Medicare long-term CPAP coverage policy: a cost-utility analysis.

PubMed

Billings, Martha E; Kapur, Vishesh K

2013-10-15

CPAP is an effective treatment for OSA that may reduce health care utilization and costs. Medicare currently reimburses the costs of long-term CPAP therapy only if the patient is adherent during a 90-day trial. If not, Medicare requires a repeat polysomnogram (PSG) and another trial which seems empirically not cost-effective. We modeled the cost-effectiveness of current Medicare policy compared to an alternative policy (clinic-only) without the adherence criterion and repeat PSG. Cost-utility and cost-effectiveness analysis. U.S. Medicare Population. N/A. N/A. We created a decision tree modeling (1) clinic only follow-up vs. (2) current Medicare policy. Costs were assigned based on Medicare reimbursement rates in 2012. Sensitivity analyses were conducted to test our assumptions. We estimated cumulative costs, overall adherence, and QALY gained for a 5-year time horizon from the perspective of Medicare as the payer. Current Medicare policy is more costly than the clinic-only policy but has higher net adherence and improved utility. Current Medicare policy compared to clinic-only policy costs $30,544 more per QALY. Current CMS policy promotes early identification of those more likely to adhere to CPAP therapy by requiring strict adherence standards. The policy effect is to deny coverage to those unlikely to use CPAP long-term and prevent wasted resources. Future studies are needed to measure long-term adherence in an elderly population with and without current adherence requirements to verify the cost-effectiveness of a policy change.

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

PubMed

Carr, Edward W; Corbett, James J

2015-08-18

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

Medicare Long-Term CPAP Coverage Policy: A Cost-Utility Analysis

PubMed Central

Billings, Martha E.; Kapur, Vishesh K.

2013-01-01

Study Objectives: CPAP is an effective treatment for OSA that may reduce health care utilization and costs. Medicare currently reimburses the costs of long-term CPAP therapy only if the patient is adherent during a 90-day trial. If not, Medicare requires a repeat polysomnogram (PSG) and another trial which seems empirically not cost-effective. We modeled the cost-effectiveness of current Medicare policy compared to an alternative policy (clinic-only) without the adherence criterion and repeat PSG. Design: Cost-utility and cost-effectiveness analysis. Setting: U.S. Medicare Population. Patients or Participants: N/A. Interventions: N/A. Measurements and Results: We created a decision tree modeling (1) clinic only follow-up vs. (2) current Medicare policy. Costs were assigned based on Medicare reimbursement rates in 2012. Sensitivity analyses were conducted to test our assumptions. We estimated cumulative costs, overall adherence, and QALY gained for a 5-year time horizon from the perspective of Medicare as the payer. Current Medicare policy is more costly than the clinic-only policy but has higher net adherence and improved utility. Current Medicare policy compared to clinic-only policy costs $30,544 more per QALY. Conclusions: Current CMS policy promotes early identification of those more likely to adhere to CPAP therapy by requiring strict adherence standards. The policy effect is to deny coverage to those unlikely to use CPAP long-term and prevent wasted resources. Future studies are needed to measure long-term adherence in an elderly population with and without current adherence requirements to verify the cost-effectiveness of a policy change. Citation: Billings ME; Kapur VK. Medicare long-term CPAP coverage policy: a cost-utility analysis. J Clin Sleep Med 2013;9(10):1023-1029. PMID:24127146

Valuation effects of health cost containment measures.

PubMed

Strange, M L; Ezzell, J R

2000-01-01

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

Does Knowledge of Medication Prices Predict Physicians’ Support for Cost Effective Prescribing Policies?

PubMed Central

Polinski, Jennifer M.; Maclure, Malcolm; Marshall, Blair; Cassels, Alan; Agnew-Blais, Jessica; Patrick, Amanda R.; Schneeweiss, Sebastian

2010-01-01

Background British Columbia implemented a generic substitution (GS) and Reference Drug Program (RDP) to contain drug expenditures without negatively affecting health outcomes. Years after implementation, these policies remain controversial among physicians. Objective To assess British Columbia general practitioners’ (GPs) opinions of RDP and GS stratified by knowledge of drug costs. Methods In telephone interviews, GPs ranked the economic and clinical appropriateness of drug policy options on a 5-point Likert scale. Responses to economic questions were stratified and compared according to the accuracy (±$10 of the actual cost) of GPs’ cost estimates for a 30-day supply of atorvastatin and omeprazole. Results The majority of 210 interviewed GPs rated the economic appropriateness of GS and RDP positively (79% and 65%) but fewer rated them clinically appropriate (60% and 43%). Ratings for GS were more favorable than RDP, economically (mean=4.3 v. 3.8, p=0.0005) and clinically (mean=3.7 v 3.1, p=0.006). GP’s assessment of the therapeutic equivalence among ACE inhibitors and among CCBs correlated with their ratings of the respective RDPs (ρ=0.3, p=0.03, and ρ=0.4, p=0.02). GPs underestimated the price for omeprazole by C$28 (33%) and atorvastatin by C$28 (34%). GPs with accurate cost estimates were equally as likely to favorably rank the economic appropriateness of RDP as those with inaccurate estimates (mean = 3.7 v. 4.0, p=0.0847). GS was assessed similarly (mean = 4.2 v. 4.5, p=0.0712). Conclusions In British Columbia, the majority of GPs hold favorable opinions of GS and RDP, but simply educating physicians about drug prices will not make them more supportive of cost-containment policies. PMID:18641423

Proprietary hospitals in cost containment.

PubMed

Jones, D A

1985-08-23

Any effort to control the rise in health care costs must start with analyzing the causes, which are really quite simple. Most cost control efforts fail because they do not address the causes. The causes are large subsidies in several forms that send a false message that health care is free and should be used abundantly, and expansive reimbursement programs that reward inefficient providers with higher payments. This combination of demand stimulation and cost-plus reimbursement produced the world's most expensive health care delivery system and strident calls for reform. A long overdue change in public policy took effect October 1, 1983, when Medicare payments moved from cost-plus reimbursement to fixed, prospectively determined prices. Because it addressed one of the causes of medical inflation, this change has been effective in slowing the rise in Medicare expenditures. Sponsorship of a hospital is not a determinant of its cost-effectiveness. There are examples of efficient and inefficient hospitals in both the voluntary and the investor-owned or taxpaying hospitals. The determining factor is the will of management to keep costs under control.

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

PubMed

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

2016-04-01

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

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

PubMed Central

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

2015-01-01

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

Cost containment: the Pacific. Japan.

PubMed

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

1994-08-01

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

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

PubMed Central

Jencks, Stephen F.; Schieber, George J.

1992-01-01

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

CASE STUDY ON AN IPILIMUMAB COST-CONTAINMENT STRATEGY IN AN ITALIAN HOSPITAL.

PubMed

Russi, Alberto; Chiarion-Sileni, Vanna; Damuzzo, Vera; Di Sarra, Francesca; Pigozzo, Jacopo; Palozzo, Angelo Claudio

2017-01-01

Ipilimumab is the first licensed immune checkpoint inhibitor for treatment of melanoma. The promising results of the registration clinical study need confirmation in real practice and its clinical success comes together with a relevant budget impact due to the high price of this drug. The aim of this work is to describe a new model of economical sustainability of ipilimumab developed in an Italian reference center for melanoma treatment. This retrospective, observational, and monocentric study was carried out at the Veneto Institute of Oncology. Ipilimumab was administered to fifty-seven patients with advanced melanoma. Overall survival, progression free survival, and toxicity were evaluated. A local management procedure was evaluated together with the cost-saving strategies implemented by the Italian Medicines Agency (AIFA). We demonstrated that the use of ipilimumab for metastatic melanoma in real practice had an efficacy and toxicity similar to that reported in the literature. In this scenario, our management model (centralization of compounding + drug-day) permitted savings up to the 11.1 percent of the gross cost for the drug (calculated assuming that no cost saving procedures were applied) while the policy of cost containment designed by AIFA produced an additional 6.2 percent of savings. In real practice conditions, the centralized administration of ipilimumab allows to replicate the results of clinical studies and in the meantime to contain the cost associated with this drug. The local strategy of management can be readily applied to most of the high cost drugs compounded in the hospital pharmacy. Impact of findings on practice: (i) We describe a new model of economic sustainability (drug-day, centralization of compounding, payback systems) of an expensive and innovative drug, ipilimumab, for treatment of melanoma within an Italian cancer center. (ii) This pivotal study demonstrated that a cost containment strategy is feasible and it needs the cooperation

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

PubMed

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

2016-09-01

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

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

ERIC Educational Resources Information Center

McBain, Lesley

2009-01-01

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

Medical education, cost and policy: what are the drivers for change? Commentary.

PubMed

Walsh, Kieran

2014-01-01

Medical education is expensive. Its expense has led many stakeholders to speculate on how costs could be reduced. In an ideal world such decisions would be made on sound evidence; however this is impossible in the absence of evidence. Sometimes practice will be informed by policy, but policy will not always be evidence based. So how is policy in the field of cost and value in medical education actually developed? The foremost influence on policy in cost and value should be evidence-based knowledge. Unfortunately policy is sometimes influenced by what might at best be termed tradition and at worst inertia. Another influence on policy will be people--but some individuals may have more influence than others. A further influence on policy in this field is events, and mainly events that have gone wrong. One final influence on emerging policy in medical education cost analysis is that of the media.

7 CFR 246.16a - Infant formula cost containment.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions § 246.16a Infant formula cost containment. (a) Who must use cost... 7 Agriculture 4 2011-01-01 2011-01-01 false Infant formula cost containment. 246.16a Section 246...

7 CFR 246.16a - Infant formula cost containment.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions § 246.16a Infant formula cost containment. (a) Who must use cost... 7 Agriculture 4 2010-01-01 2010-01-01 false Infant formula cost containment. 246.16a Section 246...

U.S. pharmacy policy: a public health perspective on safety and cost.

PubMed

Rosenau, Pauline Vaillancourt; Lal, Lincy S; Glasser, Jay H

2009-01-01

A public health perspective based on social justice and a population health point of view emphasizes pharmacy policy innovations regarding safety and costs. Such policies that effectively reduce costs include controlling profits, establishing profit targets, extending prescription providers, revising prescription classification schemes, emphasizing generic medications, and establishing formularies. Public education and universal programs may reduce costs, but co-pays and "cost-sharing" do not. Switching medications to over-the-counter (OTC) status, pill splitting, and importing medication from abroad are poor substitutes for authentic public health pharmacy policy. Where policy changes yield savings, public health insists that these savings should be used to increase access and improve population health. In the future, pharmacy policies may emphasize public health accountability more than individual liberty because of potential cost savings to society. Fear of litigation, as an informal mechanism of focusing manufacturer's attention on safety, is inefficient; public health pharmacy policy regarding safety looks toward a more active regulatory role on the part of government. A case study of direct-to-consumer advertising illustrates the complexity of public health pharmacy policy.

A Nuclear Waste Management Cost Model for Policy Analysis

NASA Astrophysics Data System (ADS)

Barron, R. W.; Hill, M. C.

2017-12-01

Although integrated assessments of climate change policy have frequently identified nuclear energy as a promising alternative to fossil fuels, these studies have often treated nuclear waste disposal very simply. Simple assumptions about nuclear waste are problematic because they may not be adequate to capture relevant costs and uncertainties, which could result in suboptimal policy choices. Modeling nuclear waste management costs is a cross-disciplinary, multi-scale problem that involves economic, geologic and environmental processes that operate at vastly different temporal scales. Similarly, the climate-related costs and benefits of nuclear energy are dependent on environmental sensitivity to CO2 emissions and radiation, nuclear energy's ability to offset carbon emissions, and the risk of nuclear accidents, factors which are all deeply uncertain. Alternative value systems further complicate the problem by suggesting different approaches to valuing intergenerational impacts. Effective policy assessment of nuclear energy requires an integrated approach to modeling nuclear waste management that (1) bridges disciplinary and temporal gaps, (2) supports an iterative, adaptive process that responds to evolving understandings of uncertainties, and (3) supports a broad range of value systems. This work develops the Nuclear Waste Management Cost Model (NWMCM). NWMCM provides a flexible framework for evaluating the cost of nuclear waste management across a range of technology pathways and value systems. We illustrate how NWMCM can support policy analysis by estimating how different nuclear waste disposal scenarios developed using the NWMCM framework affect the results of a recent integrated assessment study of alternative energy futures and their effects on the cost of achieving carbon abatement targets. Results suggest that the optimism reflected in previous works is fragile: Plausible nuclear waste management costs and discount rates appropriate for intergenerational cost

Managed care and hospital cost containment.

PubMed

Konetzka, R Tamara; Zhu, Jingsan; Sochalski, Julie; Volpp, Kevin G

2008-01-01

This study assesses the ability of managed care to contain hospital costs since the managed care backlash, using data from California's Office of Statewide Health Planning and Development for all acute-care hospitals in the state for the period 1991-2001. The analysis employs a long-differences design to examine cost growth before and after the managed care backlash. Results from the early 1990s are consistent with prior evidence that the combination of more competitive markets and high managed care penetration held down costs. Post-backlash, high managed care penetration no longer was associated with lower cost growth in the most competitive markets, indicating that the synergistic effects between managed care and hospital competition no longer may exist.

Cost containment for the public health.

PubMed

Eastaugh, Steven R

2006-01-01

The U.S. health care system has major problems with respect to patient access and cost control. Trimming excess hospital expenses and expanding public health activities are cost effective. By budgeting well, with global budgets set for the high cost sectors, the United States might emerge with lower tax hikes, a healthier population, better facilities, and enhanced access to service. Nations with global budgets have better health statistics, and lower costs, compared to the United States. With global budgets, these countries employ 75 to 85 percent fewer employees in administration and regulation, but patient satisfaction is almost double the rate in the United States. Implement a global budget for health care, or substantially raise taxes, is the basic choice faced in this country. Key words: global budget control cost containment.

How do high cost-sharing policies for physician care affect total care costs among people with chronic disease?

PubMed

Xin, Haichang; Harman, Jeffrey S; Yang, Zhou

2014-01-01

This study examines whether high cost-sharing in physician care is associated with a differential impact on total care costs by health status. Total care includes physician care, emergency room (ER) visits and inpatient care. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients. This study used the 2007 Medical Expenditure Panel Survey data with a cross-sectional study design. Difference in difference (DID), instrumental variable technique, two-part model, and bootstrap technique were employed to analyze cost data. Chronically ill individuals' probability of reducing any overall care costs was significantly less than healthier individuals (beta = 2.18, p = 0.04), while the integrated DID estimator from split results indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). This greater cost reduction in total care among sick people likely resulted from greater cost reduction in physician care, and may have come at the expense of jeopardizing health outcomes by depriving patients of needed care. Thus, these policies would be inappropriate in the short run, and unlikely in the long run to control health plans costs among chronically ill individuals. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees' health status.

Seoul's greenbelt: an experiment in urban containment

Treesearch

David N. Bengston; Youn Yeo-Chang

2005-01-01

Urban containment policies are considered by some to be a promising approach to growth management. The greenbelt-based urban containment policy of Seoul, Republic of Korea is examined as a case study. Seoul's greenbelt has generated both significant social costs and benefits. Korea's greenbelt policy is currently being revised, largely due to pressure from...

Cost-effectiveness of breast cancer screening policies using simulation.

PubMed

Gocgun, Y; Banjevic, D; Taghipour, S; Montgomery, N; Harvey, B J; Jardine, A K S; Miller, A B

2015-08-01

In this paper, we study breast cancer screening policies using computer simulation. We developed a multi-state Markov model for breast cancer progression, considering both the screening and treatment stages of breast cancer. The parameters of our model were estimated through data from the Canadian National Breast Cancer Screening Study as well as data in the relevant literature. Using computer simulation, we evaluated various screening policies to study the impact of mammography screening for age-based subpopulations in Canada. We also performed sensitivity analysis to examine the impact of certain parameters on number of deaths and total costs. The analysis comparing screening policies reveals that a policy in which women belonging to the 40-49 age group are not screened, whereas those belonging to the 50-59 and 60-69 age groups are screened once every 5 years, outperforms others with respect to cost per life saved. Our analysis also indicates that increasing the screening frequencies for the 50-59 and 60-69 age groups decrease mortality, and that the average number of deaths generally decreases with an increase in screening frequency. We found that screening annually for all age groups is associated with the highest costs per life saved. Our analysis thus reveals that cost per life saved increases with an increase in screening frequency. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cost benefit analysis of two policy options for cannabis: status quo and legalisation.

PubMed

Shanahan, Marian; Ritter, Alison

2014-01-01

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

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

PubMed Central

Shanahan, Marian; Ritter, Alison

2014-01-01

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

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

ERIC Educational Resources Information Center

Ngolovoi, Mary S.

2010-01-01

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

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

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

PubMed

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

2014-07-01

Hospitals have become a focal point for health care reform strategies in many European countries during the current financial crisis. It has been called for both, short-term reforms to reduce costs and long-term changes to improve the performance in the long run. On the basis of a literature and document analysis this study analyses how EU member states align short-term and long-term pressures for hospital reforms in times of the financial crisis and assesses the EU's influence on the national reform agenda. The results reveal that there has been an emphasis on cost containment measures rather than embarking on structural redesign of the hospital sector and its position within the broader health care system. The EU influences hospital reform efforts through its enhanced economic framework governance which determines key aspects of the financial context for hospitals in some countries. In addition, the EU health policy agenda which increasingly addresses health system questions stimulates the process of structural hospital reforms by knowledge generation, policy advice and financial incentives. We conclude that successful reforms in such a period would arguably need to address both the organisational and financing sides to hospital care. Moreover, critical to structural reform is a widely held acknowledgement of shortfalls in the current system and belief that new models of hospital care can deliver solutions to overcome these deficits. Advancing the structural redesign of the hospital sector while pressured to contain cost in the short-term is not an easy task and only slowly emerging in Europe. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Department of Defense Environmental Cleanup Cost Allowability Policy.

DTIC Science & Technology

1994-12-01

The environment is directly affected by the industrial requirements and manufacturing processes necessary to provide those goods and services. As...and the industrial base. To begin the process , DCMC initiated the Environmental Initiatives Task Force Pilot Cost Allowance Program at five locations...policy covering environmental cleanup costs. Information will be provided to assist in the decision making process regarding the factors affecting the

How do high cost-sharing policies for physician care affect inpatient care use and costs among people with chronic disease?

PubMed

Xin, Haichang

2015-01-01

Rapidly rising health care costs continue to be a significant concern in the United States. High cost-sharing strategies thus have been widely used to address rising health care costs. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies for physician care are a good strategy for controlling costs among chronically ill patients, especially whether utilization and costs in inpatient care will increase in response. This study examined whether high cost sharing in physician care affects inpatient care utilization and costs differently between individuals with and without chronic conditions. Findings from this study will contribute to the insurance benefit design that can control care utilization and save costs of chronically ill individuals. Prior studies suffered from gaps that limit both internal validity and external validity of their findings. This study has its unique contributions by filling these gaps jointly. The study used data from the 2007 Medical Expenditure Panel Survey, a nationally representative sample, with a cross-sectional study design. Instrumental variable technique was used to address the endogeneity between health care utilization and cost-sharing levels. We used negative binomial regression to analyze the count data and generalized linear models for costs data. To account for national survey sampling design, weight and variance were adjusted. The study compared the effects of high cost-sharing policies on inpatient care utilization and costs between individuals with and without chronic conditions to answer the research question. The final study sample consisted of 4523 individuals; among them, 752 had hospitalizations. The multivariate analysis demonstrated consistent patterns. Compared with low cost-sharing policies, high cost-sharing policies for physician care were not associated with a greater increase in inpatient care utilization (P = .86 for chronically ill

[Cost-effectiveness of breast cancer screening policies in Mexico].

PubMed

Valencia-Mendoza, Atanacio; Sánchez-González, Gilberto; Bautista-Arredondo, Sergio; Torres-Mejía, Gabriela; Bertozzi, Stefano M

2009-01-01

Generate cost-effectiveness information to allow policy makers optimize breast cancer (BC) policy in Mexico. We constructed a Markov model that incorporates four interrelated processes of the disease: the natural history; detection using mammography; treatment; and other competing-causes mortality, according to which 13 different strategies were modeled. Strategies (starting age, % of coverage, frequency in years)= (48, 25, 2), (40, 50, 2) and (40, 50, 1) constituted the optimal method for expanding the BC program, yielding 75.3, 116.4 and 171.1 thousand pesos per life-year saved, respectively. The strategies included in the optimal method for expanding the program produce a cost per life-year saved of less than two times the GNP per capita and hence are cost-effective according to WHO Commission on Macroeconomics and Health criteria.

24 CFR 891.670 - Cost containment and modest design standards.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 4 2011-04-01 2011-04-01 false Cost containment and modest design... Handicapped Families and Individuals-Section 162 Assistance § 891.670 Cost containment and modest design standards. (a) Restrictions on amenities. Projects must be modest in design. Except as provided in paragraph...

24 CFR 891.670 - Cost containment and modest design standards.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 4 2014-04-01 2014-04-01 false Cost containment and modest design... Handicapped Families and Individuals-Section 162 Assistance § 891.670 Cost containment and modest design standards. (a) Restrictions on amenities. Projects must be modest in design. Except as provided in paragraph...

24 CFR 891.670 - Cost containment and modest design standards.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 4 2013-04-01 2013-04-01 false Cost containment and modest design... Handicapped Families and Individuals-Section 162 Assistance § 891.670 Cost containment and modest design standards. (a) Restrictions on amenities. Projects must be modest in design. Except as provided in paragraph...

24 CFR 891.670 - Cost containment and modest design standards.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 4 2012-04-01 2012-04-01 false Cost containment and modest design... Handicapped Families and Individuals-Section 162 Assistance § 891.670 Cost containment and modest design standards. (a) Restrictions on amenities. Projects must be modest in design. Except as provided in paragraph...

24 CFR 891.670 - Cost containment and modest design standards.

Code of Federal Regulations, 2010 CFR

2010-04-01

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-13

...] Recovery Policy, RP9525.7, Labor Costs--Emergency Work AGENCY: Federal Emergency Management Agency, DHS... (FEMA) is accepting comments on RP9525.7, Labor Costs--Emergency Work. This is an existing policy that... who perform emergency work (Categories A and B). DATES: Comments must be received by September 13...

Autos, tires, aluminum, oil--and cost containment.

PubMed

Friedman, E

1978-09-01

Faced with massive increases in the costs of the health care benefits they provide for their employees, many large U.S. corporations are becoming increasingly involved in efforts to contain health care costs. Often seeing their efforts as posing an alternative to direct federal government intervention, business leaders are implementing a wide range of programs, including specific arrangements with providers, education of hospital trustees who are also employees, and fitness and preventive medicine programs.

A policy-oriented cost model for shipping commodities by truck.

DOT National Transportation Integrated Search

2009-12-01

Surprisingly, transportation planners and policy makers do not have the ability to estimate the cost of shipping a quantity of a commodity between two : locations for broad categories of goods. Costs of shipping are important components in mode, rout...

Future European health care: cost containment, health care reform and scientific progress in drug research.

PubMed

Emilien, G

1997-01-01

The cost of the development of a new pharmaceutical product from its conception and synthesis through to the regulatory approval process has more than quadrupled in the last 20 years. Both clinical and total development times have increased substantially. To amortize the costs incurred, the pharmaceutical industry has taken an international dimension. The incentives for pharmaceutical firms to discover and develop new drugs depend on the length of the development and regulatory review process plus the potential market size. Recent regulatory, economic and political changes may have significant implications for the future of new drug developments in Europe. The European Union industrial policy felt that there is a need for convergence in the area of pricing. It is recommended that the policy should aim to contain growth in pharmaceutical expenses by means specific to reimbursement rather than direct price controls. By encouraging doctors to prescribe and customers to use generics, competition is enhanced to bring down drug prices. More emphasis is being laid by government in educating customers to cost-awareness and cost-benefit ratios with regard to pharmaceuticals. Concerning clinical trials, European harmonization has been achieved by significant developments: the rights and integrity of the trial subjects are protected; the credibility of the data is established; and the ethical, scientific and technical quality of the trials has improved. Future European health care forecasts a whole change in the pharmaceutical business. Important issues in cost and outcome measurement should be carefully planned and considered in drug development. Due to important mergers and acquisitions, the pharmaceutical sector will consist mainly of important multinational corporations. In this way, valuable new products may be brought to the market.

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

PubMed Central

Vogel, Ronald J.

1984-01-01

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

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-29

... derived from 41 U.S.C. 1501. Cost Accounting Standards are rules governing the measurement, assignment... Circulars, OFPP Policy Letters, and CASB Cost Accounting Standards Included in the Semiannual Agenda of..., and Cost Accounting Standards Board (CASB) Cost Accounting Standards. OMB Circulars and OFPP Policy...

A review of cost-effectiveness, cost-containment and economics curricula in graduate medical education.

PubMed

Varkey, Prathibha; Murad, Mohammad H; Braun, Chad; Grall, Kristi J H; Saoji, Vivek

2010-12-01

Numerous studies performed over the last 30 years suggest that doctors have poor knowledge of the costs of medical care. In most graduate medical education programmes, trainees do not receive formal training in cost-effective medical practice. Comprehensive literature search of electronic bibliographic databases for articles that describe health economics, cost-containment and cost-effectiveness curricula in graduate medical education. Critical appraisal of the literature and qualitative description is presented. Heterogeneity of curricula precluded quantitative summary of data. We identified 40 articles that met the inclusion criteria for this review. Internal medicine residents were the targeted learners in 27 studies (68%); Family Medicine and Surgery residents were each targeted in five studies (13%); Rehabilitation, Paediatrics and Emergency Medicine residents were each targeted in one study. In general, the methodological quality of the included studies was poor to moderate and mostly targeted knowledge of health economics or cost-containment as opposed to targeting cost-effectiveness. In terms of describing the standard curricular components, studies sufficiently described the different educational strategies (e.g. didactics, interactive, experiential, self-directed) and the component of learner assessment, but lacked the description of other elements such as needs assessment and curriculum evaluation. Cost-effectiveness curricula in graduate medical education are lacking and clearly needed. © 2010 Blackwell Publishing Ltd.

Cost-effectiveness analysis of policy instruments for greenhouse gas emission mitigation in the agricultural sector.

PubMed

Bakam, Innocent; Balana, Bedru Babulo; Matthews, Robin

2012-12-15

Market-based policy instruments to reduce greenhouse gas (GHG) emissions are generally considered more appropriate than command and control tools. However, the omission of transaction costs from policy evaluations and decision-making processes may result in inefficiency in public resource allocation and sub-optimal policy choices and outcomes. This paper aims to assess the relative cost-effectiveness of market-based GHG mitigation policy instruments in the agricultural sector by incorporating transaction costs. Assuming that farmers' responses to mitigation policies are economically rationale, an individual-based model is developed to study the relative performances of an emission tax, a nitrogen fertilizer tax, and a carbon trading scheme using farm data from the Scottish farm account survey (FAS) and emissions and transaction cost data from literature metadata survey. Model simulations show that none of the three schemes could be considered the most cost effective in all circumstances. The cost effectiveness depends both on the tax rate and the amount of free permits allocated to farmers. However, the emissions trading scheme appears to outperform both other policies in realistic scenarios. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

PubMed

Reist, M; Jemmi, T; Stärk, K D C

2012-07-01

Animal health and residue surveillance verifies the good health status of the animal population, thereby supporting international free trade of animals and animal products. However, active surveillance is costly and time-consuming. The development of cost-effective tools for animal health and food hazard surveillance is therefore a priority for decision-makers in the field of veterinary public health. The assumption of this paper is that outcome-based formulation of standards, legislation leaving room for risk-based approaches and close collaboration and a mutual understanding and exchange between scientists and policy makers are essential for cost-effective surveillance. We illustrate this using the following examples: (i) a risk-based sample size calculation for surveys to substantiate freedom from diseases/infection, (ii) a cost-effective national surveillance system for Bluetongue using scenario tree modelling and (iii) a framework for risk-based residue monitoring. Surveys to substantiate freedom from infectious bovine rhinotracheitis and enzootic bovine leucosis between 2002 and 2009 saved over 6 million € by applying a risk-based sample size calculation approach, and by taking into account prior information from repeated surveys. An open, progressive policy making process stimulates research and science to develop risk-based and cost-efficient survey methodologies. Early involvement of policy makers in scientific developments facilitates implementation of new findings and full exploitation of benefits for producers and consumers. Copyright © 2012 Elsevier B.V. All rights reserved.

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

NASA Technical Reports Server (NTRS)

Stone, Barbara A.

1984-01-01

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

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

ERIC Educational Resources Information Center

McClure, Maureen W.; Abu-Duhou, Ibtisam

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

Determinants of change in Medicaid pharmaceutical cost sharing: does evidence affect policy?

PubMed

Soumerai, S B; Ross-Degnan, D; Fortess, E E; Walser, B L

1997-01-01

Since 1980, many Medicaid programs have instituted, adjusted, or abolished pharmaceutical copayments or limitations on the number of prescriptions per patient (caps). Studies indicate that prescription caps can harm patients and increase Medicaid costs. However, because there is little information on how state policy makers select and evaluate such policies, in-depth telephone interviews were conducted with key informants in Medicaid programs that had recently made changes in cost-sharing policies. Among the barriers to evidence-based policy making were lack of political power, skills, and infrastructure; crisis-oriented decisions; compartmentalized budgeting; lack of advocates for disadvantaged patients; and the absence of timely research. Research was applied successfully when the interests of patient advocates and the drug industry were aligned and when Medicaid analysis were able to identify and communicate relevant research to policy makers at the time, or "teachable moment," that policy was being changed.

Getting back on tap: the policy context and cost of ensuring access to low-cost drinking water in Massachusetts schools.

PubMed

Cradock, Angie L; Wilking, Cara L; Olliges, Sarah A; Gortmaker, Steven L

2012-09-01

Adequate water intake may have important health benefits for schoolchildren. Layers of federal, state, and local policy are relevant to provision of water within schools. Recently passed state and federal laws require free drinking-water access for students during mealtimes. To review Massachusetts local district wellness policies related to water access, provide estimates of costs for three water-provision strategies, and discuss implications for policy relevant to adequate drinking-water access. Legal research was conducted using the LexisNexis legal database and government websites. Local wellness policies were double-coded using existing research tools. Costs of three water-delivery options were estimated using a 10-year school-district perspective. Prior to 2010, most Massachusetts public school district wellness policies (92%-94%) did not address access to free drinking water. Ten-year costs per school for providing water during mealtimes to students, including dispenser unit, installation, water testing, water, cups, and labor, range between $12,544 and $27,922 (depending on water-delivery option) assuming the average Massachusetts school enrollment. Water-provision strategies relying on tap water are more economical than bottled water in the long term. Policy recommendations and cost considerations deserve attention at the local, state, and federal levels. Recommendations are discussed to ensure access to safe, free drinking water for all students. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Bridging environmental and financial cost of dairy production: A case study of Irish agricultural policy.

PubMed

Chen, Wenhao; Holden, Nicholas M

2018-02-15

The Irish agricultural policy 'Food Harvest 2020' is a roadmap for sectoral expansion and Irish dairy farming is expected to intensify, which could influence the environmental and economic performance of Irish milk production. Evaluating the total environmental impacts and the real cost of Irish milk production is a key step towards understanding the possibility of sustainable production. This paper addresses two main issues: aggregation of environmental impacts of Irish milk production by monetization, to understand the real cost of Irish milk production, including the environmental costs; and the effect of the agricultural policy 'Food Harvest 2020' on total cost (combining financial cost and environmental cost) of Irish milk production. This study used 2013 Irish dairy farming as a baseline, and defined 'bottom', 'target' and 'optimum' scenarios, according to the change of elementary inputs required to meet agricultural policy ambitions. The study demonstrated that the three monetization methods, Stepwise 2006, Eco-cost 2012 and EPS 2000, could be used for aggregating different environmental impacts into monetary unit, and to provide an insight for evaluating policy related to total environmental performance. The results showed that the total environmental cost of Irish milk production could be greater than the financial cost (up to €0.53/kg energy corrected milk). The dairy expansion policy with improved herbage utilization and fertilizer application could reduce financial cost and minimize the total environmental cost of per unit milk produced. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed

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

2016-02-01

To mitigate serious air pollution, the State Council of China promulgated the Air Pollution Prevention and Control Action Plan in 2013. To verify the feasibility and validity of industrial energy-saving and emission-reduction policies in the action plan, we conducted a cost-benefit analysis of implementing these policies in 31 provinces for the period of 2013 to 2017. We also completed a scenario analysis in this study to assess the cost-effectiveness of different measures within the energy-saving and the emission-reduction policies individually. The data were derived from field surveys, statistical yearbooks, government documents, and published literatures. The results show that total cost and total benefit are 118.39 and 748.15 billion Yuan, respectively, and the estimated benefit-cost ratio is 6.32 in the S3 scenario. For all the scenarios, these policies are cost-effective and the eastern region has higher satisfactory values. Furthermore, the end-of-pipe scenario has greater emission reduction potential than energy-saving scenario. We also found that gross domestic product and population are significantly correlated with the benefit-cost ratio value through the regression analysis of selected possible influencing factors. The sensitivity analysis demonstrates that benefit-cost ratio value is more sensitive to unit emission-reduction cost, unit subsidy, growth rate of gross domestic product, and discount rate among all the parameters. Compared with other provinces, the benefit-cost ratios of Beijing and Tianjin are more sensitive to changes of unit subsidy than unit emission-reduction cost. These findings may have significant implications for improving China's air pollution prevention policy. Copyright © 2015 Elsevier B.V. All rights reserved.

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

PubMed

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

2013-12-01

Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers. We constructed a cost-effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a postpartum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively. With the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and $215 million saved. A revised Medicaid sterilization policy could potentially honor women's reproductive decisions, reduce the number of unintended pregnancies and save a significant amount of public funds. Compared to the current federal Medicaid sterilization policy, a hypothetical, revised policy that reduces logistical barriers for women who desire publicly funded, postpartum sterilization could potentially avert over 29,000 unintended pregnancies annually and therefore lead to cost savings of $215 million each year. © 2013.

Cost-effectiveness of tobacco control policies and programmes targeting adolescents: a systematic review.

PubMed

Leão, Teresa; Kunst, Anton E; Perelman, Julian

2018-02-01

Consistent evidence shows the importance of preventing smoking at young ages, when health behaviours are formed, with long-term consequences on health and survival. Although tobacco control policies and programmes targeting adolescents are widely promoted, the cost-effectiveness of such interventions has not been systematically documented. We performed a systematic review on the cost-effectiveness of policies and programmes preventing tobacco consumption targeting adolescents. We systematically reviewed literature on the (i) cost and effectiveness of (ii) prevention policies targeting (iii) smoking by (iv) adolescents. PubMed, Web of Science, Cochrane, CEA-TUFTS, Health Economic Evaluations, Wiley Online Library, Centre for Reviews and Dissemination Database, the National Institute for Health and Care Excellence and Google Scholar databases were used, and Google search engine was used for other grey literature review. We obtained 793 full-text papers and 19 grey literature documents, from which 16 studies fulfilled the inclusion criteria. Of these, only one was published in the last 5 years, and 15 were performed in high-income countries. Eight analyzed the cost-effectiveness of school-based programmes, five focused on media campaigns and three on legal bans. Policies and programmes were found to be cost-effective in all studies, and both effective and cost-saving in about half of the studies. Evidence is scarce and relatively obsolete, and rarely focused on the evaluation of legal bans. Moreover, no comparisons have been made between different interventions or across different contexts and implementation levels. However, all studies conclude that smoking prevention policies and programmes amongst adolescents are greatly worth their costs. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association.

