Recent trends in workload, input costs, and expenditures in the Air Force Medical Service Direct Care System.

PubMed

Robbins, Anthony S; Moilanen, Dale A; Fonseca, Vincent P; Chao, Susan Y

2002-04-01

A study was conducted to examine the relationship between two types of trends in the Air Force Medical Service Direct Care System (AFMS/DCS): trends in expenditures, total and by categories; and trends in medical workload, defined as the sum of inpatient admissions and outpatient clinic visits. Expenditure and medical workload data were extracted from the Medical Expense and Performance Reporting System Executive Query System. Medical inflation data were obtained from the Bureau of Labor Statistics Producer Price Index series. Between fiscal years 1995 and 1999, the AFMS/DCS experienced a 21.2% decrease in medical workload, but total (nominal) expenditures declined only 3.6%. Of all expenditure categories, only inpatient medical care, outpatient medical care, and military-funded private sector care for active duty personnel (supplemental care) have any direct relationship with AFMS/DCS medical workload. Real expenditures for the three categories above decreased by 20.3% during the 5-year period. Accounting for inflation and considering only expenditures related to medical workload, these results suggest that the AFMS/DCS is spending approximately 20% less money to do approximately 20% less work.

Out-of-pocket expenditures for pharmaceuticals: lessons from the Austrian household budget survey.

PubMed

Sanwald, Alice; Theurl, Engelbert

2017-05-01

Paying pharmaceuticals out of pocket is an important source of financing pharmaceutical consumption. Only limited empirical knowledge is available on the determinants of these expenditures. In this article we analyze which characteristics of private households influence out-of-pocket pharmaceutical expenditure (OOPPE) in Austria. We use cross-sectional information on OOPPE and household characteristics provided by the Austrian household budget survey 2009/10. We split pharmaceutical expenditures into the two components prescription fees and over-the-counter (OTC) expenditures. To adjust for the specific characteristics of the data, we compare different econometric approaches: a two-part model, hurdle model, generalized linear model and zero-inflated negative binomial regression model. The finally selected econometric approaches give a quite consistent picture. The probability of expenditures of both types is strongly influenced by the household structure. It increases with age, doctoral visits and the presence of a female householder. The education level and income only increase the probability of OTC pharmaceuticals. The level of OTC expenditures remains widely unexplained while the household structure and age influence the expenditures for prescription fees. Insurance characteristics of private households, either private or public, play a minor role in explaining the expenditure levels in all specifications. This refers to a homogeneous and comprehensive provision of pharmaceuticals in the public part of the Austrian health care system. The article gives useful insights into the determinants of pharmaceutical expenditures of private households and supplements the previous research that focuses on the individual level.

A pocket-sized metabolic analyzer for assessment of resting energy expenditure.

PubMed

Zhao, Di; Xian, Xiaojun; Terrera, Mirna; Krishnan, Ranganath; Miller, Dylan; Bridgeman, Devon; Tao, Kevin; Zhang, Lihua; Tsow, Francis; Forzani, Erica S; Tao, Nongjian

2014-04-01

The assessment of metabolic parameters related to energy expenditure has a proven value for weight management; however these measurements remain too difficult and costly for monitoring individuals at home. The objective of this study is to evaluate the accuracy of a new pocket-sized metabolic analyzer device for assessing energy expenditure at rest (REE) and during sedentary activities (EE). The new device performs indirect calorimetry by measuring an individual's oxygen consumption (VO2) and carbon dioxide production (VCO2) rates, which allows the determination of resting- and sedentary activity-related energy expenditure. VO2 and VCO2 values of 17 volunteer adult subjects were measured during resting and sedentary activities in order to compare the metabolic analyzer with the Douglas bag method. The Douglas bag method is considered the Gold Standard method for indirect calorimetry. Metabolic parameters of VO2, VCO2, and energy expenditure were compared using linear regression analysis, paired t-tests, and Bland-Altman plots. Linear regression analysis of measured VO2 and VCO2 values, as well as calculated energy expenditure assessed with the new analyzer and Douglas bag method, had the following linear regression parameters (linear regression slope LRS0, and R-squared coefficient, r(2)) with p = 0: LRS0 (SD) = 1.00 (0.01), r(2) = 0.9933 for VO2; LRS0 (SD) = 1.00 (0.01), r(2) = 0.9929 for VCO2; and LRS0 (SD) = 1.00 (0.01), r(2) = 0.9942 for energy expenditure. In addition, results from paired t-tests did not show statistical significant difference between the methods with a significance level of α = 0.05 for VO2, VCO2, REE, and EE. Furthermore, the Bland-Altman plot for REE showed good agreement between methods with 100% of the results within ±2SD, which was equivalent to ≤10% error. The findings demonstrate that the new pocket-sized metabolic analyzer device is accurate for determining VO2, VCO2, and energy expenditure. Copyright © 2013 Elsevier Ltd and

Estimating the price elasticity of expenditure for prescription drugs in the presence of non-linear price schedules: an illustration from Quebec, Canada.

PubMed

Contoyannis, Paul; Hurley, Jeremiah; Grootendorst, Paul; Jeon, Sung-Hee; Tamblyn, Robyn

2005-09-01

The price elasticity of demand for prescription drugs is a crucial parameter of interest in designing pharmaceutical benefit plans. Estimating the elasticity using micro-data, however, is challenging because insurance coverage that includes deductibles, co-insurance provisions and maximum expenditure limits create a non-linear price schedule, making price endogenous (a function of drug consumption). In this paper we exploit an exogenous change in cost-sharing within the Quebec (Canada) public Pharmacare program to estimate the price elasticity of expenditure for drugs using IV methods. This approach corrects for the endogeneity of price and incorporates the concept of a 'rational' consumer who factors into consumption decisions the price they expect to face at the margin given their expected needs. The IV method is adapted from an approach developed in the public finance literature used to estimate income responses to changes in tax schedules. The instrument is based on the price an individual would face under the new cost-sharing policy if their consumption remained at the pre-policy level. Our preferred specification leads to expenditure elasticities that are in the low range of previous estimates (between -0.12 and -0.16). Naïve OLS estimates are between 1 and 4 times these magnitudes. (c) 2005 John Wiley & Sons, Ltd.

Multihospital System Membership and Patient Treatments, Expenditures, and Outcomes

PubMed Central

Madison, Kristin

2004-01-01

Objective To determine the relationship between hospital membership in systems and the treatments, expenditures, and outcomes of patients. Data Sources The Medicare Provider Analysis and Review dataset, for data on Medicare patients admitted to general medical-surgical hospitals between 1985 and 1998 with a diagnosis of acute myocardial infarction (AMI); the American Hospital Association Annual Survey, for data on hospitals. Study Design A multivariate regression analysis. An observation is a fee-for-service Medicare AMI patient admitted to a study hospital. Dependent variables include patient transfers, catheterizations, angioplasties or bypass surgeries, 90-day mortality, and Medicare expenditures. Independent variables include system participation, other admission hospital and patient traits, and hospital and year fixed effects. The five-part system definition incorporates the size and location of the index admission hospital and the size and distance of its partners. Principal Findings While the effects of multihospital system membership on patients are in general limited, patients initially admitted to small rural system hospitals that have big partners within 100 miles experience lower mortality rates than patients initially admitted to independent hospitals. Regression results show that to the extent system hospital patients experience differences in treatments and outcomes relative to patients of independent hospitals, these differences remain even after controlling for the admission hospital's capacity to provide cardiac services. Conclusions Multihospital system participation may affect AMI patient treatment and outcomes through factors other than cardiac service offerings. Additional investigation into the nature of these factors is warranted. PMID:15230926

Chronic pain and health care spending: an analysis of longitudinal data from the Medical Expenditure Panel Survey.

PubMed

Stockbridge, Erica L; Suzuki, Sumihiro; Pagán, José A

2015-06-01

To estimate average incremental health care expenditures associated with chronic pain by health care service category, expanding on prior research that focused on specific pain conditions instead of general pain, excluded low levels of pain, or did not incorporate pain duration. Medical Expenditure Panel Survey (MEPS) data (2008-2011; N = 26,671). Differences in annual expenditures for adults at different levels of pain that interferes with normal work, as measured by the SF-12, were estimated using recycled predictions from two-part logit-generalized linear regression models. "A little bit" of chronic pain-related interference was associated with a $2,498 increase in total adjusted expenditures over no pain interference (p < .0001) and a $1,008 increase over nonchronic pain interference (p = .0001). Moderate and severe chronic pain-related interference was associated with a $3,707 and $5,804 increase in expenditures over no pain interference and a $2,218 and $4,315 increase over nonchronic interference, respectively (p < .0001). Expenditure increases were most pronounced for inpatient and hospital outpatient expenditures compared to other types of health care expenditures. Chronic pain limitations are associated with higher health care expenditures. Results underscore the substantial cost of pain to the health care system. © Health Research and Educational Trust.

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

PubMed

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

2011-01-01

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

Chronic Pain and Health Care Spending: An Analysis of Longitudinal Data from the Medical Expenditure Panel Survey

PubMed Central

Stockbridge, Erica L; Suzuki, Sumihiro; Pagán, José A

2015-01-01

Objective To estimate average incremental health care expenditures associated with chronic pain by health care service category, expanding on prior research that focused on specific pain conditions instead of general pain, excluded low levels of pain, or did not incorporate pain duration. Data Source Medical Expenditure Panel Survey (MEPS) data (2008–2011; N = 26,671). Study Design Differences in annual expenditures for adults at different levels of pain that interferes with normal work, as measured by the SF-12, were estimated using recycled predictions from two-part logit-generalized linear regression models. Principal Findings “A little bit” of chronic pain-related interference was associated with a $2,498 increase in total adjusted expenditures over no pain interference (p < .0001) and a $1,008 increase over nonchronic pain interference (p = .0001). Moderate and severe chronic pain-related interference was associated with a $3,707 and $5,804 increase in expenditures over no pain interference and a $2,218 and $4,315 increase over nonchronic interference, respectively (p < .0001). Expenditure increases were most pronounced for inpatient and hospital outpatient expenditures compared to other types of health care expenditures. Conclusions Chronic pain limitations are associated with higher health care expenditures. Results underscore the substantial cost of pain to the health care system. PMID:25424348

Iranian Household Financial Protection against Catastrophic Health Care Expenditures

PubMed Central

Moghadam, M Nekoei; Banshi, M; Javar, M Akbari; Amiresmaili, M; Ganjavi, S

2012-01-01

Background: Protecting households against financial risks is one of objectives of any health system. In this regard, Iran’s fourth five year developmental plan act in its 90th article, articulated decreasing household’s exposure to catastrophic health expenditure to one percent. Hence, this study aimed to measure percentage of Iranian households exposed to catastrophic health expenditures and to explore its determinants. Methods: The present descriptive-analytical study was carried out retrospectively. Households whose financial contributions to the health system exceeded 40% of disposable income were considered as exposed to catastrophic healthcare expenditures. Influential factors on catastrophic healthcare expenditures were examined by logistic regression and chi-square test. Results: Of 39,088 households, 80 were excluded due to absence of food expenditures. 2.8% of households were exposed to catastrophic health expenditures. Influential factors on catastrophic healthcare were utilizing ambulatory, hospital, and drug addiction cessation services as well as consuming pharmaceuticals. Socioeconomics characteristics such as health insurance coverage, household size, and economic status were other determinants of exposure to catastrophic healthcare expenditures. Conclusion: Iranian health system has not achieved the objective of reducing catastrophic healthcare expenditure to one percent. Inefficient health insurance coverage, different fee schedules practiced by private and public providers, failure of referral system are considered as probable barriers toward decreasing households’ exposure to catastrophic healthcare expenditures. PMID:23193508

Linear system theory

NASA Technical Reports Server (NTRS)

Callier, Frank M.; Desoer, Charles A.

1991-01-01

The aim of this book is to provide a systematic and rigorous access to the main topics of linear state-space system theory in both the continuous-time case and the discrete-time case; and the I/O description of linear systems. The main thrusts of the work are the analysis of system descriptions and derivations of their properties, LQ-optimal control, state feedback and state estimation, and MIMO unity-feedback systems.

Health system costs by sex, age and proximity to death, and implications for estimation of future expenditure.

PubMed

Blakely, Tony; Atkinson, June; Kvizhinadze, Giorgi; Nghiem, Nhung; McLeod, Heather; Wilson, Nick

2014-05-02

Health expenditure increases with age, but some of this increase is due to costs proximal to death. We used linked health datasets (HealthTracker) to determine health expenditure by proximity to death. We then determined the impact on future health expenditure projections of accounting for proximity to death in costs. 2007 to 2009 national health event data were linked for hospitalisations, inpatient procedures, outpatient events, pharmaceuticals, laboratory tests, and primary care consultations. Each event was assigned a cost. Health expenditure by sex, age and whether in last 6 or 12 months of life or not were calculated. Future health expenditure trends were then estimated for the Statistics New Zealand median projection population counts, with 2010-12 mortality rates reducing by 2% per annum into the future. A total of $8.1, $8.8 and $9.2 billion dollars (inflation-adjusted to 2011 NZ$) was allocated to individual health events in HealthTracker in 2007, 2008 and 2009, respectively. Citizen costs for people not within 6 months of death ranged from $498 per person-year (10-14 year old females) to $6900 per person-year (90-94 year old males). Per person-year costs in the last 6 months of life were 10-fold higher on average, being maximal at $30,000 or more among infants and the older elderly (80+ years). Similar patterns were apparent for costs within 12 months of death. For people hypothetically exposed to these 2007-09 health system costs over their full life, the cumulative costs for a person dying at age 70 years was $113,000, and doubled to $223,000 for a person dying at age 90. The proportion of cumulative health expenditure in the last year of life declined with increasing age of death: e.g. 24%, 13% and 10% for someone aged 40, 70 and 90 respectively. Projections of future health system expenditure were overestimated by 2.3% to 3.5% in 2041 when not accounting for proximity to death in costs. New Zealand is fortunate to have access to rich data on health

The effect of telehealth systems and satisfaction with health expenditure among patients with metabolic syndrome.

PubMed

Uei, Shu-Lin; Tsai, Chung-Hung; Kuo, Yu-Ming

2016-04-29

Telehealth cost analysis has become a crucial issue for governments in recent years. In this study, we examined cases of metabolic syndrome in Hualien County, Taiwan. This research adopted the framework proposed by Marchand to establish a study process. In addition, descriptive statistics, a t test, analysis of variance, and regression analysis were employed to analyze 100 questionnaires. The results of the t$ test revealed significant differences in medical health expenditure, number of clinical visits for medical treatment, average amount of time spent commuting to clinics, amount of time spent undergoing medical treatment, and average number of people accompanying patients to medical care facilities or assisting with other tasks in the past one month, indicating that offering telehealth care services can reduce health expenditure. The statistical analysis results revealed that customer satisfaction has a positive effect on reducing health expenditure. Therefore, this study proves that telehealth care systems can effectively reduce health expenditure and directly improve customer satisfaction with medical treatment.

Estimated annual health care expenditures in individuals with peripheral arterial disease.

PubMed

Scully, Rebecca E; Arnaoutakis, Dean J; DeBord Smith, Ann; Semel, Marcus; Nguyen, Louis L

2018-02-01

The clinical impact of peripheral arterial disease (PAD) is well characterized and is associated with significant morbidity and mortality. Health care-related expenditures among individuals with PAD, particularly for patients, are not well described. Health care-related expenditure data from the 2011 to 2014 Agency for Healthcare Research and Quality Medical Expenditure Panel Surveys were analyzed for individuals with a diagnosis of PAD compared with U.S. adults 40 years of age and older. Weighted average annual expenditures were estimated using a multivariable generalized linear model. Subanalyses were also performed for out-of-pocket (OOP) expenditures by insurance type. Adjusted for age, gender, and race, individuals with a diagnosis of PAD (weighted n = 640,098) had significantly higher average annual health care-related expenditures compared with the U.S. adult population as a whole (weighted n = 148,387,362). Average annual expenditures per individual for patients with PAD were $11,553 (95% confidence interval [CI], $8137-$14,968) compared with only $4219 (95% CI, $4064-$4375; P < .001) for those without. Expenditures were driven by increased prescription medication expenditures as well as by expenditures for inpatient care, outpatient hospital-based care, and outpatient office-based care. Individuals with PAD had significantly higher OOP prescription medication expenditures ($386 [95% CI, $258-$515] vs $192 [95% CI, $183-$202]; P = .003), which varied by insurance type, ranging from $179 (95% CI, $70-$288) for those with Medicare to $1196 (95% CI, $106-$2244) for those without insurance, although this difference did not reach significance. Individuals with a diagnosis of PAD have higher health care-related expenditures and OOP expenses compared with other US adults. These expenditures compound lost wages, care by family members, and lost opportunity costs, increasing the burden carried by patients with PAD. Copyright © 2017 Society for Vascular Surgery

Advertising expenditures in the nursing home sector: evaluating the need for and purpose of advertising.

PubMed

Kash, Bita A; Boyer, Gregory J

2008-01-01

Marketing and advertising activities in the nursing home sector have increased in recent years, following the example of hospitals and health systems. The reasons for this trend may be related to the growth in competition but are not clearly identified yet. Theoretically, advertising becomes necessary to gain an advantage over the competition. The purpose of this study was to identify the reasons for the variation in advertising expenditures among nursing homes in Texas. For this study, we merged 2003 data from the Texas Medicaid Nursing Facility Cost Report, the Texas Nursing Home Quality Reporting System, and the Area Resource File for Texas. Using the Herfindahl-Hirschman Index, we then examined the correlations between advertising expenses and the level of market concentration. We evaluated the association between advertising expenditures and market competition using two logistic and four linear regression models. Total advertising expenses in Texas nursing homes ranged from $0 to $165,000 per year. Higher advertising expenditures were associated with larger facilities, higher occupancy, and high Medicare census. Market competition, however, was not a significant predictor of such expenses. Advertising seems to be more resource-driven than market-driven. Therefore, some advertising expenditures may be unnecessary, may lack impact, and may even be wasteful. Reducing unnecessary advertising costs could free up resources, which may be allocated to necessary resident care activities.

Determinants and Equity Evaluation for Health Expenditure Among Patients with Rare Diseases in China.

PubMed

Xin, Xiao-Xiong; Zhao, Liang; Guan, Xiao-Dong; Shi, Lu-Wen

2016-06-20

China has not established social security system for rare diseases. Rare diseases could easily impoverish patients and their families. Little research has studied the equity and accessibility of health services for patients with rare diseases in China. This study aimed to explore the factors that influence health expenditure of rare diseases and evaluate its equity. Questionnaire survey about living conditions and cost burden of patients with rare diseases was conducted. Individual and family information, health expenditure and reimbursement in 2014 of 982 patients were collected. The impact of medical insurance, individual sociodemographic characteristics, family characteristics, and healthcare need on total and out-of-pocket (OOP) health expenditures was analyzed through the generalized linear model. Equity of health expenditure was evaluated by both concentration index and Lorenz curve. Of all the surveyed patients, 11.41% had no medical insurance and 92.10% spent money to seek medical treatment in 2014. It was suggested female (P = 0.048), over 50 years of age (P = 0.062), high-income group (P = 0.021), hospitalization (P = 0.000), and reimbursement ratio (RR) (P = 0.000) were positively correlated with total health expenditure. Diseases not needing long-term treatment (P = 0.000) was negatively correlated with total health expenditure. Over 50 years of age (P = 0.065), high-income group (P = 0.018), hospitalization (P = 0.000) and having Urban Employee Basic Medical Insurance (UEBMI) (P = 0.022) were positively correlated with OOP health expenditure. Patient or the head of the household having received higher education (P = 0.044 and P = 0.081) and reimbursement ratio (P = 0.078) were negatively correlated with OOP health expenditure. The equity evaluation found concentration indexes of health expenditure before and after reimbursement were 0.0550 and 0.0539, respectively. OOP health expenditure of patients with UEBMI was significantly more than that of

State energy price and expenditure report 1994

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

NONE

1997-06-01

The State Energy Price and Expenditure Report (SEPER) presents energy price and expenditure estimates individually for the 50 States and the District of Columbia and in aggregate for the United States. The price and expenditure estimates developed in the State Energy Price and Expenditure Data System (SEPEDS) are provided by energy source and economic sector and are published for the years 1970 through 1994. Consumption estimates used to calculate expenditures and the documentation for those estimates are taken from the State Energy Data Report 1994, Consumption Estimates (SEDR), published in October 1996. Expenditures are calculated by multiplying the price estimatesmore » by the consumption estimates, which are adjusted to remove process fuel; intermediate petroleum products; and other consumption that has no direct fuel costs, i.e., hydroelectric, geothermal, wind, solar, and photovoltaic energy sources. Documentation is included describing the development of price estimates, data sources, and calculation methods. 316 tabs.« less

An evaluation of health care expenditures in Crohn's disease using the United States Medical Expenditure Panel Survey from 2003 to 2013.

PubMed

Bounthavong, Mark; Li, Meng; Watanabe, Jonathan H

Previous estimates of the economic burden of Crohn's disease (CD) varied widely from $2.0 to $18.2 billion per year (adjusted to 2015 $US). However, these estimates do not reflect recent changes in pharmaceutical treatment options and guidelines. The goal of this study was to update cost estimates of Crohn's disease based on a representative sample of the US population from the most recent 11 years (2003-2013) of the Medical Expenditure Panel Survey (MEPS). A secondary aim described expenditure trends in respondents with and without Crohn's disease pre-post FDA approvals of new biologics and the American College of Gastroenterology Crohn's disease treatment guidelines. Average annual expenditures (total, prescription, inpatient, and outpatient) were evaluated using a pooled cross-sectional design. Respondent data from the most recent 11 years (2003-2013) of MEPS were analyzed. Two-part generalized linear models with power-link were used to estimate the average annual expenditures per patient adjusted to multiple covariates. Confidence intervals (CI) were estimated using bootstrap methods. Difference-in-differences estimations were performed to compare the changes in health care expenditures pre-post FDA approvals of new biologics and the American College of Gastroenterology Crohn's disease treatment guidelines. The annual aggregate economic burden of CD was $6.3 billion in the US. Respondents with CD had higher total (+$6442; 95% CI: $4864 to $8297), prescription (+$3283; 95% CI: $2289 to $4445), inpatient (+$1764; 95% CI: $748 to $3551), and outpatient (+$1191; 95% CI: $592 to $2160) expenditures compared to respondents without CD. In the difference-in-differences estimation, respondents with CD had significantly higher total (P = 0.001) and prescription (P < 0.001) expenditures compared with respondents without CD. Although inpatient and outpatient expenditures were higher in respondents with CD, they were not statistically significant. Respondents with CD

An Approach to Forecasting Health Expenditures, with Application to the U.S. Medicare System

PubMed Central

Lee, Ronald; Miller, Timothy

2002-01-01

Objective To quantify uncertainty in forecasts of health expenditures. Study Design Stochastic time series models are estimated for historical variations in fertility, mortality, and health spending per capita in the United States, and used to generate stochastic simulations of the growth of Medicare expenditures. Individual health spending is modeled to depend on the number of years until death. Data Sources/Study Setting A simple accounting model is developed for forecasting health expenditures, using the U.S. Medicare system as an example. Principal Findings Medicare expenditures are projected to rise from 2.2 percent of GDP (gross domestic product) to about 8 percent of GDP by 2075. This increase is due in equal measure to increasing health spending per beneficiary and to population aging. The traditional projection method constructs high, medium, and low scenarios to assess uncertainty, an approach that has many problems. Using stochastic forecasting, we find a 95 percent probability that Medicare spending in 2075 will fall between 4 percent and 18 percent of GDP, indicating a wide band of uncertainty. Although there is substantial uncertainty about future mortality decline, it contributed little to uncertainty about future Medicare spending, since lower mortality both raises the number of elderly, tending to raise spending, and is associated with improved health of the elderly, tending to reduce spending. Uncertainty about fertility, by contrast, leads to great uncertainty about the future size of the labor force, and therefore adds importantly to uncertainty about the health-share of GDP. In the shorter term, the major source of uncertainty is health spending per capita. Conclusions History is a valuable guide for quantifying our uncertainty about future health expenditures. The probabilistic model we present has several advantages over the high–low scenario approach to forecasting. It indicates great uncertainty about future Medicare expenditures relative

An approach to forecasting health expenditures, with application to the U.S. Medicare system.

PubMed

Lee, Ronald; Miller, Timoth

2002-10-01

To quantify uncertainty in forecasts of health expenditures. Stochastic time series models are estimated for historical variations in fertility, mortality, and health spending per capita in the United States, and used to generate stochastic simulations of the growth of Medicare expenditures. Individual health spending is modeled to depend on the number of years until death. A simple accounting model is developed for forecasting health expenditures, using the U.S. Medicare system as an example. Medicare expenditures are projected to rise from 2.2 percent of GDP (gross domestic product) to about 8 percent of GDP by 2075. This increase is due in equal measure to increasing health spending per beneficiary and to population aging. The traditional projection method constructs high, medium, and low scenarios to assess uncertainty, an approach that has many problems. Using stochastic forecasting, we find a 95 percent probability that Medicare spending in 2075 will fall between 4 percent and 18 percent of GDP, indicating a wide band of uncertainty. Although there is substantial uncertainty about future mortality decline, it contributed little to uncertainty about future Medicare spending, since lower mortality both raises the number of elderly, tending to raise spending, and is associated with improved health of the elderly, tending to reduce spending. Uncertainty about fertility, by contrast, leads to great uncertainty about the future size of the labor force, and therefore adds importantly to uncertainty about the health-share of GDP. In the shorter term, the major source of uncertainty is health spending per capita. History is a valuable guide for quantifying our uncertainty about future health expenditures. The probabilistic model we present has several advantages over the high-low scenario approach to forecasting. It indicates great uncertainty about future Medicare expenditures relative to GDP.

Policy Guidelines for Restricted Grant Expenditures and Reporting, Fiscal Year 2001.

ERIC Educational Resources Information Center

Illinois Community Coll. Board, Springfield.

This document presents policy guidelines for restricted grant expenditures and reporting for fiscal year 2001 within the Illinois Community College system. It describes the purpose, allowable expenditures, expenditure limitations, and grant administrative standards for various types of restricted grant expenditures, including: (1) Special…

Gambling expenditure by game type among weekly gamblers in Finland.

PubMed

Salonen, Anne H; Kontto, Jukka; Perhoniemi, Riku; Alho, Hannu; Castrén, Sari

2018-06-05

Excessive expenditure and financial harms are core features of problem gambling. There are various forms of gambling and their nature varies. The aim was to measure gambling expenditure by game type while controlling for demographics and other gambling participation factors. A further aim was to find out how each game type was associated with gambling expenditure when the number of game types played is adjusted for. Using data from the 2015 Finnish Gambling survey on adult gamblers (n = 3555), multiple log-linear regression was used to examine the effects of demographics, gambling participation, and engaging in different game types on weekly gambling expenditure (WGE) and relative gambling expenditure (RGE). Male gender, lower education level, higher gambling frequency and higher number of game types increased both WGE and RGE, while younger age decreased WGE but increased RGE. Furthermore, seven specific game types increased both WGE and RGE. Weekly horse race betting and non-monopoly gambling had the strongest increasing effect on expenditure. Betting games and online poker were associated with higher expenditure even when they were played less often than weekly. Among weekly gamblers the highest mean WGE was recorded for those who played non-monopoly games (146.84 €/week), online poker (59.61 €/week), scratch games (51.77 €/week) and horse race betting (48.67 €/week). Those who played only 1-2 game types a week had the highest mean WGE and RGE on horse race betting and other betting games. It seems that overall gambling frequency is the strongest indicator of high gambling expenditure. Our results showed that different game types had different effect sizes on gambling expenditure. Weekly gambling on horse races and non-monopoly games had the greatest increasing effect on expenditure. However, different game types also varied based on their popularity. The extent of potential harms caused by high expenditure therefore also varies on the population level

Relationship between catastrophic health expenditures and household incomes and expenditure patterns in South Korea.

PubMed

Kim, Younhee; Yang, Bongmin

2011-05-01

The compositions of health expenditures by households in South Korea with and without catastrophic health expenditures were compared. Also, relationships between catastrophic health expenditures and household incomes, and between such health expenditures and expenditure patterns were explored. Data from the 2006 South Korean Household Income & Expenditure Survey, a representative survey of 90,696 households were analyzed. We used a double-hurdle model to assess each income source and expenditure category. The independent variable was the presence of catastrophic health expenditure. After adjusting for household characteristics, the results showed that earned, business, and property incomes were significantly lower, but transfer and loan incomes were significantly higher in households with catastrophic health expenditures than in those without such health expenditures. All consumption categories, other than health expenditure, were significantly lower in households with catastrophic health expenditures than in those without catastrophic health expenditures. This suggests that households with catastrophic health expenditures faced challenges in offset by the potentially excessive health expenditure and may have been obliged to reduce consumption of other items. The expansion of insurance coverage and lowering of out-of-pocket rates in the South Korean Health Insurance benefits could be a necessary first step in protecting households from the occurrence of health related economic catastrophes. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Activity limitations predict health care expenditures in the general population in Belgium.

PubMed

Van der Heyden, Johan; Van Oyen, Herman; Berger, Nicolas; De Bacquer, Dirk; Van Herck, Koen

2015-03-19

Disability and chronic conditions both have an impact on health expenditures and although they are conceptually related, they present different dimensions of ill-health. Recent concepts of disability combine a biological understanding of impairment with the social dimension of activity limitation and resulted in the development of the Global Activity Limitation Indicator (GALI). This paper reports on the predictive value of the GALI on health care expenditures in relation to the presence of chronic conditions. Data from the Belgian Health Interview Survey 2008 were linked with data from the compulsory national health insurance (n = 7,286). The effect of activity limitation on health care expenditures was assessed via cost ratios from multivariate linear regression models. To study the factors contributing to the difference in health expenditure between persons with and without activity limitations, the Blinder-Oaxaca decomposition method was used. Activity limitations are a strong determinant of health care expenditures. People with severe activity limitations (5.1%) accounted for 16.9% of the total health expenditure, whereas those without activity limitations (79.0%), were responsible for 51.5% of the total health expenditure. These observed differences in health care expenditures can to some extent be explained by chronic conditions, but activity limitations also contribute substantially to higher health care expenditures in the absence of chronic conditions (cost ratio 2.46; 95% CI 1.74-3.48 for moderate and 4.45; 95% CI 2.47-8.02 for severe activity limitations). The association between activity limitation and health care expenditures is stronger for reimbursed health care costs than for out-of-pocket payments. In the absence of chronic conditions, activity limitations appear to be an important determinant of health care expenditures. To make projections on health care expenditures, routine data on activity limitations are essential and complementary to data

Linear approximations of nonlinear systems

NASA Technical Reports Server (NTRS)

Hunt, L. R.; Su, R.

1983-01-01

The development of a method for designing an automatic flight controller for short and vertical take off aircraft is discussed. This technique involves transformations of nonlinear systems to controllable linear systems and takes into account the nonlinearities of the aircraft. In general, the transformations cannot always be given in closed form. Using partial differential equations, an approximate linear system called the modified tangent model was introduced. A linear transformation of this tangent model to Brunovsky canonical form can be constructed, and from this the linear part (about a state space point x sub 0) of an exact transformation for the nonlinear system can be found. It is shown that a canonical expansion in Lie brackets about the point x sub 0 yields the same modified tangent model.

Out-of-pocket expenditure and financial protection in the Chilean health care system-A systematic review.

PubMed

Koch, Kira Johanna; Cid Pedraza, Camilo; Schmid, Andreas

2017-05-01

Protection against financial risk due to medical spending is an explicit health guarantee within Chile's AUGE health reform. This paper seeks to analyze the degree to which out-of-pocket expenditure still expose Chilean households to financial catastrophe and impoverishment, and to explore inequalities in financial protection. A systematic literature review was conducted to identify empirical studies analyzing financial protection in Chile. The search included databases as well as grey literature, i.e. governmental and institutional webpages. The indicators are based on the conceptual framework of financial protection, as portrayed in the World Health Report 2013. We identify n=16 studies that fulfill the inclusion criteria. Empirical studies indicate that 4% of Chilean households faced catastrophic health expenditure defined as out-of-pocket expenditure exceeding 30% of household's capacity to pay, while less than 1% were pushed into poverty in 2012. In contrast to prior studies, recent data report that even publicly insured who should be fully protected from co-payments were affected by catastrophic health expenditure. Also in the private insurance system financial catastrophe is a common risk. Despite health reform efforts, financial protection is insufficient and varies to the disadvantage of the poor and vulnerable groups. More research is required to understand why current mechanisms are not as effective as expected and to enable according reforms of the insurance system. Copyright © 2017 Elsevier B.V. All rights reserved.

Projecting future drug expenditures--2009.

PubMed

Hoffman, James M; Shah, Nilay D; Vermeulen, Lee C; Doloresco, Fred; Martin, Patrick K; Blake, Sharon; Matusiak, Linda; Hunkler, Robert J; Schumock, Glen T

2009-02-01

Drug expenditure trends in 2007 and 2008, projected drug expenditures for 2009, and factors likely to influence drug expenditures are discussed. Various factors are likely to influence drug expenditures in 2009, including drugs in development, the diffusion of new drugs, drug safety concerns, generic drugs, Medicare Part D, and changes in the drug supply chain. The increasing availability of important generic drugs and drug safety concerns continue to moderate growth in drug expenditures. The drug supply chain remains dynamic and may influence drug expenditures, particularly in specialized therapeutic areas. Initial data suggest that the Medicare Part D benefit has influenced drug expenditures, but the ultimate impact of the benefit on drug expenditures remains unclear. From 2006 to 2007, total U.S. drug expenditures increased by 4.0%, with total spending rising from $276 billion to $287 billion. Drug expenditures in clinics continue to grow more rapidly than in other settings, with a 9.9% increase from 2006 to 2007. Hospital drug expenditures increased at a moderate rate of only 1.6% from 2006 to 2007; through the first nine months of 2008, hospital drug expenditures increased by only 2.8% compared with the same period in 2007. In 2009, we project a 0-2% increase in drug expenditures in outpatient settings, a 1-3% increase in expenditures for clinic-administered drugs, and a 1-3% increase in hospital drug expenditures.

Conditions for Stabilizability of Linear Switched Systems

NASA Astrophysics Data System (ADS)

Minh, Vu Trieu

2011-06-01

This paper investigates some conditions that can provide stabilizability for linear switched systems with polytopic uncertainties via their closed loop linear quadratic state feedback regulator. The closed loop switched systems can stabilize unstable open loop systems or stable open loop systems but in which there is no solution for a common Lyapunov matrix. For continuous time switched linear systems, we show that if there exists solution in an associated Riccati equation for the closed loop systems sharing one common Lyapunov matrix, the switched linear systems are stable. For the discrete time switched systems, we derive a Linear Matrix Inequality (LMI) to calculate a common Lyapunov matrix and solution for the stable closed loop feedback systems. These closed loop linear quadratic state feedback regulators guarantee the global asymptotical stability for any switched linear systems with any switching signal sequence.

Projecting future drug expenditures--2012.

PubMed

Hoffman, James M; Li, Edward; Doloresco, Fred; Matusiak, Linda; Hunkler, Robert J; Shah, Nilay D; Vermeulen, Lee C; Schumock, Glen T

2012-03-01

Factors likely to influence drug expenditures, drug expenditure trends in 2010 and 2011, and projected drug expenditures for 2012 are discussed. Data were analyzed to provide drug expenditure trends for total drug expenditures and the hospital and clinic sectors. Data were obtained from the IMS Health National Sales Perspectives database. From 2009 to 2010, total U.S. drug expenditures increased by 2.7%, with total spending rising from $299.2 billion to $307.5 billion. Drug expenditures in clinics grew by 6.0% from 2009 to 2010. Hospital drug expenditures increased at the moderate rate of 1.5% from 2009 to 2010; through the first nine months of 2011, hospital drug expenditures increased by only 0.3% compared with the same period in 2010. The dominant trend over the past several years is substantial moderation in expenditure growth for widely used drugs, primarily due to the ongoing introduction and wide use of generic versions of high-cost, frequently used medications. At the end of 2010, generic drugs accounted for 78% of all retail prescriptions dispensed. Another pattern is substantial increases in expenditures for specialized medications, particularly in the outpatient setting as growth in prescription drug expenditures for clinic-administered drugs consistently outpaces growth in total expenditures. Various factors are likely to influence drug expenditures in 2012, including drugs in development, the diffusion of new drugs, generic drugs, drug shortages, and biosimilars. For 2012, we project a 3-5% increase in total drug expenditures across all settings, a 5-7% increase in expenditures for clinic-administered drugs, and a 0-2% increase in hospital drug expenditures.

Projecting future drug expenditures--2010.

PubMed

Hoffman, James M; Doloresco, Fred; Vermeulen, Lee C; Shah, Nilay D; Matusiak, Linda; Hunkler, Robert J; Schumock, Glen T

2010-06-01

Drug expenditure trends in 2008 and 2009, projected drug expenditures for 2010, and factors likely to influence drug expenditures are discussed. Various factors are likely to influence drug expenditures in 2010, including drugs in development, the diffusion of new drugs, generic drugs, health care reform, drug safety concerns, and comparative effectiveness research. The increasing availability of important generic drugs continues to moderate growth in drug expenditures. Health care reform initiatives, including the potential for biosimilars legislation, will influence drug expenditures in all settings. From 2007 to 2008, total U.S. drug expenditures increased by 1.8%, with total spending rising from $279.6 billion to $284.7 billion. Growth in drug expenditures in clinics declined to the lowest level in a decade, a 1.0% increase from 2007 to 2008. Hospital drug expenditures increased at a moderate rate of only 2.1% from 2007 to 2008; through the first nine months of 2009, hospital drug expenditures increased by 3.0% compared with the same period in 2008. In 2010, we project a 3-5% increase in drug expenditures in outpatient settings, a 6-8% increase in expenditures for clinic-administered drugs, and a 2-4% increase in hospital drug expenditures.

Predictors of primary health care pharmaceutical expenditure by districts in Uganda and implications for budget setting and allocation.

PubMed

Mujasi, Paschal N; Puig-Junoy, Jaume

2015-08-20

There is need for the Uganda Ministry of Health to understand predictors of primary health care pharmaceutical expenditure among districts in order to guide budget setting and to improve efficiency in allocation of the set budget among districts. Cross sectional, retrospective observational study using secondary data. The value of pharmaceuticals procured by primary health care facilities in 87 randomly selected districts for the Financial Year 2011/2012 was collected. Various specifications of the dependent variable (pharmaceutical expenditure) were used: total pharmaceutical expenditure, Per capita district pharmaceutical expenditure, pharmaceutical expenditure per district health facility and pharmaceutical expenditure per outpatient department visit. Andersen's behaviour model of health services utilisation was used as conceptual framework to identify independent variables likely to influence health care utilisation and hence pharmaceutical expenditure. Econometric analysis was conducted to estimate parameters of various regression models. All models were significant overall (P < 0.01), with explanatory power ranging from 51 to 82%. The log linear model for total pharmaceutical expenditure explained about 80% of the observed variation in total pharmaceutical expenditure (Adjusted R(2) = 0.797) and contained the following variables: Immunisation coverage, Total outpatient department attendance, Urbanisation, Total number of government health facilities and total number of Health Centre IIs. The model based on Per capita Pharmaceutical expenditure explained about 50% of the observed variation in per capita pharmaceutical expenditure (Adjusted R(2) = 0.513) and was more balanced with the following variables: Outpatient per capita attendance, percentage of rural population below poverty line 2005, Male Literacy rate, Whether a district is characterised by MOH as difficult to reach or not and the Human poverty index. The log-linear model based on total

The impact of arthritis and joint pain on individual healthcare expenditures: findings from the Medical Expenditure Panel Survey (MEPS), 2011.

PubMed

Williams, Edith M; Walker, Rebekah J; Faith, Trevor; Egede, Leonard E

2017-02-28

Joint pain, including back pain, and arthritis are common conditions in the United States, affecting more than 100 million individuals and costing upwards of $200 billion each year. Although activity limitations associated with these disorders impose a substantial economic burden, this relationship has not been explored in a large U.S. cohort. In this study, we used the Medical Expenditures Panel Survey to investigate whether functional limitations explain the difference in medical expenditures between patients with arthritis and joint pain and those without. We used sequential explanatory linear models to investigate this relationship and accounted for various covariates. Unadjusted mean expenditures were $10,587 for those with joint pain or arthritis, compared with $3813 for those without. In a fully adjusted model accounting also for functional limitations, those with joint pain or arthritis paid $1638 more than those without, a statistically significant difference. The growing economic and public health burden of arthritis and joint pain, as well as the corresponding complications of functional, activity, and sensory limitations, calls for an interdisciplinary approach and heightened awareness among providers to identify strategies that meet the needs of high-risk patients in order to prevent and delay disease progression.

[Quantitative analysis of drug expenditures variability in dermatology units].

PubMed

Moreno-Ramírez, David; Ferrándiz, Lara; Ramírez-Soto, Gabriel; Muñoyerro, M Dolores

2013-01-01

Variability in adjusted drug expenditures among clinical departments raises the possibility of difficult access to certain therapies at the time that avoidable expenditures may also exist. Nevertheless, drug expenditures are not usually applied to clinical practice variability analysis. To identify and quantify variability in drug expenditures in comparable dermatology department of the Servicio Andaluz de Salud. Comparative economic analysis regarding the drug expenditures adjusted to population and health care production in 18 dermatology departments of the Servicio Andaluz de Salud. The 2012 cost and production data (homogeneous production units -HPU-)were provided by Inforcoan, the cost accounting information system of the Servicio Andaluz de Salud. The observed drug expenditure ratio ranged from 0.97?/inh to 8.90?/inh and from 208.45?/HPU to 1,471.95?/ HPU. The Pearson correlation between drug expenditure and population was 0.25 and 0.35 for the correlation between expenditure and homogeneous production (p=0.32 and p=0,15, respectively), both Pearson coefficients confirming the lack of correlation and arelevant degree of variability in drug expenditures. The quantitative analysis of variability performed through Pearson correlation has confirmed the existence of drug expenditure variability among comparable dermatology departments. Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.

Patterns of Health Expenditures and Financial Protections in Vietnam 1992-2012.

PubMed

Hoang, Van Minh; Oh, Juhwan; Tran, Tuan Anh; Tran, Thi Giang Huong; Ha, Anh Duc; Luu, Ngoc Hoat; Nguyen, Thi Kim Phuong

2015-11-01

Health financing has been considered as an important building block of a health system and has a key role in promoting universal health coverage in the Vietnam. This paper aims to describe the pattern of health expenditure, including total health expenditure and composition of health expenditure, over the last two decades in Vietnam. The paper mainly uses the data from Vietnam National Health Account and Vietnam Living Standards Survey. We also included data from other relevant published literature, reports and statistics about health care expenditure in Vietnam. The per capita health expenditure in Vietnam increased from US$ 14 in 1995 to US$ 86 in 2012. The total health expenditure as a share of GDP also rose from 5.2% in 1995 to 6.9% in 2012. Public health expenditure as percentage of government expenditure rose from 7.4% in 1995 to nearly 10% in 2012. The coverage of health insurance went up from 10% in 1995 to 68.5% in 2012. However, health financing in Vietnam was depending on private expenditures (57.4% in 2012). As a result, the proportion of households with catastrophic expenditure in 2012 was 4.2%. The rate of impoverishment in 2012 was 2.5%. To ensure equity and efficient goal of health system, policy actions for containing the health care out-of-pocket payments and their poverty impacts are urgently needed in Vietnam.

National and surgical health care expenditures, 2005-2025.

PubMed

Muñoz, Eric; Muñoz, William; Wise, Leslie

2010-02-01

Health care expenditures for 2005 in the United States were $1.9733 trillion and 15.9% of the gross domestic product (GDP). Twenty-nine percent of those expenditures were secondary to surgical revenues. Health care expenditures are increasing 2(1/2) times the rate of the general US economy and are being fed by new technologies, new medications, the aging population, more services provided per patient, defensive medicine and little tort reform, the insurance system, and the free rider problem, ie, patients are cared for as emergencies regardless of insurance coverage and legality, which all have contributed to rising health care and surgical expenditures over the last 50 years. The purpose of this study was to project aggregate national health care expenditures, aggregate surgical health care expenditures, and the United States GDP for the years 2005-2025. Model building and existing state and national data were used. Aggregate surgical health care expenditures were computed as 29% of aggregate health care expenditures using a unique model developed by the late Dr. Francis D. Moore. The model of Dr. Moore which used 1981 federal data was verified/tested using data from UMDNJ-University Hospital, and New Jersey and national data from 2005. From 1965 to 2005 mean health care expenditures increased at 4.9% per year, and US GDP increased at a mean of 2.1% per year. Aggregate surgical expenditures are expected to grow from $572 billion in 2005 (4.6% of US GDP) to $912 billion (2005 dollars) in the year 2025 (7.3% of US GDP). Aggregate health care expenditures are projected to increase from $5572 per capita (15.9% of GDP) in 2005 to $8832 per capita (2005 dollars) in 2025 (25.2% of US GDP). Both surgery and national health care expenditures are expected to expand by almost 60% during the period 2005-2025. Thus, surgical health care expenditures by 2025 are likely to be 1/14 of the US economy, and health care expenditures will be (1/4) of the US economy. Real per capita

Health Expenditure Trends in OECD Countries, 1990-2001

PubMed Central

Huber, Manfred; Orosz, Eva

2003-01-01

This article presents data on health care spending for 30 OECD countries from OECD Health Data 2003, the latest edition of OECD's annual data collection on health systems across industrialized countries. OECD data show health care expenditures as a proportion of gross domestic product at an all-time high, due to both increased expenditures and overall economic slowdown. The article discusses similarities and differences across countries in how health care expenditures are funded and how the health care dollar is spent among types of services. PMID:14997690

Household Expenditures for Medicines and the Role of Free Medicines in the Brazilian Public Health System

PubMed Central

Barros, Aluísio J. D.; Camargo, Aline Lins; Hallal, Pedro C.; Vandoros, Sotiris; Wagner, Anita; Ross-Degnan, Dennis

2011-01-01

Objectives. We sought to investigate, across different socioeconomic groups, the proportion of household medicine expenses that were paid by households and the proportion paid by the Brazilian national health system. Methods. We carried out a survey in Porto Alegre, Brazil, that included 2988 individuals of all ages. We defined 2 expenditure variables: “out-of-pocket medicines value” (the sum of retail prices of all medicines used by family members within the previous 15 days and paid for out of pocket) and “free medicines value” (a similar definition for medicines obtained without charge). Results. In 2003, the Brazilian national health system provided, free of charge, 78% of the monetary value of medicines reported (79% in the bottom wealth quintile and 32% in the top 2 quintiles). The mean out-of-pocket expense for medicines was 6 times greater among the top wealth quintiles compared with those in lower quintiles, but free medicines constituted a 3-times-greater proportion of potential expenditures for medicines among the bottom quintile than among the top 2 quintiles. Conclusions. Free provision of medicines seems to be saving substantial amounts of medicine expenditures for poor people in Brazil. PMID:20724692

Changes in health expenditures in China in 2000s: has the health system reform improved affordability.

PubMed

Long, Qian; Xu, Ling; Bekedam, Henk; Tang, Shenglan

2013-06-13

China's health system reform launched in early 2000s has achieved better coverage of health insurance and significantly increased the use of healthcare for vast majority of Chinese population. This study was to examine changes in the structure of total health expenditures in China in 2000-2011, and to investigate the financial burden of healthcare placed on its population, particularly between urban and rural areas and across different socio-economic development regions. Health expenditures data came from the China National Health Accounts study in 1990-2011, and other data used to calculate the financial burden of healthcare were from China Statistical Yearbook and China Population Statistical Yearbook. Total health expenditures were divided into government and social expenditure, and out-of-pocket payment. The financial burden of healthcare was estimated as out-of-pocket payment per capita as a percentage of annual household living consumption expenditure per capita. Between 2000 and 2011, total health expenditures in China increased from Chinese yuan 319 to 1888 (United States dollars 51 to 305), with average annual increase of 17.4%. Government and social health expenditure increased rapidly being 22.9% and 18.8% of average annual growth rate, respectively. The share of out-of-pocket payment in total health expenditure for the urban population declined from 53% in 2005 to 36% in 2011, but had only a slight decrease for the rural population from 53% to 50%. Out-of-pocket payment, as a percentage of annual household living consumption, has continued to rise, particularly in the rural population from the less developed region (6.1% in 2000 to 8.8% in 2011). The rapid increase of public funding to subsidize health insurance in China, as part of the reform strategy, did not mitigate the out-of-pocket payment for healthcare over the past decade. Financial burden of healthcare on the rural population increased. Affordability among the rural households with sick

Public health expenditure and spatial interactions in a decentralized national health system.

PubMed

Costa-Font, Joan; Pons-Novell, Jordi

2007-03-01

One of the limitations of cross-country health expenditure analysis refers to the fact that the financing, the internal organization and political restraints of health care decision-making are country-specific and heterogeneous. Yet, a way through is to examine the influence of such effects in those countries that have undertaken decentralization processes. In such a setting, it is possible to examine potential expenditure spillovers across the geography of a country as well as the influence of the political ideology of regional incumbents and institutional factors on public health expenditure. This paper examines the determinants of public health expenditure within Spanish region-states (Autonomous Communities, ACs), most of them subject to similar financing structures although exhibiting significant heterogeneity as a result of the increasing decentralization, region-specific political factors along with different use of health care inputs, economic dimension and spatial interactions. Copyright (c) 2006 John Wiley & Sons, Ltd.

