The opportunity cost of capital: development of new pharmaceuticals.

PubMed

Chit, Ayman; Chit, Ahmad; Papadimitropoulos, Manny; Krahn, Murray; Parker, Jayson; Grootendorst, Paul

2015-01-01

The opportunity cost of the capital invested in pharmaceutical research and development (R&D) to bring a new drug to market makes up as much as half the total cost. However, the literature on the cost of pharmaceutical R&D is mixed on how, exactly, one should calculate this "hidden" cost. Some authors attempt to adopt models from the field of finance, whereas other prominent authors dismiss this practice as biased, arguing that it artificially inflates the R&D cost to justify higher prices for pharmaceuticals. In this article, we examine the arguments made by both sides of the debate and then explain the cost of capital concept and describe in detail how this value is calculated. Given the significant contribution of the cost of capital to the overall cost of new drug R&D, a clear understanding of the concept is critical for policy makers, investors, and those involved directly in the R&D. © The Author(s) 2015.

The Treatment of Capital Costs in Educational Projects

ERIC Educational Resources Information Center

Bezeau, Lawrence

1975-01-01

Failure to account for the cost and depreciation of capital leads to suboptimal investments in education, specifically to excessively capital intensive instructional technologies. This type of error, which is particularly serious when planning for developing countries, can be easily avoided. (Author)

48 CFR 52.215-17 - Waiver of Facilities Capital Cost of Money.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Capital Cost of Money. 52.215-17 Section 52.215-17 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.215-17 Waiver of Facilities Capital Cost of Money. As prescribed in 15.408(i), insert the following clause: Waiver of Facilities Capital Cost of Money (OCT 1997) The Contractor did not...

48 CFR 52.215-17 - Waiver of Facilities Capital Cost of Money.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Capital Cost of Money. 52.215-17 Section 52.215-17 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.215-17 Waiver of Facilities Capital Cost of Money. As prescribed in 15.408(i), insert the following clause: Waiver of Facilities Capital Cost of Money (OCT 1997) The Contractor did not...

48 CFR 52.215-17 - Waiver of Facilities Capital Cost of Money.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Capital Cost of Money. 52.215-17 Section 52.215-17 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.215-17 Waiver of Facilities Capital Cost of Money. As prescribed in 15.408(i), insert the following clause: Waiver of Facilities Capital Cost of Money (OCT 1997) The Contractor did not...

48 CFR 52.215-17 - Waiver of Facilities Capital Cost of Money.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Capital Cost of Money. 52.215-17 Section 52.215-17 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.215-17 Waiver of Facilities Capital Cost of Money. As prescribed in 15.408(i), insert the following clause: Waiver of Facilities Capital Cost of Money (OCT 1997) The Contractor did not...

48 CFR 52.215-17 - Waiver of Facilities Capital Cost of Money.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Capital Cost of Money. 52.215-17 Section 52.215-17 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.215-17 Waiver of Facilities Capital Cost of Money. As prescribed in 15.408(i), insert the following clause: Waiver of Facilities Capital Cost of Money (OCT 1997) The Contractor did not...

Social capital and transaction costs in millet markets.

PubMed

Jacques, Damien Christophe; Marinho, Eduardo; d'Andrimont, Raphaël; Waldner, François; Radoux, Julien; Gaspart, Frédéric; Defourny, Pierre

2018-01-01

In sub-Saharan Africa, transaction costs are believed to be the most significant barrier that prevents smallholders and farmers from gaining access to markets and productive assets. In this study, we explore the impact of social capital on millet prices for three contrasted years in Senegal. Social capital is approximated using a unique data set on mobile phone communications between 9 million people allowing to simulate the business network between economic agents. Our approach is a spatial equilibrium model that integrates a diversified set of data. Local supply and demand were respectively derived from remotely sensed imagery and population density maps. The road network was used to establish market catchment areas, and transportation costs were derived from distances between markets. Results demonstrate that accounting for the social capital in the transaction costs explained 1-9% of the price variance depending on the year. The year-specific effect remains challenging to assess but could be related to a strengthening of risk aversion following a poor harvest.

The integrated supplier: key to cost management and multi-franchise capitation contracting.

PubMed

Schuweiler, R C

1996-05-01

Capitation...most healthcare providers do not work under it, comprehend it, or even want it, yet supply capitation contracting seminars are popping up everywhere creating the feeling that the bandwagon is leaving, and it might be time to get on board. Not true. Supply capitation is not for all organizations. Capitation contracting is not easy and there are not many successful models to help the uninitiated. If a panacea is sought for reducing supply costs, capitation is only one component of a systematic strategy to reduce materiel costs. This article suggests a direction using the Group Health Materiel Management (Group Health Cooperative of Puget Sound, WA) experience as a point of reference. It advocates a systematic approach that focuses on expense reduction in: cost of goods, holding cost of inventory, labor cost associated with all materiel processes, distribution cost (transportation and par stock pick, pack, and replenishment), product utilization, variation in product standards, and waste stream byproducts. At Group Health (GH) these issues are primarily addressed through the use of: information systems, supplier certification/selection processes, group purchasing compliance, supply channel management, supply capitation contracting programs, standardization, and utilization management. Because of managed care organizational structure, Group Health Cooperative supply capitation contracting, as performed at GH, is discussed not as a quick fix solution but in the spirit of sharing our experience with others who may be considering it as a cost savings tactic in the context of a broad-based materiel management strategy. This article highlights the experiences of GH beginning with materiel management's business process assumptions toward multiple-franchise supply capitation.

Structural and performance costs of reproduction in a pure capital breeder, the Children's python Antaresia childreni.

PubMed

Lourdais, Olivier; Lorioux, Sophie; DeNardo, Dale F

2013-01-01

Females often manage the high energy demands associated with reproduction by accumulating and storing energy in the form of fat before initiating their reproductive effort. However, fat stores cannot satisfy all reproductive resource demands, which include considerable investment of amino acids (e.g., for the production of yolk proteins or gluconeogenesis). Because capital breeders generally do not eat during reproduction, these amino acids must come from internal resources, typically muscle proteins. Although the energetic costs of reproduction have been fairly well studied, there are limited data on structural and performance costs associated with the muscle degradation required to meet amino acid demands. Thus, we examined structural changes (epaxial muscle width) and performance costs (constriction and strength) over the course of reproduction in a pure capital breeder, the children's python (Antaresia childreni). We found that both egg production (i.e., direct resource allocation) and maternal care (egg brooding) induce muscle catabolism and affect performance of the female. Although epaxial muscle loss was minimal in nonreproductive females, it reached up to 22% (in females after oviposition) and 34% (in females after brooding) of initial muscle width. Interestingly, we found that individuals with higher initial muscular condition allocated more of their muscle into reproduction. The amount of muscle loss was significantly linked to clutch mass, underscoring the role of structural protein in egg production. Egg brooding significantly increased proteolysis and epaxial loss despite no direct allocation to the offspring. Muscle loss was linked to a significant reduction in performance in postreproductive females. Overall, these results demonstrate that capital-breeding females experience dramatic costs that consume structural resources and jeopardize performance.

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. ...

Capital update factor: a new era approaches.

PubMed

Grimaldi, P L

1993-02-01

The Health Care Financing Administration (HCFA) has constructed a preliminary model of a new capital update method which is consistent with the framework being developed to refine the update method for PPS operating costs. HCFA's eventual goal is to develop a single update framework for operating and capital costs. Initial results suggest that adopting the new capital update method would reduce capital payments substantially, which might intensify creditor's concerns about extending loans to hospitals.

Exploring the role of social capital in urban citizens' initiatives in the Netherlands.

PubMed

Wentink, Carlijn; Vaandrager, Lenneke; van Dam, Rosalie; Hassink, Jan; Salverda, Irini

2017-07-24

This research explores the role of social capital in urban citizens' initiatives in the Netherlands, by using in-depth interviews. Social capital was operationalized as shared norms and values, connectedness, trust and reciprocity. The findings show that initiatives form around a shared idea or ambition (shared norms and values). An existing network of relationships (connectedness) is needed for an idea to emerge and take form. Connectedness can also increase as a result of an initiative. Some level of trust between people needs to be present from the start of the initiative. For the initiative to persist, strong in-group connections seem important, as well as a good balance between investments and returns. This reciprocity is mainly about intangible assets, such as energy and friendship. This study concludes that social capital within citizens' initiatives is both a prerequisite for the formation of initiatives and a result of the existence of initiatives. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Study of the Cost and Flows of Capital in the Guaranteed Student Loan Program. Final Report.

ERIC Educational Resources Information Center

Touche Ross and Co., Washington, DC.

The flow of capital to and through the Guaranteed Student Loan (GSL) Program and the cost of that capital to the federal government and the individual borrower were studied. A review of the research on student loan capital was conducted, and automated cost models were developed to test assumptions and project future costs. Attention was directed…

Capital cost reimbursement to community hospitals under Federal health insurance programs.

PubMed

Kinney, E D; Lefkowitz, B

1982-01-01

Issues in current capital cost reimbursement to community hospitals by Medicare and Medicaid are described, and options for change analyzed. Major reforms in the way the federal government pays for capital costs--in particular substitution of other methods of payment for existing depreciation reimbursement--could have significant impact on the structure of the health care system and on government expenditures. While such reforms are likely to engender substantial political opposition, they may be facilitated by broader changes in the reimbursement system.

Economic agglomerations and spatio-temporal cycles in a spatial growth model with capital transport cost

NASA Astrophysics Data System (ADS)

Juchem Neto, J. P.; Claeyssen, J. C. R.; Pôrto Júnior, S. S.

2018-03-01

In this paper we introduce capital transport cost in a unidimensional spatial Solow-Swan model of economic growth with capital-induced labor migration, considered in an unbounded domain. Proceeding with a stability analysis, we show that there is a critical value for the capital transport cost where the dynamic behavior of the economy changes, provided that the intensity of capital-induced labor migration is strong enough. On the one hand, if the capital transport cost is higher than this critical value, the spatially homogeneous equilibrium of coexistence of the model is stable, and the economy converges to this spatially homogeneous state in the long run; on the other hand, if transport cost is lower than this critical value, the equilibrium is unstable, and the economy may develop different spatio-temporal dynamics, including the formation of stable economic agglomerations and spatio-temporal economic cycles, depending on the other parameters in the model. Finally, numerical simulations support the results of the stability analysis, and illustrate the spatio-temporal dynamics generated by the model, suggesting that the economy as a whole benefits from the formation of economic agglomerations and cycles, with a higher capital transport cost reducing this gain.

Impact of Capital and Current Costs Changes of the Incineration Process of the Medical Waste on System Management Cost

NASA Astrophysics Data System (ADS)

Jolanta Walery, Maria

2017-12-01

The article describes optimization studies aimed at analysing the impact of capital and current costs changes of medical waste incineration on the cost of the system management and its structure. The study was conducted on the example of an analysis of the system of medical waste management in the Podlaskie Province, in north-eastern Poland. The scope of operational research carried out under the optimization study was divided into two stages of optimization calculations with assumed technical and economic parameters of the system. In the first stage, the lowest cost of functioning of the analysed system was generated, whereas in the second one the influence of the input parameter of the system, i.e. capital and current costs of medical waste incineration on economic efficiency index (E) and the spatial structure of the system was determined. Optimization studies were conducted for the following cases: with a 25% increase in capital and current costs of incineration process, followed by 50%, 75% and 100% increase. As a result of the calculations, the highest cost of system operation was achieved at the level of 3143.70 PLN/t with the assumption of 100% increase in capital and current costs of incineration process. There was an increase in the economic efficiency index (E) by about 97% in relation to run 1.

Willingness to pay and cost of illness for changes in health capital depreciation.

PubMed

Ried, W

1996-01-01

The paper investigates the relationship between the willingness to pay and the cost of illness approach with respect to the evaluation of economic burden due to adverse health effects. The basic intertemporal framework is provided by Grossman's pure investment model, while effects on individual morbidity are taken to be generated by marginal changes in the rate of health capital depreciation. More specifically, both the simple example of purely temporary changes and the more general case of persistent variations in health capital depreciation are discussed. The analysis generates two principal findings. First, for a class of identical individuals cost as measured by the cost of illness approach is demonstrated to provide a lower bound on the true welfare cost to the individual, i.e. cost as given by the willingness to pay approach. Moreover, the cost of illness is increasing in the size of the welfare loss. Second, if one takes into account the possible heterogeneity of individuals, a clear relationship between the cost values supplied by the two approaches no longer exists. As an example, the impact of variations in either financial wealth or health capital endowment is discussed. Thus, diversity in individual type turns out to blur the link between cost of illness and the true economic cost.

42 CFR 412.302 - Introduction to capital costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Introduction to capital costs. 412.302 Section 412.302 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... of part 413 of this chapter that are related to assets that were first put in use for patient care...

42 CFR 412.302 - Introduction to capital costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Introduction to capital costs. 412.302 Section 412.302 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... of part 413 of this chapter that are related to assets that were first put in use for patient care...

42 CFR 412.302 - Introduction to capital costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Introduction to capital costs. 412.302 Section 412.302 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... of part 413 of this chapter that are related to assets that were first put in use for patient care...

42 CFR 412.302 - Introduction to capital costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Introduction to capital costs. 412.302 Section 412.302 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... of part 413 of this chapter that are related to assets that were first put in use for patient care...

42 CFR 412.302 - Introduction to capital costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Introduction to capital costs. 412.302 Section 412.302 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... of part 413 of this chapter that are related to assets that were first put in use for patient care...

Early-Stage Capital Cost Estimation of Biorefinery Processes: A Comparative Study of Heuristic Techniques.

PubMed

Tsagkari, Mirela; Couturier, Jean-Luc; Kokossis, Antonis; Dubois, Jean-Luc

2016-09-08

Biorefineries offer a promising alternative to fossil-based processing industries and have undergone rapid development in recent years. Limited financial resources and stringent company budgets necessitate quick capital estimation of pioneering biorefinery projects at the early stages of their conception to screen process alternatives, decide on project viability, and allocate resources to the most promising cases. Biorefineries are capital-intensive projects that involve state-of-the-art technologies for which there is no prior experience or sufficient historical data. This work reviews existing rapid cost estimation practices, which can be used by researchers with no previous cost estimating experience. It also comprises a comparative study of six cost methods on three well-documented biorefinery processes to evaluate their accuracy and precision. The results illustrate discrepancies among the methods because their extrapolation on biorefinery data often violates inherent assumptions. This study recommends the most appropriate rapid cost methods and urges the development of an improved early-stage capital cost estimation tool suitable for biorefinery processes. © 2015 The Authors. Published by Wiley-VCH Verlag GmbH & Co. KGaA.

42 CFR 413.130 - Introduction to capital-related costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... incurred for the repair or maintenance of equipment or facilities. (2) Amounts included in rentals or lease... paragraph (c) of this section. (5) The costs of minor equipment that are capitalized, rather than expensed...) involving plant facilities or equipment only if the following conditions are met: (i) The rental charges are...

42 CFR 413.130 - Introduction to capital-related costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... incurred for the repair or maintenance of equipment or facilities. (2) Amounts included in rentals or lease... paragraph (c) of this section. (5) The costs of minor equipment that are capitalized, rather than expensed...) involving plant facilities or equipment only if the following conditions are met: (i) The rental charges are...

42 CFR 413.130 - Introduction to capital-related costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... incurred for the repair or maintenance of equipment or facilities. (2) Amounts included in rentals or lease... paragraph (c) of this section. (5) The costs of minor equipment that are capitalized, rather than expensed...) involving plant facilities or equipment only if the following conditions are met: (i) The rental charges are...

What's your real cost of capital?

PubMed

McNulty, James J; Yeh, Tony D; Schulze, William S; Lubatkin, Michael H

2002-10-01

In valuing any investment project or corporate acquisition, executives must decide what discount rate to use in their estimates of future cash flows. The traditional approach is to apply the capital asset pricing model (CAPM), which has remained fundamentally unchanged for 40 years. But the formula--in particular, its beta element--has long been a source of frustration. In fact, corporate executives and investment bankers routinely fudge their CAPM estimates, say the authors, because experience and intuition tell them the model produces inappropriate discount rates. CAPM has three main problems: First, beta is a measure of both a stock's correlation and its volatility; second, beta is based on historical data; and third, CAPM rates don't take into account the term of the investment. These factors together result in discount rates that defy common sense. As an alternative to CAPM and its beta element, the authors developed a forward-looking approach to calculating a company's cost of capital, the market-derived capital pricing model (MCPM). It does not incorporate any measure of historical stock-to-market correlation, relying instead on estimates of future volatility derived from the options market. This is helpful since investor expectations from the options market are built into a company's current stock price. Using GE as an example, the authors give step-by-step instructions for how to calculate discount rates with MCPM. They also offer evidence from a range of industries to show that MCPM's discount rates are more realistic--especially from the corporate investor's perspective--than are CAPM's.

The Need for Full Cost Control in Universities and Colleges Capital Expenditure Programmes.

ERIC Educational Resources Information Center

Aitchison, Ian A.

Cost control techniques as applied to university and college capital expenditure programs are discussed, as is the need for control of costs as an integral part of the design and construction of campus projects. The following phases of the cost control process are presented: pre-design advice and cost studies, preparation of the budget for the…

A disciplined approach to capital: today's healthcare imperative.

PubMed

Dupuis, Patrick J; Kaufman, Kenneth

2007-07-01

BJC HealthCare's experience exemplifies several basic principles of a finance-based approach to capital. Organizations that adopt this approach look to improve processes first, remove costs second, and spend capital last. Multiyear planning is required to quantitatively identify the profitability and liquidity requirements of strategic initiatives and address essential funding and financing issues.

Academic Capitalism and the Community College

ERIC Educational Resources Information Center

Kleinman, Ilene

2010-01-01

Profit-generating entrepreneurial initiatives have become increasingly important as community colleges look for alternative revenue to support escalating costs in an environment characterized by funding constraints. Academic capitalism was used as the conceptual framework to determine whether community colleges have become increasingly market…

Early‐Stage Capital Cost Estimation of Biorefinery Processes: A Comparative Study of Heuristic Techniques

PubMed Central

Couturier, Jean‐Luc; Kokossis, Antonis; Dubois, Jean‐Luc

2016-01-01

Abstract Biorefineries offer a promising alternative to fossil‐based processing industries and have undergone rapid development in recent years. Limited financial resources and stringent company budgets necessitate quick capital estimation of pioneering biorefinery projects at the early stages of their conception to screen process alternatives, decide on project viability, and allocate resources to the most promising cases. Biorefineries are capital‐intensive projects that involve state‐of‐the‐art technologies for which there is no prior experience or sufficient historical data. This work reviews existing rapid cost estimation practices, which can be used by researchers with no previous cost estimating experience. It also comprises a comparative study of six cost methods on three well‐documented biorefinery processes to evaluate their accuracy and precision. The results illustrate discrepancies among the methods because their extrapolation on biorefinery data often violates inherent assumptions. This study recommends the most appropriate rapid cost methods and urges the development of an improved early‐stage capital cost estimation tool suitable for biorefinery processes. PMID:27484398

Faculty Social Capital at Work in a Community College Student Success and Completion Initiative

ERIC Educational Resources Information Center

Funaro, Janette

2017-01-01

The purpose of this case study was to examine the role of social capital in the enactment of a faculty-based initiative designed to improve student success and completion at one community college. The concept of social capital--or the actual and potential resources that are embedded in relationships--has been examined in research studies in many…

10 CFR Appendix I to Part 504 - Procedures for the Computation of the Real Cost of Capital

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Procedures for the Computation of the Real Cost of Capital I Appendix I to Part 504 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS EXISTING POWERPLANTS Pt. 504, App. I Appendix I to Part 504—Procedures for the Computation of the Real Cost of Capital (a) The firm's real after-tax weighted average...

Transit forecasting accuracy : ridership forecasts and capital cost estimates, final research report.

DOT National Transportation Integrated Search

2009-01-01

In 1992, Pickrell published a seminal piece examining the accuracy of ridership forecasts and capital cost estimates for fixed-guideway transit systems in the US. His research created heated discussions in the transit industry regarding the ability o...

Intercity passenger rail : Amtrak will continue to have difficulty controlling its costs and meeting capital needs

DOT National Transportation Integrated Search

2000-05-01

This report responds to the request to review Amtrak's costs and capital investment needs. In particular, this report discusses changes since 1995 in Amtrak's operating costs, including labor costs, payments to freight railroads to access their track...

Ripple effects of reform on capital financing.

PubMed

Arduino, Kelly

2014-05-01

Healthcare leaders should inventory and quantify the capital initiatives deemed critical for success under changing business models. Key considerations in planning such initiatives are opportunity costs and potential impact on productivity. Senior leaders also should create rolling five-year estimates of expenditures in addition to a one-year budget. Approaches to paying for such initiatives include borrowing from cash reserves, partnering to share cash and other resources, and developing new revenue sources derived from the initiatives themselves.

Taxes, bankruptcy costs, and capital structure in for-profit and not-for-profit hospitals.

PubMed

Huang, Sean S; Yang, Jie; Carroll, Nathan

2018-02-01

About 60% of the US hospitals are not-for-profit and it is not clear how traditional theories of capital structure should be adapted to understand the borrowing behavior of not-for-profit hospitals. This paper identifies important determinants of capital structure taken from theories describing for-profit firms as well as prior literature on not-for-profit hospitals. We examine the differential effects these factors have on the capital structure of for-profit and not-for-profit hospitals. Specifically, we use a difference-in-differences regression framework to study how differences in leverage between for-profit and not-for-profit hospitals change in response to key explanatory variables (i.e. tax rates and bankruptcy costs). The sample in this study includes most US short-term general acute hospitals from 2000 to 2012. We find that personal and corporate income taxes and bankruptcy costs have significant and distinct effects on the capital structure of for-profit and not-for-profit hospitals. Specifically, relative to not-for-profit hospitals: (1) higher corporate income tax encourages for-profit hospitals to increase their debt usage; (2) higher personal income tax discourages for-profit hospitals to use debt; and (3) higher expected bankruptcy costs lead for-profit hospitals to use less debt. Over the past decade, the capital structure of for-profit hospitals has been more flexible as compared to that of not-for-profit hospitals. This may suggest that not-for-profit hospitals are more constrained by external financing resources. Particularly, our analysis suggests that not-for-profit hospitals operating in states with high corporate taxes but low personal income taxes may face particular challenges of borrowing funds relative to their for-profit competitors.

Carbon Emission Reduction with Capital Constraint under Greening Financing and Cost Sharing Contract.

PubMed

Qin, Juanjuan; Zhao, Yuhui; Xia, Liangjie

2018-04-13

Motivated by the industrial practices, this work explores the carbon emission reductions for the manufacturer, while taking into account the capital constraint and the cap-and-trade regulation. To alleviate the capital constraint, two contracts are analyzed: greening financing and cost sharing. We use the Stackelberg game to model four cases as follows: (1) in Case A1, the manufacturer has no greening financing and no cost sharing; (2) in Case A2, the manufacturer has greening financing, but no cost sharing; (3) in Case B1, the manufacturer has no greening financing but has cost sharing; and, (4) in Case B2, the manufacturer has greening financing and cost sharing. Then, using the backward induction method, we derive and compare the equilibrium decisions and profits of the participants in the four cases. We find that the interest rate of green finance does not always negatively affect the carbon emission reduction of the manufacturer. Meanwhile, the cost sharing from the retailer does not always positively affect the carbon emission reduction of the manufacturer. When the cost sharing is low, both of the participants' profits in Case B1 (under no greening finance) are not less than that in Case B2 (under greening finance). When the cost sharing is high, both of the participants' profits in Case B1 (under no greening finance) are less than that in Case B2 (under greening finance).

Carbon Emission Reduction with Capital Constraint under Greening Financing and Cost Sharing Contract

PubMed Central

Qin, Juanjuan; Zhao, Yuhui; Xia, Liangjie

2018-01-01

Motivated by the industrial practices, this work explores the carbon emission reductions for the manufacturer, while taking into account the capital constraint and the cap-and-trade regulation. To alleviate the capital constraint, two contracts are analyzed: greening financing and cost sharing. We use the Stackelberg game to model four cases as follows: (1) in Case A1, the manufacturer has no greening financing and no cost sharing; (2) in Case A2, the manufacturer has greening financing, but no cost sharing; (3) in Case B1, the manufacturer has no greening financing but has cost sharing; and, (4) in Case B2, the manufacturer has greening financing and cost sharing. Then, using the backward induction method, we derive and compare the equilibrium decisions and profits of the participants in the four cases. We find that the interest rate of green finance does not always negatively affect the carbon emission reduction of the manufacturer. Meanwhile, the cost sharing from the retailer does not always positively affect the carbon emission reduction of the manufacturer. When the cost sharing is low, both of the participants’ profits in Case B1 (under no greening finance) are not less than that in Case B2 (under greening finance). When the cost sharing is high, both of the participants’ profits in Case B1 (under no greening finance) are less than that in Case B2 (under greening finance). PMID:29652859

18 CFR 4.1 - Initial cost statement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... OF PROJECT COSTS Determination of Cost of Projects Constructed Under License § 4.1 Initial cost statement. (a) Notification of Commission. When a project is constructed under a license issued under the... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false Initial cost statement...

18 CFR 4.1 - Initial cost statement.

Code of Federal Regulations, 2014 CFR

2014-04-01

... OF PROJECT COSTS Determination of Cost of Projects Constructed Under License § 4.1 Initial cost statement. (a) Notification of Commission. When a project is constructed under a license issued under the... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false Initial cost statement...

18 CFR 4.1 - Initial cost statement.

Code of Federal Regulations, 2012 CFR

2012-04-01

... OF PROJECT COSTS Determination of Cost of Projects Constructed Under License § 4.1 Initial cost statement. (a) Notification of Commission. When a project is constructed under a license issued under the... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Initial cost statement...

18 CFR 4.1 - Initial cost statement.

Code of Federal Regulations, 2013 CFR

2013-04-01

... OF PROJECT COSTS Determination of Cost of Projects Constructed Under License § 4.1 Initial cost statement. (a) Notification of Commission. When a project is constructed under a license issued under the... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false Initial cost statement...

Supplement II : Summary of Capital and Operations & Maintenance Cost Experience of Automated Guideway Transit Systems : Costs and Trends for the period 1976-1979

DOT National Transportation Integrated Search

1980-03-01

This report summarizes O&M cost experience and trends for the following AGT systems for the period 1976-1979: AIRTRANS, Sea-Tac, Tampa, Disneyworld (WEDway), and Morgantown (O&M data on the Morgantown system is reported through 1978). Capital cost da...

A capital cost comparison of commercial ground-source heat pump systems

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

Rafferty, K.

1994-06-01

The purpose of the report is to compare capital costs associated with the three designs of ground source heat pumps. Specifically, the costs considered are those associated with the heat source/heat sink or ground source portion of the system. In order to standardize the heat rejection over the three designs, it was assumed that the heat pump loop would operate at a temperature range of 85{degree} (to the heat pumps) to 95{degree} (from the heat pumps) under peak conditions. The assumption of constant loop temperature conditions for all three permits an apples-to-apples comparison of the alternatives.

Cost effectiveness of the Oregon quitline "free patch initiative".

PubMed

Fellows, Jeffrey L; Bush, Terry; McAfee, Tim; Dickerson, John

2007-12-01

We estimated the cost effectiveness of the Oregon tobacco quitline's "free patch initiative" compared to the pre-initiative programme. Using quitline utilisation and cost data from the state, intervention providers and patients, we estimated annual programme use and costs for media promotions and intervention services. We also estimated annual quitline registration calls and the number of quitters and life years saved for the pre-initiative and free patch initiative programmes. Service utilisation and 30-day abstinence at six months were obtained from 959 quitline callers. We compared the cost effectiveness of the free patch initiative (media and intervention costs) to the pre-initiative service offered to insured and uninsured callers. We conducted sensitivity analyses on key programme costs and outcomes by estimating a best case and worst case scenario for each intervention strategy. Compared to the pre-intervention programme, the free patch initiative doubled registered calls, increased quitting fourfold and reduced total costs per quit by $2688. We estimated annual paid media costs were $215 per registered tobacco user for the pre-initiative programme and less than $4 per caller during the free patch initiative. Compared to the pre-initiative programme, incremental quitline promotion and intervention costs for the free patch initiative were $86 (range $22-$353) per life year saved. Compared to the pre-initiative programme, the free patch initiative was a highly cost effective strategy for increasing quitting in the population.

Reducing the cost of health care capital.

PubMed

Silberman, R

1984-08-01

Although one may ask four financial experts their opinion on the future of the hospital capital market and receive five answers, the blatant need for financial strategic planning is evident. Clearly, the hospital or system with sound financial management will be better positioned to gain and/or maintain an edge in the competitive environment of the health care sector. The trends of the future include hospitals attempting to: Maximize the efficiency of invested capital. Use the expertise of Board members. Use alternative capital sources. Maximize rate of return on investments. Increase productivity. Adjust to changes in reimbursements. Restructure to use optimal financing for capital needs, i.e., using short-term to build up debt capacity if long-term financing is needed in the future. Take advantage of arbitrage (obtain capital and reinvest it until the funds are needed). Delay actual underwriting until funds are to be used. Better management of accounts receivable and accounts payable to avoid short-term financing for cash flow shortfalls. Use for-profit subsidiaries to obtain venture capital by issuing stock. Use product line management. Use leasing to obtain balance sheet advantages. These trends indicate a need for hospital executives to possess a thorough understanding of the capital formation process. In essence, the bottom line is that the short-term viability and long-term survival of a health care organization will greatly depend on the financial expertise of its decision-makers.

Capital planning for clinical integration.

PubMed

Grauman, Daniel M; Neff, Gerald; Johnson, Molly Martha

2011-04-01

When assessing the financial implications of a physician alignment and clinical integration initiative, a hospital should measure the initiative's potential ROI, perhaps best using a combination of net present value and payback period. The hospital should compare its own historical and projected performance with rating agency median benchmarks for key financial indicators of profitability, debt service, capital and cash flow, and liquidity. The hospital should also consider potential indirect benefits, such as retained outpatient/ancillary revenue, increased inpatient revenue, improved cost control, and improved quality and reporting transparency.

Implementing a Capital Plan.

ERIC Educational Resources Information Center

Daigneau, William A.

2003-01-01

Addresses four questions regarding implementation of a long-term capital plan to manage a college's facilities portfolio: When should the projects be implemented? How should the capital improvements be implemented? What will it actually cost in terms of project costs as well as operating costs? Who will implement the plan? (EV)

Real Options as a Strategic Management Framework: A Case Study of the Operationally Responsive Space Initiative

DTIC Science & Technology

2007-03-01

of the project, and the Weighted Average Cost of Capital ( WACC ). WACC is defined as the after-tax marginal cost of capital (Copeland & Antikarov...Initial Investment t = Life Expectancy of Project (Start =1, to Finish=N) E(FCF) = Expected Free-Cash Flow WACC = Weighted Average Cost of

Cost-Effectiveness Analysis of a Capitated Patient Navigation Program for Medicare Beneficiaries with Lung Cancer.

PubMed

Shih, Ya-Chen Tina; Chien, Chun-Ru; Moguel, Rocio; Hernandez, Mike; Hajek, Richard A; Jones, Lovell A

2016-04-01

To assess the cost-effectiveness of implementing a patient navigation (PN) program with capitated payment for Medicare beneficiaries diagnosed with lung cancer. Cost-effectiveness analysis. A Markov model to capture the disease progression of lung cancer and characterize clinical benefits of PN services as timeliness of treatment and care coordination. Taking a payer's perspective, we estimated the lifetime costs, life years (LYs), and quality-adjusted life years (QALYs) and addressed uncertainties in one-way and probabilistic sensitivity analyses. Model inputs were extracted from the literature, supplemented with data from a Centers for Medicare and Medicaid Services demonstration project. Compared to usual care, PN services incurred higher costs but also yielded better outcomes. The incremental cost and effectiveness was $9,145 and 0.47 QALYs, respectively, resulting in an incremental cost-effectiveness ratio of $19,312/QALY. One-way sensitivity analysis indicated that findings were most sensitive to a parameter capturing PN survival benefit for local-stage patients. CE-acceptability curve showed the probability that the PN program was cost-effective was 0.80 and 0.91 at a societal willingness-to-pay of $50,000 and $100,000/QALY, respectively. Instituting a capitated PN program is cost-effective for lung cancer patients in Medicare. Future research should evaluate whether the same conclusion holds in other cancers. © Health Research and Educational Trust.

42 CFR 417.930 - Initial costs of operation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Initial costs of operation. 417.930 Section 417.930... PREPAYMENT PLANS Administration of Outstanding Loans and Loan Guarantees § 417.930 Initial costs of operation. Under section 1305 of the PHS, loans and loan guarantees were awarded for initial costs of operation of...

Molten Salt: Concept Definition and Capital Cost Estimate

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

Stoddard, Larry; Andrew, Daniel; Adams, Shannon

The Department of Energy’s (DOE’s) Office of Renewable Power (ORP) has been tasked to provide effective program management and strategic direction for all of the DOE’s Energy Efficiency & Renewable Energy’s (EERE’s) renewable power programs. The ORP’s efforts to accomplish this mission are aligned with national energy policies, DOE strategic planning, EERE’s strategic planning, Congressional appropriation, and stakeholder advice. ORP is supported by three renewable energy offices, of which one is the Solar Energy Technology Office (SETO) whose SunShot Initiative has a mission to accelerate research, development and large scale deployment of solar technologies in the United States. SETO hasmore » a goal of reducing the cost of Concentrating Solar Power (CSP) by 75 percent of 2010 costs by 2020 to reach parity with base-load energy rates, and to reduce costs 30 percent further by 2030. The SunShot Initiative is promoting the implementation of high temperature CSP with thermal energy storage allowing generation during high demand hours. The SunShot Initiative has funded significant research and development work on component testing, with attention to high temperature molten salts, heliostats, receiver designs, and high efficiency high temperature supercritical CO 2 (sCO2) cycles. DOE retained Black & Veatch to support SETO’s SunShot Initiative for CSP solar power tower technology in the following areas: 1. Concept definition, including costs and schedule, of a flexible test facility to be used to test and prove components in part to support financing. 2. Concept definition, including costs and schedule, of an integrated high temperature molten salt (MS) facility with thermal energy storage and with a supercritical CO 2 cycle generating approximately 10MWe. 3. Concept definition, including costs and schedule, of an integrated high temperature falling particle facility with thermal energy storage and with a supercritical CO 2 cycle generating

Applying a private sector capitation model to the management of type 2 diabetes in the South African public sector: a cost-effectiveness analysis.

PubMed

Volmink, Heinrich C; Bertram, Melanie Y; Jina, Ruxana; Wade, Alisha N; Hofman, Karen J

2014-09-30

Diabetes mellitus contributes substantially to the non-communicable disease burden in South Africa. The proposed National Health Insurance system provides an opportunity to consider the development of a cost-effective capitation model of care for patients with type 2 diabetes. The objective of the study was to determine the potential cost-effectiveness of adapting a private sector diabetes management programme (DMP) to the South African public sector. Cost-effectiveness analysis was undertaken with a public sector model of the DMP as the intervention and a usual practice model as the comparator. Probabilistic modelling was utilized for incremental cost-effectiveness ratio analysis with life years gained selected as the outcome. Secondary data were used to design the model while cost information was obtained from various sources, taking into account public sector billing. Modelling found an incremental cost-effectiveness ratio (ICER) of ZAR 8 356 (USD 1018) per life year gained (LYG) for the DMP against the usual practice model. This fell substantially below the Willingness-to-Pay threshold with bootstrapping analysis. Furthermore, a national implementation of the intervention could potentially result in an estimated cumulative gain of 96 997 years of life (95% CI 71 073 years - 113 994 years). Probabilistic modelling found the capitation intervention to be cost-effective, with an ICER of ZAR 8 356 (USD 1018) per LYG. Piloting the service within the public sector is recommended as an initial step, as this would provide data for more accurate economic evaluation, and would also allow for qualitative analysis of the programme.

Risk-adjusted capitation payments for catastrophic risks based on multi-year prior costs.

PubMed

van Barneveld, E M; van Vliet, R C; van de Ven, W P

1997-02-01

In many countries regulated competition among health insurance companies has recently been proposed or implemented. A crucial issue is whether or not the benefits package offered by competing insurers should also cover catastrophic risks (like several forms of expensive long-term care) in addition to non-catastrophic risks (like hospital care and physician services). In 1988 the Dutch government proposed compulsory national health insurance based on regulated competition among insurer as well as among providers of care. The competing insurers should offer a benefits package covering both non-catastrophic risks and catastrophic risks. The insurers would be largely financed via risk-adjusted capitation payments. The government intended to use a capitation formula that is, besides some demographic variables, based on multi-year prior costs. This paper presents the results of an explorative empirical analysis of the possible consequences of such a capitation formula for catastrophic risks. The main conclusion is that this formula would be inadequate because it would leave ample room for cream skimming.

Risk-adjusted capitation based on the Diagnostic Cost Group Model: an empirical evaluation with health survey information.

PubMed Central

Lamers, L M

1999-01-01

OBJECTIVE: To evaluate the predictive accuracy of the Diagnostic Cost Group (DCG) model using health survey information. DATA SOURCES/STUDY SETTING: Longitudinal data collected for a sample of members of a Dutch sickness fund. In the Netherlands the sickness funds provide compulsory health insurance coverage for the 60 percent of the population in the lowest income brackets. STUDY DESIGN: A demographic model and DCG capitation models are estimated by means of ordinary least squares, with an individual's annual healthcare expenditures in 1994 as the dependent variable. For subgroups based on health survey information, costs predicted by the models are compared with actual costs. Using stepwise regression procedures a subset of relevant survey variables that could improve the predictive accuracy of the three-year DCG model was identified. Capitation models were extended with these variables. DATA COLLECTION/EXTRACTION METHODS: For the empirical analysis, panel data of sickness fund members were used that contained demographic information, annual healthcare expenditures, and diagnostic information from hospitalizations for each member. In 1993, a mailed health survey was conducted among a random sample of 15,000 persons in the panel data set, with a 70 percent response rate. PRINCIPAL FINDINGS: The predictive accuracy of the demographic model improves when it is extended with diagnostic information from prior hospitalizations (DCGs). A subset of survey variables further improves the predictive accuracy of the DCG capitation models. The predictable profits and losses based on survey information for the DCG models are smaller than for the demographic model. Most persons with predictable losses based on health survey information were not hospitalized in the preceding year. CONCLUSIONS: The use of diagnostic information from prior hospitalizations is a promising option for improving the demographic capitation payment formula. This study suggests that diagnostic

CAPITAL REQUIREMENTS AND BUSBAR COSTS FOR POWER IN THE OHIO RIVER BASIN, 1985 AND 2000

EPA Science Inventory

This report was prepared as part of the Ohio River Basin Energy Study (ORBES), a multidisciplinary policy research program supported by the Environmental Protection Agency. It provides estimates of capital-output ratios and typical operating costs for the comparison of alternativ...

Falling Particles: Concept Definition and Capital Cost Estimate

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

Stoddard, Larry; Galluzzo, Geoff; Adams, Shannon

2016-06-30

The Department of Energy’s (DOE) Office of Renewable Power (ORP) has been tasked to provide effective program management and strategic direction for all of the DOE’s Energy Efficiency & Renewable Energy’s (EERE’s) renewable power programs. The ORP’s efforts to accomplish this mission are aligned with national energy policies, DOE strategic planning, EERE’s strategic planning, Congressional appropriation, and stakeholder advice. ORP is supported by three renewable energy offices, of which one is the Solar Energy Technology Office (SETO) whose SunShot Initiative has a mission to accelerate research, development and large scale deployment of solar technologies in the United States. SETO hasmore » a goal of reducing the cost of Concentrating Solar Power (CSP) by 75 percent of 2010 costs by 2020 to reach parity with base-load energy rates, and to reduce costs 30 percent further by 2030. The SunShot Initiative is promoting the implementation of high temperature CSP with thermal energy storage allowing generation during high demand hours. The SunShot Initiative has funded significant research and development work on component testing, with attention to high temperature molten salts, heliostats, receiver designs, and high efficiency high temperature supercritical CO 2 (sCO2) cycles.« less

Capital and Operating Cost of Small Arsenic Removal System and their Most Frequent Maintenance Problems

EPA Science Inventory

This presentation will first summarize the capital and operating cost of treatment systems by type and size of the systems. The treatment systems include adsorptive media (AM) systems, iron removal (IR), coagulation/filtration (CF), ion exchange (IX) systems, and point-of-use rev...

Comparing methodologies for the allocation of overhead and capital costs to hospital services.