Cost-effectiveness analysis of salt reduction policies to reduce coronary heart disease in Syria, 2010-2020.

PubMed

Wilcox, Meredith L; Mason, Helen; Fouad, Fouad M; Rastam, Samer; al Ali, Radwan; Page, Timothy F; Capewell, Simon; O'Flaherty, Martin; Maziak, Wasim

2015-01-01

This study presents a cost-effectiveness analysis of salt reduction policies to lower coronary heart disease in Syria. Costs and benefits of a health promotion campaign about salt reduction (HP); labeling of salt content on packaged foods (L); reformulation of salt content within packaged foods (R); and combinations of the three were estimated over a 10-year time frame. Policies were deemed cost-effective if their cost-effectiveness ratios were below the region's established threshold of $38,997 purchasing power parity (PPP). Sensitivity analysis was conducted to account for the uncertainty in the reduction of salt intake. HP, L, and R+HP+L were cost-saving using the best estimates. The remaining policies were cost-effective (CERs: R=$5,453 PPP/LYG; R+HP=$2,201 PPP/LYG; R+L=$2,125 PPP/LYG). R+HP+L provided the largest benefit with net savings using the best and maximum estimates, while R+L was cost-effective with the lowest marginal cost using the minimum estimates. This study demonstrated that all policies were cost-saving or cost effective, with the combination of reformulation plus labeling and a comprehensive policy involving all three approaches being the most promising salt reduction strategies to reduce CHD mortality in Syria.

Effects of the ACA on Health Care Cost Containment.

PubMed

Weiner, Janet; Marks, Clifford; Pauly, Mark

2017-02-01

This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to "bend the cost curve." Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.

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

PubMed Central

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

2013-01-01

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

Survey on Tuition Policy, Costs and Student Aid.

ERIC Educational Resources Information Center

State Higher Education Executive Officers Association.

A survey of the finance and executive officers of the statewide coordinating and governing boards in the United States and one Canadian province (Manitoba) gathered information on state policy regarding college costs, tuition, and student financial aid. The first part, completed by finance officers, asked specific questions about the…

Special Education in First Nations Schools in Canada: Policies of Cost Containment

ERIC Educational Resources Information Center

Phillips, Ron

2010-01-01

The education of First Nations students in Canada on reserve is the legal responsibility of the federal government. This article reviews and critiques the federal government's past and current special education policies and practices in regard to First Nations schools throughout Canada. The author has found that rather than establishing a…

Economic analysis of three interventions of different intensity in improving school implementation of a government healthy canteen policy in Australia: costs, incremental and relative cost effectiveness.

PubMed

Reilly, Kathryn L; Reeves, Penny; Deeming, Simon; Yoong, Sze Lin; Wolfenden, Luke; Nathan, Nicole; Wiggers, John

2018-03-20

No evaluations of the cost or cost effectiveness of interventions to increase school implementation of food availability policies have been reported. Government and non-government agency decisions regarding the extent of investment required to enhance school implementation of such policies are unsupported by such evidence. This study sought to i) Determine cost and cost-effectiveness of three interventions in improving school implementation of an Australian government healthy canteen policy and; ii) Determine the relative cost-effectiveness of the interventions in improving school implementation of such a policy. An analysis of the cost and cost-effectiveness of three implementation interventions of varying support intensity, relative to usual implementation support conducted during 2013-2015 was undertaken. Secondly, an indirect comparison of the trials was undertaken to determine the most cost-effective of the three strategies. The economic analysis was based on the cost of delivering the interventions by health service delivery staff to increase the proportion of schools 'adherent' with the policy. The total costs per school were $166,971, $70,926 and $75,682 for the high, medium and low intensity interventions respectively. Compared to usual support, the cost effectiveness ratios for each of the three interventions were: A$2982 (high intensity), A$2627 (medium intensity) and A$4730 (low intensity) per percent increase in proportion of schools reporting 'adherence'). Indirect comparison between the 'high' and 'medium intensity' interventions showed no statistically significant difference in cost-effectiveness. The results indicate that while the cost profiles of the interventions varied substantially, the cost-effectiveness did not. This result is valuable to policy makers seeking cost-effective solutions that can be delivered within budget.

Cost-effectiveness Analysis of Vascular Access Referral Policies in CKD.

PubMed

Shechter, Steven M; Chandler, Talon; Skandari, M Reza; Zalunardo, Nadia

2017-09-01

The optimal timing of vascular access referral for patients with chronic kidney disease who may need hemodialysis (HD) is a pressing question in nephrology. Current referral policies have not been rigorously compared with respect to costs and benefits and do not consider patient-specific factors such as age. Monte Carlo simulation model. Patients with chronic kidney disease, referred to a multidisciplinary kidney clinic in a universal health care system. Cost-effectiveness analysis, payer perspective, lifetime horizon. The following vascular access referral policies are considered: central venous catheter (CVC) only, arteriovenous fistula (AVF) or graft (AVG) referral upon HD initiation, AVF (or AVG) referral when HD is forecast to begin within 12 (or 3 for AVG) months, AVF (or AVG) referral when estimated glomerular filtration rate is <15 (or <10 for AVG) mL/min/1.73m 2 . Incremental cost-effectiveness ratios (ICERs, in 2014 US dollars per quality-adjusted life-year [QALY] gained). The ICER of AVF (AVG) referral within 12 (3) months of forecasted HD initiation, compared to using only a CVC, is ∼$105k/QALY ($101k/QALY) at a population level (HD costs included). Pre-HD AVF or AVG referral dominates delaying referral until HD initiation. The ICER of pre-HD referral increases with patient age. Results are most sensitive to erythropoietin costs, ongoing HD costs, and patients' utilities for HD. When ongoing HD costs are excluded from the analysis, pre-HD AVF dominates both pre-HD AVG and CVC-only policies. Literature-based estimates for HD, AVF, and AVG utilities are limited. The cost-effectiveness of vascular access referral is largely driven by the annual costs of HD, erythropoietin costs, and access-specific utilities. Further research is needed in the field of dialysis-related quality of life to inform decision making regarding vascular access referral. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Health care cost containment in Denmark and Norway: a question of relative professional status?

PubMed

Andersen, Lotte B

2014-04-01

The demand for publicly subsidized health care services is insatiable, but the costs can be contained in different ways: formal rules can limit access to and the number of subsidized services, demand and supply can be regulated through the price mechanism, the relevant profession can contain the costs through state-sanctioned self-regulation, and other professions can contain the costs (e.g. through referrals). The use of these cost containment measures varies between countries, depending on demand and supply factors, but the relative professional status of the health professions may help explain why different countries use cost containment measures differently for different services. This article compares cost containment measures in Denmark and Norway because these countries vary with regard to the professional status of the medical profession relative to other health care providers, while other relevant variables are approximately similar. The investigation is based on formal agreements and rules, historical documents, existing analyses and an analysis of 360 newspaper articles. It shows that high relative professional status seems to help professions to avoid user fees, steer clear of regulation from other professions and regulate the services produced by others. This implies that relative professional status should be taken into consideration in analyses of health care cost containment.

EEC energy costs seen higher than U. S. [Need for policy imperative

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zahn, P.

1977-02-21

Europe's dependence on imported oil, depletion of North Sea oil after 1990, and the relation of economic growth to energy costs combine to make a comprehensive energy policy for Europe imperative. Dr. Guido Brunner, the new commissioner of energy affairs for the Common Market (EEC) sees a widening gap in energy costs compared to all major industrial competitors except Japan unless a policy is developed. Present Common Market policies, which rely on individual countries to pursue programs of conserving, storing, and converting fuels, suffer from differing political and economic interpretations of the energy problem. There is no unified policy tomore » reduce dependence on imports and achieve the goal of producing 13 percent of electricity needs by nuclear energy in 1985. Brunner's appointment was generally well received because of his liberal views and low profile, but there is little optimism that he will be able to accomplish his goal of a comprehensive EEC policy. (DCK)« less

Managed care cost-containment strategies and their impact on physician prescribing and treatment of depression. Based on a presentation by Robert K. Schreter, MD.

PubMed

2000-02-01

Pharmacy costs are outpacing other healthcare expenditures, with psychotropic medications accounting for 16% to 25% of the total pharmacy costs. Managed care organizations (MCOs) can be expected to exert considerable pressure to control such costs. Avenues for cost containment include changing the management and spending decisions of MCOs, influencing physician prescribing patterns, encouraging economically efficient pharmacy policies and procedures, and controlling patient access to prescription drugs. From the cost standpoint of an MCO, briefer approaches to treating depressed patients are desirable. The MCOs prefer a limited number of psychotherapeutic sessions, rapid titration and prescription of higher dosage levels of appropriate drugs, and a longer continuation phase of pharmacological treatment to avert a relapse.

Cost risk benefit analysis to support chemoprophylaxis policy for travellers to malaria endemic countries.

PubMed

Massad, Eduardo; Behrens, Ben C; Coutinho, Francisco A B; Behrens, Ronald H

2011-05-17

In a number of malaria endemic regions, tourists and travellers face a declining risk of travel associated malaria, in part due to successful malaria control. Many millions of visitors to these regions are recommended, via national and international policy, to use chemoprophylaxis which has a well recognized morbidity profile. To evaluate whether current malaria chemo-prophylactic policy for travellers is cost effective when adjusted for endemic transmission risk and duration of exposure. a framework, based on partial cost-benefit analysis was used. Using a three component model combining a probability component, a cost component and a malaria risk component, the study estimated health costs avoided through use of chemoprophylaxis and costs of disease prevention (including adverse events and pre-travel advice for visits to five popular high and low malaria endemic regions) and malaria transmission risk using imported malaria cases and numbers of travellers to malarious countries. By calculating the minimal threshold malaria risk below which the economic costs of chemoprophylaxis are greater than the avoided health costs we were able to identify the point at which chemoprophylaxis would be economically rational. The threshold incidence at which malaria chemoprophylaxis policy becomes cost effective for UK travellers is an accumulated risk of 1.13% assuming a given set of cost parameters. The period a travellers need to remain exposed to achieve this accumulated risk varied from 30 to more than 365 days, depending on the regions intensity of malaria transmission. The cost-benefit analysis identified that chemoprophylaxis use was not a cost-effective policy for travellers to Thailand or the Amazon region of Brazil, but was cost-effective for travel to West Africa and for those staying longer than 45 days in India and Indonesia.

Cost containment: the Middle East. Israel.

PubMed

Stern, Z; Altholz, J; Sprung, C L

1994-08-01

The Israeli Health Service was established with the intent of providing an equal standard of care to the entire Israeli population. The Health Service has dealt with changes over the years, including the governing of large populations of Judea, Samaria, and Gaza. In 1990, mass immigration brought 500,000 more individuals to Israel, putting an additional burden on medical services. ICUs in Israel began to emerge after the Six Day War in 1967. The government's Ministry of Health has approved a limited amount of ICU beds. Beyond this set amount, hospital directors decide whether to establish additional ICU beds, weighing departmental pressures from within the hospital to create beds against the knowledge that the hospital will not be reimbursed more than the per diem rate of an ordinary hospital bed ($US 265). Hospital directors and administrators, knowing that the average daily cost of an ICU bed is close to $US 800, turn to their supporting organization to finance the uncontrollable deficit, seek aid from the Ministry of Health to make the per diem rates or diagnosis-related group reimbursements more realistic, and/or implement hospital policies aimed at cutting costs and personnel.

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rhoads-Weaver, Heather; Gagne, Matthew; Sahl, Kurt

2012-02-28

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

Cost-Effectiveness of the Freeze-All Policy.

PubMed

Roque, Matheus; Valle, Marcello; Guimarães, Fernando; Sampaio, Marcos; Geber, Selmo

2015-08-01

To evaluate the cost-effectiveness of freeze-all cycles when compared to fresh embryo transfer. This was an observational study with a cost-effectiveness analysis. The analysis consisted of 530 intracytoplasmic sperm injection (ICSI) cycles in a private center in Brazil between January 2012 and December 2013. A total of 530 intracytoplasmic sperm injection (ICSI) cycles - 351 fresh embryo transfers and 179 freeze-all cycles - with a gonadotropin-releasing hormone (GnRH) antagonist protocol and day 3 embryo transfers. The pregnancy rate was 31.1% in the fresh group and 39.7% in the freeze-all group. We performed two scenario analyses for costs. In scenario 1, we included those costs associated with the ICSI cycle (monitoring during controlled ovarian stimulation [COS], oocyte retrieval, embryo transfer, IVF laboratory, and medical costs), embryo cryopreservation of supernumerary embryos, hormone measurements during COS and endometrial priming, medication use (during COS, endometrial priming, and luteal phase support), ultrasound scan for frozen- thawed embryo transfer (FET), obstetric ultrasounds, and miscarriage. The total cost (in USD) per pregnancy was statistically lower in the freeze-all cycles (19,156.73 ± 1,732.99) when compared to the fresh cycles (23,059.72 ± 2,347.02). Even in Scenario 2, when charging all of the patients in the freeze-all group for cryopreservation (regardless of supernumerary embryos) and for FET, the fresh cycles had a statistically significant increase in treatment costs per ongoing pregnancy. The results presented in this study suggest that the freeze-all policy is a cost-effective strategy when compared to fresh embryo transfer.

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

PubMed

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

2011-05-01

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

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

PubMed Central

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

2011-01-01

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

In-patient costs of agitation and containment in a mental health catchment area.

PubMed

Serrano-Blanco, Antoni; Rubio-Valera, Maria; Aznar-Lou, Ignacio; Baladón Higuera, Luisa; Gibert, Karina; Gracia Canales, Alfredo; Kaskens, Lisette; Ortiz, José Miguel; Salvador-Carulla, Luis

2017-06-06

There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability. During 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area. Agitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.

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

PubMed

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

2015-04-14

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

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

ERIC Educational Resources Information Center

Krutilla, Kerry

2005-01-01

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

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

ERIC Educational Resources Information Center

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

2016-01-01

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

Assessing the Effectiveness and Cost-Benefit of Test-and-Vaccinate Policy for Supplementary Vaccination against Rubella with Limited Doses

PubMed Central

Saito, Masaya M.; Kinoshita, Ryo

2018-01-01

Elevating herd immunity level against rubella is essential to prevent congenital rubella syndrome (CRS). Insufficient vaccination coverage left susceptible pockets among adults in Japan, and the outbreak of rubella from 2012 to 2013 resulted in 45 observed CRS cases. Given a limited stock of rubella-containing vaccine (RCV) available, the Japanese government recommended healthcare providers to prioritize vaccination to those confirmed with low level of immunity, or to those likely to transmit to pregnant women. Although a test-and-vaccinate policy could potentially help reduce the use of the limited stockpile of vaccines, by selectively elevating herd immunity, the cost of serological testing is generally high and comparable to the vaccine itself. Here, we aimed to examine whether random vaccination would be more cost-beneficial than the test-and-vaccinate strategy. A mathematical model was employed to evaluate the vaccination policy implemented in 2012–2013, quantifying the benefit-to-cost ratio to achieve herd immunity. The modelling exercise demonstrated that, while the test-and-vaccinate strategy can efficiently achieve herd immunity when stockpiles of RCV are limited, random vaccination would be a more cost-beneficial strategy. As long as the herd immunity acts as the goal of vaccination, our findings apply to future supplementary immunization strategy. PMID:29565821

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

PubMed

Gray, Alastair; Read, Simon; McGale, Paul; Darby, Sarah

2009-01-06

To determine the number of deaths from lung cancer related to radon in the home and to explore the cost effectiveness of alternative policies to control indoor radon and their potential to reduce lung cancer mortality. Cost effectiveness analysis. United Kingdom. Epidemiological data on risks from indoor radon and from smoking, vital statistics on deaths from lung cancer, survey information on effectiveness and costs of radon prevention and remediation. Estimated number of deaths from lung cancer related to indoor radon, lifetime risks of death from lung cancer before and after various potential interventions to control radon, the cost per quality adjusted life year (QALY) gained from different policies for control of radon, and the potential of those policies to reduce lung cancer mortality. The mean radon concentration in UK homes is 21 becquerels per cubic metre (Bq/m(3)). Each year around 1100 deaths from lung cancer (3.3% of all deaths from lung cancer) are related to radon in the home. Over 85% of these arise from radon concentrations below 100 Bq/m(3) and most are caused jointly by radon and active smoking. Current policy requiring basic measures to prevent radon in new homes in selected areas is highly cost effective, and such measures would remain cost effective if extended to the entire UK, with a cost per QALY gained of pound11,400 ( euro12 200; $16,913). Current policy identifying and remediating existing homes with high radon levels is, however, neither cost effective (cost per QALY gained pound36,800) nor effective in reducing lung cancer mortality. Policies requiring basic preventive measures against radon in all new homes throughout the UK would be cost effective and could complement existing policies to reduce smoking. Policies involving remedial work on existing homes with high radon levels cannot prevent most radon related deaths, as these are caused by moderate exposure in many homes. These conclusions are likely to apply to most developed

The increasing importance of a continence nurse specialist to improve outcomes and save costs of urinary incontinence care: an analysis of future policy scenarios.

PubMed

Franken, Margreet G; Corro Ramos, Isaac; Los, Jeanine; Al, Maiwenn J

2018-02-17

In an ageing population, it is inevitable to improve the management of care for community-dwelling elderly with incontinence. A previous study showed that implementation of the Optimum Continence Service Specification (OCSS) for urinary incontinence in community-dwelling elderly with four or more chronic diseases results in a reduction of urinary incontinence, an improved quality of life, and lower healthcare and lower societal costs. The aim of this study was to explore future consequences of the OCSS strategy of various healthcare policy scenarios in an ageing population. We adapted a previously developed decision analytical model in which the OCSS new care strategy was operationalised as the appointment of a continence nurse specialist located within the general practice in The Netherlands. We used a societal perspective including healthcare costs (healthcare providers, treatment costs, insured containment products, insured home care), and societal costs (informal caregiving, containment products paid out-of-pocket, travelling expenses, home care paid out-of-pocket). All outcomes were computed over a three-year time period using two different base years (2014 and 2030). Settings for future policy scenarios were based on desk-research and expert opinion. Our results show that implementation of the OSCC new care strategy for urinary incontinence would yield large health gains in community dwelling elderly (2030: 2592-2618 QALYs gained) and large cost-savings in The Netherlands (2030: health care perspective: €32.4 Million - €72.5 Million; societal perspective: €182.0 Million - €250.6 Million). Savings can be generated in different categories which depends on healthcare policy. The uncertainty analyses and extreme case scenarios showed the robustness of the results. Implementation of the OCSS new care strategy for urinary incontinence results in an improvement in the quality of life of community-dwelling elderly, a reduction of the costs for payers and

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

NASA Astrophysics Data System (ADS)

Karki, Rajesh

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

Analyzing the cost effectiveness of Santiago, Chile's policy of using urban forests to improve air quality.

PubMed

Escobedo, Francisco J; Wagner, John E; Nowak, David J; De la Maza, Carmen Luz; Rodriguez, Manuel; Crane, Daniel E

2008-01-01

Santiago, Chile has the distinction of having among the worst urban air pollution problems in Latin America. As part of an atmospheric pollution reduction plan, the Santiago Regional Metropolitan government defined an environmental policy goal of using urban forests to remove particulate matter less than 10 microm (PM(10)) in the Gran Santiago area. We used cost effectiveness, or the process of establishing costs and selecting least cost alternatives for obtaining a defined policy goal of PM(10) removal, to analyze this policy goal. For this study, we quantified PM(10) removal by Santiago's urban forests based on socioeconomic strata and using field and real-time pollution and climate data via a dry deposition urban forest effects model. Municipal urban forest management costs were estimated using management cost surveys and Chilean Ministry of Planning and Cooperation documents. Results indicate that managing municipal urban forests (trees, shrubs, and grass whose management is under the jurisdiction of Santiago's 36 municipalities) to remove PM(10) was a cost-effective policy for abating PM(10) based on criteria set by the World Bank. In addition, we compared the cost effectiveness of managing municipal urban forests and street trees to other control policies (e.g. alternative fuels) to abate PM(10) in Santiago and determined that municipal urban forest management efficiency was similar to these other air quality improvement measures.

A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

PubMed

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

2014-01-01

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

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

PubMed Central

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

2014-01-01

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

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

PubMed

Heslop, Liza

2012-02-01

Australia has a long history of patient level costing initiated when casemix funding was implemented in several states in the early 1990s. Australia includes, to some extent, hospital payment based on nursing intensity adopted within casemix funding policy and the Diagnostic Related Group system. Costing of hospital nursing services in Australia has not changed significantly in the last few decades despite widespread introduction of casemix funding policy at the state level. Recent Commonwealth of Australia National Health Reform presents change to the management of the delivery of health care including health-care costing. There is agreement for all Australian jurisdictions to progress to casemix-based activity funding. Within this context, nurse costing infrastructure presents contemporary issues and challenges. An assessment is made of the progress of costing nursing services within casemix funding models in Australian hospitals. Valid and reliable Australian-refined nursing service weights might overcome present cost deficiencies and limitations. © 2012 Blackwell Publishing Asia Pty Ltd.

Has cost containment after the National Health Insurance system been successful? Determinants of Taiwan hospital costs.

PubMed

Hung, Jung-Hua; Chang, Li

2008-03-01

Taiwan implemented the National Health Insurance system (NHI) in 1995. After the NHI, the insurance coverage expanded and the quality of healthcare improved, however, the healthcare costs significantly escalated. The objective of this study is to determine what factors have direct impact on the increased costs after the NHI. Panel data analysis is used to investigate changes and factors affecting cost containment at Taipei municipal hospitals from 1990 to 2001. The results show that the expansion of insured healthcare coverage (especially to the elderly and the treatment of more complicated types of diseases), and the increased competition (requiring the growth of new technology and the longer average length of stay) are important driving forces behind the increase of hospital costs, directly influenced by the advent of the NHI. Therefore, policymakers should emphasize health prevention activities and disease management programs for the elderly to improve cost containment. In addition, hospital managers should find ways to improve the hospital efficiency (shorten the LOS) to reduce excess services and medical waste. They also need to better understand their market position and acquire suitable new-tech equipment earlier, to be a leader, not a follower. Finally, policymakers should establish related benchmark indices for what drivers up hospital costs (micro-aspect) and to control healthcare expenditures (macro-level).

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

PubMed

Kronbak, Lone Grønbæk; Vestergaard, Niels

2013-12-15

In most decision-making involving natural resources, the achievements of a given policy (e.g., improved ecosystem or biodiversity) are rather difficult to measure in monetary units. To address this problem, the current paper develops an environmental cost-effectiveness analysis (ECEA) to include intangible benefits in intertemporal natural resource problems. This approach can assist managers in prioritizing management actions as least cost solutions to achieve quantitative policy targets. The ECEA framework is applied to a selective gear policy case in Danish mixed trawl fisheries in Kattegat and Skagerrak. The empirical analysis demonstrates how a policy with large negative net benefits might be justified if the intangible benefits are included. Copyright © 2013 Elsevier Ltd. All rights reserved.

Priorities of health policy: cost shifting or population health

PubMed Central

Richardson, Jeff RJ

2005-01-01

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

Recommendations for Cost Containment for Florida Community Colleges Health Insurance Programs. A Research Report.

ERIC Educational Resources Information Center

Nickens, John M.; Trofholz, Harlan F.

This report provides a discussion of strategies for containing the costs of health insurance programs offered at Florida's community colleges. Introductory material outlines the problem of spiralling health care costs and the impact upon the community colleges. In addition, some of the strategies for containing costs are discussed; e.g.,…

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-10

... Circulars, OFPP Policy Letters, and CASB Cost Accounting Standards Included in the Semiannual Agenda of..., and Cost Accounting Standards Board (CASB) Cost Accounting Standards. DATES: The withdrawal is...

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

PubMed Central

Read, Simon; McGale, Paul; Darby, Sarah

2009-01-01

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

Time On Station Requirements: Costs, Policy Change, and Perceptions

DTIC Science & Technology

2016-12-01

Travel Management Office (2016). .........................................................................6  Table 3.  Time it took spouses to find...NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA MBA PROFESSIONAL REPORT TIME ON STATION REQUIREMENTS: COSTS, POLICY CHANGE, AND...reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instruction, searching

Secondary Containment for Underground Storage Tank Systems - 2005 Energy Policy Act

EPA Pesticide Factsheets

These grant guidelines implement the secondary containment provision in Section 9003(i)(1) of the Solid Waste Disposal Act, enacted by the Underground Storage Tank Compliance Act, part of the Energy Policy Act of 2005.

75 FR 48365 - Solicitation for a Cooperative Agreement-NIC Cost Containment Online Resource Center Project

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-10

...--NIC Cost Containment Online Resource Center Project AGENCY: National Institute of Corrections, U.S... containment online resource center. The NIC Cost Containment Online Resource Center (CCORC) will be housed on... project's four tasks are to (1) compile a guide providing a detailed review of existing evidence-based...

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

PubMed

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

1999-02-01

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

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

PubMed Central

Suelves, Josep M; Barbería, Eneko

2013-01-01

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

Generic Drug Cost Containment in Medicaid: Lessons from Five State MAC Programs

PubMed Central

Abramson, Richard G.; Harrington, Catherine A.; Missmar, Raad; Li, Susan P.; Mendelson, Daniel N.

2004-01-01

In Medicaid, generic drug cost containment revolves around two programs: the Federal upper limit (FUL) program and State maximum allowable cost (MAC) programs. This article analyzes MAC programs in five States and finds considerable variation between these programs and the FUL program in both size and pricing aggressiveness. We conclude that expansion of existing MAC programs and creation of new ones could contribute to cost containment efforts nationwide. Options for States seeking to optimize their efforts include focusing on pricing for drugs with high sales volumes, ensuring that MAC lists include prices for all forms and dosages of listed drug entities, and collaborating with other States or the Federal Government on MAC list operations. PMID:15229994

Cost-effectiveness of population-based, community, workplace and individual policies for diabetes prevention in the UK.

PubMed

Breeze, P R; Thomas, C; Squires, H; Brennan, A; Greaves, C; Diggle, P; Brunner, E; Tabak, A; Preston, L; Chilcott, J

2017-08-01

To analyse the cost-effectiveness of different interventions for Type 2 diabetes prevention within a common framework. A micro-simulation model was developed to evaluate the cost-effectiveness of a range of diabetes prevention interventions including: (1) soft drinks taxation; (2) retail policy in socially deprived areas; (3) workplace intervention; (4) community-based intervention; and (5) screening and intensive lifestyle intervention in individuals with high diabetes risk. Within the model, individuals follow metabolic trajectories (for BMI, cholesterol, systolic blood pressure and glycaemia); individuals may develop diabetes, and some may exhibit complications of diabetes and related disorders, including cardiovascular disease, and eventually die. Lifetime healthcare costs, employment costs and quality-adjusted life-years are collected for each person. All interventions generate more life-years and lifetime quality-adjusted life-years and reduce healthcare spending compared with doing nothing. Screening and intensive lifestyle intervention generates greatest lifetime net benefit (£37) but is costly to implement. In comparison, soft drinks taxation or retail policy generate lower net benefit (£11 and £11) but are cost-saving in a shorter time period, preferentially benefit individuals from deprived backgrounds and reduce employer costs. The model enables a wide range of diabetes prevention interventions to be evaluated according to cost-effectiveness, employment and equity impacts over the short and long term, allowing decision-makers to prioritize policies that maximize the expected benefits, as well as fulfilling other policy targets, such as addressing social inequalities. © 2017 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Cost containment: challenging fidelity and justice.

PubMed

Haavi Morreim, E

1988-12-01

Cost containment heralds a general tightening of health care funds, which subjects every health care intervention to scrutiny for its economic as well as its medical wisdom and imposes upon physicians a variety of controls and incentives. Fiduciary fidelity is challenged by the conflict between clinical authority and patient loyalty, by financial and professional incentives that pit the physician's own interests against those of his or her patients, by the stratification of resources which results in greater scarcity of funds for indigent care, and by standardization of care through the implementation of "efficiency protocols." Questions of clinical justice are analyzed in the areas of distribution of medical services and of contractual relations among patient, payer, physician, and institution.

Are renewables portfolio standards cost-effective emission abatement policy?

PubMed

Dobesova, Katerina; Apt, Jay; Lave, Lester B

2005-11-15

Renewables portfolio standards (RPS) could be an important policy instrument for 3P and 4P control. We examine the costs of renewable power, accounting for the federal production tax credit, the market value of a renewable credit, and the value of producing electricity without emissions of SO2, NOx, mercury, and CO2. We focus on Texas, which has a large RPS and is the largest U.S. electricity producer and one of the largest emitters of pollutants and CO2. We estimate the private and social costs of wind generation in an RPS compared with the current cost of fossil generation, accounting for the pollution and CO2 emissions. We find that society paid about 5.7 cent/kWh more for wind power, counting the additional generation, transmission, intermittency, and other costs. The higher cost includes credits amounting to 1.1 cent/kWh in reduced SO2, NOx, and Hg emissions. These pollution reductions and lower CO2 emissions could be attained at about the same cost using pulverized coal (PC) or natural gas combined cycle (NGCC) plants with carbon capture and sequestration (CCS); the reductions could be obtained more cheaply with an integrated coal gasification combined cycle (IGCC) plant with CCS.

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

PubMed Central

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

1999-01-01

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

Policy for equipment’s leasing period extension with minimum cost of maintenance

NASA Astrophysics Data System (ADS)

Lestari, C.; Kurniati, N.

2018-04-01

The cost structure for equipment investment including purchase cost and maintenance cost is getting more expensive. The company considers to lease the equipment instead of purchase it under a contractual agreement. Offering to extend the lease period, following to the base lease period, will provide more benefits for both the lessor (owner) and the lessee (user). Whenever the lease period extension offered at the beginning of the contract, there are some risks in finance e.g. uncertainty of the equipment performance and lessor responsibility. Therefore, this research attempts to model the optimal maintenance policy for lease period extension offered at the end of the contract. Minimal repair is performed to rectify a failed equipment, while imperfect preventive maintenance is conducted to improve the operational state of the equipment when reaches a certain control limit to avoid failures. The mathematical model is constructed to determine the optimal control limit, the number and degree of preventive maintenance, and the multiplication number of the lease period extension. Finally, numerical examples are given to illustrate the influences of the optimal length of the extended lease and the maintenance policy to minimize the maintenance cost.

The impact of federalism on the healthcare system in terms of efficiency, equity, and cost containment: the case of Switzerland.

PubMed

Crivelli, Luca; Salari, Paola

2014-01-01

According to the economic theory of federalism (Oates 1999), a decentralized decision to collectively fund and supply the quantity and quality of public services will increase economic welfare as long as three conditions are fulfilled: preferences and production costs of the different local constituencies are heterogeneous; local governments are better informed than the central agency because of their proximity to the citizens; and the competition between local governments exerts a significant impact on the performance of the local administration and on the ability of public agencies to implement policy innovation. Federalism also presents some negative aspects, including the opportunity costs of decentralization, which materialize in terms of unexploited economies of scale; the emergence of spillover effects among jurisdictions; and the risk of cost-shifting exercises from one layer of the government to the other. Finally, competition between fiscal regimes can affect the level of equity. The literature considers fiscal federalism as a mechanism for controlling the size of the public sector and for constraining the development of redistributive measures. The present paper reviews the impact that federalism has on the efficiency, equity, and cost containment of the healthcare system in Switzerland, a country with a strongly decentralized political system that is based on federalism and the institutions of direct democracy, a liberal economic culture, and a well-developed tradition of mutualism and social security (generous social expenditure and welfare system). By analyzing the empirical evidence available for Switzerland, we expect to draw some general policy lessons that might also be useful for other countries.

Marketing Policy and Its Cost in a College of Higher Education.

ERIC Educational Resources Information Center

Riley, Eric

1984-01-01

Discusses the development of advertising and publicity strategies and policy for student recruitment purposes at a college of education in the United Kingdom between 1972 and 1982. Covers changes in staff attitudes, selection of media, organization of administration, and cost factors. (PGD)

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

PubMed

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

2016-02-01

The South African Government recently set targets to reduce cardiovascular disease (CVD) by lowering salt consumption. We conducted an extended cost-effectiveness analysis (ECEA) to model the potential health and economic impacts of this salt policy. We used surveys and epidemiologic studies to estimate reductions in CVD resulting from lower salt intake. We calculated the average out-of-pocket (OOP) cost of CVD care, using facility fee schedules and drug prices. We estimated the reduction in OOP expenditures and government subsidies due to the policy. We estimated public and private sector costs of policy implementation. We estimated financial risk protection (FRP) from the policy as (1) cases of catastrophic health expenditure (CHE) averted or (2) cases of poverty averted. We also performed a sensitivity analysis. We found that the salt policy could reduce CVD deaths by 11%, with similar health gains across income quintiles. The policy could save households US$ 4.06 million (2012) in OOP expenditures (US$ 0.29 per capita) and save the government US$ 51.25 million in healthcare subsidies (US$ 2.52 per capita) each year. The cost to the government would be only US$ 0.01 per capita; hence, the policy would be cost saving. If the private sector food reformulation costs were passed on to consumers, food expenditures would increase by <0.2% across all income quintiles. Preventing CVD could avert 2400 cases of CHE or 2000 cases of poverty yearly. Our results were sensitive to baseline CVD mortality rates and the cost of treatment. We conclude that, in addition to health gains, population salt reduction can have positive economic impacts-substantially reducing OOP expenditures and providing FRP, particularly for the middle class. The policy could also provide large government savings on health care. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

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

NASA Astrophysics Data System (ADS)

Reger, Darren; Madanat, Samer; Horvath, Arpad

2014-10-01

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

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

May, D

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

Urban containment policies and the protection of natural areas: the case of Seoul's greenbelt

Treesearch

David N. Bengston; Yeo-Chang Youn

2006-01-01

Countries around the world have responded to the problems associated with rapid urban growth and increasingly land-consumptive development patterns by creating a wide range of policy instruments designed to manage urban growth. Of the array of growth management techniques, urban containment policies are considered by some to be a promising approach. This paper focuses...

Optimal pricing policies for services with consideration of facility maintenance costs

NASA Astrophysics Data System (ADS)

Yeh, Ruey Huei; Lin, Yi-Fang

2012-06-01

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

A dynamic model for costing disaster mitigation policies.