Gross efficiency and energy expenditure in kayak ergometer exercise.

PubMed

Gomes, B B; Mourão, L; Massart, A; Figueiredo, P; Vilas-Boas, J P; Santos, A M C; Fernandes, R J

2012-08-01

We purposed to study energy expenditure, power output and gross efficiency during kayak ergometer exercise in 12 elite sprint kayakers. 6 males (age 24.2±4.8 years, height 180.4±4.8 cm, body mass 79.7±8.5 kg) and 6 females (age 24.3±4.5 years, height 164.5±3.9 cm, body mass 65.4±3.5 kg), performed an incremental intermittent protocol on kayak ergometer with VO2 and blood lactate concentration assessment, a non-linear increase between power output and energy expenditure being observed. Paddling power output, energy expenditure and gross efficiency corresponding to VO2max averaged 199.92±50.41 W, 75.27±6.30 ml.kg - 1.min - 1, and 10.10±1.08%. Male kayakers presented higher VO2max, power output and gross efficiency at the VO2max, and lower heart rate and maximal lactate concentration than females, but no differences were found between genders regarding energy expenditure at VO2max. Aerobic and anaerobic components of energy expenditure evidenced a significant contribution of anaerobic energy sources in sprint kayak performance. Results also suggested the dependence of the gross efficiency on the changes in the amount of the aerobic and anaerobic contributions, at heavy and severe intensities. The inter-individual variance of the relationship between energy expenditure and the corresponding paddling power output revealed a relevant tracking for females (FDγ=0.73±0.06), conversely to the male group (FDγ=0.27±0.08), supporting that some male kayakers are more skilled in some paddling intensities than others. © Georg Thieme Verlag KG Stuttgart · New York.

Effects of comorbid health conditions on healthcare expenditures among people with severe mental illness.

PubMed

Lee, Sungkyu; Rothbard, Aileen; Choi, Sunha

2016-08-01

Little is known about the incremental cost burden associated with treating comorbid health conditions among people with severe mental illness (SMI). This study compares the extent to which each individual medical condition increases healthcare expenditures between people with SMI and people without mental illness. Data were obtained from the 2011 Medical Expenditure Panel Survey (MEPS; N = 17 764). Mental illness and physical health conditions were identified through ICD-9 codes. Guided by the Andersen's behavioral model of health services utilization, generalized linear models were conducted. Total healthcare expenditures among individuals with SMI were approximately 3.3 times greater than expenditures by individuals without mental illness ($11 399 vs. $3449, respectively). Each additional physical health condition increased the total healthcare expenditure by 17.4% for individuals with SMI compared to the 44.8% increase for individuals without mental illness. The cost effect of having additional health conditions on the total healthcare expenditures among individuals with SMI is smaller than those individuals without mental illness. Whether this is due to limited access to healthcare for the medical problems or better coordination between medical and mental health providers, which reduces duplicated medical procedures or visits, requires future investigation.

Maternal depressive symptoms and healthcare expenditures for publicly insured children with chronic health conditions.

PubMed

Brooks, Jada L; Beil, Heather; Beeber, Linda S

2015-04-01

This study estimated the prevalence of maternal depressive symptoms and tested associations between maternal depressive symptoms and healthcare utilization and expenditures among United States publicly insured children with chronic health conditions (CCHC). A total of 6,060 publicly insured CCHC from the 2004-2009 Medical Expenditure Panel Surveys were analyzed using negative binomial models to compare healthcare utilization for CCHC of mothers with and without depressive symptoms. Annual healthcare expenditures for both groups were compared using a two-part model with a logistic regression and generalized linear model. The prevalence of depressive symptoms among mothers with CCHC was 19 %. There were no differences in annual healthcare utilization for CCHC of mothers with and without depressive symptoms. Maternal depressive symptoms were associated with greater odds of ED expenditures [odds ratio (OR) 1.26; 95 % CI 1.03-1.54] and lesser odds of dental expenditures (OR 0.81; 95 % CI 0.66-0.98) and total expenditures (OR 0.71; 95 % CI 0.51-0.98). Children of symptomatic mothers had lower predicted outpatient expenditures and higher predicted expenditures for total health, prescription medications, dental care; and office based, inpatient and ED visits. Mothers with CCHC were more likely to report depressive symptoms than were mothers with children without chronic health conditions. There were few differences in annual healthcare utilization and expenditures between CCHC of mothers with and without depressive symptoms. However, having a mother with depressive symptoms was associated with higher ED expenditures and higher predicted healthcare expenditures in a population of children who comprise over three-fourths of the top decile of Medicaid spending.

Mathematical Model for the Contribution of Individual Organs to Non-Zero Y-Intercepts in Single and Multi-Compartment Linear Models of Whole-Body Energy Expenditure

PubMed Central

Kaiyala, Karl J.

2014-01-01

Mathematical models for the dependence of energy expenditure (EE) on body mass and composition are essential tools in metabolic phenotyping. EE scales over broad ranges of body mass as a non-linear allometric function. When considered within restricted ranges of body mass, however, allometric EE curves exhibit ‘local linearity.’ Indeed, modern EE analysis makes extensive use of linear models. Such models typically involve one or two body mass compartments (e.g., fat free mass and fat mass). Importantly, linear EE models typically involve a non-zero (usually positive) y-intercept term of uncertain origin, a recurring theme in discussions of EE analysis and a source of confounding in traditional ratio-based EE normalization. Emerging linear model approaches quantify whole-body resting EE (REE) in terms of individual organ masses (e.g., liver, kidneys, heart, brain). Proponents of individual organ REE modeling hypothesize that multi-organ linear models may eliminate non-zero y-intercepts. This could have advantages in adjusting REE for body mass and composition. Studies reveal that individual organ REE is an allometric function of total body mass. I exploit first-order Taylor linearization of individual organ REEs to model the manner in which individual organs contribute to whole-body REE and to the non-zero y-intercept in linear REE models. The model predicts that REE analysis at the individual organ-tissue level will not eliminate intercept terms. I demonstrate that the parameters of a linear EE equation can be transformed into the parameters of the underlying ‘latent’ allometric equation. This permits estimates of the allometric scaling of EE in a diverse variety of physiological states that are not represented in the allometric EE literature but are well represented by published linear EE analyses. PMID:25068692

Mathematical model for the contribution of individual organs to non-zero y-intercepts in single and multi-compartment linear models of whole-body energy expenditure.

PubMed

Kaiyala, Karl J

2014-01-01

Mathematical models for the dependence of energy expenditure (EE) on body mass and composition are essential tools in metabolic phenotyping. EE scales over broad ranges of body mass as a non-linear allometric function. When considered within restricted ranges of body mass, however, allometric EE curves exhibit 'local linearity.' Indeed, modern EE analysis makes extensive use of linear models. Such models typically involve one or two body mass compartments (e.g., fat free mass and fat mass). Importantly, linear EE models typically involve a non-zero (usually positive) y-intercept term of uncertain origin, a recurring theme in discussions of EE analysis and a source of confounding in traditional ratio-based EE normalization. Emerging linear model approaches quantify whole-body resting EE (REE) in terms of individual organ masses (e.g., liver, kidneys, heart, brain). Proponents of individual organ REE modeling hypothesize that multi-organ linear models may eliminate non-zero y-intercepts. This could have advantages in adjusting REE for body mass and composition. Studies reveal that individual organ REE is an allometric function of total body mass. I exploit first-order Taylor linearization of individual organ REEs to model the manner in which individual organs contribute to whole-body REE and to the non-zero y-intercept in linear REE models. The model predicts that REE analysis at the individual organ-tissue level will not eliminate intercept terms. I demonstrate that the parameters of a linear EE equation can be transformed into the parameters of the underlying 'latent' allometric equation. This permits estimates of the allometric scaling of EE in a diverse variety of physiological states that are not represented in the allometric EE literature but are well represented by published linear EE analyses.

Predictors of the highest long-term care expenditures in Japan.

PubMed

Olivares-Tirado, Pedro; Tamiya, Nanako; Kashiwagi, Masayo; Kashiwagi, Kimikazu

2011-05-17

In Japan, as the number of elderly covered by the Long-term Care Insurance (LTCI) system has increased, demand for long-term care services has increased substantially and consequently growing expenditures are threatening the sustainability of the system. Understanding the predictive factors associated with long-term care expenditures among the elderly would be useful in developing future strategies to ensure the sustainability of the system. We report a set of predictors of the highest long-term care expenditures in a cohort of elderly persons who received consecutive long-term care services during a year in a Japanese city. Data were obtained from databases of the LTC insurer of City A in Japan. Binary logistic regression was used to examine the predictors of the highest long-term care expenditures. We used a simplified model that focused on the effects of disability status and type of services used, while controlling for several relevant factors. Goodness of fit, a multicollinearity test, and logistic regression diagnostics were carried out for the final model. The study cohort consisted of 862 current users of LTCI system in city A. After controlling for gender and income, age, increased utilization rate of benefits, decline in functional status, higher care needs level and institutional care were found to be associated with the highest LTCI expenditures. An increased utilization rate of benefits (OR = 24.2) was a strong main effect predictors of the high LTC expenditures. However, a significant interaction between institutional care and high care need level was found, providing evidence of the combined effect of the two covariates. Beyond to confirm that disability status of elderly persons is the main factor driving the demand of LTC services and consequently the expenditures, we showed that changes in utilization rate of benefits -a specific insurance factor- and the use of institutional care conditional on the high care level, were strongest predictors of

Medical homes versus individual practice in primary care: impact on health care expenditures.

PubMed

Perelman, Julian; Roch, Isabelle; Heymans, Isabelle; Moureaux, Catherine; Lagasse, Raphael; Annemans, Lieven; Closon, Marie-Christine

2013-08-01

The medical home (MH) model has prompted increasing attention given its potential to improve quality of care while reducing health expenditures. We compare overall and specific health care expenditures in Belgium, from the third-party payer perspective (compulsory social insurance), between patients treated at individual practices (IP) and at MHs. We compare the sociodemographic profile of MH and IP users. This is a retrospective study using public insurance claims data. Generalized linear models estimate the impact on health expenditures of being treated at a MH versus IP, controlling for individual, and area-based sociodemographic characteristics. The choice of primary care setting is modeled using logistic regressions. A random sample of 43,678 persons followed during the year 2004. Third-party payer expenditures for primary care, secondary care consultations, pharmaceuticals, laboratory tests, acute and long-term inpatient care. Overall third-party payer expenditures do not differ significantly between MH and IP users (€+27). Third-party payer primary care expenditures are higher for MH than for IP users (€+129), but this difference is offset by lower expenditures for secondary care consultations (€-11), drugs (€-40), laboratory tests (€-5) and acute and long-term inpatient care (€-53). MHs attract younger and more underprivileged populations. MHs induce a shift in expenditures from secondary care, drugs, and laboratory tests to primary care, while treating a less economically favored population. Combined with positive results regarding quality, MH structures are a promising way to tackle the challenges of primary care.

Automatic energy expenditure measurement for health science.

PubMed

Catal, Cagatay; Akbulut, Akhan

2018-04-01

It is crucial to predict the human energy expenditure in any sports activity and health science application accurately to investigate the impact of the activity. However, measurement of the real energy expenditure is not a trivial task and involves complex steps. The objective of this work is to improve the performance of existing estimation models of energy expenditure by using machine learning algorithms and several data from different sensors and provide this estimation service in a cloud-based platform. In this study, we used input data such as breathe rate, and hearth rate from three sensors. Inputs are received from a web form and sent to the web service which applies a regression model on Azure cloud platform. During the experiments, we assessed several machine learning models based on regression methods. Our experimental results showed that our novel model which applies Boosted Decision Tree Regression in conjunction with the median aggregation technique provides the best result among other five regression algorithms. This cloud-based energy expenditure system which uses a web service showed that cloud computing technology is a great opportunity to develop estimation systems and the new model which applies Boosted Decision Tree Regression with the median aggregation provides remarkable results. Copyright © 2018 Elsevier B.V. All rights reserved.

An Experimental Study in Determining Energy Expenditure from Treadmill Walking using Hip-Worn Inertial Sensors

PubMed Central

Vathsangam, Harshvardhan; Emken, Adar; Schroeder, E. Todd; Spruijt-Metz, Donna; Sukhatme, Gaurav S.

2011-01-01

This paper describes an experimental study in estimating energy expenditure from treadmill walking using a single hip-mounted triaxial inertial sensor comprised of a triaxial accelerometer and a triaxial gyroscope. Typical physical activity characterization using accelerometer generated counts suffers from two drawbacks - imprecison (due to proprietary counts) and incompleteness (due to incomplete movement description). We address these problems in the context of steady state walking by directly estimating energy expenditure with data from a hip-mounted inertial sensor. We represent the cyclic nature of walking with a Fourier transform of sensor streams and show how one can map this representation to energy expenditure (as measured by V O2 consumption, mL/min) using three regression techniques - Least Squares Regression (LSR), Bayesian Linear Regression (BLR) and Gaussian Process Regression (GPR). We perform a comparative analysis of the accuracy of sensor streams in predicting energy expenditure (measured by RMS prediction accuracy). Triaxial information is more accurate than uniaxial information. LSR based approaches are prone to outlier sensitivity and overfitting. Gyroscopic information showed equivalent if not better prediction accuracy as compared to accelerometers. Combining accelerometer and gyroscopic information provided better accuracy than using either sensor alone. We also analyze the best algorithmic approach among linear and nonlinear methods as measured by RMS prediction accuracy and run time. Nonlinear regression methods showed better prediction accuracy but required an order of magnitude of run time. This paper emphasizes the role of probabilistic techniques in conjunction with joint modeling of triaxial accelerations and rotational rates to improve energy expenditure prediction for steady-state treadmill walking. PMID:21690001

Indirect synthesis of multi-degree of freedom transient systems. [linear programming for a kinematically linear system

NASA Technical Reports Server (NTRS)

Pilkey, W. D.; Chen, Y. H.

1974-01-01

An indirect synthesis method is used in the efficient optimal design of multi-degree of freedom, multi-design element, nonlinear, transient systems. A limiting performance analysis which requires linear programming for a kinematically linear system is presented. The system is selected using system identification methods such that the designed system responds as closely as possible to the limiting performance. The efficiency is a result of the method avoiding the repetitive systems analyses accompanying other numerical optimization methods.

Private health care expenditure and quality in Beveridge systems: cross-regional differences in the Italian NHS.

PubMed

Del Vecchio, Mario; Fenech, Lorenzo; Prenestini, Anna

2015-03-01

Private health care expenditure ranges from 15% to 30% of total healthcare spending in OECD countries. The literature suggests that there should be an inverse correlation between quality of public services and private expenditures. The main objective of this study is to explore the association between quality of public healthcare and private expenditures in the Italian Regional Healthcare Systems (RHSs). The institutional framework offered by the Italian NHS allows to investigate on the differences among the regions while controlling for institutional factors. The study uses micro-data from the ISTAT Household Consumption Survey (HCS) and a rich set of regional quality indicators. The results indicate that there is a positive and significant correlation between quality and private spending per capita across regions. The study also points out the strong association between the distribution of private consumption and income. In order to account for the influence of income, the study segmented data in three socio-economic classes and computed cross-regional correlations of RHSs quality and household healthcare expenditure per capita, within each class. No correlation was found between the two variables. These findings are quite surprising and call into question the theory that better quality of public services crowds out private spending, or, at the very least, it undermines the simplistic notions that higher levels of private spending are a direct consequence of poor quality in the public sector. This suggests that policies should avoid to simplistically link private spending with judgements or assessments about the functioning or efficacy of the public system and its organizations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Predictors of the highest long-term care expenditures in Japan

PubMed Central

2011-01-01

Background In Japan, as the number of elderly covered by the Long-term Care Insurance (LTCI) system has increased, demand for long-term care services has increased substantially and consequently growing expenditures are threatening the sustainability of the system. Understanding the predictive factors associated with long-term care expenditures among the elderly would be useful in developing future strategies to ensure the sustainability of the system. We report a set of predictors of the highest long-term care expenditures in a cohort of elderly persons who received consecutive long-term care services during a year in a Japanese city. Methods Data were obtained from databases of the LTC insurer of City A in Japan. Binary logistic regression was used to examine the predictors of the highest long-term care expenditures. We used a simplified model that focused on the effects of disability status and type of services used, while controlling for several relevant factors. Goodness of fit, a multicollinearity test, and logistic regression diagnostics were carried out for the final model. Results The study cohort consisted of 862 current users of LTCI system in city A. After controlling for gender and income, age, increased utilization rate of benefits, decline in functional status, higher care needs level and institutional care were found to be associated with the highest LTCI expenditures. An increased utilization rate of benefits (OR = 24.2) was a strong main effect predictors of the high LTC expenditures. However, a significant interaction between institutional care and high care need level was found, providing evidence of the combined effect of the two covariates. Conclusions Beyond to confirm that disability status of elderly persons is the main factor driving the demand of LTC services and consequently the expenditures, we showed that changes in utilization rate of benefits -a specific insurance factor- and the use of institutional care conditional on the high care

Does drug price-regulation affect healthcare expenditures?

PubMed

Ben-Aharon, Omer; Shavit, Oren; Magnezi, Racheli

2017-09-01

Increasing health costs in developed countries are a major concern for decision makers. A variety of cost containment tools are used to control this trend, including maximum price regulation and reimbursement methods for health technologies. Information regarding expenditure-related outcomes of these tools is not available. To evaluate the association between different cost-regulating mechanisms and national health expenditures in selected countries. Price-regulating and reimbursement mechanisms for prescription drugs among OECD countries were reviewed. National health expenditure indices for 2008-2012 were extracted from OECD statistical sources. Possible associations between characteristics of different systems for regulation of drug prices and reimbursement and health expenditures were examined. In most countries, reimbursement mechanisms are part of publicly financed plans. Maximum price regulation is composed of reference-pricing, either of the same drug in other countries, or of therapeutic alternatives within the country, as well as value-based pricing (VBP). No association was found between price regulation or reimbursement mechanisms and healthcare costs. However, VBP may present a more effective mechanism, leading to reduced costs in the long term. Maximum price and reimbursement mechanism regulations were not found to be associated with cost containment of national health expenditures. VBP may have the potential to do so over the long term.

Trends in prescription drug expenditures by Medicaid enrollees.

PubMed

Banthin, Jessica S; Miller, G Edward

2006-05-01

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

Wealth, Health Expenditure, and Cancer: A National Perspective.

PubMed

Chahoud, Jad; Semaan, Adele; Rieber, Alyssa

2016-08-01

The US health care system is characterized by high health expenditures with penultimate outcomes. This ecological study evaluates the associations between wealth, health expenditure, and cancer outcomes at the state level. We extracted gross domestic product (GDP) and health expenditure per capita from the 2009 Bureau of Economic Analysis and the Centers for Medicare & Medicaid Services, respectively. Using data from the NCI, we retrieved colorectal cancer (CRC), breast cancer, and all-cancer age-adjusted rates and computed mortality/incidence (M/I) ratios. We used the Spearman's rank correlation to determine the association between the financial indicators and cancer outcomes, and we constructed geographic distribution maps to describe these associations. GDP per capita significantly correlated with lower M/I ratios for all cancers, breast cancer, and CRC. As for health expenditure per capita, preliminary analysis highlighted a rift between the Northeastern and Southern states, which translated into worse breast and all-cancer outcomes in Southern states. Further analysis showed that higher health expenditure significantly correlated with decreased breast cancer M/I ratio. However, CRC outcomes were not significantly affected by health expenditure, nor were all-cancer outcomes. All cancers, breast cancer, and CRC outcomes significantly correlated with wealth, whereas only breast cancer correlated with higher health expenditure. Future research is needed to evaluate the potential role of policies in optimizing resource allocation in the states' efforts against CRC and minimizing disparities in interstate cancer outcomes. Copyright © 2016 by the National Comprehensive Cancer Network.

Assessing out-of-pocket expenditures for primary health care: how responsive is the Democratic Republic of Congo health system to providing financial risk protection?

PubMed

Laokri, Samia; Soelaeman, Rieza; Hotchkiss, David R

2018-06-15

The goal of universal health coverage is challenging for chronically under-resourced health systems. Although household out-of-pocket payments are the most important source of health financing in low-income countries, relatively little is known about the drivers of primary health care expenditure and the predictability of the burden associated with high fee-for-service payments. This study describes out-of-pocket health expenditure and investigates demand- and supply-side drivers of excessive costs in the Democratic Republic of Congo (DRC), a central African country in the midst of a process of reforming its health financing system towards universal health coverage. A population-based household survey was conducted in four provinces of the DRC in 2014. Data included type, level and utilization of health care services, accessibility to care, patient satisfaction and disaggregated health care expenditure. Multivariate logistic regressions of excessive expenditure for outpatient care using alternative thresholds were performed to explore the incidence and predictors of atypically high expenditure incurred by individuals. Over 17% (17.5%) of individuals living in sample households reported an illness or injury without being hospitalized. Of 3341 individuals reporting an event in the four-week period prior to the survey, 65.6% sought outpatient care with an average of one visit (SD = 0.0). The overall mean expenditure per visit was US$ 6.7 (SD = 10.4) with 29.4% incurring excessive expenditure. The main predictors of a financial risk burden included utilizing public services offering the complementary benefit package, dissatisfaction with care received, being a member of a large household, expenditure composition, severity of illness, residence and wealth (p < .05). The insured status influenced the expenditure level, with no association with catastrophe. Those who did not seek care when needed reported financial constraints as the major reason for

Stochastic stability properties of jump linear systems

NASA Technical Reports Server (NTRS)

Feng, Xiangbo; Loparo, Kenneth A.; Ji, Yuandong; Chizeck, Howard J.

1992-01-01

Jump linear systems are defined as a family of linear systems with randomly jumping parameters (usually governed by a Markov jump process) and are used to model systems subject to failures or changes in structure. The authors study stochastic stability properties in jump linear systems and the relationship among various moment and sample path stability properties. It is shown that all second moment stability properties are equivalent and are sufficient for almost sure sample path stability, and a testable necessary and sufficient condition for second moment stability is derived. The Lyapunov exponent method for the study of almost sure sample stability is discussed, and a theorem which characterizes the Lyapunov exponents of jump linear systems is presented.

Is distribution of health expenditure in Iran pro-poor?

PubMed

Emamgholipour, Sara; Agheli, Lotfali

2018-05-03

The size and distribution of households' health care expenditure indicate the financial burden on different income groups. Since the distribution of health expenditure evaluates the performance of health systems, this study aims to examine the health expenditure distribution among urban and rural households in Iran. This research was conducted on the distribution of health expenditure among urban and rural households in 2014. The effects of households' health expenditure on distribution of personal incomes were measured by using Kakwani and Reynolds-Smolensky indices. In addition, Theil T index was used to classify provinces based on inequality in health expenditure distribution. The calculations were made by using EXCEL. The Kakwani indices for urban and rural households were calculated around -0.572 and -0.485, respectively. Reynolds-Smolensky indices for urban and rural households were measured as much as -0.038 and -0.031, respectively. Regardless of income distribution, Theil T index shows that urban households face with the most unequal distribution in health expenditure. Based on calculations, the distribution of health expenditure is against the poor households. In addition, this distribution is more regressive in urban than rural households. As well, Reynolds-Smolensky indices indicate more uneven income distribution after paying for health care, and inequality is larger among urban than rural households. To this research, the health policymaking priorities should be given to the provinces with the highest inequality, and the expenditure burden of low-income households should be reduced through expanding insurance coverage. Copyright © 2018 John Wiley & Sons, Ltd.

Households encountering with catastrophic health expenditures in Ferdows, Iran.

PubMed

Ghoddoosinejad, Javad; Jannati, Ali; Gholipour, Kamal; Baghban Baghestan, Elham

2014-08-01

Out-of-pocket payments are the main sources of healthcare financing in most developing countries. Healthcare services can impose a massive cost burden on households, especially in developing countries. The purpose of this study was to calculate households encountered with catastrophic healthcare expenditures in Ferdows, Iran. The sample included 100 households representing 20% of all households in Ferdows, Iran. The data were collected using self-administered questionnaire. The ability to pay of households was calculated, and then if costs of household health were at least 40% of their ability to pay, it was considered as catastrophic expenditures. Rate of households encountered to catastrophic health expenditures was estimated to be 24%, of which dentistry services had the highest part in catastrophic health expenditures. Low ability to pay of households should be supported against these expenditures. More equitable health system would solve the problem, although more financial aid should be provided for households encountered to catastrophic costs.

Asymptotic Stability of Interconnected Passive Non-Linear Systems

NASA Technical Reports Server (NTRS)

Isidori, A.; Joshi, S. M.; Kelkar, A. G.

1999-01-01

This paper addresses the problem of stabilization of a class of internally passive non-linear time-invariant dynamic systems. A class of non-linear marginally strictly passive (MSP) systems is defined, which is less restrictive than input-strictly passive systems. It is shown that the interconnection of a non-linear passive system and a non-linear MSP system is globally asymptotically stable. The result generalizes and weakens the conditions of the passivity theorem, which requires one of the systems to be input-strictly passive. In the case of linear time-invariant systems, it is shown that the MSP property is equivalent to the marginally strictly positive real (MSPR) property, which is much simpler to check.

Alcohol consumption and household expenditure on alcohol in a rural district in Vietnam.

PubMed

Giang, Kim Bao; Van Minh, Hoang; Allebeck, Peter

2013-01-28

Alcohol use and alcohol-related problems are on the rise in low- and middle-income countries. Expenditure on alcohol is an important problem for families and communities and needs to be assessed. This study examines level of alcohol consumption and expenditure on alcohol in a district in Vietnam. A cross-sectional survey was conducted in a rural district in northern Vietnam. Multi-stage sampling was employed to randomly select participants from 20 communities and a town in the same district. One thousand five hundred and sixty-four adults (765 males and 799 females) aged 18-60 years were interviewed. Information about alcohol use as well as expenditure on alcohol consumption four weeks prior to the interview was gathered. Non-parametric tests and log-linear regression were employed to compare expenditure on alcohol consumption across socioeconomic groups. The prevalence of alcohol use one month prior to interview was 35% (66% among men and 5% among women). The median alcohol consumption among those who reported use of alcohol in the week prior to the interview was 7.9 standard drinks. Excessive drinking (more than 14 standard drinks per week for men and more than seven standard drinks per week for women) occurred among 35% of those who used alcohol. Median expenditure for alcohol consumption during one month by those who drank alcohol was USD 3.5, accounting for 4.6% of household food expenditure, 2.7% of total household expenditure, and 1.8% of household income. The differences in alcohol consumption and expenditure between sexes and between socioeconomic groups are also presented. Our study confirms that alcohol consumption and alcohol-related problems are common among men in Vietnam. The share of alcohol expenditure in total household expenditure is substantial, especially among poor households. This should be considered an important public health issue, which needs to be taken into account in the alcohol policy debate.

Ablation of Sim1 Neurons Causes Obesity through Hyperphagia and Reduced Energy Expenditure

PubMed Central

Xi, Dong; Gandhi, Nilay; Lai, Meizan; Kublaoui, Bassil M.

2012-01-01

Single-minded 1 (Sim1) is a transcription factor necessary for development of the paraventricular nucleus of the hypothalamus (PVH). This nucleus is a critical regulator of appetite, energy expenditure and body weight. Previously we showed that Sim1+/− mice and conditional postnatal Sim1−/− mice exhibit hyperphagia, obesity, increased linear growth and susceptibility to diet-induced obesity, but no decrease in energy expenditure. Bilateral ablation of the PVH causes obesity due to hyperphagia and reduced energy expenditure. It remains unknown whether Sim1 neurons regulate energy expenditure. In this study, Sim1cre mice were bred to homozygous inducible diphtheria toxin receptor (iDTR) mice to generate mice expressing the simian DTR in Sim1 cells. In these mice, Sim1 neuron ablation was performed by intracerebroventricular (ICV) injection of diphtheria toxin. Compared to controls, mice with Sim1 neuron ablation became obese (with increased fat mass) on a chow diet due to increased food intake and reduced energy expenditure. In post-injection mice, we observed a strong inverse correlation between the degree of obesity and hypothalamic Sim1 expression. The reduction in baseline energy expenditure observed in these mice was accompanied by a reduction in activity. This reduction in activity did not fully account for the reduced energy expenditure as these mice exhibited decreased resting energy expenditure, decreased body temperature, decreased brown adipose tissue temperature, and decreased UCP1 expression suggesting an impairment of thermogenesis. In injected mice, hypothalamic gene expression of Sim1, oxytocin (OXT) and thyrotropin releasing hormone (TRH) was reduced by about 50%. These results demonstrate that Sim1 neurons in adult mice regulate both food intake and energy expenditure. Based on the body of work in the field, feeding regulation by Sim1 neurons likely occurs in both the PVH and medial amygdala, in contrast to energy expenditure regulation by Sim

Ablation of Sim1 neurons causes obesity through hyperphagia and reduced energy expenditure.

PubMed

Xi, Dong; Gandhi, Nilay; Lai, Meizan; Kublaoui, Bassil M

2012-01-01

Single-minded 1 (Sim1) is a transcription factor necessary for development of the paraventricular nucleus of the hypothalamus (PVH). This nucleus is a critical regulator of appetite, energy expenditure and body weight. Previously we showed that Sim1(+/-) mice and conditional postnatal Sim1(-/-) mice exhibit hyperphagia, obesity, increased linear growth and susceptibility to diet-induced obesity, but no decrease in energy expenditure. Bilateral ablation of the PVH causes obesity due to hyperphagia and reduced energy expenditure. It remains unknown whether Sim1 neurons regulate energy expenditure. In this study, Sim1cre mice were bred to homozygous inducible diphtheria toxin receptor (iDTR) mice to generate mice expressing the simian DTR in Sim1 cells. In these mice, Sim1 neuron ablation was performed by intracerebroventricular (ICV) injection of diphtheria toxin. Compared to controls, mice with Sim1 neuron ablation became obese (with increased fat mass) on a chow diet due to increased food intake and reduced energy expenditure. In post-injection mice, we observed a strong inverse correlation between the degree of obesity and hypothalamic Sim1 expression. The reduction in baseline energy expenditure observed in these mice was accompanied by a reduction in activity. This reduction in activity did not fully account for the reduced energy expenditure as these mice exhibited decreased resting energy expenditure, decreased body temperature, decreased brown adipose tissue temperature, and decreased UCP1 expression suggesting an impairment of thermogenesis. In injected mice, hypothalamic gene expression of Sim1, oxytocin (OXT) and thyrotropin releasing hormone (TRH) was reduced by about 50%. These results demonstrate that Sim1 neurons in adult mice regulate both food intake and energy expenditure. Based on the body of work in the field, feeding regulation by Sim1 neurons likely occurs in both the PVH and medial amygdala, in contrast to energy expenditure regulation by Sim1

Effect of chewing speed on energy expenditure in healthy subjects.

PubMed

Paphangkorakit, Jarin; Leelayuwat, Naruemon; Boonyawat, Nattawat; Parniangtong, Auddamar; Sripratoom, Jindamanee

2014-08-01

The aim of the study was to investigate the effect of rate of chewing on energy expenditure in human subjects. Fourteen healthy subjects (aged 18-24 years) within the normal range of BMI participated in a cross-over experiment consisting of two 6-min sessions of gum chewing, slow (∼60 cycles/min) and fast (∼120 cycles/min) chewing. The resting energy expenditure (REE) and during gum chewing was measured using a ventilated hood connected to a gas analyzer system. The normality of data was explored using the Shapiro-Wilk test. The energy expenditure rate during chewing and the energy expenditure per chewing cycle were compared between the two chewing speeds using Wilcoxon signed ranks tests. The energy expenditure per chewing cycle during slow chewing (median 1.4, range 5.2 cal; mean 2.1±1.6 cal) was significantly higher than that during fast chewing (median 0.9, range 2.2 cal; mean 1.0±0.7 cal) (p < 0.005). However, the energy expenditure rate was not significantly different between the two chewing speeds (p > 0.05). The results of this study suggest that chewing at a slower speed could increase the energy expenditure per cycle and might affect the total daily energy expenditure.

Intersystem return on investment in public mental health: Positive externality of public mental health expenditure for the jail system in the U.S.

PubMed

Yoon, Jangho; Luck, Jeff

2016-12-01

This study examines the extent to which increased public mental health expenditures lead to a reduction in jail populations and computes the associated intersystem return on investment (ROI). We analyze unique panel data on 44 U.S. states and D.C. for years 2001-2009. To isolate the intersystem spillover effect, we exploit variations across states and over time within states in per capita public mental health expenditures and average daily jail inmates. Regression models control for a comprehensive set of determinants of jail incarcerations as well as unobserved determinants specific to state and year. Findings show a positive spillover benefit of increased public mental health spending on the jail system: a 10% increase in per capita public inpatient mental health expenditure on average leads to a 1.5% reduction in jail inmates. We also find that the positive intersystem externality of increased public inpatient mental health expenditure is greater when the level of community mental health spending is lower. Similarly, the intersystem spillover effect of community mental health expenditure is larger when inpatient mental health spending is lower. We compute that overall an extra dollar in public inpatient mental health expenditure by a state would yield an intersystem ROI of a quarter dollar for the jail system. There is significant cross-state variation in the intersystem ROI in both public inpatient and community mental health expenditures, and the ROI overall is greater for inpatient mental health spending than for community mental health spending. Copyright © 2016. Published by Elsevier Ltd.

Health care resource use, health care expenditures and absenteeism costs associated with osteoarthritis in US healthcare system.

PubMed

Menon, J; Mishra, P

2018-04-01

We determined incremental health care resource utilization, incremental health care expenditures, incremental absenteeism, and incremental absenteeism costs associated with osteoarthritis. Medical Expenditure Panel Survey (MEPS) for 2011 was used as data source. Individuals 18 years or older and employed during 2011 were eligible for inclusion in the sample for analyses. Individuals with osteoarthritis were identified based on ICD-9-CM codes. Incremental health care resource utilization included annual hospitalization, hospital days, emergency room visits and outpatient visits. Incremental health expenditures included annual inpatient, outpatient, emergency room, medications, miscellaneous and annual total expenditures. Of the total sample, 1354 were diagnosed with osteoarthritis, and compared to non osteoarthritis individuals. Incremental resource utilization, expenditures, absenteeism and absenteeism costs were estimated using regression models, adjusting for age, gender, sex, region, marital status, insurance coverage, comorbidities, anxiety, asthma, hypertension and hyperlipidemia. Regression models revealed incremental mean annual resource use associated with osteoarthritis of 0.07 hospitalizations, equal to 70 additional hospitalizations per 100 osteoarthritic patients annually, and 3.63 outpatient visits, equal to 363 additional visits per 100 osteoarthritic patients annually. Mean annual incremental total expenditures associated with osteoarthritis were $2046. Annually, mean incremental expenditures were largest for inpatient expenditures at $826, followed by mean incremental outpatient expenditures of $659, and mean incremental medication expenditures of $325. Mean annual incremental absenteeism was 2.2 days and mean annual incremental absenteeism costs were $715.74. Total direct expenditures were estimated at $41.7 billion. Osteoarthritis was associated with significant incremental health care resource utilization, expenditures, absenteeism and

Gender, marital status, and commercially prepared food expenditure.

PubMed

Kroshus, Emily

2008-01-01

Assess how per capita expenditure on commercially prepared food as a proportion of total food expenditure varies by the sex and marital status of the head of the household. Prospective cohort study, data collected by the United States Bureau of Labor Statistics 2004 Consumer Expenditure Survey. United States. Randomly selected nationally representative sample of 5744 US citizens. Per capita spending on commercially prepared food (dependent variable) for every $1 increase in total per capita food spending (independent variable). Linear regressions run separately for each permutation of gender and marital status (never married, married, divorced/separated). Proportionate per capita household expenditure on commercially prepared food was found to vary by marital status and gender. Households headed by unmarried men (both divorced/separated and never married) spent a significantly greater proportion of their food budget on commercially prepared food than their married male peers (38% and 60% higher, respectively). Regardless of marital status, households headed by women were found to spend approximately one-third of their total food budget on commercially prepared foods outside the home. Households headed by never married men spent 63% more per capita than those headed by never married women and households headed by divorced or separated men spent 37% more than those headed by divorced or separated women. Marital status is significantly related to the dietary patterns of households headed by men. In light of the high rates of divorce, separation, and delay of marriage, marriage cannot be considered an inclusive or permanent solution to changing male eating patterns. It is important that nutrition educators learn more about the dietary patterns of households headed by males outside the institution of marriage.

National Health Expenditures, 1993

PubMed Central

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

1994-01-01

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

Emergy Expenditure Among Municipal Wastewater Treatment Systems Across US

EPA Science Inventory

The urbanization of the modern community creates large population centers that generate concentrated wastewater. A large expenditure on wastewater treatment has to be invested to make a modern city function without human and environmental health problems. Society relies on syste...

How Important Are Health Care Expenditures for Life Expectancy? A Comparative, European Analysis.

PubMed

van den Heuvel, Wim J A; Olaroiu, Marinela

2017-03-01

The relationship between health care expenditures and health care outcomes, such as life expectancy and mortality, is complex. Research outcomes show different and contradictory results on this relationship. How and why health care expenditures affect health outcomes is not clear. A causal link between the two is not proven. Without such knowledge, effects of increase/decrease in health care expenses on health outcomes may be overestimated/underestimated. This study analyzes the relationship between life expectancy at birth and expenditures on health care, taking into account expenditures of social production and education, as well as the quantity and quality of health care provisions and lifestyles. This is a cross-sectional study, analyzing national data of 31 European countries. First, the bivariate correlation between the dependent variable and independent variables are calculated and described. Next a forward linear regression analysis is applied. The data are derived from standardized, comparative data bases as available in the Organisation for Economic Co-operation and Development and Eurostat. Health care expenditures are assessed as a percentage of the Gross Domestic Product (GDP). Health care expenditures are not the main determinant of life expectancy at birth, but social protection expenditures are. The regression analysis shows that in countries that spend a high percentage of their GDP on social protection, that have fewer curative beds and low infant mortality, whose citizens report fewer unmet health care needs and drink less alcohol, citizens have a significant longer life expectancy. To realize high life expectancy of citizens, policy measures have to be directed on investment in social protection expenditures, on improving quality of care, and on promoting a healthy life style. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

A linear quadratic regulator approach to the stabilization of uncertain linear systems

NASA Technical Reports Server (NTRS)

Shieh, L. S.; Sunkel, J. W.; Wang, Y. J.

1990-01-01

This paper presents a linear quadratic regulator approach to the stabilization of uncertain linear systems. The uncertain systems under consideration are described by state equations with the presence of time-varying unknown-but-bounded uncertainty matrices. The method is based on linear quadratic regulator (LQR) theory and Liapunov stability theory. The robust stabilizing control law for a given uncertain system can be easily constructed from the symmetric positive-definite solution of the associated augmented Riccati equation. The proposed approach can be applied to matched and/or mismatched systems with uncertainty matrices in which only their matrix norms are bounded by some prescribed values and/or their entries are bounded by some prescribed constraint sets. Several numerical examples are presented to illustrate the results.

Estimation of Energy Expenditure during Treadmill Exercise via Thermal Imaging.

PubMed

Jensen, Martin Møller; Poulsen, Mathias Krogh; Alldieck, Thiemo; Larsen, Ryan Godsk; Gade, Rikke; Moeslund, Thomas Baltzer; Franch, Jesper

2016-12-01

Noninvasive imaging of oxygen uptake may provide a useful tool for the quantification of energy expenditure during human locomotion. A novel thermal imaging method (optical flow) was validated against indirect calorimetry for the estimation of energy expenditure during human walking and running. Fourteen endurance-trained subjects completed a discontinuous incremental exercise test on a treadmill. Subjects performed 4-min intervals at 3, 5, and 7 km·h (walking) and at 8, 10, 12, 14, 16, and 18 km·h (running) with 30 s of rest between intervals. Heart rate, gas exchange, and mean accelerations of ankle, thigh, wrist, and hip were measured throughout the exercise test. A thermal camera (30 frames per second) was used to quantify optical flow, calculated as the movements of the limbs relative to the trunk (internal mechanical work) and vertical movement of the trunk (external vertical mechanical work). Heart rate, gross oxygen uptake (mL·kg·min) together with gross and net energy expenditure (J·kg·min) rose with increasing treadmill velocities, as did optical flow measurements and mean accelerations (g) of ankle, thigh, wrist, and hip. Oxygen uptake was linearly correlated with optical flow across all exercise intensities (R = 0.96, P < 0.0001; V˙O2 [mL·kg·min] = 7.35 + 9.85 × optical flow [arbitrary units]). Only 3-4 s of camera recording was required to estimate an optical flow value at each velocity. Optical flow measurements provide an accurate estimation of energy expenditure during horizontal walking and running. The technique offers a novel experimental method of estimating energy expenditure during human locomotion, without use of interfering equipment attached to the subject.

Depression treatment decreases healthcare expenditures among working age patients with comorbid conditions and type 2 diabetes mellitus along with newly-diagnosed depression.

PubMed

Bhattacharya, Rituparna; Shen, Chan; Wachholtz, Amy B; Dwibedi, Nilanjana; Sambamoorthi, Usha

2016-07-19

There are many studies in the literature on the association between depression treatment and health expenditures. However, there is a knowledge gap in examining this relationship taking into account coexisting chronic conditions among patients with diabetes. We aim to analyze the association between depression treatment and healthcare expenditures among adults with Type 2 Diabetes Mellitus (T2DM) and newly-diagnosed depression, with consideration of coexisting chronic physical conditions. We used multi-state Medicaid data (2000-2008) and adopted a retrospective longitudinal cohort design. Medical conditions were identified using diagnosis codes (ICD-9-CM and CPT systems). Healthcare expenditures were aggregated for each month for 12 months. Types of coexisting chronic physical conditions were hierarchically grouped into: dominant, concordant, discordant, and both concordant and discordant. Depression treatment categories were as follows: antidepressants or psychotherapy, both antidepressants and psychotherapy, and no treatment. We used linear mixed-effects models on log-transformed expenditures (total and T2DM-related) to examine the relationship between depression treatment and health expenditures. The analyses were conducted on the overall study population and also on subgroups that had coexisting chronic physical conditions. Total healthcare expenditures were reduced by treatment with antidepressants (16 % reduction), psychotherapy (22 %), and both therapy types in combination (28 %) compared to no depression treatment. Treatment with both antidepressants and psychotherapy was associated with reductions in total healthcare expenditures among all groups that had a coexisting chronic physical condition. Among adults with T2DM and chronic conditions, treatment with both antidepressants and psychotherapy may result in economic benefits.

10 CFR 440.18 - Allowable expenditures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... part for labor, weatherization materials, and related matters for a renewable energy system, shall not... beginning in calendar year 2010 and the $3,000 average for renewable energy systems will be adjusted... compliance with the per-home expenditure limit in § 440.18. Each dwelling unit must receive a new energy...

10 CFR 440.18 - Allowable expenditures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... part for labor, weatherization materials, and related matters for a renewable energy system, shall not... beginning in calendar year 2010 and the $3,000 average for renewable energy systems will be adjusted... compliance with the per-home expenditure limit in § 440.18. Each dwelling unit must receive a new energy...

10 CFR 440.18 - Allowable expenditures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... part for labor, weatherization materials, and related matters for a renewable energy system, shall not... beginning in calendar year 2010 and the $3,000 average for renewable energy systems will be adjusted... compliance with the per-home expenditure limit in § 440.18. Each dwelling unit must receive a new energy...

10 CFR 440.18 - Allowable expenditures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... part for labor, weatherization materials, and related matters for a renewable energy system, shall not... beginning in calendar year 2010 and the $3,000 average for renewable energy systems will be adjusted... 10 Energy 3 2010-01-01 2010-01-01 false Allowable expenditures. 440.18 Section 440.18 Energy...

10 CFR 440.18 - Allowable expenditures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... part for labor, weatherization materials, and related matters for a renewable energy system, shall not... beginning in calendar year 2010 and the $3,000 average for renewable energy systems will be adjusted... 10 Energy 3 2011-01-01 2011-01-01 false Allowable expenditures. 440.18 Section 440.18 Energy...

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

PubMed

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

2013-07-18

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

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

PubMed Central

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

2013-01-01

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

Role of leptin in energy expenditure: the hypothalamic perspective.

PubMed

Pandit, R; Beerens, S; Adan, R A H

2017-06-01

The adipocyte-derived hormone leptin is a peripheral signal that informs the brain about the metabolic status of an organism. Although traditionally viewed as an appetite-suppressing hormone, studies in the past decade have highlighted the role of leptin in energy expenditure. Leptin has been shown to increase energy expenditure in particular through its effects on the cardiovascular system and brown adipose tissue (BAT) thermogenesis via the hypothalamus. The current review summarizes the role of leptin signaling in various hypothalamic nuclei and its effects on the sympathetic nervous system to influence blood pressure, heart rate, and BAT thermogenesis. Specifically, the role of leptin signaling on three different hypothalamic nuclei, the dorsomedial hypothalamus, the ventromedial hypothalamus, and the arcuate nucleus, is reviewed. It is known that all of these brain regions influence the sympathetic nervous system activity and thereby regulate BAT thermogenesis and the cardiovascular system. Thus the current work focuses on how leptin signaling in specific neuronal populations within these hypothalamic nuclei influences certain aspects of energy expenditure. Copyright © 2017 the American Physiological Society.

Cost Sharing, Health Care Expenditures, and Utilization: An International Comparison.

PubMed

Perkowski, Patryk; Rodberg, Leonard

2016-01-01

Health systems implement cost sharing to help reduce health care expenditure and utilization by discouraging the use of unnecessary health care services. We examine cost sharing in 28 countries in the Organisation for Economic Co-operation and Development from 1999 through 2009 in the areas of medical care, hospital care, and pharmaceuticals. We investigate associations between cost sharing, health care expenditures, and health care utilization and find no significant association between cost sharing and health care expenditures or utilization in these countries. © The Author(s) 2015.

Systems of Inhomogeneous Linear Equations

NASA Astrophysics Data System (ADS)

Scherer, Philipp O. J.

Many problems in physics and especially computational physics involve systems of linear equations which arise e.g. from linearization of a general nonlinear problem or from discretization of differential equations. If the dimension of the system is not too large standard methods like Gaussian elimination or QR decomposition are sufficient. Systems with a tridiagonal matrix are important for cubic spline interpolation and numerical second derivatives. They can be solved very efficiently with a specialized Gaussian elimination method. Practical applications often involve very large dimensions and require iterative methods. Convergence of Jacobi and Gauss-Seidel methods is slow and can be improved by relaxation or over-relaxation. An alternative for large systems is the method of conjugate gradients.

[Influence of income on food expenditures away from home among Brazilian families, 2002-2003].

PubMed

Claro, Rafael Moreira; Levy, Renata Bertazzi; Bandoni, Daniel Henrique

2009-11-01

This study describes and evaluates the influence of income on the percentage of food expenditures away from home for Brazilian families. Food acquisition data from the National Household Budget Survey conducted from 2002 to 2003 (POF 2002/2003) by the Brazilian Institute of Geography and Statistics (IBGE) or National Census Bureau was used in the analysis. Information on food-and-drink expenditures away from home was analyzed. The influence of income on the share of food purchased away from home in the household budget, adjusted for socio-demographic variables, was analyzed through elasticity coefficients estimated in multiple linear regression. Food purchased away from home accounted for 21% of total food expenditures by Brazilian households. A 10% increase in income increased the share of food purchased away from home by 3%. Income elasticity was high, especially for the lowest income families. The results demonstrate an important influence of income on food expenditures away from home, and higher income is associated with a greater share of food purchased away from home.

Activity Profile and Energy Expenditure Among Active Older Adults, British Columbia, 2011-2012.

PubMed

Madden, Kenneth M; Ashe, Maureen C; Chase, Jocelyn M

2015-07-16

Time spent by young adults in moderate to vigorous activity predicts daily caloric expenditure. In contrast, caloric expenditure among older adults is best predicted by time spent in light activity. We examined highly active older adults to examine the biggest contributors to energy expenditure in this population. Fifty-four community-dwelling men and women aged 65 years or older (mean, 71.4 y) were enrolled in this cross-sectional observational study. All were members of the Whistler Senior Ski Team, and all met current American guidelines for physical activity. Activity levels (sedentary, light, and moderate to vigorous) were recorded by accelerometers worn continuously for 7 days. Caloric expenditure was measured using accelerometry, galvanic skin response, skin temperature, and heat flux. Significant variables were entered into a stepwise multivariate linear model consisting of activity level, age, and sex. The average (standard deviation [SD]) daily nonlying sedentary time was 564 (92) minutes (9.4 [1.5] h) per day. The main predictors of higher caloric expenditure were time spent in moderate to vigorous activity (standardized β = 0.42 [SE, 0.08]; P < .001) and male sex (standardized β = 1.34 [SE, 0.16]; P < .001). A model consisting of only moderate to vigorous physical activity and sex explained 68% of the variation in caloric expenditure. An increase in moderate to vigorous physical activity by 1 minute per day was associated with an additional 16 kcal expended in physical activity. The relationship between activity intensity and caloric expenditure in athletic seniors is similar to that observed in young adults. Active older adults still spend a substantial proportion of the day engaged in sedentary behaviors.

Linear systems on balancing chemical reaction problem

NASA Astrophysics Data System (ADS)

Kafi, R. A.; Abdillah, B.

