Health spending among working-age immigrants with disabilities compared to those born in the US.

PubMed

Tarraf, Wassim; Mahmoudi, Elham; Dillaway, Heather E; González, Hector M

2016-07-01

Immigrants have disparate access to health care. Disabilities can amplify their health care burdens. Examine how US- and foreign-born working-age adults with disabilities differ in their health care spending patterns. Medical Expenditures Panel Survey yearly-consolidated files (2000-2010) on working-age adults (18-64 years) with disabilities. We used three operational definitions of disability: physical, cognitive, and sensory. We examined annual total, outpatient/office-based, prescription medication, inpatient, and emergency department (ED) health expenditures. We tested bivariate logistic and linear regression models to, respectively, assess unadjusted group differences in the propensity to spend and average expenditures. Second, we used multivariable two-part models to estimate and test per-capita expenditures adjusted for predisposing, enabling, health need and behavior indicators. Adjusted for age and sex differences, US-born respondents with physical, cognitive, sensory spent on average $2977, $3312, and $2355 more in total compared to their foreign-born counterparts (P < 0.01). US-born spending was also higher across the four types of health care expenditures considered. Adjusting for the behavioral model factors, especially predisposing and enabling indicators, substantially reduced nativity differences in overall, outpatient/office-based and medication spending but not in inpatient and ED expenditures. Working-age immigrants with disabilities have lower levels of health care use and expenditures compared to their US-born counterparts. Affordable Care Act provisions aimed at increasing access to insurance and primary care can potentially align the consumption patterns of US- and foreign-born disabled working-age adults. More work is needed to understand the pathways leading to differences in hospital and prescription medication care. Copyright © 2016 Elsevier Inc. All rights reserved.

Health Spending Among Working-Age Immigrants With Disabilities Compared To Those Born In The US

PubMed Central

Tarraf, Wassim; Mahmoudi, Elham; Dillaway, Heather E; Gonzalez, Hector M.

2016-01-01

Background Immigrants have disparate access to healthcare. Disabilities can amplify their healthcare burdens. Objective/Hypothesis Examine how US- and foreign-born working-age adults with disabilities differ in their healthcare spending patterns. Methods Medical Expenditures Panel Survey yearly-consolidated files (2000-2010) on working-age adults (18-64 years) with disabilities. We used three operational definitions of disability: physical, cognitive, and sensory. We examined annual total, outpatient/office-based, prescription medication, inpatient, and emergency department (ED) health expenditures. We tested bivariate logistic and linear regression models to, respectively, assess unadjusted group differences in the propensity to spend and average expenditures. Second, we used multivariable two-part models to estimate and test per-capita expenditures adjusted for predisposing, enabling, health need and behavior indicators. Results Adjusted for age and sex differences, US-born respondents with physical, cognitive, sensory spent on average $2,977, $3,312, and $2,355 more in total compared to their foreign-born counterparts (P<0.01). US-born spending was also higher across the four types of healthcare expenditures considered. Adjusting for the behavioral model factors, especially predisposing and enabling indicators, substantially reduced nativity differences in overall, outpatient/office-based and medication spending but not in inpatient and ED expenditures. Conclusions Working-age immigrants with disabilities have lower levels of healthcare use and expenditures compared to their US-born counterparts. Affordable Care Act provisions aimed at increasing access to insurance and primary care can potentially align the consumption patterns of US- and foreign-born disabled working-age adults. More work is needed to understand the pathways leading to differences in hospital and prescription medication care. PMID:26917103

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

PubMed

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

2015-01-29

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

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study.

PubMed

Hung, Man; Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

2015-01-01

Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.

Catastrophic health expenditure and impoverishment in Mongolia.

PubMed

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

2016-07-11

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

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

PubMed Central

Raval, Amit D.; Sambamoorthi, Usha

2015-01-01

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

Metabolic Expenditures During Extravehicular Activity: Spaceflight versus Ground-based Simulation

NASA Technical Reports Server (NTRS)

Klein, Jill; Conkin, Johnny; Gernhardt, Michael; Srinivasan, Ramachandra

2008-01-01

In general metabolic rates tend to be higher in NBL than in flight: a) Restraint method dependent; b) Significant differences between the NBL and flight for BRT and APFR (buoyancy effects); and c) No significant difference between NBL and flight for free float and SRMS/SSRMS operations. The total metabolic energy expenditure for a given task and for the EVA as a whole are similar between NBL and flight: a) NBL metabolic rates are higher, but training EVAs are constrained to 5 hours; and b) Flight metabolic rates are lower, but the EVAs are typically an hour or more longer in duration. NBL metabolic rates provide a useful operational tool for flight planning. Quantifying differences and similarities between training and flight improves knowledge for preparation of safe and efficient EVAs.

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study

PubMed Central

Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

2015-01-01

Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. PMID:27227131

A macroeconomic review of dentistry in Canada in the 2000s.

PubMed

Ramraj, Chantel; Weitzner, Eleanor; Figueiredo, Rafael; Quiñonez, Carlos

2014-01-01

To describe trends in expenditures on dental health care services, the number of dental health care professionals and self-reported dental visits and cost barriers to dental care in Canada from 2000 to 2010. Data on licensed dental professionals; total expenditures on dental care, both public and private; and mean per capita amount spent on dental care were obtained from the Canadian Institute for Health Information. Information on self-reported dental visits and cost barriers to dental care were collected from the Canadian Community Health Surveys and the Canadian Health Measures Survey. To compare Canada with other countries, data from the Organisation for Economic Co-operation and Development (OECD) were used. From 2000 to 2010, the number of licensed dental professionals increased by 35%, with a particularly large rise in the number of dental hygienists (61%). Total real expenditures on dental care, after adjusting for inflation, increased by 56%, while the percentage of dental care expenditures paid by private insurance and through public funds decreased. Mean per capita expenditures increased from $233.94 in 2000 to $327.84 in 2010. Compared with other OECD countries, Canada ranked among the highest in mean per capita spending on dental care, but among the lowest in terms of public share. The proportion of people reporting a dental visit in the past year increased from 60.3% in 2001 to 75.5% in 2009, and those reporting cost barriers increased from 15% in 2001 to 17% in 2009. The dental care market appears to be growing, with increases in licensed dental professionals, total and mean per capita dental care expenditures and self-reported dental visits. However, these increases are not necessarily associated with greater effectiveness in meeting population needs and outcomes, such as equity in financing, delivery and improvements in oral health. Concerns with the financing of dental care and related issues of access may have implications for the future of dental care in Canada.

Hong Kong domestic health spending: financial years 1989/90 to 2005/06.

PubMed

Tin, K Y K; Tsoi, P K O; Leung, E S K; Tsui, E L H; Lam, D W S; Tsang, C S H; Lo, S V

2010-02-01

This report presents the latest estimates of Hong Kong domestic health spending between fiscal years 1989/90 and 2005/06, cross-stratified and categorised by financing source, provider, and function on an annual basis. In fiscal year 2005/06, total health expenditure was HK$71 557 million. In real terms, it grew 6.5% per annum on average throughout the study period, whereas gross domestic product grew 4.1%, indicating a growing percentage of health spending relative to gross domestic product, from 3.5% in 1989/90 to 5.1% in 2005/06. This increase was largely funded by public spending, which rose 8.2% per annum on average in real terms, compared with 5.1% for private spending. This represents a growing share of public spending from 40.2% to 51.6% of total health expenditure during the period. Public spending was the dominant source of health financing in 2005/06, whereas private household out-of-pocket expenditure accounted for the second largest share (34.5%), followed by employer-provided group medical benefits (7.5%), privately purchased insurance (5.1%), and other private sources (1.3%). Of the HK$71 557 million total health expenditure in 2005/06, HK$68 810 million (96.2%) was on current expenditure and HK$2746 million (3.8%) on capital expenses (ie investment in medical facilities). Services of curative care accounted for the largest share (67.3%) and were made up of ambulatory services (35.7%), in-patient services (27.7%), day patient hospital services (3.4%), and home care (0.6%). The second largest share was spending on medical goods outside the patient care setting (10.8%). In terms of health care providers, hospitals (44.0%) accounted for the largest share of total health expenditure in 2005/06, followed by providers of ambulatory health care (31.4%). We observed a system-wide trend towards service consolidation at institutions (as opposed to free-standing ambulatory clinics, most of which are staffed by solo practitioners). Not taking capital expenses (ie investment in medical facilities) into account, public current expenditure on health amounted to HK$34 849 million (50.6% of total current expenditure) in 2005/06, most of which was incurred at hospitals (76.3%), whereas private current expenditure (HK$33 961 million) was mostly incurred at providers of ambulatory health care (55.8%). This reflects the mixed health care economy of Hong Kong, where public hospitals generally account for about 90% of total bed-days and private doctors (including western and Chinese medicine practitioners) provide about 70% of out-patient care. Although both public and private spending were mostly expended on personal health care services and goods (93.0%), the patterns of distribution among functional categories differed. Public expenditure was targeted at in-patient care (53.7%) and substantially less on out-patient care (24.6%), especially low-intensity first-contact care. In comparison, private spending was concentrated on out-patient care (49.9%), followed by medical goods outside the patient care setting (22.0%) and in-patient care (19.0%). Compared to countries of the Organisation for Economic Co-operation and Development, Hong Kong has devoted a relatively low percentage of gross domestic product on health services in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than in most comparably developed economies, although commensurate with its public revenue collection base.

Industrial Base Assessment of Alternative Fuels for Military Use

DTIC Science & Technology

2010-06-07

emissions power plant in Mattoon, Illinois. The project is a government-industry partnership. DOE’s total expenditure is projected to be $1.073B. Of...and NETL o “The firms most capable of overseeing the design, construction, and operation of CTL plants are the major petrochemical companies, which...production ( refinery )-10%, production transport & distribution-1%, vehicle operation-81%. 26 (24) Figure 23. Life Cycle GHG Emissions for

Pharmaceutical expenditure on drugs for rare diseases in Canada: a historical (2007-13) and prospective (2014-18) MIDAS sales data analysis.

PubMed

Divino, Victoria; DeKoven, Mitch; Kleinrock, Michael; Wade, Rolin L; Kim, Tony; Kaura, Satyin

2016-05-21

Health Canada has defined rare diseases as life-threatening, seriously debilitating, or serious chronic conditions affecting a very small number of patients (~1 in 2,000 persons). An estimated 9 % of Canadians suffer from a rare disease. Drugs treating rare diseases (DRDs) are also known as orphan drugs. While Canada is currently developing an orphan drug framework, in the United States (US), the Orphan Drug Act (ODA) of 1983 established incentives for the development of orphan drugs. This study measured total annual expenditure of orphan drugs in Canada (2007-13) and estimated future (2014-18) orphan drug expenditure. Orphan drugs approved by the US Food and Drug Administration (FDA) in the US were used as a proxy for the orphan drug landscape in Canada. Branded, orphan drugs approved by the FDA between 1983 through 2013 were identified (N = 356 unique products). Only US orphan drugs with the same orphan indication(s) approved in Canada were included in the analysis. Adjustment via an indication factoring was applied to products with both orphan and non-orphan indications using available data sources to isolate orphan-indication sales. The IMS Health MIDAS database of audited biopharmaceutical sales was utilized to measure total orphan drug expenditure, calculated annually from 2007-2013 and evaluated as a proportion of total annual pharmaceutical drug expenditure (adjusted to 2014 CAD). Between 2007 and 2013, expenditure was measured for a final N = 147 orphan drugs. Orphan drug expenditure totaled $610.2 million (M) in 2007 and $1,100.0 M in 2013, representing 3.3- 5.6 % of total Canadian pharmaceutical drug expenditure in 2007-2013, respectively. Future trend analysis suggests orphan drug expenditure will remain under 6 % of total expenditure in 2014-18. While the number of available orphan drugs and associated expenditure increased over time, access remains an issue, and from the perspectives of society and equity, overall spending on orphan drugs is lower relative to the number of patients affected with an orphan disease in Canada. The overall budget impact of orphan drugs is small and fairly stable relative to total pharmaceutical expenditure. Concerns that growth in orphan drug expenditure may lead to unsustainable drug expenditure do not appear to be justified.

National Trends in Direct Health Care Expenditures Among US Adults With Migraine: 2004 to 2013.

PubMed

Raval, Amit D; Shah, Anal

2017-01-01

Migraine is a common neurological disorder with significant economic burden in the United States. However, changes in the economic burden of migraine in the past decade have not been examined considering therapeutic advances at the national level. Therefore, we estimated cross-sectional trends in the incremental total and types of direct health care expenditures among individuals with migraine using nationally representative data, the Medical Expenditures Panel Survey. The analytic sample was comprised of an annually weighted population of 228,010,000 adults aged 18 years and older from 2004 to 2013. Two-part models were used to estimate the incremental total and types of annual direct health care expenditures (adjusted to 2013 US dollars) among individuals with migraine after adjusting for predisposing, enabling, need, personal health practice, and external environment factors selected on the basis of the Anderson Healthcare Behavior Model. The unadjusted average annual total health care expenditure for individuals with migraine was $8,033 (standard error [SE] = $292) which comprised major proportions of outpatient ($2,952, SE = $128), prescription drugs ($2,207, SE = $91), and inpatient ($1,784, SE = $178) expenditures. Individuals with migraine had $866 (SE = $298) and $1,519 (SE = $400) greater adjusted annual total direct health care expenditures in 2004/2005 and 2012/2013 compared with those without migraine. However, those with migraine in 2012/2013 did not have significant changes in the total direct health care expenditures compared with those having migraine in 2004/2005 (changes: -$330, SE = $480). The estimated adjusted incremental total direct health care expenditures for individuals with migraine was approximately $9.20 billion per year compared with those without migraine. Although annual incremental total direct health care expenditures among individuals with migraine did not change significantly from 2004 to 2013, expenditures remained significantly greater in the migraine population compared with those without migraine across the years. Our study findings suggest the need to design and implement policy and interventions to reduce excess health care expenditures among individuals with migraine. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

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

PubMed

Bhounsule, Prajakta; Peterson, Andrew M

2015-09-01

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

An overview of health financing patterns and the way forward in the WHO African Region.

PubMed

Kirigia, J M; Preker, A; Carrin, G; Mwikisa, C; Diarra-Nama, A J

2006-09-01

The way a health system is financed affects the performance of its other functions of stewardship, input (or resource) creation and services provision, and ultimately, the achievement of health system goals of health improvement (or maintenance), responsiveness to people's non-medical expectations and fair financial contributions. To analyse the changes between 1998 and 2002,in health financing from various sources; and to propose ways of improving the performance of health financing function in the WHO African Region. A retrospective analysis of data obtained from the World Health Report, 2005. The analysis reported in this paper is based on the National Health Accounts (NHA) data for the 46 WHO Member States in the African Region. The data were obtained from the World Health Report 2005. It consisted of information on: levels of per capita expenditure on health; total expenditure on health as a percentage of gross domestic product (GDP); general government expenditure on health as a percentage of total expenditure on health; private expenditure on health as a percentage of total expenditure on health; general government expenditure on health as a percentage of total government expenditure; external expenditure as a percentage of total expenditure on health; social security expenditure on health as a percentage of general government expenditure on health; out-of-pocket expenditure as a percentage of private expenditure on health; and private prepaid plans as a percentage of private expenditure on health. The analysis was done using Lotus SmartSuite software. The analysis revealed that: fifteen countries spent less than 4.5% of their GDP on health; forty four countries spent less than 15% of their national annual budget on health; sixty three percent of the governments in the Region spent less than US$10 per person per year; fifty per cent of the total expenditure on health in 24 countries came from government sources; prepaid health financing mechanisms cover only a small proportion of populations in the Region; private spending constituted over 40% of the total expenditure on health in 31; direct out-of-pocket expenditures constituted over 50% of the private health expenditure in 38 countries. Every country needs to develop clear pro-poor health financing policy and a comprehensive health financing strategic plan with a clear roadmap of how it plans to transit from the current health financing state dominated by inequitable, catastrophic and impoverishing direct out-of-pocket payments to a visionary scenario of universal coverage. The strategic plan should strengthening of health sector advocacy and health financing capacities, health economics evidence generation and utilisation in decision-making, making better use of available and expected resources, monitoring of equity in financing, strengthening of the exemption mechanisms, managed removal of direct out-of-pocket payments (for countries that choose to), and improving country-led sectoral coordination mechanisms (e.g. Sector Wide Approaches).

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

PubMed

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

2003-04-01

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

Health care expenditures in Croatia, 2000-2013: is primary health care in the right position?

PubMed

Brodarić, Zvjezdana; Keglević, Mladenka Vrcić

2014-12-01

The research was undertaken to determine the trends in the amount and the structure of the health care expenditures in Croatia from 2000 to 2013. It is based on routinely collected and publicly available data, The Annual Reports of the Croatian Health Insurance Fund and OECD data. The income of Croatian Health Insurance Fund (CHIF) increased by 66.9%, while total expenditures increased by 62.1%. The fastest growth of expenditure is noticed in expenditures on health care. The hospital and specialist-consultant services have the highest expenditures. Furthermore, the fastest growth is that of other expenses, from 7% of total health care expenditures in 2000, to 26.7% in 2013; which can partly be interpreted as part of hospital care expenses. In the contrast, total expenditures for primary health care decreased, from 22% in 2002, to 13.1% in 2013. The publicly available data are not sufficient enough to drown up any specific conclusions about the underlying reasons for such distribution of the costs.

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

PubMed

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

2012-11-01

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

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

PubMed

Menon, J; Mishra, P

2018-04-01

We determined incremental health care resource utilization, incremental health care expenditures, incremental absenteeism, and incremental absenteeism costs associated with osteoarthritis. Medical Expenditure Panel Survey (MEPS) for 2011 was used as data source. Individuals 18 years or older and employed during 2011 were eligible for inclusion in the sample for analyses. Individuals with osteoarthritis were identified based on ICD-9-CM codes. Incremental health care resource utilization included annual hospitalization, hospital days, emergency room visits and outpatient visits. Incremental health expenditures included annual inpatient, outpatient, emergency room, medications, miscellaneous and annual total expenditures. Of the total sample, 1354 were diagnosed with osteoarthritis, and compared to non osteoarthritis individuals. Incremental resource utilization, expenditures, absenteeism and absenteeism costs were estimated using regression models, adjusting for age, gender, sex, region, marital status, insurance coverage, comorbidities, anxiety, asthma, hypertension and hyperlipidemia. Regression models revealed incremental mean annual resource use associated with osteoarthritis of 0.07 hospitalizations, equal to 70 additional hospitalizations per 100 osteoarthritic patients annually, and 3.63 outpatient visits, equal to 363 additional visits per 100 osteoarthritic patients annually. Mean annual incremental total expenditures associated with osteoarthritis were $2046. Annually, mean incremental expenditures were largest for inpatient expenditures at $826, followed by mean incremental outpatient expenditures of $659, and mean incremental medication expenditures of $325. Mean annual incremental absenteeism was 2.2 days and mean annual incremental absenteeism costs were $715.74. Total direct expenditures were estimated at $41.7 billion. Osteoarthritis was associated with significant incremental health care resource utilization, expenditures, absenteeism and absenteeism costs. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Medical care expenditures for selected circulatory diseases: opportunities for reducing national health expenditures.

PubMed

Hodgson, T A; Cohen, A J

1999-10-01

Circulatory system diseases are a significant burden in terms of morbidity, mortality, and use of health care services. This article presents total, per capita, and per condition US medical care expenditures in 1995 for circulatory diseases according to sex, age, and type of health service. Total personal health care expenditures estimated by the Health Care Financing Administration for each type of health care service are separated into components to estimate patient expenditures by age, sex, primary medical diagnosis, and health care service for all diseases of the circulatory system, heart disease, coronary heart disease, congestive heart failure, hypertensive disease, and cerebrovascular disease. Expenditures for circulatory diseases totaled $127.8 billion in 1995 (17% of all personal health care expenditures), $486 per capita, and $1,636 per condition. Approximately one half of expenditures was for hospital care and 20% was for nursing home care. Heart disease accounted for 60% of circulatory expenditures. Expenditures increased with age and reached 35% of expenditures among persons aged 85 years and older, which was almost $7,000 per capita. These relationships vary somewhat according to the specific circulatory disease, type of health care, and age. Expenditures increase with age and circulatory diseases can be expected to command an increasing share of national health expenditures as the number and proportion of the population that is elderly grows. The alteration of lifestyles and medical interventions provide many opportunities to prevent circulatory diseases and to reduce national health expenditures.

Summary Statistics of CPB-Qualified Public Radio Stations, Fiscal Year 1972.

ERIC Educational Resources Information Center

Lee, S. Young; Pedone, Ronald J.

Statistics in the areas of finance, employment, and broadcast and production for CPB-qualified (Corporation for Public Broadcasting) public radio stations are given in this report. Tables in the area of finance are presented specifying total funds, income, direct operating costs, and capital expenditure. Employment is divided into all employment…

Summary Statistics of CPB-Qualified Public Radio Stations: Fiscal Year 1971.

ERIC Educational Resources Information Center

Lee, S. Young; Pedone, Ronald J.

Basic statistics on finance, employment, and broadcast and production activities of 103 Corporation for Public Broadcasting (CPB)--qualified radio stations in the United States and Puerto Rico for Fiscal Year 1971 are collected. The first section of the report deals with total funds, income, direct operating costs, capital expenditures, and other…

Summary Statistics of Public TV Licensees, 1972.

ERIC Educational Resources Information Center

Lee, S. Young; Pedone, Ronald J.

Statistics in the areas of finance, employment, broadcast and production for public TV licenses in 1972 are given in this report. Tables in the area of finance are presented specifying total funds, income, direct operating costs, and capital expenditures. Employment is divided into all employment with subdivisions for full- and part-time employees…

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

PubMed

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

2017-04-01

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

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2013-03-15

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

Medical Expenditures and Earnings Losses Among US Adults With Arthritis in 2013.

PubMed

Murphy, Louise B; Cisternas, Miriam G; Pasta, David J; Helmick, Charles G; Yelin, Edward H

2018-06-01

We estimated the economic impact of arthritis using 2013 US Medical Expenditure Panel Survey (MEPS) data. We calculated arthritis-attributable and all-cause medical expenditures for adults age ≥18 years and arthritis-attributable earnings losses among those ages 18-64 years who had ever worked. We calculated arthritis-attributable costs using multistage regression-based methods, and conducted sensitivity analyses to estimate costs for 2 other arthritis definitions in MEPS. In 2013, estimated total national arthritis-attributable medical expenditures were $139.8 billion (range $135.9-$157.5 billion). Across expenditure categories, ambulatory care expenditures accounted for nearly half of arthritis-attributable expenditures. All-cause expenditures among adults with arthritis represented 50% of the $1.2 trillion national medical expenditures among all US adults in MEPS. Estimated total national arthritis-attributable earning losses were $163.7 billion (range $163.7-$170.0 billion). The percentage with arthritis who worked in the past year was 7.2 percentage points lower than those without arthritis (76.8% [95% confidence interval (95% CI)] 75.0-78.6 and 84.0% [95% CI 82.5-85.5], respectively, adjusted for sociodemographics and chronic conditions). Total arthritis-attributable medical expenditures and earnings losses were $303.5 billion (range $303.5-$326.9 billion). Total national arthritis-attributable medical care expenditures and earnings losses among adults with arthritis were $303.5 billion in 2013. High arthritis-attributable medical expenditures might be reduced by greater efforts to reduce pain and improve function. The high earnings losses were largely attributable to the substantially lower prevalence of working among those with arthritis compared to those without, signaling the need for interventions that keep people with arthritis in the workforce. © 2017, American College of Rheumatology.

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

PubMed

Wang, Li; Leslie, Douglas L

2010-11-01

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

Incremental health care services and expenditures associated with depression among individuals with cutaneous lupus erythematosus (CLE).

PubMed

Ogunsanya, M E; Nduaguba, S O; Brown, C M

2018-06-01

Objectives The objective of this paper is to describe the annual direct medical expenditures for cutaneous lupus erythematosus (CLE) patients, and to estimate the incremental health care expenditures and utilization associated with depression among adults with CLE, while controlling for covariates. Methods Using the 2014 Medical Expenditure Panel Survey (MEPS), we compared CLE patients with and without depression to determine differences in: (a) health care utilization-inpatient, outpatient, office-based and emergency room (ER) visits, and prescriptions filled; and (b) expenditures-total costs, inpatient, outpatient, office-based, ER, and prescription medication costs, and other costs using demography-adjusted and comorbidity-adjusted multivariate models (age, gender, race/ethnicity, marital status, education, perception of health status, poverty category, smoking status, and Charlson Comorbidity Index). Results The total direct medical expenditure associated with CLE is estimated at approximately $29.7 billion in 2014 US dollars. After adjusting for covariates, adults with CLE and depression had more hospital discharges (utilization ratio (UR) = 1.13, 95% confidence interval (CI) (1.00-1.28)), ER visits (UR = 1.17, 95% CI (1.09-1.37)), and prescribed medicines (UR = 2.15, 95% CI (1.51-3.05)) than those without depression. Adults with CLE and depression had significantly higher average annual total expenditure that those without depression ($19,854 vs. $9735). Conclusions High health care expenditures are significant for patients with CLE, especially among those with depression. Prescription drugs, inpatient visits, and ER visits contributed most to the total expenditures in CLE patients with depression. Early diagnosis and treatment of depression in CLE patients may reduce total health care expenditures and utilization in this population.

Household food insecurity and food expenditure in Bolivia, Burkina Faso, And the Philippines.

PubMed

Melgar-Quinonez, Hugo R; Zubieta, Ana C; MkNelly, Barbara; Nteziyaremye, Anastase; Gerardo, Maria Filipinas D; Dunford, Christopher

2006-05-01

This study examined the association between food insecurity, determined by a modified version of the U.S. Household Food Security Survey Module (US HFSSM), and total daily per capita (DPC) consumption (measured as household expenditures) in Bolivia, Burkina Faso, and the Philippines. Household food insecurity was determined by an adapted 9-item US HFSSM version. A short version of the World Bank's Living Standards Measurement Study (LSMS) consumption module measured household expenditures. Focus groups were used to adapt the survey instrument to each local context. The sample (n approximately 330 per country) includes residents of urban and rural areas. A 12-month food expenditure aggregate was generated as part of the total household expenditures calculation. DPC food expenditure, which represented over 60% of the total household consumption, as well as expenditures on specific food groups correlated with food insecurity both as a continuous Food Insecurity Score (FinSS) and a tricategorical food insecurity status variable. ANOVA and regression analysis were executed adjusting for social and demographic covariates. Food-secure households have significantly higher (P < 0.05) total DPC food expenditures as well as expenditures on animal source foods, vegetables, and fats and oils than moderately and severely food-insecure households. The results offer evidence that the US HFSSM is able to discriminate between households at different levels of food insecurity status in diverse developing world settings.

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

PubMed

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

2010-01-01

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

Health Care Utilization and Expenditures of Patients with Diabetes Comorbid with Depression Disorder: A National Population-Based Cohort Study.

PubMed

Huang, Chun-Jen; Hsieh, Hui-Min; Chiu, Herng-Chia; Wang, Peng-Wei; Lee, Mei-Hsuan; Li, Chih-Yi; Lin, Ching-Hua

2017-11-01

The study investigated to compare health care utilization and expenditures between diabetic patients with and without depression in Taiwan. Health care utilization and expenditure among diabetic patients with and without depression disorder during 2000 and 2004 were examined using Taiwan's population-based National Health Insurance claims database. Health care utilization included outpatient visits and the use of inpatient services, and health expenditures were outpatient, inpatient, and total medical expenditures. Moreover, general estimation equation models were used for analyzing the factors associated with outpatient visits and expenditures. Multiple logistic regression analysis was applied for identifying the factors associated with hospitalization. The average annual outpatient visits and annual total medical expenditures in the study period were 44.23-52.20; NT$87,496-133,077 and 30.75-32.92; NT$64,411-80,955 for diabetic patients with and without depression. After adjustment for covariates, our results revealed that gender and complication were associated with out-patient visits. Moreover, the time factor was associated with the total medical expenditure, and residential urbanization and complication factors were associated with hospitalization. Health care utilization and expenditures for diabetic patients with depression were significantly higher than those without depression. Sex, complications, time, and urbanization are the factors associated with health care utilization and expenditures.

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

PubMed Central

Freeland, Mark S.; Schendler, Carol Ellen

1981-01-01

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

Projecting future drug expenditures--2010.

PubMed

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

2010-06-01

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

Chronic conditions and medical expenditures among non-institutionalized adults in the United States.

PubMed

Lee, De-Chih; Shi, Leiyu; Pierre, Geraldine; Zhu, Jinsheng; Hu, Ruwei

2014-11-26

This study sought to examine medical expenditures among non-institutionalized adults in the United States with one or more chronic conditions. Using data from the 2010 Medical Expenditure Panel Survey (MEPS) Household Component (HC), we explored total and out-of-pocket medical, hospital, physician office, and prescription drug expenditures for non-institutionalized adults 18 and older with and without chronic conditions. We examined relationships between expenditure differences and predisposing, enabling, and need factors using recent, nationally representative data. Individuals with chronic conditions experienced higher total spending than those with no chronic conditions, even after controlling for confounding factors. This relationship persisted with age. Out-of-pocket spending trends mirrored total expenditure trends across health care categories. Additional population characteristics that were associated with high health care expenditures were race/ethnicity, marital status, insurance status, and education. The high costs associated with having one or more chronic conditions indicates a need for more robust interventions to target population groups who are most at risk.

Food Insecurity and Health Care Expenditures in the United States, 2011-2013.

PubMed

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

2018-06-01

To determine whether food insecurity, limited or uncertain food access owing to cost, is associated with greater health care expenditures. Nationally representative sample of the civilian noninstitutionalized population of the United States (2011 National Health Interview Survey [NHIS] linked to 2012-2013 Medication Expenditure Panel Survey [MEPS]). Longitudinal retrospective cohort. A total of 16,663 individuals underwent assessment of food insecurity, using the 10-item adult 30-day food security module, in the 2011 NHIS. Their total health care expenditures in 2012 and 2013 were recorded in MEPS. Expenditure data were analyzed using zero-inflated negative binomial regression and adjusted for age, gender, race/ethnicity, education, income, insurance, and residence area. Fourteen percent of individuals reported food insecurity, representing 41,616,255 Americans. Mean annualized total expenditures were $4,113 (standard error $115); 9.2 percent of all individuals had no health care expenditures. In multivariable analyses, those with food insecurity had significantly greater estimated mean annualized health care expenditures ($6,072 vs. $4,208, p < .0001), an extra $1,863 in health care expenditure per year, or $77.5 billion in additional health care expenditure annually. Food insecurity was associated with greater subsequent health care expenditures. Future studies should determine whether food insecurity interventions can improve health and reduce health care costs. © Health Research and Educational Trust.

State of Hawaii Department of Education Financial Report, July 1, 2003-June 30, 2004.

ERIC Educational Resources Information Center

State of Hawaii Department of Education, 2005

2005-01-01

This annual financial report of the Department of Education is prepared each year to inform interested persons of the total cost of public education in the state of Hawaii. The financial report provides both Operating and Capital Improvement Project fund information that is useful in presenting our educational system financing, expenditures and…

Projecting future drug expenditures--2009.

PubMed

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

2009-02-01

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

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

PubMed Central

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

1980-01-01

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

Medicare expenditures among nursing home residents with advanced dementia.

PubMed

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

2011-05-09

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

Animal board invited review: Dairy cow lameness expenditures, losses and total cost.

PubMed

Dolecheck, K; Bewley, J

2018-07-01

Lameness is one of the most costly dairy cow diseases, yet adoption of lameness prevention strategies remains low. Low lameness prevention adoption might be attributable to a lack of understanding regarding total lameness costs. In this review, we evaluated the contribution of different expenditures and losses to total lameness costs. Evaluated expenditures included labor for treatment, therapeutic supplies, lameness detection and lameness control and prevention. Evaluated losses included non-saleable milk, reduced milk production, reduced reproductive performance, increased animal death, increased animal culling, disease interrelationships, lameness recurrence and reduced animal welfare. The previous literature on total lameness cost estimates was also summarized. The reviewed studies indicated that previous estimates of total lameness costs are variable and inconsistent in the expenditures and losses they include. Many of the identified expenditure and loss categories require further research to accurately include in total lameness cost estimates. Future research should focus on identifying costs associated with specific lameness conditions, differing lameness severity levels, and differing stages of lactation at onset of lameness to provide better total lameness cost estimates that can be useful for decision making at both the herd and individual cow level.

Health worker remuneration in WHO Member States

PubMed Central

Poullier, JP; Van Mosseveld, CJM; Van de Maele, N; Cherilova, V; Indikadahena, C; Lie, G; Tan-Torres, T; Evans, David B

2013-01-01

Abstract Objective To present the available data on the money spent by Member States of the World Health Organization (WHO) on remunerating health workers in the public and private sectors. Methods Data on government and total expenditure on health worker remuneration were obtained through a review of official documents in WHO’s Global Health Expenditure Database and directly from country officials and country official web sites. Such data are presented in this paper, by World Bank country income groups, in millions of national currency units per calendar year for salaried and non-salaried health workers. They are presented as a share of gross domestic product (GDP), total health expenditure and general government health expenditure. The average yearly change in remuneration (i.e. compound annual growth rate) between 2000 and 2012 as a function of these parameters was also assessed. Findings On average, payments to health workers of all types accounted for more than one third of total health expenditure across countries. Such payments have grown faster than countries’ GDPs but less rapidly than total health expenditure and general government health expenditure. Remuneration of health workers, on the other hand, has grown faster than that of other types of workers. Conclusion As they seek to attain universal health coverage (UHC), countries will need to devote an increasing proportion of their GDPs to health and health worker remuneration. However, the fraction of total health expenditure devoted to paying health workers seems to be declining, partly because the pursuit of UHC calls for strengthening the health system as a whole. PMID:24347704

Hong Kong domestic health spending: financial years 1989/90 to 2011/12.

PubMed

Tin, K Y K; Tsoi, P K O; Lee, Y H; Chong, D S Y; Lam, D W S; Yeung, A Y T; Ma, E S K; Maw, C K C

2015-06-01

This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2011/12, cross-stratified and categorized by financing source, provider, and function. Total expenditure on health (TEH) was HK$101 985 million in financial year 2011/12, which represents an increase of HK$8580 million or 9.2% over the preceding year. TEH grew faster relative to gross domestic product (GDP) leading to a rise in TEH as a percentage of GDP from 5.1% in 2010/11 to 5.2% in 2011/12. During the period 1989/90 to 2011/12, total health spending per capita (at constant 2012 prices) grew at an average annual rate of 4.8%, which was faster than the average annual growth rate of per capita GDP by 1.8 percentage points. In 2011/12, public and private expenditure on health increased by 8.3% and 10.0% when compared with 2010/11, reaching HK$49,262 million and HK$52,723 million respectively. Consequently, public share of total health expenditure dropped slightly from 48.7% to 48.3% over the year. Of private spending, the most important source of health financing was out-of-pocket payments by households (34.9% of TEH), followed by employer-provided group medical benefits (7.5%) and private insurance (7.4%). It is worth noting that private insurance will likely take over employers as the second largest private payer if the insurance market continues to expand at the current rate. Of the HK$101,985 million total health expenditure in 2011/12, current expenditure comprised HK$96,572 million (94.7%), whereas HK$5413 million (5.3%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services of curative care accounted for the largest share of total health spending (65.2%), which was made up of ambulatory services (33.6%), in-patient curative care (26.9%), day patient hospital services (4.1%), and home care (0.5%). Notwithstanding its small share, the total spending for day patient hospital services shows an increasing trend over the period 1989/90 to 2011/12, likely as a result of policy directives to shift the emphasis from in-patient to day patient care. Hospitals accounted for an increasing share of total spending, from 28.2% in 1989/90 to 46.8% in 2002/03 and then dropped slightly to 42% to 44% during the period 2005/06 to 2011/12, which was primarily driven by reduced expenditure of Hospital Authority. As a result of the epidemics which are of public health importance (eg avian flu, SARS, swine flu) and the expansion of private health insurance market in the last two decades, spending on provision and administration of public health programmes, and general health administration and insurance accounted for increasing, though less significant, shares of total health spending over the period. Without taking into account capital expenses (ie investment in medical facilities), public current expenditure on health amounted to HK$45,321 million (46.9% of total current expenditure) in 2011/12 with the remaining HK$51,251 million made up of private sources of funds. Public current expenditure was mostly incurred at hospitals (74.1%), whereas private current expenditure was mostly incurred at providers of ambulatory health care (51.2%). Although both public and private spending were mostly expended on personal health care services and goods (91.1% of total current spending), the distributional patterns among functional categories differed. Public expenditure was targeted at in-patient care (47.3%) and substantially less on out-patient care (27.4%). In comparison, private spending was mostly concentrated on out-patient care (42.7%), whereas in-patient care (24.7%) and medical goods outside the patient care setting (19.9%) comprised the majority of the remaining share. Compared to the Organisation for Economic Co-operation and Development countries, Hong Kong has devoted a relatively low percentage of GDP to health care in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than those in most economies with comparable economic development and public revenue collection base. Nonetheless, Hong Kong health care system achieved service quality and health outcome that fared well by global standards, indicating cost efficiency and effectiveness.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-03

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

Robust analysis of the determinants of healthcare expenditure growth: evidence from panel data for low-, middle- and high-income countries.

PubMed

Younsi, Moheddine; Chakroun, Mohamed; Nafla, Amine

2016-10-01

This paper examines the determinants of healthcare expenditure for low-, middle- and high-income countries, and it quantifies their influences in order to assess policies for achieving universal health coverage. We elaborate two models, a fixed-effect model and the dynamic panel model, to estimate the factors associated with the total health expenditure growth as well as its major components for 167 countries over the period of 1993-2013. The panel data on total health expenditure per capita and its components were taken from the World Development Indicators. Overall, our results showed that total health expenditure per capita is rising in all countries over time as a result of rising incomes. However, our estimates showed that the income elasticity of health expenditure ranged from 0.75 to 0.96 in the fixed-effect static panel model, while in the dynamic panel model, it was smaller and ranged from 0.16 to 0.47. Our empirical findings indicate that development assistance for health reduced government domestic spending on health but increased total government health spending. Our results also indicate that the trend in health expenditure growth is significantly depending with the country's economic development. In addition, out-of-pocket expenditure is powerfully influenced by a country's capacity to increase general government revenues and social insurance contributions. Knowledge of factors associated to health expenditure might help policy makers to make wise judgments, plan health reforms and allocate resources efficiently. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Physical activity, sleep pattern and energy expenditure in double-handed offshore sailing.

PubMed

Galvani, C; Ardigò, L P; Alberti, M; Daniele, F; Capelli, C

2015-12-01

The aim of the present study was to quantify total energy expenditure, activity energy expenditure and time spent at three levels of physical activity (low, moderate, high intensity) in four two-person crews during a 500-mile double-handed sailing regatta. Physical activity intensity and energy expenditure were assessed during a 500-nautical-mile double-handed offshore competition in eight male sailors (46.3±3.4 years; 180±13 cm; 85.4±12.5 kg). During the whole regatta, they wore an activity monitor that estimated energy expenditure and minutes spent at each level of intensity (sedentary, <1.5 METs; light physical activity, 1.5-2.9 METs; moderate physical activity, 3.0-6.0 METs; vigorous physical activity, >6.0 METs). The sailors spent longer periods (P<0.0001) of time in sedentary (823±193 min/day) and light physical activities (516±177 min/day) than in moderate (95±34 min/day) or vigorous (6±4 min/day) physical activities. They slept 5 times per day (±1.4) for 36 min (±9) in each sleeping period. The total energy expenditure was 14.26±1.89 MJ/day and the activity energy expenditure was 5.06±1.42 MJ/day. Activity energy expenditure was significantly correlated with total sleep time, boat speed, and distance covered each day (P<0.05). CONCLUSION;:The high total energy expenditure was more likely a consequence of the short and rare periods of sleep during the competition rather than of the bouts of moderate and vigorous physical activities.

Cost of dry eye treatment in an Asian clinic setting.

PubMed

Waduthantri, Samanthila; Yong, Siew Sian; Tan, Chien Hua; Shen, Liang; Lee, Man Xin; Nagarajan, Sangeetha; Hla, Mynt Htoon; Tong, Louis

2012-01-01

To estimate the cost and patterns of expenditure of dry eye treatment. We retrieved data on the type and cost of dry eye treatment in Singapore National Eye Centre from pharmacy and clinic inventory databases over a 2 year period (2008-2009) retrospectively. According to the type of treatment, data were sorted into 7 groups; meibomien gland disease (MGD) treatment, preservative free lubricant eye drops, preserved lubricant eye drops, lubricant ointments and gels, cyclosporine eye drops, oral supplements and non-pharmacological treatments/procedures. Each recorded entry was considered as one patient episode (PE). Comparisons in each group between two years were carried out using Pearson Chi-Square test. Significance level was set at alpha  =  0.05. Cost data from 54,052 patients were available for analysis. Total number of recorded PEs was 132,758. Total annual expenditure on dry eye treatment for year 2008 and 2009 were US$1,509,372.20 and US$1,520,797.80 respectively. Total expenditure per PE in year 2008 and 2009 were US$22.11 and US$23.59 respectively. From 2008 to 2009, there was a 0.8% increase in total annual expenditure and 6.69% increase in expenditure per PE. Pharmacological treatment attributes to 99.2% of the total expenditure with lubricants accounting for 79.3% of the total pharmacological treatment expenditure. Total number of units purchased in preservative free lubricants, cyclosporine eye drops and MGD therapy have increased significantly (p<0.001) whereas number of units purchased in preserved lubricants and ointments/gels have reduced significantly (p<0.001) from 2008 to 2009. Dry eye imposes a significant direct burden to health care expenditure even without considering indirect costs. Health care planners should be aware that these direct costs appear to increase over the time and more so for particular types of medications. Given the limitations of socio-economic data, true societal costs of Dry eye syndrome are likely to be much higher than estimated.

25 CFR 47.7 - What are the expenditure limitations for Bureau-operated schools?

Code of Federal Regulations, 2010 CFR

2010-04-01

... schools? 47.7 Section 47.7 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION UNIFORM DIRECT FUNDING AND SUPPORT FOR BUREAU-OPERATED SCHOOLS § 47.7 What are the expenditure limitations for Bureau-operated schools? Each Bureau-operated school must spend all allotted funds in accordance with...

25 CFR 47.7 - What are the expenditure limitations for Bureau-operated schools?

Code of Federal Regulations, 2014 CFR

2014-04-01

... schools? 47.7 Section 47.7 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION UNIFORM DIRECT FUNDING AND SUPPORT FOR BUREAU-OPERATED SCHOOLS § 47.7 What are the expenditure limitations for Bureau-operated schools? Each Bureau-operated school must spend all allotted funds in accordance with...

25 CFR 47.7 - What are the expenditure limitations for Bureau-operated schools?

Code of Federal Regulations, 2013 CFR

2013-04-01

... schools? 47.7 Section 47.7 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION UNIFORM DIRECT FUNDING AND SUPPORT FOR BUREAU-OPERATED SCHOOLS § 47.7 What are the expenditure limitations for Bureau-operated schools? Each Bureau-operated school must spend all allotted funds in accordance with...

25 CFR 47.7 - What are the expenditure limitations for Bureau-operated schools?

Code of Federal Regulations, 2012 CFR

2012-04-01

... schools? 47.7 Section 47.7 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION UNIFORM DIRECT FUNDING AND SUPPORT FOR BUREAU-OPERATED SCHOOLS § 47.7 What are the expenditure limitations for Bureau-operated schools? Each Bureau-operated school must spend all allotted funds in accordance with...

25 CFR 47.7 - What are the expenditure limitations for Bureau-operated schools?

Code of Federal Regulations, 2011 CFR

2011-04-01

... schools? 47.7 Section 47.7 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION UNIFORM DIRECT FUNDING AND SUPPORT FOR BUREAU-OPERATED SCHOOLS § 47.7 What are the expenditure limitations for Bureau-operated schools? Each Bureau-operated school must spend all allotted funds in accordance with...

Utilisation and costs of nursing agencies in the South African public health sector, 2005–2010

PubMed Central

Rispel, Laetitia C.; Angelides, George

2014-01-01

Background Globally, insufficient information exists on the costs of nursing agencies, which are temporary employment service providers that supply nurses to health establishments and/or private individuals. Objective The aim of the study was to determine the utilisation and direct costs of nursing agencies in the South African public health sector. Design A survey of all nine provincial health departments was conducted to determine utilisation and management of nursing agencies. The costs of nursing agencies were assumed to be equivalent to expenditure. Provincial health expenditure was obtained for five financial years (2005/6–2009/10) from the national Basic Accounting System database, and analysed using Microsoft Excel. Each of the 166,466 expenditure line items was coded. The total personnel and nursing agency expenditure was calculated for each financial year and for each province. Nursing agency expenditure as a percentage of the total personnel expenditure was then calculated. The nursing agency expenditure for South Africa is the total of all provincial expenditure. The 2009/10 annual government salary scales for different categories of nurses were used to calculate the number of permanent nurses who could have been employed in lieu of agency expenditure. All expenditure is expressed in South African rands (R; US$1 ∼ R7, 2010 prices). Results Only five provinces reported utilisation of nursing agencies, but all provinces showed agency expenditure. In the 2009/10 financial year, R1.49 billion (US$212.64 million) was spent on nursing agencies in the public health sector. In the same year, agency expenditure ranged from a low of R36.45 million (US$5.20 million) in Mpumalanga Province (mixed urban-rural) to a high of R356.43 million (US$50.92 million) in the Eastern Cape Province (mixed urban-rural). Agency expenditure as a percentage of personnel expenditure ranged from 0.96% in KwaZulu-Natal Province (mixed urban-rural) to 11.96% in the Northern Cape Province (rural). In that financial year, a total of 5369 registered nurses could have been employed in lieu of nursing agency expenditure. Conclusions The study findings should inform workforce planning in South Africa. There is a need for uniform policies and improved management of commercial nursing agencies in the public health sector. PMID:25537936

Utilisation and costs of nursing agencies in the South African public health sector, 2005-2010.

PubMed

Rispel, Laetitia C; Angelides, George

2014-01-01

Globally, insufficient information exists on the costs of nursing agencies, which are temporary employment service providers that supply nurses to health establishments and/or private individuals. The aim of the study was to determine the utilisation and direct costs of nursing agencies in the South African public health sector. A survey of all nine provincial health departments was conducted to determine utilisation and management of nursing agencies. The costs of nursing agencies were assumed to be equivalent to expenditure. Provincial health expenditure was obtained for five financial years (2005/6-2009/10) from the national Basic Accounting System database, and analysed using Microsoft Excel. Each of the 166,466 expenditure line items was coded. The total personnel and nursing agency expenditure was calculated for each financial year and for each province. Nursing agency expenditure as a percentage of the total personnel expenditure was then calculated. The nursing agency expenditure for South Africa is the total of all provincial expenditure. The 2009/10 annual government salary scales for different categories of nurses were used to calculate the number of permanent nurses who could have been employed in lieu of agency expenditure. All expenditure is expressed in South African rands (R; US$1 ∼ R7, 2010 prices). Only five provinces reported utilisation of nursing agencies, but all provinces showed agency expenditure. In the 2009/10 financial year, R1.49 billion (US$212.64 million) was spent on nursing agencies in the public health sector. In the same year, agency expenditure ranged from a low of R36.45 million (US$5.20 million) in Mpumalanga Province (mixed urban-rural) to a high of R356.43 million (US$50.92 million) in the Eastern Cape Province (mixed urban-rural). Agency expenditure as a percentage of personnel expenditure ranged from 0.96% in KwaZulu-Natal Province (mixed urban-rural) to 11.96% in the Northern Cape Province (rural). In that financial year, a total of 5369 registered nurses could have been employed in lieu of nursing agency expenditure. The study findings should inform workforce planning in South Africa. There is a need for uniform policies and improved management of commercial nursing agencies in the public health sector.

Health care utilization and expenditures of persons with diabetes comorbid with anxiety disorder: a national population-based cohort study.

PubMed

Huang, Chun-Jen; Chiu, Herng-Chia; Hsieh, Hui-Min; Yen, Ju-Yu; Lee, Mei-Hsuan; Chang, Kao-Ping; Li, Chih-Yi; Lin, Ching-Hua

2015-01-01

The aim of this study was to investigate and compare health care utilization and expenditures between persons with diabetes comorbid with and without anxiety disorder in Taiwan. Health care utilization and expenditures among persons with diabetes with and without comorbid anxiety disorder in the period 2000-2004 were examined using the Taiwan's National Health Insurance claims data. Health care utilization included outpatient visits and use of hospital inpatient services, while expenditures included outpatient, inpatient and total medical expenditures. General estimation equation (GEE) models were used to analyze the factors associated with outpatient visits and expenditures, and multiple logistic regression analysis was applied to identify factors associated with hospitalization. In the study period, the average number of annual outpatient visits was 43.11-50.37 and 29.82-31.42 for persons with diabetes comorbid with anxiety disorder and for those without anxiety disorder, respectively. The average annual total expenditure was NT$74,875-92,781 and NT$63,764-81,667, respectively. Controlling for covariates, the GEE models revealed that age and time were associated with outpatient visits. Income and time factor were associated with total expenditure. Health care utilization and expenditures for persons with diabetes with comorbid anxiety disorder are significantly higher than those without anxiety disorder. The factors associated with health care utilization and expenditures are age, income and time. Copyright © 2015 Elsevier Inc. All rights reserved.

Healthcare Utilization and Expenditures for Persons with Diabetes Comorbid with Mental Illnesses.

PubMed

Su, Chen-Hsiang; Chiu, Herng-Chia; Hsieh, Hui-Min; Yen, Ju-Yu; Lee, Mei-Hsuan; Li, Chih-Yi; Chang, Kao-Ping; Huang, Chun-Jen

2016-09-01

The aim of this study was to investigate healthcare utilization and expenditure for patients with diabetes comorbid with and without mental illnesses in Taiwan. People with diabetes comorbid with and without mental illnesses in 2000 were identified and followed up to 2004 to explore the healthcare utilization and expenditure. Healthcare utilization included outpatient visits and use of hospital inpatient services, and expenditure included outpatient, inpatient and total medical expenditure. General estimation equation models were used to explore the factors associated with outpatient visits and expenditure. To identify the factors associated with hospitalization, multiple logistic regressions were applied. The average number of annual outpatient visits of the patients with mental illnesses ranged from 37.01 to 41.91, and 28.83 to 31.79 times for the patients without mental illnesses from 2000 to 2004. The average annual total expenditure for patients with mental illnesses during this period ranged from NT$77,123-NT$90,790, and NT$60,793- NT$84,984 for those without mental illnesses. After controlling for covariates, the results indicated that gender, age, mental illness and time factor were associated with outpatient visits. Gender, age, and time factor were associated with total expenditure. Age and mental illness were associated with hospitalization in logistic regression. The healthcare utilization and expenditure for patients with mental illnesses was significantly higher than for patients without mental illnesses. The factors associated with healthcare utilization and expenditure included gender, age, mental illness and time trends.

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

PubMed

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

2015-04-01

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

Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

PubMed Central

Shrestha, Sundar S.; Zhang, Ping; Li, Rui; Thompson, Theodore J.; Chapman, Daniel P.; Barker, Lawrence

2017-01-01

Aim We aimed at estimating excess medical expenditures associated with major depressive disorder (MDD) among working-age adults diagnosed with diabetes, disaggregated by treatment mode: insulin-treated diabetes (ITDM) or non-insulin-treated diabetes (NITDM). Methods We analyzed data for over 500,000 individuals with diagnosed diabetes from the 2008 U.S. MarketScan claims database. We grouped diabetic patients first by treatment mode (ITDM or NITDM), then by MDD status (with or without MDD), and finally by whether those with MDD used antidepressant medication. We estimated annual mean excess outpatient, inpatient, prescription drug, and total expenditures using regression models, controlling for demographics, types of health coverage, and comorbidities. Results Among persons having ITDM, the estimated annual total mean expenditure for those with no MDD (the comparison group) was $19,625. For those with MDD, the expenditures were $12,406 (63%) larger if using antidepressant medication and $7322 (37%) larger if not using antidepressant medication. Among persons having NITDM, the corresponding estimated expenditure for the comparison group was $10,746, the excess expenditures were $10,432 (97%) larger if using antidepressant medication and $5579 (52%) larger if not using antidepressant medication, respectively. Inpatient excess expenditures were the largest of total excess expenditure for those with ITDM and MDD treated with antidepressant medication; for all others with diabetes and MDD, outpatient expenditures were the largest excess expenditure. Conclusions Among working-age adults with diabetes, MDD was associated with substantial excess medical expenditures. Implementing the effective interventions demonstrated in clinical trials and treatment guidelines recommended by professional organizations might reduce the economic burden of MDD in this population. PMID:23490596

Expenditures on family dental care by active duty soldiers.

PubMed

Chisick, M C

1996-01-01

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

The Epidemiology of Physical Training Injuries in U.S. Army Infantry Trainees: Methodology, Population, and Risk Factors

DTIC Science & Technology

1988-11-01

of the weight of the individual, as is the measure of caloric expenditure per minute (kCal/min). METs and kCal/min may be converted to one another if...Fitness Measures as Risk Factors for Injury TABLE 19. Quintiles and Ranges of Total METs Expenditures as Risk Factors for Injury TABLE 20...lifted overhead. ## MLWRATIO: Maximum lift/body weight. 23 TABLE 19. Quintiles# and Ranges of Total METs Expenditures as Risk Factors for Injury. Total

Ecological Settings and State Economies as Factor Inputs in the Provision of Outdoor Recreation

NASA Astrophysics Data System (ADS)

Siderelis, Christos; Smith, Jordan W.

2013-09-01

State parks play a substantial role in the provision of outdoor recreation opportunities within the United States. Park operators must make crucial decisions in how they allocate capital expenditures, labor, and parkland to maintain recreation opportunities. Their decisions are influenced, in part, by the ecological characteristics of their state's park system as well as the vitality of their state's economy. In this research, we incorporate the characteristics of states' ecosystems and their local economies into a formal production analysis of the states' park systems from the years 1986 to 2011. Our analysis revealed all three factors of production were positive and inelastic. Expenditures on labor had the largest effect on both park utilization and operational expenditures. Our analysis also found a large degree of variability in the effects of ecological characteristics on both utilization and operating expenditures. Parkland utilization and operational expenditures were more elastic in areas such as Oceania and Mediterranean California relative to other ecological regions. These findings lead us to conclude that state park operators will experience variable levels of difficulty in both accommodating increasing demands for recreation from state parks and maintaining the existing quality of outdoor recreation provided within their system.

A cost analysis of family planning in Bangladesh.

