugs increased and negatively affected statin expenditure (Generic Mix effect). However, the use of relatively expensive ingredients within statin increase, Ingredient Mix effect contributed to increased statin expenditure (Ingredient Mix effect). In particular, the volume effect was found to be critical for increasing statin expenditure as the amount of statin consumed increased steadily throughout the study period. Conclusions The recent rapid increase in statin expenditure can largely be attributed to an increase in consumption volume. In order to check drug expenditures effectively in our current situation, in which chronic diseases remain steadily on the rise, it is necessary to not only have supply-side initiatives such as price reduction, but also demand-side initiatives that could control drug consumption volume, for example: educational programs for rational prescription, generic drug promotional policies, and policies providing prescription targets. PMID:24589172

Water-induced thermogenesis reconsidered: the effects of osmolality and water temperature on energy expenditure after drinking.

PubMed

Brown, Clive M; Dulloo, Abdul G; Montani, Jean-Pierre

2006-09-01

A recent study reported that drinking 500 ml of water causes a 30% increase in metabolic rate. If verified, this previously unrecognized thermogenic property of water would have important implications for weight-loss programs. However, the concept of a thermogenic effect of water is controversial because other studies have found that water drinking does not increase energy expenditure. The objective of the study was to test whether water drinking has a thermogenic effect in humans and, furthermore, determine whether the response is influenced by osmolality or by water temperature. This was a randomized, crossover design. The study was conducted at a university physiology laboratory. Participants included healthy young volunteer subjects. Intervention included drinking 7.5 ml/kg body weight (approximately 518 ml) of distilled water or 0.9% saline or 7% sucrose solution (positive control) on different days. In a subgroup of subjects, responses to cold water (3 C) were tested. Resting energy expenditure, assessed by indirect calorimetry for 30 min before and 90 min after the drinks, was measured. Energy expenditure did not increase after drinking either distilled water (P = 0.34) or 0.9% saline (P = 0.33). Drinking the 7% sucrose solution significantly increased energy expenditure (P < 0.0001). Drinking water that had been cooled to 3 C caused a small increase in energy expenditure of 4.5% over 60 min (P < 0.01). Drinking distilled water at room temperature did not increase energy expenditure. Cooling the water before drinking only stimulated a small thermogenic response, well below the theoretical energy cost of warming the water to body temperature. These results cast doubt on water as a thermogenic agent for the management of obesity.

Public Health System-Delivered Mental Health Preventive Care Links to Significant Reduction of Health Care Costs.

PubMed

Chen, Jie; Novak, Priscilla; Goldman, Howard

2018-04-23

The objective was to estimate the association between health care expenditures and implementation of preventive mental health programs by local health departments (LHDs). Multilevel nationally representative data sets were linked to test the hypothesis that LHDs' provision of preventive mental health programs was associated with cost savings. A generalized linear model with log link and gamma distribution and state-fixed effects was used to estimate the association between LHDs' mental illness prevention services and total health care expenditures per person per year for adults aged 18 years and older. The main outcome measure was the annual total health care expenditure per person. The findings indicated that LHD provision of population-based prevention of mental illness was associated with an $824 reduction (95% confidence interval: -$1,562.94 to -$85.42, P < 0.05) in annual health care costs per person, after controlling for individual, LHD, community, and state characteristics. LHDs can play a critical role in establishing an integrated health care model. Their impact, however, has often been underestimated or neglected. Results showed that a small investment in LHDs may yield substantial cost savings at the societal level. The findings of this research are critical to inform policy decisions for the expansion of the Public Health 3.0 infrastructure.

Energy expenditure: a critical determinant of energy balance with key hypothalamic controls.

PubMed

Richard, D

2007-09-01

Energy stores are regulated through complex neural controls exerted on both food intake and energy expenditure. These controls are insured by interconnected neurons that produce different peptides or classic neurotransmitters, which have been regrouped into anabolic' and catabolic' systems. While the control of energy intake has been addressed in numerous investigations, that of energy expenditure has, as yet, only received a moderate interest, even though energy expenditure represents a key determinant of energy balance. In laboratory rodents, in particular, a strong regulatory control is exerted on brown adipose tissue (BAT), which represent an efficient thermogenic effector. BAT thermogenesis is governed by the sympathetic nervous system (SNS), whose activity is controlled by neurons comprised in various brain regions, which include the paraventricular hypothalamic nucleus (PVH), the arcuate nucleus (ARC) and the lateral hypothalamus (LH). Proopiomelanocortin neurons from the ARC project to the PVH and terminate in the vicinity of the melanocortin-4 receptors, which are concentrated in the descending division of the PVH, which comprise neurons controlling the SNS outflow to BAT. The LH contains neurons producing melanin-concentrating hormone or orexins, which also are important peptides in the control of energy expenditure. These neurons are not only polysynaptically connected to BAT, but also linked to brains regions controlling motivated behaviors and locomotor activity and, consequently, their role in the control of energy expenditure could go beyond BAT thermogenesis.

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges.

PubMed

Phillips, Charles D

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

PubMed Central

Phillips, Charles D.

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744

Health financing for the poor produces promising short-term effects on utilization and out-of-pocket expenditure: evidence from Vietnam

PubMed Central

Axelson, Henrik; Bales, Sarah; Minh, Pham Duc; Ekman, Björn; Gerdtham, Ulf-G

2009-01-01

Background Vietnam introduced the Health Care Fund for the Poor in 2002 to increase access to health care and reduce the financial burden of health expenditure faced by the poor and ethnic minorities. It is often argued that effects of financing reforms take a long time to materialize. This study evaluates the short-term impact of the program to determine if pro-poor financing programs can achieve immediate effects on health care utilization and out-of-pocket expenditure. Method Considering that the program is a non-random policy initiative rolled out nationally, we apply propensity score matching with both single differences and double differences to data from the Vietnam Household Living Standards Surveys 2002 (pre-program data) and 2004 (first post-program data). Results We find a small, positive impact on overall health care utilization. We find evidence of two substitution effects: from private to public providers and from primary to secondary and tertiary level care. Finally, we find a strong negative impact on out-of-pocket health expenditure. Conclusion The results indicate that the Health Care Fund for the Poor is meeting its objectives of increasing utilization and reducing out-of-pocket expenditure for the program's target population, despite numerous administrative problems resulting in delayed and only partial implementation in most provinces. The main lessons for low and middle-income countries from Vietnam's early experiences with the Health Care Fund for the Poor are that it managed to achieve positive outcomes in a short time-period, the need to ensure adequate and sustained funding for targeted programs, including marginal administrative costs, develop effective targeting mechanisms and systems for informing beneficiaries and providers about the program, respond to the increased demand for health care generated by the program, address indirect costs of health care utilization, and establish and maintain routine and systematic monitoring and evaluation mechanisms. PMID:19473518

Oregon's Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures.

PubMed

McConnell, K John; Renfro, Stephanie; Lindrooth, Richard C; Cohen, Deborah J; Wallace, Neal T; Chernew, Michael E

2017-03-01

In 2012 Oregon initiated an ambitious delivery system reform, moving the majority of its Medicaid enrollees into sixteen coordinated care organizations, a type of Medicaid accountable care organization. Using claims data, we assessed measures of access, appropriateness of care, utilization, and expenditures for five service areas (evaluation and management, imaging, procedures, tests, and inpatient facility care), comparing Oregon to the neighboring state of Washington. Overall, the transformation into coordinated care organizations was associated with a 7 percent relative reduction in expenditures across the sum of these services, attributable primarily to reductions in inpatient utilization. The change to coordinated care organizations also demonstrated reductions in avoidable emergency department visits and improvements in some measures of appropriateness of care, but also exhibited reductions in primary care visits, a potential area of concern. Oregon's coordinated care organizations could provide lessons for controlling health care spending for other state Medicaid programs. Project HOPE—The People-to-People Health Foundation, Inc.

7 CFR 1484.54 - What expenditures may FAS reimburse under the Cooperator program?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 10 2014-01-01 2014-01-01 false What expenditures may FAS reimburse under the... may FAS reimburse under the Cooperator program? (a) A Cooperator may seek reimbursement for an... source. (b) Subject to paragraph (a) of this section, FAS will reimburse, in whole or in part, the cost...

7 CFR 1484.54 - What expenditures may FAS reimburse under the Cooperator program?

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 10 2012-01-01 2012-01-01 false What expenditures may FAS reimburse under the... may FAS reimburse under the Cooperator program? (a) A Cooperator may seek reimbursement for an... source. (b) Subject to paragraph (a) of this section, FAS will reimburse, in whole or in part, the cost...

7 CFR 1484.54 - What expenditures may FAS reimburse under the Cooperator program?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 10 2013-01-01 2013-01-01 false What expenditures may FAS reimburse under the... may FAS reimburse under the Cooperator program? (a) A Cooperator may seek reimbursement for an... source. (b) Subject to paragraph (a) of this section, FAS will reimburse, in whole or in part, the cost...

Effects of Medicaid disease management programs on medical expenditures: Evidence from a natural experiment in Georgia.

PubMed

Kranker, Keith

2016-03-01

In recent decades, most states' Medicaid programs have introduced disease management programs for chronically ill beneficiaries. Interventions assist beneficiaries and their health care providers to appropriately manage chronic health condition(s) according to established clinical guidelines. Cost containment has been a key justification for the creation of these programs despite mixed evidence they actually save money. This study evaluates the effects of a disease management program in Georgia by exploiting a natural experiment that delayed the introduction of high-intensity services for several thousand beneficiaries. Expenditures for medical claims decreased an average of $89 per person per month for the high- and moderate-risk groups, but those savings were not large enough to offset the total costs of the program. Impacts varied by the intensity of interventions, over time, and across disease groups. Heterogeneous treatment effect analysis indicates that decreases in medical expenditures were largest at the most expensive tail of the distribution. Copyright © 2016 Elsevier B.V. All rights reserved.

76 FR 148 - Medicaid Program; Final FY 2009 and Preliminary FY 2011 Disproportionate Share Hospital...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-03

... Federal share) IMD and other mental health facility DSH expenditures applicable to the State's FY 1995 DSH... State's total computable DSH expenditures attributable to the FY 1995 DSH allotment for mental health... health DSH expenditures applicable to the State's FY 1995 DSH allotment by the total computable amount of...

42 CFR 52c.6 - Expenditure of grant funds.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Expenditure of grant funds. 52c.6 Section 52c.6 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS MINORITY BIOMEDICAL RESEARCH SUPPORT PROGRAM § 52c.6 Expenditure of grant funds. (a) Any funds granted pursuant to this part...

42 CFR 52c.6 - Expenditure of grant funds.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Expenditure of grant funds. 52c.6 Section 52c.6 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS MINORITY BIOMEDICAL RESEARCH SUPPORT PROGRAM § 52c.6 Expenditure of grant funds. (a) Any funds granted pursuant to this part...

42 CFR 52c.6 - Expenditure of grant funds.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Expenditure of grant funds. 52c.6 Section 52c.6 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS MINORITY BIOMEDICAL RESEARCH SUPPORT PROGRAM § 52c.6 Expenditure of grant funds. (a) Any funds granted pursuant to this part...

42 CFR 52c.6 - Expenditure of grant funds.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Expenditure of grant funds. 52c.6 Section 52c.6 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS MINORITY BIOMEDICAL RESEARCH SUPPORT PROGRAM § 52c.6 Expenditure of grant funds. (a) Any funds granted pursuant to this part...

42 CFR 52c.6 - Expenditure of grant funds.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Expenditure of grant funds. 52c.6 Section 52c.6 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GRANTS MINORITY BIOMEDICAL RESEARCH SUPPORT PROGRAM § 52c.6 Expenditure of grant funds. (a) Any funds granted pursuant to this part...

The relationship of post-acute home care use to Medicaid utilization and expenditures.

PubMed

Payne, Susan M C; DiGiuseppe, David L; Tilahun, Negussie

2002-06-01

To describe the use of post-acute home care (PAHC) and total Medicaid expenditures among hospitalized nonelderly adult Medicaid eligibles and to test whether health services utilization rates or total Medicaid expenditures were lower among Medicaid eligibles who used PAHC compared to those who did not. 5,299 Medicaid patients aged 18-64 discharged in 1992-1996 from 29 hospitals in the Cleveland Health Quality Choice (CHQC) project. Linked Ohio Medicaid claims and CHQC medical record abstract data. One stay per patient was randomly selected. Observational study. To control for treatment selection bias, we developed a model predicting the probability (propensity) a patient would be referred to PAHC, as a proxy for the patient's need for PAHC. We matched 430 patients who used Medicaid-covered PAHC ("USE") to patients who did not ("NO USE") by their propensity scores. Study outcomes were inpatient re-admission rates and days of stay (DOS), nursing home admission rates and DOS, and mean total Medicaid expenditures 90 and 180 days after discharge. Of 3,788 medical patients, 12.1 percent were referred to PAHC; 64 percent of those referred used PAHC. Of 1,511 surgical patients, 10.9 percent were referred; 99 percent of those referred used PAHC. In 430 pairs of patients matched by propensity score, mean total Medicaid expenditures within 90 days after discharge were $7,649 in the USE group and $5,761 in the NO USE group. Total Medicaid expenditures were significantly higher in the USE group compared to the NO USE group for medical patients after 180 days (p < .05) and surgical patients after 90 and 180 days (p < .001). There were no significant differences for any other outcome. Sensitivity analysis indicates the results may be influenced by unmeasured variables, most likely functional status and/or care-giver support. Thirty-six percent of the medical patients referred to PAHC did not receive Medicaid-covered services. This suggests potential underuse among medical patients. The high post-discharge expenditures suggest opportunities for reducing costs through coordinating utilization or diverting it to lower-cost settings. Controlling for patients' need for services, PAHC utilization was not associated with lower utilization rates or lower total Medicaid expenditures. Medicaid programs are advised to proceed cautiously before expanding PAHC utilization and to monitor its use carefully. Further study, incorporating non-economic outcomes and additional factors influencing PAHC use, is warranted.

7 CFR 1486.404 - What expenditures are not eligible for program funding?

Code of Federal Regulations, 2010 CFR

2010-01-01

...) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS EMERGING..., unreasonable expenditures, or any cost of: (1) Branded product promotions—in-store, restaurant advertising...

Intergenerational enrollment and expenditure changes in Medicaid: trends from 1991 to 2005

PubMed Central

2012-01-01

Background From its inception, Medicaid was aimed at providing insurance coverage for low income children, elderly, and disabled. Since this time, children have become a smaller proportion of the US population and Medicaid has expanded to additional eligibility groups. We sought to evaluate relative growth in spending in the Medicaid program between children and adults from 1991-2005. We hypothesize that this shifting demographic will result in fewer resources being allocated to children in the Medicaid program. Methods We utilized retrospective enrollment and expenditure data for children, adults and the elderly from 1991 to 2005 for both Medicaid and Children’s Health Insurance Program Medicaid expansion programs. Data were obtained from the Centers for Medicare and Medicaid Services using their Medicaid Statistical Information System. Results From 1991 to 2005, the number of enrollees increased by 83% to 58.7 million. This includes increases of 33% for children, 100% for adults and 50% for the elderly. Concurrently, total expenditures nationwide rose 150% to $273 billion. Expenditures for children increased from $23.4 to $65.7 billion, adults from $46.2 to $123.6 billion, and elderly from $39.2 to $71.3 billion. From 1999 to 2005, Medicaid spending on long-term care increased by 31% to $84.3 billion. Expenditures on the disabled grew by 61% to $119 billion. In total, the disabled account for 43% and long-term care 31%, of the total Medicaid budget. Conclusion Our study did not find an absolute decrease in the overall resources being directed toward children. However, increased spending on adults on a per-capita and absolute basis, particularly disabled adults, is responsible for much of the growth in spending over the past 15 years. Medicaid expenditures have grown faster than inflation and overall national health expenditures. A national strategy is needed to ensure adequate coverage for Medicaid recipients while dealing with the ongoing constraints of state and federal budgets. PMID:22992389

Long-term Effects of Two Levels of Caloric Restriction on Body Composition, and Diet Satisfaction in CALERIE, a One Year Randomized Controlled Trial

USDA-ARS?s Scientific Manuscript database

There is little information on whether the extent of dietary energy restriction in a weight loss program influences long-term weight change. We examined the effects of two levels of caloric restriction (CR) over 12 months on body weight and fat loss, total energy expenditure (TEE), resting metabolic...

Improving nutrition in home child care: are food costs a barrier?

PubMed Central

Monsivais, Pablo; Johnson, Donna B

2015-01-01

Objective Child-care providers have a key role to play in promoting child nutrition, but the higher cost of nutritious foods may pose a barrier. The present study tested the hypothesis that higher nutritional quality of foods served was associated with higher food expenditures in child care homes participating in the Child and Adult Care Food Program (CACFP). Design In this cross-sectional study, nutritional quality of foods served to children and food expenditures were analysed based on 5 d menus and food shopping receipts. Nutritional quality was based on servings of whole grains, fresh whole fruits and vegetables, energy density (kJ/g) and mean nutrient adequacy (mean percentage of dietary reference intake) for seven nutrients of concern for child health. Food expenditures were calculated by linking receipt and menu data. Associations between food expenditures and menu quality were examined using bivariate statistics and multiple linear regression models. Setting USA in 2008–2009. Subjects Sixty child-care providers participating in CACFP in King County, Washington State. Results In bivariate analyses, higher daily food expenditures were associated with higher total food energy and higher nutritional quality of menus. Controlling for energy and other covariates, higher food expenditures were strongly and positively associated with number of portions of whole grains and fresh produce served (P = 0·001 and 0·005, respectively), with lower energy density and with higher mean nutrient adequacy of menus overall (P = 0·003 and 0·032, respectively). Conclusions The results indicate that improving the nutritional quality of foods in child care may require higher food spending. PMID:22014448

Health care costs and financing in world perspective.

PubMed Central

Roemer, M. I.

1991-01-01

Expenditures for health services, as a percentage of national wealth (gross national product, or GNP), have been rising throughout the world. Data to quantify this trend are available for many industrialized countries. The share of health spending derived from governmental sources has also been increasing. Mandatory or social insurance has developed to support health services in 70 nations. While widely used for paying doctors on a fee basis or by capitation, in Latin America doctors are organized in polyclinics and paid by salaries. General revenues are used to support Ministry of Health programs. Among health expenditures, the largest share goes to hospitalization. Cost sharing by patients is widely used to control rising costs. World trends have promoted equity in health care delivery. PMID:1814057

Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care

PubMed Central

Jones, Craig; Finison, Karl; McGraves-Lloyd, Katharine; Tremblay, Timothy; Tanzman, Beth; Hazard, Miki; Maier, Steven; Samuelson, Jenney

2016-01-01

Abstract Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by −$482 relative to the comparison (95% CI, −$573 to −$391; P < .001). The lower costs were driven primarily by inpatient (−$218; P < .001) and outpatient hospital expenditures (−$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196–205) PMID:26348492

Allowing Spouses to Be Paid Personal Care Providers: Spouse Availability and Effects on Medicaid-Funded Service Use and Expenditures

ERIC Educational Resources Information Center

Newcomer, Robert J.; Kang, Taewoon; Doty, Pamela

2012-01-01

Purpose of the Study: Medicaid service use and expenditure and quality of care outcomes in California's personal care program known as In-Home Supportive Service (IHSS) are described. Analyses investigated Medicaid expenditures, hospital use, and nursing home stays, comparing recipients who have paid spouse caregivers with those having other…

Evaluating agricultural nonpoint-source pollution programs in two Lake Erie tributaries.

PubMed

Forster, D Lynn; Rausch, Jonathan N

2002-01-01

During the past three decades, numerous government programs have encouraged Lake Erie basin farmers to adopt practices that reduce water pollution. The first section of this paper summarizes these state and federal government agricultural pollution abatement programs in watersheds of two prominent Lake Erie tributaries, the Maumee River and Sandusky River. Expenditures are summarized for each program, total expenditures in each county are estimated, and cost effectiveness of program expenditures (i.e., cost per metric ton of soil saved) are analyzed. Farmers received nearly $143 million as incentive payments to implement agricultural nonpoint source pollution abatement programs in the Maumee and Sandusky River watersheds from 1987 to 1997. About 95% of these funds was from federal sources. On average, these payments totaled about $7000 per farm or about $30 per farm acre (annualized equivalent of $2 per acre) within the watersheds. Our analysis raises questions about how efficiently these incentive payments were allocated. The majority of Agricultural Conservation Program (ACP) funds appear to have been spent on less cost-effective practices. Also, geographic areas with relatively low (high) soil erosion rates received relatively large (small) funding.

34 CFR 606.4 - What are low educational and general expenditures?

Code of Federal Regulations, 2011 CFR

2011-07-01

...) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION DEVELOPING HISPANIC-SERVING INSTITUTIONS PROGRAM General § 606.4 What are low educational and general expenditures? (a)(1) Except as provided in...

34 CFR 606.4 - What are low educational and general expenditures?

Code of Federal Regulations, 2010 CFR

2010-07-01

...) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION DEVELOPING HISPANIC-SERVING INSTITUTIONS PROGRAM General § 606.4 What are low educational and general expenditures? (a)(1) Except as provided in...

Measuring Disparities across the Distribution of Mental Health Care Expenditures

PubMed Central

Cook, Benjamin Lê; Manning, Willard; Alegría, Margarita

2013-01-01

Background Previous mental health care disparities studies predominantly compare mean mental health care use across racial/ethnic groups, leaving policymakers with little information on disparities among those with a higher level of expenditures. Aims of the Study To identify racial/ethnic disparities among individuals at varying quantiles of mental health care expenditures. To assess whether disparities in the upper quantiles of expenditure differ by insurance status, income and education. Methods Data were analyzed from a nationally representative sample of white, black and Latino adults 18 years and older (n=83,878). Our dependent variable was total mental health care expenditure. We measured disparities in any mental health care expenditures, disparities in mental health care expenditure at the 95th, 97.5th, and 99th expenditure quantiles of the full population using quantile regression, and at the 50th, 75th, and 95th quantiles for positive users. In the full population, we tested interaction coefficients between race/ethnicity and income, insurance, and education levels to determine whether racial/ethnic disparities in the upper quantiles differed by income, insurance and education. Results Significant Black-white and Latino-white disparities were identified in any mental health care expenditures. In the full population, moving up the quantiles of mental health care expenditures, Black-White and Latino-White disparities were reduced but remained statistically significant. No statistically significant disparities were found in analyses of positive users only. The magnitude of black-white disparities was smaller among those enrolled in public insurance programs compared to the privately insured and uninsured in the 97.5th and 99th quantiles. Disparities persist in the upper quantiles among those in higher income categories and after excluding psychiatric inpatient and emergency department (ED) visits. Discussion Disparities exist in any mental health care and among those that use the most mental health care resources, but much of disparities seem to be driven by lack of access. The data do not allow us to disentangle whether disparities were related to white respondent’s overuse or underuse as compared to minority groups. The cross-sectional data allow us to make only associational claims about the role of insurance, income, and education in disparities. With these limitations in mind, we identified a persistence of disparities in overall expenditures even among those in the highest income categories, after controlling for mental health status and observable sociodemographic characteristics. Implications for Health Care Provision and Use Interventions are needed to equalize resource allocation to racial/ethnic minority patients regardless of their income, with emphasis on outreach interventions to address the disparities in access that are responsible for the no/low expenditures for even Latinos at higher levels of illness severity. Implications for Health Policies Increased policy efforts are needed to reduce the gap in health insurance for Latinos and improve outreach programs to enroll those in need into mental health care services. Implications for Further Research Future studies that conclusively disentangle overuse and appropriate use in these populations are warranted. PMID:23676411

National Health Expenditures, 1993

PubMed Central

Levit, Katharine R.; Sensenig, Arthur L.; Cowan, Cathy A.; Lazenby, Helen C.; McDonnell, Patricia A.; Won, Darleen K.; Sivarajan, Lekha; Stiller, Jean M.; Donham, Carolyn S.; Stewart, Madie S.

1994-01-01

This article presents data on health care spending for the United States, covering expenditures for various types of medical services and products and their sources of funding from 1960 to 1993. Although these statistics show a slowing in the growth of health care expenditures over the past few years, spending continues to increase faster than the overall economy. The share of the Nation's health care bill funded by the Federal Government through the Medicaid and Medicare programs steadily increased from 1991 to 1993. This significant change in the share of health expenditures funded by the public sector has caused Federal health expenditures as a share of all Federal spending to increase dramatically. PMID:10140156

Using an ounce of prevention: does it reduce health care expenditures and reap pounds of profits? A study of the financial impact of wellness and health risk screening programs.

PubMed

Phillips, Janet F

2009-01-01

As we are all well aware, health care expenditures in the United States are out of control and growing at epic proportions. Since private industry shoulders a significant burden of paying these rising health care costs, the huge and ever increasing sum paid by these corporations continues to impact the US economy translating into higher prices of services and manufactured goods and reduced job opportunities when companies outsource jobs or locate manufacturing facilities to avoid paying health care benefits for workers. As a result, health care expenditures have become a centerpiece of an enormous public policy debate as Congress is currently working on several versions of a bill to completely revise health care from the ground up. This research project was accomplished to examine the effectiveness of one approach to control rising health care costs and contain corporate financial responsibility--the establishment of wellness and health risk screening programs to improve the health of employees. Total health care cost per insured individual was gathered through an online survey directly from health care benefit administrators. The survey also asked information about wellness and health risk screening programs and the related responses were used to determine if there were a relationship between health care costs and health prevention programs. While statistical analysis was hampered in the current study because of the small sample size, some valid conclusions were reached. The study was successful in identifying a benchmark of Average Total Health Care Cost per Individual from $5,100 to $5,800 for 2005 through 2007. This is especially interesting in light of the fact that an average of $7,026 was spent on health care per person in 2006 in the United States. The study was also able to contribute an estimate of the increase realized in these expenditures of 6 percent in 2007 over 2006, and 4 percent in 2006 over 2005, which were in fact similar to the national average. The final contribution of the study is to suggest an explanation for the costs which appear to be holding their own in terms of the national average. While this cannot be statistically verified, it does seem that the active participation of these companies in wellness programs could be a factor. Wellness programs were very popular in this sample of companies as 82 percent of the respondents answered "YES" when asked if the company funds their own employee wellness program. This is an impressive number of companies that have recognized wellness programs as a potential means to reduce employee health care costs. In regards to specific programs, at least 50 percent of respondents answered that they have smoking cessation, employee fitness, counseling, health risk screening, and bio-metric screening programs. The existence of health screening variables show an impressive 73 percent of respondents do practice some sort of health care screening, 50 percent offer biometric screening while 18 percent have onsite clinics and 23 percent run annual employee fairs.

Exceptional circumstance drug dispensing: history and expenditures of the Brazilian Ministry of Health.

PubMed

Carias, Claudia Mezleveckas; Vieira, Fabíola Sulpino; Giordano, Carlos V; Zucchi, Paola

2011-04-01

To describe the technical aspects of the Exceptional Circumstance Drug Dispensing Program of the Brazilian Ministry of Health, especially with respect to the cost of dispensed medication. Technical information was obtained from the ordinances that regulate the Program. Expenditure from 2000 to 2007 was obtained from the Sistema Único de Saúde's (Unified Healthcare System) Outpatient Information System. All drugs dispensed between 1993 and 2009 and the amount and cost of each procedure were evaluated, based on information from the high-complexity procedure authorization of each of the country's states. The Program changed with the increase in the number of pharmacological agents and presentations distributed by, and the number of diseases contemplated in the program. In 1993, the program distributed 15 pharmacological agents in 31 distinct presentations. This number increased to 109 agents in 243 presentations in 2009. Total Ministry of Health expenditure with medications was R$1,410,181,600.74 in 2007, almost twice the amount spent in 2000, R$684,975,404.43. Diseases whose expenditure increased in the period included chronic renal insufficiency, transplantation, and hepatitis C. The Exceptional Circumstance Drug Dispensing Program is in constant transformation, aimed at building instruments and strategies that can ensure and expand access to medication among the population. Alternatives should be sought to decrease the financial impact of the Program to a level that does not impact other sectors of the health care system, given the high cost associated with novel interventions.

Modeling regulated water utility investment incentives

NASA Astrophysics Data System (ADS)

Padula, S.; Harou, J. J.

2014-12-01

This work attempts to model the infrastructure investment choices of privatized water utilities subject to rate of return and price cap regulation. The goal is to understand how regulation influences water companies' investment decisions such as their desire to engage in transfers with neighbouring companies. We formulate a profit maximization capacity expansion model that finds the schedule of new supply, demand management and transfer schemes that maintain the annual supply-demand balance and maximize a companies' profit under the 2010-15 price control process in England. Regulatory incentives for costs savings are also represented in the model. These include: the CIS scheme for the capital expenditure (capex) and incentive allowance schemes for the operating expenditure (opex) . The profit-maximizing investment program (what to build, when and what size) is compared with the least cost program (social optimum). We apply this formulation to several water companies in South East England to model performance and sensitivity to water network particulars. Results show that if companies' are able to outperform the regulatory assumption on the cost of capital, a capital bias can be generated, due to the fact that the capital expenditure, contrarily to opex, can be remunerated through the companies' regulatory capital value (RCV). The occurrence of the 'capital bias' or its entity depends on the extent to which a company can finance its investments at a rate below the allowed cost of capital. The bias can be reduced by the regulatory penalties for underperformances on the capital expenditure (CIS scheme); Sensitivity analysis can be applied by varying the CIS penalty to see how and to which extent this impacts the capital bias effect. We show how regulatory changes could potentially be devised to partially remove the 'capital bias' effect. Solutions potentially include allowing for incentives on total expenditure rather than separately for capex and opex and allowing both opex and capex to be remunerated through a return on the company's regulatory capital value.

A comprehensive examination of the influence of state tobacco control programs and policies on youth smoking.

PubMed

Farrelly, Matthew C; Loomis, Brett R; Han, Beth; Gfroerer, Joe; Kuiper, Nicole; Couzens, G Lance; Dube, Shanta; Caraballo, Ralph S

2013-03-01

We examined the influence of tobacco control policies (tobacco control program expenditures, smoke-free air laws, youth access law compliance, and cigarette prices) on youth smoking outcomes (smoking susceptibility, past-year initiation, current smoking, and established smoking). We combined data from the 2002 to 2008 National Surveys on Drug Use and Health with state and municipality population data from the US Census Bureau to assess the associations between state tobacco control policy variables and youth smoking outcomes, focusing on youths aged 12 to 17 years. We also examined the influence of policy variables on youth access when these variables were held at 2002 levels. Per capita funding for state tobacco control programs was negatively associated with all 4 smoking outcomes. Smoke-free air laws were negatively associated with all outcomes except past-year initiation, and cigarette prices were associated only with current smoking. We found no association between these outcomes and retailer compliance with youth access laws. Smoke-free air laws and state tobacco control programs are effective strategies for curbing youth smoking.

A Comprehensive Examination of the Influence of State Tobacco Control Programs and Policies on Youth Smoking

PubMed Central

Loomis, Brett R.; Han, Beth; Gfroerer, Joe; Kuiper, Nicole; Couzens, G. Lance; Dube, Shanta; Caraballo, Ralph S.

2013-01-01

Objectives. We examined the influence of tobacco control policies (tobacco control program expenditures, smoke-free air laws, youth access law compliance, and cigarette prices) on youth smoking outcomes (smoking susceptibility, past-year initiation, current smoking, and established smoking). Methods. We combined data from the 2002 to 2008 National Surveys on Drug Use and Health with state and municipality population data from the US Census Bureau to assess the associations between state tobacco control policy variables and youth smoking outcomes, focusing on youths aged 12 to 17 years. We also examined the influence of policy variables on youth access when these variables were held at 2002 levels. Results. Per capita funding for state tobacco control programs was negatively associated with all 4 smoking outcomes. Smoke-free air laws were negatively associated with all outcomes except past-year initiation, and cigarette prices were associated only with current smoking. We found no association between these outcomes and retailer compliance with youth access laws. Conclusions. Smoke-free air laws and state tobacco control programs are effective strategies for curbing youth smoking. PMID:23327252

Time Regained: When People Stop a Physical Activity Program, How Does Their Time Use Change? A Randomised Controlled Trial

PubMed Central

Gomersall, Sjaan; Maher, Carol; English, Coralie; Rowlands, Alex; Olds, Tim

2015-01-01

The aim of this study was to investigate how previously inactive adults who had participated in a structured, partly supervised 6-week exercise program restructured their time budgets when the program ended. Using a randomised controlled trial design, 129 previously inactive adults were recruited and randomly allocated to one of three groups: a Moderate or Extensive six-week physical activity intervention (150 and 300 additional minutes of exercise per week, respectively) or a Control group. Additional physical activity was accumulated through both group and individual exercise sessions with a wide range of activities. Use of time and time spent in energy expenditure zones was measured using a computerised 24-h self-report recall instrument, the Multimedia Activity Recall for Children and Adults, and accelerometry at baseline, mid- and end-program and at 3- and 6-months follow up. At final follow up, all significant changes in time use domains had returned to within 20 minutes of baseline levels (Physical Activity 1-2 min/d, Active Transport 3-9 min/d, Self-Care 0-2 min/d, Television/Videogames 13-18 min/d in the Moderate and Extensive group, relative to Controls, respectively, p>0.05). Similarly, all significant changes in time spent in the moderate energy expenditure zone had returned to within 1-3 min/d baseline levels (p>0.05), however time spent in vigorous physical activity according to accelerometry estimates remained elevated, although the changes were small in magnitude (1 min/d in the Moderate and Extensive groups, relative to Controls, p=0.01). The results of this study demonstrate strong recidivist patterns in physical activity, but also in other aspects of time use. In designing and determining the effectiveness of exercise interventions, future studies would benefit from considering the whole profile of time use, rather than focusing on individual activities. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12610000248066 PMID:26023914

Effect of fire prevention programs on accidental and incendiary wildfires on tribal lands in the United States

Treesearch

Karen L. Abt; David T. Butry; Jeff Prestemon; Samuel Scranton

2015-01-01

Humans cause more than 55% of wildfires on lands managed by the USDA Forest Service and US Department of the Interior, contributing to both suppression expenditures and damages. One means to reduce the expenditures and damages associated with these wildfires is through fire prevention activities, which can include burn permits, public service programs or announcements...

The Allocation of Federal Expenditures Among States

NASA Technical Reports Server (NTRS)

Lee, Maw Lin

1967-01-01

This study explores factors associated with the allocation offederal expenditures by states and examines the implications of theseexpenditures on the state by state distribution of incomes. Theallocation of federal expenditures is functionally oriented toward theobjectives for which various government programs are set up. Thegeographical distribution of federal expenditures, therefore, washistorically considered to be a problem incidental to governmentactivity. Because of this, relatively little attention was given tothe question of why some states receive more federal allocation thanothers. In addition, the implications of this pattern of allocationamong the several states have not been intensively investigated.

[The effect of Seguro Popular de Salud on catastrophic and impoverishing expenditures in Mexico, 2004-2012].

PubMed

Knaul, Felicia Marie; Arreola-Ornelas, Héctor; Wong, Rebeca; Lugo-Palacios, David G; Méndez-Carniado, Oscar

2018-01-01

To determine the impact of Seguro Popular (SPS) on catastrophic and impoverishing household expenditures and on the financial protection of the Mexican health system. The propensity score matching (PSM) method was applied to the population affiliated to SPS to determine the program's attributable effect on health expenditure. This analysis uses the National Household Income and Expenditure Survey (ENIGH) during 2004-2012, conducted by Mexico's National Institute of Statistics andGeography (INEGI). It was found that SPS has a significant effect on reducing the likelihood that households will incur impoverishing expenditures. A negative effect on catastrophic expenditures was also found, but it was not statistically significant. This paper shows the effect that SPS, in particular health insurance, has as an instrument of financial protection. Future studies using longer periods of ENIGH data should analyze the persistence of high out-of-pocket expenditure.

Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State, India.

PubMed

Balasubramanian, Deepak; Prinja, Shankar; Aggarwal, Arun Kumar

2015-01-01

Generation of resources for providing health care services is an important issue in developing countries. User charges in the form of Surgical Package Program (SPP) were introduced in all district hospitals of Haryana to address this problem. We evaluate the effect of this SPP program on surgical care utilization and out-of-pocket (OOP) expenditures. Data on 25437 surgeries, from July 2006 to June 2013 in 3 districts of Haryana state, was analyzed using interrupted time series analysis to assess the impact of SPP on utilization of services. Adjustment was made for presence of any autocorrelation and seasonality effects. A cross sectional survey was undertaken among 180 patients in District hospital, Panchkula during June 2013 to assess the extent of out of pocket (OOP) expenditure incurred, financial risk protection and methods to cope with OOP expenditure. Catastrophic health expenditure, estimated as any expenditure in excess of 10% of the household consumption expenditure, was used to assess the extent of financial risk protection. User charges had a negative effect on the number of surgeries in public sector district hospitals in all the 3 districts. The mean out-of-pocket expenditure incurred by the patients was Rs.4564 (USD 74.6). The prevalence of catastrophic expenditure was 5.6%. A higher proportion among the poorest 20% population coped through borrowing money (47.2%), while majority (86.1%) of those belonging to richest quintile paid from their monthly income or savings, or had insurance. There is a need to increase the public financing for curative services and it should be based on the needs of population. Any form of user charge in public sector hospitals should be removed.

The impact of public expenditure on undernourishment distribution in Mexico.

PubMed

Moreno-Macías, Lidia; Palma-Solís, Marco; Zapata-Vázquez, Rita E

2013-09-01

The status of undernourishment in children under the age of five in Mexico is open to debate. Linked to poverty, underweight and stunting, the rates of undernourishment are reported to be diminishing, although poverty remains an incessant problem. This study was done to determine whether there is an association between public expenditure and underweight and stunting distribution in Mexico based on data from the 2006 health and population census and from macroeconomic, social, and demographic variables. We used principal component analysis to reduce the number of variables and analyze their behavior. Multiple regressions showed that underweight and stunting are significantly associated with the marginalization index, support from the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) supplies and breakfast program, the gross domestic product per capita, and expenditure from the Opportunities program. Further, public expenditure aimed to combat undernourishment is inadequately oriented to address the needs of the poor.

Effect of Workplace Weight Management on Health Care Expenditures and Quality of Life.

PubMed

Michaud, Tzeyu L; Nyman, John A; Jutkowitz, Eric; Su, Dejun; Dowd, Bryan; Abraham, Jean M

2016-11-01

We examined the effectiveness of the weight management program used by the University of Minnesota in reducing health care expenditures and improving quality of life of its employees, and also in reducing their absenteeism during a 3-year intervention. A differences-in-differences regression approach was used to estimate the effect of weight management participation. We further applied ordinary least squares regression models with fixed effects to estimate the effect in an alternative analysis. Participation in the weight management program significantly reduced health care expenditures by $69 per month for employees, spouses, and dependents, and by $73 for employees only. Quality-of-life weights were 0.0045 points higher for participating employees than for nonparticipating ones. No significant effect was found for absenteeism. The workplace weight management used by the University of Minnesota reduced health care expenditures and improved quality of life.

Designing an effective statewide tobacco control program--Massachusetts.

PubMed

Connolly, G; Robbins, H

1998-12-15

Smoking-related illnesses kill > 10,000 Massachusetts residents each year and cost hundreds of millions of dollars of public and private expenditures for health care. To combat this public health problem, in 1992 Massachusetts voters approved a referendum question calling for an increased excise tax on tobacco products, with the revenue supporting a Health Protection Fund. Approximately 40% of the fund is used to finance the Massachusetts Tobacco Control Program (MTCP), administered by the Massachusetts Department of Public Health. During the first 3 fiscal years (FY), the MTCP budget has averaged just over $40 million annually, declining during that period from approximately $43 million in FY 1995 to < $37 million in FY 1997.

