The Use of Economic Evidence to Inform Drug Pricing Decisions in Jordan.

PubMed

Hammad, Eman A

2016-01-01

Drug pricing is an example of a priority setting in a developing country with official requirements for the use of cost-effectiveness (CE) evidence. To describe the role of economic evidence in drug pricing decisions in Jordan. A prospective review of all applications submitted between November 2013 and May 2015 to the Jordan Food and Drug Association's drug pricing committee was carried out. All applications that involved requests for CE evidence were reviewed. Details on the type of study, the extent, and whether the evidence submitted was part of the formal deliberations were extracted and summarized. The committee reviewed a total of 1608 drug pricing applications over the period of the study. CE evidence was requested in only 11 applications. The submitted evidence was of limited use to the committee due to concerns about quality, relevance of studies, and lack of pharmacoeconomic expertise. There were also no clear rules describing how CE would inform pricing decisions. Limited local data and health economic experience were the main barriers to the use of economic evidence in drug pricing decisions in Jordan. In addition, there are no official rules describing the elements and process by which the CE evidence would inform drug pricing decisions. This study summarized accumulated observations for the current use of economic evaluations and evidence-based decision making in Jordan. Recommendations have been proposed to applicants and key decision makers to enhance the role of economic evidence in influencing health policies and evidence-based decision making across priority settings. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

What should be done about policy on alcohol pricing and promotions? Australian experts' views of policy priorities: a qualitative interview study.

PubMed

Fogarty, Andrea S; Chapman, Simon

2013-06-25

Alcohol policy priorities in Australia have been set by the National Preventative Health Task Force, yet significant reform has not occurred. News media coverage of these priorities has not reported public health experts as in agreement and Government has not acted upon the legislative recommendations made. We investigate policy experts' views on alcohol policy priorities with a view to establishing levels of accord and providing suggestions for future advocates. We conducted semi-structured in depth interviews with alcohol policy experts and advocates around Australia. Open-ended questions examined participants' thoughts on existing policy recommendations, obvious policy priorities and specifically, the future of national reforms to price and promotions policies. All transcripts were analysed for major themes and points of agreement or disagreement. Twenty one alcohol policy experts agreed that pricing policies are a top national priority and most agreed that "something should be done" about alcohol advertising. Volumetric taxation and minimum pricing were regarded as the most important price policies, yet differences emerged in defining the exact form of a proposed volumetric tax. Important differences in perspective emerged regarding alcohol promotions, with lack of agreement about the preferred form regulations should take, where to start and who the policy should be directed at. Very few discussed online advertising and social networks. Despite existing policy collaborations, a clear 'cut through' message is yet to be endorsed by all alcohol control advocates. There is a need to articulate and promote in greater detail the specifics of policy reforms to minimum pricing, volumetric taxation and restrictions on alcohol advertising, particularly regarding sporting sponsorships and new media.

What should be done about policy on alcohol pricing and promotions? Australian experts’ views of policy priorities: a qualitative interview study

PubMed Central

2013-01-01

Background Alcohol policy priorities in Australia have been set by the National Preventative Health Task Force, yet significant reform has not occurred. News media coverage of these priorities has not reported public health experts as in agreement and Government has not acted upon the legislative recommendations made. We investigate policy experts’ views on alcohol policy priorities with a view to establishing levels of accord and providing suggestions for future advocates. Methods We conducted semi-structured in depth interviews with alcohol policy experts and advocates around Australia. Open-ended questions examined participants’ thoughts on existing policy recommendations, obvious policy priorities and specifically, the future of national reforms to price and promotions policies. All transcripts were analysed for major themes and points of agreement or disagreement. Results Twenty one alcohol policy experts agreed that pricing policies are a top national priority and most agreed that “something should be done” about alcohol advertising. Volumetric taxation and minimum pricing were regarded as the most important price policies, yet differences emerged in defining the exact form of a proposed volumetric tax. Important differences in perspective emerged regarding alcohol promotions, with lack of agreement about the preferred form regulations should take, where to start and who the policy should be directed at. Very few discussed online advertising and social networks. Conclusions Despite existing policy collaborations, a clear ‘cut through’ message is yet to be endorsed by all alcohol control advocates. There is a need to articulate and promote in greater detail the specifics of policy reforms to minimum pricing, volumetric taxation and restrictions on alcohol advertising, particularly regarding sporting sponsorships and new media. PMID:23800324

How Can Pricing and Reimbursement Policies Improve Affordable Access to Medicines? Lessons Learned from European Countries.

PubMed

Vogler, Sabine; Paris, Valérie; Ferrario, Alessandra; Wirtz, Veronika J; de Joncheere, Kees; Schneider, Peter; Pedersen, Hanne Bak; Dedet, Guillaume; Babar, Zaheer-Ud-Din

2017-06-01

This article discusses pharmaceutical pricing and reimbursement policies in European countries with regard to their ability to ensure affordable access to medicines. A frequently applied pricing policy is external price referencing. While it provides some benchmark for policy-makers and has been shown to be able to generate savings, it may also contribute to delay in product launch in countries where medicine prices are low. Value-based pricing has been proposed as a policy that promotes access while rewarding useful innovation; however, implementing it has proven quite challenging. For high-priced medicines, managed-entry agreements are increasingly used. These agreements allow policy-makers to manage uncertainty and obtain lower prices. They can also facilitate earlier market access in case of limited evidence about added therapeutic value of the medicine. However, these agreements raise transparency concerns due to the confidentiality clause. Tendering as used in the hospital and offpatent outpatient sectors has been proven to reduce medicine prices but it requires a robust framework and appropriate design with clear strategic goals in order to prevent shortages. These pricing and reimbursement policies are supplemented by the widespread use of Health Technology Assessment to inform decision-making, and by strategies to improve the uptake of generics, and also biosimilars. While European countries have been implementing a set of policy options, there is a lack of thorough impact assessments of several pricing and reimbursement policies on affordable access. Increased cooperation between authorities, experience sharing and improving transparency on price information, including the disclosure of confidential discounts, are opportunities to address current challenges.

Method and apparatus for granting processors access to a resource

DOEpatents

Blumrich, Matthias A.; Salapura, Valentina

2010-03-16

An apparatus and method for granting one or more requesting entities access to a resource in a predetermined time interval. The apparatus includes a first circuit receiving one or more request signals, and implementing logic for assigning a priority to the one or more request signals, and, generating a set of first_request signals based on the priorities assigned. One or more priority select circuits for receiving the set of first_request signals and generating corresponding one or more fixed grant signals representing one or more highest priority request signals when asserted during the predetermined time interval. A second circuit device receives the one or more fixed grant signals generates one or more grant signals associated with one or more highest priority request signals assigned, the grant signals for enabling one or more respective requesting entities access to the resource in the predetermined time interval, wherein the priority assigned to the one or more request signals changes each successive predetermined time interval. In one embodiment, the assigned priority is based on a numerical pattern, the first circuit changing the numerical pattern with respect to the first_request signals generated at each successive predetermined time interval.

Human papillomavirus vaccine policy and delivery in Latin America and the Caribbean.

PubMed

Andrus, Jon Kim; Lewis, Merle J; Goldie, Sue J; García, Patricia J; Winkler, Jennifer L; Ruiz-Matus, Cuauhtémoc; de Quadros, Ciro A

2008-08-19

Cervical cancer caused by human papillomavirus (HPV) is a major preventable public health problem. Two vaccines are now available for primary prevention of HPV infection and their introduction offers new opportunities to enhance comprehensive cervical cancer prevention and control. Currently, HPV vaccine price is a significant barrier to rapid vaccine introduction and access. Therefore, making evidence-based decisions about whether and how to introduce HPV vaccine into the immunization schedule in the countries of Latin America and the Caribbean (LAC) requires a rigorous analysis of several factors. These include: estimates of disease burden, cost-effectiveness, operational feasibility of reaching a population of adolescent females and other key analyses that have been used in recent years to support the introduction of other vaccines, such as rotavirus and pneumococcal conjugate vaccines. Given the large number of public health priorities that are competing for limited public resources, developing and using a sound evidence base is of particular importance for vaccines, like HPV, which are currently available only at prices higher than other vaccines now in use. HPV vaccination provides the opportunity to dramatically improve women's health and partnerships must also be broad-based and effectively coordinated. This can be achieved by developing programs based on the lessons learned from vaccination strategies used to eliminate rubella and neonatal tetanus and for scaling up influenza vaccination in countries of LAC.

The ethics and economics of pharmaceutical pricing.

PubMed

Parker-Lue, Sara; Santoro, Michael; Koski, Greg

2015-01-01

The cost of drugs is a major and rapidly rising component of health-care expenditures. We survey recent literature on the ethics and economics of skyrocketing pharmaceutical prices and find that advances in economic research have increased the sharpness and focus of the ethically based calls to increase access by modifying patent protection and reducing prices. In some cases, research supports ethical arguments for broader access. Other research suggests that efforts to broaden access result in unintended consequences for innovation and the medical needs of patients. Both ethicists and economists need to be more cognizant of the real clinical settings in which physicians practice medicine with real patients. Greater cross-disciplinary interaction among economists, ethicists, and physicians can help reduce the disjunction between innovation and access and improve access and patient care. This dialogue will impact private industry and may spur new multistakeholder paradigms for drug discovery, development, and pricing.

Stakeholders’ perspectives on access-to-medicines policy and research priorities in Latin America and the Caribbean: face-to-face and web-based interviews

PubMed Central

2014-01-01

Background This study aims to rank policy concerns and policy-related research issues in order to identify policy and research gaps on access to medicines (ATM) in low- and middle-income countries in Latin America and the Caribbean (LAC), as perceived by policy makers, researchers, NGO and international organization representatives, as part of a global prioritization exercise. Methods Data collection, conducted between January and May 2011, involved face-to-face interviews in El Salvador, Colombia, Dominican Republic, and Suriname, and an e-mail survey with key-stakeholders. Respondents were asked to choose the five most relevant criteria for research prioritization and to score policy/research items according to the degree to which they represented current policies, desired policies, current research topics, and/or desired research topics. Mean scores and summary rankings were obtained. Linear regressions were performed to contrast rankings concerning current and desired policies (policy gaps), and current and desired research (research gaps). Results Relevance, feasibility, and research utilization were the top ranked criteria for prioritizing research. Technical capacity, research and development for new drugs, and responsiveness, were the main policy gaps. Quality assurance, staff technical capacity, price regulation, out-of-pocket payments, and cost containment policies, were the main research gaps. There was high level of coherence between current and desired policies: coefficients of determination (R2) varied from 0.46 (Health system structure; r = 0.68, P <0.01) to 0.86 (Sustainable financing; r = 0.93, P <0.01). There was also high coherence between current and desired research on Rational selection and use of medicines (r = 0.71, P <0.05, R2 = 0.51), Pricing/affordability (r = 0.82, P <0.01, R2 = 0.67), and Sustainable financing (r = 0.76, P <0.01, R2 = 0.58). Coherence was less for Health system structure (r = 0.61, P <0.01, R2 = 0.38). Conclusions This study combines metrics approaches, contributing to priority setting methodology development, with country and regional level stakeholder participation. Stakeholders received feedback with the results, and we hope to have contributed to the discussion and implementation of ATM research and policy priorities in LAC. PMID:24965383

Drug pricing and reimbursement information management: processes and decision making in the global economy.

PubMed

Tsourougiannis, Dimitrios

2017-01-01

Background : Cost-containment initiatives are re-shaping the pharmaceutical business environment and affecting market access as well as pricing and reimbursement decisions. Effective price management procedures are too complex to accomplish manually. Prior to February 2013, price management within Astellas Pharma Europe Ltd was done manually using an Excel database. The system was labour intensive, slow to update, and prone to error. An innovative web-based pricing information management system was developed to address the shortcomings of the previous system. Development : A secure web-based system for submitting, reviewing and approving pricing requests was designed to: track all pricing applications and approval status; update approved pricing information automatically; provide fixed and customizable reports of pricing information; collect pricing and reimbursement rules from each country; validate pricing and reimbursement rules monthly. Several sequential phases of development emphasized planning, time schedules, target dates, budgets and implementation of the entire system. A test system was used to pilot the electronic (e)-pricing system with three affiliates (four users) in February 2013. Outcomes : The web-based system was introduced in March 2013, currently has about 227 active users globally and comprises more than 1000 presentations of 150 products. The overall benefits of switching from a manual to an e-pricing system were immediate and highly visible in terms of efficiency, transparency, reliability and compliance. Conclusions : The e-pricing system has improved the efficiency, reliability, compliance, transparency and ease of access to multinational drug pricing and approval information.

Drug pricing and reimbursement information management: processes and decision making in the global economy

PubMed Central

Tsourougiannis, Dimitrios

2017-01-01

ABSTRACT Background: Cost-containment initiatives are re-shaping the pharmaceutical business environment and affecting market access as well as pricing and reimbursement decisions. Effective price management procedures are too complex to accomplish manually. Prior to February 2013, price management within Astellas Pharma Europe Ltd was done manually using an Excel database. The system was labour intensive, slow to update, and prone to error. An innovative web-based pricing information management system was developed to address the shortcomings of the previous system. Development: A secure web-based system for submitting, reviewing and approving pricing requests was designed to: track all pricing applications and approval status; update approved pricing information automatically; provide fixed and customizable reports of pricing information; collect pricing and reimbursement rules from each country; validate pricing and reimbursement rules monthly. Several sequential phases of development emphasized planning, time schedules, target dates, budgets and implementation of the entire system. A test system was used to pilot the electronic (e)-pricing system with three affiliates (four users) in February 2013. Outcomes: The web-based system was introduced in March 2013, currently has about 227 active users globally and comprises more than 1000 presentations of 150 products. The overall benefits of switching from a manual to an e-pricing system were immediate and highly visible in terms of efficiency, transparency, reliability and compliance. Conclusions: The e-pricing system has improved the efficiency, reliability, compliance, transparency and ease of access to multinational drug pricing and approval information. PMID:28740622

Multi-indication and Combination Pricing and Reimbursement of Pharmaceuticals: Opportunities for Improved Health Care through Faster Uptake of New Innovations.

PubMed

Persson, Ulf; Norlin, J M

2018-04-01

Many pharmaceuticals are effective in multiple indications and the degree of effectiveness may differ. A product-based pricing and reimbursement system with a single price per product is insufficient to reflect the variable values between different indications. The objective of this article is to present examples of actual pricing and reimbursement decisions using current value-based pricing in Sweden and to discuss their implications and possible solutions. The value of several cancer drugs was estimated for various indications based on a willingness-to-pay threshold of 1 million SEK (EUR 104,000) per QALY gained. For some drugs, the estimated value was higher than the drug acquisition cost in several indications, whilst in others, the estimated value was lower than the drug acquisition cost. Drugs used in combination present a special case. If a drug prolongs survival and consequently also a continued use of the anchor drug, the combination use may not be cost effective even at a zero price. In a product-based pricing and reimbursement system, patients may not get access to drugs or access may be delayed and manufacturers may be discouraged to invest in future indications. To overcome these issues, there are several approaches to link price and value. One approach is a "weighted-average" price based on an average of the value across all indications. Another is "multi-indication pricing," which enables price differentiation between indications. However, there are several barriers for applying multi-indication pricing and reimbursement schemes. One barrier is the lack of existing administrative infrastructure to track patients' indications.

77 FR 64148 - Postal Rate and Classification Changes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-18

... of free tracking. Priority Mail Flat Rate Box prices change to the following: Small ($5.80), Medium.... Several international ancillary services and paper money orders receive price increases. Certificates of.... International Return Receipt also receives price increases, and International Postal Money Order prices increase...

77 FR 29397 - Order Granting Application of BOX Options Exchange, LLC for a Limited Exemption From Exchange Act...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-17

... for strict price-time priority execution (``Trading System'').\\2\\ The BOX Book and the Exchange Rules...'') as set forth in Exchange Rule 7150 are an exception to the strict price-time priority execution that... in the Application, BOX will operate a fully automated electronic book (``BOX Book'') for orders to...

76 FR 9381 - Change in Contractual Priority Mail Postal Prices

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-17

... Mail Postal Prices AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is... prices. This document provides public notice of the changes and addresses related procedural steps. DATES... INFORMATION: I. Introduction On February 9, 2011, the Postal Service filed notice of a change in prices...

The high price of "free" trade: U.S. trade agreements and access to medicines.

PubMed

Lopert, Ruth; Gleeson, Deborah

2013-01-01

The United States' pursuit of increasingly TRIPS-Plus levels of intellectual property protection for medicines in bilateral and regional trade agreements is well recognized. Less so, however, are U.S. efforts through these agreements to influence and constrain the pharmaceutical coverage programs of its trading partners. Although arguably unsuccessful in the Australia- U.S. Free Trade Agreement (AUSFTA), the U.S. nevertheless succeeded in its bilateral FTA with South Korea (KORUS) in establishing prescriptive provisions pertaining to the operation of coverage and reimbursement programs for medicines and medical devices, which have the potential to adversely impact future access in that country. More recently, draft texts leaked from the current Trans Pacific Partnership Agreement (TPPA) negotiations show that U.S. objectives include not only AUSFTA-Plus and KORUS-Plus IP provisions but also ambitious inroads into the domestic health programs of its TPPA partners. This highlights the apparent conflict between trade goals - pursued through multilateral legal instruments to promote economic "health"- and public health objectives, such as the development of treatments for neglected diseases, the pursuit of efficiency and equity in priority setting, and the procurement of medicines at prices that reflect their therapeutic value and facilitate affordable access. © 2013 American Society of Law, Medicine & Ethics, Inc.

Examination of Parameters Affecting the House Prices by Multiple Regression Analysis and its Contributions to Earthquake-Based Urban Transformation

NASA Astrophysics Data System (ADS)

Denli, H. H.; Durmus, B.

2016-12-01

The purpose of this study is to examine the factors which may affect the apartment prices with multiple linear regression analysis models and visualize the results by value maps. The study is focused on a county of Istanbul - Turkey. Totally 390 apartments around the county Umraniye are evaluated due to their physical and locational conditions. The identification of factors affecting the price of apartments in the county with a population of approximately 600k is expected to provide a significant contribution to the apartment market.Physical factors are selected as the age, number of rooms, size, floor numbers of the building and the floor that the apartment is positioned in. Positional factors are selected as the distances to the nearest hospital, school, park and police station. Totally ten physical and locational parameters are examined by regression analysis.After the regression analysis has been performed, value maps are composed from the parameters age, price and price per square meters. The most significant of the composed maps is the price per square meters map. Results show that the location of the apartment has the most influence to the square meter price information of the apartment. A different practice is developed from the composed maps by searching the ability of using price per square meters map in urban transformation practices. By marking the buildings older than 15 years in the price per square meters map, a different and new interpretation has been made to determine the buildings, to which should be given priority during an urban transformation in the county.This county is very close to the North Anatolian Fault zone and is under the threat of earthquakes. By marking the apartments older than 15 years on the price per square meters map, both older and expensive square meters apartments list can be gathered. By the help of this list, the priority could be given to the selected higher valued old apartments to support the economy of the country during an earthquake loss. We may call this urban transformation as earthquake-based urban transformation.

Assessing the role of access and price on the consumption of fruits and vegetables across New York City using agent-based modeling.

PubMed

Li, Yan; Zhang, Donglan; Thapa, Janani R; Madondo, Kumbirai; Yi, Stella; Fisher, Elisa; Griffin, Kerry; Liu, Bian; Wang, Youfa; Pagán, José A

2018-01-01

Most residents in New York City (NYC) do not consume sufficient fruits and vegetables every day. Difficulties with access and high prices of fruits and vegetables in some neighborhoods contribute to different consumption patterns across NYC neighborhoods. We developed an agent-based model (ABM) to predict dietary behaviors of individuals at the borough and neighborhood levels. Model parameters were estimated from the 2014 NYC Community Health Survey, United States Census data, and the literature. We simulated six hypothetical interventions designed to improve access and reduce the price of fruits and vegetables. We found that all interventions would lead to increases in fruit and vegetable consumption but the results vary substantially across boroughs and neighborhoods. For example, a 10% increase in the number of fruit/vegetable vendors combined with a 10% decrease in the prices of fruits and vegetables would lead to a median increase of 2.28% (range: 0.65%-4.92%) in the consumption of fruits and vegetables, depending on neighborhood. We also found that the impact of increasing the number of vendors on fruit/vegetable consumption is more pronounced in unhealthier local food environments while the impact of reducing prices on fruits/vegetable consumption is more pronounced in neighborhoods with low levels of education. An agent-based model of dietary behaviors that takes into account neighborhood context has the potential to inform how fruit/vegetable access and pricing strategies may specifically work in tandem to increase the consumption of fruits and vegetables at the local level. Copyright © 2017 Elsevier Inc. All rights reserved.

The unethical focus on access: a study of medical ethics and the waiting-time guarantee.

PubMed

Karlberg, H I; Brinkmo, B-M

2009-03-01

All civilized societies favour ethical principles of equity. In healthcare, these principles generally focus on needs for medical care. Methods for establishing priorities among such needs are instrumental in this process. In this study, we analysed whether rules on access to healthcare, waiting-time guarantees, conflict with ethical principles of distributive justice. We interviewed directors, managers and other decision-makers of various healthcare providers of hospitals, primary care organizations and purchasing offices. We also conducted focus group interviews with professionals from a number of distinct medical areas. Our informants and their co-workers were reasonably familiar with the ethical platforms for priority-setting established by the Swedish parliament, giving the sickest patients complete priority. However, to satisfy the waiting-time guarantees, the informants often had to make priority decisions contrary to the ethical principles by favouring access before needs to keep waiting times within certain limits. The common opinion was that the waiting-time guarantee leads to crowding-out effects, overruling the ethical principles based on needs. For more than a decade, the interpretation in Sweden of the equitable principle based on medical needs has been distorted through political decisions, leading to healthcare providers giving priority to access rather than needs for care.

Three essays on access pricing

NASA Astrophysics Data System (ADS)

Sydee, Ahmed Nasim

In the first essay, a theoretical model is developed to determine the time path of optimal access price in the telecommunications industry. Determining the optimal access price is an important issue in the economics of telecommunications. Setting a high access price discourages potential entrants; a low access price, on the other hand, amounts to confiscation of private property because the infrastructure already built by the incumbent is sunk. Furthermore, a low access price does not give the incumbent incentives to maintain the current network and to invest in new infrastructures. Much of the existing literature on access pricing suffers either from the limitations of a static framework or from the assumption that all costs are avoidable. The telecommunications industry is subject to high stranded costs and, therefore, to address this issue a dynamic model is imperative. This essay presents a dynamic model of one-way access pricing in which the compensation involved in deregulatory taking is formalized and then analyzed. The short run adjustment after deregulatory taking has occurred is carried out and discussed. The long run equilibrium is also analyzed. A time path for the Ramsey price is shown as the correct dynamic price of access. In the second essay, a theoretical model is developed to determine the time path of optimal access price for an infrastructure that is characterized by congestion and lumpy investment. Much of the theoretical literature on access pricing of infrastructure prescribes that the access price be set at the marginal cost of the infrastructure. In proposing this rule of access pricing, the conventional analysis assumes that infrastructure investments are infinitely divisible so that it makes sense to talk about the marginal cost of investment. Often it is the case that investments in infrastructure are lumpy and can only be made in large chunks, and this renders the marginal cost concept meaningless. In this essay, we formalize a model of access pricing with congestion and in which investments in infrastructure are lumpy. To fix ideas, the model is formulated in the context of airport infrastructure investments, which captures both the element of congestion and the lumpiness involved in infrastructure investments. The optimal investment program suggests how many units of capacity should be installed and at which times. Because time is continuous in the model, the discounted cost -- despite the lumpiness of capacity additions -- can be made to vary continuously by varying the time a capacity addition is made. The main results that emerge from the analysis can be described as follows: First, the global demand for air travel rises with time and experiences an upward jump whenever a capacity addition is made. Second, the access price is constant and stays at the basic level when the system is not congested. When the system is congested, a congestion surcharge is imposed on top of the basic level, and the congestion surcharge rises with the level of congestion until the next capacity addition is made at which time the access price takes a downward jump. Third, the individual demand for air travel is constant before congestion sets in and after the last capacity addition takes place. During a time interval in which congestion rises, the individual demand for travel is below the level that prevails when there is no congestion and declines as congestion worsens. The third essay contains a model of access pricing for natural gas transmission pipelines, both when pipeline operators are regulated and when they behave strategically. The high sunk costs involved in building a pipeline network constitute a serious barrier of entry, and competitive behaviour in the transmission pipeline sector cannot be expected. Most of the economic analyses of access pricing for natural gas transmission pipelines are carried out from the regulatory perspective, and the access price paid by shippers are cost-based. The model formalized is intended to capture some essential characteristics of networks in which components interact with one another when combined into an integrated system. The model shows how the topology of the network determines the access prices in different components of the network. The general results that emerge from the analysis can be summarized as follows. First, the monopoly power of a pipeline operator is reduced by the entry of a new pipeline supply connected in parallel to the same demand node. When the pipelines are connected in series, the one upstream enjoys a first-move advantage over the one downstream, and the toll set by the upstream pipeline operator after entry by the downstream pipeline operator will rise above the original monopoly level. The equilibrium prices of natural gas at the various nodes of the network are also discussed. (Abstract shortened by UMI.)

A subjective scheduler for subjective dedicated networks

NASA Astrophysics Data System (ADS)

Suherman; Fakhrizal, Said Reza; Al-Akaidi, Marwan

2017-09-01

Multiple access technique is one of important techniques within medium access layer in TCP/IP protocol stack. Each network technology implements the selected access method. Priority can be implemented in those methods to differentiate services. Some internet networks are dedicated for specific purpose. Education browsing or tutorial video accesses are preferred in a library hotspot, while entertainment and sport contents could be subjects of limitation. Current solution may use IP address filter or access list. This paper proposes subjective properties of users or applications are used for priority determination in multiple access techniques. The NS-2 simulator is employed to evaluate the method. A video surveillance network using WiMAX is chosen as the object. Subjective priority is implemented on WiMAX scheduler based on traffic properties. Three different traffic sources from monitoring video: palace, park, and market are evaluated. The proposed subjective scheduler prioritizes palace monitoring video that results better quality, xx dB than the later monitoring spots.

Listening for Prescriptions: A National Consultation on Pharmaceutical Policy Issues

PubMed Central

Morgan, Steve; Cunningham, Colleen M.

2010-01-01

Objectives and Methods: Pharmaceutical policy is an increasingly costly, essential and challenging component of health system management. We sought to identify priority pharmaceutical policy issues in Canada and to translate them into research priorities using key informant interviews, stakeholder surveys and a deliberative workshop. Results: We found consensus on overarching policy goals: to provide all Canadians with equitable and sustainable access to necessary medicines. We also found widespread frustration that many key pharmaceutical policy issues in Canada — including improving prescription drug financing and pricing — have been persistent challenges owing to a lack of policy coordination. The coverage of extraordinarily costly medicines for serious conditions was identified as a rapidly emerging policy issue. Conclusion: Targeted research and knowledge translation activities can help address key policy issues and, importantly, challenges of policy coordination in Canada and thereby reduce inequity and inefficiency in policy approaches and outcomes. PMID:22043223

[Economic sustainability of therapies: considerations following the introduction of new drugs for hepatitis C virus].

PubMed

Spandonaro, Federico

2014-06-01

The availability of new drugs potentially able to drastically reduce the burden of very common infectious diseases like hepatitis C requires the national health services to take a different decision-making process. On the one hand, there is an evident financial issue; on the other hand, low budgets may undermine a system that provides universal access to healthcare. It is unrealistic to expect retrieving the financial resources needed from negotiating prices with pharmaceutical companies, resource reallocation or a reduction in economic waste. The national health systems need a new priority setting and a National fund for healthcare innovation should be built. Novel drugs should be evaluated balancing availability and opportunity, forcing to rethink the decision-making processes. Macro- (re-prioritization of interventions) and micro-policies (the introduction of financial aspects in the process of pricing) are needed, trying to combine welfare and industrial policies.

Optimization of Price and Quality in Service Systems,

DTIC Science & Technology

Price and service quality are important variables in the design of optimal service systems. Price is important because of the strong consumption...priorities of service offered. The paper takes a systematic view of this problem, and presents techniques for quantitative determination of the optimal prices and service quality in a wide class of systems. (Author)

Research on intelligent power consumption strategy based on time-of-use pricing

NASA Astrophysics Data System (ADS)

Fu, Wei; Gong, Li; Chen, Heli; He, Yu

2017-06-01

In this paper, through the analysis of shortcomings of the current domestic and foreign household power consumption strategy: Passive way of power consumption, ignoring the different priority of electric equipment, neglecting the actual load pressure of the grid, ignoring the interaction with the user, to decrease the peak-valley difference and improve load curve in residential area by demand response (DR technology), an intelligent power consumption scheme based on time-of-use(TOU) pricing for household appliances is proposed. The main contribution of this paper is: (1) Three types of household appliance loads are abstracted from different operating laws of various household appliances, and the control models and DR strategies corresponding to these types are established. (2) The fuzzified processing for the information of TOU price, which is based on the time intervals, is performed to get the price priority, in accordance with such DR events as the maximum restricted load of DR, the time of DR and the duration of interruptible load and so on, the DR control rule and pre-scheduling mechanism are led in. (3) The dispatching sequence of household appliances in the control and scheduling queue are switched and controlled to implement the equilibrium of peak and valley loads. The equilibrium effects and economic benefits of power system by pre-scheduling and DR dispatching are compared and analyzed by simulation example, and the results show that using the proposed household appliance control (HAC) scheme the overall cost of consumers can be reduced and the power system load can be alleviated, so the proposed household appliance control (HAC) scheme is feasible and reasonable.

75 FR 66404 - Self-Regulatory Organizations; C2 Options Exchange, Incorporated; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-28

... Change The Exchange proposes to modify the wording of Rule 6.12 relating to the C2 matching algorithm... matching algorithm and subsequently overlay certain priorities over the selected base algorithm. There are currently two base algorithms: price-time (often referred to as first in, first out or FIFO) in which...

47 CFR 69.153 - Presubscribed interexchange carrier charge (PICC).

Code of Federal Regulations, 2010 CFR

2010-10-01

... CARRIER SERVICES (CONTINUED) ACCESS CHARGES Computation of Charges for Price Cap Local Exchange Carriers... to recover revenues totaling Average Price Cap CMT Revenues per Line month times the number of base...

Transmission Pricing Issues for Electricity Generation From Renewable Resources

EIA Publications

1999-01-01

This article discusses how the resolution of transmission pricing issues which have arisen under the Federal Energy Regulatory Commission's (FERC) open access environment may affect the prospects for renewable-based electricity.

48 CFR 8.704 - Purchase priorities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Purchase priorities. 8.704... Blind or Severely Disabled 8.704 Purchase priorities. (a) The Javits-Wagner-O'Day Act requires the Government to purchase supplies or services on the Procurement List, at prices established by the Committee...

Electronic journal access: how does it affect the print subscription price?*

PubMed Central

Chen, Frances L.; Wrynn, Paul; Rieke, Judith L.

2001-01-01

Objective: This study examined the rates of print journal subscription price increases according to the type of available electronic access. The types of access included: electronic priced separately from the print, combination print with “free online” access, and aggregated, defined here as electronic access purchased as part of a collection. The percentages of print price increases were compared to each other and to that for titles available only in print. The authors were not aware of prior objective research in this area. Methods: The authors analyzed the percentage print price increases of 300 journals over a five-year time period. The titles were grouped according to type of available electronic access. The median and mean percentage print price increases were calculated and plotted for all titles within each group. Results: Using both the median and the mean to look at the percentage print price increases over five years, it was obvious that print prices for journals with electronic access exceeded journals that did not offer an electronic option. Electronic priced separately averaged 3% to 5% higher than print only titles using both measures. Combination print with “free online” access had higher increases from 1996 to 1999, but, in 2000, their percentage increases were about the same as print only titles. The rate of price increases for aggregated titles consistently went down over the past five years. Journals with no electronic option showed the lowest percentage rates of print price increase. Conclusions: The authors' findings reveal that the increases of print prices for their sample of titles were higher if a type of electronic access was offered. According to the results of this study, aggregated collections currently represent the electronic option whose percentage price increase for print prices was lowest. However, the uneven fluctuations in rates of subscription prices revealed that the pricing of journals with electronic access is still evolving. More study is recommended to see if the trends observed in this study are sustained over a longer time period. PMID:11837258

[Risk sharing methods in middle income countries].

PubMed

Inotai, András; Kaló, Zoltán

2012-01-01

The pricing strategy of innovative medicines is based on the therapeutic value in the largest pharmaceutical markets. The cost-effectiveness of new medicines with value based ex-factory price is justifiable. Due to the international price referencing and parallel trade the ex-factory price corridor of new medicines has been narrowed in recent years. Middle income countries have less negotiation power to change the narrow drug pricing corridor, although their fair intention is to buy pharmaceuticals at lower price from their scarce public resources compared to higher income countries. Therefore the reimbursement of new medicines at prices of Western-European countries may not be justifiable in Central-Eastern European countries. Confidential pricing agreements (i.e. confidential price discounts, claw-back or rebate) in lower income countries of the European Union can alleviate this problem, as prices of new medicines can be adjusted to local purchasing power without influencing the published ex-factory price and so the accessibility of patients to these drugs in other countries. In order to control the drug budget payers tend to apply financial risk sharing agreements for new medicines in more and more countries to shift the consequences of potential overspending to pharmaceutical manufacturers. The major paradox of financial risk-sharing schemes is that increased mortality, poor persistence of patients, reduced access to healthcare providers, and no treatment reduce pharmaceutical spending. Consequently, payers have started to apply outcome based risk sharing agreements for new medicines recently to improve the quality of health care provision. Our paper aims to review and assess the published financial and outcome based risk sharing methods. Introduction of outcome based risk-sharing schemes can be a major advancement in the drug reimbursement strategy of payers in middle income countries. These schemes can help to reduce the medical uncertainty in coverage decisions for valuable innovative healthcare technologies. However risk-sharing schemes can also reduce the transparency of pharmaceutical pricing and reimbursement, as the payback, and consequently the actual price per patient can be calculated only retrospectively. Therefore risk-sharing agreements can be interpreted as special forms of confidential pricing agreements to facilitate the implementation of differential pricing in middle income countries.

A win-win solution?: A critical analysis of tiered pricing to improve access to medicines in developing countries.

PubMed

Moon, Suerie; Jambert, Elodie; Childs, Michelle; von Schoen-Angerer, Tido

2011-10-12

Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines. We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that "de-link" the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term. To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices.

A win-win solution?: A critical analysis of tiered pricing to improve access to medicines in developing countries

PubMed Central

2011-01-01

Background Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines. Discussion We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that "de-link" the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term. Summary To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices. PMID:21992405

17 CFR Appendix A to Part 37 - Guidance on Compliance With Registration Criteria

Code of Federal Regulations, 2011 CFR

2011-04-01

... facility should include the system's trade-matching algorithm and order entry procedures. A submission involving a trade-matching algorithm that is based on order priority factors other than on a best price/earliest time basis should include a brief explanation of the alternative algorithm. (b) A board of trade's...

17 CFR Appendix A to Part 37 - Guidance on Compliance With Registration Criteria

Code of Federal Regulations, 2012 CFR

2012-04-01

... facility should include the system's trade-matching algorithm and order entry procedures. A submission involving a trade-matching algorithm that is based on order priority factors other than on a best price/earliest time basis should include a brief explanation of the alternative algorithm. (b) A board of trade's...

Examining the Influence of price and accessibility on willingness to shop at farmers' markets among low-income eastern North Carolina women.

PubMed

McGuirt, Jared T; Jilcott Pitts, Stephanie B; Ward, Rachel; Crawford, Thomas W; Keyserling, Thomas C; Ammerman, Alice S

2014-01-01

To examine the influence of farmers' market pricing and accessibility on willingness to shop at farmers' markets, among low-income women. Qualitative interviews using scenarios with quantitative assessment of willingness to shop at farmers' markets given certain pricing and accessibility scenarios. Eastern North Carolina. A total of 37 low-income women of childbearing age (18-44 years) receiving family planning services at the health department. Willingness to shop at a farmers' market. Fisher's exact test was used to examine associations between willingness to shop at farmers' markets by urban/rural residence, race, and employment status. Direct quotations relevant to participants' use of farmers' markets were extracted based on a positive deviance framework. Participants were increasingly willing to shop at the farmers' market when price savings increased and when the market was incrementally closer to their residence. Willingness was highest when there was at least a 20% price savings. Participants seemed to be influenced more by a visual representation of a greater quantity of produce received with the price savings rather than a quantitative representation of the money saved by the reduced price. Future farmers' market interventions should take into account these consumer level preferences. Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Examining the influence of price and accessibility on willingness to shop at farmers’ markets among low-income eastern North Carolina women

PubMed Central

McGuirt, Jared T.; Jilcott Pitts, Stephanie B.; Ward, Rachel; Crawford, Thomas W.; Keyserling, Thomas C.; Ammerman, Alice S.

2013-01-01

Objective: To examine the influence of farmers’ market pricing and accessibility on willingness to shop at farmers’ markets, among low-income women. Design: Qualitative interviews using scenarios with quantitative assessment of willingness to shop at farmers’ market given certain pricing and accessibility scenarios. Setting: Eastern North Carolina. Participants: Thirty seven low-income women of child-bearing age (18-44 years) receiving family planning services at the health department. Phenomenon of Interest: Willingness to shop at a farmers’ market. Analysis: Fisher’s exact test was used to examine associations between willingness to shop at farmers’ markets by urban/rural residence, race, and employment status. Direct quotations relevant to participants' use of farmers' markets were extracted based upon a positive deviance framework. Results: Participants were increasingly willing to shop at the farmers’ market when price savings increased and when the market was incrementally closer to their residence. Willingness was highest when there was at least a 20% price savings. Participants seemed to be influenced more by a visual representation of a greater quantity of produce received with the price savings rather than the quantitative representation of the money saved by the reduced price. Conclusions and Implications: Future farmers’ market interventions should take into account these consumer level preferences. PMID:24201077

Price adjustment for traditional Chinese medicine procedures: Based on a standardized value parity model.

PubMed

Wang, Haiyin; Jin, Chunlin; Jiang, Qingwu

2017-11-20

Traditional Chinese medicine (TCM) is an important part of China's medical system. Due to the prolonged low price of TCM procedures and the lack of an effective mechanism for dynamic price adjustment, the development of TCM has markedly lagged behind Western medicine. The World Health Organization (WHO) has emphasized the need to enhance the development of alternative and traditional medicine when creating national health care systems. The establishment of scientific and appropriate mechanisms to adjust the price of medical procedures in TCM is crucial to promoting the development of TCM. This study has examined incorporating value indicators and data on basic manpower expended, time spent, technical difficulty, and the degree of risk in the latest standards for the price of medical procedures in China, and this study also offers a price adjustment model with the relative price ratio as a key index. This study examined 144 TCM procedures and found that prices of TCM procedures were mainly based on the value of medical care provided; on average, medical care provided accounted for 89% of the price. Current price levels were generally low and the current price accounted for 56% of the standardized value of a procedure, on average. Current price levels accounted for a markedly lower standardized value of acupuncture, moxibustion, special treatment with TCM, and comprehensive TCM procedures. This study selected a total of 79 procedures and adjusted them by priority. The relationship between the price of TCM procedures and the suggested price was significantly optimized (p < 0.01). This study suggests that adjustment of the price of medical procedures based on a standardized value parity model is a scientific and suitable method of price adjustment that can serve as a reference for other provinces and municipalities in China and other countries and regions that mainly have fee-for-service (FFS) medical care.

78 FR 38227 - Connect America Fund

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-26

... different per- location support amounts based on the existing level of Internet access ($550 for homes with low-speed Internet access and $775, as in the first round, for homes with only dial-up access), and... Internet access. We adopt a process for challenges to the eligibility of specific areas where price cap...

47 CFR 64.402 - Policies and procedures for the provision of priority access service by commercial mobile radio...

Code of Federal Regulations, 2010 CFR

2010-10-01

... priority access service by commercial mobile radio service providers. 64.402 Section 64.402... RULES RELATING TO COMMON CARRIERS Procedures for Handling Priority Services in Emergencies § 64.402 Policies and procedures for the provision of priority access service by commercial mobile radio service...

47 CFR 69.123 - Density pricing zones for special access and switched transport.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Density pricing zones for special access and...) COMMON CARRIER SERVICES (CONTINUED) ACCESS CHARGES Computation of Charges § 69.123 Density pricing zones... price cap regulation may establish any number of density zones within a study area that is used for...

Medical-Grade Channel Access and Admission Control in 802.11e EDCA for Healthcare Applications

PubMed Central

Son, Sunghwa; Park, Kyung-Joon; Park, Eun-Chan

2016-01-01

In this paper, we deal with the problem of assuring medical-grade quality of service (QoS) for real-time medical applications in wireless healthcare systems based on IEEE 802.11e. Firstly, we show that the differentiated channel access of IEEE 802.11e cannot effectively assure medical-grade QoS because of priority inversion. To resolve this problem, we propose an efficient channel access algorithm. The proposed algorithm adjusts arbitrary inter-frame space (AIFS) in the IEEE 802.11e protocol depending on the QoS measurement of medical traffic, to provide differentiated near-absolute priority for medical traffic. In addition, based on rigorous capacity analysis, we propose an admission control scheme that can avoid performance degradation due to network overload. Via extensive simulations, we show that the proposed mechanism strictly assures the medical-grade QoS and improves the throughput of low-priority traffic by more than several times compared to the conventional IEEE 802.11e. PMID:27490666

New trends and challenges in the European regulation of innovative medicines.

PubMed

Enzmann, Harald

2016-10-01

Regulators' marketing authorizations for innovative medicines are linked into a complex process with successive crucial decisions. Objectives and decision criteria of the stakeholders in this process, e.g. health technology assessment (HTA) bodies, payers, physicians and patients, vary and may result not only in different but even mutually exclusive requirements. Reacting to changes in scientific, economic and social demands, European regulatory agencies alter content and format of their assessment procedures and their communication. New diagnostic options (e.g. genotyping and biomarkers) and pharmaceutical innovations (e.g. targeted medicines, nanomedicines) are the scientific drivers of this development. Social drivers are the price and reimbursement decisions by HTA bodies and payers, prerequisites for most patients' access to innovative medicines. The European Medicines Agency's adaptive licensing concept and priority medicines scheme foster the early authorization of innovative medicines. HTA builds on regulators' assessment, with additional requirements and economic components. An intensified exchange between all stakeholders, e.g. in multilateral scientific advice procedures has been initiated. Diminishing the differences in the requirements of regulators and HTA bodies is in the best interest of both patients and the pharmaceutical industry, avoiding duplication of work and accelerating patients' access by early decisions on price and reimbursement. Copyright © 2016 Elsevier Inc. All rights reserved.

Pharma Pricing & Market Access Europe 2016--Health Network Communications' Tenth Annual Conference (February 23-25, 2016--London, UK).

PubMed

D'Souza, P

2016-03-01

Tighter national budgets and escalating drug prices continue to present challenges for pharmaceutical market access strategies and societal cost of care. As pharmaceutical companies and medical governmental advisory organizations enter tougher negotiations, hospital trusts and other dispensary firms face barriers to receiving the best medical treatment, and as a result patient access is limited. The 2016 HealthNetwork Communications' Pharma Pricing & Market Access Europe meeting brought together pharmaceutical, medical governmental advisory and stakeholders and market access/pricing consultants, to encourage discussions and negotiations into how to improve the drug pricing system and consequential market access strategies while achieving the respective reimbursement and affordability objectives. Copyright 2016 Prous Science, S.A.U. or its licensors. All rights reserved.

Value based pricing, research and development, and patient access schemes. Will the United Kingdom get it right or wrong?

PubMed Central

Towse, Adrian

2010-01-01

The National Health Service (NHS) should reward innovation it values. This will enable the NHS and the United Kingdom (UK) economy to benefit and impact positively on the Research and Development (R&D) decision making of companies. The National Institute for Health and Clinical Excellence (NICE) currently seeks to do this on behalf of the NHS. Yet the Office of Fair Trading proposals for Value Based Pricing add price setting powers – initially for the Department of Health (DH) and then for NICE. This introduces an additional substantial uncertainty that will impact on R&D and, conditional on R&D proceeding, on launch (or not) in the UK. Instead of adding to uncertainty the institutional arrangements for assessing value should seek to be predictable and science based, building on NICE's current arrangements. The real challenge is to increase understanding of the underlying cost-effectiveness of the technology itself by collecting evidence alongside use. The 2009 Pharmaceutical Price Regulation Scheme sought to help do this with Flexible Pricing (FP) and Patient Access Schemes (PASs). The PASs to date have increased access to medicines, but no schemes proposed to date have yet helped to tackle outcomes uncertainty. The 2010 Innovation Pass can also be seen as a form of ‘coverage with evidence development.’ The NHS is understandably concerned about the costs of running such evidence collection schemes. Enabling the NHS to deliver on such schemes will impact favourably on R&D decisions. Increasing the uncertainty in the UK NHS market through government price setting will reduce incentives for R&D and for early UK launch. PMID:20716236

Value based pricing, research and development, and patient access schemes. Will the United Kingdom get it right or wrong?

PubMed

Towse, Adrian

2010-09-01

The National Health Service (NHS) should reward innovation it values. This will enable the NHS and the United Kingdom (UK) economy to benefit and impact positively on the Research and Development (R&D) decision making of companies. The National Institute for Health and Clinical Excellence (NICE) currently seeks to do this on behalf of the NHS. Yet the Office of Fair Trading proposals for Value Based Pricing add price setting powers--initially for the Department of Health (DH) and then for NICE. This introduces an additional substantial uncertainty that will impact on R&D and, conditional on R&D proceeding, on launch (or not) in the UK. Instead of adding to uncertainty the institutional arrangements for assessing value should seek to be predictable and science based, building on NICE's current arrangements. The real challenge is to increase understanding of the underlying cost-effectiveness of the technology itself by collecting evidence alongside use. The 2009 Pharmaceutical Price Regulation Scheme sought to help do this with Flexible Pricing (FP) and Patient Access Schemes (PASs). The PASs to date have increased access to medicines, but no schemes proposed to date have yet helped to tackle outcomes uncertainty. The 2010 Innovation Pass can also be seen as a form of 'coverage with evidence development.' The NHS is understandably concerned about the costs of running such evidence collection schemes. Enabling the NHS to deliver on such schemes will impact favourably on R&D decisions. Increasing the uncertainty in the UK NHS market through government price setting will reduce incentives for R&D and for early UK launch.

Access to hepatitis C treatment for people who inject drugs in low and middle income settings: Evidence from 5 countries in Eastern Europe and Asia.

PubMed

Luhmann, Niklas; Champagnat, Julie; Golovin, Sergey; Maistat, Ludmila; Agustian, Edo; Inaridze, Ina; Myint, Wai Moe; Butsashvili, Maia; Bouscaillou, Julie

2015-11-01

People who inject drugs (PWID) are disproportionately affected by the hepatitis C (HCV) epidemic. Of the estimated 16 million PWID worldwide, approximately 8 million live with chronic HCV, and around 26% and 23% of the global HCV infections among PWID occur in East/Southeast Asia and Eastern Europe respectively. Globally, few PWID have access to treatment for HCV. We conducted a systematic literature review and internet survey in 2014 to document the burden of disease, access to diagnosis and treatment and the existence of national policy and treatment guidelines for HCV. We included Georgia, Russia, Ukraine, Myanmar and Indonesia as countries with injection drug use epidemics. HCV antibody prevalence among the general population ranged from 0.80% in Indonesia to 5% in Georgia, and among PWID from 48.1% in Myanmar to 92% in Georgia. PWID carried a significant burden of disease, ranging from 2.7% in Indonesia to 40.4% in Russia. Yearly treatment uptake was under 1% for the general population and PWID in all countries. Diagnostic tools and disease staging investigations as well as pegylated interferon/ribavirin treatment were available at a range of prices. Despite policy and treatment protocols for HCV in the majority of countries, strategies focusing on PWID were largely absent. PWID are a priority group for treatment, and access to treatment should be based on sound national policy, accessible public treatment programmes and functional surveillance systems. Copyright © 2015 Elsevier B.V. All rights reserved.

Determinants of price setting decisions on anti-malarial drugs at retail shops in Cambodia.

PubMed

Patouillard, Edith; Hanson, Kara; Kleinschmidt, Immo; Palafox, Benjamin; Tougher, Sarah; Pok, Sochea; O'Connell, Kate; Goodman, Catherine

2015-05-30

In many low-income countries, the private commercial sector plays an important role in the provision of malaria treatment. However, the quality of care it provides is often poor, with artemisinin combination therapy (ACT) generally being too costly for consumers. Decreasing ACT prices is critical for improving private sector treatment outcomes and reducing the spread of artemisinin resistance. Yet limited evidence exists on the factors influencing retailers' pricing decisions. This study investigates the determinants of price mark-ups on anti-malarial drugs in retail outlets in Cambodia. Taking an economics perspective, the study tests the hypothesis that the structure of the anti-malarial market determines the way providers set their prices. Providers facing weak competition are hypothesized to apply high mark-ups and set prices above the competitive level. To analyse the relationship between market competition and provider pricing, the study used cross-sectional data from retail outlets selling anti-malarial drugs, including outlet characteristics data (e.g. outlet type, anti-malarial sales volumes), range of anti-malarial drugs stocked (e.g. dosage form, brand status) and purchase and selling prices. Market concentration, a measure of the level of market competition, was estimated using sales volume data. Market accessibility was defined based on travel time to the closest main commercial area. Percent mark-ups were calculated using price data. The relationship between mark-ups and market concentration was explored using regression analysis. The anti-malarial market was on average highly concentrated, suggesting weak competition. Higher concentration was positively associated with higher mark-ups in moderately accessible markets only, with no significant relationship or a negative relationship in other markets. Other determinants of pricing included anti-malarial brand status and generic type, with higher mark-ups on cheaper products. The results indicate that provider pricing as well as other key elements of anti-malarial supply and demand may have played an important role in the limited access to appropriate malaria treatment in Cambodia. The potential for an ACT price subsidy at manufacturer level combined with effective communications directed at consumers and supportive private sector regulation should be explored to improve access to quality malaria treatment in Cambodia.

'Net Equity: A Report on Income and Internet Access.

ERIC Educational Resources Information Center

Moss, Mitchell; Mitra, Steve

1998-01-01

Examines the structure of the subscriber base formed under the current pricing policies of Internet providers and investigates how access to the Internet varies in communities with different demographic characteristics. Report is based on a survey from a national Internet service provided in 1997. (SLD)

Officer Accessions Flow Model

DTIC Science & Technology

2011-07-31

officers select their own BOLC-B dates completely divorced of their unit assignment and that unit’s ARFORGEN cycle. We reschedule all FY10 cohort LTs...for BOLC-B based upon unit priority based upon number of days until LAD. Rescheduling all FY10 cohort LTs for BOLC-B based upon unit priority...with specialty branches (doctors, lawyers, nurses , chaplains, etc) which have minimal representation in BCT-level units.  DCs are not generally

47 CFR 54.806 - Calculation by the Administrator of interstate access universal service support for areas served...

Code of Federal Regulations, 2010 CFR

2010-10-01

... access universal service support for areas served by price cap local exchange carriers. 54.806 Section 54... Administrator of interstate access universal service support for areas served by price cap local exchange... calculate the Interstate Access Universal Service Support for areas served by price cap local exchange...

Climate change economics: Make carbon pricing a priority

NASA Astrophysics Data System (ADS)

Hepburn, Cameron

2017-06-01

Estimates of the social cost of carbon vary widely as a function of different ethical parameters. Faced with values ranging from US$10 to US$1,000 per tCO2 and above, some perplexed policymakers have adopted 'target-consistent' carbon pricing instead.

Prescription drug accessibility and affordability in the United States and abroad.

PubMed

Morgan, Steve; Kennedy, Jae

2010-06-01

This issue brief contrasts prescription drug access, affordability, and costs in the United States with six other high-income countries, drawing from Commonwealth Fund survey data of patient experiences as well as international spending and pricing data. The analysis reveals that Americans, particularly the relatively young and healthy, are more likely to use prescription drugs than are residents of Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom, but they also experience more financial barriers in accessing medications and spend more out-of-pocket for prescriptions. In the U.S., there are also larger income-related inequities in pharmaceutical use. Despite access barriers and disparities, spending per person in the U.S. is far higher, likely the result of paying higher prices for similar medications and using a more expensive mix of drugs. The authors say that value-based benefit designs, reference pricing, and group purchasing could reduce financial barriers and keep down pharmaceutical spending.

Internet Access in the European Union and in the United States.

ERIC Educational Resources Information Center

Bauer, Johannes M.; Berne, Michel; Maitland, Carleen F.

2002-01-01

Examines the effects of public policies towards traditional communications infrastructures on Internet access in Europe and the United States. Discusses competitive strategies and describes the influence of regulatory policies affecting market entry and the pricing of services on Internet access, based on empirical findings. (Author/LRW)

45 CFR 149.110 - Negotiated price concessions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Negotiated price concessions. 149.110 Section 149.110 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS... the employment-based plan or insurer paid for the cost of health benefits and the amount of post-point...

45 CFR 149.110 - Negotiated price concessions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Negotiated price concessions. 149.110 Section 149.110 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS... the employment-based plan or insurer paid for the cost of health benefits and the amount of post-point...

An assessment of innovative pricing schemes for the communication of value: is price discrimination and two-part pricing a way forward?

PubMed

Hertzman, Peter; Miller, Paul; Tolley, Keith

2018-02-01

With the introduction of new expensive medicines, traditional pricing schemes based on constructs such as price per pill/vial have been challenged. Potential innovative schemes could be either financial-based or performance-based. Within financial-based schemes the use of price discrimination is an emerging option, which we explore in this assessment. Areas covered: In the short term the price per indication approach is likely to become more prevalent for high cost, high benefit new pharmaceuticals, such as those emerging in oncology (e.g. new combination immunotherapies). 'Two-Part Pricing' (2PP) is a frequently used payment method in other industries, which consists of an Entry Fee, giving the buyer the right to use the product, and a Usage Price charged every time the product is purchased. Introducing 2PP into biopharma could have cross-stakeholder benefits including broader patient access, and improvement in budget/revenue predictability. A concern however is the potential complexity of the negotiation between manufacturer and payer. Expert commentary: We believe 'price discrimination' and 2PP in particular can be relevant for some new, expensive specialist medicines. A recommended first step would be to initiate pilots to test to what degree the 2PP approach meets stakeholder objectives and is practical to implement within specialty care.

Internet Access and Pricing: Sorting Out the Options.

ERIC Educational Resources Information Center

Fowler, Thomas B.

1997-01-01

Discusses Internet access and pricing options. Highlights include restructuring of the telecommunications industry; current methods of access; economics of high-speed access; the impact of cheap Internet access; long-term possibilities; and a table that provides a comparison of Internet access methods. (LRW)

Obesity and supermarket access: proximity or price?

PubMed

Drewnowski, Adam; Aggarwal, Anju; Hurvitz, Philip M; Monsivais, Pablo; Moudon, Anne V

2012-08-01

We examined whether physical proximity to supermarkets or supermarket price was more strongly associated with obesity risk. The Seattle Obesity Study (SOS) collected and geocoded data on home addresses and food shopping destinations for a representative sample of adult residents of King County, Washington. Supermarkets were stratified into 3 price levels based on average cost of the market basket. Sociodemographic and health data were obtained from a telephone survey. Modified Poisson regression was used to test the associations between obesity and supermarket variables. Only 1 in 7 respondents reported shopping at the nearest supermarket. The risk of obesity was not associated with street network distances between home and the nearest supermarket or the supermarket that SOS participants reported as their primary food source. The type of supermarket, by price, was found to be inversely and significantly associated with obesity rates, even after adjusting for individual-level sociodemographic and lifestyle variables, and proximity measures (adjusted relative risk=0.34; 95% confidence interval=0.19, 0.63) Improving physical access to supermarkets may be one strategy to deal with the obesity epidemic; improving economic access to healthy foods is another.

Analysis of prices paid by low-income countries - how price sensitive is government demand for medicines?

PubMed

Srivastava, Divya; McGuire, Alistair

2014-07-30

Access to medicines is an important health policy issue. This paper considers demand structures in a selection of low-income countries from the perspective of public authorities as the evidence base is limited. Analysis of the demand for medicines in low-income countries is critical for effective pharmaceutical policy where regulation is less developed, health systems are cash constrained and medicines are not typically subsidised by a public health insurance system This study analyses the demand for medicines in low-income countries from the perspective of the prices paid by public authorities. The analysis draws on a unique dataset from World Health Organization (WHO) and Health Action International (HAI) using 2003 data on procurement prices of medicines across 16 low-income countries covering 48 branded drugs and 18 therapeutic categories. Variation in prices, the mark-ups over marginal costs and estimation of price elasticities allows assessment of whether these elasticities are correlated with a country's national income. Using the Ramsey pricing rule, the study's findings suggest that substantial cross-country variation in prices and mark-ups exist, with price elasticities ranging from -1 to -2, which are weakly correlated with national income. Government demand for medicines thus appears to be price elastic, raising important policy implications aimed at improving access to medicines for patients in low-income countries.

Implementing differential pricing for essential medicines via country-specific bilateral negotiated discounts.

PubMed

Tetteh, Ebenezer Kwabena

2009-01-01

It is widely acknowledged that limited access to essential medicines undermines efforts at improving the health and economic well-being of low-income populations. This has spurred on a number of solutions, including differential pricing based on the economics of price discrimination. A desirable feature of differential pricing is its potential ability to reconcile static and dynamic efficiency concerns. There are, however, various shades of differential pricing and this paper aims to evaluate their consistency with economic theory. Starting with the report of the workshop on 'Differential Pricing and Financing of Essential Drugs' held by secretariats of the World Trade Organization and WHO in Hosbjor, Norway, in 2001, this paper takes issue with how differential pricing has been defined as a tool for improving access to essential drug benefits. The paper notes that inadequate attention has been given to policies and institutional arrangements for creating, expressing and maintaining 'truly' price-elastic demands in low-income nations and for segmenting markets. In addition, considerations of equity and solidarity have distracted policy advocates from balancing conflicting, yet well intended, views and general rules. The paper argues why differential pricing should be implemented via country-specific bilateral negotiated discounts. It maintains that it is feasible to muster an environment conducive to profitable differential pricing whilst satisfying general rules and concerns about self-reliance, transparency, accountability, equity and solidarity.

What is a new drug worth? An innovative model for performance-based pricing.

PubMed

Dranitsaris, G; Dorward, K; Owens, R C; Schipper, H

2015-05-01

This article focuses on a novel method to derive prices for new pharmaceuticals by making price a function of drug performance. We briefly review current models for determining price for a new product and discuss alternatives that have historically been favoured by various funding bodies. The progressive approach to drug pricing, proposed herein, may better address the views and concerns of multiple stakeholders in a developed healthcare system by acknowledging and incorporating input from disparate parties via comprehensive and successive negotiation stages. In proposing a valid construct for performance-based pricing, the following model seeks to achieve several crucial objectives: earlier and wider access to new treatments; improved transparency in drug pricing; multi-stakeholder involvement through phased pricing negotiations; recognition of innovative product performance and latent changes in value; an earlier and more predictable return for developers without sacrificing total return on investment (ROI); more involved and informed risk sharing by the end-user. © 2014 John Wiley & Sons Ltd.

Assessing the shelf life of cost-efficient conservation plans for species at risk across gradients of agricultural land use.

PubMed

Robillard, Cassandra M; Kerr, Jeremy T

2017-08-01

High costs of land in agricultural regions warrant spatial prioritization approaches to conservation that explicitly consider land prices to produce protected-area networks that accomplish targets efficiently. However, land-use changes in such regions and delays between plan design and implementation may render optimized plans obsolete before implementation occurs. To measure the shelf life of cost-efficient conservation plans, we simulated a land-acquisition and restoration initiative aimed at conserving species at risk in Canada's farmlands. We accounted for observed changes in land-acquisition costs and in agricultural intensity based on censuses of agriculture taken from 1986 to 2011. For each year of data, we mapped costs and areas of conservation priority designated using Marxan. We compared plans to test for changes through time in the arrangement of high-priority sites and in the total cost of each plan. For acquisition costs, we measured the savings from accounting for prices during site selection. Land-acquisition costs and land-use intensity generally rose over time independent of inflation (24-78%), although rates of change were heterogeneous through space and decreased in some areas. Accounting for spatial variation in land price lowered the cost of conservation plans by 1.73-13.9%, decreased the range of costs by 19-82%, and created unique solutions from which to choose. Despite the rise in plan costs over time, the high conservation priority of particular areas remained consistent. Delaying conservation in these critical areas may compromise what optimized conservation plans can achieve. In the case of Canadian farmland, rapid conservation action is cost-effective, even with moderate levels of uncertainty in how to implement restoration goals. © 2016 Society for Conservation Biology.

Funding pharmaceutical innovation through direct tax credits.

PubMed

Lybecker, Kristina M; Freeman, Robert A

2007-07-01

Rising pharmaceutical prices, increasing demand for more effective innovative drugs and growing public outrage have heightened criticism of the pharmaceutical industry. The public debate has focused on drug prices and access. As a consequence, the patent system is being reexamined as an efficient mechanism for encouraging pharmaceutical innovation and drug development. We propose an alternative to the existing patent system, instead rewarding the innovating firm with direct tax credits in exchange for marginal cost pricing. This concept is based on the fundamental assumption that innovation that benefits society at large may be financed publicly. As an industry which produces a social good characterized by high fixed costs, high information and regulatory costs, and relatively low marginal costs of production, pharmaceuticals are well-suited to such a mechanism. Under this proposal, drug prices fall, consumer surplus increases, access is enhanced, and the incentives to innovate are preserved.

A New Regulatory Policy for FTTx-Based Next-Generation Access Networks

NASA Astrophysics Data System (ADS)

Makarovič, Boštjan

2013-07-01

This article critically assesses the latest European Commission policies in relation to next-generation access investment that put focus on regulated prices and relaxing of wholesale access obligations. Pointing at the vital socio-legal and economic arguments, it further challenges the assumptions of the current EU regulatory framework and calls for a more contractual utility-based model of regulation instead of the current system that overly relies on market-driven infrastructure-based competition.

Legal and policy foundations for global generic competition: Promoting affordable drug pricing in developing societies.

PubMed

Zapatero Miguel, Pablo

2015-01-01

The so-called 'TRIPS flexibilities' restated in 2001 by the World Trade Organization's Doha Declaration on TRIPS and Public Health offer a variety of policy avenues for promoting global price-based competition for essential medicines, and thus for improving access to affordable medicines in the developing world. In recent years, developing countries and international organisations alike have begun to explore the potentialities of global generic markets and competition generally, and also of using compulsory licensing to remedy anti-competitive practices (e.g. excessive pricing) through TRIPS-compatible antitrust enforcement. These and other 'pro-competitive' TRIPS flexibilities currently available provide the critical leverage and policy space necessary to improve access to affordable medicines in the developing world.