2018-01-01

The concept of linear systems appears in a variety of applications. This paper presents a small sample of the wide variety of real-world problems regarding our study of linear systems. We show that the problem in balancing chemical reaction can be described by homogeneous linear systems. The solution of the systems is obtained by performing elementary row operations. The obtained solution represents the finding coefficients of chemical reaction. In addition, we present a computational calculation to show that mathematical software such as Matlab can be used to simplify completion of the systems, instead of manually using row operations.

Linear quadratic optimization for positive LTI system

NASA Astrophysics Data System (ADS)

Muhafzan, Yenti, Syafrida Wirma; Zulakmal

2017-05-01

Nowaday the linear quadratic optimization subject to positive linear time invariant (LTI) system constitute an interesting study considering it can become a mathematical model of variety of real problem whose variables have to nonnegative and trajectories generated by these variables must be nonnegative. In this paper we propose a method to generate an optimal control of linear quadratic optimization subject to positive linear time invariant (LTI) system. A sufficient condition that guarantee the existence of such optimal control is discussed.

National trends in prescription drug expenditures and projections for 2016.

PubMed

Schumock, Glen T; Li, Edward C; Suda, Katie J; Wiest, Michelle D; Stubbings, JoAnn; Matusiak, Linda M; Hunkler, Robert J; Vermeulen, Lee C

2016-07-15

Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2016 in nonfederal hospitals, clinics, and overall (all sectors). Drug expenditure data through calendar year 2015 were obtained from the IMS Health National Sales Perspectives database and analyzed. Other factors that may influence drug spending in hospitals and clinics in 2016, including new drug approvals and patent expirations, were also reviewed. Expenditure projections for 2016 were based on a combination of quantitative analyses and expert opinion. Total U.S. prescription sales in the 2015 calendar year were $419.4 billion, which was 11.7% higher than sales in 2014. Prescription expenditures in clinics and nonfederal hospitals totaled $56.7 billion (a 15.9% increase) and $33.6 billion (a 10.7% increase), respectively, in 2015. In nonfederal hospitals, growth in spending was driven primarily by increased prices for existing drugs. The hepatitis C combination drug ledipasvir-sofosbuvir was the top drug overall in terms of 2015 expenditures ($14.3 billion); in both clinics and nonfederal hospitals, infliximab was the top drug. Individual drugs with the greatest increases in expenditures in 2015 were specialty agents and older generics; these agents are likely to continue to influence total spending in 2016. We project an 11-13% increase in total drug expenditures overall in 2016, with a 15-17% increase in clinic spending and a 10-12% increase in hospital spending. Health-system pharmacy leaders should carefully examine local drug utilization patterns in projecting their own organization's drug spending in 2016. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

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

PubMed

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

2013-10-22

Research on the impact of depression treatment on expenditures is nascent and shows results that vary from negative associations with healthcare expenditures to increased expenditures. However many of these studies did not include psychotherapy as part of the depression treatment. None of these studies included "no treatment" as a comparison group. In addition, no study has included a broad group of chronic physical conditions in studying depression treatment expenditures. We determined the association between depression treatment and short-term healthcare expenditures using a nationally representative sample of Medicare beneficiaries with chronic physical conditions and depression. In this retrospective cohort study, we examined the association between depression treatment in the baseline year and healthcare expenditures in the following year using data from 2000 through 2005 of the Medicare Current Beneficiary Survey (MCBS), a nationally representative survey of Medicare beneficiaries. Using the rotating panel design of MCBS, we derived five two-year cohorts: 2000-2001, 2001-2002, 2002-2003, 2003-2004, and 2004-2005. The study sample included 1,055 elderly Medicare beneficiaries aged 65 or over. We compared healthcare expenditures of no depression treatment group with depression treatment groups using t-tests. Linear regressions of log-transformed dollars were used to assess the relationship between depression treatment and healthcare expenditures after controlling for demographic, socio-economic, health status, lifestyle risk factors, year of observation and baseline expenditures. Compared to no depression treatment ($16,795), the average total expenditures were higher for those who used antidepressants only ($17,425) and those who used psychotherapy with or without antidepressants ($19,733). After controlling for the independent variables, antidepressant use and psychotherapy with or without antidepressants were associated with 20.2% (95% CI: 14.1-26.7%) and 29

Projecting future drug expenditures in U.S. nonfederal hospitals and clinics--2013.

PubMed

Hoffman, James M; Li, Edward; Doloresco, Fred; Matusiak, Linda; Hunkler, Robert J; Shah, Nilay D; Vermeulen, Lee C; Schumock, Glen T

2013-03-15

Factors likely to influence drug expenditures, drug expenditure trends in 2012, and projected drug expenditures for U.S. nonfederal hospitals and clinics in 2013 are discussed. Prescription drug expenditure data for 2011 through September 2012 were obtained from the IMS Health National Sales Perspectives database. Expenditure projections were based on a combination of quantitative and qualitative analyses, combined with expert opinion. Total prescription sales in the United States for the 12-month period ending September 2012 were $326.0 billion, a 0.8% increase from the previous 12 months. This rate of growth was the lowest in recent history and can be attributed to modest increases in expenditures for new products (3.3%) and the prices of existing products (5.9%), coupled with a marked decline in overall volume and mix (-8.4%). For the 9 months ending in September 2012, total prescription expenditures grew 2.7% when compared with the same period in 2011. Oncology products remained important expenditures for hospitals and clinics. Antineoplastic agents were the top medication class for expenditures in nonfederal hospitals, and oncology products accounted for 32.2% of drug expenditures in the clinic setting in the first 9 months of 2012. For 2013, we project a 1-3% increase in total drug expenditures across all settings, a 2-4% increase in expenditures for clinic-administered drugs, and a 0.5% decline to 1.5% increase in hospital drug expenditures. Health-system pharmacy leaders should carefully examine their own local drug-utilization patterns to determine their own organization's drug expenditure forecast.

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

PubMed Central

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

2012-01-01

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

Cotton-type and joint invariants for linear elliptic systems.

PubMed

Aslam, A; Mahomed, F M

2013-01-01

Cotton-type invariants for a subclass of a system of two linear elliptic equations, obtainable from a complex base linear elliptic equation, are derived both by spliting of the corresponding complex Cotton invariants of the base complex equation and from the Laplace-type invariants of the system of linear hyperbolic equations equivalent to the system of linear elliptic equations via linear complex transformations of the independent variables. It is shown that Cotton-type invariants derived from these two approaches are identical. Furthermore, Cotton-type and joint invariants for a general system of two linear elliptic equations are also obtained from the Laplace-type and joint invariants for a system of two linear hyperbolic equations equivalent to the system of linear elliptic equations by complex changes of the independent variables. Examples are presented to illustrate the results.

Cotton-Type and Joint Invariants for Linear Elliptic Systems

PubMed Central

Aslam, A.; Mahomed, F. M.

2013-01-01

Cotton-type invariants for a subclass of a system of two linear elliptic equations, obtainable from a complex base linear elliptic equation, are derived both by spliting of the corresponding complex Cotton invariants of the base complex equation and from the Laplace-type invariants of the system of linear hyperbolic equations equivalent to the system of linear elliptic equations via linear complex transformations of the independent variables. It is shown that Cotton-type invariants derived from these two approaches are identical. Furthermore, Cotton-type and joint invariants for a general system of two linear elliptic equations are also obtained from the Laplace-type and joint invariants for a system of two linear hyperbolic equations equivalent to the system of linear elliptic equations by complex changes of the independent variables. Examples are presented to illustrate the results. PMID:24453871

Eat, Drink, Man, Woman: Gender, Income Share and Household Expenditure in South Africa

ERIC Educational Resources Information Center

Gummerson, Elizabeth; Schneider, Daniel

2013-01-01

This study examines how gendered household bargaining occurs in non-nuclear family households. We employ two South African data sets and use linear regression and household fixed effects to investigate the relationship between women's income shares and household expenditures. In married couple households, when women garner larger shares of income,…

Systematic review of factors affecting pharmaceutical expenditures.

PubMed

Mousnad, Mohamed Awad; Shafie, Asrul Akmal; Ibrahim, Mohamed Izham

2014-06-01

To systematically identify the main factors contributing to the increase in pharmaceutical expenditures. A systematic search of published studies was conducted utilising major widely used electronic databases using the search terms 'factors,' 'financing,' 'pharmaceutical,' and 'expenditures.' To be included, the studies needed to: (1) measure at least one of the following outcomes: total growth in pharmaceutical expenditures, price growth or quantity growth; (2) mention a clear method for analysing the impact of factors affecting the increases in drug expenditures; (3) be written in English. Nonprimary articles that were published only as an abstract, a review, a commentary or a letter were excluded. From a total of 2039 studies, only 25 were included in the full review. The main determinant categories that were identified in the review were factors related to price, utilisation, therapeutic choice, demand and health care system. The major cost drivers were found to be changes in drug quantities and therapies as well as new drugs. It is important for policymakers to understand pharmaceutical spending trends and the factors that influence them in order to formulate effective cost containment strategies and design optimum drug policy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Human Energy Expenditure and Postural Coordination on the Mechanical Horse.

PubMed

Baillet, Héloïse; Thouvarecq, Régis; Vérin, Eric; Tourny, Claire; Benguigui, Nicolas; Komar, John; Leroy, David

2017-01-01

The authors investigated and compared the energy expenditure and postural coordination of two groups of healthy subjects on a mechanical horse at 4 increasing oscillation frequencies. Energy expenditure was assessed from the oxygen consumption, respiratory quotient, and heart rate values, and postural coordination was characterized by relative phase computations between subjects (elbow, head, trunk) and horse. The results showed that the postural coordination of the riders was better adapted (i.e., maintenance of in-phase and antiphase) than that of the nonriders, but the energy expenditure remains the same. Likewise, we observed an energy system shifting only for nonriders (from aerobic to lactic anaerobic mode). Finally, cross-correlations showed a link between energy expenditure and postural coordination in the riders (i.e., effectiveness).

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

PubMed

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

2016-09-01

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

Acutely Decreased Thermoregulatory Energy Expenditure or Decreased Activity Energy Expenditure Both Acutely Reduce Food Intake in Mice

PubMed Central

Kaiyala, Karl J.; Morton, Gregory J.; Thaler, Joshua P.; Meek, Thomas H.; Tylee, Tracy; Ogimoto, Kayoko; Wisse, Brent E.

2012-01-01

Despite the suggestion that reduced energy expenditure may be a key contributor to the obesity pandemic, few studies have tested whether acutely reduced energy expenditure is associated with a compensatory reduction in food intake. The homeostatic mechanisms that control food intake and energy expenditure remain controversial and are thought to act over days to weeks. We evaluated food intake in mice using two models of acutely decreased energy expenditure: 1) increasing ambient temperature to thermoneutrality in mice acclimated to standard laboratory temperature or 2) exercise cessation in mice accustomed to wheel running. Increasing ambient temperature (from 21°C to 28°C) rapidly decreased energy expenditure, demonstrating that thermoregulatory energy expenditure contributes to both light cycle (40±1%) and dark cycle energy expenditure (15±3%) at normal ambient temperature (21°C). Reducing thermoregulatory energy expenditure acutely decreased food intake primarily during the light cycle (65±7%), thus conflicting with the delayed compensation model, but did not alter spontaneous activity. Acute exercise cessation decreased energy expenditure only during the dark cycle (14±2% at 21°C; 21±4% at 28°C), while food intake was reduced during the dark cycle (0.9±0.1 g) in mice housed at 28°C, but during the light cycle (0.3±0.1 g) in mice housed at 21°C. Cumulatively, there was a strong correlation between the change in daily energy expenditure and the change in daily food intake (R2 = 0.51, p<0.01). We conclude that acutely decreased energy expenditure decreases food intake suggesting that energy intake is regulated by metabolic signals that respond rapidly and accurately to reduced energy expenditure. PMID:22936977

Electronic Non-Contacting Linear Position Measuring System

DOEpatents

Post, Richard F.

2005-06-14

A non-contacting linear position location system employs a special transmission line to encode and transmit magnetic signals to a receiver on the object whose position is to be measured. The invention is useful as a non-contact linear locator of moving objects, e.g., to determine the location of a magnetic-levitation train for the operation of the linear-synchronous motor drive system.

The Evaluation of Higher Education Expenditure Performance and Investment Mechanism Reform

ERIC Educational Resources Information Center

Wang, De; Fu, Meiying

2009-01-01

Along with the reform of Chinese Government public finance, higher education belongs to the public product, gradually changes from "fund investment management" to the "expenditure performance management". The evaluation of expenditure performance system becomes the key point of higher education investment mechanism reform. This…

Combined Effects of Chewing Ability and Dietary Diversity on Medical Service Use and Expenditures.

PubMed

Lo, Yuan-Ting C; Wahlqvist, Mark L; Chang, Yu-Hung; Lee, Meei-Shyuan

2016-06-01

To examine whether chewing ability affects healthcare use and expenditure and whether improving dietary quality alleviates any such effects. Prospective cohort. The Elderly Nutrition and Health Survey in Taiwan (1999-2000), a nationwide community-based survey of people aged 65 and older. Individuals aged 65 and older (N = 1,793; 903 men, 890 women). Chewing ability (satisfactory or unsatisfactory) was assessed using a questionnaire, and dietary quality was assessed using a 24-hour dietary recall as a dietary diversity score. Data on annual medical use and expenditures from the interview date until December 31, 2006, were collected from National Health Insurance claims. Generalized linear models were used to assess the associations between chewing ability, dietary quality, and annual medical usage or expenditure. After 8 years of follow-up, older adults with unsatisfactory chewing ability had considerably higher emergency, hospitalization, and total medical expenditures. Older adults with unsatisfactory chewing ability and a poor diet used fewer annual preventive care and dental services than those with satisfactory chewing ability but had longer hospital stays and higher expenditures. After adjusting for covariates, unsatisfactory chewing ability resulted in significantly longer hospital stays in participants with a poor diet (β = 2.34, 95% confidence interval = 2.02-2.71, P < .001). Unsatisfactory chewing ability and a less-diverse diet together are associated with longer hospital stays and higher medical expenditures. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

State Action Analysis of Tax Expenditures

ERIC Educational Resources Information Center

Brown, Robert Clarke

1977-01-01

Recent judicial treatment of tax expenditures in both state action and establishment clause cases is analyzed and it is argued that tax expenditures and direct expenditures should be treated as constitutional equivalents. (LBH)

Trends in health care expenditure among US adults with heart failure: The Medical Expenditure Panel Survey 2002-2011.

PubMed

Echouffo-Tcheugui, Justin B; Bishu, Kinfe G; Fonarow, Gregg C; Egede, Leonard E

2017-04-01

Population-based national data on the trends in expenditures related to heart failure (HF) are scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition. Using 10-year data (2002-2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194US adults aged ≥18years) and a 2-part model (adjusting for demographics, comorbidities, and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency department, inpatient hospital, pharmacy, home health care, and other medical expenditures). Compared with expenditures for individuals without HF ($5511 [95% CI 5405-5617]), individuals with HF had a 4-fold higher mean expenditures of ($23,854 [95% CI 21,733-25,975]). Individuals with HF had $3446 (95% CI 2592-4299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95% CI 18,359-24,272) in 2002/2003 to $27,152 (95% CI 20,066-34,237) in 2010/2011, and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/y and the adjusted total incremental expenditure was $5.8 billion/y. Heart failure is costly and over a recent 10-year period, and direct expenditure related to HF increased markedly, mainly driven by inpatient costs. Copyright © 2017 Elsevier Inc. All rights reserved.

Health care expenditure in the Islamic Republic of Iran versus other high spending countries

PubMed Central

Khosravi, Bahman; Soltani, Shahin; Javan-Noughabi, Javad; Faramarzi, Ahmad

2017-01-01

Background: In all countries, health expenditures are a main part of government expenditure, and governments try to find policies and strategies to reduce this expenditure. Overall expenditure index has been raised 30 times during the past 20 years in Iran, while in the health sector, the growth in health expenditures index has been 71 times. The present study aimed at examining health care expenditure in the Islamic Republic of Iran versus other high spending countries. Methods: A comparative panel study was conducted in selected countries with the high mean of health expenditure per capita. Data were collected from the WORLD BANK. Out- of- pocket (OOP), health expenditure per capita, public and private health expenditure, and total health expenditure were compared among the selected counties. Results: Iran has the lowest health expenditure per capita compared to other countries and the USA has the highest health expenditures per capita. In Iran, out- of- pocket expenditure, with more than 50%, was the most cost, while in Luxembourg it was the least cost during 2004 to 2014, with less than 12%. Conclusion: Our findings revealed that politicians and health care executives should find a stable source to finance the health system. Stable sources of financing lead to having a steady trend in health expenditure. PMID:29445700

Health care expenditure in the Islamic Republic of Iran versus other high spending countries.

PubMed

Khosravi, Bahman; Soltani, Shahin; Javan-Noughabi, Javad; Faramarzi, Ahmad

2017-01-01

Background: In all countries, health expenditures are a main part of government expenditure, and governments try to find policies and strategies to reduce this expenditure. Overall expenditure index has been raised 30 times during the past 20 years in Iran, while in the health sector, the growth in health expenditures index has been 71 times. The present study aimed at examining health care expenditure in the Islamic Republic of Iran versus other high spending countries. Methods: A comparative panel study was conducted in selected countries with the high mean of health expenditure per capita. Data were collected from the WORLD BANK. Out- of- pocket (OOP), health expenditure per capita, public and private health expenditure, and total health expenditure were compared among the selected counties. Results: Iran has the lowest health expenditure per capita compared to other countries and the USA has the highest health expenditures per capita. In Iran, out- of- pocket expenditure, with more than 50%, was the most cost, while in Luxembourg it was the least cost during 2004 to 2014, with less than 12%. Conclusion: Our findings revealed that politicians and health care executives should find a stable source to finance the health system. Stable sources of financing lead to having a steady trend in health expenditure.

Social Welfare Expenditures and Infant Mortality.

PubMed

Shim, Joyce

2015-01-01

This study examines the effects of social welfare expenditures on infant mortality (deaths younger than age 1 per 1,000 live births) across 19 Organisation for Economic Co-operation and Development (OECD) countries from 1980 to 2010. Data are obtained from various sources including the OECD, World Health Organization, and World Bank. The findings indicate that among three social welfare expenditure measures for families, the expenditures on family cash allowances are predicted to reduce infant mortality. However, the other two measures-the expenditures on parental and maternity leave and expenditures on family services-have no significant effects on infant mortality.

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

Code of Federal Regulations, 2011 CFR

2011-04-01

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

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

Code of Federal Regulations, 2010 CFR

2010-04-01

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

When Education Expenditure Matters: An Empirical Analysis of Recent International Data

ERIC Educational Resources Information Center

Vegas, Emiliana; Coffin, Chelsea

2015-01-01

We analyze the diminishing correlations between education expenditure and learning outcomes to address two fundamental questions: Do education systems with different levels of education spending have different student achievement levels? If so, at what amount of education spending does the relationship between increased expenditure and student…

Essential Medicines List Implementation Dynamics: A Case Study Using Brazilian Federal Medicines Expenditures.

PubMed

Magarinos-Torres, Rachel; Lynd, Larry David; Luz, Tatiana Chama Borges; Marques, Paulo Eduardo Potyguara Coutinho; Osorio-de-Castro, Claudia Garcia Serpa

2017-09-01

The aim was to analyse the implementation dynamics of the essential medicines list (EML). We used the government expenditures on medicines and Brazil as a case study. Drug purchases were considered as a proxy for utilization. The essential medicines (EMs) expenditures were followed over time by Brazilian National EMLs life-time and defined by broad therapeutic categories and by specific medicines. Brazil increased the number of the medicines during the last four editions of Brazilian National EMLs and the federal government expenditures on them. The EML implementation dynamics changed the distribution of expenditures on EMs. We identified a common set of 404 EMs present in all four editions of the Brazilian National EMLs. There was a proportional decrease in expenditures on anti-infectives for systemic use, blood and blood-forming organs and alimentary tract and metabolism, and increase in expenditures on antineoplastic and immunomodulating agents. The expenditures distribution per specific medicines revealed that a small set of EMs was responsible for 50% or more of expenditures considering Brazilian National EML life-time for all four periods. The increase in expenditures on EMs in Brazil was a consequence of the newer medicines incorporated over time in the Brazilian National EMLs. The use of the medicines expenditures as a source of data and the definition of an EML life-time permitted follow-up of the implementation dynamics of different versions of the Brazilian National EMLs. Our results have implications for policymakers and stakeholders to gain a better understanding of the role EMLs play in health system sustainability and in the provision of the most beneficial heath care. © 2017 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

Heterogeneous effects of health insurance on out-of-pocket expenditure on medicines in Mexico.

PubMed

Wirtz, Veronika J; Santa-Ana-Tellez, Yared; Servan-Mori, Edson; Avila-Burgos, Leticia

2012-01-01

Given the importance of health insurance for financing medicines and recent policy changes designed to reduce health-related out-of-pocket expenditure (OOPE) in Mexico, our study examined and analyzed the effect of health insurance on the probability and amount of OOPE for medicines and the proportion spent from household available expenditure (AE) funds. We conducted a cross-sectional analysis by using the Mexican National Household Survey of Income and Expenditures for 2008. Households were grouped according to household medical insurance type (Social Security, Seguro Popular, mixed, or no affiliation). OOPE for medicines and health costs, and the probability of occurrence, were estimated with linear regression models; subsequently, the proportion of health expenditures from AE was calculated. The Heckman selection procedure was used to correct for self-selection of health expenditure; a propensity score matching procedure and an alternative procedure using instrumental variables were used to correct for heterogeneity between households with and without Seguro Popular. OOPE in medicines account for 66% of the total health expenditures and 5% of the AE. Households with health insurance had a lower probability of OOPE for medicines than their comparison groups. There was heterogeneity in the health insurance effect on the proportion of OOPE for medicines out of the AE, with a reduction of 1.7% for households with Social Security, 1.4% for mixed affiliation, but no difference between Seguro Popular and matched households without insurance. Medicines were the most prevalent component of health expenditures in Mexico. We recommend improving access to health services and strengthening access to medicines to reduce high OOPE. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Activity Profile and Energy Expenditure Among Active Older Adults, British Columbia, 2011–2012

PubMed Central

Ashe, Maureen C.; Chase, Jocelyn M.

2015-01-01

Introduction Time spent by young adults in moderate to vigorous activity predicts daily caloric expenditure. In contrast, caloric expenditure among older adults is best predicted by time spent in light activity. We examined highly active older adults to examine the biggest contributors to energy expenditure in this population. Methods Fifty-four community-dwelling men and women aged 65 years or older (mean, 71.4 y) were enrolled in this cross-sectional observational study. All were members of the Whistler Senior Ski Team, and all met current American guidelines for physical activity. Activity levels (sedentary, light, and moderate to vigorous) were recorded by accelerometers worn continuously for 7 days. Caloric expenditure was measured using accelerometry, galvanic skin response, skin temperature, and heat flux. Significant variables were entered into a stepwise multivariate linear model consisting of activity level, age, and sex. Results The average (standard deviation [SD]) daily nonlying sedentary time was 564 (92) minutes (9.4 [1.5] h) per day. The main predictors of higher caloric expenditure were time spent in moderate to vigorous activity (standardized β = 0.42 [SE, 0.08]; P < .001) and male sex (standardized β = 1.34 [SE, 0.16]; P < .001). A model consisting of only moderate to vigorous physical activity and sex explained 68% of the variation in caloric expenditure. An increase in moderate to vigorous physical activity by 1 minute per day was associated with an additional 16 kcal expended in physical activity. Conclusion The relationship between activity intensity and caloric expenditure in athletic seniors is similar to that observed in young adults. Active older adults still spend a substantial proportion of the day engaged in sedentary behaviors. PMID:26182147

11 CFR 110.20 - Prohibition on contributions, donations, expenditures, independent expenditures, and...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 11 Federal Elections 1 2011-01-01 2011-01-01 false Prohibition on contributions, donations... EXPENDITURE LIMITATIONS AND PROHIBITIONS § 110.20 Prohibition on contributions, donations, expenditures... meaning as in 11 CFR 300.2(d). (2) Donation has the same meaning as in 11 CFR 300.2(e). (3) Foreign...

11 CFR 110.20 - Prohibition on contributions, donations, expenditures, independent expenditures, and...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 11 Federal Elections 1 2013-01-01 2012-01-01 true Prohibition on contributions, donations... EXPENDITURE LIMITATIONS AND PROHIBITIONS § 110.20 Prohibition on contributions, donations, expenditures... meaning as in 11 CFR 300.2(d). (2) Donation has the same meaning as in 11 CFR 300.2(e). (3) Foreign...

11 CFR 110.20 - Prohibition on contributions, donations, expenditures, independent expenditures, and...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 11 Federal Elections 1 2014-01-01 2014-01-01 false Prohibition on contributions, donations... EXPENDITURE LIMITATIONS AND PROHIBITIONS § 110.20 Prohibition on contributions, donations, expenditures... meaning as in 11 CFR 300.2(d). (2) Donation has the same meaning as in 11 CFR 300.2(e). (3) Foreign...

11 CFR 110.20 - Prohibition on contributions, donations, expenditures, independent expenditures, and...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 11 Federal Elections 1 2012-01-01 2012-01-01 false Prohibition on contributions, donations... EXPENDITURE LIMITATIONS AND PROHIBITIONS § 110.20 Prohibition on contributions, donations, expenditures... meaning as in 11 CFR 300.2(d). (2) Donation has the same meaning as in 11 CFR 300.2(e). (3) Foreign...

United States Port Development Expenditure Report

DOT National Transportation Integrated Search

2003-03-01

This report analyzes the results of the American Association of Port Authorities (AAPA) capital expenditure survey for 2001. The survey included the capital expenditures for 2001 and proposed expenditures for the period 2002 through 2006 along with t...

Does Medicare Managed Care reduce racial/ethnic disparities in diabetes preventive care and healthcare expenditures?

PubMed

Mahmoudi, Elham; Tarraf, Wassim; Maroukis, Brianna L; Levy, Helen G

2016-10-01

Large and persistent racial/ethnic disparities exist in diabetes care. Considering the rapid rate of growth of Medicare Managed Care (MMC) plans among minority populations, our aim was to investigate whether disparities in diabetes management and healthcare expenditures are smaller in MMC versus Medicare fee-for-service (MFFS) plans. We hypothesized that racial/ethnic disparities in diabetes care and in health expenditures would be less pronounced in MMC compared with MFFS plans. Nationally representative data from the 2006 to 2011 Medical Expenditure Panel Survey on white, African American, and Hispanic seniors with diabetes were analyzed. We examined 4 measures of diabetes care-regular foot check, eye exam, cholesterol check, and flu vaccine-and total and out-of-pocket (OOP) healthcare expenditures. We implemented the Institute of Medicine's definition of disparity, applied propensity score weighting to adjust for potential differential selection, and used a difference-in-differences generalized linear framework to estimate outcome measures. For African Americans, MMC was associated with a $1183 (P <.036) reduction and a $547 (P <.001) increase in disparities in total and OOP healthcare expenditures, respectively. For Hispanics, disparities in foot exam, flu shot, and cholesterol check decreased by 5, 10, and 7 percentage points (P <.001); additionally, disparities in total and OOP healthcare expenditures were reduced by $3588 and $276 (P <.001), respectively. MMC plans spend less on everyone, including whites. Hispanic/white disparities in diabetes management and healthcare expenditures were smaller in MMC than in MFFS plans. African American/white disparities were not consistently larger in 1 setting than the other.

Explaining the increased health care expenditures associated with gastroesophageal reflux disease among elderly Medicare beneficiaries with chronic obstructive pulmonary disease: a cost-decomposition analysis.

PubMed

Ajmera, Mayank; Raval, Amit D; Shen, Chan; Sambamoorthi, Usha

2014-01-01

To estimate excess health care expenditures associated with gastroesophageal reflux disease (GERD) among elderly individuals with chronic obstructive pulmonary disease (COPD) and examine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors to the excess expenditures, using the Blinder-Oaxaca linear decomposition technique. This study utilized a cross-sectional, retrospective study design, using data from multiple years (2006-2009) of the Medicare Current Beneficiary Survey linked with fee-for-service Medicare claims. Presence of COPD and GERD was identified using diagnoses codes. Health care expenditures consisted of inpatient, outpatient, prescription drugs, dental, medical provider, and other services. For the analysis, t-tests were used to examine unadjusted subgroup differences in average health care expenditures by the presence of GERD. Ordinary least squares regressions on log-transformed health care expenditures were conducted to estimate the excess health care expenditures associated with GERD. The Blinder-Oaxaca linear decomposition technique was used to determine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors, to excess health care expenditures associated with GERD. Among elderly Medicare beneficiaries with COPD, 29.3% had co-occurring GERD. Elderly Medicare beneficiaries with COPD/GERD had 1.5 times higher ($36,793 vs $24,722 [P<0.001]) expenditures than did those with COPD/no GERD. Ordinary least squares regression revealed that individuals with COPD/GERD had 36.3% (P<0.001) higher expenditures than did those with COPD/no GERD. Overall, 30.9% to 43.6% of the differences in average health care expenditures were explained by differences in predisposing characteristics, enabling resources, need variables, personal health care practices, and external

Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan.

PubMed

Feng, Mei; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yoshie, Satoru; Iijima, Katsuya; Yamamoto-Mitani, Noriko

2017-11-01

The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231. © 2017 Japan Geriatrics Society.

Main drivers of health expenditure growth in China: a decomposition analysis.

PubMed

Zhai, Tiemin; Goss, John; Li, Jinjing

2017-03-09

In past two decades, health expenditure in China grew at a rate of 11.6% per year, which is much faster than the growth of the country's economy (9.9% per year). As cost containment is a key aspect of China's new health system reform agenda, this study aims to identify the main drivers of past growth so that cost containment policies are focussed in the right areas. The analysis covered the period 1993-2012. To understand the drivers of past growth during this period, Das Gupta's decomposition method was used to decompose the changes in health expenditure by disease into five main components that include population growth, population ageing, disease prevalence rate, expenditure per case of disease, and excess health price inflation. Demographic data on population size and age-composition were obtained from the Department of Economic and Social Affairs of the United Nations. Age- and disease- specific expenditure and prevalence rates by age and disease were extracted from China's National Health Accounts studies and Global Burden of Disease 2013 studies of the Institute for Health Metrics and Evaluation, respectively. Growth in health expenditure in China was mainly driven by a rapid increase in real expenditure per prevalent case, which contributed 8.4 percentage points of the 11.6% annual average growth. Excess health price inflation and population growth contributed 1.3 and 1.3% respectively. The effect of population ageing was relatively small, contributing 0.8% per year. However, reductions in disease prevalence rates reduced the growth rate by 0.3 percentage points. Future policy in optimising growth in health expenditure in China should address growth in expenditure per prevalent case. This is especially so for neoplasms, and for circulatory and respiratory disease. And a focus on effective interventions to reduce the prevalence of disease in the country will ensure that changing disease rates do not lead to a higher growth in future health expenditure

76 FR 50887 - Elections Regarding Start-Up Expenditures, Corporation Organizational Expenditures, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... begins an active trade or business, an amount equal to the lesser of (1) the amount of the start-up... begins. All start-up expenditures that relate to the active trade or business are considered in... active trade or business to which the expenditures relate begins. The election either to amortize start...

Isolators Including Main Spring Linear Guide Systems

NASA Technical Reports Server (NTRS)

Goold, Ryan (Inventor); Buchele, Paul (Inventor); Hindle, Timothy (Inventor); Ruebsamen, Dale Thomas (Inventor)

2017-01-01

Embodiments of isolators, such as three parameter isolators, including a main spring linear guide system are provided. In one embodiment, the isolator includes first and second opposing end portions, a main spring mechanically coupled between the first and second end portions, and a linear guide system extending from the first end portion, across the main spring, and toward the second end portion. The linear guide system expands and contracts in conjunction with deflection of the main spring along the working axis, while restricting displacement and rotation of the main spring along first and second axes orthogonal to the working axis.

Estimates of state-level health-care expenditures associated with disability.

PubMed

Anderson, Wayne L; Armour, Brian S; Finkelstein, Eric A; Wiener, Joshua M

2010-01-01

We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002-2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. The DAHE for all U.S. adults totaled $397.8 billion in 2006, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total, the DAHE were $118.9 billion for the Medicare population, $161.1 billion for Medicaid recipients, and $117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.

Catastrophic expenditure on medicines in Brazil

PubMed Central

Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Oliveira, Maria Auxiliadora; Arrais, Paulo Sergio Dourado; Ramos, Luiz Roberto; Pizzol, Tatiane da Silva Dal; Mengue, Sotero Serrate; Farias, Mareni Rocha; Bertoldi, Andréa Dâmaso

2016-01-01

ABSTRACT OBJECTIVE To describe the magnitude of the expenditure on medicines in Brazil according to region, household size and composition in terms of residents in a situation of dependency. METHODS Population-based data from the national household survey were used, with probabilistic sample, applied between September 2013 and February 2014 in urban households. The expenditure on medicines was the main outcome of interest. The prevalence and confidence intervals (95%CI) of the outcomes were stratified according to socioeconomic classification and calculated according to the region, the number of residents dependent on income, the presence of children under five years and residents in a situation of dependency by age. RESULTS In about one of every 17 households (5.3%) catastrophic health expenditure was reported and, in 3.2%, the medicines were reported as one of the items responsible for this situation. The presence of three or more residents (3.6%) and resident in a situation of dependency (3.6%) were the ones that most reported expenditure on medicines. Southeast was the region with the lowest prevalence of expenditure on medicines. The prevalence of households with catastrophic health expenditure and on medicines in relation to the total of households showed a regressive tendency for economic classes. CONCLUSIONS Catastrophic health expenditure was present in 5.3%, and catastrophic expenditure on medicines in 3.2% of the households. Multi-person households, presence of residents in a situation of economic dependency and belonging to the class D or E had the highest proportion of catastrophic expenditure on medicines. Although the problem is important, permeated by aspects of iniquity, Brazilian policies seem to be protecting families from catastrophic expenditure on health and on medicine. PMID:27982383

Illness, medical expenditure and household consumption: observations from Taiwan

PubMed Central

2013-01-01

Background Illness conditions lead to medical expenditure. Even with various types of medical insurance, there can still be considerable out-of-pocket costs. Medical expenditure can affect other categories of household consumptions. The goal of this study is to provide an updated empirical description of the distributions of illness conditions and medical expenditure and their associations with other categories of household consumptions. Methods A phone-call survey was conducted in June and July of 2012. The study was approved by ethics review committees at Xiamen University and FuJen Catholic University. Data was collected using a Computer-Assisted Telephone Survey System (CATSS). “Household” was the unit for data collection and analysis. Univariate and multivariate analyses were conducted, examining the distributions of illness conditions and the associations of illness and medical expenditure with other household consumptions. Results The presence of chronic disease and inpatient treatment was not significantly associated with household characteristics. The level of per capita medical expenditure was significantly associated with household size, income, and household head occupation. The presence of chronic disease was significantly associated with levels of education, insurance and durable goods consumption. After adjusting for confounders, the associations with education and durable goods consumption remained significant. The presence of inpatient treatment was not associated with consumption levels. In the univariate analysis, medical expenditure was significantly associated with all other consumption categories. After adjusting for confounding effects, the associations between medical expenditure and the actual amount of entertainment expenses and percentages of basic consumption, savings, and insurance (as of total consumption) remained significant. Conclusion This study provided an updated description of the distributions of illness conditions and

Financial Burden of Health Care Expenditures: Turkey

PubMed Central

Sulku, S Nur; Bernard, D Minbay

2012-01-01

In this study, we examine whether and to what extent the health insurance system in Turkey provided adequate protection against high out of pocket expenditures in the period prior to “The Health Transformation Programme”. Furthermore, we examine the distribution of out of pocket expenditures by demographic characteristics, poverty status, health service type, access to health care and self-reported health status. We employ the 2002/03 National Household Health Expenditure Survey data to analyze financial burden of health care expenditure. Following the literature, we define high burdens as expenses above 10 and 20% of income. We find that 19% of the nonelderly population were living in families spending more than 10% of family income and that 14% of the nonelderly population were living in families spending more than 20% of family income on health care. Furthermore, the poor and those living in economically less developed regions had the greatest risk of high out of pocket burdens. The risk of high financial burdens varied by the type of insurance among the insured due to differences in benefits among the five separate public schemes that provided health insurance in the pre-reform period. Our results are robust to three alternative specifications of the burden measure and including elderly adults in the sample population. We see that prior to the reforms there were not adequate protection against high health expenditures. Our study provides a baseline against which policymakers can measure the success of the health care reform in terms of providing financial protection. PMID:23113149

Total expenditures per patient in hospital-owned and physician-owned physician organizations in California.

PubMed

Robinson, James C; Miller, Kelly

Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3,065,551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693,254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and

Linear transformation and oscillation criteria for Hamiltonian systems

NASA Astrophysics Data System (ADS)

Zheng, Zhaowen

2007-08-01

Using a linear transformation similar to the Kummer transformation, some new oscillation criteria for linear Hamiltonian systems are established. These results generalize and improve the oscillation criteria due to I.S. Kumari and S. Umanaheswaram [I. Sowjaya Kumari, S. Umanaheswaram, Oscillation criteria for linear matrix Hamiltonian systems, J. Differential Equations 165 (2000) 174-198], Q. Yang et al. [Q. Yang, R. Mathsen, S. Zhu, Oscillation theorems for self-adjoint matrix Hamiltonian systems, J. Differential Equations 190 (2003) 306-329], and S. Chen and Z. Zheng [Shaozhu Chen, Zhaowen Zheng, Oscillation criteria of Yan type for linear Hamiltonian systems, Comput. Math. Appl. 46 (2003) 855-862]. These criteria also unify many of known criteria in literature and simplify the proofs.

Perfect commuting-operator strategies for linear system games

NASA Astrophysics Data System (ADS)

Cleve, Richard; Liu, Li; Slofstra, William

2017-01-01

Linear system games are a generalization of Mermin's magic square game introduced by Cleve and Mittal. They show that perfect strategies for linear system games in the tensor-product model of entanglement correspond to finite-dimensional operator solutions of a certain set of non-commutative equations. We investigate linear system games in the commuting-operator model of entanglement, where Alice and Bob's measurement operators act on a joint Hilbert space, and Alice's operators must commute with Bob's operators. We show that perfect strategies in this model correspond to possibly infinite-dimensional operator solutions of the non-commutative equations. The proof is based around a finitely presented group associated with the linear system which arises from the non-commutative equations.

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

PubMed

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

2012-05-01

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

Health care expenditures and gross domestic product: the Turkish case.

PubMed

Sülkü, Seher Nur; Caner, Asena

2011-02-01

Our study examines the long-term relationship among per capita gross domestic product (GDP), per capita health expenditures and population growth rate in Turkey during the period 1984-2006, employing the Johansen multivariate co-integration technique. Related previous studies on OECD countries have mostly excluded Turkey-itself an OECD country. The only study on Turkey examines the period 1984-1998. However, after 1998, major events and policy changes that had a substantial impact on income and health expenditures took place in Turkey, including a series of reforms to restructure the health and social security system. In contrast to earlier findings in the literature, we find that the income elasticity of total health expenditures is less than one, which indicates that health care is a necessity in Turkey during the period of analysis. According to our results, a 10% increase in per capita GDP is associated with an 8.7% increase in total per capita health expenditures, controlling for population growth. We find that the income elasticity of public health expenditures is less than one. But, in the case of private health care expenditures, the elasticity is greater than one, meaning that private health care is a luxury good in Turkey.

26 CFR 1.528-6 - Expenditure test.

Code of Federal Regulations, 2013 CFR

2013-04-01

.... Qualifying expenditures are expenditures by an organization for the acquisition, construction, management..., construction, management, maintenance or care of association property, shall constitute qualifying expenditures...

26 CFR 1.528-6 - Expenditure test.

Code of Federal Regulations, 2012 CFR

2012-04-01

.... Qualifying expenditures are expenditures by an organization for the acquisition, construction, management..., construction, management, maintenance or care of association property, shall constitute qualifying expenditures...

26 CFR 1.528-6 - Expenditure test.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... Qualifying expenditures are expenditures by an organization for the acquisition, construction, management..., construction, management, maintenance or care of association property, shall constitute qualifying expenditures...

Can increases in CHIP copayments reduce program expenditures on prescription drugs?

PubMed

Sen, Bisakha; Blackburn, Justin; Morrisey, Michael; Becker, David; Kilgore, Meredith; Caldwell, Cathy; Menachemi, Nir

2014-01-01

The primary aim is to explore whether prescription drug expenditures by enrollees changed in Alabama's CHIP program, ALL Kids, after copayment increases in fiscal year 2004. The subsidiary aim is to explore whether non-pharmaceutical expenditures also changed. Data on ALL Kids enrollees between 1999-2007, obtained from claims files and the state's administrative database. We used data on children who were enrolled between one and three years both before and after the changes to the copayment schedule, and estimate regression models with individual-level fixed effects to control for time-invariant heterogeneity at the child level. This allows an accurate estimate of how program expenditures change for the same individual following copayment changes. Primary outcomes of interest are expenditures for prescription drugs by class and brand-name and generic versions. We estimate models for the likelihood of any use of prescription drugs and expenditure level conditional on use. Following the copayment increase, the probability of any expenditure decline by 5.8%, brand name drugs by 6.9%, generic drugs by 7.4%. Conditional on any use, program expenditures decline by 7.9% for all drugs, by 9.6% for brand name drugs, and 6.2% for generic drugs. The largest declines are for antihistamine drugs; the least declines are for Central Nervous System agents. Declines are smaller and statistically weaker for children with chronic health conditions. Concurrent declines are also seen for non-pharmaceutical medical expenditures. Copayment increases appear to reduce program expenditures on prescription drugs per enrollee and may be a useful tool for controlling program costs.

Improving the performance of social health insurance system through increasing outpatient expenditure reimbursement ratio: a quasi-experimental evaluation study from rural China.

PubMed

Miao, Yudong; Gu, Jianqin; Zhang, Liang; He, Ruibo; Sandeep, Sandeep; Wu, Jian

2018-06-25

China has set up a universal coverage social health insurance system since the 2009 healthcare reform. Due to the inadequate funds, the social health insurance system reimbursed the inpatient expenditures with much higher ratio than outpatient expenditure. The gap in reimbursement ratios resulted in a rapid rising hospitalization rate but poor health outcomes among the Chinese population. A redistribution of social health insurance funds has become one of the main challenges for the performance of Social Health Insurance. Two comparable counties, Dangyang County and Zhijiang County, in Hubei Province of China, were sampled as the intervention group and the control group, respectively. The Social Health Insurance Management Department of the intervention group budgeted 600 yuan per capita per year to the patients with 3rd stage hypertension to cover their outpatient expenditures. The outpatient spending in the control group were paid out-of-pocket. The inpatient expenditures reimbursement policies in both groups were not changed. Besides, the Social Health Insurance Management Department of the intervention group budgeted 100 yuan per patient per year to township physicians and hospitals to provide health management services for the patients. While, the health management services in the control group were still provided by health workers. A Propensity Score Matching model and Difference-in-differences model were used to estimate the net effects of the intervention in dimensions of medical services utilization, medical expenditures, SHI reimbursement, and health outcomes. One thousand, six hundred and seventy three pairs of patients were taken as valid subjects to conduct Difference-in-differences estimation after the Propensity Score Matching. The net intervention effect is to increase outpatient frequency by 3.3 (81.0%) times (P < 0.05), to decrease hospitalization frequency by 0.075 (- 60.0%) times (P < 0.05), and to increase the per capita total medical

Effects of long-term climate change on global building energy expenditures

DOE PAGES

Clarke, Leon; Eom, Jiyong; Marten, Elke Hodson; ...

2018-01-06

Our paper explores potential future implications of climate change on building energy expenditures around the globe. Increasing expenditures result from increased electricity use for cooling, and are offset to varying degrees, depending on the region, by decreased energy consumption for heating. WE conducted an analysis using a model of the global buildings sector within the GCAM integrated assessment model. The integrated assessment framework is valuable because it represents socioeconomic and energy system changes that will be important for understanding building energy expenditures in the future. Results indicate that changes in net expenditures are not uniform across the globe. Net expendituresmore » decrease in some regions, such as Canada and Russia, where heating demands currently dominate, and increase the most in areas with less demand for space heating and greater demand for space cooling. We explain these results in terms of the basic drivers that link building energy expenditures to regional climate.« less

Effects of long-term climate change on global building energy expenditures

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

Clarke, Leon; Eom, Jiyong; Marten, Elke Hodson

Our paper explores potential future implications of climate change on building energy expenditures around the globe. Increasing expenditures result from increased electricity use for cooling, and are offset to varying degrees, depending on the region, by decreased energy consumption for heating. WE conducted an analysis using a model of the global buildings sector within the GCAM integrated assessment model. The integrated assessment framework is valuable because it represents socioeconomic and energy system changes that will be important for understanding building energy expenditures in the future. Results indicate that changes in net expenditures are not uniform across the globe. Net expendituresmore » decrease in some regions, such as Canada and Russia, where heating demands currently dominate, and increase the most in areas with less demand for space heating and greater demand for space cooling. We explain these results in terms of the basic drivers that link building energy expenditures to regional climate.« less

Non-linear dynamic compensation system

NASA Technical Reports Server (NTRS)

Lin, Yu-Hwan (Inventor); Lurie, Boris J. (Inventor)

1992-01-01

A non-linear dynamic compensation subsystem is added in the feedback loop of a high precision optical mirror positioning control system to smoothly alter the control system response bandwidth from a relatively wide response bandwidth optimized for speed of control system response to a bandwidth sufficiently narrow to reduce position errors resulting from the quantization noise inherent in the inductosyn used to measure mirror position. The non-linear dynamic compensation system includes a limiter for limiting the error signal within preselected limits, a compensator for modifying the limiter output to achieve the reduced bandwidth response, and an adder for combining the modified error signal with the difference between the limited and unlimited error signals. The adder output is applied to control system motor so that the system response is optimized for accuracy when the error signal is within the preselected limits, optimized for speed of response when the error signal is substantially beyond the preselected limits and smoothly varied therebetween as the error signal approaches the preselected limits.

Healthcare expenditure on Indigenous and non-Indigenous Australians at high risk of cardiovascular disease.

PubMed

Angell, Blake; Laba, Tracey-Lea; Lung, Tom; Brown, Alex; Eades, Sandra; Usherwood, Tim; Peiris, David; Billot, Laurent; Hillis, Graham; Webster, Ruth; Tonkin, Andrew; Reid, Christopher; Molanus, Barbara; Rafter, Natasha; Cass, Alan; Patel, Anushka; Jan, Stephen

2017-06-23

In spite of bearing a heavier burden of death, disease and disability, there is mixed evidence as to whether Indigenous Australians utilise more or less healthcare services than other Australians given their elevated risk level. This study analyses the Medicare expenditure and its predictors in a cohort of Indigenous and non-Indigenous Australians at high risk of cardiovascular disease. The healthcare expenditure of participants of the Kanyini Guidelines Adherence with the Polypill (GAP) pragmatic randomised controlled trial was modelled using linear regression methods. 535 adult (48% Indigenous) participants at high risk of cardiovascular disease (CVD) were recruited through 33 primary healthcare services (including 12 Aboriginal Medical Services) across Australia. There was no significant difference in the expenditure of Indigenous and non-Indigenous participants in non-remote areas following adjustment for individual characteristics. Indigenous individuals living in remote areas had lower MBS expenditure ($932 per year P < 0.001) than other individuals. MBS expenditure was found to increase with being aged over 65 years ($128, p = 0.013), being female ($472, p = 0.003), lower baseline reported quality of life ($102 per 0.1 decrement of utility p = 0.004) and a history of diabetes ($324, p = 0.001), gout ($631, p = 0.022), chronic obstructive pulmonary disease ($469, p = 0.019) and established CVD whether receiving guideline-recommended treatment prior to the trial ($452, p = 0.005) or not ($483, p = 0.04). When controlling for all other characteristics, morbidly obese patients had lower MBS expenditure than other individuals (-$887, p = 0.002). The findings suggest that for the majority of participants, once individuals are engaged with a primary care provider, factors other than whether they are Indigenous determine the level of Medicare expenditure for each person. Australian New Zealand Clinical Trials Registry ACTRN

Catastrophic Health Expenditure in Iran: A Review Article

PubMed Central

ARYANKHESAL, Aidin; ETEMADI, Manal; MOHSENI, Mohammad; AZAMI-AGHDASH, Saber; NAKHAEI, Majid

2018-01-01

Background: One of the main challenges of healthcare systems is to protect people from consequences of health expenditures. Such expenditures may lead to catastrophic financial loss in families so that many people deny demanding necessary healthcare services, which results in harms to their health status. The aim of this systematic review was to investigate the catastrophic health expenditures trend and its related factors in Iran. Methods: This systematic review and meta-analysis was conducted on studies conducted between 1984 and 2014. Data were collected through searching electronic databases and searching engines of PubMed, Scopus, EconLit, Google Scholar, Science Direct, MagIran, and Scientific Information Database (SID). The random effects were used with 95% confidence interval for the meta-analysis. Results: Out of 561 initially retrieved articles, finally 42 were included in the final analysis. The studies were conducted between 1984 and 2014. The overall proportion of exposure to catastrophic health expenditure in Iran was 7.5% (95% CI, 6.2 – 9.1). In the urban and rural areas, the proportion was 2.3% (95% CI, 1.8 – 2.9) and 3.4% (95% CI, 2.8 – 4.1) respectively. The overall proportion of exposure to the catastrophic health expenditure in hospitals was 35.9% (95% CI, 23.5 – 54.3). Conclusion: The catastrophic expenditures proportion of healthcare is relatively high in Iran and the government is expected to adopt effective measures in this regard, especially for the inpatient care. There are needs for special supporting policies for the financial protection of specific patients, the poor and villagers. PMID:29445626

Primate energy expenditure and life history

PubMed Central

Pontzer, Herman; Raichlen, David A.; Gordon, Adam D.; Schroepfer-Walker, Kara K.; Hare, Brian; O’Neill, Matthew C.; Muldoon, Kathleen M.; Dunsworth, Holly M.; Wood, Brian M.; Isler, Karin; Burkart, Judith; Irwin, Mitchell; Shumaker, Robert W.; Lonsdorf, Elizabeth V.; Ross, Stephen R.