PubMed

Altay, Nezih; Prasad, Sameer; Tata, Jasmine

2013-07-01

The optimal level of investment in mitigation strategies is usually difficult to ascertain in the context of disaster planning. This research develops a model to provide such direction by relying on cost of quality literature. This paper begins by introducing a static approach inspired by Joseph M. Juran's cost of quality management model (Juran, 1951) to demonstrate the non-linear trade-offs in disaster management expenditure. Next it presents a dynamic model that includes the impact of dynamic interactions of the changing level of risk, the cost of living, and the learning/investments that may alter over time. It illustrates that there is an optimal point that minimises the total cost of disaster management, and that this optimal point moves as governments learn from experience or as states get richer. It is hoped that the propositions contained herein will help policymakers to plan, evaluate, and justify voluntary disaster mitigation expenditures. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

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

PubMed

Alfaro-Murillo, Jorge A; Parpia, Alyssa S; Fitzpatrick, Meagan C; Tamagnan, Jules A; Medlock, Jan; Ndeffo-Mbah, Martial L; Fish, Durland; Ávila-Agüero, María L; Marín, Rodrigo; Ko, Albert I; Galvani, Alison P

2016-05-01

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

Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy

PubMed Central

2010-01-01

Objectives The aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI) and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass) infusion containers. Methods A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases) and patients without CLABSI (controls) were matched for admission departments, gender, age, and average severity of illness score. Costs were estimated according to micro-costing approach. In the cost effectiveness analysis, the cost component was assessed as the difference between production costs while effectiveness was measured by CLABSI rate (number of CLABSI per 1000 central line days) associated with the two infusion containers. Results A total of 43 cases of CLABSI were compared with 97 matched controls. The mean age of cases and controls was 62.1 and 66.6 years, respectively (p = 0.143); 56% of the cases and 57% of the controls were females (p = 0.922). The mean length of stay of cases and controls was 17.41 and 8.55 days, respectively (p < 0.001). Overall, the mean total costs of patients with and without CLABSI were € 18,241 and € 9,087, respectively (p < 0.001). On average, the extra cost for drugs was € 843 (p < 0.001), for supplies € 133 (p = 0.116), for lab tests € 171 (p < 0.001), and for specialist visits € 15 (p = 0.019). The mean extra cost for hospital stay (overhead) was € 7,180 (p < 0.001). The closed infusion container was a dominant strategy. It resulted in lower CLABSI rates (3.5 vs. 8.2 CLABSIs per 1000 central line days for closed vs. open infusion container) without any significant difference in total production costs. The higher acquisition cost of the closed infusion container was offset by savings incurred in other phases of production, especially waste management. Conclusions CLABSI results in

Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy.

PubMed

Tarricone, Rosanna; Torbica, Aleksandra; Franzetti, Fabio; Rosenthal, Victor D

2010-05-10

The aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI) and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass) infusion containers. A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases) and patients without CLABSI (controls) were matched for admission departments, gender, age, and average severity of illness score. Costs were estimated according to micro-costing approach. In the cost effectiveness analysis, the cost component was assessed as the difference between production costs while effectiveness was measured by CLABSI rate (number of CLABSI per 1000 central line days) associated with the two infusion containers. A total of 43 cases of CLABSI were compared with 97 matched controls. The mean age of cases and controls was 62.1 and 66.6 years, respectively (p = 0.143); 56% of the cases and 57% of the controls were females (p = 0.922). The mean length of stay of cases and controls was 17.41 and 8.55 days, respectively (p < 0.001). Overall, the mean total costs of patients with and without CLABSI were euro 18,241 and euro 9,087, respectively (p < 0.001). On average, the extra cost for drugs was euro 843 (p < 0.001), for supplies euro 133 (p = 0.116), for lab tests euro 171 (p < 0.001), and for specialist visits euro 15 (p = 0.019). The mean extra cost for hospital stay (overhead) was euro 7,180 (p < 0.001). The closed infusion container was a dominant strategy. It resulted in lower CLABSI rates (3.5 vs. 8.2 CLABSIs per 1000 central line days for closed vs. open infusion container) without any significant difference in total production costs. The higher acquisition cost of the closed infusion container was offset by savings incurred in other phases of production, especially waste management. CLABSI results in considerable and significant increase

Modeling cost-effectiveness and health gains of a "universal" versus "prioritized" hepatitis C virus treatment policy in a real-life cohort.

PubMed

Kondili, Loreta A; Romano, Federica; Rolli, Francesca Romana; Ruggeri, Matteo; Rosato, Stefano; Brunetto, Maurizia Rossana; Zignego, Anna Linda; Ciancio, Alessia; Di Leo, Alfredo; Raimondo, Giovanni; Ferrari, Carlo; Taliani, Gloria; Borgia, Guglielmo; Santantonio, Teresa Antonia; Blanc, Pierluigi; Gaeta, Giovanni Battista; Gasbarrini, Antonio; Chessa, Luchino; Erne, Elke Maria; Villa, Erica; Ieluzzi, Donatella; Russo, Francesco Paolo; Andreone, Pietro; Vinci, Maria; Coppola, Carmine; Chemello, Liliana; Madonia, Salvatore; Verucchi, Gabriella; Persico, Marcello; Zuin, Massimo; Puoti, Massimo; Alberti, Alfredo; Nardone, Gerardo; Massari, Marco; Montalto, Giuseppe; Foti, Giuseppe; Rumi, Maria Grazia; Quaranta, Maria Giovanna; Cicchetti, Americo; Craxì, Antonio; Vella, Stefano

2017-12-01

We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virus-infected patients: policy 1, "universal," treat all patients, regardless of fibrosis stage; policy 2, treat only "prioritized" patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virus-infected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policies' cost-effectiveness. The patients' age and fibrosis stage, assumed DAA treatment cost of €15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of €30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was €8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was €19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 post-sustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (€15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases

Six hospitals describe decentralization, cost containment, and downsizing.

PubMed

Lineweaver, L A; Battle, C E; Schilling, R M; Nall, C M

1999-01-01

Decentralization, cost containment, and downsizing continue in full force as healthcare organizations continue to adapt to constant economic change. Hospitals are forced to take a second and third look at how health care is managed in order to survive. Six Northwest Florida hospitals were surveyed in an effort to explore current changes within the healthcare delivery system. This article provides both managers and staff with an overview of recent healthcare changes in an area of the country with implications for staff development.

Continental Divide? The attitudes of US and Canadian oncologists on the costs, cost-effectiveness, and health policies associated with new cancer drugs.

PubMed

Berry, Scott R; Bell, Chaim M; Ubel, Peter A; Evans, William K; Nadler, Eric; Strevel, Elizabeth L; Neumann, Peter J

2010-09-20

Oncologists in the United States and Canada work in different health care systems, but physicians in both countries face challenges posed by the rising costs of cancer drugs. We compared their attitudes regarding the costs and cost-effectiveness of medications and related health policy. Survey responses of a random sample of 1,355 United States and 238 Canadian medical oncologists (all outside of Québec) were compared. Response rate was 59%. More US oncologists (67% v 52%; P < .001) favor access to effective treatments regardless of cost, while more Canadians favor access to effective treatments only if they are cost-effective (75% v 58%; P < .001). Most (84% US, 80% Canadian) oncologists state that patient out-of-pocket costs influence their treatment recommendations, but less than half the respondents always or frequently discuss the costs of treatments with their patients. The majority of oncologists favor more use of cost-effectiveness data in coverage decisions (80% US, 69% Canadian; P = .004), but fewer than half the oncologists in both countries feel well equipped to use cost-effectiveness information. Majorities of oncologists favor government price controls (57% US, 68% Canadian; P = .01), but less than half favor more cost-sharing by patients (29% US, 41% Canadian; P = .004). Oncologists in both countries prefer to have physicians and nonprofit agencies determine whether drugs provide good value. Oncologists in the United States and Canada generally have similar attitudes regarding cancer drug costs, cost-effectiveness, and associated policies, despite practicing in different health care systems. The results support providing education to help oncologists in both countries use cost-effectiveness information and discuss drug costs with their patients.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-26

... II Reform of Federal Policies Relating to Grants and Cooperative Agreements; Cost Principles And...; cost principles and administrative requirements (including Single Audit Act). The original comment...-idx?c=ecfr&tpl=/ecfrbrowse/Title02/2cfrv1_02.tpl . The Cost Principles for Hospitals are in the...

A direct healthcare cost analysis of the cryopreserved versus fresh transfer policy at the blastocyst stage.

PubMed

Papaleo, Enrico; Pagliardini, Luca; Vanni, Valeria Stella; Delprato, Diana; Rubino, Patrizia; Candiani, Massimo; Viganò, Paola

2017-01-01

A cost analysis covering direct healthcare costs relating to IVF freeze-all policy was conducted. Normal- and high- responder patients treated with a freeze-all policy (n = 63) compared with fresh transfer IVF (n = 189) matched by age, body mass index, duration and cause of infertility, predictive factors for IVF (number of oocytes used for fertilization) and study period, according to a 1:3 ratio were included. Total costs per patient (€6952 versus €6863) and mean costs per live birth were similar between the freeze-all strategy (€13,101, 95% CI 10,686 to 17,041) and fresh transfer IVF (€15,279, 95% CI 13,212 to 18,030). A mean per live birth cost-saving of €2178 (95% CI -1810 to 6165) resulted in a freeze-all strategy owing to fewer embryo transfer procedures (1.29 ± 0.5 versus 1.41 ± 0.7); differences were not significant. Sensitivity analysis revealed that the freeze-all strategy remained cost-effective until the live birth rate is either higher or only slightly lower (≥-0.59%) in the freeze-all group compared with fresh cycles. A freeze-all policy does not increase costs compared with fresh transfer, owing to negligible additional expenses, i.e. vitrification, endometrial priming and monitoring, against fewer embryo transfer procedures required to achieve pregnancy. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Global and regional estimates of the effectiveness and cost-effectiveness of price increases and other tobacco control policies.

PubMed

Ranson, M Kent; Jha, Prabhat; Chaloupka, Frank J; Nguyen, Son N

2002-08-01

The objective of this study was to provide conservative estimates of the global and regional effectiveness and cost-effectiveness of tobacco control policies. Using a static model of the cohort of smokers alive in 1995, we estimated the number of smoking-attributable deaths that could be averted by: (1) price increases, (2) nicotine replacement therapy (NRT), and (3) a package of non-price interventions other than NRT. We calculated the cost-effectiveness of these policy interventions by weighing the approximate public-sector costs against the years of healthy life saved, measured in disability-adjusted life years, or DALYs. Even with deliberately conservative assumptions, tax increases that would raise the real price of cigarettes by 10% worldwide would prevent between 5 and 16 million tobacco-related deaths, and could cost 3-70 US dollars per DALY saved in low-income and middle-income regions. NRT and a package of non-price interventions other than NRT are also cost-effective in low-income and middle-income regions, at 280-870 US dollars per DALY and 36-710 US dollars per DALY, respectively. In high-income countries, price increases were found to have a cost-effectiveness of 83-2771 US dollars per DALY, NRT 750-7206 US dollars per DALY and other non-price interventions 696-13,924 US dollars per DALY. Tobacco control policies, particularly tax increases on cigarettes, are cost-effective relative to other health interventions. Our estimates are subject to considerable variation in actual settings; thus, local cost-effectiveness studies are required to guide local policy.

Cost Effectiveness and Cost Containment in the Era of Interferon-Free Therapies to Treat Hepatitis C Virus Genotype 1

PubMed Central

Morgan, Jake R.; Pho, Mai T.; Leff, Jared A.; Schackman, Bruce R.; Horsburgh, C. Robert; Assoumou, Sabrina A.; Salomon, Joshua A.; Weinstein, Milton C.; Freedberg, Kenneth A.; Kim, Arthur Y.

2017-01-01

Abstract Background. Interferon-free regimens to treat hepatitis C virus (HCV) genotype 1 are effective but costly. At this time, payers in the United States use strategies to control costs including (1) limiting treatment to those with advanced disease and (2) negotiating price discounts in exchange for exclusivity. Methods. We used Monte Carlo simulation to investigate budgetary impact and cost effectiveness of these treatment policies and to identify strategies that balance access with cost control. Outcomes included nondiscounted 5-year payer cost per 10000 HCV-infected patients and incremental cost-effectiveness ratios. Results. We found that the budgetary impact of HCV treatment is high, with 5-year undiscounted costs of $1.0 billion to 2.3 billion per 10000 HCV-infected patients depending on regimen choices. Among noncirrhotic patients, using the least costly interferon-free regimen leads to the lowest payer costs with negligible difference in clinical outcomes, even when the lower cost regimen is less convenient and/or effective. Among cirrhotic patients, more effective but costly regimens remain cost effective. Controlling costs by restricting treatment to those with fibrosis stage 2 or greater disease was cost ineffective for any patient type compared with treating all patients. Conclusions. Treatment strategies using interferon-free therapies to treat all HCV-infected persons are cost effective, but short-term cost is high. Among noncirrhotic patients, using the least costly interferon-free regimen, even if it is not single tablet or once daily, is the cost-control strategy that results in best outcomes. Restricting treatment to patients with more advanced disease often results in worse outcomes than treating all patients, and it is not preferred. PMID:28480259

Strategies to contain the emergence of antimicrobial resistance: a systematic review of effectiveness and cost-effectiveness.

PubMed

Wilton, Paula; Smith, Richard; Coast, Joanna; Millar, Michael

2002-04-01

To conduct a systematic review of the literature to describe and critically appraise studies reporting on the cost and/or effectiveness of interventions proposed to control the emergence of antimicrobial resistance (AMR). The search for relevant studies encompassed consultation with world experts in AMR, and electronic bibliographic database search of: Medline (1960-2000); ISI (1981-2000); EMBASE (1988-2000); Grey Literature (1999-2000); Database of Reviews of Effectiveness (DARE) and the NHS Health Economic Evaluation Database (HEED) at York University's Centre for Reviews and Dissemination (CRD) (numerous years); OPAC (1975-2000); and the Cochrane Library Online (1990-2000). Only studies that concerned the effectiveness or cost-effectiveness of measures specifically designed to contain the emergence of AMR were reviewed. Standardised data extraction sheets, based on existing checklists for effectiveness and cost-effectiveness, were used to assess the validity of each study using the 'risk of bias criteria' suggested in the Cochrane Handbook. Only studies categorised as being at low or moderate risk of bias were reported fully. The reliability of the data review process was monitored by comparison of several, random, independent assessments by all authors. The mix of study methods (i.e. including studies based on non-randomised controlled trials) meant that formal meta-analysis was not possible, and thus a qualitative review was performed. In total, 43 studies were reviewed, with 21 classed as being at moderate or low risk of bias and therefore reported in the paper. These studies covered policies on: restricting the use of antimicrobials (five studies, suggesting that restriction policies can alter prescriber behaviour, although with limited evidence of subsequent effect on AMR); prescriber education, feedback and use of guidelines (six studies, with no clear conclusion); combination therapies (seven studies, showing the potential to lower drug

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

PubMed

Lavee, Doron

2010-02-01

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

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

ERIC Educational Resources Information Center

Massy, William F.

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

The effect of health payment reforms on cost containment in Taiwan hospitals: the agency theory perspective.

PubMed

Chang, Li

2011-01-01

This study aims to determine whether the Taiwanese government's implementation of new health care payment reforms (the National Health Insurance with fee-for-service (NHI-FFS) and global budget (NHI-GB)) has resulted in better cost containment. Also, the question arises under the agency theory whether the monitoring system is effective in reducing the risk of information asymmetry. This study uses panel data analysis with fixed effects model to investigate changes in cost containment at Taipei municipal hospitals before and after adopting reforms from 1989 to 2004. The results show that the monitoring system does not reduce information asymmetry to improve cost containment under the NHI-FFS. In addition, after adopting the NHI-GB system, health care costs are controlled based on an improved monitoring system in the policymaker's point of view. This may suggest that the NHI's fee-for-services system actually causes health care resource waste. The GB may solve the problems of controlling health care costs only on the macro side.

Challenging official health cost estimates: an alternative view that incorporates the behavioural and economic effects of policy changes.

PubMed

Robbins, A; Robbins, G

1992-01-01

Cost estimates of health care policy changes are extremely important. Historically, however, the US government has done a poor job in projecting the actual cost of new health care programmes. These projections have been inaccurate primarily because government forecasters use 'static' methods that fail to incorporate the change in people's behaviour as a direct result of a new policy. In contrast, 'dynamic' forecasts incorporate the behavioural effects of policy changes on individuals and the economy. Static and dynamic estimates can lead to different results for 4 areas of US health policy: (a) the Medicare Catastrophic Coverage Act; (b) mandated health benefits; (c) health insurance tax subsidies; and (d) national health insurance. Improving health care policy requires the adoption of dynamic estimation practices, periodic appraisals evaluating the accuracy of official estimates in relation to actual experience, and clear presentation of proposed policy changes and estimates to policymakers and the general public.

Value focused rationality in AIDS policy.

PubMed

Wenstøp, F; Magnus, P

2001-07-01

A health policy analysis to contain the effects of the HIV epidemic in Norway has been carried out. It was performed as a Multi Criteria Decision Analysis where participants in a decision panel used personal values to weight benefits and costs of alternative policies. The analysis is of particular interest since Norway afterwards adopted a controversial HIV policy: the authorities warned the general population against sexual relations with immigrants from countries south of Sahara. The policy might reap benefits, but a certain cost was to stigmatise that group. This paper describes the analysis and defends the underlying consequentialistic ethics against other approaches involving rule-based ethics and benefit-cost analysis. The main argument is based on Hume's insight that reason alone does not prompt action; values will always be involved and should therefore be more explicitly focused on. The paper concludes that we need an extended notion of rationality that includes well-foundedness of values. Decision-makers should try to reach an emotional equilibrium where their values concerning the issue at hand become stable. The paradigm of decision analysis provides useful methods to approach this situation, although it must be considered only an input to policy rather than something producing a final answer.

Cost-effective design of economic instruments in nutrition policy.

PubMed

Jensen, Jørgen D; Smed, Sinne

2007-04-04

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

Cost-effective design of economic instruments in nutrition policy

PubMed Central

Jensen, Jørgen D; Smed, Sinne

2007-01-01

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

Green politics in Germany: what is Green health care policy?

PubMed

Wörz, M; Wismar, M

2001-01-01

For the first time ever, a Green party has governed in Germany. From September 1998 to January 2001 the German Green party, Bündnis 90/Die Grünen, held the Federal Ministry of Health. Little has been said so far about Bündnis 90/Die Grünen and its relation to health policy. This article is intended to fill that void. An analysis of the health policy program of the Greens reveals that it centers around moving the health sector toward more comprehensiveness and decentralization, strengthened patients' rights, increased use of preventive and alternative medicine, and a critique of the German cost-containment debate and policy. The current health policy program of the Greens is closest to that of the Party of Democratic Socialism, and to a lesser extent it has affinities to the program of the Social Democratic Party. The health policy program of Bündnis 90/Die Grünen is furthest from those of the Christian Democratic Union and the Free Democratic Party. The health care reforms passed in 1998 and 1999 were not a shift toward a "Green paradigm" of health care policy, because they included no fundamental changes. In addition, cost-containment is still a major political goal in German health care policy.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-11

..., Office of Chief Counsel, Federal Emergency Management Agency, Room 835, 500 C Street, SW., Washington, DC... DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency [Docket ID FEMA-2010-0022] Environmental Planning and Historic Preservation Compliance Costs Policy; Environmental Planning and Historic...

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lavee, Doron, E-mail: doron@pareto.co.i

2010-02-15

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

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

ERIC Educational Resources Information Center

Duncombe, William; Yinger, John

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

Comparative Benefit-Cost Analysis of the Abecedarian Program and Its Policy Implications

ERIC Educational Resources Information Center

Barnett, W. S.; Masse, Leonard N.

2007-01-01

Child care and education are to some extent joint products of preschool programs, but public policy and research frequently approach these two goals independently. We present a benefit-cost analysis of a preschool program that provided intensive education during full-day child care. Data were obtained from a randomized trial with longitudinal…

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

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true Policy-Public safety: Requirement for early identification of lands containing dangerous materials. 643.22 Section 643.22 National Defense Department of...—Public safety: Requirement for early identification of lands containing dangerous materials. (a) DA will...

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

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 4 2011-07-01 2011-07-01 false Policy-Public safety: Requirement for early identification of lands containing dangerous materials. 643.22 Section 643.22 National Defense Department of...—Public safety: Requirement for early identification of lands containing dangerous materials. (a) DA will...

Report on cost/pricing relationships for the space shuttle. [NASA/STS Operations Report

NASA Technical Reports Server (NTRS)

1977-01-01

The operations cost for the shuttle is the basis for developing the user charge policy for the system. The policy contains several elements that are significant to the user and to NASA. It will encourage the full use of the system to the benefits of the U.S. The charge policy will encourage early transition from the expendable launch vehicles to the shuttle and this will result in lower user costs for government as well as commercial users. The relationship between the charge policy and the utilization of the shuttle is critical to the economic efficiency of the system. NASA recognizes the challenging a relationship between pricing the cost of using a reusable space system, and the need to make sure it is re-used often.

Toward Policy-Relevant Benchmarks for Interpreting Effect Sizes: Combining Effects with Costs

ERIC Educational Resources Information Center

Harris, Douglas N.

2009-01-01

The common reporting of effect sizes has been an important advance in education research in recent years. However, the benchmarks used to interpret the size of these effects--as small, medium, and large--do little to inform educational administration and policy making because they do not account for program costs. The author proposes an approach…

Setting limits through global budgeting: hospital cost containment in Rhode Island.

PubMed

Hackey, R B

1996-01-01

In 1974, hospitals in Rhode Island have participated in annual negotiations with state officials and representatives from Blue Cross to determine the allowed increase in statewide hospital costs (the "Maxicap") for the next fiscal year, based on projected increases in hospitals' revenues, changes in patient volume and operating expenses. Individual hospital budgets may be above or below the Maxicap as long as the total increase in hospital costs for all hospitals in the state does not exceed the negotiated amount. At a time when regulatory solutions are increasingly under fire, continued support for Rhode Island's approach to hospital cost containment from third party payers, providers and public officials stands in stark contrast to other states where rate setting was either dismantled or discredited as a cost control strategy. A negotiated global cap on hospital expenditures offers an alternative to formula-based state rate-setting methodologies which could be incorporated as part of an all-payer reimbursement methodology or as an incremental step towards more comprehensive reform.

Drug waste minimization as an effective strategy of cost-containment in Oncology

PubMed Central

2014-01-01

Background Sustainability of cancer care is a crucial issue for health care systems worldwide, even more during a time of economic recession. Low-cost measures are highly desirable to contain and reduce expenditures without impairing the quality of care. In this paper we aim to demonstrate the efficacy of drug waste minimization in reducing drug-related costs and its importance as a structural measure in health care management. Methods We first recorded intravenous cancer drugs prescription and amount of drug waste at the Oncology Department of Udine, Italy. Than we developed and applied a protocol for drug waste minimization based on per-pathology/per-drug scheduling of chemotherapies and pre-planned rounding of dosages. Results Before the protocol, drug wastage accounted for 8,3% of the Department annual drug expenditure. Over 70% of these costs were attributable to six drugs (cetuximab, docetaxel, gemcitabine, oxaliplatin, pemetrexed and trastuzumab) that we named ‘hot drugs’. Since the protocol introduction, we observed a 45% reduction in the drug waste expenditure. This benefit was confirmed in the following years and drug waste minimazion was able to limit the impact of new pricely drugs on the Department expenditures. Conclusions Facing current budgetary constraints, the application of a drug waste minimization model is effective in drug cost containment and may produce durable benefits. PMID:24507545

Containing Health Care Costs

PubMed Central

Derzon, Robert A.

1980-01-01

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

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

PubMed Central

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

2014-01-01

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

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

PubMed

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

2012-03-01

In recent years, the United States, along with many other countries, has significantly increased its detection and defense mechanisms against terrorist attacks. A potential attack with a nuclear weapon, using nuclear materials smuggled into the country, has been identified as a particularly grave threat. The system for detecting illicit nuclear materials that is currently in place at U.S. ports of entry relies heavily on passive radiation detectors and a risk-scoring approach using the automated targeting system (ATS). In this article we analyze this existing inspection system and demonstrate its performance for several smuggling scenarios. We provide evidence that the current inspection system is inherently incapable of reliably detecting sophisticated smuggling attempts that use small quantities of well-shielded nuclear material. To counter the weaknesses of the current ATS-based inspection system, we propose two new inspection systems: the hardness control system (HCS) and the hybrid inspection system (HYB). The HCS uses radiography information to classify incoming containers based on their cargo content into "hard" or "soft" containers, which then go through different inspection treatment. The HYB combines the radiography information with the intelligence information from the ATS. We compare and contrast the relative performance of these two new inspection systems with the existing ATS-based system. Our studies indicate that the HCS and HYB policies outperform the ATS-based policy for a wide range of realistic smuggling scenarios. We also examine the impact of changes in adversary behavior on the new inspection systems and find that they effectively preclude strategic gaming behavior of the adversary. © 2011 Society for Risk Analysis.

Further Evidence on the Effect of Acquisition Policy and Process on Cost Growth

DTIC Science & Technology

2016-04-30

bust periods. A complete summary also would need to take into account parallel analyses for the boom periods and the comparisons of cost growth in...qÜáêíÉÉåíÜ=^ååì~ä= ^Åèìáëáíáçå=oÉëÉ~êÅÜ= póãéçëáìã= tÉÇåÉëÇ~ó=pÉëëáçåë= sçäìãÉ=f= = Further Evidence on the Effect of Acquisition Policy and Process on Cost ...Goeller, Defense Acquisition Analyst, Institute for Defense Analyses Stanley Horowitz, Assistant Director, Cost Analysis and Research Division

Strategic research on the sustainable development cost of manufacturing industry under the background of carbon allowance and trade policy

NASA Astrophysics Data System (ADS)

Ma, Zhongmin; Cheng, Mengting; Wang, Mei

2017-08-01

The important subjects of energy consumption and carbon emission are manufacturing enterprises, with the deepening of international cooperation, and the implementation of carbon limit and trade policy, costs of manufacturing industry will rise sharply. How can the manufacturing industry survive in this reform, and it has to be a problem that the managers of the manufacturing industry need to solve. This paper analyses sustainable development cost connotation and value basis on the basis of sustainable development concept, discusses the influence of carbon allowance and trade policy for cost strategy of manufacturing industry, thinks that manufacturing industry should highlight social responsibility and realize maximization of social value, implement cost strategy the sustainable development, and pointed out the implementation way.

Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study.

PubMed

Phillips, Andrew N; Cambiano, Valentina; Nakagawa, Fumiyo; Revill, Paul; Jordan, Michael R; Hallett, Timothy B; Doherty, Meg; De Luca, Andrea; Lundgren, Jens D; Mhangara, Mutsa; Apollo, Tsitsi; Mellors, John; Nichols, Brooke; Parikh, Urvi; Pillay, Deenan; Rinke de Wit, Tobias; Sigaloff, Kim; Havlir, Diane; Kuritzkes, Daniel R; Pozniak, Anton; van de Vijver, David; Vitoria, Marco; Wainberg, Mark A; Raizes, Elliot; Bertagnolio, Silvia

2018-03-01

There is concern over increasing prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance in people initiating antiretroviral therapy (ART) in low-income and middle-income countries. We assessed the effectiveness and cost-effectiveness of alternative public health responses in countries in sub-Saharan Africa where the prevalence of pretreatment drug resistance to NNRTIs is high. The HIV Synthesis Model is an individual-based simulation model of sexual HIV transmission, progression, and the effect of ART in adults, which is based on extensive published data sources and considers specific drugs and resistance mutations. We used this model to generate multiple setting scenarios mimicking those in sub-Saharan Africa and considered the prevalence of pretreatment NNRTI drug resistance in 2017. We then compared effectiveness and cost-effectiveness of alternative policy options. We took a 20 year time horizon, used a cost effectiveness threshold of US$500 per DALY averted, and discounted DALYs and costs at 3% per year. A transition to use of a dolutegravir as a first-line regimen in all new ART initiators is the option predicted to produce the most health benefits, resulting in a reduction of about 1 death per year per 100 people on ART over the next 20 years in a situation in which more than 10% of ART initiators have NNRTI resistance. The negative effect on population health of postponing the transition to dolutegravir increases substantially with higher prevalence of HIV drug resistance to NNRTI in ART initiators. Because of the reduced risk of resistance acquisition with dolutegravir-based regimens and reduced use of expensive second-line boosted protease inhibitor regimens, this policy option is also predicted to lead to a reduction of overall programme cost. A future transition from first-line regimens containing efavirenz to regimens containing dolutegravir formulations in adult ART initiators is predicted to be effective and cost-effective in

Health-related external cost assessment in Europe: methodological developments from ExternE to the 2013 Clean Air Policy Package.

PubMed

van der Kamp, Jonathan; Bachmann, Till M

2015-03-03

"Getting the prices right" through internalizing external costs is a guiding principle of environmental policy making, one recent example being the EU Clean Air Policy Package released at the end of 2013. It is supported by impact assessments, including monetary valuation of environmental and health damages. For over 20 years, related methodologies have been developed in Europe in the Externalities of Energy (ExternE) project series and follow-up activities. In this study, we aim at analyzing the main methodological developments over time from the 1990s until today with a focus on classical air pollution-induced human health damage costs. An up-to-date assessment including the latest European recommendations is also applied. Using a case from the energy sector, we identify major influencing parameters: differences in exposure modeling and related data lead to variations in damage costs of up to 21%; concerning risk assessment and monetary valuation, differences in assessing long-term exposure mortality risks together with assumptions on particle toxicity explain most of the observed changes in damage costs. These still debated influencing parameters deserve particular attention when damage costs are used to support environmental policy making.

Health economics in the United States: cost implications.

PubMed

Whitelaw, G N

1993-01-01

World health care costs are increasing uncontrollably and will continue to grow even if draconian controls are implemented immediately. In the United States, the health care objectives are to control the escalating costs of health care and increase access to quality care. To achieve these goals, new administrative controls will be put in place to respond to the cost pressures. New policies to accommodate these new controls will be made by the state and federal governments and by various private third parties. The policies will contain incentives and disincentives for private and institutional providers and beneficiaries. As a result, providers are responding with various cost-control techniques and payors are attempting to reduce costs. In addition, new decision makers in hospitals, insurance companies, and government will be evaluating new technologies by new standards. In order to gain or maintain significant market penetration for a product, drug and device manufacturers will have to develop a multifaceted strategy to present their products in the most favorable economic light.

Officials Warn of a Crisis in Student Health Insurance as Medical Costs Soar and Companies Revise Policies.

ERIC Educational Resources Information Center

Collison, Michele N-K

1989-01-01

As costs rise and companies discontinue coverage of college students under parents' policies, students are choosing to forego insurance rather than pay for it themselves, so suggest speakers at the American College Health Association's annual meeting. Colleges offering group-insurance policies to students are also having problems renewing them.…

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

Code of Federal Regulations, 2014 CFR

2014-01-01

... NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions § 246.16a Infant formula and authorized foods... 7 Agriculture 4 2014-01-01 2014-01-01 false Infant formula and authorized foods cost containment...

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

Code of Federal Regulations, 2013 CFR

2013-01-01

... NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions § 246.16a Infant formula and authorized foods... 7 Agriculture 4 2013-01-01 2013-01-01 false Infant formula and authorized foods cost containment...

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

Code of Federal Regulations, 2012 CFR

2012-01-01

... NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN State Agency Provisions § 246.16a Infant formula and authorized foods... 7 Agriculture 4 2012-01-01 2012-01-01 false Infant formula and authorized foods cost containment...

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

PubMed Central

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

1999-01-01

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

The Costs and Benefits of Compliance with Renewable Portfolio Standards: Reviewing Experience to Date

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heeter, Jenny; Barbose, Galen; Bird, Lori

2014-03-12

More than half of U.S. states have renewable portfolio standards (RPS) in place and have collectively deployed approximately 46,000 MW of new renewable energy capacity through year-end 2012. Most of these policies have five or more years of implementation experience, enabling an assessment of their costs and benefits. Understanding RPS benefits and costs is essential for policymakers evaluating existing RPS policies, assessing the need for modifications, and considering new policies. A key aspect of this study is the comprehensive review of existing RPS cost and benefit estimates, in addition to an examination of the variety of methods used to calculatemore » such estimates. Based on available data and estimates reported by utilities and regulators, this study summarizes RPS costs to date. The study considers how those costs may evolve going forward, given scheduled increases in RPS targets and cost containment mechanisms incorporated into existing policies. The report also summarizes RPS benefits estimates, based on published studies for individual states, and discusses key methodological considerations.« less

Operational and Clinical Strategies to Address Drug Cost Containment in the Acute Care Setting.

PubMed

McConnell, Karen J; Guzman, Oscar E; Pherwani, Nisha; Spencer, Dustin D; Van Cura, Jennifer D; Shea, Katherine M

2017-01-01

To provide clinical and operational strategies to generate drug cost savings in the hospital setting. A search of the PubMed database was performed with no time limit through July 2016. All original prospective and retrospective studies, peer-reviewed guidelines, consensus statements, review articles, and accompanying references were evaluated for inclusion. Only articles published in the English language were included. Investigators reviewed 937 abstracts. The review of the literature showed that acute care hospitals are under increasing financial pressures, and the pharmacy is often responsible for opportunities to manage drug costs. The literature also indicated that cost-containment strategies in the acute care setting range from pharmacy-directed activities to initiatives requiring interdisciplinary collaboration and strategic planning. Hospital pharmacies should consider establishing an interdisciplinary team that is responsible for systematically reviewing drug cost implications and leading any initiatives that are deemed necessary. Acute care settings can use various operational and clinical strategies to lower their expenditures on high-cost drugs. Operational strategies include various activities that pharmacy staff implement related to contracting, purchasing, and inventory management. Clinical strategies utilize clinical pharmacists working with interdisciplinary teams to develop and maintain a formulary, implement established-use criteria for select drugs, use dose optimization, and implement other clinical tactics aimed at cost containment. After initiatives are implemented, assessing the outcomes of the initiatives is important to determine how successful they were at lowering costs safely and effectively. Acute care hospitals can use various operational and clinical strategies to lower overall drug costs. A systematic stepwise approach is recommended to ensure relevant drugs are regularly reviewed and addressed as needed. © 2016 Pharmacotherapy

The economics of gasoline subsidy cost reduction policy: Case study of Indonesia

NASA Astrophysics Data System (ADS)

Akimaya, Muhammad I.

A gasoline subsidy distorts the gasoline market with the resulting inefficiencies and takes substantial revenues that arguably could be spent elsewhere with a better impact on economic growth. Governments with such subsidies are aware of their cost yet face difficulties in removing the policy because of strong resistance from the public. This thesis discusses in three essays the problem faced by the government in removing the gasoline subsidy and provides an alternative policy in reducing the subsidy cost applied to the case of Indonesia. In the first essay, we examine the decision-making process from the government's perspective that has an objective of generating savings to fund other programs while maintaining political power, and the influence that the general population has over the decision. Despite the immense literature on political power, there has yet to be any research that mathematically models the decision-making process of a government with influences from the general population. Under the benchmark scenario, the equilibrium strategy is to keep the subsidy intact. However, the results are found to be very sensitive to the magnitude of the shift in political power as well as the preferences of both the government and the people. In the second essay, we estimate the cross-price elasticity of regular gasoline with respect to premium gasoline price. The importance of such knowledge is to accurately determine the impact of fuel pricing policy that tends to have different rates of tax or subsidy depending on the grade of gasoline. Using data on the Mexican gasoline market, regular gasoline demand is estimated with an Autoregressive Distributed Lag (ARDL) model. Endogeneity of the price and structural break are also investigated. The cross-price elasticities between regular and premium gasoline is found to be -0.895, which confirms high substitutability among gasoline with different grades. In the third essay, we look at the unique case of Indonesia that

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

NASA Astrophysics Data System (ADS)

Richard, Christopher L.