PubMed

Tan, Siok Swan; van Ineveld, Bastianus Martinus; Redekop, William Ken; Hakkaart-van Roijen, Leona

2009-06-01

Typically, little consideration is given to the allocation of indirect costs (overheads and capital) to hospital services, compared to the allocation of direct costs. Weighted service allocation is believed to provide the most accurate indirect cost estimation, but the method is time consuming. To determine whether hourly rate, inpatient day, and marginal mark-up allocation are reliable alternatives for weighted service allocation. The cost approaches were compared independently for appendectomy, hip replacement, cataract, and stroke in representative general hospitals in The Netherlands for 2005. Hourly rate allocation and inpatient day allocation produce estimates that are not significantly different from weighted service allocation. Hourly rate allocation may be a strong alternative to weighted service allocation for hospital services with a relatively short inpatient stay. The use of inpatient day allocation would likely most closely reflect the indirect cost estimates obtained by the weighted service method.

Direct medical costs and medication compliance among fibromyalgia patients: duloxetine initiators vs. pregabalin initiators.

PubMed

Sun, Peter; Peng, Xiaomei; Sun, Steve; Novick, Diego; Faries, Douglas E; Andrews, Jeffrey S; Wohlreich, Madelaine M; Wu, Andrew

2014-01-01

To assess and compare direct medical costs and medication compliance between patients with fibromyalgia who initiated duloxetine and patients with fibromyalgia who initiated pregabalin in 2008. A retrospective cohort study design was used based on a large US national commercial claims database (2006 to 2009). Patients with fibromyalgia aged 18 to 64 who initiated duloxetine or pregabalin in 2008 and who had continuous health insurance 1 year preceding and 1 year following the initiation were selected into duloxetine cohort or pregabalin cohort based on their initiated agent. Medication compliance was measured by total supply days, medication possession ratio (MPR), and proportion of patients with MPR ≥ 0.8. Direct medical costs were measured by annual costs per patient and compared between the cohorts in the year following the initiation. Propensity score stratification and bootstrapping methods were used to adjust for distribution bias, as well as cross-cohort differences in demographic, clinical and economic characteristics, and medication history prior to the initiation. Both the duloxetine (n = 3,033) and pregabalin (n = 4,838) cohorts had a mean initiation age around 49 years, 89% were women. During the postindex year, compared to the pregabalin cohort, the duloxetine cohort had higher totally annual supply days (273.5 vs. 176.6, P < 0.05), higher MPR (0.7 vs. 0.5, P < 0.05), and more patients with MPR ≥ 0.8 (45.1% vs. 29.4%, P < 0.05). Further, relative to pregabalin cohort, duloxetine cohort had lower inpatient costs ($2,994.9 vs. $4,949.6, P < 0.05), lower outpatient costs ($8,259.6 vs. $10,312.2, P < 0.05), similar medication costs ($5,214.6 vs. $5,290.8, P > 0.05), and lower total medical costs ($16,469.1 vs. $20,552.6, P < 0.05) in the postinitiation year. In a real-world setting, patients with fibromyalgia who initiated duloxetine in 2008 had better medication compliance and consumed less inpatient, outpatient, and total

47 CFR 65.304 - Capital structure.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Capital structure. 65.304 Section 65.304... OF RETURN PRESCRIPTION PROCEDURES AND METHODOLOGIES Exchange Carriers § 65.304 Capital structure. The proportion of each cost of capital component in the capital structure is equal to: Proportion in the capital...

Variation in outpatient mental health service utilization under capitation.

PubMed

Chou, Ann F; Wallace, Neal; Bloom, Joan R; Hu, Teh-Wei

2005-03-01

To improve the financing of Colorado's public mental health system, the state designed, implemented, and evaluated a pilot program that consisted of three reimbursement models for the provision of outpatient services. Community mental health centers (CMHCs), the primary providers of comprehensive mental health services to Medicaid recipients in Colorado, had to search for innovative ways to provide cost-effective services. This study assessed outpatient service delivery to Medicaid-eligible consumers under this program. This paper is among the first to study variations in the delivery of specific types of outpatient mental health services under capitated financing systems. This study uses claims data (1994-1997) from Colorado's Medicaid and Mental Health Services Agency. The fee-for-service (FFS) model served as the comparison model. Two capitated models under evaluation are: (i) direct capitation (DC), where the state contracts with a non-profit entity to provide both the services and administers the capitated financing, and (ii) managed behavioral health organization (MBHO), which is a joint venture between a for-profit company who manages the capitated financing and a number of non-profit entities who deliver the services. A sample of severely mentally ill patients who reported at least one inpatient visit was included in the analysis. Types of outpatient services of interest are: day-treatment visits, group therapy, individual therapy, medication monitoring, case management, testing, and all other services. Comparisons were set up to examine differences in service utilization and cost between FFS and each of the two capitated models, using a two-part model across three time periods. Results showed differences in service delivery among reimbursement models over time. Capitated providers had higher initial utilization in most outpatient service categories than their FFS counterparts and as a result of capitation, outpatient services delivered under these

Capital and operating costs of full-scale fecal sludge management and wastewater treatment systems in Dakar, Senegal.

PubMed

Dodane, Pierre-Henri; Mbéguéré, Mbaye; Sow, Ousmane; Strande, Linda

2012-04-03

A financial comparison of a parallel sewer based (SB) system with activated sludge, and a fecal sludge management (FSM) system with onsite septic tanks, collection and transport (C&T) trucks, and drying beds was conducted. The annualized capital for the SB ($42.66 capita(-1) year(-1)) was ten times higher than the FSM ($4.05 capita(-1) year(-1)), the annual operating cost for the SB ($11.98 capita(-1) year(-1)) was 1.5 times higher than the FSM ($7.58 capita(-1) year(-1)), and the combined capital and operating for the SB ($54.64 capita(-1) year(-1)) was five times higher than FSM ($11.63 capita(-1) year(-1)). In Dakar, costs for SB are almost entirely borne by the sanitation utility, with only 6% of the annualized cost borne by users of the system. In addition to costing less overall, FSM operates with a different business model, with costs spread among households, private companies, and the utility. Hence, SB was 40 times more expensive to implement for the utility than FSM. However, the majority of FSM costs are borne at the household level and are inequitable. The results of the study illustrate that in low-income countries, vast improvements in sanitation can be affordable when employing FSM, whereas SB systems are prohibitively expensive.

Capital and Operating Costs of Full-Scale Fecal Sludge Management and Wastewater Treatment Systems in Dakar, Senegal

PubMed Central

2012-01-01

A financial comparison of a parallel sewer based (SB) system with activated sludge, and a fecal sludge management (FSM) system with onsite septic tanks, collection and transport (C&T) trucks, and drying beds was conducted. The annualized capital for the SB ($42.66 capita–1 year–1) was ten times higher than the FSM ($4.05 capita–1 year–1), the annual operating cost for the SB ($11.98 capita–1 year–1) was 1.5 times higher than the FSM ($7.58 capita–1 year–1), and the combined capital and operating for the SB ($54.64 capita–1 year–1) was five times higher than FSM ($11.63 capita–1 year–1). In Dakar, costs for SB are almost entirely borne by the sanitation utility, with only 6% of the annualized cost borne by users of the system. In addition to costing less overall, FSM operates with a different business model, with costs spread among households, private companies, and the utility. Hence, SB was 40 times more expensive to implement for the utility than FSM. However, the majority of FSM costs are borne at the household level and are inequitable. The results of the study illustrate that in low-income countries, vast improvements in sanitation can be affordable when employing FSM, whereas SB systems are prohibitively expensive. PMID:22413875

Cost trend analysis of initial cancer treatment in Taiwan.

PubMed

Li, Tsai-Yun; Hsieh, Jan-Sing; Lee, King-Teh; Hou, Ming-Feng; Wu, Chia-Ling; Kao, Hao-Yun; Shi, Hon-Yi

2014-01-01

Despite the high cost of initial cancer care, that is, care in the first year after diagnosis, limited information is available for specific categories of cancer-related costs, especially costs for specific services. This study purposed to identify causes of change in cancer treatment costs over time and to perform trend analyses of the percentage of cancer patients who had received a specific treatment type and the mean cost of care for patients who had received that treatment. The analysis of trends in initial treatment costs focused on cancer-related surgery, chemotherapy, radiation therapy, and treatments other than active treatments. For each cancer-specific trend, slopes were calculated for regression models with 95% confidence intervals. Analyses of patients diagnosed in 2007 showed that the National Health Insurance (NHI) system paid, on average, $10,780 for initial care of a gastric cancer patient and $10,681 for initial care of a lung cancer patient, which were inflation-adjusted increases of $6,234 and $5,522, respectively, over the 1996 care costs. During the same interval, the mean NHI payment for initial care for the five specific cancers increased significantly (p<0.05). Hospitalization costs comprised the largest portion of payments for all cancers. During 1996-2007, the use of chemotherapy and radiation therapy significantly increased in all cancer types (p<0.05). In 2007, NHI payments for initial care for these five cancers exceeded $12 billion, and gastric and lung cancers accounted for the largest share. In addition to the growing number of NHI beneficiaries with cancer, treatment costs and the percentage of patients who undergo treatment are growing. Therefore, the NHI must accurately predict the economic burden of new chemotherapy agents and radiation therapies and may need to develop programs for stratifying patients according to their potential benefit from these expensive treatments.

48 CFR 215.404-71-4 - Facilities capital employed.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the facilities capital cost of money and capital employed using— (1) An analysis of the appropriate Forms CASB-CMF and cost of money factors (48 CFR 9904.414 and FAR 31.205-10); and (2) DD Form 1861, Contract Facilities Capital Cost of Money. (c) Use of DD Form 1861. See PGI 215.404-71-4(c) for obtaining...

48 CFR 215.404-71-4 - Facilities capital employed.

Code of Federal Regulations, 2012 CFR

2012-10-01

... the facilities capital cost of money and capital employed using— (1) An analysis of the appropriate Forms CASB-CMF and cost of money factors (48 CFR 9904.414 and FAR 31.205-10); and (2) DD Form 1861, Contract Facilities Capital Cost of Money. (c) Use of DD Form 1861. See PGI 215.404-71-4(c) for obtaining...

48 CFR 215.404-71-4 - Facilities capital employed.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the facilities capital cost of money and capital employed using— (1) An analysis of the appropriate Forms CASB-CMF and cost of money factors (48 CFR 9904.414 and FAR 31.205-10); and (2) DD Form 1861, Contract Facilities Capital Cost of Money. (c) Use of DD Form 1861. See PGI 215.404-71-4(c) for obtaining...

Costing the Australian National Hand Hygiene Initiative.

PubMed

Page, K; Barnett, A G; Campbell, M; Brain, D; Martin, E; Fulop, N; Graves, N

2014-11-01

The Australian National Hand Hygiene Initiative (NHHI) is a major patient safety programme co-ordinated by Hand Hygiene Australia (HHA) and funded by the Australian Commission for Safety and Quality in Health Care. The annual costs of running this programme need to be understood to know the cost-effectiveness of a decision to sustain it as part of health services. To estimate the annual health services cost of running the NHHI; the set-up costs are excluded. A health services perspective was adopted for the costing and collected data from the 50 largest public hospitals in Australia that implemented the initiative, covering all states and territories. The costs of HHA, the costs to the state-level infection-prevention groups, the costs incurred by each acute hospital, and the costs for additional alcohol-based hand rub are all included. The programme cost AU$5.56 million each year (US$5.76, £3.63 million). Most of the cost is incurred at the hospital level (65%) and arose from the extra time taken for auditing hand hygiene compliance and doing education and training. On average, each infection control practitioner spent 5h per week on the NHHI, and the running cost per annum to their hospital was approximately AU$120,000 in 2012 (US$124,000, £78,000). Good estimates of the total costs of this programme are fundamental to understanding the cost-effectiveness of implementing the NHHI. This paper reports transparent costing methods, and the results include their uncertainty. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

[Smoking-attributable productivity loss in Germany--a partial sickness cost study based on the human capital potential method].

PubMed

Wegner, C; Gutsch, A; Hessel, F; Wasem, J

2004-07-01

Costs of productivity loss for the Federal Republic of Germany attributable to smoking in 1999 was to be determined. Mortality and morbidity attributable to smoking is determined by a 0.5 % sample of the smoking behaviour of the German population (microcensus 1999) and the relative mortality risks of smokers (US-American cancer prevention study II). Tobacco smoke-associated cancer illnesses, cardiovascular diseases, respiratory tract diseases and illnesses of children under one year are considered. Calculation of the productivity-relevant consequences of smoking due to morbidity and mortality is effected according to the so-called human potential capital method. In Germany total of 607,393 working years were lost because of smoking in the year 1999. The costs of productivity loss are estimated at 14,480 billion euro. From this 4,525 billion euro are allotted to premature mortality, 5.759 billion euro to permanent disablement and 4.196 billion euro to temporary incapacitation for work. If the costs of productivity loss by smoking are referred to the gross national product (BSP) in the year 1999, an economical damage at a value of 0.74 % of BSPs results. This corresponds to a productivity loss of 379 euro per present or former smoker. The sensitivity analysis manifests that the inclusion of "non-marketable production" results in an immense rise productivity losses attributable to smoking. However, it should be noted that in times of mass unemployment the human capital method which is based on full employment does not measure the actual, but only the potential productivity loss cost. This partial disease cost study shows that immense economic productivity losses are associated with smoking. This loss of resources can justify a purposeful promotion of studies regarding cost effectiveness of anti-smoking therapeutic measures or preventive measures against smoking. But it should be considered that the use of the human potential capital method results in an overestimation

Metabolic costs of capital energy storage in a small-bodied ectotherm.

PubMed

Griffen, Blaine D

2017-04-01

Reproduction is energetically financed using strategies that fall along a continuum from animals that rely on stored energy acquired prior to reproduction (i.e., capital breeders) to those that rely on energy acquired during reproduction (i.e., income breeders). Energy storage incurs a metabolic cost. However, previous studies suggest that this cost may be minimal for small-bodied ectotherms. Here I test this assumption. I use a laboratory feeding experiment with the European green crab Carcinus maenas to establish individuals with different amounts of energy storage. I then demonstrate that differences in energy storage account for 26% of the variation in basal metabolic costs. The magnitudes of these costs for any individual crab vary through time depending on the amount of energy it has stored, as well as on temperature-dependent metabolism. I use previously established relationships between temperature- and mass-dependent metabolic rates, combined with a feasible annual pattern of energy storage in the Gulf of Maine and annual sea surface temperature patterns in this region, to estimate potential annual metabolic costs expected for mature female green crabs. Results indicate that energy storage should incur an ~8% increase in metabolic costs for female crabs, relative to a hypothetical crab that did not store any energy. Translated into feeding, for a medium-sized mature female (45 mm carapace width), this requires the consumption of an additional ~156 mussels annually to support the metabolic cost of energy storage. These results indicate, contrary to previous assumptions, that the cost of energy storage for small-bodied ectotherms may represent a considerable portion of their basic operating energy budget. An inability to meet these additional costs of energy storage may help explain the recent decline of green crabs in the Gulf of Maine where reduced prey availability and increased consumer competition have combined to hamper green crab foraging success in

Assessing the cost of electronic health records: a review of cost indicators.

PubMed

Gallego, Ana Isabel; Gagnon, Marie-Pierre; Desmartis, Marie

2010-11-01

We systematically reviewed PubMed and EBSCO business, looking for cost indicators of electronic health record (EHR) implementations and their associated benefit indicators. We provide a set of the most common cost and benefit (CB) indicators used in the EHR literature, as well as an overall estimate of the CB related to EHR implementation. Overall, CB evaluation of EHR implementation showed a rapid capital-recovering process. On average, the annual benefits were 76.5% of the first-year costs and 308.6% of the annual costs. However, the initial investments were not recovered in a few studied implementations. Distinctions in reporting fixed and variable costs are suggested.

Learning Curve for Seawater Reverse Osmosis Desalination Plants: Capital Cost Trend of the Past, Present, and Future

NASA Astrophysics Data System (ADS)

Caldera, Upeksha; Breyer, Christian

2017-12-01

Seawater reverse osmosis (SWRO) desalination is expected to play a pivotal role in helping to secure future global water supply. While the global reliance on SWRO plants for water security increases, there is no consensus on how the capital costs of SWRO plants will vary in the future. The aim of this paper is to analyze the past trends of the SWRO capital expenditures (capex) as the historic global cumulative online SWRO capacity increases, based on the learning curve concept. The SWRO capex learning curve is found based on 4,237 plants that came online from 1977 to 2015. A learning rate of 15% is determined, implying that the SWRO capex reduced by 15% when the cumulative capacity was doubled. Based on SWRO capacity annual growth rates of 10% and 20%, by 2030, the global average capex of SWRO plants is found to fall to 1,580 USD/(m3/d) and 1,340 USD/(m3/d), respectively. A learning curve for SWRO capital costs has not been presented previously. This research highlights the potential for decrease in SWRO capex with the increase in installation of SWRO plants and the value of the learning curve approach to estimate future SWRO capex.

47 CFR 36.182 - Cash working capital.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Cash working capital. 36.182 Section 36.182... PROCEDURES; STANDARD PROCEDURES FOR SEPARATING TELECOMMUNICATIONS PROPERTY COSTS, REVENUES, EXPENSES, TAXES... Cash Working Capital § 36.182 Cash working capital. (a) The amount for cash working capital, if not...

CAPITATION IN HEALTHCARE FINANCING IN GHANA.

PubMed

Aboagye, A Q Q

2013-05-01

To analyse implementation of the pilot study of the per capita system of healthcare financing in Ghana in 2012 for a determination of the likelihood of realising the inherent theoretical benefits when the system is rolled out nationally. First, publicly available information on how the pilot unfolded is presented, followed by the reaction of the health authorities to these developments. We then analysed accrued evidence on costs and developments vis-à-vis the theoretical benefits. It would appear that preparation for the pilot exercise could have been handled better. Concerns include i) the low level of both education and awareness of the capitation system among healthcare subscribers and primary care providers; ii) confusion about service provider to whom subscribers had been assigned for the capitation period; and iii) service providers not understanding differences between capitation financing and financing under the Ghana diagnostic Related Grouping; and iv) some indication of cost savings. Cost savings may be available nationally. This is important because cost containment is the driving force behind the introduction of the capitation system.

Analysis of nursing home capital reimbursement systems

PubMed Central

Boerstler, Heidi; Carlough, Tom; Schlenker, Robert E.

1991-01-01

An increasing number of States are using a fair-rental approach for reimbursement of nursing home capital costs. In this study, two variants of the fair-rental capital-reimbursement approach are compared with the traditional cost-based approach in terms of after-tax cash flow to the investor, cost to the State, and rate of return to investor. Simulation models were developed to examine the effects of each capital-reimbursement approach both at specific points in time and over various periods of time. Results indicate that although long-term costs were similar for the three systems, both fair-rental approaches may be superior to the traditional cost-based approach in promoting and controlling industry stability and, at the same time, in providing an adequate return to investors. PMID:10110878

A life cycle cost economics model for projects with uniformly varying operating costs. [management planning

NASA Technical Reports Server (NTRS)

Remer, D. S.

1977-01-01

A mathematical model is developed for calculating the life cycle costs for a project where the operating costs increase or decrease in a linear manner with time. The life cycle cost is shown to be a function of the investment costs, initial operating costs, operating cost gradient, project life time, interest rate for capital and salvage value. The results show that the life cycle cost for a project can be grossly underestimated (or overestimated) if the operating costs increase (or decrease) uniformly over time rather than being constant as is often assumed in project economic evaluations. The following range of variables is examined: (1) project life from 2 to 30 years; (2) interest rate from 0 to 15 percent per year; and (3) operating cost gradient from 5 to 90 percent of the initial operating costs. A numerical example plus tables and graphs is given to help calculate project life cycle costs over a wide range of variables.

Breast and prostate cancer productivity costs: a comparison of the human capital approach and the friction cost approach.

PubMed

Hanly, Paul; Timmons, Aileen; Walsh, Paul M; Sharp, Linda

2012-05-01

Productivity costs constitute a substantial proportion of the total societal costs associated with cancer. We compared the results of applying two different analytical methods--the traditional human capital approach (HCA) and the emerging friction cost approach (FCA)--to estimate breast and prostate cancer productivity costs in Ireland in 2008. Data from a survey of breast and prostate cancer patients were combined with population-level survival estimates and a national wage data set to calculate costs of temporary disability (cancer-related work absence), permanent disability (workforce departure, reduced working hours), and premature mortality. For breast cancer, productivity costs per person using the HCA were € 193,425 and those per person using the FCA were € 8,103; for prostate cancer, the comparable estimates were € 109,154 and € 8,205, respectively. The HCA generated higher costs for younger patients (breast cancer) because of greater lifetime earning potential. In contrast, the FCA resulted in higher productivity costs for older male patients (prostate cancer) commensurate with higher earning capacity over a shorter time period. Reduced working hours postcancer was a key driver of total HCA productivity costs. HCA costs were sensitive to assumptions about discount and growth rates. FCA costs were sensitive to assumptions about the friction period. The magnitude of the estimates obtained in this study illustrates the importance of including productivity costs when considering the economic impact of illness. Vastly different results emerge from the application of the HCA and the FCA, and this finding emphasizes the importance of choosing the study perspective carefully and being explicit about assumptions that underpin the methods. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

10 CFR Appendix I to Part 504 - Procedures for the Computation of the Real Cost of Capital

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Procedures for the Computation of the Real Cost of Capital I Appendix I to Part 504 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS EXISTING... parameters specified above are not obtainable, alternate parameters that closely correspond to those above...

10 CFR Appendix I to Part 504 - Procedures for the Computation of the Real Cost of Capital

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Procedures for the Computation of the Real Cost of Capital I Appendix I to Part 504 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS EXISTING... obtainable, alternate parameters that closely correspond to those above may be used. This may include...

10 CFR Appendix I to Part 504 - Procedures for the Computation of the Real Cost of Capital

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Procedures for the Computation of the Real Cost of Capital I Appendix I to Part 504 Energy DEPARTMENT OF ENERGY (CONTINUED) ALTERNATE FUELS EXISTING... parameters specified above are not obtainable, alternate parameters that closely correspond to those above...

Solar Access to Public Capital (SAPC) Mock Securitization Project

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

Mendelsohn, Michael; Lowder, Travis; Rottman, Mary

In late 2012, the National Renewable Energy Laboratory (NREL) initiated the Solar Access to Public Capital (SAPC) working group. Backed by a three-year funding facility from the U.S. Department of Energy (DOE), NREL set out to organize the solar, legal, banking, capital markets, engineering, and other relevant stakeholder communities in order to open lower-cost debt investment for solar asset deployment. SAPC engaged its members to standardize contracts, develop best practices, and comprehend how the rating agencies perceive solar project portfolios as an investment asset class. Rating agencies opine on the future creditworthiness of debt obligations. Issuers often seek investment-grade ratingsmore » from the rating agencies in order to satisfy the desires of their investors. Therefore, for the solar industry to access larger pools of capital at a favorable cost, it is critical to increase market participants' understanding of solar risk parameters. The process provided valuable information to address rating agency perceptions of risk that, without such information, could require costly credit enhancement or higher yields to attract institutional investors. Two different securities were developed--one for a hypothetical residential solar portfolio and one for a hypothetical commercial solar portfolio. Five rating agencies (Standard and Poor's, Moody's, KBRA, Fitch, and DBRS) participated and provided extensive feedback, some through conversations that extended several months. The findings represented in this report are a composite summary of that feedback and do not indicate any specific feedback from any single rating agency.« less

Next Generation Safeguards Initiative Efforts at Los Alamos National Laboratory: Developing Our Human Capital FY2015

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

Stevens, Rebecca S.; Hawkins Erpenbeck, Heather

2015-10-13

This report documents the accomplishments of the Safeguards HCD Fiscal Year 2015 (FY15) Project Work Plan, highlighting LANL’s work as well as the accomplishments of our NGSI-sponsored students, graduate and postdoctoral fellows, and mid-career professionals during this past year. While fiscal year 2015 has been a year of transition in the Human Capital Development area for LANL, we are working to revitalize our efforts to promote and develop Human Capital in Safeguards and Non-proliferation and are looking forward to implementing new initiatives in the coming fiscal year and continuing to transition the knowledge of staff who have been on assignmentmore » at IAEA and Headquarters to improve our support to HCD.« less

Effect of costing methods on unit cost of hospital medical services.

PubMed

Riewpaiboon, Arthorn; Malaroje, Saranya; Kongsawatt, Sukalaya

2007-04-01

To explore the variance of unit costs of hospital medical services due to different costing methods employed in the analysis. Retrospective and descriptive study at Kaengkhoi District Hospital, Saraburi Province, Thailand, in the fiscal year 2002. The process started with a calculation of unit costs of medical services as a base case. After that, the unit costs were re-calculated based on various methods. Finally, the variations of the results obtained from various methods and the base case were computed and compared. The total annualized capital cost of buildings and capital items calculated by the accounting-based approach (averaging the capital purchase prices throughout their useful life) was 13.02% lower than that calculated by the economic-based approach (combination of depreciation cost and interest on undepreciated portion over the useful life). A change of discount rate from 3% to 6% results in a 4.76% increase of the hospital's total annualized capital cost. When the useful life of durable goods was changed from 5 to 10 years, the total annualized capital cost of the hospital decreased by 17.28% from that of the base case. Regarding alternative criteria of indirect cost allocation, unit cost of medical services changed by a range of -6.99% to +4.05%. We explored the effect on unit cost of medical services in one department. Various costing methods, including departmental allocation methods, ranged between -85% and +32% against those of the base case. Based on the variation analysis, the economic-based approach was suitable for capital cost calculation. For the useful life of capital items, appropriate duration should be studied and standardized. Regarding allocation criteria, single-output criteria might be more efficient than the combined-output and complicated ones. For the departmental allocation methods, micro-costing method was the most suitable method at the time of study. These different costing methods should be standardized and developed as

A contemporary perspective on capitated reimbursement for imaging services.

PubMed

Schwartz, H W

1995-01-01

Capitation ensures predictability of healthcare costs, requires acceptance of a premium in return for providing all required medical services and defines the actual dollar amount paid to a physician or hospital on a per member per month basis for a service or group of services. Capitation is expected to dramatically affect the marketplace in the near future, as private enterprise demands lower, more stable healthcare costs. Capitation requires detailed quantitative and financial data, including: eligibility and benefits determination, encounter processing, referral management, claims processing, case management, physician compensation, insurance management functions, outcomes reporting, performance management and cost accounting. It is important to understand actuarial risk and capitation marketing when considering a capitation contract. Also, capitated payment methodologies may vary to include modified fee-for-service, incentive pay, risk pool redistributions, merit, or a combination. Risk is directly related to the ability to predict utilization and unit cost of imaging services provided to a specific insured population. In capitated environments, radiologists will have even less control over referrals than they have today and will serve many more "covered lives"; long-term relationships with referring physicians will continue to evaporate; and services will be provided under exclusive, multi-year contracts. In addition to intensified use of technology for image transfer, telecommunications and sophisticated data processing and tracking systems, imaging departments must continue to provide the greatest amount of appropriate diagnostic information in a timely fashion at the lowest feasible cost and risk to the patient.

Academic health systems management: the rationale behind capitated contracts.

PubMed

Taheri, P A; Butz, D A; Greenfield, L J

2000-06-01

To determine why hospitals enter into "capitated" contracts, which often generate accounting losses. The authors' hypothesis is that hospitals coordinate contracts to keep beds full and that in principal, capitated contracts reflect sound capacity management. In high-overhead industries, different consumers pay different prices for similar services (e.g., full-fare vs. advanced-purchase plane tickets, full tuition vs. financial aid). Some consumers gain access by paying less than total cost. Hospitals, like other high-overhead business enterprises, must optimize the use of their capacity, amortizing overhead over as many patients as possible. This necessity for enhanced throughput forces hospitals and health systems to discount empty beds, sometimes to the point where they incur accounting losses serving some payors. The authors analyzed the cost accounting system at their university teaching hospital to compare hospital and intensive care unit (ICU) lengths of stay (LOS), variable direct costs (VDC), overhead of capitated patients, and reimbursement versus other payors for all hospital discharges (n = 29,036) in fiscal year 1998. The data were analyzed by diagnosis-related groups (DRGs), length of stay (LOS), insurance carrier, proximity to hospital, and discharge disposition. Patients were then distinguished across payor categories based on their resource utilization, proximity to the hospital, DRG, LOS, and discharge status. The mean cost for capitated patients was $4,887, less than half of the mean cost of $10,394 for the entire hospitalized population. The mean capitated reimbursement was $928/day, exceeding the mean daily VDC of $616 but not the total cost of $1,445/day. Moreover, the mean total cost per patient day of treating a capitated patient was $400 less than the mean total cost per day for noncapitated patients. The hospital's capitated health maintenance organization (HMO) patients made up 16. 0% of the total admissions but only 9.4% of the total

13 CFR 107.240 - Limitations on including non-cash capital contributions in Private Capital.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) Licensee from its parent Licensee, valued at the lower of cost or fair value. (e) Other non-cash assets... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Limitations on including non-cash... Sbic § 107.240 Limitations on including non-cash capital contributions in Private Capital. Non-cash...

Semantic preview benefit in reading English: The effect of initial letter capitalization.

PubMed

Rayner, Keith; Schotter, Elizabeth R

2014-08-01

A major controversy in reading research is whether semantic information is obtained from the word to the right of the currently fixated word (word n + 1). Although most evidence has been negative in English, semantic preview benefit has been observed for readers of Chinese and German. In the present experiment, we investigated whether the discrepancy between English and German may be attributable to a difference in visual properties of the orthography: the first letter of a noun is always capitalized in German, but is only occasionally capitalized in English. This visually salient property may draw greater attention to the word during parafoveal preview and thus increase preview benefit generally (and lead to a greater opportunity for semantic preview benefit). We used English target nouns that can either be capitalized (e.g., We went to the critically acclaimed Ballet of Paris while on vacation.) or not (e.g., We went to the critically acclaimed ballet that was showing in Paris.) and manipulated the capitalization of the preview accordingly, to determine whether capitalization modulates preview benefit in English. The gaze-contingent boundary paradigm was used with identical, semantically related, and unrelated previews. Consistent with our hypothesis, we found numerically larger preview benefits when the preview/target was capitalized than when it was lowercase. Crucially, semantic preview benefit was not observed when the preview/target word was not capitalized, but was observed when the preview/target word was capitalized.

Semantic Preview Benefit in Reading English: The Effect of Initial Letter Capitalization

PubMed Central

Rayner, Keith; Schotter, Elizabeth R.

2014-01-01

A major controversy in reading research is whether semantic information is obtained from the word to the right of the currently fixated word (word n+1). While most evidence has been negative in English, semantic preview benefit has been observed for readers of Chinese and German. In the present experiment, we investigated whether the discrepancy between English and German may be due to a difference in visual properties of the orthography: the first letter of a noun is always capitalized in German, but is only occasionally capitalized in English. This visually salient property may draw greater attention to the word during parafoveal preview and thus increase preview benefit generally (and lead to a greater opportunity for semantic preview benefit). We used English target nouns that can either be capitalized (e.g., We went to the critically acclaimed Ballet of Paris while on vacation.) or not (e.g., We went to the critically acclaimed ballet that was showing in Paris.) and manipulated the capitalization of the preview accordingly, to determine if capitalization modulates preview benefit in English. The gaze-contingent boundary paradigm was used with identical, semantically related, and unrelated previews. Consistent with our hypothesis, we found numerically larger preview benefits when the preview/target was capitalized than when it was lowercase. Crucially, semantic preview benefit was not observed when the preview/target word was not capitalized, but was observed when the preview/target word was capitalized. PMID:24820439

Evolutionary cost analysis of valsartan initiation among patients with hypertension: a time series approach.

PubMed

Sun, Peter; Chang, Joanne; Zhang, Jie; Kahler, Kristijan H

2012-01-01

This study examines the evolutionary impact of valsartan initiation on medical costs. A retrospective time series study design was used with a large, US national commercial claims database for the period of 2004-2008. Hypertensive patients who initiated valsartan between the ages of 18 and 63, and had continuous enrollment for 24-month pre-initiation period and 24-month post-initiation period were selected. Patients' monthly medical costs were calculated based on individual claims. A novel time series model was devised with monthly medical costs as its dependent variables, autoregressive integrated moving average (ARIMA) as its stochastic components, and four indicative variables as its decomposed interventional components. The number of post-initiation months before a cost-offset point was also assessed. Patients (n = 18,269) had mean age of 53 at the initiation date, and 53% of them were female. The most common co-morbid conditions were dyslipidemia (52%), diabetes (24%), and hypertensive complications (17%). The time series model suggests that medical costs were increasing by approximately $10 per month (p < 0.01) before the initiation, and decreasing by approximately $6 per month (p < 0.01) after the initiation. After the 4th post-initiation month, medical costs for patients with the initiation were statistically significantly lower (p < 0.01) than forecasted medical costs for the same patients without the initiation. The study has its limitations in data representativeness, ability to collect unrecorded clinical conditions, treatments, and costs, as well as its generalizability to patients with different characteristics. Commercially insured hypertensive patients experienced monthly medical cost increase before valsartan initiation. Based on our model, the evolutionary impact of the initiation on medical costs included a temporary cost surge, a gradual, consistent, and statistically significant cost decrease, and a cost-offset point around the

Trends in Opportunity Costs of U.S. Postsecondary Education: A National HRD and Human Capital Theory Analysis

ERIC Educational Resources Information Center

Cornacchione, Edgard; Daugherty, Jenny L.

2013-01-01

The purpose of this study was to explore opportunity costs of postsecondary education in the U.S. in the past three decades (1975-2005), as a measure to support investment decisions at national levels and as experienced by individuals deciding on pursuing further education. Based on human capital theory and inspired by a set of studies aiming at…

Middleman Minorities and Advanced Capitalism.

ERIC Educational Resources Information Center

Bonacich, Edna

1980-01-01

Argues against the notion that advanced capitalism is not conducive to the functioning of middleman entrepreneurial minorities. Holds that ethnic groups are sometimes able to use communal solidarity to keep their costs down, and that within advanced capitalism there is still a place for groups with petit bourgeois specialities. (Author/GC)

Capitation among Medicare beneficiaries.

PubMed

Bazos, D A; Fisher, E S

1999-01-01

The Medicare program has promoted capitation as a way to contain costs. About 15% of Medicare beneficiaries nationwide are currently under capitation, but tremendous regional variation exists. The proportion of Medicare beneficiaries who have enrolled in risk-contract plans in individual states and in the 25 largest metropolitan areas in the United States. Health Care Financing Administration data files. Medicare beneficiaries are most likely to be under capitation in Arizona (38%) and California (37%). Eight other states have capitation rates greater than 20%: Colorado, Florida, Rhode Island, Oregon, Washington, Pennsylvania, Massachusetts, and Nevada. Thirty states, largely in the Great Plains area and the southern United States, have capitation rates less than 10%. Four major metropolitan areas have market penetration rates greater than 40%: San Bernardino, California; San Diego, California; Phoenix, Arizona; and Miami, Florida. Little penetration exists outside of metropolitan areas. Capitation in Medicare is a regional and predominantly an urban phenomenon.

Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia

PubMed Central

Graves, Nicholas; Page, Katie; Martin, Elizabeth; Brain, David; Hall, Lisa; Campbell, Megan; Fulop, Naomi; Jimmeison, Nerina; White, Katherine; Paterson, David; Barnett, Adrian G.

2016-01-01

Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011–2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand

Academic Health Systems Management: The Rationale Behind Capitated Contracts

PubMed Central

Taheri, Paul A.; Butz, David A.; Greenfield, Lazar J.

2000-01-01

Objective To determine why hospitals enter into “capitated” contracts, which often generate accounting losses. The authors’ hypothesis is that hospitals coordinate contracts to keep beds full and that in principal, capitated contracts reflect sound capacity management. Summary Background Data In high-overhead industries, different consumers pay different prices for similar services (e.g., full-fare vs. advanced-purchase plane tickets, full tuition vs. financial aid). Some consumers gain access by paying less than total cost. Hospitals, like other high-overhead business enterprises, must optimize the use of their capacity, amortizing overhead over as many patients as possible. This necessity for enhanced throughput forces hospitals and health systems to discount empty beds, sometimes to the point where they incur accounting losses serving some payors. Methods The authors analyzed the cost accounting system at their university teaching hospital to compare hospital and intensive care unit (ICU) lengths of stay (LOS), variable direct costs (VDC), overhead of capitated patients, and reimbursement versus other payors for all hospital discharges (n = 29,036) in fiscal year 1998. The data were analyzed by diagnosis-related groups (DRGs), length of stay (LOS), insurance carrier, proximity to hospital, and discharge disposition. Patients were then distinguished across payor categories based on their resource utilization, proximity to the hospital, DRG, LOS, and discharge status. Results The mean cost for capitated patients was $4,887, less than half of the mean cost of $10,394 for the entire hospitalized population. The mean capitated reimbursement was $928/day, exceeding the mean daily VDC of $616 but not the total cost of $1,445/day. Moreover, the mean total cost per patient day of treating a capitated patient was $400 less than the mean total cost per day for noncapitated patients. The hospital’s capitated health maintenance organization (HMO) patients made up 16

48 CFR 215.404-71-4 - Facilities capital employed.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., and equipment, as derived in DD Form 1861, Contract Facilities Capital Cost of Money. (i) In addition... facilities capital, the allocated facilities capital attributable to the buildings and equipment of those... Equipment 17.5 10 to 25 (g) Evaluation criteria. (1) In evaluating facilities capital employed, the...

Measuring human capital cost through benchmarking in health care environment.

PubMed

Kocakülâh, Mehmet C; Harris, Donna

2002-01-01

Each organization should seek to maximize its human capital investments, which ultimately lead to increased profits and asset efficiency. Service companies utilize less capital equipment and more human productivity, customer service, and/or delivery of service as the product. With the measurement of human capital, one can understand what is happening, exercise some degree of control, and make positive changes. Senior management lives or dies by the numbers and if Human Resources (HR) really wants to be a strategic business partner, HR must be judged by the same standards as everyone else in the health care organization.

Capital optimization: linking investment with strategic intent.

PubMed

Fine, Allan; Bacchetti, J Alex

2004-01-01

With operating margins showing some improvement in 2003, Y2K being a distant memory, and many critical capital investment decisions delayed as long as possible, hospitals have been on a relative spending spree, building new facilities, renovating operating rooms and inpatient units, and investing in new medical and information technologies. However, with pressure on both cost and revenue expected to continue, if not increase, this spending spree may be short-lived, and hospitals must improve their capital planning efforts; align them with their mission, vision, and strategies; and ensure that capital is available when unplanned or even expected needs arise. This article explores some of the challenges that hospitals face in their capital planning efforts and, more importantly, suggests the necessity for hospitals to integrate capital and strategic planning. Capital planning must be driven by an organization's strategies; however, we also argue that an organization's ability to execute its strategies is highly dependent on the existence of a cohesive capital prioritization and planning process. In this article, we explore a number of issues critical to developing a comprehensive capital plan, including estimating capital costs, evaluating and designing strategies to contend with risk, saving for the proverbial "rainy day," and recognizing the role and value of philanthropy, while challenging some conventional thinking of hospital executives with respect to investment, growth, and planning.

Regulation, the capital-asset pricing model, and the arbitrage pricing theory

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

Roll, R.W.; Ross, S.A.

1983-05-26

This article describes the arbitrage pricing theory (APT) as and compares it with the capital-asset pricing model (CAPM) as a tool for computing the cost of capital in utility regulatory proceedings. The article argues that the APT is a significantly superior method for determining equity cost, and demonstrates that its application to utilities derives more-sensible estimates of the cost of equity capital than the CAPM. 8 references, 1 figure, 2 tables.

Healthcare utilization and costs for patients initiating Dabigatran or Warfarin.

PubMed

Reynolds, Shannon L; Ghate, Sameer R; Sheer, Richard; Gandhi, Pranav K; Moretz, Chad; Wang, Cheng; Sander, Stephen; Costantino, Mary E; Annavarapu, Srinivas; Andrews, George

2017-06-21

Novel oral anticoagulants (NOAC) such as dabigatran, when compared to warfarin, have been shown to potentially reduce the risk of stroke in patients with non-valvular atrial fibrillation (NVAF) together with lower healthcare resource utilization (HCRU) and similar total costs. This study expands on previous work by comparing HCRU and costs for patients newly diagnosed with NVAF and newly initiated on dabigatran or warfarin, and is the first study specifically in a Medicare population. A retrospective matched-cohort study was conducted using data from administrative health care claims during the study period 01/01/2010-12/31/2012. Cox regression analyses were used to compare all-cause risk of first hospitalizations and emergency room (ER) visits. Medical, pharmacy, and total costs per-patient-per-month (PPPM) were compared between dabigatran and warfarin users. A total of 1110 patients initiated on dabigatran were propensity score-matched with corresponding patients initiated on warfarin. The mean number of hospitalizations (0.92 vs. 1.13, P = 0.012), ER visits (1.32 vs. 1.56, P < 0.01), office visits (21.43 vs. 29.41; P < 0.01), and outpatient visits (10.86 vs. 22.02; P < 0.01) were lower among dabigatran compared to warfarin users. Patients initiated on dabigatran had significantly lower risk of first all-cause ER visits [hazard ratio (HR): 0.84, 95% confidence interval (CI): 0.73-0.98] compared to those initiated on warfarin. Adjusted mean pharmacy costs PPPM were significantly greater for dabigatran users ($510 vs. $250, P < 0.001); however, mean medical costs PPPM ($1912 vs. $1956, P = 0.55) and mean total costs PPPM ($2381 vs. $2183, P = 0.10) were not significantly different compared to warfarin users. Dabigatran users had significantly lower HCRU compared to warfarin users. In addition, dabigatran users had lower risk of all-cause ER visits. Despite higher pharmacy costs, the two cohorts did not differ significantly in medical or total all

26 CFR 1.179B-1T - Deduction for capital costs incurred in complying with Environmental Protection Agency sulfur...

Code of Federal Regulations, 2010 CFR

2010-04-01

... complying with Environmental Protection Agency sulfur regulations (temporary). 1.179B-1T Section 1.179B-1T... capital costs incurred in complying with Environmental Protection Agency sulfur regulations (temporary... business refiner to comply with the highway diesel fuel sulfur control requirements of the Environmental...