47 CFR 51.907 - Transition of price cap carrier access charges.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., each Price Cap carrier shall, in accordance with bill-and-keep, as defined in § 51.713, revise and.... 51.907 Section 51.907 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.907 Transition of price cap...

Can the generic antiretroviral industry support access to a universal antiretroviral regimen?

PubMed

Amole, Carolyn D; Middlecote, Caroline; Prabhu, Vineet R; Kumarasamy, N

2017-07-01

The generic antiretroviral (ARV) industry played a critical role in the massive scale-up of HIV treatment in low-income and middle-income countries since 2000. As the global community looks ahead to a universal antiretroviral regimen, this article considers the industry's role in supporting universal access to affordable, simpler, more durable, and tolerable HIV treatment regimens. Generic manufacturers made treatment scale-up in low-income and middle-income countries possible through reducing prices, combining molecules from different originator companies to develop optimal fixed-dose combinations, and investing in production capacity to meet escalating demand. Achieving scale-up of a universal regimen will require continued partnership in these areas. Collaboration on the demand and supply sides of the ARV marketplace will be required to foster a healthy and sustainable marketplace for new regimens. This includes clear priority setting from the global treatment community on priority products; predictable demand; regulatory prioritization of optimal products; effective tendering and procurement practices that enable multiple suppliers to participate in the market; coordinated product introduction efforts between Ministries of Health, partners, and civil society; and transparency from both buyers and suppliers to promote and monitor supply security. New regimens will benefit people living with HIV, as well as buyers and generic suppliers, by maximizing existing production capacity and treatment budgets to reach the 90-90-90 goals.

78 FR 79024 - New Postal Product

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

... Priority Mail Contract 33 by the most recent cell by cell increases/decreases in prices of general... annual adjustment of Table D, by adjusting the prices by the most recent cell by cell increases/decreases... consideration of matters raised by the Postal Service's Notice. 2. Kenneth R. Moeller, previously designated to...

Inflation Adjustments for Defense Acquisition

DTIC Science & Technology

2014-10-01

remaining for attribution to the growth of other factors that are captured by the price deflator. However, we lacked access to the BEA and BLS data needed ...the consideration of hedonic methods, which are based on the system’s characteristics rather than the cost of components. The current BEA index, for...engineering change orders. A hedonic price index, by comparison, would be based on the aircraft’s “quality” variables—its physical and operational

Funding breakthrough therapies: A systematic review and recommendation.

PubMed

Hanna, E; Toumi, M; Dussart, C; Borissov, B; Dabbous, O; Badora, K; Auquier, P

2018-03-01

Advanced therapy medicinal products (ATMPs) are innovative therapies likely associated with high prices. Payers need guidance to create a balance between ensuring patient access to breakthrough therapies and maintaining the financial sustainability of the healthcare system. The aims of this study were to identify, define, classify and compare the approaches to funding high-cost medicines proposed in the literature, to analyze their appropriateness for ATMP funding and to suggest an optimal funding model for ATMPs. Forty-eight articles suggesting new funding models for innovative high-cost therapies were identified. The models were classified into 3 groups: financial agreement, health outcomes-based agreement and healthcoin. Financial agreement encompassed: discounts, rebates, price and volume caps, price-volume agreements, loans, cost-plus price, intellectual-based payment and fund-based payment. Health outcomes-based agreements were defined as agreements between manufacturers and payers based on drug performance, and were divided into performance-based payment and coverage with evidence development. Healthcoin described a new suggested tradeable currency used to assign monetary value to incremental outcomes. With a large number of ATMPs in development, it is time for stakeholders to start thinking about new pathways and funding strategies for these innovative high-cost therapies. An "ATMP-specific fund" may constitute a reasonable solution to ensure rapid patient access to innovation without threatening the sustainability of the health care system. Copyright © 2017 Elsevier B.V. All rights reserved.

Impact analysis of leading sub sector on basic sector to regional income in Siak Regency, Riau Province

NASA Astrophysics Data System (ADS)

Astuti, P.; Nugraha, I.; Abdillah, F.

2018-02-01

During this time Siak regency only known as oil producing regency in Riau province, but based on the vision of spatial planning Siak’s regency in 2031 there was a shift from petroleum towards to other sectors such as agribusiness, agroindustry and tourism. The purpose of this study was to identify the sector base, the leading subsectors and shift with their characteristics and to identify the leading subsectors development priority. The method used in this research consisted of the method of Location Quotient (LQ, Shift Share, and Overlay method). The research results were used Location Quotient (LQ) to identify sector’s base in Siak regency based on the document of PDRB. The sector’s refers to the constant prices year of 2000 were mining and quarrying sector (2.25). The sector’s base using document of PDRB at constant prices 2000 without oil and gas sector was the agricultural sector with a value of LQ was 2,45. The leading sub sector in the Siak regency with mining and quarrying sector was oil and gas (1.02) and leading sub sector without oil and gas sector was the plantation sector (1.48) and forestry sector (1.73). Overlay analysis results shown that agriculture sector as a sector base and plantation and forestry as a leading sub sector has positive value and categorize as progressive and competitiveness. Because of that, this leading sub sector gets high priority to developing.

Analysis of rice purchase decision on rice consumer in Bandung city

NASA Astrophysics Data System (ADS)

Kusno, K.; Imannurdin, A.; Syamsiyah, N.; Djuwendah, E.

2018-03-01

This study was conducted at three kinds of purchase location which were traditional market, rice kiosk, and supermarket in Bandung City, with survey data of 108 respondents which were selected by systematic random sampling. The aim of this study is to (1) identify consumer characteristics, (2) identify which atribute is considered by consumer in buying rice, and (3) analyze the relationship between purchase decision and income class. Data were analyzed by descriptive analysis and Chi Square test. The results showed most consumers in the traditional market were middle-educated and lower middle-income, at the rice kiosk, the consumer were generally middle-educated and middle-income, and in the supermarkets, the majority were high-educated and upper middle-income consumers. “Kepulenan” be the first priority of most consumers, but for the lower-middle class, the main priority was price. Thus, in case of scarcity and rice price increase, the government should immediately arrange market operations which targeting to lower-middle class consumers. There was a significant relationship between (1) the quality of rice consumed, (2) the frequency of rice purchase per month, and (3) attitudes toward rice price increase; each with the income class. Although the price of rice increase, consumers of middle and upper-middle were remain loyal to the quality of rice they consumed. This indicates rice market in Bandung city is an ideal market for premium rice so that traders and producers are expected to maintain the quality of rice, such as keep using superior seeds and applying good cultivation based on Good Agricultural Practice (GAP) rules.

Multi-attribute Regret-Based Dynamic Pricing

NASA Astrophysics Data System (ADS)

Jumadinova, Janyl; Dasgupta, Prithviraj

In this paper, we consider the problem of dynamic pricing by a set of competing sellers in an information economy where buyers differentiate products along multiple attributes, and buyer preferences can change temporally. Previous research in this area has either focused on dynamic pricing along a limited number of (e.g. binary) attributes, or, assumes that each seller has access to private information such as preference distribution of buyers, and profit/price information of other sellers. However, in real information markets, private information about buyers and sellers cannot be assumed to be available a priori. Moreover, due to the competition between sellers, each seller faces a tradeoff between accuracy and rapidity of the pricing mechanism. In this paper, we describe a multi-attribute dynamic pricing algorithm based on minimax regret that can be used by a seller's agent called a pricebot, to maximize the seller's utility. Our simulation results show that the minimax regret based dynamic pricing algorithm performs significantly better than other algorithms for rapidly and dynamically tracking consumer attributes without using any private information from either buyers or sellers.

Methods and tools to simulate the effect of economic instruments in complex water resources systems. Application to the Jucar river basin.

NASA Astrophysics Data System (ADS)

Lopez-Nicolas, Antonio; Pulido-Velazquez, Manuel

2014-05-01

The main challenge of the BLUEPRINT to safeguard Europe's water resources (EC, 2012) is to guarantee that enough good quality water is available for people's needs, the economy and the environment. In this sense, economic policy instruments such as water pricing policies and water markets can be applied to enhance efficient use of water. This paper presents a method based on hydro-economic tools to assess the effect of economic instruments on water resource systems. Hydro-economic models allow integrated analysis of water supply, demand and infrastructure operation at the river basin scale, by simultaneously combining engineering, hydrologic and economic aspects of water resources management. The method made use of the simulation and optimization hydroeconomic tools SIMGAMS and OPTIGAMS. The simulation tool SIMGAMS allocates water resources among the users according to priorities and operating rules, and evaluate economic scarcity costs of the system by using economic demand functions. The model's objective function is designed so that the system aims to meet the operational targets (ranked according to priorities) at each month while following the system operating rules. The optimization tool OPTIGAMS allocates water resources based on an economic efficiency criterion: maximize net benefits, or alternatively, minimizing the total water scarcity and operating cost of water use. SIMGAS allows to simulate incentive water pricing policies based on marginal resource opportunity costs (MROC; Pulido-Velazquez et al., 2013). Storage-dependent step pricing functions are derived from the time series of MROC values at a certain reservoir in the system. These water pricing policies are defined based on water availability in the system (scarcity pricing), so that when water storage is high, the MROC is low, while low storage (drought periods) will be associated to high MROC and therefore, high prices. We also illustrate the use of OPTIGAMS to simulate the effect of ideal water markets by economic optimization, without considering the potential effect of transaction costs. These methods and tools have been applied to the Jucar River basin (Spain). The results show the potential of economic instruments in setting incentives for a more efficient management of water resources systems. Acknowledgments: The study has been partially supported by the European Community 7th Framework Project (GENESIS project, n. 226536), SAWARES (Plan Nacional I+D+i 2008-2011, CGL2009-13238-C02-01 and C02-02), SCARCE (Consolider-Ingenio 2010 CSD2009-00065) of the Spanish Ministry of Economy and Competitiveness; and EC 7th Framework Project ENHANCE (n. 308438) Reference: Pulido-Velazquez, M., Alvarez-Mendiola, E., and Andreu, J., 2013. Design of Efficient Water Pricing Policies Integrating Basinwide Resource Opportunity Costs. J. Water Resour. Plann. Manage., 139(5): 583-592.

Evolving Markets for Commercial, Civil, and Military Services

NASA Astrophysics Data System (ADS)

Kaplan, Marshall H.

2003-01-01

Recent commercial failures in the LEO market, declining budgets for research, and other political factors have made it difficult for entrepreneurs and financial institutions to realize returns from investments in new space transportation systems and satellites. This paper explores the major factors impacting future markets that make use of our space infrastructure. At the top of the list is the high cost of space access. This has been extremely expensive, and will continue to be expensive as long as space access remains low on the nation's priority list. While launch prices have generally been reduced over the past several years, they remain well above the elastic range of supply and demand. Our best estimate is that it will take an order of magnitude reduction to significantly expand the market. Projections about market segments that will represent future winners in space and launch demand forecasts are presented. Future markets, outside of traditional strongholds, are explored, including a long-term view of new commercial space activities, conventional and ambitious future/futuristic activities, and related business aspects.

75 FR 47871 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing of a Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-09

... primary means of access to end users. Vendors impose price restraints based upon their business models... revenue. Although the business models may differ, these vendors' pricing discipline is the same: they can... other producers of proprietary data products must understand and respond to these varying business...

78 FR 15791 - Self-Regulatory Organizations; NASDAQ OMX BX, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-12

... access to end Subscribers. Vendors impose price restraints based upon their business models. For example... revenue. Although the business models may differ, these vendors' pricing discipline is the same: they can... Substance of the Proposed Rule Change The Exchange proposes add new BX Rule 7026 (Distribution Models) to...

Open to All? Nationwide Evaluation of High-Priority Web Accessibility Considerations among Higher Education Websites

ERIC Educational Resources Information Center

Kimmons, Royce

2017-01-01

This study seeks to evaluate the basic Priority 1 web accessibility of all college and university websites in the US (n = 3141). Utilizing web scraping and automated content analysis, the study establishes that even in the case of high-priority, simple-to-address accessibility requirements, colleges and universities generally fail to make their…

Sensitivity of Rooftop PV Projections in the SunShot Vision Study to Market Assumptions

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

Drury, E.; Denholm, P.; Margolis, R.

2013-01-01

The SunShot Vision Study explored the potential growth of solar markets if solar prices decreased by about 75% from 2010 to 2020. The SolarDS model was used to simulate rooftop PV demand for this study, based on several PV market assumptions--future electricity rates, customer access to financing, and others--in addition to the SunShot PV price projections. This paper finds that modeled PV demand is highly sensitive to several non-price market assumptions, particularly PV financing parameters.

Energy services in the information age: The convergence of energy, communications, and information technologies

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

Centolella, P.A.

1998-07-01

Most of the economic efficiency benefits of electric restructuring--consumer choice based on price and risk preferences, efficient capacity utilization, capacity expansion that reflects marketability, and innovative products--depend upon consumer access to information and opportunities to respond to time- and location-specific prices and customized products. Information and communications technologies from back-room data management centers to intelligent consumer gateways will play an essential role in marketing energy services in a retail access environment. This paper describes the role of information and communications technology in electric industry restructuring and retailing of energy services. It includes a survey of economic analyses on the likelymore » variability in competitive generation prices and consumer responses if such prices are effectively communicated. The paper describes the potential benefits and cost savings associated with flexible consumer responses to price variability. It identifies consumer loads and preferences. Finally, the paper describes the building blocks of information systems being developed to facilitate price-responsive energy management and provide a range of other energy services. Intelligent gateways, analytical tools for facility load prediction and optimizing energy management responses, and electronic commerce applications are discussed.« less

Obesity and Supermarket Access: Proximity or Price?

PubMed Central

Aggarwal, Anju; Hurvitz, Philip M.; Monsivais, Pablo; Moudon, Anne V

2012-01-01

Objectives. We examined whether physical proximity to supermarkets or supermarket price was more strongly associated with obesity risk. Methods. The Seattle Obesity Study (SOS) collected and geocoded data on home addresses and food shopping destinations for a representative sample of adult residents of King County, Washington. Supermarkets were stratified into 3 price levels based on average cost of the market basket. Sociodemographic and health data were obtained from a telephone survey. Modified Poisson regression was used to test the associations between obesity and supermarket variables. Results. Only 1 in 7 respondents reported shopping at the nearest supermarket. The risk of obesity was not associated with street network distances between home and the nearest supermarket or the supermarket that SOS participants reported as their primary food source. The type of supermarket, by price, was found to be inversely and significantly associated with obesity rates, even after adjusting for individual-level sociodemographic and lifestyle variables, and proximity measures (adjusted relative risk = 0.34; 95% confidence interval = 0.19, 0.63) Conclusions. Improving physical access to supermarkets may be one strategy to deal with the obesity epidemic; improving economic access to healthy foods is another. PMID:22698052

Priority and Negotiation Based Dynamic Spectrum Allocation Scheme for Multiple Radio Access Network Operators

NASA Astrophysics Data System (ADS)

Kim, Hoon; Hyon, Taein; Lee, Yeonwoo

Most of previous works have presented the dynamic spectrum allocation (DSA) gain achieved by utilizing the time or regional variations in traffic demand between multi-network operators (NOs). In this paper, we introduce the functionalities required for the entities related with the spectrum sharing and allocation and propose a spectrum allocation algorithm while considering the long-term priority between NOs, the priority between multiple class services, and the urgent bandwidth request. To take into account the priorities among the NOs and the priorities of multiple class services, a spectrum sharing metric (SSM) is proposed, while a negotiation procedure is proposed to treat the urgent bandwidth request.

The value of price transparency in residential solar photovoltaic markets

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

O'Shaughnessy, Eric; Margolis, Robert

Installed prices for residential solar photovoltaic (PV) systems have declined significantly in recent years. However price dispersion and limited customer access to PV quotes prevents some prospective customers from obtaining low price offers. This study shows that improved customer access to prices - also known as price transparency - is a potential policy lever for further PV price reductions. We use customer search and strategic pricing theory to show that PV installation companies face incentives to offer lower prices in markets with more price transparency. We test this theoretical framework using a unique residential PV quote dataset. Our results showmore » that installers offer lower prices to customers that are expected to receive more quotes. Our study provides a rationale for policies to improve price transparency in residential PV markets.« less

The value of price transparency in residential solar photovoltaic markets

DOE PAGES

O'Shaughnessy, Eric; Margolis, Robert

2018-04-05

Installed prices for residential solar photovoltaic (PV) systems have declined significantly in recent years. However price dispersion and limited customer access to PV quotes prevents some prospective customers from obtaining low price offers. This study shows that improved customer access to prices - also known as price transparency - is a potential policy lever for further PV price reductions. We use customer search and strategic pricing theory to show that PV installation companies face incentives to offer lower prices in markets with more price transparency. We test this theoretical framework using a unique residential PV quote dataset. Our results showmore » that installers offer lower prices to customers that are expected to receive more quotes. Our study provides a rationale for policies to improve price transparency in residential PV markets.« less

Factors influencing the priority of access to food and their effects on the carcass traits for Japanese Black (Wagyu) cattle.

PubMed

Takanishi, N; Oishi, K; Kumagai, H; Uemura, M; Hirooka, H

2015-12-01

The factors influencing the priority of access to food and the effects of the priority of access to food on their carcass traits were analyzed for Japanese Black (Wagyu) cattle in a semi-intensive fattening production system. The records of 96 clinically healthy steers and heifers were analyzed. The calves at ∼3 to 4 months of age were allocated to pens with four animals per pen; all four animals in the same pen were of the same sex and of similar body size. The ranking of the animals' priority of access to food (1st, 2nd, 3rd and 4th), which was determined by the farm manager, was used as an indicator of social dominance in the present study. Four models including sire line, maternal grandsire line and the difference in the animals' birth dates as fixed effects were used to analyze factors influencing the priority of access to food. Ranking was represented by ordinal scores (highest=4, lowest=1) in Model 1, and the binary scores were assigned in Model 2 (highest=1; 2nd, 3rd and 4th=0), Model 3 (1st and 2nd=1; 3rd and 4th=0) and Model 4 (1st, 2nd and 3rd=1; lowest=0). The results showed that the difference in the animals' birth dates had a significant effect on the establishment of the priority of access to food in Model 3 (P<0.05), suggesting that animals born earlier may become more dominant in the pen. The maternal grandsire line tended to affect the social rank score in Models 2 and 3 (P<0.10). Our results indicated that the maternal grandsire line may affect the temperament of calves through their mothers' genetic performance and thereby more aggressive calves may be more dominant and have higher priority of access to food. On the other hand, there was a significant effect of the priority of access to food on beef marbling score (BMS; P<0.05), and the priority of access to food also tended to influence the carcass weight (P=0.09). The highest BMS was observed for animals with the first rank of the priority of access to food (P<0.05), and the higher-ranking animals had the tendency to be heavier carcass than the lower-ranking animals. Our findings emphasized the importance of information about the priority of access to food determined by farmers' own observation on implementing best management practices in small-scaled semi-intensive beef cattle production systems.

A survey of mobile phone use in the provision of palliative care services in the African region and priorities for future development.

PubMed

Allsop, Matthew J; Namisango, Eve; Powell, Richard A

2018-01-01

Introduction Palliative care (PC) services in the African region need to adapt to manage rising numbers of patients with cancer or other life-limiting conditions. Mobile phone use in healthcare delivery (mHealth) is at an early stage of development for PC, but may provide new approaches to supporting patients regionally, particularly those with non-communicable diseases. Methods We conducted an online survey of 51 PC providers across 21 countries in the African region to identify: (i) current mHealth use in PC service delivery; (ii) potential barriers to mHealth use; and (iii) provider priorities for research development. Results mHealth approaches were reported across 71.4% of services in which respondents were based. Barriers to mHealth research include patients not having access to phones, mobile network access, and limited access to expertise and hardware required for mHealth. Research priorities were identified which included exploring ways of incorporating mHealth into patient care and ensuring access and relevance of mHealth for patients and health professionals. Discussion mHealth approaches are present across PC services in the African region, but so too are barriers to their use. Further work is required to explore how existing mHealth activities might be further developed and aligned with priority areas for PC development. Crucially, user engagement that seeks to understand the preferences and priorities of patients with PC needs, their caregivers, and those involved in the provision of PC should remain central to these efforts.

A multi-center prospective cohort study to evaluate the effect of differential pricing and health systems strengthening on access to medicines and management of hypertension and diabetes in Ghana: A study protocol.

PubMed

Mobula, Linda Meta; Sarfo, Stephen; Arthur, Lynda; Burnham, Gilbert; Plange-Rhule, Jacob; Ansong, Daniel; Gavor, Edith; Ofori-Adjei, David

2018-02-07

Background: There is evidence to suggest that the prevalence of non-communicable diseases (NCDs), in particular cardiovascular diseases and diabetes, are being recognized as forming a substantial proportion of the burden of disease among populations in Low- and Middle-Income Countries (LMICs).  Access to treatment is likely a key barrier to the control and prevention of NCD outcomes.  Differential pricing, an approach used to price drugs based on the purchasing power of patients in different socioeconomic segments, has been shown to be beneficial and leads to improved access and affordability. Methods: This is a quasi-experimental study, with a pragmatic trial design, to be conducted over the course of three years. A mixed methods design will be used to evaluate the effects of health systems strengthening and differential pricing on the management of diabetes, hypertension and selected cancers in Ghana. A public private partnership was established between all sites that will receive multi-level interventions, including health systems strengthening  and access to medicines interventions. Study populations and sites: Study participants will include individuals with new or recently diagnosed hypertension and diabetes (n=3,300), who present to two major referral hospitals, Komfo Anokye Teaching Hospital and Tamale Teaching Hospital, as well as three district hospitals, namely Kings Medical Centre, Agogo Presbyterian District Hospital, and Atua Government Hospital. Discussion: The objective of this study aims to test approaches intended to improve access to drugs for the treatment of hypertension and diabetes, and improve disease control. Patients with these conditions will benefit from health systems strengthening interventions (education, counseling, improved management of disease), and increased access to innovative medicines via differential pricing. Pilot programs also will facilitate health system strengthening at the participating institutions, which includes training of clinicians and updating of guidelines and production of protocols for the treatment of diabetes, hypertension and cancer.

Evaluating the impact of climate policies on regional food availability and accessibility using an Integrated Assessment Model

NASA Astrophysics Data System (ADS)

Gilmore, E.; Cui, Y. R.; Waldhoff, S.

2015-12-01

Beyond 2015, eradicating hunger will remain a critical part of the global development agenda through the Sustainable Development Goals (SDG). Efforts to limit climate change through both mitigation of greenhouse gas emissions and land use policies may interact with food availability and accessibility in complex and unanticipated ways. Here, we develop projections of regional food accessibility to 2050 under the alternative futures outlined by the Shared Socioeconomic Pathways (SSPs) and under different climate policy targets and structures. We use the Global Change Assessment Model (GCAM), an integrated assessment model (IAM), for our projections. We calculate food access as the weighted average of consumption of five staples and the portion of income spend on those commodities and extend the GCAM calculated universal global producer price to regional consumer prices drawing on historical relationships of these prices. Along the SSPs, food access depends largely on expectations of increases in population and economic status. Under a more optimistic scenario, the pressures on food access from increasing demand and rising prices can be counterbalanced by faster economic development. Stringent climate policies that increase commodity prices, however, may hinder vulnerable regions, namely Sub-Saharan Africa, from achieving greater food accessibility.

Drug pricing and reimbursement decision making systems in Mongolia.

PubMed

Dorj, Gereltuya; Sunderland, Bruce; Sanjjav, Tsetsegmaa; Dorj, Gantuya; Gendenragchaa, Byambatsogt

2017-01-01

It is essential to allocate available resources equitably in order to ensure accessibility and affordability of essential medicines, especially in less fortunate nations with limited health funding. Currently, transparent and evidence based research is required to evaluate decision making regarding drug registration, drug pricing and reimbursement processes in Mongolia. To assess the drug reimbursement system and discuss challenges faced by policy-makers and stakeholders. The study has examined Mongolian administrative documents and directives for stakeholders and analysed published statistics. Experts and decision-makers were interviewed about the drug pricing and reimbursement processes in Mongolia. Decisions regarding Mongolian drug registration were based on commonly used criteria of quality, safety, efficacy plus some economic considerations. A total of 11.32 billion Mongolian National Tugrugs (MNT) [5.6 million United States Dollars (USD)] or 12.1% of total health expenditure was spent on patient reimbursement of essential drugs. The highest reimbursed drugs with respect to cost in 2014 were the cardiovascular drug group. Health insurance is compulsory for all citizens; in addition all insured patients have access to reimbursed drugs. However, the decision making process, in particular the level of reimbursement was limited by various barriers, including lack of evidence based data regarding efficacy and comparative cost-effectiveness analysis of drugs and decisions regarding reimbursement. Drug registration, pricing and reimbursement process in Mongolia show an increasing trend of drug registration and reimbursement rates, along with lack of transparency. Limited available data indicate that more evidence-based research studies are required in Mongolia to evaluate and improve the effectiveness of drug pricing and reimbursement policies.

Country and regional variations in purchase prices for essential cancer medications.

PubMed

Cuomo, Raphael E; Seidman, Robert L; Mackey, Tim K

2017-08-24

Accessibility to essential cancer medications in low- and middle-income countries is threatened by insufficient availability and affordability. The objective of this study is to characterize variation in transactional prices for essential cancer medications across geographies, medication type, and time. Drug purchase prices for 19 national and international buyers (representing 29 total countries) between 2010 and 2014 were obtained from Management Sciences for Health. Median values for drug pricing were computed, to address outliers in the data. For comparing purchase prices across geographic units, medications, and over time; Mann-Whitney U tests were used to compare two groups, Kruskal Wallis H tests were used to compare more than two groups, and linear regression was used to compare across continuous independent variables. During the five-year data period examined, the median price paid for a package of essential cancer medication was $12.63. No significant differences in prices were found based on country-level wealth, country-level disease burden, drug formulation, or year when medication was purchased. Statistical tests found significant differences in prices paid across countries, regions, individual medications, and medication categories. Specifically, countries in the Africa region appeared to pay more for a package of essential cancer medication than countries in the Latin America region, and cancer medications tended to be more expensive than anti-infective medications and cardiovascular medications. Though preliminary, our study found evidence of variation in prices paid by health systems to acquire essential cancer medications. Primarily, variations in pricing based on geographic location and cancer medication type (including when comparing to essential medicines that treat cardiovascular and infectious diseases) indicate that these factors may impact availability, affordability and access to essential cancer drugs. These factors should be taken into consideration when countries assess formulary decisions, negotiate drug procurement terms, and when formulating health and cancer policy.

76 FR 58068 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-19

... linkage and to change the treatment of customer orders subject to intermarket linkage in its Select..., both Priority Customer \\4\\ and Professional Customer \\5\\ orders on the ISE that are not executable on... price.\\6\\ Since the inception of maker/taker fees on the Exchange, Priority Customer orders in the...

Ends versus means: the role of markets in expanding access to contraceptives.

PubMed

Hanson, K; Kumaranayake, L; Thomas, I

2001-06-01

Achieving and sustaining universal access to contraceptives are key policy goals of interventions supplying contraceptive commodities. Donor support for contraceptive supplies is substantial and many public and national programmes rely on donated and subsidized supplies of contraceptives. Sustainability of programme benefits is a concern to both national governments and donor agencies. At the same time, market-based provision of contraceptives has become a major source of contraceptives for individuals in a number of countries. While the goals or 'ends' of policy are to increase and sustain universal access to contraceptives, there is debate about the role of markets and their negative impacts on equity and universality. There is also concern that while public programmes supplying free contraceptives may, in the medium-term, achieve high coverage, they may hamper the achievement of long-term sustainability and the development of commercial markets. This paper focuses on the tension between the public health and market paradigms, and uses economic analysis as a framework in order to examine the relative roles or 'means' for subsidized public and commercial private sector supply of contraceptives. The review of the theory and evidence focuses on the trade-offs between public sector and market provision of contraceptives, examining the role for the public sector given the potential for market failures, the impact of public provision on the development of markets, and the role of price in demand. However, because of the potential conflict between these policy objectives, we argue that strategies to deliver contraceptives should be based on the specific characteristics of the context. In particular four variables (contraceptive prevalence rates, HIV prevalence, income level of country, size and geographic spread of private sector development) are important in characterizing this context, and these are highlighted in a matrix of programme priorities. Public choices need to take into account the ways in which they will affect the potential for development of sustainable private sources of supply. Undertaking a 'market assessment' should be a key stage in the analysis of policy options. Such an assessment should address demand factors, health priorities, actual and potential sources of supply and the relationships between public and private supply. Clearly the development of markets for contraceptives is not an end in itself, but may prove an important means of improving the health of women and men.

Factors influencing reductions in smoking among Australian adolescents.

PubMed

Dessaix, Anita; Maag, Audrey; McKenzie, Jeanie; Currow, David C

2016-01-28

A continued increase in the proportion of adolescents who never smoke, as well as an understanding of factors that influence reductions in smoking among this susceptible population, is crucial. The World Health Organization Framework Convention on Tobacco Control provides an appropriate structure to briefly examine Australian and New South Wales policies and programs that are influencing reductions in smoking among adolescents in Australia. This paper provides an overview of price and recent tax measures to reduce the demand for tobacco, the evolution of smoke-free environment policies, changes to tobacco labelling and packaging, public education campaigns, and restrictions to curb tobacco advertising. It also discusses supplyreduction measures that limit adolescents' access to tobacco products. Consideration is given to emerging priorities to achieve continued declines in smoking by Australian adolescents.

Price-Transparency and Cost Accounting

PubMed Central

Eakin, Cynthia; Fischer, Katrina

2015-01-01

Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers. PMID:25862425

78 FR 48640 - Special Access Proceeding; Comment Deadline Extension

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-09

... CONTACT: William Layton, Pricing Policy Division, Wireline Competition Bureau, 202-418-0868 or William...-198. See 44 U.S.C. 3506(c)(4). For further information, please contact William Layton, Pricing Policy... its rules for granting pricing flexibility for the special access services provided by incumbent local...

47 CFR 51.907 - Transition of price cap carrier access charges.

Code of Federal Regulations, 2013 CFR

2013-10-01

... carrier shall, in accordance with bill-and-keep, as defined in § 51.713, revise and refile its interstate.... 51.907 Section 51.907 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.907 Transition of price cap...

47 CFR 51.907 - Transition of price cap carrier access charges.

Code of Federal Regulations, 2012 CFR

2012-10-01

... carrier shall, in accordance with bill-and-keep, as defined in § 51.713, revise and refile its interstate.... 51.907 Section 51.907 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.907 Transition of price cap...

Product pricing in the Solar Array Manufacturing Industry - An executive summary of SAMICS

NASA Technical Reports Server (NTRS)

Chamberlain, R. G.

1978-01-01

Capabilities, methodology, and a description of input data to the Solar Array Manufacturing Industry Costing Standards (SAMICS) are presented. SAMICS were developed to provide a standardized procedure and data base for comparing manufacturing processes of Low-cost Solar Array (LSA) subcontractors, guide the setting of research priorities, and assess the progress of LSA toward its hundred-fold cost reduction goal. SAMICS can be used to estimate the manufacturing costs and product prices and determine the impact of inflation, taxes, and interest rates, but it is limited by its ignoring the effects of the market supply and demand and an assumption that all factories operate in a production line mode. The SAMICS methodology defines the industry structure, hypothetical supplier companies, and manufacturing processes and maintains a body of standardized data which is used to compute the final product price. The input data includes the product description, the process characteristics, the equipment cost factors, and production data for the preparation of detailed cost estimates. Activities validating that SAMICS produced realistic price estimates and cost breakdowns are described.

Food mirages: geographic and economic barriers to healthful food access in Portland, Oregon.

PubMed

Breyer, Betsy; Voss-Andreae, Adriana

2013-11-01

This paper investigated the role of grocery store prices in structuring food access for low-income households in Portland, Oregon. We conducted a detailed healthful foods market basket survey and developed an index of store cost based on the USDA Thrifty Food Plan. Using this index, we estimated the difference in street-network distance between the nearest low-cost grocery store and the nearest grocery store irrespective of cost. Spatial regression of this metric in relation to income, poverty, and gentrification at the census tract scale lead to a new theory regarding food access in the urban landscape. Food deserts are sparse in Portland, but food mirages are abundant, particularly in gentrifying areas where poverty remains high. In a food mirage, grocery stores are plentiful but prices are beyond the means of low-income households, making them functionally equivalent to food deserts in that a long journey to obtain affordable, nutritious food is required in either case. Results suggested that evaluation of food environments should, at a minimum, consider both proximity and price in assessing healthy food access for low-income households. © 2013 Elsevier Ltd. All rights reserved.

Perspective of vaccine manufacturers on financing pediatric and adolescent vaccines in the United States.

PubMed

Shen, Angela K; Rodewald, Lance E; Birkhead, Guthrie S

2009-12-01

The goal was to understand vaccine manufacturers' perspectives on vaccine financing as a barrier to immunization. Individual telephone interviews with representatives of the 6 manufacturers that produce routinely recommended vaccines for children and adolescents in the United States were conducted in November and December 2006. Although manufacturers acknowledged that the price of newer vaccines presents challenges to optimal vaccine use, they asserted that children and adolescents have access to vaccinations through public and private insurance. Respondents suggested that the system could be improved through adequate funding of the public-sector safety net. Respondents stated that providers should receive timely reimbursement for the full costs of vaccine purchase and administration, and manufacturers who sell directly to health care providers may provide flexible payment terms for vaccine purchases. Manufacturers supported targeted expansion of the Vaccines for Children program to allow children with incomplete insurance coverage for vaccines to receive vaccines at health department clinics. Manufacturers perceived delays in publication of Advisory Committee on Immunization Practices recommendations as a potential barrier to vaccine uptake. They viewed the perceived lack of public value for vaccines as a potential barrier to adequate reimbursement and optimal utilization. Respondents also maintained that their ability to negotiate vaccine prices through the private market is a crucial priority. Manufacturers assert that children and adolescents have access to immunizations through public and private insurance. Manufacturers think that they have mitigated the challenge most directly in their control: the large financial outlays required for up-front vaccine purchases.

Characterizing health plan price estimator tools: findings from a national survey.

PubMed

Higgins, Aparna; Brainard, Nicole; Veselovskiy, German

2016-02-01

Policy makers have growing interest in price transparency and in the kinds of tools available to consumers. Health plans have implemented price estimator tools that make provider pricing information available to members; however, systematic data on prevalence and characteristics of such tools are limited. The purpose of this study was to describe the characteristics of price estimator tools offered by health plans to their members and to identify potential trends, challenges, and opportunities for advancing the utility of these tools. National Web-based survey. Between 2014 and 2015, we conducted a national Web-based survey of health plans with commercial enrollment (100 plans, 43% response rate). Descriptive analyses were conducted using survey data. Health plan members have access to a variety of price estimator tool capabilities for commonly used procedures. These tools take into account member characteristics, including member zip code and benefit design. Despite outreach to members, however, challenges remain with respect to member uptake of such tools. Our study found that health plans share price and provider performance data with their members.

Pharmacy access to sterile syringes for injection drug users: attitudes of participants in a syringe exchange program.

PubMed

Junge, B; Vlahov, D; Riley, E; Huettner, S; Brown, M; Beilenson, P

1999-01-01

To examine attitudes of participants of a van-based syringe exchange program (SEP) toward the hypothetical prospect of pharmacy-based syringe access. One-time, cross-sectional survey. Baltimore, Maryland. 206 injection drug users who participate in the Baltimore SEP. Face-to-face interviews. Location preferred for obtaining syringes, drug and syringe use, past experience with pharmacies, and willingness to pay. The sample was 67% men, 95% African American, and 95% unemployed; mean age was 39.8 years. A total of 19% of respondents had bought syringes at a pharmacy during the prior six months. Some 37% reported having been turned down when asking for syringes at a pharmacy, most commonly due to lack of identification to prove diabetic status (50%). If legal restrictions were lifted, 92% of respondents would obtain syringes from pharmacies, and would be willing to pay a mean price of $0.80 (median = $1.00) per syringe. Women were more likely than men to report the intention to switch from van-based SEP to pharmacy (57% versus 38%, p = .045). If current legal restrictions were lifted, pharmacies would be a viable syringe source appealing particularly to women, suggesting gender-specific access issues that should be addressed. The per-syringe price that study participants would be willing to pay exceeds typical retail prices, suggesting that pharmacists could charge enough per syringe to recoup operational costs.

Annuity payments can increase patient access to innovative cell and gene therapies under England’s net budget impact test

PubMed Central

Jørgensen, Jesper; Kefalas, Panos

2017-01-01

ABSTRACT Background: Cell and gene therapies have the potential to provide therapeutic breakthroughs, but the high costs of researching, developing, manufacturing and delivering them translate into prices that may challenge healthcare budgets. Various measures exist that aim to address the affordability challenge, including reducing price, limiting patient numbers and/or linking remuneration to product performance. Objective: To explore how the net budget impact test recently introduced in England can affect patient access to high-value, one-off cell and gene therapies, and how managed entry agreements can improve access. Methods: We use a hypothetical example where a new high-value, one-off therapy launches in an indication where it displaces a relatively low cost chronic treatment. We calculate the number of patients that can be treated without exceeding the £20 million net budget impact threshold, and compare results for scenarios where a full upfront payment is used, and where annuity-based payments are used. Results: Charging a full upfront payment at the time of treatment can lead to suboptimal patient access. Conclusion: Annuity-based payments in combination with an outcomes-based remuneration scheme reduce consequences of decision uncertainty and can increase patient access, without exceeding the net budget impact test. PMID:28839525

Differential pricing of new pharmaceuticals in lower income European countries.

PubMed

Kaló, Zoltán; Annemans, Lieven; Garrison, Louis P

2013-12-01

Pharmaceutical companies adjust the pricing strategy of innovative medicines to the imperatives of their major markets. The ability of payers to influence the ex-factory price of new drugs depends on country population size and income per capita, among other factors. Differential pricing based on Ramsey principles is a 'second-best' solution to correct the imperfections of the global market for innovative pharmaceuticals, and it is also consistent with standard norms of equity. This analysis summarizes the boundaries of differential pharmaceutical pricing for policymakers, payers and other stakeholders in lower-income countries, with special focus on Central-Eastern Europe, and describes the feasibility and implications of potential solutions to ensure lower pharmaceutical prices as compared to higher-income countries. European stakeholders, especially in Central-Eastern Europe and at the EU level, should understand the implications of increased transparency of pricing and should develop solutions to prevent the limited accessibility of new medicines in lower-income countries.

Periodicals Price Survey 2002: Doing the Digital Flip.

ERIC Educational Resources Information Center

Van Orsdel, Lee; Born, Kathleen

2002-01-01

Presents the annual periodicals price study. Highlights include average prices; cost histories; cost projections for future budgeting; electronic journal issues; flip pricing, defined as online access at the core of pricing negotiations; various pricing models; purchasing print at deeply discounted prices; and current trends in pricing and in the…

Final priorities; National Institute on Disability and Rehabilitation Research--Disability and Rehabilitation Research Projects and Centers Program--Rehabilitation Engineering Research Centers. Final priorities.

PubMed

2013-06-11

The Assistant Secretary for Special Education and Rehabilitative Services announces priorities under the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce priorities for a Rehabilitation Engineering Research Center (RERC) on Rehabilitation Strategies, Techniques, and Interventions (Priority 1), Information and Communication Technologies Access (Priority 2), Individual Mobility and Manipulation (Priority 3), and Physical Access and Transportation (Priority 4). The Assistant Secretary may use one or more of these priorities for competitions in fiscal year (FY) 2013 and later years. We take this action to focus research attention on areas of national need. We intend these priorities to improve community living and participation, health and function, and employment outcomes of individuals with disabilities.

76 FR 59754 - Self-Regulatory Organizations; C2 Options Exchange, Incorporated; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-27

... priority allocation algorithm for the SPXPM option class,\\5\\ subject to certain conditions. \\5\\ SPXPM is... algorithm in effect for the class, subject to various conditions set forth in subparagraphs (b)(3)(A... permit the allocation algorithm in effect for AIM in the SPXPM option class to be the price-time priority...

77 FR 74247 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing And Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-13

... outcry specifically provides the following: (1) If an OTP Holder or OTP Firm purchases (sells) one or... priority in purchasing (selling) up to the equivalent number of option contracts of the same series that the OTP Holder or OTP Firm purchased (sold) at the higher (lower) price or prices, provided that the...

Modeling HIV/AIDS Drug Price Determinants in Brazil: Is Generic Competition a Myth?

PubMed Central

Meiners, Constance; Sagaon-Teyssier, Luis; Hasenclever, Lia; Moatti, Jean-Paul

2011-01-01

Background Brazil became the first developing country to guarantee free and universal access to HIV/AIDS treatment, with antiretroviral drugs (ARVs) being delivered to nearly 190,000 patients. The analysis of ARV price evolution and market dynamics in Brazil can help anticipate issues soon to afflict other developing countries, as the 2010 revision of the World Health Organization guidelines shifts demand towards more expensive treatments, and, at the same time, current evolution of international legislation and trade agreements on intellectual property rights may reduce availability of generic drugs for HIV care. Methods and Findings Our analyses are based on effective prices paid for ARV procurement in Brazil between 1996 and 2009. Data panel structure was exploited to gather ex-ante and ex-post information and address various sources of statistical bias. In-difference estimation offered in-depth information on ARV market characteristics which significantly influence prices. Although overall ARV prices follow a declining trend, changing characteristics in the generic segment help explain recent increase in generic ARV prices. Our results show that generic suppliers are more likely to respond to factors influencing demand size and market competition, while originator suppliers tend to set prices strategically to offset compulsory licensing threats and generic competition. Significance In order to guarantee the long term sustainability of access to antiretroviral treatment, our findings highlight the importance of preserving and stimulating generic market dynamics to sustain developing countries' bargaining power in price negotiations undertaken with originator companies. PMID:21858138

Modeling HIV/AIDS drug price determinants in Brazil: is generic competition a myth?

PubMed

Meiners, Constance; Sagaon-Teyssier, Luis; Hasenclever, Lia; Moatti, Jean-Paul

2011-01-01

Brazil became the first developing country to guarantee free and universal access to HIV/AIDS treatment, with antiretroviral drugs (ARVs) being delivered to nearly 190,000 patients. The analysis of ARV price evolution and market dynamics in Brazil can help anticipate issues soon to afflict other developing countries, as the 2010 revision of the World Health Organization guidelines shifts demand towards more expensive treatments, and, at the same time, current evolution of international legislation and trade agreements on intellectual property rights may reduce availability of generic drugs for HIV care. Our analyses are based on effective prices paid for ARV procurement in Brazil between 1996 and 2009. Data panel structure was exploited to gather ex-ante and ex-post information and address various sources of statistical bias. In-difference estimation offered in-depth information on ARV market characteristics which significantly influence prices. Although overall ARV prices follow a declining trend, changing characteristics in the generic segment help explain recent increase in generic ARV prices. Our results show that generic suppliers are more likely to respond to factors influencing demand size and market competition, while originator suppliers tend to set prices strategically to offset compulsory licensing threats and generic competition. In order to guarantee the long term sustainability of access to antiretroviral treatment, our findings highlight the importance of preserving and stimulating generic market dynamics to sustain developing countries' bargaining power in price negotiations undertaken with originator companies.

Youth and Violence. Medicine, Nursing, and Public Health: Connecting the Dots To Prevent Violence.

ERIC Educational Resources Information Center

American Journal of Health Education, 2001

2001-01-01

Proposes solutions to youth violence which encompass action across seven priorities. Within each priority, strategic recommendations and action steps for change are included. Priorities include: support the development of healthy families; promote healthy communities; increase access to health and mental health care services; reduce access to and…

Coupling mechanism of electric vehicle and grid under the background of smart grid

NASA Astrophysics Data System (ADS)

Dong, Mingyu; Li, Dezhi; Chen, Rongjun; Shu, Han; He, Yongxiu

2018-02-01

With the development of smart distribution technology in the future, electric vehicle users can not only charge reasonably based on peak-valley price, they can also discharge electricity into the power grid to realize their economic benefit when it’s necessary and thus promote peak load shifting. According to the characteristic that future electric vehicles can discharge, this paper studies the interaction effect between electric vehicles and the grid based on TOU (time of use) Price Strategy. In this paper, four scenarios are used to compare the change of grid load after implementing TOU Price Strategy. The results show that the wide access of electric vehicles can effectively reduce peak and valley difference.

Capacity allocation mechanism based on differentiated QoS in 60 GHz radio-over-fiber local access network

NASA Astrophysics Data System (ADS)

Kou, Yanbin; Liu, Siming; Zhang, Weiheng; Shen, Guansheng; Tian, Huiping

2017-03-01

We present a dynamic capacity allocation mechanism based on the Quality of Service (QoS) for different mobile users (MU) in 60 GHz radio-over-fiber (RoF) local access networks. The proposed mechanism is capable for collecting the request information of MUs to build a full list of MU capacity demands and service types at the Central Office (CO). A hybrid algorithm is introduced to implement the capacity allocation which can satisfy the requirements of different MUs at different network traffic loads. Compared with the weight dynamic frames assignment (WDFA) scheme, the Hybrid scheme can keep high priority MUs in low delay and maintain the packet loss rate less than 1% simultaneously. At the same time, low priority MUs have a relatively better performance.

Evaluating Drug Prices, Availability, Affordability, and Price Components: Implications for Access to Drugs in Malaysia

PubMed Central

Babar, Zaheer Ud Din; Ibrahim, Mohamed Izham Mohamed; Singh, Harpal; Bukahri, Nadeem Irfan; Creese, Andrew

2007-01-01

Background Malaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components. Methods and Findings The methodology developed by the World Health Organization (WHO) and Health Action International (HAI) was used. Price and availability data for 48 medicines was collected from 20 public sector facilities, 32 private sector retail pharmacies and 20 dispensing doctors in four geographical regions of West Malaysia. Medicine prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of medicines. Price component data were collected throughout the supply chain, and markups, taxes, and other distribution costs were identified. In private pharmacies, innovator brand (IB) prices were 16 times higher than the IRPs, while generics were 6.6 times higher. In dispensing doctor clinics, the figures were 15 times higher for innovator brands and 7.5 for generics. Dispensing doctors applied high markups of 50%–76% for IBs, and up to 316% for generics. Retail pharmacy markups were also high—25%–38% and 100%–140% for IBs and generics, respectively. In the public sector, where medicines are free, availability was low even for medicines on the National Essential Drugs List. For a month's treatment for peptic ulcer disease and hypertension people have to pay about a week's wages in the private sector. Conclusions The free market by definition does not control medicine prices, necessitating price monitoring and control mechanisms. Markups for generic products are greater than for IBs. Reducing the base price without controlling markups may increase profits for retailers and dispensing doctors without reducing the price paid by end users. To increase access and affordability, promotion of generic medicines and improved availability of medicines in the public sector are required. PMID:17388660

Evaluating drug prices, availability, affordability, and price components: implications for access to drugs in Malaysia.

PubMed

Babar, Zaheer Ud Din; Ibrahim, Mohamed Izham Mohamed; Singh, Harpal; Bukahri, Nadeem Irfan; Creese, Andrew

2007-03-27

Malaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components. The methodology developed by the World Health Organization (WHO) and Health Action International (HAI) was used. Price and availability data for 48 medicines was collected from 20 public sector facilities, 32 private sector retail pharmacies and 20 dispensing doctors in four geographical regions of West Malaysia. Medicine prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of medicines. Price component data were collected throughout the supply chain, and markups, taxes, and other distribution costs were identified. In private pharmacies, innovator brand (IB) prices were 16 times higher than the IRPs, while generics were 6.6 times higher. In dispensing doctor clinics, the figures were 15 times higher for innovator brands and 7.5 for generics. Dispensing doctors applied high markups of 50%-76% for IBs, and up to 316% for generics. Retail pharmacy markups were also high-25%-38% and 100%-140% for IBs and generics, respectively. In the public sector, where medicines are free, availability was low even for medicines on the National Essential Drugs List. For a month's treatment for peptic ulcer disease and hypertension people have to pay about a week's wages in the private sector. The free market by definition does not control medicine prices, necessitating price monitoring and control mechanisms. Markups for generic products are greater than for IBs. Reducing the base price without controlling markups may increase profits for retailers and dispensing doctors without reducing the price paid by end users. To increase access and affordability, promotion of generic medicines and improved availability of medicines in the public sector are required.

3D Printed Fluidic Hardware for DNA Assembly

DTIC Science & Technology

2015-04-10

A3909 stepper motor driver, were soldered onto the milled circuit board (Supplementary Figure 8). Custom Arduino - based firmware was written to take...initiatives such as the FabLab Foundation10. Access to digital fabrication tools and open electronics, such as Arduino and Raspberry Pi, enables access to...hardware for assembly of DNA- based genetic circuits. Solid-phase DNA synthesis has declined in price, enabling researchers to routinely design and

Recombinant Human Insulin in Global Diabetes Management – Focus on Clinical Efficacy

PubMed Central

Mbanya, Jean Claude; Sandow, Juergen; Landgraf, Wolfgang

2017-01-01

Abstract Biosynthetic human insulin and insulin analogues are the mainstay of insulin therapy for both type 1 and type 2 diabetes although access to human insulin at affordable prices remains a global issue. The world is experiencing an exponential rise in the prevalence of diabetes presenting an urgent need to establish effective diabetes therapy in countries burdened by inadequate health care budgets, malnutrition and infectious diseases. Recombinant human insulin has replaced animal insulins and animal-based semisynthetic human insulin thereby available in sufficient quantities and at affordable prices able to provide global access to insulin therapy. In many patients, analog insulins can offer additional clinical benefit, although at a considerably higher price thus severely restricting availability in low income countries. The approval process for recombinant human insulins (i.e. biosimilars) and analogue insulins is highly variable in the developing countries in contrast to Europe and in North America, where it is well established within a strict regulatory framework. This review aims to discuss the future access to human insulin therapy in a global context with an ever increasing burden of diabetes and significant economic implications. PMID:29632602

Evaluation of concurrent priority queue algorithms. Technical report

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

Huang, Q.

1991-02-01

The priority queue is a fundamental data structure that is used in a large variety of parallel algorithms, such as multiprocessor scheduling and parallel best-first search of state-space graphs. This thesis addresses the design and experimental evaluation of two novel concurrent priority queues: a parallel Fibonacci heap and a concurrent priority pool, and compares them with the concurrent binary heap. The parallel Fibonacci heap is based on the sequential Fibonacci heap, which is theoretically the most efficient data structure for sequential priority queues. This scheme not only preserves the efficient operation time bounds of its sequential counterpart, but also hasmore » very low contention by distributing locks over the entire data structure. The experimental results show its linearly scalable throughput and speedup up to as many processors as tested (currently 18). A concurrent access scheme for a doubly linked list is described as part of the implementation of the parallel Fibonacci heap. The concurrent priority pool is based on the concurrent B-tree and the concurrent pool. The concurrent priority pool has the highest throughput among the priority queues studied. Like the parallel Fibonacci heap, the concurrent priority pool scales linearly up to as many processors as tested. The priority queues are evaluated in terms of throughput and speedup. Some applications of concurrent priority queues such as the vertex cover problem and the single source shortest path problem are tested.« less

Proposed 'grant-and-access' program with price caps could stimulate development of drugs for very rare diseases.

PubMed

Valverde, Ana M; Reed, Shelby D; Schulman, Kevin A

2012-11-01

The 1983 Orphan Drug Act created incentives for the development of orphan drugs. Despite its successes, including a substantial increase in new drugs, approved orphan drugs still treat fewer than 5 percent of registered rare diseases. In addition, concerns have arisen about the high prices of many of these therapies, which can cost hundreds of thousands of dollars per patient each year. In this article, we propose a new "grant-and-access pathway," in which drug developers could opt to compete for federal grants to subsidize the costs of clinical testing. In return for the grant funding, companies would no longer claim orphan drug tax credits and would agree to price caps for marketed products based on the duration and costs associated with drug development, expected market size, and target rate of return. We identify scenarios in which such a policy could provide a net benefit to society.

International lessons in new methods for grading and integrating cost effectiveness evidence into clinical practice guidelines.

PubMed

Antioch, Kathryn M; Drummond, Michael F; Niessen, Louis W; Vondeling, Hindrik

2017-01-01

Economic evidence is influential in health technology assessment world-wide. Clinical Practice Guidelines (CPG) can enable economists to include economic information on health care provision. Application of economic evidence in CPGs, and its integration into clinical practice and national decision making is hampered by objections from professions, paucity of economic evidence or lack of policy commitment. The use of state-of-art economic methodologies will improve this. Economic evidence can be graded by 'checklists' to establish the best evidence for decision making given methodological rigor. New economic evaluation checklists, Multi-Criteria Decision Analyses (MCDA) and other decision criteria enable health economists to impact on decision making world-wide. We analyse the methodologies for integrating economic evidence into CPG agencies globally, including the Agency of Health Research and Quality (AHRQ) in the USA, National Health and Medical Research Council (NHMRC) and Australian political reforms. The Guidelines and Economists Network International (GENI) Board members from Australia, UK, Canada and Denmark presented the findings at the conference of the International Health Economists Association (IHEA) and we report conclusions and developments since. The Consolidated Guidelines for the Reporting of Economic Evaluations (CHEERS) 24 item check list can be used by AHRQ, NHMRC, other CPG and health organisations, in conjunction with the Drummond ten-point check list and a questionnaire that scores that checklist for grading studies, when assessing economic evidence. Cost-effectiveness Analysis (CEA) thresholds, opportunity cost and willingness-to-pay (WTP) are crucial issues for decision rules in CEA generally, including end-of-life therapies. Limitations of inter-rater reliability in checklists can be addressed by including more than one assessor to reach a consensus, especially when impacting on treatment decisions. We identify priority areas to generate economic evidence for CPGs by NHMRC, AHRQ, and other agencies. The evidence may cover demand for care issues such as involved time, logistics, innovation price, price sensitivity, substitutes and complements, WTP, absenteeism and presentism. Supply issues may include economies of scale, efficiency changes, and return on investment. Involved equity and efficiency measures may include cost-of-illness, disease burden, quality-of-life, budget impact, cost-effective ratios, net benefits and disparities in access and outcomes. Priority setting remains essential and trade-off decisions between policy criteria can be based on MCDA, both in evidence based clinical medicine and in health planning.

Public transparency Web sites for radiology practices: prevalence of price, clinical quality, and service quality information.

PubMed

Rosenkrantz, Andrew B; Doshi, Ankur M

2016-01-01

To assess information regarding radiology practices on public transparency Web sites. Eight Web sites comparing radiology centers' price and quality were identified. Web site content was assessed. Six of eight Web sites reported examination prices. Other reported information included hours of operation (4/8), patient satisfaction (2/8), American College of Radiology (ACR) accreditation (3/8), on-site radiologists (2/8), as well as parking, accessibility, waiting area amenities, same/next-day reports, mammography follow-up rates, examination appropriateness, radiation dose, fellowship-trained radiologists, and advanced technologies (1/8 each). Transparency Web sites had a preponderance of price (and to a lesser extent service quality) information, risking fostering price-based competition at the expense of clinical quality. Copyright © 2016 Elsevier Inc. All rights reserved.

Temporary authorization for use: does the French patient access programme for unlicensed medicines impact market access after formal licensing?

PubMed

Degrassat-Théas, Albane; Paubel, Pascal; Parent de Curzon, Olivier; Le Pen, Claude; Sinègre, Martine

2013-04-01

To reach the French market, a new drug requires a marketing authorization (MA) and price and reimbursement agreements. These hurdles could delay access to new and promising drugs. Since 1992, French law authorizes the use of unlicensed drugs on an exceptional and temporary basis through a compassionate-use programme, known as Temporary Authorization for Use (ATU). This programme was implemented to improve early access to drugs under development or authorized abroad. However, it is suspected to be inflationary, bypassing public bodies in charge of health technology assessment (HTA) and of pricing. The aim of this study is to observe the market access after the formal licensing of drugs that went through this compassionate-use programme. We included all ATUs that received an MA between 1 January 2005 and 30 June 2010. We first examined market access delays from these drugs using the standard administrative path. We positioned this result in relation to launch delays observed in France (for all outpatient drugs) and in other major European markets. Second, we assessed the bargaining power of a hospital purchaser after those drugs had obtained an MA by calculating the price growth rate after the approval. During the study period, 77 ATUs were formally licensed. The study concluded that, from the patient's perspective, licensing and public bodies' review time was shortened by a combined total of 36 months. The projected 11-month review time of public bodies may be longer than delays usually observed for outpatient drugs. Nonetheless, the study revealed significant benefits for French patient access based on comparable processing to launch time with those of other European countries with tight price control policies. In return, a 12 % premium, on average, is paid to pharmaceutical companies while drugs are under this status (sub-analysis on 56 drugs). In many instances, the ATU programme responds to a public health need by accelerating the availability of new drugs even though this study suggests an impact of the programme on the market access of these drugs for which the standard administrative path is longer than usual. In addition, pharmaceutical companies seem to market compassionate-use drugs with a presumed benefit/risk ratio at a price that guarantees a margin for future negotiation.

Kappa Group: The initial guess. A proposal in response to a commercial air transportation study

NASA Technical Reports Server (NTRS)

1991-01-01

Kappa Aerospace presents their Aeroworld Aircraft, the Initial Guess (IG). This aircraft is designed to generate profit in the market which is currently controlled by the train and boat industry. The main priority of the design team was to develop an extremely efficient aircraft that could be sold at a reasonable price. The IG offers a quick and safe alternative to the existing means of transportation at a competitive price. The cruise velocity of 28 ft/sec. allows all flights to be between 20 and 45 minutes, which is a remarkable savings in time compared to travel by boat or train. The IG is propelled by a single Astro-05 engine with a Zinger 10-6 propeller. The Astro-05 is not an extremely powerful engine; however, it provides enough thrust to meet the design and safety requirements. The major advantage of the Astro-05 is that it is the most efficient engine available. The fuel efficiency of the Astro-05 is what puts the aircraft ahead of the competition. The money saved on an efficient engine can be passed on as lower ticket prices or increased revenue. The IG has a payload of 56 passengers and a wingspan of 7 ft. The 7 ft. wingspan allows the aircraft to fit into the gates of all of the cities that are targeted. Future endeavors of Kappa Aerospace will include fitting a stretch version of the IG with a larger propulsion system. This derivative aircraft will be able to carry more passengers and will be placed on the routes which have the greatest demand for travel. The fuselage and empennage are made of a wooden truss configuration, while the wing is made of a rib/spare configuration. The stress carrying elements are made of spruce, the nonstress carrying elements are made of balsa. The wing is removable for easy access into the fuselage. The easy access to the batteries will keep maintenance costs down.

Socioeconomic differentials and availability of domestic water in South Africa

NASA Astrophysics Data System (ADS)

Dungumaro, Esther W.

The past few decades has seen massive efforts to increasing provision of domestic water. However, water is still unavailable to many people most of them located in sub-Saharan Africa, South Asia and East Asia. Furthermore, availability of water varies greatly both spatially and temporary. While other people pay so dearly for domestic water others have an easy access to adequate clean water and sanitation. Accessibility and affordability of domestic water and sanitation is determined by a great variety of factors including socioeconomic status of households. The main objective of the paper is to inform on factors which need to be taken into account when coming up with projects to provide domestic water. It is more critical when the issue of water pricing comes into the equation. Water pricing has many facets, including equity, willingness to pay and affordability. In this premise, it is deemed important to understand the socioeconomic characteristics of the people before deciding on the amount of money they will have to pay for water consumption. It is argued that understanding people’s socioeconomic situation will greatly help to ensure that principles of sustainability and equity in water allocation and pricing are achieved. To do so, the paper utilized 2002 South Africa General Household Survey (GHS), to analyze socioeconomic variables and availability of domestic water. Analysis was mainly descriptive. However, logistic regression analysis was also utilized to determine the likelihood of living in a household that obtain water from a safe source. The study found that there is a strong relationship between availability of domestic water and socioeconomic conditions. Economic status, household size and to a lesser extent gender of head of household were found to be strong predictors of living in a household which obtained water from a safe source. The paper recommends that needs and priorities for interventions in water provision should take into account socioeconomic status of households.

The crisis in access to essential medicines in India: key issues which call for action.

PubMed

Bhargava, Anurag; Kalantri, S P

2013-01-01

The government is planning to introduce free generic and essential medicines in public health facilities. Most people in India buy healthcare from the private sector, a compulsion that accounts for a high proportion of healthcare-related expenditure. To reduce the burden of healthcare costs, the government must improve availability and affordability of generic and essential medicines in the market. It can do so because India's large pharmaceutical industry is a major source of generic medicines worldwide. In this article, we discuss three factors that have impeded access to generic and essential medicines: (1) mistaken notions among policymakers, prescribers and patients about branded drugs and generic drugs in India; (2) high prices of medicines due to the progressive dismantling of the system of regulation of medicine prices, and (3) a drug approval and regulatory system that allows medicines (including fixed dose combinations) of doubtful efficacy, rationale, safety and public health relevance to dominate the market at the cost of access to affordable generic and essential medicines. The consequences of ill-health and wasted expenditure on drugs raise issues of public health ethics.Improving access to essential medicines in India is an urgent public health and ethical imperative. This should include improved public provisioning, a system of regulation of drug prices, and an evidence-based drug approval process.

Community-Based Educational Experiences for Community Colleges.

ERIC Educational Resources Information Center

Gollattscheck, James F.

The following descriptive characteristics form the groundwork for a working definition of the concept of community-based education: (1) access to all; (2) continuous service to the learner throughout his life; (3) values and priorities based on the needs of the people; (4) recognition of the market; (5) flexibility; and (6) performance…

What are today's priorities in research?

PubMed

1994-01-01

The World Health Organization (WHO) Global Programme on AIDS has identified priority areas of HIV/AIDS-related research. Vaccine trials are need to evaluate their effectiveness and their accessibility and availability (supply and price) to developing countries with the greatest need. The pharmaceutical industry and national governments should work to develop microbicidal agents for use in the vagina. Research on the care of people with AIDS is needed to document the best way to provide their care in developing countries and to improve their quality of life. Another research priority is the resurgence of tuberculosis (TB): its association with HIV infection, and management of TB in areas where the HIV prevalence is high. WHO would like to see research establishing simplified case management regimes for the control and management of sexually transmitted diseases (STDs), STD case management that can be integrated into primary health care systems or at the primary health care level, simple and inexpensive diagnostic tests (particularly for women, who often are asymptomatic), and integration of STD management into family planning programs. More research needs to conducted on the availability and use of female condoms, so women can enhance their capability of protecting themselves. WHO would like more HIV/AIDS-related behavior research in the following areas: descriptive research, economic impact, community support, women's empowerment, and behavior change. HIV/AIDS-related researchers should ask themselves 3 fundamental questions: Does it work? What is the best way to do it? What does it cost?

Patient-Centred Care in Canada: Key Components and the Path Forward.