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

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

NASA Astrophysics Data System (ADS)

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

2016-07-01

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

Cost Containment: An Economist's View

PubMed Central

Neuhauser, Duncan

1980-01-01

Rising medical care costs are not the problem they seem to be, in part because quality of care is not considered. The problem may be more the absence of choice of alternative health benefit packages with price differences. The future of health services in the United States will have more competing alternatives requiring physicians to be more cost conscious. PMID:6992461

Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol.

PubMed

Anderson, Peter; Chisholm, Dan; Fuhr, Daniela C

2009-06-27

This paper reviews the evidence for the effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol, in the areas of education and information, the health sector, community action, driving while under the influence of alcohol (drink-driving), availability, marketing, pricing, harm reduction, and illegally and informally produced alcohol. Systematic reviews and meta-analyses show that policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving and individually directed interventions to already at-risk drinkers are also effective. However, school-based education does not reduce alcohol-related harm, although public information and education-type programmes have a role in providing information and in increasing attention and acceptance of alcohol on political and public agendas. Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm. In settings with high amounts of unrecorded production and consumption, increasing the proportion of alcohol that is taxed could be a more effective pricing policy than a simple increase in tax.

Health care costs: saving in the private sector.

PubMed

Robeson, F E

1979-01-01

Robeson offers a number of options to employers to help reduce the impact of increasing health care costs. He points out that large organizations which employ hundreds of people have considerable market power which can be exerted to contain costs. It is suggested that the risk management departments assume the responsibility for managing the effort to reduce the costs of medical care and of the health insurance programs of these organizations since that staff is experienced at evaluating premiums and negotiating with third-party payors. The article examines a number of short-run strategies for firms to pursue to contain health care costs: (1) use alternative delivery systems such as health maintenance organizations (HMOs) which have cost-cutting potential but require marketing efforts to persuade employees of their desirability; (2) contracts with third-party payors which require a second opinion (peer review), a practice which saved one labor union over $2 million from 1972 to 1976; (3) implementation of insurance coverage for less expensive outpatient care; and (4) the use of claims review. These strategies are compared in terms of four criteria: supply of demand for health services; management effort; cost; and time necessary for realized savings. Robeson concludes that development of a management plan for containing health care costs requires an extensive analysis of alternatives, organizational objectives, existing policies, and resources, and offers a table summarizing the cost-containment strategies that a firm should consider.

Evaluation of caregiver-friendly workplace policy (CFWPs) interventions on the health of full-time caregiver employees (CEs): implementation and cost-benefit analysis.

PubMed

Williams, Allison M; Tompa, Emile; Lero, Donna S; Fast, Janet; Yazdani, Amin; Zeytinoglu, Isik U

2017-09-20

Current Canadian evidence illustrating the health benefits and cost-effectiveness of caregiver-friendly workplace policies is needed if Canadian employers are to adopt and integrate caregiver-friendly workplace policies into their employment practices. The goal of this three-year, three study research project is to provide such evidence for the auto manufacturing and educational services sectors. The research questions being addressed are: What are the impacts for employers (economic) and workers (health) of caregiver-friendly workplace policy intervention(s) for full-time caregiver-employees? What are the impacts for employers, workers and society of the caregiver-friendly workplace policy intervention(s) in each participating workplace? What contextual factors impact the successful implementation of caregiver-friendly workplace policy intervention(s)? Using a pre-post-test comparative case study design, Study A will determine the effectiveness of newly implemented caregiver-friendly workplace policy intervention(s) across two workplaces to determine impacts on caregiver-employee health. A quasi-experimental pre-post design will allow the caregiver-friendly workplace policy intervention(s) to be tested with respect to potential impacts on health, and specifically on caregiver employee mental, psychosocial, and physical health. Framed within a comparative case study design, Study B will utilize cost-benefit and cost-effectiveness analysis approaches to evaluate the economic impacts of the caregiver-friendly workplace policy intervention(s) for each of the two participating workplaces. Framed within a comparative case study design, Study C will undertake an implementation analysis of the caregiver-friendly workplace policy intervention(s) in each participating workplace in order to determine: the degree of support for the intervention(s) (reflected in the workplace culture); how sex and gender are implicated; co-workers' responses to the chosen intervention(s), and

Health policy in times of austerity-A conceptual framework for evaluating effects of policy on efficiency and equity illustrated with examples from Europe since 2008.

PubMed

Wenzl, Martin; Naci, Huseyin; Mossialos, Elias

2017-09-01

The objective of this paper is to provide a framework for evaluation of changes in health policy against overarching health system goals. We propose a categorisation of policies into seven distinct health system domains. We then develop existing analytical concepts of insurance coverage and cost-effectiveness further to evaluate the effects of policies in each domain on equity and efficiency. The framework is illustrated with likely effects of policy changes implemented in a sample of European countries since 2008. Our illustrative analysis suggests that cost containment has been the main focus and that countries have implemented a mix of measures that are efficient or efficiency neutral. Similarly, policies are likely to have mixed effects on equity. Additional user charges were a common theme but these were frequently accompanied by additional exemptions, making their likely effects on equity difficult to evaluate. We provide a framework for future, and more detailed, evaluations of changes in health policy. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

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

PubMed Central

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

2015-01-01

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

Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations

PubMed Central

Webb, Michael; Fahimi, Saman; Singh, Gitanjali M; Khatibzadeh, Shahab; Micha, Renata; Powles, John

2017-01-01

Objective To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide. Design Global modeling study. Setting 183 countries. Population Full adult population in each country. Intervention A “soft regulation” national policy that combines targeted industry agreements, government monitoring, and public education to reduce population sodium intake, modeled on the recent successful UK program. To account for heterogeneity in efficacy across countries, a range of scenarios were evaluated, including 10%, 30%, 0.5 g/day, and 1.5 g/day sodium reductions achieved over 10 years. We characterized global sodium intakes, blood pressure levels, effects of sodium on blood pressure and of blood pressure on cardiovascular disease, and cardiovascular disease rates in 2010, each by age and sex, in 183 countries. Country specific costs of a sodium reduction policy were estimated using the World Health Organization Noncommunicable Disease Costing Tool. Country specific impacts on mortality and disability adjusted life years (DALYs) were modeled using comparative risk assessment. We only evaluated program costs, without incorporating potential healthcare savings from prevented events, to provide conservative estimates of cost effectiveness Main outcome measure Cost effectiveness ratio, evaluated as purchasing power parity adjusted international dollars (equivalent to the country specific purchasing power of US$) per DALY saved over 10 years. Results Worldwide, a 10% reduction in sodium consumption over 10 years within each country was projected to avert approximately 5.8 million DALYs/year related to cardiovascular diseases, at a population weighted mean cost of I$1.13 per capita over the 10 year intervention. The population weighted mean cost effectiveness ratio was approximately I$204/DALY. Across nine world regions, estimated cost effectiveness of sodium reduction

Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations.

PubMed

Webb, Michael; Fahimi, Saman; Singh, Gitanjali M; Khatibzadeh, Shahab; Micha, Renata; Powles, John; Mozaffarian, Dariush

2017-01-10

 To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide.  Global modeling study.  183 countries.  Full adult population in each country.  A "soft regulation" national policy that combines targeted industry agreements, government monitoring, and public education to reduce population sodium intake, modeled on the recent successful UK program. To account for heterogeneity in efficacy across countries, a range of scenarios were evaluated, including 10%, 30%, 0.5 g/day, and 1.5 g/day sodium reductions achieved over 10 years. We characterized global sodium intakes, blood pressure levels, effects of sodium on blood pressure and of blood pressure on cardiovascular disease, and cardiovascular disease rates in 2010, each by age and sex, in 183 countries. Country specific costs of a sodium reduction policy were estimated using the World Health Organization Noncommunicable Disease Costing Tool. Country specific impacts on mortality and disability adjusted life years (DALYs) were modeled using comparative risk assessment. We only evaluated program costs, without incorporating potential healthcare savings from prevented events, to provide conservative estimates of cost effectiveness MAIN OUTCOME MEASURE:  Cost effectiveness ratio, evaluated as purchasing power parity adjusted international dollars (equivalent to the country specific purchasing power of US$) per DALY saved over 10 years.  Worldwide, a 10% reduction in sodium consumption over 10 years within each country was projected to avert approximately 5.8 million DALYs/year related to cardiovascular diseases, at a population weighted mean cost of I$1.13 per capita over the 10 year intervention. The population weighted mean cost effectiveness ratio was approximately I$204/DALY. Across nine world regions, estimated cost effectiveness of sodium reduction was best in South Asia (I$116/DALY); across the world

Dental Care And Medicare Beneficiaries: Access Gaps, Cost Burdens, And Policy Options.

PubMed

Willink, Amber; Schoen, Cathy; Davis, Karen

2016-12-01

Despite the wealth of evidence that oral health is related to physical health, Medicare explicitly excludes dental care from coverage, leaving beneficiaries at risk for tooth decay and periodontal disease and exposed to high out-of-pocket spending. To profile these risks, we examined access to dental care across income groups and types of insurance coverage in 2012. High-income beneficiaries were almost three times as likely to have received dental care in the previous twelve months, compared to low-income beneficiaries-74 percent of whom received no dental care. We also describe two illustrative policies that would expand access, in part by providing income-related subsidies. One would offer a voluntary, premium-financed benefit similar to those offered by Part D prescription drug plans, with an estimated premium of $29 per month. The other would cover basic dental care in core Medicare Part B benefits, financed in part by premiums ($7 or $15 per month, depending on whether premiums covered 25 percent or 50 percent of the cost) and in part by general revenues. The fact that beneficiaries are forgoing dental care and are exposed to significant costs if they seek care underscores the need for action. The policies offer pathways for improving health and financial independence for older adults. Project HOPE—The People-to-People Health Foundation, Inc.

Achieving health care cost containment through provider payment reform that engages patients and providers.

PubMed

Ginsburg, Paul B

2013-05-01

The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of care, such as an episode or patients' total needs over a period of time, a crucial first step. But meaningful cost containment from payment reform will not be achieved until Medicare and Medicaid establish stronger incentives for providers to contract in this way, with discouragement of nonparticipation increasing over time. In addition, the models need to evolve to engage beneficiaries, perhaps through incentives for patients to enroll in an accountable care organization and to seek care within that organization's network of providers.

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

ERIC Educational Resources Information Center

Massy, William F.

2013-01-01

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

Cost Effectiveness of the Earned Income Tax Credit as a Health Policy Investment.

PubMed

Muennig, Peter A; Mohit, Babak; Wu, Jinjing; Jia, Haomiao; Rosen, Zohn

2016-12-01

Lower-income Americans are suffering from declines in income, health, and longevity over time. Income and employment policies have been proposed as a potential non-medical solution to this problem. An interrupted time series analysis of state-level incremental supplements to the Earned Income Tax Credit (EITC) program was performed using data from 1993 to 2010 Behavioral Risk Factor Surveillance System surveys and state-level life expectancy. The cost effectiveness of state EITC supplements was estimated using a microsimulation model, which was run in 2015. Supplemental EITC programs increased health-related quality of life and longevity among the poor. The program costs about $7,786/quality-adjusted life-year gained (95% CI=$4,100, $13,400) for the average recipient. This ratio increases with larger family sizes, costing roughly $14,261 (95% CI=$8,735, $19,716) for a family of three. State supplements to EITC appear to be highly cost effective, but randomized trials are needed to confirm these findings. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Eliminating Major Gaps in DoD Data on the Fully-Burdened and Life-Cycle Cost of Military Personnel: Cost Elements Should be Mandated by Policy

DTIC Science & Technology

2013-01-07

Budgetary Assessment as well as private sector companies . Reserve Forces Policy Board Eliminating Major Gaps in DoD Data on the Fully-Burdened and Life...and utilities costs associated with the housing, childcare and recreation facilities found on major bases. This is true whether the reservist is...Notably, the current Under Secretary of Defense Comptroller, the Honorable Robert Hale has said, “the cost of pay and benefits has risen more than 87

Determinants of nursing home costs in Florida: policy implications and support in national research findings.

PubMed Central

Traxler, H G

1982-01-01

Descriptive and econometric analysis of the major nonquality determinants of nursing home costs for Florida shows that mean costs, size, and occupancy rate increased between 1971 and 1976, that per diem costs and occupancy rate were inversely related, and that the per diem cost was lower in rural than in urban areas. Regression of the data shows that--next to inflation, as expressed by the Consumer Price Index--the occupancy rate accounts for most of the variation in per diem costs, followed by size, urban-rural location, and by type of control. The hypothetical "optimal," defined as lowest cost-size range, was calculated to be more than 350 beds. Recent research substantiates most of these findings. Medicaid Cost Reports from Florida's nursing homes were the source of the information analyzed; by 1976, the sixth year of the study, the data base covered nearly 9 of 10 licensed beds in the State. Some policy implications can be drawn from the analysis. Reductions in per diem costs could be achieved by higher occupancy rates, especially in the larger nursing homes, and a reduction in the rate of inflation would reduce the rate of increase in nursing home costs. PMID:6815706

Markets and childhood obesity policy.

PubMed

Cawley, John

2006-01-01

In examining the childhood obesity epidemic from the perspective of economics, John Cawley looks at both possible causes and possible policy solutions that work through markets. The operation of markets, says Cawley, has contributed to the recent increase in childhood overweight in three main ways. First, the real price of food fell. In particular, energy-dense foods, such as those containing fats and sugars, became relatively cheaper than less energy-dense foods, such as fresh fruits and vegetables. Second, rising wages increased the "opportunity costs" of food preparation for college graduates, encouraging them to spend less time preparing meals. Third, technological changes created incentives to use prepackaged food rather than to prepare foods. Several economic rationales justify government intervention in markets to address these problems. First, because free markets generally under-provide information, the government may intervene to provide consumers with nutrition information they need. Second, because society bears the soaring costs of obesity, the government may intervene to lower the costs to taxpayers. Third, because children are not what economists call "rational consumers"--they cannot evaluate information critically and weigh the future consequences of their actions-the government may step in to help them make better choices. The government can easily disseminate information to consumers directly, but formulating policies to address the other two rationales is more difficult. In the absence of ideal policies to combat obesity, the government must turn to "second-best" policies. For example, it could protect children from advertisements for "junk food." It could implement taxes and subsidies that discourage the consumption of unhealthful foods or encourage physical activity. It could require schools to remove vending machines for soda and candy. From the economic perspective, policymakers should evaluate these options on the basis of cost

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

PubMed Central

French, Michael T.; Fang, Hai

2010-01-01

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

The cost of crime to society: new crime-specific estimates for policy and program evaluation.

PubMed

McCollister, Kathryn E; French, Michael T; Fang, Hai

2010-04-01

Estimating the cost to society of individual crimes is essential to the economic evaluation of many social programs, such as substance abuse treatment and community policing. A review of the crime-costing literature reveals multiple sources, including published articles and government reports, which collectively represent the alternative approaches for estimating the economic losses associated with criminal activity. Many of these sources are based upon data that are more than 10 years old, indicating a need for updated figures. This study presents a comprehensive methodology for calculating the cost to society of various criminal acts. Tangible and intangible losses are estimated using the most current data available. The selected approach, which incorporates both the cost-of-illness and the jury compensation methods, yields cost estimates for more than a dozen major crime categories, including several categories not found in previous studies. Updated crime cost estimates can help government agencies and other organizations execute more prudent policy evaluations, particularly benefit-cost analyses of substance abuse treatment or other interventions that reduce crime. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Evaluation of Arizona Health Care Cost Containment System, 1984-85

PubMed Central

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

1987-01-01

In this article, we describe the evaluation of the Arizona Health Care Cost Containment System (AHCCCS), Arizona's alternative to the acute care portion of Medicaid. We provide an assessment of implementation of the program's innovative features during its second 18 months of operation, from April 1984 through September 1985. Included in the evaluation are assessments of the administration of the program, provider relations, eligibility, enrollment and marketing, information systems, quality assurance and member satisfaction activities, the relationship of the county governments to AHCCCS, the competitive bidding process, and the plans and their financial status. PMID:10312395

The Cost-Effectiveness of Education Interventions in Poor Countries. Policy Insight, Volume 2, Issue 4

ERIC Educational Resources Information Center

Evans, David K.; Ghosh, Arkadipta

2008-01-01

Poor countries need development programs that are both effective and cost-effective. To assess effectiveness, researchers are increasingly using randomized trials (or quasi-experimental methods that imitate randomized trials), which provide a clear picture of which outcomes are attributable to the program being evaluated. This "Policy Insight"…

Israel's Gender Equality Policy in Education: Revolution or Containment?

ERIC Educational Resources Information Center

Eden, Devorah

2000-01-01

Examines Israel's policy of gender equality in education, discussing: social and economic forces that created the demand for equality; political processes for implementing the policy; and policy content. Data from interviews and document reviews indicate that the policy was devised to address concerns of high-tech industries and women,…

An evaluation of the cost-effectiveness of policy navigators to improve access to care for the poor in the Philippines.

PubMed

Solon, Orville; Peabody, John W; Woo, Kimberly; Quimbo, Stella A; Florentino, Jhiedon; Shimkhada, Riti

2009-09-01

Even when health insurance coverage is available, health policies may not be effective at increasing coverage among vulnerable populations. New approaches are needed to improve access to care. We experimentally introduced a novel intervention that uses Policy Navigators to increase health insurance enrollment in a poor population. We used data from the Quality Improvement Demonstration Study (QIDS), a randomized experiment taking place at the district level in the Visayas region of the Philippines. In two arms of the study, we compared the effects of introducing Policy Navigators to controls. The Policy Navigators advocated for improved access to care by providing regular system-level expertise directly to the policy-makers, municipal mayors and governors responsible for paying for and enrolling poor households into the health insurance program. Using regression models, we compared levels of enrollment in our intervention versus control sites. We also assessed the cost-effectiveness of marginal increases in enrollment. We found that Policy Navigators improved enrollment in health insurance between 39% and 102% compared to the controls. Policy navigators were cost-effective at 0.86 USD per enrollee. However, supplementary national government campaigns, which were implemented to further increase coverage, attenuated normal enrollment efforts. Policy Navigators appear to be effective in improving access to care and their success underscores the importance of local-level strategies for improving enrollment.

An Evaluation of the Cost-effectiveness of Policy Navigators to Improve Access to Care for the Poor in the Philippines

PubMed Central

Solon, Orville; Peabody, John W.; Woo, Kimberly; Quimbo, Stella A.; Florentino, Jhiedon; Shimkhada, Riti

2009-01-01

Objectives Even when health insurance coverage is available, health policies may not be effective at increasing coverage among vulnerable populations. New approaches are needed to improve access to care. We experimentally introduced a novel intervention that uses Policy Navigators to increase health insurance enrollment in a poor population. Methods We used data from the Quality Improvement Demonstration Study (QIDS), a randomized experiment taking place at the district level in the Visayas region of the Philippines. In two arms of the study, we compared the effects of introducing Policy Navigators to controls. The Policy Navigators advocated for improved access to care by providing regular system-level expertise directly to the policy-makers, municipal mayors and governors responsible for paying for and enrolling poor households into the health insurance program. Using regression models, we compared levels of enrollment in our intervention versus control sites. We also assessed the cost effectiveness of marginal increases in enrollment. Results We found that Policy Navigators improved enrollment in health insurance between 39 and 102% compared to the controls. Policy navigators were cost-effective at $0.86 USD per enrollee. However, supplementary national government campaigns, which were implemented to further increase coverage, attenuated normal enrollment efforts. Conclusion Policy Navigators appear to be effective in improving access to care and their success underscores the importance of local-level strategies for improving enrollment. PMID:19349090

The nine-year sustained cost-containment impact of swiss pilot physicians-pharmacists quality circles.

PubMed

Niquille, Anne; Ruggli, Martine; Buchmann, Michel; Jordan, Dominique; Bugnon, Olivier

2010-04-01

Six pioneer physicians-pharmacists quality circles (PPQCs) located in the Swiss canton of Fribourg (administratively corresponding to a state in the US) were under the responsibility of 6 trained community pharmacists moderating the prescribing process of 24 general practitioners (GPs). PPQCs are based on a multifaceted collaborative process mediated by community pharmacists for improving compliance with clinical guidelines within GPs' prescribing practices. To assess, over a 9-year period (1999-2007), the cost-containment impact of the PPQCs. The key elements of PPQCs are a structured continuous quality improvement and education process; local networking; feedback of comparative and detailed data regarding costs, drug choice, and frequency of prescribed drugs; and structured independent literature review for interdisciplinary continuing education. The data are issued from the community pharmacy invoices to the health insurance companies. The study analyzed the cost-containment impact of the PPQCs in comparison with GPs working in similar conditions of care without particular collaboration with pharmacists, the percentage of generic prescriptions for specific cardiovascular drug classes, and the percentage of drug costs or units prescribed for specific cardiovascular drugs. For the 9-year period, there was a 42% decrease in the drug costs in the PPQC group as compared to the control group, representing a $225,000 (USD) savings per GP only in 2007. These results are explained by better compliance with clinical and pharmacovigilance guidelines, larger distribution of generic drugs, a more balanced attitude toward marketing strategies, and interdisciplinary continuing education on the rational use of drugs. The PPQC work process has yielded sustainable results, such as significant cost savings, higher penetration of generics and reflection on patient safety, and the place of "new" drugs in therapy. The PPQCs may also constitute a solid basis for implementing more

Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care.

PubMed

Ziebarth, Nicolas R

2014-03-01

This study empirically evaluates the effectiveness of different health care cost containment measures. The measures investigated were introduced in Germany in 1997 to reduce moral hazard and public health expenditures in the market for rehabilitation care. Of the analyzed measures, doubling the daily copayments was clearly the most effective cost containment measure, resulting in a reduction in utilization of about [Formula: see text] . Indirect measures such as allowing employers to cut federally mandated sick pay or paid vacation during inpatient post-acute care stays did not significantly reduce utilization. There is evidence neither for adverse health effects nor for substitution effects in terms of more doctor visits.

Energy conservation policy evaluation. Study module IA. Volume II. Technical appendix. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bergstresser, K.; Berney, R.E.; Carter, L.F.

1978-01-01

This volume contains detailed technical analyses of the 19 energy conservation measures which were discussed as regional policy options in the report proper (PB-274 337). For each measure there is a description of how the measure works to reduce consumption; an assessment of potential savings, costs, and returns to adopters; probable 'normal' adoption rates under present policies; and potential adoption rates if some additional conservation policy options are implemented. Report includes chapters on environmental residuals from energy end uses, and policy preferences of households and energy marketers.

Operating Policies and Procedures of Computer Data-Base Systems.

ERIC Educational Resources Information Center

Anderson, David O.

Speaking on the operating policies and procedures of computer data bases containing information on students, the author divides his remarks into three parts: content decisions, data base security, and user access. He offers nine recommended practices that should increase the data base's usefulness to the user community: (1) the cost of developing…

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

NASA Astrophysics Data System (ADS)

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

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

Cost containment through pharmaceutical procurement: a Caribbean case study.

PubMed

Huff-Rousselle, M; Burnett, F

1996-01-01

This article discusses the potential for health sector cost containment in developing countries through improved pharmaceutical procurement. By describing the specific example of the Eastern Caribbean Drug Service (ECDS), which provides a pooled procurement service to nine ministries of health in the small island nations of the Caribbean, it examines the elements of the procurement operation that allowed ECDS to reduce unit costs for pharmaceuticals by over 50 per cent during its first procurement cycle. The analysis of ECDS considers: (1) political will, institutional alliances, and the creation of a public sector monopsony; (2) pooling demand; (3) restricted international tendering and the pharmaceutical industry; (4) estimating demand and supplier guarantees; (5) reducing variety and increasing volume through standardizing pack sizes, dosage forms and strengths; (6) generic bidding and therapeutic alternative bidding; (7) mode of transport from foreign suppliers; (8) financing mechanisms, including choice of currency, foreign exchange, and terms of payment; (9) market conditions and crafting and enforcing supplier contracts; and, (10) the adjudication process, including consideration of suppliers' past performance, precision requirements in the manufacturing process, number of products awarded to suppliers, and issues of judgment. The authors consider the relevance of this agency's experience to other developing countries by providing a blueprint that can be adopted or modified to suit other situations.

Cost aware cache replacement policy in shared last-level cache for hybrid memory based fog computing

NASA Astrophysics Data System (ADS)

Jia, Gangyong; Han, Guangjie; Wang, Hao; Wang, Feng

2018-04-01

Fog computing requires a large main memory capacity to decrease latency and increase the Quality of Service (QoS). However, dynamic random access memory (DRAM), the commonly used random access memory, cannot be included into a fog computing system due to its high consumption of power. In recent years, non-volatile memories (NVM) such as Phase-Change Memory (PCM) and Spin-transfer torque RAM (STT-RAM) with their low power consumption have emerged to replace DRAM. Moreover, the currently proposed hybrid main memory, consisting of both DRAM and NVM, have shown promising advantages in terms of scalability and power consumption. However, the drawbacks of NVM, such as long read/write latency give rise to potential problems leading to asymmetric cache misses in the hybrid main memory. Current last level cache (LLC) policies are based on the unified miss cost, and result in poor performance in LLC and add to the cost of using NVM. In order to minimize the cache miss cost in the hybrid main memory, we propose a cost aware cache replacement policy (CACRP) that reduces the number of cache misses from NVM and improves the cache performance for a hybrid memory system. Experimental results show that our CACRP behaves better in LLC performance, improving performance up to 43.6% (15.5% on average) compared to LRU.

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

USDA-ARS?s Scientific Manuscript database

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

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

ERIC Educational Resources Information Center

Brown, Walter A.; Gamber, Cayo

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

77 FR 43542 - Cost Accounting Standards: Cost Accounting Standards 412 and 413-Cost Accounting Standards...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-25

... rule that revised Cost Accounting Standard (CAS) 412, ``Composition and Measurement of Pension Cost... Accounting Standards: Cost Accounting Standards 412 and 413--Cost Accounting Standards Pension Harmonization Rule AGENCY: Cost Accounting Standards Board, Office of Federal Procurement Policy, Office of...

Foreign Policy Benefits from Subsidization of Trade with Eastern Europe

DTIC Science & Technology

1989-02-01

AFUDC, the projected cost per kilowatt is $2440. A reactor containment for a 1000 MW pressur - ized water reactor costs about $100 million;96 let us ...diffprencpe in interests between the Soviet Union and its East European allies in the Warsaw Pact. It examines the use of economic policy by the West as a...instead to Soviet armies, fronts, or theaters of military operations (TVDs). The Groups of Soviet Forces are stationed in Eastern Europe in part in an

Pollution Emissions, Environmental Policy, and Marginal Abatement Costs.

PubMed

He, Ling-Yun; Ou, Jia-Jia

2017-12-05

Pollution emissions impose serious social negative externalities, especially in terms of public health. To reduce pollution emissions cost-effectively, the marginal abatement costs (MACs) of pollution emissions must be determined. Since the industrial sectors are the essential pillars of China's economic growth, as well as leading energy consumers and sulfur dioxide (SO₂) emitters, estimating MACs of SO₂ emissions at the industrial level can provide valuable information for all abatement efforts. This paper tries to address the critical and essential issue in pollution abatement: How do we determine the MACs of pollution emissions in China? This paper first quantifies the SO₂ emission contribution of different industrial sectors in the Chinese economy by an Input-Output method and then estimates MACs of SO₂ for industrial sectors at the national level, provincial level, and sectoral level by the shadow price theory. Our results show that six sectors (e.g., the Mining and Washing of Coal sector) should be covered in the Chinese pollution emission trading system. We have also found that the lowest SO₂ shadow price is 2000 Yuan/ton at the national level, and that shadow prices should be set differently at the provincial level. Our empirical study has several important policy implications, e.g., the estimated MACs may be used as a pricing benchmark through emission allowance allocation. In this paper, the MACs of industrial sectors are calculated from the national, provincial and sectoral levels; therefore, we provide an efficient framework to track the complex relationship between sectors and provinces.

Pollution Emissions, Environmental Policy, and Marginal Abatement Costs

PubMed Central

He, Ling-Yun; Ou, Jia-Jia

2017-01-01

Pollution emissions impose serious social negative externalities, especially in terms of public health. To reduce pollution emissions cost-effectively, the marginal abatement costs (MACs) of pollution emissions must be determined. Since the industrial sectors are the essential pillars of China’s economic growth, as well as leading energy consumers and sulfur dioxide (SO2) emitters, estimating MACs of SO2 emissions at the industrial level can provide valuable information for all abatement efforts. This paper tries to address the critical and essential issue in pollution abatement: How do we determine the MACs of pollution emissions in China? This paper first quantifies the SO2 emission contribution of different industrial sectors in the Chinese economy by an Input-Output method and then estimates MACs of SO2 for industrial sectors at the national level, provincial level, and sectoral level by the shadow price theory. Our results show that six sectors (e.g., the Mining and Washing of Coal sector) should be covered in the Chinese pollution emission trading system. We have also found that the lowest SO2 shadow price is 2000 Yuan/ton at the national level, and that shadow prices should be set differently at the provincial level. Our empirical study has several important policy implications, e.g., the estimated MACs may be used as a pricing benchmark through emission allowance allocation. In this paper, the MACs of industrial sectors are calculated from the national, provincial and sectoral levels; therefore, we provide an efficient framework to track the complex relationship between sectors and provinces. PMID:29206170

Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco.

PubMed

Witter, S; Boukhalfa, C; Cresswell, J A; Daou, Z; Filippi, V; Ganaba, R; Goufodji, S; Lange, I L; Marchal, B; Richard, F

2016-08-02

Across the Africa region and beyond, the last decade has seen many countries introducing policies aimed at reducing financial barriers to obstetric care. This article provides evidence of the cost and effects of national policies focussed on improving financial access to caesarean and facility deliveries in Benin, Burkina Faso, Mali and Morocco. The study uses a comparative case study design with mixed methods, including realist evaluation components. This article presents results across 14 different data collection tools, used in 4-6 research sites in each of the four study countries over 2011-13. The methods included: document review; interviews with key informants; analysis of secondary data; structured extraction from medical files; cross-sectional surveys of patients and staff; interviews with patients and observation of care processes. The article finds that the policies have contributed to continued increases in skilled birth attendance and caesarean sections and a narrowing of inequalities in all four countries, but these trends were already occurring so a shift cannot be attributed solely to the policies. It finds a significant reduction in financial burdens on households after the policy, suggesting that the financial protection objectives may have been met, at least in the short term, although none achieved total exemption of targeted costs. Policies are domestically financed and are potentially sustainable and efficient, and were relatively thoroughly implemented. Further, we find no evidence of negative effects on technical quality of care, or of unintended negative effects on untargeted services. We conclude that the policies were effective in meeting financial protection goals and probably health and equity goals, at sustainable cost, but that a range of measures could increase their effectiveness and equity. These include broadening the exempted package (especially for those countries which focused on caesarean sections alone), better calibrated

Impact of drug cost sharing on service use and adverse clinical outcomes in elderly receiving antidepressants.

PubMed

Wang, Philip S; Patrick, Amanda R; Dormuth, Colin; Maclure, Malcolm; Avorn, Jerry; Canning, Claire F; Schneeweiss, Sebastian

2010-03-01

physicians or psychiatrists for depression, hospitalizations with a depression diagnosis, or long-term care admissions. The cost-sharing policies studied may have contained non-essential antidepressant use without substantially increasing mental health service utilization. However, it is possible that the policies had effects that we were unable to detect, such as increasing rates of visits to social workers or psychologists or forcing patients to reduce other spending. Further, the sequential implementation of the policy changes, makes it difficult to estimate the effect of a direct change from full coverage to a coinsurance/income-based deductible policy. It may be possible to design policies to contain non-essential antidepressant use without substantially increasing other service utilization or adverse events. However, because undertreatment remains a serious problem among depressed elderly, well-designed prescription drug policies should be coupled with interventions to address under-treatment.

Small self-contained payload overview. [Space Shuttle Getaway Special project management

NASA Technical Reports Server (NTRS)

Miller, D. S.

1981-01-01

The low-cost Small Self-Contained Payload Program, also known as the Getaway Special, initiated by NASA for providing a stepping stone to larger scientific and manufacturing payloads, is presented. The steps of 'getting on board,' the conditions of use, the reimbursement policy and the procedures, and the flight scheduling mechanism for flying the Getaway Special payload are given. The terms and conditions, and the interfaces between NASA and the users for entering into an agreement with NASA for launch and associated services are described, as are the philosophy and the rationale for establishing the policy and the procedures.

Planned special events : cost management and cost recovery

DOT National Transportation Integrated Search

2009-05-01

This purpose of this primer is to aid jurisdictions and agencies, especially Departments of Transportation, with identifying and managing the costs of planned special events (PSEs) and forming policy for cost recovery. Cost management the effectiv...

Identifying Cost-Effective Dynamic Policies to Control Epidemics

PubMed Central

Yaesoubi, Reza; Cohen, Ted

2016-01-01

We describe a mathematical decision model for identifying dynamic health policies for controlling epidemics. These dynamic policies aim to select the best current intervention based on accumulating epidemic data and the availability of resources at each decision point. We propose an algorithm to approximate dynamic policies that optimize the population’s net health benefit, a performance measure which accounts for both health and monetary outcomes. We further illustrate how dynamic policies can be defined and optimized for the control of a novel viral pathogen, where a policy maker must decide (i) when to employ or lift a transmission-reducing intervention (e.g. school closure) and (ii) how to prioritize population members for vaccination when a limited quantity of vaccines first become available. Within the context of this application, we demonstrate that dynamic policies can produce higher net health benefit than more commonly described static policies that specify a pre-determined sequence of interventions to employ throughout epidemics. PMID:27449759

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

PubMed Central

2013-01-01

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

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

PubMed

Barquera, Simon; Campos-Nonato, Ismael; Aguilar-Salinas, Carlos; Lopez-Ridaura, Ruy; Arredondo, Armando; Rivera-Dommarco, Juan

2013-02-02

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

Self-Monitoring of Blood Glucose Levels: Evaluating the Impact of a Policy of Quantity Limits on Test-Strip Use and Costs.

PubMed

Gomes, Tara; Martins, Diana; Tadrous, Mina; Paterson, J Michael; Shah, Baiju R; Juurlink, David N; Singh, Samantha; Mamdani, Muhammad M

2016-10-01

To evaluate the impact of new quantity limits for blood glucose test strips (BGTS) in August 2013 on utilization patterns and costs in the elderly population of Ontario, Canada. We conducted a population-based, cross-sectional time series analysis of all individuals 65 years of age and older who received publically funded BGTSs between August 1, 2010, and July 31, 2015, in Ontario, Canada. The number of BGTSs dispensed and the associated costs were measured for 4 diabetes therapy subgroups-insulin, hypoglycemia-inducing oral agents, non-hypoglycemia-inducing oral agents, and no drug therapy-each month during the study period. We used interventional autoregressive integrated moving average (ARIMA) models to assess the impact of Ontario's policy change on test strip use and costs. In the course of the study period, 657,338,177 test strips were dispensed to elderly patients in Ontario, at a total cost of CAN$482.3 million. Introduction of quantity limits was associated with significant reductions in the number of monthly strips dispensed and the associated costs (p<0.0001). In the year following the policy's implementation, test strip use decreased by 22.2% compared with the prior year (from 145,232,024 test strips to 113,007,795 test strips, a net decrease of 32,224,229 strips), resulting in a 22.5% reduction in costs (from $106.5 million to $82.6 million, a net cost reduction of approximately $24 million). The introduction of quantity limits, aligned with guidance from the Canadian Diabetes Association, led to immediate significant reductions in BGTS dispensing and costs. More research is needed to assess the impact of this policy on patient outcomes. Copyright © 2016 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence.