26 CFR 1.179B-1T - Deduction for capital costs incurred in complying with Environmental Protection Agency sulfur...

Code of Federal Regulations, 2014 CFR

2014-04-01

... complying with Environmental Protection Agency sulfur regulations (temporary). 1.179B-1T Section 1.179B-1T... Deduction for capital costs incurred in complying with Environmental Protection Agency sulfur regulations... small business refiner to comply with the highway diesel fuel sulfur control requirements of the...

Efficiency, new equity capital enable systems to compete.

PubMed

Brown, M; McCool, B P

1985-01-01

Because of limited cash, sponsors of some community and religious hospitals have sought to sell or lease their institutions to a not-for-profit (NFP) system or to a for-profit system. A number of national alliances address the capital formation problem of NFP institutions. Until now they have been almost exclusively concerned with acquiring less costly debt. Without new equity capital, market influence is difficult to obtain. Even well-managed voluntary systems face a serious threat from well-capitalized investor-owned systems. Increased competition among hospitals and physicians will force future advantages to those who have capital. It will also restrict funding of certain programs and services by voluntary enterprises. In anticipation of this, various forms of partnerships have developed with investor-owned systems. To regain the initiative as the premier sponsors of health care, religious and other voluntary systems must go beyond merely competing in their markets to acquiring weaker institutions. They also must revitalize private giving and excel in efficiency to offset threats from ambulatory, day-care operations and from high-technology hospitals. Structural changes in the industry can be predicted, including the following: The trend toward integration for production, financing, and marketing will continue. Public market equity capital will be increasingly used to finance medical practice. Hospitals that sell their equity values will establish service foundations. National alliances will continue, but strictly local systems will maintain operation. Investor-owned systems will move increasingly into high-technology tertiary care.

Geography and the costs of urban energy infrastructure: The case of electricity and natural gas capital investments

NASA Astrophysics Data System (ADS)

Senyel, Muzeyyen Anil

Investments in the urban energy infrastructure for distributing electricity and natural gas are analyzed using (1) property data measuring distribution plant value at the local/tax district level, and (2) system outputs such as sectoral numbers of customers and energy sales, input prices, company-specific characteristics such as average wages and load factor. Socio-economic and site-specific urban and geographic variables, however, often been neglected in past studies. The purpose of this research is to incorporate these site-specific characteristics of electricity and natural gas distribution into investment cost model estimations. These local characteristics include (1) socio-economic variables, such as income and wealth; (2) urban-related variables, such as density, land-use, street pattern, housing pattern; (3) geographic and environmental variables, such as soil, topography, and weather, and (4) company-specific characteristics such as average wages, and load factor. The classical output variables include residential and commercial-industrial customers and sales. In contrast to most previous research, only capital investments at the local level are considered. In addition to aggregate cost modeling, the analysis focuses on the investment costs for the system components: overhead conductors, underground conductors, conduits, poles, transformers, services, street lighting, and station equipment for electricity distribution; and mains, services, regular and industrial measurement and regulation stations for natural gas distribution. The Box-Cox, log-log and additive models are compared to determine the best fitting cost functions. The Box-Cox form turns out to be superior to the other forms at the aggregate level and for network components. However, a linear additive form provides a better fit for end-user related components. The results show that, in addition to output variables and company-specific variables, various site-specific variables are statistically

Economic cost of initial attack and large-fire suppression

Treesearch

Armando González-Cabán

1983-01-01

A procedure has been developed for estimating the economic cost of initial attack and large-fire suppression. The procedure uses a per-unit approach to estimate total attack and suppression costs on an input-by-input basis. Fire management inputs (FMIs) are the production units used. All direct and indirect costs are charged to the FMIs. With the unit approach, all...

Approaches of Russian oil companies to optimal capital structure

NASA Astrophysics Data System (ADS)

Ishuk, T.; Ulyanova, O.; Savchitz, V.

2015-11-01

Oil companies play a vital role in Russian economy. Demand for hydrocarbon products will be increasing for the nearest decades simultaneously with the population growth and social needs. Change of raw-material orientation of Russian economy and the transition to the innovative way of the development do not exclude the development of oil industry in future. Moreover, society believes that this sector must bring the Russian economy on to the road of innovative development due to neo-industrialization. To achieve this, the government power as well as capital management of companies are required. To make their optimal capital structure, it is necessary to minimize the capital cost, decrease definite risks under existing limits, and maximize profitability. The capital structure analysis of Russian and foreign oil companies shows different approaches, reasons, as well as conditions and, consequently, equity capital and debt capital relationship and their cost, which demands the effective capital management strategy.

Development and Initial Validation of an Instrument for Human Capital Planning

ERIC Educational Resources Information Center

Zula, Kenneth J.; Chermack, Thomas J.

2008-01-01

This article reports on development and validation of an instrument for use in human capital approaches for organizational planning. The article describes use of a team of subject matter experts in developing a measure of human capital planning, and use of exploratory factor analysis techniques to validate the resulting instrument. These data were…

Evaluation of Trends in the Cost of Initial Cancer Treatment

PubMed Central

Yabroff, K. Robin; Meekins, Angela; Topor, Marie; Lamont, Elizabeth B.; Brown, Martin L.

2008-01-01

Background Despite reports of increases in the cost of cancer treatment, little is known about how costs of cancer treatment have changed over time and what services have contributed to the increases. Methods We used data from the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database for 306 709 persons aged 65 and older and diagnosed with breast, lung, colorectal, or prostate cancer between 1991 and 2002 to assess the number of patients assigned to initial cancer care, from 2 months before diagnosis to 12 months after diagnosis, and mean annual Medicare payments for this care according to cancer type and type of treatment. Mutually exclusive treatment categories were cancer-related surgery, chemotherapy, radiation therapy, and other hospitalizations during the period of initial cancer care. Linear regression models were used to assess temporal trends in the percentage of patients receiving treatment and costs for those treated. We extrapolated our results based on the SEER data to the US Medicare population to estimate national Medicare payments by cancer site and treatment category. All statistical tests were two-sided. Results For patients diagnosed in 2002, Medicare paid an average of $39 891 for initial care for each lung cancer patient, $41 134 for each colorectal cancer patient, and $20 964 for each breast cancer patient, corresponding to inflation-adjusted increases from 1991 of $7139, $5345, and $4189, respectively. During the same interval, the mean Medicare payment for initial care for prostate cancer declined by $196 to $18261 in 2002. Costs for any hospitalization accounted for the largest portion of payments for all cancers. Chemotherapy use increased markedly for all cancers between 1991 and 2002, as did radiation therapy use (except for colorectal cancers). Total 2002 Medicare payments for initial care for these four cancers exceeded $6.7 billion, with colorectal and lung cancers being the most costly overall

Cost Study of Educational Media Systems and Their Equipment Components. Volume II, Technical Report. Final Report.

ERIC Educational Resources Information Center

General Learning Corp., Washington, DC.

A common instructional task and a set of educational environments are hypothesized for analysis of media cost data. The analytic structure may be conceptulized as a three-dimensional matrix: the first vector separates costs into production, distribution, and reception; the second vector delineates capital (initial) and operating (annual) costs;…

Administrative and policy issues in reimbursement for nursing home capital investment.

PubMed

Boerstler, H; Carlough, T; Schlenker, R E

1991-01-01

The way in which states reimburse for nursing home capital costs can create incentives for nursing home owners to use the home primarily as a vehicle for real estate speculation, with potentially adverse consequences for patient care. In order to help promote and control the stability, adequacy, and quality of capital investment in long-term care, an increasing number of states are using a fair-rental approach for calculating capital reimbursement. In this article we compare the fair-rental approach with traditional cost-based capital reimbursement in terms of administration and policy. We discuss issues of concern to the state (cost and reimbursement design options) and the investor (after-tax cash flows, rate of return, etc.). Our analysis suggests that fair-rental systems may be superior to traditional cost-based reimbursement in promoting and controlling industry stability, while at the same time providing an adequate return to investors, without incurring long-term increases in the costs of administering programs.

Taking the Initiative: Risk-Reduction Strategies and Decreased Malpractice Costs.

PubMed

Raper, Steven E; Rose, Deborah; Nepps, Mary Ellen; Drebin, Jeffrey A

2017-11-01

To heighten awareness of attending and resident surgeons regarding strategies for defense against malpractice claims, a series of risk reduction initiatives have been carried out in our Department of Surgery. We hypothesized that emphasis on certain aspects of risk might be associated with decreased malpractice costs. The relative impact of Department of Surgery initiatives was assessed when compared with malpractice experience for the rest of the Clinical Practices of the University of Pennsylvania (CPUP). Surgery and CPUP malpractice claims, indemnity, and expenses were obtained from the Office of General Counsel. Malpractice premium data were obtained from CPUP finance. The Department of Surgery was assessed in comparison with all other CPUP departments. Cost data (yearly indemnity and expenses), and malpractice premiums (total and per physician) were expressed as a percentage of the 5-year mean value preceding implementation of the initiative program. Surgery implemented 38 risk reduction initiatives. Faculty participated in 27 initiatives; house staff participated in 10 initiatives; and advanced practitioners in 1 initiative. Department of Surgery claims were significantly less than CPUP (74.07% vs 81.07%; p < 0.05). The mean yearly indemnity paid by the Department of Surgery was significantly less than that of the other CPUP departments (84.08% vs 122.14%; p < 0.05). Department of Surgery-paid expenses were also significantly less (83.17% vs 104.96%; p < 0.05), and surgical malpractice premiums declined from baseline, but remained significantly higher than CPUP premiums. The data suggest that educating surgeons on malpractice and risk reduction may play a role in decreasing malpractice costs. Additional extrinsic factors may also affect cost data. Emphasis on risk reduction appears to be cumulative and should be part of an ongoing program. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Public offerings of securities by petroleum industry: methods and costs of raising capital

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

Siemon, D.

1978-01-01

This study examines public securities offerings by the petroleum industry and the flotation costs associated with raising capital through offerings to the public. Descriptive material is presented on an aggregate basis for the industry and also by selected company characteristics. Data were obtained from the Securities and Exchange Commission's records of registration statements for public offerings and include all public offerings registered with the SEC during the period January 1970 through October 1975. The petroleum industry issued 101 debt offerings and 1058 equity offerings during the time period. The total number of offerings for all industries was estimated to bemore » 20,000, so the petroleum industry accounted for roughly 5% of the total volume.« less

18 CFR 4.1 - Initial cost statement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Initial cost statement. 4.1 Section 4.1 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION... readily ascertained. (c) Availability of information to the public. The information made available to the...

The Annual Economic Burden of Syphilis: An Estimation of Direct, Productivity, and Intangible Costs for Syphilis in Guangdong Initiative for Comprehensive Control of Syphilis Sites.

PubMed

Zou, Yaming; Liao, Yu; Liu, Fengying; Chen, Lei; Shen, Hongcheng; Huang, Shujie; Zheng, Heping; Yang, Bin; Hao, Yuantao

2017-11-01

Syphilis has continuously posed a great challenge to China. However, very little data existed regarding the cost of syphilis. Taking Guangdong Initiative for Comprehensive Control of Syphilis area as the research site, we aimed to comprehensively measure the annual economic burden of syphilis from a societal perspective. Newly diagnosed and follow-up outpatient cases were investigated by questionnaire. Reported tertiary syphilis cases and medical institutions cost were both collected. The direct economic burden was measured by the bottom-up approach, the productivity cost by the human capital method, and the intangible burden by the contingency valuation method. Three hundred five valid early syphilis cases and 13 valid tertiary syphilis cases were collected in the investigation to estimate the personal average cost. The total economic burden of syphilis was US $729,096.85 in Guangdong Initiative for Comprehensive Control of Syphilis sites in the year of 2014, with medical institutions cost accounting for 73.23% of the total. Household average direct cost of early syphilis was US $23.74. Average hospitalization cost of tertiary syphilis was US $2,749.93. Of the cost to medical institutions, screening and testing comprised the largest proportion (26%), followed by intervention and case management (22%) and operational cost (21%). Household average productivity cost of early syphilis was US $61.19. Household intangible cost of syphilis was US $15,810.54. Syphilis caused a substantial economic burden on patients, their families, and society in Guangdong. Household productivity and intangible costs both shared positive relationships with local economic levels. Strengthening the prevention and effective treatment of early syphilis could greatly help to lower the economic burden of syphilis.

78 FR 13076 - Notice of Submission of Proposed Information Collection to OMB; Border Community Capital Initiative

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-26

...The proposed information collection requirement described below has been submitted to the Office of Management and Budget (OMB) for review, as required by the Paperwork Reduction Act. The Department is soliciting public comments on the subject proposal. The purpose of this submission is for the application for the Border Community Capital Initiative grant process. Information is required to rate and rank competitive applications and to ensure eligibility of applicants for funding. Semi-annual reporting is required to monitor grant management.

Assessing present and future capital expense levels under PPS.

PubMed

Cleverley, W O

1986-09-01

The expected shift in the method of payment for capital costs will affect the way decisions are made by hospital executives. The capital expense ratio model is one way executives can better assess their present and future capital expense levels as payments begin to be made under a prospective payment system.

Improving Opportunities for Bridging Social Capital: The Story of a Full-Service Community School Initiative at an Alternative High School

ERIC Educational Resources Information Center

Newton, Xiaoxia A.; Thompson, Shanna Rose; Oh, Bangsil; Ferullo, Leah

2017-01-01

This article describes the collective efforts educators and multiple community partners are taking to transform one alternative urban high school into a full-service community school. The article presents preliminary findings on the opportunities for bridging social capital that the full-service initiative has created and the impacts such…

Cost-Effectiveness of Earlier Initiation of Antiretroviral Therapy for Uninsured HIV-Infected Adults

PubMed Central

Schackman, Bruce R.; Goldie, Sue J.; Weinstein, Milton C.; Losina, Elena; Zhang, Hong; Freedberg, Kenneth A.

2001-01-01

Objectives. This study was designed to examine the societal cost-effectiveness and the impact on government payers of earlier initiation of antiretroviral therapy for uninsured HIV-infected adults. Methods. A state-transition simulation model of HIV disease was used. Data were derived from the Multicenter AIDS Cohort Study, published randomized trials, and medical care cost estimates for all government payers and for Massachusetts, New York, and Florida. Results. Quality-adjusted life expectancy increased from 7.64 years with therapy initiated at 200 CD4 cells/μL to 8.21 years with therapy initiated at 500 CD4 cells/μL. Initiating therapy at 500 CD4/μL was a more efficient use of resources than initiating therapy at 200 CD4/μL and had an incremental cost-effectiveness ratio of $17 300 per quality-adjusted life-year gained, compared with no therapy. Costs to state payers in the first 5 years ranged from $5500 to $24 900 because of differences among the states in the availability of federal funds for AIDS drug assistance programs. Conclusions. Antiretroviral therapy initiated at 500 CD4 cells/μL is cost-effective from a societal perspective compared with therapy initiated later. States should consider Medicaid waivers to expand access to early therapy. PMID:11527782

Adaptive governance, ecosystem management, and natural capital.

PubMed

Schultz, Lisen; Folke, Carl; Österblom, Henrik; Olsson, Per

2015-06-16

To gain insights into the effects of adaptive governance on natural capital, we compare three well-studied initiatives; a landscape in Southern Sweden, the Great Barrier Reef in Australia, and fisheries in the Southern Ocean. We assess changes in natural capital and ecosystem services related to these social-ecological governance approaches to ecosystem management and investigate their capacity to respond to change and new challenges. The adaptive governance initiatives are compared with other efforts aimed at conservation and sustainable use of natural capital: Natura 2000 in Europe, lobster fisheries in the Gulf of Maine, North America, and fisheries in Europe. In contrast to these efforts, we found that the adaptive governance cases developed capacity to perform ecosystem management, manage multiple ecosystem services, and monitor, communicate, and respond to ecosystem-wide changes at landscape and seascape levels with visible effects on natural capital. They enabled actors to collaborate across diverse interests, sectors, and institutional arrangements and detect opportunities and problems as they developed while nurturing adaptive capacity to deal with them. They all spanned local to international levels of decision making, thus representing multilevel governance systems for managing natural capital. As with any governance system, internal changes and external drivers of global impacts and demands will continue to challenge the long-term success of such initiatives.

42 CFR 413.157 - Return on equity capital of proprietary providers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Return on equity capital of proprietary providers... Capital-Related Costs § 413.157 Return on equity capital of proprietary providers. (a) Definitions. For... proprietary hospitals and SNFs. (b) General rule. A reasonable return on equity capital invested and used in...

Integrating Capital Studies within Physical Plant Operations.

ERIC Educational Resources Information Center

Christensen, Douglas K.

1986-01-01

Brigham Young University's program integrating ongoing campus capital replacement and renewal into overall physical plant administration is described, including the initial capital needs study, planning for replacement cycles and one-time expenditures, and management of the information gathered. (MSE)

48 CFR 9904.404 - Capitalization of tangible assets.

Code of Federal Regulations, 2010 CFR

2010-10-01

... assets. 9904.404 Section 9904.404 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 ACCOUNTING STANDARDS 9904.404 Capitalization of tangible assets. ...

RVU costing applications.

PubMed

Berlin, M F; Faber, B P; Berlin, L M; Budzynski, M R

1997-11-01

Relative value unit (RVU) cost accounting which uses the resource-based relative value scale (RBRVS), can be used to determine the cost to produce given services and determine appropriate physician fees. The calculations derived from RVU costing have additional applications, such as analyzing fee schedules, evaluating the profitability of third-party payer reimbursement, calculating a floor capitation rate, and allocating capitation payments within the group. The ability to produce this information can help group practice administrators determine ways to manage the cost of providing services, set more realistic fees, and negotiate more profitable contracts.

Adaptive governance, ecosystem management, and natural capital

PubMed Central

Schultz, Lisen; Folke, Carl; Österblom, Henrik; Olsson, Per

2015-01-01

To gain insights into the effects of adaptive governance on natural capital, we compare three well-studied initiatives; a landscape in Southern Sweden, the Great Barrier Reef in Australia, and fisheries in the Southern Ocean. We assess changes in natural capital and ecosystem services related to these social–ecological governance approaches to ecosystem management and investigate their capacity to respond to change and new challenges. The adaptive governance initiatives are compared with other efforts aimed at conservation and sustainable use of natural capital: Natura 2000 in Europe, lobster fisheries in the Gulf of Maine, North America, and fisheries in Europe. In contrast to these efforts, we found that the adaptive governance cases developed capacity to perform ecosystem management, manage multiple ecosystem services, and monitor, communicate, and respond to ecosystem-wide changes at landscape and seascape levels with visible effects on natural capital. They enabled actors to collaborate across diverse interests, sectors, and institutional arrangements and detect opportunities and problems as they developed while nurturing adaptive capacity to deal with them. They all spanned local to international levels of decision making, thus representing multilevel governance systems for managing natural capital. As with any governance system, internal changes and external drivers of global impacts and demands will continue to challenge the long-term success of such initiatives. PMID:26082542

Investing in breastfeeding - the world breastfeeding costing initiative.

PubMed

Holla-Bhar, Radha; Iellamo, Alessandro; Gupta, Arun; Smith, Julie P; Dadhich, Jai Prakash

2015-01-01

Despite scientific evidence substantiating the importance of breastfeeding in child survival and development and its economic benefits, assessments show gaps in many countries' implementation of the 2003 WHO and UNICEF Global Strategy for Infant and Young Child Feeding (Global Strategy). Optimal breastfeeding is a particular example: initiation of breastfeeding within the first hour of birth, exclusive breastfeeding for the first six months; and continued breastfeeding for two years or more, together with safe, adequate, appropriate, responsive complementary feeding starting in the sixth month. While the understanding of "optimal" may vary among countries, there is a need for governments to facilitate an enabling environment for women to achieve optimal breastfeeding. Lack of financial resources for key programs is a major impediment, making economic perspectives important for implementation. Globally, while achieving optimal breastfeeding could prevent more than 800,000 under five deaths annually, in 2013, US$58 billion was spent on commercial baby food including milk formula. Support for improved breastfeeding is inadequately prioritized by policy and practice internationally. The World Breastfeeding Costing Initiative (WBCi) launched in 2013, attempts to determine the financial investment that is necessary to implement the Global Strategy, and to introduce a tool to estimate the costs for individual countries. The article presents detailed cost estimates for implementing the Global Strategy, and outlines the WBCi Financial Planning Tool. Estimates use demographic data from UNICEF's State of the World's Children 2013. The WBCi takes a programmatic approach to scaling up interventions, including policy and planning, health and nutrition care systems, community services and mother support, media promotion, maternity protection, WHO International Code of Marketing of Breastmilk Substitutes implementation, monitoring and research, for optimal breastfeeding practices

Increasing Returns to Education and the Impact on Social Capital

ERIC Educational Resources Information Center

Leeves, Gareth D.

2014-01-01

The returns to education have been increasing. It is suggested that high-skilled workers' social capital investment has been adversely affected by the increasing incentives to devote human capital to career development. Lower social capital is linked to reduced economic growth and innovation and higher transaction costs and is detrimental to…

Cointegration of output, capital, labor, and energy

NASA Astrophysics Data System (ADS)

Stresing, R.; Lindenberger, D.; Kã¼mmel, R.

2008-11-01

Cointegration analysis is applied to the linear combinations of the time series of (the logarithms of) output, capital, labor, and energy for Germany, Japan, and the USA since 1960. The computed cointegration vectors represent the output elasticities of the aggregate energy-dependent Cobb-Douglas function. The output elasticities give the economic weights of the production factors capital, labor, and energy. We find that they are for labor much smaller and for energy much larger than the cost shares of these factors. In standard economic theory output elasticities equal cost shares. Our heterodox findings support results obtained with LINEX production functions.

Formation of costs of high-rise objects of housing and civil purpose based on enlarged norms

NASA Astrophysics Data System (ADS)

Vorotyntseva, Anna; Ovsiannikov, Andrei; Bolgov, Vladimir

2018-03-01

When determining the cost of capital construction objects, for purposes of pre-design workings out and purposes of initial maximum initial price determination on tenders, construction price norms are used (CPNs). Modern CPNs are not designed to determine the value of high-rise buildings. It is necessary to adapt modern CPNs to get opportunity for the possibility to take into account special cost factors in determining the cost of high-rise buildings. The main ways can be: selection of new representative objects or application of additional correction factors.

Social capital and transaction cost on co-creating IT value towards inter-organizational EMR exchange.

PubMed

Chang, Hsin Hsin; Hung, Chung-Jye; Huang, Ching Ying; Wong, Kit Hong; Tsai, Yi Ju

2017-01-01

This study adopts social capital theory and transaction cost theory to explore the feasibility of an inter-organizational cross-hospital electronic medical records (EMR) exchange system, and the factors that affect its adoption. The concept of value co-creation is also used to assess such a system, and its influence on the performance of participating medical institutes. This research collected 330 valid paper-based questionnaires from the medical staff of various institutes. The results showed that social interaction ties and shared vision positively affected medical institutes' willingness to adopt the EMR exchange system, while asset specificity and uncertainty increased the related transaction costs. With a greater willingness to invest in relation-specific assets and to meet the related transaction costs, this behavior lead to an increase in medical IT value, as well as better results for the related medical institutes, medical staff, and patients. Therefore, this study suggests that such institutes encourage their medical staff to participate in seminars or reunions in order to develop their professional and social networks, and set up clear schedules and desire for expected effects when introducing the cross-hospital EMR exchange system. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Role of Capital Productivity in British Airways' Financial Recovery

NASA Technical Reports Server (NTRS)

Morrell, Peter

1999-01-01

British Airways (BA) was privatized in 1987, but its financial recovery occurred a number of years earlier, This recovery was sustained throughout the early 1990s economic recession, a period when few major airlines were operating profitably. This paper examines the role of productivity developments at British Airways from the early 1980s through 1996. The emphasis is on capital productivity and investment, but changes in capital intensity and labour productivity are also evaluated. Various measures are considered for both capital and labour productivity: outputs are measured in available tonne-kms (ATKs) and revenue tonne-kms (RTKs), with the former preferred over the latter two measures, after adjustment for work performed by BA for others. Capital inputs are measured in equivalent lease costs adjusted to constant prices with a different treatment of flight and ground equipment or assets. Labour inputs are derived from total payroll costs deflated by a UK wage price index. The airline made considerable capital investments over the period and at the same time went through two major processes of labour restructuring. This resulted in a gradual increase in capital intensity, relative high labour productivity growth, but poor capital productivity performance, However, capital investment played an important role in the airline's sustained labour and total factor productivity over the whole period.

The Role of Capital Productivity in British Airways' Financial Recovery

NASA Technical Reports Server (NTRS)

Morrell, Peter

1999-01-01

British Airways (BA) was privatised in 1987, but its financial recovery occurred a number of years earlier. This recovery was sustained throughout the early 1990s economic recession, a period when few major airlines were operating profitably. This paper examines the role of productivity developments at British Airways from the early 1980s through 1996. The emphasis is on capital productivity and investment, but changes in capital intensity and labour productivity are also evaluated. Various measures are considered for both capital and labour productivity: outputs are measured in available tonne-kms (ATKS) and revenue tonne-kms (RTKs), with the former preferred over the latter two measures, after adjustment for work performed by BA for others. Capital inputs are measured in equivalent lease costs adjusted to constant prices with a different treatment of flight and ground equipment or assets. Labour inputs are derived from total payroll costs deflated by a UK wage price index. The airline made considerable capital investments over the period and at the same time went through two major processes of labour restructuring. This resulted in a gradual increase in capital intensity, relative high labour productivity growth, but poor capital productivity performance. However, capital investment played an important role in the airline's sustained labour and total factor productivity over the whole period.

Initial Costs vs. Operational Costs. A Study of Building Improvement Projects in Fourteen Schools in the School District of Greenville County, South Carolina.

ERIC Educational Resources Information Center

Chan, Tak Cheung

To determine whether initial facility improvement costs were paid back by the reduced operational costs resulting from the improvement projects, this study examined the relationship between initial costs and operational costs of fourteen school buildings improved during the 1978-79 school year in Greenville County, South Carolina. With energy…

A Framework for Automating Cost Estimates in Assembly Processes

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

Calton, T.L.; Peters, R.R.

1998-12-09

When a product concept emerges, the manufacturing engineer is asked to sketch out a production strategy and estimate its cost. The engineer is given an initial product design, along with a schedule of expected production volumes. The engineer then determines the best approach to manufacturing the product, comparing a variey of alternative production strategies. The engineer must consider capital cost, operating cost, lead-time, and other issues in an attempt to maximize pro$ts. After making these basic choices and sketching the design of overall production, the engineer produces estimates of the required capital, operating costs, and production capacity. 177is process maymore » iterate as the product design is refined in order to improve its pe~ormance or manufacturability. The focus of this paper is on the development of computer tools to aid manufacturing engineers in their decision-making processes. This computer sof~are tool provides aj?amework in which accurate cost estimates can be seamlessly derivedfiom design requirements at the start of any engineering project. Z+e result is faster cycle times through first-pass success; lower ll~e cycie cost due to requirements-driven design and accurate cost estimates derived early in the process.« less

Supercritical Carbon Dioxide Power Generation System Definition: Concept Definition and Capital Cost Estimate

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

Stoddard, Larry; Galluzzo, Geoff; Andrew, Daniel

The Department of Energy’s (DOE’s) Office of Renewable Power (ORP) has been tasked to provide effective program management and strategic direction for all of the DOE’s Energy Efficiency & Renewable Energy’s (EERE’s) renewable power programs. The ORP’s efforts to accomplish this mission are aligned with national energy policies, DOE strategic planning, EERE’s strategic planning, Congressional appropriation, and stakeholder advice. ORP is supported by three renewable energy offices, of which one is the Solar Energy Technology Office (SETO) whose SunShot Initiative has a mission to accelerate research, development and large scale deployment of solar technologies in the United States. SETO hasmore » a goal of reducing the cost of Concentrating Solar Power (CSP) by 75 percent of 2010 costs by 2020 to reach parity with base-load energy rates, and 30 percent further reductions by 2030. The SunShot Initiative is promoting the implementation of high temperature CSP with thermal energy storage allowing generation during high demand hours. The SunShot Initiative has funded significant research and development work on component testing, with attention to high temperature molten salts, heliostats, receiver designs, and high efficiency high temperature supercritical CO 2 (sCO2) cycles. DOE retained Black & Veatch to support SETO’s SunShot Initiative for CSP solar power tower technology in the following areas: 1. Concept definition, including costs and schedule, of a flexible test facility to be used to test and prove components in part to support financing. 2. Concept definition, including costs and schedule, of an integrated high temperature molten salt (MS) facility with thermal energy storage and with a supercritical CO 2 cycle generating approximately 10MWe. 3. Concept definition, including costs and schedule, of an integrated high temperature falling particle facility with thermal energy storage and with a supercritical CO 2 cycle generating approximately

Human Capital and the Labor of Learning: A Case of Mistaken Identity

ERIC Educational Resources Information Center

Sidorkin, Alexander M

2007-01-01

In this essay, Alexander Sidorkin offers a conceptual critique of the human capital theory that makes erroneous assumptions about the nature of student work and the private cost of schooling. Specifically, human capital theorists underestimate the private cost of schooling by taking low-level manual labor as the basis for estimating students'…

Does capitation matter? Impacts on access, use, and quality.

PubMed

Zuvekas, Samuel H; Hill, Steven C

2004-01-01

Provider capitation may constrain costs, but it also may reduce access and quality of care. We examine the impacts of capitating the usual source of care of enrollees in health maintenance organizations (HMOs). We account for the endogeneity of capitation and other characteristics using generalized methods of moments (GMM) estimation on a sample from the Medical Expenditure Panel Survey for 1996 and 1997. Being organized as a group/staff HMO generally has stronger impact on access and quality than capitation. Capitation by itself may increase access to consumers' usual sources of care, improve primary preventive care, and reduce coordination, but estimates with GMM were not statistically significant.

Healthcare costs among adults with type 2 diabetes initiating saxagliptin or linagliptin: a US-based claims analysis.

PubMed

Kong, Amanda M; Farahbakhshian, Sepehr; Pendergraft, Trudy; Brouillette, Matthew A; Mukherjee, Biswarup; Smith, David M; Sheehan, John J

2017-10-01

To compare healthcare costs of adults with type 2 diabetes (T2D) after initiation of saxagliptin or linagliptin, two antidiabetic medications in the dipeptidyl peptidase-4 inhibitor medication class. Patients with T2D who were at least 18 years old and initiated saxagliptin or linagliptin (index date) between 1 June 2011 and 30 June 2014 were identified in the MarketScan Commercial and Medicare Supplemental Databases. All-cause healthcare costs and diabetes-related costs (T2D diagnosis on a medical claim and/or an antidiabetic medication claim) were measured in the 1 year follow-up period. Saxagliptin and linagliptin initiators were matched using propensity score methods. Cost ratios (CRs) and predicted costs were estimated from generalized linear models and recycled predictions. There were 34,560 saxagliptin initiators and 18,175 linagliptin initiators identified (mean ages 57 and 59; 55% and 56% male, respectively). Before matching, saxagliptin initiators had significantly lower all-cause total healthcare costs than linagliptin initiators (mean = $15,335 [SD $28,923] vs. mean = $20,069 [SD $48,541], p < .001) and significantly lower diabetes-related total healthcare costs (mean = $6109 [SD $13,851] vs. mean = $7393 [SD $26,041], p < .001). In matched analyses (n = 16,069 per cohort), saxagliptin initiators had lower all-cause follow-up costs than linagliptin initiators (CR = 0.953, 95% CI = 0.932-0.974, p < .001; predicted costs = $17,211 vs. $18,068). There was no significant difference in diabetes-related total costs after matching; however, diabetes-related medical costs were significantly lower for saxagliptin initiators (CR = 0.959, 95% CI = 0.927-0.993, p = 0.017; predicted costs = $3989 vs. $4159). Adult patients with T2D initiating treatment with saxagliptin had lower total all-cause healthcare costs and diabetes-related medical costs over 1 year compared with patients initiating treatment with

Thinking strategically about capitation.

PubMed

Boland, P

1997-05-01

All managed care stakeholders--health plan members, employers, providers, community organizations, and government entitites--share a common interest in reducing healthcare costs while improving the quality of care health plan members receive. Although capitation is a usually thought of primarily as a payment mechanism, it can be a powerful tool providers and health plans can use to accomplish these strategic objectives and others, such as restoring and maintaining the health of plan members or improving a community's health status. For capitation to work effectively as a strategic tool, its use must be tied to a corporate agenda of partnering with stakeholders to achieve broader strategic goals. Health plans and providers must develop a partnership strategy in which each stakeholder has well-defined roles and responsibilities. The capitation structure must reinforce interdependence, shift focus from meeting organizational needs to meeting customer needs, and develop risk-driven care strategies.

The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis.

PubMed

Mills, Edward J; Kanters, Steve; Hagopian, Amy; Bansback, Nick; Nachega, Jean; Alberton, Mark; Au-Yeung, Christopher G; Mtambo, Andy; Bourgeault, Ivy L; Luboga, Samuel; Hogg, Robert S; Ford, Nathan

2011-11-23

To estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Human capital cost analysis using publicly accessible data. Sub-Saharan African countries. Nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries. The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors. In the nine source countries the estimated government subsidised cost of a doctor's education ranged from $21,000 (£13,000; €15,000) in Uganda to $58,700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95% confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). Among sub-Saharan African countries most affected by HIV/AIDS, lost investment from the emigration of doctors is considerable. Destination countries should consider investing in measurable training for source countries and strengthening of their

The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis

PubMed Central

Kanters, Steve; Hagopian, Amy; Bansback, Nick; Nachega, Jean; Alberton, Mark; Au-Yeung, Christopher G; Mtambo, Andy; Bourgeault, Ivy L; Luboga, Samuel; Hogg, Robert S; Ford, Nathan

2011-01-01

Objective To estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. Design Human capital cost analysis using publicly accessible data. Settings Sub-Saharan African countries. Participants Nine sub-Saharan African countries with an HIV prevalence of 5% or greater or with more than one million people with HIV/AIDS and with at least one medical school (Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe), and data available on the number of doctors practising in destination countries. Main outcome measures The financial cost of educating a doctor (through primary, secondary, and medical school), assuming that migration occurred after graduation, using current country specific interest rates for savings converted to US dollars; cost according to the number of source country doctors currently working in the destination countries; and savings to destination countries of receiving trained doctors. Results In the nine source countries the estimated government subsidised cost of a doctor’s education ranged from $21 000 (£13 000; €15 000) in Uganda to $58 700 in South Africa. The overall estimated loss of returns from investment for all doctors currently working in the destination countries was $2.17bn (95% confidence interval 2.13bn to 2.21bn), with costs for each country ranging from $2.16m (1.55m to 2.78m) for Malawi to $1.41bn (1.38bn to 1.44bn) for South Africa. The ratio of the estimated compounded lost investment over gross domestic product showed that Zimbabwe and South Africa had the largest losses. The benefit to destination countries of recruiting trained doctors was largest for the United Kingdom ($2.7bn) and United States ($846m). Conclusions Among sub-Saharan African countries most affected by HIV/AIDS, lost investment from the emigration of doctors is considerable. Destination countries should

Human Capital, (Human) Capabilities and Higher Education

ERIC Educational Resources Information Center

Le Grange, L.

2011-01-01

In this article I initiate a debate into the (de)merits of human capital theory and human capability theory and discuss implications of the debate for higher education. Human capital theory holds that economic growth depends on investment in education and that economic growth is the basis for improving the quality of human life. Human capable…

Managerial perceptions of the incentives inherent in National Health Service capital charging.

PubMed

Heald, D; Scott, D A

1997-08-01

Capital charging was introduced into the National Health Service (NHS) in 1991 in order to stop capital being treated as a 'free' good and to encourage managers to use their assets more efficiently. This article seeks to examine the extent to which managerial thinking has been influenced. It uses as evidence interviews with NHS managers conducted in Scotland in 1994. The following uses of capital charges data are explored: capital programme; disposal programme; maintenance programme; contract pricing; and budgetary devolution. New capital programmes required more justification and capital charges were seen as relevant to estate rationalization. Less effect was found with regard to the maintenance programme, though this may have been due to a downgrading of the estates function in most Trusts. Although the capital charge costs included in contract prices affect the competitive position of providers, there was criticism of the lack of development of the purchasing function. Budgetary devolution was proceeding relatively slowly but, among those Trusts which had devolved capital charges, evidence was found that some clinicians were becoming aware of the full costs of equipment use. This article concludes, with cautious optimism, that capital charges are beginning to influence decisions and that, despite some incentives being dysfunctional, they will lead to a better managed NHS.

49 CFR 639.25 - Calculation of lease cost.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Cost-Effectiveness § 639.25 Calculation of lease cost. (a) For purposes of this part, the lease cost of a capital asset is— (1) The cost to lease the asset for the same... 49 Transportation 7 2010-10-01 2010-10-01 false Calculation of lease cost. 639.25 Section 639.25...

48 CFR 31.205-10 - Cost of money.

Code of Federal Regulations, 2013 CFR

2013-10-01

... of the cost of capital assets under construction (48 CFR 9904.417). (b) Cost of money is allowable... measured and added to the cost of capital assets under construction in accordance with 48 CFR 9904.417, as... proposals relating to the contract under which the cost is to be claimed. (c) Actual interest cost in lieu...

48 CFR 31.205-10 - Cost of money.

Code of Federal Regulations, 2012 CFR

2012-10-01

... of the cost of capital assets under construction (48 CFR 9904.417). (b) Cost of money is allowable... measured and added to the cost of capital assets under construction in accordance with 48 CFR 9904.417, as... proposals relating to the contract under which the cost is to be claimed. (c) Actual interest cost in lieu...

48 CFR 31.205-10 - Cost of money.

Code of Federal Regulations, 2010 CFR

2010-10-01

... of the cost of capital assets under construction (48 CFR 9904.417). (b) Cost of money is allowable... measured and added to the cost of capital assets under construction in accordance with 48 CFR 9904.417, as... proposals relating to the contract under which the cost is to be claimed. (c) Actual interest cost in lieu...

48 CFR 31.205-10 - Cost of money.

Code of Federal Regulations, 2014 CFR

2014-10-01

... of the cost of capital assets under construction (48 CFR 9904.417). (b) Cost of money is allowable... measured and added to the cost of capital assets under construction in accordance with 48 CFR 9904.417, as... proposals relating to the contract under which the cost is to be claimed. (c) Actual interest cost in lieu...

48 CFR 31.205-10 - Cost of money.

Code of Federal Regulations, 2011 CFR

2011-10-01

... of the cost of capital assets under construction (48 CFR 9904.417). (b) Cost of money is allowable... measured and added to the cost of capital assets under construction in accordance with 48 CFR 9904.417, as... proposals relating to the contract under which the cost is to be claimed. (c) Actual interest cost in lieu...

Non-Hardware ("Soft") Cost-Reduction Roadmap for Residential and Small Commercial Solar Photovoltaics, 2013-2020

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

Ardani, K.; Seif, D.; Margolis, R.

2013-08-01

The objective of this analysis is to roadmap the cost reductions and innovations necessary to achieve the U.S. Department of Energy (DOE) SunShot Initiative's total soft-cost targets by 2020. The roadmap focuses on advances in four soft-cost areas: (1) customer acquisition; (2) permitting, inspection, and interconnection (PII); (3) installation labor; and (4) financing. Financing cost reductions are in terms of the weighted average cost of capital (WACC) for financing PV system installations, with real-percent targets of 3.0% (residential) and 3.4% (commercial).

The friction cost method: a comment.

PubMed

Johannesson, M; Karlsson, G

1997-04-01

The friction cost method has been proposed as an alternative to the human-capital approach of estimating indirect costs. We argue that the friction cost method is based on implausible assumptions not supported by neoclassical economic theory. Furthermore consistently applying the friction cost method would mean that the method should also be applied in the estimation of direct costs, which would mean that the costs of health care programmes are substantially decreased. It is concluded that the friction cost method does not seem to be a useful alternative to the human-capital approach in the estimation of indirect costs.