PubMed

Montague, Terrence; Gogovor, Amédé; Aylen, John; Ashley, Lisa; Ahmed, Sara; Martin, Lesli; Cochrane, Bonnie; Adams, Owen; Nemis-White, Joanna

2017-01-01

Canadians' health and its care continue to evolve. Chronic diseases affect more than 50% of our aging population, but the majority of public and professional stakeholders retain a sense of care quality. An emergent issue, however, is generating an increasingly wide debate. It is the concept of patient-centred care, including its definition of key components, and efficacy. To advance the evidence base, the 2013-2014 and 2016 Health Care in Canada (HCIC) surveys measured pan-stakeholder levels of support and implementation priorities for frequently proposed components of patient centricity in healthcare. The public's highest rated component was timely access to care, followed by perceived respect and caring in its delivery, with decisions made in partnership among patients and professional providers, and within a basic belief that care should be based on patients' needs versus their ability to pay. Health professionals' levels of support for key components largely overlapped the public's levels of support for key components, with an additional accent on care influenced by an evidence base and expert opinion. In terms of priority to actually implement enhanced patient-centred care options, timely access was universally dominant among all stakeholders. Caring, respectful care, also retained high implementation priority among both the public and professionals, as did care decisions made in partnership, and, among professionals, care driven by research and expert opinion. Low priorities, for both the public and professionals, were the actual measurements of patient-centred care delivery and its impact on outcomes. In summary, there is remarkable concordance among all stakeholders in terms of favoured interventions to enhance patient-centred care, namely, timely access, caring, partnering and communicative delivery of evidence-based care. Unfortunately, the lack of contemporary imperative around the value of measuring and reporting actual use and outcomes of favoured interventions means uncertainty of their efficacy will persist for the foreseeable future. Things can be better.

Price-transparency and cost accounting: challenges for health care organizations in the consumer-driven era.

PubMed

Hilsenrath, Peter; Eakin, Cynthia; Fischer, Katrina

2015-01-01

Health care reform is directed toward improving access and quality while containing costs. An essential part of this is improvement of pricing models to more accurately reflect the costs of providing care. Transparent prices that reflect costs are necessary to signal information to consumers and producers. This information is central in a consumer-driven marketplace. The rapid increase in high deductible insurance and other forms of cost sharing incentivizes the search for price information. The organizational ability to measure costs across a cycle of care is an integral component of creating value, and will play a greater role as reimbursements transition to episode-based care, value-based purchasing, and accountable care organization models. This article discusses use of activity-based costing (ABC) to better measure the cost of health care. It describes examples of ABC in health care organizations and discusses impediments to adoption in the United States including cultural and institutional barriers. © The Author(s) 2015.

Access to Medicines in Resource-limited Settings: The End of a Golden Decade?

PubMed Central

Ford, Nathan; Arkinstall, James

2012-01-01

Strong international mobilization and political will drove a golden decade for global health. Key initiatives over the last decade include setting of health-related Millennium Development Goals; the Commission on Macroeconomics and Health; the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Doha Declaration on the TRIPS Agreement and Public Health affirming countries' rights to protect public health when implementing patent rules; and the creation of product development partnerships to address neglected areas of research and development. Significant progress was made in reducing the incidence of and morbidity and mortality from human immunodeficiency virus (HIV), tuberculosis (TB), and malaria, with a major impact made through increased access to medicines. Antiretroviral treatment for HIV was expanded to 6.6 million people, and medication prices were reduced significantly through generic competition. However, donor support has started to decline at a time when many patients still wait for treatment and the prices of needed newer medicines are on the increase due to patent protection. TB incidence has started to decrease, but progress in diagnosis and treatment of multi-drug-resistant TB has been slow due to complexity of treatment and high drug costs. Promising new TB drugs in development need to be introduced rapidly and appropriately while treatment is being expanded. The introduction of more affordable artemisinin combination therapies for malaria contributed to significantly reducing malaria incidence and mortality, but challenges remain in ensuring that the latest recommendations for treating severe malaria are implemented. Looking to the next decade, there is a worrisome mismatch between additional health priorities accompanied by shifting burdens of disease that need to be addressed and dwindling political attention and financial support. Difficulties in producing and guaranteeing access to affordable medicines are expected from a changing pharmaceutical market where an appropriate balance between trade and health has not been found. Systematic changes through a global framework for research and development and access are needed to support increased innovation and access to the health tools of the next decade.

Air Force Journal of Logistics: Logistics Dimensions Improving Bare Base Agile Combat Support, The Path to Integration. Volume 28, Number 2

DTIC Science & Technology

2004-01-01

the system is balanced, there is the right flow of new pilots to match the availability of instructors for initial training missions, the right mix of...which attempted to redesign and streamline the DoD global distribution system , significantly improved delivery time to test locations.4 During its...somewhat confusing priority system that does not guarantee cargo delivery at a specific time and a pricing system that does not adequately differentiate

Tick size reduction and price clustering in a FX order book

NASA Astrophysics Data System (ADS)

Lallouache, Mehdi; Abergel, Frédéric

2014-12-01

We investigate the statistical properties of the EBS order book for the EUR/USD and USD/JPY currency pairs and the impact of a ten-fold tick size reduction on its dynamics. A large fraction of limit orders are still placed right at or halfway between the old allowed prices. This generates price barriers where the best quotes lie for much of the time, which causes the emergence of distinct peaks in the average shape of the book at round distances. Furthermore, we argue that this clustering is mainly due to manual traders who remained set to the old price resolution. Automatic traders easily take price priority by submitting limit orders one tick ahead of clusters, as shown by the prominence of buy (sell) limit orders posted with rightmost digit one (nine).

Estimating residential price elasticity of demand for water: A contingent valuation approach

NASA Astrophysics Data System (ADS)

Thomas, John F.; Syme, Geoffrey J.

1988-11-01

Residential households in Perth, Western Australia have access to privately extracted groundwater as well as a public mains water supply, which has been charged through a two-part block tariff. A contingent valuation approach is developed to estimate price elasticity of demand for public supply. Results are compared with those of a multivariate time series analysis. Validation tests for the contingent approach are proposed, based on a comparison of predicted behaviors following hypothesised price changes with relevant independent data. Properly conducted, the contingent approach appears to be reliable, applicable where the available data do not favor regression analysis, and a fruitful source of information about social, technical, and behavioral responses to change in the price of water.

Cautionary Notes on a Global Tiered Pricing Framework for Medicines

PubMed Central

Williams, Owain D.; Ooms, Gorik

2015-01-01

Recently, there has been a policy momentum toward creating a global tiered pricing framework, which would provide differentiated prices for medicines globally, based on each country’s capacity to pay. We studied the most influential proposals for a tiered pricing framework since the 1995 World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights. We synthesized 6 critical questions to be addressed for a global framework to function and explored the many challenges of implementation. Although we acknowledge that there is the potential for an exceptional global commitment that would benefit both producers and those in developing countries in need of wider access to medicines, our greatest concern is to ensure that a global framework does not price out the poor from pharmaceutical markets nor threaten current flexibilities within the international patent regime. PMID:25973806

Physicians' fees and public medical care programs.

PubMed Central

Lee, R H; Hadley, J

1981-01-01

In this article we develop and estimate a model of physicians' pricing that explicitly incorporates the effects of Medicare and Medicaid demand subsidies. Our analysis is based on a multiperiod model in which physicians are monopolistic competitors supplying services to several markets. The implications of the model are tested using data derived from claims submitted by a cohort of 1,200 California physicians during the years 1972-1975. We conclude that the demand for physician's services is relatively elastic; that increases in the local supply of physicians reduce prices somewhat; that physicians respond strategically to attempts to control prices through the customary-prevailing-reasonable system; and that price controls limit the rate of increase in physicians' prices. The analysis identifies a family of policies that recognize the monopsony power of public programs and may change the cost-access trade-off. PMID:7021479

IMPLICATIONS OF GLOBAL PRICING POLICIES ON ACCESS TO INNOVATIVE DRUGS: THE CASE OF TRASTUZUMAB IN SEVEN LATIN AMERICAN COUNTRIES.

PubMed

Pichon-Riviere, Andres; Garay, Osvaldo Ulises; Augustovski, Federico; Vallejos, Carlos; Huayanay, Leandro; Bueno, Maria del Pilar Navia; Rodriguez, Alarico; de Andrade, Carlos José Coelho; Buendía, Jefferson Antonio; Drummond, Michael

2015-01-01

Differential pricing, based on countries' purchasing power, is recommended by the World Health Organization to secure affordable medicines. However, in developing countries innovative drugs often have similar or even higher prices than in high-income countries. We evaluated the potential implications of trastuzumab global pricing policies in terms of cost-effectiveness (CE), coverage, and accessibility for patients with breast cancer in Latin America (LA). A Markov model was designed to estimate life-years (LYs), quality-adjusted life-years (QALYs), and costs from a healthcare perspective. To better fit local cancer prognosis, a base case scenario using transition probabilities from clinical trials was complemented with two alternative scenarios with transition probabilities adjusted to reflect breast cancer epidemiology in each country. Incremental discounted benefits ranged from 0.87 to 1.00 LY and 0.51 to 0.60 QALY and incremental CE ratios from USD 42,104 to USD 110,283 per QALY (2012 U.S. dollars), equivalent to 3.6 gross domestic product per capita (GDPPC) per QALY in Uruguay and to 35.5 GDPPC in Bolivia. Probabilistic sensitivity analysis showed 0 percent probability that trastuzumab is CE if the willingness-to-pay threshold is one GDPPC per QALY, and remained so at three GDPPC threshold except for Chile and Uruguay (4.3 percent and 26.6 percent, respectively). Trastuzumab price would need to decrease between 69.6 percent to 94.9 percent to became CE in LA. Although CE in other settings, trastuzumab was not CE in LA. The use of health technology assessment to prioritize resource allocation and support price negotiations is critical to making innovative drugs available and affordable in developing countries.

Carbon payments and low-cost conservation.

PubMed

Crossman, Neville D; Bryan, Brett A; Summers, David M

2011-08-01

A price on carbon is expected to generate demand for carbon offset schemes. This demand could drive investment in tree-based monocultures that provide higher carbon yields than diverse plantings of native tree and shrub species, which sequester less carbon but provide greater variation in vegetation structure and composition. Economic instruments such as species conservation banking, the creation and trading of credits that represent biological-diversity values on private land, could close the financial gap between monocultures and more diverse plantings by providing payments to individuals who plant diverse species in locations that contribute to conservation and restoration goals. We studied a highly modified agricultural system in southern Australia that is typical of many temperate agriculture zones globally (i.e., has a high proportion of endangered species, high levels of habitat fragmentation, and presence of non-native species). We quantified the economic returns from agriculture and from carbon plantings (monoculture and mixed tree and shrubs) under six carbon-price scenarios. We also identified high-priority locations for restoration of cleared landscapes with mixed tree and shrub carbon plantings. Depending on the price of carbon, direct annual payments to landowners of AU$7/ha/year to $125/ha/year (US$6-120/ha/year) may be sufficient to augment economic returns from a carbon market and encourage tree plantings that contribute more to the restoration of natural systems and endangered species habitats than monocultures. Thus, areas of high priority for conservation and restoration may be restored relatively cheaply in the presence of a carbon market. Overall, however, less carbon is sequestered by mixed native tree and shrub plantings. © 2011 Society for Conservation Biology.

Towards equitable access to medicines for the rural poor: analyses of insurance claims reveal rural pharmacy initiative triggers price competition in Kyrgyzstan.

PubMed

Waning, Brenda; Maddix, Jason; Tripodis, Yorghos; Laing, Richard; Leufkens, Hubert Gm; Gokhale, Manjusha

2009-12-14

A rural pharmacy initiative (RPI) designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI) private pharmacies located in the region. We conducted descriptive and multivariate analyses on medicine insurance claims data from Kyrgyzstan's Mandatory Health Insurance Fund for the Jumgal District of Naryn Province from October 2003 to December 2007. We compared average quarterly medicine prices in competitor pharmacies before and after the introduction of the rural pharmacy initiative in October 2004 to determine the RPI impact on price competition. Descriptive analyses suggest competitors reacted to RPI prices for 21 of 30 (70%) medicines. Competitor medicine prices from the quarter before RPI introduction to the end of the study period decreased for 17 of 30 (57%) medicines, increased for 4 of 30 (13%) medicines, and remained unchanged for 9 of 30 (30%) medicines. Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices. Multivariate analyses on 19 medicines that met sample size criteria confirm these findings. Fourteen of these 19 (74%) competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47%) decreasing in price and 5 of 19 (26%) increasing in price. The RPI served as a market driver, spurring competition in medicine prices in competitor pharmacies, even when they were located in different villages. Initiatives designed to increase equitable access to medicines in rural regions of developing and transitional countries should consider the potential to leverage medicine price competition as a means of achieving their goal. Evaluations of interventions to increase rural access to medicines should include impact assessment on both formal and informal pharmaceutical markets.

Final priority; National Institute on Disability and Rehabilitation Research--Rehabilitation Engineering Research Centers. Final priority.

PubMed

2014-07-09

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority for a Rehabilitation Engineering Research Center (RERC) on Improving the Accessibility, Usability, and Performance of Technology for Individuals who are Deaf or Hard of Hearing. The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years. We take this action to focus research attention on an area of national need. We intend the priority to contribute to improving the accessibility, usability, and performance of technology for individuals who are deaf or hard of hearing.

78 FR 24683 - Special Access for Price Cap Local Exchange Carriers; AT&T Corporation Petition for Rulemaking To...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-26

... FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 69 [WC Docket No. 05-25; RM-10593; FCC 12-153; DA 13-379] Special Access for Price Cap Local Exchange Carriers; AT&T Corporation Petition for Rulemaking To Reform Regulation of Incumbent Local Exchange Carrier Rates for Interstate Special Access Services AGENCY...

Price differentiation and transparency in the global pharmaceutical marketplace.

PubMed

Ridley, David B

2005-01-01

Pharmaceutical manufacturers have increased the availability of their products and sometimes increased their own financial returns by charging lower prices outside of the US and by discounting to lower-income patients in the US. Examples include discounted HIV-AIDS drugs in developing countries and pharmaceutical manufacturers' discount cards in the US. Representatives of some international organisations argue that the price reductions are insufficient to make the medications widely available to lower-income patients. The WHO advocates both differential pricing and price transparency. While its efforts are well meaning, this paper identifies six concerns about its methods of comparing the price of a given molecule across manufacturers and across countries. More significantly, the WHO efforts to increase transparency are likely to lead to less price differentiation and less access to innovative pharmaceuticals. An important reason why manufacturers are reluctant to charge lower prices in lower-income countries is that they fear that such low prices will undermine the prices they charge to higher-income consumers. International organisations should not facilitate transparency but should dissuade governments from making price comparisons and basing their prices on those of lower-income countries. Furthermore, they should endeavour to keep low-priced and free drugs in the hands of the low-income consumers for which they were intended.

Availability, price and promotions for cigarettes and non-cigarette tobacco products: an observational comparison of US Air Force bases with nearby tobacco retailers, 2016.

PubMed

Kong, Amanda Y; Golden, Shelley D; Myers, Allison E; Little, Melissa A; Klesges, Robert; Talcott, Wayne; Vandegrift, Sara M; Cassidy, Daniel G; Ribisl, Kurt M

2018-04-28

Active duty military personnel have higher cigarette and smokeless tobacco use rates than civilian populations. Although US Airmen (called Airmen regardless of gender or rank) are required to be tobacco-free during initial training, many resume use once this period ends, perhaps as a result of easy access to cheap tobacco products. Between July and September 2016, we collected tobacco product, price and promotion information by visiting on-base (n=28) and off-base (n=80) tobacco retailers near the eight technical training bases where approximately 99% of Airmen attend training. We conducted mixed linear effects models to examine on-base versus off-base differences. Cigarette packs were 11%-12% cheaper at on-base retailers compared with off-base retailers. Newport Menthol and Marlboro Red cigarette packs were $0.87 and $0.80 lower on-base (p<0.001) while the cheapest pack available was $0.54 lower on-base (p<0.01). Copenhagen smokeless tobacco was also significantly cheaper on-base (B=-0.65, p<0.01). Interior price promotions were more common on-base. Retail stores located on Air Force bases sell cigarettes and smokeless tobacco products at prices well below those in nearby off-base retailers: the vast majority of these retailers feature interior price promotions for these products. Federal policies regulating prices of on-base tobacco sales, if implemented more effectively, have the potential to protect the health of Airmen by helping them remain tobacco-free after technical training. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

American Academy of Dermatology

MedlinePlus

... Center News Advocacy priorities AADA Health System Reform Principles Drug pricing and availability CVS dermatologic formulary restrictions ... Us Media contacts Advertising contacts AAD logo Advertising, marketing and sponsorships Legal notice Copyright © 2017 American Academy ...

Availability, Accessibility, and Price of Rapid HIV Self-Tests, New York City Pharmacies, Summer 2013.

PubMed

Myers, Julie E; El-Sadr Davis, Olivia Y; Weinstein, Elliott R; Remch, Molly; Edelstein, Amy; Khawja, Amina; Schillinger, Julia A

2017-02-01

We conducted an in-person survey of New York City (NYC) pharmacies to assess the availability, accessibility, and price of the over-the-counter, rapid HIV self-test kit. NYC pharmacies were stratified into high, moderate and low morbidity neighborhoods by the HIV diagnosis rate of the neighborhood in which the pharmacy was located. A random sample of 500 pharmacies was taken [250 from high morbidity neighborhoods (HighMN) and 250 from low morbidity neighborhoods (LowMN)]. Pharmacies were excluded if: closed during survey, non-retail, or >10 min walk from subway. Project staff visited pharmacies to determine kit availability (in pharmacy on day of survey), accessibility (not locked/behind counter), and price (marked on shelf/product). Of 361 pharmacies (161 LowMN; 200 HighMN), kits were available in 27 % and accessible in 10 %; there was no difference by neighborhood. Kits were most often kept behind the pharmacy counter; this was more common in HighMN than in LowMN. Kits were kept solely behind the pharmacy counter in 52 %. Median price was US $42.99 without variability across neighborhoods. The rapid HIV self-test had limited availability and access in retail pharmacies. The high median price measured suggests that cost remained a barrier.

Extension of market exclusivity and its impact on the accessibility to essential medicines, and drug expense in Thailand: analysis of the effect of TRIPs-Plus proposal.

PubMed

Akaleephan, Chutima; Wibulpolprasert, Suwit; Sakulbumrungsil, Rungpetch; Luangruangrong, Paithip; Jitraknathee, Anchalee; Aeksaengsri, Achara; Udomaksorn, Siripa; Tangcharoensathien, Viroj; Tantivess, Sripen

2009-07-01

In Thailand and the US negotiating FTA, the 'TRIPs-Plus' is one of the US proposal which would result in an extension of market exclusivity of innovative drugs. In addition, it would foreseeably lead to high and unaffordable medicine prices and inaccessibility to essential medicines. To quantify the impact on medicine expense and medicine accessibility. Based on 2000 to 2003 Thai Food and Drug Administration (FDA)'s and the Drug & Medical Supply Information Center (DMSIC), costs and accessibility were estimated upon the price and quantity costing between innovative drugs and their generics plus some parameters found from their competitive behaviour. Thereafter, we simulated the 10-year potential additional expense on the 2003 unit price of the patented and monopolized non-patented medicines. In 2003, the availability of generics helped to save 104.5% of actual expense and the accessibility would increase by 53.6%. By extension of market exclusivity, given that there were 60 new items approved annually, the cumulative potential expense was projected to be $US 6.2 million for the first year to $US 5215.8 million in tenth year. The TRIPs-Plus proposal would result in a significant increase in the medicine expense; and a delay in the increase in drug accessibility via generics. Several options as well as other related mechanisms to help reduce the negative impact are proposed.

The price may not be right: the value of comparison shopping for prescription drugs.

PubMed

Arora, Sanjay; Sood, Neeraj; Terp, Sophie; Joyce, Geoffrey

2017-07-01

To measure variations in drug prices across and within zip codes that may reveal simple strategies to improve patients' access to prescribed medications. We compared drug prices at different types of pharmacies across and within local markets. In-store prices were compared with a Web-based service providing discount coupons for prescription medications. Prices were collected for 2 generic antibiotics because most patients have limited experience with them and are less likely to know the price ranges for them. Drug prices were obtained via telephone from 528 pharmacies in Los Angeles (LA) County, California, from July to August 2014. Online prices were collected from GoodRx, a popular Web-based service that aggregates available discounts and directly negotiates with retail outlets. Drug prices found at independent pharmacies and by using discount coupons available online were lower on average than at grocery, big-box, or chain drug stores for 2 widely prescribed antibiotics. The lowest-price prescription was offered at a grocery, big-box, or chain drug store in 6% of zip codes within the LA County area. Drug prices varied dramatically within a zip code, however, and were less expensive in lower-income areas. The average price difference within a zip code was $52 for levofloxacin and $17 for azithromycin. Price shopping for medications within a small geographic area can yield considerable cost savings for the uninsured and consumers in high-deductible health plans with high negotiated prices. Clinicians and patient advocates have an incentive to convey this information to patients to improve adherence to prescribed medicines and lower the financial burden of purchasing prescription drugs.

Can hydro-economic river basin models simulate water shadow prices under asymmetric access?

PubMed

Kuhn, A; Britz, W

2012-01-01

Hydro-economic river basin models (HERBM) based on mathematical programming are conventionally formulated as explicit 'aggregate optimization' problems with a single, aggregate objective function. Often unintended, this format implicitly assumes that decisions on water allocation are made via central planning or functioning markets such as to maximize social welfare. In the absence of perfect water markets, however, individually optimal decisions by water users will differ from the social optimum. Classical aggregate HERBMs cannot simulate that situation and thus might be unable to describe existing institutions governing access to water and might produce biased results for alternative ones. We propose a new solution format for HERBMs, based on the format of the mixed complementarity problem (MCP), where modified shadow price relations express spatial externalities resulting from asymmetric access to water use. This new problem format, as opposed to commonly used linear (LP) or non-linear programming (NLP) approaches, enables the simultaneous simulation of numerous 'independent optimization' decisions by multiple water users while maintaining physical interdependences based on water use and flow in the river basin. We show that the alternative problem format allows the formulation HERBMs that yield more realistic results when comparing different water management institutions.

Innovative Approaches to Increase Access to Medicines in Developing Countries

PubMed Central

Stevens, Hilde; Huys, Isabelle

2017-01-01

Access to essential medicines is problematic for one third of all persons worldwide. The price of many medicines (i.e., drugs, vaccines, and diagnostics) is unaffordable to the majority of the population in need, especially in least-developed countries, but also increasingly in middle-income countries. Several innovative approaches, based on partnerships, intellectual property, and pricing, are used to stimulate innovation, promote healthcare delivery, and reduce global health disparities. No single approach suffices, and therefore stakeholders need to further engage in partnerships promoting knowledge and technology transfer in assuring essential medicines to be manufactured, authorized, and distributed in low- and middle-income countries (LMICs) in an effort of making them available at affordable and acceptable conditions. PMID:29270407

Pricing by timing: innovating broadband data plans

NASA Astrophysics Data System (ADS)

Ha, Sangtae; Joe-Wong, Carlee; Sen, Soumya; Chiang, Mung

2012-01-01

Wireless Internet usage is doubling every year. Users are using more of high bandwidth data applications, and the heavy usage concentrates on several peak hours in a day, forcing ISPs to overprovision their networks accordingly. In order to remain profitable, ISPs have been using pricing as a congestion management tool. We review many of such pricing schemes in practice today and argue that they do not solve ISPs' problem of growing data traffic. We believe that dynamic, time-dependent usage pricing, which charges users based on when they access the Internet, can incentivize users to spread out their bandwidth consumption more evenly across different times of the day, thus helping ISPs to overcome the problem of peak congestion. Congestion pricing is not a new idea in itself, but the time for its implementation in data networks has finally arrived. Our key contribution lies in developing new analysis and a fully integrated system architecture, called TUBE (Time-dependent Usage-based Broadband price Engineering) that enables ISPs to implement the proposed TDP plan. The theory, simulation, and system implementation of TUBE system is further complemented with consumer surveys conducted in India and the US, along with preparations for a field trial that is currently underway.

Pricing and reimbursement of orphan drugs: the need for more transparency

PubMed Central

2011-01-01

Pricing and reimbursement of orphan drugs are an issue of high priority for policy makers, legislators, health care professionals, industry leaders, academics and patients. This study aims to conduct a literature review to provide insight into the drivers of orphan drug pricing and reimbursement. Although orphan drug pricing follows the same economic logic as drug pricing in general, the monopolistic power of orphan drugs results in high prices: a) orphan drugs benefit from a period of marketing exclusivity; b) few alternative health technologies are available; c) third-party payers and patients have limited negotiating power; d) manufacturers attempt to maximise orphan drug prices within the constraints of domestic pricing and reimbursement policies; and e) substantial R&D costs need to be recouped from a small number of patients. Although these conditions apply to some orphan drugs, they do not apply to all orphan drugs. Indeed, the small number of patients treated with an orphan drug and the limited economic viability of orphan drugs can be questioned in a number of cases. Additionally, manufacturers have an incentive to game the system by artificially creating monopolistic market conditions. Given their high price for an often modest effectiveness, orphan drugs are unlikely to provide value for money. However, additional criteria are used to inform reimbursement decisions in some countries. These criteria may include: the seriousness of the disease; the availability of other therapies to treat the disease; and the cost to the patient if the medicine is not reimbursed. Therefore, the maximum cost per unit of outcome that a health care payer is willing to pay for a drug could be set higher for orphan drugs to which society attaches a high social value. There is a need for a transparent and evidence-based approach towards orphan drug pricing and reimbursement. Such an approach should be targeted at demonstrating the relative effectiveness, cost-effectiveness and economic viability of orphan drugs with a view to informing pricing and reimbursement decisions. PMID:21682893

Pricing and reimbursement of orphan drugs: the need for more transparency.

PubMed

Simoens, Steven

2011-06-17

Pricing and reimbursement of orphan drugs are an issue of high priority for policy makers, legislators, health care professionals, industry leaders, academics and patients. This study aims to conduct a literature review to provide insight into the drivers of orphan drug pricing and reimbursement. Although orphan drug pricing follows the same economic logic as drug pricing in general, the monopolistic power of orphan drugs results in high prices: a) orphan drugs benefit from a period of marketing exclusivity; b) few alternative health technologies are available; c) third-party payers and patients have limited negotiating power; d) manufacturers attempt to maximise orphan drug prices within the constraints of domestic pricing and reimbursement policies; and e) substantial R&D costs need to be recouped from a small number of patients. Although these conditions apply to some orphan drugs, they do not apply to all orphan drugs. Indeed, the small number of patients treated with an orphan drug and the limited economic viability of orphan drugs can be questioned in a number of cases. Additionally, manufacturers have an incentive to game the system by artificially creating monopolistic market conditions. Given their high price for an often modest effectiveness, orphan drugs are unlikely to provide value for money. However, additional criteria are used to inform reimbursement decisions in some countries. These criteria may include: the seriousness of the disease; the availability of other therapies to treat the disease; and the cost to the patient if the medicine is not reimbursed. Therefore, the maximum cost per unit of outcome that a health care payer is willing to pay for a drug could be set higher for orphan drugs to which society attaches a high social value. There is a need for a transparent and evidence-based approach towards orphan drug pricing and reimbursement. Such an approach should be targeted at demonstrating the relative effectiveness, cost-effectiveness and economic viability of orphan drugs with a view to informing pricing and reimbursement decisions.

The contribution of the French Muskoka Fund to improving access to essential medicines and priority health products for mothers and children.

PubMed

Macé, C; Nikiema, J-B

2016-11-01

One objective of the French Muskoka Fund since 2011 has been to improve the availability of quality healthcare services for mothers and children and thus to contribute to the continued presence of essential drugs and affordable quality health products and to their rational use by healthcare personnel. This project thus contributed to reinforcing the work of the national regulatory authorities, guarantor of the quality of the products supplied to the populations, but also to strengthening the coordination of supplies at the country level. It also enabled the provision of support for the implementation of drug price controls and helped to strengthen the ability of healthcare staff to optimize their use of the products available to them. This work should be continued in these countries as they meet the agenda of the Sustainable Development Goals, which require the establishment of universal healthcare coverage.

Gaining Access to Late French-Immersion Programs: Class-Based Perspectives of Canadian Students in an Ottawa High School

ERIC Educational Resources Information Center

Makropoulos, Josee

2009-01-01

The question of access to French-immersion programs has become a timely subject in Canada as a result of shifting political priorities, cutbacks, and growing concern around finding the most efficient way to teach French as a second language (FSL). While drawing on social selection and identity perspectives on school choice, this article presents…

Spatial access priority mapping (SAPM) with fishers: a quantitative GIS method for participatory planning.

PubMed

Yates, Katherine L; Schoeman, David S

2013-01-01

Spatial management tools, such as marine spatial planning and marine protected areas, are playing an increasingly important role in attempts to improve marine management and accommodate conflicting needs. Robust data are needed to inform decisions among different planning options, and early inclusion of stakeholder involvement is widely regarded as vital for success. One of the biggest stakeholder groups, and the most likely to be adversely impacted by spatial restrictions, is the fishing community. In order to take their priorities into account, planners need to understand spatial variation in their perceived value of the sea. Here a readily accessible, novel method for quantitatively mapping fishers' spatial access priorities is presented. Spatial access priority mapping, or SAPM, uses only basic functions of standard spreadsheet and GIS software. Unlike the use of remote-sensing data, SAPM actively engages fishers in participatory mapping, documenting rather than inferring their priorities. By so doing, SAPM also facilitates the gathering of other useful data, such as local ecological knowledge. The method was tested and validated in Northern Ireland, where over 100 fishers participated in a semi-structured questionnaire and mapping exercise. The response rate was excellent, 97%, demonstrating fishers' willingness to be involved. The resultant maps are easily accessible and instantly informative, providing a very clear visual indication of which areas are most important for the fishers. The maps also provide quantitative data, which can be used to analyse the relative impact of different management options on the fishing industry and can be incorporated into planning software, such as MARXAN, to ensure that conservation goals can be met at minimum negative impact to the industry. This research shows how spatial access priority mapping can facilitate the early engagement of fishers and the ready incorporation of their priorities into the decision-making process in a transparent, quantitative way.

Pricing and reimbursement frameworks in Central Eastern Europe: a decision tool to support choices.

PubMed

Kolasa, Katarzyna; Kalo, Zoltan; Hornby, Edward

2015-02-01

Given limited financial resources in the Central Eastern European (CEE) region, challenges in obtaining access to innovative medical technologies are formidable. The objective of this research was to develop a decision tree that supports decision makers and drug manufacturers from CEE region in their search for optimal innovative pricing and reimbursement scheme (IPRSs). A systematic literature review was performed to search for published IPRSs, and then ten experts from the CEE region were interviewed to ascertain their opinions on these schemes. In total, 33 articles representing 46 unique IPRSs were analyzed. Based on our literature review and subsequent expert input, key decision nodes and branches of the decision tree were developed. The results indicate that outcome-based schemes are better suited to deal with uncertainties surrounding cost effectiveness, while non-outcome-based schemes are more appropriate for pricing and budget impact challenges.

Pharmaceutical Pricing and Market Access Outlook Europe 2010-HealthNetwork Communications' fourth annual conference. 24-25 March 2010, London, UK.

PubMed

Ogbighele, Erhimuvi

2010-05-01

The HealthNetwork Communications' Fourth Annual Conference on Pharmaceutical Pricing and Market Access Outlook Europe 2010, held in London, included topics covering the challenges facing the pharmaceutical industry, specifically related to pricing and reimbursement, and demonstrating the value of a pharmaceutical. This conference report highlights selected presentations on a global perspective on pricing and reimbursement, with an analysis of the specific, unique challenges in the six major markets, Europe, the US, Canada, Germany, the UK and Japan, and a discussion of the benefits of risk-sharing schemes.

Enhancing medicine price transparency through price information mechanisms

PubMed Central

2014-01-01

Background Medicine price information mechanisms provide an essential tool to countries that seek a better understanding of product availability, market prices and price compositions of individual medicines. To be effective and contribute to cost savings, these mechanisms need to consider prices in their particular contexts when comparing between countries. This article discusses in what ways medicine price information mechanisms can contribute to increased price transparency and how this may affect access to medicines for developing countries. Methods We used data collected during the course of a WHO project focusing on the development of a vaccine price and procurement information mechanism. The project collected information from six medicine price information mechanisms and interviewed data managers and technical experts on key aspects as well as observed market effects of these mechanisms. The reviewed mechanisms were broken down into categories including objective and target audience, as well as the sources, types and volumes of data included. Information provided by the mechanisms was reviewed according to data available on medicine prices, product characteristics, and procurement modalities. Results We found indications of positive effects on access to medicines resulting from the utilization of the reviewed mechanisms. These include the uptake of higher quality medicines, more favorable results from contract negotiations, changes in national pricing policies, and the decrease of prices in certain segments for countries participating in or deriving data from the various mechanisms. Conclusion The reviewed mechanisms avoid the methodological challenges observed for medicine price comparisons that only use national price databases. They work with high quality data and display prices in the appropriate context of procurement modalities as well as the peculiarities of purchasing countries. Medicine price information mechanisms respond to the need for increased medicine price transparency and have the potential to contribute to improved access to medicines in developing countries. Additional research is required to explore more specific aspects. These include the market effects of dedicated donor funds for certain medicines to explain the driving force of user demands, and the effects of increased price transparency on different groups of medicines in context of the maturity of their markets. PMID:24885767

Enhancing medicine price transparency through price information mechanisms.

PubMed

Hinsch, Michael; Kaddar, Miloud; Schmitt, Sarah

2014-05-08

Medicine price information mechanisms provide an essential tool to countries that seek a better understanding of product availability, market prices and price compositions of individual medicines. To be effective and contribute to cost savings, these mechanisms need to consider prices in their particular contexts when comparing between countries. This article discusses in what ways medicine price information mechanisms can contribute to increased price transparency and how this may affect access to medicines for developing countries. We used data collected during the course of a WHO project focusing on the development of a vaccine price and procurement information mechanism. The project collected information from six medicine price information mechanisms and interviewed data managers and technical experts on key aspects as well as observed market effects of these mechanisms.The reviewed mechanisms were broken down into categories including objective and target audience, as well as the sources, types and volumes of data included. Information provided by the mechanisms was reviewed according to data available on medicine prices, product characteristics, and procurement modalities. We found indications of positive effects on access to medicines resulting from the utilization of the reviewed mechanisms. These include the uptake of higher quality medicines, more favorable results from contract negotiations, changes in national pricing policies, and the decrease of prices in certain segments for countries participating in or deriving data from the various mechanisms. The reviewed mechanisms avoid the methodological challenges observed for medicine price comparisons that only use national price databases. They work with high quality data and display prices in the appropriate context of procurement modalities as well as the peculiarities of purchasing countries. Medicine price information mechanisms respond to the need for increased medicine price transparency and have the potential to contribute to improved access to medicines in developing countries.Additional research is required to explore more specific aspects. These include the market effects of dedicated donor funds for certain medicines to explain the driving force of user demands, and the effects of increased price transparency on different groups of medicines in context of the maturity of their markets.

Working to improve the management of sarcoma patients across Europe: a policy checklist.

PubMed

Kasper, Bernd; Lecointe-Artzner, Estelle; Wait, Suzanne; Boldon, Shannon; Wilson, Roger; Gronchi, Alessandro; Valverde, Claudia; Eriksson, Mikael; Dumont, Sarah; Drove, Nora; Kanli, Athanasia; Wartenberg, Markus

2018-04-16

The Sarcoma Policy Checklist was created by a multidisciplinary expert group to provide policymakers with priority areas to improve care for sarcoma patients. This paper draws on this research, by looking more closely at how France, Germany, Italy, Spain, Sweden and the United Kingdom are addressing each of these priority areas. It aims to highlight key gaps in research, policy and practice, as well as ongoing initiatives that may impact the future care of sarcoma patients in different European countries. A pragmatic review of the published and web-based literature was undertaken. Telephone interviews were conducted in each country with clinical and patient experts to substantiate findings. Research findings were discussed within the expert group and developed into five core policy recommendations. The five identified priority areas were: the development of designated and accredited centres of reference; more professional training; multidisciplinary care; greater incentives for research and innovation; and more rapid access to effective treatments. Most of the countries studied have ongoing initiatives addressing many of these priorities; however, many are in early stages of development, or require additional funding and resources. Gaps in access to quality care are particularly concerning in many of Europe's lower-resourced countries. Equitable access to information, clinical trials, innovative treatments and quality specialist care should be available to all sarcoma patients. Achieving this across Europe will require close collaboration between all stakeholders at both the national and European level.

Next X-Prize: L1 Base with Linked Asteroid Mining as Prime Catalyst for Space Enterprise

NASA Astrophysics Data System (ADS)

Erickson, Ken R.

2006-01-01

We are at a cusp in our emergence as a space-faring race. Development of space resources offers unparalleled economic opportunities. Entrepreneurs with fortunes from the computer and internet revolutions are heavily investing in space. Their goal: to make space accessible to civilians at affordable prices, and build their next fortunes off-planet. The Ansari X-Prize showed that economic incentives can augment the pace and efficiency of this venture. Lunar and Martian missions are being touted as the top priorities by the US and other nations. However, serious and profitable expansion into space is best achieved by the establishment of an L1 base, its economic lifeblood based on processing asteroidal materials to provide the staples of all human space enterprise: oxygen, water, fuel and shielding. This paper outlines the components of an ``L1-prize'' modeled on the Ansari X-prize competition that led to the first private manned flight into space by Scaled Composites. The economic costs, crucial components and profit potential of a primary L1 base with asteroid mining technology intimately tied to it are detailed. The technical and economic benefits of the L1 location are contrasted to alternatives. The likely revenue sources are estimated, including contracting nations and industries; and orbital, lunar and Martian interplanetary enterprises. These are discussed as realistically and conservatively as possible in terms of the potential future profits for the winner of the prize.

Proportional fair scheduling algorithm based on traffic in satellite communication system

NASA Astrophysics Data System (ADS)

Pan, Cheng-Sheng; Sui, Shi-Long; Liu, Chun-ling; Shi, Yu-Xin

2018-02-01

In the satellite communication network system, in order to solve the problem of low system capacity and user fairness in multi-user access to satellite communication network in the downlink, combined with the characteristics of user data service, an algorithm study on throughput capacity and user fairness scheduling is proposed - Proportional Fairness Algorithm Based on Traffic(B-PF). The algorithm is improved on the basis of the proportional fairness algorithm in the wireless communication system, taking into account the user channel condition and caching traffic information. The user outgoing traffic is considered as the adjustment factor of the scheduling priority and presents the concept of traffic satisfaction. Firstly,the algorithm calculates the priority of the user according to the scheduling algorithm and dispatches the users with the highest priority. Secondly, when a scheduled user is the business satisfied user, the system dispatches the next priority user. The simulation results show that compared with the PF algorithm, B-PF can improve the system throughput, the business satisfaction and fairness.

Systematic reviews addressing identified health policy priorities in Eastern Mediterranean countries: a situational analysis.

PubMed

El-Jardali, Fadi; Akl, Elie A; Karroum, Lama Bou; Kdouh, Ola; Akik, Chaza; Fadlallah, Racha; Hammoud, Rawan

2014-08-20

Systematic reviews can offer policymakers and stakeholders concise, transparent, and relevant evidence pertaining to pressing policy priorities to help inform the decision-making process. The production and the use of systematic reviews are specifically limited in the Eastern Mediterranean region. The extent to which published systematic reviews address policy priorities in the region is still unknown. This situational analysis exercise aims at assessing the extent to which published systematic reviews address policy priorities identified by policymakers and stakeholders in Eastern Mediterranean region countries. It also provides an overview about the state of systematic review production in the region and identifies knowledge gaps. We conducted a systematic search of the Health System Evidence database to identify published systematic reviews on policy-relevant priorities pertaining to the following themes: human resources for health, health financing, the role of the non-state sector, and access to medicine. Priorities were identified from two priority-setting exercises conducted in the region. We described the distribution of these systematic reviews across themes, sub-themes, authors' affiliations, and countries where included primary studies were conducted. Out of the 1,045 systematic reviews identified in Health System Evidence on selected themes, a total of 200 systematic reviews (19.1%) addressed the priorities from the Eastern Mediterranean region. The theme with the largest number of systematic reviews included was human resources for health (115) followed by health financing (33), access to medicine (27), and role of the non-state sector (25). Authors based in the region produced only three systematic reviews addressing regional priorities (1.5%). Furthermore, no systematic review focused on the Eastern Mediterranean region. Primary studies from the region had limited contribution to systematic reviews; 17 systematic reviews (8.5%) included primary studies conducted in the region. There are still gaps in the production of systematic reviews addressing policymakers' and stakeholders' priorities in the Eastern Mediterranean region. Efforts should be directed towards better aligning systematic review production with policy needs and priorities. Study findings can inform the agendas of researchers, research institutions, and international funding agencies of priority areas where systematic reviews are required.

Systematic reviews addressing identified health policy priorities in Eastern Mediterranean countries: a situational analysis

PubMed Central

2014-01-01

Background Systematic reviews can offer policymakers and stakeholders concise, transparent, and relevant evidence pertaining to pressing policy priorities to help inform the decision-making process. The production and the use of systematic reviews are specifically limited in the Eastern Mediterranean region. The extent to which published systematic reviews address policy priorities in the region is still unknown. This situational analysis exercise aims at assessing the extent to which published systematic reviews address policy priorities identified by policymakers and stakeholders in Eastern Mediterranean region countries. It also provides an overview about the state of systematic review production in the region and identifies knowledge gaps. Methods We conducted a systematic search of the Health System Evidence database to identify published systematic reviews on policy-relevant priorities pertaining to the following themes: human resources for health, health financing, the role of the non-state sector, and access to medicine. Priorities were identified from two priority-setting exercises conducted in the region. We described the distribution of these systematic reviews across themes, sub-themes, authors’ affiliations, and countries where included primary studies were conducted. Results Out of the 1,045 systematic reviews identified in Health System Evidence on selected themes, a total of 200 systematic reviews (19.1%) addressed the priorities from the Eastern Mediterranean region. The theme with the largest number of systematic reviews included was human resources for health (115) followed by health financing (33), access to medicine (27), and role of the non-state sector (25). Authors based in the region produced only three systematic reviews addressing regional priorities (1.5%). Furthermore, no systematic review focused on the Eastern Mediterranean region. Primary studies from the region had limited contribution to systematic reviews; 17 systematic reviews (8.5%) included primary studies conducted in the region. Conclusions There are still gaps in the production of systematic reviews addressing policymakers’ and stakeholders’ priorities in the Eastern Mediterranean region. Efforts should be directed towards better aligning systematic review production with policy needs and priorities. Study findings can inform the agendas of researchers, research institutions, and international funding agencies of priority areas where systematic reviews are required. PMID:25139256

Browsing for the Best Internet Access Provider?

ERIC Educational Resources Information Center

Weil, Marty

1996-01-01

Highlights points to consider when choosing an Internet Service Provider. Serial Line Internet Protocol (SLIP) and Point to Point Protocol (PPP) are compared regarding price, performance, bandwidth, speed, and technical support. Obtaining access via local, national, consumer online, and telephone-company providers is discussed. A pricing chart and…

Variable disparity estimation based intermediate view reconstruction in dynamic flow allocation over EPON-based access networks

NASA Astrophysics Data System (ADS)

Bae, Kyung-Hoon; Lee, Jungjoon; Kim, Eun-Soo

2008-06-01

In this paper, a variable disparity estimation (VDE)-based intermediate view reconstruction (IVR) in dynamic flow allocation (DFA) over an Ethernet passive optical network (EPON)-based access network is proposed. In the proposed system, the stereoscopic images are estimated by a variable block-matching algorithm (VBMA), and they are transmitted to the receiver through DFA over EPON. This scheme improves a priority-based access network by converting it to a flow-based access network with a new access mechanism and scheduling algorithm, and then 16-view images are synthesized by the IVR using VDE. Some experimental results indicate that the proposed system improves the peak-signal-to-noise ratio (PSNR) to as high as 4.86 dB and reduces the processing time to 3.52 s. Additionally, the network service provider can provide upper limits of transmission delays by the flow. The modeling and simulation results, including mathematical analyses, from this scheme are also provided.

Socio-economic disparities in the consumption of vegetables, fruit and energy-dense foods: the role of motive priorities.

PubMed

Konttinen, Hanna; Sarlio-Lähteenkorva, Sirpa; Silventoinen, Karri; Männistö, Satu; Haukkala, Ari

2013-05-01

A low socio-economic status (SES) is related to less healthy dietary habits, but the reasons for this remain unclear. We examined whether the absolute or relative importance of various food choice motives contributed to SES disparities in vegetable/fruit and energy-dense food intake. We analysed cross-sectional data from the FINRISK Study 2007 by means of structural equation modelling and used a shortened version of the Food Choice Questionnaire to assess the absolute importance of health, pleasure, convenience, price, familiarity and ethicality motives. We calculated the relative importance of each motive by dividing the participant's rating of it by his/her mean score on all motives. Dietary intake was measured with an FFQ. A population-based survey in Finland. Men (n 1691) and women (n 2059) aged 25-64 years. Higher education and income were related to a greater vegetable/fruit intake (β = 0·12, P < 0·001), while education was associated negatively with the consumption of energy-dense foods (β = -0·09, P < 0·001). Socio-economically disadvantaged individuals considered price and/or familiarity more important in their food choices in both absolute and relative terms. A higher income was related to a greater relative importance of health considerations. Relative motives were more strongly associated with vegetable/fruit and energy-dense food consumption than absolute motives and the relative importance of price, familiarity and health partly mediated the effects of the SES indicators on the consumption of these food items. Individual priorities in food choice motives, rather than the absolute importance of single motives, play a role in producing SES disparities in diet.

49 CFR 33.44 - Instances where assistance may not be provided.

Code of Federal Regulations, 2014 CFR

2014-10-01

... AND ALLOCATION SYSTEM Special Priorities Assistance § 33.44 Instances where assistance may not be... attempting to: (a) Secure a price advantage; (b) Obtain delivery prior to the time required to fill a rated...

49 CFR 33.44 - Instances where assistance may not be provided.

Code of Federal Regulations, 2012 CFR

2012-10-01

... AND ALLOCATION SYSTEM Special Priorities Assistance § 33.44 Instances where assistance may not be... attempting to: (a) Secure a price advantage; (b) Obtain delivery prior to the time required to fill a rated...

49 CFR 33.44 - Instances where assistance may not be provided.

Code of Federal Regulations, 2013 CFR

2013-10-01

... AND ALLOCATION SYSTEM Special Priorities Assistance § 33.44 Instances where assistance may not be... attempting to: (a) Secure a price advantage; (b) Obtain delivery prior to the time required to fill a rated...

Do state minimum markup/price laws work? Evidence from retail scanner data and TUS-CPS

PubMed Central

Huang, Jidong; Chriqui, Jamie F; DeLong, Hillary; Mirza, Maryam; Diaz, Megan C; Chaloupka, Frank J

2016-01-01

Background Minimum markup/price laws (MPLs) have been proposed as an alternative non-tax pricing strategy to reduce tobacco use and access. However, the empirical evidence on the effectiveness of MPLs in increasing cigarette prices is very limited. This study aims to fill this critical gap by examining the association between MPLs and cigarette prices. Methods State MPLs were compiled from primary legal research databases and were linked to cigarette prices constructed from the Nielsen retail scanner data and the self-reported cigarette prices from the Tobacco Use Supplement to the Current Population Survey. Multivariate regression analyses were conducted to examine the association between MPLs and the major components of MPLs and cigarette prices. Results The presence of MPLs was associated with higher cigarette prices. In addition, cigarette prices were higher, above and beyond the higher prices resulting from MPLs, in states that prohibit below-cost combination sales; do not allow any distributing party to use trade discounts to reduce the base cost of cigarettes; prohibit distributing parties from meeting the price of a competitor, and prohibit distributing below-cost coupons to the consumer. Moreover, states that had total markup rates >24% were associated with significantly higher cigarette prices. Conclusions MPLs are an effective way to increase cigarette prices. The impact of MPLs can be further strengthened by imposing greater markup rates and by prohibiting coupon distribution, competitor price matching, and use of below-cost combination sales and trade discounts. PMID:27697948

Factors influencing global antiretroviral procurement prices.

PubMed

Wirtz, Veronika J; Forsythe, Steven; Valencia-Mendoza, Atanacio; Bautista-Arredondo, Sergio

2009-11-18

Antiretroviral medicines (ARVs) are one of the most costly parts of HIV/AIDS treatment. Many countries are struggling to provide universal access to ARVs for all people living with HIV and AIDS. Although substantial price reductions of ARVs have occurred, especially between 2002 and 2008, achieving sustainable access for the next several decades remains a major challenge for most low- and middle-income countries. The objectives of the present study were twofold: first, to analyze global ARV prices between 2005 and 2008 and associated factors, particularly procurement methods and key donor policies on ARV procurement efficiency; second, to discuss the options of procurement processes and policies that should be considered when implementing or reforming access to ARV programs. An ARV-medicines price-analysis was carried out using the Global Price Reporting Mechanism from the World Health Organization. For a selection of 12 ARVs, global median prices and price variation were calculated. Linear regression models for each ARV were used to identify factors that were associated with lower procurement prices. Logistic regression models were used to identify the characteristics of those countries which procure below the highest and lowest direct manufactured costs. Three key factors appear to have an influence on a country's ARV prices: (a) whether the product is generic or not; (b) the socioeconomic status of the country; (c) whether the country is a member of the Clinton HIV/AIDS Initiative. Factors which did not influence procurement below the highest direct manufactured costs were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President's Emergency Plan For AIDS Relief. One of the principal mechanisms that can help to lower prices for ARV over the next several decades is increasing procurement efficiency. Benchmarking prices could be one useful tool to achieve this.

47 CFR 64.402 - Policies and procedures for the provision of priority access service by commercial mobile radio...

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 3 2011-10-01 2011-10-01 false Policies and procedures for the provision of... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) MISCELLANEOUS... National Security and Emergency Preparedness personnel shall provide priority access service in accordance...

Overcoming inertia: increasing public health departments' access to evidence-based information and promoting usage to inform practice.

PubMed

LaPelle, Nancy R; Dahlen, Karen; Gabella, Barbara A; Juhl, Ashley L; Martin, Elaine

2014-01-01

In 2010, the New England Region-National Network of Libraries of Medicine at University of Massachusetts Medical School received funding to improve information access for public health departments in 6 New England states and Colorado. Public health departments were provided with desktop digital access to licensed e-resources available through special pricing. In January through mid-April 2012, we evaluated the effectiveness of providing access to and training for using e-resources to public health department staff to motivate usage in practice. We found that additional strategies are needed to accomplish this.

Optimisation of sensing time and transmission time in cognitive radio-based smart grid networks

NASA Astrophysics Data System (ADS)

Yang, Chao; Fu, Yuli; Yang, Junjie

2016-07-01

Cognitive radio (CR)-based smart grid (SG) networks have been widely recognised as emerging communication paradigms in power grids. However, a sufficient spectrum resource and reliability are two major challenges for real-time applications in CR-based SG networks. In this article, we study the traffic data collection problem. Based on the two-stage power pricing model, the power price is associated with the efficient received traffic data in a metre data management system (MDMS). In order to minimise the system power price, a wideband hybrid access strategy is proposed and analysed, to share the spectrum between the SG nodes and CR networks. The sensing time and transmission time are jointly optimised, while both the interference to primary users and the spectrum opportunity loss of secondary users are considered. Two algorithms are proposed to solve the joint optimisation problem. Simulation results show that the proposed joint optimisation algorithms outperform the fixed parameters (sensing time and transmission time) algorithms, and the power cost is reduced efficiently.

The APIC research agenda: results from a national survey.

PubMed

Wright, Marc-Oliver; Carter, Eileen; Pogorzelska, Monika; Murphy, Cathryn; Hanchett, Marilyn; Stone, Patricia W

2012-05-01

Research is an integral component of the Association for Professionals in Infection Control and Epidemiology (APIC) Strategic Plan 2020. As the role of the infection preventionist (IP) has evolved toward consumers and implementers of research, it becomes increasingly necessary to assess which topics require further evidence and how best APIC can assist IPs. In 2010, APIC determined that the research priorities first described in 2000 needed to be re-evaluated. A 33-question Web-based survey was developed and distributed via e-mail to APIC members in March 2011. The survey contained sections inquiring about respondents' demographics, familiarity with implementation science, and infection prevention research priorities. Priorities identified by a Delphi study 10 years ago were re-ranked, and open-ended items were used to identify new research priorities and understand how APIC could best serve its members in relation to research. Seven hundred one members responded. Behavioral management science, surveillance standards, and infection prevention resource optimization were the highest ranked priorities and relatively unchanged from 2000. Proposed additional research topics focused on achieving standardization in infection prevention practices and program resource allocation. The majority of respondents described APIC's role in the field of research as a disseminator of low-cost, highly accessible education to its members. This report should be used as a roadmap for APIC leadership as it provides suggestions on how APIC may best direct the association's research program. The major research priorities described and ranked in 2000 continue to challenge IPs. APIC can best serve its members by disseminating research findings in a cost-effective and easily accessed manner. Recurrent assessments of research priorities can help guide researchers and policy makers and help determine which topics will best support successful infection prevention processes and outcomes. Published by Mosby, Inc.

How the Trans Pacific Partnership Agreement could undermine PHARMAC and threaten access to affordable medicines and health equity in New Zealand.

PubMed

Gleeson, Deborah; Lopert, Ruth; Reid, Papaarangi

2013-10-01

New Zealand's Pharmaceutical Management Agency (PHARMAC) has been highly successful in facilitating affordable access to medicines through a combination of aggressive price negotiations, innovative procurement mechanisms, and careful evaluation of value for money. Recently the US government, through the establishment of a series of bilateral and plurilateral "free" trade agreements, has attempted to constrain the pharmaceutical access programs of other countries in order to promote the interests of the pharmaceutical industry. The Trans Pacific Partnership Agreement (TPPA) represents the latest example; through the TPPA the US is seeking to eliminate therapeutic reference pricing, introduce appeals processes for pharmaceutical companies to challenge formulary listing and pricing decisions, and introduce onerous disclosure and "transparency" provisions that facilitate industry involvement in decision-making around coverage and pricing of medicines (and medical devices). This paper argues that the US agenda, if successfully prosecuted, would be likely to increase costs and reduce access to affordable medicines for New Zealanders. This would in turn be likely to exacerbate known inequities in access to medicines and thus disproportionately affect disadvantaged population groups, including Māori and Pacific peoples. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Nicotine replacement therapy, tobacco products, and electronic cigarettes in pharmacies in St. Louis, Missouri.

PubMed

Barnoya, Joaquin; Jin, Linda; Hudmon, Karen Suchanek; Schootman, Mario

2015-01-01

To compare availability of nicotine replacement therapy (NRT), tobacco products, and electronic cigarettes (e-cigarettes) in pharmacies in St. Louis, MO. Cross-sectional study, on-site store audits of 322 pharmacies. St. Louis, MO. 242 eligible community pharmacies located in the study area. Pharmacies were visited by trained research assistants who conducted a 5- to 10-minute store audit using a paper-based data collection tool. Availability, accessibility, and pricing of NRT as a function of neighborhood poverty rate and proportion of black residents as well as availability of tobacco products and e-cigarettes. NRT availability decreased as neighborhood poverty rate increased (P = 0.02). Availability without pharmacy personnel assistance also decreased with increasing poverty rate (r = -0.19; 95% CI = -0.06, -0.31) and higher percentage of black residents (r = -0.18; 95% CI = -0.06, -0.31). Prices were lower in neighborhoods with higher poverty rates (P = 0.02) and a higher percentage of black residents (P = 0.03). E-cigarettes were available in 43% of pharmacies, and their availability and price did not differ by poverty rate or percentage of black residents. Low access to NRT might perpetuate smoking disparities in disadvantaged and racially diverse neighborhoods. Study data support policies to ensure equal NRT access to reduce disparities.

Access to benznidazole for Chagas disease in the United States-Cautious optimism?

PubMed

Alpern, Jonathan D; Lopez-Velez, Rogelio; Stauffer, William M

2017-09-01

Drugs for neglected tropical diseases (NTD) are being excessively priced in the United States. Benznidazole, the first-line drug for Chagas disease, may become approved by the Food and Drug Administration (FDA) and manufactured by a private company in the US, thus placing it at risk of similar pricing. Chagas disease is an NTD caused by Trypanosoma cruzi; it is endemic to Latin America, infecting 8 million individuals. Human migration has changed the epidemiology causing nonendemic countries to face increased challenges in diagnosing and managing patients with Chagas disease. Only 2 drugs exist with proven efficacy: benznidazole and nifurtimox. Benznidazole has historically faced supply problems and drug shortages, limiting accessibility. In the US, it is currently only available under an investigational new drug (IND) protocol from the CDC and is provided free of charge to patients. However, 2 companies have stated that they intend to submit a New Drug Application (NDA) for FDA approval. Based on recent history of companies acquiring licensing rights for NTD drugs in the US with limited availability, it is likely that benznidazole will become excessively priced by the manufacturer-paradoxically making it less accessible. However, if the companies can be taken at their word, there may be reason for optimism.

Investigation of Priority Needs in Terms of Museum Service Accessibility for Visually Impaired Visitors

ERIC Educational Resources Information Center

Handa, Kozue; Dairoku, Hitoshi; Toriyama, Yoshiko

2010-01-01

This study investigates the priority needs of museum service accessibility for visually impaired visitors. For this purpose, conjoint analysis was utilized. Four conjoint attributes of museum services were selected: A--facilities for wayfinding; B--exhibitions and collections including objects for touching, hearing, smelling, etc.; C--information…

Access to hepatitis C virus treatment: Lessons from implementation of strategies for increasing access to antiretroviral treatment.

PubMed

Assefa, Yibeltal; Hill, Peter S; Williams, Owain D

2018-05-01

At September's 2017 United Nations General Assembly, a state-of-the-art HIV medicine was announced to be made available at just $75 per person per year. There have been a number of strategies that the global AIDS community and countries have utilized to reduce prices and make antiretrovirals (ARVs) accessible for people living with HIV/AIDS. There appears to be an opportunity for the treatment of hepatitis C virus infection using direct-acting antivirals (DAAs) to benefit from the often painful and laboured history of driving down the prices of ARVs. In general, the success of lowering prices for ARVs has stemmed from the politics needed to initially support generic entry into the on-patent market. The use of flexibilities present in the World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) have been used to overcome patent barriers, with the use of compulsory licenses and/or the threat of their use as instruments for strengthening the bargaining power in price negotiations. These strategies have been combined with new financing mechanisms that have promoted more effective procurement and price negotiations. Partnership among the different stakeholders has also been critical in this regard. Countries have also invested in their health systems and implemented several strategies to reduce stigma and discrimination to increase access to and improve utilization of ARVs. This article suggests that any future international initiatives to increase access to DAAs can learn from these lessons surrounding price reduction, improved financing, advocacy, as well as health systems strengthening and stigma reduction. Adopting and reconfiguring these strategies will also incur substantial savings in time, money and lives. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

78 FR 2600 - Special Access for Price Cap Local Exchange Carriers; AT&T Corporation Petition for Rulemaking To...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-11

... market analysis that the Commission intends to undertake in the coming months to assist in evaluating competition in the market for special access services; possible changes to the Commission's pricing flexibility rules after the Commission conducts its market analysis; and the reasonableness of terms and...

75 FR 33611 - Implementing the National Broadband Plan by Empowering Consumers and the Smart Grid: Data Access...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-14

... Smart Grid: Data Access, Third Party Use, and Privacy AGENCY: Department of Energy. ACTION: Notice of... information from smart meters, historical consumption data, and pricing and billing information. DOE will hold... electronic form--including real-time information from smart meters, historical consumption data, and pricing...

Neglected tropical diseases: exploring long term practical approaches to achieve sustainable disease elimination and beyond.

PubMed

Ortu, Giuseppina; Williams, Oliver

2017-09-27

Remarkable progress has been made in the fight against neglected tropical diseases, but new challenges have emerged. Innovative diagnostics, better drugs and new insecticides are often identified as the priority; however, access to these new tools may not be sufficient to achieve and sustain disease elimination, if certain challenges and priorities are not considered. The authors summarise key operational challenges, and based on these, identify two major priorities: strengthening the capacity of the primary health care health system in correctly diagnosing and managing neglected tropical diseases; and establishing an effective disease surveillance process. Five steps are proposed as concrete actions to build an effective primary health care service for neglected tropical diseases, and a health management information system capable of accurately reporting these diseases. Community engagement and formalization of community health workers role are proposed as essential components of these steps. Shift of financial support from disease oriented programmes to disease integrated interventions, improved access to international guidelines for primary health care staff, and availability of donated drugs in health care structures are also suggested as key elements of the proposed process. The authors conclude that failure to address these priorities now may lead to further challenges on the long path towards neglected tropical disease elimination and beyond.

Distance to Store, Food Prices, and Obesity in Urban Food Deserts

PubMed Central

Ghosh-Dastidar, Bonnie; Cohen, Deborah; Hunter, Gerald; Zenk, Shannon N.; Huang, Christina; Beckman, Robin; Dubowitz, Tamara

2014-01-01

Background Lack of access to healthy foods may explain why residents of low-income neighborhoods and African Americans in the U.S. have high rates of obesity. The findings on where people shop and how that may influence health are mixed. However, multiple policy initiatives are underway to increase access in communities that currently lack healthy options. Few studies have simultaneously measured obesity, distance, and prices of the store used for primary food shopping. Purpose To examine the relationship among distance to store, food prices, and obesity. Methods The Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health study conducted baseline interviews with 1,372 households between May and December 2011 in two low-income, majority African American neighborhoods without a supermarket. Audits of 16 stores where participants reported doing their major food shopping were conducted. Data were analyzed between February 2012 and February 2013. Results Distance to store and prices were positively associated with obesity (p<0.05). When distance to store and food prices were jointly modeled, only prices remained significant (p<0.01), with higher prices predicting a lower likelihood of obesity. Although low- and high-price stores did not differ in availability, they significantly differed in their display and marketing of junk foods relative to healthy foods. Conclusions Placing supermarkets in food deserts to improve access may not be as important as simultaneously offering better prices for healthy foods relative to junk foods, actively marketing healthy foods, and enabling consumers to resist the influence of junk food marketing. PMID:25217097

Distance to store, food prices, and obesity in urban food deserts.

PubMed

Ghosh-Dastidar, Bonnie; Cohen, Deborah; Hunter, Gerald; Zenk, Shannon N; Huang, Christina; Beckman, Robin; Dubowitz, Tamara

2014-11-01

Lack of access to healthy foods may explain why residents of low-income neighborhoods and African Americans in the U.S. have high rates of obesity. The findings on where people shop and how that may influence health are mixed. However, multiple policy initiatives are underway to increase access in communities that currently lack healthy options. Few studies have simultaneously measured obesity, distance, and prices of the store used for primary food shopping. To examine the relationship among distance to store, food prices, and obesity. The Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health study conducted baseline interviews with 1,372 households between May and December 2011 in two low-income, majority African American neighborhoods without a supermarket. Audits of 16 stores where participants reported doing their major food shopping were conducted. Data were analyzed between February 2012 and February 2013. Distance to store and prices were positively associated with obesity (p<0.05). When distance to store and food prices were jointly modeled, only prices remained significant (p<0.01), with higher prices predicting a lower likelihood of obesity. Although low- and high-price stores did not differ in availability, they significantly differed in their display and marketing of junk foods relative to healthy foods. Placing supermarkets in food deserts to improve access may not be as important as simultaneously offering better prices for healthy foods relative to junk foods, actively marketing healthy foods, and enabling consumers to resist the influence of junk food marketing. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The impact of HTA and procurement practices on the selection and prices of medical devices.