PubMed

Rubio-Valera, Maria; Luciano, Juan V; Ortiz, José Miguel; Salvador-Carulla, Luis; Gracia, Alfredo; Serrano-Blanco, Antoni

2015-03-04

Agitation and containment are frequent in psychiatric care but little is known about their costs. The aim was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital or emergency service. Systematic searches of four electronic databases covering the period January 1998-January 2014 were conducted. Manual searches were also performed. Paper selection and data extraction were performed in duplicate. Cost data were converted to euros in 2014. Ten studies met inclusion criteria and were included in the analysis (retrospective cohorts, prospective cohorts and cost-of-illness studies). Evaluated in these studies were length of stay, readmission rates and medication. Eight studies assessed the impact of agitation on the length of stay and six showed that it was associated with longer stays. Four studies examined the impact of agitation on readmission and a statistically significant increase in the probability of readmission of agitated patients was observed. Two studies evaluated medication. One study showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. One study estimated the costs of conflict and containment incurred in acute inpatient psychiatric care in the UK. The estimation for the year 2014 of total annual cost per ward for all conflict was €182,616 and €267,069 for containment based on updated costs from 2005. Agitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Evidence is scarce and further research is needed to estimate the burden of agitation and containment from the perspective of hospitals and the healthcare system.

Self-contained, low-cost Body-on-a-Chip systems for drug development.

PubMed

Wang, Ying I; Oleaga, Carlota; Long, Christopher J; Esch, Mandy B; McAleer, Christopher W; Miller, Paula G; Hickman, James J; Shuler, Michael L

2017-11-01

Integrated multi-organ microphysiological systems are an evolving tool for preclinical evaluation of the potential toxicity and efficacy of drug candidates. Such systems, also known as Body-on-a-Chip devices, have a great potential to increase the successful conversion of drug candidates entering clinical trials into approved drugs. Systems, to be attractive for commercial adoption, need to be inexpensive, easy to operate, and give reproducible results. Further, the ability to measure functional responses, such as electrical activity, force generation, and barrier integrity of organ surrogates, enhances the ability to monitor response to drugs. The ability to operate a system for significant periods of time (up to 28 d) will provide potential to estimate chronic as well as acute responses of the human body. Here we review progress towards a self-contained low-cost microphysiological system with functional measurements of physiological responses. Impact statement Multi-organ microphysiological systems are promising devices to improve the drug development process. The development of a pumpless system represents the ability to build multi-organ systems that are of low cost, high reliability, and self-contained. These features, coupled with the ability to measure electrical and mechanical response in addition to chemical or metabolic changes, provides an attractive system for incorporation into the drug development process. This will be the most complete review of the pumpless platform with recirculation yet written.

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

ERIC Educational Resources Information Center

Turk, Frederick J.

1992-01-01

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

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

PubMed

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

2014-11-04

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

Economic costs of drug abuse: financial, cost of illness, and services.

PubMed

Cartwright, William S

2008-03-01

This article examines costs as they relate to the financial costs of providing drug abuse treatment in private and public health plans, costs to society relating to drug abuse, and many smaller costing studies of various stakeholders in the health care system. A bibliography is developed from searches across PubMed, Web of Science, and other bibliographic sources. The review indicates that a wide collection of cost findings is available to policy makers. For example, the financial aspects of health plans have been dominated by considerations of actuarial costs of parity for drug abuse treatment. Cost-of-illness methods have been developed and extended to drug abuse costing to measure the national level of burden and are important to the economic evaluation of interventions at the program level. Costing is done in many small and focused studies, reflecting the interests of different stakeholders in the health care system. For costs in programs and health plans, as well as cost offsets of the impact of substance abuse treatment on medical expenditures, findings are surprisingly important to policy makers. Maintaining ongoing research that is highly policy relevant from the point of view of health services, more is needed on costing concepts and measurement applications.

Higher Education Cost Drivers, Including Two Hidden Ones with Cost Containment Possibilities.

ERIC Educational Resources Information Center

Micceri, Ted

Identifying higher education cost drivers and working to limit their effects appears to be a necessity if higher education is to retain the support historically allocated by society. Costs occur for three groups: students, institutions, and society. This paper summarizes information about cost drivers in higher education and identifies two that…

Hospital pharmacy decisions, cost containment, and the use of cost-effectiveness analysis.

PubMed

Sloan, F A; Whetten-Goldstein, K; Wilson, A

1997-08-01

The key hypothesis of the study was that hospital pharmacies under the pressure of managed care would be more likely to adopt process innovations to assure less costly and more cost-effective provision of care. We conducted a survey of 103 hospitals and analyzed secondary data on cost and staffing. Compared to the size of the reduction in length of stay, changes in the way that a day of care is delivered appear to be minor, even in areas with substantial managed care share. The vast majority of hospitals surveyed had implemented some form of therapeutic interchange and generic substitution. Most hospitals used some drug utilization guidelines, but as of mid 1995 these were not yet important management tools for hospital pharmacies. To our knowledge, ours was the first survey to investigate the link between hospital formularies and use of cost-effectiveness analysis. At most cost-effectiveness was a minor tool in pharmaceutical decision making in hospitals at present. We could determine no differences in use of such analyses by managed care market share in the hospital's market share. One impediment to the use of cost-effectiveness studies was the lack of timeliness of studies. Other stated reasons for not using cost-effectiveness analysis more often were: lack of information on hospitalized patients and hence on the potential cost offsets accruing to the hospital: lack of independent sponsorship, and inadequate expertise in economic evaluation.

Socioeconomic disparities in access to ART treatment and the differential impact of a policy that increased consumer costs.

PubMed

Chambers, G M; Hoang, V P; Illingworth, P J

2013-11-01

What was the impact on access to assisted reproductive technology (ART) treatment by different socioeconomic status (SES) groups after the introduction of a policy that increased patient out-of-pocket costs? After the introduction of a policy that increased out-of-pocket costs in Australia, all SES groups experienced a similar percentage reduction in fresh ART cycles per 1000 women of reproductive age. Higher SES groups experienced a progressively greater reduction in absolute numbers of fresh ART cycles due to existing higher levels of utilization. Australia has supportive public funding arrangements for ARTs. Policies that substantially increase out-of-pocket costs for ART treatment create financial barriers to access and an overall reduction in utilization. Data from the USA suggests that disparities exist in access to ART treatment based on ethnicity, education level and income. Time series analysis of utilization of ART, intrauterine insemination (IUI) and clomiphene citrate by women from varying SES groups before and after the introduction of a change in the level of public funding for ART. Women undertaking fertility treatment in Australia between 2007 and 2010. Women from higher SES quintiles use more ART treatment than those in lower SES quintiles, which likely reflects a greater ability to pay for treatment and a greater need for ART treatment as indicated by the trend to later childbearing. In 2009, 10.13 and 5.17 fresh ART cycles per 1000 women of reproductive age were performed in women in the highest and lowest SES quintiles respectively. In the 12 months after the introduction of a policy that increased out-of-pocket costs from ∼$1500 Australian dollars (€1000) to ∼$2500 (€1670) for a fresh IVF cycle, there was a 21-25% reduction in fresh ART cycles across all SES quintiles. The absolute reduction in fresh ART cycles in the highest SES quintile was double that in the lowest SES quintile. In this study, SES was based on the average relative

The role of multi-target policy instruments in agri-environmental policy mixes.

PubMed

Schader, Christian; Lampkin, Nicholas; Muller, Adrian; Stolze, Matthias

2014-12-01

The Tinbergen Rule has been used to criticise multi-target policy instruments for being inefficient. The aim of this paper is to clarify the role of multi-target policy instruments using the case of agri-environmental policy. Employing an analytical linear optimisation model, this paper demonstrates that there is no general contradiction between multi-target policy instruments and the Tinbergen Rule, if multi-target policy instruments are embedded in a policy-mix with a sufficient number of targeted instruments. We show that the relation between cost-effectiveness of the instruments, related to all policy targets, is the key determinant for an economically sound choice of policy instruments. If economies of scope with respect to achieving policy targets are realised, a higher cost-effectiveness of multi-target policy instruments can be achieved. Using the example of organic farming support policy, we discuss several reasons why economies of scope could be realised by multi-target agri-environmental policy instruments. Copyright © 2014 Elsevier Ltd. All rights reserved.

Impact of Drug Cost Sharing on Service Use and Adverse Clinical Outcomes In Elderly Receiving Antidepressants

PubMed Central

Wang, Philip S.; Patrick, Amanda R.; Dormuth, Colin; Maclure, Malcolm; Avorn, Jerry; Canning, Claire F.; Schneeweiss, Sebastian

2010-01-01

policy affected the rates of visits to physicians or psychiatrists for depression, hospitalizations with a depression diagnosis, or long-term care admissions. Discussion The cost-sharing policies studied may have contained non-essential antidepressant use without substantially increasing mental health service utilization. However, it is possible that the policies had effects that we were unable to detect, such as increasing rates of visits to social workers or psychologists or forcing patients to reduce other spending. Further, the sequential implementation of the policy changes, makes it difficult to estimate the effect of a direct change from full coverage to a coinsurance/income-based deductible policy. Implications for Health Policies It may be possible to design policies to contain non-essential antidepressant use without substantially increasing other service utilization or adverse events. However, because undertreatment remains a serious problem among depressed elderly, well-designed prescription drug policies should be coupled with interventions to address under-treatment. PMID:20571181

Health policy making under information constraints: an evaluation of the policy responses to the economic crisis in Greece.

PubMed

Goranitis, Ilias; Siskou, Olga; Liaropoulos, Lycourgos

2014-09-01

Cost consolidation in the highly fragmented and inefficient Greek health care system was necessary. However, policies introduced were partly formed in a context of insufficient information. Expenditure data from a consumption point of view were lacking and the depth of the political and structural problems was of unknown magnitude to the supervisory authorities. Drawing upon relevant literature and evidence from the newly implemented OECD System of Health Accounts, the paper evaluates the health policy responses to the economic crisis in Greece. The discussion and recommendations are also of interest to other countries where data sources are not reliable or decisions are based on preliminary data and projections. Between 2009 and 2012, across-the-board cuts have resulted in a decline in public health expenditure for inpatient care by 8.6%, for pharmaceuticals by 42.3% and for outpatient care by 34.6%. Further cuts are expected from the ongoing reforms but more structural changes are needed. Cost-containment was not well targeted and expenditure cuts were not always addressed to the real reasons of the pre-crisis cost explosion. Policy responses were restricted to quick and easy fiscal adjustment, ignoring the need for substantial structural reforms or individuals' right to access health care irrespective of their financial capacity. Developing appropriate information infrastructure, restructuring and consolidating the hospital sector and moving toward a tax-based national health insurance could offer valuable benefits to the system. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

Chen, Stephanie C; Pearson, Steven D

2016-08-01

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

Dynamic Policy Evaluation for Containing Network Attacks (DEFCN)

DTIC Science & Technology

2005-03-01

API reads policy information from the target users ".ssh" directory and applies those policies to determine whether remote login is allowed to a...types of events that can be controlled by the threshold detectors and reported by the GAA-API include the number of failed login attempts within a given...other uses of the system. Emerald architecture [2] includes a data- collection module integrated with Apache Web server. The module extracts the request

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

PubMed

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

2016-08-01

To determine which factors are associated with higher costs of urethroplasty procedure and whether these factors have been increasing over time. Identification of determinants of extreme costs may help reduce cost while maintaining quality. We conducted a retrospective analysis using the 2001-2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). The HCUP-NIS captures hospital charges which we converted to cost using the HCUP cost-to-charge ratio. Log cost linear regression with sensitivity analysis was used to determine variables associated with increased costs. Extreme cost was defined as the top 20th percentile of expenditure, analyzed with logistic regression, and expressed as odds ratios (OR). A total of 2298 urethroplasties were recorded in NIS over the study period. The median (interquartile range) calculated cost was $7321 ($5677-$10,000). Patients with multiple comorbid conditions were associated with extreme costs [OR 1.56, 95% confidence interval (CI) 1.19-2.04, P = .02] compared with patients with no comorbid disease. Inpatient complications raised the odds of extreme costs (OR 3.2, CI 2.14-4.75, P <.001). Graft urethroplasties were associated with extreme costs (OR 1.78, 95% CI 1.2-2.64, P = .005). Variations in patient age, race, hospital region, bed size, teaching status, payor type, and volume of urethroplasty cases were not associated with extremes of cost. Cost variation for perioperative inpatient urethroplasty procedures is dependent on preoperative patient comorbidities, postoperative complications, and surgical complexity related to graft usage. Procedural cost and cost variation are critical for understanding which aspects of care have the greatest impact on cost. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed Central

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

2016-01-01

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

Space Planning: A Basis for Cost Containment.

ERIC Educational Resources Information Center

Snyder, Fred A.; And Others

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

76 FR 61660 - Cost Accounting Standards: Clarification of the Exemption From Cost Accounting Standards for Firm...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-05

... Accounting Standards: Clarification of the Exemption From Cost Accounting Standards for Firm-Fixed-Price... Management and Budget (OMB), Office of Federal Procurement Policy, Cost Accounting Standards Board. ACTION: Proposed rule. SUMMARY: The Office of Federal Procurement Policy (OFPP), Cost Accounting Standards (CAS...

76 FR 53378 - Cost Accounting Standards: Accounting for Insurance Costs

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-26

... Accounting Standards: Accounting for Insurance Costs AGENCY: Cost Accounting Standards Board (Board), Office... Discontinuation of Rulemaking. SUMMARY: The Office of Federal Procurement Policy (OFPP), Cost Accounting Standards... development of an amendment to Cost Accounting Standard (CAS) 416 regarding the use of the term ``catastrophic...

A qualitative study of GPs' and PCO stakeholders' views on the importance and influence of cost on prescribing.

PubMed

Prosser, Helen; Walley, Tom

2005-03-01

With prescribing expenditure rising and evidence of prescribing costs variation, general practitioners (GPs) in the UK are under increasing pressure to contain spending. The introduction of cash-limited, unified budgets and increased monitoring of prescribing within Primary Care Organizations (PCO) are intended to increase efficiency and enhance GPs financial responsibility. Whilst GPs regularly receive data on the costs of their prescribing and also performance against a set prescribing budget, little is known about the extent to which GPs take cost into account in their prescribing decisions. This study undertook a qualitative exploration of the attitudes of various stakeholders on the relative importance and influence of cost on general practice prescribing. In order to explore a plurality of perspectives, data were obtained from focus groups and a series of individual semi-structured interviews with GPs and key PCO stakeholders. The data suggest that although almost all GPs believed costs should be taken into account when prescribing, there was great variation in the extent to which this was applied and to how sensitive GPs were to costs. Cost was secondary to clinical effectiveness and safety, whilst individual patient need was emphasized above other forms of rationality or notions of opportunity costs. Conflict was apparent between a PCO policy of cost-containment and GPs' resistance to cost-cutting. GPs largely applied simple cost-minimization while cost-consideration was undermined by contextual factors. Implications for research and policy are discussed.

Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood.

PubMed

Cradock, Angie L; Barrett, Jessica L; Kenney, Erica L; Giles, Catherine M; Ward, Zachary J; Long, Michael W; Resch, Stephen C; Pipito, Andrea A; Wei, Emily R; Gortmaker, Steven L

2017-02-01

Participation in recommended levels of physical activity promotes a healthy body weight and reduced chronic disease risk. To inform investment in prevention initiatives, we simulate the national implementation, impact on physical activity and childhood obesity and associated cost-effectiveness (versus the status quo) of six recommended strategies that can be applied throughout childhood to increase physical activity in US school, afterschool and childcare settings. In 2016, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) systematic review process identified six interventions for study. A microsimulation model estimated intervention outcomes 2015-2025 including changes in mean MET-hours/day, intervention reach and cost per person, cost per MET-hour change, ten-year net costs to society and cases of childhood obesity prevented. First year reach of the interventions ranged from 90,000 youth attending a Healthy Afterschool Program to 31.3 million youth reached by Active School Day policies. Mean MET-hour/day/person increases ranged from 0.05 MET-hour/day/person for Active PE and Healthy Afterschool to 1.29 MET-hour/day/person for the implementation of New Afterschool Programs. Cost per MET-hour change ranged from cost saving to $3.14. Approximately 2500 to 110,000 cases of children with obesity could be prevented depending on the intervention implemented. All of the six interventions are estimated to increase physical activity levels among children and adolescents in the US population and prevent cases of childhood obesity. Results do not include other impacts of increased physical activity, including cognitive and behavioral effects. Decision-makers can use these methods to inform prioritization of physical activity promotion and obesity prevention on policy agendas. Copyright © 2016. Published by Elsevier Inc.

Drug Policy in Bulgaria.

PubMed

Dimova, Antoniya; Rohova, Maria; Atanasova, Elka; Kawalec, Paweł; Czok, Katarzyna

2017-09-01

Bulgaria has a mixed public-private health care financing system. Health care is financed mainly from compulsory health insurance contributions and out-of-pocket payments. Out-of-pocket payments constitute a large share of the total health care expenditure (44.14% in 2014). The share of drugs expenditure for outpatient treatment was 42.3% of the total health care expenditure in 2014, covered mainly by private payments (78.6% of the total pharmaceutical expenditure). The drug policy is run by the Ministry of Health (MoH), the National Council on Prices and Reimbursement of Medicinal Products, and the Health Technology Assessment Commission. The MoH defines diseases for which the National Health Insurance Fund (NHIF) pays for medicines. The National Council on Prices and Reimbursement of Medicinal Products maintains a positive drug list (PDL) and sets drug prices. Health technology assessment was introduced in 2015 for medicinal products belonging to a new international nonproprietary name group. The PDL defines prescription medicines that are paid for by the NHIF, the MoH, and the health care establishments; exact patient co-payments and reimbursement levels; as well as the ceiling prices for drugs not covered by the NHIF, including over-the-counter medicines. The reimbursement level can be 100%, 75%, or up to 50%. The PDL is revised monthly in all cases except for price increase. Physicians are not assigned with pharmaceutical budgets, there is a brand prescribing practice, and the substitution of prescribed medicines by pharmacists is prohibited. Policies toward cost containment and effectiveness increase include introduction of a reference pricing system, obligation to the NHIF to conduct mandatory centralized bargaining of discounts for medicinal products included in the PDL, public tendering for medicines for hospital treatment, reduction of markup margins of wholesalers and retailers, patient co-payment, and the introduction of health technology assessment

From heterogeneity to harmonization? Recent trends in European health policy.

PubMed

Gerlinger, Thomas; Urban, Hans-Jürgen

2007-01-01

In the European Union (EU), health policy and the institutional reform of health systems have been treated primarily as national affairs, and health care systems within the EU thus differ considerably. However, the health policy field is undergoing a dynamic process of Europeanization. This process is stimulated by the orientation towards a more competitive economy, recently inaugurated and known as the Lisbon Strategy, while the regulatory requirements of the European Economic and Monetary Union are stimulating the Europeanization of health policy. In addition, the so-called open method of coordination, representing a new mode of regulation within the European multi-level system, is applied increasingly to the health policy area. Diverse trends are thus emerging. While the Lisbon Strategy goes along with a strategic upgrading of health policy more generally, health policy is increasingly used to strengthen economic competitiveness. Pressure on Member States is expected to increase to contain costs and promote market-based health care provision.

Work force policy perspectives: registered nurses.

PubMed

Friss, L O

1981-01-01

If the decline in full-time labor force participation by registered nurses in hospitals is to be reversed, the issue of equal pay for comparable work must be addressed. Under pressure for cost containment, policies tend to focus on labor force economics rather than on limitations of services. While the two are interrelated, wage policies must be considered independently. This article describes the network which determines how nurse salaries are set: the relationship between the private sector, the general schedule and the Veteran's Administration. The effects of this system are documented, using testimony from a case in the tenth circuit, as well as comparisons with other reference groups: policemen, teachers, laborers, and VA career fields. The evidence suggests that there is a need for policy intervention. Prime areas for action are the comparability practices by governments, particularly in the areas of classification standards and pay setting. Hospital personnel practices which continue past effects of occupational segregation also should be changed.

National guidelines for high-cost drugs in Brazil: achievements and constraints of an innovative national evidence-based public health policy.

PubMed

Picon, Paulo D; Beltrame, Alberto; Banta, David

2013-04-01

The translation of best evidence into practice has become an important purpose of policy making in health care. In Brazil, a country of continental dimensions with widespread regional and social inequalities, the dissemination and use of the best-evidence in policy making is a critical issue for the healthcare system. The main purpose of this study is to describe an evidence-based public health policy with special emphasis on guidelines creation for high-cost medicines. We also describe how that strategy was diffused to the judiciary system and to other parts of the healthcare system. We present an 11-year follow-up of a national project for creating and updating guidelines for high-cost medicines in Brazil. A total of 109 national guidelines were published (new or updated versions) for 66 selected diseases, the first such effort in Brazilian history. The project influenced the Brazilian legislature, which has recently established a Federal Law requiring national guidelines for any new technology listed for payment by the Brazilian public healthcare system. We were able to involve many different stakeholders in a partnership between academia and policy makers, which made possible the widespread dissemination of the clinical practice guidelines. Problems and constraints were also encountered. This evolving public health strategy might be useful for other developing countries.

48 CFR 9904.414 - Cost accounting standard-cost of money as an element of the cost of facilities capital.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting standard... Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING...

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

DOE PAGES

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

2014-11-14

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

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association.

PubMed

Dunbar, Sandra B; Khavjou, Olga A; Bakas, Tamilyn; Hunt, Gail; Kirch, Rebecca A; Leib, Alyssa R; Morrison, R Sean; Poehler, Diana C; Roger, Veronique L; Whitsel, Laurie P

2018-05-08

attributable to CVD. The burden of informal caregiving for patients with CVD is significant; accounting for these costs increases total CVD costs to $616 billion in 2015 and $1.2 trillion in 2035. These estimates have important research and policy implications, and they may be used to guide policy development to reduce the burden of CVD on patients and their caregivers. © 2018 American Heart Association, Inc.

Reference drug programs: effectiveness and policy implications.

PubMed

Schneeweiss, Sebastian

2007-04-01

In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs (RDPs) or similar therapeutic substitution programs. This paper summarizes the mechanism and rationale of RDPs and presents evidence of their economic effectiveness and clinical safety. RDPs for pharmaceutical reimbursement are based on the assumption that drugs within specified medication groups are therapeutically equivalent and clinically interchangeable and that a common reimbursement level can thus be established. If the evidence documents that a higher price for a given drug does not buy greater effectiveness or reduced toxicity, then under RDP such extra costs are not covered. RDPs or therapeutic substitutions based on therapeutic equivalence are seen as logical extensions of generic substitution that is based on bioequivalence of drugs. If the goal is to achieve full drug coverage for as many patients as possible in the most efficient manner, then RDPs in combination with prior authorization programs are safer and more effective than simplistic fiscal drug policies, including fixed co-payments, co-insurances, or deductibles. RDPs will reduce spending in the less innovative but largest market, while fully covering all patients. Prior authorization will ensure that patients with a specified indication will benefit from the most innovative therapies with full coverage. In practice, however, not all patients and drugs will fit exactly into one of the two categories. Therefore, a process of medically indicated exemptions that will consider full coverage should accompany an RDP. In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs, and others are considering

Reference drug programs: Effectiveness and policy implications☆

PubMed Central

Schneeweiss, Sebastian

2010-01-01

In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs (RDPs) or similar therapeutic substitution programs. This paper summarizes the mechanism and rationale of RDPs and presents evidence of their economic effectiveness and clinical safety. RDPs for pharmaceutical reimbursement are based on the assumption that drugs within specified medication groups are therapeutically equivalent and clinically interchangeable and that a common reimbursement level can thus be established. If the evidence documents that a higher price for a given drug does not buy greater effectiveness or reduced toxicity, then under RDP such extra costs are not covered. RDPs or therapeutic substitutions based on therapeutic equivalence are seen as logical extensions of generic substitution that is based on bioequivalence of drugs. If the goal is to achieve full drug coverage for as many patients as possible in the most efficient manner, then RDPs in combination with prior authorization programs are safer and more effective than simplistic fiscal drug policies, including fixed co-payments, co-insurances, or deductibles. RDPs will reduce spending in the less innovative but largest market, while fully covering all patients. Prior authorization will ensure that patients with a specified indication will benefit from the most innovative therapies with full coverage. In practice, however, not all patients and drugs will fit exactly into one of the two categories. Therefore, a process of medically indicated exemptions that will consider full coverage should accompany an RDP. In the current economic environment, health care systems are constantly struggling to contain rapidly rising costs. Drug costs are targeted by a wide variety of measures. Many jurisdictions have implemented reference drug programs, and others are considering

Health Cost Containment, Wellness, and the 1990s.

ERIC Educational Resources Information Center

Stasica, Edward R.

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

[Consequences of the judicialization of health policies: the cost of medicines for mucopolysaccharidosis].

PubMed

Diniz, Debora; Medeiros, Marcelo; Schwartz, Ida Vanessa D

2012-03-01

This study analyzes expenditures backed by court rulings to ensure the public provision of medicines for treatment of mucopolysaccharidosis (MPS), a rare disease that requires high-cost drugs not covered by the Brazilian government's policy for pharmaceutical care and which have disputed clinical efficacy. The methodology included a review of files from 196 court rulings ordering the Brazilian Ministry of Health to provide the medicines, in addition to Ministry of Health administrative records. According to the analysis, the "judicialization" of the health system subjected the Brazilian government to a monopoly in the distribution of medicines and consequently the loss of its capacity to manage drug purchases. The study also indicates that the imposition of immediate, individualized purchases prevents obtaining economies of scale with planned procurement of larger amounts of the medication, besides causing logistic difficulties in controlling the amounts consumed and stored. In conclusion, litigation results from the lack of a clear policy in the health system for rare diseases in general, thereby leading to excessive expenditures for MPS treatment.

Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41)

PubMed Central

Gray, Alastair; Raikou, Maria; McGuire, Alistair; Fenn, Paul; Stevens, Richard; Cull, Carole; Stratton, Irene; Adler, Amanda; Holman, Rury; Turner, Robert

2000-01-01

Objective To estimate the cost effectiveness of conventional versus intensive blood glucose control in patients with type 2 diabetes. Design Incremental cost effectiveness analysis alongside randomised controlled trial. Setting 23 UK hospital clinic based study centres. Participants 3867 patients with newly diagnosed type 2 diabetes (mean age 53 years). Interventions Conventional (primarily diet) glucose control policy versus intensive control policy with a sulphonylurea or insulin. Main outcome measures Incremental cost per event-free year gained within the trial period. Results Intensive glucose control increased trial treatment costs by £695 (95% confidence interval £555 to £836) per patient but reduced the cost of complications by £957 (£233 to £1681) compared with conventional management. If standard practice visit patterns were assumed rather than trial conditions, the incremental cost of intensive management was £478 (−£275 to £1232) per patient. The within trial event-free time gained in the intensive group was 0.60 (0.12 to 1.10) years and the lifetime gain 1.14 (0.69 to 1.61) years. The incremental cost per event-free year gained was £1166 (costs and effects discounted at 6% a year) and £563 (costs discounted at 6% a year and effects not discounted). Conclusions Intensive blood glucose control in patients with type 2 diabetes significantly increased treatment costs but substantially reduced the cost of complications and increased the time free of complications. PMID:10818026

Costs of Juvenile Violence: Policy Implications.

ERIC Educational Resources Information Center

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

2001-01-01

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

Alcohol policy--evaluating the options.

PubMed

Maynard, A; Godfrey, C

1994-01-01

All policy interventions have costs and benefits and the 'harm' created by the use of alcohol can only be mitigated at a cost. The purpose of economic analysis is to measure these costs and benefits in an explicit way and to use these results to inform policy. Policy makers like to use estimates of the social costs of alcohol use but such data are of little use in identifying which interventions reduce harm at least cost: knowing alcohol use costs in local currencies $6 million in Australia, $5.8 billion in the USA, $5.7 billion in Canada and $2 billion in the UK may fuel political debate but does not identify the intervention where investment produces the greatest increase in benefit at least cost. Integrated policies to raise taxes in relation to price and income changes have significant impacts on alcohol consumption and, if complemented with advertising controls and limits on availability have even larger effects. The quantity and quality of economic evaluations of health care interventions is inadequate. What little evaluation that has been undertaken indicates that low cost minimal interventions may be cost effective for the wider population of problem drinkers. Other more intensive interventions are likely to be cost effective only if well targeted on appropriate client groups. There are many effective ways of reducing alcohol consumption. The industry will lose and oppose change but improvements in health and other aspects of life (eg civil order) will be significant.

48 CFR 9904.406 - Cost accounting standard-cost accounting period.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting standard-cost accounting period. 9904.406 Section 9904.406 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT...

Containment: Concept and Policy. Volume 1

DTIC Science & Technology

1986-01-01

Terry L. II. Gaddis, John Lewis. Ill. National De - fense University. IV. Foreign Service Institute (U.S.) E744.C7615 1986 327.73 86-23582 First printing...that a strategy of "containment" is supposed to de - fend? The very term containment suggests defense rather than offense, and that in turn implies some...Gcrman domination of Europe; after 1945 the same interest reqaired ensuring the de - fense of Western Europe and Japan against an ambitious but nervously

Cost containment and mechanical ventilation in the United States.

PubMed

Cohen, I L; Booth, F V

1994-08-01

In many ICUs, admission and discharge hinge on the need for intubation and ventilatory support. As few as 5% to 10% of ICU patients require prolonged mechanical ventilation, and this patient group consumes > or = 50% of ICU patient days and ICU resources. Prolonged ventilatory support and chronic ventilator dependency, both in the ICU and non-ICU settings, have a significant and growing impact on healthcare economics. In the United States, the need for prolonged mechanical ventilation is increasingly recognized as separate and distinct from the initial diagnosis and/or procedure that leads to hospitalization. This distinction has led to improved reimbursement under the prospective diagnosis-related group (DRG) system, and demands more precise accounting from healthcare providers responsible for these patients. Using both published and theoretical examples, mechanical ventilation in the United States is discussed, with a focus on cost containment. Included in the discussion are ventilator teams, standards of care, management protocols, stepdown units, rehabilitation units, and home care. The expanding role of total quality management (TQM) is also presented.

48 CFR 42.703-1 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Policy. 42.703-1 Section... CONTRACT ADMINISTRATION AND AUDIT SERVICES Indirect Cost Rates 42.703-1 Policy. (a) A single agency (see 42... indirect costs under cost-reimbursement contracts and in determining progress payments under fixed-price...

Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies.

PubMed

Acosta, Angela; Ciapponi, Agustín; Aaserud, Morten; Vietto, Valeria; Austvoll-Dahlgren, Astrid; Kösters, Jan Peter; Vacca, Claudia; Machado, Manuel; Diaz Ayala, Diana Hazbeydy; Oxman, Andrew D

2014-10-16

Pharmaceuticals are important interventions that could improve people's health. Pharmaceutical pricing and purchasing policies are used as cost-containment measures to determine or affect the prices that are paid for drugs. Internal reference pricing establishes a benchmark or reference price within a country which is the maximum level of reimbursement for a group of drugs. Other policies include price controls, maximum prices, index pricing, price negotiations and volume-based pricing. To determine the effects of pharmaceutical pricing and purchasing policies on health outcomes, healthcare utilisation, drug expenditures and drug use. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library (including the Effective Practice and Organisation of Care Group Register) (searched 22/10/2012); MEDLINE In-Process & Other Non-Indexed Citations and MEDLINE, Ovid (searched 22/10/2012); EconLit, ProQuest (searched 22/10/2012); PAIS International, ProQuest (searched 22/10/2012); World Wide Political Science Abstracts, ProQuest (searched 22/10/2012); INRUD Bibliography (searched 22/10/2012); Embase, Ovid (searched 14/12/2010); NHSEED, part of The Cochrane Library (searched 08/12/2010); LILACS, VHL (searched 14/12/2010); International Political Science Abstracts (IPSA), Ebsco (searched (17/12/2010); OpenSIGLE (searched 21/12/10); WHOLIS, WHO (searched 17/12/2010); World Bank (Documents and Reports) (searched 21/12/2010); Jolis (searched 09/10/2011); Global Jolis (searched 09/10/2011) ; OECD (searched 30/08/2005); OECD iLibrary (searched 30/08/2005); World Bank eLibrary (searched 21/12/2010); WHO - The Essential Drugs and Medicines web site (browsed 21/12/2010). Policies in this review were defined as laws; rules; financial and administrative orders made by governments, non-government organisations or private insurers. To be included a study had to include an objective measure of at least one of the following outcomes: drug use

48 CFR 48.102 - Policies.

Code of Federal Regulations, 2012 CFR

2012-10-01

... cost-effective value engineering procedures and processes. Agencies shall provide contractors a... services must require a mandatory value engineering program to reduce total ownership cost in accordance... VALUE ENGINEERING Policies and Procedures 48.102 Policies. (a) As required by Section 36 of the Office...

48 CFR 48.102 - Policies.

Code of Federal Regulations, 2013 CFR

2013-10-01

... cost-effective value engineering procedures and processes. Agencies shall provide contractors a... services must require a mandatory value engineering program to reduce total ownership cost in accordance... VALUE ENGINEERING Policies and Procedures 48.102 Policies. (a) As required by Section 36 of the Office...