PubMed

Fiedler, J L; Day, L M

1997-01-01

This article presents a step-down cost analysis using secondary data sources from 26 Bangladesh non-government organizations (NGOs) providing family planning services under a US Agency for International Development-funded umbrella organization. The unit costs of the NGOs' Maternal-Child Health (MCH) clinics and community-based distribution (CBD) systems were calculated and found to be minimally different. Several simulations were conducted to investigate the impact of alternative cost-reduction measures. The more general financial analysis proved more insightful than the unit cost analysis in terms of identifying means by which to improve the efficiency of the family planning operations of these NGOs. The analysis revealed that 56 per cent of total expenditures in the two-tiered umbrella's organizational structure are incurred in management operations and overheads. Of the remaining 44 per cent of project expenditures, 39 per cent is spent on the CBD program and 5 per cent on the MCH clinics. Within the CBD program, most resources are spent providing 4 million contacts (two-thirds of the annual total) which do not involve contraceptive re-supply. The clinics devote more resources to providing MCH services than to providing family planning services. The findings suggest that significant savings could be generated by containing administrative costs, improving operational efficiency, and reducing unnecessary or redundant fieldworker contacts. The magnitude of the potential savings raises a fundamental question about the continued viability and sustainability of this supply-driven CBD strategy.

[Proposal of a costing method for the provision of sterilization in a public hospital].

PubMed

Bauler, S; Combe, C; Piallat, M; Laurencin, C; Hida, H

2011-07-01

To refine the billing to institutions whose operations of sterilization are outsourced, a sterilization cost approach was developed. The aim of the study is to determine the value of a sterilization unit (one point "S") evolving according to investments, quantities processed, types of instrumentation or packaging. The time of preparation has been selected from all sub-processes of sterilization to determine the value of one point S. The time of preparation of sterilized large and small containers and pouches were raised. The reference time corresponds to one bag (equal to one point S). Simultaneously, the annual operating cost of sterilization was defined and divided into several areas of expenditure: employees, equipments and building depreciation, supplies, and maintenance. A total of 136 crossing times of containers were measured. Time to prepare a pouch has been estimated at one minute (one S). A small container represents four S and a large container represents 10S. By dividing the operating cost of sterilization by the total number of points of sterilization over a given period, the cost of one S can be determined. This method differs from traditional costing method in sterilizing services, considering each item of expenditure. This point S will be the base for billing of subcontracts to other institutions. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

[Descriptive study of the costs of diagnosis and treatment of cutaneous melanoma].

PubMed

Almazán-Fernández, F M; Serrano-Ortega, S; Moreno-Villalonga, J J

2009-11-01

Every year, health expenditure in Spain increases and, with it, the resources dedicated to cancer treatment. Cutaneous melanoma is the skin cancer with the highest morbidity and mortality. We performed a descriptive study of the costs, based on a theoretical model, to determine the healthcare expenditure for patients with cutaneous melanoma; the objective was to define the overall costs (direct and indirect) of the diagnostic and treatment process of cutaneous melanoma, divided into different stages or diagnostic-therapeutic steps, and the possible variations in these costs. For this purpose, we used the Andalusian analytical accountancy program of hospitals and districts (COAN-hyd) and the total costs module of the COAN for 2007, applied to the protocol we use in the melanoma unit of our hospital. The most important conclusions were that the greatest health care expenditure was observed inpatients with more advanced melanomas, with a poor prognosis. Management of the diagnostic-therapeutic process by dermatologists, the appropriate use of complementary tests, and operations performed by dermatologists reduce costs.

Spending on medicines in Israel in an international context.

PubMed

Sax, Philip

2005-05-01

Like most developed countries, in the last decade Israel's healthcare system has been subject to cost-containing measures in the drug sector. To provide comparative information in an international context on the level of outpatient drug expenditures in Israel, both total and those publicly financed, and to analyze how these have changed with time during the last decade. Using definitions of the OECD (Organization of Economic Cooperation and Development), internationally comparable data on total expenditure and public expenditure on medicines in Israel are provided. The Israeli estimates are based on data from the Ministry of Health audited reports of financial activities of the health management organizations and from the family expenditure surveys carried out by the Central Bureau of Statistics. Per capita total and public expenditures in Israel are analyzed over time, as are their share of national expenditure on health and of gross domestic product. Israel expenditures are then compared with those for individual member countries of the OECD, as well as a 21 country average, from 1992 to 2002. Analysis of the Israeli expenditure data shows a considerable reduction in growth of per capita total and public expenditures on medicines since 1997. Growth in the share of total drug expenditure of NEH and of GDP has also been constrained since 1997. In an international context, per capita expenditure on medicines in Israel, particularly what is publicly financed, is one of the lowest. Furthermore, its share of NEH and GDP is also very low compared to other countries. This substantive gap in spending on medicines between Israel and other countries has increased since 1997. Israel, a medium-income country with a lower than average level of expenditure on health compared to OECD countries, has a particularly low level of expenditure on medicines. Whereas the share of health expenditure of GDP in Israel is similar to the international average, the share of drug expenditure of GDP is well below the average. In addition to structural and longer-term factors contributing to Israel's low per capita spending on medicines, such as the young population and the apparently low level of actual prices paid by most institutional purchasers, recent years are witness to the growing impact of National Health Insurance budgetary pressures on HMOs as well as continual increases in prescription cost sharing by patients. The impact is felt both on the demand side (higher copayments, administrative and prescribing restrictions) and perhaps more crucially on the supply side (price competition, mainly from generics). Substantial extra public funding for the addition of new drugs to the NHI basket in recent years has had no overall impact on these longer-term spending patterns.

Parent-Reported Health Consequences and Relationship to Expenditures in Children with ADHD.

PubMed

deJong, Neal A; Williams, Christianna S; Thomas, Kathleen C

2016-04-01

(1) To describe parents' report of special needs for children with ADHD on the Children with Special Health Care Needs (CSHCN) Screener; and (2) to assess the association between responses to Screener items and annual mental health and total health expenditures per child. In pooled 2002-2011 Medical Expenditure Panel Survey (MEPS) data, we identify children ages 4-17 years with ADHD. We use OLS and two-part regressions to model the relationship between CSHCN Screener items and mental health and total health expenditures. Based on these models we estimate adjusted, average total health expenditures for children with ADHD-both with and without a co-morbid mental health condition-and different combinations of endorsed Screener items. This research was conducted in accordance with prevailing ethical principles. There were 3883 observations on 2591 children with ADHD. Without a co-morbid mental health condition, average total expenditures per year from adjusted, model-based estimates were $865 for those meeting no Screener items, $2664 for those meeting only the medication item, $3595 for those meeting the medication and counseling items, and $4203 for those meeting the medication, counseling, and use of more health services items. Children with a co-morbid mental health condition had greater total health expenditures for each combination of Screener items. The associations between Screener items and mental health expenditures were similar, but with a slightly lower marginal effect of the medication item (p < 0.001 for all comparisons). Parents' responses on the CSHCN Screener are associated with meaningful variation in expenditures for children with ADHD. Though cross-sectional, this study suggests that the CSHCN Screener can be a useful categorization scheme for children with ADHD. It may be an efficient, standardized tool at the point of care for identifying children who need more resources and for targeting intensive interventions in the context of population health management.

Direct medical costs of hospitalizations for cardiovascular diseases in Shanghai, China: trends and projections.

PubMed

Wang, Shengnan; Petzold, Max; Cao, Junshan; Zhang, Yue; Wang, Weibing

2015-05-01

Few studies in China have focused on direct expenditures for cardiovascular diseases (CVDs), making cost trends for CVDs uncertain. Epidemic modeling and forecasting may be essential for health workers and policy makers to reduce the cost burden of CVDs.To develop a time series model using Box-Jenkins methodology for a 15-year forecasting of CVD hospitalization costs in Shanghai.Daily visits and medical expenditures for CVD hospitalizations between January 1, 2008 and December 31, 2012 were analyzed. Data from 2012 were used for further analyses, including yearly total health expenditures and expenditures per visit for each disease, as well as per-visit-per-year medical costs of each service for CVD hospitalizations. Time series analyses were performed to determine the long-time trend of total direct medical expenditures for CVDs and specific expenditures for each disease, which were used to forecast expenditures until December 31, 2030.From 2008 to 2012, there were increased yearly trends for both hospitalizations (from 250,354 to 322,676) and total costs (from US $ 388.52 to 721.58 million per year in 2014 currency) in Shanghai. Cost per CVD hospitalization in 2012 averaged US $ 2236.29, with the highest being for chronic rheumatic heart diseases (US $ 4710.78). Most direct medical costs were spent on medication. By the end of 2030, the average cost per visit per month for all CVDs was estimated to be US $ 4042.68 (95% CI: US $ 3795.04-4290.31) for all CVDs, and the total health expenditure for CVDs would reach over US $1.12 billion (95% CI: US $ 1.05-1.19 billion) without additional government interventions.Total health expenditures for CVDs in Shanghai are estimated to be higher in the future. These results should be a valuable future resource for both researchers on the economic effects of CVDs and for policy makers.

Direct Medical Costs of Hospitalizations for Cardiovascular Diseases in Shanghai, China

PubMed Central

Wang, Shengnan; Petzold, Max; Cao, Junshan; Zhang, Yue; Wang, Weibing

2015-01-01

Abstract Few studies in China have focused on direct expenditures for cardiovascular diseases (CVDs), making cost trends for CVDs uncertain. Epidemic modeling and forecasting may be essential for health workers and policy makers to reduce the cost burden of CVDs. To develop a time series model using Box–Jenkins methodology for a 15-year forecasting of CVD hospitalization costs in Shanghai. Daily visits and medical expenditures for CVD hospitalizations between January 1, 2008 and December 31, 2012 were analyzed. Data from 2012 were used for further analyses, including yearly total health expenditures and expenditures per visit for each disease, as well as per-visit-per-year medical costs of each service for CVD hospitalizations. Time series analyses were performed to determine the long-time trend of total direct medical expenditures for CVDs and specific expenditures for each disease, which were used to forecast expenditures until December 31, 2030. From 2008 to 2012, there were increased yearly trends for both hospitalizations (from 250,354 to 322,676) and total costs (from US $ 388.52 to 721.58 million per year in 2014 currency) in Shanghai. Cost per CVD hospitalization in 2012 averaged US $ 2236.29, with the highest being for chronic rheumatic heart diseases (US $ 4710.78). Most direct medical costs were spent on medication. By the end of 2030, the average cost per visit per month for all CVDs was estimated to be US $ 4042.68 (95% CI: US $ 3795.04–4290.31) for all CVDs, and the total health expenditure for CVDs would reach over US $1.12 billion (95% CI: US $ 1.05–1.19 billion) without additional government interventions. Total health expenditures for CVDs in Shanghai are estimated to be higher in the future. These results should be a valuable future resource for both researchers on the economic effects of CVDs and for policy makers. PMID:25997060

Medical resource use and expenditure in patients with chronic heart failure: a population-based analysis of 88 195 patients.

PubMed

Farré, Nuria; Vela, Emili; Clèries, Montse; Bustins, Montse; Cainzos-Achirica, Miguel; Enjuanes, Cristina; Moliner, Pedro; Ruiz, Sonia; Verdú-Rotellar, Jose Maria; Comín-Colet, Josep

2016-09-01

Heart failure (HF) is one of the diseases with greater healthcare expenditure. However, little is known about the cost of HF at a population level. Hence, our aim was to study the population-level distribution and predictors of healthcare expenditure in patients with HF. This was a population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on 31 December 2012 (n = 88 195). We evaluated 1-year healthcare resource use and expenditure using the Health Department (CatSalut) surveillance system that collects detailed information on healthcare usage for the entire population. Mean age was 77.4 (12) years; 55% were women. One-year mortality rate was 14%. All-cause emergency department visits and unplanned hospitalizations were required at least once in 53.4% and 30.8% of patients, respectively. During 2013, a total of €536.2 million were spent in the care of HF patients (7.1% of the total healthcare budget). The main source of expenditure was hospitalization (39% of the total) whereas outpatient care represented 20% of the total expenditure. In the general population, outpatient care and hospitalization were the main expenses. In multivariate analysis, younger age, higher presence of co-morbidities, and a recent HF or all-cause hospitalization were independently associated with higher healthcare expenditure. In Catalonia, a large portion of the annual healthcare budget is devoted to HF patients. Unplanned hospitalization represents the main source of healthcare-related expenditure. The knowledge of how expenditure is distributed in a non-selected HF population might allow health providers to plan the distribution of resources in patients with HF. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

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

PubMed

Lee, Sungkyu; Rothbard, Aileen; Choi, Sunha

2016-08-01

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

[Energy requirements of workers in the coke chemical industry].

PubMed

Vankhanen, V D; Nelepa, A E

1978-01-01

Energy spent by workers engaged in the basic departments of a coke-chemical plant during working hours and performing operations after the Douglas-Holdeine method was measured and total energy expenditures during separate periods of the day and as a whole determined. Depending upon their jobs the energy spent by the workers during working hours varies within a range of 825 to 1860 Kcal. The energy expenditure during the time outside work, including sleep, amounts to from 1482 up to 1756 Kcal. As concerns the calorific requirements of their alimentation the workers of coke-chemical industry are subdivided into 5 groups of labour-intensity within an interval of from 2500 to 3600 kcal (for men) and from 2200 to 3100 kcal (for women).

Revenues and Expenditures for Public Elementary and Secondary Education: School Year 2013-14 (Fiscal Year 2014). First Look. NCES 2016-301

ERIC Educational Resources Information Center

Cornman, Stephen Q.; Zhou, Lei

2016-01-01

This "First Look" contains national and state totals of revenues and expenditures for public elementary and secondary education for school year 2013-14. This "First Look" includes revenues by source and expenditures by function and object, including current expenditures per pupil and instructional expenditures per pupil. This…

The influence of training characteristics on the effect of exercise training in patients with coronary artery disease: Systematic review and meta-regression analysis.

PubMed

Kraal, Jos J; Vromen, Tom; Spee, Ruud; Kemps, Hareld M C; Peek, Niels

2017-10-15

Although exercise-based cardiac rehabilitation improves exercise capacity of coronary artery disease patients, it is unclear which training characteristic determines this improvement. Total energy expenditure and its constituent training characteristics (training intensity, session frequency, session duration and programme length) vary considerably among clinical trials, making it hard to compare studies directly. Therefore, we performed a systematic review and meta-regression analysis to assess the effect of total energy expenditure and its constituent training characteristics on exercise capacity. We identified randomised controlled trials comparing continuous aerobic exercise training with usual care for patients with coronary artery disease. Studies were included when training intensity, session frequency, session duration and programme length was described, and exercise capacity was reported in peakVO 2 . Energy expenditure was calculated from the four training characteristics. The effect of training characteristics on exercise capacity was determined using mixed effects linear regression analyses. The analyses were performed with and without total energy expenditure as covariate. Twenty studies were included in the analyses. The mean difference in peakVO 2 between the intervention group and control group was 3.97ml·min -1 ·kg -1 (p<0.01, 95% CI 2.86 to 5.07). Total energy expenditure was significantly related to improvement of exercise capacity (effect size 0.91ml·min -1 ·kg -1 per 100J·kg, p<0.01, 95% CI 0.77 to 1.06), no effect was found for its constituent training characteristics after adjustment for total energy expenditure. We conclude that the design of an exercise programme should primarily be aimed at optimising total energy expenditure rather than on one specific training characteristic. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

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

ERIC Educational Resources Information Center

Mathews, Jerry G.; Johnson, Gary P.

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

Household Expenditures on Private Tutoring: Emerging Evidence from Malaysia

ERIC Educational Resources Information Center

Kenayathulla, Husaina Banu

2013-01-01

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

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

PubMed

Shen, Chan; Sambamoorthi, Usha; Rust, George

2008-06-01

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

[Changes in processed food expenditure in the population of Metropolitan Santiago in the last twenty years].

PubMed

Crovetto, Mirta; Uauy, Ricardo

2012-03-01

During recent decades household incomes have increased steadily, leading to changes in dietary habits and food expenditure. To report changes in household food expenditure focusing on trends in processed food across income quintiles in Metropolitan Santiago. Information obtained from the Fourth (1986-1987), Fifth (1996-1997) and Sixth National Institute of Statistics (INE) Surveys (2006-2007) were used. Food expenditure data over the study periods was extracted from household expenditure surveys (HES) after verifying and adjusting food prices registered by the INE to current 2007 prices. Absolute food expenditure over the study period increased for all groups; the largest increase was found in lowest income quintiles; however, the proportion of total family budget spent on food decreased in all groups. The largest increases in food expenditure corresponded to sweetened beverages, processed fruit juices, alcoholic drinks, ready meals and "eating out". Expenditure on fish rose slightly whereas the absolute spending on legumes, eggs and oils decreased. Expenditure in processed food as percentage of total food expenditure increased from 42% to 57% of total for mean household. For the 2nd quintile it rose from 31% to 48% and for the lowest quintile increased from 53% to 68% over the three decades (1987-2007). Changes were greatest in energy rich processed foods such as bread, pastries, confectioneries and granulated sugar. These particular foods are of high energy density and contain high amounts of saturated fat, sodium and added sugars. These results confirm that food consumption patterns over the past decades have progressively departed from the recommended dietary guidelines given by national and international health organizations.

Impact of orphan drugs on Latvian budget.

PubMed

Logviss, Konstantins; Krievins, Dainis; Purvina, Santa

2016-05-11

Number of orphan medicinal products on the market and number of rare disease patients, taking these usually expensive products, are increasing. As a result, budget impact of orphan drugs is growing. This factor, along with the cost-effectiveness of orphan drugs, is often considered in the reimbursement decisions, directly affecting accessibility of rare disease therapies. The current study aims to assess the budget impact of orphan drugs in Latvia. Our study covered a 5-year period, from 2010 to 2014. Impact of orphan drugs on Latvian budget was estimated from the National Health Service's perspective. It was calculated in absolute values and relative to total pharmaceutical market and total drug reimbursement budget. A literature review was performed for comparison with other European countries. Orphan drug annual expenditure ranged between EUR 2.065 and 3.065 million, with total 5-year expenditure EUR 12.467 million. It constituted, on average, 0.84 % of total pharmaceutical market and 2.14 % of total drug reimbursement budget, respectively. Average annual per patient expenditures varied widely, from EUR 1 534 to EUR 580 952. The most costly treatment was enzyme replacement therapy (Elaprase) for MPS II. Glivec had the highest share (34 %) of the total orphan drug expenditure. Oncological drugs represented more than a half of the total orphan drug expenditure, followed by drugs for metabolic and endocrine conditions and medicines for cardiopulmonary diseases. Three indications: Ph+ CML, MPS II, and PAH accounted for nearly 90 % of the total orphan drug expenditure. Budget impact of orphan drugs in Latvia is very small. It increased slightly over a period of five years, due to the slight increase in the number of patients and the number of orphan drugs reimbursed. Current Latvian drug reimbursement system is not sufficient for most orphan drugs.

Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India.

PubMed

Garg, Charu C; Karan, Anup K

2009-03-01

Out-of-pocket (OOP) expenditure on health care has significant implications for poverty in many developing countries. This paper aims to assess the differential impact of OOP expenditure and its components, such as expenditure on inpatient care, outpatient care and on drugs, across different income quintiles, between developed and less developed regions in India. It also attempts to measure poverty at disaggregated rural-urban and state levels. Based on Consumer Expenditure Survey (CES) data from the National Sample Survey (NSS), conducted in 1999-2000, the share of households' expenditure on health services and drugs was calculated. The number of individuals below the state-specific rural and urban poverty line in 17 major states, with and without netting out OOP expenditure, was determined. This also enabled the calculation of the poverty gap or poverty deepening in each region. Estimates show that OOP expenditure is about 5% of total household expenditure (ranging from about 2% in Assam to almost 7% in Kerala) with a higher proportion being recorded in rural areas and affluent states. Purchase of drugs constitutes 70% of the total OOP expenditure. Approximately 32.5 million persons fell below the poverty line in 1999-2000 through OOP payments, implying that the overall poverty increase after accounting for OOP expenditure is 3.2% (as against a rise of 2.2% shown in earlier literature). Also, the poverty headcount increase and poverty deepening is much higher in poorer states and rural areas compared with affluent states and urban areas, except in the case of Maharashtra. High OOP payment share in total health expenditures did not always imply a high poverty headcount; state-specific economic and social factors played a role. The paper argues for better methods of capturing drugs expenditure in household surveys and recommends that special attention be paid to expenditures on drugs, in particular for the poor. Targeted policies in just five poor states to reduce OOP expenditure could help to prevent almost 60% of the poverty headcount increase through OOP payments.

Impacts of the Master Settlement Agreement on the tobacco industry.

PubMed

Sloan, F A; Mathews, C A; Trogdon, J G

2004-12-01

To assess effects of the Master Settlement Agreement (MSA) and the four individual state settlements on tobacco company decisions and performance. 10-K reports filed with the US Securities and Exchange Commission, firm and daily data from the Center for Research in Security Prices, stock price indices, market share and advertising data, cigarette export and domestic consumption data, and newspaper articles were used to assess changes before (1990-98) and after (1999-2002) the MSA was implemented. Five major tobacco manufacturers in the USA. Stockholder returns, operating performance of defendant companies, exports, market share of the original participants in the MSA, and advertising/promotion expenditures. Returns to investments in the tobacco industry exceeded returns from investments in securities of other companies, using each of four indexes as comparators. Domestic tobacco revenues increased during 1999-2002 from pre-MSA levels. Profits from domestic sales rose from levels prevailing immediately before the MSA. There is no indication that the MSA caused an increase in tobacco exports. Total market share of the original participating manufacturers in the MSA decreased. Total advertising expenditures by the tobacco companies increased at a higher rate than the 1990-98 trend during 1999-2002, but total advertising expenditures net of spending on coupons and promotions decreased. The experience during the post-MSA period demonstrates that the MSA did no major harm to the companies. Some features of the MSA appear to have increased company value and profitability.

Development of an Elliptical Trainer Physical Fitness Test

DTIC Science & Technology

2006-04-02

have demonstrated caloric expenditures and ratings of perceived exertion (RPE) similar to those measured during treadmill running (Clay, 2000...elliptical trainer calculates and displays total caloric expenditure and distance for each workout session. Distance is a function of the force phase of the...total caloric expenditure will be the performance measure. Bout duration will be 12 min to make the exercise bout similar to Cooper’s 12-minute run

Feasibility analysis of a hydrogen backup power system for Russian telecom market

NASA Astrophysics Data System (ADS)

Borzenko, V. I.; Dunikov, D. O.

2017-11-01

We performed feasibility analysis of 10 kW hydrogen backup power system (H2BS) consisting of a water electrolyzer, a metal hydride hydrogen storage and a fuel cell. Capital investments in H2BS are mostly determined by the costs of the PEM electrolyzer, the fuel cell and solid state hydrogen storage materials, for single unit or small series manufacture the cost of AB5-type intermetallic compound can reach 50% of total system cost. Today the capital investments in H2BS are 3 times higher than in conventional lead-acid system of the same capacity. Wide distribution of fuel cell hydrogen vehicles, development of hydrogen infrastructure, and mass production of hydrogen power systems will for sure lower capital investments in fuel cell backup power. Operational expenditures for H2BS is only 15% from the expenditures for lead acid systems, and after 4-5 years of exploitation the total cost of ownership will become lower than for batteries.

Gender, Marital Status, and Commercially Prepared Food Expenditure

ERIC Educational Resources Information Center

Kroshus, Emily

2008-01-01

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

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

PubMed

Robinson, James C; Miller, Kelly

Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3,065,551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693,254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and physician organizations owned by multihospital systems had mean expenditures of $4776 (95% CI, $4349 to $5202) per patient. After adjusting for patient severity and other factors over the period, local hospital-owned physician organizations incurred expenditures per patient 10.3% (95% CI, 1.7% to 19.7%) higher than did physician-owned organizations (adjusted difference, $435 [95% CI, $105 to $766], P = .02). Organizations owned by multihospital systems incurred expenditures 19.8% (95% CI, 13.9% to 26.0%) higher (adjusted difference, $704 [95% CI,$512 to $895], P < .001) than physician-owned organizations. The largest physician organizations incurred expenditures per patient 9.2% (95% CI, 3.8% to 15.0%, P = .001) higher than the smallest organizations (adjusted difference, $130 [95% CI, $-32 to $292]). From the perspective of the insurers and patients, between 2009 and 2012, hospital-owned physician organizations in California incurred higher expenditures for commercial HMO enrollees for professional, hospital, laboratory, pharmaceutical, and ancillary services than physician-owned organizations. Although organizational consolidation may increase some forms of care coordination, it may be associated with higher total expenditures.

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

PubMed

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

2016-03-01

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

Hong Kong's domestic health spending--financial years 1989/90 through 2004/05.

PubMed

Leung, G M; Tin, K Y K; Yeung, G M K; Leung, E S K; Tsui, E L H; Lam, D W S; Tsang, C S H; Fung, A Y K; Lo, S V

2008-04-01

This report presents the latest estimates of Hong Kong's domestic health spending between fiscal years 1989/90 and 2004/05, cross-stratified and categorised by financing source, provider and function on an annual basis. Total expenditure on health was HK$67,807 million in fiscal year 2004/05. In real terms, total expenditure on health showed positive growth averaging 7% per annum throughout the period covered in this report while gross domestic product grew at 4% per annum on average, indicating a growing percentage of health spending relative to gross domestic product, from 3.5% in 1989/90 to 5.2% in 2004/05. This increase was largely driven by the rise in public spending, which rose 9% per annum on average in real terms over the period, compared with 5% for private spending. This represents a growing share of public spending from 40% to 55% of total expenditure on health during the period. While public spending was the dominant source of health financing in 2004/05, private household out-of-pocket expenditure accounted for the second largest share of total health spending (32%). The remaining sources of health finance were employer-provided group medical benefits (8%), privately purchased insurance (5%), and other private sources (1%). Of the $67,807 million total health expenditure in 2004/05, current expenditure comprised $65,429 million (96%) while $2378 million (4%) were capital expenses (ie investment in medical facilities). Services of curative care accounted for the largest share of total health spending (67%) which were made up of ambulatory services (35%), in-patient curative care (28%), day patient hospital services (3%), and home care (1%). The next largest share of total health expenditure was spent on medical goods outside the patient care setting (10%). Analysed by health care provider, hospitals accounted for the largest share (46%) and providers of ambulatory health care the second largest share (30%) of total health spending in 2004/05. We observed a system-wide trend towards service consolidation at institutions (as opposed to free-standing ambulatory clinics, most of which are staffed by solo practitioner). In 2004/05, public expenditure on health amounted to $35,247 million (53.9% of total current expenditure), which was mostly incurred at hospitals (76.5%), whilst private expenditure ($30,182 million) was mostly incurred at providers of ambulatory health care (54.6%). This reflects the mixed health care economy of Hong Kong where public hospitals generally account for about 90% of total bed-days and private doctors (including Western and Chinese medicine practitioners) provide 75% to 80% of out-patient care. While both public and private spending were mostly expended on personal health care services and goods (92.9%), the distributional patterns among functional categories differed. Public expenditure was targeted at in-patient care (54.2%) and substantially less on out-patient care (24.5%), especially low-intensity first-contact care. In comparison, private spending was mostly concentrated on out-patient care (49.6%), whereas medical goods outside the patient care setting (22.6%) and in-patient care (18.8%) comprised the majority of the remaining share. Compared to OECD countries, Hong Kong has devoted a relatively low percentage of gross domestic product to health in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than in most comparably developed economies, although commensurate with its public revenue collection base.

Explaining prescription drug use and expenditures using the adjusted clinical groups case-mix system in the population of British Columbia, Canada.

PubMed

Hanley, Gillian E; Morgan, Steve; Reid, Robert J

2010-05-01

Given that prescription drugs have become a major financial component of health care, there is an increased need to explain variations in the use of and expenditure on medicines. Case-mix systems built from existing administrative datasets may prove very useful for such prediction. We estimated the concurrent and prospective predictive validity of the adjusted clinical groups (ACG) system in pharmaceutical research and compared the ACG system with the Charlson index of comorbidity. We ran a generalized linear models to examine the predictive validity of the ACG system and the Charlson index and report the correlation between the predicted and observed expenditures. We reported mean predictive ratios across medical condition and cost-defined groups. When predicting use of medicines, we used C-statistics to summarize the area under the receiver operating characteristic curve. The 3,908,533 British Columbia residents who were registered for the universal health care plan for 275+ days in the calendar years 2004 and 2005. Outcomes were total pharmaceutical expenditures, use of any medicines, and use of medicines from 4+ different therapeutic categories. The ACG case mix system predicted drug expenditures better than the Charlson index. The mean predictive ratios for the ACG system models were all within 4% of the actual costs when examining medical condition group and the C-stats for the 2 dichotomous outcomes were between 0.82 and 0.89. ACG case-mix adjusters are a valuable predictor of pharmaceutical use and expenditures with much higher predictive power than age, sex, and the Charlson index of comorbidity.

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

PubMed

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

2015-08-01

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

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

PubMed

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

2015-11-01

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

Who pays the most cigarette tax in Turkey.

PubMed

Önder, Zeynep; Yürekli, Ayda A

2016-01-01

Although higher taxation of tobacco products is considered the most cost-effective tobacco control policy, its negative impact on low-income groups is one of the arguments used against it. To investigate the impact of current excise taxes and the increases of excise taxes on tobacco and household expenditures by expenditure tertiles, and examine who pays excise taxes in general. Impacts of excise taxes on cigarettes are examined with a budgetary approach. We first estimate the price elasticity of cigarettes by expenditure tertiles using data from the 2003 Turkish Household Expenditure Survey, the most recent data set covering detailed tobacco product information relevant to our analysis. We then conduct a number of simulation analyses by increasing the excise taxes per pack of cigarettes and examine the impacts of these increases on household expenditures. Finally, as excise tax increases, we predict the total excise tax paid by households in different expenditure tertiles and compare the concentration curve of excise tax spending with the Lorenz curve showing the cumulative share of total household expenditures by expenditure tertiles. We estimate the progressivity coefficient that measures the area between the Lorenz and concentration curves. The low-income group is found to be the most sensitive to tax and price increases. It spends a relatively higher share of the household expenditure on cigarettes compared with higher income groups. However, the results suggest a different outcome as excise tax increases; the share of household expenditures spent on cigarettes declines for all household tertiles but a significant reduction occurs on the lowest expenditure tertile, suggesting that increases in excise taxes are progressive. Furthermore, the highest expenditure tertile pays the highest excise tax among expenditure tertiles, and their share in total excise revenue increases as the excise tax per pack of cigarettes increases. The poor smoking households benefit the most from increases in excise taxes; from a budgetary perspective, as they reduce their smoking consumption significantly, the share of their excise payment in total household expenditures declines. From a health perspective, they are likely to have more health benefits as their consumption reduces. Government revenues are also predicted to increase with increased excise taxes, and the government can allocate a part of these revenue increases on implementing and enforcing other tobacco control measures including cessation support and smoke-free environments. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Out-of-pocket health care expenditures, by insurance status, 2007-10.

PubMed

Catlin, Mary K; Poisal, John A; Cowan, Cathy A

2015-01-01

Out-of-pocket health care spending in the United States totaled $306.2 billion in 2010 and represented 11.8 percent of total national health expenditures, according to the Centers for Medicare and Medicaid Services' National Health Expenditure Accounts. Spending by people with employer-sponsored health insurance and those covered by Medicare accounted for over 80 percent of total out-of-pocket spending. People without comprehensive medical coverage accounted for less than 8 percent of all out-of-pocket expenditures in 2010. Between 2007 and 2010 per person out-of-pocket spending grew most rapidly for people primarily covered by employer-sponsored insurance and declined for people primarily covered by Medicare and those without coverage. Project HOPE—The People-to-People Health Foundation, Inc.

National trends in prescription drug expenditures and projections for 2016.

PubMed

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

2016-07-15

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

Aviation Forecasts. Fiscal Years 1976-1987

DTIC Science & Technology

1975-09-01

period total operating expense increased 12. 7 percent causing a substantial decrease in net income when compared with FY 1974. For FY 1975 the...expenditures on plant and eouipment by the aircraft industry, factory sales of automobiles, and real per capita disposable income were the impor...consumption of a servic", income used for the personal consumption of services can be used to represent the income effect on demand. SRVC should

Public Higher Education Governance: An Empirical Examination

ERIC Educational Resources Information Center

Fowles, Jacob

2010-01-01

Public higher education is a large enterprise in the United States. Total state expenditures for higher education totaled nearly $152 billion dollars in FY2008, accounting for over ten percent of total state expenditures and representing the single largest category of discretionary spending in most states (NASBO, 2009). The last three decades have…

Adult mental health needs and expenditure in Australia.

PubMed

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

2004-06-01

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

Incremental health care utilization and expenditures for chronic rhinosinusitis in the United States.

PubMed

Bhattacharyya, Neil

2011-07-01

I determined incremental increases in health care expenditures and utilization associated with chronic rhinosinusitis (CRS). Patients with a reported diagnosis of CRS were extracted from the 2007 Medical Expenditure Panel Survey medical conditions file and linked to the consolidated expenditures file. The patients with CRS were then compared to patients without CRS to determine differences in health care utilization (office visits,emergency facility visits, and prescriptions filled), as well as differences in health care expenditures (total health care costs, office visit costs, prescription medication costs, and self-expenditures) by use of demographically adjusted and comorbidity-adjusted multivariate models. An estimated 11.1+/-0.48 million adult patients reported having CRS in 2007 (4.9%+/-0.2% of the US population). The additional incremental health care utilizations associated with CRS relative to patients without CRS for office visits, emergency facility visits, and number of prescriptions filled were 3.45+/-0.42, 0.09+/-0.03, and 5.5+/-0.8, respectively (all p

Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021.

PubMed

Kurtz, Steven M; Ong, Kevin L; Lau, Edmund; Bozic, Kevin J

2014-04-16

Few studies have explored the role of the National Health Expenditure and macroeconomics on the utilization of total joint replacement. The economic downturn has raised questions about the sustainability of growth for total joint replacement in the future. Previous projections of total joint replacement demand in the United States were based on data up to 2003 using a statistical methodology that neglected macroeconomic factors, such as the National Health Expenditure. Data from the Nationwide Inpatient Sample (1993 to 2010) were used with United States Census and National Health Expenditure data to quantify historical trends in total joint replacement rates, including the two economic downturns in the 2000s. Primary and revision hip and knee arthroplasty were identified using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Projections in total joint replacement were estimated using a regression model incorporating the growth in population and rate of arthroplasties from 1993 to 2010 as a function of age, sex, race, and census region using the National Health Expenditure as the independent variable. The regression model was used in conjunction with government projections of National Health Expenditure from 2011 to 2021 to estimate future arthroplasty rates in subpopulations of the United States and to derive national estimates. The growth trend for the incidence of joint arthroplasty, for the overall United States population as well as for the United States workforce, was insensitive to economic downturns. From 2009 to 2010, the total number of procedures increased by 6.0% for primary total hip arthroplasty, 6.1% for primary total knee arthroplasty, 10.8% for revision total hip arthroplasty, and 13.5% for revision total knee arthroplasty. The National Health Expenditure model projections for primary hip replacement in 2020 were higher than a previously projected model, whereas the current model estimates for total knee arthroplasty were lower. Economic downturns in the 2000s did not substantially influence the national growth trends for hip and knee arthroplasty in the United States. These latest updated projections provide a basis for surgeons, hospitals, payers, and policy makers to plan for the future demand for total joint replacement surgery.

Trends in Health Care Expenditure in U.S. Adults With Diabetes: 2002–2011

PubMed Central

Ozieh, Mukoso N.; Bishu, Kinfe G.; Dismuke, Clara E.

2015-01-01

OBJECTIVE Direct medical cost of diabetes in the U.S. has been estimated to be 2.3 times higher relative to individuals without diabetes. This study examines trends in health care expenditures by expenditure category in U.S. adults with diabetes between 2002 and 2011. RESEARCH DESIGN AND METHODS We analyzed 10 years of data representing a weighted population of 189,013,514 U.S. adults aged ≥18 years from the Medical Expenditure Panel Survey. We used a novel two-part model to estimate adjusted mean and incremental medical expenditures by diabetes status, while adjusting for demographics, comorbidities, and time. RESULTS Relative to individuals without diabetes ($5,058 [95% CI 4,949–5,166]), individuals with diabetes ($12,180 [11,775–12,586]) had more than double the unadjusted mean direct expenditures over the 10-year period. After adjustment for confounders, individuals with diabetes had $2,558 (2,266–2,849) significantly higher direct incremental expenditures compared with those without diabetes. For individuals with diabetes, inpatient expenditures rose initially from $4,014 in 2002/2003 to $4,183 in 2004/2005 and then decreased continuously to $3,443 in 2010/2011, while rising steadily for individuals without diabetes. The estimated unadjusted total direct expenditures for individuals with diabetes were $218.6 billion/year and adjusted total incremental expenditures were approximately $46 billion/year. CONCLUSIONS Our findings show that compared with individuals without diabetes, individuals with diabetes had significantly higher health expenditures from 2002 to 2011 and the bulk of the expenditures came from hospital inpatient and prescription expenditures. PMID:26203060

Total HIV/AIDS expenditures in Dehong Prefecture, Yunnan province in 2010: the first systematic evaluation of both health and non-health related HIV/AIDS expenditures in China.

PubMed

Shan, Duo; Sun, Jiangping; Yakusik, Anna; Chen, Zhongdan; Yuan, Jianhua; Li, Tao; Fu, Jeannia; Khoshnood, Kaveh; Yang, Xing; Wei, Mei; Duan, Song; Bulterys, Marc; Sante, Michael; Ye, Runhua; Xiang, Lifen; Yang, Yuecheng

2013-01-01

We assessed HIV/AIDS expenditures in Dehong Prefecture, Yunnan Province, one of the highest prevalence regions in China, and describe funding sources and spending for different categories of HIV-related interventions and at-risk populations. 2010 HIV/AIDS expenditures in Dehong Prefecture were evaluated based on UNAIDS' National AIDS Spending Assessment methodology. Nearly 93% of total expenditures for HIV/AIDS was contributed by public sources. Of total expenditures, 52.7% was allocated to treatment and care, 24.5% to program management and administration and 19.8% to prevention. Spending on treatment and care was primarily allocated to the treatment of opportunistic infections. Most (40.4%) prevention spending was concentrated on most-at-risk populations, injection drug users (IDUs), sex workers, and men who have sex with men (MSM), with 5.5% allocated to voluntary counseling and testing. Prevention funding allocated for MSM, partners of people living with HIV and prisoners and other confined populations was low compared to the disproportionate burden of HIV/AIDS in these populations. Overall, people living with HIV accounted for 57.57% of total expenditures, while most-at-risk populations accounted for only 7.99%. Our study demonstrated the applicability of NASA for tracking and assessing HIV expenditure in the context of China, it proved to be a useful tool in understanding national HIV/AIDS response from financial aspect, and to assess the extent to which HIV expenditure matches epidemic patterns. Limited funding for primary prevention and prevention for MSM, prisoners and partners of people living with HIV, signal that resource allocation to these key areas must be strengthened. Comprehensive analyses of regional and national funding strategies are needed to inform more equitable, effective and cost-effective HIV/AIDS resource allocation.

The financing of the health system in the Islamic Republic of Iran: A National Health Account (NHA) approach

PubMed Central

Zakeri, Mohammadreza; Olyaeemanesh, Alireza; Zanganeh, Marziee; Kazemian, Mahmoud; Rashidian, Arash; Abouhalaj, Masoud; Tofighi, Shahram

2015-01-01

Background: The National Health Accounts keep track of all healthcare related activities from the beginning (i.e. resource provision), to the end (i.e. service provision). This study was conducted to address following questions: How is the Iranian health system funded? Who distribute the funds? For what services are the funds spent on?, What service providers receive the funds? Methods: The required study data were collected through a number of methods. The family health expenditure data was obtained through a cross sectional multistage (seasonal) survey; while library and field study was used to collect the registered data. The collected data fell into the following three categories: the household health expenditure (the sample size: 10200 urban households and 6800 rural households-four rounds of questioning), financial agents data, the medical universities financial performance data. Results: The total health expenditure of the Iranian households was 201,496,172 million Rials in 2008, which showed a 34.4% increase when compared to 2007. The share of the total health expenditure was 6.2% of the GDP. The share of the public sector showed a decreasing trend between 2003-2008 while the share of the private sector, of which 95.77% was paid by households, had an increasing trend within the same period. The percent of out of pocket expenditure was 53.79% of the total health expenditure. The total health expenditure per capita was US$ 284.00 based on the official US$ exchange rate and US$ 683.1 based on the international US$ exchange rate.( exchange rate: 1$=9988 Rial). Conclusion: The share of the public and private sectors in financing the health system was imbalanced and did not meet the international standards. The public share of the total health expenditures has increased in the recent years despite the 4th and 5th Development Plans. The inclusion of household health insurance fees and other service related expenses increases the public contribution to 73% of the total. PMID:26793634

Socioeconomic inequality in catastrophic health expenditure in Brazil

PubMed Central

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

2014-01-01

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

Socioeconomic inequality in catastrophic health expenditure in Brazil.

PubMed

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

2014-08-01

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

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

PubMed

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

2017-08-01

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

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

PubMed

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

2016-06-20

China has not established social security system for rare diseases. Rare diseases could easily impoverish patients and their families. Little research has studied the equity and accessibility of health services for patients with rare diseases in China. This study aimed to explore the factors that influence health expenditure of rare diseases and evaluate its equity. Questionnaire survey about living conditions and cost burden of patients with rare diseases was conducted. Individual and family information, health expenditure and reimbursement in 2014 of 982 patients were collected. The impact of medical insurance, individual sociodemographic characteristics, family characteristics, and healthcare need on total and out-of-pocket (OOP) health expenditures was analyzed through the generalized linear model. Equity of health expenditure was evaluated by both concentration index and Lorenz curve. Of all the surveyed patients, 11.41% had no medical insurance and 92.10% spent money to seek medical treatment in 2014. It was suggested female (P = 0.048), over 50 years of age (P = 0.062), high-income group (P = 0.021), hospitalization (P = 0.000), and reimbursement ratio (RR) (P = 0.000) were positively correlated with total health expenditure. Diseases not needing long-term treatment (P = 0.000) was negatively correlated with total health expenditure. Over 50 years of age (P = 0.065), high-income group (P = 0.018), hospitalization (P = 0.000) and having Urban Employee Basic Medical Insurance (UEBMI) (P = 0.022) were positively correlated with OOP health expenditure. Patient or the head of the household having received higher education (P = 0.044 and P = 0.081) and reimbursement ratio (P = 0.078) were negatively correlated with OOP health expenditure. The equity evaluation found concentration indexes of health expenditure before and after reimbursement were 0.0550 and 0.0539, respectively. OOP health expenditure of patients with UEBMI was significantly more than that of patients without medical insurance. However, for any other medical insurance, there was no difference between OOP health expenditure of the insured patients and patients without insurance. The current reimbursement policies have increased the equity of health expenditure, but are biased toward high-income people.

Is there value in retrospective 90-day bundle payment models for shoulder arthroplasty procedures?

PubMed

Odum, Susan M; Hamid, Nady; Van Doren, Bryce A; Spector, Leo R

2018-05-01

The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative was implemented as part of the Affordable Care Act. We implemented a retrospective payment model 2 for a 90-day total shoulder arthroplasty (TSA) episode to assess the value of TSA BPCI at our private practice. Expenditures and postacute event rates of 132 fee-for-service (FFS) patients who underwent a TSA operation between 2009 and 2012 were compared with 333 BPCI patients who had a TSA operation in 2015. The 90-day postacute events included an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), and home health (HH) admissions and readmissions. Expenditures were converted to 2016 dollars using the Consumer Price Index. Wilcoxon tests and multivariate generalized estimating equation were used to assess independent cost-drivers. The median FFS expenditure was $21,157 (interquartile range, $16,894-$30,748) compared with $17,894 (interquartile range, $15,796-$20,894) for BPCI (P < .0001). The BPCI patients had significantly lower rates of SNF admissions (34% FFS vs. 16% BPCI; P < .001), IRF admissions (3% FFS vs. 0.6% BPCI; P = .05), HH utilization (49% FFS vs. 41% BPCI; P = .05), and readmissions (14% FFS vs. 7% BPCI; P = .01). After controlling for postacute events in the multivariate regression model, we found BPCI had a 4% decrease in expenditures (P = .08). All postacute events were independently associated with higher expenditures. Our private practice implemented cost-containment practices, including clinical guidelines, patient navigators, and a BPCI management team. IRF and SNF utilization and the 90-day readmission rate significantly decreased. As a result, we were able to control the postacute spending, which resulted in decreased costs of performing TSA surgery. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

An Exploratory Study of Functional Status in Post Cardiac Arrest Survivors Discharged To Home

DTIC Science & Technology

2005-08-01

estimate of the calories burned throughout the day. It measured vertical acceleration (i.e., up and down motion) and total caloric expenditure (i.e...an estimate of caloric expenditure and the intensity of one’s activity; the higher the intensity, the more calories the unit registered. A small...number of daily steps taken. It measures vertical acceleration (i.e., up and down motion) and total caloric expenditure (i.e., the calories one’s

How did the Master Settlement Agreement change tobacco industry expenditures for cigarette advertising and promotions?

PubMed

Pierce, John P; Gilpin, Elizabeth A

2004-07-01

The 1998 multistate Master Settlement Agreement (MSA) with the tobacco industry restricted cigarette advertising and promotions. The MSA monetary settlement was also associated with an average cigarette price increase of U.S.$1.19/pack between 1998 and 2001 to fund, in part, industry payments to the states. We examined Federal Trade Commission reports on how the tobacco industry spends its cigarette advertising and promotional dollars to see if changes expected as a result of the MSA occurred. Expected changes included reduced total expenditures and reductions for outdoor advertising, specialty promotional items identified with a brand (e.g., caps, t-shirts, lighters), and public entertainment. However, tobacco industry spending for advertising and promotions increased 96% between 1995 and 2001, with large increases in 1998 and 1999, as the MSA took effect. Between 1997 and 2001, outdoor advertising declined 98%, expenditures for specialty promotional items decreased 41%, although public entertainment increased 45%. However, in 2001, these categories represented only a small fraction of the total budget. Expenditures for retail-value-added increased 344% between 1997 and 2001 (to 42.5% of total), perhaps to mitigate increased cigarette prices. In 2001, the incentives-to-merchants and retail-value-added categories comprised more than 80% of total expenditures. To adequately monitor tobacco industry expenditures as they adapt to the MSA and other tobacco control efforts, more refined reporting categories are essential.

Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis.

PubMed

Fayet-Moore, Flavia; George, Alice; Cassettari, Tim; Yulin, Lev; Tuck, Kate; Pezzullo, Lynne

2018-01-02

An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target. Total healthcare expenditure and productivity cost savings associated with reduced CVD and T2D were calculated by gender, socioeconomic status, baseline dietary fibre intake, and population uptake. Total combined annual healthcare expenditure and productivity cost savings of AUD$17.8 million-$1.6 billion for CVD and AUD$18.2 million-$1.7 billion for T2D were calculated. Total savings were generally larger among adults of lower socioeconomic status and those with lower dietary fibre intakes. Given the substantial healthcare expenditure and productivity cost savings that could be realised through increases in cereal fibre, there is cause for the development of interventions and policies that encourage an increase in cereal fibre intake in Australia.

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

PubMed Central

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

2015-01-01

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

The role of park conditions and features on park visitation and physical activity.

PubMed

Rung, Ariane L; Mowen, Andrew J; Broyles, Stephanie T; Gustat, Jeanette

2011-09-01

Neighborhood parks play an important role in promoting physical activity. We examined the effect of activity area, condition, and presence of supporting features on number of park users and park-based physical activity levels. 37 parks and 154 activity areas within parks were assessed during summer 2008 for their features and park-based physical activity. Outcomes included any park use, number of park users, mean and total energy expenditure. Independent variables included type and condition of activity area, supporting features, size of activity area, gender, and day of week. Multilevel models controlled for clustering of observations at activity area and park levels. Type of activity area was associated with number of park users, mean and total energy expenditure, with basketball courts having the highest number of users and total energy expenditure, and playgrounds having the highest mean energy expenditure. Condition of activity areas was positively associated with number of basketball court users and inversely associated with number of green space users and total green space energy expenditure. Various supporting features were both positively and negatively associated with each outcome. This study provides evidence regarding characteristics of parks that can contribute to achieving physical activity goals within recreational spaces.

Effect of task familiarisation on distribution of energy during a 2000 m cycling time trial.

PubMed

Corbett, J; Barwood, M J; Parkhouse, K

2009-10-01

To investigate the effect of task familiarisation on the spontaneous pattern of energy expenditure during a series of 2000 m cycling time trials (TTs). Nine trained males completed three 2000 m TTs on a Velotron cycling ergometer. To examine pacing strategy, the data were assigned to 250 m "bins," with the pattern of aerobic and anaerobic energy expenditure calculated from total work accomplished and gas-exchange data. There were no significant differences between trials in performance times (191.4 (SD 4.3), 189.4 (4.6), 190.1 (5.6) s), total aerobic (58.3 (2.7), 58.4 (3.1), 58.0 (3.4) kJ) and total anaerobic energy expenditure (16.4 (3.3), 17.3 (2.8), 16.5 (3.1) kJ). Pacing strategy in the second and third TT differed from the first TT in that a lower power output was adopted during the first 500 m, enabling a higher power output during the final 750 m of the TT. This adjustment in the pattern of energy expenditure was mediated by an alteration in the pattern of anaerobic energy expenditure, which paralleled changes in total energy expenditure. Furthermore, participants retained an anaerobic energy "reserve" enabling an end-spurt during the second and third trials. Small modifications to the pacing strategy are made following a single bout of exercise, primarily by altering the rate of anaerobic energy expenditure. This may have served to prevent critical metabolic disturbances. The alteration in pacing strategy following the first exercise bout is compatible with a complex intelligent regulatory system.

An evaluation of the proposed organisation restructuring at Kadoma city, 2015.

PubMed

Muringazuva, A Caroline; Chirundu, Daniel; Shamu, Shepherd; Shambira, Gerald; Gombe, Notion; Juru, Tsitsi; Bangure, Donewell; Tshimanga, Mufuta

2017-01-01

Restructuring is the corporate management term for the act of reorganizing the legal, operational, or other structures of a company for the purpose of making it more profitable or better organized for its present needs. However, preparing an organization to accept and welcome any change is crucial. There is concern though over poor service delivery, untimely payment of workers, top management structure which is thought to be top heavy and employee costs taking (58%) of total expenditure. A descriptive cross sectional study was carried out. A cost benefit analysis was used to assess the cost and benefits of the proposed retrenchment exercise. A descriptive cross sectional study survey was conducted to assess the workers' perceptions towards the proposed restructuring exercise. A pretested self-administered questionnaire was used for data collection and data were analysed using EpiInfoTM (CDC 2012).Written informed consent was obtained from all study participants. Sixty nine percent of the respondents were males. The median years working for the organisation was 8 years (Q1=1; Q3=17). The total income was surpassed by expenditure with USD$11 000 and 52% of expenditures was going towards employment costs. A midyear financial review showed that 1% was channeled towards capital expenditure 2% on repairs and maintenance and employee costs accounting to 58% of all incurred expenditure. Current departmental salary budget amounted to USD 3,3million dollars. Estimated salary costs for the proposed departmental structures amount to USD 3,8 million dollars. Comparison of the current and proposed structure showed that the proposed structure costs USD$486 000 more. Projected benefits of the proposed structure aims to improve service delivery from 60%-85% . Unlike managers, lower levels workers did not want the exercise to be carried out. The proposed structure has higher costs than the current structure but with more benefits in terms of service delivery. Generally workers perceived restructuring negatively and did not want it done.

An evaluation of the proposed organisation restructuring at Kadoma city, 2015

PubMed Central

Muringazuva, A Caroline; Chirundu, Daniel; Shamu, Shepherd; Shambira, Gerald; Gombe, Notion; Juru, Tsitsi; Bangure, Donewell; Tshimanga, Mufuta

2017-01-01

Introduction Restructuring is the corporate management term for the act of reorganizing the legal, operational, or other structures of a company for the purpose of making it more profitable or better organized for its present needs. However, preparing an organization to accept and welcome any change is crucial. There is concern though over poor service delivery, untimely payment of workers, top management structure which is thought to be top heavy and employee costs taking (58%) of total expenditure. Methods A descriptive cross sectional study was carried out. A cost benefit analysis was used to assess the cost and benefits of the proposed retrenchment exercise. A descriptive cross sectional study survey was conducted to assess the workers’ perceptions towards the proposed restructuring exercise. A pretested self-administered questionnaire was used for data collection and data were analysed using EpiInfoTM (CDC 2012).Written informed consent was obtained from all study participants. Results Sixty nine percent of the respondents were males. The median years working for the organisation was 8 years (Q1=1; Q3=17). The total income was surpassed by expenditure with USD$11 000 and 52% of expenditures was going towards employment costs. A midyear financial review showed that 1% was channeled towards capital expenditure 2% on repairs and maintenance and employee costs accounting to 58% of all incurred expenditure. Current departmental salary budget amounted to USD 3,3million dollars. Estimated salary costs for the proposed departmental structures amount to USD 3,8 million dollars. Comparison of the current and proposed structure showed that the proposed structure costs USD$486 000 more. Projected benefits of the proposed structure aims to improve service delivery from 60%-85% . Unlike managers, lower levels workers did not want the exercise to be carried out. Conclusion The proposed structure has higher costs than the current structure but with more benefits in terms of service delivery. Generally workers perceived restructuring negatively and did not want it done. PMID:28748021

Revenues and Expenditures for Public Elementary and Secondary Education: School Year 2014-15 (Fiscal Year 2015). First Look. NCES 2018-301

ERIC Educational Resources Information Center

Cornman, Stephen Q.; Zhou, Lei; Howell, Malia R.; Young, Jumaane

2018-01-01

This First Look report introduces new data for national and state-level public elementary and secondary revenues and expenditures for fiscal year (FY) 2015. Specifically, this report includes the following school finance data: (1) revenue and expenditure totals; (2) revenues by source; (3) expenditures by function and object; (4) current…

Examining inequities in incidence of catastrophic health expenditures on different healthcare services and health facilities in Nigeria.

PubMed

Onwujekwe, Obinna; Hanson, Kara; Uzochukwu, Benjamin

2012-01-01

There is limited evidence about levels of socio-economic and other differences in catastrophic health spending in Nigeria and in many sub-Saharan African countries. The study estimated the level of catastrophic healthcare expenditures for different healthcare services and facilities and their distribution across socioeconomic status (SES) groups. The study took place in four Local Government Areas in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 4873 households. Catastrophic health expenditures (CHE) were measured using a threshold of 40% of monthly non-food expenditure. We examined both total monthly health expenditure and disaggregated expenditure by source and type of care. The average total household health expenditure per month was 2354 Naira ($19.6). For outpatient services, average monthly expenditure was 1809 Naira ($15.1), whilst for inpatient services it was 610 Naira ($5.1). Higher health expenditures were incurred by urban residents and the better-off SES groups. Overall, 27% of households incurred CHE, higher for poorer socioeconomic groups and for rural residents. Only 1.0% of households had a member that was enrolled in a health insurance scheme. The worse-off households (the poorest SES and rural dwellers) experienced the highest burden of health expenditure. There was almost a complete lack of financial risk protection. Health reform mechanisms are needed to ensure universal coverage with financial risk protection mechanisms.