PubMed

Callea, Giuditta; Armeni, Patrizio; Marsilio, Marta; Jommi, Claudio; Tarricone, Rosanna

2017-02-01

Technological innovation in healthcare yields better health outcomes but also drives healthcare expenditure, and governments are struggling to maintain an appropriate balance between patient access to modern care and the economic sustainability of healthcare systems. Health Technology Assessment (HTA) and centralized procurement are increasingly used to govern the introduction and diffusion of new technologies in an effort to make access to innovation financially sustainable. However, little empirical evidence is available to determine how they affect the selection of new technologies and unit prices. This paper focuses on medical devices (MDs) and investigates the combined effect of various HTA governance models and procurement practices on the two steps of the MD purchasing process (i.e., selecting the product and setting the unit price). Our analyses are based on primary data collected through a national survey of Italian public hospitals. The Italian National Health Service is an ideal case study because it is highly decentralized and because regions have adopted different HTA governance models (i.e., regional, hospital-based, double-level or no HTA), often in combination with centralized regional procurement programs. Hence, the Italian case allows us to test the impact of different combinations of HTA models and procurement programs in the various regions. The results show that regional HTA increases the probability of purchasing the costliest devices, whereas hospital-based HTA functions more like a cost-containment unit. Centralized regional procurement does not significantly affect MD selection and is associated with a reduction in the MD unit price: on average, hospitals located in regions with centralized procurement pay 10.1% less for the same product. Hospitals located in regions with active regional HTA programs pay higher prices for the same device (+23.2% for inexpensive products), whereas hospitals that have developed internal HTA programs pay 8.3% on average more for the same product. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

47 CFR Appendix B to Part 64 - Priority Access Service (PAS) for National Security and Emergency Preparedness (NSEP)

Code of Federal Regulations, 2010 CFR

2010-10-01

... leadership; (iii) Disaster shelter coordination and management; and (iv) Critical Disaster Field Office... telecommunications management and response functions during emergency/disaster situations. 3. Initiate PAS requests... priorities, priority one being the highest. The five priority levels are: 1. Executive Leadership and Policy...

Projected savings through public health voluntary licences of HIV drugs negotiated by the Medicines Patent Pool (MPP).

PubMed

Juneja, Sandeep; Gupta, Aastha; Moon, Suerie; Resch, Stephen

2017-01-01

The Medicines Patent Pool (MPP) was established in 2010 to ensure timely access to low-cost generic versions of patented antiretroviral (ARV) medicines in low- and middle-income countries (LMICs) through the negotiation of voluntary licences with patent holders. While robust data on the savings generated by MPP and other major global public health initiatives is important, it is also difficult to quantify. In this study, we estimate the savings generated by licences negotiated by the MPP for ARV medicines to treat HIV/AIDS in LMICs for the period 2010-2028 and generate a cost-benefit ratio-based on people living with HIV (PLHIVs) in any new countries which gain access to an ARV due to MPP licences and the price differential between originator's tiered price and generics price, within the period where that ARV is patented. We found that the direct savings generated by the MPP are estimated to be USD 2.3 billion (net present value) by 2028, representing an estimated cost-benefit ratio of 1:43, which means for every USD 1 spent on MPP, the global public health community saves USD 43. The saving of USD 2.3 billion is equivalent to more than 24 million PLHIV receiving first-line ART in LMICs for 1 year at average prices today.

Impacts of demand response and renewable generation in electricity power market

NASA Astrophysics Data System (ADS)

Zhao, Zhechong

This thesis presents the objective of the research which is to analyze the impacts of uncertain wind power and demand response on power systems operation and power market clearing. First, in order to effectively utilize available wind generation, it is usually given the highest priority by assigning zero or negative energy bidding prices when clearing the day-ahead electric power market. However, when congestion occurs, negative wind bidding prices would aggravate locational marginal prices (LMPs) to be negative in certain locations. A load shifting model is explored to alleviate possible congestions and enhance the utilization of wind generation, by shifting proper amount of load from peak hours to off peaks. The problem is to determine proper amount of load to be shifted, for enhancing the utilization of wind generation, alleviating transmission congestions, and making LMPs to be non-negative values. The second piece of work considered the price-based demand response (DR) program which is a mechanism for electricity consumers to dynamically manage their energy consumption in response to time-varying electricity prices. It encourages consumers to reduce their energy consumption when electricity prices are high, and thereby reduce the peak electricity demand and alleviate the pressure to power systems. However, it brings additional dynamics and new challenges on the real-time supply and demand balance. Specifically, price-sensitive DR load levels are constantly changing in response to dynamic real-time electricity prices, which will impact the economic dispatch (ED) schedule and in turn affect electricity market clearing prices. This thesis adopts two methods for examining the impacts of different DR price elasticity characteristics on the stability performance: a closed-loop iterative simulation method and a non-iterative method based on the contraction mapping theorem. This thesis also analyzes the financial stability of DR load consumers, by incorporating explicit LMP formulations and consumer payment requirements into the network-constrained unit commitment (NCUC) problem. The proposed model determines the proper amount of DR loads to be shifted from peak hours to off-peaks under ISO's direct load control, for reducing the operation cost and ensuring that consumer payments of DR loads will not deteriorate significantly after load shifting. Both MINLP and MILP models are discussed, and improved formulation strategies are presented.

Health-industry linkages for local health: reframing policies for African health system strengthening

PubMed Central

Mackintosh, Maureen; Mugwagwa, Julius; Banda, Geoffrey; Tibandebage, Paula; Tunguhole, Jires; Wangwe, Samuel; Karimi Njeru, Mercy

2018-01-01

Abstract The benefits of local production of pharmaceuticals in Africa for local access to medicines and to effective treatment remain contested. There is scepticism among health systems experts internationally that production of pharmaceuticals in sub-Saharan Africa (SSA) can provide competitive prices, quality and reliability of supply. Meanwhile low-income African populations continue to suffer poor access to a broad range of medicines, despite major international funding efforts. A current wave of pharmaceutical industry investment in SSA is associated with active African government promotion of pharmaceuticals as a key sector in industrialization strategies. We present evidence from interviews in 2013–15 and 2017 in East Africa that health system actors perceive these investments in local production as an opportunity to improve access to medicines and supplies. We then identify key policies that can ensure that local health systems benefit from the investments. We argue for a ‘local health’ policy perspective, framed by concepts of proximity and positionality, which works with local priorities and distinct policy time scales and identifies scope for incentive alignment to generate mutually beneficial health–industry linkages and strengthening of both sectors. We argue that this local health perspective represents a distinctive shift in policy framing: it is not necessarily in conflict with ‘global health’ frameworks but poses a challenge to some of its underlying assumptions. PMID:29562286

Variation in Prices of Cardiovascular Drugs in Public and Private Pharmacies in Nepal

PubMed Central

Kandel, Nirajan; Subedi, Narayan; Khanal, Vishnu

2015-01-01

Introduction: Higher price of cardiovascular drugs is one of the reasons for high out-of-pocket expenditure in cardiovascular care. The objective of the study was to determine the price variation in commonly available cardiovascular drugs between public and private hospital pharmacies in Nepal. Methods: A cross-sectional survey was conducted in 3 public and 3 private pharmacies in tertiary-level hospitals in Nepal. The price was recorded for the list of drugs commonly available in those pharmacies. A total of 23 drugs were selected for data collection. The price was recorded based on the payment receipt and price reported by surrogate customers. We defined the price variation as the difference between price of cardiovascular drugs between public hospital and private pharmacy. The price variation was expressed as percentage. Results: Price of Amlodipine 5 mg was higher by 667% in private pharmacy nearby Tribhuvan University Teaching Hospital (TUTH) compared to that of TUTH pharmacy. Price of Enalapril 5 mg was higher by 14.47% in Manmohan Cardio Thoracic and Vascular Transplant Centre (MCVTC) compared to nearby private pharmacy. We observed that the price of cardiovascular drugs varied significantly between hospital and private retail pharmacies in TUTH (P < .001) and MCVTC (P < .001). Conclusion: For most of the cardiovascular drugs, the price in private retail pharmacies were significantly higher than in hospital pharmacies. Future steps should be taken to establish and run own pharmacies in hospitals which would reduce the cost of medicine and thereby, increase access to medicine. PMID:28462249

State prescription drug price Web sites: how useful to consumers?

PubMed

Tu, Ha T; Corey, Catherine G

2008-02-01

To aid consumers in comparing prescription drug costs, many states have launched Web sites to publish drug prices offered by local retail pharmacies. The current push to make retail pharmacy prices accessible to consumers is part of a much broader movement to increase price transparency throughout the health-care sector. Efforts to encourage price-based shopping for hospital and physician services have encountered widespread concerns, both on grounds that prices for complex services are difficult to measure and compare accurately and that quality varies substantially across providers. Experts agree, however, that prescription drugs are much easier to shop for than other, more complex health services. However, extensive gaps in available price information--the result of relying on Medicaid data--seriously hamper the effectiveness of state drug price-comparison Web sites, according to a new study by the Center for Studying Health System Change (HSC). An alternative approach--requiring pharmacies to submit price lists to the states--would improve the usefulness of price information, but pharmacies typically oppose such a mandate. Another limitation of most state Web sites is that price information is restricted to local pharmacies, when online pharmacies, both U.S. and foreign, often sell prescription drugs at substantially lower prices. To further enhance consumer shopping tools, states might consider expanding the types of information provided, including online pharmacy comparison tools, lists of deeply discounted generic drugs offered by discount retailers, and lists of local pharmacies offering price matches.

Comprehensive taxonomy and worldwide trends in pharmaceutical policies in relation to country income status.

PubMed

Maniadakis, N; Kourlaba, G; Shen, J; Holtorf, A

2017-05-25

Rapidly evolving socioeconomic and technological trends make it challenging to improve access, effectiveness and efficiency in the use of pharmaceuticals. This paper identifies and systematically classifies the prevailing pharmaceutical policies worldwide in relation to a country's income status. A literature search was undertaken to identify and taxonomize prevailing policies worldwide. Countries that apply those policies and those that do not were then grouped by income status. Pharmaceutical policies are linked to a country's socioeconomics. Developed countries have universal coverage and control pharmaceuticals with external and internal price referencing systems, and indirect price-cost controls; they carry out health technology assessments and demand utilization controls. Price-volume and risk-sharing agreements are also evolving. Developing countries are underperforming in terms of coverage and they rely mostly on restrictive state controls to regulate prices and expenditure. There are significant disparities worldwide in the access to pharmaceuticals, their use, and the reimbursement of costs. The challenge in high-income countries is to maintain access to care whilst dealing with trends in technology and aging. Essential drugs should be available to all; however, many low- and middle-income countries still provide most of their population with only poor access to medicines. As economies grow, there should be greater investment in pharmaceutical care, looking to the policies of high-income countries to increase efficiency. Pharmaceutical companies could also develop special access schemes with low prices to facilitate coverage in low-income countries.

Should patients with self-inflicted illness receive lower priority in access to healthcare resources? Mapping out the debate.

PubMed

Sharkey, Kerith; Gillam, Lynn

2010-11-01

The distribution of scarce healthcare resources is an increasingly important issue due to factors such as expensive 'high tech' medicine, longer life expectancies and the rising prevalence of chronic illness. Furthermore, in the current healthcare context lifestyle-related factors such as high blood pressure, tobacco use and obesity are believed to contribute significantly to the global burden of disease. As such, this paper focuses on an ongoing debate in the academic literature regarding the role of responsibility for illness in healthcare resource allocation: should patients with self-caused illness receive lower priority in access to healthcare resources? This paper critically describes the lower priority debate's 12 key arguments and maps out their relationships. This analysis reveals that most arguments have been refuted and that the debate has stalled and remains unresolved. In conclusion, we suggest progression could be achieved by inviting multidisciplinary input from a range of stakeholders for the development of evidence-based critical evaluations of existing arguments and the development of novel arguments, including the outstanding rebuttals.

A Systematic Review of the Literature Addressing Veterinary Care for Underserved Communities.

PubMed

LaVallee, Elizabeth; Mueller, Megan Kiely; McCobb, Emily

2017-01-01

Currently, there is a care gap in veterinary medicine affecting low-income and underserved communities, resulting in decreased nonhuman-animal health and welfare. The use of low-price and community veterinary clinics in underserved populations is a strategy to improve companion-animal health through preventative care, spay/neuter, and other low-price care programs and services. Little research has documented the structure and effectiveness of such initiatives. This systematic review aimed to assess current published research pertaining to accessible health care, community-based veterinary medicine, and the use of community medicine in teaching programs. The review was an in-depth literature search identifying 51 publications relevant to the importance, benefits, drawbacks, and use of low-price and community clinics in underserved communities. These articles identified commonly discussed barriers to care that may prevent underserved clientele from seeking veterinary care. Five barriers were identified including the cost of veterinary care, accessibility of care, problems with or lack of veterinarian-client communication, culture/language, and lack of client education. The review also identified a need for additional research regarding evidence of effectiveness and efficiency in community medicine initiatives.

47 CFR 61.3 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... trunk ports, Information Surcharge, and signalling transfer point (STP) port) by the base period LS...) Dominant carrier. A carrier found by the Commission to have market power (i.e., power to control prices... billing or collection of access charges from interexchange carriers or wireless carriers. When determining...

47 CFR 61.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... trunk ports, Information Surcharge, and signalling transfer point (STP) port) by the base period LS...) Dominant carrier. A carrier found by the Commission to have market power (i.e., power to control prices... billing or collection of access charges from interexchange carriers or wireless carriers. When determining...

Microcomputers: Independence and Information Access for the Physically Handicapped.

ERIC Educational Resources Information Center

Regen, Shari S.; Chen, Ching-chih

1984-01-01

Provides overview of recent technological developments in microcomputer technology for the physically disabled, including discussion of view expansion, "talking terminals," voice recognition, and price and convenience of micro-based products. Equipment manufacturers and training centers for the physically disabled are listed and microcomputer…

Motorcycle helmets in Vietnam: ownership, quality, purchase price, and affordability.

PubMed

Hung, Dang Viet; Stevenson, Mark R; Ivers, Rebecca Q

2008-06-01

This study investigated motorcycle helmet ownership, quality, purchase price, and affordability in Vietnam. A random sample of motorcyclists was interviewed to investigate aspects of helmet ownership, the purchase price, and affordability of a motorcycle helmet. Multivariate modeling conducted to determine factors associated with the purchase price and affordability of motorcycle helmets. Helmet quality was assessed based on current legal requirements in Vietnam. The prevalence of helmet use in Vietnam remains low (23.3%) despite a high level of helmet ownership (94%), indicating that this is an important area for public health intervention. Overall the quality of helmets appeared to be good; however, few helmets displayed legally required information. Motorcyclists with a high income purchase more helmets for their household rather than more expensive helmets. To ensure that helmets are accessible to the community, policy-makers need to consider pricing motorcycle helmets at a price indicated by the results of this study. Prior to universal motorcycle helmet legislation, the government will also need to ensure that standard helmets are available and that enforcement is at a level to ensure that motorcycle helmets are actually used.

Industry Perspectives on Market Access of Innovative Drugs: The Relevance for Oncology Drugs.

PubMed

Pauwels, Kim; Huys, Isabelle; Casteels, Minne; Simoens, Steven

2016-01-01

Key Points - Representatives of the pharmaceutical industry call for a broader recognition of value within the assessment and appraisal of innovative drugs- Focus on value within the assessment and appraisal of drugs is jeopardized by financial drives as the side of industry and at the side of the payers- A well-considered value-framework, with attention for patient reported outcomes, societal preferences and dynamic approach on the drug life cycle, needs to be incorporated in assessment and appraisal at national and European level in order to coordinate the views of different stakeholders and allow efficient resource allocation This study presents industry perspectives on the challenges related to market access of innovative drugs in general and oncology drugs in specific. Fifteen interviews were conducted with representatives of pharmaceutical companies and industry associations. Interviewees call for a broader recognition of value within the assessment and appraisal of drugs. According to interviewees, focus on value is jeopardized by the lack of a common value definition across Europe, poor availability and validity of value measures and cost-saving measures such as external reference price setting and cost-effectiveness analysis at the side of the payers. Centralized assessment of relative-effectiveness at European level would provide a common value estimate across member states, independent of financial drivers. Empirical evidence on PRO and societal preferences is however essential in the development of a value definition. Furthermore, value-based pricing would imply a dynamic approach where the price is differentiated across indications and across the lifecycle of the drug, especially in fields such as oncology. Financial drivers however also threat the application of value-based pricing at the side of the industry, making value-based profitability a more appropriate term.

The effect of proportional v. value pricing on fountain drink purchases: results from a field experiment.

PubMed

Gollust, Sarah E; Tang, Xuyang; Runge, Carlisle Ford; French, Simone A; Rothman, Alexander J

2018-05-15

Reducing sugar-sweetened beverage consumption is a public health priority, yet finding an effective and acceptable policy intervention is challenging. One strategy is to use proportional pricing (a consistent price per fluid ounce) instead of the typical value-priced approach where large beverages offer better value. The purpose of the present study was to evaluate whether proportional pricing affects the purchasing of fountain beverages at a university cinema concession stand. Four price strategies for beverages were evaluated over ten weekends of film screenings. We manipulated two factors: the price structure (value pricing v. proportional pricing) and the provision of information about the price per fluid ounce (labels v. no labels). The key outcomes were the number and size of beverages purchased. We analysed data using regression analyses, with standard errors clustered by film and controlling for the day and time of purchase. A university cinema concession stand in Minnesota, USA, in spring 2015. University students. Over the study period (360 beverages purchased) there were no significant effects of the proportional pricing treatment. Pairing a label with the standard value pricing increased the likelihood of purchasing large drinks but the label did not affect purchasing when paired with proportional pricing. Proportional prices did not significantly affect the size of beverages purchased by students at a university cinema, but adding a price-per-ounce label increased large drink purchases when drinks were value-priced. More work is needed to address whether pricing and labelling strategies might promote healthier beverage purchases.

Understanding the development of minimum unit pricing of alcohol in Scotland: a qualitative study of the policy process.

PubMed

Katikireddi, Srinivasa Vittal; Hilton, Shona; Bonell, Chris; Bond, Lyndal

2014-01-01

Minimum unit pricing of alcohol is a novel public health policy with the potential to improve population health and reduce health inequalities. Theories of the policy process may help to understand the development of policy innovation and in turn identify lessons for future public health research and practice. This study aims to explain minimum unit pricing's development by taking a 'multiple-lenses' approach to understanding the policy process. In particular, we apply three perspectives of the policy process (Kingdon's multiple streams, Punctuated-Equilibrium Theory, Multi-Level Governance) to understand how and why minimum unit pricing has developed in Scotland and describe implications for efforts to develop evidence-informed policymaking. Semi-structured interviews were conducted with policy actors (politicians, civil servants, academics, advocates, industry representatives) involved in the development of MUP (n = 36). Interviewees were asked about the policy process and the role of evidence in policy development. Data from two other sources (a review of policy documents and an analysis of evidence submission documents to the Scottish Parliament) were used for triangulation. The three perspectives provide complementary understandings of the policy process. Evidence has played an important role in presenting the policy issue of alcohol as a problem requiring action. Scotland-specific data and a change in the policy 'image' to a population-based problem contributed to making alcohol-related harms a priority for action. The limited powers of Scottish Government help explain the type of price intervention pursued while distinct aspects of the Scottish political climate favoured the pursuit of price-based interventions. Evidence has played a crucial but complex role in the development of an innovative policy. Utilising different political science theories helps explain different aspects of the policy process, with Multi-Level Governance particularly useful for highlighting important lessons for the future of public health policy.

Implementation and research priorities for FCTC Articles 13 and 16: tobacco advertising, promotion, and sponsorship and sales to and by minors.

PubMed

Nagler, Rebekah H; Viswanath, Kasisomayajula

2013-04-01

Article 13 of the Framework Convention on Tobacco Control (FCTC) calls for a comprehensive ban on tobacco advertising, promotion, and sponsorship (TAPS), and Article 16 calls for prohibition of tobacco sales to and by minors. Although these mandates are based on sound science, many countries have found provision implementation to be rife with challenges. This paper reviews the history of tobacco marketing and minor access restrictions in high-, middle-, and low-income countries, identifying past challenges and successes. We consider current challenges to FCTC implementation, how these barriers can be addressed, and what research is necessary to support such efforts. Specifically, we identify implementation and research priorities for FCTC Articles 13 and 16. Although a solid evidence base underpins the FCTC's call for TAPS bans and minor access restrictions, we know substantially less about how best to implement these restrictions. Drawing on the regulatory experiences of high-, middle-, and low-income countries, we discern several implementation and research priorities, which are organized into 4 categories: policy enactment and enforcement, human capital expertise, the effects of FCTC marketing and youth access policies, and knowledge exchange and transfer among signatories. Future research should provide detailed case studies on implementation successes and failures, as well as insights into how knowledge of successful restrictions can be translated into tobacco control policy and practice and shared among different stakeholders. Tobacco marketing surveillance, sales-to-minors compliance checks, enforcement and evaluation of restriction policies, and capacity building and knowledge transfer are likely to prove central to effective implementation.

Iranian Female Adolescent’s Views on Unhealthy Snacks Consumption: A Qualitative Study

PubMed Central

Karimi-Shahanjarini, A; Omidvar, N; Bazargan3, M; Rashidian, A; Majdzadeh, R; Shojaeizadeh, D

2010-01-01

Background: Given the increasing prevalence of obesity among Iranian adolescents and the role of consumption of unhealthy snacks in this issue, interventions that focus on factors influencing food choice are needed. This study was designed to delineate factors associated with unhealthy snack use among female Iranian adolescents. Methods: The theory of Planned Behavior served as the framework of the study. Qualitative data were collected via nine focus group discussions in two middle schools (6th to 8th grades) in a socio-economically diverse district in the city of Tehran in spring 2008. The study sample included 90 female adolescents aged 12–15 years. The sampling strategy was purposive method. Data analyzed using the “framework” method. Results: Major factors identified by the respondents were taste, peer pressure, parental influence, easy access to unhealthy snacks, limited availability of healthy snacks, appeal of snacks, habit, high price of healthy snacks, and media advertisements. Nutritional value and healthiness was not one of the first priorities when buying snacks, as adolescents thought it was too early for them to worry about illness and adverse consequences of eating junk foods. Conclusions: For developing culturally sensitive evidence-based interventions that can motivate adolescents to choose healthy snacks, a broad range of factors should be taken into account. PMID:23113027

Iranian Female Adolescent's Views on Unhealthy Snacks Consumption: A Qualitative Study.

PubMed

Karimi-Shahanjarini, A; Omidvar, N; Bazargan3, M; Rashidian, A; Majdzadeh, R; Shojaeizadeh, D

2010-01-01

Given the increasing prevalence of obesity among Iranian adolescents and the role of consumption of unhealthy snacks in this issue, interventions that focus on factors influencing food choice are needed. This study was designed to delineate factors associated with unhealthy snack use among female Iranian adolescents. The theory of Planned Behavior served as the framework of the study. Qualitative data were collected via nine focus group discussions in two middle schools (6(th) to 8(th) grades) in a socio-economically diverse district in the city of Tehran in spring 2008. The study sample included 90 female adolescents aged 12-15 years. The sampling strategy was purposive method. Data analyzed using the "framework" method. Major factors identified by the respondents were taste, peer pressure, parental influence, easy access to unhealthy snacks, limited availability of healthy snacks, appeal of snacks, habit, high price of healthy snacks, and media advertisements. Nutritional value and healthiness was not one of the first priorities when buying snacks, as adolescents thought it was too early for them to worry about illness and adverse consequences of eating junk foods. For developing culturally sensitive evidence-based interventions that can motivate adolescents to choose healthy snacks, a broad range of factors should be taken into account.

Rural energy survey and cost-effectiveness analysis of renewable-energy technologies for a Philippine Island community

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

Manibog, F.R.

1982-01-01

This study presents the methodology and results of: (1) a rural energy survey that was conducted in a Philippine island community; and (2) a cost-effectiveness analysis of selected conventional and renewable-energy technologies. The rural energy survey section compares different survey techniques and analyzes energy utilization by providing: (1) a breakdown of energy flows and use patterns; (2) information on energy prices, ownership patterns, social relations, and their effects in terms of differential access to energy sources; (3) per household and per capita consumption figures; and (4) a village energy-consumption table. Correlation analysis is used to determine if the stratified, independentmore » socio-economic variables are indicators for dependent energy variables. Results of the economic analysis indicate that renewable-energy technologies are already least-cost alternatives to diesel generation in the village case study. The sensitivity analysis also shows that these technologies remain the least-cost options even if their capital costs were underestimated. The findings of the study are useful to the current Philippine renewable-energy program in terms of providing: (1) information essential for determining end-users' priority energy needs and for improving technology choice and project design; and (2) justification for promoting auto-generation based on renewable energy sources as alternatives to diesel fuel.« less

Pricing of Staple Foods at Supermarkets versus Small Food Stores

PubMed Central

Caspi, Caitlin E.; Pelletier, Jennifer E.; Harnack, Lisa J.; Erickson, Darin J.; Laska, Melissa N.

2017-01-01

Prices affect food purchase decisions, particularly in lower-income communities, where access to a range of food retailers (including supermarkets) is limited. The aim of this study was to examine differences in staple food pricing between small urban food stores and the closest supermarkets, as well as whether pricing differentials varied based on proximity between small stores and larger retailers. In 2014, prices were measured for 15 staple foods during store visits in 140 smaller stores (corner stores, gas-marts, dollar stores, and pharmacies) in Minneapolis/St. Paul, MN and their closest supermarket. Mixed models controlling for store type were used to estimate the average price differential between: (a) smaller stores and supermarkets; (b) isolated smaller stores (>1 mile to closest supermarket) and non-isolated smaller stores; and (c) isolated smaller stores inside versus outside USDA-identified food deserts. On average, all items except white bread were 10–54% more expensive in smaller stores than in supermarkets (p < 0.001). Prices were generally not significantly different in isolated stores compared with non-isolated stores for most items. Among isolated stores, there were no price differences inside versus outside food deserts. We conclude that smaller food stores have higher prices for most staple foods compared to their closest supermarket, regardless of proximity. More research is needed to examine staple food prices in different retail spaces. PMID:28809795

Pricing of Staple Foods at Supermarkets versus Small Food Stores.

PubMed

Caspi, Caitlin E; Pelletier, Jennifer E; Harnack, Lisa J; Erickson, Darin J; Lenk, Kathleen; Laska, Melissa N

2017-08-15

Prices affect food purchase decisions, particularly in lower-income communities, where access to a range of food retailers (including supermarkets) is limited. The aim of this study was to examine differences in staple food pricing between small urban food stores and the closest supermarkets, as well as whether pricing differentials varied based on proximity between small stores and larger retailers. In 2014, prices were measured for 15 staple foods during store visits in 140 smaller stores (corner stores, gas-marts, dollar stores, and pharmacies) in Minneapolis/St. Paul, MN and their closest supermarket. Mixed models controlling for store type were used to estimate the average price differential between: (a) smaller stores and supermarkets; (b) isolated smaller stores (>1 mile to closest supermarket) and non-isolated smaller stores; and (c) isolated smaller stores inside versus outside USDA-identified food deserts. On average, all items except white bread were 10-54% more expensive in smaller stores than in supermarkets ( p < 0.001). Prices were generally not significantly different in isolated stores compared with non-isolated stores for most items. Among isolated stores, there were no price differences inside versus outside food deserts. We conclude that smaller food stores have higher prices for most staple foods compared to their closest supermarket, regardless of proximity. More research is needed to examine staple food prices in different retail spaces.

Patient access to new cancer drugs in the United States and Australia.

PubMed

Wilson, Andrew; Cohen, Joshua

2011-01-01

In light of the current debate on the use value and potential impact of comparative effectiveness research on patient access, it may prove insightful to compare a health-care system that systematically bases its reimbursement decisions on comparative effectiveness evidence with the United States (US) system that hitherto has only been informed by such evidence on an ad hoc basis. For a set of 2000-2009 approved new molecular entities and biologics indicated for cancer, we compared patient access between US Medicare and Australian Pharmaceutical Benefits Scheme (PBS) beneficiaries. Here, access is defined in terms of marketing availability, payer coverage, and patient out-of-pocket costs. Although 34 drugs and biologics were approved for cancer in the US, just more than one-third (35%) were ultimately covered by the Australian PBS. The PBS also placed more restrictions on use. On the other hand, prices and patient out-of-pocket costs were greater for the US Medicare population. Our analysis points to a possible trade-off in market access to oncology drugs. Although more oncology drugs are available in the US and a higher percentage of available drugs are covered, the evidence-based approach adopted by Australia has contributed to reduced prices, thereby improving affordability for payers and patients for those medications deemed cost-effective by the reimbursement authority. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Open access, library and publisher competition, and the evolution of general commerce.

PubMed

Odlyzko, Andrew M

2015-02-01

Discussions of the economics of scholarly communication are usually devoted to Open Access, rising journal prices, publisher profits, and boycotts. That ignores what seems a much more important development in this market. Publishers, through the oft-reviled Big Deal packages, are providing much greater and more egalitarian access to the journal literature, an approximation to true Open Access. In the process, they are also marginalizing libraries and obtaining a greater share of the resources going into scholarly communication. This is enabling a continuation of publisher profits as well as of what for decades has been called "unsustainable journal price escalation." It is also inhibiting the spread of Open Access and potentially leading to an oligopoly of publishers controlling distribution through large-scale licensing. The Big Deal practices are worth studying for several general reasons. The degree to which publishers succeed in diminishing the role of libraries may be an indicator of the degree and speed at which universities transform themselves. More importantly, these Big Deals appear to point the way to the future of the whole economy, where progress is characterized by declining privacy, increasing price discrimination, increasing opaqueness in pricing, increasing reliance on low-paid or unpaid work of others for profits, and business models that depend on customer inertia. © The Author(s) 2014.

47 CFR 69.152 - End user common line for price cap local exchange carriers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false End user common line for price cap local...) COMMON CARRIER SERVICES (CONTINUED) ACCESS CHARGES Computation of Charges for Price Cap Local Exchange Carriers § 69.152 End user common line for price cap local exchange carriers. (a) A charge that is...

78 FR 21663 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-11

... price improving orders, and then are eligible to access non-price improving liquidity on the NASDAQ book.... For Type 2 Retail Orders that execute against non-price improving orders on the NASDAQ book, NASDAQ... investment intentions, they promote price discovery and dampen volatility. Accordingly, their presence in the...

Publishing priorities of biomedical research funders

PubMed Central

Collins, Ellen

2013-01-01

Objectives To understand the publishing priorities, especially in relation to open access, of 10 UK biomedical research funders. Design Semistructured interviews. Setting 10 UK biomedical research funders. Participants 12 employees with responsibility for research management at 10 UK biomedical research funders; a purposive sample to represent a range of backgrounds and organisation types. Conclusions Publicly funded and large biomedical research funders are committed to open access publishing and are pleased with recent developments which have stimulated growth in this area. Smaller charitable funders are supportive of the aims of open access, but are concerned about the practical implications for their budgets and their funded researchers. Across the board, biomedical research funders are turning their attention to other priorities for sharing research outputs, including data, protocols and negative results. Further work is required to understand how smaller funders, including charitable funders, can support open access. PMID:24154520

How Much Is Too Much to Pay for Internet Access? A Behavioral Economic Analysis of Internet Use.

PubMed

Broadbent, Julie; Dakki, Michelle A

2015-08-01

The popularity of online recreational activities, such as social networking, has dramatically increased the amount of time spent on the Internet. Excessive or inappropriate use of the Internet can result in serious adverse consequences. The current study used a behavioral economic task to determine if the amount of time spent online by problematic and nonproblematic users can be modified by price. The Internet Purchase Task was used to determine how much time undergraduate students (N=233) would spend online at 13 different prices. Despite high demand for Internet access when access was free, time spent online by both problematic and nonproblematic users decreased dramatically, even at low prices. These results suggest that the amount of time spent online may be modified by having a tangible cost associated with use, whereas having free access to the Internet may encourage excessive, problematic use.

Improving Global Access to New Vaccines: Intellectual Property, Technology Transfer, and Regulatory Pathways

PubMed Central

2014-01-01

The 2012 World Health Assembly Global Vaccine Action Plan called for global access to new vaccines within 5 years of licensure. Current approaches have proven insufficient to achieve sustainable vaccine pricing within such a timeline. Paralleling the successful strategy of generic competition to bring down drug prices, a clear consensus is emerging that market entry of multiple suppliers is a critical factor in expeditiously bringing down prices of new vaccines. In this context, key target objectives for improving access to new vaccines include overcoming intellectual property obstacles, streamlining regulatory pathways for biosimilar vaccines, and reducing market entry timelines for developing-country vaccine manufacturers by transfer of technology and know-how. I propose an intellectual property, technology, and know-how bank as a new approach to facilitate widespread access to new vaccines in low- and middle-income countries by efficient transfer of patented vaccine technologies to multiple developing-country vaccine manufacturers. PMID:25211753

Improving global access to new vaccines: intellectual property, technology transfer, and regulatory pathways.

PubMed

Crager, Sara Eve

2014-11-01

The 2012 World Health Assembly Global Vaccine Action Plan called for global access to new vaccines within 5 years of licensure. Current approaches have proven insufficient to achieve sustainable vaccine pricing within such a timeline. Paralleling the successful strategy of generic competition to bring down drug prices, a clear consensus is emerging that market entry of multiple suppliers is a critical factor in expeditiously bringing down prices of new vaccines. In this context, key target objectives for improving access to new vaccines include overcoming intellectual property obstacles, streamlining regulatory pathways for biosimilar vaccines, and reducing market entry timelines for developing-country vaccine manufacturers by transfer of technology and know-how. I propose an intellectual property, technology, and know-how bank as a new approach to facilitate widespread access to new vaccines in low- and middle-income countries by efficient transfer of patented vaccine technologies to multiple developing-country vaccine manufacturers.

[Improving global access to new vaccines: intellectual property, technology transfer, and regulatory pathways].

PubMed

Crager, Sara Eve

2015-01-01

The 2012 World Health Assembly Global Vaccine Action Plan called for global access to new vaccines within 5 years of licensure. Current approaches have proven insufficient to achieve sustainable vaccine pricing within such a timeline. Paralleling the successful strategy of generic competition to bring down drug prices, a clear consensus is emerging that market entry of multiple suppliers is a critical factor in expeditiously bringing down prices of new vaccines. In this context, key target objectives for improving access to new vaccines include overcoming intellectual property obstacles, streamlining regulatory pathways for biosimilar vaccines, and reducing market entry timelines for developing-country vaccine manufacturers by transfer of technology and know-how. I propose an intellectual property, technology, and know-how bank as a new approach to facilitate widespread access to new vaccines in low- and middle-income countries by efficient transfer of patented vaccine technologies to multiple developing-country vaccine manufacturers.

Membership within the Nonpareil Marketing Group: Examination of an unclassified accession

USDA-ARS?s Scientific Manuscript database

California almonds are categorized into marketing groups based on kernel shape and appearance to facilitate promotion and sale. Market prices for Nonpareil Marketing Group (NMG) kernels are 30% higher than for almonds in other marketing groups. Accordingly, there is economic incentive for breeders ...

78 FR 19029 - Negotiated Service Agreement

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-28

... POSTAL REGULATORY COMMISSION [Docket No. CP2013-6; Order No. 1680] Negotiated Service Agreement... applicable,'' and that the Amendment ``will not materially affect the cost coverage'' of the agreement. Id... of the agreement on the average increase in prices of general applicability for ``Priority Mail...

Factors influencing global antiretroviral procurement prices

PubMed Central

2009-01-01

Background Antiretroviral medicines (ARVs) are one of the most costly parts of HIV/AIDS treatment. Many countries are struggling to provide universal access to ARVs for all people living with HIV and AIDS. Although substantial price reductions of ARVs have occurred, especially between 2002 and 2008, achieving sustainable access for the next several decades remains a major challenge for most low- and middle-income countries. The objectives of the present study were twofold: first, to analyze global ARV prices between 2005 and 2008 and associated factors, particularly procurement methods and key donor policies on ARV procurement efficiency; second, to discuss the options of procurement processes and policies that should be considered when implementing or reforming access to ARV programs. Methods An ARV-medicines price-analysis was carried out using the Global Price Reporting Mechanism from the World Health Organization. For a selection of 12 ARVs, global median prices and price variation were calculated. Linear regression models for each ARV were used to identify factors that were associated with lower procurement prices. Logistic regression models were used to identify the characteristics of those countries which procure below the highest and lowest direct manufactured costs. Results Three key factors appear to have an influence on a country's ARV prices: (a) whether the product is generic or not; (b) the socioeconomic status of the country; (c) whether the country is a member of the Clinton HIV/AIDS Initiative. Factors which did not influence procurement below the highest direct manufactured costs were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President's Emergency Plan For AIDS Relief. Conclusion One of the principal mechanisms that can help to lower prices for ARV over the next several decades is increasing procurement efficiency. Benchmarking prices could be one useful tool to achieve this. PMID:19922690

Monitoring the tobacco use epidemic V: The environment: factors that influence tobacco use.

PubMed

Farrelly, Matthew C

2009-01-01

This environment paper (V of V) summarizes important surveillance and evaluation systems that monitor influences on tobacco use such as smoke-free laws and other legislation, excise taxes, mass media, and a broad range of tobacco control activities, discusses their strengths and weaknesses, and makes recommendations for enhancement. We summarize and expand on the recommendations from the Environment Working Group of the National Tobacco Monitoring, Research, and Evaluation Workshop prioritized surveillance needs. This group rank-ordered surveillance needs various environmental influences, considering both the perceived importance of each environmental influence and the adequacy of the current surveillance systems. Based on this ranking and subsequent discussion, the group identified key priorities for enhancement. The group arrived at two key priorities: (1) develop and implement a national system for local tobacco control ordinance surveillance, and (2) develop and implement a comprehensive program monitoring system that is used by all states and supported by all funding agencies. Other environmental influences recommended for priority monitoring include cigarette prices and tobacco countermarketing. Systematic surveillance and monitoring of key program inputs and outputs and environmental influences is central to understand the effectiveness and cost-effectiveness of tobacco control efforts.

Evidence-based decision on medical technologies in Asia Pacific: experiences from India, Malaysia, Philippines, and Pakistan.

PubMed

Thatte, Urmila; Hussain, Samsinah; de Rosas-Valera, Madeleine; Malik, Muhammad Ashar

2009-01-01

This paper discusses national programs implemented in India, Pakistan, Malaysia, and Philippines to generate and apply evidence in making informed policy decisions on the approval, pricing, reimbursement and financing of medicines, diagnostics, and medical devices. In all countries, the Ministries of Health are generally responsible for approval of health technologies through various agencies like the Central Drugs Standard Control Organisation in India, Bureau of Food and Drugs for medicines and Bureau of Health Devices and Technology for medical devices in the Philippines, the National Pharmaceutical Control Bureau, Health Technology Assessment Unit and Medical Device Bureau in Malaysia, and the Drug Control Organization in Pakistan. Product dossiers are evaluated while taking decisions. India has a strong price control mechanism through the National Pharmaceutical Pricing Authority. In the Philippines, the Essential Drug Price Monitoring System monitors prices of 37 essential drugs monthly from all drugstore outlets nationwide. In Malaysia and Pakistan registration pricing of new drugs is negotiated/fixed by the government with the vendor. A mix of social, voluntary private and community-based health insurance plans are available in India while the Philippine Health Insurance Corporation is responsible for reimbursement of drugs and medical devices in the Philippines. In Malaysia no formal reimbursement system is being practiced, and in Pakistan the government reimburses medical claims of its employees. In both India and the Philippines the bulk of health expenditure is out of pocket while the government pays for 20% and 28% respectively in both countries. The public health care services in Malaysia are heavily subsidized by the government with minimum fee being charged to the public. The government of Pakistan gives free medicines to its citizens at the public health facilities. In the region under discussion, one of the priority areas that the different regulatory agencies would benefit from is human resource development to facilitate the process of evidence based assessment of health technologies. Higher budgetary allocation and stronger legislation is also needed along with interagency and international coordination and cooperation to harmonize.

Food choice motives, attitude towards and intention to adopt personalised nutrition.

PubMed

Rankin, Audrey; Bunting, Brendan P; Poínhos, Rui; van der Lans, Ivo A; Fischer, Arnout Rh; Kuznesof, Sharron; Almeida, Mdv; Markovina, Jerko; Frewer, Lynn J; Stewart-Knox, Barbara J

2018-05-17

The present study explored associations between food choice motives, attitudes towards and intention to adopt personalised nutrition, to inform communication strategies based on consumer priorities and concerns.Design/SettingA survey was administered online which included the Food Choice Questionnaire (FCQ) and items assessing attitudes towards and intention to adopt personalised nutrition. Nationally representative samples were recruited in nine EU countries (n 9381). Structural equation modelling indicated that the food choice motives 'weight control', 'mood', 'health' and 'ethical concern' had a positive association and 'price' had a negative association with attitude towards, and intention to adopt, personalised nutrition. 'Health' was positively associated and 'familiarity' negatively associated with attitude towards personalised nutrition. The effects of 'weight control', 'ethical concern', 'mood' and 'price' on intention to adopt personalised nutrition were partially mediated by attitude. The effects of 'health' and 'familiarity' were fully mediated by attitude. 'Sensory appeal' was negatively and directly associated with intention to adopt personalised nutrition. Personalised nutrition providers may benefit from taking into consideration the importance of underlying determinants of food choice in potential users, particularly weight control, mood and price, when promoting services and in tailoring communications that are motivationally relevant.

Why Do Some Batteries Last Longer Than Others?

NASA Astrophysics Data System (ADS)

Smith, Michael J.; Vincent, Colin A.

2002-07-01

The criteria used by manufacturers to determine the market price of a commercial product are often only indirectly related to what the consumer recognizes as important. This is certainly true of the battery industry; the most expensive battery or cell does not always provide the best service. Even when the electrochemical basis for energy conversion is apparently the same, cells produced by different manufacturers often provide markedly different quantities of energy. In this experiment samples of cathode composite are removed from commercial cells and their electrochemical performance is compared using a test cell and identical discharge conditions. The results confirm that the cell with the most energy does not always have the highest price and suggest that some cell manufacturers may attribute a higher priority to other aspects of performance (power, shelf-life or resistance to abuse, for example), which increase the price without improving the quantity of deliverable energy. The objective of the experiment described in this paper is to provide information that gives the chemically aware consumer a frame of reference for future choice of cells and contributes to an improved understanding of the structure and operational basis of primary cells based on the Leclanché system.

An Empirical Study on the Preference of Supermarkets with Analytic Hierarchy Process Model

NASA Astrophysics Data System (ADS)

Weng Siew, Lam; Singh, Ranjeet; Singh, Bishan; Weng Hoe, Lam; Kah Fai, Liew

2018-04-01

Large-scale retailers are very important to the consumers in this fast-paced world. Selection of desirable market to purchase products and services becomes major concern among consumers in their daily life due to vast choices available. Therefore, the objective of this paper is to determine the most preferred supermarket among AEON, Jaya Grocer, Tesco, Giant and Econsave by the undergraduate students in Malaysia with Analytic Hierarchy Process (AHP) model. Besides that, this study also aims to determine the priority of decision criteria in the selection of supermarkets among the undergraduatestudents with AHP model. The decision criteria employed in this study are product quality, competitive price, cleanliness, product variety, location, good price labelling, fast checkout and employee courtesy. The results of this study show that AEON is the most preferred supermarket followed by Jaya Grocer, Tesco, Econsave and Giant among the students based on AHP model. Product quality, cleanliness and competitive price are ranked as the top three influential factors in this study. This study is significant because it helps to determine the most preferred supermarket as well as the most influential decision criteria in the preference of supermarkets among the undergraduate students with AHP model.

Access to affordable medicines after health reform: evidence from two cross-sectional surveys in Shaanxi Province, western China.

PubMed

Fang, Yu; Wagner, Anita K; Yang, Shimin; Jiang, Minghuan; Zhang, Fang; Ross-Degnan, Dennis

2013-10-01

Limited access to essential medicines is a global problem. Improving availability and affordability of essential medicines is a key objective of the National Essential Medicine Policy (NEMP) in China. In its initial implementation in 2009, the NEMP targeted primary hospitals with policies designed to increase availability of essential medicines and reduce patients' economic burden from purchasing medicines. We assessed medicine availability and price during the early years of the health reform in Shaanxi Province in underdeveloped western China. We undertook two public (hospitals) and private (pharmacy) sector surveys of prices and availability of medicines, in September, 2010 and April, 2012, by a standard methodology developed by WHO and Health Action International. We measured medicine availability in outlets at the time of the surveys and inflation-adjusted median unit prices (MUPs), taking 2010 as the base year. We used general estimating equations to calculate the significance of differences in availability from 2010 to 2012 and the Wilcoxon signed rank test to calculate the significance of differences in adjusted median prices. We collected data from 50 public sector hospitals and 36 private sector retail pharmacies in 2010 and 72 public hospitals and 72 retail pharmacies in 2012. Mean availability of surveyed medicines was low in both the public and private sectors; availability of many essential medicines decreased from 2010 to 2012, particularly in primary hospitals (from 27·4% to 22·3% for lowest priced generics; p<0·0001). The MUPs of originator brands and their generic equivalents decreased significantly from 2010 to 2012 in primary hospitals in comparison with secondary and tertiary hospitals. In the public sector, the median adjusted patient price was significantly lower in 2012 than in 2010 for 16 originator brands (difference -11·7%; p=0·0019) and 29 lowest-priced generics (-5·2%; p=0·0015); the median government procurement price for originator brands also decreased significantly (-10·9%; p=0·0004), whereas the decrease in median procurement price for lowest-priced generics was not significant (-4·9%; p=0·17). In the private sector, the median percentage decrease in price between 2010 and 2012 for 38 lowest-priced generics was 4·7% (IQR 6·3-13·2), compared with 7·9% (4·9-13·9) for 16 originator brands. Although inflation-adjusted medicine prices were numerically lower, there were concerning decreases in availability of lowest-priced generic medicines in both the public and private sectors in 2012 from already low availability in 2010. A long-term, stable, and consistent information system is needed to monitor effects of further implementation of the Chinese Essential Medicine Policy. The National Natural Science Fund (71103141/G0308), the China Medical Board Faculty Development Awards, the Fundamental Research Funds for the Central Universities (2011jdhz62), the Shaanxi Provincial Social Science Fund (10E066), and the Harvard Medical School Pharmaceutical Policy Research Fellowship. Copyright © 2013 Fang et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by .. All rights reserved.

The Commercial Market For Priority Review Vouchers.

PubMed

Ridley, David B; Régnier, Stephane A

2016-05-01

In 2007 the US Congress created the priority review voucher program to encourage the development of drugs for neglected diseases. Under the program, the developer of a drug that treats a neglected disease receives both a faster review of the drug by the Food and Drug Administration and a voucher for a faster review of a different drug. The developer can sell the voucher. We estimated the commercial value of the voucher using US sales of new treatments approved in the period 2007-09. A third of the commercial value of a voucher comes from capturing market share from competitors, nearly half from the value of earlier sales because of the expedited review, and less than a quarter from lengthening the time between approval and the launch of a generic competitor. We estimate that if only one priority review voucher is available in a year, it will be worth more than $200 million, but if four vouchers are available, the value could fall below $100 million. Congress should be cautious about expanding the voucher program, because increasing the number of vouchers sharply decreases the expected price. Lower voucher prices could undermine the incentive to develop new medicines for neglected diseases. Project HOPE—The People-to-People Health Foundation, Inc.

Sequential data access with Oracle and Hadoop: a performance comparison

NASA Astrophysics Data System (ADS)

Baranowski, Zbigniew; Canali, Luca; Grancher, Eric

2014-06-01

The Hadoop framework has proven to be an effective and popular approach for dealing with "Big Data" and, thanks to its scaling ability and optimised storage access, Hadoop Distributed File System-based projects such as MapReduce or HBase are seen as candidates to replace traditional relational database management systems whenever scalable speed of data processing is a priority. But do these projects deliver in practice? Does migrating to Hadoop's "shared nothing" architecture really improve data access throughput? And, if so, at what cost? Authors answer these questions-addressing cost/performance as well as raw performance- based on a performance comparison between an Oracle-based relational database and Hadoop's distributed solutions like MapReduce or HBase for sequential data access. A key feature of our approach is the use of an unbiased data model as certain data models can significantly favour one of the technologies tested.

The Potential Effects of Minimum Wage Changes on Naval Accessions

DTIC Science & Technology

2017-03-01

price floor affects the market’s demand for labor and utilizes the two-sector and search models to demonstrate how the minimum wage market ...and search models to demonstrate how the minimum wage market correlates to military ascensions. Finally, the report examines studies that show the...that Derives from a Price Floor. Source: “Price Floor” (n.d.). .....14 Figure 3. Price Floor below the Market . Source: “Price Floor” (n.d

Reducing tobacco use and access through strengthened minimum price laws.

PubMed

McLaughlin, Ian; Pearson, Anne; Laird-Metke, Elisa; Ribisl, Kurt

2014-10-01

Higher prices reduce consumption and initiation of tobacco products. A minimum price law that establishes a high statutory minimum price and prohibits the industry's discounting tactics for tobacco products is a promising pricing strategy as an alternative to excise tax increases. Although some states have adopted minimum price laws on the basis of statutorily defined price "markups" over the invoice price, existing state laws have been largely ineffective at increasing the retail price. We analyzed 3 new variations of minimum price laws that hold great potential for raising tobacco prices and reducing consumption: (1) a flat rate minimum price law similar to a recent enactment in New York City, (2) an enhanced markup law, and (3) a law that incorporates both elements.

Models and strategies for electricity distribution companies in emerging economies

NASA Astrophysics Data System (ADS)

Zaragocin Espinosa, Leonardo Vicente

Unbundling and privatization have become key elements of restructuring in the Electric Power Industry of Emerging Economies. These processes have concentrated on the Generation and Transmission areas, leaving Distribution as lower priority. Based on a comparison between the old role of Distribution Companies (DISCOS) and its new potential role this study identifies the main issues and challenges that DISCOS will face in the new environment once structural and ownership changes are completed. For the specific case of DISCOS in Emerging Economies, regulatory policies are reviewed and strategies identified in order to facilitate the transition and to assist in the integration of DISCOS with other agents in the evolving electric power market. Of particular importance in this research is the analysis of the role of Energy Efficiency (EE) in the new structural and governance environment. A theoretical study of the effects of energy efficiency measures, specifically loss reduction, on price regulation is developed within a proposed regulatory regime of privatization together with Price-Cap Regulation. This theoretical benchmark is then used as a starting point for a case study, the Electric System of Ecuador, where an analysis of the current Ecuadorian price regulation scheme (the Distribution Value Added Charge, VAD, scheme) is presented and analyzed in detail. General recommendations for improving the application of the VAD pricing approach are advanced, with special reference to the current situation in Ecuador.

Opto-microwave Butler matrixes based front-end for a multi-beam large direct radiating array antenna

NASA Astrophysics Data System (ADS)

Piqueras, M. A.; Mengual, T.; Navasquillo, O.; Sotom, M.; Caille, G.

2017-09-01

The evolution of broadband communication satellites shows a clear trend towards beam forming and beam-switching systems with efficient multiple access schemes with wide bandwidths, for which to be economically viable, the communication price shall be as low as possible.

Silviculture research priorities for strategic paper fibers in the Lake States

Treesearch

Alan A. Lucier

2004-01-01

The economic performance of the pulp and paper industry in North America has been weak for more than a decade. Factors affecting performance vary among industry sectors and regions, but generally include slow growth in demand, excess production capacity, and low prices.

Evaluation of purchase intention of customers in two wheeler automobile segment: AHP and TOPSIS

NASA Astrophysics Data System (ADS)

Sri Yogi, Kottala

2018-03-01

Winning heart of customers is preeminent main design of any business organization in global business environment. This paper explored customer’s priorities while purchasing a two wheeler automobile segment using Analytical Hierarchy Process (AHP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) as a multi criteria decision making tools to accomplish the research objectives. Study has been done to analyze different criteria to be considered during purchasing of two wheeler automobiles among respondents using structured questionnaire based on SAATY scale. Based on our previous work on empirical & fuzzy logic approach to product quality and purchase intention of customers in two wheeler- operational, performance, economic, brand value and maintenance aspects are considered as decision criteria of customers while purchasing a two wheeler. The study suggests high pick up during overtaking, petrol saving, reasonable spare parts price, unique in design and identity and easy to change gear as main criterion in purchasing process. We also found some leading two wheeler automobiles models available in Indian market using some objective function criterion in choosing some important characteristics like price, cylinder capacity, brake horse power and weight during purchasing process of two wheeler automobile in Indian market based on respondents perception.

Do state minimum markup/price laws work? Evidence from retail scanner data and TUS-CPS.

PubMed

Huang, Jidong; Chriqui, Jamie F; DeLong, Hillary; Mirza, Maryam; Diaz, Megan C; Chaloupka, Frank J

2016-10-01

Minimum markup/price laws (MPLs) have been proposed as an alternative non-tax pricing strategy to reduce tobacco use and access. However, the empirical evidence on the effectiveness of MPLs in increasing cigarette prices is very limited. This study aims to fill this critical gap by examining the association between MPLs and cigarette prices. State MPLs were compiled from primary legal research databases and were linked to cigarette prices constructed from the Nielsen retail scanner data and the self-reported cigarette prices from the Tobacco Use Supplement to the Current Population Survey. Multivariate regression analyses were conducted to examine the association between MPLs and the major components of MPLs and cigarette prices. The presence of MPLs was associated with higher cigarette prices. In addition, cigarette prices were higher, above and beyond the higher prices resulting from MPLs, in states that prohibit below-cost combination sales; do not allow any distributing party to use trade discounts to reduce the base cost of cigarettes; prohibit distributing parties from meeting the price of a competitor, and prohibit distributing below-cost coupons to the consumer. Moreover, states that had total markup rates >24% were associated with significantly higher cigarette prices. MPLs are an effective way to increase cigarette prices. The impact of MPLs can be further strengthened by imposing greater markup rates and by prohibiting coupon distribution, competitor price matching, and use of below-cost combination sales and trade discounts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

47 CFR 51.915 - Recovery mechanism for price cap carriers.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Recovery mechanism for price cap carriers. 51... SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.915 Recovery mechanism for... recover certain revenues, through the recovery mechanism outlined below, to implement reforms adopted in...

47 CFR 51.915 - Recovery mechanism for price cap carriers.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Recovery mechanism for price cap carriers. 51... SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.915 Recovery mechanism for... recover certain revenues, through the recovery mechanism outlined below, to implement reforms adopted in...

47 CFR 51.915 - Recovery mechanism for price cap carriers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false Recovery mechanism for price cap carriers. 51... SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.915 Recovery mechanism for... recover certain revenues, through the recovery mechanism outlined below, to implement reforms adopted in...

Drug Licenses: A Better Model for Pharmaceutical Pricing

PubMed Central

Goldman, Dana P.; Jena, Anupam B.; Philipson, Tomas; Sun, Eric

2013-01-01

High drug prices are a substantial barrier to patient access and compliance. Yet, low drug prices are often argued to provide inadequate incentives for innovation. We propose a “drug-licensing” model for health care which has the promise of increasing drug utilization without altering patient out-of-pocket spending, health plan costs, or pharmaceutical profits. In such a model, individuals purchase annual drug licenses which guarantee unfettered access to a clinically optimal number of prescriptions over the course of a year. For the case of statins, we illustrate how such a model may be implemented in practice. PMID:18180487

Universal Access to Health and Universal Health Coverage: identification of nursing research priorities in Latin America

PubMed Central

Cassiani, Silvia Helena De Bortoli; Bassalobre-Garcia, Alessandra; Reveiz, Ludovic

2015-01-01

Objective: To estabilish a regional list for nursing research priorities in health systems and services in the Region of the Americas based on the concepts of Universal Access to Health and Universal Health Coverage. Method: five-stage consensus process: systematic review of literature; appraisal of resulting questions and topics; ranking of the items by graduate program coordinators; discussion and ranking amongst a forum of researchers and public health leaders; and consultation with the Ministries of Health of the Pan American Health Organization's member states. Results: the resulting list of nursing research priorities consists of 276 study questions/ topics, which are sorted into 14 subcategories distributed into six major categories: 1. Policies and education of nursing human resources; 2. Structure, organization and dynamics of health systems and services; 3. Science, technology, innovation, and information systems in public health; 4. Financing of health systems and services; 5. Health policies, governance, and social control; and 6. Social studies in the health field. Conclusion: the list of nursing research priorities is expected to serve as guidance and support for nursing research on health systems and services across Latin America. Not only researchers, but also Ministries of Health, leaders in public health, and research funding agencies are encouraged to use the results of this list to help inform research-funding decisions. PMID:26487014

Projected savings through public health voluntary licences of HIV drugs negotiated by the Medicines Patent Pool (MPP)

PubMed Central

Juneja, Sandeep; Gupta, Aastha; Moon, Suerie; Resch, Stephen

2017-01-01

The Medicines Patent Pool (MPP) was established in 2010 to ensure timely access to low-cost generic versions of patented antiretroviral (ARV) medicines in low- and middle-income countries (LMICs) through the negotiation of voluntary licences with patent holders. While robust data on the savings generated by MPP and other major global public health initiatives is important, it is also difficult to quantify. In this study, we estimate the savings generated by licences negotiated by the MPP for ARV medicines to treat HIV/AIDS in LMICs for the period 2010–2028 and generate a cost-benefit ratio–based on people living with HIV (PLHIVs) in any new countries which gain access to an ARV due to MPP licences and the price differential between originator’s tiered price and generics price, within the period where that ARV is patented. We found that the direct savings generated by the MPP are estimated to be USD 2.3 billion (net present value) by 2028, representing an estimated cost-benefit ratio of 1:43, which means for every USD 1 spent on MPP, the global public health community saves USD 43. The saving of USD 2.3 billion is equivalent to more than 24 million PLHIV receiving first-line ART in LMICs for 1 year at average prices today. PMID:28542239

The availability, pricing and affordability of three essential asthma medicines in 52 low- and middle-income countries.

PubMed

Babar, Zaheer-Ud-Din; Lessing, Charon; Mace, Cécile; Bissell, Karen

2013-11-01

Almost 300 million people suffer from asthma, yet many in low- and middle-income countries have difficulty accessing essential asthma medicines. Availability, price and affordability of medicines are likely to affect access. Very few studies have included asthma medicines, particularly inhaled corticosteroids, in these countries. Reflections about international reference prices (IRPs) are generally absent from pricing studies, yet some IRPs may be masking the extent of access problems. Our objective was to determine the availability, pricing and affordability of beclometasone, budesonide and salbutamol, the three asthma medicines on the World Health Organization's Model List of Essential Medicines (EML) in selected low- and middle-income countries and to reflect on the appropriateness of using IRPs. A cross-sectional pricing survey was conducted in 52 countries. Data were collected on country demographics including national currency, $US exchange rate and daily wage of the lowest-paid unskilled government worker. Pricing and availability data were collected for salbutamol, beclometasone and budesonide in two private retail pharmacies, the national procurement centre and a main public hospital. Availability was particularly poor for corticosteroids, and worse in national procurement centres and main hospitals. The surveyed strength of beclometasone was only on the EML of ten countries. Considerable variability was found in pricing and affordability across countries. Procurement systems appeared largely inefficient when Asthma Drug Facility prices were applied as references. Some countries appear to be subsidising asthma medicines, making them free or less expensive for patients, while other countries are applying very high margins, which can significantly increase the price for patients unless a reimbursement system exists. Findings raise important policy concerns. Availability of inhaled corticosteroids is poor; many EMLs are not updated; IRPs can be misleading; health systems and patients are paying more than necessary for asthma medicines, which are unaffordable for many patients in many countries.

Assessment of the impact of market regulation in Mali on the price of essential medicines provided through the private sector.

PubMed

Maïga, Diadié; Williams-Jones, Bryn

2010-10-01

In 1998, the government of Mali adopted a national pharmaceutical policy aimed at promoting a supply system for generic essential medicines that would guarantee equal access for all citizens. Distribution and delivery is a shared responsibility of both public and private sectors (wholesalers and pharmacies). To influence private sector behaviour, the national policy uses a combination of government regulation and market forces. In 2006, the government issued a decree fixing maximum prices in the private sector for 107 prescription drugs from the national list of 426 essential medicines. The current study assessed the impact of this intervention on the evolution of market prices (wholesale and retail), and the subsequent availability and public access to essential medicines in Mali. A cross-sectional descriptive survey was conducted in February and May 2006, and January 2009, with 16 wholesalers and 30 private drugstores in Bamako, Mali. The overall availability of essential medicines at private wholesalers (p=1) and pharmacies (p=0.53) was identical before and after the enforcement of the 2006 decree fixing maximum drug prices. Contrary to concerns expressed by wholesalers and pharmacies, and the other stakeholders, the decree did not impact negatively on availability of essential medicines. In fact, median wholesale prices in 2009 were 25.6% less than those fixed by the decree. In private pharmacies, retail prices were only 3% more expensive than the recommended prices, compared with being 25.5% more expensive prior to enforcement of the decree. The study shows that prices of essential medicines in Mali have evolved favourably towards the prices recommended by the government decree. Further, the study contributes to mounting evidence that market regulation by governments does not necessarily negatively affect drug availability; in fact, given the reduction in prices, the study shows that Malians arguably have better access to more affordable essential medicines. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Achieving Internet-based efficiencies in a rural IDS: a case study.

PubMed

Bacus, R; Zunke, R

2001-09-01

After suffering payment cuts resulting from the Balanced Budget Act of 1997, Colorado-Fayette Medical Center (CFMC), a not-for-profit, rural integrated delivery system in Texas, wanted to reduce costs by gaining systemwide Internet access for its internal information system at a reasonable price. An application service provider affiliated with the Texas Hospital Association, helped CFMC achieve its goals for the project by performing a needs assessment, installing a wide-area network (WAN) with Internet access, and training staff. The new WAN enabled CFMC to improve its Web presence, allow radiologic image viewing at all sites, negotiate more favorable prices from vendors, implement electronic communication for staff members, and take advantage of on-line education opportunities. CFMC has found that the monthly fee paid to THN is offset by savings on long-distance calls, Internet service provider fees, and marketing and advertising costs.

The costs and benefits of library site licenses to academic journals

PubMed Central

Bergstrom, Carl T.; Bergstrom, Theodore C.