42 CFR 423.910 - Requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Special Rules for States-Eligibility Determinations... to defray a portion of the Medicare drug expenditures for individuals whose projected Medicaid drug... capita Medicaid expenditures for prescription drugs for 2003 for full-benefit dual eligibles not...

44 CFR 361.7 - General eligible expenditures.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS NATIONAL EARTHQUAKE HAZARDS REDUCTION ASSISTANCE TO STATE AND LOCAL GOVERNMENTS Earthquake Hazards Reduction Assistance Program § 361.7 General eligible expenditures... specifically for carrying out earthquake hazards reduction activities are eligible when engaged in the...

44 CFR 361.7 - General eligible expenditures.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS NATIONAL EARTHQUAKE HAZARDS REDUCTION ASSISTANCE TO STATE AND LOCAL GOVERNMENTS Earthquake Hazards Reduction Assistance Program § 361.7 General eligible expenditures... specifically for carrying out earthquake hazards reduction activities are eligible when engaged in the...

44 CFR 361.7 - General eligible expenditures.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS NATIONAL EARTHQUAKE HAZARDS REDUCTION ASSISTANCE TO STATE AND LOCAL GOVERNMENTS Earthquake Hazards Reduction Assistance Program § 361.7 General eligible expenditures... specifically for carrying out earthquake hazards reduction activities are eligible when engaged in the...

44 CFR 361.7 - General eligible expenditures.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS NATIONAL EARTHQUAKE HAZARDS REDUCTION ASSISTANCE TO STATE AND LOCAL GOVERNMENTS Earthquake Hazards Reduction Assistance Program § 361.7 General eligible expenditures... specifically for carrying out earthquake hazards reduction activities are eligible when engaged in the...

44 CFR 361.7 - General eligible expenditures.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., DEPARTMENT OF HOMELAND SECURITY PREPAREDNESS NATIONAL EARTHQUAKE HAZARDS REDUCTION ASSISTANCE TO STATE AND LOCAL GOVERNMENTS Earthquake Hazards Reduction Assistance Program § 361.7 General eligible expenditures... specifically for carrying out earthquake hazards reduction activities are eligible when engaged in the...

The impact of China's retail drug price control policy on hospital expenditures: a case study in two Shandong hospitals.

PubMed

Meng, Qingyue; Cheng, Gang; Silver, Lynn; Sun, Xiaojie; Rehnberg, Clas; Tomson, Göran

2005-05-01

In China, 44.4% of total health expenditures in 2001 were for pharmaceuticals. Containment of pharmaceutical expenditures is a top priority for policy intervention. Control of drug retail prices was adopted by the Chinese government for this purpose. This study aims to examine the impact of this policy on the containment of hospital drug expenditures, and to analyze contributing factors. This is a retrospective pre/post-reform case study in two public hospitals. Financial records were reviewed to analyze changes in drug expenditures for all patients. A tracer condition, cerebral infarction, was selected for in-depth examination of changes in prices, utilization, expenditures and rationality of drugs. In the two hospitals, a total of 104 and 109 cerebral infarction cases, hospitalized respectively before and after the reform, were selected. Prescribed daily dose (PDD) was used for measuring drug utilization, and the contribution of price and utilization to changes in drug expenditures were decomposed. Rationality of drug use post-reform was reviewed based on published literature. Drug expenditures for all patients still increased rapidly in the two hospitals after implementation of the pricing policy. In the provincial hospital, drug expenditures per patient for cerebral infarction cases declined, but not significantly. This was mainly attributable to reduced utilization. In the municipal hospital, drug expenditure per patient increased by 50.1% after the reform, mainly due to greater drug utilization. Three to five fold higher drug expenditure per inpatient day in the provincial hospital was due to use of more expensive drugs. Of the top 15 drugs for treating cerebral infarction cases after the reform, 19.5% and 46.5% of the expenditures, in the provincial and municipal hospitals, respectively, were spent on drugs with prices set by the government. A large proportion of expenditures for the top 15 drugs, at least 65% and 41% in the provincial and municipal hospitals, respectively, was spent on allopathic drugs without an adequate evidence base of safety and efficacy supporting use for cerebral infarction. Control of retail prices, implemented in isolation, was not effective in containing hospital drug expenditures in these two Chinese hospitals. Utilization, more than price, determined drug expenditures. Improvement of rational use of drugs and correcting the present incentive structure for hospitals and drug prescribers may be important additional strategies for achieving containment of drug expenditures.

Routine human-competitive machine intelligence by means of genetic programming

NASA Astrophysics Data System (ADS)

Koza, John R.; Streeter, Matthew J.; Keane, Martin

2004-01-01

Genetic programming is a systematic method for getting computers to automatically solve a problem. Genetic programming starts from a high-level statement of what needs to be done and automatically creates a computer program to solve the problem. The paper demonstrates that genetic programming (1) now routinely delivers high-return human-competitive machine intelligence; (2) is an automated invention machine; (3) can automatically create a general solution to a problem in the form of a parameterized topology; and (4) has delivered a progression of qualitatively more substantial results in synchrony with five approximately order-of-magnitude increases in the expenditure of computer time. Recent results involving the automatic synthesis of the topology and sizing of analog electrical circuits and controllers demonstrate these points.

Are the Chinese Saving for Old Age?: The Relationship between Future Pension Benefits of 45-60 Years Old Chinese and Current Household Expenditures.

PubMed

van Dullemen, C E; Nagel, I; de Bruijn, J M G

2017-01-01

Worldwide, older people's support used to be the adult children's responsibility. In China, two generations after introducing the one-child policy in the late 70-ies, this becomes an increasingly demanding obligation. The Chinese government took the responsibility to mitigating old- age poverty risks and realized unprecedented progress in pension coverage. At the same time, the household savings increased to about 30 % of disposable income. Built on previous research on the politics of ageing, this study analyses households responses to the established governmental and firm pension programs as well as to the New Rural Pension Scheme (NRPS), introduced in 2009. The central question is: will participation in the established and new pension programs lead to higher current Chinese household expenditures and therefore to lower savings? The China Health and Retirement Longitudinal Study (CHARLS) dataset of 2011 offered the opportunity to study the influence of the recently introduced NRPS. We find that Chinese households with members between 45 and 60 years who expect future benefits of NRPS do not have higher expenditures than those not covered by NRPS. For the participants in the established, mostly urban pension programs a correlation was found with higher current expenditures (28 % more spending on basic needs, 80 % more on luxury) However, further analysis shows that this correlation cannot be interpreted as a causal relationship. This implies that coverage by pensions, be it in urban or rural programs, does not determine higher current expenditures and lower savings.

Socioeconomic inequalities in catastrophic health expenditure and impoverishment associated with non-communicable diseases in urban Hanoi, Vietnam.

PubMed

Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Dao, Amy; Tuan, Le Thanh; Ng, Nawi

2016-10-13

The catastrophic health expenditure and impoverishment indices offer guidance for developing appropriate health policies and intervention programs to decrease financial inequity. This study assesses socioeconomic inequalities in catastrophic health expenditure and impoverishment in relation to self-reported non-communicable diseases (NCD) in urban Hanoi, Vietnam. A cross-sectional survey was conducted from February to March 2013 in Hanoi, the capital city of Vietnam. We estimated catastrophic health expenditure and impoverishment using information from 492 slum household and 528 non-slum households. We calculated concentration indexes to assess socioeconomic inequalities in catastrophic health expenditure and impoverishment. Factors associated with catastrophic health expenditure and impoverishment were modelled using logistic regression analysis. The poor households in both slum and non-slum areas were at higher risk of experiencing catastrophic health expenditure, while only the poor households in slum areas were at higher risk of impoverishment because of healthcare spending. Households with at least one member reporting an NCD were significantly more likely to face catastrophic health expenditure (odds ratio [OR] = 2.4; 95 % confidence interval [CI], 1.8-4.0) and impoverishment (OR = 2.3; 95 % CI, 1.1-6.3) compared to households without NCDs. In addition, households in slum areas, with people age 60 years and above, and belonging to the poorest socioeconomic group were significantly associated with increased catastrophic health expenditure, while only households that lived in slum areas, and belonging to the poor or poorest socioeconomic groups were significantly associated with increased impoverishment because of healthcare spending. Financial interventions to prevent catastrophic health expenditure and impoverishment should target poor households, especially those with family members suffering from NCDs, with older members and those located in slum areas in Hanoi Vietnam. Potential interventions derived from this study include targeting and monitoring of health insurance enrolment, and developing a specialized NCD service package for Vietnam's social health insurance program.

Economic and social impact of diabetes mellitus in a low-income country: A case-control study in Sudan.

PubMed

Elrayah-Eliadarous, Hind A; Östenson, Claes-Göran; Eltom, Mohamed; Johansson, Pia; Sparring, Vibeke; Wahlström, Rolf

2017-12-01

Diabetes mellitus accounts for 11% of total health expenditure worldwide, and most people with diabetes live in low- and middle-income countries. The present study examined the economic and social effects attributed to diabetes in Sudan by calculating out-of-pocket medical expenses and the health and social effects of the disease for people with diabetes (n = 375) and their families compared with a non-diabetic control group (n = 375), matched for age, sex, and residence area. Data were obtained in 2013 in four states within the Sudan, via structured interviews, using instruments from the International Diabetes Federation. Descriptive statistics were used to analyze differences between case and control participants. The median total annual medical expenditure was fourfold higher for people with than without diabetes (US$579 vs US$148, respectively). Annual mean expenditure was 85% higher for those with diabetes (US$1004 vs US$544). People with diabetes were also significantly more likely to suffer from serious comorbidities, such as cardiovascular disorders and foot ulcers, compared with control participants. Moreover, those with diabetes reported a higher proportion of personal adverse social effects, such as being prevented from doing paid work or participating in education, both for themselves and their families. The high economic burden and adverse social effects on people with diabetes and their families in Sudan call for the development of evidence-based policy and program strategies for the prevention and management of diabetes, with an emphasis on low-resource communities. © 2017 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Impact of home-based, patient-centered support for people with advanced illness in an open health system: A retrospective claims analysis of health expenditures, utilization, and quality of care at end of life.

PubMed

Sudat, Sylvia Ek; Franco, Anjali; Pressman, Alice R; Rosenfeld, Kenneth; Gornet, Elizabeth; Stewart, Walter

2018-02-01

Home-based care coordination and support programs for people with advanced illness work alongside usual care to promote personal care goals, which usually include a preference for home-based end-of-life care. More research is needed to confirm the efficacy of these programs, especially when disseminated on a large scale. Advanced Illness Management is one such program, implemented within a large open health system in northern California, USA. To evaluate the impact of Advanced Illness Management on end-of-life resource utilization, cost of care, and care quality, as indicators of program success in supporting patient care goals. A retrospective-matched observational study analyzing medical claims in the final 3 months of life. Medicare fee-for-service 2010-2014 decedents in northern California, USA. Final month total expenditures for Advanced Illness Management enrollees ( N = 1352) were reduced by US$4824 (US$3379, US$6268) and inpatient payments by US$6127 (US$4874, US$7682). Enrollees also experienced 150 fewer hospitalizations/1000 (101, 198) and 1361 fewer hospital days/1000 (998, 1725). The percentage of hospice enrollees increased by 17.9 percentage points (14.7, 21.0), hospital deaths decreased by 8.2 percentage points (5.5, 10.8), and intensive care unit deaths decreased by 7.1 percentage points (5.2, 8.9). End-of-life chemotherapy use and non-inpatient expenditures in months 2 and 3 prior to death did not differ significantly from the control group. Advanced Illness Management has a positive impact on inpatient utilization, cost of care, hospice enrollment, and site of death. This suggests that home-based support programs for people with advanced illness can be successful on a large scale in supporting personal end-of-life care choices.

The Relationship of Post-acute Home Care Use to Medicaid Utilization and Expenditures

PubMed Central

Payne, Susan MC; DiGiuseppe, David L; Tilahun, Negussie

2002-01-01

Research Objectives To describe the use of post-acute home care (PAHC) and total Medicaid expenditures among hospitalized nonelderly adult Medicaid eligibles and to test whether health services utilization rates or total Medicaid expenditures were lower among Medicaid eligibles who used PAHC compared to those who did not. Study Population 5,299 Medicaid patients aged 18–64 discharged in 1992–1996 from 29 hospitals in the Cleveland Health Quality Choice (CHQC) project. Data Sources Linked Ohio Medicaid claims and CHQC medical record abstract data. Data Extraction One stay per patient was randomly selected. Design Observational study. To control for treatment selection bias, we developed a model predicting the probability (propensity) a patient would be referred to PAHC, as a proxy for the patient's need for PAHC. We matched 430 patients who used Medicaid-covered PAHC (“USE”) to patients who did not (“NO USE”) by their propensity scores. Study outcomes were inpatient re-admission rates and days of stay (DOS), nursing home admission rates and DOS, and mean total Medicaid expenditures 90 and 180 days after discharge. Principal Findings Of 3,788 medical patients, 12.1 percent were referred to PAHC; 64 percent of those referred used PAHC. Of 1,511 surgical patients, 10.9 percent were referred; 99 percent of those referred used PAHC. In 430 pairs of patients matched by propensity score, mean total Medicaid expenditures within 90 days after discharge were $7,649 in the USE group and $5,761 in the NO USE group. Total Medicaid expenditures were significantly higher in the USE group compared to the NO USE group for medical patients after 180 days (p<.05) and surgical patients after 90 and 180 days (p<.001). There were no significant differences for any other outcome. Sensitivity analysis indicates the results may be influenced by unmeasured variables, most likely functional status and/or care-giver support. Conclusions Thirty-six percent of the medical patients referred to PAHC did not receive Medicaid-covered services. This suggests potential underuse among medical patients. The high post-discharge expenditures suggest opportunities for reducing costs through coordinating utilization or diverting it to lower-cost settings. Controlling for patients' need for services, PAHC utilization was not associated with lower utilization rates or lower total Medicaid expenditures. Medicaid programs are advised to proceed cautiously before expanding PAHC utilization and to monitor its use carefully. Further study, incorporating non-economic outcomes and additional factors influencing PAHC use, is warranted. PMID:12132601

Randomized controlled trial of a dose consolidation program.

PubMed

Delate, Thomas; Fairman, Kathleen A; Carey, Shelly M; Motheral, Brenda R

2004-01-01

To evaluate the effectiveness and financial impact of a drug dose consolidation (optimization) program using letter intervention. This pilot program in a large, mid-Atlantic health plan utilized a randomized controlled trial research design. A review of adjudicated pharmacy claims records was performed monthly for 3 consecutive months from November 2002 through February 2003 to identify inefficient (i.e., >once-daily) regimens for any one of 68 dosage strengths of 37 single-source maintenance drugs with once-daily dosing recommendations. Prescribers who had prescribed one or more inefficient regimens were identified and randomized to one of the 2 intervention arms or a control arm. Prescribers in both intervention arms were sent personalized letters with information on their patients. inefficient regimens and suggested dose consolidation options. Patients of prescribers in one intervention arm received a complementary, patient-oriented letter. Pharmacy claims for patients in all arms were examined at 180 days after the date of the letter mailing for conversion to an efficient (once-daily) regimen. Financial modeling analysis calculated net savings as changes in pharmacy expenditures minus administrative costs. A total of 2,614 inefficient regimens, representing 6.7% of claims for the targeted medications, were identified. The rate of consolidation to a suggested dosing option was lower for the Physician Letter arm (7.3%) than for the Physician/Member Letter arm (10.2%) (P = 0.046). Both intervention arms had higher consolidation rates than the Control arm (3.9%) (P = 0.018 and P = 0.000, respectively.). Approximately 30% of the regimens in each study arm were never refilled after being targeted. Financial modeling indicated that a dose consolidation intervention could save 0.03 dollars to 0.07 dollars per member per month (PMPM) in 2003 dollars with full medication compliance but only 0.02 dollars to 0.03 dollars PMPM when savings were calculated with realistic, partial compliance rates. Subanalyses performed at the drug therapy class level revealed few opportunities to justify implementing a dose consolidation program. After taking into consideration program administrative costs, high rates of refill discontinuation, and dose consolidation that occurs naturally without intervention, the results indicated that a letter-based dose consolidation program did not appreciably decrease pharmacy expenditures.

Unstop the Logjams in Your Cash Flow.

ERIC Educational Resources Information Center

Everett, R. E.

1989-01-01

A cash flow analysis is charting expenditures and revenues against a factor of time. Explains how school systems can, by charting the congruency of revenues and expenditures carefully, develop an investment program to take maximum advantage of a positive cash position. (MLF)

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 457.606 - Conditions for State allotments and Federal payments for a fiscal year.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Program (CHIP) expenditures under an approved State child health plan are— (1) Limited to the amount of... based on a percentage of State CHIP expenditures, at a rate equal to the enhanced Federal medical...

42 CFR 441.182 - Maintenance of effort: Computation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES Inpatient Psychiatric Services for Individuals Under Age 21 in Psychiatric Facilities or Programs § 441.182 Maintenance of effort: Computation. (a) For expenditures for inpatient psychiatric services... total State Medicaid expenditures in the current quarter for inpatient psychiatric services and...

Medicaid expenditures for the disabled under a work incentive program

PubMed Central

Andrews, Roxanne M.; Ruther, Martin; Baugh, David K.; Pine, Penelope L.; Rymer, Marilyn P.

1988-01-01

Congress enacted Section 1619 of the Social Security Act to enable the disabled receiving Supplemental Security Income (SSI) to obtain jobs and still retain Medicaid health benefits. Congress intended this work incentive to remove the fear of the severely disabled that by obtaining employment they would lose Medicaid benefits. Based on data from 11 States, our analysis found that Medicaid expenditures for Section 1619 enrollees were relatively small and only one-half the average Medicaid expenditure for the disabled. Retaining Medicaid appears to provide a significant work incentive because Medicaid expenditures represent 13 percent of Section 1619 enrollees' earnings. PMID:10318077

Skipping meals and alcohol consumption. The regulation of energy intake and expenditure among weight loss participants.

PubMed

Carels, Robert A; Young, Kathleen M; Coit, Carissa; Clayton, Anna Marie; Spencer, Alexis; Wagner, Marissa

2008-11-01

Research suggests that specific eating patterns (e.g., eating breakfast) may be related to favorable weight status. This investigation examined the relationship between eating patterns (i.e., skipping meals; consuming alcohol) and weight loss treatment outcomes (weight loss, energy intake, energy expenditure, and duration of exercise). Fifty-four overweight or obese adults (BMI> or =27 kg/m(2)) participated in a self-help or therapist-assisted weight loss program. Daily energy intake from breakfast, lunch, dinner, and alcoholic beverages, total daily energy intake, total daily energy expenditure, physical activity, and weekly weight loss were assessed. On days that breakfast or dinner was skipped, or alcoholic beverages were not consumed, less total daily energy was consumed compared to days that breakfast, dinner, or alcoholic beverages were consumed. On days that breakfast or alcohol was consumed, daily energy expenditure (breakfast only) and duration of exercise were higher compared to days that breakfast or alcohol was not consumed. Individuals who skipped dinner or lunch more often had lower energy expenditure and exercise duration than individuals who skipped dinner or lunch less often. Individuals who consumed alcohol more often had high daily energy expenditure than individuals who consumed alcohol less often. Skipping meals or consuming alcoholic beverages was not associated with weekly weight loss. In this investigation, weight loss program participants may have compensated for excess energy intake from alcoholic beverages and meals with greater daily energy expenditure and longer exercise duration.

Economic and policy analysis of university-based drug "detailing".

PubMed

Soumerai, S B; Avorn, J

1986-04-01

The cost-effectiveness of quality assurance programs is often poorly documented, especially for innovative approaches. The authors analyzed the economic effects of an experimental educational outreach program designed to reduce inappropriate drug prescribing, based on a four-state randomized controlled trial (N = 435 physicians). Primary care physicians randomized into the face-to-face group were offered two individualized educational sessions with clinical pharmacists, lasting an average of 18 minutes each, concerning optimal use of three drug groups that are often used inappropriately. After the program, expenditures for target drugs prescribed by these physicians to Medicaid patients decreased by 13%, compared with controls (P = 0.002); this effect was stable over three quarters. Implementation of this program for 10,000 physicians would lead to projected drug savings (to Medicaid only) of $2,050,000, compared with resource costs of $940,000. Net savings remain high, even after adjustment for use of substitution medications. Although there was a ninefold difference in average preintervention prescribing levels between the highest and lowest thirds of the sample, all groups reduced target drug expenditures at the same rate. Targeting of higher-volume prescribers would thus further raise the observed benefit-to-cost ratio from approximately 1.8 to at least 3.0. Net benefits would also increase further if non-Medicaid savings were added, or if the analysis included quality-of-care considerations. Although print materials alone may be marginally cost-effective, print plus face-to-face approaches offer greater net benefits. The authors conclude that a program of brief, face-to-face "detailing" visits conducted by academic rather than commercial sources can be a highly cost-effective method for improving drug therapy decisions. Such an approach makes possible the enhancement of physicians' clinical expertise without relying on restriction of drug choices.

Health Care Expenditures for University and Academic Medical Center Employees Enrolled in a Pilot Workplace Health Partner Intervention.

PubMed

Johnston, Kenton J; Hockenberry, Jason M; Rask, Kimberly J; Cunningham, Lynn; Brigham, Kenneth L; Martin, Greg S

2015-08-01

To evaluate the impact of a pilot workplace health partner intervention delivered by a predictive health institute to university and academic medical center employees on per-member, per-month health care expenditures. We analyzed the health care claims of participants versus nonparticipants, with a 12-month baseline and 24-month intervention period. Total per-member, per-month expenditures were analyzed using two-part regression models that controlled for sex, age, health benefit plan type, medical member months, and active employment months. Our regression results found no statistical differences in total expenditures at baseline and intervention. Further sensitivity analyses controlling for high cost outliers, comorbidities, and propensity to be in the intervention group confirmed these findings. We find no difference in health care expenditures attributable to the health partner intervention. The intervention does not seem to have raised expenditures in the short term.

State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India.

PubMed

Fan, Victoria Y; Karan, Anup; Mahal, Ajay

2012-09-01

In 2007 the state of Andhra Pradesh in southern India began rolling out Aarogyasri health insurance to reduce catastrophic health expenditures in households 'below the poverty line'. We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that within the first nine months of implementation Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population.

Walking economy during cued versus non-cued treadmill walking in persons with Parkinson's disease.

PubMed

Gallo, Paul M; McIsaac, Tara L; Garber, Carol Ewing

2013-01-01

Gait impairment is common in Parkinson's disease (PD) and may result in greater energy expenditure, poorer walking economy, and fatigue during activities of daily living. Auditory cueing is an effective technique to improve gait; but the effects on energy expenditure are unknown. To determine whether energy expenditure differs in individuals with PD compared with healthy controls and if auditory cueing improves walking economy in PD. Twenty participants (10 PD and 10 controls) came to the laboratory for three sessions. Participants performed two, 6-minute bouts of treadmill walking at two speeds (1.12 m·sec-1 and 0.67 m·sec-1). One session used cueing and the other without cueing. A metabolic cart measured energy expenditure and walking economy was calculated (energy expenditure/power). PD had worse walking economy and higher energy expenditure than control participants during cued and non-cued walking at the 0.67 m·sec-1 speed and during non-cued walking at the 1.12 m·sec-1. With auditory cueing, energy expenditure and walking economy worsened in both participant groups. People with PD use more energy and have worse walking economy than adults without PD. Walking economy declines further with auditory cuing in persons with PD.

The Incidence of Local Water Pollution Abatement Expenditures: A Case Study of the Merrimack River Basin (1974)

EPA Pesticide Factsheets

Part I is an analysis of the determinants of local government expenditures on water pollution abatement facilities. Part II is an investigation of the incidence of costs and benefits of public environmental programs.

42 CFR 403.754 - Monitoring expenditure level.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Monitoring expenditure level. 403.754 Section 403.754 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits...

42 CFR 403.754 - Monitoring expenditure level.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Monitoring expenditure level. 403.754 Section 403.754 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits...

42 CFR 403.754 - Monitoring expenditure level.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Monitoring expenditure level. 403.754 Section 403.754 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits...

42 CFR 403.754 - Monitoring expenditure level.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Monitoring expenditure level. 403.754 Section 403.754 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits...

42 CFR 403.754 - Monitoring expenditure level.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Monitoring expenditure level. 403.754 Section 403.754 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions-Benefits...

The impact of reference pricing of nonsteroidal anti-inflammatory agents on the use and costs of analgesic drugs.

PubMed

Grootendorst, Paul V; Marshall, John K; Holbrook, Anne M; Dolovich, Lisa R; O'Brien, Bernie J; Levy, Adrian R

2005-10-01

To estimate the effect of reference pricing (RP) of nonsteroidal anti-inflammatory drugs (NSAIDs) on drug subsidy program and beneficiary expenditures on analgesic drugs. Monthly claims data from Pharmacare, the public drug subsidy program for seniors in British Columbia, Canada, over the period of February 1993 to June 2001. RP limits drug plan reimbursement of interchangeable medicines to a reference price, which is typically equal to the price of the lowest cost interchangeable drug; any cost above that is borne by the patient. Pharmacare introduced two different forms of RP to the NSAIDs, Type 1 in April 1994 and Type 2 in November 1995. Under Type 1 RP, generic and brand versions of the same NSAID are considered interchangeable, whereas under Type 2 RP different NSAIDs are considered interchangeable. We extrapolated average reimbursement per day of NSAID therapy over the months before RP to estimate what expenditures would have been without the policies. These counterfactual predictions were compared with actual values to estimate the impact of the policies; the estimated impacts on reimbursement rates were multiplied by the postpolicy volume of NSAIDS dispensed, which appeared unaffected by the policies, to estimate expenditure changes. After Type 2 RP, program expenditures declined by $22.7 million (CAN), or $4 million (CAN), annually cutting expenditure by about half. Most savings accrued from the substitution of low-cost NSAIDs for more costly alternatives. About 20 percent of savings represented expenditures by seniors who elected to pay for partially reimbursed drugs. Type 1 RP produced one-quarter the savings of type 2 RP. Type 2 RP of NSAIDs achieved its goal of reducing drug expenditures and was more effective than Type 1 RP. The effects of RP on patient health and associated health care costs remain to be investigated.

Health care expenditures among Asian American subgroups.

PubMed

Chen, Jie; Vargas-Bustamante, Arturo; Ortega, Alexander N

2013-06-01

Using two nationally representative data sets, this study examined health care expenditure disparities between Caucasians and different Asian American subgroups. Multivariate analyses demonstrate that Asian Americans, as a group, have significantly lower total expenditures compared with Caucasians. Results also point to considerable heterogeneities in health care spending within Asian American subgroups. Findings suggest that language assistance programs would be effective in reducing disparities among Caucasians and Asian American subgroups with the exception of Indians and Filipinos, who tend to be more proficient in English. Results also indicate that citizenship and nativity were major factors associated with expenditure disparities. Socioeconomic status, however, could not explain expenditure disparities. Results also show that Asian Americans have lower physician and pharmaceutical costs but not emergency department or hospital expenditures. These findings suggest the need for culturally competent policies specific to Asian American subgroups and the necessity to encourage cost-effective treatments among Asian Americans.

Health Care Expenditures Among Asian American Subgroups

PubMed Central

Chen, Jie; Vargas-Bustamante, Arturo; Ortega, Alexander N.

2014-01-01

Using two nationally representative data sets, this study examined health care expenditure disparities between Caucasians and different Asian American subgroups. Multivariate analyses demonstrate that Asian Americans, as a group, have significantly lower total expenditures compared with Caucasians. Results also point to considerable heterogeneities in health care spending within Asian American subgroups. Findings suggest that language assistance programs would be effective in reducing disparities among Caucasians and Asian American subgroups with the exception of Indians and Filipinos, who tend to be more proficient in English. Results also indicate that citizenship and nativity were major factors associated with expenditure disparities. Socioeconomic status, however, could not explain expenditure disparities. Results also show that Asian Americans have lower physician and pharmaceutical costs but not emergency department or hospital expenditures. These findings suggest the need for culturally competent policies specific to Asian American subgroups and the necessity to encourage cost-effective treatments among Asian Americans. PMID:23223329

Occupational energy expenditure and leisure-time physical activity.

PubMed

Kaleta, Dorota; Jegier, Anna

2005-01-01

In the majority of countries around the world, a decrease in the leisure-time physical activity is observed. The aim of the study was to evaluate the correlation between occupational energy expenditure and leisure-time physical activity. Moreover, the correlation between other factors and leisure-time physical activity was assessed. The study was performed in a randomly selected group of full-time employees (272 men and 236 women) living in the city of Lódź. Logistic regression was used to estimate odds ratios and 95% confidence intervals as well as to control the effects of occupational workload and leisure-time physical activity limitations. Physical activity was determined by the Seven Day Physical Activity Recall (SDPAR). Leisure-time physical activity was strongly associated with energy expenditure on occupational physical activity in men and women. Among men who expended 4000 kcal/week or more on occupational physical activity, the risk of inactivity at leisure was 1.5 times higher than in men whose weekly energy expenditure on occupational activity did not exceed 4000 kcal (adjusted OR = 1.33, 95% CI: 1.06-2.34). Among women who expended 3500 kcal/week or more on occupational physical activity, the risk of not taking up leisure-time physical activity was also higher as compared to those whose weekly energy expenditure on occupational activity was lower than 3500 kcal (adjusted OR = 1.41, 95% CI: 1.09-3.40). Prophylactic schedules associated with the improvement of leisure-time physical activity should be addressed to all adults, particularly to blue-collar workers. Future programs aimed at increasing physical activity in adults should consider work-related factors.

National health expenditures, 1984

PubMed Central

Levit, Katharine R.; Lazenby, Helen; Waldo, Daniel R.; Davidoff, Lawrence M.

1985-01-01

Growth in health care expenditures slowed to 9.1 percent in 1984, the smallest increase in expenditures in 19 years. Economic forces and emerging structural changes within the health sector played a role in slowing growth. Of the $1,580 per person spent for health care in 1984, 41 percent was financed by public programs; 31 percent by private health insurance; and the remainder by other private sources. Together, Medicare and Medicaid accounted for 27 percent of all health spending. PMID:10311395

Health-seeking behavior and hospital choice in China's New Cooperative Medical System.

PubMed

Brown, Philip H; Theoharides, Caroline

2009-07-01

Since the dissolution of the Rural Cooperative Medical System at the end of the commune period, illness has emerged as a leading cause of poverty in rural China. To address the poor state of health care, the Chinese government unveiled the New Cooperative Medical System in 2002. Because local governments have been given significant control over program design, fundamental characteristics of the program vary from one county to the next. These differences may influence the decision to seek health care as well as the choice of hospital conditional on that initial decision. In this paper, we use a nested logit model to analyze household survey data from 25 counties to analyze the determinants of such health-seeking behavior. We find that age, the share of household expenditures allocated to food consumption (a measure of relative income), and the presence of other sick people in the household negatively affect the decision to seek health care while disability has a positive influence. Further, conditional on seeking treatment, the reimbursement scheme in place in each county and the average daily expenditure associated with hospitalization strongly influence hospital choice.

Change in energy expenditure and physical activity in response to aerobic and resistance exercise programs.

PubMed

Drenowatz, Clemens; Grieve, George L; DeMello, Madison M

2015-01-01

Exercise is considered an important component of a healthy lifestyle but there remains controversy on effects of exercise on non-exercise physical activity (PA). The present study examined the prospective association of aerobic and resistance exercise with total daily energy expenditure and PA in previously sedentary, young men. Nine men (27.0 ± 3.3 years) completed two 16-week exercise programs (3 exercise sessions per week) of aerobic and resistance exercise separated by a minimum of 6 weeks in random order. Energy expenditure and PA were measured with the SenseWear Mini Armband prior to each intervention as well as during week 1, week 8 and week 16 of the aerobic and resistance exercise program. Body composition was measured via dual x-ray absorptiometry. Body composition did not change in response to either exercise intervention. Total daily energy expenditure on exercise days increased by 443 ± 126 kcal/d and 239 ± 152 kcal/d for aerobic and resistance exercise, respectively (p < 0.01). Non-exercise moderate-to-vigorous PA, however, decreased on aerobic exercise days (-148 ± 161 kcal/d; p = 0.03). There was no change in total daily energy expenditure and PA on non-exercise days with aerobic exercise while resistance exercise was associated with an increase in moderate-to-vigorous PA during non-exercise days (216 ± 178 kcal/d, p = 0.01). Results of the present study suggest a compensatory reduction in PA in response to aerobic exercise. Resistance exercise, on the other hand, appears to facilitate non-exercise PA, particularly on non-exercise days, which may lead to more sustainable adaptations in response to an exercise program.

Reorienting the HIV response in Niger toward sex work interventions: from better evidence to targeted and expanded practice.

PubMed

Fraser, Nicole; Kerr, Cliff C; Harouna, Zakou; Alhousseini, Zeinabou; Cheikh, Nejma; Gray, Richard; Shattock, Andrew; Wilson, David P; Haacker, Markus; Shubber, Zara; Masaki, Emiko; Karamoko, Djibrilla; Görgens, Marelize

2015-03-01

Niger's low-burden, sex-work-driven HIV epidemic is situated in a context of high economic and demographic growth. Resource availability of HIV/AIDS has been decreasing recently. In 2007-2012, only 1% of HIV expenditure was for sex work interventions, but an estimated 37% of HIV incidence was directly linked to sex work in 2012. The Government of Niger requested assistance to determine an efficient allocation of its HIV resources and to strengthen HIV programming for sex workers. Optima, an integrated epidemiologic and optimization tool, was applied using local HIV epidemic, demographic, programmatic, expenditure, and cost data. A mathematical optimization algorithm was used to determine the best resource allocation for minimizing HIV incidence and disability-adjusted life years (DALYs) over 10 years. Efficient allocation of the available HIV resources, to minimize incidence and DALYs, would increase expenditure for sex work interventions from 1% to 4%-5%, almost double expenditure for antiretroviral treatment and for the prevention of mother-to-child transmission, and reduce expenditure for HIV programs focusing on the general population. Such an investment could prevent an additional 12% of new infections despite a budget of less than half of the 2012 reference year. Most averted infections would arise from increased funding for sex work interventions. This allocative efficiency analysis makes the case for increased investment in sex work interventions to minimize future HIV incidence and DALYs. Optimal HIV resource allocation combined with improved program implementation could have even greater HIV impact. Technical assistance is being provided to make the money invested in sex work programs work better and help Niger to achieve a cost-effective and sustainable HIV response.

Pharmacy Utilization and the Medicare Modernization Act

PubMed Central

Maio, Vittorio; Pizzi, Laura; Roumm, Adam R; Clarke, Janice; Goldfarb, Neil I; Nash, David B; Chess, David

2005-01-01

To control expenditures and use medications appropriately, the Medicare drug coverage program has established pharmacy utilization management (PUM) measures. This article assesses the effects of these strategies on the care of seniors. The literature suggests that although caps on drug benefits lower pharmaceutical costs, they may also increase the use of other health care services and hurt health outcomes. Our review raises concerns regarding the potential unintended effects of the Medicare drug program's PUM policies for beneficiaries. Therefore, the economic and clinical impact of PUM measures on seniors should be studied further to help policymakers design better drug benefit plans. PMID:15787955

What can a pilot congestive heart failure disease management program tell us about likely return on investment?: A case study from a program offered to federal employees.

PubMed

vanVonno, Catherine J; Ozminkowski, Ronald J; Smith, Mark W; Thomas, Eileen G; Kelley, Doniece; Goetzel, Ron; Berg, Gregory D; Jain, Susheel K; Walker, David R

2005-12-01

In 1999, the Blue Cross and Blue Shield Federal Employee Program (FEP) implemented a pilot disease management program to manage congestive heart failure (CHF) among members. The purpose of this project was to estimate the financial return on investment in the pilot CHF program, prior to a full program rollout. A cohort of 457 participants from the state of Maryland was matched to a cohort of 803 nonparticipants from a neighboring state where the CHF program was not offered. Each cohort was followed for 12 months before the program began and 12 months afterward. The outcome measures of primary interest were the differences over time in medical care expenditures paid by FEP and by all payers. Independent variables included indicators of program participation, type of heart disease, comorbidity measures, and demographics. From the perspective of the funding organization (FEP), the estimated return on investment for the pilot CHF disease management program was a savings of $1.08 in medical expenditure for every dollar spent on the program. Adding savings to other payers as well, the return on investment was a savings of $1.15 in medical expenditures per dollar spent on the program. The amount of savings depended upon CHF risk levels. The value of a pilot initiative and evaluation is that lessons for larger-scale efforts can be learned prior to full-scale rollout.

7 CFR 1486.404 - What expenditures are not eligible for program funding?

Code of Federal Regulations, 2011 CFR

2011-01-01

... funding? (a) CCC will not reimburse expenditures made prior to approval of a Recipient's proposal... individual students who are directly assigned to specific project activities appropriate to their backgrounds...; (10) Costs of product research or new product development; (11) Costs of developing technical...

42 CFR 457.740 - State expenditures and statistical reports.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false State expenditures and statistical reports. 457.740 Section 457.740 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES...

42 CFR 457.740 - State expenditures and statistical reports.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false State expenditures and statistical reports. 457.740 Section 457.740 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES...

42 CFR 403.750 - Estimate of expenditures and adjustments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Estimate of expenditures and adjustments. 403.750 Section 403.750 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions...

42 CFR 403.750 - Estimate of expenditures and adjustments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Estimate of expenditures and adjustments. 403.750 Section 403.750 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions...

42 CFR 403.750 - Estimate of expenditures and adjustments.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Estimate of expenditures and adjustments. 403.750 Section 403.750 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions...

42 CFR 403.750 - Estimate of expenditures and adjustments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Estimate of expenditures and adjustments. 403.750 Section 403.750 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions...

42 CFR 457.740 - State expenditures and statistical reports.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false State expenditures and statistical reports. 457.740 Section 457.740 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES...

42 CFR 457.740 - State expenditures and statistical reports.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false State expenditures and statistical reports. 457.740 Section 457.740 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES...

42 CFR 457.740 - State expenditures and statistical reports.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false State expenditures and statistical reports. 457.740 Section 457.740 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS (SCHIPs) ALLOTMENTS AND GRANTS TO STATES...

42 CFR 403.750 - Estimate of expenditures and adjustments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Estimate of expenditures and adjustments. 403.750 Section 403.750 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS SPECIAL PROGRAMS AND PROJECTS Religious Nonmedical Health Care Institutions...

34 CFR 607.4 - What are low educational and general expenditures?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 3 2011-07-01 2011-07-01 false What are low educational and general expenditures? 607.4 Section 607.4 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION STRENGTHENING INSTITUTIONS PROGRAM General...

34 CFR 607.4 - What are low educational and general expenditures?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 3 2013-07-01 2013-07-01 false What are low educational and general expenditures? 607.4 Section 607.4 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION STRENGTHENING INSTITUTIONS PROGRAM General...

34 CFR 607.4 - What are low educational and general expenditures?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 3 2014-07-01 2014-07-01 false What are low educational and general expenditures? 607.4 Section 607.4 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION STRENGTHENING INSTITUTIONS PROGRAM General...

34 CFR 607.4 - What are low educational and general expenditures?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 3 2012-07-01 2012-07-01 false What are low educational and general expenditures? 607.4 Section 607.4 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION STRENGTHENING INSTITUTIONS PROGRAM General...