2014-01-01

Humans and other primates are distinct among placental mammals in having exceptionally slow rates of growth, reproduction, and aging. Primates’ slow life history schedules are generally thought to reflect an evolved strategy of allocating energy away from growth and reproduction and toward somatic investment, particularly to the development and maintenance of large brains. Here we examine an alternative explanation: that primates’ slow life histories reflect low total energy expenditure (TEE) (kilocalories per day) relative to other placental mammals. We compared doubly labeled water measurements of TEE among 17 primate species with similar measures for other placental mammals. We found that primates use remarkably little energy each day, expending on average only 50% of the energy expected for a placental mammal of similar mass. Such large differences in TEE are not easily explained by differences in physical activity, and instead appear to reflect systemic metabolic adaptation for low energy expenditures in primates. Indeed, comparisons of wild and captive primate populations indicate similar levels of energy expenditure. Broad interspecific comparisons of growth, reproduction, and maximum life span indicate that primates’ slow metabolic rates contribute to their characteristically slow life histories. PMID:24474770

Trends in Educational Expenditure.

ERIC Educational Resources Information Center

Burke, Gerald

This study provides an overview of expenditures for education and training by educational institutions in Australia, 1991-2001. The study used newly available data from the Australian Bureau of Statistics (ABS) and administrative data from the main sectors' reports on the size and trends in public and private education expenditures. It analyzed…

Burden of Household Environmental Tobacco Smoke on Medical Expenditure for Japanese Women: A Population-Based Cohort Study

PubMed Central

Morishima, Toshitaka; Imanaka, Yuichi; Otsubo, Tetsuya; Hayashida, Kenshi; Watanabe, Takashi; Tsuji, Ichiro

2013-01-01

Background The economic consequences of environmental tobacco smoke (ETS) have been simulated using models. We examined the individual-level association between ETS exposure and medical costs among Japanese nonsmoking women. Methods This population-based cohort study enrolled women aged 40 to 79 years living in a rural community. ETS exposure in homes at baseline was assessed with a self-administered questionnaire. We then collected health insurance claims data on direct medical expenditures from 1995 through 2007. Using generalized linear models with interaction between ETS exposure level and age stratum, average total monthly expenditure (inpatient plus outpatient care) per capita for nonsmoking women highly exposed and moderately exposed to ETS were compared with expenditures for unexposed women. We performed separate analyses for survivors and nonsurvivors. Results We analyzed data from 4870 women. After adjustment for potential confounding factors, survivors aged 70 to 79 who were highly exposed to ETS incurred higher expenditures than those who were not exposed. We found no significant difference in expenditures between moderately exposed and unexposed women. Total expenditures were not significantly associated with ETS exposure among survivors aged 40 to 69 or nonsurvivors of any age stratum. Conclusions We calculated individual-level excess medical expenditures attributable to household exposure to ETS among surviving older women. The findings provide direct evidence of the economic burden of ETS, which is helpful for policymakers who seek to achieve the economically attractive goal of eliminating ETS. PMID:23183111

26 CFR 1.501(h)-1 - Application of the expenditure test to expenditures to influence legislation; introduction.

Code of Federal Regulations, 2010 CFR

2010-04-01

... expenditures to influence legislation; introduction. 1.501(h)-1 Section 1.501(h)-1 Internal Revenue INTERNAL...) Exempt Organizations § 1.501(h)-1 Application of the expenditure test to expenditures to influence... attempting to influence legislation, (except as otherwise provided in subsection (h)).” This requirement is...

Decentralization, stabilization, and estimation of large-scale linear systems

NASA Technical Reports Server (NTRS)

Siljak, D. D.; Vukcevic, M. B.

1976-01-01

In this short paper we consider three closely related aspects of large-scale systems: decentralization, stabilization, and estimation. A method is proposed to decompose a large linear system into a number of interconnected subsystems with decentralized (scalar) inputs or outputs. The procedure is preliminary to the hierarchic stabilization and estimation of linear systems and is performed on the subsystem level. A multilevel control scheme based upon the decomposition-aggregation method is developed for stabilization of input-decentralized linear systems Local linear feedback controllers are used to stabilize each decoupled subsystem, while global linear feedback controllers are utilized to minimize the coupling effect among the subsystems. Systems stabilized by the method have a tolerance to a wide class of nonlinearities in subsystem coupling and high reliability with respect to structural perturbations. The proposed output-decentralization and stabilization schemes can be used directly to construct asymptotic state estimators for large linear systems on the subsystem level. The problem of dimensionality is resolved by constructing a number of low-order estimators, thus avoiding a design of a single estimator for the overall system.

Out-of-pocket health care expenditures due to excess of body weight in Portugal.

PubMed

Veiga, Paula

2008-03-01

The prevalence for excessive weight has also been increasing dramatically in Portugal over the last decades. The consequences for families as well as for the publicly funded Portuguese health care system are a matter of policy interest. This paper uses an econometric model to compute the fraction of the national out-of-pocket health care expenditures attributable to overweight and obesity among Portuguese adults. Given that public health care system pays for a substantial share of the national health care expenditures, the estimated the out-of-pocket expenditures is only a share of the total expenditures. Per-capita expenditures and the burden that obesity and overweight impose on families are also estimated. Two waves of the Portuguese National Health Survey (NHS), namely; 1995/1996 and 1998/1999 are considered. The results suggest that out-of-pocket expenditures due to excess weight have increased sharply during these 3 years. The two-part model estimates suggest that the obese and overweight are more likely to incur out-of-pocket health care expenditures but, in the restricted sample of those that incur expenditures, there is weak or no evidence that the obese or overweight spend, on average, more than those of normal weight. Overall, it is estimated that in 1995/1996, more than 1.8% out-of-pocket health care expenditures were attributable to obesity and 2% to overweight (although not statistically significant). The estimated percentages are over 2.9% for obesity and 4% for overweight in 1998/1999. Combined, the estimated attributable percentage of national out-of-pocket expenditures due to excess weight was 3.8% in 1995/1996 and 6.9% in 1998/1999. Per-capita expenditures due to obesity or overweight are small, on average, in absolute terms, but they can be a significant cost for low income families. With respect to public policy concerns, the results suggest that measures which only slightly increase the out-of-pocket health care expenditures of being obese

National health expenditures, 1990

PubMed Central

Levit, Katharine R.; Lazenby, Helen C.; Cowan, Cathy A.; Letsch, Suzanne W.

1991-01-01

During 1990, health expenditures as a share of gross national product rose to 12.2 percent, up from 11.6 percent in 1989. This dramatic increase is the second largest increase in the past three decades. The national health expenditure estimates presented in this article document rapidly rising health care costs and provide a context for understanding the health care financing crisis facing the Nation today. The 1990 national health expenditures incorporate the most recently available data. They differ from historical estimates presented in the preceding article. The length of time and complicated process of producing projections required use of 1989 national health expenditures—data available prior to the completion of the 1990 estimates presented here. PMID:10114934

Prior health expenditures and risk sharing with insurers competing on quality.

PubMed

Marchand, Maurice; Sato, Motohiro; Schokkaert, Erik

2003-01-01

Insurers can exploit the heterogeneity within risk-adjustment classes to select the good risks because they have more information than the regulator on the expected expenditures of individual insurees. To counteract this cream skimming, mixed systems combining capitation and cost-based payments have been adopted that do not, however, generally use the past expenditures of insurees as a risk adjuster. In this article, two symmetric insurers compete for clients by differentiating the quality of service offered to them according to some private information about their risk. In our setting it is always welfare improving to use prior expenditures as a risk adjuster.

[Impact of demographic changes on health care expenditure in Germany: an analysis considering the expenditures of decedents].

PubMed

Gandjour, A; Ihle, P; Schubert, I

2008-02-01

The purpose of this study was to evaluate the impact of demographic changes on future health care expenditure of the German social health insurances considering the expenditures of survivors and decedents by age. The study analysed data from 269,646 members up to the age of 99 years of the AOK - one of Germany's largest social health insurers - in the State of Hesse in 2000/2001. In order to determine future health care expenditures, per-capita expenditures by age for outpatient, inpatient, rehabilitation, and nursing services of survivors and decedents (death within the next 12 months) were multiplied by the estimated number of survivors and decedents by age in Germany in 2020, 2035 und 2050. Expenditures for all ages were summed together. The paper shows that demographic changes until 2050 will lead to an increase of health care expenditures by 20% in total or less than 1% annually. Considering the future re-duction in workforce, demographic changes until 2050 will result in an estimated increase in health care expenditures per employee by about 57% (undifferentiated model). Considering the cost of survivors and decedents separately, this increase will amount to 50%. Hence, undifferentiated models overestimate the impact of demographic changes by about 10%.

Trends in Health Care Expenditure among U.S. Adults with Heart Failure - The Medical Expenditure Panel Survey 2002–2011

PubMed Central

Echouffo-Tcheugui, Justin B.; Bishu, Kinfe G.; Fonarow, Gregg C; Egede, Leonard E.

2017-01-01

Background Population-based national data on the trends in expenditures related to heart failure (HF) is scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition. Methods Using 10-year data (2002–2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194 U.S adults aged ≥18 years) and a two-part model (adjusting for demographics, comorbidities and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures). Results Compared to expenditures for individuals without HF ($5,511 [95% confidence interval (CI): 5,405–5,617]), individuals with HF had a four-fold higher mean expenditures of ($23,854 [95%CI: 21,733–25,975]). Individuals with HF had $3,446 (95%CI: 2,592–4,299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95%CI: 18,359–24,272) in 2002/2003 to $27,152 (95%CI: 20,066–34,237) in 2010/2011; and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/year and the adjusted total incremental expenditure $5.8 billion/year. Conclusions Heart failure is costly and over a recent 10-year period, direct expenditure related to HF increased markedly, mainly driven by inpatient costs. PMID:28454834

Investigating the correlation between paediatric stride interval persistence and gross energy expenditure.

PubMed

Fairley, Jillian A; Sejdić, Ervin; Chau, Tom

2010-02-26

Stride interval persistence, a term used to describe the correlation structure of stride interval time series, is thought to provide insight into neuromotor control, though its exact clinical meaning has not yet been realized. Since human locomotion is shaped by energy efficient movements, it has been hypothesized that stride interval dynamics and energy expenditure may be inherently tied, both having demonstrated similar sensitivities to age, disease, and pace-constrained walking. This study tested for correlations between stride interval persistence and measures of energy expenditure including mass-specific gross oxygen consumption per minute (VO₂), mass-specific gross oxygen cost per meter (VO₂) and heart rate (HR). Metabolic and stride interval data were collected from 30 asymptomatic children who completed one 10-minute walking trial under each of the following conditions: (i) overground walking, (ii) hands-free treadmill walking, and (iii) handrail-supported treadmill walking. Stride interval persistence was not significantly correlated with (p > 0.32), VO₂ (p > 0.18) or HR (p > 0.56). No simple linear dependence exists between stride interval persistence and measures of gross energy expenditure in asymptomatic children when walking overground and on a treadmill.

Research of Medical Expenditure among Inpatients with Unstable Angina Pectoris in a Single Center

PubMed Central

Wu, Suo-Wei; Pan, Qi; Chen, Tong; Wei, Liang-Yu; Xuan, Yong; Wang, Qin; Li, Chao; Song, Jing-Chen

2017-01-01

Background: With the rising incidence as well as the medical expenditure among patients with unstable angina pectoris, the research aimed to investigate the inpatient medical expenditure through the combination of diagnosis-related groups (DRGs) among patients with unstable angina pectoris in a Grade A tertiary hospital to conduct the referential standards of medical costs for the diagnosis. Methods: Single-factor analysis and multiple linear stepwise regression method were used to investigate 3933 cases between 2014 and 2016 in Beijing Hospital (China) whose main diagnosis was defined as unstable angina pectoris to determine the main factors influencing the inpatient medical expenditure, and decision tree method was adopted to establish the model of DRGs grouping combinations. Results: The major influential factors of inpatient medical expenditure included age, operative method, therapeutic effects as well as comorbidity and complications (CCs) of the disease, and the 3933 cases were divided into ten DRGs by four factors: age, CCs, therapeutic effects, and the type of surgery with corresponding inpatient medical expenditure standards setup. Data of nonparametric test on medical costs among different groups were all significant (P < 0.001, by Kruskal-Wallis test), with R2 = 0.53 and coefficient of variation (CV) = 0.524. Conclusions: The classification of DRGs by adopting the type of surgery as the main branch node to develop cost control standards in inpatient treatment of unstable angina pectoris is conducive in standardizing the diagnosis and treatment behaviors of the hospital and reducing economic burdens among patients. PMID:28639566

Research of Medical Expenditure among Inpatients with Unstable Angina Pectoris in a Single Center.

PubMed

Wu, Suo-Wei; Pan, Qi; Chen, Tong; Wei, Liang-Yu; Xuan, Yong; Wang, Qin; Li, Chao; Song, Jing-Chen

2017-07-05

With the rising incidence as well as the medical expenditure among patients with unstable angina pectoris, the research aimed to investigate the inpatient medical expenditure through the combination of diagnosis-related groups (DRGs) among patients with unstable angina pectoris in a Grade A tertiary hospital to conduct the referential standards of medical costs for the diagnosis. Single-factor analysis and multiple linear stepwise regression method were used to investigate 3933 cases between 2014 and 2016 in Beijing Hospital (China) whose main diagnosis was defined as unstable angina pectoris to determine the main factors influencing the inpatient medical expenditure, and decision tree method was adopted to establish the model of DRGs grouping combinations. The major influential factors of inpatient medical expenditure included age, operative method, therapeutic effects as well as comorbidity and complications (CCs) of the disease, and the 3933 cases were divided into ten DRGs by four factors: age, CCs, therapeutic effects, and the type of surgery with corresponding inpatient medical expenditure standards setup. Data of nonparametric test on medical costs among different groups were all significant (P < 0.001, by Kruskal-Wallis test), with R2 = 0.53 and coefficient of variation (CV) = 0.524. The classification of DRGs by adopting the type of surgery as the main branch node to develop cost control standards in inpatient treatment of unstable angina pectoris is conducive in standardizing the diagnosis and treatment behaviors of the hospital and reducing economic burdens among patients.

Forecasting Medicaid Expenditures for Antipsychotic Medications.

PubMed

Slade, Eric P; Simoni-Wastila, Linda

2015-07-01

The ongoing transition from use of mostly branded to mostly generic second-generation antipsychotic medications could bring about a substantial reduction in Medicaid expenditures for antipsychotic medications, a change with critical implications for formulary restrictions on second-generation antipsychotics in Medicaid. This study provided a forecast of the impact of generics on Medicaid expenditures for antipsychotic medications. Quarterly (N=816) state-level aggregate data on outpatient antipsychotic prescriptions in Medicaid between 2008 and 2011 were drawn from the Medicaid state drug utilization database. Annual numbers of prescriptions, expenditures, and cost per prescription were constructed for each antipsychotic medication. Forecasts of antipsychotic expenditures in calendar years 2016 and 2019 were developed on the basis of the estimated percentage reduction in Medicaid expenditures for risperidone, the only second-generation antipsychotic available generically throughout the study period. Two models of savings from generic risperidone use were estimated, one based on constant risperidone prices and the other based on variable risperidone prices. The sensitivity of the expenditure forecast to expected changes in Medicaid enrollment was also examined. In the main model, annual Medicaid expenditures for antipsychotics were forecasted to decrease by $1,794 million (48.8%) by 2016 and by $2,814 million (76.5%) by 2019. Adjustment for variable prices of branded medications and changes in Medicaid enrollment only moderately affected the magnitude of these reductions. Within five years, antipsychotic expenditures in Medicaid may decline to less than half their current levels. Such a spending reduction warrants a reassessment of the continued necessity of formulary restrictions for second-generation antipsychotics in Medicaid.

Fiscal Responsibility Law and expenditure on health personnel: an analysis of the condition of Brazilian municipalities from 2004 to 2009.

PubMed

Medeiros, Katia Rejane de; Albuquerque, Paulette Cavalcanti de; Tavares, Ricardo Antônio Wanderley; Souza, Wayner Vieira de

2017-06-01

The limits for expenditure on personnel that were imposed by the Fiscal Responsibility Act (FRA) have been considered by local health managers as an obstacle to health sector policies. This paper analyzes the linear trend for the personnel expenses indicators and the correlation of this with the profile of spending on health care personnel in 5,356 Brazilian municipalities from 2004 to 2009. The study of the time series used data from the 'Finanças do Brasil' (Finbra) and data from the Information System on Public Health Budgets (SIOPS). There was a trend towards an increase of 1.3% in the annual average of total personnel expenditure in the municipalities, but the cost of health care staff did not follow that growth. There were no correlations between the indicators, and this result is contrary to the arguments given by the health managers. They attribute the problems with hiring workers and the expansion of health systems to the FRA. The availability of data from the Finbra and the Siops system is associated with a lack of knowledge on these issues. This makes it an opportune time for conducting new research.

Chaos as an intermittently forced linear system.

PubMed

Brunton, Steven L; Brunton, Bingni W; Proctor, Joshua L; Kaiser, Eurika; Kutz, J Nathan

2017-05-30

Understanding the interplay of order and disorder in chaos is a central challenge in modern quantitative science. Approximate linear representations of nonlinear dynamics have long been sought, driving considerable interest in Koopman theory. We present a universal, data-driven decomposition of chaos as an intermittently forced linear system. This work combines delay embedding and Koopman theory to decompose chaotic dynamics into a linear model in the leading delay coordinates with forcing by low-energy delay coordinates; this is called the Hankel alternative view of Koopman (HAVOK) analysis. This analysis is applied to the Lorenz system and real-world examples including Earth's magnetic field reversal and measles outbreaks. In each case, forcing statistics are non-Gaussian, with long tails corresponding to rare intermittent forcing that precedes switching and bursting phenomena. The forcing activity demarcates coherent phase space regions where the dynamics are approximately linear from those that are strongly nonlinear.The huge amount of data generated in fields like neuroscience or finance calls for effective strategies that mine data to reveal underlying dynamics. Here Brunton et al.develop a data-driven technique to analyze chaotic systems and predict their dynamics in terms of a forced linear model.

Energy Expenditure During Extravehicular Activity: Apollo Skylab Through STS-135

NASA Technical Reports Server (NTRS)

Paul, Heather L.

2011-01-01

The importance of real-time metabolic rate monitoring during extravehicular activities (EVAs) came into question during the Gemini missions, when the energy expenditure required to conduct an EVA over-tasked the crewmember and exceeded the capabilities of vehicle and space suit life support systems. Energy expenditure was closely evaluated through the Apollo lunar surface EVAs, resulting in modifications to space suit design and EVA operations. After the Apollo lunar surface missions were completed, the United States shifted its focus to long duration human space flight, to study the human response to living and working in a microgravity environment. This paper summarizes the energy expenditure during EVA from Apollo Skylab through STS-135.

Physical activity recommendations: an alternative approach using energy expenditure.

PubMed

Mudd, Lanay M; Rafferty, Ann P; Reeves, Mathew J; Pivarnik, James M

2008-10-01

Most adults do not meet the American College of Sports Medicine and Centers for Disease Control and Prevention (ACSM/CDC) physical activity recommendations. Even fewer meet the more extreme Institute of Medicine (IOM) physical activity recommendations. Compliance with either recommendation has been conventionally assessed by combining frequencies and durations of self-reported activities. Leisure-time energy expenditure is a cumulative measure of activity that offers an alternative method of defining compliance. To calculate the leisure-time energy expenditure of adults complying with the ACSM/CDC or the IOM physical activity recommendations determined by conventional measures and to reexamine compliance with the IOM recommendation using energy expenditure criteria. National, cross-sectional data from the 2000 Behavioral Risk Factor Surveillance System determined the mode, frequency, and duration of up to two leisure-time activities performed by adults. Four mutually exclusive activity groups (Non-, Low-, ACSM/CDC-, and IOM-Active) were defined on the basis of frequencies and durations of reported activities. Leisure-time energy expenditure (kcal x kg(-1) x wk(-1)) was calculated per respondent. The energy expenditure threshold for meeting the IOM recommendation was calculated as 21 kcal x kg(-1) x wk(-1). Of the 162,669 respondents included in the analyses, 29.9% were Nonactive, whereas 42.3%, 23.3%, and 4.5% were Low-, ACSM/CDC-, and IOM-Active, respectively. Median leisure-time energy expenditure values were 9.0, 27.4, and 63.0 kcal x kg(-1) x wk(-1) for Low-, ACSM/CDC-, and IOM-Active groups, respectively. When using energy expenditure criteria, compliance with the IOM recommendation rose to 27.7% of respondents. Compliance with the IOM physical activity recommendation dramatically increased when assessed by energy expenditure compared with conventional criteria, thereby highlighting the potential bias of conventional methods. A significant proportion of adults

Krylov Subspace Methods for Complex Non-Hermitian Linear Systems. Thesis

NASA Technical Reports Server (NTRS)

Freund, Roland W.

1991-01-01

We consider Krylov subspace methods for the solution of large sparse linear systems Ax = b with complex non-Hermitian coefficient matrices. Such linear systems arise in important applications, such as inverse scattering, numerical solution of time-dependent Schrodinger equations, underwater acoustics, eddy current computations, numerical computations in quantum chromodynamics, and numerical conformal mapping. Typically, the resulting coefficient matrices A exhibit special structures, such as complex symmetry, or they are shifted Hermitian matrices. In this paper, we first describe a Krylov subspace approach with iterates defined by a quasi-minimal residual property, the QMR method, for solving general complex non-Hermitian linear systems. Then, we study special Krylov subspace methods designed for the two families of complex symmetric respectively shifted Hermitian linear systems. We also include some results concerning the obvious approach to general complex linear systems by solving equivalent real linear systems for the real and imaginary parts of x. Finally, numerical experiments for linear systems arising from the complex Helmholtz equation are reported.

Health Care Utilization and Expenditures Associated With Remote Monitoring in Patients With Implantable Cardiac Devices.

PubMed

Ladapo, Joseph A; Turakhia, Mintu P; Ryan, Michael P; Mollenkopf, Sarah A; Reynolds, Matthew R

2016-05-01

Several randomized trials and decision analysis models have found that remote monitoring may reduce health care utilization and expenditures in patients with cardiac implantable electronic devices (CIEDs), compared with in-office monitoring. However, little is known about the generalizability of these findings to unselected populations in clinical practice. To compare health care utilization and expenditures associated with remote monitoring and in-office monitoring in patients with CIEDs, we used Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases. We selected patients newly implanted with an implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy defibrillator (CRT-D), or permanent pacemaker (PPM), in 2009, who had continuous health plan enrollment 2 years after implantation. Generalized linear models and propensity score matching were used to adjust for confounders and estimate differences in health care utilization and expenditures in patients with remote or in-office monitoring. We identified 1,127; 427; and 1,295 pairs of patients with a similar propensity for receiving an ICD, CRT-D, or PPM, respectively. Remotely monitored patients with ICDs experienced fewer emergency department visits resulting in discharge (p = 0.050). Remote monitoring was associated with lower health care expenditures in office visits among patients with PPMs (p = 0.025) and CRT-Ds (p = 0.006) and lower total inpatient and outpatient expenditures in patients with ICDs (p <0.0001). In conclusion, remote monitoring of patients with CIEDs may be associated with reductions in health care utilization and expenditures compared with exclusive in-office care. Copyright © 2016 Elsevier Inc. All rights reserved.

Estimation of Energy Expenditure Using a Patch-Type Sensor Module with an Incremental Radial Basis Function Neural Network

PubMed Central

Li, Meina; Kwak, Keun-Chang; Kim, Youn Tae

2016-01-01

Conventionally, indirect calorimetry has been used to estimate oxygen consumption in an effort to accurately measure human body energy expenditure. However, calorimetry requires the subject to wear a mask that is neither convenient nor comfortable. The purpose of our study is to develop a patch-type sensor module with an embedded incremental radial basis function neural network (RBFNN) for estimating the energy expenditure. The sensor module contains one ECG electrode and a three-axis accelerometer, and can perform real-time heart rate (HR) and movement index (MI) monitoring. The embedded incremental network includes linear regression (LR) and RBFNN based on context-based fuzzy c-means (CFCM) clustering. This incremental network is constructed by building a collection of information granules through CFCM clustering that is guided by the distribution of error of the linear part of the LR model. PMID:27669249

A program for identification of linear systems

NASA Technical Reports Server (NTRS)

Buell, J.; Kalaba, R.; Ruspini, E.; Yakush, A.

1971-01-01

A program has been written for the identification of parameters in certain linear systems. These systems appear in biomedical problems, particularly in compartmental models of pharmacokinetics. The method presented here assumes that some of the state variables are regularly modified by jump conditions. This simulates administration of drugs following some prescribed drug regime. Parameters are identified by a least-square fit of the linear differential system to a set of experimental observations. The method is especially suited when the interval of observation of the system is very long.

What drives public health care expenditure growth? Evidence from Swiss cantons, 1970-2012.

PubMed

Braendle, Thomas; Colombier, Carsten

2016-09-01

A better understanding of the determinants of public health care expenditures is key to designing effective health policies. We integrate demand and supply-side determinants and factors from political economy into an empirical analysis of the highly decentralized Swiss health care system and control for major health care finance reforms. We compile a novel data set of the cantonal health care expenditure in Switzerland, which currently amounts to about one fifth of total health care expenditure. We analyze the period 1970-2012 and use dynamic panel estimation methods. We find that per capita income, the unemployment rate and the share of foreigners are positively related to public health care expenditure growth. With regard to political economy aspects, public health care expenditures increase with the share of women elected to parliament. However, institutional restrictions for politicians, such as fiscal rules, do not appear to limit public health care expenditure growth. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Increased Medicaid Financing and Equalization of African Americans' and Whites' Outpatient and Emergency Treatment Expenditures.

PubMed

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

2016-09-01

We investigated whether a new funding opportunity to finance mental health treatment, provided to autonomous county-level mental health systems without customary cost sharing requirements, equalized African American and White children's outpatient and emergency treatment expenditure inequalities. Using Whites as a benchmark, we considered expenditure patterns favoring Whites over African Americans ("disparities") and favoring African Americans over Whites ("reverse disparities"). Settlement-mandated Early Periodic Screening Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. We analyzed Medi-Cal paid claims for mental health services delivered to youth (under 18 years of age) over 64 quarters for a study period covering July 1, 1991 through June 30, 2007 in controlled cross-sectional (systems), longitudinal (quarters) analyses. Settlement-mandated increases in EPSDT treatment funding was associated with relatively greater African American vs. White expenditures for outpatient care when systems initially spent more on Whites. When systems initially spent more on African Americans, relative increases were greater for Whites for outpatient and emergency services. With new funding that requires no matching funds from the county, county mental health systems did reduce outpatient treatment expenditure inequalities. This was found to be true in counties that initially favored African Americans and in counties that initially favored Whites. Adopting a systems level perspective and taking account of initial conditions and trends can be critical for understanding inequalities.

Linear System of Equations, Matrix Inversion, and Linear Programming Using MS Excel

ERIC Educational Resources Information Center

El-Gebeily, M.; Yushau, B.

2008-01-01

In this note, we demonstrate with illustrations two different ways that MS Excel can be used to solve Linear Systems of Equation, Linear Programming Problems, and Matrix Inversion Problems. The advantage of using MS Excel is its availability and transparency (the user is responsible for most of the details of how a problem is solved). Further, we…

Lectures on algebraic system theory: Linear systems over rings

NASA Technical Reports Server (NTRS)

Kamen, E. W.

1978-01-01

The presentation centers on four classes of systems that can be treated as linear systems over a ring. These are: (1) discrete-time systems over a ring of scalars such as the integers; (2) continuous-time systems containing time delays; (3) large-scale discrete-time systems; and (4) time-varying discrete-time systems.

Health Care Expenditures and Utilization for Children With Noncomplex Chronic Disease.

PubMed

Hoefgen, Erik R; Andrews, Annie L; Richardson, Troy; Hall, Matthew; Neff, John M; Macy, Michelle L; Bettenhausen, Jessica L; Shah, Samir S; Auger, Katherine A

2017-09-01

Pediatric health care expenditures and use vary by level of complexity and chronic illness. We sought to determine expenditures and use for children with noncomplex chronic diseases (NC-CDs). We performed a retrospective, cross-sectional analysis of Medicaid enrollees (ages 0-18 years) from January 1, 2012, through December 31, 2013, using administrative claims (the Truven MarketScan Medicaid Database). Patients were categorized by chronicity of illness by using 3M Health Information System's Clinical Risk Groups (CRGs) as follows: without chronic diseases (WO-CDs) (CRG 1-2), NC-CDs (CRG 3-5), and complex chronic diseases (C-CDs) (CRG 6-9). Primary outcomes were medical expenditures, including total annualized population expenditure and per-member per-year expenditure (PMPY). Secondary outcomes included the number of health care encounters over the 2-year period. There were 2 424 946 children who met inclusion criteria, 53% were WO-CD; 36% had an NC-CD; and 11% had a C-CD. Children with NC-CDs accounted for 33% ($2801 PMPY) of the annual spending compared with 20% ($1151 PMPY) accounted for by children WO-CDs and 47% ($12 569 PMPY) by children with C-CDs. The median outpatient visit count by group over the 2-year period was 15 (interquartile range [IQR] 10-25) for NC-CD, 8 (IQR 5-13) WO-CD, and 34 (IQR 19-72) for C-CD. Children with NC-CDs accounted for 33% of pediatric Medicaid expenditures and have significantly higher PMPY and aggregate annual expenditures than children WO-CDs. The annual aggregate expenditures of the NC-CD group represent a significant societal cost because of the high volume of children, extrapolated to ∼$34.9 billion annually in national Medicaid expenditures. Copyright © 2017 by the American Academy of Pediatrics.

Linear and non-linear dynamic models of a geared rotor-bearing system

NASA Technical Reports Server (NTRS)

Kahraman, Ahmet; Singh, Rajendra

1990-01-01

A three degree of freedom non-linear model of a geared rotor-bearing system with gear backlash and radial clearances in rolling element bearings is proposed here. This reduced order model can be used to describe the transverse-torsional motion of the system. It is justified by comparing the eigen solutions yielded by corresponding linear model with the finite element method results. Nature of nonlinearities in bearings is examined and two approximate nonlinear stiffness functions are proposed. These approximate bearing models are verified by comparing their frequency responses with the results given by the exact form of nonlinearity. The proposed nonlinear dynamic model of the geared rotor-bearing system can be used to investigate the dynamic behavior and chaos.

45 CFR 260.33 - When are expenditures on State or local tax credits allowable expenditures for TANF-related...

Code of Federal Regulations, 2010 CFR

2010-10-01

... refundable dependent care credits, the refundable portion that would count as an expenditure is the amount of... 45 Public Welfare 2 2010-10-01 2010-10-01 false When are expenditures on State or local tax credits allowable expenditures for TANF-related purposes? 260.33 Section 260.33 Public Welfare Regulations...

45 CFR 260.33 - When are expenditures on State or local tax credits allowable expenditures for TANF-related...

Code of Federal Regulations, 2011 CFR

2011-10-01

... refundable dependent care credits, the refundable portion that would count as an expenditure is the amount of... 45 Public Welfare 2 2011-10-01 2011-10-01 false When are expenditures on State or local tax credits allowable expenditures for TANF-related purposes? 260.33 Section 260.33 Public Welfare Regulations...

45 CFR 260.33 - When are expenditures on State or local tax credits allowable expenditures for TANF-related...

Code of Federal Regulations, 2012 CFR

2012-10-01

... refundable dependent care credits, the refundable portion that would count as an expenditure is the amount of... 45 Public Welfare 2 2012-10-01 2012-10-01 false When are expenditures on State or local tax credits allowable expenditures for TANF-related purposes? 260.33 Section 260.33 Public Welfare Regulations...

The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time.

PubMed

Di Matteo, Livio

2005-01-01

This paper examines the determinants of real per capita health expenditures in order to assess the impact of age distribution, income and time using American state-level data for the period 1980-1998 and Canadian province-level data for the period 1975-2000. Ageing population distributions and income explain a relatively small portion of health expenditures when the impact of time effects, which is a partial proxy for technological change, is controlled for. However, the impact of age is of more concern given that cost increases are concentrated in the last few years of life and there may be cohort effects as the "Baby-Boom" generation ages. There is an urgent need to better understand the exact mechanisms driving health expenditure increases given that time accounts for approximately two-thirds of health expenditure increases and that its effect is non-linear.

The consistency of positive fully fuzzy linear system

NASA Astrophysics Data System (ADS)

Malkawi, Ghassan O.; Alfifi, Hassan Y.

2017-11-01

In this paper, the consistency of fuzziness of positive solution of the n × n fully fuzzy linear system (P - FFLS) is studied based on its associated linear system (P - ALS). That can consist of the whole entries of triangular fuzzy numbers in a linear system without fuzzy operations. The nature of solution is differentiated in case of fuzzy solution, non-fuzzy solution and fuzzy non-positive solution. Moreover, the analysis reveals that the P - ALS is applicable to provide the set of infinite number of solutions. Numerical examples are presented to illustrate the proposed analysis.

Linear Actuator System for the NASA Docking System

NASA Technical Reports Server (NTRS)

Dick, Brandon N.; Oesch, Christopher; Rupp, Timothy W.

2017-01-01

The Linear Actuator System (LAS) is a major sub-system within the NASA Docking System (NDS). The NDS Block 1 will be used on the Boeing Crew Space Transportation (CST-100) system to achieve docking with the International Space Station. Critical functions in the Soft Capture aspect of docking are performed by the LAS. This paper describes the general function of the LAS, the system's key requirements and technical challenges, and the development and qualification approach for the system.

45 CFR 260.33 - When are expenditures on State or local tax credits allowable expenditures for TANF-related...

Code of Federal Regulations, 2013 CFR

2013-10-01

... refundable dependent care credits, the refundable portion that would count as an expenditure is the amount of... 45 Public Welfare 2 2013-10-01 2012-10-01 true When are expenditures on State or local tax credits allowable expenditures for TANF-related purposes? 260.33 Section 260.33 Public Welfare Regulations Relating...

45 CFR 260.33 - When are expenditures on State or local tax credits allowable expenditures for TANF-related...

Code of Federal Regulations, 2014 CFR

2014-10-01

... refundable dependent care credits, the refundable portion that would count as an expenditure is the amount of... 45 Public Welfare 2 2014-10-01 2012-10-01 true When are expenditures on State or local tax credits allowable expenditures for TANF-related purposes? 260.33 Section 260.33 Public Welfare Regulations Relating...

26 CFR 1.617-1 - Exploration expenditures.

Code of Federal Regulations, 2012 CFR

2012-04-01

... commercial exploitation by the taxpayer. For example, core drilling expenditures paid or incurred by the... of this section. Expenditures paid or incurred in connection with core drilling to further delineate... meaning of this section. Also, expenditures for exploratory drilling from within a producing mine to...

26 CFR 1.617-1 - Exploration expenditures.

Code of Federal Regulations, 2011 CFR

2011-04-01

... commercial exploitation by the taxpayer. For example, core drilling expenditures paid or incurred by the... of this section. Expenditures paid or incurred in connection with core drilling to further delineate... meaning of this section. Also, expenditures for exploratory drilling from within a producing mine to...

26 CFR 1.617-1 - Exploration expenditures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... commercial exploitation by the taxpayer. For example, core drilling expenditures paid or incurred by the... of this section. Expenditures paid or incurred in connection with core drilling to further delineate... meaning of this section. Also, expenditures for exploratory drilling from within a producing mine to...

26 CFR 1.617-1 - Exploration expenditures.

Code of Federal Regulations, 2014 CFR

2014-04-01

... commercial exploitation by the taxpayer. For example, core drilling expenditures paid or incurred by the... of this section. Expenditures paid or incurred in connection with core drilling to further delineate... meaning of this section. Also, expenditures for exploratory drilling from within a producing mine to...

26 CFR 1.617-1 - Exploration expenditures.

Code of Federal Regulations, 2013 CFR

2013-04-01

... commercial exploitation by the taxpayer. For example, core drilling expenditures paid or incurred by the... of this section. Expenditures paid or incurred in connection with core drilling to further delineate... meaning of this section. Also, expenditures for exploratory drilling from within a producing mine to...

Catastrophic health expenditure and impoverishment in Mongolia.

PubMed

Dorjdagva, Javkhlanbayar; Batbaatar, Enkhjargal; Svensson, Mikael; Dorjsuren, Bayarsaikhan; Kauhanen, Jussi

2016-07-11

The social health insurance coverage is relatively high in Mongolia; however, escalation of out-of-pocket payments for health care, which reached 41 % of the total health expenditure in 2011, is a policy concern. The aim of this study is to analyse the incidence of catastrophic health expenditures and to measure the rate of impoverishment from health care payments under the social health insurance scheme in Mongolia. We used the data from the Household Socio-Economic Survey 2012, conducted by the National Statistical Office of Mongolia. Catastrophic health expenditures are defined an excess of out-of-pocket payments for health care at the various thresholds for household total expenditure (capacity to pay). For an estimate of the impoverishment effect, the national and The Wold Bank poverty lines are used. About 5.5 % of total households suffered from catastrophic health expenditures, when the threshold is 10 % of the total household expenditure. At the threshold of 40 % of capacity to pay, 1.1 % of the total household incurred catastrophic health expenditures. About 20,000 people were forced into poverty due to paying for health care. Despite the high coverage of social health insurance, a significant proportion of the population incurred catastrophic health expenditures and was forced into poverty due to out-of-pocket payments for health care.

Innovations in energy expenditure assessment.

PubMed

Achamrah, Najate; Oshima, Taku; Genton, Laurence

2018-06-15

Optimal nutritional therapy has been associated with better clinical outcomes and requires providing energy as closed as possible to measured energy expenditure. We reviewed the current innovations in energy expenditure assessment in humans, focusing on indirect calorimetry and other new alternative methods. Although considered the reference method to measure energy expenditure, the use of indirect calorimetry is currently limited by the lack of an adequate device. However, recent technical developments may allow a broader use of indirect calorimetry for in-patients and out-patients. An ongoing international academic initiative to develop a new indirect calorimeter aimed to provide innovative and affordable technical solutions for many of the current limitations of indirect calorimetry. New alternative methods to indirect calorimetry, including CO2 measurements in mechanically ventilated patients, isotopic approaches and accelerometry-based fitness equipments, show promises but have been either poorly studied and/or are not accurate compared to indirect calorimetry. Therefore, to date, energy expenditure measured by indirect calorimetry remains the gold standard to guide nutritional therapy. Some new innovative methods are demonstrating promises in energy expenditure assessment, but still need to be validated. There is an ongoing need for easy-to-use, accurate and affordable indirect calorimeter for daily use in in-patients and out-patients.

Dual-range linearized transimpedance amplifier system

DOEpatents

Wessendorf, Kurt O.

2010-11-02

A transimpedance amplifier system is disclosed which simultaneously generates a low-gain output signal and a high-gain output signal from an input current signal using a single transimpedance amplifier having two different feedback loops with different amplification factors to generate two different output voltage signals. One of the feedback loops includes a resistor, and the other feedback loop includes another resistor in series with one or more diodes. The transimpedance amplifier system includes a signal linearizer to linearize one or both of the low- and high-gain output signals by scaling and adding the two output voltage signals from the transimpedance amplifier. The signal linearizer can be formed either as an analog device using one or two summing amplifiers, or alternately can be formed as a digital device using two analog-to-digital converters and a digital signal processor (e.g. a microprocessor or a computer).

Does national expenditure on research and development influence stroke outcomes?

PubMed

Kim, Young Dae; Jung, Yo Han; Norrving, Bo; Ovbiagele, Bruce; Saposnik, Gustavo

2017-10-01

Background Expenditure on research and development is a macroeconomic indicator representative of national investment. International organizations use this indicator to compare international research and development activities. Aim We investigated whether differences in expenditures on research and development at the country level may influence the incidence of stroke and stroke mortality. Methods We compared stroke metrics with absolute amount of gross domestic expenditure on R&D (GERD) per-capita adjusted for purchasing power parity (aGERD) and relative amount of GERD as percent of gross domestic product (rGERD). Sources included official data from the UNESCO, the World Health Organization, the World Bank, and population-based studies. We used correlation analysis and multivariable linear regression modeling. Results Overall, data on stroke mortality rate and GERD were available from 66 countries for two periods (2002 and 2008). Age-standardized stroke mortality rate was associated with aGERD (r = -0.708 in 2002 and r = -0.730 in 2008) or rGERD (r = -0.545 in 2002 and r = -0.657 in 2008) (all p < 0.001). Multivariable analysis showed a lower aGERD and rGERD were independently and inversely associated with higher stroke mortality (all p < 0.05). The estimated prevalence of hypertension, diabetes, or obesity was higher in countries with lower aGERD. The analysis of 27 population-based studies showed consistent inverse associations between aGERD or rGERD and incident risk of stroke and 30-day case fatality. Conclusions There is higher stroke mortality among countries with lower expenditures in research and development. While this study does not prove causality, it suggests a potential area to focus efforts to improve global stroke outcomes.

Explicit reference governor for linear systems

NASA Astrophysics Data System (ADS)

Garone, Emanuele; Nicotra, Marco; Ntogramatzidis, Lorenzo

2018-06-01

The explicit reference governor is a constrained control scheme that was originally introduced for generic nonlinear systems. This paper presents two explicit reference governor strategies that are specifically tailored for the constrained control of linear time-invariant systems subject to linear constraints. Both strategies are based on the idea of maintaining the system states within an invariant set which is entirely contained in the constraints. This invariant set can be constructed by exploiting either the Lyapunov inequality or modal decomposition. To improve the performance, we show that the two strategies can be combined by choosing at each time instant the least restrictive set. Numerical simulations illustrate that the proposed scheme achieves performances that are comparable to optimisation-based reference governors.

Linear systems with structure group and their feedback invariants

NASA Technical Reports Server (NTRS)

Martin, C.; Hermann, R.

1977-01-01

A general method described by Hermann and Martin (1976) for the study of the feedback invariants of linear systems is considered. It is shown that this method, which makes use of ideas of topology and algebraic geometry, is very useful in the investigation of feedback problems for which the classical methods are not suitable. The transfer function as a curve in the Grassmanian is examined. The general concepts studied in the context of specific systems and applications are organized in terms of the theory of Lie groups and algebraic geometry. Attention is given to linear systems which have a structure group, linear mechanical systems, and feedback invariants. The investigation shows that Lie group techniques are powerful and useful tools for analysis of the feedback structure of linear systems.

Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey.

PubMed

Brinda, Ethel Mary; Andrés, Antonio Rodríguez; Andrés, Rodriguez Antonio; Enemark, Ulrika

2014-03-05

Inequality in health services access and utilization are influenced by out-of-pocket health expenditures in many low and middle-income countries (LMICs). Various antecedents such as social factors, poor health and economic factors are proposed to direct the choice of health care service use and incurring out-of-pocket payments. We investigated the association of these factors with out-of-pocket health expenditures among the adult and older population in the United Republic of Tanzania. We also investigated the prevalence and associated determinants contributing to household catastrophic health expenditures. We accessed the data of a multistage stratified random sample of 7279 adult participants, aged between 18 and 59 years, as well as 1018 participants aged above 60 years, from the first round of the Tanzania National Panel survey. We employed multiple generalized linear and logistic regression models to evaluate the correlates of out-of-pocket as well as catastrophic health expenditures, accounting for the complex sample design effects. Increasing age, female gender, obesity and functional disability increased the adults' out-of-pocket health expenditures significantly, while functional disability and visits to traditional healers increased the out-of-pocket health expenditures in older participants. Adult participants, who lacked formal education or worked as manual laborers earned significantly less (p < 0.001) and spent less on health (p < 0.001), despite having higher levels of disability. Large household size, household head's occupation as a manual laborer, household member with chronic illness, domestic violence against women and traditional healer's visits were significantly associated with high catastrophic health expenditures. We observed that the prevalence of inequalities in socioeconomic factors played a significant role in determining the nature of both out-of-pocket and catastrophic health expenditures. We propose that investment in social welfare

Analysis of the faster-than-Nyquist optimal linear multicarrier system

NASA Astrophysics Data System (ADS)

Marquet, Alexandre; Siclet, Cyrille; Roque, Damien

2017-02-01

Faster-than-Nyquist signalization enables a better spectral efficiency at the expense of an increased computational complexity. Regarding multicarrier communications, previous work mainly relied on the study of non-linear systems exploiting coding and/or equalization techniques, with no particular optimization of the linear part of the system. In this article, we analyze the performance of the optimal linear multicarrier system when used together with non-linear receiving structures (iterative decoding and direct feedback equalization), or in a standalone fashion. We also investigate the limits of the normality assumption of the interference, used for implementing such non-linear systems. The use of this optimal linear system leads to a closed-form expression of the bit-error probability that can be used to predict the performance and help the design of coded systems. Our work also highlights the great performance/complexity trade-off offered by decision feedback equalization in a faster-than-Nyquist context. xml:lang="fr"

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

PubMed

Richard, D

2007-09-01

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

Kansas School Expenditures 1998-99 through 2014-15: Trends and Details. Research Reports

ERIC Educational Resources Information Center

Kansas Association of School Boards, 2016

2016-01-01

This report examines the Kansas school district expenditure data provided by the Kansas State Department of Education on (KSDE) through its Comparative Performance & Fiscal System (CPFS--http:// cpfs.ksde.org/), which includes all school district expenditures reported by Fund, Object, and Sub Object from the 1998-99 school year through the…

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

PubMed

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

2017-11-01

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

Body mass index and the impact of a health promotion intervention on health services use and expenditures.

PubMed

Meng, Hongdao; Liebel, Dianne; Wamsley, Brenda R

2011-06-01

To examine the effect of body mass index (BMI) on the impact of a health promotion intervention on health services use and expenditures among Medicare beneficiaries with disabilities. We analyzed data from 452 Medicare beneficiaries who participated in a Medicare demonstration. The intervention included the following components: patient education, health promotion coaching, medication management, and physician care management. We performed the analysis by using generalized linear models (GLM) to examine the impact of BMI and the intervention on total health care expenditures. The intervention was cost neutral over the 2-year study period. Participants in the intervention group used less home health aide services (p = .03) and had fewer nursing home days (p = .05). The intervention appeared to have smaller effects on expenditures as BMI level increased. The findings suggest that a health promotion intervention may achieve better beneficiary outcomes without an increase in resource use in this Medicare population.

Physician utilization and expenditures in a Medicaid Population

PubMed Central

Buczko, William

1986-01-01

The determinants of physician visit utilization and expenditures for the full-year Medicaid enrollees in the State Medicaid household survey portion of the National Medical Care Utilization and Expenditure Survey are analyzed in this article. The regression analyses for the probability of a physician visit, for number of physician visits, and for physician visit expenditures underscore the importance of perceived health status as a determinant of both physician utilization and expenditures. Other important determinants of physician utilization and expenditures were regular source of care, State, enrollment group, sex, and family size. PMID:10312009

National health expenditures, 1988

PubMed Central

1990-01-01

Every year, analysts in the Health Care Financing Administration present figures on what our Nation spends for health. As the result of a comprehensive re-examination of the definitions, concepts, methods, and data sources used to prepare those figures, this year's report contains new estimates of national health expenditures for calendar years 1960 through 1988. Significant changes have been made to estimates of spending for professional services and to estimates of what consumers pay out of pocket for health care. In the first article, trends in use of and expenditure for various types of goods and services are discussed, as well as trends in the sources of funds used to finance health care. In a companion article, the benchmark process is described in more detail, as are the data sources and methods used to prepare annual estimates of health expenditures. PMID:10113395

Unobtrusive measurement of indoor energy expenditure using an infrared sensor-based activity monitoring system.

PubMed

Hwang, Bosun; Han, Jonghee; Choi, Jong Min; Park, Kwang Suk

2008-11-01

The purpose of this study was to develop an unobtrusive energy expenditure (EE) measurement system using an infrared (IR) sensor-based activity monitoring system to measure indoor activities and to estimate individual quantitative EE. IR-sensor activation counts were measured with a Bluetooth-based monitoring system and the standard EE was calculated using an established regression equation. Ten male subjects participated in the experiment and three different EE measurement systems (gas analyzer, accelerometer, IR sensor) were used simultaneously in order to determine the regression equation and evaluate the performance. As a standard measurement, oxygen consumption was simultaneously measured by a portable metabolic system (Metamax 3X, Cortex, Germany). A single room experiment was performed to develop a regression model of the standard EE measurement from the proposed IR sensor-based measurement system. In addition, correlation and regression analyses were done to compare the performance of the IR system with that of the Actigraph system. We determined that our proposed IR-based EE measurement system shows a similar correlation to the Actigraph system with the standard measurement system.