Cost-Cutting in Higher Education: Lessons Learned from Collaboration, Technology, and Outsourcing Initiatives. Draft.

ERIC Educational Resources Information Center

Kaganoff, Tessa

This document presents a review of cost-containment initiatives relevant to higher education institutions. Originally commissioned to examine cost containment initiatives carried out by institutions affiliated with the Foundation for Independent Higher Education (FIHE), the paper was expanded to include a sector-wide review of three types of…

Rock bed thermal storage: Concepts and costs

NASA Astrophysics Data System (ADS)

Allen, Kenneth; von Backström, Theodor; Joubert, Eugene; Gauché, Paul

2016-05-01

Thermal storage enables concentrating solar power (CSP) plants to provide baseload or dispatchable power. Currently CSP plants use two-tank molten salt thermal storage, with estimated capital costs of about 22-30 /kWhth. In the interests of reducing CSP costs, alternative storage concepts have been proposed. In particular, packed rock beds with air as the heat transfer fluid offer the potential of lower cost storage because of the low cost and abundance of rock. Two rock bed storage concepts which have been formulated for use at temperatures up to at least 600 °C are presented and a brief analysis and cost estimate is given. The cost estimate shows that both concepts are capable of capital costs less than 15 /kWhth at scales larger than 1000 MWhth. Depending on the design and the costs of scaling containment, capital costs as low as 5-8 /kWhth may be possible. These costs are between a half and a third of current molten salt costs.

42 CFR 413.130 - Introduction to capital-related costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... depreciable assets under § 413.134(f). (2) Taxes on land or depreciable assets used for patient care. (3... depreciable assets used for patient care or to refinance existing debt for which the original purpose was to acquire land or depreciable assets used for patient care. (11) The apportionment of the capital-related...

Health, Human Capital, and Development*

PubMed Central

Bleakley, Hoyt

2013-01-01

How much does disease depress development in human capital and income around the world? I discuss a range of micro evidence, which finds that health is both human capital itself and an input to producing other forms of human capital. I use a standard model to integrate these results, and suggest a re-interpretation of much of the micro literature. I then discuss the aggregate implications of micro estimates, but note the complications in extrapolating to general equilibrium, especially because of health’s effect on population size. I also review the macro evidence on this topic, which consists of either cross-country comparisons or measuring responses to health shocks. Micro estimates are 1–2 orders of magnitude smaller than the cross-country relationship, but nevertheless imply high benefit-to-cost ratios from improving certain forms of health. PMID:24147187

Capital financing in prospective payment.

PubMed

Oszustowicz, R J; Dreachslin, J L

1984-03-01

In the era of prospective payment, arranging financing for hospital capital projects is expected to become even more complicated than under cost-based reimbursement systems. This article outlines the information needed for a bond issue in the prospective payment environment, defines the roles and duties of several external persons and organizations involved with planning a major capital financing, and provides an overview of the entire process. This article assumes for illustrative purposes that a tax-exempt bond issue is going to be used to finance a facility expansion. This method was chosen since over 70% of all major capital financing for hospitals use the tax-exempt bond as the principal vehicle for attracting the necessary debt to finance a major construction project. The tax-exempt bond issue also requires the most detail in documentation and legal provisions.

Comparison Between Individually and Group-Based Insulin Pump Initiation by Time-Driven Activity-Based Costing

PubMed Central

Ridderstråle, Martin

2017-01-01

Background: Depending on available resources, competencies, and pedagogic preference, initiation of insulin pump therapy can be performed on either an individual or a group basis. Here we compared the two models with respect to resources used. Methods: Time-driven activity-based costing (TDABC) was used to compare initiating insulin pump treatment in groups (GT) to individual treatment (IT). Activities and cost drivers were identified, timed, or estimated at location. Medical quality and patient satisfaction were assumed to be noninferior and were not measured. Results: GT was about 30% less time-consuming and 17% less cost driving per patient and activity compared to IT. As a batch driver (16 patients in one group) GT produced an upward jigsaw-shaped accumulative cost curve compared to the incremental increase incurred by IT. Taking the alternate cost for those not attending into account, and realizing the cost of opportunity gained, suggested that GT was cost neutral already when 5 of 16 patients attended, and that a second group could be initiated at no additional cost as the attendance rate reached 15:1. Conclusions: We found TDABC to be effective in comparing treatment alternatives, improving cost control and decision making. Everything else being equal, if the setup is available, our data suggest that initiating insulin pump treatment in groups is far more cost effective than on an individual basis and that TDABC may be used to find the balance point. PMID:28366085

Capital Investment by Independent and System-Affiliated Hospitals

PubMed Central

Carroll, Nathan W.; Smith, Dean G.; Wheeler, John R. C.

2015-01-01

Capital expenditures are a critical part of hospitals’ efforts to maintain quality of patient care and financial stability. Over the past 20 years, finding capital to fund these expenditures has become increasingly challenging for hospitals, particularly independent hospitals. Independent hospitals struggling to find ways to fund necessary capital investment are often advised that their best strategy is to join a multi-hospital system. There is scant empirical evidence to support the idea that system membership improves independent hospitals’ ability to make capital expenditures. Using data from the American Hospital Association and Medicare Cost Reports, we use difference-in-difference methods to examine changes in capital expenditures for independent hospitals that joined multi-hospital systems between 1997 and 2008. We find that in the first 5 years after acquisition, capital expenditures increase by an average of almost $16 000 per bed annually, as compared with non-acquired hospitals. In later years, the difference in capital expenditure is smaller and not statistically significant. Our results do not suggest that increases in capital expenditures vary by asset age or the size of the acquiring system. PMID:26105571

Capital Investment by Independent and System-Affiliated Hospitals.

PubMed

Carroll, Nathan W; Smith, Dean G; Wheeler, John R C

2015-01-01

Capital expenditures are a critical part of hospitals' efforts to maintain quality of patient care and financial stability. Over the past 20 years, finding capital to fund these expenditures has become increasingly challenging for hospitals, particularly independent hospitals. Independent hospitals struggling to find ways to fund necessary capital investment are often advised that their best strategy is to join a multi-hospital system. There is scant empirical evidence to support the idea that system membership improves independent hospitals' ability to make capital expenditures. Using data from the American Hospital Association and Medicare Cost Reports, we use difference-in-difference methods to examine changes in capital expenditures for independent hospitals that joined multi-hospital systems between 1997 and 2008. We find that in the first 5 years after acquisition, capital expenditures increase by an average of almost $16,000 per bed annually, as compared with non-acquired hospitals. In later years, the difference in capital expenditure is smaller and not statistically significant. Our results do not suggest that increases in capital expenditures vary by asset age or the size of the acquiring system. © The Author(s) 2015.

12 strategies for managing capital projects.

PubMed

Stoudt, Richard L

2013-05-01

To reduce the amount of time and cost associated with capital projects, healthcare leaders should: Begin the project with a clear objective and a concise master facilities plan. Select qualified team members who share the vision of the owner. Base the size of the project on a conservative business plan. Minimize incremental program requirements. Evaluate the cost impact of the building footprint. Consider alternative delivery methods.

Availability and cost of major and first-line antiepileptic drugs: a comprehensive evaluation in the capital of Madagascar.

PubMed

Jost, Jeremy; Raharivelo, Adeline; Ratsimbazafy, Voa; Nizard, Mandy; Auditeau, Emilie; Newton, Charles R; Preux, Pierre-Marie

2016-01-01

The prevalence of epilepsy is high in Madagascar (23.5/1000), as is the treatment gap (estimated at 92 %). The health system of the country is underfunded; some AEDs are used, and the national drug policy does not encourage price regulation or the administration of generic agents. We conducted a cross-sectional study to assess the availability and cost of solid oral AED formulations in Antananarivo, capital of Madagascar. Data were gathered from all officially registered pharmacies (according to the drug agency list, updated in 2015) by means of telephone interviews lasting no more than 10 min and conducted by a native Malagasy speaker. With regard to other sources (hospitals, illicit sales) data were obtained at specific visits. The study received ethical approval from the Madagascar Ministry of Health. A total of 91 of 100 pharmacies (the nine not included were because of an inoperative phone number), two of three public hospitals, and two illegal outlets were investigated. Sodium valproate was available in 84.6 % of the pharmacies, while carbamazepine and phenobarbital were available in 68.1 % and 36.3 % of the pharmacies, respectively, but phenytoin was not available in any supply chain. There were more originator brands than generic formulations, with a higher cost (range 20.3-81.1 %, median 40.7 %) compared to the equivalent generic. The public system had only a very limited choice of AED, but offered the lowest costs. Illicit sources were more expensive by 54.3 % for carbamazepine and 62.5 % for phenobarbital. Concerning the annual cost of treatment, the average percentage of the gross national income per capita based on the purchasing power parity was 29.8 %/19.0 % (brand/generic) for sodium valproate, 16.4 %/7.3 % (brand/generic) for carbamazepine, 8.9 %/5.1 % (brand/generic) for phenobarbital. The main sources of AEDs were private pharmacies, but the stocks held were low. The financial burden was still important in the capital of Madagascar

38 CFR 61.11 - Applications for capital grants.

Code of Federal Regulations, 2011 CFR

2011-07-01

... on the boundaries of the area or community proposed to be served; (8) If capital grant funds are proposed to be used for acquisition or rehabilitation, documentation demonstrating that the costs associated with acquisition or rehabilitation are less than the costs associated with new construction; (9...

38 CFR 61.11 - Applications for capital grants.

Code of Federal Regulations, 2010 CFR

2010-07-01

... on the boundaries of the area or community proposed to be served; (8) If capital grant funds are proposed to be used for acquisition or rehabilitation, documentation demonstrating that the costs associated with acquisition or rehabilitation are less than the costs associated with new construction; (9...

Revisiting Academic Capitalism in Canada: No Longer the Exception

ERIC Educational Resources Information Center

Metcalfe, Amy Scott

2010-01-01

In "Academic Capitalism: Politics, Policies, and the Entrepreneurial University" (1997), Slaughter and Leslie found that Canada showed signs of resisting academic capitalism. Changes in postsecondary education funding policies and the emergence of new commercialization initiatives are evidence that Canada is certainly no longer, and…

Making Tax-Exempt Capital Financing Work.

ERIC Educational Resources Information Center

Kavanagh, Richard E.

1985-01-01

Large and small businesses have long financed capital projects through tax-exempt financing. Colleges that need large sums of money to retrofit campuses with energy-efficient equipment can achieve the lowest borrowing cost available through bond insurance. (Author/MSE)

2 CFR 200.457 - Plant and security costs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Plant and security costs. 200.457 Section... Cost § 200.457 Plant and security costs. Necessary and reasonable expenses incurred for routine and.... Capital expenditures for plant security purposes are subject to § 200.439 Equipment and other capital...

Capital intensity of photovoltaics manufacturing: Barrier to scale and opportunity for innovation

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

Powell, Douglas M.; Fu, Ran; Horowitz, Kelsey

In this study, using a bottom-up cost model, we assess the impact of initial factory capital expenditure (capex) on photovoltaic (PV) module minimum sustainable price (MSP) and industry-wide trends. We find capex to have two important impacts on PV manufacturing. First, capex strongly influences the per-unit MSP of a c-Si module: we calculate that the capex-related elements sum to 22% of MSP for an integrated wafer, cell, and module manufacturer. This fraction provides a significant opportunity to reduce MSP toward the U.S. DOE SunShot module price target through capex innovation.

Capital intensity of photovoltaics manufacturing: Barrier to scale and opportunity for innovation

DOE PAGES

Powell, Douglas M.; Fu, Ran; Horowitz, Kelsey; ...

2015-09-07

In this study, using a bottom-up cost model, we assess the impact of initial factory capital expenditure (capex) on photovoltaic (PV) module minimum sustainable price (MSP) and industry-wide trends. We find capex to have two important impacts on PV manufacturing. First, capex strongly influences the per-unit MSP of a c-Si module: we calculate that the capex-related elements sum to 22% of MSP for an integrated wafer, cell, and module manufacturer. This fraction provides a significant opportunity to reduce MSP toward the U.S. DOE SunShot module price target through capex innovation.

Rolling capital: managing investments in a value-based care world.

PubMed

Jasuta, Lynette

2016-06-01

The importance of capital planning is increasing as the healthcare industry moves toward value-based care. Replacing unwieldy and inflexible traditional capital planning processes with a rolling capital planning approach can result in: Greater standardization, facilitating better strategic planning across the whole system. Reduced labor intensity in the planning and budgeting process. Reduced costs through being able to plan better for replacement purchases and take advantage of group purchasing and bundling opportunities. Increased transparency in the decision-making process.

Controlling supply expenses through capitated supply contracting.

PubMed

Kowalski, J C

1997-07-01

Some providers dealing with the financial challenges of managed care are attempting to control supply expenses through capitated supply contracting and similar risk/reward sharing arrangements. Under such arrangements, a supplier sells products and services to a provider for a fixed, prospective price in exchange for the provider's exclusive business. If expenses exceed the prospectively established amount, the supplier and provider share the loss. Conversely, if expenses are less than the fixed amount, they share the savings. For a capitated supply arrangement to be successful, providers must be able to identify and track supply expense drivers, such as clinical pathways, technology utilization, and product selection and utilization. Sophisticated information systems are needed to capture data, such as total and per-transaction product usage/volume; unit price per item; average and cost per item; average and total cost per transaction; and total cost per outcome. Providers also will need to establish mutually cooperative relationships with the suppliers with whom they contract.

An equilibrium-conserving taxation scheme for income from capital

NASA Astrophysics Data System (ADS)

Tempere, Jacques

2018-02-01

Under conditions of market equilibrium, the distribution of capital income follows a Pareto power law, with an exponent that characterizes the given equilibrium. Here, a simple taxation scheme is proposed such that the post-tax capital income distribution remains an equilibrium distribution, albeit with a different exponent. This taxation scheme is shown to be progressive, and its parameters can be simply derived from (i) the total amount of tax that will be levied, (ii) the threshold selected above which capital income will be taxed and (iii) the total amount of capital income. The latter can be obtained either by using Piketty's estimates of the capital/labor income ratio or by fitting the initial Pareto exponent. Both ways moreover provide a check on the amount of declared income from capital.

A Capital-Financing Plan for School Systems and Local Government

ERIC Educational Resources Information Center

Hodge, Penny

2012-01-01

School business officials are best equipped to lead in funding operating and capital needs because they understand the need for a methodical means of funding ongoing costs over time and the benefits of planning for future financial needs rather than letting emergencies dictate spending priorities. A capital-financing plan makes it possible to…

Machine cost analysis using the traditional machine-rate method and ChargeOut!

Treesearch

E. M. (Ted) Bilek

2009-01-01

Forestry operations require ever more use of expensive capital equipment. Mechanization is frequently necessary to perform cost-effective and safe operations. Increased capital should mean more sophisticated capital costing methodologies. However the machine rate method, which is the costing methodology most frequently used, dates back to 1942. CHARGEOUT!, a recently...

Measuring the cost implications of the Collaborative Accountable Care initiative in Texas.

PubMed

Ho, Vivian; Allen, Timothy K; Kim, Urie; Keenan, William P; Ku-Goto, Meei-Hsiang; Sanderson, Mark

2016-09-01

We analyzed changes in healthcare spending associated with the implementation of Cigna's Collaborative Accountable Care (CAC) initiative in a large multi-clinic physician practice. We compared claims from 2009, prior to the CAC initiative, against claims for 2010 to 2011, contrasting the patients covered by Cigna's CAC initiative with patients in other practices in the same geographic area covered by Cigna's medical plan. We used a propensity weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the CAC. The CAC initiative resulted in a 5.7% reduction in net spending per patient for 2010 to 2011, relative to what spending would have been without the initiative. This reduced spending was evident in multiple service categories: evaluation and management, procedures, imaging, tests, and durable medical equipment. Professional payments, inpatient facility, and outpatient facility payments for Medical Clinic of North Texas enrollees all experienced significant cost savings relative to the control group. About half of the savings resulted from using lower-priced sources. The CAC initiative, which includes an embedded care coordinator and a list of recommended providers, was associated with cost savings similar to those reported by other initiatives, such as global budgets and risk-based contracts.

13 CFR 107.1830 - Licensee's Capital Impairment-definition and general requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 301(c) Licensees If the percentage of equity capital investments (at cost) in your portfolio is: And... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Licensee's Capital Impairment... ADMINISTRATION SMALL BUSINESS INVESTMENT COMPANIES Licensee's Noncompliance With Terms of Leverage Computation of...

42 CFR 412.304 - Implementation of the capital prospective payment system.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Hospital Capital Costs General Provisions § 412.304 Implementation of the capital prospective payment system. (a) General rule. As described in §§ 412.312 through 412.370...

The middle-range theory of nursing intellectual capital.

PubMed

Covell, Christine L

2008-07-01

This paper is a report of the development of the middle-range theory of nursing intellectual capital. Rising healthcare costs and advances in technology have contributed to the need for better understanding of the influence of nurses' knowledge, skills and experience on patient and organizational outcomes. The middle-range nursing intellectual capital theory was developed using the strategies of concept and theory derivation. The principles of research synthesis were used to provide empirical support for the propositions of the theory. The middle-range nursing intellectual capital theory was derived from intellectual capital theory to make it relevant and applicable to a specific aspect of nursing, continuing professional development. It proposes that the nursing knowledge available in healthcare organizations is influenced by variables within the work environment, and influences patient and organizational outcomes. The middle-range nursing intellectual capital theory should be tested in different healthcare systems and in different settings and countries to determine its effectiveness in guiding research.

Cost-effectiveness analysis of treatment strategies for initial Clostridium difficile infection.

PubMed

Varier, R U; Biltaji, E; Smith, K J; Roberts, M S; Jensen, M K; LaFleur, J; Nelson, R E

2014-12-01

Clostridium difficile infection (CDI) is costly. Current guidelines recommend metronidazole as first-line therapy and vancomycin as an alternative. Recurrence is common. Faecal microbiota transplantation (FMT) is an effective therapy for recurrent CDI (RCDI). This study explores the cost-effectiveness of FMT, vancomycin and metronidazole for initial CDI. We constructed a decision-analytic computer simulation using inputs from published literature to compare FMT with a 10-14-day course of oral metronidazole or vancomycin for initial CDI. Parameters included cure rates (baseline value (range)) for metronidazole (80% (65-85%)), vancomycin (90% (88-92%)) and FMT(91% (83-100%)). Direct costs of metronidazole, vancomycin and FMT, adjusted to 2011 dollars, were $57 ($43-72), $1347 ($1195-1499) and $1086 ($815-1358), respectively. Our effectiveness measure was quality-adjusted life years (QALYs). One-way and probabilistic sensitivity analyses were conducted from the third-party payer perspective. Analysis using baseline values showed that FMT($1669, 0.242 QALYs) dominated (i.e. was less costly and more effective) vancomycin ($1890, 0.241 QALYs). FMT was more costly and more effective than metronidazole ($1167, 0.238 QALYs), yielding an incremental cost-effectiveness ratio (ICER) of $124 964/QALY. One-way sensitivity analyses showed that metronidazole dominated both strategies if its probability of cure were >90%; FMT dominated if it cost <$584. In a probabilistic sensitivity analysis at a willingness-to-pay threshold of $100 000/QALY, metronidazole was favoured in 55% of model iterations; FMT was favoured in 38%. Metronidazole, as the first-line treatment for CDIs, is less costly. FMT and vancomycin are more effective. However, FMT is less likely to be economically favourable, and vancomycin is unlikely to be favourable as first-line therapy when compared with FMT. © 2014 The Authors Clinical Microbiology and Infection © 2014 European Society of Clinical Microbiology

Does the cost of care differ for patients with fee-for-service vs. capitation of payment? A case-control study in gastroenterology.

PubMed

Slattery, E; Clancy, K X; Harewood, G C; Murray, F E; Patchett, S

2013-12-01

There is growing evidence to demonstrate overuse of medical resources in fee for service (FFS) payment models (in which physicians are reimbursed according to volume of care provided) compared to capitation payment models (in which physicians receive a fixed salary regardless of level of care provided). In this medical centre, patients with and without insurance are admitted through the same access point (emergency room) and cared for by the same physicians. Therefore, apart from insurance status, all other variables influencing delivery of care are similar for both patient groups. However, physician reimbursement differs for both groups: FFS for patients with private insurance (i.e. the admitting physician's reimbursement escalates progressively with each day that the patient spends in hospital) and base salary irrespective of care provided for patients with universal insurance (capitation payment model). All admitting physicians are aware of the patient's insurance status and the duration of hospitalization is at the discretion of the admitting physician. This study aimed to compare cost of care of patients with and without insurance admitted to a teaching hospital with a primary gastroenterology or hepatology (GIH) diagnosis. All hospital inpatients admitted between January 2008 and December 2009 with a primary GI-related diagnosis related group (DRG) were identified. Patients were classified as uninsured (state-funded) or privately insured. Only DRGs with at least five patients in both the insured and uninsured patient groups were analyzed to ensure a precise estimate of inpatient costs. Patient level costing (PLC) was used to express the total cost of hospital care for each patient; PLC comprised a weighted daily bed cost plus cost of all medical services provided (e.g. radiology, pathology tests) calculated according to an activity-based costing approach, cost of medications were excluded. An overall mean cost of care per patient was calculated for both

26 CFR 1.263(a)-1 - Capital expenditures; in general.

Code of Federal Regulations, 2014 CFR

2014-04-01

... indirect costs to property produced by the taxpayer and property acquired for resale. See also section 195 requiring taxpayers to capitalize certain costs as start-up expenditures. (c) Definitions. For purposes of... the value of its stockholdings in the subsidiary. This amount must be added to the cost of the stock...

47 CFR 69.310 - Capital leases.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Capital leases. 69.310 Section 69.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) ACCESS CHARGES... prescribed for similar plant costs or shall be apportioned in the same manner as Account 2001. ...

47 CFR 69.310 - Capital leases.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Capital leases. 69.310 Section 69.310 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) ACCESS CHARGES... prescribed for similar plant costs or shall be apportioned in the same manner as Account 2001. ...

A cost and returns evaluation of alternative dairy products to determine capital investment and operational feasibility of a small-scale dairy processing facility.

PubMed

Becker, K M; Parsons, R L; Kolodinsky, J; Matiru, G N

2007-05-01

This study examines the economic feasibility of 50- and 500-cow dairy processing facilities for fluid milk, yogurt, and cheese. Net present value and internal rate of return calculations for projected costs and returns over a 10-yr period indicate that larger yogurt and cheese processing plants offer the most profitable prospects, whereas a smaller yogurt plant would break even. A smaller cheese plant would have insufficient returns to cover the cost of capital, and fluid milk processing at either scale is economically infeasible. Economic success in processing is greatly contingent upon individual business, financial management, and marketing skills.

Cost/performance of solar reflective surfaces for parabolic dish concentrators

NASA Technical Reports Server (NTRS)

Bouquet, F.

1980-01-01

Materials for highly reflective surfaces for use in parabolic dish solar concentrators are discussed. Some important factors concerning performance of the mirrors are summarized, and typical costs are treated briefly. Capital investment cost/performance ratios for various materials are computed specifically for the double curvature parabolic concentrators using a mathematical model. The results are given in terms of initial investment cost for reflective surfaces per thermal kilowatt delivered to the receiver cavity for various operating temperatures from 400 to 1400 C. Although second surface glass mirrors are emphasized, first surface, chemically brightened and anodized aluminum surfaces as well as second surface, metallized polymeric films are treated. Conventional glass mirrors have the lowest cost/performance ratios, followed closely by aluminum reflectors. Ranges in the data due to uncertainties in cost and mirror reflectance factors are given.

AutoCPAP initiation at home: optimal trial duration and cost-effectiveness.

PubMed

Bachour, Adel; Virkkala, Jussi T; Maasilta, Paula K

2007-11-01

The duration of automatic computer-controlled continuous positive airway pressure device (autoCPAP) initiation at home varies largely between sleep centers. Our objectives were to evaluate the cost-effectiveness and to find the optimal trial duration. Of the 206 consecutive CPAP-naive patients with obstructive sleep apnea syndrome, who were referred to our hospital, 166 received autoCPAP for a 5-day trial at home. Of the 166 patients, 89 (15 women) showed a successful 5-day autoCPAP trial (normalized oximetry and mask-on time exceeding 4 h/day for at least 4 days). For the first trial day, 88 (53%) patients had normalized oximetry and a mask-on time exceeding 4 h. A 1-day autoCPAP trial EUR 668 was less cost-effective than a 5-day trial EUR 653, with no differences in values of efficient CPAP pressure or residual apnea-hypopnea index (AHI). The systematic requirement of oximetry monitoring raised the cost considerably from EUR 481 to EUR 668. In selected patients with obstructive sleep apnea, the optimal duration for initiating CPAP therapy at home by autoCPAP is 5 days. Although a 1-day trial was sufficient to determine the CPAP pressure requirement, it was not cost-effective and had a high rate of failure.

Process, cost, and clinical quality: the initial oral contraceptive visit.

PubMed

McMullen, Michael J; Woolford, Samuel W; Moore, Charles L; Berger, Barry M

2013-01-01

To demonstrate how the analysis of clinical process, cost, and outcomes can identify healthcare improvements that reduce cost without sacrificing quality, using the example of the initial visit associated with oral contraceptive pill use. Cross-sectional study using data collected by HealthMETRICS between 1996 and 2009. Using data collected from 106 sites in 24 states, the unintended pregnancy (UIP) rate, effectiveness of patient education, and unit visit cost were calculated. Staff type providing education and placement of education were recorded. Two-way analysis of variance models were created and tested for significance to identify differences between groups. Sites using nonclinical staff to provide education outside the exam were associated with lower cost, higher education scores, and a UIP rate no different from that of sites using clinical staff. Sites also providing patient education during the physical examination were associated with higher cost, lower education scores, and a UIP rate no lower than that of sites providing education outside of the exam. Through analyzing process, cost, and quality, lower-cost processes that did not reduce clinical quality were identified. This methodology is applicable to other clinical services for identifying low-cost processes that do not result in lower clinical quality. By using nonclinical staff educators to provide education outside of the physical examination, sites could save an average of 32% of the total cost of the visit.

Cost estimation and analysis using the Sherpa Automated Mine Cost Engineering System

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

Stebbins, P.E.

1993-09-01

The Sherpa Automated Mine Cost Engineering System is a menu-driven software package designed to estimate capital and operating costs for proposed surface mining operations. The program is engineering (as opposed to statistically) based, meaning that all equipment, manpower, and supply requirements are determined from deposit geology, project design and mine production information using standard engineering techniques. These requirements are used in conjunction with equipment, supply, and labor cost databases internal to the program to estimate all associated costs. Because virtually all on-site cost parameters are interrelated within the program, Sherpa provides an efficient means of examining the impact of changesmore » in the equipment mix on total capital and operating costs. If any aspect of the operation is changed, Sherpa immediately adjusts all related aspects as necessary. For instance, if the user wishes to examine the cost ramifications of selecting larger trucks, the program not only considers truck purchase and operation costs, it also automatically and immediately adjusts excavator requirements, operator and mechanic needs, repair facility size, haul road construction and maintenance costs, and ancillary equipment specifications.« less

Linking Shared Organisational Context and Relational Capital through Unlearning: An Initial Empirical Investigation in SMEs

ERIC Educational Resources Information Center

Cegarra-Navarro, Juan G.; Dewhurst, Frank W.

2006-01-01

Purpose: The environment provided by an organisation to facilitate learning and create knowledge has been defined as the shared organisational context. The value to an organisation of knowledge created by the shared organisational context is called intellectual capital, of which one key component is relational capital. The purpose of this paper is…

Cost Analysis of Total Joint Arthroplasty Readmissions in a Bundled Payment Care Improvement Initiative.

PubMed

Clair, Andrew J; Evangelista, Perry J; Lajam, Claudette M; Slover, James D; Bosco, Joseph A; Iorio, Richard

2016-09-01

The Bundled Payment for Care Improvement (BPCI) Initiative is a Centers for Medicare and Medicaid Services program designed to promote coordinated and efficient care. This study seeks to report costs of readmissions within a 90-day episode of care for BPCI Initiative patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA). From January 2013 through December 2013, 1 urban, tertiary, academic orthopedic hospital admitted 664 patients undergoing either primary TKA or THA through the BPCI Initiative. All patients readmitted to our hospital or an outside hospital within 90-days from the index episode were identified. The diagnosis and cost for each readmission were analyzed. Eighty readmissions in 69 of 664 patients (10%) were identified within 90-days. There were 53 readmissions (45 patients) after THA and 27 readmissions (24 patients) after TKA. Surgical complications accounted for 54% of THA readmissions and 44% of TKA readmissions. These complications had an average cost of $36,038 (range, $6375-$60,137) for THA and $38,953 (range, $4790-$104,794) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $27,979. Medical complications of THA and TKA had an average cost of $22,775 (range, $5678-$82,940) for THA and $24,183 (range, $3306-$186,069) for TKA. Eliminating the TKA outlier of greater than $100,000 yields an average cost of $11,682. Hospital readmissions after THA and TKA are common and costly. Identifying the causes for readmission and assessing the cost will guide quality improvement efforts. Copyright © 2016 Elsevier Inc. All rights reserved.

[Cost-benefit analysis of the implementation of automated drug-dispensing systems in Critical Care and Emergency Units].

PubMed

Poveda Andrés, J L; García Gómez, C; Hernández Sansalvador, M; Valladolid Walsh, A

2003-01-01

To determine monetary impact when traditional drug floor stocks are replaced by Automated Drug Dispensing Systems (ADDS) in the Medical Intensive Care Unit, Surgical Intensive Care Unit and the Emergency Room. We analysed four different flows considered to be determinant when implementing ADDS in a hospital environment: capital investment, staff costs, inventory costs and costs related to drug use policies. Costs were estimated by calculation of the current net value. Its analysis shows that those expenses derived from initial investment are compensated by the three remaining flows, with costs related to drug use policies showing the most substantial savings. Five years after initial investment, global cash-flows have been estimated at 300.525 euros. Replacement of traditional floor stocks by ADDS in the Medical Intensive Care Unit, Surgery Intensive Care Unit and the Emergency Room produces a positive benefit/cost ratio (1.95).

Costs and cost-effectiveness analysis of 2015 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

PubMed

Berenguer, Juan; Rivero, Antonio; Blasco, Antonio Javier; Arribas, José Ramón; Boix, Vicente; Clotet, Bonaventura; Domingo, Pere; González-García, Juan; Knobel, Hernando; Lázaro, Pablo; López, Juan Carlos; Llibre, Josep M; Lozano, Fernando; Miró, José M; Podzamczer, Daniel; Tuset, Montserrat; Gatell, Josep M

2016-01-01

GESIDA and the AIDS National Plan panel of experts suggest a preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2015. The objective of this study is to evaluate the costs and the effectiveness of initiating treatment with these regimens. Economic assessment of costs and effectiveness (cost/effectiveness) based on decision tree analyses. Effectiveness was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2015. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. In the base case scenario, the cost of initiating treatment ranges from 4663 Euros for 3TC+LPV/r (OR) to 10,902 Euros for TDF/FTC+RAL (PR). The effectiveness varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/effectiveness, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR) and RAL+DRV/r (OR), respectively. The most efficient regimen was 3TC+LPV/r (OR). Among the PR and AR, the most efficient regimen was TDF/FTC/RPV (AR). Among the PR regimes, the most efficient was ABC/3TC+DTG. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Cost-effectiveness analysis of initial treatment strategies for mild-to-moderate Clostridium difficile infection in hospitalized patients.

PubMed

Ford, Diana C; Schroeder, Mary C; Ince, Dilek; Ernst, Erika J

2018-06-14

The cost-effectiveness of initial treatment strategies for mild-to-moderate Clostridium difficile infection (CDI) in hospitalized patients was evaluated. Decision-analytic models were constructed to compare initial treatment with metronidazole, vancomycin, and fidaxomicin. The primary model included 1 recurrence, and the secondary model included up to 3 recurrences. Model variables were extracted from published literature with costs based on a healthcare system perspective. The primary outcome was the incremental cost-effective ratio (ICER) between initial treatment strategies. In the primary model, the overall percentage of patients cured was 94.23%, 95.19%, and 96.53% with metronidazole, vancomycin, and fidaxomicin, respectively. Expected costs per case were $1,553.01, $1,306.62, and $5,095.70, respectively. In both models, vancomycin was more effective and less costly than metronidazole, resulting in negative ICERs. The ICERs for fidaxomicin compared with those for metronidazole and vancomycin in the primary model were $1,540.23 and $2,828.69 per 1% gain in cure, respectively. Using these models, a hospital currently treating initial episodes of mild-to-moderate CDI with metronidazole could expect to save $246.39-$388.37 per case treated by using vancomycin for initial therapy. A decision-analytic model revealed vancomycin to be cost-effective, compared with metronidazole, for treatment of initial episodes of mild-to-moderate CDI in adult inpatients. From the hospital perspective, initial treatment with vancomycin resulted in a higher probability of cure and a lower probability of colectomy, recurrence, persistent recurrence, and cost per case treated, compared with metronidazole. Use of fidaxomicin was associated with an increased probability of cure compared with metronidazole and vancomycin, but at a substantially increased cost. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Human Capital Planning in Higher Education Institutions: A Strategic Human Resource Development Initiative in Jordan

ERIC Educational Resources Information Center

Khasawneh, Samer

2011-01-01

Purpose: The primary purpose of this study is to determine the status of human capital planning in higher education institutions in Jordan. Design/methodology/approach: A random sample of 120 faculty members (in administrative positions) responded to a human capital planning (HCP) survey. The survey consisted of a pool of 38 items distributed over…

Social Capital and International Migration from Latin America

PubMed Central

Massey, Douglas S.; Aysa-Lastra, María

2011-01-01

We combine data from the Latin American Migration Project and the Mexican Migration Project to estimate models predicting the likelihood of taking of first and later trips to the United States from five nations: Mexico, the Dominican Republic, Costa Rica, Nicaragua, and Peru. The models test specific hypotheses about the effects of social capital on international migration and how these effects vary with respect to contextual factors. Our findings confirm the ubiquity of migrant networks and the universality of social capital effects throughout Latin America. They also reveal how the sizes of these effects are not uniform across settings. Social capital operates more powerfully on first as opposed to later trips and interacts with the cost of migration. In addition, effects are somewhat different when considering individual social capital (measuring strong ties) and community social capital (measuring weak ties). On first trips, the effect of strong ties in promoting migration increases with distance whereas the effect of weak ties decreases with distance. On later trips, the direction of effects for both individual and community social capital is negative for long distances but positive for short distances. PMID:21915379

Impact of State hospital rate setting on capital formation

PubMed Central

Cromwell, Jerry

1987-01-01

For this article, a new national data base of Medicare cost reports on more than 2,000 hospitals is used to measure the impact of State prospective rate setting on capital formation. Several investment measures are analyzed, both in nominal and real terms, using a combination of descriptive and multivariate techniques. Results indicate that, over the last decade, State hospital rate-setting programs have had little demonstrable effect on capital formation and they have not caused any significant aging of plant assets. Programs in both New York and Massachusetts were found to be associated with a slowing in the rate of bed growth, however, resulting in significant long-term cost savings. PMID:10312117

Does capitation affect the delivery of oral healthcare and access to services? Evidence from a pilot contact in Northern Ireland.

PubMed

Hill, Harry; Birch, Stephen; Tickle, Martin; McDonald, Ruth; Donaldson, Michael; O'Carolan, Donncha; Brocklehurst, Paul

2017-03-06

In May 2009, the Northern Ireland government introduced General Dental Services (GDS) contracts based on capitation in dental practices newly set up by a corporate dental provider to promote access to dental care in populations that had previously struggled to secure service provision. Dental service provision forms an important component of general health services for the population, but the implications of health system financing on care delivered and the financial cost of services has received relatively little attention in the research literature. The aim of this study is to evaluate the policy effect capitation payment in recently started corporate practices had on the delivery of primary oral healthcare in Northern Ireland and access to services. We analysed the policy initiative in Northern Ireland as a natural experiment to find the impact on healthcare delivery of the newly set up corporate practices that use a prospective capitation system to remunerate primary care dentists. Data was collected from GDS claim forms submitted to the Business Services Organisation (BSO) between April 2011 and October 2014. Health and Social Care Board (HSCB) practices operating within a capitation system were matched to a control group, who were remunerated using a retrospective fee-for-service system. No evidence of patient selection was found in the HSCB practices set up by a corporate provider and operated under capitation. However, patients were less likely to visit the dentist and received less treatment when they did attend, compared to those belonging to the control group (P < 0.05). The extent of preventive activity offered and the patient payment charge revenue did not differ between the two practice groups. Although remunerating NHS primary care dentists in newly set up corporate practices using a prospective capitation system managed costs within healthcare, there is evidence that this policy may have reduced access to care of registered patients.

Cost Experience of Automated Guideway Transit Systems. (Supplement V) Costs and Trends for the Period 1976-1982.

DOT National Transportation Integrated Search

1984-04-01

This report summarizes the cost experiences and trends of sixteen domestic AGT systems. Capital costs, operation and maintenance costs, system characteristics, operational statistics, and unit cost measures are presented to provide useful information...

Cost-effectiveness of a package of interventions for expedited antiretroviral therapy initiation during pregnancy in Cape Town, South Africa

PubMed Central

ZULLIGER, Rose; BLACK, Samantha; HOLTGRAVE, David R.; CIARANELLO, Andrea L.; BEKKER, Linda–Gail; MYER, Landon

2014-01-01

Initiating antiretroviral therapy (ART) early in pregnancy is an important component of effective interventions to prevent the mother-to-child transmission of HIV (PMTCT). The Rapid initiation of ART in Pregnancy (RAP) program was a package of interventions to expedite ART initiation in pregnant women in Cape Town, South Africa. Retrospective, cost-effectiveness, sensitivity and threshold analyses were conducted of the RAP program to determine the cost-utility thresholds for rapid initiation of ART in pregnancy. Costs were drawn from a detailed microcosting of the program. The overall programmatic cost was US$880 per woman and the base case cost-effectiveness ratio was US$1,160 per quality-adjusted life year (QALY) saved. In threshold analyses, the RAP program remained cost-effective if mother-to-child transmission was reduced by ≥0.33%; if ≥1.76 QALY were saved with each averted perinatal infection; or if RAP-related costs were under US$4,020 per woman. The package of rapid initiation services was very cost-effective, as compared to standard services in this setting. Threshold analyses demonstrated that the intervention required minimal reductions in perinatal infections in order to be cost-effective. Interventions for the rapid initiation of ART in pregnancy hold considerable potential as a cost-effective use of limited resources for PMTCT in sub-Saharan Africa. PMID:24122044

Intellectual Capital.

ERIC Educational Resources Information Center

Snyder, Herbert W.; Pierce, Jennifer Burek

2002-01-01

This review focuses on intellectual capital and its relationship to information professionals. Discusses asset recognition; national practices and the acceptance of intellectual capital; definitions of intellectual capital; measuring intellectual capital, including multiple and single variable measures; managing intellectual capital; and knowledge…

How does initial treatment choice affect short-term and long-term costs for clinically localized prostate cancer?

PubMed

Snyder, Claire F; Frick, Kevin D; Blackford, Amanda L; Herbert, Robert J; Neville, Bridget A; Carducci, Michael A; Earle, Craig C

2010-12-01

Data regarding costs of prostate cancer treatment are scarce. This study investigates how initial treatment choice affects short-term and long-term costs. This retrospective, longitudinal cohort study followed prostate-cancer cases diagnosed in 2000 for 5 years using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Men age≥66 years, in Medicare fee for service, diagnosed with clinically localized prostate cancer in 2000 while residing in a SEER region, were matched to noncancer controls using age, sex, race, region, comorbidity, and survival. On the basis of treatment received during the first 9 months postdiagnosis, patients were assigned to watchful waiting, radiation, hormonal therapy, hormonal+radiation, and surgery (may have received other treatments). Incremental costs for prostate cancer were the difference in costs for prostate cancer cases versus matched controls. Costs were divided into initial treatment (months -1 to 12), long-term (each 12 months thereafter), and total (months -1 to 60). Sensitivity analyses excluded the last 12 months of life. A total of 13,769 prostate-cancer cases were matched to 13,769 noncancer controls. Watchful waiting had the lowest initial treatment ($4270) and 5-year total costs ($9130). Initial treatment costs were highest for hormonal+radiation ($17,474) and surgery ($15,197). At $26,896, 5-year total costs were highest for hormonal therapy only followed by hormonal+radiation ($25,097) and surgery ($19,214). After excluding the last 12 months of life, total costs were highest for hormonal+radiation ($23,488) and hormonal therapy ($23,199). Patterns of costs vary widely based on initial treatment. These data can inform patients and clinicians considering treatment options and policy makers interested in patterns of costs. Copyright © 2010 American Cancer Society.