A bibliometric analysis of childhood immunization research productivity in Africa since the onset of the Expanded Program on Immunization in 1974

PubMed Central

2013-01-01

Background The implementation of strategic immunization plans whose development is informed by available locally-relevant research evidence should improve immunization coverage and prevent disease, disability and death in Africa. In general, health research helps to answer questions, generate the evidence required to guide policy and identify new tools. However, factors that influence the publication of immunization research in Africa are not known. We, therefore, undertook this study to fill this research gap by providing insights into factors associated with childhood immunization research productivity on the continent. We postulated that research productivity influences immunization coverage. Methods We conducted a bibliometric analysis of childhood immunization research output from Africa, using research articles indexed in PubMed as a surrogate for total research productivity. We used zero-truncated negative binomial regression models to explore the factors associated with research productivity. Results We identified 1,641 articles on childhood immunization indexed in PubMed between 1974 and 2010 with authors from Africa, which represent only 8.9% of the global output. Five countries (South Africa, Nigeria, The Gambia, Egypt and Kenya) contributed 48% of the articles. After controlling for population and gross domestic product, The Gambia, Guinea-Bissau and Sao Tome and Principe were the most productive countries. In univariable analyses, the country's gross domestic product, total health expenditure, private health expenditure, and research and development expenditure had a significant positive association with increased research productivity. Immunization coverage, adult literacy rate, human development index and physician density had no significant association. In the multivarable model, only private health expenditure maintained significant statistical association with the number of immunization articles. Conclusions Immunization research productivity in Africa is highly skewed, with private health expenditure having a significant positive association. However, the current contribution of authors from Africa to global childhood immunization research output is minimal. The lack of association between research productivity and immunization coverage may be an indication of lack of interactive communication between health decision-makers, program managers and researchers; to ensure that immunization policies and plans are always informed by the best available evidence. PMID:23497441

The Treatment of Obesity in Cardiac Rehabilitation

PubMed Central

Ades, Philip A.; Savage, Patrick D.; Harvey-Berino, Jean

2010-01-01

Obesity is an independent risk factor for the development of coronary heart disease (CHD). At entry into cardiac rehabilitation (CR) over 80% of patients are overweight and over 50% have the metabolic syndrome. Yet, CR programs do not generally include weight loss programs as a programmatic component and weight loss outcomes in CR have been abysmal. A recently published study outlines a template for weight reduction based upon a combination of behavioral weight loss counseling and an approach to exercise that maximized exercise-related caloric expenditure. This approach to exercise optimally includes walking as the primary exercise modality and eventually requires almost daily longer distance exercise to maximize caloric expenditure. Additionally, lifestyle exercise such as stair climbing and avoidance of energy-saving devices should be incorporated into the daily routine. Risk factor benefits of weight loss and exercise training in overweight patients with coronary heart disease are broad and compelling. Improvements in insulin resistance, lipid profiles, blood pressure, clotting abnormalities, endothelial-dependent vasodilatory capacity, and measures of inflammation such as C-reactive protein have all been demonstrated. CR/secondary prevention programs can no longer ignore the challenge of obesity management in patients with CHD. Individual programs need to develop clinically effective and culturally sensitive approaches to weight control. Finally, multicenter randomized clinical trials of weight loss in CHD patients with assessment of long-term clinical outcomes need to be performed. PMID:20436355

Evaluating Comprehensive State Tobacco Prevention and Control Programs Using an Outcome Indicator Framework.

PubMed

Fulmer, Erika; Rogers, Todd; Glasgow, LaShawn; Brown, Susan; Kuiper, Nicole

2018-03-01

The outcome indicator framework helps tobacco prevention and control programs (TCPs) plan and implement theory-driven evaluations of their efforts to reduce and prevent tobacco use. Tobacco use is the single-most preventable cause of morbidity and mortality in the United States. The implementation of public health best practices by comprehensive state TCPs has been shown to prevent the initiation of tobacco use, reduce tobacco use prevalence, and decrease tobacco-related health care expenditures. Achieving and sustaining program goals require TCPs to evaluate the effectiveness and impact of their programs. To guide evaluation efforts by TCPs, the Centers for Disease Control and Prevention's Office on Smoking and Health developed an outcome indicator framework that includes a high-level logic model and evidence-based outcome indicators for each tobacco prevention and control goal area. In this article, we describe how TCPs and other community organizations can use the outcome indicator framework in their evaluation efforts. We also discuss how the framework is used at the national level to unify tobacco prevention and control efforts across varying state contexts, identify promising practices, and expand the public health evidence base.

Impacts of a disease management program for dually eligible beneficiaries.

PubMed

Esposito, Dominick; Brown, Randall; Chen, Arnold; Schore, Jennifer; Shapiro, Rachel

2008-01-01

The LifeMasters Supported SelfCare demonstration program provides disease management (DM) services to Florida Medicare beneficiaries who are also enrolled in Medicaid and have congestive heart failure (CHF), diabetes, or coronary artery disease (CAD). The population-based program provides primarily telephonic patient education and monitoring services. Findings from the randomized, intent-to-treat design over the first 18 months of operations show virtually no overall impacts on hospital or emergency room (ER) use, Medicare expenditures, quality of care, or prescription drug use for the 33,000 enrollees. However, for beneficiaries with CHF who resided in high-cost South Florida counties, the program reduced Medicare expenditures by 9.6 percent.

7 CFR 1486.402 - What are ineligible contributions?

Code of Federal Regulations, 2010 CFR

2010-01-01

... expenditures; (7) Funds, services, capital goods, or personnel provided by any U.S. government agency; (8) Capital investments made by a third party, such as permanent structures, real estate, and the purchase of... program; (12) Membership fees in clubs and social or professional organizations; and (13) Any expenditure...

77 FR 71420 - Federal Financial Participation in State Assistance Expenditures; Federal Matching Shares for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Federal Financial Participation in State Assistance Expenditures; Federal Matching Shares for Medicaid, the Children's Health Insurance Program, and Aid to Needy...FMAP rates that the U.S. Department of Health and Human Services (HHS) will use in determining the...

76 FR 74061 - Federal Financial Participation in State Assistance Expenditures; Federal Matching Shares for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-30

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Federal Financial Participation in State Assistance Expenditures; Federal Matching Shares for Medicaid, the Children's Health Insurance Program, and Aid to Needy...FMAP rates that the U.S. Department of Health and Human Services (HHS) will use in determining the...

36 CFR 223.282 - Deposit and expenditure of collected fees.

Code of Federal Regulations, 2013 CFR

2013-07-01

... AGRICULTURE SALE AND DISPOSAL OF NATIONAL FOREST SYSTEM TIMBER, SPECIAL FOREST PRODUCTS, AND FOREST BOTANICAL PRODUCTS Forest Botanical Products § 223.282 Deposit and expenditure of collected fees. (a) Funds collected under the pilot program for the harvest and sale of forest botanical products shall be deposited into a...

36 CFR 223.282 - Deposit and expenditure of collected fees.

Code of Federal Regulations, 2014 CFR

2014-07-01

... AGRICULTURE SALE AND DISPOSAL OF NATIONAL FOREST SYSTEM TIMBER, SPECIAL FOREST PRODUCTS, AND FOREST BOTANICAL PRODUCTS Forest Botanical Products § 223.282 Deposit and expenditure of collected fees. (a) Funds collected under the pilot program for the harvest and sale of forest botanical products shall be deposited into a...

36 CFR 223.282 - Deposit and expenditure of collected fees.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AGRICULTURE SALE AND DISPOSAL OF NATIONAL FOREST SYSTEM TIMBER, SPECIAL FOREST PRODUCTS, AND FOREST BOTANICAL PRODUCTS Forest Botanical Products § 223.282 Deposit and expenditure of collected fees. (a) Funds collected under the pilot program for the harvest and sale of forest botanical products shall be deposited into a...

36 CFR 223.282 - Deposit and expenditure of collected fees.

Code of Federal Regulations, 2012 CFR

2012-07-01

... AGRICULTURE SALE AND DISPOSAL OF NATIONAL FOREST SYSTEM TIMBER, SPECIAL FOREST PRODUCTS, AND FOREST BOTANICAL PRODUCTS Forest Botanical Products § 223.282 Deposit and expenditure of collected fees. (a) Funds collected under the pilot program for the harvest and sale of forest botanical products shall be deposited into a...

Florida Community College Finance: Update. Report 2.

ERIC Educational Resources Information Center

Florida State Postsecondary Education Planning Commission, Tallahassee.

In Florida, community college enrollments have increased by 41% over the past 5 years. The use of a 3-year average to fund enrollment has penalized those colleges which have grown dramatically. This report analyzes the range of community college expenditures by instructional program; the relationship of instructional expenditures to support…

34 CFR 222.18 - What amount does the Secretary forgive?

Code of Federal Regulations, 2010 CFR

2010-07-01

... SECONDARY EDUCATION, DEPARTMENT OF EDUCATION IMPACT AID PROGRAMS General § 222.18 What amount does the... hardship), and the LEA's current expenditure closing balance for the LEA's fiscal year immediately...'s preceding fiscal year's current expenditure closing balance is more than ten percent of its TCE...

34 CFR 206.40 - What restrictions are there on expenditures?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false What restrictions are there on expenditures? 206.40 Section 206.40 Education Regulations of the Offices of the Department of Education OFFICE OF ELEMENTARY AND SECONDARY EDUCATION, DEPARTMENT OF EDUCATION SPECIAL EDUCATIONAL PROGRAMS FOR STUDENTS WHOSE...

76 FR 18517 - Proposed Information Collection; Comment Request; Survey: Expenditures Incurred by Recipients of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-04

... Request; Survey: Expenditures Incurred by Recipients of Biomedical Research and Development Awards From... research budget and analyzing future NIH programs. A survey of award recipient entities is currently the... CONTACT: Steven Payson, Chief of Research, Government Division (BE-57), Bureau of Economic Analysis, U.S...

7 CFR 1486.402 - What are ineligible contributions?

Code of Federal Regulations, 2011 CFR

2011-01-01

... expenditures; (7) Funds, services, capital goods, or personnel provided by any U.S. government agency; (8) Capital investments made by a third party, such as permanent structures, real estate, and the purchase of... program; (12) Membership fees in clubs and social or professional organizations; and (13) Any expenditure...

Active Video Game Exercise Training Improves the Clinical Control of Asthma in Children: Randomized Controlled Trial.

PubMed

Gomes, Evelim L F D; Carvalho, Celso R F; Peixoto-Souza, Fabiana Sobral; Teixeira-Carvalho, Etiene Farah; Mendonça, Juliana Fernandes Barreto; Stirbulov, Roberto; Sampaio, Luciana Maria Malosá; Costa, Dirceu

2015-01-01

The aim of the present study was to determine whether aerobic exercise involving an active video game system improved asthma control, airway inflammation and exercise capacity in children with moderate to severe asthma. A randomized, controlled, single-blinded clinical trial was carried out. Thirty-six children with moderate to severe asthma were randomly allocated to either a video game group (VGG; N = 20) or a treadmill group (TG; n = 16). Both groups completed an eight-week supervised program with two weekly 40-minute sessions. Pre-training and post-training evaluations involved the Asthma Control Questionnaire, exhaled nitric oxide levels (FeNO), maximum exercise testing (Bruce protocol) and lung function. No differences between the VGG and TG were found at the baseline. Improvements occurred in both groups with regard to asthma control and exercise capacity. Moreover, a significant reduction in FeNO was found in the VGG (p < 0.05). Although the mean energy expenditure at rest and during exercise training was similar for both groups, the maximum energy expenditure was higher in the VGG. The present findings strongly suggest that aerobic training promoted by an active video game had a positive impact on children with asthma in terms of clinical control, improvement in their exercise capacity and a reduction in pulmonary inflammation. Clinicaltrials.gov NCT01438294.

Active Video Game Exercise Training Improves the Clinical Control of Asthma in Children: Randomized Controlled Trial

PubMed Central

Gomes, Evelim L. F. D.; Carvalho, Celso R. F.; Peixoto-Souza, Fabiana Sobral; Teixeira-Carvalho, Etiene Farah; Mendonça, Juliana Fernandes Barreto; Stirbulov, Roberto; Sampaio, Luciana Maria Malosá; Costa, Dirceu

2015-01-01

Objective The aim of the present study was to determine whether aerobic exercise involving an active video game system improved asthma control, airway inflammation and exercise capacity in children with moderate to severe asthma. Design A randomized, controlled, single-blinded clinical trial was carried out. Thirty-six children with moderate to severe asthma were randomly allocated to either a video game group (VGG; N = 20) or a treadmill group (TG; n = 16). Both groups completed an eight-week supervised program with two weekly 40-minute sessions. Pre-training and post-training evaluations involved the Asthma Control Questionnaire, exhaled nitric oxide levels (FeNO), maximum exercise testing (Bruce protocol) and lung function. Results No differences between the VGG and TG were found at the baseline. Improvements occurred in both groups with regard to asthma control and exercise capacity. Moreover, a significant reduction in FeNO was found in the VGG (p < 0.05). Although the mean energy expenditure at rest and during exercise training was similar for both groups, the maximum energy expenditure was higher in the VGG. Conclusion The present findings strongly suggest that aerobic training promoted by an active video game had a positive impact on children with asthma in terms of clinical control, improvementin their exercise capacity and a reductionin pulmonary inflammation. Trial Registration Clinicaltrials.gov NCT01438294 PMID:26301706

Medical Expenditures among Immigrant and Non-Immigrant Groups in the U.S.: Findings from the Medical Expenditures Panel Survey (2000–2008)

PubMed Central

Tarraf, Wassim; Miranda, Patricia Y.; González, Hector M.

2011-01-01

Objective To examine time trends and differences in medical expenditures between non-citizens, foreign-born, and U.S.-born citizens. Methods We used multi-year Medical Expenditures Panel Survey (2000–2008) data on non-institutionalized adults in the U.S. (N=190,965). Source specific and total medical expenditures were analyzed using regression models, bootstrap prediction techniques, and linear and non-linear decomposition methods to evaluate the relationship between immigration status and expenditures, controlling for confounding effects. Results We found that the average health expenditures between 2000 and 2008 for non-citizens immigrants ($1,836) were substantially lower compared to both foreign-born ($3,737) and U.S.-born citizens ($4,478). Differences were maintained after controlling for confounding effects. Decomposition techniques showed that the main determinants of these differences were the availability of a usual source of healthcare, insurance, and ethnicity/race. Conclusion Lower healthcare expenditures among immigrants result from disparate access to healthcare. The dissipation of demographic advantages among immigrants could prospectively produce higher pressures on the U.S. healthcare system as immigrants age and levels of chronic conditions rise. Barring a shift in policy, the brunt of the effects could be borne by an already overextended public healthcare system. PMID:22222383

Postoperative adverse outcomes among physicians receiving major surgeries

PubMed Central

Yeh, Chun-Chieh; Liao, Chien-Chang; Shih, Chun-Chuan; Jeng, Long-Bin; Chen, Ta-Liang

2016-01-01

Abstract Outcomes after surgeries involving physicians as patients have not been researched. This study compares postoperative adverse events between physicians as surgical patients and nonhealth professional controls. Using reimbursement claims data from Taiwan's National Health Insurance Program, we conducted a matched retrospective cohort study of 7973 physicians as surgical patients and 7973 propensity score–matched nonphysician controls receiving in-hospital major surgeries between 2004 and 2010. We compared postoperative major complications, length of hospital stay, intensive care unit (ICU), medical expenditure, and 30-day mortality. Compared with nonphysician controls, physicians as surgical patients had lower adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of postoperative deep wound infection (OR 0.63, 95% CI 0.40–0.99; P < 0.05), prolonged length of stay (OR 0.68, 95% CI 0.62–0.75; P < 0.0001), ICU admission (OR 0.74, 95% CI 0.66–0.83; P < 0.0001), and increased medical expenditure (OR 0.80, 95% CI 0.73–0.88; P < 0.0001). Physicians as surgical patients were not associated with 30-day in-hospital mortality after surgery. Physicians working at medical centers (P < 0.05 for all), dentists (P < 0.05 for all), and those with fewer coexisting medical conditions (P < 0.05 for all) had lower risks for postoperative prolonged length of stay, ICU admission, and increased medical expenditure. Although our study's findings suggest that physicians as surgical patients have better outcomes after surgery, future clinical prospective studies are needed for validation. PMID:27684836

Poverty and perceived stress: Evidence from two unconditional cash transfer programs in Zambia.

PubMed

Hjelm, Lisa; Handa, Sudhanshu; de Hoop, Jacobus; Palermo, Tia

2017-03-01

Poverty is a chronic stressor that can lead to poor physical and mental health. This study examines whether two similar government poverty alleviation programs reduced the levels of perceived stress and poverty among poor households in Zambia. Secondary data from two cluster randomized controlled trials were used to evaluate the impacts of two unconditional cash transfer programs in Zambia. Participants were interviewed at baseline and followed over 36 months. Perceived stress among female caregivers was assessed using the Cohen Perceived Stress Scale (PSS). Poverty indicators assessed included per capita expenditure, household food security, and (nonproductive) asset ownership. Fixed effects and ordinary least squares regressions were run, controlling for age, education, marital status, household demographics, location, and poverty status at baseline. Cash transfers did not reduce perceived stress but improved economic security (per capita consumption expenditure, food insecurity, and asset ownership). Among these poverty indicators, only food insecurity was associated with perceived stress. Age and education showed no consistent association with stress, whereas death of a household member was associated with higher stress levels. In this setting, perceived stress was not reduced by a positive income shock but was correlated with food insecurity and household deaths, suggesting that food security is an important stressor in this context. Although the program did reduce food insecurity, the size of the reduction was not enough to generate a statistically significant change in stress levels. The measure used in this study appears not to be correlated with characteristics to which it has been linked in other settings, and thus, further research is needed to examine whether this widely used perceived stress measure appropriately captures the concept of perceived stress in this population. Copyright © 2017 UNICEF. Published by Elsevier Ltd.. All rights reserved.

The Japanese national health screening and intervention program aimed at preventing worsening of the metabolic syndrome.

PubMed

Kohro, Takahide; Furui, Yuji; Mitsutake, Naohiro; Fujii, Ryo; Morita, Hiroyuki; Oku, Shinya; Ohe, Kazuhiko; Nagai, Ryozo

2008-03-01

Similar to the healthcare systems in other industrialized countries, the Japanese healthcare system is facing the problem of increasing medical expenditure. In Japan, this situation may be primarily attributed to advanced technological developments, an aging population, and increasing patient demand. Japan also faces the problem of a declining youth population due to a low birth rate. Taken together, these problems present the healthcare system with a very difficult financial situation. Several reforms have been undertaken to contain medical expenditure, such as increasing employee copayment for health insurance from 10% to 20% in 1997 and from 20% to 30% in 2003 in order to curb unnecessary visits to medical institutions. Since the aging of the Japanese population is inevitable, a suitable method to contain medical expenditure may be to screen individuals who are likely to develop lifestyle-related diseases and conduct early intervention programs for them to prevent the development of diseases such as myocardial infarction or stroke that are costly to treat. If this goal is attained, it may contribute to the containment of medical expenditure as well as to improving the quality of life of the elderly. Therefore, the Japanese Ministry of Health, Labor and Welfare has decided to introduce a nationwide health screening and intervention program specifically targeting the metabolic syndrome commencing April 2008. Here, we discuss (1) the background of the Japanese healthcare system and the problems facing it, (2) the underlying objective and details of the new screening program, and (3) the expected impact of the program.

Medical Care Expenditures for Individuals with Prediabetes: The Potential Cost Savings in Reducing the Risk of Developing Diabetes.

PubMed

Khan, Tamkeen; Tsipas, Stavros; Wozniak, Gregory

2017-10-01

The United States has 86 million adults with prediabetes. Individuals with prediabetes can prevent or delay the development of type 2 diabetes through lifestyle modifications such as participation in the National Diabetes Prevention Program (DPP), thereby mitigating the medical and economic burdens associated with diabetes. A cohort analysis of a commercially insured population was conducted using individual-level claims data from Truven Health MarketScan ® Lab Database to identify adults with prediabetes, track whether they develop diabetes, and compare medical expenditures for those who are newly diagnosed with diabetes to those who are not. This study then illustrates how reducing the risk of developing diabetes by participation in an evidence-based lifestyle change program could yield both positive net savings on medical care expenditures and return on investment (ROI). Annual expenditures are found to be nearly one third higher for those who develop diabetes in subsequent years relative to those who do not transition from prediabetes to diabetes, with an average difference of $2671 per year. At that cost differential, the 3-year ROI for a National DPP is estimated to be as high as 42%. The results show the importance and economic benefits of participation in lifestyle intervention programs to prevent or delay the onset of type 2 diabetes.

26 CFR 1.41-6 - Aggregation of expenditures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... corporations, as defined in section 41(f)(5), or a group of trades or businesses under common control. For.... Because all members of a group under common control are treated as a single taxpayer for purposes of... Credits Against Tax § 1.41-6 Aggregation of expenditures. (a) Controlled group of corporations; trades or...

26 CFR 1.41-6 - Aggregation of expenditures.

Code of Federal Regulations, 2011 CFR

2011-04-01

... corporations, as defined in section 41(f)(5), or a group of trades or businesses under common control. For.... Because all members of a group under common control are treated as a single taxpayer for purposes of... Credits Against Tax § 1.41-6 Aggregation of expenditures. (a) Controlled group of corporations; trades or...

Do adjusted clinical groups eliminate incentives for HMOs to avoid substance abusers? Evidence from the Maryland Medicaid HealthChoice program.

PubMed

Ettner, Susan L; Johnson, Steven

2003-01-01

The adequacy of risk adjustment to eliminate incentives for managed care organizations (MCOs) to avoid enrolling costly patients had been questioned. This study explored systematic differences in expenditures between beneficiaries with and without substance disorders assigned to the same capitation rate group under the Maryland Medicaid HealthChoice program. The investigators used fiscal year (FY) 1995 to 1997 Medicaid data to assign beneficiaries to rate cells based on FY 1995 diagnoses and compared the distribution of expenditures for beneficiaries with and without substance disorders, defined using FY 1997 and FY 1995 diagnoses. Results showed that differences in FY 1997 expenditures between beneficiaries with and without FY 1995 substance disorders were negligible. However, MCOs could expect greater average losses and lower average profits on beneficiaries with FY 1997 substance disorders. Thus, the adjusted clinical groups methodology used to adjust capitation payments in the HealthChoice program attenuated, but did not eliminate, financial incentives for MCOs to avoid substance abusers.

Depression treatment and short-term healthcare expenditures among elderly Medicare beneficiaries with chronic physical conditions.

PubMed

Shen, Chan; Shah, Neel; Findley, Patricia A; Sambamoorthi, Usha

2013-10-22

Research on the impact of depression treatment on expenditures is nascent and shows results that vary from negative associations with healthcare expenditures to increased expenditures. However many of these studies did not include psychotherapy as part of the depression treatment. None of these studies included "no treatment" as a comparison group. In addition, no study has included a broad group of chronic physical conditions in studying depression treatment expenditures. We determined the association between depression treatment and short-term healthcare expenditures using a nationally representative sample of Medicare beneficiaries with chronic physical conditions and depression. In this retrospective cohort study, we examined the association between depression treatment in the baseline year and healthcare expenditures in the following year using data from 2000 through 2005 of the Medicare Current Beneficiary Survey (MCBS), a nationally representative survey of Medicare beneficiaries. Using the rotating panel design of MCBS, we derived five two-year cohorts: 2000-2001, 2001-2002, 2002-2003, 2003-2004, and 2004-2005. The study sample included 1,055 elderly Medicare beneficiaries aged 65 or over. We compared healthcare expenditures of no depression treatment group with depression treatment groups using t-tests. Linear regressions of log-transformed dollars were used to assess the relationship between depression treatment and healthcare expenditures after controlling for demographic, socio-economic, health status, lifestyle risk factors, year of observation and baseline expenditures. Compared to no depression treatment ($16,795), the average total expenditures were higher for those who used antidepressants only ($17,425) and those who used psychotherapy with or without antidepressants ($19,733). After controlling for the independent variables, antidepressant use and psychotherapy with or without antidepressants were associated with 20.2% (95% CI: 14.1-26.7%) and 29.4% (95% CI: 18.8-41.0%) increase in total expenditures, respectively. We observed that depression treatment was positively associated with inpatient, medical provider and prescription drug expenditures. Among the elderly Medicare beneficiaries with chronic physical conditions, depression treatment was associated with greater short-term healthcare expenditures. Future research needs to replicate these findings and also examine whether depression treatment reduces expenditures over a longer period of time.

Co-occurring mental illness and health care utilization and expenditures in adults with obesity and chronic physical illness.

PubMed

Shen, Chan; Sambamoorthi, Usha; Rust, George

2008-06-01

The objectives of the study were to compare health care expenditures between adults with and without mental illness among individuals with obesity and chronic physical illness. We performed a cross-sectional analysis of 2440 adults (older than age 21) with obesity using a nationally representative survey of households, the Medical Expenditure Panel Survey. Chronic physical illness consisted of self-reported asthma, diabetes, heart disease, hypertension, or osteoarthritis. Mental illness included affective disorders; anxiety, somatoform, dissociative, personality disorders; and schizophrenia. Utilization and expenditures by type of service (total, inpatient, outpatient, emergency room, pharmacy, and other) were the dependent variables. Chi-square tests, logistic regression on likelihood of use, and ordinary least squares regression on logged expenditures among users were performed. All regressions controlled for gender, race/ethnicity, age, martial status, region, education, employment, poverty status, health insurance, smoking, and exercise. All analyses accounted for the complex design of the survey. We found that 25% of adults with obesity and physical illness had a mental illness. The average total expenditures for obese adults with physical illness and mental illness were $9897; average expenditures were $6584 for those with physical illness only. Mean pharmacy expenditures for obese adults with physical illness and mental illness and for those with physical illness only were $3343 and $1756, respectively. After controlling for all independent variables, among adults with obesity and physical illness, those with mental illness were more likely to use emergency services and had higher total, outpatient, and pharmaceutical expenditures than those without mental illness. Among individuals with obesity and chronic physical illness, expenditures increased when mental illness is added. Our study findings suggest cost-savings efforts should examine the reasons for high utilization and expenditures for those with obesity, chronic physical illness, and mental illness.

Economic effect of an expansion of pharmacy benefits on total health care expenditures by a state Medicaid program.

PubMed

Jenkins, Tara L; Harrison, Donald L; Jacobs, Elgene W; Neas, Barbara R; Hagemann, Tracy M

2009-01-01

To evaluate the economic effect of a pharmacy benefit expansion on a population of Oklahoma Medicaid recipients and to determine whether recipients who routinely maximized their monthly prescription limit (cap) before the benefit expansion benefited more from the expansion than the remainder of the study population. Retrospective study. Oklahoma Medicaid claims data from January 1, 2003, to December 31, 2004. Data from 15,936 Oklahoma Medicaid recipients. Retrospective administrative analysis using the Oklahoma Health Care Authority pharmacy and medical claims databases. Total health care expenditures per recipient per year, total medical expenditures per recipient per year, and total pharmacy expenditures per recipient per year. Total health care expenditures increased 17% after the benefit expansion (P < 0.0001). Of this increase, 65% was attributed to pharmacy expenditures and 35% to medical expenditures. However, a subpopulation of recipients who routinely reached their prescription limit before the expansion had a statistically significant increase in total and pharmacy expenditures; a statistically significant increase in medical expenditures was not observed. Although total health care expenditures increased after a monthly pharmacy benefit in a Medicaid population was expanded, a subpopulation of recipients identified as high pharmacy users before the expansion did not have a statistically significant increase in medical expenditures, whereas those who were non-high users experienced a significant increase. Additionally, this subpopulation experienced a nonsignificant decrease in hospital expenditures. These results could suggest that this subpopulation was affected differently than the overall population by the expansion of the Medicaid pharmacy benefit.

National and surgical health care expenditures, 2005-2025.

PubMed

Muñoz, Eric; Muñoz, William; Wise, Leslie

2010-02-01

Health care expenditures for 2005 in the United States were $1.9733 trillion and 15.9% of the gross domestic product (GDP). Twenty-nine percent of those expenditures were secondary to surgical revenues. Health care expenditures are increasing 2(1/2) times the rate of the general US economy and are being fed by new technologies, new medications, the aging population, more services provided per patient, defensive medicine and little tort reform, the insurance system, and the free rider problem, ie, patients are cared for as emergencies regardless of insurance coverage and legality, which all have contributed to rising health care and surgical expenditures over the last 50 years. The purpose of this study was to project aggregate national health care expenditures, aggregate surgical health care expenditures, and the United States GDP for the years 2005-2025. Model building and existing state and national data were used. Aggregate surgical health care expenditures were computed as 29% of aggregate health care expenditures using a unique model developed by the late Dr. Francis D. Moore. The model of Dr. Moore which used 1981 federal data was verified/tested using data from UMDNJ-University Hospital, and New Jersey and national data from 2005. From 1965 to 2005 mean health care expenditures increased at 4.9% per year, and US GDP increased at a mean of 2.1% per year. Aggregate surgical expenditures are expected to grow from $572 billion in 2005 (4.6% of US GDP) to $912 billion (2005 dollars) in the year 2025 (7.3% of US GDP). Aggregate health care expenditures are projected to increase from $5572 per capita (15.9% of GDP) in 2005 to $8832 per capita (2005 dollars) in 2025 (25.2% of US GDP). Both surgery and national health care expenditures are expected to expand by almost 60% during the period 2005-2025. Thus, surgical health care expenditures by 2025 are likely to be 1/14 of the US economy, and health care expenditures will be (1/4) of the US economy. Real per capita GDP growth is relatively flat in the United States. Rising surgical health care expenditures and national health care expenditures are a significant issue for the US population. Unfortunately, programs at the state and federal level as well as private programs, for the last 50 years have not been able to slow the growth in health care expenditures. These trends are likely to continue and the effects will be: * A change in the US standard of living as surgical and health care expenditures become a larger part of the earned dollar per American especially with the current volatility of the US economy, * A rise in the cost of products made in the United States to pay the rising health care bill with a concomitant change in our national and international standard of living, and * An increasing debt and increases in federal and state taxes which will be required to maintain the current health care system, ie, Medicare, Medicaid, and the private health care insurance payment scheme, which has not changed substantially over the past 40 to 50 years. Surgeons must look at the incremental benefit of new technologies and procedures and determine which to choose if we are to slow the growth of surgical health care expenditures.

The heterogeneous impact of a successful tobacco control campaign: a case study of Mauritius.

PubMed

Ross, Hana; Moussa, Leelmanee; Harris, Tom; Ajodhea, Rajive

2018-01-01

Mauritius has one of the highest smoking prevalences in Africa, contributing to its high burden of non-communicable diseases. Mauritius implemented a series of tobacco control measures from 2009 to 2012, including tobacco tax increases. There is evidence that these policies reduced tobacco consumption, but it is not clear what impact they had across different socioeconomic groups. The impact of tobacco control measures on different income groups was analysed by contrasting household tobacco expenditures reported in 2006-2007 and 2012 household expenditure surveys. We employed the seemingly unrelated regression model to assess the impact of tobacco use on other household expenditures and calculated Gini coefficients to assess tobacco expenditure inequality. From 2006 to 2012, excise taxes and retail cigarette prices increased by 40.6% and 15.3% in real terms, respectively. These increases were accompanied by numerous non-price tobacco control measures. The share of tobacco-consuming households declined from 35.7% to 29.3%, with the largest relative drop among low-income households. The Gini coefficient of household tobacco expenditures increased by 10.4% due to decreased spending by low-income households. Low-income households demonstrated the largest fall in their tobacco budget shares, and the impact of tobacco consumption on poverty decreased by 26.2%. Households that continued purchasing tobacco reduced their expenditures on transportation, communication, health, and education. These results suggest that tobacco control policies, including sizeable tax increases, were progressive in their impact. We conclude that tobacco use increases poverty and inequality, but stronger tobacco control policies can mitigate the impact of tobacco use on impoverishment. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Fiscal rules, powerful levers for controlling the health budget? Evidence from 32 OECD countries.

PubMed

Schakel, Herman Christiaan; Wu, Erilia Hao; Jeurissen, Patrick

2018-03-01

Publicly funded healthcare forms an intricate part of government spending in most Organisation for Economic Co-operation and Development (OECD) countries, because of its reliance on entitlements and dedicated revenue streams. The impact of budgetary rules and procedures on publicly funded health care might thus be different from other spending categories. In this study we focus on the potential of fiscal rules to contain these costs and their design features. We assess the relationship between fiscal rules and the level of public health care expenditure of 32 (OECD) countries between 1985 and 2014. Our dataset consists of health care expenditure data of the OECD and data on fiscal rules of the International Monetary Fund (IMF) for that same period. Through a multivariate regression analysis, we estimate the association between fiscal rules and its subcategories and inflation adjusted public health care expenditure. We control for population, Gross Domestic Product (GDP), debt and whether countries received an IMF bailout for the specific period. In all our regressions we include country and year fixed effects. The presence of a fiscal rule on average is associated with a 3 % reduction of public health care expenditure. Supranational balanced budget rules are associated with some 8 % lower expenditure. Health service provision-oriented countries with more passive purchasing structures seem less capable of containing costs through fiscal rules. Fiscal rules demonstrate lagged effectiveness; the potential for expenditure reduction increases after one and two years of fiscal rule implementation. Finally, we find evidence that fiscal frameworks that incorporate multi-year expenditure ceilings show additional potential for cost control. Our study shows that there seems a clear relationship between the potential of fiscal rules and budgeting health expenses. Using fiscal rules to contain the level of health care expenditure can thus be a necessary precondition for successful strategies for cost control.

76 FR 28988 - Medicare Program; Accelerated Development Sessions for Accountable Care Organizations-June 20, 21...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-19

... health, and lower growth in health care expenditures. II. Session Participant Information and Agenda... new ways of delivering health care and paying health care providers in ways that can save money for... coordinated care can improve beneficiaries' quality outcomes and reduce the growth of Medicare expenditures...

45 CFR 263.2 - What kinds of State expenditures count toward meeting a State's basic MOE expenditure requirement?

Code of Federal Regulations, 2013 CFR

2013-10-01

... Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN...) Cash assistance, including the State's share of the assigned child support collection that is... payment; (2) Child care assistance (see § 263.3); (3) Education activities designed to increase self...

45 CFR 263.2 - What kinds of State expenditures count toward meeting a State's basic MOE expenditure requirement?

Code of Federal Regulations, 2014 CFR

2014-10-01

... Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN...) Cash assistance, including the State's share of the assigned child support collection that is... payment; (2) Child care assistance (see § 263.3); (3) Education activities designed to increase self...

45 CFR 263.2 - What kinds of State expenditures count toward meeting a State's basic MOE expenditure requirement?

Code of Federal Regulations, 2010 CFR

2010-10-01

... Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN...) Cash assistance, including the State's share of the assigned child support collection that is... payment; (2) Child care assistance (see § 263.3); (3) Education activities designed to increase self...

45 CFR 263.2 - What kinds of State expenditures count toward meeting a State's basic MOE expenditure requirement?

Code of Federal Regulations, 2011 CFR

2011-10-01

... Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN...) Cash assistance, including the State's share of the assigned child support collection that is... payment; (2) Child care assistance (see § 263.3); (3) Education activities designed to increase self...

45 CFR 263.2 - What kinds of State expenditures count toward meeting a State's basic MOE expenditure requirement?

Code of Federal Regulations, 2012 CFR

2012-10-01

... Relating to Public Welfare OFFICE OF FAMILY ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN...) Cash assistance, including the State's share of the assigned child support collection that is... payment; (2) Child care assistance (see § 263.3); (3) Education activities designed to increase self...

Does Disparity in the Way Disabled Older Adults Are Treated Imply Ageism?

ERIC Educational Resources Information Center

Kane, Robert L.; Priester, Reinhard; Neumann, Dean

2007-01-01

Although the nearly one in seven Americans who have disabilities share many characteristics, the attitudes toward and the programs, care models, expenditures, and goals for people with disabilities differ substantially across age groups in ways that suggest ageism. Expenditures per recipient are substantially higher for younger individuals with…

32 CFR 37.1290 - Expenditures or outlays.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 1 2011-07-01 2011-07-01 false Expenditures or outlays. 37.1290 Section 37.1290 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD GRANT AND AGREEMENT... outlays. Charges made to the project or program. They may be reported either on a cash or accrual basis...

32 CFR 37.1290 - Expenditures or outlays.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 1 2013-07-01 2013-07-01 false Expenditures or outlays. 37.1290 Section 37.1290 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD GRANT AND AGREEMENT... outlays. Charges made to the project or program. They may be reported either on a cash or accrual basis...

32 CFR 37.1290 - Expenditures or outlays.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Expenditures or outlays. 37.1290 Section 37.1290 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD GRANT AND AGREEMENT... outlays. Charges made to the project or program. They may be reported either on a cash or accrual basis...

32 CFR 37.1290 - Expenditures or outlays.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 1 2012-07-01 2012-07-01 false Expenditures or outlays. 37.1290 Section 37.1290 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD GRANT AND AGREEMENT... outlays. Charges made to the project or program. They may be reported either on a cash or accrual basis...

45 CFR 304.23 - Expenditures for which Federal financial participation is not available.

Code of Federal Regulations, 2011 CFR

2011-10-01

... participation is not available. 304.23 Section 304.23 Public Welfare Regulations Relating to Public Welfare... FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES FEDERAL FINANCIAL PARTICIPATION § 304.23 Expenditures for... accordance with § 304.22. (c) Construction and major renovations. (d) Education and training programs and...

Once Established, What Techniques Work Best for Monitoring the District?

ERIC Educational Resources Information Center

Triverio, Louis E.

Monitoring school budget expenditures is as important as budgeting. School boards should decide which broad financial policies will provide control of expenditures, what financial tools to use in monitoring expenditures, and what areas outside of the budget should be monitored. A board's financial policy ought to deal with the line item transfers,…

The quest for an accurate accounting of public health expenditures.

PubMed

Atchison, C; Barry, M A; Kanarek, N; Gebbie, K

2000-09-01

This article describes one effort to develop management tools that will help public health administrators and policy makers implement comprehensive public health strategies. It recounts the ongoing development of a methodology through which the Essential Public Health Services can be related to public health budgets, appropriations, and expenditures. Through three pilot projects involving: (1) nine state health agencies, (2) three local health agencies, and (3) all local jurisdictions and the state health agency in one state, a workable methodology for identifying public expenditures for comprehensive public health programming has been identified.

Cigarette prices, cigarette expenditure and smoking-induced deprivation: findings from the International Tobacco Control Mexico survey

PubMed Central

Siahpush, Mohammad; Thrasher, James F; Yong, Hua H; Cummings, K Michael; Fong, Geoffrey T; de Miera, Belén Saenz; Borland, Ron

2015-01-01

Aim Mexico implemented annual tax increases between 2009 and 2011. We examined among current smokers the association of price paid per cigarette and daily cigarette expenditure with smoking-induced deprivation (SID) and whether the association of price or expenditure with SID varies by income. Methods We used data (n = 2410) from three waves of the International Tobacco Control Mexico survey (ie, 2008, 2010, 2011) and employed logistic regression to estimate the association of price paid per cigarette and daily cigarette expenditure with the probability of SID (‘In the last 6 months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?’). Results Price paid per cigarette increased from Mex $1.24 in 2008, to Mex$1.36 in 2010, to Mex$1.64 in 2011. Daily cigarette expenditure increased from Mex $6.9, to Mex$7.6 and to Mex$8.4 in the 3 years. There was no evidence of an association between price and SID. However, higher expenditure was associated with a higher probability of SID. There was no evidence that the association of price or expenditure with SID varied by income. Conclusion Tax increases in Mexico have resulted in smokers paying more and spending more for their cigarettes. Those with higher cigarette expenditure experience more SID, with no evidence that poorer smokers are more affected. PMID:22923478

Cigarette prices, cigarette expenditure and smoking-induced deprivation: findings from the International Tobacco Control Mexico survey.