2004-01-01

Scientific publishing is rapidly shifting from a paper-based system to one of predominantly electronic distribution, in which universities purchase site licenses for online access to journal contents. Will these changes necessarily benefit the scientific community? By using basic microeconomics and elementary statistical theory, we address this question and find a surprising answer. If a journal is priced to maximize the publisher's profits, scholars on average are likely to be worse off when universities purchase site licenses than they would be if access were by individual subscriptions only. However, site licenses are not always disadvantageous. Journals issued by professional societies and university presses are often priced so as to maximize subscriptions while recovering average costs. When such journals are sustained by institutional site licenses, the net benefits to the scientific community are larger than if these journals are sold only by individual subscriptions. PMID:14715902

The costs and benefits of library site licenses to academic journals.

PubMed

Bergstrom, Carl T; Bergstrom, Theodore C

2004-01-20

Scientific publishing is rapidly shifting from a paper-based system to one of predominantly electronic distribution, in which universities purchase site licenses for online access to journal contents. Will these changes necessarily benefit the scientific community? By using basic microeconomics and elementary statistical theory, we address this question and find a surprising answer. If a journal is priced to maximize the publisher's profits, scholars on average are likely to be worse off when universities purchase site licenses than they would be if access were by individual subscriptions only. However, site licenses are not always disadvantageous. Journals issued by professional societies and university presses are often priced so as to maximize subscriptions while recovering average costs. When such journals are sustained by institutional site licenses, the net benefits to the scientific community are larger than if these journals are sold only by individual subscriptions.

77 FR 76572 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-28

... Substance of the Proposed Rule Change NASDAQ proposes to modify Chapter XV, entitled ``Options Pricing,'' governing pricing for NASDAQ members using the NASDAQ Options Market (``NOM''), NASDAQ's facility for... modify Chapter XV, entitled ``Options Pricing,'' at Section 3 entitled ``NASDAQ Options Market--Access...

Differential pricing of drugs: a role for cost-effectiveness analysis?

PubMed

Lopert, Ruth; Lang, Danielle L; Hill, Suzanne R; Henry, David A

2002-06-15

Internationally, the high costs of pharmaceutical products limit access to treatment. The principle of differential pricing is that drug prices should vary according to some measure of affordability. How differential prices should be determined is, however, unclear. Here we describe a method whereby differential prices for essential drugs could be derived in countries of variable national wealth, and, using angiotensin-converting enzyme inhibitors provide an example of how the process might work. Indicative prices for drugs can be derived by cost-effectiveness analysis that incorporates a measure of national wealth. Such prices could be used internationally as a basis of differential price negotiations.

Reducing Tobacco Use and Access Through Strengthened Minimum Price Laws

PubMed Central

Pearson, Anne; Laird-Metke, Elisa; Ribisl, Kurt

2014-01-01

Higher prices reduce consumption and initiation of tobacco products. A minimum price law that establishes a high statutory minimum price and prohibits the industry’s discounting tactics for tobacco products is a promising pricing strategy as an alternative to excise tax increases. Although some states have adopted minimum price laws on the basis of statutorily defined price “markups” over the invoice price, existing state laws have been largely ineffective at increasing the retail price. We analyzed 3 new variations of minimum price laws that hold great potential for raising tobacco prices and reducing consumption: (1) a flat rate minimum price law similar to a recent enactment in New York City, (2) an enhanced markup law, and (3) a law that incorporates both elements. PMID:25121820

Mass Notification for Higher Education

ERIC Educational Resources Information Center

Schneider, Tod

2010-01-01

Mass notification is a high priority in educational institutions. As the number of electronic communication devices has diversified, so has the complexity of designing an effective mass notification system. Picking the right system, with the right features, support services and price, can be daunting. This publication, updated quarterly due to…

Enhanced Handover Decision Algorithm in Heterogeneous Wireless Network

PubMed Central

Abdullah, Radhwan Mohamed; Zukarnain, Zuriati Ahmad

2017-01-01

Transferring a huge amount of data between different network locations over the network links depends on the network’s traffic capacity and data rate. Traditionally, a mobile device may be moved to achieve the operations of vertical handover, considering only one criterion, that is the Received Signal Strength (RSS). The use of a single criterion may cause service interruption, an unbalanced network load and an inefficient vertical handover. In this paper, we propose an enhanced vertical handover decision algorithm based on multiple criteria in the heterogeneous wireless network. The algorithm consists of three technology interfaces: Long-Term Evolution (LTE), Worldwide interoperability for Microwave Access (WiMAX) and Wireless Local Area Network (WLAN). It also employs three types of vertical handover decision algorithms: equal priority, mobile priority and network priority. The simulation results illustrate that the three types of decision algorithms outperform the traditional network decision algorithm in terms of handover number probability and the handover failure probability. In addition, it is noticed that the network priority handover decision algorithm produces better results compared to the equal priority and the mobile priority handover decision algorithm. Finally, the simulation results are validated by the analytical model. PMID:28708067

Setting a health policy research agenda for controlling cancer burden in Korea.

PubMed

Jang, Sung-In; Cho, Kyoung-Hee; Kim, Sun Jung; Lee, Kwang-Sig; Park, Eun-Cheol

2015-04-01

The aim of study was to provide suggestions for prioritizing research in effort to reduce cancer burden in Korea based on a comprehensive analysis of cancer burden and Delphi consensus among cancer experts. Twenty research plans covering 10 topics were selected based on an assessment of the literature, and e-mail surveys were analyzed using a two-round modified Delphi method. Thirty-four out of 79 experts were selected from four organizations to participate in round one, and 21 experts among them had completed round two. Each item had two questions; one regarding the agreement of the topic as a priority item to reduce cancer burden, and the other about the importance of the item on a nine-point scale. A consensus was defined to be an average lower coefficient of variation with less than 30% in importance. Seven plans that satisfied the three criteria were selected as priority research plans for reducing cancer burden. These plans are "research into advanced clinical guidelines for thyroid cancer given the current issue with over-diagnosis," "research into smoking management plans through price and non-price cigarette policy initiatives," "research into ways to measure the quality of cancer care," "research on policy development to expand hospice care," "research into the spread and management of Helicobacter pylori," "research on palliative care in a clinical setting," and "research into alternative mammography methods to increase the accuracy of breast cancer screenings." The seven plans identified in this study should be prioritized to reduce the burden of cancer in Korea. We suggest that policy makers and administrators study and invest significant effort in these plans.

Information system technologies' role in augmenting dermatologists' knowledge of prescription medication costs.

PubMed

DeMarco, Sebastian S; Paul, Ravi; Kilpatrick, Russell J

2015-12-01

Despite the recent rising costs of once affordable dermatologic prescription medications, a survey measuring dermatologists' attitudes, beliefs, and knowledge of the cost of drugs they commonly prescribe has not been conducted. Awareness of drug costs is hindered by a lack of access to data about the prices of medicines. No surveys of physicians have addressed this issue by proposing new information system technologies that augment prescription medication price transparency and measuring how receptive physicians are to using these novel solutions in their daily clinical practice. Our research aims to investigate these topics with a survey of physicians in dermatology. Members of the North Carolina Dermatology Association were contacted through their electronic mailing list and asked to take an online survey. The survey asked several questions about dermatologists' attitudes and beliefs about drug costs. To measure their knowledge of prescription medications, the National Average Drug Acquisition Cost was used as an authoritative price that was compared to the survey takers' price estimates of drugs commonly used in dermatology. Physicians' willingness to use four distinct information system technologies that increase drug price transparency was also assessed. Dermatologists believe drug costs are an important factor in patient care and believe access to price information would allow them to provide a higher quality of care. Dermatologists' knowledge of the costs of medicines they commonly prescribe is poor, but they want to utilize information system technologies that increase access to drug pricing information. There is an unmet demand for information system technologies which increase price transparency of medications in dermatology. Physicians and IT professionals have the opportunity to create novel information systems that can be utilized to help guide cost conscious clinical decision making. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Identifying priorities for quality improvement at an emergency Department in Ghana.

PubMed

DeWulf, Annelies; Otchi, Elom H; Soghoian, Sari

2017-08-30

Healthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educate staff about the World Health Organization's (WHO) definition of quality in healthcare, and to identify an initial focus for building a departmental QI program. Semi-structured interviews were conducted with ED staff using open-ended questions to probe their understanding and valuation of the six dimensions of quality defined by the WHO. Participants were then asked to rank the dimensions in order of importance for QI. Qualitative responses were thematically analyzed, and ordinal rank-order was determined for quantitative data regarding QI priorities. Twenty (20) members of staff of different cadres participated, including ED physicians, nurses, orderlies, a security officer, and an accountant. A majority of participants (61%) ranked access to emergency healthcare as high priority for QI. Two recurrent themes - financial accessibility and hospital bed availability - accounted for the majority of discussions, each linked to all the dimensions of healthcare quality. ED staff related all of the WHO quality dimensions to their work, and prioritized access to emergency care as the most important area for improvement. Participants expressed a high degree of motivation to improve healthcare quality, and the study helped with the development of a departmental QI program focused on the broad topic of access to ED services.

Implementation and Research Priorities for FCTC Articles 13 and 16: Tobacco Advertising, Promotion, and Sponsorship and Sales to and by Minors

PubMed Central

2013-01-01

Introduction: Article 13 of the Framework Convention on Tobacco Control (FCTC) calls for a comprehensive ban on tobacco advertising, promotion, and sponsorship (TAPS), and Article 16 calls for prohibition of tobacco sales to and by minors. Although these mandates are based on sound science, many countries have found provision implementation to be rife with challenges. Objective: This paper reviews the history of tobacco marketing and minor access restrictions in high-, middle-, and low-income countries, identifying past challenges and successes. We consider current challenges to FCTC implementation, how these barriers can be addressed, and what research is necessary to support such efforts. Specifically, we identify implementation and research priorities for FCTC Articles 13 and 16. Discussion: Although a solid evidence base underpins the FCTC’s call for TAPS bans and minor access restrictions, we know substantially less about how best to implement these restrictions. Drawing on the regulatory experiences of high-, middle-, and low-income countries, we discern several implementation and research priorities, which are organized into 4 categories: policy enactment and enforcement, human capital expertise, the effects of FCTC marketing and youth access policies, and knowledge exchange and transfer among signatories. Future research should provide detailed case studies on implementation successes and failures, as well as insights into how knowledge of successful restrictions can be translated into tobacco control policy and practice and shared among different stakeholders. Conclusion: Tobacco marketing surveillance, sales-to-minors compliance checks, enforcement and evaluation of restriction policies, and capacity building and knowledge transfer are likely to prove central to effective implementation. PMID:23291641

Priority scheme planning for the robust SSM/PMAD testbed

NASA Technical Reports Server (NTRS)

Elges, Michael R.; Ashworth, Barry R.

1991-01-01

Whenever mixing priorities of manually controlled resources with those of autonomously controlled resources, the space station module power management and distribution (SSM/PMAD) environment requires cooperating expert system interaction between the planning function and the priority manager. The elements and interactions of the SSM/PMAD planning and priority management functions are presented. Their adherence to cooperating for common achievement are described. In the SSM/PMAD testbed these actions are guided by having a system planning function, KANT, which has insight to the executing system and its automated database. First, the user must be given access to all information which may have an effect on the desired outcome. Second, the fault manager element, FRAMES, must be informed as to the change so that correct diagnoses and operations take place if and when faults occur. Third, some element must engage as mediator for selection of resources and actions to be added or removed at the user's request. This is performed by the priority manager, LPLMS. Lastly, the scheduling mechanism, MAESTRO, must provide future schedules adhering to the user modified resource base.

Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study.

PubMed

O'Donnell, Patrick; Tierney, Edel; O'Carroll, Austin; Nurse, Diane; MacFarlane, Anne

2016-12-03

The involvement of patients and the public in healthcare has grown significantly in recent decades and is documented in health policy documents internationally. Many benefits of involving these groups in primary care planning have been reported. However, these benefits are rarely felt by those considered marginalised in society and they are often excluded from participating in the process of planning primary care. It has been recommended to employ suitable approaches, such as co-operative and participatory initiatives, to enable marginalised groups to highlight their priorities for care. This Participatory Learning and Action (PLA) research study involved 21 members of various marginalised groups who contributed their views about access to primary care. Using a series of PLA techniques for data generation and co-analysis, we explored barriers and facilitators to primary healthcare access from the perspective of migrants, Irish Travellers, homeless people, drug users, sex workers and people living in deprivation, and identified their priorities for action with regard to primary care provision. Four overarching themes were identified: the home environment, the effects of the 'two-tier' healthcare system on engagement, healthcare encounters, and the complex health needs of many in those groups. The study demonstrates that there are many complicated personal and structural barriers to accessing primary healthcare for marginalised groups. There were shared and differential experiences across the groups. Participants also expressed shared priorities for action in the planning and running of primary care services. Members of marginalised groups have shared priorities for action to improve their access to primary care. If steps are taken to address these, there is scope to impact on more than one marginalised group and to address the existing health inequities.

Affordability of medicines in the European Union.

PubMed

Zaprutko, Tomasz; Kopciuch, Dorota; Kus, Krzysztof; Merks, Piotr; Nowicka, Monika; Augustyniak, Izabela; Nowakowska, Elżbieta

2017-01-01

Medications and their prices are key issues for healthcare. Although access to medicines at affordable prices had been specified as a key objective of the European Health Policy, it seems that these goals have not been achieved. Therefore, we attempted an evaluation of affordability of selected medicines at full prices. The analysis concerned 2012 and was conducted between 2013 and 2015 in all the European Union (EU) countries divided into 3 groups depending on the date of their accession to the EU. Finally, we considered 9 originators used in the treatment of schizophrenia and multiple sclerosis. Information on drug prices were collected from pharmacies. Participation in the study was voluntary and anonymous in order to avoid accusations of advertising. To evaluate affordability, several factors were used (e.g. minimum earnings and Gini coefficient). Due to unavailability in some countries, the exact number of analyzed medicines varies. Drug prices vary significantly between EU Member States. Almost eleven fold difference was observed between Germany (EUR 1451.17) and Croatia (EUR 132.77) in relation to Interferone beta-1a 22 μg. Generally, prices were the highest in Germany. The cheapest drugs were found in various countries but never in the poorest ones like Bulgaria or Romania. Discrepancies in wages were observed too (the smallest minimum wage was EUR 138.00 in Bulgaria and the highest EUR 1801.00 in Luxembourg). Full price of olanzapine 5mg, however, was higher in Bulgaria (EUR 64.53) than, for instance, in Belgium (EUR 37.26). Analyzed medications are still unaffordable for many citizens of the EU. Besides, access to medicines is also impaired e.g. due to parallel trade. Unaffordability of medications may lead to the patients' non-compliance and therefore to increased direct and indirect costs of treatment. Common European solutions are needed to achieve a real affordability and accessibility of medications.

Affordability of medicines in the European Union

PubMed Central

Zaprutko, Tomasz; Kopciuch, Dorota; Kus, Krzysztof; Merks, Piotr; Nowicka, Monika; Augustyniak, Izabela; Nowakowska, Elżbieta

2017-01-01

Background Medications and their prices are key issues for healthcare. Although access to medicines at affordable prices had been specified as a key objective of the European Health Policy, it seems that these goals have not been achieved. Therefore, we attempted an evaluation of affordability of selected medicines at full prices. Methods The analysis concerned 2012 and was conducted between 2013 and 2015 in all the European Union (EU) countries divided into 3 groups depending on the date of their accession to the EU. Finally, we considered 9 originators used in the treatment of schizophrenia and multiple sclerosis. Information on drug prices were collected from pharmacies. Participation in the study was voluntary and anonymous in order to avoid accusations of advertising. To evaluate affordability, several factors were used (e.g. minimum earnings and Gini coefficient). Due to unavailability in some countries, the exact number of analyzed medicines varies. Results Drug prices vary significantly between EU Member States. Almost eleven fold difference was observed between Germany (EUR 1451.17) and Croatia (EUR 132.77) in relation to Interferone beta-1a 22 μg. Generally, prices were the highest in Germany. The cheapest drugs were found in various countries but never in the poorest ones like Bulgaria or Romania. Discrepancies in wages were observed too (the smallest minimum wage was EUR 138.00 in Bulgaria and the highest EUR 1801.00 in Luxembourg). Full price of olanzapine 5mg, however, was higher in Bulgaria (EUR 64.53) than, for instance, in Belgium (EUR 37.26). Conclusions Analyzed medications are still unaffordable for many citizens of the EU. Besides, access to medicines is also impaired e.g. due to parallel trade. Unaffordability of medications may lead to the patients’ non-compliance and therefore to increased direct and indirect costs of treatment. Common European solutions are needed to achieve a real affordability and accessibility of medications. PMID:28241019

Do diagnosis-related group-based payments incentivise hospitals to adjust output mix?

PubMed

Liang, Li-Lin

2015-04-01

This study investigates whether the diagnosis-related group (DRG)-based payment method motivates hospitals to adjust output mix in order to maximise profits. The hypothesis is that when there is an increase in profitability of a DRG, hospitals will increase the proportion of that DRG (own-price effects) and decrease those of other DRGs (cross-price effects), except in cases where there are scope economies in producing two different DRGs. This conjecture is tested in the context of the case payment scheme (CPS) under Taiwan's National Health Insurance programme over the period of July 1999 to December 2004. To tackle endogeneity of DRG profitability and treatment policy, a fixed-effects three-stage least squares method is applied. The results support the hypothesised own-price and cross-price effects, showing that DRGs which share similar resources appear to be complements rather substitutes. For-profit hospitals do not appear to be more responsive to DRG profitability, possibly because of their institutional characteristics and bonds with local communities. The key conclusion is that DRG-based payments will encourage a type of 'product-range' specialisation, which may improve hospital efficiency in the long run. However, further research is needed on how changes in output mix impact patient access and pay-outs of health insurance. Copyright © 2014 John Wiley & Sons, Ltd.

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

PubMed

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

2005-05-01

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

Pharmaceutical expenditure forecast model to support health policy decision making.

PubMed

Rémuzat, Cécile; Urbinati, Duccio; Kornfeld, Åsa; Vataire, Anne-Lise; Cetinsoy, Laurent; Aballéa, Samuel; Mzoughi, Olfa; Toumi, Mondher

2014-01-01

With constant incentives for healthcare payers to contain their pharmaceutical budgets, modelling policy decision impact became critical. The objective of this project was to test the impact of various policy decisions on pharmaceutical budget (developed for the European Commission for the project 'European Union (EU) Pharmaceutical expenditure forecast' - http://ec.europa.eu/health/healthcare/key_documents/index_en.htm). A model was built to assess policy scenarios' impact on the pharmaceutical budgets of seven member states of the EU, namely France, Germany, Greece, Hungary, Poland, Portugal, and the United Kingdom. The following scenarios were tested: expanding the UK policies to EU, changing time to market access, modifying generic price and penetration, shifting the distribution chain of biosimilars (retail/hospital). Applying the UK policy resulted in dramatic savings for Germany (10 times the base case forecast) and substantial additional savings for France and Portugal (2 and 4 times the base case forecast, respectively). Delaying time to market was found be to a very powerful tool to reduce pharmaceutical expenditure. Applying the EU transparency directive (6-month process for pricing and reimbursement) increased pharmaceutical expenditure for all countries (from 1.1 to 4 times the base case forecast), except in Germany (additional savings). Decreasing the price of generics and boosting the penetration rate, as well as shifting distribution of biosimilars through hospital chain were also key methods to reduce pharmaceutical expenditure. Change in the level of reimbursement rate to 100% in all countries led to an important increase in the pharmaceutical budget. Forecasting pharmaceutical expenditure is a critical exercise to inform policy decision makers. The most important leverages identified by the model on pharmaceutical budget were driven by generic and biosimilar prices, penetration rate, and distribution. Reducing, even slightly, the prices of generics had a major impact on savings. However, very aggressive pricing of generic and biosimilar products might make this market unattractive and can be counterproductive. Worth noting, delaying time to access innovative products was also identified as an effective leverage to increase savings but might not be a desirable policy for breakthrough products. Increasing patient financial contributions, either directly or indirectly via their private insurances, is a more likely scenario rather than expanding the national pharmaceutical expenditure coverage.

Pharmaceutical expenditure forecast model to support health policy decision making

PubMed Central

Rémuzat, Cécile; Urbinati, Duccio; Kornfeld, Åsa; Vataire, Anne-Lise; Cetinsoy, Laurent; Aballéa, Samuel; Mzoughi, Olfa; Toumi, Mondher

2014-01-01

Background and objective With constant incentives for healthcare payers to contain their pharmaceutical budgets, modelling policy decision impact became critical. The objective of this project was to test the impact of various policy decisions on pharmaceutical budget (developed for the European Commission for the project ‘European Union (EU) Pharmaceutical expenditure forecast’ – http://ec.europa.eu/health/healthcare/key_documents/index_en.htm). Methods A model was built to assess policy scenarios’ impact on the pharmaceutical budgets of seven member states of the EU, namely France, Germany, Greece, Hungary, Poland, Portugal, and the United Kingdom. The following scenarios were tested: expanding the UK policies to EU, changing time to market access, modifying generic price and penetration, shifting the distribution chain of biosimilars (retail/hospital). Results Applying the UK policy resulted in dramatic savings for Germany (10 times the base case forecast) and substantial additional savings for France and Portugal (2 and 4 times the base case forecast, respectively). Delaying time to market was found be to a very powerful tool to reduce pharmaceutical expenditure. Applying the EU transparency directive (6-month process for pricing and reimbursement) increased pharmaceutical expenditure for all countries (from 1.1 to 4 times the base case forecast), except in Germany (additional savings). Decreasing the price of generics and boosting the penetration rate, as well as shifting distribution of biosimilars through hospital chain were also key methods to reduce pharmaceutical expenditure. Change in the level of reimbursement rate to 100% in all countries led to an important increase in the pharmaceutical budget. Conclusions Forecasting pharmaceutical expenditure is a critical exercise to inform policy decision makers. The most important leverages identified by the model on pharmaceutical budget were driven by generic and biosimilar prices, penetration rate, and distribution. Reducing, even slightly, the prices of generics had a major impact on savings. However, very aggressive pricing of generic and biosimilar products might make this market unattractive and can be counterproductive. Worth noting, delaying time to access innovative products was also identified as an effective leverage to increase savings but might not be a desirable policy for breakthrough products. Increasing patient financial contributions, either directly or indirectly via their private insurances, is a more likely scenario rather than expanding the national pharmaceutical expenditure coverage. PMID:27226830

45 CFR 1620.3 - Establishing priorities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... resources and must adopt a written statement of priorities, pursuant to those procedures, that determines... difficulties of access to legal services; (4) The resources of the recipient; (5) The availability of another...

45 CFR 1620.3 - Establishing priorities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... resources and must adopt a written statement of priorities, pursuant to those procedures, that determines... difficulties of access to legal services; (4) The resources of the recipient; (5) The availability of another...

45 CFR 1620.3 - Establishing priorities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... resources and must adopt a written statement of priorities, pursuant to those procedures, that determines... difficulties of access to legal services; (4) The resources of the recipient; (5) The availability of another...

45 CFR 1620.3 - Establishing priorities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... resources and must adopt a written statement of priorities, pursuant to those procedures, that determines... difficulties of access to legal services; (4) The resources of the recipient; (5) The availability of another...

Current Development Status of an Integrated Tool for Modeling Quasi-static Deformation in the Solid Earth

NASA Astrophysics Data System (ADS)

Williams, C. A.; Dicaprio, C.; Simons, M.

2003-12-01

With the advent of projects such as the Plate Boundary Observatory and future InSAR missions, spatially dense geodetic data of high quality will provide an increasingly detailed picture of the movement of the earth's surface. To interpret such information, powerful and easily accessible modeling tools are required. We are presently developing such a tool that we feel will meet many of the needs for evaluating quasi-static earth deformation. As a starting point, we begin with a modified version of the finite element code TECTON, which has been specifically designed to solve tectonic problems involving faulting and viscoelastic/plastic earth behavior. As our first priority, we are integrating the code into the GeoFramework, which is an extension of the Python-based Pyre modeling framework. The goal of this framework is to provide simplified user interfaces for powerful modeling codes, to provide easy access to utilities such as meshers and visualization tools, and to provide a tight integration between different modeling tools so they can interact with each other. The initial integration of the code into this framework is essentially complete, and a more thorough integration, where Python-based drivers control the entire solution, will be completed in the near future. We have an evolving set of priorities that we expect to solidify as we receive more input from the modeling community. Current priorities include the development of linear and quadratic tetrahedral elements, the development of a parallelized version of the code using the PETSc libraries, the addition of more complex rheologies, realistic fault friction models, adaptive time stepping, and spherical geometries. In this presentation we describe current progress toward our various priorities, briefly describe the structure of the code within the GeoFramework, and demonstrate some sample applications.

75 FR 76282 - Domestic Shipping Services Pricing and Mailing Standards Changes

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-08

... when using a qualifying shipping label managed by the PC Postage system used. b. Permit imprint... system used. b. Permit imprint customers. * * * * * 1.8 Determining Single-Piece Weight [Revise the last... imprint customers. c. Priority Mail Open and Distribute (PMOD) customers whose account volume exceeds 600...

Leveraging community-based financing for women's nonmaternal health care: experiences of rural Indian women.

PubMed

Gopalan, Saji S; Durairaj, Varatharajan

2015-03-01

Given the increasing need for mainstreaming household financing for women's nonmaternal health care and evidences on community-based financing's contribution to women's health care in general, this study explored their scope for nonmaternal health care in Orissa. A qualitative assessment conducted focus group discussions with rural women who met the eligibility criteria. Community-based financing provided financial access and risk protection for women's nonmaternal health care during the previous 1 year, though not adequately. Schemes covering outpatient care (or mild illnesses) provided relatively more financial access. The major determinants of their restricted financial access were limited sum assured, noncomprehensive coverage of services, exclusion of elderly women, and the lower priority households gave to nonmaternal health care. Community-based financing requires relevant structural changes along with demand-side behavioral modifications to ensure optimal attention to women's nonmaternal health care. © 2012 APJPH.

Use of comparative effectiveness research in drug coverage and pricing decisions: a six-country comparison.

PubMed

Sorenson, Corinna

2010-07-01

Comparative effectiveness research (CER) has assumed an increasing role in drug coverage and, in some cases, pricing decisions in Europe, as decision-makers seek to obtain better value for money. This issue brief comparatively examines the use of CER across six countries--Denmark, England, France, Germany, the Netherlands, and Sweden. With CER gaining traction in the United States, these international experiences offer insights and potential lessons. Investing in CER can help address the current gap in publicly available, credible, up-to-date, and scientifically based comparative information on the effectiveness of drugs and other health interventions. This information can be used to base coverage and pricing decisions on evidence of value, thereby facilitating access to and public and private investment in the most beneficial new drugs and technologies. In turn, use of CER creates incentives for more efficient, high-quality health care and encourages development of innovative products that offer measurable value to patients.

Pricing Policy, Social Equity and Institutional Survival in Tertiary Education in New Jersey.

ERIC Educational Resources Information Center

Lee, Alfred M.

New Jersey aids private institutions but is deficit in low-priced open access to public colleges. Discussed is higher education in New Jersey in light of this historical condition; pricing policy; social equity; decisions, especially regarding institutional support, student aid, and public tuition; and the "free market." While the…

[Cost of drugs used to treat cardiovascular disease in Brazil].

PubMed

Bueno, Cristiane Schmalz; Moreira, Angélica Cristiane; Oliveira, Karla Renata de

2012-01-01

Diseases of the circulatory system are a principal cause of mortality in Brazil. Using as a basis drugs dispensed through Brazil's Popular Pharmacy Program (FPB, for its name in Portuguese), prices for drugs used to treat circulatory diseases were analyzed to identify the advantages of using generic drugs and the FPB. Drug prices were obtained using Brazil's Pharmacy Price Guide and FPB price tables. The costs of 15 drugs available through the FPB were compared with those of three generic pharmaceutical products, three similar products, and the reference drug. The generic drugs were lower in price for 10 of the drugs and for four of the similar products. The FPB drugs were of the lowest price. Generic and FPB drugs are easily accessed by the population and thus facilitate the continuity of pharmacotherapy when these drugs are not available through the Unified Health System and/or are not affordable through other means. Access to drugs should be taken into consideration at the time prescriptions are filled, especially as regards those used to treat chronic diseases.

Priorities and strategies for improving disabled women's access to maternity services when they are affected by domestic abuse: a multi-method study using concept maps.

PubMed

Bradbury-Jones, Caroline; Breckenridge, Jenna P; Devaney, John; Duncan, Fiona; Kroll, Thilo; Lazenbatt, Anne; Taylor, Julie

2015-12-28

Domestic abuse is a significant public health issue. It occurs more frequently among disabled women than those without a disability and evidence suggests that a great deal of domestic abuse begins or worsens during pregnancy. All women and their infants are entitled to equal access to high quality maternity care. However, research has shown that disabled women who experience domestic abuse face numerous barriers to accessing care. The aim of the study was to identify the priority areas for improving access to maternity services for this group of women; develop strategies for improved access and utilisation; and explore the feasibility of implementing the identified strategies. This multi-method study was the third and final part of a larger study conducted in the UK between 2012 and 2014. The study used a modified concept mapping approach and was theoretically underpinned by Andersen's model of healthcare use. Seven focus group interviews were conducted with a range of maternity care professionals (n = 45), incorporating quantitative and qualitative components. Participants ranked perceived barriers to women's access and utilisation of maternity services in order of priority using a 5-point Likert scale. Quantitative data exploration used descriptive and non-parametric analyses. In the qualitative component of each focus group, participants discussed the barriers and identified potential improvement strategies (and feasibility of implementing these). Qualitative data were analysed inductively using a framework analysis approach. The three most highly ranked barriers to women's access and utilisation of maternity services identified in the quantitative component were: 1) staff being unaware and not asking about domestic abuse and disability; 2) the impact of domestic abuse on women; 3) women's fear of disclosure. The top two priority strategies were: providing information about domestic abuse to all women and promoting non-judgemental staff attitude. These were also considered very feasible. The qualitative analysis identified a range of psychosocial and environmental barriers experienced by this group of women in accessing maternity care. Congruent with the quantitative results, the main themes were lack of awareness and fear of disclosure. Key strategies were identified as demystifying disclosure and creating physical spaces to facilitate disclosure. The study supports findings of previous research regarding the barriers that women face in accessing and utilising maternity services, particularly regarding the issue of disclosure. But the study provides new evidence on the perceived importance and feasibility of strategies to address such barriers. This is an important step in ensuring practice-based acceptability and ease with which improvement strategies might be implemented in maternity care settings.

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

PubMed

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

2018-01-01

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

Availability, prices and affordability of the World Health Organization's essential medicines for children in Guatemala.

PubMed

Anson, Angela; Ramay, Brooke; de Esparza, Antonio Ruiz; Bero, Lisa

2012-07-02

Several World Health Organization (WHO) initiatives aim to improve the accessibility of safe and effective medicines for children. A first step in achieving this goal is to obtain a baseline measure of access to essential medicines. The objective of this project was to measure the availability, prices, and affordability of children's medicines in Guatemala. An adaption of the standardized methodology developed by the World Health Organization and Health Action International (HAI) was used to conduct a cross sectional survey to collect data on availability and final patient prices of medicines in public and private sector medicine outlets during April and May of 2010. A subset of the public sector, Programa de Accesibilidad a los Medicamentos (PROAM), had the lowest average availability (25%) compared to the private sector (35%). In the private sector, highest and lowest priced medicines were 22.7 and 10.7 times more expensive than their international reference price comparison. Treatments were generally unaffordable, costing as much as 15 days wages for a course of ceftriaxone. Analysis of the procurement, supply and distribution of specific medicines is needed to determine reasons for lack of availability. Improvements to accessibility could be made by developing an essential medicines list for children and including these medicines in national purchasing lists.

The health care value transparency movement and its implications for radiology.

PubMed

Durand, Daniel J; Narayan, Anand K; Rybicki, Frank J; Burleson, Judy; Nagy, Paul; McGinty, Geraldine; Duszak, Richard

2015-01-01

The US health care system is in the midst of disruptive changes intended to expand access, improve outcomes, and lower costs. As part of this movement, a growing number of stakeholders have advocated dramatically increasing consumer transparency into the quality and price of health care services. The authors review the general movement toward American health care value transparency within the public, private, and nonprofit sectors, with an emphasis on those initiatives most relevant to radiology. They conclude that radiology, along with other "ancillary services," has been a major focus of early efforts to enhance consumer price transparency. By contrast, radiology as a field remains in the "middle of the pack" with regard to quality transparency. There is thus the danger that radiology value transparency in its current form will stimulate primarily price-based competition, erode provider profit margins, and disincentivize quality. The authors conclude with suggested actions radiologists can take to ensure that a more optimal balance is struck between quality transparency and price transparency, one that will enable true value-based competition among radiologists rather than commoditization. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Where are we now: assessing the price, availability and affordability of essential medicines in Delhi as India plans free medicine for all.

PubMed

Kotwani, Anita

2013-07-25

Inequitable access to medicines is a major weakness in the Indian health care system. Baseline data needed to develop effective public health policy and provide equitable access to essential medicines. The present survey was conducted to investigate the price, availability, and affordability of fifty essential medicines in the public and private sector in Delhi, India using standardized WHO/HAI methodology. Data on procurement price and availability was collected (July-October 2011) from three public healthcare providers: the federal (central) government, state government and Municipal Corporation of Delhi (MCD). Data on price and availability of medicines was collected from private retail and chain pharmacies of a leading corporate house. Prices were compared to an international reference price (expressed as median price ratio-MPR). The procurement price of surveyed medicines was 0.53-0.82 times the international reference price-IRP. However, the overall mean availability of surveyed medicines in facilities under state government and MCD was 41.3% and 23.2%, respectively. The overall mean availability of medicines in three tertiary care facilities operated by the federal government was 49.3%. Availability of generic medicines was much higher in the private sector. Off-patented medicines, like diazepam, diclofenac, and doxycycline had the highest MPRs. The price ratio between procurement and retail was as high as 28 (range 11-28) for certain medicines. Seven-day treatment with a popular brand of amoxicillin+clavulanic acid or one inhaler each of budesonide and salbutamol cost 2.3 and 1.4 days' wages for the lowest paid government worker. A majority of India's population cannot afford these prices. This study revealed that procurement prices of surveyed medicines were reasonable in comparison to IRP. However, variation in procurement prices of certain medicines by different public procurement agencies was noted. Availability of medicines was very poor in public sector facilities, which are the primary source of free medicines for a majority of India's low-income population. Availability of medicines is better in private retail pharmacies but affordability remains a big challenge for a majority of the population. These data have significant policy implications that could help in amending policies to increase the access to essential medicines for India's population.

Where are we now: assessing the price, availability and affordability of essential medicines in Delhi as India plans free medicine for all

PubMed Central

2013-01-01

Background Inequitable access to medicines is a major weakness in the Indian health care system. Baseline data needed to develop effective public health policy and provide equitable access to essential medicines. The present survey was conducted to investigate the price, availability, and affordability of fifty essential medicines in the public and private sector in Delhi, India using standardized WHO/HAI methodology. Methods Data on procurement price and availability was collected (July-October 2011) from three public healthcare providers: the federal (central) government, state government and Municipal Corporation of Delhi (MCD). Data on price and availability of medicines was collected from private retail and chain pharmacies of a leading corporate house. Prices were compared to an international reference price (expressed as median price ratio-MPR). Results The procurement price of surveyed medicines was 0.53-0.82 times the international reference price-IRP. However, the overall mean availability of surveyed medicines in facilities under state government and MCD was 41.3% and 23.2%, respectively. The overall mean availability of medicines in three tertiary care facilities operated by the federal government was 49.3%. Availability of generic medicines was much higher in the private sector. Off-patented medicines, like diazepam, diclofenac, and doxycycline had the highest MPRs. The price ratio between procurement and retail was as high as 28 (range 11–28) for certain medicines. Seven-day treatment with a popular brand of amoxicillin+clavulanic acid or one inhaler each of budesonide and salbutamol cost 2.3 and 1.4 days’ wages for the lowest paid government worker. A majority of India’s population cannot afford these prices. Conclusions This study revealed that procurement prices of surveyed medicines were reasonable in comparison to IRP. However, variation in procurement prices of certain medicines by different public procurement agencies was noted. Availability of medicines was very poor in public sector facilities, which are the primary source of free medicines for a majority of India’s low-income population. Availability of medicines is better in private retail pharmacies but affordability remains a big challenge for a majority of the population. These data have significant policy implications that could help in amending policies to increase the access to essential medicines for India’s population. PMID:23885985

Engaging patients in health research: identifying research priorities through community town halls.

PubMed

Etchegary, Holly; Bishop, Lisa; Street, Catherine; Aubrey-Bassler, Kris; Humphries, Dale; Vat, Lidewij Eva; Barrett, Brendan

2017-03-11

The vision of Canada's Strategy for Patient-Oriented Research is that patients be actively engaged as partners in health research. Support units have been created across Canada to build capacity in patient-oriented research and facilitate its conduct. This study aimed to explore patients' health research priorities in the province of Newfoundland and Labrador (NL). Eight town halls were held with members of the general public in rural and urban settings across the province. Sessions were a hybrid information-consultation event, with key questions about health research priorities and outcomes guiding the discussion. Sixty eight members of the public attended town hall sessions. A broad range of health experiences in the healthcare system were recounted. Key priorities for the public included access and availability of providers and services, disease prevention and health promotion, and follow-up support and community care. In discussing their health research priorities, participants spontaneously raised a broad range of suggestions for improving the healthcare system in our jurisdiction. Public research priorities and suggestions for improving the provision of healthcare provide valuable information to guide Support Units' planning and priority-setting processes. A range of research areas were raised as priorities for patients that are likely comparable to other healthcare systems. These create a number of health research questions that would be in line with public priorities. Findings also provide lessons learned for others and add to the evidence base on patient engagement methods.

Pharmaceuticals in Australia: priorities in a teaching hospital.

PubMed

Kearney, B J

1993-01-01

In spite of rigorous government programs for control of the pricing and dissemination of pharmaceutical products in Australia, the list of new drugs continues to grow and prices to increase. To regain control over drug usage at Royal Adelaide Hospital, the Hospital Drug Committee developed a rating method that judged drugs on the basis of their cost-benefit to patients. The ratio of a total quality score to a total cost score becomes the determinant of additions to the hospital formulary. The background for the Australian approach to pharmaceuticals and the new evaluation technique at the teaching hospital are described in this report.

Criteria for classification of competitive housing projects in terms of their environmental friendliness

NASA Astrophysics Data System (ADS)

Nezhnikova, Ekaterina

2017-10-01

This article deals with social and economic essence of strategy of the housing industry development, both complex system of economic relations in field of production and consumption, which is regulated through the mechanism of prices and implemented through formation and realization of priority directions. Developed criteria for classification of housing construction projects as environmentally friendly and the quality criteria of variables for assessment of the environmental friendliness of residential buildings allowed to determine the ways of development of the industry on the basis of creation of competitive projects in interrelation with quality, environmental friendliness and price of consumption.

Effect of the Affordable Medicines Facility--malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data.

PubMed

Tougher, Sarah; Ye, Yazoume; Amuasi, John H; Kourgueni, Idrissa A; Thomson, Rebecca; Goodman, Catherine; Mann, Andrea G; Ren, Ruilin; Willey, Barbara A; Adegoke, Catherine A; Amin, Abdinasir; Ansong, Daniel; Bruxvoort, Katia; Diallo, Diadier A; Diap, Graciela; Festo, Charles; Johanes, Boniface; Juma, Elizabeth; Kalolella, Admirabilis; Malam, Oumarou; Mberu, Blessing; Ndiaye, Salif; Nguah, Samuel B; Seydou, Moctar; Taylor, Mark; Rueda, Sergio Torres; Wamukoya, Marilyn; Arnold, Fred; Hanson, Kara

2012-12-01

Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicines Facility--malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the effect of AMFm on QAACT price, availability, and market share, 6-15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar). We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identified on the basis of the Global Fund's quality assurance policy. Changes in availability, price, and market share were assessed against specified success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process. In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8-51·9 percentage points), and market share (15·9-40·3 percentage points), driven mainly by changes in the private for-profit sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US$1·28 to $4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline. Subsidies combined with supporting interventions can be effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness. The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.

Price-related promotions for tobacco products on Twitter.

PubMed

Jo, Catherine L; Kornfield, Rachel; Kim, Yoonsang; Emery, Sherry; Ribisl, Kurt M

2016-07-01

This cross-sectional study examined price-related promotions for tobacco products on Twitter. Through the Twitter Firehose, we obtained access to all public tweets posted between 6 December 2012 and 20 June 2013 that contained a keyword suggesting a tobacco-related product or behaviour (eg, cigarette, vaping) in addition to a keyword suggesting a price promotion (eg, coupon, discount). From this data set of 155 249 tweets, we constructed a stratified sampling frame based on the price-related keywords and randomly sampled 5000 tweets (3.2%). Tweets were coded for product type and promotion type. Non-English tweets and tweets unrelated to a tobacco or cessation price promotion were excluded, leaving an analytic sample of 2847 tweets. The majority of tweets (97.0%) mentioned tobacco products while 3% mentioned tobacco cessation products. E-cigarettes were the most frequently mentioned product (90.1%), followed by cigarettes (5.4%). The most common type of price promotion mentioned across all products was a discount. About a third of all e-cigarette-related tweets included a discount code. Banned or restricted price promotions comprised about 3% of cigarette-related tweets. This study demonstrates that the vast majority of tweets offering price promotions focus on e-cigarettes. Future studies should examine the extent to which Twitter users, particularly youth, notice or engage with these price promotion tweets. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Food prices, access to food outlets and child weight.

PubMed

Powell, Lisa M; Bao, Yanjun

2009-03-01

This study examines the importance of food prices and restaurant and food store outlet availability for child body mass index (BMI). We use the 1998, 2000 and 2002 waves of the child-mother merged files from the 1979 cohort of the National Longitudinal Survey of Youth combined with fruit and vegetable and fast food price data obtained from the American Chamber of Commerce Researchers Association and outlet density data on fast food and full-service restaurants and supermarkets, grocery stores and convenience stores obtained from Dun & Bradstreet. Using a random effects estimation model, we found that a 10% increase in the price of fruits and vegetables was associated with a 0.7% increase in child BMI. Fast food prices were not found to be statistically significant in the full sample but were weakly negatively associated with BMI among adolescents with an estimated price elasticity of -0.12. The price estimates were robust to whether we controlled for outlet availability based on a per capita or per land area basis; however, the association between food outlets and child BMI differed depending on the definition. The associations of fruit and vegetable and fast food prices with BMI were significantly stronger both economically and statistically among low- versus high-socioeconomic status children. The estimated fruit and vegetable and fast food price elasticities were 0.14 and -0.26, respectively, among low-income children and 0.09 and -0.13, respectively, among children with less educated mothers.

Reaching for the Horizon: Enabling 21st Century Antarctic Science

NASA Astrophysics Data System (ADS)

Rogan-Finnemore, M.; Kennicutt, M. C., II; Kim, Y.

2015-12-01

The Council of Managers of National Antarctic Programs' (COMNAP) Antarctic Roadmap Challenges(ARC) project translated the 80 highest priority Antarctic and Southern Ocean scientific questionsidentified by the community via the SCAR Antarctic Science Horizon Scan into the highest prioritytechnological, access, infrastructure and logistics needs to enable the necessary research to answer thequestions. A workshop assembled expert and experienced Antarctic scientists and National AntarcticProgram operators from around the globe to discern the highest priority technological needs includingthe current status of development and availability, where the technologies will be utilized in the Antarctic area, at what temporal scales and frequencies the technologies will be employed,and how broadly applicable the technologies are for answering the highest priority scientific questions.Secondly the logistics, access, and infrastructure requirements were defined that are necessary todeliver the science in terms of feasibility including cost and benefit as determined by expected scientific return on investment. Finally, based on consideration of the science objectives and the mix oftechnologies implications for configuring National Antarctic Program logistics capabilities andinfrastructure architecture over the next 20 years were determined. In particular those elements thatwere either of a complexity, requiring long term investments to achieve and/or having an associated cost that realistically can only (or best) be achieved by international coordination, planning and partnerships were identified. Major trends (changes) in logistics, access, and infrastructure requirements were identified that allow for long-term strategic alignment of international capabilities, resources and capacity. The outcomes of this project will be reported.

Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study.

PubMed

Baker, Phillip; Gill, Timothy; Friel, Sharon; Carey, Gemma; Kay, Adrian

2017-03-01

Effective obesity prevention requires a synergistic mix of population-level interventions including a strong role for government and the regulation of the marketing, labelling, content and pricing of energy-dense foods and beverages. In this paper we adopt the agenda of the Australian Federal Government (AFG) as a case study to understand the factors generating or hindering political priority for such 'regulatory interventions' between 1990 and 2011. Using a theoretically-guided process tracing method we undertook documentary analysis and conducted 27 interviews with a diversity of actors involved in obesity politics. The analysis was structured by a theoretical framework comprising four dimensions: the power of actors involved; the ideas the actors deploy to interpret and portray the issue; the institutional and political context; and issue characteristics. Despite two periods of sustained political attention, political priority for regulatory interventions did not emerge and was hindered by factors from all four dimensions. Within the public health community, limited cohesion among experts and advocacy groups hampered technical responses and collective action efforts. An initial focus on children (child obesity), framing the determinants of obesity as 'obesogenic environments', and the deployment of 'protecting kids', 'industry demonization' and 'economic costs' frames generated political attention. Institutional norms within government effectively selected out regulatory interventions from consideration. The 'productive power' and activities of the food and advertising industries presented formidable barriers, buttressed by a libertarian/neolibertarian rhetoric emphasizing individual responsibility, a negative view of freedom (as free from 'nanny-state' intervention) and the idea that regulation imposes an unacceptable cost on business. Issue complexity, the absence of a supportive evidence base and a strict 'evidence-based' policy-making approach were used as rationales to defer political priority. Overcoming these challenges may be important to future collective action efforts attempting to generate and sustain political priority for regulatory interventions targeting obesity. Copyright © 2017 Elsevier Ltd. All rights reserved.

Controversies and consensus in the innovation access for cancer therapy in the European countries: on the subject of metastatic prostate cancer.

PubMed

Oudard, S; Courbon, F

2017-02-01

Innovative cancer therapies and advances in drug development have created new hopes for patients and health providers. The purpose of this article was to evaluate the discrepancies in the assessment of the magnitude of benefit of four new drugs (abiraterone acetate, enzalutamide, cabazitaxel, radium-223 dichloride) for the treatment of metastatic castration-resistant prostate cancer (mCRPC). The comparison was done among three European countries (UK, Germany and France) and Canada, according to the statement of each country and to the European Society of Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale. Whereas those drugs are authorized by the European Medical Agency, one can observed that clear discrepancies in the magnitude of benefit assessment exist between selected countries, as well as between national pricing evaluation agencies and ESMO. However, price setting and reimbursement decisions remain national responsibility with differences in assessment of the medical value of new treatment across countries, leading to a heterogeneous accessibility to cancer treatments. In conclusion, several procedures have to be implemented to overcome the patchwork of administrative assessments. Among them, the assessment of medical value should be based on independent statements of learned societies, and the harmonization of access to cancer therapy in Europe has to be driven by a common European reimbursement and pricing policy. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Understanding the Development of Minimum Unit Pricing of Alcohol in Scotland: A Qualitative Study of the Policy Process

PubMed Central

Katikireddi, Srinivasa Vittal; Hilton, Shona; Bonell, Chris; Bond, Lyndal

2014-01-01

Background Minimum unit pricing of alcohol is a novel public health policy with the potential to improve population health and reduce health inequalities. Theories of the policy process may help to understand the development of policy innovation and in turn identify lessons for future public health research and practice. This study aims to explain minimum unit pricing’s development by taking a ‘multiple-lenses’ approach to understanding the policy process. In particular, we apply three perspectives of the policy process (Kingdon’s multiple streams, Punctuated-Equilibrium Theory, Multi-Level Governance) to understand how and why minimum unit pricing has developed in Scotland and describe implications for efforts to develop evidence-informed policymaking. Methods Semi-structured interviews were conducted with policy actors (politicians, civil servants, academics, advocates, industry representatives) involved in the development of MUP (n = 36). Interviewees were asked about the policy process and the role of evidence in policy development. Data from two other sources (a review of policy documents and an analysis of evidence submission documents to the Scottish Parliament) were used for triangulation. Findings The three perspectives provide complementary understandings of the policy process. Evidence has played an important role in presenting the policy issue of alcohol as a problem requiring action. Scotland-specific data and a change in the policy ‘image’ to a population-based problem contributed to making alcohol-related harms a priority for action. The limited powers of Scottish Government help explain the type of price intervention pursued while distinct aspects of the Scottish political climate favoured the pursuit of price-based interventions. Conclusions Evidence has played a crucial but complex role in the development of an innovative policy. Utilising different political science theories helps explain different aspects of the policy process, with Multi-Level Governance particularly useful for highlighting important lessons for the future of public health policy. PMID:24670519

Cost per quality-adjusted life year and disability-adjusted life years: the need for a new paradigm.

PubMed

Bevan, Gwyn; Hollinghurst, Sandra

2003-08-01

Two different paradigms have been proposed for setting priorities for access to healthcare: cost per quality-adjusted life year based on interventions, and disability-adjusted life years based on the burden of disease in a population. These formal paradigms make explicit the assumptions made implicitly every day in delivering and hence rationing access to healthcare. This paper outlines each paradigm's methodological problems and argues that each paradigm is incomplete in terms of providing the information necessary for making budgetary decisions on healthcare. It argues that a scientific revolution is required to create a new paradigm by combining the strengths of each.

47 CFR 51.701 - Scope of transport and termination pricing rules.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Non-Access Telecommunications Traffic at the terminating carrier's end office switch, or equivalent... Non-Access Reciprocal Compensation for transport and termination of Non-Access Telecommunications Traffic between LECs and other telecommunications carriers. (b) Non-Access Telecommunications Traffic. For...

47 CFR 51.701 - Scope of transport and termination pricing rules.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Non-Access Telecommunications Traffic at the terminating carrier's end office switch, or equivalent... Non-Access Reciprocal Compensation for transport and termination of Non-Access Telecommunications Traffic between LECs and other telecommunications carriers. (b) Non-Access Telecommunications Traffic. For...

Managing the effect of TRIPS on availability of priority vaccines.

PubMed Central

Milstien, Julie; Kaddar, Miloud

2006-01-01

The stated purpose of intellectual property protection is to stimulate innovation. The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) requires all Members of the World Trade Organization (WTO) to enact national laws conferring minimum standards of intellectual property protection by certain deadlines. Critics of the Agreement fear that such action is inconsistent with ensuring access to medicines in the developing world. A WHO convened meeting on intellectual property rights and vaccines in developing countries, on which this paper is based, found no evidence that TRIPS has stimulated innovation in developing market vaccine development (where markets are weak) or that protection of intellectual property rights has had a negative effect on access to vaccines. However, access to future vaccines in the developing world could be threatened by compliance with TRIPS. The management of such threats requires adherence of all countries to the Doha Declaration on TRIPS, and the protections guaranteed by the Agreement itself, vigilance on TRIPS-plus elements of free trade agreements, developing frameworks for licensing and technology transfer, and promoting innovative vaccine development in developing countries. The role of international organizations in defining best practices, dissemination of information, and monitoring TRIPS impact will be crucial to ensuring optimal access to priority new vaccines for the developing world. PMID:16710544

Optimizing Air Transportation Service to Metroplex Airports. Par 2; Analysis Using the Airline Schedule Optimization Model (ASOM)

NASA Technical Reports Server (NTRS)

Donoue, George; Hoffman, Karla; Sherry, Lance; Ferguson, John; Kara, Abdul Qadar

2010-01-01

The air transportation system is a significant driver of the U.S. economy, providing safe, affordable, and rapid transportation. During the past three decades airspace and airport capacity has not grown in step with demand for air transportation; the failure to increase capacity at the same rate as the growth in demand results in unreliable service and systemic delay. This report describes the results of an analysis of airline strategic decision-making that affects geographic access, economic access, and airline finances, extending the analysis of these factors using historic data (from Part 1 of the report). The Airline Schedule Optimization Model (ASOM) was used to evaluate how exogenous factors (passenger demand, airline operating costs, and airport capacity limits) affect geographic access (markets-served, scheduled flights, aircraft size), economic access (airfares), airline finances (profit), and air transportation efficiency (aircraft size). This analysis captures the impact of the implementation of airport capacity limits, as well as the effect of increased hedged fuel prices, which serve as a proxy for increased costs per flight that might occur if auctions or congestion pricing are imposed; also incorporated are demand elasticity curves based on historical data that provide information about how passenger demand is affected by airfare changes.

CIDR

Science.gov Websites

Employment Opportunities Related Links & Resources Access and Applications Access Applications Example Applications Project Initiation Application Schedule Service Information and Pricing Services Sample

Colorectal cancer: complexities and challenges in managed care.

PubMed

Minkoff, Neil B

2007-08-01

Managed care weighs advances and associated costs to determine whether the combination of longer life at sometimes significantly increased cost represents value. The price of treatment is only 1 factor. To review treatment decision processes for oncologic agents in managed care environments. Price can be exceptionally high for individuals. But if the population size is low, the per-member-per-month (PMPM) impact can be almost negligible, unlike treatments that have moderate costs but are used ubiquitously. Cancer therapies have, for the most part, escaped managed care's notice. For 2007, the national Cancer Institute projects that antineoplastic agents will consume almost a quarter of the overall drug spend. The Medicare population is a unique concern with regard to cancer. Traditionally, Medicare reimbursement of chemotherapeutic agents was based on average wholesale price (AWP) discounting, not the oncologist's purchasing cost. This allowed oncologists to use reimbursement for infusions to support their medical practices. The proposed plan of the Center for Medicare & Medicaid Services (CMS) to use average sales price (ASP) plus 6% to reimburse for drugs used in the office setting leads to significant problems. Pharmacy and therapeutics committees will also face challenges: fewer data are available for some agents because they have become available through the U.S. Food and drug administration's Fast Track, Priority review, or accelerated approval processes. Oncology disease management programs must reach out to patients and not necessarily deal with oncology issues directly, but address tangential issues that impact care, especially depression and pain management.

47 CFR 69.105 - Carrier common line for non-price cap local exchange carriers.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Carrier common line for non-price cap local... for non-price cap local exchange carriers. (a) This section is applicable only to local exchange... capability to provide access for an MTS-WATS equivalent service that is substantially equivalent to the...

47 CFR 69.105 - Carrier common line for non-price cap local exchange carriers.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Carrier common line for non-price cap local... for non-price cap local exchange carriers. (a) This section is applicable only to local exchange... capability to provide access for an MTS-WATS equivalent service that is substantially equivalent to the...

Final priority; Rehabilitation Services Administration--Assistive Technology Alternative Financing Program. Final priority.

PubMed

2014-08-14

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Assistive Technology Alternative Financing Program administered by the Rehabilitation Services Administration (RSA). The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years. This priority is designed to ensure that the Department funds high-quality assistive technology (AT) alternative financing programs (AFPs) that meet rigorous standards in order to enable individuals with disabilities to access and acquire assistive technology devices and services necessary to achieve education, community living, and employment goals.

[Opinion of primary care physicians from Ourense on various features of the pharmaceutical prescription].

PubMed

Díaz Grávalos, G J; Palmeiro Fernández, G; Núnñez Masid, E; Casado Górriz, I

2001-01-01

To learn the opinion of the primary care Physicians of Ourense (Spain) with respect to certain aspects of their prescription of medicines, such as their awareness of the price of drugs, the induced prescribing perceived, their relationship with the pharmaceutical industry and their opinions concerning possible measures for reducing the expenditure on medicines. In this transversal descriptive study, all of the primary care physicians in the province of Ourense (243) were surveyed by means of a previously-approved questionnaire sent to them by post. The questionnaire included demographic characteristics of the physicians, the influence of cost when prescribing medicines, their estimate of the price of 15 drugs routinely prescribed and their opinion on different aspects relating to induced prescription, the pharmaceutical industry and different strategies in order to curtail the expenditure on medicines. In order to analyze the results, the chi 2 and Student's t tests and an analysis of the variance were used, together with the Spearman correlation coefficient with alpha = 0.05. The level of participation of the physicians surveyed was 42.8% (104). The average daily duration of visits by pharmaceutical company representatives was 13.6 minutes, with new specialities being the topic of greatest interest. Close to 27% admitted to having participated in clinical testing sponsored by the industry. 23% considered the price to be a priority when prescribing. Induced prescription accounted for 39.7% of the total. The majority of physicians chose co-payment as the means for reducing expenditure on medicines. In the estimate of prices, the overall percentage of error was 45.7%, underestimating the more expensive medicines and overestimating the less expensive. There is a significant lack of awareness of the price of drugs among the primary care physicians. Most of the physicians do not feel that the price of a drug should be a priority when prescribing medicines. There is a high percentage of induced prescription perceived. With regard to the expenditure on pharmaceuticals, the majority of those surveyed feel that financial measures, specifically co-payment, are the most effective in order to curtail rising costs.

47 CFR 51.911 - Access reciprocal compensation rates for competitive LECs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Access reciprocal compensation rates for competitive LECs. 51.911 Section 51.911 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.911 Access...

47 CFR 51.911 - Access reciprocal compensation rates for competitive LECs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Access reciprocal compensation rates for competitive LECs. 51.911 Section 51.911 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.911 Access...

47 CFR 51.911 - Access reciprocal compensation rates for competitive LECs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 3 2014-10-01 2014-10-01 false Access reciprocal compensation rates for competitive LECs. 51.911 Section 51.911 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Transitional Access Service Pricing § 51.911 Access...

Acoustic Neuroma: Questions to Discuss with Your Doctor

MedlinePlus

... products will be searched. Shopping Cart Description Qty Price The Harvard Medical School 6-Week Plan for ... Memory: Understanding Age-Related Memory Loss (PDF - Lowest Price!) $18.00 Harvard Health Letter (Print & Online Access ( ...

Colonic Polyps: Questions to Discuss with Your Doctor

MedlinePlus

... products will be searched. Shopping Cart Description Qty Price The Harvard Medical School 6-Week Plan for ... Memory: Understanding Age-Related Memory Loss (PDF - Lowest Price!) $18.00 Harvard Health Letter (Print & Online Access ( ...

When You Visit Your Doctor After a Heart Attack

MedlinePlus

... products will be searched. Shopping Cart Description Qty Price The Harvard Medical School 6-Week Plan for ... Memory: Understanding Age-Related Memory Loss (PDF - Lowest Price!) $18.00 Harvard Health Letter (Print & Online Access ( ...

When You Visit Your Doctor: Irregular Menstrual Periods

MedlinePlus

... products will be searched. Shopping Cart Description Qty Price The Harvard Medical School 6-Week Plan for ... Memory: Understanding Age-Related Memory Loss (PDF - Lowest Price!) $18.00 Harvard Health Letter (Print & Online Access ( ...

47 CFR 69.158 - Universal service end user charges.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) ACCESS CHARGES Computation of Charges for Price Cap Local Exchange Carriers § 69.158 Universal... price cap baskets, and the charge to recover these contributions is not part of any other element...

Biospecimen User Fees: Global Feedback on a Calculator Tool.

PubMed

Matzke, Lise A M; Babinszky, Sindy; Slotty, Alex; Meredith, Anna; Castillo-Pelayo, Tania; Henderson, Marianne K; Simeon-Dubach, Daniel; Schacter, Brent; Watson, Peter H

2017-02-01

The notion of attributing user fees to researchers for biospecimens provided by biobanks has been discussed frequently in the literature. However, the considerations around how to attribute the cost for these biospecimens and data have, until recently, not been well described. Common across most biobank disciplines are similar factors that influence user fees such as capital and operating costs, internal and external demand, and market competition. A biospecimen user fee calculator tool developed by CTRNet, a tumor biobank network, was published in 2014 and is accessible online at www.biobanking.org . The next year a survey was launched that tested the applicability of this user fee tool among a global health research biobank user base, including both cancer and noncancer biobanking. Participants were first asked to estimate user fee pricing for three hypothetical user scenarios based on their biobanking experience (estimated pricing) and then to calculate fees for the same scenarios using the calculator tool (calculated pricing). Results demonstrated variation in estimated pricing that was reduced by calculated pricing. These results are similar to those found in a similar previous study restricted to a group of Canadian tumor biobanks. We conclude that the use of a biospecimen user fee calculator contributes to reduced variation of user fees and for biobank groups (e.g., biobank networks), could become an important part of a harmonization strategy.

Biospecimen User Fees: Global Feedback on a Calculator Tool

PubMed Central

Babinszky, Sindy; Slotty, Alex; Meredith, Anna; Castillo-Pelayo, Tania; Henderson, Marianne K.; Simeon-Dubach, Daniel; Schacter, Brent; Watson, Peter H.

2017-01-01

The notion of attributing user fees to researchers for biospecimens provided by biobanks has been discussed frequently in the literature. However, the considerations around how to attribute the cost for these biospecimens and data have, until recently, not been well described. Common across most biobank disciplines are similar factors that influence user fees such as capital and operating costs, internal and external demand, and market competition. A biospecimen user fee calculator tool developed by CTRNet, a tumor biobank network, was published in 2014 and is accessible online at www.biobanking.org. The next year a survey was launched that tested the applicability of this user fee tool among a global health research biobank user base, including both cancer and noncancer biobanking. Participants were first asked to estimate user fee pricing for three hypothetical user scenarios based on their biobanking experience (estimated pricing) and then to calculate fees for the same scenarios using the calculator tool (calculated pricing). Results demonstrated variation in estimated pricing that was reduced by calculated pricing. These results are similar to those found in a similar previous study restricted to a group of Canadian tumor biobanks. We conclude that the use of a biospecimen user fee calculator contributes to reduced variation of user fees and for biobank groups (e.g., biobank networks), could become an important part of a harmonization strategy. PMID:27576065

Drug repurposing in pharmaceutical industry and its impact on market access: market access implications.

PubMed

Murteira, Susana; Millier, Aurélie; Toumi, Mondher

2014-01-01

Drug repurposing is a group of development strategies employed in order to overcome some of the hurdles innate to drug research and development. Drug repurposing includes drug repositioning, reformulation and combination. This study aimed to identify the determinants of successful market access outcome for drug repurposing in the United States of America (USA) and in Europe. The case studies of repurposing strategies were identified through a systematic review of the literature. Price information and reimbursement conditions for all the case studies were collected mainly through access of public datasources. A list of attributes that could be associated with market access outcome (price level and reimbursement conditions) was developed, discussed, and validated by an external expert group. Detailed information for all attributes was researched and collected for each case study. Bivariate regression models were conducted to identify factors associated with price change for all repurposing cases. A similar analysis was performed for reformulation and repositioning cases, in the USA and in Europe, separately. A significance level of 5% was used for all analyses. A total of 144 repurposing case studies were included in the statistical analysis for evaluation of mean price change. Combination cases (the combination of two or more individual drug components) were excluded from the statistical analysis due to the low number of cases retrieved. The main attributes associated with a significant price increase for overall repurposing cases were 'change in administration setting to hospital' (374%, p<0.0001), 'addressing unmet needs' (69%, p<0.05), 'reformulations belonging to Group 3'-that is, change in administration route (117%, p<0.001), and being a repurposed product with the 'same brand name' as the original product (65%, p<0.05). We found that the ability of the repurposed product to address unmet needs, a reformulation where the target product had a different administration route than the source product, and having a similar brand name for repurposed and original products, were variables that impacted a positive price change for repurposed drugs overall. Our research results also suggested that orphan designation could have a positive impact for repositioning in the USA, in particular. Although a change of administration from ambulatory to hospital setting seemed to be significantly correlated with a price increase for the target product, only one case was retrieved for this parameter; as such, it was not possible to infer a firm correlation between this parameter and a change in price.