78 FR 76973 - Regulatory Capital Rules: Regulatory Capital, Implementation of Basel III, Capital Adequacy...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-20

... Discipline and Disclosure Requirements, Advanced Approaches Risk-Based Capital Rule, and Market Risk Capital..., 2013, a document adopting a final rule that revises its risk-based and leverage capital requirements... risk-based and leverage capital requirements for banking organizations. An allowance for additional...

Deviance as Pedagogy: From Nondominant Cultural Capital to Deviantly Marked Cultural Repertoires

ERIC Educational Resources Information Center

Dixon-Román, Ezekiel J.

2014-01-01

Background/Context: Pierre Bourdieu's concept of cultural capital has been employed extensively in sociological, educational, and anthropological research. However, Bourdieu's conceptualization of cultural capital has often been misread to refer only to "high status" or dominant cultural norms and resources at the cost of…

Setting capitation payments in markets for health services

PubMed Central

Ellis, Randall P.; McGuire, Thomas G.

1987-01-01

Health maintenance organizations (HMO's) are paid a capitated amount for enrolled Medicare beneficiaries that is 95 percent of what these enrollees would be expected to cost in the fee-for-service sector. However, it appears that HMO enrollees are less costly than other Medicare beneficiaries. With a simulation model, we demonstrate that with a 95-percent pricing rule, any significant degree of biased selection leads to increased cost to the payer, even when HMO's are cost effective compared with the fee-for-service sector. Optimal pricing percentages from the point of view of cost minimization are considerably less than 95 percent. PMID:10312188

A cost-effectiveness analysis of conservative versus surgical management for the initial treatment of stress urinary incontinence.

PubMed

Richardson, Monica L; Sokol, Eric R

2014-11-01

We sought to determine whether conservative or surgical therapy is more cost effective for the initial treatment of stress urinary incontinence (SUI). We created a decision tree model to compare costs and cost effectiveness of 3 strategies for the initial treatment of SUI: (1) continence pessary, (2) pelvic floor muscle therapy (PFMT), and (3) midurethral sling (MUS). We identified probabilities of SUI after 12 months of use of a pessary, PFMT, or MUS using published data. Parameter estimates included Health Utility Indices of no incontinence (.93) and persistent incontinence (0.7) after treatment. Morbidities associated with MUS included mesh erosion, retention, de novo urge incontinence, and recurrent SUI. Cost data were derived from Medicare in 2012 US dollars. One- and 2-way sensitivity analysis was used to examine the effect of varying rates of pursuing surgery if conservative management failed and rates of SUI cure with pessaries and PFMT. The primary outcome was an incremental cost-effectiveness ratio threshold <$50,000. Compared to PFMT, initial treatment of SUI with MUS was the more cost-effective strategy with an incremental cost-effectiveness ratio of $32,132/quality-adjusted life year. Initial treatment with PFMT was also acceptable as long as subjective cure was >35%. In 3-way sensitivity analysis, subjective cure would need to be >40.5% for PFMT and 43.5% for a continence pessary for the MUS scenario to not be the preferred strategy. At 1 year, MUS is more cost effective than a continence pessary or PFMT for the initial treatment for SUI. Copyright © 2014. Published by Elsevier Inc.

Costs and cost-efficacy analysis of the 2014 GESIDA/Spanish National AIDS Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

PubMed

Blasco, Antonio Javier; Llibre, Josep M; Berenguer, Juan; González-García, Juan; Knobel, Hernando; Lozano, Fernando; Podzamczer, Daniel; Pulido, Federico; Rivero, Antonio; Tuset, Montserrat; Lázaro, Pablo; Gatell, Josep M

2015-03-01

GESIDA and the National AIDS Plan panel of experts suggest preferred (PR) and alternative (AR) regimens of antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2014. The objective of this study is to evaluate the costs and the efficiency of initiating treatment with these regimens. An economic assessment was made of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied by considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and costs correspond to those of 2014. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. In the base case scenario, the cost of initiating treatment ranges from 5133 Euros for ABC/3TC+EFV to 11,949 Euros for TDF/FTC+RAL. The efficacy varies between 0.66 for ABC/3TC+LPV/r and ABC/3TC+ATV/r, and 0.89 for TDF/FTC/EVG/COBI. Efficiency, in terms of cost/efficacy, ranges from 7546 to 13,802 Euros per responder at 48 weeks, for ABC/3TC+EFV and TDF/FTC+RAL respectively. Considering ART official prices, the most efficient regimen was ABC/3TC+EFV (AR), followed by the non-nucleoside containing PR (TDF/FTC/RPV and TDF/FTC/EFV). The sensitivity analysis confirms the robustness of these findings. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Costs and cost-efficacy analysis of the 2017 GESIDA/Spanish National AIDS Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

PubMed

Rivero, Antonio; Pérez-Molina, José Antonio; Blasco, Antonio Javier; Arribas, José Ramón; Asensi, Víctor; Crespo, Manuel; Domingo, Pere; Iribarren, José Antonio; Lázaro, Pablo; López-Aldeguer, José; Lozano, Fernando; Martínez, Esteban; Moreno, Santiago; Palacios, Rosario; Pineda, Juan Antonio; Pulido, Federico; Rubio, Rafael; Santos, Jesús; de la Torre, Javier; Tuset, Montserrat; Gatell, Josep M

2018-05-01

GESIDA and the Spanish National AIDS Plan panel of experts have recommended preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral therapy (ART) as initial therapy in HIV-infected patients for 2017. The objective of this study was to evaluate the costs and the efficiency of initiating treatment with PR and AR. Economic assessment of costs and efficiency (cost-efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied considering only differential direct costs: ART (official prices), management of adverse effects, resistance studies and HLA B*5701 screening. The setting was Spain and the costs correspond to those of 2017. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. In the base case scenario, the cost of initiating treatment ranged from 6882 euro for TFV/FTC/RPV (AR) to 10,904 euros for TFV/FTC+RAL (PR). The efficacy varied from 0.82 for TFV/FTC+DRV/p (AR) to 0.92 for TAF/FTC/EVG/COBI (PR). The efficiency, in terms of cost-efficacy, ranged from 7923 to 12,765 euros per responder at 48 weeks, for ABC/3TC/DTG (PR) and TFV/FTC+RAL (PR), respectively. Considering ART official prices, the most efficient regimen was ABC/3TC/DTG (PR), followed by TFV/FTC/RPV (AR) and TAF/FTC/EVG/COBI (PR). Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Costs and cost-efficacy analysis of the 2016 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

PubMed

Rivero, Antonio; Pérez-Molina, José Antonio; Blasco, Antonio Javier; Arribas, José Ramón; Crespo, Manuel; Domingo, Pere; Estrada, Vicente; Iribarren, José Antonio; Knobel, Hernando; Lázaro, Pablo; López-Aldeguer, José; Lozano, Fernando; Moreno, Santiago; Palacios, Rosario; Pineda, Juan Antonio; Pulido, Federico; Rubio, Rafael; de la Torre, Javier; Tuset, Montserrat; Gatell, Josep M

2017-02-01

GESIDA and the AIDS National Plan panel of experts suggest preferred (PR), alternative (AR), and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for the year 2016. The objective of this study is to evaluate the costs and the efficacy of initiating treatment with these regimens. Economic assessment of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48 in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2016. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable, and least favourable. In the base case scenario, the cost of initiating treatment ranges from 4663 Euros for 3TC+LPV/r (OR) to 10,894 Euros for TDF/FTC+RAL (PR). The efficacy varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/efficacy, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR), and RAL+DRV/r (OR), respectively. Despite the overall most efficient regimen being 3TC+LPV/r (OR), among the PR and AR, the most efficient regimen was ABC/3TC/DTG (PR). Among the AR regimes, the most efficient was TDF/FTC/RPV. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

77 FR 52977 - Regulatory Capital Rules: Advanced Approaches Risk-Based Capital Rule; Market Risk Capital Rule

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-30

... Corporation 12 CFR Parts 324, 325 Regulatory Capital Rules: Advanced Approaches Risk-Based Capital Rule... 325 RIN 3064-AD97 Regulatory Capital Rules: Advanced Approaches Risk-Based Capital Rule; Market Risk... the agencies' current capital rules. In this NPR (Advanced Approaches and Market Risk NPR) the...

Allocating risk capital for a brownfields redevelopment project under hydrogeological and financial uncertainty.

PubMed

Yu, Soonyoung; Unger, Andre J A; Parker, Beth; Kim, Taehee

2012-06-15

In this study, we defined risk capital as the contingency fee or insurance premium that a brownfields redeveloper needs to set aside from the sale of each house in case they need to repurchase it at a later date because the indoor air has been detrimentally affected by subsurface contamination. The likelihood that indoor air concentrations will exceed a regulatory level subject to subsurface heterogeneity and source zone location uncertainty is simulated by a physics-based hydrogeological model using Monte Carlo realizations, yielding the probability of failure. The cost of failure is the future value of the house indexed to the stochastic US National Housing index. The risk capital is essentially the probability of failure times the cost of failure with a surcharge to compensate the developer against hydrogeological and financial uncertainty, with the surcharge acting as safety loading reflecting the developers' level of risk aversion. We review five methodologies taken from the actuarial and financial literature to price the risk capital for a highly stylized brownfield redevelopment project, with each method specifically adapted to accommodate our notion of the probability of failure. The objective of this paper is to develop an actuarially consistent approach for combining the hydrogeological and financial uncertainty into a contingency fee that the brownfields developer should reserve (i.e. the risk capital) in order to hedge their risk exposure during the project. Results indicate that the price of the risk capital is much more sensitive to hydrogeological rather than financial uncertainty. We use the Capital Asset Pricing Model to estimate the risk-adjusted discount rate to depreciate all costs to present value for the brownfield redevelopment project. A key outcome of this work is that the presentation of our risk capital valuation methodology is sufficiently generalized for application to a wide variety of engineering projects. Copyright © 2012 Elsevier

Capital death in the world market

NASA Astrophysics Data System (ADS)

Avakian, Adam; Podobnik, Boris; Piskor, Manuela; Stanley, H. Eugene

2014-03-01

We study the gross domestic product (GDP) per capita together with the market capitalization (MCAP) per capita as two indicators of the effect of globalization. We find that g, the GDP per capita, as a function of m, the MCAP per capita, follows a power law with average exponent close to 1/3. In addition, the Zipf ranking approach confirms that the m for countries with initially lower values of m tends to grow more rapidly than for countries with initially larger values of m. If the trends over the past 20 years continue to hold in the future, then the Zipf ranking approach leads to the prediction that in about 50 years, all countries participating in globalization will have comparable values of their MCAP per capita. We call this economic state "capital death," in analogy to the physics state of "heat death" predicted by thermodynamic arguments.

Inequality in Human Capital and Endogenous Credit Constraints

PubMed Central

Hai, Rong; Heckman, James J.

2017-01-01

This paper investigates the determinants of inequality in human capital with an emphasis on the role of the credit constraints. We develop and estimate a model in which individuals face uninsured human capital risks and invest in education, acquire work experience, accumulate assets and smooth consumption. Agents can borrow from the private lending market and from government student loan programs. The private market credit limit is explicitly derived by extending the natural borrowing limit of Aiyagari (1994) to incorporate endogenous labor supply, human capital accumulation, psychic costs of working, and age. We quantify the effects of cognitive ability, noncognitive ability, parental education, and parental wealth on educational attainment, wages, and consumption. We conduct counterfactual experiments with respect to tuition subsidies and enhanced student loan limits and evaluate their effects on educational attainment and inequality. We compare the performance of our model with an influential ad hoc model in the literature with education-specific fixed loan limits. We find evidence of substantial life cycle credit constraints that affect human capital accumulation and inequality. The constrained fall into two groups: those who are permanently poor over their lifetimes and a group of well-endowed individuals with rising high levels of acquired skills who are constrained early in their life cycles. Equalizing cognitive and noncognitive ability has dramatic effects on inequality. Equalizing parental backgrounds has much weaker effects. Tuition costs have weak effects on inequality. PMID:28642641

Inequality in Human Capital and Endogenous Credit Constraints.

PubMed

Hai, Rong; Heckman, James J

2017-04-01

This paper investigates the determinants of inequality in human capital with an emphasis on the role of the credit constraints. We develop and estimate a model in which individuals face uninsured human capital risks and invest in education, acquire work experience, accumulate assets and smooth consumption. Agents can borrow from the private lending market and from government student loan programs. The private market credit limit is explicitly derived by extending the natural borrowing limit of Aiyagari (1994) to incorporate endogenous labor supply, human capital accumulation, psychic costs of working, and age. We quantify the effects of cognitive ability, noncognitive ability, parental education, and parental wealth on educational attainment, wages, and consumption. We conduct counterfactual experiments with respect to tuition subsidies and enhanced student loan limits and evaluate their effects on educational attainment and inequality. We compare the performance of our model with an influential ad hoc model in the literature with education-specific fixed loan limits. We find evidence of substantial life cycle credit constraints that affect human capital accumulation and inequality. The constrained fall into two groups: those who are permanently poor over their lifetimes and a group of well-endowed individuals with rising high levels of acquired skills who are constrained early in their life cycles. Equalizing cognitive and noncognitive ability has dramatic effects on inequality. Equalizing parental backgrounds has much weaker effects. Tuition costs have weak effects on inequality.

Manual of phosphoric acid fuel cell power plant cost model and computer program

NASA Technical Reports Server (NTRS)

Lu, C. Y.; Alkasab, K. A.

1984-01-01

Cost analysis of phosphoric acid fuel cell power plant includes two parts: a method for estimation of system capital costs, and an economic analysis which determines the levelized annual cost of operating the system used in the capital cost estimation. A FORTRAN computer has been developed for this cost analysis.

Individual quality and age but not environmental or social conditions modulate costs of reproduction in a capital breeder.

PubMed

Debeffe, Lucie; Poissant, Jocelyn; McLoughlin, Philip D

2017-08-01

Costs associated with reproduction are widely known to play a role in the evolution of reproductive tactics with consequences to population and eco-evolutionary dynamics. Evaluating these costs as they pertain to species in the wild remains an important goal of evolutionary ecology. Individual heterogeneity, including differences in individual quality (i.e., among-individual differences in traits associated with survival and reproduction) or state, and variation in environmental and social conditions can modulate the costs of reproduction; however, few studies have considered effects of these factors simultaneously. Taking advantage of a detailed, long-term dataset for a population of feral horses (Sable Island, Nova Scotia, Canada), we address the question of how intrinsic (quality, age), environmental (winter severity, location), and social conditions (group size, composition, sex ratio, density) influence the costs of reproduction on subsequent reproduction. Individual quality was measured using a multivariate analysis on a combination of four static and dynamic traits expected to depict heterogeneity in individual performance. Female quality and age interacted with reproductive status of the previous year to determine current reproductive effort, while no effect of social or environmental covariates was found. High-quality females showed higher probabilities of giving birth and weaning their foal regardless of their reproductive status the previous year, while those of lower quality showed lower probabilities of producing foals in successive years. Middle-aged (prime) females had the highest probability of giving birth when they had not reproduced the year before, but no such relationship with age was found among females that had reproduced the previous year, indicating that prime-aged females bear higher costs of reproduction. We show that individual quality and age were key factors modulating the costs of reproduction in a capital breeder but that

Risk Financing for Schools: The Capital Markets Approach.

ERIC Educational Resources Information Center

Rudolph, Richard G.

1988-01-01

The capital markets approach is an alternative means of risk financing whereby a school system establishes and controls its own insurance company and makes systematic contributions to pay for expected and anticipated losses and their associated costs. (MLF)

Building Social Capital through Leadership Development

ERIC Educational Resources Information Center

Roberts, Cynthia

2013-01-01

Social capital, an important mechanism for the creation and maintenance of healthy organizational life, may be developed through initiatives such as leadership development as effective leadership development not only enhances individual effectiveness, but serves to build relationships, coordinate actions, and extend and strengthen the social…

How School Facilities Managers and Business Officials Are Reducing Operating Costs and Saving Money. Energy-Smart Building Choices.

ERIC Educational Resources Information Center

Department of Energy, Washington, DC.

This guide addresses contributions that school facility administrators and business officials can make in an effort to reduce operating costs and free up money for capital improvements. The guide explores opportunities available to utilize energy-saving strategies at any stage in a building's life, from its initial design phase through renovation.…

Strategic asset management: alternatives for capital acquisitions.

PubMed

Bluemke, Duane H

2002-11-01

A well-designed asset-management plan can reduce capital costs by prioritizing equipment and technology purchase requests and optimizing use of existing resources. Instead of purchasing new equipment, underused equipment can be moved to where it is needed. Completely overhauling equipment that is showing signs of wear may be more cost-effective than simply repairing individual components as they fail. Leasing equipment can help improve an organization's cash flow and balance sheet, while avoiding potential future concerns about obsolescence.

12 CFR 325.103 - Capital measures and capital category definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... relevant capital measures shall be: (1) The total risk-based capital ratio; (2) The Tier 1 risk-based capital ratio; and (3) The leverage ratio. (b) Capital categories. For purposes of section 38 and this... capital ratio of 10.0 percent or greater; and (ii) Has a Tier 1 risk-based capital ratio of 6.0 percent or...

The Competitive, Crowd sourced Investment (CCI) Initiative

DTIC Science & Technology

2016-03-01

any other organization of the Department of Defense. * * * Within the private sector, investment capital flows to the businesses that can best...The Competitive, Crowdsourced Investment (CCI) Initiative Col. Scott T. Wallace, USAF This article proposes an initiative for consideration by the...generate returns for investors. A result of this incentive structure is a business culture that relentlessly turns capital into future returns.Within the

Cost Analysis of a High Support Housing Initiative for Persons with Severe Mental Illness and Long-Term Psychiatric Hospitalization.

PubMed

Rudoler, David; de Oliveira, Claire; Jacob, Binu; Hopkins, Melonie; Kurdyak, Paul

2018-01-01

The objective of this article was to conduct a cost analysis comparing the costs of a supportive housing intervention to inpatient care for clients with severe mental illness who were designated alternative-level care while inpatient at the Centre for Addiction and Mental Health in Toronto. The intervention, called the High Support Housing Initiative, was implemented in 2013 through a collaboration between 15 agencies in the Toronto area. The perspective of this cost analysis was that of the Ontario Ministry of Health and Long-Term Care. We compared the cost of inpatient mental health care to high-support housing. Cost data were derived from a variety of sources, including health administrative data, expenditures reported by housing providers, and document analysis. The High Support Housing Initiative was cost saving relative to inpatient care. The average cost savings per diem were between $140 and $160. This amounts to an annual cost savings of approximately $51,000 to $58,000. When tested through sensitivity analysis, the intervention remained cost saving in most scenarios; however, the result was highly sensitive to health system costs for clients of the High Support Housing Initiative program. This study suggests the High Support Housing Initiative is potentially cost saving relative to inpatient hospitalization at the Centre for Addiction and Mental Health.

ARSENIC REMOVAL COST ESTIMATING PROGRAM

EPA Science Inventory

The Arsenic Removal Cost Estimating program (Excel) calculates the costs for using adsorptive media and anion exchange treatment systems to remove arsenic from drinking water. The program is an easy-to-use tool to estimate capital and operating costs for three types of arsenic re...

Development of a Capital Allocations Formula.

ERIC Educational Resources Information Center

Thompson, I.; And Others.

A description is presented of the present state of development of a capital allocations formula for general building project costs at the University of Toronto. The first part of the paper is devoted to a discussion of the objectives and application of the formula in its present state. A detailed description of the available data and the…

A road map for natural capitalism.

PubMed

Lovins, A B; Lovins, L H; Hawken, P

1999-01-01

No one would run a business without accounting for its capital outlays. Yet most companies overlook one major capital component--the value of the earth's ecosystem services. It is a staggering omission; recent calculations place the value of the earth's total ecosystem services--water storage, atmosphere regulation, climate control, and so on--at $33 trillion a year. Not accounting for those costs has led to waste on a grand scale. But now a few farsighted companies are finding powerful business opportunities in conserving resources on a similarly grand scale. They are embarking on a journey toward "natural capitalism," a journey that comprises four major shifts in business practices. The first stage involves dramatically increasing the productivity of natural resources, stretching them as much as 100 times further than they do today. In the second stage, companies adopt closed-loop production systems that yield no waste or toxicity. The third stage requires a fundamental change of business model--from one of selling products to one of delivering services. For example, a manufacturer would sell lighting services rather than lightbulbs, thus benefitting the seller and customer for developing extremely efficient, durable lightbulbs. The last stage involves reinvesting in natural capital to restore, sustain, and expand the planet's ecosystem. Because natural capitalism is both necessary and profitable, it will sub-sume traditional industrialism, the authors argue, just as industrialism sub-sumed agrarianism. And the companies that are furthest down the road will have the competitive edge.

12 CFR 565.4 - Capital measures and capital category definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

...-based capital ratio; (2) The Tier 1 risk-based capital ratio; and (3) The leverage ratio. (b) Capital...; and (ii) Has a Tier 1 risk-based capital ratio of 6.0 percent or greater; and (iii) Has a leverage... total risk-based capital ratio of 8.0 percent or greater; and (ii) Has a Tier 1 risk-based capital ratio...

Health economic controversy and cost-effectiveness of proton therapy.

PubMed

Lievens, Yolande; Pijls-Johannesma, Madelon

2013-04-01

Owing to increasing healthcare costs, there is a need to examine whether the benefits of new technologies are worth the extra cost. In proton therapy, where the evidence in favor is limited, it is heavily debated whether the expected benefit justifies the higher capital and operating costs. The aim of this article was to explore the existing methodologies of economic evaluations (EEs) of particle therapy and recommend an approach for future data collection and analysis. We reviewed the published literature on health economics of proton therapy using accepted guidelines on performing EE. Different cost strategies were assessed and comparisons with other treatment modalities were made in terms of cost-effectiveness. Potential bias in the existing studies was identified and new methodologies proposed. The principal cause of bias in EEs of proton therapy is the lack of valid data on effects as well as costs. The introduction of proton therapy may be seriously hampered by the lack of outcome and cost data and the situation is likely to continue not only in terms of justifying the capital investment but also covering the operational costs. We identified an urgent need to collect appropriate data to allow for reimbursement of such novel technology. In the absence of level 1 evidence, well-performed modeling studies taking into account the available cost and outcome parameters, including the current uncertainties, can help to address the problem of limited outcome and health economic data. The approach of coverage with evidence development, in which evidence is collected in an ongoing manner in population-based registries along with dedicated financing, may allow technological advances with limited initial evidence of benefit and value, such as protons, to become available to patients in an early phase of their technology life cycle. Copyright © 2013 Elsevier Inc. All rights reserved.

Associations among slipped capital femoral epiphysis, tibia vara, and type 2 juvenile diabetes.

PubMed

Bowen, James Richard; Assis, Morcello; Sinha, Kumar; Hassink, Sandra; Littleton, Aaron

2009-06-01

Clinical consequences of obesity are numerous and include slipped capital epiphysis of the femur, tibia vara, impaired mobility, insufficient muscle strength, glucose intolerance, type 2 diabetes, hyperlipidemia, nonalcoholic fatty liver disease, cholelithiasis, hypertension, sleep apnea, polycystic ovary disease, increased cardiorespiratory effort, and pseudotumor cerebri, among others. Because slipped capital femoral epiphysis, tibia vara, and type 2 diabetes are observed commonly in obese children, a degree of multiple disease occurrence in a patient would be anticipated; however, the senior author has never observed an obese adolescent who presented at the initial diagnosis with a coexistence of slipped capital femora epiphysis, tibia vara, or type 2 diabetes, so, possibly, these constellations of comorbidities may represent unique obesity phenotypes. We reviewed the population consisting of all consecutive patients with newly diagnosed slipped capital femoral epiphysis or tibia vara from 2000 to 2006 and a selected group of patients with type 2 diabetes treated at the Alfred I. duPont Hospital for Children, Wilmington, DE. There were 57 cases of slipped capital femoral epiphysis, 41 cases of tibia vara, and 53 cases of type 2 diabetes. The tibia vara group had the highest body mass index (BMI; 40.81 [13.01]); the diabetes group (BMI, 35.76 [7.04]) and the slipped capital femoral epiphysis group (BMI, 29.08 [7.07]) had the lowest BMI. There was no significant difference in age at the disease onset and height between groups. There was no overlap of disease at initial presentation among slipped capital femoral epiphysis, adolescent tibia vara, and type 2 diabetes. We observed 3 separate obesity-related phenotypes in adolescents with no overlap of disease at initial presentation among slipped capital femoral epiphysis, adolescent tibia vara, and type 2 diabetes.

High Levels Of Capitation Payments Needed To Shift Primary Care Toward Proactive Team And Nonvisit Care.

PubMed

Basu, Sanjay; Phillips, Russell S; Song, Zirui; Bitton, Asaf; Landon, Bruce E

2017-09-01

Capitated payments in the form of fixed monthly payments to cover all of the costs associated with delivering primary care could encourage primary care practices to transform the way they deliver care. Using a microsimulation model incorporating data from 969 US practices, we sought to understand whether shifting to team- and non-visit-based care is financially sustainable for practices under traditional fee-for-service, capitated payment, or a mix of the two. Practice revenues and costs were computed for fee-for-service payments and a range of capitated payments, before and after the substitution of team- and non-visit-based services for low-complexity in-person physician visits. The substitution produced financial losses for simulated practices under fee-for-service payment of $42,398 per full-time-equivalent physician per year; however, substitution produced financial gains under capitated payment in 95 percent of cases, if more than 63 percent of annual payments were capitated. Shifting to capitated payment might create an incentive for practices to increase their delivery of team- and non-visit-based primary care, if capitated payment levels were sufficiently high. Project HOPE—The People-to-People Health Foundation, Inc.

Productivity Losses Associated with Head and Neck Cancer Using the Human Capital and Friction Cost Approaches.

PubMed

Pearce, Alison M; Hanly, Paul; Timmons, Aileen; Walsh, Paul M; O'Neill, Ciaran; O'Sullivan, Eleanor; Gooberman-Hill, Rachael; Thomas, Audrey Alforque; Gallagher, Pamela; Sharp, Linda

2015-08-01

Previous studies suggest that productivity losses associated with head and neck cancer (HNC) are higher than in other cancers. These studies have only assessed a single aspect of productivity loss, such as temporary absenteeism or premature mortality, and have only used the Human Capital Approach (HCA). The Friction Cost Approach (FCA) is increasingly recommended, although has not previously been used to assess lost production from HNC. The aim of this study was to estimate the lost productivity associated with HNC due to different types of absenteeism and premature mortality, using both the HCA and FCA. Survey data on employment status were collected from 251 HNC survivors in Ireland and combined with population-level survival estimates and national wage data. The cost of temporary and permanent time off work, reduced working hours and premature mortality using both the HCA and FCA were calculated. Estimated total productivity losses per employed person of working age were EUR253,800 using HCA and EUR6800 using FCA. The main driver of HCA costs was premature mortality (38% of total) while for FCA it was temporary time off (73% of total). The productivity losses associated with head and neck cancer are substantial, and return to work assistance could form an important part of rehabilitation. Use of both the HCA and FCA approaches allowed different drivers of productivity losses to be identified, due to the different assumptions of the two methods. For future estimates of productivity losses, the use of both approaches may be pragmatic.

Eosinophilic esophagitis: dilate or medicate? A cost analysis model of the choice of initial therapy.

PubMed

Kavitt, R T; Penson, D F; Vaezi, M F

2014-07-01

Eosinophilic esophagitis (EoE) is an increasingly recognized clinical entity. The optimal initial treatment strategy in adults with EoE remains controversial. The aim of this study was to employ a decision analysis model to determine the less costly option between the two most commonly employed treatment strategies in EoE. We constructed a model for an index case of a patient with biopsy-proven EoE who continues to be symptomatic despite proton-pump inhibitor therapy. The following treatment strategies were included: (i) swallowed fluticasone inhaler (followed by esophagogastroduodenoscopy [EGD] with dilation if ineffective); and (ii) EGD with dilation (followed by swallowed fluticasone inhaler if ineffective). The time horizon was 1 year. The model focused on cost analysis of initial treatment strategies. The perspective of the healthcare payer was used. Sensitivity analyses were performed to assess the robustness of the model. For every patient whose symptoms improved or resolved with the strategy of fluticasone first followed by EGD, if necessary, it cost an average of $1078. Similarly, it cost an average of $1171 per patient if EGD with dilation was employed first. Sensitivity analyses indicated that initial treatment with fluticasone was the less costly strategy to improve dysphagia symptoms as long as the effectiveness of fluticasone remains at or above 0.62. Swallowed fluticasone inhaler (followed by EGD with dilation if necessary) is the more economical initial strategy when compared with EGD with dilation first. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

Costing imaging procedures.

PubMed

Bretland, P M

1988-01-01

The existing National Health Service financial system makes comprehensive costing of any service very difficult. A method of costing using modern commercial methods has been devised, classifying costs into variable, semi-variable and fixed and using the principle of overhead absorption for expenditure not readily allocated to individual procedures. It proved possible to establish a cost spectrum over the financial year 1984-85. The cheapest examinations were plain radiographs outside normal working hours, followed by plain radiographs, ultrasound, special procedures, fluoroscopy, nuclear medicine, angiography and angiographic interventional procedures in normal working hours. This differs from some published figures, particularly those in the Körner report. There was some overlap between fluoroscopic interventional and the cheaper nuclear medicine procedures, and between some of the more expensive nuclear medicine procedures and the cheaper angiographic ones. Only angiographic and the few more expensive nuclear medicine procedures exceed the cost of the inpatient day. The total cost of the imaging service to the district was about 4% of total hospital expenditure. It is shown that where more procedures are undertaken, the semi-variable and fixed (including capital) elements of the cost decrease (and vice versa) so that careful study is required to assess the value of proposed economies. The method is initially time-consuming and requires a computer system with 512 Kb of memory, but once the basic costing system is established in a department, detailed financial monitoring should become practicable. The necessity for a standard comprehensive costing procedure of this nature, based on sound cost accounting principles, appears inescapable, particularly in view of its potential application to management budgeting.

Applying for Initial AACSB Accreditation: An Exploratory Study to Identify Costs

ERIC Educational Resources Information Center

Heriot, Kirk C.; Franklin, Geralyn; Austin, Walt W.

2009-01-01

The authors identified the type and magnitude of costs colleges and schools incur when seeking Association to Advance Collegiate Schools of Business (AACSB) International accreditation. This issue is important to the 156 schools and colleges currently seeking initial accreditation by AACSB and to the thousands of schools worldwide that could seek…

78 FR 62417 - Regulatory Capital Rules: Regulatory Capital, Implementation of Basel III, Capital Adequacy...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-22

..., Standardized Approach for Risk-Weighted Assets, Market Discipline and Disclosure Requirements, Advanced Approaches Risk-Based Capital Rule, and Market Risk Capital Rule AGENCY: Federal Deposit Insurance... Assets, Market Discipline and Disclosure Requirements, Advanced Approaches Risk-Based Capital Rule, and...

Changing healthcare capital-to-labor ratios: evidence and implications for bending the cost curve in Canada and beyond.

PubMed

Nauenberg, Eric

2014-12-01

Healthcare capital-to-labor ratios are examined for the 10 provincial single-payer health care plans across Canada. The data show an increasing trend-particularly during the period 1997-2009 during which the ratio as much as doubled from 3 to 6 %. Multivariate analyses indicate that every percentage point uptick in the rate of increase in this ratio is associated with an uptick in the rate of increase of real per capita provincial government healthcare expenditures by approximately $31 ([Formula: see text] 0.01). While the magnitude of this relationship is not large, it is still substantial enough to warrant notice: every percentage point decrease in the upward trend of the capital-to-labor ratio might be associated with a one percentage point decrease in the upward trend of per capita government healthcare expenditures. An uptick since 1997 in the rate of increase in per capita prescription drug expenditures is also associated with a decline in the trend of increasing per capita healthcare costs. While there has been some recent evidence of a slowing in the rate of health care expenditure increase, it is still unclear whether this reflects just a pause, after which the rate of increase will return to its baseline level, or a long-term shift; therefore, it is important to continue to explore various policy avenues to affect the rate of change going forward.

An Analysis of Costs and Cenefits Associated with Initial Contracting Technical Education and Training for Unrestricted Marine Officers

DTIC Science & Technology

2017-03-01

COSTS AND BENEFITS ASSOCIATED WITH INITIAL CONTRACTING TECHNICAL EDUCATION AND TRAINING FOR UNRESTRICTED MARINE OFFICERS by Lee A. White...WITH INITIAL CONTRACTING TECHNICAL EDUCATION AND TRAINING FOR UNRESTRICTED MARINE OFFICERS 5. FUNDING NUMBERS 6. AUTHOR(S) Lee A. White 7. PERFORMING...unlimited. AN ANALYSIS OF COSTS AND BENEFITS ASSOCIATED WITH INITIAL CONTRACTING TECHNICAL EDUCATION AND TRAINING FOR UNRESTRICTED MARINE OFFICERS

The Effects of Teachers' Social and Human Capital on Urban Science Reform Initiatives: Considerations for Professional Development

ERIC Educational Resources Information Center

Yoon, Susan A.; Yom, Jessica Koehler; Yang, Zhitong; Liu, Lei

2017-01-01

Background: Recent research investigating the conditions under which science teachers can successfully implement science education reforms suggests that focusing only on professional development to improve content knowledge and teaching skills--often referred to as human capital--may not be enough. Increasingly, possessing social capital, defined…

Payment mechanism and GP self-selection: capitation versus fee for service.

PubMed

Allard, Marie; Jelovac, Izabela; Léger, Pierre-Thomas

2014-06-01

This paper analyzes the consequences of allowing gatekeeping general practitioners (GPs) to select their payment mechanism. We model GPs' behavior under the most common payment schemes (capitation and fee for service) and when GPs can select one among them. Our analysis considers GP heterogeneity in terms of both ability and concern for their patients' health. We show that when the costs of wasteful referrals to costly specialized care are relatively high, fee for service payments are optimal to maximize the expected patients' health net of treatment costs. Conversely, when the losses associated with failed referrals of severely ill patients are relatively high, we show that either GPs' self-selection of a payment form or capitation is optimal. Last, we extend our analysis to endogenous effort and to competition among GPs. In both cases, we show that self-selection is never optimal.

The Evaluation of Appropriateness of OMB Circular A-76 Studies on Revenue-Generating Functions in Defense Working Capital Fund Activities

DTIC Science & Technology

2002-12-01

E. ACTIVITY BASED COSTING (ABC) IN THE WORKING CAPITAL FUND ......................................29 F. UNIQUENESS OF DOD IN THE FREE MARKET ...FREE MARKET SYSTEM ECONOMICS AND WORKING CAPITAL FUNDS .....................................35 B. A-76 AND DEFENSE WORKING CAPITAL FUND DIRECT...Capital Fund applies free market economics and how the foundational theories of the Defense Working Capital Fund and the A-76 study parallel each

Social capital, social class and tobacco smoking.

PubMed

Lindström, Martin

2008-02-01

In all developed and some developing countries there are socioeconomic status (SES) differences in tobacco smoking. People with a low of education, manual occupation, low income as well as the unemployed are daily smokers to a higher extent than those with high SES. People with low SES also stop smoking to a lesser extent in many developed countries. Several theories have been proposed to account for SES differences in health. Social capital concerns the relationships of trust, participation and reciprocity among individuals, groups and institutions in a society that may enhance health and health-related behaviors. The materialist standpoint concerns material conditions. Studies with ecological, individual and multilevel study design, mostly cross-sectional studies, suggest that both (individual level) social capital and material factors are related to tobacco smoking, although multilevel studies concerning contextual level social capital are few and mostly, at least in adult populations, fail to demonstrate associations. There is also a want of longitudinal studies to investigate the associations between social capital and material conditions, smoking initiation, smoking continuation as well as smoking cessation, since cross-sectional studies analyze only prevalence data. More sophisticated multilevel studies are needed to investigate the association between social capital and material conditions, and tobacco smoking in SES groups in different social contexts.

Development of Optimization method about Capital Structure and Senior-Sub Structure by considering Project-Risk

NASA Astrophysics Data System (ADS)

Kawamoto, Shigeru; Ikeda, Yuichi; Fukui, Chihiro; Tateshita, Fumihiko

Private finance initiative is a business scheme that materializes social infrastructure and public services by utilizing private-sector resources. In this paper we propose a new method to optimize capital structure, which is the ratio of capital to debt, and senior-sub structure, which is the ratio of senior loan to subordinated loan, for private finance initiative. We make the quantitative analysis of a private finance initiative's project using the proposed method. We analyze trade-off structure between risk and return in the project, and optimize capital structure and senior-sub structure. The method we propose helps to improve financial stability of the project, and to make a fund raising plan that is expected to be reasonable for project sponsor and moneylender.

An Analysis of Social Capital and Environmental Management of Higher Education Institutions

ERIC Educational Resources Information Center

Evangelinos, Konstantinos I.; Jones, Nikoleta

2009-01-01

Purpose: The purpose of this paper is to analyse the importance of the theory of social capital for the challenges presented during environmental management initiatives in higher education institutions (HEIs). In particular, the paper utilises the fundamental components of social capital theory and assesses a hypothesis that higher stocks of…

Inventory-driven costs.

PubMed

Callioni, Gianpaolo; de Montgros, Xavier; Slagmulder, Regine; Van Wassenhove, Luk N; Wright, Linda

2005-03-01

In the 199os, Hewlett-Packard's PC business was struggling to turn a dollar, despite the company's success in winning market share. By 1997, margins on its PCs were as thin as a silicon wafer, and some product lines hadn't turned a profit since 1993. The problem had everything to do with the PC industry's notoriously short product cycles and brutal product and component price deflation. A common rule of thumb was that the value of a fully assembled PC decreased 1% a week. In such an environment, inventory costs become critical. But not just the inventory costs companies traditionally track, HP found, after a thorough review of the problem. The standard "holding cost of inventory"--the capital and physical costs of inventory--accounted for only about 10% of HP's inventory costs. The greater risks, it turned out, resided in four other, essentially hidden costs, which stemmed from mismatches between demand and supply: Component devaluation costs for components still held in production; Price protection costs incurred when product prices drop on the goods distributors still have on their shelves; Product return costs that have to be absorbed when distributors return and receive refunds on overstock items, and; Obsolescence costs for products still unsold when new models are introduced. By developing metrics to track those costs in a consistent way throughout the PC division, HP has found it can manage its supply chains with much more sophistication. Gone are the days of across-the-board measures such as,"Everyone must cut inventories by 20% by the end of the year," which usually resulted in a flurry of cookie-cutter lean production and just-in-time initiatives. Now, each product group is free to choose the supply chain configuration that best suits its needs. Other companies can follow HP's example.

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

ERIC Educational Resources Information Center

Council of State Governments, Lexington, KY.

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

78 FR 62017 - Regulatory Capital Rules: Regulatory Capital, Implementation of Basel III, Capital Adequacy...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-11

...The Office of the Comptroller of the Currency (OCC) and Board of Governors of the Federal Reserve System (Board), are adopting a final rule that revises their risk-based and leverage capital requirements for banking organizations. The final rule consolidates three separate notices of proposed rulemaking that the OCC, Board, and FDIC published in the Federal Register on August 30, 2012, with selected changes. The final rule implements a revised definition of regulatory capital, a new common equity tier 1 minimum capital requirement, a higher minimum tier 1 capital requirement, and, for banking organizations subject to the advanced approaches risk-based capital rules, a supplementary leverage ratio that incorporates a broader set of exposures in the denominator. The final rule incorporates these new requirements into the agencies' prompt corrective action (PCA) framework. In addition, the final rule establishes limits on a banking organization's capital distributions and certain discretionary bonus payments if the banking organization does not hold a specified amount of common equity tier 1 capital in addition to the amount necessary to meet its minimum risk-based capital requirements. Further, the final rule amends the methodologies for determining risk-weighted assets for all banking organizations, and introduces disclosure requirements that would apply to top-tier banking organizations domiciled in the United States with $50 billion or more in total assets. The final rule also adopts changes to the agencies' regulatory capital requirements that meet the requirements of section 171 and section 939A of the Dodd-Frank Wall Street Reform and Consumer Protection Act. The final rule also codifies the agencies' regulatory capital rules, which have previously resided in various appendices to their respective regulations, into a harmonized integrated regulatory framework. In addition, the OCC is amending the market risk capital rule (market risk rule) to apply to

Bonding Social Capital in Low-Income Neighborhoods

ERIC Educational Resources Information Center

Brisson, Daniel S.; Usher, Charles L.

2005-01-01

Social capital has recently become a guiding theoretical framework for family interventions in low-income neighborhoods. In the context of the Annie E. Casey Foundation's Making Connections initiative, this research uses hierarchical linear modeling to examine how neighborhood characteristics and resident participation affect bonding social…

Pretreatment costs of care and time to initial treatment for patients with cancer of unknown primary.