PubMed

Siahpush, Mohammad; Thrasher, James F; Yong, Hua H; Cummings, K Michael; Fong, Geoffrey T; de Miera, Belén Saenz; Borland, Ron

2013-07-01

Mexico implemented annual tax increases between 2009 and 2011. We examined among current smokers the association of price paid per cigarette and daily cigarette expenditure with smoking-induced deprivation (SID) and whether the association of price or expenditure with SID varies by income. We used data (n=2410) from three waves of the International Tobacco Control Mexico survey (ie, 2008, 2010, 2011) and employed logistic regression to estimate the association of price paid per cigarette and daily cigarette expenditure with the probability of SID ('In the last 6 months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?'). Price paid per cigarette increased from Mex$1.24 in 2008, to Mex$1.36 in 2010, to Mex$1.64 in 2011. Daily cigarette expenditure increased from Mex$6.9, to Mex$7.6 and to Mex$8.4 in the 3 years. There was no evidence of an association between price and SID. However, higher expenditure was associated with a higher probability of SID. There was no evidence that the association of price or expenditure with SID varied by income. Tax increases in Mexico have resulted in smokers paying more and spending more for their cigarettes. Those with higher cigarette expenditure experience more SID, with no evidence that poorer smokers are more affected.

Hepatic SIRT1 attenuates hepatic steatosis and controls energy balance in mice by inducing fibroblast growth factor 21.

PubMed

Li, Yu; Wong, Kimberly; Giles, Amber; Jiang, Jianwei; Lee, Jong Woo; Adams, Andrew C; Kharitonenkov, Alexei; Yang, Qin; Gao, Bin; Guarente, Leonard; Zang, Mengwei

2014-02-01

The hepatocyte-derived hormone fibroblast growth factor 21 (FGF21) is a hormone-like regulator of metabolism. The nicotinamide adenine dinucleotide-dependent deacetylase SIRT1 regulates fatty acid metabolism through multiple nutrient sensors. Hepatic overexpression of SIRT1 reduces steatosis and glucose intolerance in obese mice. We investigated mechanisms by which SIRT1 controls hepatic steatosis in mice. Liver-specific SIRT1 knockout (SIRT1 LKO) mice and their wild-type littermates (controls) were divided into groups that were placed on a normal chow diet, fasted for 24 hours, or fasted for 24 hours and then fed for 6 hours. Liver tissues were collected and analyzed by histologic examination, gene expression profiling, and real-time polymerase chain reaction assays. Human HepG2 cells were incubated with pharmacologic activators of SIRT1 (resveratrol or SRT1720) and mitochondrion oxidation consumption rate and immunoblot analyses were performed. FGF21 was overexpressed in SIRT1 LKO mice using an adenoviral vector. Energy expenditure was assessed by indirect calorimetry. Prolonged fasting induced lipid deposition in livers of control mice, but severe hepatic steatosis in SIRT1 LKO mice. Gene expression analysis showed that fasting up-regulated FGF21 in livers of control mice but not in SIRT1 LKO mice. Decreased hepatic and circulating levels of FGF21 in fasted SIRT1 LKO mice were associated with reduced hepatic expression of genes involved in fatty acid oxidation and ketogenesis, and increased expression of genes that control lipogenesis, compared with fasted control mice. Resveratrol or SRT1720 each increased the transcriptional activity of the FGF21 promoter (-2070/+117) and levels of FGF21 messenger RNA and protein in HepG2 cells. Surprisingly, SIRT1 LKO mice developed late-onset obesity with impaired whole-body energy expenditure. Hepatic overexpression of FGF21 in SIRT1 LKO mice increased the expression of genes that regulate fatty acid oxidation, decreased fasting-induced steatosis, reduced obesity, increased energy expenditure, and promoted browning of white adipose tissue. SIRT1-mediated activation of FGF21 prevents liver steatosis caused by fasting. This hepatocyte-derived endocrine signaling appears to regulate expression of genes that control a brown fat-like program in white adipose tissue, energy expenditure, and adiposity. Strategies to activate SIRT1 or FGF21 could be used to treat fatty liver disease and obesity. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

The Impact of China's National Essential Medicine Policy and Its Implications for Urban Outpatients: A Multivariate Difference-in-Differences Study.

PubMed

Ding, Liman; Wu, Jing

2017-03-01

To evaluate the effects of the National Essential Medicine Policy (NEMP) on outpatient service utilization and expenditure in Tianjin, China. All government-owned general primary health care centers (PHCs) within the Urban Employee Basic Medical Insurance in Tianjin were involved in the study. Of these, 49 PHCs implemented the NEMP in April 2009, and constituted the intervention group, and the remaining PHCs constituted the control group. Patients who had visited only one of the two groups at least once pre-NEMP (April 2008 to March 2009) and post-NEMP (April 2009 to March 2010) were included in the correspondent group. A difference-in-differences (DID) analysis was used to estimate the impacts adjusting for patients' sociodemographic characteristics and health status. Sensitivity was tested using the propensity score matching method. A total of 23,362 and 4,148 patients from the intervention and control groups were identified, respectively. The patients in the intervention group were older (63.7 years vs. 58.8 years; P < 0.001) and in worse health status, as indicated by the Quan-Charlson comorbidity index (1.0 vs. 0.7; P < 0.001), than their counterparts in the control group. The DID results controlling for other confounders indicated that the annual outpatient visits, total annual expenditure, drug expenditure, and out-of-pocket expenditure per capita for the intervention group were not significantly different from those of the control group. Propensity score matching-adjusted DID regression models demonstrated similar results. The China NEMP implementation did not affect the annual outpatient visits, total expenditure, drug expenditure, and out-of-pocket expenditure in the short term and the original policy goals were not met. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Supplemental Nutrition Assistance Program (SNAP) Participation and Health Care Expenditures Among Low-Income Adults.

PubMed

Berkowitz, Seth A; Seligman, Hilary K; Rigdon, Joseph; Meigs, James B; Basu, Sanjay

2017-11-01

Food insecurity is associated with high health care expenditures, but the effectiveness of food insecurity interventions on health care costs is unknown. To determine whether the Supplemental Nutrition Assistance Program (SNAP), which addresses food insecurity, can reduce health care expenditures. This is a retrospective cohort study of 4447 noninstitutionalized adults with income below 200% of the federal poverty threshold who participated in the 2011 National Health Interview Survey (NHIS) and the 2012-2013 Medical Expenditure Panel Survey (MEPS). Self-reported SNAP participation in 2011. Total health care expenditures (all paid claims and out-of-pocket costs) in the 2012-2013 period. To test whether SNAP participation was associated with lower subsequent health care expenditures, we used generalized linear modeling (gamma distribution, log link, with survey design information), adjusting for demographics (age, gender, race/ethnicity), socioeconomic factors (income, education, Social Security Disability Insurance disability, urban/rural), census region, health insurance, and self-reported medical conditions. We also conducted sensitivity analyses as a robustness check for these modeling assumptions. A total of 4447 participants (2567 women and 1880 men) were enrolled in the study, mean (SE) age, 42.7 (0.5) years; 1889 were SNAP participants, and 2558 were not. Compared with other low-income adults, SNAP participants were younger (mean [SE] age, 40.3 [0.6] vs 44.1 [0.7] years), more likely to have public insurance or be uninsured (84.9% vs 67.7%), and more likely to be disabled (24.2% vs 10.6%) (P < .001 for all). In age- and gender-adjusted models, health care expenditures between those who did and did not participate in SNAP were similar (difference, $34; 95% CI, -$1097 to $1165). In fully adjusted models, SNAP was associated with lower estimated annual health care expenditures (-$1409; 95% CI, -$2694 to -$125). Sensitivity analyses were consistent with these results, also indicating that SNAP participation was associated with significantly lower estimated expenditures. SNAP enrollment is associated with reduced health care spending among low-income American adults, a finding consistent across several analytic approaches. Encouraging SNAP enrollment among eligible adults may help reduce health care costs in the United States.

Household costs for personal protection against mosquitoes: secondary outcomes from a randomised controlled trial of dengue prevention in Guerrero state, Mexico.

PubMed

Legorreta-Soberanis, José; Paredes-Solís, Sergio; Morales-Pérez, Arcadio; Nava-Aguilera, Elizabeth; Serrano-de Los Santos, Felipe René; Sánchez-Gervacio, Belén Madeline; Ledogar, Robert J; Cockcroft, Anne; Andersson, Neil

2017-05-30

Dengue is a serious public health issue that affects households in endemic areas in terms of health and also economically, imposing costs for prevention and treatment of cases. The Camino Verde cluster-randomised controlled trial in Mexico and Nicaragua assessed the impact of evidence-based community engagement in dengue prevention. The Mexican arm of the trial was conducted in 90 randomly selected communities in three coastal regions of Guerrero State. This study reports an analysis of a secondary outcome of the trial: household use of and expenditure on anti-mosquito products. We examined whether the education and mobilisation activities of the trial motivated people to spend less on anti-mosquito products. We carried out a household questionnaire survey in the trial communities in 2010 (12,312 households) and 2012 (5349 households in intervention clusters, 5142 households in control clusters), including questions about socio-economic status, self-reported dengue illness, and purchase of and expenditure on insecticide anti-mosquito products in the previous month. We examined expenditures on anti-mosquito products at baseline in relation to social vulnerability and we compared use of and expenditures on these products between intervention and control clusters in 2012. In 2010, 44.2% of 12,312 households reported using anti-mosquito products, with a mean expenditure of USD4.61 per month among those who used them. Socially vulnerable households spent less on the products. In 2012, after the intervention, the proportion of households who purchased anti-mosquito products in the last month was significantly lower in intervention clusters (47.8%; 2503/5293) than in control clusters (53.3%; 2707/5079) (difference - 0.05, 95% CIca -0.100 to -0.010). The mean expenditure on the products, among those households who bought them, was USD6.43; 30.4% in the intervention clusters and 36.7% in the control clusters spent more than this (difference - 0.06, 95% CIca -0.12 to -0.01). These expenditures on anti-mosquito products represent 3.3% and 3.8% respectively of monthly household income for the poorest 10% of the population in 2012. The Camino Verde community mobilisation intervention, as well as being effective in reducing dengue infections, was effective in reducing household use of and expenditure on insecticide anti-mosquito products. ( ISRCTN27581154 ).

A retrospective case-control analysis of the outpatient expenditures for western medicine and dental treatment modalities in CKD patients in Taiwan.

PubMed

Huang, Ren-Yeong; Lin, Yuh-Feng; Kao, Sen-Yeong; Shieh, Yi-Shing; Chen, Jin-Shuen

2014-01-01

To determine if expenditures for dentistry (DENT) correlate with severity of chronic kidney disease (CKD). A total of 10,457 subjects were enrolled from January 2008 to December 2010, divided into three groups: healthy control (HC) group (n = 1,438), high risk (HR) group (n = 3,392), and CKD group (n = 5,627). Five stages were further categorized for the CKD group. OPD utilization and expenditures for western medicine (WM), DENT, and TCM (traditional Chinese medicine) were analyzed retrospectively (2000-2008) using Taiwan's National Health Insurance Research Database. Three major areas were analyzed among groups CKD, HR and HC in this study: 1) demographic data and medical history; 2) utilization (visits/person/year) and expenditures (9-year cumulative expenditure, expenditure/person/year) for OPD services in WM, DENT, and TCM; and 3) utilization and expenditures for dental OPD services, particularly in dental filling, root canal and periodontal therapy. OPD utilization and expenditures of WM increased significantly for the CKD group compared with the HR and HC groups, and increased steadily along with the severity of CKD stages. However, overall DENT and TCM utilization and expenditures did not increase for the CKD group. In comparison among different CKD stages, the average expenditures and utilization for DENT including restorative filling and periodontal therapy, but not root canal therapy, showed significant decreases according to severity of CKD stage, indicating less DENT OPD utilization with progression of CKD. Patients with advanced CKD used DENT OPD service less frequently. However, the connection between CKD and DENT service utilization requires further study.

Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program

PubMed Central

Howell, Doris M.; Abernathy, Tom; Cockerill, Rhonda; Brazil, Kevin; Wagner, Frank; Librach, Larry

2011-01-01

Purpose: Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services. Methods: Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot. Results: Subjects with gastrointestinal symptoms (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; p<0.001), whereas age, number of GP visits, gastrointestinal symptoms (i.e., nausea, vomiting, bowel obstruction) and eating problems (i.e., anorexia/cachexia) predicted home care expenditures. Conclusions: Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies. Relevance: Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources. PMID:22294993

24 CFR 570.504 - Program income.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Program income. 570.504 Section 570... income. (a) Recording program income. The receipt and expenditure of program income as defined in § 570... of program income received by recipients. (1) Program income received before grant closeout may be...

A moderate-intensity exercise program fulfilling the American College of Sports Medicine net energy expenditure recommendation improves health outcomes in premenopausal women.

PubMed

Dalleck, Lance C; Borresen, Erica C; Wallenta, Jeanna T; Zahler, Kyle L; Boyd, Eugene K

2008-01-01

The purpose of this study was to assess and quantify the health outcomes associated with a moderate-intensity (50% VO2R) exercise program designed to achieve the American College of Sports Medicine net caloric expenditure guideline of 1,000 kcal x wk(-1). Fifteen apparently healthy but sedentary premenopausal women with the baseline characteristics (mean +/- SD age, height, weight, body composition, and VO2max: 37.4 +/- 6.3 yr, 166.2 +/- 6.2 cm, 72.1 +/- 11.2 kg, 32.5 +/- 5.8%, and 34.8 +/- 5.8 mL x kg(-1) x min(-1), respectively) participated in and completed the study. Exercise training was performed 3-4 days per week for 10 weeks in a progressive manner at moderate intensity (50% VO2R). There were significant (P < 0.05) improvements in VO2max (+2.5 mL x kg(-1) x min(-1)), systolic (-13.7 mm Hg) and diastolic (-6.4 mm Hg) blood pressure, high-density lipoprotein cholesterol (+3.2 mg x dL(-1)), fasting blood glucose (-4.9 mg x dL(-1)), and percent body fat (-1.6%). Although the American College of Sports Medicine specifies that the energy expenditure goal should be a net caloric expenditure of 1,000 kcal x wk(-1) and classifies relative moderate intensity as 40-59% of heart rate reserve or VO2R, we are unaware of any previous investigations that have examined the specific health outcomes associated with an exercise program fulfilling these requirements. Results indicate that significant health benefits will be conferred to previously sedentary, premenopausal women who engage in a moderate-intensity, 10-week exercise program designed to fulfill the net energy expenditure guideline of 1,000 kcal x wk(-1).

The effects of hospice coverage on Medicare expenditures.

PubMed Central

Kidder, D

1992-01-01

This article reports on the findings of a study of the effects of the hospice program on Medicare Part A expenditures during the first three years of the program. The analysis compared treatment costs between hospice beneficiaries and nonbenefit patients with diagnosis of malignant cancer during their last seven months of life. It was estimated that during the first three years of the hospice program, Medicare saved $1.26 for every dollar spent on Part A expenditures. While the methodology included use of data from Medicare claims to adjust for confounding factors, including self-selection bias, our estimated savings might still have been overstated due to persistent selection effects. The extent of savings also varied according to the hospice's organization. Freestanding hospices, in contrast to those affiliated with either a hospital, nursing home, or home health agency, achieved the greatest savings by utilizing home care more extensively. However, we note that payment rates are increasing and the limits on the benefit period are being lifted, making it possible that the savings related to the hospice program found in this study will not continue. Of greater importance may be the long-term access and quality effects engendered by the benefit's preference for home care. PMID:1592605

The effects of hospice coverage on Medicare expenditures.

PubMed

Kidder, D

1992-06-01

This article reports on the findings of a study of the effects of the hospice program on Medicare Part A expenditures during the first three years of the program. The analysis compared treatment costs between hospice beneficiaries and nonbenefit patients with diagnosis of malignant cancer during their last seven months of life. It was estimated that during the first three years of the hospice program, Medicare saved $1.26 for every dollar spent on Part A expenditures. While the methodology included use of data from Medicare claims to adjust for confounding factors, including self-selection bias, our estimated savings might still have been overstated due to persistent selection effects. The extent of savings also varied according to the hospice's organization. Freestanding hospices, in contrast to those affiliated with either a hospital, nursing home, or home health agency, achieved the greatest savings by utilizing home care more extensively. However, we note that payment rates are increasing and the limits on the benefit period are being lifted, making it possible that the savings related to the hospice program found in this study will not continue. Of greater importance may be the long-term access and quality effects engendered by the benefit's preference for home care.

Impact of Medicare Part D on Medicare-Medicaid dual-eligible beneficiaries' prescription utilization and expenditures.

PubMed

Basu, Anirban; Yin, Wesley; Alexander, G Caleb

2010-02-01

To examine the effect of Part D on 65-78-year-old noninstitutionalized dual eligibles' prescription utilization and expenditures. Random sample of unique pharmacy customers of a national retail pharmacy chain who filled at least one prescription during both 2005 and 2006. For each subject, we obtained claims data for every prescription filled between January 1, 2005, and April 31, 2007. Generalized estimating equations were used to examine the experience of a "treatment" group (dual eligibles between 65 and 78 years on January 1, 2005) with that of a "control" group (near-elderly patients with Medicaid coverage between 60 and 63 years on January 1, 2005) during the first 18 months after Part D implementation. Expenditures for the treatment and control groups tracked each other closely in the pre-Part D period. Immediately following the implementation of Part D, expenditures for both groups decreased and then leveled off. There were no significant changes in trends in the dual eligibles' out-of-pocket expenditures, total monthly expenditures, pill-days, or total number of prescriptions due to Part D. We find no evidence that Part D adversely affected pharmaceutical utilization or out-of-pocket expenditures of dual eligibles during the transition period, nor during the 16 months subsequent to Part D implementation.

Energy metabolism and nutritional status in hospitalized patients with lung cancer.

PubMed

Takemura, Yumi; Sasaki, Masaya; Goto, Kenichi; Takaoka, Azusa; Ohi, Akiko; Kurihara, Mika; Nakanishi, Naoko; Nakano, Yasutaka; Hanaoka, Jun

2016-09-01

This study aimed to investigate the energy metabolism of patients with lung cancer and the relationship between energy metabolism and proinflammatory cytokines. Twenty-eight patients with lung cancer and 18 healthy controls were enrolled in this study. The nutritional status upon admission was analyzed using nutritional screening tools and laboratory tests. The resting energy expenditure and respiratory quotient were measured using indirect calorimetry, and the predicted resting energy expenditure was calculated using the Harris-Benedict equation. Energy expenditure was increased in patients with advanced stage disease, and there were positive correlations between measured resting energy expenditure/body weight and interleukin-6 levels and between measured resting energy expenditure/predicted resting energy expenditure and interleukin-6 levels. There were significant relationships between body mass index and plasma leptin or acylated ghrelin levels. However, the level of appetite controlling hormones did not affect dietary intake. There was a negative correlation between plasma interleukin-6 levels and dietary intake, suggesting that interleukin-6 plays a role in reducing dietary intake. These results indicate that energy expenditure changes significantly with lung cancer stage and that plasma interleukin-6 levels affect energy metabolism and dietary intake. Thus, nutritional management that considers the changes in energy metabolism is important in patients with lung cancer.

Increased energy expenditure and glucose oxidation during acute nontraumatic skin pain in humans.

PubMed

Holland-Fischer, Peter; Greisen, Jacob; Grøfte, Thorbjørn; Jensen, Troels S; Hansen, Peter O; Vilstrup, Hendrik

2009-04-01

Tissue injury is accompanied by pain and results in increased energy expenditure, which may promote catabolism. The extent to which pain contributes to this sequence of events is not known. In a cross-over design, 10 healthy volunteers were examined on three occasions; first, during self-controlled nontraumatic electrical painful stimulus to the abdominal skin, maintaining an intensity of 8 on the visual analogue scale (0-10). Next, the electrical stimulus was reproduced during local analgesia and, finally, there was a control session without stimulus. Indirect calorimetry and blood and urine sampling was done in order to calculate energy expenditure and substrate utilization. During pain stimulus, energy expenditure increased acutely and reversibly by 62% (95% confidence interval, 43-83), which was abolished by local analgesia. Energy expenditure paralleled both heart rate and blood catecholamine levels. The energy expenditure increase was fuelled by all energy sources, with the largest increase in glucose utilization. The pain-related increase in energy expenditure was possibly mediated by adrenergic activity and was probably to a large extent due to increased muscle tone. These effects may be enhanced by cortical events related to the pain. The increase in glucose consumption favours catabolism. Our findings emphasize the clinical importance of pain management.

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

PubMed

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

2017-10-01

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

The impact of stand-biased desks in classrooms on calorie expenditure in children.

PubMed

Benden, Mark E; Blake, Jamilia J; Wendel, Monica L; Huber, John C

2011-08-01

Childhood obesity is a public health concern with significant health and economic impacts. We conducted a prospective experimental study in 4 classrooms in central Texas to determine the effect of desks that encourage standing rather than sitting on caloric expenditure in children. Students were monitored with calorie expenditure-measuring arm-bands worn for 10 days in the fall and spring. The treatment group experienced significant increases in calorie expenditure over the control group, a finding that has implications for policy and practice.

Career and Technical Education: The Impact of Program Investment on Accountability Ratings

ERIC Educational Resources Information Center

Hersperger, Susan L.

2012-01-01

Purpose: The purpose of this study was to examine the extent to which Career and Technical Education (CTE) enrollment and expenditure differed as a function of the accountability ratings of Texas public high schools. The extent to which CTE enrollment and expenditure influences accountability ratings is not clear. Accordingly, in this study, CTE…

78 FR 16630 - Clean Air Act Grant: South Coast Air Quality Management District; Opportunity for Pubic Hearing

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-18

... Grant: South Coast Air Quality Management District; Opportunity for Pubic Hearing AGENCY: Environmental... expenditures of non-Federal funds for the South Coast Air Quality Management District (SCAQMD) in support of... to a non-selective reduction in the expenditures in the programs of the South Coast Air Quality...

45 CFR 264.74 - How will we determine the Contingency Fund MOE level for the annual reconciliation?

Code of Federal Regulations, 2010 CFR

2010-10-01

... will exclude the State's share of expenditures from the former IV-A child care programs (AFDC/JOBS..., DEPARTMENT OF HEALTH AND HUMAN SERVICES OTHER ACCOUNTABILITY PROVISIONS What Are the Requirements for the...? (a)(1) The Contingency Fund MOE level includes the State's share of expenditures for AFDC benefit...

Health Care Expenditures for Children with Autism Spectrum Disorders in Medicaid

ERIC Educational Resources Information Center

Wang, Li; Leslie, Douglas L.

2010-01-01

Objective: To study trends in health care expenditures associated with autism spectrum disorders (ASDs) in state Medicaid programs. Method: Using Medicaid data from 42 states from 2000 to 2003, patients aged 17 years and under who were continuously enrolled in fee-for-service Medicaid were studied. Patients with claims related to autistic disorder…

45 CFR 264.74 - How will we determine the Contingency Fund MOE level for the annual reconciliation?

Code of Federal Regulations, 2012 CFR

2012-10-01

... will exclude the State's share of expenditures from the former IV-A child care programs (AFDC/JOBS..., DEPARTMENT OF HEALTH AND HUMAN SERVICES OTHER ACCOUNTABILITY PROVISIONS What Are the Requirements for the...? (a)(1) The Contingency Fund MOE level includes the State's share of expenditures for AFDC benefit...

45 CFR 264.74 - How will we determine the Contingency Fund MOE level for the annual reconciliation?

Code of Federal Regulations, 2014 CFR

2014-10-01

... will exclude the State's share of expenditures from the former IV-A child care programs (AFDC/JOBS..., DEPARTMENT OF HEALTH AND HUMAN SERVICES OTHER ACCOUNTABILITY PROVISIONS What Are the Requirements for the...? (a)(1) The Contingency Fund MOE level includes the State's share of expenditures for AFDC benefit...

45 CFR 264.74 - How will we determine the Contingency Fund MOE level for the annual reconciliation?

Code of Federal Regulations, 2011 CFR

2011-10-01

... will exclude the State's share of expenditures from the former IV-A child care programs (AFDC/JOBS..., DEPARTMENT OF HEALTH AND HUMAN SERVICES OTHER ACCOUNTABILITY PROVISIONS What Are the Requirements for the...? (a)(1) The Contingency Fund MOE level includes the State's share of expenditures for AFDC benefit...

45 CFR 264.74 - How will we determine the Contingency Fund MOE level for the annual reconciliation?

Code of Federal Regulations, 2013 CFR

2013-10-01

... will exclude the State's share of expenditures from the former IV-A child care programs (AFDC/JOBS..., DEPARTMENT OF HEALTH AND HUMAN SERVICES OTHER ACCOUNTABILITY PROVISIONS What Are the Requirements for the...? (a)(1) The Contingency Fund MOE level includes the State's share of expenditures for AFDC benefit...

Making Sense of the Change: Missouri Children's Budget Watch Report.

ERIC Educational Resources Information Center

Citizens for Missouri's Children, St. Louis.

In preparing for changes in federal funding policies the state of Missouri is one of 13 states to participate in the Children's Budget Watch Project, which documents expenditures on children's programs for the fiscal years 1990, 1993, 1994 and 1995. This report from the Citizens for Missouri's Children presents data on Missouri's expenditures in a…

75 FR 80501 - Adjustments for Disaster-Recovery States to the Fourth Quarter of Fiscal Year 2011 and Fiscal...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-22

... Care, Adoption Assistance and Guardianship Assistance programs. The purpose of the increase to the FMAP... the increased FMAP is not available under title XIX include expenditures for disproportionate share... under Title XXI. The increased FMAP is available for expenditures under part E of title IV only...

77 FR 43290 - Children's Health Insurance Program (CHIP); Final Allotments to States, the District of Columbia...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-24

... subsequent fiscal years are available to match expenditures under an approved State child health plan for 2... care growth factor and the child population growth factor. The per capita health care growth factor for... National Health Expenditures from the calendar year in which the previous fiscal year ends to the calendar...

Fiscal Year 2001 Medicaid Home and Community-Based Services Expenditures Exceed Those of ICFs/MR.

ERIC Educational Resources Information Center

Lakin, K. Charlie; Prouty, Robert; Smith, Jerra; Polister, Barb; Smith, Gary

2002-01-01

This article reports that in 2001, for the first time since its creation 20 years earlier, Medicaid Home and Community-Based Services (HCBS) Waiver programs for persons with intellectual and developmental disabilities had Federal and state expenditures that exceeded those for Medicaid Intermediate Care Facilities for Persons with Mental…

Expenditures for Resources in School Library Media Centers, FY 1991-92.

ERIC Educational Resources Information Center

Miller, Marilyn L.; Shontz, Marilyn

1993-01-01

The sixth in a series of "School Library Journal" reports on trends in school library expenditures for program development shows that commitment to the teaching and motivating of reading is in conflict with fascination with technology and that access to books is being seriously curtailed by the deteriorating state of school library collections.…

[Effectiveness and economic impact of a program of integrated care with telemedicine support on insulin-treated type 2 diabetic patients (Study GITDIABE)].

PubMed

Inoriza, Jose M; Ibañez, Annabel; Pérez-Berruezo, Xavier; Inoriza-Nadal, Cristina; Coderch, Jordi

2017-03-01

To evaluate if insulin-treated type 2 diabetic patients with blood glucose self-monitoring (DIA), included in a program of integrated management of diabetes mellitus (DM), achieve a better level of metabolic control with telemedicine support than with conventional support, after 12 months follow-up. The impact on the use and cost of healthcare services, pharmaceutical expenditure, and consumption of test strips for blood glucose, was also assessed. A prospective parallel cohorts study. Four basic health areas of an integrated healthcare organisation. The study included 126 DIA patients aged 15 or more years, treated with rapid or intermediate Insulin and blood glucose self-monitoring, grouped into 42 cases and 84 controls, matched according to age, sex, level of metabolic control, and morbidity profile. Telematics physician-patient communication and download of blood glucose self-monitoring data through the Emminens eConecta ® platform; test strips home delivered according to consumption. Hidden controls with usual follow-up. Glycosylated haemoglobin (%HbA1c); perception of quality of life (EuroQol-5 and EsDQOL); cardiovascular risk; use of healthcare resources; consumption of test strips; pharmaceutical and healthcare expenditure. Reduction of 0.38% in HbA1c in the cases (95% CI:-0.89% to 0.12%). No significant differences with regard to any of the activities registered, or any significant change in the quality of life. The results obtained are similar to other equivalent studies. The profile of the patient is elderly and with multiple morbidities, who still have technological limitations. To surpass these barriers, it would be necessary to devote more time to the training and to the resolution of possible technological problems. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Cost-effectiveness of the screening and treatment of diabetic retinopathy. What are the costs of underutilization?

PubMed

Fendrick, A M; Javitt, J C; Chiang, Y P

1992-01-01

Diabetic retinal disease remains a leading cause of visual disability among those of working age. Controlled trials have demonstrated that timely diagnosis and photocoagulation treatment can reduce significantly the likelihood of visual impairment in affected diabetic patients. Using a prospective simulation model, we show that an annual screening and treatment program saves thousands of years of vision and reduces medical expenditures over the lifetime of a cohort of Swedish Type I diabetic patients.

Management. A continuing bibliography with indexes. [March 1980

NASA Technical Reports Server (NTRS)

1980-01-01

This bibliography cites 604 reports, articles, and other documents introduced into the NASA scientific and technical information system in 1979 covering the management of research and development, contracts, production, logistics, personnel, safety, reliability and quality control. Program, project, and systems management; management policy, philosophy, tools, and techniques; decision making processes for managers; technology assessment; management of urban problems; and information for managers on Federal resources, expenditures, financing, and budgeting are also covered. Abstracts are provided as well as subject, personal author, and corporate source indexes.

Homeostatic and non-homeostatic appetite control along the spectrum of physical activity levels: An updated perspective.

PubMed

Beaulieu, Kristine; Hopkins, Mark; Blundell, John; Finlayson, Graham

2017-12-28

The current obesogenic environment promotes physical inactivity and food consumption in excess of energy requirements, two important modifiable risk factors influencing energy balance. Habitual physical activity has been shown to impact not only energy expenditure, but also energy intake through mechanisms of appetite control. This review summarizes recent theory and evidence underpinning the role of physical activity in the homeostatic and non-homeostatic mechanisms controlling appetite. Energy intake along the spectrum of physical activity levels (inactive to highly active) appears to be J-shaped, with low levels of physical activity leading to dysregulated appetite and a mismatch between energy intake and expenditure. At higher levels, habitual physical activity influences homeostatic appetite control in a dual-process action by increasing the drive to eat through greater energy expenditure, but also by enhancing post-meal satiety, allowing energy intake to better match energy expenditure in response to hunger and satiety signals. There is clear presumptive evidence that physical activity energy expenditure can act as a drive (determinant) of energy intake. The influence of physical activity level on non-homeostatic appetite control is less clear, but low levels of physical activity may amplify hedonic states and behavioural traits favouring overconsumption indirectly through increased body fat. More evidence is required to understand the interaction between physical activity, appetite control and diet composition on passive overconsumption and energy balance. Furthermore, potential moderators of appetite control along the spectrum of physical activity, such as body composition, sex, and type, intensity and timing of physical activity, remain to be fully understood. Copyright © 2018 Elsevier Inc. All rights reserved.

Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh

PubMed Central

Efroymson, D.; Ahmed, S.; Townsend, J.; Alam, S. M.; Dey, A. R.; Saha, R.; Dhar, B.; Sujon, A. I.; Ahmed, K. U.; Rahman, O.

2001-01-01

OBJECTIVE—To investigate the extent of tobacco expenditures in Bangladesh and to compare those costs with potential investment in food and other essential items.
DESIGN—Review of available statistics and calculations based thereon.
RESULTS—Expenditure on tobacco, particularly cigarettes, represents a major burden for impoverished Bangladeshis. The poorest (household income of less than $24/month) are twice as likely to smoke as the wealthiest (household income of more than $118/month). Average male cigarette smokers spend more than twice as much on cigarettes as per capita expenditure on clothing, housing, health and education combined. The typical poor smoker could easily add over 500 calories to the diet of one or two children with his or her daily tobacco expenditure. An estimated 10.5 million people currently malnourished could have an adequate diet if money on tobacco were spent on food instead. The lives of 350 children could be saved each day.
CONCLUSION—Tobacco expenditures exacerbate the effects of poverty and cause significant deterioration in living standards among the poor. This aspect of tobacco use has been largely neglected by those working in poverty and tobacco control. Strong tobacco control measures could have immediate impact on the health of the poor by decreasing tobacco expenditures and thus significantly increasing the resources of the poor. Addressing the issue of tobacco and poverty together could make tobacco control a higher priority for poor countries.


Keywords: poverty; malnutrion; tobacco expenditure; Bangladesh PMID:11544383

Factors Driving Local Health Departments' Partnerships With Other Organizations in Maternal and Child Health, Communicable Disease Prevention, and Chronic Disease Control.

PubMed

Luo, Huabin; Winterbauer, Nancy L; Shah, Gulzar; Tucker, Ashley; Xu, Lei

2016-01-01

To describe levels of partnership between local health departments (LHDs) and other community organizations in maternal and child health (MCH), communicable disease prevention, and chronic disease control and to assess LHD organizational characteristics and community factors that contribute to partnerships. Data were drawn from the National Association of County & City Health Officials' 2013 National Profile Study (Profile Study) and the Area Health Resources File. LHDs that received module 1 of the Profile Study were asked to describe the level of partnership in MCH, communicable disease prevention, and chronic disease control. Levels of partnership included "not involved," "networking," "coordinating," "cooperating," and "collaborating," with "collaborating" as the highest level of partnership. Covariates included both LHD organizational and community factors. Data analyses were conducted using Stata 13 SVY procedures to account for the Profile Study's survey design. About 82%, 92%, and 80% of LHDs partnered with other organizations in MCH, communicable disease prevention, and chronic disease control programs, respectively. LHDs having a public health physician on staff were more likely to partner in chronic disease control programs (adjusted odds ratio [AOR] = 2.33; 95% confidence interval [CI], 1.03-5.25). Larger per capita expenditure was also associated with partnerships in MCH (AOR = 2.43; 95% CI, 1.22-4.86) and chronic disease prevention programs (AOR = 1.76; 95% CI, 1.09-2.86). Completion of a community health assessment was associated with partnership in MCH (AOR = 7.26; 95% CI, 2.90-18.18), and chronic disease prevention (AOR = 5.10; 95% CI, 2.28-11.39). About 1 in 5 LHDs did not have any partnerships in chronic disease control. LHD partnerships should be promoted to improve care coordination and utilization of limited health care resources. Factors that might promote LHDs' partnerships include having a public health physician on staff, higher per capita expenditure, and completion of a community health assessment. Community context likely influences types and levels of partnerships. A better understanding of these contextual factors may lead to more complete and effective LHD partnerships.

Household food group expenditure patterns are associated with child anthropometry at ages 5, 8 and 12 years in Ethiopia, India, Peru and Vietnam.

PubMed

Humphries, Debbie L; Dearden, Kirk A; Crookston, Benjamin T; Woldehanna, Tassew; Penny, Mary E; Behrman, Jere R

2017-08-01

Population-level analysis of dietary influences on nutritional status is challenging in part due to limitations in dietary intake data. Household expenditure surveys, covering recent household expenditures and including key food groups, are routinely conducted in low- and middle-income countries. These data may help identify patterns of food expenditure that relate to child growth. We investigated the relationship between household food expenditures and child growth using factor analysis. We used data on 6993 children from Ethiopia, India, Peru and Vietnam at ages 5, 8 and 12y from the Young Lives cohort. We compared associations between household food expenditures and child growth (height-for-age z scores, HAZ; body mass index-for-age z scores, BMI-Z) using total household food expenditures and the "household food group expenditure index" (HFGEI) extracted from household expenditures with factor analysis on the seven food groups in the child dietary diversity scale, controlling for total food expenditures, child dietary diversity, data collection round, rural/urban residence and child sex. We used the HFGEI to capture households' allocations of their finances across food groups in the context of local food pricing, availability and pReferences RESULTS: The HFGEI was associated with significant increases in child HAZ in Ethiopia (0.07), India (0.14), and Vietnam (0.07) after adjusting for all control variables. Total food expenditures remained significantly associated with increases in BMI-Z for India (0.15), Peru (0.11) and Vietnam (0.06) after adjusting for study round, HFGEI, dietary diversity, rural residence, and whether the child was female. Dietary diversity was inversely associated with BMI-Z in India and Peru. Mean dietary diversity increased from age 5y to 8y and decreased from age 8y to 12y in all countries. Household food expenditure data provide insights into household food purchasing patterns that significantly predict HAZ and BMI-Z. Including food expenditure patterns data in analyses may yield important information about child nutritional status and linear growth. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Determinants of medical expenditures in the last 6 months of life.

PubMed

Kelley, Amy S; Ettner, Susan L; Morrison, R Sean; Du, Qingling; Wenger, Neil S; Sarkisian, Catherine A

2011-02-15

End-of-life medical expenditures exceed costs of care during other years, vary across regions, and are likely to be unsustainable. Identifying determinants of expenditure variation may reveal opportunities for reducing costs. To identify patient-level determinants of Medicare expenditures at the end of life and to determine the contributions of these factors to expenditure variation while accounting for regional characteristics. It was hypothesized that race or ethnicity, social support, and functional status are independently associated with treatment intensity and controlling for regional characteristics, and that individual characteristics account for a substantial proportion of expenditure variation. Using data from the Health and Retirement Study, Medicare claims, and The Dartmouth Atlas of Health Care, relationships were modeled between expenditures and patient and regional characteristics. United States, 2000 to 2006. 2394 Health and Retirement Study decedents aged 65.5 years or older. Medicare expenditures in the last 6 months of life were estimated in a series of 2-level multivariable regression models that included patient, regional, and patient and regional characteristics. Decline in function (rate ratio [RR], 1.64 [95% CI, 1.46 to 1.83]); Hispanic ethnicity (RR, 1.50 [CI, 1.22 to 1.85]); black race (RR, 1.43 [CI, 1.25 to 1.64]); and certain chronic diseases, including diabetes (RR, 1.16 [CI, 1.06 to 1.27]), were associated with higher expenditures. Nearby family (RR, 0.90 [CI, 0.82 to 0.98]) and dementia (RR, 0.78 CI, 0.71 to 0.87]) were associated with lower expenditures, and advance care planning had no association. Regional characteristics, including end-of-life practice patterns (RR, 1.09 [CI, 1.06 to 1.14]) and hospital beds per capita (RR, 1.01 [CI, 1.00 to 1.02]), were associated with higher expenditures. Patient characteristics explained 10% of overall variance and retained statistically significant relationships with expenditures after regional characteristics were controlled for. The study limitations include the decedent sample, proxy informants, and a large proportion of unexplained variation. Patient characteristics, such as functional decline, race or ethnicity, chronic disease, and nearby family, are important determinants of expenditures at the end of life, independent of regional characteristics. The Brookdale Foundation.

Comprehensive geriatric intervention program with and without weekly class-style exercise: research protocol of a cluster randomized controlled trial in Kyoto-Kameoka Study

PubMed Central

Yoshida, Tsukasa; Yoshinaka, Yasuko; Yoshimoto, Mie; Tanaka, Yoko; Itoi, Aya; Yamagata, Emi; Ebine, Naoyuki; Ishikawa-Takata, Kazuko; Kimura, Misaka

2018-01-01

Objective The number of long-term care (LTC) users and the associated expenditures in Japan are increasing dramatically. The national government recommends LTC prevention through activation of communities. However, there is no clear evidence of the effect of population-based comprehensive geriatric intervention program (CGIP) for restraints of LTC users and the associated expenditures in the future. The aims of the current paper are to describe the study protocol and progress of a cluster randomized controlled trial (RCT) with a CGIP in Kameoka City. Methods The cluster RCT involved random allocation of regions as intervention (n=4,859) and nonintervention (n=7,195). Participants were elderly persons aged ≥65 years without LTC certification who had responded to a mailing survey. The residents living in intervention regions were invited to a physical check-up, and 1,463 people participated (30.3%). These individuals were invited to the CGIP, and 526 accepted. The CGIP comprised instructions on: 1) low-load resistance training using bodyweight, ankle weights, and elastic bands; 2) increasing daily physical activity; 3) oral motor exercise and care; and 4) a well-balanced diet based on a program from Ministry of Health, Labour and Welfare. We allocated the intervention regions randomly into home-based self-care program alone (HB group, 5 regions, n=275) and home-based program+weekly class-style session (CS group, 5 regions, n=251). We evaluated the effects of the CGIP at 12 weeks and at 12 or 15 months on physical function, and are conducting follow-up data collection for an indefinite period regarding LTC certification, medical costs, and mortality. Results and discussion The study was launched with good response rates in each phase. Participants of both groups significantly increased their step counts by ~1,000 per day from the baseline during the CGIP. This RCT will provide valuable information and evidence about effectiveness of a community-based CGIP. PMID:29872280

Why Are Diabetes Medications So Expensive and What Can Be Done to Control Their Cost?