Non-linear dynamic analysis of geared systems, part 2

NASA Technical Reports Server (NTRS)

Singh, Rajendra; Houser, Donald R.; Kahraman, Ahmet

1990-01-01

A good understanding of the steady state dynamic behavior of a geared system is required in order to design reliable and quiet transmissions. This study focuses on a system containing a spur gear pair with backlash and periodically time-varying mesh stiffness, and rolling element bearings with clearance type non-linearities. A dynamic finite element model of the linear time-invariant (LTI) system is developed. Effects of several system parameters, such as torsional and transverse flexibilities of the shafts and prime mover/load inertias, on free and force vibration characteristics are investigated. Several reduced order LTI models are developed and validated by comparing their eigen solution with the finite element model results. Several key system parameters such as mean load and damping ratio are identified and their effects on the non-linear frequency response are evaluated quantitatively. Other fundamental issues such as the dynamic coupling between non-linear modes, dynamic interactions between component non-linearities and time-varying mesh stiffness, and the existence of subharmonic and chaotic solutions including routes to chaos have also been examined in depth.

Evaluating direct medical expenditures estimation methods of adults using the medical expenditure panel survey: an example focusing on head and neck cancer.

PubMed

Coughlan, Diarmuid; Yeh, Susan T; O'Neill, Ciaran; Frick, Kevin D

2014-01-01

To inform policymakers of the importance of evaluating various methods for estimating the direct medical expenditures for a low-incidence condition, head and neck cancer (HNC). Four methods of estimation have been identified: 1) summing all health care expenditures, 2) estimating disease-specific expenditures consistent with an attribution approach, 3) estimating disease-specific expenditures by matching, and 4) estimating disease-specific expenditures by using a regression-based approach. A literature review of studies (2005-2012) that used the Medical Expenditure Panel Survey (MEPS) was undertaken to establish the most popular expenditure estimation methods. These methods were then applied to a sample of 120 respondents with HNC, derived from pooled data (2003-2008). The literature review shows that varying expenditure estimation methods have been used with MEPS but no study compared and contrasted all four methods. Our estimates are reflective of the national treated prevalence of HNC. The upper-bound estimate of annual direct medical expenditures of adult respondents with HNC between 2003 and 2008 was $3.18 billion (in 2008 dollars). Comparable estimates arising from methods focusing on disease-specific and incremental expenditures were all lower in magnitude. Attribution yielded annual expenditures of $1.41 billion, matching method of $1.56 billion, and regression method of $1.09 billion. This research demonstrates that variation exists across and within expenditure estimation methods applied to MEPS data. Despite concerns regarding aspects of reliability and consistency, reporting a combination of the four methods offers a degree of transparency and validity to estimating the likely range of annual direct medical expenditures of a condition. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Published by International Society for Pharmacoeconomics and Outcomes Research (ISPOR) All rights reserved.

44 CFR 206.344 - Limitations on Federal expenditures.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HOMELAND SECURITY DISASTER ASSISTANCE FEDERAL DISASTER ASSISTANCE Coastal Barrier Resources Act... within the Coastal Barrier Resources System, including but not limited to: (a) Construction... area, except that such assistance and expenditures may be made available on units designated pursuant...

Energy expenditure in adults with cerebral palsy playing Wii Sports.

PubMed

Hurkmans, Henri L; van den Berg-Emons, Rita J; Stam, Henk J

2010-10-01

To determine energy expenditure of adults with bilateral spastic cerebral palsy while playing Wii Sports tennis and boxing. Cross-sectional study. University medical center. Five men and 3 women with bilateral spastic cerebral palsy and ambulatory ability (Gross Motor Function Classification System level I or II) participated. The mean participant age ± SD was 36±7 years. Exclusion criteria were comorbidities that affected daily physical activity and fitness, contraindications to exercise, or inability to understand study instructions owing to cognitive disorders or language barriers. Participants played Wii Sports tennis and boxing, each for 15 minutes in random order. By using a portable gas analyzer, we assessed energy expenditure by oxygen uptake (Vo(2)) while sitting and during Wii Sports game play. Energy expenditure is expressed in metabolic equivalents (METs), which were calculated as Vo(2) during Wii Sports play divided by Vo(2) during sitting. Mean ± SD energy expenditure during Wii Sports game play was 4.5±1.1METs for tennis and 5.0±1.1METs for boxing (P=.024). All participants attained energy expenditures greater than 3METs, and 2 participants attained energy expenditures greater than 6METs while playing Wii Sports tennis or boxing. Both Wii Sports tennis and boxing seem to provide at least moderate-intensity exercise in adults with bilateral spastic cerebral palsy (GMFCS level I or II). These games, therefore, may be useful as treatment to promote more active and healthful lifestyles in these patients. Further research is needed to determine the energy expenditures of other physically disabled patient groups while playing active video games, and to determine the effectiveness of these games in improving health and daily activity levels. Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Effect of e-health on medical expenditures of outpatients with lifestyle-related diseases.

PubMed

Minetaki, Kazunori; Akematsu, Yuji; Tsuji, Masatsugu

2011-10-01

We analyzed the effect of e-health on medical expenditures in Nishi-aizu Town, Fukushima Prefecture, Japan, using panel data of medical expenditures for about 400 residents from 2002 to 2006. The Nishi-aizu Town system was introduced in 1994 and is still successfully operating as one of the longest running implementations of e-health in Japan. The town office maintains a register of receipts for medical expenditures paid by the National Health Insurance system and provides data on e-health users, allowing users and nonusers of e-health and their respective costs to be distinguished. Here, we focus on patients with lifestyle-related diseases such as high blood pressure, diabetes, stroke, heart failure, etc. This article postulates that e-health reduces medical expenditures via two mechanisms, decreasing travel expenses and preventing symptoms from worsening. The former implies that e-health monitoring allows patients at home to visit medical institutions less frequently, and the latter that the symptoms experienced by e-health users are less severe than those experienced by nonusers. We termed these the travel cost effect and opportunity cost effect, respectively. Chronic conditions tend not to occur singly, and many patients have more than one; for example, patients with high blood pressure or diabetes also likely have heart disease at the same time. This multiplicity of conditions hampers cost analysis. Among methodological issues, a number of recent empirical health analyses have focused on the endogenous problem of explanatory variables. Here, we solved this problem using the generalized method moments (GMM) system, which allows treatment of not only the endogenous problem of explanatory variables but also the dynamic relationship among variables, which arise due to the chronic time-lagged effect of lifestyle-related diseases on patients. We also examined a second important methodological problem related to reverse correlation between the medical expenditures of

Energy expenditure in rock/pop drumming.

PubMed

De La Rue, S E; Draper, S B; Potter, C R; Smith, M S

2013-10-01

Despite the vigorous nature of rock/pop drumming, there are no precise data on the energy expenditure of this activity. The aim of this study was to quantify the energy cost of rock/pop drumming. Fourteen male drummers (mean±SD; age 27±8 yrs.) completed an incremental drumming test to establish the relationship between energy expenditure and heart rate for this activity and a ramped cycle ergometer test to exhaustion as a criterion measure for peak values (oxygen uptake and heart rate). During live concert performance heart rate was continuously measured and used to estimate energy expenditure (from the energy expenditure vs. heart rate data derived from the drumming test). During concert performance, estimated energy expenditure (mean±SD) was 623±168 kcal.h⁻¹ (8.1±2.2 METs) during performances of 38.6±15.6 min, and drummers achieved a peak heart rate of 186±16 b.min⁻¹. During the drumming test participants attained 78.7±8.3% of the cycle ergometer peak oxygen uptake. Rock/pop drumming represents a relatively high-intensity form of physical activity and as such involves significant energy expenditure. Rock/pop drumming should be considered as a viable alternative to more traditional forms of physical activity. © Georg Thieme Verlag KG Stuttgart · New York.

Genetic Predisposition to Obesity and Medicare Expenditures.

PubMed

Wehby, George L; Domingue, Benjamin W; Ullrich, Fred; Wolinsky, Fredric D

2017-12-12

The relationship between obesity and health expenditures is not well understood. We examined the relationship between genetic predisposition to obesity measured by a polygenic risk score for body mass index (BMI) and Medicare expenditures. Biennial interview data from the Health and Retirement Survey for a nationally representative sample of older adults enrolled in fee-for-service Medicare were obtained from 1991 through 2010 and linked to Medicare claims for the same period and to Genome-Wide Association Study (GWAS) data. The study included 6,628 Medicare beneficiaries who provided 68,627 complete person-year observations during the study period. Outcomes were total and service-specific Medicare expenditures and indicators for expenditures exceeding the 75th and 90th percentiles. The BMI polygenic risk score was derived from GWAS data. Regression models were used to examine how the BMI polygenic risk score was related to health expenditures adjusting for demographic factors and GWAS-derived ancestry. Greater genetic predisposition to obesity was associated with higher Medicare expenditures. Specifically, a 1 SD increase in the BMI polygenic risk score was associated with a $805 (p < .001) increase in annual Medicare expenditures per person in 2010 dollars (~15% increase), a $370 (p < .001) increase in inpatient expenses, and a $246 (p < .001) increase in outpatient services. A 1 SD increase in the polygenic risk score was also related to increased likelihood of expenditures exceeding the 75th percentile by 18% (95% CI: 10%-28%) and the 90th percentile by 27% (95% CI: 15%-40%). Greater genetic predisposition to obesity is associated with higher Medicare expenditures. © The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Energy Expenditure of Sport Stacking

ERIC Educational Resources Information Center

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

2009-01-01

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

System theory as applied differential geometry. [linear system

NASA Technical Reports Server (NTRS)

Hermann, R.

1979-01-01

The invariants of input-output systems under the action of the feedback group was examined. The approach used the theory of Lie groups and concepts of modern differential geometry, and illustrated how the latter provides a basis for the discussion of the analytic structure of systems. Finite dimensional linear systems in a single independent variable are considered. Lessons of more general situations (e.g., distributed parameter and multidimensional systems) which are increasingly encountered as technology advances are presented.

National trends in prescription drug expenditures and projections for 2014.

PubMed

Schumock, Glen T; Li, Edward C; Suda, Katie J; Matusiak, Linda M; Hunkler, Robert J; Vermeulen, Lee C; Hoffman, James M

2014-03-15

An analysis of trends in U.S. pharmaceutical spending is presented, including projections for drug expenditures in nonfederal hospital and clinic settings in 2014. Trends in pharmaceutical expenditures and developments likely to influence future spending, including new drug approvals and patent expirations, were analyzed using data from the IMS Health National Sales Perspectives database. Projections were based on a combination of quantitative and qualitative analyses and expert opinion. Total prescription sales for the 12 months ending September 2013 were approximately $326 billion, 0.7% lower than sales during the previous 12 months; pharmaceutical spending by clinics and nonfederal hospitals grew by 4.5% and 1.8%, respectively. Vaccines were among the products driving large sales increases in clinic settings, with alteplase and pegfilgrastim topping the list of fast-growing drugs by hospital expenditures. Few new drug approvals anticipated in 2014 are expected to result in major expenditures by hospitals and clinics. Expansion of access to health care and other changes related to the Patient Protection and Affordable Care Act, as well as continued improvement in the U.S. economy, may drive growth in pharmaceutical spending over the next 12-24 months. Growth in U.S. prescription drug expenditures is expected to rebound in 2014, with a projected 3-5% increase in total drug expenditures across all settings this year, including a 5-7% increase in clinic spending and a 1-3% increase in hospital spending. Health-system pharmacy leaders should carefully examine local drug-utilization patterns to determine their respective organization's anticipated spending in 2014.

Linear Actuator System for the NASA Docking System

NASA Technical Reports Server (NTRS)

Dick, Brandon; Oesch, Chris

2017-01-01

The Linear Actuator System (LAS) is a major sub-system within the NASA Docking System (NDS). The NDS Block 1 will be used on the Boeing Crew Space Transportation (CST-100) system to achieve docking with the International Space Station. Critical functions in the Soft Capture aspect of docking are performed by the LAS, which implements the Soft Impact Mating and Attenuation Concept (SIMAC). This paper describes the general function of the LAS, the system's key requirements and technical challenges, and the development and qualification approach for the system.

Application of Nearly Linear Solvers to Electric Power System Computation

NASA Astrophysics Data System (ADS)

Grant, Lisa L.

To meet the future needs of the electric power system, improvements need to be made in the areas of power system algorithms, simulation, and modeling, specifically to achieve a time frame that is useful to industry. If power system time-domain simulations could run in real-time, then system operators would have situational awareness to implement online control and avoid cascading failures, significantly improving power system reliability. Several power system applications rely on the solution of a very large linear system. As the demands on power systems continue to grow, there is a greater computational complexity involved in solving these large linear systems within reasonable time. This project expands on the current work in fast linear solvers, developed for solving symmetric and diagonally dominant linear systems, in order to produce power system specific methods that can be solved in nearly-linear run times. The work explores a new theoretical method that is based on ideas in graph theory and combinatorics. The technique builds a chain of progressively smaller approximate systems with preconditioners based on the system's low stretch spanning tree. The method is compared to traditional linear solvers and shown to reduce the time and iterations required for an accurate solution, especially as the system size increases. A simulation validation is performed, comparing the solution capabilities of the chain method to LU factorization, which is the standard linear solver for power flow. The chain method was successfully demonstrated to produce accurate solutions for power flow simulation on a number of IEEE test cases, and a discussion on how to further improve the method's speed and accuracy is included.

[Adaptation of food ingestion to energy expenditure].

PubMed

Louis-Sylvestre, J

1987-01-01

Body energy balance is regulated in adults. The accuracy of the phenomenon is particularly evident in laboratory animals under steady conditions. Moreover, it has been repeatedly demonstrated that this balance is maintained in spite of fluctuations in food intake or energy expenditure. When animals such as rats, dogs or rabbits are presented with a diluted or concentrated version of familiar food, they compensate rapidly by increasing or decreasing their ponderal intake. This is achieved first by a change in meal frequency, then meal size adapts to the new caloric content and meal frequency returns to the original pattern. This adaptation is based on the learning of post-ingestive cues. Hypo or hyperphagia leads to reduced or increased energy expenditure, as the case may be; the basal metabolic rate is modulated by thyroid hormones and diet-induced thermogenesis by the sympathetic system. These variations are partly regulatory. In a cold environment, the increase in energy expenditure caused by increased thermogenesis is rapidly compensated by increased caloric intake. Physical activity activates the sympathetic system responsible for numerous hormonal changes, the most important of which is insulin hyposecretion. In animals or humans, moderate aerobic exercise induces a small weight loss; afterwards, weight gain is normalized and increased caloric intake compensates for energy expenditures such as exercise, increased basal metabolic rate and diet-induced thermogenesis. Extreme changes in body weight and fat are produced by gestation and lactation; they are satisfactorily explained by concomitant hormonal changes. Especially during lactation, food intake is regulated so that it allows body weight to return to pregestation level. Studies on the mechanisms implicated in the regulation of body energy balance are still in progress. Friedman and Ramirez (1985) suggest that the way fatty acids are utilized is important. Kasser et al. (1985) show a striking difference in

Impact of healthcare reforms on out-of-pocket health expenditures in Turkey for public insurees.

PubMed

Erus, Burcay; Aktakke, Nazli

2012-06-01

The Turkish healthcare system has been subject to major reforms since 2003. During the reform process, access to public healthcare providers was eased and private providers were included in the insurance package for public insurees. This study analyzes data on out-of-pocket (OOP) healthcare expenditures to look into the impact of reforms on the size of OOP health expenditures for premium-based public insurees. The study uses Household Budget Surveys that provide a range of individual- and household-level data as well as healthcare expenditures for the years 2003, before the reforms, and 2006, after the reforms. Results show that with the reforms ratio of households with non-zero OOP expenditure has increased. Share and level of OOP expenditures have decreased. The impact varies across income levels. A semi-parametric analysis shows that wealthier individuals benefited more in terms of the decrease in OOP health expenditures.

Determinants of catastrophic health expenditure in Nigeria.

PubMed

Aregbeshola, Bolaji Samson; Khan, Samina Mohsin

2018-05-01

Catastrophic health expenditure is a measure of financial risk protection and it is often incurred by households who have to pay out of pocket for health care services that are not affordable. The study assessed the determinants of catastrophic health expenditure among households in Nigeria. Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/10 was utilized to assess factors associated with catastrophic health expenditure in Nigeria. Household and individual characteristics associated with catastrophic health expenditure were determined using bivariate analysis and multivariate logistic regression. Results showed that irrespective of the threshold for the two concepts of total household expenditure and non-food expenditure, having household members aged between 6 and 14 years, having household members aged between 15 and 24 years, having household members aged between 25 and 54 years, having no education, having primary education, having secondary education, lack of health insurance coverage, visiting a private health facility, households living in north central zone, households living in north east zone and having household members with non-chronic illnesses were factors that increase the risk of incurring catastrophic health expenditure among households. Policy-makers and political actors need to design equitable health financing policies that will increase financial risk protection for people in both the formal and informal sectors of the economy.

Energy expenditure and caloric and protein intake in infants following the Norwood procedure.

PubMed

Li, Jia; Zhang, Gencheng; Herridge, Joann; Holtby, Helen; Humpl, Tilman; Redington, Andrew N; Van Arsdell, Glen S

2008-01-01

Cardiopulmonary bypass in infants results in a hypermetabolic response. Energy requirements of these patients have not been well studied. We assessed energy expenditure and caloric and protein intake during the first 3 days following the Norwood procedure. Clinical investigation. Children's hospital. Seventeen infants (15 boys, age 4-92 days, median 7 days). VO2 and VCO2 were continuously measured using respiratory mass spectrometry in 17 infants for the first 72 hrs following the Norwood procedure. The respiratory quotient was determined as VCO2/VO2. Energy expenditure was calculated using the modified Weir equation. Measurements were collected at 2- to 4-hr intervals. The mean values in the first 8 hrs, hours 8-32, hours 32-56, and the last 16 hrs were used as representative values for postoperative days 0, 1, 2, and 3. Total caloric and protein intakes were recorded for each day. Energy expenditure, VO2, and VCO2 were initially high; declined rapidly during the first 8 hrs; and were maintained relatively stable in the following hours (p < .0001). Respiratory quotient showed a significant linear increase over the 72 hrs (p = .002). Energy expenditure on days 0, 1, 2, and 3 was 43 +/- 11, 39 +/- 8, 39 +/- 8, and 41 +/- 6 kcal/kg/day, respectively. Total caloric intake was 3 +/- 1, 14 +/- 5, 31 +/- 16, and 51 +/- 16 kcal/kg/day. Protein intake was 0, 0.2 +/- 0.2, 0.6 +/- 0.5, and 0.9 +/- 0.5 g/kg/day on days 0, 1, 2, and 3, respectively. Infants exhibit a hypermetabolic response immediately following the Norwood procedure. Caloric and protein intake was inadequate to meet energy expenditure during the first 2 days after surgery. Further studies are warranted to examine the effects of caloric and protein supplementation on postoperative outcomes in infants after cardiopulmonary bypass.

Energy expenditure in patients with chronic renal failure.

PubMed

Monteon, F J; Laidlaw, S A; Shaib, J K; Kopple, J D

1986-11-01

Although nondialyzed, chronically uremic patients and patients undergoing maintenance hemodialysis often show evidence for wasting and calorie malnutrition and have low dietary energy intakes, their energy expenditure has never been systematically evaluated. It is possible that low energy intakes are an adaptive response to reduced energy needs; alternatively, energy expenditure could be normal or high and the low energy intakes would be inappropriate. Energy expenditure was therefore measured by indirect calorimetry in 12 normal individuals, 10 nondialyzed patients with chronic renal failure, and 16 patients undergoing maintenance hemodialysis. Energy expenditure was measured in the resting state, during quiet sitting, during controlled exercise on an exercise bicycle, and for four hours after ingestion of a test meal. Resting energy expenditure (kcal/min/1.73 m2) in the normal subjects, chronically uremic patients and hemodialysis patients was, respectively, 0.94 +/- 0.24 (SD), 0.91 +/- 0.20, and 0.97 +/- 0.10. There was also no difference among the three groups in energy expenditure during sitting, exercise, or the postprandial state. Within each group, energy expenditure during resting and sitting was directly correlated. During bicycling, energy expenditure was directly correlated with work performed, and the regression equation for this relationship was similar in each of the three groups. These findings suggest that for a given physical activity, energy expenditure in nondialyzed, chronically uremic patients and maintenance hemodialysis patients is not different from normal. The low energy intakes of many of these patients may be inadequate for their needs.

Can eHealth Reduce Medical Expenditures of Chronic Diseases?

PubMed

Tsuji, Masatsugu; Taher, Sheikh Abu; Kinai, Yusuke

2015-01-01

The objective of this research is to evaluate empirically the effectiveness of eHealth in Nishi-aizu Town, Fukushima Prefecture, based on a mail survey to the residents and their receipt data of National Health Insurance from November 2006 to February 2007. The residents were divided into two groups, users and non-users, and sent questionnaires to ask their characteristics or usage of the system. Their medical expenditures paid by National Health Insurance for five years from 2002 to 2006 are examined. The effects were analyzed by comparison of medical expenditures between users and non-users. The interests are focused on four chronic diseases namely heart diseases, high blood pressure, diabetes, and strokes. A regression analysis is employed to estimate the effect of eHealth to users who have these diseases and then calculate the monetary effect of eHealth on reduction of medical expenditures. The results are expected to be valid for establishment of evidence-based policy such as reimbursement from medical insurance to eHealth.

Analysis of the Unified Health System funding and expenditure in the municipalities of the "Rota dos Bandeirantes" health region, State of São Paulo, Brazil.

PubMed

Santos, João Alves Dos; Mendes, Áquilas Nogueira; Pereira, Antônio Carlos; Paranhos, Luiz Renato

2017-04-01

The national scenario of lack of resources in the Brazilian Unified Health System (SUS) has led to major differences in the municipalities funding models. Thus, this study aims to analyze SUS funding and expenditure in seven cities of the Rota dos Bandeirantes health region, State of São Paulo, SP, Brazil, from 2009 to 2012. Settled expenditure indicators were collected from the Public Health Budgets Information System (SIOPS) for analysis, showing descriptive data with absolute and relative frequency calculations. We identified that the per capita income available for the city of Barueri is almost tenfold that of the city of Carapicuíba, and that Barueri's health expenditure per capita is more than double that of the regional average and almost fivefold that of Carapicuíba. The Federal Government is responsible for 95.4% of all funding to municipalities. Most of the available income of the municipalities in the region include their own taxes and state transfers. All the municipalities showed a significant positive trend, both for available income and health expenditure. The regional average of own revenue spent on health is 27.3%. Carapicuíba achieved a level of 37.5%, which is much higher than the minimum of 15% required by the Federal Constitution.

Finite-time H∞ filtering for non-linear stochastic systems

NASA Astrophysics Data System (ADS)

Hou, Mingzhe; Deng, Zongquan; Duan, Guangren

2016-09-01

This paper describes the robust H∞ filtering analysis and the synthesis of general non-linear stochastic systems with finite settling time. We assume that the system dynamic is modelled by Itô-type stochastic differential equations of which the state and the measurement are corrupted by state-dependent noises and exogenous disturbances. A sufficient condition for non-linear stochastic systems to have the finite-time H∞ performance with gain less than or equal to a prescribed positive number is established in terms of a certain Hamilton-Jacobi inequality. Based on this result, the existence of a finite-time H∞ filter is given for the general non-linear stochastic system by a second-order non-linear partial differential inequality, and the filter can be obtained by solving this inequality. The effectiveness of the obtained result is illustrated by a numerical example.

National health expenditures, 1984

PubMed Central

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

1985-01-01

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

Linear dynamic coupling in geared rotor systems

NASA Technical Reports Server (NTRS)

David, J. W.; Mitchell, L. D.

1986-01-01

The effects of high frequency oscillations caused by the gear mesh, on components of a geared system that can be modeled as rigid discs are analyzed using linear dynamic coupling terms. The coupled, nonlinear equations of motion for a disc attached to a rotating shaft are presented. The results of a trial problem analysis show that the inclusion of the linear dynamic coupling terms can produce significant changes in the predicted response of geared rotor systems, and that the produced sideband responses are greater than the unbalanced response. The method is useful in designing gear drives for heavy-lift helicopters, industrial speed reducers, naval propulsion systems, and heavy off-road equipment.

ORACLS: A system for linear-quadratic-Gaussian control law design

NASA Technical Reports Server (NTRS)

Armstrong, E. S.

1978-01-01

A modern control theory design package (ORACLS) for constructing controllers and optimal filters for systems modeled by linear time-invariant differential or difference equations is described. Numerical linear-algebra procedures are used to implement the linear-quadratic-Gaussian (LQG) methodology of modern control theory. Algorithms are included for computing eigensystems of real matrices, the relative stability of a matrix, factored forms for nonnegative definite matrices, the solutions and least squares approximations to the solutions of certain linear matrix algebraic equations, the controllability properties of a linear time-invariant system, and the steady state covariance matrix of an open-loop stable system forced by white noise. Subroutines are provided for solving both the continuous and discrete optimal linear regulator problems with noise free measurements and the sampled-data optimal linear regulator problem. For measurement noise, duality theory and the optimal regulator algorithms are used to solve the continuous and discrete Kalman-Bucy filter problems. Subroutines are also included which give control laws causing the output of a system to track the output of a prescribed model.

IDF Diabetes Atlas estimates of 2014 global health expenditures on diabetes.

PubMed

da Rocha Fernandes, Joao; Ogurtsova, Katherine; Linnenkamp, Ute; Guariguata, Leonor; Seuring, Till; Zhang, Ping; Cavan, David; Makaroff, Lydia E

2016-07-01

To estimate health expenditures due to diabetes in 2014 for the world and its regions. Diabetes-attributable health expenditures were estimated using an attributable fraction method. Data were sourced from International Diabetes Federation (IDF) estimates of diabetes prevalence, UN population projections, WHO annual health expenditure reports, and estimates of the cost ratio of people with and without diabetes. Health expenditures were calculated in both US dollars (USD) and international dollars (ID). The average health expenditure per person with diabetes worldwide in 2014 was estimated to range from USD 1583 (ID 1742) to USD 2842 (ID 3110). The estimated annual global health expenditure attributable to diabetes ranged from USD 612 billion (ID 673 billion) to USD 1099 billion (ID 1202 billion). Together, the North America and Caribbean Region and the Europe Region were responsible for over 69% of the costs, and less than 10% of the costs were from the Africa Region, South East Asia Region, and Middle East and North Africa Region combined. The North America and Caribbean Region had the highest annual spending per person with diabetes (USD 7984 [ID 8040.39]), while the South East Asia Region had the lowest annual spending per person with diabetes (USD 92 [ID 234]). Diabetes imposes a large economic burden on health care systems across the world, yet varies across world regions. Diabetes prevention and effective management of diabetes should be a public health priority to reduce the financial burden. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Relationship between cost systems and hospital expenditure].

PubMed

García-Cornejo, Beatriz; Pérez-Méndez, José A

To analyze the relationship between the degree of development of hospital cost systems (CS) implemented by the regional health services (RHS) and the variation in unit cost of hospitals in Spanish National Health Service (NHS) between 2010 and 2013 and to identify other explanatory factors of this variation. A database of NHS hospitals was constructed from exclusively public sources. Using a multilevel regression model, explaining factors of the variation in unit cost (cost per weighted unit of activity [WAU]) of a sample of 170 hospitals were analyzed. The variables representative of the degree of development of CS are associated in a negative and significant way with the variation of the cost per WAU. It is observed that if a high-level development CS is used the cost variation per WAU would be reduced by close to 3.2%. There is also a negative and significant relationship between the variation in the cost per WAU and the variations in the percentage of high technology and the hospital occupancy rate. On the other hand, the variations in the average cost of personnel and in the number of workers per 100 beds are associated in a positive and significant way with the variation of the cost per WAU. In the period analysed, during which the main health expenditure adjustment was made, the control in hospital unit cost is associated not only with spending cuts but also with aspects related to their management, such as the implementation of more developed CS. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Health care expenditures among Asian American subgroups.

PubMed

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

2013-06-01

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

Geographical variation in camper expenditures

Treesearch

Wilbur F. LaPage; Edward G. Fisher

1971-01-01

Daily expenditures by families camping in New Hampshire State parks in 1967 averaged $11.81. Considerable variation was found between the northern, central, and southern regions of the State in both the average amount of money spent and the way in which the money was spent. Daily expenditures in the north were higher, but average visit lengths were shorter, resulting...

Energy expenditure and sex differences of golf playing.

PubMed

Zunzer, Stefan C; von Duvillard, Serge P; Tschakert, Gerhard; Mangus, Brent; Hofmann, Peter

2013-01-01

The purpose of the study was to assess the average physical intensity and energy expenditure during a single round of golf on hilly and flat courses in a heterogeneous group of healthy men and women of varying age and golf handicap. Forty-two males and 24 females completed an incremental cycle-ergometer exercise test to determine exercise performance markers. The heart rate (HR), duration, distance, walking speed, ascent and descent were measured via a global positioning system (GPS)/HR monitor during the game and energy expenditure was calculated. Playing 9 or 18-holes of golf, independent of the golf course design, the average HR was not significantly different between sexes or the subgroups. The intensities were light with respect to the percentage of maximal HR and metabolic equivalents of task (METs). Total energy expenditure of all participants was not significantly different for hilly (834 ± 344 kcal) vs. flat courses (833 ± 295 kcal) whereas male players expended significantly greater energy than female players (926 ± 292 vs. 556 ± 180 kcal), but did not have significantly greater relative energy expenditure (2.8 ± 0.8 vs. 2.2 ± 0.7 METs). As a high volume physical activity, playing golf is suggested to yield health benefits. Since the intensity was well below recommended limits, golf may have health related benefits unrelated to the intensity level of the activity.

Polynomial compensation, inversion, and approximation of discrete time linear systems

NASA Technical Reports Server (NTRS)

Baram, Yoram

1987-01-01

The least-squares transformation of a discrete-time multivariable linear system into a desired one by convolving the first with a polynomial system yields optimal polynomial solutions to the problems of system compensation, inversion, and approximation. The polynomial coefficients are obtained from the solution to a so-called normal linear matrix equation, whose coefficients are shown to be the weighting patterns of certain linear systems. These, in turn, can be used in the recursive solution of the normal equation.

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

PubMed

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

2018-01-01

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

Linking point scale process non-linearity, catchment organization and linear system dynamics in a thermodynamic state space

NASA Astrophysics Data System (ADS)

Zehe, Erwin; Loritz, Ralf; Ehret, Uwe; Westhoff, Martijn; Kleidon, Axel; Savenije, Hubert

2017-04-01

It is flabbergasting to note that catchment systems often behave almost linearly, despite of the strong non-linearity of point scale soil water characteristics. In the present study we provide evidence that a thermodynamic treatment of environmental system dynamics is the key to understand how particularly a stronger spatial organization of catchments leads to a more linear rainfall runoff behavior. Our starting point is that water fluxes in a catchment are associated with fluxes of kinetic and potential energy while changes in subsurface water stocks go along with changes in potential energy and chemical energy of subsurface water. Steady state/local equilibrium of the entire system can be defined as a state of minimum free energy, reflecting an equilibrium subsurface water storage, which is determined catchment topography, soil water characteristics and water levels in the stream. Dynamics of the entire system, i.e. deviations from equilibrium storage, are 'pseudo' oscillations in a thermodynamic state space. Either to an excess potential energy in case of wetting while subsequent relaxation back to equilibrium requires drainage/water export. Or to an excess in capillary binding energy in case of driving, while relaxation back to equilibrium requires recharge of the subsurface water stock. While system dynamics is highly non-linear on the 'too dry branch' it is essentially linear on the 'too wet branch' in case of potential energy excess. A steepened topography, which reflects a stronger spatial organization, reduces the equilibrium storage of the catchment system to smaller values, thereby it increases the range of states where the systems behaves linearly due to an excess in potential energy. Contrarily to this a shift to finer textured soils increases the equilibrium storage, which implies that the range of states where the systems behaves linearly is reduced. In this context it is important to note that an increased internal organization of the system due to

Has the Financial Protection Been Materialized in Iranian Health System? Analyzing Household Income and Expenditure Survey 2003-2014.

PubMed

Ghiasvand, Hesam; Olyaeemanesh, Alireza; Majdzadeh, Reza; Abdi, Zhaleh; Mobinizadeh, Mohammadreza

2018-01-03

The financial protection against catastrophic and impoverishing health expenditures is one of the main aspects of the universal health coverage. This study aimed to present a clear picture of the financial protection situation in Iran from 2003-2014. This is an analytical study on secondary data of Statistical Center of Iran (SCI). The study has some policy implications for policy makers; therefore, it is an applied one. Data related to the Iranian rural and urban household payments on health expenditures was obtained from annual surveys of the SCI. WHO researchers' approach was used to calculate the Fairness of Financial Contribution Indicator (FFCI), the headcount and overshoot ratios of catastrophic and impoverishing health expenditures. A logistic regression was conducted to identify the determinants of probability of occurrence of catastrophic health expenditure among Iranian households in 2014. The mean of FFCI for rural and urban households was 0.854 (0.41) and 0.867 (0.32), respectively. The average headcount ratios of catastrophic and impoverishing health expenditures were 1.32% (0.24) and 0.33% (P=0.006) for rural households and 1.4% (0.6) and 0.28% (P=0.001) for urban households. Concerning rural households, the overshoot of catastrophic and impoverishing health expenditures was 14.94% (P=0.001) and 7.22% (0.53); it was 15.59% (1.54) and 7.76% (0.52) for urban households. No significant and considerable change was found in the headcount ratios of catastrophic and impoverishing health expenditure and in their overshoot or gap amounts. This suggested a lack of well-designed and effective schemes for materializing the financial protection in Iran.

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

PubMed Central

2014-01-01

Background The rapid growth of prescription drug expenditures is a major problem in South Korea. Accordingly, the South Korean government introduced a positive listing system in 2006. They also adopted various price reduction policies. Nevertheless, the total expenditure for lipid-lowering drugs have steadily increased throughout South Korea. The present study explores the factors that have influenced the increased expenditures of lipid-lowering drugs with a particular focus on the effects of statins in this process. Methods This paper investigates the National Health Insurance claims data for prescribed lipid-lowering drugs collected between January 1, 2005 and December 31, 2009. We specifically focused on statins and assessed the yearly variation of statin expenditure by calculating the increased rate of paired pharmaceutical expenditures over a 2 year period. Our study classified statins into three categories: new entrants, core medicines and exiting medicines. For core medicines, we further examined influencing factors such as price, amount of drugs consumed by volume, and prescription changes (substitutes for other drug). Results Statin expenditure showed an average annual increase of 25.7% between 2005 and 2009. Among the different statins, the expenditure of atorvastatin showed a 36.6% annual increase rate, which was the most dramatic among all statins. Also we divided expenditure for core medicines by the price factor, volume factor, and prescription change. The result showed that annual weighted average prices of individual drug decreased each year, which clearly showed that price influenced statin expenditure in a negative direction. The use of generic drugs containing the same active ingredient as name-brand drugs increased and negatively affected statin expenditure (Generic Mix effect). However, the use of relatively expensive ingredients within statin increase, Ingredient Mix effect contributed to increased statin expenditure (Ingredient Mix effect

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

PubMed

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

2014-03-03

The rapid growth of prescription drug expenditures is a major problem in South Korea. Accordingly, the South Korean government introduced a positive listing system in 2006. They also adopted various price reduction policies. Nevertheless, the total expenditure for lipid-lowering drugs have steadily increased throughout South Korea. The present study explores the factors that have influenced the increased expenditures of lipid-lowering drugs with a particular focus on the effects of statins in this process. This paper investigates the National Health Insurance claims data for prescribed lipid-lowering drugs collected between January 1, 2005 and December 31, 2009. We specifically focused on statins and assessed the yearly variation of statin expenditure by calculating the increased rate of paired pharmaceutical expenditures over a 2 year period. Our study classified statins into three categories: new entrants, core medicines and exiting medicines. For core medicines, we further examined influencing factors such as price, amount of drugs consumed by volume, and prescription changes (substitutes for other drug). Statin expenditure showed an average annual increase of 25.7% between 2005 and 2009. Among the different statins, the expenditure of atorvastatin showed a 36.6% annual increase rate, which was the most dramatic among all statins. Also we divided expenditure for core medicines by the price factor, volume factor, and prescription change. The result showed that annual weighted average prices of individual drug decreased each year, which clearly showed that price influenced statin expenditure in a negative direction. The use of generic drugs containing the same active ingredient as name-brand drugs increased and negatively affected statin expenditure (Generic Mix effect). However, the use of relatively expensive ingredients within statin increase, Ingredient Mix effect contributed to increased statin expenditure (Ingredient Mix effect). In particular, the volume

State Energy Price and Expenditure Estimates

EIA Publications

2017-01-01

The State Energy Price and Expenditure Estimates provide data on energy prices in current dollars per million Btu and expenditures in current dollars, by state and for the United States, by energy source and by sector in annual time-series back to 1970

The linear sizes tolerances and fits system modernization

NASA Astrophysics Data System (ADS)

Glukhov, V. I.; Grinevich, V. A.; Shalay, V. V.

2018-04-01

The study is carried out on the urgent topic for technical products quality providing in the tolerancing process of the component parts. The aim of the paper is to develop alternatives for improving the system linear sizes tolerances and dimensional fits in the international standard ISO 286-1. The tasks of the work are, firstly, to classify as linear sizes the elements additionally linear coordinating sizes that determine the detail elements location and, secondly, to justify the basic deviation of the tolerance interval for the element's linear size. The geometrical modeling method of real details elements, the analytical and experimental methods are used in the research. It is shown that the linear coordinates are the dimensional basis of the elements linear sizes. To standardize the accuracy of linear coordinating sizes in all accuracy classes, it is sufficient to select in the standardized tolerance system only one tolerance interval with symmetrical deviations: Js for internal dimensional elements (holes) and js for external elements (shafts). The main deviation of this coordinating tolerance is the average zero deviation, which coincides with the nominal value of the coordinating size. Other intervals of the tolerance system are remained for normalizing the accuracy of the elements linear sizes with a fundamental change in the basic deviation of all tolerance intervals is the maximum deviation corresponding to the limit of the element material: EI is the lower tolerance for the of the internal elements (holes) sizes and es is the upper tolerance deviation for the outer elements (shafts) sizes. It is the sizes of the material maximum that are involved in the of the dimensional elements mating of the shafts and holes and determine the fits type.

Health Care Expenditures Among Asian American Subgroups

PubMed Central

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

2014-01-01

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

Fairness of Financial Contribution in Iranian Health System: Trend Analysis of National Household Income and Expenditure, 2003-2010.

PubMed

Fazaeli, Amir Abbas; Seyedin, Hesam; Vosoogh Moghaddam, Abbas; Delavari, Alireza; Salimzadeh, H; Varmazyar, Hasan; Fazaeli, Ali Akbar

2015-03-18

Social systems are dealing with the challenge of achieving fairness in the distribution of financial burden and protecting the risk of financial loss. The purpose of this paper is to present a trend analysis for the indicators related to fairness in healthcare's financial burden in rural and urban population of Iran during the eight years period of 2003 to 2010. We used the information gathered by statistical center of Iran through sampling processes for the household income and expenditures. The indicators of fairness in financial contribution of healthcare were calculated based on the WHO recommended methodology. The indices trend analysis of eight-year period for the rural, urban areas and the country level were computed. This study shows that in Iran the fairness of financial contribution index during the eight-year period has been decreased from 0.841 in 2003 to above 0.827 in 2010 and The percentage of people with catastrophic health expenditures has been increased from 2.3% to above 3.1%. The ratio of total treatment costs to the household overall capacity to pay has been increased from 0.055 to 0.068 and from 0.072 to 0.0818 in urban and rural areas respectively. There is a decline in fairness of financial contribution index during the study period. While, a trend stability of the proportion of households who suffered catastrophic health expenditures was found.

The influence of ship movements on the energy expenditure of fishermen. A study during a North Sea voyage in calm weather.

PubMed

Breidahl, Tomas; Christensen, Michael; Jepsen, Jørgen Riis; Johansen, Jens-Peter; Omland, Øyvind

2013-01-01

Former studies of professional fishing activities have indicated that movements of a ship, in itself, may increase the energy expenditure in addition to the traditional work carried out by fishermen. We have studied the effects of exposure to the ships movement during calm weather by examining the crude relation between the ship movement and the energy expenditure of the fishermen, thus ignoringthe various tasks undertaken on board. We have recruited 4 fishermen on 2 contemporary steel trawlers who participatedduring the whole study period. Each of 4 participants recorded his activities and health conditions oncean hour in a registration scheme for 4 days. Estimations of energy expenditure were done with a bodymonitoring system (SenseWear Pro 3) carried as an armband, placed at the surface on the right upper arm. Measurements of sea movements were obtained by a gyroscope placed in the vessels wheelhouse during fishing expeditions in the North Sea off the coast of Bergen. Data were analysed by linear regression. The exposure monitored in calm weather conditions was small for all measurements of heelingand pitch being less than 10o for both vessels. However, the fishermen's energy expenditure was influenced by these minor sea motions. Trends were seen in the individual graphs with increasing energy expenditureat higher exposures. Our data suggest that even the heel and pitch in calm weather have an impact on the fishermen by increasing their energy consumption, but without any observation of discomfort or negative health outcomes. This study has demonstrated the feasibility of the applied methods, which should be repeated with larger samples and in rough weather.

10 CFR 603.560 - Estimate of project expenditures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Estimate of project expenditures. 603.560 Section 603.560 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS Pre-Award Business Evaluation Fixed-Support Or Expenditure-Based Approach § 603.560 Estimate of project expenditures...

U.S. health expenditure performance: An international comparison and data update

PubMed Central

Schieber, George J.; Poullier, Jean-Pierre; Greenwald, Leslie M.

1992-01-01

In this article, the authors present the most recently available data on the health care financing and delivery systems of the 24 industrialized member countries of the Organization for Economic Cooperation and Development (OECD). U.S. health expenditure performance is compared with the performance of other OECD countries. Thirty-six tables of data from 1960-90 are presented on health expenditures, health care prices, availability and utilization of health care services, health outcomes, and basic economic and demographic factors. PMID:10121999

Out-of-pocket expenditure on maternity care for hospital births in Uttar Pradesh, India.

PubMed

Goli, Srinivas; Rammohan, Anu; Moradhvaj

2018-02-27

The studies measured Out-of-Pocket Expenditure (OOPE) for hospital births previously suffer from serious data limitations. To overcome such limitations, we designed a hospital-based study for measuring the levels and factors of OOPE on maternity care for hospital births by its detailed components. Data were collected from women for non-complicated deliveries 24-h before the survey and complicated deliveries 48-h prior to the survey at the hospital settings in Uttar Pradesh, India during 2014. The simple random sampling design was used in the selection of respondents. Bivariate analyses were used to estimate mean expenditure on Antenatal care services (ANCs), Delivery care and Total Maternity Expenditure (TME). Multivariate linear regression was employed to examine the factor associated with the absolute and relative share of expenditure in couple's annual income on ANCs, delivery care, and TME. The findings show that average expenditure on maternal health care is high ($155) in the study population. Findings suggest that factors such as income, place, and number of ANCs, type, and place of institutional delivery are significantly associated with both absolute and relative expenditure on maternity care. The likelihood of incidence of catastrophic expenditure on maternity care is significantly higher for women delivered in private hospitals (β = 2.427, p < 0.001) compared to the government hospital (β = 0). Also, it is higher among caesarean or forceps deliveries (β = 0.617, p < 0.01), deliveries conducted on doctor advise (β = 0.598, p < 0.01), than in normal deliveries (β = 0) and self or family planned deliveries (β = 0). The findings of this study suggest that the OOPE on maternity care for hospital births reported in this study is much higher as it was collected with a better methodology, although with smaller sample size. Therefore, ongoing maternity benefit scheme in India in general and Uttar Pradesh in particular

Quantum Linear System Algorithm for Dense Matrices.

PubMed

Wossnig, Leonard; Zhao, Zhikuan; Prakash, Anupam

2018-02-02

Solving linear systems of equations is a frequently encountered problem in machine learning and optimization. Given a matrix A and a vector b the task is to find the vector x such that Ax=b. We describe a quantum algorithm that achieves a sparsity-independent runtime scaling of O(κ^{2}sqrt[n]polylog(n)/ε) for an n×n dimensional A with bounded spectral norm, where κ denotes the condition number of A, and ε is the desired precision parameter. This amounts to a polynomial improvement over known quantum linear system algorithms when applied to dense matrices, and poses a new state of the art for solving dense linear systems on a quantum computer. Furthermore, an exponential improvement is achievable if the rank of A is polylogarithmic in the matrix dimension. Our algorithm is built upon a singular value estimation subroutine, which makes use of a memory architecture that allows for efficient preparation of quantum states that correspond to the rows of A and the vector of Euclidean norms of the rows of A.

Quantum Linear System Algorithm for Dense Matrices

NASA Astrophysics Data System (ADS)

Wossnig, Leonard; Zhao, Zhikuan; Prakash, Anupam

2018-02-01

Solving linear systems of equations is a frequently encountered problem in machine learning and optimization. Given a matrix A and a vector b the task is to find the vector x such that A x =b . We describe a quantum algorithm that achieves a sparsity-independent runtime scaling of O (κ2√{n }polylog(n )/ɛ ) for an n ×n dimensional A with bounded spectral norm, where κ denotes the condition number of A , and ɛ is the desired precision parameter. This amounts to a polynomial improvement over known quantum linear system algorithms when applied to dense matrices, and poses a new state of the art for solving dense linear systems on a quantum computer. Furthermore, an exponential improvement is achievable if the rank of A is polylogarithmic in the matrix dimension. Our algorithm is built upon a singular value estimation subroutine, which makes use of a memory architecture that allows for efficient preparation of quantum states that correspond to the rows of A and the vector of Euclidean norms of the rows of A .

Linear decentralized systems with special structure. [for twin lift helicopters

NASA Technical Reports Server (NTRS)

Martin, C. F.

1982-01-01

Certain fundamental structures associated with linear systems having internal symmetries are outlined. It is shown that the theory of finite-dimensional algebras and their representations are closely related to such systems. It is also demonstrated that certain problems in the decentralized control of symmetric systems are equivalent to long-standing problems of linear systems theory. Even though the structure imposed arose in considering the problems of twin-lift helicopters, any large system composed of several identical intercoupled control systems can be modeled by a linear system that satisfies the constraints imposed. Internal symmetry can be exploited to yield new system-theoretic invariants and a better understanding of the way in which the underlying structure affects overall system performance.

Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey

PubMed Central

2014-01-01

Background Inequality in health services access and utilization are influenced by out-of-pocket health expenditures in many low and middle-income countries (LMICs). Various antecedents such as social factors, poor health and economic factors are proposed to direct the choice of health care service use and incurring out-of-pocket payments. We investigated the association of these factors with out-of-pocket health expenditures among the adult and older population in the United Republic of Tanzania. We also investigated the prevalence and associated determinants contributing to household catastrophic health expenditures. Methods We accessed the data of a multistage stratified random sample of 7279 adult participants, aged between 18 and 59 years, as well as 1018 participants aged above 60 years, from the first round of the Tanzania National Panel survey. We employed multiple generalized linear and logistic regression models to evaluate the correlates of out-of-pocket as well as catastrophic health expenditures, accounting for the complex sample design effects. Results Increasing age, female gender, obesity and functional disability increased the adults’ out-of-pocket health expenditures significantly, while functional disability and visits to traditional healers increased the out-of-pocket health expenditures in older participants. Adult participants, who lacked formal education or worked as manual laborers earned significantly less (p < 0.001) and spent less on health (p < 0.001), despite having higher levels of disability. Large household size, household head’s occupation as a manual laborer, household member with chronic illness, domestic violence against women and traditional healer’s visits were significantly associated with high catastrophic health expenditures. Conclusion We observed that the prevalence of inequalities in socioeconomic factors played a significant role in determining the nature of both out-of-pocket and catastrophic health

11 CFR 9034.7 - Allocation of travel expenditures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 11 Federal Elections 1 2010-01-01 2010-01-01 false Allocation of travel expenditures. 9034.7...: PRESIDENTIAL PRIMARY MATCHING FUND ENTITLEMENTS § 9034.7 Allocation of travel expenditures. Link to an..., expenditures for travel relating to the campaign of a candidate seeking nomination for election to the office...

Exercise Training and Energy Expenditure following Weight Loss.

PubMed

Hunter, Gary R; Fisher, Gordon; Neumeier, William H; Carter, Stephen J; Plaisance, Eric P

2015-09-01

This study aims to determine the effects of aerobic or resistance training on activity-related energy expenditure (AEE; kcal·d(-1)) and physical activity index (activity-related time equivalent (ARTE)) following weight loss. It was hypothesized that weight loss without exercise training would be accompanied by decreases in AEE, ARTE, and nontraining physical activity energy expenditure (nonexercise activity thermogenesis (NEAT)) and that exercise training would prevent decreases in free-living energy expenditure. One hundred forty premenopausal women had an average weight loss of 25 lb during a diet (800 kcal·d(-1)) of furnished food. One group aerobically trained 3 times per week (40 min·d(-1)), another group resistance-trained 3 times per week (10 exercises/2 sets × 10 repetitions), and the third group did not exercise. Dual-energy x-ray absorptiometry was used to measure body composition, indirect calorimetry was used to measure resting energy expenditure (REE) and walking energy expenditure, and doubly labeled water was used to measure total energy expenditure (TEE). AEE, ARTE, and nontraining physical activity energy expenditure (NEAT) were calculated. TEE, REE, and NEAT all decreased following weight loss for the no-exercise group, but not for aerobic and resistance trainers. Only REE decreased in the two exercise groups. Resistance trainers increased ARTE. HR and oxygen uptake while walking on the flat and up a grade were consistently related to TEE, AEE, NEAT, and ARTE. Exercise training prevents a decrease in energy expenditure, including free-living energy expenditure separate from exercise training, following weight loss. Resistance training increases physical activity, whereas economy/ease of walking is associated with increased TEE, AEE, NEAT, and ARTE.