PubMed

Walker, Mark S; Weinstein, Laura; Luo, Roger; Marino, Ingrid

2018-06-01

Time to treatment and pretreatment costs may be affected by unknown primary tumor site. This retrospective study used electronic medical record data from patients in ten US community oncology practices. Eligible patients were ≥18 years, diagnosed with cancer of unknown primary (CUP) or known metastatic solid tumor, and presented between 1 January 2012 and 30 June 2014. Patients with CUP (n = 294) had a longer interval than non-CUP patients (n = 92) from presentation to treatment initiation (1.18 vs 0.49 months, p < 0.0001), and had higher pretreatment costs (US$27,882 vs US$20,449, p = 0.0075). When analyzed as monthly cost, the difference between groups in log-cost per month was nonsignificant. Higher pretreatment costs in CUP patients appeared attributable to significantly longer time to initiation of therapy.

BMP COST ANALYSIS FOR SOURCE WATER PROTECTION

EPA Science Inventory

Cost equations are developed to estimate capital, and operations and maintenance (O&M) costs for commonly used best management practices (BMPs). Total BMP volume and/or surface area is used to predict these costs. Engineering News Record (ENR) construction cost index was used t...

The Capital Intensity of Photovoltaics Manufacturing

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

Basore, Paul

2015-10-19

Factory capital expenditure (capex) for photovoltaic (PV) module manufacturing strongly influences the per-unit cost of a c-Si module. This provides a significant opportunity to address the U.S. DOE SunShot module price target through capex innovation. Innovation options to reduce the capex of PV manufacturing include incremental and disruptive process innovation with c-Si, platform innovations, and financial approaches. and financial approaches.

Cost-effectiveness Analysis of Treatment Sequence Initiating With Etanercept Compared With Leflunomide in Rheumatoid Arthritis: Impact of Reduced Etanercept Cost With Patent Expiration in South Korea.

PubMed

Park, Sun-Kyeong; Park, Seung-Hoo; Lee, Min-Young; Park, Ji-Hyun; Jeong, Jae-Hong; Lee, Eui-Kyung

2016-11-01

In south Korea, the price of biologics has been decreasing owing to patent expiration and the availability of biosimilars. This study evaluated the cost-effectiveness of a treatment strategy initiated with etanercept (ETN) compared with leflunomide (LFN) after a 30% reduction in the medication cost of ETN in patients with active rheumatoid arthritis (RA) with an inadequate response to methotrexate (MTX-IR). A cohort-based Markov model was designed to evaluate the lifetime cost-effectiveness of treatment sequence initiated with ETN (A) compared with 2 sequences initiated with LFN: LFN-ETN sequence (B) and LFN sequence (C). Patients transited through the treatment sequences, which consisted of sequential biologics and palliative therapy, based on American College of Rheumatology (ACR) responses and the probability of discontinuation. A systematic literature review and a network meta-analysis were conducted to estimate ACR responses to ETN and LFN. Utility was estimated by mapping an equation for converting the Health Assessment Questionnaire-Disability Index score to utility weight. The costs comprised medications, outpatient visits, administration, dispensing, monitoring, palliative therapy, and treatment for adverse events. A subanalysis was conducted to identify the influence of the ETN price reduction compared with the unreduced price, and sensitivity analyses explored the uncertainty of model parameters and assumptions. The ETN sequence (A) was associated with higher costs and a gain in quality-adjusted life years (QALYs) compared with both sequences initiated with LFN (B, C) throughout the lifetime of patients with RA and MTX-IR. The incremental cost-effectiveness ratio (ICER) for strategy A versus B was ₩13,965,825 (US$1726) per QALY and that for strategy A versus C was ₩9,587,983 (US$8050) per QALY. The results indicated that strategy A was cost-effective based on the commonly cited ICER threshold of ₩20,000,000 (US$16,793) per QALY in South Korea. The

Wall Street and the Pentagon: Defense Industry Access to Capital Markets, 1990-2010. An Annotated Brief

DTIC Science & Technology

2011-11-01

understand the relationship between defense spending and the financial metrics that drive access to ? and cost of ? capital for defense firms . This paper...decisionmakers understand the  relationship between defense spending and the  financial  metrics that drive access to – and cost of –  capital for defense  firms ...to access capital markets also reflects industry leaders’ concerns. In a  newspaper interview, the chief  financial  officer of a large private  firm

12 CFR 1229.5 - Capital distributions for adequately capitalized Banks.

Code of Federal Regulations, 2010 CFR

2010-01-01

... CAPITAL CLASSIFICATIONS AND PROMPT CORRECTIVE ACTION Federal Home Loan Banks § 1229.5 Capital... classification of adequately capitalized. A Bank may not make a capital distribution if such distribution would... redeem its shares of stock if the transaction is made in connection with the issuance of additional Bank...

Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial.

PubMed

de Jong, Pascal H P; Hazes, Johanna M; Buisman, Leander R; Barendregt, Pieternella J; van Zeben, Derkjen; van der Lubbe, Peter A; Gerards, Andreas H; de Jager, Mike H; de Sonnaville, Peter B J; Grillet, Bernard A; Luime, Jolanda J; Weel, Angelique E A M

2016-12-01

To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA. The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97). Data on QALYs, measured with the Dutch EuroQol, and direct and indirect cost were used. Direct costs are costs of treatment and medical consumption, whereas indirect costs are costs due to loss of productivity. Average QALYs (sd) for A, B and C were, respectively, 0.75 (0.12), 0.75 (0.10) and 0.73 (0.13) for Dutch EuroQol. Highest total costs per QALY (sd) were, respectively, €12748 (€18767), €10 380 (€15 608) and €17 408 (€21 828) for strategy A, B and C (P = 0.012, B vs C). Direct as well as indirect costs were higher with iMM (strategy C) compared with iTDT (strategy B). Higher direct costs were due to ∼40% more biologic usage over time. Higher indirect costs, on the other hand, were caused by more long-term sickness and reduction in contract hours. iTDT was >95% cost-effective across all willingness-to-pay thresholds compared with iMM. iTDT was more cost-effective and had better worker productivity compared with iMM. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

BMP COST ANALYSIS FOR SOURCE WATER PROTECTION

EPA Science Inventory

Cost equations are developed to estimate capital and operations and maintenance (O&M) for commonly used best management practices (BMPS). Total BMP volume and/or surface area is used to predict these costs. ENR construction cost index was used to adjust cost data to December 2000...

Costs of Storing and Transporting Hydrogen

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

Amos, W. A.

An analysis was performed to estimate the costs associated with storing and transporting hydrogen. These costs can be added to a hydrogen production cost to determine the total delivered cost of hydrogen. Storage methods analyzed included compressed gas, liquid hydrogen, metal hydride, and underground storage. Major capital and operating costs were considered over a range of production rates and storage times.

Exposing the Dark Side, an Exploration of the Influence Social Capital Has upon Parental Sports Volunteers

ERIC Educational Resources Information Center

Whittaker, Colin Grant; Holland-Smith, David

2016-01-01

This study explored the influence social capital had over parental sports volunteers who are considered to be of paramount importance in the delivery of UK sports initiatives. A review of the relevant literature identifies and discusses the complexities within the debate to define social capital while human and cultural capital emerge as an…

Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

PubMed

French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

2013-12-01

The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

Intellectual Capital.

ERIC Educational Resources Information Center

Van Horn, Royal

2001-01-01

According to Thomas Stewart's book, intellectual capital comprises three broad categories: human, structural, and customer. Structural, or organizational capital, is knowledge that does not leave at night (with workers, or human capital). Developing a "best practices" database using Lotus Notes software would preserve and access schools'…

78 FR 55339 - Regulatory Capital Rules: Regulatory Capital, Implementation of Basel III, Capital Adequacy...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-10

...The Federal Deposit Insurance Corporation (FDIC) is adopting an interim final rule that revises its risk-based and leverage capital requirements for FDIC-supervised institutions. This interim final rule is substantially identical to a joint final rule issued by the Office of the Comptroller of the Currency (OCC) and the Board of Governors of the Federal Reserve System (Federal Reserve) (together, with the FDIC, the agencies). The interim final rule consolidates three separate notices of proposed rulemaking that the agencies jointly published in the Federal Register on August 30, 2012, with selected changes. The interim final rule implements a revised definition of regulatory capital, a new common equity tier 1 minimum capital requirement, a higher minimum tier 1 capital requirement, and, for FDIC-supervised institutions subject to the advanced approaches risk-based capital rules, a supplementary leverage ratio that incorporates a broader set of exposures in the denominator. The interim final rule incorporates these new requirements into the FDIC's prompt corrective action (PCA) framework. In addition, the interim final rule establishes limits on FDIC-supervised institutions' capital distributions and certain discretionary bonus payments if the FDIC-supervised institution does not hold a specified amount of common equity tier 1 capital in addition to the amount necessary to meet its minimum risk-based capital requirements. The interim final rule amends the methodologies for determining risk-weighted assets for all FDIC-supervised institutions. The interim final rule also adopts changes to the FDIC's regulatory capital requirements that meet the requirements of section 171 and section 939A of the Dodd-Frank Wall Street Reform and Consumer Protection Act. The interim final rule also codifies the FDIC's regulatory capital rules, which have previously resided in various appendices to their respective regulations, into a harmonized integrated regulatory framework. In

Capital Availability for Small Businesses with Dual-Use Applications

DTIC Science & Technology

1994-07-01

on those that 1-1 receive prime contracts, limited information on the first tier of subcontractors for major weapon systems , and little or no...is a "challenge" for 30 percent of the mernbers? Capital availability ranked fifth as a challenge after the recessionary environment, health care costs ...base will contract. On the other hand, national security requires that DoD continue to have access to advanced technologies at a reasonable cost . One

[Analysis of costs and cost-effectiveness of preferred GESIDA/National AIDS Plan regimens for initial antiretroviral therapy in human immunodeficiency virus infected adult patients in 2013].

PubMed

Blasco, Antonio Javier; Llibre, Josep M; Arribas, José Ramón; Boix, Vicente; Clotet, Bonaventura; Domingo, Pere; González-García, Juan; Knobel, Hernando; López, Juan Carlos; Lozano, Fernando; Miró, José M; Podzamczer, Daniel; Santamaría, Juan Miguel; Tuset, Montserrat; Zamora, Laura; Lázaro, Pablo; Gatell, Josep M

2013-11-01

The GESIDA and National AIDS Plan panel of experts have proposed "preferred regimens" of antiretroviral treatment (ART) as initial therapy in HIV infected patients for 2013. The objective of this study is to evaluate the costs and effectiveness of initiating treatment with these "preferred regimens". An economic assessment of costs and effectiveness (cost/effectiveness) was performed using decision tree analysis models. Effectiveness was defined as the probability of having viral load <50copies/mL at week48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regime was defined as the costs of ART and its consequences (adverse effects, changes of ART regime and drug resistance analyses) during the first 48weeks. The perspective of the analysis is that of the National Health System was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, resistance studies, and determination of HLA B*5701. The setting is Spain and the costs are those of 2013. A sensitivity deterministic analysis was performed, constructing three scenarios for each regimen: baseline, most favourable, and most unfavourable cases. In the baseline case scenario, the cost of initiating treatment ranges from 6,747euros for TDF/FTC+NVP to 12,059euros for TDF/FTC+RAL. The effectiveness ranges between 0.66 for ABC/3TC+LPV/r and ABC/3TC+ATV/r, and 0.87 for TDF/FTC+RAL and ABC/3TC+RAL. Effectiveness, in terms of cost/effectiveness, varies between 8,396euros and 13,930euros per responder at 48weeks, for TDF/FTC/RPV and TDF/FTC+RAL, respectively. Taking ART at official prices, the most effective regimen was TDF/FTC/RPV, followed by the rest of non-nucleoside containing regimens. The sensitivity analysis confirms the robustness of these findings. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Methodical approaches to value assessment and determination of the capitalization level of high-rise construction

NASA Astrophysics Data System (ADS)

Smirnov, Vitaly; Dashkov, Leonid; Gorshkov, Roman; Burova, Olga; Romanova, Alina

2018-03-01

The article presents the analysis of the methodological approaches to cost estimation and determination of the capitalization level of high-rise construction objects. Factors determining the value of real estate were considered, three main approaches for estimating the value of real estate objects are given. The main methods of capitalization estimation were analyzed, the most reasonable method for determining the level of capitalization of high-rise buildings was proposed. In order to increase the value of real estate objects, the author proposes measures that enable to increase significantly the capitalization of the enterprise through more efficient use of intangible assets and goodwill.

Integrated least-cost lumber grade-mix solver

Treesearch

U. Buehlmann; R. Buck; R.E. Thomas

2011-01-01

Hardwood lumber costs account for up to 70 percent of the total product costs of U.S. secondary wood products producers. Reducing these costs is difficult and often requires substantial capital investments. However, lumber-purchasing costs can be minimized by buying the least-cost lumber grade-mix that satisfies a company's component needs. Price differentials...

Redistribution spurs growth by using a portfolio effect on risky human capital.

PubMed

Lorenz, Jan; Paetzel, Fabian; Schweitzer, Frank

2013-01-01

We demonstrate by mathematical analysis and systematic computer simulations that redistribution can lead to sustainable growth in a society. In accordance with economic models of risky human capital, we assume that dynamics of human capital is modeled as a multiplicative stochastic process which, in the long run, leads to the destruction of individual human capital. When agents are linked by fully redistributive taxation the situation might turn to individual growth in the long run. We consider that a government collects a proportion of income and reduces it by a fraction as costs for administration (efficiency losses). The remaining public good is equally redistributed to all agents. Sustainable growth is induced by redistribution despite the losses from the random growth process and despite administrative costs. Growth results from a portfolio effect. The findings are verified for three different tax schemes: proportional tax, taking proportionally more from the rich, and proportionally more from the poor. We discuss which of these tax schemes performs better with respect to maximize growth under a fixed rate of administrative costs, and the governmental income. This leads us to general conclusions about governmental decisions, the relation to public good games with free riding, and the function of taxation in a risk-taking society.

Redistribution Spurs Growth by Using a Portfolio Effect on Risky Human Capital

PubMed Central

Lorenz, Jan; Paetzel, Fabian; Schweitzer, Frank

2013-01-01

We demonstrate by mathematical analysis and systematic computer simulations that redistribution can lead to sustainable growth in a society. In accordance with economic models of risky human capital, we assume that dynamics of human capital is modeled as a multiplicative stochastic process which, in the long run, leads to the destruction of individual human capital. When agents are linked by fully redistributive taxation the situation might turn to individual growth in the long run. We consider that a government collects a proportion of income and reduces it by a fraction as costs for administration (efficiency losses). The remaining public good is equally redistributed to all agents. Sustainable growth is induced by redistribution despite the losses from the random growth process and despite administrative costs. Growth results from a portfolio effect. The findings are verified for three different tax schemes: proportional tax, taking proportionally more from the rich, and proportionally more from the poor. We discuss which of these tax schemes performs better with respect to maximize growth under a fixed rate of administrative costs, and the governmental income. This leads us to general conclusions about governmental decisions, the relation to public good games with free riding, and the function of taxation in a risk-taking society. PMID:23390505

24 CFR 941.306 - Maximum project cost.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) project costs that are subject to the TDC limit (i.e., Housing Construction Costs and Community Renewal... project, the actual project cost is determined based upon the amount of public housing capital assistance... Community Renewal Costs in excess of the TDC limit, as determined under paragraph (b)(2) of this section...

24 CFR 941.306 - Maximum project cost.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) project costs that are subject to the TDC limit (i.e., Housing Construction Costs and Community Renewal... project, the actual project cost is determined based upon the amount of public housing capital assistance... Community Renewal Costs in excess of the TDC limit, as determined under paragraph (b)(2) of this section...

12 CFR 3.11 - Capital conservation buffer and countercyclical capital buffer amount.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Capital conservation buffer and countercyclical capital buffer amount. 3.11 Section 3.11 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY CAPITAL ADEQUACY STANDARDS Capital Ratio Requirements and Buffers § 3.11 Capital conservation...

The Cost of Increasing In-School Time: Evidence from the Massachusetts Expanded Learning Time Initiative

ERIC Educational Resources Information Center

Kolbe, Tammy; O'Reilly, Fran

2017-01-01

A growing number of public schools have adopted reforms that increase the amount of time students spend in school. However, the potential costs of such reforms are not well understood. In this article, we report findings from a resource-cost study conducted in four schools that participated in the Massachusetts Expanded Learning Time Initiative.…

A comparison of the capital structures of nonprofit and proprietary health care organizations.

PubMed

Trussel, John

2012-01-01

The relative amount of debt used by an organization is an important determination of the organization's likelihood of financial problems and its cost of capital. This study addresses whether or not there are any differences between proprietary and nonprofit health care organizations in terms of capital structure. Controlling for profitability, risk, growth, and size, analysis of covariance is used to determine whether or not proprietary and nonprofit health care organizations use the same amount of leverage in their capital structures. The results indicate that there is no difference in the amount of leverage between the two institutional types. Although nonprofit and proprietary organizations have unique financing mechanisms, these differences do not impact the relative amount of debt and equity in their capital structures.

Estimating Development Cost of an Interactive Website Based Cancer Screening Promotion Program

PubMed Central

Lairson, David R.; Chung, Tong Han; Smith, Lisa G.; Springston, Jeffrey K.; Champion, Victoria L.

2015-01-01

Objectives The aim of this study was to estimate the initial development costs for an innovative talk show format tailored intervention delivered via the interactive web, for increasing cancer screening in women 50 to 75 who were non-adherent to screening guidelines for colorectal cancer and/or breast cancer. Methods The cost of the intervention development was estimated from a societal perspective. Micro costing methods plus vendor contract costs were used to estimate cost. Staff logs were used to track personnel time. Non-personnel costs include all additional resources used to produce the intervention. Results Development cost of the interactive web based intervention was $.39 million, of which 77% was direct cost. About 98% of the cost was incurred in personnel time cost, contract cost and overhead cost. Conclusions The new web-based disease prevention medium required substantial investment in health promotion and media specialist time. The development cost was primarily driven by the high level of human capital required. The cost of intervention development is important information for assessing and planning future public and private investments in web-based health promotion interventions. PMID:25749548

Effects of housing system on the costs of commercial egg production.

PubMed

Matthews, W A; Sumner, D A

2015-03-01

This article reports the first publicly available egg production costs compared across 3 hen-housing systems. We collected detailed data from 2 flock cycles from a commercial egg farm operating a conventional barn, an aviary, and an enriched colony system at the same location. The farm employed the same operational and accounting procedures for each housing system. Results provide clear evidence that egg production costs are much higher for the aviary system than the other 2 housing systems. Feed costs per dozen eggs are somewhat higher for the aviary and lower for the enriched house compared with the conventional house. Labor costs are much lower for the conventional house than the other 2, and pullet costs are much higher for the aviary. Energy and miscellaneous costs are a minimal part of total operating costs and do not differ by housing system. Total capital investments per hen-capacity are much higher for the aviary and the enriched house. Capital costs per dozen eggs depend on assumptions about appropriate interest and depreciation rates. Using the same 10% rate for each housing system shows capital costs per dozen for the aviary and the enriched housing system are much higher than capital costs per dozen for the conventional house. The aviary has average operating costs (feed, labor, pullet, energy, and miscellaneous costs that recur for each flock and vary with egg production) about 23% higher and average total costs about 36% higher compared with the conventional house. The enriched housing system has average operating costs only about 4% higher compared with the conventional house, but average total costs are 13% higher than for the conventional house. © The Author 2015. Published by Oxford University Press on behalf of Poultry Science Association.

Dying is a Living Process: A Study of the Cost-Effectiveness of Initiating a Hospice at Madigan Army Medical Center with Implications for Army-Wide Utilization

DTIC Science & Technology

1982-04-01

for Health Industry : Cut Federal Costs," Hospital Progress 61 (January 1981): 13. 2Victor R. Fuchs, "The Economics of Health In A Postindustrial... industrial Vacuum Cleaner 300 - Examining Room: Examining Table 1,000 Supply Cabinet 200 Stool 95 Lamp 100 2,890 TOTAL CAPITAL OUTLAY 12,890 TOTAL COST...25. -Index Cards 6. 6. -Manila Folders 15. 15. - Staplers 10. 10. -Miscellaneous Items 50. 50. $ 106. 106. 17 Books and Periodicals - Books 50Q. 500

Effects of housing system on the costs of commercial egg production1

PubMed Central

Matthews, W. A.; Sumner, D. A.

2014-01-01

This article reports the first publicly available egg production costs compared across 3 hen-housing systems. We collected detailed data from 2 flock cycles from a commercial egg farm operating a conventional barn, an aviary, and an enriched colony system at the same location. The farm employed the same operational and accounting procedures for each housing system. Results provide clear evidence that egg production costs are much higher for the aviary system than the other 2 housing systems. Feed costs per dozen eggs are somewhat higher for the aviary and lower for the enriched house compared with the conventional house. Labor costs are much lower for the conventional house than the other 2, and pullet costs are much higher for the aviary. Energy and miscellaneous costs are a minimal part of total operating costs and do not differ by housing system. Total capital investments per hen-capacity are much higher for the aviary and the enriched house. Capital costs per dozen eggs depend on assumptions about appropriate interest and depreciation rates. Using the same 10% rate for each housing system shows capital costs per dozen for the aviary and the enriched housing system are much higher than capital costs per dozen for the conventional house. The aviary has average operating costs (feed, labor, pullet, energy, and miscellaneous costs that recur for each flock and vary with egg production) about 23% higher and average total costs about 36% higher compared with the conventional house. The enriched housing system has average operating costs only about 4% higher compared with the conventional house, but average total costs are 13% higher than for the conventional house. PMID:25480736

Nursing intellectual capital theory: implications for research and practice.

PubMed

Covell, Christine L; Sidani, Souraya

2013-05-31

Due to rising costs of healthcare, determining how registered nurses and knowledge resources influence the quality of patient care is critical. Studies that have investigated the relationship between nursing knowledge and outcomes have been plagued with conceptual and methodological issues. This has resulted in limited empirical evidence of the impact of nursing knowledge on patient or organizational outcomes. The nursing intellectual capital theory was developed to assist with this area of inquiry. Nursing intellectual capital theory conceptualizes the sources of nursing knowledge available within an organization and delineates its relationship to patient and organizational outcomes. In this article, we review the nursing intellectual capital theory and discuss its implications for research and practice. We explain why the theory shows promise for guiding research on quality work environments and how it may assist with administrative decision-making related to nursing human resource management and continuing professional development.

Cost sharing and branded antidepressant initiation among patients treated with generics.

PubMed

Buxbaum, Jason D; Chernew, Michael E; Bonafede, Machaon; Vlahiotis, Anna; Walter, Deborah; Mucha, Lisa; Fendrick, A Mark

2018-04-01

To determine the relationship between consumer cost sharing for branded antidepressants and the initiation of branded therapy among patients with major depressive disorder (MDD) filling a prescription for generic MDD medication.  Retrospective cross-sectional analyses. Patients aged 18 to 64 years with MDD who filled a generic antidepressant were identified in commercial claims data for 2012 to 2014. For each year-specific analysis, an average cost-sharing index for branded antidepressants at the level of the plan was computed. Multivariable models were used to estimate the relationship between plan-level cost sharing for branded antidepressant medications and the filling of branded prescriptions, with demographic and clinical variables as covariates. For patients with MDD filling a generic prescription, increases in branded cost sharing were associated with significant decreases in the likelihood of filling a branded antidepressant in each year (P <.001). Results in 2012 imply that a shift from the 0th to 90th percentile in the branded cost-sharing index corresponded with a 9.5% decrease in the relative likelihood of a branded fill among patients receiving a generic antidepressant. The corresponding figures for 2013 and 2014 were 9.3% and 3.5%, respectively. In MDD, patients and clinicians who dutifully adhere to guidelines requiring a trial of first-line medication may ultimately require therapy with alternate agents to achieve adequate disease control. A "reward the good soldier" benefit design would lower cost sharing for higher-tier evidence-based therapies when clinically indicated. Results suggest that narrowing the gap in cost sharing between branded and generic medications following a trial of a generic agent might improve access to second-line treatment in MDD.

Analysis of the costs and cost-effectiveness of the guidelines recommended by the 2018 GESIDA/Spanish National AIDS Plan for initial antiretroviral therapy in HIV-infected adults.

PubMed

Pérez-Molina, José Antonio; Martínez, Esteban; Blasco, Antonio Javier; Arribas, José Ramón; Domingo, Pere; Iribarren, José Antonio; Knobel, Hernando; Lázaro, Pablo; López-Aldeguer, José; Lozano, Fernando; Mariño, Ana; Miró, José M; Moreno, Santiago; Negredo, Eugenia; Pulido, Federico; Rubio, Rafael; Santos, Jesús; de la Torre, Javier; Tuset, Montserrat; von Wichmann, Miguel A; Gatell, Josep M

2018-06-05

The GESIDA/National AIDS Plan expert panel recommended preferred regimens (PR), alternative regimens (AR) and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2018. The objective of this study was to evaluate the costs and the efficiency of initiating treatment with PR and AR. Economic assessment of costs and efficiency (cost-effectiveness) based on decision tree analyses. Effectiveness was defined as the probability of reporting a viral load <50copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug-resistance studies) over the first 48 weeks. The payer perspective (National Health System) was applied considering only differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting was Spain and the costs correspond to those of 2018. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. In the base-case scenario, the cost of initiating treatment ranges from 6788 euros for TAF/FTC/RPV (AR) to 10,649 euros for TAF/FTC+RAL (PR). The effectiveness varies from 0.82 for TAF/FTC+DRV/r (AR) to 0.91 for TAF/FTC+DTG (PR). The efficiency, in terms of cost-effectiveness, ranges from 7814 to 12,412 euros per responder at 48 weeks, for ABC/3TC/DTG (PR) and TAF/FTC+RAL (PR), respectively. Considering ART official prices, the most efficient regimen was ABC/3TC/DTG (PR), followed by TAF/FTC/RPV (AR) and TAF/FTC/EVG/COBI (AR). Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Wind-To-Hydrogen Project: Electrolyzer Capital Cost Study

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

Saur, G.

This study is being performed as part of the U.S. Department of Energy and Xcel Energy's Wind-to-Hydrogen Project (Wind2H2) at the National Renewable Energy Laboratory. The general aim of the project is to identify areas for improving the production of hydrogen from renewable energy sources. These areas include both technical development and cost analysis of systems that convert renewable energy to hydrogen via water electrolysis. Increased efficiency and reduced cost will bring about greater market penetration for hydrogen production and application. There are different issues for isolated versus grid-connected systems, however, and these issues must be considered. The manner inmore » which hydrogen production is integrated in the larger energy system will determine its cost feasibility and energy efficiency.« less

Resource utilization and costs during the initial years of lung cancer screening with computed tomography in Canada.

PubMed

Cressman, Sonya; Lam, Stephen; Tammemagi, Martin C; Evans, William K; Leighl, Natasha B; Regier, Dean A; Bolbocean, Corneliu; Shepherd, Frances A; Tsao, Ming-Sound; Manos, Daria; Liu, Geoffrey; Atkar-Khattra, Sukhinder; Cromwell, Ian; Johnston, Michael R; Mayo, John R; McWilliams, Annette; Couture, Christian; English, John C; Goffin, John; Hwang, David M; Puksa, Serge; Roberts, Heidi; Tremblay, Alain; MacEachern, Paul; Burrowes, Paul; Bhatia, Rick; Finley, Richard J; Goss, Glenwood D; Nicholas, Garth; Seely, Jean M; Sekhon, Harmanjatinder S; Yee, John; Amjadi, Kayvan; Cutz, Jean-Claude; Ionescu, Diana N; Yasufuku, Kazuhiro; Martel, Simon; Soghrati, Kamyar; Sin, Don D; Tan, Wan C; Urbanski, Stefan; Xu, Zhaolin; Peacock, Stuart J

2014-10-01

It is estimated that millions of North Americans would qualify for lung cancer screening and that billions of dollars of national health expenditures would be required to support population-based computed tomography lung cancer screening programs. The decision to implement such programs should be informed by data on resource utilization and costs. Resource utilization data were collected prospectively from 2059 participants in the Pan-Canadian Early Detection of Lung Cancer Study using low-dose computed tomography (LDCT). Participants who had 2% or greater lung cancer risk over 3 years using a risk prediction tool were recruited from seven major cities across Canada. A cost analysis was conducted from the Canadian public payer's perspective for resources that were used for the screening and treatment of lung cancer in the initial years of the study. The average per-person cost for screening individuals with LDCT was $453 (95% confidence interval [CI], $400-$505) for the initial 18-months of screening following a baseline scan. The screening costs were highly dependent on the detected lung nodule size, presence of cancer, screening intervention, and the screening center. The mean per-person cost of treating lung cancer with curative surgery was $33,344 (95% CI, $31,553-$34,935) over 2 years. This was lower than the cost of treating advanced-stage lung cancer with chemotherapy, radiotherapy, or supportive care alone, ($47,792; 95% CI, $43,254-$52,200; p = 0.061). In the Pan-Canadian study, the average cost to screen individuals with a high risk for developing lung cancer using LDCT and the average initial cost of curative intent treatment were lower than the average per-person cost of treating advanced stage lung cancer which infrequently results in a cure.

Resource Utilization and Costs during the Initial Years of Lung Cancer Screening with Computed Tomography in Canada

PubMed Central

Lam, Stephen; Tammemagi, Martin C.; Evans, William K.; Leighl, Natasha B.; Regier, Dean A.; Bolbocean, Corneliu; Shepherd, Frances A.; Tsao, Ming-Sound; Manos, Daria; Liu, Geoffrey; Atkar-Khattra, Sukhinder; Cromwell, Ian; Johnston, Michael R.; Mayo, John R.; McWilliams, Annette; Couture, Christian; English, John C.; Goffin, John; Hwang, David M.; Puksa, Serge; Roberts, Heidi; Tremblay, Alain; MacEachern, Paul; Burrowes, Paul; Bhatia, Rick; Finley, Richard J.; Goss, Glenwood D.; Nicholas, Garth; Seely, Jean M.; Sekhon, Harmanjatinder S.; Yee, John; Amjadi, Kayvan; Cutz, Jean-Claude; Ionescu, Diana N.; Yasufuku, Kazuhiro; Martel, Simon; Soghrati, Kamyar; Sin, Don D.; Tan, Wan C.; Urbanski, Stefan; Xu, Zhaolin; Peacock, Stuart J.

2014-01-01

Background: It is estimated that millions of North Americans would qualify for lung cancer screening and that billions of dollars of national health expenditures would be required to support population-based computed tomography lung cancer screening programs. The decision to implement such programs should be informed by data on resource utilization and costs. Methods: Resource utilization data were collected prospectively from 2059 participants in the Pan-Canadian Early Detection of Lung Cancer Study using low-dose computed tomography (LDCT). Participants who had 2% or greater lung cancer risk over 3 years using a risk prediction tool were recruited from seven major cities across Canada. A cost analysis was conducted from the Canadian public payer’s perspective for resources that were used for the screening and treatment of lung cancer in the initial years of the study. Results: The average per-person cost for screening individuals with LDCT was $453 (95% confidence interval [CI], $400–$505) for the initial 18-months of screening following a baseline scan. The screening costs were highly dependent on the detected lung nodule size, presence of cancer, screening intervention, and the screening center. The mean per-person cost of treating lung cancer with curative surgery was $33,344 (95% CI, $31,553–$34,935) over 2 years. This was lower than the cost of treating advanced-stage lung cancer with chemotherapy, radiotherapy, or supportive care alone, ($47,792; 95% CI, $43,254–$52,200; p = 0.061). Conclusion: In the Pan-Canadian study, the average cost to screen individuals with a high risk for developing lung cancer using LDCT and the average initial cost of curative intent treatment were lower than the average per-person cost of treating advanced stage lung cancer which infrequently results in a cure. PMID:25105438

ChargeOut! : determining machine and capital equipment charge-out rates using discounted cash-flow analysis

Treesearch

E.M. (Ted) Bilek

2007-01-01

The model ChargeOut! was developed to determine charge-out rates or rates of return for machines and capital equipment. This paper introduces a costing methodology and applies it to a piece of capital equipment. Although designed for the forest industry, the methodology is readily transferable to other sectors. Based on discounted cash-flow analysis, ChargeOut!...

A cost analysis comparing xeroradiography to film technics for intraoral radiography.

PubMed

Gratt, B M; Sickles, E A

1986-01-01

In the United States during 1978 $730 million was spent on dental radiographic services. Currently there are three alternatives for the processing of intraoral radiographs: manual wet-tanks, automatic film units, or xeroradiography. It was the intent of this study to determine which processing system is the most economical. Cost estimates were based on a usage rate of 750 patient images per month and included a calculation of the average cost per radiograph over a five-year period. Capital costs included initial processing equipment and site preparation. Operational costs included labor, supplies, utilities, darkroom rental, and breakdown costs. Clinical time trials were employed to measure examination times. Maintenance logs were employed to assess labor costs. Indirect costs of training were estimated. Results indicated that xeroradiography was the most cost effective ($0.81 per image) compared to either automatic film processing ($1.14 per image) or manual processing ($1.35 per image). Variations in projected costs indicated that if a dental practice performs primarily complete-mouth surveys, exposes less than 120 radiographs per month, and pays less than +6.50 per hour in wages, then manual (wet-tank) processing is the most economical method for producing intraoral radiographs.

Capitation pricing: Adjusting for prior utilization and physician discretion

PubMed Central

Anderson, Gerard F.; Cantor, Joel C.; Steinberg, Earl P.; Holloway, James

1986-01-01

As the number of Medicare beneficiaries receiving care under at-risk capitation arrangements increases, the method for setting payment rates will come under increasing scrutiny. A number of modifications to the current adjusted average per capita cost (AAPCC) methodology have been proposed, including an adjustment for prior utilization. In this article, we propose use of a utilization adjustment that includes only hospitalizations involving low or moderate physician discretion in the decision to hospitalize. This modification avoids discrimination against capitated systems that prevent certain discretionary admissions. The model also explains more of the variance in per capita expenditures than does the current AAPCC. PMID:10312010

Making capitated Medicare work for women: policy and research challenges.

PubMed

Bierman, A S; Clancy, C M

2000-01-01

Growth in capitated Medicare has special ramifications for older women who comprise the majority of Medicare beneficiaries. Older women are more likely than men to have chronic conditions that lead to illness and disability, and they often have fewer financial and social resources to cope with these problems. Gender differences in health status have a number of important implications for the financing and delivery of care for older women under both traditional fee-for-service Medicare and capitation. The utilization of effective preventive interventions, new therapeutic interventions for the management of common chronic disorders, and more cost-effective models of chronic disease management could potentially extend the active life expectancy of older women. However, there are financial and delivery system barriers to achieving these objectives. Traditional FFS Medicare has gaps in coverage of care for chronic illness and disability that disproportionately impact women. Managed care potentially offers flexibility to allocate resources creatively, to develop new models of care, and offer enhanced benefits with lower out-of-pocket costs. However, challenges to realizing this potential under Medicare managed care with unique implications for older women include: possible gender bias in capitation payments, risk selection, inadequacy of risk adjustment models, benefit and market instability, and disenrollment patterns.

49 CFR 639.21 - Determination of cost-effectiveness.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Determination of cost-effectiveness. 639.21... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION CAPITAL LEASES Cost-Effectiveness § 639.21 Determination of cost...-effectiveness comparison as described in this subpart, it may ask FTA to approve an alternate form of cost...

18 CFR 367.25 - Determination of service cost.

Code of Federal Regulations, 2010 CFR

2010-04-01

... be added as compensation for the use of capital constitute cost during that period. ... service cost. 367.25 Section 367.25 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY... ACT General Instructions § 367.25 Determination of service cost. A service must be deemed at cost and...

48 CFR 1602.170-5 - Cost or pricing data.

Code of Federal Regulations, 2010 CFR

2010-10-01

... adjusted for specific groups, including mental health benefits capitation rates, per diems, and Diagnostic... EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION GENERAL DEFINITIONS OF WORDS AND TERMS Definitions of FEHBP... retentions, including capitated administrative expenses and retentions. (b) Community rated carriers. Cost or...

2 CFR Appendix IV to Part 200 - Indirect (F&A) Costs Identification and Assignment, and Rate Determination for Nonprofit...

Code of Federal Regulations, 2014 CFR

2014-01-01

... the direct costs and the indirect costs must exclude capital expenditures and unallowable costs... total direct costs (excluding capital expenditures and other distorting items, such contracts or... buildings, furniture and equipment; care of grounds; maintenance and operation of buildings and other plant...

Unit Cost Analysis of PET-CT at an Apex Public Sector Health Care Institute in India.

PubMed

Gajuryal, S H; Daga, A; Siddharth, V; Bal, C S; Satpathy, S

2017-01-01

PET/CT scan service is one of the capital intensive and revenue-generating centres of a tertiary care hospital. The cost associated with the provisioning of PET services is dependent upon the unit costs of the resources consumed. The study aims to determine the cost of providing PET/CT Scan services in a hospital. This descriptive and observational study was conducted in the Department of Nuclear Medicine at a tertiary apex teaching hospital in New Delhi, India in the year 2014-15. Traditional costing methodology was used for calculating the unit cost of PET/CT scan service. The cost was calculated under two heads that is capital and operating cost. Annualized cost of capital assets was calculated using methodology prescribed by WHO and operating costs was taken on an actual basis. Average number of PET/CT scan performed in a day is 30. The annual cost of providing PET/CT scan services was calculated to be 65,311,719 Indian Rupees (INR) (US$ 1,020,496), while the unit cost of PET scan was calculated to be 9625.92 INR (US$ 150). 3/4th cost was spent on machinery and equipment (75.3%) followed by healthcare personnel (11.37%), electricity (5%), consumables and supplies (4%) engineering maintenance (3.24%), building, furniture and HVAC capital cost (0.76%), and manifold cost (0.05%). Of the total cost, 76% was capital cost while the remaining was operating cost. Total cost for establishing PET/CT scan facility with cyclotron and chemistry module and PET/CT scan without cyclotron and chemistry module was calculated to be INR 610,873,517 (US$9944899) and 226,745,158 (US$3542893), respectively. (US$ 1=INR 64).

26 CFR 1.263A-1 - Uniform capitalization of costs.

Code of Federal Regulations, 2014 CFR

2014-04-01

... or facilities. (P) Engineering and design costs. Engineering and design costs include pre-production costs, such as costs attributable to research, experimental, engineering, and design activities (to the... customer demand. (9) Research and experimental expenditures. See section 263A(c)(2) for an exception for...

26 CFR 1.263A-1 - Uniform capitalization of costs.

Code of Federal Regulations, 2013 CFR

2013-04-01

... costs. Engineering and design costs include pre-production costs, such as costs attributable to research, experimental, engineering, and design activities (to the extent that such amounts are not research and... customer demand. (9) Research and experimental expenditures. See section 263A(c)(2) for an exception for...

26 CFR 1.263A-1 - Uniform capitalization of costs.

Code of Federal Regulations, 2011 CFR

2011-04-01

... costs. Engineering and design costs include pre-production costs, such as costs attributable to research, experimental, engineering, and design activities (to the extent that such amounts are not research and... customer demand. (9) Research and experimental expenditures. See section 263A(c)(2) for an exception for...

26 CFR 1.263A-1 - Uniform capitalization of costs.

Code of Federal Regulations, 2012 CFR

2012-04-01

... costs. Engineering and design costs include pre-production costs, such as costs attributable to research, experimental, engineering, and design activities (to the extent that such amounts are not research and... customer demand. (9) Research and experimental expenditures. See section 263A(c)(2) for an exception for...

Statistical methods of estimating mining costs

USGS Publications Warehouse

Long, K.R.

2011-01-01

Until it was defunded in 1995, the U.S. Bureau of Mines maintained a Cost Estimating System (CES) for prefeasibility-type economic evaluations of mineral deposits and estimating costs at producing and non-producing mines. This system had a significant role in mineral resource assessments to estimate costs of developing and operating known mineral deposits and predicted undiscovered deposits. For legal reasons, the U.S. Geological Survey cannot update and maintain CES. Instead, statistical tools are under development to estimate mining costs from basic properties of mineral deposits such as tonnage, grade, mineralogy, depth, strip ratio, distance from infrastructure, rock strength, and work index. The first step was to reestimate "Taylor's Rule" which relates operating rate to available ore tonnage. The second step was to estimate statistical models of capital and operating costs for open pit porphyry copper mines with flotation concentrators. For a sample of 27 proposed porphyry copper projects, capital costs can be estimated from three variables: mineral processing rate, strip ratio, and distance from nearest railroad before mine construction began. Of all the variables tested, operating costs were found to be significantly correlated only with strip ratio.

Cost Analysis of Operation Theatre Services at an Apex Tertiary Care Trauma Centre of India.