Examining Inequities in Incidence of Catastrophic Health Expenditures on Different Healthcare Services and Health Facilities in Nigeria

PubMed Central

Onwujekwe, Obinna; Hanson, Kara; Uzochukwu, Benjamin

2012-01-01

Objective There is limited evidence about levels of socio-economic and other differences in catastrophic health spending in Nigeria and in many sub-Saharan African countries. The study estimated the level of catastrophic healthcare expenditures for different healthcare services and facilities and their distribution across socioeconomic status (SES) groups. Methods The study took place in four Local Government Areas in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 4873 households. Catastrophic health expenditures (CHE) were measured using a threshold of 40% of monthly non-food expenditure. We examined both total monthly health expenditure and disaggregated expenditure by source and type of care. Results The average total household health expenditure per month was 2354 Naira ($19.6). For outpatient services, average monthly expenditure was 1809 Naira ($15.1), whilst for inpatient services it was 610 Naira ($5.1). Higher health expenditures were incurred by urban residents and the better-off SES groups. Overall, 27% of households incurred CHE, higher for poorer socioeconomic groups and for rural residents. Only 1.0% of households had a member that was enrolled in a health insurance scheme. Conclusion The worse-off households (the poorest SES and rural dwellers) experienced the highest burden of health expenditure. There was almost a complete lack of financial risk protection. Health reform mechanisms are needed to ensure universal coverage with financial risk protection mechanisms. PMID:22815828

Does government expenditure reduce inequalities in infant mortality rates in low- and middle-income countries?: A time-series, ecological analysis of 48 countries from 1993 to 2013.

PubMed

Baker, Peter; Hone, Thomas; Reeves, Aaron; Avendano, Mauricio; Millett, Christopher

2018-06-27

Inequalities in infant mortality rates (IMRs) are rising in some low- and middle-income countries (LMICs) and decreasing in others, but the explanation for these divergent trends is unclear. We investigate whether government expenditures and redistribution are associated with reductions in inequalities in IMRs. We estimated country-level fixed-effects panel regressions for 48 LMICs (142 country observations). Slope and Relative Indices of Inequality in IMRs (SII and RII) were calculated from Demographic and Health Surveys between 1993 and 2013. RII and SII were regressed on government expenditure (total, health and non-health) and redistribution, controlling for gross domestic product (GDP), private health expenditures, a democracy indicator, country fixed effects and time. Mean SII and RII was 39.12 and 0.69, respectively. In multivariate models, a 1 percentage point increase in total government expenditure (% of GDP) was associated with a decrease in SII of -2.468 [95% confidence intervals (CIs): -4.190, -0.746] and RII of -0.026 (95% CIs: -0.048, -0.004). Lower inequalities were associated with higher non-health government expenditure, but not higher government health expenditure. Associations with inequalities were non-significant for GDP, government redistribution, and private health expenditure. Understanding how non-health government expenditure reduces inequalities in IMR, and why health expenditures may not, will accelerate progress towards the Sustainable Development Goals.

Assessing the Energy Expenditure of Elite Female Soccer Players: A Preliminary Study.

PubMed

Mara, Jocelyn K; Thompson, Kevin G; Pumpa, Kate L

2015-10-01

The aim of this study was to assess the total and exercise energy expenditure of elite female soccer players during a training week. Eight elite female soccer players wore SenseWear Mini Armbands (SWAs) for 7 consecutive days during the preseason phase of a national league competition. In addition, players wore 15-Hz GPSports tracking devices during 4 training sessions and a friendly game. Total energy expenditure, exercise energy expenditure, and training and game demands were collected from the SWA and GPSports devices. Mean daily energy expenditure for the game day, training days, and rest days were 12,242 kJ (SD = 603 kJ), 11,692 (SD = 274 kJ), and 9,516 (SD = 369 kJ), respectively, with significant differences shown between activities (p < 0.001, partial η2 = 0.357), as well as between individual days (p < 0.001, partial η2 = 0.517). Mean values for energy expenditure during the friendly game (mean = 2,695 kJ, SD = 301 kJ) and training sessions (mean = 2,538 kJ, SD = 316 kJ) were similar (p = 0.278, Cohen's d = 0.5). However, there were significant differences found between individual training sessions (p = 0.001-0.035). Total and exercise energy expenditure differs throughout the week in female soccer players. Nutritional intake should be adjusted accordingly to avoid energy imbalances for optimal performance and recovery.

Catastrophic spending on health care in Brazil: private health insurance does not seem to be the solution.

PubMed

Barros, Aluísio J D; Bastos, João Luiz; Dâmaso, Andréa H

2011-01-01

The objective of this study was to estimate catastrophic healthcare expenditure in Brazil, using different definitions, and to identify vulnerability indicators. Data from the 2002-2003 Brazilian Household Budget Survey were used to derive total household consumption, health expenditure and household income. Socioeconomic position was defined by quintiles of the National Economic Indicator using reference cut-off points for the country. Analysis was restricted to urban households. Catastrophic health expenditure was defined as expenditure in excess of 10% and 20% of total household consumption, and in excess of 40% of household capacity to pay. Catastrophic health expenditure varied from 2% to 16%, depending on the definition. For most definitions, it was highest among the poorer. The highest proportions of catastrophic health expenditure were found to be in the Central region of Brazil, while the South and the Southeast had the lowest. Presence of an elderly person, health insurance and socioeconomic position were associated with the outcome, and coverage by health insurance did not protect from catastrophic health expenditure.

Social Welfare Expenditures and Infant Mortality.

PubMed

Shim, Joyce

2015-01-01

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

Health care expenditures among working-age adults with physical disabilities: variations by disability spans.

PubMed

Pumkam, Chaiporn; Probst, Janice C; Bennett, Kevin J; Hardin, James; Xirasagar, Sudha

2013-10-01

Data on health care costs for working-age adults with physical disabilities are sparse and the dynamic nature of disability is not captured. To assess the effect of 3 types of disability status (persistent disability, temporary disability, and no disability) on health care expenditures, out-of-pocket (OOP) spending, and financial burden. Data from Medical Expenditure Panel Survey panel 12 (2007-2008) were used. Respondents were classified into 3 groups. Medians of average annual expenditures, OOP expenditures, and financial ratios were weighted. The package R was used for quantile regression analyses. Fifteen percent of the working-age population reported persistent disabilities and 7% had temporary disabilities. The persistent disability group had the greatest unadjusted annual medians for total expenditures ($4234), OOP expenses ($591), and financial burden ratios (1.59), followed by the temporary disability group ($1612, $388, 0.71 respectively). The persistent disability group paid approximately 15% of total health care expenditures out-of-pocket, while the temporary disability group and the no disability group each paid 22% out-of-pocket. After adjusting for other factors, quantile regression shows that the persistent disability group had significantly higher total expenditures, OOP expenses, and financial burden ratios (coefficients 1664, 156, 0.58 respectively) relative to the no disability group at the 50th percentile. Results for the temporary disability group show a similar trend except for OOP expenses. People who have disabling conditions for a longer period have better financial protection against OOP health care expenses but face greater financial burdens because of their higher out-of-pocket expenditures and their socioeconomic disadvantages. Copyright © 2013 Elsevier Inc. All rights reserved.

[Reimbursed health expenditures during the last year of life, in France, in the year 2008].

PubMed

Ricci, P; Mezzarobba, M; Blotière, P O; Polton, D

2013-02-01

To measure the reimbursed health expenditures in the last year of life and the proportion it represents in total reimbursement costs in 2008, to analyse the structure of such expenditures and to identify costs by cause of death. Data were obtained from the French national insurance information system (SNIIRAM). Data from the national hospital discharge database were linked to the outpatient reimbursement database for patients covered by the general health insurance scheme (n=49 million persons). The cost of the last year of life was calculated for the exhaustive population (361,328 deaths in 2008). The supposed cause of death was mainly derived from the primary diagnosis of the last hospital stay during which the patient died. The average reimbursed expenses during the last year of life were estimated at 22,000 € per person in 2008, with 12,500 € accounting for public hospital costs. Reimbursed health expenditures varied according to different medical causes of death: 52,300 € for HIV disease and about 40,000 € for tumors. A negative effect of age on the expenditure during the last year of life was observed. Health care spending increased with shorter time before death, the last month of life corresponding to 28% of reimbursed expenditures during the last year of life. Health care use in the last year of life represented 10.5% of the total health expenditures in 2008. This study found results similar to those observed in the past or in other countries. Our results show in particular that the weight of health expenditures during the last year of life on total health expenditures remains stable over the years. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Regional health accounts for Pakistan--expenditure disparities on provincial and district level.

PubMed

Lorenz, Christian; Khalid, Muhammad

2011-05-01

Since May 2009 the first National Health Accounts (NHA) for Pakistan have been finalised and published by Federal Bureau of Statistics (FBS) in cooperation with German Technical Cooperation (GTZ). This paper goes one step ahead of the report and analyses in more detail the regional differences in health expenditure structures in Pakistan. The further analyses can be divided into four parts: health expenditures in provinces (Provincial Health Accounts, PHA), Punjab provincial and district governments health expenditures and its comparison with ADB figures, all districts of Pakistan and comparison between total district government and provincial government expenditure for each province; the latter calculation is applied as indication for the degree of fiscal autonomy of the districts in each province. Consequently, first the provincial health expenditures by Financial Agents is analysed and compared between the provinces which leads to very heterogeneous results (section 2); the per capita health expenditures differ from 16 to 23 USD. Secondly, NHA results on Punjab district government are compared with available ADB results and differences in methods as possible reasons for different results are presented (section 3). Third, district data of all district governments in all four Pakistani provinces are analysed on the level of detailed function codes in section 4; the aim is to discover regional differences between districts of the same as well as of different provinces. Fourth, in section 5 the degree of fiscal autonomy on health of the districts in each province is analysed; therefore the ordinance description is reviewed and total district government with total provincial government expenditures are compared per province. Finally recommendations for future rounds of NHA in Pakistan are given regarding formats and necessities of detailed health expenditure data collection to ensure evidence based decision making not only on federal, but also on provincial and district level.

Association between Adult Stature and Energy Expenditure in Low-Income Women from Northeastern Brazil.

PubMed

Albuquerque, Fabiana Cristina Alves; Bueno, Nassib Bezerra; Clemente, Ana Paula Grotti; Ferriolli, Eduardo; Florêncio, Telma Maria Menezes Toledo; Hoffman, Daniel; Sawaya, Ana Lydia

2015-01-01

Perinatal undernutrition may lead to important metabolic adaptations in adult life, short stature being the most visible. The present study aimed to evaluate the association between stature and total energy expenditure of low-income women. Women aged 19-45 years from low-income communities in Maceió-AL were recruited. A sample of 67 volunteers was selected and divided into either short stature (≤ 152.4 cm; n = 34) or non-short stature (≥ 158.7 cm; n = 33) group. Data on socioeconomic status, anthropometric variables, and hormonal profiles was collected. Total energy expenditure and body composition were assessed by the doubly labeled water technique with multiple points over 14 days. In addition, physical activity levels were measured with triaxial accelerometers and dietary intake data were collected using three 24-hour food records. The mean subject age was 30.94 years. Women of short stature had lower body weight and lean body mass compared to non-short women, but there were no differences in thyroid hormone concentrations or daily energy intake between the two groups. Short-stature women showed lower total energy expenditure (P = 0.01) and a significantly higher physical activity level (P = 0.01) compared to non-short women. However, the difference in total energy expenditure was no longer significant after statistical adjustment for age, lean body mass, and triiodothyronine concentrations. Women with short stature present the same energy intake, but lower total energy expenditure than non-short women, even with a higher physical activity level, which suggests that they are more prone to weight gain.

Permethrin Exposure Dosimetry: Biomarkers and Modifiable Factors

DTIC Science & Technology

2016-08-01

the effect of body weight/ BMI and total energy expenditure on permethrin absorption and dose, as determined by measurement of urinary biomarkers...body weight/ BMI and total energy expenditure on permethrin absorption and dose, as determined by measurement of urinary biomarkers (3PBA and cis- and

Factors Influencing F/OSS Cloud Computing Software Product Success: A Quantitative Study

ERIC Educational Resources Information Center

Letort, D. Brian

2012-01-01

Cloud Computing introduces a new business operational model that allows an organization to shift information technology consumption from traditional capital expenditure to operational expenditure. This shift introduces challenges from both the adoption and creation vantage. This study evaluates factors that influence Free/Open Source Software…

Impacts of the Master Settlement Agreement on the tobacco industry

PubMed Central

Sloan, F; Mathews, C; Trogdon, J

2004-01-01

Objective: To assess effects of the Master Settlement Agreement (MSA) and the four individual state settlements on tobacco company decisions and performance. Design: 10-K reports filed with the US Securities and Exchange Commission, firm and daily data from the Center for Research in Security Prices, stock price indices, market share and advertising data, cigarette export and domestic consumption data, and newspaper articles were used to assess changes before (1990–98) and after (1999–2002) the MSA was implemented. Subjects: Five major tobacco manufacturers in the USA. Main outcome measures: Stockholder returns, operating performance of defendant companies, exports, market share of the original participants in the MSA, and advertising/promotion expenditures. Results: Returns to investments in the tobacco industry exceeded returns from investments in securities of other companies, using each of four indexes as comparators. Domestic tobacco revenues increased during 1999–2002 from pre-MSA levels. Profits from domestic sales rose from levels prevailing immediately before the MSA. There is no indication that the MSA caused an increase in tobacco exports. Total market share of the original participating manufacturers in the MSA decreased. Total advertising expenditures by the tobacco companies increased at a higher rate than the 1990–98 trend during 1999–2002, but total advertising expenditures net of spending on coupons and promotions decreased. Conclusion: The experience during the post-MSA period demonstrates that the MSA did no major harm to the companies. Some features of the MSA appear to have increased company value and profitability. PMID:15564618

Examination of Factors that Influence the Operation Income and Expenditure Balance Difference Rate of 20 Educational Foundation Universities.

PubMed

Nakajima, Hisato; Yano, Kouya; Nagasawa, Kaoko; Katou, Satoka; Yokota, Kuninobu

2017-01-01

The objective of this study is to examine the factors that influence the operation income and expenditure balance ratio of school corporations running university hospitals by multiple regression analysis. 1. We conducted cluster analysis of the financial ratio and classified the school corporations into those running colleges and universities.2. We conducted multiple regression analysis using the operation income and expenditure balance ratio of the colleges as the variables and the Diagnosis Procedure Combination data as the explaining variables.3. The predictive expression was used for multiple regression analysis. 1. The school corporations were divided into those running universities (7), colleges (20) and others. The medical income ratio and the debt ratio were high and the student payment ratio was low in the colleges.2. The numbers of emergency care hospitalizations, operations, radiation therapies, and ambulance conveyances, and the complexity index had a positive influence on the operation income and expenditure balance ratio. On the other hand, the number of general anesthesia procedures, the cover rate index, and the emergency care index had a negative influence.3. The predictive expression was as follows.Operation income and expenditure balance ratio = 0.027 × number of emergency care hospitalizations + 0.005 × number of operations + 0.019 × number of radiation therapies + 0.007 × number of ambulance conveyances - 0.003 × number of general anesthesia procedures + 648.344 × complexity index - 5877.210 × cover rate index - 2746.415 × emergency care index - 38.647Conclusion: In colleges, the number of emergency care hospitalizations, the number of operations, the number of radiation therapies, and the number of ambulance conveyances and the complexity index were factors for gaining ordinary profit.

Energy requirements of US Army Special Operation Forces during military training.

PubMed

Margolis, Lee M; Crombie, Aaron P; McClung, Holly L; McGraw, Susan M; Rood, Jennifer C; Montain, Scott J; Young, Andrew J

2014-05-12

Special Operations Forces (SOF) regularly engage in physically demanding combat operations and field training exercises, resulting in high daily energy expenditure, and thus increased energy requirements. However, the majority of studies assessing energy requirements of SOF have been conducted on soldiers going through intense SOF initiation training. The objective of the current investigation was to determine the energy expenditure of SOF conducting military training operations. Thirty-one soldiers taking part in Pre-Mission Training (PMT n = 15) and Combat Diver Qualification Courses (CDQC n = 16) volunteered to participate in this observational study. Energy expenditure was determined using doubly labeled water. Body weight (83 ± 7 kg) remained stable during both training periods. Overall energy expenditure adjusted for body composition was 17,606 ± 2326 kJ·day(-1). Energy expenditure was 19,110 ± 1468 kJ·day(-1) during CDQC and 16,334 ± 2180 kJ·day(-1) during PMT, with physical activity levels of 2.6 ± 0.2 and 2.2 ± 0.3 during CDQC and PMT, respectively. Compared to the Military Dietary Reference Intakes for energy (13,598 kJ·day(-1)), these data are in agreement with previous reports that energy requirement for SOF Soldiers exceed that of the average soldier.

Energy Requirements of US Army Special Operation Forces During Military Training

PubMed Central

Margolis, Lee M.; Crombie, Aaron P.; McClung, Holly L.; McGraw, Susan M.; Rood, Jennifer C.; Montain, Scott J.; Young, Andrew J.

2014-01-01

Special Operations Forces (SOF) regularly engage in physically demanding combat operations and field training exercises, resulting in high daily energy expenditure, and thus increased energy requirements. However, the majority of studies assessing energy requirements of SOF have been conducted on soldiers going through intense SOF initiation training. The objective of the current investigation was to determine the energy expenditure of SOF conducting military training operations. Thirty-one soldiers taking part in Pre-Mission Training (PMT n = 15) and Combat Diver Qualification Courses (CDQC n = 16) volunteered to participate in this observational study. Energy expenditure was determined using doubly labeled water. Body weight (83 ± 7 kg) remained stable during both training periods. Overall energy expenditure adjusted for body composition was 17,606 ± 2326 kJ·day−1. Energy expenditure was 19,110 ± 1468 kJ·day−1 during CDQC and 16,334 ± 2180 kJ·day−1 during PMT, with physical activity levels of 2.6 ± 0.2 and 2.2 ± 0.3 during CDQC and PMT, respectively. Compared to the Military Dietary Reference Intakes for energy (13,598 kJ·day−1), these data are in agreement with previous reports that energy requirement for SOF Soldiers exceed that of the average soldier. PMID:24824290

Revenues and Expenditures for Public Elementary and Secondary Education: School Year 2012-13 (Fiscal Year 2013). First Look. NCES 2015-301

ERIC Educational Resources Information Center

Cornman, Stephen Q.

2016-01-01

This First Look report introduces new data for national and state-level public elementary and secondary revenues and expenditures for fiscal year 2013 (FY 13). Specifically, this report includes findings from the following types of school finance data: (1) revenue and expenditure totals; (2) revenues by source; (3) expenditures by function and…

Revenues and Expenditures for Public Elementary and Secondary Education: School Year 2011-12 (Fiscal Year 2012). First Look. NCES 2014-301

ERIC Educational Resources Information Center

Cornman, Stephen Q.

2015-01-01

This First Look report introduces new data for national and state-level public elementary and secondary revenues and expenditures for fiscal year (FY) 2012. Specifically, this report includes findings from the following types of school finance data: (1) Revenue and expenditure totals; (2) Revenues by source; (3) Expenditures by function and…

National Health Accounts development: lessons from Thailand.

PubMed

Tangcharoensathien, V; Laixuthai, A; Vasavit, J; Tantigate, N A; Prajuabmoh-Ruffolo, W; Vimolkit, D; Lertiendumrong, J

1999-12-01

National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns; policy instruments to re-orientate the pattern can then be further introduced. The National Economic and Social Development Board (NESDB) of Thailand produces aggregate health expenditure data but its estimation methods have several limitations. This has led to the research and development of an NHA prototype in 1994, through an agreed definition of health expenditure and methodology, in consultation with peer and other stakeholders. This is an initiative by local researchers without external support, with an emphasis on putting the system into place. It involves two steps: firstly, the flow of funds from ultimate sources of finance to financing agencies; and secondly, the use of funds by financing agencies. Five ultimate sources and 12 financing agencies (seven public and five private) were identified. Use of consumption expenditures was listed under four main categories and 32 sub-categories. Using 1994 figures, we estimated a total health expenditure of 128,305.11 million Baht; 84.07% consumption and 15.93% capital formation. Of total consumption expenditure, 36.14% was spent on purchasing care from public providers, with 32.35% on private providers, 5.93% on administration and 9.65% on all other public health programmes. Public sources of finance were responsible for 48.79% and private 51.21% of the total 1994 health expenditure. Total health expenditure accounted for 3.56% of GDP (consumption expenditure at 3.00% of GDP and capital formation at 0.57% of GDP). The NESDB consumption expenditure estimate in 1994 was 180,516 million Baht or 5.01% of GDP, of which private sources were dominant (82.17%) and public sources played a minor role (17.83%). The discrepancy of consumption expenditure between the two estimates is 2.01% of GDP. There is also a large difference in the public and private proportion of consumption expenses, at 46:54 in NHA and 18:82 in NESDB. Future NHA sustainable development is proposed. Firstly, we need more accurate aggregate and disaggregated data, especially from households, who take the lion's share of total expenditure, based on amended questionnaires in the National Statistical Office Household Socio-Economic Survey. Secondly, partnership building with NESDB and other financing agencies is needed in the further development of the financial information system to suit the biennial NHA report. Thirdly, expenditures need breaking down into ambulatory and inpatient care for monitoring and the proper introduction of policy instruments. We also suggest that in a pluralistic health care system, the breakdown of spending on public and private providers is important. Finally, a sustainable NHA development and utilization of NHA for planning and policy development is the prime objective. International comparisons through collaborative efforts in standardizing definition and methodology will be a useful by-product when developing countries are able to sustain their NHA reports.

U.S. Educational Forecast: Enrollments and Expenditures 1978-1982. First Edition.

ERIC Educational Resources Information Center

Marcovich, Stephen

This report forecasts U.S. public school enrollments and instructional and operations expenditures by state for each year from 1978 to 1982. Enrollment predictions are for preprimary and kindergarten, elementary, secondary, special education, and ungraded classes. Instructional expenditures include textbooks and workbooks, library materials,…

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

PubMed

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

2016-10-01

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

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh.

PubMed

Mahumud, Rashidul Alam; Sarker, Abdur Razzaque; Sultana, Marufa; Islam, Ziaul; Khan, Jahangir; Morton, Alec

2017-03-01

As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh

PubMed Central

2017-01-01

Objectives As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes. PMID:28372353

[The cost of tobacco-related diseases for Brazil's Unified National Health System].

PubMed

Pinto, Márcia; Ugá, Maria Alicia Domínguez

2010-06-01

This study aimed to identify the direct costs of hospitalizations due to three smoking-related groups of diseases - cancer and circulatory and respiratory diseases - in Brazil's Unified National Health System (SUS) in 2005. For cancer, the cost of chemotherapy was also included. The study derived cost estimates using administrative databases, relative risks, smoking prevalence, and smoking-attributable fraction. According to the estimates, smoking- attributable medical expenditures for the three disease groups amounted to R$338,692,516.02 (approximately U$185 million), accounting for 27.6% of total medical expenditures. Considering all hospitalizations and chemotherapy provided by the National Health System, tobacco-related diseases accounted for 7.7% of total medical expenditures. These costs also represented 0.9% of expenditures by federally funded public health services. This study provides a conservative estimate of smoking-related costs and suggests the need for continued research on comprehensive approaches to measure the total burden of smoking for society.

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

PubMed

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

2016-02-01

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

Healthcare Expenditure and Productivity Cost Savings from Reductions in Cardiovascular Disease and Type 2 Diabetes Associated with Increased Intake of Cereal Fibre among Australian Adults: A Cost of Illness Analysis

PubMed Central

Fayet-Moore, Flavia; George, Alice; Cassettari, Tim; Yulin, Lev; Tuck, Kate; Pezzullo, Lynne

2018-01-01

An ageing population and growing prevalence of chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) are putting increased pressure on healthcare expenditure in Australia. A cost of illness analysis was conducted to assess the potential savings in healthcare expenditure and productivity costs associated with lower prevalence of CVD and T2D resulting from increased intake of cereal fibre. Modelling was undertaken for three levels of increased dietary fibre intake using cereal fibre: a 10% increase in total dietary fibre; an increase to the Adequate Intake; and an increase to the Suggested Dietary Target. Total healthcare expenditure and productivity cost savings associated with reduced CVD and T2D were calculated by gender, socioeconomic status, baseline dietary fibre intake, and population uptake. Total combined annual healthcare expenditure and productivity cost savings of AUD$17.8 million–$1.6 billion for CVD and AUD$18.2 million–$1.7 billion for T2D were calculated. Total savings were generally larger among adults of lower socioeconomic status and those with lower dietary fibre intakes. Given the substantial healthcare expenditure and productivity cost savings that could be realised through increases in cereal fibre, there is cause for the development of interventions and policies that encourage an increase in cereal fibre intake in Australia. PMID:29301298

Disentangling incentives effects of insurance coverage from adverse selection in the case of drug expenditure: a finite mixture approach.

PubMed

Munkin, Murat K; Trivedi, Pravin K

2010-09-01

This paper takes a finite mixture approach to model heterogeneity in incentive and selection effects of drug coverage on total drug expenditure among the Medicare elderly US population. Evidence is found that the positive drug expenditures of the elderly population can be decomposed into two groups different in the identified selection effects and interpreted as relatively healthy with lower average expenditures and relatively unhealthy with higher average expenditures, accounting for approximately 25 and 75% of the population, respectively. Adverse selection into drug insurance appears to be strong for the higher expenditure component and weak for the lower expenditure group. Copyright (c) 2010 John Wiley & Sons, Ltd.

Direct medical costs of hospitalisations for mental disorders in Shanghai, China: a time series study

PubMed Central

Chen, Wenming; Wang, Shengnan; Wang, Qi; Wang, Weibing

2017-01-01

Objectives To provide cost burden estimates and long-term trend forecast of mental disorders that need hospitalisations in Shanghai, China. Design Daily hospital admissions and medical expenditures for mental disorder hospitalisations between 1 January 2011 and 31 December 2015 were used for analysis. Yearly total health expenditures and expenditures per hospital admission for different populations, as well as per-admission-per-year medical costs of each service for mental disorder hospitalisations, were estimated through data from 2015. We also established time series analyses to determine the long-time trend of total direct medical expenditures for mental disorders and forecasted expenditures until 31 December 2030. Setting Shanghai, China. Participants Daily hospital admissions for mental disorders of registered residents living in all 16 districts of Shanghai, who participated in workers’ basic medical insurance or the urban residents’ basic medical insurance (n=60 306). Results From 2011 to 2015, there were increased yearly trends for both hospitalisations (from 10 919 to 14 054) and total costs (from US$23.56 to 42.13 million per year in 2015 currency) in Shanghai. Cost per mental disorder hospitalisation in 2015 averaged US$2998.01. Most direct medical costs were spent on medical supplies. By the end of 2030, the average cost per admission per month for mental disorders was estimated to be US$7394.17 (95% CI US$6782.24 to 8006.10) for mental disorders, and the total health expenditure for mental disorders would reach over US$100.52 million (95% CI US$92.20 to 108.83 million) without additional government interventions. Conclusions These findings suggest total health expenditures for mental disorders in Shanghai will be higher in the future. Effective measures should be taken to reduce the rapid growth of the economic burden of mental disorders. PMID:29084785

Direct medical costs of hospitalisations for mental disorders in Shanghai, China: a time series study.

PubMed

Chen, Wenming; Wang, Shengnan; Wang, Qi; Wang, Weibing

2017-10-30

To provide cost burden estimates and long-term trend forecast of mental disorders that need hospitalisations in Shanghai, China. Daily hospital admissions and medical expenditures for mental disorder hospitalisations between 1 January 2011 and 31 December 2015 were used for analysis. Yearly total health expenditures and expenditures per hospital admission for different populations, as well as per-admission-per-year medical costs of each service for mental disorder hospitalisations, were estimated through data from 2015. We also established time series analyses to determine the long-time trend of total direct medical expenditures for mental disorders and forecasted expenditures until 31 December 2030. Shanghai, China. Daily hospital admissions for mental disorders of registered residents living in all 16 districts of Shanghai, who participated in workers' basic medical insurance or the urban residents' basic medical insurance (n=60 306). From 2011 to 2015, there were increased yearly trends for both hospitalisations (from 10 919 to 14 054) and total costs (from US$23.56 to 42.13 million per year in 2015 currency) in Shanghai. Cost per mental disorder hospitalisation in 2015 averaged US$2998.01. Most direct medical costs were spent on medical supplies. By the end of 2030, the average cost per admission per month for mental disorders was estimated to be US$7394.17 (95% CI US$6782.24 to 8006.10) for mental disorders, and the total health expenditure for mental disorders would reach over US$100.52 million (95% CI US$92.20 to 108.83 million) without additional government interventions. These findings suggest total health expenditures for mental disorders in Shanghai will be higher in the future. Effective measures should be taken to reduce the rapid growth of the economic burden of mental disorders. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

PubMed

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

Previous estimates of the economic burden of Crohn's disease (CD) varied widely from $2.0 to $18.2 billion per year (adjusted to 2015 $US). However, these estimates do not reflect recent changes in pharmaceutical treatment options and guidelines. The goal of this study was to update cost estimates of Crohn's disease based on a representative sample of the US population from the most recent 11 years (2003-2013) of the Medical Expenditure Panel Survey (MEPS). A secondary aim described expenditure trends in respondents with and without Crohn's disease pre-post FDA approvals of new biologics and the American College of Gastroenterology Crohn's disease treatment guidelines. Average annual expenditures (total, prescription, inpatient, and outpatient) were evaluated using a pooled cross-sectional design. Respondent data from the most recent 11 years (2003-2013) of MEPS were analyzed. Two-part generalized linear models with power-link were used to estimate the average annual expenditures per patient adjusted to multiple covariates. Confidence intervals (CI) were estimated using bootstrap methods. Difference-in-differences estimations were performed to compare the changes in health care expenditures pre-post FDA approvals of new biologics and the American College of Gastroenterology Crohn's disease treatment guidelines. The annual aggregate economic burden of CD was $6.3 billion in the US. Respondents with CD had higher total (+$6442; 95% CI: $4864 to $8297), prescription (+$3283; 95% CI: $2289 to $4445), inpatient (+$1764; 95% CI: $748 to $3551), and outpatient (+$1191; 95% CI: $592 to $2160) expenditures compared to respondents without CD. In the difference-in-differences estimation, respondents with CD had significantly higher total (P = 0.001) and prescription (P < 0.001) expenditures compared with respondents without CD. Although inpatient and outpatient expenditures were higher in respondents with CD, they were not statistically significant. Respondents with CD diagnosis had higher expenditures compared to respondents without CD diagnosis from 2003 to 2013. This study captured the most recent availability of new treatment options and changes to treatment guidelines, while providing updated estimates of the economic burden of CD in the US. However, this research was unable to study the causes of these increased health care expenditures in respondents with CD. Future investigations will need to determine the causal factors for increased expenditures in CD. Copyright © 2016 Elsevier Inc. All rights reserved.

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

PubMed

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

2002-06-01

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

Determinants of catastrophic health expenditure in iran.

PubMed

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

2013-01-01

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

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

PubMed

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

2008-11-01

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

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

PubMed

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

2013-06-13

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

Medical Care Expenditures and Earnings Losses Among Persons With Arthritis and Other Rheumatic Conditions in 2003, and Comparisons With 1997

PubMed Central

Yelin, Edward; Murphy, Louise; Cisternas, Miriam G.; Foreman, Aimee J.; Pasta, David J.; Helmick, Charles G.

2010-01-01

Objective To obtain estimates of medical care expenditures and earnings losses associated with arthritis and other rheumatic conditions and the increment in such costs attributable to arthritis and other rheumatic conditions in the US in 2003, and to compare these estimates with those from 1997. Methods Estimates for 2003 were derived from the Medical Expenditures Panel Survey (MEPS), a national probability sample of households. We tabulated medical care expenditures of adult MEPS respondents, stratified by arthritis and comorbidity status, and used regression techniques to estimate the increment of medical care expenditures attributable to arthritis and other rheumatic conditions. We also estimated the earnings losses sustained by working-age adults with arthritis and other rheumatic conditions. Estimates for 2003 were compared with those from 1997, inflated to 2003 terms. Results In 2003, there were 46.1 million adults with arthritis and other rheumatic conditions (versus 36.8 million in 1997). Adults with arthritis and other rheumatic conditions incurred mean medical care expenditures of $6,978 in 2003 (versus $6,346 in 1997), of which $1,635 was for prescriptions ($899 in 1997). Expenditures for adults with arthritis and other rheumatic conditions totaled $321.8 billion in 2003 ($233.5 billion in 1997). In 2003, the mean increment in medical care expenditures attributable to arthritis and other rheumatic conditions was $1,752 ($1,762 in 1997), for a total of $80.8 billion ($64.8 billion in 1997). Persons with arthritis and other rheumatic conditions ages 18–64 years earned $3,613 less than other persons (versus $4,551 in 1997), for a total of $108.0 billion (versus $99.0 billion). Of this amount, $1,590 was attributable to arthritis and other rheumatic conditions (versus $1,946 in 1997), for a total of $47.0 billion ($43.3 billion in 1997). Conclusion Our findings indicate that the increase in medical care expenditures and earnings losses between 1997 and 2003 is due more to an increase in the number of persons with arthritis and other rheumatic conditions than to costs per case. PMID:17469096

Is hospital 'community benefit' charity care?

PubMed

Bakken, Erik; Kindig, David A

2012-10-01

The Affordable Care Act is drawing increased attention to the Internal Revenue Service (IRS) Community Benefit policy. To qualify for tax exemption, the IRS requires nonprofit hospitals to allocate a portion of their operating expenses to certain "charitable" activities, such as providing free or reduced care to the indigent. To determine the total amount of community benefit reported by Wisconsin hospitals using official IRS tax return forms (Form 990), and examine the level of allocation across allowable activities. Primary data collection from IRS 990 forms submitted by Wisconsin hospitals for 2009. Community benefit reported in absolute dollars and as percent of overall hospital expenditures, both overall and by activity category. For 2009, Wisconsin hospitals reported $1.064 billion in community benefits, or 7.52% of total hospital expenditures. Of this amount, 9.1% was for charity care, 50% for Medicaid subsidies, 11.4% for other subsidized services, and 4.4% for Community Health Improvement Services. Charity care is not the primary reported activity by Wisconsin hospitals under the IRS Community Benefit requirement. Opportunities may exist for devoting increasing amounts to broader community health improvement activities.

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

PubMed

Sülkü, Seher Nur; Caner, Asena

2011-02-01

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

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

PubMed

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

2002-04-01

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

The increasing financial impact of chronic kidney disease in australia.

PubMed

Tucker, Patrick S; Kingsley, Michael I; Morton, R Hugh; Scanlan, Aaron T; Dalbo, Vincent J

2014-01-01

The aim of this investigation was to determine and compare current and projected expenditure associated with chronic kidney disease (CKD), renal replacement therapy (RRT), and cardiovascular disease (CVD) in Australia. Data published by Australia and New Zealand Dialysis and Transplant Registry, Australian Institute of Health and Welfare, and World Bank were used to compare CKD-, RRT-, and CVD-related expenditure and prevalence rates. Prevalence and expenditure predictions were made using a linear regression model. Direct statistical comparisons of rates of annual increase utilised indicator variables in combined regressions. Statistical significance was set at P < 0.05. Dollar amounts were adjusted for inflation prior to analysis. Between 2012 and 2020, prevalence, per-patient expenditure, and total disease expenditure associated with CKD and RRT are estimated to increase significantly more rapidly than CVD. RRT prevalence is estimated to increase by 29%, compared to 7% in CVD. Average annual RRT per-patient expenditure is estimated to increase by 16%, compared to 8% in CVD. Total CKD- and RRT-related expenditure had been estimated to increase by 37%, compared to 14% in CVD. Per-patient, CKD produces a considerably greater financial impact on Australia's healthcare system, compared to CVD. Research focusing on novel preventative/therapeutic interventions is warranted.

Determinants of percent expenditure of household income due to childhood diarrhoea in rural Bangladesh.

PubMed

Das, J; Das, S K; Ahmed, S; Ferdous, F; Farzana, F D; Sarker, M H R; Ahmed, A M S; Chisti, M J; Malek, M A; Rahman, A; Faruque, A S G; Mamun, A A

2015-10-01

There is limited information on percent expenditure of household income due to childhood diarrhoea especially in rural Bangladesh. A total of 4205 children aged <5 years with acute diarrhoea were studied. Percent expenditure was calculated as total expenditure for the diarrhoeal episode divided by monthly family income, multiplied by 100. Overall median percent expenditure was 3·04 (range 0·01-94·35). For Vibrio cholerae it was 6·42 (range 0·52-82·85), for enterotoxigenic Escherichia coli 3·10 (range 0·22-91·87), for Shigella 3·17 (range 0·06-77·80), and for rotavirus 3·08 (range 0·06-48·00). In a multinomial logistic regression model, for the upper tertile of percent expenditure, significant higher odds were found for male sex, travelling a longer distance to reach hospital (⩾median of 4 miles), seeking care elsewhere before attending hospital, vomiting, higher frequency of purging (⩾10 times/day), some or severe dehydration and stunting. V. cholerae was the highest and rotavirus was the least responsible pathogen for percent expenditure of household income due to childhood diarrhoea.

Variables influencing allocation of capital expenditure in Indonesia

NASA Astrophysics Data System (ADS)

Muda, Iskandar; Naibaho, Revmianson

2018-03-01

The purpose of this study is to examine the factors affecting capital expenditure in Indonesia. The independent variables used are The Effects of Financing Surplus, Total Population and Regional Sizes and the dependent variable used is The Effects of Financing Surplus. This type of research is a causal associative research. The type of data used is secondary data in severals provinces in Indonesia with multiple regression analysis. The results show significantly the determinants of capital expenditure allocation in Indonesia are affected by Financing Surplus, Total Population and Regional Sizes.

Medicaid nursing home reimbursement policies, rates, and expenditures

PubMed Central

Harrington, Charlene; Swan, James H.

1984-01-01

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

Out-of-Pocket Household Expenditures on Medical Injections in Cambodia.

PubMed

Ozawa, Sachiko; Yemeke, Tatenda T; Tawah, Alie F; Kulkarni, Vivek; Villar Uribe, Manuela

2018-02-09

Cambodia has one of the highest rates of overall medical injection usage worldwide. Therapeutic injections, which are often unnecessary, contribute to the spread of blood-borne diseases. This study describes injection practices and associated household expenditures in rural northwest Cambodia. We assessed care-seeking patterns of surveyed adult family members who sought healthcare in the previous 30 days, including location of care, medical injection use, and out-of-pocket household expenditures for treatment. A regression model was used to explore the impact of injection use on out-of-pocket household expenditures. Among 480 households sampled, 298 included members who had been sick within the previous 30 days; a total of 342 episodes of care had been sought. Private providers accounted for over 66% (n = 226) of all episodes of care, with public and informal providers accounting for 20% (n = 69) and 14% (n = 47), respectively. Injections were administered in over 120 (35%) episodes of care, with 81% of injections administered by private providers. Patients who received injections incurred total out-of-pocket household expenditures that were, on average, 126,590 Cambodian Riel (KHR) (US$31.65) higher than those who did not receive injections (p < 0.01), equivalent to nearly half of the country's total annual health expenditure per capita. Receiving injections and perceived severity of illness were significantly associated with higher out-of-pocket household expenditures. This study found high levels of medical injection use, particularly among private healthcare providers, which was significantly associated with high healthcare expenditures. Reducing the number of medical injections would not only reduce disease transmission risk but also contribute to reduced healthcare costs and greater financial protection.

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

PubMed

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

2016-07-19

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

The cost and burden of cancer in the European Union 1995-2014.

PubMed

Jönsson, Bengt; Hofmarcher, Thomas; Lindgren, Peter; Wilking, Nils

2016-10-01

There is an intense debate about the cost of cancer and the value of new treatments. However, there is limited data on the cost of cancer in the European Union (EU) and how costs relate to the burden of disease. This paper presents new estimates on the development of the cost of cancer in the EU 1995-2014, with a focus on the major cost components: total health expenditure, cancer drugs, and production loss due to premature mortality. Data on overall health expenditure were combined with national disease estimates to derive cancer-specific health expenditure. Data on drug sales were obtained from IMS Health, and epidemiological data were used to calculate life years lost due to cancer. Health expenditure on cancer increased continuously from €35.7 billion in 1995 to €83.2 billion in 2014 in the EU and spending on cancer drugs from €7.6 billion in 2005 to €19.1 billion in 2014 (current prices). Yet the share of total health expenditure devoted to cancer was mostly constant (around 6 per cent). While expenditures on cancer drugs increased in both absolute and relative terms, other expenditures were stable or decreased, despite increases in cancer incidence driven by a growing and ageing population. Reductions in cancer mortality during working age resulted in decreasing production loss due to premature mortality. Health spending on cancer as a share of total health expenditure is rather low and stable despite the growing incidence and relative burden of cancer. Problems to reallocate funding in health care systems under economic pressure may be one explanation and shifting costs from inpatient to ambulatory care another. Copyright © 2016 Elsevier Ltd. All rights reserved.

Paid expenditures and productivity costs associated with permanent disability pensions in patients with spinal disorders: Nationwide Finnish Register-based Study, 1990-2010.

PubMed

Asklöf, Tom; Martikainen, Janne; Kautiainen, Hannu; Haanpää, Maija; Kiviranta, Ilkka; Pohjolainen, Timo

2016-01-01

The objective of this study is to present the paid expenditures and productivity costs of disability pensions (DP) due to spinal disorders (SD) in Finland during 1990-2010. This study is a register-based national study. All new cases aged 20-64 that were granted a DP due to SD were identified from the nationwide register maintained by the Finnish Centre of Pensions. The data included sex, age group, year of the DP decision, main cause of incapacity (diagnosis) leading to permanent DP and yearly paid expenditures for DPs. Annual productivity costs were estimated based on labour force participation rate and the employment rate adjusted gross domestic product. A total of 39,107 individuals (18,072 females, 21,035 males) received DPs during the study period. SDs generated 9,372 million euros extra cost during this period due to DP (females 3.5 billion, males 5.9 billion). The total DP expenditures paid increased during the first half of 1990s but decreased during the second half of 1990s (-44.8 %). For degenerative SD cases, the DP expenditure was 5.1 billion €, disc disease 3.5 billion € and for other SDs 0.7 billion €. Males, compared to females, were expected to have a rate 1.22 times greater costs due to DPs. The estimated total annual productivity costs due to SDs have been over six times higher than expenditures paid for DPs per year. The costs of DPs are different compared to occurrence rates due to salary and early retirement age differences between genders. Despite a significant decrease in DP-associated expenditures due to SDs after 1993, the annual expenditures have stayed on a high level in Finland.

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

Community College Finance: A Cost Analysis of Community College Expenditures Related to Maintenance and Operations

ERIC Educational Resources Information Center

Collins, Michael T.

2011-01-01

The purpose of this study is to develop a costing model for maintenance and operations expenditures among 16 single-campus California community college districts and assess the impact of a variety of variables including size of student enrollment, physical plant age, acreage, gross square footage, and general obligation facility bonds on district…

[Tax expenses and their impacts on performance in health and education].

PubMed

Paes, Nelson Leitão

2014-04-01

The increase in tax expenditures is a trend observed in many countries. In Brazil, the increase in tax expenditures was marked, with an increase of 47% between 2006 and 2011. Based on data from Latin American countries and the OECD, this paper investigates whether countries with high tax expenditures in relation to budget expenditures perform better in the areas of health and education. The results show that the group of Latin American countries spends much more via taxation than the OECD countries, with Brazil showing a relatively low relationship between tax expenditures and total expenditures for health and education. In relation to social indicators, this article suggests that countries that use tax expenditures more intensively have systematically worse social indicators in education and health.

45 CFR 158.221 - Formula for calculating an issuer's medical loss ratio.

Code of Federal Regulations, 2013 CFR

2013-10-01

... defined in § 158.140 of this part, plus the issuer's expenditures for activities that improve health care... reporting year, the total of the incurred claims and expenditures for activities that improve health care... incurred claims and expenditures for activities that improve health care quality are then multiplied by a...

45 CFR 158.221 - Formula for calculating an issuer's medical loss ratio.

Code of Federal Regulations, 2012 CFR

2012-10-01

... defined in § 158.140 of this part, plus the issuer's expenditures for activities that improve health care... reporting year, the total of the incurred claims and expenditures for activities that improve health care... incurred claims and expenditures for activities that improve health care quality are then multiplied by a...

45 CFR 158.221 - Formula for calculating an issuer's medical loss ratio.

Code of Federal Regulations, 2014 CFR

2014-10-01

... defined in § 158.140 of this part, plus the issuer's expenditures for activities that improve health care... reporting year, the total of the incurred claims and expenditures for activities that improve health care... incurred claims and expenditures for activities that improve health care quality are then multiplied by a...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-23

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

Prediction of energy expenditure from heart rate and accelerometry in children and adolescents using multivariate adaptive regression splines modeling

USDA-ARS?s Scientific Manuscript database

Free-living measurements of 24-h total energy expenditure (TEE) and activity energy expenditure (AEE) are required to better understand the metabolic, physiological, behavioral, and environmental factors affecting energy balance and contributing to the global epidemic of childhood obesity. The spec...

Revenue and Expenditure Projections for the Albuquerque Public Schools. Final Report.

ERIC Educational Resources Information Center

Pleyte, Parrie S.; Kohl, Bruce R.

This report is part of a 10-city national study of revenues and expenditures shared by a local government. The purpose of the study is to project operating revenues and expenditures of the Albuquerque public schools through 1975. The revenue projection includes all sources and uses various methods for estimating Federal, State, and local revenue.…

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach.

PubMed

Agarwal, Parul; Sambamoorthi, Usha

2015-12-01

Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p < 0.001) compared to those without depression. Post-regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.

Interim fiscal profile, Benton and Franklin counties, Washington: Working draft

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

Dong, F.B.; Dugan, M.K.; Clark, D.C.

1988-02-01

This report presents a fiscal profile of Benton and Franklin counties, and of the cities of Richland, Kennewick, and Pasco. Overall, changes in operating revenues and expenditures in these jurisdictions have corresponded with changes in the local economy. The combined operating expenditures of Benton County, Franklin County, Kennewick, Pasco, and Richland, expressed in current dollars, tripled between 1975 and 1985, increasing from $18.1 million to $55.0 million, an annual average increase of 11.8 percent. During this time, the population of the Benton-Franklin MSA increased from 100,000 to 140,900 people, and the national all-items price index for urban consumers doubled, increasingmore » from 161.2 to 322.2. Adjusted for inflation, per capita expenditures by these governments increased only slightly during this period, from $361.8 in 1975 to $390.3 in 1985. Employment in the Benton-Franklin MSA rose from 40,080 workers in 1970 to a peak of 75,900 in 1981 before declining to 61,100 in 1985, primarily due to the loss of 9,928 jobs in the Washington Public Power Supply System after 1981. The MSA's population followed a similar trend, with a slight lag. In 1970, total population in the Benton-Franklin MSA was 93,356 people. The MSA's population grew rapidly during the late 1970s, reached a peak of 147,900 persons in 1982, and then declined to 139,300 in 1986. 23 refs., 16 figs., 14 tabs.« less

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

PubMed

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

2015-03-19

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

Validation and reliability of two activity monitors for energy expenditure assessment.

PubMed

Brazeau, Anne-Sophie; Beaudoin, Nadia; Bélisle, Virginie; Messier, Virginie; Karelis, Antony D; Rabasa-Lhoret, Rémi

2016-01-01

This study explores the reliability and validity of the SenseWear Armband (SWA) and Actical (ACT) for free-living total energy expenditure, and energy expenditure during rest and light-to-moderate exercises (walking, ergocycling). Participants wore the 2 devices during 7 days (free-living) and then participated to 3 days of testing in our laboratory. SWA and ACT estimates of total energy expenditure was compared to the doubly labeled water technique (7 days), and energy expenditure during rest (60min), treadmill (45min; intensities ∼22% to ∼41% VO2peak) and ergocycling (45min; ∼50% VO2peak) were compared to indirect calorimetry over the following 3 days. Paired T-tests and intra-class correlation coefficient (ICC) with 95% confidence interval (CI95) were computed. Twenty adults were recruited (BMI 23.1±2.3kg/m(2)). Compared to doubly labelled water, SWA overestimated energy expenditure by 94kcal/d (±319; P=0.2) and ACT underestimated by -244kcal/d (±258; P=0.001). Energy expenditure during rest (SWA 210±116, ACT 124±133kcal/d; p<0.05) and treadmill (according on intensity: SWA 54±46 to 67±38, ACT 68±25 to 84±40kcal; p<0.05) were overestimated and underestimated during ergocycling (SWA -93±65, ACT -269±111kcal; p<0.05) compared to indirect calorimetry. High ICC were observed at rest (SWA 0.994 CI95 0.987-0.997; ACT 0.998 CI95 0.996-0.999) and during ergocycling (SWA 0.941 CI95 0.873-0.975; ACT 0.854 CI95 0.687-0.939). Acceptable estimation of total energy expenditure was observed with the SWA. Both devices were reliable but not accurate for energy expenditure's estimations during rest and for specific exercises. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

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

Code of Federal Regulations, 2010 CFR

2010-01-01

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

[Conservative and operative treatment of working age patients with gonarthritis. Economic considerations].

PubMed

Malzahn, J

2014-06-01

The development of the overall achievements for hospital performance since the introduction in Germany of the diagnosis-related groups (DRG) system in 2003 is the subject of healthcare political discussion. The field of prosthetics is often at the center of considerations. After consideration of the development of achievements with international and regional earnings, the question was investigated how the average expenditure for patients with gonarthritis developed in a time period of 1 year before and after implantation of total knee prostheses. The study was based on individual patient data from the accounting data of the AOK (General Regional Healthcare Insurance) from the categories, inpatient care, panel physician treatment, pharmaceuticals and medicines as well as disability leave periods. The data include the average expenditure and disability times calculated by the AOK for individual patients 12 months before and 12 months after implantation of a total knee prosthesis. The methods were selected because the international classification of diseases (ICD) coding does not allow a differentiation in the degree of severity and, therefore, a comparison of patients who were only conservatively treated within the scope of panel physicians which would have led to problems in risk adjustment. Due to a lack of coding guidelines for treatment by panel physicians, the accuracy of the diagnosis is also limited in comparison to inpatient treatment data. The expenditure and the average disability leave for gonarthritis patients were higher in the year following implantation of total knee prostheses than in the year prior to implantation. No conclusions can be drawn from the provision of service data with respect to the quality of life of the patients. Investigations over a longer time period seem to be necessary.

The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee.

PubMed

Anderson, D R; Whitmer, R W; Goetzel, R Z; Ozminkowski, R J; Dunn, R L; Wasserman, J; Serxner, S

2000-01-01

To assess the relationship between modifiable health risks and total health care expenditures for a large employee group. Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period. The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers. Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures. Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures. Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.

[Catastrophic health expenditures in Mexico: magnitude, distribution and determinants].

PubMed

Sesma-Vázquez, Sergio; Pérez-Rico, Raymundo; Sosa-Manzano, Carlos Lino; Gómez-Dantés, Octavio

2005-01-01

To describe the magnitude, distribution, and determinants of catastrophic health expenditures in Mexico. The information source was the National Performance Assessment Survey and the methodology, the one developed by the World Health Organization for assessing fair financing. Households with catastrophic expenditures were defined as those with health expenditures over 30% of their ability to pay. Multivariate analysis by logistic and linear regression were used to identify the determinants of catastrophic expenditures. A total of 3.8% of the households incurred in catastrophic health expenditures. There were huge differences by state. The uninsured, poor, and rural households showed a higher impoverishment risk. Sixty percent of the catastrophic expenditures were attributable to outpatient care and medication. A 10% increase of insured households could result in a 9.6% decrease in catastrophic expenditures. Disability, adults 60 years of age and older, and pregnancy increased the probability of catastrophic expenditures. The insurance of older adults, pregnant women, and persons with disabilities could reduce catastrophic health expenditures in Mexico.

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

PubMed

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

2013-10-22

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

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

NASA Astrophysics Data System (ADS)

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

2013-02-01

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

Health financing in the African Region: 2000-2009 data analysis.

PubMed

Sambo, Luis Gomes; Kirigia, Joses Muthuri; Orem, Juliet Nabyonga

2013-03-06

In order to raise African countries probability of achieving the United Nations Millennium Development Goals by 2015, there is need to increase and more efficiently use domestic and external funding to strengthen health systems infrastructure in order to ensure universal access to quality health care. The objective of this paper is to examine the changes that have occurred in African countries on health financing, taking into account the main sources of funding over the period 2000 to 2009. Our analysis is based on the National Health Accounts (NHA) data for the 46 countries of the WHO African Region. The data were obtained from the WHO World Health Statistics Report 2012. Data for Zimbabwe was not available. The analysis was done using Excel software. Between 2000 and 2009, number of countries spending less than 5% of their GDP on health decreased from 24 to 17; government spending on health as a percentage of total health expenditure increased in 31 countries and decreased in 13 countries; number of countries allocating at least 15% of national budgets on health increased from 2 to 4; number of countries partially financing health through social security increased from 19 to 21; number of countries where private spending was 50% and above of total health expenditure decreased from 29 (64%) to 23 (51%); over 70% of private expenditure on health came from household out-of-pocket payments (OOPS) in 32 (71%) countries and in 27 (60%) countries; number of countries with private prepaid plans increased from 29 to 31; number of countries financing more than 20% of their total health expenditure from external sources increased from 14 to 19; number of countries achieving the Commission for Macroeconomics and Health recommendation of spending at least US$34 per person per year increased from 11 to 29; number of countries achieving the International Taskforce on Innovative Financing recommendation of spending at least US$44 per person per year increased from 11 to 24; average per capita total expenditure on health increased from US$35 to US$82; and average per capita government expenditure on health grew from US$ 15 to US$ 41. Whilst the African Region (AFR) average government expenditure on health as a per cent of THE increased by 5.4 per cent, the average private health expenditure decreased by the same percentage between 2000 and 2009. The regional average OOPS as a per cent of private expenditure on health increased by 4.9 per cent. The average external resources for health as a percentage of THE increased by 3.7 per cent. Even though on average the quantity of health funds have increased, we cannot judge from the current study the extent to which financial risk protection, equity and efficiency has progressed or regressed.In 2009 OOPS made up over 20% of total expenditure on health in 34 countries. Evidence shows that where OOPS as a percentage of total health expenditure is less than 20%, the risk of catastrophic expenditure is negligible. Therefore, there is urgent need for countries to develop health policies that address inequities and health financing models that optimize the use of health resources and strengthen health infrastructure. Increased coverage of prepaid health-financing mechanisms would reduce over-reliance on potentially catastrophic and impoverishing out-of-pocket payments.