Catastrophic expenditure to pay for surgery worldwide: a modelling study.

PubMed

Shrime, Mark G; Dare, Anna J; Alkire, Blake C; O'Neill, Kathleen; Meara, John G

2015-04-27

Approximately 150 million individuals worldwide face catastrophic expenditure each year from medical costs alone, and the non-medical costs of accessing care increase that number. The proportion of this expenditure related to surgery is unknown. Because the World Bank has proposed elimination of medical impoverishment by 2030, the effect of surgical conditions on financial catastrophe should be quantified so that any financial risk protection mechanisms can appropriately incorporate surgery. To estimate the global incidence of catastrophic expenditure due to surgery, we built a stochastic model. The income distribution of each country, the probability of requiring surgery, and the medical and non-medical costs faced for surgery were incorporated. Sensitivity analyses were run to test the robustness of the model. 3·7 billion people (posterior credible interval 3·2-4·2 billion) risk catastrophic expenditure if they need surgery. Each year, 81·3 million people (80·8-81·7 million) worldwide are driven to financial catastrophe-32·8 million (32·4-33·1 million) from the costs of surgery alone and 48·5 million (47·7-49·3) from associated non-medical costs. The burden of catastrophic expenditure is highest in countries of low and middle income; within any country, it falls on the poor. Estimates were sensitive to the definition of catastrophic expenditure and the costs of care. The inequitable burden distribution was robust to model assumptions. Half the global population is at risk of financial catastrophe from surgery. Each year, surgical conditions cause 81 million individuals to face catastrophic expenditure, of which less than half is attributable to medical costs. These findings highlight the need for financial risk protection for surgery in health-system design. MGS received partial funding from NIH/NCI R25CA92203. Copyright © 2015 Shrime et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by Elsevier Ltd.. All rights

Medicare expenditures among nursing home residents with advanced dementia.

PubMed

Goldfeld, Keith S; Stevenson, David G; Hamel, Mary Beth; Mitchell, Susan L

2011-05-09

Nursing home residents with advanced dementia commonly experience burdensome and costly interventions (eg, tube feeding) that may be of limited clinical benefit. To our knowledge, Medicare expenditures have not been extensively described in this population. Nursing home residents with advanced dementia in 22 facilities (N = 323) were followed up for 18 months. Clinical and health services use data were collected every 90 days. Medicare expenditures were described. Multivariate analysis was used to identify factors associated with total 90-day expenditures for (1) all Medicare services and (2) all Medicare services excluding hospice. Over an 18-month period, total mean Medicare expenditures were $2303 per 90 days but were highly skewed; expenditures were less than $500 for 77.1% of the 90-day assessment periods and more than $12,000 for 5.5% of these periods. The largest proportion of Medicare expenditures were for hospitalizations (30.2%) and hospice (45.6%). Among decedents (n = 177), mean Medicare expenditures increased by 65% in each of the last 4 quarters before death owing to an increase in both acute care and hospice. After multivariable adjustment, not living in a special care dementia unit was a modifiable factor associated with higher total expenditures for all Medicare services. Lack of a do-not-hospitalize order, tube feeding, and not living in a special care unit were associated with higher nonhospice Medicare expenditures. Medicare expenditures among nursing home residents with advanced dementia vary substantially. Hospitalizations and hospice account for most spending. Strategies that promote high-quality palliative care may shift expenditures away from aggressive treatments for these patients at the end of life.

A close examination of healthcare expenditures related to fractures.

PubMed

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

2013-04-01

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

The Impact of Ambient Air Pollution on Daily Hospital Visits for Various Respiratory Diseases and the Relevant Medical Expenditures in Shanghai, China.

PubMed

Zhang, Hao; Niu, Yue; Yao, Yili; Chen, Renjie; Zhou, Xianghong; Kan, Haidong

2018-02-28

The evidence concerning the acute effects of ambient air pollution on various respiratory diseases was limited in China, and the attributable medical expenditures were largely unknown. From 2013 to 2015, we collected data on the daily visits to the emergency- and outpatient-department for five main respiratory diseases and their medical expenditures in Shanghai, China. We used the overdispersed generalized additive model together with distributed lag models to fit the associations of criteria air pollutants with hospital visits, and used the linear models to fit the associations with medical expenditures. Generally, we observed significant increments in emergency visits (8.81-17.26%) and corresponding expenditures (0.33-25.81%) for pediatric respiratory diseases, upper respiratory infection (URI), and chronic obstructive pulmonary disease (COPD) for an interquartile range increase of air pollutant concentrations over four lag days. As a comparison, there were significant but smaller increments in outpatient visits (1.36-4.52%) and expenditures (1.38-3.18%) for pediatric respiratory diseases and upper respiratory infection (URI). No meaningful changes were observed for asthma and lower respiratory infection. Our study suggested that short-term exposure to outdoor air pollution may induce the occurrences or exacerbation of pediatric respiratory diseases, URI, and COPD, leading to considerable medical expenditures upon the patients.

11 CFR 9004.7 - Allocation of travel expenditures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 11 Federal Elections 1 2010-01-01 2010-01-01 false Allocation of travel expenditures. 9004.7... travel expenditures. Link to an amendment published at 74 FR 63967, Dec. 7, 2009. (a) Notwithstanding the provisions of 11 CFR 106.3, expenditures for travel relating to a Presidential or Vice Presidential candidate...

Military Expenditure and Socio-Economic Development.

ERIC Educational Resources Information Center

Ball, Nicole

1983-01-01

The relationship between military expenditure and the stimulation of aggregate demand, inflation, investment, trade balance, foreign exchange, the improvement of taxation, and employment creation and industrialization in the Third World is analyzed. To some extent military expenditure does promote economic growth, but it does not automatically…

Comparison of total energy expenditure between school and summer months.

PubMed

Zinkel, S R J; Moe, M; Stern, E A; Hubbard, V S; Yanovski, S Z; Yanovski, J A; Schoeller, D A

2013-10-01

Childhood obesity has increased 3 to 4 fold. Some children gain excess weight in summer. Total energy expenditure increases almost linearly with fat-free mass. A lower total energy expenditure was not detected in summer. Recent data report that the youth experience greater weight gain during summer than during school months. We tested the hypothesis that a difference in total energy expenditure (TEE) between school and summer months exists and may contribute to summer weight gain. A secondary analysis was performed on cross-sectional TEE data from school-age, sedentary African-American and Caucasian youth based in or near the District of Columbia who were at-risk for adult obesity because they had body mass index (BMI) ≥ 85th percentile or had overweight parents. TEE was estimated from 18-O and deuterium measurements during 1-week intervals using urine samples collected after ingestion of doubly labelled water. Differences in summer- and school-time TEE were assessed using analysis of covariance. The data were adjusted for fat-free mass (FFM) as determined by deuterium dilution to adjust for the effect of body size on TEE. Data were collected from 162 youth (average age 10 ± 2 years, BMI 28 ± 8 kg m(-2) and BMI z-score 1.96 + 0.96). Of these, 96 youth had TEE measured during the school year (September-June); 66 different youths had TEE measured during summer months (June-August). After adjustment for FFM, average summertime TEE was 2450 ± 270 kcal d(-1) and average school-time TEE was 2510 ± 350 kcal d(-1) (P = 0.26). No difference in TEE was detected between the school year and the summer months. These data suggest that seasonal differences in youth weight gain are not necessarily due to differences in energy expenditures. © 2013 The Authors. Pediatric Obesity © 2013 International Association for the Study of Obesity.

Medicaid nursing home reimbursement policies, rates, and expenditures

PubMed Central

Harrington, Charlene; Swan, James H.

1984-01-01

Nursing home expenditures, along with those of hospitals, have been a target of cost containment efforts because they constitute a growing share of overall public expenditures for health. Of the total $287 billion spent on personal health care in 1982, $27 billion (9.5 percent) was spent on nursing home care (Gibson, Waldo, and Levit, 1983). Nationally, nursing home expenditures increased at a rate of 17.4 percent between 1980 and 1981 and 12.9 percent between 1981 and 1982, more rapidly than overall health care expenditures (Gibson, Waldo, and Levit, 1983). PMID:10310849

Conduction cooling systems for linear accelerator cavities

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

Kephart, Robert

A conduction cooling system for linear accelerator cavities. The system conducts heat from the cavities to a refrigeration unit using at least one cavity cooler interconnected with a cooling connector. The cavity cooler and cooling connector are both made from solid material having a very high thermal conductivity of approximately 1.times.10.sup.4 W m.sup.-1 K.sup.-1 at temperatures of approximately 4 degrees K. This allows for very simple and effective conduction of waste heat from the linear accelerator cavities to the cavity cooler, along the cooling connector, and thence to the refrigeration unit.

A Summary of Expenditures and Sources of Payment for Personal Health Services from the National Medical Care Expenditure Survey: Data Preview 24. National Health Care Expenditure Study.

ERIC Educational Resources Information Center

Kasper, Judith A.; And Others

The National Center for Health Services Research and Health Care Technology Assessment conducted a study to examine how Americans use health care services and to determine national patterns of health expenditures and insurance coverage. Data were obtained from the National Medical Care Expenditure Survey interviews conducted with 14,000 randomly…

Impact of a generic substitution reform on patients' and society's expenditure for pharmaceuticals.

PubMed

Andersson, Karolina; Bergström, Gina; Petzold, Max G; Carlsten, Anders

2007-05-01

Sweden's pharmaceutical expenditure has increased during the last decades. On 1 October 2002 mandatory generic substitution was introduced in Sweden with the purpose to reduce the growth in pharmaceutical expenditure. The aim of the present study was to investigate if the implementation of generic substitution was associated with changes in patients' expenses and reimbursed cost for prescribed pharmaceuticals included in the Swedish Pharmaceutical Benefits Scheme (PBS). Monthly pharmacy sales data was obtained from the National Corporation of Swedish Pharmacies (Apoteket AB). The study period ranged between 1 January 2000 and 31 December 2004. Changes in pharmaceutical expenditure associated with the introduction of generic substitution were analysed with a linear segmented regression. The study comprised outpatient prescription pharmaceuticals encompassed by PBS for Sweden in total and each county council. Two different data sets were analysed. The first comprised all prescribed pharmaceuticals. The second contained only pharmaceuticals on regular prescriptions (i.e. exclusion of multidose dispensed drugs). Changes in patient co-payment per 1000 inhabitants and working day and subsidised cost per 1000 inhabitants and working day associated with the introduction of generic substitution were analysed. Expenditure was expressed in Swedish krona, SEK (SEK 1=US$ 0.14/euro 0.11, 7 July 2006). The Swedish Consumer Price Index was used to inflation-adjust expenditures with 2004 as base. The introduction of generic substitution was associated with a significant change in slope for patient co-payment in both all prescribed pharmaceuticals and pharmaceuticals on regular prescriptions (p<0.005) for Sweden in total. The slope shifted direction from a slight increase before the reform into a decline after the reform was implemented. This was also found for the average slope of patient co-payment for all county councils (p<0.0001). The introduction of generic substitution was

Educational Expenditures in Thailand: Development, Trends, and Distribution

ERIC Educational Resources Information Center

Sagarik, Danuvas

2014-01-01

This article aims to investigate the trends of education expenditure policy during the past few decades, as well as the recent allocation and distribution of education expenditure in Thailand. It also focuses on the development of the substance of education policy in Thailand. Political connection with the education expenditure policy is also…

Gender, Marital Status, and Commercially Prepared Food Expenditure

ERIC Educational Resources Information Center

Kroshus, Emily

2008-01-01

Objective: Assess how per capita expenditure on commercially prepared food as a proportion of total food expenditure varies by the sex and marital status of the head of the household. Design: Prospective cohort study, data collected by the United States Bureau of Labor Statistics 2004 Consumer Expenditure Survey. Setting: United States.…

Estimating suppression expenditures for individual large wildland fires

Treesearch

Krista M. Gebert; David E. Calkin; Jonathan Yoder

2007-01-01

The extreme cost of fighting wildland fires has brought fire suppression expenditures to the forefront of budgetary and policy debate in the United States. Inasmuch as large fires are responsible for the bulk of fire suppression expenditures, understanding fire characteristics that influence expenditures is important for both strategic fire planning and onsite fire...

Relationship between gait kinematics and walking energy expenditure during pregnancy in South African women.

PubMed

Krkeljas, Zarko; Moss, Sarah Johanna

2018-01-01

Various musculoskeletal changes occurring during pregnancy may lead to the change in gait and contribute to the increase in walking energy expenditure. Previous research indicates that changes in gait mechanics may lead to the increase in mechanical work required during walking. However, there is little information to indicate if changes in gait mechanics during pregnancy have impact on active or total energy expenditure. Therefore, the primary aim of this study was to investigate the relationship between changes in gait kinematics and walking energy expenditure in pregnant women. Thirty-five women (mean age = 27.5 ± 6.1 years) volunteered for the study during various stages of pregnancy (1st trimester average = 12.1 ± 2.2 weeks; 2nd trimester = 22.3 ± 2.6 weeks; 3rd trimester = 31.4 ± 2.6 weeks). 3D motion analysis was used to assess changes in kinematic parameters during walking at self-selected pace. Resting metabolic rate, and walking energy expenditure expressed in terms of rate and cost of O 2 were analysed with portable metabolic analyser. Only medio-lateral deviation of centre of gravity (COG ML ) increased 13.6% between the 1st and 2nd, and 39.3% between 2nd and 3rd trimester ( p  ≤ 0.001). However, self-selected walking speed depicted strong significant positive linear relationship with net O 2 rate ( r  = 0.70; p  ≤ 0.001), and was strongly associated with the vertical excursion of the COG ( r  = 0.75, p  ≤ 0.001). Changes in gait mechanics during pregnancy may lead to an increase in walking energy expenditure. However, the consequent increase in walking energy cost may not be sufficient to offset the natural energy sparing mechanism.

Graphical Calculation of Estimated Energy Expenditure in Burn Patients.

PubMed

Egro, Francesco M; Manders, Ernest C; Manders, Ernest K

2018-03-01

Historically, estimated energy expenditure (EEE) has been related to the percent of body surface area burned. Subsequent evaluations of these estimates have indicated that the earlier formulas may overestimate the amount of caloric support necessary for burn-injured patients. Ireton-Jones et al derived 2 equations for determining the EEE required to support burn patients, 1 for ventilator-dependent patients and 1 for spontaneously breathing patients. Evidence has proved their reliability, but they remain challenging to apply in a clinical setting given the difficult and cumbersome mathematics involved. This study aims to introduce a graphical calculation of EEE in burn patients that can be easily used in the clinical setting. The multivariant linear regression analysis from Ireton-Jones et al yielded equations that were rearranged into the form of a simple linear equation of the type y = mx + b. By choosing an energy expenditure and the age of the subject, the weight was calculated. The endpoints were then calculated, and a graph was mapped by means of Adobe FrameMaker. A graphical representation of Ireton-Jones et al's equations was obtained by plotting the weight (kg) on the y axis, the age (years) on the x axis, and a series of parallel lines representing the EEE in burn patients. The EEE has been displayed graphically on a grid to allow rapid determination of the EEE needed for a given patient of a designated weight and age. Two graphs were plotted: 1 for ventilator-dependent patients and 1 for spontaneously breathing patients. Correction factors for sex, the presence of additional trauma, and obesity are indicated on the graphical calculators. We propose a graphical tool to calculate caloric requirements in a fast, easy, and portable manner.

Accelerometer output and its association with energy expenditure during manual wheelchair propulsion.

PubMed

Learmonth, Y C; Kinnett-Hopkins, D; Rice, I M; Dysterheft, J L; Motl, R W

2016-02-01

This is an experimental design. This study examined the association between rates of energy expenditure (that is, oxygen consumption (VO2)) and accelerometer counts (that is, vector magnitude (VM)) across a range of speeds during manual wheelchair propulsion on a motor-driven treadmill. Such an association allows for the generation of cutoff points for quantifying the time spent in moderate-to-vigorous physical activity (MVPA) during manual wheelchair propulsion. The study was conducted in the University Laboratory. Twenty-four manual wheelchair users completed a 6-min period of seated rest and three 6-min periods of manual wheelchair propulsion on a motor-driven wheelchair treadmill. The 6-min periods of wheelchair propulsion corresponded with three treadmill speeds (1.5, 3.0 and 4.5 mph) that elicited a range of physical activity intensities. Participants wore a portable metabolic unit and accelerometers on both wrists. Primary outcome measures included steady-state VO2 and VM, and the strength of association between VO2 and VM was based on the multiple correlation and squared multiple correlation coefficients from linear regression analyses. Strong linear associations were established between VO2 and VM for the left (R=0.93±0.44; R2=0.87±0.19), right (R=0.95±0.37; R2=0.90±0.14) and combined (R=0.94±0.38; R2=0.88±0.15) accelerometers. The linear relationship between VO2 and VM for the left, right and combined wrists yielded cutoff points for MVPA of 3659 ±1302, 3630±1403 and 3644±1339 counts min(-1), respectively. We provide cutoff points based on the linear association between energy expenditure and accelerometer counts for estimating time spent in MVPA during manual wheelchair propulsion using wrist-worn accelerometry. The similarity across wrist location permits flexibility in selecting a location for wrist accelerometry placement.

Income elasticity of health expenditures in Iran.

PubMed

Zare, Hossein; Trujillo, Antonio J; Leidman, Eva; Buttorff, Christine

2013-09-01

Because of its policy implications, the income elasticity of health care expenditures is a subject of much debate. Governments may have an interest in subsidizing the care of those with low income. Using more than two decades of data from the Iran Household Expenditure and Income Survey, this article investigates the relationship between income and health care expenditure in urban and rural areas in Iran, a resource rich, upper-middle-income country. We implemented spline and quantile regression techniques to obtain a more robust description of the relationship of interest. This study finds non-uniform effects of income on health expenditures. Although the results show that health care is a necessity for all income brackets, spline regression estimates indicate that the income elasticity is lowest for the poorest Iranians in urban and rural areas. This suggests that they will show low flexibility in medical expenses as income fluctuates. Further, a quantile regression model assessing the effect of income at different level of medical expenditure suggests that households with lower medical expenses are less elastic.

The influence of (public) health expenditure on longevity.

PubMed

Aísa, Rosa; Clemente, Jesús; Pueyo, Fernando

2014-10-01

We report new evidence on the contribution of health expenditure to increasing life expectancy in OECD countries, differentiating the effects of public and private health expenditures. A theoretical model is presented and estimated though a cross-country fixed effects multiple regression analysis for a sample of OECD countries over the period 1980-2000. Although the effect of aggregate health expenditure is not conclusive, public health expenditure plays a significant role in enhancing longevity. However, its influence diminishes as the size of the public health sector on GDP expands, reaching a maximum around the 8 %. With the influence of public health expenditure being positive, the ambiguous effect of the aggregate expenditure suggests that the weight of public and private health sectors matters, the second having a lower impact on longevity. This might explain the poor evolution of the life expectancy in countries with a high amount of private resources devoted to health. In such cases, an extension of public services could give rise to a better outcome from the overall health investment.

Association between provider volume and healthcare expenditures of patients with oral cancer in Taiwan: a population-based study.

PubMed

Chen, Li-Fu; Ho, Hsu-Chueh; Su, Yu-Chieh; Lee, Moon-Sing; Hung, Shih-Kai; Chou, Pesus; Lee, Ching-Chieh J; Lin, Li-Chu; Lee, Ching-Chih

2013-01-01

Oral cancer requires considerable utilization of healthcare services. Wide resection of the tumor and reconstruction with free flap are widely used. Due to high recurrence rate, close follow-up is mandatory. This study was conducted to explore the relationship between the healthcare expenditure of oncological surgery and one-year follow up and provider volume. From the National Health Insurance Research Database published by the Taiwanese National Health Research Institute, the authors selected a total of 1300 oral cancer patients who underwent tumor resection and free flap reconstruction in 2008. Hierarchical linear regression analysis was subsequently performed to explore the relationship between provider volume and expenditures of oncological surgery and one-year follow-up period. Emergency department (ED) visits and 30-day readmission rates were also analyzed. The mean expenditure for oncological surgery was $11080±4645 (all costs are given in U.S. dollars) and $10129±9248 for one-year follow up. For oncological surgery expenditure, oral cancer patients treated by low-volume surgeons had an additional $845 than those in high-volume surgeons in mixed model. For one-year follow-up expenditure, patients in low-volume hospitals had an additional $3439 than those in high-volume hospitals; patient in low-volume surgeons and medium-volume surgeons incurred an additional expenditure of $2065 and $1811 than those in high-volume surgeons. Oral cancer patients treated in low-volume hospitals incurred higher risk of 30-day readmission rate (odds ratio, 6.6; 95% confidence interval, 1.6-27). After adjusting for physician, hospital, and patient characteristics, low-volume provider performing wide excision with reconstructive surgery in oral cancer patients incurred significantly higher expenditure for oncological surgery and one-year healthcare per patient than did others with higher volumes. Treatment strategies adapted by high-volume providers should be further analyzed.

Increasing passive energy expenditure during clerical work.

PubMed

Beers, Erik A; Roemmich, James N; Epstein, Leonard H; Horvath, Peter J

2008-06-01

Sitting on a therapy ball or standing may be a passive means of increasing energy expenditure throughout the workday. The purpose of this study was to determine the energy expenditure and liking of performing clerical work in various postures. Subjects included 24 men and women employed in sedentary clerical occupations. Energy expenditure was measured while word processing in three standardized postures; sitting in an office chair, sitting on a therapy ball, and standing. Adults ranked their comfort, fatigue, and liking of each posture and were asked to perform their choice of 20 min of additional clerical work in one of the postures. Energy expenditure was 4.1 kcal/h greater (p expenditure between the therapy ball and standing postures (p >or= 0.48). Subjects also liked sitting on a therapy ball as much as sitting in an office chair and liked sitting on a therapy ball more than standing (p expenditure.

Decoupling in linear time-varying multivariable systems

NASA Technical Reports Server (NTRS)

Sankaran, V.

1973-01-01

The necessary and sufficient conditions for the decoupling of an m-input, m-output, linear time varying dynamical system by state variable feedback is described. The class of feedback matrices which decouple the system are illustrated. Systems which do not satisfy these results are described and systems with disturbances are considered. Some examples are illustrated to clarify the results.

Adult mental health needs and expenditure in Australia.

PubMed

Burgess, Philip; Pirkis, Jane; Buckingham, Bill; Burns, Jane; Eagar, Kathy; Eckstein, Gary

2004-06-01

Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.

Exercise Training and Energy Expenditure following Weight Loss

PubMed Central

Hunter, Gary R.; Fisher, Gordon; Neumeier, William H.; Carter, Stephen J.; Plaisance, Eric P.

2015-01-01

Purpose Determine the effects of aerobic or resistance training on activity related energy expenditure (AEE, kcal/d) and physical activity index (ARTE) following weight loss. It was hypothesized that weight loss without exercise training would be accompanied by a decrease in AEE, ARTE, and non-training physical activity energy expenditure (NEAT) and that exercise training would prevent decreases in free living energy expenditure. Methods 140 pre-menopausal women underwent an average of 25 pound weight loss during an 800 kcal/day diet of furnished food. One group aerobically trained 3 times/wk (40 min/d), another resistance trained 3 times/wk (10 exercises/2 sets x10 repetitions) and the third group did not exercise. DXA was used to measure body composition, indirect calorimetry to measure resting (REE) and walking energy expenditure, and doubly labeled water to measure total energy expenditure (TEE). AEE, ARTE, and non-training physical activity energy expenditure (NEAT) were calculated. Results TEE, REE, and NEAT all decreased following weight loss for the no exercise group, but not for the aerobic and resistance trainers. Only REE decreased in the two exercise groups. The resistance trainers increased ARTE. Heart rate and oxygen uptake while walking on the flat and up a grade were consistently related to TEE, AEE, NEAT, and ARTE. Conclusion Exercise training prevents a decrease in energy expenditure, including free living energy expenditure separate from the exercise training, following weight loss. Resistance training increased physical activity, while ease and economy in walking associates with increased TEE, AEE, NEAT, and ARTE. PMID:25606816

Chronic condition combinations and health care expenditures and out-of-pocket spending burden among adults, Medical Expenditure Panel Survey, 2009 and 2011.

PubMed

Meraya, Abdulkarim M; Raval, Amit D; Sambamoorthi, Usha

2015-01-29

Little is known about how combinations of chronic conditions in adults affect total health care expenditures. Our objective was to estimate the annual average total expenditures and out-of-pocket spending burden among US adults by combinations of conditions. We conducted a cross-sectional study using 2009 and 2011 data from the Medical Expenditure Panel Survey. The sample consisted of 9,296 adults aged 21 years or older with at least 2 of the following 4 highly prevalent chronic conditions: arthritis, diabetes mellitus, heart disease, and hypertension. Unadjusted and adjusted regression techniques were used to examine the association between chronic condition combinations and log-transformed total expenditures. Logistic regressions were used to analyze the relationship between chronic condition combinations and high out-of-pocket spending burden. Among adults with chronic conditions, adults with all 4 conditions had the highest average total expenditures ($20,016), whereas adults with diabetes/hypertension had the lowest annual total expenditures ($7,116). In adjusted models, adults with diabetes/hypertension and hypertension/arthritis had lower health care expenditures than adults with diabetes/heart disease (P < .001). In adjusted models, adults with all 4 conditions had higher expenditures compared with those with diabetes and heart disease. However, the difference was only marginally significant (P = .04). Among adults with arthritis, diabetes, heart disease, and hypertension, total health care expenditures differed by type of chronic condition combinations. For individuals with multiple chronic conditions, such as heart disease and diabetes, new models of care management are needed to reduce the cost burden on the payers.

Chronic Condition Combinations and Health Care Expenditures and Out-of-Pocket Spending Burden Among Adults, Medical Expenditure Panel Survey, 2009 and 2011

PubMed Central

Raval, Amit D.; Sambamoorthi, Usha

2015-01-01

Introduction Little is known about how combinations of chronic conditions in adults affect total health care expenditures. Our objective was to estimate the annual average total expenditures and out-of-pocket spending burden among US adults by combinations of conditions. Methods We conducted a cross-sectional study using 2009 and 2011 data from the Medical Expenditure Panel Survey. The sample consisted of 9,296 adults aged 21 years or older with at least 2 of the following 4 highly prevalent chronic conditions: arthritis, diabetes mellitus, heart disease, and hypertension. Unadjusted and adjusted regression techniques were used to examine the association between chronic condition combinations and log-transformed total expenditures. Logistic regressions were used to analyze the relationship between chronic condition combinations and high out-of-pocket spending burden. Results Among adults with chronic conditions, adults with all 4 conditions had the highest average total expenditures ($20,016), whereas adults with diabetes/hypertension had the lowest annual total expenditures ($7,116). In adjusted models, adults with diabetes/hypertension and hypertension/arthritis had lower health care expenditures than adults with diabetes/heart disease (P < .001). In adjusted models, adults with all 4 conditions had higher expenditures compared with those with diabetes and heart disease. However, the difference was only marginally significant (P = .04). Conclusion Among adults with arthritis, diabetes, heart disease, and hypertension, total health care expenditures differed by type of chronic condition combinations. For individuals with multiple chronic conditions, such as heart disease and diabetes, new models of care management are needed to reduce the cost burden on the payers. PMID:25633487

Obesity and health expenditures: evidence from Australia.

PubMed

Buchmueller, Thomas C; Johar, Meliyanni

2015-04-01

Rising rates of obesity are a public health concern in every industrialized country. This study investigates the relationship between obesity and health care expenditure in Australia, where the rate of obesity has tripled in the last three decades. Now one in four Australians is considered obese, defined as having a body mass index (BMI, kg/m(2)) of 30 or over. The analysis is based on a random sample survey of over 240,000 adults aged 45 and over that is linked at the individual-level to comprehensive administrative health care claims for the period 2006-2009. This sub-population group has an obesity rate that is nearly 30% and is a major consumer of health services. Relative to the average annual health expenditures of those with normal weight, we find that the health expenditures of those with a BMI between 30 and 35 (obese type I) are 19% higher and expenditures of those with BMI greater than 35 (obese type II/III) are 51% higher. We find large and significant differences in all types of care: inpatient, emergency department, outpatient and prescription drugs. The obesity-related health expenditures are higher for obese type I women than men, but in the obese type II/III state, obesity-related expenditures are higher for men. When we stratify further by age groups, we find that obesity has the largest impact among men over age 75 and women aged 60-74 years old. In addition, we find that obesity impacts health expenditures not only through its link to chronic diseases, but also because it increases the cost of recovery from acute health shocks. Copyright © 2015 Elsevier B.V. All rights reserved.

Factors related to criminal justice expenditure trajectories for adults with serious mental illness.

PubMed

Robst, John; Constantine, Robert; Andel, Ross; Boaz, Timothy; Howe, Andrew

2011-12-01

Criminal careers have been extensively studied in general population sample, but less is known about such patterns among people with major mental illness, and where so, criminal justice expenditure has not been taken into account. Our aim was to examine criminal justice system expenditure over time in one Florida county. Our main research question was whether treatment for mental disorders was related to a change in criminal offending and expenditure trajectory. We used the Pinellas County (Florida) Criminal Justice Information System to identify individuals under age 65 arrested between July 2003 and June 2004. Archival medical service, social and homeless services data were used to identify individuals with a serious mental illness. A two-step analysis was used to examine the data: first, we identified groups of people with similar patterns of criminal justice expenditures over 4 years (July 2002 to June 2006); second, we evaluated their demographic characteristics, diagnosis and treatment as potential predictors of group membership. Three thousand seven hundred sixty-nine people with serious mental illness were identified in the Pinellas County jail population. Their average length of stay in jail was 151 days and in prison was 48 days. The trajectory analysis identified three groups of individuals with distinct trajectories of criminal justice expenditures: those with low stable, those with initially high but decreasing and those with initially high and sustained or increasing. Mental health treatment, whether acute or sustained, voluntary or mandatory, was associated with membership of the low stable group. Review of criminal justice expenditure over time on individuals with major mental disorder may provide important indicators of unmet need for mental health services. Furthermore, it seems probable that improved provision of such services for them could reduce recidivism as well as improving health. Interventions may also be better focused if criminal

11 CFR 9003.4 - Expenses incurred prior to the beginning of the expenditure report period or prior to receipt of...

Code of Federal Regulations, 2010 CFR

2010-01-01

...: Expenditures for establishing financial accounting systems and expenditures for organizational planning... borrow from his or her legal and accounting compliance fund for the purposes of defraying permissible expenditures described in 11 CFR 9003.4(a). All amounts borrowed from the legal and accounting compliance fund...

Are All Non-Linear Systems (Approx.) Bilinear,

DTIC Science & Technology

1977-06-01

There is a rumor going around in mathematical system theory circles that all non-linear systems are bilinear or nearly so. This note examines the...case for such an assertion and finds it wanting and en passant, offers some comments on the current proliferation of mathematical literature on system theory .

[The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea].

PubMed

Song, Eun Cheol; Shin, Young Jeon

2010-09-01

The low benefit coverage rate of South Korea's health security system has been continually pointed out. A low benefit coverage rate inevitably causes catastrophic health expenditure, which can be the cause of the transition to poverty and the persistence of poverty. This study was conducted to ascertain the effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea. To determine the degree of social mobility, this study was conducted among the 6311 households that participated in the South Korea Welfare Panel Study in both 2006 and 2008. The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea was assessed via multiple logistic regression analysis. The poverty rate in South Korea was 21.6% in 2006 and 20.0% in 2008. 25.1 - 7.3% of the households are facing catastrophic health expenditure. Catastrophic health expenditure was found to affect the transition to poverty even after adjusting for the characteristics of the household and the head of the household, at the threshold of 28% or above. 25.1% of the households in this study were found to be currently facing catastrophic health expenditure, and it was determined that catastrophic health expenditure is a cause of transition to poverty. This result shows that South Korea's health security system is not an effective social safety net. As such, to prevent catastrophic health expenditure and transition to poverty, the benefit coverage of South Korea's health security system needs to the strengthened.

Incremental health expenditure and lost days of normal activity for individuals with mental disorders: results from the São Paulo Megacity Study.

PubMed

Chiavegatto Filho, Alexandre Dias Porto; Wang, Yuan-Pang; Campino, Antonio Carlos Coelho; Malik, Ana Maria; Viana, Maria Carmen; Andrade, Laura Helena

2015-08-05

With the recent increase in the prevalence of mental disorders in developing countries, there is a growing interest in the study of its consequences. We examined the association of depression, anxiety and any mental disorders with incremental health expenditure, i.e. the linear increase in health expenditure associated with mental disorders, and lost days of normal activity. We analyzed the results from a representative sample survey of residents of the Metropolitan Region of São Paulo (n = 2,920; São Paulo Megacity Mental Health Survey), part of the World Mental Health (WMH) Survey Initiative, coordinated by the World Health Organization and performed in 28 countries. The instrument used for obtaining the individual results, including the assessment of mental disorders, was the WMH version of the Composite International Diagnostic Interview 3.0 (WMH-CIDI 3.0) that generates psychiatric diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Statistical analyses were performed by multilevel generalized least squares (GLS) regression models. Sociodemographic determinants such as income, age, education and marital status were included as controls. Depression, anxiety and any mental disorders were consistently associated with both incremental health expenditure and missing days of normal activity. Depression was associated with an incremental annual expenditure of R$308.28 (95% CI: R$194.05-R$422.50), or US$252.48 in terms of purchasing power parity (PPP). Anxiety and any mental disorders were associated with a lower, but also statistically significant, incremental annual expenditure (R$177.82, 95% CI: 79.68-275.97; and R$180.52, 95% CI: 91.13-269.92, or US$145.64 and US$147.85 in terms of PPP, respectively). Most of the incremental health costs associated with mental disorders came from medications. Depression was independently associated with higher incremental health expenditure than the two most prevalent chronic

Basic patterns in national health expenditure.

PubMed

Musgrove, Philip; Zeramdini, Riadh; Carrin, Guy

2002-01-01

Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources - out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance - classified according to their completeness and reliability. Total health spending rises from around 2-3% of gross domestic product (GDP) at low incomes (< 1000 US dollars per capita) to typically 8-9% at high incomes (> 7000 US dollars). Surprisingly, there is as much relative variation in the share for poor countries as for rich ones, and even more relative variation in amounts in US dollars. Poor countries and poor people that most need protection from financial catastrophe are the least protected by any form of prepayment or risk-sharing. At low incomes, out-of-pocket spending is high on average and varies from 20-80% of the total; at high incomes that share drops sharply and the variation narrows. Absolute out-of-pocket expenditure nonetheless increases with income. Public financing increases faster, and as a share of GDP, and converges at high incomes. Health takes an increasing share of total public expenditure as income rises, from 5-6% to around 10%. This is arguably the opposite of the relation between total health needs and need for public spending, for any given combination of services. Within public spending, there is no convergence in the type of finance - general revenue versus social insurance. Private insurance is usually insignificant except in some rich countries.

Basic patterns in national health expenditure.

PubMed Central

Musgrove, Philip; Zeramdini, Riadh; Carrin, Guy

2002-01-01

Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources - out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance - classified according to their completeness and reliability. Total health spending rises from around 2-3% of gross domestic product (GDP) at low incomes (< 1000 US dollars per capita) to typically 8-9% at high incomes (> 7000 US dollars). Surprisingly, there is as much relative variation in the share for poor countries as for rich ones, and even more relative variation in amounts in US dollars. Poor countries and poor people that most need protection from financial catastrophe are the least protected by any form of prepayment or risk-sharing. At low incomes, out-of-pocket spending is high on average and varies from 20-80% of the total; at high incomes that share drops sharply and the variation narrows. Absolute out-of-pocket expenditure nonetheless increases with income. Public financing increases faster, and as a share of GDP, and converges at high incomes. Health takes an increasing share of total public expenditure as income rises, from 5-6% to around 10%. This is arguably the opposite of the relation between total health needs and need for public spending, for any given combination of services. Within public spending, there is no convergence in the type of finance - general revenue versus social insurance. Private insurance is usually insignificant except in some rich countries. PMID:11953792

The importance of proximity to death in modelling community medication expenditures for older people: evidence from New Zealand.

PubMed

Moore, Patrick V; Bennett, Kathleen; Normand, Charles

2014-12-01

Concerns about the long-term sustainability of health care expenditures (HCEs), particularly prescribing expenditures, has become an important policy issue in most developed countries. Previous studies suggest that proximity to death (PTD) has a significant effect on total HCEs, with its exclusion leading to an overestimation of likely growth. There are limited studies of pharmaceutical expenditures in which PTD is taken into account. This study presents an empirical analysis of public medication expenditure on older individuals in New Zealand (NZ). The aim of the study was to examine the individual effects of age and PTD using individual-level data. This study uses individual-level dispensing data from 2008/2009 covering the whole population of medication users aged 70 years or older and resident in NZ. A case-control methodology was used to examine individual cost and medication use for a 12-month period for decedents (cases) and survivors (controls). A random effects two-part model, with a Probit and generalized linear model (GLM) was used to explore the effect of age and PTD on expenditures. The impact of PTD on prescription expenditure is not as dramatic as studies reporting on acute and/or long-term care. The 12-month decedent-to-survivor mean expenditure ratio was 1.95; 2.09 for males and 1.82 for females. The additional cost of dying in terms of prescription drugs decreases with age, with those who die at 90 years of age or older consuming fewer drugs on average and having a lower mean expenditure than those who died in their 70s and 80s. The following variables were found to have a decreasing effect on the mean monthly prescription expenditures: a reduction of 2.2 % for each additional year of age, 4.2 % being in the Maori ethnic group, and 7.8 % for Pacific Islanders. Increases in monthly expenditure were associated with being a decedent 32.1-62.6 % (depending on month), being of Asian origin 16.2 %, or being a male 12.6 %. Given the variance reported

Projections of National Health Expenditures, 1980, 1985, and 1990

PubMed Central

Freeland, Mark; Calat, George; Schendler, Carol Ellen

1980-01-01

This paper presents projections of national health expenditures by type of expenditure and sources of funds for 1980, 1985, and 1990. A major purpose of these projections is to provide a baseline for health care expenditures in the absence of national health insurance and cost containment. Rapid growth in health expenditures is projected to continue to 1990. National health expenditures increased 350 percent between 1965 and 1978, reaching $192 billion in 1978. They are projected to reach $245 billion in 1980, $440 billion in 1985 and $760 billion in 1990, under current legislation. As a proportion of the Gross National Product (GNP), health expenditures rose from 6.2 percent to 9.1 percent between 1965 and 1978. They are projected to continue to rise, reaching 10.5 percent by 1985 and 11.5 percent by 1990. Sources of payments for these expenditures are also shifting. From 1965 to 1978, the percentage of total health expenditures that was government financed increased 16 percentage points, from 25 to 41 percent. The Federal share of public funds during the same period grew rapidly, from 53 percent in 1965 to 69 percent in 1978. In 1985, approximately 42 percent of total health spending is projected to be financed from public funds, of which 72 percent will be paid by the Federal government. Public funds are expected to account for 43 percent of total national health expenditures by 1990. PMID:10309132

A parallel solver for huge dense linear systems

NASA Astrophysics Data System (ADS)

Badia, J. M.; Movilla, J. L.; Climente, J. I.; Castillo, M.; Marqués, M.; Mayo, R.; Quintana-Ortí, E. S.; Planelles, J.

2011-11-01

HDSS (Huge Dense Linear System Solver) is a Fortran Application Programming Interface (API) to facilitate the parallel solution of very large dense systems to scientists and engineers. The API makes use of parallelism to yield an efficient solution of the systems on a wide range of parallel platforms, from clusters of processors to massively parallel multiprocessors. It exploits out-of-core strategies to leverage the secondary memory in order to solve huge linear systems O(100.000). The API is based on the parallel linear algebra library PLAPACK, and on its Out-Of-Core (OOC) extension POOCLAPACK. Both PLAPACK and POOCLAPACK use the Message Passing Interface (MPI) as the communication layer and BLAS to perform the local matrix operations. The API provides a friendly interface to the users, hiding almost all the technical aspects related to the parallel execution of the code and the use of the secondary memory to solve the systems. In particular, the API can automatically select the best way to store and solve the systems, depending of the dimension of the system, the number of processes and the main memory of the platform. Experimental results on several parallel platforms report high performance, reaching more than 1 TFLOP with 64 cores to solve a system with more than 200 000 equations and more than 10 000 right-hand side vectors. New version program summaryProgram title: Huge Dense System Solver (HDSS) Catalogue identifier: AEHU_v1_1 Program summary URL:http://cpc.cs.qub.ac.uk/summaries/AEHU_v1_1.html Program obtainable from: CPC Program Library, Queen's University, Belfast, N. Ireland Licensing provisions: Standard CPC licence, http://cpc.cs.qub.ac.uk/licence/licence.html No. of lines in distributed program, including test data, etc.: 87 062 No. of bytes in distributed program, including test data, etc.: 1 069 110 Distribution format: tar.gz Programming language: Fortran90, C Computer: Parallel architectures: multiprocessors, computer clusters Operating system

Poverty and private health expenditures in Italian households during the recent crisis.

PubMed

Sarti, Simone; Terraneo, Marco; Tognetti Bordogna, Mara

2017-03-01

The global financial crisis that began in 2008 had an overall effect on the health behaviours of Italian households. Aggregate private health expenditures have decreased while the citizens have increasingly been asked to share health costs. The reduction of households' health expenditure could have serious consequences for health, especially if it concerns the most vulnerable people. The aim of this paper is to analyse the relation between poverty and household health expenditure, considering regional and social group variations. The data used stem from the "Family Expenditure Survey" collected by the Italian Statistical Institute (ISTAT) from 1997 to 2013. Results of multivariate analysis controlling for potential socio-demographic confounders show that the propensity to spend for poor families is decreased in the last years compared to not poor households. Meanwhile, among the households who spend, the average expenditure in euro seems to have been more stable over time. This is an alarming signal for the health of the most vulnerable households. These conditions could result in a gradual deterioration of health in poor families, which is likely to increase the burden on health systems in future. Hence, at this moment public intervention does not seem able to alleviate this situation. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Fairness of Financial Contribution in Iranian Health System: Trend Analysis of National Household Income and Expenditure, 2003-2010

PubMed Central

Fazaeli, Amir Abbas; Seyedin, Hesam; Moghaddam, Abbas Vosoogh; Delavari, Alireza; Salimzadeh, H.; Varmazyar, Hasan; Fazaeli, Ali Akbar

2015-01-01

Background: Social systems are dealing with the challenge of achieving fairness in the distribution of financial burden and protecting the risk of financial loss. The purpose of this paper is to present a trend analysis for the indicators related to fairness in healthcare’s financial burden in rural and urban population of Iran during the eight years period of 2003 to 2010. Methods: We used the information gathered by statistical center of Iran through sampling processes for the household income and expenditures. The indicators of fairness in financial contribution of healthcare were calculated based on the WHO recommended methodology. The indices trend analysis of eight-year period for the rural, urban areas and the country level were computed. Results: This study shows that in Iran the fairness of financial contribution index during the eight-year period has been decreased from 0.841 in 2003 to above 0.827 in 2010 and The percentage of people with catastrophic health expenditures has been increased from 2.3% to above 3.1%. The ratio of total treatment costs to the household overall capacity to pay has been increased from 0.055 to 0.068 and from 0.072 to 0.0818 in urban and rural areas respectively. Conclusion: There is a decline in fairness of financial contribution index during the study period. While, a trend stability of the proportion of households who suffered catastrophic health expenditures was found. PMID:26156920

The Impact of HbA1c Testing on Total Annual Healthcare Expenditures Among Newly Diagnosed Patients with Diabetes.

PubMed

Bhounsule, Prajakta; Peterson, Andrew M

2015-09-01

In 2010, diabetes was the seventh leading cause of death in the United States. Diabetes also imposes a huge financial burden on the US economy. In 2009, the American Diabetes Association International Expert Committee recommended the use of the glycated hemoglobin (HbA1c) test as a uniform diagnostic measure to identify patients with diabetes. Although HbA1c is a convenient diagnostic test, it is also more expensive than older tests and could, therefore, have an impact on patients' healthcare expenditures. To determine if HbA1c testing has an impact on total annual healthcare expenditures among newly diagnosed patients with diabetes and to analyze the factors that are associated with the total healthcare expenditures among diabetic patients before and after HbA1c was implemented as a standard diagnostic factor. This was an observational, retrospective, cross-sectional study. The Medical Expenditure Panel Survey-Household Component 2009 and 2011 databases were used to form the study cohort of patients with diabetes. The total mean healthcare expenditures among patients with diabetes formed the dependent variable. A proxy variable representing a diagnosis of diabetes with and without the use of HbA1c testing in 2009 and in 2011, respectively, formed the main independent variable along with demographic factors, comorbidities, and healthcare services utilization in both years. A generalized linear regression was conducted to determine the association of HbA1c testing with total diabetes-related healthcare expenditures. The mean total healthcare expenditure decreased in 2011 compared with 2009. The HbA1c test did not show an association with the total healthcare expenditures versus earlier diabetes-related diagnostic factors. The total expenditures were associated with private insurance, the incidence of a previous heart attack, prescription drug refills, inpatient hospital stays, home care, hospital discharges, and visits to outpatient providers and physicians in both

11 CFR 9003.4 - Expenses incurred prior to the beginning of the expenditure report period or prior to receipt of...

Code of Federal Regulations, 2011 CFR

2011-01-01

... requirements of 11 CFR 100.82 for loans in the ordinary course of business to defray permissible expenditures... 110.8 shall make full repayment of principal and interest on such loans from payments received by the...: Expenditures for establishing financial accounting systems and expenditures for organizational planning...

Stochastic Stability of Sampled Data Systems with a Jump Linear Controller

NASA Technical Reports Server (NTRS)

Gonzalez, Oscar R.; Herencia-Zapana, Heber; Gray, W. Steven

2004-01-01

In this paper an equivalence between the stochastic stability of a sampled-data system and its associated discrete-time representation is established. The sampled-data system consists of a deterministic, linear, time-invariant, continuous-time plant and a stochastic, linear, time-invariant, discrete-time, jump linear controller. The jump linear controller models computer systems and communication networks that are subject to stochastic upsets or disruptions. This sampled-data model has been used in the analysis and design of fault-tolerant systems and computer-control systems with random communication delays without taking into account the inter-sample response. This paper shows that the known equivalence between the stability of a deterministic sampled-data system and the associated discrete-time representation holds even in a stochastic framework.

Low-Force Muscle Activity Regulates Energy Expenditure after Spinal Cord Injury.

PubMed

Woelfel, Jessica R; Kimball, Amy L; Yen, Chu-Ling; Shields, Richard K

2017-05-01

Reduced physical activity is a primary risk factor for increased morbidity and mortality. People with spinal cord injury (SCI) have reduced activity for a lifetime, as they cannot volitionally activate affected skeletal muscles. We explored whether low-force and low-frequency stimulation is a viable strategy to enhance systemic energy expenditure in people with SCI. This study aimed to determine the effects of low stimulation frequency (1 and 3 Hz) and stimulation intensity (50 and 100 mA) on energy expenditure in people with SCI. We also examined the relationship between body mass index and visceral adipose tissue on energy expenditure during low-frequency stimulation. Ten individuals with complete SCI underwent oxygen consumption monitoring during electrical activation of the quadriceps and hamstrings at 1 and 3 Hz and at 50 and 100 mA. We calculated the difference in energy expenditure between stimulation and rest and estimated the number of days that would be necessary to burn 1 lb of body fat (3500 kcal) for each stimulation protocol (1 vs 3 Hz). Both training frequencies induced a significant increase in oxygen consumption above a resting baseline level (P < 0.05). Energy expenditure positively correlated with stimulus intensity (muscle recruitment) and negatively correlated with adiposity (reflecting the insulating properties of adipose tissue). We estimated that 1 lb of body fat could be burned more quickly with 1 Hz training (58 d) as compared with 3 Hz training (87 d) if an identical number of pulses were delivered. Low-frequency stimulation increased energy expenditure per pulse and may be a feasible option to subsidize physical activity to improve metabolic status after SCI.

An extended GS method for dense linear systems

NASA Astrophysics Data System (ADS)

Niki, Hiroshi; Kohno, Toshiyuki; Abe, Kuniyoshi

2009-09-01

Davey and Rosindale [K. Davey, I. Rosindale, An iterative solution scheme for systems of boundary element equations, Internat. J. Numer. Methods Engrg. 37 (1994) 1399-1411] derived the GSOR method, which uses an upper triangular matrix [Omega] in order to solve dense linear systems. By applying functional analysis, the authors presented an expression for the optimum [Omega]. Moreover, Davey and Bounds [K. Davey, S. Bounds, A generalized SOR method for dense linear systems of boundary element equations, SIAM J. Comput. 19 (1998) 953-967] also introduced further interesting results. In this note, we employ a matrix analysis approach to investigate these schemes, and derive theorems that compare these schemes with existing preconditioners for dense linear systems. We show that the convergence rate of the Gauss-Seidel method with preconditioner PG is superior to that of the GSOR method. Moreover, we define some splittings associated with the iterative schemes. Some numerical examples are reported to confirm the theoretical analysis. We show that the EGS method with preconditioner produces an extremely small spectral radius in comparison with the other schemes considered.