PubMed

Siddharth, Vijaydeep; Kumar, Subodh; Vij, Aarti; Gupta, Shakti Kumar

2015-12-01

Operating room services are one of the major cost and revenue-generating centres of a hospital. The cost associated with the provisioning of operating department services depends on the resources consumed and the unit costs of those resources. The objective of this study was to calculate the cost of operation theatre services at Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi. The study was carried out at the operation theatre department of Jai Prakash Narayan Apex Trauma Centre (JPNATC), AIIMS from April 2010 to March 2011 after obtaining approval from concerned authorities. This study was observational and descriptive in nature. Traditional (average or gross) costing methodology was used to arrive at the cost for the provisioning of operation theatre (OT) services. Cost was calculated under two heads; as capital and operating cost. Annualised cost of capital assets was calculated according to the methodology prescribed by the World Health Organization and operating costs were taken on actual basis; thereafter, per day cost of OT services was obtained. The average number of surgeries performed in the trauma centre per day is 13. The annual cost of providing operating room services at JPNATC, New Delhi was calculated to be 197,298,704 Indian rupees (INR) (US$ 3,653,679), while the per hour cost was calculated to be INR 22,626.92 (US$ 419). Majority of the expenditures were for human resource (33.63 %) followed by OT capital cost (31.90 %), consumables (29.97 %), engineering maintenance cost (2.55 %), support services operating cost (1.22 %) and support services capital cost (0.73 %). Of the total cost towards the provisioning of OT services, 32.63 % was capital cost while 67.37 % is operating cost. The results of this costing study will help in the future planning of resource allocation within the financial constraints (US$ 1 = INR 54).

The Business Change Initiative: A Novel Approach to Improved Cost and Schedule Management

NASA Technical Reports Server (NTRS)

Shinn, Stephen A.; Bryson, Jonathan; Klein, Gerald; Lunz-Ruark, Val; Majerowicz, Walt; McKeever, J.; Nair, Param

2016-01-01

Goddard Space Flight Center's Flight Projects Directorate employed a Business Change Initiative (BCI) to infuse a series of activities coordinated to drive improved cost and schedule performance across Goddard's missions. This sustaining change framework provides a platform to manage and implement cost and schedule control techniques throughout the project portfolio. The BCI concluded in December 2014, deploying over 100 cost and schedule management changes including best practices, tools, methods, training, and knowledge sharing. The new business approach has driven the portfolio to improved programmatic performance. The last eight launched GSFC missions have optimized cost, schedule, and technical performance on a sustained basis to deliver on time and within budget, returning funds in many cases. While not every future mission will boast such strong performance, improved cost and schedule tools, management practices, and ongoing comprehensive evaluations of program planning and control methods to refine and implement best practices will continue to provide a framework for sustained performance. This paper will describe the tools, techniques, and processes developed during the BCI and the utilization of collaborative content management tools to disseminate project planning and control techniques to ensure continuous collaboration and optimization of cost and schedule management in the future.

Cost-benefit calculation of phytoremediation technology for heavy-metal-contaminated soil.

PubMed

Wan, Xiaoming; Lei, Mei; Chen, Tongbin

2016-09-01

Heavy-metal pollution of soil is a serious issue worldwide, particularly in China. Soil remediation is one of the most difficult management issues for municipal and state agencies because of its high cost. A two-year phytoremediation project for soil contaminated with arsenic, cadmium, and lead was implemented to determine the essential parameters for soil remediation. Results showed highly efficient heavy metal removal. Costs and benefits of this project were calculated. The total cost of phytoremediation was US$75,375.2/hm(2) or US$37.7/m(3), with initial capital and operational costs accounting for 46.02% and 53.98%, respectively. The costs of infrastructures (i.e., roads, bridges, and culverts) and fertilizer were the highest, mainly because of slow economic development and serious contamination. The cost of phytoremediation was lower than the reported values of other remediation technologies. Improving the mechanization level of phytoremediation and accurately predicting or preventing unforeseen situations were suggested for further cost reduction. Considering the loss caused by environmental pollution, the benefits of phytoremediation will offset the project costs in less than seven years. Copyright © 2015 Elsevier B.V. All rights reserved.

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...

12 CFR 324.11 - Capital conservation buffer and countercyclical capital buffer amount.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 5 2014-01-01 2014-01-01 false Capital conservation buffer and countercyclical capital buffer amount. 324.11 Section 324.11 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION... Requirements and Buffers § 324.11 Capital conservation buffer and countercyclical capital buffer amount. (a...

Costs of health care across primary care models in Ontario.

PubMed

Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

2017-08-01

The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the

The price of innovation: new estimates of drug development costs.

PubMed

DiMasi, Joseph A; Hansen, Ronald W; Grabowski, Henry G

2003-03-01

The research and development costs of 68 randomly selected new drugs were obtained from a survey of 10 pharmaceutical firms. These data were used to estimate the average pre-tax cost of new drug development. The costs of compounds abandoned during testing were linked to the costs of compounds that obtained marketing approval. The estimated average out-of-pocket cost per new drug is 403 million US dollars (2000 dollars). Capitalizing out-of-pocket costs to the point of marketing approval at a real discount rate of 11% yields a total pre-approval cost estimate of 802 million US dollars (2000 dollars). When compared to the results of an earlier study with a similar methodology, total capitalized costs were shown to have increased at an annual rate of 7.4% above general price inflation. Copyright 2003 Elsevier Science B.V.

Air Traffic Control: Surveillance Radar Request for the Cherry Capital Airport

DOT National Transportation Integrated Search

1998-05-01

In 1994, the Federal Aviation Administration (FAA) received requests to install an airport surveillance radar at the Cherry Capital Airport in Traverse City, Michigan. In response to the requests, FAA assessed the benefits and costs of installing a s...

48 CFR 1830.7002 - Facilities capital employed for facilities under construction.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Facilities capital employed for facilities under construction. 1830.7002 Section 1830.7002 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING...

The Brazilian Public Health in Contemporary Capitalism.

PubMed

Junqueira, Virgínia; Mendes, Áquilas N

2018-01-01

This article examines some political and economic facts that led to an intensification of austerity measures by the Brazilian government, including ones against the Unified Health System (SUS) and its progressive dismantling. In a country where fundamental human rights were never fully respected, nowadays social and labor rights are under severe attacks. The deepening of the capital crisis and the rise of interest-bearing capital dominance have been causing unemployment, social insecurity growth, and resulting public fund appropriation by the private capital. The Brazilian governments in the 1990s and 2000s have implemented deeper cuts in social policy expenditure, freezing security benefits, privatizing services, and prioritizing the payment of public debt interests. The right wing's project involves the demoralization of not only the Workers' Party but also the left as a whole, so that the adoption of austerity measures could be achieved without popular resistance. It is the duty of the Brazilian left wing to denounce such a project and to provoke firm initiatives to rebuild its bonds with the working class.

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…

12 CFR 217.11 - Capital conservation buffer and countercyclical capital buffer amount.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 2 2014-01-01 2014-01-01 false Capital conservation buffer and countercyclical capital buffer amount. 217.11 Section 217.11 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS... Requirements and Buffers § 217.11 Capital conservation buffer and countercyclical capital buffer amount. (a...

Analysis of capital spending and capital financing among large US nonprofit health systems.

PubMed

Stewart, Louis J

2012-01-01

This article examines the recent trends (2006 to 2009) in capital spending among 25 of the largest nonprofit health systems in the United States and analyzes the financing sources that these large nonprofit health care systems used to fund their capital spending. Total capital spending for these 25 nonprofit health entities exceeded $41 billion for the four-year period of this study. Less than 3 percent of total capital spending resulted in mergers and acquisition activities. Total annual capital spending grew at an average annual rate of 17.6 percent during the first three year of this study's period of analysis. Annual capital spending for 2009 fell by more than 22 percent over prior year's level due to the impact of widespread disruption in US tax-exempt variable rate debt markets. While cash inflow from long-term debt issues was a significant source of capital financing, this study's primary finding was that operating cash flow was the predominant source of capital spending funding. Key words: nonprofit, mergers and acquisitions (M&A), capital spending, capital financing.

The costs of nurse turnover, part 2: application of the Nursing Turnover Cost Calculation Methodology.

PubMed

Jones, Cheryl Bland

2005-01-01

This is the second article in a 2-part series focusing on nurse turnover and its costs. Part 1 (December 2004) described nurse turnover costs within the context of human capital theory, and using human resource accounting methods, presented the updated Nursing Turnover Cost Calculation Methodology. Part 2 presents an application of this method in an acute care setting and the estimated costs of nurse turnover that were derived. Administrators and researchers can use these methods and cost information to build a business case for nurse retention.

Association Between The Real Cost Media Campaign and Smoking Initiation Among Youths - United States, 2014-2016.

PubMed

Farrelly, Matthew C; Duke, Jennifer C; Nonnemaker, James; MacMonegle, Anna J; Alexander, Tesfa N; Zhao, Xiaoquan; Delahanty, Janine C; Rao, Pamela; Allen, Jane A

2017-01-20

In the United States, approximately 900,000 youths smoke their first cigarette each year (1). Health communication interventions are evidence-based strategies for preventing the initiation of tobacco use, promoting and facilitating cessation, and changing beliefs and attitudes about tobacco use (2,3). This report describes the association between the Food and Drug Administration's (FDA's) first national tobacco public education campaign, The Real Cost, and rates of smoking initiation among youths in the United States from 2014 to 2016. A nationally representative cohort study of youths (N = 5,185) was conducted during November 2013-March 2016. Results from a discrete-time survival model indicate that, among youths who reported never having smoked a cigarette in the baseline survey, the odds of reporting smoking initiation at follow-up were lower among youths with frequent exposure to campaign advertisements than among those with little or no exposure (adjusted odds ratio [aOR] = 0.70, 95% confidence interval [CI] = 0.55-0.91). Based on the results of the model, The Real Cost is associated with an estimated 348,398 U.S. youths aged 11-18 years who did not initiate smoking during February 2014-March 2016. Sustained youth-focused tobacco education campaigns, such as The Real Cost, can help speed progress toward preventing tobacco use among youths in the United States.

Beyond the Reagan tax proposal: hospital capital management strategies.

PubMed

Harris, J P

1985-11-01

If Reagan's tax proposal is implemented, low-cost tax-exempt revenue bonds, advance refunding, and the investment tax credit would be eliminated. Such possibilities could cause a serious blow to the hospital industry--the cost of capital could rise significantly, the hospital's ability to manage debt could decrease, and joint ventures could become less attractive. However, in light of the known elements in Reagan's proposal, certain financing strategies can be adopted immediately that will help offset these possibilities and help ensure long-term survival.

48 CFR 1830.7001 - Facilities capital employed for facilities in use.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Facilities capital employed for facilities in use. 1830.7001 Section 1830.7001 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION...

Reductive Degradation: Versatile, Low Cost.

ERIC Educational Resources Information Center

Water and Sewage Works, 1979

1979-01-01

This article discusses the use of reductive degradation as an economical and effective treatment of chlorinated hydrocarbons. Comparisons with activated carbon treatment show lower capital equipment and treatment costs. (CS)

Voluntary partial capitation: the Community Nursing Organization Medicare demonstration.

PubMed

Frakt, Austin B; Pizer, Steven D; Schmitz, Robert J; Mattke, Soeren

2005-01-01

In a recently concluded Medicare demonstration, Community Nursing Organizations (CNOs) received capitated payment to provide a subset of Medicare services through a nursing case management delivery system. Demonstration participation was voluntary, both for CNOs and recruited beneficiaries, raising several challenging issues associated with selection. We investigate provider and beneficiary selection, as well as Medicare costs, using multiple evaluation methodologies. We find that CNO enrollment is associated with increased payment by Medicare for CNO-covered services. Results showing CNO enrollees to be more costly to Medicare for non-CNO services are consistent with cost shifting, but could also be accounted for by biased provider selection into the demonstration.

12 CFR 6.4 - Capital measures and capital category definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... categories of asset quality, management, earnings, or liquidity. [57 FR 44891, Sept. 29, 1992, as amended at... measures. For purposes of section 38 and this part, the relevant capital measures shall be: (1) The total...) Well capitalized if the bank: (i) Has a total risk-based capital ratio of 10.0 percent or greater; and...

12 CFR 6.4 - Capital measures and capital category definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... categories of asset quality, management, earnings, or liquidity. [57 FR 44891, Sept. 29, 1992, as amended at... measures. For purposes of section 38 and this part, the relevant capital measures shall be: (1) The total...) Well capitalized if the bank: (i) Has a total risk-based capital ratio of 10.0 percent or greater; and...

Does Social Capital Explain Community-Level Differences in Organ Donor Designation?

PubMed

Ladin, Keren; Wang, Rui; Fleishman, Aaron; Boger, Matthew; Rodrigue, James R

2015-09-01

The growing shortage of life-saving organs has reached unprecedented levels, with more than 120,000 Americans waiting for them. Despite national attempts to increase organ donation and federal laws mandating the equitable allocation of organs, geographic disparities remain. A better understanding of the contextual determinants of organ donor designation, including social capital, may enhance efforts to increase organ donation by raising the probability of collective action and fostering norms of reciprocity and cooperation while increasing costs to defectors. Because community-level factors, including social capital, predict more than half the variation in donor designation, future interventions should tailor strategies to specific communities as the unit of intervention. The growing shortage of organs has reached unprecedented levels. Despite national attempts to increase donation and federal laws mandating the equitable allocation of organs, their availability and waiting times vary significantly nationwide. Organ donor designation is a collective action problem in public health, in which the regional organ supply and average waiting times are determined by the willingness of individuals to be listed as organ donors. Social capital increases the probability of collective action by fostering norms of reciprocity and cooperation while increasing costs to defectors. We examine whether social capital and other community-level factors explain geographic variation in organ donor designation rates in Massachusetts. We obtained a sample of 3,281,532 registered drivers in 2010 from the Massachusetts Department of Transportation Registry of Motor Vehicles (MassDOT RMV). We then geocoded the registry data, matched them to 4,466 census blocks, and linked them to the 2010 US Census, the American Community Survey (ACS), and other sources to obtain community-level sociodemographic, social capital (residential segregation, voter registration and participation, residential

Low-Cost High-Pressure Hydrogen Generator

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

Cropley, Cecelia C.; Norman, Timothy J.

Electrolysis of water, particularly in conjunction with renewable energy sources, is potentially a cost-effective and environmentally friendly method of producing hydrogen at dispersed forecourt sites, such as automotive fueling stations. The primary feedstock for an electrolyzer is electricity, which could be produced by renewable sources such as wind or solar that do not produce carbon dioxide or other greenhouse gas emissions. However, state-of-the-art electrolyzer systems are not economically competitive for forecourt hydrogen production due to their high capital and operating costs, particularly the cost of the electricity used by the electrolyzer stack. In this project, Giner Electrochemical Systems, LLC (GES)more » developed a low cost, high efficiency proton-exchange membrane (PEM) electrolysis system for hydrogen production at moderate pressure (300 to 400 psig). The electrolyzer stack operates at differential pressure, with hydrogen produced at moderate pressure while oxygen is evolved at near-atmospheric pressure, reducing the cost of the water feed and oxygen handling subsystems. The project included basic research on catalysts and membranes to improve the efficiency of the electrolysis reaction as well as development of advanced materials and component fabrication methods to reduce the capital cost of the electrolyzer stack and system. The project culminated in delivery of a prototype electrolyzer module to the National Renewable Energy Laboratory for testing at the National Wind Technology Center. Electrolysis cell efficiency of 72% (based on the lower heating value of hydrogen) was demonstrated using an advanced high-strength membrane developed in this project. This membrane would enable the electrolyzer system to exceed the DOE 2012 efficiency target of 69%. GES significantly reduced the capital cost of a PEM electrolyzer stack through development of low cost components and fabrication methods, including a 60% reduction in stack parts count

Neighborhood differences in social capital in Ghent (Belgium): a multilevel approach.

PubMed

Neutens, Tijs; Vyncke, Veerle; De Winter, Dieter; Willems, Sara

2013-11-13

Little research has focused on the spatial distribution of social capital, despite social capital's rising popularity in health research and policy. This study examines the neighborhood differences in social capital and the determinants that explain these differences. Five components of neighborhood social capital are identified by means of factor and reliability analyses using data collected in the cross-sectional SWING study from 762 inhabitants in 42 neighbourhoods in the city of Ghent (Belgium). Neighborhood differences in social capital are explored using hierarchical linear models with cross-level interactions. Significant neighborhood differences are found for social cohesion, informal social control and social support, but not for social leverage and generalized trust. Our findings suggest that neighborhood social capital depends on both characteristics of individuals living in the neighborhood (attachment to neighborhood) and characteristics of the neighborhood itself (deprivation and residential turnover). Our analysis further shows that neighborhood deprivation reinforces the negative effect of declining neighborhood attachment on social cohesion and informal social control. This study foregrounds the importance of contextual effects in encouraging neighborhood social capital. Given the importance of neighborhood-level characteristics, it can be anticipated social capital promoting initiatives are likely to be more effective when tailored to specific areas. Second, our analyses show that not all forms of social capital are influenced by contextual factors to the same extent, implying that changes in neighborhood characteristics are conducive to, say, trust while leaving social support unaffected. Finally, our analysis has demonstrated that complex interrelationships between individual- and neighborhood-level variables exist, which are often overlooked in current work.

A comparison of hospital administrative costs in eight nations: US costs exceed all others by far.

PubMed

Himmelstein, David U; Jun, Miraya; Busse, Reinhard; Chevreul, Karine; Geissler, Alexander; Jeurissen, Patrick; Thomson, Sarah; Vinet, Marie-Amelie; Woolhandler, Steffie

2014-09-01

A few studies have noted the outsize administrative costs of US hospitals, but no research has compared these costs across multiple nations with various types of health care systems. We assembled a team of international health policy experts to conduct just such a challenging analysis of hospital administrative costs across eight nations: Canada, England, Scotland, Wales, France, Germany, the Netherlands, and the United States. We found that administrative costs accounted for 25.3 percent of total US hospital expenditures--a percentage that is increasing. Next highest were the Netherlands (19.8 percent) and England (15.5 percent), both of which are transitioning to market-oriented payment systems. Scotland and Canada, whose single-payer systems pay hospitals global operating budgets, with separate grants for capital, had the lowest administrative costs. Costs were intermediate in France and Germany (which bill per patient but pay separately for capital projects) and in Wales. Reducing US per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011. This study suggests that the reduction of US administrative costs would best be accomplished through the use of a simpler and less market-oriented payment scheme. Project HOPE—The People-to-People Health Foundation, Inc.

7 CFR 3560.304 - Initial operating capital.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE DIRECT MULTI-FAMILY HOUSING LOANS AND GRANTS Financial Management § 3560.304 Initial operating... of 12 months prior to the withdrawal request; (4) The withdrawal will not affect the financial viability of the housing project; (5) Contributions to the reserve account are at authorized levels; (6) The...

48 CFR 31.205-29 - Plant protection costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Plant protection costs. 31....205-29 Plant protection costs. Costs of items such as (a) wages, uniforms, and equipment of personnel engaged in plant protection, (b) depreciation on plant protection capital assets, and (c) necessary...

48 CFR 31.205-29 - Plant protection costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Plant protection costs. 31....205-29 Plant protection costs. Costs of items such as (a) wages, uniforms, and equipment of personnel engaged in plant protection, (b) depreciation on plant protection capital assets, and (c) necessary...

A cost analysis: processing maple syrup products

Treesearch

Neil K. Huyler; Lawrence D. Garrett

1979-01-01

A cost analysis of processing maple sap to syrup for three fuel types, oil-, wood-, and LP gas-fired evaporators, indicates that: (1) fuel, capital, and labor are the major cost components of processing sap to syrup; (2) wood-fired evaporators show a slight cost advantage over oil- and LP gas-fired evaporators; however, as the cost of wood approaches $50 per cord, wood...

Methodologies for Optimum Capital Expenditure Decisions for New Medical Technology

PubMed Central

Landau, Thomas P.; Ledley, Robert S.

1980-01-01

This study deals with the development of a theory and an analytical model to support decisions regarding capital expenditures for complex new medical technology. Formal methodologies and quantitative techniques developed by applied mathematicians and management scientists can be used by health planners to develop cost-effective plans for the utilization of medical technology on a community or region-wide basis. In order to maximize the usefulness of the model, it was developed and tested against multiple technologies. The types of technologies studied include capital and labor-intensive technologies, technologies whose utilization rates vary with hospital occupancy rate, technologies whose use can be scheduled, and limited-use and large-use technologies.

The Assessment of Recovery Capital: properties and psychometrics of a measure of addiction recovery strengths.

PubMed

Groshkova, Teodora; Best, David; White, William

2013-03-01

Sociological work on social capital and its impact on health behaviours have been translated into the addiction field in the form of 'recovery capital' as the construct for assessing individual progress on a recovery journey. Yet there has been little attempt to quantify recovery capital. The aim of the project was to create a scale that assessed addiction recovery capital. Initial focus group work identified and tested candidate items and domains followed by data collection from multiple sources to enable psychometric assessment of a scale measuring recovery capital. The scale shows moderate test-retest reliability at 1 week and acceptable concurrent validity. Principal component analysis determined single factor structure. The Assessment of Recovery Capital (ARC) is a brief and easy to administer measurement of recovery capital that has acceptable psychometric properties and may be a useful complement to deficit-based assessment and outcome monitoring instruments for substance dependent individuals in and out of treatment. © 2012 Australasian Professional Society on Alcohol and other Drugs.

K-12 Marketplace Sees Major Flow of Venture Capital

ERIC Educational Resources Information Center

Ash, Katie

2012-01-01

The flow of venture capital into the K-12 education market has exploded over the past year, reaching its highest transaction values in a decade in 2011, industry observers say. They attribute that rise to such factors as a heightened interest in educational technology; the decreasing cost of electronic devices such as tablet computers, laptops,…

Minority Capital Resource Handbook. A Guide to Raising Capital for Minority Entrepreneurs. Second Edition.

ERIC Educational Resources Information Center

Ewing, Samuel D., Jr.; Maloney, Clifton H. W.

This minority capital resource handbook consists of a guide to raising capital for minority entrepreneurs and a listing of sources that provide such capital. The first section deals with the process of raising capital. The realities of raising capital, intermediaries and financial advisors, and assessing needs are outlined. Factors considered in…

Impact of Out-of-Pocket Costs on Prescription Fills Among New Initiators of Biologic Therapies for Rheumatoid Arthritis.

PubMed

Hopson, Sari; Saverno, Kim; Liu, Larry Z; AL-Sabbagh, Ahmad; Orazem, John; Costantino, Mary E; Pasquale, Margaret K

2016-02-01

Biologic disease-modifying antirheumatic drug (DMARD) therapies are a mainstay of treatment for rheumatoid arthritis (RA), yet high member out-of-pocket (OOP) costs for such therapies may limit patient access to these therapies. To understand whether there is a relationship between OOP costs and the initial fill and subsequent refills of biologic DMARD treatments for RA members. Members of a national Medicare Advantage and Prescription Drug (MAPD) plan with an adjudicated (paid or reversed) claim for a biologic DMARD indicated for RA were identified from July 1, 2007, to December 31, 2012, and followed retrospectively. The first adjudicated claim date was the index date. Members were required to have 180 days of continuous enrollment pre- and post-index and ≥ 1 diagnosis for RA (ICD-9-CM: 714.0 or 714.2) during pre-index or ≤ 30 days post-index. Low-income subsidy and Medicaid-Medicare dual-eligible patients were excluded. The analysis used multivariate regression models to examine associations between initial prescription (Rx) abandonment rates and OOP costs and factors influencing the refill of a biologic DMARD therapy based on pharmacy claims. The final sample size included 864 MAPD members with an adjudicated claim for a biologic DMARD. The majority were female (77.4%) and mean age was 63.5 years (SD = 10.9). Most (78%) had conventional nonbiologic DMARD utilization during pre-index. The overall initial abandonment rate was 18.2% for biologic DMARDs, ranging from 1.3% for the lowest OOP cost group ($0-$250) to 32.7% for the highest OOP cost group (> $550; P < 0.0001 for Cochran-Armitage trend test). ORs for abandonment rose from 18.4 to 32.7 to 41.2 for OOP costs of $250.01-$400.00, $400.01-$550.00, and > $550.00 respectively, relative to OOP costs of ≤ $250.00 (all P < 0.0001). Meeting the catastrophic coverage limit and utilization of a specialty pharmacy for the index claim were both associated with a decreased likelihood of abandoning therapy (OR = 0

Investment in Human Capital. Schooling Supply Constraints in Rural Ghana.

ERIC Educational Resources Information Center

Lavy, Victor

This paper hypothesizes that the cost differential between primary school and middle or secondary schooling will affect household decisions to invest in any one schooling level in Ghana. Human capital investment is usually modeled in an intertemporal optimization framework in which households or individuals maximize the present value of life-time…

Pneumatic versus laser ureteroscopic lithotripsy: a comparison of initial outcomes and cost.

PubMed

Demir, Aslan; Karadağ, Mert Ali; Ceçen, Kurşat; Uslu, Mehmet; Arslan, Omer Erkam

2014-11-01

To audit the cost of laser versus pneumatic semirigid ureteroscopic lithotripsy and to analyze their relative initial outcomes and cost. Hundred and eighty-seven patients who underwent semirigid ureteroscopic lithotripsy were analyzed retrospectively in terms of age and sex of the patients; location and size of the stones; the type of probe and ancillary equipment such as guide wire, basket catheter, JJ stent requirements; irrigation amount; operation time; the cost of the anesthesia and further treatments such as a JJ stent removal operation and shock wave lithotripsy requirements and their costs. Two groups were formed based on this type of lithotripters, pneumatic and laser lithotripsy. Operation times (min.) in terms of the stone size, for stones <100 and >100 mm(2) were 20.75 ± 10.78 and 25.82 ± 14.23, respectively (p = 0.007). Operation times for the pneumatic and laser groups were 33.05 ± 11.36 and 15.25 ± 6.14, respectively (p < 0.05).The stone-free rates for pneumatic and laser groups were 89.6 % (n = 69) and 98.2 % (n = 108), respectively (p = 0.01). The mean cost of the operations for each of the study groups was 261.5 ± 66.13 and 311.7 ± 51.97 US$, respectively (p = 0.001). The mean cost in terms of the stone size, for stones <100 and >100 mm(2), was 272.86 ± 53.05 and 323.71 ± 66.88 US$, respectively (p = 0.01). It seems that usage of laser lithotripsy (LL) in patients with ureteral stones is more effective than pneumatic lithotripsy (PL) in terms of operation time and SF rate. On the other hand, the mean cost of LL seems to be more expensive than PL. Urologists should think these parameters before the choice of these two treatment modalities. The higher the effectiveness, the greater the cost.

Risk-adjusted capitation funding models for chronic disease in Australia: alternatives to casemix funding.

PubMed

Antioch, K M; Walsh, M K

2002-01-01

Under Australian casemix funding arrangements that use Diagnosis-Related Groups (DRGs) the average price is policy based, not benchmarked. Cost weights are too low for State-wide chronic disease services. Risk-adjusted Capitation Funding Models (RACFM) are feasible alternatives. A RACFM was developed for public patients with cystic fibrosis treated by an Australian Health Maintenance Organization (AHMO). Adverse selection is of limited concern since patients pay solidarity contributions via Medicare levy with no premium contributions to the AHMO. Sponsors paying premium subsidies are the State of Victoria and the Federal Government. Cost per patient is the dependent variable in the multiple regression. Data on DRG 173 (cystic fibrosis) patients were assessed for heteroskedasticity, multicollinearity, structural stability and functional form. Stepwise linear regression excluded non-significant variables. Significant variables were 'emergency' (1276.9), 'outlier' (6377.1), 'complexity' (3043.5), 'procedures' (317.4) and the constant (4492.7) (R(2)=0.21, SE=3598.3, F=14.39, Prob<0.0001. Regression coefficients represent the additional per patient costs summed to the base payment (constant). The model explained 21% of the variance in cost per patient. The payment rate is adjusted by a best practice annual admission rate per patient. The model is a blended RACFM for in-patient, out-patient, Hospital In The Home, Fee-For-Service Federal payments for drugs and medical services; lump sum lung transplant payments and risk sharing through cost (loss) outlier payments. State and Federally funded home and palliative services are 'carved out'. The model, which has national application via Coordinated Care Trials and by Australian States for RACFMs may be instructive for Germany, which plans to use Australian DRGs for casemix funding. The capitation alternative for chronic disease can improve equity, allocative efficiency and distributional justice. The use of Diagnostic Cost

Searching for social capital: historical perspectives on health, poverty and culture.

PubMed

Welshman, John

2006-11-01

Social capital has been seen as having a positive effect on health, and the concept of social capital has been viewed as of central importance to debates about healthy, sustainable communities. More generally, behaviour and its relationship with health has become much more central to policy-making, as illustrated in the Choosing Health White Paper (2005), and the concept of social capital has been one influence on the concept of social exclusion. Robert Putnam's arguments, both those expressed in Making Democracy Work (1993) and the revised version seen in Bowling Alone (2000) have been taken up by numerous social scientists and policy-makers. But despite the explicitly historical perspective that Putnam employs in Bowling Alone in particular, the history of social capital remains rather neglected in the available literature. This article is concerned with providing a historical perspective on social capital, especially the ways in which social investigators have viewed the relationships between health, poverty and behaviour. The article puts social capital alongside that of 'underclass' concepts such as the culture of poverty thesis, and examines how the latter has been invented and reinvented in the U.K. and the U.S.A. over the last 120 years. It argues that there are important similarities between the culture of poverty and social capital, but also significant differences, and these have implications for current policy initiatives. One way of analysing concepts like social capital and social exclusion more rigorously is by locating them within this longer-term history of social investigation, in which debates about health, poverty, and culture have been of

Cost and consequences of noncompliance with osteoporosis treatment among women initiating therapy.

PubMed

Modi, Ankita; Siris, Ethel S; Tang, Jackson; Sen, Shuvayu

2015-04-01

The objective was to evaluate compliance with osteoporosis (OP) treatments and determine the fracture and healthcare burden associated with noncompliance. This retrospective analysis of a US claims database identified women initiating an OP medication from 1 January 2002 to 30 June 2009. Patients were ≥55 years and had ≥1 pharmacy claim for a bisphosphonate or non-bisphosphonate (raloxifene, calcitonin, teriparatide); the index date was the first pharmacy claim. There were three study periods: baseline (12 months pre-index); compliance period (0-12 months post-index); and follow-up period (12-24 months post-index). Medication possession ratio (MPR) was calculated during the compliance period to differentiate two cohorts: compliant (MPR ≥ 80%) and noncompliant (MPR < 80%). Outcomes during follow-up were modeled by logistic regression (presence of fracture), Poisson regression (healthcare utilization incidence rate) and gamma regression (healthcare costs), all adjusted for patient demographic and clinical characteristics. Overall, 685,505 women initiating OP therapy were identified and 57,913 (8.4%) met the inclusion criteria: only 23,430 (40.5%) were compliant and 34,483 (59.5%) were noncompliant. Mean age was 64 years. Noncompliance was associated with a 20% higher risk of any fracture (odds ratio: 1.20, 95% CI = 1.07-1.35), a higher incidence rate ratio (IRR) for inpatient utilization (IRR: 1.26, 95% CI = 1.19-1.34) and a lower rate of outpatient utilization (IRR: 0.97, 95% CI = 0.95-0.98). Noncompliant patients had 13% higher medical costs (cost ratio: 1.13, 95% CI = 1.06-1.21) than compliant patients. Inclusion in this study required 36 months of continuous healthcare coverage. Thus, the results are primarily applicable to a stable, managed care population and may not be generalizable to other populations. Noncompliance with OP therapy was associated with a higher risk of fracture, higher all-cause medical costs and a higher

48 CFR 1631.205-10 - Cost of money.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Cost of money. 1631.205-10... AND PROCEDURES Contracts With Commercial Organizations 1631.205-10 Cost of money. For the purposes of FAR 31.205-10(b)(3), the estimated facilities capital cost of money is specifically identified if it...

48 CFR 1631.205-10 - Cost of money.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Cost of money. 1631.205-10... AND PROCEDURES Contracts With Commercial Organizations 1631.205-10 Cost of money. For the purposes of FAR 31.205-10(b)(3), the estimated facilities capital cost of money is specifically identified if it...

Know Your Capital City. Bulletin, 1950, No. 18

ERIC Educational Resources Information Center

Willcockson, Mary

1950-01-01

Since any good citizen wants to know how his Government works, as an initial experience it is necessary to become acquainted with the setting--Washington, D. C. This bulletin serves as in introduction to the Capital. It provides an historical and a present-day background for appreciating the city. What kind of a community is Washington? Why does…

Integrated corridor management initiative : demonstration phase evaluation – San Diego benefit-cost analysis test plan.

DOT National Transportation Integrated Search

2012-08-01

This report presents the test plan for conducting the Benefit-Cost Analysis (BCA) for the United States Department of Transportation (U.S. DOT) evaluation of the San Diego Integrated Corridor Management (ICM) Initiative Demonstration. The ICM project...

Somerset County Renewable Energy Initiative

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

Katula, Denise

2014-05-07

The County of Somerset, New Jersey, through the Somerset County Improvement Authority (SCIA), applied Federal funding through the U.S. Department of Energy to will apply project funds to buy-down the capital costs of equipment associated with the installation of solar photovoltaic (PV) systems at two sites owned by the County. This Renewable Energy Initiative allows the County to take advantage of clean renewable energy, without any adverse debt impacts, and at a price that results in operating budget savings beyond what is presently available in the marketplace. This project addressed the objectives of the Office of Energy Efficiency and Renewablemore » Energy by making the acquisition of renewable energy more affordable for the County, thereby, encouraging other counties and local units to develop similar programs and increase the deployment of solar energy technologies. The two sites that were funded by the DOE grant are part of a much larger, ambitious, and unique renewable energy project, described in the next section.« less

Human Capital Response to Globalization: Education and Information Technology in India

ERIC Educational Resources Information Center

Shastry, Gauri Kartini

2012-01-01

Recent studies suggest that globalization increases inequality, by increasing skilled wage premiums in developing countries. This effect may be mitigated, however, if human capital responds to global opportunities. I study how the impact of globalization varies across Indian districts with different costs of learning English. Linguistic diversity…

Why the Quality Oncology Practice Initiative Matters: It's Not Just About Cost.

PubMed

Chiang, Anne C

2016-01-01

The nature and cost of cancer care is evolving, affecting more patients and often involving expensive treatment options. The upward cost trends also coincide with a national landscape of increasing regulatory mandates that may demand improved outcomes and value, but that often require significant up-front investment in infrastructure to achieve safety and quality. Oncology practices participating in the American Society of Clinical Oncology (ASCO) Institute for Quality's Quality Oncology Practice Initiative (QOPI) and the QOPI Certification Program (QCP) continue to grow in number and reflect changing demographics of the provision of cancer care. QOPI and QCP benchmarking can be used to achieve quality improvement and to build collaborative quality communities. These programs may be useful tools for oncology practices to comply with new legislation such as the Medicare Access and CHIP Reauthorization Act (MACRA).

Innovation in the pharmaceutical industry: New estimates of R&D costs.

PubMed

DiMasi, Joseph A; Grabowski, Henry G; Hansen, Ronald W

2016-05-01

The research and development costs of 106 randomly selected new drugs were obtained from a survey of 10 pharmaceutical firms. These data were used to estimate the average pre-tax cost of new drug and biologics development. The costs of compounds abandoned during testing were linked to the costs of compounds that obtained marketing approval. The estimated average out-of-pocket cost per approved new compound is $1395 million (2013 dollars). Capitalizing out-of-pocket costs to the point of marketing approval at a real discount rate of 10.5% yields a total pre-approval cost estimate of $2558 million (2013 dollars). When compared to the results of the previous study in this series, total capitalized costs were shown to have increased at an annual rate of 8.5% above general price inflation. Adding an estimate of post-approval R&D costs increases the cost estimate to $2870 million (2013 dollars). Copyright © 2016 Elsevier B.V. All rights reserved.

12 CFR 1777.20 - Capital classifications.

Code of Federal Regulations, 2010 CFR

2010-01-01

... notice of proposed capital classification, holds core capital equaling or exceeding the minimum capital... classification, holds core capital equaling or exceeding the minimum capital level. (3) Significantly... the date specified in the notice of proposed capital classification, holds core capital less than the...

In-use product stocks link manufactured capital to natural capital.

PubMed

Chen, Wei-Qiang; Graedel, T E

2015-05-19

In-use stock of a product is the amount of the product in active use. In-use product stocks provide various functions or services on which we rely in our daily work and lives, and the concept of in-use product stock for industrial ecologists is similar to the concept of net manufactured capital stock for economists. This study estimates historical physical in-use stocks of 91 products and 9 product groups and uses monetary data on net capital stocks of 56 products to either approximate or compare with in-use stocks of the corresponding products in the United States. Findings include the following: (i) The development of new products and the buildup of their in-use stocks result in the increase in variety of in-use product stocks and of manufactured capital; (ii) substitution among products providing similar or identical functions reflects the improvement in quality of in-use product stocks and of manufactured capital; and (iii) the historical evolution of stocks of the 156 products or product groups in absolute, per capita, or per-household terms shows that stocks of most products have reached or are approaching an upper limit. Because the buildup, renewal, renovation, maintenance, and operation of in-use product stocks drive the anthropogenic cycles of materials that are used to produce products and that originate from natural capital, the determination of in-use product stocks together with modeling of anthropogenic material cycles provides an analytic perspective on the material linkage between manufactured capital and natural capital.

In-use product stocks link manufactured capital to natural capital

PubMed Central

Chen, Wei-Qiang; Graedel, T. E.

2015-01-01

In-use stock of a product is the amount of the product in active use. In-use product stocks provide various functions or services on which we rely in our daily work and lives, and the concept of in-use product stock for industrial ecologists is similar to the concept of net manufactured capital stock for economists. This study estimates historical physical in-use stocks of 91 products and 9 product groups and uses monetary data on net capital stocks of 56 products to either approximate or compare with in-use stocks of the corresponding products in the United States. Findings include the following: (i) The development of new products and the buildup of their in-use stocks result in the increase in variety of in-use product stocks and of manufactured capital; (ii) substitution among products providing similar or identical functions reflects the improvement in quality of in-use product stocks and of manufactured capital; and (iii) the historical evolution of stocks of the 156 products or product groups in absolute, per capita, or per-household terms shows that stocks of most products have reached or are approaching an upper limit. Because the buildup, renewal, renovation, maintenance, and operation of in-use product stocks drive the anthropogenic cycles of materials that are used to produce products and that originate from natural capital, the determination of in-use product stocks together with modeling of anthropogenic material cycles provides an analytic perspective on the material linkage between manufactured capital and natural capital. PMID:25733904

Deferred Capital Renewal as a Spoiler for Campus Programs

ERIC Educational Resources Information Center

Whitefield, Joe

2010-01-01

For facilities managers, deferred capital renewal (DCR) is the issue that, in many ways, can play the role of spoiler for other programs and initiatives are that important to their campuses. In particular, operations and maintenance programs, campus growth strategies, and even sustainability programs can suffer setbacks caused by the unplanned…

Smart roadside initiative macro benefit analysis : user’s guide for the benefit-cost analysis tool.

DOT National Transportation Integrated Search

2015-03-01

Through the Smart Roadside Initiative (SRI), a Benefit-Cost Analysis (BCA) tool was developed for the evaluation of various new transportation technologies at a State level and to provide results that could support technology adoption by a State Depa...

COAL UTILITY EVIRONMENTAL COST (CUECOST) WORKBOOK USER'S MANUAL

EPA Science Inventory

The document is a user's manual for the Coal Utility Environmental Cost (CUECost) workbook (an interrelated set of spreadsheets) and documents its development and the validity of methods used to estimate installed capital ad annualize costs. The CUECost workbook produces rough-or...

Lives Saved Tool (LiST) costing: a module to examine costs and prioritize interventions.

PubMed

Bollinger, Lori A; Sanders, Rachel; Winfrey, William; Adesina, Adebiyi

2017-11-07

Achieving the Sustainable Development Goals will require careful allocation of resources in order to achieve the highest impact. The Lives Saved Tool (LiST) has been used widely to calculate the impact of maternal, neonatal and child health (MNCH) interventions for program planning and multi-country estimation in several Lancet Series commissions. As use of the LiST model increases, many have expressed a desire to cost interventions within the model, in order to support budgeting and prioritization of interventions by countries. A limited LiST costing module was introduced several years ago, but with gaps in cost types. Updates to inputs have now been added to make the module fully functional for a range of uses. This paper builds on previous work that developed an initial version of the LiST costing module to provide costs for MNCH interventions using an ingredients-based costing approach. Here, we update in 2016 the previous econometric estimates from 2013 with newly-available data and also include above-facility level costs such as program management. The updated econometric estimates inform percentages of intervention-level costs for some direct costs and indirect costs. These estimates add to existing values for direct cost requirements for items such as drugs and supplies and required provider time which were already available in LiST Costing. Results generated by the LiST costing module include costs for each intervention, as well as disaggregated costs by intervention including drug and supply costs, labor costs, other recurrent costs, capital costs, and above-service delivery costs. These results can be combined with mortality estimates to support prioritization of interventions by countries. The LiST costing module provides an option for countries to identify resource requirements for scaling up a maternal, neonatal, and child health program, and to examine the financial impact of different resource allocation strategies. It can be a useful tool for

Parametric study of potential early commercial power plants Task 3-A MHD cost analysis

NASA Technical Reports Server (NTRS)

1983-01-01

The development of costs for an MHD Power Plant and the comparison of these costs to a conventional coal fired power plant are reported. The program is divided into three activities: (1) code of accounts review; (2) MHD pulverized coal power plant cost comparison; (3) operating and maintenance cost estimates. The scope of each NASA code of account item was defined to assure that the recently completed Task 3 capital cost estimates are consistent with the code of account scope. Improvement confidence in MHD plant capital cost estimates by identifying comparability with conventional pulverized coal fired (PCF) power plant systems is undertaken. The basis for estimating the MHD plant operating and maintenance costs of electricity is verified.