Drug repurposing in pharmaceutical industry and its impact on market access: market access implications

PubMed Central

Murteira, Susana; Millier, Aurélie; Toumi, Mondher

2014-01-01

Background Drug repurposing is a group of development strategies employed in order to overcome some of the hurdles innate to drug research and development. Drug repurposing includes drug repositioning, reformulation and combination. Objective This study aimed to identify the determinants of successful market access outcome for drug repurposing in the United States of America (USA) and in Europe. Methods The case studies of repurposing strategies were identified through a systematic review of the literature. Price information and reimbursement conditions for all the case studies were collected mainly through access of public datasources. A list of attributes that could be associated with market access outcome (price level and reimbursement conditions) was developed, discussed, and validated by an external expert group. Detailed information for all attributes was researched and collected for each case study. Bivariate regression models were conducted to identify factors associated with price change for all repurposing cases. A similar analysis was performed for reformulation and repositioning cases, in the USA and in Europe, separately. A significance level of 5% was used for all analyses. Results A total of 144 repurposing case studies were included in the statistical analysis for evaluation of mean price change. Combination cases (the combination of two or more individual drug components) were excluded from the statistical analysis due to the low number of cases retrieved. The main attributes associated with a significant price increase for overall repurposing cases were ‘change in administration setting to hospital’ (374%, p<0.0001), ‘addressing unmet needs’ (69%, p<0.05), ‘reformulations belonging to Group 3’—that is, change in administration route (117%, p<0.001), and being a repurposed product with the ‘same brand name’ as the original product (65%, p<0.05). Conclusion We found that the ability of the repurposed product to address unmet needs, a reformulation where the target product had a different administration route than the source product, and having a similar brand name for repurposed and original products, were variables that impacted a positive price change for repurposed drugs overall. Our research results also suggested that orphan designation could have a positive impact for repositioning in the USA, in particular. Although a change of administration from ambulatory to hospital setting seemed to be significantly correlated with a price increase for the target product, only one case was retrieved for this parameter; as such, it was not possible to infer a firm correlation between this parameter and a change in price. PMID:27226833

The impact of a hybrid social marketing intervention on inequities in access, ownership and use of insecticide-treated nets.

PubMed

Agha, Sohail; Van Rossem, Ronan; Stallworthy, Guy; Kusanthan, Thankian

2007-01-29

An ITN intervention was initiated in three predominantly rural districts of Eastern Province, Zambia, that lacked commercial distribution and communication infrastructures. Social marketing techniques were used for product and message development. Public sector clinics and village-based volunteers promoted and distributed subsidized ITNs priced at 2.5 dollars per net. A study was conducted to assess the effects of the intervention on inequities in knowledge, access, ownership and use of ITNs. A post-test only quasi-experimental study design was used to compare intervention and comparison districts. A total of 2,986 respondents were interviewed. Survey respondents were grouped into four socio-economic (SES) categories: low, medium-low, medium and high. Knowledge, access, ownership and use indicators are compared. Concentration index scores are calculated. Interactions between intervention status and SES help determine how different SES groups benefited from the intervention. Although overall use of nets remained relatively low, post-test data show that knowledge, access, ownership and use of mosquito nets was higher in intervention districts. A decline in SES inequity in access to nets occurred in intervention districts, resulting from a disproportionately greater increase in access among the low SES group. Declines in SES inequities in net ownership and use of nets were associated with the intervention. The largest increases in net ownership and use occurred among medium and high SES categories. Increasing access to nets among the poorest respondents in rural areas may not lead to increases in net use unless the price of nets is no longer a barrier to their purchase.

Monitoring the impacts of trade agreements on food environments.

PubMed

Friel, S; Hattersley, L; Snowdon, W; Thow, A-M; Lobstein, T; Sanders, D; Barquera, S; Mohan, S; Hawkes, C; Kelly, B; Kumanyika, S; L'Abbe, M; Lee, A; Ma, J; Macmullan, J; Monteiro, C; Neal, B; Rayner, M; Sacks, G; Swinburn, B; Vandevijvere, S; Walker, C

2013-10-01

The liberalization of international trade and foreign direct investment through multilateral, regional and bilateral agreements has had profound implications for the structure and nature of food systems, and therefore, for the availability, nutritional quality, accessibility, price and promotion of foods in different locations. Public health attention has only relatively recently turned to the links between trade and investment agreements, diets and health, and there is currently no systematic monitoring of this area. This paper reviews the available evidence on the links between trade agreements, food environments and diets from an obesity and non-communicable disease (NCD) perspective. Based on the key issues identified through the review, the paper outlines an approach for monitoring the potential impact of trade agreements on food environments and obesity/NCD risks. The proposed monitoring approach encompasses a set of guiding principles, recommended procedures for data collection and analysis, and quantifiable 'minimal', 'expanded' and 'optimal' measurement indicators to be tailored to national priorities, capacity and resources. Formal risk assessment processes of existing and evolving trade and investment agreements, which focus on their impacts on food environments will help inform the development of healthy trade policy, strengthen domestic nutrition and health policy space and ultimately protect population nutrition. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

Security middleware infrastructure for DICOM images in health information systems.

PubMed

Kallepalli, Vijay N V; Ehikioya, Sylvanus A; Camorlinga, Sergio; Rueda, Jose A

2003-12-01

In health care, it is mandatory to maintain the privacy and confidentiality of medical data. To achieve this, a fine-grained access control and an access log for accessing medical images are two important aspects that need to be considered in health care systems. Fine-grained access control provides access to medical data only to authorized persons based on priority, location, and content. A log captures each attempt to access medical data. This article describes an overall middleware infrastructure required for secure access to Digital Imaging and Communication in Medicine (DICOM) images, with an emphasis on access control and log maintenance. We introduce a hybrid access control model that combines the properties of two existing models. A trust relationship between hospitals is used to make the hybrid access control model scalable across hospitals. We also discuss events that have to be logged and where the log has to be maintained. A prototype of security middleware infrastructure is implemented.

Users guide for WoodCite, a product cost quotation tool for wood component manufacturers [computer program

Treesearch

Jeff Palmer; Adrienn Andersch; Jan Wiedenbeck; Urs. Buehlmann

2014-01-01

WoodCite is a Microsoft® Access-based application that allows wood component manufacturers to develop product price quotations for their current and potential customers. The application was developed by the U.S. Forest Service and Virginia Polytechnic Institute and State University, in cooperation with the Wood Components Manufacturers Association.

Arbitration in crossbar interconnect for low latency

DOEpatents

Ohmacht, Martin; Sugavanam, Krishnan

2013-02-05

A system and method and computer program product for reducing the latency of signals communicated through a crossbar switch, the method including using at slave arbitration logic devices associated with Slave devices for which access is requested from one or more Master devices, two or more priority vector signals cycled among their use every clock cycle for selecting one of the requesting Master devices and updates the respective priority vector signal used every clock cycle. Similarly, each Master for which access is requested from one or more Slave devices, can have two or more priority vectors and can cycle among their use every clock cycle to further reduce latency and increase throughput performance via the crossbar.

Estimating the economic value of cultural ecosystem services in an urbanizing area using hedonic pricing.

PubMed

Sander, Heather A; Haight, Robert G

2012-12-30

A need exists to increase both knowledge and recognition of the values associated with ecosystem services and amenities. This article explores the use of hedonic pricing as a tool for eliciting these values. We take a case study approach, valuing several services provided by ecosystems, namely aesthetic quality (views), access to outdoor recreation, and the benefits provided by tree cover in Dakota County, Minnesota, USA. Our results indicate that these services are valued by local residents and that hedonic pricing can be used to elicit at least a portion of this value. We find that many aspects of the aesthetic environment significantly impact home sale prices. Total view area as well as the areas of some land-cover types (water and lawn) in views positively influenced home sale prices while views of impervious surfaces generally negatively influenced home sale price. Access to outdoor recreation areas significantly and positively influenced home sale prices as did tree cover in the neighborhood surrounding a home. These results illustrate the ability of hedonic pricing to identify partial values for ecosystem services and amenities in a manner that is highly relevant to local and regional planning. These values could be used to increase policy-maker and public awareness of ecosystem services and could improve their consideration in planning and policy decisions. Copyright © 2012 Elsevier Ltd. All rights reserved.

Nutritional considerations in project planning.

PubMed

Mason, J; Garcia, M; Mitchell, J; Test, K; Henderson, C; Tabatabai, H

1985-05-01

This paper discusses procedures for "ex ante" assessment of likely nutritional effects of development projects. Reported are results of 1 field trial in the Philippines of the "ex ante" assessment procedure in terms of: its feasibility and timeliness and the recommendations for project design that can be made and their influence. In the procedure described, emphasis is placed on assessing likely direct effects--through income, environmental changes and access to services. Indirect effects through food output and prices are assessed qualitatievly. 2 primary questions are addressed in the "ex ante" assessment: 1) who is to benefit directly from the project, in relation to their need (measured in terms of nutrition) and 2) is there reason to suppose that these benefits will not improve their nutrition? The procedure began with an initial assessment to identify the main issues based on reviewing existing data and a short field visit; since there was insufficient information, a rapid nutrition survey was conducted and analyzed; recommendations for project design were made within the necessary time for inclusion. The assessment of the large-scale development project in the Philippines indicates priority to remote areas, small farmers and subsistence fishermen. It is concluded that production-oriented components (e.g., agricultural and infrastructure development) of the project appear likely to improve nutrition insofar as they reach the priority groups defiend above. There is little reason to believe that increased income will not improve nutrition. Finally, there is evidence that an intervention to improve water supply is likely to be effective. Limitations of the procedure are that the assessment is limitied to direct, microlevel effects; long-term influences on nutrition, through changes in the overall economy of the area, are not assessed. Also, the data used cannot easily quantify expected effects on nutrition of project participants. Future application of such procedures are seen to be important if they can be fully integrated with the overall project planning.

Bringing modeling to the masses: A web based system to predict potential species distributions

USGS Publications Warehouse

Graham, Jim; Newman, Greg; Kumar, Sunil; Jarnevich, Catherine S.; Young, Nick; Crall, Alycia W.; Stohlgren, Thomas J.; Evangelista, Paul

2010-01-01

Predicting current and potential species distributions and abundance is critical for managing invasive species, preserving threatened and endangered species, and conserving native species and habitats. Accurate predictive models are needed at local, regional, and national scales to guide field surveys, improve monitoring, and set priorities for conservation and restoration. Modeling capabilities, however, are often limited by access to software and environmental data required for predictions. To address these needs, we built a comprehensive web-based system that: (1) maintains a large database of field data; (2) provides access to field data and a wealth of environmental data; (3) accesses values in rasters representing environmental characteristics; (4) runs statistical spatial models; and (5) creates maps that predict the potential species distribution. The system is available online at www.niiss.org, and provides web-based tools for stakeholders to create potential species distribution models and maps under current and future climate scenarios.

Price, public policy, and smoking in young people.

PubMed

Lewit, E M; Hyland, A; Kerrebrock, N; Cummings, K M

1997-01-01

To examine the effect of cigarette taxes, limits on public smoking, laws regulating access to tobacco by young people, and exposure to pro-tobacco and anti-tobacco messages on smoking participation and the intention to smoke among ninth-grade students (aged 13-16). Two cross-sectional, school-based surveys (total of 15432 responses) of ninth-grade students conducted in 21 North American communities in 1990 and 1992 in conjunction with the Community Intervention Trial for Smoking Cessation. A ninth-grader was classified as a smoker if he or she reported smoking a whole cigarette on at least one of the 30 days preceding the survey. Among non-smokers, a positive intention to smoke was attributed to those who claimed they probably or definitely would be smoking within a year. Both smoking participation and the intent to smoke were related to differences in cigarette prices, with estimated price elasticities of -0.87 and -0.95, respectively. Boys were far more sensitive to price than girls with respect to smoking participation (elasticities of -1.51 and -0.32, respectively); however, the effect of price on the intent to smoke was similar for boys and girls. Policies limiting minors' access to tobacco (a minimum purchase age of 18 years, a ban on cigarette vending machines, and a ban on giving away free samples of tobacco products) were associated with reductions in participation and intention to smoke. Exposure to tobacco education in school was associated with decreased participation and intention to smoke. Policies that prohibited smoking in public places and in schools were not significantly related to the smoking patterns of ninth-graders. Frequency of exposure to pro-tobacco advertisements was marginally associated with increased participation and intention to smoke; paradoxically, frequency of exposure to anti-tobacco advertisements was correlated with an increased likelihood of smoking. Policies limiting access to tobacco by young people, increasing education about the effects of tobacco use, and a sharp and sustained increase in real cigarette excise taxes are likely to be most successful in accomplishing the US Food and Drug Administration's goal of cutting the smoking prevalence of adolescents in half over the next seven years.

Influence of gender roles and rising food prices on poor, pregnant women's eating and food provisioning practices in Dhaka, Bangladesh.

PubMed

Levay, Adrienne V; Mumtaz, Zubia; Faiz Rashid, Sabina; Willows, Noreen

2013-09-26

Maternal malnutrition in Bangladesh is a persistent health issue and is the product of a number of complex factors, including adherence to food 'taboos' and a patriarchal gender order that limits women's mobility and decision-making. The recent global food price crisis is also negatively impacting poor pregnant women's access to food. It is believed that those who are most acutely affected by rising food prices are the urban poor. While there is an abundance of useful quantitative research centered on maternal nutrition and food insecurity measurements in Bangladesh, missing is an understanding of how food insecurity is experienced by people who are most vulnerable, the urban ultra-poor. In particular, little is known of the lived experience of food insecurity among pregnant women in this context. This research investigated these lived experiences by exploring food provisioning strategies of urban, ultra-poor, pregnant women. This knowledge is important as discussions surrounding the creation of new development goals are currently underway. Using a focused-ethnographic approach, household food provisioning experiences were explored. Data from participant observation, a focus group discussion and semi-structured interviews were collected in an urban slum in Dhaka, Bangladesh. Interviews were undertaken with 28 participants including 12 pregnant women and new mothers, two husbands, nine non-pregnant women, and five health care workers. The key findings are: 1) women were aware of the importance of good nutrition and demonstrated accurate, biomedically-based knowledge of healthy eating practices during pregnancy; 2) the normative gender rules that have traditionally constrained women's access to nutritional resources are relaxing in the urban setting; however 3) women are challenged in accessing adequate quality and quantities of food due to the increase in food prices at the market. Rising food prices and resultant food insecurity due to insufficient incomes are negating the recent efforts that have increased women's knowledge of healthy eating during pregnancy and their gendered empowerment. In order to maintain the gains in nutritional knowledge and women's increased mobility and decision-making capacity; policy must also consider the global political economy of food in the creation of the new development goals.

Comparing pharmaceutical pricing and reimbursement policies in Croatia to the European Union Member States.

PubMed

Vogler, Sabine; Habl, Claudia; Bogut, Martina; Voncina, Luka

2011-04-15

To perform a comparative analysis of the pharmaceutical pricing and reimbursement systems in Croatia and the 27 European Union (EU) Member States. Knowledge about the pharmaceutical systems in Croatia and the 27 EU Member States was acquired by literature review and primary research with stakeholders. Pharmaceutical prices are controlled at all levels in Croatia, which is also the case in 21 EU Member States. Like many EU countries, Croatia also applies external price referencing, i.e., compares prices with other countries. While the wholesale remuneration by a statutorily regulated linear mark-up is applied in Croatia and in several EU countries, the pharmacy compensation for dispensing reimbursable medicines in the form of a flat rate service fee in Croatia is rare among EU countries, which usually apply a linear or regressive pharmacy mark-up scheme. Like in most EU countries, the Croatian Social Insurance reimburses specific medicines at 100%, whereas patients are charged co-payments for other reimbursable medicines. Criteria for reimbursement include the medicine's importance from the public health perspective, its therapeutic value, and relative effectiveness. In Croatia and in many EU Member States, reimbursement is based on a reference price system. The Croatian pharmaceutical system is similar to those in the EU Member States. Key policies, like external price referencing and reference price systems, which have increasingly been introduced in EU countries are also applied in Croatia and serve the same purpose: to ensure access to medicines while containing public pharmaceutical expenditure.

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective.

PubMed

Wainberg, Milton L; Scorza, Pamela; Shultz, James M; Helpman, Liat; Mootz, Jennifer J; Johnson, Karen A; Neria, Yuval; Bradford, Jean-Marie E; Oquendo, Maria A; Arbuckle, Melissa R

2017-05-01

Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.

Societal value of generic medicines beyond cost-saving through reduced prices.

PubMed

Dylst, Pieter; Vulto, Arnold; Simoens, Steven

2015-01-01

This paper aims to provide an overview of the added societal value of generic medicines beyond their cost-saving potential through reduced prices. In addition, an observational case study will document the impact of generic entry on access to pharmacotherapy in The Netherlands and an illustrative exercise was carried out to highlight the budget impact of generic entry. A narrative literature review was carried out to explore the impact of generic medicines on access to pharmacotherapy, innovation and medication adherence. Data from the Medicines and Medical Devices Information Project database in The Netherlands were used for the case study in which the impact of generic medicine entrance on the budget and the number of users was calculated as an illustrative exercise. Generic medicines have an additional societal value beyond their cost-saving potential through reduced prices. Generic medicines increase access to pharmacotherapy, provide a stimulus for innovation by both originator companies and generic companies and, under the right circumstances, have a positive impact on medication adherence. Generic medicines offer more to society than just their cost-saving potential through reduced prices. As such, governments must not focus only on the prices of generic medicines as this will threaten their long-term sustainability. Governments must therefore act appropriately and implement a coherent set of policies to increase the use of generic medicines.

Availability, prices and affordability of the World Health Organization’s essential medicines for children in Guatemala

PubMed Central

2012-01-01

Background Several World Health Organization (WHO) initiatives aim to improve the accessibility of safe and effective medicines for children. A first step in achieving this goal is to obtain a baseline measure of access to essential medicines. The objective of this project was to measure the availability, prices, and affordability of children’s medicines in Guatemala. Methods An adaption of the standardized methodology developed by the World Health Organization and Health Action International (HAI) was used to conduct a cross sectional survey to collect data on availability and final patient prices of medicines in public and private sector medicine outlets during April and May of 2010. Results A subset of the public sector, Programa de Accesibilidad a los Medicamentos (PROAM), had the lowest average availability (25%) compared to the private sector (35%). In the private sector, highest and lowest priced medicines were 22.7 and 10.7 times more expensive than their international reference price comparison. Treatments were generally unaffordable, costing as much as 15 days wages for a course of ceftriaxone. Conclusions Analysis of the procurement, supply and distribution of specific medicines is needed to determine reasons for lack of availability. Improvements to accessibility could be made by developing an essential medicines list for children and including these medicines in national purchasing lists. PMID:22747646

Structural adjustment: the wrong prescription for Africa?

PubMed

Logie, D E; Woodroffe, J

1993-07-03

The medical and social consequences and the wide effects of the African structural adjustment program (SAP), specifically for women and children, and examples of the impact in Zimbabwe, Zambia, and Senegal, are discussed. Structural adjustment is defined and the history of its inception is provided. Significant economic and social welfare improvement occurred during the 1960s and 1970s, and considerable decline occurred during the 1980s. The present reality is that Africa,m contrary to popular myths about being a "bottomless pit of Western charity," transfers $10 billion/year to the rich North. Debtor countries are 61% more indebted in 1990 than they were in 1982. During the 1980s, oil prices and interest rates rose dramatically, African export prices dropped, and industrialized countries set up protectionist policies. In addition, there was civil war, drought, poor leadership which put military spending before poverty reduction, and the AIDS epidemic. The Western response was to restructure debt payments in return for implementation of SAPs. Structural adjustment involved a package of trade liberalization, devaluation, removal of government subsidies and price controls, privatization, credit shortages, higher interest rates, and "cost recovery" in health and education. The theory is that economic growth will "ultimately" lead to poverty reduction. A critical view is that SAP insures debt repayment, export of cheap raw materials to the North, and may not sustain longterm economic growth. The results for the poor have been high prices for food, transportation, school and medical fees, and a decline in wages and unemployment. Land is used for exports. A solution is to reduce the debt burden, to place the needs of the poor as a top priority in SAPs, and to put pressure on the World Bank, the International Monetary Fund, and governments to consider health outcomes. Other alternatives noted in the African Framework to SAPs are to place well being and self-reliance as development goals and outcome as a product of the society's value system. Education and training and food self-sufficiency need to be assured fully. The poor need better access to land and employment opportunities. The environment must be managed effectively. Economic development must expand beyond the export of cheap primary commodities.

[General legal conditions for prioritisation within the scope of the German Statutory Health Insurance system].

PubMed

Welti, Felix

2009-01-01

In setting health care priorities the law, and in particular the constitution, has to be obeyed. The social constitutional state must guarantee minimum access to health care. Members of the Statutory Health Insurance (SHI) shall have access to health care services protecting their life and ensuring their participation in society. They shall not be discriminated according to gender, race and ethnic origin, language, disability, age and sexual orientation. Essential decisions will have to be made by the legislator. Within the EC the right to access health care services in another EC member state may be an obstacle to prioritisation on the national level, e.g., to waiting lists. The exclusion of health care services on the basis of the social security law may be too simplistic an approach. Administrative discretion needs priorities, but it is unclear whether these are set to meet political priorities and real needs. The decisions of the Federal Joint Committee (Gemeinsamer Bundesausschuss) are sophisticated enough but have to respect the rule of law. There are deficits in research on the prioritisation effects of health care law. Diminishing these deficits is a prerequisite for turning political priorities into effective legal provisions.

Understanding How to Support Family Caregivers of Seniors with Complex Needs.

PubMed

Charles, Lesley; Brémault-Phillips, Suzette; Parmar, Jasneet; Johnson, Melissa; Sacrey, Lori-Ann

2017-06-01

The purpose of this study was to describe the experiences and challenges of supporting family caregivers of seniors with complex needs and to outline support strategies and research priorities aimed at supporting them. A CIHR-funded, two-day conference entitled "Supporting Family Caregivers of Seniors: Improving Care and Caregiver Outcomes" was held. An integrated knowledge translation approach guided this planning conference. Day 1 included presentations of research evidence, followed by participant engagement Qualitative data was collected regarding facilitators, barriers/gaps, and recommendations for the provision of caregiver supports. Day 2 focused on determination of research priorities. Identified facilitators to the provision of caregiver support included accessibility of health-care and community-based resources, availability of well-intended health-care providers, and recognition of caregivers by the system. Barriers/gaps related to challenges with communication, access to information, knowledge of what is needed, system navigation, access to financial resources, and current policies. Recommendations regarding caregiver services and research revolved around assisting caregivers to self-identify and seek support, formalizing caregiver supports, centralizing resources, making system navigation available, and preparing the next generation for caregiving. A better understanding of the needs of family caregivers and ways to support them is critical to seniors' health services redesign.

Consumers and Carers Versus Pharmacy Staff: Do Their Priorities for Australian Pharmacy Services Align?

PubMed

McMillan, Sara S; Kelly, Fiona; Sav, Adem; Kendall, Elizabeth; King, Michelle A; Whitty, Jennifer A; Wheeler, Amanda J

2015-10-01

Health professionals, including pharmacists, are encouraged to meet the needs of their consumers in an efficient and patient-centred manner. Yet, there is limited information as to what consumers with chronic conditions need from pharmacy as a healthcare destination or how well pharmacy staff understand these needs. The aim of this study was to identify service user priorities for ideal community pharmacy services for consumers with chronic conditions and their carers, and compare these priorities with what pharmacy staff think these groups want. The nominal group technique was undertaken with pharmacist, pharmacy support staff, consumer and carer groups in four Australian regions between December 2012 and April 2013. Participant ideas and priorities for ideal services or care were identified, and contextual insight was obtained by thematic analysis. Twenty-one nominal group sessions are accepted, including 15 consumer and carer, four pharmacist and two pharmacy support staff groups. Pharmacy staff views generally aligned with consumer priorities, such as access, affordability, patient-centred care and continuity and coordinated care, yet diverged with respect to consumer information or education on medication and services. Fundamentally, consumers and carers sought streamlined access to information and medication, in a coordinated, patient-centred approach. Alleviating financial burden was a key consumer priority, with a call for the continuation and extension of medication subsidies. Overall, pharmacy staff had a reasonable understanding of what consumers would prioritise, but further emphasis on the importance, delivery, or both, of consumer information is needed. Greater consideration is needed from policy makers regarding the financial barriers to accessing medication for consumers with chronic conditions.

National reimbursement listing determinants of new cancer drugs: a retrospective analysis of 58 cancer treatment appraisals in 2007-2016 in South Korea.

PubMed

Kim, Eun-Sook; Kim, Jung-Ae; Lee, Eui-Kyung

2017-08-01

Since the positive-list system was introduced, concerns have been raised over restricting access to new cancer drugs in Korea. Policy changes in the decision-making process, such as risk-sharing agreement and the waiver of pharmacoeconomic data submission, were implemented to improve access to oncology medicines, and other factors are also involved in the reimbursement for cancer drugs. The aim of this study is to investigate the reimbursement listing determinants of new cancer drugs in Korea. All cancer treatment appraisals of Health Insurance Review and Assessment during 2007-2016 were analyzed based on 13 independent variables (comparative effectiveness, cost-effectiveness, drug-price comparison, oncology-specific policy, and innovation such as new mode of action). Univariate and multivariate logistic analyses were conducted. Of 58 analyzed submissions, 40% were listed in the national reimbursement formulary. In univariate analysis, four variables were related to listing: comparative effectiveness, drug-price comparison, new mode of action, and risk-sharing agreement. In multivariate logistic analysis, three variables significantly increased the likelihood of listing: clinical improvement, below alternative's price, and risk-sharing arrangement. Cancer drug's listing increased from 17% to 47% after risk-sharing agreement implementation. Clinical improvement, cost-effectiveness, and RSA application are critical to successful national reimbursement listing.

American Heart Association Principles on the Accessibility and Affordability of Drugs and Biologics: A Presidential Advisory From the American Heart Association.

PubMed

Antman, Elliott M; Creager, Mark A; Houser, Steven R; Warner, John J; Konig, Madeleine

2017-12-12

Net US spending on pharmaceuticals reached $309.5 billion in 2015, an 8.5% increase from the year before, and is expected to reach between $370 and $400 billion by 2020. These current and projected levels have raised serious concerns by policy makers, providers, payers, and patient groups that they are unsustainable and threaten the affordability of and accessibility to much-needed therapies for patients. Two trends related to drugs/biologics and generic drugs/biosimilars underlie this overall increase in spending. First, the market entry prices of innovator pharmaceutical products, or brand drugs and biologics, are at levels that some assessments consider unaffordable to the healthcare system. Second, prices for some established generic drugs such as digoxin and captopril have seen sharp and rapid increases. As an evidence-based patient advocacy organization dedicated to improving the cardiovascular health of all Americans, the American Heart Association has a unique role in advocating for treatments, including medicines that are available, affordable, and accessible to patients. This advisory serves to lay out a set of principles that will guide association engagement in pursuit of this goal. © 2017 American Heart Association, Inc.

Impact analysis of freight vehicle access restriction (A case study of Jakarta Intra Urban Toll way)

NASA Astrophysics Data System (ADS)

Irbany, Ferdian; Hadiwardoyo, Sigit P.; Nahry, Nahdalina

2017-06-01

Since the access restriction policy on freight vehicles was implemented in some parts of Jakarta Intra-Urban Tollway (JIUT) in 2011, i.e. section Cawang - Tomang - Pluit, several sections had an improved performance. However, there were sections that showed the opposite effect. The purpose of this research was to analyze the impact of the policy on JIUT as a whole by using the parameters based on sustainable transportation indicators. The study area was divided into the statutory segment (Cawang - Tomang - Pluit) and the affected segment (Cawang - Tanjung Priok - Pluit). The assessment results of five parameters including travel time, fuel consumption, fatality rate, CO2 emissions, and noise level indicated that the implementation of the policy provided an advantage to the traffic smoothness priority at the statutory segment, but it did not support the sustainable urban transportation priority of the entire JIUT system. The proposed solution to maintain the sustainable condition of urban transportation is to complement the statutory system with the advisory system within Jakarta's territory.

Specialty pharmaceuticals: policy initiatives to improve assessment, pricing, prescription, and use.

PubMed

Robinson, James C; Howell, Scott

2014-10-01

The value of "specialty pharmaceuticals" for cancer and other complex conditions depends not merely on their molecular structures but also on the manner in which the drugs are assessed, insured, priced, prescribed, and used. This article analyzes the five principal stages through which a specialty drug must pass on its journey from the laboratory to the bedside. These include regulatory approval by the Food and Drug Administration for market access, insurance coverage, pricing and payment, physician prescription, and patient engagement. If structured appropriately, each stage improves performance and supports continued research and development. If structured inappropriately, however, each stage adds to administrative burdens, distorts clinical decision making, and weakens incentives for innovation. Cautious optimism is in order, but neither the continued development of breakthrough products nor their use according to evidence-based guidelines can be taken for granted. Project HOPE—The People-to-People Health Foundation, Inc.

[Conditional pricing for innovative medicines in France: stop telling about risk-sharing!].

PubMed

Megerlin, F

2013-09-01

Across global borders and throughout the various sectors of health care, the search for viable methods to pay for value has intensified. Driven by soaring costs and constrained budgets, public and private payers are seeking innovative ways to incentivize providers and product manufacturers to focus on effective outcomes for patients according to key performance indexes. Conditional pricing and performance-based payment for innovative medicines could facilitate access to quasi-monopsonic french market, in a context of financial crisis, loss of reciprocal confidence, and growing aversion for therapeutic and economical uncertainty. However, we consider these new methods of payment should not be termed "risk-sharing agreements", a misleading term despite its common use today. They also should not impact the national list prices of medicines, that is a decisive tool for stabilizing international trade. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Communicating laboratory results through a Web site: Patients' priorities and viewpoints.

PubMed

Sabahi, Azam; Ahmadian, Leila; Mirzaee, Moghademeh

2018-02-28

Patients can access laboratory results using various technologies. The aim of this study was to integrate the laboratory results into the hospital Web site based on patients' viewpoints and priorities and to measure patients' satisfaction. This descriptive-analytical study was conducted in 2015. First, a questionnaire was distributed among 200 patients to assess patients' priorities to receive laboratory results through the Web site. Second, those who agreed (n = 95) to receive their laboratory results through the Web site were identified. Then, the required changes were made to the hospital Web site based on patients' viewpoints and priorities. Third, patients were divided into two groups. The first group received their laboratory results through the Web site on the date had been announced during their visit to the laboratory. The second group was informed by SMS once their results were shown on the Web site. After receiving laboratory results, patients' satisfaction was evaluated. More than half of the participants (n = 53, 55.8%) were highly satisfied with receiving the results electronically. The higher number of people in SMS group (n = 9, 20.9%) reported that they were satisfied with time-saving compared to other group (n = 2, 3.8%) (P = .04). Participants after receiving the results through the Web site considered the functionalities of reprinting (P < .0001) and timeliness (P = .017) more important. Integrating laboratory results into the hospital Web site based on the patients' viewpoints and priorities can improve patient satisfaction and lower the patients' concern regarding confidentiality of their results. © 2018 Wiley Periodicals, Inc.

Research priorities for specialized nursing practice in the United Arab Emirates.

PubMed

Al-Yateem, N; Al-Tamimi, M; Brenner, M; Altawil, H; Ahmad, A; Brownie, S

2017-08-25

Globally, nurses are undertaking expanded and more specialized roles in healthcare planning and service delivery in response to changing patterns and levels of health service demand. This means the nursing profession is increasingly considered as leaders in health service policy, research and practice. The United Arab Emirates has strengthened nursing governance and practice by establishing a Nursing and Midwifery Council and increasing the activity of nursing specialization, service leadership and research. This study aimed to identify clinically relevant research priorities to facilitate nursing contributions to evidence-based care and strengthening health services in the country. A two-stage Delphi study design was used. The first round involved 783 participants. The second round involved 1116 participants, as more clinical settings were accessed. In total, 58 research priorities across a variety of nursing specialties (paediatrics, emergency care, intensive care, labour and maternity care, operating theatre and long-term care) were identified as highly important. These identified priorities will guide a more informed programme of research in each nursing specialty, with the aim of strengthening the evidence base to improving outcomes for patients and their families in the United Arab Emirates. The findings provide guidance on key areas for nurses to focus research contributions to enhance evidence-based care and strengthen health systems. The identified priorities may also guide researchers in academic institutions to conduct research informed by current, clinically relevant issues. The findings may help inform funders and policymakers to support allocation of funding to research that has potential to contribute to enhancing nursing care in specialist areas. © 2017 International Council of Nurses.

Delphi Survey of Clinical Nursing and Midwifery Research Priorities in the Eastern Mediterranean Region.

PubMed

Sun, Carolyn; Dohrn, Jennifer; Oweis, Arwa; Huijer, Huda Abu-Saad; Abu-Moghli, Fathieh; Dawani, Hania; Ghazi, Cheherezade; Larson, Elaine

2017-03-01

As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranean region concomitantly with a growing focus on achievement of universal health coverage, nurses and midwives are expected to fill major gaps in health care. Hence, the need for a solid evidence base for nursing practice and a clear direction for clinical nursing research are paramount. Therefore, a Delphi survey was conducted to determine clinical (research focused on patient outcomes) nursing and midwifery priorities for research within this region. A Delphi survey, using iterative rounds of an online survey of regional clinical nursing and midwifery research experts, was conducted between January and April 2016. Consensus was determined by percentage agreement on level of priority for topics as determined by participants. Additionally, results were compared between countries within the region by income and mortality levels using Kendall's tau. Critical research topics were focused on public/community/primary care as well as emergency preparedness for disasters, and these priorities are well aligned with gaps in the literature for this region. There were statistically significant differences between priority level and country mortality group for geriatrics, self-management of disease, and sexually transmitted infections. Critical research priorities should focus on population-based health topics. Between-country differences should be analyzed further. A clinical research database for the region may help improve research access for nurses and midwives. Practicing nurses and midwives lack extensive evidence (including culturally relevant evidence) on which to practice. Increasing research in areas identified in this survey may improve patient outcomes and quality of care regionally. © 2017 Sigma Theta Tau International.

The Development of a Veterans Health Administration Emergency Management Research Agenda

PubMed Central

Dobalian, Aram; Claver, Maria; Riopelle, Deborah; Wyte-Lake, Tamar; Canelo, Ismelda

2017-01-01

Introduction: The Veterans Health Administration (VHA), the largest integrated healthcare delivery system in the United States, is charged with ensuring timely access to high-quality care for veterans during disasters, and supporting national, state, local, and tribal emergency management and homeland security efforts. In 2008, the VHA Office of Public Health (OPH) sponsored the first VHA Emergency Management Research Agenda-setting conference to develop research priorities that address the needs of veterans and to position VHA as a national leader in emergency management by having VHA serve as a “laboratory” for the development of evidence-based emergency management practices. Methods: We focused on four steps: #1: Appraising the emergency management research portfolio of VHA-based researchers; #2: Obtaining systematic information on VHA’s role in emergency management and the healthcare needs of veterans during disasters; #3: Based upon gaps between the current research portfolio and the existing evidence base, identifying strategic priorities using a research agenda-setting conference; and #4: Laying the groundwork to foster the conduct of emergency management research within VHA. Results: Identified research priorities included how to prevent and treat behavioral health problems related to a disaster, the efficacy of training programs, crisis communication strategies, workforce resilience, and evacuating veterans from health care facilities. Conclusion: VHA is uniquely situated to answer research questions that cannot be readily addressed in other settings. VHA should partner with other governmental and private entities to build on existing work and establish shared research priorities. PMID:28439447

Progesterone for Prevention of Preterm Birth: Shortcomings and Unintended Consequences of the Orphan Drug Act.

PubMed

Gee, Rebekah E; Kuy, SreyRam; Karas, Laura O

2017-12-01

Preterm birth is a problem of major public health significance that continues to plague our country despite the existence of a therapy, 17α-hydroxyprogesterone caproate, with known efficacy in reducing the risk of spontaneous preterm birth among high-risk women. Over the past several years, the Louisiana Department of Health has undertaken a robust, multifaceted initiative to improve access to 17α-hydroxyprogesterone caproate, which resulted in a 3.5-fold increase in the percentage of eligible high-risk pregnant women in the Medicaid program who received the therapy between 2013 and 2016. Yet despite Louisiana's progress, the vast majority of the eligible population still fails to receive 17α-hydroxyprogesterone caproate. In this Current Commentary, we argue that the high price of progesterone since U.S. Food and Drug Administration approval has unnecessarily complicated access, and our nation has potentially suffered nearly 60,000 avoidable premature births as a consequence. We present the history of the orphan drug approval and manufacturer-imposed price increase for injectable progesterone, the interplay between the drug's high price and the persistence of racial and ethnic disparities in preterm birth, which are particularly germane in Louisiana, and Louisiana's broad-reaching efforts to improve progesterone coverage. The story of 17α-hydroxyprogesterone caproate highlights the durable barriers that high prices place in the way of access and helps illuminate the shortcomings and unintended consequences of the Orphan Drug Act. This case, however, is not an outlier; it is the far-too-common product of monopoly pricing in the U.S. pharmaceutical market, inadvertently bolstered by existing law, at the expense of affordability and patient access.

Performance comparison of token ring protocols for hard-real-time communication

NASA Technical Reports Server (NTRS)

Kamat, Sanjay; Zhao, Wei

1992-01-01

The ability to guarantee the deadlines of synchronous messages while maintaining a good aggregate throughput is an important consideration in the design of distributed real-time systems. In this paper, we study two token ring protocols, the priority driven protocol and the timed token protocol, for their suitability for hard real-time systems. Both these protocols use a token to control access to the transmission medium. In a priority driven protocol, messages are assigned priorities and the protocol ensures that messages are transmitted in the order of their priorities. Timed token protocols do not provide for priority arbitration but ensure that the maximum access delay for a station is bounded. For both protocols, we first derive the schedulability conditions under which the transmission deadlines of a given set of synchronous messages can be guaranteed. Subsequently, we use these schedulability conditions to quantitatively compare the average case behavior of the protocols. This comparison demonstrates that each of the protocols has its domain of superior performance and neither dominates the other for the entire range of operating conditions.

SPACEHAB missions as pathfinders for ISS services development

NASA Astrophysics Data System (ADS)

Hamill, Doris; Jackson, Kenneth; Mirra, Carlo

2003-01-01

SPACEHAB, Inc. has established a commercial business model for providing access to space. The model, based on private initiative and investment, has offered "turn key" access to space including both launch and integration and operations services. Some features of this business model should be applied directly to providing service in the ISS era: offering packaged service at a fixed price; customer focus; private investment as the basis for offering services; and efficient and continually improving customer service. But International Space Station (ISS) will pose challenges that have not been pioneered in the STS era: a new base of customers must be developed; on-orbit hardware will be more difficult to modify; access to ISS is controlled by government space agencies. These problems will tax the ingenuity of those who wish to provide services in space on a commercial business model.

Equalizing access to pandemic influenza vaccines through optimal allocation to public health distribution points.

PubMed

Huang, Hsin-Chan; Singh, Bismark; Morton, David P; Johnson, Gregory P; Clements, Bruce; Meyers, Lauren Ancel

2017-01-01

Vaccines are arguably the most important means of pandemic influenza mitigation. However, as during the 2009 H1N1 pandemic, mass immunization with an effective vaccine may not begin until a pandemic is well underway. In the U.S., state-level public health agencies are responsible for quickly and fairly allocating vaccines as they become available to populations prioritized to receive vaccines. Allocation decisions can be ethically and logistically complex, given several vaccine types in limited and uncertain supply and given competing priority groups with distinct risk profiles and vaccine acceptabilities. We introduce a model for optimizing statewide allocation of multiple vaccine types to multiple priority groups, maximizing equal access. We assume a large fraction of available vaccines are distributed to healthcare providers based on their requests, and then optimize county-level allocation of the remaining doses to achieve equity. We have applied the model to the state of Texas, and incorporated it in a Web-based decision-support tool for the Texas Department of State Health Services (DSHS). Based on vaccine quantities delivered to registered healthcare providers in response to their requests during the 2009 H1N1 pandemic, we find that a relatively small cache of discretionary doses (DSHS reserved 6.8% in 2009) suffices to achieve equity across all counties in Texas.

Prevention of HPV-related cancers in Norway: cost-effectiveness of expanding the HPV vaccination program to include pre-adolescent boys.

PubMed

Burger, Emily A; Sy, Stephen; Nygård, Mari; Kristiansen, Ivar S; Kim, Jane J

2014-01-01

Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted. A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program. Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered 'good value for money.' For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage. At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding vaccination coverage to boys and should be considered a priority.

25 CFR Appendix A to Subpart C - IRR High Priority Project Scoring Matrix

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false IRR High Priority Project Scoring Matrix A Appendix A to...—IRR High Priority Project Scoring Matrix Score 10 5 3 1 0 Accident and fatality rate for candidate...,000 or less 250,001-500,000 500,001-750,000 Over 750,000. Geographic isolation No external access to...

25 CFR Appendix A to Subpart C - IRR High Priority Project Scoring Matrix

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false IRR High Priority Project Scoring Matrix A Appendix A to...—IRR High Priority Project Scoring Matrix Score 10 5 3 1 0 Accident and fatality rate for candidate...,000 or less 250,001-500,000 500,001-750,000 Over 750,000. Geographic isolation No external access to...

25 CFR Appendix A to Subpart C - IRR High Priority Project Scoring Matrix

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false IRR High Priority Project Scoring Matrix A Appendix A to...—IRR High Priority Project Scoring Matrix Score 10 5 3 1 0 Accident and fatality rate for candidate...,000 or less 250,001-500,000 500,001-750,000 Over 750,000. Geographic isolation No external access to...

25 CFR Appendix A to Subpart C - IRR High Priority Project Scoring Matrix

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true IRR High Priority Project Scoring Matrix A Appendix A to...—IRR High Priority Project Scoring Matrix Score 10 5 3 1 0 Accident and fatality rate for candidate...,000 or less 250,001-500,000 500,001-750,000 Over 750,000. Geographic isolation No external access to...

Price and Availability of Sugar-Free, Sugar-Reduced and Low Glycemic Index Cereal Products in Northwestern México.

PubMed

Arámburo-Gálvez, Jesús G; Ontiveros, Noé; Vergara-Jiménez, Marcela J; Magaña-Ordorica, Dalia; Gracia-Valenzuela, Martina H; Cabrera-Chávez, Francisco

2017-12-18

Sugar-free (SF), sugar-reduced (SR), or low-glycemic-index (low GI) cereal products could be helpful for the dietary treatment of disorders related to glucose homeostasis. However, access and economic aspects are barriers that could hamper their consumption. Thus, the availability and price of such cereal products were evaluated in Northwestern México. The products were categorized in 10 groups. The data were collected in five cities by store visitation (from November 2015 to April 2016). The availability in specialized stores and supermarkets was expressed as availability rates based on the total number of products. The price of the SF, SR, and low GI products were compared with their conventional counterparts. Availability rates were higher in supermarkets than in specialized stores by product numbers (14.29% versus 3.76%, respectively; p < 0.001) and by product categories (53.57% versus 26.92%, respectively; p < 0.001). Five categories of products labeled as SF, SR, and low GI (oats, cookies and crackers, flours, snacks, and tostadas/totopos) had higher prices than their conventional counterparts ( p < 0.05). In conclusion, in Northwestern Mexico, the availability of SF, SR, and low GI cereal-based foods is relatively low, and these foods are more expensive than their conventional counterparts.

Occupational Stigma as a Primary Barrier To Health Care For Street-Based Sex Workers in Canada

PubMed Central

Lazarus, Lisa; Deering, Kathleen N; Nabess, Rose; Gibson, Kate; Tyndall, Mark W; Shannon, Kate

2011-01-01

Individuals working in the sex industry continue to experience many negative health outcomes. As such, disentangling the factors shaping poor health access remains a critical public health priority. Within a quasi-criminalised prostitution environment, this study aimed to evaluate the prevalence of occupational stigma associated with sex work and its relationship to barriers to accessing health services. Analyses draw on baseline questionnaire data from a community-based cohort of women in street-based sex work in Vancouver, Canada (2006–8). Of a total of 252 women, 141 (58.5%) reported occupational sex work stigma (defined as hiding occupational sex work status from family, friends and/or home community), while 125 (49.6%) reported barriers to accessing health services in the previous six months. In multivariable analysis, adjusting for socio-demographic, interpersonal and work environment risks, occupational sex work stigma remained independently associated with an elevated likelihood of experiencing barriers to health access. Study findings indicate the critical need for policy and societal shifts in views of sex work as a legitimate occupation, combined with improved access to innovative, accessible and non-judgmental health care delivery models for street-based sex workers that include the direct involvement of sex workers in development and implementation. PMID:22084992

Girls Getting to Secondary School Safely: Combating Gender-Based Violence in the Transportation Sector in Tanzania

ERIC Educational Resources Information Center

Mack, Laura

2009-01-01

While increasing girls' access to education is a global priority, there are numerous barriers that impede significant progress in achieving gender parity in schools. While enrollment of girl students is up in Tanzania, especially at the primary and secondary levels, AED has become concerned about the barriers girls face, including gender-based…

Associations between bride price stress and intimate partner violence amongst pregnant women in Timor-Leste.

PubMed

Rees, Susan; Mohsin, Mohammed; Tay, Alvin Kuowei; Soares, Elisa; Tam, Natalino; da Costa, Zelia; Tol, Wietse; Silove, Derrick

2017-08-28

Reducing violence against women is a global public health priority, particularly in low-income and conflict-affected societies. However, more needs to be known about the causes of intimate partner violence (IPV) in these settings, including the stress of bride price obligations. The representative study of women attending ante-natal clinics in Dili, Timor-Leste was conducted between June, 2013 and September, 2014 with 1672 pregnant women, a response rate of 96%. We applied contextually developed measures for the stress of bride price and poverty, and the World Health Organisation measure for intimate partner violence. Compared to those with no problems with bride price, women with moderate or serious problems with that custom reported higher rates of IPV (18.0% vs. 43.6%). Adjusting for socio-demographic factors, multivariate analysis revealed that ongoing poverty (OR = 1.75, 95% CI: 1.20-2.56) was significantly associated with IPV. Importantly, the strongest association with IPV was problems with bride price (OR = 2.73, 95% CI: 1.86-4.01). This is the first large consecutively sampled study to demonstrate a strong association between the stressors of bride price and poverty with IPV. Notably, bride price stress had the strongest association with IPV. Revealing this hitherto unrecognized factor of bride price stress may prove pivotal in guiding policy and interventions aimed at reducing IPV, and thereby improve the health and psychosocial status of women in low income and conflict-affected settings.

Tradition of healthy food access in low-income neighborhoods: Price and variety of curbside produce vending compared to conventional retailers

PubMed Central

Brinkley, Catherine; Chrisinger, Benjamin; Hillier, Amy

2014-01-01

This paper describes the longstanding, naturally emergent model of curbside vending of whole fruit and vegetable produce across several low-income, low-health Philadelphia neighborhoods. We conducted open-ended interviews with managers of 11 curbside produce vendors and compared prices and varieties of fruits and vegetables with the 11 closest conventional outlets. We find that produce trucks offer significantly lower prices on common fruit and vegetable items and they carry a variety of items comparable to that carried by limited-assortment grocery stores. We conclude with recommendations regarding zoning, licensing, and Supplemental Nutrition Assistance Program (SNAP) authorization that could stabilize and expand this model of healthy food access. PMID:25541595

The prices people pay for medicines in Zimbabwe.

PubMed

Gavaza, P; Simoyi, T; Makunike, B; Maponga, C C

2009-01-01

To collect, analyse and compare prices of medicines in different sectors and parts of the country and to compare them with the medicine prices in other countries. A prospective cross sectional study. Pharmacy outlets in Zimbabwe comprising 27 retail pharmacies, 23 dispensing doctors, eight public hospital pharmacies and seven municipal clinics. Median price ratios, 25th percentiles and 75th percentiles. Innovator brands in the private sector were priced 10 times the International References Prices (IRP) and more than three times the price of generic medicines. Dispensing doctors were charging the highest prices for medicines and the public sector had the least prices. The national procurement agency, NatPharm, procured medicines at prices slightly below the Management Sciences for Health (MSH) prices. Prices of medicines in the public sector were higher than average prices for medicines from seven other African countries. Medicine prices in Zimbabwe are high, a scenario that may compromise affordability and accessibility to medicines especially by the poor. Urgent steps are needed to reduce the level and effect of the high prices on the population, especially the poor.

Hierarchical data security in a Query-By-Example interface for a shared database.

PubMed

Taylor, Merwyn

2002-06-01

Whenever a shared database resource, containing critical patient data, is created, protecting the contents of the database is a high priority goal. This goal can be achieved by developing a Query-By-Example (QBE) interface, designed to access a shared database, and embedding within the QBE a hierarchical security module that limits access to the data. The security module ensures that researchers working in one clinic do not get access to data from another clinic. The security can be based on a flexible taxonomy structure that allows ordinary users to access data from individual clinics and super users to access data from all clinics. All researchers submit queries through the same interface and the security module processes the taxonomy and user identifiers to limit access. Using this system, two different users with different access rights can submit the same query and get different results thus reducing the need to create different interfaces for different clinics and access rights.

A review of the health and economic implications of patent protection, with a specific focus on Thailand.

PubMed

Yamabhai, Inthira; Smith, Richard D

2012-08-01

Although it has been two decades since the Thai Patent Act was amended to comply with the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), there has been little emphasis given to assessing the implications of this amendment. The purpose of this review is to summarize the health and economic impact of patent protection, with a focus on the experience of Thailand. A review of national and international empirical evidence on the health and economic implications of patents from 1980 to 2009 was undertaken. The findings illustrate the role of patent protection in four areas: price, present access, future access, and international trade and investment. Forty-three empirical studies were found, three of which were from Thai databases. Patenting does increase price, although the size of effect differs according to the methodology and country. Although weakening patent rights could increase present access, evidence suggests that strengthening patenting may benefit future access; although this is based on complex assumptions and estimations. Moreover, while patent protection appears to have a positive impact on trade flow, the implication for foreign direct investment (FDI) is equivocal. Empirical studies in Thailand, and other similar countries, are rare, compromising the robustness and generalizability of conclusions. However, evidence does suggest that patenting presents a significant inter-temporal challenge in balancing aspects of current versus future access to technologies. This underlines the urgent need to prioritize health research resources to assess the wider implications of patent protection.

WASP: Is open access publishing the way forward? A review of the different ways in which research papers can be published.

PubMed

Cuschieri, Sarah

2018-06-01

Academics have a duty towards peers and scholars alike to engage in research work and to publish their findings. This also assists in establishing personal academic success as well as the attainment of research grants. In the past, authors used to publish their research articles for free but access to these articles was restricted to subscription users only. Recently, open access publishing has gained momentum, whereby such articles are made freely accessible online. However open access publishing comes with a price tag for the author through article processing charges. Open access may also question a journal's credibility within the academic world if improperly implemented. This is particularly so following the unsolicited bombardment of researchers' email accounts with invitations for submissions to predatory open access journals. For these reasons, authors needs to rigorously weigh the pros and cons of whether to choose a subscription based or an open access journal for publication. Copyright © 2018 Elsevier B.V. All rights reserved.

47 CFR 51.501 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) INTERCONNECTION Pricing of Elements § 51.501 Scope. (a) The rules in this subpart apply to the pricing of network elements, interconnection, and methods of obtaining access to unbundled elements, including physical collocation and virtual...

Southeast Alaska economics: a resource-abundant region competing in a global marketplace.

Treesearch

Lisa K. Crone

2005-01-01

Questions related to economics figured prominently in the priority information needs identified in the 1997 Tongass Land Management Plan. Follow-on studies in economics werc designed to improve understanding of aspects of the competitiveness of the Alaska forest sector, links between Alaska timber markets and other markets as evident in prices, and the relationship...

76 FR 40593 - Competitive and Noncompetitive Non-Formula Federal Assistance Programs-Administrative Provisions...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-11

...;Prices of new books are listed in the first FEDERAL REGISTER issue of each #0;week. #0; #0; #0; #0;#0... gasification research priorities of USDA and the Department of Energy at the State and regional levels. With... Economics. Purpose The objectives of the Sun Grant Program are to enhance national energy security through...

78 FR 16338 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-14

... trades where none of the parties to the trade are Priority Customers (i.e., market makers, broker-dealers... that this proposed rule change is a fair way to address the issue of a trade executing through a customer's limit order price while balancing the competing interests of certainty that trades stand versus...

"Cigarettes Are Priority": A Qualitative Study of How Australian Socioeconomically Disadvantaged Smokers Respond to Rising Cigarette Prices

ERIC Educational Resources Information Center

Guillaumier, Ashleigh; Bonevski, Billie; Paul, Christine

2015-01-01

Despite substantial modelling research assessing the impact of cigarette taxes on smoking rates across income groups, few studies have examined the broader financial effects and unintended consequences on very low-income smokers. This study explored how socioeconomically disadvantaged smokers in a high-income country manage smoking costs on…

Orphan drugs for rare diseases: is it time to revisit their special market access status?

PubMed

Simoens, Steven; Cassiman, David; Dooms, Marc; Picavet, Eline

2012-07-30

Orphan drugs are intended for diseases with a very low prevalence, and many countries have implemented legislation to support market access of orphan drugs. We argue that it is time to revisit the special market access status of orphan drugs. Indeed, evidence suggests that there is no societal preference for treating rare diseases. Although society appears to assign a greater value to severity of disease, this criterion is equally relevant to many common diseases. Furthermore, the criterion of equity in access to treatment, which underpins orphan drug legislation, puts more value on health improvement in rare diseases than in common diseases and implies that population health is not maximized. Finally, incentives for the development, pricing and reimbursement of orphan drugs have created market failures, including monopolistic prices and the artificial creation of rare diseases. We argue that, instead of awarding special market access status to orphan drugs, there is scope to optimize research and development (R&D) of orphan drugs and to control prices of orphan drugs by means of, for example, patent auctions, advance purchase commitments, pay-as-you-go schemes and dose-modification studies. Governments should consider carefully the right incentive strategy for R&D of orphan drugs in rare diseases.

Rural Healthy People 2020: New Decade, Same Challenges.

PubMed

Bolin, Jane N; Bellamy, Gail R; Ferdinand, Alva O; Vuong, Ann M; Kash, Bita A; Schulze, Avery; Helduser, Janet W

2015-01-01

The health of rural America is more important than ever to the health of the United States and the world. Rural Healthy People 2020's goal is to serve as a counterpart to Healthy People 2020, providing evidence of rural stakeholders' assessment of rural health priorities and allowing national and state rural stakeholders to reflect on and measure progress in meeting those goals. The specific aim of the Rural Healthy People 2020 national survey was to identify rural health priorities from among the Healthy People 2020's (HP2020) national priorities. Rural health stakeholders (n = 1,214) responded to a nationally disseminated web survey soliciting identification of the top 10 rural health priorities from among the HP2020 priorities. Stakeholders were also asked to identify objectives within each national HP2020 priority and express concerns or additional responses. Rural health priorities have changed little in the last decade. Access to health care continues to be the most frequently identified rural health priority. Within this priority, emergency services, primary care, and insurance generate the most concern. A total of 926 respondents identified access as the no. 1 rural health priority, followed by, no. 2 nutrition and weight status (n = 661), no. 3 diabetes (n = 660), no. 4 mental health and mental disorders (n = 651), no. 5 substance abuse (n = 551), no. 6 heart disease and stroke (n = 550), no. 7 physical activity and health (n = 542), no. 8 older adults (n = 482), no. 9 maternal infant and child health (n = 449), and no. 10 tobacco use (n = 429). © 2015 The Authors The Journal of Rural Health published by Wiley Periodicals, Inc. on behalf of National Rural Health Association.

[The economics of health care in developing countries: what the fight against the AIDS epidemics has changed].

PubMed

Moatti, Jean Paul

2008-12-01

Since the start of the new century, development aid targeted on health care has seen an unprecedented rise, driven by the fight against AIDS. This article shows how this struggle has been accompanied with a renewal of the economic paradigms governing international action in favour of health care in developing countries: the idea that an improvement in health care constitutes an unavoidable prerequisite to macroeconomic growth, rather than a consequence; the insistence on the founding of mechanisms for health insurance to finance the costs of health care, rather than covering the costs at the point of use by the health care users; a concern to impose price differentials for access to medicine in developing countries, and to introduce flexibility in the regulation of international intellectual property law; the priority to vertical programmes targeted on certain illnesses, thought to act as levers for a global reinforcement of health care systems. This article discusses the pertinence of these new paradigms in light of the evolution of the AIDS/HIV epidemic, and the international context.

Essays on regulation, institutions, and industrial organization

NASA Astrophysics Data System (ADS)

Bergara, Mario Esteban

Essay I develops a comparative institutional analysis of network access price regulation and "light-handed" regulation. While the former is a specific-agency-based arrangement with higher political influence, the latter is a court-based system. Consequently, the main trade-off between both frameworks reflects the merits of having efficient political and judicial institutions. Price regulation is superior when distributional concerns are irrelevant and information asymmetries are lower. Poorly functioning political systems and high welfare costs of raising funds make price regulation less attractive. Light regulation is more attractive when potential rents are smaller, the monopolist is more risk averse, the judicial system is more efficient, and the threat of government intervention is more credible. The possibility of private transfers makes price regulation more advantageous. Higher information asymmetries among firms makes light-handed regulation more attractive. The main results are consistent with a plausible interpretation of the drastic deregulatory process in New Zealand. Essay II studies the preliminary effects of the deregulation of direct access in the New Zealand's electricity market. A slight improvement in quality standards and an overall efficiency increase took place after two years of deregulation. Retailers were able to successfully enter in large demand, dense areas, with a large proportion of industrial and commercial users, where incumbents were not distributing electricity efficiently. Pricing policies appears to be influenced by market forces (associated to economic and demographic characteristics) as expected in a light regulatory framework. Essay III focuses on the possibility of endogenous sunk costs and the introduction of new products. Firms that exert some monopoly power in one market and introduce a new good whose demand is determined by a broader set of consumers might be forced to change their competing strategies. If the new product is a "quality" good, the resulting competitive process may include advertising outlays, affecting the degree of competition in the old market. In the Uruguayan private banking sector, larger institutions pursued more aggressive advertising strategies to maintain or improve their market positions than smaller firms. Market power in the financial intermediation market has considerably declined after the introduction of new products in the early nineties.

Status and determinants of small farming households' food security and role of market access in enhancing food security in rural Pakistan

PubMed Central

Ying, Liu; Bashir, Muhammad Khalid; Abid, Muhammad; Zulfiqar, Farhad

2017-01-01

In most of the developing countries, lack of resources and little market accessibility are among the major factors that affect small farming household food security. This study aims to investigate the status of small farming households’ food security, and its determinants including the role of market accessibility factors in enhancing food security at household level. In addition, this study also determines the households’ perception about different kinds of livelihoods risks. This study is based on a household survey of 576 households conducted through face-to-face interviews using structured interviews in Punjab, Pakistan. Food security status is calculated using dietary intake method. The study findings show that one-fourth of the households are food insecure. The study findings reveal that farm households perceive increase in food prices, crop diseases, lack of irrigation water and increase in health expenses as major livelihood risks. Further, the results of logistic regression show that family size, monthly income, food prices, health expenses and debt are main factors influencing the food security status of rural households. Furthermore, the market accessibility factors (road distance and transportation cost) do significantly affect the small farming household food security. The results suggest that local food security can be enhanced by creating off-farm employment opportunities, improved transportation facilities and road infrastructure. PMID:29077719

Status and determinants of small farming households' food security and role of market access in enhancing food security in rural Pakistan.

PubMed

Ahmed, Umar Ijaz; Ying, Liu; Bashir, Muhammad Khalid; Abid, Muhammad; Zulfiqar, Farhad

2017-01-01

In most of the developing countries, lack of resources and little market accessibility are among the major factors that affect small farming household food security. This study aims to investigate the status of small farming households' food security, and its determinants including the role of market accessibility factors in enhancing food security at household level. In addition, this study also determines the households' perception about different kinds of livelihoods risks. This study is based on a household survey of 576 households conducted through face-to-face interviews using structured interviews in Punjab, Pakistan. Food security status is calculated using dietary intake method. The study findings show that one-fourth of the households are food insecure. The study findings reveal that farm households perceive increase in food prices, crop diseases, lack of irrigation water and increase in health expenses as major livelihood risks. Further, the results of logistic regression show that family size, monthly income, food prices, health expenses and debt are main factors influencing the food security status of rural households. Furthermore, the market accessibility factors (road distance and transportation cost) do significantly affect the small farming household food security. The results suggest that local food security can be enhanced by creating off-farm employment opportunities, improved transportation facilities and road infrastructure.

Reimbursed Price of Orphan Drugs: Current Strategies and Potential Improvements.

PubMed

Mincarone, Pierpaolo; Leo, Carlo Giacomo; Sabina, Saverio; Sarriá-Santamera, Antonio; Taruscio, Domenica; Serrano-Aguilar, Pedro Guillermo; Kanavos, Panos

2017-01-01

The pricing and reimbursement policies for pharmaceuticals are relevant to balance timely and equitable access for all patients, financial sustainability, and reward for valuable innovation. The proliferation of high-cost specialty medicines is particularly true in rare diseases (RDs) where the pricing mechanism is characterised by a lack of transparency. This work provides an overall picture of current strategies for the definition of the reimbursed prices of orphan drugs (ODs) and highlights some potential improvements. Current strategies and suggestions are presented along 4 dimensions: (1) comprehensive value assessment, (2) early dialogs among relevant stakeholders, (3) innovative reimbursement approaches, and (4) societal participation in producing ODs. Comprehensive value assessment could be achieved by clarifying the approach of distributive justice to adopt, ensuring a representative participation of stakeholders, and with a broad consideration of value-bearing factors. With respect to early dialogs, cross-border cooperation can be determinant to companies and agencies. The cost-benefit ratio of early dialogs needs to be demonstrated and the "regulatory capture" effect should be monitored. Innovative reimbursement approaches were developed to balance the need for evidence-based decisions with the timely access to innovative drugs. The societal participation in producing ODs needs to be recognised in a collaborating framework where adaptive agreements can be developed with mutual satisfaction. Such agreements could also impact on coverage and reimbursement decisions as additional elements for the determination of a comprehensive societal value of ODs. Further research is needed to investigate the highlighted open challenges so that RDs will not remain, in practical terms, orphan diseases. © 2017 S. Karger AG, Basel.