Health financing in the African Region: 2000–2009 data analysis

PubMed Central

2013-01-01

Background In order to raise African countries probability of achieving the United Nations Millennium Development Goals by 2015, there is need to increase and more efficiently use domestic and external funding to strengthen health systems infrastructure in order to ensure universal access to quality health care. The objective of this paper is to examine the changes that have occurred in African countries on health financing, taking into account the main sources of funding over the period 2000 to 2009. Methods Our analysis is based on the National Health Accounts (NHA) data for the 46 countries of the WHO African Region. The data were obtained from the WHO World Health Statistics Report 2012. Data for Zimbabwe was not available. The analysis was done using Excel software. Results Between 2000 and 2009, number of countries spending less than 5% of their GDP on health decreased from 24 to 17; government spending on health as a percentage of total health expenditure increased in 31 countries and decreased in 13 countries; number of countries allocating at least 15% of national budgets on health increased from 2 to 4; number of countries partially financing health through social security increased from 19 to 21; number of countries where private spending was 50% and above of total health expenditure decreased from 29 (64%) to 23 (51%); over 70% of private expenditure on health came from household out-of-pocket payments (OOPS) in 32 (71%) countries and in 27 (60%) countries; number of countries with private prepaid plans increased from 29 to 31; number of countries financing more than 20% of their total health expenditure from external sources increased from 14 to 19; number of countries achieving the Commission for Macroeconomics and Health recommendation of spending at least US$34 per person per year increased from 11 to 29; number of countries achieving the International Taskforce on Innovative Financing recommendation of spending at least US$44 per person per year increased from 11 to 24; average per capita total expenditure on health increased from US$35 to US$82; and average per capita government expenditure on health grew from US$ 15 to US$ 41. Conclusion Whilst the African Region (AFR) average government expenditure on health as a per cent of THE increased by 5.4 per cent, the average private health expenditure decreased by the same percentage between 2000 and 2009. The regional average OOPS as a per cent of private expenditure on health increased by 4.9 per cent. The average external resources for health as a percentage of THE increased by 3.7 per cent. Even though on average the quantity of health funds have increased, we cannot judge from the current study the extent to which financial risk protection, equity and efficiency has progressed or regressed. In 2009 OOPS made up over 20% of total expenditure on health in 34 countries. Evidence shows that where OOPS as a percentage of total health expenditure is less than 20%, the risk of catastrophic expenditure is negligible. Therefore, there is urgent need for countries to develop health policies that address inequities and health financing models that optimize the use of health resources and strengthen health infrastructure. Increased coverage of prepaid health-financing mechanisms would reduce over-reliance on potentially catastrophic and impoverishing out-of-pocket payments. PMID:23497637

Calculating Confidence Intervals for Regional Economic Impacts of Recreastion by Bootstrapping Visitor Expenditures

Treesearch

Donald B.K. English

2000-01-01

In this paper I use bootstrap procedures to develop confidence intervals for estimates of total industrial output generated per thousand tourist visits. Mean expenditures from replicated visitor expenditure data included weights to correct for response bias. Impacts were estimated with IMPLAN. Ninety percent interval endpoints were 6 to 16 percent above or below the...

Higher Education Research Expenditure in South Africa: A Review of the New Funding Framework

ERIC Educational Resources Information Center

Odhiambo, Nicholas M.; Ntenga, Lydia

2015-01-01

The trends and the trajectory of higher education research expenditure in South Africa since the introduction of the New Funding Formula in 2004 have been analysed. The paper also compares the level of South Africa's total gross expenditure on research and development with those of other selected economies. The findings show that following…

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

PubMed Central

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

2017-01-01

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

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

PubMed

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

2017-01-01

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

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

PubMed

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

2010-02-01

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

Caregivers' health literacy and their young children's oral-health-related expenditures.

PubMed

Vann, W F; Divaris, K; Gizlice, Z; Baker, A D; Lee, J Y

2013-07-01

Caregivers' health literacy has emerged as an important determinant of young children's health care and outcomes. We examined the hypothesis that caregivers' health literacy influences children's oral-health-care-related expenditures. This was a prospective cohort study of 1,132 child/caregiver dyads (children's mean age = 19 months), participating in the Carolina Oral Health Literacy Project. Health literacy was measured by the REALD-30 (word recognition based) and NVS (comprehension based) instruments. Follow-up data included child Medicaid claims for CY2008-10. We quantified expenditures using annualized 2010 fee-adjusted Medicaid-paid dollars for oral-health-related visits involving preventive, restorative, and emergency care. We used descriptive, bivariate, and multivariate statistical methods based on generalized gamma models. Mean oral-health-related annual expenditures totaled $203: preventive--$81, restorative--$99, and emergency care--$22. Among children who received services, mean expenditures were: emergency hospital-based--$1282, preventive--$106, and restorative care--$343. Caregivers' low literacy in the oral health context was associated with a statistically non-significant increase in total expenditures (average annual difference = $40; 95% confidence interval, -32, 111). Nevertheless, with both instruments, emergency dental care expenditures were consistently elevated among children of low-literacy caregivers. These findings provide initial support for health literacy as an important determinant of the meaningful use and cost of oral health care.

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

PubMed Central

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

2002-01-01

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

Improved Estimates of Capital Formation in the National Health Expenditure Accounts

PubMed Central

Sensenig, Arthur L.; Donahoe, Gerald F.

2006-01-01

The National Health Expenditure Accounts (NHEA) were revised with the release of the 2004 estimates. The largest revision was the incorporation of a more comprehensive measure of investment in medical sector capital. The revision raised total health expenditures' share of gross domestic product (GDP) from 15.4 to 15.8 percent in 2003. The improved measure encompasses investment in moveable equipment and software, as well as expenditures for the construction of structures used by the medical sector. PMID:17290665

Economic Burden of Attention-Deficit/Hyperactivity Disorder among Pediatric Patients in the United States.

PubMed

Gupte-Singh, Komal; Singh, Rakesh R; Lawson, Kenneth A

2017-04-01

To determine the adjusted incremental total costs (direct and indirect) for patients (aged 3-17 years) with attention-deficit/hyperactivity disorder (ADHD) and the differences in the adjusted incremental direct expenditures with respect to age groups (preschoolers, 0-5 years; children, 6-11 years; and adolescents, 12-17 years). The 2011 Medical Expenditure Panel Survey was used as the data source. The ADHD cohort consisted of patients aged 0 to 17 years with a diagnosis of ADHD, whereas the non-ADHD cohort consisted of subjects in the same age range without a diagnosis of ADHD. The annual incremental total cost of ADHD is composed of the incremental direct expenditures and indirect costs. A two-part model with a logistic regression (first part) and a generalized linear model (second part) was used to estimate the incremental costs of ADHD while controlling for patient characteristics and access-to-care variables. The 2011 Medical Expenditure Panel Survey database included 9108 individuals aged 0 to 17 years, with 458 (5.0%) having an ADHD diagnosis. The ADHD cohort was 4.90 times more likely (95% confidence interval [CI] 2.97-8.08; P < 0.001) than the non-ADHD cohort to have an expenditure of at least $1, and among those with positive expenditures, the ADHD cohort had 58.4% higher expenditures than the non-ADHD cohort (P < 0.001). The estimated adjusted annual total incremental cost of ADHD was $949.24 (95% CI $593.30-$1305.18; P < 0.001). The adjusted annual incremental total direct expenditure for ADHD was higher among preschoolers ($989.34; 95% CI $402.70-$1575.98; P = 0.001) than among adolescents ($894.94; 95% CI $428.16-$1361.71; P < 0.001) or children ($682.71; 95% CI $347.94-$1017.48; P < 0.001). Early diagnosis and use of evidence-based treatments may address the substantial burden of ADHD. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Social-economic analysis of patients with Sjogren's syndrome dry eye in East China: a cross-sectional study.

PubMed

Yao, Wang; Le, Qihua

2018-02-02

Sjogren's syndrome is the leading cause for aqueous tear-deficiency dry eye. Little is known regarding the relationship between Sjogren's syndrome dry eye (SSDE) and patients' medical expenditure, clinical severity and psychological status changes. Thirty-four SSDE patients and thirty non-Sjogren's syndrome dry eye (non-SSDE) subjects were enrolled. They were required to complete three self-report questionnaires: Ocular Surface Disease Index, Zung Self Rating Anxiety Scales, and a questionnaire designed by the researchers to study the patients' treatment, medical expenditure and income. The correlations between expenditures and these parameters were analyzed. The annual total expenditure on the treatment of SSDE was Chinese Yuan 7637.2 (approximately US$1173.8) on average, and the expense paid by SSDE patients themselves was Chinese Yuan 2627.8 (approximately US$403.9), which were 5.5 and 4.5 times higher than non-SSDE patients (both P < 0.001). The annual total expense on Chinese medicine and western medicine were 35.6 times and 78.4% higher in SSDE group than in non-SSDE group (both P < 0.001). Moreover, indirect costs associated with the treatment were 70.0% higher in SSDE group. In SSDE group, the score of Zung Self Rating Anxiety Scales had significantly positive correlation with total medical expenditure and the expense on Chinese medicine (ρ = 0.399 and ρ = 0.400,both P = 0.019). Nevertheless, total medical expenditure paid by the patients in non-SSDE group positively correlated with the score of Ocular Surface Disease Index (ρ = 0.386, P = 0.035). Medication expenditures and associated costs is an unignorable economic burden to the patients with SSDE. The medical expense had a significantly correlation with clinical severity of SSDE and the patients' psychological status.

Do health care workforce, population, and service provision significantly contribute to the total health expenditure? An econometric analysis of Serbia.

PubMed

Santric-Milicevic, M; Vasic, V; Terzic-Supic, Z

2016-08-15

In times of austerity, the availability of econometric health knowledge assists policy-makers in understanding and balancing health expenditure with health care plans within fiscal constraints. The objective of this study is to explore whether the health workforce supply of the public health care sector, population number, and utilization of inpatient care significantly contribute to total health expenditure. The dependent variable is the total health expenditure (THE) in Serbia from the years 2003 to 2011. The independent variables are the number of health workers employed in the public health care sector, population number, and inpatient care discharges per 100 population. The statistical analyses include the quadratic interpolation method, natural logarithm and differentiation, and multiple linear regression analyses. The level of significance is set at P < 0.05. The regression model captures 90 % of all variations of observed dependent variables (adjusted R square), and the model is significant (P < 0.001). Total health expenditure increased by 1.21 standard deviations, with an increase in health workforce growth rate by 1 standard deviation. Furthermore, this rate decreased by 1.12 standard deviations, with an increase in (negative) population growth rate by 1 standard deviation. Finally, the growth rate increased by 0.38 standard deviation, with an increase of the growth rate of inpatient care discharges per 100 population by 1 standard deviation (P < 0.001). Study results demonstrate that the government has been making an effort to control strongly health budget growth. Exploring causality relationships between health expenditure and health workforce is important for countries that are trying to consolidate their public health finances and achieve universal health coverage at the same time.

Economic impact of chikungunya epidemic: out-of-pocket health expenditures during the 2007 outbreak in Kerala, India.

PubMed

Vijayakumar, K; George, B; Anish, T S; Rajasi, R S; Teena, M J; Sujina, C M

2013-01-01

The southern state of Kerala, India was seriously affected by a chikungunya epidemic in 2007. As this outbreak was the first of its kind, the morbidity incurred by the epidemic was a challenge to the state's public health system. A cross sectional survey was conducted in five districts of Kerala that were seriously affected by the epidemic, using a two-stage cluster sampling technique to select households, and the patients were identified using a syndromic case definition. We calculated the direct health expenditure of families and checked whether it exceed the margins of catastrophic health expenditure (CHE). The median (IQR) total out-of-pocket (OOP) health expenditure in the study population was USD7.4 (16.7). The OOP health expenditure did not show any significant association with increasing per-capita monthly income.The major share (47.4%) of the costs was utilized for buying medicines, but costs for transportation (17.2%), consultations (16.6%), and diagnoses (9.9%) also contributed significantly to the total OOP health expenditure. The OOP health expenditure was high in private sector facilities, especially in tertiary care hospitals. For more than 15% of the respondents, the OOP was more than double their average monthly family income. The chikungunya outbreak of 2007 had significantly contributed to the OOP expenditure of the affected community in Kerala.The OOP health expenditure incurred was high, irrespective of the level of income. Governments should attempt to ensure comprehensive financial protection by covering the costs of care, along with loss of productivity.

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

PubMed

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

2013-12-01

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

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.

Army Digital Systems Complexity

DTIC Science & Technology

2008-05-22

recently published Chamber of Commerce report entitled Defense Trade: Keeping America Secure in March of 2007, indicates that the defense industry employs... Chamber of Commerce published report indicated that the national defense expenditures totaled $474.4 billion in 2005 and represented 3.8 percent of U.S...from the U.S. Chamber of Commerce , published in March 2007, shows total direct defense expenditure projections

Energy requirements of military personnel.

PubMed

Tharion, William J; Lieberman, Harris R; Montain, Scott J; Young, Andrew J; Baker-Fulco, Carol J; Delany, James P; Hoyt, Reed W

2005-02-01

Energy requirements of military personnel (Soldiers, Sailors, Airmen, and Marines) have been measured in garrison and in field training under a variety of climatic conditions. Group mean total energy expenditures for 424 male military personnel from various units engaged in diverse missions ranged from 13.0 to 29.8 MJ (3109-7131 kcal) per day. The overall mean was 19.3+/-2.7 MJ (mean+/-SD) (4610+/-650 kcal) per day measured over an average of 12.2 days (range 2.25-69 days). For the 77 female military personnel studied, mean total energy expenditures for individual experimental groups ranged from 9.8 to 23.4 MJ (2332-5597 kcal) per day, with an overall mean of 11.9+/-2.6 MJ (2850+/-620 kcal) per day, measured over an average of 8.8 days (range 2.25-14 days). Women, presumably due to their lower lean body mass, resting metabolic rate, and absolute work rates, had lower total energy expenditures. Combat training produced higher energy requirements than non-combat training or support activities. Compared to temperate conditions, total energy expenditures did not appear to be influenced by hot weather, but tended to be higher in the cold or high altitude conditions.

Health Care Utilization and Expenditures for Children with Autism: Data from U.S. National Samples

ERIC Educational Resources Information Center

Liptak, Gregory S.; Stuart, Tami; Auinger, Peggy

2006-01-01

Little is known about the use of medical services by children who have autism (ASD). Provide nationally representative data for health service utilization and expenditures of children with ASD. Cross-sectional survey using the Medical Expenditure Panel (MEPS), and National (Hospital) Ambulatory Medical Care Surveys (N(H)AMCS). A total of 80…

2012-2013 CAUT Almanac of Post-Secondary Education in Canada = 2012-2013 Almanach de l'enseignement postsecondaire au Canada de l'ACPPU

ERIC Educational Resources Information Center

Canadian Association of University Teachers, 2013

2013-01-01

In previous editions of the CAUT Almanac, data for provincial postsecondary education expenditures, total expenditures and university and college revenues and expenditures was reported from Statistics Canada's Financial Management System (FMS), which Statistics Canada last published for the 2008-2009 fiscal year. Statistics Canada will be adopting…

Estimating Energy Expenditure with the RT3 Triaxial Accelerometer

ERIC Educational Resources Information Center

Maddison, Ralph; Jiang, Yannan; Vander Hoorn, Stephen; Mhurchu, Cliona Ni; Lawes, Carlene M. M.; Rodgers, Anthony; Rush, Elaine

2009-01-01

The RT3 is a relatively new triaxial accelerometer that has replaced the TriTrac. The aim of this study was to validate the RT3 against doubly labeled water (DLW) in a free-living, mixed weight sample of adults. Total energy expenditure (TEE) was measured over a 15-day period using DLW. Activity-related energy expenditure (AEE) was estimated by…

The Current and Projected Taxpayer Shares of US Health Costs.

PubMed

Himmelstein, David U; Woolhandler, Steffie

2016-03-01

We estimated taxpayers' current and projected share of US health expenditures, including government payments for public employees' health benefits as well as tax subsidies to private health spending. We tabulated official Centers for Medicare and Medicaid Services figures on direct government spending for health programs and public employees' health benefits for 2013, and projected figures through 2024. We calculated the value of tax subsidies for private spending from official federal budget documents and figures for state and local tax collections. Tax-funded health expenditures totaled $1.877 trillion in 2013 and are projected to increase to $3.642 trillion in 2024. Government's share of overall health spending was 64.3% of national health expenditures in 2013 and will rise to 67.1% in 2024. Government health expenditures in the United States account for a larger share of gross domestic product (11.2% in 2013) than do total health expenditures in any other nation. Contrary to public perceptions and official Centers for Medicare and Medicaid Services estimates, government funds most health care in the United States. Appreciation of government's predominant role in health funding might encourage more appropriate and equitable targeting of health expenditures.

The Current and Projected Taxpayer Shares of US Health Costs

PubMed Central

Woolhandler, Steffie

2016-01-01

Objectives. We estimated taxpayers’ current and projected share of US health expenditures, including government payments for public employees’ health benefits as well as tax subsidies to private health spending. Methods. We tabulated official Centers for Medicare and Medicaid Services figures on direct government spending for health programs and public employees’ health benefits for 2013, and projected figures through 2024. We calculated the value of tax subsidies for private spending from official federal budget documents and figures for state and local tax collections. Results. Tax-funded health expenditures totaled $1.877 trillion in 2013 and are projected to increase to $3.642 trillion in 2024. Government’s share of overall health spending was 64.3% of national health expenditures in 2013 and will rise to 67.1% in 2024. Government health expenditures in the United States account for a larger share of gross domestic product (11.2% in 2013) than do total health expenditures in any other nation. Conclusions. Contrary to public perceptions and official Centers for Medicare and Medicaid Services estimates, government funds most health care in the United States. Appreciation of government’s predominant role in health funding might encourage more appropriate and equitable targeting of health expenditures. PMID:26794173

Diabetes in employer-sponsored health insurance.

PubMed

Peele, Pamela B; Lave, Judith R; Songer, Thomas J

2002-11-01

To examine medical and mental health care expenditures for large numbers of individuals with diabetes enrolled in employment-sponsored insurance plans. Health insurance billing data for approximately 1.3 million individuals enrolled in health insurance plans sponsored by 862 large self-insured employers nationwide were used to examine employer expenditures and consumer out-of-pocket payments for 20,937 people identified with diabetes. These expenditures were compared with expenditures for individuals with other chronic illnesses. Main outcome measures were covered charges, insurance plan reimbursements, and estimated consumer out-of-pocket payments for both medical and mental health services. A total of 1.7% of enrollees were identified as having diabetes and approximately 11% of those used at least one mental health service during 1996. Health care expenditures were three times higher for those with diabetes compared with all health care consumers in these insurance plans, but when compared with individuals with other chronic illnesses such as heart disease, HIV/AIDS, cancer, and asthma, those with diabetes were not more expensive for employers' insurance plans. Diabetes accounts for 6.5% of total health plan expenditures. Diabetes is not more expensive for either consumers or their employer-sponsored insurance plans than other chronic illnesses.

10 CFR 603.1260 - Expenditure-based award.

Code of Federal Regulations, 2010 CFR

2010-01-01

... adjustment does not exceed the total Government funds obligated to the award. Most Federal Government grants... Used in this Part § 603.1260 Expenditure-based award. A Federal Government assistance award for which...

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

PubMed Central

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

2013-01-01

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

Medicaid Managed Care and Cost Containment in the Adult Disabled Population

PubMed Central

Burns, Marguerite E.

2010-01-01

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

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

PubMed

Perkowski, Patryk; Rodberg, Leonard

2016-01-01

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

Comparing Medical Ecology, Utilization, and Expenditures Between 1996-1997 and 2011-2012.

PubMed

Johansen, Michael E

2017-07-01

This study compared ecology (number of individuals using a service), utilization (number of services used), and expenditures (dollars spent) for various categories of medical services between primarily 1996-1997 and 2011-2012. A repeated cross-sectional study was performed using nationally representative data mainly from the 1996, 1997, 2011, and 2012 Medical Expenditure Panel Survey (MEPS). These data were augmented with the 2002-2003 MEPS as well as the 1999-2000 and 2011-2012 National Heath and Nutrition Examination Survey. Individuals (number per 1,000 people), utilization, and expenditures during an average month in 1996-1997 and 2011-2012 were determined for 15 categories of services. The number of individuals who used various medical services was unchanged for many categories of services (total, outpatient, outpatient physician, users of prescribed medications, primary care and specialty physicians, inpatient hospitalization, and emergency department). It was, however, increased for others (optometry/podiatry, therapy, and alternative/complementary medicine) and decreased for a few (dental and home health). The number of services used (utilization) largely mirrored the findings for individual use, with the exception of an increase in the number of prescribed medications and a decrease in number of primary care physician visits. There were large increases in dollars spent (expenditures) in every category with the exception of primary care physician and home health; the largest absolute increases were in prescribed medications, specialty physicians, emergency department visits, and likely inpatient hospitalizations. Although the number of individuals with visits during an average month and the total utilization of medical services were largely unchanged between the 2 time periods, total expenditures increased markedly. The increases in expenditure varied dramatically by category. © 2017 Annals of Family Medicine, Inc.

Welfare generosity and population health among Canadian provinces: a time-series cross-sectional analysis, 1989-2009.

PubMed

Ng, Edwin; Muntaner, Carles

2015-10-01

Recent work in comparative social epidemiology uses an expenditures approach to examine the link between welfare states and population health. More work is needed that examines the impact of disaggregated expenditures within nations. This study takes advantage of provincial differences within Canada to examine the effects of subnational expenditures and a provincial welfare generosity index on population health. Time-series cross-sectional data are retrieved from the Canadian Socio-Economic Information Management System II Tables for 1989-2009 (10 provinces and 21 years=210 cases). Expenditures are measured using 20 disaggregated indicators, total expenditures and a provincial welfare generosity index, a ombined measure of significant predictors. Health is measured as total, male and female age-standardised mortality rates per 1000 deaths. Estimation techniques include the Prais-Winsten regressions with panel-corrected SEs, a first-order autocorrelation correction model, and fixed-unit effects, adjusted for alternative factors. Analyses reveal that four expenditures effectively reduce mortality rates: medical care, preventive care, other social services and postsecondary education. The provincial welfare generosity index has even larger effects. For an SD increase in the provincial welfare generosity index, total mortality rates are expected to decline by 0.44 SDs. Standardised effects are larger for women (β=-0.57, z(19)=-5.70, p<0.01) than for men (β=-0.38, z(19)=-5.59, p<0.01). Findings show that the expenditures approach can be effectively applied within the context of Canadian provinces, and that targeted spending on health, social services and education has salutary effects. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Sensitivity analysis and comparison of two methods of using heart rate to represent energy expenditure during walking.

PubMed

Karimi, Mohammad Taghi

2015-01-01

Heart rate is an accurate and easy to use method to represent the energy expenditure during walking, based on physiological cost index (PCI). However, in some conditions the heart rate during walking does not reach to a steady state. Therefore, it is not possible to determine the energy expenditure by use of the PCI index. The total heart beat index (THBI) is a new method to solve the aforementioned problem. The aim of this research project was to find the sensitivity of both the physiological cost index (PCI) and total heart beat index (THBI). Fifteen normal subjects and ten patients with flatfoot disorder and two subjects with spinal cord injury were recruited in this research project. The PCI and THBI indexes were determined by use of heart beats with respect to walking speed and total distance walked, respectively. The sensitivity of PCI was more than that of THBI index in the three groups of subjects. Although the PCI and THBI indexes are easy to use and reliable parameters to represent the energy expenditure during walking, their sensitivity is not high to detect the influence of some orthotic interventions, such as use of insoles or using shoes on energy expenditure during walking.

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

PubMed

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

2018-03-01

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

Distribution of alcohol consumption and expenditures and the impact of improved measurement on coverage of alcohol sales in the 2000 National Alcohol Survey.

PubMed

Kerr, William C; Greenfield, Thomas K

2007-10-01

To validate improved survey estimates of alcohol volume and new expenditures questions, these measures were aggregated and evaluated through comparison to sales data. Using the new measures, we examined their distributions by estimating the proportion of mean intake, heavy drinking days, and alcohol expenditures among drinkers grouped by volume. The 2000 National Alcohol Survey is a random digit dialed telephone survey of the United States with 7,612 respondents including 323 who were recontacted for drink ethanol measurement. Among drinkers, we utilized improved drink ethanol content estimates and beverage-specific graduated frequency measures to assess alcohol consumption and past month beverage-specific spending reports to estimate expenditures. Coverage of alcohol sales by the new measures was estimated to be 52.3% for consumption and 59.3% for expenditures. Coverage was best for wine at 92.1% of sales, but improved most for spirits from 37.2% to 55.2%, when empirical drink ethanol content was applied. Distribution estimates showed that the top 10% of drinkers drank 55.3% of the total alcohol consumed, accounted for 61.6% of all 5+ and nearly 80% of all 12+ drinking days. Spirits consumption was the most concentrated with the top decile consuming 62.9% of the total for this beverage. This decile accounted for 33% of total expenditures, even though its mean expenditure per drink was considerably lower ($0.79) than the bottom 50% of drinkers ($4.75). The distributions of mean alcohol intake and heavy drinking days are highly concentrated in the U.S. population. Lower expenditures per drink by the heaviest drinkers suggest substantial downward quality substitution, drinking in cheaper contexts or other bargain pricing strategies. Empirical drink ethanol estimates improved survey coverage of sales particularly for spirits, but significant under-coverage remains, highlighting need for further self-report measurement improvement.

Meaningful Use of Electronic Health Records and Medicare Expenditures: Evidence from a Panel Data Analysis of U.S. Health Care Markets, 2010-2013.

PubMed

Lammers, Eric J; McLaughlin, Catherine G

2017-08-01

To determine if recent growth in hospital and physician electronic health record (EHR) adoption and use is correlated with decreases in expenditures for elderly Medicare beneficiaries. American Hospital Association (AHA) General Survey and Information Technology Supplement, Health Information Management Systems Society (HIMSS) Analytics survey, SK&A Information Services, and the Centers for Medicare & Medicaid Services (CMS) Chronic Conditions Data Warehouse Geographic Variation Database for 2010 through 2013. Fixed effects model comparing associations between hospital referral region (HRR) level measures of hospital and physician EHR penetration and annual Medicare expenditures for beneficiaries with one of four chronic conditions. Calculated hospital penetration rates as the percentage of Medicare discharges from hospitals that satisfied criteria analogous to Meaningful Use (MU) Stage 1 requirements and physician rates as the percentage of physicians using ambulatory care EHRs. An increase in the hospital penetration rate was associated with a small but statistically significant decrease in total Medicare and Medicare Part A acute care expenditures per beneficiary. An increase in physician EHR penetration was also associated with a significant decrease in total Medicare and Medicare Part A acute care expenditures per beneficiary as well as a decrease in Medicare Part B expenditures per beneficiary. For the study population, we estimate approximately $3.8 billion in savings related to hospital and physician EHR adoption during 2010-2013. We also found that an increase in physician EHR penetration was associated with an increase in lab test expenses. Health care markets that had steeper increases in EHR penetration during 2010-2013 also had steeper decreases in total Medicare and acute care expenditures per beneficiary. Markets with greater increases in physician EHR had greater declines in Medicare Part B expenditures per beneficiary. © Health Research and Educational Trust.

Energy metabolism, body composition, and urea generation rate in hemodialysis patients.

PubMed

Sridharan, Sivakumar; Vilar, Enric; Berdeprado, Jocelyn; Farrington, Ken

2013-10-01

Hemodialysis (HD) adequacy is currently assessed using normalized urea clearance (Kt/V), although scaling based on Watson volume (V) may disadvantage women and men with low body weight. Alternative scaling factors such as resting energy expenditure and high metabolic rate organ mass have been suggested. The relationship between such factors and uremic toxin generation has not been established. We aimed to study the relationship between body size, energy metabolism, and urea generation rate. A cross-sectional cohort of 166 HD patients was studied. Anthropometric measurements were carried on all. Resting energy expenditure was measured by indirect calorimetry, fat-free mass by bio-impedance and total energy expenditure by combining resting energy expenditure with a questionnaire-derived physical activity data. High metabolic rate organ mass was calculated using a published equation and urea generation rate using formal urea kinetic modeling. Metabolic factors including resting energy expenditure, total energy expenditure and fat-free mass correlated better with urea generation rate than did Watson volume. Total energy expenditure and fat-free mass (but not Watson Volume) were independent predictors of urea generation rate, the model explaining 42% of its variation. Small women (

Energy expenditure during a single-handed transatlantic yacht race.

PubMed

Myers, S D; Leamon, S M; Nevola, V R; Llewellyn, M G L

2008-04-01

The popularity of sports that expose people to consecutive days of high-intensity physical activity continues to increase. The ability to adequately nourish the human body to sustain the required level of competitive performance may be a key contributor to success in such events. The energy expenditure of a male competitor in a single-handed, transatlantic race (Transat 2004) was assessed using the doubly-labelled water technique. Mean total daily energy expenditure (TDEE) during the race (13 days) was 14.5 MJ/day with a peak expenditure of 18.6 MJ during the most physically demanding 24-hour period. This mean TDEE was approximately 25% lower than that reported in a previous study (14.5 vs. 19.3 MJ/day) for a 13-day leg of a fully crewed offshore race. The difference in results was probably due to the fact that in the previous study, the crew operated in "watches" (work shifts), affording each crew member greater opportunity to eat, rest and sleep. Effective planning and efficient management of resources is essential to the success of the solo sailor. However, the extent to which maintenance of energy balance underpins competitive success remains to be established. To maintain energy balance during the race, a mean daily energy intake of 14.5 MJ/day was necessary for the subject in this study. However, this mean value for energy intake would have been inadequate to match the peak energy expended during the most physically demanding 24 hours of the race.

Health status, emotional/behavioral problems, health care use, and expenditures in overweight/obese US children/adolescents.

PubMed

Turer, Christy Boling; Lin, Hua; Flores, Glenn

2013-01-01

To examine the association of overweight/obesity with health, health care utilization, and expenditures in a national sample of 10- to 17-year-old children and adolescents. Secondary analysis of 2005 to 2009 Medical Expenditure Panel Survey data (n = 17,224). Outcome measures included suboptimal health, emotional/behavioral problems, health care utilization, and expenditures. Overweight and obese children and adolescents had greater risk of suboptimal health (adjusted risk ratio [ARR], 1.4 and 1.7; P < .01), use of prescriptions (ARR, both 1.1; P = .01), and emergency department visits (ARR, 1.2 and 1.1; P = .01); overweight children/adolescents had lower mean out-of-pocket expenditures (∼$100, P < .01); and obese children/adolescents had greater risk of emotional/behavioral problems (ARR, 1.2; P < .01) and specialist visits (ARR, 1.1; P = .01). The most common specialty referral among obese children/adolescents was psychiatry. Overweight and obesity were not associated with office visits or total expenditures. A greater proportions of children and adolescents with suboptimal health and emotional/behavioral problems had health care expenditures, and those with suboptimal health were more likely to have out-of-pocket expenditures. Pediatric overweight and obesity affect child and adolescent health status, emotional/behavioral problems, and specific domains of health care utilization, but do not appear to be associated with total health care expenditures. Out-of-pocket expenditures are lower among overweight children and adolescents. These findings highlight the need for early intervention in overweight children/adolescents, when health care expenditures may not be greater, and suggest that it may prove useful to pay special attention to the health status and emotional/behavioral problems of overweight and obese children/adolescents in weight-management interventions. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Dental care utilization and expenditures in children with special health care needs.

PubMed

Beil, Heather; Mayer, Michelle; Rozier, R Gary

2009-09-01

The authors compared children with special health care needs (CSHCN) and children without special health care needs (SHCN) with respect to the odds, amount and determinants of having any dental care and dental care expenditures. The authors assessed data from the 2004 Medical Expenditures Panel Survey, Agency for Healthcare Research and Quality, to identify a sample of 8,518 children aged 2 to 17 years. The authors used logistic regression to determine the effect of having SHCN on the probability of having any dental care expenditure, for total dental care expenditures and procedure-specific expenditures. They tested the modifying effect between CSHCN and other variables on the probability of having any dental care expenditure. Compared with children without SHCN, CSHCN did not differ in the probability (odds ratio = 0.91, 95 percent confidence interval [CI] = 0.76 to 1.09) or amount (beta = 30.17, 95 percent CI = -162.93 to 223.27) of total dental care expenditures. Likewise, CSHCN did not differ in their likelihood of having undergone a preventive, restorative, diagnostic or other procedure. Known determinants of dental care utilization did not modify the relationships between having SCHN and any dental care expenditure. Despite the reported difficulty in CSHCN's accessing dental care, the authors found that CSHCN had dental care utilization and expenditures that were comparable with those of children without SHCN. Furthermore, the association of CSHCN status and any dental care expenditure was not modified by known determinants of dental care utilization. Future research should focus on characterizing risk for dental disease among CSHCN more accurately and identifying factors that affect dental care utilization in CSHCN, including provider and parent characteristics. The study results highlight low rates of dental care utilization among all young children, including CSHCN. Efforts to increase dental care utilization among children are warranted and need to include broad-based provider and parent initiatives.

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

PubMed

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

2013-01-28

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

Changes in the Cost of Energy in One State's School Districts. Issues & Answers. REL 2010-No. 088

ERIC Educational Resources Information Center

Cymrot, Donald J.; Martinez, Miguel; Jones, Joseph F.

2010-01-01

To support the work of Tennessee's Energy Efficient Schools Initiative (EESI) Council, this report describes data on energy expenditures in school districts for 2002/03-2007/08. Energy expenditures rose from about 2.6 percent to about 3.0 percent of total expenditures over the period, with some differences in the mix of energy types and…

What variables should be considered in allocating Primary health care Pharmaceutical budgets to districts in Uganda?

PubMed

Mujasi, Paschal N; Puig-Junoy, Jaume

2015-01-01

A key policy question for the government of Uganda is how to equitably allocate primary health care pharmaceutical budgets to districts. This paper seeks to identify variables influencing current primary health care pharmaceutical expenditure and their usefulness in allocating prospective pharmaceutical budgets to districts. This was a cross sectional, retrospective observational study using secondary administrative data. We collected data on the value of pharmaceuticals procured by primary health care facilities in each district from National Medical Stores for the financial year 2011/2012. The dependent variable was expressed as per capita district pharmaceutical expenditure. By reviewing literature we identified 26 potential explanatory variables. They include supply, need and demand, and health system organization variables that may influence the demand and supply of health services and the corresponding pharmaceutical expenditure. We collected secondary data for these variables for all the districts in Uganda (n = 112). We performed econometric analysis to estimate parameters of various regression models. There is a significant correlation between per capita district pharmaceutical expenditure and total district population, rural poverty, access to drinking water and outpatient department (OPD) per capita utilisation.(P < 0.01). The percentage of health centre IIIs (HC III) among each district's health facilities is significantly correlated with per capita pharmaceutical expenditure (P < 0.05). OPD per capita utilisation has a relatively strong correlation with per capita pharmaceutical expenditure (r = 0.498); all the other significant factors are weakly correlated with per capita pharmaceutical expenditure (r < 0.5). From several iterations of an initially developed model, the proposed final model for explaining per capita pharmaceutical expenditure explains about 53% of the variation in pharmaceutical expenditure among districts in Uganda (Adjusted R(2) = 0.528). All variables in the model are significant (p < 0.01). From evaluation of the various models, proposed variables to consider in allocating prospective primary health care pharmaceutical budgets to districts in Uganda are: district outpatient department attendance per capita, total district population, total number of government health facilities in the district and the district human poverty index.

Differentiated protection method in passive optical networks based on OPEX

NASA Astrophysics Data System (ADS)

Zhang, Zhicheng; Guo, Wei; Jin, Yaohui; Sun, Weiqiang; Hu, Weisheng

2011-12-01

Reliable service delivery becomes more significant due to increased dependency on electronic services all over society and the growing importance of reliable service delivery. As the capability of PON increasing, both residential and business customers may be included in a PON. Meanwhile, OPEX have been proven to be a very important factor of the total cost for a telecommunication operator. Thus, in this paper, we present the partial protection PON architecture and compare the operational expenditures (OPEX) of fully duplicated protection and partly duplicated protection for ONUs with different distributed fiber length, reliability requirement and penalty cost per hour. At last, we propose a differentiated protection method to minimize OPEX.

Hong Kong domestic health spending: financial years 1989/90 to 2009/10.

PubMed

Tin, K Y K; Tsoi, P K O; Lee, Y H; Tsui, E L H; Lam, D W S; Chui, A W M; Lo, S V

2013-04-01

This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2009/10, cross-stratified and categorised by financing source, provider and function. Total expenditure on health (TEH) was HK$88,721 million in financial year 2009/10, which represents an increase of HK$5031 million or 6.0% over the preceding year. As a result of a slow revival in the economy from the financial tsunami in 2008, TEH grew faster relative to gross domestic product (GDP) leading to a marked increase in TEH as a percentage of GDP from 5.0% in 2008/09 to 5.2% in 2009/10. During the period 1989/90 to 2009/10, total health spending per capita (at constant 2010 prices) grew at an average annual rate of 4.9%, which was faster than the average annual growth rate of per capita GDP by 2.0 percentage points. In 2009/10, public and private expenditure on health increased by 6.2% and 5.8% when compared with 2008/09, reaching HK$43,823 million and HK$44,898 million, respectively. Consequently, public and private shares of total health expenditure stayed at similar levels (49% and 51% respectively) in the 2 years. With respect to private spending, the most important source of health financing was out-of-pocket payments by households (34.9% of TEH), followed by employer-provided group medical benefits (7.4%) and private insurance (6.8%). During the period, a growing number of households (mostly in middle to high income groups) have taken out pre-payment plans to finance health care. As such, private insurance has taken on an increasingly important role in financing private spending. Of the HK$88,721 million total health expenditure in 2009/10, current expenditure comprised HK$84,874 million (95.7%), whereas HK$3847 million (4.3%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share (66.2%), which was made up of ambulatory services (33.5%), in-patient curative care (27.3%), day patient hospital services (4.9%) and home care (0.5%). Notwithstanding the small share of total spending for day patient hospital services, there was an increasing trend over the period 1989/90 to 2009/10, likely as a result of policy directives to shift the emphasis from in-patient to day patient care. Hospitals accounted for an increasing share of total spending, from 28.2% in 1989/90 to 46.8% in 2002/03 and then dropped steadily to 43% to 44% during the period 2005/06 to 2009/10. This trend was primarily driven by reduced expenditure by the Hospital Authority. As a result of epidemics that were of public health importance (eg avian flu, SARS, swine flu) and expansion of the private health insurance market in the last 2 decades, spending on provision and administration of public health programmes, and general health administration and insurance accounted for increasing, though less significant, shares of total health spending over the period. Without taking into account capital expenses (ie investment in medical facilities), public current expenditure on health amounted to HK$40,951 million (48.2% of total current expenditure) in 2009/10. The remaining HK$43,923 expenditure was mostly incurred at hospitals (74.1%), whereas private current expenditure was mostly incurred at providers of ambulatory health care (50.9%). Although both public and private spending were mostly expended on personal health care services and goods (91.0% of total current spending), the distribution patterns among functional categories differed. Public expenditure was targeted at in-patient care (48.9%) and substantially less on out-patient care (26.0%). In comparison, private spending was mostly concentrated on out-patient care (43.4%), whereas in-patient care (23.3%) and medical goods outside the patient care setting (19.5%) accounted for the majority of the remaining share. Compared to the Organisation for Economic Cooperation and Development countries, Hong Kong has devoted a relatively low percentage of GDP to health care in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than in most economies with comparable economic development and public revenue collection base.

Vehicle conversion to hybrid gasoline/alternative fuel operation

NASA Technical Reports Server (NTRS)

Donakowski, T. D.

1982-01-01

The alternative fuels considered are compressed natural gas (CNG), liquefied natural gas (LNG), liquid petroleum gas (LPG), and methanol; vehicles were required to operate in a hybrid or dual-fuel gasoline/alternative fuel mode. Economic feasibility was determined by comparing the costs of continued use of gasoline fuel with the use of alternative fuel and retrofitted equipment. Differences in the amounts of future expenditures are adjusted by means of a total life-cycle costing. All fuels studied are technically feasible to allow a retrofit conversion to hybrid gasoline/alternative fuel operation except for methanol. Conversion to LPG is not recommended for vehicles with more than 100,000 km (60,000 miles) of prior use. Methanol conversion is not recommended for vehicles with more than 50,00 km (30,000 miles).

A comparison of direct medical costs across racial and ethnic groups among children with cancer.

PubMed

Wang, Junling; Dong, Zhiyong; Hong, Song Hee; Suda, Katie J

2008-03-01

Previous studies reported that some minority childhood cancer patients are likely to develop worse outcomes than white children. This study examines whether there are racial and ethnic disparities in health expenditures among children with cancer. A retrospective study was conducted among children (younger than 20) with cancer diagnoses in the Medical Expenditure Panel Survey (MEPS; 1996 to 2004). Total health expenditures and the following subcategories were examined across racial and ethnic groups: (1) office-based visits; (2) outpatient visits; (3) inpatient and emergency room visits; (4) home health care; (5) prescription drugs; and (6) dental, vision, and other health care expenditures. Consumer price indexes were used to convert all expenditures to 2004 dollars. A classical linear model was analyzed using the natural logarithm of health expenditures as the dependent variable, with the purpose of determining whether there were racial and ethnic differences in health expenditures after adjusting for confounding factors. Study sample included 394 non-Hispanic whites (weighted to 4 958 685), 53 non-Hispanic blacks (weighted to 352 534), and 94 Hispanic whites (weighted to 424 319). Hispanic blacks and other minority populations were excluded from the analysis due to insufficient sample size. The annual total health expenditure for treating each child with cancer was $3467.40, $2156.15, and $5545.34, respectively, among non-Hispanic whites, non-Hispanic blacks, and Hispanic whites. The differences in the various subcategories of health expenditures across racial and ethnic groups were generally not significant according to both descriptive and analytical analyses with very few exceptions. This study did not identify significant racial and ethnic disparities in health care costs. However, one important study limitation is the small sample size of the minority populations in the study sample.

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

PubMed

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

2015-01-01

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

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

PubMed Central

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

2015-01-01

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

Analysis of health promotion and prevention financing mechanisms in Thailand

PubMed Central

Watabe, Akihito; Wongwatanakul, Weranuch; Thamarangsi, Thaksaphon; Prakongsai, Phusit; Yuasa, Motoyuki

2017-01-01

Summary In the transition to the post-2015 agenda, many countries are striving towards universal health coverage (UHC). Achieving this, governments need to shift from curative care to promotion and prevention services. This research analyses Thailand's financing system for health promotion and prevention, and assesses policy options for health financing reforms. The study employed a mixed-methods approach and integrates multiple sources of evidence, including scientific and grey literature, expenditure data, and semi-structured interviews with key stakeholders in Thailand. The analysis was underpinned by the use of a well-known health financing framework. In Thailand, three agencies plus local governments share major funding roles for health promotion and prevention services: the Ministry of Public Health (MOPH), the National Health Security Office, the Thai Health Promotion Foundation and Tambon Health Insurance Funds. The total expenditure on prevention and public health in 2010 was 10.8% of the total health expenditure, greater than many middle-income countries that average 7.0–9.2%. MOPH was the largest contributor at 32.9%, the Universal Coverage scheme was the second at 23.1%, followed by the local governments and ThaiHealth at 22.8 and 7.3%, respectively. Thailand's health financing system for promotion and prevention is strategic and innovative due to the three complementary mechanisms in operation. There are several methodological limitations to determine the adequate level of spending. The health financing reforms in Thailand could usefully inform policymakers on ways to increase spending on promotion and prevention. Further comparative policy research is needed to generate evidence to support efforts towards UHC. PMID:26989011

Analysis of health promotion and prevention financing mechanisms in Thailand.

PubMed

Watabe, Akihito; Wongwatanakul, Weranuch; Thamarangsi, Thaksaphon; Prakongsai, Phusit; Yuasa, Motoyuki

2017-08-01

In the transition to the post-2015 agenda, many countries are striving towards universal health coverage (UHC). Achieving this, governments need to shift from curative care to promotion and prevention services. This research analyses Thailand's financing system for health promotion and prevention, and assesses policy options for health financing reforms. The study employed a mixed-methods approach and integrates multiple sources of evidence, including scientific and grey literature, expenditure data, and semi-structured interviews with key stakeholders in Thailand. The analysis was underpinned by the use of a well-known health financing framework. In Thailand, three agencies plus local governments share major funding roles for health promotion and prevention services: the Ministry of Public Health (MOPH), the National Health Security Office, the Thai Health Promotion Foundation and Tambon Health Insurance Funds. The total expenditure on prevention and public health in 2010 was 10.8% of the total health expenditure, greater than many middle-income countries that average 7.0-9.2%. MOPH was the largest contributor at 32.9%, the Universal Coverage scheme was the second at 23.1%, followed by the local governments and ThaiHealth at 22.8 and 7.3%, respectively. Thailand's health financing system for promotion and prevention is strategic and innovative due to the three complementary mechanisms in operation. There are several methodological limitations to determine the adequate level of spending. The health financing reforms in Thailand could usefully inform policymakers on ways to increase spending on promotion and prevention. Further comparative policy research is needed to generate evidence to support efforts towards UHC. © The Author 2016. Published by Oxford University Press.

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

NASA Astrophysics Data System (ADS)

Buri, N.; Mantau, Z.

2018-05-01

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

Energy expenditure through physical activity in a population of community-dwelling Brazilian elderly: cross-sectional evidences from the Bambuí Cohort Study of Aging.

PubMed

Ramalho, Juciany Rodrigues de Oliveira; Lima-Costa, Maria Fernanda; Firmo, Josélia O A; Peixoto, Sérgio Viana

2011-01-01

The aim of this study was to estimate physical activity energy expenditure among older adults. The study comprised 1,585 residents in Bambuí, Minas Gerais State, Brazil, aged > 60 years (91% of the town's total elderly), and examined the frequency and duration of 23 types of physical activity among them. Median energy expenditure was 975 MET.min/week (1,195.8 among men and 803.1 among women), declining significantly with age in both sexes. The prevalence of sedentary lifestyles (< 450 MET.min/week) was 31.2%. Unhurried walking accounted for about 1/3 of total energy expenditure. Multivariate analysis based on ordinal logistic regression showed inverse associations between energy expenditure and age and hospitalizations in both sexes. Among men, inverse associations were observed with smoking, number of chronic diseases and number of medical appointments. These results emphasize the need for effective strategies to increase physical activity in older elderly, and underscore the high prevalence of walking in this group.

Analysis of the influence of recent reforms in China: cardiovascular and cerebrovascular medicines as a case history to provide future direction.

PubMed

Zeng, Wenjie; Zhen, Junjie; Feng, Mengying; Campbell, Stephen M; Finlayson, Alexander E; Godman, Brian

2014-07-01

Pharmaceutical expenditure has grown by 16% per annum in China, enhanced by incentives for physicians and hospitals. Hospital pharmacies dispense 80% of medicines in China, accounting for 46% of total hospital expenditure. Principal measures to moderate drug expenditure growth include pricing initiatives as limited demand-side measures. Assess current utilization and expenditure including traditional Chinese medicines (TCMs) between 2006 and 2012. Uncontrolled retrospective study of medicines to treat cardiovascular and cerebrovascular diseases in one of the largest hospitals in southwest China. Utilization increased 3.3-fold for cerebrovascular medicines, greatest for TCMs, with expenditure increasing 4.85-fold. Low prices for generics were seen, similar to Europe. However, there was variable utilization of generics at 29-31% of total product volumes in recent years. There continued to be irrationality in prescribing with high use of TCMs, and the utilization of different medicines dropping significantly once they achieved low prices. Prices still have an appreciable impact on utilization in China. Potential measures similar to those implemented among western European countries could improve prescribing rationality and conserve resources.

Health care spending and utilization by race/ethnicity under the Affordable Care Act's dependent coverage expansion.

PubMed

Chen, Jie; Bustamante, Arturo Vargas; Tom, Sarah E

2015-07-01

We estimated the effect of the ACA expansion of dependents' coverage on health care expenditures and utilization for young adults by race/ethnicity. We used difference-in-difference models to estimate the impact of the ACA expansion on health care expenditures, out-of-pocket payments (OOP) as a share of total health care expenditure, and utilization among young adults aged 19 to 26 years by race/ethnicity (White, African American, Latino, and other racial/ethnic groups), with adults aged 27 to 30 years as the control group. In 2011 and 2012, White and African American young adults aged 19 to 26 years had significantly lower total health care spending compared with the 27 to 30 years cohort. OOP, as a share of health care expenditure, remained the same after the ACA expansion for all race/ethnicity groups. Changes in utilization following the ACA expansion among all racial/ethnic groups for those aged 19 to 26 years were not significant. Our study showed that the impact of the ACA expansion on health care expenditures differed by race/ethnicity.

Estimation of Potential Savings Through Therapeutic Substitution.

PubMed

Johansen, Michael E; Richardson, Caroline

2016-06-01

Therapeutic substitution offers potential to decrease pharmaceutical expenditures and potentially improve the efficiency of the health care system. To estimate potential savings through therapeutic substitution in terms of both overall and out-of-pocket expenditures of branded drugs when a generic in the same class with the same indication was available. Repeated cross-sectional study using the 107 132 individuals included in the nationally representative Medical Expenditure Panel Survey (2010-2012) along with their reported prescribed medicine use. The Orange Book, company financial statements, US Food and Drug Administration records, and published research were used for adjunctive information. Estimated excess expenditure due to branded drug overuse when a lower-cost generic in the same class with the same indication was available. The study included 107 132 individuals between 2010 and 2012, of whom 62.1% (95% CI, 61.4%-62.8%) reported use of any prescribed medicine. A total of 31.5% (95% CI, 30.7%-32.2%) used a medication from an included drug class, whereas 16.6% (95% CI, 16.0%-17.1%) of the population used a branded drug from the included classes compared with 24.0% (95% CI, 23.4%-24.7%) who used a generic and 9.1% (95% CI, 8.7%-9.4%) who used both. In the included drug classes, the majority of the drugs were generics, with a total of 93.5 billion standardized doses compared with 47.4 billion standardized doses of branded drugs. Total expenditure of the branded drugs accounted for $147 (95% CI, $137-$156) billion compared with $62.7 (95% CI, $58.9-$66.5) billion for the generics. Between 2010 and 2012, an estimated $73.0 (95% CI, $67.6-$78.5) billion in total excess expenditure and $24.6 (95% CI, $22.6-$26.5) billion in out-of-pocket excess expenditure was attributable to branded drug overuse. The excess was present across numerous drug classes throughout many aspects of medicine and equates to 9.6% of total and 14.1% of out-of-pocket prescribed medicine expenses. The drug classes with the highest excess expenditure included statins ($10.9 [SE, $0.41] billion), atypical antipsychotics ($9.99 [SE, $1.03] billion), proton pump inhibitors ($6.12 [SE, $0.38] billion), selective serotonin reuptake inhibitors ($6.08 [SE, $0.49] billion), and angiotensin receptor blockers ($5.53 [SE, $0.35] billion). Although therapeutic substitution is controversial, it offers a potential mechanism to significantly decrease drug costs if it can be implemented in a way that does not negatively affect quality of care.

Revenues and Expenditures for Public Elementary and Secondary School Districts: School Year 2013-14 (Fiscal Year 2014). First Look. NCES 2016-303

ERIC Educational Resources Information Center

Cornman, Stephen Q.

2017-01-01

This First Look report presents data on public elementary and secondary education revenues and expenditures at the local education agency (LEA) or school district level for fiscal year (FY) 2014.1 Specifically, this report includes findings from the following types of school finance data: (1) Revenue and expenditure totals by state and the 100…

Revenues and Expenditures for Public Elementary and Secondary School Districts: School Year 2012-13 (Fiscal Year 2013). First Look. NCES 2015-303

ERIC Educational Resources Information Center

Cornman, Stephen Q.

2016-01-01

This First Look report presents data on public elementary and secondary education revenues and expenditures at the local education agency (LEA) or school district level for fiscal year (FY) 2013. Specifically, this report includes findings from the following types of school finance data: (1) revenue and expenditure totals by state and the 100…

Revenues and Expenditures for Public Elementary and Secondary School Districts: School Year 2011-12 (Fiscal Year 2012). First Look. NCES 2014-303

ERIC Educational Resources Information Center

Cornman, Stephen Q.

2015-01-01

This First Look report presents data on public elementary and secondary education revenues and expenditures at the local education agency (LEA) or school district level for fiscal year (FY) 2012.1. Specifically, this report includes findings from the following types of school finance data: (1) Revenue and expenditure totals by state and the 100…

Resistant starch and energy balance: impact on weight loss and maintenance.

PubMed

Higgins, Janine A

2014-01-01

The obesity epidemic has prompted researchers to find effective weight-loss and maintenance tools. Weight loss and subsequent maintenance are reliant on energy balance--the net difference between energy intake and energy expenditure. Negative energy balance, lower intake than expenditure, results in weight loss whereas positive energy balance, greater intake than expenditure, results in weight gain. Resistant starch has many attributes, which could promote weight loss and/or maintenance including reduced postprandial insulinemia, increased release of gut satiety peptides, increased fat oxidation, lower fat storage in adipocytes, and preservation of lean body mass. Retention of lean body mass during weight loss or maintenance would prevent the decrease in basal metabolic rate and, therefore, the decrease in total energy expenditure, that occurs with weight loss. In addition, the fiber-like properties of resistant starch may increase the thermic effect of food, thereby increasing total energy expenditure. Due to its ability to increase fat oxidation and reduce fat storage in adipocytes, resistant starch has recently been promoted in the popular press as a "weight loss wonder food". This review focuses on data describing the effects of resistant starch on body weight, energy intake, energy expenditure, and body composition to determine if there is sufficient evidence to warrant these claims.

Intensive care unit drug costs in the context of total hospital drug expenditures with suggestions for targeted cost containment efforts.

PubMed

Altawalbeh, Shoroq M; Saul, Melissa I; Seybert, Amy L; Thorpe, Joshua M; Kane-Gill, Sandra L

2018-04-01

To assess costs of intensive care unit (ICU) related pharmacotherapy relative to hospital drug expenditures, and to identify potential targets for cost-effectiveness investigations. We offer the unique advantage of comparing ICU drug costs with previously published data a decade earlier to describe changes over time. Financial transactions for all ICU patients during fiscal years (FY) 2009-2012 were retrieved from the hospital's data repository. ICU drug costs were evaluated for each FY. ICU departments' charges were also retrieved and calculated as percentages of total ICU charges. Albumin, prismasate (dialysate), voriconazole, factor VII and alteplase denoted the highest percentages of ICU drug costs. ICU drug costs contributed to an average of 31% (SD 1.0%) of the hospital's total drug costs. ICU drug costs per patient day increased by 5.8% yearly versus 7.8% yearly for non-ICU drugs. This rate was higher for ICU drugs costs at 12% a decade previous. Pharmacy charges contributed to 17.7% of the total ICU charges. Growth rates of costs per year have declined but still drug expenditures in the ICU are consistently a significant driver in this resource intensive environment with a high impact on hospital drug expenditures. Copyright © 2017 Elsevier Inc. All rights reserved.

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

PubMed

Vilhjálmsson, Rúnar

2009-10-01

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

The Impacts of Local Health Department Consolidation on Public Health Expenditures: Evidence From Ohio

PubMed Central

Morris, Michael E.; Stefanak, Matthew; Filla, Joshua; Prodhan, Rohit; Smith, Sharla A.

2015-01-01

We examined the effects of local health department (LHD) consolidations on the total and administrative expenditures of LHDs in Ohio from 2001 to 2011. We obtained data from annual records maintained by the state of Ohio and through interviews conducted with senior local health officials and identified 20 consolidations of LHDs occurring in Ohio in this time period. We found that consolidating LHDs experienced a reduction in total expenditures of approximately 16% (P = .017), although we found no statistically significant change in administrative expenses. County health officials who were interviewed concurred that their consolidations yielded financial benefits, and they also asserted that their consolidations yielded public health service improvements. PMID:25689193

The impacts of local health department consolidation on public health expenditures: evidence from Ohio.