PubMed

McEwen, Laura N; Casagrande, Sarah Stark; Kuo, Shihchen; Herman, William H

2017-09-01

The purposes of this study were to describe how medication prices are established, to explain why antihyperglycemic medications have become so expensive, to show trends in expenditures for antihyperglycemic medications, and to highlight strategies to control expenditures in the USA. In the U.S., pharmaceutical manufacturers set the prices for new products. Between 2002 and 2012, expenditures for antihyperglycemic medications increased from $10 billion to $22 billion. This increase was primarily driven by expenditures for insulin which increased sixfold. The increase in insulin expenditures may be attributed to several factors: the shift from inexpensive beef and pork insulins to more expensive genetically engineered human insulins and insulin analogs, dramatic price increases for the available insulins, physician prescribing practices, policies that limit payers' abilities to negotiate prices, and nontransparent negotiation of rebates and discounts. The costs of antihyperglycemic medications, especially insulin, have become a barrier to diabetes treatment. While clinical interventions to shift physician prescribing practices towards lower cost drugs may provide some relief, we will ultimately need policy interventions such as more stringent requirements for patent exclusivity, greater transparency in medication pricing, greater opportunities for price negotiation, and outcomes-based pricing models to control the costs of antihyperglycemic medications.

Energy expenditure and enjoyment during video game play: differences by game type.

PubMed

Lyons, Elizabeth J; Tate, Deborah F; Ward, Dianne S; Bowling, J Michael; Ribisl, Kurt M; Kalyararaman, Sriram

2011-10-01

Play of physically active video games may be a way to increase physical activity and/or decrease sedentary behavior, but games are not universally active or enjoyable. Active games may differ from traditional games on important attributes, which may affect frequency and intensity of play. The purpose of this study was to investigate differences in energy expenditure and enjoyment across four game types: shooter (played with traditional controllers), band simulation (guitar or drum controller), dance simulation (dance mat controller), and fitness (balance board controller). Energy expenditure (METs) and enjoyment were measured across 10 games in 100 young adults age 18-35 yr (50 women). All games except shooter games significantly increased energy expenditure over rest (P < 0.001). Fitness and dance games increased energy expenditure by 322% (mean ± SD = 3.10 ± 0.89 METs) and 298% (2.91 ± 0.87 METs), which was greater than that produced by band simulation (73%, 1.28 ± 0.28 METs) and shooter games (23%, 0.91 ± 0.16 METs). However, enjoyment was higher in band simulation games than in other types (P < 0.001). Body mass-corrected energy expenditure was greater in normal weight than in overweight participants in the two most active game types (P < 0.001). Active video games can significantly increase energy expended during screen time, but these games are less enjoyable than other more sedentary games, suggesting that they may be less likely to be played over time. Less active but more enjoyable video games may be a promising method for decreasing sedentary behavior.

The Addition of a Video Game to Stationary Cycling: The Impact on Energy Expenditure in Overweight Children.

PubMed

Haddock, Bryan L; Siegel, Shannon R; Wikin, Linda D

2009-01-01

INTRODUCTION: The prevalence of obesity in children has reached epidemic proportions with over 37% of children aged 6-11 years in the U.S. being classified as "at risk for overweight" or "overweight." Utilization of active video games has been proposed as one possible mechanism to help shift the tide of the obesity epidemic. PURPOSE: The purpose of this study was to determine if riding a stationary bike that controlled a video game would lead to significantly greater energy expenditure than riding the same bike without the video game connected. METHODS: Twenty children, 7-14 years old, with a BMI classification of "at risk for overweight" or "overweight" participated in this study. Following familiarization, energy expenditure was evaluated while riding a stationary bike for 20 minutes. One test was performed without the addition of a video game and one test with the bike controlling the speed of a car on the video game. RESULTS: Oxygen consumption and energy expenditure were significantly elevated above baseline in both conditions. Energy expenditure was significantly higher while riding the bike as it controlled the video game (4.4 ± 1.2 Kcal·min(-1)) than when riding the bike by itself (3.7 ± 1.1 Kcal·min(-1)) (p<0.05). Perceived exertion was not significantly different between the two sessions (p>0.05). CONCLUSION: Using a stationary bike to control a video game led to greater energy expenditure than riding a stationary bike without the video game and without a related increase in perceived exertion.

Energy Expenditure and Enjoyment during Video Game Play: Differences by Game Type

PubMed Central

Lyons, Elizabeth J.; Tate, Deborah F.; Ward, Dianne S.; Bowling, J. Michael; Ribisl, Kurt M.; Kalyararaman, Sriram

2012-01-01

Purpose Play of physically active video games may be a way to increase physical activity and/or decrease sedentary behavior, but games are not universally active or enjoyable. Active games may differ from traditional games on important attributes, which may affect frequency and intensity of play. The purpose of this study was to investigate differences in energy expenditure and enjoyment across four game types: shooter (played with traditional controllers), band simulation (guitar or drum controller), dance simulation (dance mat controller), and fitness (balance board controller). Methods Energy expenditure (metabolic equivalents [METs]) and enjoyment were measured across ten games in 100 young adults aged 18 to 35 (50 females). Results All games except shooter games significantly increased energy expenditure over rest (P < .001). Fitness and dance games increased energy expenditure by 322 (mean [SD] 3.10 [0.89] METs) and 298 (2.91 [0.87] METs) percent, which was greater than that produced by band simulation (73%, 1.28 [0.28] METs) and shooter games (23%, 0.91 [0.16] METs). However, enjoyment was higher in band simulation games than in other types (P < .001). Body mass-corrected energy expenditure was greater in normal weight than overweight participants in the two most active game types (P < .001). Conclusions Active video games can significantly increase energy expended during screen time, but these games are less enjoyable than other more sedentary games, suggesting that they may be less likely to be played over time. Less active but more enjoyable video games may be a promising method for decreasing sedentary behavior. PMID:21364477

Standardization of Type 2 Diabetes Outpatient Expenditure with Bundled Payment Method in China.

PubMed

Xu, Guo-Chao; Luo, Yun; Li, Qian; Wu, Meng-Fan; Zhou, Zi-Jun

2016-04-20

In recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services. This study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination. We found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups. We argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures.

Acute Effects of Capsaicin on Energy Expenditure and Fat Oxidation in Negative Energy Balance

PubMed Central

Janssens, Pilou L. H. R.; Hursel, Rick; Martens, Eveline A. P.; Westerterp-Plantenga, Margriet S.

2013-01-01

Background Addition of capsaicin (CAPS) to the diet has been shown to increase energy expenditure; therefore capsaicin is an interesting target for anti-obesity therapy. Aim We investigated the 24 h effects of CAPS on energy expenditure, substrate oxidation and blood pressure during 25% negative energy balance. Methods Subjects underwent four 36 h sessions in a respiration chamber for measurements of energy expenditure, substrate oxidation and blood pressure. They received 100% or 75% of their daily energy requirements in the conditions ‘100%CAPS’, ‘100%Control’, ‘75%CAPS’ and ‘75%Control’. CAPS was given at a dose of 2.56 mg (1.03 g of red chili pepper, 39,050 Scoville heat units (SHU)) with every meal. Results An induced negative energy balance of 25% was effectively a 20.5% negative energy balance due to adapting mechanisms. Diet-induced thermogenesis (DIT) and resting energy expenditure (REE) at 75%CAPS did not differ from DIT and REE at 100%Control, while at 75%Control these tended to be or were lower than at 100%Control (p = 0.05 and p = 0.02 respectively). Sleeping metabolic rate (SMR) at 75%CAPS did not differ from SMR at 100%CAPS, while SMR at 75%Control was lower than at 100%CAPS (p = 0.04). Fat oxidation at 75%CAPS was higher than at 100%Control (p = 0.03), while with 75%Control it did not differ from 100%Control. Respiratory quotient (RQ) was more decreased at 75%CAPS (p = 0.04) than at 75%Control (p = 0.05) when compared with 100%Control. Blood pressure did not differ between the four conditions. Conclusion In an effectively 20.5% negative energy balance, consumption of 2.56 mg capsaicin per meal supports negative energy balance by counteracting the unfavorable negative energy balance effect of decrease in components of energy expenditure. Moreover, consumption of 2.56 mg capsaicin per meal promotes fat oxidation in negative energy balance and does not increase blood pressure significantly. Trial Registration Nederlands Trial Register; registration number NTR2944 PMID:23844093

Out-of-pocket expenditure on chronic non-communicable diseases in sub-Saharan Africa: the case of rural Malawi.

PubMed

Wang, Qun; Fu, Alex Z; Brenner, Stephan; Kalmus, Olivier; Banda, Hastings Thomas; De Allegri, Manuela

2015-01-01

In Sub-Saharan Africa (SSA) the disease burden of chronic non-communicable diseases (CNCDs) is rising considerably. Given weaknesses in existing financial arrangements across SSA, expenditure on CNCDs is often borne directly by patients through out-of-pocket (OOP) payments. This study explored patterns and determinants of OOP expenditure on CNCDs in Malawi. We used data from the first round of a longitudinal household health survey conducted in 2012 on a sample of 1199 households in three rural districts in Malawi. We used a two-part model to analyze determinants of OOP expenditure on CNCDs. 475 respondents reported at least one CNCD. More than 60% of the 298 individuals who reported seeking care incurred OOP expenditure. The amount of OOP expenditure on CNCDs comprised 22% of their monthly per capita household expenditure. The poorer the household, the higher proportion of their monthly per capita household expenditure was spent on CNCDs. Higher severity of disease was significantly associated with an increased likelihood of incurring OOP expenditure. Use of formal care was negatively associated with the possibility of incurring OOP expenditure. The following factors were positively associated with the amount of OOP expenditure: being female, Alomwe and household head, longer duration of disease, CNCDs targeted through active screening programs, higher socio-economic status, household head being literate, using formal care, and fewer household members living with a CNCD within a household. Our study showed that, in spite of a context where care for CNCDs should in principle be available free of charge at point of use, OOP payments impose a considerable financial burden on rural households, especially among the poorest. This suggests the existence of important gaps in financial protection in the current coverage policy.

Out-of-Pocket Expenditure on Chronic Non-Communicable Diseases in Sub-Saharan Africa: The Case of Rural Malawi

PubMed Central

Wang, Qun; Fu, Alex Z.; Brenner, Stephan; Kalmus, Olivier; Banda, Hastings Thomas; De Allegri, Manuela

2015-01-01

In Sub-Saharan Africa (SSA) the disease burden of chronic non-communicable diseases (CNCDs) is rising considerably. Given weaknesses in existing financial arrangements across SSA, expenditure on CNCDs is often borne directly by patients through out-of-pocket (OOP) payments. This study explored patterns and determinants of OOP expenditure on CNCDs in Malawi. We used data from the first round of a longitudinal household health survey conducted in 2012 on a sample of 1199 households in three rural districts in Malawi. We used a two-part model to analyze determinants of OOP expenditure on CNCDs. 475 respondents reported at least one CNCD. More than 60% of the 298 individuals who reported seeking care incurred OOP expenditure. The amount of OOP expenditure on CNCDs comprised 22% of their monthly per capita household expenditure. The poorer the household, the higher proportion of their monthly per capita household expenditure was spent on CNCDs. Higher severity of disease was significantly associated with an increased likelihood of incurring OOP expenditure. Use of formal care was negatively associated with the possibility of incurring OOP expenditure. The following factors were positively associated with the amount of OOP expenditure: being female, Alomwe and household head, longer duration of disease, CNCDs targeted through active screening programs, higher socio-economic status, household head being literate, using formal care, and fewer household members living with a CNCD within a household. Our study showed that, in spite of a context where care for CNCDs should in principle be available free of charge at point of use, OOP payments impose a considerable financial burden on rural households, especially among the poorest. This suggests the existence of important gaps in financial protection in the current coverage policy. PMID:25584960

Comorbidity and the concentration of healthcare expenditures in older patients with heart failure.

PubMed

Zhang, James X; Rathouz, Paul J; Chin, Marshall H

2003-04-01

To examine comorbidity and concentration of healthcare expenditures in older patients with heart failure (HF) in the Medicare program. Retrospective analysis of older fee-for-service HF patients, using the 1996 Medicare Current Beneficiary Survey and linked Medicare claims. Variety of clinical settings. One thousand two hundred sixty-six older HF patients from a nationally representative survey. Medicare expenditure per person and by types of healthcare services, prevalence of comorbid conditions, and multivariate regression on the association between comorbidities and healthcare expenditure. Medicare spent an average of 16,514 dollars on medical reimbursement for each HF patient in 1996. Eighty-one percent of patients had one or more comorbid diseases according to a 17-disease grouping index. The top 20% of HF patients accounted for 63% of total expenditure. Comorbidity was associated with significantly higher Medicare expenditure. HF patients with more-expensive comorbidities included those with peripheral vascular disease (24% of patients, mean total expenditure 26,954 dollars), myocardial infarction (16% of patients, mean total expenditure 29,867 dollars), renal disease (8% of patients, mean total expenditure 33,014 dollars), and hemiplegia or paraplegia (5% of patients, mean total expenditure 33,234 dollars). Diseases and disorders other than heart failure constituted a significant fraction of the causes of inpatient admissions. Comorbid conditions were more likely to be associated with expensive inpatient care, and patients with these diseases were more likely to spend more overall and more on other types of Medicare services including home health aid, skilled nursing facility, and hospice care. Disease management should consider comorbid conditions for improving care and reducing expenditures in older patients with HF.

77 FR 37428 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-21

...); Category #2: Enforcement and educational programs to promote compliance with these laws/regulations... justice and child welfare systems; and (e) Any other State efforts or programs that target underage... and educational programs; programs targeting youth, parents, and caregivers; and State expenditures...

Using the cost distribution report in estimating private sector payments: what adjustments should researchers make?

PubMed

Nugent, Gary; Grippen, Glen; Parris, Y C; Mitchell, Mary

2003-06-01

To reapportion Veterans Health Administration (VA) annual expenditures into benefit categories for comparison with estimated payments by private sector providers. Total expenditures for six VA medical centers for federal fiscal year 1999 were reapportioned by benefit category using the cost distribution report (CDR). Health benefit categories were based on those of health care insurers. Cost reapportionment was based on CDR data and reviews of source accounting and payroll documents. Actual expenditures for many benefits can be accurately identified and reapportioned using CDR data, but other expenditures were not identifiable in the CDR and required inspection of source documents. Inpatient expenditures amounting to $75,110,094 US dollars and outpatient expenditures amounting to $73,594,284 US dollars were reapportioned into other benefit categories, primarily professional fees. Expenditures for some VA benefits could not be identified because of differences in accounting and clinical practice between the VA and the community. Revisions to bring the CDR more in line with private sector payment categories would improve effectiveness for internal VA analyses and external expenditure comparisons. CDR revisions would require changes in recording some clinical workload (eg, rehabilitation and extended care) and classifying residential and domiciliary programs separate from inpatient care. Benefits that were not assigned expenditures for comparison with payments represent a potential liability if the VA were to purchase health care services in the marketplace. Variation among hospitals on expenditures not clearly identified in the CDR was significant and raises questions about the effectiveness of capitated budget methodologies using either the CDR or the decision support system.

26 CFR 56.4911-10 - Members of a limited affiliated group of organizations.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... Thus, as modified by this section, the regulations under sections 501(h) and 4911 apply to electing... 501(h) and 4911 to controlling member organizations (within the meaning of paragraph (c) of this...) Grass roots expenditures. A controlling member organization for which the expenditure test election is...

26 CFR 56.4911-10 - Members of a limited affiliated group of organizations.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... Thus, as modified by this section, the regulations under sections 501(h) and 4911 apply to electing... 501(h) and 4911 to controlling member organizations (within the meaning of paragraph (c) of this...) Grass roots expenditures. A controlling member organization for which the expenditure test election is...

Fee-for-Service Health Care Expenditures: Evidence of Selection Effects among Subscribers Who Choose HMOs. Health Insurance Experiment Series.

ERIC Educational Resources Information Center

Buchanan, Joan; Cretin, Shan

Although competition among health plans has been encouraged as a means to control health care expenditures, some fee-for-service (FFS) insurers attribute part of their increased average expenditures to favorable selection of low users into newly offered health maintenance organization (HMO) plans. To test this hypothesis, the health care…

SIRT1 genetic variants associate with the metabolic response of Caucasians to a controlled lifestyle intervention--the TULIP Study.

PubMed

Weyrich, Peter; Machicao, Fausto; Reinhardt, Julia; Machann, Jürgen; Schick, Fritz; Tschritter, Otto; Stefan, Norbert; Fritsche, Andreas; Häring, Hans-Ulrich

2008-11-12

Sirtuin1 (SIRT1) regulates gene expression in distinct metabolic pathways and mediates beneficial effects of caloric restriction in animal models. In humans, SIRT1 genetic variants associate with fasting energy expenditure. To investigate the relevance of SIRT1 for human metabolism and caloric restriction, we analyzed SIRT1 genetic variants in respect to the outcome of a controlled lifestyle intervention in Caucasians at risk for type 2 diabetes. A total of 1013 non-diabetic Caucasians from the Tuebingen Family Study (TUEF) were genotyped for four tagging SIRT1 SNPs (rs730821, rs12413112, rs7069102, rs2273773) for cross-sectional association analyses with prediabetic traits. SNPs that associated with basal energy expenditure in the TUEF cohort were additionally analyzed in 196 individuals who underwent a controlled lifestyle intervention (Tuebingen Lifestyle Intervention Program; TULIP). Multivariate regressions analyses with adjustment for relevant covariates were performed to detect associations of SIRT1 variants with the changes in anthropometrics, weight, body fat or metabolic characteristics (blood glucose, insulin sensitivity, insulin secretion and liver fat, measured by magnetic resonance techniques) after the 9-month follow-up test in the TULIP study. Minor allele (X/A) carriers of rs12413112 (G/A) had a significantly lower basal energy expenditure (p = 0.04) and an increased respiratory quotient (p = 0.02). This group (rs12413112: X/A) was resistant against lifestyle-induced improvement of fasting plasma glucose (GG: -2.01%, X/A: 0.53%; p = 0.04), had less increase in insulin sensitivity (GG: 17.3%, X/A: 9.6%; p = 0.05) and an attenuated decline in liver fat (GG: -38.4%, X/A: -7.5%; p = 0.01). SIRT1 plays a role for the individual lifestyle intervention response, possibly owing to decreased basal energy expenditure and a lower lipid-oxidation rate in rs12413112 X/A allele carriers. SIRT1 genetic variants may, therefore, represent a relevant determinant for the response rate of individuals undergoing caloric restriction and increased physical activity.

1976-77 California Public Schools Selected Statistics: Operating Units, Revenues, Teachers and Pupils, Expenditures.

ERIC Educational Resources Information Center

California State Dept. of Education, Sacramento. Bureau of School Apportionments and Reports.

Statistics on the California school system presented in this publication are prerequisites to the determination of policy at the state and local levels. This publication lists the number of pupils, teachers, and schools in the California school system and associated programs in the 1976-77 school year. It also records the expenditures of public…

Problems and Alternatives in Capital Financing for Minnesota Elementary and Secondary Schools.

ERIC Educational Resources Information Center

Hopeman, Alan R.

The primary sources of capital funds in Minnesota are the local capital expenditure levy and school district bond sales. The state provides assistance to low-wealth districts by providing a capital expenditure equalization aid program and two types of loans under the Maximum Effort School Aid Law. It has been argued that the concepts of equal…

Outsourcing: A Descriptive Study of the Outsourcing of Non-Educational Services in the Bergen and Passaic County Public Schools

ERIC Educational Resources Information Center

Pecora, Albert J.

2012-01-01

Due to a diminishing level of available funds, school leaders are faced with difficult decisions associated with reducing budget expenditures. The only way to prevent losing more programs and services is to reduce spending. An area which is quickly gaining popularity in reducing expenditures is outsourcing. Many schools have turned to outside…

An answer to a burning question: what will the Forest Service spend on fire suppression this summer?

Treesearch

Karen L. Abt; Jeffrey P. Prestemon; Krista M. Gebert

2009-01-01

Wildfire management has become an ever-larger part of Forest Service, U.S. Department of Agriculture, and other land management agency appropriations and expenditures. In fiscal year (FY) 2008, the wildfire program budget was nearly 44 percent of initial Forest Service discretionary appropriations (U.S. Congress 2008). Total expenditures for suppression eventually...

Energy metabolism of Macaca mulatta during spaceflight

NASA Technical Reports Server (NTRS)

Hoban-Higgins, T. M.; Stein, T. P.; Dotsenko, M. A.; Korolkov, V. I.; Fuller, C. A.

2000-01-01

The mean daily energy expenditure rates of two rhesus monkeys (Macaca mulatta) were determined during spaceflight on the joint U.S./Russian Bion 11 mission by the doubly labeled water (DLW, 2H218O) method. Control values were obtained from two studies performed under flight-like conditions (n = 4). The mean inflight energy expenditure for the two Bion 11 monkeys was 81.3 kcal/kg/day, which was higher than that seen previously. The average energy expenditure (77.6 +/- 4.4 kcal/kg/day) for the four ground control monkeys was slightly lower than had been measured previously.

Households across all income quintiles, especially the poorest, increased animal source food expenditures substantially during recent Peruvian economic growth.

PubMed

Humphries, Debbie L; Behrman, Jere R; Crookston, Benjamin T; Dearden, Kirk A; Schott, Whitney; Penny, Mary E

2014-01-01

Relative to plant-based foods, animal source foods (ASFs) are richer in accessible protein, iron, zinc, calcium, vitamin B-12 and other nutrients. Because of their nutritional value, particularly for childhood growth and nutrition, it is important to identify factors influencing ASF consumption, especially for poorer households that generally consume less ASFs. To estimate differential responsiveness of ASF consumption to changes in total household expenditures for households with different expenditures in a middle-income country with substantial recent income increases. The Peruvian Young Lives household panel (n = 1750) from 2002, 2006 and 2009 was used to characterize patterns of ASF expenditures. Multivariate models with controls for unobserved household fixed effects and common secular trends were used to examine nonlinear relationships between changes in household expenditures and in ASF expenditures. Households with lower total expenditures dedicated greater percentages of expenditures to food (58.4% vs.17.9% in 2002 and 24.2% vs. 21.5% in 2009 for lowest and highest quintiles respectively) and lower percentages of food expenditures to ASF (22.8% vs. 33.9% in 2002 and 30.3% vs. 37.6% in 2009 for lowest and highest quintiles respectively). Average percentages of overall expenditures spent on food dropped from 47% to 23.2% between 2002 and 2009. Households in the lowest quintiles of expenditures showed greater increases in ASF expenditures relative to total consumption than households in the highest quintiles. Among ASF components, meat and poultry expenditures increased more than proportionately for households in the lowest quintiles, and eggs and fish expenditures increased less than proportionately for all households. Increases in household expenditures were associated with substantial increases in consumption of ASFs for households, particularly households with lower total expenditures. Increases in ASF expenditures for all but the top quintile of households were proportionately greater than increases in total food expenditures, and proportionately less than overall expenditures.

Households across All Income Quintiles, Especially the Poorest, Increased Animal Source Food Expenditures Substantially during Recent Peruvian Economic Growth

PubMed Central

Humphries, Debbie L.; Behrman, Jere R.; Crookston, Benjamin T.; Dearden, Kirk A.; Schott, Whitney; Penny, Mary E.

2014-01-01

Background Relative to plant-based foods, animal source foods (ASFs) are richer in accessible protein, iron, zinc, calcium, vitamin B-12 and other nutrients. Because of their nutritional value, particularly for childhood growth and nutrition, it is important to identify factors influencing ASF consumption, especially for poorer households that generally consume less ASFs. Objective To estimate differential responsiveness of ASF consumption to changes in total household expenditures for households with different expenditures in a middle-income country with substantial recent income increases. Methods The Peruvian Young Lives household panel (n = 1750) from 2002, 2006 and 2009 was used to characterize patterns of ASF expenditures. Multivariate models with controls for unobserved household fixed effects and common secular trends were used to examine nonlinear relationships between changes in household expenditures and in ASF expenditures. Results Households with lower total expenditures dedicated greater percentages of expenditures to food (58.4% vs.17.9% in 2002 and 24.2% vs. 21.5% in 2009 for lowest and highest quintiles respectively) and lower percentages of food expenditures to ASF (22.8% vs. 33.9% in 2002 and 30.3% vs. 37.6% in 2009 for lowest and highest quintiles respectively). Average percentages of overall expenditures spent on food dropped from 47% to 23.2% between 2002 and 2009. Households in the lowest quintiles of expenditures showed greater increases in ASF expenditures relative to total consumption than households in the highest quintiles. Among ASF components, meat and poultry expenditures increased more than proportionately for households in the lowest quintiles, and eggs and fish expenditures increased less than proportionately for all households. Conclusions Increases in household expenditures were associated with substantial increases in consumption of ASFs for households, particularly households with lower total expenditures. Increases in ASF expenditures for all but the top quintile of households were proportionately greater than increases in total food expenditures, and proportionately less than overall expenditures. PMID:25372596

Constraining National Health Care Expenditures. Achieving Quality Care at an Affordable Cost.

DTIC Science & Technology

1985-09-30

Medicaid (federal/state) 10.8 Other state/local government programs 5.1 Other federal programs 5.4 Philanthropy and industrial in-plant 1.2 .- Source: U.S...expenditures. Projections of future outlays and income for the Medicare Trust Fund indicate serious financing problems by the . mid to late 1990’s. The...7.1 0 France 6.4 7.9 23 West Germany 6.4 9.2 44 Italy 6 .1a 6.4 5 Netherlands 6.3 8.2 30 Sweden 7.4 9.8 32 Switzerland n/a 6.9 United Kingdom 4.3 5.2

Hypothalamic inflammation and the central nervous system control of energy homeostasis.

PubMed

Pimentel, Gustavo D; Ganeshan, Kirthana; Carvalheira, José B C

2014-11-01

The control of energy homeostasis relies on robust neuronal circuits that regulate food intake and energy expenditure. Although the physiology of these circuits is well understood, the molecular and cellular response of this program to chronic diseases is still largely unclear. Hypothalamic inflammation has emerged as a major driver of energy homeostasis dysfunction in both obesity and anorexia. Importantly, this inflammation disrupts the action of metabolic signals promoting anabolism or supporting catabolism. In this review, we address the evidence that favors hypothalamic inflammation as a factor that resets energy homeostasis in pathological states. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Metabolic vs. hedonic obesity: a conceptual distinction and its clinical implications

PubMed Central

Zhang, Y.; Mechanick, J. I.; Korner, J.; Peterli, R.

2015-01-01

Summary Body weight is determined via both metabolic and hedonic mechanisms. Metabolic regulation of body weight centres around the ‘body weight set point’, which is programmed by energy balance circuitry in the hypothalamus and other specific brain regions. The metabolic body weight set point has a genetic basis, but exposure to an obesogenic environment may elicit allostatic responses and upward drift of the set point, leading to a higher maintained body weight. However, an elevated steady‐state body weight may also be achieved without an alteration of the metabolic set point, via sustained hedonic over‐eating, which is governed by the reward system of the brain and can override homeostatic metabolic signals. While hedonic signals are potent influences in determining food intake, metabolic regulation involves the active control of both food intake and energy expenditure. When overweight is due to elevation of the metabolic set point (‘metabolic obesity’), energy expenditure theoretically falls onto the standard energy–mass regression line. In contrast, when a steady‐state weight is above the metabolic set point due to hedonic over‐eating (‘hedonic obesity’), a persistent compensatory increase in energy expenditure per unit metabolic mass may be demonstrable. Recognition of the two types of obesity may lead to more effective treatment and prevention of obesity. PMID:25588316

Medical Expenditures Associated With Hypertension in the U.S., 2000-2013.

PubMed

Zhang, Donglan; Wang, Guijing; Zhang, Ping; Fang, Jing; Ayala, Carma

2017-12-01

Trends of prevalence, treatment, and control of hypertension have been documented in the U.S., but changes in medical expenditures associated with hypertension over time have not been evaluated. This study analyzed these expenditures during 2000-2013 among U.S. adults. Data from the Medical Expenditure Panel Survey were analyzed in 2016. The study population was non-institutionalized men and non-pregnant women aged ≥18 years. Hypertension was defined as ever been diagnosed with hypertension or currently taking antihypertensive medications. Medical expenditures included all payments to medical care providers. Expenditures associated with hypertension were estimated by two-part regression models and adjusted into 2015 U.S. dollars. Controlling variables included sociodemographic characteristics, marital status, insurance, region, smoking status, weight status, health status, and comorbidities. Trends were analyzed using joinpoint method. Total per-person annual expenditures associated with hypertension in 2000-2001 ($1,399) were not significantly different from those in 2012-2013 ($1,494) (average annual percent change [AAPC]= -0.6%, p=0.794), but annual national spending increased significantly from $58.7 billion to $109.1 billion (AAPC=8.3%, p=0.015), mainly because of the increase in the number of people treated for hypertension. Per-person outpatient payments were 22.7% higher in 2012-2013 than in 2000-2001 ($416 vs $322, p<0.05; AAPC=0.8%, p-trend=0.826). Payments for prescription medications took up a larger proportion of the medical expenditures associated with hypertension, compared to payments for outpatient or other services (33%-46%). During 2000-2013, annual national medical expenditures associated with hypertension increased significantly. Preventing hypertension could alleviate hypertension-associated economic burden. Copyright © 2017 American Journal of Preventive Medicine. All rights reserved.

Do motion controllers make action video games less sedentary? A randomized experiment.

PubMed

Lyons, Elizabeth J; Tate, Deborah F; Ward, Dianne S; Ribisl, Kurt M; Bowling, J Michael; Kalyanaraman, Sriram

2012-01-01

Sports- and fitness-themed video games using motion controllers have been found to produce physical activity. It is possible that motion controllers may also enhance energy expenditure when applied to more sedentary games such as action games. Young adults (N = 100) were randomized to play three games using either motion-based or traditional controllers. No main effect was found for controller or game pair (P > .12). An interaction was found such that in one pair, motion control (mean [SD] 0.96 [0.20] kcal · kg(-1) · hr(-1)) produced 0.10 kcal · kg(-1) · hr(-1) (95% confidence interval 0.03 to 0.17) greater energy expenditure than traditional control (0.86 [0.17] kcal · kg(-1) · hr(-1), P = .048). All games were sedentary. As currently implemented, motion control is unlikely to produce moderate intensity physical activity in action games. However, some games produce small but significant increases in energy expenditure, which may benefit health by decreasing sedentary behavior.

Do Motion Controllers Make Action Video Games Less Sedentary? A Randomized Experiment

PubMed Central

Lyons, Elizabeth J.; Tate, Deborah F.; Ward, Dianne S.; Ribisl, Kurt M.; Bowling, J. Michael; Kalyanaraman, Sriram

2012-01-01

Sports- and fitness-themed video games using motion controllers have been found to produce physical activity. It is possible that motion controllers may also enhance energy expenditure when applied to more sedentary games such as action games. Young adults (N = 100) were randomized to play three games using either motion-based or traditional controllers. No main effect was found for controller or game pair (P > .12). An interaction was found such that in one pair, motion control (mean [SD] 0.96 [0.20] kcal · kg−1 · hr−1) produced 0.10 kcal · kg−1 · hr−1 (95% confidence interval 0.03 to 0.17) greater energy expenditure than traditional control (0.86 [0.17] kcal · kg−1 · hr−1, P = .048). All games were sedentary. As currently implemented, motion control is unlikely to produce moderate intensity physical activity in action games. However, some games produce small but significant increases in energy expenditure, which may benefit health by decreasing sedentary behavior. PMID:22028959

Medicare Expenditures of Individuals with Alzheimer's Disease and Related Dementias or Mild Cognitive Impairment Before and After Diagnosis.

PubMed

Lin, Pei-Jung; Zhong, Yue; Fillit, Howard M; Chen, Er; Neumann, Peter J

2016-08-01

To characterize Medicare expenditure and usage trends in individuals with a coded diagnosis of Alzheimer's disease and related dementia (ADRD) or mild cognitive impairment (MCI) during the periods leading up to and after diagnosis. Retrospective observational cohort study. Five percent sample of the 2009 to 2013 Medicare claims files. Individuals newly diagnosed with ADRD (n = 25,916) or MCI (n = 2,784), each with a propensity-score matched control subject. Medicare expenditures and usage during the 24 months before and after a new diagnosis of ADRD or MCI. Medicare expenditures were 42% higher in participants with ADRD ($10,622 vs $15,091, P < .001) and 41% higher in those with MCI ($9,728 vs $13,691, P < .001) during the year before diagnosis than in matched controls. Medicare expenditures of participants with ADRD increased to $27,126 for the first 12 months immediately after diagnosis and decreased to $17,257 during the 12 months after that. For participants with MCI, average Medicare expenditures were $20,386 for the 12 months after diagnosis and $14,286 for the 12 months after that. Use of inpatient care, postacute skilled nursing facility care, and home health care increased substantially after diagnosis of ADRD or MCI. Participants with ADRD and MCI incurred significantly higher Medicare expenditures than matched controls, even before they received a formal diagnosis. Medicare expenditures of individuals with ADRD and MCI may start to increase at least 12 months before their diagnosis, peak during the first few months immediately after diagnosis, and decrease afterward but remain at a higher level than before diagnosis. These findings highlight the importance of early diagnosis and indicate the need for complex case management to coordinate care transitions for individuals with ADRD and MCI. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Controlling prescription drug expenditures: a report of success.

PubMed

Miller, David P; Furberg, Curt D; Small, Ronald H; Millman, Franklyn M; Ambrosius, Walter T; Harshbarger, Julia S; Ohl, Christopher A

2007-08-01

To determine whether a multi-interventional program can limit increases in prescription drug expenditures while maintaining utilization of needed medications. Quasi-experimental, pre-post design. The program included formulary changes, quantity limits, and mandatory pill splitting for select drugs implemented in phases. We assessed the short-term effects of each intervention by comparing class-specific drug spending and generic medication use before and after benefit changes. Long-term effects were determined by comparing overall spending with projected spending estimates, and by examining changes in the planwide use of generic medications over time. Effects on medication utilization were assessed by examining members' use of selected classes of chronic medications before and after the policy changes. Over 3 years, the plan and members saved $6.6 million attributed to the interventions. Most of the savings were due to the reclassification of select brand-name drugs to nonpreferred status (estimated annual savings, $941,000), followed by the removal of nonsedating antihistamines from the formulary (annual savings, $565,000), and the introduction of pill splitting (annual savings, $342,000). Limiting quantities of select medications had the smallest impact (annual savings, $135,000). Members' use of generic medications steadily increased from 40% to 57%. Although 17.5% of members stopped using at least 1 class of selected medications, members' total use of chronic medications remained constant. A combination of interventions can successfully manage prescription drug spending while preserving utilization of chronic medications. Additional studies are needed to determine the effect of these cost-control interventions on other health outcomes.

Responsibility of Families For Their Severely Disabled Elders

PubMed Central

Callahan, James J.; Diamond, Lawrence D.; Giele, Janet Z.; Morris, Robert

1980-01-01

In the past 13 years, total expenditures for nursing home care under the Medicaid program have increased drastically. They show no signs of abating. Government, therefore, has become aware of the need to control this rapid increase. Familes, who currently provide a large amount of informal, long-term care for their disabled elderly, are seen as a potential resource to maintain people in the community. Although demographic elements appear to mitigate against increased family responsibility, governmental incentives may be able to reverse the trend. While demographic variables cannot be modified by public policies, programs can be developed to modify family situations, increasing family capacity—and willingness—to care for disabled, elderly adults. PMID:10309133

Utility of an emulation and simulation computer model for air revitalization system hardware design, development, and test

NASA Technical Reports Server (NTRS)

Yanosy, J. L.; Rowell, L. F.

1985-01-01

Efforts to make increasingly use of suitable computer programs in the design of hardware have the potential to reduce expenditures. In this context, NASA has evaluated the benefits provided by software tools through an application to the Environmental Control and Life Support (ECLS) system. The present paper is concerned with the benefits obtained by an employment of simulation tools in the case of the Air Revitalization System (ARS) of a Space Station life support system. Attention is given to the ARS functions and components, a computer program overview, a SAND (solid amine water desorbed) bed model description, a model validation, and details regarding the simulation benefits.

Energy expenditure and activity of transfemoral amputees using mechanical and microprocessor-controlled prosthetic knees.

PubMed

Kaufman, Kenton R; Levine, James A; Brey, Robert H; McCrady, Shelly K; Padgett, Denny J; Joyner, Michael J

2008-07-01

To quantify the energy efficiency of locomotion and free-living physical activity energy expenditure of transfemoral amputees using a mechanical and microprocessor-controlled prosthetic knee. Repeated-measures design to evaluate comparative functional outcomes. Exercise physiology laboratory and community free-living environment. Subjects (N=15; 12 men, 3 women; age, 42+/-9 y; range, 26-57 y) with transfemoral amputation. Research participants were long-term users of a mechanical prosthesis (20+/-10 y as an amputee; range, 3-36 y). They were fitted with a microprocessor-controlled knee prosthesis and allowed to acclimate (mean time, 18+/-8 wk) before being retested. Objective measurements of energy efficiency and total daily energy expenditure were obtained. The Prosthetic Evaluation Questionnaire was used to gather subjective feedback from the participants. Subjects demonstrated significantly increased physical activity-related energy expenditure levels in the participant's free-living environment (P=.04) after wearing the microprocessor-controlled prosthetic knee joint. There was no significant difference in the energy efficiency of walking (P=.34). When using the microprocessor-controlled knee, the subjects expressed increased satisfaction in their daily lives (P=.02). People ambulating with a microprocessor-controlled knee significantly increased their physical activity during daily life, outside the laboratory setting, and expressed an increased quality of life.

Psychiatric service utilization and cost for persons with schizophrenia in a Medicaid managed care program.

PubMed

Rothbard, Aileen B; Kuno, Eri; Hadley, Trevor R; Dogin, Judith

2004-01-01

A pre-post study design was used to look at changes in behavioral health care services and costs for Medicaid-eligible individuals with schizophrenia in a managed care (MC) carve-out compared to a fee-for-service (FFS) program in Pennsylvania between 1995 and 1998. Statistically significant reductions of 59% were found in hospital expenditures in the MC program compared to 18.3% in the FFS program. The decline in hospital costs was due to dramatic fee reductions in the MC site. No significant differences in overall ambulatory utilization were found in either program; however, ambulatory expenditures rose 57% in the MC program versus a decline of 11% in fee for service. The ambulatory cost increase resulted from a cost shift between county block grant funds, and Medicaid funds, with no additional revenues provided to outpatient providers. Study implications are that cost reductions from MC are mainly due to reducing utilization and payments to hospitals, similar to the findings for private sector programs.

Mental Health Policy in Brazil: federal expenditure evolution between 2001 and 2009.