Estimating the waiting time of multi-priority emergency patients with downstream blocking.

PubMed

Lin, Di; Patrick, Jonathan; Labeau, Fabrice

2014-03-01

To characterize the coupling effect between patient flow to access the emergency department (ED) and that to access the inpatient unit (IU), we develop a model with two connected queues: one upstream queue for the patient flow to access the ED and one downstream queue for the patient flow to access the IU. Building on this patient flow model, we employ queueing theory to estimate the average waiting time across patients. Using priority specific wait time targets, we further estimate the necessary number of ED and IU resources. Finally, we investigate how an alternative way of accessing ED (Fast Track) impacts the average waiting time of patients as well as the necessary number of ED/IU resources. This model as well as the analysis on patient flow can help the designer or manager of a hospital make decisions on the allocation of ED/IU resources in a hospital.

Equity in Pharmaceutical Pricing and Reimbursement: Crossing the Income Divide in Asia Pacific.

PubMed

Daems, Rutger; Maes, Edith; Glaetzer, Christoph

2013-05-01

The article takes a three-dimensional approach (triangulation) in defining international pricing policy for pharmaceuticals using cost-effectiveness analysis (CEA), willingness-to-pay (WTP) analysis, and ability-to-pay (ATP) analysis. It attempts to find a balance between the various economic methods of which some focus on effectiveness while others are geared toward incorporating equity in the equation. A critical review of the first two established economic methods and their ability to evaluate not only "efficacy" but also "fairness" in pricing decisions identifies a gap in the latter. Therefore, a third analytic method is presented that measures the ATP based on a country's score in the human development index of the United Nations Development Program for 120 countries. This approach allows practicing differential pricing among and within countries. To refine this equity-driven pricing concept, two additional parameters can be added to the model: the Oxford "Multidimensional Poverty Index" and the "Out-of-Pocket" or "Self Pay" health expenditure as reported by the World Bank. There is no hierarchy between the above three pricing methods. Because one method provides further insight into the other, however, it is recommended to start with CEA followed by WTP analysis. These types of analysis are closely linked in that the first provides the CE ratio for the compound investigated and the other sets the anticipated ceiling threshold of the payer's WTP (in a particular country). The ATP method provides a supplementary "equity" check and facilitates the process of equity-based differential pricing. A third method should be used in conjunction with the standard CEA and WTP analysis that measures the ATP with the human development index as yardstick to provide sustainable and equitable access to medicines. We recommend that ATP analysis becomes an additional practice in policy decision making and in defining international pricing strategies for pharmaceuticals. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Guidelines for Outsourcing Remote Access.

ERIC Educational Resources Information Center

Hassler, Ardoth; Neuman, Michael

1996-01-01

Discusses the advantages and disadvantages of outsourcing remote access to campus computer networks and the Internet, focusing on improved service, cost-sharing, partnerships with vendors, supported protocols, bandwidth, scope of access, implementation, support, network security, and pricing. Includes a checklist for a request for proposals on…

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

O`Driscoll, M.

The Federal Energy Regulatory Commission`s transmission pricing policy signals acceptance of what previously had been taboo: any departure from the embedded cost, postage-stamp rates that have characterized transmission pricing for decades but are becoming increasingly difficult to deal with as the power industry develops a more competitive profile. The transmission pricing policy gives the electric utility industry the flexibility it wants but, the utilities must provide comparability of pricing - an extension of the golden rule of transmission access to transmission pricing. Comparability of service applies to price as well as to terms and conditions. But, the commission said, pricingmore » comparability does not mean all customers should pay the same price. FERC said it supports proposals that disaggregate costs in order to give better price signals to all users of the system, third parties and the transmission owner itself.« less

Pricing appraisal of anti-cancer drugs in the South East Asian, Western Pacific and East Mediterranean Region.

PubMed

Salmasi, Shahrzad; Lee, Kah Seng; Ming, Long Chiau; Neoh, Chin Fen; Elrggal, Mahmoud E; Babar, Zaheer-Ud- Din; Khan, Tahir Mehmood; Hadi, Muhammad Abdul

2017-12-28

Globally, cancer is one of the leading causes of mortality. High treatment cost, partly owing to higher prices of anti-cancer drugs, presents a significant burden on patients and healthcare systems. The aim of the present study was to survey and compare retail prices of anti-cancer drugs between high, middle and low income countries in the South-East Asia, Western Pacific and Eastern Mediterranean regions. Cross-sectional survey design was used for the present study. Pricing data from ten counties including one from South-East Asia, two from Western Pacific and seven from Eastern Mediterranean regions were used in this study. Purchasing power parity (PPP)-adjusted mean unit prices for 26 anti-cancer drug presentations (similar pharmaceutical form, strength, and pack size) were used to compare prices of anti-cancer drugs across three regions. A structured form was used to extract relevant data. Data were entered and analysed using Microsoft Excel®. Overall, Taiwan had the lowest mean unit prices while Oman had the highest prices. Six (23.1%) and nine (34.6%) drug presentations had a mean unit price below US$100 and between US$100 and US$500 respectively. Eight drug presentations (30.7%) had a mean unit price of more than US$1000 including cabazitaxel with a mean unit price of $17,304.9/vial. There was a direct relationship between income category of the countries and their mean unit price; low-income countries had lower mean unit prices. The average PPP-adjusted unit prices for countries based on their income level were as follows: low middle-income countries (LMICs): US$814.07; high middle income countries (HMICs): US$1150.63; and high income countries (HICs): US$1148.19. There is a great variation in pricing of anticancer drugs in selected countires and within their respective regions. These findings will allow policy makers to compare prices of anti-cancer agents with neighbouring countries and develop policies to ensure accessibility and affordability of anti-cancer drugs.

The effect of carbon credits on savanna land management and priorities for biodiversity conservation.

PubMed

Douglass, Lucinda L; Possingham, Hugh P; Carwardine, Josie; Klein, Carissa J; Roxburgh, Stephen H; Russell-Smith, Jeremy; Wilson, Kerrie A

2011-01-01

Carbon finance offers the potential to change land management and conservation planning priorities. We develop a novel approach to planning for improved land management to conserve biodiversity while utilizing potential revenue from carbon biosequestration. We apply our approach in northern Australia's tropical savanna, a region of global significance for biodiversity and carbon storage, both of which are threatened by current fire and grazing regimes. Our approach aims to identify priority locations for protecting species and vegetation communities by retaining existing vegetation and managing fire and grazing regimes at a minimum cost. We explore the impact of accounting for potential carbon revenue (using a carbon price of US$14 per tonne of carbon dioxide equivalent) on priority areas for conservation and the impact of explicitly protecting carbon stocks in addition to biodiversity. Our results show that improved management can potentially raise approximately US$5 per hectare per year in carbon revenue and prevent the release of 1-2 billion tonnes of carbon dioxide equivalent over approximately 90 years. This revenue could be used to reduce the costs of improved land management by three quarters or double the number of biodiversity targets achieved and meet carbon storage targets for the same cost. These results are based on generalised cost and carbon data; more comprehensive applications will rely on fine scale, site-specific data and a supportive policy environment. Our research illustrates that the duel objective of conserving biodiversity and reducing the release of greenhouse gases offers important opportunities for cost-effective land management investments.

The Effect of Carbon Credits on Savanna Land Management and Priorities for Biodiversity Conservation

PubMed Central

Douglass, Lucinda L.; Possingham, Hugh P.; Carwardine, Josie; Klein, Carissa J.; Roxburgh, Stephen H.; Russell-Smith, Jeremy; Wilson, Kerrie A.

2011-01-01

Carbon finance offers the potential to change land management and conservation planning priorities. We develop a novel approach to planning for improved land management to conserve biodiversity while utilizing potential revenue from carbon biosequestration. We apply our approach in northern Australia's tropical savanna, a region of global significance for biodiversity and carbon storage, both of which are threatened by current fire and grazing regimes. Our approach aims to identify priority locations for protecting species and vegetation communities by retaining existing vegetation and managing fire and grazing regimes at a minimum cost. We explore the impact of accounting for potential carbon revenue (using a carbon price of US$14 per tonne of carbon dioxide equivalent) on priority areas for conservation and the impact of explicitly protecting carbon stocks in addition to biodiversity. Our results show that improved management can potentially raise approximately US$5 per hectare per year in carbon revenue and prevent the release of 1–2 billion tonnes of carbon dioxide equivalent over approximately 90 years. This revenue could be used to reduce the costs of improved land management by three quarters or double the number of biodiversity targets achieved and meet carbon storage targets for the same cost. These results are based on generalised cost and carbon data; more comprehensive applications will rely on fine scale, site-specific data and a supportive policy environment. Our research illustrates that the duel objective of conserving biodiversity and reducing the release of greenhouse gases offers important opportunities for cost-effective land management investments. PMID:21935363

Having your cake and eating it: office of fair trading proposal for funding new drugs to benefit patients and innovative companies.

PubMed

Godman, Brian; Haycox, Alan; Schwabe, Ulrich; Joppi, Roberta; Garattini, Silvio

2008-01-01

There are insufficient resources in the UK to fund all new technologies and new indications approved by the National Institute for Health and Clinical Excellence (NICE). Diverting funding from existing sources will have a detrimental effect on the provision of other priority services. The UK Office of Fair Trading (OFT) recently suggested a value-based pricing approach that appears workable but has generated considerable debate. Their proposal of a 25% premium for the originator product once generics are available is more generous than seen in a number of other European countries, where typically only the lowest priced product is reimbursed. The OFT proposal for a maximum 50% premium for patent-protected products, versus the prices of generics in a class or related classes, is also more generous than the proposed reforms for the pricing of proton pump inhibitors in Sweden or current reforms in Germany. In our opinion, the OFT proposals are persuasive and in accordance with the reforms seen in other European countries, and therefore should be adopted. The alternatives to fully funding new drugs or new indications as approved by NICE are either tightening the cost per QALY threshold, giving NICE an annual national budget to fund its advice alongside suggested areas for disinvestment, proactively switching patients from high-cost brand-name drugs to generics, or further delaying funding for new drugs and new indications approved by NICE. The majority of these suggestions are not in the best interests of patients or innovative pharmaceutical companies seeking to reap the rewards of their efforts.

Oil turmoil

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

Not Available

1979-07-01

A review of US oil production, refining, and retailing reveals the severity of the energy problem and illustrates the confusion over what can be accomplished by decontrolling oil prices. Conflicting statements from members of Congress, the President, and the oil industry have further confused the public. The shortages can be traced to a decline in domestic production incentives and foreign production, a slowdown in refinery expansion because of environmental constraints, competition between home heating oil and gasoline for priority, the failure of states to enforce speed limits, and a national preoccupation with oil profits. Senator Kennedy, for example, advocates continuedmore » price controls with a world-wide drilling program funded by the World Bank, while decontrol advocates feel price controls will only artifically restrain US production. The economic effects of decontrol on inflation are unclear, but conservation efforts, the development of alternative energy sources, and oil development from shale and tar sands are predicted to increase as political rhetoric declines.« less

Consumer-defined health plans: emerging challenges from tort and contract.

PubMed

Morreim, E Haavi

2006-01-01

The emergence of Consumer-Defined Health Plans with large deductibles means that many people will be financially responsible for all or most of their healthcare during any given year. This increasing exposure to costs will bring important changes in the physician-patient relationship, as patients seek more information about the care their physicians propose. Litigation can be anticipated in two areas. First, in tort law, informed consent claims may allege that providers failed to disclose the likely costs and medical importance of their care. Second, in contract law, patients may challenge the reasonableness of the prices they are charged. This Article explores potential causes of action in both areas. Ultimately, increasing transparency of pricing may lend greater rationality not only to pricing structures but also, it is to be hoped, to healthcare itself, as cost-worthiness of care assumes higher priority in medical decisionmaking.

Pharmaceutical pricing and reimbursement in China: When the whole is less than the sum of its parts.

PubMed

Hu, Jia; Mossialos, Elias

2016-05-01

In recent years, there has been rapid growth in pharmaceutical spending in China. In addition, the country faces many challenges with regards to the quality, pricing and affordability of drugs. Pricing and reimbursement are important aspects of pharmaceutical policy that must be prioritised in order to address the many challenges. This review draws on multiple sources of information. A review of the academic and grey literature along with official government statistics were combined with information from seminars held by China's State Council Development Research Center to provide an overview of pharmaceutical pricing and reimbursement in China. Pricing and reimbursement policy were analysed through a framework that incorporates supply-side policies, proxy-demand policies and demand-side policies. China's current pharmaceutical policies interact in such a way to create dysfunction in the form of high prices, low drug quality, irrational prescribing and problems with access. Finally, the country's fragmented regulatory environment hampers pharmaceutical policy reform. The pricing and reimbursement policy landscape can be improved through higher drug quality standards, greater market concentration, an increase in government subsidies, quality-oriented tendering, wider implementation of the zero mark-up policy, through linking reimbursement with rational prescribing, and the promotion of health technology assessment and comparative effectiveness research. Addressing broader issues of regulatory fragmentation, the lack of transparency and corruption will help ensure that policies are created in a coherent, evidence-based fashion. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Limited Use of Price and Quality Advertising Among American Hospitals

PubMed Central

Wilks, Chrisanne E A; Richter, Jason P

2013-01-01

Background Consumer-directed policies, including health savings accounts, have been proposed and implemented to involve individuals more directly with the cost of their health care. The hope is this will ultimately encourage providers to compete for patients based on price or quality, resulting in lower health care costs and better health outcomes. Objective To evaluate American hospital websites to learn whether hospitals advertise directly to consumers using price or quality data. Methods Structured review of websites of 10% of American hospitals (N=474) to evaluate whether price or quality information is available to consumers and identify what hospitals advertise about to attract consumers. Results On their websites, 1.3% (6/474) of hospitals advertised about price and 19.0% (90/474) had some price information available; 5.7% (27/474) of hospitals advertised about quality outcomes information and 40.9% (194/474) had some quality outcome data available. Price and quality information that was available was limited and of minimal use to compare hospitals. Hospitals were more likely to advertise about service lines (56.5%, 268/474), access (49.6%, 235/474), awards (34.0%, 161/474), and amenities (30.8%, 146/474). Conclusions Insufficient information currently exists for consumers to choose hospitals on the basis of price or quality, making current consumer-directed policies unlikely to realize improved quality or lower costs. Consumers may be more interested in information not related to cost or clinical factors when choosing a hospital, so consumer-directed strategies may be better served before choosing a provider, such as when choosing a health plan. PMID:23988296

Comparing pharmaceutical pricing and reimbursement policies in Croatia to the European Union Member States

PubMed Central

Vogler, Sabine; Habl, Claudia; Bogut, Martina; Vončina, Luka

2011-01-01

Aim To perform a comparative analysis of the pharmaceutical pricing and reimbursement systems in Croatia and the 27 European Union (EU) Member States. Methods Knowledge about the pharmaceutical systems in Croatia and the 27 EU Member States was acquired by literature review and primary research with stakeholders. Results Pharmaceutical prices are controlled at all levels in Croatia, which is also the case in 21 EU Member States. Like many EU countries, Croatia also applies external price referencing, ie, compares prices with other countries. While the wholesale remuneration by a statutorily regulated linear mark-up is applied in Croatia and in several EU countries, the pharmacy compensation for dispensing reimbursable medicines in the form of a flat rate service fee in Croatia is rare among EU countries, which usually apply a linear or regressive pharmacy mark-up scheme. Like in most EU countries, the Croatian Social Insurance reimburses specific medicines at 100%, whereas patients are charged co-payments for other reimbursable medicines. Criteria for reimbursement include the medicine’s importance from the public health perspective, its therapeutic value, and relative effectiveness. In Croatia and in many EU Member States, reimbursement is based on a reference price system. Conclusion The Croatian pharmaceutical system is similar to those in the EU Member States. Key policies, like external price referencing and reference price systems, which have increasingly been introduced in EU countries are also applied in Croatia and serve the same purpose: to ensure access to medicines while containing public pharmaceutical expenditure. PMID:21495202

Limited use of price and quality advertising among American hospitals.

PubMed

Muhlestein, David B; Wilks, Chrisanne E A; Richter, Jason P

2013-08-29

Consumer-directed policies, including health savings accounts, have been proposed and implemented to involve individuals more directly with the cost of their health care. The hope is this will ultimately encourage providers to compete for patients based on price or quality, resulting in lower health care costs and better health outcomes. To evaluate American hospital websites to learn whether hospitals advertise directly to consumers using price or quality data. Structured review of websites of 10% of American hospitals (N=474) to evaluate whether price or quality information is available to consumers and identify what hospitals advertise about to attract consumers. On their websites, 1.3% (6/474) of hospitals advertised about price and 19.0% (90/474) had some price information available; 5.7% (27/474) of hospitals advertised about quality outcomes information and 40.9% (194/474) had some quality outcome data available. Price and quality information that was available was limited and of minimal use to compare hospitals. Hospitals were more likely to advertise about service lines (56.5%, 268/474), access (49.6%, 235/474), awards (34.0%, 161/474), and amenities (30.8%, 146/474). Insufficient information currently exists for consumers to choose hospitals on the basis of price or quality, making current consumer-directed policies unlikely to realize improved quality or lower costs. Consumers may be more interested in information not related to cost or clinical factors when choosing a hospital, so consumer-directed strategies may be better served before choosing a provider, such as when choosing a health plan.

Final priority; National Institute on Disability and Rehabilitation Research--Disability and Rehabilitation Research Projects and Centers Program--Rehabilitation Engineering Research Centers. Final priority.

PubMed

2013-06-14

The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for a Rehabilitation Engineering Research Center (RERC) on Universal Interfaces and Information Technology Access under the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). The Assistant Secretary may use this priority for a competition in fiscal year (FY) 2013 and later years. We take this action to focus research attention on areas of national need. We intend to use this priority to improve outcomes for individuals with disabilities.

Corporate social responsibility to improve access to medicines: the case of Brazil.

PubMed

Thorsteinsdóttir, Halla; Ovtcharenko, Natasha; Kohler, Jillian Clare

2017-02-21

Access to medicines and the development of a strong national pharmaceutical industry are two longstanding pillars of health policy in Brazil. This is reflected in a clear emphasis by Brazil's Federal Government on improving access to medicine in national health plans and industrial policies aimed at promoting domestic pharmaceutical development. This research proposes that such policies may act as incentives for companies to pursue a strategic Corporate Social Responsibility (CSR) agenda. CSR that supports Governmental priorities could help companies to benefit significantly from the Governmental industrial policy. We sought to determine whether CSR activities of Brazilian pharmaceutical firms are currently aligned with the Federal Government's health prioritization. To do so we examined key Brazilian health related policies since 2004, including the specific priorities of Brazil's 2012-2015 Health Plan, and compared these with CSR initiatives that are reported on the websites of select pharmaceutical firms in Brazil. Brazil's national health plans and industrial policies demonstrated that the Federal Government has followed diverse approaches for improving access to medicines, including strengthening health care infrastructure, increasing transparency, and supporting product development partnerships. Case studies of six pharmaceutical firms, representing both public and private companies of varying size, support the perspective that CSR is a priority for firms. However, while many programs target issues such as health infrastructure, health care training, and drug donation, more programs focus on areas other than health and do not seem to be connected to Governmental prioritization. This research suggests that there are loose connections between Governmental priorities and pharmaceutical firm CSR. However, there remains a significant opportunity for greater alignment, which could improve access to medicines in the country and foster a stronger relationship between the Government and industry.

Harnessing the private health sector by using prices as a policy instrument: Lessons learned from South Africa.

PubMed

Barber, Sarah L; Kumar, Ankit; Roubal, Tomas; Colombo, Francesca; Lorenzoni, Luca

2018-05-01

Governments frequently draw upon the private health care sector to promote sustainability, optimal use of resources, and increased choice. In doing so, policy-makers face the challenge of harnessing resources while grappling with the market failures and equity concerns associated with private financing of health care. The growth of the private health sector in South Africa has fundamentally changed the structure of health care delivery. A mutually reinforcing ecosystem of private health insurers, private hospitals and specialists has grown to account for almost half of the country's spending on health care, despite only serving 16% of the population with the capacity to pay. Following years of consolidation among private hospital groups and insurance schemes, and after successive failures at establishing credible price benchmarks, South Africa's private hospitals charge prices comparable with countries that are considerably richer. This compromises the affordability of a broad-based expansion in health care for the population. The South African example demonstrates that prices can be part of a structure that perpetuates inequalities in access to health care resources. The lesson for other countries is the importance of norms and institutions that uphold price schedules in high-income countries. Efforts to compromise or liberalize price setting should be undertaken with a healthy degree of caution. Copyright © 2018 Elsevier B.V. All rights reserved.

From market access to patient access: overview of evidence-based approaches for the reimbursement and pricing of pharmaceuticals in 36 European countries.

PubMed

Panteli, Dimitra; Eckhardt, Helene; Nolting, Alexandra; Busse, Reinhard; Kulig, Michael

2015-09-25

Coverage decisions determining the benefit baskets of health systems have been increasingly relying on evidence regarding patient benefit and costs. Relevant structures, methodologies, and processes have especially been established for pharmaceuticals but approaches differ. The objective of this work was thus to identify institutions in a broad range of European countries (n = 36) in charge of determining the value of pharmaceuticals for pricing and reimbursement purposes and to map their decision-making process; to examine the different approaches and consider national and supranational possibilities for best practice. Institutions were identified through websites of international networks, ministries, and published literature. Details on institutional practices were supplemented with information from institution websites and linked online sources. The type and extent of information available varied considerably across countries. Different types of public regulatory bodies are involved in pharmaceutical coverage decisions, assuming a range of responsibilities. As a rule, the assessment of scientific evidence is kept structurally separate from its appraisal. Recommendations on value are uniformly issued by specific committees within or commissioned by responsible institutions; these institutions often also act as decision-makers on reimbursement status and level or market price. While effectiveness and costs are important criteria in all countries, the latter are often considered on a case-by-case basis. In all countries, manufacturer applications, including relevant evidence, are used as one of the main sources of information for the assessment. Transparency of evidence-based coverage decisions should be enhanced. International collaboration can facilitate knowledge exchange, improve efficiency of information production, and strengthen new or developing systems.

HANDBOOK FOR OIL SPILL PROTECTION AND CLEANUP PRIORITIES

EPA Science Inventory

This handbook was developed in an easily accessible yet extensive field format for use by federally designated on-scene coordinators (OSC) to guide them in assessing priorities during all phases of an oil spill response. The guidelines presented will enable the OSC to (1) determi...

Embedded controller for GEM detector readout system

NASA Astrophysics Data System (ADS)

Zabołotny, Wojciech M.; Byszuk, Adrian; Chernyshova, Maryna; Cieszewski, Radosław; Czarski, Tomasz; Dominik, Wojciech; Jakubowska, Katarzyna L.; Kasprowicz, Grzegorz; Poźniak, Krzysztof; Rzadkiewicz, Jacek; Scholz, Marek

2013-10-01

This paper describes the embedded controller used for the multichannel readout system for the GEM detector. The controller is based on the embedded Mini ITX mainboard, running the GNU/Linux operating system. The controller offers two interfaces to communicate with the FPGA based readout system. FPGA configuration and diagnostics is controlled via low speed USB based interface, while high-speed setup of the readout parameters and reception of the measured data is handled by the PCI Express (PCIe) interface. Hardware access is synchronized by the dedicated server written in C. Multiple clients may connect to this server via TCP/IP network, and different priority is assigned to individual clients. Specialized protocols have been implemented both for low level access on register level and for high level access with transfer of structured data with "msgpack" protocol. High level functionalities have been split between multiple TCP/IP servers for parallel operation. Status of the system may be checked, and basic maintenance may be performed via web interface, while the expert access is possible via SSH server. System was designed with reliability and flexibility in mind.

Fuzzy-based failure mode and effect analysis (FMEA) of a hybrid molten carbonate fuel cell (MCFC) and gas turbine system for marine propulsion

NASA Astrophysics Data System (ADS)

Ahn, Junkeon; Noh, Yeelyong; Park, Sung Ho; Choi, Byung Il; Chang, Daejun

2017-10-01

This study proposes a fuzzy-based FMEA (failure mode and effect analysis) for a hybrid molten carbonate fuel cell and gas turbine system for liquefied hydrogen tankers. An FMEA-based regulatory framework is adopted to analyze the non-conventional propulsion system and to understand the risk picture of the system. Since the participants of the FMEA rely on their subjective and qualitative experiences, the conventional FMEA used for identifying failures that affect system performance inevitably involves inherent uncertainties. A fuzzy-based FMEA is introduced to express such uncertainties appropriately and to provide flexible access to a risk picture for a new system using fuzzy modeling. The hybrid system has 35 components and has 70 potential failure modes, respectively. Significant failure modes occur in the fuel cell stack and rotary machine. The fuzzy risk priority number is used to validate the crisp risk priority number in the FMEA.

The hidden cost of low prices: limited access to new drugs in India.

PubMed

Berndt, Ernst R; Cockburn, Iain M

2014-09-01

The pricing and accessibility of patent-protected drugs in low- and middle-income countries is a contentious issue in the global context. But questions about price have little meaning if a drug is not available for purchase, and the extent to which patent policy affects when (and if) new drugs become available in these countries has largely been overlooked. We examined data on the sales of 184 drugs approved by the US Food and Drug Administration between 2000 and 2009. We found that 50 percent of those 184 drugs went on sale in India only after lags of more than five years from their first worldwide introduction. More than half of the drugs that became newly available in India during the study period were produced and sold by multiple manufacturers in the country within one year of their introduction. The presence of multiple manufacturers indicates sharp competition and weak patent protection--factors that are disincentives to manufacturers to incur the costs of gaining access to the market. We conclude that modest patent and regulatory reform could bring the faster availability of a wider range of new drugs in India with limited impact on prices--a trade-off that merits greater policy attention. Project HOPE—The People-to-People Health Foundation, Inc.

Generic medicines: solutions for a sustainable drug market?

PubMed

Dylst, Pieter; Vulto, Arnold; Godman, Brian; Simoens, Steven

2013-10-01

Generic medicines offer equally high-quality treatment as originator medicines do at much lower prices. As such, they represent a considerable opportunity for authorities to obtain substantial savings. At the moment, the pharmaceutical landscape is changing and many pharmaceutical companies have altered their development and commercial strategies, combining both originator and generic divisions. In spite of this, the generic medicines industry is currently facing a number of challenges: delayed market access; the limited price differential with originator medicines; the continuous downwards pressure on prices; and the negative perception regarding generic medicines held by some key stakeholder groups. This could jeopardize the long-term sustainability of the generic manufacturing industry. Therefore, governments must focus on demand-side policies, alongside policies to accelerate market access, as the generic medicines industry will only be able to deliver competitive and sustainable prices if they are ensured a high volume. In the future, the generic medicines industry will increasingly look to biosimilars and generic versions of orphan drugs to expand their business.

Obesity and government.

PubMed

Kahan, Scott; Zvenyach, Tracy

2016-10-01

Despite much effort, obesity prevalence and disease severity continues to worsen. The purpose of this review is to describe the leading government supported food and nutrition interventions and policies to prevent and address obesity in the USA. The review also summarizes obesity interventions and policies that the government plays a role in, but further development is warranted. The government's role in obesity has largely focused on interventions and policies such as national surveillance, obesity education and awareness, grant-based food subsidy programs, zoning for food access, school-based nutrition programs, dietary guidelines, nutrition labeling, and food marketing and pricing policies. The government has played a lesser role in obesity interventions and policies that provide access to evidence-based obesity care to people affected by the disease. Given the magnitude of the obesity epidemic, the government should explore multiple evidence-based interventions and policies across prevention and clinical care.

Stranded cost recovery presents stumbling block to open access

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

Del Roccili, J.A.

Much of the impetus for the movement to competitive power markets is a result of the tremendous variance in energy prices across the country. Large commercial and industrial customers are becoming increasingly aware of these discrepancies and are marshaling the market and political forces required to guarantee the eventual development of a national open-access transmission policy. Such a policy will facilitate competition and equalize prices on a regional, and to some extent, national level. The stumbling block, however, is the recovery of stranded investment. Under traditional regulation, historical costs could be collected through approved rates for a bundled service. Withmore » the protection of a monopoly franchise, average electricity prices provide the possibility of cost recovery for assets that might not be recoverable in a competitive market.« less

E-Mobility and the Energy Transition.

PubMed

Schlögl, Robert

2017-09-04

Since the reduction of greenhouse gases is the top priority of the Energy Transition, primary electricity should be converted to material energy carriers. In this way electricity can be "stored" and made accessible for other applications. This Essay focuses on the integration of mobility in the Energy Transition and the development of sustainable alternatives to electricity-based transportation. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Measuring Access to Medicines: A Survey of Prices, Availability and Affordability in Shaanxi Province of China

PubMed Central

Jiang, Minghuan; Yang, Shimin; Yan, Kangkang; Liu, Jun; Zhao, Jun; Fang, Yu

2013-01-01

Objective To measure the prices and availability of selected medicines in Shaanxi Province after the implementation of new healthcare reform in 2009. Methods Data on the prices and availability of 47 medicines were collected from 50 public and 36 private sector medicine outlets in six regions of Shaanxi Province, Western China using a standardized methodology developed by the World Health Organization and Health Action International from September to October 2010. Medicine prices were compared with international reference prices to obtain a median price ratio. Affordability was measured as the number of days’ wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions. Findings The mean availabilities of originator brands and lowest-priced generics were 8.9% and 26.5% in the public sector, and 18.1% and 43.6% in the private sector, respectively. The public sector procured generics and originator brands at median price ratios of 0.75 and 8.49, respectively, while patients paid 0.97 and 10.16. Final patient prices for lowest-priced generics and originator brands in the private sector were about 1.53 and 8.36 times their international retail prices, respectively. Public sector vendors applied high markups of 30.4% to generics, and 19.6% to originator brands. In the private sector, originator brands cost 390.7% more, on average, than their generic equivalents. Generic medicines were priced 17.3% higher in the private sector than the public sector. The lowest-paid government worker would need 0.1 day’s wages to purchase captopril for lowest-priced generics from private sector, while 6.6 days’ wages for losartan. For originator brands, the costs rise to 1.2 days’ wages for salbutamol inhaler and 15.6 days’ wages for omeprazole. Conclusions The prices, availability and affordability of medicines in China should be improved to ensure equitable access to basic medical treatments, especially for the poor. This requires multi-faceted interventions, as well as the review and refocusing of policies, regulations and educational interventions. PMID:23936471

Measuring access to medicines: a survey of prices, availability and affordability in Shaanxi province of China.

PubMed

Jiang, Minghuan; Yang, Shimin; Yan, Kangkang; Liu, Jun; Zhao, Jun; Fang, Yu

2013-01-01

To measure the prices and availability of selected medicines in Shaanxi Province after the implementation of new healthcare reform in 2009. Data on the prices and availability of 47 medicines were collected from 50 public and 36 private sector medicine outlets in six regions of Shaanxi Province, Western China using a standardized methodology developed by the World Health Organization and Health Action International from September to October 2010. Medicine prices were compared with international reference prices to obtain a median price ratio. Affordability was measured as the number of days' wages required for the lowest-paid unskilled government worker to purchase standard treatments for common conditions. The mean availabilities of originator brands and lowest-priced generics were 8.9% and 26.5% in the public sector, and 18.1% and 43.6% in the private sector, respectively. The public sector procured generics and originator brands at median price ratios of 0.75 and 8.49, respectively, while patients paid 0.97 and 10.16. Final patient prices for lowest-priced generics and originator brands in the private sector were about 1.53 and 8.36 times their international retail prices, respectively. Public sector vendors applied high markups of 30.4% to generics, and 19.6% to originator brands. In the private sector, originator brands cost 390.7% more, on average, than their generic equivalents. Generic medicines were priced 17.3% higher in the private sector than the public sector. The lowest-paid government worker would need 0.1 day's wages to purchase captopril for lowest-priced generics from private sector, while 6.6 days' wages for losartan. For originator brands, the costs rise to 1.2 days' wages for salbutamol inhaler and 15.6 days' wages for omeprazole. The prices, availability and affordability of medicines in China should be improved to ensure equitable access to basic medical treatments, especially for the poor. This requires multi-faceted interventions, as well as the review and refocusing of policies, regulations and educational interventions.

Insulin prices, availability and affordability: a cross-sectional survey of pharmacies in Hubei Province, China.

PubMed

Liu, Chenxi; Zhang, Xinping; Liu, Chaojie; Ewen, Margaret; Zhang, Zinan; Liu, Guoqin

2017-08-24

Poor access to affordable insulin results in serious and needless complications and premature deaths for those with diabetes who need this essential medicine. To help address this issue, we assessed insulin availability, prices, affordability and price components in Hubei Province as China has the heaviest burden of diabetes globally. In 2016, insulin availability and price data was collected in the capital and five other cities. A total of 30 public sector outlets (hospitals and primary care institutions) and 30 private pharmacies were sampled, using an adaptation of the World Health Organization/Health Action International methodology, Data was collected for all human and analogue insulins in stock, then analyzed by type (prandial, basal or pre-mixed) and duration of action. Prices were expressed as Median Price Ratios (MPRs) to Australian PBS prices. Price components were tracked for five insulin products in two cities.. Affordability was assessed as the number of days' wages of the lowest paid unskilled government worker needed to purchase 10 ml 100 IU/ml (approximately 30 days' supply). Mean availability was highest in public hospitals for prandial (70%), basal (80%) and pre-mixed insulin (90%). In primary care institutions and private pharmacies mean availability ranged from 10% to 33%. Median prices of all insulin types were higher that Australian PBS prices in all three sectors for human and analogue insulins (ranging from1.36-2.59 times). Patients have to pay 4 to 16 days' wages to purchase a month's treatment depending on the insulin type and sector. The largest component of the patient price was the manufacturers' selling price (60%). Taxes in the form of import duties and VAT are applied in some sectors. The availability of insulin in primary care institutions and private retail pharmacies was very low in Hubei. Only public hospitals had good insulin availability. Insulin prices were high in all sectors making this life-saving medicine unaffordable, especially for those on low incomes. Governments should consider using its bargaining power to reduce prices, abolish taxes on essential medicines such as insulin, and develop strategies for more equitable access to insulin.

Analysis of genetic diversity of Persea bombycina "Som" using RAPD-based molecular markers.

PubMed

Bhau, Brijmohan Singh; Medhi, Kalyani; Das, Ambrish P; Saikia, Siddhartha P; Neog, Kartik; Choudhury, S N

2009-08-01

The utility of RAPD markers in assessing genetic diversity and phenetic relationships in Persea bombycina, a major tree species for golden silk (muga) production, was investigated using 48 genotypes from northeast India. Thirteen RAPD primer combinations generated 93 bands. On average, seven RAPD fragments were amplified per reaction. In a UPGMA phenetic dendrogram based on Jaccard's coefficient, the P. bombycina accessions showed a high level of genetic variation, as indicated by genetic similarity. The grouping in the phenogram was highly consistent, as indicated by high values of cophenetic correlation and high bootstrap values at the key nodes. The accessions were scattered on a plot derived from principal correspondence analysis. The study concluded that the high level of genetic diversity in the P. bombycina accessions may be attributed to the species' outcrossing nature. This study may be useful in identifying diverse genetic stocks of P. bombycina, which may then be conserved on a priority basis.

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective

PubMed Central

Wainberg, Milton L.; Scorza, Pamela; Shultz, James M.; Helpman, Liat; Mootz, Jennifer J.; Johnson, Karen A.; Neria, Yuval; Bradford, Jean-Marie E.; Oquendo, Maria A.; Arbuckle, Melissa R.

2017-01-01

Purpose of Review Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. Recent Findings Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Summary Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions. PMID:28425023

What should dental services for people with disabilities be like? Results of an Irish Delphi panel survey.

PubMed

Mac Giolla Phadraig, Caoimhin; Nunn, June; Dougall, Alison; O'Neill, Eunan; McLoughlin, Jacinta; Guerin, Suzanne

2014-01-01

This study aimed to generate prioritised goals for oral health services for people with disabilities as a first step in meeting the need for evidence based oral health services for people with disabilities in Ireland. The study used a three round modified e-Delphi method, involving dental service professionals and people with disabilities or their representatives, in Ireland. Three rounds were completed online using SurveyMonkey. Round 1 asked: "List what you think dental services for people with disabilities in Ireland should be like." Items for subsequent rounds were generated from responses to Round 1. Round 2 and Round 3 used 5 point Likert scales to rank these items by priority: from No Priority (1) to Top Priority (5). Consensus was achieved on each item where at least 80% of respondents considered an item either High or Top Priority. A consensus meeting concluded the process. Sixty-one panelists started and 48 completed the survey. The Delphi panel agreed on level of priority for 69 items and generated 16 consensus statements. These statements covered a range of topics such as access to care, availability of information and training, quality of care, dental treatment and cost. A recurrent theme relating to the appropriateness of care to individual need arose across topics suggesting a need to match service delivery according to the individual's needs, wants and expectations rather than the disability type/diagnosis based service which predominates today. This process produced a list of prioritised goals for dental services for people with disabilities. This creates a foundation for building evidence-based service models for people with disabilities in Ireland.

Pricing and reimbursement experiences and insights in the European Union and the United States: Lessons learned to approach adaptive payer pathways.

PubMed

Faulkner, S D; Lee, M; Qin, D; Morrell, L; Xoxi, E; Sammarco, A; Cammarata, S; Russo, P; Pani, L; Barker, R

2016-12-01

Earlier patient access to beneficial therapeutics that addresses unmet need is one of the main requirements of innovation in global healthcare systems already burdened by unsustainable budgets. "Adaptive pathways" encompass earlier cross-stakeholder engagement, regulatory tools, and iterative evidence generation through the life cycle of the medicinal product. A key enabler of earlier patient access is through more flexible and adaptive payer approaches to pricing and reimbursement that reflect the emerging evidence generated. © 2016 American Society for Clinical Pharmacology and Therapeutics.

Burden of Disease Study and Priority Setting in Korea: an Ethical Perspective

PubMed Central

2016-01-01

When thinking about priority setting in access to healthcare resources, decision-making requires that cost-effectiveness is balanced against medical ethics. The burden of disease has emerged as an important approach to the assessment of health needs for political decision-making. However, the disability adjusted life years approach hides conceptual and methodological issues regarding the claims and value of disabled people. In this article, we discuss ethical issues that are raised as a consequence of the introduction of evidence-based health policy, such as economic evidence, in establishing resource allocation priorities. In terms of ethical values in health priority setting in Korea, there is no reliable rationale for the judgment used in decision-making as well as for setting separate and distinct priorities for different government bodies. An important question, therefore, is which ethical values guiding the practice of decision-making should be reconciled with the economic evidence found in Korean healthcare. The health technology assessment core model from the European network for Health Technology Assessment (EUnetHTA) project is a good example of incorporating ethical values into decision-making. We suggest that a fair distribution of scarce healthcare resources in South Korea can be achieved by considering the ethical aspects of healthcare. PMID:27775247

Social values and health priority setting in Australia: an analysis applied to the context of health technology assessment.

PubMed

Whitty, Jennifer A; Littlejohns, Peter

2015-02-01

To describe the role of social values in priority setting related to health technology assessment processes and decision-making in Australia. The processes and decision criteria of the Pharmaceutical and Medical Benefits Advisory Committees are described based on literature and policy sources, and analysed using a framework for identifying social values in priority-setting. Transparency and accountability of processes are apparent. Participation balances inclusiveness and effectiveness of decision-making, but presents an opportunity to enhance priority setting processes. Clinical and cost-effectiveness are important content considerations. Social values related to justice/equity are considered, without quantification of criteria weights for equity relative to other factors. HTA processes support solidarity through subsidising approved technologies for all Australians, whilst retaining autonomy by permitting non-subsidised technologies to be accessed privately, leading to possible tension between the values of solidarity, autonomy and equity. Priority setting related to health technology subsidy incorporates a range of inter-related social values in the processes and content of decision-making. Participation in decision-making could arguably be improved if a patient and public engagement policy were to be formulated alongside more widespread changes across processes to assess social values using approaches such as the Citizens' Jury. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

77 FR 47681 - Self-Regulatory Organizations; BOX Options Exchange LLC; Notice of Filing of Proposed Rule Change...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-09

... against the customer order designated for the PIP (``PIP Order'') in price/time priority. The result of... PIP Broadcast: \\3\\ Capitalized terms not otherwise defined herein shall have the meaning as defined in the Exchange Rules. Public Customer to buy 30 contracts at $2.00; Market Maker A to buy 40 contracts...

Competing priorities that rival health in adults on probation in Rhode Island: substance use recovery, employment, housing, and food intake.

PubMed

Dong, Kimberly R; Must, Aviva; Tang, Alice M; Beckwith, Curt G; Stopka, Thomas J

2018-02-27

Individuals on probation experience economic disadvantage because their criminal records often prohibit gainful employment, which compromises their ability to access the basic components of wellbeing. Unemployment and underemployment have been studied as distinct phenomenon but no research has examined multiple determinants of health in aggregate or explored how these individuals prioritize each of these factors. This study identified and ranked competing priorities in adults on probation and qualitatively explored how these priorities impact health. We conducted in-depth interviews in 2016 with 22 adults on probation in Rhode Island to determine priority rankings of basic needs. We used Maslow's hierarchy of needs theory and the literature to guide the priorities we pre-selected for probationers to rank. Within a thematic analysis framework, we used a modified ranking approach to identify the priorities chosen by participants and explored themes related to the top four ranked priorities. We found that probationers ranked substance use recovery, employment, housing, and food intake as the top four priorities. Probationers in recovery reported sobriety as the most important issue, a necessary basis to be able to address other aspects of life. Participants also articulated the interrelatedness of difficulties in securing employment, food, and housing; these represent stressors for themselves and their families, which negatively impact health. Participants ranked healthcare last and many reported underinsurance as an issue to accessing care. Adults on probation are often faced with limited economic potential and support systems that consistently place them in high-risk environments with increased risk for recidivism. These findings emphasize the need for policies that address the barriers to securing gainful employment and safe housing. Interventions that reflect probationer priorities are necessary to begin to mitigate the health disparities in this population.

The devil is in the details: An investigation of the relationships between conflict, food price and climate across Africa.

PubMed

Raleigh, Clionadh; Choi, Hyun Jin; Kniveton, Dominic

2015-05-01

This study investigates the relationship between violent conflict, food price, and climate variability at the subnational level. Using disaggregated data on 113 African markets from January 1997 to April 2010, interrelationships between the three variables are analyzed in simultaneous equation models. We find that: (i) a positive feedback exists between food price and violence - higher food prices increase conflict rates within markets and conflict increases food prices; (ii) anomalously dry conditions are associated with increased frequencies of conflict; and (iii) decreased rainfall exerts an indirect effect on conflict through its impact on food prices. These findings suggest that the negative effects of climate variability on conflict can be mitigated by interventions and effective price management in local markets. Creating environments in which food prices are stable and reliable, and markets are accessible and safe, can lower the impacts of both climate change and conflict feedbacks.

New Evidence on the Price Effects of Cigarette Tax Competition.

PubMed

Carpenter, Christopher S; Mathes, Michael T

2016-05-01

Multiple studies have shown that cigarette taxes are more than fully passed through to cigarette prices and that access to a nearby state with a lower cigarette tax also reduces local cigarette prices. We study two other sources of tax competition: nearby Native American reservations and online sales. Using quarterly data on local cigarette prices from 1976-2003, we show that the opening of a Native American casino within 25 miles of a city center is associated with a $0.016-$0.027 lower per-pack price, while a 50 percentage point increase in internet penetration is associated with a $0.22-$0.25 per-pack price reduction. These effects are not observed for other local prices for which there is no potential tax savings. Our results further our understanding of how tax competition affects local cigarette prices and provide context to studies linking Native American reservations and internet penetration to cigarette smuggling.

New Evidence on the Price Effects of Cigarette Tax Competition

PubMed Central

Carpenter, Christopher S.; Mathes, Michael T.

2016-01-01

Multiple studies have shown that cigarette taxes are more than fully passed through to cigarette prices and that access to a nearby state with a lower cigarette tax also reduces local cigarette prices. We study two other sources of tax competition: nearby Native American reservations and online sales. Using quarterly data on local cigarette prices from 1976–2003, we show that the opening of a Native American casino within 25 miles of a city center is associated with a $0.016-$0.027 lower per-pack price, while a 50 percentage point increase in internet penetration is associated with a $0.22-$0.25 per-pack price reduction. These effects are not observed for other local prices for which there is no potential tax savings. Our results further our understanding of how tax competition affects local cigarette prices and provide context to studies linking Native American reservations and internet penetration to cigarette smuggling. PMID:27840571

Performance Optimization of Priority Assisted CSMA/CA Mechanism of 802.15.6 under Saturation Regime

PubMed Central

Shakir, Mustafa; Rehman, Obaid Ur; Rahim, Mudassir; Alrajeh, Nabil; Khan, Zahoor Ali; Khan, Mahmood Ashraf; Niaz, Iftikhar Azim; Javaid, Nadeem

2016-01-01

Due to the recent development in the field of Wireless Sensor Networks (WSNs), the Wireless Body Area Networks (WBANs) have become a major area of interest for the developers and researchers. Human body exhibits postural mobility due to which distance variation occurs and the status of connections amongst sensors change time to time. One of the major requirements of WBAN is to prolong the network lifetime without compromising on other performance measures, i.e., delay, throughput and bandwidth efficiency. Node prioritization is one of the possible solutions to obtain optimum performance in WBAN. IEEE 802.15.6 CSMA/CA standard splits the nodes with different user priorities based on Contention Window (CW) size. Smaller CW size is assigned to higher priority nodes. This standard helps to reduce delay, however, it is not energy efficient. In this paper, we propose a hybrid node prioritization scheme based on IEEE 802.15.6 CSMA/CA to reduce energy consumption and maximize network lifetime. In this scheme, optimum performance is achieved by node prioritization based on CW size as well as power in respective user priority. Our proposed scheme reduces the average back off time for channel access due to CW based prioritization. Additionally, power based prioritization for a respective user priority helps to minimize required number of retransmissions. Furthermore, we also compare our scheme with IEEE 802.15.6 CSMA/CA standard (CW assisted node prioritization) and power assisted node prioritization under postural mobility in WBAN. Mathematical expressions are derived to determine the accurate analytical model for throughput, delay, bandwidth efficiency, energy consumption and life time for each node prioritization scheme. With the intention of analytical model validation, we have performed the simulations in OMNET++/MIXIM framework. Analytical and simulation results show that our proposed hybrid node prioritization scheme outperforms other node prioritization schemes in terms of average network delay, average throughput, average bandwidth efficiency and network lifetime. PMID:27598167

Open access and beyond

PubMed Central

Mathur, Shawn; Schmidt, Christian; Das, Chhaya; Tucker, Philip W

2006-01-01

Uncensored exchange of scientific results hastens progress. Open Access does not stop at the removal of price and permission barriers; still, censorship and reading disabilities, to name a few, hamper access to information. Here, we invite the scientific community and the public to discuss new methods to distribute, store and manage literature in order to achieve unfettered access to literature. PMID:16956402

Open Access and beyond.

PubMed

Mathur, Shawn; Schmidt, Christian; Das, Chhaya; Tucker, Philip W

2006-09-06

Uncensored exchange of scientific results hastens progress. Open Access does not stop at the removal of price and permission barriers; still, censorship and reading disabilities, to name a few, hamper access to information. Here, we invite the scientific community and the public to discuss new methods to distribute, store and manage literature in order to achieve unfettered access to literature.

A comparative analysis of two contrasting European approaches for rewarding the value added by drugs for cancer: England versus France.

PubMed

Drummond, Michael; de Pouvourville, Gerard; Jones, Elizabeth; Haig, Jennifer; Saba, Grece; Cawston, Hélène

2014-05-01

Within Europe, contrasting approaches have emerged for rewarding the value added by new drugs. In Ireland, The Netherlands, Sweden and the UK, the price of, and access to, a new drug has to be justified by the health gain it delivers compared with current therapy, typically expressed in quality-adjusted life-years (QALYs) gained. By contrast, in France and Germany, the assessment of added benefit is expressed on an ordinal scale, based on an assessment of the clinical outcomes as compared with existing care. This assessment then influences price negotiations. The objective of this paper is to assess the pros and cons of each approach, both in terms of the assessments they produce and the efficiency and practical feasibility of the process. We reviewed the technology appraisals performed by the National Institute for Health and Care Excellence (NICE) relating to 49 anticancer drug decisions in the UK from September 2003 to January 2012. Estimates of the QALYs gained and incremental cost per QALY gained were then compared with the assessments of the Amélioration du Service Médical Rendu (ASMR) made by the Haute Autorité de Santé (HAS) in France for the same drugs in the same clinical indications. We also undertook a qualitative assessment of the two approaches, considering the resources required, timeliness, transparency, stakeholder engagement, and political acceptability. In the UK, the estimates of QALYs gained ranged from 0.003 to 1.46 and estimates of incremental cost per QALY from £3,320 to £458,000. The estimate of cost per QALY gained was a good predictor of the level of restriction imposed on the use of the drug concerned. Patient access schemes, which normally imply price reductions, were proposed in 45 % of cases. In France, the distribution of ASMRs was I, 12 %; II, 18 %; III, 24 %; IV, 18 %; V, 22 %; and uncategorized/non-reimbursed, 4 %. Since ASMRs of IV and above signify minor or no improvement over existing therapy, these ratings imply that, in around 40 % of cases, the drugs concerned would face price controls. Overall, the assessments of value added in the two jurisdictions were very similar. A superior ASMR rating was associated with higher QALYs gained. However, a superior ASMR was not associated with a lower incremental cost per QALY. There are substantial differences in respect of the other attributes considered, but these mainly reflect the result of institutional choices in the jurisdictions concerned and it is not possible to conclude that one approach is universally superior to the other. The two approaches produce very similar assessments of added value, but have different attributes in terms of cost, timeliness, transparency and political acceptability. How these considerations impact market access and prices is difficult to assess, because of the lack of transparency concerning prices in both countries and the fact that market access also depends on a broader range of factors. There is some evidence of convergence in the approaches, with the movement in France towards producing cost-effectiveness estimates and the movement in the UK towards negotiated prices.

Environmental Assessment for the Construction and Operation of a Battalion Headquarters for the U.S. Army Priority Air Transport at Joint Base Andrews-Naval Air Facility Washington, Prince George’s County, Maryland

DTIC Science & Technology

2012-12-01

counts for gate accessible off-base roadways..........................3-10 Table 3-9 Labor force and unemployment ...association with steep stream banks . JBA sits on a plateau between the Anacostia River and the Patuxent River. Surface elevations at JBA range from...storm sewer lines cause isolated ponding during low-intensity rainfalls (URS 2012). The base operates under two general NPDES permits: (1) Multi- Sector

Searching for Best Direction in Healthcare: Distilling Opportunities, Priorities and Responsibilities.

PubMed

Montague, Terrence; Gogovor, Amédé; Marshall, Lucas; Cochrane, Bonnie; Ahmed, Sara; Torr, Emily; Aylen, John; Nemis-White, Joanna

2016-01-01

Canada's health and its care are evolving. Evidence from serial Health Care in Canada surveys of the public and health professionals over the last two decades reveal a persistent sense of care quality, despite an aging population, decreasing levels of good and excellent health, increasing prevalence of chronic illnesses; and sub-optimal access to timely and patient-centred care. Stakeholders are, however, somewhat pessimistic and many sense complete rebuilding, or major changes, may be necessary. To improve access, the primary health concern of all Canadians - increasing medical and nursing school enrolment, and requiring professionals to work in teams - have attracted increasingly high support from both the public and professionals. However, physicians' support lags behind that of nursing, pharmacy and administrative colleagues; and, currently, only a minority of patients and professionals are actively involved in team care programs. Another example in which high levels of support may not necessarily translate into priority implementation of promising interventions is the realm of patient-centred care. The public and all professionals report a very high level of general support for care provided in a caring and respectful manner. However, while the public rank it second in implementation priority, following timely access, the majority of professionals rank it only fourth. By contrast, there is remarkable pan-stakeholder concordance around interventions to improve the overall health system, with the majority of public and professional stakeholders rating the creation of national supply systems as their top priority to expedite the clinical and cost efficiency of new treatments. There is a similar pan-stakeholder concordance around priority of responsibility to drive innovations, the top three being: federal/provincial governments; research hospitals/regional health authorities; and the pharmaceutical industry. In summary, Canadians are at a healthcare crossroads. Population health is decreasing, chronic diseases are increasing and desire for timely access to patient-centred, team-delivered and technology-supported care remain top concerns. Despite some disconnects between theoretical support for, and priority to implement, promising innovations, there is universal support to optimize resources to make things better. And there is concordance around the leadership best suited to lead innovation. Things can be better.

Understanding How to Support Family Caregivers of Seniors with Complex Needs

PubMed Central

Charles, Lesley; Brémault-Phillips, Suzette; Parmar, Jasneet; Johnson, Melissa; Sacrey, Lori-Ann

2017-01-01

Purpose of the Study The purpose of this study was to describe the experiences and challenges of supporting family caregivers of seniors with complex needs and to outline support strategies and research priorities aimed at supporting them. Design and Methods A CIHR-funded, two-day conference entitled “Supporting Family Caregivers of Seniors: Improving Care and Caregiver Outcomes” was held. An integrated knowledge translation approach guided this planning conference. Day 1 included presentations of research evidence, followed by participant engagement Qualitative data was collected regarding facilitators, barriers/gaps, and recommendations for the provision of caregiver supports. Day 2 focused on determination of research priorities. Results Identified facilitators to the provision of caregiver support included accessibility of health-care and community-based resources, availability of well-intended health-care providers, and recognition of caregivers by the system. Barriers/gaps related to challenges with communication, access to information, knowledge of what is needed, system navigation, access to financial resources, and current policies. Recommendations regarding caregiver services and research revolved around assisting caregivers to self-identify and seek support, formalizing caregiver supports, centralizing resources, making system navigation available, and preparing the next generation for caregiving. Implication A better understanding of the needs of family caregivers and ways to support them is critical to seniors’ health services redesign. PMID:28690707

Village poultry consumption and marketing in relation to gender, religious festivals and market access.

PubMed

Aklilu, H A; Almekinders, C J M; Udo, H M J; Van der Zijpp, A J

2007-04-01

This study aimed to examine village poultry consumption and marketing in Ethiopia in relation to gender, socio-cultural events and market access. The main objects of the research were producers, poultry markets, producer-sellers, and intermediary sellers in three locations representing different levels of market access in Tigray. About 3000 farm records were collected over a period of 12 months from 131 producers to obtain quantitative data on sales and consumption. Ninety-three semi-structured interviews with 58 producer-sellers and 35 intermediaries and 12 group discussions with these market actors were conducted to explore organization, price dynamics and socio-cultural aspects of poultry marketing. In total, 928 producer-sellers and 225 intermediaries were monitored monthly to examine participation by gender in poultry marketing. Better market access was associated with a shorter market chain and higher prices for the producers. Female-headed households had smaller poultry sales and consumption per household but sale and consumption per family member were 25% and 66% higher, respectively, than in male-headed households. While women dominated in the producer-sellers group, intermediaries were mainly men. Religious festivals periodically shifted local demand and prices of poultry. To improve the benefit of poultry keeping, poverty-stricken households may profit from better market access through better market information, infrastructure, market group formation and careful planning to match the dynamics in demand.

Assessing the potential of economic instruments for managing drought risk at river basin scale

NASA Astrophysics Data System (ADS)

Pulido-Velazquez, M.; Lopez-Nicolas, A.; Macian-Sorribes, H.

2015-12-01

Economic instruments work as incentives to adapt individual decisions to collectively agreed goals. Different types of economic instruments have been applied to manage water resources, such as water-related taxes and charges (water pricing, environmental taxes, etc.), subsidies, markets or voluntary agreements. Hydroeconomic models (HEM) provide useful insight on optimal strategies for coping with droughts by simultaneously analysing engineering, hydrology and economics of water resources management. We use HEMs for evaluating the potential of economic instruments on managing drought risk at river basin scale, considering three criteria for assessing drought risk: reliability, resilience and vulnerability. HEMs allow to calculate water scarcity costs as the economic losses due to water deliveries below the target demands, which can be used as a vulnerability descriptor of drought risk. Two generic hydroeconomic DSS tools, SIMGAMS and OPTIGAMS ( both programmed in GAMS) have been developed to evaluate water scarcity cost at river basin scale based on simulation and optimization approaches. The simulation tool SIMGAMS allocates water according to the system priorities and operating rules, and evaluate the scarcity costs using economic demand functions. The optimization tool allocates water resources for maximizing net benefits (minimizing total water scarcity plus operating cost of water use). SIMGAS allows to simulate incentive water pricing policies based on water availability in the system (scarcity pricing), while OPTIGAMS is used to simulate the effect of ideal water markets by economic optimization. These tools have been applied to the Jucar river system (Spain), highly regulated and with high share of water use for crop irrigation (greater than 80%), where water scarcity, irregular hydrology and groundwater overdraft cause droughts to have significant economic, social and environmental consequences. An econometric model was first used to explain the variation of the production value of irrigated agriculture during droughts, assessing revenue responses to varying crop prices and water availability. Hydroeconomic approaches were then used to show the potential of economic instruments in setting incentives for a more efficient management of water resources systems.

47 CFR 69.123 - Density pricing zones for special access and switched transport.

Code of Federal Regulations, 2011 CFR

2011-10-01

... switched transport. 69.123 Section 69.123 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED... for special access and switched transport. (a)(1) Incumbent local exchange carriers not subject to... at least 15 percent of that carrier's special access and transport revenues within that study area...

Open-Access Electronic Textbooks: An Overview

ERIC Educational Resources Information Center

Ovadia, Steven

2011-01-01

Given the challenging economic climate in the United States, many academics are looking to open-access electronic textbooks as a way to provide students with traditional textbook content at a more financially advantageous price. Open access refers to "the free and widely available information throughout the World Wide Web. Once an article's…

47 CFR 54.807 - Interstate access universal service support.

Code of Federal Regulations, 2011 CFR

2011-10-01

... supported service within the study area of a price cap local exchange carrier shall receive Interstate Access Universal Service Support for each line that it serves within that study area. (b) In any study... Service Support Per Line by dividing Study Area Access Universal Service Support by twelve times all...

The Many Faces of the Economic Bulletin Board.

ERIC Educational Resources Information Center

Boettcher, Jennifer

1996-01-01

The Economic Bulletin Board (EBB), a one-stop site for economic statistics and government-sponsored business information, can be accessed on the World Wide Web, gopher, telnet, file transfer protocol, dial-up, and fax. Each access method has advantages and disadvantages related to connections, pricing, depth of access, retrieval, and system…

Increasing access by priority populations to Australian sexual health clinics.

PubMed

Ali, Hammad; Donovan, Basil; Fairley, Christopher K; Chen, Marcus Y; O'Connor, Catherine C; Grulich, Andrew E; McNulty, Anna; Ryder, Nathan; Hellard, Margaret E; Guy, Rebecca J

2013-10-01

Data from a network of 35 Australian sexual health clinics, in geographically diverse locations, showed that the number and proportion of patients from priority populations (ie, young people, men who have sex with men, indigenous people, and female sex workers) increased significantly between 2004 and 2011.

Influence of gender roles and rising food prices on poor, pregnant women’s eating and food provisioning practices in Dhaka, Bangladesh

PubMed Central

2013-01-01

Background Maternal malnutrition in Bangladesh is a persistent health issue and is the product of a number of complex factors, including adherence to food 'taboos’ and a patriarchal gender order that limits women’s mobility and decision-making. The recent global food price crisis is also negatively impacting poor pregnant women’s access to food. It is believed that those who are most acutely affected by rising food prices are the urban poor. While there is an abundance of useful quantitative research centered on maternal nutrition and food insecurity measurements in Bangladesh, missing is an understanding of how food insecurity is experienced by people who are most vulnerable, the urban ultra-poor. In particular, little is known of the lived experience of food insecurity among pregnant women in this context. This research investigated these lived experiences by exploring food provisioning strategies of urban, ultra-poor, pregnant women. This knowledge is important as discussions surrounding the creation of new development goals are currently underway. Methods Using a focused-ethnographic approach, household food provisioning experiences were explored. Data from participant observation, a focus group discussion and semi-structured interviews were collected in an urban slum in Dhaka, Bangladesh. Interviews were undertaken with 28 participants including 12 pregnant women and new mothers, two husbands, nine non-pregnant women, and five health care workers. Results The key findings are: 1) women were aware of the importance of good nutrition and demonstrated accurate, biomedically-based knowledge of healthy eating practices during pregnancy; 2) the normative gender rules that have traditionally constrained women’s access to nutritional resources are relaxing in the urban setting; however 3) women are challenged in accessing adequate quality and quantities of food due to the increase in food prices at the market. Conclusions Rising food prices and resultant food insecurity due to insufficient incomes are negating the recent efforts that have increased women’s knowledge of healthy eating during pregnancy and their gendered empowerment. In order to maintain the gains in nutritional knowledge and women’s increased mobility and decision-making capacity; policy must also consider the global political economy of food in the creation of the new development goals. PMID:24069937

A review of the health and economic implications of patent protection, with a specific focus on Thailand

PubMed Central

2012-01-01

Background Although it has been two decades since the Thai Patent Act was amended to comply with the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), there has been little emphasis given to assessing the implications of this amendment. The purpose of this review is to summarize the health and economic impact of patent protection, with a focus on the experience of Thailand. Methods A review of national and international empirical evidence on the health and economic implications of patents from 1980 to 2009 was undertaken. Results The findings illustrate the role of patent protection in four areas: price, present access, future access, and international trade and investment. Forty-three empirical studies were found, three of which were from Thai databases. Patenting does increase price, although the size of effect differs according to the methodology and country. Although weakening patent rights could increase present access, evidence suggests that strengthening patenting may benefit future access; although this is based on complex assumptions and estimations. Moreover, while patent protection appears to have a positive impact on trade flow, the implication for foreign direct investment (FDI) is equivocal. Conclusions Empirical studies in Thailand, and other similar countries, are rare, compromising the robustness and generalizability of conclusions. However, evidence does suggest that patenting presents a significant inter-temporal challenge in balancing aspects of current versus future access to technologies. This underlines the urgent need to prioritize health research resources to assess the wider implications of patent protection. PMID:22849392

Optimized oral cholera vaccine distribution strategies to minimize disease incidence: A mixed integer programming model and analysis of a Bangladesh scenario.