PubMed

Hoornbeek, John; Morris, Michael E; Stefanak, Matthew; Filla, Joshua; Prodhan, Rohit; Smith, Sharla A

2015-04-01

We examined the effects of local health department (LHD) consolidations on the total and administrative expenditures of LHDs in Ohio from 2001 to 2011. We obtained data from annual records maintained by the state of Ohio and through interviews conducted with senior local health officials and identified 20 consolidations of LHDs occurring in Ohio in this time period. We found that consolidating LHDs experienced a reduction in total expenditures of approximately 16% (P = .017), although we found no statistically significant change in administrative expenses. County health officials who were interviewed concurred that their consolidations yielded financial benefits, and they also asserted that their consolidations yielded public health service improvements.

[Estimated operational costs of vaccination campaign to combat yellow fever in Abidjan].

PubMed

Zengbe-Acray, Pétronille; Douba, Alfred; Traore, Youssouf; Dagnan, Simplice; Attoh-Toure, Harvey; Ekra, Daniel

2009-01-01

A cost effectiveness study was conducted with the main objective to assess the operational costs of a vaccination campaign against yellow fever organised and implemented in Abidjan from September 21st to October 2nd, 2001. The study was carried out from the perspective of the health authorities. Data was collected retrospectively on all information related to resources needed and required activities. The justification of the monetary value of resources was provided with written proof and receipts as well as other supporting documents. The coverage achieved was 91.33% with 2 584 360 doses of vaccine having been administered. Spending on vaccines and vaccine supplies amounted to 1 123 177 128 FCFA; the average cost per dose was 539.40 FCFA. Human resource costs amounted to 2590 people who were mobilized for a total cost of 125 678 400 FCFA. The total operational cost of the vaccination campaign was 1 394 010 829 FCFA. Vaccines and supplies were the largest item of expenditure, or 80.57% of the total spent. The results of this study could serve as a tool for decision-making related to funding a vaccination campaign. Taking account of these results could contribute to the development of strategies to effectively reduce the operational cost of a vaccination campaign.

A low-cost method for estimating energy expenditure during soccer refereeing.

PubMed

Ardigò, Luca Paolo; Padulo, Johnny; Zuliani, Andrea; Capelli, Carlo

2015-01-01

This study aimed to apply a validated bioenergetics model of sprint running to recordings obtained from commercial basic high-sensitivity global positioning system receivers to estimate energy expenditure and physical activity variables during soccer refereeing. We studied five Italian fifth division referees during 20 official matches while carrying the receivers. By applying the model to the recorded speed and acceleration data, we calculated energy consumption during activity, mass-normalised total energy consumption, total distance, metabolically equivalent distance and their ratio over the entire match and the two halves. Main results were as follows: (match) energy consumption = 4729 ± 608 kJ, mass normalised total energy consumption = 74 ± 8 kJ · kg(-1), total distance = 13,112 ± 1225 m, metabolically equivalent distance = 13,788 ± 1151 m and metabolically equivalent/total distance = 1.05 ± 0.05. By using a very low-cost device, it is possible to estimate the energy expenditure of soccer refereeing. The provided predicting mass-normalised total energy consumption versus total distance equation can supply information about soccer refereeing energy demand.

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

PubMed

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

2009-06-01

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

Hong Kong domestic health spending: financial years 1989/90 to 2008/09.

PubMed

Tin, K Y K; Tsoi, P K O; Lee, Y H; Tsui, E L H; Lam, D W S; Chui, A W M; Lo, S V

2012-08-01

This report presents the latest estimates of Hong Kong domestic health spending for financial years 1989/90 to 2008/09, cross-stratified and categorised by financing source, provider and function. Total expenditure on health (TEH) was HK$84,391 million in financial year 2008/09, which represents an increase of HK$5030 million or 6.3% over the preceding year. Amid the financial tsunami in late 2008, TEH grew faster relative to gross domestic product (GDP) leading to a marked increase as a percentage of GDP from 4.8% in 2007/08 to 5.1% in 2008/09. During the period 1989/90 to 2008/09, TEH per capita (at constant 2009 prices) grew at an average annual rate of 4.9%, which was faster than that of per capita GDP by 2.0 percentage points. 6.4% when compared with 2007/08, reaching HK$41 257 million and HK$43 134 million, respectively. Consequently, public and private shares of total health expenditure remained the same in the 2 years at 48.9% and 51.1%, respectively. Regarding private spending, the most important source of health financing was out-of-pocket payments by households (35.4% of TEH), followed by employer-provided group medical benefits (7.5%) and private insurance (6.4%). During the period, a growing number of households (mostly in middle to high-income groups) subscribed to pre-payment plans for financing health care. As such, private insurance has taken on an increasingly important role for financing private spending. Of the HK$84 391 million total health expenditure in 2008/09, current expenditure comprised HK$81 186 million (96.2%), whereas HK$3206 million (3.8%) was for capital expenses (ie investment in medical facilities). Analysed by health care function, services for curative care accounted for the largest share of total health spending (66.1%), which was made up of ambulatory services (32.8%), in-patient curative care (28.8%), day patient hospital services (3.9%) and home care (0.5%). Notwithstanding the small share of total spending for day patient hospital services, there was an increasing trend over the period 1989/90 to 2008/09, likely as a result of policy directives to shift the emphasis from inpatient to day patient care. 1989/90 to 46.8% in 2002/03 and then dropped slightly to 43.1% in 2007/08, which was primarily driven by reduced expenditure of Hospital Authority. Compared with the preceding year, expenditure on hospitals increased by HK$2935 million in 2008/09, whereas the corresponding increase for providers of ambulatory health care was only HK$919 million. As a result, the hospital share rebounded a little to 44.0% of total health spending, whereas that of providers of ambulatory health care dropped to 29.1%. Without taking into account capital expenses (ie investment in medical facilities), public current expenditure on health amounted to HK$39 301 million (48.4% of total current expenditure) in 2008/09 with the remaining HK$41 885 million made up from private sources. Public current expenditure was mostly incurred at hospitals (76.1%), whereas private current expenditure was mostly incurred at providers of ambulatory health care (48.9%). Although both public and private spending were mostly expended on personal health care services and goods (91.8% of total current spending), the patterns of distribution among functional categories differed. Public expenditure was targeted at in-patient care (51.8%) and substantially less on out-patient care (25.1%). In comparison, private spending was mostly concentrated on out-patient care (42.6%), whereas in-patient care (23.4%) and medical goods outside the patient care setting (22.5%) accounted for the majority of the remaining share. Compared to the Organisation for Economic Cooperation and Development countries, Hong Kong has devoted a relatively low percentage of GDP to health care in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) in Hong Kong was also lower than that in most economies with comparable economic development and public revenue collection base.

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

PubMed

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

2018-06-25

China has set up a universal coverage social health insurance system since the 2009 healthcare reform. Due to the inadequate funds, the social health insurance system reimbursed the inpatient expenditures with much higher ratio than outpatient expenditure. The gap in reimbursement ratios resulted in a rapid rising hospitalization rate but poor health outcomes among the Chinese population. A redistribution of social health insurance funds has become one of the main challenges for the performance of Social Health Insurance. Two comparable counties, Dangyang County and Zhijiang County, in Hubei Province of China, were sampled as the intervention group and the control group, respectively. The Social Health Insurance Management Department of the intervention group budgeted 600 yuan per capita per year to the patients with 3rd stage hypertension to cover their outpatient expenditures. The outpatient spending in the control group were paid out-of-pocket. The inpatient expenditures reimbursement policies in both groups were not changed. Besides, the Social Health Insurance Management Department of the intervention group budgeted 100 yuan per patient per year to township physicians and hospitals to provide health management services for the patients. While, the health management services in the control group were still provided by health workers. A Propensity Score Matching model and Difference-in-differences model were used to estimate the net effects of the intervention in dimensions of medical services utilization, medical expenditures, SHI reimbursement, and health outcomes. One thousand, six hundred and seventy three pairs of patients were taken as valid subjects to conduct Difference-in-differences estimation after the Propensity Score Matching. The net intervention effect is to increase outpatient frequency by 3.3 (81.0%) times (P < 0.05), to decrease hospitalization frequency by 0.075 (- 60.0%) times (P < 0.05), and to increase the per capita total medical service utilization frequency by 3.225 (76.8%) times (P < 0.05). The per capita total medical expenditure decreased 394.2 (- 27.7%) yuan. The SHI reimbursed 90.3 yuan more per capita for the outpatient spending, but the per capita inpatient expenditure reimbursement and per capita total medical expenditure reimbursement decreased significantly by 282.6 (- 44.0%) yuan and 192.3 (- 28.5%) yuan, respectively (P < 0.05). The intervention reduced the per capita inpatient out-of-pocket expenditure and the per capita total out-of-pocket expenditure by 192.8 (- 36.7%) yuan and 201.9 (- 29.9%) yuan, respectively (P < 0.05). The intervention significantly decreased the diastolic blood pressure of the intervention group by 2.9 mmHg (P < 0.05) but had no significant impact on the systolic blood pressure (- 7.9 mmHg, P > 0.05). For China and countries attempting to establish a universal coverage SHI with inadequate funds, inpatient services were expensive but might not produce good health outcomes. Outpatient care for patients with chronic diseases should be fundamental, and outpatient expenditures should be reimbursed with a higher ratio.

42 CFR 441.182 - Maintenance of effort: Computation.

Code of Federal Regulations, 2010 CFR

2010-10-01

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

Contractor assistance in highway maintenance : state-of-the-art evaluation.

DOT National Transportation Integrated Search

1980-01-01

The purpose of this study was to perform a state-of-the art evaluation of contractor assistance in Virginia's highway maintenance. The study revealed that expenditures for contractor assistance accounted for 2.79% of the total expenditure on ordinary...

HIV Spending as a Share of Total Health Expenditure: An Analysis of Regional Variation in a Multi-Country Study

PubMed Central

Amico, Peter; Aran, Christian; Avila, Carlos

2010-01-01

Background HIV has devastated numerous countries in sub-Saharan Africa and is a dominant health force in many other parts of the world. Its undeniable importance is reflected in the establishment of Millennium Development Goal No. 6. Unprecedented amounts of funding have been committed and disbursed over the past two decades. Many have argued that this enormous influx of funding has been detrimental to building stronger health systems in recipient countries. This paper examines the funding share for HIV measured against the total funding for health. Methodology/Principal Findings A descriptive analysis of HIV and health expenditures in 2007 from 65 countries was conducted. Comparable data from individual countries was used by applying a consistent definition for HIV expenditures and total health expenditures from NHAs to align them with National AIDS Assessment Reports. In 2007, the total public and international expenditure in LMICs for HIV was 1.6 percent of the total spending on health, while the share in SSA was 19.4 percent. HIV prevalence was six-fold higher in SSA than the next highest region and it is the only region whose share of HIV spending exceeded the burden of HIV DALYs. Conclusions/Significance The share of HIV spending across the 65 countries was quite moderate considering that the estimated share of deaths attributable to HIV stood at 3.8 percent and DALYs at 4.4 percent. Several high spending countries are using a large share of their total health spending for HIV health, but these countries are the exception rather than representative of the average SSA country. There is wide variation between regions, but the burden of disease also varies significantly. The percentage of HIV spending is a useful indicator for better understanding health care resources and their allocation patterns. PMID:20885986

Estimating the budget impact of orphan drugs in Sweden and France 2013–2020

PubMed Central

2014-01-01

Background The growth in expenditure on orphan medicinal products (OMP) across Europe has been identified as a concern. Estimates of future expenditure in Europe have suggested that OMPs could account for a significant proportion of total pharmaceutical expenditure in some countries, but few of these forecasts have been well validated. This analysis aims to establish a robust forecast of the future budget impact of OMPs on the healthcare systems in Sweden and France. Methods A dynamic forecasting model was created to estimate the budget impact of OMPs in Sweden and France between 2013 and 2020. The model used historical data on OMP designation and approval rates to predict the number of new OMPs coming to the market. Average OMP sales were estimated for each year post-launch by regression analysis of historical sales data. Total forecast sales were compared with expected sales of all pharmaceuticals in each country to quantify the relative budget impact. Results The model predicts that by 2020, 152 OMPs will have marketing authorization in Europe. The base case OMP budget impacts are forecast to grow from 2.7% in Sweden and 3.2% in France of total drug expenditure in 2013 to 4.1% in Sweden and 4.9% in France by 2020. The principal driver of expenditure growth is the number of new OMPs obtaining OMP designation. This is tempered by the slowing success rate for new approvals and the loss of intellectual property protection on existing orphan medicines. Given the forward-looking nature of the analysis, uncertainty exists around model parameters and sensitivity analysis found peak year budget impact varying between 2% and 11%. Conclusion The budget impact of OMPs in Sweden and France is likely to remain sustainable over time and a relatively small proportion of total pharmaceutical expenditure. This forecast could be affected by changes in the success rate for OMP approvals, average cost of OMPs, and the type of companies developing OMPs. PMID:24524281

Estimating the budget impact of orphan drugs in Sweden and France 2013-2020.

PubMed

Hutchings, Adam; Schey, Carina; Dutton, Richard; Achana, Felix; Antonov, Karolina

2014-02-13

The growth in expenditure on orphan medicinal products (OMP) across Europe has been identified as a concern. Estimates of future expenditure in Europe have suggested that OMPs could account for a significant proportion of total pharmaceutical expenditure in some countries, but few of these forecasts have been well validated. This analysis aims to establish a robust forecast of the future budget impact of OMPs on the healthcare systems in Sweden and France. A dynamic forecasting model was created to estimate the budget impact of OMPs in Sweden and France between 2013 and 2020. The model used historical data on OMP designation and approval rates to predict the number of new OMPs coming to the market. Average OMP sales were estimated for each year post-launch by regression analysis of historical sales data. Total forecast sales were compared with expected sales of all pharmaceuticals in each country to quantify the relative budget impact. The model predicts that by 2020, 152 OMPs will have marketing authorization in Europe. The base case OMP budget impacts are forecast to grow from 2.7% in Sweden and 3.2% in France of total drug expenditure in 2013 to 4.1% in Sweden and 4.9% in France by 2020. The principal driver of expenditure growth is the number of new OMPs obtaining OMP designation. This is tempered by the slowing success rate for new approvals and the loss of intellectual property protection on existing orphan medicines. Given the forward-looking nature of the analysis, uncertainty exists around model parameters and sensitivity analysis found peak year budget impact varying between 2% and 11%. The budget impact of OMPs in Sweden and France is likely to remain sustainable over time and a relatively small proportion of total pharmaceutical expenditure. This forecast could be affected by changes in the success rate for OMP approvals, average cost of OMPs, and the type of companies developing OMPs.

Reviews of Data on Science Resources, No. 35. State and Local Government R&D Expenditures, FY 1977.

ERIC Educational Resources Information Center

National Science Foundation, Washington, DC. Div. of Science Resources Studies.

Presented are data on State and local government research and development (R&D) expenditures for fiscal year 1977. State agency R&D and R&D plant expenditures are compared graphically for the years 1964, 1968, 1973, and 1977 in both 1977 and constant 1972 dollars, and the trend of State support to R&D is analyzed. A graph of total State agency R&D…

45 CFR 86.41 - Athletics.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

45 CFR 86.41 - Athletics.

Code of Federal Regulations, 2013 CFR

2013-10-01

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

45 CFR 86.41 - Athletics.

Code of Federal Regulations, 2014 CFR

2014-10-01

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

Gross domestic product and health expenditure associated with incidence, 30-day fatality, and age at stroke onset: a systematic review.

PubMed

Sposato, Luciano A; Saposnik, Gustavo

2012-01-01

Differences in definitions of socioeconomic status and between study designs hinder their comparability across countries. We aimed to analyze the correlation between 3 widely used macrosocioeconomic status indicators and clinical outcomes. We selected population-based studies reporting incident stroke risk and/or 30-day case-fatality according to prespecified criteria. We used 3 macrosocioeconomic status indicators that are consistently defined by international agencies: per capita gross domestic product adjusted for purchasing power parity, total health expenditures per capita at purchasing power parity, and unemployment rate. We examined the correlation of each macrosocioeconomic status indicator with incident risk of stroke, 30-day case-fatality, proportion of hemorrhagic strokes, and age at stroke onset. Twenty-three articles comprising 30 population-based studies fulfilled the eligibility criteria. Age-adjusted incident risk of stroke using the standardized World Health Organization World population was associated to lower per capita gross domestic product adjusted for purchasing power parity (ρ=-0.661, P=0.027, R(2)=0.32) and total health expenditures per capita at purchasing power parity (ρ=-0.623, P=0.040, R(2)=0.26). Thirty-day case-fatality rates and proportion of hemorrhagic strokes were also related to lower per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity. Moreover, stroke occurred at a younger age in populations with low per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity. There was no correlation between unemployment rates and outcome measures. Lower per capita gross domestic product adjusted for purchasing power parity and total health expenditures per capita at purchasing power parity were associated with higher incident risk of stroke, higher case-fatality, a greater proportion of hemorrhagic strokes, and lower age at stroke onset. As a result, these macrosocioeconomic status indicators may be used as proxy measures of quality of primary prevention and acute care and considered as important factors for developing strategies aimed at improving worldwide stroke care.

Impact of radio-frequency identification (RFID) technologies on the hospital supply chain: a literature review.

PubMed

Coustasse, Alberto; Tomblin, Shane; Slack, Chelsea

2013-01-01

Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce costs, improve patient safety, and improve supply chain management effectiveness by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Despite ongoing RFID implementation in the hospital supply chain, barriers to widespread and rapid adoption include significant total expenditures, unclear return on investment, and competition with other strategic imperatives.

Impact of Radio-Frequency Identification (RFID) Technologies on the Hospital Supply Chain: A Literature Review

PubMed Central

Coustasse, Alberto; Tomblin, Shane; Slack, Chelsea

2013-01-01

Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce costs, improve patient safety, and improve supply chain management effectiveness by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Despite ongoing RFID implementation in the hospital supply chain, barriers to widespread and rapid adoption include significant total expenditures, unclear return on investment, and competition with other strategic imperatives. PMID:24159272

Diagnostic, pharmacy-based, and self-reported health measures in risk equalization models.

PubMed

Stam, Pieter J A; van Vliet, René C J A; van de Ven, Wynand P M M

2010-05-01

Current research on the added value of self-reported health measures for risk equalization modeling does not include all types of self-reported health measures; and/or is compared with a limited set of medically diagnosed or pharmacy-based diseases; and/or is limited to specific populations of high-risk individuals. The objective of our study is to determine the predictive power of all types of self-reported health measures for prospective modeling of health care expenditures in a general population of adult Dutch sickness fund enrollees, given that pharmacy and diagnostic data from administrative records are already included in the risk equalization formula. We used 4 models of 2002 total, inpatient and outpatient expenditures to evaluate the separate and combined predictive ability of 2 kinds of data: (1) Pharmacy-based (PCGs) and Diagnosis-based (DCGs) Cost Groups and (2) summarized self-reported health information. Model performance is measured at the total population level using R2 and mean absolute prediction error; also, by examining mean discrepancies between model-predicted and actual expenditures (ie, expected over- or undercompensation) for members of potentially "mispriced" subgroups. These subgroups are identified by self-reports from prior-year health surveys and utilization and expenditure data from 5 preceding years. Subjects were 18,617 respondents to a health survey, held among a stratified sample of adult members of the largest Dutch sickness fund in 2002, with an overrepresentation of people in poor health. The data were extracted from a claims database and a health survey. The claims-based data are the outcomes of total, inpatient, and outpatient annualized expenditures in 2002; age, gender, PCGs, DCGs in 2001; and health care expenditures and hospitalizations during the years 1997 to 2001. The SF-36, Organization for Economic Cooperation and Development items, and long-term diseases and conditions were collected by a special purpose health survey conducted in the last quarter of 2001. Out-of-sample R2 equals 17.2%, 2.6%, and 32.4% for the models of total, inpatient and outpatient expenditures including PCGs, DCGs, and self-reported health measures. Self-reported health measures contribute less to predictive power than PCGs and DCGs. PCGs and DCGs also predict better than self-reported health measures for people with top 25% total expenditures or hospitalizations in each year during a 5-year period. On the other hand, self-reported health measures are better predictors than PCGs and DCGs for people without any top 25% expenditures during the 5-year period, for switchers, and for most subgroups of relatively unhealthy people defined by self-reported health measures. Among the set of self-reported health measures, the SF-36 adds most to predictive power in terms of R2, mean absolute prediction error, and for almost all studied subgroups. It is concluded that the self-reported health measures make an independent contribution to forecasting health care expenditures, even if the prediction model already includes diagnostic and pharmacy-based information currently used in Dutch risk equalization models.

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

PubMed Central

2012-01-01

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

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

PubMed

Ding, Liman; Wu, Jing

2017-03-01

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

[The introduction of generic pharmaceutical products into Galicia].

PubMed

Verdejo González, A; López-Lázaro, L; Rodríguez Moreno, C; Piñeiro Lago, B; Pereira Martínez, M L

1999-11-30

To know the evolution of the introduction of generic drugs (GDs) in Galicia. Secondarily, to evaluate its potential impact on pharmaceutical expenditure. Descriptive study of GDs utilization. Cost-minimization analysis. Galician autonomous region, year 1998. Using data from the prescription billing registry of Social Security we have selected the active ingredients corresponding to GDs with prescriptions in Galicia in 1997. We have analyzed the data for their oral single substance preparations by quarters. Consumption in DHDs of allopurinol, atenolol, captopril, naproxen and ranitidine remained stable during 1998. The market share for their GDs in quantitative terms relative to both total consumption of the active ingredients and to their pharmaceutical equivalents, showed an overall growing trend. The maximum observed value was seen for ranitidine at last quarter. Total expenditure (in final customer prices) during 1998 on the selected active substances was higher than 1864 million pesetas. Potential savings afforded by substitution for the lowest price GD prescribed in Galicia would reach 427 million pesetas. GDs market penetration in Galicia during 1998 was limited but increasing. Its utilization may afford estimated savings of 21-28% of the cost for the selected drugs. However, the expenditure on the above drugs was just 2.7% of total pharmaceutical expenditure.

Two-tier charging in Maputo Central Hospital: costs, revenues and effects on equity of access to hospital services.

PubMed

McPake, Barbara; Hongoro, Charles; Russo, Giuliano

2011-06-02

Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations. A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures. The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital. While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total), where capital and drug costs were surprisingly low (2 and 4% respectively). We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a) the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b) because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic operations, rather than the other way around. We conclude that the observed lack of transparency may create scope for an inequitable cross subsidy of private customers by public resources.

Public expenditure for plasma-derived and recombinant medicinal products in Italy.

PubMed

Lanzoni, Monica; Candura, Fabio; Calizzani, Gabriele; Biffoli, Claudia; Grazzini, Giuliano

2013-09-01

In Italy, the supply of plasma-derived medicinal products funded by the National Health Service can be through public healthcare facilities, accredited pharmacies or toll fractionation agreements between Regions and the manufacturer. Pharmaceutical public expenditure includes the supply related to the first two channels and costs can significantly vary because of channel-specific price reductions. This paper describes 2011 public expenditure for plasma-derived medicinal products purchased on the market, as well as the cost analysis per active substance. Analysis of the usage of plasma-derived medicinal products and of the related expenditure in public facilities has been carried out using medicinal product traceability data. The analysis related to the accredited pharmacies channel has been carried out using quantities for every medicinal package recorded by Pharmacy Associations and applying reference prices in force on March 1(st), 2012 as well as discounts for the accredited pharmaceutical expenditure imposed by law. At national and regional level, total and total per capita expenditures on plasma-derived medicinal products by market channel and funded by the National Health Service are shown. Analysis was conducted considering the active substances in three groups: substances included in toll fractionation agreements, recombinant coagulation factors, and other substances not included in toll fractionation agreements. In 2011, the national expenditure estimate for plasma-derived and recombinant medicinal product acquisition on the market was about € 535 million. The purchased volumes and mean purchased prices per unit of each substance have a significant influence on the observed regional variability of the pharmaceutical public expenditure. A strategy of regional comparison aimed at both sharing a national range of reference for purchase prices and evaluating modalities for centralised purchasing is desirable.

Medical Expenditures Associated With Diabetes Among Youth With Medicaid Coverage.

PubMed

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

2017-07-01

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

The impact of diabetes mellitus on healthcare costs in Italy.

PubMed

Giorda, Carlo B; Manicardi, Valeria; Diago Cabezudo, Jesús

2011-12-01

Diabetes mellitus is an increasingly common chronic disease that has a great impact not only in terms of clinical effects, but also in terms of economic burden worldwide. Expenditures due to diabetes derive essentially from direct and indirect costs. Current estimates of global healthcare expenditures due to diabetes are US$376 billion and are expected to increase to US$490 billion by 2030. In particular, costs associated with diabetes-related complications represent the most relevant part of the national healthcare expenditure for diabetes and are higher than the costs of managing diabetes itself. The major expenditure depends on the type and the number of complications: cardiovascular complications increase direct costs, especially for hospitalization. Moreover, diabetic comorbidity has a greater economic impact on the health expenditure in comparison with those patients without diabetes. In Europe, the CODE-2 study was the first attempt to evaluate the costs of diabetes: the annual costs per patient were estimated at €2384 and the highest value, €2991, was registered in Italy. This indicates an overall annual cost of €5170 million for the whole Italian population with diabetes. Current estimates for 2010 healthcare expenditure for diabetes are US$105 billion (10% of total healthcare expenditure, US$2046 per person) for the whole European region, and US$11 billion (9% of total healthcare expenditure, US$2087 per person) for Italy. More studies are needed in order to better define the real significance of the healthcare costs of diabetes in Italy. An effective therapy with a good metabolic control can reduce the risk of complications and represents a valid strategy from an economic point of view.

Gambling expenditure predicts harm: evidence from a venue-level study.

PubMed

Markham, Francis; Young, Martin; Doran, Bruce

2014-09-01

The Total Consumption Theory of gambling suggests that gambling expenditure is positively associated with gambling-related harm. We test the hypothesis that electronic gaming machine (EGM) expenditure predicts gambling-related harm at the level of the EGM venue. Cross-sectional analysis of survey and administrative data. General urban adult population of the Northern Territory of Australia. The sample consisted of 7049 respondents to a mail-survey about venue visitation and gambling behaviour across 62 EGM venues. Gambling-related harm was defined as the endorsement of two or more items on the Problem Gambling Severity Index. We obtained venue-level EGM expenditure data from the local licensing authority for all venues in the study area. We compared the prevalence of gambling-related harm among patrons aggregated at the venue level with the estimated mean EGM expenditure for each adult resident in the venue's service area using a Huff model, correlation analysis and multivariate binomial regression. Aggregated to the venue level (n = 62), per-capita EGM expenditure was correlated significantly with rates of gambling-related harm (r = 0.27, n = 62, P = 0.03). After adjusting for venue type and number of EGMs, an increase in mean per-capita monthly EGM expenditure from $AU10 to $AU150 was associated with a doubling in the prevalence of gambling-related harm from 9% (95% CI = 6-12%) to 18% (95% CI = 13-23%). As suggested by the Total Consumption Theory of gambling, aggregate patron electronic gaming machine expenditure predicts the prevalence of gambling-related harm at the venue level. © 2014 Society for the Study of Addiction.

Health expenditures among high-risk patients after gastric bypass and matched controls.

PubMed

Maciejewski, Matthew L; Livingston, Edward H; Smith, Valerie A; Kahwati, Leila C; Henderson, William G; Arterburn, David E

2012-07-01

To determine whether bariatric surgery is associated with reduced health care expenditures in a multisite cohort of predominantly older male patients with a substantial disease burden. Retrospective cohort study of bariatric surgery. Outpatient, inpatient, and overall health care expenditures within Department of Veterans Affairs (VA) medical centers were examined via generalized estimating equations in the propensity-matched cohorts. Bariatric surgery programs in VA medical centers. Eight hundred forty-seven veterans who were propensity matched to 847 nonsurgical control subjects from the same 12 VA medical centers. Bariatric surgical procedures. Health expenditures through December 2006. Outpatient, inpatient, and total expenditures trended higher for bariatric surgical cases in the 3 years leading up to the procedure and then converged back to the lower expenditure levels of nonsurgical controls in the 3 years after the procedure. Based on analyses of a cohort of predominantly older men, bariatric surgery does not appear to be associated with reduced health care expenditures 3 years after the procedure.

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

PubMed

Braendle, Thomas; Colombier, Carsten

2016-09-01

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

Medicaid Expenditures for Fee-for-Service Enrollees with Behavioral Diagnoses: Findings from a 50 State Claims Analysis.

PubMed

Ward, Martha C; Lally, Cathy; Druss, Benjamin G

2017-01-01

Medicaid is an important funder of care for individuals with behavioral (psychiatric and/or substance use) diagnoses, and expenditures will likely increase with expansion of services under the Affordable Care Act. This study provides national estimates of Medicaid expenditures using a comprehensive sample of fee-for-service Medicaid enrollees with behavioral diagnoses. Data for analysis came from 2003 to 2004 Medicaid Analytic eXtract (MAX) files for 50 states and the District of Columbia. Individuals with behavioral diagnoses had high rates of chronic medical comorbidities, and expenditures for medical (non-behavioral) diagnoses accounted for 74 % of their health care expenditures. Total Medicaid expenditure was approximately 15 billion dollars (equivalent to 18.91 billion in 2016 dollars) for individuals with any behavioral diagnosis. Medicaid fee-for-service beneficiaries with behavioral diagnoses have a high treated prevalence of individual medical comorbid conditions, and the majority of health care expenditures in these individuals are for medical, rather than behavioral health, services.

National health accounts data from 1996 to 2010: a systematic review

PubMed Central

Bui, Anthony L; Lavado, Rouselle F; Johnson, Elizabeth K; Brooks, Benjamin PC; Freeman, Michael K; Graves, Casey M; Haakenstad, Annie; Shoemaker, Benjamin; Hanlon, Michael

2015-01-01

Abstract Objective To collect, compile and evaluate publicly available national health accounts (NHA) reports produced worldwide between 1996 and 2010. Methods We downloaded country-generated NHA reports from the World Health Organization global health expenditure database and the Organisation for Economic Co-operation and Development (OECD) StatExtract website. We also obtained reports from Abt Associates, through contacts in individual countries and through an online search. We compiled data in the four main types used in these reports: (i) financing source; (ii) financing agent; (iii) health function; and (iv) health provider. We combined and adjusted data to conform with OECD’s first edition of A system of health accounts manual, (2000). Findings We identified 872 NHA reports from 117 countries containing a total of 2936 matrices for the four data types. Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types. Thirty-eight countries reported an average not-specified-by-kind value greater than 20% for all data types and years. Some countries reported substantial year-on-year changes in both the level and composition of health expenditure that were probably produced by data-generation processes. All study data are publicly available at http://vizhub.healthdata.org/nha/. Conclusion Data from NHA reports on health expenditure are often incomplete and, in some cases, of questionable quality. Better data would help finance ministries allocate resources to health systems, assist health ministries in allocating capital within the health sector and enable researchers to make accurate comparisons between health systems. PMID:26478614

Measuring racial/ethnic disparities across the distribution of health care expenditures.

PubMed

Cook, Benjamin Lê; Manning, Willard G

2009-10-01

To assess whether black-white and Hispanic-white disparities increase or abate in the upper quantiles of total health care expenditure, conditional on covariates. Nationally representative adult population of non-Hispanic whites, African Americans, and Hispanics from the 2001-2005 Medical Expenditure Panel Surveys. We examine unadjusted racial/ethnic differences across the distribution of expenditures. We apply quantile regression to measure disparities at the median, 75th, 90th, and 95th quantiles, testing for differences over the distribution of health care expenditures and across income and education categories. We test the sensitivity of the results to comparisons based only on health status and estimate a two-part model to ensure that results are not driven by an extremely skewed distribution of expenditures with a large zero mass. Black-white and Hispanic-white disparities diminish in the upper quantiles of expenditure, but expenditures for blacks and Hispanics remain significantly lower than for whites throughout the distribution. For most education and income categories, disparities exist at the median and decline, but remain significant even with increased education and income. Blacks and Hispanics receive significantly disparate care at high expenditure levels, suggesting prioritization of improved access to quality care among minorities with critical health issues.

What Contributes Most to High Health Care Costs? Health Care Spending in High Resource Patients.

PubMed

Pritchard, Daryl; Petrilla, Allison; Hallinan, Shawn; Taylor, Donald H; Schabert, Vernon F; Dubois, Robert W

2016-02-01

U.S. health care spending nearly doubled in the decade from 2000-2010. Although the pace of increase has moderated recently, the rate of growth of health care costs is expected to be higher than the growth in the economy for the near future. Previous studies have estimated that 5% of patients account for half of all health care costs, while the top 1% of spenders account for over 27% of costs. The distribution of health care expenditures by type of service and the prevalence of particular health conditions for these patients is not clear, and is likely to differ from the overall population. To examine health care spending patterns and what contributes to costs for the top 5% of managed health care users based on total expenditures. This retrospective observational study employed a large administrative claims database analysis of health care claims of managed care enrollees across the full age and care spectrum. Direct health care expenditures were compared during calendar year 2011 by place of service (outpatient, inpatient, and pharmacy), payer type (commercially insured, Medicare Advantage, and Medicaid managed care), and therapy area between the full population and high resource patients (HRP). The mean total expenditure per HRP during calendar year 2011 was $43,104 versus $3,955 per patient for the full population. Treatment of back disorders and osteoarthritis contributed the largest share of expenditures in both HRP and the full study population, while chronic renal failure, heart disease, and some oncology treatments accounted for disproportionately higher expenditures in HRP. The share of overall expenditures attributed to inpatient services was significantly higher for HRP (40.0%) compared with the full population (24.6%), while the share of expenditures attributed to pharmacy (HRP = 18.1%, full = 21.4%) and outpatient services (HRP = 41.9%, full = 54.1%) was reduced. This pattern was observed across payer type. While the use of physician-administered pharmaceuticals was slightly higher in HRP, their use did not alter this spending pattern. Overall, expenditures in the HRP population are more than 10-fold higher compared with the full population. Managed care pharmacy can benefit from understanding what contributes to these higher costs, and managed care directors should consider an appropriately balanced assessment of the share of total spend by service and therapeutic category in HRP when devising drug usage and related cost-management strategies.

Out of Pocket Payment for Obstetrical Complications: A Cost Analysis Study in Iran

PubMed Central

Yavangi, Mahnaz; Sohrabi, Mohammad Reza; Riazi, Sahand

2013-01-01

Background: This study was conducted to determine the total expenditure and out of pocket payment on pregnancy complications in Tehran, the capital of Iran. Methods: A cross-sectional study conducted on 1172 patients who admitted in two general teaching referral Hospitals in Tehran. In this study, we calculated total and out of pocket inpatient costs for seven pregnancy complications including preeclampsia, intrauterine growth restriction (IUGR), abortion, ante-partum hemorrhage, preterm delivery, premature rupture of membranes and post-dated pregnancy. We used descriptive analysis and analysis of variance test to compare these pregnancy complications. Results: The average duration of hospitalization was 3.28 days and the number of visits by physicians for a patient was 9.79 on average. The average total cost for these pregnancy complications was 735.22 Unites States Dollars (USD) (standard deviation [SD] = 650.53). The average out of packet share was 277.08 USD (SD = 350.74), which was 37.69% of total expenditure. IUGR with payment of 398.76 USD (SD = 418.54) (52.06% of total expenditure) had the greatest amount of out of pocket expenditure in all complications. While, abortion had the minimum out of pocket amount that was 148.77 USD (SD = 244.05). Conclusions: Obstetrics complications had no catastrophic effect on families, but IUGR cost was about 30% of monthly household non-food costs in Tehran so more financial protection plans and insurances are recommended for these patients. PMID:24404365

Systematic review of factors affecting pharmaceutical expenditures.

PubMed

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

2014-06-01

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

Health Care Spending and Utilization by Race/Ethnicity Under the Affordable Care Act’s Dependent Coverage Expansion

PubMed Central

Bustamante, Arturo Vargas; Tom, Sarah E.

2015-01-01

Objectives. We estimated the effect of the ACA expansion of dependents’ coverage on health care expenditures and utilization for young adults by race/ethnicity. Methods. We used difference-in-difference models to estimate the impact of the ACA expansion on health care expenditures, out-of-pocket payments (OOP) as a share of total health care expenditure, and utilization among young adults aged 19 to 26 years by race/ethnicity (White, African American, Latino, and other racial/ethnic groups), with adults aged 27 to 30 years as the control group. Results. In 2011 and 2012, White and African American young adults aged 19 to 26 years had significantly lower total health care spending compared with the 27 to 30 years cohort. OOP, as a share of health care expenditure, remained the same after the ACA expansion for all race/ethnicity groups. Changes in utilization following the ACA expansion among all racial/ethnic groups for those aged 19 to 26 years were not significant. Conclusions. Our study showed that the impact of the ACA expansion on health care expenditures differed by race/ethnicity. PMID:25905850

Measuring the Displacement and Replacement of Government Health Expenditure

PubMed Central

Dieleman, Joseph L; Hanlon, Michael

2014-01-01

Research assessing the relationship between government health expenditure and development assistance for health channeled to governments (DAHG) has not considered that this relationship may depend on whether DAHG is increasing or decreasing. We explore this issue using general method of moments estimation and a panel of financial flows data spanning 119 countries and 16 years. Our primary concern is how DAHG affects government health expenditure as source (GHES). We disaggregate the average effect of DAHG and separately identify the effects of increases versus decreases in DAHG. We find that a $1 year-over-year increase in DAHG leads to a $0.62 (90% confidence interval (CI): 0.15, 1.09) decrease in GHES, whereas a $1 year-over-year decrease in DAHG does not have an effect on GHES that is statistically different from zero (CI: −0.67, 1.17). Simulation shows that the displacement of GHES between 1995 and 2010 reduced total government health expenditure by $152.8 billion (CI: 46.9, 277.6). Moreover, the irregular disbursement of DAHG reduced total government expenditure by $96.9 billion (CI: 0.5, 212.4). Thus, this research shows that health aid is fungible and highlights the cost of displacement and erratic aid disbursement. PMID:24327240

Health care expenditures among Asian American subgroups.

PubMed

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

2013-06-01

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

Impact of new medical technologies on health expenditures in Israel 2000-07.

PubMed

Rabinovich, Mordechai; Wood, Francis; Shemer, Joshua

2007-01-01

The aim of this study was to estimate the impact of new medical technologies on public healthcare expenditures in Israel over the period 2000-07. For each year, government estimates for the costs of new technologies recommended as high-priority for public funding were summarized. The ratio of projected costs of these technologies to total public healthcare expenditures was calculated and compared with actual governmental budget allocations for new technologies. Funding all new high-priority medical technologies would have increased healthcare expenditures by 2.1 percent per year. Government allocations for new technologies raised expenditures by 1.0 percent per year. New medical technologies significantly increase healthcare expenditures in Israel. Budgetary constraints have reduced their actual impact by 52 percent. This study indicates the need for an annual addition of 2 percent to public healthcare budget for funding new high-priority technologies.

Health Care Expenditures Among Asian American Subgroups

PubMed Central

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

2014-01-01

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

No short-term savings in health care expenditures for physically active adults.

PubMed

Chevan, Julia; Roberts, Dawn E

2014-06-01

The purpose of this study was to investigate the association of physical activity and health care expenditures in a nationally representative sample of non-disabled adults. This was a secondary analysis of data from 8843 adults. Physical activity measures were derived from participants in the 2006 and 2007 National Health Interview Survey. Demographic and expenditure variables came from the Medical Expenditure Panel Survey data files for panels 12 (2007-2008) and 13 (2008-2009). Multivariable regression models were used to determine the association between levels of physical activity participation and total health care expenditures, drug expenditures, and out-of-pocket health care expenditures. Unadjusted data revealed lower health care expenditures among those whose activity level met the CDC guidelines with greater savings apparent among those who exercised above recommended guidelines. However, in the models that adjusted for age, sex, race, income and health status these differences disappeared. In the short-term, the amount of physical activity undertaken by an adult may have little effect on the expenditures for health services, drugs and the money expended directly out-of-pocket. However, given the benefits of physical activity in terms of chronic disease prevention there are very likely long-term expenditure savings to be had. Copyright © 2014 Elsevier Inc. All rights reserved.

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

PubMed

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

2015-06-01

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

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

PubMed Central

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

2012-01-01

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

Recent revisions to and recommendations for national health expenditures accounting

PubMed Central

Haber, Susan G.; Newhouse, Joseph P.

1991-01-01

The Health Care Financing Administration (HCFA) has importantly revised the methodology for estimating annual national health expenditures. Among other changes, the revisions estimated out-of-pocket spending directly, disaggregated expenditures to a greater degree, and reduced undercounting and double counting. Estimates of total spending and out-of-pocket spending changed. This article summarizes a meeting of a technical advisory panel, convened by HCFA, that reviewed the modifications adopted and made recommendations for future revisions. PMID:10114932

Comparison of International Transportation R&D Expenditures and Priorities. (Second clearance edition)

DOT National Transportation Integrated Search

1999-07-01

This report provides a summary of total expenditures on research and development (R&D) in general, and of transportation R&D in particular, by the major performers of transportation R&D within the international community. It also compares these level...

42 CFR 422.388 - Deposits.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) If at any time uncovered expenditures exceed 10 percent of a PSO's total health care expenditures... 42 Public Health 3 2014-10-01 2014-10-01 false Deposits. 422.388 Section 422.388 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE...

42 CFR 422.388 - Deposits.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) If at any time uncovered expenditures exceed 10 percent of a PSO's total health care expenditures... 42 Public Health 3 2013-10-01 2013-10-01 false Deposits. 422.388 Section 422.388 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE...

42 CFR 422.388 - Deposits.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) If at any time uncovered expenditures exceed 10 percent of a PSO's total health care expenditures... 42 Public Health 3 2012-10-01 2012-10-01 false Deposits. 422.388 Section 422.388 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE...

Total energy expenditure in burned children using the doubly labeled water technique

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

Goran, M.I.; Peters, E.J.; Herndon, D.N.

Total energy expenditure (TEE) was measured in 15 burned children with the doubly labeled water technique. Application of the technique in burned children required evaluation of potential errors resulting from nutritional intake altering background enrichments during studies and from the high rate of water turnover relative to CO2 production. Five studies were discarded because of these potential problems. TEE was 1.33 +/- 0.27 times predicted basal energy expenditure (BEE), and in studies where resting energy expenditure (REE) was simultaneously measured, TEE was 1.18 +/- 0.17 times REE, which in turn was 1.16 +/- 0.10 times predicted BEE. TEE was significantlymore » correlated with measured REE (r2 = 0.92) but not with predicted BEE. These studies substantiate the advantage of measuring REE to predict TEE in severely burned patients as opposed to relying on standardized equations. Therefore we recommend that optimal nutritional support will be achieved in convalescent burned children by multiplying REE by an activity factor of 1.2.« less

Biliopancreatic Diversion is associated with greater increases in energy expenditure than Roux-en-Y Gastric Bypass.

PubMed

Werling, Malin; Fändriks, Lars; Olbers, Torsten; Mala, Tom; Kristinsson, Jon; Stenlöf, Kaj; Wallenius, Ville; Docherty, Neil G; le Roux, Carel W

2018-01-01

The greater weight loss achieved following Biliopancreatic Diversion with Duodenal Switch (BPDS) versus Roux-en-Y Gastric Bypass (RYGB) has been attributed to the malabsorptive effects of BPDS. Increased weight loss after BPDS could also be underpinned by larger increases in energy expenditure. Hypothetically, the more radical reconfiguration of the small intestine in BPDS could result in an accentuated increase in meal associated thermogenesis (MAT). Female subjects (baseline mean age 40 years, mean BMI-55kg/m2) were assessed four years after randomization to BPDS (n = 6) or RYGB (n = 6). Energy expenditure (EE) and respiratory quotient (RQ) were measured by indirect calorimetry over 24 hours. A detailed protocol allowed for discrimination of basal metabolic rate (BMR), fasting EE and MAT as components of total energy expenditure (TEE) normalised for total and lean tissue by dual-energy x-ray absorptiometry. Median weight loss at follow-up was 1.5-fold higher following BPDS relative to RYGB, resulting in respective median BMIs of 29.5 kg/m2 (21.7 to 36.7) after BPDS and 37.8 kg/m2 (34.1 to 45.7) after RYGB (p = 0.015). The BPDS group had a lower fat:lean ratio compared to the RYGB group (p = 0.009). Overall 24-hour TEE adjusted for total tissue was higher in the BPDS group, as were BMR, fasting EE and MAT (all p<0.05). Differences between RYGB and BPDS in BMR and TEE were nullified when normalised for lean mass. Postprandial RQ increased significantly but to a similar extent in both groups. Enhanced and prolonged MAT and lower fat:lean mass ratios after BPDS may explain relative increases in total energy expenditure as compared to RYGB.

Biliopancreatic Diversion is associated with greater increases in energy expenditure than Roux-en-Y Gastric Bypass

PubMed Central

Werling, Malin; Fändriks, Lars; Olbers, Torsten; Mala, Tom; Kristinsson, Jon; Stenlöf, Kaj; Wallenius, Ville; le Roux, Carel W.

2018-01-01

Objective The greater weight loss achieved following Biliopancreatic Diversion with Duodenal Switch (BPDS) versus Roux-en-Y Gastric Bypass (RYGB) has been attributed to the malabsorptive effects of BPDS. Increased weight loss after BPDS could also be underpinned by larger increases in energy expenditure. Hypothetically, the more radical reconfiguration of the small intestine in BPDS could result in an accentuated increase in meal associated thermogenesis (MAT). Design Female subjects (baseline mean age 40 years, mean BMI-55kg/m2) were assessed four years after randomization to BPDS (n = 6) or RYGB (n = 6). Energy expenditure (EE) and respiratory quotient (RQ) were measured by indirect calorimetry over 24 hours. A detailed protocol allowed for discrimination of basal metabolic rate (BMR), fasting EE and MAT as components of total energy expenditure (TEE) normalised for total and lean tissue by dual-energy x-ray absorptiometry. Results Median weight loss at follow-up was 1.5-fold higher following BPDS relative to RYGB, resulting in respective median BMIs of 29.5 kg/m2 (21.7 to 36.7) after BPDS and 37.8 kg/m2 (34.1 to 45.7) after RYGB (p = 0.015). The BPDS group had a lower fat:lean ratio compared to the RYGB group (p = 0.009). Overall 24-hour TEE adjusted for total tissue was higher in the BPDS group, as were BMR, fasting EE and MAT (all p<0.05). Differences between RYGB and BPDS in BMR and TEE were nullified when normalised for lean mass. Postprandial RQ increased significantly but to a similar extent in both groups. Conclusion Enhanced and prolonged MAT and lower fat:lean mass ratios after BPDS may explain relative increases in total energy expenditure as compared to RYGB. PMID:29617391

Caregiver stress: does states' expenditure on home- and community-based services matter?

PubMed

Hong, Michin; Casado, Banghwa Lee

2015-01-01

This study examined how state expenditure on home- and community-based services (HCBS) and individual factors are associated with caregiver stress. A total of 1,849 cases from the 2004 National Long-Term Care Survey were included. Gender, education, perceived physical strain, and economic hardship, as well as the number of limitations in instrumental activities of daily living (IADL) for the care recipient, were associated with caregiver stress. The cross-level interaction between service utilization and state expenditure on HCBS was significant, suggesting that living in states with a higher expenditure on HCBS is associated with reduced stress regardless of service utilization.

Assessment of energy balance of Indian farm women in relation to their nutritional profile in lean and peak agricultural seasons.

PubMed

Singh, Suman; Sinwal, Sushma; Rathore, Hemu

2012-01-01

In India, the farm women are not only involved in household activities but also contribute in various farm operations, animal husbandry. The objective was to assess nutritional profile of the farmwomen and their occupational health problems, to compare the physiological workload in lean and peak seasons and to find out relationship between physiological workload and nutritional intake. The study was conducted on a sample of 90 farmwomen. Energy Intake was calculated using physiological fuel values of carbohydrate, fat and protein. Energy Expenditure Rate (EER), Total Energy Expenditure (TEE) and Energy Balance were calculated. The physiological workload was assessed using sub-maximal workload technique. The results revealed that all the respondents of all categories were, more or less, performing all the agriculture, allied and household activities. In all the agriculture activities physiological hazards such as body pain and fatigue were dominant. Dietary, nutritional and energy intake was lower for heavy workers, from all landholding and BMI categories. HR and OCR were in linear relationship in all BMI categories. Physical work capacity increased with good nutritional status and decreased with age. Regression equations were suggested for calculating oxygen consumption (y) at their known heart rate (x) during various agriculture operations.

Evaluating the impact of the national health insurance scheme of Ghana on out of pocket expenditures: a systematic review.

PubMed

Okoroh, Juliet; Essoun, Samuel; Seddoh, Anthony; Harris, Hobart; Weissman, Joel S; Dsane-Selby, Lydia; Riviello, Robert

2018-06-07

Approximately 150 million people suffer from financial catastrophe annually because of out-of-pocket expenditures (OOPEs) on health. Although the National Health Insurance Scheme (NHIS) of Ghana was designed to promote universal health coverage, OOPEs as a proportion of total health expenditures remains elevated at 26%, exceeding the WHO's recommendations of less than 15-20%. To determine whether enrollment in the NHIS reduces the likelihood of OOPEs and catastrophic health expenditures (CHEs) in Ghana, we undertook a systematic review of the published literature. We searched for quantitative articles published in English between January 1, 2003 and August 22, 2017 in PubMed, Google Scholar, Economic Literature, Global Health, PAIS International, and African Index Medicus. Two independent authors (J.S.O. & S.E.) reviewed the articles for inclusion, extracted the data, and conducted a quality assessment of the studies. We accepted the World Health Organization definition of catastrophic health expenditures which is out of pocket payments for health care which exceeds 20% of annual house hold income, 10% of household expenditures, or 40% of subsistence expenditures (total household expenditures net food expenditures). Of the 1094 articles initially identified, 7 were eligible for inclusion. These were cross-sectional household studies published between 2008 and 2016 in Ghana. They demonstrated that the uninsured paid 1.4 to 10 times more in out-of-pocket payments (OOPs) and were more likely to incur CHEs than the insured. Yet, 6 to 18% of insured households made catastrophic payments for healthcare and all studies reported insured members making OOPs for medicines. Evidence suggests that the national health insurance scheme of Ghana over the last 14 years has made some impact on reducing OOPEs, and yet healthcare costs remain catastrophic for a large proportion of insured households in Ghana. Future studies need to explore reasons for the persistence of OOPs for medicines and services that are covered under the scheme.

National Trends in Nonstatin Use and Expenditures Among the US Adult Population From 2002 to 2013: Insights From Medical Expenditure Panel Survey.

PubMed

Salami, Joseph A; Warraich, Haider J; Valero-Elizondo, Javier; Spatz, Erica S; Desai, Nihar R; Rana, Jamal S; Virani, Salim S; Blankstein, Ron; Khera, Amit; Blaha, Michael J; Blumenthal, Roger S; Katzen, Barry T; Lloyd-Jones, Donald; Krumholz, Harlan M; Nasir, Khurram

2018-01-22

Evidence supporting nonstatin lipid-lowering therapy in atherosclerotic cardiovascular disease risk reduction is variable. We aim to examine nonstatin utilization and expenditures in the United States between 2002 and 2013. We used the Medical Expenditure Panel Survey database to estimate national trends in nonstatin use and cost (total and out-of-pocket, adjusted to 2013 US dollars using a gross domestic product deflator) among adults 40 years or older. Nonstatin users increased from 3 million (2.5%) in 2002-2003 (20.1 million prescriptions) to 8 million (5.6%) in 2012-2013 (45.8 million prescriptions). Among adults with atherosclerotic cardiovascular disease, nonstatin use increased from 7.5% in 2002-2003 to 13.9% in 2012-2013 after peaking at 20.3% in 2006-2007. In 2012-2013, 15.9% of high-intensity statin users also used nonstatins, versus 9.7% of low/moderate-intensity users and 3.6% of statin nonusers. Nonstatin use was significantly lower among women (odds ratio 0.80; 95% confidence interval 0.75-0.86), racial/ethnic minorities (odds ratio 0.41; 95% confidence interval 0.36-0.47), and the uninsured (odds ratio 0.47; 95% confidence interval 0.40-0.56). Total nonstatin expenditures increased from $1.7 billion (out-of-pocket cost, $0.7 billion) in 2002-2003 to $7.9 billion (out-of-pocket cost $1.6 billion) in 2012-2013, as per-user nonstatin expenditure increased from $550 to $992. Nonstatin expenditure as a proportion of all lipid-lowering therapy expenditure increased 4-fold from 8% to 32%. Between 2002 and 2013, nonstatin use increased by 124%, resulting in a 364% increase in nonstatin-associated expenditures. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

26 CFR 53.4955-1 - Tax on political expenditures.

Code of Federal Regulations, 2011 CFR

2011-04-01

... continuing, substantial involvement in the day-to-day operations or management of the organization. An... political expenditures by the organization is made by the District Director. (f) Effective date. This... substantive standards for tax exemption under section 501(c)(3), under which an organization is described in...

26 CFR 1.248-1T - Election to amortize organizational expenditures (temporary).

Code of Federal Regulations, 2010 CFR

2010-04-01

..., a corporation begins business when it starts the business operations for which it was organized; a... taxable year in which a corporation begins business, an electing corporation may deduct an amount equal to... the month in which the corporation begins business. All organizational expenditures of the corporation...

The Incredible Shrinking Institution: A Five-Component Downsizing Model.

ERIC Educational Resources Information Center

Dawson, Bradley L.

1991-01-01

Most colleges and universities need to reduce expenditures and downsize. Such a project is difficult and emotionally charged. Many immediate remedies can ba applied to reduce and better control expenditures, but a more thorough analysis of the institution's organizational structure, operating procedures, automated systems, strategic planning, and…

Maximal heat dissipation capacity and hyperthermia risk: neglected key factors in the ecology of endotherms.

PubMed

Speakman, John R; Król, Elzbieta

2010-07-01

1. The role of energy in ecological processes has hitherto been considered primarily from the standpoint that energy supply is limited. That is, traditional resource-based ecological and evolutionary theories and the recent 'metabolic theory of ecology' (MTE) all assume that energetic constraints operate on the supply side of the energy balance equation. 2. For endothermic animals, we provide evidence suggesting that an upper boundary on total energy expenditure is imposed by the maximal capacity to dissipate body heat and therefore avoid the detrimental consequences of hyperthermia--the heat dissipation limit (HDL) theory. We contend that the HDL is a major constraint operating on the expenditure side of the energy balance equation, and that processes that generate heat compete and trade-off within a total boundary defined by heat dissipation capacity, rather than competing for limited energy supply. 3. The HDL theory predicts that daily energy expenditure should scale in relation to body mass (M(b)) with an exponent of about 0.63. This contrasts the prediction of the MTE of an exponent of 0.75. 4. We compiled empirical data on field metabolic rate (FMR) measured by the doubly-labelled water method, and found that they scale to M(b) with exponents of 0.647 in mammals and 0.658 in birds, not significantly different from the HDL prediction (P > 0.05) but lower than predicted by the MTE (P < 0.001). The same statistical result was obtained using phylogenetically independent contrasts analysis. Quantitative predictions of the model matched the empirical data for both mammals and birds. There was no indication of curvature in the relationship between Log(e) FMR and Log(e)M(b). 5. Together, these data provide strong support for the HDL theory and allow us to reject the MTE, at least when applied to endothermic animals. 6. The HDL theory provides a novel conceptual framework that demands a reframing of our views of the interplay between energy and the environment in endothermic animals, and provides many new interpretations of ecological and evolutionary phenomena.