PubMed

Gonçalves, Renata Weber; Vieira, Fabíola Sulpino; Delgado, Pedro Gabriel Godinho

2012-02-01

To analyze the evolution of estimates of federal spending in Brazil's Mental Health Program since the promulgation of the national mental health law. The total federal outlay of the Mental Health Program and its components of hospital and extra-hospital expenses were estimated based on 21 expenses categories from 2001 to 2009. The expenses amount was updated to values in reais of 2009 by means of the use of the Índice de Preços ao Consumidor Amplo (Broad Consumer Price Index). The per capita/year value of the federal expenditure on mental health was calculated. The outlay on mental health rose 51.3% in the period. The breakdown of the expenditures revealed a significant increase in the extra-hospital value (404.2%) and a decrease in the hospital one (-39.5%). The per capita expenditures had a lower, but still significant, growth (36.2%). The historical series of the disaggregated per capita expenditures showed that in 2006, for the first time, the extra-hospital expenditure was higher than the hospital one. The extra-hospital per capita value increased by 354.0%; the per capita hospital value decreased by 45.5%. There was a significant increase in federal outlay on mental health between 2001 and 2009 and an expressive investment in extra-hospital actions. From 2006 onwards, resources allocation was shifted towards community services. The funding component played a crucial role as the inducer of the change of the mental health care model. The challenge for the coming years is maintaining and increasing the resources for mental health in a context of underfunding of the National Health System.

A combination of exercise and capsinoid supplementation additively suppresses diet-induced obesity by increasing energy expenditure in mice

PubMed Central

Ohyama, Kana; Nogusa, Yoshihito; Suzuki, Katsuya; Shinoda, Kosaku; Kajimura, Shingo

2014-01-01

Exercise effectively prevents the development of obesity and obesity-related diseases such as type 2 diabetes. Capsinoids (CSNs) are capsaicin analogs found in a nonpungent pepper that increase whole body energy expenditure. Although both exercise and CSNs have antiobesity functions, the effectiveness of exercise with CSN supplementation has not yet been investigated. Here, we examined whether the beneficial effects of exercise could be further enhanced by CSN supplementation in mice. Mice were randomly assigned to four groups: 1) high-fat diet (HFD, Control), 2) HFD containing 0.3% CSNs, 3) HFD with voluntary running wheel exercise (Exercise), and 4) HFD containing 0.3% CSNs with voluntary running wheel exercise (Exercise + CSN). After 8 wk of ingestion, blood and tissues were collected and analyzed. Although CSNs significantly suppressed body weight gain under the HFD, CSN supplementation with exercise additively decreased body weight gain and fat accumulation and increased whole body energy expenditure compared with exercise alone. Exercise together with CSN supplementation robustly improved metabolic profiles, including the plasma cholesterol level. Furthermore, this combination significantly prevented diet-induced liver steatosis and decreased the size of adipocyte cells in white adipose tissue. Exercise and CSNs significantly increased cAMP levels and PKA activity in brown adipose tissue (BAT), indicating an increase of lipolysis. Moreover, they significantly activated both the oxidative phosphorylation gene program and fatty acid oxidation in skeletal muscle. These results indicate that CSNs efficiently promote the antiobesity effect of exercise, in part by increasing energy expenditure via the activation of fat oxidation in skeletal muscle and lipolysis in BAT. PMID:25516550

Inhibition of in vitro and in vivo brown fat differentiation program by myostatin.

PubMed

Braga, Melissa; Pervin, Shehla; Norris, Keith; Bhasin, Shalender; Singh, Rajan

2013-06-01

Obesity arises mainly due to the imbalance between energy storage and its expenditure. Metabolically active brown adipose tissue (BAT) has recently been detected in humans and has been proposed as a new target for anti-obesity therapy because of its unique capacity to regulate energy expenditure. Myostatin (Mst), a negative regulator of muscle mass, has been identified as a potential target to regulate overall body composition. Although the beneficial effects of Mst inhibition on muscle mass are well known, its role in the regulation of lipid metabolism, and energy expenditure is not very clear. We tested the effects of Mst inhibition on the gene regulatory networks that control BAT differentiation using both in vivo and in vitro model systems. PRDM16 and UCP1, two key regulators of brown fat differentiation were significantly up regulated in levator-ani (LA) and gastrocnemius (Gastroc) muscles as well as in epididymal (Epi) and subcutaneous (SC) fat pads isolated from Mst knock out (Mst KO) male mice compared with wild type (WT) mice. Using mouse embryonic fibroblast (MEFs) primary cultures obtained from Mst KO group compared to the WT group undergoing adipogenic differentiation, we also demonstrate a significant increase in select genes and proteins that improve lipid metabolism and energy expenditure. Treatment of Mst KO MEFs with recombinant Mst protein significantly inhibited the gene expression levels of UCP1, PRDM16, PGC1-α/β as well as BMP7. Future studies to extend these findings and explore the therapeutic potential of Mst inhibition on metabolic disorders are warranted. Copyright © 2012 The Obesity Society.

When science and politics listen to each other: good prospects from a new school breakfast program in Peru.

PubMed

Jacoby, E R; Cueto, S; Pollitt, E

1998-04-01

This article provides an overview of a school breakfast program implemented in 1993 in the Peruvian Andes. The program, designed by the Instituto de Investigación Nutricional in Lima and supported by the government of Peru, constitutes a clear departure from previous school feeding programs, which were heavily politicized and poorly documented. From the program's inception, nutritionists, managers, and social scientists have collaborated to produce a sound nutritional design, efficient distribution mechanisms, and effective evaluation methods. During the program's first year, controlled evaluations conducted in several Andean regions documented improved dietary intake and a significant decline in the prevalence of anemia. An educational evaluation also found improved verbal skills, higher school attendance, and lower dropout rates among recipients of the school breakfast. The results have prompted the Peruvian government to continue supporting the program, thus setting a new standard for the effective management of social expenditure in the context of economic adjustment.

Leisure time physical activity of patients in maintenance cardiac rehabilitation.

PubMed

Schairer, John R; Keteyian, Steven J; Ehrman, Jonathan K; Brawner, Clinton A; Berkebile, Nichole D

2003-01-01

PURPOSE Increasing caloric expenditure through physical activity is associated with reduced mortality. On the basis of observational studies, previous authors have suggested that at least 1000 kcal per week and possibly 1500 kcal per week of physical activity is necessary for health benefits. The authors have previously reported that patients in maintenance cardiac rehabilitation accumulate approximately 230 kcal per exercise session, suggesting that additional activity outside of cardiac rehabilitation is needed to achieve the goal of 1500 kcal per week. The authors estimated the amount of energy expenditure performed each week by patients in cardiac rehabilitation during both program participation and leisure time. METHODS For this study, 104 patients enrolled in a supervised maintenance cardiac rehabilitation program at both tertiary care and community settings for at least 6 months completed a self-administered physical activity questionnaire. Energy expenditure in cardiac rehabilitation and leisure time activity was measured in kilocalories. Total caloric expenditure was determined by adding up the number of kilocalories expended by the patients each week climbing stairs, walking, participating in cardiac rehabilitation, and engaging in sports. RESULTS Patients in cardiac rehabilitation expended weekly, on the average, 1504 +/- 830 kcal in physical activity, 830 +/- 428 kcal in cardiac rehabilitation, and 675 +/- 659 kcal in leisure time activity. There was a significant difference in caloric expenditure between men and women, between those with a body mass index (BMI) less than 30 and those with a BMI of 30 or more, and between those younger than 70 years and those 70 years or older. There was no difference between races. Whereas 43% of the patients accumulated 1500 kcal, 57% did not. CONCLUSIONS The findings showed that 72% of the patients in cardiac rehabilitation accumulated at least 1000 kcal of energy expenditure per week and met public health guidelines. Also, 43% of the patients in cardiac rehabilitation accumulated more than 1500 kcal of energy expenditure per week, a level identified as necessary to reduce all-cause mortality. Women of either race, patients with a BMI of 30 or more, and patients age 70 years or older are the groups least likely to achieve 1500 kcal of energy expenditure per week. The authors recommend incorporating weekly kilocalories of energy expenditure in the exercise prescription of patients to ensure achievement of maximum health benefits.

Standardization of Type 2 Diabetes Outpatient Expenditure with Bundled Payment Method in China

PubMed Central

Xu, Guo-Chao; Luo, Yun; Li, Qian; Wu, Meng-Fan; Zhou, Zi-Jun

2016-01-01

Background: In recent years, the prevalence of type 2 diabetes among Chinese population has been increasing by years, directly leading to an average annual growth rate of 19.90% of medical expenditure. Therefore, it is urgent to work on strategies to control the growth of medical expenditure on type 2 diabetes on the basis of the reality of China. Therefore, in this study, we explored the feasibility of implementing bundled payment in China through analyzing bundled payment standards of type 2 diabetes outpatient services. Methods: This study analyzed the outpatient expenditure on type 2 diabetes with Beijing Urban Employee's Basic Medical Insurance from 2010 to 2012. Based on the analysis of outpatient expenditure and its influential factors, we adopted decision tree approach to conduct a case-mix analysis. In the end, we built a case-mix model to calculate the standard expenditure and the upper limit of each combination. Results: We found that age, job status, and whether with complication were significant factors that influence outpatient expenditure for type 2 diabetes. Through the analysis of the decision tree, we used six variables (complication, age, diabetic foot, diabetic nephropathy, cardiac-cerebrovascular disease, and neuropathy) to group the cases, and obtained 11 case-mix groups. Conclusions: We argued that it is feasible to implement bundled payment on type 2 diabetes outpatient services. Bundled payment is effective to control the increase of outpatient expenditure. Further improvements are needed for the implementation of bundled payment reimbursement standards, together with relevant policies and measures. PMID:27064041

Tobacco expenditure, smoking-induced deprivation and financial stress: results from the International Tobacco Control (ITC) Four-Country Survey.

PubMed

Siahpush, Mohammad; Borland, Ron; Yong, Hua-Hie; Cummings, K Michael; Fong, Geoffrey T

2012-07-01

While higher tobacco prices lead to a reduction in smoking prevalence, there is a concern that paying more for cigarettes can lead to excess financial burden. Our primary aim was to examine the association of daily cigarette expenditure with smoking-induced deprivation (SID) and financial stress (FS). We used data from wave 7 (2008-2009) of the International Tobacco Control (ITC) Four-Country Survey which is a survey of smokers in Canada, the USA, the UK and Australia (n = 5887). Logistic regressions were used to assess the association of daily cigarette expenditure with SID and FS. In multivariate analyses, a one standard deviation increase in daily cigarette expenditure was associated with an increase of 24% (P = 0.004) in the probability of experiencing SID. While we found no association between daily cigarette expenditure and FS, we found that SID is a strong predictor of FS (odds ratio 6.25; P < 0.001). This suggests that cigarette expenditure indirectly affects FS through SID. Results showed no evidence of an interaction between cigarette expenditure and income or education in their effect on SID or FS. Our results imply that spending more on tobacco may result in SID but surprisingly has no direct effect on FS. While most smokers may be adjusting their incomes and consumption to minimise FS, some fail to do so occasionally as indexed by the SID measure. Future studies need to prospectively examine the effect of increased tobacco expenditure on financial burden of smokers. © 2012 Australasian Professional Society on Alcohol and other Drugs.

75 FR 32182 - Medicaid Program: Proposed Implementation of Section 614 of the Children's Health Insurance...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-07

... of the Children's Health Insurance Program Reauthorization Act of 2009 for Adjustments to the Federal... subject to adjustment pursuant to section 614 of the Children's Health Insurance Program Reauthorization... assistance expenditures under the Children's Health Insurance Program under title XXI of the Social Security...

Financing Education Programs for Handicapped Children: Regional Conference Highlights. Report No. 50.

ERIC Educational Resources Information Center

Cain, Nancy Ellen, Comp.

Presented are five papers selected from five regional 1973 conferences on financing education programs for handicapped children. R. Rossmiller's paper, "Coming to Grips with Costs and Expenditures" discusses such program aspects as organizational programs, financial policies, population identification, and empirical and theoretical studies. An…

Differences in medical care expenditures for adults with depression compared to adults with major chronic conditions.

PubMed

Lurie, Ithai Z; Manheim, Larry M; Dunlop, Dorothy D

2009-06-01

Approximately 17.1 million adults report having a major depressive episode in 2004 which represents 8% of the adult population in the U.S. Of these, more than one-third did not seek treatment. In spite of the large and extensive literature on the cost of mental health, we know very little about the differences in out-of-pocket expenditures between adults with depression and adults with other major chronic disease and the sources of those expenditures. For persons under age 65, compare total and out-of-pocket expenditures of those with depression to non-depressed individuals who have another major chronic disease. This study uses two linked, nationally representative surveys, the 1999 National Health Interview Survey (NHIS) and the 2000 Medical Expenditure Panel Survey (MEPS), to identify the population of interest. Depression was systematically assessed using a short form of the World Health Organization's (WHO) Composite International Diagnostic Interview--Short Form (CIDI-SF). To control for differences from potentially confounding factors, we matched depressed cases to controls using propensity score matching. We estimate that persons with depression have about the same out-of-pocket expenditures while having 11.8% less total medical expenditures (not a statistically significant difference) compared to non-depressed individuals with at least one chronic disease. High out-of-pocket expenditures are a concern for individuals with chronic diseases. Our study shows that those with depression have comparable out-of-pocket expenses to those with other chronic diseases, but given their lower income levels, this may result in a more substantial financial burden. IMPLICATION FOR POLICY: High out-of-pocket expenditures are a concern for individuals with depression and other chronic diseases. For both depressed individuals and non-depressed individuals with other chronic diseases, prescription drug expenditures contribute most to out-of-pocket expenses. Given the important role medications play in treatment of depression, high copayment rates are a concern for limiting compliance with appropriate treatment.

Economic Comparison of Processes Using Spreadsheet Programs

NASA Technical Reports Server (NTRS)

Ferrall, J. F.; Pappano, A. W.; Jennings, C. N.

1986-01-01

Inexpensive approach aids plant-design decisions. Commercially available electronic spreadsheet programs aid economic comparison of different processes for producing particular end products. Facilitates plantdesign decisions without requiring large expenditures for powerful mainframe computers.

40 CFR 35.9020 - Planning targets.

Code of Federal Regulations, 2014 CFR

2014-07-01

... STATE AND LOCAL ASSISTANCE Financial Assistance for the National Estuary Program § 35.9020 Planning... expenditures by each estuary program and are directly related to the activities that are to be carried out by...

40 CFR 35.9020 - Planning targets.

Code of Federal Regulations, 2013 CFR

2013-07-01

... STATE AND LOCAL ASSISTANCE Financial Assistance for the National Estuary Program § 35.9020 Planning... expenditures by each estuary program and are directly related to the activities that are to be carried out by...

40 CFR 35.9020 - Planning targets.

Code of Federal Regulations, 2010 CFR

2010-07-01

... STATE AND LOCAL ASSISTANCE Financial Assistance for the National Estuary Program § 35.9020 Planning... expenditures by each estuary program and are directly related to the activities that are to be carried out by...

40 CFR 35.9020 - Planning targets.

Code of Federal Regulations, 2011 CFR

2011-07-01

... STATE AND LOCAL ASSISTANCE Financial Assistance for the National Estuary Program § 35.9020 Planning... expenditures by each estuary program and are directly related to the activities that are to be carried out by...

40 CFR 35.9020 - Planning targets.

Code of Federal Regulations, 2012 CFR

2012-07-01

... STATE AND LOCAL ASSISTANCE Financial Assistance for the National Estuary Program § 35.9020 Planning... expenditures by each estuary program and are directly related to the activities that are to be carried out by...

Zero-Based Budgeting in Nursing Education.

ERIC Educational Resources Information Center

Farrell, Marie; Eckert, Joseph

1979-01-01

Zero-based budgeting (ZBB) refers to a system whereby the entire nursing program is reevaluated yearly and justification for all programs and expenditures must be made. ZBB is compared to the governmental sunset law. (JOW)

Curricular Innovations in Tobacco Cessation Education for Prelicensure Baccalaureate Nursing Students.

PubMed

Schwindt, Rhonda G; McNelis, Angela M; Agley, Jon

2016-08-01

Tobacco use is the primary preventable cause of morbidity and mortality in the United States, resulting in enormous health care expenditures. The burden of smoking is higher among disadvantaged populations, such as individuals with mental illness. As the largest group of health care providers, nurses must assume a leading role in tobacco control efforts to decrease the deleterious impact on health outcomes. Investigators used a randomized control group design to assess the effectiveness of a theory-based tobacco education program on the perceived competence and intrinsic motivation of prelicensure BSN students (N = 134) to engage in cessation interventions with patients with mental illness. Students completing the program reported a significant increase in perceived competence, compared with their peers who received standard instruction only. Intrinsic motivation did not increase significantly for either group. Findings suggest that the program improves students' perceived competence, but further research is needed to determine its effect on motivation and its usefulness in other health care contexts. [J Nurs Educ. 2016;55(8):425-431.]. Copyright 2016, SLACK Incorporated.

Examination of the costs, benefits and enery conservation aspects of the NASA aircraft fuel conservation technology program

NASA Technical Reports Server (NTRS)

1975-01-01

The costs and benefits of the NASA Aircraft Fuel Conservation Technology Program are discussed. Consideration is given to a present worth analysis of the planned program expenditures, an examination of the fuel savings to be obtained by the year 2005 and the worth of this fuel savings relative to the investment required, a comparison of the program funding with that planned by other Federal agencies for energy conservation, an examination of the private industry aeronautical research and technology financial posture for the period FY 76 - FY 85, and an assessment of the potential impacts on air and noise pollution. To aid in this analysis, a computerized fleet mix forecasting model was developed. This model enables the estimation of fuel consumption and present worth of fuel expenditures for selected commerical aircraft fleet mix scenarios.

Nutritional recovery with rice bran did not modify energy balance and leptin and insulin levels.

PubMed

Martins, Maria Salete F; Oyama, Lila M; Latorraca, Marcia Q; Gomes-da-Silva, Maria Helena G; Nascimento, Claudia M O

2010-03-01

To investigate the effect of nutritional recovery with rice bran on energy balance, leptin and insulin levels. Weaned Wistar rats were fed on a 17% (Control - C) or 0.5% (Aproteic - A) protein diet for 12d. After this, rats were kept on a C diet (C) or recovered with control (Recovered Control - RC) or control plus recovered rice bran diet (Recovered Rice Bran - RRB). Despite the increased food intake, group A exhibited lower carcass fat associated to low serum leptin. RRB and RC groups showed lower carcass weight and energy intake and expenditure. Energy expenditure was positively associated with food intake and carcass weight. Negative correlations between HOMA-IR and energy expenditure and energy intake were observed. Nutritional recovery with rice bran did not modify energy balance, leptin and insulin levels.

Neural substrates of the impaired effort expenditure decision making in schizophrenia.

PubMed

Huang, Jia; Yang, Xin-Hua; Lan, Yong; Zhu, Cui-Ying; Liu, Xiao-Qun; Wang, Ye-Fei; Cheung, Eric F C; Xie, Guang-Rong; Chan, Raymond C K

2016-09-01

Unwillingness to expend more effort to pursue high value rewards has been associated with motivational anhedonia in schizophrenia (SCZ) and abnormal dopamine activity in the nucleus accumbens (NAcc). The authors hypothesized that dysfunction of the NAcc and the associated forebrain regions are involved in the impaired effort expenditure decision-making of SCZ. A 2 (reward magnitude: low vs. high) × 3 (probability: 20% vs. 50% vs. 80%) event-related fMRI design in the effort-expenditure for reward task (EEfRT) was used to examine the neural response of 23 SCZ patients and 23 demographically matched control participants when the participants made effort expenditure decisions to pursue uncertain rewards. SCZ patients were significantly less likely to expend high level of effort in the medium (50%) and high (80%) probability conditions than healthy controls. The neural response in the NAcc, the posterior cingulate gyrus and the left medial frontal gyrus in SCZ patients were weaker than healthy controls and did not linearly increase with an increase in reward magnitude and probability. Moreover, NAcc activity was positively correlated with the willingness to expend high-level effort and concrete consummatory pleasure experience. NAcc and posterior cingulate dysfunctions in SCZ patients may be involved in their impaired effort expenditure decision-making. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Health care expenditures for children with autism spectrum disorders in Medicaid.

PubMed

Wang, Li; Leslie, Douglas L

2010-11-01

To study trends in health care expenditures associated with autism spectrum disorders (ASDs) in state Medicaid programs. Using Medicaid data from 42 states from 2000 to 2003, patients aged 17 years and under who were continuously enrolled in fee-for-service Medicaid were studied. Patients with claims related to autistic disorder (autism) were identified, as were patients with claims for any ASD other than autism. Total expenditures per treated patient consisted of Medicaid reimbursements from inpatient, outpatient, and long-term care and prescription drugs. Inflation-adjusted expenditures were compared over time and with expenditures associated with other mental health disorders. A total of 2,184,677 children were diagnosed with some type of mental disorder during the study period. Of these children, 69,542 had an ASD, with 49,921 having autism and the rest having another ASD. Mean total health care expenditures per child with ASD were $22,079 in 2000 (in 2003 US dollars), and rose by 3.1% to $22,772 in 2003. The treated prevalence of autism per 10,000 covered lives rose by 32.2% from 40.6 to 53.6, the highest rate of increase among all mental disorders. Total health care expenditures for ASDs per 10,000 covered lives grew by 32.8% from $1,270,435 in 2000 (in 2003 dollars) to $1,686,938 in 2003. Medicaid-reimbursed health care expenditures for ASD were quite substantial. Although the per patient expenditures grew slightly over time, the large increase in treated prevalence caused a considerable rise in total ASD-associated health care expenditures. Copyright © 2010 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

TCAP Scores and per Pupil Expenditures: Statewide Changes before and after Tennessee's First to the Top Act

ERIC Educational Resources Information Center

Cantrell, Martha Ely

2013-01-01

The purpose of this study was to investigate the relationships between the changes in Tennessee Comprehensive Assessment Program (TCAP) scores and the changes in Per Pupil Expenditures (PPE) after the enactment of "First to the Top Act of 2010" and the receipt of $501,000,000 in federal Race to the Top (RTTT) grant monies. Half of that…

COLUMBIA RIVER BASIN SALMON AND STEELHEAD: Federal Agencies’ Recovery Responsibilities, Expenditures and Actions

DTIC Science & Technology

2002-07-01

Monthly. Caspian Tern Working Group Developing a plan to reduce smolt predation by Caspian terns nesting in the Columbia River estuary. As needed...Environment and Public Works, U.S. SenateJuly 2002 COLUMBIA RIVER BASIN SALMON AND STEELHEAD Federal Agencies’ Recovery Responsibilities... COLUMBIA RIVER BASIN SALMON AND STEELHEAD: Federal Agencies Recovery Responsibilities, Expenditures and Actions Contract Number Grant Number Program

Revenues and Expenditures for Public Elementary and Secondary Education: School Year 2006-07 (Fiscal Year 2007): First Look. NCES 2009-337

ERIC Educational Resources Information Center

Zhou, Lei

2009-01-01

This report presents findings on public education revenues and expenditures using fiscal year 2007 (FY 07) data from the National Public Education Financial Survey (NPEFS) of the Common Core of Data (CCD) survey system. Programs covered in the NPEFS include regular, special, and vocational education; charter schools that reported data to the state…

Physical activity, energy requirements, and adequacy of dietary intakes of older persons in a rural Filipino community.

PubMed

Risonar, Maria Grace D; Rayco-Solon, Pura; Ribaya-Mercado, Judy D; Solon, Juan Antonio A; Cabalda, Aegina B; Tengco, Lorena W; Solon, Florentino S

2009-05-04

Aging is a process associated with physiological changes such as in body composition, energy expenditure and physical activity. Data on energy and nutrient intake adequacy among elderly is important for disease prevention, health maintenance and program development. This descriptive cross-sectional study was designed to determine the energy requirements and adequacy of energy and nutrient intakes of older persons living in private households in a rural Filipino community. Study participants were generally-healthy, ambulatory, and community living elderly aged 60-100 y (n = 98), 88 of whom provided dietary information in three nonconsecutive 24-hour food-recall interviews. There was a decrease in both physical activity and food intake with increasing years. Based on total energy expenditure and controlling for age, gender and socio-economic status, the average energy requirement for near-old (>or= 60 to < 65 y) males was 2074 kcal/d, with lower requirements, 1919 and 1699 kcal/d for the young-old (>or= 65 to < 75 y) and the old-old (>or= 75 y), respectively. Among females, the average energy requirements for the 3 age categories were 1712, 1662, and 1398 kcal/d, respectively. Actual energy intakes, however, were only approximately 65% adequate for all subjects as compared to energy expenditure. Protein, fat, and micronutrients (vitamins A and C, thiamin, riboflavin, iron and calcium) intakes were only approximately 24-51% of the recommended daily intake. Among this population, there was a weight decrease of 100 g (p = 0.012) and a BMI decrease of 0.04 kg/m2 (p = 0.003) for every 1% decrease in total caloric intake as percentage of the total energy expenditure requirements. These community living elderly suffer from lack of both macronutrient intake as compared with energy requirements, and micronutrient intake as compared with the standard dietary recommendations. Their energy intakes are ~65% of the amounts required based on their total energy expenditure. Though their intakes decrease with increasing age, so do their energy expenditure, making their relative insufficiency of food intake stable with age.

Physical activity, energy requirements, and adequacy of dietary intakes of older persons in a rural Filipino community

PubMed Central

Risonar, Maria Grace D; Rayco-Solon, Pura; Ribaya-Mercado, Judy D; Solon, Juan Antonio A; Cabalda, Aegina B; Tengco, Lorena W; Solon, Florentino S

2009-01-01

Background Aging is a process associated with physiological changes such as in body composition, energy expenditure and physical activity. Data on energy and nutrient intake adequacy among elderly is important for disease prevention, health maintenance and program development. Methods This descriptive cross-sectional study was designed to determine the energy requirements and adequacy of energy and nutrient intakes of older persons living in private households in a rural Filipino community. Study participants were generally-healthy, ambulatory, and community living elderly aged 60–100 y (n = 98), 88 of whom provided dietary information in three nonconsecutive 24-hour food-recall interviews. Results There was a decrease in both physical activity and food intake with increasing years. Based on total energy expenditure and controlling for age, gender and socio-economic status, the average energy requirement for near-old (≥ 60 to < 65 y) males was 2074 kcal/d, with lower requirements, 1919 and 1699 kcal/d for the young-old (≥ 65 to < 75 y) and the old-old (≥ 75 y), respectively. Among females, the average energy requirements for the 3 age categories were 1712, 1662, and 1398 kcal/d, respectively. Actual energy intakes, however, were only ~65% adequate for all subjects as compared to energy expenditure. Protein, fat, and micronutrients (vitamins A and C, thiamin, riboflavin, iron and calcium) intakes were only ~24–51% of the recommended daily intake. Among this population, there was a weight decrease of 100 g (p = 0.012) and a BMI decrease of 0.04 kg/m2 (p = 0.003) for every 1% decrease in total caloric intake as percentage of the total energy expenditure requirements. Conclusion These community living elderly suffer from lack of both macronutrient intake as compared with energy requirements, and micronutrient intake as compared with the standard dietary recommendations. Their energy intakes are ~65% of the amounts required based on their total energy expenditure. Though their intakes decrease with increasing age, so do their energy expenditure, making their relative insufficiency of food intake stable with age. PMID:19409110

What drives public health care expenditure growth? Evidence from Swiss cantons, 1970-2012.

PubMed

Braendle, Thomas; Colombier, Carsten

2016-09-01

A better understanding of the determinants of public health care expenditures is key to designing effective health policies. We integrate demand and supply-side determinants and factors from political economy into an empirical analysis of the highly decentralized Swiss health care system and control for major health care finance reforms. We compile a novel data set of the cantonal health care expenditure in Switzerland, which currently amounts to about one fifth of total health care expenditure. We analyze the period 1970-2012 and use dynamic panel estimation methods. We find that per capita income, the unemployment rate and the share of foreigners are positively related to public health care expenditure growth. With regard to political economy aspects, public health care expenditures increase with the share of women elected to parliament. However, institutional restrictions for politicians, such as fiscal rules, do not appear to limit public health care expenditure growth. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Medicare Expenditures Associated With Hospital and Emergency Department Use Among Beneficiaries With Dementia

PubMed Central

Daras, Laura Coots; Feng, Zhanlian; Wiener, Joshua M.; Kaganova, Yevgeniya

2017-01-01

Understanding expenditure patterns for hospital and emergency department (ED) use among individuals with dementia is crucial to controlling Medicare spending. We analyzed Health and Retirement Study data and Medicare claims, stratified by beneficiaries’ residence and proximity to death, to estimate Medicare expenditures for all-cause and potentially avoidable hospitalizations and ED visits. Analysis was limited to the Medicare fee-for-service population age 65 and older. Compared with people without dementia, community residents with dementia had higher average expenditures for hospital and ED services; nursing home residents with dementia had lower average expenditures for all-cause hospitalizations. Decedents with dementia had lower expenditures than those without dementia in the last year of life. Medicare expenditures for individuals with and without dementia vary by residential setting and proximity to death. Results highlight the importance of addressing the needs specific to the population with dementia. There are many initiatives to reduce hospital admissions, but few focus on people with dementia. PMID:28301976

Chronic conditions and medical expenditures among non-institutionalized adults in the United States.

PubMed

Lee, De-Chih; Shi, Leiyu; Pierre, Geraldine; Zhu, Jinsheng; Hu, Ruwei

2014-11-26

This study sought to examine medical expenditures among non-institutionalized adults in the United States with one or more chronic conditions. Using data from the 2010 Medical Expenditure Panel Survey (MEPS) Household Component (HC), we explored total and out-of-pocket medical, hospital, physician office, and prescription drug expenditures for non-institutionalized adults 18 and older with and without chronic conditions. We examined relationships between expenditure differences and predisposing, enabling, and need factors using recent, nationally representative data. Individuals with chronic conditions experienced higher total spending than those with no chronic conditions, even after controlling for confounding factors. This relationship persisted with age. Out-of-pocket spending trends mirrored total expenditure trends across health care categories. Additional population characteristics that were associated with high health care expenditures were race/ethnicity, marital status, insurance status, and education. The high costs associated with having one or more chronic conditions indicates a need for more robust interventions to target population groups who are most at risk.

The effects of a disease management program on self-reported health behaviors and health outcomes: evidence from the "Florida: a healthy state (FAHS)" Medicaid program.

PubMed

Morisky, Donald E; Kominski, Gerald F; Afifi, Abdelmonem A; Kotlerman, Jenny B

2009-06-01

Premature morbidity and mortality from chronic diseases account for a major proportion of expenditures for health care cost in the United States. The purpose of this study was to measure the effects of a disease management program on physiological and behavioral health indicators for Medicaid patients in Florida. A two-year prospective study of 15,275 patients with one or more chronic illnesses (congestive heart failure, hypertension, diabetes, or asthma) was undertaken. Control of hypertension improved from baseline to Year 1 (adjusted odds ratio = 1.60, p < .05), with maintenance at Year 2. Adjusted cholesterol declined by 6.41 mg/dl from baseline to Year 1 and by 12.41 mg/dl (p < .01) from baseline to Year 2. Adjusted average medication compliance increased by 0.19 points (p < .01) in Year 1 and 0.29 points (p < .01) in Year 2. Patients in the disease management program benefited in terms of controlling hypertension, asthma symptoms, and cholesterol and blood glucose levels.

Developmental programming of hypothalamic neuronal circuits: impact on energy balance control

PubMed Central

Gali Ramamoorthy, Thanuja; Begum, Ghazala; Harno, Erika; White, Anne

2015-01-01

The prevalence of obesity in adults and children has increased globally at an alarming rate. Mounting evidence from both epidemiological studies and animal models indicates that adult obesity and associated metabolic disorders can be programmed by intrauterine and early postnatal environment- a phenomenon known as “fetal programming of adult disease.” Data from nutritional intervention studies in animals including maternal under- and over-nutrition support the developmental origins of obesity and metabolic syndrome. The hypothalamic neuronal circuits located in the arcuate nucleus controlling appetite and energy expenditure are set early in life and are perturbed by maternal nutritional insults. In this review, we focus on the effects of maternal nutrition in programming permanent changes in these hypothalamic circuits, with experimental evidence from animal models of maternal under- and over-nutrition. We discuss the epigenetic modifications which regulate hypothalamic gene expression as potential molecular mechanisms linking maternal diet during pregnancy to the offspring's risk of obesity at a later age. Understanding these mechanisms in key metabolic genes may provide insights into the development of preventative intervention strategies. PMID:25954145

Factors Associated with Expenditures for Medicaid Home and Community Based Services (HCBS) and Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) Services for Persons with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Lakin, K. Charlie; Doljanac, Robert; Byun, Soo-Yong; Stancliffe, Roger J.; Taub, Sarah; Chiri, Giuseppina

2008-01-01

This article examines expenditures for a random sample of 1,421 adult Home and Community Based Services (HCBS) and Intermediate Care Facility/Mental Retardation (ICF/MR) recipients in 4 states. The article documents variations in expenditures for individuals with different characteristics and service needs and, controlling for individual…

The Current and Projected Taxpayer Shares of US Health Costs.

PubMed

Himmelstein, David U; Woolhandler, Steffie

2016-03-01

We estimated taxpayers' current and projected share of US health expenditures, including government payments for public employees' health benefits as well as tax subsidies to private health spending. We tabulated official Centers for Medicare and Medicaid Services figures on direct government spending for health programs and public employees' health benefits for 2013, and projected figures through 2024. We calculated the value of tax subsidies for private spending from official federal budget documents and figures for state and local tax collections. Tax-funded health expenditures totaled $1.877 trillion in 2013 and are projected to increase to $3.642 trillion in 2024. Government's share of overall health spending was 64.3% of national health expenditures in 2013 and will rise to 67.1% in 2024. Government health expenditures in the United States account for a larger share of gross domestic product (11.2% in 2013) than do total health expenditures in any other nation. Contrary to public perceptions and official Centers for Medicare and Medicaid Services estimates, government funds most health care in the United States. Appreciation of government's predominant role in health funding might encourage more appropriate and equitable targeting of health expenditures.

The Current and Projected Taxpayer Shares of US Health Costs

PubMed Central

Woolhandler, Steffie

2016-01-01

Objectives. We estimated taxpayers’ current and projected share of US health expenditures, including government payments for public employees’ health benefits as well as tax subsidies to private health spending. Methods. We tabulated official Centers for Medicare and Medicaid Services figures on direct government spending for health programs and public employees’ health benefits for 2013, and projected figures through 2024. We calculated the value of tax subsidies for private spending from official federal budget documents and figures for state and local tax collections. Results. Tax-funded health expenditures totaled $1.877 trillion in 2013 and are projected to increase to $3.642 trillion in 2024. Government’s share of overall health spending was 64.3% of national health expenditures in 2013 and will rise to 67.1% in 2024. Government health expenditures in the United States account for a larger share of gross domestic product (11.2% in 2013) than do total health expenditures in any other nation. Conclusions. Contrary to public perceptions and official Centers for Medicare and Medicaid Services estimates, government funds most health care in the United States. Appreciation of government’s predominant role in health funding might encourage more appropriate and equitable targeting of health expenditures. PMID:26794173

Pharmaceutical reference prices. How do they work in practice?

PubMed

Dickson, M; Redwood, H

1998-11-01

Reference pricing systems are reimbursement ceilings set by payers in an effort to constrain pharmaceutical expenditure for a private or public drug benefit. In recent years, many governments have adopted reference pricing either as a replacement or in addition to product specific price controls. Programme administrators should consider whether these policies are providing the intended benefits or whether there may be a more effective method. This article provides a review of reference pricing in Europe, North America and other countries. There are many similarities in the reference price policies but the markets to which they apply are more likely to be different. The European experience gives a 'once-for-all' lowering effect on pharmaceutical expenditure, often at the expense of compromises on prescribing. In Germany and The Netherlands, reference pricing has been relatively ineffective in lowering expenditure which has led to a succession of other interventions to achieve expenditure control goals. The US also has reference pricing, but it occurs in a very competitive market which may be responsible (at least in part) for the relatively modest growth in expenditure compared with European countries. The review of countries with reference pricing policies suggests that such policies are less effective than competitive markets in moderating pharmaceutical expenditure. Nonetheless, governments continue to pursue reference pricing strategies.

Statewide program to promote institutional delivery in Gujarat, India: who participates and the degree of financial subsidy provided by the Chiranjeevi Yojana program.

PubMed

Sidney, Kristi; Iyer, Veena; Vora, Kranti; Mavalankar, Dileep; De Costa, Ayesha

2016-01-27

The Chiranjeevi Yojana (CY) is a large public-private partnership program in Gujarat, India, under which the state pays private sector obstetricians to provide childbirth services to poor and tribal women. The CY was initiated statewide in 2007 because of the limited ability of the public health sector to provide emergency obstetric care and high out-of-pocket expenditures in the private sector (where most qualified obstetricians work), creating financial access barriers for poor women. Despite a million beneficiaries, there have been few reports studying CY, particularly the proportion of vulnerable women being covered, the expenditures they incur in connection with childbirth, and the level of subsidy provided to beneficiaries by the program. Cross-sectional facility based the survey of participants in three districts of Gujarat in 2012-2013. Women were interviewed to elicit sociodemographic characteristics, out-of-pocket expenditures, and CY program details. Descriptive statistics, chi square, and a multivariable logistic regression were performed. Of the 901 women surveyed in 129 facilities, 150 (16 %) were CY beneficiaries; 336 and 415 delivered in government and private facilities, respectively. Only 36 (24 %) of the 150 CY beneficiaries received a completely cashless delivery. Median out-of-pocket for vaginal/cesarean delivery among CY beneficiaries was $7/$71. The median degree of subsidy for women in CY who delivered vaginally/cesarean was 85/71 % compared to out-of-pocket expenditure of $44/$208 for vaginal/cesarean delivery paid by non-program beneficiaries in the private health sector. CY beneficiaries experienced a substantially subsidized childbirth compared to women who delivered in non-accredited private facilities. However, despite the government's efforts at increasing access to delivery services for poor women in the private sector, uptake was low and very few women experienced a cashless delivery. While the long-term focus remains on strengthening the public sector's ability to provide emergency obstetric care, the CY program is a potential means by which the state can ensure its poor mothers have access to necessary care if uptake is increased.

Acutely Decreased Thermoregulatory Energy Expenditure or Decreased Activity Energy Expenditure Both Acutely Reduce Food Intake in Mice

PubMed Central

Kaiyala, Karl J.; Morton, Gregory J.; Thaler, Joshua P.; Meek, Thomas H.; Tylee, Tracy; Ogimoto, Kayoko; Wisse, Brent E.

2012-01-01

Despite the suggestion that reduced energy expenditure may be a key contributor to the obesity pandemic, few studies have tested whether acutely reduced energy expenditure is associated with a compensatory reduction in food intake. The homeostatic mechanisms that control food intake and energy expenditure remain controversial and are thought to act over days to weeks. We evaluated food intake in mice using two models of acutely decreased energy expenditure: 1) increasing ambient temperature to thermoneutrality in mice acclimated to standard laboratory temperature or 2) exercise cessation in mice accustomed to wheel running. Increasing ambient temperature (from 21°C to 28°C) rapidly decreased energy expenditure, demonstrating that thermoregulatory energy expenditure contributes to both light cycle (40±1%) and dark cycle energy expenditure (15±3%) at normal ambient temperature (21°C). Reducing thermoregulatory energy expenditure acutely decreased food intake primarily during the light cycle (65±7%), thus conflicting with the delayed compensation model, but did not alter spontaneous activity. Acute exercise cessation decreased energy expenditure only during the dark cycle (14±2% at 21°C; 21±4% at 28°C), while food intake was reduced during the dark cycle (0.9±0.1 g) in mice housed at 28°C, but during the light cycle (0.3±0.1 g) in mice housed at 21°C. Cumulatively, there was a strong correlation between the change in daily energy expenditure and the change in daily food intake (R2 = 0.51, p<0.01). We conclude that acutely decreased energy expenditure decreases food intake suggesting that energy intake is regulated by metabolic signals that respond rapidly and accurately to reduced energy expenditure. PMID:22936977

23 CFR 1313.4 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ALCOHOL-IMPAIRED DRIVING PREVENTION PROGRAMS § 1313.4 General requirements. (a) Qualification requirements... enforcement of alcohol-impaired driving prevention programs in § 1313.6 and other associated costs permitted... prevention programs at or above the average level of such expenditures in fiscal years 2004 and 2005 (either...