Building workplace social capital: A longitudinal study of student nurses' clinical placement experiences.

PubMed

Materne, Michelle; Henderson, Amanda; Eaton, Emma

2017-09-01

Quality clinical placement experiences have been associated with nurses' workplace social capital. Social capital is broadly understood as the social organisation of trust, norms and networks that benefit society. Building social capital in the workplace may benefit experiences of staff and students. The aim of this study was to assess the impact of building workplace social capital on student nurse perceptions of clinical learning experiences. A quality improvement process was measured through repeated student surveys. First, second, third year students (n = 1176) from three universities completed a validated Student Clinical Learning Culture Survey (SCLCS) following their placement, at the commencement of quality improvement initiatives and five years later. The SCLCS measured students' perceptions of social affiliation, their motivation, satisfaction and dissatisfaction with clinical contexts. The first year of systematic changes focused on increasing student numbers along with improving communication, trust and knowledge sharing, antecedents to workplace social capital. No change was evident after the first year. Six years after commencement of building workplace social capital differences across all subscales, except dissatisfaction, were significant (p < 0.001). Leadership that promotes open communication and connections across staff and students to achieve common goals can build workplace social capital that enhances student placement experiences. Copyright © 2017 Elsevier Ltd. All rights reserved.

Capital Expert System

NASA Astrophysics Data System (ADS)

Dowell, Laurie; Gary, Jack; Illingworth, Bill; Sargent, Tom

1987-05-01

Gathering information, necessary forms, and financial calculations needed to generate a "capital investment proposal" is an extremely complex and difficult process. The intent of the capital investment proposal is to ensure management that the proposed investment has been thoroughly investigated and will have a positive impact on corporate goals. Meeting this requirement typically takes four or five experts a total of 12 hours to generate a "Capital Package." A Capital Expert System was therefore developed using "Personal Consultant." The completed system is hybrid and as such does not depend solely on rules but incorporates several different software packages that communicate through variables and functions passed from one to another. This paper describes the use of expert system techniques, methodology in building the knowledge base, contexts, LISP functions, data base, and special challenges that had to be overcome to create this system. The Capital Expert System is the successful result of a unique integration of artificial intelligence with business accounting, financial forms generation, and investment proposal expertise.

20 CFR 632.37 - Allowable costs.

Code of Federal Regulations, 2011 CFR

2011-04-01

... CFR 1-15.7. (c) Costs associated with repairs, maintenance, and capital improvements of existing... when the agreement: (1) Is for classroom training; (2) Is fixed unit price; and (3) Stipulates that...

The physician as a source of hospital capital.

PubMed

Fried, J M

1984-06-01

As hospitals search for means of financing renovation during the next decade, physicians will represent a source of capital through tax-shelter financing. Limited partnerships, condominiums , and joint ventures in acquiring medical equipment or syndicating existing facilities are among the most promising investment vehicles for taking advantage of tax benefits that normally do not apply to nonprofit institutions. In a hospital-physician limited partnership, tax deductions are passed through to the partners, of which there are two kinds: general partners and limited partners. Income (or loss) and tax credits from the entire venture can be divided among the partners and reflected on an individual limited partner's tax return. Rather than shouldering the whole cost of renovating a medical office building, thereby losing the potential tax credit, a hospital could carry out the renovation through a limited partnership with physicians. This would reduce the hospital's capital costs and debt requirements, maintain its credit, and enable it to take advantage of the depreciation deduction. In a condominium venture, the individual physician actually owns the office within which he or she works. As with the limited partnership, the hospital will want to restrict physicians' ability to dispose of their ownership interests.(ABSTRACT TRUNCATED AT 250 WORDS)

Mobile dental operations: capital budgeting and long-term viability.

PubMed

Arevalo, Oscar; Chattopadhyay, Amit; Lester, Harold; Skelton, Judy

2010-01-01

The University of Kentucky College of Dentistry (UKCD) runs a large mobile dental operation. Economic conditions dictate that as the mobile units age it will be harder to find donors willing or able to provide the financial resources for asset replacement. In order to maintain current levels of access for the underserved, consideration of replacement is paramount. A financial analysis for a new mobile unit was conducted to determine self-sustainability, return on investment (ROI), and feasibility of generating a cash reserve for its replacement in 12 years. Information on clinical income, operational and replacement costs, and capital costs was collected. A capital budgeting analysis (CBA) was conducted using the Net Present Value (NPV) methodology in four different scenarios. Depreciation funding was calculated by transferring funds from cash inflows and reinvested to offset depreciation at fixed compound interest. A positive ROI was obtained for two scenarios. He depreciation fund did not generate a cash reserve sufficient to replace the mobile unit. Mobile dental programs can play a vital role in providing access to care to underserved populations and ensuring their mission requires long-term planning. Careful financial viability and CBA based on sound assumptions are excellent decision-making tools.

Cultural capital in context: heterogeneous returns to cultural capital across schooling environments.

PubMed

Andersen, Ida Gran; Jæger, Mads Meier

2015-03-01

This paper tests two competing explanations of differences in returns to cultural capital across schooling environments: Cultural reproduction (cultural capital yields a higher returns in high-achieving environments than in low-achieving ones) and cultural mobility (cultural capital yields higher returns in low-achieving environments). Using multilevel mixture models, empirical results from analyses based on PISA data from three countries (Canada, Germany, and Sweden) show that returns to cultural capital tend to be higher in low-achieving schooling environments than in high-achieving ones. These results principally support the cultural mobility explanation and suggest that research should pay explicit attention to the institutional contexts in which cultural capital is converted into educational success. Copyright © 2014 Elsevier Inc. All rights reserved.

The impact of a prevention delivery system on perceived social capital: the PROSPER project.

PubMed

Chilenski, Sarah M; Ang, Patricia M; Greenberg, Mark T; Feinberg, Mark E; Spoth, Richard

2014-04-01

The current study examined the impact of the PROSPER delivery system for evidence-based prevention programs on multiple indicators of social capital in a rural and semi-rural community sample. Utilizing a randomized blocked design, 317 individuals in 28 communities across two states were interviewed at three time points over the course of 2.5 years. Bridging, linking, and the public life skills forms of social capital were assessed via community members' and leaders' reports on the perceptions of school functioning and the Cooperative Extension System, collaboration among organizations, communication and collaboration around youth problems, and other measures. Longitudinal mixed model results indicate significant improvements in some aspects of bridging and linking social capital in PROSPER intervention communities. Given the strength of the longitudinal and randomized research design, results advance prevention science by suggesting that community collaborative prevention initiatives can significantly impact community social capital in a rural and semi-rural sample. Future research should further investigate changes in social capital in different contexts and how changes in social capital relate to other intervention effects.

The effect of referral and transfer patients on hospital funding in a capitated health care delivery system.

PubMed

Pietz, Kenneth; Byrne, Margaret M; Daw, Christina; Petersen, Laura A

2007-10-01

(1) To investigate whether inpatients referred or transferred between facilities result in increased financial loss compared with those admitted directly, in a health care delivery system funded by capitation methods. (2) To determine whether the higher cost of those patients transferred or referred is fairly compensated by a diagnosis-based risk adjustment system, and whether tertiary care facilities bear an unfair financial burden for such patients in a capitated financing environment. The study cohort included all Veterans Affairs (VA) beneficiaries who received inpatient care during fiscal year (FY) 2004. Referral was defined as an outpatient visit to 1 facility followed by an admission to another facility. Transfers were consecutive inpatient stays at different hospitals. We defined loss as cost minus the share of budget determined by a Diagnostic Cost Group-based allocation. Both t tests and linear regression were used to compare the effect on cost and loss for patients transferred or not and referred or not. Mean loss to a facility for patients transferred in was 1231 dollars more than for those not transferred. Mean loss for referred patients was 3341 dollars more than for those not referred, controlling for disease burden. For tertiary hospitals, the difference in losses for transfer patients was less than for other hospitals but greater for referral patients. Patients referred or transferred from other facilities are more costly than those who are not. The difference may not be compensated by a diagnosis-based allocation system. A capitated health care system may consider additional funding to cover the cost of such patients.

48 CFR 1602.170-5 - Cost or pricing data.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Cost or pricing data. 1602... Terms 1602.170-5 Cost or pricing data. (a) Experience-rated carriers. Cost or pricing data for... payments made to providers of medical services for the provision of healthcare, such as capitation not...

48 CFR 1602.170-5 - Cost or pricing data.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Cost or pricing data. 1602... Terms 1602.170-5 Cost or pricing data. (a) Experience-rated carriers. Cost or pricing data for... payments made to providers of medical services for the provision of healthcare, such as capitation not...

48 CFR 1602.170-5 - Cost or pricing data.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Cost or pricing data. 1602... Terms 1602.170-5 Cost or pricing data. (a) Experience-rated carriers. Cost or pricing data for... payments made to providers of medical services for the provision of healthcare, such as capitation not...

48 CFR 1602.170-5 - Cost or pricing data.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Cost or pricing data. 1602... Terms 1602.170-5 Cost or pricing data. (a) Experience-rated carriers. Cost or pricing data for... payments made to providers of medical services for the provision of healthcare, such as capitation not...

Investment opportunity : the FPL low-cost solar dry kiln

Treesearch

George B. Harpole

1988-01-01

Two equations are presented that may be used to estimate a maximum investment limit and working capital requirements for the FPL low-cost solar dry kiln systems. The equations require data for drying cycle time, green lumber cost, and kiln-dried lumber costs. Results are intended to provide a preliminary estimate.

[Voluntary abortion cost in France and prospective payment system: to raise the issue of so many misstatements].

PubMed

Betala Belinga, J-F; Valence, A; Zaccabri, A; Fresson, J

2010-11-01

Despite the implementation of prospective payment approach in France, induced legal abortion are still paid by capitation. Our aim was to evaluate the real cost of induced abortion in a public hospital in France. This study took place during the year 2008 in a public health hospital. Induced abortion cost was calculated according to national study cost's recommendations. The cost drawn from this was compared to what is paid by the medical insurance for spontaneous abortion. Induced abortion calculated cost was 562 €, the capitation amount was 286.86 €, the spontaneous abortion compensation amount was 645 €. Induced abortion should be paid by a prospective payment evaluation similar to diagnosis related groups approaches rather than a capitation payment, in order to reduce misstatements. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Neighborhood differences in social capital in Ghent (Belgium): a multilevel approach

PubMed Central

2013-01-01

Background Little research has focused on the spatial distribution of social capital, despite social capital’s rising popularity in health research and policy. This study examines the neighborhood differences in social capital and the determinants that explain these differences. Methods Five components of neighborhood social capital are identified by means of factor and reliability analyses using data collected in the cross-sectional SWING study from 762 inhabitants in 42 neighbourhoods in the city of Ghent (Belgium). Neighborhood differences in social capital are explored using hierarchical linear models with cross-level interactions. Results Significant neighborhood differences are found for social cohesion, informal social control and social support, but not for social leverage and generalized trust. Our findings suggest that neighborhood social capital depends on both characteristics of individuals living in the neighborhood (attachment to neighborhood) and characteristics of the neighborhood itself (deprivation and residential turnover). Our analysis further shows that neighborhood deprivation reinforces the negative effect of declining neighborhood attachment on social cohesion and informal social control. Conclusions This study foregrounds the importance of contextual effects in encouraging neighborhood social capital. Given the importance of neighborhood-level characteristics, it can be anticipated social capital promoting initiatives are likely to be more effective when tailored to specific areas. Second, our analyses show that not all forms of social capital are influenced by contextual factors to the same extent, implying that changes in neighborhood characteristics are conducive to, say, trust while leaving social support unaffected. Finally, our analysis has demonstrated that complex interrelationships between individual- and neighborhood–level variables exist, which are often overlooked in current work. PMID:24225005

An Assessment of Capital Budgeting Practices for Public Higher Education

ERIC Educational Resources Information Center

Manns, Derrick

2004-01-01

The capital renewal and replacement of the nation's public higher education facilities has been a growing problem for several decades. While the need for new and improved facilities has increased over the years, many campuses simply have too many aging infrastructures that are too costly to replace. This, at a time when we have less than …

Health Care Utilization and Costs After Initiating Budesonide/Formoterol Combination or Fluticasone/Salmeterol Combination Among COPD Patients New to ICS/LABA Treatment.

PubMed

Davis, Jill R; Kern, David M; Williams, Setareh A; Tunceli, Ozgur; Wu, Bingcao; Hollis, Sally; Strange, Charlie; Trudo, Frank

2016-03-01

Chronic obstructive pulmonary disease (COPD) affects approximately 15 million people in the United States and accounts for approximately $36 billion in economic burden, primarily due to medical costs. To address the increasing clinical and economic burden, the Global Initiative for Chronic Obstructive Lung Disease emphasizes the use of therapies that help prevent COPD exacerbations, including inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA). To evaluate health care costs and utilization among COPD patients newly initiating ICS/LABA combination therapy with budesonide/formoterol (BFC) or fluticasone/salmeterol (FSC) in a managed care system. COPD patients aged 40 years and older who initiated BFC (160/4.5 μg) or FSC (250/50 μg) treatment between March 1, 2009, and March 31, 2012, were identified using claims data from major U.S. health plans. BFC and FSC patients were propensity score matched (1:1) on age, sex, prior asthma diagnosis, prior COPD-related health care utilization, and respiratory medication use. COPD-related, pneumonia-related, and all-cause costs and utilization were analyzed during the 12-month follow-up period. Post-index costs were assessed with generalized linear models (GLMs) with gamma distribution. Health care utilization data were analyzed via logistic regression (any event vs. none) and GLMs with negative binomial distribution (number of visits) and were adjusted for the analogous pre-index variable as well as pre-index characteristics that remained imbalanced after matching. After matching, each cohort had 3,697 patients balanced on age (mean 64 years), sex (female 52% BFC and 54% FSC), asthma and other comorbid conditions, prior COPD-related health care utilization, and respiratory medication use. During the 12-month follow-up, COPD-related costs averaged $316 less for BFC versus FSC patients ($4,326 vs. $4,846; P = 0.003), reflecting lower inpatient ($966 vs. $1,202; P < 0.001), pharmacy ($1,482 vs. $1,609; P = 0.002), and

Observation Versus Initial Treatment for Men With Localized, Low-Risk Prostate Cancer A Cost-Effectiveness Analysis

PubMed Central

Hayes, Julia H.; Ollendorf, Daniel A.; Pearson, Steven D.; Barry, Michael J.; Kantoff, Philip W.; Lee, Pablo A.; McMahon, Pamela M.

2015-01-01

Background Observation is underused among men with localized, low-risk prostate cancer. Objective To assess the costs and benefits of observation versus initial treatment. Design Decision analysis simulating treatment or observation. Data Sources Medicare schedules, published literature. Target Population Men ages 65 and 75 years with newly diagnosed low-risk prostate cancer (prostate-specific antigen level <10 μg/L, stage ≤T2a, Gleason score ≤3+3). Time Horizon Lifetime. Perspective Societal. Intervention Treatment (brachytherapy, intensity-modulated radiation therapy, or radical prostatectomy) or observation (active surveillance [AS] or watchful waiting [WW]). Outcome Measures Quality-adjusted life expectancy, costs. Results of Base-Case Analysis Observation was more effective and less costly than initial treatment. Compared with AS, WW provided 2 additional months of quality-adjusted life expectancy (9.02 vs. 8.85 years) at a savings of $15 374 ($24 520 vs. $39 894) in men aged 65 years and 2 additional months (6.14 vs. 5.98 years) at a savings of $11 746 ($18 302 vs. $30 048) in men aged 75 years. Brachytherapy was the most effective and least expensive initial treatment. Results of Sensitivity Analysis Treatment became more effective than observation when it led to more dramatic reductions in prostate cancer death (hazard ratio, 0.47 vs. WW and 0.64 vs. AS). Active surveillance became as effective as WW in men aged 65 years when the probability of progressing to treatment on AS decreased below 63% or when the quality of life with AS versus WW was 4% higher in men aged 65 years or 1% higher in men aged 75 years. Watchful waiting remained least expensive in all analyses. Limitation Results depend on outcomes reported in the published literature, which is limited. Conclusion Among these men, observation is more effective and costs less than initial treatment, and WW is most effective and least expensive under a wide range of clinical scenarios. Primary

Initial investigation into lower-cost CT for resource limited regions of the world

NASA Astrophysics Data System (ADS)

Dobbins, James T., III; Wells, Jered R.; Segars, W. Paul; Li, Christina M.; Kigongo, Christopher J. N.

2010-04-01

This paper describes an initial investigation into means for producing lower-cost CT scanners for resource limited regions of the world. In regions such as sub-Saharan Africa, intermediate level medical facilities serving millions have no CT machines, and lack the imaging resources necessary to determine whether certain patients would benefit from being transferred to a hospital in a larger city for further diagnostic workup or treatment. Low-cost CT scanners would potentially be of immense help to the healthcare system in such regions. Such scanners would not produce state-of-theart image quality, but rather would be intended primarily for triaging purposes to determine the patients who would benefit from transfer to larger hospitals. The lower-cost scanner investigated here consists of a fixed digital radiography system and a rotating patient stage. This paper describes initial experiments to determine if such a configuration is feasible. Experiments were conducted using (1) x-ray image acquisition, a physical anthropomorphic chest phantom, and a flat-panel detector system, and (2) a computer-simulated XCAT chest phantom. Both the physical phantom and simulated phantom produced excellent image quality reconstructions when the phantom was perfectly aligned during acquisition, but artifacts were noted when the phantom was displaced to simulate patient motion. An algorithm was developed to correct for motion of the phantom and demonstrated success in correcting for 5-mm motion during 360-degree acquisition of images. These experiments demonstrated feasibility for this approach, but additional work is required to determine the exact limitations produced by patient motion.

Facilities Capital as a Factor in Contract Pricing,

DTIC Science & Technology

1985-05-01

resulting from new investment. Investments must provide contractors with a rate of return competitive with what they can earn on investments elsewhere...DoD’s profit objective rate (profit objective as a percentage of cost objective) is determined by the level of facilities capital employed, the mix of...business base were analyzed. These sources serve as independent checks on each other and present a consistent picture of what has occurred. In each

Keep it simple? Predicting primary health care costs with clinical morbidity measures

PubMed Central

Brilleman, Samuel L.; Gravelle, Hugh; Hollinghurst, Sandra; Purdy, Sarah; Salisbury, Chris; Windmeijer, Frank

2014-01-01

Models of the determinants of individuals’ primary care costs can be used to set capitation payments to providers and to test for horizontal equity. We compare the ability of eight measures of patient morbidity and multimorbidity to predict future primary care costs and examine capitation payments based on them. The measures were derived from four morbidity descriptive systems: 17 chronic diseases in the Quality and Outcomes Framework (QOF); 17 chronic diseases in the Charlson scheme; 114 Expanded Diagnosis Clusters (EDCs); and 68 Adjusted Clinical Groups (ACGs). These were applied to patient records of 86,100 individuals in 174 English practices. For a given disease description system, counts of diseases and sets of disease dummy variables had similar explanatory power. The EDC measures performed best followed by the QOF and ACG measures. The Charlson measures had the worst performance but still improved markedly on models containing only age, gender, deprivation and practice effects. Comparisons of predictive power for different morbidity measures were similar for linear and exponential models, but the relative predictive power of the models varied with the morbidity measure. Capitation payments for an individual patient vary considerably with the different morbidity measures included in the cost model. Even for the best fitting model large differences between expected cost and capitation for some types of patient suggest incentives for patient selection. Models with any of the morbidity measures show higher cost for more deprived patients but the positive effect of deprivation on cost was smaller in better fitting models. PMID:24657375

Total Health-Related Costs Due to Absenteeism, Presenteeism, and Medical and Pharmaceutical Expenses in Japanese Employers

PubMed Central

Nagata, Tomohisa; Mori, Koji; Ohtani, Makoto; Nagata, Masako; Kajiki, Shigeyuki; Fujino, Yoshihisa; Matsuda, Shinya; Loeppke, Ronald

2018-01-01

Objective: This study aimed to examine a detailed breakdown of costs (absenteeism, presenteeism, and medical/pharmaceutical expenses), of the employees in four pharmaceutical companies in Japan. Methods: This is a cross-sectional study. Absenteeism and presenteeism were measured by a self-administered questionnaire for workers, and their costs were estimated using the human capital approach. Presenteeism was evaluated by the degree affected quality and quantity of work. Medical and pharmaceutical expenses were obtained by insurance claims. Results: The monetary value due to absenteeism was $520 per person per year (11%), that of presenteeism was $3055 (64%), and medical/pharmaceutical expenses were $1165 (25%). Two of the highest total cost burdens from chronic illness were related to mental (behavioral) health conditions and musculoskeletal disorders. Conclusion: A total cost approach can help employers set priorities for occupational health, safety, and population health management initiatives. PMID:29394196

Transforming individual civic engagement into community collective efficacy: the role of bonding social capital.

PubMed

Collins, Charles R; Neal, Jennifer Watling; Neal, Zachary P

2014-12-01

Collective efficacy is defined as residents' perceived collective capacity to take coordinated and interdependent action on issues that affect their lives. This study explored factors associated with neighborhood collective efficacy among residents. Utilizing a national sample of 4,120 urban households provided by Annie E. Casey Foundation's Making Connection Initiative, we investigated the mediating role of residents' perceptions of bonding social capital (i.e. reciprocity, trust, and shared norms) in the association between civic engagement and collective efficacy. Multiple regression analyses revealed that civic engagement and bonding social capital were both directly related to collective efficacy. Additionally, bonding social capital partially mediated the relationship between civic engagement and collective efficacy. Specifically, residents who reported greater levels of civic engagement also reported higher levels of bonding social capital. In turn, residents who reported higher levels of bonding social capital also reported higher levels of neighborhood collective efficacy. We discuss implications of these findings for researchers and practitioners interested in associations of neighborhood collective efficacy.

Models of Disease Vector Control: When Can Aggressive Initial Intervention Lower Long-Term Cost?

PubMed

Oduro, Bismark; Grijalva, Mario J; Just, Winfried

2018-04-01

Insecticide spraying of housing units is an important control measure for vector-borne infections such as Chagas disease. As vectors may invade both from other infested houses and sylvatic areas and as the effectiveness of insecticide wears off over time, the dynamics of (re)infestations can be approximated by [Formula: see text]-type models with a reservoir, where housing units are treated as hosts, and insecticide spraying corresponds to removal of hosts. Here, we investigate three ODE-based models of this type. We describe a dual-rate effect where an initially very high spraying rate can push the system into a region of the state space with low endemic levels of infestation that can be maintained in the long run at relatively moderate cost, while in the absence of an aggressive initial intervention the same average cost would only allow a much less significant reduction in long-term infestation levels. We determine some sufficient and some necessary conditions under which this effect occurs and show that it is robust in models that incorporate some heterogeneity in the relevant properties of housing units.

Bus Lifecycle Cost Model for Federal Land Management Agencies.

DOT National Transportation Integrated Search

2011-09-30

The Bus Lifecycle Cost Model is a spreadsheet-based planning tool that estimates capital, operating, and maintenance costs for various bus types over the full lifecycle of the vehicle. The model is based on a number of operating characteristics, incl...

Measuring Social Capital Investment: Scale Development and Examination of Links to Social Capital and Perceived Stress

PubMed Central

Wegner, Rhiana; Gong, Jie; Fang, Xiaoyi; Kaljee, Linda

2014-01-01

Individuals with greater social capital have better health outcomes. Investment in social capital likely increases one’s own social capital, bearing great implications for disease prevention and health promotion. In this study, the authors developed and validated the Social Capital Investment Inventory (SCII). Direct effects of social capital investment on perceived stress, and indirect effects through social capital were examined. 397 Participants from Beijing and Wuhan, China completed surveys. Analyses demonstrated that the SCII has a single factor structure and strong internal consistency. Structural equation modeling showed that individuals who invested more in social capital had greater bonding social capital, and subsequently less perceived stress. Results suggest that disease prevention and health promotion programs should consider approaches to encourage social capital investment; individuals may be able to reduce stress by increasing their investment in social capital. Future research is needed to provide additional empirical support for the SCII and observed structural relationships. PMID:25648725

A simulation model to estimate the cost and effectiveness of alternative dialysis initiation strategies.

PubMed

Lee, Chris P; Chertow, Glenn M; Zenios, Stefanos A

2006-01-01

Patients with end-stage renal disease (ESRD) require dialysis to maintain survival. The optimal timing of dialysis initiation in terms of cost-effectiveness has not been established. We developed a simulation model of individuals progressing towards ESRD and requiring dialysis. It can be used to analyze dialysis strategies and scenarios. It was embedded in an optimization frame worked to derive improved strategies. Actual (historical) and simulated survival curves and hospitalization rates were virtually indistinguishable. The model overestimated transplantation costs (10%) but it was related to confounding by Medicare coverage. To assess the model's robustness, we examined several dialysis strategies while input parameters were perturbed. Under all 38 scenarios, relative rankings remained unchanged. An improved policy for a hypothetical patient was derived using an optimization algorithm. The model produces reliable results and is robust. It enables the cost-effectiveness analysis of dialysis strategies.

Nuclear Power Plant Module, NPP-1: Nuclear Power Cost Analysis.

ERIC Educational Resources Information Center

Whitelaw, Robert L.

The purpose of the Nuclear Power Plant Modules, NPP-1, is to determine the total cost of electricity from a nuclear power plant in terms of all the components contributing to cost. The plan of analysis is in five parts: (1) general formulation of the cost equation; (2) capital cost and fixed charges thereon; (3) operational cost for labor,…

18 CFR 367.1011 - Account 101.1, Property under capital leases.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Account 101.1, Property under capital leases. 367.1011 Section 367.1011 Conservation of Power and Water Resources FEDERAL ENERGY... date, (4) Original cost or fair market value of property leased, (5) Future minimum lease payments, (6...

Two-Year Costs and Quality in the Comprehensive Primary Care Initiative.

PubMed

Dale, Stacy B; Ghosh, Arkadipta; Peikes, Deborah N; Day, Timothy J; Yoon, Frank B; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Conway, Patrick H; Rajkumar, Rahul; Press, Matthew J; Sessums, Laura; Brown, Randall

2016-06-16

The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. The practices reported improvements in approaches to the delivery of primary care in areas such as management of the care of high-risk patients and enhanced access to care. Changes in average monthly Medicare expenditures per beneficiary did not differ significantly between initiative and comparison practices when care-management fees were not taken into account (-$11; 95% confidence interval [CI], -$23 to $1; P=0.07; negative values indicate less growth in spending at initiative practices) or when these fees were taken into account ($7; 95% CI, -$5 to $19; P=0.27). The only significant differences in other measures were a 3% reduction in primary care visits for initiative practices relative to comparison practices (P<0.001) and changes in two of the six domains of patient experience--discussion of decisions regarding medication with patients and the provision of support for patients taking care of their own health--both of which showed a small improvement in initiative practices

Cost-price: a useful way to evaluate timber growing alternatives.

Treesearch

Allen L. Lundgren

1973-01-01

This paper explains how to calculate and use cost-price as an investment criterion for timber and other forest products. Cost-price is the cost (including a return on invested capital) of producing a unit of output, usually expressed as dollars per cubic foot or other unit of output.

The Effects of the Capital Accumulation Ratio on Wealth

ERIC Educational Resources Information Center

Harness, Nathaniel J.; Finke, Michael S.; Chatterjee, Swarn

2009-01-01

The capital accumulation ratio (CAR) is commonly used in academic research as a measure of household portfolio quality. This study tested whether a higher initial CAR impacts change in wealth over a decade among households in the accumulation life cycle stage. Meeting the 25% CAR guideline resulted in a 28.1% increase in net worth between 1994 and…

Perceptions of community, social capital, and how they affect self-reported health: a multilevel analysis.

PubMed

Dziadkowiec, O; Meissen, G J; Merkle, E C

2017-11-01

The link between social capital and self-reported health has been widely explored. On the other hand, we know less about the relationship between social capital, community socioeconomic characteristics, and non-social capital-related individual differences, and about their impact on self-reported health in community settings. Cross-sectional study design with a proportional sample of 7965 individuals from 20 US communities were analyzed using multilevel linear regression models, where individuals were nested within communities. The response rates ranged from 13.5% to 25.4%. Findings suggest that perceptions of the community and individual level socioeconomic characteristics were stronger predictors of self-reported health than were social capital or community socioeconomic characteristics. Policy initiatives aimed at increasing social capital should first assess community member's perceptions of their communities to uncover potential assets to help increase social capital. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

48 CFR 1830.7002-2 - Cost of money calculations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Cost of money calculations. 1830.7002-2 Section 1830.7002-2 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE ADMINISTRATION GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION Facilities Capital...

Global rural electrification - A different race initiative

NASA Astrophysics Data System (ADS)

Leonard, Raymond S.

1991-10-01

The paper considers global rural electrification based on electric power from power stations, built in geosynchronous orbit out of lunar materials. These materials are distributed to individual villages and rural electric cooperatives via microwaves for a cost of about 6-45 cents per kilowatt-hour. Power would be available in modular increments of 25-100 kilowatts with an average capital cost as low as $5000 per kilowatt. The global rural electrification program is aimed at providing electric power from space at competitive costs, relative to current costs, to rural and agricultural areas and diverting resources from weapons development to infrastructure development.

High cost sharing and specialty drug initiation under Medicare Part D: a case study in patients with newly diagnosed chronic myeloid leukemia.

PubMed

Doshi, Jalpa A; Li, Pengxiang; Huo, Hairong; Pettit, Amy R; Kumar, Rishab; Weiss, Brenda M; Huntington, Scott F

2016-03-01

Specialty drugs often offer medical advances but are frequently subject to high cost sharing. This is particularly true with Medicare Part D, where after meeting a deductible, patients without low-income subsidies (non-LIS) typically face 25% to 33% coinsurance (initial coverage phase with "specialty tier" cost sharing), followed by ~50% coinsurance (coverage gap phase), and then 5% coinsurance (catastrophic phase). Yet, no studies have examined the impact of such high cost sharing on specialty drug initiation under Part D. Oral tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML), making it an apt case study. A retrospective claims-based analysis utilizing 2011 to 2013 100% Medicare claims. TKI initiation rates and time to initiation were compared between fee-for-service non-LIS Part D patients newly diagnosed with CML and their LIS counterparts who faced nominal cost sharing of ≤ $5. The first 30-day TKI fill "straddled" benefit phases, for a mean out-of-pocket cost of $2600 or more for non-LIS patients. Non-LIS patients were less likely than LIS patients to have a TKI claim within 6 months of diagnosis (45.3% vs 66.9%; P < .001) and those initiating a TKI took twice as long to fill it (mean = 50.9 vs 23.7 days; P < .001). Cox regressions controlling for sociodemographic, clinical, and plan characteristics confirmed descriptive findings (hazard ratio, 0.59; 95% CI, 0.45-0.76). Extensive sensitivity analyses confirmed the robustness of our findings. High cost sharing was associated with reduced and/or delayed initiation of TKIs. We discuss policy strategies to reduce current financial barriers that adversely impact access to critical therapies under Medicare Part D.

77 FR 52791 - Regulatory Capital Rules: Regulatory Capital, Implementation of Basel III, Minimum Regulatory...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-30

...The Office of the Comptroller of the Currency (OCC), Board of Governors of the Federal Reserve System (Board), and the Federal Deposit Insurance Corporation (FDIC) (collectively, the agencies) are seeking comment on three Notices of Proposed Rulemaking (NPR) that would revise and replace the agencies' current capital rules. In this NPR, the agencies are proposing to revise their risk-based and leverage capital requirements consistent with agreements reached by the Basel Committee on Banking Supervision (BCBS) in ``Basel III: A Global Regulatory Framework for More Resilient Banks and Banking Systems'' (Basel III). The proposed revisions would include implementation of a new common equity tier 1 minimum capital requirement, a higher minimum tier 1 capital requirement, and, for banking organizations subject to the advanced approaches capital rules, a supplementary leverage ratio that incorporates a broader set of exposures in the denominator measure. Additionally, consistent with Basel III, the agencies are proposing to apply limits on a banking organization's capital distributions and certain discretionary bonus payments if the banking organization does not hold a specified amount of common equity tier 1 capital in addition to the amount necessary to meet its minimum risk- based capital requirements. This NPR also would establish more conservative standards for including an instrument in regulatory capital. As discussed in the proposal, the revisions set forth in this NPR are consistent with section 171 of the Dodd-Frank Wall Street Reform and Consumer Protection Act (Dodd-Frank Act), which requires the agencies to establish minimum risk-based and leverage capital requirements. In connection with the proposed changes to the agencies' capital rules in this NPR, the agencies are also seeking comment on the two related NPRs published elsewhere in today's Federal Register. The two related NPRs are discussed further in the SUPPLEMENTARY INFORMATION.

Psychological Capital, Career Identity and Graduate Employability in Uganda: The Mediating Role of Social Capital

ERIC Educational Resources Information Center

Ngoma, Muhammad; Dithan Ntale, Peter

2016-01-01

This paper seeks to evaluate the relationship between psychological capital, career identity, social capital and graduate employability. We also seek to evaluate the mediating role of social capital on the relationships between psychological capital, career identity and graduate employability in Uganda. A population of 480 unemployed young people…

A Low-Cost, Passive Approach for Bacterial Growth and Distribution for Large-Scale Implementation of Bioaugmentation

DTIC Science & Technology

2012-07-01

technologies with significant capital costs, secondary waste streams, the involvement of hazardous materials, and the potential for additional worker...or environmental exposure. A more ideal technology would involve lower capital costs, would not generate secondary waste streams, would be...of bioaugmentation technology in general include low risk to human health and the environment during implementation, low secondary waste generation

Overview of Medicaid capitation and case-management initiatives

PubMed Central

Freund, Deborah A.; Neuschler, Edward

1986-01-01

Case-management programs have grown in number and in acceptance in the Medicaid program since 1981. In this article, we review their structure and incentives as well as what is known about their impact on cost and use. These programs also have been difficult to implement, posing myriad management challenges for prepaid program managers and State administrators. We highlight the problems in the following areas: eligibility, enrollment, rate setting, and management information systems. PMID:10311923

Dancing on the Bottom Line: An Unruly Cost-Benefit Analysis of Three Academic Development Initiatives

ERIC Educational Resources Information Center

Sword, Helen

2014-01-01

This article offers an unconventional cost-benefit analysis of three academic development initiatives at a large Australasian university: a three-day foundation course for new academics, a series of one-on-one teaching consultations and a two-year postgraduate certificate program. Weaving together qualitative, quantitative and arts-based…

Management Costs of DoD Military Construction Projects.

DTIC Science & Technology

1983-04-01

by 13 percent to include full costs of civilian retirement and other benefits which are only partially included in organizational budget and...capitalization of costs of owned facilities and equipment as well as the total costs paid for personnel benefits (including all payments to...of these is civilian personnel benefits , the cost of which is 20.4 percent of base pay for retirement and 5.6 for insurance and other items, for a

Cost-benefit analysis of screening for esophageal and gastric cardiac cancer.

PubMed

Wei, Wen-Qiang; Yang, Chun-Xia; Lu, Si-Han; Yang, Juan; Li, Bian-Yun; Lian, Shi-Yong; Qiao, You-Lin

2011-03-01

In 2005, a program named "Early Detection and Early Treatment of Esophageal and Cardiac Cancer" (EDETEC) was initiated in China. A total of 8279 residents aged 40-69 years old were recruited into the EDETEC program in Linzhou of Henan Province between 2005 and 2008. Howerer, the cost-benefit of the EDETEC program is not very clear yet. We conducted herein a cost-benefit analysis of screening for esophageal and cardiac cancer. The assessed costs of the EDETEC program included screening costs for each subject, as well as direct and indirect treatment costs for esophageal and cardiac severe dysplasia and cancer detected by screening. The assessed benefits of this program included the saved treatment costs, both direct and indirect, on esophageal and cardiac cancer, as well as the value of prolonged life due to screening, as determined by the human capital approach. The results showed the screening cost of finding esophageal and cardiac severe dysplasia or cancer ranged from RMB 2707 to RMB 4512, and the total cost on screening and treatment was RMB 13 115-14 920. The cost benefit was RMB 58 944-155 110 (the saved treatment cost, RMB 17 730, plus the value of prolonged life, RMB 41 214-137 380). The ratio of benefit-to-cost (BCR) was 3.95-11.83. Our results suggest that EDETEC has a high benefit-to-cost ratio in China and could be instituted into high risk areas of China.

Social Cost of Substance Abuse in Russia.

PubMed

Potapchik, Elena; Popovich, Larisa

2014-09-01

To summarize results of studies that estimate the social costs of alcohol, tobacco, and illicit drug abuse in Russia. The purpose of these studies was to inform policymakers about the real economic burden of risky behaviors and to provide conditions for evidence-based and well-informed decision making in this area. The cost-of-illness method was applied to estimate the social cost of substance abuse. The intangible cost was not included in estimation. A prevalence-based approach was applied to estimate the tangible cost. For the estimation of direct costs, a top-down method was used. Indirect costs were estimated using two methods: the human capital and the friction cost. In 2008, the social cost of substance abuse in Russia comprised 677.2 billion rubles if the friction cost method is applied and 1965.9 billion rubles if the human capital method is used. The social cost of substance abuse is defined to the greatest extent by alcohol consumption, comprising about 45% of the economic burden. Illicit drug use comprises about 30% of the economic burden and tobacco consumption 25%. The results of economic studies demonstrated that psychoactive substances impose a considerable economic burden on society. Analysis of the substance abuse social cost pattern shows that the main losses that society bears because of these behavioral risk factors fall outside the health care system and lay in other sectors of the economy such as social care, law enforcement, and productivity losses. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

"Capitalizing on Sport": Sport, Physical Education and Multiple Capitals in Scottish Independent Schools

ERIC Educational Resources Information Center

Horne, John; Lingard, Bob; Weiner, Gaby; Forbes, Joan

2011-01-01

This paper draws on a research study into the existence and use of different forms of capital--including social, cultural and physical capital--in three independent schools in Scotland. We were interested in understanding how these forms of capital work to produce and reproduce "advantage" and "privilege". Analysis is framed by…

26 CFR 1.263A-1 - Uniform capitalization of costs.

Code of Federal Regulations, 2010 CFR

2010-04-01

... these terms and conditions, the principles of § 1.263A-7 must be applied in revaluing inventory property... tax principles. In determining whether a taxpayer is a bona-fide service provider under this paragraph... costs are marketing, selling, advertising, and distribution costs. (B) Research and experimental...

A comparative cost analysis of robot-assisted versus traditional laparoscopic partial nephrectomy.

PubMed

Hyams, Elias; Pierorazio, Philip; Mullins, Jeffrey K; Ward, Maryann; Allaf, Mohamad

2012-07-01

Robot-assisted laparoscopic partial nephrectomy (RALPN) is supplanting traditional laparoscopic partial nephrectomy (LPN) as the technique of choice for minimally invasive nephron-sparing surgery. This evolution has resulted from potential clinical benefits, as well as proliferation of robotic systems and patient demand for robot-assisted surgery. We sought to quantify the costs associated with the use of robotics for minimally invasive partial nephrectomy. A cost analysis was performed for 20 consecutive robot-assisted partial nephrectomy (RPN) and LPN patients at our institution from 2009 to 2010. Data included actual perioperative and hospitalization costs as well as professional fees. Capital costs were estimated using purchase costs and amortization of two robotic systems from 2001 to 2009, as well as maintenance contract costs. The estimated cost/case was obtained using total robotic surgical volume during this period. Total estimated costs were compared between groups. A separate analysis was performed assuming "ideal" robotic utilization during a comparable period. RALPN had a cost premium of +$1066/case compared with LPN, assuming actual robot utilization from 2001 to 2009. Assuming "ideal" utilization during a comparable period, this premium decreased to +$334; capital costs per case decreased from $1907 to $1175. Tumor size, operative time, and length of stay were comparable between groups. RALPN is associated with a small to moderate cost premium depending on assumptions regarding robotic surgical volume. Saturated utilization of robotic systems decreases attributable capital costs and makes comparison with laparoscopy more favorable. Purported clinical benefits of RPN (eg, decreased warm ischemia time, increased utilization of nephron-sparing surgery) need further study, because these may have cost implications.