An Empirical Analysis of Rural-Urban Differences in Out-Of-Pocket Health Expenditures in a Low-Income Society of China.

PubMed

Wang, Lidan; Wang, Anjue; Zhou, Detong; FitzGerald, Gerry; Ye, Dongqing; Jiang, Qicheng

2016-01-01

The paper examines whether out-of-pocket health care expenditure also has regional discrepancies, comparing to the equity between urban and rural areas, and across households. Sampled data were derived from Urban Household Survey and Rural Household Survey data for 2011/2012 for Anhui Province, and 11049 households were included in this study. The study compared differences in out-of-pocket expenditure on health care between regions (urban vs. rural areas) and years (2011 vs. 2012) using two-sample t-test, and also investigated the degree of inequality using Lorenz and concentration curves. Approximately 5% and 8% of total household consumption expenditure was spent on health care for urban and rural populations, respectively. In 2012, the wealthiest 20% of urban and rural population contributed 49.7% and 55.8% of urban and rural total health expenditure respectively, while the poorest 20% took only 4.7% and 4.4%. The concentration curve for out-of-pocket expenditure in 2012 fell below the corresponding concentration curve for 2011 for both urban and rural areas, and the difference between curves for rural areas was greater than that for urban areas. A substantial and increasing gap in health care expenditures existed between urban and rural areas in Anhui. The health care financing inequality merits ample attention, with need for policymaking to focus on improving the accessibility to essential health care services, particularly for rural and poor residents. This study may provide useful information on low income areas of China.

National trends in prescription drug expenditures and projections for 2014.

PubMed

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

2014-03-15

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

Daily energy expenditure across the course of lactation among urban Bangladeshi women.

PubMed

Rashid, M; Ulijaszek, S J

1999-12-01

Measures of energy intake of lactating women in developing countries show that intakes are often lower than those recommended by international bodies, while fat-mass losses are often substantially less than the 3-4 kg used in the calculations of recommendations, suggesting that physiological adaptation must be commonplace among such women. The cost of lactation may be met by reduction in energy expenditure, including reduced physical activity, as well as by mobilization of bodily soft tissue. However, daily energy expenditure of lactating women has been shown to increase across the course of lactation among women in a rural population in the Philippines and an urban population in India, with a decline in body weight across the course of lactation in both studies. In the present study, total daily energy expenditure and anthropometric body composition were measured longitudinally in 68 mothers from a poor urban area of Dhaka, Bangladesh, at 0, 1, 2, 4, and 8 months of lactation, to determine whether the increasing energy expenditure across lactation observed elsewhere also occurs in Bangladeshi women. In addition, the extent to which an extended period of lactation was accompanied by weight and body fat change in these women was determined. Energy expenditure by heart-rate monitoring and activity report, and body composition from anthropometry was carried out four times across the 8-month period of lactation. A small decline in body fat mass and a significant increase in total energy expenditure across this period were observed, confirming similar observations elsewhere in the developing world. Copyright 1999 Wiley-Liss, Inc.

Impact of Provider Participation in ACO Programs on Preventive Care Services, Patient Experiences, and Health Care Expenditures in US Adults Aged 18-64.

PubMed

Hong, Young-Rock; Sonawane, Kalyani; Larson, Samantha; Mainous, Arch G; Marlow, Nicole M

2018-05-15

Little is known about the impact of accountable care organization (ACO) on US adults aged 18-64. To examine whether having a usual source of care (USC) provider participating in an ACO affects receipt of preventive care services, patient experiences, and health care expenditures among nonelderly Americans. A cross-sectional analysis of the 2015 Medical Organizations Survey linked with the Medical Expenditure Panel Survey. Survey respondents aged 18-64 with an identified USC and continuous health insurance coverage during 2015. Preventative care services (routine checkup, flu vaccination, and cancer screening), patient experiences with health care (access to care, interaction quality with providers, and global satisfaction), and health care expenditures (total and out-of-pocket expenditures) for respondents with USC by ACO and non-ACO provider groups. Among 1563, nonelderly Americans having a USC, we found that nearly 62.7% [95% confidence interval (CI), 58.6%-66.7%; representing 15,722,208 Americans] were cared for by ACO providers. Our analysis showed no significant differences in preventive care services or patient experiences between ACO and non-ACO groups. Adjusted mean total health expenditures were slightly higher for the ACO than non-ACO group [$7016 (95% CI, $4949-$9914) vs. $6796 (95% CI, $4724-$9892)]; however, this difference was not statistically significant (P=0.250). Our findings suggest that having a USC provider participating in an ACO is not associated with preventive care services use, patient experiences, or health care expenditures among a nonelderly population.

An Empirical Analysis of Rural-Urban Differences in Out-Of-Pocket Health Expenditures in a Low-Income Society of China

PubMed Central

Wang, Lidan; Wang, Anjue; Zhou, Detong; FitzGerald, Gerry; Ye, Dongqing; Jiang, Qicheng

2016-01-01

Objective The paper examines whether out-of-pocket health care expenditure also has regional discrepancies, comparing to the equity between urban and rural areas, and across households. Method Sampled data were derived from Urban Household Survey and Rural Household Survey data for 2011/2012 for Anhui Province, and 11049 households were included in this study. The study compared differences in out-of-pocket expenditure on health care between regions (urban vs. rural areas) and years (2011 vs. 2012) using two-sample t-test, and also investigated the degree of inequality using Lorenz and concentration curves. Result Approximately 5% and 8% of total household consumption expenditure was spent on health care for urban and rural populations, respectively. In 2012, the wealthiest 20% of urban and rural population contributed 49.7% and 55.8% of urban and rural total health expenditure respectively, while the poorest 20% took only 4.7% and 4.4%. The concentration curve for out-of-pocket expenditure in 2012 fell below the corresponding concentration curve for 2011 for both urban and rural areas, and the difference between curves for rural areas was greater than that for urban areas. Conclusion A substantial and increasing gap in health care expenditures existed between urban and rural areas in Anhui. The health care financing inequality merits ample attention, with need for policymaking to focus on improving the accessibility to essential health care services, particularly for rural and poor residents. This study may provide useful information on low income areas of China. PMID:27223811

The current cost of angina pectoris to the National Health Service in the UK

PubMed Central

Stewart, S; Murphy, N; Walker, A; McGuire, A; McMurray, J J V

2003-01-01

Objective: To calculate the cost of angina pectoris to the UK National Health Service (NHS) in the year 2000. Methods: Calculation of the cost of hospital admissions, revascularisation procedures, hospital outpatient consultations, general practice (GP) consultations, and prescribed drug treatment. Results: 634 000 individuals (1.1% of the UK population) consulted GPs 2.35 million times, costing £60.5 million. They required 16.0 million prescriptions (cost £80.7 million) and 254 000 hospital outpatient referrals (cost £30.4 million). There were 149 000 hospital admissions, 117 000 coronary angiograms, 21 400 coronary artery bypass operations, 17 700 percutaneous coronary interventions, and 516 000 outpatient visits, at a cost of £208.4 million, £69.9 million, £106.2 million, £60.7 million, and £52.2 million, respectively. The direct cost of angina was therefore £669 million (1.3% of total NHS expenditure), with hospital bed occupancy and procedures accounting for 32% and 35% of this total, respectively. Conclusions: Angina is a common and costly public health problem. It consumed over 1% of all NHS expenditure in the year 2000, mainly because of hospital bed occupancy and revascularisation procedures. This is likely to be a conservative estimate of its true cost. PMID:12860855

42 CFR 422.388 - Deposits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... uncovered expenditures exceed 10 percent of a PSO's total health care expenditures, then the PSO must place... 42 Public Health 3 2011-10-01 2011-10-01 false Deposits. 422.388 Section 422.388 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE...

42 CFR 422.388 - Deposits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... uncovered expenditures exceed 10 percent of a PSO's total health care expenditures, then the PSO must place... 42 Public Health 3 2010-10-01 2010-10-01 false Deposits. 422.388 Section 422.388 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE...

Effects of network node consolidation in optical access and aggregation networks on costs and power consumption

NASA Astrophysics Data System (ADS)

Lange, Christoph; Hülsermann, Ralf; Kosiankowski, Dirk; Geilhardt, Frank; Gladisch, Andreas

2010-01-01

The increasing demand for higher bit rates in access networks requires fiber deployment closer to the subscriber resulting in fiber-to-the-home (FTTH) access networks. Besides higher access bit rates optical access network infrastructure and related technologies enable the network operator to establish larger service areas resulting in a simplified network structure with a lower number of network nodes. By changing the network structure network operators want to benefit from a changed network cost structure by decreasing in short and mid term the upfront investments for network equipment due to concentration effects as well as by reducing the energy costs due to a higher energy efficiency of large network sites housing a high amount of network equipment. In long term also savings in operational expenditures (OpEx) due to the closing of central office (CO) sites are expected. In this paper different architectures for optical access networks basing on state-of-the-art technology are analyzed with respect to network installation costs and power consumption in the context of access node consolidation. Network planning and dimensioning results are calculated for a realistic network scenario of Germany. All node consolidation scenarios are compared against a gigabit capable passive optical network (GPON) based FTTH access network operated from the conventional CO sites. The results show that a moderate reduction of the number of access nodes may be beneficial since in that case the capital expenditures (CapEx) do not rise extraordinarily and savings in OpEx related to the access nodes are expected. The total power consumption does not change significantly with decreasing number of access nodes but clustering effects enable a more energyefficient network operation and optimized power purchase order quantities leading to benefits in energy costs.

Cost of hospitalization for childbirth in India: how equitable it is in the post-NRHM era?

PubMed

Tripathy, Jaya Prasad; Shewade, Hemant D; Mishra, Sanskruti; Kumar, A M V; Harries, A D

2017-08-15

Information on out-of-pocket (OOP) expenditure during childbirth in public and private health facilities in India is needed to make rational decisions for improving affordability to maternal care services. We undertook this study to evaluate the OOP expenditure due to hospitalization from childbirth and its impact on households. This is a secondary data analysis of a nationwide household survey by the National Sample Survey Organization in 2014. The survey reported health service utilization and health care related expenditure by income quintiles and type of health facility. The recall period for hospitalization expenditure was 365 days. OOP expenditure amounting to more than 10% of annual consumption expenditure was termed as catastrophic. Median expenditure per episode of hospitalisation due to childbirth was US$54. The expenditure incurred was about six times higher among the richest quintile compared to the poorest quintile. Median private sector OOP hospitalization expenditure was nearly nine times higher than in the public sector. Hospitalization in a private sector facility leads to a significantly higher prevalence of catastrophic expenditure than hospitalization in a public sector (60% vs. 7%). Indirect cost (43%) constituted the largest share in the total expenditure in public sector hospitalizations. Urban residence, poor wealth quintile, residing in eastern and southern regions of India and delivery in private hospital were significantly associated with catastrophic expenditure. We strongly recommend cash transfer schemes with effective pro-poor targeting to reduce the impact of catastrophic expenditure. Strengthening of public health facilities is required along with private sector regulation.

Metabolic Energy Costs of USAF Explosive Ordnance Disposal Render Safe Procedures: Field Determinations

DTIC Science & Technology

1991-05-01

work requirement in the moderate to hard work category. This level of energy expenditure should be within the capacity of the average EOD technician...Review of the component tasks of the RSP indicates that peak, short-term work expenditure did not approach the estimated maximal work category (1.9 1 min...hazard which would significantly increase the total energy cost of the RSP. The majority of the expected increase in energy expenditure would result from

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

NASA Technical Reports Server (NTRS)

Paul, Heather L.

2011-01-01

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

Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study.

PubMed

Turchetti, Giuseppe; Pierotti, Francesca; Palla, Ilaria; Manetti, Stefania; Freschi, Cinzia; Ferrari, Vincenzo; Cuschieri, Alfred

2017-02-01

Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches. The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p < 0.001). The study showed no significant difference in total costs between OS and DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p < 0.001), but not against DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge. The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach.

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

PubMed

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

2012-05-01

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

Are Free Maternity Services Completely Free of Costs?

PubMed

Acharya, Jeevan

2016-02-01

The Government of Nepal revised free maternity health services, "Aama Surakshya Karyakram", beginning at the start of Fiscal Year 2012/13, which specifies the services to be funded, the tariffs for reimbursement, and the system for claiming and reporting on free deliveries each month. This study was designed to investigate the amount of monetary expenditure incurred by families using apparently free maternity services. Between August 2014 and December 2014, a hospital-based cross-sectional study was conducted at Manipal Teaching Hospital and Western Regional Hospital. Nepalese women were not involved with family finances and had very little knowledge of income or expenditures. Therefore, face-to-face interviews with 384 postpartum mothers with their husbands or the head of the family household were conducted at the time of discharge by using a pre-tested semi-structural questionnaire. The average monthly family income was 19,272.4 NRs (189.01 US$), the median duration of hospital stay was 4 days (range, 2-19 days), and the median patient expenditure was equivalent to 13% of annual family income. The average total visible cost was 3,887.07 NRs (38.1 US$). When the average total hidden cost of 27,288.5 NRs (267.6 US$) was added, then the average total maternity care expenditure was 31,175.6 NRs (305.76 US$), with an average cost per day of 7,167.5 NRs (70.29 US$). The mean patient expenditure on food and drink, clothes, transport, and medicine was equivalent to 53.07%, 9.8%. 7.3%, and 5.6% of the mean total maternity care expenditure, respectively. The earnings lost by respondent women, husbands, and heads of household were 5,963.7 NRs (58.4 US$), 7,429.3 NRs (72.9 US$), and 6,175.9 NRs (60.6 US$), respectively. The free maternity service in Nepal has high out-of-pocket expenditures, and did not represent a system completely free of costs. Therefore, arrangements should be made by hospitals free of cost to provide medicine that is not included as essential during the hospital stay and at discharge time. Similarly, arrangements for liquid, food, and hot water, as well as clothes for mothers and newborns, should be made by the hospital in order to enhance hospital attendance.

Revision of dietary reference intakes for energy in preschool-age children

USDA-ARS?s Scientific Manuscript database

Dietary Reference Intakes (DRI) for energy aim to balance energy expenditure at a level of physical activity consistent with health and support adequate growth in children. DRIs were derived from total energy expenditure (TEE) measured by using the doubly labeled water (DLW) method; however, the dat...

Modeling regulated water utility investment incentives

NASA Astrophysics Data System (ADS)

Padula, S.; Harou, J. J.

2014-12-01

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

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

PubMed

Gandjour, A; Ihle, P; Schubert, I

2008-02-01

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

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

PubMed

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

2004-05-01

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

Effect of chewing speed on energy expenditure in healthy subjects.

PubMed

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

2014-08-01

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

Financial burden of household out-of pocket health expenditure in Viet Nam: findings from the National Living Standard Survey 2002-2010.

PubMed

Van Minh, Hoang; Kim Phuong, Nguyen Thi; Saksena, Priyanka; James, Chris D; Xu, Ke

2013-11-01

In Viet Nam, household direct out-of-pocket (OOP) health expenditure as a share of the total health expenditure has been always high, ranging from 50% to 70%. The high share of OOP expenditure has been linked to different inequity problems such as catastrophic health expenditure (households must reduce their expenditure on other necessities) and impoverishment. This paper aims to examine catastrophic and poverty impacts of household out-of-pocket health expenditure in Viet Nam over time and identify socio-economic indicators associated with them. Data used in this research were obtained from a nationally representative household survey, Viet Nam Living Standard Survey 2002, 2004, 2006, 2008 and 2010. The findings revealed that there were problems in health care financing in Viet Nam - many households encountered catastrophic health expenditure and/or were pushed into poverty due to health care payments. The issues were pervasive over time. Catastrophic expenditure and impoverishment problems were more common among the households who had more elderly people and those located in rural areas. Importantly, the financial protection aspect of the national health insurance schemes was still modest. Given these findings, more attention is needed on developing methods of financial protection in Viet Nam. Copyright © 2012 Elsevier Ltd. All rights reserved.

Health care expenditures associated with pediatric pain-related conditions in the United States.

PubMed

Groenewald, Cornelius B; Wright, Davene R; Palermo, Tonya M

2015-05-01

The primary objective of this study was to assess the impact of pediatric pain-related conditions on health care expenditures. We analyzed data from a nationally representative sample of 6- to 17-year-old children captured in the 2007 National Health Interview Survey and 2008 Medical Expenditure Panel Survey. Health care expenditures of children with pain-related conditions were compared with those of children without pain-related conditions. Pain-related conditions were associated with incremental health care expenditures of $1339 (95% confidence interval [CI], $248-$2447) per capita. Extrapolated to the nation, pediatric pain-related conditions were associated with $11.8 billion (95% CI, $2.18-$21.5 billion) in total incremental health care expenditures. The incremental health care expenditures associated with pediatric pain-related conditions were similar to those of attention deficit and hyperactivity disorder ($9.23 billion; 95% CI, $1.89-$18.1 billion), but more than those associated with asthma ($5.35 billion; 95% CI, $0-$12.3 billion) and obesity ($0.73 billion; 95% CI, $6.28-$8.81 billion). Health care expenditures for pediatric pain-related conditions exert a considerable economic burden on society. Efforts to prevent and treat pediatric pain-related conditions are urgently needed.

Iranian Households’ Payments on Food and Health Out-of-Pocket Expenditures: Evidence of Inequality

PubMed Central

GHIASVAND, Hesam; NAGHDI, Seyran; ABOLHASSANI, Nazanin; SHAARBAFCHIZADEH, Nasrin; MOGHRI, Javad

2015-01-01

Background: Inequality in households’ payments on food and health expenditures presents the accessibility and utilization patterns between them. This study investigated the Iranian rural and urban households’ inequality in payments on food and Out-of-Pocket health expenditures from 1998 to 2012. Methods: This descriptive study was conducted through the analysis of Iranian Statistics Centre data on Iranian households’ income and expenditures. The Gini Coefficients, Concentration and Kakwani indices have been calculated for Iranian rural and urban households’ Out-of-Pocket health and food expenditures. Results: The means of Iranian rural and urban total consumption expenditures inequality were 0.48 and 0.48, respectively. The means of concentration index of food expenditures for rural and urban regions were 0.35 and 0.34, respectively. The means of Out-of-Pocket payments for health services for rural and urban regions were 0.51 and 0.5, respectively. Finally the means of Kakwani index of Out-of-Pocket health payments in rural and urban households were −0.005 and −0.018, respectively. Conclusion: There are relative high levels of inequality in Iranian households’ payments on food and Out-of-Pocket health expenditures. PMID:26587474

Improved estimates of Belgian private health expenditure can give important lessons to other OECD countries.

PubMed

Calcoen, Piet; Moens, Dirk; Verlinden, Pieter; van de Ven, Wynand P M M; Pacolet, Jozef

2015-03-01

OECD Health Data are a well-known source for detailed information about health expenditure. These data enable us to analyze health policy issues over time and in comparison with other countries. However, current official Belgian estimates of private expenditure (as published in the OECD Health Data) have proven not to be reliable. We distinguish four potential major sources of problems with estimating private health spending: interpretation of definitions, formulation of assumptions, missing or incomplete data and incorrect data. Using alternative sources of billing information, we have reached more accurate estimates of private and out-of-pocket expenditure. For Belgium we found differences of more than 100% between our estimates and the official Belgian estimates of private health expenditure (as published in the OECD Health Data). For instance, according to OECD Health Data private expenditure on hospitals in Belgium amounts to €3.1 billion, while according to our alternative calculations these expenses represent only €1.1 billion. Total private expenditure differs only 1%, but this is a mere coincidence. This exercise may be of interest to other OECD countries looking to improve their estimates of private expenditure on health. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

PubMed Central

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

2015-01-01

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

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

PubMed

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

2016-04-01

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

Predicting Student Achievement in Ohio: The Role of Expenditure Distribution

ERIC Educational Resources Information Center

De Luca, Barbara M.; Hinshaw, Steven A.

2013-01-01

The purpose of this research was to investigate the role of school district expenditures in predicting student achievement in Ohio for the school year 2009-2010. Building upon the concept of the "65 percent solution," the research questions that guided this study were: (1) What percentage of Ohio's school district's operating budgets…

Reduce Operating Costs with an EnergySmart School Project

ERIC Educational Resources Information Center

US Department of Energy, 2008

2008-01-01

Energy costs are a school district's second highest expenditure after personnel. Public schools currently spend more than $8 billion per year for energy. School energy expenditures rose, on average, 20 percent per year between 2000 and 2002--and the costs continue to rise. Natural gas prices alone increased 14 percent annually between 2003 and…

Campaign Expenditures in School Levy Referenda and Their Relationship to Voter Approval: Evidence from Ohio, 2007-2010

ERIC Educational Resources Information Center

Ingle, William Kyle; Johnson, Paul Andrew; Givens, Matt Ryan; Rampelt, Jerry

2013-01-01

Using logistic regression, this study sought to understand the relationship between district characteristics, district finances, levy characteristics, and campaign expenditures with new operating levy outcomes. We found that employee benefits as a percentage of the district's budget were negatively associated with levy outcomes, while salaries…

26 CFR 1.612-5 - Charges to capital and to expense in case of geothermal wells.

Code of Federal Regulations, 2010 CFR

2010-04-01

... expenditures made by an operator for wages, fuel, repairs, hauling, supplies, etc., incident to and necessary... water. Such expenditures have for convenience been termed intangible drilling and development costs... applies are all amounts paid for labor, fuel, repairs, hauling, and supplies, or any of them, which are...

Michigan and Ohio K-12 Educational Financing Systems: Equality and Efficiency

ERIC Educational Resources Information Center

Conlin, Michael; Thompson, Paul N.

2014-01-01

We consider issues of equality and efficiency in two different school funding systems--a state-level system in Michigan and a foundation system in Ohio. Unlike Ohio, the Michigan system restricts districts from generating property or income tax revenue to fund operating expenditures. In both states, districts fund capital expenditures with local…

Finances of Public School Systems in 1979-80.

ERIC Educational Resources Information Center

Bureau of the Census (DOC), Suitland, MD.

Thirteen tables present 1979-1980 data on public school enrollment, revenue sources, capital and operating expenditures, debt, and cash and security holdings. Data are provided for each state, for categories of school-district enrollment size, and for all individual school systems with over 15,000 students. Revenues and expenditures for each state…

Elements of Property Wealth and Educational Expenditures in Illinois.

ERIC Educational Resources Information Center

Lows, Raymond L.; Ho, Fanny

This study examines the relationships between various elements of property wealth and operating expenditures per pupil by types of school district--elementary (K-8), high (9-12), and unit (K-12). Elements of property wealth were defined as the equalized assessed valuation per pupil for each of the following property tax classifications:…

Economic growth and inflation rate: implications for municipal revenue and health expenditure of the municipalities of Pernambuco, Brazil.

PubMed

Feliciano, Marciana; Bezerra, Adriana Falangola Benjamin; Santo, Antônio Carlos Gomes do Espírito

2017-06-01

This paper analyzes the implications of municipal budget revenue growth and the monetary policy's inflation rates goals in the availability of public health resources of municipalities. This is a descriptive, exploratory, quantitative, retrospective and longitudinal cross-sectional study covering the period 2002-2011. We analyzed health financing and expenditure variables in the municipalities of the state of Pernambuco, Brazil, describing the trend and the relationship between them. Data showed the growth of the variables and trend towards homogeneity. The exception was for the participation of Intergovernmental Transfers in the Total Health Expenditure of the Municipality. We found a significant correlation between Budget Revenue per capita and Health Expenditure per capita and a strong significant negative correlation between Inflation Rate, Budget Revenue per capita and Health Expenditure per capita. We concluded that increased health expenditure is due more to higher municipal tax revenue than to increased transfers that, in relative terms, did not increase. The strong inverse relationship between inflation rate and the Financing and Expenditure variables show that the monetary policy's inflation goals have restricted health financing to municipalities.

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

PubMed

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

2014-10-01

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

The Role of Policy and Institutions on Health Spending.

PubMed

de la Maisonneuve, Christine; Moreno-Serra, Rodrigo; Murtin, Fabrice; Oliveira Martins, Joaquim

2017-07-01

This paper investigates the impact of policies and institutions on health expenditures for a large panel of Organisation for Economic Co-operation and Development countries for the period of 2000-2010. A set of 20 policy and institutional indicators developed by the Organisation for Economic Co-operation and Development are integrated into a theoretically motivated econometric framework, alongside control variables related to demographic (dependency ratio) and non-demographic (income, prices and technology) drivers of health expenditures per capita. Although a large share of cross-country differences in public health expenditures can be explained by demographic and economic factors (around 71%), cross-country variations in policies and institutions also have a significant influence, explaining most of the remaining difference in public health spending (23%). Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Measuring the displacement and replacement of government health expenditure.

PubMed

Dieleman, Joseph L; Hanlon, Michael

2014-02-01

Research assessing the relationship between government health expenditure and development assistance for health channeled to governments (DAHG) has not considered that this relationship may depend on whether DAHG is increasing or decreasing. We explore this issue using general method of moments estimation and a panel of financial flows data spanning 119 countries and 16 years. Our primary concern is how DAHG affects government health expenditure as source (GHES). We disaggregate the average effect of DAHG and separately identify the effects of increases versus decreases in DAHG. We find that a $1 year-over-year increase in DAHG leads to a $0.62 (90% confidence interval (CI): 0.15, 1.09) decrease in GHES, whereas a $1 year-over-year decrease in DAHG does not have an effect on GHES that is statistically different from zero (CI: -0.67, 1.17). Simulation shows that the displacement of GHES between 1995 and 2010 reduced total government health expenditure by $152.8 billion (CI: 46.9, 277.6). Moreover, the irregular disbursement of DAHG reduced total government expenditure by $96.9 billion (CI: 0.5, 212.4). Thus, this research shows that health aid is fungible and highlights the cost of displacement and erratic aid disbursement. © 2013 The Authors. Health Economics published by John Wiley & Sons, Ltd.

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

PubMed

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

2009-05-04

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

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

PubMed Central

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

2009-01-01

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

Participant characteristics associated with errors in self-reported energy intake from the Women's Health Initiative food-frequency questionnaire.

PubMed

Horner, Neilann K; Patterson, Ruth E; Neuhouser, Marian L; Lampe, Johanna W; Beresford, Shirley A; Prentice, Ross L

2002-10-01

Errors in self-reported dietary intake threaten inferences from studies relying on instruments such as food-frequency questionnaires (FFQs), food records, and food recalls. The objective was to quantify the magnitude, direction, and predictors of errors associated with energy intakes estimated from the Women's Health Initiative FFQ. Postmenopausal women (n = 102) provided data on sociodemographic and psychosocial characteristics that relate to errors in self-reported energy intake. Energy intake was objectively estimated as total energy expenditure, physical activity expenditure, and the thermic effect of food (10% addition to other components of total energy expenditure). Participants underreported energy intake on the FFQ by 20.8%; this error trended upward with younger age (P = 0.07) and social desirability (P = 0.09) but was not associated with body mass index (P = 0.95). The correlation coefficient between reported energy intake and total energy expenditure was 0.24; correlations were higher among women with less education, higher body mass index, and greater fat-free mass, social desirability, and dissatisfaction with perceived body size (all P < 0.10). Energy intake is generally underreported, and both the magnitude of the error and the association of the self-reporting with objectively estimated intake appear to vary by participant characteristics. Studies relying on self-reported intake should include objective measures of energy expenditure in a subset of participants to identify person-specific bias within the study population for the dietary self-reporting tool; these data should be used to calibrate the self-reported data as an integral aspect of diet and disease association studies.

The Cost of Arbovirus Disease Prevention in Europe: Area-Wide Integrated Control of Tiger Mosquito, Aedes albopictus, in Emilia-Romagna, Northern Italy

PubMed Central

Canali, Massimo; Rivas-Morales, Stefano; Beutels, Philippe; Venturelli, Claudio

2017-01-01

Aedes albopictus (tiger mosquito) has become the most invasive mosquito species worldwide, in addition to being a well-known vector of diseases, with a proven capacity for the transmission of chikungunya and dengue viruses in Europe as well as the Zika virus in Africa and in laboratory settings. This research quantifies the cost that needs to be provided by public-health systems for area-wide prevention of arboviruses in Europe. This cost has been calculated by evaluating the expenditure of the plan for Aedes albopictus control set up in the Emilia-Romagna region (Northern Italy) after a chikungunya outbreak occurred in 2007. This plan involves more than 280 municipalities with a total of 4.2 million inhabitants. Public expenditure for plan implementation in 2008–2011 was examined through simple descriptive statistics. Annual expenditure was calculated to be approximately €1.3 per inhabitant, with a declining trend (from a total of €7.6 million to €5.3 million) and a significant variability at the municipality level. The preventative measures in the plan included antilarval treatments (about 75% of total expenditure), education for citizens and in schools, entomological surveillance, and emergency actions for suspected viremias. Ecological factors and the relevance of tourism showed a correlation with the territorial variability in expenditure. The median cost of one antilarval treatment in public areas was approximately €0.12 per inhabitant. Organizational aspects were also analyzed to identify possible improvements in resource use. PMID:28425959

Health-Related Financial Catastrophe, Inequality and Chronic Illness in Bangladesh

PubMed Central

Rahman, Md. Mizanur; Gilmour, Stuart; Saito, Eiko; Sultana, Papia; Shibuya, Kenji

2013-01-01

Background Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP) payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk. Objective This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe. Methods A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively. Results On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults. Conclusion Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by reducing the health system's dependency on OOP payments and providing more financial risk protection. PMID:23451102

A cross-sectional analysis of the cost and affordability of achieving recommended intakes of non-starchy fruits and vegetables in the capital of Vanuatu.

PubMed

Jones, Holly A; Charlton, Karen E

2015-03-28

The low-income Pacific Island nation of Vanuatu is experiencing a double burden of diet-related disease whereby micronutrient deficiencies and underweight occur at the same time as obesity related non-communicable diseases. Increasing intakes of nutrient dense, energy dilute foods such as fruits and vegetables will be important to address this issue. However, reduced access to agricultural land in urban areas provides limited opportunities for traditional subsistence fruit and vegetable production. Set in Port Vila, Vanuatu's capital and main urban centre, this study aimed to determine the cost and affordability of meeting international recommendations to consume at least 400 g of non-starchy fruits and vegetables (NSFV) per person per day, and assess the adequacy of households' NSFV expenditure. NSFV prices from the 2010 Vanuatu Consumer Price Index (n = 56) were used to determine the minimum monthly cost of purchasing 400 g of local NSFV per person, after accounting for wastage. The 2010 Vanuatu Household Income and Expenditure Survey (n = 578 households) was analysed to determine the proportion of households' total and food budget required to purchase 400 g of local NSFV for all household members. Household NSFV costs were also compared against actual household expenditure on these items. Consumption of own-produce and gifts received were included within estimates of food expenditure. The minimum cost of purchasing the recommended amount of local NSFV was 1,486.24 vatu ($16.60 US) per person per month. This level of expenditure would require an average of 9.6% (SD 6.4%) of households' total budget and 26.3% (SD 25.8%) of their food budget. The poorest households would need to allocate 40.9% (SD 34.3%) of their total food budget to NSFV to purchase recommended amounts of these foods. Twenty-one percent of households recorded sufficient NSFV expenditure while 23.4% recorded less than 10% of the expenditure required to meet the NSFV recommendations. Achieving recommended intakes of local NSFV in Port Vila is largely unaffordable, and expenditure on these foods was inadequate for most households in Port Vila in 2010. Addressing fruit and vegetable affordability will be an important consideration in prevention of non-communicable diseases in the Pacific region.

Using Analogs for Performance Testing of Humans in Spacesuits in Simulated Reduced Gravity

NASA Technical Reports Server (NTRS)

Norcross, Jason R.

2013-01-01

In general metabolic rates tend to be higher in NBL than in flight: a) Restraint method dependant; b) Significant differences between the NBL and flight for BRT and APFR (buoyancy effects). c) No significant difference between NBL and flight for free float and SRMS/SSRMS operations. The total metabolic energy expenditure for a given task and for the EVA as a whole are similar between NBL and flight: a) NBL metabolic rates are higher, but training EVAs are constrained to 5 1/2 hours. b) Flight metabolic rates are lower, but the EVAs are typically an hour or more longer in duration. NBL metabolic rates provide a useful operational tool for flight planning. Quantifying differences and similarities between training and flight improves knowledge for preparation of safe and efficient EVAs.

Assessing the catastrophic effects of out-of-pocket healthcare payments prior to the uptake of a nationwide health insurance scheme in Ghana

PubMed Central

Akazili, James; McIntyre, Diane; Kanmiki, Edmund W.; Gyapong, John; Oduro, Abraham; Sankoh, Osman; Ataguba, John E.

2017-01-01

ABSTRACT Background: Financial risk protection against the cost of unforeseen healthcare has gained global attention in recent years. Although Ghana implemented a nationwide health insurance scheme with a goal of reducing financial barriers to accessing healthcare and addressing impoverishing effects of out-of-pocket (OOP) healthcare payments, there is a paucity of knowledge on the extent of financial catastrophe of such payments in Ghana. Thus, this paper assesses the catastrophic effect of OOP healthcare payments in Ghana. Methods: Ghana Living Standard Survey (GLSS 5) data collected in 2005/2006 are used in this study. Catastrophic effect of OOP healthcare payments is assessed using various thresholds of total household expenditure and non-food expenditure. Furthermore, four indices, namely the catastrophic payment headcount, catastrophic payment gap, weighted catastrophic payment headcount and weighted catastrophic payment gap, are defined and computed. Results: As at 2005/2006, it was estimated that 11.0% of households in Ghana spent over 5% of their total household expenditure on healthcare OOP. However, after adjusting for the concentration of such spending, it decreased to 10.9%. Also 10.7% of households spent more than 10% of their non-food consumption expenditure on OOP healthcare payments. Furthermore, about 2.6% of households are observed to have spent in excess of 20% of their total household income on healthcare OOP. With the exception of the 5% threshold of household expenditure, because the concentration indices of these expenditures are negative, the burden of such expenditures rests more on the poor. Conclusions: Significant levels of financial catastrophe existed in Ghana prior to the uptake of the national health insurance scheme. Poorer households were at a higher risk than the relatively well-off households. The results of this study present baseline assessment of the impact of Ghana’s health insurance policy on catastrophic healthcare payments. Thus, there is a need for continuous monitoring of financial catastrophe in the system to ensure that households are adequately protected. PMID:28485675

Age-Related Variation in Health Service Use and Associated Expenditures among Children with Autism

ERIC Educational Resources Information Center

Cidav, Zuleyha; Lawer, Lindsay; Marcus, Steven C.; Mandell, David S.

2013-01-01

This study examined differences by age in service use and associated expenditures during 2005 for Medicaid-enrolled children with autism spectrum disorders. Aging was associated with significantly higher use and costs for restrictive, institution-based care and lower use and costs for community-based therapeutic services. Total expenditures…

Low levels of energy expenditure in childhood cancer survivors: Implications for obesity prevention

USDA-ARS?s Scientific Manuscript database

Childhood cancer survivors are at an increased risk of obesity but causes for this elevated risk are uncertain. We evaluated total energy expenditure in childhood cancer survivors using the doubly labeled water method in a cross-sectional study of 17 survivors of pediatric leukemia or lymphoma (medi...

Expenditures on Children by Rural Families.

ERIC Educational Resources Information Center

Lino, Mark

2002-01-01

From 1960 to 2000, total expenses to rear a rural child to age 18 increased in real terms. Food expenses decreased, but child care and educational expenses increased more. Details are presented on child-rearing expenditures by low-, middle-, and higher-income rural and urban families on housing, food, transportation, clothing, health care, child…

State Medicaid ICF-MR Utilization and Expenditures in the 1980-1984 Period.

ERIC Educational Resources Information Center

Harrington, Charlene; Swan, James H.

1990-01-01

State Medicaid expenditures for Intermediate Care Facilities for the Mentally Retarded (ICF-MR) increased sharply between 1980 and 1984. The ICF-MR bed capacity declined relative to the total state population, while numbers of ICF-MR Medicaid recipients increased. Trends among states are examined, emphasizing changes in demographic factors,…

State Education Finance and Governance Profile: Delaware

ERIC Educational Resources Information Center

Canon, Katherine

2010-01-01

This article presents the state education finance and governance of Delaware. Funding for public education generally comes from three sources: the federal government (7.6%), the state government (64.3%), and local governments (28.1%). Educational expenditures for K-12 public schools in Delaware total $1.66 billion. Per-pupil expenditure in the…

Energy expenditure and nutritional status of coal miners: A cross-sectional study.

PubMed

Bilici, Saniye; Saglam, Fatma; Beyhan, Yasemin; Barut-Uyar, Banugul; Dikmen, Derya; Goktas, Zeynep; Attar, A James; Mucka, Patrick; Uyar, M Fatih

2016-09-02

The objectives of this study were to assess the nutritional status, daily energy intake, and daily energy expenditure of coal miners in Turkey. A total of 135 healthy coal miners (aged 19-64 years) were evaluated. Heart rates were measured using Polar watches, and the total energy expenditure was calculated using physical activity level formula and Hiilloskorpi equation. The average body mass index of the participants was 25.7 ± 3.98 kg/m 2 , and the average energy intake was 3,973.7 ± 420.85 kcal. According to Dietary Reference Intakes, the energy and nutrient intakes of the miners were adequate, except for the intake of vitamin D. The coal miners were found to be at moderate (43.0%), heavy (41.5%), and very heavy (13.3%) activity levels. Calculations of the energy expenditure at work were found to be 2,189.8 ± 376.19 to 2,788.8 ± 359.89 kcal per day. Further studies have to be conducted for developing national standards for each occupation.

Mechanical energy estimation during walking: validity and sensitivity in typical gait and in children with cerebral palsy.

PubMed

Van de Walle, P; Hallemans, A; Schwartz, M; Truijen, S; Gosselink, R; Desloovere, K

2012-02-01

Gait efficiency in children with cerebral palsy is usually quantified by metabolic energy expenditure. Mechanical energy estimations, however, can be a valuable supplement as they can be assessed during gait analysis and plotted over the gait cycle, thus revealing information on timing and sources of increases in energy expenditure. Unfortunately, little information on validity and sensitivity exists. Three mechanical estimation approaches: (1) centre of mass (CoM) approach, (2) sum of segmental energies (SSE) approach and (3) integrated joint power approach, were validated against oxygen consumption and each other. Sensitivity was assessed in typical gait and in children with diplegia. CoM approach underestimated total energy expenditure and showed poor sensitivity. SSE approach overestimated energy expenditure and showed acceptable sensitivity. Validity and sensitivity were best in the integrated joint power approach. This method is therefore preferred for mechanical energy estimation in children with diplegia. However, mechanical energy should supplement, not replace metabolic energy, as total energy expended is not captured in any mechanical approach. Copyright © 2011 Elsevier B.V. All rights reserved.

Energy Cost of Active and Sedentary Music Video Games: Drum and Handheld Gaming vs. Walking and Sitting

PubMed Central

MIRANDA, EDWIN; OVERSTREET, BRITTANY S.; FOUNTAIN, WILLIAM A.; GUTIERREZ, VINCENT; KOLANKOWSKI, MICHAEL; OVERSTREET, MATTHEW L.; SAPP, RYAN M.; WOLFF, CHRISTOPHER A.; MAZZETTI, SCOTT A.

2017-01-01

To compare energy expenditure during and after active and handheld video game drumming compared to walking and sitting. Ten experienced, college-aged men performed four protocols (one per week): no-exercise seated control (CTRL), virtual drumming on a handheld gaming device (HANDHELD), active drumming on drum pads (DRUM), and walking on a treadmill at ~30% of VO2max (WALK). Protocols were performed after an overnight fast, and expired air was collected continuously during (30min) and after (30min) exercise. DRUM and HANDHELD song lists, day of the week, and time of day were identical for each participant. Significant differences (p < 0.05) among the average rates of energy expenditure (kcal·min−1) during activity included WALK > DRUM > HANDHELD. No significant differences in the rates of energy expenditure among groups during recovery were observed. Total energy expenditure was significantly greater (p < 0.05) during WALK (149.5 ± 30.6 kcal) compared to DRUM (118.7 ± 18.8 kcal) and HANDHELD (44.9±11.6 kcal), and greater during DRUM compared to HANDHELD. Total energy expenditure was not significantly different between HANDHELD (44.9 ± 11.6 kcal) and CTRL (38.2 ± 6.0 kcal). Active video game drumming at expert-level significantly increased energy expenditure compared to handheld, but it hardly met moderate-intensity activity standards, and energy expenditure was greatest during walking. Energy expenditure with handheld video game drumming was not different from no-exercise control. Thus, traditional aerobic exercise remains at the forefront for achieving the minimum amount and intensity of physical activity for health, individuals desiring to use video games for achieving weekly physical activity recommendations should choose games that require significant involvement of lower-body musculature, and time spent playing sedentary games should be a limited part of an active lifestyle. PMID:29170705

Cardiovascular Health and Healthcare Utilization and Expenditures Among Medicare Beneficiaries: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study.

PubMed

Aaron, Kristal J; Colantonio, Lisandro D; Deng, Luqin; Judd, Suzanne E; Locher, Julie L; Safford, Monika M; Cushman, Mary; Kilgore, Meredith L; Becker, David J; Muntner, Paul

2017-02-01

Better cardiovascular health is associated with lower cardiovascular disease risk. We determined the association between cardiovascular health and healthcare utilization and expenditures in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. We included 6262 participants ≥65 years with Medicare fee-for-service coverage for the year after their baseline study visit in 2003-2007. Cardiovascular health at baseline was assessed using the American Heart Association's Life's Simple 7 (LS7) metric, which includes 7 factors: cigarette smoking, physical activity, diet, body mass index, blood pressure, cholesterol, and glucose. Healthcare utilization and expenditures were ascertained using Medicare claims in the year following baseline. Overall, 17.2%, 31.1%, 29.0%, 16.4% and 6.4% of participants had 0 to 1, 2, 3, 4, and 5 to 7 ideal LS7 factors, respectively. The multivariable-adjusted relative risk (95% confidence interval [CI]) for having any inpatient and outpatient encounters comparing participants with 5 to 7 versus 0 to 1 ideal LS7 factors were 0.55 (0.39, 0.76) and 1.00 (0.98, 1.02), respectively. Among participants with 0 to 1 and 5 to 7 ideal LS7 factors, mean inpatient expenditures were $3995 and $1250, respectively, mean outpatient expenditures were $5166 and $2853, respectively, and mean total expenditures were $9147 and $4111, respectively. After multivariable adjustment, the mean (95% CI) cost difference comparing participants with 5 to 7 versus 0 to 1 ideal LS7 factors was -$2551 (-$3667, -$1435) for inpatient, -$2410 (-$3089, -$1731) for outpatient, and -$5016 (-$6577, -$3454) for total expenditures. Better cardiovascular health is associated with lower risk for inpatient encounters and lower inpatient and outpatient healthcare expenditures. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Hours spent and energy expended in physical activity domains: results from the Tomorrow Project cohort in Alberta, Canada.

PubMed

Csizmadi, Ilona; Lo Siou, Geraldine; Friedenreich, Christine M; Owen, Neville; Robson, Paula J

2011-10-10

Knowledge of adult activity patterns across domains of physical activity is essential for the planning of population-based strategies that will increase overall energy expenditure and reduce the risk of obesity and related chronic diseases. We describe domain-specific hours of activity and energy expended among participants in a prospective cohort in Alberta, Canada. The Past Year Total Physical Activity Questionnaire was completed by 15,591 Tomorrow Project® participants, between 2001 and 2005 detailing physical activity type, duration, frequency and intensity. Domain-specific hours of activity and activity-related energy expenditure, expressed as a percent of total energy expenditure (TEE) (Mean (SD); Median (IQR)) are reported across inactive (<1.4), low active (1.4 to 1.59), active (1.6 to 1.89) and very active (≥ 1.9) Physical Activity Level (PAL = TEE:REE) categories. In very active women and amongst all men except those classified as inactive, activity-related energy expenditure comprised primarily occupational activity. Amongst inactive men and women in active, low active and inactive groups, activity-related energy expenditure from household activity was comparable to, or exceeded that for occupational activity. Leisure-time activity-related energy expenditure decreased with decreasing PAL categories; however, even amongst the most active men and women it accounted for less than 10 percent of TEE. When stratified by employment status, leisure-time activity-related energy expenditure was greatest for retired men [mean (SD): 10.8 (8.5) percent of TEE], compared with those who were fully employed, employed part-time or not employed. Transportation-related activity was negligible across all categories of PAL and employment status. For the inactive portion of this population, active non-leisure activities, specifically in the transportation and occupational domains, need to be considered for inclusion in daily routines as a means of increasing population-wide activity levels. Environmental and policy changes to promote active transport and workplace initiatives could increase overall daily energy expenditure through reducing prolonged sitting time.

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

PubMed

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

2011-11-01

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

Energy Cost of Active and Sedentary Music Video Games: Drum and Handheld Gaming vs. Walking and Sitting.

PubMed

Miranda, Edwin; Overstreet, Brittany S; Fountain, William A; Gutierrez, Vincent; Kolankowski, Michael; Overstreet, Matthew L; Sapp, Ryan M; Wolff, Christopher A; Mazzetti, Scott A

2017-01-01

To compare energy expenditure during and after active and handheld video game drumming compared to walking and sitting. Ten experienced, college-aged men performed four protocols (one per week): no-exercise seated control (CTRL), virtual drumming on a handheld gaming device (HANDHELD), active drumming on drum pads (DRUM), and walking on a treadmill at ~30% of VO 2max (WALK). Protocols were performed after an overnight fast, and expired air was collected continuously during (30min) and after (30min) exercise. DRUM and HANDHELD song lists, day of the week, and time of day were identical for each participant. Significant differences (p < 0.05) among the average rates of energy expenditure (kcal·min -1 ) during activity included WALK > DRUM > HANDHELD. No significant differences in the rates of energy expenditure among groups during recovery were observed. Total energy expenditure was significantly greater (p < 0.05) during WALK (149.5 ± 30.6 kcal) compared to DRUM (118.7 ± 18.8 kcal) and HANDHELD (44.9±11.6 kcal), and greater during DRUM compared to HANDHELD. Total energy expenditure was not significantly different between HANDHELD (44.9 ± 11.6 kcal) and CTRL (38.2 ± 6.0 kcal). Active video game drumming at expert-level significantly increased energy expenditure compared to handheld, but it hardly met moderate-intensity activity standards, and energy expenditure was greatest during walking. Energy expenditure with handheld video game drumming was not different from no-exercise control. Thus, traditional aerobic exercise remains at the forefront for achieving the minimum amount and intensity of physical activity for health, individuals desiring to use video games for achieving weekly physical activity recommendations should choose games that require significant involvement of lower-body musculature, and time spent playing sedentary games should be a limited part of an active lifestyle.

Florida's Public Education Spending. School Choice Issues in the State

ERIC Educational Resources Information Center

Aud, Susan

2006-01-01

This study analyzes and explains Florida's education finance system. It explains the sources of revenue and the expenditure of funds, reporting figures for each of the state's 67 districts. It also analyzes the trend in current expenditures --that is, the day-to-day operating costs of schools--to address the question of whether they have been…

26 CFR 1.612-5 - Charges to capital and to expense in case of geothermal wells.

Code of Federal Regulations, 2014 CFR

2014-04-01

... expenditures made by an operator for wages, fuel, repairs, hauling, supplies, etc., incident to and necessary... applies are all amounts paid for labor, fuel, repairs, hauling, and supplies, or any of them, which are... expenditures are amounts paid for wages, fuel, repairs, hauling, supplies, etc. used in the installation of...

26 CFR 1.612-5 - Charges to capital and to expense in case of geothermal wells.

Code of Federal Regulations, 2012 CFR

2012-04-01

... expenditures made by an operator for wages, fuel, repairs, hauling, supplies, etc., incident to and necessary... applies are all amounts paid for labor, fuel, repairs, hauling, and supplies, or any of them, which are... expenditures are amounts paid for wages, fuel, repairs, hauling, supplies, etc. used in the installation of...

26 CFR 1.612-5 - Charges to capital and to expense in case of geothermal wells.

Code of Federal Regulations, 2013 CFR

2013-04-01

... expenditures made by an operator for wages, fuel, repairs, hauling, supplies, etc., incident to and necessary... applies are all amounts paid for labor, fuel, repairs, hauling, and supplies, or any of them, which are... expenditures are amounts paid for wages, fuel, repairs, hauling, supplies, etc. used in the installation of...

Current Operating Costs of Two-Year Colleges in the South.

ERIC Educational Resources Information Center

Scales, Eldridge E.

This analysis of current expenditures of 127 accredited public and private 2-year colleges in 11 southern states is intended to provide data for comparison of expenditures by private and public colleges, to show administrators where spending differs among the colleges, and to provide objective data for them to judge the efficiency of their own…

Carbon dioxide utilization in a microalga-based biorefinery: Efficiency of carbon removal and economic performance under carbon taxation.

PubMed

Wiesberg, Igor Lapenda; Brigagão, George Victor; de Medeiros, José Luiz; de Queiroz Fernandes Araújo, Ofélia

2017-12-01

Coal-fired power plants are major stationary sources of carbon dioxide and environmental constraints demand technologies for abatement. Although Carbon Capture and Storage is the most mature route, it poses severe economic penalty to power generation. Alternatively, this penalty is potentially reduced by Carbon Capture and Utilization, which converts carbon dioxide to valuable products, monetizing it. This work evaluates a route consisting of carbon dioxide bio-capture by Chlorella pyrenoidosa and use of the resulting biomass as feedstock to a microalgae-based biorefinery; Carbon Capture and Storage route is evaluated as a reference technology. The integrated arrangement comprises: (a) carbon dioxide biocapture in a photobioreactor, (b) oil extraction from part of the produced biomass, (b) gasification of remaining biomass to obtain bio-syngas, and (c) conversion of bio-syngas to methanol. Calculation of capital and operational expenditures are estimated based on mass and energy balances obtained by process simulation for both routes (Carbon Capture and Storage and the biorefinery). Capital expenditure for the biorefinery is higher by a factor of 6.7, while operational expenditure is lower by a factor of 0.45 and revenues occur only for this route, with a ratio revenue/operational expenditure of 1.6. The photobioreactor is responsible for one fifth of the biorefinery capital expenditure, with footprint of about 1000 ha, posing the most significant barrier for technical and economic feasibility of the proposed biorefinery. The Biorefinery and Carbon Capture and Storage routes show carbon dioxide capture efficiency of 73% and 48%, respectively, with capture cost of 139$/t and 304$/t. Additionally, the biorefinery has superior performance in all evaluated metrics of environmental impacts. Copyright © 2017 Elsevier Ltd. All rights reserved.

Asthma expenditures in the United States comparing 2004 to 2006 and 1996 to 1998.

PubMed

Rank, Matthew A; Liesinger, Juliette T; Ziegenfuss, Jeanette Y; Branda, Megan E; Lim, Kaiser G; Yawn, Barbara P; Li, James T; Shah, Nilay D

2012-09-01

To describe how the types of healthcare expenditures for patients with asthma have changed over the past decade. Cross-sectional comparison between individuals from 1996 to 1998 and 2004 to 2006. Expenditures among US individuals (aged 5 to 56 years) with asthma were compared using the 1996 to 1998 and the 2004 to 2006 Medical Expenditure Panel Surveys. Direct expenditures (medications, inpatient, outpatient, and emergency services) and changes in productivity (missed school and work days) were compared over this time frame. The adjusted analyses controlled for age, education level, race/ethnicity, gender, poverty, region, metropolitan statistical area, self-reported health, and Charlson Comorbidity Index. Mean annual per capita healthcare expenditures increased between 1996 to 1998 and 2004 to 2006 ($3802 vs $5322 inflated to 2010 US dollars, P <.0001). Annual medication expenditures doubled from $974 to $2010 per person (P <.0001) and outpatient visit expenditures increased from $861 to $1174 (P <.0001) while hospitalization and emergency department (ED) visit expenditures were similar over the same time period. Missed school and work days decreased between the 2 periods (9.23 days in 1996-1998 vs 6.39 days in 2004-2006, P = .001). An increase in total direct expenditures in individuals with asthma was largely driven by an increase in spending on medications comparing 2004 to 2006 and 1996 to 1998 data. However, this increase was not offset by lower spending on hospitalization and ED visits.

Effectiveness and cost effectiveness of television, radio and print advertisements in promoting the New York smokers' quitline.

PubMed

Farrelly, Matthew C; Hussin, Altijani; Bauer, Ursula E

2007-12-01

This study assessed the relative effectiveness and cost effectiveness of television, radio and print advertisements to generate calls to the New York smokers' quitline. Regression analysis was used to link total county level monthly quitline calls to television, radio and print advertising expenditures. Based on regression results, standardised measures of the relative effectiveness and cost effectiveness of expenditures were computed. There was a positive and statistically significant relation between call volume and expenditures for television (p<0.01) and radio (p<0.001) advertisements and a marginally significant effect for expenditures on newspaper advertisements (p<0.065). The largest effect was for television advertising. However, because of differences in advertising costs, for every $1000 increase in television, radio and newspaper expenditures, call volume increased by 0.1%, 5.7% and 2.8%, respectively. Television, radio and print media all effectively increased calls to the New York smokers' quitline. Although increases in expenditures for television were the most effective, their relatively high costs suggest they are not currently the most cost effective means to promote a quitline. This implies that a more efficient mix of media would place greater emphasis on radio than television. However, because the current study does not adequately assess the extent to which radio expenditures would sustain their effectiveness with substantial expenditure increases, it is not feasible to determine a more optimal mix of expenditures.

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

PubMed

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

2017-11-01

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

Resource flows for health care: Namibia reproductive health sub-accounts.

PubMed

Mbeeli, Thomas; Samahiya, Muine; Ravishankar, Nirmala; Zere, Eyob; Kirigia, Joses M

2011-12-24

Implementing initiatives to achieve the targets of MDG 5 requires sufficient financial resources that are mobilized and utilized in an equitable, efficient and sustainable manner. Informed decision making to this end requires the availability of reliable health financing information. This is accomplished by means of Reproductive Health (RH) sub-account, which captures and organizes expenditure on RH services in two-dimensional tables from financing sources to end users. The specific objectives of this study are: (i) to quantify total expenditure on reproductive health services; and (ii) to examine the flow of RH funds from sources to end users. The RH sub-account was part of the general National Health Accounts exercise covering the Financial Years 2007/08 and 2008/09. Primary data were collected from employers, medical aid schemes, donors and government ministries using questionnaire. Secondary data were obtained from various documents of the Namibian Government and the health financing database of the World Health Organization. Data were analyzed using a data screen designed in Microsoft Excel. RH expenditure per woman of reproductive age was US$ 148 and US$ 126 in the 2007/08 and 2008/09 financial years respectively. This is by far higher than what is observed in most African countries. RH expenditure constituted more than 10-12% of the total expenditure on health. Out-of-pocket payment for RH was minimal (less than 4% of the RH spending in both years). Government is the key source of RH spending. Moreover, the public sector is the main financing agent with programmatic control of RH funds and also the main provider of services. Most of the RH expenditure is spent on services of curative care (both in- and out-patient). The proportion allocated for preventive and public health services was not more than 5% in the two financial years. Namibia's expenditure on reproductive health is remarkable by the standards of Africa and other middle-income countries. However, an increasing maternal mortality ratio does not bode well with the level of reproductive health expenditure. It is therefore important to critically examine the state of efficiency in the allocation and use of reproductive health expenditures in order to improve health outcomes.