Provider Behavior Under Global Budgeting and Policy Responses

PubMed Central

Chang, Chao-Kai; Xirasagar, Sudha; Chen, Brian; Hussey, James R.; Wang, I-Jong; Chen, Jen-Chieh; Lian, Ie-Bin

2015-01-01

Third-party payer systems are consistently associated with health care cost escalation. Taiwan’s single-payer, universal coverage National Health Insurance (NHI) adopted global budgeting (GB) to achieve cost control. This study captures ophthalmologists’ response to GB, specifically service volume changes and service substitution between low-revenue and high-revenue services following GB implementation, the subsequent Bureau of NHI policy response, and the policy impact. De-identified eye clinic claims data for the years 2000, 2005, and 2007 were analyzed to study the changes in Simple Claim Form (SCF) claims versus Special Case Claims (SCCs). The 3 study years represent the pre-GB period, post-GB but prior to region-wise service cap implementation period, and the post-service cap period, respectively. Repeated measures multilevel regression analysis was used to study the changes adjusting for clinic characteristics and competition within each health care market. SCF service volume (low-revenue, fixed-price patient visits) remained constant throughout the study period, but SCCs (covering services involving variable provider effort and resource use with flexibility for discretionary billing) increased in 2005 with no further change in 2007. The latter is attributable to a 30% cap negotiated by the NHI Bureau with the ophthalmology association and enforced by the association. This study demonstrates that GB deployed with ongoing monitoring and timely policy responses that are designed in collaboration with professional stakeholders can contain costs in a health insurance–financed health care system. PMID:26324511

77 FR 4807 - Revised Fee Policy for Acceptance of Foreign Research Reactor Spent Nuclear Fuel From High-Income...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-31

...This notice announces a change in the fee policy by the Department of Energy (DOE) for receipt and management of spent nuclear fuel (SNF) from foreign research reactors (FRR) containing uranium enriched in the U.S. in countries with high-income economies, as identified in the World Bank Development Report. The fee will increase in three phases (See Table 1) for all future SNF shipments (including Training, Research, Isotopes, General Atomics (TRIGA) from high-income economy countries. The first phase will take effect immediately and the fee will increase from no higher than $3,750 per kg total mass (not heavy metal mass) to $5,625 per kg total mass for SNF containing low enriched uranium (LEU). The second phase will be implemented automatically on January 1, 2014, and the fees will increase from $5,625 per kg total mass to $7,500 per kg total mass for shipments of SNF containing LEU and from no higher than $4,500 per kg total mass to $6,750 per kg total mass for SNF containing highly enriched uranium (HEU). The third phase will be implemented automatically on January 1, 2016, and the fee will increase from $6,750 per kg total mass to $9,000 per kg total mass for shipments of SNF containing HEU. DOE is also implementing a new minimum fee of $200,000 per shipment of any type and amount of eligible SNF to reflect a minimum cost of providing acceptance services. This minimum fee will take effect immediately. In the case where a reactor operator already has a signed and executed contract with DOE, DOE intends to negotiate an equitable adjustment to the fee in accordance with this revised fee policy. Under this revised fee policy, the fee for return of TRIGA fuel will be the same as that of aluminum based fuel. All other aspects of the fee policy are unaffected by this Notice. This is the first fee increase since the fee policy was established in 1996, and will help DOE offset a portion of the increase in operation costs of managing SNF. DOE will continue to pay the

The costs of 'free': Experiences of facility-based childbirth after Benin's caesarean section exemption policy.

PubMed

Lange, Isabelle L; Kanhonou, Lydie; Goufodji, Sourou; Ronsmans, Carine; Filippi, Véronique

2016-11-01

As one of many similar policies in the region, in 2009 Benin launched a free c-section policy in publicly funded hospitals intended to decrease the barriers to facility delivery and the heavy financial burdens on women and their families. We conducted a qualitative study for eight months between 2012 and 2014 to understand women's experiences of care in maternity wards. We carried out semi-structured interviews with 30 women who had delivered via c-section at five hospitals. Two of these hospitals became case study sites where in-depth research was undertaken that consisted of participant observation in each maternity ward and 32 further interviews with women who had complicated, vaginal and c-section deliveries. Overall, women continue to pay for care, both in the form of under-the-table payments to health workers and prescribed payments for services not covered by the policy, though they consider the costs reasonable compared to what the charges were before. Lifting the fees has facilitated conditions for midwives to alert doctors that the procedure might be needed. Partly because c-sections are still feared by most women, in one hospital this led to some women perceiving them as a threat if their labour was progressing more slowly. Implementation of the policy differed greatly between the two case study hospitals. We conclude that some burdens on women's access to care have been addressed but deterrents remain to the improved perception of quality of care on the part of women. Findings detail how important context is to the implementation of the policy, and suggest that similar user-fee removal policies should be accompanied by other measures addressing staff management and quality of care. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2015-01-01

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

Economics and National Security: Issues and Implications for U.S. Policy

DTIC Science & Technology

2011-01-04

reduction between 2012 and 2015 through cuts in discretionary spending, tax reform, health care cost containment, mandatory savings, Social ...economic policy: • market capitalism was superior to socialism (high standards of living, vibrant entrepreneurs, and innovation were nourished best by...federal budget and its deficit; on the ability of the economy to fund both national defense and social programs and on issues such as savings

Seniors' prescription drug cost inflation and cost containment: evidence from British Columbia.

PubMed

Morgan, Steven G; Agnew, Jonathan D; Barer, Morris L

2004-06-01

We develop an analytic framework to map out the nature and relative importance of different cost-driving trends in the prescription drug market. This is used to measure prescription drug cost-drivers for the population of seniors in British Columbia during a period when they received comprehensive public drug coverage. Between 1991 and 2001, expenditures on prescription drugs for BC seniors increased from dollar 149 to 320 million. Increases in the population of seniors, and the rate at which they utilized therapies contributed under half of the total cost increase over the period. Changes in the mix of therapies and the type of product selected explained over half of the observed drug expenditure inflation. Increased generic substitution significantly reduced the price of products selected over the period.

Generic medicines policies in the Asia Pacific region: ways forward.

PubMed

Nguyen, Tuan A; Hassali, Mohamed A A; McLachlan, Andrew

2013-01-01

Generic medicines are a key strategy used by governments and third-party payers to contain medicines costs and improve the access to essential medicines. This strategy represents an important opportunity provided by the global intellectual property regimes to discover and develop copies of original products marketed by innovator companies once the patent protection term is over. While there is an extensive experience regarding generic medicines policies in developed countries, this evidence may not translate to developing countries. The generic medicines policies workshop at the Asia Pacific Conference on National Medicines Policies 2012 provided an important opportunity to discuss and document country-specific initiatives for improving access to and the rational of use of generic medicines in the Asia Pacific region. Based on the identified barriers and enablers to implementation of generic medicines policies in the region, a set of future action plans and recommendations has been made.

Comments on Professor Alkin's Paper Entitled "Evaluating the Cost-Effectiveness of Instructional Programs."

ERIC Educational Resources Information Center

Bormuth, John

Evaluation of the ratio of cost to benefit of instruction must play an important part in the formation of a public policy on education. However, it is doubtful if evaluation is sufficiently developed to play such a role, because evaluation is based on student responses to test items which contain an indefinite bias and cannot be accepted as…

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

ERIC Educational Resources Information Center

Stringer, William L.; Cunningham, Alisa F.

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

An economic evaluation of salt reduction policies to reduce coronary heart disease in England: a policy modeling study.

PubMed

Collins, Marissa; Mason, Helen; O'Flaherty, Martin; Guzman-Castillo, Maria; Critchley, Julia; Capewell, Simon

2014-07-01

Dietary salt intake has been causally linked to high blood pressure and increased risk of cardiovascular events. Cardiovascular disease causes approximately 35% of total UK deaths, at an estimated annual cost of £30 billion. The World Health Organization and the National Institute for Health and Care Excellence have recommended a reduction in the intake of salt in people's diets. This study evaluated the cost-effectiveness of four population health policies to reduce dietary salt intake on an English population to prevent coronary heart disease (CHD). The validated IMPACT CHD model was used to quantify and compare four policies: 1) Change4Life health promotion campaign, 2) front-of-pack traffic light labeling to display salt content, 3) Food Standards Agency working with the food industry to reduce salt (voluntary), and 4) mandatory reformulation to reduce salt in processed foods. The effectiveness of these policies in reducing salt intake, and hence blood pressure, was determined by systematic literature review. The model calculated the reduction in mortality associated with each policy, quantified as life-years gained over 10 years. Policy costs were calculated using evidence from published sources. Health care costs for specific CHD patient groups were estimated. Costs were compared against a "do nothing" baseline. All policies resulted in a life-year gain over the baseline. Change4life and labeling each gained approximately 1960 life-years, voluntary reformulation 14,560 life-years, and mandatory reformulation 19,320 life-years. Each policy appeared cost saving, with mandatory reformulation offering the largest cost saving, more than £660 million. All policies to reduce dietary salt intake could gain life-years and reduce health care expenditure on coronary heart disease. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Prohibition, regulation or laissez faire: The policy trade-offs of cannabis policy.

PubMed

Rogeberg, Ole

2018-06-01

Trade-offs are central to the cannabis policy debate. Prohibition and strict regulation may help reduce the physical, mental and social harms of cannabis consumption, but at the cost of increasing the harms from illegal markets and reducing consumption benefits. An economic model clarifies how these costs and benefits relate to policy and connects them to observable prices and tax-levels given the assumptions of the analysis. These model- based arguments are related to the ongoing academic policy debate. While some arguments from this literature modify the interpretation of the model (e.g., due to dependence, cognitive biases and market structure), the literature often fails to appropriately account for the magnitude of the policy costs and benefits identified. Taking various caveats into account, the framework indicates that a strict regulation would likely be preferable to prohibition given current estimates of excess harms (externalities and internalities) from cannabis use. While cannabis prohibition appears difficult to justify within an economic regulatory framework, risks from industry influence, policy ratchet effects, and human "decision-making flaws" speak to the need for caution and strong regulation when implementing legal regimes. Copyright © 2018 The Author. Published by Elsevier B.V. All rights reserved.

Real-world Direct Health Care Costs for Metastatic Colorectal Cancer Patients Treated With Cetuximab or Bevacizumab-containing Regimens in First-line or First-line Through Second-line Therapy.

PubMed

Johnston, Stephen; Wilson, Kathleen; Varker, Helen; Malangone-Monaco, Elisabetta; Juneau, Paul; Riehle, Ellen; Satram-Hoang, Sacha; Sommer, Nicolas; Ogale, Sarika

2017-12-01

The present study examined real-world direct health care costs for metastatic colorectal cancer (mCRC) patients initiating first-line (1L) bevacizumab (BEV)- or cetuximab (CET)-containing regimen in 1L or 1L-through-second-line (1L-2L) therapy. Using a large US insurance claims database, patients with mCRC initiating 1L BEV- or 1L CET-containing regimen from January 1, 2008 to September 30, 2014 were identified. The per-patient per-month (PPPM) all-cause health care costs (2014 US dollars) were measured during 1L therapy and, for patients continuing to a 2L biologic-containing regimen, 1L-2L therapy. Multivariable regression analyses were used to compare PPPM total health care costs between patients initiating a 1L BEV- versus 1L CET-containing regimen. A total of 6095 patients initiating a 1L BEV- and 453 initiating a 1L CET-containing regimen were evaluated for 1L costs; 2218 patients initiating a 1L BEV- and 134 initiating a 1L CET-containing regimen were evaluated for 1L-2L costs. In 1L therapy, 1L CET had adjusted PPPM costs that were $3135 (95% confidence interval [CI], $1174-$5040; P < .001) greater on average than 1L BEV. In 1L-2L therapy, 1L BEV-2L CET had adjusted PPPM costs that were $1402 (95% CI, $1365-$1442; P = .010) greater than those for 1L BEV-2L BEV, and 1L CET-2L BEV had adjusted PPPM costs that were $4279 (95% CI, $4167-$4400; P = .001) greater on average than those for 1L BEV-2L BEV. The adjusted PPPM cost differences for 1L BEV-2L other biologic or 1L CET-2L other biologic agent were numerically greater but statistically insignificant. PPPM total health care costs for 1L and 2L therapy tended to be greater for patients treated with 1L CET-containing regimens than for 1L BEV-containing regimens. Also, continuing treatment with BEV-containing regimens 1L-2L was less costly than switching between BEV and CET. The cost differences between BEV and CET hold important implications for treatment decisions of mCRC patients in real-world clinical

48 CFR 48.102 - Policies.

Code of Federal Regulations, 2014 CFR

2014-10-01

... VALUE ENGINEERING Policies and Procedures 48.102 Policies. (a) As required by 41 U.S.C. 1711, agencies shall establish and maintain cost-effective value engineering procedures and processes. Agencies shall... cost in accordance with 48.101(b)(2). However, there must be no sharing of value engineering savings in...

Do Health Reforms Impact Cost Consciousness of Health Care Professionals? Results from a Nation-Wide Survey in the Balkans

PubMed Central

Jakovljevic, Mihajlo; Vukovic, Mira; Chen, Chia-Ching; Antunovic, Mirjana; Dragojevic-Simic, Viktorija; Velickovic-Radovanovic, Radmila; Djendji, Mladenovic Siladji; Jankovic, Nikola; Rankovic, Ana; Kovacevic, Aleksandra; Antunovic, Marko; Milovanovic, Olivera; Markovic, Veroljub; Dasari, Babu N.S.; Yamada, Tetsuji

2016-01-01

Background: Serbia, as the largest market of the Western Balkans, has entered socioeconomic transition with substantial delay compared to most of Eastern Europe. Its health system reform efforts were bold during the past 15 years, but their results were inconsistent in various areas. The two waves of global recession that hit Balkan economies ultimately reflected to the financial situation of healthcare. Serious difficulties in providing accessible medical care to the citizens became a reality. A large part of the unbearable expenses actually belongs to the overt prescription of pharmaceuticals and various laboratory and imaging diagnostic procedures requested by physicians. Therefore, a broad national survey was conducted at all levels of the healthcare system hierarchy to distinguish the ability of cost containment strategies to reshape clinician’s mindsets and decision-making in practice. Aims: Assessment of healthcare professionals’ judgment on economic consequences of prescribed medical interventions and evaluation of responsiveness of healthcare professionals to policy measures targeted at increasing cost-consciousness. Study Design: Cross-sectional study. Methods: A nationwide cross-sectional survey was conducted through a hierarchy of medical facilities across diverse geographical regions before and after policy action, from January 2010 to April 2013. In the middle of the observed period, the National Health Insurance Fund (RFZO) adopted severe cost-containment measures. Independently, pharmacoeconomic guidelines targeted at prescribers were disseminated. Administration in large hospitals and community pharmacies was forced to restrict access to high budget-impact medical care. Economic Awareness of Healthcare Professionals Questionnaire–29 (EAHPQ-29), developed in Serbian language, was used in face-to-face interviews. The questionnaire documented clinician’s attitudes on: Clinical-Decision-Making-between-Alternative-Interventions (CDMAI), Quality

STS pricing policy

NASA Technical Reports Server (NTRS)

Lee, C. M.; Stone, B.

1982-01-01

In 1977 NASA published Shuttle Reimbursement Policies for Civil U.S. Government, DOD and Commercial and Foreign Users. These policies were based on the principle of total cost recovery over a period of time with a fixed flat price for initial period to time to enhance transition. This fixed period was to be followed with annual adjustments thereafter, NASA is establishing a new price for 1986 and beyond. In order to recover costs, that price must be higher than the initial fixed price through FY 1985. NASA intends to remain competitive. Competitive posture includes not only price, but other factors such as assured launch, reliability, and unique services. NASA's pricing policy considers all these factors.

48 CFR 9904.401 - Cost accounting standard-consistency in estimating, accumulating and reporting costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.401 Cost... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting standard...

GME: at what cost?

PubMed

Young, David W

2003-11-01

Current computing methods impede determining the real cost of graduate medical education. However, a more accurate estimate could be obtained if policy makers would allow for the application of basic cost-accounting principles, including consideration of department-level costs, unbundling of joint costs, and other factors.

Social cost of carbon pricing of power sector CO2: accounting for leakage and other social implications from subnational policies

NASA Astrophysics Data System (ADS)

Bistline, John E.; Rose, Steven K.

2018-01-01

In environments where climate policy has partial coverage or unequal participation, carbon dioxide (CO2) emissions or economic activity may shift to locations and sectors where emissions are unregulated. This is referred to as leakage. Leakage can offset or augment emissions reductions associated with a policy, which has important environmental and economic implications. Although leakage has been studied at national levels, analysis of leakage for subnational policies is limited. This is despite greater market integration and many existing state and regional environmental regulations in the US. This study explores leakage potential, net emissions changes, and other social implications in the US energy system with regionally differentiated pricing of power sector CO2 emissions. We undertake an economic analysis using EPRI’s US-REGEN model, where power sector CO2 emissions are priced in individual US regions with a range of social cost of carbon (SCC) values. SCC estimates are being considered by policy-makers for valuing potential societal damages from CO2 emissions. In this study, we evaluate the emissions implications within the SCC pricing region, within the power sector outside the SCC region, and outside the power sector (i.e. in the rest of the energy system). Results indicate that CO2 leakage is possible within and outside the electric sector, ranging from negative 70% to over 80% in our scenarios, with primarily positive leakage outcomes. Typically ignored in policy analysis, leakage would affect CO2 reduction benefits. We also observe other potential societal effects within and across regions, such as higher electricity prices, changes in power sector investments, and overall consumption losses. Efforts to reduce leakage, such as constraining power imports into the SCC pricing region likely reduce leakage, but could also result in lower net emissions reductions, as well as larger price increases. Thus, it is important to look beyond leakage and consider a

[Costs and benefits of smoking].

PubMed

Polder, J J; van Gils, P F; Kok, L; Talhout, R; Feenstra, T L

2017-01-01

- Two recent societal cost-benefit analyses have documented the costs of smoking and the cost-effectiveness of preventing smoking.- Smoking costs the Netherlands society EUR 33 billion per year.- The majority of this is the monetary value of health loss; these are "soft" euros that cannot be re-spent.- There is not a great deal of difference between costs and benefits when expressed in "hard" euros, which means that there is no clear business case for anti-smoking policy.- The greatest benefit of discouraging smoking is improved health for the individual and increased productivity for the business sector; however, the benefits cannot be easily realised, because even in the most favourable scenario the number of smokers will decrease slowly.- Excise duties seem to offer the most promising avenue for combating smoking. The benefits of anti-smoking policy, therefore, consist mainly of tax revenues for the government.- Stringent policy is required to transform tax revenues into health gains.

Financing Child Care. A Public Policy Report from the Ewing Marion Kauffman Foundation. Winter 2002.

ERIC Educational Resources Information Center

Ewing Marion Kauffman Foundation, Kansas City, MO.

This public policy report focuses on financing child care in the United States. The report contains brief articles on the following topics: (1) child care wages in comparison to other positions; (2) benefits to businesses when employees have high-quality child care; (3) resources for funding early education systems; (4) comparison of the cost of…

Combustible cigarettes cost less to use than e-cigarettes: global evidence and tax policy implications.

PubMed

Liber, Alex C; Drope, Jeffrey M; Stoklosa, Michal

2017-03-01

Some scholars suggest that price differences between combustible cigarettes and e-cigarettes could be effective in moving current combustible smokers to e-cigarettes, which could reduce tobacco-related death and disease. Currently, in most jurisdictions, e-cigarettes are not subject to the same excise taxes as combustible cigarettes, potentially providing the category with a price advantage over combustible cigarettes. This paper tests whether e-cigarettes tax advantage has translated into a price advantage. In a sample of 45 countries, the price of combustible cigarettes, disposable e-cigarettes and rechargeable cigarettes were compared. Comparable units of combustible cigarettes cost less than disposable e-cigarettes in almost every country in the sample. While the e-liquids consumed in rechargeable e-cigarettes might cost less per comparable unit than combustible cigarettes, the initial cost to purchase a rechargeable e-cigarette presents a significant cost barrier to switching from smoking to vaping. Existing prices of e-cigarettes are generally much higher than of combustible cigarettes. If policymakers wish to tax e-cigarettes less than combustibles, forceful policy action-almost certainly through excise taxation-must raise the price of combustible cigarettes beyond the price of using e-cigarettes. 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/.

Replacement policy of residential lighting optimized for cost, energy, and greenhouse gas emissions

NASA Astrophysics Data System (ADS)

Liu, Lixi; Keoleian, Gregory A.; Saitou, Kazuhiro

2017-11-01

Accounting for 10% of the electricity consumption in the US, artificial lighting represents one of the easiest ways to cut household energy bills and greenhouse gas (GHG) emissions by upgrading to energy-efficient technologies such as compact fluorescent lamps (CFL) and light emitting diodes (LED). However, given the high initial cost and rapidly improving trajectory of solid-state lighting today, estimating the right time to switch over to LEDs from a cost, primary energy, and GHG emissions perspective is not a straightforward problem. This is an optimal replacement problem that depends on many determinants, including how often the lamp is used, the state of the initial lamp, and the trajectories of lighting technology and of electricity generation. In this paper, multiple replacement scenarios of a 60 watt-equivalent A19 lamp are analyzed and for each scenario, a few replacement policies are recommended. For example, at an average use of 3 hr day-1 (US average), it may be optimal both economically and energetically to delay the adoption of LEDs until 2020 with the use of CFLs, whereas purchasing LEDs today may be optimal in terms of GHG emissions. In contrast, incandescent and halogen lamps should be replaced immediately. Based on expected LED improvement, upgrading LED lamps before the end of their rated lifetime may provide cost and environmental savings over time by taking advantage of the higher energy efficiency of newer models.

Proposed Reliability/Cost Model

NASA Technical Reports Server (NTRS)

Delionback, L. M.

1982-01-01

New technique estimates cost of improvement in reliability for complex system. Model format/approach is dependent upon use of subsystem cost-estimating relationships (CER's) in devising cost-effective policy. Proposed methodology should have application in broad range of engineering management decisions.

Cost-effectiveness of cognitive-behavioural therapy for mental disorders: implications for public health care funding policy in Canada.

PubMed

Myhr, Gail; Payne, Krista

2006-09-01

Publicly funded cognitive-behavioural therapy (CBT) for mental disorders is scarce in Canada, despite proven efficacy and guidelines recommending its use. This paper reviews published data on the economic impact of CBT to inform recommendations for current Canadian mental health care funding policy. We searched the literature for economic analyses of CBT in the treatment of mental disorders. We identified 22 health economic studies involving CBT for mood, anxiety, psychotic, and somatoform disorders. Across health care settings and patient populations, CBT alone or in combination with pharmacotherapy represented acceptable value for health dollars spent, with CBT costs offset by reduced health care use. International evidence suggests CBT is cost-effective. Greater access to CBT would likely improve outcomes and result in cost savings. Future research is warranted to evaluate the economic impact of CBT in Canada.

The impact of cost recovery and sharing system on water policy implementation and human right to water: a case of Ileje, Tanzania.

PubMed

Kibassa, Deusdedit

2011-01-01

In Tanzania, the National Water Policy (NAWAPO) of 2002 clearly stipulates that access to water supply and sanitation is a right for every Tanzanian and that cost recovery is the foundation of sustainable service delivery. To meet these demands, water authorities have introduced cost recovery and a water sharing system. The overall objective of this study was to assess the impact of cost recovery and the sharing system on water policy implementation and human rights to water in four villages in the Ileje district. The specific objectives were: (1) to assess the impact of cost recovery and the sharing system on the availability of water to the poor, (2) to assess user willingness to pay for the services provided, (3) to assess community understanding on the issue of water as a human right, (4) to analyse the implications of the results in relation to policies on human rights to water and the effectiveness of the implementation of the national water policy at the grassroots, and (5) to establish the guidelines for water pricing in rural areas. Questionnaires at water demand, water supply, ability and willingness to pay and revenue collection were the basis for data collection. While 36.7% of the population in the district had water supply coverage, more than 73,077 people of the total population of 115,996 still lacked access to clean and safe water and sanitation services in the Ileje district. The country's rural water supply coverage is 49%. Seventy-nine percent of the interviewees in all four villages said that water availability in litres per household per day had decreased mainly due to high water pricing which did not consider the income of villagers. On the other hand, more than 85% of the villagers were not satisfied with the amount they were paying because the services were still poor. On the issue of human rights to water, more than 92% of the villagers know about their right to water and want it exercised by the government. In all four villages, more than

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leonardo Trasande; Clyde Schechter; Karla A. Haynes

2006-09-15

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

Policy interactions and underperforming emission trading markets in China.

PubMed

Zhang, Bing; Zhang, Hui; Liu, Beibei; Bi, Jun

2013-07-02

Emission trading is considered to be cost-effective environmental economic instrument for pollution control. However, the ex post analysis of emission trading program found that cost savings have been smaller and the trades fewer than might have been expected at the outset of the program. Besides policy design issues, pre-existing environmental regulations were considered to have a significant impact on the performance of the emission trading market in China. Taking the Jiangsu sulfur dioxide (SO2) market as a case study, this research examined the impact of policy interactions on the performance of the emission trading market. The results showed that cost savings associated with the Jiangsu SO2 emission trading market in the absence of any policy interactions were CNY 549 million or 12.5% of total pollution control costs. However, policy interactions generally had significant impacts on the emission trading system; the lone exception was current pollution levy system. When the model accounted for all four kinds of policy interactions, the total pollution control cost savings from the emission trading market fell to CNY 39.7 million or 1.36% of total pollution control costs. The impact of policy interactions would reduce 92.8% of cost savings brought by emission trading program.

48 CFR 9904.420 - Accounting for independent research and development costs and bid and proposal costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.420 Accounting for independent research and development costs and bid and proposal costs. ...

Commercial Insurance vs Community-Based Health Plans: Time for a Policy Option With Clinical Emphasis to Address the Cost Spiral

ERIC Educational Resources Information Center

Amundson, Bruce

2005-01-01

The nation continues its ceaseless struggle with the spiraling cost of health care. Previous efforts (regulation, competition, voluntary action) have included almost every strategy except clinical. Insurers have largely failed in their cost-containment efforts. There is a strong emerging body of literature that demonstrates the relationship…

School Capital Policies, Regulations and Guidelines.

ERIC Educational Resources Information Center

Alberta Dept. of Education, Edmonton. Finance and Administration Div.

This document is a compendium of the policies, regulations, and guidelines that govern provincial school capital funding in Alberta. The compendium supplements the general framework of policies, guidelines, and procedures contained in the earlier Management and Finance Plan (MFP). Each section of the compendium contains a set of policies,…

Rigorous Program Evaluations on a Budget: How Low-Cost Randomized Controlled Trials Are Possible in Many Areas of Social Policy

ERIC Educational Resources Information Center

Coalition for Evidence-Based Policy, 2012

2012-01-01

The increasing ability of social policy researchers to conduct randomized controlled trials (RCTs) at low cost could revolutionize the field of performance-based government. RCTs are widely judged to be the most credible method of evaluating whether a social program is effective, overcoming the demonstrated inability of other, more common methods…

Assessment and Educational Policy.

ERIC Educational Resources Information Center

Smith, Virginia B.

1975-01-01

Because of increased access of postsecondary education in the 1950's and 1960's, higher education cost analysis gained importance. Attempts have been made to develop a standard unit cost, but it is hard to see unit cost accounting by itself as a valuable tool for public accountability or policy making. For these purposes a cost-effectiveness ratio…

The High Cost of Teacher Turnover. Policy Brief

ERIC Educational Resources Information Center

National Commission on Teaching and America's Future, 2007

2007-01-01

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

48 CFR 9904.411 - Cost accounting standard-accounting for acquisition costs of material.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting standard-accounting for acquisition costs of material. 9904.411 Section 9904.411 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND...

Life cycle costing with a discount rate

NASA Technical Reports Server (NTRS)

Posner, E. C.

1978-01-01

This article studies life cycle costing for a capability needed for the indefinite future, and specifically investigates the dependence of optimal policies on the discount rate chosen. The two costs considered are reprocurement cost and maintenance and operations (M and O) cost. The procurement price is assumed known, and the M and O costs are assumed to be a known function, in fact, a non-decreasing function, of the time since last reprocurement. The problem is to choose the optimum reprocurement time so as to minimize the quotient of the total cost over a reprocurement period divided by the period. Or one could assume a discount rate and try to minimize the total discounted costs into the indefinite future. It is shown that the optimum policy in the presence of a small discount rate hardly depends on the discount rate at all, and leads to essentially the same policy as in the case in which discounting is not considered.

48 CFR 9905.501 - Cost accounting standard-consistency in estimating, accumulating and reporting costs by...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting standard....501 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST...

Doses per vaccine vial container: An understated and underestimated driver of performance that needs more evidence.

PubMed

Heaton, Alexis; Krudwig, Kirstin; Lorenson, Tina; Burgess, Craig; Cunningham, Andrew; Steinglass, Robert

2017-04-19

The widespread use of multidose vaccine containers in low and middle income countries' immunization programs is assumed to have multiple benefits and efficiencies for health systems, yet the broader impacts on immunization coverage, costs, and safety are not well understood. To document what is known on this topic, how it has been studied, and confirm the gaps in evidence that allow us to assess the complex system interactions, the authors undertook a review of published literature that explored the relationship between doses per container and immunization systems. The relationships examined in this study are organized within a systems framework consisting of operational costs, timely coverage, safety, product costs/wastage, and policy/correct use, with the idea that a change in dose per container affects all of them, and the optimal solution will depend on what is prioritized and used to measure performance. Studies on this topic are limited and largely rely on modeling to assess the relationship between doses per container and other aspects of immunization systems. Very few studies attempt to look at how a change in doses per container affects vaccination coverage rates and other systems components simultaneously. This article summarizes the published knowledge on this topic to date and suggests areas of current and future research to ultimately improve decision making around vaccine doses per container and increase understanding of how this decision relates to other program goals. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

48 CFR 9904.402 - Cost accounting standard-consistency in allocating costs incurred for the same purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.402 Cost... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting standard...

The cost of alcohol in the workplace in Belgium.

PubMed

Tecco, Juan; Jacques, Denis; Annemans, Lieven

2013-09-01

It has been suggested that alcohol problems have a major impact in the workplace. It has long been recognized that misuse can have serious consequences for the productivity of workers. The extent of the problem is still an uncalculated cost. Few studies provide clear evidence of a cause, effect or relationship between substance abuse and workplace costs and valuable guidance to employers in evaluating the cost of substance abuse in their workplaces is missing. To estimate the awareness, policies and cost to employers of drinking in the workplace in Belgium and to illustrate the potential gains from drinking cessation provision. Costs vary with type of industry and policy in place; therefore, to estimate these costs, results from a survey were combined with evidence drawn from a review of literature. An Internet survey of 216 workplaces in Belgium, based on a stratified random sample of workplaces with 50 or more employees, was conducted in 2005. Further information was collected from 150 occupational physicians. Additional evidence was compiled from a review of the literature of drinking-related costs. 216 General Directors or HR Directors completed a questionnaire related to awareness, policy and costs. 150 occupational physicians completed a questionnaire related to awareness and policy. Companies are unaware or underestimate alcohol misuse among their employees. At least 84% of companies have no education or information policy about substance abuse. Absenteeism, accidents and turnover account for 0.87% of the wage bill. Reduced productivity/ (presenteeism accounts for 2.8%. The construction industry, postal services, hospitality industry (hotel/restaurants and catering) and sanitation industry (collection, street cleaning) are the most problematic sectors. Awareness: many companies are totally unaware of the impact of substance abuse and those that are aware underestimate the problem. Sectors are heterogeneous; some are more problematic than others. Policy

Benefits and costs of oil palm expansion in Central Kalimantan, Indonesia, under different policy scenarios.

PubMed

Sumarga, Elham; Hein, Lars

Deforestation and oil palm expansion in Central Kalimantan province are among the highest in Indonesia. This study examines the physical and monetary impacts of oil palm expansion in Central Kalimantan up to 2025 under three policy scenarios. Our modelling approach combines a spatial logistic regression model with a set of rules governing land use change as a function of the policy scenario. Our physical and monetary analyses include palm oil expansion and five other ecosystem services: timber, rattan, paddy rice, carbon sequestration, and orangutan habitat (the last service is analysed in physical units only). In monetary terms, our analysis comprises the contribution of land and ecosystems to economic production, as measured according to the valuation approach of the System of National Accounts. We focus our analysis on government-owned land which covers around 97 % of the province, where the main policy issues are. We show that, in the business-as-usual scenario, the societal costs of carbon emissions and the loss of other ecosystem services far exceed the benefits from increased oil palm production. This is, in particular, related to the conversion of peatlands. We also show that, for Central Kalimantan, the moratorium scenario, which is modelled based on the moratorium currently in place in Indonesia, generates important economic benefits compared to the business-as-usual scenario. In the moratorium scenario, however, there is still conversion of forest to plantation and associated loss of ecosystem services. We developed an alternative, sustainable production scenario based on an ecosystem services approach and show that this policy scenario leads to higher net social benefits including some more space for oil palm expansion.

Avoidable cost of alcohol abuse in Canada.

PubMed

Rehm, Jürgen; Patra, Jayadeep; Gnam, William H; Sarnocinska-Hart, Anna; Popova, Svetlana

2011-01-01

To estimate avoidable burden and avoidable costs of alcohol abuse in Canada for the year 2002. A policy effectiveness approach was used. The impact of six effective and cost-effective alcohol policy interventions aimed to reduce alcohol consumption was modeled. In addition, the effect of privatized alcohol sales that would increase alcohol consumption and alcohol-attributable costs was also modeled. The effects of these interventions were compared with the baseline (aggregate) costs obtained from the second Canadian Study of Social Costs Attributable to Substance Abuse. It was estimated that by implementing six cost-effective policies from about 900 million to two billion Canadian dollars per year could be saved in Canada. The greatest savings due to the implementation of these interventions would be achieved in the lowering of productivity losses, followed by health care, and criminality. Substantial increases in burden and cost would occur if Canadian provinces were to privatize alcohol sales. The implementation of proven effective population-based interventions would reduce alcohol-attributable burden and its costs in Canada to a considerable degree. Copyright © 2010 S. Karger AG, Basel.

The Costs and Consequences of Excess Credit Hours Policies

ERIC Educational Resources Information Center

Kramer, Dennis A., II; Holcomb, Michael R.; Kelchen, Robert

2018-01-01

The growth of the public discourse on college completion and student debt has pushed policymakers and institutional leaders to implement a variety of policies aimed at incentivizing student completion. This article examines state-adopted excess credit hour (ECH) policies on student completion and median debt outcomes. Using a quasi-experimental…

Climate targets and cost-effective climate stabilization pathways

NASA Astrophysics Data System (ADS)

Held, H.

2015-08-01

Climate economics has developed two main tools to derive an economically adequate response to the climate problem. Cost benefit analysis weighs in any available information on mitigation costs and benefits and thereby derives an "optimal" global mean temperature. Quite the contrary, cost effectiveness analysis allows deriving costs of potential policy targets and the corresponding cost- minimizing investment paths. The article highlights pros and cons of both approaches and then focusses on the implications of a policy that strives at limiting global warming to 2 °C compared to pre-industrial values. The related mitigation costs and changes in the energy sector are summarized according to the IPCC report of 2014. The article then points to conceptual difficulties when internalizing uncertainty in these types of analyses and suggests pragmatic solutions. Key statements on mitigation economics remain valid under uncertainty when being given the adequate interpretation. Furthermore, the expected economic value of perfect climate information is found to be on the order of hundreds of billions of Euro per year if a 2°-policy were requested. Finally, the prospects of climate policy are sketched.

"Should I Buy or Should I Grow?" How drug policy institutions and drug market transaction costs shape the decision to self-supply with cannabis in the Netherlands and the Czech Republic.