Optimal Level of Expenditure to Control the Southern Pine Beetle

Treesearch

Joseph E. de Steiguer; Roy L. Hedden; John M. Pye

1987-01-01

Optimal level of expenditure to control damage to commercial timber stands by the southern pine beetle was determined by models that simulated and analyzed beetle attacks during a typical season for 11 Southern States. At a real discount rate of 4 percent, maximized net benefits for the Southern region are estimated at about $50 million; at 10 percent, more than $30...

State University of New York Stony Brook University Hospital: Selected Expenditure Controls. Report 92-S-66.

ERIC Educational Resources Information Center

New York State Office of the Comptroller, Albany. Div. of Management Audit.

An audit was done of selected expenditure controls at the State University of New York (SUNY) at Stony Brook University Hospital particularly payroll costs and procurement practices. The Hospital reported an operating loss of $24 million in 1992. The audit reviewed Hospital management and staff and applicable policies and procedures as well as…

Neuroimaging Studies of Factors Related to Exercise: Rationale and design of a 9 month trial

PubMed Central

Herrmann, Stephen D.; Martin, Laura E.; Breslin, Florence J.; Honas, Jeffery J.; Willis, Erik A.; Lepping, Rebecca J.; Gibson, Cheryl A.; Befort, Christie A.; Lambourne, Kate; Burns, Jeffrey M.; Smith, Bryan K.; Sullivan, Debra K.; Washburn, Richard A.; Yeh, Hung-Wen; Donnelly, Joseph E.; Savage, Cary R.

2014-01-01

The prevalence of obesity is high resulting from chronic imbalances between energy intake and expenditure. On the expenditure side, regular exercise is associated with health benefits, including enhanced brain function. The benefits of exercise are not immediate and require persistence to be realized. Brain regions associated with health-related decisions, such as whether or not to exercise or controlling the impulse to engage in immediately rewarding activities (e.g., sedentary behavior), include reward processing and cognitive control regions. A 9 month aerobic exercise study will be conducted in 180 sedentary adults (n = 90 healthy weight [BMI= 18.5 to 26.0 kg/m2]; n = 90 obese [BMI=29.0 to 41.0 kg/m2) to examine the brain processes underlying reward processing and impulse control that may affect adherence in a new exercise regimen. The primary aim is to use functional magnetic resonance imaging (fMRI) to examine reward processing and impulse control among participants that adhere (exercise >80% of sessions) and those that do not adhere to a nine-month exercise intervention with secondary analyses comparing sedentary obese and sedentary healthy weight participants. Our results will provide valuable information characterizing brain activation underlying reward processing and impulse control in sedentary obese and healthy weight individuals. In addition, our results may identify brain activation predictors of adherence and success in the exercise program along with measuring the effects of exercise and improved fitness on brain activation. PMID:24291150

State tobacco control expenditures and tax paid cigarette sales

PubMed Central

Tauras, John A.; Xu, Xin; Huang, Jidong; King, Brian; Lavinghouze, S. Rene; Sneegas, Karla S.; Chaloupka, Frank J.

2018-01-01

This research is the first nationally representative study to examine the relationship between actual state-level tobacco control spending in each of the 5 CDC’s Best Practices for Comprehensive Tobacco Control Program categories and cigarette sales. We employed several alternative two-way fixed-effects regression techniques to estimate the determinants of cigarette sales in the United States for the years 2008–2012. State spending on tobacco control was found to have a negative and significant impact on cigarette sales in all models that were estimated. Spending in the areas of cessation interventions, health communication interventions, and state and community interventions were found to have a negative impact on cigarette sales in all models that were estimated, whereas spending in the areas of surveillance and evaluation, and administration and management were found to have negative effects on cigarette sales in only some models. Our models predict that states that spend up to seven times their current levels could still see significant reductions in cigarette sales. The findings from this research could help inform further investments in state tobacco control programs. PMID:29652890

Technology transfer

NASA Technical Reports Server (NTRS)

Penaranda, Frank E.

1992-01-01

The topics are presented in viewgraph form and include the following: international comparison of R&D expenditures in 1989; NASA Technology Transfer Program; NASA Technology Utilization Program thrusts for FY 1992 and FY 1993; National Technology Transfer Network; and NTTC roles.

Who pays the most cigarette tax in Turkey.

PubMed

Önder, Zeynep; Yürekli, Ayda A

2016-01-01

Although higher taxation of tobacco products is considered the most cost-effective tobacco control policy, its negative impact on low-income groups is one of the arguments used against it. To investigate the impact of current excise taxes and the increases of excise taxes on tobacco and household expenditures by expenditure tertiles, and examine who pays excise taxes in general. Impacts of excise taxes on cigarettes are examined with a budgetary approach. We first estimate the price elasticity of cigarettes by expenditure tertiles using data from the 2003 Turkish Household Expenditure Survey, the most recent data set covering detailed tobacco product information relevant to our analysis. We then conduct a number of simulation analyses by increasing the excise taxes per pack of cigarettes and examine the impacts of these increases on household expenditures. Finally, as excise tax increases, we predict the total excise tax paid by households in different expenditure tertiles and compare the concentration curve of excise tax spending with the Lorenz curve showing the cumulative share of total household expenditures by expenditure tertiles. We estimate the progressivity coefficient that measures the area between the Lorenz and concentration curves. The low-income group is found to be the most sensitive to tax and price increases. It spends a relatively higher share of the household expenditure on cigarettes compared with higher income groups. However, the results suggest a different outcome as excise tax increases; the share of household expenditures spent on cigarettes declines for all household tertiles but a significant reduction occurs on the lowest expenditure tertile, suggesting that increases in excise taxes are progressive. Furthermore, the highest expenditure tertile pays the highest excise tax among expenditure tertiles, and their share in total excise revenue increases as the excise tax per pack of cigarettes increases. The poor smoking households benefit the most from increases in excise taxes; from a budgetary perspective, as they reduce their smoking consumption significantly, the share of their excise payment in total household expenditures declines. From a health perspective, they are likely to have more health benefits as their consumption reduces. Government revenues are also predicted to increase with increased excise taxes, and the government can allocate a part of these revenue increases on implementing and enforcing other tobacco control measures including cessation support and smoke-free environments. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Medicare Financing of Graduate Medical Education

PubMed Central

Rich, Eugene C; Liebow, Mark; Srinivasan, Malathi; Parish, David; Wolliscroft, James O; Fein, Oliver; Blaser, Robert

2002-01-01

The past decade has seen ongoing debate regarding federal support of graduate medical education, with numerous proposals for reform. Several critical problems with the current mechanism are evident on reviewing graduate medical education (GME) funding issues from the perspectives of key stakeholders. These problems include the following: substantial interinstitutional and interspecialty variations in per-resident payment amounts; teaching costs that have not been recalibrated since 1983; no consistent control by physician educators over direct medical education (DME) funds; and institutional DME payments unrelated to actual expenditures for resident education or to program outcomes. None of the current GME reform proposals adequately address all of these issues. Accordingly, we recommend several fundamental changes in Medicare GME support. We propose a re-analysis of the true direct costs of resident training (with appropriate adjustment for local market factors) to rectify the myriad problems with per-resident payments. We propose that Medicare DME funds go to the physician organization providing resident instruction, keeping DME payments separate from the operating revenues of teaching hospitals. To ensure financial accountability, we propose that institutions must maintain budgets and report expenditures for each GME program. To establish educational accountability, Residency Review Committees should establish objective, annually measurable standards for GME program performance; programs that consistently fail to meet these minimum standards should lose discretion over GME funds. These reforms will solve several long-standing, vexing problems in Medicare GME funding, but will also uncover the extent of undersupport of GME by most other health care payers. Ultimately, successful reform of GME financing will require “all-payer” support. PMID:11972725

A Cost-Effectiveness Comparision of Two Types of Occupational Home Economics Programs in the State of Kentucky. Final Report.

ERIC Educational Resources Information Center

Gabbard, Lydia Carol Moore

A study compared the cost effectiveness of secondary child care and commercial foods occupational home economics programs in Kentucky. Identified as dependent variables in the study were program effectiveness, cost efficiency, and cost effectiveness ratio. Program expenditures, community size, and program age were considered as independent…

Joint pricing and production management: a geometric programming approach with consideration of cubic production cost function

NASA Astrophysics Data System (ADS)

Sadjadi, Seyed Jafar; Hamidi Hesarsorkh, Aghil; Mohammadi, Mehdi; Bonyadi Naeini, Ali

2015-06-01

Coordination and harmony between different departments of a company can be an important factor in achieving competitive advantage if the company corrects alignment between strategies of different departments. This paper presents an integrated decision model based on recent advances of geometric programming technique. The demand of a product considers as a power function of factors such as product's price, marketing expenditures, and consumer service expenditures. Furthermore, production cost considers as a cubic power function of outputs. The model will be solved by recent advances in convex optimization tools. Finally, the solution procedure is illustrated by numerical example.

European Long-Term Care Programs: Lessons for Community Living Assistance Services and Supports?

PubMed Central

Nadash, Pamela; Doty, Pamela; Mahoney, Kevin J; von Schwanenflugel, Matthias

2012-01-01

Objective To uncover lessons from abroad for Community Living Assistance Services and Supports (CLASS), a federally run voluntary public long-term care (LTC) insurance program created under the Accountable Care Act of 2010. Data Sources Program administrators and policy researchers from Austria, England, France, Germany, and the Netherlands. Study Design Qualitative methods focused on key parameters of cash for care: how programs set benefit levels; project expenditures; control administrative costs; regulate the use of benefits; and protect workers. Data Collection/Extraction Methods Structured discussions were conducted during an international conference of LTC experts, followed by personal meetings and individual correspondence. Principal Findings Germany's self-financing mandate and tight targeting of benefits have resulted in a solvent program with low premiums. Black markets for care are likely in the absence of regulation; France addresses this via a unique system ensuing legal payment of workers. Conclusions Programs in the five countries studied have lessons, both positive and negative, relevant to CLASS design. PMID:22091672

The Central Control of Energy Expenditure: Exploiting Torpor for Medical Applications.

PubMed

Cerri, Matteo

2017-02-10

Autonomic thermoregulation is a recently acquired function, as it appears for the first time in mammals and provides the brain with the ability to control energy expenditure. The importance of such control can easily be highlighted by the ability of a heterogeneous group of mammals to actively reduce metabolic rate and enter a condition of regulated hypometabolism known as torpor. The central neural circuits of thermoregulatory cold defense have been recently unraveled and could in theory be exploited to reduce energy expenditure in species that do not normally use torpor, inducing a state called synthetic torpor. This approach may represent the first steps toward the development of a technology to induce a safe and reversible state of hypometabolism in humans, unlocking many applications ranging from new medical procedures to deep space travel.

Impact of Health Programs on Instructional Expenditures in Higher Education. Working Paper Series.

ERIC Educational Resources Information Center

Smith, John D.

The reporting of financial statistics for the Higher Education General Information Survey by health professional programs (medical, veterinary, osteopathic, dental, and related programs) was investigated. Attention was directed to how HEGIS data can be used to compare institutions when the mix of programs within the institutions complicates the…

Chapter I Mathematics Program, 1983-84. Report of Evaluation.

ERIC Educational Resources Information Center

Tompkins, John F.

This report provides an evaluation of the Chapter I mathematics program for 1,020 first through eighth grade students in the Des Moines Independent Community School District. Included is a description of the program, information on program budget and expenditures, and narrative accounts of the attainment of 17 performance and process objectives.…

Multifunctional Information Distribution System (MIDS)

DTIC Science & Technology

2015-12-01

UNCLASSIFIED 2 Table of Contents Common Acronyms and Abbreviations for MDAP Programs 3 Program Information 5 Responsible Office 5...Contracts 77 Deliveries and Expenditures 84 Operating and Support Cost 85 Common Acronyms and Abbreviations for MDAP Programs Acq O&M...Acquisition-Related Operations and Maintenance ACAT - Acquisition Category ADM - Acquisition Decision Memorandum APB - Acquisition Program Baseline

The impact of structural adjustment policies on women's and children's health in Tanzania.

PubMed

Lugalla, J L

1995-03-01

Since 1981, the government of Tanzania has adopted a variety of policy measures including the National Economic Survival Plan (NESP), Structural Adjustment Program (SAP), Economic Recovery Program (ERP) I, ERP II, Economic and Social Action Plan (ESAP), and Priority Social Action Plan (PSAP) to deal with the country's present social and economic crisis dating back to the late 1970s. The main objective of the these adjustment measures has been to attain macroeconomic balance by bringing national expenditure into line with national income to reduce inflation and to increase exports. Other objectives have been to maintain egalitarian income distribution and the provision of basic social services to the majority of the population. To realize these objectives, the government has been controlling credit and removed subsidies on certain food items and agricultural inputs, introduced a system of progressive devaluation, liberalized trade, and has been trying to reduce government expenditure by introducing cost sharing measures in the education and health sector. The author concludes that the erosion of real incomes and increased poverty have had a devastating effect upon women and children. Rural women have heavier workloads as males migrate to urban areas in search of work, there is increased maternal mortality, and chronic malnutrition and poverty make it difficult to implement HIV/AIDS intervention strategies.

77 FR 43301 - Medicaid Program; Disproportionate Share Hospital Allotments and Institutions for Mental Diseases...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-24

... increase in the CPI-U for the prior FY (0.0 percent). Column F FY 2010 TC MAP Exp. Incl. DSH. This column... including DSH expenditures. Column G FY 2010 TC MAP Exp. Net of DSH. This column contains the amount of the States' actual FY 2010 total computable DSH expenditures. Column H FY 2010 TC MAP Exp. Net of DSH. This...

National Health Expenditures, 1982

PubMed Central

Gibson, Robert M.; Waldo, Daniel R.; Levit, Katharine R.

1983-01-01

Rapid growth in the share of the nation's gross national product devoted to health expenditure has heightened concern over the survival of government entitlement programs and has led to debate of the desirability of current methods of financing health care. In this article, the authors present the data at the heart of the issue, quantifying spending for various types of health care in 1982 and discussing the sources of funds for that spending. PMID:10310273

Does informal care reduce public care expenditure on elderly care? Estimates based on Finland’s Age Study

PubMed Central

2013-01-01

Background To formulate sustainable long-term care policies, it is critical first to understand the relationship between informal care and formal care expenditure. The aim of this paper is to examine to what extent informal care reduces public expenditure on elderly care. Methods Data from a geriatric rehabilitation program conducted in Finland (Age Study, n = 732) were used to estimate the annual public care expenditure on elderly care. We first constructed hierarchical multilevel regression models to determine the factors associated with elderly care expenditure. Second, we calculated the adjusted mean costs of care in four care patterns: 1) informal care only for elderly living alone; 2) informal care only from a co-resident family member; 3) a combination of formal and informal care; and 4) formal care only. We included functional independence and health-related quality of life (15D score) measures into our models. This method standardizes the care needs of a heterogeneous subject group and enabled us to compare expenditure among various care categories even when differences were observed in the subjects’ physical health. Results Elder care that consisted of formal care only had the highest expenditure at 25,300 Euros annually. The combination of formal and informal care had an annual expenditure of 22,300 Euros. If a person received mainly informal care from a co-resident family member, then the annual expenditure was only 4,900 Euros and just 6,000 Euros for a person living alone and receiving informal care. Conclusions Our analysis of a frail elderly Finnish population shows that the availability of informal care considerably reduces public care expenditure. Therefore, informal care should be taken into account when formulating policies for long-term care. The process whereby families choose to provide care for their elderly relatives has a significant impact on long-term care expenditure. PMID:23947622

Exercise, energy expenditure, and body composition in people with spinal cord injury.

PubMed

Tanhoffer, Ricardo A; Tanhoffer, A I; Raymond, Jacqueline; Hills, Andrew P; Davis, Glen M

2014-09-01

The objective of this study was to verify the long-term effects of exercise on energy expenditure and body composition in individuals with spinal cord injury (SCI), as very little information is available on this population under free-living conditions. Free-living energy expenditure and body composition using doubly labeled water (DLW) was measured in 13 individuals with SCI, subdivided in 2 groups: (1) sedentary (SED; N = 7) and (2) regularly engaged in any exercise program, for at least 150 min·wk(-1) (EXE; N = 6). The total daily energy expenditure (TDEE) was significantly higher in the EXE group (33 ± 4.5 kcal·kg(-1)·day(-1)) if compared with SED group (27 ± 4.3 kcal·kg(-1)·day(-1)). The percentage of body fat was significantly higher in SED group than in EXE group (38 ± 6% and 28 ± 9%). Our findings revealed that, despite the severity of SCI, the actual ACSM's guidelines for weight management for healthy adults exercise could significantly increase TDEE and BMR and improve body composition in individuals who regularly perform exercise. However, the EXE group still showed a high percentage of body fat, suggesting that a more specific approach might be considered (ie, increased intensity or volume, or combining with a diet program).

Energy Expenditure and Activity of Transfemoral Amputees Using Mechanical and Microprocessor-Controlled Prosthetic Knees

PubMed Central

Kaufman, Kenton R.; Levine, James A.; Brey, Robert H.; McCrady, Shelly K.; Padgett, Denny J.; Joyner, Michael J.

2009-01-01

Objective To quantify the energy efficiency of locomotion and free-living physical activity energy expenditure of transfemoral amputees using a mechanical and microprocessor-controlled prosthetic knee. Design Repeated-measures design to evaluate comparative functional outcomes. Setting Exercise physiology laboratory and community free-living environment. Participants Subjects (N=15; 12 men, 3 women; age, 42±9y; range, 26 –57y) with transfemoral amputation. Intervention Research participants were long-term users of a mechanical prosthesis (20±10y as an amputee; range, 3–36y). They were fitted with a microprocessor-controlled knee prosthesis and allowed to acclimate (mean time, 18±8wk) before being retested. Main Outcome Measures Objective measurements of energy efficiency and total daily energy expenditure were obtained. The Prosthetic Evaluation Questionnaire was used to gather subjective feedback from the participants. Results Subjects demonstrated significantly increased physical activity–related energy expenditure levels in the participant’s free-living environment (P=.04) after wearing the microprocessor-controlled prosthetic knee joint. There was no significant difference in the energy efficiency of walking (P=.34). When using the microprocessor-controlled knee, the subjects expressed increased satisfaction in their daily lives (P=.02). Conclusions People ambulating with a microprocessor-controlled knee significantly increased their physical activity during daily life, outside the laboratory setting, and expressed an increased quality of life. PMID:18586142

The importance of proximity to death in modelling community medication expenditures for older people: evidence from New Zealand.

PubMed

Moore, Patrick V; Bennett, Kathleen; Normand, Charles

2014-12-01

Concerns about the long-term sustainability of health care expenditures (HCEs), particularly prescribing expenditures, has become an important policy issue in most developed countries. Previous studies suggest that proximity to death (PTD) has a significant effect on total HCEs, with its exclusion leading to an overestimation of likely growth. There are limited studies of pharmaceutical expenditures in which PTD is taken into account. This study presents an empirical analysis of public medication expenditure on older individuals in New Zealand (NZ). The aim of the study was to examine the individual effects of age and PTD using individual-level data. This study uses individual-level dispensing data from 2008/2009 covering the whole population of medication users aged 70 years or older and resident in NZ. A case-control methodology was used to examine individual cost and medication use for a 12-month period for decedents (cases) and survivors (controls). A random effects two-part model, with a Probit and generalized linear model (GLM) was used to explore the effect of age and PTD on expenditures. The impact of PTD on prescription expenditure is not as dramatic as studies reporting on acute and/or long-term care. The 12-month decedent-to-survivor mean expenditure ratio was 1.95; 2.09 for males and 1.82 for females. The additional cost of dying in terms of prescription drugs decreases with age, with those who die at 90 years of age or older consuming fewer drugs on average and having a lower mean expenditure than those who died in their 70s and 80s. The following variables were found to have a decreasing effect on the mean monthly prescription expenditures: a reduction of 2.2 % for each additional year of age, 4.2 % being in the Maori ethnic group, and 7.8 % for Pacific Islanders. Increases in monthly expenditure were associated with being a decedent 32.1-62.6 % (depending on month), being of Asian origin 16.2 %, or being a male 12.6 %. Given the variance reported between survivors and decedents, future projections should include PTD in their models to improve accuracy. Policies targeted at reducing expenditures should not focus on age but on ensuring appropriate and cost-effective prescribing, particularly towards the end of life.

40 CFR 51.362 - Motorist compliance enforcement program oversight.

Code of Federal Regulations, 2013 CFR

2013-07-01

...., the test fee plus the minimum waiver expenditure). (b) Information management. In establishing an... information management activities. [57 FR 52987, Nov. 5, 1992, as amended at 65 FR 45534, July 24, 2000] ... program shall be audited regularly and shall follow effective program management practices, including...

40 CFR 51.362 - Motorist compliance enforcement program oversight.

Code of Federal Regulations, 2012 CFR

2012-07-01

...., the test fee plus the minimum waiver expenditure). (b) Information management. In establishing an... information management activities. [57 FR 52987, Nov. 5, 1992, as amended at 65 FR 45534, July 24, 2000] ... program shall be audited regularly and shall follow effective program management practices, including...

40 CFR 51.362 - Motorist compliance enforcement program oversight.

Code of Federal Regulations, 2014 CFR

2014-07-01

...., the test fee plus the minimum waiver expenditure). (b) Information management. In establishing an... information management activities. [57 FR 52987, Nov. 5, 1992, as amended at 65 FR 45534, July 24, 2000] ... program shall be audited regularly and shall follow effective program management practices, including...

Catastrophic household expenditure on health in Nepal: a cross-sectional survey.

PubMed

Saito, Eiko; Gilmour, Stuart; Rahman, Md Mizanur; Gautam, Ghan Shyam; Shrestha, Pradeep Krishna; Shibuya, Kenji

2014-10-01

To determine the incidence of - and illnesses commonly associated with - catastrophic household expenditure on health in Nepal. We did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household surveyed, out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household's total expenditure over the same period was considered to be catastrophic. We estimated the incidence and intensity of catastrophic health expenditure. We identified the illnesses most commonly associated with such expenditure using a Poisson regression model and assessed the distribution of expenditure by economic quintile of households using the concentration index. Overall, 284 of the 1997 households studied in Kathmandu, i.e. 13.8% after adjustment by sampling weight, reported catastrophic health expenditure in the 30 days before the survey. After adjusting for confounders, this expenditure was found to be associated with injuries, particularly those resulting from road traffic accidents. Catastrophic expenditure by households in the poorest quintile were associated with at least one episode of diabetes, asthma or heart disease. In an urban area of Nepal, catastrophic household expenditure on health was mostly associated with injuries and noncommunicable diseases such as diabetes and asthma. Throughout Nepal, interventions for the control and management of noncommunicable diseases and the prevention of road traffic accidents should be promoted. A phased introduction of health insurance should also reduce the incidence of catastrophic household expenditure.

Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries?: A time-series, ecological analysis of 48 countries from 1993 to 2013.

PubMed

Baker, Peter; Hone, Thomas; Reeves, Aaron; Avendano, Mauricio; Millett, Christopher

2018-06-27

Inequalities in infant mortality rates (IMRs) are rising in some low- and middle-income countries (LMICs) and decreasing in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMRs. We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country observations). Slope and Relative Indices of Inequality in IMRs (SII and RII) were calculated from Demographic and Health Surveys between 1993 and 2013. RII and SII were regressed on government expenditure (total, health and non-health) and redistribution, controlling for gross domestic product (GDP), private health expenditures, a democracy indicator, country fixed effects and time. Mean SII and RII was 39.12 and 0.69, respectively. In multivariate models, a 1 percentage point increase in total government expenditure (% of GDP) was associated with a decrease in SII of -2.468 [95% confidence intervals (CIs): -4.190, -0.746] and RII of -0.026 (95% CIs: -0.048, -0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were non-significant for GDP, government redistribution, and private health expenditure. Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.

34 CFR 361.60 - Matching requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE VOCATIONAL REHABILITATION SERVICES PROGRAM Financing of State Vocational Rehabilitation Programs § 361.60 Matching requirements. (a) Federal share—(1) General... State under the State plan, including expenditures for the provision of vocational rehabilitation...

The influence of health expenditures on household impoverishment in Brazil

PubMed Central

Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Posenato, Leila Garcia; Peres, Karen Glazer

2014-01-01

OBJECTIVE To analyze the variation in the proportion of households living below the poverty line in Brazil and the factors associated with their impoverishment. METHODS Income and expenditure data from the Household Budget Survey, which was conducted in Brazil between 2002-2003 (n = 48,470 households) and 2008-2009 (n = 55,970 households) with a national sample, were analyzed. Two cutoff points were used to define poverty. The first cutoff is a per capita monthly income below R$100.00 in 2002-2003 and R$140.00 in 2008-2009, as recommended by the Bolsa Família Program. The second, which is proposed by the World Bank and is adjusted for purchasing power parity, defines poverty as per capita income below US$2.34 and US$3.54 per day in 2002-2003 and 2008-2009, respectively. Logistic regression was used to identify the sociodemographic factors associated with the impoverishment of households. RESULTS After subtracting health expenditures, there was an increase in households living below the poverty line in Brazil. Using the World Bank poverty line, the increase in 2002-2003 and 2008-2009 was 2.6 percentage points (6.8%) and 2.3 percentage points (11.6%), respectively. Using the Bolsa Família Program poverty line, the increase was 1.6 (11.9%) and 1.3 (17.3%) percentage points, respectively. Expenditure on prescription drugs primarily contributed to the increase in poor households. According to the World Bank poverty line, the factors associated with impoverishment include a worse-off financial situation, a household headed by an individual with low education, the presence of children, and the absence of older adults. Using the Bolsa Família Program poverty line, the factors associated with impoverishment include a worse-off financial situation and the presence of children. CONCLUSIONS Health expenditures play an important role in the impoverishment of segments of the Brazilian population, especially among the most disadvantaged. PMID:25372171

The influence of health expenditures on household impoverishment in Brazil.

PubMed

Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Posenato, Leila Garcia; Peres, Karen Glazer

2014-10-01

To analyze the variation in the proportion of households living below the poverty line in Brazil and the factors associated with their impoverishment. Income and expenditure data from the Household Budget Survey, which was conducted in Brazil between 2002-2003 (n = 48,470 households) and 2008-2009 (n = 55,970 households) with a national sample, were analyzed. Two cutoff points were used to define poverty. The first cutoff is a per capita monthly income below R$100.00 in 2002-2003 and R$140.00 in 2008-2009, as recommended by the Bolsa Família Program. The second, which is proposed by the World Bank and is adjusted for purchasing power parity, defines poverty as per capita income below US$2.34 and US$3.54 per day in 2002-2003 and 2008-2009, respectively. Logistic regression was used to identify the sociodemographic factors associated with the impoverishment of households. After subtracting health expenditures, there was an increase in households living below the poverty line in Brazil. Using the World Bank poverty line, the increase in 2002-2003 and 2008-2009 was 2.6 percentage points (6.8%) and 2.3 percentage points (11.6%), respectively. Using the Bolsa Família Program poverty line, the increase was 1.6 (11.9%) and 1.3 (17.3%) percentage points, respectively. Expenditure on prescription drugs primarily contributed to the increase in poor households. According to the World Bank poverty line, the factors associated with impoverishment include a worse-off financial situation, a household headed by an individual with low education, the presence of children, and the absence of older adults. Using the Bolsa Família Program poverty line, the factors associated with impoverishment include a worse-off financial situation and the presence of children. Health expenditures play an important role in the impoverishment of segments of the Brazilian population, especially among the most disadvantaged.

Gender disparities in medical expenditures attributable to hypertension in the United States.

PubMed

Basu, Rituparna; Franzini, Luisa; Krueger, Patrick M; Lairson, David R

2010-01-01

We sought to examine and attempt to explain gender disparities in hypertension-attributable expenditure among noninstitutionalized individuals in the United States. Using the 2001-2004 Medical Expenditure Panel Survey and the Aday and Andersen health care use model, we estimated hypertension-attributable health care expenditures for inpatient stay, outpatient visits, prescription drugs, office visits, and emergency room (ER) visits among men and women by applying the method of recycled prediction. Hypertensive individuals were identified using International Classification of Diseases, 9th edition, codes or self-report of a diagnosis of hypertension. The adjusted mean hypertension-attributable expenditure per individual was significantly higher for women than for men for prescription drugs, inpatient stays, office visits, outpatient visits and ER visits expenditures. However, as age increased, the gender difference in adjusted mean expenditures became smaller and eventually reversed. This reversal occurred at different ages for different expenditures. For prescription drugs, office visits and outpatient expenditures, the reversal in expenditures occurred around age 50 to 59. The maximum difference was observed in outpatient expenditures, where women's average expenditure was $102 more than men's below age 45 but $103 less than men's above age 75. These differences remained significant even after controlling for predisposing, enabling, and need predictors of health care use. Our findings imply that there are gender disparities in hypertension-related expenditures, but that this disparity depends on age. These findings support recent findings on gender disparities in heart diseases and raise the question of physicians' bias in their diagnostic or prognostic approaches to hypertension in men and women. Copyright 2010 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Hospital ownership and performance: evidence from stroke and cardiac treatment in Taiwan.

PubMed

Lien, Hsien-Ming; Chou, Shin-Yi; Liu, Jin-Tan

2008-09-01

This paper compares program expenditure and treatment quality of stroke and cardiac patients between 1997 and 2000 across hospitals of various ownership types in Taiwan. Because Taiwan implemented national health insurance in 1995, the analysis is immune from problems arising from the complex setting of the U.S. health care market, such as segmentation of insurance status or multiple payers. Because patients may select admitted hospitals based on their observed and unobserved characteristics, we employ instrument variable (IV) estimation to account for the endogeneity of ownership status. Results of IV estimation find that patients admitted to non-profit hospitals receive better quality care, either measured by 1- or 12-month mortality rates. In terms of treatment expenditure, our results indicate no difference between non-profits and for-profits index admission expenditures, and at most 10% higher long-term expenditure for patients admitted to non-profits than to for-profits.

Federal expenditures on maternal and child health in the United States.

PubMed

Kenney, Mary Kay; Kogan, Michael D; Toomer, Stephanie; van Dyck, Peter C

2012-02-01

The goals of this study are to estimate federal maternal and child health (MCH) expenditures and identify their sources. This analysis is intended to provide a broad view of MCH funding appropriations and a basis for discussion of whether funds could be better utilized for the benefit of the population served. Data on federal maternal and child health expenditures for fiscal year (FY) 2006 were derived from examining federal legislation, department/agency budgets, and various web-based program documents posted by federal agencies. Based on selected criteria, we identified programs targeting children under 21 or pregnant/parenting women within the United States. The funding levels of agency programs for maternal and child health activities were determined and the programs briefly summarized. The identifiable funding for maternal and child health programs in FY 2006 approached $57.5 billion dollars. Funding sources for maternal and child health were concentrated within the U.S. Department of Health and Human Services, but spread across several different agencies within the department and in the Departments of Defense, Education, Agriculture, Housing and Urban Development, and the Environmental Protection Agency. Multiple agencies and offices often funded related activities, without evidence of a common underlying strategy. Federal maternal and child health funding mechanisms may lead to a fragmentation in maternal and child health activities. The funding and service delivery apparatus would benefit from an integrative MCH infrastructure approach to pediatric research, service delivery, and data collection/access that incorporates life-course and social/environmental determinants perspectives.

Engagement, enjoyment, and energy expenditure during active video game play

PubMed Central

Lyons, Elizabeth J.; Tate, Deborah F.; Ward, Dianne S.; Ribisl, Kurt M.; Bowling, J. Michael; Kalyanaraman, Sriram

2014-01-01

Objective Playing active video games can produce moderate levels of physical activity, but little is known about how these games motivate players to be active. Several psychological predictors, such as perceptions of competence, control, and engagement, may be associated with enjoyment of a game, which has in turn been hypothesized to predict energy expended during play. However, these relationships have yet to be tested in active video games. Methods Young adults aged 18–35 (N = 97, 50 female) < 300 pounds played a Dance Dance Revolution game for 13 minutes while energy expenditure was measured using indirect calorimetry. Self-reported measures of engagement, perceived competence, perceived control, and enjoyment were taken immediately afterwards. Mediation was analyzed using path analysis. Results A path model in which enjoyment mediated the effects of engagement, perceived competence, and perceived control on energy expenditure and BMI directly affected energy expenditure was an adequate fit to the data, χ2(1, N = 97) = .199, p = .655; CFI = 1.00; RMSEA < .001; 90% CI = .000 - .206; p = .692. Enjoyment mediated the relationship between engagement and energy expenditure (indirect effect = .138, p = .028), but other mediated effects were not significant. Conclusion Engagement, enjoyment, and BMI affect energy expended during active video game play. Games that are more enjoyable and engaging may produce greater intensity activity. Developers, practitioners, and researchers should consider characteristics that influence these predictors when creating or recommending active video games. PMID:23527520

A National Survey of Tobacco Cessation Programs for Youths

PubMed Central

Curry, Susan J.; Emery, Sherry; Sporer, Amy K.; Mermelstein, Robin; Flay, Brian R.; Berbaum, Michael; Warnecke, Richard B.; Johnson, Timothy; Mowery, Paul; Parsons, Jennifer; Harmon, Lori; Hund, Lisa; Wells, Henry

2007-01-01

Objectives. We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics. Methods. We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified. Results. We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was $2000. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment. Conclusions. There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths’ smoking prevalence. PMID:17138932

5 CFR 591.201 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... include Government-controlled corporations. Bureau of Labor Statistics (BLS) means the Bureau of Labor Statistics of the Department of Labor. Commonwealth of the Northern Mariana Islands (CNMI) means the....207. Detailed Expenditure Category (DEC) means the lowest level of expenditure shown in tabulated...

Managing prescription drug costs: a case study.

PubMed

DuBois, R W; Feinberg, P E

1994-06-01

Pharmacy costs in most private insurance companies and public concerns have risen over the past several years. To address the problem of increased expenditures in its government employee pharmacy program, the State of New York sought bids from outside vendors to help it control pharmaceutical costs. The following is a case study of the tools the state employed in that effort. Over time, both prescription drug coverage and mental health and substance abuse benefits were carved out of the medical plan and are now provided under free-standing programs. In order to participate, an independent pharmacy must accept a discount of 10% off the average wholesale price of brand name drugs and 25% off the average generic price of generic drugs.

77 FR 39224 - Notice of Proposed Information Collection Requests; Office of Special Education and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-02

..., Rehabilitation Services Administration (RSA)-2 collects data on the vocational rehabilitation (VR) and supported... Rehabilitation Program/Cost Report (RSA-2) collects data on the vocational rehabilitation (VR) and supported... (Rehabilitation Act). The RSA-2 captures: administrative expenditures for the VR and SE programs; VR program...

Cost Differentials in State Aid Programs in Selected States.

ERIC Educational Resources Information Center

Jordan, K. Forbis

This paper discusses the merits of cost differentials and weighted-pupil formulas as vehicles for allocating State school support funds to local school districts. The research conducted by the National Educational Finance Project to identify educational program expenditures and to develop cost differentials for each educational program in a…

Censored Quantile Instrumental Variable Estimates of the Price Elasticity of Expenditure on Medical Care.

PubMed

Kowalski, Amanda

2016-01-02

Efforts to control medical care costs depend critically on how individuals respond to prices. I estimate the price elasticity of expenditure on medical care using a censored quantile instrumental variable (CQIV) estimator. CQIV allows estimates to vary across the conditional expenditure distribution, relaxes traditional censored model assumptions, and addresses endogeneity with an instrumental variable. My instrumental variable strategy uses a family member's injury to induce variation in an individual's own price. Across the conditional deciles of the expenditure distribution, I find elasticities that vary from -0.76 to -1.49, which are an order of magnitude larger than previous estimates.

Implementation of equity in resource allocation for regional earthquake risk mitigation using two-stage stochastic programming.

PubMed

Zolfaghari, Mohammad R; Peyghaleh, Elnaz

2015-03-01

This article presents a new methodology to implement the concept of equity in regional earthquake risk mitigation programs using an optimization framework. It presents a framework that could be used by decisionmakers (government and authorities) to structure budget allocation strategy toward different seismic risk mitigation measures, i.e., structural retrofitting for different building structural types in different locations and planning horizons. A two-stage stochastic model is developed here to seek optimal mitigation measures based on minimizing mitigation expenditures, reconstruction expenditures, and especially large losses in highly seismically active countries. To consider fairness in the distribution of financial resources among different groups of people, the equity concept is incorporated using constraints in model formulation. These constraints limit inequity to the user-defined level to achieve the equity-efficiency tradeoff in the decision-making process. To present practical application of the proposed model, it is applied to a pilot area in Tehran, the capital city of Iran. Building stocks, structural vulnerability functions, and regional seismic hazard characteristics are incorporated to compile a probabilistic seismic risk model for the pilot area. Results illustrate the variation of mitigation expenditures by location and structural type for buildings. These expenditures are sensitive to the amount of available budget and equity consideration for the constant risk aversion. Most significantly, equity is more easily achieved if the budget is unlimited. Conversely, increasing equity where the budget is limited decreases the efficiency. The risk-return tradeoff, equity-reconstruction expenditures tradeoff, and variation of per-capita expected earthquake loss in different income classes are also presented. © 2015 Society for Risk Analysis.

Review of Florida's Eminent Scholar and Major Gift Challenge Grant Programs. Report No. 96-01.

ERIC Educational Resources Information Center

Florida State Legislature, Tallahassee. Office of Program Policy Analysis and Government Accountability.

This audit report presents results of a review of the Florida Eminent Scholar and Major Gift Challenge Grant Programs. In four chapters the report: (1) reviews the purpose, scope, and background of the programs; (2) looks at program successes, fees, and expenditures, noting that the programs have raised $219 million in private donations to support…

Acquired immunodeficiency syndrome in California's Medicaid program, 1981-84

PubMed Central

Andrews, Roxanne M.; Keyes, Margaret A.; Pine, Penelope L.

1988-01-01

In this article, Medicaid enrollment, use, and expenditures for persons with acquired immunodeficiency syndrome in California from 1981-84 are examined. The data are from Tape-to-Tape, a person-level Medicaid enrollment and claims data base. It was found that expenditures per month of enrollment decreased as length of enrollment during the year increased. Average annual expenditures increased from 1982 to 1983 and then decreased in 1984. This decrease was most pronounced in hospital services with no indication of a substitution of ambulatory services. This decline is primarily a result of a decrease in hospital reimbursement per day as opposed to changes in use, because discharge rates decreased and length of stay increased. PMID:10312824

45 CFR 95.1 - Scope.

Code of Federal Regulations, 2014 CFR

2014-10-01

... of Health and Human Services GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Time Limits for States To File... State to claim Federal financial participation in expenditures under State plans approved under the...

45 CFR 95.1 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Time Limits for States To File... State to claim Federal financial participation in expenditures under State plans approved under the...

45 CFR 95.1 - Scope.

Code of Federal Regulations, 2011 CFR

2011-10-01

... OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Time Limits for States To File... State to claim Federal financial participation in expenditures under State plans approved under the...

45 CFR 95.1 - Scope.

Code of Federal Regulations, 2012 CFR

2012-10-01

... OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Time Limits for States To File... State to claim Federal financial participation in expenditures under State plans approved under the...