Impacts of drug reimbursement reductions on utilization and expenditures of oral antidiabetic medications in Taiwan: an interrupted time series study.

PubMed

Hsu, Jason C; Lu, Christine Y; Wagner, Anita K; Chan, K Arnold; Lai, Mei-Shu; Ross-Degnan, Dennis

2014-06-01

To control increasing pharmaceutical expenditures, Taiwan's National Health Insurance has implemented a series of drug reimbursement price reductions since 2000. This study examined changes in use and expenditures of oral antidiabetic medications following the price regulation in November 2006. We obtained claims data between January 2006 and August 2007 from Taiwan's National Health Insurance Research Database. We categorized oral antidiabetic products as affected by the reimbursement reduction ("targeted") or not ("non-targeted"), by level of relative price reduction, and by manufacturer type (international vs. local manufacturers). We used an interrupted time series design and segmented regression models to estimate changes in monthly per capita prescribing rate, volume, and insurance reimbursement expenditures following the policy. The majority (129/178; 72.5%) of oral antidiabetic products were targeted by this round of price reductions. There was a relative reduction of 9.5% [95%CI: -12.68, -6.32] in total expenditures at ten months post-policy compared to expected rates. For targeted products, there were 2.04% [95%CI: -4.15, 0.07] and 13.26% [95%CI: -16.64, -9.87] relative reductions in prescribing rate and expenditures, respectively, at ten months post-policy. Non-targeted products increased significantly (22% [95%CI: 10.49, 33.51] and 22.85% [95%CI: 11.69, 34.01] relative increases in prescribing rate and expenditures respectively). Larger reimbursement cuts led to greater reductions in prescribing rate, volume, and insurance reimbursement expenditures of targeted products. Prescribing rates of both targeted and non-targeted products by international manufacturers declined after the policy while rates of prescribing non-targeted products by local manufacturers increased. While total government expenditures for oral antidiabetic medications were contained by the policy, our results indicate that prescribing shifted at the margin from targeted to non-targeted products and from international to local products. Further research is warranted to understand how changes in medication use due to price regulation policies affect medication adherence and patient health outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Medicaid prospective payment: Case-mix increase

PubMed Central

Baker, Samuel L.; Kronenfeld, Jennie J.

1990-01-01

South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced. PMID:10113463

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

PubMed

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

2015-07-01

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

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

PubMed Central

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

2011-01-01

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

A smooth mixture of Tobits model for healthcare expenditure.

PubMed

Keane, Michael; Stavrunova, Olena

2011-09-01

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

Determinants of catastrophic health expenditure in Nigeria.

PubMed

Aregbeshola, Bolaji Samson; Khan, Samina Mohsin

2018-05-01

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

Modeling Health Care Expenditures and Use.

PubMed

Deb, Partha; Norton, Edward C

2018-04-01

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

Increased Body Weight Reduces Voluntary Movement to Maintain Energy Expenditure of Rats Exposed to Increases in Gravity

NASA Technical Reports Server (NTRS)

Wade, C. E.; Moran, M. M.; Stein, T. P.; Sin, Sidney (Technical Monitor)

2001-01-01

With the increase in obesity related diseases there is heightened interest in mechanisms regulating body weight. To assess the influence of increases in body weight on energy expenditure and intake in rats we employed variable levels of gravity. Our approach afforded the means to measure interactions of energy expenditure and intake in response to increases in body weight (body mass x gravity level). We found a dose relationship between rapid elevation of body weight and reduction of voluntary movement, such that the energy requirements for activity are unchanged, and total energy expenditure and intake maintained. Reduction of movement appears to be a response to increased body weight, rather than a contributing factor, suggesting a new regulatory pathway.

User Guide for the International Jobs and Economic Development Impacts Model

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

Keyser, David; Flores-Espino, Francisco; Uriarte, Caroline

The International Jobs and Economic Development Impacts (I-JEDI) model is a freely available economic model that estimates gross economic impacts from wind, solar, and geothermal energy projects for several different countries. Building on the original JEDI model, which was developed for the United States, I-JEDI was developed under the USAID Enhancing Capacity for Low Emission Development Strategies (EC-LEDS) program to support countries in assessing economic impacts of LEDS actions in the energy sector. I-JEDI estimates economic impacts by characterizing the construction and operation of energy projects in terms of expenditures and the portion of these expenditures made within the countrymore » of analysis. These data are then used in a country-specific input-output (I-O) model to estimate employment, earnings, gross domestic product (GDP), and gross output impacts. Total economic impacts are presented as well as impacts by industry. This user guide presents general information about how to use I-JEDI and interpret results as well as detailed information about methodology and model limitations.« less

European Union-28: An annualised cost-of-illness model for venous thromboembolism.

PubMed

Barco, Stefano; Woersching, Alex L; Spyropoulos, Alex C; Piovella, Franco; Mahan, Charles E

2016-04-01

Annual costs for venous thromboembolism (VTE) have been defined within the United States (US) demonstrating a large opportunity for cost savings. Costs for the European Union-28 (EU-28) have never been defined. A literature search was conducted to evaluate EU-28 cost sources. Median costs were defined for each cost input and costs were inflated to 2014 Euros (€) in the study country and adjusted for Purchasing Power Parity between EU countries. Adjusted costs were used to populate previously published cost-models based on adult incidence-based events. In the base model, annual expenditures for total, hospital-associated, preventable, and indirect costs were €1.5-2.2 billion, €1.0-1.5 billion, €0.5-1.1 billion and €0.2-0.3 billion, respectively (indirect costs: 12 % of expenditures). In the long-term attack rate model, total, hospital-associated, preventable, and indirect costs were €1.8-3.3 billion, €1.2-2.4 billion, €0.6-1.8 billion and €0.2-0.7 billion (indirect costs: 13 % of expenditures). In the multiway sensitivity analysis, annual expenditures for total, hospital-associated, preventable, and indirect costs were €3.0-8.5 billion, €2.2-6.2 billion, €1.1-4.6 billion and €0.5-1.4 billion (indirect costs: 22 % of expenditures). When the value of a premature life-lost increased slightly, aggregate costs rose considerably since these costs are higher than the direct medical costs. When evaluating the models aggregately for costs, the results suggests total, hospital-associated, preventable, and indirect costs ranging from €1.5-13.2 billion, €1.0-9.7 billion, €0.5-7.3 billion and €0.2-6.1 billion, respectively. Our study demonstrates that VTE costs have a large financial impact upon the EU-28's healthcare systems and that significant savings could be realised if better preventive measures are applied.

Comparison of total energy expenditure between school and summer months.

PubMed

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

2013-10-01

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

Collision activity during training increases total energy expenditure measured via doubly labelled water.

PubMed

Costello, Nessan; Deighton, Kevin; Preston, Thomas; Matu, Jamie; Rowe, Joshua; Sawczuk, Thomas; Halkier, Matt; Read, Dale B; Weaving, Daniel; Jones, Ben

2018-06-01

Collision sports are characterised by frequent high-intensity collisions that induce substantial muscle damage, potentially increasing the energetic cost of recovery. Therefore, this study investigated the energetic cost of collision-based activity for the first time across any sport. Using a randomised crossover design, six professional young male rugby league players completed two different 5-day pre-season training microcycles. Players completed either a collision (COLL; 20 competitive one-on-one collisions) or non-collision (nCOLL; matched for kinematic demands, excluding collisions) training session on the first day of each microcycle, exactly 7 days apart. All remaining training sessions were matched and did not involve any collision-based activity. Total energy expenditure was measured using doubly labelled water, the literature gold standard. Collisions resulted in a very likely higher (4.96 ± 0.97 MJ; ES = 0.30 ± 0.07; p = 0.0021) total energy expenditure across the 5-day COLL training microcycle (95.07 ± 16.66 MJ) compared with the nCOLL training microcycle (90.34 ± 16.97 MJ). The COLL training session also resulted in a very likely higher (200 ± 102 AU; ES = 1.43 ± 0.74; p = 0.007) session rating of perceived exertion and a very likely greater (- 14.6 ± 3.3%; ES = - 1.60 ± 0.51; p = 0.002) decrease in wellbeing 24 h later. A single collision training session considerably increased total energy expenditure. This may explain the large energy expenditures of collision-sport athletes, which appear to exceed kinematic training and match demands. These findings suggest fuelling professional collision-sport athletes appropriately for the "muscle damage caused" alongside the kinematic "work required".

Effect of the California Tobacco Control Program on Personal Health Care Expenditures

PubMed Central

Lightwood, James M; Dinno, Alexis; Glantz, Stanton A

2008-01-01

Background Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California's large-scale tobacco control program on aggregate personal health care expenditures in the state. Methods and Findings Cointegrating regressions were used to predict (1) the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2) the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started) and 2004, the California program was associated with $86 billion (2004 US dollars) (95% confidence interval [CI] $28 billion to $151 billion) lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%–12.1%) of total health care expenditures in 2004. Conclusions A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures. PMID:18752344

On the nexus of air pollution and health expenditures: new empirical evidence.

PubMed

Blázquez-Fernández, Carla; Cantarero-Prieto, David; Pascual-Sáez, Marta

2018-05-21

To analyse the impact of per capita income and environmental air quality variables on health expenditure determinants. In this study, we analyse the relationship between air pollution and health expenditure in 29 OECD countries over the period 1995-2014. In addition, we test whether our findings differ between countries with higher or lower incomes. The econometric results show that per capita income has a positive effect on health expenditure, but is not as statistically significant as expected when lag-time is incorporated. In addition, an anchorage effect is observed, which implies that about 80%-90% of previous expenditure explain current expenditure. Our empirical results are quite consistent between groups and when compared with the full sample. Nevertheless, there appear to be some differences when broken down by financing scheme (total, public, and private). Overall, our findings could be used to clarify the appropriate health expenditure level or to obtain better environmental quality and social well-being. That is, empirical support is provided on how health management and policy makers should include more considerations for the use of cleaner fuels in developed countries. Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Education in Rural and City School Systems: Some Statistical Indices for 1947-48. Circular 329.

ERIC Educational Resources Information Center

Smith, Rose Marie

Nine comparative indices present both financial and non-financial statistics for rural and urban public elementary and secondary schools in 36 states and for all 36 states combined. The 1947-48 data cover the average salary of the instructional staff, instructional expenditure per pupil, total current expenditure per pupil, capital outlay per…

To What Degree Does Money Matter for Student Success? A Quantitative Examination of the Relationships between Institutional Expenditures and Student Success Outcomes

ERIC Educational Resources Information Center

El Fattal, David

2014-01-01

California community colleges are under pressure to increase core student attainment outcomes such as graduation rates, transfer rates, and certificate completion rates. This study examined whether, or how, the allocation of institutional expenditures for instructional, student support, administrative, and total educational and general activities…

Research Expenditures. Texas Public Institutions of Higher Education. September 1, 1990-August 31, 1991.

ERIC Educational Resources Information Center

Texas Higher Education Coordinating Board, Austin.

An annual study, mandated by the Texas State Legislature, was done of research expenditures at Texas public institutions of higher education for the fiscal year 1990-1991. The year's report contains, for the first time, data on intellectual property patents, copyrights, and licensing agreements. Findings indicate the following: (1) total research…

[Assessment of financial flow in the health system of Serbia in a period 2003-2006].

PubMed

Gajić-Stevanović, Milena; Teodorović, Nevenka; Dimitrijević, Snezana; Jovanović, Dragan

2010-05-01

The main goal of every health policy is not merely the establishment of the health system sustainability, but the accessability of health services to the whole population, as well. This objective is shared in European Union countries, and the consequence is the implementation of National Health Accounts (NHA). NHA, as a tool for evidence-based management, provides data regarding financial flow in health at national level and allows international comparability. The aim of this study was to determine Serbian overall health spending patterns by National Health Accounts, and to determine health care indices to provide policy makers with internationally comparable health indicators. A retrospective analysis of healthcare expenditures was obtained from the published final financial reports of relevant state institutions during a period of 2003 to 2006. The various sources of data on healthcare expenditures were connected according to instructions by the OECD "A System of Health Accounts (SHA)" Version 1.0. The obtained results showed: health expenditures in Serbia made up 8.6%, 8.3%, 8.7% and 9% of the GDP in 2003, 2004, 2005 and 2006, respectively; the Health Insurance Fund was a predominant financing source of the public sector with 93% in 2006; the largest part of the total health expenditures went towards hospitals and for health services; the expenditure per capita in 2006 was 365 US$; Serbian population finances the state institutions "out of pocket" with 21.28% of their sources, which was 7.3% of the total healthcare expenditures, and the private institutions with 78.72% of their financial sources, which is 27% of the total healthcare expenditures. In 2006 Serbia allocated financial resources out of GDP in the amount similar to the European Unity, while comparing to the countries of the region, these funds were less only than in Bosnia and Hertzegovina. This allocating of financial resources in total, however, was low as the consequence of relatively low level of GDP in Serbia. Establishing NHA provided a pattern of national healthcare spending and allowed a comparison of healthcare system in Serbia with the systems of other countries. Analysing a period 2003-2006 revealed a similarity between Serbia and the countries of the European Unity in regard to the level of average financial resources allocation for healthcare expressed as a percentage of GDP, as well as in regard to financiers in the system of healthcare. A high purchasing power disparity, however, in healthcare services was observed between the population of Serbia and other European countries.

Physician drug dispensing in Switzerland: association on health care expenditures and utilization.

PubMed

Trottmann, Maria; Frueh, Mathias; Telser, Harry; Reich, Oliver

2016-07-08

Several countries recently reassessed the roles of drug prescribing and dispensing, either by enlarging pharmacists' rights to prescribe (e.g. the US and the United Kingdom) or by limiting physicians' rights to dispense (e.g. Taiwan and South Korea). While integrating the two roles might increase supply and be convenient for patients, concern is that drug mark-ups incite providers to prescribe unnecessary drugs. We aimed to assess the association of physician dispensing (PD) in Switzerland on various outcomes. We performed a retrospective cohort study, using health care claims data for patients in the year 2013. The analysis of the association of PD was perfomed using a large patient level dataset and several target variables, including the number of different chemical agents, share of generic drugs, number of visits to physicians and expenditures. Different multivariate econometric models were applied in order to capture the association PD on the target variables. A total of 101'784 patients were enrolled in 2013, whereas 54 % were PD patients. We find that PD is associated with lower pharmaceutical expenditure per patient, which can be explained by an increased use of generic drugs. The decrease is compensated by higher use of physician services. We find no significant impact of physician dispensing on total health care expenditure. Our study offers insights for policy makers who are (re-)considering the separation between drug prescribing and dispensing, either by allowing physicians to dispense or pharmacists to prescribe certain drugs. In terms of total health care expenditures, we find no difference between the two systems, so we are doubtful that changing dispensing rights are a good measure to contain cost, at least in Switzerland.

Disenrollment from Medicare HMOs.

PubMed

Call, K T; Dowd, B E; Feldman, R; Lurie, N; McBean, M A; Maciejewski, M

2001-01-01

Since the program's inception, there has been great interest in determining whether beneficiaries who enter and subsequently leave Medicare health maintenance organizations (HMOs) are more or less costly than those remaining in fee-for-service (FFS) Medicare. To examine whether relatively high-cost beneficiaries disenroll from Medicare HMOs (disenrollment bias) and whether disenrollment bias varies by Medicare HMO market characteristics. In addition, we compare rates of surgical procedures and hospitalizations for ambulatory care-sensitive conditions for disenrollees and continuing FFS beneficiaries. Cross-sectional analysis of 1994 Medicare data. Medicare beneficiaries were first sampled from the 124 counties with at least 1000 Medicare HMO enrollees. From this pool, HMO disenrollees and a sample of continuing FFS beneficiaries were drawn. The FFS beneficiaries were assigned dates of "pseudodisenrollment." Expenditures and inpatient service use were compared for 6 months after disenrollment or pseudodisenrollment. The HMO disenrollees were no more likely than the continuing FFS beneficiaries to have positive total expenditures (Part A plus Part B) or Part B expenditures in the first 6 months after disenrollment. However, disenrollees were more likely to have Part A expenditures. Among beneficiaries with spending, disenrollees had higher total and Part B expenditures than continuing FFS beneficiaries. Moreover, the disparity in total and Part B spending between disenrollees and continuing FFS beneficiaries increased with HMO market penetration. Although Part A spending was higher for disenrollees with spending, it was not sensitive to changes in market share. The HMO disenrollees received more surgical procedures and were hospitalized for more of the ambulatory care-sensitive conditions than the FFS beneficiaries. On several measures, Medicare HMOs experienced favorable disenrollment relative to continuing FFS beneficiaries as recently as 1994, which increased as HMO market share increased.

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

PubMed

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

2015-01-01

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

Gender, marital status, and commercially prepared food expenditure.

PubMed

Kroshus, Emily

2008-01-01

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

Expenditures on health research in sub-Saharan African countries: results of a questionnaire-based survey.

PubMed

Kebede, Derege; Zielinski, Chris; Mbondji, Peter Ebongue; Sanou, Issa; Kouvividila, Wenceslas; Lusamba-Dikassa, Paul-Samson

2014-05-01

To estimate the sources of funds for health research (revenue) and the uses of these funds (expenditure). A structured questionnaire was used to solicit financial information from health research institutions. Forty-two sub-Saharan African countries. Key informants in 847 health research institutions in the 42 sub-Saharan African countries. Expenditure on health research by institutions, funders and subject areas. An estimated total of US$ 302 million was spent on health research by institutions that responded to the survey in the World Health Organization (WHO) African Region for the biennium 2005-2006. The most notable funders for health research activities were external funding, ministries of health, other government ministries, own funds and non-profit institutions. Most types of health research performers spent significant portions of their resources on in-house research, with medical schools spending 82% and government agencies 62%. Hospitals spent 38% of their resources on management, and other institutions (universities, firms, etc.) spent 87% of their resources on capital investment. Research on human immunodeficiency virus/tuberculosis and malaria accounted for 30% of funds, followed by research on other communicable diseases and maternal, perinatal and nutritional conditions (23%). Research on major health problems of the Region, such as communicable diseases, accounts for most of the research expenditures. However, the total expenditure is very low compared with other WHO regions. © The Royal Society of Medicine.

Dental Treatment and Expenditures Under General Anesthesia Among Medicaid-Enrolled Children in North Carolina.

PubMed

Meyer, Beau D; Lee, Jessica Y; Casey, Mark W

2017-11-01

Many studies reporting dental utilization under general anesthesia (GA) are dated. The purpose of this study was to provide contemporaneous data about children receiving dental GA by: (1) determining trends in utilization and associated expenditures; and (2) examining the effects of provider distribution. This time series cross-sectional study of Medicaid-eligible children ages zero to eight years old in North Carolina used aggregate Medicaid claims from State Fiscal Years (SFY) 2011 to 2015 to collect demographic and dental treatment information. Descriptive statistics were stratified by age and year to examine trends over time. Panel analysis techniques were used to explore regional effects of provider distribution on dental GA utilization. For SFY 2011 to 2015, the overall dental utilization rate was 517.1 per 1,000 (total enrolled equals 632,941 children/year), and the dental GA utilization rate was 15.8 per 1,000. Total dental expenditures averaged $113 million per year, and dental GA averaged $16.7 million per year. The dental GA proportion of expenditures increased over time (P<.001). Provider distribution did not affect dental GA utilization rate (P=.178) but did increase the number of children receiving dental GA (P<.001). Utilization and expenditures associated with dental treatment under general anesthesia continue to increase. While this reflects increased access to care, interventions should be examined to provide preventive care earlier in a child's life.

Local and Categorical Inservice Expenditures in New York State 1970-71 and 1971-72.

ERIC Educational Resources Information Center

Levin, S.; Van Ryn, M.

In June of 1971 and of 1972, the New York State Department of Education's Division of Teacher Education and Certification, in cooperation with the Department's Information Center, undertook a survey of direct in-service expenditures by local school districts. Seven hundred and one of the state's 735 operating school districts (New York City and…

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

ERIC Educational Resources Information Center

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

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

State University of New York Stony Brook University Hospital: Selected Expenditure Controls. Report 92-S-66.

ERIC Educational Resources Information Center

New York State Office of the Comptroller, Albany. Div. of Management Audit.

An audit was done of selected expenditure controls at the State University of New York (SUNY) at Stony Brook University Hospital particularly payroll costs and procurement practices. The Hospital reported an operating loss of $24 million in 1992. The audit reviewed Hospital management and staff and applicable policies and procedures as well as…

Health financing in Malawi: Evidence from National Health Accounts

PubMed Central

2010-01-01

Background National health accounts provide useful information to understand the functioning of a health financing system. This article attempts to present a profile of the health system financing in Malawi using data from NHA. It specifically attempts to document the health financing situation in the country and proposes recommendations relevant for developing a comprehensive health financing policy and strategic plan. Methods Data from three rounds of national health accounts covering the Financial Years 1998/1999 to 2005/2006 was used to describe the flow of funds and their uses in the health system. Analysis was performed in line with the various NHA entities and health system financing functions. Results The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. The country had not met the Abuja of allocating at least 15% of national budget on health. The percentage of total health expenditure from households' direct out-of-pocket payments decreased from 26% in 1998/99 to 12.1% in 2005/2006. Conclusion There is a need to increase government contribution to the total health expenditure to at least the levels of the Abuja Declaration of 15% of the national budget. In addition, the country urgently needs to develop and implement a prepaid health financing system within a comprehensive health financing policy and strategy with a view to assuring universal access to essential health services for all citizens. PMID:21062503

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

PubMed

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

2012-08-01

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

Financial Effect of a Drug Distribution Model Change on a Health System.

PubMed

Turingan, Erin M; Mekoba, Bijan C; Eberwein, Samuel M; Roberts, Patricia A; Pappas, Ashley L; Cruz, Jennifer L; Amerine, Lindsey B

2017-06-01

Background: Drug manufacturers change distribution models based on patient safety and product integrity needs. These model changes can limit health-system access to medications, and the financial impact on health systems can be significant. Objective: The primary aim of this study was to determine the health-system financial impact of a manufacturer's change from open to limited distribution for bevacizumab (Avastin), rituximab (Rituxan), and trastuzumab (Herceptin). The secondary aim was to identify opportunities to shift administration to outpatient settings to support formulary change. Methods: To assess the financial impact on the health system, the cost minus discount was applied to total drug expenditure during a 1-year period after the distribution model change. The opportunity analysis was conducted for three institutions within the health system through chart review of each inpatient administration. Opportunity cost was the sum of the inpatient administration cost and outpatient administration margin. Results: The total drug expenditure for the study period was $26 427 263. By applying the cost minus discount, the financial effect of the distribution model change was $1 393 606. A total of 387 administrations were determined to be opportunities to be shifted to the outpatient setting. During the study period, the total opportunity cost was $1 766 049. Conclusion: Drug expenditure increased for the health system due to the drug distribution model change and loss of cost minus discount. The opportunity cost of shifting inpatient administrations could offset the increase in expenditure. It is recommended to restrict bevacizumab, rituximab, and trastuzumab through Pharmacy & Therapeutics Committees to outpatient use where clinically appropriate.

Public Expenditures for Mental Health Services in Canadian Provinces: Dépenses publiques pour les services de santé mentale dans les provinces canadiennes.

PubMed

Wang, Jian; Jacobs, Philip; Ohinmaa, Arto; Dezetter, Anne; Lesage, Alain

2018-04-01

The purpose of this study is to measure provincial spending for mental health services in fiscal year (FY) 2013 and to compare these cost estimates to those of FY 2003. This study estimated the costs of publicly funded provincial mental health services in FY 2013 and compared them to the estimates for FY 2003 from a previously published report. Our data were obtained from publicly accessible databases. The cross-year cost comparisons for provincial mental health services were restricted to general and psychiatric hospital inpatients, clinical payments to physicians and psychologists, and prescribed psychotropic medications. Total public expenditures were inflation adjusted and expressed per capita and as a percentage of the total provincial health spending. Total public spending for mental health and addiction programs/services was estimated to be $6.75 billion for FY 2013. The largest component of the expenditures was hospital inpatient services ($4.02 billion, 59.6%), followed by clinical payments to physicians or psychologists ($1.69 billion, 25%), and then publicly funded prescribed psychotherapeutic medications ($1.04 billion, 15.4%). Nationally, the portion of total public spending on health that was spent on mental health decreased from FY 2003 to FY 2013 from 5.4% to 4.9%. Our results reveal that mental health spending, as a proportion of public health care expenditures, decreased in the decade from FY 2003 to FY 2013. Due to large differences in how the provinces report community mental health services, we still lack a comprehensive picture of the mental health system.

Calculation versus measurement of total energy expenditure.

PubMed

van Lanschot, J J; Feenstra, B W; Vermeij, C G; Bruining, H A

1986-11-01

In acutely ill patients both hypo- and hyperalimentation must be avoided by adjusting caloric intake to total energy expenditure (TEE). We determined the discrepancy between basal energy expenditure (BEE) calculated from the basic Harris-Benedict formula and TEE measured by continuous indirect calorimetry in a heterogeneous group of mechanically ventilated surgical patients. We also compared the accuracy of TEE calculated from the corrected Harris-Benedict formula or estimated by intermittent indirect calorimetry to that of TEE measured by continuous indirect calorimetry. The poor correlation between calculated BEE and measured TEE was significantly (p less than .05) improved by a correction factor based on each patient's clinical condition. The mean absolute difference between calculated TEE and measured TEE was 8.9 +/- 9.6 (SD) %. Calculations were significantly (p less than .05) improved by estimating TEE from two 5-min recording periods, which suggests that continuous indirect calorimetry may not always be necessary to guide caloric replacement.

Quantifying the economic impact of government and charity funding of medical research on private research and development funding in the United Kingdom.

PubMed

Sussex, Jon; Feng, Yan; Mestre-Ferrandiz, Jorge; Pistollato, Michele; Hafner, Marco; Burridge, Peter; Grant, Jonathan

2016-02-24

Government- and charity-funded medical research and private sector research and development (R&D) are widely held to be complements. The only attempts to measure this complementarity so far have used data from the United States of America and are inevitably increasingly out of date. This study estimates the magnitude of the effect of government and charity biomedical and health research expenditure in the United Kingdom (UK), separately and in total, on subsequent private pharmaceutical sector R&D expenditure in the UK. The results for this study are obtained by fitting an econometric vector error correction model (VECM) to time series for biomedical and health R&D expenditure in the UK for ten disease areas (including 'other') for the government, charity and private sectors. The VECM model describes the relationship between public (i.e. government and charities combined) sector expenditure, private sector expenditure and global pharmaceutical sales as a combination of a long-term equilibrium and short-term movements. There is a statistically significant complementary relationship between public biomedical and health research expenditure and private pharmaceutical R&D expenditure. A 1% increase in public sector expenditure is associated in the best-fit model with a 0.81% increase in private sector expenditure. Sensitivity analysis produces a similar and statistically significant result with a slightly smaller positive elasticity of 0.68. Overall, every additional £1 of public research expenditure is associated with an additional £0.83-£1.07 of private sector R&D spend in the UK; 44% of that additional private sector expenditure occurs within 1 year, with the remainder accumulating over decades. This spillover effect implies a real annual rate of return (in terms of economic impact) to public biomedical and health research in the UK of 15-18%. When combined with previous estimates of the health gain that results from public medical research in cancer and cardiovascular disease, the total rate of return would be around 24-28%. Overall, this suggests that government and charity funded research in the UK crowds in additional private sector R&D in the UK. The implied historical returns from UK government and charity funded investment in medical research in the UK compare favourably with the rates of return achieved on investments in the rest of the UK economy and are greatly in excess of the 3.5% real annual rate of return required by the UK government to public investments generally.

Objectively Measured Physical Activity and Healthcare Expenditures Related to Arterial Hypertension and Diabetes Mellitus in Older Adults: SABE Study.

PubMed

Bueno, Denise Rodrigues; Marucci, Maria de Fátima Nunes; Rosa, Clara Suemi da Costa; Fernandes, Rômulo Araújo; de Oliveira Duarte, Yeda Aparecida; Lebão, Maria Lucia

2017-10-01

Research using questionnaires has shown that physical activity level (PAL) is associated with healthcare costs. The purpose of this study was to examine the association between objectively measured PAL and healthcare costs among hypertensive and diabetic noninstitutionalized Brazilian older people. The method consisted of a cross-sectional study forming part of the SABE Study, composed of 377 older people interviewed in 2010. Expenditures were estimated taking into account self-reported medicine prescription, outpatient service, and hospitalizations, with the highest quartile of expenditures considered as a risk category. PAL was estimated using an Actigraph accelerometer. Associations were expressed as odds ratios and 95% confidence intervals, adjusted for covariates. Overall expenditures were higher in the sedentary group. The insufficiently active group presented greater odds for higher total, outpatient, and hospitalization expenditure. It was concluded that healthcare expenditures were lower in more active hypertensive and diabetic older people. The promotion of physical activity could be relevant in the attenuation of the burden of chronic diseases in economic losses.

Catastrophic expenditure on medicines in Brazil

PubMed Central

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

2016-01-01

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

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

PubMed

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

2003-06-01

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

Effectiveness and cost effectiveness of television, radio and print advertisements in promoting the New York smokers' quitline

PubMed Central

Farrelly, Matthew C; Hussin, Altijani; Bauer, Ursula E

2007-01-01

Objectives This study assessed the relative effectiveness and cost effectiveness of television, radio and print advertisements to generate calls to the New York smokers' quitline. Methods Regression analysis was used to link total county level monthly quitline calls to television, radio and print advertising expenditures. Based on regression results, standardised measures of the relative effectiveness and cost effectiveness of expenditures were computed. Results There was a positive and statistically significant relation between call volume and expenditures for television (p<0.01) and radio (p<0.001) advertisements and a marginally significant effect for expenditures on newspaper advertisements (p<0.065). The largest effect was for television advertising. However, because of differences in advertising costs, for every $1000 increase in television, radio and newspaper expenditures, call volume increased by 0.1%, 5.7% and 2.8%, respectively. Conclusions Television, radio and print media all effectively increased calls to the New York smokers' quitline. Although increases in expenditures for television were the most effective, their relatively high costs suggest they are not currently the most cost effective means to promote a quitline. This implies that a more efficient mix of media would place greater emphasis on radio than television. However, because the current study does not adequately assess the extent to which radio expenditures would sustain their effectiveness with substantial expenditure increases, it is not feasible to determine a more optimal mix of expenditures. PMID:18048625

Pharmaceutical innovation: impact on expenditure and outcomes and subsequent challenges for pharmaceutical policy, with a special reference to Greece.

PubMed

Karampli, E; Souliotis, K; Polyzos, N; Kyriopoulos, J; Chatzaki, E

2014-04-01

Over the recent decades, advances in healthcare technology have led to significant improvements in the quality of healthcare and in population health. At the same time, technological change in healthcare, rising national income and expansion of insurance coverage have been acknowledged as the main determinants of the historical growth in health spending in industrialized countries. The pharmaceutical sector is of particular interest as it constitutes a market characterized by rapid technological change and high expenditure growth rates. The purpose of this article is to provide an overview of research findings on the impact of pharmaceutical innovation on pharmaceutical expenditure growth, total health expenditure and population health outcomes and to bring forward the challenges that arise for pharmaceutical policy in Greece.

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

PubMed

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

2007-05-01

Sweden's pharmaceutical expenditure has increased during the last decades. On 1 October 2002 mandatory generic substitution was introduced in Sweden with the purpose to reduce the growth in pharmaceutical expenditure. The aim of the present study was to investigate if the implementation of generic substitution was associated with changes in patients' expenses and reimbursed cost for prescribed pharmaceuticals included in the Swedish Pharmaceutical Benefits Scheme (PBS). Monthly pharmacy sales data was obtained from the National Corporation of Swedish Pharmacies (Apoteket AB). The study period ranged between 1 January 2000 and 31 December 2004. Changes in pharmaceutical expenditure associated with the introduction of generic substitution were analysed with a linear segmented regression. The study comprised outpatient prescription pharmaceuticals encompassed by PBS for Sweden in total and each county council. Two different data sets were analysed. The first comprised all prescribed pharmaceuticals. The second contained only pharmaceuticals on regular prescriptions (i.e. exclusion of multidose dispensed drugs). Changes in patient co-payment per 1000 inhabitants and working day and subsidised cost per 1000 inhabitants and working day associated with the introduction of generic substitution were analysed. Expenditure was expressed in Swedish krona, SEK (SEK 1=US$ 0.14/euro 0.11, 7 July 2006). The Swedish Consumer Price Index was used to inflation-adjust expenditures with 2004 as base. The introduction of generic substitution was associated with a significant change in slope for patient co-payment in both all prescribed pharmaceuticals and pharmaceuticals on regular prescriptions (p<0.005) for Sweden in total. The slope shifted direction from a slight increase before the reform into a decline after the reform was implemented. This was also found for the average slope of patient co-payment for all county councils (p<0.0001). The introduction of generic substitution was associated with a statistically significant shift in slope for subsidised cost for Sweden in total (p<0.001). The slope shifted from a monthly increase before October 2002 to a monthly decline for all prescribed pharmaceuticals afterwards. Similar results were found for the average slope of subsidised cost for all county councils both for all prescribed pharmaceuticals and pharmaceuticals on regular prescriptions (p<0.0001). The introduction of generic substitution was associated with a shift in trend from an increase into a decrease both for patients' and society's expenditures. This suggests that generic substitution has contributed to a reduction in the growth of pharmaceutical expenditure.

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

Treesearch

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

2009-01-01

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

The private sector economic and employment benefits to the nation and to each state of proposed FY 1990 NASA procurement expenditures

NASA Technical Reports Server (NTRS)

1989-01-01

The private sector economic and employment benefits (disaggregated among 80 industries and 475 occupations) of the proposed FY 1990 NASA procurement expenditures to the nation and to each state are estimated. Nationwide, it is found that FY 1990 NASA procurement expenditures of $11.3 billion will have an economic multiplier of 2.1 and will create, directly and indirectly, 237,000 jobs, $23.2 billion in total industry sales, $2.4 billion in corporate profits, and $7.4 billion in Federal, state, and local government tax revenues. These benefits are widely dispersed throughout the United States and are significant in many states not normally considered to be major beneficiaries of NASA spending. The indirect economic benefits are identified for each state resulting from the second-, third-, and fourth rounds of industry purchases generated by NASA procurement expenditures. Each state is ranked on the basis of several criteria, including the total benefits, indirect benefits, and per capita benefits received from NASA spending. The estimates developed are important for maintaining a viable U.S. Space Program through the remainder of this century.

Consumption patterns and levels among households with HIV positive members and economic impoverishment due to medical spending in Pune city, India.

PubMed

Sharma, Varun; Krishnaswamy, Divya; Mulay, Sanjeevanee

2015-01-01

HIV infection poses a serious threat to the economy of a household. Out of pocket (OOP) health spending can be prohibitive and can drag households below poverty level. Based on the data collected from a cross-sectional survey of 401 households with HIV+ members in Pune city, India, this paper examines the consumption levels and patterns among households, and comments on the economic impoverishment resulting from OOP medical spending. Analysis reveals that households with HIV members spend a major portion of their monthly consumption expenditure on food items. Medical expenditure constitutes a large portion of their total consumption spending. Expenditure on children's education constitutes a minor proportion of total monthly spending. A high proportion of medical expenditure has a bearing on the economic condition of households with HIV members. Poverty increases by 20% among the studied HIV households when OOP health spending is adjusted. It increases 18% among male-headed households and 26% among female-headed households. The results reiterate the need of greater support from the government in terms of accessibility and affordability of health care to save households with HIV members from economic catastrophe.

Affordable measurement of human total energy expenditure and body composition using one-tenth dose doubly labelled water.

PubMed

Mann, D V; Ho, C S; Critchley, L; Fok, B S P; Pang, E W H; Lam, C W K; Hjelm, N M

2007-05-01

The doubly labelled water (DLW) method is the technique of choice for measurement of free-living total energy expenditure (TEE) in humans. A major constraint on the clinical applicability of the method has been the expense of the (18)O isotope. We have used a reduced-dose (one-tenth of the currently recommended standard dose) of DLW for the measurement of TEE and body composition in nine healthy adult male volunteers. TEE measured by reduced-dose DLW was positively correlated with resting energy expenditure measured by metabolic cart (r=0.87, P<0.01). Isotope-derived fat mass and body mass index were strongly correlated (r=0.86, P<0.01). In four subjects in whom we performed a complementary evaluation using standard-dose isotope enrichment, the TEE measurements were satisfactorily comparable (mean+/-s.d.: reduced dose 2586+/-155 kcal/day vs standard dose 2843+/-321 kcal/day; mean difference 257+/-265 kcal/day). These data indicate that DLW measurements of human energy expenditure and body composition can be performed at a substantially reduced dose (and cost) of isotope enrichment than is currently employed.

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.

Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran.

PubMed

Piroozi, Bakhtiar; Moradi, Ghobad; Nouri, Bijan; Mohamadi Bolbanabad, Amjad; Safari, Hossein

2016-03-14

One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE. © 2016 by Kerman University of Medical Sciences

Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran

PubMed Central

Piroozi, Bakhtiar; Moradi, Ghobad; Nouri, Bijan; Mohamadi Bolbanabad, Amjad; Safari, Hossein

2016-01-01

Background: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. Methods: A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. Results: The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. Conclusion: The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE. PMID:27694669

Characteristics, treatment, and health care expenditures of Medicare supplemental-insured patients with painful diabetic peripheral neuropathy, post-herpetic neuralgia, or fibromyalgia.

PubMed

Johnston, Stephen S; Udall, Margarita; Alvir, Jose; McMorrow, Donna; Fowler, Robert; Mullins, Daniel

2014-04-01

To describe the characteristics, treatment, and health care expenditures of Medicare Supplemental-insured patients with painful diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), or fibromyalgia. Retrospective cohort study. United States clinical practice, as reflected within a database comprising administrative claims from 2.3 million older adults participating in Medicare supplemental insurance programs. Selected patients were aged ≥65 years, continuously enrolled in medical and prescription benefits throughout years 2008 and 2009, and had ≥1 medical claim with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for DPN, PHN, or fibromyalgia, followed within 60 days by a medication or pain intervention procedure used in treating pDPN, PHN, or fibromyalgia during 2008-2009. Utilization of, and expenditures on, pain-related and all-cause pharmacotherapy and medical interventions in 2009. The study included 25,716 patients with pDPN (mean age 75.2 years, 51.2% female), 4,712 patients with PHN (mean age 77.7 years, 63.9% female), and 25,246 patients with fibromyalgia (mean age 74.4 years, 73.0% female). Patients typically had numerous comorbidities, and many were treated with polypharmacy. Mean annual expenditures on total pain-related health care and total all-cause health care, respectively, (in 2010 USD) were: $1,632, $24,740 for pDPN; $1,403, $16,579 for PHN; and $1,635, $18,320 for fibromyalgia. In age-stratified analyses, pain-related health care expenditures decreased as age increased. The numerous comorbidities, polypharmacy, and magnitude of expenditures in this sample of Medicare supplemental-insured patients with pDPN, PHN, or fibromyalgia underscore the complexity and importance of appropriate management of these chronic pain patients. Wiley Periodicals, Inc.

Who is bearing the financial burden of non-communicable diseases in Mongolia?

PubMed Central

Dugee, Otgontuya; Palam, Enkhtuya; Dorjsuren, Bayarsaikhan; Mahal, Ajay

2018-01-01

Background Non-communicable diseases (NCDs) pose a formidable health and development challenge for low- and middle-income countries (LMICs). However, translating this challenge into resource allocation is seriously constrained by a lack of country specific evidence on NCD financing and its distributional implications. This study estimated expenditures associated with NCDs in Mongolia and their distributions across socioeconomic groups, focusing especially on private out-of-pocket (OOP) spending on the major NCDs. Methods Secondary data analysis of multiple data sources on NCD related health service use and expenditures including detailed administrative data, World Health Organization STEPwise approach to Surveillance (STEPs) survey for Mongolia, and household surveys. Sample-weighted estimates of OOP expenditures for NCDs were constructed using STEPs data. OOP payments per discharge and per outpatient visit were estimated by condition and type of service provider, and survey data on utilization, after adjusting for utilization in administrative records. Results NCDs in Mongolia accounted for more than one-third of total health expenditures in 2013. A significant fraction of this expenditure was borne by households in the form of OOP spending. CVD-related health spending is the major driver of NCD-spending in Mongolia, accounting for about 24.2% of total health expenditure. OOP health payments, largely driven by outpatient diagnostics and drugs, were incurred disproportionately by the better-off, seeking more specialist services and better quality private care. Conclusion A high share of OOP spending for NCDs in Mongolia, which ostensibly enjoys universal health coverage, provides a cautionary tale for LMICs in a similar situation. Improvement in the quality of services at the primary care level and rural health care facilities, where the poor mainly attend, is desirable together with an effective exemption policy for user fees at higher level hospitals. PMID:29564086

Financing incidence analysis of household out-of-pocket spending for healthcare: getting more health for money in Nigeria?

PubMed

Onwujekwe, Obinna; Hanson, Kara; Ichoku, Hyacinth; Uzochukwu, Benjamin

2014-01-01

The study examined the burden of out-of-pocket spending (OOPS) to households, because available data showed that OOPS dominates household expenditure on health in Nigeria. The study took place in rural and urban districts in Nigeria. A household questionnaire was used to collect data from 4873 households on their healthcare expenditures and payment mechanisms by using a 1-month expenditure recall period. Financing incidence analysis was assessed at the household level on the basis of socio-economic status (SES) groups and rural-urban location of the households. Concentration curves of OOPS were plotted with the Lorenz curve of total household expenditures to show the distribution of the burden of OOPS by SES compared with total household expenditure. The Kakwani index was computed to examine the overall progressivity or regressivity of OOPS. There was lack of financial risk protection for healthcare in the study area. The results showed that 3150 (98.8%) of payments were made using OOPS, nine (0.3%) using reimbursement by employers, one (0.03%) through private voluntary health insurance (PVHI), nine (0.3%) using instalment and 14 (0.44%) through 'others'. The average monthly household OOPS was 2219.1 Naira. The Kakwani index for financing incidence of OOPS was -0.18, showing that OOPS was regressive. The most-poor SES groups and rural dwellers experienced the highest burden of health expenditure. Urgent steps should be taken by the government to increase or enhance universal coverage in the country with financial protection mechanisms such as the National Health Insurance Scheme in addition to possibly abolishing some of the user fees that cause high incidence and burden of OOPS. Copyright © 2013 John Wiley & Sons, Ltd.

Economic impact of interventional study on rational use of antiseptics and disinfectants in Super Speciality Hospital of Nagpur.

PubMed

Agarwal, Vandana; Gharpure, Kunda; Thawani, Vijay; Makhija, Sushil; Thakur, Anita; Powar, Rajaram

2008-03-01

To measure the impact of interventions on rational use of antiseptics and disinfectants (A and D) for cost containment in Super Speciality Hospital (SSH) of Government Medical College, Nagpur (GMCN), India. This study was conducted from October 2003 to March 2007 in SSH of GMCN. In the pre-interventional phase (Phase-I), purchase, stocking and distribution of A and D was studied to find problem areas. Based on this formative data an intervention was planned (Phase-II) during which rationing of the A and D was done. Rational quantities needed for different A and D procedures were calculated based on recommendations of National Aids Control Organization (NACO) with modifications to suit our hospital setup. Detailed information, education, communication and training about rational use of A and D were provided to the hospital staff. In the post-interventional phase (Phase-III), the use of A and D was rationalized at the distribution level and the efficacy of in-use A and D was tested at user sites. Data about medicine expenditure, patient record and A and D usage in various departments was obtained from hospital records. Savings on A and D as against total annual medicine expenditure was calculated taking the cost of A and D in the post-intervention period. The expenditure on A and D as a result of intervention decreased by 20.7%. Out of the total medicine expenditure, the expenditure on A and D which accounted for 6.2% before intervention, decreased to 1.95% after the intervention. The information, education and communication (IEC) interventions attempted by us resulted in significant decrease in the use and expenditure of A and D.

Energy expenditure and enjoyment of common children's games in a simulated free-play environment.

PubMed

Howe, Cheryl A; Freedson, Patty S; Feldman, Henry A; Osganian, Stavroula K

2010-12-01

To measure the energy expenditure and enjoyment of children's games to be used in developing a school-based intervention for preventing excessive weight gain. Healthy weight (body mass index [BMI] < 85th percentile) and overweight or obese (BMI ≥ 85th percentile) third-grade children (15 boys; 13 girls) were recruited. In a large gymnasium, children performed 10 games randomly selected from 30 games used in previous interventions. Total energy expenditure was measured with a portable metabolic unit and perceived enjoyment was assessed using a 9-point Likert scale of facial expressions. Mean physical activity energy expenditure (PAEE = total energy expenditure minus resting metabolism) and enjoyment of the games were adjusted for sex and BMI classification. PAEE and enjoyment were compared using a repeated-measures ANOVA with sex, BMI classification, and games as main effects. The games elicited a moderate intensity effort (mean ± standard deviation = 5.0 ± 1.3 metabolic equivalents, 123 ± 36 kcal/30 min). PAEE was higher for boys than for girls (0.12 ± 0.04 versus 0.11 ± 0.04 kcal/kg/min) and for healthy weight compared with overweight children (0.13 ± 0.04 versus 0.11 ± 0.03 kcal/kg/min). Twenty-two of the 30 games elicited a sufficiently high PAEE (≥ 100 kcal/30 min) and enjoyment (≥ neutral expression) for inclusion in future school-based interventions. Not all children's games are perceived as enjoyable or resulted in an energy expenditure that was sufficiently high for inclusion in future physical activity interventions to prevent the excess weight gain associated with childhood obesity. Copyright © 2010 Mosby, Inc. All rights reserved.

The association between different types of exercise and energy expenditure in young nonoverweight and overweight adults

PubMed Central

Drenowatz, Clemens; Hand, Gregory A.; Shook, Robin P.; Jakicic, John M.; Hebert, James R.; Burgess, Stephanie; Blair, Steven N.

2015-01-01

With decades of trends for decreasing activity during work and travel, exercise becomes an important contributor to total physical activity (PA) and energy expenditure. The purpose of this study was to examine the contribution of different types of exercise to the variability in energy expenditure and time spent at different PA intensities in young adults. Four hundred and seventeen adults (49.9% male; 46.2 overweight/obese) between 21 and 36 years of age provided valid objective PA and energy expenditure data, assessed via the SenseWear Armband (BodyMedia Inc.). Frequency and duration of participation in various exercise types was self-reported. Weight status was based on body mass index (BMI) (kg/m2) with body weight and height being measured according to standard procedures. Eighty-four percent of the participants reported regular exercise engagement with no difference in participation rate by sex or BMI category. Exercise time along with sex and ethnicity explained roughly 60% of the variability in total daily energy expenditure (TDEE) while the association between exercise and time spent in moderate to vigorous PA or being sedentary was low or nonsignificant. Engagement in endurance exercise and sports contributed predominantly to the variability in energy expenditure and PA in nonoverweight participants. In overweight/obese participants engagement in resistance exercise and swimming contributed significantly to variability in TDEE. Current exercise recommendations focus primarily on aerobic exercise, but results of the present study suggest that nonweight-bearing exercises, such as resistance exercise and swimming, contribute significantly to the variability in TDEE in overweight/obese adults, which would make these types of activities viable options for exercise interventions. PMID:25647557

Economic impact of interventional study on rational use of antiseptics and disinfectants in Super Speciality Hospital of Nagpur

PubMed Central

Agarwal, Vandana; Gharpure, Kunda; Thawani, Vijay; Makhija, Sushil; Thakur, Anita; Powar, Rajaram

2008-01-01

Objective: To measure the impact of interventions on rational use of antiseptics and disinfectants (A and D) for cost containment in Super Speciality Hospital (SSH) of Government Medical College, Nagpur (GMCN), India. Materials and Methods: This study was conducted from October 2003 to March 2007 in SSH of GMCN. In the pre-interventional phase (Phase-I), purchase, stocking and distribution of A and D was studied to find problem areas. Based on this formative data an intervention was planned (Phase-II) during which rationing of the A and D was done. Rational quantities needed for different A and D procedures were calculated based on recommendations of National Aids Control Organization (NACO) with modifications to suit our hospital setup. Detailed information, education, communication and training about rational use of A and D were provided to the hospital staff. In the post-interventional phase (Phase-III), the use of A and D was rationalized at the distribution level and the efficacy of in-use A and D was tested at user sites. Data about medicine expenditure, patient record and A and D usage in various departments was obtained from hospital records. Savings on A and D as against total annual medicine expenditure was calculated taking the cost of A and D in the post-intervention period. Results: The expenditure on A and D as a result of intervention decreased by 20.7%. Out of the total medicine expenditure, the expenditure on A and D which accounted for 6.2% before intervention, decreased to 1.95% after the intervention. Conclusion: The information, education and communication (IEC) interventions attempted by us resulted in significant decrease in the use and expenditure of A and D. PMID:21279171

Public spending for illegal drug and alcohol treatment in hospitals: an EU cross-country comparison.

PubMed

Lievens, Delfine; Vander Laenen, Freya; Christiaens, Johan

2014-06-30

In view of the current economic crisis and the resulting austerity measures being implemented by governments across Europe, public expenditure for substance abuse treatment has increasingly become a subject of discussion. An EU cross-country comparison would allow an estimation of the total amount of public resources spent on substance abuse treatment, compare various substance abuse treatment funding options, and evaluate the division of expenditures between alcohol and illegal drugs. The purpose of this study is to estimate the public spending of EU countries for alcohol and illegal drug abuse treatment in hospitals. Our study uses a uniform methodology in order to enable valid cross-national comparisons. Our data are drawn from the Eurostat database, which provides anno 2010 data on government spending for the treatment of illegal drug and alcohol abuse in 21 EU member states. The cross-country comparison is restricted to hospitals, since data were unavailable for other types of treatment providers. The systematic registration of in- and outpatient data is essential to monitoring public expenditures on substance abuse treatment using international databases. Total public spending for hospital-based treatment of illegal drug and alcohol abuse in the 21 EU member states studied is estimated to be 7.6 billion euros. Per capita expenditures for treatment of illegal drug abuse vary, ranging from 0.1 euros in Romania to 13 euros in Sweden. For alcohol abuse, that figure varied from 0.9 euros in Bulgaria to 24 euros in Austria. These results confirm other studies indicating that public expenditures for alcohol treatment exceed that for illegal drug treatment. Multiple factors may influence the number of hospital days for alcohol or illegal substance abuse treatment, and expenditures fluctuate accordingly. In this respect, we found a strong correlation between gross domestic product (GDP) per capita and public expenditures per hospital day. The prevalence of problematic (illegal or legal) drug use in a country did not correlate significantly with the number of hospital days. Other factors must be included in the analysis of public expenditures for the treatment of substance abuse, such as the drug policy in a given country and the social norms regarding alcohol consumption.

Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries

PubMed Central

Arsenijevic, Jelena; Pavlova, Milena; Rechel, Bernd; Groot, Wim

2016-01-01

Introduction It is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries. Methods The SHARE dataset for individuals aged 50+ and their households, collected in 2010–2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model. Results We found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure. Discussion Our study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio-economic contexts, but also due to the specific characteristics of the different health systems. In view of the ageing of European populations, it will be crucial to strengthen the mechanisms for financial protection for older people with chronic diseases. PMID:27379926

Hours spent and energy expended in physical activity domains: Results from The Tomorrow Project cohort in Alberta, Canada

PubMed Central

2011-01-01

Background Knowledge of adult activity patterns across domains of physical activity is essential for the planning of population-based strategies that will increase overall energy expenditure and reduce the risk of obesity and related chronic diseases. We describe domain-specific hours of activity and energy expended among participants in a prospective cohort in Alberta, Canada. Methods The Past Year Total Physical Activity Questionnaire was completed by 15,591 Tomorrow Project® participants, between 2001 and 2005 detailing physical activity type, duration, frequency and intensity. Domain-specific hours of activity and activity-related energy expenditure, expressed as a percent of total energy expenditure (TEE) (Mean (SD); Median (IQR)) are reported across inactive (<1.4), low active (1.4 to 1.59), active (1.6 to 1.89) and very active (≥ 1.9) Physical Activity Level (PAL = TEE:REE) categories. Results In very active women and amongst all men except those classified as inactive, activity-related energy expenditure comprised primarily occupational activity. Amongst inactive men and women in active, low active and inactive groups, activity-related energy expenditure from household activity was comparable to, or exceeded that for occupational activity. Leisure-time activity-related energy expenditure decreased with decreasing PAL categories; however, even amongst the most active men and women it accounted for less than 10 percent of TEE. When stratified by employment status, leisure-time activity-related energy expenditure was greatest for retired men [mean (SD): 10.8 (8.5) percent of TEE], compared with those who were fully employed, employed part-time or not employed. Transportation-related activity was negligible across all categories of PAL and employment status. Conclusion For the inactive portion of this population, active non-leisure activities, specifically in the transportation and occupational domains, need to be considered for inclusion in daily routines as a means of increasing population-wide activity levels. Environmental and policy changes to promote active transport and workplace initiatives could increase overall daily energy expenditure through reducing prolonged sitting time. PMID:21985559

Bucking the trend? Health care expenditures in low-income countries 1990-1995.

PubMed

Jowett, M

1999-01-01

Health care expenditures in low-income countries are analysed for the years 1990 and 1995 using four key indicators. Key findings include a substantial reduction in public spending per capita across low-income countries between 1990-95; a significant shift towards private expenditures, which appears increasingly to be substituting rather than supplementing public expenditures; a fall in total and public health spending in many countries despite growth in national income, contradicting the relationship found in other studies. Two possible explanations are put forward. First that the patterns found are a direct result of the structural adjustment policies adopted by many low-income countries, which aim to control and often cut public financing, whilst promoting private health expenditures. Secondly, that following the wave of privatization of state industries, many governments are finding problems adapting to their new role as a tax collector, and are thus not benefiting from economic growth to the extent that might be expected.

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

PubMed

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

2009-11-01

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

Adjusting Health Expenditures for Inflation: A Review of Measures for Health Services Research in the United States.

PubMed

Dunn, Abe; Grosse, Scott D; Zuvekas, Samuel H

2018-02-01

To provide guidance on selecting the most appropriate price index for adjusting health expenditures or costs for inflation. Major price index series produced by federal statistical agencies. We compare the key characteristics of each index and develop suggestions on specific indexes to use in many common situations and general guidance in others. Price series and methodological documentation were downloaded from federal websites and supplemented with literature scans. The gross domestic product implicit price deflator or the overall Personal Consumption Expenditures (PCE) index is preferable to the Consumer Price Index (CPI-U) to adjust for general inflation, in most cases. The Personal Health Care (PHC) index or the PCE health-by-function index is generally preferred to adjust total medical expenditures for inflation. The CPI medical care index is preferred for the adjustment of consumer out-of-pocket expenditures for inflation. A new, experimental disease-specific Medical Care Expenditure Index is now available to adjust payments for disease treatment episodes. There is no single gold standard for adjusting health expenditures for inflation. Our discussion of best practices can help researchers select the index best suited to their study. © Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Estimating the Relationship between Economic Growth and Health Expenditures in ECO Countries Using Panel Cointegration Approach.