PubMed

Belackova, Vendula; Maalsté, Nicole; Zabransky, Tomas; Grund, Jean Paul

2015-03-01

This paper uses the framework of institutional economics to assess the impact of formal and informal institutions that influence the transaction costs on the cannabis market, and users' decisions to self-supply in the Czech Republic and the Netherlands, two countries with seemingly identical policies towards cannabis cultivation. A comparative analysis was conducted using secondary qualitative and quantitative data in four areas that were identified as relevant to the decision to cultivate cannabis: (i) the rules of the game - cannabis cultivation policy; (ii) "playing the game" - implementation of cannabis cultivation policy, (iii) informal institutions - cannabis cultivation culture, and (iv) the transaction costs of the cannabis market - availability, quality, and relative cannabis prices adjusted by purchasing power parity. Although the two policies are similar, their implementation differs substantially. In the Czech Republic, law enforcement has focused almost exclusively on large-scale cultivation. This has resulted in a competitive small-scale cultivation market, built upon a history of cannabis self-supply, which is pushing cannabis prices down. In the Netherlands, the costs of establishing one's own self-supply have historically outweighed the costs associated with buying in coffee shops. Additionally, law enforcement has recently pushed small-scale growers away from the market, and a large-scale cannabis supply, partly controlled by organised criminal groups, has been established that is driving prices up. The Czech cannabis prices have become relatively lower than the Dutch prices only recently, and the decision to buy on the market or to self-supply will be further shaped by the transactions costs on both markets, by policy implementation and by the local culture. The ability to learn from the impacts of cannabis cultivation policies conducted within the framework of UN drug treaties is particularly important at a time when increasing numbers of

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

NASA Astrophysics Data System (ADS)

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

2014-12-01

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

The Shuttle Cost and Price model

NASA Technical Reports Server (NTRS)

Leary, Katherine; Stone, Barbara

1983-01-01

The Shuttle Cost and Price (SCP) model was developed as a tool to assist in evaluating major aspects of Shuttle operations that have direct and indirect economic consequences. It incorporates the major aspects of NASA Pricing Policy and corresponds to the NASA definition of STS operating costs. An overview of the SCP model is presented and the cost model portion of SCP is described in detail. Selected recent applications of the SCP model to NASA Pricing Policy issues are presented.

Cost justification of filmless PACS and national policy

NASA Astrophysics Data System (ADS)

Lim, Jae H.

2002-05-01

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

Should the provision of home help services be contained?: Validation of the new preventive care policy in Japan

PubMed Central

2010-01-01

Background To maintain the sustainability of public long-term care insurance (LTCI) in Japan, a preventive care policy was introduced in 2006 that seeks to promote active improvement in functional status of elderly people who need only light care. This policy promotes the use of day care services to facilitate functional improvement, and contains the use of home help services that provide instrumental activity of daily living (IADL) support. However, the validity of this approach remains to be demonstrated. Methods Subjects comprised 241 people aged 65 years and over who had recently been certified as being eligible for the lightest eligibility level and had began using either home help or day care services between April 2007 and October 2008 in a suburban city of Tokyo. A retrospective cohort study was conducted ending October 2009 to assess changes in the LTCI eligibility level of these subjects. Cox's proportional hazards model was used to calculate the relative risk of declining in function to eligibility Level 4 among users of the respective services. Results Multivariate analysis adjusted for factors related to service use demonstrated that the risk of decline in functional status was lower for users of home help services than for users of day care services (HR = 0.55, 95% CI: 0.31-0.98). The same result was obtained when stratified by whether the subject lived with family or not. Furthermore, those who used two or more hours of home help services did not show an increase in risk of decline when compared with those who used less than two hours. Conclusions No evidence was obtained to support the effectiveness of the policy of promoting day care services and containing home help services for those requiring light care. PMID:20678189

23 CFR 626.3 - Policy.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 23 Highways 1 2013-04-01 2013-04-01 false Policy. 626.3 Section 626.3 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS PAVEMENT POLICY § 626.3 Policy. Pavement shall be designed to accommodate current and predicted traffic needs in a safe, durable, and cost...

23 CFR 626.3 - Policy.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 23 Highways 1 2012-04-01 2012-04-01 false Policy. 626.3 Section 626.3 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS PAVEMENT POLICY § 626.3 Policy. Pavement shall be designed to accommodate current and predicted traffic needs in a safe, durable, and cost...

23 CFR 626.3 - Policy.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 23 Highways 1 2014-04-01 2014-04-01 false Policy. 626.3 Section 626.3 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS PAVEMENT POLICY § 626.3 Policy. Pavement shall be designed to accommodate current and predicted traffic needs in a safe, durable, and cost...

23 CFR 626.3 - Policy.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Policy. 626.3 Section 626.3 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS PAVEMENT POLICY § 626.3 Policy. Pavement shall be designed to accommodate current and predicted traffic needs in a safe, durable, and cost...

23 CFR 626.3 - Policy.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false Policy. 626.3 Section 626.3 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION ENGINEERING AND TRAFFIC OPERATIONS PAVEMENT POLICY § 626.3 Policy. Pavement shall be designed to accommodate current and predicted traffic needs in a safe, durable, and cost...

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

PubMed

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

2013-01-01

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

Reducing costs while maintaining quality in endovascular neurosurgical procedures.

PubMed

Kashlan, Osama N; Wilson, Thomas J; Chaudhary, Neeraj; Gemmete, Joseph J; Stetler, William R; Dunnick, N Reed; Thompson, B Gregory; Pandey, Aditya S

2014-11-01

As medical costs continue to rise during a time of increasing medical resource utilization, both hospitals and physicians must attempt to limit superfluous health care expenses. Neurointerventional treatment has been shown to be costly, but it is often the best treatment available for certain neuropathologies. The authors studied the effects of 3 policy changes designed to limit the costs of performing neurointerventional procedures at the University of Michigan. The authors retrospectively analyzed the costs of performing neurointerventional procedures during the 6-month periods before and after the implementation of 3 cost-saving policies: 1) the use of an alternative, more economical contrast agent, 2) standardization of coil prices through negotiation with industry representatives to receive economies of scale, and 3) institution of a feedback method to show practitioners the costs of unused products per patient procedure. The costs during the 6-month time intervals before and after implementation were also compared with costs during the most recent 6-month time period. The policy requiring use of a more economical contrast agent led to a decrease in the cost of contrast usage of $42.79 per procedure for the first 6 months after implementation, and $137.09 per procedure for the most current 6-month period, resulting in an estimated total savings of $62,924.31 for the most recent 6-month period. The standardized coil pricing system led to savings of $159.21 per coil after the policy change, and $188.07 per coil in the most recent 6-month period. This yielded total estimated savings of $76,732.56 during the most recent 6-month period. The feedback system for unused items decreased the cost of wasted products by approximately $44.36 per procedure in the 6 months directly after the policy change and by $48.20 per procedure in the most recent 6-month period, leading to total estimated savings of $22,123.80 during the most recent 6-month period. According to

The Costs of Online Learning. Creating Sound Policy for Digital Learning: A Working Paper Series from the Thomas B. Fordham Institute

ERIC Educational Resources Information Center

Battaglino, Tamara Butler; Haldeman, Matt; Laurans, Eleanor

2012-01-01

The latest installment of the Fordham Institute's "Creating Sound Policy for Digital Learning" series investigates one of the more controversial aspects of digital learning: How much does it cost? In this paper, the Parthenon Group uses interviews with more than fifty vendors and online-schooling experts to estimate today's average…

Real-world cost-effectiveness of pharmacogenetic screening for epilepsy treatment.

PubMed

Chen, Zhibin; Liew, Danny; Kwan, Patrick

2016-03-22

To assess the cost-effectiveness of the HLA-B*15:02 screening policy for the treatment of epilepsy in Hong Kong. From all public hospitals and clinics in Hong Kong, 13,231 patients with epilepsy who started their first antiepileptic drug (AED) between September 16, 2005, and September 15, 2011 (3 years before and 3 years after policy implementation on September 16, 2015), were identified retrospectively. A decision tree model was constructed to incorporate the real-world data on AED prescription patterns, incidences of AED-induced Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), costs of AED treatments, SJS/TEN treatment, and HLA-B*15:02 testing, and quality of life. Cost-effectiveness of the screening policy was analyzed for 3 scenarios: (1) current real-world situation, (2) "ideal" situation assuming full policy adherence and preferable testing practices, and (3) "extended" situation simulating the extension of HLA-B*15:02 screening to phenytoin in ideal practice. The current screening policy was associated with an incremental cost-effectiveness ratio of US $85,697 per quality-adjusted life year (QALY) compared with no screening. The incremental cost-effectiveness ratio was estimated to be US $11,090/QALY in the ideal situation and US $197,158/QALY in the extended situation. The HLA-B*15:02 screening policy, as currently practiced, is not cost-effective. Its cost-effectiveness may be improved by enhancing policy adherence and by low-cost point-of-care genotyping. Extending the screening to phenytoin would not be cost-effective because of the low incidence of phenytoin-SJS/TEN among HLA-B*15:02 carriers. © 2016 American Academy of Neurology.

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

PubMed

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

2010-01-01

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

Predictable Unpredictability: the Problem with Basing Medicare Policy on Long-Term Financial Forecasting.

PubMed

Glied, Sherry; Zaylor, Abigail

2015-07-01

The authors assess how Medicare financing and projections of future costs have changed since 2000. They also assess the impact of legislative reforms on the sources and levels of financing and compare cost forecasts made at different times. Although the aging U.S. population and rising health care costs are expected to increase the share of gross domestic product devoted to Medicare, changes made in the program over the past decade have helped stabilize Medicare's financial outlook--even as benefits have been expanded. Long-term forecasting uncertainty should make policymakers and beneficiaries wary of dramatic changes to the program in the near term that are intended to alter its long-term forecast: the range of error associated with cost forecasts rises as the forecast window lengthens. Instead, policymakers should focus on the immediate policy window, taking steps to reduce the current burden of Medicare costs by containing spending today.

Evaluation of commercial boric acid containing vials for urine culture: low risk of contamination and cost effectiveness considerations.

PubMed

Appannanavar, Suma B; Biswal, Manisha; Rajkumari, Nonika; Mohan, Balvinder; Taneja, Neelam

2013-01-01

Urine culture is a gold standard in the diagnosis of urinary tract infection. Clean catch midstream urine collection and prompt transportation is essential for appropriate diagnosis. Improper collection and delay in transportation leads to diagnostic dilemma. In developing countries, higher ambient temperatures further complicate the scenario. Here, we have evaluated the role of boric acid as a preservative for urine samples prior to culture in female patients attending outpatient department at our center. Consecutive 104 urine samples were cultured simultaneously in plain uricol (Control-C) and boric acid containing tubes from Becton Dickinson urine culture kit (Boric acid group-BA). In the real-time evaluation, we found that in almost 57% (59/104) of the urine samples tested, it was more effective in maintaining the number of the organisms as compared to samples in the container without any preservative. Our in vitro study of simulated urine cultures revealed that urine samples could be kept up to 12 h before culture in the preservative without any inhibitory effect of boric acid. Though the use of boric acid kit may marginally increase the initial cost but has indirect effects like preventing delays in treatment and avoidance of false prescription of antibiotics. If the man-hours spent on repeat investigations are also taken into consideration, then the economic cost borne by the laboratory would also decrease manifold with the use of these containers.

Computed tomography imaging in the management of headache in the emergency department: cost efficacy and policy implications.

PubMed

Jordan, Yusef J; Lightfoote, Johnson B; Jordan, John E

2009-04-01

To evaluate the economic impact and diagnostic utility of computed tomography (CT) in the management of emergency department (ED) patients presenting with headache and nonfocal physical examinations. Computerized medical records from 2 major community hospitals were retrospectively reviewed of patients presenting with headache over a 2.5-year period (2003-2006). A model was developed to assess test outcomes, CT result costs, and average institutional costs of the ED visit. The binomial probabilistic distribution of expected maximum cases was also calculated. Of the 5510 patient records queried, 882 (16%) met the above criteria. Two hundred eighty-one patients demonstrated positive CT findings (31.8%), but only 9 (1.02%) demonstrated clinically significant results (requiring a change in management). Most positive studies were incidental, including old infarcts, chronic ischemic changes, encephalomalacia, and sinusitis. The average cost of the head CT exam and ED visit was $764 (2006 dollars). This was approximately 3 times the cost of a routine outpatient visit (plus CT) for headache ($253). The incremental cost per clinically significant case detected in the ED was $50078. The calculated expected maximum number of clinically significant positive cases was almost 50% lower than what was actually detected. Our results indicate that emergent CT imaging of nonfocal headache yields a low percentage of positive clinically significant results, and has limited cost efficacy. Since the use of CT for imaging patients with headache in the ED is widespread, the economic implications are considerable. Health policy reforms are indicated to better direct utilization in these patients.

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

PubMed

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

2006-09-01

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

Views of US physicians about controlling health care costs.

PubMed

Tilburt, Jon C; Wynia, Matthew K; Sheeler, Robert D; Thorsteinsdottir, Bjorg; James, Katherine M; Egginton, Jason S; Liebow, Mark; Hurst, Samia; Danis, Marion; Goold, Susan Dorr

2013-07-24

Physicians' views about health care costs are germane to pending policy reforms. To assess physicians' attitudes toward and perceived role in addressing health care costs. A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile. Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale. A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a "major responsibility" for reducing health care costs, whereas only 36% reported that practicing physicians have "major responsibility." Most were "very enthusiastic" for "promoting continuity of care" (75%), "expanding access to quality and safety data" (51%), and "limiting access to expensive treatments with little net benefit" (51%) as a means of reducing health care costs. Few expressed enthusiasm for "eliminating fee-for-service payment models" (7%). Most physicians reported being "aware of the costs of the tests/treatments [they] recommend" (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they "should be solely devoted to individual patients' best interests, even if that is expensive" (78%) and that "doctors need to take a more prominent role in limiting use of unnecessary tests" (89%). Most (85%) disagreed that they "should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more." In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for "eliminating fee for service" (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1

Analyzing Screening Policies for Childhood Obesity

PubMed Central

Yang, Yan; Goldhaber-Fiebert, Jeremy D.; Wein, Lawrence M.

2013-01-01

Due to the health and economic costs of childhood obesity, coupled with studies suggesting the benefits of comprehensive (dietary, physical activity and behavioral counseling) intervention, the United States Preventive Services Task Force recently recommended childhood screening and intervention for obesity beginning at age six. Using a longitudinal data set consisting of the body mass index of 3164 children up to age 18 and another longitudinal data set containing the body mass index at ages 18 and 40 and the presence or absence of disease (hypertension and diabetes) at age 40 for 747 people, we formulate and numerically solve – separately for boys and girls – a dynamic programming problem for the optimal biennial (i.e., at ages 2, 4, …, 16) obesity screening thresholds. Unlike most screening problem formulations, we take a societal viewpoint, where the state of the system at each age is the population-wide probability density function of the body mass index. Compared to the biennial version of the task force’s recommendation, the screening thresholds derived from the dynamic program achieve a relative reduction in disease prevalence of 3% at the same screening (and treatment) cost, or – due to the flatness of the disease vs. screening tradeoff curve – achieves the same disease prevalence at a 28% relative reduction in cost. Compared to the task force’s policy, which uses the 95th percentile of body mass index (from cross-sectional growth charts tabulated by the Centers for Disease Control and Prevention) as the screening threshold for each age, the dynamic programming policy treats mostly 16 year olds (including many who are not obese) and very few males under 14 years old. While our results suggest that adult hypertension and diabetes are minimized by focusing childhood obesity screening and treatment on older adolescents, the shortcomings in the available data and the narrowness of the medical outcomes considered prevent us from making a

Railroad cost conditions : implications for policy

DOT National Transportation Integrated Search

2000-05-10

This report, which is posted on the FRA homepage, includes a simplified framework for examining the welfare implications of railroad mergers and competition. It examines the cost implications of mergers and competition over existing rail lines by tes...

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

PubMed

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

1998-09-01

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

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

ERIC Educational Resources Information Center

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

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

48 CFR 9905.502 - Cost accounting standard-consistency in allocating costs incurred for the same purpose by...

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting standard... 9905.502 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST...

Cost Containment Study, Maryland Community Colleges: A Report to the Senate Budget and Taxation Committee and House Appropriations Committee.

ERIC Educational Resources Information Center

Maryland State Board for Community Colleges, Annapolis.

In response to legislative mandate, this report reviews the management initiatives taken by community colleges in Maryland over the last several years to contain and reduce costs; investigates the potential for the regionalization of Maryland's community colleges; and determines new initiatives that should be considered by individual colleges in…

7 CFR 1709.2 Policy. - [Reserved

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false [Reserved] 1709.2 Policy. Section 1709.2 Policy. Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ASSISTANCE TO HIGH ENERGY COST COMMUNITIES General Requirements § 1709.2 Policy. [Reserved] ...

7 CFR 1709.2 Policy. - [Reserved

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 11 2011-01-01 2011-01-01 false [Reserved] 1709.2 Policy. Section 1709.2 Policy. Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ASSISTANCE TO HIGH ENERGY COST COMMUNITIES General Requirements § 1709.2 Policy. [Reserved] ...

7 CFR 1709.2 Policy. - [Reserved

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 11 2012-01-01 2012-01-01 false [Reserved] 1709.2 Policy. Section 1709.2 Policy. Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ASSISTANCE TO HIGH ENERGY COST COMMUNITIES General Requirements § 1709.2 Policy. [Reserved] ...

Adaptive salinity management in the Murray-Darling Basin: a transaction cost study

NASA Astrophysics Data System (ADS)

Loch, A. J.

2017-12-01

Transaction costs hinder or promote effective management of common good resource intertemporal externalities. Appropriate policy choices may reduce externalities and improve social welfare, and transaction cost analysis can help to evaluate policy choices. However, without measurement of relevant transaction costs such policy evaluation remains challenging. This article uses a time series dataset of salinity management program to test theory aimed at transaction cost-based policy evaluation and adaptive resource management over a period of 30 years worth of data. We identify peaks and troughs in transaction costs over time, lag-effects in program expenditure, and calculate the decay in transaction cost impacts. We conclude that Australian salinity management programs are achieving flexible institutional outcomes and effective policy arrangements with long-term benefits. Proposed changes to the program moving forward add weight to our assertions of adaptive strategies, and illustrate the value of the novel data-driven tracnsaction cost analysis approach for other jurisdictions.

Group Policy Reference Systems and Network Attack Center (SNAC)

DTIC Science & Technology

2001-03-02

Policy Snap-in for a given Active Directory container . It is hoped that this map will alleviate some of the complexity in managing and understanding...help the reader locate specific policies within the Group Policy Snap-in for a given Active Directory container . It is hoped that this map will alleviate...Policy Snap-in for a given Active Directory container . It is hoped that this map will alleviate some of the complexity in managing and

The Disappearing Fourth Wall: John Marburger, Science Policy, and the SSC

NASA Astrophysics Data System (ADS)

Crease, Robert

2015-04-01

John H. Marburger (1941-2011) was a skilled science administrator who had a fresh and unique approach to science policy and science leadership. His posthumously published book Science Policy up Close contains recollections of key science policy episodes in which he participated or observed closely. One was the administration of the Superconducting Supercollider (SSC); Marburger was Chairman of the Universities Research Association, the group charged with managing the SSC, from 1988-1994. Many accounts of the SSC saga attribute its demise to a combination of transitory factors: poor management, rising cost estimates, the collapse of the Soviet Union and thus of the Cold War threat, complaints by ``small science'' that the SSC's ``big science'' was consuming their budget, Congress's desire to cut spending, unwarranted contract regulations imposed by the Department of Energy (DOE) in response to environmental lapses at nuclear weapons laboratories, and so forth. Marburger tells a subtler story whose implications for science policy are more significant and far-reaching. The story involves changes in the attitude of the government towards large scientific projects that reach back to management reforms introduced by the administration of Presidents Johnson, Nixon, and Carter in the 1960s and 1970s. This experience impressed Marburger with the inevitability of public oversight of large scientific projects, and with the need for planners of such projects to establish and make public a cost and schedule tracking system that would model the project's progress and expenditures.

Stimulating learning-by-doing in advanced biofuels: effectiveness of alternative policies

NASA Astrophysics Data System (ADS)

Chen, Xiaoguang; Khanna, Madhu; Yeh, Sonia

2012-12-01

This letter examines the effectiveness of various biofuel and climate policies in reducing future processing costs of cellulosic biofuels due to learning-by-doing. These policies include a biofuel production mandate alone and supplementing the biofuel mandate with other policies, namely a national low carbon fuel standard, a cellulosic biofuel production tax credit or a carbon price policy. We find that the binding biofuel targets considered here can reduce the unit processing cost of cellulosic ethanol by about 30% to 70% between 2015 and 2035 depending on the assumptions about learning rates and initial costs of biofuel production. The cost in 2035 is more sensitive to the speed with which learning occurs and less sensitive to uncertainty in the initial production cost. With learning rates of 5-10%, cellulosic biofuels will still be at least 40% more expensive than liquid fossil fuels in 2035. The addition of supplementary low carbon/tax credit policies to the mandate that enhance incentives for cellulosic biofuels can achieve similar reductions in these costs several years earlier than the mandate alone; the extent of these incentives differs across policies and different kinds of cellulosic biofuels.

Making healthy eating policy practice: A group randomized controlled trial on changes in snack quality, costs, and consumption in after school programs

PubMed Central

Beets, Michael W.; Weaver, R. Glenn; Turner-McGrievy, Gabrielle; Huberty, Jennifer; Ward, Dianne S.; Freedman, Darcy; Hutto, Brent; Moore, Justin B.; Beighle, Aaron

2017-01-01

Purpose The aim of this study was to evaluate an intervention designed to assist after school programs (ASPs) in meeting snack nutrition policies that specify that a fruit or vegetable (FV) be served daily, and sugar-sweetened beverages/foods and artificially flavored foods eliminated. Design One-year group randomized controlled trial Setting Afterschool programs operating in South Carolina, US. Subjects Twenty ASPs serving over 1,700 children were recruited, match-paired post-baseline on enrollment size and days FV were served/week (days/wk), and randomized to either an intervention (n=10) or control (n=10) groups. Intervention Strategies To Enhance Practice for Healthy Eating (STEPs-HE), a multi-step adaptive intervention framework, which assists ASP leaders and staff to serve snacks that meet nutrition policies while maintaining cost. Measures Direct observation of snacks served and consumed, and monthly snack expenditures via receipts. Analysis Nonparametric and mixed-model repeated-measures Results By post-assessment, intervention ASPs increased serving FV to 3.9±2.1 vs. 0.7±1.7days/wk and decreased serving sugar-sweetened beverages to 0.1±0.7 vs. 1.8±2.4days/wk and foods to 0.3±1.1 vs. 2.7±2.5days/wk compared to controls, respectively. Cost of snacks increased by $0.02/snack in the intervention ASPs ($0.36 to $0.38) compared to a $0.01/snack decrease in the control ($0.39 to $0.38). Across both assessments and groups 80–100% of children consumed FV. Conclusions The STEPs-HE intervention can assist ASPs in meeting nationally endorsed nutrition policies with marginal increases in cost. PMID:26158679

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

PubMed

Schlander, Michael

2005-06-15

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

Single-Use Devices in Argentina: Cost Comparison Analysis of a "Re-Use" versus a "Single-Use" Policy for Trocars, Endocutters, Linear Cutters, and Harmonic Scalpels.

PubMed

Garay, Osvaldo Ulises; Elorrio, Ezequiel Garcia; Rodríguez, Viviana; Spira, Cintia; Augustovski, Federico; Pichon-Riviere, Andrés

2017-12-01

Re-use of medical devices labeled and marketed for single use only is a current practice around the world. To estimate the average difference per surgery in device-related costs (DRCs) when performed with single-use devices under a single-use policy (SUP) instead of a re-use policy (RP) from the perspective of the private health sector of Argentina. An analytical model was developed in Microsoft Excel and populated with data from a literature review, a Delphi-like panel, and local cost estimations. Four single-use devices were selected for analysis: plastic trocars, endocutters, linear cutters, and harmonic scalpels. DRCs were expressed in 2012 US dollars and divided into four cost categories: devices, adverse events, device failure, and surgical time extension. Outputs were expressed as DRCs per surgery under a SUP, under a RP, the difference between them expressed in US dollars (Diff_$), and the difference between them expressed as a percentage of surgery costs (Diff_%S). Deterministic and probabilistic sensitivity analyses were performed to analyze the impact of uncertainty on results. Expected DRCs per surgery were as follows: for trocars: SUP, US $424.6; RP, US $244.2; Diff_$, US $-180.4; and Diff_%S, -3.8%; for endocutters: SUP, US $1667.4; RP, US $1102.3; Diff_$, US $-565.1; and Diff_%S, -11.1%; for linear cutters: SUP, US $1228.1; RP, US $1045.9; Diff_$, US $-182.2; and Diff_%S, -3.4%; and for harmonic scalpels: SUP, US $1040.9; RP, US $292.4; Diff_$, US $-748.5; and Diff_%S, -14.8%. Sensitivity analyses showed results to be robust. RP was shown to be less costly in all devices and scenarios considered. Nevertheless, the real frequency of adverse events and their cost implications are still uncertain. More research is needed to assess the effectiveness and safety of these off-label policies. Copyright © 2017. Published by Elsevier Inc.

Costs and Benefits of Policy-Oriented Community Research: A Case Study.

ERIC Educational Resources Information Center

Brand, Stephen; Moore, Thom

Recent developments in the social policy literature suggest a growing overlap in community and social policy interests and methods. This combination of community and policy interests is illustrated by tracing successive steps of the Illinois Residential Life Survey in order to support programming decisions about community mental health in a…

Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine.

PubMed

Sanders, Gillian D; Neumann, Peter J; Basu, Anirban; Brock, Dan W; Feeny, David; Krahn, Murray; Kuntz, Karen M; Meltzer, David O; Owens, Douglas K; Prosser, Lisa A; Salomon, Joshua A; Sculpher, Mark J; Trikalinos, Thomas A; Russell, Louise B; Siegel, Joanna E; Ganiats, Theodore G

2016-09-13

Since publication of the report by the Panel on Cost-Effectiveness in Health and Medicine in 1996, researchers have advanced the methods of cost-effectiveness analysis, and policy makers have experimented with its application. The need to deliver health care efficiently and the importance of using analytic techniques to understand the clinical and economic consequences of strategies to improve health have increased in recent years. To review the state of the field and provide recommendations to improve the quality of cost-effectiveness analyses. The intended audiences include researchers, government policy makers, public health officials, health care administrators, payers, businesses, clinicians, patients, and consumers. In 2012, the Second Panel on Cost-Effectiveness in Health and Medicine was formed and included 2 co-chairs, 13 members, and 3 additional members of a leadership group. These members were selected on the basis of their experience in the field to provide broad expertise in the design, conduct, and use of cost-effectiveness analyses. Over the next 3.5 years, the panel developed recommendations by consensus. These recommendations were then reviewed by invited external reviewers and through a public posting process. The concept of a "reference case" and a set of standard methodological practices that all cost-effectiveness analyses should follow to improve quality and comparability are recommended. All cost-effectiveness analyses should report 2 reference case analyses: one based on a health care sector perspective and another based on a societal perspective. The use of an "impact inventory," which is a structured table that contains consequences (both inside and outside the formal health care sector), intended to clarify the scope and boundaries of the 2 reference case analyses is also recommended. This special communication reviews these recommendations and others concerning the estimation of the consequences of interventions, the valuation of health

77 FR 69422 - Cost Accounting Standards: Revision of the Exemption From Cost Accounting Standards for Contracts...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-19

... Accounting Standards: Revision of the Exemption From Cost Accounting Standards for Contracts and Subcontracts... Federal Procurement Policy (OFPP), Cost Accounting Standards (CAS) Board. ACTION: Proposed rule. SUMMARY... J. M. Wong, Director, Cost Accounting Standards Board (telephone: 202-395-6805; email: Raymond_wong...

48 CFR 48.102 - Policies.

Code of Federal Regulations, 2010 CFR

2010-10-01

... VALUE ENGINEERING Policies and Procedures 48.102 Policies. (a) As required by Section 36 of the Office... cost-effective value engineering procedures and processes. Agencies shall provide contractors a... engineering provisions in appropriate supply, service, architect-engineer and construction contracts as...

The influence of cost-per-DALY information in health prioritisation and desirable features for a registry: a survey of health policy experts in Vietnam, India and Bangladesh.

PubMed

Teerawattananon, Yot; Tantivess, Sripen; Yamabhai, Inthira; Tritasavit, Nattha; Walker, Damian G; Cohen, Joshua T; Neumann, Peter J

2016-12-03

Economic evaluation has been implemented to inform policy in many areas, including coverage decisions, technology pricing, and the development of clinical practice guidelines. However, there are barriers to evidence-based policy in low- and middle-income countries (LMICs) that include limited stakeholder awareness, resources and data availability, as well as the lack of capacity to conduct country-specific economic evaluations. This study aims to survey health policy experts' opinions on barriers to use of cost-effectiveness data in these settings and to obtain their advice on how to make a new cost-per-DALY database being developed by Tufts Medical Center more relevant to LMICs. It also identifies the factors influencing transferability. In-depth interviews were conducted with 32 participants, including policymakers, technical advisors, and researchers in Health Ministries, universities and non-governmental organisations in Bangladesh, India (New Delhi, Tamil Nadu and Karnataka) and Vietnam. The survey revealed that, in all settings, the use of cost-effectiveness information in policy development is lacking, owing to limited knowledge among policymakers and inadequate human resources with health economics expertise in the government sector. Furthermore, researchers in universities do not have close connections with health authorities. In India and Vietnam, the demand for evidence to inform coverage decisions tends to increase as the countries are moving towards universal health coverage. The informants in all countries argue that cost-effectiveness data are useful for decision-makers; however, most of them do not perform data searches by themselves but rely on the information provided by the technical advisor counterparts. Most interviewees were familiar with using evidence from other countries and were also aware of the influences of contextual elements as a limitation of transferability. Finally, strategies to promote the newly developed database include

Variations in cost calculations in spine surgery cost-effectiveness research.

PubMed

Alvin, Matthew D; Miller, Jacob A; Lubelski, Daniel; Rosenbaum, Benjamin P; Abdullah, Kalil G; Whitmore, Robert G; Benzel, Edward C; Mroz, Thomas E

2014-06-01

Cost-effectiveness research in spine surgery has been a prominent focus over the last decade. However, there has yet to be a standardized method developed for calculation of costs in such studies. This lack of a standardized costing methodology may lead to conflicting conclusions on the cost-effectiveness of an intervention for a specific diagnosis. The primary objective of this study was to systematically review all cost-effectiveness studies published on spine surgery and compare and contrast various costing methodologies used. The authors performed a systematic review of the cost-effectiveness literature related to spine surgery. All cost-effectiveness analyses pertaining to spine surgery were identified using the cost-effectiveness analysis registry database of the Tufts Medical Center Institute for Clinical Research and Health Policy, and the MEDLINE database. Each article was reviewed to determine the study subject, methodology, and results. Data were collected from each study, including costs, interventions, cost calculation method, perspective of cost calculation, and definitions of direct and indirect costs if available. Thirty-seven cost-effectiveness studies on spine surgery were included in the present study. Twenty-seven (73%) of the studies involved the lumbar spine and the remaining 10 (27%) involved the cervical spine. Of the 37 studies, 13 (35%) used Medicare reimbursements, 12 (32%) used a case-costing database, 3 (8%) used cost-to-charge ratios (CCRs), 2 (5%) used a combination of Medicare reimbursements and CCRs, 3 (8%) used the United Kingdom National Health Service reimbursement system, 2 (5%) used a Dutch reimbursement system, 1 (3%) used the United Kingdom Department of Health data, and 1 (3%) used the Tricare Military Reimbursement system. Nineteen (51%) studies completed their cost analysis from the societal perspective, 11 (30%) from the hospital perspective, and 7 (19%) from the payer perspective. Of those studies with a societal

Cost containment in laundry and linen service.

PubMed

Ellis, B

1978-03-16

One major problem looms among all others in the area of laundry and linen service, whether a hospital has an in-house operation, is part of a shared or central laundry, or uses a commercial service. That is the costly problem of controling linen consumption and replacement. A recent seminar offers some insight into reasons for the problem and some possible solutions.

48 CFR 951.101 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 951.101 Federal Acquisition Regulations System DEPARTMENT OF ENERGY CONTRACT MANAGEMENT USE OF GOVERNMENT SOURCES BY CONTRACTORS Contractor Use of Government Supply Sources 951.101 Policy. (a) It is Department of Energy (DOE) policy that contractors performing under cost-reimbursement contracts should meet...

48 CFR 1348.102 - Policies.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ENGINEERING Policies and Procedures 1348.102 Policies. (a) Contracting activities shall send contractor-submitted Value Engineering Change Proposals (VECPs) to the appropriate technical personnel for review. (b... adequacy of the contractor's estimate of cost savings; make a written report; and recommend acceptance or...

48 CFR 1348.102 - Policies.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ENGINEERING Policies and Procedures 1348.102 Policies. (a) Contracting activities shall send contractor-submitted Value Engineering Change Proposals (VECPs) to the appropriate technical personnel for review. (b... adequacy of the contractor's estimate of cost savings; make a written report; and recommend acceptance or...

48 CFR 1348.102 - Policies.

Code of Federal Regulations, 2012 CFR

2012-10-01

... ENGINEERING Policies and Procedures 1348.102 Policies. (a) Contracting activities shall send contractor-submitted Value Engineering Change Proposals (VECPs) to the appropriate technical personnel for review. (b... adequacy of the contractor's estimate of cost savings; make a written report; and recommend acceptance or...

Societal and Family Lifetime Cost of Dementia: Implications for Policy.

PubMed

Jutkowitz, Eric; Kane, Robert L; Gaugler, Joseph E; MacLehose, Richard F; Dowd, Bryan; Kuntz, Karen M

2017-10-01

To estimate the cost of dementia and the extra cost of caring for someone with dementia over the cost of caring for someone without dementia. We developed an evidence-based mathematical model to simulate disease progression for newly diagnosed individuals with dementia. Data-driven trajectories of cognition, function, and behavioral and psychological symptoms were used to model disease progression and predict costs. Using modeling, we evaluated lifetime and annual costs of individuals with dementia, compared costs of those with and without clinical features of dementia, and evaluated the effect of reducing functional decline or behavioral and psychological symptoms by 10% for 12 months (implemented when Mini-Mental State Examination score ≤21). Mathematical model. Representative simulated U.S. incident dementia cases. Value of informal care, out-of-pocket expenditures, Medicaid expenditures, and Medicare expenditures. From time of diagnosis (mean age 83), discounted total lifetime cost of care for a person with dementia was $321,780 (2015 dollars). Families incurred 70% of the total cost burden ($225,140), Medicaid accounted for 14% ($44,090), and Medicare accounted for 16% ($52,540). Costs for a person with dementia over a lifetime were $184,500 greater (86% incurred by families) than for someone without dementia. Total annual cost peaked at $89,000, and net cost peaked at $72,400. Reducing functional decline or behavioral and psychological symptoms by 10% resulted in $3,880 and $680 lower lifetime costs than natural disease progression. Dementia substantially increases lifetime costs of care. Long-lasting, effective interventions are needed to support families because they incur the most dementia cost. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

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

ERIC Educational Resources Information Center

Henderson, Cathy

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

Vaccine supply, demand, and policy: a primer.