Optimal Linear Responses for Markov Chains and Stochastically Perturbed Dynamical Systems

NASA Astrophysics Data System (ADS)

Antown, Fadi; Dragičević, Davor; Froyland, Gary

2018-03-01

The linear response of a dynamical system refers to changes to properties of the system when small external perturbations are applied. We consider the little-studied question of selecting an optimal perturbation so as to (i) maximise the linear response of the equilibrium distribution of the system, (ii) maximise the linear response of the expectation of a specified observable, and (iii) maximise the linear response of the rate of convergence of the system to the equilibrium distribution. We also consider the inhomogeneous, sequential, or time-dependent situation where the governing dynamics is not stationary and one wishes to select a sequence of small perturbations so as to maximise the overall linear response at some terminal time. We develop the theory for finite-state Markov chains, provide explicit solutions for some illustrative examples, and numerically apply our theory to stochastically perturbed dynamical systems, where the Markov chain is replaced by a matrix representation of an approximate annealed transfer operator for the random dynamical system.

High-Expenditure Pharmaceutical Use Among Children in Medicaid.

PubMed

Cohen, Eyal; Hall, Matt; Lopert, Ruth; Bruen, Brian; Chamberlain, Lisa J; Bardach, Naomi; Gedney, Jennifer; Zima, Bonnie T; Berry, Jay G

2017-09-01

Medication use may be a target for quality improvement, cost containment, and research. We aimed to identify medication classes associated with the highest expenditures among pediatric Medicaid enrollees and to characterize the demographic, clinical, and health service use of children prescribed these medications. Retrospective, cross-sectional study of 3 271 081 Medicaid-enrolled children. Outpatient medication spending among high-expenditure medication classes, defined as the 10 most expensive among 261 mutually exclusive medication classes, was determined by using transaction prices paid to pharmacies by Medicaid agencies and managed care plans among prescriptions filled and dispensed in 2013. Outpatient medications accounted for 16.6% of all Medicaid expenditures. The 10 most expensive medication classes accounted for 63.9% of all medication expenditures. Stimulants (amphetamine-type) accounted for both the highest proportion of expenditures (20.6%) and days of medication use (14.0%) among medication classes. Users of medications in the 10 highest-expenditure classes were more likely to have a chronic condition of any complexity (77.9% vs 41.6%), a mental health condition (35.7% vs 11.9%), or a complex chronic condition (9.8% vs 4.3%) than other Medicaid enrollees (all P < .001). The 4 medications with the highest spending were all psychotropic medications. Polypharmacy was common across all high-expenditure classes. Medicaid expenditure on pediatric medicines is concentrated among a relatively small number of medication classes most commonly used in children with chronic conditions. Interventions to improve medication safety and effectiveness and contain costs may benefit from better delineation of the appropriate prescription of these medications. Copyright © 2017 by the American Academy of Pediatrics.

Parallel/distributed direct method for solving linear systems

NASA Technical Reports Server (NTRS)

Lin, Avi

1990-01-01

A new family of parallel schemes for directly solving linear systems is presented and analyzed. It is shown that these schemes exhibit a near optimal performance and enjoy several important features: (1) For large enough linear systems, the design of the appropriate paralleled algorithm is insensitive to the number of processors as its performance grows monotonically with them; (2) It is especially good for large matrices, with dimensions large relative to the number of processors in the system; (3) It can be used in both distributed parallel computing environments and tightly coupled parallel computing systems; and (4) This set of algorithms can be mapped onto any parallel architecture without any major programming difficulties or algorithmical changes.

Expenditures on family dental care by active duty soldiers.

PubMed

Chisick, M C

1996-01-01

Expenditures on family dental care by U.S. active duty soldiers were explored in this 1992 worldwide survey. Of 9,560 respondents (62% response rate), 7,187 claimed dependents and 5,569 provided reliable data. Mean annual expenditures and multinomial regression on a distribution of expenditures were calculated. Results show average family dental care expenditures were as follows: total sample, $135; childless couples, $59; couples with children, $154; and single parents, $120. Between 72 and 83% of families spent $0 on dental care. Excluding non-spenders, overall expenditures averaged as follows: total sample, $531; childless couples, $354; couples with children, $560; and single parents, $470. Regression results show that expenditures on family dental care by soldiers are influenced by different factors depending on family composition. Policy measures to encourage optimal dental care by families of active duty soldiers should focus on increasing insurance coverage and use.

The impact of no-fault compensation on health care expenditures: an empirical study of OECD countries.

PubMed

Vandersteegen, Tom; Marneffe, Wim; Cleemput, Irina; Vereeck, Lode

2015-03-01

Around the world, governments are faced with spiralling health care expenditures. This raises the need for further insight in the determinants of these expenditures. Existing literature focuses primarily on income, ageing, health care financing and supply variables. This paper includes medical malpractice system characteristics as determinants of health spending in OECD countries. Estimates from our regression models suggest that no-fault schemes for medical injuries with decoupling of deterrence and compensation reduce health expenditures per capita by 0.11%. Furthermore, countries that introduced a no-fault system without decoupling of deterrence and compensation are found to have higher (+0.06%) health care spending. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Linear unsaturating magnetoresistance in disordered systems

NASA Astrophysics Data System (ADS)

Lai, Ying Tong; Lara, Silvia; Love, Cameron; Ramakrishnan, Navneeth; Adam, Shaffique

Theoretical works have shown that disordered systems exhibit classical magnetoresistance (MR). In this talk, we examine a variety of experimental systems that observe linear MR at high magnetic fields, including silver chalcogenides, graphene, graphite and Weyl semimetals. We show that a careful analysis of the magnitude of the MR, as well as the field strength at which the MR changes from quadratic to linear, reveal important properties of the system, such as the ratio of the root-mean-square fluctuations in the carrier density and the average carrier density. By looking at other properties such as the zero-field mobility, we show that this carrier density inhomogeneity is consistent with what is known about the microscopic impurities in these experiments. The application of this disorder-induced MR to a variety of different experimental scenarios underline the universality of these theoretical models. This work is supported by the Singapore National Research Foundation (NRF-NRFF2012-01) and the Singapore Ministry of Education and Yale-NUS College through Grant Number R-607-265-01312.

DataView: National Health Expenditures, 1998

PubMed Central

Cowan, Cathy A.; Lazenby, Helen C.; Martin, Anne B.; McDonnell, Patricia A.; Sensenig, Arthur L.; Stiller, Jean M.; Whittle, Lekha S.; Kotova, Kimberly A.; Zezza, Mark A.; Donham, Carolyn S.; Long, Anna M.; Stewart, Madie W.

1999-01-01

In 1998, national health care expenditures reached $1.1 trillion, an increase of 5.6 percent from the previous year. This marked the fifth consecutive year of spending growth under 6 percent. Underlying the stability of the overall growth, major changes began taking place within the Nation's health care system. Public payers felt the initial effects of the Balanced Budget Act of 1997 (BBA), and private payers experienced increased health care costs and increased premium growth. PMID:11481774

Effects of Light Color on Energy Expenditure and Behavior in Broiler

PubMed Central

Kim, ChickensNara; Lee, Sang-rak; Lee, Sang-Jin

2014-01-01

This study was conducted in order to investigate whether the presence of light or different colors of light would influence the energy expenditure and behavior of broiler chickens. Eight 8-week-old broiler chickens were adapted to a respiration chamber (Length, 28.5 cm; Height, 38.5 cm; Width, 44.0 cm) for one week prior to the initiation of the experiment. In experiment 1, energy expenditure and behavior of the chickens were analyzed in the presence or absence of light for four days. Chickens were exposed to 6 cycles of 2 h light/2 h dark period per day. In experiment 2, the broiler chickens that had been used in experiment 1 were used to evaluate the effect of 4 different wavelength light-emitting diodes (LEDs) on the energy expenditure and behavior of broiler chickens. The LEDs used in this study had the following wavelength bands; white (control), red (618 to 635 nm), green (515 to 530 nm) and blue (450 to 470 nm). The chickens were randomly exposed to a 2-h LED light in a random and sequential order per day for 3 days. Oxygen consumption and carbon dioxide production of the chickens were recorded using an open-circuit calorimeter system, and energy expenditure was calculated based on the collected data. The behavior of the chickens was analyzed based on following categories i.e., resting, standing, and pecking, and closed-circuit television was used to record these behavioral postures. The analysis of data from experiment 1 showed that the energy expenditure was higher (p<0.001) in chickens under light condition compared with those under dark condition. The chickens spent more time with pecking during a light period, but they frequently exhibited resting during a dark period. Experiment 2 showed that there was no significant difference in terms of energy expenditure and behavior based on the color of light (white, red, green, and blue) to which the chickens were exposed. In conclusion, the energy expenditure and behavior of broiler chickens were found to be

The Allocation of Federal Expenditures Among States

NASA Technical Reports Server (NTRS)

Lee, Maw Lin

1967-01-01

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

Willingness to pay for other individuals' healthcare expenditures.

PubMed

Borges, A P; Reis, A; Anjos, J

2017-03-01

The need to improve the sustainability of public health expenditure, in a climate of growing pressure on national budgets, inevitably leads to a discussion about resource rationing, and the extent of society's responsibility for those expenditures. To contribute to this discussion empirically, this study evaluated the willingness of Portuguese respondents to pay for other individuals' healthcare expenditures through out-of-pocket payments. A questionnaire addressed to the general public was developed, with 296 respondents. The survey was divided into three sections: (i) sociodemographic characteristics of the respondents; (ii) health-related habits; and (iii) willingness to pay other individuals' healthcare expenditures and, if so, how much. Logit and ordered logit models were applied. Respondents were divided fairly even between those who were willing to pay for other individuals' healthcare expenditures and those who were not. Respondents with health insurance contracts were more willing to contribute, and the contribution value was higher. Having a degree-level education was associated with reduced willingness to pay for other individuals' healthcare expenditures, and reduced probability of paying a larger amount, which may be associated with holding individuals accountable for their choices. Considering self-reported risky behaviours, the respondents who consumed alcohol were more likely to be willing to pay for other individuals' healthcare expenditures, and to a greater extent, whereas smokers were less likely to pay larger amounts. These effects suggest that respondents with different unhealthy behaviours are not equally altruistic. These findings highlight the need to combine health policy and social beliefs. The respondents seem to be interested to discuss healthcare funding, given that they agreed to reveal their willingness to pay for other individuals' healthcare expenditures. Moreover, respondents' sociodemographic characteristics and health

Private dental insurance expenditure in Brazil

PubMed Central

Cascaes, Andreia Morales; de Camargo, Maria Beatriz Junqueira; de Castilhos, Eduardo Dickie; Silva, lexandre Emídio Ribeiro; Barros, Aluísio J D

2018-01-01

ABSTRACT OBJECTIVE To quantify the household expenditure per capita and to estimate the percentage of Brazilian households that have spent with dental insurance. METHODS We analyzed data from 55,970 households that participated in the research Pesquisa de Orçamentos Familiares in 2008–2009. We have analyzed the annual household expenditure per capita with dental insurance (business and private) according to the Brazilian states and the socioeconomic and demographic characteristics of the households (sex, age, race, and educational level of the head of the household, family income, and presence of an older adult in the household). RESULTS Only 2.5% of Brazilian households have reported spending on dental insurance. The amount spent per capita amounted to R$5.10 on average, most of which consisted of private dental insurance (R$4.70). Among the characteristics of the household, higher educational level and income were associated with higher spending. São Paulo was the state with the highest household expenditure per capita (R$10.90) and with the highest prevalence of households with expenditures (4.6%), while Amazonas and Tocantins had the lowest values, in which both spent less than R$1.00 and had a prevalence of less than 0.1% of households, respectively. CONCLUSIONS Only a small portion of the Brazilian households has dental insurance expenditure. The market for supplementary dentistry in oral health care covers a restricted portion of the Brazilian population. PMID:29489995

Energy expenditure in obesity associated with craniopharyngioma

PubMed Central

Shah, Rachana; Tershakovec, Andy M.; Zemel, Babette S.; Sutton, Leslie N.; Grimberg, Adda; Moshang, Thomas

2010-01-01

Background and purpose Obesity is a common yet incompletely understood complication of childhood craniopharyngioma. We hypothesized that craniopharyngioma is associated with specific defects in energy balance compared to obese control children. Methods Eleven craniopharyngioma patients were recruited for a study on body composition and energy balance. Eight subjects were obese. The obese craniopharyngioma patients had a mean age (±SD) of 11.2±1.7 years. The average body mass index z score was 2.33 (±0.32). A previously studied group of obese children (BMI z score 2.46±0.46) served as controls. Resting energy expenditure (REE) was determined by indirect calorimetry and body composition by dual energy X-ray absorptiometry in all children. Results Obese craniopharyngioma patient subjects had increased mean (±standard error) fat-free mass compared to obese controls (57%±0.88 % vs 50.0%±0.87%, p=0.02). The obese craniopharyngioma patients had a 17% lower REE compared to values expected from the World Health Organization equation (1,541±112.6 vs 1,809±151.8 kcal; p=0.01). In contrast, the obese control children had measured REE within 1% of predicted (1,647±33.2 vs. 1,652±40.2; p=0.8). In a linear regression model, REE remained significantly lower than predicted after controlling for FFM. Conclusions Lower REE may be a factor contributing to obesity in children with craniopharyngioma. Further study is needed into the mechanisms for reduced energy expenditure in patients with craniopharyngioma. PMID:20107994

Conjugate gradient type methods for linear systems with complex symmetric coefficient matrices

NASA Technical Reports Server (NTRS)

Freund, Roland

1989-01-01

We consider conjugate gradient type methods for the solution of large sparse linear system Ax equals b with complex symmetric coefficient matrices A equals A(T). Such linear systems arise in important applications, such as the numerical solution of the complex Helmholtz equation. Furthermore, most complex non-Hermitian linear systems which occur in practice are actually complex symmetric. We investigate conjugate gradient type iterations which are based on a variant of the nonsymmetric Lanczos algorithm for complex symmetric matrices. We propose a new approach with iterates defined by a quasi-minimal residual property. The resulting algorithm presents several advantages over the standard biconjugate gradient method. We also include some remarks on the obvious approach to general complex linear systems by solving equivalent real linear systems for the real and imaginary parts of x. Finally, numerical experiments for linear systems arising from the complex Helmholtz equation are reported.

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

PubMed

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

2017-08-01

expenditure patterns data in analyses may yield important information about child nutritional status and linear growth. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Socioeconomic inequality in catastrophic health expenditure in Brazil.

PubMed

Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; Barros, Aluísio Jardim Dornellas de; Posenato, Leila Garcia; Peres, Karen Glazer

2014-08-01

To analyze the evolution of catastrophic health expenditure and the inequalities in such expenses, according to the socioeconomic characteristics of Brazilian families. Data from the National Household Budget 2002-2003 (48,470 households) and 2008-2009 (55,970 households) were analyzed. Catastrophic health expenditure was defined as excess expenditure, considering different methods of calculation: 10.0% and 20.0% of total consumption and 40.0% of the family's capacity to pay. The National Economic Indicator and schooling were considered as socioeconomic characteristics. Inequality measures utilized were the relative difference between rates, the rates ratio, and concentration index. The catastrophic health expenditure varied between 0.7% and 21.0%, depending on the calculation method. The lowest prevalences were noted in relation to the capacity to pay, while the highest, in relation to total consumption. The prevalence of catastrophic health expenditure increased by 25.0% from 2002-2003 to 2008-2009 when the cutoff point of 20.0% relating to the total consumption was considered and by 100% when 40.0% or more of the capacity to pay was applied as the cut-off point. Socioeconomic inequalities in the catastrophic health expenditure in Brazil between 2002-2003 and 2008-2009 increased significantly, becoming 5.20 times higher among the poorest and 4.17 times higher among the least educated. There was an increase in catastrophic health expenditure among Brazilian families, principally among the poorest and those headed by the least-educated individuals, contributing to an increase in social inequality.

Analysis of USDA Forest Service fire-related expenditures 1970-1995

Treesearch

Ervin G. Schuster; David A. Cleaves; Enoch F. Bell

1997-01-01

Forest Service expenditures for fire presuppression and suppression activities increased from $61 million in FY 1970 to $951 million in FY 1994. Yet, real (net of inflation) expenditures have not increased significantly since FY 1970, if FY 1994 expenditures are excluded. During any given year, 56 percent of suppression expenditures are spent on supplies and services,...

National Health Expenditures: Short-Term Outlook and Long-Term Projections

PubMed Central

Freeland, Mark S.; Schendler, Carol Ellen

1981-01-01

This paper presents projections of national health expenditures by type of expenditure and source of funds for 1981, 1985, and 1990. Rapid growth in national health expenditures is projected to continue through 1990. National health expenditures increased 400 percent between 1965 and 1979, reaching $212 billion in 1979. As a proportion of the Gross National Product (GNP), health expenditures rose from 6.1 percent to 9.0 percent between 1965 and 1979. They are expected to continue to rise, reaching 10.8 percent by 1990. This study projects that, under current legislation, national health expenditures will reach $279 billion in 1981, $462 billion in 1985, and $821 billion in 1990. Sources of payments for these expenditures are shifting. From 1965 to 1979, the percentage of total health expenditures financed by public funds increased 17 percentage points—from 26 to 43 percent. The Federal share of public funds during this same period grew rapidly, from 51 percent in 1965 to 67 percent in 1979. This study projects that in 1985 approximately 45 percent of total health spending will be financed from public funds, of which 68 percent will be paid for by the Federal government. Public funds will account for 46 percent of total national health expenditures by 1990. PMID:10309366

Feedback linearizing control of a MIMO power system

NASA Astrophysics Data System (ADS)

Ilyes, Laszlo

Prior research has demonstrated that either the mechanical or electrical subsystem of a synchronous electric generator may be controlled using single-input single-output (SISO) nonlinear feedback linearization. This research suggests a new approach which applies nonlinear feedback linearization to a multi-input multi-output (MIMO) model of the synchronous electric generator connected to an infinite bus load model. In this way, the electrical and mechanical subsystems may be linearized and simultaneously decoupled through the introduction of a pair of auxiliary inputs. This allows well known, linear, SISO control methods to be effectively applied to the resulting systems. The derivation of the feedback linearizing control law is presented in detail, including a discussion on the use of symbolic math processing as a development tool. The linearizing and decoupling properties of the control law are validated through simulation. And finally, the robustness of the control law is demonstrated.

26 CFR 1.263A-11 - Accumulated production expenditures.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 3 2011-04-01 2011-04-01 false Accumulated production expenditures. 1.263A-11... TAX (CONTINUED) INCOME TAXES (CONTINUED) Items Not Deductible § 1.263A-11 Accumulated production expenditures. (a) General rule. Accumulated production expenditures generally means the cumulative amount of...

26 CFR 1.263A-11 - Accumulated production expenditures.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 3 2013-04-01 2013-04-01 false Accumulated production expenditures. 1.263A-11... TAX (CONTINUED) INCOME TAXES (CONTINUED) Items Not Deductible § 1.263A-11 Accumulated production expenditures. (a) General rule. Accumulated production expenditures generally means the cumulative amount of...

26 CFR 1.263A-11 - Accumulated production expenditures.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 3 2014-04-01 2014-04-01 false Accumulated production expenditures. 1.263A-11... TAX (CONTINUED) INCOME TAXES (CONTINUED) Items Not Deductible § 1.263A-11 Accumulated production expenditures. (a) General rule. Accumulated production expenditures generally means the cumulative amount of...

26 CFR 1.263A-11 - Accumulated production expenditures.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 3 2012-04-01 2012-04-01 false Accumulated production expenditures. 1.263A-11... TAX (CONTINUED) INCOME TAXES (CONTINUED) Items Not Deductible § 1.263A-11 Accumulated production expenditures. (a) General rule. Accumulated production expenditures generally means the cumulative amount of...

Obesity and People with Disabilities: The Implications for Health Care Expenditures

PubMed Central

Anderson, Wayne L.; Wiener, Joshua M.; Khatutsky, Galina; Armour, Brian S.

2015-01-01

Objective This study estimates additional average health care expenditures for overweight and obesity for adults with disabilities vs. without. Design and Methods Descriptive and multivariate methods were used to estimate additional health expenditures by service type, age group, and payer using 2004–2007 Medical Expenditure Panel Survey data. Results In 2007, 37% of community-dwelling Americans with disabilities were obese vs. 27% of the total population. People with disabilities had almost three times ($2,459) the additional average obesity cost of people without disabilities ($889). Prescription drug expenditures for obese people with disabilities were three times as high and outpatient expenditures were 74% higher. People with disabilities in the 45- to 64-year age group had the highest obesity expenditures. Medicare had the highest additional average obesity expenditures among payers. Among people with prescription drug expenditures, obese people with disabilities had nine times the prevalence of diabetes as normal weight people with disabilities. Overweight people with and without disabilities had lower expenditures than normal-weight people with and without disabilities. Conclusions Obesity results in substantial additional health care expenditures for people with disabilities. These additional expenditures pose a serious current and future problem, given the potential for higher obesity prevalence in the coming decade. PMID:23804319

Obesity and people with disabilities: the implications for health care expenditures.

PubMed

Anderson, Wayne L; Wiener, Joshua M; Khatutsky, Galina; Armour, Brian S

2013-12-01

This study estimates additional average health care expenditures for overweight and obesity for adults with disabilities vs. without. Descriptive and multivariate methods were used to estimate additional health expenditures by service type, age group, and payer using 2004-2007 Medical Expenditure Panel Survey data. In 2007, 37% of community-dwelling Americans with disabilities were obese vs. 27% of the total population. People with disabilities had almost three times ($2,459) the additional average obesity cost of people without disabilities ($889). Prescription drug expenditures for obese people with disabilities were three times as high and outpatient expenditures were 74% higher. People with disabilities in the 45- to 64-year age group had the highest obesity expenditures. Medicare had the highest additional average obesity expenditures among payers. Among people with prescription drug expenditures, obese people with disabilities had nine times the prevalence of diabetes as normal weight people with disabilities. Overweight people with and without disabilities had lower expenditures than normal-weight people with and without disabilities. Obesity results in substantial additional health care expenditures for people with disabilities. These additional expenditures pose a serious current and future problem, given the potential for higher obesity prevalence in the coming decade. Copyright © 2013 The Obesity Society.

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

PubMed

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

2017-01-01

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

Trends in out-of-pocket health care expenditures in Canada, by household income, 1997 to 2009.

PubMed

Sanmartin, Claudia; Hennessy, Deirdre; Lu, Yuqian; Law, Michael Robert

2014-04-01

Canadian households are spending an increasing share of their household income on health care not covered by public plans. This study investigates trends in out-of-pocket expenditures for health care services and products by household income quintile from 1997 to 2009. Biennial estimates from the Survey of Household Spending between 1997 and 2009 were used to examine changes in out-of-pocket health care expenditures, by household income quintile. The statistical significance of these changes was assessed using linear and logistic regression. In 2009, the percentage of after-tax household income spent on health care among low-income households (5.7%) was nearly twice that of high-income households (2.6%). Approximately 40% of households in the two lowest income quintiles spent more than 5% of their total after-tax income on health care services and products, compared with 14% of households in the highest income quintile. The increase in spending between 1997 and 2009 was greatest for households in the lowest income quintile (63%). Out-of-pocket health care expenditures have increased for households in all income quintiles, but the relative increase was greatest among households in lower income quintiles.

Nonautonomous linear system of the terrestrial carbon cycle

NASA Astrophysics Data System (ADS)

Luo, Y.

2012-12-01

Carbon cycle has been studied by uses of observation through various networks, field and laboratory experiments, and simulation models. Much less has been done on theoretical thinking and analysis to understand fundament properties of carbon cycle and then guide observatory, experimental, and modeling research. This presentation is to explore what would be the theoretical properties of terrestrial carbon cycle and how those properties can be used to make observatory, experimental, and modeling research more effective. Thousands of published data sets from litter decomposition and soil incubation studies almost all indicate that decay processes of litter and soil organic carbon can be well described by first order differential equations with one or more pools. Carbon pool dynamics in plants and soil after disturbances (e.g., wildfire, clear-cut of forests, and plows of soil for cropping) and during natural recovery or ecosystem restoration also exhibit characteristics of first-order linear systems. Thus, numerous lines of empirical evidence indicate that the terrestrial carbon cycle can be adequately described as a nonautonomous linear system. The linearity reflects the nature of the carbon cycle that carbon, once fixed by photosynthesis, is linearly transferred among pools within an ecosystem. The linear carbon transfer, however, is modified by nonlinear functions of external forcing variables. In addition, photosynthetic carbon influx is also nonlinearly influenced by external variables. This nonautonomous linear system can be mathematically expressed by a first-order linear ordinary matrix equation. We have recently used this theoretical property of terrestrial carbon cycle to develop a semi-analytic solution of spinup. The new methods have been applied to five global land models, including NCAR's CLM and CABLE models and can computationally accelerate spinup by two orders of magnitude. We also use this theoretical property to develop an analytic framework to

Modeling Health Care Expenditures and Use.

PubMed

Deb, Partha; Norton, Edward C

2018-04-01

Health care expenditures and use are challenging to model because these dependent variables typically have distributions that are skewed with a large mass at zero. In this article, we describe estimation and interpretation of the effects of a natural experiment using two classes of nonlinear statistical models: one for health care expenditures and the other for counts of health care use. We extend prior analyses to test the effect of the ACA's young adult expansion on three different outcomes: total health care expenditures, office-based visits, and emergency department visits. Modeling the outcomes with a two-part or hurdle model, instead of a single-equation model, reveals that the ACA policy increased the number of office-based visits but decreased emergency department visits and overall spending.

[The federal health expenditure on the uninsured population: Mexico 1980-1995].

PubMed

Lara, A; Gómez-Dantés, O; Urdapilleta, O; Bravo, M L

1997-01-01

In the last fifteen years Mexico suffered several economic crisis which have negatively affected public expenditure in social welfare and, as a consequence, public expenditure in health. This paper discusses the relationship between the adjustment policies adopted to confront these crisis and public expenditure in health care for the non-insured population, as well as the regional distribution of this expenditure. In part one, the evolution of general public expenditure, public expenditure in social welfare, and public expenditure in health between 1980 and 1995 is described. In part two, the distribution of public health expenditure for the non-insured population among the five regions in which the country was divided by the National Health Survey II is discussed. The main conclusion of this paper is that, between 1980 and 1995, the public expenditure gaps that have existed for a long time in Mexico among regions remained unchanged. These gaps basically affect the southern states of the country, are not related to health needs, and may deepen in view of the new relative cuts in public expenditure in social welfare announced by the new administration.

FAST Modularization Framework for Wind Turbine Simulation: Full-System Linearization

DOE PAGES

Jonkman, Jason M.; Jonkman, Bonnie J.

2016-10-03

The wind engineering community relies on multiphysics engineering software to run nonlinear time-domain simulations e.g. for design-standards-based loads analysis. Although most physics involved in wind energy are nonlinear, linearization of the underlying nonlinear system equations is often advantageous to understand the system response and exploit well-established methods and tools for analyzing linear systems. Here, this paper presents the development and verification of the new linearization functionality of the open-source engineering tool FAST v8 for land-based wind turbines, as well as the concepts and mathematical background needed to understand and apply it correctly.

FAST modularization framework for wind turbine simulation: full-system linearization

NASA Astrophysics Data System (ADS)

Jonkman, J. M.; Jonkman, B. J.

2016-09-01

The wind engineering community relies on multiphysics engineering software to run nonlinear time-domain simulations e.g. for design-standards-based loads analysis. Although most physics involved in wind energy are nonlinear, linearization of the underlying nonlinear system equations is often advantageous to understand the system response and exploit well- established methods and tools for analyzing linear systems. This paper presents the development and verification of the new linearization functionality of the open-source engineering tool FAST v8 for land-based wind turbines, as well as the concepts and mathematical background needed to understand and apply it correctly.

Optimum Damping in a Non-Linear Base Isolation System

NASA Astrophysics Data System (ADS)

Jangid, R. S.

1996-02-01

Optimum isolation damping for minimum acceleration of a base-isolated structure subjected to earthquake ground excitation is investigated. The stochastic model of the El-Centro1940 earthquake, which preserves the non-stationary evolution of amplitude and frequency content of ground motion, is used as an earthquake excitation. The base isolated structure consists of a linear flexible shear type multi-storey building supported on a base isolation system. The resilient-friction base isolator (R-FBI) is considered as an isolation system. The non-stationary stochastic response of the system is obtained by the time dependent equivalent linearization technique as the force-deformation of the R-FBI system is non-linear. The optimum damping of the R-FBI system is obtained under important parametric variations; i.e., the coefficient of friction of the R-FBI system, the period and damping of the superstructure; the effective period of base isolation. The criterion selected for optimality is the minimization of the top floor root mean square (r.m.s.) acceleration. It is shown that the above parameters have significant effects on optimum isolation damping.

5 CFR 591.211 - What are the categories of consumer expenditures?

Code of Federal Regulations, 2011 CFR

2011-01-01

... furnishings and supplies, medical, education and communication, recreation, and miscellaneous. (b) Primary expenditure groups. OPM subdivides each MEG into primary expenditure groups (PEGs). There are approximately 40... different types of categories: Major expenditure groups, primary expenditure groups, and detailed...

5 CFR 591.211 - What are the categories of consumer expenditures?

Code of Federal Regulations, 2013 CFR

2013-01-01

... furnishings and supplies, medical, education and communication, recreation, and miscellaneous. (b) Primary expenditure groups. OPM subdivides each MEG into primary expenditure groups (PEGs). There are approximately 40... different types of categories: Major expenditure groups, primary expenditure groups, and detailed...

5 CFR 591.211 - What are the categories of consumer expenditures?

Code of Federal Regulations, 2014 CFR

2014-01-01

... furnishings and supplies, medical, education and communication, recreation, and miscellaneous. (b) Primary expenditure groups. OPM subdivides each MEG into primary expenditure groups (PEGs). There are approximately 40... different types of categories: Major expenditure groups, primary expenditure groups, and detailed...

5 CFR 591.211 - What are the categories of consumer expenditures?

Code of Federal Regulations, 2012 CFR

2012-01-01

... furnishings and supplies, medical, education and communication, recreation, and miscellaneous. (b) Primary expenditure groups. OPM subdivides each MEG into primary expenditure groups (PEGs). There are approximately 40... different types of categories: Major expenditure groups, primary expenditure groups, and detailed...

Determinants of catastrophic health expenditure in iran.

PubMed

Abolhallaje, M; Hasani, Sa; Bastani, P; Ramezanian, M; Kazemian, M

2013-01-01

This study will provide detailed specification of those variables and determinants of unpredictable health expenditure in Iran, and the requirements to reduce extensive effects of the factors affecting households' payments for health and other goods and services inappropriately. This study aims to identify measures of fair financing of health services and determinants of fair financing contribution, regarding the required share of households that prevents their catastrophic payments. In this regard, analysis of shares of households' expenditures on main groups of goods and services in urban and rural areas and in groups of deciles in the statistics from households' expenditure surveys was applied. The growth of spending in nominal values within the years 2002-2008 was considerably high and the rate for out-of-pocket payments is nearly the same or greater than the rate for total health expenditure. In 2008, urban and rural households in average pay 6.4% and 6.35% of their total expenditure on health services. Finally three categories of determinants of unfair and catastrophic payments by households were recognized in terms of households' socio-economic status, equality/inequality conditions of the distribution of risk of financing, and economic aspects of health expenditure distribution. While extending the total share of government and prepayment sources of financing health services are considered as the simplest policy for limiting out-of-pocket payments, indicators and policies introduced in this study could also be considered important and useful for the development of health sector and easing access to health services, irrespective of health financing fairness.

Recursive inversion of externally defined linear systems

NASA Technical Reports Server (NTRS)

Bach, Ralph E., Jr.; Baram, Yoram

1988-01-01

The approximate inversion of an internally unknown linear system, given by its impulse response sequence, by an inverse system having a finite impulse response, is considered. The recursive least squares procedure is shown to have an exact initialization, based on the triangular Toeplitz structure of the matrix involved. The proposed approach also suggests solutions to the problems of system identification and compensation.

Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis.

PubMed

Lee, John Tayu; Hamid, Fozia; Pati, Sanghamitra; Atun, Rifat; Millett, Christopher

2015-01-01

The burden of non-communicable disease (NCDs) has grown rapidly in low- and middle-income countries (LMICs), where populations are ageing, with rising prevalence of multimorbidity (more than two co-existing chronic conditions) that will significantly increase pressure on already stretched health systems. We assess the impact of NCD multimorbidity on healthcare utilisation and out-of-pocket expenditures in six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Secondary analyses of cross-sectional data from adult participants (>18 years) in the WHO Study on Global Ageing and Adult Health (SAGE) 2007-2010. We used multiple logistic regression to determine socio-demographic correlates of multimorbidity. Association between the number of NCDs and healthcare utilisation as well as out-of-pocket spending was assessed using logistic, negative binominal and log-linear models. The prevalence of multimorbidity in the adult population varied from 3.9% in Ghana to 33.6% in Russia. Number of visits to doctors in primary and secondary care rose substantially for persons with increasing numbers of co-existing NCDs. Multimorbidity was associated with more outpatient visits in China (coefficient for number of NCD = 0.56, 95% CI = 0.46, 0.66), a higher likelihood of being hospitalised in India (AOR = 1.59, 95% CI = 1.45, 1.75), higher out-of-pocket expenditures for outpatient visits in India and China, and higher expenditures for hospital visits in Russia. Medicines constituted the largest proportion of out-of-pocket expenditures in persons with multimorbidity (88.3% for outpatient, 55.9% for inpatient visit in China) in most countries. Multimorbidity is associated with higher levels of healthcare utilisation and greater financial burden for individuals in middle-income countries. Our study supports the WHO call for universal health insurance and health service coverage in LMICs, particularly for vulnerable groups such as the elderly with multimorbidity.

Virtual Estimator for Piecewise Linear Systems Based on Observability Analysis

PubMed Central

Morales-Morales, Cornelio; Adam-Medina, Manuel; Cervantes, Ilse; Vela-Valdés and, Luis G.; García Beltrán, Carlos Daniel

2013-01-01

This article proposes a virtual sensor for piecewise linear systems based on observability analysis that is in function of a commutation law related with the system's outpu. This virtual sensor is also known as a state estimator. Besides, it presents a detector of active mode when the commutation sequences of each linear subsystem are arbitrary and unknown. For the previous, this article proposes a set of virtual estimators that discern the commutation paths of the system and allow estimating their output. In this work a methodology in order to test the observability for piecewise linear systems with discrete time is proposed. An academic example is presented to show the obtained results. PMID:23447007

Household Expenditures on Private Tutoring: Emerging Evidence from Malaysia

ERIC Educational Resources Information Center

Kenayathulla, Husaina Banu

2013-01-01

Private tutoring has been a burgeoning phenomenon in Malaysia for decades. This study examines the determinants of private tutoring expenditures in Malaysia using the 2004/2005 Household Expenditures Survey and applies hurdle regression models to the data. The results indicate that total household expenditures, household head's level of education,…

Symmetric linear systems - An application of algebraic systems theory

NASA Technical Reports Server (NTRS)

Hazewinkel, M.; Martin, C.

1983-01-01

Dynamical systems which contain several identical subsystems occur in a variety of applications ranging from command and control systems and discretization of partial differential equations, to the stability augmentation of pairs of helicopters lifting a large mass. Linear models for such systems display certain obvious symmetries. In this paper, we discuss how these symmetries can be incorporated into a mathematical model that utilizes the modern theory of algebraic systems. Such systems are inherently related to the representation theory of algebras over fields. We will show that any control scheme which respects the dynamical structure either implicitly or explicitly uses the underlying algebra.

Main Determinants of Catastrophic Health Expenditures: A Bayesian Logit Approach on Iranian Household Survey Data (2010)

PubMed Central

Fazaeli, Ali Akbar; Ghaderi, Hossein; Fazaeli, Amir Abbas; Lotfi, Farhad; Salehi, Masoud; Mehrara, Mohsen

2015-01-01

Background: During recent decades, increase in both health care expenditures and improvement of the awareness as well as health expectations have created some problems with regard to finance healthcare expenditures so that the issue of health financing by households has been determined as a major challenge in health sector. According to the definition by the World Health Organization, catastrophic health expenditure is considered if financial contribution for health service is more than 40% of income remaining after subsistence needs have been met. Objectives: The purpose of our study was determination of Main factors on catastrophic health expenditures in Iranian households. Patients and Methods: In this study, using an econometrics Bayesian logit model, determinants of the appearance of catastrophic health expenditure based on household budget data collected in 2010 were evaluated. Results: Among Iranian households, the following groups were more likely to encounter with unsustainable health expenditures: rural households, households with the numbers of the elderly more than 65 years, illiterate householders, unemployed householders, households with some unemployed persons, households in upper rank and households with larger equivalent household size were higher than the average of community could significantly predict catastrophic health expenditures. Conclusions: About 2.1% of households were faced with catastrophic health expenditures in 2010. Thus, the implemented policies could not make considerable and significant change in improving justice in financing in health systems. PMID:25946936

Main determinants of catastrophic health expenditures: a Bayesian logit approach on Iranian household survey data (2010).

PubMed

Fazaeli, Ali Akbar; Ghaderi, Hossein; Abbas Fazaeli, Amir; Lotfi, Farhad; Salehi, Masoud; Mehrara, Mohsen

2015-01-26

During recent decades, increase in both health care expenditures and improvement of the awareness as well as health expectations have created some problems with regard to finance healthcare expenditures so that the issue of health financing by households has been determined as a major challenge in health sector. According to the definition by the World Health Organization, catastrophic health expenditure is considered if financial contribution for health service is more than 40% of income remaining after subsistence needs have been met. The purpose of our study was determination of Main factors on catastrophic health expenditures in Iranian households. In this study, using an econometrics Bayesian logit model, determinants of the appearance of catastrophic health expenditure based on household budget data collected in 2010 were evaluated. Among Iranian households, the following groups were more likely to encounter with unsustainable health expenditures: rural households, households with the numbers of the elderly more than 65 years, illiterate householders, unemployed householders, households with some unemployed persons, households in upper rank and households with larger equivalent household size were higher than the average of community could significantly predict catastrophic health expenditures. About 2.1% of households were faced with catastrophic health expenditures in 2010. Thus, the implemented policies could not make considerable and significant change in improving justice in financing in health systems.

A survey of packages for large linear systems

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

Wu, Kesheng; Milne, Brent

2000-02-11

This paper evaluates portable software packages for the iterative solution of very large sparse linear systems on parallel architectures. While we cannot hope to tell individual users which package will best suit their needs, we do hope that our systematic evaluation provides essential unbiased information about the packages and the evaluation process may serve as an example on how to evaluate these packages. The information contained here include feature comparisons, usability evaluations and performance characterizations. This review is primarily focused on self-contained packages that can be easily integrated into an existing program and are capable of computing solutions to verymore » large sparse linear systems of equations. More specifically, it concentrates on portable parallel linear system solution packages that provide iterative solution schemes and related preconditioning schemes because iterative methods are more frequently used than competing schemes such as direct methods. The eight packages evaluated are: Aztec, BlockSolve,ISIS++, LINSOL, P-SPARSLIB, PARASOL, PETSc, and PINEAPL. Among the eight portable parallel iterative linear system solvers reviewed, we recommend PETSc and Aztec for most application programmers because they have well designed user interface, extensive documentation and very responsive user support. Both PETSc and Aztec are written in the C language and are callable from Fortran. For those users interested in using Fortran 90, PARASOL is a good alternative. ISIS++is a good alternative for those who prefer the C++ language. Both PARASOL and ISIS++ are relatively new and are continuously evolving. Thus their user interface may change. In general, those packages written in Fortran 77 are more cumbersome to use because the user may need to directly deal with a number of arrays of varying sizes. Languages like C++ and Fortran 90 offer more convenient data encapsulation mechanisms which make it easier to implement a clean and intuitive

Household catastrophic health expenditures: a comparative analysis of twelve Latin American and Caribbean Countries.

PubMed

Knaul, Felicia Marie; Wong, Rebeca; Arreola-Ornelas, Héctor; Méndez, Oscar

2011-01-01

Compare patterns of catastrophic health expenditures in 12 countries in Latin America and the Caribbean. Prevalence of catastrophic expenses was estimated uniformly at the household level using household surveys. Two types of prevalence indicators were used based on out-of-pocket health expense: a) relative to an international poverty line, and b) relative to the household's ability to pay net of their food basket. Ratios of catastrophic expenditures were estimated across subgroups defined by economic and social variables. The percent of households with catastrophic health expenditures ranged from 1 to 25% in the twelve countries. In general, rural residence, lowest quintile of income, presence of older adults, and lack of health insurance in the household are associated with higher propensity of catastrophic health expenditures. However, there is vast heterogeneity by country. Cross national studies may serve to examine how health systems contribute to the social protection of Latin American households.

Assessing household health expenditure with Box-Cox censoring models.

PubMed

Chaze, Jean-Paul

2005-09-01

In order to assess the combined presence of zero expenditures and a heavily skewed distribution of positive expenditures, the Box-Cox transformation with location parameter is used to define a set of models generalising the standard Tobit, Heckman selection and double-hurdle models. Extended flexibility with respect to previous specifications is introduced, notably regarding negative transformation parameters, which may prove necessary for medical expenditures, and corner-solution outcomes. An illustration is provided by the analysis of household health expenditure in Switzerland. Copyright (c) 2005 John Wiley & Sons, Ltd.

Socioeconomic inequality in catastrophic health expenditure in Brazil

PubMed Central

Boing, Alexandra Crispim; Bertoldi, Andréa Dâmaso; de Barros, Aluísio Jardim Dornellas; Posenato, Leila Garcia; Peres, Karen Glazer

2014-01-01

OBJECTIVE To analyze the evolution of catastrophic health expenditure and the inequalities in such expenses, according to the socioeconomic characteristics of Brazilian families. METHODS Data from the National Household Budget 2002-2003 (48,470 households) and 2008-2009 (55,970 households) were analyzed. Catastrophic health expenditure was defined as excess expenditure, considering different methods of calculation: 10.0% and 20.0% of total consumption and 40.0% of the family’s capacity to pay. The National Economic Indicator and schooling were considered as socioeconomic characteristics. Inequality measures utilized were the relative difference between rates, the rates ratio, and concentration index. RESULTS The catastrophic health expenditure varied between 0.7% and 21.0%, depending on the calculation method. The lowest prevalences were noted in relation to the capacity to pay, while the highest, in relation to total consumption. The prevalence of catastrophic health expenditure increased by 25.0% from 2002-2003 to 2008-2009 when the cutoff point of 20.0% relating to the total consumption was considered and by 100% when 40.0% or more of the capacity to pay was applied as the cut-off point. Socioeconomic inequalities in the catastrophic health expenditure in Brazil between 2002-2003 and 2008-2009 increased significantly, becoming 5.20 times higher among the poorest and 4.17 times higher among the least educated. CONCLUSIONS There was an increase in catastrophic health expenditure among Brazilian families, principally among the poorest and those headed by the least-educated individuals, contributing to an increase in social inequality. PMID:25210822

Expenditure and financial burden for the diagnosis and treatment of colorectal cancer in China: a hospital-based, multicenter, cross-sectional survey.

PubMed

Huang, Hui-Yao; Shi, Ju-Fang; Guo, Lan-Wei; Bai, Ya-Na; Liao, Xian-Zhen; Liu, Guo-Xiang; Mao, A-Yan; Ren, Jian-Song; Sun, Xiao-Jie; Zhu, Xin-Yu; Wang, Le; Song, Bing-Bing; Du, Ling-Bin; Zhu, Lin; Gong, Ji-Yong; Zhou, Qi; Liu, Yu-Qin; Cao, Rong; Mai, Ling; Lan, Li; Sun, Xiao-Hua; Ren, Ying; Zhou, Jin-Yi; Wang, Yuan-Zheng; Qi, Xiao; Lou, Pei-An; Shi, Dian; Li, Ni; Zhang, Kai; He, Jie; Dai, Min

2017-04-28

The increasing prevalence of colorectal cancer (CRC) in China and the paucity of information about relevant expenditure highlight the necessity of better understanding the financial burden and effect of CRC diagnosis and treatment. We performed a survey to quantify the direct medical and non-medical expenditure as well as the resulting financial burden of CRC patients in China. We conducted a multicenter, cross-sectional survey in 37 tertiary hospitals in 13 provinces across China between 2012 and 2014. Each enrolled patient was interviewed using a structured questionnaire. All expenditure data were inflated to the 2014 Chinese Yuan (CNY; 1 CNY = 0.163 USD). We quantified the overall expenditure and financial burden and by subgroup (hospital type, age at diagnosis, sex, education, occupation, insurance type, household income, clinical stage, pathologic type, and therapeutic regimen). We then performed generalized linear modeling to determine the factors associated with overall expenditure. A total of 2356 patients with a mean age of 57.4 years were included, 57.1% of whom were men; 13.9% of patients had stage I cancer; and the average previous-year household income was 54,525 CNY. The overall average direct expenditure per patient was estimated to be 67,408 CNY, and the expenditures for stage I, II, III, and IV disease were 56,099 CNY, 59,952 CNY, 67,292 CNY, and 82,729 CNY, respectively. Non-medical expenditure accounted for 8.3% of the overall expenditure. The 1-year out-of-pocket expenditure of a newly diagnosed patient was 32,649 CNY, which accounted for 59.9% of their previous-year household income and caused 75.0% of families to suffer an unmanageable financial burden. Univariate analysis showed that financial burden and overall expenditure differed in almost all subgroups (P < 0.05), except for sex. Multivariate analysis showed that patients who were treated in specialized hospitals and those who were diagnosed with adenocarcinoma or diagnosed at a later

A smooth mixture of Tobits model for healthcare expenditure.

PubMed

Keane, Michael; Stavrunova, Olena

2011-09-01

This paper develops a smooth mixture of Tobits (SMTobit) model for healthcare expenditure. The model is a generalization of the smoothly mixing regressions framework of Geweke and Keane (J Econometrics 2007; 138: 257-290) to the case of a Tobit-type limited dependent variable. A Markov chain Monte Carlo algorithm with data augmentation is developed to obtain the posterior distribution of model parameters. The model is applied to the US Medicare Current Beneficiary Survey data on total medical expenditure. The results suggest that the model can capture the overall shape of the expenditure distribution very well, and also provide a good fit to a number of characteristics of the conditional (on covariates) distribution of expenditure, such as the conditional mean, variance and probability of extreme outcomes, as well as the 50th, 90th, and 95th, percentiles. We find that healthier individuals face an expenditure distribution with lower mean, variance and probability of extreme outcomes, compared with their counterparts in a worse state of health. Males have an expenditure distribution with higher mean, variance and probability of an extreme outcome, compared with their female counterparts. The results also suggest that heart and cardiovascular diseases affect the expenditure of males more than that of females. Copyright © 2011 John Wiley & Sons, Ltd.

National Health Expenditures, 19801

PubMed Central

Gibson, Robert M.; Waldo, Daniel R.

1981-01-01

The United States spent an estimated $247 billion for health care in 1980 (Figure 1), an amount equal to 9.4 percent of the Gross National Product (GNP). Highlights of the figures that underlie this estimate include the following: Health care expenditures in 1980 accelerated at a time when the economy as a whole exhibited sluggish growth. The 9.4 percent share of the GNP was a dramatic increase from the 8.9 percent share in 1979.Health care expenditures amounted to $1,067 per person in 1980 (Table 1). Of that amount, $450, or 42.2 percent, came from public funds.Expenditures for health care included $64.9 billion in premiums to private health insurance, $70.9 billion in Federal payments, and $33.3 billion in State and local government funds (Table 2).Hospital care accounted for 40.3 percent of total health care spending in 1980 (Table 3). These expenditures increased 16.2 percent between 1979 and 1980, to a level of $99.6 billion.Spending for the services of physicians increased 14.5 percent to $46.6 billion, 18.9 percent of all health care spending.All third parties combined—private health insurers, governments, philanthropists, and industry—financed 67.6 percent of the $217.9 billion spent for personal health care in 1980 (Table 4), ranging from 90.9 percent of hospital care services to 62.7 percent of physicians' services and 38.5 percent of the remainder (Table 5).Direct payments by consumers reached $70.6 billion in 1980 (Table 6). This accounted for 32.4 percent of all personal health care expenses.Outlays for health care benefits by the Medicare and Medicaid programs totaled $60.6 billion, including $35.8 billion for hospital care. The two programs combined to pay for 27.8 percent of all personal health care in the nation (Table 7). PMID:10309470

Parameter identifiability of linear dynamical systems

NASA Technical Reports Server (NTRS)

Glover, K.; Willems, J. C.

1974-01-01

It is assumed that the system matrices of a stationary linear dynamical system were parametrized by a set of unknown parameters. The question considered here is, when can such a set of unknown parameters be identified from the observed data? Conditions for the local identifiability of a parametrization are derived in three situations: (1) when input/output observations are made, (2) when there exists an unknown feedback matrix in the system and (3) when the system is assumed to be driven by white noise and only output observations are made. Also a sufficient condition for global identifiability is derived.