PubMed

Hatam, Nahid; Tourani, Sogand; Homaie Rad, Enayatollah; Bastani, Peivand

2016-02-01

Increasing knowledge of people about health leads to raising the share of health expenditures in government budget continuously; although governors do not like this rise because of budget limitations. This study aimed to find the association between health expenditures and economic growth in ECO countries. We added health capital in Solow model and used the panel cointegration approach to show the importance of health expenditures in economic growth. For estimating the model, first we used Pesaran cross-sectional dependency test, after that we used Pesaran CADF unit root test, and then we used Westerlund panel cointegration test to show if there is a long-term association between variables or not. After that, we used chaw test, Breusch-Pagan test and Hausman test to find the form of the model. Finally, we used OLS estimator for panel data. Findings showed that there is a positive, strong association between health expenditures and economic growth in ECO countries. If governments increase investing in health, the total production of the country will be increased, so health expenditures are considered as an investing good. The effects of health expenditures in developing countries must be higher than those in developed countries. Such studies can help policy makers to make long-term decisions.

Analysis of temperature difference on the total of energy expenditure during static bicycle exercise

NASA Astrophysics Data System (ADS)

Sugiono

2016-04-01

How to manage energy expenditure for cyclist is very crucial part to achieve a good performance. As the tropical situation, the differences of temperature level might be contributed in energy expenditure and durability. The aim of the paper is to estimate and to analysis the configuration of energy expenditure for static cycling activity based on heart rate value in room with air conditioning (AC)/no AC treatment. The research is started with study literatures of climate factors, temperature impact on human body, and definition of energy expenditure. The next step is design the experiment for 5 participants in 2 difference models for 26.80C - 74% relative humidity (room no AC) and 23,80C - 54.8% relative humidity (room with AC). The participants’ heart rate and blood pressure are measured in rest condition and in cycling condition to know the impact of difference temperature in energy expenditure profile. According to the experiment results, the reducing of the temperature has significantly impact on the decreasing of energy expenditure at average 0.3 Kcal/minute for all 5 performers. Finally, the research shows that climate condition (temperature and relative humidity) are very important factors to manage and to reach a higher performance of cycling sport.

Labelled drug-related public expenditure in relation to gross domestic product (gdp) in Europe: A luxury good?

PubMed Central

2010-01-01

"Labelled drug-related public expenditure" is the direct expenditure explicitly labelled as related to illicit drugs by the general government of the state. As part of the reporting exercise corresponding to 2005, the European Monitoring Centre for Drugs and Drug Addiction's network of national focal points set up in the 27 European Union (EU) Member States, Norway, and the candidates countries to the EU, were requested to identify labelled drug-related public expenditure, at the country level. This was reported by 10 countries categorised according to the functions of government, amounting to a total of EUR 2.17 billion. Overall, the highest proportion of this total came within the government functions of Health (66%), and Public Order and Safety (POS) (20%). By country, the average share of GDP was 0.023% for Health, and 0.013% for POS. However, these shares varied considerably across countries, ranging from 0.00033% in Slovakia, up to 0.053% of GDP in Ireland in the case of Health, and from 0.003% in Portugal, to 0.02% in the UK, in the case of POS; almost a 161-fold difference between the highest and the lowest countries for Health, and a 6-fold difference for POS. Why do Ireland and the UK spend so much in Health and POS, or Slovakia and Portugal so little, in GDP terms? To respond to this question and to make a comprehensive assessment of drug-related public expenditure across countries, this study compared Health and POS spending and GDP in the 10 reporting countries. Results found suggest GDP to be a major determinant of the Health and POS drug-related public expenditures of a country. Labelled drug-related public expenditure showed a positive association with the GDP across the countries considered: r = 0.81 in the case of Health, and r = 0.91 for POS. The percentage change in Health and POS expenditures due to a one percent increase in GDP (the income elasticity of demand) was estimated to be 1.78% and 1.23% respectively. Being highly income elastic, Health and POS expenditures can be considered luxury goods; as a nation becomes wealthier it openly spends proportionately more on drug-related health and public order and safety interventions. PMID:20478069

Labelled drug-related public expenditure in relation to gross domestic product (GDP) in Europe: a luxury good?

PubMed

Prieto, Luis

2010-05-17

"Labelled drug-related public expenditure" is the direct expenditure explicitly labelled as related to illicit drugs by the general government of the state. As part of the reporting exercise corresponding to 2005, the European Monitoring Centre for Drugs and Drug Addiction's network of national focal points set up in the 27 European Union (EU) Member States, Norway, and the candidates countries to the EU, were requested to identify labelled drug-related public expenditure, at the country level. This was reported by 10 countries categorised according to the functions of government, amounting to a total of EUR 2.17 billion. Overall, the highest proportion of this total came within the government functions of Health (66%), and Public Order and Safety (POS) (20%). By country, the average share of GDP was 0.023% for Health, and 0.013% for POS. However, these shares varied considerably across countries, ranging from 0.00033% in Slovakia, up to 0.053% of GDP in Ireland in the case of Health, and from 0.003% in Portugal, to 0.02% in the UK, in the case of POS; almost a 161-fold difference between the highest and the lowest countries for Health, and a 6-fold difference for POS. Why do Ireland and the UK spend so much in Health and POS, or Slovakia and Portugal so little, in GDP terms? To respond to this question and to make a comprehensive assessment of drug-related public expenditure across countries, this study compared Health and POS spending and GDP in the 10 reporting countries. Results found suggest GDP to be a major determinant of the Health and POS drug-related public expenditures of a country. Labelled drug-related public expenditure showed a positive association with the GDP across the countries considered: r = 0.81 in the case of Health, and r = 0.91 for POS. The percentage change in Health and POS expenditures due to a one percent increase in GDP (the income elasticity of demand) was estimated to be 1.78% and 1.23% respectively. Being highly income elastic, Health and POS expenditures can be considered luxury goods; as a nation becomes wealthier it openly spends proportionately more on drug-related health and public order and safety interventions.

Economic impact of a Medicaid population health management program.

PubMed

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

2011-10-01

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

Economic Impact of a Medicaid Population Health Management Program

PubMed Central

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

2011-01-01

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

Consistency of metabolic responses and appetite sensations under postabsorptive and postprandial conditions.

PubMed

Gonzalez, Javier T; Veasey, Rachel C; Rumbold, Penny L S; Stevenson, Emma J

2012-10-01

The present study aimed to investigate the reliability of metabolic and subjective appetite responses under fasted conditions and following consumption of a cereal-based breakfast. Twelve healthy, physically active males completed two postabsorption (PA) and two postprandial (PP) trials in a randomised order. In PP trials a cereal based breakfast providing 1859 kJ of energy was consumed. Expired gas samples were used to estimate energy expenditure and fat oxidation and 100mm visual analogue scales were used to determine appetite sensations at baseline and every 30 min for 120 min. Reliability was assessed using limits of agreement, coefficient of variation (CV), intraclass coefficient of correlation and 95% confidence limits of typical error. The limits of agreement and typical error were 292.0 and 105.5 kJ for total energy expenditure, 9.3 and 3.4 g for total fat oxidation and 22.9 and 8.3mm for time-averaged AUC for hunger sensations, respectively over the 120 min period in the PP trial. The reliability of energy expenditure and appetite in the 2h response to a cereal-based breakfast would suggest that an intervention requires a 211 kJ and 16.6mm difference in total postprandial energy expenditure and time-averaged hunger AUC to be meaningful, fat oxidation would require a 6.7 g difference which may not be sensitive to most meal manipulations. Copyright © 2012 Elsevier Ltd. All rights reserved.

Genotype by energy expenditure interaction with metabolic syndrome traits: the Portuguese healthy family study.

PubMed

Santos, Daniel M V; Katzmarzyk, Peter T; Diego, Vincent P; Souza, Michele C; Chaves, Raquel N; Blangero, John; Maia, José A R

2013-01-01

Moderate-to-high levels of physical activity are established as preventive factors in metabolic syndrome development. However, there is variability in the phenotypic expression of metabolic syndrome under distinct physical activity conditions. In the present study we applied a Genotype X Environment interaction method to examine the presence of GxEE interaction in the phenotypic expression of metabolic syndrome. A total of 958 subjects, from 294 families of The Portuguese Healthy Family study, were included in the analysis. Total daily energy expenditure was assessed using a 3 day physical activity diary. Six metabolic syndrome related traits, including waist circumference, systolic blood pressure, glucose, HDL cholesterol, total cholesterol and triglycerides, were measured and adjusted for age and sex. GxEE examination was performed on SOLAR 4.3.1. All metabolic syndrome indicators were significantly heritable. The GxEE interaction model fitted the data better than the polygenic model (p<0.001) for waist circumference, systolic blood pressure, glucose, total cholesterol and triglycerides. For waist circumference, glucose, total cholesterol and triglycerides, the significant GxEE interaction was due to rejection of the variance homogeneity hypothesis. For waist circumference and glucose, GxEE was also significant by the rejection of the genetic correlation hypothesis. The results showed that metabolic syndrome traits expression is significantly influenced by the interaction established between total daily energy expenditure and genotypes. Physical activity may be considered an environmental variable that promotes metabolic differences between individuals that are distinctively active.

Trends in medicines procurement by the Brazilian federal government from 2006 to 2013

PubMed Central

Chama Borges Luz, Tatiana; Garcia Serpa Osorio-de-Castro, Claudia; Magarinos-Torres, Rachel; Wettermark, Bjorn

2017-01-01

The costs of medicines pose a growing burden on healthcare systems worldwide. A comprehensive understanding of current procurement processes provides strong support for the development of effective policies. This study examined Brazilian Federal Government pharmaceutical procurement data provided by the Integrated System for the Administration of General Services (SIASG) database, from 2006 to 2013. Medicine purchases were aggregated by volume and expenditure for each year. Data on expenditure were adjusted for inflation using the Extended National Consumer Price Index (IPCA) for December 31, 2013. Lorenz distribution curves were used to study the cumulative proportion of purchased therapeutic classes. Expenditure variance analysis was performed to determine the impact of each factor, price and/or volume, on total expenditure variation. Annual expenditure on medicines increased 2.72 times, while the purchased volume of drugs increased 1.99 times. A limited number of therapeutic classes dominated expenditure each year. Drugs for infectious diseases drove the increase in expenditures from 2006 to 2009 but were replaced by antineoplastic and immunomodulating agents beginning in 2010. Immunosuppressants (L04), accounted for one third of purchases since 2010, showing the most substantial growth in expenditures during the period (250-fold increase). The overwhelming price-related increase in expenditures caused by these medicines is bound to have a relevant impact on the sustainability of the pharmaceutical supply system. We observed increasing trends in expenditures, especially in specific therapeutic classes. We propose the development and implementation of better medicine procurement systems, and strategies to allow for monitoring of product price, effectiveness, and safety. This must be done with ongoing assessment of pharmaceutical innovations, therapeutic value and budget impact. PMID:28388648

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

PubMed

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

2017-09-01

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

Genetic Predisposition to Obesity and Medicare Expenditures.

PubMed

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

2017-12-12

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

Trends in Healthcare Expenditures Among US Adults With Hypertension: National Estimates, 2003-2014.

PubMed

Kirkland, Elizabeth B; Heincelman, Marc; Bishu, Kinfe G; Schumann, Samuel O; Schreiner, Andrew; Axon, R Neal; Mauldin, Patrick D; Moran, William P

2018-05-30

One in 3 US adults has high blood pressure, or hypertension. As prior projections suggest hypertension is the costliest of all cardiovascular diseases, it is important to define the current state of healthcare expenditures related to hypertension. We used a nationally representative database, the Medical Expenditure Panel Survey, to calculate the estimated annual healthcare expenditure for patients with hypertension and to measure trends in expenditure longitudinally over a 12-year period. A 2-part model was used to estimate adjusted incremental expenditures for individuals with hypertension versus those without hypertension. Sex, race/ethnicity, education, insurance status, census region, income, marital status, Charlson Comorbidity Index, and year category were included as covariates. The 2003-2014 pooled data include a total sample of 224 920 adults, of whom 36.9% had hypertension. Unadjusted mean annual medical expenditure attributable to patients with hypertension was $9089. Relative to individuals without hypertension, individuals with hypertension had $1920 higher annual adjusted incremental expenditure, 2.5 times the inpatient cost, almost double the outpatient cost, and nearly triple the prescription medication expenditure. Based on the prevalence of hypertension in the United States, the estimated adjusted annual incremental cost is $131 billion per year higher for the hypertensive adult population compared with the nonhypertensive population. Individuals with hypertension are estimated to face nearly $2000 higher annual healthcare expenditure compared with their nonhypertensive peers. This trend has been relatively stable over 12 years. Healthcare costs associated with hypertension account for about $131 billion. This warrants intense effort toward hypertension prevention and management. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Life Years Lost and Lifetime Health Care Expenditures Associated With Diabetes in the U.S., National Health Interview Survey, 1997–2000

PubMed Central

Leung, Man-Yee Mallory; Pollack, Lisa M.; Colditz, Graham A.

2015-01-01

OBJECTIVE This study analyzed the lifetime health care expenditures and life years lost associated with diabetes in the U.S. RESEARCH DESIGN AND METHODS Data from the National Health Interview Survey (NHIS), the Medical Expenditure Panel Survey from 1997 to 2000, and the NHIS Linked Mortality Public-use Files with a mortality follow-up to 2006 were used to estimate age-, race-, sex-, and BMI-specific risk of diabetes, mortality, and annual health care expenditures for both patients with diabetes and those without diabetes. A Markov model populated by the risk and cost estimates was used to compute life years and total lifetime health care expenditures by age, race, sex, and BMI classifications for patients with diabetes and without diabetes. RESULTS Predicted life expectancy for patients with diabetes and without diabetes demonstrated an inverted U shape across most BMI classifications, with highest life expectancy being for the overweight. Lifetime health care expenditures were higher for whites than blacks and for females than males. Using U.S. adults aged 50 years as an example, we found that diabetic white females with a BMI >40 kg/m2 had 17.9 remaining life years and lifetime health expenditures of $185,609, whereas diabetic white females with normal weight had 22.2 remaining life years and lifetime health expenditures of $183,704. CONCLUSIONS Our results show that diabetes is associated with large decreases in life expectancy and large increases in lifetime health care expenditures. In addition to decreasing life expectancy by 3.3 to 18.7 years, diabetes increased lifetime health care expenditures by $8,946 to $159,380 depending on age-race-sex-BMI classification groups. PMID:25552420

Association Between Modifiable Risk Factors and Pharmaceutical Expenditures Among Adults With Atherosclerotic Cardiovascular Disease in the United States: 2012-2013 Medical Expenditures Panel Survey.

PubMed

Salami, Joseph A; Valero-Elizondo, Javier; Ogunmoroti, Oluseye; Spatz, Erica S; Rana, Jamal S; Virani, Salim S; Blankstein, Ron; Younus, Adnan; Arrieta, Alejandro; Blaha, Michael J; Veledar, Emir; Nasir, Khurram

2017-06-09

Atherosclerotic cardiovascular disease (ASCVD) causes most deaths in the United States and accounts for the highest healthcare spending. The association between the modifiable risk factors (MRFs) of ASCVD and pharmaceutical expenditures are largely unknown. We examined the association between MRFs and pharmaceutical expenditures among adults with ASCVD using the 2012 and 2013 Medical Expenditure Panel Survey. A 2-part model was used while accounting for the survey's complex design to obtain nationally representative results. All costs were adjusted to 2013 US dollars using the gross domestic product deflator. The annual total pharmaceutical expenditure among those with ASCVD was $71.6 billion, 33% of which was for medications for cardiovascular disease and 14% medications for diabetes mellitus. The adjusted relationship between MRFs and pharmaceutical expenditures showed significant marginal increase in average annual pharmaceutical expenditure associated with inadequate physical activity ($519 [95% confidence interval (CI), $12-918; P =0.011]), dyslipidemia ($631 [95% CI, $168-1094; P =0.008]), hypertension: ($1078 [95% CI, $697-1460; P <0.001)], and diabetes mellitus ($2006 [95% CI, $1470-2542]). Compared with those with optimal MRFs (0-1), those with average MRFs (2-3) spent an average of $1184 (95% CI, $805-1564; P <0.001) more on medications, and those with poor MRFs (≥4) spent $2823 (95% CI, $2338-3307; P <0.001) more. Worsening MRFs were proportionally associated with higher annual pharmaceutical expenditures among patients with established ASCVD regardless of non-ASCVD comorbidity. In-depth studies of the roles played by other factors in this association can help reduce medication-related expenditures among ASCVD patients. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

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

PubMed

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

2014-01-01

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

Medical expenditure for liver cancer in urban China: A 10-year multicenter retrospective survey (2002-2011).

PubMed

Qiu, Wu-Qi; Shi, Ju-Fang; Guo, Lan-Wei; Mao, A-Yan; Huang, Hui-Yao; Hu, Guang-Yu; Dong, Pei; Bai, Fang-Zhou; Yan, Xiao-Ling; Liao, Xian-Zhen; Liu, Guo-Xiang; Bai, Ya-Na; Ren, Jian-Song; Sun, Xiao-Jie; Zhu, Xin-Yu; Zhou, Jin-Yi; Gong, Ji-Yong; Zhu, Lin; Mai, Ling; Du, Ling-Bing; Zhou, Qi; Xing, Xiao-Jing; Song, Bing-Bing; Liu, Yu-Qin; Lou, Pei-An; Sun, Xiao-Hua; Wu, Shou-Ling; Cao, Rong; Qi, Xiao; Lan, Li; Ren, Ying; Zhang, Kai; He, Jie; Qu, Chunfeng; Dai, Min

2018-01-01

This study aims to understand the medical expenditure for liver cancer during 2002-2011 in urban areas of China. This is a retrospective study. Based on a stratified cluster sampling method, a medical expenditure survey collected basic personal information from related medical records. Two-tailed independent sample t-test, variance analysis, and Student-Newman-Keuls Tests were used in cost analysis for the corresponding data types. A total of 12,342 liver cancer patients were included in the analysis. Overall average medical expenditure per case for liver cancer diagnosis and treatment in China has increased from ¥21, 950 to ¥40, 386 over the study period. For each liver cancer patient diagnosed between 2009 and 2011, the average expenditures were 29,332 CNY for stage I, 35,754 CNY for stage II, 34,288 CNY for stage III, and 30,275 CNY for stage IV diseases (P < 0.001). Pharmaceuticals accounted for the biggest part of the medical expenditure and it rose from 48.01% to 52.96% during these ten years, and the share of nursing fee expenses was the lowest (around 1%). Over the entire 10-year data period, the per capita expenditure of the east region (32,983 CNY) was higher than that of the west region (26,219 CNY) and slightly higher than the central region (31,018 CNY, P < 0.001). As a major cancer in China, liver cancer accounts for a large portion of health economic burden and its medical expenditure is heavy for families. Early diagnosis and treatment for liver cancer will save medical expenditure. The economic burden of liver cancer is high in China and related medical expenditure has increased.

Trends in medicines procurement by the Brazilian federal government from 2006 to 2013.

PubMed

Chama Borges Luz, Tatiana; Garcia Serpa Osorio-de-Castro, Claudia; Magarinos-Torres, Rachel; Wettermark, Bjorn

2017-01-01

The costs of medicines pose a growing burden on healthcare systems worldwide. A comprehensive understanding of current procurement processes provides strong support for the development of effective policies. This study examined Brazilian Federal Government pharmaceutical procurement data provided by the Integrated System for the Administration of General Services (SIASG) database, from 2006 to 2013. Medicine purchases were aggregated by volume and expenditure for each year. Data on expenditure were adjusted for inflation using the Extended National Consumer Price Index (IPCA) for December 31, 2013. Lorenz distribution curves were used to study the cumulative proportion of purchased therapeutic classes. Expenditure variance analysis was performed to determine the impact of each factor, price and/or volume, on total expenditure variation. Annual expenditure on medicines increased 2.72 times, while the purchased volume of drugs increased 1.99 times. A limited number of therapeutic classes dominated expenditure each year. Drugs for infectious diseases drove the increase in expenditures from 2006 to 2009 but were replaced by antineoplastic and immunomodulating agents beginning in 2010. Immunosuppressants (L04), accounted for one third of purchases since 2010, showing the most substantial growth in expenditures during the period (250-fold increase). The overwhelming price-related increase in expenditures caused by these medicines is bound to have a relevant impact on the sustainability of the pharmaceutical supply system. We observed increasing trends in expenditures, especially in specific therapeutic classes. We propose the development and implementation of better medicine procurement systems, and strategies to allow for monitoring of product price, effectiveness, and safety. This must be done with ongoing assessment of pharmaceutical innovations, therapeutic value and budget impact.

Exercise Training and Energy Expenditure following Weight Loss.

PubMed

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

2015-09-01

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

The economic cost of infertility-related services: an examination of the Massachusetts infertility insurance mandate.

PubMed

Griffin, M; Panak, W F

1998-07-01

To examine the costs and outcomes of infertility-related services in Massachusetts during a time of expanded use of assisted reproductive technology (ART). Cost data were obtained from the Massachusetts Department of Insurance Rate-Setting Commission and 9 large group insurance plans for the period 1986-1993. Utilization and success rates of ART were examined, and the cost per live delivery with the use of ART in 1993 was estimated. The state of Massachusetts, in which access to infertility-related services has been mandated by law since 1989. The study population consisted of 8 large health maintenance organization plans and the Blue Cross/Blue Shield indemnity plan. None. Per capita infertility-related expenditures, infertility-related expenditures as a percentage of total expenditures, live deliveries per initiated ART cycle, and cost per live delivery. Expenditures for infertility services increased at a rate similar to or slower than inflation during the years 1988-1992. Increases were slowest in health maintenance organizations, probably as a result of provider arrangements. Infertility services accounted for 0.41% of total expenditures within the indemnity plan in 1993 (approximately $1.71 per contract-month). Examination of ART utilization showed no evidence of overutilization by patients with a low chance of success. The cost per live delivery with the use of ART in 1993 was $59,484. Mandated infertility coverage was associated with increased use of ART but not with excessive increases in consumer cost for infertility insurance coverage.

Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility.

PubMed

Newcomer, Robert J; Ko, Michelle; Kang, Taewoon; Harrington, Charlene; Hulett, Denis; Bindman, Andrew B

2016-03-01

Individuals who receive long-term services and supports (LTSS) are among the most costly participants in the Medicare and Medicaid programs. To compare health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care. Retrospective cohort analysis of California dually eligible adult Medicaid and Medicare beneficiaries who initiated Medicaid LTSS, identified as HCBS or extended nursing facility care, in 2006 or 2007. Propensity score matching for demographic, health, and functional characteristics resulted in a subsample of 34,660 users who initiated Medicaid HCBS versus extended nursing facility use. Those with developmental disabilities or in managed care plans were excluded. Average monthly adjusted acute, postacute, long-term, and total Medicare and Medicaid expenditures for the 12 months following initiation of either HCBS or extended nursing facility care. Those initiating extended nursing facility care had, on average, $2919 higher adjusted total health care expenditures per month compared with those who initiated HCBS. The difference was primarily attributable to spending on LTSS $2855. On average, the monthly LTSS expenditures were higher for Medicare $1501 and for Medicaid $1344 when LTSS was provided in a nursing facility rather than in the community. The higher cost of delivering LTSS in a nursing facility rather than in the community was not offset by lower acute and postacute spending. Medicare and Medicaid contribute similar amounts to the LTSS cost difference and both could benefit financially by redirecting care from institutions to the community.

Poor agreement between continuous measurements of energy expenditure and routinely used prediction equations in intensive care unit patients.

PubMed

Reid, Clare L

2007-10-01

A wide variation in 24h energy expenditure has been demonstrated previously in intensive care unit (ICU) patients. The accuracy of equations used to predict energy expenditure in critically ill patients is frequently compared with single or short-duration indirect calorimetry measurements, which may not represent the total energy expenditure (TEE) of these patients. To take into account this variability in energy expenditure, estimates have been compared with continuous indirect calorimetry measurements. Continuous (24h/day for 5 days) indirect calorimetry measurements were made in patients requiring mechanical ventilation for 5 days. The Harris-Benedict, Schofield and Ireton-Jones equations and the American College of Chest Physicians recommendation of 25 kcal/kg/day were used to estimate energy requirements. A total of 192 days of measurements, in 27 patients, were available for comparison with the different equations. Agreement between the equations and measured values was poor. The Harris-Benedict, Schofield and ACCP equations provided more estimates (66%, 66% and 65%, respectively) within 80% and 110% of TEE values. However, each of these equations would have resulted in clinically significant underfeeding (<80% of TEE) in 16%, 15% and 22% of patients, respectively, and overfeeding (>110% of TEE) in 18%, 19% and 13% of patients, respectively. Limits of agreement between the different equations and TEE values were unacceptably wide. Prediction equations may result in significant under or overfeeding in the clinical setting.

The short-term impact of Ontario's generic pricing reforms.

PubMed

Law, Michael R; Ystma, Alison; Morgan, Steven G

2011-01-01

Canadians pay amongst the highest generic drug prices in the world. In July 2010, the province of Ontario enacted a policy that halved reimbursement for generic drugs from the public drug plan, and substantially lowered prices for private purchases. We quantified the impact of this policy on overall generic drug expenditures in the province, and projected the impact in other provinces had they mimicked this pricing change. We used quarterly prescription generic drug dispensing data from the IMS-Brogan CompuScript Audit. We used the price per unit in both the pre- and post-policy period and two economics price indexes to estimate the expenditure reduction in Ontario. Further, we used the post-policy Ontario prices to estimate the potential reduction in other provinces. We estimate that total expenditure on generic drugs in Ontario during the second half of 2010 was between $181 and $194 million below what would be expected if prices had remained at pre-policy level. Over half of the reduction in spending was due to savings on just 10 generic ingredients. If other provinces had matched Ontario's prices, their expenditures over during the latter half of 2010 would have been $445 million lower. We found that if Ontario's pricing scheme were adopted nationally, overall spending on generic drugs in Canada would drop at least $1.28 billion annually--a 5% decrease in total prescription drug expenditure. Other provinces should seriously consider both changes to their generic drug prices and the use of more competitive bulk purchasing policies.

Diabetes: cost of illness in Norway

PubMed Central

2010-01-01

Background Diabetes mellitus places a considerable burden on patients in terms of morbidity and mortality and on society in terms of costs. Costs related to diabetes are expected to increase due to increasing prevalence of type 2 diabetes. The aim of this study was to estimate the health care costs attributable to type 1 and type 2 diabetes in Norway in 2005. Methods Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, medical equipment, nutrition guidance, physiotherapy, acupuncture, foot therapy and indirect costs were collected from national registers and responses to a survey of 584 patients with diabetes. The study was performed with a prevalence approach. Uncertainty was explored by means of bootstrapping. Results When hospital stays with diabetes as a secondary diagnosis were excluded, the total costs were €293 million, which represents about 1.4% of the total health care expenditure. Pharmaceuticals accounted for €95 million (32%), disability pensions €48 million (16%), medical devices €40 million (14%) and hospital admissions €21 million (7%). Patient expenditures for acupuncture, physiotherapy and foot therapy were many times higher than expenditure for nutritional guidance. Indirect costs (lost production from job absenteeism) accounted for €70.1 million (24% of the €293 million) and included sick leave (€16.7 million), disability support and disability pensions (€48.2 million) and other indirect costs (€5.3 million). If all diabetes related hospital stays are included (primary- and secondary diagnosis) total costs amounts to €535 million, about 2.6% of the total health care expenditure in Norway. Conclusions Diabetes represents a considerable burden to society in terms of health care costs and productivity losses. PMID:20854689

Prevalence and economic burden of cardiovascular diseases in France in 2013 according to the national health insurance scheme database.

PubMed

Tuppin, Philippe; Rivière, Sébastien; Rigault, Alexandre; Tala, Stéphane; Drouin, Jérôme; Pestel, Laurence; Denis, Pierre; Gastaldi-Ménager, Christelle; Gissot, Claude; Juillière, Yves; Fagot-Campagna, Anne

2016-01-01

Cardiovascular diseases (CVDs) constitute the second leading cause of death in France. The Système national d'information interrégimes de l'assurance maladie (SNIIRAM; national health insurance information system) can be used to estimate the national medical and economic burden of CVDs. To describe the rates, characteristics and expenditure of people reimbursed for CVDs in 2013. Among 57 million general health scheme beneficiaries (86% of the French population), people managed for CVDs were identified using algorithms based on hospital diagnoses either during the current year (acute phase) or over the previous 5 years (chronic phase) and long-term diseases. The reimbursed costs attributable to CVDs were estimated. A total of 3.5 million people (mean age, 71 years; 42% women) were reimbursed by the general health scheme for CVDs (standardized rate, 6.5%; coronary heart disease, 2.7%; arrhythmias/conduction disorders, 2.1%; stroke, 1.1%; heart failure, 1.1%). These frequencies increased with age and social deprivation, and were higher in Northern and Eastern France and Réunion Island. The total sum reimbursed by all schemes for CVDs was € 15.1 billion (50% for hospital care and 43% for outpatient care [including 15% for drugs and 12% for nurses/physiotherapists]); coronary heart disease accounted for € 4 billion, stroke for € 3.5 billion and heart failure for € 2.5 billion (i.e. 10% of the total expenditure reimbursed by all national health insurance schemes for all conditions). CVDs constitute the leading group in terms of numbers of patients reimbursed and total reimbursed expenditure, despite a probable underestimation of both numbers and expenditure. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

A patient-centred approach to estimate total annual healthcare cost by body mass index in the UK Counterweight programme.

PubMed

Tigbe, W W; Briggs, A H; Lean, M E J

2013-08-01

Previous studies, based on relative risks for certain secondary diseases, have shown greater healthcare costs in higher body mass index (BMI) categories. The present study quantifies the relationship between BMI and total healthcare expenditure, with the patient as the unit of analysis. Analyses of cross-sectional data, collected over 18-months in 2002-2003, from 3324 randomly selected patients, in 65 general practices across UK. Healthcare costs estimated from primary care, outpatient, accident/emergency and hospitalisation attendances, weighted by unit costs taken from standard sources. In univariate analyses, significant associations (P<0.05) were found between total healthcare expenditure and all dependent variables (women>men, drinkernon-smokers, and increasing with greater physical activity, age and BMI. In multivariate analysis, age, sex, BMI, smoking and alcohol consumption remained significantly associated with healthcare cost, and together explained just 9% of the variance in healthcare expenditure. Adjusted total annual healthcare cost was £16 (95% CI £11-£21) higher per unit BMI. All cost categories were significantly (P<0.003) higher for those with BMI >40 compared with BMI <20 kg m(-2): prescription drugs (men: £390 versus £16; women: £211 versus £73), hospitalisation (men: £72 versus £0; women: £243 versus £107), primary care (men: £191 versus £69; women: £268 versus £153) and outpatient care (£234 versus £107 women only). Annual healthcare expenditure rose a mean of £16 per unit greater BMI, doubling between BMI 20-40 kg m(-2). This gradient may be an underestimate if the lower-BMI patients with heights and weights recorded had other costly diseases.

Providing Comprehensive Educational Opportunity to Low Income Students. Part 3: How Much Does New York City Now Spend on Children's Services?

ERIC Educational Resources Information Center

Belfield, Clive; Garcia, Emma

2011-01-01

This report sets out to estimate the total annual expenditures on children in New York City and to create a "fiscal map" to detail them. This fiscal map describes these expenditures according to a series of classifications, including age of child (early childhood, elementary, and high school); source of funding (public, tax-related, and…

Industrial R&D Expenditures Rise to $22 Billion in 1974. Science Resources Studies Highlights, January 14, 1976.

ERIC Educational Resources Information Center

National Science Foundation, Washington, DC. Div. of Science Resources Studies.

Reported in this newsletter in narrative, graphical, and tabular form are data related to industrial research and development expenditures in 1974, showing a seven percent increase over 1973. It is noted that more than 80 percent of a total of $22.3 billion was spent by five industries; these included electrical equipment and communication,…

Prediction Equations of Energy Expenditure in Chinese Youth Based on Step Frequency during Walking and Running

ERIC Educational Resources Information Center

Sun, Bo; Liu, Yu; Li, Jing Xian; Li, Haipeng; Chen, Peijie

2013-01-01

Purpose: This study set out to examine the relationship between step frequency and velocity to develop a step frequency-based equation to predict Chinese youth's energy expenditure (EE) during walking and running. Method: A total of 173 boys and girls aged 11 to 18 years old participated in this study. The participants walked and ran on a…

Two ways of estimating the euro value of the illicit market for cannabis in France.

PubMed

Legleye, Stephane; Ben Lakhdar, Christian; Spilka, Stanislas

2008-09-01

The most recent health surveys in general population are used in order to estimate the annual market size for cannabis in France in 2005. Two methods for arriving at an estimate are proposed: the first based on reported consumption, the other on reported expenditure on cannabis. The annual sales figure for cannabis in France is between 746 and 832 million euro. Men's expenditure accounts for between 80 and 85% of total expenditure and those aged between 15 and 24 years account for the greatest part of the size of the cannabis market, between 57 and 60%, depending upon the method. According to these estimates, consumers' average annual expenditure on cannabis is around euro 202 in France, compared to estimates obtained for New Zealand and Holland (euro 124) and the United States (euro 362).

Exercise Training and Energy Expenditure following Weight Loss

PubMed Central

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

2015-01-01

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

Improving Reserve Compensation: A Review of Current Compensation and Related Personnel and Training Readiness Issues

DTIC Science & Technology

1989-09-01

with increased capital expenditures, improvements in compensation, or additional labor resources or increased nonpersonnel Operation and Maintenance ( O ...facilities. These problems primarily need increased capital expenditures. Another category of problems relates to shortages of supplies, manuals, and other O ...service differ from gross reserve compen- sation because of the following factors: " Federal, state, and FICA taxes " Forgone civilian income - During

[Evaluation of Direct and Indirect Expenditures for Management of Patients With Stable Ischemic Heart Disease After Stenting of Coronary Arteries].

PubMed

Sveshnikova, N D; Paleev, F N

2016-03-01

Assessment of cost of management of patients during 1 year after stenting of coronary arteries has shown that priority should be given to active introduction into practical health care of technologies increasing duration of life and lowering probability of invalidization. We stress the need for evaluation of indirect expenditures on patients care because of their substantial share in the total cost. We also consider essential to elaborate measures of state regulation of medication supply irrespective of type of treatment for shifting expenditures from hospital to ambulatory sector and improvement of effectiveness of pharmacotherapy.

Mitochondrial DNA variation in human metabolic rate and energy expenditure

PubMed Central

Tranah, Gregory J.; Manini, Todd M.; Lohman, Kurt K.; Nalls, Michael A.; Kritchevsky, Stephen; Newman, Anne B.; Harris, Tamara B.; Miljkovic, Iva; Biffi, Alessandro; Cummings, Steven R.; Liu, Yongmei

2014-01-01

The role of climate in driving selection of mtDNA as Homo sapiens migrated out of Africa into Eurasia remains controversial. We evaluated the role of mtDNA variation in resting metabolic rate (RMR) and total energy expenditure (TEE) among 294 older, community-dwelling African and European American adults from the Health, Aging and Body Composition Study. Common African haplogroups L0, L2 and L3 had significantly lower RMRs than European haplogroups H, JT and UK with haplogroup L1 RMR being intermediate to these groups. This study links mitochondrial haplogroups with ancestry-associated differences in metabolic rate and energy expenditure. PMID:21586348

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

PubMed

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

2014-02-01

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

Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso.

PubMed Central

Su, Tin Tin; Kouyaté, Bocar; Flessa, Steffen

2006-01-01

OBJECTIVE: To quantify the extent of catastrophic household health care expenditure and determine the factors responsible for it in Nouna District, Burkina Faso. METHODS: We used the Nouna Health District Household Survey to collect data on 800 households during 2000-01 for our analysis. The determinants of household catastrophic expenditure were identified by multivariate logistic regression method. FINDINGS: Even at very low levels of health care utilization and modest amount of health expenditure, 6-15% of total households in Nouna District incurred catastrophic health expenditure. The key determinants of catastrophic health expenditure were economic status, household health care utilization especially for modern medical care, illness episodes in an adult household member and presence of a member with chronic illness. CONCLUSION: We conclude that the poorest members of the community incurred catastrophic health expenses. Setting only one threshold/cut-off value to determine catastrophic health expenses may result in inaccurate estimation leading to misinterpretation of important factors. Our findings have important policy implications and can be used to ensure better access to health services and a higher degree of financial protection for low-income groups against the economic impact of illness. PMID:16501711

Assessment of Physical Activity and Energy Expenditure: An Overview of Objective Measures

PubMed Central

Hills, Andrew P.; Mokhtar, Najat; Byrne, Nuala M.

2014-01-01

The ability to assess energy expenditure (EE) and estimate physical activity (PA) in free-living individuals is extremely important in the global context of non-communicable diseases including malnutrition, overnutrition (obesity), and diabetes. It is also important to appreciate that PA and EE are different constructs with PA defined as any bodily movement that results in EE and accordingly, energy is expended as a result of PA. However, total energy expenditure, best assessed using the criterion doubly labeled water (DLW) technique, includes components in addition to physical activity energy expenditure, namely resting energy expenditure and the thermic effect of food. Given the large number of assessment techniques currently used to estimate PA in humans, it is imperative to understand the relative merits of each. The goal of this review is to provide information on the utility and limitations of a range of objective measures of PA and their relationship with EE. The measures discussed include those based on EE or oxygen uptake including DLW, activity energy expenditure, physical activity level, and metabolic equivalent; those based on heart rate monitoring and motion sensors; and because of their widespread use, selected subjective measures. PMID:25988109

On the effect of emotional states on operator thinking. [psychological test for operator selection

NASA Technical Reports Server (NTRS)

Solodkova, A. V.

1975-01-01

A combination sonic and electrical skin stimuli stress test is reported that is suitable for the psychological selection of individuals to perform operator functions. The behavior of these people is characterized by a fighting spirit, increased work capacity, minimum expenditure of strength and insignificant fatigue.

34 CFR 602.24 - Additional procedures certain institutional accreditors must have.

Code of Federal Regulations, 2010 CFR

2010-07-01

... revenues and expenditures and cash flow at the branch campus; and (iii) The operation, management, and... that the branch campus has sufficient educational, financial, operational, management, and physical... institution notifies the agency that it intends to cease operations entirely or close a location that provides...

[12th Annual] Maintenance & Operations Cost Study.

ERIC Educational Resources Information Center

Deriso, Jerald L.; Lane, C. Jerome

1983-01-01

Comparisons are shown between budgeted maintenance and operations costs for 1982-83 and the preceding two years' actual costs. Also provided is a summary of a 10-year comparison of net current expenditures per student, compared with maintenance and operations costs per student. Data are presented for 10 geographical regions. (MLF)

13th Annual Maintenance & Operations Cost Study.

ERIC Educational Resources Information Center

Deriso, Jerald L.

1984-01-01

Comparisons are drawn between budgeted maintenance and operations costs for 1983-84 and the preceding 2 years' actual costs. Also provided is a summary of a 10-year comparison of net current expenditures per student, compared with maintenance and operations costs per student. Data are presented for 10 geographical regions. (MLF)

[The application of National AIDS spending assessment in a county of Dehong prefecture, Yunnan province, China].

PubMed

Shan, Duo; Sun, Jiang-ping; Yakusik, Anna; Chen, Zhong-dan; Yuan, Jian-hua; Li, Tao; Duan, Song; Yang, Xing; Wei, Mei; Michael, Sante; Ye, Run-hua; Xiang, Li-fen; Yang, Yue-cheng; Ren, Da

2012-11-01

To calculate the actual expenditures in a county of Dehong prefecture, Yunnan province, China by using the method of National AIDS Spending Assessment (NASA) in 2010. Data were collected through NASA data collection form based on adapted NASA classification in the county of Dehong prefecture from October to December, 2011, and complemented by semi-structured interview with 16 well trained programmatic and financial representatives in 8 spending units. Data were entered in Resource Tracking Software (RTS) V 2009.3.0, and SPSS 13.0 was used for data processing and analysis. The NASA estimations showed that the county spent a total of ¥16 235 954 on HIV/AIDS in 2010. Public funds constituted 96.3% of the total expenditure (¥15 630 937), followed by Global Fund which accounted for 3.0% (¥484 585) and private sources which accounted for 0.7% (¥120 432). Findings based on NASA categories showed that AIDS spendings were mainly on 4 areas, and expenditure on Care & Treatment was ¥12 401 382 (76.4% of total expenditure), followed by Prevention which accounted for 14.3% (¥2 325 707), Program Management & Administration which accounted for 7.8% (¥1 268 523) and human resources which accounted for 1.5% (¥240 342). The most beneficial population group was People Living with HIV (PLHIV), accounting for 84.7% of total expenditure. (¥13 753 428), followed by 4.8% for high risk population, including female sex workers and their partners (¥297 333), injection drug users and their partners (¥293 143), men having sex with men and their partners (¥185 136) and 1.5% (¥241 429) for the general population. The local funds for HIV/AIDS in this county was insufficient. The local government should increase corresponding funds based on central government funding. Care and treatment was the first spending priority in the county and the investment of prevention services needs to be increased. Prevention and treatment and care should be combined to ensure the effectiveness of comprehensive prevention and treatment of AIDS.

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

PubMed

Veiga, Paula

2008-03-01

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

The metabolic power and energetic demands of elite Gaelic football match play.

PubMed

Malone, Shane; Solan, Barry; Collins, Kieran; Doran, Dominic

2017-05-01

Metabolic power has not yet been investigated within elite Gaelic football. The aim of the current investigation was to compare the metabolic power demands between positional groups and examine the temporal profile of elite Gaelic football match play. Global positional satellite system (GPS) data were collected from 50 elite Gaelic football players from 4 inter-county teams during 35 elite competitive matches over a three season period. A total of 351 complete match samples were obtained for final analysis. Players were categorized based on positional groups; full-back, half-back, midfield, half-forward and full-forward. Instantaneous raw velocity data was obtained from the GPS and exported to a customized spreadsheet which provided estimations of both speed based, derived metabolic power and energy expenditure variables (total distance, high speed distance, average metabolic power, high power distance and total energy expenditure). Match mean distance was 9222±1588 m, reflective of an average metabolic power of 9.5-12.5 W·kg-1, with an average energy expenditure of 58-70 Kj·kg-1 depending on position. There were significant differences between positional groups for both speed-based and metabolic power indices. Midfielders covered more total and high-speed distance, as well as greater average and overall energy expenditure compared to other positions (P<0.001). A reduction in total, high-speed, and high-power distance, as well as average metabolic power throughout the match (P<0.001) was observed. Positional differences exist for both metabolic power and traditional running based variables. The middle three positions (midfield, half-back and half-forward) possess greater activity profiles when compared to other positional groups. The reduction in metabolic power and traditional running based variables are comparable across match play. The current study demonstrates that metabolic power may contribute to our understanding of Gaelic football match-play.

Estimates of Energy Intake and Expenditure in Elite Female Touch Players During an International Tournament.

PubMed

Marsh, Nicola; Dobbin, Nick; Twist, Craig; Curtis, Chris

2017-12-01

This study assessed energy intake and expenditure of international female touch players during an international tournament. Energy intake (food diary) and expenditure (accelerometer, global positioning system) were recorded for 16 female touch players during a four-day tournament, competing in 8.0 ± 1.0 matches; two on Days 1, 2, and 4, and three on Day 3. Total daily energy expenditure (43.6 ± 3.1 Kcal·kg -1 body mass (BM)) was not different (p > .05) from energy intake (39.9 ± 9.4 Kcal·kg -1 BM). Carbohydrate intakes were below current recommendations (6-10 g·kg -1 BM) on Days 1 (4.4 ± 0.6 g·kg -1 BM) and 3 (4.7 ± 1.0 g·kg -1 BM) and significantly below (p < .05) on Day 2 (4.1 ± 1.0 g·kg -1 BM). Protein and fat intakes were consistent with recommendations (protein, 1.2-2.0 g·kg -1 BM: fat, 20-35% total Kcal) across Days 1-3 (protein, 1.9 ± 0.8, 2.2 ± 0.8, and 2.0 ± 0.7 g·kg -1 BM; fat, 35.6 ± 6.8, 38.5 ± 6.4, and 35.9 ± 5.4% total Kcal). Saturated fat intakes were greater (p < .05) than recommendations (10% total Kcal) on Days 1-3 (12.4 ± 2.9, 14.2 ± 5.1, and 12.7 ± 3.5% total Kcal). On average, female touch players maintained energy balance. Carbohydrate intakes appeared insufficient and might have contributed to the reduction (p < .05) in high-intensity running on Day 3. Further research might investigate the applicability of current nutrition recommendations and the role of carbohydrate in multimatch, multiday tournaments.

Assessment of Universal Healthcare Coverage in a District of North India: A Rapid Cross-Sectional Survey Using Tablet Computers

PubMed Central

Singh, Tarundeep; Roy, Pritam; Jamir, Limalemla; Gupta, Saurav; Kaur, Navpreet; Jain, D. K.; Kumar, Rajesh

2016-01-01

Objective A rapid survey was carried out in Shaheed Bhagat Singh Nagar District of Punjab state in India to ascertain health seeking behavior and out-of-pocket health expenditures. Methods Using multistage cluster sampling design, 1,008 households (28 clusters x 36 households in each cluster) were selected proportionately from urban and rural areas. Households were selected through a house-to-house survey during April and May 2014 whose members had (a) experienced illness in the past 30 days, (b) had illness lasting longer than 30 days, (c) were hospitalized in the past 365 days, or (d) had women who were currently pregnant or experienced childbirth in the past two years. In these selected households, trained investigators, using a tablet computer-based structured questionnaire, enquired about the socio-demographics, nature of illness, source of healthcare, and healthcare and household expenditure. The data was transmitted daily to a central server using wireless communication network. Mean healthcare expenditures were computed for various health conditions. Catastrophic healthcare expenditure was defined as more than 10% of the total annual household expenditure on healthcare. Chi square test for trend was used to compare catastrophic expenditures on hospitalization between households classified into expenditure quartiles. Results The mean monthly household expenditure was 15,029 Indian Rupees (USD 188.2). Nearly 14.2% of the household expenditure was on healthcare. Fever, respiratory tract diseases, gastrointestinal diseases were the common acute illnesses, while heart disease, diabetes mellitus, and respiratory diseases were the more common chronic diseases. Hospitalizations were mainly due to cardiovascular diseases, gastrointestinal problems, and accidents. Only 17%, 18%, 20% and 31% of the healthcare for acute illnesses, chronic illnesses, hospitalizations and childbirth was sought in the government health facilities. Average expenditure in government health facilities was 16.6% less for acute care, 15% less for hospitalization and 50% less for childbirth than in the private healthcare facilities. Out-of-pocket expenditure was mostly on medicines followed by diagnostic and laboratory tests. Among households experiencing hospitalization, 56.5% had incurred catastrophic expenditures, which was significantly higher in the poorest compared to richest household expenditure quartile (p <0.002). Conclusions Expenditure on healthcare remains high in Punjab state of India. Efforts to increase utilization of the public sector could decrease out-of-pocket healthcare expenditure. PMID:27351743

Assessment of Universal Healthcare Coverage in a District of North India: A Rapid Cross-Sectional Survey Using Tablet Computers.

PubMed

Singh, Tarundeep; Roy, Pritam; Jamir, Limalemla; Gupta, Saurav; Kaur, Navpreet; Jain, D K; Kumar, Rajesh

2016-01-01

A rapid survey was carried out in Shaheed Bhagat Singh Nagar District of Punjab state in India to ascertain health seeking behavior and out-of-pocket health expenditures. Using multistage cluster sampling design, 1,008 households (28 clusters x 36 households in each cluster) were selected proportionately from urban and rural areas. Households were selected through a house-to-house survey during April and May 2014 whose members had (a) experienced illness in the past 30 days, (b) had illness lasting longer than 30 days, (c) were hospitalized in the past 365 days, or (d) had women who were currently pregnant or experienced childbirth in the past two years. In these selected households, trained investigators, using a tablet computer-based structured questionnaire, enquired about the socio-demographics, nature of illness, source of healthcare, and healthcare and household expenditure. The data was transmitted daily to a central server using wireless communication network. Mean healthcare expenditures were computed for various health conditions. Catastrophic healthcare expenditure was defined as more than 10% of the total annual household expenditure on healthcare. Chi square test for trend was used to compare catastrophic expenditures on hospitalization between households classified into expenditure quartiles. The mean monthly household expenditure was 15,029 Indian Rupees (USD 188.2). Nearly 14.2% of the household expenditure was on healthcare. Fever, respiratory tract diseases, gastrointestinal diseases were the common acute illnesses, while heart disease, diabetes mellitus, and respiratory diseases were the more common chronic diseases. Hospitalizations were mainly due to cardiovascular diseases, gastrointestinal problems, and accidents. Only 17%, 18%, 20% and 31% of the healthcare for acute illnesses, chronic illnesses, hospitalizations and childbirth was sought in the government health facilities. Average expenditure in government health facilities was 16.6% less for acute care, 15% less for hospitalization and 50% less for childbirth than in the private healthcare facilities. Out-of-pocket expenditure was mostly on medicines followed by diagnostic and laboratory tests. Among households experiencing hospitalization, 56.5% had incurred catastrophic expenditures, which was significantly higher in the poorest compared to richest household expenditure quartile (p <0.002). Expenditure on healthcare remains high in Punjab state of India. Efforts to increase utilization of the public sector could decrease out-of-pocket healthcare expenditure.

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

PubMed

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

2014-03-03

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

General budget support: has it benefited the health sector?

PubMed

Fernandes Antunes, Adelio; Xu, Ke; James, Chris D; Saksena, Priyanka; Van de Maele, Nathalie; Carrin, Guy; Evans, David B

2013-12-01

There has been recent controversy about whether aid directed specifically to health has caused recipient governments to reallocate their own funds to non-health areas. At the same time, general budget support (GBS) has been increasing. GBS allows governments to set their own priorities, but little is known about how these additional resources are subsequently used. This paper uses cross-country panel data to assess the impact of GBS programmes on health spending in low-income and middle-income countries, using dynamic panel techniques to estimate unbiased coefficients in the presence of serial correlation. We found no clear evidence that GBS had any impact, positive or negative, on government health spending derived from domestic sources. GBS also had no observed impact on total government health spending from all sources (external as well as domestic). In contrast, health-specific aid was associated with a decline in health expenditures from domestic sources, but there was not a full substitution effect. That is, despite this observed fungibility, health-specific aid still increases total government health spending from all sources. Finally, increases in total government expenditure led to substantial increases in domestic government health expenditures. Copyright © 2012 John Wiley & Sons, Ltd.

Operations Expenditures: Historical Trends and Continuing Challenges (Presentation)

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

Lantz, E.

2013-05-01

In this presentation for the American Wind Energy Association 2013 conference, NREL's Eric Lantz examines historical trends and continuing challenges of wind power operating expenses. Lowering such expenses could increase profitability and contribute to lowering the cost of energy.

Harris-Benedict equation estimations of energy needs as compared to measured 24-h energy expenditure by indirect calorimetry in people with early to mid-stage Huntington's disease.

PubMed

Gaba, Ann; Zhang, Kuan; Moskowitz, Carol B; Boozer, Carol N; Marder, Karen

2008-10-01

Weight loss and energy metabolism are important clinical research areas in understanding the disease mechanisms in Huntington's disease. Having an accurate method to estimate expected total energy expenditure would likely facilitate the development of studies about these features of the disease. The Harris-Benedict equation is a formula commonly used to estimate basal energy expenditure of individuals, adjusted for height, weight, age and gender. This estimate is then multiplied by a physical activity factor to estimate total daily energy needs to maintain the given weight. Data from 24-h indirect calorimetry was utilized to derive an adjustment formula for the physical activity factor of the Harris-Benedict equation for 13 early to mid-stage Huntington's disease patients. The adjusted activity factor provided the most accurate estimate of energy needs. This adjusted formula can be used in clinical assessments of Huntington's disease patients, as well as in research studies when indirect calorimetry has not been performed.

Cost accounting in a surgical unit in a teaching hospital--a pilot study.

PubMed

Malalasekera, A P; Ariyaratne, M H; Fernando, R; Perera, D; Deen, K I

2003-09-01

Economic constraints remain one of the major limitations on the quality of health care even in industrialised countries. Improvement of quality will require optimising facilities within available resources. Our objective was to determine costs of surgery and to identify areas where cost reduction is possible. 80 patients undergoing routine major and intermediate surgery during a period of 6 months were selected at random. All consumables used and procedures carried out were documented. A unit cost was assigned to each of these. Costing was based on 3 main categories: preoperative (investigations, blood product related costs), operative (anaesthetic charges, consumables and theatre charges) and post-operative (investigations, consumables, hospital stay). Theatre charges included two components: fixed (consumables) and variable (dependent on time per operation). The indirect costs (e.g. administration costs, 'hotel' costs), accounted for 30%, of the total and were lower than similar costs in industrialised nations. The largest contributory factors (median, range) towards total cost were, basic hospital charges (30%; 15 to 63%); theatre charges fixed (23%; 6 to 35%) and variable (14%; 8 to 27%); and anaesthetic charges (15%; 1 to 36%). Cost reduction in patients undergoing surgery should focus on decreasing hospital stay, operating theatre time and anaesthetic expenditure. Although definite measures can be suggested from the study, further studies on these variables are necessary to optimise cost effectiveness of surgical units.

Where Have All the Dollars Gone? Public Expenditures for Human Resource Development in New York City, 1961-71.

ERIC Educational Resources Information Center

Brecher, Charles

The author has reviewed the rise in the expense budget of New York City from the early 1960's to the early 1970's, concentrating on the expenditures for human resources development (education, health, welfare, and family back-up services) which account for about 70 percent of the total. One reason for rising expenses has been the expansion of…

Forest resources, government policy, and investment location decisions of the forest products industry in the southern United States

Treesearch

Changyou Sun; Daowei Zhang

2010-01-01

In this article, the results of an initial attempt to estimate the effects of state attributes on plant location and investment expenditure were presented for the forest products industry in the southern United States. A conditional logit model was used to analyze new plant births, and a time-series cross-section model to assess the total capital expenditure....

77 FR 43301 - Medicaid Program; Disproportionate Share Hospital Allotments and Institutions for Mental Diseases...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-24

... increase in the CPI-U for the prior FY (0.0 percent). Column F FY 2010 TC MAP Exp. Incl. DSH. This column... including DSH expenditures. Column G FY 2010 TC MAP Exp. Net of DSH. This column contains the amount of the States' actual FY 2010 total computable DSH expenditures. Column H FY 2010 TC MAP Exp. Net of DSH. This...

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

PubMed

van den Heuvel, Wim J A; Olaroiu, Marinela

2017-03-01

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