PubMed

Muzumdar, Jagannath M; Cline, Richard R

2009-01-01

To provide an overview of supply and demand issues in the vaccine industry and the policy options that have been implemented to resolve these issues. Medline, Policy File, and International Pharmaceutical Abstracts were searched to locate academic journal articles. Other sources reviewed included texts on the topics of vaccine history and policy, government agency reports, and reports from independent think tanks. Keywords included vaccines, immunizations, supply, demand, and policy. Search criteria were limited to English language and human studies. Articles pertaining to vaccine demand, supply, and public policy were selected and reviewed for inclusion. By the authors. Vaccines are biologic medications, therefore making their development and production more difficult and costly compared with "small-molecule" drugs. Research and development costs for vaccines can exceed $800 million, and development may require 10 years or more. Strict manufacturing regulations and facility upgrades add to these costs. Policy options to increase and stabilize the supply of vaccines include those aimed at increasing supply, such as government subsidies for basic vaccine research, liability protection for manufacturers, and fast-track approval for new vaccines. Options to increase vaccine demand include advance purchase commitments, government stockpiles, and government financing for select populations. High development costs and multiple barriers to entry have led to a decline in the number of vaccine manufacturers. Although a number of vaccine policies have met with mixed success in increasing the supply of and demand for vaccines, a variety of concerns remain, including developing vaccines for complex pathogens and increasing immunization rates with available vaccines. New policy innovations such as advance market commitments and Medicare Part D vaccine coverage have been implemented and may aid in resolving some of the problems in the vaccine industry.

Health economic studies: an introduction to cost-benefit, cost-effectiveness, and cost-utility analyses.

PubMed

Angevine, Peter D; Berven, Sigurd

2014-10-15

Narrative overview. To provide clinicians with a basic understanding of economic studies, including cost-benefit, cost-effectiveness, and cost-utility analyses. As decisions regarding public health policy, insurance reimbursement, and patient care incorporate factors other than traditional outcomes such as satisfaction or symptom resolution, health economic studies are increasingly prominent in the literature. This trend will likely continue, and it is therefore important for clinicians to have a fundamental understanding of the common types of economic studies and be able to read them critically. In this brief article, the basic concepts of economic studies and the differences between cost-benefit, cost-effectiveness, and cost-utility studies are discussed. An overview of the field of health economic analysis is presented. Cost-benefit, cost-effectiveness, and cost-utility studies all integrate cost and outcome data into a decision analysis model. These different types of studies are distinguished mainly by the way in which outcomes are valued. Obtaining accurate cost data is often difficult and can limit the generalizability of a study. With a basic understanding of health economic analysis, clinicians can be informed consumers of these important studies.

48 CFR 2101.301 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Policy. 2101.301 Section... Acquisition Regulations 2101.301 Policy. (a) Procedures, contract clauses, and other aspects of the... the policies and procedures contained in this chapter as implemented and supplemented from time to...

48 CFR 2101.301 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Policy. 2101.301 Section... Acquisition Regulations 2101.301 Policy. (a) Procedures, contract clauses, and other aspects of the... the policies and procedures contained in this chapter as implemented and supplemented from time to...

48 CFR 2101.301 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Policy. 2101.301 Section... Acquisition Regulations 2101.301 Policy. (a) Procedures, contract clauses, and other aspects of the... the policies and procedures contained in this chapter as implemented and supplemented from time to...

Approaches to appropriate care delivery from a policy perspective: A case study of Australia, England and Switzerland.

PubMed

Robertson-Preidler, Joelle; Anstey, Matthew; Biller-Andorno, Nikola; Norrish, Alexandra

2017-07-01

Appropriateness is a conceptual way for health systems to balance Triple Aim priorities for improving population health, containing per capita cost, and improving the patient experience of care. Comparing system approaches to appropriate care delivery can help health systems establish priorities and facilitate appropriate care practices. We conceptualized system appropriateness by identifying policies that aim to achieve the Triple Aim and their consequent trade-offs for financing, clinical practice, and the individual patient. We used secondary data sources to compare the appropriate care approaches of Australia, England, and Switzerland according to financial, clinical, and individual appropriateness policies. Health system approaches to appropriate care delivery varied. England prioritizes public health, equity and efficiency at the expense of individual choice, while Switzerland focuses on individual patient preferences, but has higher per capita and out of pocket costs. Australia provides equity in public care access and private health care options that allows for more patient choice, with health care costs falling between the two. Integrating the Triple Aim into health system design and policy can facilitate appropriate care delivery at the system, clinical, and individual levels. Approaches will vary and require countries to negotiate and justify priorities and trade-offs within the context of thehealth system. Copyright © 2017 Elsevier B.V. All rights reserved.

48 CFR 2942.101 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Policy. 2942.101 Section 2942.101 Federal Acquisition Regulations System DEPARTMENT OF LABOR CONTRACT MANAGEMENT CONTRACT ADMINISTRATION AND AUDIT SERVICES Contract Audit Services 2942.101 Policy. The OASAM Division of Cost...

Views of US Physicians About Controlling Health Care Costs

PubMed Central

Tilburt, Jon C.; Wynia, Matthew K.; Sheeler, Robert D.; Thorsteinsdottir, Bjorg; James, Katherine M.; Egginton, Jason S.; Liebow, Mark; Hurst, Samia; Danis, Marion; Goold, Susan Dorr

2017-01-01

Importance Physicians' views about health care costs are germane to pending policy reforms. Objective To assess physicians' attitudes toward and perceived role in addressing health care costs. Design, Setting, and Participants A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile. Main Outcomes and Measures Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale. Results A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing health care costs, whereas only 36% reported that practicing physicians have “major responsibility.” Most were “very enthusiastic” for “promoting continuity of care” (75%), “expanding access to quality and safety data” (51%), and “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs. Few expressed enthusiasm for “eliminating fee-for-service payment models” (7%). Most physicians reported being “aware of the costs of the tests/treatments [they] recommend” (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they “should be solely devoted to individual patients' best interests, even if that is expensive” (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests” (89%). Most (85%) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.” In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type

Military Benefits for Former Spouses: Legislation and Policy Issues

DTIC Science & Technology

2017-03-06

cost of a survivor benefit . The USFSPA provides that members or retirees may voluntarily elect to name a former spouse as beneficiary for divorces...more). Therefore, the beneficiary of the life insurance policy will continue to benefit , while the entire cost of the policy is borne by the retiree...Military Benefits for Former Spouses: Legislation and Policy Issues Kristy N. Kamarck Analyst in Military Manpower March 6, 2017

Making Healthy Eating Policy Practice: A Group Randomized Controlled Trial on Changes in Snack Quality, Costs, and Consumption in After-School Programs.

PubMed

Beets, Michael W; Weaver, R Glenn; Turner-McGrievy, Gabrielle; Huberty, Jennifer; Ward, Dianne S; Freedman, Darcy; Hutto, Brent; Moore, Justin B; Beighle, Aaron

2016-09-01

The aim of this study was to evaluate an intervention designed to assist after-school programs (ASPs) in meeting snack nutrition policies that specify that a fruit or vegetable be served daily and sugar-sweetened beverages/foods and artificially flavored foods eliminated. The study used a 1-year group-randomized controlled trial. The study took place in ASPs operating in South Carolina, United States. Twenty ASPs serving over 1700 children were recruited, match-paired postbaseline on enrollment size and days fruits/vegetables were served per week, and randomized to either intervention (n = 10) or control (n = 10) groups. The study used Strategies To Enhance Practice for Healthy Eating (STEPs-HE), a multistep adaptive intervention framework that assists ASP leaders and staff to serve snacks that meet nutrition policies while maintaining cost. Direct observation of snacks served and consumed and monthly snack expenditures as determined by receipts were used. The study used nonparametric and mixed-model repeated measures. By postassessment, intervention ASPs increased serving of fruits/vegetables to 3.9 ± 2.1 vs. 0.7 ± 1.7 d/wk and decreased serving sugar-sweetened beverages to 0.1 ± 0.7 vs. 1.8 ± 2.4 d/wk and sugar-sweetened foods to 0.3 ± 1.1 vs. 2.7 ± 2.5 d/wk compared to controls, respectively. Cost of snacks increased by $0.02/snack in the intervention ASPs ($0.36 to $0.38) compared to a $0.01 per snack decrease in the control group ($0.39 to $0.38). Across both assessments and groups, 80% to 100% of children consumed FVs. The STEPs-HE intervention can assist ASPs in meeting nationally endorsed nutrition policies with marginal increases in cost. © 2016 by American Journal of Health Promotion, Inc.

A review of the costs and cost effectiveness of interventions in chronic kidney disease: implications for policy.

PubMed

Menzin, Joseph; Lines, Lisa M; Weiner, Daniel E; Neumann, Peter J; Nichols, Christine; Rodriguez, Lauren; Agodoa, Irene; Mayne, Tracy

2011-10-01

Given rising healthcare costs and a growing population of patients with chronic kidney disease (CKD), there is an urgent need to identify health interventions that provide good value for money. For this review, the English-language literature was searched for studies of interventions in CKD reporting an original incremental cost-utility (cost per QALY) or cost-effectiveness (cost per life-year) ratio. Published cost studies that did not report cost-effectiveness or cost-utility ratios were also reviewed. League tables were then created for both cost-utility and cost-effectiveness ratios to assess interventions in patients with stage 1-4 CKD, waitlist and transplant patients and those with end-stage renal disease (ESRD). In addition, the percentage of cost-saving or dominant interventions (those that save money and improve health) was compared across these three disease categories. A total of 84 studies were included, contributing 72 cost-utility ratios, 20 cost-effectiveness ratios and 42 other cost measures. Many of the interventions were dominant over the comparator, indicating better health outcomes and lower costs. For the three disease categories, the greatest number of dominant or cost-saving interventions was reported for stage 1-4 CKD patients, followed by waitlist and transplant recipients and those with ESRD (91%, 87% and 55% of studies reporting a dominant or cost-saving intervention, respectively). There is evidence of opportunities to lower costs in the treatment of patients with CKD, while either improving or maintaining the quality of care. In order to realize these cost savings, efforts will be required to promote and effectively implement changes in treatment practices.

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

PubMed Central

2013-01-01

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

7 CFR 772.1 - Policy.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Policy. 772.1 Section 772.1 Agriculture Regulations of... PROGRAMS SERVICING MINOR PROGRAM LOANS § 772.1 Policy. (a) Purpose. This part contains the Agency's policies and procedures for servicing Minor Program loans which include: Grazing Association loans...

48 CFR 1601.301 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Policy. 1601.301 Section... Regulation (FEHBAR) 1601.301 Policy. (a) Procedures, contract clauses, and other aspects of the acquisition... policies and procedures contained in this regulation as implemented and supplemented from time to time; and...

32 CFR 231.2 - Policy.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Policy. 231.2 Section 231.2 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS PROCEDURES... Policy. The policy pertaining to financial institutions operating on DoD installations is contained in Do...

48 CFR 1601.301 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Policy. 1601.301 Section... Regulation (FEHBAR) 1601.301 Policy. (a) Procedures, contract clauses, and other aspects of the acquisition... policies and procedures contained in this regulation as implemented and supplemented from time to time; and...

48 CFR 1601.301 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Policy. 1601.301 Section... Regulation (FEHBAR) 1601.301 Policy. (a) Procedures, contract clauses, and other aspects of the acquisition... policies and procedures contained in this regulation as implemented and supplemented from time to time; and...

Environmental costs of freshwater eutrophication in England and Wales.

PubMed

Pretty, Jules N; Mason, Christopher F; Nedwell, David B; Hine, Rachel E; Leaf, Simon; Dils, Rachael

2003-01-15

Eutrophication has many known consequences, but there are few data on the environmental and health costs. We developed a new framework of cost categories that assess both social and ecological damage costs and policy response costs. These findings indicate the severe effects of nutrient enrichment and eutrophication on many sectors of the economy. We estimate the damage costs of freshwater eutrophication in England and Wales to be $105-160 million yr(-1) (pound 75.0-114.3 m). The policy response costs are a measure of how much is being spent to address this damage, and these amount to $77 million yr(-1) pound 54.8 m). The damage costs are dominated by seven items each with costs of $15 million yr(-1) or more: reduced value of waterfront dwellings, drinking water treatment costs for nitrogen removal, reduced recreational and amenity value of water bodies, drinking water treatment costs for removal of algal toxins and decomposition products, reduced value of nonpolluted atmosphere, negative ecological effects on biota, and net economic losses from the tourist industry. In common with other environmental problems, it would represent net value (or cost reduction) if damage was prevented at source. A variety of effective economic, regulatory, and administrative policy instruments are available for internalizing these costs.

Strengthening Cost-Effectiveness Analysis for Public Health Policy.

PubMed

Russell, Louise B; Sinha, Anushua

2016-05-01

Although the U.S. spends more on medical care than any country in the world, Americans live shorter lives than the citizens of other high-income countries. Many important opportunities to improve this record lie outside the health sector and involve improving the conditions in which Americans live and work: safe design and maintenance of roads, bridges, train tracks, and airports; control of environmental pollutants; occupational safety; healthy buildings; a safe and healthy food supply; safe manufacture of consumer products; a healthy social environment; and others. Faced with the overwhelming array of possibilities, U.S. decision makers need help identifying those that can contribute the most to health. Cost-effectiveness analysis is designed to serve that purpose, but has mainly been used to assess interventions within the health sector. This paper briefly reviews the objective of cost-effectiveness analysis and its methodologic evolution and discusses the issues that arise when it is used to evaluate interventions that fall outside the health sector under three headings: structuring the analysis, quantifying/measuring benefits and costs, and valuing benefits and costs. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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

PubMed Central

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

2015-01-01

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

Secondary Schools in a County in Kenya Seem to Be Taking Advantages of the Cost Sharing Policy: Understanding Its Practice and Implications

ERIC Educational Resources Information Center

Makori, Andrew; Chepchieng, Gideon; Misoi, Pauline; Kiplagat, Rotich

2015-01-01

The study set out to research on parents' views regarding the practice of cost sharing policy in secondary schools in Kenya in relation to form one entry items requirement and fee payment. This article reports on its findings. The study adopted a quantitative survey and employed a questionnaire (both closed and open-ended) to collect data. The…

Can a Costly Intervention Be Cost-effective?

PubMed Central

Foster, E. Michael; Jones, Damon

2009-01-01

Objectives To examine the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence among at-risk children. A previous report documented the favorable effect of intervention on the highest-risk group of ninth-graders diagnosed with conduct disorder, as well as self-reported delinquency. The current report addressed the cost-effectiveness of the intervention for these measures of program impact. Design Costs of the intervention were estimated using program budgets. Incremental cost-effectiveness ratios were computed to determine the cost per unit of improvement in the 3 outcomes measured in the 10th year of the study. Results Examination of the total sample showed that the intervention was not cost-effective at likely levels of policymakers' willingness to pay for the key outcomes. Subsequent analysis of those most at risk, however, showed that the intervention likely was cost-effective given specified willingness-to-pay criteria. Conclusions Results indicate that the intervention is cost-effective for the children at highest risk. From a policy standpoint, this finding is encouraging because such children are likely to generate higher costs for society over their lifetimes. However, substantial barriers to cost-effectiveness remain, such as the ability to effectively identify and recruit such higher-risk children in future implementations. PMID:17088509

A Model for Understanding the Relationship Between Transaction Costs and Acquisition Cost Breaches

DTIC Science & Technology

2014-04-30

an assistant professor and received a BA in anthropology and a BA and MA in economics (2004) and a PhD in political economy and public policy (2008...between transaction costs and cost overruns. Biggs (2013) showed that as the EAC SE/PM cost ratio rises there is a statistically significant corresponding...Estimate at Completion ( EAC ) is the sum of the ACWP and the estimate to completion (ETC) for the remaining work. The ETC can be calculated using the cost

Public Policy and Pharmaceutical Innovation

PubMed Central

Grabowski, Henry G.

1982-01-01

Historically, new drug introductions have played a central role in medical progress and the availability of cost-effective therapies. Nevertheless, public policy toward pharmaceuticals has been characterized in recent times by increasingly stringent regulatory controls, shorter effective patent terms, and increased encouragement of generic product usage. This has had an adverse effect on the incentives and capabilities of firms to undertake new drug research and development activity. The industry has experienced sharply rising research and development costs, declining annual new drug introductions, and fewer independent sources of drug development. This paper considers the effects of government regulatory policies on the pharmaceutical innovation process from several related perspectives. It also examines the merits of current public policy proposals designed to stimulate drug innovation including patent restoration and various regulatory reform measures. PMID:10309721

The effect of cost construction based on either DRG or ICD-9 codes or risk group stratification on the resulting cost-effectiveness ratios.

PubMed

Chumney, Elinor C G; Biddle, Andrea K; Simpson, Kit N; Weinberger, Morris; Magruder, Kathryn M; Zelman, William N

2004-01-01

As cost-effectiveness analyses (CEAs) are increasingly used to inform policy decisions, there is a need for more information on how different cost determination methods affect cost estimates and the degree to which the resulting cost-effectiveness ratios (CERs) may be affected. The lack of specificity of diagnosis-related groups (DRGs) could mean that they are ill-suited for costing applications in CEAs. Yet, the implications of using International Classification of Diseases-9th edition (ICD-9) codes or a form of disease-specific risk group stratification instead of DRGs has yet to be clearly documented. To demonstrate the implications of different disease coding mechanisms on costs and the magnitude of error that could be introduced in head-to-head comparisons of resulting CERs. We based our analyses on a previously published Markov model for HIV/AIDS therapies. We used the Healthcare Cost and Utilisation Project Nationwide Inpatient Sample (HCUP-NIS) data release 6, which contains all-payer data on hospital inpatient stays from selected states. We added costs for the mean number of hospitalisations, derived from analyses based on either DRG or ICD-9 codes or risk group stratification cost weights, to the standard outpatient and prescription drug costs to yield an estimate of total charges for each AIDS-defining illness (ADI). Finally, we estimated the Markov model three times with the appropriate ADI cost weights to obtain CERs specific to the use of either DRG or ICD-9 codes or risk group. Contrary to expectations, we found that the choice of coding/grouping assumptions that are disease-specific by either DRG codes, ICD-9 codes or risk group resulted in very similar CER estimates for highly active antiretroviral therapy. The large variations in the specific ADI cost weights across the three different coding approaches was especially interesting. However, because no one approach produced consistently higher estimates than the others, the Markov model's weighted

48 CFR 223.7301 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Minimizing the Use of Materials Containing Hexavalent Chromium 223.7301 Policy. It is DoD policy to minimize hexavalent chromium (an anti-corrosive) in items acquired by...

Cost-Effectiveness and Cost-Reduction in United States Colleges and Universities.

ERIC Educational Resources Information Center

Miller, Richard I.; Miller, Peggy M.

1991-01-01

The relationship in college administration between cost effectiveness/cost reduction and planning, management, and evaluation is explored, and approaches to cost accounting and financial ratio analysis are discussed. It is concluded that it is important to emphasize institutional mission and people rather than cost containment and productivity.…

Airline policy for passengers requiring supplemental in-flight oxygen.

PubMed

Walker, Jacqueline; Kelly, Paul T; Beckert, Lutz

2009-05-01

The aim of this study was to investigate the current Australian/New Zealand airline policy on supplemental in-flight oxygen for passengers with lung disease. Fifty-four commercial airlines servicing international routes were surveyed. Information was gathered from airline call centres and web sites. The survey documented individual airline policy on in-flight oxygen delivery, approval schemes, equipment and cost. Of the 54 airlines contacted, 43 (81%) were able to support passengers requiring in-flight oxygen. The majority (88%) of airlines provided a cylinder for passengers to use. Airline policy for calculating the cost of in-flight oxygen differed considerably between carriers. Six (14%) airlines supplied oxygen to passengers free of charge; however, three of these airlines charged for an extra seat. Fifteen airlines (35%) charged on the basis of oxygen supplied, that is, per cylinder. Fourteen airlines (33%) had a flat rate charge per sector. This study confirmed that most airlines can accommodate passengers requiring supplemental oxygen. However, the findings highlight inconsistencies in airline policies and substantial cost differences for supplemental in-flight oxygen. We advocate an industry standardization of policy and cost of in-flight oxygen.

33 CFR 239.8 - Cost sharing.

Code of Federal Regulations, 2010 CFR

2010-07-01

... to provide additional cost sharing to reflect special local benefits or betterments. Such additional... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Cost sharing. 239.8 Section 239.8... RESOURCES POLICIES AND AUTHORITIES: FEDERAL PARTICIPATION IN COVERED FLOOD CONTROL CHANNELS § 239.8 Cost...

48 CFR 9904.417 - Cost of money as an element of the cost of capital assets under construction.

Code of Federal Regulations, 2010 CFR

2010-10-01

... element of the cost of capital assets under construction. 9904.417 Section 9904.417 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT... of money as an element of the cost of capital assets under construction. ...

Policies of containment: immigration in the era of AIDS.

PubMed Central

Fairchild, A L; Tynan, E A

1994-01-01

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

Air quality co-benefits of subnational carbon policies

DOE PAGES

Thompson, Tammy M.; Rausch, Sebastian; Saari, Rebecca K.; ...

2016-05-18

To mitigate climate change, governments ranging from city to multi-national have adopted greenhouse gas (GHG) emissions reduction targets. While the location of GHG reductions does not affect their climate benefits, it can impact human health benefits associated with co-emitted pollutants. Here, an advanced modeling framework is used to explore how subnational level GHG targets influence air pollutant co-benefits from ground level ozone and fine particulate matter. Two carbon policy scenarios are analyzed, each reducing the same total amount of GHG emissions in the Northeast US: an economy-wide Cap and Trade (CAT) program reducing emissions from all sectors of the economy,more » and a Clean Energy Standard (CES) reducing emissions from the electricity sector only. Results suggest that a regional CES policy will cost about 10 times more than a CAT policy. Despite having the same regional targets in the Northeast, carbon leakage to non-capped regions varies between policies. Consequently, a regional CAT policy will result in national carbon reductions that are over six times greater than the carbon reduced by the CES in 2030. Monetized regional human health benefits of the CAT and CES policies are 844% and 185% of the costs of each policy, respectively. Benefits for both policies are thus estimated to exceed their costs in the Northeast US. The estimated value of human health co-benefits associated with air pollution reductions for the CES scenario is two times that of the CAT scenario. Implications: In this research, an advanced modeling framework is used to determine the potential impacts of regional carbon policies on air pollution co-benefits associated with ground level ozone and fine particulate matter. Study results show that spatially heterogeneous GHG policies have the potential to create areas of air pollution dis-benefit. It is also shown that monetized human health benefits within the area covered by policy may be larger than the model estimated cost of

Air quality co-benefits of subnational carbon policies.

PubMed

Thompson, Tammy M; Rausch, Sebastian; Saari, Rebecca K; Selin, Noelle E

2016-10-01

To mitigate climate change, governments ranging from city to multi-national have adopted greenhouse gas (GHG) emissions reduction targets. While the location of GHG reductions does not affect their climate benefits, it can impact human health benefits associated with co-emitted pollutants. Here, an advanced modeling framework is used to explore how subnational level GHG targets influence air pollutant co-benefits from ground level ozone and fine particulate matter. Two carbon policy scenarios are analyzed, each reducing the same total amount of GHG emissions in the Northeast US: an economy-wide Cap and Trade (CAT) program reducing emissions from all sectors of the economy, and a Clean Energy Standard (CES) reducing emissions from the electricity sector only. Results suggest that a regional CES policy will cost about 10 times more than a CAT policy. Despite having the same regional targets in the Northeast, carbon leakage to non-capped regions varies between policies. Consequently, a regional CAT policy will result in national carbon reductions that are over six times greater than the carbon reduced by the CES in 2030. Monetized regional human health benefits of the CAT and CES policies are 844% and 185% of the costs of each policy, respectively. Benefits for both policies are thus estimated to exceed their costs in the Northeast US. The estimated value of human health co-benefits associated with air pollution reductions for the CES scenario is two times that of the CAT scenario. In this research, an advanced modeling framework is used to determine the potential impacts of regional carbon policies on air pollution co-benefits associated with ground level ozone and fine particulate matter. Study results show that spatially heterogeneous GHG policies have the potential to create areas of air pollution dis-benefit. It is also shown that monetized human health benefits within the area covered by policy may be larger than the model estimated cost of the policy. These

48 CFR 234.7100 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... DEFENSE SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Cost and Software Data Reporting 234.7100 Policy. (a) The cost and software data reporting (CSDR) requirement is mandatory for major defense... data reporting and software resources data reporting. (b) Prior to contract award, contracting officers...

48 CFR 234.7100 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... DEFENSE SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Cost and Software Data Reporting 234.7100 Policy. (a) The cost and software data reporting (CSDR) requirement is mandatory for major defense... data reporting and software resources data reporting. (b) Prior to contract award, contracting officers...

48 CFR 234.7100 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... DEFENSE SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Cost and Software Data Reporting 234.7100 Policy. (a) The cost and software data reporting (CSDR) requirement is mandatory for major defense... data reporting and software resources data reporting. (b) Prior to contract award, contracting officers...

48 CFR 234.7100 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... DEFENSE SPECIAL CATEGORIES OF CONTRACTING MAJOR SYSTEM ACQUISITION Cost and Software Data Reporting 234.7100 Policy. (a) The cost and software data reporting (CSDR) requirement is mandatory for major defense... data reporting and software resources data reporting. (b) Prior to contract award, contracting officers...

[Mortality cost of smoking in Spain].

PubMed

Cobacho Tornel, Ma Belén; López Nicolás, Angel; Ramos Parreño, José María

2010-01-01

Public policies are crucial for smoking prevention and improving health among the population. Despite the positive impact in Spain of the law for smoking prevention in 2006, there is room for further improvement in this area of public policy. The estimate of the mortality cost per pack of cigarretes is a crucial factor in cost-benefit analysis for policies aimed to reducing smoking induced mortality. The aim of this paper is twofold. First, we estimate the Value of Statistical Life (VSL) among Spanish smokers. Secondly, we quantify the mortality cost of smoking. We use a hedonic wage model to quantify the marginal value of an increase in the mortality risk in monetary terms. We estimate the model for the Spanish labour market using the European Community Household Data and the Encuesta de Accidentes de Trabajo from the Ministerio de Trabajo e Inmigración. We estimate a VSL of 3.78 million Euros for Spanish smokers. Using this value, in conjunction with the increase in the mortality risk over the life cycle due to smoking, the private mortality cost of smoking is 78 Euros per pack for men, and 54 Euros per pack for women (in 2000 Euros). The mortality cost per pack of cigarettes is highly above its market price.

Tax subsidies for health insurance: costs and benefits.

PubMed

Gruber, J; Levitt, L

2000-01-01

The continued rise in the uninsured population has lead to considerable interest in tax-based policies to raise the level of insurance coverage. Using a detailed microsimulation model for evaluating these policies, we find that while tax subsidies could significantly increase insurance coverage, even very generous tax policies could not cover more than a sizable minority of the uninsured population. For example, a generous refundable credit that costs $13 billion per year would reduce the ranks of the uninsured by only four million persons. We also find that the efficiency of tax policies, in terms of the cost per newly insured, inevitably would fall as more of the uninsured were covered.

Cost accounting in radiology: new directions and importance for policy.

PubMed

Muchantef, Karl; Forman, Howard P

2005-12-01

The purpose of this article is to promote insight into radiology costs through improvements in assessing patient-level cost data. Accurate patient costing is a prerequisite for establishing a proper payment system-one where the price paid for a service approximates the cost of delivering that service. In the absence of an accurate payment scheme, margins can vary significantly from one patient to the next. The resulting financial incentives skew the radiology marketplace away from the provision of efficient and appropriate care toward the selection of patients whose costs are low relative to reimbursements.

Using simulation modelling to examine the impact of venue lockout and last-drink policies on drinking-related harms and costs to licensees.

PubMed

Scott, Nick; Livingston, Michael; Reporter, Iyanoosh; Dietze, Paul

2017-06-01

Many variations of venue lockout and last-drink policies have been introduced in attempts to reduce drinking-related harms. We estimate the public health gains and licensee costs of these policies using a computer simulated population of young adults engaging in heavy drinking. Using an agent-based model we implemented 1 am/2 am/3 am venue lockouts in conjunction with last drinks zero/one/two hours later, or at current closing times. Outcomes included: the number of incidents of verbal aggression in public drinking venues, private venues or on the street; and changed revenue to public venues. The most effective policy in reducing verbal aggression among agents was 1 am lockouts with current closing times. All policies produced substantial reductions in street-based incidents of verbal aggression among agents (33-81%) due to the smoothing of transport demand. Direct revenue losses were 1-9% for simulated licensees, with later lockout times and longer periods between lockout and last drinks producing smaller revenue losses. Simulation models are useful for exploring consequences of policy change. Our simulation suggests that additional hours between lockout and last drinks could reduce aggression by easing transport demand, while minimising revenue loss to venue owners. Implications for public health: Direct policies to reduce late-night transport-related disputes should be considered. © 2017 The Authors.

48 CFR 632.702-70 - DOS policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false DOS policy. 632.702-70... REQUIREMENTS CONTRACT FINANCING Contract Funding 632.702-70 DOS policy. The Department's policy is to provide... incremental funding of cost-reimbursement contracts. Fixed-price, labor-hour, and time-and-materials contracts...

Wastewater Treatment Costs and Outlays in Organic Petrochemicals: Standards Versus Taxes With Methodology Suggestions for Marginal Cost Pricing and Analysis

NASA Astrophysics Data System (ADS)

Thompson, Russell G.; Singleton, F. D., Jr.

1986-04-01

With the methodology recommended by Baumol and Oates, comparable estimates of wastewater treatment costs and industry outlays are developed for effluent standard and effluent tax instruments for pollution abatement in five hypothetical organic petrochemicals (olefins) plants. The computational method uses a nonlinear simulation model for wastewater treatment to estimate the system state inputs for linear programming cost estimation, following a practice developed in a National Science Foundation (Research Applied to National Needs) study at the University of Houston and used to estimate Houston Ship Channel pollution abatement costs for the National Commission on Water Quality. Focusing on best practical and best available technology standards, with effluent taxes adjusted to give nearly equal pollution discharges, shows that average daily treatment costs (and the confidence intervals for treatment cost) would always be less for the effluent tax than for the effluent standard approach. However, industry's total outlay for these treatment costs, plus effluent taxes, would always be greater for the effluent tax approach than the total treatment costs would be for the effluent standard approach. Thus the practical necessity of showing smaller outlays as a prerequisite for a policy change toward efficiency dictates the need to link the economics at the microlevel with that at the macrolevel. Aggregation of the plants into a programming modeling basis for individual sectors and for the economy would provide a sound basis for effective policy reform, because the opportunity costs of the salient regulatory policies would be captured. Then, the government's policymakers would have the informational insights necessary to legislate more efficient environmental policies in light of the wealth distribution effects.

An assessment of electric vehicles: technology, infrastructure requirements, greenhouse-gas emissions, petroleum use, material use, lifetime cost, consumer acceptance and policy initiatives.

PubMed

Delucchi, M A; Yang, C; Burke, A F; Ogden, J M; Kurani, K; Kessler, J; Sperling, D

2014-01-13

Concerns about climate change, urban air pollution and dependence on unstable and expensive supplies of foreign oil have led policy-makers and researchers to investigate alternatives to conventional petroleum-fuelled internal-combustion-engine vehicles in transportation. Because vehicles that get some or all of their power from an electric drivetrain can have low or even zero emissions of greenhouse gases (GHGs) and urban air pollutants, and can consume little or no petroleum, there is considerable interest in developing and evaluating advanced electric vehicles (EVs), including pure battery-electric vehicles, plug-in hybrid electric vehicles and hydrogen fuel-cell electric vehicles. To help researchers and policy-makers assess the potential of EVs to mitigate climate change and reduce petroleum use, this paper discusses the technology of EVs, the infrastructure needed for their development, impacts on emissions of GHGs, petroleum use, materials use, lifetime costs, consumer acceptance and policy considerations.

Economic aspects of addiction policy.

PubMed

Maynard, A

1986-05-01

One definition of policy or government action in the Oxford English Dictionary is "craftiness" i.e. cunning or deceit. Such qualities have to be employed by governments because of the potential vote-losing effects of radical addiction policies. Health promotion, in relation to addictive substances such as alcohol and tobacco in particular, involves a trade-off between the costs of such policies, especially to industry (which seeks regulation to protect itself from competitors), and the benefits--improvements in the quality and length of life. Measures of such benefits (quality-adjusted life-years or QALYs) are available now to use in the evaluation of competing health promotion policies to determine their efficiency at the margin. Analysis of the market for tobacco indicates that consumption has been falling generally in the UK except among teenagers who appear to be the target of the industry's advertising and sponsorship efforts. This fall in consumption appears to be explained by health promotion rather than the active use of fiscal instruments of control. The recognition of the health effects of passive smoking and the impact of advertising and sponsorship, especially on the young, are policy areas requiring careful review and the evaluation of the costs and benefits of competing policies.(ABSTRACT TRUNCATED AT 250 WORDS)

76 FR 49365 - Cost Accounting Standards: Elimination of the Exemption From Cost Accounting Standards for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-10

... Accounting Standards: Elimination of the Exemption From Cost Accounting Standards for Contracts and...: Office of Management and Budget (OMB), Office of Federal Procurement Policy (OFPP), Cost Accounting... Accounting Standards (CAS) Board, is publishing a final rule to eliminate the exemption from regulations...

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

PubMed

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

2014-02-01

Endovascular aneurysm repair (EVAR) is associated with significant direct device costs. Such costs place EVAR at odds with efforts to constrain healthcare expenditures. This study examines the procedure-associated costs and operating margins associated with EVAR at a tertiary care academic medical center. All infrarenal EVARs performed from April 2011 to March 2012 were identified (n = 127). Among this cohort, 49 patients met standard commercial instruction for use guidelines, were treated using a single manufacturer device, and billed to Medicare diagnosis-related group (DRG) 238. Of these 49 patients, net technical operating margins (technical revenue minus technical cost) were calculated in conjunction with the hospital finance department. EVAR implant costs were determined for each procedure. DRG 238-associated costs and length of stay were benchmarked against other academic medical centers using University Health System Consortium 2012 data. Among the studied EVAR cohort (age 75, 82% male, mean length of stay, 1.7 days), mean technical costs totaled $31,672. Graft implants accounted for 52% of the allocated technical costs. Institutional overhead was 17% ($5495) of total technical costs. Net mean total technical EVAR-associated operating margins were -$4015 per procedure. Our institutional costs and length of stay, when benchmarked against comparable centers, remained in the lowest quartile nationally using University Health System Consortium costs for DRG 238. Stent graft price did not correlate with total EVAR market share. EVAR is currently associated with significant negative operating margins among Medicare beneficiaries. Currently, device costs account for over 50% of EVAR-associated technical costs and did not impact EVAR market share, reflecting an unawareness of cost differential among surgeons. These data indicate that EVAR must undergo dramatic care delivery redesign for this practice to remain sustainable. Copyright © 2014 Society for Vascular

48 CFR 2129.170 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Policy. 2129.170 Section 2129.170 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT, FEDERAL EMPLOYEES GROUP... Policy. (a) OPM shall consider taxes as a FEGLI Program cost under 2131.205-41. (b) For purposes of the...

48 CFR 2129.170 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Policy. 2129.170 Section 2129.170 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT, FEDERAL EMPLOYEES GROUP... Policy. (a) OPM shall consider taxes as a FEGLI Program cost under 2131.205-41. (b) For purposes of the...

48 CFR 2129.170 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Policy. 2129.170 Section 2129.170 Federal Acquisition Regulations System OFFICE OF PERSONNEL MANAGEMENT, FEDERAL EMPLOYEES GROUP... Policy. (a) OPM shall consider taxes as a FEGLI Program cost under 2131.205-41. (b) For purposes of the...

Costs and effects of new professional roles: Evidence from a literature review.