Quantum computation for solving linear systems

NASA Astrophysics Data System (ADS)

Cao, Yudong

Quantum computation is a subject born out of the combination between physics and computer science. It studies how the laws of quantum mechanics can be exploited to perform computations much more efficiently than current computers (termed classical computers as oppose to quantum computers). The thesis starts by introducing ideas from quantum physics and theoretical computer science and based on these ideas, introducing the basic concepts in quantum computing. These introductory discussions are intended for non-specialists to obtain the essential knowledge needed for understanding the new results presented in the subsequent chapters. After introducing the basics of quantum computing, we focus on the recently proposed quantum algorithm for linear systems. The new results include i) special instances of quantum circuits that can be implemented using current experimental resources; ii) detailed quantum algorithms that are suitable for a broader class of linear systems. We show that for some particular problems the quantum algorithm is able to achieve exponential speedup over their classical counterparts.

Estimating Physical Activity Energy Expenditure with the Kinect Sensor in an Exergaming Environment

PubMed Central

Nathan, David; Huynh, Du Q.; Rubenson, Jonas; Rosenberg, Michael

2015-01-01

Active video games that require physical exertion during game play have been shown to confer health benefits. Typically, energy expended during game play is measured using devices attached to players, such as accelerometers, or portable gas analyzers. Since 2010, active video gaming technology incorporates marker-less motion capture devices to simulate human movement into game play. Using the Kinect Sensor and Microsoft SDK this research aimed to estimate the mechanical work performed by the human body and estimate subsequent metabolic energy using predictive algorithmic models. Nineteen University students participated in a repeated measures experiment performing four fundamental movements (arm swings, standing jumps, body-weight squats, and jumping jacks). Metabolic energy was captured using a Cortex Metamax 3B automated gas analysis system with mechanical movement captured by the combined motion data from two Kinect cameras. Estimations of the body segment properties, such as segment mass, length, centre of mass position, and radius of gyration, were calculated from the Zatsiorsky-Seluyanov's equations of de Leva, with adjustment made for posture cost. GPML toolbox implementation of the Gaussian Process Regression, a locally weighted k-Nearest Neighbour Regression, and a linear regression technique were evaluated for their performance on predicting the metabolic cost from new feature vectors. The experimental results show that Gaussian Process Regression outperformed the other two techniques by a small margin. This study demonstrated that physical activity energy expenditure during exercise, using the Kinect camera as a motion capture system, can be estimated from segmental mechanical work. Estimates for high-energy activities, such as standing jumps and jumping jacks, can be made accurately, but for low-energy activities, such as squatting, the posture of static poses should be considered as a contributing factor. When translated into the active video gaming

Linear Quantum Systems: Non-Classical States and Robust Stability

DTIC Science & Technology

2016-06-29

quantum linear systems subject to non-classical quantum fields. The major outcomes of this project are (i) derivation of quantum filtering equations for...derivation of quantum filtering equations for systems non-classical input states including single photon states, (ii) determination of how linear...history going back some 50 years, to the birth of modern control theory with Kalman’s foundational work on filtering and LQG optimal control

10 CFR 603.1265 - Expenditures or outlays.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Expenditures or outlays. 603.1265 Section 603.1265 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS Definitions of Terms... prepared on a . . . Expenditures are the sum of . . . (a) Cash basis (1) Cash disbursements for direct...

National health expenditures, 1991

PubMed Central

Letsch, Suzanne W.; Lazenby, Helen C.; Levit, Katharine R.; Cowan, Cathy A.

1992-01-01

Spending for health care rose to $751.8 billion in 1991, an increase of 11.4 percent from the 1990 level. National health expenditures as a share of gross domestic product increased to 13.2 percent, up from 12.2 percent in 1990. The health care sector exhibited strong growth, despite slow growth in the overall economy. This combination resulted in the largest increase in the share of the Nation's output consumed by health care in the past three decades. In this article, the authors present estimates of health spending in the United States for 1991. The authors also examine reasons for the unusually large growth in Medicaid expenditures and highlight recent trends in the hospital sector. PMID:10127445

European healthcare policies for controlling drug expenditure.

PubMed

Ess, Silvia M; Schneeweiss, Sebastian; Szucs, Thomas D

2003-01-01

In the last 20 years, expenditures on pharmaceuticals - as well as total health expenditures - have grown faster than the gross national product in all European countries. The aim of this paper was to review policies that European governments apply to reduce or at least slow down public expenditure on pharmaceutical products. Such policies can target the industry, the wholesalers and retailers, prescribers, and patients. The objectives of pharmaceutical policies are multidimensional and must take into account issues relating to public health, public expenditure and industrial incentives. Both price levels and consumption patterns determine the level of total drug expenditure in a particular country, and both factors vary greatly across countries. Licensing and pricing policies intend to influence the supply side. Three types of pricing policies can be recognised: product price control, reference pricing and profit control. Profit control is mainly used in the UK. Reference pricing systems were first used in Germany and The Netherlands and are being considered in other countries. Product price control is still the most common method for establishing the price of drugs. For the aim of fiscal consolidation, price-freeze and price-cut measures have been frequently used in the 1980s and 1990s. They have affected all types of schemes. For drug wholesalers and retailers, most governments have defined profit margins. The differences in price levels as well as the introduction of a Single European Pharmaceutical Market has led to the phenomenon of parallel imports among member countries of the European Union. This may be facilitated by larger and more powerful wholesalers and the vertical integration between wholesalers and retailers. To control costs, the use of generic drugs is encouraged in most countries, but only few countries allow pharmacists to substitute generic drugs for proprietary brands. Various interventions are used to reduce the patients' demand for drugs by

A methodology for design of a linear referencing system for surface transportation

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

Vonderohe, A.; Hepworth, T.

1997-06-01

The transportation community has recently placed significant emphasis on development of data models, procedural standards, and policies for management of linearly-referenced data. There is an Intelligent Transportation Systems initiative underway to create a spatial datum for location referencing in one, two, and three dimensions. Most recently, a call was made for development of a unified linear reference system to support public, private, and military surface transportation needs. A methodology for design of the linear referencing system was developed from geodetic engineering principles and techniques used for designing geodetic control networks. The method is founded upon the law of propagation ofmore » random error and the statistical analysis of systems of redundant measurements, used to produce best estimates for unknown parameters. A complete mathematical development is provided. Example adjustments of linear distance measurement systems are included. The classical orders of design are discussed with regard to the linear referencing system. A simple design example is provided. A linear referencing system designed and analyzed with this method will not only be assured of meeting the accuracy requirements of users, it will have the potential for supporting delivery of error estimates along with the results of spatial analytical queries. Modeling considerations, alternative measurement methods, implementation strategies, maintenance issues, and further research needs are discussed. Recommendations are made for further advancement of the unified linear referencing system concept.« less

26 CFR 1.616-1 - Development expenditures.

Code of Federal Regulations, 2013 CFR

2013-04-01

... (CONTINUED) INCOME TAXES (CONTINUED) Natural Resources § 1.616-1 Development expenditures. (a) General rule... taxpayer for the development of a mine or other natural deposit (other than an oil or gas well... natural deposit. Under section 616(b), the taxpayer may elect to defer development expenditures made in...

26 CFR 1.616-1 - Development expenditures.

Code of Federal Regulations, 2014 CFR

2014-04-01

...) INCOME TAXES (CONTINUED) Natural Resources § 1.616-1 Development expenditures. (a) General rule. Section... taxpayer for the development of a mine or other natural deposit (other than an oil or gas well... natural deposit. Under section 616(b), the taxpayer may elect to defer development expenditures made in...

18 CFR 154.401 - RD&D expenditures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false RD&D expenditures. 154.401 Section 154.401 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION... file to recover research, development, and demonstration (RD&D) expenditures in its rates under this...

26 CFR 1.528-6 - Expenditure test.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 7 2014-04-01 2013-04-01 true Expenditure test. 1.528-6 Section 1.528-6 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Homeowners Associations § 1.528-6 Expenditure test. (a) In general. An...

Playing active video games increases energy expenditure in children.

PubMed

Graf, Diana L; Pratt, Lauren V; Hester, Casey N; Short, Kevin R

2009-08-01

To compare energy expenditure rates in children playing the physically active video games, Dance Dance Revolution (DDR) and Nintendo's Wii Sports in relation to treadmill walking. Energy expenditure, heart rate, step rate, and perceived exertion were measured in 14 boys and 9 girls (ages 10-13 years; BMI at 3-98th percentile for age and gender) while watching television at rest, playing DDR at 2 skill levels, playing Wii bowling and boxing, and walking at 2.6, 4.2, and 5.7 km/h. Arterial elasticity was measured at rest and immediately after gaming. Compared with watching television, energy expenditure while gaming or walking increased 2- to 3-fold. Similarly, high rates of energy expenditure, heart rate, and perceived exertion were elicited from playing Wii boxing, DDR level 2, or walking at 5.7 km/h. This occurred despite variations in step rate among activities, reflecting greater use of upper body during Wii play (lowest step rate) than during walking (highest step rate) or DDR play. Wii bowling and beginner level DDR elicited a 2-fold increase in energy expenditure compared to television watching. Large-artery elasticity declined immediately after both DDR and Wii. The change was inversely related to the increment in energy expenditure above rest achieved during the activity. Energy expenditure during active video game play is comparable to moderate-intensity walking. Thus, for children who spend considerable time playing electronic screen games for entertainment, physically active games seem to be a safe, fun, and valuable means of promoting energy expenditure.

Targeted health department expenditures benefit birth outcomes at the county level.

PubMed

Bekemeier, Betty; Yang, Youngran; Dunbar, Matthew D; Pantazis, Athena; Grembowski, David E

2014-06-01

Public health leaders lack evidence for making decisions about the optimal allocation of resources across local health department (LHD) services, even as limited funding has forced cuts to public health services while local needs grow. A lack of data has also limited examination of the outcomes of targeted LHD investments in specific service areas. This study used unique, detailed LHD expenditure data gathered from state health departments to examine the influence of maternal and child health (MCH) service investments by LHDs on health outcomes. A multivariate panel time-series design was used in 2013 to estimate ecologic relationships between 2000-2010 LHD expenditures on MCH and county-level rates of low birth weight and infant mortality. The unit of analysis was 102 LHD jurisdictions in Washington and Florida. Results indicate that LHD expenditures on MCH services have a beneficial relationship with county-level low birth weight rates, particularly in counties with high concentrations of poverty. This relationship is stronger for more targeted expenditure categories, with expenditures in each of the three specific examined MCH service areas demonstrating the strongest effects. Findings indicate that specific LHD investments in MCH have an important effect on related health outcomes for populations in poverty and likely help reduce the costly burden of poor birth outcomes for families and communities. These findings underscore the importance of monitoring the impact of these evolving investments and ensuring that targeted, beneficial investments are not lost but expanded upon across care delivery systems. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

26 CFR 56.4911-8 - Excess lobbying expenditures of affiliated group.

Code of Federal Regulations, 2010 CFR

2010-04-01

... grass roots ceiling amounts for the affiliated group for a taxable year are calculated under § 1.501(h... expenditures, lobbying expenditures, and grass roots expenditures of an affiliated group of organizations, and... 4911(a). For any taxable year of the affiliated group, the group's lobbying expenditures, grass roots...

26 CFR 56.4911-8 - Excess lobbying expenditures of affiliated group.

Code of Federal Regulations, 2011 CFR

2011-04-01

... grass roots ceiling amounts for the affiliated group for a taxable year are calculated under § 1.501(h... expenditures, lobbying expenditures, and grass roots expenditures of an affiliated group of organizations, and... 4911(a). For any taxable year of the affiliated group, the group's lobbying expenditures, grass roots...

Healthcare use and expenditure for diabetes in Bangladesh

PubMed Central

Lechner, Andreas; Ferrari, Uta; Laxy, Michael; Seissler, Jochen; Brown, Jonathan; Niessen, Louis W; Holle, Rolf

2017-01-01

Background Diabetes imposes a huge social and economic impact on nations. However, information on the costs of treating and managing diabetes in developing countries is limited. The aim of this study was to estimate healthcare use and expenditure for diabetes in Bangladesh. Methods We conducted a matched case–control study between January and July 2014 among 591 adults with diagnosed diabetes mellitus (DMs) and 591 age-matched, sex-matched and residence-matched persons without diabetes mellitus (non-DMs). We recruited DMs from consecutive patients and non-DMs from accompanying persons in the Bangladesh Institute of Health Science (BIHS) hospital in Dhaka, Bangladesh. We estimated the impact of diabetes on healthcare use and expenditure by calculating ratios and differences between DMs and non-DMs for all expenses related to healthcare use and tested for statistical difference using Student's t-tests. Results DMs had two times more days of inpatient treatment, 1.3 times more outpatient visits, and 9.7 times more medications than non-DMs (all p<0.005). The total annual per capita expenditure on medical care was 6.1 times higher for DMs than non-DMs (US$635 vs US$104, respectively). Among DMs, 9.8% reported not taking any antidiabetic medications, 46.4% took metformin, 38.7% sulfonylurea, 40.8% insulin, 38.7% any antihypertensive medication, and 14.2% took anti-lipids over the preceding 3 months. Conclusions Diabetes significantly increases healthcare use and expenditure and is likely to impose a huge economic burden on the healthcare systems in Bangladesh. The study highlights the importance of prevention and optimum management of diabetes in Bangladesh and other developing countries, to gain a strong economic incentive through implementing multisectoral approach and cost-effective prevention strategies. PMID:28588991

Fixed order dynamic compensation for multivariable linear systems

NASA Technical Reports Server (NTRS)

Kramer, F. S.; Calise, A. J.

1986-01-01

This paper considers the design of fixed order dynamic compensators for multivariable time invariant linear systems, minimizing a linear quadratic performance cost functional. Attention is given to robustness issues in terms of multivariable frequency domain specifications. An output feedback formulation is adopted by suitably augmenting the system description to include the compensator states. Either a controller or observer canonical form is imposed on the compensator description to reduce the number of free parameters to its minimal number. The internal structure of the compensator is prespecified by assigning a set of ascending feedback invariant indices, thus forming a Brunovsky structure for the nominal compensator.

[Out-of-pocket health care expenditures among population groups in Iceland].

PubMed

Vilhjálmsson, Rúnar

2009-10-01

Out-of-pocket health expenditures affect access to health care. The study investigated trends in these expenditures, and whether certain population groups spent more than others. The data come from two national health surveys among Icelandic adults from 1998 and 2006. The response rate was 69% in the former survey (N=1924), and 60% in the latter (N= 1532). Average household health expenditures and household expenditure burden (expenditures as % of total household income) were compared over time and between groups. Household health expenditures increased by 29% in real terms between 1998 and 2006. The biggest items in 2006 were drugs and dental care. Women, younger and older individuals, the single and divorced, smaller households, the unemployed and non-employed, individuals with low education and income, the chronically ill, and the disabled, had the highest household expenditure burden. Comparison between 1998 and 2006 indicated increased expenditure burden among young people, students, the unemployed, and the least educated, but decreased burden among the elderly, the widowed, and parents of young children. Household health expenditures differ substantially between groups, suggesting reconsideration of current health insurance policies, especially with regard to disabled, non-employed, low-income, and young individuals.

Understanding Expenditure Data.

ERIC Educational Resources Information Center

Dyke, Frances L.

2000-01-01

Stresses the importance of common understandings of cost definitions and data collection in order to create reliable databases with optimal utility for inter-institutional analysis. Examines definitions of common expenditure categories, discusses cost-accumulation rules governing financial reporting, and explains differences between direct costs…

Development of a Compendium of Energy Expenditures for Youth

PubMed Central

Ridley, Kate; Ainsworth, Barbara E; Olds, Tim S

2008-01-01

Background This paper presents a Compendium of Energy Expenditures for use in scoring physical activity questionnaires and estimating energy expenditure levels in youth. Method/Results Modeled after the adult Compendium of Physical Activities, the Compendium of Energy Expenditures for Youth contains a list of over 200 activities commonly performed by youth and their associated MET intensity levels. A review of existing data collected on the energy cost of youth performing activities was undertaken and incorporated into the compendium. About 35% of the activity MET levels were derived from energy cost data measured in youth and the remaining MET levels estimated from the adult compendium. Conclusion The Compendium of Energy Expenditures for Youth is useful to researchers and practitioners interested in identifying physical activity and energy expenditure values in children and adolescents in a variety of settings. PMID:18782458

Experimental quantum computing to solve systems of linear equations.

PubMed

Cai, X-D; Weedbrook, C; Su, Z-E; Chen, M-C; Gu, Mile; Zhu, M-J; Li, Li; Liu, Nai-Le; Lu, Chao-Yang; Pan, Jian-Wei

2013-06-07

Solving linear systems of equations is ubiquitous in all areas of science and engineering. With rapidly growing data sets, such a task can be intractable for classical computers, as the best known classical algorithms require a time proportional to the number of variables N. A recently proposed quantum algorithm shows that quantum computers could solve linear systems in a time scale of order log(N), giving an exponential speedup over classical computers. Here we realize the simplest instance of this algorithm, solving 2×2 linear equations for various input vectors on a quantum computer. We use four quantum bits and four controlled logic gates to implement every subroutine required, demonstrating the working principle of this algorithm.

Private Schooling in the U.S.: Expenditures, Supply, and Policy Implications

ERIC Educational Resources Information Center

Baker, Bruce D.

2009-01-01

This report provides a first-of-its-kind descriptive summary of private school expenditures. It includes comparisons of expenditures among different types and affiliations of private schools, and it also compares those expenditures with public school expenditures for districts in the same state and labor market. Results indicate that (1) the…

String Stability of a Linear Formation Flight Control System

NASA Technical Reports Server (NTRS)

Allen, Michael J.; Ryan, Jack; Hanson, Curtis E.; Parle, James F.

2002-01-01

String stability analysis of an autonomous formation flight system was performed using linear and nonlinear simulations. String stability is a measure of how position errors propagate from one vehicle to another in a cascaded system. In the formation flight system considered here, each i(sup th) aircraft uses information from itself and the preceding ((i-1)(sup th)) aircraft to track a commanded relative position. A possible solution for meeting performance requirements with such a system is to allow string instability. This paper explores two results of string instability and outlines analysis techniques for string unstable systems. The three analysis techniques presented here are: linear, nonlinear formation performance, and ride quality. The linear technique was developed from a worst-case scenario and could be applied to the design of a string unstable controller. The nonlinear formation performance and ride quality analysis techniques both use nonlinear formation simulation. Three of the four formation-controller gain-sets analyzed in this paper were limited more by ride quality than by performance. Formations of up to seven aircraft in a cascaded formation could be used in the presence of light gusts with this string unstable system.

Relationship Between Catastrophic Health Expenditures and Income Quintile Decline

PubMed Central

Kang, Jeong-Hee; Kim, Chul-Woung

2018-01-01

Objectives The aims of this study were to investigate the proportion of households facing catastrophic health expenditures based on household income quintiles, and to analyze the relationship between expenditures and household income quintile decline. Methods Study data were obtained from an annually conducted survey of the 2012–2013 Korean health panel. There were 12,909 subjects aged 20–64 years from economically active households, whose income quintile remained unchanged or declined by more than one quintile from 2012 to 2013. Logistic regression analysis was performed to determine whether catastrophic health expenditures in 2012 were related to more than one quintile income decline in 2013. Results Households facing catastrophic health expenditures of ≥ 40%, ≥ 30%, and ≥ 10% of a household’s capacity to pay, were 1.58 times (p < 0.003), 1.75 times (p < 0.000), and 1.23 times (p < 0.001) more likely to face a decline in income quintile, respectively. Conclusion Over a 1 year period, the proportion of households facing more than one quintile income decline was 16.4%, while 2.1% to 2.5% of households in Korea faced catastrophic health expenditures. Catastrophic health expenditure experienced in 2012 was significantly associated with income quintile decline 1 year later. Therefore, lowering the proportion of households with catastrophic health expenditure may reduce the proportion of households with income quintiles decline. PMID:29740531

Changes in economic status of households associated with catastrophic health expenditures for cancer in South Korea.

PubMed

Choi, Jae-Woo; Cho, Kyoung-Hee; Choi, Young; Han, Kyu-Tae; Kwon, Jeoung-A; Park, Eun-Cheol

2014-01-01

Cancer imposes significant economic challenges for individuals, families, and society. Households of cancer patients often experience income loss due to change in job status and/or excessive medical expenses. Thus, we examined whether changes in economic status for such households is affected by catastrophic health expenditures. We used the Korea Health Panel Survey (KHPS) Panel 1st-4th (2008- 2011 subjects) data and extracted records from 211 out of 5,332 households in the database for this study. To identify factors associated with catastrophic health expenditures and, in particular, to examine the relationship between change in economic status and catastrophic health expenditures, we conducted a generalized linear model analysis. Among 211 households with cancer patients, 84 (39.8%) experienced catastrophic health expenditures, while 127 (40.2%) did not show evidence of catastrophic medical costs. If a change in economic status results from a change in job status for head of household (job loss), these households are more likely to incur catastrophic health expenditure than households who have not experienced a change in job status (odds ratios (ORs)=2.17, 2.63, respectively). A comparison between households with a newly-diagnosed patient versus households with patients having lived with cancer for one or two years, showed the longer patients had cancer, the more likely their households incurred catastrophic medical costs (OR=1.78, 1.36, respectively). Change in economic status of households in which the cancer patient was the head of household was associated with a greater likelihood that the household would incur catastrophic health costs. It is imperative that the Korean government connect health and labor policies in order to develop economic programs to assist households with cancer patients.

The linear regulator problem for parabolic systems

NASA Technical Reports Server (NTRS)

Banks, H. T.; Kunisch, K.

1983-01-01

An approximation framework is presented for computation (in finite imensional spaces) of Riccati operators that can be guaranteed to converge to the Riccati operator in feedback controls for abstract evolution systems in a Hilbert space. It is shown how these results may be used in the linear optimal regulator problem for a large class of parabolic systems.

Measuring financial protection against catastrophic health expenditures: methodological challenges for global monitoring.

PubMed

Hsu, Justine; Flores, Gabriela; Evans, David; Mills, Anne; Hanson, Kara

2018-05-31

relative country progress. We therefore recommend financial protection against catastrophic health expenditures be measured across a range of thresholds using a catastrophic incidence curve as shown in this paper. We further recommend evaluating financial protection in relation to a country's health financing system arrangements in order to better understand the extent of protection and better inform future policy changes.

Modal interaction in linear dynamic systems near degenerate modes

NASA Technical Reports Server (NTRS)

Afolabi, D.

1991-01-01

In various problems in structural dynamics, the eigenvalues of a linear system depend on a characteristic parameter of the system. Under certain conditions, two eigenvalues of the system approach each other as the characteristic parameter is varied, leading to modal interaction. In a system with conservative coupling, the two eigenvalues eventually repel each other, leading to the curve veering effect. In a system with nonconservative coupling, the eigenvalues continue to attract each other, eventually colliding, leading to eigenvalue degeneracy. Modal interaction is studied in linear systems with conservative and nonconservative coupling using singularity theory, sometimes known as catastrophe theory. The main result is this: eigenvalue degeneracy is a cause of instability; in systems with conservative coupling, it induces only geometric instability, whereas in systems with nonconservative coupling, eigenvalue degeneracy induces both geometric and elastic instability. Illustrative examples of mechanical systems are given.

Lifetime medical expenditures among hypertensive men and women in the United States.

PubMed

Basu, Rituparna; Krueger, Patrick M; Lairson, David R; Franzini, Luisa

2011-01-01

Our objective was to estimate lifetime medical expenditures that can be attributed to hypertension, by gender, in the United States, given important gender differences in both survival and medical expenditures. We estimated lifetime medical expenditures among hypertensive and nonhypertensive men and women aged 20 and older. Expenditures were estimated from the 2001 to 2004 Medical Expenditure Panel Survey and life expectancies were estimated from the 1986 to 2002 National Health Interview Survey Linked Mortality Files. Assuming that medical technology, the cost of health care services, the incidence of disease, and survival were fixed, the cross-sectional age-specific expenditures and the survival profiles were used to estimate the lifetime expenditures from ages 20 to older than 85. The estimated lifetime expenditure for an average life table individual at age 20 was $188,300 for hypertensive men and $254,910 for hypertensive women; however, a greater share of lifetime expenditures can be attributed to hypertension among men ($88,033) than among women ($40,960). Although hypertensive women had greater lifetime expenditures than hypertensive men, hypertension was associated with a greater increase in lifetime expenditures for men than for women. Gender differences in both survival and health care utilization have important implications for gender differences in lifetime medical expenditures. Copyright © 2011 Jacobs Institute of Women's Health. All rights reserved.

26 CFR 1.616-1 - Development expenditures.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 7 2011-04-01 2009-04-01 true Development expenditures. 1.616-1 Section 1.616-1...) INCOME TAXES (CONTINUED) Natural Resources § 1.616-1 Development expenditures. (a) General rule. Section... taxpayer for the development of a mine or other natural deposit (other than an oil or gas well...

26 CFR 1.616-1 - Development expenditures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 7 2010-04-01 2010-04-01 true Development expenditures. 1.616-1 Section 1.616-1...) INCOME TAXES (CONTINUED) Natural Resources § 1.616-1 Development expenditures. (a) General rule. Section... taxpayer for the development of a mine or other natural deposit (other than an oil or gas well...

Energy expenditure during tennis play: a preliminary video analysis and metabolic model approach.

PubMed

Botton, Florent; Hautier, Christophe; Eclache, Jean-Paul

2011-11-01

The aim of this study was to estimate, using video analysis, what proportion of the total energy expenditure during a tennis match is accounted for by aerobic and anaerobic metabolism, respectively. The method proposed involved estimating the metabolic power (MP) of 5 activities, which are inherent to tennis: walking, running, hitting the ball, serving, and sitting down to rest. The energy expenditure concerned was calculated by sequencing the activity by video analysis. A bioenergetic model calculated the aerobic energy expenditure (EEO2mod) in terms of MP, and the anaerobic energy expenditure was calculated by subtracting this (MP - EEO2mod). Eight tennis players took part in the experiment as subjects (mean ± SD: age 25.2 ± 1.9 years, weight 79.3 ± 10.8 kg, VO2max 54.4 ± 5.1 ml·kg(-1)·min(-1)). The players started off by participating in 2 games while wearing the K4b2, with their activity profile measured by the video analysis system, and then by playing a set without equipment but with video analysis. There was no significant difference between calculated and measured oxygen consumptions over the 16 games (p = 0.763), and these data were strongly related (r = 0.93, p < 0.0001). The EEO2mod was quite weak over all the games (49.4 ± 4.8% VO2max), whereas the MP during points was up to 2 or 3 times the VO2max. Anaerobic metabolism reached 32% of the total energy expenditure across all the games 67% for points and 95% for hitting the ball. This method provided a good estimation of aerobic energy expenditure and made it possible to calculate the anaerobic energy expenditure. This could make it possible to estimate the metabolic intensity of training sessions and matches using video analysis.

Per Pupil Expenditures and School District Accreditation: What Does the Total Per Pupil Expenditure Indicator in the 1993 Mississippi Report Card Really Mean?

ERIC Educational Resources Information Center

Mathews, Jerry G.; Johnson, Gary P.

The 1993 Mississippi Report Card was the result of legislative and accountability processes. The state's Education Reform Act of 1982 created a mandate to establish a performance-based school-accreditation system. This paper presents findings of a study that disaggregated and analyzed the total per-pupil expenditure indicators in the 1993…

40 CFR 1066.220 - Linearity verification for chassis dynamometer systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... dynamometer speed and torque at least as frequently as indicated in Table 1 of § 1066.215. The intent of... linear regression and the linearity criteria specified in Table 1 of this section. (b) Performance requirements. If a measurement system does not meet the applicable linearity criteria in Table 1 of this...

Towards Stability Analysis of Jump Linear Systems with State-Dependent and Stochastic Switching

NASA Technical Reports Server (NTRS)

Tejada, Arturo; Gonzalez, Oscar R.; Gray, W. Steven

2004-01-01

This paper analyzes the stability of hierarchical jump linear systems where the supervisor is driven by a Markovian stochastic process and by the values of the supervised jump linear system s states. The stability framework for this class of systems is developed over infinite and finite time horizons. The framework is then used to derive sufficient stability conditions for a specific class of hybrid jump linear systems with performance supervision. New sufficient stochastic stability conditions for discrete-time jump linear systems are also presented.

Catastrophic expenditure on medicines in Brazil.

PubMed

Luiza, Vera Lucia; Tavares, Noemia Urruth Leão; Oliveira, Maria Auxiliadora; Arrais, Paulo Sergio Dourado; Ramos, Luiz Roberto; Pizzol, Tatiane da Silva Dal; Mengue, Sotero Serrate; Farias, Mareni Rocha; Bertoldi, Andréa Dâmaso

2016-12-01

To describe the magnitude of the expenditure on medicines in Brazil according to region, household size and composition in terms of residents in a situation of dependency. Population-based data from the national household survey were used, with probabilistic sample, applied between September 2013 and February 2014 in urban households. The expenditure on medicines was the main outcome of interest. The prevalence and confidence intervals (95%CI) of the outcomes were stratified according to socioeconomic classification and calculated according to the region, the number of residents dependent on income, the presence of children under five years and residents in a situation of dependency by age. In about one of every 17 households (5.3%) catastrophic health expenditure was reported and, in 3.2%, the medicines were reported as one of the items responsible for this situation. The presence of three or more residents (3.6%) and resident in a situation of dependency (3.6%) were the ones that most reported expenditure on medicines. Southeast was the region with the lowest prevalence of expenditure on medicines. The prevalence of households with catastrophic health expenditure and on medicines in relation to the total of households showed a regressive tendency for economic classes. Catastrophic health expenditure was present in 5.3%, and catastrophic expenditure on medicines in 3.2% of the households. Multi-person households, presence of residents in a situation of economic dependency and belonging to the class D or E had the highest proportion of catastrophic expenditure on medicines. Although the problem is important, permeated by aspects of iniquity, Brazilian policies seem to be protecting families from catastrophic expenditure on health and on medicine. Descrever a magnitude do gasto catastrófico em medicamentos no Brasil segundo região, tamanho das famílias e composição familiar em termos de moradores em situação de dependência. Utilizados dados de inqu

Out-of-pocket healthcare expenditures of older Americans with depression.

PubMed

Harman, Jeffrey S; Kelleher, Kelly J; Reynolds, Charles F; Pincus, Harold Alan

2004-05-01

The objective of this study was to estimate mean annual out-of-pocket (OOP) healthcare expenditures of Americans aged 65 and older with self-reported depression and compare these expenditures with the OOP expenditures of older Americans with hypertension, heart disease, diabetes mellitus, and arthritis. Data from the 1999 Medical Expenditure Panel Survey, which employs a nationally representative stratified random sample of households in the United States, were used to estimate mean OOP expenditures for health care during 1999. The data were limited to observations on individuals aged 65 and older living in households in the United States included in the 1999 Medical Expenditure Panel Survey sample (N=2,730). Mean OOP expenditures for older Americans with depression were $1,835 in 1999. Most of the spending ($1,090) was for prescription drugs in this population. For patients with depression, only 8% of total OOP spending was for depression-specific services and treatments. Mean OOP spending was greater for persons with depression than it was for older Americans with hypertension ($1,181) and arthritis ($1,190), whereas OOP spending for depression was similar to spending of older Americans with heart disease ($1,412) and diabetes mellitus ($1,527). Older Americans with depression have high OOP expenditures, with most of this spending for health services and drugs to treat general medical conditions.

36 CFR 262.4 - Audit of expenditures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Audit of expenditures. 262.4 Section 262.4 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE LAW ENFORCEMENT SUPPORT ACTIVITIES Rewards and Payments § 262.4 Audit of expenditures. The Chief of the Forest Service shall, through appropriate directives...

24 CFR 982.157 - Budget and expenditure.

Code of Federal Regulations, 2010 CFR

2010-04-01

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

Feedback linearization of singularly perturbed systems based on canonical similarity transformations

NASA Astrophysics Data System (ADS)

Kabanov, A. A.

2018-05-01

This paper discusses the problem of feedback linearization of a singularly perturbed system in a state-dependent coefficient form. The result is based on the introduction of a canonical similarity transformation. The transformation matrix is constructed from separate blocks for fast and slow part of an original singularly perturbed system. The transformed singular perturbed system has a linear canonical form that significantly simplifies a control design problem. Proposed similarity transformation allows accomplishing linearization of the system without considering the virtual output (as it is needed for normal form method), a technique of a transition from phase coordinates of the transformed system to state variables of the original system is simpler. The application of the proposed approach is illustrated through example.

Preprocessing Inconsistent Linear System for a Meaningful Least Squares Solution

NASA Technical Reports Server (NTRS)

Sen, Syamal K.; Shaykhian, Gholam Ali

2011-01-01

Mathematical models of many physical/statistical problems are systems of linear equations. Due to measurement and possible human errors/mistakes in modeling/data, as well as due to certain assumptions to reduce complexity, inconsistency (contradiction) is injected into the model, viz. the linear system. While any inconsistent system irrespective of the degree of inconsistency has always a least-squares solution, one needs to check whether an equation is too much inconsistent or, equivalently too much contradictory. Such an equation will affect/distort the least-squares solution to such an extent that renders it unacceptable/unfit to be used in a real-world application. We propose an algorithm which (i) prunes numerically redundant linear equations from the system as these do not add any new information to the model, (ii) detects contradictory linear equations along with their degree of contradiction (inconsistency index), (iii) removes those equations presumed to be too contradictory, and then (iv) obtain the minimum norm least-squares solution of the acceptably inconsistent reduced linear system. The algorithm presented in Matlab reduces the computational and storage complexities and also improves the accuracy of the solution. It also provides the necessary warning about the existence of too much contradiction in the model. In addition, we suggest a thorough relook into the mathematical modeling to determine the reason why unacceptable contradiction has occurred thus prompting us to make necessary corrections/modifications to the models - both mathematical and, if necessary, physical.

Time-delay control of a magnetic levitated linear positioning system

NASA Technical Reports Server (NTRS)

Tarn, J. H.; Juang, K. Y.; Lin, C. E.

1994-01-01

In this paper, a high accuracy linear positioning system with a linear force actuator and magnetic levitation is proposed. By locating a permanently magnetized rod inside a current-carrying solenoid, the axial force is achieved by the boundary effect of magnet poles and utilized to power the linear motion, while the force for levitation is governed by Ampere's Law supplied with the same solenoid. With the levitation in a radial direction, there is hardly any friction between the rod and the solenoid. The high speed motion can hence be achieved. Besides, the axial force acting on the rod is a smooth function of rod position, so the system can provide nanometer resolution linear positioning to the molecule size. Since the force-position relation is highly nonlinear, and the mathematical model is derived according to some assumptions, such as the equivalent solenoid of the permanently magnetized rod, so there exists unknown dynamics in practical application. Thus 'robustness' is an important issue in controller design. Meanwhile the load effect reacts directly on the servo system without transmission elements, so the capability of 'disturbance rejection; is also required. With the above consideration, a time-delay control scheme is chosen and applied. By comparing the input-output relation and the mathematical model, the time-delay controller calculates an estimation of unmodeled dynamics and disturbances and then composes the desired compensation into the system. Effectiveness of the linear positioning system and control scheme are illustrated with simulation results.

Circadian rhythm of energy expenditure and oxygen consumption.

PubMed

Leuck, Marlene; Levandovski, Rosa; Harb, Ana; Quiles, Caroline; Hidalgo, Maria Paz

2014-02-01

This study aimed to evaluate the effect of continuous and intermittent methods of enteral nutrition (EN) administration on circadian rhythm. Thirty-four individuals, aged between 52 and 80 years, were fed through a nasoenteric tube. Fifteen individuals received a continuous infusion for 24 hours/d, and 19 received an intermittent infusion in comparable quantities, every 4 hours from 8:00 to 20:00. In each patient, 4 indirect calorimetric measurements were carried out over 24 hours (A: 7:30, B: 10:30, C: 14:30, and D: 21:30) for 3 days. Energy expenditure and oxygen consumption were significantly higher in the intermittent group than in the continuous group (1782 ± 862 vs 1478 ± 817 kcal/24 hours, P = .05; 257 125 vs 212 117 ml/min, P = .048, respectively). The intermittent group had higher levels of energy expenditure and oxygen consumption at all the measured time points compared with the continuous group. energy expenditure and oxygen consumption in both groups were significantly different throughout the day for 3 days. There is circadian rhythm variation of energy expenditure and oxygen consumption with continuous and intermittent infusion for EN. This suggests that only one indirect daily calorimetric measurement is not able to show the patient's true needs. Energy expenditure is higher at night with both food administration methods. Moreover, energy expenditure and oxygen consumption are higher with the intermittent administration method at all times.

Catastrophic household expenditure on health in Nepal: a cross-sectional survey.

PubMed

Saito, Eiko; Gilmour, Stuart; Rahman, Md Mizanur; Gautam, Ghan Shyam; Shrestha, Pradeep Krishna; Shibuya, Kenji

2014-10-01

To determine the incidence of - and illnesses commonly associated with - catastrophic household expenditure on health in Nepal. We did a cross-sectional population-based survey in five municipalities of Kathmandu Valley between November 2011 and January 2012. For each household surveyed, out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household's total expenditure over the same period was considered to be catastrophic. We estimated the incidence and intensity of catastrophic health expenditure. We identified the illnesses most commonly associated with such expenditure using a Poisson regression model and assessed the distribution of expenditure by economic quintile of households using the concentration index. Overall, 284 of the 1997 households studied in Kathmandu, i.e. 13.8% after adjustment by sampling weight, reported catastrophic health expenditure in the 30 days before the survey. After adjusting for confounders, this expenditure was found to be associated with injuries, particularly those resulting from road traffic accidents. Catastrophic expenditure by households in the poorest quintile were associated with at least one episode of diabetes, asthma or heart disease. In an urban area of Nepal, catastrophic household expenditure on health was mostly associated with injuries and noncommunicable diseases such as diabetes and asthma. Throughout Nepal, interventions for the control and management of noncommunicable diseases and the prevention of road traffic accidents should be promoted. A phased introduction of health insurance should also reduce the incidence of catastrophic household expenditure.

[Fair health financing and catastrophic health expenditures: potential impact of the coverage extension of the popular health insurance in Mexico].

PubMed

Knaul, Felicia; Arreola-Ornelas, Héctor; Méndez, Oscar; Martínez, Alejandra

2005-01-01

To assess the impact on fair health financing and household catastrophic health expenditures of the implementation of the Popular Health Insurance (Seguro Popular de Salud). Data analyzed in this study come from the National Income and Expenditure Household Survey (Encuesta Nacional de Ingresos y Gastos de los Hogares, ENIGH), 2000, and the National Health Insurance and Expenditure Survey, (Encuesta Nacional de Aseguramiento y Gasto en Salud, ENAGS), 2001. Estimations are based on projections of extension of the Popular Health Insurance under different conditions of coverage and out-of-pocket expenditure reductions in the uninsured population. The mathematic simulation model assumes applying the new Popular Health Insurance financial structure to the 2000 expenditure values reported by ENIGH, given the probability of affiliation by households. The model of determinants of affiliation to the Popular Health Insurance yielded three significant variables: being in income quintiles I and II, being a female head of household, and that a household member had a medical visit in the past year. Simulation results show that important impacts on the performance of the Mexican Health System will occur in terms of fair financing and catastrophic expenditures, even before achieving the universal coverage goal in 2010. A reduction of 40% in out-of-pocket expenditures and a Popular Health Insurance coverage of 100% will decrease catastrophic health expenditures from 3.4% to 1.6%. Our results show that the reduction of out-of-pocket expenditures generated by the new financing and health provision Popular Health Insurance model, will improve the financial fairness index and the financial contribution to the health system, and will decrease the percentage of households with catastrophic expenditures, even before reaching universal coverage. A greater impact may be expected due to coverage extension initiating in the poorest communities that have a very restricted and progressive

10 CFR 603.310 - Use of an expenditure-based TIA.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Use of an expenditure-based TIA. 603.310 Section 603.310 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS TECHNOLOGY INVESTMENT AGREEMENTS... expenditure-based TIA. In general, the contracting officer must use an expenditure-based TIA under conditions...

Postprandial energy expenditure in whole-food and processed-food meals: implications for daily energy expenditure.

PubMed

Barr, Sadie B; Wright, Jonathan C

2010-07-02

Empirical evidence has shown that rising obesity rates closely parallel the increased consumption of processed foods (PF) consumption in USA. Differences in postprandial thermogenic responses to a whole-food (WF) meal vs. a PF meal may be a key factor in explaining obesity trends, but currently there is limited research exploring this potential link. The goal was to determine if a particular PF meal has a greater thermodynamic efficiency than a comparable WF meal, thereby conferring a greater net-energy intake. Subjective satiation scores and postprandial energy expenditure were measured for 5-6 h after isoenergetic meals were ingested. The meals were either 'whole' or 'processed' cheese sandwiches; multi-grain bread and cheddar cheese were deemed whole, while white bread and processed cheese product were considered processed. Meals were comparable in terms of protein (15-20%), carbohydrate (40-50%), and fat (33-39%) composition. Subjects were healthy women (n=12) and men (n=5) studied in a crossover design. There were no significant differences in satiety ratings after the two meals. Average energy expenditure for the WF meal (137+/-14.1 kcal, 19.9% of meal energy) was significantly larger than for the PF meal (73.1+/-10.2 kcal, 10.7% of meal energy). Ingestion of the particular PF meal tested in this study decreases postprandial energy expenditure by nearly 50% compared with the isoenergetic WF meal. This reduction in daily energy expenditure has potential implications for diets comprised heavily of PFs and their associations with obesity.

Energy expenditure in caving

PubMed Central

Antoni, Giorgia; Marini, Elisabetta; Curreli, Nicoletta; Tuveri, Valerio; Comandini, Ornella; Cabras, Stefano; Gabba, Silvia; Madeddu, Clelia; Crisafulli, Antonio

2017-01-01

The aim of this study was to determine the energy expenditure of a group of cavers of both genders and different ages and experience during a 10 hour subterranean exploration, using portable metabolimeters. The impact of caving activity on body composition and hydration were also assessed through bioelectrical impedance, and nutritional habits of cavers surveyed. During cave activity, measured total energy expenditure (TEE) was in the range 225–287 kcal/h for women-men (MET = 4.1), respectively; subjects had an energy intake from food in the range 1000–1200 kcal, thus inadequate to restore lost calories. Bayesian statistical analysis estimated the effect of predictive variables on TEE, revealing that experienced subjects had a 5% lower TEE than the less skilled ones and that women required a comparatively larger energy expenditure than men to perform the same task. BIVA (bioelectrical impedance vector analysis) showed that subjects were within the range of normal hydration before and after cave activity, but bioelectrical changes indicated a reduction of extracellular water in men, which might result in hypo-osmolal dehydration in the case of prolonged underground exercise. All these facts should be considered when planning cave explorations, preparing training programs for subjects practising caving, and optimizing a diet for cavers. Further, information gathered through this study could be of value to reduce accidents in caves related to increase in fatigue. PMID:28158208

Energy expenditure in caving.

PubMed

Antoni, Giorgia; Marini, Elisabetta; Curreli, Nicoletta; Tuveri, Valerio; Comandini, Ornella; Cabras, Stefano; Gabba, Silvia; Madeddu, Clelia; Crisafulli, Antonio; Rinaldi, Andrea C

2017-01-01

The aim of this study was to determine the energy expenditure of a group of cavers of both genders and different ages and experience during a 10 hour subterranean exploration, using portable metabolimeters. The impact of caving activity on body composition and hydration were also assessed through bioelectrical impedance, and nutritional habits of cavers surveyed. During cave activity, measured total energy expenditure (TEE) was in the range 225-287 kcal/h for women-men (MET = 4.1), respectively; subjects had an energy intake from food in the range 1000-1200 kcal, thus inadequate to restore lost calories. Bayesian statistical analysis estimated the effect of predictive variables on TEE, revealing that experienced subjects had a 5% lower TEE than the less skilled ones and that women required a comparatively larger energy expenditure than men to perform the same task. BIVA (bioelectrical impedance vector analysis) showed that subjects were within the range of normal hydration before and after cave activity, but bioelectrical changes indicated a reduction of extracellular water in men, which might result in hypo-osmolal dehydration in the case of prolonged underground exercise. All these facts should be considered when planning cave explorations, preparing training programs for subjects practising caving, and optimizing a diet for cavers. Further, information gathered through this study could be of value to reduce accidents in caves related to increase in fatigue.

Validating self-reported food expenditures against food store and eating-out receipts.

PubMed

Tang, W; Aggarwal, A; Liu, Z; Acheson, M; Rehm, C D; Moudon, A V; Drewnowski, A

2016-03-01

To compare objective food store and eating-out receipts with self-reported household food expenditures. The Seattle Obesity Study II was based on a representative sample of King County adults, Washington, USA. Self-reported household food expenditures were modeled on the Flexible Consumer Behavior Survey (FCBS) Module from 2007 to 2009 National Health and Nutrition Examination Survey (NHANES). Objective food expenditure data were collected using receipts. Self-reported food expenditures for 447 participants were compared with receipts using paired t-tests, Bland-Altman plots and κ-statistics. Bias by sociodemographics was also examined. Self-reported expenditures closely matched with objective receipt data. Paired t-tests showed no significant differences between receipts and self-reported data on total food expenditures, expenditures at food stores or eating out. However, the highest-income strata showed weaker agreement. Bland-Altman plots confirmed no significant bias across both methods-mean difference: 6.4; agreement limits: -123.5 to 143.4 for total food expenditures, mean difference 5.7 for food stores and mean difference 1.7 for eating out. The κ-statistics showed good agreement for each (κ 0.51, 0.41 and 0.49 respectively. Households with higher education and income had significantly more number of receipts and higher food expenditures. Self-reported food expenditures using NHANES questions, both for food stores and eating out, serve as a decent proxy for objective household food expenditures from receipts. This method should be used with caution among high-income populations, or with high food expenditures. This is the first validation of the FCBS food expenditures question using food store and eating-out receipts.

Validating self-reported food expenditures against food store and eating-out receipts

PubMed Central

Tang, Wesley; Aggarwal, Anju; Liu, Zhongyuan; Acheson, Molly; Rehm, Colin D; Moudon, Anne Vernez; Drewnowski, Adam

2015-01-01

Objectives To compare objective food store and eating-out receipts with self-reported household food expenditures. Design and setting The Seattle Obesity Study (SOS II) was based on a representative sample of King County adults, Washington, USA. Self-reported household food expenditures were modeled on the Flexible Consumer Behavior Survey (FCBS) Module from 2007–2009 National Health and Nutrition Examination Survey (NHANES). Objective food expenditure data were collected using receipts. Self-reported food expenditures for 447 participants were compared to receipts using paired t-tests, Bland-Altman plots, and kappa statistics. Bias by socio-demographics was also examined. Results Self-reported expenditures closely matched with objective receipt data. Paired t-tests showed no significant differences between receipts and self-reported data on total food expenditures, expenditures at food stores, or eating out. However, the highest income strata showed weaker agreement. Bland Altman plots confirmed no significant bias across both methods - mean difference: 6.4; agreement limits: −123.5, 143.4 for total food expenditures, mean difference 5.7 for food stores, and mean difference 1.7 for eating-out. Kappa statistics showed good agreement for each (kappa 0.51, 0.41 and 0.49 respectively. Households with higher education and income had significantly more number of receipts and higher food expenditures. Conclusion Self-reported food expenditures using NHANES questions, both for food stores and eating-out, serve as a decent proxy for objective household food expenditures from receipts. This method should be used with caution among high income populations, or with high food expenditures. This is the first validation of the FCBS food expenditures question using food store and eating-out receipts. PMID:26486299

Variations in the persistence of health expenditures and the implications for the design of capitation payments in Taiwan.

PubMed

Ku, Li-Jung Elizabeth; Chiou, Meng-Jiun; Liu, Li-Fan

2015-07-01

The National Health Insurance (NHI) system in Taiwan launched a trial capitation provider payment programme in 2011, with the capitation formula based on patients' average NHI expenditure in the previous year. This study seeks to examine the concentration and persistence of health care expenditure among the elderly, and to assess the performance of the current capitation formula in predicting future high-cost users. This study analysed NHI expenditures for a nationally representative sample of people aged 65 years and over who took part in Taiwan's National Health Interview Survey, 2005. Expenditure concentration was assessed by the proportion of NHI expenditures attributable to four groups by expenditure percentile. Four transition probability matrixes examined changes in a person's position in the expenditure percentiles and generalized estimation equation models were estimated to identify significant predictors of a patient being in the top 10% of users. Between 2005 and 2009, the top 10% of users on average accounted for 55% of total NHI expenditures. Of the top 10% in 2005, 39% retained this position in 2006. However, expenditure persistence was the highest (77%) among the bottom 50% of users. NHI expenditure percentiles in both the baseline year and the prior year, and chronic conditions all significantly predicted future high expenditures. The model including chronic conditions performed better in predicting the top 10% of users (c-statistics increased from 0.772 to 0.904) than the model without. Given the increase in predictive ability, adding chronic conditions and baseline health care use data to Taiwan's capitation payment formula would correctly identify more high users. © The Author(s) 2015.

36 CFR 223.282 - Deposit and expenditure of collected fees.