PubMed

Smalley, Hannah K; Keskinocak, Pinar; Swann, Julie; Hinman, Alan

2015-11-17

In addition to improved sanitation, hygiene, and better access to safe water, oral cholera vaccines can help to control the spread of cholera in the short term. However, there is currently no systematic method for determining the best allocation of oral cholera vaccines to minimize disease incidence in a population where the disease is endemic and resources are limited. We present a mathematical model for optimally allocating vaccines in a region under varying levels of demographic and incidence data availability. The model addresses the questions of where, when, and how many doses of vaccines to send. Considering vaccine efficacies (which may vary based on age and the number of years since vaccination), we analyze distribution strategies which allocate vaccines over multiple years. Results indicate that, given appropriate surveillance data, targeting age groups and regions with the highest disease incidence should be the first priority, followed by other groups primarily in order of disease incidence, as this approach is the most life-saving and cost-effective. A lack of detailed incidence data results in distribution strategies which are not cost-effective and can lead to thousands more deaths from the disease. The mathematical model allows for what-if analysis for various vaccine distribution strategies by providing the ability to easily vary parameters such as numbers and sizes of regions and age groups, risk levels, vaccine price, vaccine efficacy, production capacity and budget. Copyright © 2015 Elsevier Ltd. All rights reserved.

Politics, power and poverty: health for all in 2000 in the Third World?

PubMed

Green, R H

1991-01-01

Health for All by 2000 could become a reality in the Third World countries. On present resource allocation, medical professional and political patterns and trends that is unlikely to happen in more than a few countries. For it to happen requires basic priority shifts to universal access primary health care (including preventative). The main obstacles to such a shift are not absolute resource constraints but medical professional conservatism together with its interaction with elite interests and with political priorities based partly on perceived demand and partly on (largely medical) professional advice. These obstacles are surmountable-as illustrated by divergent performances among countries--but only if education, promotion, efficiency in terms of lives saved and healthy years gained, community participation and political activism for Health for All are more carefully analytically based and pursued more seriously and widely than they have been to date.

Family Wellness, Not HIV Prevention

PubMed Central

Swendeman, Dallas; Flannery, Diane

2010-01-01

HIV exceptionalism (and disease-specific programs generally) garner both unbalanced funding and the most talented personnel, distorting local health priorities. In support of HIV exceptionalism, the successful mobilization of significant global health sector resources was not possible prior to HIV. Both sides of the debate have merits; rather than perpetuating polarization, we suggest that sustained improvements in global health require creating a prevention infrastructure to meet multiple health challenges experienced by local communities. We propose four fundamental shifts in HIV and disease prevention: (1) horizontally integrating prevention at one site locally, with priorities tailored to local health challenges and managed by local community leaders; (2) using a family wellness metaphor for services, not disease prevention; (3) implementing evidence-based prevention programs (EBPP) based on common principles, factors, and processes, rather than replication of specific programs; and (4) utilizing the expertise of private enterprise to re-design EBPP into highly attractive, engaging, and accessible experiences. PMID:19148744

Global land cover mapping and characterization: present situation and future research priorities

USGS Publications Warehouse

Giri, Chandra

2005-01-01

The availability and accessibility of global land cover data sets plays an important role in many global change studies. The importance of such science‐based information is also reflected in a number of international, regional, and national projects and programs. Recent developments in earth observing satellite technology, information technology, computer hardware and software, and infrastructure development have helped developed better quality land cover data sets. As a result, such data sets are increasingly becoming available, the user‐base is ever widening, application areas have been expanding, and the potential of many other applications are enormous. Yet, we are far from producing high quality global land cover data sets. This paper examines the progress in the development of digital global land cover data, their availability, and current applications. Problems and opportunities are also explained. The overview sets the stage for identifying future research priorities needed for operational land cover assessment and monitoring.

Will Online Learning Lower the Price of College?

ERIC Educational Resources Information Center

Casement, William

2013-01-01

Online learning is revolutionizing the way colleges do business. Study via the Internet makes more knowledge more easily obtainable for more students than ever before. Along with expanded access to higher education, many people are optimistic about an accompanying benefit--a lower price tag. Basic economic factors make the prospect appear…

Quick Access: Find Statistical Data on the Internet.

ERIC Educational Resources Information Center

Su, Di

1999-01-01

Provides an annotated list of Internet sources (World Wide Web, ftp, and gopher sites) for current and historical statistical business data, including selected interest rates, the Consumer Price Index, the Producer Price Index, foreign currency exchange rates, noon buying rates, per diem rates, the special drawing right, stock quotes, and mutual…

Experiments and hands-on activities for geoscience observing and measuring by using low-priced instruments

NASA Astrophysics Data System (ADS)

Yang, S. S.; Lin, Y. Y.; Tang-Iunn, S. S.

2016-12-01

In this presentation, we will introduce five experiments and hands-on activities for geoscience observing and measuring by using low-priced and small-sized commercial instruments. The Black Box for Environmental Measuring (BBEM) system is based on Arduino platform, low-power consumption sensors are employed to measure meteorological and environmental parameters. Commercial GPS receiver is used to observe the influence of geomagnetic storms on GPS system. Webcam is an accessible instrument which is suitable for detecting and recording sprites, thunders, and the development of cumulonimbus. Real-time flight trackers and websites are employed to determine the altitude of cloud base. A simple VLF receiver is built by using the audio interface on computer, and the observed signals showed the variations of the D-region of the ionosphere. All these experiments and activities are practical and have been applied in classroom and science outreach in Taiwan.

[Trust-based economics with medicine outcome-based pricing].

PubMed

Lhoste, F

2013-09-01

In recent decades, the pharmaceutical industry as built a high level of confidence thanks to innovative medicines that improve both duration and quality of life. Some recent scandals have however discredited this industry, now suspected of cheating or bribery. Even the scientific progresses are challenged on the ground of possible conflicts of interests and value uncertainty. This situation is deleterious. Simultaneously the economic crisis exacerbates the payers' expectations in terms of clinical value and value/price ratio. It also stimulates the demand for outcomes in real life. This induces a new economic approach for the market access of highly expensive reimbursable drugs. It consists in paying only for drugs actually proven effective in terms of actual outcomes, with a full or partial refund of the payer in case of failure, according to accurate and simple criteria in so called "performance agreement". Confidence is restored accordingly. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

A framework supporting the development of a Grid portal for analysis based on ROI.

PubMed

Ichikawa, K; Date, S; Kaishima, T; Shimojo, S

2005-01-01

In our research on brain function analysis, users require two different simultaneous types of processing: interactive processing to a specific part of data and high-performance batch processing to an entire dataset. The difference between these two types of processing is in whether or not the analysis is for data in the region of interest (ROI). In this study, we propose a Grid portal that has a mechanism to freely assign computing resources to the users on a Grid environment according to the users' two different types of processing requirements. We constructed a Grid portal which integrates interactive processing and batch processing by the following two mechanisms. First, a job steering mechanism controls job execution based on user-tagged priority among organizations with heterogeneous computing resources. Interactive jobs are processed in preference to batch jobs by this mechanism. Second, a priority-based result delivery mechanism that administrates a rank of data significance. The portal ensures a turn-around time of interactive processing by the priority-based job controlling mechanism, and provides the users with quality of services (QoS) for interactive processing. The users can access the analysis results of interactive jobs in preference to the analysis results of batch jobs. The Grid portal has also achieved high-performance computation of MEG analysis with batch processing on the Grid environment. The priority-based job controlling mechanism has been realized to freely assign computing resources to the users' requirements. Furthermore the achievement of high-performance computation contributes greatly to the overall progress of brain science. The portal has thus made it possible for the users to flexibly include the large computational power in what they want to analyze.

Engineering Social Justice into Traffic Control for Self-Driving Vehicles?

PubMed

Mladenovic, Milos N; McPherson, Tristram

2016-08-01

The convergence of computing, sensing, and communication technology will soon permit large-scale deployment of self-driving vehicles. This will in turn permit a radical transformation of traffic control technology. This paper makes a case for the importance of addressing questions of social justice in this transformation, and sketches a preliminary framework for doing so. We explain how new forms of traffic control technology have potential implications for several dimensions of social justice, including safety, sustainability, privacy, efficiency, and equal access. Our central focus is on efficiency and equal access as desiderata for traffic control design. We explain the limitations of conventional traffic control in meeting these desiderata, and sketch a preliminary vision for a next-generation traffic control tailored to address better the demands of social justice. One component of this vision is cooperative, hierarchically distributed self-organization among vehicles. Another component of this vision is a priority system enabling selection of priority levels by the user for each vehicle trip in the network, based on the supporting structure of non-monetary credits.

Routinely collected data as a strategic resource for research: priorities for methods and workforce.

PubMed

Jorm, Louisa

2015-09-30

In the era of 'big data', research using routinely collected data offers greater potential than ever before to drive health system effectiveness and efficiency, and population health improvement. In Australia, the policy environment, and emerging frameworks and processes for data governance and access, increasingly support the use of routinely collected data for research. Capitalising on this strategic resource requires investment in both research methods and research workforce. Priorities for methods development include validation studies, techniques for analysing complex longitudinal data, exploration of bias introduced through linkage error, and a robust toolkit to evaluate policies and programs using 'natural experiments'. Priorities for workforce development include broadening the skills base of the existing research workforce, and the formation of new, larger, interdisciplinary research teams to incorporate capabilities in computer science, partnership research, research translation and the 'business' aspects of research. Large-scale, long-term partnership approaches involving government, industry and researchers offer the most promising way to maximise returns on investment in research using routinely collected data.

Mapping for the masses: using free remote sensing data for disaster management

NASA Astrophysics Data System (ADS)

Teeuw, R.; McWilliam, N.; Morris, N.; Saunders, C.

2009-04-01

We examine the uses of free satellite imagery and Digital Elevation Models (DEMs) for disaster management, targeting three data sources: the United Nations Charter on Space and Disasters, Google Earth and internet-based satellite data archives, such as the Global Land Cover Facility (GLCF). The research has assessed SRTM and ASTER DEM data, Landsat TM/ETM+ and ASTER imagery, as well as utilising datasets and basic GIS operations available via Google Earth. As an aid to Disaster Risk Reduction, four sets of maps can be produced from satellite data: (i) Multiple Geohazards: areas prone to slope instability, coastal inundation and fluvial flooding; (ii) Vulnerability: population density, habitation types, land cover types and infrastructure; (iii) Disaster Risk: produced by combining severity scores from (i) and (ii); (iv) Reconstruction: zones of rock/sediment with construction uses; areas of woodland (for fuel/construction) water sources; transport routes; zones suitable for re-settlement. This set of Disaster Risk Reduction maps are ideal for regional (1:50,000 to 1:250,000 scale) planning for in low-income countries: more detailed assessments require relatively expensive high resolution satellite imagery or aerial photography, although Google Earth has a good track record for posting high-res imagery of disaster zones (e.g. the 2008 Burma storm surge). The Disaster Risk maps highlight areas of maximum risk to a region's emergency planners and decision makers, enabling various types of public education and other disaster mitigation measures. The Reconstruction map also helps to save lives, by facilitating disaster recovery. Many problems have been identified. Access to the UN Charter imagery is fine after a disaster, but very difficult if assessing pre-disaster indicators: the data supplied also tends to be pre-processed, when some relief agencies would prefer to have raw data. The limited and expensive internet access in many developing countries limits access to archives of free satellite data, such as the GLCF. Finally, data integration, spatial/temporal analysis and map production are all hindered by the high price of most GIS software, making the development of suitable open-source software a priority.

Real estate market and building energy performance: Data for a mass appraisal approach

PubMed Central

Bonifaci, Pietro; Copiello, Sergio

2015-01-01

Mass appraisal is widely considered an advanced frontier in the real estate valuation field. Performing mass appraisal entails the need to get access to base information conveyed by a large amount of transactions, such as prices and property features. Due to the lack of transparency of many Italian real estate market segments, our survey has been addressed to gather data from residential property advertisements. The dataset specifically focuses on property offer prices and dwelling energy efficiency. The latter refers to the label expressed and exhibited by the energy performance certificate. Moreover, data are georeferenced with the highest possible accuracy: at the neighborhood level for a 76.8% of cases, at street or building number level for the remaining 23.2%. Data are related to the analysis performed in Bonifaci and Copiello [1], about the relationship between house prices and building energy performance, that is to say, the willingness to pay in order to benefit from more efficient dwellings. PMID:26793751

Real estate market and building energy performance: Data for a mass appraisal approach.

PubMed

Bonifaci, Pietro; Copiello, Sergio

2015-12-01

Mass appraisal is widely considered an advanced frontier in the real estate valuation field. Performing mass appraisal entails the need to get access to base information conveyed by a large amount of transactions, such as prices and property features. Due to the lack of transparency of many Italian real estate market segments, our survey has been addressed to gather data from residential property advertisements. The dataset specifically focuses on property offer prices and dwelling energy efficiency. The latter refers to the label expressed and exhibited by the energy performance certificate. Moreover, data are georeferenced with the highest possible accuracy: at the neighborhood level for a 76.8% of cases, at street or building number level for the remaining 23.2%. Data are related to the analysis performed in Bonifaci and Copiello [1], about the relationship between house prices and building energy performance, that is to say, the willingness to pay in order to benefit from more efficient dwellings.

Analysis of Consumers' Preferences and Price Sensitivity to Native Chickens.

PubMed

Lee, Min-A; Jung, Yoojin; Jo, Cheorun; Park, Ji-Young; Nam, Ki-Chang

2017-01-01

This study analyzed consumers' preferences and price sensitivity to native chickens. A survey was conducted from Jan 6 to 17, 2014, and data were collected from consumers (n=500) living in Korea. Statistical analyses evaluated the consumption patterns of native chickens, preference marketing for native chicken breeds which will be newly developed, and price sensitivity measurement (PSM). Of the subjects who preferred broilers, 24.3% do not purchase native chickens because of the dryness and tough texture, while those who preferred native chickens liked their chewy texture (38.2%). Of the total subjects, 38.2% preferred fried native chickens (38.2%) for processed food, 38.4% preferred direct sales for native chicken distribution, 51.0% preferred native chickens to be slaughtered in specialty stores, and 32.4% wanted easy access to native chickens. Additionally, the price stress range (PSR) was 50 won and the point of marginal cheapness (PMC) and point of marginal expensiveness (PME) were 6,980 won and 12,300 won, respectively. Evaluation of the segmentation market revealed that consumers who prefer broiler to native chicken breeds were more sensitive to the chicken price. To accelerate the consumption of newly developed native chicken meat, it is necessary to develop a texture that each consumer needs, to increase the accessibility of native chickens, and to have diverse menus and recipes as well as reasonable pricing for native chickens.

Analysis of Consumers’ Preferences and Price Sensitivity to Native Chickens

PubMed Central

Lee, Min-A; Jung, Yoojin; Jo, Cheorun

2017-01-01

This study analyzed consumers’ preferences and price sensitivity to native chickens. A survey was conducted from Jan 6 to 17, 2014, and data were collected from consumers (n=500) living in Korea. Statistical analyses evaluated the consumption patterns of native chickens, preference marketing for native chicken breeds which will be newly developed, and price sensitivity measurement (PSM). Of the subjects who preferred broilers, 24.3% do not purchase native chickens because of the dryness and tough texture, while those who preferred native chickens liked their chewy texture (38.2%). Of the total subjects, 38.2% preferred fried native chickens (38.2%) for processed food, 38.4% preferred direct sales for native chicken distribution, 51.0% preferred native chickens to be slaughtered in specialty stores, and 32.4% wanted easy access to native chickens. Additionally, the price stress range (PSR) was 50 won and the point of marginal cheapness (PMC) and point of marginal expensiveness (PME) were 6,980 won and 12,300 won, respectively. Evaluation of the segmentation market revealed that consumers who prefer broiler to native chicken breeds were more sensitive to the chicken price. To accelerate the consumption of newly developed native chicken meat, it is necessary to develop a texture that each consumer needs, to increase the accessibility of native chickens, and to have diverse menus and recipes as well as reasonable pricing for native chickens. PMID:28747834

Addressing the challenge of high-priced prescription drugs in the era of precision medicine: A systematic review of drug life cycles, therapeutic drug markets and regulatory frameworks

PubMed Central

van der Gronde, Toon; Uyl-de Groot, Carin A.

2017-01-01

Context Recent public outcry has highlighted the rising cost of prescription drugs worldwide, which in several disease areas outpaces other health care expenditures and results in a suboptimal global availability of essential medicines. Method A systematic review of Pubmed, the Financial Times, the New York Times, the Wall Street Journal and the Guardian was performed to identify articles related to the pricing of medicines. Findings Changes in drug life cycles have dramatically affected patent medicine markets, which have long been considered a self-evident and self-sustainable source of income for highly profitable drug companies. Market failure in combination with high merger and acquisition activity in the sector have allowed price increases for even off-patent drugs. With market interventions and the introduction of QALY measures in health care, governments have tried to influence drug prices, but often encounter unintended consequences. Patent reform legislation, reference pricing, outcome-based pricing and incentivizing physicians and pharmacists to prescribe low-cost drugs are among the most promising short-term policy options. Due to the lack of systematic research on the effectiveness of policy measures, an increasing number of ad hoc decisions have been made with counterproductive effects on the availability of essential drugs. Future challenges demand new policies, for which recommendations are offered. Conclusion A fertile ground for high-priced drugs has been created by changes in drug life-cycle dynamics, the unintended effects of patent legislation, government policy measures and orphan drug programs. There is an urgent need for regulatory reform to curtail prices and safeguard equitable access to innovative medicines. PMID:28813502

Addressing the challenge of high-priced prescription drugs in the era of precision medicine: A systematic review of drug life cycles, therapeutic drug markets and regulatory frameworks.

PubMed

Gronde, Toon van der; Uyl-de Groot, Carin A; Pieters, Toine

2017-01-01

Recent public outcry has highlighted the rising cost of prescription drugs worldwide, which in several disease areas outpaces other health care expenditures and results in a suboptimal global availability of essential medicines. A systematic review of Pubmed, the Financial Times, the New York Times, the Wall Street Journal and the Guardian was performed to identify articles related to the pricing of medicines. Changes in drug life cycles have dramatically affected patent medicine markets, which have long been considered a self-evident and self-sustainable source of income for highly profitable drug companies. Market failure in combination with high merger and acquisition activity in the sector have allowed price increases for even off-patent drugs. With market interventions and the introduction of QALY measures in health care, governments have tried to influence drug prices, but often encounter unintended consequences. Patent reform legislation, reference pricing, outcome-based pricing and incentivizing physicians and pharmacists to prescribe low-cost drugs are among the most promising short-term policy options. Due to the lack of systematic research on the effectiveness of policy measures, an increasing number of ad hoc decisions have been made with counterproductive effects on the availability of essential drugs. Future challenges demand new policies, for which recommendations are offered. A fertile ground for high-priced drugs has been created by changes in drug life-cycle dynamics, the unintended effects of patent legislation, government policy measures and orphan drug programs. There is an urgent need for regulatory reform to curtail prices and safeguard equitable access to innovative medicines.

A national survey on availability, price and affordability of selected essential medicines for non communicable diseases in Sri Lanka.

PubMed

Dabare, Panthihage Ruvini L; Wanigatunge, Chandanie A; Beneragama, Bvs Hemantha

2014-08-08

Access to medicines is a universal right. Low availability and low affordability of medicines are issues that deny this right to a significant proportion of the world population. The objective of this study was to determine the availability, price and affordability of essential medicines prescribed to treat non communicable diseases in Sri Lanka. Methodology was based on the 2nd edition of the World Health Organization Health Action International Manual. A country survey was conducted and facilities representing both public and private pharmacies were selected. A total of 109 facilities was surveyed. At each facility data on the availability and prices of 50 essential medicines for non communicable diseases were collected. Percentage availability, median price of originator brand and lowest priced generic, median price ratio to the International Reference Price were calculated for surveyed medicines. Affordability was determined using the daily incomes of the lowest--paid unskilled government worker. Semi government community pharmacies had the highest (>80%) availability while outdoor pharmacies of public health care facilities, private pharmacies and outdoor pharmacies of private hospital showed a fairly high availability (50 - 80%) of surveyed medicines.Unit price of 76% of selected individual medicines was less than ten Sri Lankan rupees. Out of these 28% of medicines cost less than one Sri Lanka rupee. For 21 of the surveyed medicines the median price ratio to the international reference price was less than one. The prices of originator brands for 14 surveyed medicines were more than five times that of the lowest price generics.Less than a single day's wages was adequate to purchase a month's supply of the lowest priced generic of more than 67% of surveyed medicines. The availability of selected essential medicines was fairly high in both public and private sectors in Sri Lanka. Most medicines are affordable to the lowest income earners in the community. There were many generic brands and generics available for most of the medicines in private and semi government community pharmacies increasing both availability and affordability.

Pricing and Reimbursement of Biosimilars in Central and Eastern European Countries

PubMed Central

Kawalec, Paweł; Stawowczyk, Ewa; Tesar, Tomas; Skoupa, Jana; Turcu-Stiolica, Adina; Dimitrova, Maria; Petrova, Guenka I.; Rugaja, Zinta; Männik, Agnes; Harsanyi, Andras; Draganic, Pero

2017-01-01

Objectives: The aim of this study was to review the requirements for the reimbursement of biosimilars and to compare the reimbursement status, market share, and reimbursement costs of biosimilars in selected Central and Eastern European (CEE) countries. Methods: A questionnaire-based survey was conducted between November 2016 and January 2017 among experts from the following CEE countries: Bulgaria, Czech Republic, Croatia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Romania. The requirements for the pricing and reimbursement of biosimilars were reviewed for each country. Data on the extent of reimbursement of biologic drugs (separately for original products and biosimilars) in the years 2014 and 2015 were also collected for each country, along with data on the total pharmaceutical and total public health care budgets. Results: Our survey revealed that no specific criteria were applied for the pricing and reimbursement of biosimilars in the selected CEE countries; the price of biosimilars was usually reduced compared with original drugs and specific price discounts were common. Substitution and interchangeability were generally allowed, although in most countries they were at the discretion of the physician after a clinical assessment. Original biologic drugs and the corresponding biosimilars were usually in the same homogeneous group, and internal reference pricing was usually employed. The reimbursement rate of biosimilars in the majority of the countries was the same and amounted to 100%. Generally, the higher shares of expenditures were shown for the reimbursement of original drugs than for biosimilars, except for filgrastim, somatropin, and epoetin (alfa and zeta). The shares of expenditures on the reimbursement of biosimilar products ranged from 8.0% in Estonia in 2014 to 32.4% in Lithuania in 2015, and generally increased in 2015. The share of expenditures on reimbursement of biosimilars in the total pharmaceutical budget differed between the countries, with the highest observed value for Slovakia and Hungary and the lowest—for Croatia. Conclusions: The requirements for the pricing and reimbursement of biosimilar products as well as the access of patients to biologic treatment do not differ significantly between the considered CEE countries. Biosimilar drugs significantly influence the reimbursement systems of these countries, and the expenditure on the reimbursement of biosimilars is increasing as they are becoming more accessible to patients. PMID:28642700

High-Price And Low-Price Physician Practices Do Not Differ Significantly On Care Quality Or Efficiency

PubMed Central

Roberts, Eric T.; Mehrotra, Ateev; McWilliams, J. Michael

2017-01-01

Provider consolidation has intensified concerns that providers with market power may be able to charge higher prices without having to deliver better care. Providers have argued that higher prices cover the costs of delivering higher-quality care. We examined the relationship between physician practice prices for outpatient services and the quality and efficiency of care provided to their patients. Using commercial claims, we classified practices as high-priced or low-priced. We compared care quality, utilization, and spending between high-priced and low-priced practices in the same areas using data from the Consumer Assessment of Health Care Providers and Systems survey and linked claims for Medicare beneficiaries. Compared with low-priced practices, high-priced practices were much larger and received 36% higher prices. Patients of high-priced practices reported significantly higher scores on some measures of care coordination and management, but did not differ meaningfully in their overall care ratings, other domains of patient experiences (including physician ratings and access to care), receipt of mammography, vaccinations, or diabetes services, acute care use, or total Medicare spending. These findings suggest an overall weak relationship between practices’ prices and the quality and efficiency of care they provide, calling into question claims that high-priced providers deliver substantially higher-value care. PMID:28461352

Global Location-Based Access to Web Applications Using Atom-Based Automatic Update

NASA Astrophysics Data System (ADS)

Singh, Kulwinder; Park, Dong-Won

We propose an architecture which enables people to enquire about information available in directory services by voice using regular phones. We implement a Virtual User Agent (VUA) which mediates between the human user and a business directory service. The system enables the user to search for the nearest clinic, gas station by price, motel by price, food / coffee, banks/ATM etc. and fix an appointment, or automatically establish a call between the user and the business party if the user prefers. The user also has an option to receive appointment confirmation by phone, SMS, or e-mail. The VUA is accessible by a toll free DID (Direct Inward Dialing) number using a phone by anyone, anywhere, anytime. We use the Euclidean formula for distance measurement. Since, shorter geodesic distances (on the Earth’s surface) correspond to shorter Euclidean distances (measured by a straight line through the Earth). Our proposed architecture uses Atom XML syndication format protocol for data integration, VoiceXML for creating the voice user interface (VUI) and CCXML for controlling the call components. We also provide an efficient algorithm for parsing Atom feeds which provide data to the system. Moreover, we describe a cost-effective way for providing global access to the VUA based on Asterisk (an open source IP-PBX). We also provide some information on how our system can be integrated with GPS for locating the user coordinates and therefore efficiently and spontaneously enhancing the system response. Additionally, the system has a mechanism for validating the phone numbers in its database, and it updates the number and other information such as daily price of gas, motel etc. automatically using an Atom-based feed. Currently, the commercial directory services (Example 411) do not have facilities to update the listing in the database automatically, so that why callers most of the times get out-of-date phone numbers or other information. Our system can be integrated very easily with an existing web infrastructure, thereby making the wealth of Web information easily available to the user by phone. This kind of system can be deployed as an extension to 911 and 411 services to share the workload with human operators. This paper presents all the underlying principles, architecture, features, and an example of the real world deployment of our proposed system. The source code and documentations are available for commercial productions.

An adjusted bed net coverage indicator with estimations for 23 African countries

PubMed Central

2013-01-01

Background Many studies have assessed the level of bed net coverage in populations at risk of malaria infection. These revealed large variations in bed net use across countries, regions and social strata. Such studies are often aimed at identifying populations with low access to bed nets that should be prioritized in future interventions. However, often spatial differences in malaria endemicity are not taken into account. By ignoring variability in malaria endemicity, these studies prioritize populations with little access to bed nets, even if these happen to live in low endemicity areas. Conversely, populations living in regions with high malaria endemicity will receive a lower priority once a seizable proportion is protected by bed nets. Adequately assigning priorities requires accounting for both the current level of bed net coverage and the local malaria endemicity. Indeed, as shown here for 23 African countries, there is no correlation between the level of bed net coverage and the level of malaria endemicity in a region. Therefore, the need for future interventions can not be assessed based on current bed net coverage alone. This paper proposes the Adjusted Bed net Coverage (ABC) statistic as a measure taking into account both local malaria endemicity and the level of bed net coverage. The measure allows setting priorities for future interventions taking into account both local malaria endemicity and bed net coverage. Methods A mathematical formulation of the ABC as a weighted difference of bed net coverage and malaria endemicity is presented. The formulation is parameterized based on a model of malaria epidemiology (Smith et al. Trends Parasitol 25:511-516, 2009). By parameterizing the ABC based on this model, the ABC as used in this paper is proxy for the steady-state malaria burden given the current level of bed net coverage. Data on the bed net coverage in under five year olds and malaria endemicity in 23 Sub-Saharan countries is used to show that the ABC prioritizes different populations than the level of bed net coverage by itself. Data from the following countries was used: Angola, Burkina Faso, Burundi, Cameroon, Congo Democratic Republic, Ethiopia, Ghana, Guinea, Kenya, Liberia, Madagascar, Malawi, Mali, Mozambique, Namibia, Nigeria, Rwanda, Senegal, Sierra Leone, Tanzania, Uganda, Zambia and Zimbabwe. The priority order given by the ABC and the bed net coverage are compared at the countries’ level, the first level administrative divisions and for five different wealth quintiles. Results Both at national level and at the level of the administrative divisions the ABC suggests a different priority order for selecting countries and divisions for future interventions. When taking into account malaria endemicity, measures assessing equality in access to bed nets across wealth quintiles, such as slopes of inequality, are prone to change. This suggests that when assessing inequality in access to bed nets one should take into account the local malaria endemicity for populations from different wealth quintiles. Conclusion Accounting for malaria endemicity highlights different countries, regions and socio-economic strata for future intervention than the bed net coverage by itself. Therefore, care should be taken to factor out any effects of local malaria endemicity in assessing bed net coverage and in prioritizing populations for further scale-up of bed net coverage. The ABC is proposed as a simple means to do this that is derived from an existing model of malaria epidemiology. PMID:24359227

32 CFR 3.8 - DoD access to records policy.

Code of Federal Regulations, 2011 CFR

2011-07-01

... for defined payable milestones, with no provision for financial or cost reporting that would be a... necessary to verify statutory cost share or to verify amounts generated from financial or cost records that... General access. (1) Fixed-price type OT agreements. (i) General—DoD access to records is not generally...

32 CFR 3.8 - DoD access to records policy.

Code of Federal Regulations, 2010 CFR

2010-07-01

... for defined payable milestones, with no provision for financial or cost reporting that would be a... necessary to verify statutory cost share or to verify amounts generated from financial or cost records that... General access. (1) Fixed-price type OT agreements. (i) General—DoD access to records is not generally...

Access to Information in Both CitaDel and FirstSearch: A Comparative Study of Dissertation Coverage.

ERIC Educational Resources Information Center

Perry, Stephen; Salisbury, Lutishoor

1995-01-01

Presents a comparative analysis of electronic access to theses and dissertations through CitaDel and FirstSearch. Highlights include the effectiveness and ease of use in providing enduser access; strengths and weaknesses of searching capabilities; coverage; pricing; and examples of direct retrieval comparison. (LRW)

Access to Orphan Drugs: A Comprehensive Review of Legislations, Regulations and Policies in 35 Countries.

PubMed

Gammie, Todd; Lu, Christine Y; Babar, Zaheer Ud-Din

2015-01-01

To review existing regulations and policies utilised by countries to enable patient access to orphan drugs. A review of the literature (1998 to 2014) was performed to identify relevant, peer-reviewed articles. Using content analysis, we synthesised regulations and policies for access to orphan drugs by type and by country. Fifty seven articles and 35 countries were included in this review. Six broad categories of regulation and policy instruments were identified: national orphan drug policies, orphan drug designation, marketing authorization, incentives, marketing exclusivity, and pricing and reimbursement. The availability of orphan drugs depends on individual country's legislation and regulations including national orphan drug policies, orphan drug designation, marketing authorization, marketing exclusivity and incentives such as tax credits to ensure research, development and marketing. The majority of countries (27/35) had in place orphan drug legislation. Access to orphan drugs depends on individual country's pricing and reimbursement policies, which varied widely between countries. High prices and insufficient evidence often limit orphan drugs from meeting the traditional health technology assessment criteria, especially cost-effectiveness, which may influence access. Overall many countries have implemented a combination of legislations, regulations and policies for orphan drugs in the last two decades. While these may enable the availability and access to orphan drugs, there are critical differences between countries in terms of range and types of legislations, regulations and policies implemented. Importantly, China and India, two of the largest countries by population size, both lack national legislation for orphan medicines and rare diseases, which could have substantial negative impacts on their patient populations with rare diseases.

78 FR 33886 - Identification of Ukraine as a Priority Foreign Country and Initiation of Section 301 Investigation

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-05

... Representative) identified Ukraine as a priority foreign country due to Ukraine's denial of adequate and effective protection of intellectual property rights and its denial of fair and equitable market access to... system for collecting societies, which are responsible for collecting and distributing royalties to U.S...

78 FR 38349 - Draft Guidance for Industry on Expedited Programs for Serious Conditions-Drugs and Biologics...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-26

... approval, and priority review designation. DATES: Although you can comment on any guidance at any time (see... designation, (3) accelerated approval, and (4) priority review designation. The draft guidance describes... (the FD&C Act) (Enhancement of Accelerated Approval Access to New Medical Treatments) within 1 year of...

Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending.

PubMed

Wouters, Olivier J; Kanavos, Panos G; McKEE, Martin

2017-09-01

Policy Points: Our study indicates that there are opportunities for cost savings in generic drug markets in Europe and the United States. Regulators should make it easier for generic drugs to reach the market. Regulators and payers should apply measures to stimulate price competition among generic drugmakers and to increase generic drug use. To meaningfully evaluate policy options, it is important to analyze historical context and understand why similar initiatives failed previously. Rising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs. We compared generic drug prices and market shares in 13 European countries, using data from 2013, to assess the amount of variation that exists between countries. To place these results in context, we reviewed evidence from recent studies on the prices and use of generics in Europe and the United States. We also surveyed peer-reviewed studies, gray literature, and books published since 2000 to (1) outline existing generic drug policies in European countries and the United States; (2) identify ways to increase generic drug use and to promote price competition among generic drug companies; and (3) explore barriers to implementing reform of generic drug policies, using a historical example from the United States as a case study. The prices and market shares of generics vary widely across Europe. For example, prices charged by manufacturers in Switzerland are, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. The proportion of prescriptions filled with generics ranges from 17% in Switzerland to 83% in the United Kingdom. By comparison, the United States has historically had low generic drug prices and high rates of generic drug use (84% in 2013), but has in recent years experienced sharp price increases for some off-patent products. There are policy solutions to address issues in Europe and the United States, such as streamlining the generic drug approval process and requiring generic prescribing and substitution where such policies are not yet in place. The history of substitution laws in the United States provides insights into the economic, political, and cultural issues influencing the adoption of generic drug policies. Governments should apply coherent supply- and demand-side policies in generic drug markets. An immediate priority is to convince more physicians, pharmacists, and patients that generic drugs are bioequivalent to branded products. Special-interest groups continue to obstruct reform in Europe and the United States. © 2017 The Authors The Milbank Quarterly published by Wiley Periodicals, Inc. on behalf of The Millbank Memorial Fund.

[Innovative medicines and market access agreements].

PubMed

Toumi, M; Zard, J; Duvillard, R; Jommi, C

2013-09-01

Market Access Agreements (MAA) for drugs have emerged in response to the need to control health expenditures, as well as to the uncertainty about the true benefit of a drug. It is possible to group MAA in two types of agreements: financial agreements and outcome-based agreements. MAA is a growing trend and is shifting towards conditional access. However, the willingness to use these contracts and their implementation differ across countries, and some are still resistant to put them in place. The MAA challenges to overcome encompass the complexity of the schemes, the administrative burden and the difficulty of evaluating MAA. It is likely that these agreements might experience further evolution in the future to become a faster pathway for therapeutic innovations, at a fair price. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Committed to High-Quality Education for All Children: An Interview with Hugh Price.

ERIC Educational Resources Information Center

Goldberg, Mark F.

2000-01-01

Hugh Price has dedicated his career to achieving racial equality. The president of the National Urban League stresses each child's right to a high-quality preschool education, highly qualified teachers with high expectations, access to challenging courses of study, and organization of communities for learning, not just maintaining order. (MLH)

47 CFR 69.731 - Low-end adjustment mechanism.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Low-end adjustment mechanism. 69.731 Section 69...) ACCESS CHARGES Pricing Flexibility § 69.731 Low-end adjustment mechanism. (a) Any price cap LEC obtaining...-MSA portion of any study area in its service region, shall be prohibited from making any low-end...

Evidence-based psychosocial practices and recovery from schizophrenia.

PubMed

Shean, Glenn D

2009-01-01

Pessimistic views about the course and outcome of schizophrenia have been replaced by a more hopeful perspective that emphasizes on providing opportunities for recovery. Recovery, from a provider perspective, means that priority is placed on providing access to treatments and community services that have been proven effective in both decreasing symptoms and assisting individuals to lead maximally productive and personally meaningful lives. In 2004, the Schizophrenia Patient Outcomes Research Team (PORT) published a consensus list of evidence-based practices (EBPs) that includes six psychosocial treatments. These psychosocial interventions in combination with access to pharmacotherapy are important components of comprehensive treatment programs for the seriously mentally ill. This paper summarizes and updates the research basis for the PORT psychosocial EBPs and discusses several additional issues and research topics to be considered in the future.

Policy Analysis of Poverty Alleviation in Semarang City Using Spatial and Sectoral Approach

NASA Astrophysics Data System (ADS)

Muktiali, M.

2018-02-01

Poverty is a multidimensional problem. Therefore, poverty reduction policy is not only related to the increase of income, but also various other dimensions such as improvement of education, health, quality of life, access to electricity, access to sanitation and water supply. Semarang City Government in 2012 initiated a policy of poverty reduction synergy program called “Gerdu Kempling”. Gerdu Kempling is an integrated policy which gives priority to addressing poverty in each village and sub-district in Semarang based on aspects of health, economy, education, infrastructure, and environment. Based on the results of Budget Allocation Analysis and Analysis of Geographic Information Systems (Poverty Mapping), it can be concluded that the program and budget allocation for poverty alleviation in Semarang City are not synchronized either spatially or sectorally.

The price of access: capitalization of neighborhood contextual factors

PubMed Central

2013-01-01

Background Studies of neighborhood context on health behavior have not considered that the health benefits of context may be ‘capitalized’ into, or included in, higher housing values. This study examines the associations of better neighborhood context with neighborhood housing values. Methods We use the third wave of Add Health (2000-2001) to estimate the association of neighborhood contextual variables and housing values first across then within income types. This is a census block group-level analysis. Results We find that neighborhood context, especially access to fruit and vegetable outlets, is capitalized into, or associated with, higher housing values. Fast food and convenience store access are associated with lower housing values. Capitalization differs by income quartile of the neighborhood. Even those in the poorest neighborhoods value access to fresh fruits and vegetables, and those in the wealthier neighborhoods value activity resources. All neighborhood incomes types place negative value on fast food access and convenience store access. Conclusions Access to health-related contextual attributes is capitalized into higher housing prices. Access to fresh fruits and vegetables is valued in neighborhoods of all income levels. Modeling these associations by neighborhood income levels helps explain the mixed results in the literature on the built environment in terms of linking health outcomes to access. PMID:23927010

An analysis of volumes, prices and pricing trends of the pediatric antiretroviral market in developing countries from 2004 to 2012.

PubMed

Lee, Janice Soo Fern; Sagaon Teyssier, Luis; Dongmo Nguimfack, Boniface; Collins, Intira Jeannie; Lallemant, Marc; Perriens, Joseph; Moatti, Jean-Paul

2016-03-15

The pediatric antiretroviral (ARV) market is poorly described in the literature, resulting in gaps in understanding treatment access. We analyzed the pediatric ARV market from 2004 to 2012 and assessed pricing trends and associated factors. Data on donor funded procurements of pediatric ARV formulations reported to the Global Price Reporting Mechanism database from 2004 to 2012 were analyzed. Outcomes of interest were the volume and mean price per patient-year ARV formulation based on WHO ARV dosing recommendations for a 10 kg child. Factors associated with the price of formulations were assessed using linear regression; potential predictors included: country income classification, geographical region, market segment (originator versus generic ARVs), and number of manufacturers per formulation. All analyses were adjusted for type of formulations (single, dual or triple fixed-dose combinations (FDCs)) Data from 111 countries from 2004 to 2012 were included, with procurement of 33 formulations at a total value of USD 204 million. Use of dual and triple FDC formulations increased substantially over time, but with limited changes in price. Upon multivariate analysis, prices of originator formulations were found to be on average 72 % higher than generics (p < 0.001). A 10 % increase in procurement volume was associated with a 1 % decrease (p < 0.001) in both originator and generic prices. The entry of one additional manufacturer producing a formulation was associated with a decrease in prices of 2 % (p < 0.001) and 8 % (p < 0.001) for originator and generic formulations, respectively. The mean generic ARV price did not differ by country income level. Prices of originator ARVs were 48 % (p < 0.001) and 14 % (p < 0.001) higher in upper-middle income and lower-middle income countries compared to low income countries respectively, with the exception of South Africa, which had lower prices despite being an upper-middle income country. The donor funded pediatric ARV market as represented by the GPRM database is small, and lacks price competition. It is dominated by generic drugs due to the lower prices offered and the practicality of FDC formulations. This market requires continued donor support and the current initiatives to protect it are important to ensure market viability, especially if new formulations are to be introduced in the future.

Impacts of National Decarbonization Targets for Subnational Societal Priorities

NASA Astrophysics Data System (ADS)

Peng, W.; Iyer, G.

2017-12-01

Carbon mitigation has well-recognized linkages with other environmental and socioeconomic priorities, such as air pollution, economic development, employment, etc. While climate change is a global issue, many other societal priorities are local concerns. Since local efforts form the pillars of achieving co-benefits and avoiding dis-benefits at the national level, it is critical to go beyond national-level analyses and focus on the synergies and tradeoffs at the subnational level. Here we use the United States as an example to evaluate the impacts of mid-century national-level deep decarbonization target for state-level societal priorities. Based on the Global Change Assessment Model with state-level details for the US (GCAM-USA), we design two mid-century scenarios: A Reference scenario that assumes the U.S. undertakes no additional climate mitigation policy, and a Deep Decarbonization Scenario that assumes the U.S. achieves the NDC goal through 2025 (26-28% reduction relative to 2005 levels) and then follows a straight-line trajectory to 80% reductions in economy-wide GHG emissions by 2050 relative to 2005. We then compare these two scenarios for a variety of metrics of carbon mitigation and other societal priorities in 2050. We highlight two findings. First, the synergies and tradeoffs of carbon mitigation with other societal goals at the subnational level can be quite different from the national level. For example, while deep decarbonization could improve national energy security by reducing the overall dependence on energy imports, it may exacerbate energy independence goals for some states by increasing inter-state electricity imports. Second, achieving national-level decarbonization target could result in unequal regional impacts across states. We find uneven geographic impacts for air pollution (more co-reductions occur in the eastern states), economic costs (energy prices increase more in the northeastern states) and employment (jobs increase in the western states where renewable capacity scales up, and decrease in the northeast due to reduced mining activities). Therefore, local decision makers may find decarbonization in line or contradicting with the most urgent local priority to address, highlighting the importance of evaluating the synergies and tradeoffs at the subnational level.

Prevention of HPV-Related Cancers in Norway: Cost-Effectiveness of Expanding the HPV Vaccination Program to Include Pre-Adolescent Boys

PubMed Central

Burger, Emily A.; Sy, Stephen; Nygård, Mari; Kristiansen, Ivar S.; Kim, Jane J.

2014-01-01

Background Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted. Methods A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program. Results Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered ‘good value for money.’ For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage. Conclusions At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding vaccination coverage to boys and should be considered a priority. PMID:24651645

Measuring Land Uses Accessibility by Using Fuzzy Majority Gis-Based Multicriteria Decision Analysis Case Study: Malayer City

NASA Astrophysics Data System (ADS)

Taravat, A.; Yari, A.; Rajaei, M.; Mousavian, R.

2014-10-01

Public spaces accessibility has become one of the important factors in urban planning. Therefore, considerable attention has been given to measure accessibility to public spaces on the UK, US and Canada, but there are few studies outside the anglophone world especially in developing countries such as Iran. In this study an attempt has been made to measure objective accessibility to public spaces (parks, school, library and administrative) using fuzzy majority GIS-based multicriteria decision analysis. This method is for defining the priority for distribution of urban facilities and utilities as the first step towards elimination of social justice. In order to test and demonstrate the presented model, the comprehensive plan of Malayer city has been considered for ranking in three objectives and properties in view of index per capital (Green space, sport facilities and major cultural centers like library and access index). The results can be used to inform the local planning process and the GIS approach can be expanded into other local authority domains. The results shows that the distribution of facilities in Malayer city has followed on the base of cost benefit law and the human aspect of resource allocation programming of facilities (from centre to suburbs of the city).

Artemisinin combination therapies price disparity between government and private health sectors and its implication on antimalarial drug consumption pattern in Morogoro Urban District, Tanzania

PubMed Central

2012-01-01

Background Universal access to effective treatments is a goal of the Roll Back Malaria Partnership. However, despite official commitments and substantial increases in financing, this objective remains elusive, as development assistance continue to be routed largely through government channels, leaving the much needed highly effective treatments inaccessible or unaffordable to those seeking services in the private sector. Methods To quantify the effect of price disparity between the government and private health systems, this study have audited 92 government and private Drug Selling Units (DSUs) in Morogoro urban district in Tanzania to determine the levels, trend and consumption pattern of antimalarial drugs in the two health systems. A combination of observation, interviews and questionnaire administered to the service providers of the randomly selected DSUs were used to collect data. Results ALU was the most selling antimalarial drug in the government health system at a subsidized price of 300 TShs (0.18 US$). By contrast, ALU that was available in the private sector (coartem) was being sold at a price of about 10,000 TShs (5.9 US$), the price that was by far unaffordable, prompting people to resort to cheap but failed drugs. As a result, metakelfin (the phased out drug) was the most selling drug in the private health system at a price ranging from 500 to 2,000 TShs (0.29–1.18 US$). Conclusions In order for the prompt diagnosis and treatment with effective drugs intervention to have big impact on malaria in mostly low socioeconomic malaria-endemic areas of Africa, inequities in affordability and access to effective treatment must be eliminated. For this to be ensued, subsidized drugs should be made available in both government and private health sectors to promote a universal access to effective safe and affordable life saving antimalarial drugs. PMID:22455367

Artemisinin combination therapies price disparity between government and private health sectors and its implication on antimalarial drug consumption pattern in Morogoro Urban District, Tanzania.

PubMed

Malisa, Allen Lewis; Kiriba, Deodatus

2012-03-28

Universal access to effective treatments is a goal of the Roll Back Malaria Partnership. However, despite official commitments and substantial increases in financing, this objective remains elusive, as development assistance continue to be routed largely through government channels, leaving the much needed highly effective treatments inaccessible or unaffordable to those seeking services in the private sector. To quantify the effect of price disparity between the government and private health systems, this study have audited 92 government and private Drug Selling Units (DSUs) in Morogoro urban district in Tanzania to determine the levels, trend and consumption pattern of antimalarial drugs in the two health systems. A combination of observation, interviews and questionnaire administered to the service providers of the randomly selected DSUs were used to collect data. ALU was the most selling antimalarial drug in the government health system at a subsidized price of 300 TShs (0.18 US$). By contrast, ALU that was available in the private sector (coartem) was being sold at a price of about 10,000 TShs (5.9 US$), the price that was by far unaffordable, prompting people to resort to cheap but failed drugs. As a result, metakelfin (the phased out drug) was the most selling drug in the private health system at a price ranging from 500 to 2,000 TShs (0.29-1.18 US$). In order for the prompt diagnosis and treatment with effective drugs intervention to have big impact on malaria in mostly low socioeconomic malaria-endemic areas of Africa, inequities in affordability and access to effective treatment must be eliminated. For this to be ensued, subsidized drugs should be made available in both government and private health sectors to promote a universal access to effective safe and affordable life saving antimalarial drugs.

Setting Physicians' Prices in FFS Medicare: An Economic Perspective

PubMed Central

Dowd, Bryan; Feldman, Roger; Nyman, John; Town, Bob

2006-01-01

Recent policy discussions by the Medicare Payment Advisory Commission (MedPAC) regarding physician prices in the traditional fee-for-service (FFS) Medicare Program reflect movement toward a market pricing model. Earlier objectives such as sustainable levels of spending have given way to concerns over the relationship between fees and actual costs, access to care, and the importance of demand and supply in local markets. An important objective in other policy settings is economically efficient distribution of services. We explain the meaning of economic efficiency for Medicare physician prices and explore difficulties one might encounter in pursuing economic efficiency, as well as the cost of not pursuing it. PMID:17427848

Prioritization and willingness to pay for bariatric surgery: the patient perspective

PubMed Central

Gill, Richdeep S.; Majumdar, Sumit R.; Wang, Xiaoming; Tuepah, Rebecca; Klarenbach, Scott W.; Birch, Daniel W.; Karmali, Shahzeer; Sharma, Arya M.; Padwal, Raj S.

2014-01-01

Background Access to publicly funded bariatric surgery is limited, potential candidates face lengthy waits, and no universally accepted prioritization criteria exist. We examined patients’ perspectives regarding prioritization for surgery. Methods We surveyed consecutively recruited patients awaiting bariatric surgery about 9 hypothetical scenarios describing patients waiting for surgery. Respondents were asked to rank the priority of these hypothetical patients on the wait list relative to their own. Scenarios examined variations in age, clinical severity, functional impairment, social dependence and socioeconomic status. Willingness to pay for faster access was assessed using a 5-point ordinal scale and analyzed using multivariable logistic regression. Results The 99 respondents had mean age of 44.7 ± 9.9 years, 76% were women, and the mean body mass index was 47.3 ± SD 7.6. The mean wait for surgery was 34.4 ± 9.4 months. Respondents assigned similar priority to hypothetical patients with characteristics identical to theirs (p = 0.22) and higher priority (greater urgency) to those exhibiting greater clinical severity (p < 0.001) and functional impairment (p = 0.003). Lower priority was assigned to patients at the extremes of age (p = 0.006), on social assistance (p < 0.001) and of high socioeconomic status (p < 0.001). Most (85%) respondents disagreed with payment to expedite access, although participants earning more than $80 000/year were less likely to disagree. Conclusion Most patients waiting for bariatric surgery consider greater clinical severity and functional impairments related to obesity to be important prioritization indicators and disagreed with paying for faster access. These findings may help inform future efforts to develop acceptable prioritization strategies for publicly funded bariatric surgery. PMID:24461224

Prioritization and willingness to pay for bariatric surgery: the patient perspective.

PubMed

Gill, Richdeep S; Majumdar, Sumit R; Wang, Xiaoming; Tuepah, Rebecca; Klarenbach, Scott W; Birch, Daniel W; Karmali, Shahzeer; Sharma, Arya M; Padwal, Raj S

2014-02-01

Access to publicly funded bariatric surgery is limited, potential candidates face lengthy waits, and no universally accepted prioritization criteria exist. We examined patients' perspectives regarding prioritization for surgery. We surveyed consecutively recruited patients awaiting bariatric surgery about 9 hypothetical scenarios describing patients waiting for surgery. Respondents were asked to rank the priority of these hypothetical patients on the wait list relative to their own. Scenarios examined variations in age, clinical severity, functional impairment, social dependence and socioeconomic status. Willingness to pay for faster access was assessed using a 5-point ordinal scale and analyzed using multivariable logistic regression. The 99 respondents had mean age of 44.7 ± 9.9 years, 76% were women, and the mean body mass index was 47.3 ± SD 7.6. The mean wait for surgery was 34.4 ± 9.4 months. Respondents assigned similar priority to hypothetical patients with characteristics identical to theirs (p = 0.22) and higher priority (greater urgency) to those exhibiting greater clinical severity (p < 0.001) and functional impairment (p = 0.003). Lower priority was assigned to patients at the extremes of age (p = 0.006), on social assistance (p < 0.001) and of high socioeconomic status (p < 0.001). Most (85%) respondents disagreed with payment to expedite access, although participants earning more than $80 000/year were less likely to disagree. Most patients waiting for bariatric surgery consider greater clinical severity and functional impairments related to obesity to be important prioritization indicators and disagreed with paying for faster access. These findings may help inform future efforts to develop acceptable prioritization strategies for publicly funded bariatric surgery.

Mitigating regulatory impact: the case of partial price controls on metformin in India.

PubMed

Bhaskarabhatla, Ajay; Chatterjee, Chirantan; Anurag, Priyatam; Pennings, Enrico

2017-03-01

The use of drug price controls is a contentious issue globally. Low- and middle-income countries use direct price controls to improve access to essential drugs. But such price controls have little meaning if they are not designed and implemented well, and the extent to which firms coordinate in these countries to weaken price controls has been largely overlooked. In mid-2013, India adopted partial price-cap regulation for some, but not all, formulations of several essential medicines. Using data on sales and prices of the out-of-patent oral antidiabetic drug Metformin—considered essential by WHO since 1998—and employing the differences-in-differences methodology, we examine the impact of the regulation on curbing prices. We find that firms coordinated to increase the price of the regulated formulation in the period before regulation, which led to a higher ceiling price. We also find, using triple-differences analyses, that the coordination is stronger among larger firms and for time-release formulations. We present anecdotal evidence to suggest that pharmaceutical trade associations facilitated coordination among firms, and we conclude that partial price control of Metformin in India is, at best, a modest improvement over no regulation.

Quality of service policy control in virtual private networks

NASA Astrophysics Data System (ADS)

Yu, Yiqing; Wang, Hongbin; Zhou, Zhi; Zhou, Dongru

2004-04-01

This paper studies the QoS of VPN in an environment where the public network prices connection-oriented services based on source, destination and grade of service, and advertises these prices to its VPN customers (users). As different QoS technologies can produce different QoS, there are according different traffic classification rules and priority rules. The internet service provider (ISP) may need to build complex mechanisms separately for each node. In order to reduce the burden of network configuration, we need to design policy control technologies. We considers mainly directory server, policy server, policy manager and policy enforcers. Policy decision point (PDP) decide its control according to policy rules. In network, policy enforce point (PEP) decide its network controlled unit. For InterServ and DiffServ, we will adopt different policy control methods as following: (1) In InterServ, traffic uses resource reservation protocol (RSVP) to guarantee the network resource. (2) In DiffServ, policy server controls the DiffServ code points and per hop behavior (PHB), its PDP distributes information to each network node. Policy server will function as following: information searching; decision mechanism; decision delivering; auto-configuration. In order to prove the effectiveness of QoS policy control, we make the corrective simulation.

Delays in Prior Living Kidney Donors Receiving Priority on the Transplant Waiting List

PubMed Central

Klassen, David K.; Kucheryavaya, Anna Y.; Stewart, Darren E.

2016-01-01

Background and objectives Prior living donors (PLDs) receive very high priority on the Organ Procurement and Transplantation Network (OPTN) kidney waiting list. Program delays in adding PLDs to the waiting list, setting their status to active, and submitting requests for PLD priority can affect timely access to transplantation. Design, setting, participants, & measurements We used the OPTN and the Centers for Medicare and Medicaid Services data to examine timing of (1) listing relative to start of dialysis, (2) activation on the waiting list, and (3) requests for PLD priority relative to listing date. There were 210 PLDs (221 registrations) added to the OPTN kidney waiting list between January 1, 2010 and July 31, 2015. Results As of September 4, 2015, 167 of the 210 PLDs received deceased donor transplants, six received living donor transplants, two died, five were too sick to transplant, and 29 were still waiting. Median waiting time to deceased donor transplant for PLDs was 98 days. Only 40.7% of 221 PLD registrations (n=90) were listed before they began dialysis; 68.3% were in inactive status for <90 days, 17.6% were in inactive status for 90–365 days, 8.6% were in inactive status for 1–2 years, and 5.4% were in inactive status for >2 years. Median time of PLDs waiting in active status before receiving PLD priority was 2 days (range =0–1450); 67.4% of PLDs received PLD priority within 7 days after activation, but 15.4% waited 8–30 days, 8.1% waited 1–3 months, 4.1% waited 3–12 months, and 5.0% waited >1 year in active status for PLD priority. After receiving priority, most were transplanted quickly. Median time in active status with PLD priority before deceased donor transplant was 23 days. Conclusions Fewer than one half of listed PLDs were listed before starting dialysis. Most listed PLDs are immediately set to active status and receive PLD priority quickly, but a substantial number spends time in active status without PLD priority or a large amount of time in inactive status, which affects access to timely transplants. PMID:27591296

Practical Aspects of Discussing Marijuana in a New Era.

PubMed

Lenoue, Sean R; Wongngamnit, Narin; Thurstone, Christian

2016-11-01

The use of marijuana for the treatment of medical conditions is a highly controversial topic. Misconceptions by both patients and providers concerning the safety of and evidence-based indications for marijuana can complicate treatment planning and outcomes. Maintaining skills such as motivational interviewing, providing evidence-based informed consent, and increasing access to care remain top priorities for providing quality patient care. The goal of this article is to offer guidance to clinical providers who are adapting to the changing realities of medical marijuana and legalized recreational marijuana.

Access and Equity for all Students: Students with Disabilities. Report 09-02

ERIC Educational Resources Information Center

Humphrey, Karen; Angeli, Mallory

2009-01-01

Access and equity for all students in higher education continues to be a high priority for the California Postsecondary Education Commission. Recent work in this area has focused on students with disabilities as well as Lesbian, Gay, Bisexual and Transgender (LGBT) students. The Commission formed an Access and Equity for All Students Advisory…

Food Price Volatility and Decadal Climate Variability

NASA Astrophysics Data System (ADS)

Brown, M. E.

2013-12-01

The agriculture system is under pressure to increase production every year as global population expands and more people move from a diet mostly made up of grains, to one with more meat, dairy and processed foods. Weather shocks and large changes in international commodity prices in the last decade have increased pressure on local food prices. This paper will review several studies that link climate variability as measured with satellite remote sensing to food price dynamics in 36 developing countries where local monthly food price data is available. The focus of the research is to understand how weather and climate, as measured by variations in the growing season using satellite remote sensing, has affected agricultural production, food prices and access to food in agricultural societies. Economies are vulnerable to extreme weather at multiple levels. Subsistence small holders who hold livestock and consume much of the food they produce are vulnerable to food production variability. The broader society, however, is also vulnerable to extreme weather because of the secondary effects on market functioning, resource availability, and large-scale impacts on employment in trading, trucking and wage labor that are caused by weather-related shocks. Food price variability captures many of these broad impacts and can be used to diagnose weather-related vulnerability across multiple sectors. The paper will trace these connections using market-level data and analysis. The context of the analysis is the humanitarian aid community, using the guidance of the USAID Famine Early Warning Systems Network and the United Nation's World Food Program in their response to food security crises. These organizations have worked over the past three decades to provide baseline information on food production through satellite remote sensing data and agricultural yield models, as well as assessments of food access through a food price database. Econometric models and spatial analysis are used to describe the connection between shocks and food prices, and to demonstrate the importance of these metrics in overall outcomes in food-insecure communities.

Availability, prices and affordability of essential medicines in Haiti

PubMed Central

Chahal, Harinder Singh; St. Fort, Nazaire; Bero, Lisa

2013-01-01

Background Haiti is the poorest country in the Western Hemisphere and faces numerous challenges, including inadequate medication access for its residents. The objective of this study was to determine the availability, prices, and affordability of essential medicines in Haiti and compare these findings to other countries. Methods We conducted a cross–sectional nationwide survey in 2011 of availability and consumer prices of 60 essential medicines in Haiti using a standardized methodology developed by the World Health Organization and Health Action International. The survey was conducted in 163 medicine outlets in four health care sectors (public, retail, nonprofit and mixed sectors). Medicine prices were expressed as ratios relative to the International Reference Price. Affordability was calculated by comparing the costs of treatment for common conditions with the salary of the lowest paid government worker and was compared to available data from four Latin American countries. Results For generic medicines, the availability in public, retail, nonprofit and mixed sectors was 20%, 37%, 24% and 23% of medications, respectively. Most of the available medicines were priced higher than the International Reference Price. The lowest paid government worker would need 2.5 days’ wages to treat an adult respiratory infection with generic medicines from the public sector. For treatment of common conditions with originator brands (OB) purchased from a retail pharmacy, costs were between 1.4 (anaerobic bacterial infection) and 13.7 (hyperlipidemia) days’ wages, respectively. Treatment of pediatric bacterial infections with the OB of ceftriaxone from a retail pharmacy would cost 24.6 days’ wages. Prices in Bolivia, Colombia, Mexico and Nicaragua were frequently lower for comparable medications. Conclusions The availability of essential medicines was low and prices varied widely across all four sectors. Over 75% of Haitians live on less than US$ 2.00 /day; therefore, most medication regimens are largely unaffordable. Inclusion of essential medications on the national formulary and working with organizations responsible for importing medications into Haiti, particularly drug donation agencies, are important first steps to increasing medication access. PMID:24363923

Improving access to malaria medicine through private-sector subsidies in seven African countries.

PubMed

Tougher, Sarah; Mann, Andrea G; Ye, Yazoume; Kourgueni, Idrissa A; Thomson, Rebecca; Amuasi, John H; Ren, Ruilin; Willey, Barbara A; Ansong, Daniel; Bruxvoort, Katia; Diap, Graciela; Festo, Charles; Johanes, Boniface; Kalolella, Admirabilis; Mallam, Oumarou; Mberu, Blessing; Ndiaye, Salif; Nguah, Samual Blay; Seydou, Moctar; Taylor, Mark; Wamukoya, Marilyn; Arnold, Fred; Hanson, Kara; Goodman, Catherine

2014-09-01

Improving access to quality-assured artemisinin combination therapies (ACTs) is an important component of malaria control in low- and middle-income countries. In 2010 the Global Fund to Fight AIDS, Tuberculosis, and Malaria launched the Affordable Medicines Facility--malaria (AMFm) program in seven African countries. The goal of the program was to decrease malaria morbidity and delay drug resistance by increasing the use of ACTs, primarily through subsidies intended to reduce costs. We collected data on price and retail markups on antimalarial medicines from 19,625 private for-profit retail outlets before and 6-15 months after the program's implementation. We found that in six of the AMFm pilot programs, prices for quality-assured ACTs decreased by US$1.28-$4.34, and absolute retail markups on these therapies decreased by US$0.31-$1.03. Prices and markups on other classes of antimalarials also changed during the evaluation period, but not to the same extent. In all but two of the pilot programs, we found evidence that prices could fall further without suppliers' losing money. Thus, concerns may be warranted that wholesalers and retailers are capturing subsidies instead of passing them on to consumers. These findings demonstrate that supranational subsidies can dramatically reduce retail prices of health commodities and that recommended retail prices communicated to a wide audience may be an effective mechanism for controlling the market power of private-sector antimalarial retailers and wholesalers. Project HOPE—The People-to-People Health Foundation, Inc.

The use of low cost compact cameras with focus stacking functionality in entomological digitization projects

PubMed Central

Mertens, Jan E.J.; Roie, Martijn Van; Merckx, Jonas; Dekoninck, Wouter

2017-01-01

Abstract Digitization of specimen collections has become a key priority of many natural history museums. The camera systems built for this purpose are expensive, providing a barrier in institutes with limited funding, and therefore hampering progress. An assessment is made on whether a low cost compact camera with image stacking functionality can help expedite the digitization process in large museums or provide smaller institutes and amateur entomologists with the means to digitize their collections. Images of a professional setup were compared with the Olympus Stylus TG-4 Tough, a low-cost compact camera with internal focus stacking functions. Parameters considered include image quality, digitization speed, price, and ease-of-use. The compact camera’s image quality, although inferior to the professional setup, is exceptional considering its fourfold lower price point. Producing the image slices in the compact camera is a matter of seconds and when optimal image quality is less of a priority, the internal stacking function omits the need for dedicated stacking software altogether, further decreasing the cost and speeding up the process. In general, it is found that, aware of its limitations, this compact camera is capable of digitizing entomological collections with sufficient quality. As technology advances, more institutes and amateur entomologists will be able to easily and affordably catalogue their specimens. PMID:29134038

The Challenge of Designing Optimum Legal Services for Disabled People: The New Zealand Experience

ERIC Educational Resources Information Center

Diesfeld, K.; McLean, M.; Phelan, T.; Patston, P.; Miller-Burgering, W.; Vickery, R.

2008-01-01

In 2005 New Zealand signalled its intention to reform legal services by contracting research on disabled people's priorities in Auckland. The Legal Services Agency reported that because many disabled people do not have access to necessary legal services in New Zealand their priorities should be identified. This article suggests that the social…