45 CFR 95.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-10-01

... OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Time Limits for States To File... State to claim Federal financial participation in expenditures under State plans approved under the...

45 CFR 95.505 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION GENERAL ADMINISTRATION-GRANT PROGRAMS (PUBLIC ASSISTANCE, MEDICAL ASSISTANCE AND STATE CHILDREN'S HEALTH INSURANCE PROGRAMS) Cost Allocation Plans § 95.505... State agency except expenditures for financial assistance, medical vendor payments, and payments for...

A combination of exercise and capsinoid supplementation additively suppresses diet-induced obesity by increasing energy expenditure in mice.

PubMed

Ohyama, Kana; Nogusa, Yoshihito; Suzuki, Katsuya; Shinoda, Kosaku; Kajimura, Shingo; Bannai, Makoto

2015-02-15

Exercise effectively prevents the development of obesity and obesity-related diseases such as type 2 diabetes. Capsinoids (CSNs) are capsaicin analogs found in a nonpungent pepper that increase whole body energy expenditure. Although both exercise and CSNs have antiobesity functions, the effectiveness of exercise with CSN supplementation has not yet been investigated. Here, we examined whether the beneficial effects of exercise could be further enhanced by CSN supplementation in mice. Mice were randomly assigned to four groups: 1) high-fat diet (HFD, Control), 2) HFD containing 0.3% CSNs, 3) HFD with voluntary running wheel exercise (Exercise), and 4) HFD containing 0.3% CSNs with voluntary running wheel exercise (Exercise + CSN). After 8 wk of ingestion, blood and tissues were collected and analyzed. Although CSNs significantly suppressed body weight gain under the HFD, CSN supplementation with exercise additively decreased body weight gain and fat accumulation and increased whole body energy expenditure compared with exercise alone. Exercise together with CSN supplementation robustly improved metabolic profiles, including the plasma cholesterol level. Furthermore, this combination significantly prevented diet-induced liver steatosis and decreased the size of adipocyte cells in white adipose tissue. Exercise and CSNs significantly increased cAMP levels and PKA activity in brown adipose tissue (BAT), indicating an increase of lipolysis. Moreover, they significantly activated both the oxidative phosphorylation gene program and fatty acid oxidation in skeletal muscle. These results indicate that CSNs efficiently promote the antiobesity effect of exercise, in part by increasing energy expenditure via the activation of fat oxidation in skeletal muscle and lipolysis in BAT. Copyright © 2015 the American Physiological Society.

For what illnesses is a disease management program most effective?

PubMed

Jutkowitz, Eric; Nyman, John A; Michaud, Tzeyu L; Abraham, Jean M; Dowd, Bryan

2015-02-01

We examined the impact of a disease management (DM) program offered at the University of Minnesota for those with various chronic diseases. Differences-in-differences regression equations were estimated to determine the effect of DM participation by chronic condition on expenditures, absenteeism, hospitalizations, and avoidable hospitalizations. Disease management reduced health care expenditures for individuals with asthma, cardiovascular disease, congestive heart failure, depression, musculoskeletal problems, low back pain, and migraines. Disease management reduced hospitalizations for those same conditions except for congestive heart failure and reduced avoidable hospitalizations for individuals with asthma, depression, and low back pain. Disease management did not have any effect for individuals with diabetes, arthritis, or osteoporosis, nor did DM have any effect on absenteeism. Employers should focus on those conditions that generate savings when purchasing DM programs. This study suggests that the University of Minnesota's DM program reduces hospitalizations for individuals with asthma, cardiovascular disease, depression, musculoskeletal problems, low back pain, and migraines. The program also reduced avoidable hospitalizations for individuals with asthma, depression, and low back pain.

Identifying indicators of harmful and problem gambling in a Canadian sample through receiver operating characteristic analysis.

PubMed

Quilty, Lena C; Avila Murati, Daniela; Bagby, R Michael

2014-03-01

Many gamblers would prefer to reduce gambling on their own rather than to adopt an abstinence approach within the context of a gambling treatment program. Yet responsible gambling guidelines lack quantifiable markers to guide gamblers in wagering safely. To address these issues, the current investigation implemented receiver operating characteristic (ROC) analysis to identify behavioral indicators of harmful and problem gambling. Gambling involvement was assessed in 503 participants (275 psychiatric outpatients and 228 community gamblers) with the Canadian Problem Gambling Index. Overall gambling frequency, duration, and expenditure were able to distinguish harmful and problematic gambling at a moderate level. Indicators of harmful gambling were generated for engagement in specific gambling activities: frequency of tickets and casino; duration of bingo, casino, and investments; and expenditures on bingo, casino, sports betting, games of skill, and investments. Indicators of problem gambling were similarly produced for frequency of tickets and casino, and expenditures on bingo, casino, games of skill, and investments. Logistic regression analyses revealed that overall gambling frequency uniquely predicted the presence of harmful and problem gambling. Furthermore, frequency indicators for tickets and casino uniquely predicted the presence of both harmful and problem gambling. Together, these findings contribute to the development of an empirically based method enabling the minimization of harmful or problem gambling through self-control rather than abstinence.

78 FR 14516 - Agency Information Collection Activities; Submission to the Office of Management and Budget for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-06

... Program/Cost Report (RSA 2) collects data on the vocational rehabilitation (VR) and supported employment... (Rehabilitation Act). The RSA-2 captures: administrative expenditures for the VR and SE programs; VR program... for the VR program by number of individuals served; the costs of types of services provided; and a...

Drug pricing and control of health expenditures: a comparison between a proportional decision rule and a cost-per-QALY rule.

PubMed

Gandjour, Afschin

2015-01-01

In Germany, the Institute for Quality and Efficiency in Health Care (IQWiG) makes recommendations for reimbursement prices of drugs on the basis of a proportional relationship between costs and health benefits. This paper analyzed the potential of IQWiG's decision rule to control health expenditures and used a cost-per-quality-adjusted life year (QALY) rule as a comparison. A literature search was conducted, and a theoretical model of health expenditure growth was built. The literature search shows that the median incremental cost-effectiveness ratio of German cost-effectiveness analyses was €7650 per QALY gained, thus yielding a much lower threshold cost-effectiveness ratio for IQWiG's rule than an absolute rule at €30 000 per QALY. The theoretical model shows that IQWiG's rule is able to contain the long-term growth of health expenditures under the conservative assumption that future health increases at a constant absolute rate and that the threshold incremental cost-effectiveness ratio increases at a smaller rate than health expenditures. In contrast, an absolute rule offers the potential for manufacturers to raise drug prices in response to the threshold, thus resulting in an initial spike in expenditures. Results suggest that IQWiG's proportional rule will lead to lower drug prices and a slower growth of health expenditures than an absolute cost-effectiveness threshold at €30 000 per QALY. This finding is surprising as IQWiG's rule-in contrast to a cost-per-QALY rule-does not start from a fixed budget. Copyright © 2014 John Wiley & Sons, Ltd.

Public Health Care Financing and the Costs of Cancer Care: A Cross-National Analysis

PubMed Central

Voda, Ana Iolanda

2018-01-01

Expenditure and financing aspects in the healthcare system in general, and in cancer care in particular, are subjects of increasing concern to the medical community. Nowadays, it is imperative for the healthcare system to respond to the challenge of universal access to quality healthcare, by measuring the financial resources within the healthcare sector. The purpose of this review is to highlight the major gaps in the healthcare expenditures for all types of care, as well as on cancer and anti-cancer drugs across 28 European Union member states. The indicators taken into account are divided into two major groups: (1) healthcare expenditures for all types of care, and (2) healthcare expenditures on cancer and anti-cancer drugs. The programs used for our analysis are SPSS Statistics V20.0 (IBM Corporation, Armonk, NY, USA) and Stat World Explorer. The overall picture confirms that there are considerable disparities between the 28 countries in relation to their expenditures on health. The trend in public expenditures for all types of care, compared to the share of healthcare expenditures as a percentage of the GDP, shows the increase of health expenses between 2010 and 2014, but a lower rise compared to the total GDP increase. Healthcare expenditure on cancer (%THE) is rather low, despite the high cost associated with anti-cancer drugs. New treatments and drugs development will be increasingly difficult to achieve if the share devoted to cancer does not increase, and the lack of funds may act as a barrier in receiving high-quality care. PMID:29649115

Diagnosed prevalence and health care expenditures of mental health disorders among dual eligible older people.

PubMed

Lum, Terry Y; Parashuram, Shriram; Shippee, Tetyana P; Wysocki, Andrea; Shippee, Nathan D; Homyak, Patricia; Kane, Robert L; Williamson, John B

2013-04-01

Little is known about mental health disorders (MHDs) and their associated health care expenditures for the dual eligible elders across long-term care (LTC) settings. We estimated the 12-month diagnosed prevalence of MHDs among dual eligible older adults in LTC and non-LTC settings and calculated the average incremental effect of MHDs on medical care, LTC, and prescription drug expenditures across LTC settings. Participants were fee-for-service dual eligible elderly beneficiaries from 7 states. We obtained their 2005 Medicare and Medicaid claims data and LTC program participation data from federal and state governments. We grouped beneficiaries into non-LTC, community LTC, and institutional LTC groups and identified enrollees with any of 5 MHDs (anxiety, bipolar, major depression, mild depression, and schizophrenia) using the International Classification of Diseases Ninth Revision codes associated with Medicare and Medicaid claims. We obtained medical care, LTC, and prescription drug expenditures from related claims. Thirteen percent of all dual eligible elderly beneficiaries had at least 1 MHD diagnosis in 2005. Beneficiaries in non-LTC group had the lowest 12-month prevalence rates but highest percentage increase in health care expenditures associated with MHDs. Institutional LTC residents had the highest prevalence rates but lowest percentage increase in expenditures. LTC expenditures were less affected by MHDs than medical and prescription drug expenditures. MHDs are prevalent among dual eligible older persons and are costly to the health care system. Policy makers need to focus on better MHD diagnosis among community-living elders and better understanding in treatment of MHDs in LTC settings.

Program review: resource evaluation, reservoir confirmation, and exploration technology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ward, S.H.

1978-05-01

The details of the program review are reported. A summary of the recommendations, means for their implementation, and a six year program of expenditures which would accomplish the objectives of the recommendations are presented. Included in appendices are the following: DOE/DGE consortia participants; program managers contacted for opinion; communications received from program managers; participants, program review panel; and program strategy for resource evaluation and reservoir confirmation. (MHR)

Ageing in India: Financial hardship from health expenditures.

PubMed

Lee, Ting-Hsuan J; Saran, Indrani; Rao, Krishna D

2018-04-01

India's rapidly ageing population raises concerns about the burden of health care payments among older individuals who may have both limited income and greater health care needs. Using a nationally representative household survey, we investigate the association between age and financial hardship due to health expenditures. We find that both the probability of experiencing health problems and mean total out-of-pocket health expenditures increase with age. Second, the probability of households experiencing catastrophic health expenditures increases with each additional member aged 60 and above-33% of households with one 60+ member and 38% of households with 2 or more 60+ members experienced catastrophic health expenditures, compared to only 20% in households with all members under the age of 60 years. Lastly, we show that individuals aged 60 and above had a much higher probability of becoming impoverished as a result of health expenditures-the probability of impoverishment for 60+ individuals was 3 percentage points higher than for individuals under the age of 60. Overall, around 4.8% of the older population, representing 4.1 million people, fell into poverty. The results suggest that there is an urgent need for public investments in financial protection programs for older people in India. Copyright © 2017 John Wiley & Sons, Ltd.

A care pathway analysis of tuberculosis patients in benin: Highlights on direct costs and critical stages for an evidence-based decision-making.

PubMed

Laokri, Samia; Amoussouhui, Arnaud; Ouendo, Edgard M; Hounnankan, Athanase Cossi; Anagonou, Séverin; Gninafon, Martin; Kassa, Ferdinand; Tawo, Léon; Dujardin, Bruno

2014-01-01

Free tuberculosis control fail to protect patients from substantial medical and non-medical expenditure, thus a greater degree of disaggregation of patient cost is needed to fully capture their context and inform policymaking. A retrospective cross-sectional study was conducted on a convenience sample of six health districts of Southern Benin. From August 2008 to February 2009, we recruited all smear-positive pulmonary tuberculosis patients treated under the national strategy in the selected districts. Direct out-of-pocket costs associated with tuberculosis, time delays, and care-seeking pattern were collected from symptom onset to end of treatment. Population description and outcome data were reported for 245 patients of whom 153 completed their care pathway. For them, the median overall direct cost was USD 183 per patient. Payments to traditional healers, self-medication drugs, travel, and food expenditures contributed largely to this cost burden. Patient, provider, and treatment delays were also reported. Pre-diagnosis and intensive treatment stages were the most critical stages, with median expenditure of USD 43 per patient and accounting for 38% and 29% of the overall direct cost, respectively. However, financial barriers differed depending on whether the patient lived in urban or rural areas. This study delivers new evidence about bottlenecks encountered during the TB care pathway. Financial barriers to accessing the free-of-charge tuberculosis control strategy in Benin remain substantial for low-income households. Irregular time delays and hidden costs, often generated by multiple visits to various care providers, impair appropriate patient pathways. Particular attention should be paid to pre-diagnosis and intensive treatment. Cost assessment and combined targeted interventions embodied by a patient-centered approach on the specific critical stages would likely deliver better program outcomes.

Performance Based Design of a New Virtual Locomotion Control

DTIC Science & Technology

2000-11-01

constraints on movements, caloric energy expenditure , etc.). (2) The control action should interact with other actions (looking, manipulation, posturing...velocity, natural cadence, caloric expenditure , etc.) but it is unlikely that one set of tuning parameters will satisfy all criteria. Experimental...tethered for safety. OSIRIS, developed by the US Army’s Night Vision Laboratory, is a stair -stepper device that can only be used upright [Lorenzo et al

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

PubMed Central

Shrestha, Sundar S.; Zhang, Ping; Li, Rui; Thompson, Theodore J.; Chapman, Daniel P.; Barker, Lawrence

2017-01-01

Aim We aimed at estimating excess medical expenditures associated with major depressive disorder (MDD) among working-age adults diagnosed with diabetes, disaggregated by treatment mode: insulin-treated diabetes (ITDM) or non-insulin-treated diabetes (NITDM). Methods We analyzed data for over 500,000 individuals with diagnosed diabetes from the 2008 U.S. MarketScan claims database. We grouped diabetic patients first by treatment mode (ITDM or NITDM), then by MDD status (with or without MDD), and finally by whether those with MDD used antidepressant medication. We estimated annual mean excess outpatient, inpatient, prescription drug, and total expenditures using regression models, controlling for demographics, types of health coverage, and comorbidities. Results Among persons having ITDM, the estimated annual total mean expenditure for those with no MDD (the comparison group) was $19,625. For those with MDD, the expenditures were $12,406 (63%) larger if using antidepressant medication and $7322 (37%) larger if not using antidepressant medication. Among persons having NITDM, the corresponding estimated expenditure for the comparison group was $10,746, the excess expenditures were $10,432 (97%) larger if using antidepressant medication and $5579 (52%) larger if not using antidepressant medication, respectively. Inpatient excess expenditures were the largest of total excess expenditure for those with ITDM and MDD treated with antidepressant medication; for all others with diabetes and MDD, outpatient expenditures were the largest excess expenditure. Conclusions Among working-age adults with diabetes, MDD was associated with substantial excess medical expenditures. Implementing the effective interventions demonstrated in clinical trials and treatment guidelines recommended by professional organizations might reduce the economic burden of MDD in this population. PMID:23490596

Financing tuberculosis control: the role of a global financial monitoring system.

PubMed

Floyd, Katherine; Pantoja, Andrea; Dye, Christopher

2007-05-01

Control of tuberculosis (TB), like health care in general, costs money. To sustain TB control at current levels, and to make further progress so that global targets can be achieved, information about funding needs, sources of funding, funding gaps and expenditures is important at global, regional, national and sub-national levels. Such data can be used for resource mobilization efforts; to document how funding requirements and gaps are changing over time; to assess whether increases in funding can be translated into increased expenditures and whether increases in expenditure are producing improvements in programme performance; and to identify which countries or regions have the greatest needs and funding gaps. In this paper, we discuss a global system for financial monitoring of TB control that was established in WHO in 2002. By early 2007, this system had accounted for actual or planned expenditures of more than US$ 7 billion and was systematically reporting financial data for countries that carry more than 90% of the global burden of TB. We illustrate the value of this system by presenting major findings that have been produced for the period 2002-2007, including results that are relevant to the achievement of global targets for TB control set for 2005 and 2015. We also analyse the strengths and limitations of the system and its relevance to other health-care programmes.

Control of food intake and energy expenditure by Nos1 neurons of the paraventricular hypothalamus.

PubMed

Sutton, Amy K; Pei, Hongjuan; Burnett, Korri H; Myers, Martin G; Rhodes, Christopher J; Olson, David P

2014-11-12

The paraventricular nucleus of the hypothalamus (PVH) contains a heterogeneous cluster of Sim1-expressing cell types that comprise a major autonomic output nucleus and play critical roles in the control of food intake and energy homeostasis. The roles of specific PVH neuronal subtypes in energy balance have yet to be defined, however. The PVH contains nitric oxide synthase-1 (Nos1)-expressing (Nos1(PVH)) neurons of unknown function; these represent a subset of the larger population of Sim1-expressing PVH (Sim1(PVH)) neurons. To determine the role of Nos1(PVH) neurons in energy balance, we used Cre-dependent viral vectors to both map their efferent projections and test their functional output in mice. Here we show that Nos1(PVH) neurons project to hindbrain and spinal cord regions important for food intake and energy expenditure control. Moreover, pharmacogenetic activation of Nos1(PVH) neurons suppresses feeding to a similar extent as Sim1(PVH) neurons, and increases energy expenditure and activity. Furthermore, we found that oxytocin-expressing PVH neurons (OXT(PVH)) are a subset of Nos1(PVH) neurons. OXT(PVH) cells project to preganglionic, sympathetic neurons in the thoracic spinal cord and increase energy expenditure upon activation, though not to the same extent as Nos1(PVH) neurons; their activation fails to alter feeding, however. Thus, Nos1(PVH) neurons promote negative energy balance through changes in feeding and energy expenditure, whereas OXT(PVH) neurons regulate energy expenditure alone, suggesting a crucial role for non-OXT Nos1(PVH) neurons in feeding regulation. Copyright © 2014 the authors 0270-6474/14/3415306-13$15.00/0.

Health care utilization and expenditures of persons with diabetes comorbid with anxiety disorder: a national population-based cohort study.

PubMed

Huang, Chun-Jen; Chiu, Herng-Chia; Hsieh, Hui-Min; Yen, Ju-Yu; Lee, Mei-Hsuan; Chang, Kao-Ping; Li, Chih-Yi; Lin, Ching-Hua

2015-01-01

The aim of this study was to investigate and compare health care utilization and expenditures between persons with diabetes comorbid with and without anxiety disorder in Taiwan. Health care utilization and expenditures among persons with diabetes with and without comorbid anxiety disorder in the period 2000-2004 were examined using the Taiwan's National Health Insurance claims data. Health care utilization included outpatient visits and use of hospital inpatient services, while expenditures included outpatient, inpatient and total medical expenditures. General estimation equation (GEE) models were used to analyze the factors associated with outpatient visits and expenditures, and multiple logistic regression analysis was applied to identify factors associated with hospitalization. In the study period, the average number of annual outpatient visits was 43.11-50.37 and 29.82-31.42 for persons with diabetes comorbid with anxiety disorder and for those without anxiety disorder, respectively. The average annual total expenditure was NT$74,875-92,781 and NT$63,764-81,667, respectively. Controlling for covariates, the GEE models revealed that age and time were associated with outpatient visits. Income and time factor were associated with total expenditure. Health care utilization and expenditures for persons with diabetes with comorbid anxiety disorder are significantly higher than those without anxiety disorder. The factors associated with health care utilization and expenditures are age, income and time. Copyright © 2015 Elsevier Inc. All rights reserved.

Asthma expenditures in the United States comparing 2004 to 2006 and 1996 to 1998.

PubMed

Rank, Matthew A; Liesinger, Juliette T; Ziegenfuss, Jeanette Y; Branda, Megan E; Lim, Kaiser G; Yawn, Barbara P; Li, James T; Shah, Nilay D

2012-09-01

To describe how the types of healthcare expenditures for patients with asthma have changed over the past decade. Cross-sectional comparison between individuals from 1996 to 1998 and 2004 to 2006. Expenditures among US individuals (aged 5 to 56 years) with asthma were compared using the 1996 to 1998 and the 2004 to 2006 Medical Expenditure Panel Surveys. Direct expenditures (medications, inpatient, outpatient, and emergency services) and changes in productivity (missed school and work days) were compared over this time frame. The adjusted analyses controlled for age, education level, race/ethnicity, gender, poverty, region, metropolitan statistical area, self-reported health, and Charlson Comorbidity Index. Mean annual per capita healthcare expenditures increased between 1996 to 1998 and 2004 to 2006 ($3802 vs $5322 inflated to 2010 US dollars, P <.0001). Annual medication expenditures doubled from $974 to $2010 per person (P <.0001) and outpatient visit expenditures increased from $861 to $1174 (P <.0001) while hospitalization and emergency department (ED) visit expenditures were similar over the same time period. Missed school and work days decreased between the 2 periods (9.23 days in 1996-1998 vs 6.39 days in 2004-2006, P = .001). An increase in total direct expenditures in individuals with asthma was largely driven by an increase in spending on medications comparing 2004 to 2006 and 1996 to 1998 data. However, this increase was not offset by lower spending on hospitalization and ED visits.

Energy expenditure in patients with chronic renal failure.

PubMed

Monteon, F J; Laidlaw, S A; Shaib, J K; Kopple, J D

1986-11-01

Although nondialyzed, chronically uremic patients and patients undergoing maintenance hemodialysis often show evidence for wasting and calorie malnutrition and have low dietary energy intakes, their energy expenditure has never been systematically evaluated. It is possible that low energy intakes are an adaptive response to reduced energy needs; alternatively, energy expenditure could be normal or high and the low energy intakes would be inappropriate. Energy expenditure was therefore measured by indirect calorimetry in 12 normal individuals, 10 nondialyzed patients with chronic renal failure, and 16 patients undergoing maintenance hemodialysis. Energy expenditure was measured in the resting state, during quiet sitting, during controlled exercise on an exercise bicycle, and for four hours after ingestion of a test meal. Resting energy expenditure (kcal/min/1.73 m2) in the normal subjects, chronically uremic patients and hemodialysis patients was, respectively, 0.94 +/- 0.24 (SD), 0.91 +/- 0.20, and 0.97 +/- 0.10. There was also no difference among the three groups in energy expenditure during sitting, exercise, or the postprandial state. Within each group, energy expenditure during resting and sitting was directly correlated. During bicycling, energy expenditure was directly correlated with work performed, and the regression equation for this relationship was similar in each of the three groups. These findings suggest that for a given physical activity, energy expenditure in nondialyzed, chronically uremic patients and maintenance hemodialysis patients is not different from normal. The low energy intakes of many of these patients may be inadequate for their needs.

Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance.

PubMed

Li, Ye; Wu, Qunhong; Xu, Ling; Legge, David; Hao, Yanhua; Gao, Lijun; Ning, Ning; Wan, Gang

2012-09-01

To assess the degree to which the Chinese people are protected from catastrophic household expenditure and impoverishment from medical expenses and to explore the health system and structural factors influencing the first of these outcomes. Data were derived from the Fourth National Health Service Survey. An analysis of catastrophic health expenditure and impoverishment from medical expenses was undertaken with a sample of 55 556 households of different characteristics and located in rural and urban settings in different parts of the country. Logistic regression was used to identify the determinants of catastrophic health expenditure. The rate of catastrophic health expenditure was 13.0%; that of impoverishment was 7.5%. Rates of catastrophic health expenditure were higher among households having members who were hospitalized, elderly, or chronically ill, as well as in households in rural or poorer regions. A combination of adverse factors increased the risk of catastrophic health expenditure. Families enrolled in the urban employee or resident insurance schemes had lower rates of catastrophic health expenditure than those enrolled in the new rural corporative scheme. The need for and use of health care, demographics, type of benefit package and type of provider payment method were the determinants of catastrophic health expenditure. Although China has greatly expanded health insurance coverage, financial protection remains insufficient. Policy-makers should focus on designing improved insurance plans by expanding the benefit package, redesigning cost sharing arrangements and provider payment methods and developing more effective expenditure control strategies.

Healthcare Utilization and Expenditures for Persons with Diabetes Comorbid with Mental Illnesses.

PubMed

Su, Chen-Hsiang; Chiu, Herng-Chia; Hsieh, Hui-Min; Yen, Ju-Yu; Lee, Mei-Hsuan; Li, Chih-Yi; Chang, Kao-Ping; Huang, Chun-Jen

2016-09-01

The aim of this study was to investigate healthcare utilization and expenditure for patients with diabetes comorbid with and without mental illnesses in Taiwan. People with diabetes comorbid with and without mental illnesses in 2000 were identified and followed up to 2004 to explore the healthcare utilization and expenditure. Healthcare utilization included outpatient visits and use of hospital inpatient services, and expenditure included outpatient, inpatient and total medical expenditure. General estimation equation models were used to explore the factors associated with outpatient visits and expenditure. To identify the factors associated with hospitalization, multiple logistic regressions were applied. The average number of annual outpatient visits of the patients with mental illnesses ranged from 37.01 to 41.91, and 28.83 to 31.79 times for the patients without mental illnesses from 2000 to 2004. The average annual total expenditure for patients with mental illnesses during this period ranged from NT$77,123-NT$90,790, and NT$60,793- NT$84,984 for those without mental illnesses. After controlling for covariates, the results indicated that gender, age, mental illness and time factor were associated with outpatient visits. Gender, age, and time factor were associated with total expenditure. Age and mental illness were associated with hospitalization in logistic regression. The healthcare utilization and expenditure for patients with mental illnesses was significantly higher than for patients without mental illnesses. The factors associated with healthcare utilization and expenditure included gender, age, mental illness and time trends.

Effects of robotic knee exoskeleton on human energy expenditure.

PubMed

Gams, Andrej; Petric, Tadej; Debevec, Tadej; Babic, Jan

2013-06-01

A number of studies discuss the design and control of various exoskeleton mechanisms, yet relatively few address the effect on the energy expenditure of the user. In this paper, we discuss the effect of a performance augmenting exoskeleton on the metabolic cost of an able-bodied user/pilot during periodic squatting. We investigated whether an exoskeleton device will significantly reduce the metabolic cost and what is the influence of the chosen device control strategy. By measuring oxygen consumption, minute ventilation, heart rate, blood oxygenation, and muscle EMG during 5-min squatting series, at one squat every 2 s, we show the effects of using a prototype robotic knee exoskeleton under three different noninvasive control approaches: gravity compensation approach, position-based approach, and a novel oscillator-based approach. The latter proposes a novel control that ensures synchronization of the device and the user. Statistically significant decrease in physiological responses can be observed when using the robotic knee exoskeleton under gravity compensation and oscillator-based control. On the other hand, the effects of position-based control were not significant in all parameters although all approaches significantly reduced the energy expenditure during squatting.

A weight-loss program adapted to the menstrual cycle increases weight loss in healthy, overweight, premenopausal women: a 6-mo randomized controlled trial.

PubMed

Geiker, Nina Rw; Ritz, Christian; Pedersen, Sue D; Larsen, Thomas M; Hill, James O; Astrup, Arne

2016-07-01

Hormonal fluctuations during the menstrual cycle influence energy intake and expenditure as well as eating preferences and behavior. We examined the effect in healthy, overweight, premenopausal women of a diet and exercise weight-loss program that was designed to target and moderate the effects of the menstrual cycle compared with the effect of simple energy restriction. A total of 60 healthy, overweight, premenopausal women were included in a 6-mo weight-loss program in which each subject consumed a diet of 1600 kcal/d. Subjects were randomly assigned to either a combined diet and exercise program that was tailored to metabolic changes of the menstrual cycle (Menstralean) or to undergo simple energy restriction (control). Thirty-one women (19 Menstralean and 12 control women) completed the study [mean ± SD body mass index (in kg/m(2)): 32.0 ± 5.2]. Both groups lost weight during the study. In an intention-to-treat analysis, the Menstralean group did not achieve a clinically significant weight loss compared with that of the control group (P = 0.61). In per-protocol analyses, a more-pronounced weight loss of 4.3 ± 1.4 kg (P = 0.002) was shown in adherent Menstralean subjects than in the control group. A differentiated diet and exercise program that is tailored to counteract food cravings and metabolic changes throughout the menstrual cycle may increase weight loss above that achieved with a traditional diet and exercise program in women who can comply with the program. This trial was registered at clinicaltrials.gov as NCT01622114. © 2016 American Society for Nutrition.

Economic evaluation of the eradication program for bovine viral diarrhea in the Swiss dairy sector.

PubMed

Thomann, B; Tschopp, A; Magouras, I; Meylan, M; Schüpbach-Regula, G; Häsler, B

2017-09-15

Since 2008, the Swiss veterinary service has been running a mandatory eradication program for Bovine Viral Diarrhea (BVD) that is focused on detecting and eliminating persistently infected (PI) animals. Detection was initially based on antigen testing from ear tag samples of the entire cattle population, followed by antigen testing of all newborn calves until 2012. Since then, bulk milk serology (dairy herds) and blood sample serology (beef herds) have been used for the surveillance of disease-free herds. From 2008 to 2012, the proportion of newborn PI calves decreased from 1.4% to less than 0.02%. However, this success was associated with substantial expenditures. The aim of this study was to conduct an economic evaluation of the BVD eradication program in the Swiss dairy sector. The situation before the start of the program (herd-level prevalence: 20%) served as a baseline scenario. Production models for three dairy farm types were used to estimate gross margins as well as net production losses and expenditures caused by BVD. The total economic benefit was estimated as the difference in disease costs between the baseline scenario and the implemented eradication program and was compared to the total eradication costs in a benefit-cost analysis. Data on the impact of BVD virus (BVDV) infection on animal health, fertility and production parameters were obtained empirically in a retrospective epidemiological case-control study in Swiss dairy herds and complemented by literature. Economic and additional production parameters were based on benchmarking data and published agricultural statistics. The eradication costs comprised the cumulative expenses for sampling and diagnostics. The economic model consisted of a stochastic simulation in @Risk for Excel with 20,000 iterations and was conducted for a time period of 14 years (2008-2021). The estimated annual financial losses in BVDV infected herds were CHF 85-89 per dairy cow and CHF 1337-2535 for an average farm, depending on the production type. The median net present value (NPV) was estimated at CHF 44.9 million (90% central range: CHF 13.4 million-69.4 million) and the break-even point to have been reached in 2015. Overall, the outcomes demonstrate that the Swiss BVD eradication program results in a net benefit for the dairy sector. These findings are relevant for planning similar BVD control programs in other countries. Copyright © 2017. Published by Elsevier B.V.

Indian Education Program. Annual Report, 1970-1971 to United States Bureau of Indian Affairs.

ERIC Educational Resources Information Center

Poehlman, Charles H.

After a 2-page history of the Johnson-O'Malley Act, which provides funds for Indian children attending public schools, basic objectives for educational programs, the problems encountered in developing these programs, and accompanying recommendations are discussed. Tabular reports of Johnson-O'Malley (JOM) expenditures are then presented in…

Exercise Level and Energy Expenditure in the Take 10![R] In-Class Physical Activity Program.

ERIC Educational Resources Information Center

Stewart, James A.; Dennison, David A.; Kohl, Harold W., III; Doyle, J. Andrew

2004-01-01

This study evaluated the effectiveness of an innovative, classroom-based physical activity prevention program designed to integrate academic curriculum elements along with a physical activity program in providing moderate-to-vigorous intensity physical activity. A convenience sample of three public school classrooms (one first, third, and fifth…

32 CFR 34.41 - Monitoring and reporting program and financial performance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... performance. 34.41 Section 34.41 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... and business status, as follows: (1) The program portions of the reports must address progress toward... program progress reported in the periodic report, in relation to reported expenditures, is sufficient to...

32 CFR 34.41 - Monitoring and reporting program and financial performance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... performance. 34.41 Section 34.41 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... and business status, as follows: (1) The program portions of the reports must address progress toward... program progress reported in the periodic report, in relation to reported expenditures, is sufficient to...

32 CFR 34.41 - Monitoring and reporting program and financial performance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... performance. 34.41 Section 34.41 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... and business status, as follows: (1) The program portions of the reports must address progress toward... program progress reported in the periodic report, in relation to reported expenditures, is sufficient to...

32 CFR 34.41 - Monitoring and reporting program and financial performance.

Code of Federal Regulations, 2012 CFR

2012-07-01

... performance. 34.41 Section 34.41 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... and business status, as follows: (1) The program portions of the reports must address progress toward... program progress reported in the periodic report, in relation to reported expenditures, is sufficient to...

Corporate smoking cessation on Long Island.

PubMed

Mulligan, Peter

2010-03-01

Tobacco addiction is a treatable health care problem. Employers are experiencing major annual increases in the cost of providing health insurance benefits. The expenditures due to smoking-related diseases are a major contributor to the escalating cost of employer-sponsored health and life benefit plans. An initiative that employers have adopted to help control increases in health care costs as well as improve the lifestyle of employees is the establishment of corporate wellness programs. Programs that promote healthy lifestyles and wellness are connected to the principle that a happy and healthy worker will be more effective and productive. Another dividend of corporate wellness programs is higher employee retention and better employee morale. An earlier study investigated the impact of wellness programs for Long Island employers. One of the major findings of that research was the confirmation of the prevalence of smoking cessation initiatives as components of the successful wellness programs. This article, through analysis of a follow-up survey, confirms that corporate smoking cessation programs have a significant return on investment. Further, the analysis identifies the components of the cessation programs and measures the relative impact of each element.

Censored Quantile Instrumental Variable Estimates of the Price Elasticity of Expenditure on Medical Care

PubMed Central

Kowalski, Amanda

2015-01-01

Efforts to control medical care costs depend critically on how individuals respond to prices. I estimate the price elasticity of expenditure on medical care using a censored quantile instrumental variable (CQIV) estimator. CQIV allows estimates to vary across the conditional expenditure distribution, relaxes traditional censored model assumptions, and addresses endogeneity with an instrumental variable. My instrumental variable strategy uses a family member’s injury to induce variation in an individual’s own price. Across the conditional deciles of the expenditure distribution, I find elasticities that vary from −0.76 to −1.49, which are an order of magnitude larger than previous estimates. PMID:26977117

Pros and cons of the health transformation program in Iran: evidence from financial outcomes at the household level.

PubMed

Homaie Rad, Enayatollah; Yazdi-Feyzabad, Vahid; Yousefzadeh-Chabok, Shahrokh; Afkar, Abolhasan; Naghibzadeh, Ahmad

2017-01-01

The health transformation program was a recent reform in the health system of Iran that was implemented in early 2014. Some of the program's important goals were to improve the equity of payments and to reduce out-of-pocket (OOP) payments and catastrophic health expenditures (CHE). In this study, these goals were evaluated using a before-and-after analysis. Data on household income and expenditures in Guilan Province were gathered for the years 2013 and 2015. OOP payments for outpatient, inpatient, and drug services were calculated, and the results were compared using the propensity score matching technique after adjusting for confounding variables. Concentration indices and curves were added to quantify changes in inequity before and after the reform. The incidence of catastrophic expenditures was then calculated. Overall and outpatient service OOP payments increased by approximately 10 dollars, while for other types of services, no significant changes were found. Inequity and utilization of services did not change after the reform. However, a significant reduction was observed in CHE incidence (5.75 to 3.82%). The reform was successful in decreasing the incidence of CHE, but not in reducing the monetary amount of OOP payments or affecting the frequency of health service utilization.

Start-Up and Ongoing Practice Expenses of Behavioral Health and Primary Care Integration Interventions in the Advancing Care Together (ACT) Program.

PubMed

Wallace, Neal T; Cohen, Deborah J; Gunn, Rose; Beck, Arne; Melek, Steve; Bechtold, Donald; Green, Larry A

2015-01-01

Provide credible estimates of the start-up and ongoing effort and incremental practice expenses for the Advancing Care Together (ACT) behavioral health and primary care integration interventions. Expenditure data were collected from 10 practice intervention sites using an instrument with a standardized general format that could accommodate the unique elements of each intervention. Average start-up effort expenses were $44,076 and monthly ongoing effort expenses per patient were $40.39. Incremental expenses averaged $20,788 for start-up and $4.58 per patient for monthly ongoing activities. Variations in expenditures across practices reflect the differences in intervention specifics and organizational settings. Differences in effort to incremental expenditures reflect the extensive use of existing resources in implementing the interventions. ACT program incremental expenses suggest that widespread adoption would likely have a relatively modest effect on overall health systems expenditures. Practice effort expenses are not trivial and may pose barriers to adoption. Payers and purchasers interested in attaining widespread adoption of integrated care must consider external support to practices that accounts for both incremental and effort expense levels. Existing knowledge transfer mechanisms should be employed to minimize developmental start-up expenses and payment reform focused toward value-based, Triple Aim-oriented reimbursement and purchasing mechanisms are likely needed. © Copyright 2015 by the American Board of Family Medicine.

77 FR 71005 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-28

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Proposed Information Collection Activity; Comment Request Proposed Projects Title: Child Support Enforcement Program Expenditure Report (Form OCSE-396A) and the Child Support Enforcement Program Collection Report (Form OCSE-34A...

75 FR 71710 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-24

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Submission for OMB Review; Comment Request Title: OCSE-396A: Child Support Enforcement Program Expenditure Report; OCSE-34A: Child Support Enforcement Program Collection Report. OMB No.: 0970-0181. Description: State...

75 FR 10805 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-09

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Proposed Information Collection Activity; Comment Request Proposed Projects: Title: Child Support Enforcement Program Expenditure Report (Form OCSE-396A) and the Child Support Enforcement Program Collection Report (Form OCSE-34A...

29 CFR 36.450 - Athletics.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Secretary of Labor NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities... unequal expenditures for male and female teams if a recipient operates or sponsors separate teams will not...

10 CFR 1042.450 - Athletics.

Code of Federal Regulations, 2013 CFR

2013-01-01

... ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or... unequal expenditures for male and female teams if a recipient operates or sponsors separate teams will not...

44 CFR 19.450 - Athletics.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SECURITY GENERAL NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities... unequal expenditures for male and female teams if a recipient operates or sponsors separate teams will not...

10 CFR 1042.450 - Athletics.

Code of Federal Regulations, 2014 CFR

2014-01-01

... ENERGY (GENERAL PROVISIONS) NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or... unequal expenditures for male and female teams if a recipient operates or sponsors separate teams will not...

44 CFR 19.450 - Athletics.

Code of Federal Regulations, 2014 CFR

2014-10-01

... SECURITY GENERAL NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities... unequal expenditures for male and female teams if a recipient operates or sponsors separate teams will not...

29 CFR 36.450 - Athletics.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Secretary of Labor NONDISCRIMINATION ON THE BASIS OF SEX IN EDUCATION PROGRAMS OR ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs or Activities... unequal expenditures for male and female teams if a recipient operates or sponsors separate teams will not...

7 CFR 15a.41 - Athletics.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the Secretary of Agriculture EDUCATION PROGRAMS OR ACTIVITIES RECEIVING OR BENEFITTING FROM FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs and Activities Prohibited... unequal expenditures for male and female teams if a recipient operates or sponsors separate teams will not...

7 CFR 15a.41 - Athletics.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the Secretary of Agriculture EDUCATION PROGRAMS OR ACTIVITIES RECEIVING OR BENEFITTING FROM FEDERAL FINANCIAL ASSISTANCE Discrimination on the Basis of Sex in Education Programs and Activities Prohibited... unequal expenditures for male and female teams if a recipient operates or sponsors separate teams will not...